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Archive for March, 2013

Help, I have a sore throat! Is it Strep? Understanding pharyngitis

Tuesday, March 26th, 2013

Sore throat is one of the most common problems that people have in the winter when they come to the medical clinic. There are many different causes of a sore throat, including bacterial or viral infections. Although a sore throat usually resolves without any complications, there are times that antibiotic treatment is required. There are very rare causes of sore throat pain that can be serious or life threatening.

Pharyngitis Treatment | Dallas ENT Group | Dallas, TX

When to call the doctor: Since it’s tough to know your sore throat is caused by a virus or bacteria, I encourage you to call your doctor if one or more of the following are present: temperature > 101 degrees F or 38 degrees C, season is late fall, winter or early spring, you don’t have a cough, the age of the patient is between 5-15 years old, recent exposure to someone with strep throat, difficulty breathing/swallowing, your voice sounds muffled, they have a stiff neck or difficulty opening their mouth.

Causes of sore throat: Viruses are the most common cause of sore throat, but bacteria are another common cause. The causes of sore throat depend on the age of the patient as well as the season and geographic location. Many different viruses can cause swelling and throat pain. Most common viruses that cause sore throat also cause the common cold, but others include influenza, adenovirus, and Epstein-Barr virus (the cause of mononucleosis).

Symptoms of viral pharyngitis: Usually with a viral infection, the patient will have runny nose, nasal congestion and can even have irritation and/or redness of the eyes, cough, hoarseness, skin rash and even diarrhea. Viral infections can also cause fever that makes you feel miserable. A high fever does not mean that your you have a bacterial infection.

Group A streptococcus – (GAS): The bacteria that causes strep throat. Other bacteria can also cause sore throat, but group a strep is the most common. Up to 30% of children with sore throat will have strep throat. Winter and early spring are the most common times of the year when it occurs. It is the most common in school-age children and their young siblings.

Symptoms of Strep Throat: Sudden development of fever (temperature > 100.4 degrees F), headache, abdominal pain, nausea and vomiting, swollen glands in the neck, white patches of pus in the back or sides of throat, small red spots on the roof of the mouth. A cough and cold are not usually seen with strep throat.

Diagnosis: Most of the time the cause of the sore throat is a virus and does not require treatment with antibiotics. It is, however important to recognize and treat kids with strep throat to prevent complications of strep throat which can cause rheumatic fever. There are two types of tests that can help diagnose strep throat. One is a rapid strep test and the other is a throat culture. Both of these tests require a swab of the back of the throat to look for the strep bacteria. The throat culture is more accurate, but it takes 24-48 hours to get the results back. The rapid test isn’t quite as accurate but the benefit is that you know the results before going home from the clinic.

Treatment: The treatment of sore throat depends on the cause; strep throat is treated with antibiotic while viral pharyngitis is treated with rest, pain relievers and measure to make the patient more comfortable while the body heals. It is important to monitor for dehydration because some children with sore throat are reluctant to drink or eat due to pain.
Strep throat is usually treated with an antibiotic such as penicillin or similar antibiotic. After 24 hours of treatment, children can return to school most of the time. If they are having trouble swallowing or eating, they should not go to school and should be re-evaluated. The antibiotic is usually continued for a full 10 day course.

Anti-inflammatory medications such as naproxen, ibuprofen, dexamethasone or prednisone can be helpful to reduce the pain of sore throat. Oral rinses such as salt-water gargles, sprays, lozenges, and sipping warm liquids can also be helpful for sore throat pain.

Complications of strep throat: Most of the time strep throat itself isn’t dangerous. It can, however lead to serious complications such as the spread of the bacteria to the sinuses, skin, blood and middle ear. Strep throat can also lead to Scarlet fever (illness with rash), inflammation of the kidney (post-streptococcal glomerulonephritis), and even Rheumatic fever, which is a serious condition that can affect the heart, joints, nervous system and skin.

This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.

If you would like to schedule an appointment at Dallas ENT Group please feel free to call us at (972) 566-8300 or visit our website to book an appointment online at www.dallasentgroup.com

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Sports Endurance/ Nasal Airway

Thursday, March 21st, 2013

The ability to continue exercise during high-intensity sports such as cycling is dependent on both physiologic factors and the perception of fatigue.

Sports Endurance/ Nasal Airway | Dallas ENT Group | Dallas, TX

In 2008 Ansley, et al (1) showed that head cooling significantly decreased the perception of fatigue and increased the exercise time to fatigue by 51%. Not only were athletes able to exercise dramatically longer with head cooling, but their production of a stress hormone thought to be involved in feeling fatigue, prolactin, was nearly eliminated.

In 1995 White and Cabanac found that this head cooling is achieved by the body during exercise via increased blood flow to the nose (2) and that improving nasal airflow increases cooling (3).

Taken together, these studies suggest that improving the nasal airway in athletes will dramatically improve their endurance. Its important to point out that there have been many misleading claims made over the years about how this works and attempts by not-so-reputable groups to sell useless products based on this information. A better nasal airway does not improve an athlete’s VO2 max (maximum exercise capacity of heart and lungs) or his/her oxygen intake. A better nasal airway does improve an athlete’s ability to continue exercise under conditions of heat and fatigue by measurably decreasing both.

So how can you achieve a “Better Nasal Airway”? One simple solution is Breathe Right Strips. They have been shown in studies to increase the internal cross-sectional area of the nose. However, if you have significant allergies, a deviated septum, or other nasal abnormalities these strips may have limited effectiveness. In that case, treating the allergies or nasal obstruction will give you a Better Nasal Airway.

