|
Changing
physiology:
With
aging,
the
physiology
and
function
of the
nose
changes.
The nose
lengthens,
and the
nasal
tip
begins
to droop
due to
weakening
of the
supporting
cartilage.
This in
turn
causes a
restriction
of nasal
airflow,
particularly
at the
nasal
valve
region
(where
the
upper
and
lower
lateral
cartilages
meet).
Narrowing
in this
area
results
in the
complaint
of nasal
obstruction,
often
referred
to as
geriatric
rhinitis.
Patients
with
geriatric
rhinitis
typically
complain
of
constant
"sinus
drainage,"
a
chronic
need to
clear
the
throat
or
"hawk"
mucus,
and a
sense of
nasal
obstruction,
most
often
when
they lie
down.
Other
features
include
nasal
crusting
especially
in the
winter
and in
patients
taking
diuretics,
vague
facial
pressure
(attributed
to
"sinus
trouble"),
and a
decreased
sense of
smell
and
taste.
However,
it is a
mistake
to blame
all
upper
respiratory
problems
on the
aging
process.
Elderly
patients
with
symptoms
such as
repeated
sneezing,
and
watery
eyes,
nasal
obstruction
with
clear
profuse
watery
runny
nose,
and
soft,
pale
turbinates
(top-shaped
bones in
the
nose)
may have
allergic
rhinitis.
Patients
with
this
diagnosis
will
benefit
from
consultation
with an
otolaryngic
allergist.
Patients
with
chronic
sinusitis
will
have a
long
history
of thick
drainage
that is
often
foul
smelling
and
tasting
and is
associated
with
nasal
obstruction,
headaches,
and
facial
pressure.
These
patients
usually
have pus
drainage
and
nasal
redness.
In
contrast,
the
geriatric
rhinitis
patient
usually
has a
dry,
irritated
nose.
The
diagnosis
of
chronic
sinusitis
can be
confirmed
with a
screening
coronal
CT of
the
sinuses.
Recent
studies
by
otolaryngologist-head
and neck
surgeons
have
sought
to
better
define
the
association
between
rhinitis
and
sinusitis.
They
have
concluded
that
sinusitis
is often
preceded
by
rhinitis
and
rarely
occurs
without
concurrent
rhinitis.
The
symptoms,
nasal
obstruction/discharge
and loss
of smell
occur in
both
disorders.
Most
importantly,
computed
tomography
(CT
scan)
findings
have
established
that the
mucosal
linings
of the
nose and
sinuses
are
simultaneously
involved
in the
common
cold
(previously,
thought
to
affect
only the
nasal
passages).
Otolaryngologists,
acknowledging
the
inter-relationship
between
the
nasal
and
sinus
passages,
now
refer to
sinusitis
as
rhinosinusitis.
The
fluids
within
these
cavities
are
dynamic
and are
related
to
dynamic
pathologic
changes
in the
bone and
soft
tissues
of the
nasal
cavity
and
paranasal
sinuses.
Symptoms
associated
with
rhinosinusitis
include
nasal
obstruction,
nasal
congestion,
nasal
discharge,
nasal
purulence,
postnasal
drip,
facial
pressure
and
pain,
alteration
in the
sense of
smell,
cough,
fever,
halitosis,
fatigue,
dental
pain,
pharyngitis,
otologic
symptoms
(e.g.,
ear
fullness
and
clicking),
and
headache. |
