Rhinology (NOSES) with John Craig

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Oh hello, hey, Hi, it's your little newborn niece who looks like an old Greek sailor. Ali Ward here with another episode of Ologies. So in this episode we're going to talk to a person who is passionate, so passionate about those lumpy snoots we've all got sniffing around right in the bullseye center of our faces. And this ologist really knowses stuff. So much information on allergies and smells

Are we on?

We were on, We're already rolling. But thank you so much for letting me come to this hospital on a very very rainy sunday in Detroit.

We are in the depth of the d.

We'll start with the basics. How long have you been a rhinologist? And that is a word, correct.

It is a word. Yes, So I've been in practice for three years now. That's after doing a five year residency in E and T surgery and then a one year fellowship in dedicated rhinology.

When you were a kid, did you have a fascination with certain body parts or certain types of medicine? Or I mean, I want to ask how you picked noses, but that's not it. I feel like how you've selected noses would be a better way of phrasing that, but it.

Could call No, there wasn't any particular my father was an emergency room position.

Oh he was, so you grew up around I grew up around.

Yeah, my mother was a X ray tech as well, so a lot of medical conversation. I was just always fascinated by not so much anatomy because we didn't talk about anatomy that much, but just the thought processes behind medical decision making. And for some reason that that was interesting to me, and like, you know, the high school

Do you find that when when rhinologists get together, it's just like a chat? Are all cha boxes?

Big doork session?

Oh?

Yeah, it's pretty common. Actually, it's probably one reason I liked it too. Everybody's very passionate about the nose and the sciences. So I definitely had a lot of sinus slash nasal issues growing up. And I don't think it drove me to choose to do this, but it is interesting. There must be some subconscious process or maybe conscious that drove me.

There's got to be a doctor heel self situation, like you know, I'm also a client, Like there's got to be something there. Now, I'm sure you get this a lot. E and T's why are ears, noses, and throats all lumped together? Were you studying and you're like, I'm leondering about this throat and these ears, but I really care about the noses. Was there any part of you where you're like, let's just get to the noses. Do you prefer the nose over the ears in the throat is what I'm asking?

Oh, yes, okay, very much so. Yeah, No, I've always been since about midway through residency. I was more fascinated by the inner workings of the sinuses and the nasal cavity. So all those areas for me were just more interesting than the throat in the ears.

Poor throat in ears. The ears seem like a whole other situation, to be honest, because I get that the nose in the throat are connected. Anyone who's ever gotten soda up a nose or out a nose. I threw up jello shots on my twenty first birthday out of my nose, So we get that they're connected. But the ears, that's hearing. Did you have to learn everything about ears as well, and then you could say, okay, noses, I'm on to you.

I think that's a very insightful comment you just made. A lot of us do feel that the ears are their own world. But yes, I think the people treating the nose definitely view the ear as a separate entity. A lot of times the hearing apparatus is definitely a separate entity.

I do also feel like ears are like, we have the smallest bone in the body, and everyone knows that fact about us. Yes, that's okay, ears, we get it so quick. Aside, this was going to be an insert to just talk shit on the smallest bone in the body and the ear for being like, yes, I do contain this smallest bone in the body. But I looked

But they can cause significant quality of life issues for patients. If you have trouble breeding through your nose, a lot of a lot of pain bleeding. These things affect your daily life. It's hard to conduct normal work day if you always have blood or fluid pouring from your nose.

It's true, it is very like a first day with a bloody nose. Yeah, not happening.

Not good.

Do people ever shove tampons up their nose when they have bloody noses? Sorry, I'm still asked some.

Version of that. Yes, some type of packing material can be.

Placed perfect for it to be honest.

I've actually definitely seen a patient show up to my office with a tampon on their nose, so it's possible.

Was it a lady or a man?

Man?

Yeah, I have a feeling he borrowed.

It from somewhere I think he did. Yes, were you like well done, sir? I definitely applauded his efforts. He got the job done.

So when you talk about pathologies, run me down some of the big eiaes. I mean, what would you say, or maybe run me down what your most common issue is. Is it like I can't sleep because my nose is messed up? Or is it allergies?

That's a great question. So the full gambit, I would say, from inflammation to tumors, So inflammation would be things like allergies sinusitis. Sinusitis can actually be either inflammation driven or infection driven, so it doesn't always mean an infection heads up.

Itis just means inflamed or swollen, red, painful, So siny sitis just means inflamed nosal area. Now, if you've ever had senioritis your last semester of school, you have maybe been inflamed and hot and swollen, which honestly sounds a lot more like a freshman problem. But I'm not a doctor, so I don't know. Okay, onto nose problems.

The nasal obstruction is a huge one. What do I mean they're just trouble breathing through your nose?

I thought you meant someone shoving something up there.

No, no, we'll talk about that. But so with nasal obstruction, it can be an anatomic cause. People talk about a deviated septum. So those would be the more common things, but then you have the rare things such as tumors, and then this area that I also work on. It was called the skull base, which is the bony separation between the sinus cavity and the brain cavity.

