Quitting Smoking, Tobacco and Nicotine

John R. Bennett, MD
801-328-2522

1255 East 3900 South #301, Millcreek, Utah 84124
756 East 12200 South, Draper, Utah 84020
22 South 900 East, Salt Lake City, Utah 84102

Updated 03/22/2018

Quitting Smoking, Tobacco and Nicotine

Congratulations on considering quitting smoking (or chewing or vaping)! Giving up nicotine will be one of the best things you ever do for yourself. Quitting is very hard. The average person tries to quit eight times before they succeed. Never quit trying to quit. Know that some day soon you will be a nonsmoker (nonchewer, nonvaper). Go ahead and get mad at the tobacco and the tobacco companies! Tobacco is robbing you of your health, your money, your youth, your good looks, and ultimately, your life. Think of tobacco as a dear friend, a friend you love being with, but a dear friend that is trying to kill you. It is time to say goodbye to tobacco.

The most important factor in quitting tobacco is deciding to quit. Get mad, and get motivated. Don’t let yourself grow much older before you quit. Stay young and healthy and good-looking as long as you can, and quitting nicotine and tobacco is the best way to do that. If your partner uses nicotine, talk to them about quitting with you. It is far easier to quit with someone else, and it is far harder to quit if your partner keeps using nicotine.

It is easier to quit if you aren’t consuming as much nicotine, so start by cutting back on how much you smoke, chew, or vape. When you have cut way back and are ready to quit, pick a quit date, and tell everybody. Make it a public event so you have lots of support. When you are heading out for an evening with friends, remind them that you are now a nonsmoker, and if they are nice friends, they will support you! As you are quitting, you will often not be in a very good mood for a month or so, so tell everybody to be understanding! It is common to get in a disagreement at home or at work when you are trying to quit, and you will want to go have a smoke. Don’t fall for that – that is just the nicotine addiction taking advantage of a weak moment! Think about when you like to smoke or chew, and try to replace the smoking with something else. If you smoke in the car, have candy or gum to distract you. If you smoke in the morning, have a piece of toast in your hand instead. You can still enjoy a drink with friends in the evening, but remind them to help you to not smoke with that drink!

There are many aids to assist you giving up nicotine, and you may want to try these, especially if you have already failed to quit several times. Check out SmokefreeTXT, QuitGuide app, 1-800-QUIT-NOW (1-800-784-8669), or 1-877-44U-QUIT (1-877-448-7848). Stay busy when you are quitting to distract you from your cravings- exercise, take a walk, chew gum or hard candy, keep your hands busy, drink lots of water, relax with deep breathing, go to a movie, spend time with nonsmoking friends, and go to a restaurant. Avoid smoking triggers- throw away your cigarettes, lighters, and ash trays, avoid caffeine (which can make you jittery), get plenty of rest and eat healthy, change your routine. Stay positive and reward your successes. Get help. Various devices are available to you. Nicotine patches have a 14% success rate of smoking cessation at 6 months. Zyban pills have a 30% smoking cessation at 6 months. Adding nicotine patches to Zyban increases smoking cessation to 35% at 6 months. Chantix pills have a success rate of 70% at 3 months, and 44% at 12 months. Some people like to use e-cigs to help them stop smoking, but be careful, as many people then just continue smoking and add vaping, and can actually increase their nicotine intake. E-cigs are probably less dangerous than smoking as you aren’t getting the tar and many other dangerous chemicals, but you are getting ten times the amounts of formaldehyde and acetaldehyde, both of which cause cancer. Although e-cigs aren’t as dangerous as smoking, they are still very bad for you. Other more helpful devices to help you quit smoking are gum, lozenges, and inhalers that don’t heat or vaporize the nicotine.

Nicotine exposure is very harmful to healing after surgery. Nicotine causes small blood vessels to spasm, and these are the small blood vessels that ‘knit’ wounded tissue back together after surgery. People who smoke, vape, chew, or take nicotine after surgery have much higher complication rates such as infection, wounds re-opening, and deep ugly scars. Do not use nicotine for three weeks before and three weeks after surgery, especially surgery on thin delicate tissue, such as nasal and facial surgery. If you find you are unable to stop using nicotine before your surgery, please cancel the surgery and reschedule for a later date when you can quit using nicotine, particularly elective surgery such as septoplasty and rhinoplasty.

Dangers of Smoking

Cigarette smoking causes 480,000 deaths in the USA every year. This is nearly 1 in 5 deaths.

People that continue smoking have a 50% chance of dying of their tobacco.

Smoking causes more deaths each year than the following causes combined: illegal drug use, alcohol, motor vehicle accidents, HIV, and firearm-related incidents.

More than ten times as many Americans have died of smoking than have died in all of the wars fought by the United States.

Smoking causes 2-4 times the risk of heart attack, and 2-4 times the risk of stroke.

Smokers die 10-14 years earlier than nonsmokers.

Smoking causes 1/3 of all cancers, and causes over 90% of lung cancers.

More women die from lung cancer each year than die from breast cancer.

One in 14 women smoke during pregnancy. Smoking during pregnancy causes premature birth, triples the risk of sudden infant death syndrome (SIDS), and causes asthma and heart defects in children.

Smoking causes 80% of all deaths from COPD (emphysema).

One out of seven smokers will get lung cancer, and smoking increases your risk of getting lung cancer 25 times.

People who smoke fewer than 5 cigarettes a day still have increased heart disease and stroke.

Smoking can cause the following cancers: bladder, blood, cervix, colon and rectum, esophagus, kidney and ureter, larynx, liver, mouth and throat, pancreas, stomach, as well as trachea, bronchus, and lung.

Secondhand Smoke

There is no risk-free level of secondhand smoke. Secondhand smoke contains more than 7,000 chemicals, hundreds of which are toxic, and at least 70 of these chemicals cause cancer.

