What are nose disorders?

Nose Disorders

Also called: Nasal disorders

Whether it's large or small, button-like or beak-like, your nose is important to your health. It filters the air you breathe, removing dust, germs and irritants. It warms and moistens the air to keep your lungs and tubes that lead to them from drying out. Your nose also contains the nerve cells that help your sense of smell. When there is a problem with your nose, your whole body can suffer. For example, the stuffy nose of the common cold can make it hard for you to breathe, sleep or get comfortable.

Many problems besides the common cold can affect the nose. They include

• Deviated septum – a shifting of the wall that divides the nasal cavity into halves
• Nasal polyps – soft growths that develop on the lining of your nose or sinuses
• Nosebleeds
• Rhinitis – inflammation of the nose and sinuses sometimes caused by allergies. The main symptom is a runny nose

Medlineplus

Voice Health

Taking Care of Your Voice

What is voice?

We rely on our voices to inform, persuade, and connect with other people. Your voice is as unique as your fingerprint. Many people you know use their voices all day long, day in and day out. Singers, teachers, doctors, lawyers, nurses, sales people, and public speakers are among those who make great demands on their voices. Unfortunately, these individuals are most prone to experiencing voice problems. It is believed that 7.5 million people have diseases or disorders of voice. Some of these disorders can be avoided by taking care of your voice.

What are some causes of voice problems?

Causes of vocal problems may include upper respiratory infections, inflammation caused by acid reflux, vocal misuse and abuse, vocal nodules or laryngeal papillomatosis (growths), laryngeal cancer, neuromuscular diseases (such as spasmodic dysphonia or vocal cord paralysis), and psychogenic conditions due to psychological trauma. Keep in mind that most voice problems are reversible and can be successfully treated when diagnosed early.

How do you know when your voice is not healthy?

Has your voice become hoarse or raspy?

Have you lost your ability to hit some high notes when singing?

Does your voice suddenly sound deeper?

Does your throat often feel raw, achy, or strained?

Has it become an effort to talk?

Do you find yourself repeatedly clearing your throat?

If you answer "yes" to any of these questions, you may be experiencing a voice problem. You should consult a doctor. An otolaryngologist (oh-toe-lar-in-GAH-luh-jist) is the physician and surgeon who specializes in diseases or disorders of the ears, nose, and throat. He or she can determine the underlying cause of your voice problem. The professional who can help you with improving the use of your voice and avoiding vocal abuse is a speech-language pathologist.

Tips to Prevent Voice Problems

• Limit your intake of drinks that include alcohol or caffeine. These act as diuretics (substances that increase urination) and cause the body to lose water. This loss of fluids dries out the voice. Alcohol also irritates the mucous membranes that line the throat.
• Drink plenty of water. Six to eight glasses a day is recommended.
• Don't smoke and avoid second-hand smoke. Cancer of the vocal folds is seen most often in individuals who smoke.
• Practice good breathing techniques when singing or talking. It is important to support your voice with deep breaths from the diaphragm, the wall that separates your chest and abdomen. Singers and speakers are often taught exercises that improve this breath control. Talking from the throat, without supporting breath, puts a great strain on the voice.
• Avoid eating spicy foods. Spicy foods can cause stomach acid to move into the throat or esophagus (reflux).
• Use a humidifier in your home. This is especially important in winter or in dry climates. Thirty percent humidity is recommended.
• Try not to overuse your voice. Avoid speaking or singing when your voice is hoarse.
• Wash your hands often to prevent colds and flu.
• Include plenty of whole grains, fruits, and vegetables in your diet. These foods contain vitamins A, E, and C. They also help keep the mucus membranes that line the throat healthy.
• Do not cradle the phone when talking. Cradling the phone between the head and shoulder for extended periods of time can cause muscle tension in the neck.
• Exercise regularly. Exercise increases stamina and muscle tone. This helps provide good posture and breathing, which are necessary for proper speaking.
• Get enough rest. Physical fatigue has a negative effect on voice.
• Avoid talking in noisy places. Trying to talk above noise causes strain on the voice.
• Avoid mouthwash or gargles that contain alcohol or irritating chemicals. If you still wish to use a mouthwash that contains alcohol, limit your use to oral rinsing. If gargling is necessary, use a salt water solution.
• Avoid using mouthwash to treat persistent bad breath. Halitosis (bad breath) may be the result of a problem that mouthwash can't cure, such as low grade infections in the nose, sinuses, tonsils, gums, or lungs, as well as from gastric reflux from the stomach.
• Consider using a microphone. In relatively static environments such as exhibit areas, classrooms, or exercise rooms, a lightweight microphone and an amplifier-speaker system can be of great help.
• Consider voice therapy. A speech-language pathologist who is experienced in treating voice problems can provide education on healthy use of the voice and instruction in proper voice techniques.

