Snoring is a sound produced by vibration of the soft tissues of the upper airway during sleep and is indicative of increased upper airway resistance. Studies estimate that 45% of men and 30% of women snore on a regular basis. It can affect not only the snorer’s sleep but also the sleep of a spouse or other family members nearby. In fact, snoring causes many couples to sleep in separate rooms and often places strain on marriages and relationships. Recent evidence suggests that snoring may even cause thickening of the carotid arteries over time and potentially increase risk of stroke.

Snoring also may be a sign of a more serious health condition known as obstructive sleep apnea (OSA), characterized by a repetitive stopping or slowing of breathing that can occur hundreds of times through the night. Most patients who snore should receive a comprehensive sleep evaluation, by a trained physician, that often includes sleep testing either done in the home or sleep laboratory.

1) Palatal stiffening procedures

  • Palatial Implants: – Palatal implant therapy, also known as the Pillar procedure, involves the placement of three polyester implants into the soft palate under local anesthesia in the office. The implants, in conjunction with the body’s scarring response, result in stiffening of the palate, and subsequently, less vibration and flutter that causes snoring. Potential benefits of this method include ease of application, minimal discomfort, fast recovery and potentially more long-term benefit. Complications are rare but include implant extrusion requiring replacement. The primary drawback for many patients considering this option is the relatively high cost of the implants.
  • Injection Snoreplasty: – In this method, also done under local anesthesia in the office, a chemical is injected into the soft palate. The subsequent inflammation and scar tissue stiffen the palate, therefore decreasing vibration and snoring. The most commonly used agent is Sodium tetradecyl sulfate which has been used in the treatment of varicose veins. Injection snoreplasty has the advantage of lower cost than other methods but is associated with more pain and recovery time. Some patients may also require additional injection treatments to achieve optimal results.
  • Radiofrequency: – Radiofrequency treatment, also an office-based procedure performed under local anesthesia, uses heat to stiffen portions of the soft palate. Multiple treatment sessions may be required to achieve the desired results. Discomfort and recovery are generally less than injection snoreplasty but more than palatal implants. Cost of radiofrequency also usually falls in between the other two options.

2) Tonsillectomy/Adenoidectomy

Enlarged tonsils and adenoids are a common cause of snoring and sleep disruption in children. The tonsils are clusters of lymphoid tissue in the back of the throat while the adenoids are a similar mound of tissue in the back of the nose. Although less commonly a problem in adults, some adults can receive excellent resolution of snoring through removal of enlarged tonsils and/or adenoids.

As opposed to the above office-based procedures, tonsillectomy/adenoidectomy is an outpatient surgery performed in the operating room under general anesthesia. Most patients require a recovery time at home of approximately one week but may continue to experience a sore throat for two weeks. The most common complication is bleeding, often occurring over a week after the surgery. Serious bleeding is rare.

3) Nasal Surgery

Increased nasal congestion has been shown to cause or contribute to snoring. Nasal obstruction may result from many causes, including allergies, polyps, septal deviation and turbinate hypertrophy. Medical treatment options, such as a nasal steroid spray or allergy management may be helpful in some patients. Structural problems, such as a deviated septum, often benefit from surgical treatment.

One surgical option, known as radiofrequency turbinate reduction (RFTR), can often be performed in the office setting under local anesthesia. RFTR uses radiofrequency heat to shrink swollen tissues in each side of the nose. Other nasal surgeries, including septoplasty and polyp removal, are usually performed in the operating room under general anesthesia. In select patients, treatment of nasal congestion can result in improvement or resolution of snoring.

What else should I know?

There are also other available treatments such as oral appliances, nasal devices, positional therapy and a variety of over-the-counter products. Careful patient and procedure selection is critical to successful management of snoring. Talk to your ear, nose and throat doctor for a complete evaluation and to learn what treatment may be best for you.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Tonsils and adenoids are the body’s first line of defense as part of the immune system. They “sample” bacteria and viruses that enter the body through the mouth or nose, but they sometimes become infected. At times, they become more of a liability than an asset and may even cause airway obstruction or repeated bacterial infections. Your ear, nose and throat (ENT) specialist can suggest the best treatment options.

What are tonsils and adenoids?

Tonsils and adenoids are similar to the lymph nodes or “glands” found in the neck, groin and armpits. Tonsils are the two round lumps in the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth or nose without special instruments.

What affects tonsils and adenoids?

The two most common problems affecting the tonsils and adenoids are recurrent infections of the nose and throat, and significant enlargement that causes nasal obstruction and/or breathing, swallowing and sleep problems.

