Nose
Your Nose: The Guardian Of Your Lungs 
Deviated Septum Nosebleeds Post Nasal Drip Stuffy Nose
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Your Nose: The Guardian Of Your Lungs
You might not think your nose is a “vital organ,” but indeed it is! To understand its importance, all that most people need to experience is a bad cold. Nasal congestion and a runny nose have a noticeable effect on quality of life, energy level, ability to breathe, ability to sleep, and ability to function in general. Connected to your nose are your sinus cavities, which are intricately involved with and affected by nasal function and can often be confused or lumped together with the nose in terms of symptoms, complaints and treatments. In many ways, the nose and sinuses should be considered separately.
Why Is Your Nose So Important?
It 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.
* Humidifying 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.
* Providing increased surface area and air contact for maintaining and developing normal immune function.
For these and many other reasons, normal nasal function is essential. Do your lungs a favor; take care of your nose.
Because the connection between the nose and lungs is so important, paying attention to problems in the nose--allergic rhinitis for instance – 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 can badly impact dental health.
* Ignoring nasal allergies increases the chance that you will develop asthma; it also makes asthma worse if you already have it.
So, it is important to treat nasal symptoms promptly to prevent worsening of lung problems.
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, but larger volumes of salt water used less frequently will be less likely to leave you with nasal dryness that can result from dissolving your own normal nasal secretions.
* 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.
Medications Prescribed To Treat Nasal Problems:
Be aware of the nasal effects of other medications
* Diuretic blood pressure medications cause dryness in the nose and throat, making them more susceptible to germs and pollens.
* Many anti-anxiety medications also have a drying effect on the nose and throat.
* Birth control pills, blood pressure medicines called beta-blockers, and Viagra can cause increased nasal congestion.
* Eye drops can aggravate nasal symptoms when they drain into the nose with tears.
Be sure you understand their purpose. Each one is important and plays a separate role in treating nasal symptoms.
The foundation of the treatment of chronic nasal conditions is the regular use of an anti-inflammatory prescription nasal spray, which address all types of nose and sinus inflammation. Antihistamine sprays are also available to reduce sneezing, itching, and extra drainage from an otherwise non-congested nose. These sprays should be used only as directed by your doctor. Always aim nasal sprays to the side of the nose; spraying into the center of the nose can cause too much dryness, which may result in nosebleeds and frustration with their use.
Antihistamines effectively relieve sneezing, itching and runny nose, but they have no effect on nasal congestion at least in the short term. Over-the-counter antihistamines cause drowsiness, slow the cleaning function of the cilia, and increase the stickiness of nasal mucus--causing germs and pollens to stay in the nose longer. There are prescription antihistamines that do not have any of these side effects.
Decongestants help to unclog stopped up noses but do very little for runny noses and sneezing. They work much faster to unclog the nose, but to achieve this quick action, there are often side-effects such as dry mouth, nervousness, and insomnia. The correct dose often has to be customized to get the benefit without the side-effects.
Be aware of medication side effects; no medicine works well for all people, and all medications can cause side effects.
Deviated Septum
The shape of your nasal cavity could be the cause of chronic nasal complaints and even sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.
A "deviated septum" occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.
Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma, infections, and can be the result of previous unrelated nasal or facial surgery.
A deviated septum may cause one or more of the following:
* Blockage of one or both nostrils
* Nasal congestion, sometimes one-sided
* Frequent nosebleeds
* Frequent sinus infections
* At times, facial pain, headaches, postnasal drip
* Noisy breathing during sleep
Nasal obstruction, the septum and sinusitis
Patients with chronic sinusitis often have nasal congestion, and many have nasal septal deviations. However, for those with this debilitating condition, there may be additional reasons for the nasal airway obstruction. The problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof. A trained specialist in diagnosing and treating ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal obstruction.
Your First Visit: After discussing your symptoms, the primary care physician or specialist will inquire if you have ever incurred severe trauma to your nose and if you have had previous nasal surgery. Next, an examination of the general appearance of your nose will occur, including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril. A thorough examination of your septum and nasal cavity may also involve the use of endoscopic viewing of the back of your nose and the throat behind it.
