Now Smell This…or Not

According to ear, nose and throat doctors, one of the most significant complaints for many people over 50 is difficulty breathing through the nose. This can result from a common condition called nasal airway obstruction (NAO), which impacts more than 20 million Americans.

NAO often hinders a person's sense of smell, ease of breathing and sleep. Still, it can also affect health and lead to more serious issues including medical episodes such as anxiety and panic attacks, loss of consciousness and cardiac issues.

The structure and ability of the nose to do its job changes over time. The soft tissue in the nose becomes more inflamed as people age. "It's not just our skin and joints that show the passage of time; the nose also undergoes changes which can impact its function, such as the nasal tip starting to droop due to a loss of structure and the skin in the nose becoming thinner due to a reduction in collagen and elastin," said Roheen Raithatha, MD, an otolaryngologist in New York City. 

"As our nose ages, the cartilage can gradually become weaker, and the lateral (side) wall of the nose may collapse more — either at rest or especially when one takes a deep breath into the nose. It really can impact someone's ability to breathe comfortably through their nose."

People often think of seeing an eye doctor to maintain healthy eyes or a dentist for their teeth, but they might need to see a specialist to check their nose and throat. Older people may be hesitant to see their doctor for NAO as they assume that the only options available for them are invasive procedures, especially if they have not gotten relief from the standard treatments such as nasal steroid sprays and allergy medicines like antihistamines, according to Raithatha.

The most common symptoms of NAO include trouble sleeping, difficulty breathing through your nose during exertion or exercising, nasal congestion and frequent mouth breathing. The ability to smell can also be affected. Additionally, being able to breathe slowly through an unblocked nose can help to ease anxiety.

The nose filters debris from the air and humidifies and moisturizes the atmosphere as a person breathes in. "People should breathe primarily through the nose most of the day, including while exercising and while sleeping at night," said Raithatha.

"Breathing primarily through the mouth can contribute to ailments that may be harmful to older adults, such as decreased lung function, blood pressure and poor sleep quality, which impacts energy. Mouth breathing can also lead to dry mouth, bad breath, periodontal disease like gingivitis and cavities and snoring," he explained.

"Allergies can be a big factor as they can lead to swelling within the nasal passages and cause nasal congestion. Other factors that may contribute to NAO include a collapsed nasal valve, deviated nasal septum, swelling of the inferior turbinates (the long thin bones of the nose covered with a layer of tissue), and nasal polyps, among other issues," Raithatha said.

Daily saline rinses can clear out triggers of inflammation and mucus from the nose. Other first-line therapies include nasal steroid sprays, decongestants, antihistamines (oral and/or nasal), Breathe-Right Strips or nasal cones. Allergy testing can assess allergic causes of NAO. A complete exam by an ear, nose and throat (ENT) doctor, including a nasal endoscopy (a small camera to look in the nose), is helpful to determine the area/causes of the nasal airway blockage.

"When medications or sprays aren't effective or a patient is looking for something that offers lasting relief, we start to look at minimally and non-invasive therapies, which are preferred for older adults who have preexisting conditions and may not be good surgical candidates," noted Raithatha. 

In-office options for treating NAO include an isolated inferior turbinate reduction using radio frequency ablation or a microdebrider and a procedure to place a bioabsorbable nasal implant (called Latera) into the sidewall of the nose to support the upper and lower cartilages. "These two procedures, however, each just work on one component of NAO," he said.

Another office-based treatment, VivAer, uses radiofrequency technology to help remodel the side wall of the nose to help open the nasal valve and can also be used to reduce a swollen area on the surface of the nasal septum (nasal septal swell body) and reduce the inferior turbinates. 

For suitable candidates, the treatment — covered by Medicare and some insurance plans — is done under local and topical anesthesia with minimal recovery. Reduction of nasal obstruction symptoms lasts through two years, according to one study.  

Diana Packard, age 65, didn't know the cause of her loud nightly snoring or why she could not breathe fully, exercise like she wanted to or get a restful night's sleep. After a sleep study, she ended up with a CPAP machine.

"However, due to my narrow nasal airways, I just couldn't breathe properly with my CPAP. I couldn't get enough air through my nose. I saw a sleep specialist, but the doctor had no recommendations for me," she said.

Frustrated, she found her way to an ENT, who did an exam and told her that she had NAO. After trying breathing strips to no avail, she received the VivAer procedure, which enabled her to take full and deep breaths through the nose, and her sense of smell returned. 

"I'm sleeping through the night just about every night now and my physical activity has improved, too. When I go for a walk, I can get more air through my nose than I can through my mouth. I love walking my dogs and being outside, and it's easier to recover when I need to catch my breath," Packard said.

While NAO is a common condition, it's often underdiagnosed and left untreated. "People should talk to an ENT about their symptoms, have a complete examination and ask about non-surgical treatment options," said Raithatha. 

Lisa B. Samalonis is a writer and editor based in New Jersey. She writes about health, parenting, books and personal finance. Read More