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Snoring? The 10-cent and 50-cent cure

Snoring? The 10-cent and 50-cent cure

 Murray Grossan, MD.
 About the author: Dr. Grossan is an otolaryngologist and head and neck surgeon with the Tower Ear, Nose and Throat Clinic at Cedars-Sinai Medical Center in Los  Angeles and the founder of the Web based Grossan Sinus & Health Institute (http://www.grossaninstitute.com). He is author of Free Yourself from Sinus and Allergy  Problems Permanently.

Many people snore. The problem is that snoring that disturbs the partner, can develop into snoring that severely affects one’s health, such as Obstructive Sleep Apnea. (OSA) Obstructive sleep apnea is a condition in which the sleeper doesn’t get enough air. This means that for periods of time the nose or throat is blocked and the percentage of oxygen that gets to the brain is reduced. The partner may notice that for periods of time her husband has stopped breathing!

Why does obstructive sleep apnea occur? The word apnea means no air. A stands for not, and pnea stands for air. The causes vary. Sometimes the soft palate and uvula are enlarged and very heavy. When he sleeps on his back, the heavy soft palate falls back and blocks the airway.

A frequent cause originates from the nose; there may be blockage due to infection, growths in the nose called nasal polyps, allergy, or adenoid tissue, (located above the throat, behind the nose) that enlarges to block breathing. A common cause of snoring is enlarged tonsils. In kids, the tonsils and adenoids may be so large that the kid barely breathes in sleep, causing him to snore loudly, be tired and grumpy, and have bad breath. Obstructive sleep apnea is an advanced form of snoring that can develop from simple snoring.

Alice experienced snoring at age twenty-five that annoyed her roommate. It was a symptom of a sinus condition. She ignored the condition and took pills when it bothered her. However, because she didn’t get good sleep, she ate excessively to overcome her next day fatigue and gained weight.

As her weight increased, her throat tissues became heavier, as did the fat in her neck. Because of her eating before bed,  she developed acid reflux. This swelled her throat tissues and made her snoring worse. Eventually she developed obstructive sleep apnea and had to use a breathing machine to overcome her airway blockage at night.

Note the vicious cycle: because Alice was fatigued the next day, she ate excessively for energy. Because she ate excessively, the throat tissues grew heavy and blocked her breathing, so she was more fatigued and ate more, and the snoring became worse.

Fortunately, there are simple remedies: the ten-cent and the fifty-cent cure. For those whose snoring is caused by a drooping nose, which closes a valve of the nasal airway, if you raise the tip, that valve opens. Cut a three-inch piece of ½-inch medical grade tape, start under the nasal tip, elevate the tip, and then secure the tape on the bridge of the nose up to between the eyes. With the airway valve open, there is less or no snoring.

If you lie on your back, the tissues of the throat fall back and block the airway. If you sleep on your side, the tissues fall forward, and the air passages are opened. To sleep through the night on your side, secure a used tennis ball to the back of a T-shirt; when you sleep on your back, the ball will nudge you gently and you will turn onto your side, and stop snoring. This is the fifty-cent cure. There are some very expensive gadgets that signal you to turn to your side when you snore from lying on your back. Actually, I prefer the ball because it doesn’t disturb your sleep pattern, as some of the electronic ones do.

Nasal blockage often is caused by bacteria in the sinuses. Normally the nose contains millions of tiny hairs called cilia. In health, these cilia move in synchrony to move bacteria out of the nose, to the back of the throat, where they are swallowed. When the cilia fail, bacteria sit there and multiply, and this leads to chronic nasal congestion and blockage due to infection. To restore the good cilia movement, patients use pulse rate saline nasal/sinus irrigation. The pulse rate of the irrigator is designed to match the normal rate of cilia pulse movement; that frequency is ideal to restore normal cilia function and clear sinusitis and postnasal drip.

Swollen fatty throat tissue is corrected by using a throat attachment to the pulse irrigator, the Hydro Pulse™. It is designed to remove bacteria from the “holes” in the tonsils and to massage throat/tonsil tissue. By restoring good nasal airway and reducing puffy throat tissue, many people’s snoring is relieved. Making the throat muscles stronger keeps the tissue from blocking the airway. By repeating these throat exercises, the muscles become firm and strong, just as weight lifting does for flabby arms.

