Q & A

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I have a growth in my mouth

Question: I have what appears to be a skin tag in the back of my mouth. My general physician has monitored this growth in my mouth, and it has not grown in size and is fleshy in substance. I would feel much better seeing a specialist, but not sure which specialist to see.

Answer:

Any unusual growth in the mouth should be evaluated by a doctor. While most mouth growths are noncancerous (benign), they could also be precancerous (dysplastic) or cancerous (malignant). However, this also depends on how long this growth has been in your mouth. Typically lesions that are noncancerous resolve in a few weeks. Sometimes your doctor can tell by looking, but the growth may have to be biopsied or even removed to make sure it is not cancer or a pre-cancerous lesion.

It’s common for noncancerous growths to occur due to irritation, and can be surgically removed if necessary. Even ordinary, noncancerous warts (verrucae vulgaris) can be transferred to the mouth if a person has one growing on their finger, and they put it in their mouth. However, there is a new understanding of oral papillomas, which are basically warts, in the oral cavity. These may look like skin tags, but can be precancerous and should be removed. Obviously, anything that has not grown is less likely to be worrisome, but that is not always the case. To be on the safe side, get this checked out as soon as possible.

Specialists in Otolaryngology-Head and Neck Surgery (ENT) are the specialists one would usually see for this. Although one may also see a dentist with a subspecialty in oral surgery. Especially if the growth in your mouth is located on your gums.

I hope this clears things up.

Robert Pincus MD

NY Sinus Center

NY Otolaryngology Group

Q & A

Question: I have a strep infection and when I blow my nose, mucus comes out of my eyes.

Question:
I have cultured positive for strep in throat. The next day, my sinuses became inflamed and when I blew my nose, I had snot coming out of eyes and it also burned my eyes. Is this normal?

Answer:
While this is not what one would consider “normal”, it certainly can happen with a sinus infection (sinusitis).

Strep can not only cause a throat infection, but is a common bacteria causing sinusitis. When you get a sinus infection it is because the lining of the nose gets so swollen that the sinuses can’t drain. Typically the musus from sinusitis drains through the nose.

However, there are other “tubes” that drain into the nose, which can also get blocked in the same way. The eustachian tube drains the middle ear fluid into the back of the nose. If this gets blocked from swelling or congestion in the nose, fluid builds up in the space behind the ear drum and you can get a middle ear infection. (acute otitis media) This is quite common in children, because their eustachian tubes are shorter, more horizontal and often also blocked partially by adenoids (lymph tissue in the back of the nose). Adults can get this, of course, also.

The tear ducts are another set of tubes that drain into the nose. If they get blocked, we often tend to feel that we are making excess tears- as our normal tears can’t drain. If you blow your nose and the nose is congested- or hold the nose too tightly when you blow- mucus from the nose can go the other way- through the tear ducts and around the eye. This is likely what is going on in your case. Be careful not to blow the nose too forcefully while your nose is congested as the mucus from sinusitis can cause you to get conjunctivitis (pink eye).

I hope this clears things up.

Robert L Pincus MD

Co-Director NY Sinus Center

Q & A

I want to know if facial reconstructive surgery can help me remove the scar on my nose and let me have the nose I was born with?

Question: I have a square scar at my nose area. The size of the scar is about the size of a dime. I have had this scar since I was in my early 20s and I am 41 years old now. The scar hurts my self-confidence, and I have a problem looking at people straight face to face sometimes. My wife asked me one time what happened to my nose, but I did not answer her. She never asked me again because she probably knows I don’t want to talk about it. Can facial reconstructive surgery for scars be done? I want to know if facial reconstructive surgery can help me remove the scar on my nose and let me have the nose I was born with. I also want to know about the cost and recovery time based on what I described.

Thank you.

Answer:

Hello!