Oh, there's a bony separation there.

Yes, okay, they're very close to each other.

I didn't realize that we had a bony separation because I feel like you always learned about like in Egyptian mummies would use a hook to gather the brains through the nose. I figured it was a straight shot.

In it's kind of a straight shot. But yes, you would have to go through the skull base to do that.

Oh, you'd have to poke through. You'd have to preforate it. How thin is it?

It's a good question. Pretty thin overall, some areas or a couple of millimeters.

Some areas are less than a MILLIMETERSO is anyone else having an existential meltdown? Thinking about like a millimeters thin plate of bone separating your brain from the entire world, including, but not limited to the air of a porta potty, or the door handle of a mall, Like we have thin bone plates in our skeleton heads with the fuck So you had to do a lot of dissecting, of course in.

Your life, right, many many, And I also have a weird interest in cadaver dissections, so I've actually published a number of papers on that.

So it's wait, okay, you have a weird interest in cadaver dissection. Yes, explain to me what a normal interest in cadaver times section would because I feel.

Like that's it might be true.

What do you mean by that?

Because that just means that in training you're always expected to do some degree of cadaver dissection as part of your learning. But I just realized that it's harder to read it in books than it is to just get in there. And so in both residency and fellowship, and even now, whenever we have cadavers available, I stressed to the residents that I teach that it's really important to get in there and really explore the anatomy, so.

Everyone, because I have a friend who's a doctor who said that once you crack someone open, there's so much more variation than you would imagine. Oh yeah, you think like this is when the limit goes. But just as people's faces look different, like their livers look different, and their pancrases look different, like you really got to see a lot of them. Yep, was that scary the first time you cut open a cadaver? I'm sorry, I gotta ask.

I wouldn't use the word scary, but different for sure.

I feel like different is what you would call something like like pineapp couscous or jazz fusion. Cutting open a husk of a person seems like a bit of an understatement for that word. But once again, all Ward here is not a doctor. I have never filayed a dead volunteer in order to fix living.

People gives you a different perspective on life.

Did you do you find that, having been around cadavers that you embrace your living life more. You're more aware of mortality or no, No.

It doesn't affect me that way.

I guess I feel like I would be man, I'd be like, that's gonna be amazing. Would you ever donate your body to science?

Uh?

Yes, I haven't officially done that yet, but.

Well I know you're alive, but you've considered it.

Yes.

The one thing that's weird about the nose is it's something that's in our in our face. But you look at a skull and you're like, there's just an empty cavity. Noses are just cartilage, which is kind of crazy to me. So this, but can you give me the breakdown of the anatomy of a nose? What is a nose made out?

All? Right? So, if you think the nose is an external component, kind of the floppy part that you actually see, there are cartilages that form kind of the external architecture, but they're in places that you wouldn't really predict, and so it's not like one solid sheet of cartilage. There's two sets of cartilage that do some weird curvature things. But that's how the tip of your nose is formed. And then we call them the side walls kind of

By the way, I had a boyfriend whose Polish grandmother called nostrils n assholes. Oh, she didn't realize that wasn't the word for them, And I've ever since then, I've always loved the term soles.

That's pretty good. Yeah, well, remember.

That, what are the sinuses?

So you've got cheek sinuses we call them the maxillary sinuses in each cheek, and then the forehead or frontal sinuses up in the forehead, and then you have these other weird sinuses that go kind of further back in the nose between the eyes, called the ethmoid sinuses. And then way back, about seven or eight centimeters back in the nasal cavities, you have the sphenoid sinuses.

So to recap, you are just lousy with sinuses, just tiny hidden rooms in your face. And your skull. But wait, how many and what exactly are they where? What are they doing there?

In total? We say there are eight sinuses, four on each side, and then what are they They're basically just air filled spaces within the bones of the face. But they're lined by that mucosa that we spoke of. All right, So the mucosa that's what gets swollen when we talk about allergies and sinusitus. So you can imagine if you have these sinus chambers draining into the nasal cavities. They drain through small holes.

Gross, but stay with me.

So if circumferentially around that opening the tissue that mucosa swells up too much, that's when we have problems with straining. And if you have that swelling curry inside the nose too much, you could have trouble breathing through your nose.

So a lot of the stuff that comes out of your nose originates in these in these caves in your face. Yes, what happens when you have let's say, allergies or you have an infection. Why does your why does this tissue insist on swelling? What does the inflammation help? What's the point? Why do why is it like, oh, there's pollen in the air well for you, I'm going to swell up so you can't breathe.

Yeah, well, it's definitely not an adaptive measure. It's not normal for people to have this swelling, right, the average human being. So you get fluids ceping into the tissue that causes swelling, and that's when you get a lot of the symptoms. Now, patients with allergies and they have a significant histamine response, all right, So they have certain cells on their tissue that release histamine and that sets off a whole cascade of different symptoms.

