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Tonsillitis and When Is Tonsillectomy Needed

What is Tonsillitis?

Tonsillitis is an inflammation of your tonsils called palatine tonsils — two oval-shaped masses of soft tissue that sit at the rear of your throat— one on each side.

Tonsils are part of your immune system and help fight off germs entering through your nose and throat. They are, therefore, at risk of becoming infected.

Though tonsillitis is more common in children and teens, adults can also develop the condition.

What Causes Tonsillitis?

Tonsillitis occurs due to an infection, most likely a viral infection (such as the common cold) but a bacterial infection (most commonly a strep throat) may also trigger the condition. You or your child can contract these bacteria or viruses after coming in contact with contaminated droplets of an infected person during coughing, sneezing, talking, or kissing.

What are the Different Types of Tonsillitis?

Tonsillitis can be:

  • Acute, in which case it lasts anywhere from three days to two weeks, and can either be bacterial or viral in origin.
  • Chronic, which can persist for long periods, usually beyond two weeks, and is almost always bacterial.
  • Recurrent, in which case, a patient experiences several, usually five or more episodes of tonsillitis in a year.

What are the Signs and Symptoms of Tonsillitis?

Tonsillitis can give rise to the following signs and symptoms:

  • Sore throat
  • Difficulty or pain while swallowing
  • A scratchy sensation inside the throat
  • Fever
  • Headache
  • Earache
  • Stomachache
  • Bad breath
  • Jaw and neck tenderness
  • Red and enlarged tonsils
  • Inflamed, or red, throat (pharynx) in acute tonsillitis — which is why acute tonsillitis is also sometimes called pharyngeal tonsillitis
  • Whitish or sometimes yellowish spots on tonsils

How Is Tonsillitis Diagnosed?

Diagnosis of tonsillitis requires complete evaluation and tests to determine if tonsillitis is caused by a bacterium or a virus. The treatment will vary with the causative factor. Hence, it’s imperative to establish the cause of tonsillitis.

Examination for tonsillitis includes the following: 

  • Examining your throat for redness, swelling or white spots on the tonsils
  • Examining your ears and nose for other signs of infection
  • Feeling the sides of your neck to check if the lymph nodes are swollen and tender

Determining the Cause of Tonsillitis

After examination, the next step is to determine the cause. To confirm or refute strep throat as the underlying cause, your ENT specialist will order a rapid antigen test (RADT), also known as a rapid strep test. This test entails swirling a long cotton swab inside the back of your throat to collect a sample. The results of this test are readily available in about 10-15 minutes.

However, If RADT is negative, but there’s a strong suspicion of strep throat, a throat culture can be ordered to confirm the diagnosis. This test checks for the presence of specific bacteria in your throat. Its results come back in 2-5 days.

Negative test results for bacterial tonsillitis indicate that the tonsillitis is viral, not bacterial.

How do you Treat Tonsillitis?

The treatment of tonsillitis depends on the cause.

Viral tonsillitis

It is treated with supportive measures such as:

  • Adequate rest
  • Plenty of fluids to stay hydrated
  • Medications for relieving pain and lowering fever, like ibuprofen or acetaminophen (paracetamol)
  • Sucking on throat lozenges
  • Gargling and rinsing with warm salt water to help soothe a sore throat

Bacterial tonsillitis

If the test results detect a bacterial infection, an antibiotic is prescribed for about 7 to 10 days to help the infection go away somewhat faster. Taking an antibiotic will also stop you or your child from being contagious within 24 hours. But this doesn’t mean that you stop taking the antibiotic before completing the entire course. Doing so can worsen your condition. Besides, antibiotics can also cut down your risk of developing complications – though these are rare in tonsillitis.

When is a Tonsillectomy Needed?

Tonsillectomy is the surgical removal of the tonsils. It used to be a fairly common procedure for treating tonsillitis in the olden days. Today, however, tonsillectomy is not recommended for every patient with tonsillitis. It is only performed in patients who have:

1. Recurrent, frequent episodes of tonsillitis, generally defined as:

  • At least seven episodes in the preceding year
  • At least five episodes a year in each of the previous two years
  • At least three episodes a year for three years in a row

2. Chronic or recurrent bacterial tonsillitis that fails to respond to optimal doses of appropriate antibiotics.

3. Severe symptoms that hamper everyday life, such as missing school or work.

4. Complications of tonsillitis, such as:

  • the formation of a pus-filled pocket close to your tonsils called peritonsillar abscess – that doesn’t improve with medical treatment or drainage
  • difficulty breathing due to enlarged tonsils
  • pauses in breathing while sleeping, indicating a condition called sleep apnea (more than 70% of children who undergo tonsillectomy for sleep apnea report an improvement of their symptoms)
  • difficulty swallowing

5. Multiple antibiotic allergies or intolerances.

How is a Tonsillectomy Performed?

