Fever Blisters and Canker Sores
Know the Score on Facial Sports Injuries
Doctor, What is Bell's Palsy?
Smell and Taste Disorders
Doctor, what is TMJ?
Doctor, Explain GERD and LPR
Fever Blisters and Canker Sores
If you have been bothered by a sore in your mouth that made
it painful to eat and talk, you are not alone. Many otherwise
healthy people suffer from recurrent mouth sores.
Two of the most common recurrent oral lesions
are fever blisters (also called cold sores) and canker sores
(aphthous ulcers). When they occur in the mouth, it may be difficult
to distinguish one from the other. Since the treatment and cause
of these two sores are completely different, it is extremely
important to know which is which.
What Are Fever Blisters (Cold Sores)?
These are common names for fluid filled blisters that commonly
occur on the lips. They also can occur in the mouth, particularly
on the gums and roof of the mouth (hard palate), but this is
rare. Fever blisters are usually painful; in fact, the pain
may precede the appearance of the lesion by a few days. The
blisters rupture within hours, then crust over. They last about
Fever blisters result from a herpes simplex
virus which becomes active. This virus is latent (dormant) in
afflicted people, but can be activated by conditions such as
stress, fever, trauma, hormonal changes, and exposure to sunlight.
When lesions reappear, they tend to form in the same location.
Can Fever Blisters Be Spread?
Yes, the time from blister rupture until the
sore is completely healed is the time of greatest risk for spread
of infection. The virus can spread to your own eyes and genitalia,
as well as to other people.
avoid mucous membrane contact when a lesion is present
do not squeeze,
pinch or pick at the blister
wash hands carefully
before touching your eyes or genital area, or another person
Despite all caution, it is important to remember that it
is possible to transmit herpes virus even when no blisters are
Treatment consists of coating the lesions with
a protective barrier ointment containing an antiviral agent,
for example 5% acyclovir ointment. Presently, there is no cure,
but there is much research activity underway in this field.
Contact your doctor or dentist for the latest information.
What are Canker Sores?
Canker sores (also called aphthous ulcers) are small, shallow
ulcers occurring on the tongue, soft palate, or inside the lips
and cheeks. They are quite painful, and usually last 5-10 days.
The best available evidence suggests that canker
sores result from an altered local immune response associated
with stress, trauma, or local irritants, such as eating acidic
foods (i.e., tomatoes, citrus fruits and some nuts.)
Can Canker Sores Be Spread?
No, since they are not caused by bacteria or
viral agents, they cannot be spread locally or to anyone else.
The treatment is directed toward relieving discomfort
and guarding against infection. A topical corticosteroid preparation
such as triamcinolone dental paste (Kenalog in Orabase 0.1%®)
is helpful. Unfortunately, no cure exists at present.
What About Other Sores?
For any mouth lesion that does not heal in two
weeks, you should see your physician or dentist.
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Know the Score on Facial Sports Injuries
catch, shooting hoops, bicycling on a scenic path or just kicking
around a soccer ball have more in common than you may think.
On the up side, these activities are good exercise and are enjoyed
by thousands of Americans. On the down side, they can result
in a variety of injuries to the face.
Many injuries are preventable by wearing the
proper protective gear, and your attitude toward safety can
make a big difference. However, even the most careful person
can get hurt. When an accident happens, it's your response that
can make the difference between a temporary inconvenience and
When Someone Gets Hurt: What First Aid
Supplies Should You Have on Hand in Case of An Emergency?
Ask "Are you all right?" Determine
whether the injured person is breathing and knows who and where
Be certain the person can see, hear and maintain
balance. Watch for subtle changes in behavior or speech, such
as slurring or stuttering. Any abnormal response requires medical
Note weakness or loss of movement in the forehead,
eyelids, cheeks and mouth.
Look at the eyes to make sure they move in the
same direction and that both pupils are the same size.
If any doubts exist, seek immediate medical
When Medical Attention Is Required,
What Can You Do?
Call for medical
Do not move the victim, or remove helmets or protective gear.
Do not give food, drink or medication until the extent of the
injury has been determined.
Remember HIV...be very careful around body fluids. In an emergency
protect your hands with plastic bags.
Apply pressure to bleeding wounds with a clean cloth or pad,
unless the eye or eyelid is affected or a loose bone can be
felt in a head injury. In these cases, do not apply pressure
but gently cover the wound with a clean cloth.
Apply ice or a cold pack to areas that have suffered a blow
(such as a bump on the head) to help control swelling and pain.
Remember to advise your doctor if the patient has HIV or hepatitis.