Now, histamines, before you float them to the top of your shit list, can have your back when things are good. They keep you awake and they help flush out bacteria that might want to kill you. But with allergies like to pollen or dust or pets, the immune system senses it freaks the fuck out, like this pollen is trying to kill us. All hands on deck and sends a group text essentially to your body being like if you see this pollen around eighty six, this mofo, we hate it.

Yeah, so I'm going to throw out a disclaimer first off. Okay, well, I am a rhinologist. I lean on my allergy colleagues here significantly, so I can tell you what I do, and then when things get too complex, I definitely employ analogists. But in general, if you have kind of run of the mill allergies, I think the simplest, safest thing you

Oh like a netty pot.

Yeah, much like a netti pot.

I've never used a netty pot.

Oh, you got to try it.

I imaginely have is it really?

Oh?

Yeah, Okay, there's part of me that knows I'm not going to flood my brain with saline. But I'm like, what if I'm the one person that has just a gaping hole in my skull based bone and I just flood my brain?

Well, we could put one thing to rest. If you don't have clear fluid pouring out of your nose at the baseline, you probably don't have a spinal fluid leak, which means you probably don't have a hole in your skull base. But but no, I mean, the one in a trillion type situation of that happening, I wouldn't worry about that.

What does it feel like, I've never done it?

If you do it properly, you know, head over a sink. I use a squeeze bottle. Personally, but some people do. The netty pot fluid will go inside one nasal cavity, it comes out behind your nose back out the other nasal cab So you score it on the right, it's going to come out the left.

Where is it going in the meantime.

That's a good question if you have not had sinus surgery before. Most of it just goes through the nasal cavities and in some of these nooks and crannies called the me eight I within nose. But if you haven't had sinus surgery, they don't usually get into the sinuses themselves, okay, so they just go in and out. So basically you're flushing out any crust debris, maybe thinning out the layer that's in your nose.

But it does seem to help, so squeeze bottle daddy pot so. Doctor Craig says that well, the salty nose enema is a great starting measure. Most patients might need an over the counter topical steroid like a flownaise which will drop the inflammatory response in the nose, or like

The interesting part and the problem in my field is that there's a lot of rare pathology. Some tough ones that come to mind would be nasal polyps. So nasal polyps if you've ever heard of them. They're basically extreme swelling of tissue inside the sinus and nasal cavities. They turn into basically like swollen grapes hanging down on your nose, and so they can cause the whole spectrum of sinucide of symptoms, trouble breathing through the nose, lack of smell would be the classic ones.

Ooh, nose grapes.

Yeah, no, no, not a good fruit to have.

Do you this stupid question? But can you spot a nose job a mile away? Usually yes you can?

How so it takes Actually, rhinoplasty is separate from my feel. I collaborate with rhinoplasty surgeons when I need the external portion of the nose addressed. And so do you mean the classic esthetic rhinoplasty? How you tell? Yeah? Usually there's a narrower look to the nose, perhaps the nasal tip is a little more upturned than average and just in general smaller.

And have you seen any trends with that or you know, I mean, if you look at hair trends over the last thirty years, there have been some good ones and some bad ones. Do you see that happening in and I know that you don't focus on rhinoplasty, but do you see that happening in like cosmetic surgeries at all? Like is this nose very in from these this year to this year?

Definitely in the eighties nineties there was a characteristic nose that people were going for. Definitely the narrower look. There are definitely trends.

Like with fashion, it's probably just look up at Kardashian's Instagram or something.

No, I won't comment on that.

Yeah, but I wonder if people are like, I want to Jane nose.

Oh, I'm sure that.

So I look this up and this is indeed the case. So a bunch of plastic surgeons are saying that the tiny, eurocentric look is falling out of fashion. People don't want perfectly straight or symmetrical noses either. They're like, change it up a little bit. I still want to look like me,

Uh? An undone paper clip?

Why?

Uh so it was actually a child?

Oh? Man, ouch, poor kid place.

It up their respective grandparents knows while sleeping.

Oh never mind, that child is ruthless. Okay they what did they do?

Well? We had to go to surgery and it was interesting, to say the least.

Once again, interesting is good for pineapple couscoose. This is intense and brutal ps. It wasn't a paper clip.

And actually was multiple paper clips. So yeah. Luckily they're malleable, so you can kind of bend them with instruments and get them out of the nooks and crannies of the sinuses.

But multiple when you say multiple, are you saying two or are you saying there are three? That's too many? Yeah, once you get over one, it's too many paper clips.

One would argue one is a lot, but I.

Think that's I think that's more than enough. How was the patient's morale?

So it's funny. So this case that always comes to mind was when I was in training and I didn't follow the patient pre impostoperatively, So I don't totally know, but one would imagine there may be some familial tension after that.

Yeah, you think, I wonder what the kids next birthday was like. It's like, uh, Grandpa's on a cruise on purpose and is never going to make it to your birthday. Man, Yeah, that's rough. Did you ever see that Simpsons episode where Homer puts a crayon off his nose? No?

