The nose is one of the most important organs that affect our quality of life and health. Our sense of smell, which is one of our five senses, is located in the nose, although it is the most important part of our breathing. Smell works in conjunction with our sense of taste. Although smell disorders are rare, nasal congestion is one of the most common complaints.
If we cannot breathe comfortably, our physical performance is affected and we get tired more quickly. Our sleep patterns and quality deteriorate. Snoring occurs and we feel tired during the day because we cannot rest well. We are more likely to have cardiovascular and pulmonary disease in the future. Sexual reluctance and performance disorders have been reported in studies. It has been reported that it affects the psychological state of the patient and facilitates the emergence of other diseases.
It causes speech disorders, night urination, ear problems and hearing problems, especially in children. There has been an increase in surgeries related to this. Nasal congestion generally impairs our quality of life for these reasons.
Nasal congestion can occur due to the anatomical curve of the cartilage and bones forming the inside of the nose, as well as with diseases that affect the mucous membranes such as allergies. Polyps that sometimes form in the nose due to allergies also cause nasal congestion and even obstruct the olfactory pathways, leading to olfactory disorders. Rarely, causes such as tumors that develop inside the nose also cause nasal congestion.
In children, this is often caused by the adenoids, and it also causes middle ear problems because it is close to the ear tubes.
Allergic rhinitis, which we see frequently in our country, is among the main causes of nasal congestion. It occurs as a result of a reaction developed by the body against the allergic substances circulating in the air and causes complaints by affecting all the mucous membranes lining the nose. It causes a thick sticky discharge.
It causes nasal congestion with the swelling of the tissues, as well as causing sinusitis by clogging the sinus openings.
What is the ideal nose and how should it be?
The concept of “ideal nose” may vary from society, geography and person to person. About 7 billion people live in the world and there is an ideal nose shape for that many different face types. According to the researches, when the angle between the tip of the nose (nasal type) and the upper lip is 106 degrees, the facial beauty of women becomes evident. A nose with an angle of less than 90 degrees looks more masculine and longer.
However, according to us experts, it is much more important to make an appearance suitable for the facial features of the individual rather than the general formulas. When we look at the face in general, the nose is the ideal nose, which is proportional to the facial features, looks beautiful and harmonious, the nose wings are not very wide, and the parts such as the tip of the nose and the back of the nose complete each other in itself.
At the same time, the ideal nose, which should be in a symmetrical structure, is expected to be equal when the nose wings and the middle line of the nose are viewed from the opposite side.
When we divide the face into 3 equal parts, including the inner canthus and lip line of the nose in the midline of the face, a nose proportional to these parts is the ideal nose. At the same time, the fact that the nostrils that are not open are at the level of the eye midline completes the proportional perfection.
During the Renaissance, famous artists and architects used the “golden ratio” formula while creating their works. Centuries later, scientists tried to explain the secrets of facial beauty using this mathematical formula.
According to researches, Hollywood stars such as Liz Hurley, Scarlett Johansson and Jessica Alba have the closest face sizes to these criteria.
The Most Important Point of Our Nose
The nose is the most important organ as it is the first entry point in our breathing.
It forms the entrance channel of the airway. As the air passes here, it warms and moistens and reaches the lungs cleanly. The narrowest point is where the nostrils begin. Air begins its journey through this narrowest point, reaching the lungs. The nostrils are in a triangular structure consisting of bone at the bottom, septum cartilage in the middle, and alar cartilages forming the nose type at the top. The characteristic of this structure is that it consists of hard tissues and is suitable for adequate air penetration. Any constriction that will occur here makes it impossible to breathe through the nose.
Another reason why the nostrils are composed of hard tissues such as cartilage and bone is the laws of physics in air movements. This principle is called Bernoulli’s Law. According to this law; The speed of air moving from one place to another is inversely proportional to its pressure. That is, the pressure of the accelerating air decreases. This basic principle allows airplanes to take off and move through the air. In short, it is this law that makes those giant planes fly.