What research on voice is NIDCD supporting?

The National Institute on Deafness and Other Communication Disorders (NIDCD) supports and conducts research and research training on the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. NIDCD also supports the development of assistive or augmentative devices that improve communication for individuals who have communication challenges. Within the research support for voice is a range of activity from the molecular mechanisms of disease processes, such as papilloma virus, to clinical research that identifies strategies for diagnosis, treatment, or cure of voice disorders.

An active area of research is examining the dose of vibrational exposure that human vocal folds receive during phonation. At the cellular level, the effect of gene expression and protein production are being studied as a function of this vibrational dose. Results may lead to engineered vocal fold tissues that can withstand vibrational stress.

Other studies of voice disorders focus on determining the nature, causes, diagnosis, and prevention of these disorders. These studies may lead to the development of treatments and interventions that will improve the quality of life for those who are already challenged by severe voice disorders. Substantial progress has been made in the development of augmentative communication devices to facilitate the expressive communication of persons with severe communication disabilities. An investigation of conversational performance by users of augmentative communicative devices is in progress. Other funded research evaluates whether a low-cost, laser-activated keyboard for accessing personal computers is feasible. With access to personal computers, individuals with disabilities can immediately use software programs and speech synthesizers for augmentative communication. There is ongoing research on the mechanisms of laryngeal papillomatosis and of laryngeal cancer.

Because teachers are among the individuals with a high incidence of vocal disorders, NIDCD is supporting the development of an educational web site for teachers to support healthy behaviors and protection of their voices.

NIDCD

Balance and Dizziness

Balance, Dizziness, and You

Millions of Americans have disorders of balance they describe as dizziness. What can be difficult for both a patient and his or her doctor is that dizziness is what is called "a subjective term." (That means a word like dizziness can be used by people to describe different sensations they are experiencing, but it is hard for anyone but the person experiencing the symptoms to understand or measure the nature or severity of the sensations.) Another difficulty is that people tend to use different terms to describe the same kind of problem. "Balance problems," "dizziness," "imbalance," and "disorders of balance" are all used interchangeably.

What is dizziness?

For some people, dizziness is a feeling of unsteadiness or a spinning sensation. Others may experience extreme balance disorders that affect many aspects of their lives. Dizziness may be a fleeting sensation or the prolonged and intense symptom of a wide range of health problems that can affect a person's independence, ability to work, and quality of life. Experts believe that more than 40 percent of Americans will experience dizziness that is serious enough to go to a doctor. Even dizziness that seems minor, if undiagnosed, may be a signal of underlying disorders.

Balance problems are among the most common reasons that older adults seek help from a doctor. Many people are surprised to learn that the source of their imbalance may be in their inner ears. Balance (or vestibular) problems are reported in about 9 percent of the population who are 65 years of age or older. Fall-related injuries such as breaking (or fracturing) a hip are a leading cause of death and disability in older individuals. Many of these hip fractures are related to balance disorders. Although this fact sheet is about adults, children who complain about or describe balance problems should be seen by a doctor.

Balance disorders may also lead to other problems including fatigue, difficulty walking, or disinterest in everyday and leisure activities. If you or your child, parent, friend, or co-worker has a balance problem–take it seriously. Talk to the doctor about what happens when you feel dizzy or lose your balance. Be as careful as possible to describe your experience of dizziness specifically.

Describe your symptoms for your doctor

Ask yourself the following questions. If you answer "yes" to any of these questions, you should discuss the symptom with your doctor.