I didn't, mister Simpson.

I'm afraid you have a crayon lodged in your brain. They find that he has a blue crane up his nose and that is my Homer's Homer. They take it out and Homer is very like realizes how dysfunctional society is and how.

Wow was it in his brain? He was in his brain interesting.

And I think at the end he puts the crayon back in because he's just like, you.

Know, all right, tell me when I hit this week, but deeper, you Pilsner pusher. Maybe he had a spinal fluid leak.

Afterward, let's debunk some flint flam. What do you think is the biggest myth about noses and sinuses that you're like, that is not correct?

I love this question. One thing is that facial pain is most commonly not from SIGNI sitis. What is it from most commonly, and this has been studied some form of neurogenic pain, so whether that's migraine would be a very common one. Actually migraine. Everybody thinks of the classic migraines, but there are atypical forms of it where you can just have isolated facial pain and a running nose and

Oh no, so and it might just be an unlucky migraine. Yes, oh god, that's got to be frustrating.

Yeah, it can be very frustrating. And so whenever I see patients with those conditions, I just get them checked out by a facial pain person. And it almost every time, like seriously, almost every time, they find something that they can treat medically and then we avoid sign a surgery.

How often would you say that it's that case where it's like it's just an unlucky migraine.

So we're talking isolated facial pain nearly. I mean, it's over ninety percent of the time.

Really, that's so interesting. I didn't know that it's crazy.

I mean, I probably see out of twenty patients, twenty thirty patients a day, I see at least three per day with isolated migraines.

So if you have a face ache instead of a headache, it might be a migraine. How crazy is that? Now? Why does our nose run? Why do we get stuffy when we cry?

So if you cry too much, you could get some tears literally coming out of your nose, and then there's probably some emotional nerve response that again signals those same nerves that somebody's get signaled with migraines and can cause a runniness and that the congestion though, does that happen when you cry a lot? I guess I don't cry very often, so.

I feel like you get congested when you cry. So evidently when your nose cries, like literally tears come out of your nose, your tissues get coated with liquid sadness and things just jam up a bit. In there also, your tissues swell, causing you to need tissues.

I'm going to blame the same nerve reflex.

I'm sure it is. It's got to be a nerve reflex your brains is like, are we sad, let's jack some things up to distract you.

Yeah.

Perhaps, And now, how much of your work involves smell in disorders with.

Smell percentage wise? Isolated smell loss is not a major part of my practice. I mean, I definitely see those patients. It's a very difficult condition. You kind of break it down into how long it's been there, and you try to figure out why it occurred. Sometimes you don't come up with a true reason. People just develop spontaneous smell loss.

Oh, my friend Micah had a fever as a baby. He has no sense of smell. So you just don't have to shower when you go out to brunch as much as you want. It's great.

Not for him though, yeah other people.

Yeah, but what is happening when you're smelling something? It's going through your tissues? Does the air? Does the air hit your sinuses and then your sinuses pick it up and tell your brain what smell it is?

Like, what sort of But it's more about the location of those smell fibers. So air brings in odor molecules. Those molecules hit the surface the nasal surf. It's more than nasal cavity than the sinuses. So airflow normally doesn't go into the sinuses. It actually just goes through that

So there are certain areas of the inside of your nose at smell, and certain areas are like, that's not my job.

Most of it definitely occurs. Yeah, just to the nasal cavity.

Do people give you a lot of nose gifts like coffee mugs in the shape of noses?

I wish, but no, there's not a lot of.

Like Etsy items for rhinologists.

There actually are. I mean, I've got like a Picasso painting that has a big nose. Whenever I do see weird nose art or anything, I definitely pick it up.

Side note, I popped over to Etsy to see what kind of nose gifts the craft of Sphere had to offer. And first off, there are a lot of delicate nose rings out there, and also crocheted nosewarmers which look kind of like a macrome bikini top and a surgical mask bread tiny children. There was also an item advertised as a bronze's nose refrigerator magnet, which seems like at eighteen bucks, a steel for solid bronze, but it turns out it's a painted plaster object according to the seller quote, an

Oh? Yeah, you do?

Oh yeah, what's your latest nose dream?

It's usually more perioperative stress, you know, like you just did a case and you think about the end. I see people sinuses in my mind all the time.

You do.

Oh yeah, I remember people sinuses. It's weird.

But yeah, like how you would remember a dog or a face.

I'm probably better. I'm probably better with that than I am with like remembering names.

What do they look like?

Well, you just remember their surgical anatomy and some of the challenges during the case and specific surgical maneuvers and things like that.

So what was your first surgery, like on a live human being, Because you're good at cadavers, Like the first time you were like, they're like, all right, Doc Europe.

Yeah, it's creepy. Yeah, it's a nerve wracking. Plus you have people watching you and critiquing you, so it's always it's a unique experience, to say the least.

Cutting into a person is unique, like a good pineapple couscous You.

