THE RESPIRATORY SYSTEM: The Nose

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Coleen Mosley
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THE RESPIRATORY SYSTEM: The Nose BACKGROUND Anatomy and Physiology of the respiratory system The nasal cavity refers to the interior of the nose, which opens exteriorly at the nostrils.

The nasal cavity can be divided into: Nasal vestibule the dilated area at the nostril opening. Respiratory section the passages through which air travels into the respiratory system.

1 THE RESPIRATORY SYSTEM: The Nose BACKGROUND Anatomy and Physiology of the respiratory system The nasal cavity refers to the interior of the nose, which opens exteriorly at the nostrils. The nasal cavity is lined by the nasal mucosa and is separated down the middle by the nasal septum, a piece of cartilage which shapes and separates the nostrils. The nasal cavity can be divided into: Nasal vestibule the dilated area at the nostril opening. Respiratory section the passages through which air travels into the respiratory system. Each nostril has four turbinate bones, with meatuses (passages into the interior body structures) which connect the nasal cavity to the para-nasal sinuses. Olfactory region the olfactory receptors (smell receptors) are found in this region Other structures include: Para-nasal sinuses these surround the nasal cavity and develop as outgrowths of the nasal cavity into which it drains. The mucosa of the sinuses connects to the nasal mucosa. Naso-lacrimal ducts these ducts connect the lacrimal (tear) duct in the eyes to the nasal cavity.

2 Oral cavity the nasal cavity is separated from the interior of the mouth by the hard palate. The nose functions as an airway and is the outermost extremity of the respiratory tract. Air is drawn in from the atmosphere and supplied to the lungs. Protruding into the nose are three bones, the turbinates, which act as air filters and air conditioners. At the very top of the nose you have a plate called the cribiform plate, which has small holes through which the nerves, responsible for smell, pass through into the nasal cavity. On the nasal cavity side, the cribiform plate is covered by a specialised mucosal membrane called the olfactory epithelium. This epithelium contains cells for smell detection, these cells form the nerves that course through the cribiform plate to the olfactory centre in the brain. The nose is also supplied by nerves that are able to detect pain, temperature and pressure. Within the facial bones and surrounding the nasal cavity are a system of air cells called paranasal sinuses. These are lined by the same mucosa that lines the nasal cavity, and communicates with the nasal cavity by a series of small holes called ostia The nasal mucosa lines the entire nasal cavity. The initial one-third of the nasal cavity is lined with flat-surfaced cells, several layers thick. The posterior two-thirds are lined by cells which are arranged into columns and project tiny hairs called cilia. This layer also contains goblet cells (mucus producing cells). The nasal sub-mucosa underlies the basement membrane (a network of tough fibres which supports the epithelium). This nasal sub-mucosa is made up of glands which secrete watery substances and mucus; it also has nerves, an extensive blood supply and cellular elements like blood plasma. The nasal mucosa lining the olfactory system does not project cilia and contains nerves which connect to the olfactory nerve.

The nasal mucosa plays an important role in mediating immune responses to allergens and infectious particles which enter the nose, preventing the invasion of the nasal cavity and the spreading to

3 The nasal mucosa plays an important role in mediating immune responses to allergens and infectious particles which enter the nose, preventing the invasion of the nasal cavity and the spreading to other body structures, e.g. the lungs. The mucus secreted by the mucosa provides a physical barrier against invasion by pathogens (harmful organisms). It is sticky and traps pathogens when they enter the nasal cavity. Therefore, the nasal mucosa has a Air conditioning function: The nasal mucosa warms and moistens the cold air on its way into the body Filtering function: The cilia (lining the mucosa) and mucus (produced by the glands in the mucosa), filter and trap any particles that may be carried in the air such as pollution, dust, viruses, bacteria, etc. The nose therefore acts as the body s first line of defence. If the nasal mucosa dries out, or if the cilia are dirty and clogged, they can no longer protect us against external agents. The nasal mucosa is also lined with cilia or small hairs which project from the epithelium. Cilia can be divided into two types, namely, motile and non-motile or cilia. The motile cilia are found in the lungs, respiratory tract and middle ear. These cilia have a rhythmic waving or beating motion and work to keep the airways clear of mucus and dirt, allowing ease of breathing without irritation. Non-motile or primary cilia are found in various organs, e.g. kidney and eye, in some cases act as sensory antenna for the cell, receiving signals from other cells or fluids nearby. The motile cilia create motions which drain mucus from the nasal passage to the throat from where it is swallowed and digested by stomach juices.

