NOSES with John Craig

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$50 minimum, subject to availability, restrictions apply. Oh, hello, hey. Hi, it's your little

newborn niece who looks like an old Greek sailor. Alliward. Oh, we know some facts about noses. You're

about to learn them. Rhinology, it's a thing. Of course, you can't see your nose probably

unless you cross your eyes, but it's there and we're going to talk about foods. All right,

sniff into it. 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 thisologist really knows his stuff so much information on allergies and smells and history.

So you likely have a firm but soft and a beautiful but gross wedge of flesh holding court on your

face. But how well do you know it? I mean, it's a mystery in there, man. It's a moist catacombe.

The leads to your brain. Is that how it works? We're going to find out. So first off,

Rhinology comes from the Greek for snout. Now, thisologist who, by the by, has an entire

YouTube channel, brimming with sinus surgeries, took me to an office and we gabbed about noses

for almost an hour, over an hour, side note. Okay. I can deal with a lot of groceries.

I've held spiders as big as my palm. I've eaten scorpions, but I cannot deal with the word

or the concept of this. And I'm in a whisper one time. Okay. Mucous. I did not want this episode

to be a sonic minefield for my gag reflex from now on when you hear the that's just me bleeping the

moist and word. I'm censoring the word that rhymes with fukus because I can and I will. I just can't

deal. So it's dings from here on out. It's dad's podcast. She'll do it the way she wants. Okay.

All right. Oh, man. In this episode, we talk about hey fever and septums and snoring and smelling

and I had no idea of the mysteries deep, deep in my skull holes. So open your ears, throat and

yes, your nose for the life altering wisdom of rhinologist Dr. John Craig.

Oh, you know how my tongue works? Yeah, get up in it. All right. Um, thank you by the way for

doing this. Are we on? We were on. Okay. We're already rolling, but um, thank you so much for letting

me come to this hospital on a very, very rainy Sunday in Detroit. We are in the depths of the D.

We'll start with the basics. I'm sure you get this a lot. E and T's. Why are ears, noses and

throats all lumped together? Are, are you, were you studying and you're like, I'm wondering 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 than the throat

is what I'm asking? Oh, yes. Okay. Very much so. Uh, yeah. No, I've always been 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 and the ears. Poor throat and ears. The ears seem like a whole

other situation, to be honest, because I get that the nose and the throat are connected. Anyone who's

ever, uh, gotten soda, upper nose or outer nose, 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 true too. Okay, ears, we get it. So,

quick aside, I looked up this little thing. It's called the stapes. It means stirrup because it's

shaped just like a metal stirrup that you slide your boot in while hooking around on a horse.

It also looks like a tiny, tiny wishbone glued to a plate. And I wanted to be like whatever ears

who cares, but I gotta be straight with you. I gotta come clean and say it's a really cute phone.

Like it is so tiny. It's smaller than your pinky nail. This cute little thing and it's held

aloft in your inner ear by tendons. And it makes the femur look like Godzilla. And it's so cute

that you have two of these probably gently rattling around in your skull like micro machines.

Anyway, Dr. Craig cares about nose medicine in particular. This area that I also work on is 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, they're very close to each other. I didn't realize that

we had a bony separation. I figured it was a straight shot in the dome. It's kind of a straight

shot, but yes, you would have to go through the skull base to do that. How thin is it?

It's a good question. It's pretty thin overall. Some areas are a couple millimeters. Some areas

are less than a millimeter. 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. I don't like these. The one thing that's weird about the nose is it's

something that's 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. But can you give me the breakdown of

the anatomy of a nose? What are the nose made out of? All right, so if you think the nose is an

external component kind of 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 sidewalls,

kind of the floppy nostril parts. They provide support there. And then the inner lining of the nose

is made up of what we call mucosa. Mucosa is like the inside skin. Of course, you got the nostrils

that lead into each respective nasal cavity. And then how deep do we want to go inside the nose

here? How deep do I go inside the nostril? What are the sinuses? Okay, so you've got cheek sinuses.

We call them 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 spinoid 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 for 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 sinusitis.

