Does your nose constantly feel stuffy or congested? Do you always feel like you have a cold that doesn’t go away? It’s possible that your symptoms may be related to nasal polyps. Nasal polyps are typically benign (noncancerous) “grape-like” growths that develop within the lining of the nasal passages or sinus cavities.
Although the cause of nasal polyps is not always known, in many cases they are triggered by chronic inflammation/swelling of the nasal mucosa . Recurrent sinus infections, chronic sinus swelling (chronic sinusitis), and allergic rhinitis (allergies) can all cause inflammation/swelling in the nose. Another condition associated with nasal polyps is Samter’s triad. Samter’s triad is a condition characterized by asthma, aspirin sensitivity, and nasal polyps. This condition is thought to affect roughly 10% of nasal polyp patients.
Nasal polyps can vary in size. Smaller polyps might not cause any symptoms while larger nasal polyps can completely obstruct the nasal passages and make it extremely difficult to breathe thru the nose. Typical complaints include nasal congestion, facial pressure, decreased sense of smell (hyposmia), runny nose (rhinorrhea), sneezing, and postnasal drip.
Nasal polyps may be difficult to visualize in the nasal or sinus passages in many cases. A quick and painless in-office procedure called a nasal endoscopy can often identify nasal polyps and help to determine treatment options. During this procedure, a Ear Nose Throat physician will guide a thin, flexible endoscope into the nasal and sinus passages to help determine the presence and type of nasal polyps. Other abnormalities in the nose and sinuses can also be identified, such as a nasal septal deviation, enlarged adenoids, or sinus cysts. Sometimes a CT scan of the sinuses may be ordered to determine the exact size and location of the nasal polyps. If surgery is indicated to remove the nasal polyps, the CT scan can also be used to help facilitate image guided surgery to improve accuracy and decrease any potential risk.
At times, nasal polyps may represent cancerous disorders or be a manifestation of a systemic disease process, such as Sarcoidosis and should be biopsied.
Medications that reduce inflammation in the nose are often used for treating nasal polyps. Intranasal steroid sprays (Flonase, Rhinocort, Nasonex), sinus irrigations with steroids (Pulmicort/Budesonide), and periodic courses of oral steroids are commonly used. If nasal polyps do not improve with medications, surgical removal can be considered. This is called a polypectomy and is often performed using endoscopes either in the office or operating room. Other common procedures done in the same setting as nasal polypectomy include: sinus balloon dilation (dilation of blocked or narrow sinuses) ,endoscopic sinus surgery (opening blocked sinus passages), & septoplasty (straightening a deviated nasal septum).
If you or family members have concerns regarding nasal polyps, please do not hesitate to contact Colden Ear, Nose, Throat, and Allergy to set up and appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for a medical evaluation performed by a medical provider.
Do you feel that your allergy symptoms get worse during the late spring and early summer? It’s possible that you may have a grass allergy. The summer season is grass pollination season, causing an array of bothersome symptoms in individuals who are allergic to it. The condition is called seasonal allergic rhinitis.
Common complaints of allergic rhinitis include recurrent sneezing, a runny nose, water/itchy eyes, postnasal drip, nasal congestion, or throat congestion. Those with severe grass allergies may report itchiness of the skin or urticaria (hives) after contact with grass. Other conditions that are associated with grass allergies include asthma, eczema, conjunctivitis, nasal polyps, sinusitis (sinus swelling), sleep apnea, laryngitis, and ear infections. Some individuals with grass allergies may also suffer from oral allergy syndrome (OAS), a condition marked by itchiness of the mouth and throat after consuming raw fruits and vegetables (tomatoes, potatoes, peaches).
The first step in minimizing allergy symptoms is to see what grass pollens you are allergic to. This can be accomplished via allergy testing. Patients are often tested for several different grass species usually dependent on which grasses are found in their area. A typical New England panel may include Rye grass, Bermuda grass, Timothy grass, Bahia grass, and Johnson grass. Allergy testing can be performed via a quick, pain-free skin test or by a blood test, which is often sent away to a reference lab. Both testing methods are safe and effective for diagnosing grass, as well as other types of environmental allergies. Skin testing is advantageous in that it can be performed in the office setting, the results are readily available, and multiple grass allergens can be tested.
