Rancho Ear, Nose and Throat

Understanding the nose and the problems affecting it, while simple on the surface, is actually a complex process of understanding numerous medical and surgical conditions. The nose must both function well and have the right shape, as well as interact with the environment in a correct way to work correctly. In addition to understanding the nose itself, we must also grasp a fundamental understanding of its neighbor, the sinuses, which are airspaces above and below the eyes which communicate air and mucous to the nose. When we discuss the nose, we need to understand the nose’s primary purpose is to help bring in air to the lungs. In so doing, it must also warm and humidify the air by passing through the nasal lining, warming the cold or dry air before it gets to the lungs. The nasal lining has a large amount of blood flowing through it to accomplish this task. The nose is also responsible for allowing a sampling of the air that passes through it to reach the smell receptors high up near to the brain to give us our sense of smell. What are the purposes of the sinuses? The sinuses, in contrast to the nose, have a very unclear purpose. Some theorize the sinus spaces are a fancy crumple zone for injury while others think the sinuses lighten the head to make it more mobile on our necks. Irrespective of their purpose or lack thereof, when the plumbing to the sinuses takes a turn for the worse it produces significant pain, headaches and drainage. Billions of dollars a year are spent on medications and treatments trying to correct the impacts of malfunctioning sinuses and abnormally functioning nasal lining, or troubles breathing through the nose. Sinus and Allergy Diagnosis When you come to the doctor, the first challenge is effectively communicating what is your actual concern. Keep the following in mind when you visit the Poway sinus care specialist at Rancho ENT: I have ‘sinus’ or ‘congestion’ or ‘allergies’ means something distinct to your physician, but it may mean something different to you. Using simple terms to describe your concerns such as ‘I feel like I cannot breathe’, ‘I feel like I have mucous draining down my throat”, or ‘I get pressure and pain in my head’, may be more effective than misusing the equating terms of congestion, postnasal drip, and sinus headaches which may paint a different picture if misused. Many people come to our Rancho Bernardo ENT doctor complaining of ‘allergies’, which may or may not be the culprit for any or all of the above symptoms. Allergy is a complex topic in of itself, but in short, can be thought of as an overactive body defense response to something harmless. Liken this to calling the fire department out for simple cooking smoke. Many conditions, including allergies, can cause the symptoms of sinus pressure, nasal drainage, or trouble breathing. Examples of non-allergic conditions that can contribute include a distorted shape of the nose, infectious problems or simple environmental irritation, to name a few. Sinus Treatment Patients in Poway Understanding your concern is the beginning of the road to finding a treatment for your condition. As ENT physicians at Rancho Ear Nose and Throat, we are uniquely able to address all aspects of nasal and sinus care. We are able to provide every facet of nasal treatment, ranging from simple education, medications, allergy treatment, therapy and counselling, to surgical intervention on your nose and sinuses. Additionally, we are able to address many cosmetic or aesthetic concerns for your nose. Having all the tools available to treat you allows us to pick the right treatment in the least invasive fashion. If medications are needed we can prescribe antibiotics if they are needed, as well as recommend over the counter prescriptions allergy and sinus relief treatments tailored to your nose’s need. If allergies are suspected, we can perform allergy testing so we can help counsel you on avoidance measures, or prescribe you allergy medications to limit the impact of allergy symptoms on you. We can also prescribe immunotherapy, a course of desensitization treatment, through allergy shots, or newly available allergy drops (home sublingual immunotherapy) to help retrain your nose and immune system to be less reactive to what you are allergic to. San Diego’s Top Sinus Surgeons Rancho Ear Nose and Throat physicians are also skilled surgeons with the expertise to drain sinus infections as well as reestablish optimal nasal airflow pathways to improve nasal breathing and sinus drainage (septoplasty, turbinate reductions and endoscopic sinus surgery). At Rancho ENT we are on the cutting edge of the latest technology offering the latest advancements in minimally invasive care such as in office and in operating room balloon sinusplasty, as well as steroid eluting stent therapy (Propel Stents). We also utilize computerize navigation to minimize risk

