General

What Are They?

Tonsil Stones, also known as tonsilloliths, are lumps that form within the tonsils. These can be either white or yellow and are usually firm. Though very unpleasant for the sufferer, tonsil stones are not contagious and rarely go on to be anything serious. Quite often, a person with tonsil stones will not be aware they have them to start with as they aren’t easy to see and although they can get to be the size of a grape, they can also be as small as a grain of rice. They can cause swelling and pain in the tonsils and they have an unpleasant odour.

Causes

Mucus, food, saliva and dead cells can build up in the pockets of the tonsils (tonsil crypts). This causes bacteria and fungi to develop and with time this will form a tonsil stone. Sometimes one will form, other times it can be several at a time. Things that can cause this build-up include:

• Bad oral hygiene
• Chronic sinus problems
• Oversized tonsils
• Chronic tonsillitis

Symptoms

It can be hard to visibly spot tonsil stones but there are symptoms that come with them that will make you aware there is an issue. These include:

• Yellow or white lumps on the tonsils
• Earache
• Painful and swollen tonsils
• Persistent cough
• Smelly breath
• Sore throat
• Difficulty swallowing

Prevention

Tonsil stones can return once you have them. There are several things you can do to prevent this from happening. These include:

• Keep hydrated with plenty of fresh water
• Keep on top of oral hygiene and brush your tongue as well as your teeth
• Swill your mouth out with salty water regularly
• Do not smoke

Treatment

Although tonsil stones are usually harmless, most people understandably want them gone as soon as possible. Methods to remove them include:

• Coughing – Vigorous coughing can loosen the stones
• Minor Surgery – In extreme cases, this is an option although rarely cures the underlying problem
• Gargling – Using salty water or mouthwashes to gargle can ease the pain and swelling and help to loosen the stones
• Tonsillectomy – Removal of the tonsils to prevent further infections in chronic cases will solve the problem
• Antibiotics – These will lower the build-up of bacteria but will not treat the initial cause

The National Institute of Clinical Excellence (NICE) has published guidance in September 2019 about Implant surgery for prominent ears, including Earfold. The recommendations support the use of Earfold in the context of a clinical or research study. I am in the process of preparing a clinical study protocol so that patients can continue to benefit from a choice between traditional pinnapasty and minimally invasive techniques such as Earfold, in order that the most appropriate recommendations can be made.

It is surprising and somewhat alarming how common it is for these small household batteries to be swallowed by children, and the fatality rate has actually risen in the last decade. These batteries are small and sweet-shaped which makes them a hazard with young children around. Damage from swallowing the battery can occur within two hours so it is essential that removal takes place as soon as possible to reduce oesophageal damage. The battery reacts with the oesophagus tissue and saliva, forming a hydroxide-rich alkaline substance that damages tissue.

The symptoms of a child with an oesophageal button battery include:

• Cough
• Fever
• Sore Throat
• Noisy Breathing
• Finding it hard to swallow

The serious complications that could be caused by an oesophageal button battery include:

• Vocal cord paralysis
• Tissue erosion into major blood vessels or airways
• Oesophageal perforation leading to a chest infection

The longer it is between ingestion of the battery and the removal, the higher the risk of these serious complications. This has led to research being carried out into the effectiveness of certain household products that can help to reduce potential damage before the battery is successfully removed. Sodas, juices and sports drinks have all been tested, but honey has proven to be the most effective in protecting small children against button battery injury. This has been demonstrated by a team of ENT specialists at the Philadelphia Children’s Hospital, USA,  who found that eating some honey after swallowing a button battery can help minimise injuries for young children. The research suggests that honey can reduce morbidity and mortality from the batteries significantly. The honey works by coating the battery thereby preventing the alkaline-rich solution from damaging tissue.  It should not be used in children less than a year old or where there is a known allergy to honey. It is essential that the administration of the honey should not delay the transfer of the child to their nearest A&E department for definitive management. Obviously, it is also advised to ensure all batteries are kept out of reach of children and those that are in household items and toys should not be easily accessed.

Inflamed and swollen sinuses can cause sinus headaches, and this can be due to infections, colds or allergies. It can sometimes be difficult to differentiate between a sinus headache and a migraine and it is always best to seek advice from your GP to be sure. Both conditions can cause very similar symptoms, including pain in the face and head, although there are some key differences. Sinus headaches tend to cause pain in the face and frontal part of the head (forehead), including the cheeks, eyes, ears and upper teeth, but rarely anywhere else. In migraines, the headaches are usually also more severe, one-sided and often preceded by an aura or symptoms that the migraine is about to start, such as flashing lights or a feeling of nausea. Pain that is felt predominantly in the neck area is unlikely to be due to sinusitis and is also rare due to migraine. Other causes might need to be considered, such as neck stiffness due to a musculoskeletal cause, an injury or a vascular (blood vessel) cause. It is, however, possible to get some tightness in the neck due to tension or stress, and this can also accompany sinusitis or migraine, although the neck pain is likely to be less severe than the facial pain/pressure.

