Post-graduate course

Nasal anatomy, physiology, and function

Nathan Geurkink, M.D. Hanover, N.H.

Knowledge of the anatomy and physiology of the nose is a necessary prerequisite for
understanding the pathophysiologic characteristics of rhinitis and occupational allergy. The nose
and paranasal sinuses have a unique anatomical location, shape, and function in modifying and
transforming inhaled air. The anatomy of the nose and paranasal sinuses and their basic
physiologic functions are reviewed. (/ALLERGY CUN IMMUNOL 72:123-128, 1983.1

NASAL ANATOMY AND DEVELOPMENT
The outward protuberance of the external noseen-
closes osseous,cartilaginous, epithelial, and neuro-
epithelial structures. Its outward appearancedoesnot
necessarily provide any indication of its internal
structure.
The nasal passageis composed of a horizontally
skin-lined vestibule with the passagesbeing directed
upward and backward and separatedby a cartilagi-
nous and bony nasal septum. The lateral nasal walls
are convoluted with strategically placed air-warmer
turbinates that mold the air streamto their configura-
tions and changing dimensions.The accessorysinuses
that communicate with the nasal chambers by their
respective ostia are situated laterally in the maxilla,
superiolaterally in the ethmoid bones, superiorly in
the frontal bone, and posteriorly in the sphenoidbone.
The olfactory cleft is situated in the superior portion
of the nasal chamber. The histology of this mucous
membraneof the noseand the paranasalsinusesvaries
in its anatomical location. Both nonolfactory and ol-
factory epithelia are present. The nasal mucous
membrane derives its sensory supply from the fifth
cranial nerve and has both parasympatheticand sym-
From the Hitchcock Clinic, Dartmouth Medical
mouth-Hitchcock Medical Center, Hanover, N.H.
Presented at the Postgraduate Course-Rhinitis, 39th Annual Meet-
ing American Academy of Allergy, March, 1983, Hollywood,
Fla.
Received for publication Feb. 16, 1983.
Accepted for publication Feb. 16, 1983.
Reprint requests: Dr. Nathan Geurkink, Hitchcock
mouth Medical School, Dartmouth-Hitchcock
Hanover, NH 03756.
pathetic autonomic nervous system fibers. The neu-
roepithelium for olfaction is derived from the first
cranial nerve. The control of the arterial and venous
supply to the mucous membrane of the nose by the
autonomic nervous system is one of the most impor-
tant fundamental physiologic phenomenathat will be
reviewed.
Internal anatomy-gross and developmental
After about 3 wk of fetal life, olfactory placodes
appear in the frontonasal processand within a week
they becomenasalpits that are the first indication of a
vestibular-like structure. By 5 wk of fetal age, the
nasalpits have progressedinto cleftlike structuresand
are separatedby a primitive septum. Around the sixth
week of embryonic life, both maxillary and ethmoid
folds begin to appearand theseare the first evidences
of nasalturbinates. The nasalchamber and the primi-
tive stomodeumare not separateduntil approximately
3 mo when palatal fusion is complete. During the
third and fourth month of fetal life, the maxillary
sinus, ethmoid sinus,and sphenoidsinusoutpouching
begins.
The vestibule of the adult noseis lined with squa-
mousepithelium that contains vibrissae and sweatand
sebaceousglands. Within this vestibule are baffles
School, Dart-
created by the protrusion of the medial crus of the
lower lateral cartilage and the lower end of the upper
lateral cartilage. Just superior to this is one of the
more important areasof the nose. It has been called
the nasal valve. It is the areaof the lateral nasal wall
Clinic, Dart-
and the adjacent septumjust anterior to the tips of the
Medical Center, middle and inferior turbinate and the upper border of
the vestibule. This mobile portion of the nosehasthe

123
124 Geurkink
ability to both open and close and creates a varying
amount of air flow resistance.
The nasal septum, which was first apparent as a
broad, thick structure between the nasal pits, is ulti-
mately composed of two separate supporting tissues.
Anteriorly, the septum is composed of skin and carti-
lage and posteriorly, of thin sheets of bone. The car-
tilaginous septum is formed by a very large quadran-
gular cartilage that has a posteriorly directed tail
called the sphenoidal process. In early life this
sphenoidal process is in continuity with the sphenoid
bone and would separate the perpendicular plate from
the vomer. The perpendicular plate of the ethmoid
forms the superior bony structure of the septum. In-
feriorly, the septum is composed of the vomer, which
forms the medial portion of the posterior choana. This
rests on the nasal crest of the maxilla and the nasal
crest of the palatine bone.
