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Q: Why do I lose my voice all the time?

A: There are many reasons for losing your voice, but one of the most common reasons for chronic voice problems is due to acid reflux. This is not your typical gastro-esophageal reflux (GRED) in that you don’t have to have any heartburn or indigestion. The only thing you may feel is hoarseness, but more often than not, you’ll also have chronic post-nasal drip, throat clearing, cough, a lump sensation, difficulty swallowing, or pain. This is called laryngo-pharyngeal reflux disease, or LPRD.

Initially, try eating dinner much earlier, and avoid alcohol close to bedtime. There are various over-the-counter medications for acid reflux, but they are not designed for this type of reflux. If your problem persists for more than a few weeks, or keeps coming back, it’s probably prudent to see an ear, nose and throat specialist for a proper evaluation.

 

 

Q: How do I know if I have Strep throat?

A: The only official way is to undergo a throat culture (which takes 2-3 days), or undergo a rapid “Strep” test in the office (but only 80-90% accurate). The only strain of bacteria that’s tested for is GABHS, or group A beta hemolytic streptococcus. This particular strain of bacteria can produce toxins that can potentially injure the heart or the kidneys. There are many other types of “Strep” that can also cause throat infections, but are harmless to vital organs. In most cases, GABHS presents with high fever (102 to 103˚ F), pus on the tonsils or throat, and very swollen, inflamed neck glands. Severe throat pain by itself is not a reason to treat with oral antibiotics.

 

 

Q: Which medicines can I use to help for my stuffy nose?

A: Nasal decongestants work by constricting blood vessels that supply your nasal mucous membranes, especially the wing-like structures on the side-wall of your nose called turbinates. There are two types: pills and sprays. Pills (or liquid oral forms) contain the ingredients pseudoephedrine or phelylephrine. Sudafed is a brand name of one of the major over-the-counter cold remedy companies. Many of their products contain either active ingredient or in combination with other cold medications for other symptoms. Some people are very sensitive to these ingredients and taking too much can make you feel jittery. Decongestant nasal sprays can contain either phenylephrine (lasting 4 hours) or oxymetazoline (lasting 12 hours). Be careful not to use these particular sprays for more than three days, as they can be addictive. The safest thing to take on a long-term basis is any form of nasal saline.

 

 

Q: What’s a deviated septum?

A: The nasal septum is the midline partition that divides your nose into your right and left nasal cavities. You have other septums in your body as well, including your heart and your frontal nasal sinuses. The front part of the nasal septum is made of cartilage, but parts of the rear are made of thin bone. It starts just behind your fleshy nostrils in the middle, continues to the roof of your nose and ends just above your hard palate, in the rear of your nose. No one has a perfectly straight septum. However, if it’s slightly deviated to the right or the left, any degree of nasal inflammation in the other parts of the nose can narrow your breathing passageways, leading to a stuffy nose.

 

 

Q: What’s the best sleep position?

A: Although there are many studies in the psychology fields about personality types and sleep position, you may be surprised by how important sleep position may be for some of you. If you normally like to sleep on your back and are able to sleep well, waking up refreshed in the morning, then continue to do so. If you prefer to sleep on your side or stomach, then keep doing what you’re doing. But if you used to love sleeping on your stomach and now have to sleep on your back due to a neck, shoulder or back injury, then try to do everything possible to go back to your side or stomach again. If your grandmother told you that it’s healthy to sleep on your back, but you love to sleep on your stomach, ignore your grandmother. If your dermatologist tells you to sleep on your back to prevent facial wrinkles, then ignore your dermatologist as well. Sleeping better will be much more to prevent wrinkles and aging than keeping your face off your pillow.

The reason that sleep position is so important is that for many people, due to certain oral cavity features, the tongue falls back somewhat due to gravity. But if your jaw is on the small side, then the tongue falls back even more, and then when you go into deep sleep on your back, due to muscle relaxation, you obstruct and wake up. You can wake up subconsciously to light sleep or completely awake. People with these issues generally compensate well by not sleeping on their backs, but can never get deep refreshing sleep.

 

 

Q: If You Need Your Tonsils, Why Take Them Out?

A: Tonsils are part of the immune system, but when they are too large or are prone to frequent infections, then surgical removal is a consideration. One or two infections every year is not too worrisome, but having an infection every month can be debilitating for most people. For many children (and some adults), very large tonsils can lead to breathing problems at night. 

 

More Questions About Tonsils

Q: What are tonsils? 

A: Tonsils are paired lymphoid or glandular tissues that sit on the side-walls of your throat just behind your tongue. They are part of a complete circle of lymphoid tissues that is involved in programming your immune system what is foreign and what is self. The adenoids sit in the mid-line at the back of your nose and the lingual tonsils are also in the mid-line at the rear of the tongue, just above the voice box. They are most active from ages 3-5, and this is the time that most problems arise. 

Q: Do you need tonsils? 

A: Yes, especially when you have an infection. Most of the immune system programming occurs in early childhood. As you get older, the tonsil shrink to a much smaller size in adulthood. However, if there is chronic irritation, such as from allergies, colds or acid reflux, they can remain enlarged. Tonsils and adenoids are only a small part of a much larger system of lymph glands and immune mechanisms. 

Q: What happens if my tonsils are too big? 

A: Just because your tonsils are big does not mean they have to be removed. If you have no problems, then with time, they should shrink. But if you have signs or symptoms of a sleep-breathing disorder, such as daytime fatigue, poor concentration, memory problems, attention problems, asthma, cough, nasal congestion, or snoring, then they should be looked at by an ear, nose and throat physician. Sometimes I see young children who snore heavily, with severe asthma, attention and behavioral problems, and who are on Ritalin for ADHD. On exam they are found to have very large “kissing” tonsils. Due to the prevalent myths about tonsils and surgery, the parents refuse any form of surgical therapy. They would rather treat the end result of their child’s sleep-breathing problem (asthma, ADHD) with long-term medications, when surgery could be curative. On the flip side, there are also too many people with tonsils that are taken to the operating room prematurely, with no clinical reasoning whatsoever. 

Q: Can large tonsils cause snoring? 

A: Yes. Anything that narrows the upper airway, from the nose to the voice box, can cause snoring or other breathing problems. In children, large tonsils are a common cause of snoring. Snoring itself in children has been linked to behavioral, memory and concentration problems, asthma, and chronic cough. A significant number of children (and adults) who snore are also found to have obstructive sleep apnea, which can lead to fatigue, depression, high blood pressure, heart disease and many other conditions. It’s also associated with sexual dysfunction and frequent urination at night. 

Q: Doesn’t undergoing a tonsillectomy hurt? 

A: Yes. But with advances in technology, it doesn’t hurt as much. Traditional tonsillectomy using an electrocautery device will leave you with a very sore throat for 4-7 days. You’ll be on soft or liquid diet until the pain subsides, after which you slowly progress to foods of more solid consistency. The best part is that you can eat lots of ice cream. With newer techniques (such as the Coblator) you’ll have only 2-5 days of pain, with some people not taking any pain medications at all. 

Q: What are the potential complications of tonsillectomy? 

A:  As with any operation, there’s always a very small chance of bleeding or infection. If it occurs, then it will be addressed appropriately. Specific to the procedure, there is a small chance that you may have persistent symptoms even after surgery. There are many reasons for this, including not taking enough tonsil tissues out, or it may be due to something entirely different. Two common reasons include post-nasal drip and laryngopharyngeal reflux disease. There’s also a very small risk to general of complications from anesthesia is lower than being hit by a car.

 

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