A tonsillectomy is done under general anesthesia (i.e., by sedating you or your child with medications). You will not be aware of the procedure and will not feel any pain while your ENT surgeon is removing the tonsils.

There are several ways of surgically removing the tonsils. However, Surgeons at Ear, Nose, Throat & Allergy Specialists use the Coblation method of tonsillectomy due to its high precision and safety profile.

What is a Coblation Tonsillectomy

Coblation, which means controlled ablation, delivers low-temperature radiofrequency waves with the help of an electrical wand to dissolve the tonsils at the molecular level. This procedure allows your tonsils to be precisely removed without injuring the nearby tissues.

Because there is minimal to no damage to surrounding areas, coblation tonsillectomy is considered a minimally invasive procedure. It leads to considerably less pain, post-operative bleeding, fewer infections, and a faster return to daily activities as compared to the traditional approach.

How is the Recovery after a Tonsillectomy?

Recovery from a tonsillectomy can take anywhere between 10 to 14 days, and depends on the type of surgical procedure employed. It’s normal to experience small streaks or specks of dark or dried blood right within 24 hours of surgery (called primary bleeding) and between 5 and 10 days when scabs fall off from the surgical site (called secondary bleeding).

Adults usually take longer to recover from the surgery than children. You’ll have throat pain and discomfort for 1 to 2 weeks or even longer. The pain may get worse before it gets better and may make your ears hurt. You may also sleep with your mouth open and breathe through your mouth, especially while lying down at night.

All these complaints usually improve in 7 to 14 days after surgery. However, mouth breathing can make your mouth very dry. Therefore, make sure to keep yourself or your child well-hydrated. Placing a humidifier by the bed may also be a good idea to increase humidity and ease dry mouth symptoms.

What to Eat After a Tonsillectomy?

The key to recovery is drinking plenty of fluids. It’s always best to start with clear liquids and advance to soft, semi-solid foods that are easily chewable. You may gradually add to your or your child’s diet as tolerated. It’s best to avoid hard, crunchy, and spicy foods, as these can aggravate discomfort and irritation.

File:Blausen 0859 Tonsils&Adenoids.png. (2018, January 31). Wikimedia Commons, the free media repository. Retrieved April 29, 2020 from https://commons.wikimedia.org/w/index.php?title=File:Blausen_0859_Tonsils%26Adenoids.png&oldid=284404815.

Is There a Connection Between Hearing Loss and Cognitive Decline?

“The researchers found that hearing loss was associated with higher risk of subjective cognitive function (SCF) decline, Dr. Curhan said. Compared with men who did not experience hearing loss, the multivariable-adjusted relative risk of incident SCF decline was 30% higher among men with mild hearing loss, 42% higher among men with moderate hearing loss, and 54% higher among men with severe hearing loss who didn’t use hearing aids.”

Read more at ENT Today

Ear, Nose, Throat & Allergy Specialists Now Offering Appointments via Internet

Living in the North Georgia mountains often brings a sense of welcomed isolation from the crowds and busy roads of Atlanta.  Ear, Nose, Throat, and Allergy Specialists is a 3-office team of 2 surgeons, 3 nurse practitioners, and 2 audiologists that serve a wide geographical area in North Georgia.  Even though we are rural, we have realized we cannot avoid the growing presence of the corona virus, COVID 19, which is affecting the most of the United States and world to some degree.

            As a practice, we have had to quickly learn and adapt to keep patients and staff safe.  Hospitals have dedicated personnel to develop and implement isolation and infectious disease protocols which help reduce the chance of spread of infection.  Fortunately, most of our providers including myself, have lots of hospital experience in dealing with isolation protocols and procedures and applying them to infectious or potentially infectious patients.  Over the past 2 weeks, we have began implementing these practices in all of our office locations with success.  Our goal is to continue to provide needed care to our patients and eliminate the risk of our patients coming to our offices for treatment.

            First, all of our patients are pre-screened on the telephone to ensure they do not have any symptoms of acute cough, cold, or fever.  Patients that do have these symptoms are encouraged to increase fluids and rest as well as to use common cold remedies, and reschedule their appointment after they recover.  If needed, we help direct them to locations where flu and COVID 19 screening are provided. 

