Nose Article

Nose is a chamber divided into two by a midline septum (in about 90% it is off midline but doesn’t cause trouble) and its side walls contain mounds & troughs (called turbinates & meati). These turbinates & meati produce turbulence in airflow through nose. This, along with hair in the front part of nose, will stop good number of dust particles from entering the lungs. The most important function of the nose is to humidify the air, which enters lungs for oxygenation of our body. Also, it adjusts the temperature of air so that it is not harmful to lungs. The nose takes the brunt of this process and projects the more delicate and sensitive lungs.

Common Cold :
Most of the times, it is due to virus infection. In 99% of cases it subsides in a week’s time without treatment, but little care will reduce the chances of complications.

Steam inhalation-vapours of plain hot water (no need to add Medicines, turmeric, mint etc). The temperature of steam need not be high and it should be comfortable to face. Ideally this should be started in the very early phase of viral infection.

Put two drops of nasal decongestant in each nostril twice a day in the given position (keep a pillow behind the shoulders; extend the neck, lift up the chin in such a way that chin and ear are same vertical line). In this position the drops will open the blocked sinus openings and prevent sinusitis. A word of caution: These drops are good for short courses of 5 to 10 days and prolonged use can lead a very dreaded condition called Rhinitis medicamentosa.

Complications of common cold :

The viral infection turns into bacterial & needs antibiotics. Infections spreads to throat (sore throat); to ear (acute Suppurative Otitis media, severe pain in the ear with block sensation. This needs urgent treatment from ENT specialist); very rarely to eye.
Sinusitis: Due to oedema/ swelling of sinus drainage path, the sinuses airflow is curtailed and results in negative pressure; collection of fluid – retention and stagnation of fluids will provide good environment for bacteria and fungi to multiply and “fix” the “Sinusitis”.

Deviated nasal septum: Gross deviations of the nasal septum to one side may block not only that side of the nose but also the opposite side. In such situation a Septoplasty operation is the only answer. However, all the deviated nasal septums need not be corrected, especially if they are not causing any trouble. This can be in the anterior (front half of the nose which is visible easily) or posterior (back half of the nose which is visible in Endoscopy only).

Allergy of the Nose/ Polyps in the Nose :

Allergy of the nose, called allergic rhinitis, can be seasonal or perennial. In Seasonal allergic rhinitis, the symptoms are limited to particular seasons which are linked to the release of pollen from certain plants. These patients should identify these plants and be away from them. If this is not possible practically then they can use antihistamine tablets which are very safe in the long term use also. However they should consult the doctor for changing the type of drug once in 6 months. Perennial rhinitis can be due to allergy or pollution or both.

This is a little stubborn to manage, but again long-term antihistamine medicines are quite safe to use and should be used to avoid other complications and late stages of the allergic rhinitis like polyps in the nose.

Nose bleed (Epistaxis) :
“Nose bleed” is a problem which almost everyone of us encounters in our life. Although most frequently it happens in elderly adults.

In children it is usually minor in amount but recurs frequently. Most of these children suffer from recurrent nose infections also. This infection leads to formation of crusts in the nose. Separation of the crust can lead to raw area, which bled.

Many children and adults have the habit of nose pricking, which also leads to raw surface (ulcer) in the nose that can bleed. To prevent this, nose pricking should be avoided. Parent of the child should consult an ENT physician to identify the cause of the bleeding and get appropriate treatment.

In adolescent age, a tumor called “angiofibroma” can lead to minor to severe bleeding. So, any teenage boy (this tumor dose not occur in girls) having repeated bleeding should consult an ENT specialist.

In adults and elderly, arthrosclerosis of the blood vessels lead to hardening of the blood vessels. This makes the blood vessel prone to injury and it leads recurrent bleeding. High blood pressure and people taking asprin also are prone to nose bleed. Some times elderly people can have tumor in the nose which can lead to bleeding. Chronic sinus problem, polyps are also cause of nose bleeds.

As a first aid in the home, the nose (soft part) of the bleeding person should be pinched hard for 3-4 minutes. Application of ice on nose and face is also helpful. If bleeding does not stop with these measures, that patient should be taken to ENT specialist.

Changing Concepts in Management of “Sinus Problems” :

“Sinusitis”- infection of sinuses – is one of the most common conditions affecting humans. With increasing amount of pollution and allergens in the environment, more and more people are getting affected with this problem.

Sinus infection of short duration – which is called “Acute Sinusitis” in medical term, is managed with medicine.
Usually doctors prescribe antibiotics, painkillers and steam. It is important to complete the course of antibiotics and other medicines religiously to prevent the condition becoming “chronic”.

Once a patient suffers from chronic sinusitis that is usually more than 3 months, he/ she is usually told by the physician or consulting surgeon that surgery might be needed.

Still at this stage it is worth while to try a long course of antibiotic (up to 2-3 weeks duration) along with anti allergic medicine.

Sinus surgery as such has a bad reputation in the general public opinion that it “Does not work”. This notion has some truth as operation done in the past had a success rate of 30-40%. In the “past”, surgeons used to open the sinuses with a scar on the face and tried to remove all the diseased lining of the sinus.

This used to be a futile exercise in most of the cases.

Sinus symptoms: Nose block; nasal discharge; facial or malar pain; headache; post nasal drip (feeling of phlegm/thick secretions coming into throat from back of the nose).

Now a days with the help of sinus endoscopes and CT scan, we identify the reason of sinus drainage obstruction. Subsequently this obstruction is corrected with the help of minute sophisticated instruments.

The whole process is called Functional Endoscopic Sinus Surgery (FESS). This procedure is done from inside the nose under endoscopic vision, so there will be no scar on the face.