infection


Tonsils – Episode 110

An image of a caucasian child's mouth, open wide with their teeth, tongue, and uvula visible. This is representative of the way one may open wide for a doctor to inspect the tonsils and throat.

Tonsils Basics

Your tonsils can be found in the back of your throat.  You can open your mouth and look in the mirror and see them on each side of your mouth behind your teeth and tongue.  You can also feel them below your earlobes and behind your jaw bone.

Tonsils are composed of lymph tissue since they are a part of your lymph system.  They store white blood cells that help you fight off infection.  Their activation during sickness is why they swell and get sore.

They are covered with the same mucosal membrane as the rest of the inside of your mouth.  This mucosa layer has pits and crevices called crypts.  These crypts increase the surface area of the mucosa that comes in contact with the lymph tissue and allows more opportunity for infectious material to be directly accessed by the immune system.

Infectious Tonsil Issues

Tonsillitis is the inflammation of the tonsils.  It can be classified as acute or chronic.  Acute tonsillitis is directly related to a viral or bacterial infection.  Chronic tonsillitis can be either a persistent, long-lasting infection or multiple consecutive acute episodes that can appear to be one long sickness.

Swollen tonsils can cause simple activities such as swallowing, talking, and breathing very painful.  You can see your swollen tonsils when you look in the mirror.  They will appear red or possibly blistered.

Mono, an infection caused in adolescents and adults by the Epstein-Barr virus, cause severe swelling in all the lymph nodes, including the tonsils.  This is one of the situations where your tonsils will be so inflamed, you can see the swelling on the outside of your face and neck.  Because such a large portion of your lymph system is involved, including your spleen, this is a serious sickness.

Strep throat is probably the first infection you think about when you think of swollen tonsils.  The bacteria, streptococcus, infect the lining of the tonsils and throat.  This is why the doctor will swab your tonsils when they’re testing for strep.

Non-Infectious Tonsil Issues

A non-infectious reason the tonsils will be large is a condition caused hypertrophic tonsils.  The tonsil tissue and/or mucosa overgrow and become oversized without any infection or immune activation being involved.  Overgrown tonsil tissue can lead to snoring or sleep apnea, and that’s bad.

Another non-infectious issue with your tonsils is called tonsilloliths or tonsil stones.  These stones happen when dead bacteria or food debris gets stuck in the crypts and they become calcified.  They cause a sensation many describe as a crumb stuck in your throat.   They can become quite large and can interfere with swallowing and eustachian tube function.  Because the eustachian tubes run from your eardrum into your throat, if the tonsil is swollen enough, it may close off the tube to the ear and cause ear pressure/pain.  Some tonsil stones are large enough to be visible and may have to be manually removed.  Lastly, due to the composition of the stones (dead bacteria and old food), frequent tonsil stones can be the cause of bad breath.

There’s no way to prevent tonsil stones 100%.  Good oral hygiene can certainly help reduce the frequency of stones, and can also help remove them quickly if they occur.  The most common way of trying to remove a tonsil stone involve coughing, clearing your throat, or hissing.  All three of these ways produce vibrations in the lining of the throat and mouth.  So along with the exhalation of these methods, hopefully, the result is the stone coming out of the tonsil and out of your mouth.

PSA:  Please DO NOT scratch your tonsils with your fingernails to remove a tonsil stone!

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Sleep Hygiene
All About Sleep

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Tongue Issues – Episode 106

Born With…

Ankyloglossia is also known as a tongue tie.  It is a result of a short frenulum.  This issue is easily corrected if it interferes with eating and talking.

Macroglossia is am abnormally large tongue.  This is one of the visible characteristics of Down’s Syndrome.  It is described as the tongue looks and feels to be bigger than space in the mouth.

Infected With…

Strawberry tongue

The tongue can appear extremely red and papillae are swollen to look like seeds on a strawberry.  This is a symptom of several conditions.

