Itchy mouth after eating could be tell-tale sign of pollen food syndrome
How To Stop A Runny Nose? Here's TWO Easy Tips For Quick Relief, Says This Morning's Dr Zoe
IT'S time to streeeetch! New research from University of Rochester, New York, has found that yoga classes could help reduce the risk of relapse after cancer.
It's thanks to how the gentle form of exercise significantly cuts inflammation in the body.
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Dr Zoe Williams answers some health questions sent in by Sun readersAnd the benefits of yoga don't stop there – it can help improve flexibility, balance and muscle strength.
Best of all, it's a great tool for supporting mental health, giving you a moment to focus on breathing and relax.
Why not give it a try?
Here's what readers asked me this week…
Q: I HAVE had a runny nose for about nine weeks and it's driving me mad. Sometimes it feels like I've got the flu, but I can't stop my nose running, no matter what. I'm a 79-year-old male and healthy other than that.
A: The medical term for a runny nose is rhinorrhoea.
A runny nose can be annoying to say the least, but usually they clear up in a few days or a week or two.
It is often caused by inflammation in the nasal passages — we call this rhinitis, and it's often accompanied by sneezing, itching and/or congestion.
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Infections such as the common cold are the main cause, but tend to be short lived.
Allergic rhinitis is another leading cause and common allergens include pollen, dust mite, mould and animal dander.
Rhinitis can also be triggered by changes in temperature, humidity, and exposure to irritating chemicals, smells, or certain medications — especially some types of antidepressants, beta blockers or nonsteroidal anti inflammatory drugs.
So if you've started taking new medication in the last nine weeks, speak to your pharmacy to see if there could be a link.
Some people do get symptoms caused by age-related changes.
A reduction of blood flow to the mucosal lining of the nasal cavity can cause the tissues of the nose to shrink and dry out, causing rhinitis.
If you haven't sought any medical attention so far, please do, as this does need to be looked at by a doctor to check for nasal polyps and to rule out concern of a more serious cause, such as nasal cancer.
In the meantime I'd advise using daily nasal saline sprays or washes, and consider trying a nasal steroid — both of which you can buy from your pharmacist.
Q: FOR weeks I have had a white spot on the side of my tongue that will not go away. I first had a sore there, it cleared up, then the white spot appeared. Is it something I should be worried about?
A: If it's been there for more than three weeks, my advice would be to visit either your dentist or your GP.
White spots on the tongue aren't unusual but they usually disappear in a week to ten days.
There are a few things it could be; oral thrush is a common fungal infection that may happen if we're run down or if we've taken a recent course of antibiotics.
It is also more common in people with diabetes, those who wear dentures, people with anaemia and smokers.
It's rarely serious but if it doesn't clear up on its own — which yours hasn't — it may require treatment.
It could also be an aphthous ulcer which can be triggered by a virus, bacteria or a weakened immune system.
Allergies, stress and vitamin deficiencies can make you more susceptible to them too, as can any oral trauma.
Leukoplakia is where white or grey spots appear on the tongue or gums.
It's associated with smoking and while it usually clears up on its own, it does carry a small risk of developing into mouth cancer, so it's worth getting it checked out.
Q: I HAVE an enlarged anus and have tried to contact the doctor about it. But I had to speak to a receptionist to explain my problem, and twice they haven't called me back. I have still not spoken to a doctor and it's been a month now.
I'm so sorry your experience has been a negative one so far.
Please do persevere to try to get that appointment.
Doctors' receptionists often ask what the condition you're calling about is so they can triage your call and make sure you speak to the right person, however, you don't have to explain it if you'd rather not.
You can simply explain it's a personal issue that you'd rather not disclose.
Anal swelling can be caused by haemorrhoids, which develop from increased pressure in the lower rectum.
This often occurs when people strain to go to the toilet or sit on the toilet for a long time.
Anusitis is another condition which causes anal swelling, it's not serious and can be treated with a cream.
It's worth thinking about your diet too: has anything changed?
Anusitis often flares with dietary changes.
It could also be down to an anal fissure, abscess or anal fistula, so it is important to see a doctor for a diagnosis to be made.