Since the 1964 Surgeon General’s Report alerting people to the dangers of smoking, 2.5 million adult nonsmokers have died of secondhand smoke.

In infants and children, secondhand smoke causes more frequent and severe asthma attacks, respiratory infections, ear infections, and Sudden Infant Death Syndrome (SIDS).

Secondhand smoke in adults causes coronary heart disease, stroke, and lung cancer.

Smoking during pregnancy results in more than 1,000 infant deaths annually.

Secondhand smoke causes nearly 34,000 premature deaths from heart disease each year in the US among nonsmokers.

Secondhand smoke causes 7,300 lung cancer deaths in nonsmokers each year in the US.

Secondhand smoke causes 8,000 deaths from stroke every year.

Secondhand smoke increases the risk of heart disease in nonsmokers 25-30%.

Secondhand smoke increases the risk of stroke in nonsmokers 20-30%.

Even brief exposure to secondhand smoke can damage the lining of blood vessels and cause platelets to stick, potentially causing a heart attack in susceptible individuals with heart disease.

Please do not allow anyone to ever smoke in your house or car, even if children and nonsmoking adults are not there at the time, because the dangerous chemicals linger.

What’s the good news?

Quitting smoking sharply drops your risk of heart attack within one year of quitting.

Your risk of stroke after quitting drops to the same risk of a nonsmoker in just 2-5 years.

Your risk of cancers of the mouth, throat, esophagus, and bladder drop by half within 5 years of quitting.

Ten years after quitting, your risk of lung cancer drops by half.

It is never too late to quit: 80 year-olds who quit smoking outlive other 80 year-olds who don’t quit smoking by 2-3 years.

Dangers of Chewing Tobacco

Smokeless tobacco has at least thirty chemicals that cause cancer.

Chewing tobacco causes cancers of the mouth, esophagus, and pancreas.

Chewing tobacco causes heart disease and stroke.

Chewing tobacco causes gum disease, tooth decay, and tooth loss.

Chewing tobacco absorbs more nicotine than cigarettes, potentially making it more addictive.

Those who chew tobacco (especially young people) are more likely to start smoking.

Pregnant women who chew tobacco have higher incidences of early birth and stillbirth; nicotine affects how the baby’s brain grows. Nicotine harms brain development if used below the age of 20.

Chewing tobacco can cause nicotine poisoning in children.

Dangers of Vaping

Vaping has up to ten times the levels of formaldehyde and acetaldehyde than smoking; both of these chemicals cause cancer. These are present even if the vaping has no nicotine.

Vaping with nicotine causes heart disease, strokes, birth defects, and poisoning.

Vaping reduces heart and lung function, and increases inflammation.

Vaping causes hypotension, seizure, chest pain, rapid heartbeat, disorientation, and congestive heart failure.

Vaping causes abdominal pain, headache, blurred vision, throat and mouth irritation, nausea, vomiting, and coughing.

Vaping with nicotine below the age of 20 harms brain development.

Vaping is a gateway to smoking in young people and other nonsmokers.

Vaping has a poor track record of helping people quit smoking, and often leads to both smoking and vaping, ultimately increasing your nicotine intake.

Vaping often leads to putting off actually quitting smoking.

There is dramatic variability in e-cigarettes and their liquid ingredients, and the aerosol you inhale. You really don’t know how much nicotine, chemicals, and heavy metals you are getting.

Dangers of Marijuana

Marijuana has 33 carcinogens (and counting), and deposits 4 times as much tar as tobacco, as people inhale much more deeply and hold it longer.

In high doses, marijuana causes hallucinations, delusions, and psychosis.

Marijuana causes respiratory problems and heart attacks.

Marijuana affects brain development in young people. Marijuana impairs thinking, memory, learning functions, general knowledge, and verbal ability. Teens who smoke marijuana into adulthood lose an average of 8 IQ points. Teens who use marijuana have worse school performance, and ultimately have lower income, increased use of welfare, higher unemployment, higher rates of criminal behavior, and decreased satisfaction with life.

Marijuana increases anxiety, depression, and psychotic illness. It can cause temporary hallucinations and paranoia, and worsens symptoms in people with schizophrenia, as well as increasing the risk of developing schizophrenia. Marijuana has been linked to suicidal thoughts.

Marijuana causes dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, intense nausea and vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucinations.

In the short term, marijuana alters the senses, alters sense of time, changes mood, impairs body movement, impairs thinking and problem solving, and impairs memory.

Marijuana use in pregnancy causes lower birth weights, and increased risk of childhood brain and behavioral problems. Children who have been exposed to marijuana have problems with attention, memory, and problem-solving.

The amount of THC in marijuana has been rising steadily over the last several decades. People trying marijuana for the first time have much higher risks of toxicity, causing rapidly rising numbers of visits to the ER. Edible marijuana has much slower onset of symptoms, so people tend to eat a lot more of it to get high before they realize how much they have consumed, with dangerous results. Higher levels of THC also cause higher levels of addiction.

Marijuana is addictive in 9 to 30% of people who use it. Teens who use marijuana, however, are 4-7 times more likely to develop addiction to it.

Marijuana has only moderate evidence of being helpful with chronic pain and spasticity. There is low evidence that marijuana helps nausea, vomiting, weight gain in HIV, sleep disorders, hepatitis C, Crohn’s disease, Parkinson’s, and Tourettes. It has been found to be helpful for Dravet’s syndrome, a rare form of childhood epilepsy. It is not helpful for sickle cell disease, PTSD, psoriasis, and ALS. Multiple studies have found no reduction in opioid use in chronic pain sufferers when they also used marijuana, but a single recent study has shown reduced opioid usage. Other studies have shown increased opioid usage when also using marijuana.

