Woman with Scented Candles/ShutterStock, Antonio Guillem
In a recent study of 6,000 respondents in six countries, 90 percent of respondents said their sense of smell was closely linked to their strongest memories. The smells of family recipes evoke the most nostalgia, and the smells of bread coming out of the oven, pastries and coffee are among the most favorite smells of most respondents.
78% of respondents said that their sense of smell greatly influences their mood and a similar proportion expressed fear of losing it. "The nose is the organ that is often taken for granted," says Dr. Meir Warman, an ENT specialist and nose and sinus surgeon at Kaplan Hospital in Rehovot.
"In the nose, the organ solely responsible for the sense of smell, there must be a constant flow of warm, moist air to the upper respiratory passages. As soon as inflammation develops in the nasal cavities due to an allergy or genetic predisposition of the person, or a general level of inflammation in the body, edema and blockage of the air passages in the nose are created, as a result of which the air flow stops and the continuous blockage manifests itself in swelling of the internal mucosa in the nose, into clusters of edema called polyps." The inflammation in the nose is usually type 2 inflammation which contains eosinophil inflammatory cells.
According to Dr. Warman, there are several diseases associated with the same inflammation, one of which is chronic sinusitis with polyposis (or by its scientific name Chronic Rhinosinusitis with Nasal Polyposis). The disease is caused by chronic inflammation of the facial cavities. As a result of this inflammation, changes are created in the mucosa that surrounds the cavities, causing bumps inside the facial and nasal cavities. The disease, which affects 2% of the population, aged 20-50 - in some of them there is a delay in diagnosis thinking that it is a "cold that does not go away" and this delay can be many years. Many of them have comorbidities such as asthma or skin asthma (atopic dermatitis). Sometimes a family member gets one of these diseases, all of which have one basis: type 2 inflammation.
Dr. Meir Warman/PR
When the feeling of a cold does not go away after a week or two, one can already suspect that it is not a normal cold
Why is this happening?
According to Dr. Warman, the disease can be caused by a number of reasons. Sometimes it is a structural problem of contact between the mucous membranes inside the nose, and the contact causes inflammation to develop. Another possibility is the presence of a bacterium in the nose that causes the awakening of the immune system and the formation of an inflammatory reaction, in severe cases chronic inflammation develops. Another reason stems from an allergic reaction during which the control of the immune system is disrupted, for a reason that has not yet been clarified, and inflammation occurs. This type 2 inflammation is created within the body itself and not as a result of an external factor and is what contributes to the formation and growth of polyps.
What are the symptoms?
The first symptoms are a feeling of blockage in the nose, sometimes a feeling of cold and runny nose and, as a result, a decrease in the sense of smell. "When the feeling of a cold does not go away after a week or two, and it continues for many months, with feelings of congestion that you try to blow but nothing comes out and there is also a feeling of heaviness inside, you can already suspect that this is not a normal cold. It is important to see an ENT specialist who will perform an endoscopic examination, diagnose and treat," says the expert.
In addition to complaints of nasal air obstruction, most patients complain of impairment or disappearance of the sense of smell, and severe impairment of quality of life, including sleep disturbance, disturbance during physical activity, since patients breathe only through the mouth and impairment of the enjoyment of a delicious meal. "Many patients come to me with claims that different foods taste the same only in different textures, and for some patients the sense of smell is related to their profession," explains the expert.
Studies show that when you stop breathing through your nose, you can have a very significant impact on quality of life/ShutterStock
Breathing through the nose is extremely
important. Studies show that when you stop breathing through your nose, you can have a very significant impact on quality of life. Although sinusitis seems to be a mild problem because "only" one does not breathe from the nose, it has been proven according to designated questionnaires that the impairment of the quality of life of patients with chronic sinusitis is extremely severe and similar to severe chronic patients such as heart failure and severe chronic lung disease. Moreover, breathing through the nose slowly and calmly is important not only for a person's peace of mind but also for respiratory function by delivering a gas called nitric oxide to the lower respiratory tract, the lungs.
How is it treated? According to Dr. Warman, "Treatment develops according to the severity of the disease. When the disease is mild, non-pharmacological treatment is initiated: rinses of saline. The salt water opens up the areas of the stagnation (STASIS = a state in which liquid or air flows slowly or stops) that can promote the development of inflammation."
"If that doesn't help, and you can't open the blockage and allow air to pass through your nose, you start drug treatment whose goal is to reduce the polyps and stop the worsening. These are two classes of drugs: corticosteroids or leukotrienes," explains Dr. Warman, noting that "leukotrienes are chemicals produced by white blood cells that help the immune system fight infections. However, they can also cause allergic reactions or inflammatory reactions."
Steroids can be administered in different ways, orally, by injection into the muscle or by spray. "But we will try to avoid long-term steroid administration because they can cause side effects. The reason is that they act not in a targeted manner but extensively on any inflammation in the body. The patient feels relief, the polyps recede in temporary size, air circulation is restored and there is a benefit. However, this benefit in most patients only helps in the short term," emphasizes Dr. Warman.
According to him, if there is no improvement in the previous two stages, they move on to a stage that includes complex surgeries to treat surgical removal of the polyps from the nose and facial cavities. "This is a complex surgery that requires high surgical skill, we remove the polyps and clear the passageways, in order to allow the flow of air. The location of the sinuses is below the base of the skull - near the eyes, sometimes a few millimeters away, so appropriate experience and skill is needed to remove the polyps without harming the nearby organs."
"The latest drug line, which is a new generation of biological drugs, intended for the severely ill with sinusitis that is not balanced despite all existing treatments. Biologics are based on antibodies specifically developed to act on specific inflammatory cells. They know how to identify the factors that cause the disease, focus on them and paralyze them. And they work well as long as they persist in treatment," Dr. Warman describes, noting that "this is real news for the most difficult patients for whom until now the only solution available to them is repeated surgeries, every 3-4 years. And today they have hope." Some patients describe the benefit in their lives after starting biological therapy as a "life-changing event."
For more information or questions, contact your physician. Provided as a public service by Sanofi.
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