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I promise your doctor won't be disturbed by your symptoms, we deal with issues like these on a daily basis, so please persevere and try and get an appointment.
If a phone call isn't working, see if your surgery has an online consultation option where you can explain everything online.
'Odd bumps on the face'
Q: MY uncle has been struggling to get an appointment with his doctor and I was wondering could you give him any advice about a series of bumps on his face?
A: There are a number of different types of skin lesions I can see on the photos you've sent.
Some small white lumps mostly in the area between the eyes, some larger brown, warty looking lumps on the cheeks look like seborrhoeic keratosis, and there are also some signs of rosacea present.
The full history is really required as well as an in person examination of the skin, but on first glance, none of these are alarming.
But I'd really like to know more about the brown patch on your uncle's lower lip, especially how long that has been there and if it is changing.
This just goes to show how useful an e-consultation can be, as you can submit photographs along with some details of your query.
If I received this as an e-consult, I'd likely give your uncle a quick call to ask a couple of questions about the lip and then bring him in for a face to face appointment, the urgency of which being based on his answers to those questions.
So please do advise him to do an e-consult if his practice offers this, and submit this photo along with some details about the lip lesion
Cutting-Edge Nasal Tech Could Usher In A New Era Of Medicine
June 19, 2023 – Noses are like caverns — twisting, turning, no two exactly the same. But if you nose past anyone's nostrils, you'll discover a surprisingly sprawling space.
"The size of the nasal cavity is about the same as a large handkerchief," said Hugh Smyth, PhD, a professor of molecular pharmaceutics and drug delivery at the University of Texas at Austin.
Thoroughly coating that cavity with medication can result in rapid, efficient absorption, making the nose's inner chamber an attractive target for drug delivery.
"It's very accessible tissue, and it has a lot of blood flow," said Smyth. "The speed of onset can often be as fast as injections, sometimes even faster."
It's nothing new to get medicines via your nose. For decades, we've squirted various sprays into our nostrils to treat local maladies like allergies or infections. Even the ancients saw wisdom in the nasal route.
But recently, the nose has gained scientific attention as a gateway to the rest of the body – even the brain, a notoriously difficult target.
The upshot: Someday, inhaling therapies could be as routine as swallowing pills.
The nasal route is quick, needle-free, and user-friendly, and it often requires a smaller dose than other methods, since the drug doesn't have to pass through the digestive tract, losing potency during digestion.
But there are challenges.
How Hard Can It Be?
Old-school nasal sprayers, mostly unchanged since the 1800s, aren't cut out for deep-nose delivery. "The technology is relatively limited because you've just got a single spray nozzle," said Michael Hindle, PhD, a professor of pharmaceutics at Virginia Commonwealth University.
These traditional devices (similar to perfume sprayers) don't consistently push meds past the lower to middle sections inside the nose, called the nasal valve – if they do so at all: In a 2020 Rhinology study, conventional nasal sprays only reached this first segment of the nose, a less-than-ideal spot to land.
Inside the nasal valve, the surface is skin-like and doesn't absorb very well. Its narrow design slows airflow, preventing particles from moving to deeper regions, where tissue is vascular and porous like the lungs.
Even if you surpass this structural roadblock, other hurdles remain.
Your nose is designed to keep stuff out. Nose hair, cilia, mucus, sneezing, coughing – all make "distributing drugs evenly across the nasal cavity difficult," said Smyth. "The spray gets filtered out before it reaches those deeper zones," potentially dripping out of the nostrils instead of being absorbed.
Complicating matters is how every person's nose is different. In a 2018 study, Smyth and a research team created 3D-printed models of people's nasal cavities. They varied widely. "Nasal cavities are very different in size, length, and internal geometry," he said. "This makes it challenging to target specific areas."
Although carefully positioning the spray nozzle can help, even something as minor as sniffing too hard (constricting the nostrils) can keep sprays from reaching the absorptive deeper regions.
Still, the benefits are enough to compel researchers to find a way in.
"This really is a drug delivery challenge we've been wrestling with," said Hindle. "It's not new formulations we hear about. It's new devices and delivery methods trying to target the different nasal regions."
