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7/28/20 in Blog Posts
Swimmer’s Ear (Otitis Externa)
Otitis externa is inflammation of the external ear canal. The most common type is acute otitis externa, also known as swimmer’s ear. It requires two events- presence of bacteria and an injury to the skin of the ear canal. Moisture also creates an environment in the ear that contributes to infection. Symptoms include pain, decreased hearing, and ear drainage. Although a bacterial infection is most common, fungal infections occur as well.
Treatment involves cleaning of infected debris from the ear canal by an ENT, antibiotic ear drops and dry ear precautions. One can help prevent these types of infections by avoiding using q-tips and other instruments in side the ear. For those who suffer recurrent infections, using earplugs while swimming and using alcohol-based drops after swimming can be helpful.
Otitis externa can also be chronic. A common cause is eczema or seborrheic dermatitis of the ear canals. Sufferers from this condition have itchy, irritated ears and often feel compelled to scratch their ear canals with q-tips or other implements. This itch-scratch cycle tends to exacerbate the problem and can result in acute infection. Treatment involves strict dry ear precautions, avoiding scratching the ear, and use of steroid and/or antibiotic drops or cream.
Ear Infections (Otitis Media)
Otitis media means inflammation of the middle ear. It is most commonly used in the context of acute otitis media, the common middle ear infection of early childhood. During an episode, infected fluid fills the usually air-filled space behind the ear drum. Symptoms include ear pain, fever, and decreased hearing. The reason why this type of infection affects children more than adults is the immaturity of the Eustachian tube in children 0-6 years of age.
Treatment often involves oral antibiotics, although in children over two, a 48-hour observation period is often employed prior to initiating antibiotics. Motrin or acetaminophen may be used for the pain. In children with recurrent infections, sometimes myringotomy tubes are recommended.
Chronic serous otitis media is also more common in children than adults. This is when uninfected fluid is present in the middle ear space for a prolonged period of time. Often, the only symptom is hearing loss, but discomfort may be present on occasion. This can be one cause of speech delay in children, and if persistent and causing enough hearing loss, may be treated with drainage and myringotomy tubes.
Asthma is a chronic disease of the lungs. Although it is chronic, not everyone with asthma has symptoms all of the time. Some individuals with asthma have symptoms that occur intermittently, and can go several weeks or months with no symptoms at all. Others with more severe asthma may have symptoms every day.
The hallmark symptom of asthma is wheezing, a high pitched noise evident usually on expiration. This is often accompanied by a cough, and a feeling of chest tightness, or not being able to get a full breath in. These symptoms are often brought on by asthma triggers which can differ from one individual to another. Probably the most common asthma trigger is a cold or upper respiratory infection. Other common triggers are inhaling cold air, strong scents like perfume or the odor of cleaning solutions, cigarette smoke, exercise and a change in the weather. Many individuals with asthma have allergies which are a trigger for their symptoms. These could include allergies to pets, pollen, dust or molds.
The first step in treating asthma is to avoid one’s triggers. This could involve the use of a scarf in cold weather, avoiding strong odors and cigarette smoke, keeping away from pets and maintaining a dust-free environment. These steps can help one to decrease the frequency and severity of asthma symptoms.
For those individuals with allergies, allergy shots are a way to reduce their sensitivity to allergens and thereby reduce asthma symptoms.
Many patients suffer from contact dermatitis, or skin allergies. These patients experience a rash after direct contact with a substance to which they are allergic. This rash may develop hours or even days after the exposure, and is typically itchy. The rash is often red and inflamed, and may have tiny blisters filled with clear fluid.
Contact dermatitis does not typically improve with antihistamines, though they may help the itching somewhat. The rash is likely to improve with steroid creams, though prescription-strength steroid creams or ointments may be necessary. Severe cases may be treated with oral steroids.
The best treatment for contact dermatitis is to identify the triggers and avoid exposure. Numerous allergens may cause contact dermatitis and are often found in cosmetics, jewelry, personal care products, household products, and materials used for hobbies or at work. Contact allergies may develop over time, so products which you have used for years may now be causing a reaction. A patch test is often performed to identify contact dermatitis triggers.
At ENT & Allergy, our allergists have access to hundreds of allergens that can be applied for patch testing. A patch test is often prepared specifically for you, based on the nature of your skin condition and types of exposures. A standard patch test will evaluate for reactions to common metals, fragrances, beauty products, and chemicals found in common household and and occupational products. If needed, patch testing can be performed for additional allergens such as cosmetic materials, haircare materials and dyes, dental products, metals, woodworking and rubber working supplies, plastics and glues, and medications such as anesthetics and steroids.