           When patients arrive for their appointment, our dedicated and knowledgeable staff perform in-person screening for illness and fever which allows us to quickly isolate any potential infectious person.  Our diligent phone screening has nearly eliminated the chance of an infectious person coming to the office, but we feel this helps ensure a healthy environment for our patients to be treated in. 

           To accommodate the needs of our patients, we have now implemented live, one-on-one, Telehealth appointments.  If you are an existing patient and do not feel comfortable physically coming to the office, our staff will help you set up a virtual appointment using your computer at home.  This allows our patients to remain in contact with us and communicate their needs so we can continue to provide the high level of care we enjoy giving.  Please visit this page to learn more information.

            On behalf of all of our providers and staff at ENT Specialists, we want to let our patients know that we will continue to provide ongoing support and do our part to keep you safe and healthy.  We extend you and your family best wishes, for a safe and healthy experience, as we continue to provide both in-person and virtual visits to our office.

-Josh Snearly, NP-C

Nurse Practitioner

Allergy Testing and Immunotherapy

The Bottom Line

Allergy problems are extremely prevalent in the United States. The American Academy of Otolaryngic Allergy (AAOA) estimates that allergies significantly affect about 50 million Americans, and allergies represent some of the most common types of chronic illness in the US. Allergy issues can range from seasonal allergies, such as allergic reactions to certain types of pollen, to environmental allergies like problems with pet dander and dust mites. Allergic responses to insect stings, like bee venom, can also be severe and even life-threatening.

Types of Allergies

There are several common types of allergies, classified according to the kind of allergen or substance that triggers the allergy. These allergy types include:

Seasonal allergies – This type of allergy is triggered by exposure to pollen. As the name implies, seasonal allergies are usually limited to one or two seasons of the year. For example, ragweed pollen is a frequent cause of seasonal fall allergies, and pollen from trees is often the source of spring and seasonal summer allergies. Seasonal allergies are usually minimized in the winter due to low pollen counts.

Mold allergies – Many species of mold can trigger allergies. These species include Penicillium, Aspergillus, and Alternaria. While it is possible to suffer mold allergies from outdoor exposure, most mold allergy cases occur from indoor exposure due to a higher concentration of mold spores.  

Insect allergies – Insect stings can be painful and annoying for anyone, but around 5 – 7.5% of the population suffers from allergic reactions to bee, wasp, yellow jacket, and other insect stings. The severity of reactions ranges from intense swelling and discomfort near the site of the sting to difficulty breathing, which may lead to death without immediate treatment.

Food allergies – Allergies to certain foods have increased in recent decades. The most common foods that cause allergic reactions include cow’s milk, shellfish, tree nuts, peanuts, and eggs.

Latex allergies – Latex is a type of rubber frequently used in healthcare. Latex allergies are most common in healthcare workers who experience frequent exposure to latex gloves and other latex products.

Environmental allergies – This is a broad group of allergies that can include mold allergies as well as allergies to animal dander, dust mites, and other irritants.

Allergy Symptoms

Allergy symptoms vary according to the type of allergy. A runny nose, watery and red eyes, sneezing, coughing, and congestion are the hallmarks of seasonal, mold, and environmental allergies. If allowed to continue, these symptoms may worsen into a case of sinusitis or bronchitis.

An allergic reaction to certain foods usually manifests as stomach upset, diarrhea, and nausea and vomiting. In addition to these gastrointestinal symptoms, food allergies can cause hives, itching of the mouth and skin, and facial and throat swelling. A latex allergy also causes a localized reaction of hives and itching along with swelling and sometimes a runny nose.

An allergic reaction to an insect sting will cause swelling at the site of the sting and may also cause swelling in other parts of the body. Insect allergies may also result in hives, flushing, redness of the skin, and anaphylaxis.

Anaphylaxis

In certain individuals, food, insect, and latex allergies can lead to a condition called anaphylaxis. Anaphylaxis is potentially life-threatening and constitutes an extreme medical emergency. Characteristics of anaphylaxis include swelling of the throat and face, skin reactions like hives and flushing, difficulty breathing, fainting and dizziness, low blood pressure, and a rapid pulse. Anaphylaxis requires an immediate injection of epinephrine, also called adrenaline, and professional medical attention.  

What Causes Allergies?

An inappropriate immune response is the source of allergy symptoms. Specifically, a foreign substance like wasp venom or pollen triggers the immune system. The immune system identifies this foreign substance as an invasive microorganism like bacteria or a virus. In turn, the immune system produces antibodies and other factors that cause inflammation.

In reality, allergens do not pose a major threat to the body. It is the immune system’s overblown response to allergens that causes allergy symptoms from a mildly runny nose to deadly anaphylaxis.

