ACUTE OTITIS EXTERNA (SWIMMER’S EAR)
WHAT IS SWIMMER’S EAR?
Swimmer’s ear is an infection of the ear canal, which is a slender channel about one-inch long that leads from the outer ear to the eardrum. Symptoms of swimmer’s ear can include pain, redness, and swelling of the ear canal and an itchy feeling in the ear. Pain when tugging the earlobe, or when chewing food, is also a symptom. Some patients report temporary hearing loss or their ears feeling “full.” Patients may experience symptoms differently and at different levels of severity. It is important to note that swimmer’s ear is different from a middle ear infection, which is common in young children.
WHAT CAUSES SWIMMER’S EAR? ARE THERE RISK FACTORS?
Swimmer’s ear is an infection that occurs when water remains trapped in the ear canal. This moist environment is ideal for the growth of bacteria, and, in rare cases, fungus. Some patients get swimmer’s ear from swimming, although it can happen from bathing,showering, or even sweating. A lack of earwax due to aggressive cleaning with cotton swabs or small objects can cause swimmer’s ear. Earwax limits the growth of bacteria and is a natural barrier to moisture. Skin conditions such as eczema, and chemicals from hairspray or dyes, can also prompt swimmer’s ear.
Stress, sweating, wearing hearing aids, and allergies have been linked to the condition as well. People swimming in pools with poor water quality are more likely to get swimmer’s ear. Those living in warmer climates do are also more likely to get swimmer’s ear because they spend more time swimming or doing water sports. Some studies show that those with Type A blood may be at increased risk for swimmer’s ear.
WHAT CAN YOU DO?
Seeking medical care quickly after the onset of symptoms will help avoid misdiagnosis or delayed diagnosis and improve the success of treatment.Untreated swimmer’s ear can be very painful and can temporarily affect hearing.
If left untreated, swimmer’s ear could spread beyond the ear canal, lead to a chronic infection, or even permanently damage the ear.
Swimmer’s ear is diagnosed by a physical examination and medical history by a healthcare provider. A doctor may examine the ears using a device called an otoscope (pronounced oh/ toe/ scope), which allows for a good view inside the ear canal. By using this device, a doctor can exclude any other causes of the patient’s symptoms, such as excessive ear wax or infection in the middle ear. A doctor may also clean the inside of the ear canal and take a sample of drainage from the ear, if present.
TIPS FOR HEALTHY VOICES
Voice problems usually are associated with hoarseness (also known as roughness), instability, or problems with voice endurance. If you are unsure if you have an unhealthy voice, ask yourself the following:
- Has your voice become hoarse or raspy?
- Does your throat often feel raw, achy or strained?
- Has it become an effort to talk?
- Do you repeatedly clear your throat?
- Do people regularly ask you if you have a cold when in fact you do not?
- Have you lost your ability to hit some high notes when singing?
Voice problems arise from a variety of sources including voice overuse or misuse, cancer, infection, or injury. Here are steps that can be taken to prevent voice problems and maintain a healthy voice:
- Drink water (stay well hydrated): Keeping your body well hydrated by drinking plenty of water each day (6-8 glasses) is essential to maintaining a healthy voice. The vocal cords vibrate extremely fast even with the most simple sound production; remaining hydrated through water consumption optimizes the throat’s mucous production, aiding vocal cord lubrication. To maintain sufficient hydration avoid or moderate substances that cause dehydration. These include alcohol and caffeinated beverages (coffee, tea, soda). And always increase hydration when exercising.
- Do not smoke: It is well known that smoking leads to lung or throat cancer. Primary and secondhand smoke that is breathed in passes by the vocal cords causing significant irritation and swelling of the vocal cords. This will permanently change voice quality, nature, and capabilities.
- Do not abuse or misuse your voice: Your voice is not indestructible. In every day communication, be sure to avoid habitual yelling, screaming, or cheering. Try not to talk loudly in locations with significant background noise or noisy environments. Be aware of your background noise—when it becomes noisy, significant increases in voice volume occur naturally, causing harm to your voice. If you feel like your throat is dry, tired, or your voice is becoming hoarse, stop talking.
- To reduce or minimize voice abuse or misuse use non-vocal or visual cues to attract attention, especially with children. Obtain a vocal amplification system if you routinely need to use a “loud” voice especially in an outdoor setting. Try not to speak in an unnatural pitch. Adopting an extremely low pitch or high pitch can cause an injury to the vocal cords with subsequent hoarseness and a variety of problems.
