The Effect of Aging on the Nose and Paranasal Sinuses: What We Now Know and a Review of the Literature

Main Article Content

Premyot Ngaotepprutaram
Jate Lumyongsatien


    Over the past decade, the phenomenon of the aging society has become a major topic around the world, and many countries (including Thailand) are now classified as aged societies. Accordingly, the aim of this review was to provide physicians with a multi-perspective update regarding what is now known about the effect of aging on the nose and paranasal sinuses. Multiple changes in the nose and paranasal system can be observed in older aged healthy populations and rhinologic patients. Physiologic deterioration of nasal mucosa that occurs when people get older contributes to nasal obstruction, dryness, crusting, postnasal drip, and frequent throat clearing. Age-related immunosenescence renders people more vulnerable to infection, which may intensify nasal inflammation. Moreover, polypharmacy among older people requires awareness and caution on the part of the physician to decrease the risk of drug interaction and side effect. Olfactory disturbance can occur as a result of physiologic change or premotor manifestation of neurodegenerative diseases. Enhanced understanding of sinonasal change in older adults will improve diagnosis, patient care, and quality of life.


Download data is not yet available.

Article Details

Review Articles


1. Situation of the Thai Elderly 2016. Foundation of Thai Gerontology Research and Development Institute, 2017.
2. Edelstein DR. Aging of the normal nose in adults. Laryngoscope 1996; 106(9 Pt 2): 1-25.
3. DelGaudio JM, Panella NJ. Presbynasalis. Int Forum Allergy Rhinol 2016; 6: 1083-7.
4. Agius AM, Smallman LA, Pahor AL. Age, smoking and nasal ciliary beat frequency. Clin Otolaryngol Allied Sci. 1998; 23: 227-30.
5. Jorissen M, Willems T, Van der Schueren B. Nasal ciliary beat frequency is age independent. Laryngoscope 1998; 108: 1042-7.
6. Ho JC, Chan KN, Hu WH, Lam WK, Zheng L, Tipoe GL, et al. The effect of aging on nasal mucociliary clearance, beat frequency, and ultrastructure of respiratory cilia. Am J Respir Crit Care Med 2001; 163: 983-8.
7. Busse PJ, Mathur SK. Age-related changes in immune function: effect on airway inflammation. J Allergy Clin Immunol 2010; 126: 690-9.
8. Proenca de Oliveira-Maul J, Barbosa de Carvalho H, Goto DM, Maia RM, Flo C, Barnabe V, et al. Aging, diabetes, and hypertension are associated with decreased nasal mucociliary clearance. Chest 2013; 143: 1091-7.
9. Kao CH, Jiang RS, Wang SJ, Yeh SH. Influence of age, gender, and ethnicity on nasal mucociliary clearance function. Clin Nucl Med 1994; 19: 813-6.
10. Yadav J, Ranga RK, Singh A. Effects of aging on nasal mucociliary clearance. Clinical Rhinology 2011; 4: 1-3.
11. Sahin Yilmaz AA, Corey JP. Rhinitis in the elderly. Curr Allergy Asthma Rep 2006; 6: 125-31.
12. Riedler KL, Shokrani A, Markarian A, Fisher LM, Pepper JP. Age-related histologic and biochemical changes in auricular and septal cartilage. Laryngoscope 2017; 127: E399-407.
13. Lee JW, McHugh J, Kim JC, Baker SR, Moyer JS. Age-related histologic changes in human nasal cartilage. JAMA Facial Plast Surg 2013; 15: 256-62.
14. Lindemann J, Sannwald D, Wiesmiller K. Age-related changes in intranasal air conditioning in the elderly. Laryngoscope 2008;118: 1472-5.
15. Kalmovich LM, Elad D, Zaretsky U, Adunsky A, Chetrit A, Sadetzki S, et al. Endonasal geometry changes in elderly people: acoustic rhinometry measurements. J Gerontol A Biol Sci Med Sci 2005; 60: 396-8.
