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Top 10 Home Remedies for AllergiesThat Actually Work!

 

10. Replace carpeting with solid surface flooring, or vacuum and shampoo carpets often.

Carpet is a magnet for dust mites, pet dander, mold spores and pollens. These allergens find their way into your home and gravity pulls them toward the floor where they get trapped in the woven fabric of the carpet. If you have pets and are allergic to them, you should probably vacuum daily. If not, once a week should suffice.

9. Shut your windows and use your heating and air-conditioning system.

Windows allow dust, pollens and mold spores from outside to come inside. When you use your heating and air system instead, many of these allergens are filtered through your furnace filter. That is, if you are keeping the filter changed and maintained!

8. Use allergy-rated or H.E.P.A. filters on your furnace and vacuum.

These remove the airborne dust and pollen particles that are circulating through the air you breathe. These types of filters are great in removing these particles, but you must remember to change them monthly. There are online monthly subscriptions that will send you a new furnace filter monthly to remind you to change it!

7. Wash bedding in hot water once a week and use a clothes dryer rather than a clothes line.

This will remove dust and dust mites from the bed you sleep in and reduce the number that you are encountering on your skin and breathing in. Also, use a clothes dryer rather than a clothes line to limit the number of dust and pollens accumulated on the fabric after washing.

6. Resist the kitsch. Avoid knickknacks, wall pennants, and macramé.

Additional items sitting around collect dust and make it hard to dust surfaces effectively. Choose a few easy to clean items over soft items or items with a lot of grooves that are harder to clean and dust your surfaces and décor weekly to help control excess dust.

5. Use washable cloth rather than plastic shower curtains – and glass shower doors or no doors are better yet!

It takes far longer for plastic shower curtains to dry, which often leads to mold growth. Even the “mold resistant” liners never really live up to their name. Fabric shower curtains are recommended to be washed weekly to limit mold growth as well, but at least they can be washed!

4. Hire out big cleaning or demolition projects.

Cleaning out an old barn, house or building or demolition projects mean that you will encounter a lot of potential allergens. From mold to dust to animal dander and excrement. Such projects are known to cause allergy sufferers to flare, which often lead to sinus infections, increased nasal polyp growth, and even respiratory distress.

3. Wear a mask when mowing the lawn or raking leaves and shower right afterwards.

We recommend that if you are allergic to any grasses, trees, and pollens that you wear a mask while working in your yard to help with breathing in those pesky allergens. We also recommend that you change your clothes and shower right after coming in the house to limit the pollens still stuck on your clothes and skin.

 

2. Avoid fruits and vegetables that make seasonal allergies worse.

More than 30% of individuals who have seasonal allergies may experience oral allergy syndrome (OAS). Pollens and fruit proteins are like first cousins. This is often seen with foods such as apples, tomatoes, and cantaloupe. However, there are many more not mentioned that should be avoided if you have severe pollen allergies, as 2% of patients that experience OAS can have reactions severe enough to cause anaphylaxis. Grass Allergy Foods, Sagebrush or Mugwort Allergy Foods, Ragweed Allergy Foods, Tree Allergy Foods

1. Use a sinus rinse 1-2 times a day.

Studies have proven that sinus rinses improve the function of the nasal lining allowing the nose to move mucus better. Furthermore, sinus rinses and NettiPots also remove allergens from the nose producing less allergy response.

 

Do You Really NEED Antibiotics for a Sinus Infection?

Sinus infections or sinusitis is very common and affects 1 in 8 adults (about 12% of the US population). Sinusitis is associated with physical, functional, and emotional impairments and significant treatment costs. In fact, studies estimate that an average sinusitis patient will spend $1100 per year on acute infection treatment not counting days missed from work, which average about 18 missed days per year or an estimated productivity cost of $10,077. Imagine what you could buy if you had this type of money back in your pocket! Even more interesting is that primary care providers, such as your family doctor or Internist, see sinusitis patients twice as often and fill FIVE times as many prescriptions. More than 1 in 5 antibiotics in adults is prescribed for sinusitis! But, you must wonder, are all these antibiotics necessary? Studies say no!

