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ENT News from Rancho Ear, Nose and Throat
It seems like allergies is the “in” diagnosis for the last 10 years. While certainly allergies affect a broad range of people in a broad range of ways, we have to be careful not to run away with the rubber stamper. The management and treatment of allergies (as they pertain to symptoms of nasal congestion, sinusitis, runny nose, ear pressure and fullness, eye irritation, and cough) has a rational basis, but must include a thorough evaluation of both allergic and non-allergic problems that may be contributing to these symptoms. Furthermore, effective treatment of allergies requires an effective strategy to control symptoms. Understanding how allergies work is the first step to any type of treatment. Allergies are simply your body’s defense systems overreacting to something that is otherwise harmless. For instance, a floating pollen comes in contact with your nose, and your nose does everything in its ability to attack the pollen as if it were under attack from a bacteria or virus. The primary response involves chemical mediators working to increase blood flow to your nose to make your nose run, become congested, and increase your body’s defense cells in the area. Your body will also try to sneeze the pollen away as part of the defense. This is great for removing truly harmful things, but innocent things like pollens are ubiquitous in nature and do not require this response. Liken this to calling out the fire department for each time you turn on your stove. You would hate to be hosed down with water when nothing is wrong. So why do we react this way, and why does this affect only certain people? To give a simple answer to a complex question, no two person’s defense systems are the same, and no single person’s defense system is perfect. It’s just a matter of being exposed to something in your environment that exposes a programming error in your defense system. When you change your environment, such as getting a new pet or moving to a new area or home, you may encounter something new that exposes your weaknesses. Treatment of allergies involves avoidance, medication and possible immunotherapy. But before that step commences, evaluation for common problems that mimic allergies or worsen them must be done. For instance, nasal passages are often narrowed by crooked bones or cartilage internally. Tonsils and adenoids, particularly in children, often swell to the point they narrow the nasal passages. Both of these problems will make you congested with a runny nose chronically, but are better treated with surgery rather than lifelong medication. Irritants in the air such as cigarette smoke create similar symptoms to allergies, but are not caused by an over activity of the body’s defense system. When the other reasonable causes of the problems have been evaluated, identifying the triggers for your allergies is the next step. Sometimes this is easy, i.e.- your new cat makes you feel sick when you are around her. Sometimes it’s not so easy- you go to the park and feel ill, where you are surrounded by a variety of trees, grasses, pollens, etc. Even more complicated are problems that are year round such as dusts and food allergies. When allergies are suspected, the reasonable next step is allergy testing. Allergy testing comes in a few different forms. Skin testing works great for inhalants such as pollens, trees, dusts, grasses, etc. A small puncture in the skin is used to introduce a portion of the item being tested, and if you are positive, a reaction in the skin is detected there and measured. Blood testing (RAST) works great for those unable to tolerate skin testing such as young children or people with severe reactions. Dietary trials can identify the non-obvious food allergies. Once you have an idea of what you are allergic to, avoidance is the best treatment. Unfortunately, this is not always practical-i.e. you can avoid or give away your cat, but you can not avoid trees forever. Medications for allergies are plentiful and many are now available over the counter, but understanding how they can be used for your optimum benefit with minimum side effects is something you should discuss with your physician. In addition, certain medications are available only by prescription. If medications are not helping, the only way to “cure” allergies is to modify your body’s immune responses in a process called immunotherapy. This can be done by very carefully receiving doses of the allergen in gradually increasing amounts, usually in a series of injections through a physician’s office. If you are interested in learning more about what’s troubling your nose, or suspect you have allergies, please contact our office at 858-674-1165, or visit our website at www.ranchoent.com. I wish you the best of health.
