Nose

When your nose works well, you seldom give it a second thought. Iif your nose doesn’t work right, you may have trouble breathing, smelling, and tasting. This can lead to headaches, sore throats, and more. These can be signs of a problem that nasal surgery could help correct.

These is no “ideal” nose: Noses come in all sizes and shapes. But you may not like the way your nose fits with the rest of your face. Maybe you think your nose is too large or too crooked. Maybe it’s too wide or has too many bumps for you. If so, nasal surgery may be able to help.

Information About Nosebleeds

The nose is an area of the body that contains many tiny blood vessels or arterioles that can break easily. In the United States, one of every seven people will develop a nosebleed some time in their lifetime. Nosebleeds can occur at any age but are most common in children aged 2-10 years and adults aged 50-80 years. Nosebleeds are divided into two types, depending on whether the bleeding is coming from the front or back of the nose.

Anterior Nosebleeds

Most nosebleeds or epistaxes 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. Nosebleed coming from the front of the nose or anterior nosebleeds often begin with a flow of blood out one nostril when the patient is sitting or standing.

Anterior nosebleeds are common in dry climates or during the winter months when dry, heated indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented by placing a light coating of petroleum jelly or an antibiotic ointment on the end of a fingertip and then rub it inside the nose, especially on the middle portion of the nose (the septum).

How Do I Stop an Anterior Nosebleed?

  • Stay calm, or help a young child stay calm. A person who is agitated may bleed more profusely than someone who’s been reassured and supported.
  • Keep head higher than the level of the heart. Sit up.
  • Lean slightly forward so the blood won’t drain in the back of the throat.
  • Using the thumb and index finger, pinch all the soft parts of the nose or place a cotton ball soaked with Afrin, Neo-Synephrine, or Dura-Vent spray into the nostril and apply pressure. The area where pressure should be applied is located between the end of the nose and the hard, bony ridge that forms the bridge of the nose. Do not pack the inside of the nose with gauze or cotton.
  • Apply ice—crushed in a plastic bag or washcloth—to nose and cheeks.
  • Hold the position for five minutes. If it’s still bleeding, hold it again for an additional 10 minutes.

What is a 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.

Obviously, when lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow toward the back of the throat especially if coughing or blowing the nose.

It is important to try to make the distinction between the anterior and posterior nosebleed, since posterior 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.

What are the Causes of Recurring Nosebleeds?

  • Allergies, infections, or dryness that cause itching and lead to picking of the nose.
  • Vigorous nose blowing that ruptures superficial blood vessels.
  • Clotting disorders that run in families or are due to medications.
  • Drugs (such as anticoagulants or anti-inflammatories).
  • Fractures of the nose or the base of the skull. Head injuries that cause nosebleeds should be regarded seriously.
  • Hereditary hemorrhagic telangiectasia, a disorder involving a blood vessel growth similar to a birthmark in the back of the nose.
  • Tumors, both malignant and nonmalignant, have to be considered, particularly in the older patient or in smokers.

When Should an Otolaryngologist be Consulted?

If frequent nosebleeds are a problem, it is important to consult an otolaryngologist. An ear, nose, and throat specialist will carefully examine the nose using an endoscope, a tube with a light for seeing inside the nose, prior to making a treatment recommendation. Two of the most common treatments are cautery and packing the nose. Cautery is a technique in which the blood vessel is burned with an electric current, silver nitrate, or a laser. Sometimes, a doctor may just pack the nose with a special gauze or an inflatable latex balloon to put pressure on the blood vessel.

Tips to Prevent a Nosebleed

  • Keep the lining of the nose moist by gently applying a light coating of petroleum jelly or an antibiotic ointment with a cotton swab three times daily, including at bedtime. Commonly used products include Bacitracin, A and D Ointment, Eucerin, Polysporin, and Vaseline.
  • Keep children’s fingernails short to discourage nose picking.
  • Counteract the effects of dry air by using a humidifier.
  • Use a saline nasal spray to moisten dry nasal membranes.
  • Quit smoking. Smoking dries out the nose and irritates it.
  • Tips 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.

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.
  • Repeat the steps to stop an anterior nosebleed.
  • Call a doctor if bleeding persists after 30 minutes or if nosebleed occurs after an injury to the head.

