Ear, Nose & Throat

We tend to take our senses for granted—until something goes wrong. If you’ve ever had ringing in your ears, a stuffy nose or floaters in your
eyes, you know how important it is to keep your five senses in tip-top shape.

Each year, more than 35 million Americans suffer from sinusitis—an inflammation or swelling of the tissue lining the sinuses. It’s a costly problem for the health care system, but now there’s a new, less-invasive procedure that is revolutionizing the way chronic sinusitis is treated.

cold or condition
It can be difficult to differentiate between a common cold and sinusitis. The symptoms—nasal congestion, clear or discolored drainage from the nose or into the throat, postnasal drip, headaches and fatigue—are the same. But many with sinusitis experience facial or dental pain, and the duration is longer.

what is it?
Acute sinusitis, also called rhinosinusitis, is most often caused by an upper respiratory virus, says Dr. John Schneider, assistant professor at Washington University School of Medicine. “The nasal and sinus linings become inflamed trying to fight off the virus,” he says. “If symptoms last more than 10 days, then we call that post-viral sinusitis. Very rarely will a bacterial infection cause sinusitis.” According to Schneider, doctors do not know exactly why inflammation does not go down for some people, but it may be that they’re genetically more susceptible to chronic inflammation or their immune system works differently.

Structural abnormalities or nasal polyps (small growths in the lining of the nose) also may be to blame. “Colds and allergic reactions can cause swelling that blocks the openings between your sinuses and your nose,” says Dr. James Gould, medical director of the St. Louis Sinus Center. “For patients who have abnormally narrow sinus cavities—either from birth or trauma—once these openings become blocked, they will not fully open up again and the mucous cannot be secreted, leading to a vicious cycle.”

Acute sinusitis is any sinus infection that lasts up to four weeks. Gould says when symptoms get worse or do not improve after 10 to 14 days, antibiotics may be appropriate. Schneider recommends waiting four weeks before starting antibiotics. “It is very rare for people to get a bacterial sinusitis that needs antibiotics,” he says. “Most of the time a virus is to blame for your symptoms.” He normally suggests topical or oral steroids, as well as nasal saline irrigation.

a new option
Gould cautions that symptoms alone do not make for a reliable diagnosis. “In my office, we do a nasal endoscopy to evaluate the status of the nasal cavity, perform a CT scan test to assess the degree of infection, and test for allergies.”

Surgery can’t remove inflammation, but it can open the sinus cavities to drain and allow anti-inflammatory medications to reach the tissues, Schneider says. Sinusitis traditionally has been treated with endoscopic surgery, but a new procedure, balloon sinus dilation, can reverse symptoms with no cutting and little down time.

“A wand is inserted into the nose and then into the opening of the narrowed or blocked sinuses,” Gould explains. “On the tip of the wand, a balloon is gently inflated inside the sinus cavity to reestablish normal ventilation. The procedure is very much like an angioplasty in cardiology, but we do not put in a stent.”

Gould, who coauthored a paper on the procedure, says multiple studies have shown that balloon sinus dilation offers great long-term results. In one, 95 percent of participants returned to work within 24 to 48 hours.

[phantom noises]
More than 50 million Americans are robbed of silence by tinnitus, a sensation of ringing or other noises in the ears. Only about 5 percent of those will seek out medical help, though.

about tinnitus
Tinnitus is the perception of sound when no external source is present, explains Tina McWhorter, an audiologist at Associated Hearing Professionals. “Patients will describe ringing, swishing, crickets, frying noise or high-pitched squeal,” she says. “It can be a life-altering issue, affecting sleep, temperament and relationships.”

There are two types: subjective or nonpulsatile tinnitus, which are sounds only you can hear; and objective tinnitus, which are head or ear noises audible to other people. Some experience a sound that beats in time with the pulse, known as pulsatile tinnitus. But the vast majority of tinnitus cases—about 90 percent—are nonpulsatile, according to Dr. Anthony Mikulec, SLUCare otolaryngologist. Mikulec says tinnitus is usually a symptom of another problem, most commonly hearing loss. “When the brain doesn’t get the input it’s used to, sometimes it makes up for it with a buzzing sound—like a radio between stations,” he says.

