Loss of Smell. (hyposmia-anosmia)

Our sense of smell helps us enjoy life. We delight in the aromas of our favorite foods or the fragrance of flowers. Our sense of smell also is a warning system, alerting us to danger signals such as a gas leak, spoiled food, or a fire. Any loss in our sense of smell can have a negative effect on our quality of life. It also can be a sign of more serious health problems.

Loss of smell (anosmia) can be partial or complete, although a complete loss of smell is fairly rare. Loss of smell can also be temporary or permanent, depending on the cause.

Causes of Anosmia  

Nasal congestion from a cold, allergy, sinus infection, or poor air quality is the most common cause of anosmia. 

Other anosmia causes include:

• Nasal polyps
• Injury to the nose and smell nerves from surgery or head trauma.
• Exposure to toxic chemicals, such as pesticides or solvents.
• Certain medications, including antibiotics, antidepressants, anti-inflammatory medication, heart medications, and others.
• Cocaine abuse.
• Old age. Like vision and hearing, your sense of smell can become weaker as you age. In fact, one's sense of smell is most keen between the ages of 30 and 60 and begins to decline after age 60.
• Certain medical conditions, such as Alzheimer's disease, Parkinson's disease, multiple sclerosis, nutritional deficiencies, congenital conditions, and hormonal disturbances.
• Radiation treatment of head and neck cancers.

Diagnosis

It is important to identify and treat the underlying cause of a potential smell disorder. An accurate assessment of a smell disorder will include, among other things,

• a physical examination of the ears, nose, and throat
• a review of your health history, such as exposure to toxic chemicals or injury, and
• a smell test
• a CT scan may be necessary for further information

Treatments
If nasal congestion from a cold or allergy is the cause of anosmia, treatment is usually not needed, and the problem will resolve automatically. Short-term use of decongestants may help free the nasal passages..

If a polyp or growth is present, surgery may be needed to remove the obstruction and regain your sense of smell.

Unfortunately, anosmia is not always treatable, especially if age is the cause.

Smoking can dull your senses, including the sense of smell. So smoking cessation is a key step to regain your sense of smell.

Corticosteroids may also improve the olfaction if deemed necessary.

Nasal Polyps

Nasal Polyps

Nasal polyps are soft, painless, noncancerous growths on the lining of the nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.

Small nasal polyps may not cause symptoms. Larger growths or groups of nasal polyps can block the nasal passages or lead to breathing problems, a loss of smell, and frequent infections.

Symptoms

Nasal polyps are associated with inflammation of the lining of the nasal passages and sinuses that lasts more than 12 weeks (chronic rhinosinusitis). However, it's possible to have chronic sinusitis without nasal polyps.

Common signs and symptoms of chronic sinusitis with nasal polyps include:

• A runny nose
• Persistent stuffiness
• Postnasal drip
• Decreased or absent sense of smell
• Loss of sense of taste
• Facial pain or headache
• Pain in your upper teeth
• A sense of pressure on the forehead and face
• Snoring

Cause

Scientists don't yet fully understand what causes nasal polyps. It's not clear why some people develop chronic inflammation or why ongoing inflammation triggers polyp formation in some people and not in others. The inflammation occurs in the fluid-producing lining (mucous membrane) of the nose and sinuses.

There's some evidence that people who develop polyps have a different immune system response and different chemical markers in their mucous membranes than do those who don't develop polyps.

Nasal polyps can form at any age, but they're most common in young and middle-aged adults. Nasal polyps may form anywhere in your sinuses or nasal passages, but they appear most often in an area where sinuses near your eyes, nose and cheekbones all drain through winding passages into your nose (ostiomeatal complex).

Risk factors

Any condition that triggers chronic inflammation in the nasal passages or sinuses, such as infections or allergies, may increase the risk of developing nasal polyps. 

Conditions often associated with nasal polyps include:

• Asthma, a disease that causes overall airway inflammation and constriction
• Aspirin sensitivity may cause some people to be more likely to develop nasal polyps
• Allergic fungal sinusitis, an allergy to airborne fungi
• Cystic fibrosis, a genetic disorder that results in the production and secretion of abnormally thick, sticky fluids, including thick mucus from nasal and sinus membranes
• Churg-Strauss syndrome, a rare disease that causes the inflammation of blood vessels

Family history also may play a role. There's some evidence that certain genetic variations associated with immune system function make you more likely to develop nasal polyps.

Diagnosis 

A diagnosis is usually made based on the symptoms, a general physical exam and an examination of the nose. Polyps may be visible with the aid of a simple lighted instrument.

