THE CARE OF YOUR NOSE AND SINUSES

Head & Neck Surgery Department Kaiser Permanente Medical Centers, Oakland / Richmond

Warming and moistening the air you breathe are two of the many functions of the nose and sinuses. When heaters are turned on in the winter, air conditioners are used in the summer, or after nasal and/or sinus surgery of any type has been performed, the nasal and sinus mucous membranes become dry and irritated. The cilia (hair cells of the lining membrane of the nose) may die so that normal nasal secretions do not get swept to the back of the nose for swallowing, but stay in the nose and become crusts and scabs. The following are ways to help improve and normalize the moisture of the nasal and sinus mucous membranes in order to minimize nasal dryness, crusting and bleeding. Moisture Inhalation: Moistening the air that you breathe will help to minimize crusting and scabbing of the nose, as well as decreasing the risk of developing nasal bleeding. Breathe steam in through your nose 2-4 times a day or more. Listed below are ways you can humidify the air that you breathe. Turn the hot water on in the shower and either take a shower, or sit in the shower room in order to inhale the steam. Fill a sink with hot water and/or leave the hot water running. Place a towel over your head to make a steam tent and inhale the steam. Boil some water over the stove and stand over the pot so you can inhale the steam. Sit close enough to a vaporizer or humidifier so you can inhale the mist. Saline Nasal Irrigation: Use normal saline (salt water) in your nose at least 2-4 times a day. You may spray the saline into your nose, sniff it from your palm or irrigate it into your nose with a large syringe. Maximum contact is obtained by lying on your back, on your bed, with your head hanging upside down and instilling saline into your nose. You may mix your own salt water by putting teaspoon full of salt in a 12-oz. glass of water. You can also purchase, at drugstores without a prescription, either Ocean Nasal Spray or Ayr, commercially produced normal saline solution in plastic squeeze bottles. Crust Removal: Gently remove crusts and/or scabs in the nose with a Q-Tip soaked in saline or water. Ointment Application to the Nose: Apply a bland ointment (Vaseline, A&D or an antibiotic such as Polysporin, bacitracin) inside each nostril, every hour or so, at least 2-4 times a day. Temporary Nasal Rest: Place a piece of cotton in either or both nostrils. This eliminates air passing into the nasal cavity and adding to crusting, drying and irritation of the nose. Change the cotton when it becomes moist or dirty and after you have done the above three treatments. You may remove it when your symptoms have improved or resolved. Increase Fluid Intake: Drink enough water, juices or other liquids so when you urinate your urine is either transparent (like water) or pale-yellow. Dark-yellow urine signifies your body is too dry. Medication Precautions: The drugs listed below have a variety of benefits, but use or overuse of these medications may tend to dry the nose and increase the risk of nasal bleeding and crusting. If your doctor advises you to use these medications, you should be aware of the possible side effects and increase the use of the techniques listed above to minimize them. Antihistamines or decongestants (Actifed, Chlor-Trimeton, Dimetapp, Sudafed, etc.) tend to dry the nose and increases the risk of crusting and nasal bleeding. Caffeine that is present in coffee, tea, cola drinks and chocolate, will dry out the body including the nasal mucous membranes and increase the chance of bleeding. Over-the-counter nasal sprays (Afrin, Neo-Synephrine, etc.) will dry and irritate the nasal mucosal membranes. Excessive and/or prolonged use will also lead to nasal blockage. Steroid nasal sprays (Beconase, Flonase, Nasarel, Vancenase, etc.) should be used, at the direction of your physician, since they can occasionally cause drying of nasal mucous membranes and subsequent bleeding. Aspirin and aspirin containing products, such as nonsteroidal anti-inflammatory drugs (Motrin, Advil, etc.) thin the blood and increase the possibility of prolonged bleeding. Management of Nasal Bleeding: If your nose bleeds, you should use each and every one of the suggestions listed above (steam, salt water, ointment and fluids) 2-4 times a day until the bleeding has stopped for two weeks. When you have nasal bleeding, you should sit down, relax, breathe through the mouth and press the nose together for five minutes. If this does not stop the bleeding, lightly blow the blood out of your nose and continue constant pressure for ten minutes. Place ice at the back of the neck and over the forehead. If the bleeding still continues, you should then contact the Advice Nurse, the Emergency Room or the Head & Neck Surgery Department.
6/2003