It is very common for patients to schedule an appointment with their doctor or their ENT because they feel that they are “coming down with something,” and they want to get an antibiotic so that they don’t get worse. There are two problems with this thinking: 1. Doctors cannot prevent you from getting sick. 2. Antibiotics do not treat viral infections, and most sinus infections are viral! Pressure from uneducated patients often lead many providers to prescribe unnecessary antibiotics, which only contribute to antibiotic resistance and can mean some serious side effects (sometimes even hospitalization).

How do I know if I need to see a doctor for an antibiotic?

Based on multiple studies, antibiotics are only indicated in the following situations:

If you visit your doctor or ENT and do not fit into one of these categories, PLEASE do not pressure them into giving you an antibiotic, as this is neither in your best interest or the best interest of humanity. If you haven’t had symptoms over 10 days or double worsening, studies show that only 5% of patients will even get relief from an antibiotic! For this reason, your doctor is likely to offer other forms of treatment. Some providers may request that you call back in a few days if not better for a prescription, while others use a WASP or SNAP prescription (Wait and See Prescription or Safety Net Antibiotic Prescription). When your doctor provides you a WASP or SNAP prescription they are trusting their patients to act responsibly and wait a week or wait until their symptoms worsen before filling the prescription.

So, if I don’t need an antibiotic, what should I be doing to get rid of this sinus infection?

You can start treatment for a sinus infection at home without the help of your doctor and save yourself some time, money and potential heartache! These are the steps that we advise patients to follow to help themselves get better on their own:

  1. Start over the counter Afrin and use religiously as per the directions on the bottle for 3-5 DAYS THEN STOP no matter what!
  2. Start an over the counter nasal steroid such as Flonase, Flonase Sensimist, Nasacort, or Rhinocort and use EVERY DAY ONCE A DAY until the sinusitis is cleared.
  3. Start rinsing your nose at least 2-3 TIMES A DAY with a Neilmed sinus rinse kit or NettiPot until drainage is clear then ok to reduce to once a day or stop completely.

 

Studies show that this regimen is MORE EFFECTIVE for sinus infections within the first few days of infection than antibiotics!

If you do these things for yourself and either get worse or don’t get better after 10 days, please see a doctor, as you now likely have a bacterial sinus infection and require an antibiotic. If your symptoms last longer than 3 months despite treatment or you get more than 3-4 infections a year, you likely need an ENT specialist to run special lab tests, look in your nose a little further, or provide you with other forms of testing and treatment. Let us know if this is the case, because our office offers these services all in one convenient clinic; just request an appointment today or call 402-778-5250!

 

Reference

Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-S39.

Pynnonen MA, Lynn S, Kern HE, et al. Diagnosis and treatment of acute sinusitis in the primary care setting: a retrospective cohort. Laryngoscope. 2015;125: 2266-2272.

Tashima L and Piccirillo JF. Are antibiotics indicated for acute sinusitis? Laryngoscope. 2014;124: 1979-1980. Doi:10.1002/lary.24540

Rosenfeld RM, Andes D, Bhattacharyya N, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137: S1-37.

Marple BF. Dilemma in trial design: do current study designs adequately evaluate effectiveness antibiotic antibiotic in ABRS? Otolaryngol Head Neck Surg. 2005; 133:200-1.

Williamson IG, Rumsby K, Benge S, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA 2007;298:2487-96.

 

Nasal Polyps & Sinus Polyps: A picture containing indoor, person, pair, chocolateDescription generated with high confidenceThe Weeds of the Human Nose

Nasal polyps are inflammatory growths along the lining of the nasal passages that can occur in patients suffering from chronic sinusitis. The symptoms of chronic sinusitis include nasal discharge, congestion, facial pain, and a loss of sense of smell. 1 Unlike colon polyps, nasal and sinus polyps are rarely ever cancerous in nature, but instead are a sign of some sort of allergy.