  • Kawasaki Disease is a rare but serious childhood disease.  The blood vessels become inflamed, and this includes the blood vessels in the tongue, making it appear red.
  • Scarlet Fever is caused by the same bacteria as strep throat.  The infection goes from being just in the throat to the bacteria toxins spreading in the bloodstream.
  • Toxic Shock Syndrome is when the bacteria called Staph aureus (yes, this is the staph that lives on your skin and can cause wound infections) gets into the bloodstream.  This is a medical emergency and needs to be treated immediately.

Hairy Tongue

White hairy tongue appears as patches on the sides of the tongue.  It can happen when someone who is immunocompromised gets the Epstein-Barr Virus. (Epstein-Barr is a virus that causes mild childhood illness or a disease we know as Mono when teens and adults.)

Black hairy tongue is a little more obscure with several possible root causes.

  • Smoking, excessive coffee or tea consumption, excessive alcohol consumption, or soft diet can lead to the inability to shed dead skin cells.
  • Antibiotic overuse leads to overgrowth of fungus or bacteria.
  • Overuse of peroxide-based mouthwash causes oxidation and discoloration of the skin cells.

Function Lost

Motor Neuron Disease occurs in the later stages of ALS or Lou Gerig’s Disease when the nerves and muscles of the tongue for speech and swallowing become affected.

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Mouth Issues – Episode 102

open mouth

Mouth Issues

Ulcers

They are uncomfortable and mostly non-serious.  Also known as “canker sores”.  Can take 2-3 weeks to completely heal.  Anything lasting over 3 weeks should be checked out by your doctor or dentist.  Ulcers can appear on the inside of the cheeks or lips, the roof of the mouth, or the tongue.  A minor ulcer versus a major ulcer is determined by the size of the sore and the layers of skin affected.  Any ulcer that is bleeding should be checked out despite the length of time.  The edges are red while the center can be yellow, white, or grey.  And they are PAINFUL!!

Ulcers can be caused by acidic or spicy foods, braces, stress, hormones, and some medications (such as beta-blockers for blood pressure or NSAIDs).  Nutritional deficiencies can increase your risk of ulcers.  Malabsorption due to conditions like celiac or deficiencies in B-vitamins and iron are the most common culprits.  Also, decreased immunity can make the skin inside the mouth more prone to ulcer recurrence.

Thrush

This is a yeast infection the mouth caused by the overgrowth of Candida, known as oral candidiasis.  It appears as white patches on the inside of the cheeks, tongue, or roof of the mouth, and the spots cannot be scraped off.  Candida is normal in the body and is kept in balance by the rest of the body’s normal flora.  Overgrowth can occur after antibiotic treatments, during times of decreased immunity due to treatments or disease states, or from inhaled steroid treatments.

Thrush is treated with a topical antifungal that the doctor directs you to swish around in the mouth to coat the affected areas, usually Nystatin.  If yeast is wide-spread, a systemic antifungal will be used.  Probiotics are a great way to keep your normal flora in balance.

Angular cheilitis (ky-ly-tis)

Cheilitis = inflammation of the lips.  This is the cracking that can occur in the corners of your mouth.  Many sources will tell you this is caused by a vitamin deficiency – like B-vitamins, iron, and zinc.  Other times, it may be a wound caused by contact dermatitis from increases contact with the tongue or your hands, and then they may become infected with normal skin bacteria or other bacteria in saliva.  An infected wound is one that doesn’t ever appear to heal.  Fungal infections, in the same way, cause the skin to crack open and appear overly dry and never-healing.

Lie Bumps

Transient Lingual Papillitis (swollen taste buds).  They can appear to be white or red, and they can be asymptomatic or very bothersome.  Not sure what exactly causes it.  Definitely NOT caused by lying.  *I used to think they were “lye bumps” as in sodium hydroxide that is a strong base and used to be popular as a detergent.*

Cleft lip/palate

A birth defect that has a strong genetic component, but also linked to environmental components that have not been pinpointed yet.  A cleft lip or palate is a result of parts of the mouth and face not fusing together during fetal development, and requires surgical correction after the baby is born.  The oral and nasal cavities are supposed to be separate and when they are not, it can increase the risk of sinus and ear infections.  Ear tubes are usually recommended.