NOSEBLEEDS

John R. Bennett, MD
801-328-2522
1255 East 3900 South #301, Millcreek, Utah 84124
756 East 12200 South, Draper, Utah 84020

22 South 900 East, Salt Lake City, Utah 84102

Updated 7/4/17

NOSEBLEEDS

There are two categories of nosebleeds. “Anterior” bleeds originate in the forward part of the nose and are the most common. Although blood may run down the back of your throat (particularly if you pinch your nose or tip your head back) or even out of both nostrils, anterior bleeds initially bleed on one side and out the front of the nose. The other category of nosebleed is called a “posterior” bleed. These are less common and usually seen in older people, and are more dangerous because they tend to be associated with greater blood loss and are more difficult to control. Posterior bleeds tend to bleed down the back of the throat, although there will be blood coming out the front of the nose as well.

Common causes of nosebleeds include: trauma (punched or picking), dry nose (from dry air or medicines that dry you out such as antihistamines), bleeding problems (blood thinners, excessive aspirin or anti-inflammatory drugs, systemic disease), high blood pressure, infection, twisted septum, septal perforation, overuse of over-the-counter nasal decongestant sprays (more than 3 days in a row can break down the nasal lining), cocaine, etc.

How to Stop the Bleeding

The easiest way to stop a nosebleed is pressure:

  1. Gently blow your nose to clear out all the blood clots (there may be some big ones).
  2. Use a decongestant nasal spray (like Afrin or Neosynephrine), which will quickly squeeze down the blood vessels.
  3. Place tissues under the nose, and pinch your nose by placing your thumb and index finger on either side of the soft lower half of your nose. Feel for the bony step-off and place the pads of your fingers just beneath.
    1. Do not pack tissue into the nose, as this irritates the nasal lining, setting you up for future bleeds. It also rips the clot off the bleeding area when you pull out the tissue plug, re-starting the bleeding.
  4. Apply firm but gentle pressure by squeezing the nostrils together for 10-20 minutes.
  5. An ice pack laid across the bridge of the nose as you pinch the lower nose is helpful.
  6. If this doesn’t fix the problem or the bleeding comes back later, please call us.

Office Procedures to Stop the Bleeding

To stop nosebleeds in the office, we can use silver nitrate chemical “sticks,” an electric cautery, or a variety of nasal packs. The nose is first sprayed with Afrin to squeeze the vessels and Lidocaine to numb the nose. This will drip down the back of the nose, so you will notice a bad taste and a numb throat for about an hour. If we need to use an electric cautery, we will give you a numbing shot as well.

After the Bleeding Stops

If your nose was cauterized:

  1. Take it easy for a few days. Strenuous activity (yard work, lifting, weightlifting) or even just bending over at the waist can increase your chances of bleeding again.
  2. Sneeze with your mouth open so that the air will pass through your mouth instead of your nose. Try not to sneeze through the cauterized side, and don’t blow that side of your nose.
  3. Place Vaseline or an antibiotic ointment such as Bacitracin, Neosporin, or Bactroban just inside the nostril three times a day with a Q-tip or your fingertip for a week. Gently place the ointment just inside the nostrils, not higher. It will melt with your body temperature and coat the lining of your nose.
  4. Spray nasal saline mist in the nostrils every 1-2 hours while awake for about a week.
  5. A humidifier next to the bed at night for a week will help keep your nose moist and help it heal.

If your nose was packed:

  1. Take your antibiotic as directed to avoid sinus infection or even toxic shock syndrome.
  2. Take your pain medicine as needed. Do NOT use aspirin or ibuprofen, as both of these thin the blood.
  3. Come back in 3-4 days and we will remove the packing. Removing the packing before then may result in bleeding again.
  4. Do NOT pull the packing out yourself. If it seems to be slipping out, press it back in place and call our office. If it seems to be slipping backwards, call our office or go to the emergency room.
  5. Please call the office with any fever, visual problems, or headache not relieved with your pain medicine.

One or two brief bleeds after cautery is okay, but if you continue to have significant bleeds, please come back for further treatment.

Please call our office immediately at 801-328-2522 or proceed to the emergency room if you have sudden, severe bleeding, or notice excessive bleeding down the back of your throat. Nosebleeds can cause a large volume of blood to be lost in a relatively short amount of time. Some people even need a transfusion if the bleeding is heavy enough or goes on for a prolonged period of time. If you feel lightheaded or faint when you sit up or stand, please contact the office or proceed to the emergency room for evaluation.

EAR CARE

John R. Bennett, MD
801-328-2522
1255 East 3900 South #301, Millcreek, Utah 84124
756 East 12200 South, Draper, Utah 84020 22 South 900 East, Salt Lake City, Utah 84102

Updated 7/4/17

EAR CARE

Generally speaking, the ears are designed to take care of themselves. Ear wax is only made in the outer 1/3 of the ear canal, and it naturally drifts outwards, where it dries and flakes at the opening to the ear. Q-tips should only be used at the openings of the ears, and in a circular motion. Never push the Q-tip deep into the ear canal, as this only pushes the wax deep, and the Q-tip becomes a ‘ramrod’. Do not allow bath water or shower water into the ears, as this irritates the ear lining. If the ear does become packed with wax, you can purchase ear wax softening drops, such as Debrox, to soften and partially dissolve the wax. Most kits also come with irrigation to flush out the ear after softening the wax. This may get rid of smaller particles of wax, but is unlikely to get rid of large cerumen impactions. When the ear gets plugged with wax, please make an appointment with us, and let us clean out the ear in the office. As we age, the wax gets thicker, and it is harder for the wax to come out on its own, especially for men who grow more hair in their ear canals as they age. Some people need to come in every year or so for ear cleaning.

