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Snoring Sniffles Sinusitis Ask an Expert

Online Health Chat with Dr. Mariah Salloum

August 13, 2010


Introduction

Is your partner’s snoring keeping you from a peaceful night’s sleep? Wondering why your voice is so hoarse? Is chronic throat pain becoming a bother? Dr. Mariah Salloum, an ear, nose, and throat specialist, is here to help! Get your questions answered about a variety of conditions that affect your ears, nose, and throat such as ear infections, nosebleeds, hearing loss, excessive snoring, throat soreness, nasal polyps, and sinusitis. Please join us in this live web chat and allow Dr. Salloum to identify your condition and recommend the best treatment options.

Dr. Salloum, MD works in the Otolaryngology Department of the Elyria Family Health and Surgery Center. Her treatments and services include the following: adult and pediatric ENT, head and neck surgery, ear disease, voice disorders, salivary gland disease, thyroid surgery, and sinus disease.

She received her undergraduate degree from Case Western Reserve University, obtained her medical degree from The Ohio State University College of Medicine and Public Health, and completed her residency at Tufts-New England Medical Center in Boston, MA.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Mariah Salloum. We are happy to have him here today for our chat on Snoring? Sniffles? Sinusitis? Let’s begin with the questions.


Ears/Hearing

rss: What are some of the most common symptoms of an ear infection?

Speaker_-_Dr__Mariah_Salloum: Ear infections can be painful. Trapped fluid puts pressure on the eardrum, causing it to bulge. Other symptoms include:

  1. Ear pain – this symptom is obvious in adults, but for children who cannot yet speak, you should watch for other signs, like rubbing or tugging on the ear lobes or excessive crying.
  2. Loss of appetite – this may be most apparent in young children, especially during bottle feedings. Pressure changes in the middle ear as the child swallows, cause more pain and less desire to eat.
  3. Irritability – any kind of persistent pain may cause irritability in children and adults.
  4. Poor sleep – pain may be more persistent when lying down as fluid is shifting.
  5. Fever – ear infections can cause temperatures up to 104°F.
  6. Drainage from the ear – yellow, brown or white fluid that isn’t earwax may seep from the ear. This indicates the rupture of the eardrum.
  7. Difficulty hearing – the middle ear space (behind the ear drum) is usually filled with air; during an infection, it contains fluid which does not transmit sound as well, and therefore hearing loss is a common symptom.

nadie: Do childhood earaches cause hearing loss later on in life?

Speaker_-_Dr__Mariah_Salloum: Recurrent ear infections during childhood can sometimes lead to chronic hearing loss. If an infection is suspected, the child should be seen by a physician for appropriate treatment.

salben: What happens when tubes are inserted in small children’s ears to eliminate ear infections?

Speaker_-_Dr__Mariah_Salloum: Ear infections are caused by Eustachian tube dysfunction. This leads to negative pressure in the middle ear space, which causes fluid accumulation and infections. An ear tube allows another passage to equalize pressure and prevent fluid and infections. The tubes typically last six to twelve months, then fall out on their own. If left in longer than 2 years, your doctor may recommend taking them out to prevent complications.

turkgb: What is ‘swimmer’s ear’ and why does a solution of vinegar oil and alcohol applied early work in eliminating and preventing infection?

Speaker_-_Dr__Mariah_Salloum: Swimmer’s ear is an infection of the ear canal, also known as otitis externa. We call it swimmer’s ear because it often starts with excessive moisture of the ear canal. This creates a good environment for bacteria to grow. The reason vinegar and alcohol are sometimes used to treat this problem is because they work to dry out the canal. Sometimes antibiotic and steroid drops are also used. Keeping the ear clean and dry are key to treating these infections as well.

bmn: What causes tinnitus? I know there are treatments, but is there a cure?

Speaker_-_Dr__Mariah_Salloum: Tinnitus is a very common problem. This may be a ringing in the ears, low pitch noises or sometimes a buzzing or 'crickets' sound. There are many causes for tinnitus. Probably the most common cause is hearing loss. Treatment of the hearing loss, such as with hearing aids, will often help. There is no known cure for tinnitus, but there may be treatment options, depending on the cause.

alexk: I am deaf in one ear. My hearing loss began with low frequencies and at a young age. Have there been any advances in determining the cause of this type of loss? They were never able to come up with a cause. Can I expect to lose the hearing in my other ear as well? Also, is this hereditary? My grandmother had the same type of hearing loss.

