Abstract
The impact of the aging world population forces rhinologists to become familiar with how aging affects both normal nasal physiology and contributes to disease. There are several aspects of nasal function that change with age. These include alterations to the framework of the nasal structure and the respiratory epithelium which lines the inside. Changes in vascular regulation and airflow also affect other functional aspects of the nose such as nasal conditioning and mucociliary transport. Rhinitis is a common condition in older patients and its etiology is poorly understood. Consideration of these physiological changes is important to effective treatment of rhinitis in older patients. A number of therapies are useful for this condition, but special attention to principles of geriatric medicine is warranted to safely and effectively treat rhinitis in older patients.
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References
Alford RH. Effects of chronic bronchopulmonary disease and aging on human nasal secretion IgA concentrations. J Immunol. 1968;101(5):984–8.
Allen DB. Systemic effects of intranasal steroids: an endocrinologist’s perspective. J Allergy Clin Immunol. 2000;106(4 Suppl):S179–90.
American Society of Geriatric Otolaryngology. [Internet] 2007 [updated Aug 2007; cited Sep 2012]. Available from: http://geriatricotolaryngology.org/index.html
Assanasen P, Baroody FM, Rouadi P, Naureckas E, Solway J, Naclerio RM. Ipratropium bromide increases the ability of the nose to warm and humidify air. Am J Respir Crit Care Med. 2000;162(3 Pt 1):1031–7.
Ban JH, Kwon HJ, Lee KC. Outcomes of endoscopic sinus surgery in an elderly population: comparison with those in an adult population. Clin Otolaryngol. 2010;35(4):300–6.
Benninger MS, Ahmad N, Marple BF. The safety of intranasal steroids. Otolaryngol Head Neck Surg. 2003;129(6):739–50.
Bhutta MF. Sex and the nose: human pheromonal responses. J R Soc Med. 2007;100(6):268–74.
Bousquet J, Khaltaev N, Cruz AA, Denbur J, Fokkens WJ, Togias A, et al. Allergy and its impact on asthma (ARIA) 2008 update. Allergy. 2008;63 Suppl 86:8–160.
Brämerson A, Johansson L, Ek L, Nordin S, Bende M. Prevalence of olfactory dysfunction: the skövde population-based study. Laryngoscope. 2004;114(4):733–7.
Busse PJ, Mathur SK. Age-related changes in immune function: effect on airway inflammation. J Allergy Clin Immunol. 2010;126(4):690–9.
Cain WS, Stevens JC. Uniformity of olfactory loss in aging. Ann N Y Acad Sci. 1989;561:29–38.
Cardona V, Guilarte M, Luengo O, Labrador-Horrillo M, Sala-Cunill A, Garriga T. Allergic diseases in the elderly. Clin Transl Allergy. 2011;1(1):11.
Chaaban M, Corey JP. Pharmacotherapy of rhinitis and rhinosinusitis. Facial Plast Surg Clin North Am. 2012;20(1):61–71.
Cochran CS, Ducic Y, DeFatta RJ. Restorative rhinoplasty in the aging patient. Laryngoscope. 2007;117(5):803–7.
Colclasure JC, Gross CW, Kountakis SE. Endoscopic sinus surgery in patients older than sixty. Otolaryngol Head Neck Surg. 2004;131(6):946–9.
Cole P. Respiratory mucosal vascular responses, air conditioning, and thermoregulation. J Laryngol Otol. 1954;68:613–22.
de Oliveira-Maul JP, de Carvalho HB, Miyuki Goto D, Mendonça Maia R, Fló4 C, Barnabé V, Reis Franco D, et al. Aging, diabetes and hypertension are associated with decreased nasal mucociliary clearance. Chest. 2013;143(4):1091–7.
Di Lorenzo G, Leto-Barone MS, La Piana S, Ditta V, Di Fede G, Rini GB. Clinical course of rhinitis and changes in vivo and in vitro of allergic parameters in elderly patients: a long-term follow-up study. Clin Exp Med. 2013;13(1):67–73.
Doshi J. Rhinitis medicamentosa: what an otolaryngologist needs to know. Eur Arch Otorhinolaryngol. 2009;266(5):623–5.
Edelstein DR. Aging of the normal nose in adults. Laryngoscope. 1996;106(9 Pt 2):1–25.
Ellegard EK. Pregnancy rhinitis. Immunol Allergy Clin North Am. 2006;26(1):119–35.
Fokkens WJ. Thoughts on the pathophysiology of nonallergic rhinitis. Curr Allergy Asthma Rep. 2002;2(3):203–9.
