Abstract
Impairment of nasal breathing is a highly prevalent and bothersome symptom that affects
daily functioning and/or sleep quality. Those surgeons dealing with patients seeking
rhinoplasty need to carefully analyze the preoperative nasal breathing capacity and
predict the positive or even negative impact of rhino(septo)plasty on nasal breathing.
Given the lack of correlation between the subjective feeling of suboptimal nasal breathing
and the objective measurements of nasal flow and nasal resistance, a critical and
mainly clinical evaluation of all anatomical, mucosal, and sensory mechanisms involved
in nasal obstruction is mandatory. Indeed, thermo-, mechano-, and chemosensory receptors
on the nasal mucosa, airflow, and respiratory dynamics might all contribute to the
overall perception of nasal breathing capacity. In this review, we provide an overview
of the factors determining suboptimal nasal breathing including different diagnostic
and experimental tests that can be performed to evaluate nasal flow and nasal resistance
and current limitations in our understanding of the problem of nasal breathing in
an individual patient. An algorithm for the preoperative or diagnostic workup for
nasal obstruction is included that might be useful as a guide for clinicians dealing
with patients seeking nose surgery.
Keywords
nasal obstruction - preoperative evaluation - rhinoplasty