Know, in training, you start like not so much in the operating room, but maybe in the er and you're closing up lacerations in the face, and that's always a unique experience as a young resident training.

So people's bleeding faces.

Yeah, yeah, they can be pretty extensive lacerations or dog bites or things like that.

So ooh and so surgically, they kind of train you and you go up and up until you get deeper into the face perhaps sort of.

Yeah, you definitely start with more run of the mill surgeries up front, things like tonsils and adenoids, and then more in the middle of your training. You developed the endoscopic skills for for sinus surgery.

So you've had to do tons of ectomies. Oh yeah, I got one of those.

Oh at what age?

Oh twenty six, dude.

Not pleasant.

It was not It was not okay, But I it was the only time I've ever been put under, and I remember waking up being like that wasn't so bad. And then I looked in the mirror and I just saw a little smear of blood under my chin that they had not wiped, they had missed, And I was like, what happened here? Like if this is just a smear that they missed, Like there's just must have been blood all over my face, right, Like, is that what happens.

Who knows. I meant the anesthesiologist pulled the tube out, you.

Know, Okay. I was just like, never the surgeon's fault. No, no, But I was like, what kind of game of throne shit was going down when I was asleep?

Like, well, that's a whole other world. Yes, it's the operating room environment, but I mean, you guys.

This always this always surprises me that like as surgeons, you guys talk and play music and like it's it's not I've pictured just deally silence and like you could hear someone breathing. What is the actual environment, Like what's the what's the mood, what's the atmosphere.

Yeah, I mean it definitely varies by you know, surgeon personality. So they're definitely some people that prefer very quiet or I don't prefer it that way. I like music. I like people talking because I do a lot of teaching, so I expect people to be asking me questions throughout the whole case, and I also fire questions back at them. So it's a very interactive or environment with me.

That's cool though if I'm pretty much half deaf on the operating table, so there's no reason for everyone else to have stony silence. Right, what do you listen to?

Oh? So I am a hip hop fan. Okay, so, and I'm in Detroit and I've almost been an Eminem fan, so I do listen to Eminem. I also listen to a lot of nineties hip hop. I'm from the West Coast, so I'm a big Tupac fan. And then I often will listen to Hits stations, you know, And I don't want to offend anybody, So if anybody's offended by rap, then I definitely will just go to the Hits.

The patient can't object, and that'd be great if they came out of it and suddenly they were like, you know, let's put on some Tupac on the way home.

Yeah, a little subconscious recollection would be cool.

So what kind of situation would get you on the rhinologists table as a professional? As a rhinologist, what should people be on the lookout for when it comes to their nose health? Because we don't think about our noses unless we're contouring them or there's fluid pouring out of them. What should we be aware of?

Yeah, there are some more red flag symptoms that sometimes get overlooked and we might as well just highlight them. So I always think of anytime you have one sided symptoms. So if for like the last month or two, the left side of your nose is completely blocked and not the right, or you only have left sided nosebleeds, it's probably time to get checked out. You know, it could be as something as simple as a deviated septum, but

And now you will put a camera up a n asshole and poke around. Has that been like revolutionary?

Yes, game changing, I mean totally change the field.

You mean you must have to use less radiology as well, right.

It's that great comment. Yes, I actually am very principled against unnecessary radio or radiographic imagine because I can see the important areas where the scinus is drain, and so we don't need to be getting cat scans and things to radiate people all.

The time, and so what anything else that anyone should look for.

Yeah, another one that has been popping up in the media too, or is the spinal fluid leak?

So god? Uh okay, So yeah, this is brain fluid, so stuff from the comfy, watery sack surrounding your brain kind of like when you buy a pickle and a pouch at seven eleven. But it's brain fluid out of your face. So doctor Craig says that if you ever have clear fluid leaking from your nose, especially if it's one sided, definitely get it checked out because normally clear nasal drainage should be both sides. So one quick question, fuck,

Correct?

That should be like fire alarm emergency, Like that's not something you want to happen.

No, you don't. But the problem is it's not common enough to where even a whole lot of physicians are thinking about it all the time. So if patients present and they have a runny nose, they might just get put on some sprays and then follow up in three months.

Oh my god, how mad would you be if your brain fluid was leaking out your nose and someone's like, take some clareton.

I know it happens. It's not that uncommon for that to happen.

I feel like it's too bad that brain fluid isn't tinted a certain color like a transmission fluid or something. Oh it's blue. Like this is a real issue, and what would cause that?

So two main causes. One would be trauma. Okay, So if you have a high velocity head injury, you can crack that skull based bone and the leak may occur then, or it could occur like months later, just from a delayed wound healing process. Or there's another type called spontaneous spinal fluid leaks. The thought is you get chronic pressure

Oh so it's like a burst dam kind of yeah. Oh yeah, man, So watch out for those things. What's happening when people put cocaine up their nose, when people are crushing things and snorting them. I'm sure that you have a cautionary tail or two.

