Hey Reddit - I am Dr. Geoff Trenkle and our practice is the Los Angeles Center for Ear, Nose, Throat and Allergy.

So we have been working to create a new treatment for patients who have a hard time breathing through their nose. The new Breathe Better procedure is also called Total Nasal Airway Procedure and we have been changing some peoples lives with it. A ton of people can't breathe through their nose fully. It impacts restful sleep, snoring, playing sports and dozens of other things. Can you breathe through your nose well? A lot of people don't even realize it is effecting them that much and they start becoming mouth-breathers. I have been asked a lot of questions about why this happens and what this new treatment is. I want to get the word out so people are more aware it is a thing and so they can help make their own lives better by getting it corrected.

Ask me anything!

Proof Proof

Not really proof on nasal airway improvement but cred we are full-fledged ENTs: enjoy some gnarly ear wax removal: Proof and Proof.

Comments: 1502 • Responses: 78  • Date: 

vegancheezits869 karma

I have constant post nasal drip and it feels like there's always something wrong with my sinuses. I'm thinking it's allergies, but medication doesn't really help. It's especially annoying as I'm a singer and my throat and sinuses never feel completely healthy. Any advice?

DrTrenkle179 karma

BGO is right! This is often due to what we call "silent" reflux, because it doesn't cause the symptoms of GERD. The other name for it is Laryngopharyngeal Reflux or LPR. This can often cause a PND because the acid on the vocal folds causes a reaction from the nose. Don't count out allergies though! It is often multifactorial and as a singer you use your vocal folds more rigorously than the rest of us so you will often be more sensitive. See a good ENT or better yet a Laryngologist (voice specialist). They will be integral in your pathway to a better career.

WeakEmu8383 karma

Can you briefly describe the procedure?

I had a sinus surgery perhaps 20 years ago, it was not a pleasant experience (though I'm quite satisfied with the results, I can breathe so much easier).

I'm curious to hear what's being done today.

DrTrenkle209 karma

A lot has changed in sinus surgery. I now do full sinus surgery in the office for select patients or a minimally invasive approach called balloon sinuplasty. This approach spares the mucosa and allows a more natural healing process. It also requires significantly less downtime. For full sinus surgery we now use steroid implants that help a great deal with the healing process.

My total nasal airway procedure ( TNAP ) is a different procedure more for obstruction. It combines multiple procedures in one to address the nasal septum, inferior turbinates and nasal valve. It allows for improved air flow (but does not address the sinuses).

THR33ZAZ3S316 karma

I have trouble waking up in the morning, feeling extremely groggy, even if Ive slept for 8 or more hours. Ive been told I snore and I have to lift the tip of my nose if I want perfect airflow through my nose.

Is this why I feel so groggy? Do I need surgery or a CPAP machine?

DrTrenkle309 karma

Based on your symptoms it sounds like you have sleep apnea. The main treatment for that is CPAP, but it depends on how bad your sleep score (AHI) is and what anatomic abnormalities you have. If someone has told you that, then you likely have poor nasal airflow. I would say to make sure you see an ENT and get a sleep study. You can even do them at home now!

THR33ZAZ3S69 karma

Thank you so much for the first answer to a question I have posed in an AMA lol

My gf swears I have a deviated septum, at some point I would like to be formally diagnosed. I have heard of at home sleep studies, I guess theres only one way to find out!

For those of us with less than stellar health insurance, are there any more temporary, over the counter methods of relief for sleep apnea you reccomend or think has any efficacy like breatherite strips or similar?

DrTrenkle67 karma

Yes of course. Start with nasal lavages such as the sinus rinse kit and over-the-counter nasal steroids such as flonase. You can consult with a dentist about a bite block but they can also be expensive. Raise up your bed using some sort of block and sleep at an angle of at least 30 degrees. Weight loss helps as well if you are over-weight. These are some basic things you can do without the help of pesky doctors.

blackfantasy217 karma

I frequently can only breathe through one nostril or the other, rarely are both always open. Was once told by a doctor that was normal for it to alternate, don’t really know. What is your opinion?

DrTrenkle176 karma

That is a normal process for sure but the fact that you notice is not normal. That generally indicates obstruction on both sides (though it may be mild). If it bothers you then it is a problem. At least that's my general view.

blackfantasy29 karma

Would that be a natural born obstruction or a build up over time?

I also think I have what they call a post nasal drip that can be pretty annoying at times. I haven’t looked too much into treatment for it.