The other cartilage of the septum is simply the me-
dial crus of the alar cartilage. The quadrangular carti-
lage articulates with the premaxillary crest and the
vomer in a tongue-and-groove fashion. The flared
parts of the vomer and the premaxilla form what is
known as premaxillary wings. These project into the
airstream and act as baffles to air flow.
The vomeronasal cartilages are structures associ-
ated with the rudimentary vomeronasal organ of
Jacobson. In some animals there are olfactory nerves
in this area, but in man the organ is very short and is
of no apparent significance.
Anterior rhinoscopic examination reveals that the
septum varies in thickness from anterior to posterior.
The septum in the area of the nasal valve and posterior
to the anterior margins of the middle and inferior tur-
binates tends to be thicker so that the airstream is not
precisely vertical but tends to curve in two different
planes. It is not difficult to understand how deflections
or deviations of this structure may cause increased
airway resistance to the point of obstruction.
The turbinates are located on the lateral nasal walls.
The maximal development of the number of ethmoid
turbinates occurs in the fetus at around 7 mo. After
this, coalescence occurs, so that only two or three
turbinates of the ethmoid group will be present at
birth. These structures consist of an underlying bony
framework. The inferior turbinate is attached to the
medial wall of the maxillary bone, the middle turbi-
nate is attached to the roof of the nose just lateral to
the cribriform plate and laterally to the ethmoid bone,
and the superior turbinate is situated in the spheno-
ethmoid recess. The bony skeleton shows this ar-
rangement .2 The inferior turbinate is placed more an-
teriorly than either the middle or the superior, and the
J. ALLERGY CLIN. IMMUNOL.
AUGUST 1983
middle turbinate is anterior to the superior. The in-
ferior meatus is that space lateral and inferior to the
middle turbinate. In the anterior portion of this in-
ferior meatus, the opening of the nasolacrimal duct is
found. The middle meatus is that space beneath and
lateral to the middle turbinate. The ostia of the frontal
maxillary, and anterior and middle ethmoid sinuses,
are found here. The middle turbinate is shaped more
like a pontoon, whereas the inferior turbinate has no
anterior overhanging edge. The superior turbinate is
less than half the length of the other two turbinates
and its anterior margin begins at about the middle of
the middle turbinate. The posterior end of each turbi-
nate ends in the posterior choana. The superior turbi-
nate is located in the sphenoethmoid recess and is in
close proximity to the front face of the sphenoid
sinus. These bony structures are covered with muco-
periosteum and are very smooth and streamlined in
appearance.
The paranasal sinuses begin to develop as out-
pouchings of the mucosa of the nasal chamber during
the third and fourth fetal months. The maxillary and
ethmoid sinuses are present at birth. The frontal sinus
is a very small diverticulum at birth and undergoes
almost all of its development after birth. By about the
third year of life, the sphenoid sinus invades the
sphenoid bone. These sinuses may vary from indi-
vidual to individual. The maxillary sinus is paired. It
is the largest of the paranasal sinuses and is located
within the body of the maxillary bone. The opening to
the maxillary sinus is located on the highest part of its
medial wall. Drainage of the sinus occurs by ciliary
activity and it opens into the medial meatus, which is
a common place for nasal polyposis. Because of this,
it is common to have an obstructive phenomenon
creating sinusitis.
The number of ethmoid sinuses is more varied.
They resemble honeycombs. There may be as few as
three or four or as many as 18 or 20 cells and they are
located lateral to the middle turbinate and medial to
the medial orbital wall. The majority of these sinuses
open into the middle meatus. The posterior ethmoid
cells open into the superior meatus. The anterior
ethmoid cells may invade the perpendicular part of the
frontal bone.
The size of the frontal sinus varies. The nasofrontal
duct communicates with the middle meatus through
the ethmoid infundibulum.
The sphenoid sinuses are bilateral. They are in the
posterior portion of the nose and are situated an-
teriorly and inferiorly to the sella turcica. The ostium
is in the anterior wall and communicates with the
sphenoethmoid recess. Its degree of expansion into
VOLUME 72
NUMBER 2
the sphenoid bone varies greatly. The capacity of the
sinus may range from 1 to 30 mm, the average being
approximately 7 mm. Vital structures are related to its
lateral walls. The carotid artery, the optic nerve, the
maxillary nerve, and the cavernous sinus are in very
close proximity to this wall. The anatomic relation-
ships of the sphenoid sinus with the pituitary gland
and the nasal septum make it a ready avenue for sur-
gical approaches to the pituitary gland.
