What are tonsils

The tonsils that most of us are familiar with are actually known as the palatine tonsils to differentiate them from the lingual tonsils, which are tissue that can be found on the back portion of the tongue.  The tonsils are lymphoid tissue and therefore are part of the body’s surveillance system to identify and react to “foreign invasion” to maintain one’s health, whether it is forms of infection or abnormal cells in the body such as cancer.  Material that exists outside blood vessels (“lymph”) is collected into the lymphatics, a separate collection of small vessels that eventually feed into structures such as a lymph node -or a tonsil- where the material is assessed and any necessary response by the body is initiated.  Eventually, this fluid is collected and directed back into veins to ultimately be processed as waste.  In the head and neck area, the system has tremendous redundancy with not only the tonsil and adenoid tissue, but also hundreds of lymph nodes.

What is tonsillitis

Tonsillitis refers to inflammation of the tonsil tissue.  It is the most common infectious and can be caused by either bacteria or viruses.  Symptoms include a sore throat, which can be quite severe, difficulty swallowing or speaking, fever, lethargy, and painful lymph nodes in the neck.  Occasionally the infection can cause referred pain in the ear.  Accompanying these symptoms, examination of the throat will reveal swollen, red tonsils, which may have a white or yellow coating or “exudate” on the surface.

Types of tonsillitis

Bacterial tonsillitis

Bacterial tonsillitis is thought to be more commonly associated with a more severe sore throat and the presence of an exudate.  Although several different bacteria can cause tonsillitis, group A streptococcus or “group A strep” is the most commonly discussed and responsible for tonsillitis strep throat.  This infection is a contagious form of tonsillitis passed through close contact.  The reason for concern regarding strep throat is that children and teens risk developing rheumatic fever and subsequent damage to the heart and kidney if a health care provider does not properly treat the infection.

Due to this risk, a rapid strep test is commonly performed when the diagnosis is considered.  This involves a swab over the tonsils and back of the throat.  Although this may be slightly uncomfortable and cause the child to gag, there is no real risk associated with one’s health with this test.  It can provide the doctor with information very quickly as to whether group A strep is detected.  Since the test is approximately 95% sensitive, a negative test should be followed by culture by the doctor to rule out the 5% chance the rapid test was incorrect.

It should not be assumed, however, that a negative strep test confirms a viral cause.  The previously mentioned throat culture can be performed, but results can take a few days. While the medical doctor and patient should understand the risk of indiscriminate use of antibiotics, the presence of significant symptoms in a patient with a negative strep test may still warrant antibiotic treatment.

Peritonsillar abscess

Typically tonsillectomy affects both tonsils symmetrically.  However, the patient occasionally reports that the sore throat is more significant on one side.  There may even be ear pain on that side, a change in voice, and difficulty swallowing.  If these symptoms occur, the patient should be seen urgently by a medical doctor, preferably one trained in otolaryngology (ENT), as it may indicate the formation of a peritonsillar abscess.  This infection has progressed with the formation of an abscess around the tonsil.  If not treated urgently, it may spread and cause serious complications, even death.  Care involves antibiotics and commonly surgical drainage.  If surgical drainage is deemed necessary to treat the infection, it can be performed by the doctor either in the office or in the hospital, depending on the severity.

Viral tonsillitis

Viral tonsillitis is more common than bacterial, comprising 60-70% of all cases of child sore throat.  There are typically associated symptoms such as fever, cough, and fatigue.  The strep test and culture, if performed, would be negative.  Care is typically based on symptoms- normalizing fever, controlling discomfort, and decreasing congestion and cough.

Mononucleosis

A specific type of viral infection associated with tonsillitis is mononucleosis (mono), caused by the Epstein-Barr virus (EBV).   Mono typically is associated with systemic symptoms such as fatigue, swollen lymph nodes, and fever.  Enlargement of the liver and spleen may also occur.  Tonsillitis in mono can result in significant growth of the tonsils, making it difficult to swallow or even feeling as if it is difficult to breathe.  In these cases, treatment may include oral steroids to decrease the swelling.

Chronic tonsillitis

In some patients, symptoms of tonsillitis seem to keep occurring over and over again.  A patient may be left with a chronic sore throat and even fatigue, despite the absence of the more severe symptoms of an acute attack. These chronic cases are thought to be because certain organisms can form biofilms.  Biofilms are a community of organisms that form an exterior coating which can allow them to exist in areas of the body- such as the tonsils-without the host being able to eliminate the organism.  Antibiotics also are not effective against biofilm protection.  This contained infection can then erupt into an acute episode, especially if the host’s immune system is weakened temporarily.

Tonsillectomy for tonsillitis

Indications for tonsillectomy

If a child has a single or only occasional episode of tonsillitis, medical management, as discussed previously, is usually adequate to maximize the patient’s health.  However, in the patient with recurrent acute tonsillitis-repeated episodes lasting days-or chronic tonsillitis- chronic low-grade symptoms such as sore throat- a more permanent solution may be indicated.

Guidelines for surgical treatment of tonsillitis have been established for those individuals in the pediatric age group with recurrent acute tonsillitis.  The most recent recommendations are for a child with seven or greater infections in the past year, five infections a year for the past two years or three infections a year for the past three years.  Although these recommendations are helpful, one must evaluate each child since tonsillectomy may be reasonable in those patients falling below those criteria but who have complicating factors such as the severity of the infections, duration of illness affecting work or school, or difficulty with repeated antibiotics.

Tonsillectomy may also be indicated in those patients who have chronic tonsillitis.  Chronic sore throat or the repeated formation of tonsil stones (tonsilliths), which can cause bad breath, can alter one’s quality of life such that a permanent solution is desired.

Tonsillectomy

Tonsillectomy involves the removal of the tonsil tissue.  There are records that the first such procedure was done over 2000 years ago.  Over the years, numerous techniques have been used.  These have included a traditional surgical scalpel, wire “snares,” and various forms of heat energy, including lasers.  Although each technique has its proponents, no single technique has been shown to be dramatically better than the others.  More recently, however, the performance of an intracapsular tonsillectomy which leaves a very thin layer of tonsil tissue behind, has demonstrated an improved recovery.

No matter which technique the otolaryngologist uses, the procedure is performed under general anesthesia in a hospital or surgery center.  A device keeps the mouth open, and each tonsil is carefully dissected from the bed in which it sits.  The numerous blood vessels that feed the tonsil are usually cauterized during removal to reduce the chance of bleeding.  Once the surgery is complete, the child is awakened from anesthesia and observed in the recovery room.  Most patients can be discharged home after an hour or so.

Recovery

The recovery from a tonsillectomy involves significant discomfort and can last 7-10 days.  Pediatric patients may need significant encouragement and support to eat and drink enough to sustain themselves.  Pain management can involve non-narcotic and narcotic pain medicines.

Overall, tonsillectomy is a very safe procedure. However, the one significant risk is postoperative bleeding which most commonly occurs 5-8 days after the surgery in 1-7% of cases.  Cauterization may be required in the doctor’s office or operating room under a brief anesthetic.  Once the child( recovers, the episodes of tonsillitis should end as the inflamed tissue has been removed.

