Ear, Nose and Throat Disorders

(From the PDR Family Guide to Prescription Drugs)

Although ear, nose and throat disorders aren't usually fatal, they still can be quite debilitating. Even a minor stuffed nose can make breathing and talking difficult. Ear disorders can disturb our equilibrium or compromise our hearing, impairing our ability to get along in life. Throat ailments can make it hard to eat, breathe and talk.

How the Ear Works

The organ we loosely refer to as the ear consists of a whole array of parts, including the outer ear, the ear canal, the eardrum (tympanic membrane), the middle ear and inner ear (cochlea), the hearing nerve, and the eustachian tube. Hearing occurs when sound waves strike the eardrum, sending vibrations through a set of tiny bones leading to the inner ear. There the sound is transformed into nerve impulses that then travel to the brain.

INSIDE THE EAR

The ear boasts two main passageways, one visible, the other hidden. The visible outer ear canal connects the middle and inner ear with the outside world; the hidden eustachian tube travels from the middle ear to the back of the nasal cavity, providing a way to equalize air pressure. Riding atop the inner ear are the semicircular canals, which help us maintain our balance.

To maintain health, air in the middle ear must be at the same atmospheric pressure as that outside the ear. Air reaches the middle ear via the eustachian tube, which is connected to the back of the nose. Air passes through this tube to equalize pressure 1,000 times a day.

What the Nose Does

The nose is the main entry point of air for the lungs. Inhaled air is cleansed, moisturized, and warmed by the cilia and mucus that line the nasal passages. In addition, when cilia are touched by air, they send nerve impulses to the olfactory areas of the brain, which register our sense of smell. Mucus is produced in the nose, lungs, and sinuses (air pouches that extend from the inside of the nose to the bones of the face and skull).

A Close Look at the Throat

The throat consists of the pharynx, epiglottis, and larynx. Food travels through the pharynx on the way to the esophagus and stomach. Air passes through the pharynx en route to the trachea and lungs.

When we swallow, food and liquid chewed or manipulated in the mouth is propelled backward by the tongue. It then moves through the pharynx and on to the esophagus and stomach. During this automatic swallowing response, the epiglottis covers the larynx--or voice box--to prevent food from entering the lungs.

With this basic anatomy in mind, let's take a look at the afflictions to which all three of these crucial organs are most prone.

Treating Ear Disorders

Swimmer's ear, or infection of the outer ear canal, is caused by bacteria or fungus that grow when water becomes trapped in that passageway. Symptoms include a feeling of blockage or itching, swelling, pain, foul-smelling discharge, and a temporary partial loss of hearing. Treatment includes acetaminophen (or aspirin for adults) and eardrops containing antibacterial, antifungal, and steroid drugs, such as Cortisporin Otic.

The outer ear canal can also be infected through incorrect use of cotton swabs to clean the ear. Avoid pushing swabs into the canal.

Otitis media, or middle ear infection, is a common reason for childhood visits to the doctor; and adults, too, can be at risk. The condition occurs when the eustachian tube becomes inflamed from a cold, a sinus or throat infection, or an allergic reaction, causing fluid to accumulate in the middle ear. If bacteria or viruses take hold, the resulting infection causes pain, an inflamed eardrum, and a buildup of pus and mucus behind the eardrum.

Common symptoms of otitis media are severe ear pain, fever, a feeling of blockage or pressure, and muffled hearing. (Young babies may tug at their ears.) There may also be signs of an upper respiratory tract infection, nausea, vomiting, and dizziness. On the other hand, there may be no symptoms at all.

Prompt treatment of this condition is vital to prevent it from becoming chronic and causing complications. Therapy consists of antibiotics such as ampicillin, amoxicillin, cefaclor, clarithromycin, or the combination drug trimethoprim/sulfamethoxazole (Bactrim). Acetaminophen is used for pain. The doctor may also prescribe antihistamines or pain-relieving eardrops. If these measures are not sufficient, a myringotomy (an incision in the ear drum to allow drainage) may be necessary.

If the eardrum ruptures on its own, the pus drains out of the ear, but may be trapped in the middle ear by the swollen eustachian tube. This condition is known as middle ear fluid or effusion, or serous otitis media. It may become chronic, lasting weeks or months past the original infection, and making the individual vulnerable to frequent recurrences of the acute infection.

Mastoiditis is a rare complication of otitis media, usually resulting from the chronic form. It is an infection of the airspace that connects the mastoid sinus to the middle ear. Symptoms include tenderness and a dull ache in the involved area, along with a discharge. This condition requires antibiotics and myringotomy for drainage. If the surrounding bone is diseased, removal of the bones, or mastoidectomy, may be necessary.

A cholesteatoma is an abnormal skin growth in the middle ear behind the eardrum. Often the result of repeated infection, cholesteatomas frequently take the form of a cyst or pouch that sheds layers of old skin, causing a buildup inside the ear. If a cholesteatoma grows too large, it can destroy the bones of the middle ear. Symptoms include a feeling of pressure, a foul-smelling discharge, earache, and hearing loss. Dizziness and/or muscle weakness on one side of the face are particularly ominous symptoms, signaling the possibility of serious complications. If they occur, seek medical attention immediately. Treatment consists of antibiotics, ear drops, and careful cleansing of the ear. Large cholesteatomas usually necessitate surgery.

A perforated eardrum, often the result of infection or trauma, usually heals spontaneously in a few weeks. If it doesn't, surgery is required. In either circumstance, the eardrum should be observed by a physician and protected from water and trauma.

Meniere's disease is a disorder of the inner ear thought to result from an overproduction or malabsorption of the fluids contained therein. Its symptoms are ringing or roaring in the ears, vertigo, and hearing loss. The vertigo is sometimes accompanied by disequilibrium, nausea, and vomiting. Treatment includes meclizine (Antivert) or diazepam (Valium). A low-salt diet and a diuretic may be recommended to reduce frequency of attacks over time.