Risk Factors

Allergies can strike anyone. However, there are a few risk factors that can make an individual more likely to experience allergies.

Family history – A family history of allergies or related conditions such as hives, asthma, and eczema may increase the likelihood of allergy problems.

Age – Children are more likely to experience allergies than adults. Sometimes children will “grow out” of childhood allergies as they mature.

Frequent exposure – Repeated and prolonged exposure to certain allergens can cause allergies to develop. For example, healthcare workers who often wear latex gloves may develop a latex allergy. Similarly, beekeepers have a higher rate of bee sting allergies than the general population.

Preventing Allergies

Once allergies surface, avoidance of allergens is among the most effective measures to prevent allergy symptoms. For instance, being careful concerning a diet is important for those with food allergies. Likewise, wearing good quality filter masks when doing yard work and taking measures to limit exposure to outside air may help significantly with seasonal allergies.

Lifestyle changes are sometimes necessary to control allergies. Those with allergies to cat dander may need to consider a different choice of pet, for example. Also, latex allergy triggers can be avoided by switching to a different material, like nitrile protective gloves.

Of course, avoidance is not always possible. Those with severe allergies need to be prepared. Individuals who suffer from severe allergic reactions should always carry an epinephrine delivery device (brand names include EpiPen and Adrenaclick) and a medical identification alert. They should also ensure that those close to them are aware of their allergy and the symptoms of anaphylaxis. Fortunately, there are also desensitization immunotherapy treatments available for some types of allergies, discussed in the section below.

Allergy Treatment

In the case of mild seasonal or environmental allergies, over-the-counter medications are often sufficient to control symptoms. Effective medications include antihistamines for nasal symptoms and cortisone creams for skin problems. Symptoms of moderate severity may require prescription medications such as corticosteroids.

When allergy symptoms are severe or interfere with daily life and avoidance of triggers is not feasible, allergy testing and immunotherapy can be quite beneficial. Doctors perform allergy testing to identify the specific allergens causing the symptoms. A patient may only know that they develop allergy symptoms during the spring. They may not realize that oak tree pollen is the offending substance. Allergy testing pinpoints the problem while eliminating other potential causes.

Allergy testing can be done in several ways. The modified quantitative testing (MQT) protocol is an allergy diagnostic that is dependable, minimally invasive, and proven safe. This protocol is a combination of skin prick testing and intradermal testing (IDT) that is quite comfortable and causes no pain. Ear, nose, and throat (ENT) specialists use MQT to identify moderate to severe allergies. MQT can be performed safely in-office and does not require a hospital visit.

Blood testing for allergies, called RAST, may be an option for individuals who have severe skin conditions, take medications that interfere with MQT testing, or are otherwise not good candidates for the MQT protocol. RAST testing involves a simple blood draw. The blood sample is analyzed in a laboratory, and the results are provided to the ENT physician.

Immunotherapy, commonly called allergy shots, can often be done when more conservative measures like allergen avoidance and medications have failed. Immunotherapy involves injecting minute amounts of an allergen to desensitize the immune system to that allergen.

Only certain types of allergies respond to immunotherapy. Unfortunately, food allergies and latex allergies cannot currently be controlled through immunotherapy. However, insect, environmental, and seasonal allergies often show good responses to immunotherapy treatments. For instance, about 85% of people experience excellent results from immunotherapy for hayfever (allergic rhinitis).

In immunotherapy, the ENT creates a customized vial for each patient. The vial contains a mixture of allergens to which testing has demonstrated the patient has a sensitivity. The patient receives an injection each week, gradually advancing the dose at a safe rate. Over time, this treatment will cause the immune system to create antibodies to the offending allergens. Ultimately, immunotherapy will result in immunity to the offending allergen, and the patient will have no symptoms when they are around the allergen.

Typically, in our practice, we perform a four-month trial of immunotherapy, and if there is a significant reduction in symptoms, we will continue with the full course of immunotherapy. The course consists of injections weekly for the first year, twice monthly for the second year, and monthly for the last year. Over-the-counter and prescription allergy medications only help to mask the symptoms of allergies. Immunotherapy is the only method of actually eliminating symptoms by acclimating the body to allergens and stimulating antibody production.

Immunotherapy through desensitization injections can allow allergy sufferers to experience a greatly improved quality of life. Often, they are able to enjoy the outdoors again and are no longer limited by their symptoms. In the case of insect allergies, immunotherapy can even be potentially lifesaving.

Tinnitus: Causes, Risk Factors & Treatment

What Causes Ringing in the Ears?