The olfactory cleft is that area of the nose between
the middle turbinate and the septum. It is covered
with the neuroepithelium of the olfactory nerve. The
olfactory mucous membrane is limited to the upper
third of the mucosa on the lateral wall of the nose and
the adjacent part of the roof and corresponding parts
of the septum. It is yellow in color.
Histology of the mucous membrane of the
nose and the paranasal sinuses
The mucous membrane of the nasal cavity can be
divided into the nonolfactory epithelium and the ol-
factory epithelium. The nonolfactory epithelium is a
highly vascular tissue that is covered by a pseu-
dostratified, columnar, ciliated epithelium. It is par-
ticularly thick in the area over the medial surfaces of
the middle and inferior turbinates. It is very tightly
attached to either perichondrium or periosteum, de-
pending on its relationship to cartilage or bone in the
nose. The thickness and the thermal properties of the
mucosa in the nose are regulated by the sympathetic
and parasympathetic nerve fibers that are supplied this
membrane. Superficial and deep layers of arterioles
supply the lamina propria. Between the venules and
the capillaries are numerous sinuses or venous lakes
that have been likened to erectile tissue because of the
rapidity with which they can become engorged. Small
muscle bundles are present at the distal ends of these
venous lakes and act as sphincters to bring about an
engorgement of the sinusoids. This pattern is most
marked in the inferior turbinate area but is also pres-
ent in the middle turbinate and on portions of the
septum.
The olfactory epithelium is pseudostratified co-
lumna in type and consists of specialized olfactory
cells, supporting cells, and both serous and mucous
glands. The olfactory cells are bipolar neurons and act
as peripheral receptors and first-order ganglion cells.
It has been estimated that 10 to 20 million cells are in
each nasal fossa. Cilium-like rods protrude from these
cells into the mucous blanket and the approximately
1000 filaments on the rods of each cell magnify the
surface area of the cell itself. The axons of these
olfactory cells form bundles to pass through the crib-
Nasal anatomy, physiology, and function 125
riform plate as the olfactory nerves. There are approx-
imately 20 nerves in each nasal fossa.
Innervation
The general sensation of the nasal cavity is supplied
by the first and second divisions of the fifth cranial
nerve. The branches of the first division of the fifth
nerves supply the anterior superior and anterior por-
tion of the nose. The vestibule of the nose is supplied
by the infraorbital nerve.
The autonomic nervous system plays a major role
in the control of the vascular supply of the nasal mu-
cous membrane. The parasympathetic innervation of
the mucous membrane begins in the superior sa-
livatory nucleus of the brainstem. Fibers from this
nucleus unite with the fibers of the facial nerve and
after leaving the geniculate ganglion join the post-
ganglionic sympathetic fibers of the superior cervical
ganglion. These fibers form the nerve of the vidian
canal, which enters the sphenopalatine ganglion. The
parasympathetic nerve fibers synapse at this ganglion
and their postganglionic fibers are distributed to the
nose and nasopharynx.
Those fibers of sympathetic nervous system origin
arise from the first and second thoracic segments of
the spinal cord in the lateral horn cells. They exit from
the spinal cord with the anterior nerve root and
synapse in the superior cervical ganglion high in the
neck. The postganglionic sympathetic fibers then
form a network around the internal carotid artery and
join the parasympathetic fibers from the seventh cra-
nial nerve. They are distributed with the parasym-
pathetic nerve fibers as branches of the sphenopalatine
nerve.
Vascular supply
The arterial supply to the nose is derived from both
the external and the internal carotid arteries. The
terminal branch of the maxillary artery, which is a
branch of the external carotid, supplies the spheno-
palatine artery, which in turn supplies the lateral and
medial wall of the nasal chamber. The anterior and
posterior ethmoid branches come from the ophthalmic
artery, which is a branch of the internal carotid artery.
These vessels supply the anterior portion of the nose.
In addition, there are twigs from the facial artery that
supply the vestibule and the anterior portion of the
septum. A few vessels from the greater palatine artery
pass through the incisive canal of the palate to reach
the anterior part of the nose.
The veins of the nose drain into the sphenopalatine
foramen and then into the pterygoid plexus, whereas
others accompany the ethmoid arteries to join the su-

126 Geurkink
perior ophthalmic vein. Those that are anterior in the
nose drain into the facial vein.