The post Parents’ Guide to Tonsillitis in Children appeared first on Jerome Hester, MD.

Quality Sleep

Quality sleep is one of the foundations of good health. We all should spend roughly 30% of our lives sleeping. We should not only want to spend enough time asleep but also ensure our sleep is uninterrupted and provides our body with all the benefits it is meant to have.

In some cases, we are at fault. We do not follow the correct framework to facilitate quality sleep. We may not allow ourselves enough hours to sleep or do not provide an appropriate environment to fall asleep or stay asleep. However, there are sleep disorders that interfere with our sleep that are not caused by issues entirely under our control.

Obstructive Sleep Apnea

Sleep apnea occurs when breathing is disrupted during sleep. Obstructive sleep apnea (sometimes referred to as “OSA”), which is present in 5-10% of the population, is caused by a physical obstruction in one or more locations of the airway from the nose to the back of the tongue. As an individual attempts to enter the deeper stages of sleep, muscle relaxation occurs. However, if a part of the airway is too narrow or too “floppy,” it will close off the breathing passage. Luckily, in most cases, this obstruction to breathing is recognized by the brain, which then shifts the patient into a more superficial level of sleep, reinstituting muscle tone and opening the airway. Unfortunately, this disrupts the normal sleep cycle.

Additionally, oxygen levels in the bloodstream can drop, and chemicals such as adrenaline are released in response to the obstruction of breathing. The heart and brain are two organs that can be damaged by this combination of low oxygen and increased needs stimulated by adrenaline. Heart attack and stroke risk have increased in individuals with even moderate untreated sleep apnea. Therefore, sleep apnea symptoms can be caused by disrupted deep sleep and the physiologic response to these interruptions.

Central Sleep Apnea

Clinically significant central sleep apnea is fortunately very rare. In this disorder, the cause is the lack of a “drive” to breathe from the brain. With this, the breath is initiated. The risk caused by this disorder is severe because an external treatment must then provide breathing. More commonly, some episodes of central sleep apnea may occur in a setting of obstructive sleep apnea. Symptoms in these cases can include those listed below. Treatment can consist of treating obstructive sleep apnea; in many cases, the central sleep apnea events will disappear. 

Know the Signs of Sleep Apnea in Yourself or Your Partner

The signs and symptoms of obstructive sleep apnea can be due to the interruption of sleep or the body’s response to the obstruction – or a combination of both. Understanding that not all signs must be present to suspect obstructive sleep apnea is essential. Instead, if even one of these symptoms is present and there is no genuinely identifiable cause, the patient should seek information and care from a trained health professional. The symptoms of sleep apnea include the following:

Fatigue

Feeling tired, especially after sleeping adequately, is a common sign of untreated sleep apnea. However, since fatigue is a subjective complaint, it is not always acknowledged by the patient. In many cultures, admitting fatigue can be perceived as laziness. Therefore this symptom can be minimalized or even denied by the patient. Fatigue can also be blamed on other factors such as stress, lack of exercise, or age. In addition, sometimes, a significant amount of time is spent investigating other health causes, such as anemia or hypothyroidism. Some patients are labeled with Chronic Fatigue Syndrome before their sleep is evaluated. While all these issues can contribute to fatigue, it is essential to rule out sleep apnea, as untreated sleep apnea has serious health consequences.

For the reasons above, as well as other issues, the lack of fatigue should not be considered a reason to rule out the diagnosis of obstructive sleep apnea. In some patients, this chronic disruption of restorative sleep is manifested in alterations in attention span, concentration, cognitive function, and memory. In the pediatric age group, as many as 40% of all children diagnosed with attention deficit disorder or attention-deficit/hyperactivity disorder are found to have sleep apnea as a cause or contributor.

Depression

Depression may be the only sign of undiagnosed sleep apnea. A patient diagnosed with depression may exhibit poor sleep, weight gain, difficulty concentrating, and altered mood- all symptoms that can be caused by disruption of deep, restorative sleep. At the very least, restoring quality sleep will allow the patient to have an increased ability to deal with the side effects of these disorders. 

Anxiety

Anxiety may be caused or worsened by obstructive sleep apnea. The interruption of deep sleep and lack of recovery of specific brain areas can lead to heightened irritability and difficulty coping with daily routine issues. Also, due to similar side effects of undiagnosed and untreated sleep apnea, the obsessive-compulsive disorder can be encountered.

Hypertension

Difficult to control- sometimes referred to as refractory- hypertension can be due to untreated sleep apnea. The National Institute of Health estimates that 50% of all patients with hypertension have obstructive sleep apnea and labeled sleep apnea as a critical secondary cause in 2003. However, this association is still commonly missed. Therefore, if a patient has newly diagnosed high blood pressure and does not respond to typical treatment, evaluation for sleep apnea should be performed.

Headaches

Headaches, especially first thing in the morning, can signify untreated sleep apnea. It is presumed that these headaches can be due to the disruption of deep sleep and the intermittent decrease of oxygen to the brain.

Obstructed Breathing-Apnea and Hypopnea

One likely has sleep apnea if one’s bed partner observes obstructed breathing during sleep. This can be true apnea- the stoppage of breathing for longer than 10 seconds- but can also include gasping or struggling to breathe. Partial obstructions, some of which can be missed by a bed partner, are called hypopneas and may impart as much risk as true apnea. Snoring can also be a sign of sleep apnea. 

In children, snoring is always an indication of airway obstruction during sleep and should be evaluated. In adults, loud snoring is likely to indicate sleep apnea in 80% of cases. It should be noted, however, that the absence of snoring does not rule out sleep apnea. Even health information shows that snoring without a finding of obstructive sleep apnea can increase the risk of heart disease and stroke. If there are other signs or symptoms, an evaluation with a doctor should still be considered.

Teeth Grinding

Bruxism, or grinding one’s teeth, can indicate sleep apnea. If one is aware of this issue or evidence is apparent on a dental examination, a thorough evaluation of the patient’s airway and questions regarding other possible signs or symptoms should be undertaken.

Frequent Urination at Night

Nocturia, awakening during the night to urinate, may indicate untreated sleep apnea. Over 84% of patients with sleep apnea reported it as a symptom. Indeed, this symptom is more frequent as we age; however, care should be taken to assume it is not a sign of obstructive sleep apnea.

If You Suspect Your Life is Being Affected by Sleep Apnea, Don’t Wait to See a Doctor

Quality sleep is vital for health. However, untreated sleep apnea will destroy good sleep and increase the chances of other potentially life-threatening diseases, such as heart disease and stroke. Therefore, awareness of the potential signs and symptoms of sleep apnea is essential for your doctor and you so the diagnosis is noticed.

Some Sleep Apnea Statistics

• Sleep apnea affects an estimated 22 million Americans (7-8% of the population).
• Approximately 80% of people with sleep apnea are undiagnosed.
• Men are twice as likely to have sleep apnea than women.
• People who are overweight or obese are at a higher risk of developing sleep apnea.
• People aged 40 and older are more likely to have sleep apnea.
• Snoring is the most common symptom of sleep apnea, occurring in 90% of cases.
• Other common sleep apnea symptoms include daytime fatigue, morning headaches, and difficulty concentrating.
• Sleep apnea can lead to an increased risk of stroke, heart attack, and high blood pressure.
• Untreated sleep apnea can reduce life expectancy by up to 10 years.
• People with sleep apnea can experience up to 30 episodes of apnea per hour during sleep.