Understanding Sinuses & Sinus Infections in San Diego At Rancho ENT in San Diego we aim to treat the underlying causes of sinus disease as well as relieve the symptoms through medical and surgical care. The sinuses are 4 paired air spaces that connect to the nasal passages. The maxillary sinuses are at the level of the cheeks. The frontal sinuses are at the level of the forehead. The ethmoid sinuses are multiple spaces within the nasal cavity itself. The sphenoid sinuses sit deep within the head underneath the brain and pituitary. The purposes of the sinuses are unknown, but they are thought to decrease the weight of the head on the neck to allow better neck mobility. The sinuses are self-cleaning by design. They produce a mucus layer on the perimeter of the air spaces. Small hair-like arms on the lining of the sinuses known as cilia move the mucous around the sinus to keep the sinuses clear of debris and infection. The mucous is removed out of the sinuses through small openings/doors (known as antra) that deposit the mucous into the nose where it is eventually swallowed as it drips back down the throat. Ideally, the sinuses are kept sterile this way and the usual progression of mucous down the throat is imperceptible. Sinuses become infected for a variety of reasons. Typically there is some sort of swelling or inflammation in the nose causing the lining inside the nose to swell and block the drainage pathway for the sinuses. Causes for swelling include a cold virus, inflammation from allergies, physical obstruction from bad anatomy or cold virus, inflammation from allergies, or physical obstruction from bad anatomy or growths such as polyps within the nose. Mucous collects inside the sinus when it is blocked. Bacteria from the nose then have a culture media to grow in. As bacteria find their way back into the sinus from the nose, they grow and replicate there, resulting in an infection. Distinguishing between a common viral infection (a common cold) of the nose and a true sinus infection is important. Antibiotics will not be beneficial for a viral infection, whereas a bacterial infection of the sinuses caused by a viral infection may be treated with antibiotics. Patients with recurrent infections may have debris or thick mucus trapped in the sinus, chronic inflammatory conditions that keep the passage ways swollen, or poorly shaped sinuses that do not allow the sinuses to drain properly. Less likely, the sinuses may have improper function of the cilia or the immune system that make infections more likely. Treatment For Sinus Disease Evaluation of sinus disease at Rancho Ear Nose and Throat is designed to be a comprehensive evaluation involving both medical and surgical solutions to optimize outcomes from sinus disease. Through the availability of allergy treatments, medical treatments, judicious use of medications, minimally invasive surgical solutions as part of endoscopic sinus surgery, and availability of macro surgery when needed, we are able to offer the full complement of sinus treatment options. Patients with repeated sinus problems, such as sinus infections, benefit from an evaluation by San Diego sinus surgeon Dr. Wadhwa for anatomical and inflammatory causes of sinus infection. Patients may be identified to have polyps, fungus, thickened mucous debris in the sinuses or anatomic obstruction from a deviated nasal septum, among other problems. Medical treatment for chronic and/or recurrent sinusitis may involve the use of steroids, antibiotics, topical nasal sprays and/or allergy medicines. Allergy testing as an adjunct may also be beneficial in identifying particles in the environment that may be triggering the inflammation. Surgery and medication for recurrent and chronic sinusitis generally target facilitating the drainage of the sinuses so the sinuses are less likely to back up. Medications primarily decrease the inflammation of the sinus lining to block or thin the mucous so it may drain easier. Sinus surgery is generally directed at enlarging the openings of the sinuses so they do not become blocked in the first place. Surgery for sinuses has evolved considerably over the years. In the past, open surgery such as Caldwell-Luc (which involved direct cuts underneath the cheek to gain access to the sinuses) was popular. As technology has evolved, endoscopic sinus surgery has emulated the older techniques. Endoscopic sinus surgery involves using small telescopes and cameras within the nasal cavity to target surgery to those areas where the sinuses need to drain (the antrums of the sinuses). By working on the areas in the nose and sinus where the cilia are moving mucus, better outcomes can be achieved.