Surgery may be the recommended treatment if the deviated septum is causing significant obstruction, debilitating and demonstrably related headaches, troublesome nosebleeds or recurrent sinus infections. Additional testing may be required in some circumstances.
Septoplasty: Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.
Nosebleeds
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.
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.
Additional Causes Of Nosebleeds:
* 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.
Types Of Nosebleeds
Obviously, when the patient is lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow posteriorly, especially if the patient is coughing or blowing his nose.
It is important to try to make the distinction since 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.
Anterior 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). Water-based ointment is preferred over petroleum products when this is performed, as skin and mucus-membrane irritation with some of the petroleum compounds can occur. Contact your physician for recommendations for appropriate nasal ointments.
Treatment For Nosebleeds
The management for a sudden nosebleed is often misunderstood or misinterpreted by patients. A nosebleed is usually a scary experience and panic may overwhelm reason when bleeding occurs. It is important to remain as calm as possible, sitting in an upright chair rather than lying down. Bending forward is undesirable, as this increases blood-flow to the nose and face. Leaning backward in the chair, with the sides of the nose pinched firmly between thumb and forefinger is the best way of controlling a nosebleed. Once the pinching has begun, do not let go of the nose for 15 minutes strictly measured by the clock. Rinsing the nose after this with cool water will help to constrict bleeding vessels and to clear up the nose to determine if bleeding is continuing. If it continues, your physician or care in the nearest emergency room should be sought.
When nosebleeds are less trouble, but continue to be a minor nuisance problems, hygiene and a humidification maintenance program ay be necessary. Many physicians suggest any of the following lubricating creams or ointments, such as saline gel. Up to three applications a day may be needed, but usually every night at bedtime is enough. A saline nasal spray will also moisten dry nasal membranes.
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.
What About Rebleeding?
To prevent rebleeding after initial bleeding has stopped:
* Do not pick or blow nose.
* Do not strain or bend down to lift anything heavy.
* Keep head higher than the heart.
* Use a humidifier during dry winter months.
* Use a water-based ointment in your nose
If rebleeding occurs:
* Attempt to clear nose of all blood clots.
* Spray nose four times in the bleeding nostril(s) with a decongestant spray such as Afrin or Neo-Synephrine.
* Perform steps 1 and 2 shown in the “To stop an anterior nosebleed” box in this leaflet. Repeat these steps as necessary.
* Call your doctor if bleeding persists.
Post-Nasal Drip
The glands in your nose and throat continually produce mucus (one to two quarts a day). The mucus moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. The mucus can be rich in immune proteins and debris that has been brought out of your sinus cavities. 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.
What Causes Abnormal Secretions – Thin and Thick
Increased thin clear secretions can be due to colds and flu, allergies, cold temperatures, bright lights, certain foods/spices, pregnancy, and other hormonal changes. Various drugs (including birth control pills and high blood pressure medications) and structural abnormalities can also produce increased secretions. These abnormalities might include a deviated or irregular nasal septum (the cartilage and bony dividing wall that separates the two nostrils). The most concerning abnormal thin secretion emanating from the nose is called cerebrospinal fluid rhinorrhea. This occurs when the cushioning fluid surrounding the brain leaks through a defect in the bone of the roof of the nose or a nearby structure drips into the nose after a fracture, nasal or facial surgery, or, rarely, without identifiable cause. CSF rhinorrhea is usually a constant clear nasal dripping and can often be salty and bitter to the taste. It may be accompanied by positional headaches or subtle fluctuations in mental state.
Increased thick secretions in the winter often result from too little moisture in heated buildings and homes. They can also result from sinus or nose infections and some allergies, especially to certain foods such as dairy products. If thin secretions become thick and green or yellow, it is possible that a bacterial sinus infection is developing. It is important to realize that not all colored nasal secretions correlate with a nasal infection, however. In children, thick secretions from one side of the nose can mean that something is stuck in the nose (such as a bean, wadded paper, or piece of toy, etc.).
Vasomotor Rhinitis describes a nonallergic "hyperirritable nose" that feels congested, blocked, or wet. It may be aggravated by cold weather exposure or exercise. A similar and related condition, gustatory rhinitis, occurs when a patient is eating and is particularly aggravated by spicy or hot foods.