Eye Allergy (Allergic Conjunctivitis)
In general, allergies occur when your immune system has an overreaction when in comes in contact with something in the environment that would not be bothersome to most people. With eye allergies, the surface of your eye comes in contact with an allergen (like pollen or dander) and produces an inflammatory response resulting in itching, redness, burning and clear watery discharge. Most eye allergies are seasonal and occur during the spring, summer and/or fall, although animal dander and dust may also be triggers.
Eye Allergy Symptoms
• Redness (usually both eyes especially with seasonal triggers )
• Clear discharge
• Often accompanied by dark circles under the eyes (allergic shiners), runny nose, nasal congestion
Insect Sting (ex: Bee Sting)
There are several insects whose stings can result in allergic reactions. These include honey bee, wasp, yellow jacket, and hornet. There is also a prevalence of fire ant in the southern portion of the United States.
Allergic reactions can present in different ways ranging from a small local reaction that resolves without treatment to a life threatening reaction that affects multiple parts and organs of the body and requires immediate medical attention. A person’s symptoms can include redness, swelling, and itching of the skin, difficulty breathing, and feeling faint. Fortunately, life threatening reactions are rare and occur in approximately 0.5% of children and 3% of adults.
After you or a family member has experienced an allergic reaction to an insect sting, there are likely many questions that start going through your mind. Was this a mild or a severe reaction? Will it get worse with the next sting? What can I do to prevent a sting? What treatments should I have available? When can I treat the sting at home and when do I need to seek medical attention? Do I need to get tested to know to which stinging insects I am allergic?
For patients with severe reactions to insect stings, there are several measures that can be helpful: education regarding avoidance of stinging insects, having rescue medications prescribed and available (examples are an antihistamine and epinephrine), carrying medical information bracelets identifying the allergy, testing to see which stinging insects can cause reactions for that patient, and immunotherapy (venom shots) which can cure the allergy in the majority of cases.
Testing for stinging insect allergy involves placing a small amount of venom on the surface or just underneath the skin and observing for a small hive in the area. The results are available within 15 minutes. If the result is negative, then a higher concentration is used in the next round of testing.
Sinus Problems - Sinusitis
Sinuses are air-filled spaces in the face and head that are lined by mucous membranes. They produce mucus (or phlegm) to cleanse the nose and upper respiratory tract. There are multiple sinuses located on each side of our face (maxillary, ethmoid, frontal, sphenoid) which have small openings that drain mucus and circulate air from the nose.
What is Sinusitis? Irritants or infections in the nose can cause swelling of the nasal cavity and sinuses, leading to pressure and pain. The extra mucus that is produced along with the swelling can cause blockage of the breathing passages. The common symptoms of sinusitis include:
• Pain/pressure over sinuses
• Discolored nasal drainage or mucus
• Nasal congestion
• Inability to smell
• Low grade fever
• Phlegm in throat
• Post-nasal drip
What are Treatments for Sinusitis? Medical treatment for sinusitis includes:
• Saline spray, wash, irrigation (Neilmed sinus rinse, Neti Pot)
• Decongestants - oral or nasal
• Antihistamines - oral or nasal
• Antibiotics (oral, topical, intravenous)
• Steroids (nasal or oral)
Urticaria, otherwise known as hives, normally consists of raised red or white areas of skin that typically itch or burn and can rapidly resolve with minutes or hours. Hives can frequently occur together with angioedema. Angioedema is a swelling of the underlying skin most typically involving the face. Urticaria can be mild and occur less than one day in duration. In other circumstances, hives can come and go daily or episodically for years. It is very commonly thought that all hives are a result of allergy, but most cases of hives that last for more than several days do not have a known cause.
A consultation with an Allergist will involve a thorough history, physical exam and possible skin/blood testing to help determine if there could be an identifiable cause of a patient’s urticaria/angioedema. An Allergist is also the most qualified physician to help determine the right medication(s) to treat urticaria/angioedema. The typical first line of medical therapy for urticaria/angioedema are oral antihistamines. There are other prescription medications that can be used if oral antihistamines do not effectively control symptoms. Your allergist will be able to help determine which is the proper medication regimen to help control symptoms to maximize your quality of life.
Hoarseness is a very common complaint that usually resolves spontaneously over the course of days to weeks. Prolonged change in the voice can be caused by a more serious condition that requires further evaluation. Generally, any change in voice that lasts for two weeks or more should be evaluated by an Otolaryngologist or voice specialist. Commonly caused by self-limited infections, such as upper respiratory infections, other causes of hoarseness may be due to benign or cancerous growths, acid reflux, over-use or abuse of the voice, trauma, and neurological disorders.