Dysfunction: Breathing Problems, Rhinorrhea & Others

Of course the primary function of the nose is to breathe efficiently and comfortably. Unfortunately, this isn't always possible. Many people are afflicted with breathing problems, both during the day and at night, at play and at rest - it is a reality. This can cause many persons to experience anxiety, depression and even anti social behavior due to not being able to participate in sports or other high or medium impact activities. 

There can also be problems where scar tissue not only partially or fully blocks the airways but can make it to where the air is forced through these hills and valleys caused by cars tissue and causes "whistling" or others loud sounds. This can be both embarrassing and cumbersome to the patient. 

There can also be what is known as rhinorrhea, which is what I have. This is where the turbinates, mucous membranes or sinuses produce an excess amount of mucous or fluid that drips constantly. Mine is caused not by standard inflammation or irritation from allergies but by damage to the concha media, or middle turbinate. This can happen due to scar tissue, during the breaking of the nasal bones, surgical instruments or just plain bad luck. It happens. And although it is VERY common to have rhinorrhea for many months after a rhinoplasty - at the time of this entry, it has lasted me almost 3 years.

rhi*nor*rhea
: excessive mucous secretion from the nose 
(Merriam-Webster Medical Dictionary)

Rhinorrhea Rhinitis is another disorder that can cause discomfort but is usually due to inflammation from allergies. Although the symptoms usually addressed by rhinoplastyseptoplasty/turbinectomy are due to mechanical obstruction.

rhi*ni*tis
plural -nit*i*des 
(noun)
: inflammation of the mucous membrane of the nose <allergic ~>; also : any of various conditions characterized by such inflammation 
(Merriam-Webster Medical Dictionary)

If allergies are the case then I suspect your problem is not mechanical in regards to physical obstruction by the anatomy but rather from inflammation due to the elements. Of course this diagnosis should be carried out by a qualified physician - if need be have several opinions. Certain medications and even cauterization (called Laser conchotomy or LACON) by the inferior or even total turbinates can relieve allergic rhinitis. This is where the anterior (front) area of the mucosa of the turbinates are "vaporized". In extreme cases, more than the superficial mucosa is removed. 

Of course there is non-allergic rhinitis as well. Non-allergic rhinitis is when their is no Immunoglobuilin E (IgE) present in swabs taken from the affected (runny) nose. 

Immunoglobuilin E
(noun)
: a class of antibodies that function esp. in allergic reactions --called also IgE 
(Merriam-Webster Medical Dictionary)

Gustatory Rhinorrhea (runny nose while eating)

gus*ta*to*ry
(adjective)
: relating to, affecting, associated with, or being the sense of taste 
(Merriam-Webster Medical Dictionary)

This is downright annoying. I get this a lot. another reason why I am more than likely having some turbinate cauterization. I always have to have a Kleenex on my lap white eating - especially if it is Thai or Mexican food due to its spiciness. According to eMedicine.com:

Gustatory Rhinorrhea is: "Parasympathetic and sympathetic cross excitation as a result of misdirected regeneration of nerve fibers subsequent to the trauma of surgery may cause rhinorrhea during eating. The treatment of this condition is difficult, but antihistamines may help some patients."

Turbinectomy: Surgery For Breathing Obstruction or Other Afflictions
This is a common but sometimes painful surgery. It is important to try other measures before resorting to Turbinectomy but sometimes, you really have no choice. The pain is usually connected to the dryness and the crusting afterwards not to mention the now missing turbinate(s). Please have several opinions before committing to a turbinectomy. There are patients who report having an increase in headaches, depression, dryness, nasal bleeding and sinus problems several months post turbinectomy. 

Plus it is just smart to be sure that is what you need and not a simple deviated septum or excess scar tissue or too thin of a nose or collapse of sorts. Take a look at the diagrams below to understand where  and what exactly your turbinates look like.

sinus_lateral.gif (62760 bytes) nasalconchae.gif (52418 bytes)
sinus (lateral)
turbinates (conchae)

Lateral wall of right nasal cavity showing inferior concha in situ.

*click diagrams for a larger image*

Would You Like To See Actual Photos Of The Turbinate Structures As Seen With An Endoscope?

Be sure that removal of some or all of the turbinates are what you REALLY require. Once they are removed - they don't grow back! Even improper removal can bring about problems such as reported above. Some surgeons deny this and state that the patients are delusional but some do agree and it is a fact that lack or moisture and difference in ideal temperature can cause problems. Remember, in the body, when something is removed, changed or affected in anyway - the domino affect can result no matte how slight. Just remember if you DO need it, the disorientation and complications are rare and not to sorry too much because the anxiety can actually cause problems post-operatively. Suggestion is powerful, I assure you. 

There are several ways to perform a Turbinectomy, the most common being manual resection where the extra mucosal tissue is removed via a pair of very sharp surgical scissors. This minor resection is often called "Turbinotomy" or "Conchotomy". Although this is the least invasive other than superficial mucosal cauterization, still care must be taken so that the periosteum [the membrane that covers the skeleton/bones]. If bare bone is present this can cause problems later on such as bone infection and sensitivity. 

Turbinoplasty of the lower two (inferior and medial - see diagram) is also an option but this is a little more detailed and invasive and is very effective for blockage. The bone and the mucosal flap is removed. Although the presence of bare bone can prove problematic later on, this chance is lessened greatly due to the mucosal flap on the above turbinate being rolled down, covering the now resected bone and periosteum.

The submucosal inferior turbinate (see diagram) can be removed as well, as its prominence can obstruct breathing as well. Just remember that all of these are not just simple, uninvasive operations. Simple in the sense that that are not without cause and effect. Although effective they should be reviewed and all options and avenues researched before committal. If you should choose to have such an operation know that post-operative bleeding is common and dryness is as well. The dryness can be relieved with a buffered saline wash or unmedicated (unless specifically instructed otherwise) nasal spray. Breathing can actually be worse within the first few days to weeks. For more information please seek a consultation with a qualified surgeon.

Septoplasty for Deviated Septum
Deviated Septum is by far the most common reasons for non-cosmetic nasal surgery. Your Septum can be twisted and crooked and result in a smaller nasal passage on one side or the other, or both. The mucosal lining of the nasal passages normally swell and retract several times during the day so when a person with a severe or even minor deviated septum experiences difficulty breathing from either side of the nose it is usually from the already small passageway being blocked further from the swollen mucosal lining. Where there is a straight septum this is even possible if there is redundant mucosal tissue or cartilage and sometimes even bone. But if it is a relatively
"normal-functioning" nose we usually do not notice the sporadic swelling of the mucosa.

References
Merriam-Webster Medical Dictionary
Graylab Online Medical Dictionary - UK
Anatomy of the Human Body, Henry Gray (1821–1865)
Online Version of Anatomy of the Human Body - Bartleby.com 
Guyuron B, Michelow BJ, Thomas T; Gustatory Rhinorrhea - A complication of Septoplasty. Plast.Reconstr. Surg. 94: 454-456
Gluckman JL, Stegmoyer R; Nonallergic rhinitis. Otolaryngology. 1991; 1889-98
Functional Endoscopic Sinus Surgery - September 1, 1998 - American Academy of Family Physicians


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