PHYSIOLOGY OF

NOSE &
PARANASAL
SINUSES

BY: DR GOPAL SINGH

PHYSIOLOGY
 Nose contains organs of olfaction & respiration.
 Functions of nose:-
 RESPIRATION
 HEAT EXCHANGE
 HUMIDIFICATION
 FILTRATION
 COOLING & REMOVAL OF WATER FROM THE EXPIRED AIR
 NASAL RESISTANCE
 PROTECTION OF LOWER AIRWAY
 NASAL NEUROVASCULAR REFLEXES
 VOICE MODIFICATION (Adds quality to the speech
production)
 OLFACTION
RESPIRATION
Provides O2 for metabolism & removes
CO2 coming from the body.
The function of nose is to modify air so
that it is ideal for this purpose.
This exchange is achieved without
damaging the alveoli.
HEAT EXCHANGE
 Temp. of inspired air can vary from –500C to 500C

 Nose in different racial groups is modified to suit

the local ambient temperatures.

 Heat may be transferred by conduction,

convection or radiation.

 Radiation does not play much part in warming

the inspired air.
 Contd.

 Nose may be considered as a Heat exchange

system where two fluids (inspired air & blood
supply of the nose) are in Thermal but not direct
contact.
 The main blood supply in derived from the
sphinopalatine artery & its branches run forward
in the nose particularly over turbinates.
 During inspiration the airflow is opposite or in
counter current to blood flow thus it is more
efficient in warming the inspired air.
 .
Filteration
Particles with size (in Are trapped
microns) by
0.5-3 Nasal mucus
>3 Vibrissae

Airflow = VA (is constant)

V = average velocity in m/s and
A = cross sectional area in m2.
If the cross section is decreased
then the velocity increases.

7
 Order of airflow through meatus:
middle
↓
inferior
↓
superior (active)

 When the Reynolds number varies b/w

2000-4000 the flow changes from laminar
to turbulent.

8
INSPIRATORY AIR
CURRENTS
During inspiration airflow is directed
upwards & backwards from the nasal
valve initially mainly over the anterior
part of the inferior turbinate.
Splits into 2, below & over the middle
turbinate, rejoining in the posterior
choana
INSPIRATORY AIR CURRENTS
10
EXPIRATORY AIR
CURRENTS-
Air enters the choana from nasopharynx &
air current divides into-
A portion passes out through the nostril
Remainder forms a large central eddy
current, whiriling back through the inferior
meatus & rising from nasopharynx
•A part of this central eddy passes under
middle turbinates
•It is turbulent as direction changes &
turbinates have more surface area.
EXPIRATORY AIR CURRENTS

12
HUMIDIFICATION OF INSPIRED AIR
Protection of Pulmonary alveolar epithelium
from dust & foreign particles, depends on
continuous activity of ciliated epithelium ,
for which 2 things are essential
adequate saturation of inspired air.
Moisture - for proper cleaning of pharyngeal
mucosa & exchange of gases at alveoli
MECHANISM OF HUMIDIFICATION-
1)Transudation through mucosal epithelium
2)Secretion of-
 simple tubular gland & goblet cells of
Mucosa
 compound tubular glands of Submucosa
 Approx. daily secretion is 1 liters; 700ml is
used in saturating inspired air & the rest is
used in cilliary cleansing property
HUMIDIFIACTION
Efficiency of saturation of inspired air depends on-
 Variation of environmental temeprature
 Geographical region
 Different season

Faliure of humidification results in

 drying of mucosa
 accumulation of strings of ropy mucous & inspissated
secretion
 hyperplasia & reduced resistance to infections
PROTECTION OF THE LOWER
AIRWAY –
 Mechanical and chemical : The
nose is able to remove particles of 30
mm or more from the inspired air. This
includes most pollen particles which
are among the smallest particles
deposited on the nasal mucosa and
accounts for the nose being the
predominantly affected site in hay
fever.
NASAL SECRETIONS-
 Glycoprotein - sialomucins, fucomucins,
sulfomucins.
 Enzymes – Lysozymes, Lactoferrin.
 Circulatoryproteins–

Complement,2 macroglobulin C reactive

protein.
 Immunoglobulins – IgA, IgE, IgG, IgM, IgD.
 Cells – Surface epithelium, basophills,
eosinophills, leucocytes.
 .

