SYMPTOMS OF NASAL DISEASE 19 reflex is an explosive one, and is accompanied by a twitching of the face and eyes, and by an increased secretion of nasal mucus and tears, while there is a transient engorgement of the nasal mucosa. Sneezing cannot be induced voluntarily, but it is brought about by the inhalation of an irritant, such as pepper, or an allergen in atopic individuals, or by looking at bright sunlight. SNORING Many individuals do not seek advice regarding snoring until pressed to do so by their wife or husband, while parents may complain of snoring in their children. The sound is made by vibrations of the soft palate while the patient is asleep, often on his back, and during inspiration through the mouth. It has been shown that a reservoir of air in the nasopharynx is essential for snoring, and thus it is not found in complete nasal obstruction, e.g. a bilateral choanal atresia. Snoring may occur in families, and this is usually due to a characteristic configuration of the face and jaw, or in those with a short thick neck. One of the facial characteristics is a receding chin, so that the tongue may slip backwards. In children snoring may be due to hypertrophied adenoids with or without hypertrophied tonsils, but it may also occur in the child with the high arched palate and an underslung lower jaw which leaves a gap between the upper and lower incisor teeth. Nasal allergic swelling of the mucous membrane of the nose or a deflected nasal septum may result in snoring in children or adults, while nasal polypi frequently cause it in adults. Collapse of one or both alae nasi may give rise to snoring in adults (Fig. 15). Fig. 15. Snoring due to collapsed ala nasi. (.Reproduced by permission of Mr Ian Robin and the * Proceedings of the Royal Society of Medicine*.) Treatment is that of the cause. In children removal of hypertrophied tonsils and adenoids, or adenoids alone if the tonsils are of normal size, will usually result in a cure. Removal of any intranasal cause, such as nasal polypi, or correction of a deflected nasal septum, or treatment of nasal allergy should be recommended. Collapse of the alae nasi should be treated by the insertion of silver nasal dilators during the hours of sleep. Positive breathing exercises to correct the weak dilator muscles should be advised. The open mouth may be corrected by some form of chin strap, while correction of ill-fitting dentures may prevent the tongue from slipping posteriorly. A cotton reel or other such object fastened to the back of the pyjama jacket or nightdress will prevent the snorer from sleeping on his back. A cure is only obtained in some 50 per cent of cases.