Nose

Congestion, allergic rhinitis, a deviated septum, and mouth sores are just a few of the varied health problems that occur in this region of the body. Information about ways you can relieve symptoms at home and when you should see a physician can be found in this section.

Millions of Americans suffer from nasal allergies, commonly known as hay fever. Often fragrant flowers are blamed for the uncomfortable symptoms, yet they are rarely the cause; their pollens are too heavy to be airborne. An ear, nose, and throat specialist can help determine the substances causing your discomfort and develop a management plan that will help make life more enjoyable.

Why does the body develop allergies?

Allergy symptoms appear when the immune system reacts to an allergic substance that has entered the body as though it was an unwelcomed invader. The immune system will produce special antibodies capable of recognizing the same allergic substance if it enters the body at a later time.

When an allergen reenters the body, the immune system rapidly recognizes it causing a series of reactions. These reactions often involve tissue destruction, blood vessel dilation, and production of many inflammatory substances including histamine. Histamine produces common allergy symptoms such as itchy, watery eyes, nasal and sinus congestion, headaches, sneezing, scratchy throat, hives, shortness of breath, etc. Other less common symptoms are balance disturbances, skin irritations such as eczema, and even respiratory problems like asthma.

What allergens should be avoided?

Many common substances can be allergens. Pollens, food, mold, dust, feathers, animal dander, chemicals, drugs such as penicillin, and environmental pollutants commonly cause many to suffer allergic reactions.

Pollens

One of the most significant causes of allergic rhinitis in the United States is ragweed. It begins pollinating in late August and continues until the first frost. Late springtime pollens come from the grasses, i.e., timothy, orchard, red top, sweet vernal, Bermuda, Johnson, and some bluegrasses. Early springtime hay fever is most often caused by pollens of trees such as elm, maple, birch, poplar, beech, ash, oak, walnut, sycamore, cypress, hickory, pecan, cottonwood, and alder. Colorful or fragrant flowering plants rarely cause allergy symptoms because their pollens are too heavy to be airborne.

Household allergens

Certain allergens are present all year long. These include house dust, pet danders, some foods and chemicals. Symptoms from these are frequently worse in the winter when the house is closed up and where there is poor ventilation.

Mold

Mold spores can also cause allergy problems. Molds are present all year long, and grow outdoors and indoors. Dead leaves and farm areas are common sources for outdoor molds. Indoor plants, old books, bathrooms, and damp areas are common sources of indoor mold growth. Mold is also common in foods, such as cheese and fermented beverages.

How can allergies be managed?

Allergies are rarely life threatening, but often cause lost work days, decreased work efficiency, poor school performance, and a negative effect on the quality of life. Considering the millions spent on antiallergy medications and the cost of lost work time, allergies cannot be considered a minor problem.

For some allergy sufferers symptoms may be seasonal, but for others it is a year-round discomfort. Allergy symptom control is most successful when multiple management approaches are used simultaneously. They may include minimizing exposure to allergens, desensitization with allergy shots, and medications.

If used properly, medications, including antihistamines, nasal decongestant sprays, steroid sprays, saline sprays, and cortisone-type preparations, can be helpful. Even over-the-counter drugs can be beneficial, but some may cause drowsiness.

When should a doctor be consulted?

The most appropriate person to evaluate allergy problems is an otolaryngologist (ear, nose, and throat specialist). Aside from gathering a detailed history and completing a thorough examination of the ears, nose, throat, head, and neck, the doctor will offer advice on proper environmental control and evaluate the sinuses to determine if infection or structural abnormality (deviated septum, polyps) is contributing to the symptoms.

In addition, the doctor may advise testing to determine the specific allergen that is causing discomfort. In some cases immunotherapy or allergy shots may be recommended. Immunotherapy is a unique treatment because it induces the build up of protective antibodies to specific allergens.

Tips for reducing the exposure to common allergens

  • Wear a pollen mask when mowing grass or house cleaning (most drugstores sell them).
  • Change the air filters regularly in heating and air conditioning systems, and/or install an air purifier.
  • Keep windows and doors closed during heavy pollen seasons.
  • Rid the home of sources of mildew.
  • Dont allow dander-producing animals (i.e., cats, dogs, etc.) into the home and bedroom.
  • Change feather pillows, woolen blankets, and woolen clothing to cotton or synthetic materials.
  • Enclose mattress, box springs, and pillows in plastic barrier cloth.
  • Use antihistamines and decongestants as necessary and as tolerated.
  • Sleep with the head of the bed tilted upward. Elevating the head of the bed helps relieve nasal congestion.
  • Observe general good health practices: exercise daily, do not smoke, avoid air pollutants, eat a balanced diet, and supplement diet with vitamins, especially C.
  • Use a humidifier in the winter. Be sure to clean the humidifier regularly to avoid mold build-up.
  • Discuss hay fever and allergy symptoms with a physician when experiencing an allergic reaction.

Drugs for stuffy nose, sinus trouble, congestion and drainage, and the common cold constitute a large segment of the over-the-counter market for America's pharmaceutical industry. Even though they do not cure allergies, sinusitis, colds, or the flu, they provide welcome relief for at least some of the discomforts of seasonal allergies and upper respiratory infections. However, its essential for consumers to read the ingredient labels, evaluate their symptoms, and choose the most appropriate remedy.

What are antihistamines?

Histamine is an important body chemical that is responsible for the congestion, sneezing, and runny nose and itching that a patient suffers with an allergic attack or an infection. Antihistamine drugs block the action of histamine, therefore reducing these symptoms. For the best result, antihistamines should be taken before allergic symptoms get well established, but they can also be very effective if taken after the onset of symptoms.

What are the side effects of antihistamines?

Most of the older over-the-counter antihistamines produce drowsiness, and are therefore not recommended for anyone who may be driving an automobile or operating equipment that could be dangerous. The first few doses cause the most sleepiness; subsequent doses are usually less troublesome. Some of the newer over-the-counter and prescription antihistamines do not produce drowsiness.

Typical antihistamines include Benadryl®, Chlor-Trimetron®, Claritin®, Dimetane®, Hismanal®, Nolahist®, PBZ®, Polaramine®, Seldane®, Tavist®, Teldrin®, Zyrtec®, Allegra®, and Allavert®.

What are decongestants?

Congestion in the nose, sinuses, and chest is due to swollen, expanded, or dilated blood vessels in the membranes of the nose and air passages. These membranes, with a great capacity for expansion, have an abundant supply of blood vessels. Once the membranes swell, one becomes congested.

Decongestants help to shrink the blood vessels in the nasal membranes and allow the air passages to open up. Decongestants are chemically related to adrenaline, the natural decongestant, which is also a type of stimulant. Therefore, the side effect of decongestants taken as a pill or liquid is a jittery or nervous feeling causing difficulty in going to sleep and elevating blood pressure and pulse rate.

Who should not use decongestants?

Decongestants should not be used by a patient who has an irregular heart rhythm, high blood pressure, heart disease, or glaucoma. Some patients taking decongestants experience difficulty with urination. Furthermore, decongestants are often used as ingredients in diet pills. To avoid excessively stimulating effects, patients taking diet pills should not take decongestants.

Typical decongestants in pill or liquid form are Dura-Vent®, Exgest®, Entex®, Propagest®, Novafed®, and Sudafed®.

May be available over the counter without a prescription. Read labels carefully, and use only as directed.

Decongestants are also available over the counter in nasal spray form. This method of medication delivery brings immediate relief to the nasal mucous membranes without the usual side effects that accompany pills or liquids that are swallowed. Over-the-counter decongestant nose sprays should be reserved for urgent, emergency and short term use. Because repetitive use can lead to lack of effectiveness and return of the congestion, and thus lead to the urge to use more sprays more frequently, these medications often carry a warning label, Do not use this product for more than three days. This problem will only improve once the use of the nasal drops or spray is discontinued.

What are combination remedies?

Theoretically, if the side effects could be properly balanced, the sleepiness caused by antihistamines could be cancelled by the stimulation of decongestants. For instance, one might take the antihistamine only at night and take the decongestant alone in the daytime. Alternatively, one could take them together, increasing the dosage of antihistamine at night (while decreasing the decongestant dose) and then doing the opposite for daytime use. Since no one reacts exactly the same as another to drug side effects, a consumer may wish to adjust the time of day the medications are taken until finding the combination that works best.

Antihistamines/decongestants: Many pharmaceutical companies have combined antihistamines and decongestants together in one pill.

Typical combinations of antihistamines with decongestants are: Actifed®, A.R.M.®, Chlor-Trimeton D®, Claritin D®, Contac®, CoPyronil 2®, Deconamine®, Demazin®, Dimetapp®, Drixoral®, Isoclor®, Nolamine®, Novafed A®, Ornade®, Sudafed Plus®, Tavist D®, Triaminic®, and Trinalin®.

What should I look for in a cold remedy?

Decongestants and/or antihistamines are the principal ingredients in cold remedies, but drying agents, aspirin (or aspirin substitutes), and cough suppressants may also be added. Therefore, consumers should choose remedies with ingredients best suited to combat their own symptoms. If the label does not clearly state the ingredients and their functions, the consumer should ask the pharmacist to explain them.

Which medicine do I need?

The chart below makes it simple for you to determine which type of medicine is right for you based on the symptoms that each treats.

MEDICINE SYMPTOMS RELIEVED SIDE EFFECTS
Antihistamines Sneezing Runny nose
Stuffy nose Itchy eyes
Congestion
Drowsiness Dry mouth & nose
Decongestants Stuffy nose Congestion Stimulation Insomnia Rapid heart beat
Combination of above All of above Any of above (more or less)

Snoring Problems

Forty -five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons and it usually grows worse with age. Snoring sounds are caused when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose.

Only recently have the adverse medical effects of snoring and its association with Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) been recognized. Various methods are used to alleviate snoring and/or OSA. They include behavior modification, sleep positioning, Continuous Positive Airway Pressure (CPAP), Uvulopalatopharyngoplasty (UPPP), and Laser Assisted Uvula Palatoplasty (LAUP), and jaw adjustment techniques.

What Is Continuous Positive Airway Pressure (CPAP)?

Nasal CPAP delivers air into your airway through a specially designed nasal mask or pillows. The mask does not breathe for you; the flow of air creates enough pressure when you inhale to keep your airway open. CPAP is considered the most effective nonsurgical treatment for the alleviation of snoring and obstructive sleep apnea.

If your otolaryngologist determines that the CPAP treatment is right for you, you will be required to wear the nasal mask every night. During this treatment, you may have to undertake a significant change in lifestyle. That change could consist of losing weight, quitting smoking, or adopting a new exercise regimen.

Before the invention of the nasal CPAP, a recommended course of action for a patient with sleep apnea or habitual snoring was a tracheostomy, or creating a temporary opening in the windpipe. The CPAP treatment has been found to be nearly 100 percent effective in eliminating sleep apnea and snoring when used correctly and will eliminate the necessity of a surgical procedure.

So, If I Use A Nasal CPAP I Will Never Need Surgery?

With the exception of some patients with severe nasal obstruction, CPAP has been found to be nearly 100 percent effective, although it does not cure the problem. However, studies have shown that long term compliance in wearing the nasal CPAP is about 70 percent. Some people have found the device to be claustrophobic or have difficulty using it when traveling. If you find that you cannot wear a nasal CPAP each night, a surgical solution might be necessary. Your otolaryngologist will advise you of the best course of action.

Should You Consider CPAP?

If you have significant sleep apnea, you may be a prime for CPAP. Your otolaryngologist will evaluate you and ask the following questions:

  • Do you snore loudly and disturb your family and friends?
  • Do you have daytime sleepiness?
  • Do you wake up frequently in the middle of the night?
  • Do you have frequent episodes of obstructed breathing during sleep?
  • Do you have morning headaches or tiredness?

Suitability for CPAP use is determined after a review of your medical history, lifestyle factors (alcohol and tobacco intake as well as exercise), cardiovascular condition, and current medications. You will also receive a physical and otorhinolaryngological (ear, nose, and throat) examination to evaluate your airway.

Before receiving the nasal mask, you would need to have the proper CPAP pressure set during a "sleep study." This will complete the evaluation necessary for prescribing the appropriate treatment for your needs.

Playing catch, shooting hoops, bicycling on a scenic path or just kicking around a soccer ball have more in common than you may think. On the up side, these activities are good exercise and are enjoyed by thousands of Americans. On the down side, they can result in a variety of injuries to the face.

Many injuries are preventable by wearing the proper protective gear, and your attitude toward safety can make a big difference. However, even the most careful person can get hurt. When an accident happens, it"s your response that can make the difference between a temporary inconvenience and permanent injury.

When Someone Gets Hurt:

What First Aid Supplies Should You Have on Hand in Case of An Emergency?

  • sterile cloth or pads
  • scissors
  • ice pack
  • tape
  • sterile bandages
  • cotton tipped swabs
  • hydrogen peroxide
  • nose drops
  • antibiotic ointment
  • eye pads
  • cotton balls
  • butterfly bandages
  • Ask "Are you all right?" Determine whether the injured person is breathing and knows who and where they are.
  • Be certain the person can see, hear and maintain balance. Watch for subtle changes in behavior or speech, such as slurring or stuttering. Any abnormal response requires medical attention.
  • Note weakness or loss of movement in the forehead, eyelids, cheeks and mouth.
  • Look at the eyes to make sure they move in the same direction and that both pupils are the same size.
  • If any doubts exist, seek immediate medical attention.

When Medical Attention Is Required, What Can You Do?

  • Call for medical assistance (911).
  • Do not move the victim, or remove helmets or protective gear.
  • Do not give food, drink or medication until the extent of the injury has been determined.
  • Remember HIV...be very careful around body fluids. In an emergency protect your hands with plastic bags.
  • Apply pressure to bleeding wounds with a clean cloth or pad, unless the eye or eyelid is affected or a loose bone can be felt in a head injury. In these cases, do not apply pressure but gently cover the wound with a clean cloth.
  • Apply ice or a cold pack to areas that have suffered a blow (such as a bump on the head) to help control swelling and pain.
  • Remember to advise your doctor if the patient has HIV or hepatitis.

Facial Fractures

Sports injuries can cause potentially serious broken bones or fractures of the face. Common symptoms of facial fractures include:

  • swelling and bruising, such as a black eye
  • pain or numbness in the face, cheeks or lips
  • double or blurred vision
  • nosebleeds
  • changes in teeth structure or ability to close mouth properly

It is important to pay attention to swelling because it may be masking a more serious injury. Applying ice packs and keeping the head elevated may reduce early swelling.

If any of these symptoms occur, be sure to visit the emergency room or the office of a facial plastic surgeon (such as an otolaryngologist-head and neck surgeon) where x-rays may be taken to determine if there is a fracture.

Upper Face

When you are hit in the upper face (by a ball for example) it can fracture the delicate bones around the sinuses, eye sockets, bridge of the nose or cheek bones. A direct blow to the eye may cause a fracture, as well as blurred or double vision. All eye injuries should be examined by an eye specialist (ophthalmologist).

Lower Face

When your jaw or lower face is injured, it may change the way your teeth fit together. To restore a normal bite, surgeries often can be performed from inside the mouth to prevent visible scarring of the face; and broken jaws often can be repaired without being wired shut for long periods. Your doctor will explain your treatment options and the latest treatment techniques.

Soft Tissue Injuries

Bruises cuts and scrapes often result from high speed or contact sports, such as boxing, football, soccer, ice hockey, bicycling skiing, and snowmobiling. Most can be treated at home, but some require medical attention.

You should get immediate medical care when you have:

  • deep skin cuts
  • obvious deformity or fracture
  • loss of facial movement
  • persistent bleeding
  • change in vision
  • problems breathing and/or swallowing
  • alterations in consciousness or facial movement

Bruises

Also called contusions, bruises result from bleeding underneath the skin. Applying pressure, elevating the bruised area above the heart and using an ice pack for the first 24 to 48 hours minimizes discoloration and swelling. After two days, a heat pack or hot water bottle may help more. Most of the swelling and bruising should disappear in one to two weeks.

Cuts and Scrapes

The external bleeding that results from cuts and scrapes can be stopped by immediately applying pressure with gauze or a clean cloth. When the bleeding is uncontrollable, you should go to the emergency room.