Delivering the Goods
In the late aughts, John Hoekman was a graduate student in the University of Washington's pharmaceutics program, studying nasal drug delivery. In his experiments, he noticed that drugs distributed differently, depending on the region targeted – aiming for the upper nasal cavity led to a spike in absorption.
The results convinced Hoekman to stake his future on nasal drug delivery.
In 2008, while still in graduate school, he started his own company, now known as Impel Pharmaceuticals. In 2021, Impel released its first product: Trudhesa, a nasal spray for migraines. Although the drug itself – dihydroergotamine mesylate – was hardly novel, used for migraine relief since 1946, it was usually delivered through an IV, often in the emergency room.
But with Hoekman's POD device – short for precision olfactory delivery – the drug can be given by the patient, via the nose. This generally means faster, more reliable relief, with fewer side effects. "We were able to lower the dose and improve the overall absorption," said Hoekman.
The POD's nozzle is engineered to spray a soft, narrow plume. It's gas-propelled, so patients don't have to breathe in any special way to ensure delivery. The drug can zip right through the nasal valve into the upper nasal cavity.
Another company – OptiNose – has a "bidirectional" delivery method that propels drugs, either liquid or dry powder, deep into the nose.
"You insert the nozzle into your nose, and as you blow through the mouthpiece, your soft palate closes," said Hindle. With the throat sealed off, "the only place for the drug to go is into one nostril and out the other, coating both sides of the nasal passageways."
The device is only available for Onzetra Xsail, a powder for migraines. But another application is on its way.
In May, OptiNose announced that the FDA is reviewing Xhance, which uses the system to direct a steroid to the sinuses. In a clinical trial, patients with chronic sinusitis who tried the drug-device combo saw a decline in congestion, facial pain, and inflammation.
Targeting the Brain
Both of those migraine drugs — Trudhesa and Onzetra Xsail – are thought to penetrate the upper nasal cavity. That's where you'll find the olfactory zone, a sheet of neurons that connects to the olfactory bulb. Located behind the eyes, these two nerve bundles detect odors.
"The olfactory region is almost like a backdoor to the brain," said Hoekman.
By bypassing the "blood-brain barrier" (a sort of TSA checkpoint for that most vital of organs), it offers a direct pathway – the only direct pathway, actually – between an exposed area of the body and the brain. Meaning it can ferry drugs straight from the nasal cavity to the central nervous system.
Nose-to-brain treatments could be game-changing for central nervous system disorders, such as Parkinson's disease, Alzheimer's, or anxiety.
But reaching the olfactory zone is notoriously hard. "The vasculature in your nose is like a big freeway, and the olfactory tract is like a side alley," explained Hoekman. "It's very limiting in what it will allow through." The region is also small, occupying only 3% to 10% of the nasal cavity's surface area.
Again, POD means "precision olfactory delivery." But the device isn't quite as laser-focused on the region as its name implies. "We're not at the stage where we're able to exclusively deliver to one target site in the nose," said Hindle.
While wending its way toward the olfactory zone, some of the drug will be absorbed by other regions, then circulate throughout the body.
"About 59% of the drug that we put into the upper nasal space gets absorbed into the bloodstream," said Hoekman.
Janssen Pharmaceuticals' Spravato – a nasal spray for treatment-resistant depression – is thought to work similarly: Some goes straight to the brain via the olfactory nerves, while the rest takes a more roundabout route, passing through the blood vessels to circulate in your system.
A Needle-Free Option
Sometimes, the bloodstream is the main target. Because the nose's middle and upper stretches are so vascular, drugs can be rapidly absorbed.
This is especially valuable for time-sensitive conditions. "If you give something nasally, you can have peak uptake in 15 to 30 minutes," said Hoekman.
Take Narcan nasal spray, which delivers a burst of naloxone to quickly reverse the effects of opioid an overdose. Or Noctiva nasal spray. Taken just half an hour before bed, it can prevent frequent nighttime urination.
There's also a group of seizure-stopping sprays, known as "rescue treatments." One works by temporarily loosening the space between nasal cells, allowing the seizure drug to be quickly absorbed through the vessels.