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 occurring 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 caves in your face. Yes. What happens when you have, let's say, allergies,

or you have an infection? Why does this tissue insist on swelling? What does the inflammation

help? What's the point? 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 fluid,

seep into the tissue that causes swelling. And that's when you get a lot of the symptoms. Now,

patients with allergies, they have a significant histamine response. All right, so they have certain

cells in their tissue that release histamine. And that sets off a whole cascade of different

symptoms. Now, histamines 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. Breaks 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, we hate it. Pollons like, hey, I don't even want to be in your nose holes.

You inhaled me. Calm down. But histamines tell your blood vessels to get leaky. Y'all,

and your eyes and nose water to flush it out of your body. Thank you. Very helpful.

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 sometimes get signal with migraines and can cause

a runnyness. And the congestion though, does that happen when you cry a lot? I guess I don't

cry very often. 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 are like, are we sad? Let's jack some things up to distract you, perhaps.

And now, what is happening when you're smelling something? It's going through your tissues.

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 nasal surf. It's more than nasal cavity than the sinuses.

So air flow normally doesn't go into the sinuses. It actually just goes through that central

kind of inner chamber that we spoke of. And so the olfactory receptors on specific nerves are

located high up in the nose. And then there are certain structures in the nose where there are

higher concentrations of these olfactory cells. And then that triggers a whole cascade of chemical

and neurogenic reflexes that go to the brain. And then that's how we interpret smell.

So there are certain areas of the inside of your nose that smell and certain areas that are like,

that's not my job. Most of it definitely occurs, yeah, just through the nasal cavity.

But what about putting things on the outside of your whiffer? Oh, I did forget to ask, do

strips that you stick to your nose that open your nose up to prevent snoring? Do they work

and how? So they work, but it's not so much for the snoring. What it works on is what we call

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 breatherite strip is, hell, or generic strips, whatever are helping with,

they'll just lift the floppy nostril outward, kind of like flair in 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.

And in those situations, if that's your only cause for snoring, it'll help with snoring.

But snoring is multifactorial. You can have obstruction at any level of the throat that won't

help with a breatherite strip. 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.

Okay. So onward and upward nose hair trimming, should we do it? Should we not do it?

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 cost you any 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 unbearable. Yeah.

Just the nerve innervation. It's those nerves again. They have to be very, very sensitive.

Oh, God. I know. Yeah. It's a, what a form of torture. It is. Yeah. It's crazy. How painful that is.

Do you want to do a lightning round? Sure. Okay. These are questions from listeners.

Okay. About noses to you specifically. 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,

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Okay. Your questions?

Christa Vampato 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?

Hmm. So there's 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. Okay.

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, 30 seconds each,

four cents, okay, around three times a day, that may stimulate more smell function.

Really?

Yeah. And actually, I've seen it work. So it's got good evidence behind it at least.

Oh, that's amazing. I thought you were just got a look there. You're just plum out of luck.

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

So, so have some essential oils see what happens.

Yeah. Great. Got a couple 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, I have that where if I'm going to 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. That'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 the sneeze

and it's just like devastating, you're like, where did I go? If I look at a bright light,

then my pupils get smell and then that's what triggers the sneeze. But my DNA profile said,

you're likely to have a photo sneeze reflex. So yes, this is called photic sneeze reflex and

it happens to about 20 to 30% of people and it is inheritable. So next time you're about to disseminate

your nose contents away from your body in a hundred miles an hour, which is what a sneeze is,

but it might go away, look at light and see if that does the all trick. Also, this whole thing

is called readiness autosomal compelling heliophthalmolic outburst, which sounds like a real mouthful,

but guess what? It stands for a chew. Yes, someone background him that's so hardcore and I have to say

that that achievement is nothing to sneeze at. Sorry. You love it. You love all of it.

I love these questions. I know. Here's Carrie or here's Carl wants to know, does

mucophagy, mucophagy boost your immune system? That sounds like eating. So now I'm going to

barf right now onto my computer. Does it help your immune system? I don't think so. I mean,

we all swallow our own about one to two quarts a day. So what did you quartz? 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, but oh my god. How do we make

that much fluids? Well, it's part of the mucosa. 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, V-A-S-O-M-O-T-O-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 Dr. Craig says there are other triggers, like temperature

change. Now, with 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 atrovent. It basically binds the receptor on the gland and

just blocks it from secreting. There's a new treatment out that I do offer. It's an intranasal cryotherapy.