Scrapes should be washed with soap and water to remove any foreign material that could cause infection and discoloration of the skin. Scrapes or abrasions can be treated at home by cleaning with 3% hydrogen peroxide and covering with an antibiotic ointment or cream until the skin is healed. Cuts or lacerations, unless very small, should be examined by a physician. Stitches may be necessary, and deeper cuts may have serious effects. Following stitches, cuts should be kept clean and free of scabs with hydrogen peroxide and antibiotic ointment. Bandages may be needed to protect the area from pressure or irritation from clothes. You may experience numbness around the cut for several months. Healing will continue for 6 to 12 months. The application of sunscreen is important during the healing process to prevent pigment changes. Scars that look too obvious after this time should be seen by a facial plastic surgeon.

Nasal Injuries

The nose is one of the most injured areas on the face. Early treatment of a nose injury consists of applying a cold compress and keeping the head higher than the rest of the body. You should seek medical attention in the case of:

  • breathing difficulties
  • deformity of the nose
  • persistent bleeding
  • cuts

Bleeding

Nosebleeds are common and usually short-lived. Often they can be controlled by squeezing the nose with constant pressure for 5 to 10 minutes. If bleeding persists, seek medical attention.

Bleeding also can occur underneath the surface of the nose. An otolaryngologist/facial plastic surgeon will examine the nose to determine if there is a clot or collection of blood beneath the mucus membrane of the septum (a septal hematoma) or any fracture. Hematomas should be drained so the pressure does not cause nose damage or infection.

Fractures

Some otolaryngologist-head and neck specialists set fractured bones right away before swelling develops, while others prefer to wait until the swelling is gone. These fractures can be repaired under local or general anesthesia, even weeks later.

Ultimately, treatment decisions will be made to restore proper function of the nasal air passages and normal appearance and structural support of the nose. Swelling and bruising of the nose may last for 10 days or more.

Neck Injuries

Whether seemingly minor or severe, all neck injuries should be thoroughly evaluated by an otolaryngologist -- head and neck surgeon. Injuries may involve specific structures within the neck, such as the larynx (voicebox), esophagus (food passage), or major blood vessels and nerves.

Throat Injuries

The larynx is a complex organ consisting of cartilage, nerves and muscles with a mucous membrane lining all encased in a protective tissue (cartilage) framework.

The cartilages can be fractured or dislocated and may cause severe swelling, which can result in airway obstruction. Hoarseness or difficulty breathing after a blow to the neck are warning signs of a serious injury and the injured person should receive immediate medical attention.

Prevention Of Facial Sports Injuries

The best way to treat facial sports injuries is to prevent them. To insure a safe athletic environment, the following guidelines are suggested:

  • Be sure the playing areas are large enough that players will not run into walls or other obstructions.
  • Cover unremoveable goal posts and other structures with thick, protective padding.
  • Carefully check equipment to be sure it is functioning properly.
  • Require protective equipment - such as helmets and padding for football, bicycling and rollerblading; face masks, head and mouth guards for baseball; ear protectors for wrestlers; and eyeglass guards or goggles for racquetball and snowmobiling are just a few.
  • Prepare athletes with warm-up exercises before engaging in intense team activity.
  • In the case of sports involving fast-moving vehicles, for example, snowmobiles or dirt bikes - check the path of travel, making sure there are no obstructing fences, wires or other obstacles.
  • Enlist adequate adult supervision for all children"s competitive sports.

Q. How common is sinusitis?

A.More than 37 million Americans suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade possibly due to increased pollution, urban sprawl, and increased resistance to antibiotics.

Q. What is sinusitis?

A.Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants; chronic sinusitis is characterized by at least four recurrences of acute sinusitis. Either medication or surgery is a possible treatment.

Q. What are the signs and symptoms of acute sinusitis?

A.For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough not due to asthma (in children). Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain, and cough.

Acute sinusitis can last four weeks or more. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection.

Q. How is acute sinusitis treated?

A.Acute sinusitis is generally treated with ten to 14 days of antibiotic care. With treatment, the symptoms disappear, and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms.

Q. What are the signs and symptoms of chronic sinusitis?

A.Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: facial pain/pressure, facial congestion/fullness, nasal obstruction/blockage, thick nasal discharge/discolored post-nasal drainage, pus in the nasal cavity, and at times, fever. They may also have headache, bad breath, and fatigue.

Q. What measures can be taken at home to relieve sinus pain?

A.Warm moist air may alleviate sinus congestion. Experts recommend a vaporizer or steam from a pan of boiled water (removed from the heat). Humidifiers should be used only when a clean filter is in place to preclude spraying bacteria or fungal spores into the air. Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are also helpful in moisturizing nasal passages.

Q. How effective are non-prescription nose drops or sprays?

A.Use of nonprescription drops or sprays might help control symptoms. However, extended use of non-prescription decongestant nasal sprays could aggravate symptoms and should not be used beyond their label recommendation. Saline nasal sprays or drops are safe for continuous use.

Q. How does a physician determine the best treatment for acute or chronic sinusitis?

A.To obtain the best treatment option, the physician needs to properly assess the patient" s history and symptoms and then progress through a structured physical examination.

Q. What should one expect during the physical examination for sinusitis?

A.At a specialist" s office, the patient will receive a thorough ear, nose, and throat examination. During that physical examination, the physician will explore the facial features where swelling and erythema (redness of the skin) over the cheekbone exist. Facial swelling and redness are generally worse in the morning; as the patient remains upright, the symptoms gradually improve. The physician may feel and press the sinuses for tenderness. Additionally, the physician may tap the teeth to help identify an inflamed paranasal sinus.

Q. What other diagnostic procedures might be taken?

A.Other diagnostic tests may include a study of a mucous culture, endoscopy, x-rays, allergy testing, or CT scan of the sinuses.

Q. What is nasal endoscopy?

A.An endoscope is a special fiber optic instrument for the examination of the interior of a canal or hollow viscus. It allows a visual examination of the nose and sinus drainage areas.

Q. Why does an ear, nose, and throat specialist perform nasal endoscopy?

A.Nasal endoscopy offers the physician specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. First, the patient" s nasal cavity is anesthetized; a rigid or flexible endoscope is then placed in a position to view the nasal cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the physician specialist also looks for pus as well as polyp formation and structural abnormalities that may cause recurrent sinusitis.

Q. What course of treatment will the physician recommend?

A.To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral decongestants. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). Antihistamines may be recommended for the treatment of allergies.

Q. Will any changes in lifestyle be suggested during treatment?

A.Smoking is never condoned, but if one has the habit, it is important to refrain during treatment for sinus problems. A special diet is not required, but drinking extra fluids helps to thin mucus.

Q. When is sinus surgery necessary?

A.Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell). Inflammation from allergy causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus surgery can correct the problem.

Q. What does the surgical procedure entail?

A.The basic endoscopic surgical procedure is performed under local or general anesthesia. The patient returns to normal activities within four days; full recovery takes about four weeks.

Q. What does sinus surgery accomplish?

A.The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in place as possible. Otolaryngologist--head and neck surgeons have found endoscopic surgery to be highly effective in restoring normal function to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus.

Q. What are the consequences of not treating infected sinuses?

A.Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and infection of the bone or bone marrow can occur.

Q. Where should sinus pain sufferers seek treatment?

A.If you suffer from severe sinus pain, you should seek treatment from an otolaryngologist-head and neck surgeon, a specialist who can treat your condition with medical and/or surgical remedies.

Allergic rhinitis (hay fever) is an especially common chronic nasal problem in adolescents and young adults. Allergies to inhalants like pollen, dust, and animal dander begin to cause sinus and nasal symptoms in early childhood. Infants and young children are especially susceptible to allergic sensitivity to foods and indoor allergens.

What causes allergic rhinitis?

Allergic rhinitis typically results from two conditions: family history/genetic predisposition to allergic disease and exposure to allergens. Allergens are substances that produce an allergic response.

LChildren are not born with allergies but develop symptoms upon repeated exposure to environmental allergens. The earliest exposure is through food and infants may develop eczema, nasal congestion, nasal discharge, and wheezing caused by one or more allergens (milk protein is the most common). Allergies can also contribute to repeated ear infections in children. In early childhood, indoor exposure to dust mites, animal dander, and mold spores may cause an allergic reaction, often lasting throughout the year. Outdoor allergens including pollen from trees, grasses, and weeds primarily cause seasonal symptoms.

The number of patients with allergic rhinitis has increased in the past decade, especially in urban areas. Before adolescence, twice as many boys as girls are affected; however, after adolescence, females are slightly more affected than males. Researchers have found that children born to a large family with several older siblings and day care attendance seem to have less likelihood of developing allergic disease later in life.

What are allergic rhinitis symptoms?

Symptoms can vary with the season and type of allergen and include sneezing, runny nose, nasal congestion, and itchy eyes and nose. A year-long exposure usually produces nasal congestion (chronic stuffy nose).

In children, allergen exposure and subsequent inflammation in the upper respiratory system cause nasal obstruction. This obstruction becomes worse with the gradual enlargement of the adenoid tissue and the tonsils inherent with age. Consequently, the young patient may have mouth-breathing, snoring, and sleep-disordered breathing such as obstructive sleep apnea. Sleep problems such as insomnia, bed-wetting, and sleepwalking may accompany these symptoms along with behavioral changes including short attention span, irritability, poor school performance, and excessive daytime sleepiness.

In these patients, upper respiratory infections such as colds and ear infections are more frequent and last longer. A childs symptoms after exposure to pollutants such as tobacco smoke are usually amplified in the presence of ongoing allergic inflammation.

When should my child see a doctor?

If your childs cold-like symptoms (sneezing and runny nose) persist for more than two weeks, it is appropriate to contact a physician.

Emergency treatment is rarely necessary except for upper airway obstruction causing severe sleep apnea or an anaphylactic reaction caused by exposure to a food allergen. Treatment of anaphylactic shock should be immediate and requires continued observation and care.

What happens during a physician visit?

The doctor will first obtain an extensive history about the child, the home environment, possible exposures, and progression of symptoms. Family history of atopic/allergic disease and the presence of other disorders such as eczema and asthma strongly support the diagnosis of allergic rhinitis. The physician will seek a link between the symptoms and exposure to certain allergens.

The physician will examine the skin, eyes, face and facial structures, ears, nose, and throat. In some cases, a nasal endoscopy may be performed. If the history and the physical exam suggest allergic rhinitis, a screening allergy test is ordered. This can be a blood test or a skin prick test. In most children it is easier to obtain a blood test known as the RadioAllergoSorbent Test or RAST. This test measures the amount of specific Immunoglobulin E antibodies (IgE) in the blood responding to various environmental and food allergens.

The skin test results, often immediately available, may be affected by the recent use of antihistamines and other medications, dermatologic conditions, and age of the patient. The blood test is not affected by medication, and results are usually available in several days.

How is allergic rhinitis treated?

The most common treatment recommendation is to have the child avoid the allergens causing the allergic sensitivity. The physician will work with caregivers to develop an avoidance strategy based on the nature of the allergen, exposure, and availability of avoidance measures.

Cost and lifestyle are important factors to consider. For mild, seasonal allergies, avoidance could be the most effective course of action. If pet dander is the offender, consideration should be given to removing the pet from the childs environment.

Severe symptoms, multiple allergens, year-long exposure, and limited resources for environmental control may call for additional treatment measures. Nasal saline irrigations, nasal steroid sprays, and non-sedating antihistamines are indicated for symptom control. Nasal steroids are the most effective in reducing nasal symptoms of allergic rhinitis. A short burst of oral steroids may be appropriate for some patients with severe symptoms or to gain control during acute attacks.

If symptoms are severe and due to multiple allergens, the child is symptomatic more than six months in a year, and if all other measures fail, then immunotherapy (IT) (or desensitization) may be suggested. IT is delivered by injections of the allergen in doses that are increased incrementally to a maximum that is tolerated without a reaction. Maintenance injections can be delivered at increasing intervals starting from weekly to bi-weekly to monthly injections for up to three to five years. Children with pollen sensitivities benefit most from this treatment. IT is also effective in reducing the onset of pollen-induced asthma.

Inflammation of the nasal mucous membrane is called rhinitis. The symptoms include sneezing and runny and/or itchy nose, caused by irritation and congestion in the nose. There are two types: allergic rhinitis and non-allergic rhinitis.

Allergic Rhinitis occurs when the bodys immune system over-responds to specific, non-infectious particles such as plant pollens, molds, dust mites, animal hair, industrial chemicals (including tobacco smoke), foods, medicines, and insect venom. During an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast cells (cells that release histamine) in the lungs, skin, and mucous membranes. Once IgE connects with the mast cells, a number of chemicals are released. One of the chemicals, histamine, opens the blood vessels and causes skin redness and swollen membranes. When this occurs in the nose, sneezing and congestion are the result.

Seasonal allergic rhinitis or hayfever occurs in late summer or spring. Hypersensitivity to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75 percent of all Americans who suffer from this seasonal disorder. People with sensitivity to tree pollen have symptoms in late March or early April; an allergic reaction to mold spores occurs in October and November as a consequence of falling leaves.

Perennial allergic rhinitis occurs year-round and can result from sensitivity to pet hair, mold on wallpaper, houseplants, carpeting, and upholstery. Some studies suggest that air pollution such as automobile engine emissions can aggravate allergic rhinitis. Although bacteria is not the cause of allergic rhinitis, one medical study found a significant number of the bacteria Staphylococcus aureus in the nasal passages of patients with year-round allergic rhinitis, concluding that the allergic condition may lead to higher bacterial levels, thereby creating a condition that worsens the allergies.

Patients who suffer from recurring bouts of allergic rhinitis should observe their symptoms on a continuous basis. If facial pain or a greenish-yellow nasal discharge occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment.

Non-Allergic Rhinitis does not depend on the presence of IgE and is not due to an allergic reaction. The symptoms can be triggered by cigarette smoke and other pollutants as well as strong odors, alcoholic beverages, and cold. Other causes may include blockages in the nose, a deviated septum, infections, and over-use of medications such as decongestants.

Rhinosinusitis: Clarifying The Relationship Between The Sinuses And Rhinitis

Recent studies by otolaryngologist head and neck surgeons have better defined the association between rhinitis and sinusitis. They have concluded that sinusitis is often preceded by rhinitis and rarely occurs without concurrent rhinitis. The symptoms, nasal obstruction/discharge and loss of smell, occur in both disorders. Most importantly, computed tomography (CT scan) findings have established that the mucosal linings of the nose and sinuses are simultaneously involved in the common cold (previously, thought to affect only the nasal passages). Otolaryngologists, acknowledging the inter-relationship between the nasal and sinus passages, now refer to sinusitis as rhinosinusitis.

The catalyst relating the two disorders is thought to involve nasal sinus overflow obstruction, followed by bacterial colonization and infection leading to acute, recurrent, or chronic sinusitis. Likewise, chronic inflammation due to allergies can lead to obstruction and subsequent sinusitis.

Other medical research has supported the close relationship between allergic rhinitis and sinusitis. In a retrospective study on sinus abnormalities in 1,120 patients (from two to 87 years of age), thickening of the sinus mucosa was more commonly found in sinusitis patients during July, August, September, and December, months in which pollen, mold, and viral epidemics are prominent. A review of patients (four to 83 years of age) who had surgery to treat their chronic sinus conditions revealed that those with seasonal allergy and nasal polyps are more likely to experience a recurrence of their sinusitis.

An antibiotic is a soluble substance derived from a mold or bacterium that inhibits the growth of other microorganisms.

The first antibiotic was Penicillin, discovered by Alexander Fleming in 1929, but it was not until World War II that the effectiveness of antibiotics was acknowledged, and large-scale fermentation processes were developed for their production.

Acute sinusitis is one of many medical disorders that can be caused by a bacterial infection. However, it is important to remember that colds, allergies, and environmental irritants, which are more common than bacterial sinusitis, can also cause sinus problems. Antibiotics are effective only against sinus problems caused by a bacterial infection.

