General

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

What Is A Tonsillectomy?

A Tonsillectomy is an operation in which the tonsils are taken out. If a child is having frequent cases of Tonsillitis (this is when the tonsils become infected) then they may require a Tonsillectomy to rectify it. Having this operation will stop your child from suffering from Tonsillitis and the pain, fever and discomfort that comes with it. There are some national guidelines that govern when and if your child might be suitable for a tonsillectomy. If your child has at least seven cases of Tonsillitis in a year, five each year for two years or three each year for three years then this procedure is likely to be the next step. This might come as some surprise to many parents as even one or two severe attacks per year can be quite debilitating  and in many cases surgery is recommended even if the official guidelines are not quite met. Tonsillitis might in some cases resolve by itself but this is not guaranteed. If Tonsillitis is left untreated, it can lead to further complications such as hospitalisation for intravenous antibiotics, severe breathing problems and the spread of infection to nearby structures such as deep tissue or neck abscesses.

What Does The Surgery Entail?

There are several ways to perform tonsillectomy from a surgical point of view. By whichever method, Tonsillectomy is performed under a general anaesthetic and takes around half an hour to complete. The operation will be performed through the child’s mouth. The tonsils will be cut away from the layer of muscle beneath it or heat may be used to remove them and cauterise the area. Any extra bleeding will be stopped.

Recovery And Complications

Usually you will be able to take your child home the day of the operation. The pain will last for up to two weeks and will feel more tender in the mornings. The pain can be quite severe and will get worse before it gets better. You will need to keep your child off school for the two-week recovery period. This will help to avoid infection while the throat is healing.

The common complications associated with a Tonsillectomy are pain, bleeding, infection in the wound and blood clots, ear pain, altered or reduced taste and dryness of the lips and gums. There is a very small chance of some regrowth of tonsil tissue in the future although this is quite unusual.

It may come as no surprise to hear this if teaching is your chosen profession, but studies have shown that teachers are at a higher risk of vocal damage.

A teacher’s voice is their main tool in interacting with students, and is often used for prolonged periods of time, usually in noisy environments.

A study at the University of Malaga in Spain, focusing on 282 teachers, has revealed that 62.7% report having problems with their voice on a daily or weekly basis. This can lead to various problems, as the study also found teaching staff with vocal problems report less respect for their work and more insecurities in their duties.

Looking after your voice as a teacher is vital, and there are a few things you can do to prevent damage:

• Rest your voice – Alternate the types of activities you do with your class to give your voice a rest every so often
• Avoid Shouting When Possible – When you are competing with loud background noise or a large teaching area, you may have no choice but to raise your voice, but try to avoid shouting whenever you can as this puts extra strain on your vocals
• Stop clearing your throat – Try swallowing hard or sipping water instead
• Keep hydrated – 6-8 glasses of water a day can help keep your vocal chords moist. If they are irritated, try breathing in steam to soothe them
• Breathe through your stomach and diaphragm – Shallow breathing from your upper chest can damage your voice. It is a good idea to practice slower breathing from your diaphragm, feeling your rib cage move in and out as you breathe. Concentrate on the tension you are releasing by breathing in this manner.

If you have had persistent voice/throat problems for more than a few weeks, it is advisable to seek out professional medical advice to rule out any underlying problems.

Glossitis is an inflammation of the tongue, causing swelling and changes in the tongue’s texture and colour.

Types Of Glossitis:

Acute glossitis – Develops fast with severe symptoms.

Chronic glossitis – Usually caused by an underlying condition.

Atrophic glossitis – The small bumps on the tongue, called papillae, shrink. This causes the tongue’s surface to look glossy.

Median rhomboid glossitis – Usually caused by a Candida yeast infection.

Symptoms

Pain and swelling in the tongue

Difficulty swallowing

Burning or itching

Change in the texture and colour of the surface of the tongue

Issues speaking or eating

Causes

Allergic reaction

Mouth injuries, such as cuts or burns

Dental braces

Diseases such as celiac disease, protein-calorie malnutrition, pernicious anaemia and Sjögren’s Syndrome.

Infections, either bacterial, viral or fungal

Nutritional deficiencies

Diagnosis

If someone has symptoms of glossitis, they should see a dentist or a doctor. They will assess the person’s history and symptoms as well as examine their mouth and tongue thoroughly, noting any abnormalities, bumps or blisters on the tongue’s surface or on the gums. A saliva swab or blood test may also be taken.

