Bacon Can Stop Nosebleeds! No joke…

When I saw this research, I had to re-read it to believe it… Nasal packing with good-old fashioned bacon stops nosebleeds!!!

Yes… you heard me correctly… and it was actually published in a reputable ENT journal in Nov 2011. AND, it was conducted here in the USA (Detroit, Michigan).

“Cured salted pork crafted as a nasal tampon and packed within the nasal vaults successfully stopped nasal hemorrhage promptly, effectively, and without sequelae … To our knowledge, this represents the first description of nasal packing with strips of cured pork for treatment of life-threatening hemorrhage in a patient with Glanzmann thrombasthenia.”

The current standard of care for nasal packing to treat nosebleeds is using synthetic hemostatic products that appear similar to tampons used for menstruation.

However, this publication in 2011 wasn’t the first to document use of bacon for nosebleeds.

There have been reports on use of bacon since 1940 sporadically (see references below).

In this day and age of cost-cutting and finding cheaper alternatives, bacon is pretty much as cheap as one can go to address nosebleeds. Compare this to synthetic nasal packing which costs on upwards of $50 or more.

Read more about nosebleed management.

Another unusual nosebleed management includes the application of female hormone estrogen (vaginal premarin cream) to the nasal mucosa.

Traditional nosebleed treatment includes nasal emollient application, humidification, nasal cauterization, septoplasty, and eventually nasal packing.

References:
Nasal Packing With Strips of Cured Pork as Treatment for Uncontrollable Epistaxis in a Patient With Glanzmann Thrombasthenia. Ann Otol Rhinol Laryngol 2011;120:732-736.

Rendu-Osler-Weber Disease— Is Embolization Beneficial? Arch Otolaryngol. 1976;102(6):385.

GENERAL PRINCIPLES IN TREATMENT OF NASAL HEMORRHAGE. AMA Arch Otolaryngol. 1953;57(1):51-59.

USE OF SALT PORK IN CASES OF HEMORRHAGE. Arch Otolaryngol. 1940;32(5):941-946.

Nasal Hair Removal and Nasal Sores

It is not unusual that I encounter a patient who develops crusting and sores around the entrance to the nose where coincidentally nasal hair is found… in both men and women.

Other complaints/symptoms beyond crusting and sores include:

• Skin Splitting

• Pimple/Acne Formation

• Scabbing

• Ulcers

People often try applying lotion, neosporin, or cortisone cream… which does help, but not completely with recurrent flareups.

The most common triggers I find that lead to such recurrent sores are nose-picking and nasal hair removal.

The best thing is to avoid doing either… but… if one must…

Nose picking is pretty self-explanatory, but nasal hair removal does require some clarification.

People often use tweezers or even their fingers to pull the offending long nasal hair out for either cosmetic or annoyance reasons.

Yanking nasal hair out is not a good idea beyond the watery eyes it may bring. It causes micro-trauma to the surrounding skin and hair follicle that may lead to infection. Furthermore, just like any other place on the body where hair is removed, ingrown hair growth can also occur.

Aha! one might say… Use an electric nasal hair cutter! That’s a good idea, but make sure it does not cut down to the skin for the same reasons as stated above. Also, ensure the blades are kept sharp to prevent hair pulling.

There are good nasal hair cutters and there are bad ones…

From personal testing of a variety of nasal hair cutters, I like the Groom Mate Platinum XL.

I’m sure there are other good ones, but it may also come down to personal preference.

Now, if there’s an active recurrent nasal sore that’s not healing, the best way to treat it is with prescription cortisporin ointment.

However, best to have a doctor to check it out as there are other more malicious reasons for a nasal sore including skin cancer.
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Amoeba Deaths from Neti-Pot Use and How to Minimize Risk

In the past few weeks, there have been numerous stories about the 2nd death in Louisiana from Neti-Pot use leading to an amoeba infection of the brain. The culprit organism Naegleria fowleri causes a life-threatening encephalitis after passing thru the nose and up into the brain where the organism eats neurons for food.

As such, recommendations have been issued to use water as instructed with the Neti-Pot packaging… water should be boiled, distilled, or filtered.

However, before the millions of people who may have elected to simply use tap-water change their daily routine, consider that more commonly, swimming in warm lakes or rivers causes 2-3 amoeba related deaths per year… and swimming in and of itself leads to thousands of drownings per year. So far, there have been only TWO amoeba-related deaths linked with Neti-Pot usage that we know of so far.

In any case, lets talk about boiled, distilled, or filtered water and what a Neti-Pot user can do keep their daily routine simple. After all, it is so simple to simply fill the container with running tap-water. The additional step to keep things safe can become annoying.