Treating Nose Disorders

BEHIND THE NOSE

the air-filled cavities we call the sinuses. Between the sinuses, hair-like cilia hang from the roof of the nasal cavity, bringing the olfactory nerves in contact with the odors we inhale. Near the juncture of the nasal cavity and the throat below, the entrance of the eustachian tube leads to the middle ear.

Nosebleeds are usually not serious, especially in children. Often caused by trauma, they can originate either in the front (anterior) or back (posterior) of the nose. In the former instance, the blood flows out of the nostrils. In the latter, it will flow down the back of the nose and throat even while the patient is standing or sitting. Nosebleeds can also result from acute or chronic infections, polyps, nose-picking, or the inhalation of irritating substances.

Home treatment for an anterior nosebleed includes pinching the nose, pressing firmly toward the face, and holding for five minutes while sitting or lying with head elevated. Ice may also be applied to the nose and cheeks. To prevent re-bleeding, the nose should not be picked or blown, the head should be kept at a level higher than the heart, and the person should not strain or bend down.

If re-bleeding occurs, the nose should be cleared of all clots by gently blowing out through the nose. The involved nostril should be sprayed four times with decongestant spray, and the nose should be pinched and held as described above. In addition, a doctor should be contacted.

Since posterior nosebleeds tend to be more serious, they always require a physician's care. If bleeding continues for 10 minutes after pressure is applied, it is considered severe.

Medical care for nosebleeds may include application of epinephrine to the bleeding site, gauze packing, or a nasal balloon catheter. If packing is needed for longer than 24 hours, antibiotics may be necessary.

A stuffy nose may be a symptom of allergies, upper respiratory infections, or structural abnormalities. Other less common causes of nasal congestion are a chronic condition called vasomotor rhinitis, thyroid disease, emotional stress, and pregnancy. Used correctly, over-the-counter medications can provide relief for most stuffy noses. Products to consider should include antihistamines, decongestants, or a combination of these agents. Surgery is sometimes necessary to correct structural abnormalities such as a deviated septum.

Sinusitis is an infection of the sinuses that may be either acute or chronic. It usually begins with a cold or allergy episode that causes swelling of the mucous membranes and increased production of watery mucus. Because the sinuses are swollen, the mucus tends to build up and become blocked, resulting in the pressure and pain of a sinus headache. The trapped mucus also becomes a breeding ground for bacteria.

Symptoms of sinusitis include characteristic pain in the face, cheeks, forehead and upper teeth; a green or yellow colored and foul-smelling nasal discharge; malaise; fever; and sore throat.

Treatment for sinusitis includes an antibiotic such as Amoxil, Bactrim, or a cephalosporin; decongestants; and occasionally application of a drug such as phenylephrine to constrict the nasal blood vessels. Steam inhalation or heat applications help relieve pain. If sinusitis recurs frequently, it should prompt your doctor to search for an underlying cause, such as structural abnormalities, allergic rhinitis, or immune deficiency.

Postnasal drip, the sensation that mucus is dripping downward from the back of the nose into the throat, results from excessive mucus production due to infection, allergies, irritation, swallowing disorders, or structural abnormalities.

Antibiotics may be required to clear up an underlying infection, while antihistamines, decongestants, inhaled corticosteroids, or immunotherapy might be recommended if allergy is the cause. Structural abnormalities such as a deviated septum or septal spur (sharp projection) may require surgery.

Nasal polyps are associated with chronic allergies, chronic sinusitis, chronic rhinitis, and nasal infections. The primary symptoms are nasal obstruction and loss of the sense of smell. Medical treatment usually includes inhaled corticosteroids, antihistamines and decongestants (for allergy), and antibiotics (for infection). If this fails to provide complete relief, surgery may be considered.

Treating Throat Disorders

Pharyngitis or sore throat, one of the most common medical complaints, is caused by viruses 90 percent of the time. The streptococcus bacteria, responsible for strep throat in one in 10 Americans every year, is a common non-viral cause.

Symptoms include soreness, difficulty swallowing, the feeling of having a lump in the throat, and the constant urge to swallow. The infection may also be accompanied by headache, muscle and joint pain, and fever.

Treatment consists of warm salt-water gargles, mildly anesthetic throat lozenges, fluids, painkillers, and rest. If the infection is bacterial, penicillin or a broad-spectrum antibiotic will be required. (See Chapter 17, "Counterattacking Major Infections," for more information about strep.)

Acute tonsillitis typically starts out as a mild-to-severe sore throat. Symptoms may then progress to fever, difficulty swallowing, tenderness and swelling of the lymph glands, joint and muscle pain, headache, chills, malaise, and ear pain. In chronic tonsillitis, the sore throat recurs and is usually accompanied by discolored discharge in the area of the tonsils.

Treatment for acute tonsillitis consists of aspirin (for adults) or acetaminophen, rest, and adequate fluid intake. If the infection is bacterial, antibiotics such as penicillin or erythromycin are necessary. Chronic tonsillitis may require surgical removal of the tonsils.

Acute or chronic laryngitis is an inflammation of the vocal cords. It may be caused by a local infection, or can be part of a bacterial or viral upper-respiratory infection. Symptoms include mild to severe hoarseness and even complete loss of the voice. Laryngitis may be accompanied by pain, a dry cough, malaise, swelling in the throat, and fever.

Treatment consists of resting the voice and taking analgesics and anesthetic throat lozenges. If the infection is bacterial, antibiotics are necessary. Hospitalization may be required if acute laryngitis is so severe that the airways become obstructed.