good evening welcome to the holiday show ask the dr we have a super special guest tonight st nose and throat you know tell us a little bit about how you got your training and what you do actually i had a sort of and an unusual route in my training ok i  that was too tough a question i was going to back it up back no no no no it's ok it's a lot of the beaten path for me ok i was actually accepted at ice out of high school into an accelerated program at penn state and then i went from there to jefferson medical oh yeah this is a bad time for nose bleeds so who gets them and how do we stop them they come at all ages they come in all situations lots of people can get  some younger children often get them they tend to be more severe when older people get them the blood vessels tend to be a little harder and they often are more likely to bleed the larger blood vessels are more likely to bleed for older patients and and they can be serious nosebleeds can be sometimes a nuisance they can interrupt a party or a function or become an embarrassment a certain socialist function or they can actually become life threatening so they they run the gamut so how do we  how do we know when we have to see i mean once like a typical nosebleed that gets to you well the people that come to see me generally come because they keep having small ones over and over war they have really severe ones or some somewhere in the middle between they you know they have a lot of moderately severe ones and basically ones ones that don't stop on their own that they can reliably before we get into the anatomy because i know you love to use your point during pointing now to me what are some common things that people can do to stop and well will one of the most common things that i tell people to do is to put pressure on the front and the pressure has to come in the movable part of the ice often see people have been told to press up here and it doesn't really do any good you just sort of press and on the actually what often helps when children have nose bleeds and they don't like their nose plugged you can sometimes put ice on the rubber lip it's an axe it's a little side trick sometimes the the artery that comes up through the lip up towards the quickly in an older patient particularly when the large arteries are involved they they can be life threatening we have seen people casely go into shock from those bleeds that's very rare but it is as  we say not something to sneeze at ok is there any prevention is that the folks out there can and the most important thing i always tell my patients is to keep the air humidified if at all possible the nose likes the humidity of around forty to fifty percent and the average heated home in western pennsylvania can be anywhere around ten to twenty percent humidity and so that the moisture isn't actually important to the function of the nose now the other thing is what's also very important is there's an awful lot of people who for various reasons are taking medicines within their blood you know people that have had  coronary stands or that have irregular heart rhythms are that had a stroke before and their physicians keep them on blood thinners i always tell those patients they should always consider using a humidifier because they're a much higher risk to have a nosebleed that doesn't stop as readily as someone who's might who might have a guy who's not on those medication and humidifiers at the same thing as a vaporizer well technically a humidifier puts out water droplets in the vaporizer puts out steam the distinction is not all that important to the nose the nose likes moisture however it gets there that the steam has advantages and disadvantages some people if you get too close to it a child can actually get a burn from but if it's too hot so it but some people don't like cold more ice there than they hearing how many have been there enough times meister i got that they're ok so how about the scientists they like moisture also the sinuses most definitely more you can tell us a little bit about where the sinuses are because we always hear i have a sinus headache but not everybody knows what a sinus is well the sinus is actually a hole in the head and it's kind of interesting for years we didn't really know why we even have sinuses and i think that the latest know three stooges sinuses there you have the these honeycombs here these ethmoid sinuses these the ones between the eyes they're actually groups of small air cells and these are often cause problems because these small little air cells that are in here can become more easily blocked in and filled with crusting again we go back to that dry air issue when that when the air is dry the mucus that is formed becomes thicker and it's like pouring molasses instead of water can be very serious if they get out of control because the optic nerve the carotid artery into terri gland are all in close very close in to that of those sinuses as well as the the i is the eye travels back along these honeycomb with some exercise it might have been you know might have been one of those things that could mean that you know cold or a flu or something yes that's just that's actually most commonly how it starts although it can start they can be an issues with people who have allergies that as we get to the colder months we often start here now it's  dry the mucous membrane gets thicker and you get that molasses and all that stuff in there and you get a cold now all the sinuses even when they're larger they drain like a funnel there's sort of a big hole but the drainage for it was really small  out and it's a really long narrow thing that pops it out and gets rid of it circles out in the nose down throat gone but when this area become when the mucus becomes thick or when this area becomes swollen if you have a cold you have you have an opening like this they have a cold and swells down like this it doesn't take much to shut off a this narrow portal and then what happens is the bacteria that would work its way out sort of swirls back in here and these bacteria these sort of small medicines or with humidifiers or with irrigations or neti pots or with surgery it's all in trying to find a way to get it to drain to an aide to nate and enable the body to clear itself it's not that antibiotics will cure antibiotics just lower that bacteria count to give the body a chance for it to clear so what kind of medicines can you take to help simon well it depends on how far along things are there you can take things that will fit in the mucus you know such as robitussin or wife aniston or you can drink a lot of water minute fire anything that puts more hydration in your body enables the body to make the mucus more thin when your body becomes dehydrated for whatever reason the mucus becomes more thick and it works against you so