Blocked Nose and Snoring: How Can I Breathe Clearly and Stop Coughing?

Are you suffering from a persistently blocked nose with loud snoring, causing difficulty breathing and a feeling of suffocating? Many people have a frequently or persistently blocked nose and depend on their mouths to breathe, but yet don’t realise that mouth-breathing is abnormal. Mouth-breathing usually means that your nasal airways are blocked, and this restricts the oxygen flow into your body, affecting your sleep and daytime work performance. Some people who have had a blocked nose all their lives don’t even know what it’s like to be able to breathe clearly!

As an ENT specialist in Singapore for children and adults, I see many patients with blocked nose and difficulty breathing. Some patients have been depending on over-the-counter medications such as Afrin, Iliadin, Oxymetazoline decongestant sprays, and keep using them daily to help them sleep. Well, although these nasal decongestant sprays do help to reduce nasal congestion and mucus, they are not supposed to be used longterm and really, for no longer than a week at most if used on a daily basis. But many people don’t know that it is very difficult to stop using these decongestant sprays if used for too long as they grow dependent on them. There is also a risk of rebound congestion with longterm use, leading to even more episodes of sinus infections with worsening symptoms that they started off with! Rhinitis medicamentosa is the medical term given to such a condition caused by over use or longterm use of nasal decongestant sprays and it can be challenging to treat. The nerve endings in the soft tissue inside the nose (turbinates) become desensitised with longterm use of nasal sprays so that they then start to react abnormally to airflow, temperate and humidity changes. But it’s a vicious nasal cycle because then some patients begin to spray their nose with the nasal decongestant sprays even more often or increase the dose, which only worsens the situation.

So if you find that you just can’t seem to get by without your nasal decongestant spray, something’s wrong and you need to see your friendly ENT specialist in Singapore for a thorough nose check-up. There are many causes of a persistently blocked nose such as a deviated nasal septum (crooked nose bones inside), swollen inferior turbinates (the “sausages” of the nose), enlarged adenoids, nasal polyps and rarely, a nasal tumour. Nasal allergies, or allergic rhinitis, is also a common cause of excessive mucus production, nasal congestion, irritating nasal backdrip and a persistent cough! The key point here is that lower airway symptoms such as a cough, are often caused by upper airway conditions leading to a persistent nasal backdrip, a postnasal drip, which flows down into your throat and voicebox/larynx to irritate it to cause a persistent cough, keeping you up at night. Many patients see the respiratory specialist first, mistakenly thinking that it is a lung condition, so the respiratory doctor then starts them on medications like inhalers for apparent asthma (hypersensitive lower airways in the lungs). But they fail to realise that the “asthma” symptoms are very often caused by a persistent postnasal drip originating from the nose itself. Imagine a tap left running 24 hours a day, 7 days a week, with all that wet sticky mucus pouring down the back of your nose to enter the windpipe and lungs, resulting in a persistent cough reflex by your body to try to clear this from your lower airways. So doesn’t it make sense to target the treatment now towards turning off the dripping tap above?

Your friendly ENT specialist in Singapore will examine your nose with an endoscope camera or “the scope”, a tiny flexible camera which gives us a great view of your entire upper airway from the nostrils to the back of the nose to the throat and voicebox/lower airways. I would say the most common causes of a persistently blocked nose are 1) deviated nasal septum and 2) enlarged swollen inferior turbinates, the “sausages” of the nose. So this means there are both structural/anatomical reasons as well as soft tissue problems which need to be corrected to improve the nasal airways to help you breathe better. The same group of medications may be used to improve the blocked nose and postnasal drip symptoms: These consist of Sinus rinse (seasalt saline irrigation for your nose), nasal steroid sprays and antihistamines. Quite often, after a nasty viral upper respiratory tract infection like the flu, the common cold or Covid infections, the nose will produce too mucus as a backdrip or “runny nose from the back” and this may sometimes last for quite a few weeks. Antibiotics may not always help these nasal symptoms.

So what happens if you still can’t breathe through your nose in spite of using all these nasal sprays and tablets? Well, then surgery may be an option for you to correct the deviated nasal septum and enlarged soft tissue of the inferior turbinates. These procedures are called “septoplasty” and “turbinoplasties”, with the main aim to open up the blocked nasal passages to help you breathe clearly. We often perform these 2 nasal procedures together at the same time under a short general anaesthesia with you asleep. They don’t usually cause much discomfort and although there is some form of nasal packing inserted at the end of the operation to prevent bleeding, we usually do try to pack just one side of the nose for comfort. The nasal packs are gently slid out of the nose the following morning after surgery if there is an overnight stay postop. Sometimes, this nasal surgery can also be undertaken as day surgery. Septoplasty with turbinoplasties do work quite well to help patients breathe better and hence sleep better, in turn helping you function better in the daytime at work and at school. The weird thing is, some people have been living their entire lives with a blocked nose and they don’t realise until many years later, that having a blocked nose and breathing mostly through their mouth, is in fact abnormal. Then when they find out that surgery can often play a life-changing role in improving their difficulty breathing, they are absolutely amazed, even more so after surgery when they finally experience what it is like to actually breathe through the nose!

In conclusion, having a blocked nose and coughing constantly due to an itchy throat or backdrip is abnormal and definitely treatable! See your friendly ENT specialist in Singapore for help with your breathing issues.

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