Uh you know what's fun I haven't seen that many people yet. I mean I've seen a few. So what's happening is cocaine basically acts to constrict blood vessels, so it's extreme. We call it vasoconstriction. And so there's obviously mechanical trauma from the actual shards of cocaine and that can cut the nose and then it gets deposited in the tissue that will cause a really extreme construction of the blood vessel, so that over time can basically cause

Use. God, why do people snort some drugs instead of just putting them in their body through other mucosal areas.

I couldn't give you perfect answers, but I mean, for one, it gets absorbed fairly quickly. I think that gives the like initial high quicker. But I don't know if there's ingestible form of cocaine. To be honest, it.

Didn't strike me until later. But yes, if you've ever read up on altitude sickness in Machu Pichu, you may have heard that a lot of hikers keep a soggy lump of chewed up cocoa in the cheek, or you can drink cocoa tea. Also booty bumping. What's booty bumping? Oh, it's the same as key stirring or plugging or butt chugging, which is when you mix drugs with water and then stream them up your dark canals of your posterior, thereby

That probably is also true.

Yes, if anyone really needs an upper I drank yerbamate for a number of years, and boy, oh boy, that thing that have you ever had it?

What's that?

It's a type of South American tea. Oh seriously, though, your bmate, man, I don't know how it's legal, because like a month's supply is four dollars and I would scrub my bathroom grout at midnight for fun. I had to finally quit because I drank too much and I turned into the human equivalent of a scared chihuahua. Yeah. I had some friends that are like, are you on drugs? And I was like, no, I discovered a tea at Trader Joe's. It's very care oftenative. It was, It's intense

Hmm? There is of course the potential when you take it out that you would have a hole in your septum. So to me it would seem like unnecessary risk. But if it's you know, a strong personal preference, I don't know. I haven't seen too many problems from them holes in the septum.

That's good. So you don't see a lot of people coming in just like dragging themselves into the er with an infect.

Effectually, I haven't, but I mean, it's of course a possibility if.

You're let's say you had a child that's like, Dad, I'd like a septum piercing. Would you be like, okay, but I'm doing it.

I would probably just be with them at the piercing studio and hyper analyze exactly what they're doing.

But I feel like it's an easy one to fake though, you know what I mean. I feel like there's some good clip on septum rings.

It could be true, right, kind of makes sense. I mean, it might be a market you should explore.

I try to find out what percentage of septum piercings you see in the wild are actually piercings and what percentage are just clip on? But like a bow tie, you'd have to tug on it or ask or launch a multifaceted study on it. Now, I did learn that they don't actually pierce your cartilage. They find what's called your sweet spot, scientifically known as the columella, which is a little bit of flesh at the tip of your nose past your actual septum, which makes the whole shebang

They work, But it's not so much for the snoring. What it works on is what we call nasal valve collapse.

Ooh, get in bed with nasal valve collapse.

So the floppy part of the nose, the nostrils, we call them the nasal valve region. So it's actually pretty common to have some degree of narrowing or collapse there. So what the breathe right strip is help or you know, generic strips whatever are helping with They'll just lift the floppy nostril outward, kind of like flaring the nose. So if that is your area of obstruction, which isn't necessarily the case, but if it is, then it should improve airflow.

Does snoring sound different if it's a nose snore versus a throat snore? Like, could you if someone played you an audio clip, could you be like, that's a flopping asshole?

Good question. I don't. I don't. I'm not aware of any literature on it, and I don't watch enough snores.

So if you try it and you are told that you're still snoring, you might it might be in the throat, it might be something else.

Yeah, snoring actually is not a prominent primary complaint.

I would think that would be the first. You just have a line of snores that are in there with like maybe a tired cranky spouses being like good at fixed.

Well. In some people's clinics, yes, but in my rhinology clinic, it's not the primary. But it's definitely I mean a huge you know area of healthcare right now right obstructive SLEAPABNA. So yeah, a lot of people see that.

So I looked at one website appropriately called stopth umble dot com that tried to describe the sounds of snores based on the cause, but it had a lot of weird pop up ads. So I don't know if it's even trustworthy. Now, as soon as I have a some knowledgist on this is going to be a top order of business, trust me. Okay, So onward and upward. Nose hair trimming. Should we do it? Should we not do it?

Hmmm? Probably overall the recommendation should be you don't do it.

Okay.

There is some function to the nose hairs. They catch debris, but you can trim it up and it's fine. I mean, listen, if you are having nose hair growing out of the nostril and it bothers you. It's safe to clip them. You're not going to costume me problems. But if you do trim the tissue and cause a nose blade, then you could have a problem.

Why does it? Do you know why it hurts so much if you pluck a nose hair. We've all done it. It's horrible.

Yeah, it is quite it's the worst. Yeah, just the nerve innervation. It's those nerves again, they have to.

Be very very sensitive.

Mm hm, oh god, I know.

Yeah, it's a it's a what a form of torture. I mean, as a person who's had a lot of things waxed, there's nothing I would rather wax my entire body twice than one nose hair.