The activity level of cilia is dependent on temperature. In cold temperatures the cilia become less active.

Condition which cause nasal congestion: Common cold: Symptoms usually start 2 to 3 days after initial contact with the virus and symptoms affect mainly the nose, e.g. nasal congestion, runny nose, scratchy throat and sneezing.

The recommended management of cold and flu include plenty of rest, increase fluid intake and over-the-counter medicine and cough medicine which help to ease the symptoms but do not make the cold go

4 The activity level of cilia is dependent on temperature. In cold temperatures the cilia become less active. Infectious particles and allergens also impair cilia activity and can lead to symptoms such as congested or runny nose. Condition which cause nasal congestion: Common cold: Symptoms usually start 2 to 3 days after initial contact with the virus and symptoms affect mainly the nose, e.g. nasal congestion, runny nose, scratchy throat and sneezing. Adults and older children with colds may or may not have a low fever. The recommended management of cold and flu include plenty of rest, increase fluid intake and over-the-counter medicine and cough medicine which help to ease the symptoms but do not make the cold go away faster. The common cold may be associated with the following complications acute otitis media, sinusitis, an asthma attack or acute bronchitis. Allergic rhinitis: also referred to as allergies or hay fever, occurs when the immune system overreacts to particles (allergens) in the air you breathe. People with allergies may have symptoms often during the year or just at certain times. The symptoms associated with allergic rhinitis include, sneezing, runny/hypertonic Nasal Spray and postnasal drip, watery and itchy eyes and itchy ears, nose and throat. The drainage from the runny nose is usually clear and thin but may become thicker and cloudy or yellowish if the patient presents with a nasal or sinus infection. Allergens that can cause an allergic reaction include dust mites, animal dander, cockroaches and moulds. Rhino-pharyngitis: is an acute or chronic inflammation of the mucous membrane lining the nose and throat caused by a viral infection. The symptoms associated with rhino-pharyngitis include a red, inflamed throat, runny or Hypertonic Nasal Spray, sneezing, and general feeling of ill health (malaise), fever, sensations of pins and needles and a tickling sensation in the throat. It is a contagious condition which is transmitted via airborne droplets of saliva and nasal secretions of infected individuals. Complications of rhinopharyngitis include sinusitis, otitis media (middle ear infection) and laryngitis.

Sinusitis: the sinuses are cavities, or air-filled pockets, near the nasal passage. Like the nasal passage, the sinuses are lined with mucous membranes.

5 Sinusitis: the sinuses are cavities, or air-filled pockets, near the nasal passage. Like the nasal passage, the sinuses are lined with mucous membranes. There are four different types of sinuses: Ethmoid sinus. Located around the area of the bridge of the nose. This sinus is present at birth, and continues to grow. Maxillary sinus. Located around the area of the cheeks. This sinus is also present at birth, and continues to grow. Frontal sinus. Located in the area of the forehead. This sinus does not develop until around 7 years of age. Sphenoid sinus. Located deep in the face, behind the nose. This sinus does not develop until adolescence. Sinusitis is an infection of the sinuses. Sinusitis may be acute or chronic. Acute sinusitis can occur several times a year, but usually goes away after a few weeks. In chronic sinusitis the symptoms are more persistent and do not go away for a long period of time. These infections usually occur after a cold or after an allergic inflammation. Sometimes, a sinus infection happens after an upper respiratory infection (URI) or common cold. The URI causes inflammation of the nasal passages that can block the opening of the paranasal sinuses, and result in a sinus infection. Allergies can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus. There are other possible conditions that can block the normal flow of secretions out of the sinuses and can lead to sinusitis including the following: secondary smoke, enlarged adenoids, swimming, tooth infections, cleft palate. When the flow of secretions from the sinuses is blocked, bacteria may begin to grow. This leads to a sinus infection, or sinusitis. Signs and symptoms include: runny nose, night time cough, headaches, sore throat, post-nasal drip, swelling around the eyes.