What is the treatment for nasal polyps and sinus polyps?

The first line of treatment for nasal and sinus polyps are nasal steroids (such as Flonase, Nasacort, Rhinocort, etc.) and oral steroids. Although these treatments are shown to reduce the size of polyps, they rarely cure the problem. Surgery is almost always indicated for removal of polyps, as polyps can grow trapping infection in areas around the eyes and brain, which can over time become dangerous. Sinus polyps and nasal polyps are an aggressive and chronic disease process, and although many people do report improvement after surgery to remove them, studies have shown that approximately 60% to 70% of patients will redevelop polyps within 18 months of surgery to remove them despite steroid treatment after surgery.2 So much like weeds in your backyard, your nasal polyps are likely to pop up despite constant weed pulling (surgery) and weed killer (nasal steroid spray).

Is there anything out there to help control or treat polyps?

For the last couple of years, the surgeons at ENT Consultants have been using a device during surgery that reduces polyp regrowth in months following surgery by 46%. This device is the Propel dissolvable implant, which is available in 3 different sizes to be used for all the sinuses. During surgery, the implants are placed dissolving over the next couple of weeks and delivering a steroid directly to the tissue that likes to develop polyps.3 4 5  

What if I have already had surgery (or more than one surgery) for my polyps and would like to stay away from surgery? Or, what if I have had surgery in the past and am not very compliant with my nasal steroid spray?

Prior to this year, our answer to this would have been “you must use your nasal spray and you must continue to have your polyps removed for best results.” However, as of February 12th of 2018, there is a better answer. ENT Consultants is the first and only ENT in Nebraska at this time currently offering the Sinuva Implant, which is placed in the office during a routine visit. Sinuva expands into the previously operated on sinus cavity, delivering a steroid directly to the affected sinus for up to 90 days. The implant will soften over time and can be removed 90 days or earlier at the physician’s discretion. Studies have demonstrated a reduction in polyps, nasal obstruction/congestion, a reduction in need for repeat sinus surgery, and an improvement in impaired sense of smell.6

So, if you are patient who has been battling those pesky polyps and would like a better answer than daily nasal sprays or repeat surgeries, we invite you to come visit with one of our ENT specialists about your candidacy for the Sinuva sinus implant. Appointment Request online or call us today at 402-778-5250.

 

References

1 Wynn, R. and G. Har-El (2004). "Recurrence rates after endoscopic sinus surgery for massive sinus polyposis." Laryngoscope 114(5): 811-813.  

2 DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2016;126: 550-555.

3 Han JK, Marple BF, Smith TL et al. Int Forum Allergy Rhinol. 2012; 2(4) 271-279

4 Marple BF, Smith TL, Han JK et al. Otolaryngol Head Neck Surg. 2012; 146(6) 1004-1011.

5 Murr AH, Smith TL, Hwang PH, et al. Int Forum Allergy Rhinol. 2011; 1:23–32.

6 Data on file, Intersect ENT. RESOLVE II CSR R 28017 Rev. 3.0 February 2017  

 

 

 

Surgery for Sleep Apnea: Miraculous Cure or Painful Failure?

Obstructive sleep apnea OSA) is a potentially serious sleep disorder where sufferers repeatedly stop and start breathing. OSA is becoming more and more common, and doctors are taking note due to well-established risk factors associated with the disorder including heart disease, heart attack, stroke and death1. The gold standard treatment for this disorder is CPAP (continuous positive airway pressure). CPAP has shown to have the highest rate of effectiveness in treating this OSA. The problem is that these results are completely reliant on patient compliance. Because this disorder is so serious with serious implications when left untreated, your primary care doctor may refer you to an ENT surgeon to discuss whether you may be a candidate for surgery to help with your sleep apnea. But, even for your ENT, determining whether you are a candidate, can be tricky, as surgery for obstructive sleep apnea runs a fine line of being a miraculous cure or a painful failure in most patients.

