STUFFY NOSE - RUNNY NOSE
HOW THE NOSE WORKS:
How easy the nose is to breathe through and how wet it is depends on the
combination of (1) fixed architecture and (2) structures which adjust
their size and degree of wetness.
The anatomy of the nose - the architecture - is the arena in which nasal
breathing takes place. The nasal passage looks like the attic under a
pitched roof, only with a wall down the center dividing it into two
parts. Shelves called turbinates run along the side walls of the
space. Turbinates can expand or contract in order to open or close the
space. The wall between the two sides of the nose, the nasal
septum, continues to grow throughout life. if one inherits a septum
which is destined to be too big for one's nose, the septum will have to
buckle to fit and contributes to obstruction. If the pitch on the
"roof" is too steep, making the nose too narrow, there is less room for
the septum to twist.
Shelves on the side walls of the nose, in addition to the ability to
expand and contract, have the job of secreting mucus into the nose.
This architecture forms an arena in which a tug of war takes place. How
swollen and wet the turbinates are depends on two competing streams of
instructions coming through the housekeeper nervous system. This system,
the autonomic, is the same system which
controls basic functions such as heart rate, blood pressure, and the
progress of food through the gut.
One set of these forces, mediated by the sympathetic side of the
autonomic nervous system, keeps the nose open and dry, by
shrinking the shelves orturbinates and reducing the amount of mucus
being secreted. The other side of the autonomic nervous system, the
parasympathetic side, sends a constant stream of instructions to keep
the nose swollen and wet. Where the nose is at any one time actually
depends on the balance between these two sets of forces. This balance
changes throughout the day. Every two hours one side of the nose will
close and the other side will open. This balance is also affected by
gravity so that when one lays down there is more of a tendency of the
nose to be blocked up.
The sinus cavities are off to the sides and have no direct effect
on breathing. Sinuses are auxiliary mucus generators only. The mucus
linings of the nose and sinuses have a conveyor belt quality (as a
result of ciliary activity) which causes the constant normal
lubricating mucus to stream backward in the nose down into the throat
where it meets another stream always being generated by the lungs. The
combined flow from the nose and the lungs is designed to be
swallowed, not expectorated, so the mucus can be decontaminated in the
stomach and the components recycled by the digestive system.
BLOCKAGE AND WETNESS:
The onset of a blocked, stuffy nose is a sign that the balance of forces
has been shifted in the direction of over-secretion and closure.
Surgical procedures which change the shape of the nose for
appearance reasons usually diminish the amount of airway available for
the function of the turbinates and the growth of the septum.
Occasionally, nasal fractures can produce the same results.
Over-the-counter nose sprays if used longer than two days will
reverse their effects and block the nose by swelling turbinates. The
most common example of a shift in the balance is the common cold which
moves the balance temporarily but dramatically in favor of the
wet, blocked nose. Hayfever accomplishes the same thing. Less
obvious causes include the fluctuating levels of estrogen that accompany
the menstrual cycle, since the hormones which are primarily designed to
control the surfaces in the genitaltract have echoes in the airway. All
of these effects are magnified in the dry air. Medications which change
the balance in the housekeeper system such as those used for controlling
blood pressure or stomach cramps have nasal side effects.
Infection in the sinuses can affect the balance although this is
relatively uncommon. Nasal polyps are fleshy exaggerations of the
linings of unknown cause.
How much distress one experiences from a blocked nose probably has to do
with how dependent one is on nasal breathing. Just as most people are
right handed and a few are lefties, so most people are nasal breathers,
but some are mouth breathers. The amount of
blockage which causes great distress in one person may not cause any
problems for somebody who finds it easy to switch over to mouth
breathing. Young children with their characteristically runny noses
often are less bothered by the blockage than their parents. This
probably reflects the "wiring" in the nervous system just as handedness
does.
UNBLOCKING THE NOSE
Simple adjustments in the environment are often sufficient to improve
nasal function. Avoidance of smoking, avoiding known allergens,
and the regular use of a humidifier during dry conditions will promote
good nasal function.
Antihistamines and decongestants are occasionally helpful, but often
wind up increasing the difficulty because of the tendency to dry the
nose and to decrease the efficiency of the ciliary conveyor belt. The
best medication currently available consists of steroids in one form or
another. Steroid sprays for the nose have revolutionized the management
of nasal obstruction. Although probably safe when used daily, their long
term side effects have not
yet been completely worked out.
Systemic steroids in short courses avoid possible undesirable side
effects and are the best decongestants available. Antibiotics are
un-blockers on those rare occasions when bacterial infection is the
cause of nasal obstruction.
Surgery reduces the architectural basis for nasal obstruction. Sinus
surgery is designed to provide increased ventilation of the
sinuses and eliminate the infections, all of which diminishes the amount
of mucus sinuses secrete and improves the efficiency of the mucus
transport mechanism. Reshaping of the septum and turbinate
reduction surgery bring the inside of the nose into harmony with its
outside framework, making the nose less likely to obstruct. Nasal polyps
are usually removed surgically, though they tend to come back
eventually.
The exact blend of medication and surgery varies from person to person
and usually requires sophisticated CAT scan x-rays of the sinuses to
help choose the best approach. Surgery is now done with sophisticated
micro-cutters using the latest