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Colds, Flu, Allergies and Your Ears

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Colds, flu and allergies have similar symptoms: sneezing, coughing, stuffy nose, watery, itchy eyes and a general feeling of sickness. But did you know your ears could be affected as well? Colds, flu and allergies can cause diminished hearing, a clogged or “full” feeling in the ears. While somewhat annoying, it’s usually a temporary condition.

The parts of the ear

Your ears are wonderful little “machines” with three parts that contribute not only to hearing, but to balance as well. The outer ear, the middle ear and the inner ear all can be affected by illness and allergies.

The outer ear is the outside portion of your ear and the ear canal. When you’re sick, it may become swollen or red. An infection occurs most often in the middle ear, the location of the Eustachian tube. This part of your ear is like a pressure release valve, a drainage tube of sorts. When it is clogged by mucus, pressure builds up and it becomes difficult to hear. The inner ear is filled with fluid and is called the labyrinth. It also can become infected, leading to dizziness, ringing in the ear or loss of balance.

Allergies, viruses and hearing

Allergies and colds are the most likely to cause a middle ear infection, also known as otitis media. After a few days of a stuffy or runny nose, the lining of your middle ear is irritated. This can block the Eustachian tube, which can feel like popping in the ears, fullness or congestion. Sometimes this blockage results in a temporary hearing loss, called conductive hearing loss. It usually resolves itself once the cold or allergy is gone.

The flu also can lead to conductive hearing loss due to congestion. This also usually resolves itself. However, the flu might also cause a more serious hearing problem known as sensorineural hearing loss. This is when the inner ear nerves that transmit sound signals to the brain are damaged. It happens when the flu virus attacks the inner ear. Sensorineural hearing loss may be permanent if it’s not treated quickly, usually within two days. However, it’s difficult to diagnose, so if you have the flu and experience a sudden loss of hearing, see your health care provider as soon as possible.

Treatments for colds and allergies

Antihistamines and decongestants can help reduce ear pressure and the feeling of fullness. Sometimes a warm compress helps. If an infection is present, a doctor will prescribe an antibiotic. Over-the-counter pain relievers can relieve earaches.

Because your ears, nose and throat are so closely connected, a problem in one area often leads to another. That’s why a stuffy nose and blocked ears often happen at the same time when you have a cold, the flu or allergies. Usually any loss of hearing is temporary, but if problems persist, a visit to your hearing professional is important.

Earache

Is this your child’s symptom?

• Pain in or around the ear
• The older child complains about ear pain
• Younger child acts like he did with last ear infection or cries a lot
• Not caused by an ear injury

Causes of Earaches

• Ear Infection. An infection of the middle ear (space behind the eardrum) is the most common cause. Ear infections can be caused by viruses or bacteria. Usually, a doctor can tell the difference by looking at the eardrum.
• Swimmer’s Ear. An infection or irritation of the skin that lines the ear canal. Main symptom is itchy ear canal. If the canal becomes infected, it also becomes painful. Mainly occurs in swimmers and in the summer time.
• Ear Canal Injury. A cotton swab or fingernail can cause a scrape in the canal.
• Ear Canal Abscess. An infection of a hair follicle in the ear canal can be very painful. It looks like a small red bump. Sometimes, it turns into a pimple. It needs to be drained.
• Earwax. A big piece of hard earwax can cause mild ear pain. If the wax has been pushed in by cotton swabs, the ear canal can become blocked. This pain will be worse.
• Ear Canal Foreign Object. Young children may put small objects in their ear canal. It will cause pain if object is sharp or pushed in very far.
• Airplane Ear. If the ear tube is blocked, sudden increases in air pressure can cause the eardrum to stretch. The main symptom is severe ear pain. It usually starts when coming down for a landing. It can also occur during mountain driving.
• Pierced Ear Infections. These are common. If not treated early, they can become very painful.
• Referred Pain. Ear pain can also be referred from diseases not in the ear. Tonsil infections are a common example. Tooth decay in a back molar can seem like ear pain. Mumps can be reported as ear pain. Reason: the mumps parotid gland is in front of the ear. Jaw pain (TMJ syndrome) can masquerade as ear pain.

Ear Infections: Most Common Cause

• Definition. An infection of the middle ear (the space behind the eardrum). Viral ear infections are more common than bacterial ones.
• Symptoms. The main symptom is an earache. Younger children will cry, act fussy or have trouble sleeping because of pain. About 50% of children with an ear infection will have a fever.
• Diagnosis. A doctor can diagnose a bacterial ear infection by looking at the eardrum. It will be bulging and have pus behind it. For viral ear infections, the eardrum will be red but not bulging.
• Age Range. Ear infections peak at age 6 months to 2 years. They are a common problem until age 8. The onset of ear infections is often on day 3 of a cold.
• Frequency. 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.
• Complication of Bacterial Ear Infections. In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.
• Treatment. Bacterial ear infections need an oral antibiotic. Viral ear infections get better on their own. They need pain medicine and supportive care.

When to Call for Earache

Call 911 Now

• Not moving or too weak to stand
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Severe earache and not improved 2 hours after taking ibuprofen
• Pink or red swelling behind the ear
• Outer ear is red, swollen and painful
• Stiff neck (can’t touch chin to the chest)
• Walking is not steady
• Pointed object was put into the ear canal (such as a pencil, stick, or wire)
• Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• Fever over 104° F (40° C)
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Earache, but none of the symptoms above. Reason: could be an ear infection.
• Pus or cloudy discharge from ear canal

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Earache

1. What You Should Know About Earaches:
   • Your child may have an ear infection. The only way to be sure is to look at the eardrum.
   • It is safe to wait until your doctor’s office is open to call. It is not harmful to wait if the pain starts at night.
   • Ear pain can usually be controlled with pain medicine.
   • Many earaches are caused by a virus and don’t need an antibiotic.
   • Here is some care advice that should help until you talk with your doctor.
2. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
3. Cold Pack for Pain:
   • Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.
   • Note: some children prefer heat for 20 minutes.
   • Caution: heat or cold kept on too long could cause a burn or frostbite.
4. Ear Infection Discharge:
   • If pus is draining from the ear, the eardrum probably has a small tear. Usually, this is from an ear infection. Discharge can also occur if your child has ear tubes.
   • The pus may be blood-tinged.
   • Most often, this heals well after the ear infection is treated.
   • Wipe the discharge away as you see it.
   • Do not plug the ear canal with cotton. Reason: retained pus can cause an infection of the lining of the ear canal.
5. Fever Medicine:
   • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Note: fevers less than 102° F (39° C) are important for fighting infections.
   • For all fevers: keep your child well hydrated. Give lots of cold fluids.
6. Return to School:
   • Ear infections cannot be spread to others.
   • Can return to school or child care when the fever is gone.
7. Call Your Doctor If:
   • Pain becomes severe
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 05/30/2021

Last Revised: 03/11/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

Colds, coughs and ear infections in children

Children’s colds

It’s normal for a child to have 8 or more colds a year.

This is because there are hundreds of different cold viruses and young children have no immunity to any of them as they have never had them before.

They gradually build up immunity and get fewer colds.

Most colds get better in 5 to 7 days but can take up to 2 weeks in small children.

Here are some suggestions for how to ease the symptoms in your child: 

• Make sure your child drinks plenty of fluids.
• Saline nose drops can help loosen dried snot and relieve a stuffy nose. Ask your pharmacist, GP or health visitor about them.
• If your child has a fever, pain or discomfort, children’s paracetamol or ibuprofen can help. Children with asthma may not be able to take ibuprofen, so check with a pharmacist, GP or health visitor first. Always follow the instructions on the packet.
• Encourage the whole family to wash their hands regularly to stop the cold spreading.

Cough and cold remedies for children

Children under 6 should not have over-the-counter cough and cold remedies, including decongestants (medicines to clear a blocked nose), unless advised to by a GP or pharmacist.

Information:

Call a pharmacy or contact them online before going in person. You can get medicines delivered or ask someone to collect them.

Children’s sore throats

Sore throats are often caused by viral illnesses such as colds or flu.

Your child’s throat may be dry and sore for a day or 2 before a cold starts. You can give them paracetamol or ibuprofen to reduce the pain.

Most sore throats get better on their own after a few days.

If your child has a sore throat for more than 4 days, a high temperature and is generally unwell, see a GP.

If they’re unable to swallow fluids or saliva or have any difficulty breathing, go to A&E or call 999 immediately as they’ll need urgent treatment in hospital.

Find your nearest A&E department

Children’s coughs

Children often cough when they have a cold because of mucus trickling down the back of the throat.

If your child is feeding, drinking, eating and breathing normally and there’s no wheezing, a cough is not usually anything to worry about.

Although it’s upsetting to hear your child cough, coughing helps clear away phlegm from the chest or mucus from the back of the throat.

If your child is over the age of 1, they can try drinking a warm drink of lemon and honey.

To make hot lemon with honey at home, you need to:

• squeeze half a lemon into a mug of boiled water
• add 1 to 2 teaspoons of honey
• drink while still warm (do not give hot drinks to small children)

If your child has had a cough that’s lasted longer than 3 weeks, see your GP.

If your child’s temperature is very high, or they feel hot and shivery, they may have a chest infection. You should take them to a GP, or you can call 111.

If this is caused by bacteria rather than a virus, your GP will prescribe antibiotics to treat the infection. Antibiotics will not soothe or stop the cough straight away.

