Know Your Nose: Common Nasal Problems and Solutions

The nose may be the most prominent part of the human face, the first feature you see when you look at someone. But it’s easily under-recognized for its usefulness. Not only does it allow us to breathe, but it also enables our sense of smell and much of our sense of taste. These are abilities we typically take for granted — until they’re taken away.

When our noses are congested and we’re forced to breathe through our mouths, the air we take in is not fully warmed, filtered, and humidified, as it should be. (This is one reason yoga practitioners have long held that breathing through the nose is superior to breathing through the mouth.) People who lose their sense of smell — with age or from cigarette smoking or simply because they are congested — can no longer taste food quite as well. They cannot enjoy the scent of a rose or fresh country air and all the memories such fine aromas conjure. And they cannot use their nostrils to guide them away from mold, rot, waste, smoke, gas leaks, and other potential health hazards.

As important as smell is to humans, it is perhaps more crucial to other mammals. Mice, for example, have about 1,000 smell receptors in their noses, while we have only a few hundred. Some 40 million years ago, around the same time that apes and Old World monkeys developed their acute, full-color vision, their sense of smell diminished, says Emily Liman, an associate professor of neurobiology at the University of Southern California, in Los Angeles. But those 300 receptors operate in countless combinations to give humans and other primates a respectable, and useful, sense of smell.

Smells, good and bad, can call up emotional memories from as long ago as childhood, like when you catch a scent of the perfume your mother wore when you were young. Scientists say this is because our olfactory sense is perceived in the brain’s limbic system, a center of emotional processing.

The flow of air through our noses is not a simple stream, but rather a course of whirls and eddies moving past curved, spongy bones known as turbinates. Scientists have found that this flow is more complex than that of blood through the heart or air over the wing of an airplane. Before we can smell something, this turbulence must reach the olfactory bulb, at the top of the nose, which explains why we often take a deep breath when savoring a scent such as freshly baked bread.

The airflow through the nasal passages runs in cycles that switch from one nostril to the other, so that you are usually breathing through just one nostril at a time, says Marcella Bothwell, an otolaryngologist at Rady Children’s Hospital, in San Diego, and a spokeswoman for the American Academy of Otolaryngology-Head and Neck Surgery. Someone with a very deviated septum (meaning the piece of cartilage that separates the nostrils is set closer to one side of the nose than the other) can sometimes breathe easily and sometimes not so well.

Although we remain blessedly unaware of it much of the time, the nose also produces a steady stream of mucus that cilia propel from front to back, where it is swallowed. “We swallow about a quart of mucus a day from our nose,” Bothwell says. “It’s tiny amounts, and it’s constant, and it’s cleaning your nose.”

Many of the troubles that afflict the nose involve this mucus, which accumulates when your body fights off a cold, a bacterial infection, or an allergen, such as cat dander or pollen.

Runny NoseĀ 

This common condition, essentially an excess of mucus, causes blood vessels in the nose to swell, making it difficult to breathe through the nostrils. The surplus mucus can overflow, filling the sinuses, little cavities in the skull between the eyes and in the cheekbones.

The best way to treat a simple runny nose, caused by a cold or allergies, is to use a saline rinse. When you have a cold, Bothwell says, you can wash your nasal passages as many as 20 times a day. This is better than blowing your nose, which is best avoided; the pressure can force bacteria from the nose into the sinuses and set the stage for bacterial sinusitis.

For allergy-related congestion, rinsing a couple of times a day will probably suffice. “It’s really a matter of hygiene of the nose,” Bothwell says.

During the first two or three days of a cold, you also might want to use oxymetazoline, a nasal decongestant. (Afrin and Allerest are two brand-name examples.) “It will open your nose up so that infection can run out,” Bothwell says.

Sinusitis

Infection and inflammation of the sinuses is a burdensome American health problem, afflicting one in seven adults and costing $5.8 billion a year in medical treatments. More than 20 percent of antibiotics prescribed to adults are meant to treat the condition. Some of these prescriptions would not be necessary if doctors were better able to diagnose whether a case of sinusitis is really caused by bacteria, and thus treatable with a course of antibiotics, and whether the case is severe enough to need treatment.

