Why do people suffer from epistaxis (nosebleeds) more during the Winter?
December 7th, 2011
Let us review some of the basic anatomy of the nose before we can understand why nosebleeds occur. The nose itself is a conduit for the breathing as the air enters our body and reaches deep down into the lungs. The membranes of the inside of the nose are designed to provide moisture, heat, and filtering functions before the outside air reaches our lungs. Sincewe breath gallons of air on a daily basis, there is a lot of turnaround that needs to happen in our nasal membranes on a regular basis.
In order for the membranes to be able to keep up with this demand, the nasal passages have a very rich supply of blood vessels. This supply is much richer than most other organs in our body. In fact, there are three main arteries that supply either side of the nasal passages. Additionally, the blood vessels of the nasal membranes happen to be much more superficial than most other places accessible to the outside world. Therefore, any slight scraping or dryness can lead to exposed blood vessels.
During the winter, the air around us is much colder and much more dry. Basically, as the temperature around us drops, the moisture in the environment drops as well. In addition, most of us are exposed to central heating, which is a dry heating mode (as compared to the old style fireplaces that used to be the main heating elements in most houses).
The combination of cold weather and dry heat is very damaging to the nasal membrane. Frequently, the membranes cannot stand up to their demand, and they start having superficial cracks. These can lead to nosebleeds of capillary, vein, or artery origin.
The best way to improve the hygiene of the nose in order to prevent any unnecessary bleeding is to give it extra moisture. Over-the-counter saline sprays can be used periodically throughout the day to keep the moisture up in the nose. Rhinaris® is the only over-the-counter nasal spray that in addition to saline contains an emollient designed to further soothe the dry nasal membranes. You can also put a small amount of Vaseline on a Q-Tip and gently rub on the inside of the nostrils to provide extra moisture to the membranes couple of times a day. Make sure you keep up oral intake of liquid in order to keep up the hydration of the body as a general principle.
Another important element is to provide environmental humidification. Using a cold mist humidifier can replace the missing moisture in environment around you. The optimal place for use of the humidifier is in your bedroom in a location near the head of the bed. This will make sure that the air that you breathe all night is optimally moisturized, and you will avoid a dry nose as you wake up in the morning.  I recommend that you have the humidifier working in your bedroom all nights, every night.  Ideally, in climates similar to New York, this should be done from November until April.
Tags: epistaxis, humidifier, Nose, nosebleed, saline
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What are tonsil stones?
November 26th, 2011
The correct medical term for the “holes” in the tonsils is tonsil crypts. Â The normal immune-mediated swelling of the tonsil tissue sometimes creates indentations in the suface of the tonsils, which create Swiss cheese type of holes on the surface.
Technically, this is more of a nuisance than a medical problem. However, the tonsils crypts could trap food particles or prevent the normal shedding of the superficial lining from being discarded. Â Often, these particles stay in the crypts and irritate the surrounding tissue. Â The particles can also form concretions, knows as “tonsil stones”. Â The medical term for these concretions is tonsilliths.
The most simple way of dealing with this problem is to chew carefully and thorougly, and to avoid foods with small particles (sesame seeds, etc.). Â It is ideal to gargle with saline rinse right after meals, so that any trappped material could be washed out right away. Â Occasonally, various procedures or even tonsillectomy might be recommended, depending on the severity of the symptoms.
Tags: tonsil, tonsil concretions, tonsil stones, tonsillith
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Does Ear Candling Work?
November 15th, 2011
Many patients inquire about a holistic way of removing earwax naturally, namely using ear candling device. Basically, this is a cone-shaped device made from paraffin. Creating a fire on the wider end of the cone creates negative pressure, which then sucks in air through the narrow end of the cone. If this is placed in the ear canal, ideally the earwax would be sucked from the ear canal into the cone, leaving the ear canal wax-free.
I am not opposed to holistic or alternative methods of medical therapy. In fact, I have supplemented my Western medical education by learning acupuncture for physicians. I frequently use acupuncture techniques in order to better help my patients in any way possible.
However, there are several drawbacks to using the candling technique in the ear. First, the candling is done “blindly.” By this I mean that there is usually an assumption that there is earwax in the ear that needs to be removed, and therefore the candling should be used. Not all cases of fullness in the ear are due to earwax build-up. Other reasons for blockage of the ear could be due to ear infection or water stuck in the ears. Therefore, when candling is used by lay persons without first examining the ear for the actual cause of the fullness of the ear, one might not treat the correct problem.
Secondly, not looking into the ear with an otoscope, a lay person can never determine what is the endpoint. Simply because the ear feels less clogged does not mean that all of the earwax that was present came out successfully. Only with direct visualization with an otoscope one can determine if the earwax problem is completely resolved or if there is still remnants present in the ear canal.
