The blocked nose and its impact on your health – What can be done?

In the previous article, we discuss the impact of a blocked nose and how many of us may not be aware we are blocked nor the health implications. So what can we do?

For any blocked nose, there are two components. Firstly a reversible component that is usually due to the congestion of the nasal lining. Secondly there is a non-reversible component due to a bent septum or excessive tissue that has built up over time and has become non-reversible.  These may exist in isolation by themselves, or co-exist and collaborating together to narrow the nasal airway to the detriment of your health.

Saline nose douching, topical steroid sprays and antihistamines as well as rest can reduce the reversible component of the blocked nose. When we are stressed and do not have enough sleep, our nasal vessels are more likely to be congested. In individuals with only allergy related blockage, this is very effective treatment, which is usually required seasonally, or long term for as long as the offending allergen/s is in your environment e.g. house dust, molds, pollens, etc. A good regimen of care will also reduce the severity of the other down line impacts of a congested nose e.g. sinusitis, mouth breathing and sore throats. In some case with headaches, the reduction in contact between the internal nasal tissues as well as reduced congestion and re-venting of the sinuses also reduces or abolishes these headaches.

However even after a trial of medical treatment, you may still find your nose blocked, and the treatment only partially effective. An endoscopic examination of the nose with possible imaging of the sinuses may declare that the obstruction is substantial due to pre-existing anatomical changes in the nose. The septum may be bent, the nasal lining now too swollen and thickened, nasal polyps may have formed which no longer can be reduced and/or the sinuses are chronically infected, and their openings now are too blocked for medical treatment to reverse the condition. Under these conditions, together with a clear history of symptoms and signs, surgery may be the solution. Surgery may include straightening the septum, reducing the turbinate size, removing the nasal polyps, re-venting the sinus openings and rinsing out the sinuses, or any of these combinations. Essentially the aim is to undertake whatever is necessary to improve the nasal airway and to permit natural re-venting of the sinuses.

So we can now breathe better after surgery and our overall health and sleep has improved. But does it end with surgery? Our environment usually remains the same; there is house dust, molds and pollens around us still. Some of us are still going to require saline irrigation of the nose and nasal sprays for the allergic flare-ups. Well funnily enough, opening the nasal airway by surgery does not only just improve airflow, it also improves the access for delivery of saline during nasal douching, and drug delivery via nasal sprays. That is the bad news. The good news is that most of us do not require long-term medical treatment… and all of us will live and sleep better now that the nose breathes better.

The Chinese version of this article was published in Hong Kong Economic Journal on 20 July 2015

The blocked nose and its impact on your health

Who hasn’t had a blocked nose? Especially when we have a cold and, thank goodness that the blocked nose, runny nose, sneezing as well as fever last only a few days. So can you imagine having a blocked nose all the year round? Most of us cannot imagine this! Yet most of us who live in polluted cities like Hong Kong probably are walking around with a blocked nose; a chronically blocked nose that creeps up on us so slowly that we never even guessed it.

Aside from smelling fragrances, the aroma of food, the appreciation of flavor as well as making our face look more beautiful, our nose has another far more important job. It protects our lungs by warming, filtering and cleansing the air before it reaches our delicate lungs. If the air is dirty, it causes our turbinates to swell inside so as to narrow or even block our nasal passages so that the air cannot enter. Our nose secretes mucus to wash away the dust and pollen, and if that is not enough, it gets all itchy and makes us sneeze so we can blow out the dust-filled mucus. So what happens to us when our nose gets chronically blocked? Actually quite a lot can happen. It affects our nose, our sinuses and eyes, our ears, our throat and finally our beauty sleep.

When the nose is blocked, we experience a nasally voice and have a postnasal drip. As the sensitive turbinates inside the nose swell up, they may make contact with one another or with the septum, and this sometimes causes “Sluder’s headaches” with pain of one/both temples, at the top and/or the back of the head. This may sometimes be mistaken for the more uncommon migraine.

When the lining of the nose is swollen, it also blocks the openings of structures that open into the nose. Blockage of any of the sinuses that drain into the nose can cause sinus pressure headaches above, below, between or behind the eyes as well as at the top of the head. A bacterial sinusitis can also occur if the sinuses cannot drain themselves. Our tear ducts also drain into the nose so a blocked nose may cause our eyes to “flood” more with tearing, impairing our clear vision. This can be troublesome indeed.

