Nasal airway evaluation with Dr. Henry Sandel
Nasal Breathing Disorders
Difficulty breathing through the nose has several possible causes, and they often occur together. Evaluation identifies which structures are responsible before any treatment is recommended.
At a glance
Surgeon
Dr. Henry Sandel
Focus
Nasal obstruction
First step
History and examination
Treatment
Medical or surgical
Common sources
Septum, turbinates, valve
Often combined
More than one cause
Insurance
Out-of-network; may reimburse
What causes nasal obstruction
The nasal airway is narrow by design, so a small structural change can have a large effect on airflow. Obstruction is rarely traced to one thing. A deviated septum, enlarged turbinates, and a collapsing sidewall frequently appear together, and treating only one of them can leave you still blocked.
A deviated septum
Enlarged turbinates
Internal or external nasal valve collapse
Prior nasal trauma or fracture
Changes following previous nose surgery
Chronic inflammation, allergy, or nasal polyps
Some of these are structural and some are inflammatory, and the distinction matters: inflammatory causes often respond to medical treatment, while structural narrowing generally does not.
When to have it evaluated
An evaluation is reasonable when obstruction is persistent, one-sided, or affecting your sleep.
Congestion that does not clear with sprays or antihistamines
Breathing that is noticeably worse on one side
Mouth breathing, snoring, or disrupted sleep
Nasal blockage that began after an injury or a previous surgery
Reliance on over-the-counter decongestants
Dr. Sandel’s approach
Patients often arrive certain their septum is the problem, because that is the diagnosis everyone has heard of. Often it is part of the problem. The examination is there to find the rest of it.
Related procedures
Insurance
Insurance does not cover surgery to change the appearance of the nose, but typically does cover treatment that is medically necessary. Dr. Sandel is an out-of-network provider, so where your plan offers out-of-network benefits, you would be reimbursed by your insurer directly. We provide the medical notes, procedure codes, and diagnostic codes to support that claim.
How it is evaluated
The examination is directed at finding which structures are contributing, and how much:
A history of symptoms, injuries, allergies, and prior surgery
Examination of the inside of the nose
Assessment of the sidewall while you breathe in
Identifying each contributing structure and its share of the obstruction
Separating structural narrowing from inflammatory swelling
Treatment options
Treatment follows the findings rather than a fixed sequence. Where inflammation is the main driver, medical management comes first.
Medical management when allergy or inflammation is the primary cause
Septoplasty when the septum is the obstruction
Turbinate reduction when the turbinates are enlarged
Nasal valve repair when the sidewall collapses on inspiration
Combined procedures when several factors are present
Rhinoplasty at the same time when appearance is also a concern
Where more than one structure is involved, addressing them together in a single procedure is usually preferable to staging them.
Nasal Breathing Disorders FAQs.
Not necessarily. Some obstruction is inflammatory and responds to medical treatment. Surgery is considered when the narrowing is structural, or when medical treatment has not been enough.
Frequently. Septal deviation, turbinate enlargement, and valve collapse often coexist. Treating only one of them may leave you still obstructed.
Your policy may pay for medically necessary parts of the procedure. Insurance does not cover surgery to change the cosmetic appearance of the nose. Dr. Sandel is an out-of-network provider. If your insurance company offers you out-of-network benefits, and you have a deviated septum, nasal valve collapse, or a broken nose — any of which with breathing issues not improved by medical treatments — then you could be reimbursed for that portion of the procedure. We will give you the medical notes, procedure codes, and diagnostic codes to help with this process.
Functional surgery is planned to preserve appearance. Where appearance is also a concern, it can be addressed at the same time.
Not on its own. Nasal obstruction can contribute to snoring and disturbed sleep, but snoring has other causes, and sleep apnea needs its own evaluation.
Prior surgery is a common contributor, particularly where structural support was reduced. Those cases are evaluated with revision in mind.
No. It is the best known cause, which is why it is often assumed to be the only one. The nasal valve in particular is easy to overlook.
Find out what is actually blocking it.
A consultation reviews your symptoms, injuries, allergies, and any prior nasal surgery, and includes an examination of the nasal passages and sidewall. The purpose is to identify the cause before discussing whether treatment should be medical, surgical, or both.