DrTrenkle41 karma

It can be either/or. Sometimes people are born with a deviated septum or with other anatomic abnormalities and others get them over time due to poor airflow or allergies etc.

This procedure can have a secondary effect on post nasal drip but is not my treatment of choice for that. It is mostly designed at helping improve airflow through the nose.

Shrapnel384 karma

The first time i tried oxymetazoline (afrin) my world changed. I didn't i could breath like that. It was the fulfillment of my wildest dreams.

As i understand afrin is a an anti inflammatory medicine. How would your treatment help someone whos breathing is mostly affected by inflammation?

DrTrenkle66 karma

It helps in a number of different ways. Afrin helps with mucosal inflammation which causes obstruction. The procedure addresses this by increasing the nasal airway (so it is not as affected by inflammation) as well as destroying the inflammatory cells. This is done using the TRACT airway balloon which is designed to help cause a pressure necrosis of the cells. It also uses VIVAER which is a heat based therapy to reduce septal swell bodies and inflammation of the turbinates. Here is a long video I made using drawings (sorry I'm not an artist) to try to better explain the procedure.

waverly36039 karma

I had deviated septum surgery a few years ago as well as turbinate reduction. After the several week recovery, I experienced my first clear night of breathing, which was amazing. It lasted, at most, 2 weeks. After that it was mostly back to normal. A year later I went back and told the ENT that things were back to where they were...maybe worse. He said to use a drop of Afrin in each nostril before bed. That was life changing and has been my regime for the last 2 years. Still, I worry about Afrin rebounds (and think I have experienced them.). Have there been any new developments that would explain why turbinates swell so much in some folks? I've tried fasting, avoiding gluten, dairy, etc. Foods definitely have a negative impact ( beer and bourbon/whisky seem to have one of the worst effects.). Nothing has been a silver bullet though..other than periodic relief via Afrin.

DrTrenkle27 karma

You likely just have increased inflammation which can be caused by any number of things. You also may have mild valve collapse. Either way the Afrin relief is only temporary and will cause it to get worse.

candidateforhumanity75 karma

Why does over 1/3 of the entire population have trouble breathing through the nose?

Is it always been that way? What are the main natural or environmental causes?

DrTrenkle55 karma

That is a great question that I don't have a good answer for. I would guess that it is affected by environmental causes such as pollution and a likely increase in allergies over time due to changes in our immune responses. Most people have some sort of anatomic abnormality that they are born with or have developed from trauma over time.

Camsy3462 karma

Whenever I fly by plane, as I gain altitude my nose makes what I can only describe as a squeaking sound and suddenly I'm able to breathe much more deeply and freely through my nose. As I descend, it feels like my nose is closing back up and I get a migraine above my eyebrow. What is causing my nose to have this reaction to high altitude?

DrTrenkle64 karma

The sinuses do a number of things but one very important one is pressure equalization. When they are chronically inflamed you often get an inability to equalize. This causes an increase in pressure within the sinuses which is why you get the pain. I'd recommend seeing an ENT who can help treat your chronic sinusitis and depending on how you respond to medication consider a CT scan. For flight attendants and others who frequently fly I will be more aggressive about balloon dilation of the natural ostia to help with this problem. In the meantime try getting an over-the-counter nasal decongestant such as Afrin (careful you don't use often) and spray it in the nose 15 minutes before takeoff and descent. This will help with an acute anti-inflammatory response but is not great to do long term and can be addicting. It is safe if done responsibly though.

BackWaterBackWash50 karma

What’s the weirdest stuff you’ve had to remove from someone’s nostrils?

DrTrenkle116 karma

We don't have enough time for this one... haha.

Kids usually put the weirdest stuff up there. Play-doh, beads, coins, paper, and batteries are all common. I'd say the craziest stuff is maggots... Yes, that's right. I've had to clean out a nest of maggots from a rotting nose. Nobody told me that when I signed up for this!

Gingershred32 karma

I’ve grown up a mouth breather and I snore quite badly now when I used to never snore growing up. I noticed at of the time I lay down that it becomes very difficult to breathe through my nose (it feels like the tissue is inflamed evenly on both sides),but when I was a teenager my pediatrician told me I did not have a deviated septum. Do you know what else might be causing this?

