Nasal Physiology and Pathophysiology of Nasal Disorders PDF
Preview Nasal Physiology and Pathophysiology of Nasal Disorders
T. Metin Önerci Editor Nasal Physiology and Pathophysiology of Nasal Disorders 123 Nasal Physiology and Pathophysiology of Nasal Disorders T. Metin Önerci Editor Nasal Physiology and Pathophysiology of Nasal Disorders Editor T. Metin Önerci Department of Otorhinolaryngology Faculty of Medicine Hacettepe University Ankara Turkey ISBN 978-3-642-37249-0 ISBN 978-3-642-37250-6 (eBook) DOI 10.1007/978-3-642-37250-6 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2013945731 © Springer-Verlag Berlin Heidelberg 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To my loving wife, Semra, and my daughters, Özlem and Zeynep, for their support and accepting a part-time father. To my teachers and colleagues who inspire me to learn and to my students who inspire me to teach. T. Metin Önerci Foreword Interest in the function and malfunction of the nose has a long history, but this has accelerated in recent years with the application of new technology and methods of investigation. This book is therefore, very timely, covering all aspects of nasal physiology and pathophysiology. Consequently it has a wide appeal to basic scientists, clinical researchers, and physicians from many dis- ciplines including otorhinolaryngology, allergy, immunology, and respiratory medicine. Professor Onerci has gathered a distinguished group of authors, all con- tributors in their respective fi elds to comprehensively consider all aspects of this area which also have synergies with the lower respiratory tract and adja- cent structures such as the eye, nasopharynx, and mouth. All aspects of mucociliary function, olfaction, airway, and immune defense are covered in a number of detailed chapters from both a structural and func- tional perspective. Normal structure is considered macroscopically, micro- scopically, and ultrastructurally together with the consequences of disease and therapeutic intervention. Diffi cult clinical phenomena such as facial pain, the dry nose, and the effects of nutrition and age are all explored – providing insight and help in their management. Everyone from medical students to experts will fi nd this book fascinating and intellectually stimulating – I certainly did! London, UK Valerie J. Lund CBE vii Preface The human nose protruding as a pyramid from the midface is unique in the realm of mammals. In the earlier days, the nose was considered as an impor- tant structure in the middle of the face aesthetically and as a simple double tube for the passage of air to the lungs. It was also thought to have a relation- ship with the personality of a person. From the religious side, the nose was very important: “The life force within man came when God blew into his nostrils the soul of life and man became a living being” (Genesis 2:7). The nose is thus considered to be the organ through which the soul enters and leaves. Furthermore, the nose has also a special appreciation among the fi ve senses: “In the Garden of Eden, Adam and Eva defi led four out of their fi ve senses. They heard the serpent’s alluring words, the fruit was a delight to the eyes, they touched it by taking from its fruit and they tasted it. But the sense of ‘smell’ remained untarnished. Accordingly, this sense denotes inner purity and deep attachment to God and the fulfi lment of His Will” (Bnei Yissacher, Adar 1:10). In the last century we learned that the nose is a highly complex organ with many functions and that it is the main internal organ that keeps functioning even to the last moment of our earthly existence. The nose, however, has not found the adequate appreciation as to its complex functions in the textbooks of physiology and rhinology. The respiratory tract is considered to be a unifi ed airway system, and any processes affecting the nose also affect the lower airways. The nose warms, humidifi es, and fi ltrates more than 14,000 l of air per day. Through heat exchange, the nasal mucosa maintains the nasal cavity at a range of 31–37 °C. Vascular mucosa increases relative humidity to 95 % before air reaches the nasopharynx, requiring more than 680 g of water, which is approximately 20 % of daily water intake. In addition to humidifi cation, warming, and fi ltering out particles in inspired air, the nose also serves to provide fi rst-line immunologic defense by bringing inspired air in contact with mucus-coated membranes. Physiologic nasal fl uids, ciliary function, epithelial cells, and the secretory tissue (submu- cosal glands and anterior or lateral serous glands) are important in the defense system of the nose. The mucus secreted by the secretory tissue lines the mucosa and provides a physical barrier against invasion by pathogens and traps pathogens when they enter the nasal cavity. Trapping pathogens enables components of the mucus to attack and destroy the microbes. Antigen-binding proteins in the epithelium present allergens to antigen-presenting cells. These ix
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