Treatment

Treatment of glossitis depends on the cause. If it is infection or disease, medication may be prescribed. Glossitis will usually respond well to treatment once the cause is determined. A doctor may issue dietary supplements if a nutritional deficiency is the cause. They may also advise of the dietary changes needed.

Prevention

You can lower your risk of glossitis, but it is not always possible to fully prevent it. Things that can help keep it away are eating a healthy diet, brushing, flossing and rinsing your mouth and teeth at least twice a day and cutting out irritants such as spicy foods, acidic drinks and cigarettes.

Overview

A glossitis sufferer will usually make a full recovery over time with the right treatment. If the symptoms persist they will need to seek further medical attention. If the tongue is severely swollen and begins to block the airways, the person will require emergency medical attention as this could suggest a serious underlying condition.

Hyperosmia is a condition in which the person has a heightened sense of smell, usually caused by another condition but in some cases, it can occur on its own. Here we look at the symptoms, causes and treatment of hyperosmia.

Symptoms

• A heightened sense of smell
• A dislike to strong and overwhelming smells, sometimes becoming unbearable
• Discomfort or illness when smelling potent things
• Headaches and migraines
• Nausea and vomiting
• In rare cases, anxiety or depression

Trigger Smells

• Certain chemicals
• Perfumes
• Scented candles
• Cleaning products

 Causes

• Pregnancy – The hormonal changes that occur during pregnancy can cause hyperosmia. This can lead to increased nausea and vomiting during the pregnancy, however the hypersomia tends to go away once the pregnancy is over.
• Genetics – Although not fully backed up by science due to lack of research, it is thought that hyperosmia could be partly due to genetic/inherited factors
• Autoimmune disorders
• Kidney issues
• Lupus
• Lyme disease – This attacks the nervous system which in turn can change your sense of smell. Not everyone with Lyme disease will have hyperosmia although the risk is increased
• Allergies
• Diabetes
• Nutrient deficiencies
• Some prescription medication

Treatment

Hyperosmia usually improves ones the underlying cause has been treated, and in a lot of cases your smell will return to normal over time even without any treatment. Chewing peppermint gum is thought to help until you are away from offending smells. If there is a growth, polyp or tumour that is causing the hypersomnia then that should be removed. The main thing to do if you are suffering with a heightened sense of smell is to establish the triggers and do all that you can to avoid them until the root cause is pinpointed and treated. Be sure to talk to your doctor to avoid the condition impacting on your everyday life.

Drooling can be embarrassing for children and adults when it occurs, as it is something usually associated with babies. Therefore, most people will avoid talking about it, even if it is becoming a problem. But what are the causes?

Drooling is something everyone does occasionally, particularly when sleeping when swallowing doesn’t occur as frequently. Therea re many possible causes to consider. The best treatment can depend on what the cause of the problem is.

• Treat sinus problems – Stuffy noses cause people to breathe out of their mouth, thus creating more saliva and making it easier for that saliva to escape. Getting this treated may eliminate your problem.
• Botox injections – This may sound extreme, but injecting Botox into the salivary glands using ultrasound imaging will paralyze the muscles in that area, preventing the saliva forming. This is used to treat people with neurological conditions, and the effects last around 6 months before needing to be repeated.
• Medication – This may be recommended by a doctor for patients with neurological conditions and is called scopolamine. It works by intercepting nerve impulses, and is usually a patch placed behind the ear, each one lasting for 72 hours. Glycopyrrolate is another medication used, but the side effects tend to be more extreme.
• Oral appliances – This is a device placed in the mouth to help with tongue positioning and lip closure, which in turn help with swallowing, meaning a person would drool less.
• Surgery – A last resort, usually only used in patients with an underlying neurological condition when other treatments have failed to work. This will involve removal of the salivary glands.

Finally, there are some less common conditions such as cerebral palsy where drooling is more common because the muscles in the mouth and neck are less tight and more floppy, as well as the position of the head being a little more bent forwards in many cases. This makes it easier for the saliva to flow forwards out of the mouth rather than back into the throat and oesophagus (food pipe).

