The Human Perception of Breathing: How Do We Perceive Breathing and Why Surgery Cannot Always Resolve Nasal Congestion

Abstract

Abstract Purpose of Review The purpose of this review is to summarize the current literature regarding the human perception of breathing and answer in questions of how do we perceive breathing and why surgery cannot always resolve nasal congestion. Recent Findings TRPM8 thermoreceptors expressing the majority of trigeminal afferents nerve endings within the nasal mucosa are responsible for human subjective perception of breathing. Human nose seems to sense patency with mechanisms involving localized peak mucosal cooling. A subset of patients after surgery for nasal obstruction suffers from persistent blocked nose, although clinical and laboratory examinations confirm normal airflow. The potential mechanism is a lower intranasal trigeminal sensitivity leading to a decreased subjective airflow perception. Summary Different factors and mechanisms like nasal thermoreceptors/mechanoreceptors, nasal mucosa cooling, nasonasal reflexes, and nasal cycle are implicated with the human perception of breathing. Abnormalities in nasal framework and/or trigeminal function may result in nasal congestion sensation. Surgery cannot always resolve this problem due to failed surgical technique, suboptimal preoperative diagnosis of concomitant disorders, and impaired intranasal trigeminal function.