Transcription:
Common Causes For Nasal Breathing And Sinus Issues

Maggie McCay (Host): Welcome to Jamaica Hospital Med Talk. I'm Maggie McKay. And today we're going to talk about nasal breathing and sinus issues, what the common causes are, how to treat and prevent these concerns and more. Our guest is Dr. Moustafa Mourad, Chief of Otolaryngology, Head and Neck Surgery, with Jamaica Hospital Medical Center. Welcome Doctor. We appreciate you being here.

Moustafa Mourad, MD (Guest): Thanks for having me.

Host: So let's just get right into it. Doctor, what are some of the causes of nasal breathing problems?

Dr. Mourad: Generally speaking, there could be a broad range of causes for having the inability to breathe through your nose. It could be medical related, such as allergies, nasal congestion, infections. There also could be structural issues with the nose such as a deviated septum, nasal polyps, nasal masses. So, the nose is a very complicated area and it is the first line of airway inspiration that a person experiences. So, anytime there's pathology that leads to obstruction of the nasal airways, anytime there's obstruction of the nasal airway, it could be related to a multitude of factors.

Host: Okay. And you mentioned a deviated septum and what about nasal valve collapse. Can you explain these issues?

Dr. Mourad: So, broadly speaking, the anatomical causes to the inability to breathe, it could be related to the cartilages of the nose. There are five cartilages of the nose. There's the upper lateral cartilages, which is in the middle part of the nose and the lower lateral cartilages, which form the nasal tip and the nasal septum, which actually separates the left and right sides of the nasal airways.

So, if you have a deviated septum, the cartilage can migrate or move into either the left side or the right side of the nasal airway sometimes both, causing the inability to draw air through the nose. Nasal valve collapse refers to the inability to move air through the nose. As it relates to the internal nasal valve or external nasal valve. The internal nasal valve is comprised of the upper lateral cartilages and the septum. Whereas the external nasal valve is made up of the lower lateral cartilages or nostril cartilages.

So, nasal valve collapse can refer to essentially pinching of the middle part of the nose or the lower parts of the nose, also contributing to an inability to pass air through the nose.

Host: And how would someone know if they had either of these conditions? I just went to my ENT for some issues and he said, oh yeah, you have a deviated septum. I never knew that for my whole life. So how do you know?

Dr. Mourad: When it comes to a deviated septum, one of the telltale signs is if the nasal airway obstruction is single-sided and fixed, that means it doesn't get better with time or position, or temperature or allergens. If you can't breathe through one side of your nose and it's always there, then there's a good chance that there's a deviated septum.

Also, if you have bilateral or nasal airway obstruction on both sides of the nose, that's also fixed that doesn't really change with temperature, humidity, allergens, then you might have a twisted septum that has obstructed into both sides, but really, nasal airway obstruction that's unremitting and fixed is a good sign of a deviated septum. Other signs and symptoms of a deviated septum is nasal airway obstruction, not associated with things like sneezing, watery eyes, itchiness, mucus discharge. When it comes to valve collapse, internal nasal valve collapse usually gets worse with deep inspiration and usually gets better with people that are pull up on the skin of their cheek or lift the tip of their nose. That kind of nasal airway obstruction, usually the sign of a valve collapse. And then finally, for the external nasal valve, the most telltale sign of that is pinching with deep inspiration of your nostrils.

Host: Okay. So what are some of the treatment options for these conditions?

Dr. Mourad: When it comes to the structural problems of the nose, the mainstay treatment would be surgery to either correct the deviation in the septum or to reinforce or reconstruct the internal or external nasal valves. Now, if the structural obstruction of the nasal airway obstruction is compounded or made worse by medical related reasons for nasal airway obstruction, such as allergies or sinus infections, then one can avoid surgery by managing some of the concurrent pathology such as allergies to avoid surgery. So, if you have a deviated septum and really bad allergies, you can manage the allergies with nasal sprays or anti-histamines to alleviate some of the medical reasons to the obstruction and avoid surgery. So usually, you can be tried on medical management, which consists of a lot of the times nasal steroids or nasal saline irrigation, over the counter anti-histamines. But ultimately if those fail, you may need a surgical correction of the structural problems in the nose.

Host: Are there any other causes for breathing problems?

Dr. Mourad: Yes, there's a, there's a multitude of reasons that you might not be able to breathe. Things like nasal polyps, masses, tumors may block the nasal airway, chronic infections, such as chronic sinus infections, chronic nasal congestion related to allergens and allergies can also cause nasal airway obstruction. So there's a broad range of things that can really impact your nose and its ability to pass air.

Host: And we talked about anatomical reasons. Can a medical condition also be the source of the issue?

Dr. Mourad: Yes, many medical conditions are known to obstruct or cause pathology within the nasal passages that can ultimately lead to nasal airway obstruction. Things such as nasal polyps and nasal polyps have a broad range of causes, but nasal polyps in general can cause nasal airway obstruction. Conditions such as cystic fibrosis can lead to nasal polyps, for example, or really bad allergies or, allergic fungal sinusitis can also cause nasal airway obstruction. Other causes of nasal airway obstruction may be related to things such as, maybe related to manifestations of other disorders in the nose, such as asthma, Wegener's granulomatosis, sarcoidosis, many different types of diseases can manifest themselves as pathology within the nose, obstructing the airway.

Host: When it comes to sinus infections, how can I prevent getting one? And if you get one, what are some of the treatment options?

Dr. Mourad: Well first, let's talk about what a sinus infection is. The nose and paranasal sinuses are composed of separate sinus passages. These include the maxillary sinuses, which are two cheek sinuses below the eyes, the frontal sinuses, which sit between the eyes and in the forehead and the ethmoid and sphenoid sinuses, which sit at the back of the nose.

