Nasal obstruction
Less air filtered through nose + dry air → less mucous → increased respiratory infections, wheeze, tooth decay
Change of tongue position during sleep → high arched palate, crowded teeth lower jaw, chin retraction
OSA:
- Leads to behavioural changes, learning difficulties, hyperactivity

Symptoms

Note: Mouth breathing can aggravate malocclusion in growing children

Examination

Investigations

Management

Treat underlying cause: Intranasal corticosteroids for allergies, surgical correction for deviated septum or large adenoids
Encourage nasal breathing during the day
Regular dental check-ups and hydration to counteract dry mouth
Note: Consider early orthodontic referral for malocclusion due to chronic mouth breathing

Complications

Poor oral health, sleep disturbances, altered facial growth (e.g., "long face syndrome")
OSA may further exacerbate cardiovascular or metabolic risks if untreated

Notes:

Early intervention prevents malocclusion, ENT complications, OSA
Multidisciplinary approach (ENT, allergist, paediatrician, dentist/orthodontist)
Follow-up essential post-surgical intervention (e.g., adenoidectomy, septoplasty)

Mouth Breathing

Causes

Pathology

Reduced air filtration and humidification when bypassing nasal passages, increasing risk of infections, wheezing, and dental caries
Altered tongue position during sleep contributing to high-arched palate, dental crowding, or mandibular retraction
Potential progression to obstructive sleep apnoea (OSA) with behavioural changes, learning difficulties, and daytime hyperactivity

Presentation

Daytime mouth breathing, sneezing, itchy eyes, nasal discharge
Night-time snoring, apnoeic episodes, choking, gasping, poor sleep quality, daytime fatigue or hyperactivity
Recurrent upper respiratory tract infections
Orthodontic or dental issues (crowded teeth, malocclusion)
Behavioural changes or learning difficulties in children

Differential Diagnosis

Allergic rhinosinusitis, typically the most frequent cause
Inferior turbinate hypertrophy secondary to chronic inflammation
Deviated nasal septum
Adenoid or tonsillar hypertrophy
Nasal polyps (especially in chronic cases or certain conditions like cystic fibrosis)

Management

Identify and treat the underlying cause
- Allergic rhinosinusitis managed with intranasal corticosteroids, antihistamines, or allergen avoidance
- Nasal obstruction from deviated septum or enlarged turbinates may require ENT referral for surgical correction
- Enlarged tonsils or adenoids can be removed if significantly obstructive or recurrently infected
Supportive Measures
- Encourage nasal breathing through saline nasal irrigation, proper nasal hygiene, and treatment of nasal inflammation
- Orthodontic evaluation if dental misalignment or high-arched palate
- Speech therapy if speech delay or articulation issues are present
- Sleep hygiene measures and screening for OSA
Lifestyle and Environmental Factors
- Reduce exposure to allergens or irritants that exacerbate nasal congestion
- Maintain good hydration to counteract oral dryness
- Encourage avoidance of passive smoke or pollutants

Complications

Increased susceptibility to respiratory infections, cavities, and gum disease
Potential progression to obstructive sleep apnoea with neurocognitive and cardiovascular consequences
Long-term impact on facial growth and jaw development in growing children
Possible hearing issues if eustachian tube dysfunction arises from chronic nasal obstruction

Notes:

Prompt identification of mouth breathing and its underlying causes can prevent dental malocclusion, ENT complications, and OSA
Multidisciplinary approach may be needed, including ENT, allergist, paediatrician, and dentist or orthodontist
Early intervention in children is critical to avoid long-term developmental and behavioural sequelae
Follow-up ensures treatment efficacy, especially if surgical intervention is undertaken (e.g., adenoidectomy, septoplasty)

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