Throat Exercises

  • Hold the tongue up against the hard palate. Say the vowel sounds- a, e, i, o, u. Place the tongue in front of the roof of the mouth. Then slide it all the way to the back of the roof of the mouth, repeat the vowels in various positions for three minutes.
  • Press the tongue hard against the hard palate. Press frequently.
  • Press the tip of the tongue into the spot just behind the upper incisor teeth while pushing the back of the tongue into the floor of the mouth. Now do this pushing on the lower incisors.
  • Swallow keeping the tongue on the roof of the mouth.

Do these three minutes each. It takes time to build and strengthen muscles by exercise and the throat is no exception. As the snoring problem gets worse, symptoms of acid reflux appear.  Here too, you have a vicious circle. The more acid from the stomach that irritates the throat, the more snoring from swollen tissue occurs. Gasping for air in sleep because of nasal blockage is a factor because the gasping tends to push the stomach upwards.

To prevent the acid reflux problem, keep the head of the bed elevated. Don’t eat for three hours before bedtime; avoid excess spices. Avoid alcohol before bedtime.

To aid sleep, the bedroom should be dark. You should go to bed at a regular time, with a set routine that you repeat each night, so as to set your sleep clock. Losing weight is a definite way to cure snoring, but very hard to do when snoring is present, for the reasons discussed here.

Why is good sleep without snoring important? It is estimated that at least thirty percent of traffic and industrial accidents are related to poor sleep; she fell asleep while driving and drove over the cliff.

On the other hand, opening the nasal valve, using a ball to nudge you to sleep on your side, using pulsatile irrigation for the nose and throat, and doing the throat exercises are easy to do; and when started early, can be effective to assure a good night’s sleep for you and your partner.

For more information, visit:
www.grossaninstitute.com
www.ent-consult.com

 

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Is It a Cold, Flu, Allergies or Something Else?

Is It a Cold, Flu, Allergies or Something Else?

 Murray Grossan, MD.
 About the author: Dr. Grossan is an otolaryngologist and head and neck surgeon with the Tower Ear, Nose and Throat Clinic at Cedars-Sinai Medical Center in Los  Angeles and the founder of the Web based Grossan Sinus & Health Institute (http://www.grossaninstitute.com). He is author of Free Yourself from Sinus and Allergy  Problems Permanently.

How to tell what it is and the best way to treat it:

Sniffling, sneezing and wiping your eyes? You might assume you have a cold…but not so fast! These symptoms also can come from the flu, allergies, something similar to an allergy, or even from something else entirely—sinusitis! Telling these five conditions apart can be tricky, even for doctors, but knowing the difference is the key to getting the most effective treatment.

COLDS

Colds can be caused by more than 100 different viruses. Your symptoms will depend on the specific virus you are infected with.

TELLTALE  SIGNS: In addition to common cold symptoms such as sneezing, a sore throat, congestion and/or a cough, you may also have a low-grade fever, mild body aches and aching, swollen sinuses. Symptoms usually last a week or two.

My favorite cold remedies: Get into bed and rest! Chicken soup, hot soups and decaffeinated green tea with lemon and honey may help, as chicken soup and green tea have anti-inflammatory properties that help fight infection. If you can, watch a funny movie. Some research shows that laughing promotes healing. If you need help sleeping, try 3 mg to 10 mg of Melatonin, an over the counter sleeping aid.

For an immune-boosting herbal cough syrup: Mix one-half teaspoon each of cayenne pepper and freshly grated gingerroot, two tablespoons each of honey and apple cider vinegar and four tablespoons of water. Take one teaspoon every few waking hours.

THE FLU

The flu will make you feel awful.

TELLTALE SIGNS: Symptoms can be the same as a cold, but you will have significant body aches and probably a fever. The flu also comes on more suddenly than a cold.

