Nose

The nose has multiple functions. It is a passageway to the lungs and it filters, humidifies and warms the air that we breathe. It is also the organ of smell. The nose and sinuses also function as a kind of 'crumple zone' to protect the brain from trauma. Some normal structures of the nose include the septum, the inferior, middle, and superior turbinates. There are also the four paired sinuses: frontal, ethmoid, maxillary, and sphenoid.

Allergies

WHAT IS AN ALLERGY?

An allergy is an 'overreaction' by the body to something in the environment or something that is brought into the body by eating or injection. An allergic reaction can be due to pollen, dust, mold, weeds, bee stings, penicillin, peanuts, etc. An allergic reaction causes swelling, itching, irritation, increased production of mucus and other symptoms which vary based on the location in the body of the allergic reaction. For example an allergic reaction in the skin may cause a rash, where an allergic reaction in the nose may cause sneezing. In both cases similar body chemicals are released, but due to the location there is a different symptom.

WHAT IS 'HAYFEVER'?

Reactions to environmental allergens (weeds, trees, molds) trigger symptoms people generally call 'hayfever'. Sometimes people have recurring colds, sinus problems, or 'sneezing on sunny days', all of which may be due to allergies. Other possible symptoms include pressure or popping in the ears, itchy, burning, watery eyes, or persistent tickle in the throat. The medical name which includes all of the above symptoms is allergic rhinitis.

Some people have a more serious reaction to things such as penicillin or other medications, bee stings, peanuts, shrimp, etc. which includes hives, redness, and swelling. In unusual cases there can be swelling of the lips, tongue, face, and throat which can be life-threatening. This type of severe potentially life threatening allergic reaction is called anaphylaxis. It is uncommon, related to ingestion or IV injection of something you are allergic to. It does not happen with environmental allergies.

WHO GETS ALLERGIES?

Allergies can develop at any age in life. People who develop allergies have a genetic predisposition to allergy and repeated exposure to something they can become allergic to. For example a person can take penicillin with no difficulty for many years and then suddenly become allergic. During those previous episodes of using the antibiotic they were becoming sensitized to penicillin, that next time they had an allergic reaction. The same process is true for environmental allergies like grass, trees, or pets. This does not happen to everyone, only to people who can become allergic to that substance. There is no way to prevent or avoid this. When symptoms develop, treatment can begin.

ARE ALLERGIES BECOMING MORE COMMON?

Allergies and asthma (which is triggered by an allergic reaction in the lungs), are becoming more frequent. There are different theories about the reason for this. One of these theories is called the hygiene hypothesis. The hygiene hypothesis is that as our environment becomes more sterile due to infection control products -antibacterial soaps, hand-cleaners, etc- the body defense system is not challenged so frequently by bacteria and becomes more sensitive to other types of challenges like allergies. While this theory does make sense with a lot of what we know about how the immune system works, it has not been proven, it is only a theory. Scientific research is being done in this area which may lead to new ways of treating allergies.

WHY GO TO AN EAR, NOSE AND THROAT ALLERGIST?

When the body 'overreacts' there is swelling, itching, and increased mucous production-all of which are part of allergic inflammation. There is a mucous membrane that covers the inside of the nose and sinuses. This membrane also goes into the middle ear, the throat, and even down to the lungs. Anywhere along this mucous membrane there can be allergic inflammation causing symptoms. This is why allergy treatment is so important in treating ear nose and throat diseases. All three of these areas are connected by a continuous mucous membrane which can be inflamed by an allergic reaction.

Ear, nose and throat specialists provide medical and surgical treatment for those conditions where allergies can be a contributing factor such as sinus infections, nasal obstruction, sleep apnea, ear infections, and other illnesses.

Nasal Blockage

Symptoms can include difficulty breathing at night, sleep apnea, snoring, nose bleeds, altered smell and taste, and post nasal drip.

If the blockage is continuous there is usually a structural problem such as a deviation of the septal cartilage/bone, enlargement of the turbinates, or a growth in the nose such as a polyp or tumor. Structural blockages usually require a surgical procedure.

If the blockage is intermittent there is usually a component of inflammation, possibly allergic inflammation. Inflammation causes swelling of the mucous membranes inside the nose leading to blockage. Prescription nasal sprays, saline nasal irrigations, saline nasal flushes, and/or systemic decongestants can help to control inflammation and improve nasal breathing. If medications fail, surgical treatments may be of benefit.

Sinusitis

The sinuses are spaces in the skull that are lined with a mucous membrane. For the sinuses to be healthy the mucous that is produced has to drain out and air has to circulate. The drainage and air flow occur through narrow drainage channels that lead into the nose (see diagram). Most sinusitis is caused by blockage of these drainage areas. These are very narrow channels that can be blocked by structural factors such as a septal deviation, enlargement of the turbinate bones, abnormally small drainage passages, polyps or tumors. They can also be blocked by inflammation due to allergies or infection.

When the sinuses are blocked, fluid builds up, air cannot circulate, and this creates an environment that promotes bacterial growth. Symptoms include sinus headaches, sinus pressure, discolored nasal drainage, recurrent sinus infections, facial pain, sinus polyps, chronic post nasal drip, or a chronic cough.

Treatments are directed at 1) killing bacteria if present, 2) reducing inflammation to re-open the sinus drainage area and promote air circulation. Antibiotics and anti-inflammatory medications are used. Endoscopic examination in the office determines if there are growths present and evaluates the turbinate anatomy and the presence of pus which may be cultured. If infections are chronic or recur frequently then a CT scan is ordered which provides a detailed look at the sinus anatomy and these drainage areas.

Some patients will also be evaluated for allergies with allergy testing and allergy immunotherapy (allergy shots). Other patients will be evaluated for possible migraine headaches.

In some cases surgery is indicated.

BALLOON SINUPLASTY
A new minimally invasive surgical technique which we are offering where the sinus opening are widened using a high pressure balloon dilator. This helps reduce post operative pain and recovery time.

Snoring and Sleep Apnea

Snoring is produced by a combination of blocked air flow and vibrating tissue. Blockages that contribute to snoring occur in the nose, the back of the throat, and the back of the tongue. These narrowed areas cause the tissues to collapse when you breathe, and these collapsed tissues vibrate and produce the sound of snoring.

Sleep apnea is a condition characterized by a significant slow down or cessation of airflow through the airway while sleeping. This can last for several seconds to a minute or more and happens repeatedly during the night. When breathing stops, the heart and lungs must work harder to circulate oxygen to the body. When the oxygen level drops low enough the body wakes up allowing breathing to restart. This prevents restorative deep sleep. The body does not get enough rest and this contributes to conditions like heart disease, high blood pressure, and sudden death.

People with sleep apnea generally snore. Most people who snore do not have sleep apnea. The medical condition of sleep apnea is diagnosed with a sleep study.

Sleep apnea in adults is controlled by using a Continuous Positive Airway Pressure (CPAP) device every night. Surgery can also be helpful in certain cases.

There are also procedures that help with snoring without sleep apnea. Over the counter devices like the nasal strips may help with mild snoring. Severe snoring that can be heard outside of the room or occurs in all sleeping positions can be significantly reduced with surgical treatments.

In children, sleep apnea is caused by enlarged tonsils and adenoids about 90% of the time. Unlike adults with sleep apnea who tend to be overweight and have difficulty staying awake during the day, children with sleep apnea may actually be thinner and smaller than their peers, and are often hyperactive. Children with sleep apnea may also have problems with bed wetting. In children Tonsillectomy and Adenoidectomy alone often cures sleep apnea in the majority of cases.