Georgalas C, Jovancevic L. Gustatory rhinitis. Curr Opin Otolaryngol Head Neck Surg. 2012;20(1):9–14.
Getchell ML, Chen Y, Ding X, Sparks DL, Getchell TV. Immunohistochemical localization of a cytochrome P-450 isozyme in human nasal mucosa: age-related trends. Ann Otol Rhinol Laryngol. 1993;102:368–74.
Handley OJ, Morrison CM, Miles C, Bayer AJ. ApoE gene and familial risk of Alzheimer’s disease as predictors of odour identification in older adults. Neurobiol Aging. 2006;27(10):1425–30.
Hawkes C. Olfaction in neurodegenerative disorder. Adv Otorhinolaryngol. 2006;63:133–51.
Herz RS, Schooler JW. A naturalistic study of autobiographical memories evoked by olfactory and visual cues: testing the Proustian hypothesis. Am J Psychol. 2002;115(1):21–32.
Hicklin LA, Ryan C, Wong DK, Hinton AE. Nose-bleeds after sildenafil (viagra). J R Soc Med. 2002;95(8):402–3.
Hirschberg A, Roithmann R, Parikh S, Miljeteig H, Cole P. The airflow resistance profile of healthy nasal cavities. Rhinology. 1995;33(1):10–3.
Ho JC, Chan KN, Hu WH, Lam WK, Zheng L, Tipoe GL, et al. The effect of aging on nasal mucociliary clearance, beat frequency, and ultrastructure of respiratory cilia. Am J Respir Crit Care Med. 2001;163(4):983–8.
Hofer-Dückelmann C. Gender and polypharmacotherapy in the elderly: a clinical challenge. Handb Exp Pharmacol. 2012;214:169–82.
Hoffman HJ, Ishii EK, MackTurk RH. Age-related changes in the prevalence of smell/taste problems among the United States adult population. Results of the 1994 disability supplement to the National Health Interview Survey (NHIS). Ann N Y Acad Sci. 1998;855(1):716–22.
Hutton JL, Baracos VE, Wismer WV. Chemosensory dysfunction is a primary factor in the evolution of declining nutritional status and quality of life in patients with advanced cancer. J Pain Symptom Manage. 2007;33(2):156–65.
Jacob S, McClintock MK, Zelano B, Ober C. Paternally inherited HLA alleles are associated with women’s choice of male odor. Nat Genet. 2002;30(2):175–9.
Johnsen J, Bratt BM, Michel-Barron O, Glennow C, Petruson B. Pure sesame oil vs isotonic sodium chloride solution as treatment for dry nasal mucosa. Arch Otolaryngol Head Neck Surg. 2001;127(11):1353–6.
Kahn DM, Shaw RB. Overview of current thoughts on facial volume and aging. Facial Plast Surg. 2010;26(5):350–5.
Kalmovich LM, Elad D, Zaretsky U, Adunsky A, Chetrit A, Sadetzki S, et al. Endonasal geometry changes in elderly people: acoustic rhinometry measurements. J Gerontol A Biol Sci Med Sci. 2005;60(3):396–8.
Karabulut H, Baysal S, Acar B, Babademez MA, Karasen RM. Allergic rhinitis (AR) in geriatric patients. Arch Gerontol Geriatr. 2011;53(3):270–3.
Kay GG, Quig ME. Impact of sedating antihistamines on safety and productivity. Allergy Asthma Proc. 2001;22(5):281–3.
Kim SW, Mo JH, Kim JW, Kim DY, Rhee CS, Lee CH, et al. Change of nasal function with aging in Korea. Acta Otolaryngol Suppl. 2007;558:90–4.
King MJ, Lockey RF. Allergen prick-puncture skin testing in the elderly. Drugs Aging. 2003;20(14):1011–7.
Koga T, McGhee JR, Kato H, Kato R, Kiyono H, Fujihashi K. Evidence for early aging in the mucosal immune system. J Immunol. 2000;65(9):5352–9.
Kovacs T. Mechanisms of olfactory dysfunction in aging and neurodegenerative disorders. Ageing Res Rev. 2004;3(2):215–32.
Lafreniere D, Mann N. Anosmia: loss of smell in the elderly. Otolaryngol Clin North Am. 2009;42(1):123–31.
Lal D, Corey JP. Vasomotor rhinitis update. Curr Opin Otolaryngol Head Neck Surg. 2004;12(3):243–7.
Landis BN, Konnerth CG, Hummel T. A study on the frequency of olfactory dysfunction. Laryngoscope. 2004;114(10):1764–9.