Tinnitus is a pervasive problem in the United States. According to both the Mayo Clinic and the American Tinnitus Association, about 15 to 20% of Americans suffer from daily tinnitus. This number represents approximately 50 million people. There are various causes of tinnitus, and fortunately, several treatments are available for this condition.

We’ll take a look at the different possible causes of tinnitus below. We will also explore risk factors, prevention, and treatment options for tinnitus. Remember, although this article provides valuable information about tinnitus, your ear, nose, and throat (ENT) specialist is always your best source of tinnitus advice and guidance. 

What is Tinnitus?

Tinnitus is a ringing or buzzing in the ears. These sounds can be heard only by the patient and are not generated by an external source. While almost everyone has experienced at least one episode of tinnitus during their life, people with chronic tinnitus may suffer from daily bouts.

The nature of tinnitus varies from person to person. While most patients report their tinnitus as ringing or buzzing, tinnitus may also take the form of a hissing, clicking, or whooshing sound. Some people experience tinnitus only in quiet conditions, such as at night when preparing for bed. For others, tinnitus is near-constant and also occurs in a noisy environment.

Pulsatile tinnitus is a common variant of the condition. In pulsatile tinnitus, the patient feels a pulsing sensation that occurs along with the noise of tinnitus. The condition may feel like blood rushing in the ears and often produces a whooshing sound.

Tinnitus may occur in one or both ears. The severity of tinnitus cases also varies. Tinnitus may be mild and only an occasional annoyance. However, tinnitus can also manifest as a severe condition that interferes with sleep, focus, and the ability to hold a conversation.

Causes of Tinnitus

Tinnitus has many possible causes, and some of these causes respond better to treatment than others. To understand the origins of tinnitus, it is necessary to give an overview of how hearing works. In summary, sound waves stimulate cells in the inner ear called hair cells. In turn, these cells generate electrical impulses that travel along the auditory nerve to the brain, where the impulses are interpreted as sound. Any damage or blockage of this process can result in tinnitus.

Here are some specific causes of tinnitus:

Loud noise exposure – Exposure to loud noise is one of the most common tinnitus causes. High-decibel sounds can result in hearing damage, which leads to tinnitus. Both brief and extended exposure to loud noises can be triggers for tinnitus. Tinnitus that results from a brief or single exposure to loud sound will usually resolve spontaneously. However, tinnitus arising from repeated exposures may be chronic or long-lasting.

Examples of sound sources that can cause tinnitus include jet engines, heavy equipment, loud music, gunshots, and more. It is important to always wear ear protection when exposed to high-volume sounds to avoid problems with both hearing loss and tinnitus.

Age-related tinnitus – As people age, their propensity for tinnitus increases. Those older than 60 have the highest incidence of tinnitus. The high rate of tinnitus among seniors is due to a lifetime of noise exposure as well as age-related degeneration in the structures of the inner ear. Additionally, build-up of plaque in the arteries can lead to higher-than-normal pressure in the blood flow of the inner ear. This phenomenon can cause tinnitus or pulsatile tinnitus.

Earwax accumulation – Earwax, also called cerumen, protects the skin of the ear canal and helps to guard against harmful microorganisms. However, earwax can accumulate to the point that it blocks the ear canal and reduces hearing acuity. When this happens, tinnitus can result.

Acoustic neuroma – This is a benign tumor that grows on the nerves in the inner ear responsible for hearing and balance. Also called a vestibular schwannoma, the tumor may lead to balance issues and tinnitus in one ear only.

Ménière’s disease – Ménière’s is a disease characterized by abnormal inner ear pressure. In some cases, patients experience tinnitus as an early symptom of Ménière’s.

Eustachian tube dysfunction – The Eustachian tube connects the middle ear to the back of the throat. Eustachian tube dysfunction occurs when this tube stays open even when it should close. This condition can cause a sensation of fullness in the ear and is often mistaken for an earwax blockage by patients. Tinnitus is another common symptom of Eustachian tube dysfunction.

Head and neck trauma – Injuries to the head, face, and neck may result in problems with tinnitus. These injuries do not have to be sound-related but can result from automobile crashes, sports accidents, and workplace incidents.

Low zinc levels – Zinc, a common mineral, is normally present in the human bloodstream. Research suggests that some tinnitus patients have low zinc levels, a condition called hypozincemia. Studies have been contradictory as to whether taking zinc supplements can help lessen tinnitus symptoms, and the findings remain controversial.

Certain medications – Taking certain classes of medications may increase the chances of developing tinnitus, at least in the short term.