Sneezing? Must be allergies. Eyes red? Must be allergies. Congested? Must be allergies. Ears popping? It seems like allergies is the “in” diagnosis for the last 10 years. While certainly allergies affect a broad range of people in a broad range of ways, we have to be careful not to run away with the rubber stamper. The management and treatment of allergies (as they pertain to symptoms of nasal congestion, sinusitis, runny nose, ear pressure and fullness, eye irritation, and cough) has a rational basis, but must include a thorough evaluation of both allergic and non-allergic problems that may be contributing to these symptoms. Rancho ENT’s Dr. Wadwha is an allergy specialist who can help you pinpoint the cause of your allergy-like symptoms. Furthermore, effective treatment of allergies requires an effective strategy to control symptoms. At Rancho ENT, we offer personalized allergy treatment to our San Diego patients. Understanding how allergies work is the first step to any type of treatment. What causes allergies? Allergies are simply your body’s defense systems overreacting to something that is otherwise harmless. For instance, a floating pollen comes in contact with your nose, and your nose does everything in its ability to attack the pollen as if it were under attack from a bacteria or virus. The primary response involves chemical mediators working to increase blood flow to your nose to make your nose run, become congested, and increase your body’s defense cells in the area. Your body will also try to sneeze the pollen away as part of the defense. This is great for removing truly harmful things, but innocent things like pollens are ubiquitous in nature and do not require this response. Liken this to calling out the fire department for each time you turn on your stove. You would hate to be hosed down with water when nothing is wrong. Why do people have a unique set of allergies? So why do we react this way, and why does this affect only certain people? To give a simple answer to a complex question, no two person’s defense systems are the same, and no single person’s defense system is perfect. It’s just a matter of being exposed to something in your environment that exposes a programming error in your defense system. When you change your environment, such as getting a new pet or moving to a new area or home, you may encounter something new that exposes your weaknesses. Treatment of allergies involves avoidance, medication and possible immunotherapy. But before that step commences, evaluation for common problems that mimic allergies or worsen them must be done. For instance, nasal passages are often narrowed by crooked bones or cartilage internally. Tonsils and adenoids, particularly in children, often swell to the point they narrow the nasal passages. Both of these problems will make you congested with a runny nose chronically, but are better treated with surgery rather than lifelong medication. Irritants in the air such as cigarette smoke create similar symptoms to allergies, but are not caused by an over activity of the body’s defense system. Identifying and treating my allergies? When the other reasonable causes of the problems have been evaluated, identifying the triggers for your allergies is the next step. Sometimes this is easy, i.e.- your new cat makes you feel sick when you are around her. Sometimes it’s not so easy- you go to the park and feel ill, where you are surrounded by a variety of trees, grasses, pollens, etc. Even more complicated are problems that are year round such as dusts and food allergies. When allergies are suspected, the reasonable next step is allergy testing. Allergy testing comes in a few different forms. Skin testing works great for inhalants such as pollens, trees, dusts, grasses, etc. A small puncture in the skin is used to introduce a portion of the item being tested, and if you are positive, a reaction in the skin is detected there and measured. Blood testing (RAST) works great for those unable to tolerate skin testing such as young children or people with severe reactions. Dietary trials can identify the non-obvious food allergies. Once you have an idea of what you are allergic to, avoidance is the best treatment. Unfortunately, this is not always practical-i.e. you can avoid or give away your cat, but you cannot avoid trees forever. Medications for allergies are plentiful and many are now available over the counter, but understanding how they can be used for your optimum benefit with minimum side effects is something you should discuss with your physician. In addition, certain medications are available only by prescription. If medications are not helping, the only way to “cure” allergies is to modify your body’s immune responses in a process called immunotherapy.

