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Nose



How the Nose Works

Your nose processes the air that you breathe before it enters your lungs. Most of this activity takes place in and on the turbinates, located on the sides of the nasal passages. In an adult, 18,000 to 20,000 liters of air pass through the nose each day.

Your nose protects your health by:

  • Filtering all that air and retaining particles as small as a pollen grain with 100% efficiency.
  • Humidifiing the air that you breathe, adding moisture to the air to prevent dryness of the lining of the lungs and bronchial tubes.
  • Warming cold air to body temperature before it arrives in your lungs.

Because the connection between the nose and lungs is so important, paying attention to problems in the nose can reduce or avoid problems in the lungs such as bronchitis and asthma. Ignoring nasal symptoms such as congestion, sneezing, runny nose, or thick nasal discharge can aggravate lung problems and lead to other problems:

  • Nasal congestion reduces the sense of smell.
  • Mouth breathing causes dry mouth, which increases the risk of mouth and throat infections and reduces the sense of taste. Mouth breathing also pulls all pollution and germs directly into the lungs; dry cold air in the lungs makes the secretions thick, slows the cleaning cilia, and slows down the passage of oxygen into the blood stream.
  • Ignoring nasal allergies increases the chance that you will develop asthma; it also makes asthma worse if you already have it.

It is important to treat nasal symptoms promptly to prevent worsening of lung problems.

For these and many other reasons, normal nasal function is essential. Do your lungs a favor; take care of your nose. Here are some tips to improve the health of your nose and lungs:

  • If your nose is dry, its various functions will be impaired. Try over-the-counter salt-water (saline) nasal mists and sprays to help maintain nasal health. These can be used liberally and at your discretion.
  • Beware of over-the-counter nasal decongestant sprays; prolonged use of these sprays may damage the cilia that clear the nose and sinuses. Decongestants can become addictive and actually cause nasal congestion to get worse.
  • Think of your nose when you’re traveling. Air-conditioned cruise ships may have high levels of mold in the cabins. Airplane air is very dry and contains a lot of recirculated particles and germs; a dry nose is more susceptible to germs. Use saline nasal mist frequently during the flight, and drink lots of water.

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Nosebleeds

Nosebleeds (epistaxis) are classified into two different types:

Anterior nosebleed: Most nosebleeds begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. This type of nosebleed comes from the front of the nose and begins with a flow of blood out one nostril when the patient is sitting or standing. These nosebleeds are common in dry climates or during the winter months when heated, dry indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented if you place a bit of lubricating cream or ointment about the size of a pea on the end of your fingertip and then rub it inside the nose, especially on the middle portion of the nose (the septum).

Posterior nosebleed: More rarely, a nosebleed can begin high and deep within the nose and flow down the back of the mouth and throat even if the patient is sitting or standing. Posterior (back of nasal cavity) nosebleeds are often more severe and almost always require a physician’s care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face.

Nosebleeds can be caused by:

  • Allergies, infections, or dryness that cause itching and lead to picking of the nose.
  • Vigorous nose blowing that ruptures superficial blood vessels in the elderly and in the young.
  • Clotting disorders that run in families or are due to medications.
  • Fractures of the nose or of the base of the skull that can cause bleeding and should be regarded seriously when the bleeding follows a head injury.
  • Rarely, tumors (both malignant and nonmalignant) have to be considered, particularly in the older patient or in smokers.

If the nosebleeds persist, you should see your doctor. Using an endoscope, a tube with a light for seeing inside the nose, your physician may find a problem within the nose that can be fixed. He or she may recommend cauterization (sealing) of the blood vessel that is causing the trouble.

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Post-Nasal Drip

The glands in your nose and throat continually produce mucus (one to two quarts a day). It moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although mucus normally is swallowed unconsciously, the feeling that it is accumulating in the throat or dripping from the back of your nose is called post-nasal drip. This feeling can be caused by excessive or thick secretions or by throat muscle and swallowing disorders.

Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling of a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.

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Nasal Congestion

Nasal congestion, stuffiness, or obstruction to nasal breathing is one of the oldest and most common complaints. The causes of nasal congestion and obstruction have been classified into four categories. It is not unusual for a patient to have an overlap exist among the four categories.

The four categories are:

  • Infection—Caused by cold viruses (the common cold)
  • Structural—Caused by deformities of the nose (usually due to injuries)
  • Allergy—Inflamed reaction due to pollen, dust, grass, etc.
  • Vasomotor Rhinitis—Over expansion or severe constriction of the blood vessels in the nose.

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Nasal Endoscopy

The nasal endoscope is an optical instrument consisting of a tube, a light and a lens for an eyepiece or connection to video and monitor, used to look into the nasal cavities.

  • Nasal problems are very common but without an endoscope the normal nasal examination is quite limited.
  • The nasal endoscope allows the doctor to look at the most of the nasal cavities and the sinuses, even around corners using a special angled scope like a periscope.
  • Developing techniques using the nasal endoscope allow minor operations, previously only available in an operating theatre, to be performed in out-patient clinics.
  • The nasal endoscope is being increasingly used for major surgical ENT procedures as it offers more less disruptive access to the naso-pharynx than traditional methods.

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