The post Common Signs You Have Sleep Apnea appeared first on Jerome Hester, MD.

Anatomy of the Nose and Turbinate

The structural anatomy of the nose includes the septum which is the midline structure that separates the left and right breathing passages.  It begins just behind the columella which is the division seen on the external nose.  The front part of the septum is cartilage, whereas it consists of bone posteriorally.  Along both sides, it is covered by mucosa, a type of skin that lines the entire nasal cavity.  The mucosa does have the ability to produce mucous and become inflamed and swollen when it is irritated or infected. Posteriorly, the septum ends, allowing both sides of the nasal cavity to join into one passageway before entering the back of the throat.

Turbinates

On the lateral side of the interior nose are the turbinates.  There are typically three on each side- the inferior, middle, and superior.  In some individuals, there is a fourth- the supreme turbinate.  These structures are like “shelves” that protrude from the side walls.  They are composed of a thin piece of bone surrounded by tissue that is very vascular-it contains a large number of small blood vessels.  Finally, the layer of mucosa covers this tissue.  This large number of blood vessels very close to the surface results in the surface being warmed.  This warmth, along with the moisture on the mucosa, provides the turbinates with their function- to warm and humidify the air as it passes through the nose.

The superior and supreme turbinates are rarely crucial in causing nasal or sinus problems.  The middle turbinate can play a role in sinus infections- not truly impacting the ability to breathe, but instead potentially blocking the normal drainage from the sinus.

Turbinate Hypertrophy

The inferior turbinates can cause significant issues, especially congestion and the actual ability to breath through one’s nose.  The numerous small blood vessels inside the turbinate can dilate, therefore becoming more significant and causing the entire turbinate to enlarge or “hypertrophy.”  This can be temporary or more chronic.

Causes of Turbinate Hypertrophy

Temporary Causes of Turbinate Hypertrophy

For example, the nasal cycle is a typical event in which every 4-6 hours the majority of the blood flow to the nose shifts from one side to the other, causing the turbinates, and actually the lining of that entire side of the nose , to swell and reduce the size of the nasal airway.  This typically does not cause symptoms unless the nasal passage is otherwise narrowed, for example, by a deviated septum.  Similarly, when we are lying down there is an increase in blood that pools in the small vessels leading to enlargement or hypertrophy of the turbinates.

Inflammatory Causes of Turbinate Hypertrophy

Other causes of temporary or intermittent turbinate hypertrophy include allergies, nasal irritation, non-allergic rhinitis, abnormalities of the septum, or chronic sinusitis.When a patient is allergic to items in the environment, an abnormal response occurs, releasing a chemical called histamine.  Two side effects in the nasal cavity are dilation of the small blood vessels in the lining of the nose and a change in mucous production.  Alternatively, many times a patient will have these symptoms, but allergy testing is negative. This results in a diagnosis of non-allergic rhinitis, also known as vasomotor rhinitis.  It is crucial for the patient and physician to understand that this is an accurate diagnosis and does have treatment options that can be different than allergic rhinitis, but also very effective.  Allergic and non-allergic rhinitis can cause either acute or chronic turbinate hypertrophy depending on the severity and frequency.

Nasal Septum Contributing to Turbinate Hypertrophy

Abnormalities of the nasal septum can also lead to turbinate hypertrophy.  A deviated septum, where the bone or cartilage of the septum is crooked or “deviated,”  will produce turbulent airflow through the nose.  This constant irritation of air hitting the turbinates, instead of passing straight by, can cause the turbinate to hypertrophy-similar to forming a callous. In this case, the hypertrophy tends to be permanent and less likely to fluctuate.  Many times the patient may assume or even be told by a health professional that they have allergies.  A specialist such as an otolaryngologist (ENT doctor) can examine the nose to determine the exact cause of these symptoms.  A septal perforation can result from trauma, overuse of legal or illegal drugs placed in the nasal cavity, or after surgery.  In this situation, a hole forms in the septum.  Although commonly asymptomatic, occasionally, this can cause abnormalities of the flow of air or mucous, which through irritation can lead to chronic hypertrophy of the turbinates.  Rarely tumors of the head and neck region can involve the septum or other areas of the nasal cavity and sinuses.  Once again, this can lead to the obstruction of air and mucous causing chronic inflammation.

Infectious Causes of Turbinate Hypertrophy

Finally, infection of the nose and or sinuses can cause turbinate hypertrophy.  The sinuses, which are bony cavities not in the nose, but rather drain their mucous into the nose through small passages, can be infected acutely- commonly for 5-7 days, chronically in which case the infection never truly resolved.  Having infection adjoining the nasal cavity can result in the nose becoming inflamed and enlarging the turbinates.  Primary infections of the nose are less common but include bacteria such as Staphylococcus. These are often evident by small pimples or “furuncles” at the entrance of the nose.  The inflammation caused by this can result in turbinate hypertrophy.

Treatment of Turbinate Hypertrophy

Conservative Management of Turbinate Hypertrophy

In some instances, then use of turbinate hypertrophy, especially if it is an environmental allergy, can be identified and eliminated, resulting in the relief of symptoms.  This may require formal allergy testing or simply observation by the patient to isolate the offending substance.  If the allergen is ubiquitous or just something the patient cannot or will not avoid, then treatment with immunotherapy (allergy shots) or medication such as antihistamines or nasal steroid sprays can be used.  It may not be desirable to take a chronic medication without pursuing other treatments such as those offered after a thorough examination by an ENT physician.

Nasal irrigations can also be used to improve turbinate hypertrophy.  This treatment involves using a mechanism to irrigate the nasal cavity and rinse away irritants therefore cleaning the nose.  It is necessary to use some force behind the rise, either with a squeeze bottle or bulb or one of the several mechanized versions available.  Many different solutions are available, but usually a saline based liquid is mild and effective.

Procedural Treatment of Turbinate Hypertrophy

if these relatively conservative treatments are not satisfactory in relieving the patient’s symptoms, or if the patient desires a more permanent solution, then a procedural option should be considered.  At this point, evaluation should be performed by an ENT physician to correctly identify the diagnosis of turbinate hypertrophy and attempt to identify contributing factors as mentioned previously, which may also need to be treated to achieve success.

Surgery of Turbinate Hypertrophy

In the past, surgery of the turbinates was the only procedural option.  This was typically done under general anesthesia and involved surgically “trimming” the turbinates to remove a portion of the turbinate physically, reducing its size and therefore giving the patient more room to breathe.  Postoperatively there was packing consisting of. Gauze-like material is placed in the nasal cavities for 3-5 days.  This is very uncomfortable for the patient.  Additionally, the patient experiences bleeding and crusting for a few weeks as the area heals.  This surgery typically produces an excellent result but overall is an unpleasant recovery.  Also, very infrequently, the patient can experience a permanently dry nose, also known as empty nose syndrome, if the resection is overly aggressive.

