B. If the inferior turbinate has the small size, the main airstream fails into the inferior nasal passageway, where the distance to nasopharynx is the shortest, but there are not of paranasal sinuses.
     

	Feasible measures of the individual defence against infection by Severe Acute Respiratory Syndrome - SARS or Danger of infection by Severe Acute Respiratory Syndrome (SARS) is programmed, when there is disorder of nasal aerodynamics. Yuri P. Uliyanov. The Medical Center AGAMY, Moscow Russia (tel: 219-9110)
	Nowadays, the threat of spreading of Severe Acute Respiratory Syndrome (SARS) - Atypical pneumonia or Hongkong influenzae continues, because, the nature of this fatal illness is learned not quite enough. Therefore, there is no effective therapy and reliable defend against of this disease and so, like the unique known remedy for protection from the virus of SARS recognizes the gauze mask onto the mouth and nose. As a result, the number of dead from this disease already has achieved more than 200 and infected more than 4000 (in China, Singapore, Canada, USA, Philippines and many others). Therefore, the lookings for any defence against this sickness becomes today the prime significance in the effort to restrict its distribution. In this connection, the natural protective properties of the upper respiratory ways represent particular interest, because, they are intended for defense of lungs from insalubrities of an ambient air (cold, droughty and dusty air with every possible microbes and viruses). As is known, the basic protective mechanism of the respiratory ways is the mucociliary clearance (transport) which one in the form of mucus film covers a mobile cilia of the epithelium of mucosa of the nose, throat, trachea and bronchuses. This mucus pellicle has secretory leucocytes which are capable to destroy many types of bacteria and viruses arriving upon inspiration, while, the protective properties of an organism are capable to adapt secretory leucocytes against the characters of the arriving infection. Hence, the human organism could adapt the mucociliary clearance and against the virus of SARS (atypical ðneumonia). In this connection, it should be noted that the main part of the protective function of the human respiratory ways - 70 % is on a share of the nose. It is caused, that in the walls of the nose there are the rich by cells paranasal sinuses through which an airstream passes before it enters to the throat. In this cellular system of paranasal sinuses the air is warmed, wetted and refines especially actively, that saves and holds up the protective statuses of the mucociliary clearance. As a result, when outsideat is 15 degrees below zero, into the throat the air enters with heating until 25 degrees above zero and during the day the nasal mucose selects 500.0 ml. of the fluid for humidification of the inspired air. That is what provides the protective properties of the mucosa of the respiratory ways even during the fall-winter period of average and northern latitudes. The people with such nasal aerodynamics in practically are no cold and so, this type of aerodynamics of the nose was called as Northern (Fig. 1) [the Russian Patents No 1572505 and 1602472]. Fig.1 In cases of the Northern type of nasal aerodynamics the inferior turbinate has a big size and so, it almost reaches the nasal septum, that demarcates the inferior and middle meatus. Therefore, the main airstream rises into the middle meatus. About efficiency of such defence of the mucociliary clearance efficacy using of the gauze masks onto the mouth and nose testifies, because, they do not defend from viruses, but very effectual protects the mucociliary clearance from any cooling, drying up and dust contents, and this indeed often guards the people against infection of SARS. However, in the case of the Southern type of nasal aerodynamics, the danger of infection by SARS considerably increases, as at the same time, the main airflow enters into the throat directly through the lower nasal passageway, where there are no paranasal sinuses and perfection of the air (warming, wetting and clearing from powder and micro-organisms) in practically do not occurs. As a result, when outside is 15 degrees below zero in the throat the air enters with cold temperature below zero too, and drying up and dust content of the mucosa