I am studying the nasal secrotory system of the nose (lymphatic system not relevant; serum) after infection of influenza A virus when there is a big red edema at the back of the nose. I found no relevant picture about the secretory system of the nouse in Sobotta Atlas. Only this one
I am thinking what the edema can cause to the nouse. Assume when squeezing the nose horizontally at the apex of the nose that there are
- dull pain at the apex
- sharp, specific pain on the left mucosa (not symmetric) of the nares
Some of you may have also felt very sensitive nose sometimes, just touching nose causes pain. I am interested in what is the cause of this kind of pains. This pain can differ during time of the symptoms: influenza time, dry air time, fever time and allergic time, for instance. Allergic edema is associated with
- increased permeability of blood vessels
- induce histamine
- hypersensitivity reactions
so the increased volume is in the interstitium so allergic edema is interstitial edema at the back of the nose which obstructs either
- nasal secretion circulation
- or lymphatic circulation nearby the nose (not sure how effective lymphatic circulation is near the nose; I think irrelevant),
and obstruction of nasal secretion circulation causes also probably interstitial edema (not sure about this) in the nasal apex. Assume there is no color in the nose (no inflammation), only pain when pressing. This suggests me that the pain is due to atrophy of cartilage. There is no blood vessels in the nose. So you cannot classify this as edema allergic. I think the correct classification is just atrophy of apex nasalis.
My assistant says that healing the edema at the back of the nose is a way to heal the whole nose. Some people solve the complication of these edemas only by oiling the dryness. I am interested in understanding the mechanism behind the pains in the nose.
- pain at the apex nasalis is due to atrophy (no inflammation response; only humoral immunity through IgA)
- edema at posterior nasalis is allergic (interstitial) edema associated in a prolonged stage with a chronic inflammation
Blockage of lymphatic circulation (not reachable to nose) does not explain the cause for the back side of the edema; but instead probably blockage of nasal secretion circulation. The secondary cause of the back side edema is often viral damage (influenza A virus) of upper respiratory epithelium i.e. cytopathic effect to host cells during invasion so result a pleque. This plaque can be studied by plaque-forming unit assay.
I am interested how this back side edema spreads inflammatory process to the apex of the nose. How can the edema at posterior nasalis lead to atrophy of apex nasalis? I think this is done through septum nasalis and by deterioration of the humoral immunity (IgA).
I think the inflammation process can be a chronic one because the symptoms last long term. They evolve through a sequence of stages and last long. It takes months sometimes for the process to end. I am not completely sure if there really occurs atrophy in apex nasalis epithelium. It is probably too much. Probably, just chronic inflammation. Assume that chronic inflammation of apex nasalis is caused by posterior nasalis epithelium. What is triggering the chronic inflammation of posterior nasalis epithelium? Agglutination of Fc cells and deterioration of humoral immunity is one possibility.
Influenza virus A
I just read about influenza virus A. This kind of nasal obstruction is most often started with influenza lasting one month but prolongs when winter dry air and allergic time come. So the total period may be 3-4 months with such a nasal edema.
Assume patient has never received influenza vaccine. So there is very little preexisting AB to the original drain. Influenza A virus undergoes AG drift, but still earlier vaccination helps against the virus. Immunity is long-lived and subtype-specific. So the infection of influenza virus is always severe in unvaccinated patient with prolonged damaged nasal epithelium and development of chronic phase. Also, one notice about antibodies against the antigens
- Serum AB persists for years, but
- Secretory AB only several months
and secretory antibodies are in the nasal secretion. So the vaccine should be taken some moths before the influenza period to protect the nose. Very early vaccine protects in serum and thus in lymphatic circulation. I think there is very little lymphatic circulation in the nose so no protection. Nose has special type of structure which makes it a challenging environment. Those antibodies against HA and NA are important in immunity and much challenging in building nasal immunity.
How can you make the secretory IgA in nasal secretions last longer? I think now that the primary cause of such a prolonged nasal edema is virus, for intance, influenza virus. Inactivated vaccines do not generate local IgA but humoral cell-mediated immune responses. So one way to solve this problem is to develop a living vaccine.