[Music] good evening and welcome to doctors on call i'm dr peter nalen professor and department head of family medicine and biobehavioral health associate dean for rural medicine and co-leader of the duluth campus of the university of minnesota medical school i'm your host for our program tonight on ear nose and throat problems including sleep apnea the success of this program is very dependent on you the viewer so please call in your questions or email them to ask at wdsc.org the telephone numbers can be found at the bottom of your screen our panelists this evening include dr andrew davis an ear nose and throat specialist with saint luke's ear nose and throat associates and dr jason wall a family medicine physician with essentia health and faculty member at the duluth family medicine residency program our medical students answering the phones tonight are jenny fournier of hermantown jace leslie from hibbing and sarah rykov from duluth and now on to tonight's program on ear nose and throat problems including sleep apnea and already dr wahl we have a question via email if someone diagnosed with sleep apnea stops using the prescribed sleep machine how might this affect their other chronic medical problems like diabetes asthma or reflux thanks dr neyland so originally a lot of sleep apnea we realized that people who have untreated sleep apnea have higher risk of uncontrolled blood pressure heart disease or diabetes and so it really has a there are a lot of ramifications of and we know that people struggle sometimes with getting used to it or the fatigue of having to to spend every night getting a machine set up but the the benefits are clear that you're going to have a healthier heart better blood pressure better control of your blood sugars and certainly a more functional day from the enhanced sleep that you'll have from the machine use and they've really come a long way with all of the different mechanisms to deliver that airflow to prevent the obstruction in your upper airway i mean there are nose pieces there are face pieces they're soft there's a whole whole industry out there to it's just keep working with us and we'll figure it out thank you and dr davis a related question a patient with mild hypopnea could not tolerate the cpap machine and its nasal cannula could allergies be part of this problem that's a very good question and it's something i see my practice a lot the nose can definitely have an effect on patients compliance with cpap there's a number of different treatments we can use including some simple things like nasal steroids to help open up the nasal passages a little bit um but if there's an obstruction issue there's surgical procedures we can do to help that as well so we also have a surgical question are tonsillectomies less common and what explains this trend it's something that we've seen you know over the last two to three years with the covet pandemic kids are in daycare less kids are in school less so they're not getting the necessary four to six tonsillitis a year so the overall tonsillectomies we've been doing has gone down significantly and now i would say the most common reason we're doing tonsillectomies in kids is for obstructive sleep apnea it's interesting dr wahl how do you interpret the locations of sinus pains so a sinus infection is is one of those uh it can be a mimic and so sometimes uh people come to us and they say oh i have migraines or i have um you know i every time i put my head down i have you know something's wrong because every time i put my head down i have you know pain behind my eyes and so i think uh in the past there used to be a lot more we used to try to trans-illuminate and of course we're gonna you know get a good history that's the first thing is you know is it behind your right eye is it behind your nose that'll you know there are ethmoid sinuses maxillary sinuses frontal sinuses uh basically four four sets of sinuses when it really comes down to it if it's kind of deeper in the nose we often need some advanced imaging to see or we can ask our good colleague dr davis to you know kind of take a look with um some with a fiber optic scope but classically you know there are some sinuses uh up in the forehead sinuses right below the eyes will be your maxillary and then behind the nose or back deep you have some ethno ethmoid and sphenoid sinuses so those can be a little trickier to to diagnose and certainly on the rarer end but the location of the pain can kind of help the treatment is largely going to be the same but when it's ethmoid we also get concerned about potentially some more rare conditions is there are there some benign growths or even could there be a a a cancerous growth that's um kind of causing sinus pain because of its location within the skull um it yeah pictures are are ultimately going to be the our best friend with uh with cases that don't resolve um immediately speaking of uh imaging and diagnosis dr davis how is it actually possible to pass a flexible scope in through the nose well fortunately unfortunately my pain a lot of my patients have to experience this with me um we at ent we do flexible fiber optic laryngoscopies all the time i'm doing probably about 10 to 15 a day and depending on what the patient needs sometimes they