The Common Head Cold:
Principles And Practice Of Hardening
Home Care And Treatment
Nasal Obstruction And Mouth Breathing
Voice And Speech
Summary And Conclusions
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Nasal Obstruction And Mouth Breathing
( Originally Published Early 1900's )
Just as there are persons who go along for years with considerable near-sightedness or other defect of vision, and do not realise their imperfection unless perchance correcting glasses are fitted, whereupon a new world is opened to them; and just as an individual with one good ear may be unaware that the other one is deaf, until this fact has been demonstrated by a systematic test of his hearing, so too it is frequently the case that individuals go through life with insufficient nasal respiration, never realising that there is anything abnormal.
I have even found persons who because of completely closed nasal passages breathed only through the mouth and who seemed to think this was entirely normal. As in the case of sight and hearing, when we repair the defective function and restore his nasal respiration to its full physiologic capacity, the individual will rejoice and marvel at the gain.
There are many persons who theoretically appreciate the evil of mouth breathing, but who are fully unaware of the fact that they themselves are guilty, because the physiologic error is committed only at night and during the unconsciousness of sleep. Such a patient will indignantly deny the accusation of mouth breathing, but if he confesses that he awakens every morning with a coated tongue, parched lips and his throat feeling dry, a strong suspicion may be justly entertained despite the denial; and if besides you can get the testimony of an ear witness to the fact of snoring, the evidence is surely convincing.
The symptoms and evil effect of nasal obstructions will depend upon whether it is partial or complete. Stand before a mirror and take a number of quick deep breaths through the nose, and observe whether the nostril dilates, as it should, or contracts as it should not with each inspiration.
Normally with each act of inspiration the nares are dilated by the action of the muscles which supply the nasal wings, thus making a little wider the air passages at its inlet. But sometimes these muscles are paralysed or flabby, and in such a case the weak collapsed wings will be drawn in with each inspiration and the already narrow nares will become thus still further narrowed.
More often, the nasal insufficiency arises from diseased conditions which are to be found farther back in the nasal passages. It may be a simple catarrhal swelling, it may be a permanent en-largement of the turbinai bodies, it may be a cartilaginous or a bony spur which has grown out from the septum, or it may be due to a deflection of the septum. Any obstruction blocking one side of the nose for a long time, especially if it be of a permanent character, constitutes a cause of nasal insufficiency.
One of the commoner conditions producing a unilateral nasal stoppage is a deviation to one side or the other of the septum, the partition which normally constitutes a vertical plane, dividing the nose in equal halves. It is seldom perfectly straight but is usually bent a little to one side or the other, very often so much so as to compromise the space of the side toward which it is bent, sometimes completely closing it.
One might ask the question : would not the greater space produced on the side away from which the septum is bent compensate for the narrowness on the other side?
It does not do so because the deflection never involves the entire septum. The bend is chiefly in the anterior or softer part of the septum, the posterior portion, which is of stout unyielding bone, always keeping its place strictly in the middle line. Therefore, notwithstanding the spaciousness of the cavity, the current of air which can pass through is not appreciably increased.
Septum deviations, however, seldom consist of a single bend to one side, but generally there is a double bend, the so-called S-shaped feature, one convexity being toward one side, and the other toward the opposite, so that both nasal passages are more or less narrowed. It is quite common to find a curve to one side, complicated by a spur or outgrowth of bone or cartilage which further compromises the capacity of the side on which it occurs.
The amount of interference in the nasal breathing depends in a great measure upon the situation of the obstruction. The current of air passing through the nose in the act of inspiration does not follow a direct line backward, but its course is represented rather by a crescentic band, or arc which passes from the nostrils upward through the level of the middle meatus or channel and finally downward to enter the nasopharynx. A small swelling, located in the tract of this current, will constitute a considerably greater interference with nasal respiration than a large swelling located above or below.
Many persons suffer from a nasal obstruction which is not present all the time, but occurs intermittently. This may be the case when there are small polyps in the nose which vary with barometrical conditions.
Certain kinds of catarrhal swelling also have a tendency to fluctuate in size. The nose may be perfectly free now, and yet within a few minutes it will be completely closed.
