Mouth breathing and hypernasal

Hi, I have a patient referred to me by her orthodontist for orofacial myology treatment.  She has a recurring anterior openbite after orthodontic appliance correction.  She had surgery to remove her adenoids in February due to significant hypertrophy. The ENT did not remove the tonsils because they were not excessively large and patient didn’t have history of strep throat.   Since her adenoidectomy, she can now breathe through her nose during the day (which she didn’t do before surgery), but continues to mouth breathe at night.  She sounds mildly hypo nasal all the time.  She can breathe easier through her left nostril than right, and reports that when she pushes on her nasal bridge (to move it over slightly to the side) she can breathe easier.  Her face is visually asymmetrical.   I’m wondering if she might have a deviated septum and if this could be contributing to the difficulty breathing through her nose at night. If this is the case (or if there is a different reason for a breathing obstruction making her breathe through her mouth at night only), is she likely to be able to make progress in therapy, or do you think the night breathing issue needs to be addressed first?  Do you think she might benefit from wearing nasal strips at night? Thank you very much for any insight you can provide!

A:  Response provided by Becky Ellsworth, instructor at Neo-Health Services, Inc. With permission from the parent, I would be asking for the ability speak with the ENT to find out all their observations prior to surgery. Did they check for a possible septal deviation, nasal polyps, nasal turbinate enlargements, etc.? I would be surprised if they didn’t look at all areas but you need to know. After your Orofacial Myology evaluation, what did her palate look like as far as the vault height and width? Can she achieve a palatal suction with her tongue? Where are her tongue and lip rest postures? Does her facial asymmetry coincide with the right side of her face? Our bodies have a built in nasal cycle in which every four hours, the nasal turbinates’ enlarge on one side of the nasal passageway while the other side shrinks. It could be that while she is sleeping, even she has an off-set septum instead of a deviated one, when the turbinate on that side enlarges, she must breathe through her mouth. Does she snore? There is also the possibility that her tonsils are still an issue…. All barriers to nasal breathing need to be addressed for complete success. If the answers to my questions are all no, then I would address the night breathing issue right away. This is assuming that she is able to maintain correct tongue and lip rest posture during the day…. Nasal strips might be a great solution for her to help establish a correct night breathing habit. There are also night auto suggestions within the Myo Manual treatment program to get the subconscious side of the brain to aid in achieving a nasal breathing posture.