So what does this have to do with our nostrils?
I mentioned that the anatomical structure of the nostrils consists of hard tissues. The speed of the air passing through the holes, which is the narrowest part of the nose, will be higher than in other places. Therefore, the pressure will decrease as the air passes through.
The negative pressure that will occur here attracts the soft tissues and causes the hole to narrow. This will make it difficult for air to pass, leading to nasal congestion. In a normal nose, if there are no anatomical disorders such as deviation and enlargement of the nasal concha, this effect does not occur and is not felt.
Or, if nose surgery is performed for such reasons and the bone and cartilage tissues here are taken more than necessary to open the airway, our complaints of nasal congestion will begin, in which Bernoulli’s Law comes into play. I see these complaints mostly after rhinoplasty surgeries. Therefore, the point that I pay the most attention to when performing rhinoplasty is the physiological structure of the nostrils.
Collapse that will occur with the narrowing of the nostrils or the loss of hard tissues such as cartilage and bone will cause nasal congestion.
My advice to physicians who perform this surgery is to always use their preferences to protect physiology and never forget Bernoulli’s Law.
What is Nasal Congestion?
What are the causes of “nasal congestion”, one of the most common complaints we hear?
Physical Disorders: The most common nasal division curvature is “deviation”. As we can see due to accidental nasal trauma, it can also appear as a congenital disorder. In cases of accidental nasal fractures, curvature also occurs in the bone above the nose. Their treatment is surgery and it is necessary to perform the surgery using the Rhinoplasty technique.
Nasal Flesh Swelling: Nasal meats are three pieces of meat on both side walls of the nasal cavity, with a bone leaf inside and covered with a mucous membrane. Its most important benefits are to warm and humidify the air passing through the nose. Nasal meats can swell for reasons such as allergies, and as a result, they cause nasal congestion.
Nasal canal surgery can be performed under general anesthesia, or if only the concha will be intervened, it can also be performed under local anesthesia in office conditions. When allergy progresses, it can cause polyps in the nose, and the only treatment for this condition, which we call chronic allergic sinusitis, is surgery. After the operation, it is necessary to apply an effective and continuous treatment of allergic rhinitis to the patient.
Nasal congestion caused by all these reasons causes various ailments. These include poor physical performance and sleep disorders. Sleep quality deteriorates with snoring and frequent waking at night, and sleep apnea may also be seen with snoring. It has been observed that patients with chronic nasal obstruction experience blood pressure problems due to cardiovascular diseases more frequently in older ages.
Patients with nasal congestion are more likely to get upper respiratory tract infections. If there are habits that disrupt intranasal activities such as smoking, this rate doubles. Numerous articles have been published on the negative effects of nasal congestion on sexual performance. It occurs with sexual reluctance, sleep disorder and easy fatigue. In children, it creates ear problems that can lead to speech disorders, night urination, middle ear infections and hearing loss.
In order to eliminate these diseases caused by nasal obstruction, a paranasal sinus tomography to be taken after a careful examination and history reveals the entire nasal anatomy as a photograph. It is possible to eliminate the complaints with interventions such as deviation, nasal concha and sinusitis surgery.
Why Do We Snore?
Snoring is actually the state of the air passing through our upper airways while sleeping, making a disturbing sound during the time it takes until it reaches the lungs. Studies show that snoring is a health problem as well as a social possibility. Snoring can be seen in almost every age group and gender. It can also cause sleep apnea, depending on its severity and the amount of carbon dioxide in the blood.
Although snoring and sleep apnea cause different clinical complaints, they occur due to the same anatomical disorders. These anatomical features are seen in 90% of patients who snore. These are the organs and tissues in the upper airways such as the curved nasal septum (deviation), sinusitis, adenoids, large tonsils, stenosis of the tongue root and throat wall, and small jawbone. In addition, the severity of snoring increases with the retraction of structures such as the soft palate and pharynx wall in the throat created by the rapidly passing air in the throat area. Some drugs and alcohol double these effects.
