September Tip of the Month
Cold
Gradual onset Runny nose Stuffy nose No fever or very low grade No chills Few body aches Cough Headache Sore throat Decrease appetite
Flu
Sudden onset More severe Dry nose, not runny High fevers Chills Body aches Dry cough Possible Headache Mild sore throat Fatigue Both the flu and a cold are respiratory illnesses caused by different viruses. They are transmitted from person to person contact. To prevent transmission, avoid direct contact with those who are ill. Wash hands frequently. The best treatment for both the cold and the flu is rest and lots of fluids. You can also use over-the-counter medications to help with symptom relief. Nasal decongestants and expectorants are sometimes helpful. Avoid using Afrin nasal spray. Taking antibiotics will not help a viral infection. Most viral infections last 5-10 days. Please call your doctor if you have symptoms that do not resolve on their own after 10 days. Also, please call if you are experiencing any chest pain, shortness of breath or if you are bringing up green or bloody sputum. April is World Voice Month! During this month of voice awareness, Northeast ENT would like to provide you with some facts on laryngopharyngeal reflux: _ LPR (reflux that affects the larynx and pharynx) has proved to be its own unique entity and different from classic GERD. There has been a substantial amount of research to support LPR as a separate diagnosis from GERD and a number of distinct symptoms have been identified. _ The pattern of reflux and the response to treatment helps to define the difference between these two diagnoses as noted below:
_ The sensitivity of the larynx and the absence of the same protective mechanism as the esophagus makes the larynx more vulnerable to stomach acid. Acid exposure in some patients may be brief and infrequent yet still cause irritation to the tissues of the larynx and pharynx. _ Northeast ENT provides comprehensive assessment of patients with suspected laryngopharyngeal reflux. A thorough examination of the throat is performed to look for clinical manifestations of LPR and rule out other pathologies. If necessary, dual-channel 24 hour pH monitoring is performed to confirm the diagnosis of LPR and/or determine medication efficacy. Please visit our website for more information about LPR, our practice, and other ear, nose, and throat problems at www.northeastent.comDid you know that May is better Speech and Hearing month? The American Speech and Hearing Association has labeled May as "Better Speech and Hearing month." The goal is to raise public awareness of speech, language and hearing problems which affect over 40 million people. Speech problems can range from having hoarseness or an inability to remember words, to stuttering, or having difficulty swallowing food. Hearing problems can range from having difficulty following a conversation in a large group, or being unable to hear the doorbell, to having a constant ringing noise in the ears, or having trouble with balance. Speech and hearing problems are frustrating, isolating and can even impact your ability to work. Imagine being unable to talk to your loved ones or to sing along to your favorite song. Also imagine being unable to hear the sound of your grandchild's voice or being unable to understand a sermon at your church. Speech-Language Pathologists are specially trained to evaluate and treat problems with talking, understanding and swallowing. Likewise, Audiologists are specially trained to evaluate and treat problems with hearing. For more information on speech-language or hearing disorders, go to www.ASHA.org and click on "Public." Northeast Ear, Nose and Throat is pleased to provide both Speech-Language Pathology services and Audiology services in our Dartmouth and Wareham offices. Our certified speech-language pathologist specializes in voice and swallowing disorders in adults and children as well as laryngectomy rehabilitation. To schedule an appointment with an Audiologist or Speech-language Pathologist, contact our Dartmouth office at (508) 995-0700 or our Wareham office at (508) 291-1300.What is Otitis Externa? Otitis externa (OE) is an inflammation of the ear canal between the ear drum and the outside of the ear. The ear canal can be easily infected because it is dark and warm and bacteria or fungus may grow there. OE is different from the kind of infection you get in the middle part of your ear. That kind of infection is called otitis media. What causes OE? Several things can make OE more likely including the following:
Your ear might itch. It can hurt very badly. The pain might get worse when your ear moves while you're chewing. The ear can feel plugged up. You might not be able to hear as well. Your ears will usually drain. See your doctor if any of these things happen. How is OE treated? Your doctor will look in your ear canal and remove any drainage or pus. Most OE infections can be treated with ear drops, but sometimes pills are needed. Follow your doctor's directions carefully and use all of your medicines. OE can be hard to treat. Here are some things that will help you get better:
