October 10, 2010

The Science of Nose-Picking

Most everybody does it whether they admit it or not, both in kids and adults. In fact, according to one research survey, people do it about 4 times a day. In 7.6%, they do it >20 times a day!

Nose-picking, also known as rhinotillexomania in medical-speak, generally is a benign, sedentary (and private) solo activity, but when excessive, can lead to a number of medical problems including nosebleeds (25% of nose-pickers), septal perforation, staph infections, etc. In one extreme case, it even led to a self-inflicted ethmoidectomy (sinus surgery)!

Though most people pick their nose with their finger and use their fingernail to "dig" the golden nugget out, it is recommended to avoid use of the nail due to the danger of causing mucosal trauma (just like when itching the eye, use of the fingernail is not ideal). Using a saline nasal spray or saline flushes can help soften as well as minimize nasal crusting accumulation and enable one to "blow" the nasal boogers out. Humidification, especially when the air is cool and dry, is important to prevent hard nasal boogers from occurring in the first place.  Nasal emollients like ponaris are also quite helpful as a preventative measure.

Now, it is a well-accepted fact that ENT physicians are the experts in removing unwanted nasal snot. So what's our secret?

Beyond our 5 years of surgical training, we have fancy equipment in order to obtain optimal visualization of nasal cavity. Use of a nasal speculum as shown below provides direct visualization of the entrance of the nose and suffices in most situations.

However, we are also skilled in the use of nasal endoscopic equipment to examine harder to visualize parts of the nasal cavity.

With visualization, we have at our disposal a large array of equipment that can be used for removal/retrieval. Our workhorse tool is the bayonet forcep. This tool is ideal for the hard nasal crusting in the front part of the nasal cavity.

When the booger is farther back, rather than using bayonet forceps, a tool with forceps only at the tip is utilized (ethmoid forceps). The neato thing with this instrument is that the tip comes in all sorts of different sizes and angles in order to reach into any part of a person's nose!

When the snot is more mucoid rather than hard, a suction device (frasier tip) can be used instead.

So, that's probably more information than you ever wanted to know about boogers, but there you have it!

A preliminary survey of rhinotillexomania in an adolescent sample. J Clin Psychiatry. 2001 Jun;62(6):426-31.

Rhinotillexomania: psychiatric disorder or habit? J Clin Psychiatry. 1995 Feb;56(2):56-9.

Self-induced ethmoidectomy from rhinotillexomania. AJNR Am J Neuroradiol. 1997 Nov-Dec;18(10):1949-50.

Nose picking and nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol. 2006 Aug;27(8):863-7. Epub 2006 Jul 20.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

1 comment:

Linn said...

Interesting article. I especially like the video of the endoscopy.

But I was a bit taken aback by the use of the words "booger" and "snot." Are these terms accepted medical jargon?

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