depends from quality of the ambient air. This can lead to overcooling and auscultation of the mucosa especially into the inferior meatus and pharynx to such extend, that the mucociliary clearance is stopping. As a result, the mucosa of the nose and pharynxe become so defenceless, that even the saprophytic flora, which harmless for healthy human mucosas, becomes aggressive-traumatizing down to development of an inflammation in the form of acute respiratory disease, which one proceeds particularly painfully. As these people are the most adapted to a warm (heartwarming) climate of mediterranean, such type of nasal aerodynamics got the name Southern (Fig. 2). Fig.2     In case of the Southern type of nasal aerodynamics the inferior turbinate has a small sizes and it together with middle meatus combines in the common one. Therefore, the main airstream fails into the inferior nasal passageway, where the distance to nasopharynx is the shortest. Such defencelessness of the nasal mucosa with the Southern type of nasal aerodynamics (STA) is significant facilitates fault of it by the virus of SARS. Consequently, the people with the STA should be attributed to the high-risk group, which is programmed not only to catchall diseases, but also to lesion by the virus of SARS. More severe group of the heightened risk is made by the persons with the unilateral STA, when on the counter half of the nose there is the NTA (Fig. 3), because, it is produced owing to the shorter distance until the nasopharynxes along the inferior meatus and therefore the respiration in these cases occurs only through the Southern half of the nose, that leades to its double overloading with the even major damage of the mucociliary clearance. Ðèñ.3 Unilateral Southern type of nasal aerodynamics is when at one side of the nose there is the Southern type (if the space between the inferior turbinate and nasal septum is less 2mm.), and on the opposite side there is the Northern type (when this spacing interval is more than 2 mm.). Accordingly, acute respiratory disease to these persons development more active and the respiratory infection of SARS is more aggressive too. Therefore, for to defend oneself from the virus of SARS, the people with the Southern type of nasal aerodynamics (STA) are in need: 1- In the protection of the mucosa of the inferior meatus and pharynx from overloading by any cooling, desiccation or dust content and 2- in the medical help for the restoration of the mucociliary clearance activity. For the STA the most radical method for defence of the mucociliary clearance is the surgical reconfiguration into the Northern type by our techniques, which one has been used successfuly for adult and children already more than 25 years (Russian Patent No 2090156; 2118894; 2141798; 2179416). Such reconstruction of nasal aerodynamics is the most required to the unilateral Southern type, because, the plastic operation at one side of the nose can restore the normal respiration on the both sides, at once, that considerably improves stability these people to catchig cold and infection by SARS. In the cases with the STA on two sides, the reconstruction of nasal aerodynamics at each half is required, that becomes necessary, when there are the apart expressed forms of aerodynamics violation. However, at the transition forms of nasal aerodynamics which are between the STA and the Northern type (which one occurs more often) defence of the nasal and pharynx mucosa with medicinal support of its function can be quite successfuly to restore and support of protective properties of the mucociliary clearance, that reduces danger of catarrhal diseases and improves stability to SARS. That is why, currently, when the most of people a character of their nasal aerodynamics do not know yet, it is necessary to suppose for them the Southern type and for increase of their resistance to infection by SARS, the measure for defence of the mucociliary clearance against overcooling, overdrying and dust content are necessary, together with medicinal aid for rising and maintaining of its activity. The individual measures for the prophylaxis and defence against of SARS are the following: 1. The gauze mask onto the mouth and nose, which one broad is used and provide quite enough wetting and warming of the inspired air, that keeps protective properties of the