The following symptoms may indicate the presence of a bacterial infection in your sinuses:

  • Pain in your cheeks or upper back teeth
  • A lot of bright yellow or green drainage from your nose for more than 10 days
  • No relief from decongestants, and/or
  • Symptoms that get worse instead of better after your cold is gone.

Most patients with a clinical diagnosis of acute sinusitis caused by a bacterial infection improve without antibiotic treatment. The specialist will initially offer appropriate doses of analgesics (pain-relievers), antipyretics (fever reducers), and decongestants. However if symptoms persist, a treatment consisting of antibiotics may be recommended.

Antibiotic Treatment For Sinusitis

Antibiotics are labeled as narrow-spectrum drugs when they work against only a few types of bacteria. On the other hand, broad-spectrum antibiotics are more effective by attacking a wide range of bacteria, but are more likely to promote antibiotic resistance. For that reason, your ear, nose, and throat specialist will most likely prescribe narrow-spectrum antibiotics, which often cost less. He/she may recommend broad-spectrum antibiotics for infections that do not respond to treatment with narrow-spectrum drugs.

Acute Sinusitis

In most cases, antibiotics are prescribed for patients with specific findings of persistent purulent nasal discharge and facial pain or tenderness who are not improving after seven days or those with severe symptoms of rhinosinusitis, regardless of duration. On the basis of clinical trials, amoxicillin, doxycycline, or trimethoprim sulfamethoxazole are preferred antibiotics.

Chronic Sinusitis

Even with a long regimen of antibiotics, chronic sinusitis symptoms can be difficult to treat. In general, however, treating chronic sinusitis, such as with antibiotics and decongestants, is similar to treating acute sinusitis. When antibiotic treatment fails, allergy testing, desensitization, and/or surgery may be recommended as the most effective means for treating chronic sinusitis. Research studies suggest that the vast majority of people who undergo surgery have fewer symptoms and better quality of life.

Pediatric Sinusitis

Antibiotics that are unlikely to be effective in children who do not improve with amoxicillin include trimethoprim-sulfamethoxazole (Bactrim) and erythromycin-sulfisoxazole (Pediazole), because many bacteria are resistant to these older antibiotics. For children who do not respond to two courses of traditional antibiotics, the dose and length of antibiotic treatment is often expanded, or treatment with intravenous cefotaxime or ceftriaxone and/or a referral to an ENT specialist is recommended.

As many as 20 percent of high school boys and two percent of high school girls continue to use smokeless tobacco, according to the Centers for Disease Control and Prevention. Despite public education campaigns sponsored by medical societies, organized baseball, and individuals, 12 to 14 million American users, one third are under age 21, and more than half of those developed the habit before they were 13. Peer pressure is just one of the reasons for starting the habit. Serious users often graduate from brands that deliver less nicotine to stronger ones. With each use, you need a little more of the drug to get the same feeling.

There has been some progress. The organizer of America"s fastest growing sport, National Association for Stock Car Auto Racing (NASCAR) has dropped its long-time affiliation with Winston tobacco. NASCAR president Mike Helton says a total tobacco ban is "an issue that"s on our radar for next year."

And there have been setbacks in the fight against smoking tobacco. New marketing campaigns that feature flavored smokeless products have won over new young users. Journalistic coverage of Dr. Brad Rodu and his support of smokeless tobacco as a substitute for cigarettes has diluted the Academy"s "No Smokeless Tobacco Use" message that has been an official campaign for this Academy since 1989. In a November 10, 2005 study; "New Cigarette Brands with Flavors That Appeal to Youth: Tobacco Marketing Strategies; Health Affairs, November/December 2005, Volume 24, number 6, funded by the American Legacy Foundation and the National Cancer Institute noted that candy flavors were also added to smokeless tobacco products, cigars and cigarette rolling papers. "

Gregory Connolly, senior author of the study and a professor of the practice of public health at the Harvard School of Pubic Health noted, "Tobacco companies are using candy-like flavors and high tech delivery devices to turn a blowtorch into a flavored popsicle, misleading millions of youngsters to try a deadly product. Although the study focuses primarily on cigarettes, it noted that the addiction to smokeless tobacco or "chew" is as strong if not stronger than to cigarettes. Additional research has shown that there continues to be substantial evidence that smokeless tobacco is deadly. A December 18, 2003 study by Patricia Richter, Ph.D and Francis Spierto, Ph.D, two CDC researchers released by the Center for the Advancement of Health reported that the most popular brands of smokeless tobacco contain the highest amounts of nicotine that can be readily absorbed by the body. According to Richter, "Consumers need to know that smokeless tobacco products, including loose-leaf and moist snuff, are not safe alternatives to smoking," Richter says. "The amount of nicotine absorbed per dose from using smokeless tobacco is greater than the amount of nicotine absorbed from smoking one cigarette.

Kicking Tobacco Means Kicking It All

In November 11, 2005 Reuters story, "Oral Tocacco Not Safe Sbustiute for Smoking," Dr. Stephen Hecht and colleagues from the University of Minnesota Cancer Center in Minneapolis related data from their current research that compared the levels of cancer-causing nitrosamines in popular smokeless tobacco products and medicinal nicotine products such as the nicotine patch, nicotine gum, and nicotine lozenges.

The results "clearly showed that the levels of cancer-causing nitrosamines are far higher in smokeless tobacco products than they are in medicinal nicotine products," Hecht said during a press briefing. While smokeless tobacco has "demonstrably less carcinogens and toxins than cigarette smoke," said Hecht, smokeless tobacco still has "remarkably high levels of carcinogenic tobacco-specific nitrosamines -- levels that are 100 to 1,000 times higher than in any other consumer product that is designed for oral consumption." In a separate study, the team evaluated carcinogen biomarker levels in individuals using these products. They had 54 users of popular US smokeless tobacco products use their usual brand for two weeks and then had them switch to either Swedish snus or a nicotine patch for four weeks.

The team found that carcinogen levels in urine were statistically significantly lower after the switch from US-made smokeless tobacco brands to snus or to the nicotine patch. When comparing snus users to patch users, levels of cancer- causing compounds were significantly lower in patch users, indicating that medicinal nicotine is safer than snus, Hecht said. These results conflict with some prior studies that suggested that smokeless tobacco including moist snuff may be a less harmful habit than cigarette smoking because many of the carcinogens in cigarette smoke are either reduced or absent in smokeless tobacco. The bottom line, Dr.Hecht said, is that "smokeless tobacco products are dangerous."

"The evidence suggests," he continued, "that smokeless products are in fact a cause of oral cancer and pancreatic cancer in humans. The current evidence does not support smokeless tobacco as a substitute for cigarette smoking."

Pediatric Obstructive Sleep Apnea

Sleep disordered breathing (SDB) is a common problem for adults leading to hypertension, heart attack, stroke, and early death. Other consequences are bedroom disharmony, excessive daytime sleepiness, weight gain, poor performance at work, failing personal relationships, and increased risk for accidents, including motor vehicle accidents.

Sleep disordered breathing in children, from infancy through puberty, is in some ways a similar condition but has different causes, consequences, and treatments. A child with SDB does not necessarily have this condition as an adult.

Pediatric obstructive sleep apnea

The premiere symptom of sleep disordered breathing is snoring that is loud, present every night regardless of sleep position, and is ultimately interrupted by complete obstruction of breathing with gasping and snorting noises. Approximately 10 percent of children are reported to snore. Ten percent of these children (one percent of the total pediatric population) have obstructive sleep apnea.

When an individual, young or old, obstructs breathing during sleep, the body perceives this as a choking phenomenon. The heart rate slows, the sympathetic nervous system is stimulated, blood pressure rises, the brain is aroused, and sleep is disrupted. In most cases a childs vascular system can tolerate the changes in blood pressure and heart rate. However, a childs brain does not tolerate the repeated interruptions to sleep, leading to a child that is sleep deprived, cranky, and ill behaved.

Consequences of untreated pediatric sleep disordered breathing

  • Snoring: A problem if a child shares a room with a sibling and during sleepovers.
  • Sleep deprivation: The child may become moody, inattentive, and disruptive both at home and at school. Classroom and athletic performance may decrease along with overall happiness. The child will lack energy, often preferring to sit in front of the television rather than participate in school and other activities. This may contribute to obesity.
  • Abnormal urine production: SDB also causes increased nighttime urine production, and in children, this may lead to bedwetting.
  • Growth: Growth hormone is secreted at night. Those with SDB may suffer interruptions in hormone secretion, resulting in slow growth or development.
  • Attention deficit disorder (ADD) / attention deficit hyperactivity disorder (ADHD): There are research findings that identify sleep disordered breathing as a contributing factor to attention deficit disorders.

Diagnosis of sleep disordered breathing

The first diagnosis of sleep disordered breathing in children is made by the parents observation of snoring. Other observations may include obstructions to breathing, gasping, snorting, and thrashing in bed as well as unexplained bedwetting. Social symptoms are difficult to diagnose but include alteration in mood, misbehavior, and poor school performance. (Note: Every child who has sub par academic and social skills may not have SDB, but if a child is a serious snorer and is experiencing mood, behavior, and performance problems, sleep disordered breathing should be considered.)

A child with suspected SDB should be evaluated by an otolaryngologist head and neck surgeon. If the symptoms are significant and the tonsils are enlarged, the child is strongly recommended for T&A, or tonsillectomy and adenoidectomy (removal of the tonsils and adenoids). Conversely, if the symptoms are mild, academic performance remains excellent, the tonsils are small, and puberty is eminent (tonsils and adenoids shrink at puberty), it may be recommended that SDB be treated only if matters worsen. The majority of cases fall somewhere in between, and physicians must evaluate each child on a case-by-case basis.

There are other pediatric sleep disorder diagnoses. Sudden infant death syndrome (SIDS) and apparent life threatening episode (ALTE) are considered forms of sleep disordered breathing. Children with these conditions warrant thorough evaluation by a pediatric sleep specialist. Children with craniofacial abnormalities, primarily abnormalities of the jaw bones, tongue, and associated structures, often have sleep disordered breathing. This must be managed and the deformities treated as the child grows.

The sleep test is the standard diagnostic test for sleep disordered breathing. This test can be performed in a sleep laboratory or at home. Sleep tests can produce inaccurate results, especially in children. Borderline or normal sleep test results may still result in a diagnosis of SDB based on parental observation and clinical evaluation.

Treatment for sleep disordered breathing

Enlarged tonsils are the most common cause for SDB, thus tonsillectomy/adenoidectomy is the most effective treatment for pediatric sleep disordered breathing. T&A achieves a 90 percent success rate for childhood SDB. Of the nearly 400,000 T&As performed in the U.S. each year, 75 percent are performed to treat sleep disordered breathing.

Not every child with snoring should undergo T&A. The procedure does have risks and possible complications. Aside from the mental anguish experienced by the parent and child, potential problems include: anesthesia risks, bleeding, and infection.

Who is in day care?

The 2000 census reported that of among the nation"s 19.6 million preschoolers, grandparents took care of 21 percent, 17 percent were were cared for by their father (while their mother was employed or in school); 12 percent were in day care centers; nine percent were cared for by other relatives; seven percent were cared for by a family day care provider in their home; and six percent received care in nursery schools or preschools. More than one-third of preschoolers (7.2 million) had no regular child-care arrangement and presumably were under maternal care.

Day care establishments are defined as those primarily engaged in care of infants or children, or in providing pre-kindergarten education, where medical care and/or behavioral correction are not a primary function or major element. Some may or may not have substantial educational programs, and some may care for older children when they are not in school.

What are your child"s risks of being exposed to a contagious illness at a day care center?

Medline, a service of the National Library of Medicine and the National Institutes of Health, reports that day care centers do pose some degree of an increased health risk for children, because of the exposure to other children who may be sick.

When your child is in a day care center, the risk is greatest for viral upper respiratory infection (affecting the nose, throat, mouth, voice box) and the common cold, ear infections, and diarrhea. Some studies have tried to link asthma to day care. Other studies suggest that being exposed to all the germs in day care actually IMPROVES your child"s immune system.

Studies suggest that the average child will get eight to ten colds per year, lasting ten - 14 days each, and occurring primarily in the winter months. This means that if a child gets two colds from March to September, and eight colds from September to March, each lasting two weeks, the child will be sick more than over half of the winter.

At the same time, children in a day care environment, exposed to the exchange of upper respiratory tract viruses every day, are expected to have three to ten episodes of otitis media annually. This is four times the incidence of children staying at home.

When should your child remain at home instead of day care or school?

Simply put, children become sick after being exposed to other sick children. Some guidelines to follow are:

  • When your child has a temperature higher than 100 degrees, keep him/her at home. A fever is a sign of potentially contagious infection, even if the child feels fine. Schools often advise keeping the child at home until a fever-free period has existed for 24 hours.
  • When other children in the day care facility have a known contagious infection, such as chicken pox, strep throat or conjunctivitis, keep your child at home.
  • Children taking antibiotics should be kept at home until they have taken the medicine for one or two days.
  • If your child is vomiting or has diarrhea, the young patient should not be around other children. Other signs of illness are an inability to take fluids, weakness or lethargy, sunken eyes, a depressed soft spot on top of infants head, crying without tears, and dry mouth.

Can you prevent your child from becoming sick at a day care center?

The short answer is no. Exposure to other sick children will increase the likelihood that your child may catch the same illness, particularly with the common cold. The primary rule is to keep your own children at home if they are sick. However, you can:

  • Teach your child to wash his or her hands before eating and after using the toilet. Infection is spread the most by children putting dirty toys and hands in their mouths, so check your day cares hygiene cleaning practices.
  • Have your child examined by a physician before enrollment in a day care center or school. During the examination, the physician will:
    • Look for otitis (inflammation) in the ear. This is an indicator of future ear infections.
    • Review with you any allergies your child may have. This will assist in determining if the diet offered at the day care center may be harmful to your child.
    • Examine the childs tonsils for infection and size. Enlarged tonsils could indicate that your child may not be getting a healthy sleep at night, resulting in a tired condition during the day.
  • Alert the day care center manager when your child is ill, and include the nature of the illness.

Day care has become a necessity for millions of families. Monitoring the health of your own child is key to preventing unneccessary sickness. If a serious illness occurs, do not hesitate to have your child examined by a physician.

The shape of your nasal cavity could be the cause of chronic sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.

Estimates are that 80 percent of all nasal septums are off-center, a condition that is generally not noticed. A "deviated septum" occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.

Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma.

A deviated septum may cause one or more of the following:

  • Blockage of one or both nostrils
  • Nasal congestion, sometimes one-sided
  • Frequent nosebleeds
  • Frequent sinus infections
  • At times, facial pain, headaches, postnasal drip
  • Noisy breathing during sleep (in infants and young children)

In some cases, a person with a mildly deviated septum has symptoms only when he or she also has a "cold" (an upper respiratory tract infection). In these individuals, the respiratory infection triggers nasal inflammation that temporarily amplifies any mild airflow problems related to the deviated septum. Once the "cold" resolves, and the nasal inflammation subsides, symptoms of a deviated septum often resolve, too.

Diagnosis Of A Deviated Septum:

Patients with chronic sinusitis often have nasal congestion, and many have nasal septal deviations. However, for those with this debilitating condition, there may be additional reasons for the nasal airway obstruction. The problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof. A trained specialist in diagnosing and treating ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal obstruction.

Your First Visit:

After discussing your symptoms, the primary care physician or specialist will inquire if you have ever incurred severe trauma to your nose and if you have had previous nasal surgery. Next, an examination of the general appearance of your nose will occur, including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril.

Surgery may be the recommended treatment if the deviated septum is causing troublesome nosebleeds or recurrent sinus infections. Additional testing may be required in some circumstances.

Septoplasty:

Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery.

The time required for the operation averages about one to one and a half hours, depending on the deviation. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. After the surgery, nasal packing is inserted to prevent excessive postoperative bleeding. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.

If a deviated nasal septum is the sole cause for your chronic sinusitis, relief from this severe disorder will be achieved.

Sinusitis is inflammation of the lining membrane of any sinus. Take the following quiz to see if you have sinusitis.

Choose "yes" if you have any of the following symptoms for ten days or longer; otherwise, choose "no."