Even after repair, a child may require speech and occupational therapies to develop the muscles needed for normal speech and eating habits.  Many times, a follow-up surgery is required as the child grows, and many other types of mental support are needed.

Bonus

*Mouth Cancers: the most common cause of mouth cancers is tobacco use (smoking, chewing).  It can start out as something that appears minor like a mouth sore, but can develop quickly into something deadly.  In the end, it can result in large areas of the mouth having to be surgically removed.

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Probiotics

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Nose Issues [Show Notes]

Nose issues that cause your breathing to fail

  • Congestion from allergies, viruses, or infections.
  • Deviated septum – the septum (the bone that separates the nasal cavity and divides your nostrils) can get crooked and change the size and access of the nostrils or nasal cavity.  Can be from trauma, or may gradually get crooked from chronic pressure.
  • Turbinate Hypertrophy – over-growth of tissue covering the turbinates (tissue-covered bones that add warmth and moisture to the air you breathe). This can lead to snoring.  May be treated by steroid nasal sprays or surgery to remove extra tissue.
  • Nasal Polyps – uneven overgrowth of mucus membranes (symptoms may be runny nose, post-nasal drip, stuffiness).  They are not cancerous.  Treated by snipping them out.
  • Sinus cancer – a single growing tumor that causes bulging, either around the eye, face, or mouth.

Nose issues that cause your smelling to fail

  • Age
  • Deviated septum (see above)
  • Polyps (see above)
  • Chronic sinus infections – the smelling sensors are inflamed or covered with mucus so much that they become damaged or less sensitive.
  • Smoking – smoke and toxins can damage smelling receptors in your nose.  Also, the receptors become so clogged up with smoke and tobacco molecules that there’s no room for other molecules to be detected.  This can be temporary or permanent.

Nosebleeds

  • In kids, this is usually from trauma (either bumps and bonks or picking).  Can also be caused by dry air in the wintertime (use vaseline in the nostrils).
  •  In adults, can be from hypertension (high blood pressure) or chronic use of blood thinners.

PSA: Treatment for a nosebleed:  DO NOT tip your head backwards!!!!!  It makes you swallow that blood!  THAT’S GROSS!!  Proper treatment:  pinch the nose and tip the head forward.  This allows a clot to form and clots stop the bleeding.

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Ear Issues [Show Notes]

PSA:  Please don’t stick things in your ear any larger than your elbow…and that includes your finger.

Review

Outer ear = the part that you can touch
Middle ear = the area being the ear drum
Inner ear = the cochlea and area responsible for your balance

3 common ear problems

  • Ear infections (otitis media)
  • Vertigo (and motion sickness)
  • Tinnitus (ringing in your ear)

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*Ear wax

Ear Infections

The area behind your ear drum has air in it and that pressure is equalized through the eustachian tube.  If that area gets fluid in it, that fluid can grow bacteria and that leads to infection.  The natural motion of opening and closing your jaw helps massage the eustachian tubes and moves air in and out (like when you fly or drive in the mountains and you chew gum or yawn).

Cold and allergies can be the source of the fluid build up that leads to ear infection.  You may have decreased hearing, pain, decreased balance – infection can require antibiotics.

Vertigo

This is the sensation of spinning, dizziness, being off balance
The semi-circular canals are responsible for your balance.  If it get sloshed too much, or doesn’t level out exactly right, then the signals sent to the brain may translate to being off balance even though your body is upright.  The signal confusion is what can lead to nausea (it’s not actually happening in your stomach – at least not until you vomit!)
The fluid moving around in these canals are why kids can induce dizziness when they spin around in circles (think about the clothes in your washer during the spin cycle – they get pushed to the outside).
Medications  for vertigo are the same as some medications for nausea – plus they have drowsy side effects, so maybe you just sleep it off.
There are many suspected causes, but nothing definite or proven.

Tinnitus

Defined as ringing, buzzing, roaring, whooshing sound when nothing is actually making that noise.
Causes: hearing loss (either due to aging or exposure to loud noises); high blood pressure (pulsating); medications
One theory: the hairs in the cochlea are damaged so those frequencies of sound (usually high pitched sounds) can’t be picked up anymore; the brain fills in the gaps with “made up sound”.  This is NOT PROVEN!
High blood pressure can cause you to hear the blood pulsing through the blood vessels in your ears.

