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Wise et al.

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postnasal drip, dry nose, intranasal crusting, and decreased olfaction. 199,200 A recent publication by DelGaudio and Panella 201 reviewed the literature pertaining to intranasal findings of the aging nose, which they have termed “presbynasalis.” Age-related rhinorrhea.: Rhinitis of the older adult (ie, “drippy nose” or “senile rhinorrhea”) is a well-recognized entity. Rodriguez et al. 202 used a questionnaire to demonstrate that clear rhinorrhea increases with age. Results showed that only 33% of the younger age group respondents (n = 76, mean age 19 years) regularly reported clear anterior drainage as compared to 74% of the older age group respondents (n = 82, mean age 86 years). The physiologic reason for increased rhinorrhea with age is not entirely known. However, it is known that α and β receptors become less sensitive and autonomic function declines with age, which leads to an imbalance of sympathetic and parasympathetic tone. 202-204 It is possible that decreased sympathetic tone with unopposed parasympathetic stimulation results in a rise in glandular activity in the nasal cavity, leading to increased nasal drainage. 202,205 This mechanism is similar to vasomotor rhinitis/non-allergic rhinopathy, where the autonomic response to certain stimulants causes the nasal mucosal blood vessels to vasodilate and the mucus glands to become over-active, resulting in hypersecretion and drainage. 206 Vasomotor rhinitis/non-allergic rhinopathy is the most common type of NAR, 205 and the highest prevalence of NAR is seen in the elderly. 144,189,200,207 This would suggest an autonomic dysregulation as the reason for increased rhinorrhea in the aging population. Age-related nasal obstruction and congestion.: Factors that contribute to an increase in nasal obstruction/congestion in the aging nose include thicker mucus secondary to a decrease in body water content, 208-210 nasal airflow obstruction secondary to structural changes caused by the loss of nasal cartilage elasticity and tip support, 198,200,210 and mucus stasis secondary to less effective MCC. 200,209 Ho et al. 211 demonstrated a decline in MCC effectiveness with age in 90 healthy subjects aged 11 to 90 years. Subjects over 40 years of age had a slower ciliary beat frequency, increased microtubule disarrangement, and longer MCC times on saccharin testing. Thickened mucus and a less effective MCC system may also lead to postnasal drip, which is a common nasal complaint in the elderly population. 200 Another factor contributing to nasal obstruction/congestion in the elderly is age-related central nervous system changes that affect the physiologic nasal cycle. 208,212 Mirza et al. 212 measured the relative airflow of the 6 nasal chambers at 15-minute intervals for 6 hours across 4 different age groups (n = 60) using liquid crystal thermography. They found that the proportion of subjects exhibiting the classic nasal cycle decreased with age, being lowest in the 70-year-old to 85-year-old group. Age-related nasal dryness and intranasal crusting.: Nasal dryness and intranasal crusting are more common in the elderly population. This is likely due to age-related changes of the nasal mucosa, 199 such as a decrease in mucosal blood flow and an increase in epithelial atrophy. 213 Schrodter et al. 214 evaluated nasal mucosa samples from the middle turbinate of

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Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.