1. Facial pressure/pain?

     Yes No


2. Headache pain?

     Yes No


3. Congestion or stuffy nose?

     Yes No


4. Thick, yellow-green nasal discharge?

     Yes No


5. Low fever (99-100°)?

     Yes No


6. Bad breath?

     Yes No


7. Pain in the upper teeth?

     Yes No

If you answered "Yes" to three or more of the symptoms listed above, you may have a sinus infection resulting from allergies, bacteria, or a response to fungi. An examination by an ear, nose, and throat specialist may be warranted.

Editor"s Note: The text from this quiz may be freely used. Attribution to the American Academy of Otolaryngology - Head and Neck Surgery is required.

Your child has been diagnosed with allergic rhinitis, a physiological response to specific allergens such as pet dander or ragweed. The symptoms are fairly simple a runny nose (rhinitis), watery eyes, and some periodic sneezing. The best solution is to administer over-the-counter antihistamine, and the problem will resolve on its own right?

Not really the interrelated structures of the ears, nose, and throat can cause certain medical problems which trigger additional disorders all with the possibility of serious consequences.

Simple hay fever can lead to long term problems in swallowing, sleeping, hearing, and breathing. Lets see what else can happen to a child with a case of hay fever.

Ear infections:

One of childrens most common medical problems is otitis media, or middle ear infection. These infections are especially common in early childhood. They are even more common when children suffer from allergic rhinitis (hay fever) as well. Allergic inflammation can cause swelling in the nose and around the opening of the Eustachian tube (ear canal). This swelling has the potential to interfere with drainage of the middle ear. When bacteria laden discharge clogs the tube, infection is more likely.

Sore throats:

The hay fever allergens may lead to the formation of too much mucus which can make the nose run or drip down the back of the throat, leading to "post-nasal drip." It can lead to cough, sore throats, and husky voice. Although more common in older people and in dry inland climates, thick, dry mucus can also irritate the throat and be hard to clear. Air conditioning, winter heating, and dehydration can aggravate the condition. Paradoxically, antihistamines will do so as well. Some newer antihistamines do not produce dryness.

Snoring:

Chronic nasal obstruction is a frequent symptom of seasonal allergic rhinitis (hay fever) and perennial (year-round) allergic rhinitis. This allergic condition may have a debilitating effect on the nasal turbinates, the small, shelf-like, bony structures covered by mucous membranes (mucosa). The turbinates protrude into the nasal airway and help to warm, humidify, and cleanse air before it reaches the lungs. When exposed to allergens, the mucosa can become inflamed. The blood vessels inside the membrane swell and expand, causing the turbinates to become enlarged and obstruct the flow of air through the nose. This inflammation, or rhinitis, can cause chronic nasal obstruction that affects individuals during the day and night.

Enlarged turbinates and nasal congestion can also contribute to headaches and sleep disorders such as snoring and obstructive sleep apnea, because the nasal airway is the normal breathing route during sleep. Once turbinate enlargement becomes chronic, it is irreversible except with surgical intervention.

Pediatric sinusitis:

Allergic rhinitis can cause enough inflammation to obstruct the openings to the sinuses. Consequently, a bacterial sinus infection occurs. The disease is similar for children and adults. Children may or may not complain of pain. However, in acute sinusitis, they will often have pain and typically have fever and a purulent nasal discharge. In chronic sinusitis, pain and fever are not evident. Some children may have mood or behavior changes. Most will have a purulent, runny nose and nasal congestion even to the point where they must mouth breathe. The infected sinus drains around the Eustachian tube, and therefore many of the children will also have a middle ear infection.

Seasonal allergic rhinitis may resolve after a short period. Administration of the proper over-the-counter antihistamines may alleviate the symptoms. However, if your child suffers from perennial (year round) allergic rhinitis, an examination by specialist will assist in preventing other ear, nose, and throat problems from occurring.

Today in the United States, studies estimate that 34 percent of U.S. adults are overweight and an additional 31 percent (approximately 60 million) are obese. Combined, approximately 127 million Americans are overweight or obese. Some 42 years ago, 13 percent of Americans were obese, and in 1980 15 percent were considered obese.

Alarmingly, the number of children who are overweight or obese has doubled in the last two decades as well. Currently, more than 15 percent of 6- to 11-year-olds and more than 15 percent of 12- to 19-year-olds are considered overweight or obese.

What is the difference between designated "obese" versus "overweight?"

Unfortunately, the words overweight and obese are often interchanged. There is a difference:

  • Overweight: Anyone with a body mass index (BMI) (a ratio between your height and weight) of 25 or above (e.g., someone who is 5-foot-4 and 145 pounds) is considered overweight.
  • Obesity: Anyone with a BMI of 30 or above (e.g., someone who is 5-foot-4 and 175 pounds) is considered obese.
  • Morbid obesity: Anyone with a BMI of 40 or above (e.g., someone who is 5-foot-4 and 233 pounds) is considered morbidly obese. "Morbid" is a medical term indicating that the risk of obesity related illness is increased dramatically at this degree of obesity.

Obesity can present significant health risks to the young child. Diseases are being seen in obese children that were once thought to be adult diseases. Many experts in the study of children"s health suggest that a dysfunctional metabolism, or failure of the body to change food calories to energy, precedes the onset of disease. Consequently, these children are at risk for Type II Diabetes, fatty liver, elevated cholesterol, SCFE (a major hip disorder), menstrual irregularities, sleep apnea, and irregular metabolism. Additionally, there are psychological consequences; obese children are subject to depression, loss of self-esteem, and isolation from their peers.

Pediatric obesity and otolaryngic problems

Otolaryngologists, or ear, nose, and throat specialists, diagnose and treat some of the most common children"s disorders. They also treat ear, nose, and throat conditions that are common in obese children, such as:

Sleep apnea:

Children with sleep apnea literally stop breathing repeatedly during their sleep, often for a minute or longer, usually ten to 60 times during a single night. Sleep apnea can be caused by either complete obstruction of the airway (obstructive apnea) or partial obstruction (obstructive hypopnea hypopnea is slow, shallow breathing), both of which can wake one up. There are three types of sleep apnea obstructive, central, and mixed. Of these, obstructive sleep apnea (OSA) is the most common. Otolaryngologists have pioneered the treatment for sleep apnea; research shows that one to three percent of children have this disorder, often between the age of two-to-five years old.

Enlarged tonsils, which block the airway, are usually the key factor leading to this condition. Extra weight in obese children and adults can also interfere with the ability of the chest and abdomen to fully expand during breathing, hindering the intake of air and increasing the risk of sleep apnea.

The American Academy of Pediatrics has identified obstructive sleep apnea syndrome (OSAS) as a "common condition in childhood that results in severe complications if left untreated." Among the potential consequences of untreated pediatric sleep apnea are growth failure; learning, attention, and behavior problems; and cardio-vascular complications. Because sleep apnea is rarely diagnosed, pediatricians now recommend that all children be regularly screened for snoring.

Middle ear infections:

Acute otitis media (AOM) and chronic ear infections account for 15 to 30 million visits to the doctor each year in the U.S. In fact, ear infections are the most common reason why an American child sees a doctor. Furthermore, the incidence of AOM has been rising over the past decades. Although there is no proven medical link between middle ear infections and pediatric obesity there may be a behavioral association between the two conditions. Some studies have found that when a child is rubbing or massaging the infected ear the parent often responds by offering the child food or snacks for comfort.

When a child does have an ear infection the first line of treatment is often a regimen of antibiotics. When antibiotics are not effective, the ear, nose and throat specialist might recommend a bilateral myringotomy with pressure equalizing tube placement (BMT), a minor surgical procedure. This surgery involves the placement of small tubes in the eardrum of both ears. The benefit is to drain the fluid buildup behind the eardrum and to keep the pressure in the ear the same as it is in the exterior of the ear. This will reduce the chances of any new infections and may correct any hearing loss caused by the fluid buildup.

Postoperative vomiting (POV) is a common problem after bilateral myringotomy surgery. The overall incidence is 35 percent, and usually occurs on the first postoperative day, but can occur up to seven days later. Several factors are known to affect the incidence of POV, including age, type of surgery, postoperative care, medications, co-existing diseases, past history of POV, and anesthetic management. Obesity, gastroparesis, female gender, motion sickness, pre-op anxiety, opiod analgesics, and the duration of anesthetic all increase the incidence of POV. POV interferes with oral medication and intake, delays return to normal activity, and increases length of hospital stay. It remains one of the most common causes of unplanned postoperative hospital admissions.

Tonsillectomies:

A child"s tonsils are removed because they are either chronically infected or, as in most cases, enlarged, leading to obstructive sleep apnea. There are several surgical procedures utilized by ear, nose, and throat specialists to remove the tonsils, ranging from use of a scalpel to a wand that emits energy that shrinks the tonsils.

Research conducted by otolaryngologists found that Morbid obesity was a contributing factor for requiring an overnight hospital admission for a child undergoing removal of enlarged tonsils. Most children who were diagnosed as obese with sleep apnea required a next-day physician follow-up.

A study from the University of Texas found that morbidly obese patients have a significant increase of additional medical disorders following tonsillectomy and adenoidectomy for obstructive sleep apnea or sleep-disordered breathing when compared to moderately obese or overweight patients undergoing this procedure for the same diagnosis. On average they have longer hospital stays, a greater need for intensive care, and a higher incidence of the need for apnea treatment of continuous positive airway pressure upon discharge from the hospital. The study found that although the morbidly obese group had a greater degree of sleep apnea, they did benefit from the procedure in regards to snoring, apneic spells, and daytime somnolence.

What you can do?

If your child has a weight problem, contract your pediatrician or family physician to discuss the weight"s effect on your child"s health, especially prior to treatment decisions. Second, ask your physician about lifestyle and diet changes that will reduce your child"s weight to a healthy standard.

Not every headache is the consequence of sinus and nasal passage problems. For example, many patients visit an ear, nose, and throat specialist to seek treatment for a sinus headache and learn they actually have a migraine or tension headache. The confusion is common, a migraine can cause irritation of the trigeminal or fifth cranial nerve (with branches in the forehead, cheeks and jaw). This may produce pain at the lower-end branches of the nerve, in or near the sinus cavity.

Symptoms Of Sinusitis

Pain in the sinus area does not automatically mean that you have a sinus disorder. On the other hand, sinus and nasal passages can become inflamed leading to a headache. Headache is one of the key symptoms of patients diagnosed with acute or chronic sinusitis. In addition to a headache, sinusitis patients often complain of:

  • Pain and pressure around the eyes, across the cheeks and the forehead
  • Achy feeling in the upper teeth
  • Fever and chills
  • Facial swelling
  • Nasal stuffiness
  • Yellow or green discharge

However, it is important to note that there are some cases of headaches related to chronic sinusitis without other upper respiratory symptoms. This suggests that an examination for sinusitis be considered when treatment for a migraine or other headache disorder is unsuccessful.

Treatment For A Sinus Headache

Sinus headaches are associated with a swelling of the membranes lining the sinuses (spaces adjacent to the nasal passages). Pain occurs in the affected region the result of air, pus, and mucus being trapped within the obstructed sinuses. The discomfort often occurs under the eye and in the upper teeth (disguised as a headache or toothache). Sinus headaches tend to worsen as you bend forward or lie down. The key to relieving the symptoms is to reduce sinus swelling and inflammation and facilitate mucous drainage from the sinuses.

There are several at-home steps that help prevent sinus headache or alleviate its pain. They include:

  • Breathe moist air: Relief for a sinus headache can be achieved by humidifying the dry air environment. This can be done by using a steam vaporizer or cool-mist humidifier, steam from a basin of hot water, or steam from a hot shower.
  • Alternate hot and cold compresses: Place a hot compress across your sinuses for three minutes, and then a cold compress for 30 seconds. Repeat this procedure three times per treatment, two to six times a day.
  • Nasal irrigation: Some believe that when nasal irrigation or rinse is performed, mucus, allergy creating particles and irritants such as pollens, dust particles, pollutants and bacteria are washed away, reducing the inflammation of the mucous membrane. Normal mucosa will fight infections and allergies better and will reduce the symptoms. Nasal irrigation helps shrink the sinus membranes and thus increases drainage. There are several over-the-counter nasal rinse products available. Consult your ear, nose, and throat specialist for directions on making a home nasal rinse or irrigation solution.
  • Over-the-counter medications: Some over-the-counter (OTC) drugs are highly effective in reducing sinus headache pain. The primary ingredient in most OTC pain relievers is aspirin, acetaminophen, ibuprofen, naproxen, or a combination of them. The best way to choose a pain reliever is by determining which of these ingredients works best for you.
  • Decongestants: Sinus pressure headaches caused by allergies are usually treated with decongestants and antihistamines. In difficult cases, nasal steroid sprays may be recommended.
  • Alternative medicine: Chinese herbalists use Magnolia Flower as a remedy for clogged sinus and nasal passages. In conjunction with other herbs, such as angelica, mint, and chrysanthemum, it is often recommended for upper respiratory tract infections and sinus headaches, although its effectiveness for these problems has not been scientifically confirmed.

If none of these preventative measures or treatments is effective, a visit to an ear, nose, and throat specialist may be warranted. During the examination, a CT scan of the sinuses may be ordered to determine the extent of blockage caused by chronic sinusitis. If no chronic sinusitis were found, treatment might then include allergy testing and desensitization (allergy shots). Acute sinusitis is treated with antibiotics and decongestants. If antibiotics fail to relieve the chronic sinusitis and accompanying headaches, endoscopic or image-guided surgery may be the recommended treatment.

Why Do We Suffer From Nasal And Sinus Discomfort?

The body"s nasal and sinus membranes have similar responses to viruses, allergic insults, and common bacterial infections. Membranes become swollen and congested. This congestion causes pain and pressure; mucus production increases during inflammation, resulting in a drippy, runny nose. These secretions may thicken over time, may slow in their drainage, and may predispose to future bacterial infection of the sinuses.

Congestion of the nasal membranes may even block the eustachian tube leading to the ear, resulting in a feeling of blockage in the ear or fluid behind the eardrum. Additionally, nasal airway congestion causes the individual to breathe through the mouth.

Each year, more than 37 million Americans suffer from sinusitis, which typically includes nasal congestion, thick yellow-green nasal discharge, facial pain, and pressure. Many do not understand the nature of their illness or what produces their symptoms. Consequently, before visiting a physician, they seek relief for their nasal and sinus discomfort by taking non-prescription or over-the-counter (OTC) medications.

What Is The Role Of OTC Medication For Sinus Pain?

There are many different OTC medications available to relieve the common complaints of sinus pain and pressure, allergy problems, and nasal congestion. Most of these medications are combination products that associate either a pain reliever such as acetaminophen with a decongestant or an antihistamine. Knowledge of these products and of the probable cause of symptoms will help the consumer to decide which product is best suited to relieve the common symptoms associated with nasal or sinus inflammation.

OTC nasal medications are designed to reduce symptoms produced by the inflammation of nasal membranes and sinuses. The goals of OTC medications are to: (1) reopen to nasal passages; (2) reduce nasal congestion; (3) relieve pain and pressure symptoms; and (4) reduce potential for complications. The medications come in several forms.

Nasal Saline Sprays: Non-Medicated Nasal Sprays Nasal saline is an invaluable addition to the list of over-the-counter medications. It is ideal for all types of nasal problems. The added moisture produced by the saline reduces thick secretions and assists in the removal of infectious agents. There is no risk of becoming "addicted" to nasal saline. It should be applied as a mist to the nose up to six times per day. Nasal saline can also be made at home: contact your otolaryngologist for details.

Nasal Decongestant Sprays: Medicated Nasal Sprays

Afrin nasal spray, Neo-Synephrine, Otrivin, Dristan nasal spray, and other brands decongest the swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating the initial stages of a common cold or viral infection. Nasal decongestant sprays are safe to use, especially appropriate for preventing eustachian tube problems when flying, and to halt progression of sinus infections following colds. However, they should only be utilized for 3-5 days because prolonged use leads to rebound congestion or "getting hooked on nasal sprays." The patient with nasal swelling caused by seasonal allergy problems should use a cromolyn sodium nasal spray. The spray must be used frequently (four times a day) during allergy season to prevent the release of histamine from the tissues, which starts the allergic reaction. It works best before symptoms become established by stabilizing the nasal membranes and has few side effects.

