Introduction

See the figure A Look at the Nose and Throat.

Savoring the aroma of a favorite food and belting out a verse from a familiar song are but two examples of how the sense of smell and the ability to use one's voice can add richness to a person's quality of life. The sense of smell and the ability to use one's voice can even be the difference between life and death, as any person knows who has ever smelled smoke in a building and called out to alert others. And any person who has experienced an improperly working nose or sinuses may well know the vexing discomfort and challenges faced in trying to lie down and sleep comfortably. The sense of smell, the proper functioning of the nose and sinuses, and the ability to use one's voice, all remain vitally important to older people. Therefore, disorders of the nose and throat, even if they seem minor at first, cannot be considered trivial.

The Nose and Sinuses

The expression "as plain as the nose on your face" does not give the nose its due: There is so much more to the nose than what can be observed in the mirror. The nose can be thought of as having two parts. The visible part consists of bone and cartilage. Hollow passageways extend from the nostrils (nares) upward and inward along the sides of the nose, separated by a thin sheet of cartilage and bone called the nasal septum. The hidden part begins where passageways from the visible part of the nose join a hollow space (nasal cavity) that extends back to the upper part of the throat (nasopharynx), connecting the nose with the airways. Together, the passageways in the visible part of the nose and the nasal cavity in the hidden part of the nose are sometimes called the nasal passages.

Sinuses are smaller hollow spaces in the front portion of the skull. The purpose of the sinuses remains unknown. The paranasal sinuses, of which there are several types, are located around the nose and eyes. The maxillary sinuses are under the cheekbones and just above the upper teeth. The ethmoid sinuses are on the sides of the upper nose and between the eyes. The sphenoid sinuses are behind the ethmoid sinuses. The frontal sinuses are above the eyebrows. All of the paranasal sinuses have passageways that open into the nasal cavity.

The nose plays an important role in breathing and in the sense of smell. It also protects against infection and contributes to a person's appearance and tone of voice. But aging changes the nose. The mucous membranes lining the nasal passages become thinner and drier, which may increase the risk of nosebleeds and impair the sense of smell. Sense of smell is further impaired as the nerves responsible for smell deteriorate with aging. A runny nose and mucus draining into the throat become more common because of changes in the nerves controlling blood vessels in the nasal passages. Cosmetic changes occur as well. Cartilage weakens, causing the tip of the nose to droop. This drooping makes the nose appear longer and more humped. These cosmetic changes also contribute to the sense of nasal obstruction that grows more common with aging.

Chronic disorders of the nose and sinuses can affect a person's appetite and nutrition, sense of smell, breathing, appearance, and sense of well-being. Nasal and sinus congestion, the most common symptoms of nose disorders, frequently cause problems when a person lies down, thus making it difficult to fall and stay asleep. Nasal and sinus congestion usually cause fatigue from both the sleep disturbance and the constant effort to get air through the congested nose.

The Throat

The throat, like the nose, is more complex than its appearance suggests. The throat has three main parts. The upper part (nasopharynx) connects with the nasal passages as they pass into the back of the mouth. The middle part (oropharynx) is in the back of the mouth and is visible when the mouth is opened wide. This part of the throat extends to the base of the tongue and assists in swallowing and speech. The lower part (hypopharynx) extends into the windpipe (trachea) in the neck, where the voice box (larynx) is located. The voice box is a complex structure composed of cartilage and muscle. Muscles in the voice box (vocal cords) vibrate and move to produce the basic tone that is shaped by the rest of the throat, mouth, and lips into speech.

With aging, the muscles in and around the tongue weaken, leading to less efficient, prolonged swallowing. These changes can put older people at risk of undernourishment and of inhalation of unswallowed food (aspiration). The vocal cords grow weaker, leading to change in pitch (presbylarynx). A woman's voice may become huskier and lower in pitch, whereas a man's may become thinner and higher in pitch. Hoarseness is more likely to accompany colds or excessive voice use as the vocal cords weaken. Uncommonly, a tremor of the voice develops and grows more pronounced with aging; this voice tremor tends to occur with tremors of the hands. Disorders of the throat can change the sound and volume of a person's voice. Throat disorders can also impair swallowing, thereby adding to the risk of undernutrition and aspiration.