Other diagnostic tests include:

Nasal endoscopy. 

A narrow, flexible tube with a lighted magnifying lens or tiny camera (nasal endoscope) enables the doctor to perform a detailed examination inside the nose and sinuses. An endoscope is inserted into a nostril and guided it into the nasal cavity.

Imaging studies. 

Images obtained with computerized tomography (CT) scan or magnetic resonance imaging (MRI) can pinpoint the size and location of polyps in deeper areas of the sinuses and evaluate the extent of inflammation. These studies may also help rule out the presence of other possible obstructions in the nasal cavity, such as structural abnormalities or another type of cancerous or noncancerous growth.

Treatments and drugs

Chronic sinusitis, with or without polyps, is a challenging condition to eliminate completely.

A long-term treatment plan to manage thesymptoms is needed and to treat factors, such as allergies, that may contribute to chronic inflammation.

The treatment goal for nasal polyps is to reduce their size or eliminate them. Medications are usually the first approach, which include topical nasal sprays and corticosteroids. Surgery may sometimes be needed, but it may not provide a permanent solution because polyps tend to recur.

Surgery

If drug treatment doesn't shrink or eliminate nasal polyps, endoscopic surgery is recommended to remove polyps and to correct problems with the sinuses that make them prone to inflammation and polyp development.

In functional endoscopic surgery (FESS) the surgeon inserts a small tube with a magnifying lens or tiny camera (endoscope) into the nostrils and guides it into the sinus cavities.

After surgery, the use of a saltwater (saline) rinse to promote healing is recommended as well as medication such as a corticosteroid nasal spray to help prevent the recurrence of nasal polyps.

Lose Weight with Acupuncture

Weight loss comes under the topic of "Weight Control". This is a multi-faceted problem, and a good program involves diet, exercise and stress reduction techniques.

Acupuncture is an ADJUNCT therapy. It is not a wonder cure in the treatment of weight control. But, acupuncture is effective in making it easier to lose and maintain that loss if the patient is willing to change their lifestyle. 

This technique is safe, sound and reliable. And, even more exciting, using acupuncture for weight loss helps you lose weight in several different ways.

How Does Acupuncture Help With Weight Loss?

• Acupuncture helps balance hormones. Acupuncture can increase endorphins, which reduce cravings and generally make you feel more positive. This can help reduce binge eating.
• It also decreases the hormones that contribute to weight gain.
• Acupuncture helps with weight loss is by reducing stress. Cortisol, the stress hormone, can affect weight in several ways. It disrupts digestion, contributes to depression and escalates your “fight or flight” response. If you feel overwhelmed, you are more likely to binge for emotional reasons and to assume you have no time to prepare healthy meals.
• Acupuncture can aid digestion. According to Traditional Chinese Medicine (TCM), the spleen is responsible for digestion. Disharmony and imbalance in the spleen can lead to fatigue, slow metabolism, water retention, loose stools, and a feeling of heaviness.

By balancing your organ system, you support weight loss both physically and

psychologically.

What does it involve?

Acupuncture involves the insertion of very fine, sterile needles at specific body points or "energy pathways" or on specific points on there ear. Electroacupuncture helps to increase the stimulation of these points and therefore increase the metabolism of the fatty tissue. 

Each session lasts 20-25 minutes and for quicker results the therapies are combined  with auricular acupuncture.

How Acupuncture works:

• Creates ideal conditions for weight loss 
• Reduces the volume of the fatty cells
• Increases the metabolism (increased local metabolic activity of adipocytes) 
• Increases local blood flow and improves venous drainage in areas of the body with cellulite.

Acupuncture Treatment for Asthma

Acupuncture for Asthma Is a Breath of Fresh Air.

Asthma is on the World Health Organization’s list of conditions “for which the therapeutic effect of acupuncture has been shown but for which further proof is needed.”

Acupuncture has been used safely and effectively for thousands of years to rectify the underlying imbalances that cause asthma symptoms such as shortness of breath, coughing and wheezing.

Asthma can be tackled with acupuncture in a variety of ways. Points are selected according to the patient’s unique combination of symptoms along the most apt meridians in order to evoke the harmonious flow of energy "qi".