Do I feel unsteady?

Do I feel as if the room is "spinning" around me?

Do I feel as if I'm moving when I know I'm standing or sitting still?

Do I lose my balance and fall?

Do I feel as if I'm falling?

Do I feel as if I might faint? (sometimes people call this "lightheaded")

Does my vision become blurred?

Do I ever feel disoriented? (lose my sense of time, place, identity)

What should I do?

Balance disorders are serious. The most important thing you can do if you think you have a balance disorder is to see a doctor. Your doctor may refer you to an otolaryngologist (oh-toe-lair-in-GAH-luh-jist), the doctor who specializes in the ear, nose, and throat. An otolaryngologist will try to find out why you have balance problems and may discuss treatment options.

NIDCD

What is a Balance Disorder?

What is a balance disorder?

A balance disorder is a disturbance that causes an individual to feel unsteady, giddy, woozy, or have a sensation of movement, spinning, or floating. An organ in our inner ear, the labyrinth, is an important part of our vestibular (balance) system. The labyrinth interacts with other systems in the body, such as the visual (eyes) and skeletal (bones and joints) systems, to maintain the body's position. These systems, along with the brain and the nervous system, can be the source of balance problems.

Three structures of the labyrinth, the semicircular canals, let us know when we are in a rotary (circular) motion. The semicircular canals, the superior, posterior, and horizontal, are fluid-filled. Motion of the fluid tells us if we are moving. The semicircular canals and the visual and skeletal systems have specific functions that determine an individual's orientation. The vestibule is the region of the inner ear where the semicircular canals converge, close to the cochlea (the hearing organ). The vestibular system works with the visual system to keep objects in focus when the head is moving. Joint and muscle receptors also are important in maintaining balance. The brain receives, interprets, and processes the information from these systems that control our balance.

How does the balance system work?

Movement of fluid in the semicircular canals signals the brain about the direction and speed of rotation of the head–for example, whether we are nodding our head up and down or looking from right to left. Each semicircular canal has a bulbed end, or enlarged portion, that contains hair cells. Rotation of the head causes a flow of fluid, which in turn causes displacement of the top portion of the hair cells that are embedded in the jelly-like cupula. Two other organs that are part of the vestibular system are the utricle and saccule. These are called the otolithic organs and are responsible for detecting linear acceleration, or movement in a straight line. The hair cells of the otolithic organs are blanketed with a jelly-like layer studded with tiny calcium stones called otoconia. When the head is tilted or the body position is changed with respect to gravity, the displacement of the stones causes the hair cells to bend.

What are the symptoms of a balance disorder?

When balance is impaired, an individual has difficulty maintaining orientation. For example, an individual may experience the "room spinning" and may not be able to walk without staggering, or may not even be able to arise. Some of the symptoms a person with a balance disorder may experience are:

A sensation of dizziness or vertigo (spinning).

Falling or a feeling of falling.

Lightheadedness or feeling woozy.

Visual blurring.

Disorientation.

Some individuals may also experience nausea and vomiting, diarrhea, faintness, changes in heart rate and blood pressure, fear, anxiety, or panic. Some reactions to the symptoms are fatigue, depression, and decreased concentration. The symptoms may appear and disappear over short time periods or may last for a longer period of time.

What causes a balance disorder?

Infections (viral or bacterial), head injury, disorders of blood circulation affecting the inner ear or brain, certain medications, and aging may change our balance system and result in a balance problem. Individuals who have illnesses, brain disorders, or injuries of the visual or skeletal systems, such as eye muscle imbalance and arthritis, may also experience balance difficulties. A conflict of signals to the brain about the sensation of movement can cause motion sickness (for instance, when an individual tries to read while riding in a car). Some symptoms of motion sickness are dizziness, sweating, nausea, vomiting, and generalized discomfort. Balance disorders can be due to problems in any of four areas:

Peripheral vestibular disorder, a disturbance in the labyrinth.

Central vestibular disorder, a problem in the brain or its connecting nerves.

Systemic disorder, a problem of the body other than the head and brain.

Vascular disorder, or blood flow problems.