Risk Factors

The following are major risk factors for tinnitus:

Loud noise exposure – Prolonged exposure to loud noises often leads to tinnitus. Individuals who work in heavy industry, construction, and music are particularly at-risk.

Age – Those older than 60 have a greater risk of tinnitus than the general population.

Male sex – Men are more likely to experience tinnitus than women, although the reasons for this fact are still unknown.

Other medical conditions – Conditions such as cardiovascular disease, Ménière’s disease, and previous head trauma can increase the likelihood of tinnitus.

Smoking status – Smokers suffer from a huge variety of medical conditions at a higher rate than non-smokers, including tinnitus.

Preventing Tinnitus

The most effective way to prevent tinnitus is to protect against loud noise exposure. Hearing protection should always be worn in noisy environments, and music should be enjoyed at a reasonable volume. It is also important to have hearing checked on a regular basis so that any hearing loss or other problems can be identified early.

Other than sound protection, patients should also safeguard their ears in other ways. For example, earwax removal should never be attempted on one’s own. Instead, a visit to the ENT can safely remove excess earwax while checking for any problems. Also, protected the ear from water can prevent irritation and infections, which could lead to tinnitus. Consulting an ENT about earplugs or other ways of avoiding swimmer’s ear is an excellent idea.

Another effective method of tinnitus prevention is keeping in good general health. Good diet and exercise are crucial for overall health, but these measures can also cut the risk of cardiovascular disease that can contribute to tinnitus. Also, quitting smoking is paramount for both tinnitus prevention and longevity.

Tinnitus Treatment

Treatment of tinnitus largely depends on the underlying cause of the problem. For instance, if the tinnitus is due to an earwax obstruction, the treatment may be as simple as an ear cleaning by an ENT. Likewise, a doctor may decide zinc supplementation is the best course of action if a patient’s zinc levels are low.

Surgery is usually necessary to resolve tinnitus caused by an acoustic neuroma. If the tinnitus is due to medication, a physician may decide to discontinue that medication or switch to an alternate drug. This point illustrates the importance of keeping the entire healthcare team up-to-date on a patient’s entire medication list, both prescription and over-the-count.

In cases of age-related tinnitus or tinnitus resulting from noise exposure, the latest hearing aids can be quite helpful. Some degree of hearing loss usually accompanies these types of tinnitus, and patients often have trouble understanding conversational speech or audio from devices like phones and televisions. The latest hearing aids are “smart” devices that do more than merely amplify sound.

These smart hearing aids contain microprocessors that also filter out noise, such as background sounds and the buzz of tinnitus. This feature can be invaluable for patients dealing with severe tinnitus, enhancing their quality of life and allowing them to take part in social interactions. Many smart hearing aids also have Bluetooth connectivity so that they can interface with smartphones, smart TVs, etc.

First Steps

Consulting an ENT specialist should be the first action for anyone experiencing lasting tinnitus or suspected hearing loss. A proper diagnosis is necessary for meaningful treatment, and ENTs are experts in all forms of hearing issues. Tinnitus can be frustrating and even debilitating, but help is available.

How do Sinus Infections Become Chronic?

Data from the Centers for Disease Control and Prevention (CDC) show that chronic sinusitis is quite common among Americans. In 2018, over 28 million American adults suffered from chronic sinusitis, and this number represents greater than 10% of all the adults in the US. In 2016, sinusitis was the chief reason for more than 4 million doctor’s visits. 

Obviously, chronic sinusitis is a huge problem for many people. But what exactly is chronic sinusitis, and what role do sinus infections play in sinusitis? We will take a deeper look at what constitutes sinusitis, reveal facts about sinus infections, and outline the prevention and treatment of these illnesses.

What is Sinusitis?

Simply put, sinusitis is an inflammation of the sinuses. The sinuses are spaces in the skull near the nose and around the eyes. Normally, sinuses contain only air. However, the sinuses fill with fluid during a case of sinusitis. This change presents an opportunity for infection and causes pain, a sensation of pressure, a runny nose, and multiple other symptoms.

A variety of factors can inflame the sinuses and lead to sinusitis. The causes include allergic rhinitis (inflammation of the nasal lining due to allergies), airborne irritants, structural abnormalities with the nose, and infections from microorganisms. Some people are especially sensitive to airborne irritants, such as environmental pollution and tobacco smoke. These individuals may encounter sinusitis triggered by exposure to automobile exhaust, smog, secondhand smoke, and other substances.

However, microorganism infections are the most common cause of sinusitis, with viral infections being the most frequent culprit. In fact, since infections are the source of so many sinusitis cases, many physicians and healthcare workers use the terms “sinusitis” and “sinus infections” interchangeably. This condition may also be called rhinosinusitis because it causes nasal symptoms as well as sinus problems.