6 Management of conditions which cause nasal congestion A congested or blocked nose can be unpleasant especially if it makes breathing through the nose difficult. There are various OTC products which can be used to manage nasal congestion, and we will have a look at what is recommended for each condition. treatment of the common cold is symptomatic, and includes analgesics for pain and fever, anti-inflammatories for body aches, nasal decongestants (oral or topical) and antihistamines for post nasal drips as well as cough mixtures. Saline solutions also aid in relieving nasal secretions and congestion. Common cold - treatment of the common cold is symptomatic, and includes analgesics for pain and fever, anti-inflammatories for body aches, nasal decongestants (oral or topical) and antihistamines for post nasal drips as well as cough mixtures. Saline solutions also aid in relieving nasal secretions and congestion. Allergic rhinitis there is no cure for allergic rhinitis, but it is strongly recommended to avoid the allergens which cause the allergic reactions. Antihistamines work well for treating allergy symptoms, both oral dosage forms and nasal sprays can be used. Nasal corticosteroid sprays are the most effective treatment for allergic rhinitis, and they work best when used continuously. Nasal decongestants sprays are helpful in reducing symptoms of nasal stuffiness but should not be used for longer than 7 10 days. Saline solutions also aid in relieving nasal secretions and congestion. Rhino-pharyngitis - treatment is symptomatic, and includes analgesics for pain and fever, anti-inflammatories for body aches, nasal decongestants (oral or topical) and antihistamines for post nasal drips as well as cough mixtures. Saline solutions also aid in relieving nasal secretions and congestion. Sinusitis corticosteroid nasal sprays are commonly used to treat sinusitis as they reduce the inflammation and help to reduce the swelling of the mucous membranes in the sinuses. The disadvantage of these sprays is that they can cause headaches and nosebleeds. Analgesics and decongestant nasal sprays are also used. Unlike corticosteroid nasal sprays, decongestants provide immediate relief. The continuous use of decongestant nasal sprays can result in the opposite effect, i.e. rebound congestion (Rhinitis medicamentosa), where the membranes in the nose start to swell up again. Saline solutions and inhalations also aid with nasal decongestion.

7 Stérimar Sea Water Nasal Spray Stérimar is sea water solution. The nasal spray is drug and preservative free and contains mineral salts and trace elements, such as: Copper is used for its anti-infectious and anti-inflammatory properties: o It protects the nasal mucosa against infectious agents (bacteria, viruses); o It participates in cell regeneration. Manganese for its anti-allergic and anti-oxidant effect: o It helps protect the nasal mucosa against allergens. o It participates in cell regeneration Silver & Zinc: Known for their antiseptic properties Sulphur: Known for its trophic/nourishing effect on the nasal mucosa Hypertonic vs. Isotonic Solutions The concentration of salt in the solution will determine if the solution is hypertonic or isotonic. An isotonic saline solution contains the same amount of sodium/salt as the cells in the body s fluids, whereas a hypertonic solution contains more sodium/salt than that found in the body s fluids. Fluid has a tendency to move from a low concentration (less) of salt to a high concentration (more) of salt. So what effect does this have on the cells or mucous membranes? In an isotonic solution, the salt concentration is the same in the solution as well as the body s fluids; therefore there is little movement of fluid. The saline solution bathes the cells and restores moisture to the nasal passages. Isotonic solutions also reduce the symptoms of sinusitis, viz. nasal secretions & postnasal drip, and it effectively alleviates chronic sinusitis. It also reduces sino-nasal symptoms caused by air borne irritants, e.g. pollen and dust.

8 In a hypertonic solution, the salt concentration is higher in the solution than in the body s fluids, therefore there is movement of fluid out of the cell, having a drying/decongestant effect. Hypertonic solutions also provide relief for sinusitis and allergic rhinitis, as well as nasal congestion.

9 PRODUCT CHARACTERISTICS Product: Active Ingredient: Scheduling Status: Dosage Strengths: Pharmacological Classification: Indications: Mechanism of Action Dosage: USP s: STERIMAR NASAL SPRAY Stérimar Nasal Spray Sea Water Trace elements and minerals Purified Water to 100 ml Unscheduled Isotonic Seawater Solution Nasal Spray DAILY NASAL HYGIENE of the newborn, child and adult HUMIDIFICATION OF THE NASAL MUCOUS MEMBRANE in a dry environment. Stérimar NS is an isotonic sea water solution which bathes the cells of nasal mucosa aiding in daily nasal hygiene and to remove secretions from the nose. Two to six sprays per day in each nostril Contains mineral salts and trace elements Preservative free Non-return valve which ensures the integrity of the contents for the duration of the shelf life The diffuser mounted in the nozzle produces a micro-diffusion effect, gently delivering a fine spray