DrTrenkle23 karma

It's not uncommon to start to develop more inflammation as you age. You may have a subtle deformity that has been accented by more inflammation. This can be caused by any number of problems from a deviated septum to just mild acquired allergies. You should see an ENT or at least your GP to start the process. If it gets more complicated feel free to reach out.

blamethepunx24 karma

What are the chances of devepoling empty nose syndrome with this treatment? I have always had sinus issues but reading about that has kept me well away from any treatments

DrTrenkle14 karma

Very unlikely as it is mucosa sparing and I do not remove the head of the turbinate. I am very cautious with the mucosa when I do turbinate reductions and it is why I do it in this fashion. I have never had (knock on wood) a patient develop ENS after this procedure or any others that I do for this reason. The mucosa on the turbinate is the most important part in feeling the sensation of airflow. This needs to be left intact.

rftb201922 karma

I went and saw an ETN specialist a year ago about having "something" swollen up my nose and having trouble breathing. Sometimes one is clogged for an hour or two or they will flip flop on which nostril is harder to breath through. i was told to get a CT scan on sinuses, which i did and i turns out i have swollen turbinates. she gave me a steroid shot in hip, which helped for about an hour. a couple weeks later i saw her again she then gave me a shot right into the turbinates itself - still didnt resolve. i have had a chronic cough for 11 years (itch in throat) and acid reflux. What do you suggest?

DrTrenkle21 karma

Enlarged turbinates can really cause a lot of obstruction. I often start with basic nasal sprays, but when they do not work I move to minimally invasive treatments such as in office turbinate reduction. My new procedure addresses the turbinates more thoroughly by reducing them in size by removing a small portion of the bony aspect and fracturing them out to create more room. It also addresses the mucosal swelling through pressure necrosis using the new TRACT airway balloon. Many people suffering from enlarged turbinates have collapse of their nasal valve and mild septal deformities as well. Both are addressed with the procedure.

rftb20198 karma

Ok cool, yeah I’ve done nasal sprays in the past and they just dry up my nose because I overdue it sometimes. I’ll check out coming in then. Are there prices anywhere that I can check?

DrTrenkle6 karma

Yes that is very common. You can check out the link above for our website if you want to contact us.

Cornato18 karma

I watched a TED talk about this. About how mouth breathing is the root of some bad stuff. I also read about humming(vibrating nasal cavity) increases nitric oxide or nitrogen somehow. Have you heard of this?

DrTrenkle11 karma

Yes, I have conversations with my dentist about it frequently. I think we will learn a lot more about that in the future. As for the Nitric Oxide check out this article from the Washington Post.

indifferentials16 karma

Would your treatment be able to help me? I can barely breath through my nose because it's always slightly stuffy. I get periodic 24-hour "attacks" where my nose is extremely stuffy and congested, my throat itches and my eyes water and I feel fatigued. I've been to several specialists and gotten allergy tested but the tests came up negative. I even had my adenoids removed. I'm on zyrtec daily but nothing helps me. I don't have a deviated septum or anything of the sort - doctors are at a loss as to what's wrong with me.

DrTrenkle13 karma

It sounds like you have a very challenging case. I can't promise I could make you better, but I have a lot of cases like yours that I can usually find an answer to. The hard part is being patient and working with me and my team to go through all of your symptoms and figure out what is causing your attacks. My procedure may help, but it might be something different. The key is exploring ALL available options and not limiting ourselves to "standard" treatments. Feel free to call our office or make an appointment online.

swingerofbirch10 karma

This isn't specifically related to your procedure, but what could cause nonstop very dry boogers that are high up in the nose? I can't blow them out. They are big and seem to attach around hairs and get stuck. Sometimes dried blood with it. Always green. But super rock hard dry. I will do saline wash and get it all out (even then it won't come out at first—it will just get wet and it takes a while), and within 12 hours they start forming again. My PCP has looked in my nose several times and calls them "goldens" and not to worry about it, but they are SO annoying. The last time he saw me I had just done the nasal lavage with saline and so it was clear and he said it looked good (he's just looking with an otoscope). And he said just to keep doing what I'm doing. But I have to do saline twice a day. I can feel the boogers blowing back and forth in the upper nostrils which is annoying, they also hurt because they get very sharp from being so dry. I am on two drying (anticholinergic) medications which may be a cause (Paxil and Seroquel). But when I asked the doctor he didn't know about that. At one point he gave me Keflex but I had an adverse reaction and had to stop it after 2 days. I know I need to see an ENT but I almost never leave the house (agoraphobia). I was hoping maybe something topical like iodine could help, but the vestibule itself looks fine. The boogers are coming from high up. I don't know what the genesis is. Also it's been going on for almost a year so it's not just dry weather. It happens even in very humid months.

