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Full text of "Diseases Of The Nose Throat And Ear"

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This is a common symptom of nasal disease and may affect one or both sides.
It may be comglete or-partiaL continuousjaiJafermittent, and it may vary
from time to'time and from side to side. Nasal airway may vary with atmo-
spheric conditions. The air currents within the nasal cavities may be impeded
by a deflected septum, enlargement of the anterior or posterior ends of the
inferior concha or the anterior end of the middle^ concha, the presence of
nasal poj^gi or intranasal tumours, atresia of the choanae, enlarged adenoids,
or polypus or tumour of the nasopharynx. Intranasal surgery may cause
mucosal oedema with nasal obstruction, and a similar condition may be
produced by alterations of temperature or humidity of the inspired air.
Nasal obstruction which is more marked on expiration is often due to a large
posterior polypus on a stalk which swings as a ball-valve to block the airway.

The most serious effect of nasal obstruction is seen in a neonate with a
bilateral choanal atresia, and the baby may die if this is not relieved. Partial
nasal obstruction in infancy interferes with the act of sucking, the baby having
to come off the breast or bottle repeatedly in order to breathe. Thus feeds are
prolonged, the infant tires and takes insufficient food. In children nasal
obstruction leads to mouth breathing being established, and, if unchecked,
this leads to the constantly open mouth, high arched..palate, crowde_d ieeth
and atrophy of the dilator muscles of the alae nasi, a picture which used to be
described as 'adenoid facies*.

The presence or absence of a nasal airway is usually easily determined by
holding a cold plated tongue depressor on the upper lip, and observing the
presence and size of the steamed area due to condensation of expired, air. If
an airway appears to be confined to one side in a child the possibility of a
unilateral choanal atresia must be suspected, and tested for by passing a probe
through that side of the nose under general anaesthesia.


This is also a very common symptom of nasal disease. The seromucinous
glands of the nasal mucosa constantly produce mucus which covers the
mucosa like a blanket and is propelled by the cilia towards the posterior
nares. From there it-descends, through the nasopharynx, pharynx and hypo-
pharynx to reach the oesophagus which transmits it to the stomach where it is
digested. In the normal course of events the subject is unaware of this unless
the amount of the secretion varies or its viscosity alters. Typically, this occurs
in the common cold when in the early stages the amount of mucus increases