Decongestant Medications

Pressure and congestion are common symptoms of nasal passage swelling. Decongestant medications are OTC products that relieve nasal swelling, pressure, and congestion but do not treat the cause of the inflammation. They reduce blood flow to the nasal membranes leading to improved airflow, less breathing through the mouth, decreased pressure in the sinuses and head, and subsequently less discomfort. Decongestants do not relieve drippy noses. Their side effects may include light headedness or giddiness and increased blood pressure and heart rate. (Patients with high blood pressure or heart problems should consult a physician before use.) In addition, other medications may interact with oral decongestants causing side effects. Both of these are available as single products or in combination with a pain reliever or an antihistamine. They are labeled as "non-drowsy" due to a side effect of stimulation of the nervous system.

Decongestant-Combination Products

Some medications are combined to reduce the number of pills. Tylenol® Sinus or Advil Cold and Sinus® exemplify products that join a pain reliever (acetaminophen or ibuprophen) with a decongestant (pseudoephedrine). These products relieve both sinus and cold/flu symptoms yet retain all the attributes of the individual drug including side effects.

Antihistamine Medications

Antihistamines combat allergic problems leading to nasal congestion. OTC antihistamines such as diphenhydramine (Benadryl®), or clemastine (Tavist®) may be used for relieving allergic symptoms of itching, sneezing, and nasal congestion. They relieve the drainage associated with the allergic inflammation but not obstruction or congestion. Antihistamines have a potential for sedation causing grogginess and dryness after use. Newer non-sedating antihistamines are available.

Antihistamine-Decongestant Combination ProductsAntihistamines and decongestant products are often combined to relieve multiple symptoms of congestion and drainage and reduce the side effects of both products. Antihistamines produce sedation; decongestants are added to make them "non-drowsy." The combined allergy product then relieves congestion and a runny nose.

The ear, nose, and throat specialist will prescribe many medications (antibiotics, decongestants, nasal steroid sprays, antihistamines) and procedures (flushing) for treating acute sinusitis. There are occasions when physician and patient find that the infections are recurrent and/or non-responsive to the medication. When this occurs, surgery to enlarge the openings that drain the sinuses is an option.

A recommendation for sinus surgery in the early 20th century would easily alarm the patient. In that era, the surgeon would have to perform an invasive procedure, reaching the sinuses by entering through the cheek area, often resulting in scarring and possible disfigurement. Today, these concerns have been eradicated with the latest advances in medicine. A trained surgeon can now treat sinusitis with minimal discomfort, a brief convalescence, and few complications.

A clinical history of the patient will be created before any surgery is performed. A careful diagnostic workup is necessary to identify the underlying cause of acute or chronic sinusitis, which is often found in the anterior ethmoid area, where the maxillary and frontal sinuses connect with the nose. This may necessitate a sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected blood tests to determine an operative strategy. Note: Sinus X rays have limited utility in the diagnosis of acute sinusitis and are of no value in the evaluation of chronic sinusitis.

Sinus Surgical Options Include:

Functional endoscopic sinus surgery (FESS): Developed in the 1950s, the nasal endoscope has revolutionized sinusitis surgery. In the past, the surgical strategy was to remove all sinus mucosa from the major sinuses. The use of an endoscope is linked to the theory that the best way to obtain normal healthy sinuses is to open the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa has an opportunity to return to normal.

FESS involves the insertion of the endoscope, a very thin fiber-optic tube, into the nose for a direct visual examination of the openings into the sinuses. With state of the art micro-telescopes and instruments, abnormal and obstructive tissues are then removed. In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort.

The advantage of the procedure is that the surgery is less extensive, there is often less removal of normal tissues, and can frequently be performed on an outpatient basis. After the operation, the patient will sometimes have nasal packing. Ten days after the procedure, nasal irrigation may be recommended to prevent crusting.

Image guided surgery: The sinuses are physically close to the brain, the eye, and major arteries, always areas of concern when a fiber optic tube is inserted into the sinus region. The growing use of a new technology, image guided endoscopic surgery, is alleviating that concern. This type of surgery may be recommended for severe forms of chronic sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or where a patient"s sinus anatomy is very unusual, making typical surgery difficult.

Image guidance is a near-three-dimensional mapping system that combines computed tomography (CT) scans and real-time information about the exact position of surgical instruments using infrared signals. In this way, surgeons can navigate their surgical instruments through complex sinus passages and provide surgical relief more precisely. Image guidance uses some of the same stealth principles used by the United States armed forces to guide bombs to their target.

Caldwell Luc operation: Another option is the Caldwell-Luc operation, which relieves chronic sinusitis by improving the drainage of the maxillary sinus, one of the cavities beneath the eye. The maxillary sinus is entered through the upper jaw above one of the second molar teeth. A "window" is created to connect the maxillary sinus with the nose, thus improving drainage. The operation is named after American physician George Caldwell and French laryngologist Henry Luc and is most often performed when a malignancy is present in the sinus cavity.

More than 20 percent of U.S. residents will be 65 or older in 2030. Of all Americans 65 and older, 14.1 percent report that they suffer from chronic sinusitis; for those 75 years and older, the rate declines to 13.5 percent.

Geriatric Rhinitis Complaints Are:

  • Constant need to clear the throat
  • A sense of nasal obstruction
  • Nasal crusting
  • Vague facial pressure
  • Decreased sense of smell and taste

For the most part, sinusitis symptoms, diagnosis, and treatment are the same for the elderly as other adult age groups. However, there are special considerations for older Americans.

Changing Physiology:

With aging, the physiology and function of the nose changes. The nose lengthens, and the nasal tip begins to droop due to weakening of the supporting cartilage. This in turn causes a restriction of nasal airflow, particularly at the nasal valve region (where the upper and lower lateral cartilages meet). Narrowing in this area results in the complaint of nasal obstruction, often referred to as geriatric rhinitis.

Patients with geriatric rhinitis typically complain of constant "sinus drainage," a chronic need to clear the throat or "hawk" mucus, and a sense of nasal obstruction, most often when they lie down. Other features include nasal crusting especially in the winter and in patients taking diuretics, vague facial pressure (attributed to "sinus trouble"), and a decreased sense of smell and taste.

However, it is a mistake to blame all upper respiratory problems on the aging process. Elderly patients with symptoms such as repeated sneezing, and watery eyes, nasal obstruction with clear profuse watery runny nose, and soft, pale turbinates (top-shaped bones in the nose) may have allergic rhinitis. Patients with this diagnosis will benefit from consultation with an otolaryngic allergist.

Patients with chronic sinusitis will have a long history of thick drainage that is often foul smelling and tasting and is associated with nasal obstruction, headaches, and facial pressure. These patients usually have pus drainage and nasal redness. In contrast, the geriatric rhinitis patient usually has a dry, irritated nose. The diagnosis of chronic sinusitis can be confirmed with a computed tomography scan (CT scan) of the sinuses.

Sinusitis or rhinosinusitis, which is it? In recent studies, otolaryngologist head and neck surgeons have concluded that sinusitis is often preceded by rhinitis and rarely occurs without concurrent rhinitis. The symptoms, nasal obstruction/discharge and loss of smell, occur in both disorders. Symptoms associated with rhinosinusitis include nasal obstruction, nasal congestion, nasal discharge, nasal purulence, postnasal drip, facial pressure and pain, alteration in the sense of smell, cough, fever, halitosis, fatigue, dental pain, pharyngitis, otologic symptoms (e.g., ear fullness and clicking), and headache. Patients with documented chronic sinusitis unresponsive to medications should be referred to an otolaryngologist.

Osteoporosis:

Osteoporosis is a significant health problem in the United States affecting approximately 24 million Americans, 15 to 20 million of whom are women over 45 years of age. Because of the concerns regarding prolonged estrogen use in postmenopausal women, a nasal calcitonin spray is sometimes prescribed to prevent bone loss. The most common side effect reported with nasal calcitonin spray is a runny nose. Other symptoms that may occur include nasal crust, dryness, redness, irritation, sinusitis, nosebleeds, and headache. Sinusitis sufferers using a nasal calcitonin spray should inform their physicians.

Medications For Geriatric Rhinitis:

Treatment for this age group needs to be more individualized to meet the patient"s slower metabolism and the increasing potential for side effects. The majority (80 to 85 percent) of the nation"s elderly have chronic diseases and take multiple drugs including over-the-counter medications, Placing them at higher risk for drug interactions than other patients.

Surgery For Geriatric Rhinitis:

Nasal and sinus surgery is occasionally advised for older patients. Patients with structural abnormalities, such as a deviated septum or nasal valve collapse causing severe nasal problems, should be referred to an otolaryngologist for evaluation and possible surgical management.

Sources For Aging Patients:

Administration on Aging (AoA), U.S. Department of Health and Human Services; Geriatrics.

Symptoms Of Sinusitis:

  • symptoms of upper respiratory infection lasting ten days or more
  • facial pressure or pain
  • nasal discharge that is yellow or green
  • post-nasal drip
  • cough

At-Home Treatments For Sinusitis:

  • saline nasal sprays that moisturize the nasal cavity, reduce dryness, and help clear thick or crusty mucus
  • humidification (moisturizing the air) of living spaces in dry climates will to aid the movement of mucus through the sinuses

A Physician Visit For Your Sinus Pain Will:

  • determine if you have an infection requiring an appropriate antibiotic
  • discover if you require intensive medical treatment for a condition such as a nasal obstructions, necessitating sinus surgery

You might not think your nose is a "vital organ," but indeed it is! To understand its importance, all that most people need to experience is a bad cold. Nasal congestion and a runny nose have a noticeable effect on quality of life, energy level, ability to breathe, ability to sleep, and ability to function in general.

Why Is Your Nose So Important?

It processes the air that you breathe before it enters your lungs. Most of this activity takes place in and on the turbinates, located on the sides of the nasal passages. In an adult, 18,000 to 20,000 liters of air pass through the nose each day.

Your Nose Protects Your Health By:

  • Filtering all that air and retaining particles as small as a pollen grain with 100% efficiency.
  • Humidifiing the air that you breathe, adding moisture to the air to prevent dryness of the lining of the lungs and bronchial tubes.
  • Warming cold air to body temperature before it arrives in your lungs.

For these and many other reasons, normal nasal function is essential. Do your lungs a favor; take care of your nose.

TIP:Keep a list of all your medications; know all the potential side effects; and discuss possible interactions with your doctors.

Because the connection between the nose and lungs is so important, paying attention to problems in the nose--allergic rhinitis for instance can reduce or avoid problems in the lungs such as bronchitis and asthma. Ignoring nasal symptoms such as congestion, sneezing, runny nose, or thick nasal discharge can aggravate lung problems and lead to other problems:

  • Nasal congestion reduces the sense of smell.
  • Mouth breathing causes dry mouth, which increases the risk of mouth and throat infections and reduces the sense of taste. Mouth breathing also pulls all pollution and germs directly into the lungs; dry cold air in the lungs makes the secretions thick, slows the cleaning cilia, and slows down the passage of oxygen into the blood stream.
  • Ignoring nasal allergies increases the chance that you will develop asthma; it also makes asthma worse if you already have it.

So, it is important to treat nasal symptoms promptly to prevent worsening of lung problems.

Tips To Improve The Health Of Your Nose And Lungs:

If your nose is dry, its various functions will be impaired. Try over-the-counter salt-water (saline) nasal mists and sprays to help maintain nasal health. These can be used liberally and at your discretion.

Beware of over-the-counter nasal decongestant sprays; prolonged use of these sprays may damage the cilia that clear the nose and sinuses. Decongestants can become addictive and actually cause nasal congestion to get worse.

Think of your nose when you"re traveling. Air-conditioned cruise ships may have high levels of mold in the cabins. Airplane air is very dry and contains a lot of recirculated particles and germs; a dry nose is more susceptible to germs. Use saline nasal mist frequently during the flight, and drink lots of water.

Medications Prescribed To Treat Nasal Problems:

Be aware of the nasal effects of other medications

  • Diuretic blood pressure medications cause dryness in the nose and throat, making them more susceptible to germs and pollens.
  • Many anti-anxiety medications also have a drying effect on the nose and throat.
  • Birth control pills, blood pressure medicines called beta-blockers, and Viagra can cause increased nasal congestion.
  • Eye drops can aggravate nasal symptoms when they drain into the nose with tears.

Be sure you understand their purpose. Each one is important and plays a separate role in treating nasal symptoms.

The foundation of the treatment of chronic nasal conditions is the regular use of an anti-inflammatory prescription nasal spray, which address all types of nose and sinus inflammation. These sprays should be used only as directed by your doctor. This is in contrast to medications that are inhaled by mouth into the lungs, which often have high levels of absorption into the blood stream. Always aim nasal sprays to the side of the nose; spraying into the center of the nose can cause too much dryness.

Antihistamines effectively relieve sneezing, itching and runny nose, but they have no effect on nasal congestion at least in the short term. Over-the-counter antihistamines cause drowsiness, slow the cleaning function of the cilia, and increase the stickiness of nasal mucus--causing germs and pollens to stay in the nose longer. There are prescription antihistamines that do not have any of these side effects. To achieve this safety, the relief is often slower starting, so patience is required.

Decongestants help to unclog stopped up noses but do very little for runny noses and sneezing. They work much faster to unclog the nose, but to achieve this quick action, there are often side-effects such as dry mouth, nervousness, and insomnia. The correct dose often has to be customized to get the benefit without the side-effects.

Be aware of medication side effects; no medicine works well for all people, and all medications can cause side effects.

What Is A Fungus?

Fungi are plant-like organisms that lack chlorophyll. Since they do not have chlorophyll, fungi must absorb food from dead organic matter. Fungi share with bacteria the important ability to break down complex organic substances of almost every type (cellulose) and are essential to the recycling of carbon and other elements in the cycle of life. Fungi are supposed to "eat" only dead things, but sometimes they start eating when the organism is still alive. This is the cause of fungal infections; the treatment selected has to eradicate the fungus to be effective.

In the past 30 years, there has been a significant increase in the number of recorded fungal infections. This can be attributed to increased public awareness, new immunosuppressive therapies (medications such as cyclosporine that "fool" the body"s immune system to prevent organ rejection) and overuse of antibiotics (anti-infectives).When the body"s immune system is suppressed, fungi find an opportunity to invade the body and a number of side effects occur. Because these organisms do not require light for food production, they can live in a damp and dark environment. The sinuses, consisting of moist, dark cavities, are a natural home to the invading fungi. When this occurs, fungal sinusitis results.

There Are Four Types Of Fungal Sinusitis:

Mycetoma Fungal Sinusitis produces clumps of spores, a "fungal ball," within a sinus cavity, most frequently the maxillary sinuses. The patient usually maintains an effective immune system, but may have experienced trauma or injury to the affected sinus(es). Generally, the fungus does not cause a significant inflammatory response, but sinus discomfort occurs. The noninvasive nature of this disorder requires a treatment consisting of simple scraping of the infected sinus. An anti-fungal therapy is generally not prescribed.

Allergic Fungal Sinusitis (AFS) is now believed to be an allergic reaction to environmental fungi that is finely dispersed into the air. This condition usually occurs in patients with an immunocompetent host (possessing the ability to mount a normal immune response). Patients diagnosed with AFS have a history of allergic rhinitis, and the onset of AFS development is difficult to determine. Thick fungal debris and mucin (a secretion containing carbohydrate-rich glycoproteins) are developed in the sinus cavities and must be surgically removed so that the inciting allergen is no longer present. Recurrence is not uncommon once the disease is removed. Anti-inflammatory medical therapy and immunotherapy are typically prescribed to prevent AFS recurrence.

Note: A 1999 study published in the Mayo Clinic Proceedings asserts that allergic fungal sinusitis is present in a significant majority of patients diagnosed with chronic rhinosinusitis. The study found 96 percent of the study subjects with chronic rhinosinusitis to have a fungus in cultures of their nasal secretions. In sensitive individuals, the presence of fungus results in a disease process in which the body"s immune system sends eosinophils (white blood cells distinguished by their lobulated nuclei and the presence of large granules that attract the reddish-orange eosin stain) to attack fungi, and the eosinophils irritate the membranes in the nose. As long as fungi remain, so will the irritation.

