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Many patients I see have dryness and crusting of the nasal cavity. Most have mild cases. We all probably have some dry mucus in the front of our noses. It can become a bit worse in the winter, when the low indoor humidity (in colder climates) and the low outdoor humidity cause the nasal passages to dry quite a bit. This is all pretty normal.
However, there are several medical conditions that cause the nose to dry quite a bit more. Then it crusts. Then it becomes infected. These infections can mimic sinusitis, because patients have lots of nasal obstruction, lots of yellow green discharge, some pressure, and a good response to antibiotics (because its a nose infection). However, this is often just a nose infection, not a sinus infection.
Who gets this most often? Well , there are a group of patients who get “sicca” syndrome or dryness of the eyes and mouth. If sicca syndrome is associated with other autoimmune diseases (disease of connective tissue such as rheumatoid arthritis, lupus, scleroderma or polymyositis.), its call Sjogren syndrome,
There is a great preponderance of females. About 90% of Sjogren syndrome patients are female, usually in middle age or older.
Sjogren syndrome is an inflammatory disease of glands and other tissues of the body. Inflammation of the glands that produce tears (the lacrimal glands) leads to decreased tears and dry eyes. Inflammation of the glands that produce the saliva in the mouth (salivary glands, including the parotid glands) leads to dry mouth. The syndrome can consequently be complicated by infections of the eyes, breathing passages, and mouth.
But most studies fail to mention that patients get dry nose as well, then crusting, then bacterial infections.
Other disorders that cause a lot of crusting are Sarcoidosis, Wegeners disease of the nose. They are much less common than sicca.
So, when we treat patients with dryness , crusting, and repeated nasal infections, I typically ask if the patient complains of dry eyes and dry mouth also. If so, they have sicca, and I follow up to see if they have other immune disorders or symptoms.
The treatment involves keeping the nose moist: There are several different classses of drugs that are helpful: Saline mist sprays, saline irrigations, and solutions that have plant oils in them. The three most helpful plant-oil containing nasal sprays/rinses that I recommend to patients are: (1) Pretz nasal spray, (2) Alkalol nasal rinse, and (3) ponaris nasal drops. They are each different.
Pretz nasal spray contains glycerin and Yerba Santa plant oil. It comes out as a spray. It keeps the nose moister for much longer than saline sprays. Its small and easy to carry.
Alkalol solution has several oils in it. It comes in a pint bottle. It is soothing and moisturizing. Its typically delivered in a larger bottle of nasal rinse, for instance by putting several tablespoons in an 8 ounce NeilMed Sinus rinse bottle. It also lasts much longer than saline sprays or even rinses, because of the oils.
Finally, Ponaris nasal drops contain several plant oils. Its very thick and is instilled as a drop. I don’t think it goes ver far back into the nasal cavity. So I use it for people with severe crusting that is confined to the anterior (front) part of the nose.
The links for each of the plant oil products are in each paragraph.
Finally, even more simple than these plant oils sprays, rinses or drops is just saline sprays (Ocean Spray is one common brand, but there are many now), and saline rinses (the most popular amongst ENT doctors in the U.S. being the Neilmed Sinus Rinse System.
I’ll write more about nasal rinses in the future.
Your comments are welcome.
Jeffrey E. Terrell, MD