Ear, Nose, Throat, & Allergy

MMMM…..Wax Buildup

Posted on June 27th, 2016
Earwax, also known as cerumen, is the brownish-yellow substance that accumulates in the outer ear canal. Produced by small glands in the ear, cerumen has protective, lubricating and antimicrobial properties. When present in moderation, cerumen is considered healthy for the ear. The ear is considered “self-cleaning”, meaning the ear canal slowly pushes cerumen out of the ear on its own. Old cerumen is constantly being moved, assisted by chewing and jaw motion. Once it reaches the exterior ear, the wax dries up and flakes out. Cerumen is only formed in the outer third of the ear canal, not the deeper portion close to the eardrum (tympanic membrane). Therefore it is imperative for patients to avoid sticking fingers or objects (especially Q-tips!) into the ear canal. By doing so, patients may accidentally push cerumen towards the back of the ear, further impacting it. This condition is called cerumen impaction, and sometimes causes hearing loss, blocked ears, ear pain, itching, ringing, or sensation of fullness. If you or a family member is experiencing any of these symptoms it is important to be seen by an Ear, Nose, and Throat physician (otolaryngologist) for a routine examine. Cerumen impaction can diagnosed by visualizing the ear canal with a tiny microscopy (otoscope). A variety of quick and painless methods in-office can be used to remove cerumen; including use of suction (a tiny vacuum cleaner), forceps, or curette. On many occasions special ear drops are used to soften the wax, making it easier to remove. There are no proven ways to prevent cerumen buildup in the ears, but not inserting Q-tips or other objects is strongly recommended to avoid impaction. Over the counter ear drops such as Debrox, or hydrogen peroxide can be helpful to prevent excessive cerumen from developing in the ear canal. Patients who are prone to recurrent cerumen impaction should see an Ear, Nose, and Throat physician (otolaryngologist) every 6-12 months for routine cleaning and examination. If you or family members have concerns regarding cerumen impaction, please do not hesitate to contact Colden & Seymour Ear, Nose, Throat, and Allergy to schedule an examination. Opinions expressed here are those of Daryl Colden, MD, FACS and Christopher Jayne, BA. They are not substituted for the advice of your personal physician.

What Causes Snoring?

Posted on June 20th, 2016
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 and Seymour 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.

Do I need to get my tonsils removed?

Posted on June 13th, 2016
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 & Seymour Ear, Nose, Throat, and Allergy to schedule an examination.

Swallowing Issues

Posted on May 23rd, 2016
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.