What are some types of balance disorders?
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Some of the more common balance disorders are:

Benign Paroxysmal Positional Vertigo (BPPV)–a brief, intense sensation of vertigo that occurs because of a specific positional change of the head. An individual may experience BPPV when rolling over to the left or right upon getting out of bed in the morning, or when looking up for an object on a high shelf. The cause of BPPV is not known, although it may be caused by an inner ear infection, head injury, or aging.

Labyrinthitis–an infection or inflammation of the inner ear causing dizziness and loss of balance.

Ménière's disease–an inner ear fluid balance disorder that causes episodes of vertigo, fluctuating hearing loss, tinnitus (a ringing or roaring in the ears), and the sensation of fullness in the ear. The cause of Ménière's disease is unknown.

Vestibular neuronitis–an infection of the vestibular nerve, generally viral.

Perilymph fistula–a leakage of inner ear fluid to the middle ear. It can occur after head injury, physical exertion or, rarely, without a known cause.

How are balance disorders diagnosed?

Diagnosis of a balance disorder is complicated because there are many kinds of balance disorders and because other medical conditions–including ear infections, blood pressure changes, and some vision problems–and some medications may contribute to a balance disorder. A person experiencing dizziness should see a physician for an evaluation.

The primary physician may request the opinion of an otolaryngologist to help evaluate a balance problem. An otolaryngologist is a physician/surgeon who specializes in diseases and disorders of the ear, nose, throat, head, and neck, with expertise in balance disorders. He or she will usually obtain a detailed medical history and perform a physical examination to start to sort out possible causes of the balance disorder. The physician may require tests to assess the cause and extent of the disruption of balance. The kinds of tests needed will vary based on the patient's symptoms and health status. Because there are so many variables, not all patients will require every test.

Some examples of diagnostic tests the otolaryngologist may request are a hearing examination, blood tests, an electronystagmogram (ENG–a test of the vestibular system), or imaging studies of the head and brain.

The caloric test may be performed as part of the ENG. In this test, each ear is flushed with warm and then cool water, usually one ear at a time; the amount of nystagmus resulting is measured. Weak nystagmus or the absence of nystagmus may indicate an inner ear disorder.

Another test of the vestibular system, posturography, requires the individual to stand on a special platform capable of movement within a controlled visual environment; body sway is recorded in response to movement of the platform and/or the visual environment.

How are balance disorders treated?

There are various options for treating balance disorders. One option includes treatment for a disease or disorder that may be contributing to the balance problem, such as ear infection, stroke, or multiple sclerosis. Individual treatment will vary and will be based upon symptoms, medical history, general health, examination by a physician, and the results of medical tests.

Another treatment option includes balance retraining exercises (vestibular rehabilitation). The exercises include movements of the head and body specifically developed for the patient. This form of therapy is thought to promote compensation for the disorder. Vestibular retraining programs are administered by professionals with knowledge and understanding of the vestibular system and its relationship with other systems in the body.

For people diagnosed with Ménière's disease, dietary changes such as reducing intake of sodium may help. For some people, reducing alcohol, caffeine, and/or avoiding nicotine may be helpful. Some aminoglycoside antibiotics, such as gentamicin and streptomycin, are used to treat Ménière's disease. Systemic streptomycin (given by injection) and topical gentamicin (given directly to the inner ear) are useful for their ability to affect the hair cells of the balance system. Gentamicin also can affect the hair cells of the cochlea, though, and cause hearing loss. In cases that do not respond to medical management, surgery may be indicated.

A program of talk therapy and/or physical rehabilitation may be recommended for people with anxiety.

How can I help my doctor make a diagnosis?

You can take the following steps that may be helpful to your physician in determining a diagnosis and treatment plan.

Bring a written list of symptoms to your doctor.

Bring a list of medications currently being used for balance disorders to your doctor.

Be specific when you describe the nature of your symptoms to your doctor. For example, describe how, when, and where you experience dizziness.

Lastly, remember to write down any instructions or tips your doctor gives you.

What research is being done for balance disorders?