Abscesses around the tonsils, chronic tonsillitis and infections of small pockets within the tonsils that produce foul-smelling white deposits can also affect the tonsils and adenoids, making them sore and swollen. Cancers of the tonsil, while uncommon, require early diagnosis and aggressive treatment.

When should I see a doctor?

You should see your doctor when you or your child experience the common symptoms of infected or enlarged tonsils or adenoids.

Your physician will ask about problems of the ear, nose and throat and examine the head and neck. He or she may use a small mirror or a flexible lighted instrument to see these areas.

Other methods used to check tonsils and adenoids are:

  • Medical history
  • Physical examination
  • Throat cultures/Strep tests – helpful in determining infections in the throat
  • X-rays – helpful in determining the size and shape of the adenoids
  • Blood tests – helpful in diagnosing infections such as mononucleosis
  • Sleep study, or polysomnogram – helpful in determining whether sleep disturbance is occurring because of large tonsils and adenoids.

Tonsillitis and its symptoms

Tonsillitis is an infection of the tonsils. One sign is swelling of the tonsils. Other symptoms are:

  • Redder than normal tonsils
  • A white or yellow coating on the tonsils
  • A slight voice change due to swelling
  • Sore throat, sometimes accompanied by ear pain
  • Uncomfortable or painful swallowing
  • Swollen lymph nodes (glands) in the neck
  • Fever
  • Bad breath

Enlarged tonsils and/or adenoids and their symptoms

If your or your child’s adenoids are enlarged, it may be hard to breathe through the nose. If the tonsils and adenoids are enlarged, breathing during sleep may be disturbed. Other signs of adenoid and or tonsil enlargement are:

  • Breathing through the mouth instead of the nose most of the time
  • Nose sounds “blocked” when the person speaks
  • Chronic runny nose
  • Noisy breathing during the day
  • Recurrent ear infections
  • Snoring at night
  • Restlessness during sleep, pauses in breathing for a few seconds at night (may indicate sleep apnea).

How are tonsil and adenoid diseases treated?

Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy) may be recommended if there are recurrent infections despite antibiotic therapy, and/or difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness, and may even cause behavioral or school performance problems in some children.

Chronic infections of the adenoids can affect other areas such as the eustachian tube – the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and buildup of fluid in the middle ear that may cause temporary hearing loss. Studies also find that removal of the adenoids may help some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).

In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., prednisone) is sometimes helpful.

How to prepare for surgery

Children

  • Talk to your child about his/her feelings and provide strong reassurance and support
  • Encourage the idea that the procedure will make him/her healthier.
  • Be with your child as much as possible before and after the surgery.
  • Tell him/her to expect a sore throat after surgery, and that medicines will be used to help the soreness.
  • Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward.
  • It may be helpful to talk about the surgery with a friend who has had a tonsillectomy or adenoidectomy.
  • Your otolaryngologist can answer questions about the surgical procedure.

Adults and children

For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome). Your doctor may ask to you to stop taking other medications that may interfere with clotting.

  • Tell your surgeon if the patient or patient’s family has had any problems with anesthesia or clotting of blood. If the patient is taking medications, has sickle cell anemia, has a bleeding disorder, is pregnant, or has concerns about the transfusion of blood, the surgeon should be informed.
  • A blood test may be required prior to surgery.
  • •A visit to the primary care doctor may be needed to make sure the patient is in good health at surgery.
  • You will be given specific instructions on when to stop eating food and drinking liquids before surgery. These instructions are extremely important, as anything in the stomach may be vomited when anesthesia is induced.

When the patient arrives at the hospital or surgery center, the anesthesiologist and nursing staff may meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.

After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient closely until discharge. Every patient is unique, and recovery time may vary.

Your ENT specialist will provide you with the details of pre-operative and post-operative care and answer your questions.

After surgery

There are several post-operative problems that may arise. These include swallowing problems, vomiting, fever, throat pain and ear pain. Occasionally, bleeding from the mouth or nose may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately. It is also important to drink liquids after surgery to avoid dehydration.
Any questions or concerns you have should be discussed openly with your surgeon.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What is an Oral Appliance?

Oral appliances are one of the treatment options for snoring and obstructive sleep apnea (OSA). These devices are similar to mouth guards or orthodontic retainers that are worn in the mouth during sleep. They are designed to prevent soft tissue in the airway from collapsing and causing obstruction. These appliances can be used alone or in combination with Continuous Positive Airway Pressure (CPAP) or surgery.

How do Oral Appliances Work?