Freezing? Yeah. It's a very difficult problem to treat. When patients either aren't responding

adequately or just don't love using atrovent nasal spray whenever they have a running nose,

it's an option. It's a non-surgical option. You usually do it in the office with them awake.

So, anyways. It just frees off an area. Yeah, just one area in the back of the nose where most

of the nerve fibers are playing 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. It's a little trickier procedure. But think of the money you're going to save on

Kleenex. There you go. See? These are Kleenex types that you're like, don't use the kind of

lotion in it. Use the kind of lotion in it. Storage 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.

Is toilet paper okay to use on your nose? Not the rough stuff. Okay. Just checking. 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, yeah. So usually the problem is not

blowing. The problem is just to swollen in there. So it feels like something's blocking and you

can clear it. But a lot of times there's something in your nose called your turbinates.

Turbinates. So T-U-R-B-I-N-A-T-E-S. Okay. There are 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 the outside.

And so those are what classily get crazy swollen during allergies. And so even a normal person

without any disease at all may notice sometimes that one side's blocked. And then a few hours later,

the other side's blocked. And then it switches back and forth. So what can happen when you have a cold

or bad allergies? Those tissues can both on both sides get crazy swollen. And then it's tough to

breathe in, but it's also hard to blow out. Yeah. So obviously if it's not getting better,

if this is not a temporary congestion and issue blowing your nose, you really should get checked out.

Okay. Usually it'll be a fleeting thing. You just have to deal with it for hours to a day or

something. Now this next question is quick and gross, but we're going to get through together.

Michael Kierce has a question about if Buggers serve any real purpose other than being annoying

and embarrassing. No, not really. Just try it out. It's annoying. Okay. Good to know. I was hoping

we weren't enough to go down a real... I could talk about drain clogs and I have in this podcast,

but for some reason, Buggers is one of the things that I'm like, like my gag reflex chokes up,

and that's very rare for me. I let spiders crawl on my body, like I don't gross out by a lot,

but that's one thing that I'm like... Buggers? Yeah. You're a good man, too. I pick a lot of them out

every day. Oh god, you're... That's good karma. Okay. Last question for lighting around. Jamie Gibbs

wants to know why it smells such a big trigger for memories, but I think that's more 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, all the memories. So true. So, 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 the most gratifying, but there's definitely something fascinating behind deeply understanding

an area that is very rare in terms of the disease that affect the nose. The longer you do this,

the more patent sinuses you see, very gratifying, because usually patent nice, widely open sinuses

result in better outcomes. So, I always joke with patients and say that pretty much, if not the,

probably the second purpose in my life is to keep sinuses open. Literally. So, my day deteriorates,

the more sinuses I see in the office that are starting to close down, because then I have to find

ways to keep them open. It's like whack them all with sinuses. Just keep them open. Keep them open.

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 Dr. Nose Best

embroidered on the back? I would not be against that. I have made a sweatshirt already. What does it say?

It just says Henry Ford Rhinology with my name on it. And you got it made? But I make them for

the residents too. 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 those are room for it, to be honest. Very. I learned so much. Now I can't stop thinking

about my skull plate base. Yes, yes, the skull base. Well, thank you so much for having me.

Oh my god, I loved it. So as always, ask smart people questions. Even if they don't feel so smart,

because every question is a good one. And that is how we learn. So to hear more about Dr. 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 ENT group. Now I'll also post more links on my website at alleyboard.com slash allergies.

So if you like smologies, tell your friends, tell your teachers, tell anyone who might need a good

science podcast and likes learning. Now we like to keep things short around here. So all of the

credits are in the show notes. Huge thanks, of course, to producer and lead editor Mercedes

mainland of mainland audio for making sure that these get out the door and into your ears. And if you

stick around to the variant, which look at us, you have or else you wouldn't be hearing this.

I give you a piece of advice. I give you a little life lesson. And I asked listeners if they could

tell me some things to tell you. And Jill Burnham had a great one. They said, this is obvious,

and we've heard it a million times. But when you feel judgmental, try being curious instead.

And I second that, Jill, I don't think it's obvious. I think a lot of people probably don't know that.

So if you go, why is that person doing that? You might have no idea the reasons behind it,

or what it means to them. So be curious. Maybe even ask. You might learn something about yourself,

or them. Okay. Until next week. Bye bye.

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