My third concern with the procedure is that the device is in fact shaped like a cone. The fire is burning at the wider end, which is typically held in the upright position. From time-to-time the paraffin can melt from the heat and come down through the cone in reverse and actually enter the ear canal. I have occasionally seen instances of the hardened paraffin that had entered the external ear canal and caused a superficial burn and additional blockage of the ear. I have also seen instances of paraffin dust scattered through the ear, and it takes months for the natural cleaning mechanisms of the ear to eradicate this.
Therefore, as much as I am not opposed to any holistic measures of eradicating the earwax problem effectively, I do not think that using candling without proper medical supervision and equipment is advised. In an ideal setting, a trained professional should first inspect the ear to determine what is the nature of the blockage. If the blockage is in fact due to earwax build-up, various different techniques could be applied to remove this earwax. Only through a second inspection can determination be made if all the earwax came out successfully.
Many general care practitioners feel comfortable removing most instances of earwax build-up in their office. Occasionally, the texture or the amount of earwax is beyond the capacity of a general practitioner, and the patient needs to be referred to an ear, nose, and throat specialist for expert care. Most ear, nose, and throat specialist have all the necessary equipment (and skill) in the office to successfully remove earwax or other reasons for the blockage.
Tags: candling, cerumen, Ears, earwax, Q-tips
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What is the Best Way to Clean My Ears?
November 15th, 2011
Many people contemplate what is the best way to clean the ears. To understand my recommendations, let’s discuss the basis anatomy of the outer ear first. The ear canal is narrow and hollow tubing that ends in the eardrum. Earwax is usually made in the mid section of the ear canal, and it slowly comes out with the passage of time. However, if the earwax accumulates, the ear can feel blocked and subsequent sensation of hearing loss ensues.
Let’s also review the basic physiology of the ear canal and earwax production. In other parts of the body, as we take a shower, the dead skin sheds off and new skin is generated from the bottom up. Since the skin of the ear canal is not generally accessible to typical cleaning during a shower, the ear has adopted other mechanisms for cleaning itself. The center of growth of the ear canal skin is actually on the eardrum itself (this is how most perforations of the eardrum can generally heal themselves spontaneously). As the ear skin grows from the center of the eardrum, older skin slowly migrates towards the outside of the ear, and it stops at the junction of the entrance of the ear canal to the outside world. This growth of skin typically carries any earwax or any other particles with it. The earwax and particles are then deposited right at the entrance of the ear canal.
Many people have the misconception that a good way to clean the ears is to use cotton tip swabs (Q-tips®). These cotton swabs are generally the same size as the ear canal, and with inserting them into the ear canal you might actually push in the earwax deeper. If this is done repeatedly over a period of time, the earwax can become impacted into the ear canal and make the cleaning worse.
Ideally, the best way to clean the ears on a regular basis is to simply use a finger wrapped with tissue. After taking a shower, when everything is moist, wrap a tissue around your small finger. Then use the finger to grab whatever you can from the entrance of the ear canal. This is as deep as one should go, and any attempt at going deeper with a Q-tip might make matters worse by pushing the earwax back in.
Over-the-counter ear drop preparations for removal of earwax are also available. These generally have a peroxide-based solution, which is designed to loosen any earwax accumulation. Some people might use it preventively every few weeks to remove any residual earwax that might have accumulated over a period of time. Additionally, if one has a sensation of excessive buildup, the ear drops might make the earwax softer and thus making it easier for the earwax to drain out spontaneously. One general misconception is that by applying those eardrops to the ear, the earwax is going to simply disappear. This is not the case.  The eardrops are simply designed to make the earwax softer. Any residual softer earwax still needs to be physically removed either by a bulb syringe that comes with over-the-counter kits, or by a physician in office setting.
Alternatively, the patients with known history of recurrent earwax production and blockage should see their ear, nose, and throat specialist on a routine basis for preventive cleaning. This will assure that the earwax is removed safely with full inspection. Please make an appointment to see your ear, nose, and throat specialist on a regular basis for this purpose if you are affected with excessive earwax.
Tags: cerumen, Ears, earwax, Q-tips
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Welcome to my Blog
September 19th, 2011
 Within this regularly updated feature of my website, I will provide visitors with practice news and specials, as well as information regarding the most recent technological advances and new treatments in otolaryngology.Â
I believe that patient education and open communication with your doctor are the keys to achieving healthy, fully functional results and patient satisfaction, which is why I strive to provide the highest quality of Sotolaryngologic care for patients of all ages. This is done by combining technical skill and broad experience with cutting-edge technology for impeccable medical results.
I sincerely appreciate you taking the time to visit my new blog. Please check back often to learn about the latest news, updates and additions to the practice and within the field of otolaryngology, and feel free to post comments and/or suggestions on any posts that you find of interest.
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