I'm Dr.

Ryan Harden, faculty member from the department of family medicine and biiobehavioral health at the University of Minnesota Medical School Duth campus and family medicine physician at the Gateway Family Health Clinic in Moose Lake.

I am your host for our episode tonight on ear, nose, and throat problems, sleep apnoa, allergies, and infections.

The success of this program is very dependent on you, the viewer.

So, please call in your questions or send them to our email address, askpbsnorth.org.

Our panelists this evening include Dr.

Andrew Davis from Aspirus St.

Luke's clinic in Duth, Dr.

Robert Grul from Assentia in Duth, and Dr.

David Monte from Community Memorial Hospital in Cloquet.

Our phone volunteers tonight are Dne Nelson from Glendon, Minnesota, Katie Conlay from Worthington, Minnesota, and Matteline Guler from Pelican Rapids, Minnesota.

They are standing by to answer your calls.

And now on to tonight's program on ear, nose, and throat problems, sleep apnea, allergies, and infections.

Well, welcome doctors.

I appreciate everybody being here.

I think we're quite fortunate to have three ear, nose, and throat surgeons on the show tonight.

So, um, if you could, Dr.

Davis, if you could briefly tell us about your practice in town.

Sure.

Yeah.

I offer, uh, ENT services to, uh, both Aspire St.

Luke's and Duth and Aspirus and Hibbing.

Um, there we offer full scope, uh, pediatric and, uh, adult ENT services.

And I love being in Duth.

I'm from Duth and have uh, enjoyed being back.

So wonderful.

Dr.

Gro, if you could talk about your practice.

I would say uh very similar to Dr.

Davis.

Um just uh in Duth and from cradle to grave from newborn babies to um throughout the whole span of life, all ENT problems.

Wonderful.

And Dr.

Monte?

Yes.

So I practice in two locations.

One is Cloquet where I'm there uh four days a month and I see patients of all ages as well in a general ENT practice and also at Henipin Healthcare in Minneapolis.

All right.

Well, thank you everybody and again thanks for being here.

Um I've collected a couple questions for my patients over the past couple weeks in anticipation of tonight's show.

Um one of my patients was wondering, this is a patient from Sandstone.

What is meant by fluid in the ear?

How is it treated?

and does it affect my hearing?

So, Dr.

Davis, yeah, so fluid in the ear usually is uh you can get fluid behind your eard drum which uh it can either be one in infected fluid which usually causes pain and discomfort or it can just be just fluid that just sits there and yes, it will affect your hearing.

Um it's treated most of the time by if there's an infection we treat with antibiotics but most of the time if it's not infected we just let time take its course.

Sometimes we'll do some uh nasal decongestion sprays or things like that to try to get the the fluid to drain out, but if it stays there for 3 months or longer, we usually go and drain it through an incision.

And a followup to that question, how do you tell if it's infected?

Uh just by doing a good examination.

Typically the eardrum looks very red and irritated and uh you kind of lose some of the normal landmarks.

If it's not infected, you usually can still see through the fluid and it usually has a yellowish hue to it.

Okay, great.

So, something of people should probably get checked out if they think they have fluid behind their ear.

Exactly.

Yep.

Definitely.

And Dr.

Grul, a question from a patient in Moose Lake.

Is it dangerous to get piercings in the nose, lips, and ears?

That's a good question.

I think um the nose, lips, and ears.

I think that a vast majority of people do very well and don't have a problem, but there are certain circumstances where a piercing can be a little dangerous and um sometimes if the if um someone who's not qualified does it and it's not done cleanly, it could cause an infection or occasionally um you you just have to be careful with the type of um earring that you're using because sometimes in um the backings can become log.

just in the ear and it's important to have that uh dealt with before the skin grows over it.

So um but otherwise not usually.

So probably if somebody decided they wanted to get a piercing, it should be done by a professional.

Definitely.

Okay.

Um and Dr.

Monte, can a deviated septum affect sense of smell?

This is from a patient in Cloquet.

That's a great question.

I would say most of the time a deviated septum alone would not.

A lot of times the deviated septum is to one side of the nasal cavity.

So you should still be able to, you know, smell from the other side.