Modifying your environment can be very effective way to decrease grass allergy symptoms. This includes keeping home windows closed, staying indoors on high pollen days, not drying clothing outside, showering before bedtime, and wearing appropriate clothing when mowing the lawn. Medical management includes over the counter antihistamines (e.g. Claritin, Zyrtec) and intranasal steroid sprays (e.g. Flonase), decongestants as well as some other otc type medications. For patients who are interested in long term improvement and decreased usage of allergy medications, immunotherapy can be considered. Immunotherapy is a method to improve the body’s immune system against those allergens that one is reacting to negatively. Immunotherapy can be administer subcutaneously (SCIT – “allergy shots”) or sublingually (SLIT – “allergy drops”). Multiple studies over the past 50 years have consistently demonstrated that SCIT is a safe and effective way to minimize allergy symptoms. SLIT is the most common form of allergy treatment in Europe and many studies have show it to be as safe and effective as traditional “allergy shots”. The major disadvantage for SLIT is that it is currently not FDA approved (although the drops are made from the exact same extract as allergy shots), and therefore this treatment would not be covered through medical insurance. Many of our patients have been successfully treated with both types of immunotherapy over the past 15 years.
If you or family members have questions or concerns regarding grass allergies, please do not hesitate to contact Colden Ear, Nose, Throat, and Allergy to schedule an examination. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for direct medical evaluation and advice.
Just about everyone has had some experience with a person who snores. Snoring is very common among adults, affecting 90 million Americans. Although snoring may not be bothersome to the patient, his or her bed partner might feel differently as it can prevent them from obtaining a good night sleep.
Snoring refers to a low-pitched, rattling sound that a person makes while they breathe during sleep. The noise is caused by obstruction of airflow through the passages at the back of the mouth and nose. After falling asleep, the muscles in the roof of the mouth (palate), tongue, and throat begin to relax and collapse. This causes narrowing of the airway and obstruction of free air flow during inhalation and exhalation. As a result, structures in the nose/mouth begin to vibrate, creating the bothersome rattling noise that keeps people up at night. Patients with a large uvula (the thing that hangs down in the back of the throat), tongue, tonsils, and adenoids are more likely to snore at night. Excessive weight gain can be another cause of snoring.
Not only can snoring be annoying, but it might also be an indicator of a more serious health condition known as obstructive sleep apnea (OSA). OSA is a disorder in which a person’s breathing pauses while they are asleep. If untreated, OSA can increase the risk for cardiac and pulmonary related disease, such as high blood pressure and heart disease. The best way to get evaluated for OSA is obtain a complete head and neck examination (usually done by a Otolaryngologist-Head and Neck Surgeon) to identify anatomical risk factors for OSA (as well as snoring) .The next appropriate test in many situations is a sleep study (polysomnogram). A sleep study is usually performed by spending a night in the hospital while the patient’s sleep habits are recorded. In some situations, it is also possible to have an at-home sleep study, although the results underestimate the degree of sleep disturbance. If OSA is present, patients may be considered candidates for continuous positive airway pressure, or CPAP. CPAP is a small machine that has a mask attached to it which helps patients breathe at night. If no OSA is present, conservative measures are usually recommended. This includes exercise and weight loss, avoid sleeping in the supine position (laying on back), and avoid sedatives and stimulants (alcohol and coffee) right before bedtime. If snoring doesn’t improve conservatively and patients are extremely bothered by it, there are surgical procedures that can be performed which may help. One procedure is called a somnoplasty, in which the uvula is treated with a specialized energy source known as radiofrequency, whereby reducing the size and floppiness of this anatomical area, thereby reducing the sound known as snoring. For patients who snore and have OSA, a tonsillectomy and adenoidectomy may also be considered.
If you or family members have concerns regarding snoring or sleep apnea, please do not hesitate to contact Colden Ears, Nose, Throat, and Allergy and set up an appointment today. Opinions expressed here are those of Daryl Colden, MD, FACS and Christopher Jayne, BA. They are not intended as medical advice and cannot substitute for the advice of your personal physician.