My advice: Get a flu shot once you have recovered, or in advance. If you still come down with the flu, stay home for at least 24 hours after any fever is gone so you will not spread the virus. Adults over age 65 and those with any chronic health problem should take an anti viral drug such as oseltamivir (Tamiflu) to avoid flu complications including pneumonia. Anti-virals work best if taken within 48 hours of starting to feel sick.

ALLERGIES

Allergic rhinitis (nasal allergy) is caused by a hypersensitive immune system that identifies an otherwise innocuous substance as harmful and attacks it, causing uncomfortable symptoms.

TELLTALE  SIGNS: Nasal allergies can cause symptoms nearly indistinguishable from a cold—congestion, sneezing, red and runny eyes, scratchy throat, etc.—but allergies do not cause the mild fever or achiness of a cold. With seasonal allergies, you get symptoms from exposure to pollen (trees in spring, grass in summer and weeds in fall). Allergies to pet dander, dust, etc., tend to occur year-round.

Helpful: Use a diary to track your symptoms and the times they occur. It will help you distinguish allergies from other conditions.

My advice: Steroid sprays such as fluticasone propionate (Flonase) and azelastine (Astelin) work for most people with less risk for side effects than antihistamine pills. Avoid strong odors and spicy foods, which can worsen nasal allergies.

NONALLERGIC RHINITIS (Vasomotor Rhinitis)

This condition causes virtually the same symptoms as allergies, but is not a true allergy that involves the immune system. Non-allergic rhinitis is triggered by specific irritants such as certain odors, smoke and exhaust— or even changes in the weather.

TELLTALE SIGNS: With nonallergic rhinitis, standard allergy medications fail to relieve symptoms, and allergy tests are negative. Postnasal drip (an irritating flow of mucus down the back of the throat) tends to be worse with nonallergic rhinitis than with seasonal allergies.

My advice: Avoid irritants that you are sensitive to and consider using the prescription drug Ipratropium Bromide (Atrovent), an inhaled nasal spray that helps relax and open air passages. This drug can cause side effects including dizziness, so use it only when needed and at the lowest dose possible.

SINUSITIS

Sinusitis is tough to diagnose because it often occurs in conjunction with colds and allergies because of excess mucus from congestion providing an optimal breeding ground for bacteria and viruses.

TELLTALE SIGNS: Congestion accompanied by tenderness and a feeling of pressure around the eyes, cheeks or forehead. In addition, when you blow your nose, the mucus will usually have a yellow or greenish color. Fever may be present as well. Symptoms can last for several weeks (acute) or even longer (chronic).

My advice: Prescription nasal sprays such as TK  help open the airways. Acetaminophen (Tylenol) or naproxen (Aleve) work for sinus pain. Bromelain (from pineapple) and papain (from papaya) also help reduce pain. Antibiotics are not always needed for acute sinusitis.

Natural Remedies for All Sinus Problems!

Nasal cilia (tiny hairlike strands) help clear mucus from the nasal cavity. Slow-moving cilia can lead to nasal and sinus irritation and congestion.

To stimulate cilia:

 Hum. It may sound far-fetched, but the vibrations from humming break up and thin accumulated mucus. Patients of mine who hum for a few minutes several times a day tend to get fewer sinus infections.

Keep the nose moist by using a preservative-free saline nasal spray such as NeilMed NasaMist Hypertonic Saline Spray, available at Walgreens and online. Do daily irrigation with a NeilMed NetiPot or NeilMed Sinus Rinse.

Stay warm. Cold temperatures can slow the movement of nasal cilia, so wear a jacket, a hat and scarf to keep warm. Additionally, avoid cold beverages and drink hot green or black tea, which contain L- theanine, an amino acid that increases ciliary activity. The excess fluid will also help thin and clear mucus speeding recovery.