It is. Yeah, it's crazy how painful it is.

Do you want to do a lightning round? Sure? Okay, these are questions from listeners. Okay about noses to you. Okay, But before we take questions from you, our beloved listeners, we're going to take a quick break for sponsors of the show. Sponsors. Why sponsors, you know what they do? They help us give money to different charities every week. So if you want to know where ologies gives our money. You can go to aliwar dot com and look for

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Okay, your questions, Krista Avanpado asks, My eye doctor once gave me exercises to strengthen my eyes and they worked. Wonders, is there anything we can do to strengthen our sense of smell?

Hmmm, So there's some some good evidence when you have smell loss that something called olfactory training helps. I'm not aware. If you already have good smell, then I don't know if it'll strengthen it. But if you've lost your smell, then some studies have shown that if you get like some of those extract oils like citrus, rose, geranium, things like that, if you smell those thirty seconds each four cents, okay, around three times a day, that may stimulate more smell function.

So oh that's amazing. I had I thought you were just just shit out of luck. There, you're just plumb out of luck.

Sometimes sometimes you are, but sometimes you can fix it.

So so huff some essential oil. See what happens?

Yeah?

Great? Late night Pie wants to know. I frequently get allergies. What can help me breathe better? Any nose exercises or herbal remedies that you suggest? Anything herbal?

So I'm not aware of any herbal remedies. I'm sure there are some that would work, but just from you know, evidence based medicine per se, I would say, you know, a topical steroid is very safe for long periods of time, and the saline rents that I mentioned before are just good simple nasal treatments. And then if you have a lot of the itchiness it you knows that you eyes or some other you know, body hives or you know, antihistamines would be great.

Okay, I got a couple of questions about sneezing. Tyler Q wants to know what's the deal with bright lights making people sneeze? What's the correlation there? And I have that where if I'm gonna sneeze and I'm about to lose it, if I look at light, I think your pupils constrict, and there's some like photo sneeze reflex.

I need to read more. Apparently, Yeah, it's interesting. I wanted to blame it on migraines, but I guess maybe there's actually if.

I am about to sneeze, you know when you lose a sneeze and it's just like devastating. Yeah, you're like where did that go? If I look at a bright light, then my pupils get small and then that's what triggers the sneeze. But my DNA profile said I'm likely to have a photo sneeze reflex, and I was like, damn straight, I do interesting? So yes, This is called photic sneeze reflex and it happens to about twenty to thirty percent

I love these questions.

I know, here's Carrie or here's carl wants to know? Does muco faigi mute coffage boost your immune system? That sounds like eating and I'm gonna bar right now onto my computer. Does it help your immune system?

I don't think so, okay, and we all swallow our own about one. Did do court today?

So when did you courts?

Yeah? Four to eight cups if you want to do the measurements. So you're all, we're all swallowing it. Only a certain percentage of people actually notice it and get bothered by it.

Oh my god, how do we make that much fluids?

Well, it's part of the mucosa. It's it's a secreting powerhouse.

Just keeps going, Oh my god, that's a lot. Julie Rose asks that. She says that her nose runs every time she eats, even if it's not anything spicy, every time she eats. Now, why do spicy things make our nose run? And why does her nose run every time she eats? She says, it happens. It's been happening as long as she can remember.

Yeah, so definitely read up on vaso motor rhinitis vaso m oto r rhinitis.

Now, if this happens to you, it might be an overactive nerve response or something is wonky at the junction between a nerve and a gland. But doctor Craig says there are other triggers, like temperature change or wine. Now with Rose on a patio season upon us, what do you do?

And there's actually a nasal spray that works usually very well for it it's called atravant okay, and it basically binds a receptor on the gland. It just blocks it from secreting. Oh so, and there's actually there's a new treatment out that I do offer. I think I'm one of the few people in Michigan right now. It's an nasal cryotherapy that freezing yeah. Yeah, and it's there's a

So so anyway, you just freeze off an area, Yeah.

Just one area in the back of the nose where most of the nerve fibers applying glands are and then if that fails, there's a surgical option that most people don't need. But every once in a while you'll have to consider cutting a nerve further back, a little trickier procedure.

But but think of the money you're going to save on cleenex.

There you go, see is there a.

Kleenex types that you're like, don't use a kind of lotion in it, use a kind of lotion in it?

So large for organic, I think I would just go with whatever feels smooth and less annoying to the tip of the nose. But nothing sticks out as superior.

It's try the paper, okay to use on your nose.

Not the rough stuff.

Okay, just checking, yeah, okay. Charles Anderson wants to know what is the best technique for blowing your nose when you're super stuffed up? What do you do when it's just a traffic jam up there?

Oh? Yes, So usually the problem is not blowing. The problem is too swollen in there, so it feels like something's like blocking and you can clear it. But a lot of times there's something in your nose called your turbinot's turbo t U r b I nat ees. Okay, they're tissues that swell up periodically. It's like their job. But they're kind of puffy, bulbous structures on the inside of the nose on the side walls, and they're made of bone on the inside and then puffy tissue on

But affron spray, yes, can you get addicted?