Treatment For Post-Nasal Drip
A correct diagnosis requires a detailed ear, nose, and throat exam and possible laboratory, endoscopic, and x-ray studies. Each treatment is different:
Bacterial infection, when present, is treated with antibiotics. These drugs may provide only temporary relief. In cases of chronic sinusitis, surgery to open the blocked sinuses may be required. This is discussed in detail elsewhere on our webpage. Sometimes, other types of nasal surgery will be recommended for persisting and stubborn nasal drainage, including turbinate or septum surgery.
Allergy is managed by avoiding the cause if possible. Antihistamines and decongestants, steroid nasal sprays, and other forms of steroids may offer relief. Immunotherapy (allergy shots) also may be helpful. However, some older, sedating antihistamines may dry and thicken post-nasal secretions even more; newer nonsedating antihistamines, available by prescription only, do not have this effect. Decongestants can aggravate high blood pressure, heart, and thyroid disease. Steroid sprays generally may be used safely under medical supervision.
General measures for thinning secretions so they can pass more easily may be recommended when it is not possible to determine whether an existing structural abnormality is causing the post-nasal drip or if some other condition is to blame.
Many people, especially older persons, need more fluids to thin secretions. Drinking more water, eliminating caffeine, and avoiding diuretics (fluid pills) will help. Mucous-thinning agents such as guaifenesin (MucinexÆ) may also thin secretions.
Nasal irrigations may alleviate thickened secretions. These can be performed two to four times a day with as simple a device as possible to prevent contamination of the irrigation system itself. Several devices for doing this can be found at your local pharmacy or supermarket. A clear plastic syringe will also work very well. . Warm water with baking soda and non-iodized salt (1/2 to 1 tsp. to the pint for each). Finally, use of simple saline (salt) nonprescription nasal sprays (e.g., OceanÆ, NeilMed Sinus RinseÆ) to moisten the nose is often very beneficial.
Stuffy Nose
Nasal congestion, stuffiness, or obstruction to nasal breathing is one of man's oldest and most common complaints. While it may be a mere nuisance to some persons, to others it is a source of considerable discomfort, and it detracts from the quality of their lives.
Medical writers have classified the causes of nasal obstruction into four categories, recognizing that overlap exists between these categories and that it is not unusual for a patient to have more than one factor involved in his particular case.
Vasomotor Rhinitis
"Rhinitis" means inflammation of the nose and nasal membranes. "Vasomotor" means blood vessel forces. The membranes of the nose have an abundant supply of arteries, veins, and capillaries, which have a great capacity for both expansion and constriction. Normally these blood vessels are in a half-constricted, half-open state. When a person exercises vigorously, his/her hormones of stimulation (i.e., adrenaline) increase. The adrenaline causes constriction or squeezing of the nasal membranes so that the air passages open up and the person breathes more freely.
The opposite takes place when an allergic attack or a ''cold'' develops: The blood vessels expand, the membranes become congested (full of excess blood), and the nose becomes stuffy, or blocked.
In addition to allergies and infections, other events can also cause nasal blood vessels to expand, leading to vasomotor rhinitis. These include psychological stress, inadequate thyroid function, pregnancy, certain anti-high blood pressure drugs, and overuse or prolonged use of decongesting nasal sprays and irritants such as perfumes and tobacco smoke.
In the early stages of each of these disorders, the nasal stuffiness is temporary and reversible. That is, it will improve if the primary cause is corrected. However, if the condition persists for a long enough period, the blood vessels lose their capacity to constrict. They become somewhat like varicose veins. They fill up when the patient lies down and when he/she lies on one side, the lower side becomes congested. The congestion often interferes with sleep. So it is helpful for stuffy patients to sleep with the head of the bed elevated two to four inches by placing a brick or two under each castor of the bedposts at the head of the bed. Surgery may offer dramatic and long time relief.