Oral appliances work by repositioning the lower jaw and/or pulling the tongue forward. Mandibular-repositioning devices keep the lower jaw in a protruded position during sleep. This keeps the airway open by preventing the tongue and soft tissue in the throat from collapsing. Tongue-retaining devices hold the tongue with a suction bulb, preventing the back of the tongue from obstructing the airway during sleep.

What are the Indications for Oral Appliances?

Oral appliances are most effective in treating snoring and mild to moderate sleep apnea. These appliances are recommended for patients who are non-compliant with CPAP and fail positional and weight loss therapy. They can also be used for patients with moderate to severe OSA who cannot tolerate CPAP use. Oral appliances are also recommended for patients who fail, refuse or are otherwise not candidates for surgical treatment.

What are the Advantages of Oral Appliances?

Oral appliances provide a non-invasive alternative for treatment of snoring and sleep apnea. In comparison to CPAP, they have a higher compliance rate, are more compact and less cumbersome.

What are the Disadvantages of Oral Appliances?

With the use of oral appliances, patients may develop excessive salivation, dry mouth, tooth and jaw discomfort, permanent changes in occlusion, and temporomandibular joint disorder. Some patients discontinue the use of oral appliances due to these side effects.

What are the other Treatment Options for Obstructive Sleep Apnea?

Treatment options for OSA include lifestyle modifications, weight loss, sleep positioning, CPAP and various surgical procedures to reduce airway obstruction.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Improving Form and Function of the Nose

Each year thousands of people undergo surgery of the nose. Nasal surgery may be performed for cosmetic purposes, or a combination procedure to improve both form and function. It also may alleviate or cure nasal breathing problems, correct deformities from birth or injury, or support an aging, drooping nose.

Patients who are considering nasal surgery for any reason should seek a doctor who is a specialist in nasal airway function, as well as plastic surgery. This will ensure that efficient breathing is as high a priority as appearance.

Can Cosmetic Nasal Surgery Create a “Perfect” Nose?

Aesthetic nasal surgery (rhinoplasty) refines the shape of the nose, bringing it into balance with the other features of the face. Because the nose is the most prominent facial feature, even a slight alteration can greatly improve appearance (some patients elect chin augmentation in conjunction with rhinoplasty to better balance their features). Rhinoplasty alone cannot give you a perfect profile, make you look like someone else or improve your personal life. Before surgery, it is very important that the patient have a clear, realistic understanding of what change is possible as well as the limitations and risks of the procedure.

Skin type, ethnic background and age will be among the factors considered preoperatively by the surgeon. Except in cases of severe breathing impairment, young patients usually are not candidates until their noses are fully grown, at 15 or 16 years of age. The surgeon will also discuss risk factors, which are generally minor, as well as where the surgery will be performed – in a hospital, freestanding outpatient surgical center or a certified office operating room.

To reshape the nose, the skin is lifted, allowing the surgeon to remove or rearrange the bone and cartilage. The skin is then re-draped and sutured over the new frame. A nasal splint on the outside of the nose helps retain the new shape during healing. If soft, absorbent material is placed inside the nose to stabilize the septum, it will normally be removed the morning after surgery. External nasal dressings and splints are usually removed five to seven days after surgery.

When Should Surgery Be Considered to Correct a Chronically Stuffy Nose?

Millions of Americans perennially suffer the discomfort of nasal stuffiness. This may be indicative of chronic breathing problems that don’t respond well to ordinary treatment. The blockage may be related to structural abnormalities inside the nose or to swelling caused by allergies or viruses.

There are numerous causes of nasal obstruction. A deviated septum (the partition between the nostrils) can be crooked or bent as the result of abnormal growth or injury. This can partially or completely close one or both nasal passages. The deviated septum can be corrected with a surgical procedure called septoplasty. Cosmetic changes to the nose are often performed at the same time, in a combination procedure called septorhinoplasty.

Overgrowth of the turbinates is yet another cause of stuffiness. (The turbinates are the tissues that line the inside of the nasal passages.) Sometimes the turbinates need treatment to make them smaller and expand the nasal passages. Treatments include injection, freezing and partial removal. Allergies, too, can cause internal nasal swelling, and allergy evaluation and therapy may be necessary.

Can Surgery Correct a Stuffy, Aging Nose?

Aging is a common cause of nasal obstruction. This occurs when cartilage in the nose and its tip are weakened by age and droop because of gravity, causing the sides of the nose to collapse inward, obstructing air flow. Mouth breathing or noisy and restricted breathing are common.