In the case of a sinus infection, you may also be experiencing other sinus related issues such as nasal congestion, a stuffy or runny nose (especially with an unpleasant nasal mucus discharge which can be green or yellow), or excessive sneezing. If neck pain is present it will likely be a tension-type pain, which is often worse after long periods of inactivity such as after sleeping, on bending over or going from hot to cold temperatures. This neck and head pain together can make you feel fatigued and can be quite unpleasant especially if you also have a fever.

Remedies

To treat sinus headaches and neck pain successfully you can start by using over the counter medicines such as decongestants and anti-inflammatory painkillers such as ibuprofen. This will not only help to relieve the pain but also the pressure caused by congestion. Antihistamines can also be effective if the issue has been irritated by allergies. It is always best to consult your GP before choosing your medication. If there are also signs of an infection, such as green/yellow nasal discharge and a fever, then it is possible that you will require a course of antibiotics from your GP or specialist.

Steps to Prevent flare-ups

The first step towards preventing sinus headaches and neck pain is to find out what the cause is. If the cause is a virus or common cold, then take the usual precautions to prevent a cold by washing hands and surfaces thoroughly and avoiding close contact with people suffering from a cold. If allergies are the cause, then you can take an antihistamine daily, as well as making efforts to avoid the substances to which you are allergic. It is also advised to avoid activities that alter the air pressure such as underwater swimming and flying activities, until such time that the symptoms have improved and you are feeling much better. Otherwise, the changes in air pressure can make the sinus infection (and therefore symptoms) much worse.

Signs Of Something More Serious

It is important to note that a fever along with a headache, neck stiffness and in some cases a skin rash can also be a sign of a more serious issue such as meningitis so always be sure to consult your GP if you are not sure or if your symptoms worsen suddenly over a short period of time.

It is very common to reach for painkillers such as aspirin to ease a headache or a fever, but if you suffer from a disorder known as aspirin-exacerbated respiratory disease (AERD) taking this medication could actually make you feel much worse. AERD can often be treated easily, it causes breathing issues and is triggered by sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs)

Causes

Things that can make you at risk of AERD include:

• Smoking or being exposed to second-hand smoke as a child
• AERD tends to be more common among people between the ages of 20-50
• Having asthma can increase the risk
• Nasal polyps

Symptoms

There is a range of respiratory issues that can occur for an AERD sufferer. These include:

• Sinus problems and pain
• Stuffy nose and nasal congestions
• Headaches
• Watery eyes
• Sneezing
• Nasal polyps
• Asthma attack
• Wheezing or coughing
• Tightness of the chest
• Dizziness
• Fatigue
• Abdominal cramping
• Nausea
• Some people with AERD also find that alcohol can cause respiratory issues.

Diagnosis

There is no blood test to confirm AERD but your doctor can diagnose you by checking your respiratory reactions and symptoms when taking NSAIDs. They can perform what is known as an ‘aspirin challenge’, this is when they watch you take aspirin and monitor your reaction to it. This test should be avoided if you are pregnant or have heart, liver or kidney disease.  It is increasingly the case that this test is administered within a specialist allergy or respiratory clinic in a hospital.

Treatment

There are no known cures for AERD but there are ways of treating and managing it. You may be prescribed inhaled steroids to take daily, nasal steroid sprays or steroid sinus rinses. If you have nasal polyps, you can have surgery to remove or shrink them, although the chance of the polyps recurring if you have AERD is increased. Another possible treatment is aspirin desensitisation. This involves a doctor watching you take small doses of aspirin and increasing the dose over time. When you show a reaction, you will remain on that dose until you are able to manage it with ease. Then the process continues. This has proven to be successful in up to 90% of cases. However, the benefit of aspirin desensitisation continues only for as long as you continue to take the aspirin.

Most children will occasionally snore, and some will snore frequently. Light snoring that can barely be heard is rarely a cause for concern. If a child is consistently snoring loudly this could be an indication that they have a respiratory infection or an allergy. However, it could also be a sign of a more serious illness such as sleep apnoea.