 

How is candidacy for sleep apnea surgery determined?

The most popular surgery performed for sleep apnea is what is called UPPP or uvulopalatopharyngoplasty. It usually involves removing the tonsils and part of the soft palate opening the back of the throat. Sounds mean, right? It is, and very painful. So, is the pain worth the gain? I guess the answer would lie in one’s chances that the surgery would be a success. Chances for success for patients undergoing UPPP have been studied and there is now a formula that your ENT would use to measure candidacy for such a surgery. This is called the Friedman score. This score takes into consideration the patient’s BMI (body mass index – figured by using a patient’s height in relation to their weight), how much room in the patient’s pharynx (Mallampati score) and the patient’s tonsil size. The higher the Friedman score, the less likely UPPP is successful2. This can be seen in the table below:

FRIEDMAN SCORE

BMI

MALLAMPATI SCORE

TONSIL SIZE

EFFECTIVENESS OF UPPP

I

Less than 40

1, 2

3, 4

80.6%

II

Less than 40

1, 2, 3, 4

0, 1, 2, 3, 4

37.9%

III

Less than 40

More than 40

3, 4

Any size

0, 1, 2

Any

8.1%

 

So, how do you determine your Mallampati score and tonsil size? The photos below illustrate this quite well.

Mallampati Score

Tonsil Size

UPPP offers a poor chance of success in stage II and stage III patients when performed alone; however, your ENT may combine this procedure with nasal procedures to help patients tolerate their CPAP better. While not exactly a Win for a complete cure, control of OSA with better CPAP compliance is considered a win with a lower case “w.” Also, to keep in mind that due to the relatively low success rate of UPPP, many insurances will require that a patient tries and fails CPAP prior to covering the surgery.

 

Can fixing my nose alone fix my sleep apnea?

So, what if I have sleep apnea and am not interested in the painful and highly unsuccessful UPPP, can fixing my nose alone fix my sleep apnea? There is no scientific evidence to suggest that patients with OSA will show improvement in their sleep apnea objectively (such as sleep study scores) after surgery alone; however, nasal surgery is associated with better quality of life measures such as subjectively better sleep, less fatigue, and generally improved quality of life3.

 

Miraculous Cure or Painful Failure?

For just the right patient whose BMI is not too high, who has a fair amount of room in the back of the throat, and small tonsils, UPPP could be your miraculous cure; however, this is not the case for most patients suffering from sleep apnea. So, for those patients, a candid discussion with their ENT about realistic expectations is key to getting that win with a lower case “w” so that the search for a miraculous cure doesn’t end up being a very painful failure.

 

References

1 Rosvall, B. R. and Chin, C. J. (2017), Is UPPP effective in obstructive sleep apnea?. The Laryngoscope, 127:2201-2202.

2 Friedman, M., Ibrahim, H., and Bass, L. (2002), Clinical staging for sleep-disordered breathing. American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. 0194-5998 doi:10.1067/mhn.2002.126477.

3 Rosow, D.E. and Steward, M.G. (2010), Is nasal surgery effective treatment for obstructive sleep apnea?. The Laryngoscope, 120:1496-1497.doi:10.1002/lary.20954.

Cough is one of the most prevalent complaints in our ENT clinic; however, a cough is not considered chronic until it has persisted for over 8 weeks. It is believed that chronic cough is a secondary nerve condition that could be related to nerve damage caused by inflammation, infection, or allergy1. In ENT, when we see a chronic cough, it is usually related to acid reflux or sinus/allergy drainage. Pulmonologists also see a lot of chronic cough for other lung and bronchial related issues such as asthma and allergic bronchitis. Your ENT may refer you to a Pulmonologist to rule out one of these conditions or vice versa depending on your other symptoms.

