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With aging, the physiology and function of the nose changes. The
nose lengthens, and the nasal tip begins to droop due to
weakening of the supporting cartilage. This in turn causes a
restriction of nasal airflow, particularly at the nasal valve
region (where the upper and lower lateral cartilages meet).
Narrowing in this area results in the complaint of nasal
obstruction, often referred to as geriatric rhinitis.
Patients with geriatric rhinitis typically complain of constant
“sinus drainage,” a chronic need to clear the throat or “hawk”
mucus, and a sense of nasal obstruction, most often when they
lie down. Other features include nasal crusting especially in
the winter and in patients taking diuretics, vague facial
pressure (attributed to “sinus trouble”), and a decreased sense
of smell and taste.
However, it is a mistake to blame all upper respiratory problems
on the aging process. Elderly patients with symptoms such as
repeated sneezing, and watery eyes, nasal obstruction with clear
profuse watery runny nose, and soft, pale turbinates (top-shaped
bones in the nose) may have allergic rhinitis. Patients with
this diagnosis will benefit from consultation with an
otolaryngic allergist.
Patients with chronic sinusitis will have a long history of
thick drainage that is often foul smelling and tasting and is
associated with nasal obstruction, headaches, and facial
pressure. These patients usually have pus drainage and nasal
redness. In contrast, the geriatric rhinitis patient usually has
a dry, irritated nose. The diagnosis of chronic sinusitis can be
confirmed with a computed tomography scan (CT scan) of the
sinuses.
Sinusitis or rhinosinusitis, which is it? In recent studies,
otolaryngologist–head and neck surgeons have concluded that
sinusitis is often preceded by rhinitis and rarely occurs
without concurrent rhinitis. The symptoms, nasal
obstruction/discharge and loss of smell, occur in both
disorders. Symptoms associated with rhinosinusitis include nasal
obstruction, nasal congestion, nasal discharge, nasal purulence,
postnasal drip, facial pressure and pain, alteration in the
sense of smell, cough, fever, halitosis, fatigue, dental pain,
pharyngitis, otologic symptoms (e.g., ear fullness and
clicking), and headache. Patients with documented chronic
sinusitis unresponsive to medications should be referred to an
otolaryngologist. |
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Osteoporosis is a significant health problem in the United
States affecting approximately 24 million Americans, 15 to 20
million of whom are women over 45 years of age. Because of the
concerns regarding prolonged estrogen use in postmenopausal
women, a nasal calcitonin spray is sometimes prescribed to
prevent bone loss. The most common side effect reported with
nasal calcitonin spray is a runny nose. Other symptoms that may
occur include nasal crust, dryness, redness, irritation,
sinusitis, nosebleeds, and headache. Sinusitis sufferers using a
nasal calcitonin spray should inform their physicians. |
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