Sometimes you can have a deviated septum to both sides.

And if you had other swelling in your nose, like from allergies or something like that, you could have it could affect your sense of smell.

But most of the time, a deviated septum is just going to make it hard to breathe through one side of your nose constantly.

uh harder to breathe through than the other side.

And is that if somebody had a deviated septum, is that something that needs to be treated?

It doesn't always need to be treated.

There are many people with a deviated septum that don't even know it.

It's mainly a problem if you're having difficulty breathing through one side of your nose.

Uh some people have that problem uh with a CPAP as well.

Uh they have trouble with the air moving through the nose and difficulty wearing it for that reason.

Okay.

And I'm glad you brought up CPAP because I anticipate we're going to get a lot of questions tonight about sleep apnea and a question from one of my patients a couple weeks ago.

Is sleep apnea hereditary?

Dr.

Davis, I guess I I'm not 100% sure if it's hereditary, but it usually does tend to come in families.

You know, there's the, you know, the number one cause of sleep apnea is overweight, but 40% of pe people with sleep apnnea do not have weight issues.

So um there's another there's a number of other uh medical problems that can you know cause sleep apnea.

If you are having daytime uh somulance or you're you're tired throughout the day requiring a lot of naps you should uh probably get checked out by your local provider or your ENT.

Okay.

Excellent.

And Dr.

Grul, maybe we should talk a little bit about what sleep apnea is.

So if you could talk to our viewers a little bit about what that is.

Right.

So um I think well there's more than one type of uh sleep apnnea but most people end up having obstructive sleep apnnea where the upper airway collapses and causes um pauses in breathing at night.

So that can be due to a um a restriction at multiple levels.

It could be partially due to the nose, could be due to the back of the throat or even the back of the tongue.

So um it's it's different too between children and adults like children most of the time can be their sleep apnnea can be fixed with tonslectomy and adnoidctomy and in adults it's a little bit more complicated um addressing those different levels that can collapse.

Well thank you for that answer and Dr.

Monte, this is a question I get from my patients a lot.

Um, one of our callers tonight was wondering, "What is the difference between a home sleep study and an inhosp sleep study?"

So, an inhosp sleep study may measure a few other things.

Um, they're able to measure your effort of breathing, which is one way you can tell the difference between obstructive and central sleep apnea.

Um, I think both tests will tell they'll measure your pulse ox.

So, they'll measure your oxygen levels to see if that will drop uh when you're sleeping, which is important to know as well.

Um, some places can also measure your carbon dioxide levels to see if you're ventilating well enough.

And a home sleep study definitely would not do that.

And just one more thing about sleep apnnea.

Why do we need to treat it?

I mean, all this talk about sleep apnnea, all the different treatments that are out there, having people do sleep studies, why is it important that we treat sleep apnnea?

Untreated sleep apnnea we we know can cause high blood pressure, cardiac disease, uh accidental death increases your risk of stroke.

So you know it puts a significant strain on your heart and your lungs and that strain over multiple years can be extremely problematic and uh so diagnosing it early can add years on your life.

So something that needs to be treated if somebody has it.

Absolutely.

Okay, great.

Uh Dr.

Grul Gary from Duth called and was wondering what causes ear wax and how do we control it?

That's a great question.

So just like the oil that your skin has that makes a protective coating and if you wash your hands too much you wash off all that oil and it gets cracked.

The same principles for the for your ears.

Your ears make serumin or ear wax that kind of acts as a lining and a protective layer against irritants, bacteria, and all types of bad things.

And what what sometimes happens is people try to clean their ears with Q-tips, which are pretty abrasive since the ear canal skin's so thin.

And it can remove that protective layer, and it can be irritating.

it can actually push the ear wax in a little bit and it can even sometimes cause infections or inflammation.

So, I would say a lot in in general, you don't have to clean your ears.

I've never cleaned my ears.

And um but if if people do have problem with their ears getting plugged, using something like mineral oil or olive oil occasionally to thin it out so it comes out naturally or little um home cleaning kits that use peroxide based cleaners, but putting something in the ear is typically not advised at home.

So just to reiterate, people should not be using Q-tips in their ears.

Correct.

Yeah.

Okay, great.