Chronic Indolent Sinusitis is an invasive form of fungal sinusitis in patients without an identifiable immune deficiency. This form is generally found outside the US, most commonly in the Sudan and northern India. The disease progresses from months to years and presents symptoms that include chronic headache and progressive facial swelling that can cause visual impairment. Microscopically, chronic indolent sinusitis is characterized by a granulomatous inflammatory infiltrate (nodular shaped inflammatory lesions). A decreased immune system can place patients at risk for this invasive disease.

Fulminant Sinusitis is usually seen in the immunocompromised patient (an individual whose immunologic mechanism is deficient either because of an immunodeficiency disorder or because it has been rendered so by immunosuppressive agents). The disease leads to progressive destruction of the sinuses and can invade the bony cavities containing the eyeball and brain.

The recommended therapies for both chronic indolent and fulminant sinusitis are aggressive surgical removal of the fungal material and intravenous anti-fungal therapy.

Projecting prominently from the central part of the face, it is no surprise that the nose is the most commonly broken bone on the head. A broken nose (nasal fracture) can significantly alter your appearance. It can also make it much harder to breathe through the nose.

What is a nasal fracture?

Getting struck on the nose, whether by another person, a door, or the floor is not pleasant. Your nose will hurt usually a lot. You"ll likely have a nose bleed and soon find it difficult to breathe through your nose. Swelling develops both inside and outside the nose, and you may get dark bruises around your eyes ("black eyes").

Nasal fractures can affect both bone and cartilage. A collection of blood (called a "septal hematoma") can sometimes form on the nasal septum (a wall made of bone and cartilage inside the nose that separates the sides of the nose).

What causes a nasal fracture?

Nasal fractures, or broken noses, result from facial injuries in contact sports or falls. Injuries affecting the teeth and mouth may also affect the nose.

How can I prevent a broken nose?

  • Wear protective gear to shield your face when participating in contact sports
  • Avoid fist fights

When should I see a doctor?

If you"ve been struck in the nose, it"s important to see a physician to check for septal hematoma. Seeing your primary doctor or an emergency room physician is usually adequate to determine if you have a septal hematoma or other associated problems from your accident. If a septal hematoma is present, it must be treated promptly to prevent worse problems from developing in the nose. If you suspect your nose may be broken, see an otolaryngologist head and neck surgeon within one week of the injury. If you are seen within one to two weeks, it may be possible to repair your nose immediately. If you wait longer than two weeks (one week for children) you will likely need to wait several months before your nose can be surgically straightened and fixed.

If left untreated, a broken nose can leave you with an undesirable appearance as well as permanent difficulty in trying to breathe.

How will my doctor determine if I have a broken nose?

Your doctor will ask you several questions and will examine your nose and face. You will be asked to explain how the fracture occurred, the state of your general health, and how your nose looked before the injury. The doctor will examine not only your nose, but also the surrounding areas including your eyes, jaw, and teeth, and will look for bruising, lacerations, and swelling.

Sometimes your physician will recommend an x-ray or computed tomography (CT) scan. These can help to identify other facial fractures but are not always helpful in determining if you have a broken nose. The best way to determine that your nose is broken is if it looks very different or is harder to breathe through.

What are my treatment options?

If your nose is broken but not out of position, you may need no treatment other than rest and being careful not to bump your nose.

If your nose is broken so badly that it needs to be repositioned, you have several options. You can have your nose repaired in the office in some situations. Your doctor can give you some local anesthesia, reposition the broken bones into place, and then hold them in the right location with a "cast" made of plastic, plaster, or metal. This cast will then stay in place for a week. In the first two weeks after the injury, your doctor may offer you this kind of repair, or a similar approach using general anesthesia in the operating room.

What if I need surgery?

If more than two weeks have passed since the time of your injury, you may need to wait a while before having your nose straightened surgically. It may be necessary to wait two to three months before a good repair can be done, by which time there will be less swelling and your nose will have begun to heal. Reduced swelling will allow the surgeon to get a more accurate picture of how your nose originally looked. This type of surgery is considered reconstructive plastic surgery, as its goal is to restore your appearance to the way it was prior to injury. If your repair is done within two weeks of the injury, restoring prior appearance is the only possible goal. If you have waited several months for the repair, it is often possible to change the appearance of your nose as you desire. Should you be interested in this kind of appearance change as well as repair, you can feel confident that your otolaryngologist is a specialist in all surgery of the nose. No other specialty has more training in surgery on the nose, and some otolaryngologists focus exclusively on plastic surgery of the face.

Improving Form And Function Of The Nose

Each year thousands of people undergo surgery of the nose. Nasal surgery may be performed for cosmetic purposes, or a combination procedure to improve both form and function. It also may alleviate or cure nasal breathing problems, correct deformities from birth or injury, or support an aging, drooping nose.

Patients who are considering nasal surgery for any reason should seek a doctor who is a specialist in nasal airway function, as well as plastic surgery. This will ensure that efficient breathing is as high a priority as appearance.

Can Cosmetic Nasal Surgery Create A "Perfect" Nose?

Aesthetic nasal surgery (rhinoplasty) refines the shape of the nose, bringing it into balance with the other features of the face. Because the nose is the most prominent facial feature, even a slight alteration can greatly improve appearance. (Some patients elect chin augmentation in conjunction with rhinoplasty to better balance their features.) Rhinoplasty alone cannot give you a perfect profile, make you look like someone else, or improve your personal life. Before surgery, it is very important that the patient have a clear, realistic understanding of what change is possible as well as the limitations and risks of the procedure.

Skin type, ethnic background, and age will be among the factors considered preoperatively by the surgeon. Except in cases of severe breathing impairment, young patients usually are not candidates until their noses are fully grown, at 15 or 16 years of age. The surgeon will also discuss risk factors, which are generally minor, as well as where the surgery will be performed-in a hospital, freestanding outpatient surgical center, or a certified office operating room.

To reshape the nose, the skin is lifted, allowing the surgeon to remove or rearrange the bone and cartilage. The skin is then redraped and sutured over the new frame. A nasal splint on the outside of the nose helps retain the new shape during healing. If soft, absorbent material is placed inside the nose to stabilize the septum, it will normally be removed the morning after surgery. External nasal dressings and splints are usually removed five to seven days after surgery.

When Should Surgery Be Considered to Correct a Chronically Stuffy Nose?

Millions of Americans perennially suffer the discomfort of nasal stuffiness. This may be indicative of chronic breathing problems that don"t respond well to ordinary treatment. The blockage may be related to structural abnormalities inside the nose or to swelling caused by allergies or viruses.

There are numerous causes of nasal obstruction. A deviated septum (the partition between the nostrils) can be crooked or bent as the result of abnormal growth or injury. This can partially or completely close one or both nasal passages. The deviated septum can be corrected with a surgical procedure called septoplasty. Cosmetic changes to the nose are often performed at the same time, in a combination procedure called septorhinoplasty.

Overgrowth of the turbinates is yet another cause of stuffiness. (The turbinates are the tissues that line the inside of the nasal passages.) Sometimes the turbinates need treatment to make them smaller and expand the nasal passages. Treatments include injection, freezing, and partial removal. Allergies, too, can cause internal nasal swelling, and allergy evaluation and therapy may be necessary.

Can Surgery Correct a Stuffy, Aging Nose?

Aging is a common cause of nasal obstruction. This occurs when cartilage in the nose and its tip are weakened by age and droop because of gravity, causing the sides of the nose to collapse inward, obstructing air flow. Mouth breathing or noisy and restricted breathing are common.

Try lifting the tip of your nose to see if you breathe better. If so, the external adhesive nasal strips that athletes have popularized may help. Or talk to a facial plastic surgeon/otolaryngolgist about septoplasty, which will involve trimming, reshaping or repositioning portions of septal cartilage and bone. (This is an ideal time to make other cosmetic improvements as well.) Internal splints or soft packing may be placed in the nostrils to hold the septum in its new position. Usually, patients experience some swelling for a week or two. However, after the packing is removed, most people enjoy a dramatic improvement in breathing.

What Treatment Is Needed for a Broken Nose?

Bruises around the eyes and/or a slightly crooked nose following injury usually indicate a fractured nose. If the bones are pushed over or out to one side, immediate medical attention is ideal. But once soft tissue swelling distorts the nose, waiting 48-72 hours for a doctor"s appointment may actually help the doctor in evaluating your injury as the swelling recedes. (Apply ice while waiting to see the doctor.) What"s most important is whether the nasal bones have been displaced, rather than just fractured or broken.

For markedly displaced bones, surgeons often attempt to return the nasal bones to a straighter position under local or general anesthesia. This is usually done within seven to ten days after injury, so that the bones don"t heal in a displaced position. Because so many fractures are irregular and won"t "pop" back into place, the procedure is successful only half the time. Displacement due to injury often results in compromised breathing so corrective nasal surgery, typically septorhinoplasty, may then be elected. This procedure is typically done on an outpatient basis, and patients usually plan to avoid appearing in public for about a week due to swelling and bruising.

Will Insurance Cover Nasal Surgery?

Insurance usually does not cover cosmetic surgery. However, surgery to correct or improve breathing function, major deformity, or injury is frequently covered in whole or in part. Patients should obtain cost information from their surgeons and discuss with their insurance carrier prior to surgery.

The nose is an area of the body that contains many tiny blood vessels or arterioles that can break easily. In the United States, one of every seven people will develop a nosebleed some time in their lifetime. Nosebleeds can occur at any age but are most common in children aged 2-10 years and adults aged 50-80 years. Nosebleeds are divided into two types, depending on whether the bleeding is coming from the front or back of the nose.

What is an anterior nosebleed?

Most nosebleeds or epistaxes begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. Nosebleed coming from the front of the nose or anterior nosebleeds often begin with a flow of blood out one nostril when the patient is sitting or standing.

Anterior nosebleeds are common in dry climates or during the winter months when dry, heated indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented by placing a light coating of petroleum jelly or an antibiotic ointment on the end of a fingertip and then rub it inside the nose, especially on the middle portion of the nose (the septum).

How to stop an anterior nosebleed?

  • Stay calm, or help a young child stay calm. A person who is agitated may bleed more profusely than someone whos been reassured and supported.
  • Keep head higher than the level of the heart. Sit up.
  • Lean slightly forward so the blood wont drain in the back of the throat.
  • Using the thumb and index finger, pinch all the soft parts of the nose or place a cotton ball soaked with Afrin, Neo-Synephrine, or Dura-Vent spray into the nostril and apply preassure. The area where pressure should be applied is located between the end of the nose and the hard, bony ridge that forms the bridge of the nose. Do not pack the inside of the nose with gauze or cotton.
  • Apply ice crushed in a plastic bag or washcloth to nose and cheeks.
  • Hold the position for five minutes. If its still bleeding, hold it again for an additional 10 minutes.

What is a posterior nosebleed?

More rarely, a nosebleed can begin high and deep within the nose and flow down the back of the mouth and throat even if the patient is sitting or standing.

Obviously, when lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow toward the back of the throat especially if coughing or blowing the nose. It is important to try to make the distinction between the anterior and posterior nosebleed, since posterior nosebleeds are often more severe and almost always require a physicians care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face.

What are the causes of recurring nosebleeds?

  • Allergies, infections, or dryness that cause itching and lead to picking of the nose.
  • Vigorous nose blowing that ruptures superficial blood vessels.
  • Clotting disorders that run in families or are due to medications.
  • Drugs (such as anticoagulants or anti-inflammatories).
  • Fractures of the nose or the base of the skull. Head injuries that cause nosebleeds should be regarded seriously.
  • Hereditary hemorrhagic telangiectasia, a disorder involving a blood vessel growth similar to a birthmark in the back of the nose.
  • Tumors, both malignant and nonmalignant, have to be considered, particularly in the older patient or in smokers.

When should an otolaryngologist be consulted?

If frequent nosebleeds are a problem, it is important to consult an otolaryngologist. An ear, nose, and throat specialist will carefully examine the nose using an endoscope, a tube with a light for seeing inside the nose, prior to making a treatment recommendation. Two of the most common treatments are cautery and packing the nose. Cautery is a technique in which the blood vessel is burned with an electric current, silver nitrate, or a laser. Sometimes, a doctor may just pack the nose with a special gauze or an inflatable latex balloon to put pressure on the blood vessel.

Tips to prevent a nosebleed

  • Keep the lining of the nose moist by gently applying a light coating of petroleum jelly or an antibiotic ointment with a cotton swab three times daily, including at bedtime. Commonly used products include Bacitracin, A and D Ointment, Eucerin, Polysporin, and Vaseline.
  • Keep childrens fingernails short to discourage nose picking.
  • Counteract the effects of dry air by using a humidifier.
  • Use a saline nasal spray to moisten dry nasal membranes.
  • Quit smoking. Smoking dries out the nose and irritates it.

Tips to prevent rebleeding after initial bleeding has stopped

  • Do not pick or blow nose.
  • Do not strain or bend down to lift anything heavy.
  • Keep head higher than the heart.

If rebleeding occurs:

  • Attempt to clear nose of all blood clots.
  • Spray nose four times in the bleeding nostril(s) with a decongestant spray such as Afrin or Neo-Synephrine.
  • Repeat the steps to stop an anterior nosebleed.

Call a doctor if bleeding persists after 30 minutes or if nosebleed occurs after an injury to the head.

Glands in your nose and throat continually produce mucus (one to two quarts a day). Mucus moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although it is normally swallowed unconsciously, the feeling of it accumulating in the throat or dripping from the back of your nose is called post-nasal drip. This sensation can be caused by excessively thick secretions or by throat muscle and swallowing disorders.

What causes abnormal secretions?

Thin secretions:

Increased thin clear secretions can be due to colds and flu, allergies, cold temperatures, bright lights, certain foods/spices, pregnancy, and other hormonal changes. Various drugs (including birth control pills and high blood pressure medications) and structural abnormalities can also produce increased secretions. These abnormalities might include a deviated or irregular nasal septum (the cartilage and bony dividing wall that separates the two nostrils).

Thick secretions:

Increased thick secretions in the winter often result from dryness in heated buildings and homes. They can also result from sinus or nose infections and allergies, especially to foods such as dairy products. If thin secretions become thick, and turn green or yellow, it is likely that a bacterial sinus infection is developing. In children, thick secretions from one side of the nose can mean that something is stuck in the nose such as a bean, wadded paper, or piece of toy. If these symptoms are observed, seek a physician for examination.

How is swallowing affected?

Swallowing problems may result in accumulation of solids or liquids in the throat that may complicate or feel like post-nasal drip. When the nerves and muscles in the mouth, throat, and food passage (esophagus) aren"t interacting properly, overflow secretions can spill into the voice box (larynx) and breathing passages (trachea and bronchi), causing hoarseness, throat clearing, or coughing.

Several factors contribute to swallowing problems:

  • With age, swallowing muscles often lose strength and coordination, making it difficult for even normal secretions to pass smoothly into the stomach.
  • During sleep, swallowing occurs much less frequently, and secretions may gather. Coughing and vigorous throat clearing are often needed upon waking.
  • When nervous or under stress, throat muscles can trigger spasms that make it feel as if there is a lump in the throat. Frequent throat clearing, which usually produces little or no mucus, can make the problem worse by increasing irritation.
  • Growths or swelling in the food passage can slow or prevent the movement of liquids and/or solids.

Swallowing problems may also be caused by gastroesophageal reflux disease (GERD). This is a backup of stomach contents and acid into the esophagus or throat. Heartburn, indigestion, and sore throat are common symptoms. GERD may be aggravated by lying down, especially following eating. Hiatal hernia, a pouch-like tissue mass where the esophagus meets the stomach, often contributes to the reflux.

How is the throat affected?

Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling that there is a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.

How is it treated?