Sports injuries can cause potentially
serious broken bones or fractures of the face. Common symptoms
of facial fractures include:
swelling and bruising, such as a black eye
pain or numbness in the face, cheeks or lips
double or blurred vision
changes in teeth structure or ability to close mouth properly
It is important to pay attention to swelling
because it may be masking a more serious injury. Applying ice
packs and keeping the head elevated may reduce early swelling.
If any of these symptoms occur, be sure to visit
the emergency room or the office of a facial plastic surgeon
(such as an otolaryngologist-head and neck surgeon) where x-rays
may be taken to determine if there is a fracture.
When you are hit in the upper face (by a ball for example) it
can fracture the delicate bones around the sinuses, eye sockets,
bridge of the nose or cheek bones. A direct blow to the eye
may cause a fracture, as well as blurred or double vision. All
eye injuries should be examined by an eye specialist (ophthalmologist).
When your jaw or lower face is injured, it may change the way
your teeth fit together. To restore a normal bite, surgeries
often can be performed from inside the mouth to prevent visible
scarring of the face; and broken jaws often can be repaired
without being wired shut for long periods. Your doctor will
explain your treatment options and the latest treatment techniques.
Soft Tissue Injuries
Bruises cuts and scrapes often result from high speed or contact
sports, such as boxing, football, soccer, ice hockey, bicycling
skiing, and snowmobiling. Most can be treated at home, but some
require medical attention.
You should get immediate medical care when you have:
deep skin cuts
obvious deformity or fracture
loss of facial movement
change in vision
problems breathing and/or swallowing
alterations in consciousness or facial movement
Also called contusions, bruises result from bleeding underneath
the skin. Applying pressure, elevating the bruised area above
the heart and using an ice pack for the first 24 to 48 hours
minimizes discoloration and swelling. After two days, a heat
pack or hot water bottle may help more. Most of the swelling
and bruising should disappear in one to two weeks.
Cuts and Scrapes
The external bleeding that results from cuts and scrapes can
be stopped by immediately applying pressure with gauze or a
clean cloth. When the bleeding is uncontrollable, you should
go to the emergency room.
Scrapes should be washed with soap and water
to remove any foreign material that could cause infection and
discoloration of the skin. Scrapes or abrasions can be treated
at home by cleaning with 3% hydrogen peroxide and covering with
an antibiotic ointment or cream until the skin is healed. Cuts
or lacerations, unless very small, should be examined by a physician.
Stitches may be necessary, and deeper cuts may have serious
effects. Following stitches, cuts should be kept clean and free
of scabs with hydrogen peroxide and antibiotic ointment. Bandages
may be needed to protect the area from pressure or irritation
from clothes. You may experience numbness around the cut for
several months. Healing will continue for 6 to 12 months. The
application of sunscreen is important during the healing process
to prevent pigment changes. Scars that look too obvious after
this time should be seen by a facial plastic surgeon.
The nose is one of the most injured areas on the face. Early
treatment of a nose injury consists of applying a cold compress
and keeping the head higher than the rest of the body. You should
seek medical attention in the case of:
deformity of the nose
Nosebleeds are common and usually short-lived.
Often they can be controlled by squeezing the nose with constant
pressure for 5 to 10 minutes. If bleeding persists, seek medical
Bleeding also can occur underneath the surface
of the nose. An otolaryngologist/facial plastic surgeon will
examine the nose to determine if there is a clot or collection
of blood beneath the mucus membrane of the septum (a septal
hematoma) or any fracture. Hematomas should be drained so the
pressure does not cause nose damage or infection.
Some otolaryngologist-head and neck specialists set fractured
bones right away before swelling develops, while others prefer
to wait until the swelling is gone. These fractures can be repaired
under local or general anesthesia, even weeks later.
Ultimately, treatment decisions will be made
to restore proper function of the nasal air passages and normal
appearance and structural support of the nose. Swelling and
bruising of the nose may last for 10 days or more
Whether seemingly minor or severe, all neck injuries should
be thoroughly evaluated by an otolaryngologist -- head and neck
surgeon. Injuries may involve specific structures within the
neck, such as the larynx (voicebox), esophagus (food passage),
or major blood vessels and nerves.
The larynx is a complex organ consisting of cartilage, nerves
and muscles with a mucous membrane lining all encased in a protective
tissue (cartilage) framework.
The cartilages can be fractured or dislocated
and may cause severe swelling, which can result in airway obstruction.
Hoarseness or difficulty breathing after a blow to the neck
are warning signs of a serious injury and the injured person
should receive immediate medical attention.
The best way to treat facial sports injuries is to prevent them.
To insure a safe athletic environment, the following guidelines
Be sure the playing areas are large enough that
players will not run into walls or other obstructions.
Cover unremoveable goal posts and other structures
with thick, protective padding.