Scientists are working to understand the various balance disorders and the complex interactions between the labyrinth, other balance-sensing organs, and the brain. Scientists are studying eye movement to understand the changes that occur in aging, disease, and injury. Scientists are collecting data about eye movement and posture to improve diagnosis and treatment of balance disorders. Scientists are also studying the effectiveness of certain exercises as a treatment option.

Recent findings from studies supported by the National Institute on Deafness and Other Communication Disorders (NIDCD) suggest that the vestibular system plays an important role in modulating blood pressure. The information from these studies has potential clinical relevance in understanding and managing orthostatic hypotension (lowered blood pressure related to a change in body posture). Other studies of the otolithic organs, the detectors of linear movement, are exploring how these organs differentiate between downward (gravitational) motion from linear (forward-to-aft, side-to-side) motion.

Other projects supported by NIDCD include studies of the genes essential to normal development and function in the vestibular system. Scientists are also studying inherited syndromes of the brain that affect balance and coordination.

The Institute supports research to develop new tests and refine current tests of balance and vestibular function. For example, scientists have developed computer-controlled systems to measure eye movement and body position by stimulating specific parts of the vestibular and nervous systems. Other tests to determine disability, as well as new physical rehabilitation strategies, are under investigation in clinical and research settings.

NIDCD, along with other Institutes at the National Institutes of Health, joined the National Aeronautics and Space Administration (NASA) for Neurolab, a research mission dedicated to the study of life sciences. Neurolab focused on the most complex and least understood part of the human body, the nervous system (including the balance system).

Exposure to the weightlessness of space is known to temporarily disrupt balance on return to Earth and to gravity. A team of NIDCD and NASA investigators had previously studied the effects of microgravity exposure on balance control in astronauts who had returned from short-duration space flight missions, but these studies did not include an aged individual. During the October 29-November 7, 1998, Space Shuttle Discovery mission, NIDCD and NASA collaborated in another study of postflight balance control. For the first time, a previously experienced, but now elderly astronaut, Senator John Glenn, participated. Data collected during this mission, which are still being analyzed, may help to explain the mechanisms of recovery from balance disorders experienced on Earth as well as in the space environment. Scientists also hope that this data will help to develop strategies to prevent injury from falls, a common occurrence among people with balance disorders, particularly as they grow older.

NIDCD

Laryngeal Cancer and Papillomatosis

Benign and especially malignant (cancerous) tumors of the larynx (voice box) are rare. Malignant tumors may be associated with benign tumors such as polyps and papillomas. These tumors may cause hoarseness, difficulty swallowing, and enlargement of the lymph nodes of the neck. Rhabdomyosarcoma (a malignant tumor of muscle tissue) is the most common malignant tumor of the larynx in children and is usually treated with chemotherapy and radiation therapy instead of surgery. Squamous cell carcinoma of the larynx should be managed with surgery and radiation therapy. Laser surgery may be the first type of treatment used for these cancers.

Papillomatosis of the larynx is a benign overgrowth of tissues lining the larynx. It is associated with the human papillomavirus (HPV) and is treated with laser surgery. This condition is not cancerous, but may recur after treatment. These tumors can cause hoarseness because of their association with wart -like nodules on the vocal cords that rarely extend into the lung. Cancerous changes may develop over time in the larynx and lung.

National Cancer Institute

Salivary Gland Tumors

Salivary glands are the parts of the mouth and throat that produce saliva. Many of the tumors in these areas arise in the parotid gland. About 15% of these tumors may arise in the submandibular glands or in the minor salivary glands under the tongue and jaw. These tumors are most frequently noncancerous but on very rare occasions may be malignant (cancerous). Sialoblastomas are a type of salivary gland tumor found in the first months of life. They are usually benign (not cancer), but may rarely be cancerous. The malignant lesions include adenocarcinoma, undifferentiated carcinoma, acinic cell carcinomas, and mucoepidermoid carcinoma. These tumors may occur after radiation therapy and chemotherapy are given for treatment of primary leukemia or solid tumors. Complete surgical removal is the treatment of choice whenever possible, with additional use of radiation therapy and chemotherapy. Prognosis (outcome) for patients with these tumors is generally good.