If a cough continues for a long time, especially if it’s worse at night or is brought on by your child running about, it could be a sign of asthma.

Take them to a GP, who will be able to check if your child has asthma.

If your child is finding it hard to breathe, go to A&E or call 999 immediately as they’ll need urgent treatment in hospital.

Find your nearest A&E department

Find out more about coughs

Croup

A child with croup has a distinctive barking cough and will make a harsh sound, known as stridor, when they breathe in. 

They may also have a runny nose, sore throat and high temperature.

Croup can usually be diagnosed by a GP and treated at home.

But if your child’s symptoms are severe and they’re finding it hard to breathe, go to A&E or call 999 immediately as they’ll need urgent treatment in hospital.

Find your nearest A&E department

Read more about the symptoms of croup.

Children’s ear infections

Ear infections are common in babies and small children. They often follow a cold and sometimes cause a high temperature.

A baby or toddler may pull or rub at an ear. Other possible symptoms include fever, irritability, crying, difficulty feeding, restlessness at night, and a cough.

If your child has earache, with or without fever, you can give them paracetamol or ibuprofen at the recommended dose.

Try one medicine first and, if it does not work, you can try giving the other one.

You should not give children paracetamol and ibuprofen at the same time, unless advised to by a healthcare professional.

Do not put any oil, eardrops or cotton buds into your child’s ear, unless your GP advises you to do so.

Most ear infections are caused by viruses, which cannot be treated with antibiotics.

They’ll just get better by themselves, usually within about 3 days.

After an ear infection, your child may have some hearing loss.

Their hearing should get better within a few weeks. But if the problem lasts for any longer than this, ask your GP for advice.

Find out more about ear infections (otitis media)

Glue ear in children

Repeated middle ear infections (otitis media) may lead to glue ear (otitis media with effusion), where sticky fluid builds up and can affect your child’s hearing.  

This may lead to unclear speech or behavioural problems.

If you smoke, your child is more likely to develop glue ear and will get better more slowly.

Your GP can give you advice on treating glue ear and can help you stop smoking.

Find out more about how to stop smoking

See glue ear for further information.

Video: how do I treat my child’s cold? (9 to 30 months)

This video explains what to do if your child gets a cold.

Media last reviewed: 10 October 2020
Media review due: 10 October 2023

Symptoms and Complications of Pneumococcal Disease

Pneumococcal disease can include many different types of infections. Symptoms depend on the part of the body that is infected. Most pneumococcal infections are mild. However, some can be deadly or result in long-term problems.

Pneumonia

Symptoms of pneumococcal pneumonia, a lung infection, include:

• Fever and chills
• Cough
• Rapid breathing or difficulty breathing
• Chest pain

Older adults with pneumococcal pneumonia may experience confusion or low alertness, rather than the more common symptoms listed above.

Complications of pneumococcal pneumonia include:

• Infection of the space between membranes that surround the lungs and chest cavity (empyema)
• Inflammation of the sac surrounding the heart (pericarditis)
• Blockage of the airway that allows air into the lungs (endobronchial obstruction), with collapse within the lungs (atelectasis) and collection of pus (abscess) in the lungs

Pneumococcal pneumonia kills about 1 in 20 who get it. 

Meningitis

Symptoms of pneumococcal meningitis, an infection of the lining of the brain and spinal cord, include:

• Stiff neck
• Fever
• Headache
• Photophobia (eyes being more sensitive to light)
• Confusion

In babies, meningitis may cause poor eating and drinking, low alertness, and vomiting.

About 1 in 12 children and 1 in 7 older adults who get pneumococcal meningitis dies of the infection. Those who survive may have long-term problems, such as hearing loss or developmental delay.

Blood Infection

Symptoms of pneumococcal bacteremia, a blood infection, include:

• Fever
• Chills
• Low alertness

About 1 out of 30 children with pneumococcal bacteremia die of it. Pneumococcal bacteremia kills about 1 out of 7 adults who get it. For those who survive, pneumococcal bacteremia can lead to loss of limb(s).

Sepsis

Symptoms of sepsis, the body’s extreme response to an infection, include:

• Confusion or disorientation
• Shortness of breath
• High heart rate
• Fever, shivering, or feeling very cold
• Extreme pain or discomfort
• Clammy or sweaty skin

Complications of sepsis include kidney failure and damage to the brain, lungs, or heart.

alert icon

Call your clinician right away if you think you or your child might have a serious pneumococcal infection

Middle Ear Infection

Symptoms of middle ear infections (otitis media), which pneumococcal bacteria commonly cause, include:

• Ear pain
• A red, swollen ear drum
• Fever
• Sleepiness

Ear infections are usually mild and are more common than the more severe forms of pneumococcal disease. However, some children develop repeated ear infections and may need ear tubes.

Sinus Infection

Symptoms of sinus infections include:

• Headache
• Stuffy or runny nose
• Loss of the sense of smell
• Facial pain or pressure
• Postnasal drip (mucus building up in the back of the throat or nose)

Complications are rare, but include infection of the tissue surrounding the eyes, bone infection, and a painful collection of pus (abscess).

Infections | Immune Deficiency Foundation

Infections are the hallmark of a primary immunodeficiency. For many patients, a primary immunodeficiency diagnosis is suspected and made only after the patient has had recurrent infections or infections that are uncommon or unusually severe. This section discusses common infections.

Infections in the Patient with Primary Immunodeficiency

Anyone can get an infection, and everyone does. But an infection in a person with a primary immunodeficiency may require different treatment than a similar infection in a person with a normal immune system. For example, the person with a primary immunodeficiency may require a longer course or higher dose of antibiotics than someone who does not have a primary immunodeficiency.

Your primary care provider should be the first point of contact when you are ill. The provider may then want to confer with your immunologist about the management and treatment of a particular infection. Your immunologist needs to know about the infections that you are having, as this knowledge may affect your treatment. For example, antibody deficient individuals who receive immunoglobulin (Ig) therapy may need to have their dose adjusted if they are experiencing frequent “breakthrough” infections.

The goals of medical treatment and supportive care are to reduce the frequency of infections, prevent complications and prevent an acute infection from becoming chronic and potentially causing irreversible organ damage. The patient, family and members of the healthcare team must work together and effectively communicate among each other if these goals are to be accomplished.

A description of several kinds of infections follows. Many other infections including skin infections, deep abscesses, bone infections, meningitis and encephalitis are not covered in this chapter, but these may occur in patients with primary immunodeficiency.

Remember that the suffix “itis” means an inflammation of a particular body part, like tonsillitis or appendicitis. The inflammation is usually caused by an infection, but not always.

Eye Infections

Conjunctivitis – Conjunctivitis, or pink eye, is an inflammation or infection of the lining of the eyelid and of the membrane covering the outer layer of the eyeball (conjunctiva). It can be caused by bacteria, viruses or chemical irritants such as smoke or soap. Conjunctivitis may occur by itself or in association with other illnesses, such as the common cold. The symptoms commonly associated with conjunctivitis are redness and/or swelling of the eyelids, tearing and discharge of mucus or pus. These symptoms are frequently accompanied by itching, burning and sensitivity to light.

In the morning, it is not unusual to find the eyelids “stuck” together from the discharge that has dried while the eyes were closed during sleep. These secretions are best loosened by placing a clean washcloth or cotton ball soaked in warm water on each eye. After a few minutes, gently clean each eye, working from the inner corner to the outer corner of the eye. Meticulous hand washing is necessary for anyone coming in contact with the eye discharge in order to prevent the spread of the infection as conjunctivitis is usually very contagious.

It may be necessary to be seen by a physician if vision is significantly affected or if symptoms persist, in order to determine the type of conjunctivitis. The eye discharge may be cultured to determine if the infection is bacterial or viral. Topical antibiotics (ointment or eye drops) may be prescribed if the infection is bacterial in nature. If the inflammation is caused by an irritant, avoidance of that irritant will be important.

Ear Infections

Otitis Media – Otitis Media is an infection of the middle ear and is usually caused by bacteria or viruses. A small tube called the Eustachian tube connects the middle ear with the back of the throat and nose. In the infant and small child, the tube is shorter and more horizontal than in the adult, and provides a ready path for bacteria and viruses to gain entrance into the middle ear and not drain out. In some infections and allergic conditions, the Eustachian tube may actually swell and close, preventing drainage from the middle ear.

The characteristic symptom associated with otitis media is pain, caused by irritation of the nerve endings in the inflamed ear from inflammatory secretions or changes in ear pressure. A baby or young child may indicate pain by crying, head rolling, or pulling at the infected ear(s). The older child or adult may describe the pain as being sharp and piercing. Restlessness, irritability, fever, nausea and vomiting may also be present. Pressure in the infected eardrum tends to increase when the individual is in a flat position. This explains why pain is often more severe at night, causing the individual to wake up frequently. As fluid pressure increases within the eardrum, pain becomes more severe and the eardrum may actually rupture. The appearance of pus or bloody drainage in the ear canal is an indication of a possible eardrum rupture. Although pain is usually relieved when the eardrum ruptures, the infection still exists.

Whenever an ear infection is suspected, the patient should be seen by a healthcare provider. Antibiotic therapy is usually started in order to cure the infection. Analgesic (pain killing) ear drops may also be prescribed to help with pain. A follow-up examination may be recommended to be sure that the infection has cleared and that no residual fluid remains behind the eardrum. Repeated episodes of otitis media may actually cause hearing impairment or loss.