Most often, the cause is a virus, says Richard Rosenfeld, an otolaryngologist at Long Island College Hospital, in Brooklyn, New York, and the lead author of the latest clinical-practice guidelines for sinusitis. Contrary to common wisdom, you cannot distinguish a viral infection from a bacterial one by the color of the mucus. When someone has a cold, Rosenfeld says, the mucus always starts out clear and then becomes cloudy and finally becomes greenish or yellowish.

Nor is a fever useful for diagnosis, because fever can occur with a viral or a bacterial infection. The only way to tell whether someone has a bacterial infection is to consider the timing. If symptoms continue for 10 days or more without improvement, the infection is likely to be bacterial. Or if the symptoms begin to subside but then, five to 10 days after they began, the patient suddenly feels awful, bacteria in the sinuses are likely at work.

Mild cases of sinusitis, even bacterial ones, often go away on their own, without antibiotics. Seventy-three percent of people with bacterial sinusitis feel better in seven to 12 days, even without treatment, Rosenfeld says. With antibiotics, 87 percent of people feel better, but it still takes a week or more for symptoms to diminish, and improvement comes mainly from the body’s own fight against the infection, not from the antibiotics, he says. Sometimes doctors may write a prescription for antibiotics but ask the patient to wait a few days before filling it to see if the congestion begins to clear on its own.

“Holding off only makes sense if it’s a mild infection,” Rosenfeld says. “However, if someone is really sick and has a high fever and feels awful, it makes sense to take antibiotics.”

Nose First Aid

The nose most often bleeds from arteries that are very low in the nose, along the septum, so it usually pays to pinch the nose at the bottom, at the loose opening rather than up by the bony part. “The bleeder is usually only about a centimeter in, right along the floor of the nose,” says Marcella Bothwell, an otolaryngologist at Rady Children’s Hospital, in San Diego. “So hold it at the bottom, and hold it for at least five minutes — no peeking.”

It can help sometimes to use Afrin nasal spray, a decongestant, because it shrinks blood vessels. Sticking cotton or tissue in the nose is not an effective treatment, Bothwell says.

The All Clear

Nasal Saline Solutions
Rinsing the nose when you have a cold, the flu, a sinus infection, or allergies helps clear the buildup of dried mucus that can keep sinuses from draining properly. This in turn can encourage an existing infection to heal and help prevent new ones from developing. Saline rinses also reduce the swelling of nasal tissue that can make breathing difficult.

Saline is sold in the form of sprays or packets of solution (made by Simply Saline, for example, or Ayr) that you mix with water. You also can easily make your own solution by mixing one heaping teaspoon of noniodized salt (such as pickling or canning salt) and one heaping teaspoon of baking soda with one quart of tap water. Fill a neti pot (a small vessel designed for nasal irrigation, available at health-food stores and drugstores) or a bulb syringe with the salt solution. Standing over a sink — or while you’re in the shower — tilt your head down and to one side, pour a little solution into one nostril, and let it drain out the other one. Keep rinsing the nose, a little at a time, until the solution comes out clear.

People suffering from a bad cold or infection may want to do this several times a day. But even people in good health may benefit from rinsing the nose once or twice a day, doctors say. The irrigation keeps the nasal passages hydrated and clear, which may help prevent sinusitis.

Antihistamines
These drugs block the action of histamines, substances that cause allergy-induced sneezing and a runny nose. But using them is not necessarily a good idea when you have a cold, the flu, or a sinus infection. They make mucus thicker, and that impairs drainage. They also make you sleepy.

Nasal Decongestant Sprays
Simple decongestants (those not mixed with other medicines), such as oxymetazoline, can be used safely for two or three days to open up your nose and help mucus run out. Marcella Bothwell, of Rady Children’s Hospital, in San Diego, recommends using a saline wash along with decongestants.

Avoid using decongestants for more than three days, however, because the tissue in your nose can easily become dependent on them and begin to overswell, causing you to need the decongestants all the time.

Nasal Allergy Sprays
If you have a mild sinus infection but are looking to avoid taking antibiotics, you might try prescription nasal allergy sprays such as Nasonex, says Richard Rosenfeld, an otolaryngologist at Long Island College Hospital, in Brooklyn, New York. These contain a dilute steroid that does not get into the bloodstream but can reduce congestion. “They’re safe to use for weeks at a time,” Rosenfeld says, “and give relief comparable to antibiotics.”

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