Thyroid Nodules – What you need to know

Posted on May 16th, 2016
The thyroid gland is a small organ located at the front of the neck right below the larynx (Adam’s apple). The gland is shaped like a butterfly with two separate lobes and wraps itself around the trachea (windpipe). As a component of the endocrine system, the thyroid is responsible for releasing hormones (T3, T4, and calcitonin) into the bloodstream which help regulate metabolism, heart rate, body temperature, and blood calcium levels. On many occasions, abnormal growths or lumps can develop on the thyroid gland. These are called thyroid nodules. Thyroid nodules can be solid or fluid filled. They can be found isolated or grouped with other nodules. Under most circumstances, thyroid nodules do not cause symptoms and go unnoticed to the patient. In rare cases, a nodule will become excessively large, and symptoms will develop, including difficulty swallowing, hoarseness, neck pain, or enlargement of the neck. Thyroid nodules are often found incidentally during routine examination or on imaging studies (MRI, CT, US) that are obtained for unrelated reasons, but these nodules will still need to be evaluated to ensure that they will not cause any problems. An abnormal thyroid function test may also indicate whether a nodule is present. Thyroid function tests measure the blood levels of T3, T4, and thyroid stimulating hormone (TSH). It is also important to know whether the thyroid hormone levels are normal, or higher or lower than expected, which can affect body function. Although most thyroid nodules are consistent with benign disease (>90%), additional evaluation is important to ensure that that there is not anything more worrisome occurring. The first step in evaluation after physical examination is obtaining a neck/thyroid ultrasound, which gives accurate measurements of the size, shape and other important characteristics of the thyroid gland and any nodules that may be present. An ultrasound is a quick painless procedure that will give detailed information about the presence, number, size, and location of any thyroid nodules. Depending on the results, additional evaluation may be necessary. For nodules that are consider large (typically greater than 1-1.5 centimeter), a specialized biopsy technique called a fine needle aspirate (FNA) is often recommended to rule out worrisome findings. In many cases, an FNA is performed under ultrasound guidance, ensuring better accuracy. FNA results will often demonstrate whether or not a nodule is benign (harmless) or malignant (cancerous). When FNA results are indeterminate (uncertain), additional assessment is often necessary. A new technique that has recently been used to better determine the chance of malignancy in this situation is a specialized “genetic test”, which can help us place patients in low or high risk categories when previously we were unable to make an assessment. In those patients with nodules that are cancerous or high risk, we would recommend surgical removal of part or all of the thyroid gland. Recent guidelines from the American Thyroid Association has shown that for some less aggressive thyroid cancers, removing only part of the thyroid gland may be appropriate, allow for quicker healing, less need for medications postoperatively, and afford similarly high cure rates. If you or a family member have any concern regarding head and neck symptoms, please do not hesitate to contact Colden &Seymour Ear, Nose, Throat, and Allergy to schedule and examination.

Noise Induced Hearing Loss- What?????

Posted on May 9th, 2016
Humans are exposed to all kinds of sounds on a daily basis; including cars, engines, televisions, or radios. Under most circumstances, these sounds are at safe levels and do not affect our hearing. However, when we are exposed to loud noises, sensitive structures inside the inner ear can be damaged. This condition is referred to as noise induced sensorineural hearing loss. Hearing is a complex mechanism which requires several structures to work together. The outer ear includes the pinna and external auditory canal. The pinna functions to collect sound waves and direct them into the auditory canal. Because of its unique structure, sounds are amplified as they travel towards the back of the auditory canal. The captured sound waves then reach the tympanic membrane (eardrum) at the back of the canal, causing it to vibrate back and forth. The eardrum represents the separating barrier between the outer and the middle ear. As the eardrum vibrates, three tiny bones behind it begin to shift with it. These tiny bones are considered the smallest in the body, and are called ossicles. The last tiny bone, commonly referred to as the stapes, then transfers the vibrating motion to the organ of hearing, the cochlea. It is inside the cochlea where tiny structures called “hair cells” convert the vibrating energy into an electrical signal. The signal travels to the brain where perception occurs. When noises are too loud, the tiny hair cells within the inner ear are damaged and eventually die. This results in decreased hearing. Noise induced hearing loss can be caused by a one-time exposure to an intense sound (such as a blast) or by continuous exposure to loud sounds over an extended period of time (working in a loud shop). Leisure activities can also put one at risk for noise induced hearing loss. This might include listening to MP3 players at high volumes or attending loud rock concerts. There are many other causes of hearing loss besides noise, and these causes include aging (presbycusis), genetics, disease (history of recurrent middle ear infections, viral inner ear infections, and Meniere’s disease), and trauma .The severity of hearing loss depends on all of these factors , which can co-exist and be additive. Individuals with a mild hearing loss might only experience difficulty hearing with background noises. Individuals with a severe hearing loss may experience difficulty during normal conversation, which can impact their personal and professional life significantly. Another common symptom of hearing loss is ringing or buzzing in the ear, which is referred to as tinnitus. Tinnitus will often come and go, and can be extremely bothersome to patients. Machines that create masking sounds (white noise) can be used to “cancel-out” the tinnitus in many cases. Noise induced hearing loss is the only type of hearing loss that can be completely prevented. The best way to do so is to avoid loud noises. If one cannot avoid excessive noise, hearing protection is recommended. Ear plugs or ear muffs are frequently used to help decrease loud noises. Proper assessment of hearing loss requires a hearing evaluation. If one suspects that their hearing has decreased it is important to see an otolaryngologist (Ears, Nose, and Throat physician) or licensed hearing professional who can perform a specialized hearing test. Depending on the results and exam, a patient may be a candidate for a hearing aid or other assistive listening devices. Other modalities include fabricating a custom ear plug that can minimize additional noise exposure if one is routinely exposed to loud noises at work or during hobbies (i.e. musicians). If a patient wishes to pursue hearing aids, a hearing aid evaluation is set up. During a hearing aid evaluation a trained audiologist or hearing instrument specialist will meet with the patient and help them find a hearing aid model which works best for them. If you have any questions about Noise Induced Hearing Loss or want to set up an evaluation with one of our Board Certified Ear Nose Throat specialists, or licensed audiologists or hearing instrument specialists, please contact us at Colden & Seymour Ear Nose Throat and Allergy at 978-997-1550, or through our website.

