My Nose is Always Blocked! Why?

Have you wondered why your nose is always blocked? Why do you always find it so difficult to breathe through your nose? Breathing through your mouth will give rise to a dry mouth, especially in the morning. This means that little airflow is entering your nose at night when you sleep, due to a variety of reasons. Mouth-breathing is abnormal by the way……

A) Deviated nasal septum

There are many reasons why your nose could be blocked, making it difficult to breathe through your nose. For example, could the nasal blockage be due to a deviated nasal septum? Sometimes this is developmental but this could also be due to previous nasal injury or even a nasal bone fracture. Surgery is the only method to straighten the crooked deviated septum to help you breathe more clearly. As this is a structural problem, medications usually will not help any septal abnormalities.

In the photo below: This is the left nasal passage severely narrowed by a nasal septum deviated to the patient’s left, further crowded by an enlarged swollen inferior turbinate, the “sausage” of the nose.

B) Allergic rhinitis

Nose allergies or allergic rhinitis is a very common condition in Singapore. This also causes recurrent nasal congestion, runny nose, itchy throat, persistent backdrip and sneezing. Your family doctor will usually prescribe nasal steroids sprays such as Nasonex or Avamys. Antihistamines such as Zyrtec or clarityn are also commonly used to control allergic rhinitis. Using a simple sinus rinse or saline spray to keep your nose clean can be very helpful to prevent frequent attacks of allergic rhinitis.

Allergy testing is the most important investigation to identify what could be irritating your nose. The allergy test may be carried out as a skin prick test in clinic with results on the spot. Allergy testing may also be performed as a blood test to include other allergens such as food. The standard allergy panel includes three types of house dust mite, cat, dog, mould species and grass. Skin prick testing may not be suitable if you have taken antihistamines or steroids within the last seven days as the test may return as a false negative. In comparison, an allergy blood test may be performed accurately at any time, regardless of the medication you might have taken.

If indicated, sublingual immunotherapy (SLIT) may be helpful for you to consider, especially if you suffer from severe house dust mite allergies (see photo below).

Sometimes, if allergic rhinitis is poorly-controlled, you may fall ill with secondary sinus infections more often than usual. Then this means headaches, thick yellow or even green nasal discharge, feeling unwell with a fever. You will then probably need a course of antibiotics to treat your sinus infection. Prevention is always better so again, it’s a good idea to rinse your nose daily with a nasal saline douche.

C) Nasal Polyps

Nasal polyps can be rather troublesome consequences of poorly-controlled allergic rhinitis. Nasal polyps grow as a result of the chronically inflamed nasal lining which thickens to form a grape-like lump. They are usually benign but they cause breathing problems when they get too large and block your airway.

Nasal polyps then lead to secondary sinus infections because they also block off the normal sinus drainage pathways, leading to easy growth of bacteria in your sinuses. A course of oral and topical steroids can help to control nasal polyps but this may not be a longterm solution as they do tend to grow back. So sometimes, surgery is needed to clear the nasal polyps followed by immunotherapy injections such as Dupixent for longer term control

I guess at the end of the day, if your nasal congestion has been worsening despite all the medications we have mentioned above, then you need to get your nose carefully checked by your friendly ENT specialist in Singapore. Just in case it might turn out to be a nasal tumour….In Singapore, we worry most about underlying nasopharyngeal cancer (NPC) which is one of the top 10 most common cancers here.

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