My New Nose

Last year, on Valentine’s Day, I had my septoplasty. I had a deviated septum, which veered to the left; my deaf side. For as long as I could remember, I had been unable to breathe through my left nostril – something I hadn’t paid much regard to until my hearing loss and the onset of the associated feeling of pressure in my ears and head.

The pressure is often the most difficult symptom to manage. It is more prominent than my tinnitus. It is ever-present, unlike my sound sensitivity for which the degree of severity is dependent on environmental sounds. With more pressure in my ears comes more dizziness. I would try almost anything to help relieve some of this discomfort as it is extremely hard to disconnect from.

Following a consultation with a particular specialist, in which he stated with confidence that the reason for the feeling of pressure in my ears was because I couldn’t breathe properly, I had elected to have the septoplasty operation. Not all specialists had given me this opinion, and so I tried not to get my hopes up regarding an improvement in my ear discomfort. The straightening of my nasal septum would enable airflow through both nostrils which, at the very least, I hoped would help me sleep better. I also had a faint hope that it could result in a reduction in the feeling of pressure in my ears and head.

The outcome of the surgery wasn’t quite what I had hoped for. The operation had been a success in that my septum was now straight. However, although I was now able to breathe air ‘out’ of the left side, I was unable to inhale. Unfortunately, the nasal valve on the left side of my nose collapsed following the surgery. This meant that every time I tried to breathe air in, the weakened side of my left nostril caved into the nasal passage; blocking the airflow. If I wore a nasal dilator strip, which I opted for during the night, I was able to breathe through both nostrils. But, as soon as the strip was removed, my nasal valve collapsed again. And so, after my septoplasty, I was still unable to breathe naturally through my left nostril and for this reason, the operation also had no impact on my associated ear symptoms.

This year I was offered another procedure to help me breathe, and of course, I agreed to it. The surgery would involve reshaping my nose to correct my breathing problem. I still refused to give up hope for having the minimum comfort of being able to breathe properly. Moreover, I retained my guarded hope for some relief from the persistent ear pressure. 

I spent the weeks leading up to my surgery exploring how my new nose would feel. To simulate my anticipated, improved breathing function I would press my left index finger on a patch of skin next to the left side of my nose and pull the skin away from my nose gently; opening up my airways. The feeling of breathing through both nostrils was wonderful and the pressure around my nose was clearly reduced. I ignored the confused and sometimes disturbed looks passers-by would give me and I’d smile with delight at the thought of this extraordinarily oxygenated state could soon be my new ‘normal’.

I had the open rhinoplasty surgery six days ago and am recovering well. The operation experience was very similar to my septoplasty. I awoke from the anaesthesia with my nostrils full of packing. There was gauze taped under my nose to catch the blood that steadily drained for the next couple of days. The first two days were predictably the most difficult. I was in a significant amount of pain, and it was very uncomfortable trying to eat or drink anything with my nose blocked with dressings. When I returned to the hospital 2 days following the surgery, the specialist removed the nasal packing and I immediately felt a lot more comfortable and had some marvellous breaths of air through both nostrils. On leaving the hospital I felt quite lightheaded from all the air I was able to breathe.

Recovery will take time and patience. My nose is full of stitches and is very sore. My face is bruised and swollen and at present, I resemble an old bruised potato. My nose is currently congested due to swelling, and I am not allowed to blow it, so it feels like I have a very bad cold. But, I am hopeful for some more wonderful full breaths of fresh air. I am hopeful for better sleep. And, I am still holding on to my most cautious of hopes; for some reduction in the constant feeling of pressure.

…I also wonder what my new nose will look like.

Specialist appointment part 2: Ear bubbles, a blocked nose… and a plan

…The specialist only briefly addressed my noise sensitivity. It had been my understanding from my previous appointment, with the previous specialist, that the reason for me meeting with this particular Ears Nose and Throat (ENT) doctor, was to receive some sound therapy. This therapy would help retrain the auditory processing centre of my brain to accept everyday sounds. Instead of therapy, I was given a suggestion of a procedure I could perform by myself. The advice I was given during this consultation was to subject my hearing ear to noise or music, at a volume level which I found too loud, for a period of 20 minutes. I was to do this 3 times a day. I was given the example of listening to nature sounds on my headphones, whilst keeping the volume as loud as I could possibly bear it. The ENT specialist told me that eventually I would be able to turn the volume up to higher levels. He told me that there were special hearing centres I could go to, but these would cost money, and it was customary and also effective for patients to carry out this treatment themselves. I found it curious that in the same appointment in which I had been told to avoid loud noises in order to protect my only hearing ear, I was also told to subject the same ear to noise that would cause me discomfort.

After feeling yet a little more deflated on realizing the only therapy or support this specialist was going to offer me, was the small piece of advice he’d just given me, and not a series of therapy sessions, which I had been hoping for, I started to hastily ask my friend to enquire about a few more issues; as the feeling of outstaying our allotted time started to encroach upon us.