Benefits of acupuncture for asthma:

• Reduction of asthma symptoms 
• Can significantly reduce the need inhalant drugs
• Balances chemical imbalances in the body 
• Strengthens the immune system 
• No harmful and dangerous side effects 
• Acupuncture decreases the frequency and severity of asthma attacks
• Long lasting effects

Acupuncture entails the placing of very thin needles into the body and face. A session lasts 20 to 30 minutes normally. The treatments take place twice a week for a duration of three to 6 weeks, depending on the severity of each case. Acupuncture has a cumulative effect and therefore the results are usually evaluated after 4 to 6 sessions.

Auricular acupuncture can also be applied to bring about impressive results. In recent years auricular acupuncture has received international recognition and is taught in many countries. The World Health Organization recognizes it as a therapeutic system with a wide range of applications, good results, safety and ease of implementation.

Difficulty swallowing. Dysphagia

Difficulty in swallowing also known as dysphagia is the disruption of the normal process of the transfer of food and liquids from the mouth to the stomach.

Often, dysphagia makes it difficult to obtain enough calories and  fluids to the body and can lead to serious medical problems (dehydration and weight loss).

Other symptoms that may accompany dysphagia:

• Cough  
• Hoarseness 
• Reflux of gastric fluids
• Weight Loss 
• Pneumonia due  to aspiration
• Dehydration

Causes of dysphagia:

Neurological disorders. Certain disorders, such as post-polio syndrome, multiple sclerosis, muscular dystrophy and Parkinson's disease, may first be noticed because of oropharyngeal dysphagia.
Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can cause difficulty swallowing or an inability to swallow.

Pharyngeal diverticula. A small pouch forms and collects food particles in your throat, often just above your esophagus, leading to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing.
Cancer. Certain cancers and some cancer treatments, such as radiation, can cause difficulty swallowing.

Oesophageal disorders:

• Obstruction of foreign body
• Esophageal Stenosis
• Cancer of the esophagus
• Esophageal Achalasia
• Gastro-oesophageal reflux disease

Treatment

Treatment usually depends on the cause and type of dysphagia. The type of dysphagia will be clarified after the clinical and laboratory testing with endoscopy, an X-ray with a contrast material (barium X-ray) and a dynamic swallowing study if necessary.

Conservative treatments include: 

• Change in eating habits
• Drinking fluids
• Medication for gastro-oesophageal reflux 
• Exercises for sawallowing 

Surgical Methods 

Esophageal dilation. For a tight esophageal sphincter (achalasia) or an esophageal stricture, your doctor may use an endoscope with a special balloon attached to gently stretch and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilatation).
Surgery. For an esophageal tumor, achalasia or pharyngeal diverticula, you may need surgery to clear your esophageal path.

Feeding tube.

Complications 

• Chronic dry cough 
• Aspiration pneumonia 
• Significant Weight Loss
• Dehydration

Vocal cord nodules

Vocal cord nodules are benign (noncancerous) growths on both vocal cords that are caused by vocal abuse. They are also known as "singers' nodules".

Over time, repeated abuse of the vocal cords results in soft, swollen spots on each vocal cord. These spots develop into harder, callous-like growths called nodules. The nodules will become larger and stiffer the longer the vocal abuse continues.

A change in voice quality and persistent hoarseness are often the first warning signs of a vocal cord lesion.

Other symptoms can include:

• Vocal fatigue 
• Unreliable voice 
• Delayed voice initiation
• Low, gravelly voice
• Low pitch
• Voice breaks in first passages of sentences
• Airy or breathy voice 
• Inability to sing in high, soft voice
• Increased effort to speak or sing
• Hoarse and rough voice quality
• Frequent throat clearing
• Extra force needed for voice

Treatment

The most common treatment options for benign vocal cord lesions include: voice rest, voice therapy, singing voice therapy, and phonomicrosurgery, a type of surgery involving the use of microsurgical techniques and instruments to treat abnormalities on the vocal cord.

Treatment options can vary according to the degree of voice limitation and the exact voice demands of the patient. For example, if a professional singer develops benign vocal cord lesions and undergoes voice therapy, which improves speaking but not singing voice, then surgery might be considered to restore singing voice. 

Successful and appropriate treatment is highly individual and includes consideration of the patient’s vocal needs and the clinical judgment of the otolaryngologist.

Hoarseness

Hoarseness refers to a difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or quality of the voice may change.

Hoarseness is most often caused by a problem with the vocal cords, which are part of the voice box (larynx) in the throat. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness.