PHYSIOLOGY AND FUNCTION OF THE
NOSE
In order to review the functions of the nose, the
following factors should be considered: (1) airway,
(2) air conditioning, (3) olfaction, (4) effects on
speech, (5) reflex functions, and (6) common factors
that will affect nasal blood flow.
Airway
The nose is one of the most important components
to airflow resistance. It has been calculated to provide
between 30% and 50% of the total resistance to inspi-
ration. The cross-sectional diameter of the anterior
nares is much smaller than the posterior choana, so
that inspiratory air currents are much different than
expiratory air currents. The former are directed up-
ward across the superior surface of the inferior turbi-
nate and the main surfaces of the middle turbinate into
the nasopharynx. This upward direction is governed
somewhat by the horizontal position of the anterior
mu-es and the smooth anterior ends and surfaces of the
turbinates and the shape of the septum. These stream-
lined structures tend to create a minimal resistance in
guiding the inflow of air. The cartilaginous frame-
work of the nasal alae prevents total collapse of these
structures during negative pressure of inspiration. The
nasal value is one of the most important structures
governing the rate and volume of air traversing the
anterior nares. The baffles created by the shape of
the vestibule add to this airway resistance.
The expiratory airway is different in that it begins
to traverse the nose from a larger posterior choana
adjacent to the nasopharynx to a relative constriction
of the anterior nares. This creates a large central eddy
or recurrent stream through the inferior meatus to
finally join the main stream from the nasopharynx.
This action conserves some of the heat of the expired
air. Deflections of the septum, masses in the nose, or
hypertrophy of the mucous membrane obviously will
distort and obstruct the air currents through the nose.
The pattern of airflow to stimulate olfaction is
somewhat different. It is initiated by sniffing. This
redirects the air superiorly into the olfactory cleft for
stimulation of the neuroepithelial membrane.
Air conditioning
One of the better known functions of the nose is
that of providing humidification and heating of the
inspired air. The volume and rate of airflow along
with the specialized vascular nasal mucosa are espe-
J ALLERGY CLIN. IMMUNOL
AUGUST 1983
cially important in maintaining a constant range of
temperature of the inspired air from the portal of entry
to the alveoli. Cole: has stated that air in the
nasopharynx will have a relative humidity approach-
ing saturation. The rather rapid change in the process
of conditioning this air occurs because the inspiratory
air comes into contact with a moist and warm nasal
mucous membrane. Its high gradients of temperature
and water vapor pressure are responsible for this rapid
change.
The phase of expiration is in a sense a reverse of
inspiration. Some of the least well-conditioned air is
expelled from the dead space in the tracheobronchial
tree and passes over the mucosa of the pharynx and
nose that has been cooled by the previous inspired air.
This air gives up its heat and moisture to this mem-
brane. Cole4 has estimated that a third of the heat and
water is returned to the mucous membrane during
expiration. He also stated that a normal, healthy adult
residing in a temperate environment would lose be-
tween 300 and 400 ml of water and between 250 and
350 kcal in the expired air in a 24 hr period. Physical
activity and living in dry, cold environments will in-
crease these figures.
Occurring simultaneously with the heating of in-
spired air is the humidification of the air. The main
supply of moisture is through a physical process of
transudation of fluid through the mucosal epithelium.
Secretions of the epithelial glands and goblet cells in
the nasal membrane provide a smaller volume. The
exact volume of fluid necessary to create this high
percent of saturation will depend to some degree on
the temperature and the relative humidity of the am-
bient air. A rough calculation of the daily volume of
secretion and transudate from the nose is 1000 cc. It
has been estimated that three fourths of this is used to
saturate the inspired air and the remainder is used in
the ciliary mechanisms of cleaning and purifying the
inspired air.
Protective mechanism
The vibrissae in the vestibule and nose are respon-
sible for removing particles in the ambient air that are
larger than 15 pm in size. Only 5% of those particles
smaller than 1 pm are removed by the mucous
membrane.
Muscociliary activity
The mucous blanket is another important aspect in
the protective function of the nose. It consists of two
layers. The outer layer is relatively viscous and rests
on a thin layer of serous fluid that tends to facilitate
the action of the underlying cilia. The fine particulate
VOLUME 72
NUMBER 2
matter that enters the inspired air is filtered by the
process of adhering to the mucous film. This occurs
by two mechanisms. One is the impaction of the par-
ticles on the surface of the mucous membrane and the
other is an electrostatic surface charge. So efficient is
this function that the mucous membrane of the
posterior choana contain very few bacteria and the
sinuses are normally sterile.