Uh Dr.

Monte, a caller from Virginia is wondering what is the latest on Inspire?

I'm assuming they're talking about the treatment for for sleep apnnea, right?

Uh, so both of our other physicians here today do that surgery.

I personally do not do that surgery, but basically it's a a pacemaker device that gets implanted and there's an electrode that goes around a nerve that helps protrude the tongue.

And so if you're having sleep apnea from your tongue collapsing back into your airway, um it will allow it'll allow the tongue to move forward when you inspire, there's a sensor for your um for your chest wall muscles as well.

So the device knows when you're inspiring and it will move your tongue forward to allow you to breathe.

Quite an effective treatment for sleep apnea.

I understand.

Yes.

Um, our phones are kind of ringing off the hook here.

So, lots of questions, but a caller from Ashland is wondering, "What do the doctors think about nonprescription hearing aids that are advertised on TV?"

So, I think they're a great entry-level hearing aid.

They're more amplifiers than anything else.

Um, so if you have a low level of hearing loss, I think they can be very effective.

Um but the um if you have more significant hearing loss or if you have one ear that hears worse than the other, it's better to get have an aiologist exam examine you, get a formal hearing test and to you know actually get a diagnosis of how significant your hearing loss is.

But um if you're just kind of dabbling in the market and want to see if it's a good starter, that's what they're there for.

So something worth a try, but it might not be the right treatment for everybody.

Exactly.

I would not count out traditional hearing aids if you get a bad result with an overcount hearing aid, but they're probably cheaper.

Much cheaper.

Okay.

Um Dr.

Grul, a caller from Duth is wondering, "How is a chronic cough evaluated?"

That's um that's a topic in and of itself, honestly.

Um there's there's a lot of different causes of chronic cough and I think that it's a very um there are a lot of questions to be asked on individual.

It could be anything from allergies, sinuses, um throat irritation, reflux, or even lung issues like asthma or other um chronic lung issues.

And you can go through a series of treatments to ru to rule in or out each one of those things or um a a series of tests.

Okay.

Excellent.

Um I'm getting a number of questions on tinitus.

So Dr.

Monte, if you could talk a little bit about what tinitus is and how we treat it.

There are two types of tinidis really.

There's subjective tinidis, which means only you yourself can hear this noise in your ears when there's no other noise going on in the environment.

And then there's objective tinidis, which can be something like the sound of your heartbeat that someone could actually hear like with a stethoscope if they tried.

Um, in general though, most tinidis is this subjective tinidis where it's just a noise, sometimes a high pitch, sometimes people describe it as crickets.

And I would say 90% of the time it's associated with hearing loss.

Um, and it's sort of just a side effect of having that hearing loss.

So if somebody's having tenitus or ringing in their ears, they should probably get it evaluated.

A hearing test would definitely be advised if you're experiencing tinitis and especially if it's on one side only.

Okay.

Wonderful.

Well, here come here's a here's a surgical question.

Um, Dr.

Davis, a caller is wondering, "How long should a tube stay in my child's ear after surgery?"

Typically, uh, uh, tubes stay in for about 6 to 18 months on average.

Um, you know, they can stay in longer.

Everyone's practice is a little bit different, but if I have a child who has not had any drainage for 18 to 24 months or any ear infections for 18 to 24 months and they parents want the tubes out, then we can either one try to remove them in the clinic or give them some anesthesia and uh remove it under anesthesia.

But some and sometimes they come out on their own.

Sometimes 90% of the time they come out on their own.

You have you don't need them surgically removed.

And Tube Tubes are what are they used for?

So T- tubes, um, at least in my practice, if you, if a child needs a third set of tubes, so they've had two prior sets, I'll put a T- tube in.

And what a T- tube does is it lasts typically from two to five years.

And it will, uh, uh, this stays in longer um, because kind of flanges that go underneath the eard drum and um, they it's more meant for children who are going to have longer term ear infections.

Okay.

Wonderful.

Thank you.

Dr.

Grul, uh, a caller from Duth is wondering, is it possible to get my sense of smell back after two years after CO?

That's a good question.

I think that we don't know it.

It's only been five, six years, I guess, now that CO's been with us.