The most common cause of hoarseness:

• Acute laryngitis 
• Infections of the upper respiratory 
• Severe cough 
• Vocal cord nodules 
• Vocal cord polyps 
• Reinke edema 
• Laryngopharyngeal reflux 
• Smoking 
• Allergies

Less common causes are:

• Malignant and benign tumors of the larynx 
• Malignancies of the lung, esophagus, or thyroid 
• Wounds and injuries 
• Hypothyroidism 
• Neurological diseases 
• Age 
• Myasthenia gravis

Consult you Otorhinolaryngologist if:

• You have trouble breathing or swallowing
• Hoarseness occurs with drooling, especially in a small child
• Hoarseness has lasted for more than 1 week in a child, or 2-3 weeks in an adult
• It's associated with coughing up blood
• It's associated with a lump in the neck

Diagnosis:

The ENT surgeon will conduct a mirror examination of the throat  and a laryngeal endoscopy examination.

Things to do at home to help relieve the problem include:

• Talk only when necessary, until hoarseness goes away.
• Drink plenty of fluids to help keep the airways moist. (Gargling does not help.)
• Use a vaporizer to add moisture to the air.
• Avoid actions that strain the vocal cords such as whispering, shouting, crying, and singing.
• Take medicines to reduce stomach acid if hoarseness is due to gastroesophageal reflux disease (GERD).
• Do NOT use decongestants which can dry out the vocal cords.
• If you smoke, cut down or stop at least until hoarseness goes away.

Other treatments may include voice therapy or surgical removal of laryngeal polyps or nodes if deemed necessary by the ENT surgeon.

Cough

A cough is an action the body takes to get rid of substances that are irritating to the air passages, which carry the air a person breathes in from the nose and mouth to the lungs. A cough occurs when cells along the air passages get irritated and trigger a chain of events. The result is air in the lungs is forced out under high pressure. A person can choose to cough (a voluntary process), or the body may cough on its own (an involuntary process).

Causes of Coughs

• Allergy and asthma 
• Sinusitis with postnasal drip 
• Laryngitis. Aside from coughing, laryngitis accompanied by voice alteration, hoarseness, throat constriction and difficulty breathing. 
• Pneumonia, acute bronchitis and other lung infections such as tuberculosis, pertussis 
• Chronic obstructive lung disease, chronic bronchitis and emphysema, in which the main culprit is smoking 
• Gastroesophageal reflux disease is characterized by the return fluid and contents from the stomach back into the esophagus. Due to failure of the lower esophageal sphincter. This condition causes dry cough, heartburn, bad smelling breath, difficulty swallowing. 
• Heart failure, congestive type 
• Lung cancer 
• Pulmonary embolism 
• Cystic fibrosis.

Consult a doctor if: 

• Coughing up blood. 
• Cough is associated with intense wheezing. 
• Difficulty in breathing. 
• Cough is associated with a fever and sputum production.
• Cough fails to get better after other symptoms go away or lessen.
• Cough changes in character.
• Cough is associated with chest pain.
• Accompanying weight loss.

For a quick recovery 

• Stop smoking. 
• Drink lots of water and fluids.
• Treatment to reduce acid reflux in GERD
• Lots of rest

Facial nerve Paralysis

Facial nerve Paralysis

Facial paralysis occurs when a person is no longer able to move some or all of the muscles on one side of the face. The facial nerve is the main nerve that innervates the muscles of the face and therefore enables facial expression.

Facial paralysis is almost always caused by:

• Damage or swelling of the facial nerve, which carries signals from the brain to the muscles of the face
• Damage to the area of the brain that sends signals to the muscles of the face

Fortunately, 85% of facial palsy is due to idiopathic palsy (Bell's Palsy). The etiology remains unclear although viral infections have been implicated and it occurs more frequently in pregnant women. The diagnosis of idiopathic paralysis is made by excluding all other causes. Healing occurs automatically within 6 months and usually no neurological signs remain.

Permanent paralysis is primarily due to:

• Injuries and fractures of the temporal bone
• Large facial traumas
• Tumors (neurofibromas, cholesteatomas, brain tumors, tumors  of the parotid gland, etc.) 
• Autoimmune diseases
• Metabolic diseases

Symptoms

• Sudden weakness or paralysis on one side of the face that causes it to droop. This is the main symptom. 
• It may make it hard for you to close the eye on that side of the face.
• Drooling.
• Eye problems, such as excessive tearing or a dry eye.
• Loss of ability to taste.
• Pain in or behind the ear.
• Numbness in the affected side of the face.
• Increased sensitivity to sound.