If patients with sleep apnea also have serious cardiovascular problems, this can lead to a life-threatening condition. Studies have shown that the most common death time of 432000 deaths due to cardiovascular causes occurred during sleep, when the activity was the lowest, such as between 5 and 6 in the morning.
In studies conducted in children, it has been observed that the ECG findings of children who snore due to tonsil adenoids improve after surgery.
What is Nose Filling?
Facial rejuvenation and non-surgical facial aesthetic techniques applied to the face have also started to be applied to the nose, and lately, a lot of questions have been coming from my followers, especially on social media. In response to these questions and to enlighten my patients, I wanted to share information about nose filling, the rising trend of recent times, in this blog post.
Nose filler; It is a filling application that allows to change the external appearance of the nose without surgery. Hyaluronic acid and its derivatives are generally used as fillers. With nasal filling, the curvature of the nose can be alleviated or the tip of the nose can be lifted.
It is not possible to solve anatomical problems such as breathing problems or valve failure with nasal filling. In other words, we use the filling for aesthetic purposes, not to provide functional solutions, except in exceptional cases. Its permanence lasts for 1 – 1.5 years.
It is an application that should be used by experienced hands because it carries a risk of complications, just like face filling. It also requires a very good knowledge of anatomy. Before the application, we conduct a detailed examination by meeting with the patient and the filling decision is made accordingly.
I can recommend it to my patients who are hesitant about undergoing rhinoplasty, but it should be reminded that it is not permanent and will not lead to a functional change.
In addition, every substance made between the nose, skin and cartilage creates a healing tissue and causes a small-scale reaction. This reaction causes a permanent tissue change in the place where it is made, just like the wound healing tissue. While this leads to good results in some cases, it sometimes leads to situations that need to be corrected with surgery.
When filling our patients who have never had rhinoplasty surgery, it is always necessary to calculate the possible results by considering the anatomical features of the nose. It should be explained in detail to the patients that the decision for surgery is taken without the need for filling, and that in some cases it may be necessary to apply to auxiliary materials such as filling during or after the operation.
The filling physician should always have a good grasp of the anatomy and physiology of the organ he is filling and know all kinds of operations to be performed on that organ.
Deviation and Headache
One of the most frequently asked questions by ENT physicians; Does the nasal division curvature (deviation) cause a headache? Headache is thought to be caused by sinusitis. However, no significant relationship was found between headache and sinusitis in the examinations and paranasal sinus tomography.
In acute sinusitis, pain may be seen in the front of the head, although it may not be too much. In chronic sinusitis, this is expressed as a feeling of fullness rather than pain. An ENT physician should always request computed sinus tomography when investigating whether the headache is due to sinusitis.
At the end of this examination, the presence of sinusitis can be understood in detail. In this X-ray, which can scan the detailed head and sinus region by fine division, it can also be determined that the septum deviation is present in the majority of patients. When evaluating the results, if the presence of sinusitis could not be revealed, the frequently asked question is, does this deviation cause headache if there is no sinusitis? Since the sinuses are divided into thin sections radiologically in computed sinus tomography, the neighborhood of this bone curvature with the sinuses and concha can be seen in great detail.
Although it has been suggested that they may trigger a headache due to contact, since the neighborhood of the nasal septum curvature with the sinus holes and nasal concha were revealed in the studies conducted by various centers, it was stated that this was not significant in studies with larger numbers.
Although the deviation does not cause headache, it can physically block the sinus openings in upper respiratory tract infections and lead to easier sinus infections, as well as very often causing nasal congestion. Therefore, the most common complaint of ENT physicians is nasal congestion. Sinusitis may cause headache from time to time, but it has not been proven that septum deviation causes headache.