Scars can certainly cause significant distress, especially when they are in extremely visible facial areas. In order to best counsel you on scar revision, it would be ideal to know what type of skin you have, your scarring history, how the scar occurred, how it has changed over the years, and what type of revision techniques have already been performed. Most scars can be significantly improved with medical and surgical scar revision techniques, but it would be rare to have a scar “disappear” entirely. I like to focus on good, solid improvement. Some simpler scars are amenable to in-office revision techniques, and the costs can range from several hundred to several thousand dollars depending on what is required. Other more complicated scars have to be revised in the operating room and would have an additional operating room and anesthesia fees attached to it.

I hope this helps! I’d be happy to see you in further consultation and evaluate the scar for possible revision.

Corinne Horn, MD

Q & A

My husband has Methicillin Resistant Staph (MRSA) in his Sinuses

Question:
My husband, who has had sinus problems for years (and two sinus surgeries), sees an ENT, Dr. Raymond Schettino, every three months. A recent culture showed an infection, and the doctor prescribed a nebulized Vancomycin solution. The office did not let us know the results of the culture, only that it was positive. When I discovered he was taking Vancomycin, I became worried that he could have MRSA, so I asked my husband to contact the office to find out the results. Sure enough, he does have MRSA in the sinuses. I have three questions:

1) Is Vancomycin via nebulizer known to work on MRSA?

2) Is MRSA in the sinuses highly contagious?

3) What kinds of precautions should my children and I be taking to avoid contracting MRSA in the sinuses?

4) Is MRSA in the sinuses becoming more common among healthy people:

I am upset that this office didn’t let us know that my husband had a MRSA infection. When I called and mentioned this to the nurse, she waved me off, saying that any infection is contagious.

Answer:

First of all, thank you for your question. It really poses quite a few issues about both sinus infections and MRSA.

We certainly believe strongly that sinus infections should be treated, based on a culture. However, a positive culture does not mean the same thing as an infection. We all have bacteria in our body and our nose and sinuses, especially. Staphylococcus is a common bacteria on all of our skin and in our noses. MRSA is a type of staphylococcus that is resistant to the usual antibiotics we use for a staphylococcus infection. Many today are carriers of MRSA in their sinuses and nose, without actually having a sinus infection. The difference one needs to make is clinical. – i.e. is the patient sick?

Vancomycin is a very strong medication, used for resistant organisms. The usual recommendation for MRSA carriers in the nose is topical Mupiricin ointment (Bactroban).

I know of no good studies about the use of Vancomycin as a nebulizer, although it certainly is used for this by many.

Additionally, different strains of MRSA are able to be treated successfully with more common medications. Most MRSA in the community can be well treated with Bactrim- an old sulfa medication- which would be preferable to using Vancomycin, if possible.

MRSA is not especially contagious. The problem is that we (docs) usually treat infections with antibiotics that will not work against MRSA, and we may not realize it is MRSA until the patient gets sicker on medications. Today, we will often treat initially with medications that work against most MRSA.

In order to avoid getting MRSA, like any infection,- wash your hands frequently and cover your mouth when sneezing.

MRSA is becoming quite common in the community, today, in normal healthy individuals- replacing the previous types of staphylococcus. If your husband had MRSA- either as a healthy carrier- or as a cause of infection- I would suggest that you and your family members see your doctor for a culture. Most infectious disease doctors would probably not treat an MRSA carrier unless you are working in health care or are closely in contact with a newborn or someone with a weakened immune system. However, should you develop an infection in the future, we would know to treat you with something that would cover MRSA.

Robert L. Pincus MD

Associate Professor Otolaryngology

Co-Director NY Sinus Center/ NY Otolaryngology Group

Q & A

Is Tap Water safe for nasal irrigation?

Question: I used a sinus rinse last night and this morning to alleviate some pressure that has been causing me frontal headaches and snoring. Is using NYC tap water for nasal irrigation safe? I live in New York City and used its – famously clean – tap water for the rinse, though have since learned that this could be very dangerous due to the risk of bacteria and amoeba (and that boiled or filtered water is recommended). While I certainly wouldn’t see any adverse symptoms by this point, I have felt a little more sluggish and groggy today than usual. Are these common issues after using a sinus rinse and should I be concerned about the risk of infection after having used tap water?