Try lifting the tip of your nose to see if you breathe better. If so, the external adhesive nasal strips that athletes have popularized may help. Or talk to a facial plastic surgeon/otolaryngologist about septoplasty, which will involve trimming, reshaping or repositioning portions of septal cartilage and bone. (This is an ideal time to make other cosmetic improvements as well.) Internal splints or soft packing may be placed in the nostrils to hold the septum in its new position. Usually, patients experience some swelling for a week or two. However, after the packing is removed, most people enjoy a dramatic improvement in breathing.

What Treatment Is Needed for a Broken Nose?

Bruises around the eyes and/or a slightly crooked nose following injury usually indicate a fractured nose. If the bones are pushed over or out to one side, immediate medical attention is ideal. But once soft tissue swelling distorts the nose, waiting 48-72 hours for a doctor’s appointment may actually help the doctor in evaluating your injury as the swelling recedes. (Apply ice while waiting to see the doctor.) What’s most important is whether the nasal bones have been displaced, rather than just fractured or broken.

For markedly displaced bones, surgeons often attempt to return the nasal bones to a straighter position under local or general anesthesia. This is usually done within seven to ten days after injury, so that the bones don’t heal in a displaced position. Because so many fractures are irregular and won’t “pop” back into place, the procedure is successful only half the time. Displacement due to injury often results in compromised breathing so corrective nasal surgery, typically septorhinoplasty, may then be elected. This procedure is typically done on an outpatient basis, and patients usually plan to avoid appearing in public for about a week due to swelling and bruising.

Will Insurance Cover Nasal Surgery?

Insurance usually does not cover cosmetic surgery. However, surgery to correct or improve breathing function, major deformity or injury is frequently covered in whole or in part. Patients should obtain cost information from their surgeons and discuss with their insurance carrier prior to surgery.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Why Do We Suffer From Nasal and Sinus Discomfort?

The body’s nasal and sinus membranes have similar responses to viruses, allergic insults and common bacterial infections. Membranes become swollen and congested. This congestion causes pain and pressure; mucus production increases during inflammation, resulting in a drippy, runny nose. These secretions may thicken over time, may slow in their drainage, and may predispose to future bacterial infection of the sinuses.

Congestion of the nasal membranes may even block the eustachian tube leading to the ear, resulting in a feeling of blockage in the ear or fluid behind the eardrum. Additionally, nasal airway congestion causes the individual to breathe through the mouth.

Each year, more than 37 million Americans suffer from sinusitis, which typically includes nasal congestion, thick yellow-green nasal discharge, facial pain and pressure. Many do not understand the nature of their illness or what produces their symptoms. Consequently, before visiting a physician, they seek relief for their nasal and sinus discomfort by taking non-prescription or over-the-counter (OTC) medications.

What is The Role of OTC Medication for Sinus Pain?

There are many different OTC medications available to relieve the common complaints of sinus pain and pressure, allergy problems and nasal congestion. Most of these medications are combination products that associate either a pain reliever such as acetaminophen with a decongestant or an antihistamine. Knowledge of these products and of the probable cause of symptoms will help the consumer to decide which product is best suited to relieve the common symptoms associated with nasal or sinus inflammation.

OTC nasal medications are designed to reduce symptoms produced by the inflammation of nasal membranes and sinuses. The goals of OTC medications are to: (1) reopen to nasal passages; (2) reduce nasal congestion; (3) relieve pain and pressure symptoms; and (4) reduce potential for complications. The medications come in several forms.

Nasal Saline Sprays: Non-Medicated Nasal Sprays

Nasal saline is an invaluable addition to the list of over-the-counter medications. It is ideal for all types of nasal problems. The added moisture produced by the saline reduces thick secretions and assists in the removal of infectious agents. There is no risk of becoming “addicted” to nasal saline. It should be applied as a mist to the nose up to six times per day. Nasal saline can also be made at home: contact your otolaryngologist for details.

Nasal Decongestant Sprays: Medicated Nasal Sprays

Afrin® nasal spray, Neo-Synephrine®, Otrivin®, Dristan® nasal spray and other brands decongest the swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating the initial stages of a common cold or viral infection. Nasal decongestant sprays are safe to use, especially appropriate for preventing eustachian tube problems when flying, and to halt progression of sinus infections following colds. However, they should only be utilized for 3-5 days because prolonged use leads to rebound congestion or “getting hooked on nasal sprays.” The patient with nasal swelling caused by seasonal allergy problems should use a cromolyn sodium nasal spray. The spray must be used frequently (four times a day) during allergy season to prevent the release of histamine from the tissues, which starts the allergic reaction. It works best before symptoms become established by stabilizing the nasal membranes and has few side effects.

