Sunday, January 29, 2006

Open thread

Question on your mind? Spit it out.

The question that is, not your mind. Eeew.



At 10:23 PM, Blogger THIS! Christine said...

Dear Dr. Doug,

Not exactly your area of expertise but I think it falls under the eww ick department.
12 yr old son's hormones kicked in and he has localised acne and black heads (over his nose) this started about a yr ago, for the last 4 months he's been (gently) cleansing his face twice a day and using acne pads whenever he thinks of it (prolly no more than two more times a day (he keeps the pads on his desk) using over the counter acne medications.
This isn't the odd puss filled pimple either. we're talking big nasty red eruptions that merge all over his nose and no matter how diligent he is in his cleaning regimen nothing seems to be clearing it up (or at least keeping it under a non freakish control).

So my question, should I take him to the docs and get a prescription for the acne before this problem spreads all over his face?


At 2:06 PM, Blogger Douglas Hoffman said...

If it were my son, he'd be in the dermatologist's office asking for whatever the current top-of-the-line med is. Why suffer with this? Poor kid.

At 6:38 PM, Blogger Kate R said...

well? is this news 100 years old too?

At 10:39 PM, Anonymous Anonymous said...

I'm looking for some advice on where to turn next and I'd appreciate any help you can give me. I have been dealing with eustachian tube dysfunction for a little over 3 years. The quick version is: Following a mild cold, my ear got that "plugged up feeling", so I went to my family doc, he said I had a wax impaction, told me to use eardrops to soften the wax, then had his nurse irrigate the ear. (Horrible, painful, and dizzy-ing experience). This did not remedy the situation, so off I went to the ENT who diagnosed an infection, then another infection, etc. After 4 courses of antibiotics, a fiberoptic scope of my nose, a light shined through my sinuses, and air blown up my nasal cavity, he put a ventilation tube in my ear. The tube came out 4 months later. After 6 more courses of antibiotics within 4 months, no progress, and seemingly no concern that my hearing was getting significantly worse, I went to another ENT. (there's more to my story of choosing another doc that's not pertinent to this)
This ENT tested my hearing (30-35% loss), put in another ventilation tube, did a nasopharyngoscopy, and a biopsy of my nasopharnyx, which came back ok. That tube lasted just over 2 years, with only one ear infection during that time. The tube came out about a month ago.
I am now in worse shape than when this started. My ear is horribly plugged, last weeks hearing test showed that my good ear now has some hearing loss as well, and the ringing in my ear is driving me nuts. Added to this, I have a few other symptoms- I don't know whether they are related or not. These include: a lump on my jaw bone, some swelling in neck (possibly residual to a parotid [sorry if the term or spelling is wrong] gland infection approximately 5 months ago, and an occassional sore throat that feels like a muscle spasm and lasts for 5-10 minutes and recurs maybe 4-5 times a month. All of this is on the same side as my bad ear. I have been to the dentist for a check up, just in case, and she says my teeth are fine, no cavities, etc.
My ENT wants to hold off on putting in another tube, taking a more "wait and see" approach. He also suggested that I try the "plug your nose and blow" technique to try to force the ear to unplug. This has done nothing but plug the good ear up. Basically, I'm tired, frustrated, and scared that a)I have a tumor or something growing in there causing all of this, and b)this hearing loss is permanent and progressive. I go back to my ENT in 2 days for a check up. What do you suggest I ask him? Is there anything else that can be done for this?

At 10:30 PM, Blogger Douglas Hoffman said...

Kate, that is, indeed, news to me.

Anonymous: hate to disappoint you, but you've overwhelmed me. I don't think these are very helpful questions, but . . . I'd ask why this happened to you as an adult when you hadn't previously had these problems (I'm assuming). I'd ask if the hearing loss is conductive (which is potentially reversible) or sensorineural (which isn't reversible). Finally, I'd ask for a referral to an otologist.

At 11:12 PM, Anonymous Anonymous said...

I'm sorry I've overwhelmed you, that was quite a bit of information, wasn't it?. I have to admit, I'm a bit overwhelmed myself. Thank you for the response.

At 7:58 PM, Anonymous Anonymous said...

My problem is a feeling of congestion in the right maxillary sinus area. Sometimes the root of one of my molars in the same spot is tender and achy. Pan x-ray showed nothing more than slight thickening of mucosa of right maxillary sinus. CT scan showed nothing abnormal. Decongestants, antihistamines, Flonase, sinus irrigation (with Grossan irrigator) do not help. Painful stinging sensation with Grossan irrigation on right side, bringing tears to my right eye.

I am always fine in the morning. This congestion and discomfort comes in the afternoon or evening, always only on the right side.

I have an appointment to see an ENT on Feb 27. My question is: Can you see anything with a scope that would not show on a CT scan? My doctor and I suspect this may be a neurological problem (facial neuralgia or atypical migraine) and going to the ENT may be a waste of time. What do you think? Should I cancel my appointment?