Li KZ, Lindenberger U. Relations between aging sensory/sensorimotor and cognitive functions. Neurosci Biobehav Rev. 2002;26(7):777–83.
Lindemann J, Sannwald D, Wiesmiller K. Age-related changes in intranasal air conditioning in the elderly. Laryngoscope. 2008;118(8):1472–5.
Lindemann J, Tsakiropoulou E, Konstantinidis I, Lindemann K. Normal aging does not deteriorate nose-related quality of life: assessment with “NOSE” and “SNOT-20” questionnaires. Auris Nasus Larynx. 2010;37(3):303–7.
Liston SL, Siegel LG. Nasal and sinus disorders in the elderly: which ones are life-threatening? Geriatrics. 1981;36(2):91–102.
Little D. Allergies in the aging. Geriatr Aging. 2005;8(5):52–3.
Malmberg H, Grahne B, Holopainen E, Binder E. Ipratropium (Atrovent) in the treatment of vasomotor rhinitis of elderly patients. Clin Otolaryngol Allied Sci. 1983;8(4):273–6.
Mattes RD, Cowart BJ. Dietary assessment of patients with chemosensory disorders. J Am Diet Assoc. 1994;94(1):50–6.
Mattes RD, Cowart BJ, Schiavo MA, Arnold C, Garrison B, Kare MR, et al. Dietary evaluation of patients with smell and/or taste disorders. Am J Clin Nutr. 1990;51(2):233–40.
McNeely W, Wiseman LR. Intranasal azelastine: a review of its efficacy in the management of allergic rhinitis. Drugs. 1998;56(1):91–114.
Mediaty A, Neuber K. Total and specific serum IgE decreases with age in patients with allergic rhinitis, asthma and insect allergy but not in patients with atopic dermatitis. Immun Ageing. 2005;2(1):9.
Meltzer EO. Intranasal anticholinergic therapy of rhinorrhea. J Allergy Clin Immunol. 1992;90(6 Pt 2):1055–64.
Meltzer EO. The role of nasal corticosteroids in the treatment of rhinitis. Immunol Allergy Clin North Am. 2011;31(3):545–60.
Mirza N, Kroger H, Doty RL. Influence of age on the ’nasal cycle’. Laryngoscope. 1997;107(1):62–6.
Miwa T, Furukawa M, Tsukatani T, Costanzo RM, DeNardo LJ, Reiter ER. Impact of olfactory impairment on quality of life and disability. Arch Otolaryngol Head Neck Surg. 2001;127(5):497–503.
Naclerio RM, Pinto J, Assanasen P, Baroody FM. Observations on the ability of the nose to warm and humidify inspired air. Rhinology. 2007;45(2):102–11.
NAMCS. Report of the panel of communicative disorders to the National Advisory Neurological and Communicative Disorders and Stroke Council. Washington, DC: Public Health Service; 1979.
Neuland C, Bitter T, Marschner H, Gudziol H, Guntinas-Lichius O. Health-related and specific olfaction-related quality of life in patients with chronic functional anosmia or severe hyposmia. Laryngoscope. 2011;121(4):867–72.
NIDCD. Quick statistics about taste and smell. [Internet]. 2010 [updated Jun 2010; cited Oct 2012]. Available from: http://www.nidcd.nih.gov/health/statistics/smelltaste/Pages/stquickstats.aspx
Ochs KL, Zell-Kanter M, Mycyk MB, Toxikon Consortium. Hot, blind, and mad: avoidable geriatric anticholinergic delirium. Am J Emerg Med. 2012;30(3):514.
Paik SI, Lehman MN, Seiden AM, Duncan HJ, Smith DV. Human olfactory biopsy: the influence of age and receptor distribution. Arch Otolaryngol Head Neck Surg. 1992;118(7):731–8.
Palmer RM. Perioperative care of the elderly patient: an update. Cleve Clin J Med. 2009;76 Suppl 4:S16–21.
Patterson CN. The aging nose:characteristics and correction. Otolaryngol Clin North Am. 1980;13(2):275–88.
Philpott CM, Robinson AM, Murty GE. Nasal pathophysiology and its relationship to the female ovarian hormones. J Otolaryngol Head Neck Surg. 2008a;37(4):540–6.
Philpott CM, Wild DC, Wolstensholme CR, Murty GE. The presence of ovarian hormone receptors in the nasal mucosa and their relationship to nasal symptoms. Rhinology. 2008b;46(3):221–5.
Quatela VC, Pearson JM. Management of the aging nose. Facial Plast Surg. 2009;25(4):215–21.