need a little bit of a local numbing medication inside their nose to kind of make it a little bit more tolerable but most patients just are able it's a quick exam and most patients are able to tolerate it without too much problems but um i always tell patients it's kind of like getting a covet test but i can actually see where i'm going so thank you and dr wahl do you encounter mononucleosis that is mono in your practice and and how does it relate to ear nose and throat it's been quite some time since i've seen mono it's it's out there i can't speak from an epidemiologic standpoint why there's maybe less of it right now it's certainly out there we have you know rapid tests for it and how it could you know certainly one of the hallmark symptoms of mononucleosis is going to be fatigue associated with significant lymphadenopathy which translates to swollen lymph nodes and so you can get a lot of lymph nodes swelling you can also get swelling of your liver but that's going to really affect your breathing and it's going to lead to potentially uncomfortable eating more difficulty you know snoring would be a classic symptom and i think you know from a family medicine perspective i i don't immediately go to it being an ear nose and throat concern i'm much more concerned about if somebody's diagnosed with mono and they're a young person then they're active i'm worried about just keeping their their spleen um you know i don't want them to because your spleen can swell when you have mono and if you're playing football hockey you know you accidentally that swing is spleen is swollen and you accidentally fall you know say just even slipping on the ice it can it can be kind of a you you can bleed a lot when you're when your spleen is damaged so that's not related to ent but certainly you could expect to have some upper airway all the lymph nodes in your tonsillar tissue and in your neck could be quite swollen and that should get better but it's going to be weeks not days okay thank you dr davis back to the nose what is a deviated septum and is it natural or traumatic so it can be both no one's septum is truly straight i mean it's uh babies are born with deviated septums but the majority of them are usually traumatic and the majority of them are usually benign they usually don't cause any problems just because you have a dba septum doesn't necessarily mean that you have you know obstruction of breathing or any difficulties breathing but it's the patients come to see me when it gets to the point where you know they're doing their sports activities or their daily activities and they're noticing there's more difficulty to get air flow in through the nose so it can be a natural thing but also can be a traumatic thing as well thank you dr wahl can allergic rhinitis occur in the winter certainly there are perhaps you know more insidious allergens that cause because especially in this recent weather 20 below whether you're burning wood in your house so wood smoke more pet dander you don't really have your windows open when it's 20 below out and so all of the environmental allergens that are normally occurring in our house pet dander wood smoke cooking fumes they're all going to be concentrated in the winter and so it's not a luxury everyone has but you know if you have the option of an air exchanger in your house that can bring clean air in and there are certainly ways if you suffer from allergies talking to about a way to to make sure that you're moving fresh air into your house and of course continuing the prescribed treatment nasal steroids as dr davis mentioned are the really the backbone of treating all of those environmental whether it's a seasonal allergy in the spring of the fall or an environmental allergy of course there are some very specific allergies to like certain um like i know in certain situations certain living environments there can be like uh dander or um feces from mice and other things some people develop very specific allergies and we do have some very specific medications for those but that would you would see a specialist and they would diagnose your specific allergy by and large most of the winter allergies are due to the pet dander and the particulates in the air from and so those are treated with the nasal steroid thank you dr davis a caller asks which one is better oral appliance or cpap in the treatment of sleep apnea that's a great question um the the gold standard treatment for sleep apnea is always going to be cpap there's no there's no question about it now oral appliances are very effective and can be as good as cpap in certain patients but the if the tried and true method to treat sleep apnea is always going to be cpap thank you and dr wahl a viewer asks is melatonin safe and does it work for sleep issues excellent question melatonin is generally regarded as safe however if used improperly can melatonin released by the pineal gland in the brain is part of our circadian circadian rhythm people will use melatonin to help reset their sleep wake cycle if they were to take an overnight flight to say you know across to europe the thought would be that when you take melatonin you're setting your body up you're telling your body to sleep so using it at the wrong time or in excess amounts can