Everyone is allowed to have a short gap or break in their breathing pattern at night, however If a child’s snoring also includes frequent or particularly long pauses or gasps (10 seconds is thought to be an acceptable upper limit), this could be a symptom of  sleep-disordered breathing, or obstructive sleep apnoea syndrome (OSAS). These pauses and gasps cause inconsistent breathing patterns for the child which in turn causes the child not to get the required amount of quality sleep meaning they will be overtired in the daytime. There are some known contributing factors to sleep apnoea, which include:

• Asthma
• Allergies
• Enlarged or swollen tonsils and/or adenoids
• Obesity
• Reflux disorders
• Face or jaw (craniofacial) physical abnormalities

So how can you know if your child is suffering from sleep apnoea? Well, there are a few signs that you can look out for. Obviously, snoring is the first symptom, so keep a note of your child’s snoring pattern and volume. This isn’t the only sign to watch out for though, if your child is frequently waking up during the night then they will likely be tired during the daytime. They could also be sleeping in unusual positions in order to make their breathing easier, or be particularly restless and fidgety. If your child’s behaviour and moods seem to change then keep an eye on these changes as it could also be linked to sleep patterns due to snoring and breathing issues. Finally, excessive or increasing sweating at night can indicate that your child is working harder than they should be to breathe comfortably.

To determine if your child does, in fact, have OSAS you will first need to be assessed by an ear, nose and throat (ENT) consultant or a paediatrician, or in some cases both specialists. It is possible that further tests may be required, such as blood tests, X-rays and/or an overnight sleep study at a hospital. Your GP or specialist can make the necessary referrals for this. The sleep study will record breathing patterns and the heart rate of your child and the results will provide the diagnosis and a treatment plan can be made.

There are a number of treatments available for OSAS. These are:

• Medical treatments such as steroid drops or sprays or even antibiotics in some cases, following an ENT review
• Nasal prongs to keep the airway open – occasionally required in young children or infants with syndromic or craniofacial problems.
• CPAP – The child wears a mask while asleep which provides continuous air flow. This is usually only required in the most severe cases.
• Surgery – one of the commonest causes of sleep-disordered breathing or sleep apnoea in children is having large tonsils and/or adenoids. Surgery to address these problems (adenotonsillectomy) is occasionally required and very often extremely effective.

If you are worried about your child snoring, you should make an appointment with your GP in the first instance to discuss the treatment options.

It’s one of those annoying things that often goes hand in hand with illnesses such as the ‘flu, sinus issues or a cold, and it can make you feel even worse than you already do. Ear pressure can be particularly irritating but it is something that can be eased. It usually goes away by itself once the illness is over but there are ways that you can relieve ear pressure.

Why Do Your Ears React When You Are Sick?

When you are ill with a feeling of a congested or sore head, it is likely that your ears feel stuffy, blocked or tender. This is due to the fact that our ears, nose and throat are all connected so they tend to all suffer together.  We have two Eustachian tubes situated at the back of the nose, which connect directly with the idle part of the ear, so any pressure related issues in the nose or sinuses can be transmitted to the ears. This can occur during congestion caused by a cold or ‘flu, but also due to a change in atmospheric pressure such as occurs when flying or scuba diving.

What Can You Do To Relieve Ear Pressure?

More often than not, your ear pressure will go once your illness does, whether that be on its own like a cold or with medication for an infection. You can reduce the stuffiness and pressure in your ears by treating the congestion and swelling in the ears nose or throat that is causing the issue. This can be done by:

• Nasal decongestants. This can be in the form of a spray or tablets such as Sudafed. The spray is particularly effective during an acute cold or ‘flu, although they should not be used for more than 5-7 days continuously. Always be sure to follow instructions for any medication.
• Clearing your sinus by inhaling steam either on its own or with the addition of menthol / eucalyptus drops is usually very helpful and will also make you feel better.
• Saline (salt water) nasal rinses – either a spray such as Sterimar or a more thorough rinsing system such as NeilMed Sinurinse are effective at clearing out excessive mucus from the nose, thereby helping to clear the Eustachian Tubes
• An antihistamine may also be useful particularly if you suffer with allergies

A few simple things to try that may solve the issue quickly, particularly if it feels like your ears have “popped” are:

• Yawning
• Swallowing / Gulping
• Suck on a cough sweet
• Hold your nostrils closed and close your mouth, then gently breath out.
• Chewing gum

Signs To Look Out For

If the pressure you have been feeling in your ear remains once the illness has passed or you experience pain, leaking fluid or hearing loss then it Is best to be seen by your GP or an ENT specialist as you may have an ear infection or other ear related condition that could require a different line of treatment or medication.

A recent study suggests that our noses could be capable of adapting themselves to efficiently inform the brain of the most typical smells in our surroundings. These new findings can help us to gain a better understanding of why and how our noses adapt to these smells, as well as why time and age can decrease the neurons in the nose making our sensitivity to smell weaker.

When molecules drift from items in our surroundings they trigger the receptor neurons in our nose. Mice have up to 10 million receptor neurons in their nose, which are separated into more than 1,000 types. Each type will respond in a different way depending on the molecules detected. Every smell can activate a number of different receptors and every receptor can be activated by a number of smells. So, to fully understand a smell, our brain must be capable of reading the coding of the receptor types and how they are activated.