Raherison C, Nejjari C, Marty ML, Filleul L, Barberger-Gateau P, Dartigues JF, et al. IgE level and Phadiatop in an elderly population from the PAQUID cohort: relationship to respiratory symptoms and smoking. Allergy. 2004;59(9):940–5.
Ritchie CS. Oral health, taste, and olfaction. Clin Geriatr Med. 2002;18(4):709–17.
Robinson AM, Conley DB, Shinners MJ, Kern RC. Apoptosis in the aging olfactory epithelium. Laryngoscope. 2002;112(8 Pt 1):1431–5.
Rohrich RJ, Hollier Jr LJ, Janis JE, Kim J. Rhinoplasty with advancing age. Plast Reconstr Surg. 2004;114(7):1936–44.
Rotter N, Tobias G, Lebl M, Roy AK, Hansen MC, Vacanti CA, et al. Age-related changes in the composition and mechanical properties of human nasal cartilage. Arch Biochem Biophys. 2002;403(1):132–40.
Sakakura Y, Ukai K, Majima Y, Murai S, Harada T, Miyoshi Y. Nasal mucociliary clearance under various conditions. Acta Otolaryngol. 1983;96(1–2):167–73.
Salzano FA, Guastini L, Mora R, Ellepiane M, Salzano G, Santomauro V, et al. Nasal tactile sensitivity in elderly. Acta Otolaryngol. 2010;130(12):1389–93.
Santos DV, Reiter ER, DiNardo LJ, Costanzo RM. Hazardous events associated with impaired olfactory function. Arch Otolaryngol Head Neck Surg. 2004;130(3):317–9.
Sapci T, Yazici S, Evcimik MF, Bozkurt Z, Karavus A, Ugurlu B, et al. Investigation of the effects of intranasal botulinum toxin type A and ipratropium bromide nasal spray on nasal hypersecretion in idiopathic rhinitis without eosinophilia. Rhinology. 2008;46(1):45–51.
Sastre J, Mosges R. Local and systemic effects of intranasal corticosteroids. J Investig Allergol Clin Immunol. 2012;22(1):1–12.
Schiffman SS, Sattely-Miller EA, Suggs MS, Graham BG. The effect of pleasant odors and hormone status on mood of women at midlife. Brain Res Bull. 1995a;36:19–29.
Schiffman SS, Suggs MS, Sattely-Miller EA. Effect of pleasant odors on mood of males at midlife: comparison of African-American and European-American men. Brain Res Bull. 1995b;36:31–7.
Schrödter S, Biermann E, Halata Z. Histological evaluation of age-related changes in human respiratory mucosa of the middle turbinate. Anat Embryol (Berl). 2003;207(1):19–27.
Schroer B, Pien LC. Nonallergic rhinitis: common problem, chronic symptoms. Cleve Clin J Med. 2012;79(4):285–93.
Schubert CR, Carmichael LL, Murphy C, Klein BE, Klein R, Cruickshanks KJ. Olfaction and the 5-year incidence of cognitive impairment in an epidemiological study of older adults. J Am Geriatr Soc. 2008;56(8):1517–21.
Settipane RA. Other causes of rhinitis: mixed rhinitis, rhinitis medicamentosa, hormonal rhinitis, rhinitis of the elderly, and gustatory rhinitis. Immonol Allergy Clin North Am. 2011;31(3):457–67.
Settipane RA, Charnock DR. Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol. 2007;19:23–34.
Shah R, McGrath KG. Nonallergic rhinitis. Allergy Asthma Proc. 2012;33 Suppl 1:S19–21.
Shaw AC, Panda A, Joshi SR, Qian F, Allore HG, Montgomery RR. Dysregulation of human toll-like receptor function in aging. Ageing Res Rev. 2011;10(3):346–53.
Slavin RG. Treating rhinitis in the older population: special considerations. Allergy Asthma Clin Immunol. 2009;5(1):9.
Stefan M, Iglesia Lino L, Fernandez G. Medical consultation and best practices for preoperative evaluation of elderly patients. Hosp Pract (Minneap). 2011;39(1):41–51.
Stevens JC, Plantinga A, Cain WS. Reduction of odor and nasal pungency associated with aging. Neurobiol Aging. 1982;3(2):125–32.
Storms W, Farrar JR. Guaifenesin in rhinitis. Curr Allergy Asthma Rep. 2009;9(2):101–6.
Supiano MA, Alessi C, Chernoff R, Goldberg A, Morley JE, Schmader KE, et al. Department of veterans affairs geriatric research, education, and clinical centers: translating aging research into clinical geriatrics. J Am Geriatr Soc. 2012;60(7):1347–56.