- Minimize throat clearing: Clearing your throat can be compared to slapping or slamming the vocal cords together. Consequently, excessive throat clearing can cause vocal cord injury and subsequent hoarseness. An alternative to voice clearing is taking a small sip of water or simply swallowing to clear the secretions from the throat and alleviate the need for throat clearing or coughing. The most common reason for excessive throat clearing is an unrecognized medical condition causing one to clear their throat too much. Common causes of chronic throat clearing include gastroesophageal reflux, laryngopharyngeal reflux disease, sinus and/or allergic disease.
- Moderate voice use when sick: Reduce your vocal demands as much as possible when your voice is hoarse due to excessive use or an upper respiratory infection (cold). Singers should exhibit extra caution if one’s speaking voice is hoarse because permanent and serious injury to the vocal cords are more likely when the vocal cords are swollen or irritated. It is important to “listen to what your voice is telling you.”
Your voice is an extremely valuable resource and is the most commonly used form of communication. Our voices are invaluable for both our social interaction as well as for most people’s occupation. Proper care and use of your voice will give you the best chance for having a healthy voice for your entire lifetime.
Hoarseness or roughness in your voice is often caused by a medical problem. Contact an otolaryngologist—head and neck surgeon if you have any sustained changes to your voice.
ALLERGIES AND HAY FEVER
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 were an unwelcome 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 ARE COMMON ALLERGENS?
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.
One of the most significant causes of allergic rhinitis in the United States is ragweed. It begins pollinating in late August in most of the U.S. and continues until the first frost. Late springtime pollens come from grasses like 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. Flowering plants rarely cause allergy symptoms.
Certain allergens are present all year long. These include house dust, pet danders, and some foods and chemicals. Symptoms caused by these allergens often worsen in the winter when the house is closed up, due to poor ventilation.
Mold spores also cause allergy problems. Molds are present all year long and grow both 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.
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 of dollars spent on anti-allergy 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 they produce year-round discomfort. Symptom control is most successful when multiple approaches are used simultaneously to manage the allergy. They may include minimizing exposure to allergens, desensitization with allergy shots or drops, 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, ENT doctors will offer advice on proper environmental control. They will also 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 subcutaneous immunotherapy (allergy shots) or sublingual immunotherapy (allergy drops) may be recommended. Immunotherapy is a method of treating allergies by desensitizing individuals to allergens over time, in many cases with the goal that they be cured of their allergies.
TIPS FOR REDUCING THE EXPOSURE TO COMMON ALLERGENS:
- Wear a pollen mask when mowing grass or cleaning house (most drugstores sell them).
- Change your air filters regularly in heating and air conditioning systems and vacuum cleaners and/or install an air purifier. Consider a HEPA filter in your bedroom or other rooms where you spend a lot of time.
- Keep windows and doors closed during heavy pollen seasons.
- Wipe down indoor-outdoor animals as they return inside to remove pollen on their fur.
- Use daily saline nasal rinses to cleanse your nose and sinuses of the offending allergens.
- Rid your home of sources of mildew.
- Try not to allow dander-producing animals (i.e., cats, dogs, etc.) into your home and bedroom. However, if you have a pet, ask your ENT for suggestions to allow you to enjoy your pet while also enjoying a life free of allergies.
- Change feather pillows, woolen blankets, and woolen clothing to cotton or synthetic materials.
- Enclose mattress, box springs, and pillows in a plastic barrier.
- Use over-the-counter antihistamines and decongestants as needed and as tolerated. However, you will likely find the best allergy symptom control with topical nasal sprays and eye drops that can be prescribed by your ENT.
- Sleep with the head of the bed tilted upward. Elevating it helps relieve nasal congestion.
Discuss hay fever and allergy symptoms with a physician when experiencing an allergic reaction
SNORING AND SLEEP APNEA
INSIGHT INTO SLEEPING DISORDERS AND SLEEP APNEA
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 people and usually worsens with age. Snoring may be an indication of obstructed breathing and should not be taken lightly. An otolaryngologist can help you to determine where the anatomic source of your snoring may be, and offer solutions for this noisy and often embarrassing behavior.
WHAT CAUSES SNORING?
The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.
In children, snoring may be a sign of problems with the tonsils and adenoids. A chronically snoring child should be examined by an otolaryngologist, who may recommend a tonsillectomy and adenoidectomy to return the child to full health.
PEOPLE WHO SONORE MAY SUFFER FROM:
- Poor muscle tone in the tongue and throat: When muscles are too relaxed, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. Some relaxation is natural during deep sleep, but may become a problem if exacerbated by alcohol or drugs that cause sleepiness
- soft tissue in the neck that can lead to airway narrowing. Cysts or tumors are rare causes of airway narrowing.