16. Baptist AP, Nyenhuis S. Rhinitis in the Elderly. Immunol Allergy Clin North Am 2016; 36: 343-57.
17. Loftus PA, Wise SK, Nieto D, Panella N, Aiken A, DelGaudio JM. Intranasal volume increases with age: Computed tomography volumetric analysis in adults. Laryngoscope 2016; 126: 2212-5.
18. Wrobel BB, Bien AG, Holbrook EH, Meyer GE, Bratney NA, Meza J, et al. Decreased nasal mucosal
sensitivity in older subjects. Am J Rhinol 2006; 20: 364-8.
19. Mathur SK. Allergy and asthma in the elderly. Semin Respir Crit Care Med 2010; 31: 587-95.
20. Gruver AL, Hudson LL, Sempowski GD. Immunosenescence of ageing. J Pathol 2007; 211: 144-56.
21. Milgrom H, Huang H. Allergic disorders at a venerable age: a mini-review. Gerontology. 2014; 60: 99-107.
22. Gubbels Bupp MR. Sex, the aging immune system, and chronic disease. Cell Immunol 2015; 294: 102-10.
23. Franceschi C, Bonafe M, Valensin S, Olivieri F, De Luca M, Ottaviani E, et al. Inflamm-aging. An evolutionary perspective on immunosenescence. Ann N Y Acad Sci 2000; 908: 244-54.
24. Mari D, Mannucci PM, Coppola R, Bottasso B, Bauer KA, Rosenberg RD. Hypercoagulability in centenarians: the paradox of successful aging. Blood. 1995; 85: 3144-9.
25. Mari D, Mannucci PM, Duca F, Bertolini S, Franceschi C. Mutant factor V (Arg506Gln) in healthy centenarians. Lancet 1996; 347(9007): 1044.
26. Wikby A, Nilsson BO, Forsey R, Thompson J, Strindhall J, Lofgren S, et al. The immune risk phenotype is associated with IL-6 in the terminal decline stage: findings from the Swedish NONA immune longitudinal study of very late life functioning. Mech Ageing Dev 2006; 127: 695-704.
27. Franceschi C, Olivieri F, Marchegiani F, Cardelli M, Cavallone L, Capri M, et al. Genes involved in immune response/inflammation, IGF1/insulin pathway and response to oxidative stress play a major role in the genetics of human longevity: the lesson of centenarians. Mech Ageing Dev 2005; 126: 351-61.
28. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340: 115-26.
29. Eikelenboom P, Veerhuis R. The importance of inflammatory mechanisms for the development of Alzheimer's disease. Exp Gerontol. 1999; 34: 453-61.
30. Enright PL, Kronmal RA, Higgins MW, Schenker MB, Haponik EF. Prevalence and correlates of respiratory symptoms and disease in the elderly. Cardiovascular Health Study. Chest 1994; 106: 827-34.
31. Pinto JM, Jeswani S. Rhinitis in the geriatric population. Allergy Asthma Clin Immunol 2010; 6: 10.
32. Meltzer EO. The prevalence and medical and economic impact of allergic rhinitis in the United States. J Allergy Clin Immunol 1997; 99(6 Pt 2): S805-28.
33. Simola M, Holopainene E, Malmberg H. Changes in skin and nasal sensitivity to allergens and the course of rhinitis; a long-term follow-up study. Ann Allergy Asthma Immunol 1999; 82: 152-6.
34. Di Lorenzo G, Leto-Barone MS, La Piana S, Ditta V, Di Fede G, Rini GB. Clinical course of rhinitis and changes in vivo and in vitro of allergic parameters in elderly patients: a long-term follow-up study. Clin Exp Med 2013; 13: 67-73.
35. Derby L, Maier WC. Risk of cataract among users of intranasal corticosteroids. J Allergy Clin Immunol 2000; 105: 912-6.
36. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol 2011; 127(1 Suppl): S1-55.
37. Jutel M, Agache I, Bonini S, Burks AW, Calderon M, Canonica W, et al. International Consensus on Allergen Immunotherapy II: Mechanisms, standardization, and pharmacoeconomics. J Allergy Clin Immunol 2016; 137: 358-68.