Suzukawa K, Kondo K, Kanaya K, Sakamoto T, Watanabe K, Ushio M, et al. Age-related changes of the regeneration mode in the mouse peripheral olfactory system following olfactotoxic drug methimazole-induced damage. J Comp Neurol. 2011;519(11):2154–74.
Thorton K, Alston M, Dye H, Williamson S. Are saline irrigations effective in relieving chronic rhinosinusitis symptoms? A review of the evidence. J Nurse Pract. 2011;7(8):680–6.
Tillmann HC, Laske A, Bernasconi C, Stuck BA. Age determines vascular reactivity as measured by optical rhinometry. Eur J Clin Invest. 2009;39(11):1010–6.
Togias A. Age relationships and clinical features of nonallergic rhinitis. J Allergy Clin Immunol. 1990;85:182.
Toppozada H. The human nasal mucosa in the menopause: a histochemical and electron microscopic study. J Laryngol Otol. 1988;102:314–8.
Tran NP, Vickery J, Blaiss MS. Management of rhinitis: allergic and non-allergic. Allergy Asthma Immunol Res. 2011;3(3):148–56.
Varghese M, Glaum MC, Lockey RF. Drug-induced rhinitis. Clin Exp Allergy. 2010;40(3):381–4.
Ventura MT, Gelardi M, D’Amato A, Buquicchio R, Tummolo R, Misciagna G, et al. Clinical and cytologic characteristics of allergic rhinitis in elderly patients. Ann Allergy Asthma Immunol. 2012;108(3):141–4.
Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122:S1–84.
Wang L, Xie Y, Zhu LJ, Change TT, Man YG, Li J. An association between immunosenescence and CD4(+) CD25(+) regulatory T cells: a systematic review. Biomed Environ Sci. 2010;23(4):327–32.
Watabe-Rudolph M, Begus-Nahrmann Y, Lechel A, Rolyan H, Scheithauer MO, Rettinger G. Telomere shortening impairs regeneration of the olfactory epithelium in response to injury but not under homeostatic conditions. PLoS One. 2011;6(11):e27801. Epub 2011 Nov 16.
Werner CA. The older population: 2010. US Census Bureau; [Internet] Nov 2011. Available from: http://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf
Wilson RS, Arnold SE, Tang Y, Bennett DA. Odor identification and decline in different cognitive domains in old age. Neuroepidemiology. 2006;26(2):61–7.
Wilson RS, Arnold SE, Schneider JA, Tang Y, Bennett DA. The relationship between cerebral Alzheimer’s disease pathology and odour identification in old age. J Neurol Neurosurg Psychiatry. 2007a;78(1):30–5.
Wilson RS, Schneider JA, Arnold SE, Tang Y, Boyle PA, Bennett DA. Olfactory identification and incidence of mild cognitive impairment in older age. Arch Gen Psychiatry. 2007b;64(7):802–8.
Wilson RS, Arnold SE, Schneider JA, Boyle PA, Buchman AS, Bennett DA. Olfactory impairment in presymptomatic Alzheimer’s disease. Ann N Y Acad Sci. 2009;1170:730–5.
Wolfe JM, Kluender KR, Levi DM, Bartoshuk LM, Herz RS, Klatzky RL, et al. Sensation & perception. 2nd ed. Sunderland: Sinauer Associates; 2008.
Wysocki CJ, Gilbert AN. National Geographic Smell Survey. Effects of age are heterogenous. Ann N Y Acad Sci. 1989;561:12–28.
Wysocki CJ, Pelchat ML. The effects of aging on the human sense of smell and its relationship to food choice. Crit Rev Food Sci Nutr. 1993;33(1):63–82.
Zacharisen MC. Rhinitis in children, adolescents, the elderly, and pregnant women: special considerations. Immunol Allergy Clin North Am. 2000;20(2):425–44.
Zlotnick DM, Helisch A. Recurrent stress cardiomyopathy induced by Sudafed PE. Ann Intern Med. 2012;156(2):171–2.
Acknowledgments
JMP was supported by the National Institute on Aging (K23 AG036762 and T35 AG029795), the Institute for Translational Medicine (KL2RR025000, UL1RR024999) at The University of Chicago, the Allergy, Asthma and Immunology Education and Research Trust (ARTrustTM) and the McHugh Otolaryngology Research Fund.
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Varga-Huettner, V.E., Pinto, J.M. (2013). Physiology of the Aging Nose and Geriatric Rhinitis. In: Önerci, T. (eds) Nasal Physiology and Pathophysiology of Nasal Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37250-6_13
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