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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.


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.

The main functions of the nose are:

  • 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

The main symptoms of nasal disorders are discharge, blockage, sneezing, anosmia, itching, postnasal drip, bleeding and snoring (see TABLE 48.1).1

Table 48.1Typical symptoms for nasal disorders2

Nasal discharge is a common and important symptom to evaluate. The characteristics of nasal discharge are summarised in TABLE 48.2.

Table 48.2Characteristics of nasal discharge

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.

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


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.

The disorders can be classified as:3

  • 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

Disorders of smell can be caused by conductive or sensorineural disturbances, part of normal ageing or considered as idiopathic (see ...

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