mucociliary clearance of the respiratory ways mucosa against of the viruses and bacterias; 2. Instillation of vegetable oil into the nose (2-3 times a day) as well promotes to defence the mucosa from drying up and cooling, and so, to preservation activities of the mucociliary clearance; 3. Instillation into the nose of anti-inflammatory drops provide particulary favourable influence upon activity of the mucociliary clearance and protective properties of the nasal and pharynx mucosas. However, such drops are required the individual selection by modality described by us, as it turned out, that (for example) for 37 % of the Russians are suitable only colloidal silver drops, and for the rest mosts of the people are required antihistamine drops (Rassian Patent No 95112165). 4.Protectives properties of the mucociliary clearance is considerably activated and healed by mucous-active medicaments of direct and indirect agency. A) The medicament of directly agency is acting through the superficial contacts with the nasal and pharynxes mucosa: Cysteine, Trypsine, Jod, Physiological or Hypertonical solutions etc. Particularly effective is American buffer hypertonic solution - "ENTsol" for washing and irrigation of the nose, that considerably strengthens activity of the mucociliary clearance (www.entsolwash.com). Similar agency is rendering by the phytoncides of an onion and propolisum, burning pepper, salted foods, acute spiceries, spices etc., and also, instillation into the nose (5-6 times a day) Physiological solution or salt slightly and boiled water, steam inhalations, hot drink especially before dream, damping of the air in a bedroom and other ways of humidification of the respiratory ways mucosa. B) ) Mucous-active medications of indirect agency are secreted from the respiratory mucosa, that very good restores and well activates the mucociliary clearance. To them relate: carbocysteine, ambroxol, bromhexine, terpinhydrat, grayfenzin (tussin, robitussin), etc. The Italian drug Fluifort (S-Carboxymehylcisteyne) is more effective, and it creates the greatest concentration in the respiratory ways mucosa, where it is remained 24 hours after of reception inside and have good compatibility with antibiotics. 5. Moderate exercise stresses in the every morning for an ventilation of the paranasal sinuses is necessary to liquidate stagnant processes into them. 6. Administration of vitaminized complexes and anti-virus drugs as well is quite justified. Sharp warning: All medicines, phytoncides, foodstuffs and spices, which one can dry the mucosa of respiratory ways are counterindicated. It is a garlic, lemon, unripe citron (oranges, pineapples etc.), sea-buckthorned oil, liquid paraffin, Mentholum(menthol), Vaselinum, Lanolinum and others, and smoking too. The overcoolings of an organism can lead to development of catch a cold, which can also provoke and infection by SARS. Conclusions: 1. Gauze mask onto the mouth and nose is really defence against infection by SARS (Severe Acute Respiratory Syndrome), because, it very effectual safeguards the mucociliary clearance of the respiratory ways from any cooling, drying up and dust contents like the Northern type of nasal aerodynamics. However, the Southern type of nasal aerodynamics heightens danger of infection by SARS, because, it too much weakens the mucociliary clearance. 2. Northern type of nasal aerodynamics is capable to defend a person from infects with SARS or to reduce its aggressiveness, but the Southern type of nasal aerodynamics creates the high-risk group, which is programmed to the heightened danger of infection by SARS. 3. Nowadays, when the most of the people do not know yet about their type of nasal aerodynamics, it is necessary to suppose that they have the Southern type and so, for increase of their stability to SARS, the measures for protection of the mucociliary clearance against overcooling, overdrying and dust content, and also, medicinal assistance on rising and keeping up of its protective function by the mucus-active drugs direct and indirect agency are necessary. 