Recent blog posts – Alabama Nasal & Sinus Center – Page 2
One of the most anxiety producing events that may occur during a visit to the ENT is the nasal endoscopy or fiberoptic laryngoscopy. This is understandable. We are hard wired to avoid allowing foreign objects into our bodies, especially our noses. In addition, the endoscopy is done without general anesthesia -you are awake for this thing! I’m here to set your mind at ease. Nasal endoscopy and fiberoptic laryngoscopy are very important tools that we use to evaluate the head and neck anatomy of our patients. In office endoscopy is very safe and virtually no adverse effects or complications are ever encountered. In our office here at ANSC, we have a state of the art set-up with each room set up as an endoscopy suite. That means that you and/or your family/friends can watch on your own screen as the endoscopy is performed. I know some of you will not want to watch, and that is OK. Either way, the endoscopy is a great way to define anatomy, ensure accurate diagnosis, and educate patients and family. I am proud to say that I’m not asking you to do anything that I haven’t had done to me several times. If I can survive it, so can you!.
God bless,
Kris Lay, M.D.
“Doc, I got sinus!”
We hear that statement a lot. Determining what a patient means by “sinus” is sometimes a challenge. Most people mean that they have nasal congestion and pressure. Some also have a feeling of nasal drainage. Many have sinus headaches. Some will present with the stuff they blow out of their nose. Whatever, the case, “sinus” has a broad differential diagnosis. All of the possible causes, however, have a common thread – namely, inflammation.
Onset and duration of symptoms often determines the underlying disease process. The most common cause of nasal/sinus symptoms is the viral upper respiratory infection or common cold. This will usually present with acute onset of nasal obstruction and congestion with fever and either clear or discolored nasal discharge. Contrary to popular belief, the color of the nasal discharge alone is not indicative of bacterial versus viral rhinosinusitis. The above symptoms can be treated with over-the-counter medications and home remedies and they should resolve naturally in seven to ten days. Symptoms that worsen after five days or persist for more than ten days will benefit from more aggressive treatment, such as topical and/or oral steroids and oral antibiotics. These treatments will shorten the severity and duration of symptoms. The second sickening, worsening of symptoms after a period of seeming to get better, or symptoms lasting greater than ten days, suggests that the acute viral illness has become complicated by bacterial infection.
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There is a lot of confusion out there these days regarding what foods to eat. Eat this, not that. Well, now that may cause cancer in small rodents if taken in excess, so careful eating THAT. What’s an omnivore to do? So many options turns into so many possible land mines. Well, I hope that I can ease you mind a little with this post.
You may be asking, “What does an ENT know about diet?” Well, this ENT is also a human who likes to eat a lot and I have a special interest in allergy and sinus disease, both of which are affected by the foods we eat. Much of my knowledge comes from first hand experience. As a person who has a history of arthritis and allergies, I began searching for the underlying cause of my problems years ago. I found that part of the problem for me is that I have food sensitivities or cyclic food allergies. These types of food allergies/sensitivities are mediated by a different type of immunoglobulin than the classic type food allergy, which most people are familiar with. Fixed food allergy reactions are immediate in onset and involve swelling of the face and possibly affect the airway. This type of reaction was dramatically, though comically, portrayed by Will Smith in the movie Hitch. Cyclic food allergies, on the other hand, present as nasal congestion, sneezing, and headaches, with or without stomach upset, starting four to twenty-four hours after ingesting the offending food. Thus, it is difficult to make the connection between the food you are sensitive to and the symptoms of allergy or inflammation you are having.
The allergy symptoms caused by food sensitivities are very similar to more typical inhalant allergy symptoms. A patient may have both inhalant allergies and food sensitivities concomittantly. Thorough history taking and testing are the only way to know for certain what may be causing your particular problems. The chronic inflammatory state that is affected, however, can lead to sleep disturbance, chronic sinus infections, and arthritides. Strangely, few people that I meet have ever considered that the food they eat, that is, the products that they put in their bodies several times a day, might have anything to do with how they are feeling. Personal experience and scientific data now support a link between foods and inflammatory processes, many of which manifest in sinus and allergy conditions. So, I, for one, am in favor of fruits….and nuts, and lots of vegetables. Stay away from sugar and minimize your grains. Look at eating as an adventure and enjoy the bountiful options available at local farmers markets and at many local grocers. Y’all call me 205-980-2091. I’d love to talk to you more about this or any other topic of interest to you.