Itchy ears are usually caused by fungal and bacterial growth in the ear canal, but can also sometimes be caused by allergies. White vinegar is a weak acid that, mixed 50:50 with water in an empty dropper bottle (available at drug stones), destroys most fungal and bacterial growth in the ears. Several drops of half-strength vinegar several times a day in the ears takes care of most itchy ears. If your ear is moist and itchy, mix vinegar 50:50 with rubbing alcohol. This will take care of the itch, and also dries out the ear. Hydrogen peroxide to dissolve wax can also be mixed with the vinegar and alcohol, giving you an inexpensive home-made treatment that gets rid of the itch, dries the ears, and dissolves wax.

Swimmer’s Ear is an infection of the ear canal. Although a moist ear is more likely to become infected, the main culprit in Swimmer’s Ear is actually Q-tips, which can rough up the delicate skin of the ear canal, and other attempts to scratch the ear canal. The ear canal skin is paper thin and right over bone, and even scratching with a Q-tip causes enough trauma to allow the fungus and bacteria normally in our ear canals to get under the skin of the ear canal, causing Swimmer’s Ear, also known as otitis externa. Caught early, the home-made drops of vinegar and alcohol may correct it, but people often need prescription antibiotic drops. The infection can get so swollen and painful, that sometimes a sponge wick needs to be placed in the ear canal for several days to allow the antibiotic drops to reach all the way in.

Another risk of putting Q-tips and bobby pins into the ear is that you may traumatize the ear drum, or even poke a hole right through the ear drum. This is of course exceedingly painful, and often occurs when someone is cleaning their ear with a Q-tip, and someone else opens the bathroom door and bumps into you, driving the Q-tip through the ear drum. This hole will sometime heal on its own, but we may have to perform a surgery to fix the perforation.

Eustachian tube dysfunction is common in early childhood, but can occur in adults, particularly with the onset of a cold or allergies. The Eustachian tube connects the back of the nose to the air-filled middle ear space, behind the ear drum. The Eustachian tube is normally closed, and the air in the middle ear space is slowly absorbed by the surrounding tissue. Within several hours, a vacuum forms in the middle ear, stretching and pulling in the ear drum. Most of the time, we subconsciously yawn when we feel this. The yawn tugs on the muscles of the Eustachian tube, allowing air to rush back up the Eustachian tube, giving a gentle pop. We do this every several hours our entire life, and most of us don’t even realize we are doing it. If the Eustachian tube becomes blocked with a cold, hay fever, etc., a simple yawn may not open the ear. In this situation, we should perform a valsalva: close the mouth, pinch the nose, and puff the cheeks out. If the ears still don’t pop, continue puffing the cheeks out, but jut out the chin, and wriggle the jaw side-to-side. Keep trying. Consider over-the-counter nasal sprays such as Afrin, Sudafed pills, and nasal steroid sprays (Nasacort, Rhinocort, Flonase) to decongest the nose and the Eustachian tubes. Try again to pop the ears. If you are unable to pop the ears for several days, then fluid can collect behind the ear drum, and bacteria could grow in this, causing a painful middle ear infection, or otitis media. At this point you will need to go see your doctor.

Please wear hearing protection around loud noises such as concerts, mowing the lawn, and other machinery. If you are around very loud noises such as gun fire, consider using double protection, with ear plugs AND ear muffs. Even a single loud noise close to the ears can cause permanent hearing loss. Once you have lost some of your hearing, it is gone forever. The noise damage is cumulative, and often the effects are not seen until many years later. Protect your hearing, as you will need your ears for the rest of your life!

The first range of hearing loss that most people experience is the high frequency, where the consonant sounds of ‘th,’ ‘f,’ ‘s,’ and ‘k’ are. Most people’s first realization of their hearing loss is in a loud restaurant, and the consonant sounds of the person across the table are washed out by the background noise. You often will still hear the vowel sounds, and it will sound like the other person is mumbling. Please schedule a hearing test if you have noticed hearing loss when there is lots of background noise. We recommend a baseline hearing test at the age of 50.

People with hearing loss, who do not get hearing aids, find they often stop going to social events they used to enjoy, as it is too frustrating for them and the people around them. This leads to loneliness and depression. Recent evidence from Johns Hopkins also shows that people with uncorrected hearing loss are more likely to suffer from dementia, probably from decreased brain stimulation of conversation. The nerve of hearing is a “use it or lose it” nerve, meaning if you wait a long time to get hearing aids, you may lose some of the hearing pathways in the brain that allow you to understand speech. In this case, you might get hearing aids that are turned up high enough to hear the words, but the brain may have lost the ability to understand what you are hearing. Hearing aids would then be much less satisfying. Do not delay getting hearing aids when you need them. When your family says you need hearing aids, they are usually right! Hearing aids are constantly getting better and better. The hearing aids of today are dramatically better than the hearing aids of 5-10 years ago. Our Audiologists have better selection, service, and prices of hearing aids than anyone else in town, work closely with our Physicians, and they will let you try out the hearing aids for a month for free.

When you lose hearing, the brain replaces the missing sound with a ringing or buzzing noise, called tinnitus. Tinnitus does not cause hearing loss. Hearing loss often causes the phantom signal or noise of tinnitus. Many medicines can cause tinnitus, especially Aspirin and other anti-inflammatories. Nicotine and caffeine also can cause tinnitus. Anyone with tinnitus should have a hearing test. The vast majority of tinnitus is completely benign, but some tinnitus can be a sign of a more serious problem, especially one sided tinnitus, rapidly worsening tinnitus, tinnitus with dizziness or any other nerve change, or the sound of your heart beating or fluid pulsing through the ear. These require a careful work up by your Physician. Tinnitus is best dealt with by avoiding complete silence, especially when trying to go to sleep at night. Having the soft noise of a fan, or an alarm clock set to ‘ocean waves’ or ‘mountain stream’ can be quite helpful. There are a number of herbal and vitamin therapies available on line, but these have not been proven to be very helpful, and most tinnitus tends to come and go over time, anyhow. Melatonin and antidepressants have been shown to help people with tinnitus fall asleep better, but their side effects prevent most people from staying on them. Tinnitus training devices or ‘masking’ devices can be built into a hearing aid, or can be purchased from our Audiologists separately. There are also ‘apps’ on smart phones that train you not to notice the tinnitus as much.

