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Dan Carothers, M.D.
Chicago, IL
At rest and during sleep, nasal breathing is the natural human state. If a situation exists whereby insufficient air is taken in by nasal breathing, mouth breathing takes over. When nasal congestion forces mouth breathing during sleep, greater negative pressure develops behind the uvula and soft palate. This negative pressure increases the vibration of these "noise-makers" during sleep, helping to create the sound we know as snoring.
Nasal congestion has a variety of causes, and a number of medical and surgical treatments are available to treat these conditions. Chronic nasal congestion usually relates to the presence of one of several factors. Seasonal and perennial allergies as well as sinusitis can cause chronic swelling of the lining of the nose and turbinates, which increases nasal congestion. Physical blockages can exist due to narrow intra-nasal anatomy from a deviated nasal septum, large turbinates or a combination of both. Intra-nasal and sinus polyps, and benign and cancerous growths can also physically block airflow.
Treatment of seasonal and perennial allergic rhinitis typically involves avoiding the offending allergens, taking allergy medications (antihistamines, nasal steroids) and/or immunotherapy. Sinusitis can usually be managed by treating the infection with antibiotics and treatment of other contributing factors, such as allergies. The presence of a physical blockage does not necessarily mean that surgery is required. However, if the above treatments have been attempted with continued symptoms, surgery can be very helpful for the patient who suffers with chronic nasal congestion. Surgical treatments for nasal congestion can be performed in the office or in the operating room. Office treatments for nasal obstruction include radiofrequency turbinate ablation (Somnoplasty, Coblation) and laser turbinate surgery. Operating room treatments include correction of septal deviation, turbinate reduction, nasal valve surgery, and endoscopic sinus surgery.
Although improved nasal airflow can be very helpful in the treatment of snoring, the diagnosis and treatment of other contributing factors is often necessary to increase the probability for cure. Other major risk factors for snoring include obesity, large tonsils, long uvula and palate, and the presence of a large tongue with respect to the jaw size. In some cases, snoring is a sign of a medical condition called obstructive sleep apnea. Obstructive sleep apnea exists when significant breath holding or shallow breathing episodes occur during sleep. A sleep study is generally required to differentiate between snoring and OSA. Similar treatments are beneficial for both snoring and OSA. If you suffer from nasal congestion, snoring, or suspect sleep apnea contact your local otorhinolarynology specialist.
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