Today we’re going to talk about where sinus drainage comes from!

On occasion, you may wonder to yourself, where is all of this drainage coming from in my nose?  How to get there?  And why is there so much of it?  These are all really great questions, and they have answers.

The sinuses are spaces within the skull that are filled with air.  Ideally, we have four main families of sinuses in our own skull – the Frontal sinus, the Ethmoid sinus, the Maxillary sinus, and the Sphenoid sinus. >>> insert photo <<<

inside the nasal cavity we also have a special type of lining that generates mucus.  You can pick a mucus as the oil that lubricates the inside of the nose and sinuses.  It’s also very special, because it contains immune agents that help to keep you from getting infected.  This special lining however can go a little haywire and occasionally can leave us with more mucus than we actually want or need!

You already know several things that can cause us to have drainage in her nose and sinuses.  From personal experience you may have had difficulties with allergies, and infections.  Some of the lesser-known things that can cause drainage to be a nuisance can be things such as foreign bodies.  Not infrequently, small children will play something inside the nasal cavity and the nose will continue to run and run and run.  Also, polyps can cause patients to have a chronic runny nose as well.


Throughout a typical day while we are breathing, through her nose we may inhale as much as 20,000 L of air.  During this typical day some of it may cause problems because of the allergies, or viruses that may contain.  We generally secrete 1 to 1 ½ leaders of mucus a day.  But this can fluctuate based upon our locality, or help, and medications that we may be taking.


If you are having problems with feeling as though you’re making too much sinus drainage there are a few things that you can do.  Make sure that your allergies are under control.  Do a little research to see whether or not any of the OTC allergy medicines may help you.  Consider using a saline nasal rinse, or the OTC X-clear rinse is another great choice.  Finally, some individuals simply need an antihistamine and/or a decongestant to help him get through difficult times.  If you are finding that you are having hard time controlling the amount of sinus drainage that you’re having you may want to speak to your primary care provider as well.


Being more efficient at your Doctor’s office



We don’t think about it much, but when going to the doctor there are a few tips that we can use that will help to be more efficient with our visit.

Generally when we go to see a physician, we are set in the waiting room, for an interminable amount of time (I promise we’re working!). Finally, we are called back to see the physician so that we can get our appointment underway. In actuality, there are things that we could have done before the appointment that would make it much more efficient. I’m going to talk a little bit about that today, in hopes that this will be a valuable piece of information to you that you can use in your life.

When you call your doctor’s office to get an appointment, many times you are being sent by your primary care provider with a specific problem in mind as to why you are seeing this particular doctor. With the best meaning intentions your primary care provider may not have been able to send any of the records that relate to your particular problem at this time, or in some cases the records may not be available.  Because of the vast disconnectedness of the medical information system that we have at this time this can put both you and your new doctor behind the curve in getting to an answer.

Here are a few things that I recommend that you have ready before you come to the appointment:

  • Describe in your own words what the problem is that you want addressed…
  • As best as possible identify the onset, location, duration, and any characteristics of the problem that you think are relevant.…
  • Describe what you feel makes it better, or what makes it worse…
  • To your knowledge is there anything that you think contributed to this?

Additionally, if your primary care practitioner has already performed some tests try to get copies of them and bring them to your appointment. Do not count on the medical establishment to send the information for you. For instance:

  • If a CT, or MRI has been ordered, when was it ordered? And do you have a copy the results?
  • If you don’t have results, where was the test done?
  • If you have seen another specialist, do you have any notes? What did they tell you?
  • Have you been placed on any medications? Do they work?

The whole purpose of your being your appointment is to get to your problem, and find a solution. If you can help in even a small part of doing what is listed above I guarantee that it will help you achieve your goal. In most cases, your physician is trying to be as efficient as possible. With your help, you can move the process along efficiently and be the better for it!


Stay Healthy!


Common ENT Problem – Hoarseness

If you think about what a wonderful device the human voices, it is simply amazing! From the beginning of our lives when we come into this world screaming to the last words we say we are always using it. Some fortunate people have even created art with their voice. But what exactly happens when we are having difficulty with her voice? Today we’re going to take a look at the voice, and hoarseness.


I know of a few other organs in the body with his much odd nomenclature as the human voice box. Take for instance the anatomical term is – the larynx. This is more commonly known as the voice box. It is the area that plays a crucial role in our speech, and breathing. It also helps to separate the air that we breathe, from the food that we eat. The voice portion, larynx, is separated into an upper portion (supraglottis) a middle portion (glottis) and a lower portion (subglottis).  The actual voice is created from the middle portion. Within the larynx specialized muscles come together in a, “V” shape and vibrate together. This rhythmic movement created during inhalation and exhalation is what creates our voice. The characteristic narrowing and opening of this aperture in combination with muscular tension produces different pitches of the sounds that we hear. Some of you ever wondered why you go hoarse?