Non-Surgical Procedural Options for Turbinate Hypertrophy

There are now several options to reduce the size of the turbinates that can be performed under local anesthesia in the physician’s office.  Most involve the use of heat energy, such as radiofrequency, which is delivered into the turbinate.  This results in turbinate reduction.  This is well tolerated by the patient, does not result in bleeding or scabbing, and  does not require packing, allowing a patient to return to normal activities almost immediately.  Success rates rival traditional surgery, and the risk of a permanently dry nose is essentially eliminated.

if allergic or non allergic rhinitis is determined to be a contributing factor in causing turbinate hypertrophy, there are now procedures that are performed in the office that provide longstanding relief.  The posterior nasal nerve provides the stimulus that guides nasal congestion and drainage.  In both types of rhinitis, this nerve can produce abnormal impulses causing an increase in these symptoms.  Recently, two treatments one using cryotherapy, the other radiofrequency have been shown to be effective and safe in treating this disorder.  Both techniques require only local anesthesia and involve the ENT doctor to use a small endoscope to locate the area overlying the nerve precisely.  A small device is then placed on the area under direct vision.  Cryotherapy applies very cold temperatures to the area, while radiofrequency uses heat energy.  Both techniques take less than a minute to treat each site, and 2-3 sites are usually treated on each side of the nose.  The treatment and recovery are not painful, although some patients undergoing cryotherapy will experience a headache for up to 24 hours.  The patient may resume normal activity immediately.  Many times the elimination of the rhinitis symptoms will allow the turbinates to return to average size, or the turbinates can be reduced directly at the same time by one of the minimally invasive techniques mentioned previously.

Turbinate Hypertrophy-Summary

Turbinate hypertrophy can cause nasal obstruction and difficulty breathing.  If symptoms are bothersome to the patient, a thorough examination by an ENT doctor can help confirm the diagnosis and identify any contributing factors.  Medical management and in-office procedures are now available and can provide relief from these symptoms safely and effectively.

The post What Is Turbinate Hypertrophy and How is it Treated? appeared first on Jerome Hester, MD.

Sinus infections can be incredibly painful, and they can become debilitating if when they are not diagnosed and treated properly. The relief of a “cured” sinus infection quickly evaporates when the telltale symptoms of an infection return and patients are left wondering why sinusitis won’t stay away. In addition to causing discomfort and/or missed days of work, untreated and recurrent sinus infections can lead to more permanent damage in the sinus cavities and nasal passages. 

While the very occasional, acute sinus infection (sinusitis) is relatively normal, recurrent or chronic sinus infections are not. If a sinus infection returns again after you’ve finished a round of antibiotics and/or have followed your physician’s at-home treatment instructions to the letter, please schedule another appointment ASAP.  

You may need a referral to an ENT (ear-nose-throat) specialist to determine why the sinus infection continues to come back, and whether anatomical corrections may be necessary to fix the problem once and for all.  

Acute Versus Chronic Sinus Infection 

The American Academy of Otolaryngology defines sinus infections in one of two ways: 

Acute sinusitis 

This is the normal manifestation of a sinus infection. Acute sinusitis clears up in four weeks or less and is often the unfortunate effect of a respiratory infection (cold or flu) or from chronic allergies. It occurs once, it lasts for a short time, the infection is treated with or without medication (yes, some sinus infections clear on their own!), and the patient should remain sinus infection free for a year or more.  

Chronic sinusitis 

If your sinus infection lasts for longer than 12-weeks, or it continues to come back again and again within a matter of weeks or months, you’re diagnosed with chronic sinusitis. There are multiple causes of untreatable or frequently occurring sinus infections. Chronic infections are most frequently connected to some type of obstruction that prevents sinus cavities from draining properly, trapping bacteria and/or viruses inside the sinus cavities. 

Visit our video about the Cause of Chronic Sinusitis to learn more. 

Reasons Your Sinusitis Keeps Coming Back 

Here are some of the reasons your chronic sinusitis continues to come back: 

Excessive inflammation of the nasal passages 

Contrary to what most people think, the sinuses consist of far more space than just the nasal passages and behind the cheekbones. There are four sets of sinuses located in the head, and all of these drain mucus through the nasal passages, which act as one of the body’s sinus exit points. Your throat also acts as a drain for the sinuses. This is why people with sinusitis often experience discomfort in the throat, resulting from post-nasal drip. 

If the nasal passages become inflamed, they get stopped up and the body has a hard time draining all of that backed up, infected, and often thickened mucus. This exacerbates the sinus infection, causing it to settle in even more.  

There are several things you can do to relieve and reverse swollen and sensitive sinus passages: 

• Inhale steam (a hot shower is great for this) and use a nasal-specific saline solution to flush the nasal passages once, twice, or three times per day. Your doctor can show you how to do this safely. 
• Avoid smoking cigarettes or inhaling second-hand smoke 
• Use an air purifier and humidifier, especially while you sleep, to keep the passages moist 
• Take a shower at night to flush allergens from the day down and out of your sinuses, and then splash your face with warm water in the morning to flush allergens and irritants that settled on your face or in your nose while you slept 
• Drink lots of fluids (hot teas, especially herbal teas designed to support breathing, sinus pressure and/or allergies are highly recommended) 
• Avoid outdoor activities that over-expose you to pollen such as mowing the grass, laying in a field, hiking through high grasses/weed, etc. 
• Take care of your immune system by eating well (try an anti-inflammatory diet), getting plenty of rest, and managing stress. This is your body’s best chance of fighting infections on its own. 

Dr. Hester may prescribe a corticosteroid nasal spray or even an oral steroid to provide more immediate and dramatic inflammation relief. These meds should be used as directed. NEVER use corticosteroid nasal sprays or oral steroids for longer than advised. You can wind up doing more harm than good. If the sinus symptoms persist, contact your doctor to schedule a follow-up appointment. 

Your sinusitis keeps coming back because you don’t have an accurate diagnosis 

If the infection lasts longer than a couple of weeks or the pain is becoming unbearable, seek medical treatment immediately. Accurate diagnosis is key to treating sinusitis, especially when the infections return over and over again. You can treat allergies all you want, but a polyp, deviated septum, or other anatomical abnormalities in the nasal passages won’t disappear without more expert treatment. 

A comprehensive examination of the nose and sinus passages by a specialist is necessary to evaluate the correct diagnosis and cause of your symptoms. In some cases, what has been previously diagnosed as a ”sinus” issue has, in fact, been caused by another issue. Identifying the correct diagnosis is the first step to feeling better.

You may have an anatomical issue blocking sinus drainage 

There are several anatomical issues that prevent sinus cavities and/or the nasal passages from draining properly. Examples of these include: 

A previous nasal fracture (you broke your nose) 

Nasal bones are the most commonly broken bones in the body. Sometimes they heal well on their own, or they seem as if they did. Over time, you may experience signs or symptoms that the nose didn’t heal as well as you’d hoped. In fact, your previously fractured nose may have set in a crooked position. Or, the break may have been worse than you knew, leading to fractures deeper in the sinus cavities that didn’t heal well.  