10 STERIMAR BABY NASAL SPRAY Product: Active Ingredient: Scheduling Status: Dosage Strengths: Pharmacological Classification: Indications: Mechanism of Action: Dosage: USP s: Stérimar Baby Nasal Spray Sea Water Trace elements and minerals Purified Water to 50 ml Unscheduled Isotonic Seawater Solution Nasal Spray It is recommended for babies from 0 3 years to: Cleanse the nasal passages to enhance the action of medicated treatments Aid with daily nasal hygiene and assist in removing secretions from the nasal passages Stérimar Baby NS is an isotonic sea water solution which bathes the cells of nasal mucosa aiding in daily nasal hygiene and to remove secretions from the nose. One spray per nostril two to six times per day Contains mineral salts and trace elements Non-return valve which ensures the integrity of the contents for the duration of the shelf life Salt content and pressure have been developed to be gentle on baby s nasal mucosa The nozzle is graduated and has a safety flange to ensure it is not inserted too deep into baby s nose

11 STERIMAR BABY-CHILD HYPERTONIC NASAL SPRAY Product: Stérimar Baby-Child Hypertonic Nasal Spray Sea Water 60 ml (1,7 g/l) Copper salt Active Ingredient: Manganese salt Purified Water to 100 ml Scheduling Status: Unscheduled Dosage Strengths: Salt concentration 1.7 g/l (1.7 %) Pharmacological Decongestant Nasal Spray Classification: It is recommended for short-term use in babies from 3 months and children to : Provide relief from nasal congestion caused by the Indications: common cold, rhino-pharyngitis, allergic rhinitis and sinusitis Cleanse the nasal passages to enhance the action of medicated treatments Stérimar Hypertonic Nasal Spray contains a moderately higher salt concentration than what is found in the body s Mechanism of cells, this causes the movement of water out of the cells in Action the nasal mucosa resulting in decongestion of the nasal passages. Dosage: USP s: One spray per nostril two to six times per day Contains mineral salts and trace elements Contains added copper and manganese Non-return valve which ensures the integrity of the contents for the duration of the shelf life Salt content and pressure have been developed to be gentle on baby s nasal mucosa The nozzle is graduated and has a safety flange to ensure it is not inserted too deep into baby s nose MECHANISM OF ACTION Stérimar Baby-Child Hypertonic Nasal Spray is a moderately hypertonic sea water solution which is enriched with copper. The nasal spray is drug and preservative free and contains mineral salts and trace elements. The hypertonicity of the sea water solution is what allows for decongestion to take place.

When the nose is blocked, the nasal mucosa becomes swollen and the cilia of the nasal epithelium are trapped in mucus and cannot filter and evacuate foreign particles and excess mucus.

12 When the nose is blocked, the nasal mucosa becomes swollen and the cilia of the nasal epithelium are trapped in mucus and cannot filter and evacuate foreign particles and excess mucus. Stérimar Hypertonic Nasal Spray is able to unblock the nose by the physical effect of osmosis. Osmotic effect mechanism The process of osmosis causes the movement of secretions out of the congested nasal mucosa into the nasal passage, reducing the swelling of the nasal mucosa and opening of the nasal passages making it easier to breathe. The significance of Copper in Stérimar Hypertonic Nasal Spray: Copper is a trace element with antiseptic action. The copper enriched formula of Stérimar Hypertonic Nasal Spray helps to reduce the risk of bacterial colonisation of the nasal mucosa. INDICATION Stérimar Baby-Child Hypertonic Nasal Spray is indicated for use in children 3 months and older to: Provide relief from nasal congestion associated with the common cold, allergic rhinitis, rhino-pharyngitis and sinusitis Cleanse the nasal passages to enhance the action of medicated treatments

DOSAGE AND DIRECTIONS FOR USE One spray per nostril two to six times per day. SIDE-EFFECTS Stérimar Baby-Child Hypertonic Nasal Spray has no known side effects or special precautions.