Carefully check equipment to be sure it is functioning
Require protective equipment - such as helmets
and padding for football, bicycling and rollerblading; face
masks, head and mouth guards for baseball; ear protectors for
wrestlers; and eyeglass guards or goggles for racquetball and
snowmobiling are just a few.
Prepare athletes with warm-up exercises before
engaging in intense team activity.
In the case of sports involving fast-moving
vehicles, for example, snowmobiles or dirt bikes - check the
path of travel, making sure there are no obstructing fences,
wires or other obstacles.
Enlist adequate adult supervision for all children's
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The skin is the largest organ in our body. It provides protection
against heat, cold, light, and infection. The skin is made up
of two major layers (epidermis and dermis) as well as various
types of cells. The top (or outer) layer of the skin-the epidermis-is
composed of three types of cells: flat, scaly cells on the surface
called squamous cells; round cells called basal cells; and melanocytes,
cells that provide skin its color and protect against skin damage.
The inner layer of the skin-the dermis-is the layer that contains
the nerves, blood vessels, and sweat glands.
What Is Skin Cancer?
Skin cancer is a disease in which cancer (malignant) cells are
found in the outer layers of your skin. There are several types
of cancer that originate in the skin. The most common types
are basal cell carcinoma (70 percent of all skin cancers) and
squamous cell carcinoma (20 percent). These types are classified
as nonmelanoma skin cancer. Melanoma (five percent of all skin
cancers) is the third type of skin cancer. It is less common
than basal cell or squamous cell skin cancer, but potentially
much more serious. Other types of skin cancer are rare.
Basal Cell Carcinoma
Basal cell carcinoma is the most common type of skin cancer.
It typically appears as a small raised bump that has a pearly
appearance. It is most commonly seen on areas of the skin that
have received excessive sun exposure. These cancers may spread
to the skin around the cancer but rarely spread to other parts
of the body.
Squamous Cell Carcinoma
Squamous cell carcinoma is also seen on the areas of the body
that have been exposed to excessive sun (nose, lower lip, hands,
and forehead). Often this cancer appears as a firm red bump
or ulceration of the skin that does not heal. Squamous cell
carcinomas can spread to lymph nodes in the area.
Melanoma is a skin cancer (malignancy) that arises from the
melanocytes in the skin. These cancers typically arise as pigmented
(colored) lesions in the skin with an irregular shape, irregular
border, and multiple colors. It is the most harmful of all the
skin cancers, because it can spread to other sites in the body.
Fortunately, most melanomas have a very high cure rate when
identified and treated early.
Who Gets Skin Cancer?
Skin cancer is a disease that has shown a steady increase over
the past 20 years. Fortunately, with early diagnosis and treatment,
it remains a very curable disease. A variety of factors have
been identified that place a person at a higher risk to develop
skin cancer (see "Am I at risk?").
How Is Skin Cancer Diagnosed?
The vast majority of skin cancers can be cured if diagnosed
and treated early. Aside from protecting your skin from sun
damage, it is important to recognize the early signs of skin
Skin sores that do not heal,
Bumps or nodules
in the skin that are enlarging, and
Changes in existing
moles (size, texture, color).
If you notice any of the factors listed above see your doctor
right away. If you have a spot or lump on your skin, your doctor
may remove the growth and examine the tissue under the microscope.
This is called a biopsy. A biopsy can usually be done in the
doctor's office and usually involves numbing the skin with a
local anesthetic. Examination of the biopsy under the microscope
will tell the doctor if the skin lesion is a cancer (malignancy).
How Is Skin Cancer Treated?
There are varieties of treatments available, including surgery,
radiation therapy, and chemotherapy, to treat skin cancer. Treatment
for skin cancer depends on the type and size of cancer, your
age, and your overall health.
Surgery is the most common form of treatment.
It generally consists of an office or outpatient procedure to
remove the lesion and check edges to make sure all the cancer
was removed. In many cases, the site is then repaired with simple
stitches. In larger skin cancers, your doctor may take some
skin from another body site to cover the wound and promote healing.
This is termed skin grafting. In more advanced cases of skin
cancer, radiation therapy or chemotherapy (drugs that kill cancer
cells) may be used with surgery to improve cure rates.
Am I At Risk?
People with any of the factors listed below have a higher risk
of developing skin cancer and should be particularly careful
about sun exposure.
long-term sun exposure
fair skin (typically
blonde or red hair with freckles)
place of residence
(increased risk in Southern climates)
moles, particularly if there are irregular edges, uneven coloring,
or an increase
in the size of the mole
of skin cancer
use of indoor
as a child
or nodules in the skin.
Early identification of skin cancer can save your life.
How Can I Lower My Risk?
