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 or turbinates 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.
|
back to top of page
|
| 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
Image Guide Technology.
|
|
back to top of page
back to our services
|
|