- Long soft palate and/or uvula: A long palate narrows the opening from the nose into the throat. The excessive length of the soft palate and/or uvula acts as a noisy flutter valve during relaxed breathing.
- Obstructed nasal airways: A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat that pulls together the floppy tissues of the throat, and snoring results. So snoring may only occur during the hay fever season or with a cold or sinus infection. Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.
WHY IS SNORING SERIOUS?
Socially – Snoring can make the snorer an object of ridicule and can cause the bed partner to experience sleepless nights and fatigue.
Medically – It disturbs sleeping patterns and deprives the snorer of adequate rest. It may be a sign of obstructive sleep apnea (OSA), which can lead to serious, long-term health problems.
WHAT IS OBSTRUCTIVE SLEEP APNEA?
Snoring may be a sign of a more serious condition known as obstructive sleep apnea (OSA). OSA is characterized by multiple episodes of breathing pauses greater than 10 seconds at a time, due to upper airway narrowing or collapse. This results in lower amounts of oxygen in the blood, which causes the heart to work harder. It also causes disruption of the natural sleep cycle, which makes people feel poorly rested despite adequate time in bed. Apnea patients may experience 30 to 300 such events per night.
The immediate effect of sleep apnea is that the snorer must sleep lightly and keep the throat muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he or she may be sleepy during the day, which impairs job performance and makes him or her a hazardous driver or equipment operator. Untreated obstructive sleep apnea increases the risk of developing heart attacks, strokes, diabetes, and many other medical problems.
HOW IS HEAVY SNORING EVALUATED?
Heavy snorers should seek medical advice to ensure that sleep apnea is not a problem. Heavy snorers include people who snore constantly in any position or who negatively impact a bed partner’s sleep. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck, often using a fiberoptic scope. An examination can reveal if the snoring is caused by nasal allergy, infection, nasal obstruction, or enlargement of tonsils and adenoids. A sleep study in a laboratory or at home may be necessary to determine if snoring is due to OSA.
All snorers with any of the following symptoms should be evaluated for possible obstructive sleep apnea:
- Witnessed episodes of breath pauses or apnea during sleep
- Daytime sleepiness or fatigue
- High blood pressure
- Heart disease
- History of a stroke
WHAT TREATMENTS ARE AVAILABLE?
Treatment depends on the diagnosis and level(s) of upper airway narrowing. In some cases, more than one area may be involved.
Snoring or OSA may respond to various treatments offered by many otolaryngologist—head and neck surgeons:
- Obstructive sleep apnea is most often treated with a device that opens the airway with a small amount of positive pressure. This pressure is delivered via a nasal mask worn during sleep. This treatment is called CPAP; it is currently the initial treatment of choice for patients with OSA.
- Uvulopalatopharyngoplasty (UPPP) is surgery for treating snoring and obstructive sleep apnea. It removes excess soft palate tissue and opens the airway. In addition, the remaining tissue stiffens as it heals, thereby minimizing tissue vibration. The size of the air passage may be further enlarged when a tonsillectomy is added to the procedure.
- Thermal ablation procedures reduce tissue bulk in the nasal turbinates, tongue base, and/or soft palate. These procedures are used for both snoring and OSA. Different methods of thermal ablation include bipolar cautery, laser, and radio frequency.
These procedures may be done in the operating room or during an office visit. Several treatments may be required.
Methods to increase the stiffness of the soft palate without removing tissue include injecting an irritating substance that causes stiffness in the injected area near the uvula. Another method is inserting stiffening rods (Pillar implants) into the soft palate.
Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.
A custom-fit oral appliance, which repositions the lower jaw forward, may also be considered for certain patients with snoring/ OSA. This should be fitted by an otolaryngologist, dentist, or oral surgeon with expertise in sleep dentistry.
In some patients, significant weight loss can also improve snoring and OSA.
DO YOU RECOMMEND OVER-THE-COUNTER DEVICES?
There is no specific device recommended. More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. Different methods include products that help a person avoid sleeping on their back, since snoring is often worse in that position. Some devices open nasal air passages; others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs. While a person may find a product that works for him or her, underlying poor sleep quality may remain.
SLEF-HELP FOR THE LIGHT SNORER:
Adults who suffer from mild or occasional snoring should try the following self-help remedies:
- Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
- Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.
- Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring.
- Establish regular sleeping patterns.
- Sleep on your side rather than your back.
- Elevate the head of your bed four inches.
Source: American Academy of Otolaryngology — Head and Neck Surgery Copyright 2014.