Anyone who has broken their nose in the past is at higher risk for chronic sinus infections, so make sure to mention your nasal fracture history when you make an appointment with our office. 

Nasal polyps or other soft tissue obstructions 

Sometimes, for reasons that are unclear, the thin tissue lining the nasal passages develop small, benign (non-cancerous) tumors. We call these nasal polyps. As you know, it does not take much to obstruct the airway, so even a single polyp can lead to significant airway and breathing issues – including chronic snoring – as well as recurring sinus infections. Most often though, people with polyp-related sinusitis have multiple polyps obstructing the nasal passages.  

Fortunately, we can remove nasal polyps or other soft tissue obstructions using minimally-invasive procedures such as nasal airway remodeling. 

Deviated septum 

Some people are born with deviated septums, others develop them after a traumatic accident or injury – even when the injury seemed relatively mild. The nasal septum is that thin wall that divides the right and left sides of your nasal passages. If the wall is offset or deviated to a severe enough degree, it compromises both breathing and sinus drainage.  

If the septum has deviated to the point that it causes health problems, Dr. Hester will work with you to determine which treatment method or surgical procedure is best for correcting the deviation.  

Scar tissue in the sinus cavities 

Previous injuries, anatomic defects from birth, or previous sinus injections can all cause scar tissue to build up in the sinuses. This blocks the cavities from functioning and draining properly, which can trap irritants in the cavity. Recurrent sinus infections can continue causing more scar tissue, further compounding the problem. 

If Dr. Hester notices that scar tissue is impacting sinus function, he may recommend endoscopic sinus surgery to clear the tissue away.  

Turbinate hypertrophy 

The turbinates are long, narrow passageways that occur along the main nasal passageways. Their job is to warm and moisten the air that you breathe. Most people have three turbinates – inferior, middle, and superior turbinates. Once in a while, people are born with four. If the turbinates become inflamed or enlarged (called turbinate hypertrophy), they fill up the nasal cavity and it won’t drain properly. 

Turbinates are responsible for all kinds of sinus and breathing issues, including difficulty breathing, snoring, chronic stuffiness, and sinus infections that never seem to end. Enlargement of the inferior and/or middle turbinates are the most likely to cause issues. If you are diagnosed with turbinate hypertrophy, Dr. Hester can provide a comprehensive outline of treatment options to find the one that is right for you. In some cases, home treatments and/or medications can reduce their enlargement enough to be effective. For others, surgical procedures are the only successful mode of treatment. 

Abnormal growths or other anatomical abnormalities 

The body is a mysterious and complex series of systems. Seemingly out of nowhere, tissues can thicken, cells can excessively multiply causing tumors, or small issues that didn’t cause problems in the past can begin to cause you trouble. If your nasal passages or sinus cavities experience abnormal growths of any kind, they can usually be removed through surgery. If it is a tumor or mass, we will biopsy the tissue to make sure it is not cancerous.  

Most anatomical abnormalities affecting the bony or soft tissues comprising the sinus cavities can be repaired via surgery, greatly eliminating the experience of recurrent sinus issues. 

Accurate Sinus Diagnosis And Treatments Is Essential 

The only way to stop recurring sinus infections once and for all is to have an evaluation by a specialist who has the specialized training and experience to accurately diagnose their cause. Once you have an accurate diagnosis, we can discuss the options. The goal is always to provide the patient with all the available options, discuss the advantages and disadvantages of each, and help you find the best treatment plan for you.

Stop Suffering 

Do you suffer from recurring sinus infections? Contact us here at the office of Dr. Jerome Hester, ENT, or give us a call at (650) 268-5133, to discuss your concerns. Dr. Hester is an expert at treating all of the variations that lead to chronic sinusitis, and he always strives to find the least invasive treatment methods. Everyone deserves to breathe easily, and we look forward to helping you do just that.

The post Why Sinusitis Keeps Coming Back appeared first on Jerome Hester, MD.

Snoring is no laughing matter. It’s more than just an irritant or annoyance. In fact, snoring affects sleep in such a negative way that chronic snoring increases your risk for a range of health issues, and compromises the wellbeing of others. It is our hope that learning how snoring negatively impacts sleep will inspire you into action.  

Schedule an appointment with your physician to discuss your snoring patterns to determine whether or not you need support from an ENT or an accredited sleep expert. While sleep apnea is one of the most common causes of snoring, there are many other potential causes. And, contrary to what most people think, you may not need a CPAP machine to breathe easy – and sleep well again.  

Click Here to learn more about CPAP machines as well as other treatment options for sleep apnea. 

So, read up to learn more about how snoring is the enemy of sleep, and then work toward finding your best solution.  

Snoring Affects Sleep And Interrupts Vital Sleep Cycles 

The longer the body is deprived of oxygen via snoring, the more it “wakes itself” to get a good breath in. As a result, continuous snoring means consistent disruption of vital sleep cycles. The average non-snorer spends the night moving in and out of various sleep cycles, ranging from 90- to 110-minutes long, forming a sleep rhythm. We call this the ultradian sleep cycle, and it varies between rapid eye movement (REM) cycles and non-rapid eye movement (NREM).  

Over the course of a good night’s sleep, you go through four different stages of sleep, and four separate REM cycles. Each of the cycles and stages of sleep is responsible for different physiological processes. Any interruptions in these cycles mean compromising your body’s biochemical processes – including things like hormone balance, metabolism, mood regulation, and so on. We recommend visiting snoringhq.com’s article, Understanding Sleep Stages and How Snoring Affects Them, to learn more about sleep cycles and what they’re responsible for in terms of physical, mental, and emotional health.  

You (And Your Sleep Partner) Are More Restless 

As anyone who sleeps with a snorer is aware, snoring is a sleep disruptor in its own right. However, snoring also has an effect on your body’s physical motions while you sleep. Someone in the midst of deep, healthy sleep barely moves at all outside minor position changes. However, those who snore often jolt awake, which then causes them to toss and turn until they fall back to sleep. Note: If you sleep with a restless partner, and you are on an old mattress, consider investing in a mattress with memory foam technology, which reduces motion transmission from one side of the mattress to the other. 

Those who sleep with snorers wake up due to the high volume level of the snores, as well as their partner’s active body motions. This, in turn, makes the non-snorer a more restless sleeper. It becomes a vicious cycle where the two of you are waking due to snoring, and then waking up even more due to restless sleeping. 

Studies have shown that those who sleep with people who snore wake up almost as much as their partners. For example, a Mayo Clinic study showed that those with sleep apnea woke up an average of 27 times, and their partners woke up at least 21 times. Another study by the British Snoring and Sleep Apnea Association (BSSAA) estimated that when you measure the amount of sleep a snorer’s partner loses, and you factor that out over an average span of a 24-year marriage, the non-snorer loses about two full years of sleep! 

Diminished Sleep = Diminished Health 

Snoring leads to lost sleep, leading to diminished health. That’s where the snoring pavement hits the road, so to speak. While you may downplay your notorious snoring reputation, there are serious consequences from all that consistently lost sleep. 