Tonsillectomy is the surgical removal of the tonsils, which are the paired glands located in the back of the throat. Although long practiced, the tonsillectomy is still one of the most common major surgeries in the US, with over 500,000 cases performed annually. Reasons to have a tonsillectomy tend to vary. The most common reasons include recurrent tonsil infections (tonsillitis) that don’t respond to antibiotics, sleep apnea, difficulty breathing or swallowing or concern for malignancy (cancer).
Having large tonsils does not necessarily indicate that surgery is needed. When the tonsils are so large that they are touching each other, they are considered “kissing tonsils”. Unless a patient experiences trouble breathing or difficulty swallowing, large tonsils that are not infected are usually observed. Sometimes this condition can be treated medically.
Recurrent tonsil infections (including streptococcal type infections) are very common in younger children. Symptoms typically include throat pain, difficulty swallowing, and enlarged lymph nodes. Under most circumstances, surgery should be considered after 5-7 infections in 1 year, 5 infections per year for two years in a row, or 3 infections per year for 3 years in a row. It should also be considered after missing a substantial amount of school or work (>2 weeks per year). Sometimes patients experience a severe infection in which an abscess develops on the tonsil, also known as a peritonsillar abscess (PTA). Tonsillectomy should be considered for patients who experience multiple PTA’s.
Sleep apnea is another indication for sleep apnea. Large tonsils (usually with enlarged adenoids) can obstruct the airway and cause difficulty breathing at night. By removing the tonsils ( and adenoids at times) patients may experience improved sleep quality, less snoring, and less daytime fatigue.This is a very common, effective treatment for children with pediatric sleep apnea.
If you or family members have concerns regarding tonsil or throat symptoms, please do not hesitate to contact Colden Ear, Nose, Throat, and Allergy to schedule an examination.
Difficulty swallowing (sometimes referred to as dysphagia) is a common problem among all age groups, especially the elderly. Typical complaints of dysphagia include food getting stuck in the throat, inability to swallow pills, and/or regurgitation. Often patients will choke on bits of food, liquid, or saliva that are not passing easily. In more extreme cases, patients may aspirate foods or liquids that will spill into the lungs, causing pneumonia at times.
The process of swallowing is very complex and requires several structures to function properly in a coordinated fashion. Swallowing is broken down into three separate phases; the oral phase, the pharyngeal phase, and the esophageal phase. During the oral phase, food is chewed up, mixed with saliva, and voluntarily pushed towards the back of the throat (oropharynx). This initiates the pharyngeal phase which represents the food being passed from the throat (pharynx) to the esophagus (the food tube leading to the stomach). In the final phase, the food or liquid is carried down to the stomach.
Swallowing issues can structural, functional, or both. The most common structural issue is inflammation of the throat and esophagus. Inflammation can be caused acid reflux (GERD), radiation exposure (as with cancer treatments), allergies (eosinophilic esophagitis), or swallowing medications without enough fluid to wash them down properly. Other structural issues might include esophageal stricture (narrowing of the esophagus), anatomical abnormalities (such as a paralyzed vocal cord), or head and neck cancerous lesions. Functional issues are caused by inability to use the swallowing muscles appropriately, and may be caused by advanced age (presbyesophagus), stroke, and other neurological or systemic conditions.
Although swallowing issues rarely indicate a serious medical condition, a thorough upper airway examination is recommended to rule out worrisome findings or treatable causes. This can be accomplished by seeing an Otolaryngologist (also known as an Ear, Nose, and Throat physician), who can perform a quick and painless in-office procedure known as a laryngoscopy. The laryngoscopy, which is performed after spraying lidocaine in the nose and mouth, allows the physicians to evaluate vital structures including the vocal cords, epiglottis, and pyriform sinuses (opening into the esophagus), which may be contributing to the swallowing issues. Sometimes additional testing and evaluation may be required. One common test is called the barium swallow study, in which X-ray images are taken while a patient drinks a liquid known as barium. At times CT or MRI imaging can be obtained if there is concern about more worrisome findings. When the swallowing does not appear to involve the upper aerodigestive tract (larynx and pharynx), the patient may be referred to follow up with another specialist known as a Gastroenterologist (GI), who may perform an esophagoscopy to directly look at the esophagus. This test is usually done under anesthesia.
