A nose-picking gag in a recent episode of The Big Bang Theory really stuck with me. In "The Earworm Reverberation," two characters who, for this episode, play music in an unknown band, stalk their one Facebook fan until they spot him in a coffee shop. Once there, they witness the fan picking his nose, and they bolt. For some reason, the audience then roars with appreciation. While I agree that boogers are objectively funny, it's weird that they're still judgmental about the guy's hygiene, as though picking your nose is some kind secret shame—one that's even darker than stalking someone you found on the internet.
After all, according to the Merck Manual Home Health Handbook, a diagnostic guide for non-doctors, winter weather can make you want to pick your nose bloody. And even if you don't bleed all over yourself, there's still a social stigma attached, so picking your nose can negatively affect your life by making you look gross on TV.
But can putting your finger up your nose start a chain of events with fatal consequences? And if you really get overzealous, can you just miss your boogers altogether and accidentally jab yourself in the brain?
To find out, we talked to Zara Patel a rhinologist and skull base surgeon who teaches medicine at Stanford University. Patel deals with everything from the kinds of serious nasal infections that require surgical intervention, to what can happen to your brain if something catastrophic happens to your sinuses. She seemed like the perfect person to ask about the worst case scenarios resulting from nasal prospecting.
VICE: Hi Dr. Patel! Is it OK for me to pick my nose?
Dr. Zara Patel: I really strongly discourage people from putting their fingers in their noses, whether it's to pick a booger or to feel something that they think is in there, because introducing bacteria from your hands into the nasal cavity—and what might therefore become bacteria in your sinus cavity—can only lead to problems and complications, whether it's just a colonization of foreign bacteria in your nose, or an actual, big infection that can become worse.
Is that because the nose is part of something called "The Danger Triangle of the Face"? People used to warn me not to pop pimples near my nose or else I might get an infection and die.
There's actually some medical literature supporting all these complications—brain infections from what we call facial furuncles—infection of the pores and follicles of the skin—in that area. But "am I going to die from popping a pimple?" That would be extremely rare—much more common before the advent of antibiotics.
What about now, after the advent of antibiotics?
You're much more likely to get an intracranial complication from a sinus infection these days than you are from picking a pimple on your face. The area that is closest to that sort of dangerous area that I'm talking about is the back of your sinuses. Your sinuses go all the way to what we call the skull base. The skull base is this very thin plate of bone that your brain sits on. In certain areas, this plate of bone is extremely thin—like an eggshell thin. People have these really bad fulminant infections in these areas, and that can lead to the infection breaking through the thin bone, and causing infection in really sensitive areas, like your [eye socket], or the brain above, or the cavernous sinus, which is kind of the worst.
OK, a bad infection can spread to the brain, but has anyone ever definitely died from picking their nose?
There's no case report like: This person put their finger in their nose, and that caused it. But we do know there are the typical kinds of bacteria that live in our sinuses. We all have normal kinds of OK bacteria that live in our sinus and nasal cavities—that's called normal respiratory flora. And that's a different kind of bacteria from what is found on the surface of our skin, and very different from the types of bacteria that are in our mouths. When you introduce your finger into your nose, you're introducing a different type of bacteria that can overgrow and replace the normal bacteria, and there are reports in the medical literature about infections from these sort of rare bacteria.
Can you jab yourself in the brain when you pick your nose and die that way?
The skull base is a very thin plate of bone. In a baby it's even more thin. In adults, there are areas of our skull base that are less than a millimeter wide.
How far is it from the nostril opening to the brain?
It's a different distance depending on where along the skull base, but it can be anywhere from 6-11 centimeters [or about 2 1/3 to 4 1/3 inches]. It's closer to the skull base if you go straight up. Say you're measuring from just inside your nasal cavity straight up in between your eyes, that distance is probably 6-7 centimeters. Going further back, back to all the way behind your sphenoid sinus from the nasal sill, that would be more like 11-12 centimeters (up to 5 inches).