disrupt that but in theory melatonin should it's just my experience is sleep if you allow me it's it's kind of like a lot of things it it really depends uh if you have a lot of stress in your life if you are you know a four-pot a day coffee drinker and you're drinking coffee well into the afternoon if you're taking medications that are are stimulants such as for attention deficit hyperactivity disorder uh using another medication to help you sleep might only be part of the solution and so i think for somebody who's having trouble sleeping there's a whole area of sleep hygiene which means you know avoiding bright screens going through the same routine every night making sure that your room is cool you've not had stimulants your nicotine is another stimulant so there are any number of things that you want to make sure are not preventing you from sleeping and then moving to a medication like melatonin would be a for a good next option thank you dr davis a parent asks will my child's eardrums heal completely after the ear tubes fall out this is a common question i get and part of the kind of informed consent process with uh miriam academy and tubes are putting your tubes in um ninety-five percent of the time they do um five percent they don't in that five percent a lot of times we can do small little procedures that don't have to have uh you know ear drum reconstruction or anything like that but we can kind of get them to close on on their own but um about five percent of kids tend to uh hold on to those holes and we have to do things when they get a little bit older um to make those holes close okay thank you dr wahl do sinus cleaning machines really work a caller from superior asks fascinating question uh certainly if you go into the uh sinus aisle at your local pharmacy you're going to see a number of nasal rinses and spray bottles and so i'm not sure that you know i'd have to know the exact details of the machine certainly many people all over the world do irrigate their sinuses people may be familiar with the neti pot that's another way of irrigating your sinuses certainly using a saline solution the salt draw is a mucolytic agent meaning it loosens all the mucus and breaks it down in the sinuses and allows it to be flushed out and so people that have some anatomic um deformities to their sinuses uh excess mucus production or irritated mucosal meaning the lining of the sinuses that that tissue lining the sinuses can all benefit from rinsing and using a machine that's going to rinse or just simply uh using a like a neti pot that will irrigate their sinuses now with that said um it's also useful in seasonal allergies you can wash the pollen and the allergens out of your sinuses too so dr davis you might have some additional insights yeah i mean i think it's extremely important in terms of uh sinusitis and uh chronic allergy treatment i mean it's my reflexive thing i put my patients on is saline rinses at least twice a day flonase or nasal steroids and then amongst depending on what the issue is other treatments but almost all my allergy patients get at least saline irrigation so a nutty pot or else nasal steroids also dr davis a viewer describes having had meniere's disease and now the jaw moves and sounds like a clicking keyboard in the ear what might be causing that well i sympathize you with you for your meniere's disease that is one of the uh toughest diagnoses that we can give to vertigo patients it's a it's a very trying diagnosis jaw clicking is can be kind of a widespread complicated thing the majority of jaw clicking is secondary to temporal mandibular joint disorder or tmj for short which can kind of kind of localize jaw pain clicking and soreness that's usually what it is but if it's causing you significant symptoms i'd definitely recommend going to your local ent or your primary care provider dr wahl another question about sleep apnea is it true that losing weight can help sleep apnea yes yes weight loss is one of the um it's the probably most effective ways short of cpap to cpap will you'll notice immediate benefit and weight loss will amplify that benefit okay and is sleep apnea hereditary i don't know the answer to that my guess is yes absolutely i think we all have the architecture of our hypopharynx the back of our throat is going to be genetically influenced and some people just have necks that are shorter stouter and when we um and with the amount of tissue that you have in the back of your throat when you fall asleep it relaxes and it can fall over your airway and occlude the airflow into your lungs and so i think there's certainly a genetic component to that yeah i would agree there's definitely a genetic previous predisposition to it dr davis we're getting uh two questions about tinnitus ringing in the ears one is what can treat it and are medications involved tinnitus is a really difficult problem millions and millions and millions of people across the country struggle with tinnitus and kind of how i describe it to patients is kind of the brain's understanding or the brain's feedback to their hearing loss so attendance is usually caused from you know hearing loss um how to treat it that is a extremely difficult problem that you know the fda and many different groups across the