Secretions of mucosal glands & goblet cells , diluted with

watery transudates passing through the lining epithelial layer
& secretions of lacrimal sac.
Composition-
96% Water
1-2% Inorganic salts
2.5 -3% Mucin
Thin elastic highly viscous with fair degree of tensile stength
Small change in mucin content changes viscosity & propulsion
FACTORS RESPONSIBLE FOR STICKING
Direct impaction of particles on to surface of mucus
Attraction by electrolytic surface charges

Bacteriostactic property
assigned to nasal mucus; mainly due to:-
 Mechanical action of ciliated epithelium
 specific bacteriolytic Enzymes( lysozyme)

Efficient functioning of nasal mucus blanket

depends on-
 Continuous removal & renewal; effected by constant motion
like conveyer belt
 This association of ciliary motion & mucus secretion forms so
called – self cleansing mechanism of nose
The cillia remains in the aqueous layer and only tip reaches
the gel layer
There are small slender microvilli scattered between main cilia
(~1µm)
Each cell have ~ 250 cilia & 150 microvilli
CILLIARY ACTION-
Wall of nasal chamber & accessory sinus are lined
almost entirely by Pseudo stratified columnar
ciliated epithelium
(except in pre turbinal & olfactory area which are
non ciliated)

Human nasal cilia is delicate, tappering ~7 µm

long , ~ 0.3 µm thick; projecting from free end, it is
slightly curved in the direction of ciliary beat.
CILLIARY MOVMENT-
 Forward / effective stroke – rapid, propulsive,
vigorous movement; cilia remains rigid (1/5th
time of cycle).
 Backward / recovery stroke - slow, cilia
relatively limp.
 At normal temprature cilia beats ~10-15/sec.
This produces streaming movment of overlying
mucus ~ 0.25-0.75 cm/min; not equal in all
parts, rapid in posterior 2/3rd than anterior 1/3rd
& more in protected meatal recesses than in
exposed part.
MUCOUS BLANKET-
THE BEAT PATTERN OF A CILIUM.
ONLY THE TIP IS IN THE GEL LAYER

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FACTORS DECREASING CILIARY ACTIONS-
 Drying
 Temprature >45 C & < 10 C (optimal – 28-38).
 Hypertonic or hypotonic nasal secretions (Optimal
at Isotonic i.e. 0.9 mml/lit).
 pH > 6.4
 Smoking
 Hypoxia
 Upper respiratory tract infection
 Air pollutants an nasal irritants
 Drugs: adrenaline , propranolol , steroids.
(acetylcholine – increase the rate)
 Cocaine hydrochloride – cause immediate paralysis
REGULATION OF
CILLIARY ACTION-
Rhythymic coordinated movement of cilia is
independent of nervous control
Movement is result of shortening of longitudinally
disposed contractile

Effective stroke due to initial shortening of contractile

filament one side & subsequent contraction on other
side
Rate can be influenced by extrinsic autonomic
activity
RESISTANCE & OBSTRUCTION TO AIR
CURRENTS-
 Nasal resistant inversely proportion to r4
 Nasal resistant determine by cross
sectional area
 Cross sectional area determine by septal
deviatation , turbinate medialization and
hypertrophy, nasal valve.
 Air currents mainly restricted to central
part of the nasal chambers (except in
forced respiration); air currents do not pass
through upper olfactory or the lower part
of nasal cavity

 Thus narrowing in this region of middle

meatus (septal deviation/ spur /polyp/
.
May result imperfect conditioning of the air & local
changes of mucosa, with reduction in resistance to
bacterial invasion

Inferior turbinate attributed as valvular function ;

engorgement & depletion of its mucosa, with
reduction in resistance to bacterial invasion

