Mouth Breathing in Singapore

Chronic mouth breathing typically results from structural or functional issues that block normal nasal airflow:

• Nasal obstruction from a deviated septum, where the wall between the nostrils is displaced
• Enlarged adenoids and tonsils blocking the upper airway, particularly common in children
• Chronic nasal congestion due to allergic rhinitis
• Nasal polyps creating physical blockages within the nasal passages
• Chronic sinusitis causing persistent inflammation and mucus production
• Facial structure abnormalities including narrow palate or retrognathia
• Habitual patterns developed during childhood that persist into adulthood

Several factors may increase the likelihood of developing chronic mouth breathing:

• Family history of allergies, asthma, or structural nasal issues
• Environmental allergens in tropical climates
• Exposure to air pollution and indoor air quality issues
• Premature birth or low birth weight affecting airway development
• Chronic upper respiratory infections during early childhood
• Prolonged pacifier use or thumb sucking
• Obesity contributing to airway obstruction during sleep
• Untreated sleep disorders including sleep apnoea

Medical management forms the foundation of mouth breathing treatment. Intranasal corticosteroid sprays may help reduce inflammation in the nasal passages, particularly for allergic rhinitis. These medications require consistent daily use before benefit may be achieved. Antihistamines, available in oral or nasal spray form, can help control allergy symptoms that contribute to nasal obstruction. Saline nasal irrigation may help clear mucus and allergens, providing relief without medication side effects.

Comprehensive allergy treatment may improve nasal breathing in sensitised individuals. Allergen avoidance strategies include using HEPA air purifiers, maintaining low indoor humidity, and regularly washing bedding in hot water. Immunotherapy (allergy shots or sublingual tablets) aims to provide long-term desensitisation for persistent allergies unresponsive to standard medications. Treatment typically continues for several years but may offer relief from allergic symptoms.

Orofacial myofunctional therapy aims to retrain oral and facial muscles to promote proper breathing patterns. This therapy involves exercises that may help strengthen tongue position, improve lip seal, and establish correct swallowing patterns. Sessions typically occur weekly, with daily home exercises essential for success. Children often respond well to myofunctional therapy, potentially avoiding more invasive interventions.

Structured breathing retraining programmes aim to teach patients to consciously shift from mouth to nasal breathing. Techniques include diaphragmatic breathing exercises, controlled breath holds to increase carbon dioxide tolerance, and progressive nasal breathing during physical activities. These exercises require consistent practice but may help break habitual mouth breathing patterns.

Palatal expansion devices may help widen narrow upper jaws, creating more space for nasal breathing and proper tongue positioning. These appliances work optimally in growing children, but modified versions may benefit adults. Treatment duration varies depending on the degree of expansion needed. Orthodontic treatment addressing malocclusion or crowding may be recommended concurrently to optimise facial development and breathing function.

When structural abnormalities cause persistent nasal obstruction, surgical correction may be necessary.

• Septoplasty aims to straighten a deviated nasal septum and is typically performed as day surgery.
• Turbinate reduction aims to decrease enlarged nasal turbinates using various techniques, including radiofrequency ablation or partial resection.
• Adenoidectomy and tonsillectomy remove enlarged lymphoid tissue obstructing airways, particularly beneficial for children with sleep-disordered breathing.
• Functional endoscopic sinus surgery (FESS) addresses chronic sinusitis or polyps through minimally invasive techniques. This procedure may help improve nasal breathing.
• Expansion pharyngoplasty or other sleep surgery procedures may be indicated for patients with concurrent obstructive sleep apnoea.

Continuous positive airway pressure (CPAP) therapy aims to maintain airway patency during sleep in patients with sleep apnoea, thereby reducing mouth breathing. Modern CPAP devices feature heated humidification that may help reduce mouth dryness. Oral appliances repositioning the jaw forward may benefit selected patients, particularly those with sleep apnoea who prefer alternatives to CPAP.