Month: October 2021

Eustachian Tube Dysfunction and Allergies

• October 6, 2021
• Black & Kletz Allergy

The Eustachian tube is a small tubular passageway that connects the middle ear with the junction of the back of the nose and upper throat. It is approximately 1.5 inches long and 3 mm. (0.12 inches) in diameter. It is the structure in the ear that pops when one goes to high altitudes or descends deep in the water. The tube helps to regulate pressure in the middle ear, shield the ear from hearing its own body noises, and drain fluid from the middle ear. The Eustachian tube has a valve that opens and closes. If the tube stays open too much, one may get a constant feeling of increased pressure in one’s ear. In addition, one may hear their own body noises such as hearing one’s voice too loudly or hearing one’s own breathing. On the other hand, if the Eustachian tube stays closed, there may be a buildup of fluid which may result in a feeling of increased pressure and/or pain in the ear as well as a decrease in hearing.

Eustachian tube dysfunction occurs when the tube fails to open and gets stuck closed during swallowing or yawning. This results in a difference in the air pressure between the inside and outside of the middle ear.

The most common cause of Eustachian tube dysfunction is an upper respiratory infection (URI) such as the common cold, flu, or a sinus infection. Other causes of Eustachian tube dysfunction may include allergies (i.e., allergic rhinitis), enlarged tonsils/adenoids, nasal polyps, cigarette smoke, pollution, nasal tumors, cleft palate, and/or tumor at base of the skull. Note that the last 3 causes mentioned are fairly rare causes of Eustachian tube dysfunction.

We will focus on allergies as a cause for Eustachian tube dysfunction. Allergic rhinitis (i.e., hay fever) is a very common condition and accounts for a fair amount of Eustachian tube dysfunction. The classic symptoms of allergic rhinitis may include runny nose, nasal congestion, sneezing, post-nasal drip, snoring, itchy eyes, watery eyes, redness of the eyes, sinus pain/pressure, itchy nose, and itchy throat. As a result of a post-nasal drip, some individuals may experience hoarseness and a sore throat. Others may develop asthma symptoms such as chest tightness, coughing, wheezing, and/or shortness of breath.

Still others, however, may develop symptoms of Eustachian tube dysfunction. These symptoms may include clogged ears, hearing loss, increased ear pressure/pain, popping of the ears, vertigo/dizziness, and/or ringing of the ears (i.e., tinnitus). Allergies may cause a narrowing of the Eustachian tube opening or its passageway resulting in the symptoms described above.

The diagnosis of an allergic cause of Eustachian tube dysfunction begins with a comprehensive history and physical examination. If an allergy is suspected, allergy skin testing or blood tests may be performed. A CT scan of the sinuses may be ordered for individuals who present with recurrent or chronic sinus infections.

The management of the underlying allergies in patients with allergy-induced Eustachian tube dysfunction is the goal of treatment. Treating the underlying allergy may help to reduce the swelling in the lining of the Eustachian tube. Nasal corticosteroids are often effective in reducing the symptoms of Eustachian tube dysfunction. Oral or nasal decongestants may also be beneficial. Oral and nasal antihistamines have also proven beneficial in the treatment of allergic rhinitis. Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a very effective tool to treat allergic rhinitis as it works in 80-85% of patients on this therapy.

The board certified allergy doctors at Black & Kletz Allergy have been treating Eustachian tube dysfunction as well as allergies, sinus problems, and asthma. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years and treat both adult and pediatric patients. All 3 offices at Black & Kletz Allergy offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you are concerned that you may have Eustachian tube dysfunction, allergies, sinus problems, asthma, hives, eczema (atopic dermatitis), or immune system problems, please call us to schedule an appointment. You may also click Request an Appointment and we will reply within 24 hours by the next business day. At Black & Kletz Allergy, we strive to improve the quality of life in allergic individuals in a professional and compassionate setting.

Seasonal Flu and Asthma

• October 5, 2021
• Black & Kletz Allergy

Viruses cause a variety of illnesses in humans ranging from mild upper respiratory infections (URIs) to life-threatening pulmonary and extra-pulmonary diseases. Rhinoviruses, adenoviruses, respiratory syncytial virus (RSV), coronaviruses, and influenza viruses are the most common viruses infecting the respiratory tract. Among these rhinoviruses, RSV, and influenza viruses are common causes of wheezing in children. Recurrent infections with these viruses may play a role in the development of asthma.

Patients with asthma are more susceptible to contracting infections with the influenza virus. In addition, they are also more likely to develop serious complications from influenza. In fact, more than 75% of acute flare-ups of asthma are triggered by infections from influenza, RSV, or rhinovirus.

Infections typically occur in the United States between October and November with a peak infection rate between January and March. There are 3 strains of influenza viruses that cause human infections; influenza A, influenza B and influenza C.