Decongestant Medications

Pressure and congestion are common symptoms of nasal passage swelling. Decongestant medications are OTC products that relieve nasal swelling, pressure and congestion but do not treat the cause of the inflammation. They reduce blood flow to the nasal membranes leading to improved airflow, less breathing through the mouth, decreased pressure in the sinuses and head and subsequently less discomfort. Decongestants do not relieve drippy noses. Their side effects may include light headedness or giddiness and increased blood pressure and heart rate (patients with high blood pressure or heart problems should consult a physician before use). In addition, other medications may interact with oral decongestants, causing side effects. Both of these are available as single products or in combination with a pain reliever or an antihistamine. They are labeled as “non-drowsy” due to a side effect of stimulation of the nervous system.

Decongestant-Combination Products

Some medications are combined to reduce the number of pills. Tylenol® Sinus or Advil® Cold and Sinus exemplify products that join a pain reliever (acetaminophen or ibuprofen) with a decongestant (pseudoephedrine). These products relieve both sinus and cold/flu symptoms yet retain all the attributes of the individual drug, including side effects.

Antihistamine Medications

Antihistamines combat allergic problems leading to nasal congestion. OTC antihistamines such as diphenhydramine (Benadryl®), or clemastine (Tavist®) may be used for relieving allergic symptoms of itching, sneezing and nasal congestion. They relieve the drainage associated with the allergic inflammation, but not obstruction or congestion. Antihistamines have a potential for sedation, causing grogginess and dryness after use. Newer non-sedating antihistamines are available.

Antihistamine-Decongestant Combination Products

Antihistamines and decongestant products are often combined to relieve multiple symptoms of congestion and drainage and reduce the side effects of both products. Antihistamines produce sedation; decongestants are added to make them “non-drowsy.” The combined allergy product then relieves congestion and a runny nose.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What is CPAP?

The most common and effective nonsurgical treatment for sleep apnea is Continuous Positive Airway Pressure, or CPAP, which is applied through a nasal or facial mask while you sleep. The CPAP device does not breathe for you. Instead, it creates a flow of air pressure when you inhale that is strong enough to keep your airway passages open. Once your otolaryngologist determines that CPAP is the right treatment, you will need to wear the CPAP mask every night.

How Do You Know if You Need CPAP?

When evaluating sleep apnea, your otolaryngologist may ask the following questions:

  • Does your snoring disturb your family and friends?
  • Do you have daytime sleepiness?
  • •Do you wake frequently throughout the night?
  • •Have you had episodes of obstructed breathing during sleep?
  • •Do you have morning headaches or tiredness?

After a review of your medical history and an examination of your airway, your otolaryngologist will order an overnight sleep study. A CPAP recommendation is made after your otolaryngologist reviews the results of the study.

How Do You Get CPAP?

If your otolaryngologist recommends CPAP, you may be scheduled for a second sleep study during which you will be fitted for a mask and CPAP device. The level of air pressure will be adjusted during the study to eliminate the airway obstruction. Alternatively, you may be placed on a self- adjusting CPAP machine which will determine the pressure needed to keep the airway open.

What are the Advantages of CPAP?

CPAP is the most effective means of treating snoring and sleep apnea. It keeps airway passages open which prevents pauses in breathing and helps you to get better sleep. This, in turn, reduces daytime sleepiness, fatigue and other sleep apnea related health problems such as high blood pressure, heart disease, diabetes and stroke.

What are the Disadvantages of CPAP?

The CPAP device needs to be used every night. Some patients complain of mask discomfort, nasal congestion, and nose and throat dryness when using CPAP. Others find the device to be too constrictive and cumbersome, particularly when traveling. Unfortunately, these complaints sometimes lead to inconsistent use or abandonment of the device altogether. Proper mask fitting and use of a humidifier can resolve these issues.

What are the Alternative Treatments for Sleep Apnea?

Lifestyle change including weight loss and exercise can help to improve sleep apnea and its related health problems. Sleep positioning and oral appliances have also been found to be effective. In cases when non-invasive treatments fail, a surgical solution might be necessary. Your otolaryngologist will be able to advise you on the treatment options.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Drugs for stuffy nose, sinus trouble, congestion and drainage, and the common cold constitute a large segment of the over-the-counter market for America’s medication industry. Even though they do not cure allergies, colds or the flu, they provide welcome relief for at least some of the discomforts of seasonal allergies and upper respiratory infections. However, it’s essential for consumers to read the ingredient labels, evaluate their symptoms and choose the most appropriate remedy. It is not necessary to take medication if your symptoms are mild to moderate. Seek care from a physician if your symptoms persist beyond 7-10 days or are accompanied by fevers greater than 101.5º and worsening illness.