I asked my friend, who had accompanied me to help with translation, to question the specialist about the operation I had been told about months ago, which would straighten my nasal septum, in order to help me breathe more easily. The specialist had no visible response to this enquiry, and he continued scribbling notes into my medical history booklet. With perseverance, intent on maximizing my time with the consultant, I asked my friend to mention the feeling of pressure I have in my ears, and about my bouts of dizziness, and to ask if there was anything I could do to relieve these symptoms. Without raising his head to acknowledge us, he pointed to an examination chair across the room from where we were sitting, and he mumbled something inaudible. I obediently went and sat in the chair. I had sat in this chair before. I hoped that I wasn’t going to have the customary experience of having a viewing tube inserted into my nose, for the third time. The specialist put on a head mirror and some surgical gloves, and then he reached for an examination tool. This tool appeared less sophisticated than the viewing tube. The tool resembled a pair of metal pliers; with thinner handles, and two hooked jaws. He inserted the contraption into my nose, with both of the metal hooks sliding into each nostril respectively. He swiftly and forcefully lifted the handles of the device upwards at an angle, to view inside my nose; examining the structure of my septum. He said that my nostril was completely blocked on the left side, due to the deviation of my septum. I already knew this. I have been unable to breathe through my left nostril for as long as I can remember. I had also had this same discussion, two times previously, in this same room, with two other former specialists. This information was in my medical notes, in the booklet that was sitting on the desk in this same room.

Then, without further explanation, I was asked to leave to room. I was instructed to go, for perhaps my fifth visit over the past year or so, to have a tympanometry test. A tympanometry test is often used to assess the function of the middle ear. The results of tympanometry are represented on a graph called a tympanogram. This is a graphic representation of the relationship between the air pressure in the ear canal and the movement of the eardrum, and the tiny bones in the air-filled middle ear space. When the eardrum is disturbed by a sound, part of the sound is absorbed and sent through the middle ear while the other part of the sound is reflected. The information derived from tympanometry provides information regarding middle ear function, especially Eustachian tube function.

The nurse who carried out the test was a nurse I was familiar with. She was friendly and jolly and seemed intent on carefully explaining everything to me. In the interest of respecting her, much appreciated, caring nature, I acted as though I was unfamiliar with the procedure. She kindly explained the process to me, through my friend; my translator. An ear probe was promptly placed, first into my hearing ear, and then into my deaf ear, to test the responses. As the probe in my hearing ear caused the air pressure in my ear canal to change, I heard some low-pitched tones. When my deaf ear was tested, it remained silent, with only the sound of tinnitus prevailing. While the pressure was changing, measurements of my eardrum’s movement were being taken and recorded. The test was over in a few minutes. When the nurse examined my results, she scrunched her face into a painful expression. She asked me if I have the constant feeling of being in an aeroplane. Yes! I have an unceasing pressure in my left ear, and though not as pronounced, in my right ear too. It is the feeling of pressure, comparable to being in an aeroplane and not being able to pop my ears. I also have the occasional sound of little bubbles similar to those in the foam made by bubble bath, or bubbles in fizzy drinks traveling to the surface, escaping into the air with a with a crackling sound. These sensations are sometimes accompanied by a sharp deep and momentary pain. Yes! This pressure is causing me constant discomfort, and is more difficult to manage than my actual hearing loss. Yes! This pressure I feel is what I’ve told every specialist about. Yes! This wonderful nurse had immediately identified this as a significant source of discomfort, and was showing empathy towards my situation. She was the first person in over a year of consultations, to not just read my results and identify a problem, but to actually show some understanding of the unpleasantness I was experiencing.

I returned to the consultation room, and showed the doctor my tympanogram. After regarding it for a moment, he told me with confidence that the reason I have the feeling of pressure in my ears is because I can’t breathe properly. This is not what I’d been told before. I had been told that there could possibly be a link between my inability to breathe effectively through my left nostril, and my ear pressure. I had believed that the pressure was a consequence of my hearing loss. The onset of the feeling of pressure had, after all, coincided exactly with the moment I lost my hearing. I told him that it had not been communicated previously to me that the issues with my nose were the certain cause of the discomfort in my ears. He repeated with vehement assurance that the pressure in my ears was a direct result of my difficulty breathing. This was something new to me.

The specialist then questioned me about my sleeping habits. I told him how I have struggled to sleep, to the best of my recollection, for most of my adult life. I told him how I find it difficult to fall asleep, due to problems breathing. I told him how my brain seems to wake me up just as the rest of my body feels like it’s going to sleep. I told him that I am only able to sleep effectively whilst lying on my left side. If I sleep on my right side; the side of my functioning airway, the nostril closes up which means I can’t breathe at all through my nose. He told me that I needed the septoplasty. This operation would straighten my septum, allowing for better airflow through my nose.

There are long term effects of a deviated septum. In my case, having a deviated septum has meant that not only have I had many sinus infections, but I also often get throat infections; as I regularly breathe through my mouth. The blocked nasal breathing due to septal deviation also has a negative effect on the Eustachian tube, which means drainage from the nose is not efficient. If what the specialist was saying was correct, having the operation could lead to better tubal drainage from my nose, and as a result this could relieve some of the pressure I am feeling in my ears.

My hope for this operation is that it will help me feel more comfortable whilst sleeping at night, as I will be able to breathe through both nostrils. After time I should start breathing through my nose more during the night, and therefore shouldn’t wake up as much; as a result of having a dry mouth, or as a response to my body warning me that I am not managing to get enough oxygen into my lungs. In consequence, I hope I will also feel more refreshed when I wake up. My most cautious hope however, is for an eventual reduction in the pressure I am feeling in my ears.

And so, after over a year of rapid changes of emotion, I am once again feeling hopeful…