A sore throat can have many causes. The majority are caused by infections, either viral or bacterial. However chronic throat pain may have other underlying causes such as allergy or reflux. Viruses: Most viral sore throats accompany flu or colds along with a stuffy, runny nose, sneezing, and general body aches and pains. These viruses are highly contagious and spread quickly, especially in the winter. Most viral infections resolve over 7-10 days. Taking antibiotics will not help with a viral infection. There is one viral infection that is more serious and that is a severe tonsillitis called “mono”. Mono is usually accompanied by significant swelling of the tonsils along with white patches. You may also have swollen glands in neck, armpit and groin. Extreme fatigue is usually present. It is important to see a doctor if you think you have mono tonsillitis. Bacteria: Strep throat is a common bacterial infection that requires treatment with an antibiotic. Diagnosis is made by a throat culture that is performed by your provider. Bacterial infections in the nose and sinuses can also cause a sore throat from the mucous that drains down into the throat. Allergy: The same pollen, dust and molds that irritate the nose may also irritate the throat. Your provider can work this up for you and begin appropriate allergy treatment. Irritation: During the cold months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. Using a humidifier will usually help along with increased water intake. Patients with a chronic stuffy nose will also suffer a dry throat. Tobacco smoke and alcohol and spicy foods can also cause irritation. Reflux: Another cause of morning sore throat is reflux, the regurgitation of stomach acids into your throat. To avoid reflux: elevate the head of your bed, don’t eat within 3 hours of bedtime, and eliminate caffeine and alcohol. If you have persistent reflux, see your doctor for a complete work-up, medication may be necessary. Tumors: Tumors of the throat may cause a mild chronic sore throat and difficulty swallowing. There may be pain that radiates to the ear. These tumors a re usually associated with long term smoking. Other symptoms may include hoarseness that persists longer than 2 weeks, a lump in the neck, unexplained weight loss, and/or spitting up blood. Call your doctor if your sore throat is severe and persists longer than 5-7 days or if there is a high fever associated with it. Or if you believe it may not be related to an infection. Symptomatic treatment for sore throat: Increase liquid intake, Warm tea with honey is very soothing, Use a humdifier, Gargle with warm salt water several times daily, Take Tylenol or Advil(ibuprofen) for any discomfort. What Is TMJ? "TMJ" stands for Temporo-Mandibular Joint, or the jaw joint. You have two TMJs, one in front of each ear, connecting the lower jaw bone (the mandible) to the skull. The joints allow movement up and down, side to side, and forward and back—all the mobility necessary for biting, chewing and swallowing food, for speaking and for making facial expressions. Temporomandibular joint diseases and disorders, commonly called TMJ, are a collection of poorly understood conditions characterized by pain in the jaw and surrounding tissues and limitations in jaw movements. Injury and conditions that routinely affect other joints in the body, such as Arthritis, also affect the temporomandibular joint. What Are The Symptoms? Pain is the most common symptom. TMJ pain is often described as a dull aching pain in the jaw joint and nearby areas, including the ear, which comes and goes. It can also be a sharp, searing pain at times. Some people, however, report no pain, but still have problems using their jaws. Other symptoms can include:
What Is The Treatment: Most common jaw joint problems are temporary. If diagnosed early it will usually respond to these simple remedies: eating soft foods, applying moist heat, and avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing). Taking an anti-inflammatory regularly for a few days will often relieve most discomfort. If you grind or clench your teeth, seeing a dentist for a bite block may help with the symptoms. Improving the alignment of the upper and lower teeth and surgical options are available through your dentist or oral surgeon for advanced cases. SILENT REFLUX LARYNGOPHARYNGEAL REFLUX (LPR)