It is suggested that receptor types are used differently depending on the smell they are exposed to, and that our nose can train itself to inform the brain efficiently as possible about the smells in particular surroundings. Tiberiu Tesileanu, a spokesperson for this recent study explains that the receptor types that are triggered by variable smells carry a lot of information to the brain about regarding this variability and are therefore more abundant in the nose. This appears to be the first time that such coding ideas have been used when looking at the use of these receptor neurons. Further work is needed to look at the types of smells that are typical of our surroundings and how they are detected by our receptor neurons and further experiments could be carried out and compared to help gain a greater understanding of how efficiently neurons carry information to our brains when a new smell is detected.

People who are suffering with a poor or absent sense of smell can help themselves by undertaking ‘smell training’. This is a more modern concept which aims to stimulate the olfactory (smell) neurons in the nose as well as central pathways and also by reactivating smell memories from the brain, with the objective of improving the appreciation of smell. It is a bit like going to the gym to train a muscle except this time it is to improve your sense of smell.

Please visit www.smelltraining.co.uk or www.fifthsense.org.uk for further information about the sense of smell and training.

Hoarseness is a word that describes a change in the voice. This change will differ from person to person. Usually the voice takes on a rough, raspy quality, although it can also show signs of weakness or a changed in volume. It may also have become higher or lower pitched or become more strained. Words often used to describe the voice changes include ‘creaky’, ‘rough’, ‘squeaky’, ‘raspy’ and ‘breathy’

Causes Of Hoarseness
There are a number of causes of hoarseness, most of which are not serious and improve quickly with help. Hoarseness is caused when something alters the vocal cords in our voice box (larynx). Some voice changes are normal and not cause for concern. Children’s voices will change as they grow up, especially boys during the puberty years. Elderly people tend to gradually lose the quality and strength of their voice, particularly after the age of 70. These are natural causes of hoarseness that can not be helped but do not pose a threat.
The most common medical cause of hoarseness is a cold or a virus. This could be your common cold which is an infection in the nose, throat and larynx or a virus such as influenza. When a virus causes swelling of the vocal folds in the larynx and changes our voice, It is known as laryngitis. People who over use their voice, repeatedly clear their throat or shout a lot are more at risk of laryngitis, including people who smoke and drink.
There are less common causes of voice hoarseness, such as damage to the throat, benign tumours, cancer, Parkinson’s disease or a stroke.

Treatment
If the hoarseness is the result of a virus, this will not require antibiotics. Your GP may advise the following:

• Minimise use of the voice and use it quietly
• Quit smoking
• Keep hydrated, especially with water.
• Avoid caffeine and alcohol
• Use over the counter painkillers

If you experience any of the following, then your GP may feel there is a more serious reason for your voice hoarseness they may refer you to hospital.
• If you have not had a cold or virus
• If you are a heavy drinker or smoker
• If you have pain swollen or lumps in the neck / throat
• If the hoarseness persists for more than 3 weeks without improvement
In such situations, you will be referred to an ENT surgeon who will examine your larynx as well as undertake a general ENT examination. This is to rule out a structural problem with the larynx. If there any problems then they can be treated. This might involve speech therapy to strengthen the muscles of the voice box, or possibly surgery in some cases.

Acid reflux is a common condition which occurs when the acid in the stomach travels back up to the oesophagus (food pipe) and irritates its lining. If it reaches the throat, this can cause a dry cough, sore throat, bitter tastes, heartburn and indigestion. You may notice acid reflux after a big meal, while laying down or bending over or after eating something spicy.
Symptoms Of A Sore Throat From Acid Reflux Include:
• A persistent cough
• Food getting stuck in the throat
• Constantly needing to clear the throat
• Tightness in the throat or a feeling of something stuck
• Burning feeling in the mouth
• Voice becoming hoarse
• A bitter taste in the mouth
Treatment
Usually the sufferer will need to make some life style changes to reduce cases of acid reflux and the complications that come with it, such as a sore throat. Avoiding the foods and activities that set it off is the first step to take. There are some medications that can help reduce stomach acid and relieve the symptoms associated with reflux. There are also some home remedies to try, these include:
• Eating little and often and avoiding larger meals particularly in the evening
• Keep to a healthy weight
• Do not smoke
• Avoid dairy where possible
• Do not wear tight clothing such as trousers
• Do not eat within three hours of bedtime
• Cut out alcohol, caffeine and carbonated drinks
• Avoid citric foods and drinks
• Cut out chocolate and mint
• Reduce stress where possible
Complications
If you suffer with acid reflux and a sore throat for a long time you may go on to experience complications such as narrowing of the esophagus or erosion of the tissues which can cause painful ulcers. Consult your doctor if you experience any of the following:
• Trouble breathing, swallowing or opening the mouth
• Pain in joints
• Earache
• A sore throat that last longer than a week
• A feeling of a lump in the throat
• A lump in the neck
• A rash
• A high temperature
• Blood in saliva
• Chest pain