Intranasal pressure varies from -6 to +6mmof water

;depends on relative size of nostril & choana
N A S A L V A LV E

1. EXTERNAL VALVE 2. INTERNAL NASAL VALVE

Columela .provides 1/2 of all resistant
Nasal floor . slit like triangle
Caudal border of lower lateral cartilage . compose of
* ant end of inferior turbinate
*septum
* caudal aspect of upper
lat cartilage
SIGNIFICANCE of nasal resistance and reducing air flow is: Warming,
Humidification & Cleaning of air .
As the anterior valve is the narrowest part of the airway it is one of the main
factors in promoting turbulent airflow since it is the largest resistor in the
whole airway
# when negative pressure exceeds the cartilage rigidity it leads to collapse
of the lateral nasal wall
NASAL COMPONENT IN AIRWAY RESISTANCE-

30% of total resistance is nasal

Frictional resistance
 between moving mass of air
 between moving air & walls of
passages

Resistance
α density
α velocity of flow
α length of duct
α/ ( diameter of tube)*4
Work in overcoming nasal resistance is element of
total work done by respiratory muscle, thus the
Nasal resistance –
Produced by two resistors in parallel and
each cavity has a variable resistance value
as a result of the nasal cycle.
Resistance is made up of two elements.
The first is the bone, cartilage and
attached muscles, while the second is the
mucosa.
 Narrowest part of the nose is the nasal
valve (max resistance)

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VOCAL RESONANCE
Nose form a resonating chamber for
certain consonants in speech mainly
N/M/NG.
Sound passes through nasopharyngeal
isthmus and emitted through nose .
When nasopharynx is blocked speech
become denasal , so M/N/NG
pronounced as B/D/G
MAMA=BABA
NANA=DADA
NASAL CYCLE
The cycle consist of alternate nasal
blockage between the passages.
The changes are produced by vascular
activity ,particularly the volume of blood
by sinosoids(capacitance vessels)
Cyclical changes occur every 4 min to 4
hrs.
* Nasal cycle less frequent in - very
young and very old
*No affect overall olfactory
FACTORS AFFECTING
NASAL CYCLE
High amount of CO2 reduce nasal resistance
Anticholinergic affect of antihistamine block
parasympathetic improve airway as increase
sympathetic activity
Allergy
Infection
Exercise
Puberty
Sexual activities
Pregnancy affect nasal mucosa (Hormonal)
VASCULAR RESPONSES OF
NASAL MUCUS MEMBRANE-
VASCULAR ARRANGEMENT-
Sphenopalatine branches of maxillary artery
Anterior & posterior ethmoidal branches of
opthalmic artery
Arteriols in deeper layer arrange in parallel
longitudinal rows  periglandular capillary
network subepithelial capillary network
efferents from vessel superficial capillary
bed large venous sinusoids wall of these
spaces supported by abundant elastic
tissue& by marked development of circular
&spirally arranged bundles of plain muscles
Ends of sinusoids have sphinteric muscle
These sinusoids drain into deeper venous
plexus
This vascular organization constitute a type of
erectile cavernous tissue ( in inferior turbinate
, lower margins & posterior end of middle
turbinate & corresponding septal mucosa )
VASOMOTOR NERVE
SUPPLY-
FACTORS AFFECTING NASAL BLOOD FLOW-

# LOCAL FACTOR-
Temprature & Humidity ;
Vasoconstrictor , Vasodilator
Sympathomimetics  vasoconstriction; adrenalin/ ephedrins/
neosynepherin/
2- aminoheptane sulphate/
Amphetamines(volatile decongestant)

Parasympathomimetics  vasodilation; methcholyl/

carbachol/neostigmine.