The single most important thing you can do to lower your risk
of skin cancer is to avoid direct sun exposure. Sunlight produces
ultraviolet (UV) radiation that can directly damage the cells
(DNA) of our skin. People who work outdoors (farming, construction,
boating, outdoor sports) are at the highest risk of developing
a skin cancer. The sun's rays are the most powerful between
10 am and 2 pm, so you must be particularly careful during those
hours. If you must be out during the day, wear clothing that
covers as much of your skin as possible, including a wide-brimmed
hat to block the sun from your face, scalp, neck, and ears.
In addition to protective clothing, the use of a sunscreen can
reflect light away from the skin and provide protection against
UV radiation. When selecting a sunscreen, choose one with a
Sun Protection Factor (SPF) of 15 or more. Sunscreen products
do not completely block the damaging rays, but they do allow
you to be in the sun longer without getting sunburn. In addition
to being sun-smart, it is critical to recognize early signs
of trouble on your skin. The best time to do self-examination
is after a shower in front of a full-length mirror. Note any
moles, birthmarks, and blemishes. Be on the alert for sores
that do not heal or new nodules on the skin. Any mole that changes
in size, color, or texture should be carefully examined. If
you notice anything new or unusual, see your physician right
away. Catching skin cancer early can save your life.
Ultraviolet Index: What You Need to
The new Ultraviolet (UV) Index provides important information
to help you plan your outdoor activities and avoid overexposure
to the damaging rays of the sun. Developed by the National Weather
Service and the Environmental Protection Agency , the UV Index
is issued daily as a national service.
The UV Index gives the next day's amount of
exposure to UV rays. The Index predicts UV levels on a 0-10+
scale (see chart).
Always take precautions against overexposure,
and take special care when the UV Index predicts exposure levels
of moderate to above (5 - 10+).
Index Number Exposure Level
0 - 2
3 - 4 Low
5 - 6 Moderate
7 - 9 High
10+ Very High
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Doctor, What is Bell's Palsy?
Insight into facial nerve problems
Twitching, weakness, or paralysis of the face
are symptoms of a disorder involving the facial nerve, not a
disease in itself. Abnormal movement or paralysis of the face
can result from infection, injury, or tumors, and an evaluation
by your physician is needed to determine the cause. An otolaryngologist-head
and neck surgeon has special training and experience in managing
facial nerve disorders.
What Is the Facial Nerve?
The facial nerve resembles a telephone cable
and contains 7,000 individual nerve fibers. Each fiber carries
electrical impulses to a specific facial muscle. Information
passing along the fibers of this nerve allows us to laugh, cry,
smile, or frown, hence the name, "the nerve of facial expression."
When half or more of these individual nerve
fibers are interrupted, facial weakness occurs. If these nerve
fibers are irritated, then movements of the facial muscles appear
as spasms or twitching. The facial nerve not only carries nerve
impulses to the muscles of the face, but also to the tear glands,
to the saliva glands, and to the muscle of the stirrup bone
in the middle ear (the stapes). It also transmits taste from
the front of the tongue. Since the function of the facial nerve
is so complex, many symptoms may occur when the fibers of the
facial nerve are disrupted. A disorder of the facial nerve may
result in twitching, weakness, or paralysis of the face, in
dryness of the eye or the mouth, or in disturbance of taste.
How Does It Work?
anatomy of the facial nerve is very complex. The facial nerve
passes through the base of the skull in transit from the brain
to the muscles of facial expression. After leaving the brain,
the facial nerve enters the bone of the ear (temporal bone)
through a small bony tube (the internal auditory canal) in very
close association with the hearing and balance nerves. Along
its inch-and-a-half course through a small canal within the
temporal bone, the facial nerve winds around the three middle
ear bones, in back of the eardrum, and then through the mastoid
(the bony area behind the part of the ear that is visible).
After the facial nerve leaves the mastoid, it passes through
the salivary gland in the face (parotid gland) and divides into
many branches, which supply the various facial muscles. The
facial nerve gives off many branches as it courses through the
temporal bone: to the tear gland, to the stapes muscle, to the
tongue (for taste sensation), and to the saliva glands.
Bell's palsy and other causes
The most common cause of facial weakness which
comes on suddenly is referred to as "Bell's palsy."
This disorder is probably due to the body's response to a virus:
in reaction to the virus the facial nerve within the ear (temporal)
bone swells, and this pressure on the nerve in the bony canal
In order to be sure that this is the cause of
the facial weakness, and not something else, a special set of
questions will be asked. After an examination of the head, neck,
and ears, a series of tests may be performed. The most common
Hearing Test: Determines if the cause of damage
to the nerve has involved the hearing nerve, inner ear, or delicate
Test: Evaluates balance nerve involvement.
Test: Measures the eye's ability to produce tears.
Eye drops may be necessary to prevent drying of the surface
of the eye (cornea).
CT (computerized tomography) or MRI (magnetic resonance
imaging) determine if there is infection, tumor, bone fracture,
or other abnormality in the area of the facial nerve.