Some patients may benefit from non-drug therapies for nasal symptoms, such as nasal salt-water sprays or mists and nasal saline irrigations. As with all over-the-counter medications and treatments, read and follow the product’s instructions before use.

What are antihistamines?

Histamine is an important body chemical that is responsible for the congestion, sneezing, runny nose and itching that a patient suffers with an allergic attack or an infection. Antihistamine drugs block the action of histamine, therefore reducing these symptoms. For the best result, antihistamines should be taken before allergic symptoms get well established, but they can also be very effective if taken after the onset of symptoms.

What are the side effects of antihistamines?

Most of the older over-the-counter antihistamines produce drowsiness, and are therefore not recommended for anyone who may be driving a car or operating equipment that could be dangerous. The first few doses cause the most sleepiness; subsequent doses are usually less troublesome. Some of the newer over-the-counter and prescription antihistamines do not produce drowsiness.

Typical generic antihistamines include: cetirizine, levocetirizine, loratadine, desloratadine, fexofenadine, diphenhydramine, chlorpheniramine, azelastine, brompheniramine. (Brand names: Benadryl®*, Chlor-Trimetron®*, Claritin®, Dimetane®*, Hismanal®, Nolahist®*, PBZ®*, Polaramine®, Tavist®*, Zyrtec®, Xyzal®, Allegra®, Claritin®, Clarinex® and Alavert®).

What are decongestants?

Congestion in the nose, sinuses and chest is due to swollen, expanded or dilated blood vessels in the membranes of the nose and air passages. These membranes, with a great capacity for expansion, have an abundant supply of blood vessels. Once the membranes swell, you start to feel congested.

Decongestants help to shrink the blood vessels in the nasal membranes and allow the air passages to open up. Decongestants are chemically related to adrenaline, the natural decongestant, which is also a type of stimulant. Therefore, the side effect of decongestants taken as a pill or liquid is a jittery or nervous feeling, causing difficulty in going to sleep and elevating blood pressure and pulse rate.

Who should not use decongestants?

Decongestants should not be used by a patient who has an irregular heart rhythm, high blood pressure, heart disease or glaucoma. Some patients taking decongestants experience difficulty with urination. Furthermore, decongestants are often used as ingredients in diet pills. To avoid excessively stimulating effects, patients taking diet pills should not take decongestants.

Typical decongestants in pill or liquid form are Drixoral®, Dimetapp®, Dura-Vent®, Exgest®, Entex®, Propagest®, Novafed®* and Sudafed®*.

Decongestants are also available over-the-counter in nasal spray form. This method of medication delivery brings immediate relief to the nasal mucous membranes without the usual side effects that accompany pills or liquids that you swallow. Over-the-counter decongestant nose sprays should be reserved for urgent, emergency and short-term use. Because repetitive use can lead to lack of effectiveness and return of the congestion, and thus lead to the urge to use more sprays more frequently, these medications often carry a warning label: “Do not use this product for more than three days.” This problem will improve only when the use of the nasal drops or spray is discontinued.

What are combination remedies?

Theoretically, if the side effects could be properly balanced, the sleepiness caused by antihistamines could be cancelled by the stimulation of decongestants. For instance, one might take the antihistamine only at night and take the decongestant alone in the daytime. Alternatively, you could take them together, increasing the dosage of antihistamine at night (while decreasing the decongestant dose) and then doing the opposite for daytime use. Since no one reacts exactly the same as another to drug side effects, you may wish to adjust the time of day the medications are taken until you find the combination that works best.

Antihistamines/decongestants: Many pharmaceutical companies have combined antihistamines and decongestants together in one pill. Typical combinations include (brand names): Actifed®*, A.R.M.®*, Chlor-Trimeton D®*, Claritin D®, Contac®*, CoPyronil 2®*, Deconamine®, Demazin®*, Dimetapp®*, Drixoral®*, Isoclor®*, Nolamine®, Novafed A®, Ornade®, Sudafed Plus®, Tavist D®*, Triaminic®* and Trinalin®.

What should I look for in a “cold” remedy?

Decongestants and/or antihistamines are the principal ingredients in “cold” remedies, but drying agents, aspirin (or aspirin substitutes) and cough suppressants may also be added. Therefore, consumers should choose remedies with ingredients best suited to combat their own symptoms. If the label does not clearly state the ingredients and their functions, ask the pharmacist to explain them.