Acute vs. Chronic

In medicine, an acute condition usually lasts for a relatively brief time. Common colds, for example, are typically acute. On the other hand, chronic disease or illness lasts for an extended period. Diabetes mellitus is one example of a chronic condition.

The symptoms of acute sinusitis usually arrive suddenly and resolve within 12 weeks. The limited lifespan of acute sinusitis does not affect the problem’s intensity. Acute sinusitis may feel like it will last forever, but it does eventually clear up. Conversely, the duration of chronic sinusitis is 12 weeks or longer. Chronic sinusitis originates from acute sinusitis, often from repeated episodes of acute sinusitis called recurrent acute sinusitis.

Recurrent acute sinusitis, as well as other problems like nasal polyps, can cause lasting damage to the sinuses. Furthermore, if the sinuses are frequently filled with fluid, they become a breeding ground for infectious viruses and bacteria. Chronic sinusitis can develop as a result of this microorganism growth.

Risk Factors

The risk factors of acute sinusitis are similar to those of chronic sinusitis. These risk factors include the presence of nasal polyps, frequent upper respiratory infections, a deviated nasal septum, or environmental allergies to substances like animal dander and pollen. Additionally, people who have suffered facial or nasal injuries have a higher likelihood of sinusitis than the general population.

Another risk factor for sinusitis is a compromised immune system. This state may results from HIV infections, taking immunosuppressant medications, or chronic disease. To decrease sinusitis risk, the immune system must be able to fight off harmful microorganisms effectively. Other risk factors include prolonged oxygen use for medical conditions and lying in a supine position (on the back) for extended periods. Oxygen administration may dry out and irritate the nasal passages, and lying down for long periods can allow fluid to accumulate in the sinuses.   

Symptoms

The most common sinusitis symptoms are:

Nasal inflammation – The inflammation can manifest as sore, swollen, and red nasal passages. Rhinitis, more commonly called a runny nose, is also a common sign and can cause nasal congestion. The nasal discharge may be colored white, green, or yellow.

Postnasal drainage – Also called postnasal drip, this is the discharge that runs down the back of the throat. Postnasal drainage is often foul-tasting and can cause nausea, frequent coughing, and the need for throat clearing.

Ear pain – Sinusitis may lead to ear pain, pressure, or a sensation of fullness or blockage in the ears.

Facial aching and pain – Pain from sinusitis usually focus on the forehead, cheeks, eyes, upper jaw, and even the teeth. Full body aches are uncommon, but patients may notice pain in the ears and into the neck area.

Sore throat – A sore throat during sinusitis is usually the result of irritation from postnasal drip and coughing. However, a sore throat can also be caused by a concurrent infection, such as strep throat.

Fever – Fever is not a frequent symptom of chronic sinusitis, but fever may be present during cases of acute sinusitis.

Preventing Sinus Infections

There are several simple measures that can effectively inhibit many cases of acute sinusitis, and, in turn, help to avoid chronic sinus infections. Perhaps chief among these is preventing upper respiratory infections. Frequent handwashing and avoidance of sick individuals can go a long way toward infection prevention.

Management of allergy problems is also important for sinus infection prevention. Patients with environmental allergies should work with their healthcare team to avoid allergens and keep their symptoms under control. All patients, whether they have allergies or not, should refrain from smoking and limit their exposure to secondhand smoke whenever possible. People who are particularly sensitive to environmental allergens can also reduce their sinusitis risk by staying indoors on days with high pollen counts or poor air quality. Exposure to mold can also be a sinusitis trigger, so everyone should be on guard against mold problems in their homes and workplaces.

It may seem counterintuitive, but dry air can actually irritate nasal passages and sinus, leading to fluid-filled sinuses. Using air humidifiers can help, especially during cold and dry winter months. However, patients should be careful as humid environments can also breed mold, which can contribute to sinus infections.

Sinus Infection Treatment

Treatment of acute sinusitis may consist of only over-the-counter medications and time off work to recover. These medications may include decongestants, anti-inflammatory drugs like acetaminophen, and saline nasal sprays and rinses to soothe the nasal passages and keep them moist. Many patients with acute sinusitis do not need to visit their doctors. However, persistent or recurrent symptoms may mean a larger problem is at hand, and the development of a fever is a reason to schedule a doctor’s appointment immediately.