Sinuses are air-filled cavities in the skull. They drain into the nose through small openings. Blockages in the openings from swelling due to colds, flu, or allergies may lead to acute sinus infection. A viral "cold" that persists for 10 days or more may have become a bacterial sinus infection. With this infection you may notice increased post-nasal drip. If you suspect that you have a sinus infection, you should see your physician for antibiotic treatment.
Chronic Sinusitis occurs when sinus blockages persist and the lining of the sinuses swell further. Polyps (growths in the nose) may develop with chronic sinusitis. Patients with polyps tend to have irritating, persistent post-nasal drip. Evaluation by an otolaryngologist may include an exam of the interior of the nose with a fiberoptic scope and CAT scan. If medication does not relieve the problem, surgery may be recommended.
This is described in detail elsewhere on our webpage>
Allergic and other conditions affecting the nose
Allergic nasal symptoms include sneezing and runny and/or itchy nose, caused by irritation and congestion in the nose. There are similar symptoms that arise in the absence of demonstrated allergies; this is called chronic rhinitis rather than allergic rhinitis.
Allergic Rhinitis: This condition occurs when the body’s immune system over-responds to specific, non-infectious particles such as plant pollens, molds, dust mites, animal hair, industrial chemicals (including tobacco smoke), foods, medicines, and insect venom. During an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast cells (cells that release histamine) in the lungs, skin, and mucous membranes. Once IgE connects with the mast cells, a number of chemicals are released. One of the chemicals, histamine, opens the blood vessels and causes skin redness and swollen membranes. When this occurs in the nose, sneezing and congestion are the result.
Seasonal allergic rhinitis or hayfever occurs in late summer or spring. Hypersensitivity to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75 percent of all Americans who suffer from this seasonal disorder. People with sensitivity to tree pollen have symptoms in late March or early April; an allergic reaction to mold spores occurs in October and November as a consequence of falling leaves.
Perennial allergic rhinitis occurs year-round and can result from sensitivity to pet hair, mold on wallpaper, houseplants, carpeting, and upholstery. Some studies suggest that air pollution such as automobile engine emissions can aggravate allergic rhinitis. Although bacteria is not the cause of allergic rhinitis, one medical study found a significant number of the bacteria Staphylococcus aureus in the nasal passages of patients with year-round allergic rhinitis, concluding that the allergic condition may lead to higher bacterial levels, thereby creating a condition that worsens the allergies.
Patients who suffer from recurring bouts of allergic rhinitis should observe their symptoms on a continuous basis. If facial pain or a greenish-yellow nasal discharge occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment.
Non-Allergic Rhinitis: This form of rhinitis does not depend on the presence of IgE and is not due to an allergic reaction. The symptoms can be triggered by cigarette smoke and other pollutants as well as strong odors, alcoholic beverages, and cold. Other causes may include blockages in the nose, a deviated septum, infections, and over-use of medications such as decongestants.
Please review our section on sinus diease, as nasal and sinus conditions are so inter-related that most patients are confused about how to distinguish between strictly nasal and sinus/nose conditions.
Surgery for nasal obstruction
Distorted anatomy in the nose is identified after appropriate medical measures have been exhausted. This may include oral antibiotics and/or steroids, and almost involves the trial use of anti-inflamatory sprays and washes. When these have been fairly attempted and obstruction persists, examination of the nose will often reveal a deviated septum and/or enlarged nasal turbinates. The turbinates are the primary air filtering structures in the nose and are responsible for maintaining inhaled air temperature, humidity, and cleanliness. While they are dynamic structures and can shrink and expand to allow for environmental and internal changes, the turbinates are not immune to misbehavior by adopting a chronically enlarged state.
Surgery for blockage and excess drainage may involve both the septum and the turbinates. Septal surgery has been described elsewhere on our webpage. Early nasal surgeons often completely removed the turbinates to accomplish nasal airway opening. Later, we realize that the turbinates are necessary structures and can best be treated when enlarged by shrinking them rather than eliminating them. This is accomplished either by partial removal of their interior bulk with typical surgical techniques such as cutting, removing tissue, and suturing the incision closed, or by usage of newer technologies to shrink and eliminate tissue swelling from within the turbinate without incisions. Some of these procedures can be accomplished in the office without the need for general anesthesia, but also without the experience of pain.
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