Speaker_-_Dr__Mariah_Salloum: There have been many advances in understanding genetic patterns of hearing loss. A workup may include a hearing test, imaging studies or genetic testing. Some types of hearing loss may affect both ears. A doctor will help determine which studies may be appropriate and possible genetic contributions.

pictureperfect: What causes ear wax? I have to have my ears flushed out at least every year. Can this cause hearing loss?

Speaker_-_Dr__Mariah_Salloum: Ear wax is naturally produced by cells of the ear canal. It helps protect the ear and keep it moist. The ear typically cleans itself out; some people who produce excessive wax or have narrow ear canals may need to have their ears cleaned periodically. Excessive ear wax can cause decreased hearing. Using cotton swabs or Q-tips to clean the ear may actually push wax in further, causing more problems.

heavenly: What can be done for an itchy ear? There seems to be no ear wax. This condition has persisted for two years. There has been no response to over the counter remedies.

Speaker_-_Dr__Mariah_Salloum: An itchy ear may be due to a condition of the skin, such as dry skin or eczema. It may also be due to underlying allergies. An ENT may determine the most likely cause and appropriate treatment options.

carolelangley: I have pressure in my ears that was thought to be chronic sinusitis. Doctors are now looking into migraine headaches instead, as a cause. A neurologist has been recommended. Is this a logical?

Speaker_-_Dr__Mariah_Salloum: Sensation of pressure in the ears may be caused by a variety of problems, including sinusitis, TMJ, inner ear problems or headaches. A thorough evaluation by your primary care doctor is a good start. Additional evaluations by ENT, Neurology or other specialists may also be helpful.

Pronto: Could a loud rock concert hurt a pregnant woman’s child? Hearing?

Speaker_-_Dr__Mariah_Salloum: Noise exposure can lead to hearing loss, but probably would not cause hearing loss in a fetus.Hearing loss at birth is more commonly genetic, due to infection, or abnormal development of the inner ear.


Sinus

sims: What is sinusitis and who gets it?

Speaker_-_Dr__Mariah_Salloum: Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. There are two types of sinusitis: Acute sinusitis: a sudden onset of cold symptoms such as runny nose, stuffy nose, and facial pain that does not go away after 7-10 days. It responds well to decongestants and nasal steroids; antibiotics are sometimes, but not always indicated. Chronic sinusitis: characterized by nasal congestion, drainage, facial pain/pressure, and decreased sense of smell for at least 12 weeks.

About 37 million Americans suffer from at least one episode of sinusitis each year. People who have the following conditions have a higher risk of sinusitis: Nasal mucus membrane swelling as from a common cold, blockage of sinus openings, structure differences that narrow the sinus openings, and conditions that result in an increased risk of infection.

In children, common environmental factors that contribute to sinusitis include allergies, illness from other children at day care or school, pacifiers, bottle drinking while lying on the back, and smoke in the environment.

foolishme: Why is it usually necessary to repeat surgeries for patients with chronic sinusitis?

Speaker_-_Dr__Mariah_Salloum: As the name implies, chronic sinusitis is a chronic disease. There are usually multiple factors that contribute to the problem. Surgery is not meant to cure the problem, but certainly to help relieve the symptoms. It is important to also treat underlying conditions, such as allergic rhinitis and tobacco exposure, to prevent the sinusitis from recurring.

jacqueline: Why can prolonged fullness of the inner ear and tinnitus occur after sinusitis has cleared up by using antibiotics?

Speaker_-_Dr__Mariah_Salloum: Sinusitis can sometimes lead to middle ear infections, or fluid in the middle ear space (behind the ear drum). Even after the infection has been appropriately treated, middle ear fluid may remain for up to 3 months. This would cause a feeling of fullness as well as decreased hearing and tinnitus.

emmy: What about nasal sprays? Can they cure a sinus infection?