At 11:05 PM, Blogger Douglas Hoffman said...

Hi Sabine. With the evidence you've given me, I'd be leaning more towards a dental expanation than a sinus explanation, even with the normal panorex. I don't think the ENT eval will hurt (and, to answer your question, a nasal endoscopy will indeed give information not available on CT) but I would get a second opinion from an oral surgeon, too.

Facial neuralgia is a diagnosis of exclusion. That means your doctors must make every effort to EXCLUDE all other potential diagnoses before deciding it's neuralgia. Very important not to skip steps in this process. Best of luck to you!

At 10:44 AM, Anonymous Anonymous said...

Thank you, Dr. Doug. I've almost gone as far as I can following the dental route. Trying to keep this short, so won't include all details but I do thank you for taking the time to respond to my question.

At 10:27 PM, Anonymous Jen said...

One week ago I finished a 2 week course of Augmentin for a bad case of bronchitis and sinus infection. I also took Prednisone for 5 days (40) and take Advair 250/50 twice a day for asthma and Rhino Cort. The sinus infection seemed to clear up and I don't cough up blobs anymore from the bronchitis, but last weekend I had an episode where I tried to take my daughter to the mall and I got really weak, I could barely walk, short of breath, and "goofy." My husband had to come pick me up because I was too nauseated and weak to drive. Since then, for one week, I have had bad nausea in the afternoons and evenings, and fatigue, and just feel "wrong" in the head. (NOT preganant, confirmed) Blood tests taken on Wednesday were normal except for an elevated white blood cell count.
Now I have a sore throat and white patches on my tonsils, this happened today. My doc thinks the nausea/dizziness is from the Prednisone, but I haven't taken that for two weeks now. And finally my sinuses are really swollen since the infection, per the doc and how my head feels. I wash them with saline twice a day and use a saline spray.

Help please! I don't think my doctor really listened to me when I told her about the timeline, (another doctor, my allergist, saw me for the bronchitis due to my asthma issues) and I don't understand why Prednisone would start to affect me so badly at least a week after I stopped taking it. Generally I never miss work from illness but the bronchitis was so bad I missed over a week, and I am still so weak and nauseased that I have only been working until 2 or 3. What should I be asking about? How can I have another infection so quickly after the Augmentin?

At 11:38 PM, Anonymous Anonymous said...

I'm the person who asked about fluid behind the eardrum a few threads back. Just wanted to let you know that I stuck it out, and my ear feels a lot better now. Thanks for your help!

At 1:32 PM, Blogger Douglas Hoffman said...

Jen, ask about yeast infection for starters. Give your doc all the info you've given me (naturally). Nothing else comes to mind, I'm afraid; this is a case where a history and physical exam are essential, and my curbside opinion is worse than useless.

Anonymous, great! Thanks for the followup.

At 11:41 PM, Anonymous Anonymous said...

Dr. Hoffman,
I'm the one that gave the overwhelming amount of info a couple of weeks back. A quick update, if you're interested...
After looking at my nasopharynx again and seeing some "irregularities" and changes since the last time, my doc (actually, he's an otolaryngologist / head and neck surgeon - I need to pay better attention)decided he wanted another biopsy. On friday, I had another surgery for the biopsy (in through the nose this time) and myringotomy. I can hear out of that ear again (answers the permanent question) and I'm just waitng on the biopsy results.

At 6:05 PM, Anonymous Anonymous said...

Hey Doug,

I stumbled across your site and had a few questions for you.

I went to the doctor's today after a week of hearing loss in my left ear. By the last day of this week, I had a low grade fever, and my ear was slightly painful to the touch. I decided it would be prudent to see my physician. I went to him, thinking that I had an ear infection. In fact, my ear was blocked with wax. After several irrigation/debrox combinations, they had managed to dislodge all the wax. (And boy was there a LOT of wax)

After finishing up, my doctor said that I had small tubes in my ear, and that many people with small tubes often have a hard time draining the warwax from their ears.

My two questions are:

1) My ear is still feeling slightly "swollen" to the touch. Is this normal, and how long before it goes away?

2) Is there anything else, other than the information on your site, that would aid me and my small ear tubes in draining ear wax more efficiently?

At 2:47 PM, Anonymous Anonymous said...

I have a stopped up right ear from a cold. I have been taking Mucinex and drinking lots of water. I am experiencing a lot of drainage and think I have blown my nose too hard. I used some nose spray and it relieved the pressure for a while but it is stopped up again. I have to fly tomorrow morning. HELP ME PLEASE!

At 6:55 PM, Blogger kendra23 said...

I started out with tonsilitis on monday, by tuesday it was turning into a sinus infection, its now wednesday and my eyes, face and nose kill, sore neck and a headache to boot. When I have to blow my nose and it come from deep in the back of my head it has blood trace and hurts, same as when I have to hack up the nasal drip, I am 9 weeks pregnant, do i need to go back to the doctor? hey put me on amoxicillin.


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