What is the Eustachian tube dysfunction?

Posted on May 2nd, 2016
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.

Springtime Allergies…Ahhh…those allergies!

Posted on April 25th, 2016
Springtime has arrived and so have spring allergies. The spring is notoriously referred to as the “tree allergy season”. With warmer weather comes the onslaught of tree pollination. Billions of tiny airborne pollen particles are released into the environment and are carried great distances by the winds. As the pollen particles waft through the air they are easily inhaled by allergy sufferers which trigger a series of bothersome symptoms. This condition is sometimes referred to as “Hay Fever,” or seasonal allergic rhinitis, and affects roughly 30 to 60 million people in the United States on an annual basis. Seasonal allergies can cause a variety of symptoms. The most common include recurrent sneezing, a runny nose, watery/itchy eyes, and nasal or throat congestion. Severe allergies may cause polyps to form in the nose and sinus, further blocking the ability to breathe comfortably through the nose and triggering recurrent sinus infections. Conditions associated with hay fever include asthma, eczema, conjunctivitis, nasal polyps, sinusitis, sleep apnea, laryngitis, and ear infections. Individuals with asthma may become more symptomatic when exposed to tree allergens, and often report increased wheezing, shortness of breath, or coughing. Another strange symptom that may indicate that you have seasonal allergies is itchiness of the mouth and throat after eating raw fruits (apples, bananas). This condition is called oral allergy syndrome and is highly prevalent in individuals with tree allergies such as birch. The first step in minimizing spring allergies is to determine which trees you are sensitized (or allergic) to. An allergy test determines whether your body has an allergic reaction to a specific substance in the environment, in this case tree pollen. Because tree pollen particles have very unique proteins (and therefore have less cross-over between different types of trees), patients are often tested for several different tree species, usually dependent on which trees are found in their region. A tree allergy test panel for New England may include oak, elm, maple, sycamore, and birch to name a few of the more common tree pollen offenders. Allergy testing can be performed either via a quick pain-free skin test or by a blood test. Both types of testing are safe and can be effective for diagnosing tree allergies, as well as other types of allergies. Skin testing has the advantage of being performed in the office setting, and other benefits may include: immediately available results, the ability to test for multiple tree allergens, and the immediate patient feedback regarding how they react to certain tree pollens in their environment. In preparation for skin testing, patients are advised to discontinue taking antihistamines and other types of medications that may interfere with test results. Tree allergies can be treated in variety of ways. Firstly, environmental modifications are recommended for anyone who is allergic to pollen. This includes keeping home windows closed, staying indoors on high pollen days, not drying clothing outside, and showering before bedtime. If environmental modifications are not enough, medical management may be necessary. This includes over the counter antihistamines (e.g. Claritin, Zyrtec) and intranasal steroid sprays (e.g. Flonase). Other types of medications include nasal inhaled antihistamines, mast cell stabilizer nasal sprays, and oral decongestants. For patients who are interested in additional improvement and decreasing their usage of allergy medications, immunotherapy should be considered. Immunotherapy can be given in two different ways, including subcutaneous immunotherapy (SCIT or allergy shots) and sublingual immunotherapy (SLIT or allergy drops). SCIT (allergy shots) has shown repeatedly over the past 50 years to be a very safe and effective way to minimize both seasonal and year round allergies. SLIT (allergy drops) is the most common form of allergy treatment in Europe, and has been shown to be as effective and safe as traditional allergy shots, but has the added benefit of being able to do this treatment in the convenience of your home (you can self-administer the drops daily). The major disadvantage of SLIT is that it is currently not FDA approved in the USA (although the drops are made from the exact same allergy extracts that are used to create the allergy shots), and therefore this treatment would not be covered through medical insurance. If you or a family member have any concerns regarding spring allergies, please do not hesitate to contact Colden & Seymour Ear Nose Throat and Allergy and schedule an allergy evaluation as your first step towards symptom relief. Opinions expressed here are those of Dr. Daryl Colden and Christopher Jayne, BA. They are not intended as medical advice and cannot substitute for the advice of your personal physician.