A correct diagnosis requires a detailed ear, nose, and throat exam, and possibly laboratory, endoscopic (procedures that use a tube to look inside the body), and x-ray studies. Treatment varies according to the following causes:

  • Bacterial infections are treated with antibiotics. These drugs may only provide temporary relief. In cases of chronic sinusitis, surgery to open the blocked sinuses may be required.
  • Allergies are managed by avoiding the causes. Antihistamines and decongestants, cromolyn and steroid (cortisone type) nasal sprays, and other forms of steroids may offer relief. Immunotherapy, either by shots or sublingual (under the tongue drops) may also be helpful. However, some older, sedating antihistamines may dry and thicken post-nasal secretions even more; newer nonsedating antihistamines, available by prescription only, do not have this effect. Decongestants can aggravate high blood pressure, heart, and thyroid disease. Steroid sprays may be used safely under medical supervision. Oral and injectable steroids rarely produce serious complications in short-term use. Because significant side-effects can occur, steroids must be monitored carefully when used for more than one week.
  • Gastroesophageal reflux is treated by elevating the head of the bed six to eight inches, avoiding foods and beverages for two to three hours before bedtime, and eliminating alcohol and caffeine from the daily diet. Antacids such as Maalox®, Mylanta®, Gaviscon®, and drugs that block stomach acid production such as Zantac®, Tagamet®, or Pepcid®) may be prescribed. If these are not successful, stronger medications can be prescribed. Trial treatments are usually suggested before x-rays and other diagnostic studies are performed.

General measures that allow mucus secretions to pass more easily may be recommended when it is not possible to determine the cause. Many people, especially older persons, need more fluids to thin out secretions. Drinking more water, eliminating caffeine, and avoiding diuretics (medications that increase urination) will help. Mucous-thinning agents such as guaifenesin (Humibid®, Robitussin®) may also thin secretions. Nasal irrigations may alleviate thickened secretions. These can be performed two to four times a day either with a nasal douche device or a Water Pik® with a nasal irrigation nozzle. Warm water with baking soda or salt (½ to 1 tsp. to the pint) or Alkalol®, a nonprescription irrigating solution (full strength or diluted by half warm water), may be helpful. Finally, use of simple saline (salt) nonprescription nasal sprays (e.g., Ocean®, Ayr®, or Nasal®) to moisten the nose is often very beneficial.

Sinus Conditions

Sinuses are air-filled cavities in the skull. They drain into the nose through small openings. Blockages in the openings from swelling due to colds, flu, or allergies may lead to acute sinus infection. A viral cold that persists for 10 days or more may have become a bacterial sinus infection. This infection may increase post-nasal drip. If you suspect that you have a sinus infection, you should see your physician to see if it needs antibiotic treatment.

Chronic sinusitis occurs when sinus blockages persist, causing the lining of the sinuses to swell further. Polyps (growths in the nose) may develop with chronic sinusitis. Patients with polyps tend to have irritating, persistent post-nasal drip. Evaluation by an otolaryngologist may include an exam of the interior of the nose with a fiberoptic scope and CAT scan x-rays. If medication does not relieve the problem, surgery may be recommended.

Vasomotor Rhinitis describes a nonallergic "hyperirritable nose" that feels congested, blocked, or wet.

Access to quality healthcare for children is forwarded by the availability of good healthcare information. With this years release of a new surgeon generals report on secondhand smoke, the following information should be shared with patients.

New Warning on Secondhand Smoke

In July 2006, the Surgeon General released evidence supporting the fact that secondhand smoke, smoke from a burning cigarette and the smoke exhaled by the smoker, represents a dangerous health hazard.

The new report states that there is no risk-free level of secondhand smoke exposure. Although secondhand smoke is dangerous to everyone, fetuses, infants, and children are at most risk. Even brief exposures can be harmful to children. This is because secondhand smoke can damage developing organs, such as the lungs and brain.

Infants and Children Effects and Exposure

Babies of mothers who smoked and those exposed to smoke are more likely to die from Sudden Infant Death Syndrome (SIDS) than babies who are not exposed to smoke.

Babies of mothers who smoked and those exposed to smoke after birth have weaker lungs and thereby increased risk of more health problems.

Children with asthma exposed to secondhand smoke experience more frequent and severe attacks.

Children exposed to secondhand smoke are at increased risk for ear infections and are more likely to need an operation to insert ear tubes for drainage.

Youth and Teens Effects and Exposure

Secondhand smoke exposure causes respiratory symptoms, including cough, phlegm, wheeze, and breathlessness, among school-aged children.

On average, children are exposed to more secondhand smoke than nonsmoking adults.

Statistics

More than 4,000 different chemicals have been identified in secondhand smoke and at least 43 of these chemicals cause cancer.

On average, children are exposed to more secondhand smoke than nonsmoking adults.

Approximately 26 percent of adults in the United States currently smoke cigarettes, and 50 to 67 percent of children less than five years of age live in homes with at least one adult smoker.

28 percent of high schoolers are exposed to secondhand smoke in their own homes.

A recent study found that 34 percent of teens begin smoking as a result of tobacco company promotional activities.

Among middle school students who were current smokers, 71 percent reported never being asked to show proof of age when buying cigarettes in a store, and 66 percent were not refused purchase because of their age.

Checklist for Protection Against Secondhand Smoke:

Young children

Remember that you are a powerful role model. If you dont smoke, your children are less likely to smoke.

Make your home and car smoke-free spaces. Put up no-smoking stickers and signs in your home.

Make sure you and your kids arent exposed to second-hand smoke at daycare, school, or friends homes.

Support businesses and activities that are smoke-free. Let other businesses owners know that you cant support their businesses until they become 100 percent smoke-free too.

If you cant find a smoke-free restaurant and must go to one that allows some smoking, ask to sit in the nonsmoking section.

If your asthma or COPD is triggered by smoke, dont risk it stay away from any place that allows smoking.

Support laws that restrict smoking.

Youth and Teens

Parents-

Talk to your children about smoking; theyll be less likely to smoke than if you ignore the problem.

Support tobacco education in the schools and ban all smoking on school grounds, on school buses, and at school-sponsored events for students, school personnel, and visitors.

Ask that schools enforce the policy and consistently administer penalties for violations and that this is communicated in written and oral form to students, staff, and visitors.

Vote for public smoking restrictions as an important component of the social environment that supports healthy behavior, reducing the number of opportunities to smoke, and making smoking less socially acceptable.

Support tax increases on tobacco products so young people cannot afford them.

Teens-

If your friends smoke, ask them in a caring way to quit or at least not to smoke around you.

Peers, siblings, and friends are powerful influences on you and others. Understand that the most common situation for first trying a cigarette is with a friend who already smokes.

Families-

Work together to uphold restrictions on tobacco advertising and promotions.

Sources and Resources

The Health Consequences of Involuntary Exposure to Tobacco Smoke: Children are Hurt by Secondhand Smoke. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006; Available at: www.surgeongeneral.gov/library/secondhandsmoke/factsheets/factsheet2.html

CDC. Tobacco Use, Access & Exposure to Tobacco Among Middle & High School Students, US 2004 MMWR. Vol. 54(12) April 2005.

American Legacy Foundation. 2004 National Youth Tobacco Survey. 2005

CDC. Cigarette Use Among High School Students United States, 1991-2003. Morbidity and Mortality Weekly Report 2004; 53(23): 499-502.

King C, Siegel M. The Master Settlement Agreement with the Tobacco Industry and Cigarette Advertising in Magazines. New England Journal of Medicine 2001; 345: 504-511.

Have you ever had a cold or allergy attack that wouldn't go away? If so, there's a good chance you actually had sinusitis. Experts estimate that 37 million people are afflicted with sinusitis each year, making it one of the most common health conditions in America. That number may be significantly higher, since the symptoms of bacterial sinusitis often mimic those of colds or allergies, and many sufferers never see a doctor for proper diagnosis and treatment.

What is sinusitis?

Acute bacterial sinusitis is an infection of the sinus cavities caused by bacteria. It usually is preceded by a cold, allergy attack, or irritation by environmental pollutants. Unlike a cold, or allergy, bacterial sinusitis requires a physician"s diagnosis and treatment with an antibiotic to cure the infection and prevent future complications.

Normally, mucus collecting in the sinuses drains into the nasal passages. When you have a cold or allergy attack, your sinuses become inflamed and are unable to drain. This can lead to congestion and infection. Diagnosis of acute sinusitis usually is based on a physical examination and a discussion of your symptoms. Your doctor also may use x-rays of your sinuses or obtain a sample of your nasal discharge to test for bacteria.

When does acute sinusitis become chronic?

When you have frequent sinusitis, or the infection lasts three months or more, it could be chronic sinusitis. Symptoms of chronic sinusitis may be less severe than those of acute; however, untreated chronic sinusitis can cause damage to the sinuses and cheekbones that sometimes requires surgery to repair.

What treatments are available?

Antibiotic therapy: Therapy for bacterial sinusitis should include an appropriate antibiotic. If you have three or more symptoms of sinusitis (see chart), be sure to see your doctor for diagnosis. In addition to an antibiotic, an oral or nasal spray or drop decongestant may be recommended to relieve congestion, although you should avoid prolonged use of nonprescription nasal sprays or drops. Inhaling steam or using saline nasal sprays or drops can help relieve sinus discomfort.

Antibiotic resistance means that some infection-causing bacteria are immune to the effects of certain antibiotics prescribed by your doctor. Antibiotic resistance is making even common infections, such as sinusitis, challenging to treat. You can help prevent antibiotic resistance. If the doctor prescribes an antibiotic, it is important that you take all of the medication just as your doctor instructs, even if your symptoms are gone before the medicine runs out.

Intensive antibiotic therapy: If your doctor thinks you have chronic sinusitis, intensive antibiotic therapy may be prescribed. Surgery is sometimes necessary to remove physical obstructions that may contribute to sinusitis.

Sinus surgery: Surgery should be considered only if medical treatment fails or if there is a nasal obstruction that cannot be corrected with medications. The type of surgery is chosen to best suit the patient and the disease. Surgery can be performed under the upper lip, behind the eyebrow, next to the nose or scalp, or inside the nose itself.

Functional endoscopic sinus surgery (FESS) is recommended for certain types of sinus disease. With the endoscope, the surgeon can look directly into the nose, while at the same time, removing diseased tissue and polyps and clearing the narrow channels between the sinuses. The decision whether to use local or general anesthesia will be made between you and your doctor, depending on your individual circumstances.

Before surgery, be sure that you have realistic expectations for the results, recovery, and postoperative care. Good results require not only good surgical techniques, but a cooperative effort between the patient and physician throughout the healing process. It is equally important for patients to follow pre- and postoperative instructions.

When should a doctor be consulted?

Because the symptoms of sinusitis sometimes mimic those of colds and allergies, you may not realize you need to see a doctor. If you suspect you have sinusitis, review these signs and symptoms. If you suffer from three or more, you should see your doctor.

What are the symptoms of sinusitis vs. a cold or allergy?

Sign / symptom

SINUSITIS

ALLERGY

COLD

Facial pressure / pain

yes

sometimes

sometimes

Duration of illness

More than 10-14 days

Varies

Less than 10 days

runny nose

White or color

Clear, thin, watery

Thick, whitish or thin

fever

sometimes

N

sometimes

Headache

sometimes

sometimes

sometimes

Pain in upper teeth

sometimes

N

N

bad Breath

sometimes

N

N

cough

sometimes

sometimes

yes

Nasal congestion

yes

sometimes

yes

sneezing

N

sometimes

yes

 

Can children suffer from sinus infections?

Your child"s sinuses are not fully developed until age 20. However, children can still suffer from sinus infection. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Sinusitis is difficult to diagnose in children because respiratory infections are more frequent, and symptoms can be subtle. Unlike a cold or allergy, bacterial sinusitis requires a physician"s diagnosis and treatment with an antibiotic to prevent future complications.

The following symptoms may indicate a sinus infection in your child:

  • a "cold" lasting more than 10 to 14 days, sometimes with low-grade fever
  • thick yellow-green nasal drainage
  • post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
  • headache, usually not before age 6
  • irritability or fatigue
  • swelling around the eyes

If despite appropriate medical therapy these symptoms persist, care should be taken to seek an underlying cause. The role of allergy and frequent upper respiratory infections should be considered.

Tips to prevent sinusitis

As always, an ounce of prevention is worth a pound of cure. To avoid developing sinusitis during a cold or allergy attack, keep your sinuses clear by:

  • using an oral decongestant or a short course of nasal spray decongestant
  • gently blowing your nose, blocking one nostril while blowing through the other
  • drinking plenty of fluids to keep nasal
  • discharge thin
  • avoiding air travel. If you must fly, use a nasal spray decongestant before take-off to prevent blockage of the sinuses allowing mucus to drain
  • If you have allergies, try to avoid contact with things that trigger attacks. If you cannot, use over-the-counter or prescription antihistamines and/or a prescription nasal spray to control allergy attacks

Allergy testing, followed by appropriate allergy treatments, may increase your tolerance of allergy-causing substances. If you believe you may have sinusitis, see our tips for sinusitis sufferers.

Problems with these senses have a big impact on our lives. Smell and taste contribute to our enjoyment of life by stimulating a desire to eat which not only nourishes our bodies, but also enhances our social activities. When smell and taste become impaired, we eat poorly, socialize less, and feel worse. Smell and taste warn us of dangers, such as fire, poisonous fumes, and spoiled food. Loss of the sense of smell may indicate sinus disease, growths in the nasal passages, or, at times, brain tumors.

How do smell and taste work?

Smell and taste belong to our chemical sensing system (chemosensation). The complicated process of smelling and tasting begins when molecules released by the substances around us stimulate special nerve cells in the nose, mouth, or throat. These cells transmit messages to the brain, where specific smells or tastes are identified.

Olfactory (smell nerve) cells are stimulated by the odors around us the fragrance from a rose, the smell of bread baking. These nerve cells are found in a tiny patch of tissue high up in the nose, and they connect directly to the brain.

Gustatory (taste nerve) cells are clustered in the taste buds of the mouth and throat. They react to food or drink mixed with saliva. Many of the small bumps that can be seen on the tongue contain taste buds. These surface cells send taste information to nearby nerve fibers, which send messages to the brain.

Our body"s ability to sense chemicals is another chemosensory mechanism that contributes to our senses of smell and taste. In this system, thousands of free nerve endings especially on the moist surfaces of the eyes, nose, mouth, and throat identify sensations like the sting of ammonia, the coolness of menthol, and the "heat" of chili peppers.

What causes loss of smell and taste?

Scientists have found that the sense of smell is most accurate between the ages of 30 and 60 years. It begins to decline after age 60, and a large proportion of elderly persons lose their smelling ability. Women of all ages are generally more accurate than men in identifying odors.

Some people are born with a poor sense of smell or taste. Upper respiratory infections are blamed for some losses, and injury to the head can also cause smell or taste problems.

Loss of smell and taste may result from polyps in the nasal or sinus cavities, hormonal disturbances, or dental problems. They can also be caused by prolonged exposure to certain chemicals such as insecticides, and by some medicines.

Tobacco smoking is the most concentrated form of pollution that most people are exposed to. It impairs the ability to identify odors and diminishes the sense of taste. Quitting smoking improves the smell function.

Radiation therapy patients with cancers of the head and neck often complain of lost smell and taste. These senses can also be lost in the course of some diseases of the nervous system.

Patients who have lost their larynx (voice box) commonly complain of poor ability to smell and taste. Laryngectomy patients can use a special "bypass" tube to breathe through the nose again. The enhanced air flow through the nose helps smell and taste sensations to be re-established.

How are smell and taste loss diagnosed?

The extent of loss of smell or taste can be tested using the lowest concentration of a chemical that a person can detect and recognize. A patient may also be asked to compare the smells or tastes of different chemicals, and how the intensities of smells and tastes grow when a chemical concentration is increased.

  • Smell: Scientists have developed an easily administered "scratch-and-sniff" test to evaluate the sense of smell.
  • Taste: Patients react to different chemical concentrations in taste testing; this may involve a simple "sip, spit, and rinse" test, or chemicals may be applied directly to specific areas of the tongue.

Can these disorders be treated?