Speaker_-_Dr__Mariah_Salloum: Certain prescription nasal sprays, such as nasal steroids or antihistamines, are helpful in treating sinus infections. Over-the-counter nasal sprays are often used to decongest the nose, but the nose may become addicted to these sprays over time. I would recommend only using nasal sprays as instructed by your doctor.

frankie: When I lie down, my nose becomes stuffed and sometimes I have to breath with my mouth open. Why and what I can do to change this?

Speaker_-_Dr__Mariah_Salloum: Lying flat increases blood flow to the nose, which can increase congestion. Gravity may also allow secretions to pool in the nose when lying down. Nasal steroids or decongestants may be helpful (consult your doctor before starting these). Anatomic problems, such as septal deviation or weak cartilage may also be a factor. An ENT could help determine the specific cause in each person.

doglover894: I have a deviated septum. My nose feels clogged, but nothing comes out if I blow it. What is the best treatment to keep it clear? I use a neti pot and Breathe Right strips? Is glycerin ok to put in as a moisturizer? –Thanks.

Speaker_-_Dr__Mariah_Salloum: Nasal steroids, decongestants, and nasal saline may all help to improve the breathing. However, repair of the deviated septum would probably be the most beneficial treatment. Glycerine or other ointment will help keep the nose moist, but may not significantly improve breathing.

kn654: I have blockage in my nose that cuts off air when I am asleep. I wake up in a hurry, with a vengeance, then can’t sleep or am afraid to sleep. What can I do?

Speaker_-_Dr__Mariah_Salloum: Blockage in the nose may be due to nasal congestion, such as with seasonal allergies, or an anatomic problem, such as septal deviation. Pauses in breathing when asleep may be obstructive sleep apnea. There is usually no immediate danger, but may lead to long term health problems. Evaluation by a doctor would be helpful.

church3cs: Can surgery be performed for removal of nasal polyps if asthmatic?

Speaker_-_Dr__Mariah_Salloum: Yes, absolutely! Nasal polyps and asthma are often seen together and often these patients may also be sensitive to aspirin products. This is known as Samter's Triad. Removal of nasal polyps is often necessary in these patients, as well as close follow up after surgery.


Snoring/Sleep Apnea

kissie: How effectively can ‘appliances’ be used to control snoring (i.e. Breath Right strips or that plastic thing to invert in nostrils to open nasal passages?

Speaker_-_Dr__Mariah_Salloum: The right appliance may be very helpful, but this will vary from person to person. If weakness of the nasal cartilage is a problem, for instance, Breath Right strips may be helpful. An evaluation by an ENT could help determine your specific sites of airway obstruction and the most appropriate treatment options.

petewes: What is the correlation between obesity and snoring? The reason for the snoring? What about the thin person who snores?

Speaker_-_Dr__Mariah_Salloum: Snoring is caused by turbulent airflow when breathing. The changes in airflow are caused by some degree of obstruction. This may be a problem anywhere from the nose to the pharynx and throat. It is common in obesity due to the increased pressure created when breathing. In non-obese people, it may represent an obstruction such as nasal septal deviation, or enlarged tonsils or adenoids. An evaluation by an ENT is helpful to determine the specific cause and site of obstruction.

jlong: I have heard of obstructive sleep apnea, what is that? What are some of the causes of my snoring?

Speaker_-_Dr__Mariah_Salloum: Some snorers may experience the most serious form of snoring, called obstructive sleep apnea. Obstructive sleep apnea is characterized by loud snoring, which is interrupted by frequent periods when breathing is restricted (hypopnea) or actually stops (apnea). This disorder is sometimes fatal if apnea extends over longer periods of time and becomes more frequent. Many snorers are unaware of the implications of the problem of obstructive sleep apnea. A laboratory sleep study can be performed by an ENT doctor to determine the extent and severity of obstructive sleep apnea.

Snoring occurs when the airway becomes physically obstructed. This may be caused by poor muscle tone in the throat and tongue, which allows them to collapse and fall back into the airway. Snoring also occurs with enlarged tonsils and adenoids or with a long palate and/or uvula. These obstructing tissues vibrate loudly when the person breathes, resulting in a snoring sound.


Throat

doglover894: Is tonsillectomy risky for an older adult? I've read about bleeding. Can tonsillectomy help adults with sleep apnea if their tonsils are enlarged?