Treatment

For treatment to be effective it should be started immediately or at the latest within the first three days of symptoms. Treatment includes medication and physical therapy. The medication consists of antibiotics and cortisone. Antibiotics to fight infection and cortisone to reduce the swelling of the nerve and thus the depressurisation. Supplemental vitamins administered to the patient, especially B complex to strengthen the nerve and eye drops to protect the corneas.

Clinical studies also show that acupuncture is at least as effective as corticosteroids and may improve the recovery of patients with palsy Bell, either as monotherapy or in combination with medication.

Voice Care/Vocal Hygeine

Vocal Hygeine

Careers that depend on a person’s use of their voice, may include: a teacher, attorney, corporate trainer or an entertainer.

For a professional voice user, it is of the utmost importance to take good care of the voice. The following are some helpful hints to help maintain good vocal hygiene:

1. Hydration
It cannot be overemphasized how important it is to maintain good water intake. 6 to 8 eight glasses of water a day, are recommended to maintain adequate hydration. Good water intake helps keep the lubricating mucus on the vocal cords thin, creating the ideal environment for the vocal cords to work.

2. Thick Mucus
Increasing water intake, as outlined above, will frequently help take care of problems with thick mucous. Despite these measures, some people continue to have the sensation of thick mucous in their throat or on their vocal cords. In many instances, this is due to backflow of stomach acid into the throat - so called gastroesophageal reflux disease, or GERD.

3. Throat Clearing
This is a common problem with many professional voice users. It is often seen in people with excessive mucous or GERD (reflux disease). Throat clearing is extremely traumatic to the vocal cords, leading to excessive wear and tear. The following strategies are helpful to avoid this: swallowing, a sip of water, or silent clearing of the throat without allowing the vocal cords to touch.

4. Gastroesophageal Reflux Disease (GERD)
Although the reflux of stomach contents into the esophagus and throat commonly leads to heartburn, many patients never experience this symptom. Treatment of this condition involves changes in diet and lifestyle, as well as medications to reduce the acid production from the stomach.

5. Vocal Abuse/Overuse

It has been said, "everything in moderation". Avoiding lengthy conversations on the phone and resting the voice for ten minutes every 2-3 hours will go a long way towards easing the strain on the voice.
Talking at a low to moderate volume; this will sometimes mean using different strategies when there is excessive background noise (cars, parties, airplanes, restaurants).
Shouting and screaming should be avoided. There are much better ways to get people's attention, and these methods will not traumatize the vocal cords as screaming will. Examples would include using a whistle or the clapping of hands.
Needless to say, smoking is one of the worst things for the voice. Irritation to the vocal cords from cigarette smoke can lead to chronic laryngitis, vocal cord polyps, or cancer of the larynx.

6. Drugs that Affect the Voice
Antihistamines/Decongestants: These drugs are commonly found in cold preparations and allergy medications. They will result in a drying effect on the vocal cords which is detrimental. Other medications that cause the drying of the vocal cords are all diuretics and local anesthetics.

7. Work Environment
Smoke filled and dusty environments should be avoided. Traveling to dry environments may also cause voice problems. It is best to keep a humidifier on at night, and to maintain good water intake. Airplanes are also notoriously dry environments.

Cancer of the Mouth

Oropharyngeal Carcinoma

The harmful effects of smoking are well-established and is confirmed daily as new statistics come to light.

As is known smoking is implicated in the cancer of the larynx, oropharynx, esophagus, causing 50-75% mortality. They usually occur after the age of 40 years.

The majority of these cancers of the mouth and throat are caused by smoking, alcohol abuse, or both. 

Other factors that substantially increase the risk of cancer of the mouth:

• Immunodeficiency 
• Malnutrition 
• Poor oral hygiene 
• Shoddy dentures that do not fit well 
• Excessive exposure to ultraviolet radiation from the sun that is responsible for causing cancer especially of the lips 
• Occupational exposure to toxins
• Viral Infections 

Signs and Symptoms:

• Sore mouth that does not heal or that bleeds easily 
• White or red lesions in the mouth that do not heal 
• Presence of a lump or bulge
• Pain in mouth,  throat,tongue 
• Difficulty chewing or swallowing 
• Loss of teeth 

The sooner these symptoms and lesions are evaluated by an ear-nose and throat surgeon the greater the chance of  a successful therapy.

.
The survival rates of patients with cancer of the mouth or throat decreases dramatically once there are metastatic lesions.

Treatment
Oropharynx: Treatment options depend on the stage and aggressiveness of the disease, the location of the tumor and the general health of the patient. Treatment options include surgery, radiotherapy and chemotherapy.