Medications that causing ringing in the ears

  • Aspirin (acute over-use)
  • Aminoglycosides (i.e. Gentamicin = antibiotic) – it has a small therapeutic window, too much can lead to ear damage, it stopped in time, permanent ear damage can be avoided
  • Quinine = usually asked for to help leg cramps, also medically prescribed to prevent malaria.  Can only be readily consumed by drinking tonic water.

Flavonoids are put in vitamins and advertised to help tinnitus.  Flavonoids are phytonutrients (nutrients you get from plants).  These nutrients can’t grow the hairs back in the cochlea.  Most of the vitamins and nutrients in the flavonoid vitamins have anti-oxidative properties, but I doubt that tinnitus is a major oxidation problem.

Audience Question

Can being slapped over time cause ringing in the ears?

  • Being bopped in the face and head can probably cause permanent damage to the structures on the inside and outside of your head.  Being hit in the side of the head can cause pressure build-up in the ear where the air causes the ear drum to rupture (like “boxing” the ears).
  • Slaps to the face (like “you jerk!” kind of slaps) don’t usually cause ear problems, but punches or slaps to the side of the head near or on the ears can possibly cause damage.

Prevent ear problems: be nice to your ears!

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Punctures and Cellulitis [Show Notes]

Puncture Wound

A wound that is deep but a small point of entry (i.e. nail).   This allows the bacteria to get stuck inside.  Thus it won’t always bleed cuz the opening is too small for it to make it out.   So if the blood can’t get out, then antibiotic ointments can’t get in.

Signs of Infection

  • Swelling
  • Redness
  • Pain
  • Warm
  • “Lumpy” or “Dimpled”
  • Oozing
  • “Running” or “crawling” veins

Lockjaw anyone?  Tetanus is an opportunistic infection that gets into the body from dirty objects and then causes muscle rigidity (among other things).  It is very easy to prevent with a booster shot.

Cellulitis is not the same as cellulite, but does affect the same layer of the skin! It’s an infection caused by the normal bacteria that live on your skin.  As long as it’s on your skin – cool, we’re friends.  If it gets in your skin – that’s trouble.  Staph or strep – friends on the outside, enemies on the inside.  Requires oral antibiotics, and sometimes, even IV antibiotics.

Necrotizing fasciitis – bacterial infection gets so deep into the skin layers that it starts eating away the dermis and muscles below it.

Risks for Cellulitis

  • surgical sites
  • cuts and abrasions
  • puncture wounds!!!!
  • skin ulcers (from prosthetics, wheelchairs, or being bedridden)
  • spider and insect bites (bugs aren’t sterile, plus toxins – ick!)
  • cracked dry skin
  • hangnails
  • athlete’s foot (skin changes, including cracking)

Takeaway

Puncture wounds should not be treated at home – especially if you were stuck by something dirty.

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Cleaning Up Bacteria’s Mess [Show Notes]

Bacteria and Antibiotics

MIC stands for Minimum Inhibitory Concentration, and is the lowest amount of antibiotic required to stop the bacteria.

Antibiotics either kill the bacteria or slow it down enough that your own immune system can get rid of it.

Antibiotics are designed to keep a certain amount of medicine in your body over a certain number of days to ensure the infection is completely gone.

Do not take antibiotics that you have left over because you most likely do not have enough medicine for a full course of treatment.

Here’s a Metaphor

Think about a spot of dirt on the floor:

Dirt + a few drops of water = mud

Dirt + a whole pitcher of water = a watery mess

Dirt + a wet rag = clean floor

Relate it to Bacteria

Infection + too little antibiotic = resistance

Infection + too much antibiotic = side effects

Infection + the right dose of antibiotic = you get better

The Take Away

The gap between the lowest effective dose and the highest, non-toxic dose is called the Therapeutic Index.  This is the information that is used to determine the dose of many medications and how they should be taken. 

That is why you should always take antibiotics exactly as directed and until they are all gone.

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