So anytime there's a collection of material that is infected within any or all of these sinuses, you have what's called a sinus infection. This can manifest itself as pressure in the cheeks or in the eyes, nasal discharge, foul smelling nasal discharge, mucus from the nose, nasal congestion, fevers, headache, postnasal drip, where things are dripping down to the back of your throat. Anytime that these symptoms progress beyond seven days, that do not resolve on their own; you may have a sinus infection and need to be evaluated.

So some people are more predisposed to getting sinus infections. Some people get one a year, some people get three to four and some people have chronic infections that can last for weeks or sometimes even months. If you are prone to sinus infections, the best thing to do is to one, see, and be evaluated by an otolaryngologist. Also known as an ear nose and throat doctor who can evaluate why you're getting recurrent or chronic sinus infections. So, ultimately the preventative treatment is to irrigate the nose out with salt water rinses, manage any concurrent nasal pathologies, such as bad allergies or asthma, and to really reduce the risk of mucus and pus building up into the sinus passageways.

Host: Okay. So you said some people are more susceptible to sinus infections than others. Who would fall under that category? And can there be lingering complications?

Dr. Mourad: Yes. So, the vast majority of people that have susceptibilities to sinus infections have these susceptibilities because they have anatomical predisposition. The channels that communicate the sinuses to the nasal passages are very tight. Ultimately the narrowing of these communications or these channels lead to a backup of fluid and mucus in the sinuses that can't get out. When the mucus and fluid cannot get out, it sits there in the sinuses and it becomes infected. So, anatomical narrowing of the communication channels really is the number one predisposing factor to recurrent acute or chronic infections. Other reasons to have a susceptibility to sinus infections include highly reactive disorders, such as asthma or auto-immune disorders such as Wegener's or sarcoidosis or other inflammatory disorders such as allergic rhinitis.

Host: Can sinus infections be hereditary?

Dr. Mourad: Yes. Certainly sinus infections can be hereditary, especially when it comes to disorders that manifest themselves as pathology in the nasal airway. The one that comes to mind is cystic fibrosis. Cystic fibrosis manifests in a very young age with polyps in the nose. These polyps are very obstructive, very inflammatory and lead to a backup of fluid and mucus in the sinuses that ultimately become infected.

Host: Can sinus conditions come on later in life, or when you're in a different environment, like let's say you move from the city to nature for example.

Dr. Mourad: Absolutely. So sinuses that develop when you move to a different environment really is related to an exacerbation of allergies. So, when you move to a different environment, you may be exposed to allergens that are inflammatory and that your body's highly reactive to. Within the nose, you have these two things called the turbinates. They are the first line thermostat for the body. They react to temperature, humidity, allergens, viruses, bacteria. The purpose of the turbinates is that they sense the air that's first coming into the body before it goes into the throat and into the lungs. And sometimes the thermostat or the turbinates are very sensitive.

I explain it to my patients like the volume is turned up on the thermostat or it's very sensitive to whatever's coming in. So, they become congested, enlarged and inflamed trying to reduce whatever it is that it's sensitive to.

So if you move environments, you may have some increased sensitivity to some allergens within the environment that caused an increase in inflammation and swelling within the nose. What ends up happening is that swelling and inflammation then also can obstruct the sinus passages leading to acute or chronic infections. It's very common that people may develop new allergies or sensitivities to certain allergens after moving that ultimately can manifest as sinus infections.

Host: And going in reverse, maybe can they just go away all their problems if they move somewhere where they're not sensitive to their environment?

Dr. Mourad: That's a really good point, actually. And that's absolutely true. Anecdotally, what we realized through the COVID pandemic is that many people were staying home and because they were staying home, they were reducing their exposure to environmental allergens. And what we noticed as otolaryngologists, both anecdotally and through studies that are just emerging, that we had a dramatic decrease in number of people presenting with sinus infections or sinus related pathology.

Now it could also be related to the fact that people just didn't want to go to the doctor, but as things started to open up and we were seeing our old patients that were suffering from chronic and acute infections, they told us that their symptoms were resolved or non-existence throughout their quarantine. Here in New York City for a long period of time. And a lot of patients reported that their sinus symptoms did certainly improve. So yes, by controlling your environment and your sensitivity to the environment, and again, the turbinates and the reactivity, you can reduce the amount of sinus infections that you're getting.

Host: That's so interesting. In closing, can you tell us the difference between allergies and sinus infection?

Dr. Mourad: Allergies typically refers to sensitivity to the environment and is related to allergens that your body may not necessarily like, and usually manifest itself as sneezing, itchiness, watery eyes, nasal congestion and a lot of clear, thin mucus. Sinuses on the other hand is refers to an infection. So a buildup of mucus and bacteria within the sinus and nasal passages. And that usually manifests more along the lines of fever, headaches, facial pressure, thicker nasal discharge. So instead of that clear, thin liquid nasal discharge with allergies, with a sinus infection, it might be more thick, may have a foul smell and may be associated with signs and symptoms of an infection such as fever, fatigue, malaise. So, sinus infections really are as a manifestation of an underlying infection. Whereas allergies are manifested as a sensitivity and reactivity to the environment.

Host: Thank you so much for being here and sharing your expertise today, Doctor.

Dr. Mourad: Well, it was my pleasure. And thanks for having me.

Host: For more information or to schedule an appointment with Dr. Mourad or any of Jamaica Hospital's, other highly qualified ENTs, please call 718-206-7110. And to find out about the services Jamaica Hospital offers, visit our website at Jamaicahospital.org/podcast. All content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast. This has been Jamaica Hospital Med Talk. I Maggie McKay. Thanks for listening. And.