Atropine/cocain (contractile)

Compression of -juglar vein congestion ;

General factor-
.
Endocrine- hyperthyroid temprature rise;adrenal medulla ;sex
homone
Emotinal stress- fear & terrorconstriction&
shrinkage(sympathetic);
resentment/anxitey/humiliation/ frustation vascular
engorgement
(parasympathetic type)
Hyperemia;hypersecretion
 irritant fumes& dust, inhalation of pollen & substance with
senstisation; cooling body surface; mensturation; pregnancy
General vasomaotor reflexes
Asphyxia  vasoconstriction
REFLEX INITIATED FROM
NOSE-
Olfactory & trigeminal

Olfactory Trigeminal

Receptor Olfactory Touch;temperature;

receptor pressure;pain;
Chemical irritant

Afferent Salivary; trigeminal neurons

gastric;
pancreatic
glands
Sneezing reflex- parasympathetic innervation-single slow deep
inspiration or series of inspiratory effort followed after a short pause
by sudden forcible expiratory movement
Stimulation of larynx causes a cough reflex with
bronchoconstriction and bradycardia
Nasopulmonary reflex-stimulation of afferent nerve ending by
cold air fumes in nasal mucosa or by mechanical stimulation
produces bronchioconstriction.
Corporonasal reflex /diving reflex – the reflex is trigged by cold
water to face and result in bradycardia and peripheral
vasoconstriction.(it is also use to treat supraventricular tachycardia)
Nasovascular reflex- peripheral vasoconstruction
Nasocardiac reflex- bradycardia and hypotension during nasal
manipulation
Gastric stimulation and irritation causes increase nasal
mucous production.
Genitonasal reflex
OLFACTION-
Ability to detect environmental chemical is primary
function
Olfaction initiates & modifies behavior in many
creatures;
Povide information regarding – safety of subastance
,asthetic properties, element basic communication
Olfactory system contributes siginificantly to persons
quality of life.
Older person mortality 2 ½ times more than which has
low odour identification test
OLFACTORY AREA-
Olfactory cleft an opening of 1mm wide and 7cm deep to nostril
Olfactory neuroepithelim exist with in approx 2cm area in upper recess of nasal
chamber .
Roof of nasal cavity , the superior turbinal area of lateral wall & upper 1/3 rd of nasal
septum; here mucosa appears brown in colour in contrast to pink
Histology-mucus membrane lined by – thick pseudostratified columnar non-ciliated
epithelium
Epithelium has 6 types of cells-
1. BIPOLAR SENSORY RECEPTOR NEURON ( CNS origin )with cilia
2. Supporting (Insulator,regulate mucous ,Detoxifies ,Degards odourants)
3. Duct cell of Bowmans gland (mucous in olfactory region )
4. Microvillar cell (supporting )
5. Horizontal basal cells /dark cell (stem cell within basement)
6. Globose basal cells (multipotent basal cell)
.

The human has 200-400 mm2 of sensory epithelium with a

cellular density of about 6x104 receptor cells / mm2
About 6 million receptor cell in human which is only less than
Vision receptor cell.
Only 10-15% air reaches the olfactory neuroepithelium
Minor change in nasal architecture result blockage olfactory
region without much impairment in nasal respiratory ability.
When excessive turbinate removal resulting decrease olfactory
activity.

Sniffing : Maximum exposure of the

olfactory area to smells achieved by
sniffing which causes turbulent air flow.
 OLFACTION
Olfaction initiates and modifies behaviour in many
creatures.
Odours are a complex mixture of different compounds,
each one at a low concentration. Olfactory compounds
must contact the nasal mucosa in order to produce a smell
and have to be soluble in water and lipids man is able to
discriminate between a large number of different smells.
The olfactory mucosa and pathway is rapidly fatigued but
recovers quickly.
Sniffing : Maximum exposure of the olfactory area to smells
achieved by sniffing which causes turbulent air flow.
Olfactory area : The area of the olfactory epithelium varies
between species. Dogs and rabbits have larger olfactory
areas than man. The human has 200-400 mm2 of sensory
epithelium with a cellular density of about 5x104 receptor
cells / mm2.
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CLASSIFICATION OF
ODOUR-
From electrophysiological studies , Adrain proposed 4
types of chemical compound-
1) aromatic hydrocarbons
2) paraffin hydocarbons
3) terpenes
4) amyl & ethyl acetates
 .
Pathways – There is no interaction between the individual
receptor cells. Each receptor cell is connected to the olfactory
bulb by non myelinated nerve fibres.