As with most things in the human body, we don’t really think about our ears until they don’t do what they are expected to do. The ears occupy a central location in the head making diseases of the ear have wide reaching effects. Ears are notably difficult to examine and require special instrumentation and testing for evaluation of anything more than the most basic ear infection or wax impactions. Dr. Wadhwa of Rancho ENT near Poway is a hearing doctor with extensive training and experience in audiology and treating ear-related issues. You should visit the audiologist as soon as you notice any abnormalities in hearing or pain in the ears that might indicate an infection. Our ears are first responsible for hearing sound. The quality of our hearing greatly impacts our quality of life as it is essential for most basic forms of communication and social interaction. The energy and brain power that we must expend to compensate for hearing loss can be tremendous, and the social withdrawal associated with hearing loss can be debilitating. What causes hearing issues? Hearing loss on a basic level can simply be broken down into conditions where either this is a problem of sound getting in (conductive loss) or a problem of the nerve picking up sound (sensorineural loss). Our audiologists have many surgeries and medical treatments for fixing conductive losses, but we are still waiting for technology to catch up with curing sensorineural losses. Although we may not be able to correct all forms of hearing loss today, fortunately technology has made it possible for us to compensate well through medical care, surgical care and the use of hearing instrumentation such as hearing aids or cochlear implants. If you suspect your hearing is not what it used to be, schedule an appointment with us for a hearing test at our San Diego office. If our audiologists determine that your hearing has worsened, we will work with you to determine whether a hearing aid, cochlear implant or another hearing treatment is best for you. Ear Infections and Treatments In addition to problems hearing, the ears are subject to frequent infections, particularly in children. Because of their need to ventilate and communicate air to nose and throat passages to equalize air pressure, conditions of the nose and throat frequently translate to secondary ear problems. While some problems may be self-correcting or easily treated with antibiotic therapy, others may require surgical drainage to restore hearing and function to the ear. The neighboring areas to the ear include the brain, the arteries and veins to the brain and neck, and the jaw joint. To complicate matters even further, the ears share common sensory nerves with the throat, the teeth, the nose and the jaw joint making for a diagnostic challenge for anyone with the simple complaint of ear pain. Understanding the cause of ear pain and proper treatment of ear infections, except in the most basic instances, often will require the specialty understanding of the entire head and neck to achieve successful outcomes. Ears and Balance (Vertigo & Dizziness Treatment) Aside from problems hearing, perhaps one of the most acutely debilitating malfunctions of the ear is the loss of balance function. The vestibular system of the ear is responsible for helping us stay upright and to be able to move without falling over. Together with the brain, vision and sensory feedback from our feet, the ears form an integral part of the apparatus necessary to make motion and balance possible. Understanding the complex interplay of all of these different aspects of the balance system, makes the treatment and management of balance disorders a medical challenge. If you’ve experienced vertigo or tinnitus, it may be time to visit an ear specialist. At Rancho Ear Nose and Throat we have the expertise with all aspects of ear and balance problems to expeditiously and cost effectively diagnose and treat your ear condition. Please contact us to set up an appointment for a hearing test or a general examination of ear, nose and throat health with Poway ear specialist Dr. Wadhwa.

Hoarseness is also known as dysphonia. It is any change or abnormality in the sound of the voice. It is different from dysarthria which is an abnormality in enunciation or the articulation of speech. Hoarseness is usually caused by changes to the voice box, or larynx, and it is deemed chronic when it lasts longer than 4 to 6 weeks. The larynx has 3 primary functions. Besides its function in speaking, it also regulates swallowing and breathing. For this reason, when there is dysfunction in the voice box causing hoarseness, the patient may also experience changes in their swallowing (dysphagia) and breathing (dyspnea) as well as chronic throat clearing or coughing. Laryngitis is any inflammation of the voice box and is the most common cause of hoarseness. Laryngitis that comes on suddenly is usually caused by viral or bacterial infections. Viral infections generally resolve on their own whereas bacterial infections require antibiotics. Some patients, such as those who are on steroid inhalers, acquire a fungal laryngitis which can also be treated by antifungal medications. Other common causes of laryngitis include acid reflux as well as allergies. This kind of laryngitis tends to be more gradual and lasts longer (usually weeks or months). Treating the underlying cause of the hoarseness is the best way to resolve the symptoms. When evaluating a patient for hoarseness, it is important to get a clear history from the patient regarding when the hoarseness started, whether there were any precipitating events such as illness or emotional stress. The patient should describe how their voice has changed, whether it is raspy, breathy, strained, quieter, or higher or lower in pitch. Any history of vocal abuse such as prolonged speaking, singing, or yelling should be discussed. Also, any aggravating factors such as smoking, heartburn, or allergies needs to be addressed. On physical exam, the ears, nose, mouth, and neck need to be carefully examined to rule out other causes of hoarseness. A laryngoscopy is an endoscopic procedure which is done usually with the patient awake, and it allows for the visualization and functional assessment of the voice box. During this procedure, a physician would be able to assess if there are any lesions of the voice box causing hoarseness. She would also be able to assess the strength of the voice box, whether it is moving normally or if