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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 (1812–1870), 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 48.1).1
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Nasal discharge is a common and important symptom to evaluate. The characteristics of nasal discharge are summarised in TABLE 48.2.
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A major presenting problem is nasal obstruction with the complaint of a blocked or ‘stuffy’ nose. In those without a current URTI, 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 bloodstained discharge
Toddler with offensive nasal discharge, esp. unilateral
Post-traumatic periseptal swelling
Rhinitis medicamentosa
Chronic sinusitis + LRTI = ?Wegener granulomatosis
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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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Disorders of smell can be caused by conductive or sensorineural disturbances, part of normal ageing or considered as idiopathic (see ...