The Ultimate Guide to Blocked Nose: I Can't Breathe!

Have you ever suffered from a persistently blocked nose? Some patients just cannot breathe through their nose. They depend on regular use of decongestant drops or sprays, just to breathe through their nose. This is not advisable due to long-term side effects of such over-the-counter medications!

It is very difficult to wean patients off such medications, which include Iliadin and Afrin. When their blocked nose becomes so uncomfortable, they realise they need to see an experienced ENT specialist in Singapore! Their blocked nose may be so uncomfortable for them to breathe that they are unable to sleep well at night. This in turn has negative effects on their daytime performance in school or at work, making them feel tired.

You should not use such decongestant medications daily for more than a week! It is safer to change nasal steroid sprays and antihistamines if you are going to suffer from a blocked nose daily.

So what could be one of the more common causes of having nasal congestion? Sometimes, the breathing difficulty may have started from a severe upper respiratory tract infection (URTI). In other cases, it may be triggered by a flare-up of underlying nasal allergy (allergic rhinitis). Nasal congestion may sometimes occur together with fever, cough and a poor sense of smell (anosmia).

Many ENT patients in Singapore also suffer pain inside their nose when their nose becomes blocked. There may also be symptoms of runny nose or a constant backdrip (postnasal drip) of mucus. In turn, this may lead to throat irritation, cough or sore throat. A persistent itchy, dry cough is the classic telltale sign of having a postnasal drip! It's not coming from your throat or chest but from the back of your inflamed, blocked nose! So using inhalers, antibiotics and mucus-loosening medications from your family doctor may not help!

Sinus infections may also be a common cause of a persistent blocked nose, especially if there is yellow nasal discharge. Some patients report having a recurrent headache or facial pressure discomfort. This is definitely not a good time to fly if you suffer from these sinus symptoms!

Some patients actually have nasal polyps blocking their nasal passages. Nasal polyps are usually benign growths which look like grapes. They usually start to grow due to poorly-controlled allergic rhinitis and subsequent infection. Therefore it is so important to treat any allergic rhinitis and blocked nose before your nose goes on to develop nasal polyps!

Let me tell you about my 18-year-old patient who was constantly waking up in the middle of the night. He was unable to breathe through his nose, leading to a dry, uncomfortable throat and mouth. Sometimes, his nose felt more blocked on the left. At other times, his blocked nose was worse on the right side. He had already tried a steroid nasal spray, decongestant and antihistamine medication like Zyrtec and Clarityn but his blocked nose still troubled him a lot.

This patient also believed that he was falling ill more often and more easily. This was unsurprising because people who breathe through their mouth most of the time lose the protective filter function of their nose! I bet you didn't realise how important the nose is in filtering bacteria while trapping and killing germs! The nose also warms and humidifies the air you breathe in.

Examination of his nose with an endoscope camera showed a deviated nasal septum. What does having a deviated septum mean? It means that the bony division in the middle of his nose, called the nasal septum, was not straight. Instead, the nasal septum protruded out to one side of his nose to make it narrower. He also had enlarged swollen "sausages" on each side of his nose, called the inferior turbinates. In addition, he had excessive soft tissue growing at the back of his nose, called the adenoids, which consist of lymph gland tissue.

Adenoids and tonsils are commonly enlarged in young children as they form part of the immune system at that age. However, they are supposed to shrink naturally from the age of 5. So most adults have hardly any adenoid and tonsil tissue remaining. When your adenoids remain persistently enlarged, they start to cause problems like recurrent infection and blocked nose. Snoring and sleep apnea may also arise due to enlarged adenoids blocking the airway. Some children and adults then become mouth-breathers and develop the typical "adenoid face".

Well, we had a careful discussion with the patient and his family about the risks versus benefits of having surgery to improve his nasal airway. All we wanted to do was to help him breathe better! The patient underwent a septoplasty to straighten the deviated nasal septum. He also had his swollen inferior turbinates reduced. We also removed the enlarged adenoid tissue at the back of his nose by using coblation to "melt" the adenoids. The operation went very well. How do I know this? The patient can now breathe clearly through his nose and can sleep much better after surgery!