This systemic access also has potential for drugs that would otherwise have to be injected, such as biologics.
The same goes for vaccines. Mucosal tissue inside the nasal cavity offers direct access to the infection-fighting lymphatic system, making the nose a prime target for inoculation against certain viruses.
Inhaling Protection Against Viruses
Despite the recent surge of interest, nasal vaccines faced a rocky start. After the first nasal flu vaccine hit the market in 2001, it was pulled due to potential toxicity and reports of Bell's palsy, a type of facial paralysis.
FluMist came in 2003 and has been plagued by problems ever since. Because it contains a weakened live virus, flu-like side effects can occur. And it doesn't always work. During the 2016-2017 flu season, FluMist protected only 3% of kids, prompting the CDC to advise against the nasal route that year.
Why FluMist can be so hit-or-miss is poorly understood. But generally, the nose can pose an effectiveness challenge. "The nose is highly cycling," said Hindle. "Anything we deposit usually gets transported out within 15 to 20 minutes."
For kids – big fans of not using needles – chronically runny noses can be an issue. "You squirt it in the nose, and it will probably just come back out in their snot," said Jay Kolls, MD, a professor of medicine and pediatrics at Tulane University, who is developing an intranasal pneumonia vaccine.
Even so, nasal vaccines became a hot topic among researchers after the world was shut down by a virus that invades through the nose.
"We realized that intramuscular vaccines were effective at preventing severe disease, but they weren't that effective at preventing transmission," said Michael Diamond, MD, PhD, an immunologist at Washington University School of Medicine in St. Louis.
Nasal vaccines could solve that problem by putting an immune barrier at the point of entry, denying access to the rest of the body. "You squash the infection early enough that it not only prevents disease," said Kolls, "but potentially prevents transmission."
And Yes, a Nasal COVID Vaccine Is On the Way
In March 2020, Diamond's team began exploring a nasal COVID vaccine. Promising results in animals prompted a vaccine development company to license the technology. The resulting nasal vaccine – the first for COVID – has been approved in India, both as a primary vaccine and a booster.
It works by stimulating an influx of IgA, a type of antibody found in the nasal passages, and production of resident memory T cells, immune cells on standby just beneath the surface tissue in the nose.
By contrast, injected vaccines generate mostly IgG antibodies, which struggle to enter the respiratory tract. Only a tiny fraction – an estimated 1% – typically reach the nose.
Nasal vaccines could also be used along with shots. The latter could prime the whole body to fight back, while a nasal spritz could pull that immune protection to the mucosal surfaces.
Nasal technology could yield more effective vaccines for infections like tuberculosis or malaria, or even safeguard against new – sometimes surprising – conditions.
In a 2021 Nature study, an intranasal vaccine derived from fentanyl was better at preventing overdose than an injected vaccine. "Through some clever chemistry, the drug [in the vaccine] isn't fentanyl anymore," said study author Elizabeth Norton, PhD, an assistant professor of microbiology and immunology at Tulane University School of Medicine. "But the immune system still has an antibody response to it."
Novel applications like this represent the future of nasal drug delivery.
"We're not going to innovate in asthma or COPD. We're not going to innovate in local delivery to the nose," said Hindle. "Innovation will only come if we look to treat new conditions."
Nasal Polyp Surgery: Cost, Recovery, And More
Nasal polyp surgery removes noncancerous growths from your nasal and sinus passageways. In the weeks following surgery, you may notice slight bleeding from your nose and crusts. It's common for polyps to return.
Polyps are noncancerous (benign) growths that may resemble a cluster of grapes. They may be located near the front of your nose or farther back, in your sinuses.
Nasal polyps can cause symptoms that impact your quality of life, such as:
Surgery is usually considered only when other treatments don't alleviate these symptoms.
Surgery to remove nasal polyps is known as nasal polypectomy.
This may not be appropriate if you smoke or have a history of bleeding concerns or conditions like severe pulmonary or cardiac problems. A healthcare professional can recommend whether polypectomy is right for you.
And while your symptoms may dramatically improve, polyps often grow back gradually.