that's one thing now some people like decongestants with the theory being that it will actually shrink those blood vessels and possibly open the area up the problem is that the body sometimes gets a tolerance to those after a while and they age based on times will stop working sometimes work in a pinch for a short run but i've gotten the bodies starts counteracting them so i started working after a while how do you know when you have to get on antibiotics if you have a sinus problem generally if it lasts a week to ten days and looks as though it's not getting better and we start to think that there may be some bacterial information more as your average cold is going to get better in seven days maybe a little bit a couple days after that you think the cold getting better before that time it's viral and there's really not much need for antibiotics and sometimes even bites actually be counterproductive because i can sometimes make nastier bacteria by killing off ones that aren't so bad so you have to be able be careful but one of the plays of the antibiotics are often overused is with trying to differentiate a cold from a sinus infection so we usually urge people that are have normally functioning immune systems to sort of wait some of these out because the body will often clear them even if there is a little bit bacteria in there if the body can get  pot where they i don't know if that is it's actually founded on i or vedic indian medicine i think that i said it really it's nothing more than a small picture that you put in the nose and you don't put it in there or you try to hydrate the area here infections there's different kinds of your infections there's you have your has three parts you have your outer ear and the outer ear we actually including report on here well that's that's the yes the i get that out here in fact i now oh yeah well that's actually more common in the summer the now because it's sometimes from sweat and stuff and you can get your wax builds up in there irritates the skin and you can get the but you don't want to put it in the year because it whenever it wants to get the wax in here it starts to hurt you can see the ism is spongy out here you have this cartilage you have this fast this is the willie part doesn't hurt so much but once you getting here is ok being dry ok in moisture actually decreases the defense mechanisms of the outer ear so you don't want more easter lean green in the journey now now in the middle ear different ballgame this is more moisture and this is where you get your conventional ear infections and one of the kids getting the ones that you get associated with sinus infections are actually inside here and again we're back to this moist lining this you station two here opens in the back of the nose so when you have all this pos infection crap drain out your nose some of it lingers around here at the opening of this new station tube and if it swells or doesn't function properly or if some of it starts to travel up here and even to the middle in this spot here is how you could load in the sinuses it's a place where bacteria can grow and you get this tightest media or a middle ear infection so that's the different ballgame then the outer ear infection and that is actually more common when it's associated with sinus infections or colds and we and when you have younger children they still have big adenoid tissue for a while and often the adenoids are a place where bacteria congregate and lodge and they sit right in by this inside the bone and that's usually not a bacterial thing that's usually a viral thing and people are dizzy or they have hearing loss they're spinning around and that's raining in here rain in years and there's never you can get rain years from infection some of that those inflammatory chemicals can work their way through the little membranes even without the bacteria in which case you can get into the interview you're in so a little ear infection can then sometimes  even though this there is a membrane here that effectively protects the inner ear from the middle ear sometimes some of the stuff does filter through and alters the chemistry and a little bit altering the chemistry can sometimes throw off  you dizzy or sometimes just a little bit off balance and then sometimes i think that's actually a frequent symptom of quickly bad ear infections do you have to treat your affections with antibiotics or surgery or well there are different kinds of your infections it's interesting in europe for years it was sort of de rigueur garin not to use antibiotics and they came up with the the dictum that about eighty percent of ear infections may get better without antibiotics and probably half of ear infections are viral at least in children however the problem the problem with that is that we don't always know which ones you can get away with not treating and which ones you can't and you run the risk if you don't treat one that you can get a secondary problem from that your infection that it can spread to some of these other problems that we used they used to see many years ago when they didn't have an advice would get into the mast or in the back here where you could actually involved put it with the brain at risk in a more serious infection so fortunately nowadays we don't see that very often and we actually and the reason they put tubes in the kids ears is to try to allow this face to air race so this area doesn't get infected in a way that surgery in the sinuses would bleed sinusitis and otitis media and we're quickly running out of time for tonight's show so i want you to kind of summarize give folks an idea what type of surgery you do what they're what you can accomplish in kandahar hospital for for them well surgeries when it comes the sinuses comes to the ears it's sort of when you get down the road you can't do anything else when when the sinuses will not drain themselves we basically surgically and large the openings to allow that to happen so when all these sinuses drain through here there's usually a little bony wall like this and we take that out so that the opening is more like this you can see that an opening such as this is much more apt to become clogged with a little bit of swelling that opening such as this tonsils have little to do with the sinuses sometimes or secondarily involved actually fixing the sinuses sometimes off to the tonsils as opposed to tonsils helping the sinuses the fix the ad will often tell the sinuses and kids so they're that's a different ballgame adenoids and sinuses they sound like they go together but i'm of the sinuses they do different things i understand well we're running out of time for tonight's show so i'm going to have to have you back to do sleep apnea could we do an entire show and sleep now we can't i can't believe we're not already we're done