Allergy, Nose & Sinus

Thick mucous in your nose or phlegm? It may be coming from your sinuses! (WARNING – SOME GRAPHIC MEDICAL IMAGES & VIDEO)

February 10, 2020
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Recently, Dr Gan saw a patient, Mr A who has been suffering from blocked nose, yellow-brown nose mucous and headaches for close to half a year. In addition, he also coughs out thick pieces of phlegm almost on a daily basis. He has seen many doctors and has been treated with multiple courses of antibiotics, nose washes and nose sprays which does relieve some of his symptoms. However, he was frustrated that he constantly spits out clumps of thick brown mucous and had persistent headaches despite these treatments. When he saw Dr Gan, a scope through his nose was performed in the clinic. His nose was congested but there were no signs of sinusitis such as pus, or swelling near the drainage pathway of the sinuses. However, in view of his clinical history, a CT scan (series of special X-rays) of his nose and sinuses was performed. It showed that he had infection of most of his sinuses, with the sinuses at the back of his nose known as the sphenoid sinuses completed filled with inspissated mucous (in a normal CT scan of the sinuses, the sinuses should be completely filled with air and appears black. In Mr A’s case, his sphenoid sinuses were completely grey – i.e. completely  filled with mucous!)



CT Image sphenoid sinus

A front on CT image of the sphenoid sinuses showing complete blockage



CT Image sphenoid sinus

A CT image showing the sphenoid sinus (from a side view) that is completely filled with mucous (appears grey on the scan)



Mr A underwent sinus surgery to clear his infections. During surgery, inspissated mucous was found stuck in his sphenoid sinuses. This resulted in polyps and severe swelling in the sinuses. The consistency of this mucous is typical of “Allergic or Eosinophilic Mucin”. This is a subtype of sinusitis (either Eosinophilic Mucinous Rhinosinusitis or Allergic Fungal Rhinosinusitis) that is difficult to treat and often, a combination of sinus surgery and medication is required to keep the condition under control.



Thick Mucous

Thick mucous was found in the sphenoid sinus during surgery





It has been just over 6 weeks since Mr A’s sinus surgery. He no longer suffers from the nasal symptoms that used to impair his quality of life. His days of constant headaches and spitting out clumps of phlegm are over (hopefully forever! – fingers crossed). Although majority of sinusitis can be treated with medications, it is important to understand that if the sinusitis is recurrent, have failed medical treatments or is of a certain subtype (e.g fungal, allergic fungal or eosinophilic mucin rhinosinusitis), surgical intervention may be required in addition to medical treatments. Mr A has been advised to keep his disease under control with daily nasal steroid washes.  Fluctuation in disease states and relapses can occur with this subtype of sinusitis. Hence, regular and long term surveillance is of paramount importance.

    When Should You See an ENT Specialist in Singapore?

    • Any ear, nose or throat symptoms that you are troubled with or concerned about
    • Persistent blocked nose with mouth breathing or snoring

    Dr Gan Eng Cern

    Dr Gan Eng Cern is a distinguished ENT doctor with fellowship training. In addition to his clinical practice as an ear, nose and throat specialist in Singapore, Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.


    • 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
    • 2016 – Best Educator Award (Eastern Health Alliance)
    • 2016 – “Wow” Award (Patient Compliment)
    • 2014 – Eastern Health Alliance Caring Award – Silver
    • 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
    • 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
    • 2007 – Singhealth Best Doctor Award


    • MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
    • MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
    • MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
    • FAMS – Fellow of the Academy of Medicine Singapore

    Why Choose Dr Gan Eng Cern


    Reliable & Reputable ENT Expert

    Experienced and patient ENT Specialist who has your best interests at heart. We aim to provide you with accessible and specialized care for any ENT condition in a comfortable setting.


    Friendly & Helpful Clinic Staff

    Our friendly staff will assist you to the best of our ability and we are happy to accept most insurance providers and assist with E-filing with relevant insurance providers or Medisave.


    Advanced ENT Equipment & Fully Equipped Facility

    Our ENT Specialist, Dr Gan Eng Cern, will be able to diagnose and offer personalised treatments for your specific ENT condition. You can expect a high level of ENT care in a spacious setting with in-house minor surgical, endoscopy, allergy testing and microscopy services.


    Financial Options

    There are various financial options available for you to ensure that you are able to receive the most optimal treatment and care. Our ENT clinic staff will be able to assist you with your medical insurance claims and work with your chosen healthcare organization to minimize the hassle and paperwork required. In some cases, you may be able to utilise the funds in your Medisave account to defray part of the costs of your treatment. As our clinic is accredited by the Medisave board, we are able to process your claims from your Medisave for certain clinic procedures.

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