Edit: Also as of recently there is pain high up in the left nostril side. It feels like a sore or cut, but I can't see anything with a flashlight. It hurts if I press on the outside of the nose. But I had that when I saw the PCP and when he looked he didn't see anything. I also find myself lately pressing on the outside of my nose on the right side and pushing it left because it makes it easier to breathe through my left nostril when I do. As soon as I let go it's almost impossible to breathe through my nose. Another recent change is that when I do the saline wash it pools up in one side and won't go through to the other side like it used to, no matter how far I turn my head.

DrTrenkle12 karma

This could be any number of things, but when the nose gets too dry it causes significant crusting. Unfortunately, you already know the answer to the question that you need to see an ENT who can perform an endoscopy to see what is going on up there. It can be something as bad as an autoimmune disease causing dry nose or "empty nose syndrome." I'd highly advise you to see a local ENT.

At home remedy would include a humidifier, frequent nasal lavage, nasal saline gel and staying hydrated.

lizardwizard10010 karma

I’ve been told I have a deviated septum, does that mean my breathing is impacted?


I also have a deviated septum, and I can tell you that the surgery has 100% impacted my daily quality of life. My nose still isn't perfect, but it's very rare for me to have issues anywhere near what I used to.

DrTrenkle5 karma

Yes it is very helpful and patients love it. Thanks for sharing your experience.

DrTrenkle15 karma

A deviated septum can definitely impact your breathing. The septum is the part of the nose that splits the two sides. When it is crooked it causes turbulent airflow which impacts how much air flow you are getting. It also makes you FEEL as though it is more obstructed. Here is a short video explanation of how it impacts your breathing.

lizardwizard1006 karma

That makes sense. Part of the reason I ask is because I’m training for a marathon and my coach has told me I need to practice better nasal breathing habits during excercise, this seems to be one of my biggest roadblocks. Will this procedure make much of a difference in terms of athletics?

DrTrenkle6 karma

Yes, this is a great procedure for those that are interested in improving nasal breathing techniques for either exercise or meditation. Many professional athletes use breathe right strips to help gain an "edge." This procedure can also be used electively for those trying to improve their ability to exercise or for breathing exercises such as meditation and yoga.

Sean-Tanner9 karma

Would it be necessary to get the procedure if you only have partial difficulty with breathing through your nose?

DrTrenkle13 karma

Usually I will try basic nasal sprays and lavages first. If those don't work and you still have obstruction or just want to breath better for sports or meditation it is very helpful.

calliemccabe38 karma

It’s hard for me to breathe from my nose and difficult really smell anything at all... and my friends always have a hard time sleeping next to me because they say I snore so loud. Additionally - I only really like food if I put hot sauce on it because if not I feel like the food doesn’t taste as good and theres not much taste there. Do you think my lack in taste could do to the blockage of my nose?? And would this procedure be beneficial for these problems I’m experiencing?

DrTrenkle4 karma

This is a loaded question, but the short answer is yes! I think it would take a little more than just this procedure, but I have helped countless people with dysosmia (trouble smelling) and dysguisia (trouble tasting) using this procedure and others to address nasal inflammatory disease.

TheACmadman7 karma

Hey man, thanks for doing this. I have a bit of a weird question. Like other’s, I believe I may have a deviated septum, however I have one symptom I can’t find anywhere online..

Say I’m laying with my left ear to the ground in bed, I will feel the pressure switch to my left nostril, and it will close up almost completely. If I switch to the right side, I can feel the pressure change in my nose as the left becomes unblocked for moment, then the right becomes blocked. Have you got any experience with this as a symptom?

DrTrenkle7 karma

I get a lot of patients complaining of pressure or obstruction when they lay on either side. In my opinion it has a lot to do with gravity and blood flow. If you already have obstruction in your nose and only a small amount of space to breathe, any subtle change can cause you to feel blocked up or pressure. When you lay on one side the blood will flow with gravity into that side and you will likely feel more pressure. This is fixed generally with TNAP or many other procedures or medicine.

mvcvluso7 karma

My father is an ENT and has always told me balloon sinuplasty is BS when compared to FESS. In your experience, how well do you think balloon sinuplasty works?

Seems like your approach is using sinuplasty plus other means which may or may not actually work - are you basing this new procedure off of any objective data or RCTs?