And it and it seems like depending on when you are infected, I feel like people complain of hyposmia or anosmia a little bit more.

But what I would say is that it's definitely worth looking into and maybe coming to an ENT office just to make sure because some people lose their sense of smell from COVID in the in the way that we know about meaning it directly affects the nerves and sometimes that can regenerate.

But sometimes people have chronic sinus infections as a result and that can also cause a loss of smell.

So, I think making sure you don't also have that.

Um, but you know, there are smell retraining programs or kits that you can do and um to try and help your smell come back.

But I do think it's worth looking in to make sure there's not another cause.

Oh, wonderful.

Thank you for that answer.

Dr.

Monte, a caller from Hibbing is wondering how are ears related to vertigo?

So there's there are multiple causes of vertigo um related to the ears.

And when we say vertigo, we're referring to a spinning sensation that you get.

Either you feel like you're spinning around or the room feels like it's spinning around.

One of the most common types is when um some crystal particles in the inner ear fall out of place and go into a place they're not supposed to be.

And when they move around in those canals, your your brain thinks your head is moving when it's not.

and it causes you to have this vertigenous or vertigo feeling.

And we have some simple physical therapy maneuvers that can sometimes cure that.

Um there's another type of vertigo you can get from inflammation of your balance nerve and that type of vertigo would last for sometimes a day or two with constant spinning sensation which would just it's an awful feeling for patients.

Yeah.

And there's another type too uh with something called Menier's disease where you can have increased pressure in your ear.

uh you would usually have tinidis with that pressure in your ear, fluctuating hearing.

So there there are a variety of of causes of uh vertigo related to the ear and some that aren't related to the ear.

And I'll just add from my practice, some patients who have vertigo tends to be relatively mild and self-limited, but it can be quite disabling in some cases.

That's definitely true.

Yes.

Um Dr.

Davis, a question from a caller from Duth.

If I have a history of thyroid cancer, it has been removed, can that cancer come back?

It can.

Um, so typically with after thyroid cancer and after thyroid surgery, we usually do five years of followup with ultrasound and laboratory evaluations.

Um, it is depending on, you know, how extensive the cancer was originally.

It's uh kind of depends on whether or not the risk of it coming back.

Typically thyroid cancer is a good actor.

It's not a you know a very uh lethal cancer and usually the survival rates in most populations is exceedingly high.

And if somebody had a history of thyroid cancer that's probably something that should be followed over time.

In my practice I usually see the patient every six to 12 months for five years.

Okay.

Excellent.

Well thank you.

Uh Dr.

Grul a caller from um West Duth.

What else can be done in my home to reduce allergens after dusting and using a humidifier?

That's a good question.

You know, um it depends.

There's a I mean, I guess there's two ways of looking at it.

One is if someone's had allergy testing and know and they know what they're allergic to.

Obviously, those specific allergens can be dealt with.

Um, but one of the other major harboring places for allergens that are difficult to remove is um is carpet, especially old carpet.

Okay.

So, it's it's hard like I guess I I don't have a firm cut off rule and but I think that if carpet's been in for 10, 20, 30 years, I think that may harbor allergens that are difficult to clean.

Well, thank you for that answer.

It's good to know that there's other things they can do other than dusting and humidifier.

Um, Dr.

Monte, a caller from the Iron Range is wondering, "What are tonsil stones and how are they treated?"

Tonsil stones are actually a very common problem that we see a lot.

Uh, usually also a self-limited thing.

Um, but we have little pockets in our tonsils.

They're called crypts.

And when we eat, uh, sometimes particles of food can get stuck in there.

And then the normal bacteria that we have sort of mixes with the food particles and creates these things called tonsil stones.

And it's the bacteria that we have in our mouth that uh gives them a bad smell.

A lot of people think they have bad breath with it.

Um a simple thing to do would be like saltwater goggles to try to remove them.

Um some people can use a water pick.

You'd use to floss your teeth as well on a very low setting.

Don't try it on high setting.

Um but that those can be helpful things and it's my understanding in some cases a tonslectomy might be a treatment for that if it's extremely bothersome um that is something that you can do.

It's somewhat of a radical thing to do for it but it can be done.