Test: Stimulates the facial nerve to assess how badly
the nerve is damaged. This test may have to be repeated at frequent
intervals to see if the disease is progressing.
Diagnosis, Prognosis and Treatment
The three questions most often asked by the
patient are: What is the cause (diagnosis)?, When can I expect
recovery (prognosis)?, and What can be done to bring about the
best recovery at the earliest possible moment (treatment)? In
order to answer these questions, your doctor must perform an
extensive evaluation to determine the cause and which area of
the facial nerve is involved, so that the best treatment can
The results of diagnostic testing will
If infection is the cause, then an antibiotic to fight bacteria
(as in middle ear infections) or antiviral agents (to fight
syndromes caused by viruses like Ramsay Hunt) may be used.
If simple swelling
is believed to be responsible for the facial nerve disorder,
then steroids are often prescribed.
circumstances, surgical removal of the bone around the nerve
(decompression) may be appropriate.
Help your recovery
When the facial nerve is paralyzed, considerable
attention must be given to maintaining a healthy eye, which
requires a constant flow of tears. These tears are spread out
over the eye by blinking, but blinking is diminished or eliminated
in facial nerve paralysis. Diminished blinking and the absence
of tearing together can reduce or eliminate the flow of tears
across the eyeball, resulting in drying, erosion, and ulcer
formation on the cornea and possible loss of the eye.
Closing the eye with a finger is an effective
way of keeping the eye moist. Use the back of the finger to
ensure that the eye is not injured with the fingertip. Protective
glasses or clear eye patches are often used to keep the eye
moist, and to keep foreign materials from entering the eye.
If the eye is dry, you may be advised to use
artificial tears to keep it moist. The drops should be used
as directed by your doctor. You may have to put one or two drops
in the affected eye every hour while you are awake, and place
ointment in your eye at bedtime.
Patients with permanent facial paralysis may
be rehabilitated through a variety of surgical procedures including
eyelid weights or springs, muscle transfers and nerve substitutions.
Some patients may benefit from a special form of physical therapy
called facial retraining. Other medical treatments for complications
of facial paralysis including excessive motion of the face or
muscle spasm may involve surgical division of overactive muscles
or weakening them by chemical injection. If these procedures
are needed, your physician will discuss them with you.
Disorders of the facial nerve, including paralysis,
are not rare and have a variety of causes. The appropriate diagnosis
and treatment are very important to achieving the best possible
recovery of facial nerve function. Even patients with permanent
facial nerve injury can be helped by surgical procedures designed
to improve facial function.
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Smell and Taste Disorders
Smell and taste problems can have a big impact on our lives.
Because these senses
contribute substantially to our enjoyment of life, our desire
to eat, and be social, smell and taste disorders can be serious.
When smell and taste are impaired, life loses some zest. We
eat poorly, socialize less, and as a result, feel worse. Many
older people experience this problem.
Smell and taste also warn us about dangers,
such as fire, poisonous fumes, and spoiled food. Certain jobs
require that these senses be accurate-chefs and firemen rely
on taste and smell. One study estimates that more than 200,000
people visit a doctor with smell and taste disorders every year,
but many more cases go unreported.
Loss of the sense of smell may be a sign of
sinus disease, growths in the nasal passages, or, in rare circumstances,
How do smell and taste work?
Smell and taste belong to our chemical sensing
system (chemosensation). The complicated processes of smelling
and tasting begin when molecules released by the substances
around us stimulate special nerve cells in the nose, mouth,
or throat. These cells transmit messages to the brain, where
specific smells or tastes are identified.
Olfactory (small nerve) cells
are stimulated by the odors around us-the fragrance from a rose,
the smell of bread baking. These nerve cells are found in a
tiny patch of tissue high up in the nose, and they connect directly
to the brain.
Gustatory (taste nerve) cells
react to food or drink mixed with saliva and are clustered in
the taste buds of the mouth and throat. Many of the small bumps
that can be seen on the tongue contain taste buds. These surface
cells send taste information to nearby nerve fibers, which send
messages to the brain.
The common chemical sense, another chemosensory
mechanism, contributes to our senses of smell and taste. In
this system, thousands of free nerve endings-especially on the
moist surfaces of the eyes, nose, mouth, and throat-identify
sensations like the sting of ammonia, the coolness of menthol,
and the "heat" of chili peppers.
We can commonly identify four basic
Certain combinations of these tastes-along with texture, temperature,
odor, and the sensations from the common chemical sense-produce
a flavor. It is flavor that lets us know whether we are eating
peanuts or caviar.
flavors are recognized mainly through the sense of smell. If
you hold your nose while eating chocolate, for example, you
will have trouble identifying the chocolate flavor, even though
you can distinguish the food's sweetness or bitterness. This
is because the familiar flavor of chocolate is sensed largely
by odor. So is the well-known flavor of coffee. This is why
a person who wishes to fully savor a delicious flavor (e.g.,
an expert chef testing his own creation) will exhale through
his nose after each swallow.