Long-term exposure to excessively loud noise, like working in an industrial setting or serving in the military, or a single, intense blast such as a gunshot, can be a trigger, McWhorter says. Other potential causes include physical trauma to the head or neck; medical conditions like hypertension, acoustic neuroma, thyroid or vascular disease, Meniere’s disease and impacted cerumen; and certain drugs.

The best way to prevent tinnitus is to protect your ears. McWhorter recommends ear coverings when working around loud noises—not just in a factory, but also around construction and even power tools and yard equipment. Protection against hearing loss at loud concerts, firing ranges and when listening to your MP3 player is also advised. “A temporary ringing in your ear is a sign that damage has been done to the hair cells in inner cochlea,” Mikulec says.

treatment options
According to Mikulec, no treatment on the market has been found to work or has the backing of the FDA. The best option is treating the underlying condition. “By far, the most important thing is to get your hearing checked. A hearing aid often can help tinnitus, similar to how eyeglasses can treat blurry vision. At night, many people use a fan or sound machine,” Mikulec says. McWhorter recommends avoiding aspirin, if possible, and using quinine, which some take for leg cramps (it’s also found in tonic water). Dietary changes, such as salt restriction, may help tinnitus, too. “Some patients find relief by listening to specific sounds in the affected ear, with counseling or with medication and stress reduction. Clinical masking devices introduce a broadband sound that can ‘mask’ out the annoying tinnitus,” McWhorter says.

Some patients simply adapt to their tinnitus and it becomes less bothersome over time. But for patients with severe tinnitus, depression and anxiety are common. McWhorter says these patients may benefit from professional counseling and medication. “Biofeedback and other relaxation techniques are helpful, as tinnitus not only can cause stress but also can be aggravated by stress,” she says.

[oral cancer]
It may surprise you to learn that oral cancer is the sixth most common form of cancer, according to the Oral Cancer Foundation (OCF). Men are twice as likely to develop these cancers, which include cancers of the lips, tongue, cheeks, palate, sinuses and throat (pharynx).

awful, but avoidable
Oral cancers are largely preventable, says Dr. Douglas Adkins, oncologist at Siteman Cancer Center. For one thing, approximately 25 percent of these are caused by tobacco use. Over the past decade, there also has been a large increase in cases of throat and tongue cancer caused by the Human Papillomavirus (HPV). “High-risk sexual behaviors and marijuana usage are associated with infection by HPV and later development of these cancers,” Adkins says.

The prognosis for patients with oral cancer caused by HPV generally is better than for patients with smoking-induced cancer. The OCF says the death rate for oral cancer is higher than that of many well known cancers, including cervical cancer, Hodgkin’s lymphoma or skin cancer (malignant melanoma).

telltale signs
Unfortunately, oral cancers have few early warning signs. But when they are detected early, the chance of survival increases to 80 to 90 percent, says Dr. Peter Pagano of Artistic Dentistry. Screening is fairly simple and should be done in conjunction with regular dental visits. During the exam, doctors look for things such as lesions, red dots, white bumps or lumps in the throat or swelling that cannot be explained by illness. “Any sore, discoloration or lump that doesn’t heal or subside within 14 days should be looked at by a dentist or ENT,” Pagano says.

treatment and rehabilitation
According to Adkins, treatment for oral cancers typically involves surgery, radiation and chemotherapy. The location of the tumor, the stage of the cancer, and the patient’s age and overall health will affect the treatment plan. “Although these treatments are often effective, they constitute intensive therapy and can cause acute (mouth sores) and chronic (dry mouth and trouble swallowing) side effects,” he says.

Additionally, oral cancer treatment can disfigure the face and neck and affect the patient’s speech, ability to chew and swallow and sense of smell. According to the OCF, proper nutrition is a vital part of cancer treatment. It may become necessary to blend meals and drink them, or even use a feeding tube.

Following treatment, rehabilitation may include speech and physical therapy, and a 2009 study in Clinical Advances in Hematology & Oncology found that as many as half of patients with head and neck cancer suffer from depression.

new link to diabetes
Individuals with diabetes have a nearly 50 percent greater chance of developing head and neck cancer. That’s according to research out of Taiwan published in the August 2014 issue of JAMA Otolaryngology – Head & Neck Surgery.

The researchers found that the incidence of head and neck cancer was 147 times higher for the diabetes group compared to the control group, with the risk greatest for individuals aged 40-65 years.

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