Olfactory bulb located on ventral surface of cribriform plate

These fibres terminate and synapse on olfactory

glomeruli,Information conversion at glomeruli

The glomerulus fires with an all or none response into the mitral
or tufted cells whose axons transport the signal through the
lateral olfactory tract.

Inhibition is derived from feedback from the high cortical

centres.

48
49
NEUROTRANSMITTE : PRIMARY GLUTAMATE
DOPAMINE APPEAR TO BE
NECESSARY MODULATOR
 Contd.

Higher centres – The anterior olfactory nucleus send impulses to the

opposite bulb and also to the Ipsilateral forebrain through the anterior
commissure.

The primary olfactory cortex lies rostral to the telencephalon and

includes the olfactory tubercle, the prepyriform and pre amygdaloid
areas.

There are projections to the thalamus where they are integrated with
taste fibres, and there are also projection to the hypothalamus.

52
Lack of olfactory function can be early sign of serious
disease-
Sinus infection
Frontal meningioma
Parkinsonism
Alzheimer s
Nasopharyngeal cacinoma
 Anterior Lesion Posterior
Total lacks of smell OLFACTORY TRIGONE partial lacks of
smell
(neuroepithelium, bulb, tract)
Sudden olfactory loss ;
Trauma (olfactory loss in blunt trauma over occipital >frontal )
Ischaemia
Infection
Psychaitric
Gradual loss –progressive and obstructive
Intermittent loss –inflammatory nasal &sinus disease
Smell impairment real failure,liver disease,hypothyroidism,diabetes
PARA NASAL
SINUSES
FUNCTION OF
PARANASAL SINUSES-
1. warming and moistening of inspired air
occurs as that in nasal cavity.
2. resonance to laryngeal voice.
3. temperature buffer.
4. reducing the weight of the skull.
5. mucociliary clearance.
Mucociliary clearance:- the sinuses act
as a constant source of sterile mucous
blanket, which is essential to replace the
contaminated secretion in the nasal cavity.
Anatomical abnormalities in the nasal cavity
especially in the middle meatus can obstruct
the outlet of paranasal sinuses causing
persistence ds in sinuses.
CILIARY PATHWAY-
Cilia directs mucus from PNS & nasal chamber
Main antral stream-from middle&inferior meatus-
Anterior part of lateral wall passes back through middle &
inferior meatus

In Middle meatus joined with mucosa from sinus opening

into the recess
 Mucus from antrum steams back along upper portion of
middle meatus to its

. poterior end

From here main stream passes laterally & downwards;

anterior to eustachian tube opening

Continue down just behind posterior pillar

a portion directed anterior to pillar

Main stream is joined with streams from superior meatus &

sphenoidal sinus
CILIARY PATHWAY-
FROM SPHENOIDAL SINUS-
From ostium mucus passes down to the top of nasal choana

Then backward on roof of nasopharanx;

Spreading in fanwise into a series of streams

Passes outwards & join main antral stream below lower margin
of the palate

small part contine down to pyriform sinus

Combined stream passes posterior to posterior pillar to the
dorsum of tongue
FROM SUPERIOR MEATUS-

Including posterior ethmoidal cells stream passes

into nasopharynx & divides into –
Large anterior steams extends down in front of
eustachian tube and join main antral stream
Small posterior pass behind eustachian orifice &
downwards through the fossa of rosenmuller & then
curves forward to join main stream
Maxillary sinus:- the secretion from the
maxillary sinus start in stelate fassion from
the floor of the sinus along its wall to reach
the inner maxillary ostium at uppermost and
post corner of the sinus in lateral nasal wall.
Secretions never drain through accessory
ostium,rather they move along its margin and
finally proceed through natural ostium.
Frontal sinus:- secretion starts from interfrontal
septum , the roof, walls of frontal sinus laterally,
returning to the floor of sinus and leaving inne osteum.
Retrograde flow of secretion occur.

Ethmoid sinuses :-secretion transport occur in spiral

fashion.
secretion from sinuses form two streams of flow:
Infratubal stream
Supratubal steam
.
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