4. Medicaments and foodstuffs (garlic, lemon, oil of sea-buckthorn etc.), dry up of the nasal and pharynxes mucosa and also smoking, chilling and impaired organism weaken activity of the mucociliary clearance and so, they are extremely counterindicatived, because they increase danger of infection by SARS. REFERENCES: Uliyanov Y.P. Relaytions bitween bronchial-pulmonary conditions and nasal aerodynamics. Vestnic of the Center of Endosurgery and Lithotripsy, Moscow, 1997; 1: 32-37. (In Russian). Atkarskaya, A.A., On the physiology of paranasal sinuses. - Zhurnal ushnykh, nosovykh i gorlovykh boleznei, 1925, No.5-6, pp.274-295 [in Russian]. Bachmann, W., Technik und Bedeutung der Funktionsprüfung des Osteun maxillare. - HMO (Berl.), 1978, vol.26, pp.25-27. Cole, R., Some aspects of temperature, moisture and heat relationships in the upper respiratory tract. - J,Laryngol.Otol., 1953, no.67, pp.449-456. Ingelstedt, S., Studies on the conditioning of air in the respiratory. - Acta Otolaryngol., 1956, vol.131, pp.1-10. Likhachev, A.G., in: Diseases of ear, throat, and nose. Moscow, 1947, 374 pp. [in Russian]. Palchun, V.T., Yu.A.Ustyanov, and N.D.Dmitriyev, Paranasal sinusiti-des. Moscow, 1982, 150 pp. [in Russian]. Piskunov, G.Z., in: Materals of the international symposium "Allergic and infections rhino-sinusitides" held in Jerusalem, 1994. - Rossiiskaya rinologiya, 1994, no.2, pp.91-94. Piskunov, S.Z., Physiology and pathophysiology of nose and paranasal sinuses. - Rossiiskaya rinologiya, 1993, no.1, pp.19-38. [in Russian]. Sagalovich, B.M., Physiology and pathophysiology of the upper respi-ratory tract. 1967, 328 pp. [in Russian]. Stucker FJ, Smith TE. Pitfalls in management of defects of bony dorsum and cartilaginous vault. Arch Otolaryngol 1976; 102: 695. Stucker F.J. Management of the scoliotic nasal.J.Laryngoscope.1982;Vol.92, 2:128. Stucker.F.J. Contemporary septal nasal surgery. J. Rossiyskaya Rinologya. 1997; 1:4-8. ( In Russian ). Stucker FJ, Ansel TE. A case against nasal packing Laryngoscope 1987; 88: 1314. Yedinak, E.N., A method of the analysis of air exchange within the Highmore sinus in highmoritides. Patent of USSR no.187009. Uliyanov Y.P., Polivanov P.P. Russian patents ¹¹ 1,572,505; 1,602,472,(1988). (In Russian). Uliyanov Y.P. Nose aerodynamics. Arch. Otolaryngol. Head Neck Surg. 1995; 121: 352 Uliyanov Y.P. Nose aerodynamics. Jor. Vrach, Moscow, 1996; 11: 39-40. (In Russian). Ulyanov Y.P. Normogram of nasal aerodynamics. Jr. Russian Rhinology. 1996, No 5 : 15-7. [in Russian]. Uliyanov Y.P. Method reconstruction of nasal aerodynamics. Jor. Vrach, Moscow,1997; 7: 31-33. (In Russian). Ulyanov Y.P. Method of reconstruction of the protective function of the nose. Russian patent ¹95105086. Ulyanov Y.P. Normogram of nasal aerodynamics. XYI World Congr. Of Otolar. Head Neck Surg.(Sydney, Australia, 2-7 March, 1997: 1603-1607. Uliyanov Y.P. Physiological bridge represented by the nasal valve and its variants. XVI World Congress of Otolaryng. Head and Neck Surg. Sydney, 1997.p. 1597-601. Uliyanov Y.P. Surgical reconstruction of nasal aerodynamics. XYI World Congr. Of Otolar. Head Neck Surg.(Sydney, Australia, 2-7 March, 1997: 1591-1595. Uliyanov Yu. Clinical Medicine (Reference book of a practicing physician). MSPI, Moscow, 1997,V-2:1103 - 1152. (In Russian). Uliyanov Y.P. Relaytions bitween bronchial-pulmonary conditions and nasal aerodynamics. Vestnic of the Center of Endosurgery and Lithotripsy, Moscow, 1997; 1: 32-37. (In Russian). Uliyanov Y.P. Clinical manifestations of the Variants of the Nasal Aerodynamics. Otolaryng. HNS 1998; 119: 2: 152-3. Uliyanov Y.P. On Contraindication to Septoplasty. Otolaryngology-Head and Neck Surgery -August 1998; 119 (2): 153-4. Uliyanov Y.P The local REASONS(CAUSES) and consequences of snore. International Medical Journal. 1999, 1-2:108-10. (In Russian). Uliyanov Y Septoplasty under control of nasal aerodynamics Æóðíàë ÂÐÀ×, 2000,6: 28-31. . (In Russian). Uliyanov Y.P. The insidiousness of unilateral "southern" type of nasal aerodynamics. 115N- The XYII World Congr. of Otorhinolaringology. (IFOS,Sept.28-Oct.3,2002,Cairo, Egypt.) Uliyanov Y.P. Peculiarities of the therapy of the chronic ethmoiditis when treating "Silver People". 113N-o The XYII World Con. of Otorhinolaringology. (IFOS,Sept.28-Oct.3,2002,Cairo, Egypt) Uliyanov Y.P. Septoplasty under control of nasal aerodynamics. 116N-o The XYII World Con.of Otorhinolaringology.(IFOS,Sept.28-Oct.3,2002,Cairo, Egypt Uliyanov Y.P. Snoring at the saved nasal respiration. 114S-o The XYII World Con. of Otorhinolaringology. (IFOS,Sept.28-Oct.3,2002,Cairo, Egypt.)