Sinus Headaches – The Facts

Sinus Headaches are very common and usually follow an infection or allergy. We have four pairs of sinuses which are situated above the eyes, in between the eyes at the bridge of the nose and over the cheeks. A sinus headache can be felt along any of these areas and can also affect either one or both sides of the face. Treatment usually involves tackling the initial cause.

Symptoms

If someone has an infection or allergy, this can cause the sinus membrane to swell up, resulting in a feeling of pressure and/or pain over the face and the beginnings of a headache. The pain will be in the cheeks or above the eyes or nose and these areas may appear swollen.

Sinusitis is an infection that can trigger sinus headaches. A sufferer may have a fever, a blocked nose, green or yellow mucus from either the nose or down the back of the throat (catarrh or postnasal drip) and a lowered sense of smell. The pain may increase after sneezing, coughing or bending down. The severity of the symptoms depends on whether the infection is caused by a virus (such as after a common cold) or bacteria, and how long it has been building for.

Treatment

Medication – If the sinus headache is mild it can be treated at home by simply drinking plenty of fluid and taking painkillers. If the pain is more severe then the sufferer will need to see a doctor. Decongestants may be issued for treatment and antibiotics could be prescribed to tackle the infection.  If allergies are the cause, then you may be given a nasal spray containing steroids or antihistamines.

Surgery – If the sinus headaches are persistent over a few months then you may be referred to an ear nose and throat specialist who will go through your symptoms and medical history, undertake a careful examination of the nose and sinuses with a nasal endoscope, and perhaps arrange a CT scan of the sinuses. Some patients may need surgery to widen the sinuses. In many cases this can be done in a relatively straightforward and minimally invasive way using surgical balloons to treat the problem (balloon sinuplasty).

Home Remedies – You could try breathing in steam to open the sinuses which can relieve pressure. Put your face over a bowl of boiled water, cover your head with a towel and slowly breath through your nose. You can use plain steam or add a few drops of menthol or eucalyptus. You can also use a salt water solution to clean your nasal passage, which can help to drain the mucus from the sinuses. A warm wash cloth placed against the sinus areas for a few minutes three times a day can also be soothing.

A nosebleed (Epistaxis) is usually caused by a broken blood vessel in the nose or sinuses. Nasal bleeding, particularly when blowing it, is very common and usually not a cause for worry.

As many as 60% of people experience nosebleeds but only around 6% need medical attention. It can be difficult to know what causes broken blood vessels in the nose. There are several things that can contribute to this.

Common Causes:

• Dry nasal cavities
• Nasal injury
• Nose picking
• Blowing too hard or too often
• Infection or allergies
• Dry cavities or sinuses
• Exposure to dry or cold air
• Antibiotic medications
• Blood thinning medications
• Changes in humidity
• High altitude
• Septum issues

Less common causes:

• Nasal, sinus, face, or eye surgery
• Nasal tumors
• Inflammatory conditions
• High blood pressure
• Holes in the septum
• Blood disorders
• Leukemia
• Liver or kidney issues
• Severe vitamin C deficiency
• Cocaine use
• Chemotherapy
• Exposure to toxic chemicals

Treatment

Often, a nosebleed will stop after a few minutes without treatment. If not, you can try the following:

• Gently pinching the nose over the soft lower part that can be squeezed between thumb and finger (not the bony part at the top)
• Relax and breathe orally
• Tilting your head slightly back
• Avoid touching or picking the nose
• Nasal packing
• Local haemostatic agents
• Antiseptic creams and antibiotics
• Blood vessel surgery
• Clotting medicines

Prevention

• Be gentle when blowing your nose
• Avoid picking
• Avoid exposure to cold air
• Treat allergies with sprays or pills
• Use nasal lubricants or saline for dryness
• Avoid exposure to toxic chemicals
• Do not use cocaine

When to seek advice

If nosebleeds are chronic or repetitive then you should seek medical advice. If your nosebleeds are accompanied by any of the following you should also see your doctor:

• The nosebleed does not stop after 20 minutes
• The nosebleed does not slow down or stop when you apply pressure and tilt your head
• Eye pain
• Persistent stuffy nose
• Excess mucus in the throat
• Vision changes
• Swollen neck glands
• The appearance of the nose changes
• Pus
• Facial numbness
• Headache
• Persistent watery eyes
• Loss or reduction in sense of smell
• Ear pain or pressure
• Loss of hearing
• Tooth pain or looseness
• Trouble opening the mouth