There is a marked tendency for the stoppage to occur alternately first on one side of the nose and then on the other, and it will be influenced by such slight causes as a mere change in the position of the body. The patient afflicted with a blockage of this type, usually imagines it to be due to an accumulation of secretions in the nasal passages and he blows very forcibly to clear the nose, but without result. It is not due to any accumulation of mucus but to a swelling of the spongy tissues which make up, as we have already explained, a great part of the turbinal bodies.
Certain forms of catarrhal trouble are characterised by a lack of tone in the vessels of this spongy tissue, as a result of which they become too easily distended and filled with blood. There is, in other words, a lack of control with a resulting imbalance, and the erectile tissue may either shrink or become swollen without adequate provocation.
Children with adenoid vegetation in the nasopharynx will also exhibit changing nasal obstruction due to the variableness of this growth. They may be able to breathe thoroughly under normal conditions, but a slight congestion from any cause will produce a swelling of the growth sufficient to encroach upon the throat and the nasal pas-sage and cause respiratory obstruction.
Mouth breathing is of course a necessity whenever there exists any disease, deformity, foreign body or growth which will produce complete nasal obstruction, so long as the obstruction lasts. If the obstruction be permanent, as well as complete, then the mouth breathing must become a permanent and fixed habit. Obstruction both complete and continuous can occur in children who have very large adenoids. In adults it is most often due to polyps or other tumors, or to irregular deflections in the septum. Whether it be complete or only partial, whether it be permanent or only temporary and intermittent, nasal obstruction is a very serious defect, because it interferes with the proper performance of a physiologic act of truly vital importance to the organism, one in fact so vital that it cannot be suspended for more than a few minutes continuously without death.
The slightest impairment assumes significant proportions when we take into consideration the accumulative loss in an act so frequently as well as so constantly performed. One breathes ordinarily about 26,000 times a day. In the course of a year the sum of respiration amounts to about ten millions. No matter then how slight the insufficiency of each single act the total loss is momentous.
In children the evil effects are to be seen in actual malformations of the chest. When the child must constantly tug for its breath, the resulting increased negative pulmonary pressure can exert a modifying influence over the soft yielding chest wall. Chicken breast and other mal-formation in children are, produced in this way.
Mouth breathing is a wholly inadequate substitution for the nasal method of respiration.
One might, thinking of capacity only, wonder why as much oxygen could not be carried to the air cells by the mouth as by way of the nasal passages. But respiration, it should be known, is in a great measure an involuntary function, de-pending for its regular performance upon the reflex stimulation of the air cells by a properly prepared and purified air. Otherwise, breathing is superficial and fails to bring about the full inter-change of gases between the air on one side and the circulation of blood on the other. Notwithstanding the volume of air, the blood is therefore not sufficiently oxygenated, and anemia is the consequence. The tissues of the body supplied by the thus impoverished blood suffer in their turn and thus it is that mouth breathers are constantly pale, weakly, undeveloped and ill-nourished.
One need only recall the important functions the nose has to perform as a respiratory organ to appreciate the evil consequences that mouth breathing has for the system in general and for the respiration in particular. The preparation of the air by filtering it, sterilising it, warming and moistening it, is a function which the nose only is able to properly perform. Let the air enter the mouth directly and it will soon abstract from the mucous membrane more heat and moisture than it can afford. The result is a general dryness and parching of the membranes with, of course, a great lowering of its vitality.
The dust and dirt deposited in the membranes cannot be gotten rid of as they are by the nose, and therefore remain to produce irritation and sooner or later inflammation. While the nose possesses certain germicidal properties, the mucous membranes of the mouth are, in this regard, utterly lacking. Indeed, examinations have repeatedly shown that while secretions removed from the interior of the nose are sterile, those from the mouth are swarming with bacteria of different kinds. It is estimated that 14,000 germs are taken in with each act of inspiration. In the peculiar construction of the nasal organs, nature has made wise provision for disposing of this vast army of invaders.
As this important protective function cannot be fully replaced, we cannot do otherwise than view with serious alarm the deflection of the inspiratory current from its natural channels, thereby opening a possible way to bacterial infection, which may be fraught with grave dangers, to the general health.