Sometimes certain medications are the cause of smell or taste disorders, and improvement occurs when that medicine is stopped or changed. Although certain medications can cause chemosensory problems, others particularly anti-allergy drugs seem to improve the senses of taste and smell. Some patients, notably those with serious respiratory infections or seasonal allergies, regain their smell or taste simply by waiting for their illness to run its course. In many cases, nasal obstructions, such as polyps, can be removed to restore airflow to the receptor area and can correct the loss of smell and taste. Occasionally, chemosenses return to normal just as spontaneously as they disappeared.

How do you cope with smell or taste problems?

If you experience problems in smelling or tasting, try to identify and record the circumstances surrounding it. When did you first become aware of it? Did you have a cold or flu then? A head injury? Were you exposed to air pollutants, pollens, danders, or dust to which you might be allergic? Is this a recurring problem? Does it come in any special season, like hayfever time?

Bring all this information with you when you visit a physician who deals with diseases of the nose and throat (an otolaryngologist head and neck surgeon). Proper diagnosis by a trained professional can provide reassurance that your illness is not imaginary. You may even be surprised by the results. For example, what you may think is a taste problem could actually be a smell problem, because much of what you taste is really caused by smell.

Diagnosis may also lead to treatment of an underlying cause for the disturbance. Remember, many types of smell and taste disorders are reversible.

Flavor

Four commonly identified taste sensations:

  • sweet
  • sour
  • bitter
  • salty

Certain tastes combine with texture, temperature, and odor to produce a flavor that allows us to identify what we are eating.

Many flavors are recognized through the sense of smell. If you hold your nose while eating chocolate, for example, you will have trouble identifying the chocolate flavor, even though you can distinguish the food's sweetness or bitterness. This is because the familiar flavor of chocolate is sensed largely by odor. So is the well known flavor of coffee. This is why a person who wishes to fully savor a delicious flavor (e.g., an expert chef testing his own creation) will exhale through his nose after each swallow.

Taste and smell cells are the only cells in the nervous system that are replaced when they become old or damaged. Scientists are examining this phenomenon while studying ways to replace other damaged nerve cells.

Three percent of American adults are smokeless tobacco users. They run the same risks of gum disease, heart disease, and addiction as cigarette users, but an even greater risk of oral cancer. Each year about 30,000 Americans are diagnosed with oral and pharyngeal cancers, and more than 8,000 people die of these diseases. Despite the health risks associated with tobacco use, consumers continue to demand the product. In 2001, the five largest tobacco manufacturers spent $236.7 million on smokeless tobacco advertising and promotion.

What is smokeless tobacco?

There are two forms of smokeless tobacco: chewing tobacco and snuff. Chewing tobacco is usually sold as leaf tobacco (packaged in a pouch) or plug tobacco (in brick form). Both are placed between the cheek and gum. Users keep chewing tobacco in their mouths for several hours to get a continuous high from the nicotine in the tobacco.

Snuff is a powdered tobacco (usually sold in cans) that is put between the lower lip and the gum. It is also referred to as "dipping." Just a pinch is all that's needed to release the nicotine, which is then swiftly absorbed into the bloodstream, resulting in a quick high.

The chemicals contained in chew or snuff are poisonous and addictive. Every time smokeless tobacco is used, the body adjusts to the amount of tobacco needed to get a high. Consequently, the next time tobacco is used, the body will need a little more tobacco to get the same feeling. Holding an average-sized dip or chew in the mouth for 30 minutes gives the user as much nicotine as smoking four cigarettes.

Is smokeless tobacco less harmful than cigarettes?

In 1986, the U.S. Surgeon General declared that the use of smokeless tobacco "is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous conditions and can lead to nicotine addiction and dependence." Also since 1991, the National Cancer Institute has recommended that the public avoid the use of all tobacco products due to their high levels of nitrosamines.

In a recent study, cancer researchers found that oral tobacco products including lozenges and moist snuff are not a good alternative to smoking, since the levels of cancer-causing nitrosamines in smokeless tobacco and lozenges are very high. Some smokeless products contain the highest amounts of nicotine that can be readily absorbed by the body.

What are the ingredients in smokeless tobacco?

  • Polonium 210 (nuclear waste)
  • N-Nitrosamines (cancer-causing)
  • Formaldehyde (embalming fluid)
  • Nicotine (addictive drug)
  • Cadmium (used in batteries and nuclear reactor shields)
  • Cyanide ( poisonous compound)
  • Arsenic (poinsonous metallic element)
  • Benzene (used in insecticides and motor fuels)
  • Lead (nerve poison)

Who are the most common smokeless tobacco users?

According to the 2000 National Household Survey on Drug Abuse conducted by the Substance Abuse and Mental Health Services Administration, young adults between the ages of 18-25 are the most common smokeless tobacco users. This trend may be influenced by innovative marketing tactics targeted at a younger audience.

Smokeless tobacco manufacturers are marketing flavored smokeless tobacco. A 2005 American Legacy Foundation and National Cancer Institute study noted, "Tobacco companies are using candy-like flavors and high tech delivery devices to turn a blowtorch into a flavored popsicle, misleading millions of youngsters to try a deadly product."

Cancer. Smokeless tobacco is a cancer-causing agent or carcinogen. Cancers are most likely to develop at the site where tobacco is held in the mouth, but it may also include the lips, tongue, cheek, and throat.

Leukoplakia. Smokeless tobacco users may develop a condition in which white spots form on the gums, inside of the cheeks and sometimes tongue. It can be caused by the irritation from the tobacco juice. The disorder can be considered pre-cancerous. Therefore, if a white patch does not heal within one week, a doctor should be consulted.

Heart disease. The stimulating effects of nicotine, an organic compound made out of carbon, hydrogen, nitrogen, and sometimes oxygen, increase the heart rate and blood pressure and may trigger irregular heart beats.

Gum and tooth disease. Smokeless tobacco permanently discolors teeth, causes halitosis (bad breath), and may contribute to tooth loss. Smokeless tobacco contains a lot of sugar which forms and acid that may eat away the tooth enamel causing cavities and mouth sores. Also, its direct and repeated contact with the gums may cause them to recede.

Social effects. Bad breath, discolored teeth.

What are some early warning signs of oral cancer?

  • A sore that bleeds easily and does not heal
  • A lump or thickening anywhere in the mouth or neck
  • Soreness or swelling that does not go away
  • A red or white patch that does not go away
  • Trouble chewing, swallowing, or moving the tongue or jaw

Tips to quit using smokeless tobacco for a lifetime

  • Write down a list of reasons to quit. For example:
    • - Don"t want to risk getting cancer.
    • - Family members find it offensive.
    • - Don"t like having bad breath after chewing and dipping.
    • - Don"t want stained teeth or no teeth.
    • - Don"t like being addicted to nicotine.
    • - Want to start leading a healthier life.
  • Pick a quit date and throw out all chewing tobacco and snuff.
  • Remember daily of the decision to stop chewing tobacco.
  • Ask friends and family to help stay committed to the decision to quit by giving support and encouragement.
  • Find alternatives to smokeless tobacco, such as sugarless gum, pumpkin or sunflower seeds, apple slices, raisins, or dried fruit.
  • Engage in recreational activities to keep the mind off of smokeless tobacco.
  • Develop a personalized plan that works best; set realistic goals.
  • Reward successes.

Nasal congestion, stuffiness, or obstruction to nasal breathing is one of the oldest and most common human complaints. For some, it may only be a nuisance; for others, nasal congestion can be a source of considerable discomfort.

Medical writers have established four main causes of nasal obstruction: infection, structural abnormalities, allergic, and nonallercic (vasomotor) rhinitis. Patients often have a combination of these factors which vary from person to person.

What are the causes of nasal congestion?

Infection

An average adult suffers a "common cold" two to three times per year. These viral infections occur more often in childhood because immunity strengthens with age. A cold is caused by one of many different viruses, some of which are airborne, but most are transmitted by hand-to-nose contact. Once the virus is absorbed by the nose, it causes the body to release histamine, a chemical which dramatically increases blood flow to the nose and causes nasal tissue to swell. This inflames the nasal membranes which become congested with blood and produce excessive amounts of mucus that "stuffs up" the nasal airway. Antihistamines and decongestants help relieve the symptoms of a cold, but no medication can cure it. Ultimately, time is what is needed to get rid of the infection.

During a viral infection, the nose has poor resistance to bacteria, which is why infections of the nose and sinuses often follow a "cold." When the nasal mucus turns from clear to yellow or green, it usually means that a bacterial infection has set in. In this case, a physician should be consulted.

Acute sinus infections produce nasal congestion and thick discharge. Pain may occur in cheeks and upper teeth, between and behind the eyes, or above the eyes and in the forehead, depending on which sinuses are involved.

Chronic sinus infections may or may not cause pain, but usually involve nasal obstruction and offensive nasal or postnasal discharge. Some people develop polyps (fleshy growths in the nose) from sinus infections, and the infection can spread to the lower airways, leading to a chronic cough, bronchitis, or asthma. Acute sinus infections generally respond to antibiotic treatment; chronic sinusitis may require surgery.

Structural abnormalities

These include deformities of the nose and nasal septum; the thin, flat cartilage and bone that divides the two sides of the nose and nostrils. These deformities are usually the result of an injury, sometimes having occurred in childhood. Seven percent of newborn babies suffer significant nasal injury in the birth process. Nasal injuries are common in both children and adults. If they obstruct breathing, surgical correction may be helpful.

One of the most common causes of nasal obstruction in children is enlargement of the adenoids. These are a tonsil-like tissue located in the back of the nose, behind the palate. Children with this problem may experience noisy breathing at night and may snore. Children who are chronic mouth breathers may develop a sagging face and dental deformities. In this case, surgery to remove the adenoids and/or tonsils may be advisable.

Other causes in this category include nasal tumors and foreign bodies. Children are often known to insert small objects into their noses. If a foul-smelling discharge is observed draining from one nostril, a physician should be consulted.

Allergies

Hay fever, rose fever, grass fever, and summertime colds are various names for allergic rhinitis. Allergy is an exaggerated inflammatory response to a substance which, in the case of a stuffy nose, is usually pollen, mold, animal dander, or some element in house dust. Pollen may cause problems during spring, summer, and fall, whereas house dust allergies are often most evident in the winter. Molds may cause symptoms year-round. In the allergic patient, the release of histamine and similar substances results in congestion and excess production of watery nasal mucus. Antihistamines help relieve the sneezing and runny nose of allergy. Typical antihistamines include Benadryl®, Chlortrimetron®, Claritin®, Teldrin®, Dimetane®, Hismanal®, Nolahist®, PBZ®, Polaramine®, Seldane®, Tavist®, Zyrtec®, Allegra®, and Alavert®, which are often available without a prescription and are available in several generic forms. Combinations of antihistamines with decongestants are also available.

Allergy shots are a specific and successful treatment method. SLIT skin tests and sometimes blood tests are used to make up vials of allergy-inducing substances specific to an individual patient's profile. The physician determines the best concentration for the first treatment. Once injected, these treatments form blocking antibodies in the patient's blood stream that interfere with the allergic reaction. Injections are typically given for a period of three to five years. Patients with allergies are more likely to need treatment for sinus infections.

Vasomotor Rhinitis

"Rhinitis" means inflammation of the nose and nasal membranes. "Vasomotor" means pertaining to the nerves that control the blood vessels. Membranes in the nose have an abundant supply of arteries, veins, and capillaries, which have the ability to expand and constrict. Normally these blood vessels are in a half-constricted or half-open state. But when a person exercises vigorously, hormone (adrenaline) levels increase. Adrenaline causes constriction of the nasal membranes so that the air passages open up and the person breathes freely.

The opposite takes place when an allergic attack or a cold develops. During a cold, blood vessels expand, membranes become congested, and the nose becomes stuffy, or blocked.

In addition to allergies and infections, certain circumstances can cause nasal blood vessels to expand, leading to vasomotor rhinitis. These include psychological stress, inadequate thyroid function, pregnancy, certain anti-high blood pressure drugs, prolonged overuse of decongesting nasal sprays, and exposure to irritants such as perfumes and tobacco smoke.

In the early stages of these disorders, nasal stuffiness is temporary and reversible. It usually improves when the primary cause is corrected. However, if the condition persists, the blood vessels lose their capacity to constrict, much like varicose veins. When the patient lies down on one side, the lower side becomes congested, which interferes with sleep. It is helpful to sleep with the head of the bed elevated two to four inches. Surgery is another option that can provide dramatic and long-time relief.

Are there any risks when treating congestion?

Patients who get sleepy from antihistamines should not drive an automobile or operate dangerous equipment after taking them. Decongestants increase pulse rate and elevate blood pressure and therefore should be avoided by those with high blood pressure, irregular heart beat, glaucoma, or difficulty urinating.

Pregnant patients should consult their obstetricians before taking any medicine.

Cortisone-like drugs (corticosteriods) are powerful decongestants, administered as nasal sprays to minimize the risk of serious side effects associated with other dosage forms. Patients using steroid nasal sprays should follow instructions carefully, and consult a physician immediately if they develop nasal bleeding, crusting, pain, or vision changes.

Where can I find out more?

Additional information and suggestions can be found in the AAO-HNS pamphlets, "Doctor, Please Explain Antihistamines, Decongestants, and Cold Remedies," "Doctor, Please Explain Allergies & Hay Fever," and "Doctor, Please Explain Sinusitis."

Your child’s sinuses are not fully developed until late in the teen years. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms of sinusitis can be caused by other problems, such as viral illness and allergy.

How Do I Know when My Child Has Sinusitis?

The following symptoms may indicate a sinus infection in your child:

  • - a cold lasting more than 10 to 14 days, sometimes with a low-grade fever
  • - thick yellow-green nasal drainage
  • - post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
  • - headache, usually in children age six or older
  • - irritability or fatigue
  • - swelling around the eyes. 

Young children are more prone to infections of the nose, sinus, and ears, especially in the first several years of life. These are most frequently caused by viral infections (colds), and they may be aggravated by allergies. However, if your child remains ill beyond the usual week to ten days, a sinus infection may be the cause.
 
You can reduce the risk of sinus infections for your child by reducing exposure to known environmental allergies and pollutants such as tobacco smoke, reducing his/her time at day care, and treating stomach acid reflux disease.

How Will the Doctor Treat Sinusitis?

Acute sinusitis: Most children respond very well to antibiotic therapy. Nasal decongestant sprays or saline nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function. Over-the-counter decongestants and antihistamines are not general effective for viral upper respiratory infections in children, and the role of such medications for treatment of sinusitis is not well defined. Such medications should not be given to children younger than two years old.

If your child has acute sinusitis, symptoms should improve within the first few days of treatment. Even if your child improves dramatically within the first week of treatment, it is important that you complete the antibiotic therapy. Your doctor may decide to treat your child with additional medicines if he/she has allergies or other conditions that make the sinus infection worse.
 
Chronic sinusitis: If your child suffers from one or more symptoms of sinusitis for at least 12 weeks, he or she may have chronic sinusitis. Chronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year, are indications that you should seek consultation with an otolaryngologist (an ear, nose, and throat—ENT—specialist). The ENT may recommend medical or surgical treatment of the sinuses.

Diagnosis of sinusitis: If your child sees an ENT specialist, the doctor will examine his/her ears, nose, and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the office visit. An x-ray called a CT scan may help to determine how completely your child's sinuses are developed, where any blockage has occurred, and confirm the diagnosis of sinusitis. The doctor may look for factors that make your child more likely to get sinus infection, including structural changes, allergies, and problems with the immune system.

When Is Surgery Necessary for Sinusitis?

Surgery is considered for the small percentage of children with severe or persistent sinusitis symptoms despite medical therapy. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of your child's sinuses and makes the narrow passages wider. This also allows for culturing so that antibiotics can be directed specifically against your child's sinus infection. Opening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infections.
 
Also, your doctor may advise removing adenoid tissue from behind the nose as part of the treatment for sinusitis. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis (obstruction of the back of the nose), can cause many symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough, and headache.

Summary

Sinusitis in children is different than sinusitis in adults. Children more often demonstrate a cough, bad breath, crankiness, low energy, and swelling around the eyes, along with a thick yellow-green nasal or post-nasal drip. Once the diagnosis of sinusitis has been made, children are successfully treated with antibiotic therapy in most cases. In the rare child where medical therapy fails, surgical therapy can be used as a safe and effective method of treating sinus disease in children.