Taste and smell cells are the only cells in
the nervous system that are replaced when they become old or
damaged. Scientists are examining this phenomenon while studying
ways to replace other damaged nerve cells.
What causes smell and taste disorders?
Scientists have found that the sense of smell
is most accurate between the ages of 30 and 60 years. It begins
to decline after age 60, and a large proportion of elderly persons
lose their smelling ability. Women of all ages are generally
more accurate than men in identifying odors.
Some people are born with a poor sense of smell
or taste. Upper respiratory infections are blamed for some losses,
and injury to the head can also cause smell or taste problems.
Loss of smell and taste may result from polyps
in the nasal or sinus cavities, hormonal disturbances, or dental
problems. They can also be caused by prolonged exposure to certain
chemicals such as insecticides and by some medicines.
Tobacco smoking is the most concentrated form
of pollution that most people will ever be exposed to. It impairs
the ability to identify odors and diminishes the sense of taste.
Quitting smoking improves the smell function.
Radiation therapy patients with cancers of the
head and neck later complain of lost smell and taste. These
senses can also be lost in the course of some diseases of the
Patients who have lost their larynx (voice box)
commonly complain of poor ability to smell and taste. Laryngectomy
patients can use a special "bypass" tube to breathe
through the nose again. The enhanced airflow through the nose
helps smell and taste sensation to be re-established.
How are smell and taste disorders diagnosed?
The extent of loss of smell or taste can be
tested using the lowest concentration of a chemical that a person
can detect and recognize. A patient may also be asked to compare
the smells or tastes of different chemicals, or how the intensities
of smells or tastes grow when a chemical concentration is increased.
Smell. Scientists have developed an easily
administered "scratch-and-sniff" test to evaluate
the sense of smell.
Patients react to different chemical concentrations in taste
testing; this may involve a simple "sip, spit, and rinse"
test, or chemicals may be applied directly to specific areas
of the tongue.
Can smell and taste disorders be treated?
Sometimes a certain medication is the cause
of smell or taste disorders, and improvement occurs when that
medicine is stopped or changed. Although certain medications
can cause chemosensory problems, others-particularly anti-allergy
drugs-seem to improve the senses of taste and smell. Some patients,
notably those with serious respiratory infections or seasonal
allergies, regain their smell or taste simply by waiting for
their illness to run its course. In many cases, nasal obstructions,
such as polyps, can be removed to restore airflow to the receptor
area and can correct the loss of smell and taste. Occasionally,
chemosenses return to normal just as spontaneously as they disappeared.
What can I do to help myself?
If you experience a smell or taste problem,
try to identify and record the circumstances surrounding it.
When did you first become aware of it? Did you have a "cold"
or "flu" then? A head injury? Were you exposed to
air pollutants, pollens, danders, or dust to which you might
be allergic? Is this a recurring problem? Does it come in any
special season, like hay fever time?
Bring all this information with you when you
visit a physician who deals with diseases of the nose and throat
(an otolaryngologist-head and neck surgeon). Proper diagnosis
by a trained professional can provide reassurance that your
illness is not imaginary. You may even be surprised by the results.
For example, what you may think is a taste problem could actually
be a smell problem, because much of what you think you taste
you really smell.
Diagnosis may also lead to treatment of an underlying
cause for the disturbance. Many types of smell and taste disorders
are reversible. But, if yours is not, it is important to remember
that you are not alone. Thousands of other patients have faced
the same situation.
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Doctor, what is TMJ?
Insight into temporo-mandibular joint pain
Pain and the TMJ
What is the TMJ?
You may not have heard of it, but you use it
hundreds of times every day. It is the
Temporo-Mandibular Joint (TMJ), the joint where the mandible
(the lower jaw) joins the temporal bone of the skull, immediately
in front of the ear on each side of your head. A small disc
of cartilage separates the bones, much like in the knee joint,
so that the mandible may slide easily; each time you chew you
move it. But you also move it every time you talk and each time
you swallow (every three minutes or so). It is, therefore, one
of the most frequently used of all joints of the body and one
of the most complex.
You can locate this joint by putting your finger
on the triangular structure in front of your ear. Then move
your finger just slightly forward and press firmly while you
open your jaw all the way and shut it. The motion you feel is
the TMJ. You can also feel the joint motion in your ear canal.
These maneuvers can cause considerable discomfort
to a patient who is having TMJ trouble, and physicians use these
maneuvers with patients for diagnosis.