DrTrenkle5 karma

The procedure I'm talking about is different than balloon sinuplasty. As with any new procedure, patient selection is key. There are a lot of ENTs who are very late to the game in using sinuplasty for a number of reasons. There are a lot of ENTs who abuse it as well which is why it sometimes has a bad reputation amongst older ENT docs (not to call your dad old). The new procedure I am doing is just using traditional techniques in an office setting. It is important to select the right patients. This forum is mostly to bring awareness to what is available these days as our field has changed dramatically.

HiggsBoson626 karma

Can you explain what’s different about your treatment? How does it differ from traditional treatments? Has it been performed by other ENTs or just those in your practice?

DrTrenkle5 karma

Of course! What I am doing is not much different than others and can be done by any ENT (I'm not special). It is just a combination of different treatments that many other ENTs perform. The main difference is that I perform them all together under local anesthesia which is very uncommon. This link describes the procedure in more detail and this video is how I explain it to patients during consultations. The four procedures are Septoplasty, submucous resection and outfracture of inferior turbinates, repair of vestibular stenosis and destruction of septal swell bodies. Each one has a purpose and I don't do them all every time if the patient does not require them. I think what really makes it unique is just how we choose patients and take the time to truly analyze what the problem is and what needs to be done to fix it.

S2Pac6 karma

I badly smashed my nose as a kid & had a rhinoplasty nearly 30 years ago to remove a lot of my septum/cartilage in the bottom half of my nose. What’s left is very crooked and I snore like a train and think I have sleep apnea as a result. Could your procedure help me?

DrTrenkle7 karma

It's possible. A lot of times you would need a full revision, but sometimes the minimally invasive approach works better for basic obstruction. Each patient is different but I'm mostly aiming to give a good option for those that want to avoid the operating room.

Arcanine266 karma

I'm familiar with the whole breathing through one nostril at a time and they switch thing, but every now and again, one of my nostrils gets like hyper clear and I can feel the air going deeper than usual. Is that a normal experience?

DrTrenkle9 karma

Yes, it can be. Part of breathing is just sensation. Often times if we were to measure the airflow it may not be bad, but the mucosa can have inflammation on it which causes a sensation of poor breathing. For example, after procedures patients often get "crusting" which is like a scab on the head of the turbinate. When I remove that scab they feel their breathing is significantly improved even if its only a small crust. The mucosa has nerves which tell us we are breathing. That is why mucosa sparing techniques are so important.

MoonchildStardom5 karma

How is your work, doctor? Are you proud of it? What initiated you to design a treatment for a specific problem within otorhinolaryngology. That seems like an obscure idea. I am intrigued as to where it all began?

DrTrenkle19 karma

I honestly love doing minimally invasive work. Giving patients options is what drives me. Shifting paradigms is a big one too. This procedure does both which is why I think I enjoy doing it. Anything that allows advancement of my specialty and helps provide relief to those that are told they cannot be fixed is a success to me.

Syncrondome5 karma

Is your surgery able to avoid Empty Nose Syndrome (ENS)? Some people get Empty Nose Syndrome from turbinate reduction surgery and some of them have even committed suicide as a result of the deterioration in the quality of life that ENS causes them to have. :( Seriously.

DrTrenkle7 karma

All turbinate surgeries can avoid ENS. I like mine because I specifically ensure the mucosa is spared. It is very important to spare the mucosa. Most submucous resection techniques spare mucosa. Obviously it is Physician dependent but this complication is relatively rare.

DrTrenkle5 karma

Hello reddit community! I’m sorry but I have to sign off. I promise I will answer EVERY question you all post for the rest of the evening when I wake up tomorrow. It has been a pleasure providing you all with this information. For those with current questions most of them have been answered if you dig through the comments.

ZLERBER4 karma

Not really a nose thing - but those ear wax removal vids are based! What is the worst ear wax removal case you have ever done?

DrTrenkle14 karma

We frequently pull out chunks of wax as big as tootsie rolls. I think the worst things we pull out of ears are insects (cockroach is the most common). Just like any orifice, people stick weird things in their ears...

drdrillaz4 karma

My seasonal allergies are so bad I literally can not breathe 99% of the time without meds. My typical routine consists of 4 pumps Flonase in each nostril every morning along with 2 Zyrtec D 24 hr. That usually gets me functional until the night where I have to do oxymetazaline decongestant to be able to sleep. If I don’t have it I won’t sleep at all. It’s a terrible routine and I’d love to be able to breathe. Would I be a candidate?