For children with repeated episodes of otitis media, a procedure called a myringotomy may be recommended. In this procedure a small hole is made in the eardrum and a tube placed in the hole, to promote drainage of fluid from the middle ear and equalize the pressure between the ear canal and middle ear.

Upper Respiratory (Sinus and Throat) Infections

Rhinitis – Rhinitis is a term used to describe an inflammation of the nose. It is usually caused by bacteria, viruses, chemical irritants and/or allergens. Symptoms may include sneezing, difficulty in breathing through the nose, and nasal discharge (rhinorrhea). The nasal discharge may vary from thin and watery, to thick and yellow or green. It is generally accepted that green nasal discharge is a sign of acute infection, but this may not always be the case.

Acute Sinusitis – Sinusitis is an inflammation of one or more of the sinuses. The sinuses are small cavities, lined with mucous membranes, located in the facial bones surrounding the nasal cavities. The purpose of the sinuses is thought to be to decrease the weight of the skull and to give resonance and timbre to the voice. The basic causes of sinusitis are the blockage of normal routes of sinus drainage and infections spread from the nasal passages. Pain, particularly in the forehead and cheekbones, and tenderness over the face in these same areas is characteristic symptoms. In addition, there may be pain in and around the eyes and in the teeth of the upper jaw. The pain and headache associated with sinusitis is typically more pronounced in the morning due to accumulated secretions in the sinuses during sleep. Being in an upright position during the day facilitates sinus drainage and usually provides some temporary relief. Depending on the amount of sinus drainage, there may be cough, throat irritation, bad breath and decreased appetite. Sinusitis may be accompanied by a fever.

A sinus infection can be difficult to treat in the patient with a primary immunodeficiency and may require a longer course of antibiotics than would be usually prescribed. Many patients get benefit from the use of daily sinus rinses to keep the sinuses free of accumulating secretions. Repeated or prolonged episodes of acute sinusitis may lead to chronic sinusitis and damage to the mucosal surfaces.

Acute Coryza – Coryza, also known as upper respiratory infection (URI) or the common cold, is an acute inflammation of the upper respiratory tract (nose and throat or nasopharynx). Early symptoms include a dry tickling sensation in the throat, followed by sneezing, coughing and increased amounts of nasal discharge. There may also be symptoms of fatigue and generalized aches and discomfort. A cold is usually caused by a rhinovirus. Symptomatic treatment may bring some relief, but there is no antibiotic currently available that will kill or inactivate a rhinovirus. Taking an antibiotic will not cure a cold any quicker. A cold generally lasts about a week. There is some validity to that old joke that a cold with treatment lasts about seven days and without treatment, a week.

But if your “cold” lasts more than a week and is accompanied by a fever, productive cough and/or difficulty breathing, it may be more than a cold and you should see your primary care provider.

Influenza – Influenza, or “Flu” (a short form of the word “influenza”), is a term that is often used generically to describe the fever, aches, cough, congestion, etc. that we associate with many common respiratory viruses. However, true influenza is caused only by an influenza virus and may be more severe and dangerous than other common respiratory viruses. Flu season is generally in the fall and winter. Flu may occur sporadically or in epidemics. Usually epidemics occur every two to four years and develop rapidly because of the short incubation period of the disease.

The incubation period is the time from when a person is exposed to an infection to the time symptoms appear. Symptoms of the flu include sudden onset of high fever, chills, headache, muscle ache, weakness, fatigue and runny nose. Vomiting and diarrhea may also be present. Sometimes a bacterial infection may develop during or after the flu.

There are anti-viral drugs available to treat the flu, but they must be started shortly (one or two days) after the onset of symptoms in order for them to be effective. There is also some evidence to suggest that these drugs may prevent the flu or decrease its severity if taken after someone has been exposed to the flu. Influenza can be a very serious infection, particularly in someone with a primary immunodeficiency and medical attention should always be sought.

Pharyngitis – Pharyngitis describes an inflammation of the throat (sore throat). It is usually caused by a bacterial or viral infection but may also be caused by simple irritation. Symptoms include a raw or tickling sensation in the back of the throat and there may be difficulty swallowing. Sometimes these symptoms are accompanied by a fever. Sore throats that are caused by streptococcus (strep throat) can cause other diseases such as rheumatic fever or kidney inflammation if they are not treated. If you have a sore throat, you should seek medical attention as a quick test or culture to determine if it is a Strep infection is usually indicated.

Tonsillitis – Tonsillitis is an inflammation of the tonsils. Some people have chronic tonsillar infections, and it may be recommended that the tonsils be removed (sometimes along with the adenoids).

Adenitis or Lymphadenitis – Lymphadenitis, or swollen glands, is an inflammation of the lymph nodes. Lymph nodes are present all over the body, but particularly in the neck, axillae and groin areas. The lymph system functions to help the immune system respond to infection. For example the lymph nodes in the neck can become inflamed as the body is recovering from an upper respiratory infection. This is called reactive lymphadenopathy because it is a normal response, or reaction, to an infection. It is also possible for the lymph nodes to become inflamed because they themselves are infected.

Lower Respiratory Infections

Croup – Croup is a general term used to describe an infection, usually in children, which causes narrowing of the air passages leading to the lungs. Croup can be caused by viruses or bacteria. The child’s temperature may be normal or slightly elevated. The onset of croup may be sudden or occur gradually. In some instances, the onset occurs at night, and the child may awaken with a tight “barking” cough and respiratory distress. Breathing is difficult due to the narrowing of the trachea (windpipe). Croup can be a frightening experience for both the parents and child. Unfortunately, the child’s anxiety may increase the severity of the symptoms. It is important for the parents to remain as calm and as reassuring as possible. Urgent medical attention may be needed. Depending on the severity of symptoms, advice may be sought from the primary care on call provider, and sometimes an emergency room visit is in order.

Acute Bronchitis – Acute bronchitis is an inflammation of the bronchi, which are the major branches off the trachea (windpipe). It often accompanies or follows an upper respiratory infection. Symptoms include fever and cough. At the onset, the cough is usually dry but gradually becomes more productive.

Pneumonia – Pneumonia is an acute infection of the lungs and can be caused by bacteria, viruses and/or fungi. Symptoms include chills, high fever, cough and chest pain associated with breathing. Symptoms of pneumonia should always be reported to the primary care provider. In some people with a primary immunodeficiency, bronchiectasis may develop if there are repeated episodes of pneumonia. Bronchiectasis is an irreversible condition where the airways become widened and scarred. After this occurs, it becomes difficult to clear the airways of mucus and bacteria, which leads to even more serious lung infections.

General Care of Respiratory Infections

Respiratory infections may be merely bothersome, like a cold or more serious like pneumonia. Management of these infections is directed toward the relief of symptoms and the prevention of complications. The primary care provider may recommend a medication to relieve fever and general body aches. Antibiotics may be prescribed to cure infections that are caused by bacteria. Expectorants may be prescribed to liquify (water down) mucus secretions and make them easier to cough up. Decongestants to shrink swollen mucous membranes may also be recommended. Fluids should be encouraged to promote adequate hydration. Drinking a variety of beverages is important. Beverages served with crushed ice can be soothing to a sore throat. Warm beverages, such as tea, may promote nasal drainage and relieve chest tightness. During the acute phase of any of these types of illnesses, there may be a loss of appetite. This is generally short lived. It is usually effective to have small frequent feedings of liquid and light foods. Once the appetite returns, a high caloric, high protein diet, to replace the proteins lost during the acute phase of the illness, might be recommended.

General comfort measures also include rinsing the mouth with plain water at regular intervals. This will relieve the dryness and “bad taste” that often accompanies illness and mouth breathing. A vaporizer may be helpful in increasing room humidity. However, if a vaporizer is used, daily cleaning is imperative to prevent contamination with molds. A coating (such as petrolatum or lip balm) can provide relief and protection to irritated lips and nose. Adequate rest is important. If persistent coughing or post nasal drip interferes with rest, elevation of the head and shoulders with extra pillows during periods of sleep should be attempted. Sometime a cough suppressant can be prescribed at night to prevent interruption of sleep.

Respiratory infections tend to be easily passed from one individual to another. The person who is ill should always be encouraged to cover the mouth and nose when sneezing and coughing. Soiled tissues should be promptly discarded. Frequent hand washing is critical to prevent the spread of the infection. In some cases of bronchitis and pneumonia, coughing and breathing deeply at regular intervals should be encouraged as coughing protects the lungs by removing mucus and foreign particles from the air passages. Deep breathing promotes full expansion of the lungs, reducing the risk of further complications. In some situations, the primary care provider may order chest postural drainage, chest physiotherapy or sinus postural drainage, which are all ways of helping to loosen and clear mucus.

