The nasal cavity is the usual starting point for the flu. This is produced by viral invasion of the nasal lining, successfully attacking it when local resistance is reduced. This is common following or during chills, being in crowded surroundings with others soughing and sneezing germs about in profusion. A slight burning or itching is soon followed by a thin watery discharge, which generally becomes infected with secondary invaders to produce the typical thick, yellowish nasal discharge.
As toxins spread to other parts of the body, general feelings of malaise, elevated temperatures, aches and pains take place. The virus rapidly becomes established in other parts of the respiratory tract, and advances quickly to the pharynx (throat), larynx, bronchi and lungs. It can also travel into the sinuses on either side of the nasal passageways, and along the Eustachian tubes into the idle ear, setting up infections in each cc, together with a further set of symptoms.
The flu is the most common of all infectious disorders, and can account for the discomfort and disability, as well as tune loss in industry.
Chronic rhinitis sometimes will not completely disappear, and a long-standing chronic swelling of the nasal linings will occur. Also obstruction to the airways, due to mechanical blockage, or due to injury or allergy, may develop. There may be a chronic sinus infection, and the nasal passages may swell along with this. Fumes, dust, the ubiquitous house-dust mite, and an unsuitable climate have all been incriminated.
There is swelling and redness of the mucosal lining of the nasal passages, and often respiratory difficulty. In the early stages it may be intermittent, or only on one side, but this may become more persistent, sometimes affecting both nostrils. There may be a thick, sticky discharge, with much hawking and nose blowing to gain freedom.
If the Eustachian tubes become blocked, hearing reduction may occur. Often there is a headache, with a feeling of fullness in the head, the voice becomes nasal, and mouth breathing and snoring may occur. The patient probably uses nasal drops to excess, and in due course this may aggravate the condition.
These are usually those of nasal obstruction, generally in a person prone to hay fever or other systemic allergies. Generally it affects both sides and there is some discharge. It may be colorless and mucoid in nature. If infections occur, this will become JW, will contain pus and probably be A. Often there are few other symptoms; headaches are unusual. Frequently the most troublesome symptoms are from the allergies that produced polyps in the first place, for these can persist.
Most patients tend to overuse nasal drops, but these give little if any relief, for usual polyp is far too large to be reduced by drops aimed at causing blood vessel walls to contract.
Sometimes the polyps can be seen when inspecting the internal part of the nose from the outside.
This consists of finding a possible underlying cause, such as foreign bodies, infections, septal deviations, environmental factors etc, and rectifying these where possible. Ceasing smoking, stopping the overuse of nasal decongestants, and getting out in the fresh air may help.
Antihistamines and the corticosteroid inhalants (such as beclamethasone dipropionate inhalant for nasal use) may give relief if there is an allergy basis. If these simple measures are unsuccessful, the ENT doctor may resort to submucosal diathermy. When this heals, the surface tissues will contract and reduce the swelling. In severe cases, resort to surgery may be necessary.
Nasal allergy. This is common, especially in young adults and children, although anybody may be affected. It simply means the body is allergic to various substances (called antigens) it contacts. An immediate reaction may occur, producing the typical set of symptoms.
The condition is more common in spring and early summer, when pollens from flowering grasses arc about in profusion. But many other allergens arc around. Each person will have a well-defined series of items to which he is allergic. These may include inhalants, items that are eaten or contacted. Moulds, feathers, pollens, house-dust (or more accurately the house-dust mite), some foods, most notably fish, milk and egg products, and certain drugs are well-established for causing trouble with many patients. Once sensitized to a substance, this tendency will remain. Symptoms are frequently widespread through the body.
There may be sneezing, with an itchy, watering nose that often blocks up. In severe cases, the allergic response may extend to the lungs, causing mild breathing difficulties and even a wheeze. This condition is widespread and important, and in recent times a significant advance has been made in treatment. It is now possible to gain very satisfactory results, even in cases that were once severe and sustained considerable degrees of disability.
Nasal polyps. Nasal polyps are grayish masses of tissue that can occur anywhere in the nasal passageways. They resemble a tiny bunch of grapes, having narrow stalks by which they are attached to the walls of the nasal passages. Almost always they are due to swelling of the nasal canal linings. In sonic areas the lining becomes waterlogged (oedematous) and as the tissue may be loose, it tends to sag. Constant nasal blowing, the addition of more fluid from infections, or more commonly allergies, produces further swelling. Gravity helps the downward movement, and finally a polyp is born.
This is usually carried out by the ENT surgeon. Diagnosis is made by a thorough inspection of the nasal passages, both from the front as well as from behind. Mirrors are used that give a good of the back parts of the nasal canals, and often large polyps are seen there.
Surgical removal of the polyps gives the best results, and this is carried out with a flu wire “snare” that grasps the polyp at its stalk and severs it. Results are A, and immediate normal nasal airway function is again possible. However, it is essential that any basic underlying cause is treated at the same time, otherwise recurrences are almost inevitable. Allergies, sinus infections and septal deformities should all be attended to, for unless this occurs, the operation may be redundant as the polyps make reappearance later on, producing identical symptoms.