Healthwise

A healthy nose for better health

Dhaneshi YATAWARA

Your nose not only adds to the beauty of your face or support your glasses, but it plays an important role in your overall well-being and health. The most obvious function of the nose is breathing. Air enters your body through your nose and it is warmed, humidified and filtered. That same heat and humidity are recaptured each time you exhale.

Dr. Chandra Jayasuriya, Consultant ENT Surgeon, Colombo National Hospital Pic : Dushmantha Mayadunne

The nose forms an important part of one’s appearance. We all have expectations of what our noses should look like and if your nose looks different because it is bigger, smaller or crooked, it might change your self image.

In addition to warming, cleansing, and humidifying the air you breathe,

it helps you to smell and taste. A normal person will produce about two quarts of fluid each day (mucus), which helps to keep the respiratory tract clean and moist. Tiny microscopic hair (cilia), line the surfaces helping to brush away particles.

Nasal and sinus complaints are one of the most common causes for people to consult physicians. Many of them can be easily diagnosed. Most of them are best treated with simple remedies.

“We are only able to externally see the two nostrils. But the nose cannot be considered so simple. It definitely is complicated as a main sensory organ of the human body,” said Doctor Chandra Jayasuriya, the Consultant ENT Surgeon of the Colombo National Hospital explaining the importance of nasal health.

Protruding down into each nasal passage are three small mucosal covered bones called turbinates. They increase the filtering and warming the surface of each nasal cavity. Residing to the side of the nose, underneath your eyes and up into your forehead are large air pockets in the facial bones. These connect with the nasal cavity. They are called sinuses or more correctly paranasal sinuses. They are named the maxillary, ethmoid, frontal and sphenoid sinuses.

The nose and the paranasal sinuses are lined with a tissue which is called mucosa. The mucosa has little hairs called cilia and floating over these hairs is a layer of fluid. On top of the fluid layer floats a layer of mucus. The cilia beat back and forth in the fluid layer and they move or propel the mucus blanket along, out of your sinuses into your nose. Eventually this mucus blanket is moved to the back of the throat where it is unconsciously swallowed. This entire process is closely regulated by several body systems. This whole system is called the mucociliary transport system and it is the key to nasal health.

If the mucociliary system becomes impaired, then nasal and sinus secretions stagnate. They become infected with the bacteria which are always present within your nose and infection develops, be it in your nose or your sinuses.

When your nose is ill it is often blocked and you are forced to breathe through your mouth which most consider to be irritating inconvenience. Germs can enter your body through your nose. A common cold is the best known example and when this happens your nose and sinuses become blocked and filled with secretion and even the toughest of us are reduced to constantly blowing, sniffing and basically not feeling well.

“Nasal diseases and disorders could be more frequent than the ear or throat infections. Yet a very few people consult an ENT surgeon. They prefer to consult a General Practitioner (GP) and get treatment,” Doctor Chandra Jayasuriya said elaborating on the subject.

When a cold gets prolonged, a discharge of phlegm (yellow in colour) is usually experienced. If this condition persists, it needs medical attention.

The discharge is caused by infected sinuses. The main sinuses are open to the nasal passage.

Sinuses are covered with hair cells. With the movement of these hair cells, the phlegm travels towards the nose through the openings, enters the throat and is swallowed. These passages/openings may get blocked due to various reasons leading to phlegm stagnating inside the sinuses, ultimately getting infected with bacteria. Runny nose, headache, bad smells emanating are the symptoms of the sinusitis.

Causes for the sinuses getting blocked are identified as allergies, catarrh, viral infections like cold. Allergy is a hypersensitive conditions leading to swelling of the sinus walls and nasal processes. In catarrh, the nasal nerves get innervated, causing the swelling of the nasal processes. Viral infections cause swelling of the nasal processes leading to phlegm problems.

Nasal blockage may even lead up to a dried up nose. This causes dysfunction of the hair cells in the sinuses resulting in stagnated phlegm. Administering nasal decongestants for a long time without medical supervision leading to swollen sinus walls also helps sinuses getting blocked. Infected teeth in the upper jaw have also found to be leading to infections spreading to sinuses.