Thank you!

Answer:

Thanks for your question. We do believe that nasal rinsing with hypertonic (saltier than normal saline) water is effective in helping the nose and sinuses become better filters. We usually recommend using either distilled, boiled (and cooled) or bottled water to make the solution. There have been no good studies on whether tap water is safe, however, for nasal rinsing. There is that case report of the infection after nasal rinsing, as you mention. However, I believe that if you would feel safe drinking the water, then probably (and I emphasize probably) tap water for nasal irrigation will be OK for an otherwise healthy individual. An immune compromised person should probably only use sterile water to rinse, if at all.

I doubt your symptoms are from infection from your sinus rinse- although people can have adverse effects, like getting water into the ear or getting water stuck in the sinuses If that happens, either rinse less forcefully, or stop doing so.

In the past, we had marketed a nasal rinse, Saltaire, which is premixed and still might be available on line.

Robert Pincus MD

NY Sinus Center

Q & A

I think my sinus infections stem from a problem with my immune system

Question:

I had sinus surgery 8 months ago. Since then I have been on 5 courses of steriods and 8 courses of antibiotics for the 8 sinus infections I have had post surgery. As soon as I get off an antibiotic, within a few days, I get another infection. I also have been doing a nasal mist with three antibiotics (bethmethasone, tobramycin and mupirocin). I have become totally unresponsive to antibiotics. I am desperate and starting to loss hope. I am interested in IGG because I believe the problem is my immune system. Do you know of an resources in the DC area that could help me with this?

Answer:

Thanks for your question. There is a small group of people who have recurrent respiratory infections, in spite of treatment, because of a weaknesss in their immune system. This is not related to AIDS. Generally these people have a “partial immune deficiency”- that is their white blood cells do not fight certain bacteria well. This causes them to be more susceptible to infections. Infections caused by immune deficiency can be treated successfully by supplementing one’s own immune cells with immunoglobulins given intravenously.

The best way to see if that is your problem is to be tested for this. It certainly makes sense at this point to do so. This type of evaluation is usually done by an immunologist. (a subspecialty within Allergy-Immunology) I would ask your doctor, or your own allergist if you have one, who is best for this – Should that not be the case, immunoglobulins would not likely be of help. I would look to for other, untreated causes of your problems- either at the NY Sinus Center or nearer to home.

I hope this clears things up.

Robert Pincus MD

NY Sinus Center

Q & A

My daughter has a hole in her septum and is called a nasal cripple

Question: My daughter, age 46 does not have a septum. In her late twenties, she had tried cocaine and supposedly lost the septum at that time. She has had two surgeries to clear her sinus and to no avail. She is called a “nasal cripple.” My concern is that nothing can be done and she is chronically ill with an infection and has been of leviquin for years. She has a hard time breathing at nite, so she is always tired. Do you have any suggestions on where to go next? What are her options for Empty Nose Syndrome treatment? Any advice would help. Thank you!

Answer:

Thanks for your question. We have quite a bit of experience dealing with this issue at the NY Sinus Center.

Many things can cause a hole in the septum, including the use of cocaine. One should first make sure that the hole was not caused by a medical illness, as a hole in the septum can be a sign of a life-threatening illness. Cocaine diminishes the blood flow to the nose and can cause the tissues to become inflamed, infected and often causes the death of the tissue locally. For any treatment to be successful, one must first get the patient to stop using. One must also find a doctor who is invested in non-judgementally helping his or her patient, no matter how the hole occurred. Treatment of septal perforations frequently requires a lot of work and commitment from both the doctor and patient.