DrTrenkle10 karma

Oh no! That is an aggressive routine. You need formal allergy testing and are likely a candidate for immunotherapy. I would consult a local allergist and get started. Using oxymetazaline at night is also a big no, no. This actually causes a paradoxical rebound congestion which continues to happen over time. It is a very hard habit to kick. The procedure would very likely help you, but before I do any procedures on people I make sure they are completely off oxymetazaline. It is very important for the healing process. Likely the reason you started it in the first place is what you need addressed for long term improvement. There are a lot of issues here and your treatment would be multifaceted for sure.

drdrillaz7 karma

Thanks for the reply. I know it’s a terrible routine but it’s the only thing that allows me to sleep. A friend of mine used to be a practicing ENT and now does facial plastics. He was sitting next to me at dinner one night and told me I needed to see a colleague of his immediately because I sounded so bad. That was 3 months ago.

DrTrenkle7 karma

Your friend sounds smart! I would definitely go see someone who can help you with this. It will only continue to get worse. It is called "rhinitis medicamentosa" and can be a very hard problem to recover from. The sooner you seek help the better.

SpikesNvAns3 karma

I've tried asking a doctor before, but they kinda just dismissed it. I snore quite loudly, and it's made my wife miserable. I have a hard time breathing through one of my nostrils and I've noticed what looks and feels like excess bone that makes the nostril smaller. My nose always gets really dry and bleeds, causing it to get blocked up more often. I've been trying to use a bit of vasoline, and it helps, but is there a fix? Or am I really just normal?

DrTrenkle7 karma

Wow! You have a very common problem called a deviated septum that can be fixed with simple surgery. It can have a drastic effect on snoring. There are a number of reasons we snore (see link) and it can be one or more, but I would see an ENT. Most of us see these consults daily.

cmo_212 karma

I’ve always had trouble breathing through my nose, to the point that taking up sports was a challenge for me. Recently a friend of mine connect this to my energy levels, especially in workouts. Is there actually a connection to breathing through ones nose, and their energy/ activity levels?

DrTrenkle6 karma

Yes for sure. When you are actually exercising it helps a great deal to use your nose to breath. It helps the tissue oxygenate. This article in the Washington Post did a great job of explaining it in more detail if you are interested.

lens3142 karma

I seem to be able to breathe through only on nostril at a time, is this normal?

DrTrenkle3 karma

Yes and no. This is a normal physiologic fluctuation of the nose. Most people do not notice though. The fact that you notice usually means you have some level of obstruction. Maybe do a self trial of fluticasone OTC and see if it helps. If not I would see a local ENT to see if you have an anatomic abnormality such as a deviated septum or enlarged turbinates.

MyPigWaddles2 karma

Hi there!

A member of my family has obstructed breathing and could probably do with an operation, but he's a singer and is nervous that a procedure would impact his voice. Is this a concern he should have?

DrTrenkle2 karma

It is unlikely that a procedure or surgery will impact his voice but it is a risk. Intubation is also a risk. There are ways to mitigate that risk by going slowly and doing less before you do more. Overall the situation is unique and my patients who are professional singers are always people that require specific treatment plans. Not sure if that helped or not.

alexwasnotavailable2 karma

How does your procedure differ from what I had done, which was septoplasty and turbinate reduction? I had this procedure done a year ago, and while it helped a lot, I still have to use nasal rinses with budesonide steroid ampule in it just about every-other-day now. Side question: Will the rinses eventually not be required? Is it common to have to continue doing this?

PS: I had the balloon procedure first a few years ago, and it didn’t help one bit.

DrTrenkle2 karma

It’s very similar to those surgeries. It is done in a less invasive environment however if done correctly those procedures should do about 80% of what mine would do. The answer to your question is I’m not sure if this will help you or not. I would have to evaluate your nose more thoroughly. You may have vestibular collapse which would not have been addressed with either of those procedures. This does happen from time to time with patients that I see in my clinic.

heynow99912 karma

HI, I feel like I have difficulty breathing, and I snore. I wear nose cones at night. I feel they help because I sleep through the night, but I used to wake up regularly before I started wearing them. I feel my problem is my nose is simply too small . When I push up on the tip of my nose it feels much easier to breathe.

My idea is that if I could get more rigid nose cones (the nose cones I have tried are very flexible) and then get progessively larger ones, I could stretch my nose over time to make it easier to breathe. Maybe I could get them 3d printed ? Any coments?