Treatments such as antibiotics, painkillers, steam inhalation etc., may work in the initial period but if the condition persists removing stagnated phlegm could be done through a surgical procedure. Treatment should be given to eliminate the cause to stop a recurrence.

As Dr. Jayasuriya further explained nasal blockage may happen due to various other reasons as well.

Swollen nasal turbinates due to catarrh and allergies is one of such causes. Turbinates can also swell due to temperature changes, as a side-effect of certain medicines and hormonal changes in the body.

Nasal septal deviation due to previous trauma, cancers and tumours of nose, nasal stones formed inside the nose (calculus) leading to nasal blockage (similar to renal stones in kidneys) could be identified as other reasons contributing to nasal blockage.

Another major cause is nasal polyps. These are small rounded pieces of the lining of the nose that can extend to the passages of the nose. They are common among patients with catarrh and allergies. The exact cause for nasal polyps has not yet been found.

People with allergies, catarrh and asthma are more prone to this condition. Children usually do not get nasal polyps.

Patients with polyps have blocked runny nose with a reduced sense of smell. They may snore in the night. Polyps, resembling the shape of a bunch of grapes, could be seen during examination. Nasal processes (turbinates) should be distinguished from nasal growths. Many patients mistakenly take these for polyps and seek medical advice. (These processes are pink in colour and are attached tightly to the sidewalls).

Small polyps can be treated medically. Large polyps, with complete nasal blockage and growth occurring only in one side, should be removed surgically. Samples have to be sent for pathology tests.

Allergic conditions and catarrh must be treated to avoid a recurrence. As the above factors are hereditary, precaution is an imperative.

“During summer in Europe, pollens cause allergies. During harvest, too, this can be observed. As we do not have such weather patterns in our country, there is no specific period during which we experience these symptoms,” Dr. Jayasuriya explained.

Certain foods, especially those based on dairy milk, such as yoghurt, ice cream, butter, puddings, cheese, eggs as well as oily meats and bananas should be avoided.

People with allergies should wear a mask when exposed to a dusty environment. Allergic reactions which may occur due to pets (dogs, cats, birds) at home, also leading to nasal growths keep the nose free of phlegm during a cold.

The use of a handkerchief among children must be made a habit and keep the head covered during outings early in the morning and at night. Exercises that cause sweating will lessen the nasal blockage. Steam inhalation may also help, the doctors advise you.

Nasal decongestant drops or sprays may help to lessen the swelling. But this treatment should be strictly on medical advice and on a short-term basis.

“Nose has vast surface area and the interior cannot be seen or examined by an ordinary doctor. Special instruments are essential to examine the inside of the nose,” Dr. Jayasuriya pointed out.

Hence if post nasal dripping, cold, sinusitis or any such discomforts continue in the nose it’s best to consult an ENT surgeon if one needs to live a healthy life.

‘Cardiac asthma’

Dr. D. P. Atukorale

It is common knowledge among medical personnel and some laymen that there are two types of asthma (a) bronchial asthma and (b) “cardiac asthma” (pulmonary oedema). Out of these two ailments “cardiac asthma” is more dangerous than bronchial asthma. The medical term for cardiac asthma is pulmonary oedema. Bronchial asthma is the most common type of asthma, physicians come across in their practice and is not so dangerous as cardiac asthma. Bronchial asthma can rarely be very dangerous.

Bronchial asthma

As mentioned earlier, when a layman refers to the term asthma, what he or she means is bronchial asthma. Bronchial asthma is common both in children and adults and majority of these patients can be treated as outpatient department (O.P.D.) patients and occurs on relatively healthy people who give a long history of asthma dating back to childhood.

They usually give a family history of bronchial asthma or some type of allergy such as catarrh (allergic rhinitis) or eczema and as mentioned earlier majority of them can be treated as O.P.D. Patients with drugs such as ephedrine or aminophyllin or cyclosone and when they do not respond to above drugs they are admitted to hospital for treatment with oxygen, corticosteroids (hydro cortisone etc.) and subjected to nebulization.

Pulmonary oedema

On the other hand patients suffering from pulmonary oedema (cardiac asthma) are extremely ill and are admitted to a hospital (preferably one with a Intensive Care Unit).