Gastrointestinal (GI) Infections

Diarrhea – Diarrhea is characterized by frequent, loose, watery bowel movements (stools). Diarrhea is a symptom and may indicate an infection or inflammation of the GI tract. Infections may be caused by viruses, bacteria, fungi or parasites. The primary care provider may order stool cultures to determine the cause of the infection. Certain medications may also cause diarrhea. Diarrhea may be mild to severe in nature. Whether it is mild or severe depends on the frequency, the volume and the consistency of the stools. Diarrheal illnesses may be accompanied by fever. In some cases severe diarrhea can cause dehydration. Infants, young children and the elderly are at the greatest risk of serious problems associated with dehydration. Diarrheal illnesses may sometimes be accompanied by vomiting, further increasing risks of dehydration. Signs of dehydration can include:

• Loss of skin elasticity
• Dry parched lips, tongue and mucus membranes
• Thirst
• Decreased urine output
• In infants, depressed or sunken fontanelles (soft spots on the head)
• An appearance of sunken eyes
• Behavioral changes ranging from restlessness to extreme fatigue and weakness

The general care of diarrhea focuses on the replacement of lost body fluids and salts and the prevention of dehydration. When diarrhea is mild, changes in the diet and increased fluid intake may compensate for fluid losses. The primary care provider may suggest a clear liquid diet, including weak tea, sports drinks, bouillon and “flattened” (without carbonation) soft drinks. As clear liquids are tolerated and the frequency and volume of stools decrease, the diet may be gradually advanced. In case of severe dehydration, hospitalization and intravenous fluids may be necessary.

General comfort measures include coating the rectal area with a petroleum jelly preparation. This will help protect the skin and reduce irritation from frequent diarrheal stools. Soiled diapers and clothing should also be changed immediately. The older child and adult may be encouraged to rinse his or her mouth with water regularly. This helps to relieve mouth dryness and “bad taste” associated with illness and is especially important after vomiting.

In infectious diarrhea, several measures are used to reduce the chances of spreading the illness to other family members. It may be easier for the infected person to use disposable cups, dishes and utensils. Soiled diapers, clothing and linens should be kept separate and washed separately from other family laundry. Bathrooms should be cleaned with a disinfectant solution as often as necessary. Frequent hand washing is essential for everyone.

Bloody diarrhea and diarrhea accompanied by urgency and severe abdominal cramping may be signs of illnesses other than infections. These symptoms should always be reported to the primary care provider. Diarrhea can be caused by many things in addition to infections including certain drugs, malabsorption, inflammatory bowel diseases like ulcerative colitis or Crohns disease, etc., and additional testing may be required to determine its cause.

Other GI Infections

Any of the gastrointestinal organs can become inflamed. Examples of these disorders include hepatitis (liver), gastritis (stomach), pancreatitis (pancreas), cholecystitis (gall bladder) or colitis (large intestine). This inflammation may be caused by infection. Symptoms can include pain, yellowing of the skin and/or eyes (jaundice), diarrhea, nausea or loss of appetite. Medical attention should always be sought for these types of symptoms.

Bloodstream Infections

The blood can become infected with any kind of germ (bacteria, fungus, virus). The general term for this is “sepsis.” These are extremely serious infections usually accompanied by high fever and signs of severe acute illness. It is necessary for the blood to be drawn and cultured to see if infectious organisms are present. Very often, blood stream infections require treatment with intravenous antibiotics.

Infections at Unusual Locations or with Unusual Organisms

Infections that occur with defects in the innate immune system may be quite different from those that affect individuals with defects in T-cells or B-cell/antibody production. For example, children with Chronic Granulomatous Disease (CGD) are usually healthy at birth. The most common CGD infection in infancy is a skin or bone infection with the bacteria Serratia marcescens, an organism that very rarely causes infections in other primary immunodeficiency diseases and any infant with an infection with this particular organism should be tested for CGD.

Infections in CGD may involve any organ or tissue, but the skin, lungs, brain, lymph nodes, liver and bones are the usual sites of infection and abscess formation is common. Infections may rupture and drain with delayed healing and residual scarring. Infection of lymph nodes (under the arm, in the groin, in the neck) is a common problem in CGD, often requiring drainage or surgery along with antibiotics.

Pneumonia is also a common problem in CGD. Pneumonias due to the fungus Aspergillus may come on very slowly, initially only causing fatigue, and only later causing cough or chest pain. Fungal pneumonias often do not cause fever. In contrast, bacterial infections (Staphylococcus aureus, Burkholderia cepacia complex, Serratia marcescens, Nocardia) usually come on very quickly with fever and cough. Nocardia in particular causes high fevers and lung abscesses that can destroy parts of the lung.

With CGD it is particularly important to identify infections early and treat them completely, usually for a long period of time, so it is critical to seek medical attention early. If pneumonia is found it is very important to figure out exactly which microorganism is the cause, which may require a biopsy, usually done with a needle or a bronchoscope and not surgery. Treatment may require many weeks.

Liver abscesses occur in about a third of patients with CGD. It can start as fever and fatigue but may also cause mild pain over the right upper abdomen. Staphylococcus aureus causes most liver abscesses. Abscesses can also develop in the brain or bones (osteomyelitis) and can involve the spine, particularly if a fungal infection in the lungs spreads into it.

Treatment of Infections

There are many “anti-infective” drugs: antibacterial, antifungal, antiviral and anti-parasitic. The term “antibiotic” usually refers to a drug that fights bacterial infections. Anti-infective drugs are very specific. Different infections require different treatment. While penicillin is an excellent antibacterial antibiotic, it does not kill every kind of bacteria and has no effect at all on a virus or a fungus. An infection can only be cured if it is treated with the right drug. Every infection does not necessarily need to be treated with an antibiotic or an anti-infective. The body has many defenses and mechanisms to fight off and kill infections. These defenses are present, even in people with immunodeficiencies. For example, the skin and mucus membranes are the first line of defense against many infections. Phagocytes (germ killing white blood cells) usually work very well in people with antibody disorders just as antibodies are produced and work effectively in people with certain phagocyte problems. Some infections are mild and will resolve on their own, even in someone with primary immunodeficiency.

Sometimes prophylactic (or preventive) antibiotics may be prescribed for patients with some immunodeficiencies. For example, people with CGD usually receive daily antibiotics to protect them against certain kinds of infections. People with cellular immune defects may take antibiotics to protect them against a particular kind of pneumonia. Prophylactic antibiotics are not, however, routinely recommended for all people with primary immunodeficiencies. There can be risks associated with antibiotic therapy. For example drug-resistant organisms can develop or severe diarrhea can occur if normal body, non-pathogenic organisms are killed by an antibiotic. Only your immunologist can determine if prophylactic antibiotics are appropriate for you.

It is always important to try and determine the cause of a particular infection in someone with a primary immunodeficiency. In order to determine what the “right” drug is, it may be necessary to get a culture. For example, if you have a respiratory infection with a cough, sputum that is coughed up can be sent to the lab to identify what the infecting agent is and its sensitivity to different antimicrobial agents. Cultures can be obtained on any type of drainage or body fluid. Sometimes, a biopsy of a tissue needs to be done. This involves taking a sample of a particular tissue and testing it to see if infection is present. For example, during a colonoscopy, tiny samples of the tissue from the intestinal wall are taken and examined by the pathologist to determine if an infection or other kind of inflammation is present.

Summary of Infections

While infections of all kinds (acute, chronic, frequent or recurrent) are always going to be problematic for people with primary immunodeficiencies, it is important to remember that prevention and early intervention are always the best approaches. A healthy lifestyle that includes adequate rest, nutrition and exercise can go a long way to preventing infections. Similarly, a common sense approach to prevention that includes such measures as frequent handwashing and avoiding others who are ill can also be highly effective. However, once symptoms of an infection are present, seeking medical care in a timely manner is critical so that infections can be diagnosed early and treated appropriately, thereby preventing complications.

Excerpted from the IDF Patient & Family Handbook for Primary Immunodeficiency Diseases FIFTH EDITION Copyright 2013 by Immune Deficiency Foundation, USA. This page contains general medical information which cannot be applied safely to any individual case. Medical knowledge and practice can change rapidly. Therefore, this page should not be used as a substitute for professional medical advice.

evidence for chronic cough as a sensory vagal neuropathy

J Thorac Dis. 2014 Oct; 6(Suppl 7): S748–S752.

,^1,2,^1,2 and ³

¹Priority Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia; ²Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia; ³Division of Asthma, Allergy and Lung Biology, King’s College London, Denmark Hill, London SE5 9RS, UK

Corresponding author.Correspondence to: Nicole M. Ryan. Clinical Toxicology & Pharmacology, Level 5 New Med Building, Calvary Mater Newcastle, Edith Street Waratah, NSW 2298, Australia. Email: [email protected].

Received 2014 Feb 11; Accepted 2014 Apr 5.

Copyright 2014 Pioneer Bioscience Publishing Company. All rights reserved.This article has been cited by other articles in PMC.

Abstract

Arnold’s nerve ear-cough reflex is recognised to occur uncommonly in patients with chronic cough. In these patients, mechanical stimulation of the external auditory meatus can activate the auricular branch of the vagus nerve (Arnold’s nerve) and evoke reflex cough. This is an example of hypersensitivity of vagal afferent nerves, and there is now an increasing recognition that many cases of refractory or idiopathic cough may be due to a sensory neuropathy of the vagus nerve. We present two cases where the cause of refractory chronic cough was due to sensory neuropathy associated with ear-cough reflex hypersensitivity. In both cases, the cough as well as the Arnold’s nerve reflex hypersensitivity were successfully treated with gabapentin, a treatment that has previously been shown to be effective in the treatment of cough due to sensory laryngeal neuropathy (SLN).