For more information, visit:
www.grossaninstitute.com
www.ent-consult.com

 

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img1_28May2016The spectre of super-bacteria resistant to antibiotic therapy is once again in the news. Media coverage, (notably in The Economist, a widely read newsweekly) has highlighted that bacteria are increasingly gaining the capacity to be resistant to commonly used antibiotics, and that this will have a serious impact upon human health.
What impact does this have on sinusitis sufferers? Possibly quite a bit.
Acute bacterial sinusitis is frequently caused by the bacteria Streptococcus pneumonia. This used to be easily treated with . However, in 1988 Don Low, a Canadian infectious disease specialist working at the University of Toronto reported the emergence of a penicillin-resistant Streptococcus pneumonia in samples form respiratory tract infections. National monitoring strategies were put in place over the following decade and showed an increase not only in penicillin resistance, but also showed the emergence of resistance to the macrolide class (claritrhromycin (Biaxin™) and azithromycin (Zithromax™)). Further work from Dr. Low and others demonstrated how inappropriate use of antibiotics to treat respiratory infections was responsible for the development of bacterial resistance in Streptococci. As sinusitis is responsible for 25% of all oral antibiotic use in humans, this led to the development of guidelines, both in Canada and internationally, for appropriate antibiotic use in order to minimize risk of development of resistance.
While these had been reasonably effective in Canada, in many other countries, antibiotic resistance to these two agents has reached epidemic levels . Thus, in many places, effective treatment of acute bacterial sinusitis now requires either newer, stronger medications or drug combinations.
Patients with chronic rhinosinusitis (CRS) also have cause for concern. Staphylococcus aureus is frequently implicated in CRS, and antibiotic resistance in S Aureus has been increasing rapidly. While resistance to penicillin by S Aureus was noted only 3 years after the introduction of penicillin, methicllin resistant staphylococcus Aureus (MRSA) are now seen in patients with CRS, particularly those with long standing disease and multiple sinus surgeries. In an additional novel twist, Gram-negative agents such as Acinetobacter and Klebsiella are increasingly resistant to ampicillin, a synthetic penicillin recommended as first line therapy by many guidelines. Thus, clinicians are increasingly required to perform a culture of sinus secretions in order to precisely identify bacterial resistance in patients not responding to initial therapy.
What does the future hold? It’s not hopeless but will certainly require new strategies as new antibiotics may not be an option. While drug companies were previously able to invent new molecules to treat these antibiotic resistant bacteria, this strategy appears to be growing thin and we may be running out of the effective medication to treat these bugs which are easily capable of modifying their genetic makeup to develop resistance strategies.
Novel strategies may instead involve use of bacteriophages, small viruses which attack and destroy bacteria. Or they may instead opt to introduce ‘healthy’ bacteria into the sinuses, in order to drive out replace ‘bad’ bacteria or prevent them from taking hold. In all instances, continued efforts to educate patients and physicians on the responsible use of antibiotics will vital in preventing the further development of resistance.
This column is dedicated to the memory of Don Low, who passed away in 2013 at the age of 68. We miss you Don but your wisdom carries on.

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Maintenance Therapy For Your Nose and Sinuses

Maintenance Therapy For Your Nose and Sinuses

Dr.Nathan B. Sautter Nathan B. Sautter, MD
Board certified in Otolaryngology – Head & Neck Surgery
Assistant Professor of Otolaryngology
Oregon Sinus Center at Oregon Health & Science University
About the author: Dr. Sautter completed a fellowship in Rhinology/Sinus Surgery and has been practicing at Oregon Health & Science University for the past 6 years. His practice is devoted to treatment of chronic rhinosinusitis, allergy, and all other disorders of the nose and sinuses.