What causes nose bleeds?

Posted on April 19th, 2016
Recurrent nose bleeds are very common and can range in severity from being a nuisance to being on rare occasions life threatening. The clinical term for bleeding from the nose is epistaxis. Nose bleeds occur due to the bursting of tiny blood vessels known as capillaries that are found throughout the nasal cavity. Roughly 90% of bleeds start near the front of the nose in a small region called Kisselbach’s plexus. Kisselbach’s plexus is a collection of fragile blood vessels on the surface of the nasal septum (the wall that divides the left and right nasal passages) that is exposed to irritants, such as cold weather, dry heat, digital manipulation and trauma. These blood vessels can be easily broken by simple trauma such as excessive nose blowing, or they can on occasion rupture for no apparent reason. Bleeding that occurs towards the back of the nose (posterior) is less common and may be more difficult to control. If bleeding occurs on one side of the nose, it can sometimes drip to the back of the throat and be coughed up, or even pass through to the other side of the nose through the back of the throat or breaks in the septum. Causes of nose bleeds can be divided into three categories, local, systemic, and idiopathic (unknown). Local causes, which are the most common, include nasal trauma, nasal dryness, and septal abnormalities. Trauma of the nose might be related to a nasal fracture, frequent nose picking, excessive nose blowing, or nasal surgery. Nasal dryness mostly occurs during winter months when patients live in warmer and dryer environments. When the nose is dry and irritated becomes more susceptible to bleeding. Abnormalities of the nasal septum include septal deviations (bending of the wall that separates the passages) and septal perforations (a hole in the septum). Such abnormalities can cause turbulent airflow in the nose which may contribute to nasal irritation, and subsequent nasal bleeding. Systemic causes include various blood disorders and certain types of medications that may thin the blood. Patients with high or poorly controlled blood pressure are at higher risk for nasal bleeding because the blood vessels are more likely to burst when they are under high pressure. In addition, patients who take anticoagulants (blood thinning medications) are also at a higher risk. Some of the more common prescribed medications include Coumadin and Plavix, but there are many others. Many over the counter medications taken in high quantities can thin the blood, such as Advil/Motrin or aspirin. Other conditions associated with nose bleeds include liver disease (which makes platelets that are necessary for clotting not as effective), and primary bleeding disorders, such as Von Willebrand’s disease. It is very important to know what other medical problems co-exist, what medications a patient may be taking, and family or personal history of bleeding or bruising to best determine the potential cause and treatment of nose bleeds. No matter what the cause of a nosebleed, one should apply pressure to the front of the nose when an active nosebleed is occurring. Holding pressure in this area for 10 minutes will put pressure on the capillaries that commonly bleed (Kisselbach’s plexus), and is the most effective way to stop the bleeding. Nasal decongestants such as oxymetazoline or neosynephrine may also be used, either directly sprayed in the nose or applied to a cotton ball then placed in the nasal cavity. Ice to the nasal regions can also reduce bleeding in some cases. If bleeding persists, medical intervention is recommended. One common procedure that can be done in the office setting is cauterization, whereby a chemical called silver nitrate is applied to the nasal vessels to help seal them up. If bleeding still doesn’t resolve, either an electrical cautery can be used, or various types of nasal packing can be applied to tamponade the blood vessels and stop bleeding. Usually these nasal packs need to remain in place for a few days, and although they may be uncomfortable, they typically have a 95% chance of stopping a nosebleed. Because nasal packs can sometimes cause infections, it is very important that patients be placed on an oral antibiotic at the same time. Nasal packing can be absorbable or non-absorbable. Preventative measures include nighttime humidification, avoiding digital manipulation of the nose, and applying daily moisturizers to the inner nose. Common moisturizers that are effective are Vaseline, nasal emollients, and saline nasal sprays. Minimizing aspirin and Motrin as well as controlling your high blood pressure may also help to reduce nose bleeds. Resting and avoiding undue force in the nasal cavity can be effective, so we usually recommend 2-3 days of light activity and avoiding bending or lifting. If you experience recurrent nose bleeds, or have had a severe one that is difficult to stop, please consider an evaluation by a trained expert, i.e. Ear Nose Throat specialist, that can better evaluate the entire nasal cavity by performing a quick painless in office procedure called a nasal endoscopy to better determine potential causes and treatment options. 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.