Speaker_-_Dr__Mariah_Salloum: Enlarged tonsils can certainly contribute to sleep apnea, at any age. Although it is a significant risk of surgery, bleeding is uncommon and occurs in less than 5% of cases.

actee3: What causes a person to constantly have to clear their throat? For a non-smoker.

Speaker_-_Dr__Mariah_Salloum: Very often, frequent throat clearing is a symptom of acid reflux. I often see people with symptoms of reflux, who do not have heartburn. We call this laryngopharyngeal reflux (reflux of the throat and pharynx). These people may also have a feeling of a lump in the throat, non-productive cough and hoarseness. Evaluation by a specialist is a good idea.

gammy: What are some of the main causes of hoarseness and how is it diagnosed by my doctor?

Speaker_-_Dr__Mariah_Salloum: Hoarseness can be caused by the following: Common cold or upper respiratory tract viral infection, voice abuse: when you use your voice either too much, too loudly, or improperly over extended periods of time, gastroesophageal reflux: when stomach acid comes up the swallowing tube and irritates the vocal fold, smoking, and allergies, thyroid problems, neurological disorders, rheumatoid arthritis and trauma to the voice box.

Hoarseness is diagnosed by your physician when a thorough history of your hoarseness and your general health is obtained. The voice box and surrounding tissue will then be examined using a mirror or a laryngoscope (a small lighted flexible instrument placed in the back of your throat). Voice quality is then evaluated: A breathy voice may suggest poor vocal cord function, which may be caused by a benign tumor, polyp or larynx cancer. A raspy voice may indicate vocal cord thickening due to swelling, inflammation from infection, a chemical irritant, voice abuse or paralysis of the vocal chords. A high, shaky voice or a soft voice may suggest trouble getting enough breathing force or air. Lab tests, such as a biopsy, x-rays, or thyroid function may be ordered depending on the findings of the physical exam.

cap2: How do I know if my child has tonsillitis and when should I consider a tonsillectomy procedure for my child? Can enlarged tonsils obstruct my child’s airway for breathing?

Speaker_-_Dr__Mariah_Salloum: Tonsil infections can be caused by strep and other bacteria, as well as viruses. The symptoms of tonsillitis may include fever, sore throat, trouble swallowing and enlargement of the lymph glands in the neck; it is usually treated with oral antibiotics after a culture has been done. Generally, a tonsillectomy is only recommended when there are frequent infections over a prolonged period of time. By maintaining rigorous criteria, we determine whether the child will most likely benefit from surgery or will outgrow the problem.

Tonsils often enlarge in young children as a response to the bacteria that routinely reside in their upper respiratory tracts. This enlargement is very common and generally of no consequence. However, in some children the tonsils get large enough to cause problems with breathing during sleep, which is obvious to most parents as snoring, gasping, and occasionally brief stops in the pattern of breathing, called apneas. Other symptoms can include irritability, daytime sleepiness, and occasionally bed wetting. For children with apnea and for children less severely affected who have obstructive sleep disturbances, tonsillectomy with adenoidectomy is often an effective treatment.


Allergies

hearty: My allergies symptoms manifest as my nose closing up. I do not get sniffles, runny nose, watering eyes or sneezing. I have not been able to find any over the counter meds that help me. What else can I try?

Speaker_-_Dr__Mariah_Salloum: Nasal congestion, or difficulty breathing through the nose, is a common symptom of allergic rhinitis. If over the counter decongestants and antihistamines have not been effective, a doctor may be able to recommend other medical or surgical treatment options.
mad2: How are allergies identified?

In some cases, allergies may be identified just by history. In other cases a more extensive workup, including allergy testing, may be helpful. Documenting your symptoms and any possible triggers is a helpful tool for your doctor to diagnose allergy problems.


Closing

Speaker_-_Dr__Mariah_Salloum: Thanks to everyone who participated today. I'm sorry I could not get to all of the questions, but I hope you found this helpful.

Cleveland_Clinic_Host: To make an appointment with Dr. Salloum or any of the other specialists in our Elyria Family Health and Surgery Center at Cleveland Clinic, please call 440.366.9444 or 440.204.7900. You can also visit us online at my.clevelandclinc.org/family_health_centers


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