* May be available over-the-counter without a prescription, although often obtained at the counter itself. Read labels carefully and use only as directed.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Secondhand smoke is a combination of the smoke from a burning cigarette and the smoke exhaled by a smoker. Also known as environmental tobacco smoke (ETS), it can be recognized easily by its distinctive odor. ETS contaminates the air and is retained in clothing, hair, curtains and furniture. Many people find ETS unpleasant, annoying and irritating to the eyes and nose. More importantly, it represents a dangerous health hazard. Over 4,000 different chemicals have been identified in ETS, and at least 43 of these chemicals cause cancer.

Is exposure to ETS common?

Approximately 26 percent of adults in the United States currently smoke cigarettes, and 50 to 67 percent of children under five live in homes with at least one adult smoker.

Smoke’s effect on…

The fetus and newborn

Maternal, fetal and placental blood flow change when pregnant women smoke, although the long-term health effects of these changes are not known. Some studies suggest that smoking during pregnancy causes birth defects such as cleft lip or palate. Smoking mothers produce less milk, and their babies have a lower birth weight. Maternal smoking also is associated with neonatal death from Sudden Infant Death Syndrome, the major cause of death in infants between one month and one year old.

Children’s lungs and respiratory tracts

Exposure to ETS decreases lung efficiency and impairs lung function in children of all ages. It increases both the frequency and severity of childhood asthma. Secondhand smoke can aggravate sinusitis, rhinitis, cystic fibrosis and chronic respiratory problems such as cough and postnasal drip. It also increases the number of children’s colds and sore throats. In children under two, ETS exposure increases the likelihood of bronchitis and pneumonia. In fact, a 1992 study by the Environmental Protection Agency says ETS causes 150,000 – 300,000 lower respiratory tract infections each year in infants and children under 18 months old. These illnesses result in as many as 15,000 hospitalizations. Children of parents who smoke half a pack a day or more are at nearly double the risk of hospitalization for a respiratory illness.

The ears

Exposure to ETS increases both the number of ear infections a child will experience and the duration of the illness. Inhaled smoke irritates the eustachian tube, which connects the back of the nose with the middle ear. This causes swelling and obstruction which interferes with pressure equalization in the middle ear, leading to pain, fluid and infection. Ear infections and middle ear fluid are the most common cause of children’s hearing loss. When they do not respond to medical treatment, the surgical insertion of tubes into the ears is often required.

The brain

Children of mothers who smoked during pregnancy are more likely to suffer behavioral problems such as hyperactivity than children of non-smoking mothers. Modest impairment in school performance and intellectual achievement has also been demonstrated.

Who is at risk?

Although ETS is dangerous to everyone, fetuses, infants and children are at most risk because it can damage developing organs, such as the lungs and brain.

Secondhand smoke causes cancer

You have read how ETS harms the development of your child, but did you know that your risk of developing cancer from ETS is about 100 times greater than from outdoor cancer-causing pollutants? Did you know that ETS causes more than 3,000 non-smokers to die of lung cancer each year? While these facts are alarming for everyone, you can stop your child’s exposure to secondhand smoke right now.

What can you do?

  • If you smoke, stop now. Consult your physician for help, if needed. There are many new pharmaceutical products available to help you quit.
  • If you have household members who smoke, help them stop. If it is not possible to stop their smoking, do not allow them to smoke in your home or near your children.
  • Do not smoke or allow smoking in your car.
  • Be certain that your children’s schools and day-care facilities are smoke-free.

Acknowledgment to the American Society of Pediatric Otolaryngology for contributions to this content.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Dust, mites, pet dander and ragweed are not the only allergic threats to your child. Food allergies and sensitivities may cause a wide range of adverse reactions to the skin, respiratory system, stomach and other physiological functions of the body.

Determining what foods are the cause of an allergic reaction is key to treatment. Before you identify the ingestible culprit you must consider what type of food allergy your child has. There are two types, classified as:

  • Fixed (immediate) food allergies: A fixed food allergy may be very apparent, such as the child whose lips swell and throat itches immediately in response to eating peanuts. The cause for this type of food allergy is similar to that of inhalant allergies, so the diagnosis is more easily reached. Blood testing (i.e., RAST test) is typically used to verify fixed food allergies. Approximately 5 to 15 percent of food allergies are of the fixed variety.
  • Cyclic (delayed) food allergies: These allergies are far more common but less understood. Delayed food allergy symptoms can take up to three days to appear. This type of reaction is associated with the body’s immunoglobulin G (IgG) or antibodies. Unlike fixed food allergies, this allergic response is cyclical in nature. As an example, a child may be IgG sensitive to milk. Consequently, symptoms might appear if the child increases the intake and/or frequency of milk consumption.