How does the TMJ work?
When you bite down hard, you put force on the
object between your teeth and on the joint. In terms of physics,
the jaw is the lever and the TMJ is the fulcrum. Actually, more
force is applied (per square foot) to the joint surface than
to whatever is between your teeth. To accommodate such forces
and to prevent too much wear and tear, the cartilage between
the mandible and skull normally provides a smooth surface, over
which the joint can freely slide with minimal friction.
Therefore, the forces of chewing can be distributed
over a wider surface in the joint space and minimize the risk
of injury. In addition, several muscles contribute to opening
and closing the jaw and aid in the function of the TMJ.
Sore jaw muscles
Locking of the
opening the mouth fully
How does TMJ dysfunction feel?
The pain may be sharp and searing, occurring
each time you swallow, yawn, talk, or chew, or it may be dull
and constant. It hurts over the joint, immediately in front
of the ear, but pain can also radiate elsewhere. It often causes
spasms in the adjacent muscles that are attached to the bones
of the skull, face, and jaws. Then, pain can be felt at the
side of the head (the temple), the cheek, the lower jaw, and
A very common focus of pain is in the ear. Many
patients come to the ear specialist quite convinced their pain
is from an ear infection. When the earache is not associated
with a hearing loss and the eardrum looks normal, the doctor
will consider the possibility that the pain comes from a TMJ
There are a few other symptoms besides pain
that TMJ dysfunction can cause. It can make popping, clicking,
or grinding sounds when the jaws are opened widely. Or the jaw
locks wide open (dislocated). At the other extreme, TMJ dysfunction
can prevent the jaws from fully opening. Some people get ringing
in their ears from TMJ trouble.
How can things go wrong with the TMJ?
In most patients, pain associated with the TMJ
is a result of displacement of the cartilage disc that causes
pressure and stretching of the associated sensory nerves. The
popping or clicking occurs when the disk snaps into place when
the jaw moves. In addition, the chewing muscles may spasm, not
function efficiently, and cause pain and tenderness.
Both major and minor trauma to the jaw can significantly
contribute to the development of TMJ problems. If you habitually
clench, grit, or grind your teeth, you increase the wear on
the cartilage lining of the joint, and it doesn't have a chance
to recover. Many persons are unaware that they grind their teeth,
unless someone tells them so.
Chewing gum much of the day can cause similar
problems. Stress and other psychological factors have also been
implicated as contributory factors to TMJ dysfunction. Other
causes include teeth that do not fit together properly (improper
bite), malpositioned jaws, and arthritis. In certain cases,
chronic malposition of the cartilage disc and persistent wear
in the cartilage lining of the joint space can cause further
What can be done?
Because TMJ symptoms often develop in the head
and neck, otolaryngologists are appropriately qualified to diagnose
TMJ problems. Proper diagnosis of TMJ begins with a detailed
history and physical, including careful assessment of the teeth
occlusion and function of the jaw joints and muscles. If the
doctor diagnoses your case early, it will probably respond to
these simple, self-remedies:
Rest the muscles and joints by eating soft foods.
Do not chew
with moist heat (1/2 hour at least twice daily).
In cases of joint injury, ice packs applied soon after the injury
can help reduce swelling. Relaxation techniques and stress reduction,
patient education, non-steroidal anti-inflammatory drugs, muscle
relaxants or other medications may be indicated in a dose your
Other therapies may include fabrication of an
occlusal splint to prevent wear and tear on the joint. Improving
the alignment of the upper and lower teeth and surgical options
are available for advanced cases. After diagnosis, Dr. Adelglass
may suggest further consultation with your dentist and oral
surgeon to facilitate effective management of TMJ dysfunction.
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Doctor, Explain GERD and LPR
What is GERD?
Gastroesophageal reflux, often referred to as GERD, occurs when
acid from the stomach
backs up into the esophagus. Normally, food travels from the
mouth, down through the esophagus and into the stomach. A ring
of muscle at the bottom of the esophagus, the lower esophageal
sphincter (LES), contracts to keep the acidic contents of the
stomach from “refluxing” or coming back up into the esophagus.
In those who have GERD, the LES does not close properly, allowing
acid to move up the esophagus.
When stomach acid touches the sensitive tissue
lining the esophagus and throat, it causes a reaction similar
to squirting lemon juice in your eye. This is why GERD is often
characterized by the burning sensation known as heartburn.
In some cases, reflux can be SILENT, with no
symptoms until a problem arises. Almost all individuals have
experienced reflux (GER), but the disease (GERD) occurs when
reflux happens on a frequent basis often over a long period
What is LPR?