Please call Dr. Bennett at 801-328-2522 if you have any questions, problems, or concerns.

SINUSITIS

John R. Bennett, MD
801-328-2522
1255 East 3900 South #301, Millcreek, Utah 84124
756 East 12200 South, Draper, Utah 84020 22 South 900 East, Salt Lake City, Utah 84102

Updated 7/4/17

SINUSITIS

Symptoms of sinusitis are sinus pressure, nasal congestion, thick discolored drainage anteriorly, and thick post-nasal drip. There is often a cough at night when the post-nasal drip is worse as you lay flat. Fevers typically are low, if any. Sinusitis generally isn’t very painful, but it may trigger a painful headache. Sinusitis feels a lot like a viral cold, but lasts longer. Our immune systems can usually get rid of a cold in a week or so, but the viral cold may trigger a bacterial infection. Any “cold” that lasts more than 7-10 days is probably a bacterial sinus infection. Anything that causes swelling in the nose may pinch off the sinus openings, causing the sinuses to fill with fluid and leading to infection. Viral colds, allergies, air irritants, and smoking are common irritants that trigger sinusitis. Our sinuses constantly secrete mucus, which drips down the back of our noses, cleaning our nasal passages and lubricating our throats. When this mucus gets stuck in our sinuses it quickly becomes a great place for bacteria to grow. Sinusitis is treated by first facilitating drainage, and second, sterilization with antibiotics if improved drainage isn’t enough to return the sinuses to good health.

When the nose becomes congested and the sinuses become blocked, conservative measures can often get the sinuses draining, and sinusitis can be avoided. Two things have clearly been shown to get the sinuses draining again- nasal steroid sprays and salt water irrigations (flushes). Nasal steroid sprays such as Flonase (fluticasone), Nasacort (triamcinolone), and Rhinocort (budesonide) are available over-the-counter. These should be used daily, but they take several days to build up and become effective. They may be used for weeks, months, and possibly years, but will ultimately dry out the nose, cause nosebleeds, and may even contribute to cataract formation in the eyes over many years. Although fluticasone (Flonase) is the most popular and widely advertised of the three steroid sprays, it is the only one that is alcohol based, and it tends to dry out the nose more than the other two (especially here in Utah with our high dry desert air). Nasal flushes like Neti pot and Neil-med saline nasal rinses decongest the nose while physically removing debris from the nose, and do a great job getting the sinuses to drain. They should be used twice a day when the sinuses are symptomatic. They are squirted up each side of the nose, and they drain out the opposite side of the nose and also out of the mouth. Nasal rinses usually take several tries before you get used to them!

The following medications have not been clearly shown to help sinusitis despite many studies, so at best these are all optional. Over-the-counter nasal decongestants like Afrin and Neosynephrine work immediately and can be used several times a day but must be stopped after three days as they diminish blood flow in the nasal lining, damage the nasal lining after 3-5 days of use, cause rebound congestion when stopped, and can even cause a hole to form in the septum. Nasal saline mist spray every several hours (while awake) naturally decongests the nose, keeps the nose healthy and moist, and allows debris to drain out. Mucinex (guaifenesin) is an over-the-counter pill that thins mucus, allowing the sinuses to drain easier. Mucinex-D has Sudafed to also decongest, but as this keeps most people awake at night, consider using Mucinex-D in the morning, and plain Mucinex at night. Sudafed should be avoided by those with high blood pressure, heart rhythm irregularities, enlarged prostates, and people who don’t tolerate the feeling of anxiety that Sudafed can cause. Antihistamines should be avoided as they dry out and thicken the nasal mucus, which make it harder for our sinuses to drain. If allergies are suspected, an allergy test and treatment can be very helpful.

The first goal in helping our sinuses is to get them to drain, which is what the conservative measures do. If symptoms persist beyond 7-10 days, then you may need antibiotics. If you haven’t had any antibiotics for 6 months, you may do well with just high-dose Amoxicillin (for adults, 2000 mg twice a day for 5-10 days), but often more aggressive antibiotics are needed, such as high-dose Augmentin (Amoxicillin plus Clavulanic acid, 875 mg, PLUS another 1000mg of Amoxicillin twice a day) or Levaquin. A number of other antibiotics are often employed. A five-ten day course of antibiotics may be inadequate for curing sinusitis, so refills may be necessary. If no improvement is noticed, it may be wise to get a sinus CT. Some apparent sinusitis can actually be something else, such as a migraine or tension headache, allergic rhinitis, or even a deviated nasal septum pushing into the lateral nasal wall causing constant congestion, irritation, and drainage.

Chronic sinusitis is sinusitis that lasts more than three months. A sinus infection resistant to multiple antibiotics, or someone who has recurrent sinusitis (such as three bad episodes a year for three years, five episodes a year for two years) may need to consider sinus surgery. Endoscopic sinus surgery is performed through the nostrils. The natural sinus openings are enlarged to facilitate nasal drainage, making it harder for the sinuses to block off and get infected, and easier for nasal medications to penetrate into the sinuses. Someone who has had sinus surgery can use medicated rinses to put antibiotics and steroids directly into the sinuses, avoiding antibiotic and steroid pills, and their side effects. Sinus openings may scar down after surgery, requiring a revision surgery. Image guided sinus surgery allows the surgeon to see exactly where the instruments are during surgery, making the surgery safer, as sinus surgery is performed between the eyes and below the brain. Balloon sinuplasty uses catheters with balloons to safely enlarge sinus openings in certain situations, either in the clinic or in the OR.