there are any weakness or spasms in the muscles of the voice box. The vocal cords, or vocal folds, are the functional portion of the voice box that move and squeeze together every time we speak or swallow. A stroboscopy is a special kind of laryngoscopy whereby a flashing light is used to visualize the vibrations of the vocal folds. Abnormalities in the vibration of the vocal folds result in hoarseness. In addition to testing in the office, your doctor may also order imaging of the neck if there are any lumps detected during the exam. Tests for swallowing or breathing may also be ordered depending on the patient’s needs. Treatment for hoarseness depends primarily on the cause. Good vocal hygiene provides a foundation on which to build treatment. Increasing hydration and limiting extended voice use allows the voice box to recover from the trauma of overuse or misuse. Controlling any acid reflux and allergies helps to reduce these aggravating factors which can make the voice worse. Lifestyle modifications to reduce the effects of acid reflux include diet changes to limit spices, caffeine, citrus and tomato products, carbonated drinks, fatty foods, chocolate, mints, and alcohol. Eating smaller, more frequent meals and avoiding foods within 2 to 3 hours of bedtime can also help reduce reflux. Using a sinus rinse can improve hydration as well as help with allergies and post nasal drainage. Working with a speech therapist is an important factor in rehabilitating the voice. He can help not only to strengthen the muscles of the voice box but also teach the patient to use them in the correct manner so as to not strain the accessory muscles of the neck and shoulders. He can also teach special breathing techniques to reduce laryngeal irritability and chronic cough. In addition to speech therapy, there are also multiple procedures available to rehabilitate the voice when there is dysfunction, depending on the cause. Below are a few additional common causes of chronic hoarseness: Vocal cord nodules (Singer’s nodules) These are benign lumps on both vocal folds which generally result from vocal trauma or overuse of the voice. Patients may notice that their voice is more raspy, less clear in tone, and they may experience vocal fatigue. Generally resting the voice will help these nodules to resolve on their own. Speech therapy can be very helpful in preventing these from occurring or recurring in the future.

Swallowing starts in the mouth and terminates when food or liquid passes completely through the esophagus and reaches the stomach. In the initial phase of swallowing, food is prepared by chewing and mixing it with saliva, then moving it to the back of the mouth. Next, with the food in the back of the mouth, breathing is momentarily held, and the food is pushed quickly through the throat to the esophagus by involuntary contractions of muscles of the throat. Finally, the muscles of the esophagus push food through the esophagus down to the stomach. What is Dysphagia? Dysphagia is the difficulty swallowing usually due to abnormalities of either the throat or esophagus. Common Causes of Dysphagia Originating in Both the Throat and Esophagus: Gastroesophageal Reflux Disease Stomach acid coming up to the esophagus frequently causes heartburn, but many patients can have symptoms due to reflux and not have any heartburn at all. These symptoms can include chronic throat clearing, a feeling of something stuck in the back of the throat, feeling like there is excessive phlegm in the throat, voice changes, and feeling like foods such as breads and pills have trouble going down. Neurologic Conditions Problems with the nervous system such as having a stroke, Parkinson’s disease, multiple sclerosis, or muscular dystrophy will cause the muscles of throat and esophagus to be weaker resulting in difficulty swallowing both solids and liquids. Cancer A mass of either the throat or esophagus will obstruct food from passing down. Pureed foods and liquids will be much easier to pass. The patient may also notice changes in the voice, a lump in the neck, unintentional weight loss, or ear pain. Treatment may involve surgery, radiation therapy, and chemotherapy. Common Causes of Dysphagia Originating in the Throat Zenker’s Diverticulum This is a pouch that forms in the throat and collects food. Patients may regurgitate this food hours later, bringing it up in an undigested form. When the contents of the pouch spill over into the throat, it can cause sudden coughing or choking. This pouch forms due to longstanding spasms of the cricopharyngeus muscles. This muscles is supposed to relax to allow food to pass from the throat into the esophagus, and when it does not, that food can back up into the Zenker’s diverticulum pouch in the throat. Cutting this muscle to prevent it from spasming significantly relieves symptoms for most patients. Common Causes of Dysphagia Originating in the Esophagus Esophagitis This refers to inflammation of the esophagus. This can be caused by an infection, reflux, or allergies. Treating the main cause will lead to improvement in symptoms. Esophageal Spasms When the muscles of the esophagus squeezes in an uncoordinated manner, it can block the passage of food moving down toward the stomach and cause chest pain at the same time. Treatment may include diet modifications, Botox injections to weaken the spasming muscles, or procedures to stretch the esophagus or cut the muscles. Achalasia In this disease, the lower esophageal muscle which relaxes to allow food to pass into the stomach and contracts to protect stomach contents from refluxing back into the esophagus stays permanently contracted, blocking food from passing downward. This may be associated with chest pain. Treatment may include medications that help the muscle to relax, Botox injections to weaken the muscle, or procedures to stretch the esophagus or cut the muscle. Scleroderma In this condition, the esophagus hardens and loses its ability to contract and appropriately push food down. The muscles protecting the esophagus from stomach contents refluxing up from the stomach into the esophagus may also be weak, making acid reflux symptoms worse. Masses Outside the Esophagus Sometimes things outside the esophagus such as the thyroid gland, lymph nodes, tumors, or bones may press on the esophagus and prevent foods from passing down normally. Imaging of the esophagus and the chest can diagnose this problem, and treatment depends on the origin of the compression.