National Cancer Institute

Oral (Mouth) Cancers

Oral cancer in children or in adolescents is extremely rare. Most oral tumors are benign (not cancer). Malignant tumors include lymphomas (often Burkitt lymphoma) and sarcomas (soft tissue tumors). Oral squamous cell carcinoma (cancer of the thin, flat cells lining the mouth) is the most common type of oral cancer in adults, but is rare in children; adolescents (teens) with oral squamous cell carcinoma should be screened for a condition called Fanconi anemia. Mucoepidermoid carcinomas are rare and may be cured with surgery alone. Treatment of oral cancer in children may include surgery, chemotherapy, and radiation therapy.

National Cancer Institute

Cancer of the Nose and Throat

Cancers that start in the lining of the nasal cavity and throat are called nasopharyngeal cancers. This type of cancer is very uncommon in children younger than 10 years, and occurs slightly more often in older children and teenagers aged 10 to 19 years.

Nasopharyngeal cancer occurs in association with Epstein-Barr virus (EBV) infection, the virus associated with infectious mononucleosis. This cancer most frequently spreads to lymph nodes in the neck, which may alert the patient, parent, or physician to the presence of this tumor. The tumor may spread to the nose, mouth, and pharynx, causing snoring, nosebleeds, obstruction of the Eustachian tubes, or hearing loss. It may invade the base of the skull, causing cranial nerve palsy or difficulty with movements of the jaw (trismus). The cancer may spread to distant sites such as the bones, lungs, and liver.

Treatment combines the use of surgery, radiation therapy, and chemotherapy. Nasopharyngeal cancer generally has spread to bones of the skull and to lymph nodes in the neck at the time of diagnosis; thus, the principal role of surgery is to obtain adequate diagnostic material from a biopsy of the involved lymph node or the primary site. Studies show that combining chemotherapy with radiation therapy is the most effective treatment for this tumor.

National Cancer Institute

Ear Infections

Ear Infections

Also called: Otitis media
Ear infections are the most common illnesses in babies and young children. Most often, the infection affects the middle ear and is called otitis media. The tubes inside the ears become clogged with fluid and mucus. This can affect hearing, because sound cannot get through all that fluid.

If your child does not yet talk, you need to look for signs of an infection:

Tugging at ears
Crying more than usual
Ear drainage
Trouble sleeping
Balance difficulties
Hearing problems
Often, ear infections go away on their own, but your health care provider may recommend pain relievers. Severe infections and infections in young babies may require antibiotics. Children who get frequent infections may need surgery to place small tubes inside their ears. The tubes relieve pressure in the ears so that the child can hear again.

National Institute on Deafness and Other Communication Disorders

Glossopharyngeal Neuralgia

What is Glossopharyngeal Neuralgia?

Glossopharyngeal neuralgia (GN) is a rare pain syndrome that affects the glossopharyngeal nerve (the ninth cranial nerve that lies deep within the neck)  and causes sharp, stabbing pulses of pain in the back of the throat and tongue, the tonsils, and the middle ear.  The excruciating pain of GN can last for a few seconds to a few minutes, and may return multiple times in a day or once every few weeks.  Many individuals with GN relate the attacks of pain to specific trigger factors such as swallowing, drinking cold liquids, sneezing, coughing, talking, clearing the throat, and touching the gums or inside the mouth.  GN can be caused by compression of the glossopharyngeal nerve, but in some cases, no cause is evident.  Like trigeminal neuralgia, it is associated with multiple sclerosis.  GN primarily affects the elderly.

Is there any treatment?

Most doctors will attempt to treat the pain first with drugs.  Some individuals respond well to anticonvulsant drugs, such as carbamazepine and gabapentin.  Surgical options, including nerve resection, tractotomy, or microvascular decompression, should be considered when individuals either don’t respond to, or stop responding to, drug therapy.  Surgery is usually successful at ending the cycles of pain, although there may be some sensory loss in the mouth, throat, or tongue.

What is the prognosis?

Some individuals recover from an initial attack and never have another.  Others will experience clusters of attacks followed by periods of short or long remission.  Individuals may lose weight if they fear that chewing, drinking, or eating will cause an attack.

NINDS

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