During gastroesophageal reflux, the acidic stomach
contents may reflux all the way up the esophagus, beyond the
upper esophageal sphincter (a ring of muscle at the top of the
esophagus), and into the back of the throat and possibly the
back of the nasal airway. This is known as laryngopharyngeal
reflux (LPR), which can affect anyone. Adults with LPR often
complain that the back of their throat has a bitter taste, a
sensation of burning, or something “stuck.” Some may have difficulty
breathing if the voice box is affected.
In infants and children, LPR may cause breathing
problems such as: cough, hoarseness, stridor (noisy breathing),
croup, asthma, sleep disordered breathing, feeding difficulty
(spitting up), turning blue (cyanosis), aspiration, pauses in
breathing (apnea), apparent life threatening event (ALTE), and
even a severe deficiency in growth. Proper treatment of LPR,
especially in children, is critical.
What are the symptoms of GERD and LPR?
The symptoms of GERD may include persistent
heartburn, acid regurgitation, nausea, hoarseness in the morning,
or trouble swallowing. Some people have GERD without heartburn.
Instead, they experience pain in the chest that can be severe
enough to mimic the pain of a heart attack. GERD can also cause
a dry cough and bad breath. Some people with LPR may feel as
if they have food stuck in their throat, a bitter taste in the
mouth on waking, or difficulty breathing although uncommon.
If you experience any symptoms on a regular
basis (twice a week or more) then you may have GERD or LPR.
For proper diagnosis and treatment, you should be evaluated
by your primary care doctor for GERD or an otolaryngologist—head
and neck surgeon (ENT doctor).
Who gets GERD or LPR?
Women, men, infants, and children can all have
GERD. This disorder may result from physical causes or lifestyle
factors. Physical causes can include a malfunctioning or abnormal
lower esophageal sphincter muscle (LES), hiatal hernia, abnormal
esophageal contractions, and slow emptying of the stomach. Lifestyle
factors include diet (chocolate, citrus, fatty foods, spices),
destructive habits (overeating, alcohol and tobacco abuse) and
even pregnancy. Young children experience GERD and LPR due to
the developmental immaturity of both the upper and lower esophageal
Unfortunately, GERD and LPR are often overlooked
in infants and children leading to repeated vomiting, coughing
in GER and airway and respiratory problems in LPR such as sore
throat and ear infections. Most infants grow out of GERD or
LPR by the end of their first year; however, the problems that
resulted from the GERD or LPR may persist.
What role does an ear, nose, and throat
specialist have in treating GERD and LPR?
A gastroenterologist, a specialist in treating
gastrointestinal orders, will often provide initial treatment
for GERD. But there are ear, nose, and throat problems that
are either caused by or associated with GERD, such as hoarseness,
laryngeal (singers) nodules, croup, airway stenosis (narrowing),
swallowing difficulties, throat pain, and sinus infections.
These problems require an otolaryngologist—head and neck surgeon,
or a specialist who has extensive experience with the tools
that diagnose GERD and LPR. They treat many of the complications
of GERD, including: sinus and ear infections, throat and laryngeal
inflammation and lesions, as well as a change in the esophageal
lining called Barrett’s esophagus, which is a serious complication
that can lead to cancer.
Your primary care physician or pediatrician
will often refer a case of LPR to an otolaryngologist—head and
neck surgeon for evaluation, diagnosis, and treatment.
Diagnosing and treating GERD and LPR
In adults, GERD can be diagnosed or evaluated
by a physical examination and the patient’s response to a trial
of treatment with medication. Other tests that may be needed
include an endoscopic examination (a long tube with a camera
inserted into the nose, throat, windpipe, or esophagus), biopsy,
x-ray, examination of the throat and larynx, 24 hour pH probe,
acid reflux testing, esophageal motility testing (manometry),
emptying studies of the stomach, and esophageal acid perfusion
(Bernstein test). Endoscopic examination, biopsy, and x-ray
may be performed as an outpatient or in a hospital setting.
Endoscopic examinations can often be performed in your ENT’s
office, or may require some form of sedation and occasionally
Symptoms of GERD or LPR in children should be
discussed with your pediatrician for a possible referral to
Most people with GERD respond favorably to a
combination of lifestyle changes and medication. On occasion,
surgery is recommended. Medications that could be prescribed
include antacids, histamine antagonists, proton pump inhibitors,
pro-motility drugs, and foam barrier medications. Some of these
products are now available over-the-counter and do not require
Children and adults who fail medical treatment
or have anatomical abnormalities may require surgical intervention.
Such treatment includes fundoplication, a procedure where a
part of the stomach is wrapped around the lower esophagus to
tighten the LES, and endoscopy, where hand stitches or a laser
is used to make the LES tighter.
Adult lifestyle changes to prevent GERD
and drinking within two to three hours prior to bedtime
Do not drink
Eat small meals
Tomato and citrus
Fatty and fried
Wear loose clothing
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