Boiled Water: Naegleria fowleri can not survive in temperatures above 47°C. As such, by boiling water, you guarantee death if any are present in the water.

Save time by boiling a large amount of water and storing in 1 gallon containers for daily use.

Distilled Water: By definition, distillation involves boiling the water and then condensing the steam into a clean container. It’s a slow process, but it not only kills any micro-organisms much like simple boiling does, but also removes any inorganic “impurities” that may be harmful like mercury as well as beneficial minerals including calcium, magnesium, and sodium. Distillation does not discriminate.

It is not feasible for most individuals to set up a home water distillation process just so they can use the Neti-Pot. Though can get expensive over the years, save time by purchasing large volumes of distilled water to have at home. But, there are portable water distilling machines you can purchase as well.

Filtered Water: Water that is filtered is cleaned by means of a fine physical barrier, a chemical process or a biological process. In most homes, filtered water is almost universally achieved by a physical barrier. There are numerous vendors out there that sell devices to filter the water including Pur Water and Brita.

Save time by purchasing a faucet attachment that automatically filters water into your Neti-Pot when you need it.

How to Make Xylitol Nasal Flush at Home

Given the unusually large reader response to my last blog regarding xylitol nasal rinses regarding the “recipe,” I thought it easier to write a blog about it!!!

To be brief, xylitol is a naturally-occurring plant-based sugar substitute that apparently has all sorts of anti-bacterial as well as anti-fungal properties. Given these properties, daily xylitol gum chewingor xylitol nasal sprayuse has been shown to help prevent recurrent acute ear infections and sinus infections… safe for use even in infants.

When used as part of nasal flushes to the nose, it seems to work even better than traditional saline flushes to the nose (read more about this here).

So, I have provided below a few different recipes to make xylitol nasal flushes at home. One may be more comfortable than the other, but it is user dependent. Obviously, convenience will play a role as well.

Just as an FYI, you can also purchase pre-packaged packetsthat contain xylitol for the ultimate convenience. Just open one packet and mix it in with water inside your nasal flush kit of choice (Nasopure, Neti Pot, Neilmed, etc)

Recipe #1 (Complex):
1 cup of water (8 ounces)
1/2 tsp salt
1/2 tsp of xylitol crystals
1/2 tsp baking soda
4 drops of grapefruit seed extract

Recipe #2:

1 cup of water (8 ounces)

1/2 tsp salt

1/2 tsp of xylitol crystals

Recipe #3:

1 cup of water (8 ounces)

1/2 – 1 tsp of xylitol crystals

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Nasal Dripologist

I always thought that pediatricians, primary care physicians, allergists, and ENTs were the true nasal dripologists, but I guess I’m wrong…

Saw this ad by Target promoting their pharmacists…

Xylitol Nasal Flushes Helps Prevent Chronic Sinusitis

Over the years, there has been much about how beneficial a safe food additive called “xylitol” is in preventing infections. This naturally-occurring plant-based sugar substitute apparently has all sorts of anti-bacterial as well as anti-fungal properties.

Given these properties, daily xylitol gum chewing or xylitol nasal spray use has been shown to help prevent recurrent acute ear infections and sinus infections… safe for use even in infants.

How may this occur? Toronto researchers figured out that xylitol inhibits the adherence of germs (burkholderia in the study) to airway linings thereby helping to prevent recurrent infections.

Another beneficial practice found to be helpful in preventing sinus infections are saline flushes to the nose. For those who don’t realize the difference, saline flushes are different from saline nasal sprays in the volume of irrigation performed (think garden hose versus squirt bottle). Nasopure
nasal flushes is being shown in the picture above (there are many different styles but all basically do the same thing).

Now what if we combine saline flushes with xylitol for those who suffer from particularly difficult chronic sinus infections???

Stanford University researchers conducted a small study (20 subjects) to see whether xylitol flushes (rather than nasal spray) to nose works even better than plain saline flushes to the nose. In spite of its small size, it was a prospective, randomized, double-blinded, controlled crossover pilot study.

What they found, at least in the short term, is that xylitol nasal irrigations resulted in greater improvement of chronic rhinosinusitis symptoms as compared to saline irrigations.
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Reference:
Xylitol nasal irrigation in the management of chronic rhinosinusitis: A pilot study. The Laryngoscope
Volume 121, Issue 11, pages 2468–2472, November 2011

A novel model to study bacterial adherence to the transplanted airway: inhibition of Burkholderia cepacia adherence to human airway by dextran and xylitol. J Heart Lung Transplant. 2004 Dec;23(12):1382-91.