Blood pressure goes up 

When your body loses oxygen, as it does when you snore, it immediately begins to compensate. An article by the sleep experts from SleepFoundation.org writes: 

As oxygen levels fall, receptors in the brain are triggered. The result: Your brain sends a message to the blood vessels to increase the available oxygen to the heart and brain so the body can keep functioning. This increase in blood flow puts pressure on the blood vessels’ walls, elevating levels to higher than normal.  

Unlike high blood pressure caused by a poor diet or being overweight, high blood pressure caused by sleep apnea can only be lowered by successful treatment. 

You gain weight 

We mentioned above that interrupting sleep patterns means interrupting essential, biochemical, and physiological processes. This includes the hormones responsible for your body’s metabolic processes as well as stress. The combination of a slower metabolism, combined with increased cravings for sugar (a common response to stress), leads to unhealthy weight gain.  

That becomes a slippery slope since weight gain affects every aspect of your health. In addition to exacerbating existing sleep apnea, weight gain also increases your risks of developing other weight-related health issues such as heart disease and type 2 diabetes. 

You may experience abnormal heart rhythms 

Similarly, chronic snorers often experience abnormal heart rhythms, such as atrial fibrillation. When left undiagnosed and untreated, atrial fibrillation can lead to blood clots, stroke, and other heart complications. Anyone with atrial fibrillation also has an elevated risk of heart failure. 

By getting your nighttime breathing and heart rhythm in check, you give your heart a much-needed break, and that benefits your body as a whole.  

Increased risk of auto- or work-related accidents  

Lack of sleep causes a lack of mental clarity, not to mention excessive daytime sleepiness. After a while, those suffering from lack of sleep become unaware they’re “suffering” at all. Being tired, foggy-brained, and less able to focus on the task(s) at hand begins to feel like the norm. As a result, those with untreated sleep apnea are more prone to automobile and work-related accidents. 

Several studies have been done along these lines. In one 2007 study, the researchers evaluated 316 male truck drivers and their driving records. Of the nearly 100 drivers who were involved in an accident, 20% reported falling asleep at the wheel. Of that 20 %, nearly 80% of them were chronic snorers or had symptoms of sleep apnea.  

Another, more recent article published findings from a meta-analysis that reviewed obstructive sleep apnea (OSA) and work accidents. Researchers noted that the risk of a work-related accident doubled for employees exhibiting symptoms of OSA. As a result, many employers are beginning to make OSA assessment and treatment a part of their hiring process for drivers, heavy equipment operators, or other jobs where work-related injuries can lead to serious or fatal accidents. 

Compromised immune system 

A healthy adult immune system relies on an average of seven to nine hours of sleep per night. Anything more or less than that begins to throw things out of balance. 

Sleep experts from Mayo Clinic write: 

During sleep, your immune system releases proteins called cytokines, some of which help promote sleep. Certain cytokines need to increase when you have an infection or inflammation, or when you’re under stress. Sleep deprivation may decrease the production of these protective cytokines. In addition, infection-fighting antibodies and cells are reduced during periods when you don’t get enough sleep…your body needs sleep to fight infectious diseases.  

In addition to fighting infectious diseases, your immune system manages the body’s inflammatory response. A compromised immune system leads to a heightened inflammatory response, which negatively impacts any existing health issues you may have. Treating your sleep apnea may even help to reverse some of the symptoms of existing health conditions by boosting your body’s natural ability to take care of itself. 

Snoring affects sleep and your intimate and personal relationships

The American Sleep Apnea Association (ASAA) has a wealth of information about how snoring and lack of sleep impact both your intimate relationships as well as other personal relationships. Losing sleep impacts mood regulation, which means you can become moodier than usual and may suffer from a shorter temper. You may have a harder time being patient with those around you or you may find yourself falling asleep at the dinner table or in the middle of a long-anticipated movie date, all of which detract from both personal and romantic relationships.  

In an article titled, Is Your Intimate Relationship Suffering Due to Untreated Apnea?, the ASAA writes: 

“…untreated sleep apnea may reduce sexual quality of life (QOL) because of reduced libido and intimacy, erectile dysfunction, and several other mechanisms. People who suffer from sleep debt due to untreated sleep disorders can also experience poor moods, mental health issues, not to mention exhaustion. What’s more, both men and women can become less in tune or cognizant of the needs of their partners.” 

A study conducted by the Sleep Disorders Center at Rush University Medical Center studied whether treating sleep apnea improved the couple’s relationship and quality of life. The following example of how treating sleep apnea can improve marital relationships is common across the board: 

Following treatment, the wife’s quality of life measure jumped from a 1.2 to a 7, meaning the sleep apnea was no longer bothering her at all. Her sleepiness scale, which measures how tired she feels during the day, dropped from 12 to 6. Marital satisfaction scores improved from 3 to 5.8 and the wife’s sleep efficiency jumped from 73 percent to 82 percent. 

And there’s more… 

Those are six of the most negative and potentially damaging effects of chronic snoring and apnea. Additional issues or symptoms of how snoring affects sleep include: 

• Increased headaches, particularly in the morning 
• Moodiness and irritability 
• Dry mouth, which increases your risk of dental issues and gum disease 
• Chest pain  
• Depression 
• Acid reflux 
• Mental confusion and memory loss 
• Liver problems in the form of higher-than-normal levels of liver enzymes 
• Breathing troubles and adult asthma 

Imagine being able to erase or notably diminish all of the above risks and potentials. The great news is, you can. Schedule an appointment with us today so we can evaluate any anatomical causes for your snoring and determine if you have sleep apnea. The sooner you find out why you’re snoring and how snoring affects sleep for you, the sooner we can treat the problem.

We’re Here For You When You’re Ready

Contact the office of Dr. Jerome Hester and schedule an appointment for a comprehensive evaluation and discussion of all potential treatments by an expert in the area of snoring and sleep apnea. We’re excited to show you (and your partner) how great it feels to get a good night’s sleep. 

The post Snoring Is Not Harmless: How Snoring Affects Sleep appeared first on Jerome Hester, MD.

The coronavirus is a conundrum in more ways than one. In addition to rapidly escalating to the most notable pandemic of our era, it is a mystery to healthcare providers. While some experience coronavirus as hardly anything at all, others find themselves in ICUs struggling to breathe and fighting for their lives.

And, while sore throat and coronavirus do go hand in hand, it is so important to realize that a sore throat is also a symptom of multiple other conditions, from common cold (yes – they still exist, too) to seasonal allergies or snoring at night. If you experience a sore throat, do not panic. Instead, take good care of yourself, get plenty of liquids and pay attention to other signs and symptoms.

IMPORTANT NOTE: There is so much misinformation floating around on the internet and social media channels, which makes it difficult to know what to believe. We highly recommend ignoring any and all information unless it comes from legitimate medical or health organization websites such as:

• Center for Disease Control (CDC)
• The World Health Organization (WHO)
• Reputable university websites such as Harvard.edu or Johns Hopkins.

As researchers at Harvard University write, “Just as the number of people and countries affected by this new virus has spread, so have conspiracy theories and unfounded claims about it. Social media sites, including Facebook, Twitter, YouTube, and TikTok, have seen a number of false and misleading posts…”

Do not fall victim to false information, and avoid being a part of the misinformation chain! Taking responsibility for where you get your information helps to protect you and the ones you love.

