Rhinoplasty for chronic rhinitis and nasal obstruction

Chronic rhinitis and nasal obstruction are common conditions that affect many people in the UK, often leading to persistent discomfort and impaired quality of life. While these issues are usually managed with medication or lifestyle changes, in some cases, surgical intervention such as rhinoplasty may be necessary. This article by consultant ENT surgeon Mr Mohamed Khatwa explains chronic rhinitis and nasal obstruction, how rhinoplasty can help, and what patients can expect from the procedure.

What are chronic rhinitis and nasal obstruction?

Chronic rhinitis refers to ongoing inflammation of the nasal mucosa — the lining inside the nose. There are allergic and non-allergic possible causes, and it is accompanied by symptoms such as nasal congestion, sneezing, a runny nose, and postnasal drip. Allergic rhinitis occurs when the immune system overreacts to allergens like pollen, dust, or pet dander, while non-allergic rhinitis may be triggered by irritants such as smoke or strong smells. When congestion or inflammation completely obstructs airflow, that is called a nasal obstruction – though nasal obstructions can also occur from a deviated nasal septum, enlarged turbinates (nasal structures that humidify and filter air), or nasal polyps. Symptoms include difficulty breathing through the nose, mouth breathing, snoring, and sometimes recurrent sinus infections.

Impaired nasal function can affect sleep, concentration, and overall well-being. While many patients find relief with medications like nasal steroids, antihistamines, or decongestants, surgical options are considered when conservative treatments fail, such as a rhinoplasty.

What is rhinoplasty?

Rhinoplasty, commonly known as a ‘nose job,’ is a surgical procedure designed to alter the shape and structure of the nose. While it is well known as a cosmetic treatment aimed at improving the appearance, rhinoplasty also has important functional applications.

In a medical context, rhinoplasty can be performed to correct structural abnormalities that cause breathing difficulties, such as a deviated septum or nasal valve collapse. When the procedure addresses these functional problems, it is often referred to as functional rhinoplasty or septorhinoplasty. The goal is to restore or improve nasal airflow while preserving or enhancing the nose’s aesthetic appearance.

Thus, rhinoplasty uniquely bridges the gap between functional improvement and cosmetic enhancement, helping patients breathe better while looking better.

How can rhinoplasty help with nasal obstruction and chronic rhinitis?

Rhinoplasty can significantly improve symptoms of nasal obstruction by correcting underlying anatomical issues. For example, if a deviated septum is causing blockage, surgical straightening of the septum can restore proper airflow. Similarly, reducing enlarged turbinates can relieve congestion.

In cases where chronic rhinitis has led to persistent swelling or nasal valve collapse, rhinoplasty can stabilise and support the nasal framework to prevent collapse during breathing. This structural support reduces obstruction and improves nasal breathing.

Importantly, rhinoplasty is not a direct treatment for the inflammation of chronic rhinitis itself but rather addresses the mechanical factors that worsen nasal obstruction in these patients. By improving nasal airflow and reducing obstruction, rhinoplasty can enhance the effectiveness of ongoing medical treatments for rhinitis and improve patients’ overall comfort.

What happens during rhinoplasty?

Rhinoplasty is usually performed under general anaesthesia in a hospital or day surgery setting. The procedure may take between one and three hours, depending on its complexity.

In recent years, endoscopic techniques have revolutionised functional rhinoplasty. Using a small camera called an endoscope inserted through the nostrils, surgeons can view internal nasal structures on a monitor with magnification. This minimally invasive approach allows for the precise correction of anatomical abnormalities with reduced trauma to surrounding tissues.

The surgeon may reshape the nasal bones and cartilage, correct a deviated septum, reduce turbinate size, and reinforce the nasal valves. Sutures and cartilage grafts are sometimes used to support the nasal framework and maintain the new shape, one that the patient may have designed or requested beforehand.

After surgery, patients typically experience some swelling and bruising around their nose and eyes but can expect gradual improvement in nasal breathing over weeks to months as healing progresses.