Both the population and the activity of the cilia in
the mucous membrane of the nose have been studied
exhaustively., - 6 In the front part of the nose there is a
paucity of cilia and the movement of the mucous is
slow at about 1 to 2 mmihr. However, in the posterior
aspect of the nose, the mucus may be propagated at a
rate of 10 mm each minute and the mucous blanket in
the posterior two thirds of the nose will tend to recon-
stitute itself every 10 to 1.5 min. The ciliated cells
have from 12 to 20 cilia that project from the luminal
surface of the cell into the mucus. The beat of the cilia
is quick and forceful in a forward, propulsive stroke
that is followed by a slower recovery stroke. This
cycle may be repeated hundreds of times each min-
ute. The beating appears to pass from one region to
another adjacent posterior one in a metachronous
fashion.
Anything that affects ciliary activity is of clinical
importance. Drying of the nasal mucous membrane
will cause cessation of ciliary activity while prompt
moistening will restore its normal activity. The op-
timum temperature range for ciliary activity is 28 to
30 C. Hypotonic saline solutions will inhibit ciliary
activity; hypertonic saline solutions will cause it to
stop. The use of adrenaline and cocaine in the nose
will ultimately cause irreversible inhibition of the
ciliate cell activity if they are exposed to them for a
sufficient length of time.
Olfaction
The olfactory area in the human nose is confined to
the roof of the nasal cavity, the superior part of each
superior turbinate in the lateral wall of the nose, and
approximately the upper one third of the nasal septum
of each side. The histologic appearance of the mem-
brane is that of a thick, pseudostratified, columnar
nonciliated epithelium. It contains three types of cells:
basal cells, supporting cells, and olfactory receptor
cells. The receptor cells are situated among the sup-
porting cells. Their number has been estimated to be
between 10 and 20 million. They act as both periph-
eral sensory receptors and neuronal cell bodies with
processes and are oval in shape. The central elongated
end of each olfactory cell acts as a continuous strand
or thick axon that is enveloped by the basal cells. The
Nasal anatomy, physiology, and function 127
filaments pierce the basement membrane and become
directly continuous as a nerve axon of unmyelinated
nature. These axons group together to form the fibers
of the olfactory nerve, which ultimately terminate in
the glomeruli of the olfactory bulbs.
Olfactory stimulation, sensitivity, and
discrimination
The exact mechanism of stimulation and sensitivity
of the olfactory system is still unclear.7 It is clear that
the odor must reach the olfactory area or, more spe-
cifically, the olfactory mucosa. Normal breathing
does not necessarily bring the air current into that area
of the nasal chamber. Odor detection may bring about
reflex sniffing that diverts the air flow into the olfac-
tory cleft. It is not really certain to what extent the
perception of odor is influenced by sniffing. Whether
the volume of air, the duration of contact with the
olfactory membrane, the change in air flow, or pres-
sure is responsible for odor perception is also not
known.
The perception of an odor that is detected depends
on a number of aspects. It would include whether or
not the odor is volatile, what its concentration in
the inspired air may be, the exact volume of air that
reaches the mucosa of the olfactory region, and pos-
sibly the force with which it strikes the mucosa. The
lipid water solubility and the state of olfactory mucosa
at the time of stimulation are also important. Obvi-
ously the integrity of the olfactory nervous pathway
and cortical centers for perception are also important.
Speech
The nose provides vocal resonance. It is obvious
that a persons voice can be changed by nasal
obstruction for any cause. Rhinolalial clausa is the
medical term used to describe nasal resonance due to
a nasal obstruction. Rhinolalial aperta occurs when
the vibrating air column passes from the larynx to the
pharynx, mouth, and into the nose. This is most
commonly observed in an individual with a cleft pal-
ate. Only the nasal consonants M, N, and NC are
made by the vibrating air column of air passing from
the larynx through the nose.