What is Silent Reflux? Reflux refers to the flow of stomach contents or acid back into the esophagus. Normally, two valves (called sphincter muscles) at the top and bottom of the esophagus prevent this backflow. In some people, for a variety of reasons, these valves allow acid to reach all the way up into the throat and voice box. Many people with silent reflux or LPR do not experience heartburn, hence the term "silent." This is because the material that is refluxed does not usually stay in the esophagus for very long and does not have enough time to irritate the esophagus and cause heartburn. While a person may not experience heartburn, there may still be injury and irritation to the sensitive tissues of the throat and voice box. Even small amounts of refluxed acid present for short periods of time can irritate the throat and voice box tissues causing a variety of symptoms. LPR patients usually experience reflux during the daytime but it may also occur at night. LPR can occur even if a person hasn't eaten and can be aggravated by certain foods, certain patterns of eating, as well as stress. Symptoms of LPR: Hoarseness, dysphagia (trouble swallowing), a "lump" sensation in the throat, too much phlegm or mucus, chronic cough or throat clearing, chronic sore throat or burning in the throat. Some or all of these symtoms may occur frequently or intermittently and may also be accompanied by heartburn. Evaluating LPR: First, a Otolaryngologist (Ear, Nose and Throat doctor) will look at your throat to determine if you have signs of reflux. The most common signs are red, swollen tissues and thick mucus. If necessary, some tests may be ordered to help confirm the diagnosis. Some tests include 24 hour pH monitoring and a barium swallow. A barium swallow involves swallowing a chalky white substance while an x-ray is taken of your throat, esophagus and stomach. This shows how you swallow as well as any other abnormality in the throat or esophagus. A 24-hour pH test is a special test that involves wearing a small, flexible tube through your nose and into your esophagus overnight. The tube is connected to a small computer that measures the acid in your esophagus and throat. This test is often very helpful in determining the amount and frequency of acid reflux events and is sometimes used to determine how effective the medications are at stopping acid. Treating LPR: Sometimes, dietary and lifestyle changes that are known to aggravate reflux symptoms are recommended. In most cases, however, dietary and lifestyle changes are not enough and must be combined with medications to control reflux. In severe cases, surgery may be recommended to prevent reflux. There are various medications used to treat reflux. Acid neutralizers such as Mylanta, Maalox, and Tums are designed to neutralize the stomach acid to some degree and are thought to be minimally effective in controlling the symptoms long-term. H2 blockers such as Zantac, Axid and Pepcid, which can be bought over the counter or prescribed by your doctor, are considered more effective than neutralizers as they work to limit the production of stomach acid. Finally, proton pump inhibitors such as Nexium, Prevacid, Prilosec, Protonix and Aciphex are considered the most effective class of medicines for reflux. These medicines also work to limit the production of stomach acid. A combination of these medicines may be prescribed to best control your symptoms. Dietary restrictions and lifestyle changes to reduce reflux and control symptoms :
How long is treatment needed? The answer to this question is different for everyone. It often takes a number of months for injury to the throat and voice box to heal once acid has been suppressed. In many cases, increasing the dosage or frequency of the medication for an extended period of time may be necessary for a person to get relief. Many people with LPR require treatment indefinitely to control symptoms. Some people require treatment intermittently. That is, a person may recover completely for months or years and not require medications, then they may have a recurrence of symptoms and again require treatment. In severe cases, aggressive, prolonged treatment of the reflux with medications and routine monitoring of the throat is recommended. Further testing may also be necessary to test the strength of the lower stomach valve. In some cases, a type of "anti-reflux" surgery (called fundoplication) is recommended to "tighten" the lower stomach valve. Taking your Reflux Medications : Most commonly, proton pump inhibitors (e.g., Prilosec, Prevacid) are prescribed for reflux. The role of this drug is to limit the production of stomach acid before it starts. For the drug to be most effective, it is important to take the medication 1/2 hour to 1 hour BEFORE eating a meal. If you are prescribed once a day dosing, take the medication 1/2-1 hour BEFORE breakfast or the first meal of the day. If you are prescribed twice a day dosing, take the second dose 1/2 to 1 hour BEFORE your supper meal. If you take the medicine after you eat, you've already produced some stomach acid. Also, if you take the pill but do not eat, the medicine will not be as effective. Compliance and consistency with taking your medications are extremely important. If you frequently skip dosages or take the medication sporadically, you are not likely to improve. Remember, only small amounts of acid experienced intermittently may be enough to continue irritation and inflammation of the throat and voice box. (* some information adapted from Patient Information Sheet on Laryngopharyngeal Reflux, J. Koufman, ww.bgsm.edu/voice) |
