The Nose Rules: How to Live and Perform with Yours
Stephen A. Mitchell, MD, FACS
Nashville Ear, Nose and Throat Clinic
The nose, you can’t live without it and sometimes you wonder if you will survive with it. This overview will cover what that structure in the middle of the face is supposed to do, what happens when it messes up, and what the performer can do to professionally survive regardless.
When functioning properly, the nose will provide sufficient humidified, filtered air to the lungs for most activities. The moisture provided prevents drying of the larynx and windpipe which will lead to hoarseness, coughing, and deterioration of the respiratory tract function. The filtering is vital when breathing in dusty, smoky, or pollen-laden air. Performers in nightclubs and orchestra pits can appreciate this action.
A more subtle task is the sense of smell which not only heightens the quality of life but alerts the body about dangers such as spoiled food, poisonous fumes, smoke, and poor personal hygiene. The sinuses use the nose as a passageway and equalize their pressure and drain into the nose. The space of the nasal and sinus cavity adds a richness of resonance to the voice.
The eustachian tube runs behind the ear drum to just behind the back of the nose and is lubricated by the nasal secretions and aids in equalizing the pressure of the ears.
Mucous secretions from the nose gently coat the back of the throat and palate, making them supple and protecting the lining from trauma and infection. This lubrication also modifies the vibratory characteristics of the tissues of the throat and palate.
Unfortunately, this is an imperfect world and things go wrong. The optimal performance of the nose can be disrupted by a legion of items including viruses, bacteria, hormones, medications, solvents, aging, surgery, smoke, alcohol, allergies, cocaine to name a few.
The lubrication of the nose has to be just right. Too little and the mucous is thick and gummy with a tendency to form crusts and scabs in the nose. Too much and the excess pours out the front and back of the nose with the attendant wet sleeves and hankies. The glands will tend to over produce in response to irritants like smoke, pollen, solvents and viral colds. Drying is a common effect of many medications, both over-the-counter and prescription. Aging and some arthritis like disorders reduce the number of glands that help produce moisture. Some surgical procedures permanently remove lubricators in the nasal cavity.
Hormonal changes associated with pregnancy, menopause, or thyroid imbalance will make the lining of the nose swell and clog off the airway. Clogging also occurs with severe nasal allergies, medication reactions, and sinus infections. This reduction in airway mandates mouth breathing of unhumidified air with drying of the mouth and frequent snoring.
Any of these problems in a professional instrumentalist or vocalist will interfere with performance.
Unfortunately, treatment must be custom tailored to the individual as we are not all created equal. This makes Ten Commandment pronouncements difficult but some generalizations are still possible for some conditions.
Allergic rhinitis (runny, sneezing nose) is treated by avoiding the allergen. For dogs and cats, that means kicking them out of the bedroom and limiting contact elsewhere. For food allergies, that means not eating the offending food. For pollen, that means rolling up the windows and limiting outdoor activity. When avoidance is insufficient, medications that control the symptoms with minimal side effects are used. These include non-sedating antihistamines and steroid nasal sprays. Decongestants like pseudoephedrine are avoided because they dry the mouth, cause the heart to speed up, and promote jittery hands and fingers. When medications fail, then allergy testing and shots may be next.
The stuffy nose needs investigation to determine the cause. A dangerous practice is to frequently use an over-the-counter nasal spray to fix the problem. After less than a week, the nose can get addicted to the spray and get worse as a result. Although medications can help here, they can also be the culprit. Sometimes surgery is the best treatment, but only after careful medical workup.
Bloody noses can be due to dryness, high blood pressure, aspirin, nose picking, to name a few. Drinking more water, using saline nose spray, and applying a small dab of Vaseline to the nose may be all that is required in simple cases. Persistent cases require evaluation.
Sinus infections require immediate rest, fluids, and three days of over the counter nose spray. If this doesn’t allow the body’s immune system to cure it, then antibiotics and medical treatment are required as soon as possible. The longer the infection runs, the harder it is to cure and longer the patient is impaired.
The first line of defense is a strong offense, in other words, prevention. It is mandatory to actively strive to do healthy things to reduce the risk of problems. Rest, good eating habits, good mental health, exercise, and avoidance of abuse are the cornerstones of a body that can resist infection and disease. To expect multivitamins and aromatherapy to offset marijuana, Jack Daniels, and Twinkies is delusional.
Informed prevention is augmented by knowledge. Knowledge of the effects of medical conditions, medications taken, allergies suffered, and allergens in the home or work place. Knowledge of what therapy to use for each condition and the pros and cons of each. Knowledge by your doctor of what the requirements of your profession are. Learn all that you can and ask questions. Good luck and keep your nose clean.
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