Nasal reflex functions
There are a myriad of reflex functions originating in
the nose. They consist of two primary groups: those
that originate from the sense of smell and those that
are initiated through trigeminal nerve ending termi-
nals. Common examples of olfactory group functions
are reflexes related primarily to digestive actions. Sal-
ivary, gastric, and pancreatic glands are reflexly
128 Geurkink J. ALLERGY CLIN. IMMUNOL.
AUGUST 1983

stimulated by the olfactory centers. Fifth nerve re- its unique internal anatomy and the vascular tone of
flexes include changes in the lower respiratory tract, its mucous membrane. In addition, it houses the re-
particularly in the larynx, trachea, and tracheobron- ceptor side of the first cranial nerve. This receptor is
chial tree, changes in the heart rate, and changes in relatively primitive in man and probably less effective
pulmonary ventilation, and reflex sneezing. in monitoring his environment than that of other
mammals. The nose is the portal by which the am-
Common factors that may affect nasal blood bient air first enters the body. The nose functions as a
flow guard dog or watch dog for the lungs. It condi-
Many different factors, both local and general, will tions air to a specific range of temperature and
affect the vasomotor reaction of the nose. Local fac- humidity. Its protective filtration and ciliary mecha-
tors include changes in the ambient temperature and nisms are abundant. Nasal reflex functions affect the
humidity, the topical administration of vasoactive lower respiratory tract and cardiopulmonary functions
drugs, the external compression of large veins in the and respond to intense emotional situations. Since the
neck, trauma, and inflammation. The normal mucous time of Proetz original essays on the physiology of
membrane of the nose reacts to maintain the homeo- the nose, a great deal of study has been done on the
static mechanism in the nasopharynx and tracheo- various and myriad functions of the nose. A working
bronchial airway. understanding of its peculiar anatomy and unusual
Sympathomimetic drugs that have been applied lo- functions are important for understanding the patho-
cally to the mucosa will produce shrinkage with physiology of nasal disease.
blanching. This action may persist for 1 to 3 hr, de-
pending on the drug used. Common drugs causing REFERENCES
this action are adrenaline, Neo-Synephrine, and 1. Fairbanks DNF: Embryology and anatomy. In Bluestone CD,
ephedrine. Stool SE, editors: Pediatric otolaryngology. Philadelphia, 1983,
Parasympathomimetic drugs will produce conges- W. B. Saunders Co., vol. II, pp 647-648.
2. Hollingshead WH: Anatomy for surgeons-the head and neck,
tion in the nasal mucous membrane and decreased ed. 3. Philadelphia, 1982, Harper & Row Publishers, vol. I.,
airflow and will increase the volume of nasal secre- chap. 4.
tions. Atropine causes constriction of the capillaries 3. Cole P: Upper respiratory airflow. In Proctor DF, Anderson IB,
and contraction of the cavernous tissue in the nose and editors: The nose: upper airway physiology and the atmospheric
cocaine produces marked contraction of these erectile environment. Amsterdam. 1982, Elsevier Biomedical Press
BV, p. 166.
spaces. 4. Cole P: Modification of inspired air. In Proctor DF, Anderson
General factors that affect nasal blood flow have IB, editors: The nose: upper airway physiology and the atmo-
been known for some time. Holmes et al. ,H in their spheric environment. Amsterdam, 1982, Elsevier Biomedical
monograph on the nose, describe the emotional fac- Press BV, pp. 370-371.
tors that are characteristic of nasal symptoms. Fear 5. Mygind N, Pederson M, Nielsen MH: Morphology of the upper
airway epithelium. In Proctor DF, Anderson IB, editors: The
was found to create a sympathetic type of response nose: upper airway physiology and the atmospheric environ-
of the nasal mucous membrane, whereas frustration, ment. Amsterdam, 1982, Elsevier Biomedical Press BV, p. 81.
humiliation, and anxiety engorged the nasal mucous 6. Proctor DF: The mucociliary system. In Proctor DF, Anderson
membrane and caused a parasympathetic type of IB, editors: The nose: upper airway physiology and the atmo-
response. They demonstrated these effects by compar- spheric environment. Amsterdam, 1982, Elsevier Biomedical
Press BV, pp. 245-278.
ing the emotional tone with biopsies of the inferior
7. Berglund B, Lindval T: Olfaction. In Proctor DF, Anderson IB,
turbinate mucosa from subjects undergoing different editors: The nose: upper airway physiology and the atmospheric
periods of emotional conflict. environment. Amsterdam, 1982, Elsevier Biomedical Press
The nasal vessels may react to other sympathetic BV, p. 283.
vasomotor responses of the body. Auditory stimuli, 8. Holmes TH, Goode11 H, Wolf S, Wolff HG: The nose. Spring-
field, Ill., 1950, Charles C Thomas, Publisher.
deep breathing, and breath holding may produce va-
9. Proetz AW: Essays on the applied physiology of the nose, ed. 2.
soconstriction in the nasal mucosa. Painful stimula- St. Louis, 1953, Annals Publishing Co., p. 153.
tion may cause marked vasoconstriction. Overventi-
lation may produce dilatation of the nasal vessels.

SUMMARY
The nose in man, despite its unusual external ap-
oearance. has a varietv of functions that are related to