In this episode of BackTable ENT, Dr. Shah and Dr. Agan speak with Dr. Colleen Plein about functional nasal breathing in the treatment of facial pain, sleep apnea, postural defects, and improving general quality of life.

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SHOW NOTES

First, Dr. Plein defines functional nasal breathing, which is unobstructed nasal breathing with a closed mouth. Nasal breathing is the best way to optimize airflow through the nose because the nose humidifies and filters air, the sinuses produce nitric oxide to increase oxygen delivery to tissue, and a slower breathing rate can be established, which stabilizes blood pH. Dr. Plein then explains the evolutionary transition from nasal to mouth breathing in humans. The “Great Leap Forward” involved the descension of the larynx and posterior displacement of the tongue so humans could develop speech. Unfortunately, these anatomical changes allowed airways to be more easily obstructed. Additionally, narrowing of the human skull occurred because humans now chew less due to our processed diets. The lack of mastication caused hypoplasia of the maxilla and mandible, which led to narrowing of nasal aperture.

In a child with mouth breathing, Dr. Plein emphasizes the importance of early orthodontic intervention; early maxillary expansion is more likely to occur because the sutures have not fused yet. Besides turbinate reduction therapy, she encourages non-invasive therapies for children such as myofunctional therapy and eating less processed foods. The doctors also discuss different pathologies linked to mouth breathing besides obstructive sleep apnea. Dr. Plein explains how mouth breathing can lead to TMJ pain, poor posture, facial pain, and migraines.

Next, Dr. Plein gives her tips for examining a mouth breathing patient. She believes that taking a thorough clinical history is important and always asks about snoring, posture, headaches, shoulder/neck pain, as some patients don’t realize they have problems with nasal breathing. She also mentions that some patients who grind their teeth may be using a mouth guard that pushes the tongue further back, which can worsen sleep apnea. She notes that tongue scalloping and outwardly oriented teeth are indicative of tongue thrust, which is diagnostic of sleep apnea. She has a low threshold for recommending home sleep tests and always examines the nose with nasal endoscopy. During endoscopy, she does Cottle’s maneuvers to look for static and dynamic nasal valve collapse. In addition to a scope exam, she gets CT imaging of the sinuses.

Next, Dr. Plein emphasizes the importance of collaborating with myofunctional therapists, dentists, orthodontists, and TMJ physical therapists to care for her nasal obstruction / mouth breathing patients. Finally, she summarizes some non-invasive technology and medications that can help optimize nasal breathing, such as intranasal steroids, antihistamines, nasal irrigation, Breathe Right strips, and a gluten-free diet.