With improvements in both allergy treatments (such as Sublingual Immunotherapy or Allergy Drops) and minimally invasive nasal surgery (turbinate reduction, septoplasty, nasal valve augmentation), a Better Nasal Airway can be achieved with little effort, downtime or discomfort. Visit our website for more information or an appointment; www.dallasentgroup.com.

1) Ansley L, Marvin G, Sharma A, Kendall MJ, Jones DA, Bridge MW The effects of head cooling on endurance and neuroendocrine responses to exercise in warm conditions. Physiol Res. 2008;57(6):863-72. Epub 2007 Nov 30.

2) White MD, Cabanac M. Eur J Appl Physiol Occup Physiol. Nasal mucosal vasodilatation in response to passive hyperthermia in humans. 1995;70(3):207-12.

3) White, M. D. and Cabanac, M. (1995). Physical dilation of the nostrils lowers the thermal strain of exercising humans. European Journal of Applied Physiology, 70, 200-206.

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Ear Wax (Cerumen) – The Ear Annoyance

Wednesday, March 13th, 2013

Ear Wax Accumulation Treatment | Ear Wax Accumulation Symptoms | Ear Wax Accumulation Causes | Dallas ENT Group | Dallas, TX

Ear wax, also called cerumen is a water resistant coating in the ear canal that protects the skin of the canal from water damage, infection, trauma and debris. If it accumulates it is usually not noticeable, but can lead to hearing loss as well as pain/infection. Normally it is supposed to migrate from near the ear drum along the canal and fall out of the ear.

Cerumen is a mixture made up of secretions of both sebaceous (oil), dried skin cells, and sometimes hair. It is identified in the ear canal in your doctor’s office with an instrument called an otoscope. It’s appearance and texture vary widely – sometimes it has the appearance and texture of a liquid, and other times it looks like clay or rock.

Causes of ear wax accumulation: Narrowing of the ear canal can make it difficult for the ear wax to fall out of the ear. Skin disorders such as eczema can cause excessive cerumen. Also as people age, they produce less fluid in the cerumen and it gets harder migrates slower out of the ear canal. Epithelial migration can also occur as a result of using cotton swabs in the ears. Q-tips tend to push ear wax deeper into the ear canal and over time can cause complete blockage of the ear canal in some people. Hearing aids, ear plugs and swim molds also after prolonged use can contribute to ceumen accumulation.

Overproduction: Some people produce more cerumen than others and this overcomes the ear canal’s ability to eliminate it.

Symptoms of ear wax accumulation: Hearing loss, earache, ear fullness, itchiness, dizziness, and/or ear ringing.

Removal methods: Ear wax is usually removed with one of three popular methods –medication to break down the wax, irrigation, and manual removal with a small ear spoon to scoop it out.

How to prevent cerumen accumulation: Many people have difficulty preventing ear wax accumulation, especially if they have predisposing conditions such as a narrow ear canal, eczema or produce more was than average. For many patients, topical drops such as mineral oil soaked on a cotton ball and left in the ear for about 10-20 minutes once a week while also not using a hearing aid overnight (if applicable) is helpful.

Routine cleaning of the ears by a healthcare provider every 6-12 months is also helpful to many people. If the wax becomes very difficult to remove, an Ear/Nose/Throat doctor can use a ear microscope and special instruments to help remove it more easily.

This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.

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I’m having ear pain, but the doctor said there was no ear infection – what is Eustachian Tube Dysfunction?

Wednesday, March 6th, 2013


The Eustachian tube connects the middle ear to the back of the throat and nose. It equalizes the pressure of the ear and is often responsible for the pop sensation that you may feel as you are gaining elevation if you ride on an airplane or drive your car up a mountain pass. If there is a problem with the Eustachian tube, the air pressure inside the middle ear becomes different than the outside air pressure. This leads to pain and a pressure sensation of the ear drum. It can also caused decreased hearing on the affected side. In the medical profession, we use the term “barotrauma” to describe this phenomenon.

Symptoms of Eustachian tube dysfunction (ETD):

1) Ear pain – this can feel just as painful as an ear infection

2) Trouble hearing

3) Ringing in the ear

4) Feeling dizzy

5) Feeling pressure or fullness in the ear

Most of the time Eustachian tube problems are not serious and they get better on their own. They rarely can lead to a more serious problem such as:

1) Middle ear infection

2) Torn eardrum

3) Hearing loss

If a child has Eustachian tube problems for long periods of time, they can have language or speech problems as a result of not hearing well.

Causes: Anything that make the Eustachian tube swollen or inflamed such as recent upper respiratory infection or common cold, allergies, sinus infection or sudden air pressure changes (happens when people fly on an airplane, scuba dive or drive in the mountains).

When to seek medical help: If the symptoms are severe, getting worse or are not improving within a few days.

Treatment: The treatment of Eustachian tube dysfunctions is tailored to the individual patient and the cause of the disorder. Some possible treatment options might be:

1) Nasal sprays – for example Flonase, Nasonex, or Rhinocort

2) Oral antihistamine medications such as Benedryl, Zyrtec, Claritin or Allegra

3) Oral or topical decongestant medications such as Sudafed or Afrin nasal spray

4) Surgery: Most of the time ear tubes are not needed for this problem, however some people do have tube placed in the ear drugs to help with this disorder

5) Special ear plugs that are used on an airplane, or when driving that help decrease the pressure on the ear drum.

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