Hypopharynx: Treatment options depend on the stage of disease, to preserve as much as possible the patient's ability to speak, eat and breath, and the general health of the patient. The treatment options include surgery, radiotherapy, chemotherapy.

Smoking cessation is the ultimate preventitive method, as it significantly reduces the risk of cancer, heart disease and lung disease, regardless of age.

Salivary Gland Disorders

Salivary glands make as much as a quart of saliva each day. Saliva is important to lubricate the mouth, help with swallowing, protect the teeth against bacteria, and aid in the digestion of food. 

The three major pairs of salivary glands are:

• parotid glands on the insides of the cheeks
• submandibular glands at the floor of the mouth
• sublingual glands under the tongue

There are also several hundred minor salivary glands throughout the mouth and throat. Saliva drains into the mouth through small tubes called ducts.

Often, they can be afflicted by various diseases such as inflammation (viral or bacterial), autoimmune diseases, salivary gland stones, or neoplastic diseases.

Childhood mumps, certain bacterial infections (for example, of the tonsils or teeth), and other diseases that are typically more common among adults (such as AIDS, Sjögren syndrome, diabetes mellitus, sarcoidosis, and bulimia) often cause swelling of the major salivary glands)

The most common reasons for which a patient will make a visit to the doctor are: 

• The swelling of the salivary gland  
• Pain 
• Fever 
• Purulent discharge mouth

Swelling  occurs:
Salivary gland stones:
A stone can form from salts contained in the saliva. Stones are particularly likely to form when people are dehydrated or take drugs that decrease saliva production. People with gout are also more likely to form stones. Salivary gland stones are most common among adults. 

Tumours:
Swelling also can result from cancerous (malignant) or noncancerous (benign) tumors in the salivary glands. Swelling resulting from a tumor is usually firmer than that caused by an infection. If the tumor is cancerous, the gland may feel stone-hard and may be fixed firmly to surrounding tissues.

Treatment

The infections are treated with antibiotics and antiinflammatory drugs.
The salivary stones, can be identified and removed using very thin endoscopes, without requiring surgery.
Benign tumors are removed surgically. The surgery is very delicate and requires skill and experience.
Malignant tumors other than surgical excision may require radiotherapy and chemotherapy.

Reflux of Gastric Fluid into the Larynx

The term Laryngopharyngeal Reflux (LPR) refers to the backflow of food or stomach acid all of the way back up into the larynx (the voice box) or the pharynx (the throat). LPR (silent reflux) can occur during the day or night, even if a person who has LPR hasn't eaten a thing.

Silent Reflux Can Cause:

• Hoarseness
• A "lump" in the throat
• Trouble swallowing
• Chronic cough
• Too much throat mucus
• Heartburn

There are many symptoms of LPR, all of which relate to sensations in the throat. Fifty percent of people with LPR do not have symptoms of heartburn or indigestion.

Diagnosis of LPR:

Most often, the ENT surgeon can diagnose LPR through a combination of a medical history and symptom score and a thorough clinical examination of  your throat and vocal cords with a rigid or flexible endocope. The voice box is typically red, irritated, and swollen from acid reflux damage. This swelling and inflammation will eventually resolve with medical treatment, although it may take a few months.

Treatment

Most of the time, LPR is well controlled with medications (Proton Pump Inhibitors, or PPI's), taken long periods of time.

Silent reflux treatment for adults may include these lifestyle modifications:

• Lose weight, if needed.
• Quit smoking, if you are a smoker.
• Avoid alcohol.
• Restrict chocolate, mints, fats, citrus fruits, carbonated beverages, spicy or tomato-based products, red wine, and caffeine.
• Stop eating at least three hours before going to bed.
• Elevate the head of the bed about 4 to 6 inches.
• Avoid wearing tight-fitting clothes around the waist.
• Try chewing gum to increase saliva and neutralize acid.

Mucocele in the floor of the Mouth. (Ranula)

A ranula is a type of mucocele found on the floor of the mouth. 

Ranulas present as a swelling of connective tissue consisting of collected mucin from a ruptured salivary gland duct. These lesions occur as the result of trauma or obstruction to the salivary gland excretory duct and spillage of mucin into the surrounding soft tissues.

Symptoms

Mucoceles often show up on the inside of your lower lips, your gums, the roof of your mouth, or under your tongue. Those on the floor of the mouth are called ranulas. These are rare, but because they are larger, they can cause more problems with speech, chewing, and swallowing.