What is COVID-19? Its  Signs and Symptoms

As we mentioned above, the current coronavirus pandemic is caused by a version of the virus (which is covered with crown-like spikes on its surface) is called COVID-19 and is a version of the SARS virus.

Without an actual test, COVID-19 is impossible to accurately diagnose because it replicates other versions of common colds and cases of flu. To complicate matters, the only way to be tested is to visit a local healthcare provider, which means potentially exposing yourself to the real coronavirus if all you have is a common cold.

This is why healthcare providers recommend staying at home and calling them via office lines or their 24-hour nurse line. By describing your symptoms and their severity, healthcare professionals can provide a tremendous amount of support while allowing you to stay safely at home. That way, only those in the greatest need occupy medical facility space, and the rest of us with potential coronavirus cases remain quarantined at home, preventing further spread of the virus.

If symptoms are severe enough, your healthcare provider will give you explicit instructions on how to safely travel to and enter their facility for testing and treatment.

First and Most Common Symptoms

Symptoms of COVID-19 typically appear within two to five days after exposure. In almost all but the most severe cases, the virus runs its course within 14 days.

The first and most common symptoms of coronavirus are:

• Fatigue
• Headache
• Sore throat
• Low-grade fever

Additional symptoms

As with any cold or flu, the symptoms vary from person to person, and they tend to get worse after the initial two to three day onset. Additional symptoms of COVID-19 include:

• Muscle aches
• Difficulty smelling or tasting (a common side effect of viruses because they attack the cells that our noses and brains use to detect scent, which enhances our sense of taste)
• Headache
• More elevated fever
• Diarrhea and/or stomach upset

Severe symptoms of COVID-19

Some of the most severe symptoms are most likely to result in hospital admission and testing. These are:

• Persistent pain or pressure in the chest
• Difficulty breathing
• Bluish lips or face
• Inability to rouse from sleep or a resting state or mental confusion

Any of these symptoms should result in a phone call to a 24-hour nurse hotline or 9-1-1, when you will be given explicit instructions on how to proceed.

Soothing a Sore Throat – Coronavirus or Otherwise

The very good news is that the large majority of those who catch COVID-19 never experience severe symptoms. In fact, some never have any symptoms at all, or a sore throat may be the only coronavirus they experience.

Again, the best thing you can do for yourself if you experience any of the potential coronavirus symptoms (headache, sore throat, fever, fatigue, aches, etc.) is the same thing you would do for any other flu – hydrate, eat soft, nourishing foods, and get plenty of rest. Fortunately, sheltering-in-place mandates make it easier than ever to take good care of yourself.

Drink plenty of fluids – preferably water and herbal teas

Your sore throat is inflamed and the body produces mucous to drain viruses or bacteria out of your system. Mucous drainage from the nose, which travels and can linger in the throat, is also a cause of sore throats. Drinking fluids flushes those out of the throat and soft palate area, which minimizes irritation. Remaining hydrated also boosts your body’s natural immune boosting response.

If you have a sore throat, try:

• Sipping on room temperature or cool (rather than ice-cold) water to keep the throat moist and lubricated. Sometimes drinking ice water causes throat spasms, which can lead to coughing and further throat irritation.
• Warming or heating water and adding a squeeze of lemon and a teaspoon of honey, which is a known throat-soother
• Sip decaf teas or herbal teas that advertise throat-soothing properties
• Suck on ice chips or 100% juice ice popsicles if your throat is really sore. This helps your body absorb fluids through the mouth while minimizing painful swallowing

DO NOT: Consume alcohol. Alcohol irritates inflamed throat tissues. Plus, as the CDC states on their Coronavirus Myth Busters page, “Frequent or excessive alcohol consumption can increase your risk of health problems…Drinking alcohol does not protect you from against COVID-19…” Plus, alcohol is dehydrating, which is counterproductive when focusing on hydration.

Try to avoid…

You may also want to avoid sports drinks and fruit juice. While they may seem like a good idea, they are loaded with sugar and the acid content in most fruit juices often irritate inflamed throats. Coffee is also high in acid and the caffeine may prevent you from getting the rest you need.

Get lots of rest

Your body does its best healing when you are at rest. Sleeping and lying low allows your body to divert as much energy as possible towards fighting off the invader, whether that be a bacterial infection, a virus, or COVID-19.

In fact, multiple studies have proven that sleep really is the best medicine against the flu. A study conducted by the University of Washington found that when we have a flu virus, our bodies produce an extra amounts of the protein AcPb. While we sleep, this protein interacts with immune system signaling chemical called interleukin-1. Together, they catalyze more sleep and expedited healing.

Eat nourishing foods

Typically a sore throat and flu include that aforementioned lack of smell and taste. Altogether, it can diminish your appetite. However, healthy and nourishing foods will help to boost your immune system can help you feel better at the same time.

The post Your Sore Throat and Coronavirus: Care & Treatment appeared first on Jerome Hester, MD.

Snoring in an adult can be a humorous or societal issue. However, snoring in a young child actually more commonly is a significant medical issue. Snoring occurs when there’s obstruction of the airway, and this leads to narrowing of the airway and obstruction to air flow, causing vibration of tissue.

In an adult, approximately 80% of all habitual snorers have sleep apnea. However, that number approaches 100% in children who are habitual snorers. Therefore, this truly demands that if a child is a snorer night in and night out, or at least most nights, that they truly should be evaluated by a specialist.

Many times, such issues are attributed to allergies or nasal congestion. Although those issues may play a role occasionally in children, they are rarely the cause of the issue. The most common cause in children is the enlargement of tonsillar or adenoidal tissues. The adenoids are tissue very similar to tonsils, but behind the child’s nose, and therefore out of view of most routine examinations.

If one does have a child who snores, remember that the presence of sleep apnea in a child is rarely accompanied by the typical signs of poor sleep such as fatigue or complaints about sleep. Actually, in the younger person, if anything, it is actually much more common that the child will have issues with attention span, concentration issues, perhaps even behavioral issues, and in fact, many times will actually have decreased growth because of the lack of deep sleep. Therefore, the recommendation for any child who snores regularly is an evaluation by an individual who specializes in sleep medicine and evaluation of the airway. In adults, we commonly recommend for all patients that they obtain a sleep study, a test where a patient is monitored overnight to look for obstruction. That still is a very useful test in a child, but it is not as diagnostic in a child as it is in an adult, and therefore, consideration by your physician may be that evaluation just by a physical examination and a history is enough to warrant proceeding with treatment.

Treatments in children can involve non-procedural treatments such as CPAP, although tolerance of this treatment in a child is very, very low. The procedural treatments indicated are most commonly removing the tonsil tissue, removing the adenoid tissue, and shrinking inflammatory tissue in the nose known as turbinates. That surgery is very common and is very effective for treating these individuals, but full evaluation of the patient should be made before any treatment is initiated.

The post Why Does My Child Snore? appeared first on Jerome Hester, MD.

