PHYSIOLOGY OF NOSE

AND PNS
DR. KRISHNA CHANDRA RIJAL

Functions of Nose
1.

Respiration

2.

Air conditioning of inspired air

3.

Protection of lower airway

4.

Ventilation & drainage of P.N.S.

5.

Olfaction

6.

Nasal resistance

7.

Vocal resonance

8.

Nasal reflexes

1. Respiration

Inspiration: air current passes along mid-portion of

nasal cavity in lamellar flow.

Expiration: resistance of nasal valve & turbinates

leads to formation of eddy current in expired air.

This results in awareness of breathing & ventilation

of paranasal sinus.

2. Air conditioning of inspired air

a) Filtration and purification:
The front of the nose can filter particles up to 3 m
Nasal mucus traps particles as fine as 0.5-3.0 m.
Particles smaller than 0.5 m seem to pass through
the nose into lower airways without difficulty.
(b) Temperature :
Inspired air which may be at 20C or 0C or even
at subzero temperature is heated to near body
temperature (37C) in one-fourth of second that
the air takes to pass from the nostril to the
nasopharynx. Similarly, hot air is cooled to the level
of body temperature.

(c) Humidification:
Relative humidity of atmospheric air varies depending on climatic
conditions.
Air is dry in winter and saturated with moisture in summer months.
Nasal mucous membrane adjusts the relative humidity of the inspired
air to 75% or more.
Water, to saturate the inspired air, is provided by the nasal mucous
membrane which is rich in mucous and serous secreting glands.
About 1000 ml of water is evaporated from the surface of nasal
mucosa in 24 hours.
Moisture is essential for integrity and function of the ciliary
epithelium.
At 50% relative humidity, ciliary function stops in 8-10 minutes.
Thus, dry air predisposes to infections of the respiratory tract.
Humidification also has a significant effect on gas exchange in the
lower airways.
In nasal obstruction, gaseous exchange is affected in the lungs,
leading to rise in pCO2, causing apnoeic spells during sleep; it also
decreases pO2.

3. Protection of lower airway

Muco-ciliary blanket: traps pathogens in

inspired air > 0.5 m & transports them to
nasopharynx for swallowing

Sneezing: protects against irritants

Lysozyme: kills bacteria & viruses

Immunoglobulins A & E: for bacteria

Interferon: for protection against virus

Factors decreasing mucociliary function

Dry atmosphere (absence of humidity)

Smoking, air pollutants & nasal irritants

Infection

Extremes of temperature

Hypoxia

Drugs:

anaesthetics,

sedatives,

decongestants, beta blockers

topical

nasal

4. Ventilation of P.N.S.

Inspiration: negative pressure created in nasal

cavity sucks out air from paranasal sinuses via
their ostium.

Expiration: eddies within nasal cavity create

positive pressure ventilates paranasal sinuses via
their ostium.

5. Nasal resistance
Nasal
resistance
to
expired air
keeps
positive
pressure
in
respiratory
tract
&
prevents
alveolar
collapse

Nose provides 50-60 % of total airway resistance

Nasal resistance is provided by 3 areas:

Nasal vestibule

Nasal valve (maximum contribution)

Nasal turbinates

Nasal valve
Anterior nasal valve (ostium internum) is
located at limen nasi, 1.5 cm posterior to
anterior nares.
Consists of inferior margin of upper lateral
nasal cartilage + anterior end of inferior
turbinate + adjacent nasal septum.
Cross-section of airway here is 20-40 mm 2 on
each side.
It is narrowest part of upper respiratory
tract.
Cottles test checks valve patency.

6. Vocal Resonance
Nose forms a resonating chamber for certain
consonants in speech.
In phonating nasal consonants (M/N/NG), sound
passes through the nasopharyngeal isthmus and is
emitted through the nose.
When nose (or nasopharynx) is blocked, speech
becomes denasal, i.e. M/N/NG are uttered as B/D/G
respectively.

7. Nasal reflexes

Smell reflex: increases secretions of saliva & gastric

juice

Naso-pulmonary

reflex:

Chronic,

severe

obstruction increased pulmonary resistance

pulmonary hypertension

Sneeze reflex: protection against F.B.

nasal

8. Olfaction
Important for pleasure and for enjoying the taste of
food.
When nose is blocked, food tastes bland and
unpalatable.
Vapours of ammonia are never used to test the
sense of smell as they stimulate fibres of the
trigeminal nerve and cause irritation in the nose
rather than stimulate the olfactory receptors.

Disorder of sense of smell:

1. Anosmia: absence of olfactory sensation
2. Hyposmia: decreased olfactory sensation
3. Parosmia / cachosmia: perception of a pleasant odour
as unpleasant odour
4. Phantosmia: perception of odour in absence of
olfactory stimulus
5. Hyperosmia: increased olfactory sensation
6. Olfactory agnosia: unable to identify odour
7. Presbyosmia: decreased olfactory sensation due to
ageing process

PHYSIOLOGY OF PARANASAL SINUSES

Ventilation of Sinuses:
Ventilation of paranasal sinuses takes place through
their ostia.
During inspiration, air current causes negative pressure
in the nose.
This varies from -6 mm to -200 mm of H2O, depending on
the force of inspiration.
During expiration, positive pressure is created in the
nose and this sets up eddies which ventilate the
sinuses.
Thus, ventilation of sinuses is paradoxical; they are
emptied of air during inspiration and filled with air
during expiration.

Mucus Drainage of Sinuses:

Mucus secreted in the paranasal sinuses travels to the
ostium in a spiral manner.
Here the cilia are very active and propel mucus into the
meatuses from where it is carried to the pharynx.

Functions of Paranasal Sinuses:

1. Air-conditioning of the inspired air by providing
large surface area over which the air is humidified
and warmed.
2. To provide resonance to voice.
3. To act as thermal insulators to protect the delicate
structures in the orbit and the cranium from
variations of intranasal temperature.
4. To lighten the skull bones.