Dr Kevin McCarroll
Ear, nose and throat complaints can be a source of much discomfort and are frequent accounting for a significant proportion of GP visits.
One of the most common symptoms is a sore throat that in the majority of cases is caused by viral infections and doesn’t generally require treatment with antibiotics. Gargling with salty water or aspirin can be soothing as well as using lozenges.
If very uncomfortable, local anaesthetic sprays can help but their effect is short-lived. If your sore throat is not improving within a few days or you have swollen nodes in your neck or ongoing fever then you may have a streptococcal infection and should go on a course of antibiotics.
Acid reflux from the stomach can also cause a sore throat, a sensation of something sticking, a cough and also hoarseness. It can persist for days to weeks and often occurs in the absence of any symptoms of heartburn.
Irritation
In particular, gastric acid can reflux into the gullet at night when lying flat and cause significant irritation to the throat and vocal cords. If symptoms are due to reflux they usually resolve within a few weeks of taking regular antacids with meals and medications that suppress gastric acid secretion.
Hoarseness is commonly caused by viral laryngitis which often happens in conjunction with a cold or sore throat but also other factors like excessive vocal use and drinks that are acidic or high in alcohol content. Resting your voice, avoiding vocal cord irritants including cigarette smoke and using humidified air or inhaling steam can help.
However, hoarseness persisting for more than three weeks may need further investigations with a laryngoscopy (camera test) to visualise the vocal cords especially if you smoke or take alcohol in excess. Hoarseness secondary to voice misuse or overuse is not uncommon in teachers, lecturers and singers and can be helped with vocal training.
Up to 20% of the population suffer with hay fever and tend to get a relapse of symptoms in the spring and summer due to increasing levels of airborne pollen or spores.
In Ireland, the most common allergen is grass pollen and spores that come from fungi or mould. The usual symptoms are a runny or blocked nose, sneezing and also watery eyes. To prevent flare ups, you should consider avoiding grassy areas or cutting grass and where possible going outdoors when the pollen count is high. You should also keep windows shut and avoid fresh flowers and pets in the house.
Over the counter tablets such as antihistamines can help with sneezing itching and watery eyes but may not be as effective for a runny nose which responds better to nasal decongestants. Some steroid nasal sprays are available without prescription and are very effective at relieving nasal congestion though work best when used regularly.
If your sinuses are congested you may also have facial pain around your nose or forehead and as well as taking the above treatments may require a course of antibiotics.
With nasal congestion from a cold, the Eustachian tube can also get blocked and cause fluid to accumulate in the middle ear causing hearing loss. This is also problematic when flying as failure to equalise pressure between your ear and nasal passage on airplane ascent or descent can cause the eardrum to be stretched outwards or inwards, which can be very painful and occasional result in it perforating.
Taking decongestants in advance can help prevent this as well as yawning and other manoeuvres (like blowing out with your nose pinched and mouth closed).
Wax in the ear canal shouldn’t be overlooked as a cause of hearing loss. Ear drops can be used to help dissolve it but often it will have to be removed with ear syringing which your GP can do. Removal by microscopic suction at an ENT outpatient clinic is sometimes required when wax is deeply impacted.
Vertigo or the sensation of things spinning around is often due to an ear problem. It can occur with an acute viral infection of the inner ear and is often associated with nausea. It usually settles down after a few days and medications can be given that are effective for symptoms. Intermittent vertigo that happens when moving your head or changing posture can sometimes be treated with special physical manoeuvres of the head that can correct middle ear dysfunction.
Tinnitus or a ringing / buzzing in the ear is usually associated with hearing impairment and damage to the inner ear but can also occur with irritation from impacted wax or infection and occasionally other medical conditions.
Unfortunately, in the absence of a reversible cause treatment is limited. However, low volume background noise can help mask tinnitus and you should avoid loud noises and stress which may make it feel worse. Reducing alcohol and caffeine intake may also help.
Dr Kevin McCarroll is a Consultant Physician in Geriatric Medicine, St James’s Hospital, Dublin.