Both children and adults are susceptible to food allergies. The bad news for children is that they often have more skin reactions, such as eczema, to foods than do adults. But the good news for the young patient is that a child often outgrows his or her food sensitivities over time, even those that are positive on a RAST test. Food allergies may fade, and then inhalant (e.g, dust, ragweed) allergies may begin to manifest themselves.

Diagnosing and treating the cyclic food allergy

If your child is experiencing allergic reactions to food of unknown origin, you should ask yourself, “Are there any foods that my child craves or any food that I avoid offering?” These foods may be the ones that are causing difficulties for the young patient.

Your physician may also suggest the Elimination and Challenge Diet. This dietary test consists of the following steps:

  1. Keep a detailed food diary, tracking what was eaten (including ingredients), when it was eaten, medications taken, and any symptoms that developed. Be honest! Some well-meaning parents or caregivers often create a food diary that looks healthier than it really is. Your child can receive the best diagnosis if the diet records are accurate, timed precisely and truthful. The diet diary can be evaluated by the doctor to identify food items that may be the culprits.
  2. Conduct an elimination and challenge diet at home based upon your physician’s assessment of your child’s diet diary. It is best if you carefully maintain a new diet diary for your child during this period. During this diet, your child must abstain from one, and only one, of the possible food culprits at a time for a period of four days. This can be difficult to carry out if the food is very common, such eggs or cereal, so you need to pay strict attention to your child’s diet during the elimination phase. Any cheating will invalidate the results. On the fifth day, you will be asked to feed your child the suspected culprit food item. This is the challenge! Provide your child an average-sized portion of the food in question to be eaten in five minutes. In one hour the child should eat another half portion if no symptoms have developed. Any symptoms that develop are then timed and recorded. With a true cyclic food allergy, you would expect a significant worsening of the symptoms described in the original diet diary, although the challenge symptoms may vary as well.
  3. If the Elimination and Challenge Diet confirms a cyclic food allergy, then you will be asked to abstain from feeding your child this food for a period of three to six months. After this time you can slowly reintroduce the food on a rotary basis; it is not to be eaten more frequently than every four days (once or twice a week).

For minor, moderate discomfort from the testing, the caregiver may choose to offer one of the following: 1) a child’s laxative to decrease the transit time through the digestive system; 2) Alka Seltzer® Gold; 3) buffered Vitamin C (one gram).

Fixed food allergies should never be deliberately challenged unless under the direct supervision of a physician.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Does your child have allergies? Allergies can cause many ear, nose and throat symptoms in children, but allergies can be difficult to separate from other causes. Here are some clues that allergies may be affecting your child.

Children with nasal allergies often have a history of other allergic tendencies (or atopy). These may include early food allergies or atopic dermatitis in infancy. Children with nasal allergies are at higher risk for developing asthma.

Nasal allergies can cause sneezing, itching, nasal rubbing, nasal congestion and nasal drainage. Usually, allergies are not the primary cause of these symptoms in children under four years old. In allergic children, these symptoms are caused by exposure to allergens (mostly pollens, dust, mold and dander). Observing which time of year or in which environments the symptoms are worse can be important clues to share with your doctor.

Ear infections:

One of childrens’ most common medical problems is otitis media, or middle ear infection. In most cases, allergies are not the main cause of ear infections in children under two years old. But in older children, allergies may play role in ear infections, fluid behind the eardrum, or problems with uncomfortable ear pressure. Diagnosing and treating allergies may be an important part of healthy ears.

Sore throats:

Allergies may lead to the formation of too much mucus which can make the nose run or drip down the back of the throat, leading to “post-nasal drip.” It can lead to cough, sore throats and a husky voice.

Sleep disorders:

Chronic nasal obstruction is a frequent symptom of seasonal allergic rhinitis and perennial (year-round) allergic rhinitis. Nasal congestion can contribute to sleep disorders such as snoring and obstructive sleep apnea, because the nasal airway is the normal breathing route during sleep. Fatigue is one of the most common, and most debilitating, allergic symptoms. Fatigue not only affects children’s quality of life, but has been shown to affect school performance.

Pediatric sinusitis:

Allergies should be considered in children who have persistent or recurrent sinus disease. Depending on the age of your child, their individual history and an exam, your doctor should be able to help you decide if allergies are likely. Some studies suggest that large adenoids (a tonsil-like tissue in the back of the nose) are more common in allergic children.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery