Blocked nose (nasal obstruction) – Part Two

Q: Why does my head feel heavy, and sometimes I experience pain between, above and/or behind the eyes, when I am blocked and sneezing?

A: The sinus openings and linings inside the nose, are the same as the nose itself. Hence a rhinitis (inflammation of the nasal lining) is indistinguishable from sinusitis. In fact ENT physicians usually called it by its proper condition i.e. rhinosinusitis.

When the sinus openings are blocked by the inflammation, and they themselves are inflamed, the sinus pressure drops. This negative sinus pressure results in pain and heaviness around and behind the eyes, because the sinuses are all surrounding our eyes. Sinus pressure pain is characteristically worst especially if we put our heads between our knees or bend down to pick something up

Q: I feel tired in the morning and unrefreshed, even though I have had a good 8 hours of sleep? 

A: Quantity sleep is not the same as quality sleep. If your nose is blocked due to enlarged turbinates, the turbinates are going to even more engorged when lying flat. When one’s nose is blocked, we then have to breathe through our mouth.  Although the mouth is a much larger airway than the nose technically, it can obstruct if the tongue is drawn back during deep sleep, or the tonsils are enlarged. Hence our oxygenation drops intermittently and disrupts our sleep pattern, depriving us of quality sleep.

Q: And my mouth always feels dry in the morning?

A: With a blocked nose, we have to open our mouth to breathe. It will inevitably be dry in the morning.

Mouth-breathing, especially if persistent, predisposes to recurrent sore throat, recurrent mouth ulcers, bad breath and increased dental caries and gum disease.

Q: My spouse / partner tells me I snore heavily. I notice this especially when my nose is blocked. Why?

A: Air passing from the nose to the lung, needs to navigate a gauntlet of structures. In the nose, the structures are relatively fixed, and it is either open or blocked. Nothing vibrates.

But below the nose, the air flows and  passes through

•    behind the soft palate and uvula,
•    between the tonsils,
•    behind the tongue and then
•    behind the epiglottis.

All these structures are relatively mobile. They can, and do vibrate according to the airway pressure changes when we breathe in, and especially when the nose is blocked during sleep. When each of these structures vibrate, they emit their own resonant sound like “ a flag furling in the wind “. These different vibrating structures create their own “symphony” of the snore, and the music of the night!

Q: I just feel tired all the time and forgetful, with the blocked nose!

A: This is again related to the poor quality of the sleep.

You should speak to your ENT Physician to assess the underlying blocked nose, and to further assess if there is significant obstructive sleep apnea that requires further management.

The information aims to provide educational purpose only. Anyone who is reading it should consult ENT Specialists before considering treatment and should not rely on the information above.