Chronic cough relating to acid reflux disease or GERD.

While some patients will complain of heartburn, chest or back pain, and/or a sour taste in the mouth, many of our ENT patients deny any of these symptoms other than a chronic cough. Most often, the cough does not occur on its own but with other associated symptoms such as a feeling of something in the throat, throat pain, throat clearing, hoarseness, and difficulty swallowing2. In such cases where these symptoms present, your ENT will usually perform a laryngoscopy to rule out any other laryngeal disorders as cause for these symptoms such as vocal cord nodules or throat cancer. Chronic cough that could be related to GERD is often treated with a Proton Pump Inhibitor (PPI) such as omeprazole/Prilosec or any of the many others. Low level symptoms may be treated with a histamine blocking medication such as ranitidine/Zantac instead. While this treatment is designed to control any potential reflux, studies have shown that with chronic cough, the problem of reflux could be a simple case of which came first, the chicken or the egg. Cough can cause excess abdominal pressure causing reflux, and the irritation from reflux can cause cough. So, while the medication is treating the reflux, it may not actually be helping the cough, and that is when your ENT may start to examine other causes such as allergy and sinus drainage1.

Chronic cough relating to allergy and sinus drainage.

Post nasal drip (drainage in the throat) and throat clearing usually go hand in hand, and when these symptoms are associated with nasal discharge or nasal congestion, we usually blame cough associated with this feeling with allergies or sinus problems. Your ENT will likely try a combination of medications that could include an antihistamine pill or spray, a nasal steroid spray, an anticholinergic spray, steroid pills, and/or antibiotics1. If the problem persists despite medication, a sinus CT may be ordered to see if chronic sinusitis is the source. If negative, however, other reasons for the cough may be pursued.

Idiopathic or neurogenic cough, or cough of an unknown cause.

When pulmonary sources and ENT sources of cough have been ruled out (usually by failure to respond to treatment), we will label the diagnosis as neurogenic cough or idiopathic cough. For this reason, neurogenic cough is often labeled as a diagnosis of exclusion2. It is believed by researchers that in the patient’s past there was an assault on the nerves (such as virus, allergy, reflux, etc) causing inflammatory changes in the sensory nerves that produce cough. It is also believed that the act of coughing itself can be producing these changes leading only to further cough1.

Treating neurogenic or idiopathic cough.

This topic of research has been popping up recently in the ENT journals, and with very few studies to confirm and create a widely accepted care plan. The only information to share on this matter is that findings are showing that short term relief can be found in using speech therapy along with a nerve medication such as Neurontin combined with antidepressant amitriptyline. The problem is that adverse side effects are very common and further studies are still needed to draw conclusions on what agents work best, how medications should be dosed, duration of therapy, and long-term outcomes of such treatment3. It is for this reason, that your ENT is not likely to suggest this form of treatment for the foreseeable future.

Perhaps the greatest ray of hope in all of this is that for most patients that come to our ENT clinic, we can get most of patients feeling better by medically treating their acid reflux, allergies, sinusitis or all of the above. We also offer a full-service Allergy Clinic at ENT Consultants, LLC to help those whose cough is allergy related and CareStream In-Office CT Scanning and The Minimally Invasive Sinus Center for cough due to chronic sinus problems. So if you have a cough that has lasted 8 weeks or more, Appointment Request so that we can evaluate you and hopefully get you feeling better!

 

Reference

1 Chung KF. Approach to chronic cough: the neuropathic basis for cough hypersensitivity syndrome. J Thorac Dis. 2014 Oct; 6 (Suppl 7): S699-S707. [PubMed]

2 Altman KW, Noordzij JP, Rosen CA, Cohen S, Sulica L. Neurogenic cough. Laryngoscope. 2015;125:1675-1681.

3 Giliberto JP, Cohen SM, Misono S. Are neuromodulating medications effective for treatment of chronic neurogenic cough? Laryngoscope. 2017;127:1007-1008.





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