Hoarseness can come from a whole host of different reasons. For instance, if you’ve had an upper respiratory tract infection such as a sinus infection or cold the type of mucus that your sinuses generate changes. With this change comes a difference in the mucus is ability to lubricate the voice box. This will cause your voice to crack, go hoarse, and sometimes your voice will completely go away. Because mucus plays such an important role to the voice box I like to think of it as the oil that lubricates the engine of our voice. Certainly other factors can affect the voice as well through the same mechanism. Allergies, are another example that changes the mucus for the worse and can alter the voice.

Vocal abuse is another way in which we can create hoarseness. Who among us has not been to a concert and yelled overly loud only to find out the next morning that you could not speak at all. This type of mechanism is really more like muscular overload, and secondary swelling. The vocal cords, which are very tiny, have been stressed over their limit and if you could see them with a microscope you would see that there is significant swelling and inflammation of the vocal cords and because of that the very fine contact points that allow you to generate your unique pitch have been damaged. Hopefully, for most individuals, it is only a temporary problem and will heal over time. Unfortunately, some individuals repeatedly do this type of damage to the vocal cords causing more permanent changes. Changes such as singers nodules, or vocal cord polyps, can occur over time and permanently change the lighting of the voice box.

The final group of individuals who have are the ones that are very concerning. These are individuals who, in many cases, have smoked and created chronic irritation of their voice box. Of course, most people are familiar with the deepening pitch of the voice box, as a person accumulates years of smoking. Unfortunately, the deepening pitch is not the only thing that changes with the voice box. The repeated damage caused by smoke can cause cancerous changes to the voice box. These changes very frequently alter the frequency of the voice, or sometimes remove it altogether. This is very concerning and needs to be looked at by a specialist. This is a condition that can be treated in many cases, if caught early enough.

So, when you find yourself alone today go ahead and sing out, and enjoy your voice. It is a most amazing instrument of our being. Think about your voice, and all that it does for you. Perhaps you are the most gifted singer (I know I am not) but your voice is still, your voice.

Stay Healthy!


Ear problems in Adults

Most people are familiar with ear infections in children. That nagging high fever, fussiness, and trouble sleeping that cause children and their parents misery.  But adults get ear problems too!  Very frequently people will come in to see me with either muffled hearing, pain in the ear, or a failure of the ear to clear with pressure, and be surprised that they are having ear issues as an adult. Ear problems are not limited to babies and school-age children. They can be a significant source of problems for many adults as well.

First thing to be aware of is the anatomy of the inner ear and how the ear works. The outer ear, and the canal itself funnel sound to the eardrum in order to provide the maximum amount of sound energy to the eardrum. At the level of the eardrum sound energy is converted to mechanical energy by striking the drum itself and causing the bones (Hammer, Anvil, and Stirrup) to vibrate. At the end of the Stirrup the mechanical energy is transferred to a fluid medium inside the cochlea. Once inside the cochlea, like a wave in a swimming pool, the wave proceeds through the cochlea bouncing off the walls stimulating the nerve of the inner ear. This creates a small electrical change which is transmitted from the cochlea through the nerve of hearing to the brain and we are able to perceive sound!!!

Ear infections can cause damage in multiple different areas of the hearing mechanism allowing us to have continued and repeated infections, as well as decreased hearing. For instance, the following areas can be damaged if you have had infections to them:

  • Eardrum
  • Middle ear cavity
  • Eustachian tube opening
  • Mastoid cavity
  • Ossicles (bones of hearing)

Most commonly in our area of northern Nevada we have issues with individuals who have problems in the middle ear, and eustachian tube. This can be created from prior ear infections as a child, or it can be created with allergy issues that cause swelling and inflammation. You must remember that the clearances inside the middle ear cavity are extremely small. For most patients the opening of the eustachian tube if a hundredth of a millimeter and is normal. The tolerances are so exceedingly small that it is not uncommon for a person with a normal ear to have transient difficulty. When you combine this with the large amount of altitude change in northern Nevada it is easy to understand how elevation changes, as well as allergies will only serve to cause the system to malfunction.

Quite frequently patients are surprised that they are having ear issues. But as I try to explain to them the pollens and other allergens combined with the drastic altitude changes causing ensuing barometric pressure changes are a unique attribute of our high desert lifestyle.

Generally, treatment strategies are directed at trying to reduce the inflammation and swelling and provide better airflow through the middle ear cavity and mastoid system. This can be accomplished by using antihistamines such as Allegra, Claritin, and Zyrtec. And it can be augmented by using nasal sprays such as Flonase, and Nasacort. All of these medications work in conjunction to reduce swelling, and alleviate the blockage of flow that is encountered. If you are having difficulties like this please mention it to your primary care provider and they will be able to help you.

Stay Healthy