Pulmonary oedema is usually secondary to coronary heart disease (C.H.D.), rheumatic heart disease (R.H.D.), hypertension, near drowing, balbiturate poisoning, following stroke, rapid administration of blood or plasma or other intravenous fluids.

As mentioned earlier, the commonest cause of pulmonary oedema is C.H.D.

In pulmonary oedema, there is accumulation of fluid in the lung tissue and these patients can get drowned in their own secretions. Majority of patients with pulmonary oedema are brought to hospital during the night and they usually give a very short history progressive dyspnoea (difficulty in breathing) and fatigue.

As mentioned previously, pulmonary oedema is an acute medical emergency. If any of your relatives develop pulmonary oedema, the patient should be propped up in bed with two or three pillows and should be made to swallow 40mg or 80mg of fursemide (lasix) and one or two tablets of sub-lingual glyceryl trinitrate should be administered if above drugs are available. If your relative is a hypertensive, the patients should be made to take a tablet of captopril sub lingually and after contacting the family physician, you must arrange for an ambulance or some other vehicle. During transfer of patient to the hospital, patient should be made to sit up with a few pillows.

In the medical ward or I.C.U. patient is propped up and humidified oxygen is administered and the patient is nebulised.

As the patient with pulmonary oedema is very restless and apprehensive, patient is usually given a sedative such as morphine. The patient is given intravenous fursemide and within minutes patient improves and his blush colour of tongue and fingers improves. The patients engorged neck veins get better.

If the patient coughs out reddish frothy sputum, he should be sucked. If the patient has bronchospasm and has wheezing, slow intravenous aminophyllin is administered. In spite of above, if the patient is still in respiratory distress, the patient should be ventilated in an I.C.U.

If patient is a case of myocardial infarction with pulmonary oedema, in addition to E.C.G. tests such as cardiac enzymes, troponin tests, C-reactive proteins are done.

Routine blood counts, blood urea, serum electrolytes in-ward Chest X’Ray, ESR are done in the ward or I.C.U. arranging a 2D-Echo is very useful if there are facilities.

Sometimes physicians find it extremely difficult to differentiate between bronchial asthma and pulmonary oedema. If there is a doubt that the patient may be having bronchial asthma, drugs such as morphine are contra - indicated. Oxygen and aminophyllin (slow IV) help both types of asthma. Same is true of nebulisation. In both conditions, patient should be propped up. If E.C.G. shows ischaemic changes or if the blood pressure is grossly elevated the patient should be treated as a case of pulmonary oedema. If there is doubt, IV frusemid should be given. Urgent in-ward C.X.R. is very useful in differentiating between the two types of asthma. If the patient has fever antibiotics should be administered. If there is cardiomegaly (enlargement of the heart) clinically or if there are cardiac bruits (murmurs) the patient should be treated as a case of pulmonary oedema.

If the family physician is not sure of the diagnosis, the patient should be transferred to the nearest hospital, after administering an IV aminophyllin injection and an IV Fursemide injection.

Even after serving the Institute of Cardiology for 23 years very rarely I have been unable to diagnose pulmonary oedema on admission of the patient and I take the precautions that I have mentioned earlier and confirm the diagnose after doing E.C.G. and other tests and while treating the patient with the medications I have mentioned earlier. This is in spite of treating thousands of patients with pulmonary oedema.

New bonus benefits of breastfeeding for moms

Heather HAJEK

New data shows that breastfeeding isn’t only good for the baby, butcan also benefit the mother. Mothers who breastfeed may benefit from lower risks of heart attacks, heart disease, and stroke because of reduced fat stored in the body.Though breastfeeding had been losing steam for many decades with themigration of more women in the work place, it seems over the past several years the trend is actually gaining in popularity. Research has shown many positive effects of breastfeeding for a baby, such as lowering risks for infections in the gastrointestinal, urinary, and respiratory tracts, reducing instances of ear infections, diarrhea andthe risk of SIDS (sudden-infant death syndrome). B reastfeeding hasalso shown to potentially ward off allergies, diabetes, and even obesity later in life for breastfed babies. According to AudreyNaylor, M.D., "Even if a mother breastfeeds for just a few weeks after giving birth, she is giving her baby an enormous health boost with positive effects that can be seen almost immediately, as well as long-term benefits that may help her child remain healthier clear into adulthood.” Now there is research emerging showing the benefits of breastfeeding on mothers who nurse.A new study released in the May issue of Obstetrics & Gynecology, conducted by researchers at the University of Pittsburgh involved over 139,000 postmenopausal women.

