The nose and throat at altitude

High altitude mountaineers from the first ever reconnaissance expedition to Everest in 1921 complained about a variety of problems affecting their nose and throat. Since then, anecdotal accounts abound in all mountaineering books about runny nose, dry nose, and blocked, bleeding and crusting noses. These nasal problems are obviously sufficient at times to cause real distress to even tough mountaineers! In addition, dry, painful sore throats are common at high altitude and a wide variety of persistent and at times severe coughing has in many instances led to mountaineers breaking ribs and becoming extremely unwell with a variety of lung problems leading to them having to abandon climbing. In addition to the problems with the nose and throat, loss of taste and smell with or without accompanying loss of appetite are also well described. Whilst not all mountaineers lose their appetite at high altitude, weight loss can be a serious problem and is not altogether understood. Even in mountaineering expeditions with an excellent food supply, appetite and weight loss can have serious consequences.

Surprisingly, a different, but in some respects similar, scenario can occur in patients who have been successfully treated for life-threatening illness on our modern intensive care units. Many of these patients may have required ventilation with oxygen during their illness and sometimes prolonged periods of breathing support by means of a machine. The oxygen is delivered via a variety of tubes placed into the patient?s airway via the nose and throat. In the ensuing recovery period, these patients can have significant problems with the whole spectrum of nose and throat symptoms and alteration of their smell, taste and appetite in a manner similar to the mountaineers. These symptoms make their ability to eat and to recover from their illness considerably more difficult.

	Taste testing

Following a careful review of the very limited scientific publications on the subject, the Caudwell Xtreme Everest group have undertaken studies using a detailed questionnaire covering nose and sinus symptoms (delightfully known as the ?SNOT 20? questionnaire!) and a detailed internationally recognised smell test from the University of Pennsylvania. The smell test involves 4 booklets of ?scratch and sniff? tests which cover more than 40 different odours. Taste is tested by placing the five different solutions of bitter, sweet, salty, sour and savoury on to the tongue. The first 70 trekkers ascending to Base Camp had these tests performed at sea level in the Archway laboratory prior to departure and then at a level at 5,300 m at Base Camp.

The ever patient and hardy Caudwell Xtreme Everest Base Camp scientists and the highly successful climbing team have, in addition, had further tests of their nasal function and a variety of detailed photographs taken of their noses and throats by special telescopes, light sources and cameras during the many weeks at Base Camp, and after their successful climb to the summit. In addition, the Caudwell Xtreme group evaluated a number of simple nasal medications and a simple face mask that aim to lessen the effect of cold, dry air on the nose and throat.

David Howard