The nose serves many important functions, including filtration of the air we breathe. Dust, pollution, mold, bacteria, viruses and other microscopic particles are often present in the air that enters the nose. The nasal and sinus membranes are coated with a thin, mobile layer of mucus responsible for trapping particles in the air when we breathe in through the nose, preventing these particles from reaching the lungs where they may cause irritation or infection. The cells that comprise the nasal membranes are covered with tiny hairs, or cilia, that work together to move this mucus blanket along with the trapped particles towards the back of the nose where it is directed into the digestive tract. Acid in the stomach neutralizes any viruses, bacteria or other microorganisms present in the swallowed mucus, and this functions as an important first line of defense against infection.
Any condition that results in inflammation in the nose and sinuses, such as allergies, chronic sinusitis, scarring from prior surgeries, or anatomic abnormalities can impact the normal function of the nasal cilia and mucus blanket. This may result in buildup of sticky, tenacious mucus, crusting, chronic infection and inflammation which can cause symptoms of loss of sense of smell, foul smell, nasal obstruction and thick nasal drainage. Ultimately, the normal function and physiology of the nose and sinuses may be compromised by this process.
Regular saline nasal irrigations aid in cleansing the nasal and sinus membranes, preventing buildup of abnormally thick mucus and crusting in order to maintain a healthy nose filter. Just as the air filter in your car or home ventilation system requires regular maintenance for optimal function, so does your nose. In patients who are prone to nasal and sinus inflammation due to processes such as allergy or chronic sinusitis, I routinely recommend regular, daily saline nasal irrigations. I find this is particularly effective in patients who have had prior surgery to open the sinuses. Regular irrigations also aid in the healing process following sinus surgery, and may help to speed recovery during a routine cold or sinus infection. In selected patients, addition of special medications to the saline nasal irrigations may further help to reduce inflammation, thick mucus and infection.
Nasal saline irrigations are an effective, inexpensive and safe treatment for many different nasal and sinus ailments, and may help to prevent problems in healthy individuals who happen to work or live in dusty, smoky or moldy environments. I encourage my patients to make nasal saline irrigations part of their daily routine along with showering and brushing their teeth. It is a simple, easy and natural method for maintaining the health of your air filter!

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Buffered saline solution irrigations help manage symptomatic septal perforations

Dr.Paul_Schalch Paul Schalch, MD.
Board certified Otolaryngologist – Head and Neck Surgeon.
Clinical assistant professor at Southern Illinois University School of Medicine.
About the author: Dr Schalch works at Southern Illinois Healthcare, in Carbondale, Illinois, and has a special interest in rhinology and sleep apnea surgery.

Patients that seek help with septal perforations typically present with symptoms such as nasal obstruction, crusting, foul-smelling discharge, intermittent nasal bleeding and occasionally, a whistling sound when breathing through the nose. Patients occasionally have a subjective feeling of nasal obstruction, even if their exam reveals wide-open passages (perhaps due to the loss of sensate mucosa along the septum).

While some autoimmune and chronic inflammatory diseases are possible causes for septal perforations (Wegener’s granulomatosis, sarcoidosis), most often the cause is a history of nasal surgery or procedures (septo- and/or rhinoplasty, or procedures to control nasal bleeding, like cauterizations or nasal packing), nasal fractures or trauma (particularly in the setting of undiagnosed hematoma in the septum, or placement of nasogastric tubes), chronic use of oxygen via nasal cannula, or recreational drug use (typically intranasal cocaine). Rarer causes include infections (fungal, tuberculosis) or exposure to industrial fumes and gases, that may lead to the development of malignancy.

The diagnosis of septal perforations is typically made during the nasal portion of the physical exam. Anterior rhinoscopy (done with a headlight and nasal speculum) or nasal endoscopy usually reveal an area of crusting or bleeding that is adjacent to the edge of a perforated area in the septum. Anterior perforations (closer to the vestibule of the nose) tend to be more symptomatic than posterior perforations. The size of the perforation can be variable, and it may involve cartilage or bone or both.
Regardless of the cause, strategies should focus on managing the excessive crusting and occasional bleeding that tends to occur with these perforations. Maintaining the nasal mucosa well moisturized with saline gel and other nasal emollients is a useful strategy, along with buffered saline sprays or irrigation, which prevent the formation of large crusts that cause nasal obstruction and bleeding. It is important to instruct patients to avoid chronic use of topical decongestants (such as oxymethazoline), because of concerns of rebound congestion and dependence (rhinitis medicamentosa). It is also useful to add the use of a humidifier in the bedroom at bedtime. Patients on oxygen via nasal cannula should be switched to humidified face mask.

Surgical strategies are available to address perforations with variable rates of success. These may range from septal buttons (small silicone implants that are placed to cover perforations) to more extensive open rhinoplasty approaches with tissue flaps/rearrangement. Recently, some biomaterials have been introduced as possible adjuncts to surgical repair.

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