Influenza A and B are typically associated with seasonal disease but also have been associated with several pandemics during the 20th century. For example, in 1918, the Spanish influenza (i.e., Spanish flu), a strain of H1N1 of influenza A, caused between 50 and 100 million deaths worldwide with a mortality rate of 2.5 to 3%. Most of the deaths occurred in adults between the ages of 20 and 40 years old. In 1957, the Asian influenza or Asian flu of the H2N2 strain of influenza A, caused between 1.5 and 2 million deaths. In 1968, the Hong Kong influenza (i.e., Hong Kong flu), a strain of H3N2 influenza A, caused over 1 million deaths.

Currently circulating influenza A viruses of the H1N1 variety are related to the 2009 H1N1 pandemic that emerged in the Spring of 2009 and caused a flu pandemic.

Influenza infection begins with invasion of the respiratory epithelium by the virus. This site in the respiratory system serves as a place for both viral replication and the resulting host’s immune response. Destruction of normal airway tissue and a pro-inflammatory immune response are the primary causes of symptoms associated with influenza infection.

The immune response of the host causes many of the symptoms associated with a viral respiratory infection and those associated with exacerbations of underlying asthma. Certain individuals seem to be at a higher risk for developing infections in the lower airway (i.e. lungs). For example, age less than 6 months old, second-hand smoke exposure, and genetic factors play a role in increasing the risk of infection. Allergic subjects are also more susceptible to infections due to an impaired immune response.

Symptoms:

• Runny nose, stuffy nose, post-nasal drip
• Sore throat
• Cough
• Fever, chills
• Achiness
• Vomiting, diarrhea
• Fatigue

Complications:

• Pneumonia
• Exacerbation of asthma symptoms
• Inflammation of the heart muscle
• Inflammation of the brain

Treatment:

Most cases of influenza are mild and symptoms usually resolve within 7 to 10 days. Symptomatic relief can be given by over-the-counter medications such as Tylenol (i.e., acetaminophen) in order to reduce fevers, chills and/or achiness. Inhaled medications such as albuterol (i.e., ProAir, Ventolin) are given to help relieve asthma-like symptoms which may include wheezing, chest tightness, coughing and/or shortness of breath. Rest and increased oral fluids may hasten the recovery process.

The indications for antiviral medications include patients that are at high risk of influenza-related complications including pregnant women, adults over 65 years of age, immunocompromised individuals, and those with chronic medical conditions such as asthma, chronic obstructive pulmonary disease (COPD), and diabetes. Antiviral medications should be used if an individual requires hospitalization, during severe or complicated infection, and during pregnancy. Many primary care physicians recommend antiviral therapy for other scenarios and individuals should check with their physician to see what they recommend.

Antiviral treatment works the best when begun soon after flu-like symptoms begin.  When treatment is started within 2 days of developing flu-like symptoms, antiviral drugs can reduce fever and flu symptoms and shorten the duration of the illness.  They also may decrease the risk of complications such as ear infections in children, respiratory complications requiring antibiotics, and hospitalizations in adults. Some of the antiviral medications used for the treatment of the flu are as follows:

• Tamiflu (i.e., oseltamivir) is available as a pill or liquid suspension and is FDA approved for the early treatment of the flu in individuals over the age of 2 weeks.
• Relenza (i.e., zanamivir) is a powder that is inhaled and approved for the early treatment of the flu in individuals 7 years of age and older.  Relenza is administered using an inhaler device and is not recommended for individuals with breathing problems such as asthma or COPD.)
• Oseltamivir and zanamivir are given twice a day for 5 days.
• Xofluza (i.e., baloxavir) is a pill given as a single dose by mouth and is approved for early treatment of flu in people 12 years and older.  Xofluza is not recommended for pregnant women, breastfeeding mothers, and outpatients with complicated or progressive illness.
• Rapivab (i.e., peramivir) is given intravenously by a primary care physician and is approved for the early treatment of flu in individuals 6 months of age and older.

Prevention:

Staying home as much as possible and avoiding contact with others will reduce the risk of acquiring an influenza infection.

Routine annual influenza vaccination (i.e., flu shots) is recommended for all persons 6 months of age and older.  Many types of flu vaccines are licensed by the FDA this year with varying indications based on one’s age group and health status.  Please see the following link for more information.

www.cdc.gov/flu/professionals/acip/summary/summary-recommendations.htm

The board certified allergists at Black & Kletz Allergy treats both adults and children and will gladly answer any questions you have concerning the flu as well as any allergy/immunology topic. Black & Kletz Allergy has 3 offices in the Washington, DC, northern Virginia, and Maryland metropolitan area with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location and our Washington, DC and McLean offices are also Metro accessible. There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line. If you would like to make an appointment with an allergy specialist, please call us. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been providing quality allergy, asthma, sinus, and immunological services to the DC metro area for more than 5 decades