13 DOSAGE AND DIRECTIONS FOR USE One spray per nostril two to six times per day. SIDE-EFFECTS Stérimar Baby-Child Hypertonic Nasal Spray has no known side effects or special precautions. It may be used in combination with other nasal sprays (corticosteroid nasal sprays). Stérimar Baby-Child Hypertonic Nasal Spray should only be used for a short period of time, as continuous use causes drying out of the nasal mucosa and can lead to nose bleeds. POINTS TO NOTE!! Stérimar Baby-Child Hypertonic Nasal Spray, provides relief from nasal congestion, but there are other conventional, medicated nasal sprays which can also be used to provide nasal decongestion, namely, nasal sprays containing xylometazoline and oxymetazoline. These conventional nasal sprays should not be used continuously for more than 7 10 days as they may cause drug-induced or rebound congestion (Rhinitis medicamentosa). Rebound congestion is the abnormal swelling and enlargement (hypertrophy) of the nasal mucosa which blocks the nasal airway and causes discomfort and difficulty breathing. This rebound congestion is temporarily relieved by the administration of the decongestant nasal spray. When the temporary effect wears off, the nasal mucosa becomes swollen again blocking the nasal airway. Stérimar Baby-Child Hypertonic Nasal Spray does not cause rebound congestion as the mechanism by which it aids decongestion is different to that of conventional, medicated nasal sprays. Stérimar Hypertonic Nasal Spray causes decongestion by the process of osmosis (movement of fluid out of cells) whereas conventional decongestant nasal sprays cause decongestion by the stimulation of certain receptors on blood vessels in the nasal mucosa. However, it is also recommended that Stérimar Hypertonic Nasal Spray not be used continuously to avoid drying out of the nasal mucosa which could results in nose bleeds.

14 THE POSITIONING STATEMENT Stérimar Baby Nasal Spray and Stérimar Baby-Child Hypertonic Nasal Spray are both sea water nasal sprays; however, it is important to be able to distinguish between the two nasals sprays and to know when each should be recommended for use. Stérimar Baby Sea Water Nasal Spray Stérimar Baby-Child Hypertonic Nasal Spray Recommended age Recommended for use in children from 0 3 years Recommended for use in children from 3 months and older Indication Daily nasal hygiene Provide relief from nasal congestion associated with the common cold, allergic rhinitis and sinusitis Benefits Assists in clearing nasal secretions allowing for easy breathing esp. during feeding and before the use of medicated treatments Isotonic sea water solution which contains trace elements and minerals Preservative free Features Graduated nozzle with safety flange preventing insertion too deep into the nostril avoiding injury on administration Nozzle designed to deliver a micro-fine spray with gentle pressure Pocket size easy for travelling The salt content allows for gentle decongestant action Contains copper which has antiseptic properties, reducing the risk of bacterial colonisation Preservative free Cleanses to enhance action of medicated treatments Graduated nozzle with safety flange preventing insertion to deep in the nostril avoiding injury on administration Nozzle designed to deliver a micro-fine spray with gentle pressure Pocket size easy for travelling

15 In summary: Stérimar Hypertonic Nasal Spray is indicated to provide relief from nasal congestion associated with the common cold, sinusitis and allergic rhinitis. It should only be used during periods of congestion and not on a continual basis Stérimar Baby is indicated for daily nasal hygiene and may be used on a daily basis for indefinite periods of time Once nasal congestion is relieved by Stérimar Hypertonic Nasal Spray, the patient may use Stérimar Baby on a daily basis again Condition Common cold Allergic rhinitis Sinusitis Benefits of Sterimar Copper is used for its anti-infectious properties: It protects the nasal mucosa against infectious agents (bacteria, viruses); It participates in cell regeneration. Manganese for its anti-allergic and anti-oxidant effect: It helps protect the nasal mucosa against allergens. It participates in cell regeneration. Silver & Zinc: Known for their antiseptic properties Sterimar rids the nasal passages of allergens, reducing nasal congestion, the volume of mucus & restoring nasal function Copper: Known for its anti-infectious and anti-inflammatory properties Manganese: Known for its anti-allergic properties Sterimar clears the nose & sinus cavities by washing away excess mucus & inflammatory material relief of congestion & stimulates the noses own mucus clearing system Copper: Known for its anti-infectious and anti-inflammatory properties Manganese: Known for its anti-allergic properties Sulphur: Known for its trophic/nourishing effect on the nasal mucosa Silver & Zinc: Known for their antiseptic properties

What are the causes of nasal congestion?

What are the causes of nasal congestion? Stuffy Noses Nasal congestion, stuffiness, or obstruction to nasal breathing is one of the oldest and most common human complaints. For some, it may only be a nuisance; for others, nasal congestion can