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Introduction

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The face of Mrs Gamp—the nose in particular—was somewhat red and swollen, and it was difficult to enjoy her society without becoming conscious of the smell of spirits.

Charles Dickens (1812–70), Martin Chuzzlewit

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Disorders of the nose, which include the everyday problems of rhinitis, postnasal drip, epistaxis, folliculitis and disorders of smell, are very common in everyday general practice.

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The main functions of the nose are:

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  • airflow

  • filtration—of dust, organisms and other air-borne particles

  • olfaction (smell)

  • self-cleansing and moisturising of the mucous membrane

  • humidification and warming of air in its passage to the lungs

  • vocal resonance

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The main symptoms of nasal disorders are discharge, blockage, sneezing, anosmia, itching, postnasal drip, bleeding and snoring (see Table 59.1).1

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Table Graphic Jump Location
Table 59.1

Typical symptoms for nasal disorders2

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Nasal discharge is a common and important symptom to evaluate. The characteristics of nasal discharge are summarised in Table 59.2.

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Table Graphic Jump Location
Table 59.2

Characteristics of nasal discharge

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A major presenting problem is nasal obstruction with the complaint of a blocked or ‘stuffy’ nose. Common causes are physiological (the nasal cycle), rhinosinusitis (allergic or non-allergic), polyps, adenoid hypertrophy and mechanical such as septal deformity.

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Red flag pointers for nasal disorders

  • Unilateral nasal ‘polyp’

  • Unilateral blood-stained discharge

  • Toddler with offensive nasal discharge esp. unilateral

  • Post-traumatic periseptal swelling

  • Rhinitis medicamentosa

  • Chronic sinusitis + LRTI = ? Wegener granulomatosis

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Disorders of smell

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The basic sense of smell is detected in the olfactory region by the olfactory nerve (cranial nerve I) while irritant sensors in the nose, mediated by the maxillary branch of the trigeminal nerve (cranial nerve V), detect some noxious odours.

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The disorders can be classified as:3

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  • anosmia—no smell

  • hyposmia—reduced smell

  • hyperosmia—increased sensitivity to odours

  • dysosmia—distortion of smell perception

    • cacosmia—normal odours seem foul or unpleasant

    • parosmia—a perverse sense of smell

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Disorders of smell can be caused by conductive or sensorineural disturbances or considered as idiopathic (see Table 59.3). Conductive disorders present as anosmia or hyposmia, ...

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