Mucoceles may have these characteristics:

• Moveable and painless
• Soft, round, dome-shaped
• Pearly or semi-clear surface or bluish in color
• 2 to 10 millimeters in diameter

Treatment

Normally the ranula or mucoceles resolves spontaneously,  but in some cases they may persist and become enlarged and therfore are in need of surgical treatment. The ENT surgeon surgically removes the ranula with the use of a micromarsupialization technique and in some cases removal of the sublingual salivary gland as well may be necessary in order to prevent recurrence.

Sore Throat. Pharyngitis

A sore throat is pain, scratchiness or irritation of the throat that often worsens when swallowing.
A sore throat is the primary symptom of pharyngitis — inflammation of the pharynx, or throat. But the terms "sore throat" and "pharyngitis" are often used interchangeably.
The most common cause of a sore throat is a viral infection, such as a cold or the flu. A sore throat caused by a virus usually resolves on its own with at-home care. A bacterial infection, a less common cause of sore throat, requires additional treatment with antibiotic drugs. Most cases of pharyngitis occur during the colder months. The illness often spreads among family members.

Symptoms of pharyngitis

• Pain or a scratchy sensation in the throat
• Pain that worsens with swallowing or talking
• Difficulty swallowing
• Dry throat
• Sore, swollen glands in your neck or jaw
• Swollen, red tonsils
• White patches or pus on your tonsils
• Hoarse or muffled voice
• Refusal to eat (infants and toddlers)Other symptoms may include:
• Fever
• Headache
• Joint pain and muscle aches
• Skin rashes

Risk factors

Although anyone can get a sore throat, some factors make you more susceptible. These factors include:

• Age. Children and teens are most likely to develop sore throats. Children are also more likely to have strep throat, the most common bacterial infection associated with a sore throat.
• Tobacco. Smoking and secondhand smoke can irritate the throat. The use of tobacco products also increases the risk of cancers of the mouth, throat and voice box.
• Allergies. If you have seasonal allergies or ongoing allergic reactions to dust, molds or pet dander, you're more likely to develop a sore throat than are people who don't have allergies.
• Exposure to chemical irritants. Particulate matter in the air from the burning of fossil fuels, as well as common household chemicals, can cause throat irritation.
• Chronic or frequent sinus infections. Chronic or frequent sinus infections increase the risk of sore throat, because drainage from the nose can irritate the throat or spread infection.
• Living or working in close quarters. Viral and bacterial infections spread easily anywhere people gather — child care centers, classrooms, offices, prisons and military installations.
• Lowered immunity. You're more susceptible to infections in general if your resistance is low. Common causes of lowered immunity include HIV, diabetes, treatment with steroids or chemotherapy drugs, stress, fatigue, and poor diet.

Lifestyle and home remedies

Regardless of the cause of your sore throat, at-home care strategies usually provide temporary relief. 

• Rest. Get plenty of sleep and rest your voice.
• Fluids. Drink plenty of water to keep the throat moist and prevent dehydration.
• Comforting foods and beverage. Warm liquids — broth, caffeine-free tea or warm water with honey — and cold treats such as ice pops can soothe a sore throat.
• Saltwater gargle. A saltwater gargle of 1 teaspoon (5 milliliters) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a sore throat. Gargle the solution and then spit it out.
• Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat or sit for several minutes in a steamy bathroom.
• Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.
• Treat pain and fever. Ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may minimize throat pain. 

Treatment
Because viral illnesses are the most common cause of a sore throat, it is important not to use antibiotics to treat them. 

Antibiotics do not alter the course of viral infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.Viruses will run their own course and the infection usually will resolve when the body fights them off. Bacterial infections of the tonsils or adenoids are treated with antibiotics.

Chronic infections may require surgery to remove the tonsils or adenoids.

Ear Pathology associated with Scuba Diving

The freediving and scuba diving are activities that require a good physical condition and perfect condition of the ear, nose and paranasal sinuses. As is known to those skilled in diving more than 50% of a diver's emerging problems are related to an Otolaryngologist's area of epertise and more than 90% of these problems are related to the ears. 

Normally the air pressure in the ear is equilibrated to atmospheric pressure, by the Eustachian tube, which is normally closed and opens during swallowing, yawning or actively by using the Valsalva Maneuvre.

During scubadiving  the air pressure in the ear may sometimes not be equalised and this leads to overpressure of the middle ear. This will result in barotitis media which is the most frequently reported injury among divers. 