The conservative measures described earlier will often stop sinusitis from getting started or from worsening, and should be regularly used by those with chronic and recurrent sinusitis.

Please call Dr. Bennett at 801-328-2522 if you have any questions, problems, or concerns.

Temporomandibular Joint (TMJ) Disorder

John R. Bennett, MD
801-328-2522
1255 East 3900 South #301, Millcreek, Utah 84124
756 East 12200 South, Draper, Utah 84020 22 South 900 East, Salt Lake City, Utah 84102

Updated 7/4/17

Temporomandibular Joint (TMJ) Disorder

The TMJ, or jaw joints, become easily inflamed when over-used, typically from clenching one’s teeth when stressed, and grinding teeth while asleep. As the nerve to the jaw joints is the same nerve as to the ear, jaw pain and ear pain can become virtually indistinguishable. TMJ pain radiates into the ear, down the jaw and neck, and up into the scalp. There is often grinding and popping in the joints, or one or both joints can become less mobile as the individual protects the joint, often unconsciously. There is pain with yawning and chewing. Stress can often trigger the pain, or it can become chronic.

The first step to stopping the pain is stopping the contact of the teeth. The teeth should never touch unless you are chewing, and the teeth should just barely come together while chewing. To break the habit, you must start paying attention to the teeth. I recommend a quick mental check every hour to see if the teeth are touching, and teach yourself to relax the jaw, even as the lips are kept together. When you are feeling stress, check and see if the teeth are touching. It may take months to break the habit, but it is a habit that can be overcome. The lips should be closed, but the teeth should never touch.

While breaking the clenching habit, a soft diet should be used. No hard breads, no hard vegetables, no hard meats, and no gum. Eat only soft foods. Warm soaks to the area of the jaw joint, and massaging the surrounding muscles is helpful. Anti-inflammatories such as Motrin are helpful. Prescription muscle relaxants such as Flexeril help some people, but as they make most people very sleepy, they usually are only helpful at bedtime. Getting help for stress and anxiety often prove very helpful. Working with a Physical Therapist is very helpful.

If you wake up with ear/jaw pain, or your spouse has noticed you grinding your teeth at night, the only thing that helps this is a bite block. Cheap ones can be purchased at all drug stores. They tend to be bulky, but if they work for you, that may be all you need. Dentists and Oral Surgeons can also make a much nicer form-fitted bite block, but these can get expensive.

If these measures do not help you, and other causes of the pain have been ruled out, then a referral to an Oral Surgeon or Dentist who treats TMJ dysfunction is the next step.

Remember: the teeth should never touch! Please call Dr. Bennett at 801-328-2522 if you have any questions, problems, or concerns.

Laryngopharyngeal Reflux Disease

Laryngopharyngeal Reflux Disease

and Recommendations to Prevent Acid Reflux

Updated 7/4/17

What is Reflux?

When we eat something, the food reaches the stomach by traveling down the muscular tube called the esophagus. Once food reaches the stomach, the stomach adds acid and pepsin (a digestive enzyme) so that the food can be digested. The esophagus has two sphincters (bands of muscle fiber that close off the tube) that help keep the contents of the stomach where they belong. One sphincter is at the top of the esophagus (at the junction with the upper throat) and one is at the bottom of the esophagus (the junction with the stomach). The term REFLUX means “a backward return of flow”, and refers to the backward flow of stomach contents up through the sphincters and into the esophagus or throat.

What is GERD and what is LPRD?

Some people have an abnormal amount of reflux of stomach acid up through the lower sphincter and into the esophagus. This is referred to as GERD or Gastroesophageal Reflux Disease. If the reflux makes it all the way up through the upper sphincter and into the back of the throat it is called LPRD or Laryngopharyngeal Reflux Disease. The structures in the throat (pharynx, larynx, and trachea) are much more sensitive to stomach acid and digestive enzymes, so small amounts of reflux into the area can result in more damage.

Why Don’t I have heartburn of stomach problems?

This is a question that is often asked by people with LPRD. The fact is that only one third of patients with LPRD experience significant heartburn. Heartburn occurs when the tissue in the esophagus becomes irritated. Most of the reflux events that can cause damage happen without the patient ever knowing that they are occurring, and is called ‘silent’ reflux.

Common Symptoms of LPRD:

  • Hoarseness
  • Chronic (ongoing) cough
  • Frequent throat clearing
  • Burning, pain or sensation in the throat
  • Lump in the throat feeling
  • Problems while swallowing
  • Bad/bitter taste in mouth
  • Dry throat
  • Asthma-like symptoms
  • Referred ear pain
  • Post nasal drip
  • Singing: Difficulty with high notes, difficulty with soft notes, delayed onsets or decreased clarity.

Diagnosis of LPRD:

The following signs seen by the patient are strong indicators of LPRD

  • Swollen, red, irritated arytenoids (structures at the back of the vocal cords)
  • Red, irritated vocal cords
  • Small laryngeal ulcers
  • Swelling of the vocal cords
  • Granulomas in the voice box
  • Evidence of hiatal hernia (may or may not be associated with reflux).
  • Significant laryngeal pathology of any type.

Testing for LPRD:

Esophageal endoscopy, Barium Esophagram, and a 24 hour pH probe monitoring are some of the tests that may be used to evaluate for LPRD. However, the reflux does not always show up in these tests, but is present enough to irritate the voice or throat. Often, a 3-6 month trial of a reflux medication, along with the following behavioral strategies, is the best test for LPRD.

