Tuesday, March 11, 2008

A mucusy smorgasbord

Remember, if you need a question answered, send it to azureus at harborside dot com. And don't forget to see me at the blog and give me some love.


Heck, I don't even need to give you the letter on this next one. The answer is self-explanatory.


1. Itchy ears: if they're bothering you enough, consider asking your ENT for a prescription for Elocon (mometasone cream). The patient applies a thin layer to the ear canal openings once a day only as needed for itching. Works for most itchy ears. Caveat: some folks, and you may be one of them, have itching of the Eustachian tubes due to postnasal drainage. In that case, the only thing that will help is to treat the underlying nasal/sinus condition.

2. Tinnitus: currently, the only medication that seems to have any benefit is Zoloft, an antidepressant. Seems to help with tinnitus about 50% of the time. Not great odds, but better than nothing. (Be warned, though, that it occasionally makes tinnitus worse.) Masking is the old standby -- having some background noise in the room to distract your brain from its internal noise. But Zoloft is useful for folks who are getting loopy from the noise. I'm not sure how well this would work out with your Wellbutrin, though. Could be a problem.

3. For the mucus problem, the key interventions are (a) hydration (shoot for 64 ounces/day noncaffeinated, nonalcoholic beverages), (b) mucolytics such as guaifenesin (Mucinex, which is available OTC), (c) saline irrigation -- and nothing beats the NeilMed stuff, and (d) treatment of the underlying problem. Mucinex is the least important of those four things, hydration arguably is the most important.

4. Sometimes a person has nasal airway obstruction without any obvious source of obstruction. If that's the case, I check for nasal valve collapse. If this is the problem, lateral traction on the cheek greatly improves the airway. A Q-tip inserted into the nostril to "tent up" the ala ("wing" of the nostril) greatly improves the airway. If this is the case, there are two options: Breathe Right strips and surgery. There are a couple of approaches which bolster the nasal valve from within, essentially accomplishing internally what Breathe Right strips do externally.

5. It's very hard to say if your rhinitis and/or sinusitis has been managed with a sufficient level of aggression. There may be a role for oral antibiotics, antibiotic irrigation, antifungal irrigation, or nasal antihistamine spray (Astelin). Rarely, I use oral steroids (like Prednisone) which occasionally work better than nasal steroid sprays (like Flonase). Aggressive allergy management, either by avoidance or desensitization, may also be indicated. This part of the problem goes way beyond what I could accomplish for you in an email. I only wanted to point out that Flonase is a pretty wimpy first step at treating this problem, and there's a hell of a lot more that someone could do for you.

6. You may be wondering about obtaining a culture from the sinuses to find out what is causing the infection (if there is any infection). Nasal cultures are worthless, so the only way to get a worthwhile culture is by getting a surgical specimen. Since most of us leave surgery as a last resort, culturing the sinuses isn't much of an option. (ENTs can puncture into the sinus on an awake patient to get a valid culture, but it's REALLY unpleasant for the patient.)

This should give you plenty to discuss with your doctor.