Yes? So it's it causes something called taca phal axis, which is just an immediate kind of Your body immediately needs more of it pretty much, So then you have to keep using it, keep using it, and when it wears off, the tissue gets even more swollen. So that's a condition that we call rhinitis. Medica mintosa. And it's it's not a great scenario because it's hard to get rid of because patients don't want to stop using their affron chasing the dragon right exactly. So we do have

But that's really interesting to know that you can get addicted.

Yeah.

I had a friend in high school named Jeff who was addicted to afron, and we're like, well, if a kid's going to get addicted to something, I guess right, the affron. But still you.

Don't have like withdrawal from it. If anybody's wondering, it's just annoying to try to get off it.

How long is the how long would it take to kick afron?

So I actually it's funny. When I was in college, I had no idea about this, and I had a horribly deviated septum, couldn't breathe through my nose, and so I used afron because somebody told me to try affron, and I just use it for a few weeks and then I tried stopping it and I was like, oh my gosh, I can't breathe it all through my nose. So it took me, as I recall, two weeks before I felt like I don't need it anymore. But I kicked it. I just said, just so.

Doctor Craig says you can kick affron addiction with a little topical steroid spray, which affron is not. It's kind of like weaning you off and then assess what caused you to need the affron So flownase is it's kind of like the methodone in this situation. I think I don't know. Okay, now this next question is quick and gross, but we're going to get through it together. Michael Kris has a question about if boogers serve any real purpose other than being annoying and embarrassing.

No, not really, it's just dried up. It's annoying.

Okay, good to know. I was hoping we weren't have to go down a real there's I could. I could talk about drain clogs, and I have in this podcast, but for some reason, boogers is one of the things that I'm like, like, my gag reflex chokes up, and that's very rare for me. I've let spiders crawl on my body, Like, I'm not grossed out by a lot, but that's one thing that I'm like, book, Yeah, you're a good man, dude.

I pick a lot of them every day.

Oh God, you're that's good karma. Okay. A last question for the lightning round. Jamie Gibbs wants to know why is smell such a big trigger for memories. But I think that's more a neurological thing.

No, there's a specific section of your brain responsible for smell related memory, so it's strong too. I mean, it's a very strong neural connection.

So side note, blame this heavy whiff of nostalgia on the old factory bulb having direct connections to the amygdala and the hippocampus. These are parts of the brain that deal with memory and emotion. So your smell center essentially cuts the line and is like, Hi, I'm here for the emotions right through the back door. It is nuts. You can smell a perfume from you know, high school and be like, oh.

Ah, the memories, So true.

Prom So what we just talked a little bit about having to pick buggers, But what's the worst part about your job? The thing that you're like, uh, is it spreadsheets? Is it anything disgusting? Is it?

Well? I suppose as a physician, definitely the there's issues with the administrative side separate from the clinical side. So I mean the administrative things we just as doctors. It's just part of the job. Now you have a lot of paperwork, and now it's ework, but you spend you know, a good couple hours every day after a long day doing documentation, So that's it. It comes with the territory. It's just it's probably the less gratifying part of the job.

Once again, this brave hero would rather literally pick strangers' noses than fill out forms. And honestly, I get it. What do you love about your job the most? What's the most gratifying or what moment has been like made you want to cry about it in a good way.

I mean, there's just something gratifying about going to work every day, working hard to fix people's problems. You know, I don't think there's one thing that makes my job most gratifying, but there's definitely something fascinating behind deeply understanding an area that is very rare in terms of the diseases that affect the nose. The longer you do this, the more patent sinuses you see very gratifying because usually

It's like whack the mole with sinuses, just keeping them open, keeping them open. Yep, everyone, sinuses, keep them open. May your nose tears be joyous and your sinuses be as open as your heart. Have you considered getting a satin jacket with the words doctor knows best embroidered on the back.

I would not be against that. I have made a sweatshirt already what it just says Henry Ford rhinology with my name on.

It, and you got it made.

But I make them for the residents toos. But no satin is a good spin on that. I might have to consider that next time.

Just saying, just some fancy embroidery, perhaps a couple of more nose puns in your life. I think there was a room for it, to be honest, very I learned so much now I can't stop thinking about my skull plate base.

Ah yes, yes, the skull base.

No spinal fluid dripping out of it.

Well, thank you so much for having me.

Oh my god, I loved it so To hear more about doctor Craig's rhinology work, you can head to his YouTube channel, which I'll link in the show notes, or you can just search Henry Ford Rhinology on YouTube, or you can look for the Facebook page for the Henry Ford e NT group. Now. I'll also post more links on my website at alibard dot com slash ologies. You can follow ologies on Instagram at ologies also on Twitter at ologies. I'm on both as Ali ward with one l. Now.