Nasal polyp surgery removes polyps from the lining of your nasal and sinus passageways. The procedure you'll require depends on where the polyps are located.
For larger polyps located in the front of your nose, a doctor may be able to remove them in the office using an instrument called a microdebrider. It debrides (removes tissue) and suctions loosened material at the same time.
Alternately, your doctor might remove the polyps using small graspers. This process is called an intranasal polypectomy.
For polyps that are very small in size, more extensive, located deeper in your nasal cavity, or complicated in other ways, you may require a nasal polypectomy in an operating room with anesthesia.
For this minimally invasive surgery, your doctor will use an endoscope, which is a small tube with a light and camera at the end. With the endoscope, your doctor will identify polyps, then remove them using small instruments.
How long does it takeNasal polyp surgery itself usually lasts a few hours. If you're undergoing general anesthesia, you may spend the day in surgery preparation and postsurgery recovery.
In most cases, you should be able to go home the same day as your surgery. Some people may need to stay at the hospital overnight.
Make sure you've arranged for a ride home and for someone to stay with you overnight to help monitor your condition.
What to expectNasal polyp surgery is conducted at a hospital or an outpatient facility. You may be prepped by a nurse or an anesthesiologist before undergoing your operation.
A surgeon performs nasal polypectomy entirely through your nose. Unlike other types of surgery, no incisions are made to access the polyps. You'll need local or possibly general anesthesia, depending on the extent of the extractions from your nasal cavities.
With an endoscopic nasal polypectomy, the surgeon inserts a thin tube with a small camera into your nasal cavity. This helps them see the polyps more clearly, especially when the growths are located deep in your cavities.
Once your surgeon locates the polyps, they'll remove them with a microdebrider or surgical graspers.
The complication rate from nasal polyp surgery is lower than for general sinus surgery. You may notice slight bleeding from your nose for the few weeks.
Your surgeon might arrange a follow-up visit about a week after the surgery to check how your nasal passages are healing and remove any crusts. They may also place steroid-eluting stents in your nasal cavity.
These stents are placed to stop inflammation and slow or prevent the growth of new polyps. A healthcare professional will remove them in follow-up visits.
You'll likely start feeling better within a few days. You may want to take up to 1 week off from work to recover, if possible.
After nasal polyp surgery, the doctor will likely recommend using a saline spray several times a day. They may also prescribe:
Rare complications of nasal polyp surgery include:
The cost of a nasal polypectomy will vary depending on:
You may consider weighing the cost of this surgery versus other treatments.
One 2017 study of people with chronic rhinosinusitis with and without nasal polyps estimated that the cost of surgery was comparable to the cost of some medications taken for life.
Surgery can sometimes treat nasal polyps when steroid drops or sprays don't relieve symptoms. Unfortunately, it's common for polyps to come back despite surgery.
One small 12-year study of people who underwent nasal polyp surgery found that nearly 80 percent developed recurring growths. Despite the high recurrence, people who had the surgery said they experienced significant symptom reduction and improved quality of life.
It's not possible to predict when polyps will return. You should see your doctor right away if you start to experience symptoms again. They can help you determine whether it's best to follow up with additional surgery or to treat nasal polyps with medication.
If you have chronic rhinosinusitis with nasal polyps, your doctor may suggest the biologic monoclonal antibodies dupilumab (Dupixient) or omalizumab (Xolair).
Some research suggests that these agents may be more effective at addressing symptoms than steroids and may reduce the need for surgery.
Surgery can successfully remove nasal polyps and reduce symptoms.
You may experience bleeding from your nose for the first few weeks. You should also be prepared for the possibility that polyps may eventually return.
Nasal polyps are very common benign growths. Despite being benign, they can lead to a host of uncomfortable symptoms that may interfere with your daily life.
If your symptoms don't respond to traditional treatments, surgery may be an option.
Nasal polyp surgery is tolerated well by most people with this condition. It's important to talk with your doctor about risks and side effects.
There's a chance your nasal polyps will grow back after surgery. Your doctor will help you decide whether the post-surgery benefits will outweigh such risks.
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