Keywords: Gabapentin, Arnold’s ear-cough reflex, sensory vagal neuropathy, refractory chronic cough

Introduction

Cough may arise from anywhere in the distribution of the vagus nerve. Cough arising from the ear (Arnold ear-cough reflex) is rare with only 15 cases having been previously reported. It is considered a medical curiosity, but now takes on more significance due to increasing observations that refractory chronic cough may be re-evaluated as a form of sensory neuropathy of the vagus nerve. Cough initiated by mechanical stimulation of the ear involves the integration of both ongoing airway vagal afferent nerve input with additional afferent input arising from the ear. Sensory laryngeal neuropathy (SLN) (1) and post viral vagal neuropathy (PVVN) (2,3) can occur after viral infections and are associated with chronic cough. Similarly, injury to various branches of the vagus nerve have been described as potential causes of unexplained chronic cough. Patients with these conditions frequently describe symptoms that suggest sensitization of the cough reflex and a neuropathic response. Examples are an abnormal throat sensation, for example, “tickle”, representing laryngeal paresthesia, increased cough sensitivity in response to a known tussigen, for example, smoke (hypertussia), and cough that is triggered in response to a nontussive stimulus, for example, exposure to cold air (allotussia) (4). Twenty percent to 40% of chronic cough patients do not respond to usual medical treatment; this is referred to as a refractory chronic cough with the precise aetiology and mechanism remaining a challenge to the medical community. We present two cases of sensory neuropathic chronic cough due to ear-cough reflex hypersensitivity and its successful treatment with gabapentin. The cases and their treatment response further strengthen the concept that vagal neuropathy may be an important cause of refractory chronic cough.

Case report

Case 1

A 61-year-old female presented with non-specific chronic cough. The patient had cough duration of 30 months. She had normal spirometry and a negative response to previously trialled proton pump inhibitor and inhaled corticosteroid treatment. Associated symptoms included a scratchy, raw and very dry throat, voice changes, nocturnal cough and coughing bouts triggered by cleaning of the ears and teeth. A number of subjective and objective investigations were undertaken (). These included, cough severity by visual analogue scale (VAS), cough quality of life by Leicester Cough Questionnaire (LCQ), generic quality of life by the SF36 questionnaire, extrathoracic airway hyperresponsiveness (EAHR) (greatest fall in mid inspiratory flow during hypertonic saline challenge testing), fibre optic laryngoscopy to determine the presence of vocal cord dysfunction (VCD) and the Leicester cough monitor with external microphone to measure the frequency of the patient’s cough during ear stimulation. The patient had significantly impaired cough specific and generic quality of life, increased extrathoracic airway responsiveness, and there was evidence of VCD during fibre optic laryngoscopy, ie, paradoxical vocal fold movement with posterior chinking during inspiration ().

Table 1

Pre and post treatment results for patient 1 and patient 2 with gabapentin 1,800 mg/day for ≥1 month

We stimulated the external auditory meatus with a cotton bud and this triggered a hypersensitive cough reflex with 12 discrete cough events recorded after stimulation ().

Leicester cough monitor trace from case 1. Schematic shows induced cough event during stimulation of the external auditory meatus in case 1.

The patient was treated for sensory vagal neuropathy with gabapentin 1,800 mg/day for 1 month. The investigations were repeated and with treatment there was a significant improvement in cough severity (,
), cough quality of life (,
) and general quality of life for both the physical and mental domains (,
). Repeat stimulation of the external auditory meatus after successful gabapentin treatment () led to a marked reduction in cough frequency to four coughs ().

Cough severity pre vs. post gabapentin (1,800 mg/day) treatment. VAS, visual analogue scale.

Cough quality of life pre vs. post gabapentin (1,800 mg/day) treatment. LCQ, Leicester Cough Questionnaire.

Pre vs. post gabapentin treatment for SF36 generic quality of life questionnaire in patient 1. *, Pre vs. post treatment result significantly different for these domains.

Case 2

A 69-year-old male presented with non-specific chronic cough and gave a history of cough triggered by mechanical stimulation of the ear. Patient 2 reported cough duration of 96 months and had normal spirometry and a negative response to treatment trials with inhaled corticosteroids, oral corticosteroids and nasal steroid treatment. His associated symptoms included post nasal drip syndrome, heartburn, “tickle” in throat and voice changes. Cough triggers included cold air, dry foods such as breadcrumbs, positional manoeuvres (bending down and rising after sleep) and cleaning of the ears. There was evidence of EAHR during hypertonic saline challenge testing (). The patient was treated with gabapentin 1,800 mg/day for 3 months and the investigations repeated (). There was a significant improvement in cough severity, (,
) and cough quality of life (,
) when on gabapentin 1,800 mg/day.

Written consent was obtained from patients and the study was approved by The University of Newcastle, H-2008-0241 and the Hunter New England Human Research Ethics committees, 08/03/19/3.04.

This study is registered with the Australian New Zealand Clinical Trials Register, ACTRN12608000248369.

Discussion

We describe two cases where Arnold’s nerve ear-cough reflex was a manifestation of a vagal sensory neuropathy and this was identified as the cause of a refractory chronic cough that was successfully treated with gabapentin. In both cases, the cough was triggered by mechanical stimulation of the external auditory meatus and accompanied by other neuropathic features such as throat irritation (laryngeal paresthesia), and cough triggered upon exposure to nontussive triggers such as cold air and eating (termed allotussia). These features suggest a neuropathic origin to the cough (4). We therefore used gabapentin to treat the patients based on its known success in sensory neuropathic disorders (5,6) and recently chronic cough (7,8). These observations strengthen the emerging concept that vagal sensory neuropathy may underlie many cases of refractory or idiopathic chronic cough.

SLN (1) and PVVN (2,3) have been described as potential causes of chronic cough. SLN may occur after viral infections or after mechanical trauma to the vagus or superior laryngeal nerve (1,3,9). It is thought to result in a lowered threshold for sensory laryngeal nerve firing and is consequently perceived as throat irritation and often chronic cough. In 2005, a form of hereditary sensory neuropathy was observed to be associated with chronic cough in a case study of two families (10). Affected individuals had an adult onset of paroxysmal cough, gastroesophageal reflux disease and distal sensory loss. Cough could be triggered by noxious odours or by pressure in the external auditory canal (Arnold’s ear-cough reflex). Other features included throat clearing, hoarse voice, cough syncope and sensorineural hearing loss. This disorder clearly demonstrated how cough could be linked to denervation hypersensitivity of the upper airways and oesophagus. Similarly, PVVN is a condition that occurs following an upper respiratory illness, which represents injury to various branches of the vagus nerve. The pattern of symptoms and findings in this condition are consistent with the hypothesis that viral infection causes or triggers vagal dysfunction (9). These patients may also have airway hyperresponsiveness persisting beyond the acute upper respiratory tract infection that manifests as a decrease in cough threshold in response to irritating chemical or mechanical stimuli.

There is therefore a body of evidence that links chronic cough to a neuropathic disorder involving the vagus nerve. The cases reported here extend this data by objectively documenting the Arnold nerve cough reflex, and showing that a treatment approach based on a neuropathic disorder can effectively improve cough severity, cough frequency and quality of life. We also observed an association with VCD in the first case. Cough is not uncommon in VCD, and may be a manifestation of upper airway hypersensitivity (11). Further, EAHR was also evident in one of the two cases reported. This may be a physiological example of paradoxical vocal cord closure, and is a more prevalent syndrome than first thought, potentially affecting areas under vagal innervation. In a study by Cho et al. (12) cough sensitivity was found to be closely related with EAHR during capsaicin provocation in some CC subjects. It is therefore possible that EAHR may be one of the mechanisms developing some subtypes of CC. The presence of EAHR is confirmed in this case report by hypertonic saline challenge testing with a greater than 20% fall in mid-inspiratory airflow and/or the identification of associated VCD confirmed by fibre optic laryngoscopy which also presents with extrathoracic obstruction and chronic cough.

Conclusions

This case report highlights the need for thorough investigation into patients previously diagnosed with refractory chronic cough. Uncommon causes and novel therapeutic management should be considered. In this case series chronic cough was associated with sensory neuropathy and we have shown this by identifying and triggering cough by external auditory meatus stimulation. In both cases, the cough was successfully treated with gabapentin.

Acknowledgements

Nicole M Ryan was funded by an NHMRC CCRE in Respiratory & Sleep Medicine PhD scholarship and HMRI PhD Support Scholarship donated by the Greaves Family. Peter G Gibson is an NHMRC practitioner research fellow.

Disclosure: The authors declare no conflict of interest.

