Common Nasal Problems In Hilly Nepal

 By Prakash Bhattarai

I recently visited a place reputedly known all over the world as the place where the Sangri-La of the world can be touched. Categorized in the mountain region (more than 2000m).

Daaman is situated about 2350m above sea level and it is really a paradise on the earth.

Most of the country (almost 80% of whole area) consists of hilly and mountain terrain. There are some common health problems over these areas. Round the year, except for 4 months of summer most people have to hide inside their homes due to the cold environment. Some aspects of common nasal problems in the hilly area are better prevented than cured!

Some few cases that came across:

Cases:

1.18 years female from Aghori Makwanpur, Nearby Daaman presented to us with history of nasal obstruction for around 2 years, on/off. She also has nasal discharge which is really disturbing her for a long duration. Her voice also appears  to be changed.

Diagnosis: Chronic Simple Rhinitis

2. 43 years male from Shikharkot, Daaman tells us he suddenly sneezes for more than 20-25 times at a time, often in cold season, followed by nasal obstruction, watery nasal discharge and itching over nose, eyes and pharyngeal area. He also gets frequent colds and chronic cough. He  gives a history of these symptoms from childhood and it is also common in the family members.

Diagnosis: Perennial Allergic Rhinitis

3. 22 years female from Palung, reports to us that her husband hates her because she has 2 years history of offensive foul-smelling breath, but she cannot smell any bad breath at all. She has long history of nasal obstruction but nothing comes out on sneezing and mopping except some flecks and greenish crusts.

Diagnosis: Atrophic Rhinitis

Magnitude of problem:

Everybody gets cold. Everyone suffers from running nose. Almost 80% of the populations in the hilly and urban region are found to have running nose, stuffy nose or other nose related problem at a time. This is most common disease which can be prevented all over the world!

What are common nasal problems?

Nasal discharge, sneezing, nasal obstruction, headache, post-nasal irritation and discharge, heaviness of head, anosmia(loss of smell perception), foul breath, cough, with or without fever.

What is the root cause?

Acute rhinitis is almost infective. It could be by viral, bacterial causes. Viral infection are more common, are cured if various preventive measures are adopted. Almost all conditions are caught through air-borne route. Bacterial conditions are more severe and can be cured by antibiotics.

Acute rhinitis may be an allergic condition, for which a special gene present in that person is sensitive towards some dirt, pollen and other environmental factors in the surroundings.

One of my relative who lives in the USA, comes frequently to Nepal with a dry and good nose, but when he stays he gets cold and returns back with a running , red and congested nose. I wonder what is causative agent in his own country where he was grown up, that has made his nose so distant !

Chronic conditions appear lately only if acute conditions do not resolve. Various predisposing factors like persistence of infection, chronic irritation with dust, nasal obstruction with other pathology, vasomotor conditions, other systemic diseases and lack of fresh air or exercises may lead to chronicity of the nasal conditions.

What makes these simple problems worse?

Most of People especially in village area do not consult to the health worker until they get severely ill and as a result of which they fall in the bed or are fully dependent on other people. Until they get high fever or severe pain they never care for their health at all. This is why almost all health conditions are aggravated and which leads to various complications.

Almost all health conditions show a preliminary clinical feature, if recognized and treated at that level then we can save budget for cure and also save time of the health workers.
Simple Care can prevent various complications!

As presented above, most of the conditions are avoidable, i.e, preventable and/ or curable! A simple care of self can save nine! Here are simple measures that can be followed to prevent these conditions.

• Take care of self. Beware of extreme cold, humidity, dusts and dirt’s. Take plenty of fluids.
• Take simple measure of closing your mouth and nose while sneezing and coughing. Spit only in selective places.
• Avoid the behavior of frequent nose pricking and avoid use of common handkerchief and towels.
• Wash your hands with soap-water before meals and also before eating non-cooked foods.

Treatment of cases:

• Plenty of hot fluids, good nutrition, adequate rest.
• Do steam inhalation with or without Vick’s to sooth your pain.
• Avoid the factor what seems to aggravate your condition, like dirt’s or specific vegetable.
• Consult to health worker; they will give you some sort of antibiotics, nasal decongestants, antihistamines and antipyretic.
• Treat the cause which has predisposed the condition to be chronic.
• Surgical approach in severe cases.

What if?

Various complications may appear with lapse of time! If Not treated then problems like :

Sinusitis (PINAAS), pharyngitis, tonsillitis, bronchitis, pneumonia, otitis media (infection of middle ear), asthma(in allergic cases), nasal polyp(mass coming out of nose), dental problems, and various problems .

Prakash Bhattarai  is a fourth year med student of  Kathmandu University, College of Medical Sciences, Bharatpur, Citwan, Nepal.  This article was published by his permission from his Blog.