CC: How Your Nose Works

The Modern Nose Clinic brings to you our Clinical Concept video on how your nose is supposed to work. We start off with the basics.

Many of you watching this may have had an appointment with us already, and you would like to learn a little bit more about some of the vocabulary that we use, some of the anatomy.

First of all, I think it's important to talk about normal function of the nasal airway.

Your nose has three basic functions:

1. Smell and taste

2. Filter and clean

3. Condition the nasal airflow

When you move air across the upper part of the nose where my finger is pointing, you will expose the airflow to the nerve that can sense smell; the nerve is called the olfactory nerve. You can see the small, little tunnels or perforations through which that nerve will move. There are so many people who cannot smell very well, and therefore, their sense of taste is also dramatically diminished. Having normal nasal function will provide you with maximum – an ideal sense of smell.

As air moves across the sinuses and, basically, to the outside portion of a structure called a middle turbinate – so we say, lateral to the middle turbinate – air will move across the openings of various sinuses where secretions are created, and as it moves through, it'll bounce off of several mucosal surfaces. This will enable the nose to – through its stickiness – attract any particulate matter, and that particulate matter will be filtered out of the air. Particulate matter may include smoke, viral particles, fungus bacteria, or any other pathogen that could be floating in the air.

So one very important concept is that there should be some resistance when air moves through your nose because that's the filtration process occurring. The secret is to not have too much resistance where you're unable to breathe through your nose at all. If that were to occur, then you get no filtration whatsoever.

By the time the air has reached the posterior or the back part of your nasal airway, it will have been conditioned. And this is different from filtering out particulate matter. Conditioning involves moistening the air as additional humidity is created and to warm the air, typically. In rare occasions, it may actually cool the air. But basically, you want to prepare the air to go into your lungs, and it's going to be maximally moistened and warmed.

So the first clinical concept is, what we refer to at the Modern Nose Clinic, a term called physiologic nasal airflow. We believe the air should follow a pattern as it moves through the nasal airway to maximally achieve the above three functions. The corollary to this is that any anatomic problem in your nose will prevent the nose from moving air through efficiently. From 100% to something less than that. For instance, if you breathe exclusively or mostly through your mouth, then you will be using zero percent of your nasal functions. If you undergo a traditional nasal surgery in the operating room where the inferior turbinate is dramatically reduced in size, this could channel airflow along the floor of the nose and remove the upper 90% from performing its normal functions. This would lead to less than 10% efficiency of the nose. This also could predispose you to a condition called empty nose syndrome. Feel free to see my video on empty nose syndrome for additional information.

So let's pause and make our first summary point. At the Modern Nose Clinic, our procedures will provide you with physiologic nasal airflow. The next few discussion points focuses on what other ear nose and throat clinics will do and should be avoided.

Traditional nasal surgery will involve reducing the size of the inferior turbinate, which has been demarcated here with several small lines. The problem with doing that is that air will then be channeled along the path of least resistance, which will be the floor of the nasal airway. Unfortunately, patients will recover from this surgery initially excited that they can breathe without any nasal resistance at all. The problem is that you should have some resistance. As we mentioned earlier, there is supposed to be a filtration function occurring, and when air moves along the floor of the nose and does not utilize the upper 90%, you have basically rendered your nose crippled. And therefore, this practice should be avoided or only undertaken with extreme caution.

If 90% of your airflow moves along the floor of the nose, then you never have the opportunity to move the air across the olfactory nerve, and your sense of smell will be diminished. This may not be immediately obvious to you, but your sense of smell and taste could have been better had you undergone a more elegant or delicate surgery. You basically have created a second mouth because the mouth does not have the ability to filter out air as the nose does, and the air will move from the front of the nose to the back without any humidity, without any conditioning, and with very minimal filtration.

So that's physiologic nasal airflow, and the three important functions of the nose. It's important to start with this so that the rest the anatomy will make more sense. See ya.

Thank you from the Modern Nose Clinic