Behavioral Strategies:

  1. Stress: Take significant steps to reduce your stress! Make time in your schedule to do activities that lower your stress level. Even moderate stress can dramatically increase the amount of reflux.
  2. Smoking: If you smoke, STOP! This dramatically causes reflux and many other damaging effects to your body.
  3. Tight Clothing: Avoid tight belts and other restrictive clothing.
  4. Body Weight: Being over weight can dramatically increase reflux. Try to maintain a healthy body weight.
  5. Exercise: Exercise regularly. However, avoid exercising immediately after eating. Do not lift heavy things after eating. Sit-ups and abdominal crunches can put pressure on your lower esophageal sphincter and worsen reflux.
  6. Nighttime Reflux: Recent studies have shown that LPRD often occurs during the day. However, if you experience some of your symptoms more in the morning, you may be having some reflux at night. Do not prop the body up with extra pillows. This may increase the reflux by kinking the stomach. Do elevate the head of your bed 4-6 inches with books, bricks, or boards to achieve a 10 degree slant. Or, purchase a foam wedge that is made specifically for this purpose. Your entire torso must be elevated from the hips up.
  7. Foods: You should pay close attention to how your system reacts to various foods. Each person will discover which foods cause an increase in reflux. The following foods have been shown to cause reflux in many people. It may be necessary to avoid of minimize some of the following foods.
    1. Spicy, acidic and tomato-based foods like Mexican or Italian food.
    2. Acidic fruit juices such as orange juice, grapefruit juice, cranberry juice etc..
    3. Fast foods and other high fat foods, especially fried foods.
    4. Caffeinated beverages (coffee, tea, soft drinks) and chocolate.
    5. Alcohol, peppermint, nuts.
    6. Carbonated beverages.
    7. Limit dairy product consumption, especially late at night. Dairy products digest slowly, which encourages acid reflux.
  8. Mealtime:
    1. Don’t gorge yourself at mealtime.
    2. Eat sensibly (moderate amount of foods)
    3. Eat meals three hours before bedtime
    4. Avoid bedtime snacks
    5. Drink at least 8 ounces of water each day, but do not drink too much before bedtime
    6. If you do eat a spicy meal, don’t have alcohol or caffeine with it. Instead, drink water.
    7. Learn to moderate the foods that may cause reflux. You don’t have to give up ice cream forever, but if you have heartburn when you eat it, don’t have a bowl of ice cream just before you go to bed. Learn what your body can and cannot handle.

Medications for LDRP:

  1. Take one dose (as recommended on the label) at meals and at bedtime of and over the counter antacid such as Tums or Mylanta. Tums has the added benefit of containing calcium.
  2. Medications such as H2 Blockers (Axid, Pepcid, Tagamet, Zantac), and Proton pump inhibitors (Prilosec [omeprazole], Prevacid, Aciphex, Protonix, or Nexium) may be prescribed or recommended by your physician. These medicines are usually taken for at least several weeks at a time, and often several months. If you need to take these medicines for longer periods of time, you will be referred to a Gastroenterologist. Prolonged use of reflux medicines has been linked to pneumonia, diarrhea with C. difficile bacteria, increased risks of fractures, and low levels of calcium, Vit B12, and magnesium.

Ear Hygiene

Swimmer's ear fungal infection

By: Megan Evans

What causes Swimmer’s ear?

 

Swimmer’s ear (otitis externa) is inflammation caused by water or other substances entering the ear canal.  Debris and water interferes with the lipid layer, a protective coating of the ear. Once the lipid layer is irritated, infection may occur. It is important not to scratch inside your ear because the lipid layer protects the skin, assists in cleaning and lubrication, and also provides some protection from bacteria, fungi, insects and water.

For instance, ear wax (cerumen) is known to reduce the viability of a wide range of bacteria, including Haemophilus influenzae, Staphylococcus aureus, and many variants of Escherichia coli, sometimes by as much as 99%. If you already have swimmer’s ear, avoid getting water in your ear for 5-7 days or until your symptoms clear.

How to prevent Swimmer’s ear:

  • Wear earplugs or a silicone ear cap when swimming and when showering.
  • Avoid getting any type of debris in your ear. Debris such as soap and shampoo may also cause irritation.
  • If your ears are sensitive, opt for external head phones so that you don’t irritate your ear canal.
  • Impacted ear canals can also increase your chance of getting an ear infection.
  • Do not put any sharp objects in your ear and avoid using a Q-tip. Instead, opt for over-the-counter ear cleaning kits or an ear wax vacuum.

How to clean your ear:

Tilt your head to the side and insert a few drops of rubbing alcohol, which will absorb excess water and kill bacteria and fungi. Hold your head to the side for several minutes so that the rubbing alcohol can thoroughly clean your ear. If rubbing alcohol is too harsh, try a 50:50 mixture with white vinegar. Acetic acid, an organic compound found in vinegar, will also kill bacteria and fungi.  

Caution: Consult your doctor prior to using this mixture if you have had ear surgery, an ear infection, or a perforated, ruptured, or punctured eardrum.

 

 

 

What is Strep Throat?

Sometime in your childhood you were probably diagnosed with strep throat. You likely had a fever, a painful sore throat and swollen lymph nodes. Strep throat is often painful but typically doesn’t last much longer than a week.

Our Utah Ear, Nose and Throat doctors regularly diagnose and treat patients who suffer from strep throat. We’ve written the following articles to help you understand strep throat:

  • What is Strep Throat?
  • What are Strep Throat Symptoms?
  • How is Strep Throat Diagnosed?
  • How is Strep Throat Treated?

What is Strep Throat?

Strep throat is not a virus. Strep throat is an infection caused by group A streptococcus bacteria that settles in the throat and often makes the throat suddenly feel sore. Typically, strep throat infections are more painful that a sore throat caused by a virus. In fact, since most sore throats are NOT caused by strep throat, a particularly painful sore throat is a good indication that you may have strep throat.

Read: What are Strep Throat Symptoms?

Strep Throat is Highly Contagious

Whether your strep throat symptoms are mild or severe, strep throat is contagious. That means everyone who comes into contact with someone who has strep throat is at risk of catching strep throat.

