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Disorders of the Nasal Mucous Membrane

Merck Manual of Geriatrics (3rd Edition), 2000

Chapter 130.
Nose and Throat Disorders Topics:     | | Disorders of the Nasal Mucous Membrane | | | | | | | Disorders of the Nasal Mucous Membrane Nasal dryness: With age, the mucous membrane becomes thinner, the number and size of elastic fibers and the amount of submucosal tissue decrease, and mucus-secreting structures atrophy, resulting in decreased mucus production and nasal dryness.
In elderly persons, exposure to cold air or intake of certain foods (especially hot or spicy foods) may cause excessive watery, dripping nasal secretions.
This effect probably results from age-related changes in the function of parasympathetic vasomotor secretory fibers in the nose.
Ipratropium bromide 0.03% nasal spray is effective, although it should be used with caution in patients who have narrow-angle glaucoma or benign prostatic hyperplasia.
Anticholinergic antihistamines are dangerous in the elderly and should not be used; antihistamines without anticholinergic properties have no effect on rhinorrhea unless it is caused by allergy.
Epistaxis (nosebleed): With age, the nasal mucous membrane atrophies and blood vessel walls in the nose thin.
Anterior epistaxis may result from ulceration of the mucosa overlying old septal spurs, from deviations (particularly in patients taking anticoagulants, such as daily aspirin for general cardiovascular prophylaxis), or from use of oxygen through nasal cannulas.
Posterior epistaxis, the more serious type, is most commonly caused by rupture of a branch of the sphenopalatine artery, located near the posterior tip of the inferior turbinate.
Coagulopathies, if present, should be corrected at least temporarily, so that a thrombus can form and the mucous membrane can heal.
Acute anterior epistaxis may be managed with oxymetazoline 0.05% nasal spray, which has long-acting vasoconstrictive properties and no significant systemic effects.