References

1. Lee B, Woo P.Chronic cough as a sign of laryngeal sensory neuropathy: diagnosis and treatment. Ann Otol Rhinol Laryngol 2005;114:253-7. [PubMed] [Google Scholar]2. Altman KW, Simpson CB, Amin MR, et al. Cough and paradoxical vocal fold motion. Otolaryngol Head Neck Surg 2002;127:501-11. [PubMed] [Google Scholar]3. Bastian RW, Vaidya AM, Delsupehe KG. Sensory neuropathic cough: a common and treatable cause of chronic cough. Otolaryngol Head Neck Surg 2006;135:17-21. [PubMed] [Google Scholar]4. Vertigan AE, Gibson PG. Chronic refractory cough as a sensory neuropathy: evidence from a reinterpretation of cough triggers. J Voice 2011;25:596-601. [PubMed] [Google Scholar]5. Backonja M, Glanzman RL. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials. Clin Ther 2003;25:81-104. [PubMed] [Google Scholar]6. Gilron I.Gabapentin and pregabalin for chronic neuropathic and early postsurgical pain: current evidence and future directions. Curr Opin Anaesthesiol 2007;20:456-72. [PubMed] [Google Scholar]7. Ryan NM, Birring SS, Gibson PG. Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial. Lancet 2012;380:1583-9. [PubMed] [Google Scholar]8. Van de Kerkhove C, Goeminne PC, Van Bleyenbergh P, et al. A cohort description and analysis of the effect of gabapentin on idiopathic cough. Cough 2012;8:9. [PMC free article] [PubMed] [Google Scholar]9. Amin MR, Koufman JA. Vagal neuropathy after upper respiratory infection: a viral etiology? Am J Otolaryngol 2001;22:251-6. [PubMed] [Google Scholar]10. Spring PJ, Kok C, Nicholson GA, et al. Autosomal dominant hereditary sensory neuropathy with chronic cough and gastro-oesophageal reflux: clinical features in two families linked to chromosome 3p22-p24. Brain 2005;128:2797-810. [PubMed] [Google Scholar]11. Ryan NM, Gibson PG. Characterization of laryngeal dysfunction in chronic persistent cough. Laryngoscope 2009;119:640-5. [PubMed] [Google Scholar]12. Cho YS, Lee CK, Yoo B, et al. Cough sensitivity and extrathoracic airway responsiveness to inhaled capsaicin in chronic cough patients. J Korean Med Sci 2002;17:616-20. [PMC free article] [PubMed] [Google Scholar]90,000 Colds. The author of the article: pediatrician Olga Anatolyevna Sidinkova.

03 December 2019

Family Health Magazine

Very often, when we have
runny nose or sore throat, fever rises, we diagnose ourselves: flu!
But don’t jump to conclusions.There are others
viral infections that are similar in symptoms to the flu.
Autumn and early spring are seasons of high humidity and a sharp increase in the number of colds. But really
you can not put a barrier this far
harmless ailments? Only an integrated approach will help to maintain health.
to the prevention of colds.
Earlier, colds were combined into the group of “acute respiratory diseases (ARI)”, now medical scientists
believe that the more correct name “sharp
respiratory viral infections ”
(ARVI).There are adenoviruses, parainfluenza,
respiratory syncytial viruses. All of them
differ in their structure and biological properties, and diseases have
symptoms characteristic of each of the ARVIs.
Typical symptoms of a cold are general weakness, malaise, chest pain
cage, dry cough, or cough with phlegm, increased body temperature. Like this
you can describe the symptoms of each of the colds, including such a terrible viral infection as the flu:

• if you have severe headaches,
  “Aches” joints and muscles throughout the body
  weakness spreads, and the nerves seem to be bare, the temperature is about 39 ° C, in the throat
  itching, the nose is stuffy, but there is no runny nose as such, which means you have the flu;
• if the nose is running, but the state of health is quite bearable and the temperature is not higher than 37 ° C
  – You have contracted a rhinovirus infection,
  or in other words, you have a common cold;
• if the voice is hoarse and constantly bothers
  “Barking cough” means you are sick
  laryngitis – inflammation of the larynx.And the parainfluenza virus brought it with him;
• if in the process of the first signs of illness it became difficult for you
  breathe, first a dry, painful, and then with phlegm cough and
  the temperature does not want to decrease in any way
  – it means that you have bronchitis, which may have become a consequence of the flu;
• if, on the 2nd or 3rd day, a feeling of cramps increased to chills, cough and runny nose
  in one or both eyes, tonsils
  and the throat is grayish or white
  film, and the lymph nodes have noticeably increased, you should know: you have become a victim of an adenovirus infection, or, simply put,
  sore throats.

One of the urgent problems in pediatrics is the treatment of colds.

PREVENTION AND TREATMENT
COLD DISEASES IN CHILDREN.

Vaccination is a promising area of ​​modern prevention of colds, as well as
use of special tools for
rinsing the nasal cavity. The action of this
method is aimed at cleansing and moisturizing the nasal mucosa, normalizing
protective function of the ciliated epithelium,
preventing the formation of crusts, facilitating nasal breathing.As before, prevention is subdivided into specific and non-specific. Both have great
importance, since they reduce not only the incidence of respiratory infections, but also the number of bacterial complications.
Components of nonspecific prophylaxis: mucosal therapy
upper respiratory tract using
saline solutions, antiviral drugs, immunomodulators, inducers
interferons with antiviral activity, homeopathic medicines with proven efficacy, herbal medicines and vitamins (anaferon,
strepsils, nurofen, etc.).
Prevention of colds
aims to strengthen the respiratory system and normalize the function of the external
breathing. Prevention of colds improves tissue elasticity
lungs, normalizes gas exchange between blood and air, increases bronchial
conductivity. And also the prevention of colds has a general strengthening effect on the entire body and stimulates immune processes.
Prevention of colds
– this is a whole complex of measures, which, only with regular and systematic use, can eliminate frequent morbidity.First of all, it is,
hardening, of course. And also, these are activities
on exercise equipment (exercise bike, treadmill), walking, running, swimming and special physiotherapy exercises.
Separately, it should be said about physiotherapy exercises. Physiotherapy exercises as prevention of colds has
very great value.
Vulnerable “risk group” is
a group of frequently ill children. Frequently ill children endure during the year from 6 to
12 episodes of respiratory morbidity, which causes the development of secondary immunological insufficiency, the formation of chronic pathology
bronchopulmonary system and ENT organs,
allergopathology, etc.Often sick children are prescribed
analysis of the immune status. Based on the analyzes received, drugs are prescribed. One of the main goals is to reduce the number of people with frequent illnesses.
children. In the treatment of such children, drugs are used that are capable of sanitizing the nasopharynx and upper respiratory
paths. The most important condition for the speedy
recovery are the care and attention from the parents, the psychological climate in the family, living conditions
and food.
In the treatment of colds
Nowadays, nebulizers are actively used, which are special
metered-dose aerosol inhalers,
which are very easy to use.If the child has an inflamed mucous membrane and there is swelling in the nose, then in the first days
antihistamines are prescribed.
For colds, it is necessary
plentiful sweet and sour drink. Exist
special procedures to warm up
baby’s hands, feet with the help of special baby creams, or inhalation procedures based on extracts of medicinal plants. But if the child has
allergic diseases are necessary
already other drugs. The old forgotten method should not be neglected either.
may be effective – mustard plasters in sunflower oil.WHAT MISTAKES CAN BE COMMITTED BY
Trying to get rid of
A CHILD’S NOSE STOPPED?
One of the main mistakes is untimely access to a doctor and treatment.
runny nose by their own methods, which is fraught with complications. To the health of the child
should be treated with all the attention and care and consult a specialist doctor.

COMPLICATIONS IN COLD
DISEASES.

Leading position among complications
are occupied by acute viral and bacterial
pneumonia.The second most frequent place is occupied by complications from ENT organs
(sinusitis, otitis media, frontal sinusitis, sinusitis). Most often, exacerbation of the existing chronic pathology of the upper respiratory
pathways and lungs (chronic sinusitis,
tone zillitis, chronic bronchitis, bronchial asthma) develop against the background of ARVI,
as well as exacerbations of herpes-viral chronic persistent in the body
infections. Very often there is a complication on
ear is otitis media. Distinguish between acute medium,
chronic purulent, exudative medium, adhesive otitis media.With sinusitis in children, nasal congestion, pain in the forehead, weakness,
lethargy and high fever. To reduce edema and swelling of the mucous membrane, vasoconstrictor is instilled into the nose.
funds either use antibiotic therapy. Nasal lavage and physiotherapy techniques are recommended
treatment. With an inflammatory process in
maxillary sinuses require hospitalization of the child.

Thus, comprehensive prophylaxis in childhood and timely treatment are needed to avoid complications in the future.

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90,000 Otitis media in a child – symptoms and treatment of otitis media 2019.

Otitis media is the medical name for otitis media caused by infection.The disease is most common in young children, this is due to the peculiarity of the structure of the ENT organs in babies (a shorter and wider ear canal than in older children or adults). Acute otitis media is an infection that usually develops from a buildup of fluid in the middle ear.Otitis media can be caused by viruses or bacteria. Most children with otitis media first develop acute respiratory viral infections or acute respiratory infections, which then turn into otitis media, causing inflammation and swelling in the nasal passages and the Eustachian tube. The risk of recurrent middle ear infections is increased in children who:

• Attend nursery or kindergarten
• Domestic exposure to cigarette or stove smoke
• Have enlarged adenoids that can obstruct drainage of the Eustachian tube

Symptoms of acute otitis media usually include ear pain and fever.Otitis media with effusion (discharge of fluid or pus), also known as cohesive otitis media, occurs when there is fluid in the middle ear after the infection has cleared. This condition usually does not cause pain, but it can cause hearing loss in a child.

Children with acute otitis media generally recover quickly with anti-inflammatory drugs and proper care. Sometimes, antibiotics may be prescribed to the child if the doctor is certain that the disease is caused by bacteria. Children who develop adhesive otitis media and other complications may need additional physiotherapy treatments.