Predisposing factors for barotrauma: 

• Common cold (runny nose) 
• Allergic rhinitis 
• Nasal polyps 
• Septal deviation

External auditory meatus

Pain in the external ear is due to the negative pressure that occurs during the dive, which may result in small hemorrhages in the skin of the ear canal and the eardrum. Treatment is not usually necessary, however, diving should stop until healing is completed. 

Otitis externa is an inflammation of the ear canal caused by bacteria. If the ear remains moist from immersion in the water, this moisture, coupled with the warmth of the body, creates an inviting growth area for many microorganisms, especially opportunistic bacteria.

Middle ear 

Barotrauma of the middle ear is the most common injury reported by divers.
It should be highlighted that the first 10 to 11 meters below the surface, are the critical threshold for the pressure to equalize in the ears. The diver who can not achieve this equalisation in pressure, may encounter severe pain, hearing loss and vertigo either immediately after the dive or even a few days later.

Diving precautions

• Decongestant nasal spray (if the nasal passages are congested) 
• Systemic administration of decongestants 
• Valsalva Maneuvre
• Diving feet first

Reverse barotrauma: occurs when ascending to the surface if the Eustachian tube is blocked and causes:

• severe pain 
• dizziness. 
• bleeding in the ear, 
• trauma to the ear drum  
• permanent hearing loss. 

Inner ear

This injury generally occurs when divers attempt to forcefully equalize their ears. This "hard" blowing over-pressurizes the middle ear and can result in implosive or explosive damage to the round and oval windows. The symptoms caused by inner ear barotrauma are vertigo, vomiting, hearing loss and loud tinnitus.

PREVENTION

Most of these ear injuries can be avoided if the diver is precisely evaluated and screened for any predisposing factors before scubadiving. Emphasis should be placed on a healthy and functional Eustachian tube, nasal cavaties, paranasal sinuses and the nasopharynx.

• This screening examination should include the following tests: otoscopy, audiogram, Valsalva maneuvre, nasal and nasopharyngeal endoscopy.

Preventive measures during the dive include:

1. properly equalizing
2. never diving with a cold or other congestion, and
3. abstaining from diving if you cannot clear your ears.

Oral Ulcers

Aphthous mouth ulcers
Aphthous mouth ulcers are painful sores that can occur anywhere inside the mouth. They are the most common type of mouth ulcer. At least 1 in 5 people can develop aphthous mouth ulcers at some stage in their life. Women are affected more often than men. Aphthous ulcers usually first occur between the ages of 10 and 40 years. 

The cause is not known. They are not infectious, and you cannot 'catch' aphthous mouth ulcers. In most cases, the ulcers develop for no apparent reason in people who are healthy.

Several genetic and environmental factors have been implicated that favor the development of this condition:

• immunological and hormonal disorders 
• allergies 
• stress 
• heredity 
• microbial infections 
• trauma 
• smoking cessation 
• lack of certain vitamins and elements (B6, B12, folic acid and iron) 
• certain medications (steroids, anti-inflammatory)

Also, the existence of certain conditions such as:

• celiac disease, 
• Adamantiades-Bechet syndrome 
• cyclic neutropenia, 
• Crohn's disease and 
• HIV infection can lead to the induction of recurrent aphthous stomatitis

Clinical Presentation

Mouth ulcers are painful round or oval sores that form in the mouth, most often on the inside of the cheeks or lips.

They're usually white, red, yellow or grey in colour and are inflamed (red and swollen) around the edge.

Although mouth ulcers can be uncomfortable, especially when you eat, drink or brush your teeth, they are usually harmless.

Most mouth ulcers will clear up spontaneously within a week or two.

Treatment

Most mouth ulcers don't require specific treatment, as they will usually heal on their own within 10-14 days.

However, treatment may be necessary if the ulcers are severe, painful or interfere with your daily activities (such as eating). The treatment normally includes corticosteroids and antibiotics.

Self-help tips

If you have a mild mouth ulcer, there are some steps you can take yourself to help your ulcer heal more quickly:

• Use a soft toothbrush when brushing your teeth.
• Avoid hard, sharp, spicy and acidic foods and drinks until the ulcer heals – stick to soft foods that are easier to chew.
• Avoid specific foods that may trigger oral ulcers.
• Reduce your stress levels by doing an activity that you find relaxing, such as yoga, meditation orexercise. Read more about relaxation tips to avoid stress.

If your ulcer has a specific physical cause, such as a sharp tooth or filling cutting the inside of your cheek, it will usually heal naturally once the cause has been treated. If you suspect that a sharp tooth or filling has caused an ulcer, visit your dentist so that they can repair it.