Therapeutic Approach to Nasal Airway Obstruction

Most adults with nasal airway obstruction have either enlarged nasal turbinates or septal deviation or a combination of both.

Over 300 articles in medical journals describe a confusing array of methods used to treatenlarged nasal turbinates,most often the lower turbinates. None of the approaches meets the standards required by evidence-based medicine to prove that it is effective and superior to other methods. We prefer to reduce the size of the turbinates with CO2 laser or radio frequency ablation (Fig. 1). In some cases, multiple procedures are required to trim the turbinates to the ideal size. Often one must go slowly, as a rapid reduction in size of the turbinates may lead to excessive destruction of mucosa so essential for conditioning inhaled air. When mucosal damage is excessive, there may be drying out of secretions and crust formation which can be both persistent and unpleasant. 

Septoplasty (correction of septal deviation) is performed through a small incision in the nasal mucosa leaving a scar which is not seen externally. The deviated or crooked part of the septum is mobilized, removed and reinserted in a trimmed or straightened form. Two sutures are inserted in the septum for stabilization close to the nostrils. The sutures are removed after one week.