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Comment & Response
Jan/Feb 2018

Mental Health and Nasal Function

Author Affiliations
  • 1Department of Surgery, University of Auckland, Auckland, New Zealand
JAMA Facial Plast Surg. 2018;20(1):86-87. doi:10.1001/jamafacial.2017.2043

To the Editor Strazdins and colleagues1 have noted that patients with poor mental health status have a poorer self-perception of nasal function. More than 60 years ago, Holmes et al observed a similar relationship between anxiety and a number of nasal symptoms, including nasal congestion. In a previous report,2 I noted that hyperventilation and hyperventilation syndrome, which is associated with both anxiety and depression, is common in patients presenting with nasal congestion, particularly after failed nasal surgery. Hanna et al3 have made similar observations. Physiological, epidemiological, and clinical evidence support a “unified” upper and lower respiratory airway model.4 The limbic system or emotional brain has an independent control over lower respiratory breathing pattern and rate.2,4,5 People who are prone to anxiety attacks have lower arterial carbon dioxide levels (5 mm Hg on average) compared with controls, and their carbon dioxide receptors are more responsive to changes in arterial carbon dioxide levels.2