The study found that women who breastfed their babies for more than a year were around 10 percent less likely of experiencing a heart attack, stroke, or developing heart disease,compared to those who never breastfed their children. The researcher found that mothers who nursed their babies for at least a month may reduce risks of diabetes, high blood pressure, and high cholesterol.The study involved women ranging in age from 50 to 79 who hadpreviously given birth, and 58 percent of the participants reported nursing their children. An average of 35 years had past since any ofthe participants had breastfed their children.

Those women who breastfed for at least two years during their lifetime had a 13 percent lower risk of high blood pressure, 12 percent lower risk ofdiabetes and a 20 percent lower risk of high cholesterol. This means that breastfeeding has some pretty significant benefits for the long-term health of mothers. According to Dr. Adam Aponte, chairman of pediatrics and ambulatory care at North General Hospital in New York City, "In the short term, breastfeeding increases the production of oxytocin, a hormone that not only encourages milkproduction, but also helps a mother feel more relaxed and calm."Previous research has shown that breastfeeding for as little as a month may reduce a mother’s risks of breast, uterine and ovariancancer, and can potentially lead to stronger bones.

Breastfeeding helps a mother’s uterus to contract even after birth and return to its pre-pregnancy state and preventing postpartum hemorrhaging.Research suggests that breastfeeding reducing cardiovascular risks maybe due to the reduction of fat stores in the body, but could also be linked to the release of hormones breastfeeding stimulates. According to Dr. Eleanor Bimla Schwarz, “We have known for years that breastfeeding is important for babies’ health; we know that it is important for mothers’ health as well.” She added, “Breastfeeding is an important part of the way women’s bodies recover from pregnancy.”Interrupting this process could lead to a number of health problems such as, heart attacks and strokes. Based on research, breastfeeding seems to be a win-win situation,benefiting both mother and baby. The longer a mother nurses her baby the better for both of them. It is recommended by the American Academy of Pediatrics that mothers breastfeed their babies with no supplementation of other liquids, only mother's milk, for six months,but to continue breastfeeding along with liquid supplementation if desired, throughout a baby's first year of life and beyond.

Health News

What is the nose?

The word “nose” comes from the Latin, “nasus”. The nose is the organ in the middle of the face which performs several functions, including smelling purification of air, humidification of air, warming of air. The nose is divided into two passage ways by a partition called the septum. Opening to these passage ways are the nostrils. Protruding into each breathing passage are bony projections, called turbinates, which help to increase the surface area of the inside of the nose. There are three turbinates on each side of the nose (the inferior, middle, and superior turbinates).

The internal part of the nose lies above the roof of the mouth. The nose consists of:

external meatus - triangular-shaped projection in the center of the face.

external nostrils - two chambers divided by the septum.

septum - made up primarily of cartilage and bone and covered by mucous membranes. The cartilage also gives shape and support to the outer part of the nose.

nasal passages - passages that are lined with mucous membranes and tiny hairs (cilia) that help to filter the air.

sinuses - four pairs of air-filled cavities, also lined with mucous membranes.

What are sinuses?

The sinuses are cavities, or air-filled pockets, near the nasal passage. As in the nasal passage, the sinuses are lined with mucous membrane.

There are four different types of sinuses -

Ethmoid sinuses - located inside the face, around the area of the bridge of the nose. These sinuses are present at birth, and continue to grow.

Maxillary sinuses - located inside the face, around the area of the cheeks. These sinuses are also present at birth, and continue to grow.

Frontal sinus - located inside the face, in the area of the forehead. This sinus does not develop until around 7 years of age.

Sphenoid sinuses - located deep in the face, behind the nose. These sinuses do not develop until adolescence.