A Story About a Sugar: The X-Factor. Blog by Dr. Faust

Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010 Oct;49(10):754-61.

A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998 Oct;102(4 Pt 1):879-84.

Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ. 1996 Nov 9;313(7066):1180-4.

Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.

The Doctors TV Show Does Adenoidectomy

Dr. Nina Shapiro was the featured otolaryngologist when The Doctors television show discussed nasal congestion as well as large adenoids. A sanitized view of adenoid removal surgery was also shown.

For a more detailed view of the surgery, click here.

For more info on adenoids and its surgical removal, click here.

Why Does the Nose Whistle in Some People?

Though most people like the professional nose whistler shown here require an instrument to enable the nose to whistle, in others it occurs naturally due to unique anatomic features within the nose.

Why might someone’s nose whistle?

Septal Perforation

The most common reason it may occur constantly is due to a hole in the septum (septal perforation). The septum is a wall that divides the right nasal cavity from the left side. Normally, it should be straight and without any openings.

However, when a hole is present in the septum and it is in just the right size and place, whenever air is breathed in and out the nose, it will whistle. In this situation, the hole is the “window” of the whistle and the nose itself is the mouthpiece.

Correction of this problem is by either closing the hole (septal button or surgery) or making it bigger such that the aerodynamics eliminate the conditions conducive to nasal whistling. As an FYI, surgical correction of a septal perforation is quite difficult.

Septal Deviation and Some Nasal Congestion

The other situation when the nose may whistle, but only intermittently, is when there is a deviated septum. In this scenario, the septum rather than being straight, it is slightly crooked to one side making one side more narrow than the other.

Add some slight swelling of the nasal lining such that the opening of the nose is restricted to just right size and shape, and it may whistle.

This type of nasal whistling is akin to grass whistling (blowing between two thumbs holding a blade of grass).

Thankfully, the nasal conditions that lead to nasal whistling is quite rare and requires the perfect storm of just the right amount of septal deviation with just the right amount of nasal congestion.

As such, correction of this problem is fairly easy as one needs to change either the congestion causing the nasal lining to swell with a nasal spray or anti-histamine OR fix the deviated septum. If the inferior turbinates are enlarged, they can be reduced in size as well.

Of course, one can take this unusual condition and make it a positive feature worthy of a concert hall… WITHOUT the assistance of any instrument!

Nasal Congestion Affected By How Well the Nose is Able to Cool Itself

Researchers at Monell Chemical Senses Center have figured out that nasal congestion is influenced by more than just nasal airflow. Apparently temperature and humidity influence the perception of nasal congestion just as much as how physically obstructed the nose is.

By having volunteers breath air with variations in temperature and humidity, they have determined that cool and dry air minimizes nasal congestion without any change in how open the nasal cavity is.

By taking into account other measured variables, they have deduced that nasal congestion is influenced by how well the nose is able to cool itself from the nasal airflow specifically. The more warm and humid the air is, the less able the nose is able to cool itself leading to perception of nasal congestion.

With actual nasal obstruction, it may be not so much that you can’t breath that causes the feeling of nasal congestion, but rather the reduced ability of the nose to cool itself from the absence/reduction of air circulation within the nasal cavity.

So… if nasal cooling influences perception of nasal congestion, this may be one of many factors that may help explain the phenomenon of Empty Nose Syndrome. Patients suffering from Empty Nose Syndrome have an abnormally open nasal cavity from extensive surgical removal of internal nasal structures… yet complain the most bitterly about how congested their nose feels.

This information may also help guide treatment in patients with tracheostomy who also have a totally open nose, but because they breath thru an opening in the neck, have no nasal airflow in the nose which leads to the sense of nasal congestion.

Based on this new research, in these particular patient populations, providing allergy medications like steroid nasal sprays and anti-histamines may not be the best way of addressing nasal congestion.

Clearly, more research is needed on this topic, but certainly opens other new avenues of possible treatment protocols.

Reference:
Perceiving Nasal Patency through Mucosal Cooling Rather than Air Temperature or Nasal Resistance. PLoS ONE 6(10): e24618. doi:10.1371/journal.pone.0024618

New Webpage on Facial Fractures and Nasal Fractures

Our office has created a new webpage describing the evaluation and management of not only nasal fractures, but also facial fractures.

Fracture types discussed include:

• Nasal Fractures
• Orbital Fractures (around the eye)
• Maxillary Fractures (cheek)
• Zygomatic Fractures (behind cheekbone)
• Tripod Fractures (cheekbone)
• Mandible (lower jawbone)
• LeFort (upper jawbone)

Check it out here!