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 and Seymour 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 & Seymour 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.
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.