Symptoms of otitis media in children

Most children with acute otitis media will complain of ear pain. If the child is still small and does not know how to speak, otitis media may be evidenced by a long aching cry, the child’s refusal to breastfeed. Other symptoms may include:

• Irritability, capriciousness
• “forced” position (if there is pain on one side, the child can put his hand to his ear or try to lie on the sore ear)
• Lethargy, weakness
• sleep disorders
• fever
• decreased or lack of appetite
• vomiting

Since many cases of otitis media are caused by a viral infection, other symptoms associated with the infection, such as a runny nose, watery eyes, or cough, are often present.

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Diagnosis of otitis media

If your child has ear pain for more than 2 days, or if your child is less than 2 years old and you suspect that he has ear pain, you should urgently seek help from an otolaryngologist, pediatrician or general practitioner.Delay can threaten that the child will lose hearing or become completely deaf.

Your doctor will use an instrument called an otoscope to examine your child’s ears and eardrums. In acute otitis media, the eardrum will be inflamed and bulging due to accumulation of fluid in the middle ear. The doctor will take the temperature and examine the child for other infections (such as bronchitis). There are no specific tests for diagnosing otitis media. One of the effective diagnostic methods is ENT endoscopy using a flexible ENT endoscope, which is successfully carried out in our medical center by experienced ENT doctors.Such a diagnosis is absolutely painless and can be performed according to the doctor’s indications in the smallest children, from the age of 9 months.

Otitis media

Your child’s treatment will depend on their age and health.

It is generally assumed that children over 6 months of age who have mild otitis media receive only anti-inflammatory drugs at first. If symptoms persist for more than 48 hours or if they worsen, broad-spectrum antibiotics may be needed.Children with acute otitis media younger than 6 months are usually given antibiotics right away.because it is extremely important in any way to prevent complications of the disease. The first antibiotic of choice for the treatment of acute otitis media in children is amoxicillin. An alternative antibiotic will be given if the child is allergic to penicillin. Antihistamines and corticosteroids have not been shown to be beneficial in the treatment of acute otitis media.

Possible complications

Perforation (rupture) of the tympanic membrane is a common complication of acute otitis media in children.This can lead to leakage of fluid from the ear, while fluid or pus begins to flow out of the middle ear cavity, which relieves the child’s condition: pain in the ear decreases due to the decrease in pressure on the eardrum. By itself, a rupture of the tympanic membrane does not lead to deafness; in the process of treating otitis media, the integrity of the membrane is quickly restored. Treatment is the same as for acute otitis media. A child should not be immersed in water or in a pool until the eardrum has healed.

Otitis media sometimes develops after an acute ear infection. This means there is fluid in the middle ear (otitis media with effusion), which can cause temporary hearing loss. Most children with this complication recover within 3 months without the need for special treatment. If the condition is chronic, tympanostomy treatment may be necessary – a small drainage tube is inserted into the eardrum to drain fluid and allow air to enter the middle ear to restore hearing.

Chronic suppurative otitis media is a middle ear infection with a perforated eardrum and fluid from the ear that lasts for at least 6 weeks. In this case, the ear canal must be sanitized several times a day, and an antibiotic (for example, the drug “Otipax”) must be dripped into the ear. It may also be necessary to take antibiotics by mouth.

Acute mastoiditis is an infectious inflammation of the bone behind the ear (the mastoid bone of the temporal bone) that is treated with antibiotic therapy.

A timely visit to a pediatric ENT doctor will allow you to quickly determine the presence of otitis media in a child and begin treatment. Otoscopy and ENT endoscopy are excellent methods for accurately diagnosing this disease.

Read also:

Why does the child’s ears hurt?

90,000 Why does ears clog with a cold

Let’s see why the ears “stick” in case of a cold?

One of the most common symptoms of a cold is a runny nose (rhinitis), which gives the patient a lot of unpleasant sensations: the sense of smell disappears, the appetite disappears, and breathing becomes difficult during sleep.In addition to discomfort, inflammation of the nasal mucosa can also lead to hearing loss, congestion, “squelching” or “clicking” in the ears.

The fact is that the auditory tube anatomically connects the nasopharynx and the tympanic cavity. During swallowing, air through the auditory tube enters the tympanic cavity, thus maintaining a constant pressure in the latter.

During a runny nose, not only the nasal cavity swells, but the lumen of the auditory tube also narrows or even closes.All this contributes to a decrease in pressure in the tympanic cavity, the eardrum retracts and loses its mobility, as a result of which hearing deteriorates.

What to do if your ears are blocked

If ear congestion is present for more than a day, medical attention is required. To assess the patient’s condition, the doctor conducts the necessary research.

Often, after examining the patient, the specialist resorts to an additional research method – acoustic impedance (tympanometry), which allows you to clarify the pathology of the auditory tube and exclude the onset of inflammation in the middle ear.

Ear congestion that occurs during a cold is a problem that requires timely diagnosis and treatment. Timely prescribed therapy helps prevent the development of many unpleasant complications from the middle ear.

Do not postpone treatment, make an appointment with an experienced otorhinolaryngologist by calling the unified contact center +7 (495) 775 75 66, use the online appointment service or contact the clinic’s registry.

Information for you has been prepared by:

Anna Anatolyevna Kotenkova – otorhinolaryngologist. Leads a reception in the building of the clinic on Usacheva.

90 029 90 000 Questions from the category Otorhinolaryngology (ENT) on the website of the Preobrazhenskaya clinic

90,000 How to recognize a mild form of coronavirus – Search

03/19/2020

Everyone is afraid of the coronavirus, but most of those infected – more than 80 percent – carry the disease easily.Knowing the symptoms is very important, however, as you can become a carrier. Moreover, asymptomaticity is the main reason for the rapid spread of the virus, scientists say. So the main question for today is how to recognize the disease?

So, the symptoms of coronavirus are as follows – fever, cough (usually dry or with a small amount of sputum), shortness of breath, a feeling of tightness in the chest. Sometimes there may be signs of an acute sinus infection or a general feeling of illness without fever.With a mild form of the disease, the symptoms disappear after a week or two; in severe cases, they may persist for six or more weeks. There are also unusual signs, doctors say. For example, about two-thirds of the patients reported impairment of smell and taste. Diarrhea was noted in 30 percent of cases, RIA Novosti writes.

In a mild form, COVID-19 manifests itself with a slight fever, a headache may be a little, a person gets tired quickly, feels sore throat, coughing, muscle aches, mild symptoms of a cold, pallor, chills.There may be a runny nose.

Advice on how not to confuse COVID-19 with acute respiratory viral infections or colds: with acute respiratory viral infections and colds, unlike COVID-19, the cough is wet, not dry, and there is always nasal congestion and a runny nose. Similar symptoms include a slight fever and mild to moderate headache.

How not to confuse COVID-19 with influenza: COVID-19 and influenza have similar parameters: “both cause respiratory illness with a wide range of variations – from asymptomatic or mild to severe illness and death”.But with the flu, there is no shortness of breath or other breathing problems, and the temperature is almost always high, unlike COVID-19.

The recommendations of the Ministry of Health for medical workers indicate: any clinical manifestations of ARVI, bronchitis or pneumonia in combination with an epidemiological history are considered suspicious symptoms. They can be caused by:

– visiting 14 days before the first signs of infection in epidemiologically unfavorable countries and regions for COVID-19;

– close contacts in the last 14 days with persons who have fallen ill with COVID-19, or those who have laboratory confirmed this diagnosis;

– close contacts over the past 14 days with persons under observation in connection with the novel SARS-CoV-2 coronavirus.

In any of these cases, if even mild symptoms of a cold appear, the infection should be called a doctor at home and not self-medicate.

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Andrey Gorbachev

How to quickly get rid of a sore throat?

Many of us associate winter with an increased likelihood of collapsing with a cold. We can pick it up at work, in transport, or receive this gift from a child at home. Often one of the first symptoms of a cold, along with general malaise and fever, is a sore throat and sore throat.However, few people, given the intense pace of modern life, can afford to fall out of the cage for a long time. Therefore, efficiency and speed of action, together with a favorable safety profile, are at the forefront when choosing a rational therapy for sore throat. Next, we will talk about what to do and what is best not to do when your throat hurts.

Why does your throat hurt?

First of all, it is necessary to pay attention to the fact that a sore throat can be caused not only by viruses – causative agents of the common cold, but also by other factors.Among the most common, one can distinguish not only infectious agents familiar to a common man in the street, such as viruses, but also factors of a non-infectious nature: inhalation of vapors of irritating substances, dry air (air conditioning in the summer, central heating in winter), overstrain of the vocal cords (lecturers , teachers, trainers, etc.) and so on.

Nevertheless, despite the variety of causes of sore throat, they all cause inflammation of the pharyngeal mucosa – pharyngitis, most often with a superficial flow (catarrhal).Moreover, the most common reason for the development of pharyngitis is acute respiratory viral infections. So, acute pharyngitis in 90% of cases is caused by various viruses, including rino, coronaviruses, respiratory syncytial virus, adenovirus, influenza and parainfluenza viruses (Subbotina M.V., 2010; Zaitseva O.V., 2011). Its main symptoms are sore throat, sore throat and dry cough that does not bring relief, and fever.