Problems are caused by persistent inflammation in the area and the hole itself. We treat the inflammation by cleaning the nose and sinuses back to normal healthy tissue- (debridement)- sometimes opening blocked sinuses either with minimally invasive procedures or ballooning the sinuses open (balloon sinuplasty). However, the lack of a septum itself causes dryness, crusting and further inflammation. That is treated with sprays, washes and moisturizing. Nasal hygiene is the most crucial part of care.

Sometimes we can put in a prosthetic “button” to bridge the hole inside the nose- which classically helps the symptoms. Lastly, smaller holes can be repaired- although larger perforations usually won’t be closed successfully.

It’s never perfect, but usually, patients with large septal perforations can be helped.

I hope this helps clear things up…

Robert Pincus MD
Co-director NY Sinus Center

Q & A

Lost sense of smell after oral surgery

Question: A month ago I had oral surgery, I had a frenectomy, tooth extraction, bone graft, and an implant. My jaw bone was shaved and I was not prescribed the standard pre & post-op antibiotics, so, unfortunately, I developed a jaw bone infection. I had severe facial & neck swelling from the infection and was in the hospital for five days. I thought my decreased sense of smell & taste was due to all the medications but now I am off all of them and no smell or taste has returned. I can only taste or smell a little bit of bitter. I can’t even taste salt. Is this nerve damage from all the facial swelling? Do you think my lost sense of smell after oral surgery will ever return? It is absolutely devastating not being able to smell and taste. I had been a person with a hypersensitive sense of smell, I would get headaches if smells were too strong and avoided perfumes and the soap aisle in stores. I can’t imagine living the rest of my life like this.

Thank you.

Answer: I just posted a response to a question about the loss of smell on our web site- www.nyogmd.com – under ask the doctors- and I won’t repeat the whole answer…

Your issue is certainly more specific- We don’t always know what causes the loss of taste and lost sense of smell after oral surgery. Smell makes up much of the sense of taste-
The smell fibers are at the top of the nose and we can lose the sense of smell because of nasal congestion (think a bad cold)- or from nerve damage- which can occur after trauma, infection, surgery, or from an unknown reason.

You should be evaluated to make sure you don’t still have a sinus infection which can be causing the former loss- certainly, that can be improved-

Nerve losses are more difficult to treat. The nerve can re-grow over up to about a year. So there certainly is a good chance your smell and taste will return after an acute loss such as yours. We have been suggesting alpha lipoic acid to help with this process.

You might also consider the use of topical theophylline nasal spray. You would have to be in a study at this point, though, such as at the NY Sinus Center, as it is not yet commercially available.

R Pincus MD

NY Sinus Center

Q & A

Loss of Smell- Something New?

Question: I am a 75-year-old female, and I am losing my sense of smell. I have had sinus and allergy problems all my life, and I always have a tissue with me. In the past 4—5 years I have lost about 95% of my ability to smell. Taste is fine. Since I live alone, losing the sense of smell can be a real hazard. I miss this sense very much. I tried zinc. Nothing happened. Is there anything new that might bring back my ability to smell?? Thank you so much.

Answer:

Finally, there may be something new…

The loss of the sense of smell can be a devastating problem. Smell is important not just for the enjoyment of food and activities of life, but for safety – avoiding fire and spoiled foods. A person’s sense of smell becomes limited because of nasal congestion- in that case, air does not reach the smell fibers, or due to damage to the fibers themselves. Damage can occur after trauma, an upper respiratory infection, or for reasons unknown. We all do lose some sense of smell as we age.

The loss of the sense of smell should, however, get evaluated. One needs to be sure that there is no growth obstructing the smell fibers or damaging them directly. The nasal cavity should be evaluated to make sure there is no unusual congestion (polyps, chronic infection). Most otolaryngologists (ear nose and throat doctors) can do the appropriate evaluations and recommend therapy if indicated.

When these causes are ruled out, the treatment for the loss of smell is limited. We have recommended alpha lipoic acid- a vitamin that may help with nerve regrowth- but its there is no proof of its effectiveness as of yet.