DrTrenkle2 karma

Very interesting solution. I hadn't thought of that! Not sure how I would make it but you may want to submit your patent before I do, haha. I would tell you that there are two procedures I do that help solve this problem permanently. One is called VIVAER and the other LATERA. They both address the issue you are having. In my TNAP procedure I often address them both. Many ENTs do the above procedures so you may want to look into them. If they are not enough then usually surgical grafting is needed to create "permanent" cones. You may be on to something though...

mm8252 karma

What are your recommendations for at home ear wax removal? My ears are constantly plugged up, every airplane ride is like a 48 hours process before they're not popping again.

DrTrenkle6 karma

Those are actually 2 different problems. For at home ear wax removal I recommend using debrox to loosen the wax and rinse it in the shower. If that doesn't do it see a local ENT.

As for the plugged ears, that is often due to a Eustachian Tube Dysfunction. This is a problem where the tube that equalizes the pressure in your ears does not work well. I have a lot of different ways to treat that problem but if you fly a lot doing an ear tube or dilating the ET with a balloon are good options.

DakuYoruHanta2 karma

I breath through my nose when I’m awake just fine but always wake up to realize I’ve been breathing through my mouth in my sleep. Is that a problem?

DrTrenkle3 karma

This is generally a sign of nasal obstruction. At night we are obligate nasal breathers. If you are breathing through your mouth at night you are likely breaking that habit. It can be changed but one reason to address the nasal airway is to give yourself the best possible chance to break the habit.

icuntadulttoday2 karma

Why is 1/3 of the population having issues with breathing through their nose? (myself included)

DrTrenkle2 karma

Mostly anatomic abnormalities such as a deviated septum, but environmental factors such as allergies play a roll as well.

black_curl1 karma

I can't find a solution to cure my nasal turbinate hypertrophy. Do you have any suggestions about rhat?

DrTrenkle2 karma

No problem! I answered this awhile ago (I wouldn't expect you to scroll through them all though) so don't mind the copy and paste. Hope this helps!

Enlarged turbinates can really cause a lot of obstruction. I often start with basic nasal sprays, but when they do not work I move to minimally invasive treatments such as in office turbinate reduction. My new procedure addresses the turbinates more thoroughly by reducing them in size by removing a small portion of the bony aspect and fracturing them out to create more room. It also addresses the mucosal swelling through pressure necrosis using the new TRACT airway balloon. Many people suffering from enlarged turbinates have collapse of their nasal valve and mild septal deformities as well. Both are addressed with the procedure.

Netsuko1 karma

Does this interfere with or remove the nasal cycle? https://en.m.wikipedia.org/wiki/Nasal_cycle

DrTrenkle2 karma

No it can actually improve the nasal cycle if done correctly. The procedure is designed to help with problems causing defects in this cycle. It is mucosa soaring so this helps decrease complications.

tweist1 karma

My wife recently found out she has a deviated septum, to the point where after reviewing the MRI (screening for a sinus infection) the ENT started asking if she was sure she didn’t want to go ahead and schedule surgery.

Many many years ago, her father had surgery done and was adamant that it was a horrible healing process. However she was told that the recovery wouldn’t be bad if she had it done...

Have procedures changed over the years that this could be worth considering?

Also, do deviated septum’s run in the family?

Thanks for your time!

DrTrenkle1 karma

Septoplasty surgery has come a long way depending on the doctor. Most of the surgeries that we do now have less recovery time but honestly it is very patient dependent. Under general anesthesia there is built in recovery time due to medications (propofol - Michael Jackson drug), paralytic (causes full body aches), intubation (tube in throat gives a sore throat), and not to mention the surgery itself. Overall I'd say recovery for septoplasty is a week and is not terrible, but that is why I offer this option to patients to have it done in the office under a local anesthesia.

Yes, deviated septums can "run in the family"

Hope that helps!

Theabsentee51 karma

Does your treatment help people with sleep apnea?

DrTrenkle2 karma

It is not designed specifically to treat those with sleep apnea, but I use it frequently to help those that cannot use a face mask and want to switch to nasal pillows. If you have very minor sleep apnea it could potentially be curative, but that is uncommon.

DrTrenkle1 karma

No problem!

dashbaumgarten1 karma

When I was in the hospital, I had to get a tube up the nose and down into my stomach. The tube actually wouldn't go all the way back in one of the nostrils, but went fine in the other. I forgot what the nurse said this might be. What could it be?

DrTrenkle1 karma

That is usually due to a deviated septum. We see that all the time when we perform flexible scopes such as that for patients in the office or hospital. It doesn't mean you need to do anything about it unless you have trouble breathing through the nose.

