OLDER PEOPLE

. Posted in SPECIAL PATIENTS

Many older men complain that their nose is constantly running. Others complain that their nose runs when they eat certain foods.

This symptom can be treated by your primary physician; however, these problems can be caused by a testosterone imbalance or by other endocrine disorders like hypothyroidism and gigantism. If you are suffering from this condition, it may be wise to consult with an otolaryngologist and an endocrinologist. There are various medicines that can also cause rhinitis with nasal discharge, and you should provide the entire list of medicines that you are taking because one of them may be the culprit of your nasal discharge.

Another sign of aging is that the mucous membranes may begin to dry. Some of my older patients complain that their nose often gets dry and crusty. Of the various disorders that may lead to a dry nose, one of the more common diseases is called Sjogren’s syndrome. This is a chronic autoimmune disorder caused by an inflammatory attack of lymphocytes on the salivary glands. It is characterized by an exceedingly dry mouth and dry eyes. This loss of tear and saliva production may cause structural changes to the eyes and in the mouth. The nose may be affected as well. Often, those who suffer from this disease experience deterioration of the teeth due to cavities, increased oral infections, difficulty in swallowing, and a painful mouth. The blood of Sjogren’s patients contains antibodies directed against normal cells. Therefore, this disease is termed an autoimmune disorder, to denote the reaction of the immune system against the
patient’s own tissues. The cause for this process remains unknown, but may be a virus.

Sjogren’s usually occurs in middle-aged women. If you have been diagnosed with this disease, you may also have inflammation of the joints (arthritis), muscles, nerves (neuropathy), thyroid, kidneys, or other areas of the body. You may experience severe fatigue, and wake often during the night. Many Sjogren’s sufferers complain of nasal dryness and have symptoms of sinusitis with postnasal drip. In my experience, people with Sjogren’s do not get a higher frequency of sinusitis infections than other individuals. However, the infections tend to last longer and have a higher chance of developing into bronchitis or pneumonia. Diagnosis is based on clinical examination of the eyes and mouth. Specific blood tests and a biopsy taken from the inside of the lower lip help confirm the diagnosis.

Sjogren’s syndrome is not fatal. However, you need to actively prevent possible complications due to dry mouth and dry eyes, as well as treatment of other organ systems involved as a consequence of the disease. My initial approach is to provide increased moisture to the eyes, nose, and mouth by use of nasal saline sprays during the day, and sleeping in a room with a humidifier at night. By rinsing the nose with a saline solution after loosening the secretions with a humidifier or in the shower, you can break the cycle of repeated sinus and upper-respiratory tract infections. There are many different types of cool-mist humidifiers that vary in size and cost. I recommend the smaller, portable units (choose one that is silent and easy to clean/refill) rather than large humidifiers that are added to a home’s furnace/air-conditioning systems. The large room units may become contaminated with yeast or fungus that can subsequently irritate the sinuses. This problem is less likely to happen with the smaller units that can be cleaned and changed daily. In areas where the water is hard (contains large amounts of calcium and other salts), using distilled water may be less irritating and easier on the humidifier than water from the tap.

It is also important to keep the nose and sinuses clear, since mouth breathing can exacerbate the dry mouth problems associated with Sjogren’s syndrome. In addition to the saline spray, it may be beneficial to
irrigate the nose daily to remove dry, crusted, infected secretions. You can also try sucking candies and saliva substitutes, as well as eye drops that are recommended by an ophthalmologist. Medical options for treating severe cases of Sjogren’s include steroids or other immune system suppressants. Patients with Sjogren’s syndrome should create a medical team consisting of their primary-care physician, ophthalmologist, otolaryngologist, and rheumatologist in addition to any other practitioners who are treating them.

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