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Well, sports fans, as we look forward to Fall Saturdays spent cheering for our favorite college football team, many of us will be facing the prospect of suffering the other days of the week with seasonal allergies. Yes, ragweed, pigweed, Goosefoot, Lamb’s quarter (yummy!), and Russian thistle (oh, my!) are filling the air this month. Symptoms of seasonal allergic rhinitis include sneezing, watery eyes, nasal congestion and runny nose. You may also experience headaches and blurred vision as a result of the onslaught of histamine, as your body reacts to the numerous unseen particles of pollen floating in the air or carried on clothing. All of these symptoms, in addition to hormonal changes triggered by the allergic response, make sleep difficult. The end result is a person walking around in a fog, with decreased productivity at work and diminished capacity for life at home.
Most people who suffer from seasonal allergies are well aware of medications that work for them during their toughest seasons. Many frontline allergy treatments, which were once by prescription only, are now over-the-counter. These include all of the non-sedating antihistamines like Claritin, Zyrtec, and Allegra. There are newer versions of all of these medicines out on the market, but they require a prescription from your doctor and often are more expensive, as a result. Older traditional medications, such as Benedryl or chlorpheniramine, are effective, but lead to significant drowsiness.
Allergies are best treated in a multi-tiered fashion, especially when symptoms are at their worst. The first tier of treatment is avoidance and/or environmental control. If you know that your allergy triggers are certain foods or animals, you can completely avoid exposure and thus have no allergic reactions. If you have seasonal allergies, it may be hard to completely avoid your allergen, but you may be able to minimize outdoor activities during the peak season. People with allergy to molds or dust mites suffer symptoms year-round. Environmental control, such as frequent washing of sheets in hot water, air filters and removal of dust collecting fabrics helps to some degree. The first line of medical treatment when I see patients for allergy problems is usually a nasal steroid spray. There are several brands on the market today, all of which work by inhibiting the cascade of inflammatory reactions triggered by presentation of an antigen into the nasal cavity and upper respiratory tract. The commercially produced nasal steroids are not absorbed into the blood stream to any appreciable extent, so that patients should not worry about systemic steroid side effects. The medication works only in the nasal mucosa (tissue lining the nasal cavity and sinuses). As such, however, the most common adverse side effect is thinning of the nasal mucosa and nose bleeds. These problems usually only occur after prolonged use and can be reversed easily with cessation of the spray.
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A recent article in the International Forum of Allergy & Rhinology (Vol. 1, Issue3, pp.219-224) got me thinking about what really concerns the patient considering endoscopic sinus surgery. What struck me, as an Otolaryngologist (Ear, Nose, and Throat physician), is that what appears to worry patients is not always discussed with the patient before surgery. Typically, my pre-operative counseling discussion with a patient considering surgery reviews the risks of endoscopic sinus surgery, including, but not limited to, risk of orbital injury or blindness, cerebrospinal fluid leak, bleeding and infection. However, the data from the article cited above reveals that patients are most concerned about the wait time for surgery, followed by concerns about undergoing anesthesia, the problem not being fixed by the surgery, and pain and discomfort. Believe it or not, most patients will not raise these types of questions in the pre-operative interview. I encourage you, dear reader, to not be intimidated by the white coat. Go ahead and ask the doctor about that which worries you most. The only dumb question is the one you never ask.
I hope to help you today by addressing each of the top concerns reported in the article. As for wait time for surgery, it’s impossible for me to speak specifically about every case. Generally, however, you can expect a two to four weeks wait before surgery can be scheduled. This is due to a myriad of factors, many of which are out of our control. I try to schedule patients for surgery as soon as possible given availability of OR time and limitations placed on us by insurance companies and delays in pre-certification.
Another common fear it the fear of death or complication from anesthesia. Modern anesthesia is very safe, as a general rule. The most important information for your surgeon and the anesthesia team to ensure a safe procedure is your personal and family history of response to anesthetics. The risk of death from general anesthesia is less than that of death from motor vehicle collision – a risk we all assume several times a day.
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