Treatment options for dysphagia tend to vary. For individuals who frequently choke on foods or liquids, slowing down the swallowing process can be helpful. Patients should chew foods slowly, sit up straight when swallowing, and stay upright 15-20 minutes after eating. Better management of acid reflux can also be helpful. This can be accomplished by avoiding spicy and acidic foods and taking medications such as omeprazole or ranitidine. Sometimes treating allergy disorders can be helpful. Many swallowing disorders can also be improved by the assistance of a speech and swallow pathologist who can initiate “swallow therapy”, which is like physical therapy for dysphagia. Speech pathologists can provide specialized exercises which can help strengthen the swallow reflex. At times structural diseases that are identified may be treated with surgery.
Opinions expressed here are those of our medical writers. They are not intended as medical advice and cannot substitute for the advice of your personal physician.
Have your ears ever felt blocked while flying on an airplane, climbing up a mountain, or scuba diving underwater? This sensation is a common response of the Eustachian tube following changes in atmospheric pressure.
The Eustachian tube is a narrow canal located deep inside of your ear behind the eardrum. The tube is about 3 to 4 centimeters long in adults and connects the middle ear space to the back of the nose (known as the nasopharynx). The primary function of the Eustachian tube is to equalize the pressure of the middle ear. Under normal circumstances, the tube is closed at rest and rapidly opens when yawning or swallowing. When the tube opens, it allows for an air exchange to occur between the middle ear and the back of the nose (where the pressure is close to the external environment).
Blockage of the Eustachian tube, or inability to open, causes the middle ear space to become isolated from the exterior environment. This condition is called Eustachian tube dysfunction (ETD). When the tube fails to open, the lining of the middle ear may absorb the trapped air and create a negative pressure which pulls the eardrum inward. As a result, the patient may experience a blocked sensation, pain, pressure, or hearing loss. Long-term blockage of the Eustachian tube may result in the accumulation of fluid in the middle ear space. Younger children are more susceptible to middle ear fluid, ear infections, and Eustachian tube dysfunction because their eustachian tubes are shorter and more narrow, therefore causing decreased function. In addition, children often have enlarged adenoids in the back of the nose (nasopharynx), which can block the opening of the Eustachian tube and cause increased ear symptoms. Most children will eventually develop better eustachian tube function as they mature, but if eustachian tube dysfunction causes repeated ear infections, persistent ear fluid, or hearing loss related to ear fluid then certain types of surgical procedures can be considered, such as ear tube placement and/or removal of enlarged adenoids. Ear tube placement is shown to be a very safe and effective treatment for ear infections, ear fluid and hearing loss caused by eustachian tube dysfunction, and the ear tubes are designed to fall out on their own usually within 1 year.
There are a variety of ways to test the function and patency of the Eustachian tube. This includes a pneumatic otoscope (a small device that visualizes the ear canal and blows air towards the eardrum), a tympanogram (a test to evaluate eardrum motility), and a specialized hearing test. Also, a quick and painless in-office procedure called a nasopharyngoscopy allows physicians to evaluate the nose, sinuses and nasopharynx to insure that there is no blockage of Eustachian tube opening, usually caused by enlarged adenoids or nasal polyps.
Self-inflation of the ears is perhaps the easiest treatment for ETD. This can be accomplished by pinching the nose closed and “popping the ear”, also known as the Valsalva maneuver. ETD is often made worse by underlying allergies or sinus issues. Identification and treatment of allergic rhinitis and/or sinusitis may help reduce inflammation of the Eustachian tube and improve overall function. For patients with chronic ETD, treating underling sinus and allergy disease will often be helpful to reduce symptoms. For patients who will be flying and are prone to ETD, use of an oral decongestant (sudafed) or a nasal decongestant spray known as oxymetazoline (Afrin) should be considered in the short term. These medications are most effective if used during ascent and descent. Depending on severity of symptoms, some severe or chronic cases of ETD in adults may be treated by placement of an ear tube in the office setting, which can help equalize pressure in the middle ear.
Daryl Colden, MD FACS and Christopher Jayne, BS
Opinions expressed here are those of myself, Dr. Daryl Colden. They are not intended as medical advice and cannot substitute for the advice of your personal physician.