What is Ear Fluid and What Can We Do?

Posted on April 4th, 2016
The ear is made up of three major parts: the outer, middle, and inner ear. All of these various areas are essential for hearing, and when there is an abnormality in one area, it can affect hearing adversely. The outer ear consists of the pinna (the rigid cartilage covered by bone that we can see) and the auditory canal (a short tube from the pinna to the eardrum, or tympanic membrane). The middle ear contains the eardrum (tympanic membrane), and a small air-filled cavity behind it which contains three tiny bones, known as ossicles. These ossicles transmit sound to the inner ear, or the organ of hearing (cochlea), which will then transmit impulses via a major nerve (acoustic nerve) to the brain, which completes the hearing loop. The middle ear periodically becomes swollen (inflamed) and fluid accumulates in the air-filled region behind the eardrum. This condition is called otitis media with effusion (or middle ear fluid). Viral and bacterial infections are the most common cause of middle ear infections and the subsequent middle ear fluid that may accumulate. Children are more prone to infections and fluid buildup due to a variety of factors, including frequent exposure to others with illness, poor Eustachian tube function, or an immature immune system. Often, this middle ear fluid will result in a “blocked ear” feeling with decreased hearing. Under acute and more severe circumstances, patients will experience a localized ear pain, fever, irritability, and upper respiratory symptoms. Children with chronic middle ear fluid or recurrent ear infections may present with hearing deficits, poor attention, and even speech and language delays. Middle ear fluid can be diagnosed through a variety of methods. This includes use of a pneumatic otoscope (a small device that visualizes the ear canal and blows air towards the eardrum), a tympanogram (a test to evaluate eardrum mobility), and a specialized hearing test. Treatment options depend on the duration or frequency of ear symptoms. For patients experiencing their first ear infection, antibiotics and ibuprofen are usually the treatment of choice. If there are nasal or allergy symptoms occurring with the ear issues, it would be helpful to evaluate and treat these potential triggers. If a patient experiences recurrent ear infections or chronic middle ear fluid, ventilation ear tube insertion may be considered (ear tubes). These microscopic tubes are placed to remove ear fluid, reduce or eliminate ear infections, and restore the ability to equalize pressure between the middle ear and outside atmosphere (for example: no ear pressure when flying). Placing ear tubes is a short and painless procedure which can sometimes be done in the office setting but other times may require anesthesia in the hospital.