Think of strep throat as a person-to-person illness that is typically transmitted through close contact between someone who has strep throat and another individual. Strep is contained within the saliva or nasal secretions (mucus) of the contagious person. When that person coughs or sneezes, tiny droplets fly and people nearby come into close contact with the strep bacteria.

Because strep is shared socially, strep bacteria is often found in settings where many people live and work in close proximity. This may include schools, day care centers, airplanes, public transportation and within the home.

Children and teens between the ages of 5 and 15-years old are the most likely to become infected with strep throat. However, people of all ages are impacted by strep throat. Outbreaks of strep throat increase during the school year and often between late fall and early spring.

Diagnosis and Treatment of Strep Throat is Important

Although strep throat often clears up within a week if left untreated, our ENT doctors recommend you seek diagnosis and treatment for strep because strep can lead to complications such as kidney inflammation and rheumatic fever.

Call the Ear, Nose and Throat Center at 801-328-2522 to set an appointment.

Read: What are Strep Throat Symptoms?

Read: How is Strep Throat Diagnosed?

Read: How is Strep Throat Treated?

Strep Throat Symptoms

A sudden, painful sore throat can be a good indication that you have strep throat. Yet a viral infection and not strep bacteria cause most sore throats. Even more surprising, if you have typical cold symptoms like a stuffy and/or runny nose and a cough, you likely do NOT have strep throat.

The most common signs of strep throat may include:

  • Sudden and severe sore throat: With strep throat, sore throat pain emerges quickly and can be very painful.
  • Difficulty swallowing: It’s normal to feel pain while swallowing when you have a sore throat. But strep throat can make it difficult to swallow even liquids.
  • Fever above 101 degrees: The onset of strep throat is often accompanied by a high fever.
  • White or yellow pus on your tonsils and/or redness on the back of throat: Use a flashlight to illuminate the back of your throat. If you see white or yellow spots on a bright red throat, you may have strep throat.
  • Swollen lymph nodes in the neck: Lymph nodes in your neck will often feel tender and sensitive to the touch when you have strep throat.
  • Lack of congestion, cough and upper-respiratory symptoms: A painful sore throat, minus other cold-like symptoms, can be a good indication that you have strep throat.

The last symptom is important to remember: the more cold symptoms you have, the more likely it is that you DON’T have strep throat.

Strep Throat Symptoms Appear 2 to 5 Days After Exposure

Strep throat symptoms do not appear immediately following contact with someone who has a strep infection. Usually, the signs of strep throat appear two to five days following exposure.

Although strep throat usually goes away within three to seven days following exposure without treatment, you remain contagious for two to three weeks.

Read that again: even though your strep throat symptoms will disappear within a week of infection, unless you are treated with antibiotics, you remain contagious for 14 to 21 days afterwards. That’s why it’s important to seek treatment of strep throat with antibiotics.

Read: How Does the ENT Center Diagnose Strep Throat?

The good news is that most patients are no longer contagious (or less contagious) within 24 hours of starting to use antibiotics to fight strep throat.

Contact the Ear, Nose and Throat Center for Strep Throat Questions

Strep throat is painful and can become serious if left untreated. If you suspect you may have strep throat, contact our ENT doctors in Utah at 801-328-2522 for an appointment.

Read: How the ENT Center Treats Strep Throat

Read: What is Strep Throat?

Read: 5 Tips to Avoid Strep Throat

Strep Throat Diagnosis

There are two ways to diagnose strep throat: a clinical exam and a laboratory test. We’ll cover both options here so you can understand what to expect when you visit an ear, nose and throat doctor.

Our Ear, Nose and Throat center physicians typically perform both the clinical exam and a laboratory test to ensure we accurately diagnose strep throat.

Clinical Strep Throat Exam

A clinical exam begins by looking for common strep throat symptoms such as:

  • A severe sore throat
  • Fever above 101 degrees
  • White or yellow pus on your tonsils and/or redness on the back of your throat
  • Swollen lymph nodes in the neck
  • Absence of traditional cold symptoms such as cough, congestion or a runny nose

Read: Common strep throat symptoms

Your ENT doctor will typically use a tongue depressor to ensure your throat and tonsils are clearly visible. We’ll also consider the patient’s age—strep throat is most common in patients between the ages of 5 and 15 years old—and the time of year since strep throat infections are more common between late fall and early spring.

Laboratory Strep Throat Tests

If indications for strep throat appear likely following the clinical exam, your ENT doctor will order a laboratory test to confirm a strep infection. The doctor or physician’s assistant will quickly and gently swab the back of your throat and order a rapid strep test. We may also order a throat culture.

  • Rapid Strep Test: The rapid stress test is also known as a rapid antigen detection test. The good news is that the Ear, Nose and Throat Center can confirm a strep throat infection within a few minutes using the rapid stress test.
  • Throat Culture: While the rapid stress test regularly identifies strep throat, it may not detect all cases of strep throat.  In some instances, we may choose to order a throat culture so we can more thoroughly analyze your condition. The downside to a throat culture is that results may not be available for a few days, which is why we typically use the rapid stress test. Your doctor will consider your symptoms following an exam and recommend the appropriate tests to confirm diagnosis.

Next Step: Strep Throat Treatment

Once your ENT physician has completed the exam and ordered the appropriate tests that confirm strep throat, we will prescribe antibiotics to treat strep throat. The good news is that you will no longer be infectious within 24 hours of starting antibiotic treatment and patients start to feel better quickly.

If you have questions about strep throat, please contact the Ear, Nose and Throat Center at 801-328-2522 to set an appointment with ENT doctors in Salt Lake City, Park City and Draper, Utah.

Read: How is Strep Throat Treated?

Read: What is Strep Throat?

Read: What are Strep Throat Symptoms?

Read: 5 Tips to Prevent Strep Throat