38. Reh DD, Mace J, Robinson JL, Smith TL. Impact of age on presentation of chronic rhinosinusitis and outcomes of endoscopic sinus surgery. Am J Rhinol 2007; 21: 207-13.
39. Cho SH, Kim DW, Lee SH, Kolliputi N, Hong SJ, Suh L, et al. Age-related increased prevalence of asthma and nasal polyps in chronic rhinosinusitis and its association with altered IL-6 trans-signaling. Am J Respir Cell Mol Biol 2015; 53: 601-6.
40. Cho SH, Hong SJ, Han B, Lee SH, Suh L, Norton J, et al. Age-related differences in the pathogenesis of chronic rhinosinusitis. J Allergy Clin Immunol 2012; 129: 858-60 .
41. Stevens WW, Lee RJ, Schleimer RP, Cohen NA. Chronic rhinosinusitis pathogenesis. J Allergy Clin Immunol 2015; 136: 1442-53.
42. Colclasure JC, Gross CW, Kountakis SE. Endoscopic sinus surgery in patients older than sixty. Otolaryngol Head Neck Surg 2004; 131: 946-9.
43. Ramadan HH, VanMetre R. Endoscopic sinus surgery in geriatric population. Am J Rhinol 2004; 18: 125-7.
44. Hummel T, Kobal G, Gudziol H, Mackay-Sim A. Normative data for the "Sniffin' Sticks" including tests of odor identification, odor discrimination, and olfactory thresholds: an upgrade based on a group of more than 3,000 subjects. Eur Arch Otorhinolaryngol 2007; 264: 237-43.
45. Kobal G, Klimek L, Wolfensberger M, Gudziol H, Temmel A, Owen CM, et al. Multicenter investigation of 1,036 subjects using a standardized method for the assessment of olfactory function combining tests of odor identification, odor discrimination, and olfactory thresholds. Eur Arch Otorhinolaryngol 2000; 257: 205-11.
46. Schubert CR, Fischer ME, Pinto AA, Klein BEK, Klein R, Cruickshanks KJ. Odor detection thresholds in a population of older adults. Laryngoscope 2017; 127: 1257-62.
47. Zhang C, Wang X. Initiation of the age-related decline of odor identification in humans: A meta-analysis. Ageing Res Rev 2017; 40: 45-50.
48. Kern DW, Wroblewski KE, Schumm LP, Pinto JM, Chen RC, McClintock MK. Olfactory function in Wave 2 of the National Social Life, Health, and Aging Project. J Gerontol B Psychol Sci Soc Sci 2014; 69 (Suppl 2): S134-43.
49. Doty RL, Shaman P, Applebaum SL, Giberson R, Siksorski L, Rosenberg L. Smell identification ability: changes with age. Science 1984; 226(4681): 1441-3.
50. Doty RL, Kamath V. The influences of age on olfaction: a review. Front Psychol 2014; 5: 20.
51. Wilson RS, Yu L, Bennett DA. Odor identification and mortality in old age. Chem Senses. 2011; 36: 63-7.
52. Gopinath B, Sue CM, Kifley A, Mitchell P. The association between olfactory impairment and total mortality in older adults. J Gerontol A Biol Sci Med Sci 2012; 67: 204-9.
53. Kalmey JK, Thewissen JG, Dluzen DE. Age-related size reduction of foramina in the cribriform plate. Anat Rec 1998; 251: 326-9.
54. Rawson NE, Gomez G, Cowart BJ, Kriete A, Pribitkin E, Restrepo D. Age-associated loss of selectivity in human olfactory sensory neurons. Neurobiol Aging 2012; 33: 1913-9.
55. Doty RL. Olfaction in Parkinson's disease and related disorders. Neurobiol Dis 2012; 46: 527-52.
56. Marin C, Vilas D, Langdon C, Alobid I, Lopez-Chacon M, Haehner A, et al. Olfactory Dysfunction in Neurodegenerative Diseases. Curr Allergy Asthma Rep 2018; 18: 42.
57. Hawkes C. Olfaction in neurodegenerative disorder. Adv Otorhinolaryngol 2006; 63: 133-51.
58. Doty RL. Olfactory dysfunction in neurodegenerative diseases: is there a common pathological substrate? Lancet Neurol 2017; 16: 478-88.