A recent study, however, just published in November of 2012, is quite promising. Revealed in this study, the use of a low dose theophylline nasal spray (an old asthma drug- usually taken by mouth) helped almost all of a small group of patients improve their sense of smell, without reported side effects.

While this clearly needs to be further evaluated, the possible ill effects seem quite small- and the prospects for improvement are encouraging. We plan on doing a study shortly at the NY Sinus Center to see if we can confirm these results. Please call us for an appointment if you would be interested.

Robert Pincus MD

Co-director NY Sinus Center

Q & A

Can ear pain be from my teeth?

Question: Is my ear pain from teeth?

I found your Web Page while trying to figure out what is wrong with me, if you were closer to California I’d book an appointment. I’m a 41 yrs old and I started having trouble with my right ear they keep our offices very cold I sit directly under three vents I have been sitting under the vents for about three years now I do come down with the minor head cold occasional flu sometimes I believe that contributes to it since I wash my hair in the mornings and it’s too thick to completely dry with a blow dryer so my hair remains damp and having the cold air blast down on me all day at work does not help.

Well, with the holidays fast approaching and too much to get done before our holiday break I didn’t have time to be sick so I kept ignoring the fact that my ear was hurting … my ear pain was not tolerable it was hurting so bad I looked up some ear remedies I found online I poured in a few drops of Hydrogen peroxide into the infected year and it seemed to have helped a bit until that night I woke up with the worst pain my that shot from my ear to my teeth so Sunday morning I was in urgent care the Dr. or PA whatever he was asked a lot of questions even took an EKG to my surprise and diagnosed me as having facial arthritis and recommended I go see my dentist about my teeth, I was shocked.

So I went to see my dentist he took x-rays tapped on teeth, did a cold test that did eventually result in major pain and referred me to an Endodontic I have an apt with him tomorrow. But still refuse to believe it’ my teeth all this started with an earache that is still present and a swollen gland all of this by the way is on the right side, maybe I should believe it might be facial arthritis I highly doubt since I have no history of arthritis, and I believe I would probably be getting it in my hands before my face since I tend to use my hands more. I need to know if someone can have ear pain from teeth related issues.

Answer:

Thanks for your question. While I can’t tell for sure what is causing your ear pain without examining you. There are certinaly casesof ear pain from teeth, or more likely your jaw joint. The back wall of the jaw joint is also the front wall of the ear canal. Pain from the jaw joint typically presents as ear pain- and usually much more painful than what one gets from an actual ear infection- it creates a muscle spasm pain like when your back goes out.-

This can occur from a dental infection- but most commonly it is ear pain from teeth grinding (bruxism).

Put your finger just in front of the ear and open your mouth- if that is painful, you are likely to have what is often called ” TMJ”. You don’t need to have true arthritis.

The treatment is first making sure there is in fact no ear infection. If the problem is from the jaw- we recommend a warm compress, a soft diet and an anti-inflammatory (motrin, advil, aleve etc)- Should this persist, then we suggest following up with your dentist- If you are indeed grinding your teeth, you may find a bite plate at night (either from your dentist- or there are some availble at the drug store for this purpose) helpful.

R Pincus MD

NY Sinus Center

ENT Doctor Archives - Page 4 of 5 - The New York Otolaryngology Group

I have a growth in my mouth

Question: I have a strep infection and when I blow my nose, mucus comes out of my eyes.

I want to know if facial reconstructive surgery can help me remove the scar on my nose and let me have the nose I was born with?

My husband has Methicillin Resistant Staph (MRSA) in his Sinuses

Is Tap Water safe for nasal irrigation?

I think my sinus infections stem from a problem with my immune system

My daughter has a hole in her septum and is called a nasal cripple

Lost sense of smell after oral surgery

Loss of Smell- Something New?

Can ear pain be from my teeth?