One of the things that we at Rancho ENT are called upon rather frequently for is the management of snoring. While some might find it somewhat laughable to think of seeking medical treatment for a social taboo, you may be surprised to learn snoring can be a sign of serious diseases to come if not only a source of social isolation. Distinguishing snoring from obstructive sleep apnea, the actual prolonged cessation from breathing while sleeping from throat tissue collapse is an important delineation that needs to be made. Snoring typically results from vibration of normal tissues in the throat as air passes through it. During the daytime, our muscles are awake and this keeps the throat open so that this vibration does not occur. When we go to bed at night, particularly during the deep stages of sleep, a relaxation of most of the body’s muscles will occur, including those around your throat. Gravity is now allowed to let mobile tissues in the throat, namely the palate and the back portion of the tongue, to drop backwards. As the air passes through the throat, the mobile tissues will vibrate and make the snoring sound. Taken to the extreme, if you snore and your throat collapses for a prolonged period of time, you will periodically stop breathing. In medical terms, going without breathing is called apnea- hence “sleep apnea”. What are the long-term effects of sleep apnea? Sleep apnea is a more serious problem. If you periodically stop breathing whenever you go into the deep stages of sleep, your body and brain are obligated to keep you breathing, hence limiting the time you can actually stay in the deep stages of sleep. Unfortunately, the deep stages of sleep are the ones most needed for our body to get properly rested. Hence, sleep for a patient with sleep apnea restful, and a person with sleep apnea feels tired during the day despite sleeping at nighttime. Such a person tends to be sleepy during the day or even nod off when things are slow, because the body is craving sleep whenever it can. Despite spending additional time sleeping, they are still not getting rested because of the lack of deep stage sleep. Why should I seek treatment for sleep apnea? Untreated, sleep apnea can also lead to more serious long-term health problems. Because the person is chronically tired, they exercise less and gain weight with its concomitant medical issues. As the body goes without breathing at night during sleep, it also drops body oxygen levels, which over time cause the heart and lungs to work harder, which over time can lead to heart and lung difficulties. Furthermore, the additional weight gain factors back in to worsen the sleep apnea, setting up a vicious cycle. Many people function well enough despite their sleep apnea, and are unaware of the process going on at nighttime. The signs though are frequently present in their day to-day lives– the ongoing fatigue, feeling un-refreshed in the mornings, tendency to nod off during meetings, watching TV or movies, or in the extreme scenarios even drifting to sleep while driving. Frequently a spouse or significant other is the one to identify the problem, noticing the loud snoring with prolonged cessations of breathing while sleeping. What causes snoring and sleep apnea? The causes of snoring and obstructive sleep apnea can vary. In a heavier person, this may be the weight or laxity of throat tissues promoting collapse. In a person with large tonsils, it may be the tonsils themselves. If you have a long uvula (the dangly thing in the back of your throat), it may be vibrating or even collapsing with the palate while you sleep. Often, it is a combination of all of these things. Sometimes the tissues of the throat are fine, but the nose breathing passages are fundamentally small. If you have ever tried to drink a thick milkshake with a small straw before, you know the straw will collapse. Likewise, breathing through a narrow nose can be likened to pinching a straw, promoting collapse of tissues in the throat. What are some effective treatments for snoring? Treatment for snoring without apnea involves a range of options from conservative measures such as weight loss (if overweight), avoiding sleeping on your back, and avoiding drinking alcohol late at night. Surgical options including modification of the nose, throat, palate, tonsils, or tongue base, each of which has to be tailored to each individual patient’s anatomy. Minor office procedures are also available to help reduce snoring.

