GENERAL ENT
Nose

Have you ever experienced a smell that instantly took you back to a past event, making you relive it as if it happened all over again? The nose is a remarkable organ and in many ways a window to our brain.

The nose plays a central role in the ear, nose and throat system as well as the rest of the body. As a part of our respiratory system, its main function is to filter, warm and humidify the air that passes through it on its way to the lungs. At the same time, our nose allows us to detect millions of smells and link them to our memory. It provides a passageway to the brain via the olfactory nerve, a cranial nerve responsible for our sense of smell. This way the nose is also intricately connected with our limbic system, which is the main region of our brain linked to emotion and memory. It is therefore no surprise that a loss of sense of smell has a significant effect on our mental health and can lead to depression. The ancient Egyptians recognized the importance of the nose when vandalizing their statues (which were thought to be capable of direct contact with the gods) for political or religious reasons. By damaging the statues’ noses, they hoped to destroy their ‘breath of life’. 

Problems of the nose are very common at any age. They can be very unpleasant, as many of them interfere with your breathing pattern. Nasal breathing can help filter out dust and allergens, boost your oxygen uptake, and humidify the air. It is also believed that nasal breathing is associated with relaxation and cardiovascular health through lowering blood pressure. 

Nasal problems may involve nasal discharge, nasal obstruction (problems breathing through your nose), snoring and disturbed sleep, nosebleeds, nasal polyps, acute and chronic sinus infections (sinusitis) and loss of sense of smell (anosmia), amongst others. 

Diseases of other organ systems may also present with, or be accompanied by, problems in the nose. One of the most striking examples is when we find a loss of sense of smell in the early stages of disease of the brain and central nervous system, such as Alzheimer’s and Parkinson’s disease.  In the majority of those cases, the motor or cognitive symptoms are preceded by at least 2 to 4 years of a loss of sense of smell. Many autoimmune diseases (in which the body’s immune system attacks its own healthy tissues), show very typical manifestations in the nose. Conversely, a blocked nose leading to snoring and disturbed breathing during sleep, can have major effects on some of our other organ systems, for instance cardiovascular problems through reduced oxygen uptake, and even weight gain through hormonal disturbances due to lack of sleep.

During your consultation for nasal problems, examination may include one or more of the following:

Anterior rhinoscopy

This is an examination of your nostrils and nasal cavities, carried with a small nasal speculum and a headlight. It will tell us about the state of your nasal septum, nasal lining and turbinates (shelves of bone in your nose covered in mucous membranes). On occasion a nasal swab might be necessary. In some cases a focus of bleeding, most often on the nasal septum, may be cauterized. This is done either with a chemical swab containing silver nitrate, or with an electric current.

Flexible endoscopy

This involves inserting a small camera into your nasal cavity to inspect the back of your nose, your throat and voice box. The endoscope we use is a thin, flexible tube with a tiny, built-in camera at the tip of it. This is inserted into your nostril and carefully advanced a bit further in the nose, to examine your nasal lining, the openings to some of your nasal sinuses, and the space behind the nose (nasopharynx). It is there that in children, as well as some (young) adults, an organ called the adenoid may be found.

The adenoid is a patch of tissue that is part of the lymphatic system. When enlarged or inflamed, it plays a role in recurrent nasal infections, nasal discharge, nasal obstruction, and even ear conditions such as glue ear and acute ear infections. Flexible endoscopy is done awake, but at your request a local anesthetic (numbing) spray can be used. In children, a smaller size endoscope is used. In some cases we choose to combine this examination with a surgical procedure under general anesthesia, especially in children.

Nose Diagram
  1. nasal cavity
  2. throat
  3. oral cavity
  4. tongue
  5. flexible tube
  6. endoscope
    Illustration used with permission from MedicalVisuals.

Imaging – you may be referred to our radiologic clinic for a scan of your sinuses, this is most often a CT-scan, but in some cases an MRI-scan might be more suitable. We will book two appointments: one for your scan, and a follow-up appointment at one of our clinics to discuss your results together.