It should be noted that acute pharyngitis in 90% of patients disappears within a week, regardless of the use of drugs, including antibiotics.The use of antibiotics for viral infections is ineffective, since they show their activity exclusively against microorganisms. At the same time, despite the fact that in most cases the cause of sore throat is a viral infection, inappropriate use of antibiotics by patients as a result of self-medication remains widespread. At the same time, antibacterial drugs are characterized by a wide range of side effects, and taking them unnecessarily increases the likelihood of developing antibiotic resistance, and when antibiotics are really needed, they may simply not have the expected effect.Therefore, the use of antibiotics should be approached extremely responsibly. In addition, according to research results, their irrational intake increases the likelihood of repeated visits to a medical institution for pharyngitis (Turovsky A.B., Khamzalieva R.B., 2006). At the same time, it is necessary to note the important role in the process of choosing and recommending a drug for the symptomatic treatment of sore throat, which belongs to the pharmacist, because it is he who is often asked for advice.

Memo for pharmacist

Sore throat is one of the most frequent reasons people go to pharmacies to purchase drugs that have a quick symptomatic effect.It is important to remember that when advising a patient about the choice of symptomatic treatment for a sore throat, it is imperative to find out if he has threatening symptoms that allow him to suspect a serious illness and require a visit to a doctor.

These are:

• Difficulty breathing, inability to pronounce a few words between breaths;
• inability to swallow saliva;
• a sharp increase in the palatine tonsils, plaque or ulceration on the tonsils;
• bright (glowing) redness of the throat;
• enlargement and soreness of the lymph nodes when palpating;
• body temperature above 38.5 ° C;
• sore throat with skin rash;
• sore throat accompanied by severe headache, ear pain, abdominal pain;
• sore throat accompanied by discoloration of urine.

Effective solution for sore throat

In the absence of the above symptoms, the pharmacist may recommend medicines indicated for symptomatic treatment, including topical preparations. It should be borne in mind that sore throat in acute pharyngitis is caused by the development of an inflammatory process, which also results in edema and difficulty in swallowing. Therefore, it is logical that in the treatment of acute pharyngitis, like any other inflammation, the use of non-steroidal anti-inflammatory drugs (NSAIDs), which have pronounced anti-inflammatory and analgesic properties, will be relevant.One of them is Strepsils Intensive (Reckitt Benckiser International, UK). The active ingredient of this drug is flurbiprofen. It should be emphasized that Strepsils Intensive products are the only topical preparations on the Ukrainian pharmaceutical market that contain flurbiprofen.

Flurbiprofen (fluorinated ibuprofen derivative) is one of the fast-acting NSAIDs that has anti-inflammatory and analgesic effects.Its efficacy and safety profile have been proven in numerous studies and over 30 years of successful use. The feasibility of taking flurbiprofen for sore throat is based on the fact that, unlike systemic NSAIDs, it acts only in the inflammation focus (Fang J.Y. et al., 2003). Thus, flurbiprofen is more suitable than other NSAIDs for topical administration in inflammation. When taken correctly, the therapeutic effect occurs quickly and lasts a long time, without systemic manifestations (absorption into the blood is insignificant), therefore it can be recommended even for those patients who are trying to limit the use of systemic NSAIDs (A.A., Karpov O.I., 2003).

Since the rate of onset of action of the drug and, accordingly, the onset of relief from sore throat is one of the important criteria for its effectiveness, as well as a key indicator when choosing a treatment, a number of studies of the effectiveness of its use have been carried out with respect to flurbiprofen (Strepsils Intensive). Their results prove that taking flurbiprofen contributes to a significant decrease in the severity of pain sensations already 2 minutes after application, and also that its effect can last more than 4 hours (Benrimoj S.I. et al., 2001, Schachtel B. et al., 2012).

The results of double-blind, placebo-controlled studies have demonstrated high efficacy and good tolerance of flurbiprofen (Watson N. et al., 2000; Benrimoj S.I. et al., 2001). Thus, its tolerability did not differ significantly from that in the placebo group (Benrimoj S.I. et al., 2001).

Another argument in favor of flurbiprofen is the possibility of its recommendation with the treatment already prescribed by the doctor as symptomatic therapy to increase the effectiveness of complex treatment.The effect of taking a combination of flurbiprofen with other drugs and different dosage regimens have also been studied. As a result, the effectiveness of multiple doses of the drug (8.75 mg each) was confirmed when used both as monotherapy and in combination with antibacterial drugs (Blagden M et al., 2002). When taking the drug, there was a significant reduction in the severity of difficulty in swallowing and a significant decrease in the sensation of pain in the oropharynx.

Thus, for complaints of severe sore throat, difficulty swallowing due to edema, the pharmacist can recommend flurbiprofen (Strepsils Intensive) as an effective drug from the arsenal of OTC drugs for symptomatic therapy, which is characterized by a rapid onset of action, high efficiency and a favorable profile. safety, which is confirmed by the results of numerous studies.

Press service of “Weekly APTEKA”

Information for you:

Sore throat | symptoms | treatment

Consultations of specialist doctors: (812) 200-48-48

What to do if your throat hurts? We will give advice that will definitely help, but temporarily, before visiting a doctor.
And we must not miss the symptoms in which the doctor needs to appear urgently!
A sore throat is something that each of us encounters from time to time.However, the fact that we have a sore throat quite often does not mean that it can be endured this time too.
Occasionally painful sensations can indicate a serious health threat. Don’t miss this moment! You can die. If you are vaccinated against all infectious diseases, the risk of dying is greatly reduced.

Sore throat – symptoms

If you have a sore throat and the following symptoms appear along with these pains, contact your doctor or ENT specialist as soon as possible:
• Difficulty breathing.
• Difficulty opening your mouth.
• In addition to the throat, the ears, eyes, tongue and so on hurt.
• Blood in saliva.
• Swelling (enlargement) of the submandibular or cervical lymphatic glands.
• A lump in the throat that makes it difficult to swallow.
• Rash (rash) in the mouth or on the skin.
• High temperature.
• Hoarseness if it does not go away for a long time.
By the way, the ENT doctor is taking 24/7 at our trauma center on the emb. Black River, 41/2B. This is the only place in our city where you can get emergency outpatient ENT care for adults and children at any time.
If these symptoms are not present, then a visit to a doctor with a sore throat is still desirable in any case.

Sore throat – how to treat

What to do right now if your throat is sore:
1. Rinse with salt water.
Grandma’s method, but it may work a little, especially at the very beginning of the disease.
Saline solution reduces microbial activity, reduces inflammation and accelerates wound healing, which together leads to pain relief. 1 teaspoon of salt in a glass of warm water.You can also make a soda-salt solution: ¹⁄₄ teaspoon of baking soda and ⅛ teaspoon of salt in a glass of warm water.
2. Drink chicken stock if you have chicken at home.
Do not let your throat dry out. Chicken broth copes with this task best of all: it has not only a moisturizing, but also a slight anti-inflammatory effect. And heat can reduce discomfort if it is caused by colds.
If broth, i.e. there is no chicken at hand, warm (not hot!) tea will do.Adding honey is a good idea. Honey also has a mild anti-inflammatory and softening effect on the pharynx, including helping to eliminate tickling and coughing.
Chamomile tea and other herbal teas have also worked well for sore throats.
3. Monitor the humidity in the room
Dry air is an unnecessary irritant for the nasopharynx. The optimum level of humidity in the apartment is 40-60%. And it’s easy to achieve.
4. Eat something cold.
For example, ice cream. Or drink a little cold milk.Cold constricts blood vessels, thereby reducing swelling, slowing down the development of the inflammatory process and reducing pain.
5. Dissolve cold lollipop or caramel, preferably without sugar.
This will increase salivation, which means that the mucous membrane will be moistened. Special pharmacy lozenges for sore throat contain additives – softening the throat or distracting from unpleasant sensations.
6. Use sprays and tablets.
Sprays and lozenges often contain local anesthetics (not antibiotics, local antibiotics are not effective) that relieve pain: benzocaine, tetracaine, lidocaine … The use of such drugs is indicated, for example, for angina, when the sore throat is severe and sharp.
These drugs have contraindications, so check with your doctor first.
It is advisable to apply all these “grandmothers” and “grandfathers” methods described by me on the first day of illness and when a visit to a doctor is not possible at a given time. It is impossible to treat this, but it is imperative to go to the doctor.

Causes of sore throat

Why does the throat hurt?
Most often, sore throat is caused by viral diseases. This is how ARVI, flu, tonsillitis and more manifest themselves.However, the reason may be different, for example bacterial. Often, sore throat is a symptom of group A streptococcus infection: they are very contagious and, if inadequately treated, can lead to a number of complications: from middle ear infections to kidney inflammation and toxic shock syndrome.
Also sore throat can be caused by other, often non-obvious reasons:
• Allergies (to pollen, dust, mold, pet dander).
• A specific reaction to excessively dry indoor air.
• A variety of irritants, from tobacco smoke to chemicals found in detergents, wall paint, furniture, and more.
• Experienced muscle tension. If, for example, you screamed a lot at the new stadium in St. Petersburg, rooting for Zenit.
• Disorders of the digestive system. For example, gastroesophageal reflux disease (GERD), in which stomach contents, including hydrochloric acid, enter the esophagus and pharynx.
• HIV infection.
• A developing tumor.

Given the abundance of possible reasons, it is still better to entrust the diagnosis to a therapist or ENT doctor. The doctor will be able to correctly decipher what exactly caused the sore throat, if necessary, prescribe additional studies and recommend effective therapy.

Vanin D.N.

ENT trauma center CORIS
for adults and children – around the clock:
nab.