I've got an embarrassing problem with my nose. For some reason, my mucus dries into flakes. These flakes detach themselves (usually while I'm exhaling) and find their way out of my nose at any random moment. I don't have any breathing problems -- my nose generally isn't stuffed up. I may be a bit dehydrated at times, but I drink plenty of fluids. I used to think it had something to do with dry weather, but even during the humid summer, the problem has persisted. I tried a saline nose spray anyway, but the effect was negligible. As you can imagine, this has a large influence on my daily life!

A.L.

This is an unusual problem, and I can certainly understand why you find it embarrassing. We live in a society that is very nervous about ANY bodily secretion.
Mucus is produced by tiny mucus-secreting glands that are scattered throughout the nasal and sinus cavities. Mucus forms a thin blanket covering the delicate tissue lining the sinus and nasal cavities. This tissue is called mucosa. Under ordinary circumstances, mucus flows to the back of the throat and is promptly swallowed. We produce approximately 1 liter (4 cups) of mucus each day, and nearly all of this ends up in our stomachs!

Mucus production is increased when an inflammatory condition is present. Sinusitis and nasal allergies are two very common conditions in which mucus production is increased. I suspect that you have such an inflammatory condition and are producing more mucus than you really need. I also suspect that you have a larger-than-normal nasal cavity (which may or may not mean that you have a large nose -- the external nose is "the tip of the iceberg" in relation to the remainder of the nasal cavity). Increased mucus production and a high air flow rate could combine to create the flakes that are so onerous to you. If you were my patient, I would adopt the following approach:

1. First, I'd want to know if you have any obvious signs or symptoms of nasal inflammation. Do you sneeze frequently, and do you have itching of the eyes, nose or throat? Do you ever get facial headaches? Do you have postnasal drainage? The answers to such questions might indicate whether you have an inflammatory nasal condition. Even if you did not have such a condition, I would be tempted to place you on an anti-inflammatory nasal spray, to see whether this changed your nasal mucus in a way that was favorable to your condition.
   
2. You say you are drinking enough fluids, but are you really? The most recent formal recommendation that I have heard is a whopping 10 eight-ounce glasses (2.4 liters) per day of noncaffeinated, nonalcoholic beverages. This increases if you live in a dry climate and especially if you do a great deal of physical labor.
   
3. You say you used a nasal saline spray, but how often did you use it? I would have you spray each nostril several times, followed by some nose-blowing, four times per day. And if you really want to do the job right, learn how to irrigate your nose with saline. (In some cultures, this is a daily ritual, similar to brushing one's teeth.) You'd need to buy a suction bulb. (They're used to suck mucus out of babies' noses. Most pharmacies carry them.) Then get some sterile saline. (I often recommend that people purchase the saline made for contact lenses.) Suck up some saline into the bulb. Position your head over the sink. Blast away -- very gently at first, and then, as you get used to it, you can use more force. Ideally, the saline will go all the way to the back of the throat, and you will be spitting out saline -- as well as blowing some out of your nose! Work up to this, though; early on, you may feel as if you are drowning. This is a difficult "skill" that some folks can get used to, while others detest even the earliest stages of it.
   
4. Finally, there are medications (called mucolytics, which means "breaks up mucus") that change the physical characteristics of mucus. Under a doctor's guidance, a trial of such a medication may prove helpful.