Information About Post-Nasal Drip

Glands in your nose and throat continually produce mucus (one to two quarts a day). Mucus moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although it is normally swallowed unconsciously, the feeling of it accumulating in the throat or dripping from the back of your nose is called post-nasal drip. This sensation can be caused by excessively thick secretions or by throat muscle and swallowing disorders.

What Causes Abnormal Secretions?

Thin Secretions. 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).

Thick Secretions. Increased thick secretions in the winter often result from dryness in heated buildings and homes. They can also result from sinus or nose infections and allergies, especially to foods such as dairy products. If thin secretions become thick, and turn green or yellow, it is likely that a bacterial sinus infection is developing. 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. If these symptoms are observed, seek a physician for examination.

How is Swallowing Affected?

Swallowing problems may result in accumulation of solids or liquids in the throat that may complicate or feel like post-nasal drip. When the nerves and muscles in the mouth, throat, and food passage (esophagus) aren’t interacting properly, overflow secretions can spill into the voice box (larynx) and breathing passages (trachea and bronchi), causing hoarseness, throat clearing, or coughing.

Several factors contribute to swallowing problems:

  • With age, swallowing muscles often lose strength and coordination, making it difficult for even normal secretions to pass smoothly into the stomach.
  • During sleep, swallowing occurs much less frequently, and secretions may gather. Coughing and vigorous throat clearing are often needed upon waking.
  • When nervous or under stress, throat muscles can trigger spasms that make it feel as if there is a lump in the throat. Frequent throat clearing, which usually produces little or no mucus, can make the problem worse by increasing irritation.
  • Growths or swelling in the food passage can slow or prevent the movement of liquids and/or solids.
  • Swallowing problems may also be caused by gastroesophageal reflux disease (GERD). This is a backup of stomach contents and acid into the esophagus or throat. Heartburn, indigestion, and sore throat are common symptoms. GERD may be aggravated by lying down, especially following eating. Hiatal hernia, a pouch-like tissue mass where the esophagus meets the stomach, often contributes to the reflux.

How is the Throat Affected?

Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling that there is a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.

How is it Treated?

A correct diagnosis requires a detailed ear, nose, and throat exam, and possibly laboratory, endoscopic (procedures that use a tube to look inside the body), and x-ray studies. Treatment varies according to the following causes:

Bacterial infections are treated with antibiotics. These drugs may only provide temporary relief. In cases of chronic sinusitis, surgery to open the blocked sinuses may be required.

Allergies are managed by avoiding the causes. Antihistamines and decongestants, cromolyn and steroid (cortisone type) nasal sprays, and other forms of steroids may offer relief. Immunotherapy, either by shots or sublingual (under the tongue drops) may also 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 may be used safely under medical supervision. Oral and injectable steroids rarely produce serious complications in short-term use. Because significant side-effects can occur, steroids must be monitored carefully when used for more than one week.

Gastroesophageal reflux is treated by elevating the head of the bed six to eight inches, avoiding foods and beverages for two to three hours before bedtime, and eliminating alcohol and caffeine from the daily diet. Antacids such as Maalox®, Mylanta®, Gaviscon®, and drugs that block stomach acid production such as Zantac®, Tagamet®, or Pepcid®) may be prescribed. If these are not successful, stronger medications can be prescribed. Trial treatments are usually suggested before x-rays and other diagnostic studies are performed.

General measures that allow mucus secretions to pass more easily may be recommended when it is not possible to determine the cause. Many people, especially older persons, need more fluids to thin out secretions. Drinking more water, eliminating caffeine, and avoiding diuretics (medications that increase urination) will help. Mucous-thinning agents such as guaifenesin (Humibid®, Robitussin®) may also thin secretions. Nasal irrigations may alleviate thickened secretions. These can be performed two to four times a day either with a nasal douche device or a Water Pik® with a nasal irrigation nozzle. Warm water with baking soda or salt (½ to 1 tsp. to the pint) or Alkalol®, a nonprescription irrigating solution (full strength or diluted by half warm water), may be helpful. Finally, use of simple saline (salt) nonprescription nasal sprays (e.g., Ocean®, Ayr®, or Nasal®) to moisten the nose is often very beneficial.