AmaiRose1 karma

I have had 3 years of nasal inflammation, have been tested clear for allergies, and have tried 3 sprays and 3 antihistamine pills, some worked briefly and then stopped, others had no effect. Right now I'm breathing okay on oral prednisione for my RA (wierd that local spray didn't work but oral did). Nette pots help for about 8 hours. I have super gross tonsil stones that are never not there. My FD doesn't think there is a link. Basically, it's been suggested I get used to mouth breathing. That seems crappy to me. Any advice?

DrTrenkle5 karma

This is a very common problem and I don't suggest you "get used" to mouth breathing =0. You are one of many people that would likely be a good candidate for the procedure or at least one of them. I'd say to try and see an ENT if you can and preferably one that does multiple types of procedures. Nasal inflammation is not necessarily due to allergies and there are many causes of it.

ducks_are_dinosaurs1 karma

What are your views and thoughts on neti pots? When would you recommend it to someone?

DrTrenkle2 karma

Neti pots are amazing! Sinus and nasal lavage is key to keeping down inflammation.

Dude9021 karma

I already had sinus surgery for this reason, can I still get TNAP?

DrTrenkle1 karma

Yes you would still be a candidate. I often do this procedure after someone has failed sinus surgery. It just depends on the patient and their physical exam as well as symptoms.

Tuff_Wizardess1 karma

What percentage of people have had successful results from the procedure?

DrTrenkle2 karma

I don't have a percentage, but almost everyone has improved breathing after the procedure. If I don't think you will do better I likely won't offer it. If there is a small chance of improvement then I will be very honest and up front with you before we would even try. Usually, those that are at a last resort are the ones that really want to try it because they have failed traditional therapy.

byronshelleykipling1 karma

I've heard that underdeveloped air passageways can affect the attractiveness of the face by morphing your facial structure over time, especially if issues starts when you're younger as a kid. There's a doc/researcher in England named Dr. Mew who gives lectures making that claim with crazy before and afters. Is there any real scientific basis for this or is the guy a hack? If real, can you really affect your face when you're older by fixing breathing issues (obviously less than when a kid..)?

DrTrenkle1 karma

I can't speak to the work Dr. Mew is doing as I'm not familiar with it. It is possible that some patients have "unattractive" faces due to underdeveloped nasal passages. I'm not sure how that would be fixed with anything other than invasive surgery, but I'm going to look into it once this is over.

byronshelleykipling1 karma

I'd love to hear your opinion on the topic! i have another question, if you don't mind. I remember having something removed as a kid in the back of my throat -- I'm pretty sure they were called adenoids(..it was a non-English speaking country). Am I missing something important now and could there be some adverse effects throughout my life that I should be aware of? I've never heard of anyone else having such procedure among my friends.

DrTrenkle1 karma

That is correct. Adenoids often cause nasal obstruction in childhood. No you are not missing anything important. They are very useful in the first few years of life, but afterward often harbor bacteria and obstruct the nose. It is very common in the US to have the adenoids removed at the same time as the tonsils.

gonnagetossed1 karma


DrTrenkle2 karma

This procedure won't likely help, but there are a number of options for polyp patients other than traditional surgery. It usually depends on how bad they are. I usually present multiple options for patients. If they are very mild, there are some nasal sprays that can keep them at bay and potentially improve them such as XHANCE (no commercial ties to them). There are also in-office procedures and surgeries I have performed which help as well such as SINUVA (dissolvable implant) and in-office sinus surgery.

flyingmountain-1 karma

Man, how are you an ENT doctor and yet can’t remember that “breath” is a noun and the verb is “breathe,” both in regular typing as well as when linking to your own website on which it’s actually spelled correctly?

DrTrenkle3 karma

Haha, that is embarrassing. Corrected now. Appreciate the grammar check.

BigHairyDingo-1 karma

Isn't the whole point of nose hairs and a small airway to help fllter out stuff before it hits your lungs?

Arn't you worried that you are altering one of natures best defenses against respiratory diseases?

DrTrenkle2 karma

Quite the contrary. This procedure is actually sparing the nasal anatomy which is why I call it minimally invasive. Traditional techniques often require damaging the mucosa or cutting or removing tissue. This technique does just the opposite. Many people are born with deformities that don't allow them to breath well. This procedure helps get them feeling "normal" without having to endure an invasive surgery that may change or alter the natural defenses.