Sounds difficult since that's just about the entire length of one of my fingers. Could I ram a blunt instrument like a chopstick into my brain if I were picking my nose with it?
If you held a chopstick into your nasal cavity, and someone pounded that chopstick up with a hammer, with enough force, then yeah, it would go into your brain. It depends how strong you are, and how motivated your are to get to your brain. It would also depend on the exact part of the skull base you were directing this to. Like I said, parts of it are naturally more thin.
What if I precision-aimed the chopstick at the thinnest part?
For example, you have an area that's right at the very top of your nasal cavity, where the olfactory bulb [which is part of the brain] sits on top of it and sends all of its little nerve fibers down into your nasal cavity, and that's how you smell. That plate is called the cribriform plate, and it naturally has all these tiny little holes to let those nerves go through it. And there's a plate of bone just right next to it, part of the skull base, that is the thinnest part of your skull base, so if you were to aim a chopstick right at that area, it actually wouldn't take that much effort to go all the way through.
Taking this out of the realm of crazy self-destructive hypotheticals, does that thin section of skull pose real hazards?
Sometimes when people come in, and they have a really bad sinus infection, you can see on imaging that sometimes when people have had infections in their sinuses for long enough, the bone is actually already eroded, and the inflammation surrounding the infection can erode through bone. So sometimes you see them come in, and they already have a loss of the bone between their sinuses and their eyes or their sinuses and their brain above. In those patients, I really encourage them to get surgery done quickly before it becomes something worse.
When the bone erodes from infection, is the brain just hanging out, naked?
There's a mucosal surface remaining. The inside of the sinus has what's called mucosa—like what's inside your mouth. And the sinuses are lined with mucosa. Then there's the lining of your brain, called the dura, which in and of itself is really good at preventing infections from really getting into the brain above, but again, there are areas where important nerves come in and out of your skull base, and that's where the dura is most thin.
If the infection really spreads like crazy, what happens to your brain?
It depends on what part of your brain the infection has spread to. For example: the cavernous sinus is kind of the most dreaded area that an infection or tumor would spread to, because it's an area where a lot of really important structures run through. Through the cavernous sinus runs the carotid artery. The carotid artery is the main artery that brings blood to your brain. If you had enough infection, or an embolism in that area from an infection, and that affected the blood supply to your brain, you could have a stroke. That's one thing.
Yikes. But if it didn't cause a stroke, would it have an effect on your senses?
In that area are multiple cranial nerves—most of the ones running through that area control movements of your eye, and vision. If you had an infection in one of those nerves, after treating it aggressively you would be able to bring that function back, but that doesn't always happen. And then the optic nerve runs just above that area we're talking about, so that's very susceptible also. You could completely lose vision actually.
Just in the one affected eye?
The scariest part about the cavernous sinus is that it's this complex of veins that actually is a bilateral system. Say you have an infection in the right sigmoid sinus—the sinus that's all the way in the back of all your sinuses—and that eroded into the cavernous sinus on that side. Well, that's a free-flowing space to the other side. You can get bilateral—or complete—blindness because of that.
Is that really the scariest thing?
You've probably seen cavernous sinus thrombosis. If you Google it you can see some pretty gruesome images of what happens if it goes to both eyes.
If you're a big-time nose picker and you think you've given yourself a horrible infection, what are the early warning signs?
Sometimes all you'll see at the very beginning is some redness and swelling around one eye. Signs that you're getting an intracranial infection directly are usually the same kinds of signs that we see with meningitis. Meningitis is kind of the earliest sign of infection—inflammation of the meninges, the layering around the brain. Those are things like lethargy, confusion, certain positions make your head hurt more than others.
Is it always so obvious?
Interestingly there are parts of your brain that you can have an infection in, and you don't actually have that many signs outwardly. People usually will say something like 'I had a headache,' but a headache is so nonspecific that a lot of the time people don't go in. People get headaches for all sorts of reasons. I don't want you to publish something that says 'if you have a headache you might have a frontal lobe infection,' but that's unfortunately sometimes the only really small warning sign.
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