Recurrent acute sinusitis or chronic sinusitis usually indicates an underlying problem. Patients suffering from these conditions may have a deviated nasal septum, an immune system issue, or sinus obstruction. Ear, nose, and throat specialists (ENTs) and other physicians usually first try prescription medications, such as steroids and/or antibiotics, to resolve the issue. However, a doctor may forgo these measures if they suspect the sinus infection is due to another cause.

Tests to determine the origin of sinusitis can include MRI scans or x-rays of the sinuses, allergy testing, and cultures of nasal discharge or sinus fluid to identify harmful microorganisms. ENTs may also perform a sinuscopy where they pass a tiny scope into the sinuses to inspect their condition.

Unfortunately, approximately 20% of chronic sinusitis cases do not respond to medication and saline rinse therapies. These patients usually have sinuses that cannot freely drain because the passages are blocked by tissue or bone. Older treatment for this condition consisted of invasive sinus surgery where the ENT surgeon would shave excess tissue from the sinuses, opening them so that they could drain. This surgery generally has a recovery time of at least three to five days and can leave scarring in the sinus cavities.

Newer Treatment

However, a more attractive alternative to traditional sinus surgery is now available. Called balloon sinuplasty, the Food and Drug Administration (FDA) approved this treatment for chronic sinusitis in 2005. Balloon sinuplasty is much less invasive than traditional sinus surgery and results in less bleeding and an average of just two days off work. It is an outpatient procedure, meaning it does not require hospital admission and can be performed in an ENT’s office or hospital outpatient surgery center.

During balloon sinuplasty, the ENT guides a small catheter containing a balloon through the nose to the sinuses. They then gradually inflate the balloon, gently enlarging the sinuses so that they can drain. Studies have shown that the number of positive outcomes from balloon sinuplasty meets or exceeds those from traditional sinus surgery. Balloon sinuplasty is generally non-traumatic and does not cause nearly as much bleeding or scarring as older sinus surgery techniques.

Balloon sinuplasty may be available without general anesthesia, using only local anesthetic. The vast majority of patients who undergo balloon sinuplasty experience results that last an average of nine months to two years. The procedure requires evaluation prior to evaluation by an ENT, and the outcomes can be incredibly beneficial for patients who struggle with chronic sinusitis and want a minimally-invasive solution.

North Georgia Allergy Season

North Georgia is renowned for its fall season with its colorful leaf changes and cooler temperatures.  With a dense tree and vegetation population, North Georgia is also considered to be one of the leading areas in regard to allergens like pollens and molds.  Most associate allergy season with the springtime tree blooms and summertime grass pollens, however, fall allergens can cause discomfort and irritation for many people.

Fall allergens are most typically characterized by weed and mold allergies.  Weed allergies include the common ragweed, sheep sorrel, and pigweed.  There are many types of molds in the air and they mostly originate from damp conditions under leaves and dirt and also grow on the north side of many trees here in North Georgia. 

It can be difficult for individuals to be able to discern if they are having a sinus infection or an acute allergy exacerbation because the symptoms can be similar.  Patients are often treated with antibiotics for sinus infection when they are actually having an allergic reaction.  Symptoms of an allergy flare-up include sinus pain and pressure, nasal drainage, sneezing, itchy watery eyes, and even asthma flair ups. 

At Ear, Nose, Throat, and Allergy Specialists, we can evaluate your symptoms and perform an in-office allergy test to discover what allergens are causing your symptoms.  Allergy testing is also beneficial and lets you know what times of the year you will experience the majority of your symptoms, helping guide your individual therapy.  Medication options for treatment include various nasal sprays and antihistamines.  ENT Specialists also provide custom-tailored immunotherapy for patients that de-sensitizes you to the specific things you are allergic to lead to an overall improvement in allergy symptoms.

On behalf of all of us here at ENT Specialists, we hope you have a wonderful fall season and stay healthy.  Should you need help with your allergies, we would be glad to get you an appointment for an evaluation. 

Back to School ENT Health

It is back to school time again. That wonderful time of year that our kids start sharing germs that lead to illness. One of the most common complaints of school-age kids is a sore throat or tonsillitis. Tonsillitis can be caused by several things including postnasal drainage, allergic rhinitis, and viral or bacterial infections.

ENT evaluation is recommended if episodes of tonsillitis become recurrent. If your child begins to snore or have difficulty sleeping ENT evaluation is also important. Recurrent tonsillitis (6+ times per year) or obstructive sleep apnea combined with enlarged tonsils warrant a discussion about tonsillectomy.

A tonsillectomy is a surgical procedure to remove the tonsils. This procedure will likely improve sleep quality and eliminate the recurrence of strep throat. The recovery time for tonsillectomy varies from 10-14 days.

– Crystal Rice, MSN, FNP-C