DEAR READERS: In yesterday's column, I responded to a reader's question about acute pharyngitis -- inflammation of the throat caused by infection with bacteria or viruses. I was taught that diagnosing and treating a patient with a sore throat was not complicated: The sore throat was caused either by Group A streptococcus ("strep," a kind of bacteria) or by a virus. If a throat culture showed strep, you treated it with penicillin. Simple. But in my view (some colleagues disagree), it's not that simple. The risk from an untreated infection with Group A strep is much lower today in the United States than it was 70 years ago. That means that the value of treatment is reduced. But the chance of side effects from the treatment -- antibiotics -- is not reduced.
Ear, Nose, Throat
DEAR DOCTOR K: I saw my doctor last week, who said I had acute pharyngitis but didn't say what that was. It sounds serious. What is it?
DEAR READER: Good news: It's rarely serious. I know the word "acute" in front of any medical term makes it sound serious. And I know that Latin-based words like "pharyngitis" sound alien. But acute pharyngitis simply means that your throat has become inflamed by something, usually an infection.
DEAR DOCTOR K: I get painful cold sores in my mouth every couple of weeks. Why do I get them? And what can I do to make them go away faster?
DEAR READER: Cold sores are caused by the herpes simplex virus (HSV) Types 1 and 2. HSV Type 1 is the most common cause of cold sores. Type 2 more often causes genital herpes, but it can also produce cold sores. HSV spreads easily from person to person; at least half of all adults are infected with the virus.
DEAR DOCTOR K: Why does my nose run in cold weather? Does it mean I'm getting a cold?
DEAR READER: Cold air is not only cold, but also dry. The lungs are built to deal with air that is warm and moist. So, a main function of your nose is to make the air you breathe in warm and moist. Bones in the nose (called turbinates) are covered with blood-filled membranes. The blood running through the turbinates is at body temperature: around 98.7 degrees F. The heat in the blood warms the cold air you breathe in.
DEAR DOCTOR K: I think I have a nasal polyp. Will I need to have surgery to remove it?
DEAR READER: A nasal polyp is a noncancerous tumor that grows from the lining of your nose or sinuses, usually in the nasal passages. Nasal polyps often grow in clusters and obstruct airflow in and out of the nose.
DEAR DOCTOR K: I'm a woman in my 30s who has suffered from sinus headaches for years. Allergy medications haven't helped. What else can I try?
DEAR READER: Seasonal allergies can cause sinus congestion, sneezing and a runny nose. But when you experience pain and pressure in your head, it may be time to consider other causes. That's because sinus problems do not usually cause headaches. At least, they don't cause what most people refer to when they use the term "headache." Most people with sinus congestion refer to "head congestion," not headache.
DEAR DOCTOR K: I've had four bouts of "bacterial sinusitis" over the past several months. How can I kick this infection for good?
DEAR READER: Sinusitis is inflammation of the sinuses. Everyone has sinuses, and many of us are not happy about that. Like you, my sinuses frequently get inflamed. Sinuses are the moist air spaces behind the eyes, forehead, nose and cheeks, on each side of our head.
DEAR DOCTOR K: I have a perforated eardrum caused by an ear infection. How will it be treated? Will my hearing be permanently affected?
DEAR READER: Your eardrum is a thin membrane involved in hearing. It separates your ear canal (the part that is open to the outside) from your middle ear. The eardrum is delicate -- and it has to be. Sound waves that enter your ear move the eardrum, which begins the process that allows you to hear.
DEAR DOCTOR K: I have a lot of wax in my ear. Should I try to remove it? How?
DEAR READER: Earwax is created when the oily substance made by cells lining the ear canal mixes with dead skin and debris. Normally, the mixture slowly moves out of the ear on its own. But sometimes earwax gets blocked in the ear. Certain conditions make this more likely:
DEAR DOCTOR K: My son suffers from occasional nosebleeds. What's the best way to stop a nosebleed?
DEAR READER: Many people suffer from nosebleeds. I tend to get them this time of year when the air is cold and dry, as it irritates the normally warm, moist surfaces inside the nose. Most nosebleeds occur when a blood vessel in the nose's soft cartilage leaks.