Yeah it seems like when when I was a lot younger tonslectomies were very common and they seem to be less common now.

Dr.

Davis is that true?

Yeah the the uh recommendations have changed pretty significantly for tonslectomies.

know when I was a kid pretty much if you wanted a tonslectomy you could get one.

Nowadays um the cut offs for number of strep throats and throat infections you had to have seven episodes of tonsillitis in a single year five and two consecutive years or three and three consecutive years but the most common reason at least in my practice that we're doing tonslectories on kids now is for sleep apnea in children um by far the most common reason why we're doing tonslectomy in kids but as you know Dr.

Monte said there are some other indications chronic throat pain um over three months and I'll usually try to talk my tonsil stone patients out of doing a tonslectomy because it's a little bit more on the radical side or there's usually more conservative measures that can be taken.

Wonderful.

Well, thank you.

Um Dr.

Grul, a caller from Hibbing is wondering, is there any way to prevent chronic sinus infections from my CPAP machine?

Um, well, yes, and maybe they're already doing that, but there are parts that need to be replaced and cleaned.

I think that's probably the most important thing to help.

Um, but if there that's just purely from the CPAP part, if you're more prone to sinus infections, then cleaning the nose as well, irrigating with saline like a nutty pot once or twice a day is important.

And it's also important to replace that bottle every 3 months and use distilled or boiled water.

and um long-term like nasal steroid sprays like Flonese can help decrease inflammation and decrease the risk of sinus infections as well.

Well, thank you for that answer.

Dr.

Monte, you brought up Maner's disease a little bit earlier.

So, a caller was wondering um they think they have Maner's disease.

A caller from Grand Rapids wondering if there's a cure for Maner's disease.

So there is a wide range of things you can do uh for minier's disease and most of it is to just sort of um manage the exacerbations of it when you have flare-ups of it.

Uh the first thing to do is try to limit your salt intake and it's less than 1500 milligrams per day is usually what we recommend which is extremely difficult to do because sodium's and everything.

Yeah.

Um, if that's not working, you can start a water pill, a diuretic, and it can sometimes make you lose sodium, and that can sometimes control the episodes.

Um, if that's not helping, sometimes we have patients come in and they can get uh steroids and either like a steroid injection through the eardrum or steroids that they take by mouth and that can sometimes control the symptoms as well.

And then there are even more severe things that you can do after that to help control it.

So definitely treatments that we can do for this.

There are treatments that we can do.

Okay.

And Dr.

Davis, uh question about nose bleeds.

Um a caller from Duth is wondering why is it not standard treatment to cauterize a frequently bleeding nose while on a blood thinner.

So to be honest, the worst time to cauterize a nose is when you're on a blood thinner because what what we do with cauter is we we create a sore.

we create a wound um by doing the cauterization and like all scabs and wounds that after that scab falls off you're prone to bleeding.

So a lot of patients you're kind of if you're if you're cauterizing the nose on a blood thinner you're kind of chasing your tail a little bit because you're just usually creating more bleeding down the road.

So, and what we do is we the safest practice is to try conservative measures, humidification, topical ointments, and uh nasal saline sprays.

And if that doesn't help them, what we do is we'll get the patient off their blood thinner and then bring them in the office and do cauterization at that point.

All right.

And just one last question.

We have about 15 seconds left.

Um, and I'll just throw that out there to everybody.

Why are nosebleleeds more common in the winter?

cold, you know, dry air and uh forced heat in the house.

You're just it's much more dry in the in the winter.

All right, wonderful.

Well, unfortunately, we're out of time.

So, thank you everybody for your answers.

I really appreciate it.

I want to thank our panelists, Dr.

David Monte, Dr.

Robert Grul, and Dr.

Andrew Davis.

Please join doctors on call next week where Dr.

Mary Owen will be joined by regional experts for a panel discussion about cardiovascular health, heart disease, coronary artery conditions, valve disorders, high blood pressure, and broader vascular concerns with a panel of ex experts from around the region.

And if you're looking for more tips, tricks, and conversation around health and wellness in the Northland, make sure to check out Northern Balance on the PBS North YouTube channel.

Thank you for watching and for joining us for season 44 of Doctors on Call.

Good night.