The Nose

All about our most overlooked contributor to good health

The nose is an important feature of human anatomy and is one of our most vital organs. It is complex in both form and function, and consists of skin, bone, cartilage, blood vessels and nerves. It also provides our sense of smell and plays and important function in our breathing process.

The anatomy and physiology of the nose interact to form a dynamic system to protect our health.

Tiny hairs inside the nose filter the air and prevent particles as small as a pollen grain from entering the lungs. It humidifies the air that you breathe, adding moisture to the air to prevent dryness of the lining of the lungs and bronchial tubes. It also warms cold air to body temperature before it enters the lungs. In adults, 18,000 to 20,000 litres of air pass through the nose each day.

Specialist cells within the nose determine our sense of smell (part of the Olfactory System). When we smell, the molecules carrying the odour bind to receptors in the nose. The receptors connect with neurons that relay impulses to the brain which is thought to store the smell in its memory.

Chemicals known as Pheromones play a role in sexual attraction. It is believed that the nose and the corners of the mouth are ‘pheromone rich sites’ and that romantic kissing is a means to detect these pheromones.

Sneezing is caused by foreign particles irritating the nasal mucosa but can also be caused by sudden exposure to bright light (the Photic Sneeze Reflex). Sneezing is a means of transmitting infections as tiny droplets from the nose spread infectious microbes.

Because the interaction between the nose and the lungs is so important ignoring nasal conditions such as allergic rhinitis, congestion and sinusitis can lead to more serious health problems. Nasal congestion not only reduces our sense of smell and taste and makes breathing difficult, it also causes a dry mouth that encourages ‘mouth breathing’. Mouth breathing increases the risk of mouth and throat infections by breathing pollution and germs directly into the lungs. Mouth breathing also encourages snoring by allowing air to vibrate the tissues in the back of the mouth and throat.

It is estimated that around 13 in every 100 patients visit the GP due to sinusitis. It is the fifth most common diagnosis for which antibiotics are prescribed. Sinusitis can severely affect the quality of life of patients and can rate as high as back pain, heart disease and COPD (chronic obstructive pulmonary disease).

The Sinuses

The sinuses are hollow spaces in the skull behind the face. They act to warm, moisten and filter the air, insulate and lighten the skull and provide resonation for the vocal chords. The sinuses contain mucous, but when inflammation and swelling occur, known as sinusitis, the mucous builds up and provides the perfect opportunity for bacteria to breed. Sinusitis is often caused by allergens such as dust, house dust mite, pollen, pet hair, mould or other environmental irritants. In other cases it is caused by infectious agents like viruses, bacteria and fungi.

Rhinitis is the inflammation of the mucous membranes in the nose. When both the nose and one or more of the sinuses are inflamed, this is known as rhinosinusitis. This can cause congestion, post nasal drip, facial pain and pressure, headache, bad breath and fever.

Nasal Irrigation

In 1895 the ‘civilised nose’ was described in an editorial in the British Medical Journal as ‘ … one of the dirtiest organs in the body,’ and for washing it, one was ‘to plunge the face into a basin of clean water, cold or tepid, and take slight sniffs, in and out, while under water’. However, nasal irrigation dates back to the ancient yoga practice of ‘jala neti’.

Nasal irrigation is a simple and inexpensive method of treating nasal conditions such as congestion and sinusitis. It is very safe, soothing and less expensive than typical over the counter or prescription drugs. The nose can be irrigated every day with salt (saline) solution with no side effects. The process can be mildly uncomfortable in the beginning but most people quickly become used to the sensation. The benefits of better breathing are worth it.

How Does Nasal Irrigation Work?

Saline solution (see below) and a container for the solution are required. Neti pots are by far the most popular of containers but there are a range of other methods that are equally good (see below). The process of flushing the nasal cavity and sinuses is quite simple and takes less than 4 minutes.

Neti Pots

Neti pots (look like tea pots) come in all shapes and sizes and can be made from copper, stainless steel, ceramic, plastic or glass.

Other Methods Of Nasal Irrigation

Plastic bulb syringe can be squeezed to push saline solution through a nozzle into a nostril. Because it is compact and easy to hold it is suitable for both adults and children to use.

Pulsatile irrigation devices produce a gentle pulsating stream of saline through a nozzle into a nostril. The flow rate pulsates in order to stimulate the cilia (tiny hairs in the nose) to remove the mucous.

Atomiser sprays are convenient to use as they come complete with saline solution. However, they are not as effective as neti pots.

Salt (Saline) Solutions: Isotonic Or Hypertonic?

An isotonic saline solution contains salt concentrations similar to the concentration of the body’s fluids. Using this type of solution can be very soothing but may not reduce swelling caused by congestion and sinusitis.

A hypertonic saline solution, which is more like sea water, contains a higher concentration of salt. Salt absorbs moisture in the nose and sinuses and is effective in relieving swelling.

Research on the effectiveness of both concentrations has shown controversial results. Hypertonic solutions may be more effective in reducing swelling but may be more irritating to the sinuses than the isotonic solutions.

Sinus rinses can be purchased pre-prepared or for preparation at home. The solution is a combination of water and pure non-iodized salt (not table salt). The nasal wash percentages are approximately 240 ml (8 fluid ounces) warm water to ¼ teaspoon non-iodized salt.

Why Not Just Use Plain Water?

The tissues of the nose and sinuses will absorb plain water which in fact will encourage swelling, whereas the saline solution will not be absorbed and will help to reduce swelling.

Clinical Evidence

The evidence for using nasal irrigation is varied but a growing base of large-scale clinical trials is in agreement that it is an effective and inexpensive treatment for symptom relief of sinus discomfort and disease. The procedure is safe for both adults and children and there have been no documented serious adverse effects. Clinical trials indicate that patients treated with nasal irrigation are less reliant on other medications. One study found statistically significant improvements in quality of life, sinusitis and rhinosinusitis over a 6 month period. They experienced fewer episodes of nasal congestion, sinus headache, frontal pain and pressure and used fewer antibiotics and nasal sprays compared with control subjects. Compliance with nasal irrigation at the end of the 6 month trial was between 76% - 91%. On completion of the study patients stated that they will continue to use nasal irrigation and that they would recommend it to friends and family.

More Trivia 

• The nose is susceptible to frostbite.
• Nasal congestion reduces the sense of smell.
• Some people believe the nose get longer with age. Instead of growing longer, the tip of the nose drops and elongates due to gravity. By the time a person reaches the age of 50 years the skin will have lost its elasticity and the soft tissue underneath stretches and weakens. The stretching and lengthening of the ‘smile muscles’ also influences the deteriorating appearance of the nose.
• Sinuses were discovered in the 17th century when a woman who had a tooth extracted stuck a hair pin in the hole left in her gum. The pin disappeared and the doctor determined that it was stuck in a grape-like cluster of cavities behind the woman’s face now known as the sinuses.
• One-third of American adults pick their nose at least once an hour.
• The scientific name for nose picking is rhinotillexomania.
• The first ‘nose jobs’ were done in Italy during the Renaissance. Today ‘nose jobs’ are the most common form of plastic surgery for both men and women.
• In New Zealand nose pressing or ‘hongi’ is a traditional greeting among Mauri people.
• In 1848 George Jabet wrote his book Nasology: or hints towards a classification of noses.

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Image of man's nose taken by David M. Goehring via flickr