It’s the time of the year for holidays, celebrations, vacations, and yes, unfortunately, the time of the year for many of our young ones to bring home the sniffles. While getting the usual cold is perhaps unavoidable, stopping the chain from progressing to ear infections and sinus infections should help our children feel better faster. Why are children more susceptible to ear and sinus infections? So how does the chain work? Why are children such easy targets? The answer is that small noses have tight spaces which easily get blocked with even the smallest amount of swelling. When these tight spaces get blocked, normal routes of communication for air and fluid flow in the ears and sinuses to the nose also get blocked. When mucous or fluid builds up in their ears or sinuses and is unable to drain, the mucous gets stagnant. This stagnant mucous becomes a ready target for bacteria and an infection may occur. Children are also easier targets than adults for infections because our body’s defense system is one which will only get wiser with time. In essence, the body helps to prevent infections by remembering how it fought a particular virus or bacteria the first time, limiting or even preventing a second infection to the same virus or bacteria in the future. Hence, adults get less infections than children because their immune system is more experienced. A typical adult gets about three colds per year, while a child may get six or seven. How can ear infections and sinus infections among children be prevented? So how do we prevent the chain? First and foremost, we prevent the chain from ever starting. Simple things like washing hands, avoiding sharing of drinks and covering our mouths and noses with our elbows or arms during sneezing and coughing, are the basic measures which we all already teach our children. If the chain starts, as it typically will with a cold, consider using over the counter cold medicines with a decongestant, if your child is otherwise healthy and over 2 years of age. If you are unsure about your child’s health, check with his or her physician, but most children over 2 years are able to take decongestants without trouble when given in appropriate doses (under 2 years check with a doctor first). The decongestant will help keep the sinuses and the ears from building fluid by decreasing the swelling in the nose. Decongestant medications typically used are pseudophedrine or phenylephrine grouped with other medications for cough and fever (i.e. Tylenol Cold or Dimetapp). Children’s Tylenol may be used in addition to a decongestant if the decongestant product does not have Tylenol in it. Tylenol may be used to help with fevers and may help your child feel better. Chicken soup and steam may be added if desired. At what point should I take my child to an ENT specialist? Colds are generally marked by congestion, runny nose, and a low grade fever, as well as a mild sore throat. Almost all colds are caused by viruses, which do not respond to antibiotics. However, colds can lead to bacterial infections as we described above, at which point antibiotics may become necessary. Drainage for a typical cold is clear to hazy. If colored drainage, bad breath, or higher fever is noticed, a call or visit to a physician is warranted. Most colds improve within 5-7 days, but if your child is not showing improvement in this time frame, a visit to the pediatric ENT could also be worthwhile. Sore throat without nose congestion, or a particularly bad sore throat also warrants evaluation and a throat culture to help distinguish viral infections from strep throat which will require antibiotics to get better. Development of ear pain or fluid draining from the ear is also an ominous sign for the development of a bacterial ear infection which may also require antibiotics. As we mentioned, frequent colds are expected in our younger children as a part of their immune system’s learning process. However, frequent infections of the ears, sinuses and throat should not be considered normal and can be harmful to your child’s health. Frequent ear infections may lead to hearing loss from fluid build up in the ears, or even more serious ear conditions. Frequent throat infections may lead to swollen tonsils and adenoids causing night time breathing problems such as snoring, sleep apnea, as well as increased frequency of ear and throat infections from bacteria that stay in the tonsils and adenoids. In these situations, treatment with medication or surgery may be necessary and a visit to an ear nose and throat specialist may be helpful. If you are concerned about your child’s health or wish to learn more about what was discussed in this article, please schedule a visit for personalized pediatric ENT care in San Diego by calling 858-674-1165.