It’s the time of the year for holidays, celebrations, vacations, and yes, unfortunately, the time of the year for many of our young ones to bring home the sniffles. While getting the usual cold is perhaps unavoidable, stopping the chain from progressing to ear infections and sinus infections should help our children feel better faster. So how does the chain work? Why are children such easy targets? The answer is that small noses have tight spaces which easily get blocked with even the smallest amount of swelling. When these tight spaces get blocked, normal routes of communication for air and fluid flow in the ears and sinuses to the nose also get blocked. When mucous or fluid builds up in the ears or sinuses and is unable to drain, the mucous gets stagnant. This stagnant mucous becomes a ready target for bacteria and thus an infection most likely will occur. Children are also easier targets than adults for infections because our body’s defense system is one which will only get wiser with time. In essence, the body helps to prevent infections by remembering how it fought a particular virus or bacteria the first time, limiting or even preventing a second infection to the same virus or bacteria in the future. Hence, adults get less infections than children because their immune system is more experienced. A typical adult gets about three colds per year, while a child may get six or seven. So how do we prevent the chain? First and foremost, we prevent the chain from ever starting. Simple things like washing hands, avoiding sharing of drinks, covering our mouths and noses with our elbows or arms during sneezing and coughing, are the basic measures which we all already teach our children. If the chain starts, as it typically will with a cold, consider using over the counter cold medicines with a decongestant, if your child is otherwise healthy and over 2 years of age. If you are unsure about your child’s health, check with his or her physician, but most children over 2 years are able to take decongestants without trouble when given in appropriate doses (under 2 years check with a doctor first). The decongestant will help keep the sinuses and the ears from building fluid by decreasing the swelling in the nose. Decongestant medications typically used are medications such as pseudophedrine or phenylephrine which are usually grouped with other medications for cough and fever (i.e. Tylenol Cold or Dimetapp). Children’s Tylenol can be used in addition to a decongestant if the decongestant product does not have Tylenol in it. Tylenol can be used to help with fevers and can help your child feel better. Chicken soup and steam can be added if desired. Colds are generally marked by congestion, runny nose, and a low grade fever, as well as a mild sore throat. Almost all colds are caused by viruses, which do not respond to antibiotics. However, colds can lead to bacterial infections as we described above, at which point antibiotics may become necessary. Drainage for a typical cold is clear to hazy. If colored drainage, bad breath, or higher fever is noticed, a call or visit to a physician is warranted. Most colds improve within 5-7 days, but if your child is not showing improvement in this time frame, a visit to the doctor could also be worthwhile. Sore throat without nose congestion, or a particularly bad sore throat also warrants evaluation and a throat culture to help distinguish viral infections from strep throat which will require antibiotics to get better. Development of ear pain or fluid draining from the ear is also an ominous sign for the development of a bacterial ear infection which may also require antibiotics to get better. As we mentioned, frequent colds are expected in our younger children as a part of their immune system’s learning process. However, frequent infections of the ears, sinuses, and throat should not be considered normal and can be harmful to your child’s health. Frequent ear infections may lead to hearing loss from fluid build up in the ears, or even more serious ear conditions. Frequent throat infections can lead to swollen tonsils and adenoids causing night time breathing problems such as snoring, sleep apnea, as well as increased frequency of ear and throat infections from bacteria that stay in the tonsils and adenoids. Treatment with medication or surgery may be indicated in these situations. In these situations, a visit to an ear nose and throat specialist may be helpful. If you are concerned about your child’s health or wish to learn more about what was discussed in this article, please visit our website at www.ranchoent.com or call us at our office 858-674-1165. I wish you and your children the best of health. Ashish K. Wadhwa, MD
As an Ear, Nose, and Throat physician, one of the things that I am called upon rather frequently for is the management of snoring. While some might find it somewhat laughable to think of seeking medical treatment for a social taboo, you may be surprised to learn snoring can be a sign of serious diseases to come if not only a source of social isolation. Distinguishing snoring from obstructive sleep apnea, the actual prolonged cessation from breathing while sleeping from throat tissue collapse is an important delineation that needs to be made. Snoring typically results from vibration of normal tissues in the throat as air passes through it. During the daytime, our muscles are awake and this keeps the throat open so that this vibration does not occur. When we go to bed at night, particularly during the deep stages of sleep, a relaxation of most of the body’s muscles will occur, including those around your throat. Gravity is now allowed to let mobile tissues in the throat, namely the palate and the back portion of the tongue, to drop backwards. As the air passes through the throat, the mobile tissues will vibrate and make the snoring sound. Taken to the extreme, if you snore and your throat collapses for a prolonged period of time, you will periodically stop breathing. In medical terms, going without breathing is called apnea- hence “sleep apnea”. Sleep apnea is a more serious problem. If you periodically stop breathing whenever you go into the deep stages of sleep, your body and brain are obligated to keep you breathing, hence limiting the time you can actually stay in the deep stages of sleep. Unfortunately, the deep stages of sleep are the ones most needed for our body to get properly rested. Hence, sleep for a patient with sleep apnea is not restful, and a person with sleep apnea feels tired during the day despite sleeping at nighttime. Such a person tends to be sleepy during the day or even nod off when things are slow, because the body is craving sleep whenever it can. Despite spending additional time sleeping, they are still not getting rested because of the lack of deep stage sleep. Untreated, sleep apnea can also lead to more serious long-term health problems. Because the person is chronically tired, they exercise less and gain weight with its concomitant medical issues. As the body goes without breathing at night during sleep, it also drops body oxygen levels, which over time cause the heart and lungs to work harder, which over time can lead to heart and lung difficulties. Furthermore, the additional weight gain factors back in to worsen the sleep apnea, setting up a viscious cycle. Treatment of obstructive sleep apnea and its separation from snoring alone requires a physician evaluation and possibly a sleep study. A sleep study is an assessment either in your home or in a sleep laboratory where monitors are placed on you to assess your stage of sleep, blood oxygen level, and frequency/rate of breathing to see if significant cessations of airflow are occurring. Treatment includes those things discussed above for snoring, in addition to the possibility of using a continuous positive airway pressure (CPAP) machine, which helps to maintain an open throat by application of air pressure through a facemask. Sometimes an oral prosthetic device can be fit to help improve the positioning of the tongue base. Surgical treatment options are also available, and this is again needs to be tailored to the individual patient’s anatomy and disease severity. Modifications to the tissues of the throat or improvement of the nasal airway to decrease obstruction to air movement can frequently be achieved. If you wish to learn more about snoring, sleep apnea, or their treatments, please contact your physician or contact our office at 858-674-1165. You can also visit us on the web at RanchoENT.com. I wish you the best of health. By Ashish K. Wadhwa, MD |