country have put millions and millions of dollars into that to be honest we don't really have an effective treatment so what i usually tell patients to do is masking treatments meaning you know have a fan on the background have the radio on in the background to kind of dumb down the noise if it bothers you at night to have a noisemaker on shusher you can get in the baby aisle to kind of help bring down that tinnitus if you google tinnitus there's a million different treatments out there there's million different medications none of them are recommended by the ent groups and i would talk to your primary care doctor or your local ent before starting the treatments okay and a quick follow-up question dr wahl could receiving a vaccine lead to tinnitus i'm not aware of any particular vaccines where it is a certainly of the hundreds of millions of vaccines there there have been there's a whole reporting system for adverse events uh it's not a common side effect or even a rare side effect of any any vaccine okay and a question from duluth dr davis is removing tonsils from a 28 year old more difficult and how long is the recovery now that's a great question um it's not technically more difficult that surgery takes about the same amount of time it is a much more difficult in the patient postoperatively post-operatively compared to kids and we don't really know why it's probably because the tonsils are more scarred in they've had 28 years of infections and you know just chronic scar tissue um i tell patients to expect at least two weeks of significant pain postoperatively and their their major side effect of tonsillectomies that we worry about is you know post-operative bleeding and that can go up to five to ten percent so you really need to have a thorough discussion with your local ent if that's something you want to go under thank you dr walla viewer from duluth is suffering from post nasal drip that leads to sneezing why is that so mucus there's an irritant or mucus is coming from your sinuses and draining down the back of your throat and stimulating uh some of the either the the receptors in the back your throat or further down that are causing you to gag or sneeze and so the treatment for that would be to decrease the flow of mucus and the best way we have of doing that is with a nasal steroid doesn't happen right away but the mucus the inflamed tissue stops secreting so much mucus and then you slow down the nasal drip dr davis what is a schotsky ring and what causes it so shosky's ring it's a kind of a concentric area of scar tissue in the esophagus that you know causes patients to have pretty significant swallowing issues i mean i've you can have really bad regurgitation and you can get food completely stuck in your esophagus where you really struggle to get it up now the main cause usually is chronic reflux or chronic irritation but there's other things such as trauma and things that can cause it too but reflux would be the main issue there okay and dr wahl a quick question a caller has seen a patch worn for sleep apnea what is that boy i i'm not familiar with the patch i personally don't know what the patches have now okay and dr davis a brief question what's a common imaging test you order and how does it help you i mean the kind of the uh the thoroughbred of imaging for ent is a ct scan so we get ct scans for you know neck masses for sinuses for a number of different things so ct is my go-to okay thank you and dr walla patient calls about a clicking and discomfort in the jaw hinge while chewing what might lead to it or what might help certainly as dr davis mentioned earlier temporal mandibular joint dysfunction otherwise known as tmj syndrome involves where the the jawbone articulates with the skull and sometimes it's genetic sometimes simply wear and tear lots of times it's due to trauma or poor over the years bites and people grind you know bruxism grinding your teeth at night people aren't even aware of it and they're putting tremendous force on those joints in their jaw and it can lead to breakdown of the cartilage and a clicking and when they go to open their mouth to eat or chew um they'll they'll notice a popping and clicking and so i think the second part is what can be done about it there are whole clinics and to try to we have medications um we have injections uh a lot of it has to do with uh making sure that we address the the reason that led to uh the the damage in the joint the first place lots of times that's uh clenching the teeth at night too so sometimes seeing a dentist or making sure you have the right um protection for your jaw and your teeth at night too dr davis you may have some other no i i agree with those points very good well this has been a most illuminating set of questions that have come in quite briskly from our callers and viewers and really appreciate your time and attention in answering them both of you thank you thank you well i want to thank our panelists dr andrew davis and dr jason wall and our medical student volunteers jenny fournier jace leslie and sarah rykov please join mary owen next week for a program on lower gi problems when our panelists will be dr robert erickson and dr stephanie judd irwin thank you for watching good night [Music] [Music] [Music] you