At the back of the nose lies the opening to the Eustachian tubes that re-pressurise our middle ear compartment. If the nose, and therefore the tube is blocked, a lower middle ear pressure can result. This is the same feeling we experience when a plane lands. Sometimes though it can be very painful especially for children. Longstanding obstruction of this tube often leads to repeated middle ear infections and/or perforated eardrums, and hearing problems especially in children.

So our nose is block. That is not a problem as we can breathe though our mouth, right? Correct…we can breathe through our mouth but why then do we need a nose? Actually most of us would automatically start to breathe though our mouth without realizing it when our nose is blocked. This leads to so many things like dry lips, bad breath, repeated mouth ulcers, sore throats that lead to large tonsils and repeated tonsil infections. Breathing and speaking through our mouth becomes a problem too. As the mouth gets drier, we cannot sense that we are breathing in less air than we should so. So when we speak, we cannot project our voice well. So we compensate by powering up our voice box to do all the work and that is why we end up with a hoarse voice.

Finally the blocked nose and the compensatory mouth breathing affects even our sleep. Although the mouth is a larger opening for air, inside our throat sits our mobile tongue and also tonsils. These sometimes are sucked in and obstruct during sleep, as the nose cannot act as its usual passage for air intake. Snoring, poor quality sleep and maybe even obstructive sleep apnea then occurs. Over time, the poor quality sleep we get every night makes us irritable, easily frustrated, gives us oily skin with acne, eye bags and a generally darker facial complexion.

All the above can occur because of a chronically blocked nose. The interesting thing is that many of us remain unaware that is happening as the process is such a gradual one. However, as quietly as it can be blocked, thankfully it can also be reversed with medication and/or surgery. So yes… we can still get the beauty sleep in our beautiful city…and all because of a nose!in our beautiful city…and all because of a nose! 

The Chinese version of this article was published in Hong Kong Economic Journal on 1 June 2015

Sinus and nose-related headaches – Treatment

In the last article, we discussed the causes of sinus and nose related headaches. These include causes such as:

·        nose allergy,

·        a bent nasal septum blocking the sinus opening or in contact with the    

         opposite nasal lining,
·        a narrowed sinus opening/s with a sinus infection and
·        an obstructed sinus with a negative sinus pressure

Sometimes possibly all of the above can be present in the same person at the same time. All of these conditions can stimulate and irritate the trigeminal nerve, which then generates the headache that we feel.

Treatment begins with the correct diagnosis. A full external and internal endoscopic examination of the nose should be undertaken. In instances when a sinus-related cause is suspected e.g. facial pains above, behind and below the eyes, and at the top of the head, a CT scan of the sinuses can exclude sinus disease. X-ray of the sinuses are traditionally undertaken but for a more comprehensive picture, CT scans provide a great deal more information as well as serve as the roadmap for sinus surgery should that be required.

Usually common things happen commonly, and by far the commonest nasal cause of a headache is inflammation of allergy or infection. If infection is seen, a simple course of antibiotics can be undertaken. Nasal allergy is easily treated also by avoiding the allergen e.g. house dust or pollen, saline nasal irrigation, topical nasal steroids and/or antihistamines. The reduction in the inflammation desensitizes the nasal lining as well as reduces the possibility of nasal lining contact and sinus obstruction.

Perhaps the next most likely cause for nasal irritation is when two opposing nasal linings touch one another forming a trigger point. This is likely to occur when the nasal septum is bent inside the nose. Often the patient would be aware of the bent septum as they are aware of a blocked nose, more on one side than the other although both may be equally blocked.

Sometimes a frank sinus infection is seen on endoscopy. Then antibiotic treatment with nasal decongestants also, would normally suffice, as sinus surgery is not the usual first line treatment modality. However in situations when the sinus condition becomes chronic without relenting or recurrent, then usually a more permanent solution to re-open the sinus drainage and re-vent the sinuses may be indicated. Nowadays, sinus surgery is extremely high tech, using endoscopes for minimally invasive surgery. Surgery is targeted at re-opening the natural openings of the sinuses. To make the surgery even less traumatic, when appropriate, the sinus openings can be re-dilated with inflatable balloons; this technique is known as balloon sinuplasty.

So to summarize, nose and sinus-related headaches are not altogether that uncommon especially today in our polluted modern world. It should be differentiated from all the other causes of headaches by its picture. Treatment of these headaches are usually very successful once the correct diagnosis has been established, as there is often a triggering point that fires off the nerve-endings of the trigeminal nerve that gives us these so-called Sluder’s headaches. You can almost imagine Dr. Sluder himself having a bad headache when he first described it too! 

The Chinese version of this article was published in Hong Kong Economic Journal on 5 Jan 2015