the NOSEgenerates significant pressure that can
force congestion into the SINUSESand eustachian
tubes. The best method is to blow through both
nostrils with a gentle and steady pressure with the
head upright, pausing between blows to allow
gravity to help move congestion downward
toward the nostrils. Short, hard bursts of blowing
can activate a REFLEX action, which commonly
occurs after a SNEEZE, in which the nasal passages
briefly swell and fill with mucus. Doctors believe
this reflex congestion occurs as a protective meas-
ure to block harmful substances from entering the
nose, as sneezing is a mechanism for ejecting for-
eign matter from the nose. Applying unscented
lotion or aloe to the SKINaround the nostrils helps
protect against irritation and INFLAMMATIONfrom
frequent nose blowing.
See also COLDS; EPISTAXIS; EUSTACHIAN TUBE; FOR-
EIGN OBJECTS IN THE EAR OR NOSE; NASAL VESTIBULITIS;
POSTNASAL DRIP; RHINORRHEA; SINUSITIS.
Bogart-Bacall syndrome An overuse condition
affecting the VOCAL CORDSand larynx. The key char-
acteristic is a low, husky speaking voice (such as
immortalized by famed actors Humphrey Bogart
and Lauren Bacall, the namesakes of this condi-
tion). Speaking in the lower registers of pitch
strains the muscles of the larynx and the tissues of
the vocal cords, causing symptoms such as voice
fatigue (inability to maintain volume when speak-
ing), soreness or PAINin the THROAT, and hoarseness
or raspiness when speaking. Treatment focuses on
improving breath control to speak when the lungs
contain an adequate volume of air. Efficient
BREATHINGduring speech lessens the tension of the
muscles in the throat that control the vocal cords
and flow of air. Some people, particularly women,
whose voices are naturally in a higher register of
pitch than the voices of men, benefit from VOICE
THERAPYto learn to speak at a higher pitch.
See also LARYNGITIS; PHARYNGITIS; SPEECH DISOR-
DERS; SWALLING DISORDERS; VOCAL CORD NODULE;
VOCAL CORD POLYP.broken nose A FRACTUREof the nasal BONE, typi-
cally resulting from a direct blow. The NOSE is
especially vulnerable to impact injuries, and the
nasal bones are the most commonly fractured on
the face. Injury to the CARTILAGEand other tissues
of the nose often accompanies a nasal fracture;
these injuries are typically painful and result in
significant swelling and bruising. A fracture can
displace the bones and the cartilage, altering the
flow of air through the nose, and can result in
bleeding within the nasal passages. Ice applied to
the area as soon as possible after the injury helps
contain the swelling.
Most often the doctor will order X-rays of the
face to confirm a nasal fracture as well as to deter-
mine whether other fractures, such as of the
orbital bones around the eyes, also exist. The doc-
tor often can reduce (reposition) a simple nasal
fracture by external manipulation done with local
ANESTHESIA(closed reduction). Injury more exten-
sive than a simple nasal fracture typically requires
surgery to return the bones to their normal posi-
tions (open reduction). A protective splint worn
over the nose helps safeguard the fracture from
further injury while it heals. The bones become
set in about a week; the fracture heals fully in four
to six weeks. Sometimes after HEALINGis complete
the structures of the nose remain out of align-
ment, which can affect BREATHING. Such complica-
tions require further medical assessment by an
otolaryngologist or facial surgeon and may re-
quire further surgery. Most nasal fractures heal
uneventfully and have no long-term conse-
quences.
See also RHINOPLASTY; SEPTAL DEVIATION; SURGERY
BENEFIT AND RISK ASSESSMENT; X-RAY.broken nose 13