Although society’s attitude toward snoring is usually somewhat humorous, this can be a major issue for individuals. Aside from the fact that it itself can happen and cause couples not to be able to share the same bed, it also may be a sign of a much more serious health issue. Snoring occurs routinely when the soft tissues of the airway, especially the roof of the mouth or what’s known as the soft palate, vibrates due to narrowing of the airway and therefore vibration of that tissue as air passes by it. The most common time for this relaxation to occur is when one gets into deeper sleep. At that time soft tissues in the body, including muscles, generally relax.

It is likely to be true that almost any adult can snore occasionally in certain indications such as perhaps when they’re extremely fatigued, had an extra glass of red wine with dinner, or have a bad cold. However, any individual that is a routine snorer, snoring most nights, should really be evaluated. About 80% of those individuals will be found to have sleep apnea, and sleep apnea has a myriad of very serious medical side effects and potential complications, some of which are even life-threatening.

An individual who denies any other symptoms of sleep apnea but just snores still is at risk for this very real diagnosis. On top of that, more recently there have been at least one or two studies that have demonstrated individuals who have only primary snoring, who have a normal test for sleep apnea, who still show an increased risk of heart attack and stroke. Therefore, snoring itself may actually be its risk by itself. Any individual who snores routinely should have a sleep study. A sleep study is a diagnostic test ordered by your physician that can either involve a night stay at a sleep center or can actually be taken home and performed in your own bed. This will measure whether or not there is significant enough obstruction to provide the diagnosis of obstructive sleep apnea.

It is very important to do this before treatments are initiated because the type of treatment that may be safe for that individual who’s snoring and also the predicted success rates of treatments vary on whether sleep apnea is present or not, and if it is present, the severity of sleep apnea. If, in fact, a sleep study is normal, and the patient does not have sleep apnea and still wishes to have their snoring treated, there are a variety of mechanisms to treat that, both non-surgical and procedural. The non-procedural treatments include the use of CPAP, which is typically used for sleep apnea, even mild to moderate sleep apnea, where positive-pressure air is used to stent the airway open.

There are other options now available that are slightly less invasive but are based on the similar techniques, and then there are devices known as dental devices or mandibular repositioning devices similar to a teen’s orthodontic retainer that is used instead to pull the lower jaw slightly forward to open the airway. These have the benefit of not being invasive but do have to be worn each night to prevent the snoring. There are office-based procedural treatments that can involve using heat energy to tighten the tissue, using implanted devices that will strengthen and tighten the tissue, or even surgical treatment that basically removes the redundant tissue to relieve the snoring. All of which have their place in the treatment of snoring but really demand an evaluation to determine whether any other issues are present in order to maximize their potential for success.

The post Can Snoring Indicate Major Health Issues in Adults? appeared first on Jerome Hester, MD.

Children have increased number of middle ear infections for a variety of reasons. The main reason is that the eustachian tube, which is the small tube that goes from behind the nose to behind the eardrum and ventilates that area, is immature in children, and over time reaches its mature state. But in the meantime, between that issue and various other exposure issues, children do have more ear infections. Most of the times, these can be managed quite easily. However, it should not be discounted the amount of discomfort, feeling of being unwell, that the children go through because of these infections. It is significant for them.

Most of these infections do end up being treated with antibiotics, although certainly there has been a significant discussion regarding the fact that many of these infections may be viral and therefore antibiotics are not used. Despite that, most infections do receive antibiotics, and so a child may receive numerous courses of antibiotics over a year or two years’ time, which carries a risk itself.

On top of that, the other concerns are related to the fact that fluid that may remain behind the eardrum either during the infection or even for months afterwards and this decreases hearing. Although it will resolve, in those young individuals who are developing speech, things like pronunciation can be retarded at this time and they do not progress as rapidly as they might otherwise.

Finally, although it is very uncommon with those individuals who do have access to medical care, there is a risk that these recurring infections can become more serious and even penetrate into the bone surrounding the area and therefore, demonstrate a more impactful infection and may in fact require aggressive surgical management.

Overall, if a child has repetitive infections, consideration of the placement of pressure equalizing tubes should be made. The idea behind the tube is that a temporary ventilation airway between the outside world and behind the eardrum can be established until the child’s eustachian tube does mature. Unfortunately at this point, there is no good way to estimate when that tube may mature, so therefore, sometimes with the placement of tubes, the need for the tube may require six months, 12 months, or even longer.

The tube is placed generally under anesthesia. A small incision is made in the eardrum. Any infection or fluid that is present at that time is removed, restoring normal hearing almost immediately, and a small tube that may look something like a spool of thread with a ventilation port down the center and wider flanges on the end to hold it in place are placed. By most experienced otolaryngologists, this a process that takes less than minutes, and the patient is able to go back to normal activities almost immediately. The long term success of these tubes is very high. A small portion of individuals will have some issues with occasional drainage out of the ears. That is usually easily managed by the otolaryngologist. And as I mentioned earlier, sometimes the tubes, which typically last six to 12 months, need to be replaced due to the fact that the issue continues for longer than that period of time. However, during that time, the patient generally is asymptomatic and does not have recurring ear infections. Hearing is back to normal and the patient can avoid ongoing antibiotic usage.

In most cases, the need for water protection after the placement of tubes is not necessary. Certainly, the individual may not be able to submerge their head deeply under water, but routine issues such as swimming on the surface and even showering or bathing can be entertained without any kind of ear protection. Therefore, the child is really able to lead a fairly normal, active life with the absence of these infections.

The post Pressure-Equalizing Tubes In Repetitive Middle Ear Infections appeared first on Jerome Hester, MD.

Recently, the National Transportation Safety Board found that two separate fatal train accidents, one in New York and one in New Jersey, were likely the result of untreated obstructive sleep apnea. It is well known that untreated sleep apnea will lead to fatigue, which is not always obvious to the individual suffering from the disease. The government has put in restrictions on the diagnosis and testing for this disease among train engineers, pilots and even captains of large vessels. However, these guidelines are not always followed. This has led to other issues where sleep deprivation, and in many cases, sleep apnea itself have been blamed for these accidents.

This includes the Exxon Valdez, the incident involving a large tanker hitting the Bay Bridge here in the San Francisco Bay Area leading to a large oil spill, and even airplane accidents leading to fatalities. As worrisome as all these are, it brings to light a much more common and probably imminent danger to the rest of us, which is the same issues that lead to fatigue playing a role in these accidents leads to a significant role in automobile accidents. It has been estimated that an individual with even mild to moderate sleep apnea has somewhere in the realm of four to seven times the baseline risk of being involved in a fatal car accident. This means that that individual who is fatigued behind the wheel can cause the death not only of themselves but of other innocent individuals as well.

Attempts to regulate this have not been easy for governmental agencies. Therefore, I believe all of us should understand that if there are signs and symptoms of sleep apnea, that not only should one pursue these for the risks such as heart disease, stroke and just the fatigue itself, but also the fact that this provides a significant risk to others on the road who are innocent. Once again, the recent episodes bring to light any incident that shows us that sleep apnea or sleep deprivation may be there should be considered a true risk factor when operating any kind of motor vehicle.

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