Functional Nasal Breathing Rehabilitation: Effectiveness and Feasibility of an Online Integrative Breathing Therapy Protocol

Purpose: Nasal disuse and mouth breathing are associated with negative structural, functional, postural, occlusal, and behavioural changes. While there is some research to suggest that nasal breathing exercises can reduce mouth breathing, clinical protocols have not been extensively investigated. The purpose of this research was to determine the feasibility and effectiveness of a nasal breathing rehabilitation protocol based on Integrative Breathing Therapy principles called Functional Nasal Breathing Rehabilitation (FNBR). Methods: Twenty-three participants with symptoms of nasal obstruction and self-reported mouth breathing completed the 4-week online FNBR training. Outcome measures included the Nasal Obstruction Symptom Evaluation (NOSE) scale, a numeric rating scale (NRS) for nasal breathing difficulty and obstruction, allergy symptoms, self-reported daytime and nighttime mouth breathing, and a composite questionnaire called the Self-reported Nasal Breathing Difficulty Questionnaire (SRNBQ) to compare symptoms of nasal obstruction, allergy and reported mouth breathing pre- and post-trial. A content analysis was performed on qualitative data collected during weekly online interviews. Results: There were statistically significant improvements in the SRNBQ total score (p = 0.002), NOSE scale (p = 0.006), NRS score (p = 0.008), and mouth breathing daytime and night-time (MBDS) score (p = 0.024), but not in allergy symptoms. Participants were highly adherent with the techniques, with 91% of the participants completing formal breathing practice more than four times a week and 96% reporting that they used the practices informally in daily life mostly or all of the time. Conclusion: Functional Nasal Breathing Rehabilitation appears to be a feasible and effective modality for reducing mouth breathing and improving nasal obstruction symptoms in patients with subjective signs of nasal obstruction.