The smell fibers are one of the most primitive sensory fibers in terms of development. The smell organ is a series of small nerves that come from the brain and end in the roof of the nasal cavity. Most commonly, the sense of smell can be lost if air cannot get to the smell fibers- such as with nasal congestion from a cold, sinus infection or allergies. In these cases, once the nasal passages are clear, the sense of smell usually returns. Treatment is directed at the cause of the obstruction. There can be, however, damage to these nerve fibers. This occurs in general slowly as we age, but can come suddenly after trauma or infection as well. Treatment aimed at these causes is often less successful.

While taste fibers are separate from the sense of smell, the sense of smell has an important role in our appreciation of taste. They are usually not really damaged together.

It is not unusual for a person to develop a sinus infection after a dental infection, a failed upper root canal or after an extraction. The maxillary (cheek) sinus is quite close to these teeth- and often the tooth roots extend directly into the sinus. A dental infection in this area often can lead to a sinus infection that could interfere with the sense of smell. Resolution of the infection would be expected to bring about restoration of the sense of smell. In any case, I would ask that your husband be evaluated by an ear nose and throat doctor to find the cause and treatment for his particular case. We would be happy to see him here at the NY Sinus Center for this.

It is not uncommon to get small sores, or pimples in the nose.  Anything that irritates the delicate mucous membranes at the front of the nose can cause these.  They  can occur from work exposure, dust or dirt exposure, or certainly by using one’s finger in the nose.  Often, the roots of the hair fibers in the front of the nose, “vibrissa” can get irritated and cause a small abscess of the hair follicle “folliculitis”.   That can be dangerous as infections may rapidly spread from this area.

When you get such a sore, I would suggest using a topical antibiotic ointment on a finger tip (not q tip) just at the very entrance to the nose.  If this fails to improve, you may need to see your doctor for oral antibiotics.

When you know you will be exposed to environmental irritants, such as dirt, dust, wood, metal, or other particles, it helps to wear a mask and rinse your nose after exposure with a hypertonic saline rinse, such as SaltAire or NeilMed.

Robert Pincus MD

NY Sinus Center

There are different problems that can cause these symptoms.  We can have noises such as you describe from having something as simple as wax in the ear canal.  Wax can cause symptoms by blocking the ability of sound to get through and making your own internal sounds  louder.  It can allow water to get into the ear canal and then not get out.

Another problem may be fluid behind the ear drum- or otitis media.  We make fluid in the little space behind the ear drum, which then drains through the eustachian tube to the back of the nose-  The tube should open every time we yawn or swallow.  If that tube gets blocked, the middle ear cannot drain, and then the space typically fills with fluid.  It makes us feel like we are hearing under water, and often creates a bubbling and crackling sound as the tube struggles to open.

Hearing losses from actual damage to the inner ear can cause us to hear noises and buzzing- and finally, a problem with the jaw joint may cause one to hear crackling noises opening the jaw and/or chewing.  This can often affect both ears as cause head ache as well.

So, finally, to this one there is no simple answer- other than have your doctor take a look and tell you- It’s not hard to figure out which is causing your problem with a simple exam.

R Pincus MD

Thanks for your recent question.  I have recently answered a similar question from a 21 year old man and have taken the liberty of using much of the answer I wrote to him.  Obviously, this is not a rare problem, and can be quite disconcerting to those affected.  Fortunately, most can be helped with a simple outpatient surgical procedure, called  a thyroplasty.  There should be people in your area who can do this surgery- or you can certainly contact us at the NY Voice Center of the NY Otolaryngology Group.

Thank you for your question.  As we age our voices change.  There is a specific change in a male teenager’s voice as the cartilage of the larynx (voice box) gets thicker around puberty.  However, sometimes this does not occur as one would like, leaving the voice with a high pitch.  A high pitched voice can be quite a social problem for a young man- just as a low pitched voice can be an issue for a woman in our society.

A high pitched voice is not usually caused by a lump in the throat or a post nasal drip.   The problem can be from using one’s voice incorrectly- such as in a falsetto- which should respond to voice therapy.  Vocal cord paralysis or vocal cord nodules or polyps can result in a high pitched voice which is also usually breathy.  Comprehensive evaluation of these areas by an ear nose and throat physician should readily determine the cause.

However, often a high pitched voice is due to the vocal cords being stretched too tightly by the failure to develop a thickening of the voice box with puberty.  If one pictures a string instrument, we  raise the pitch by tightening the string and lower it by loosening the string.  Groundbreaking work was done by Professor Ishiiki from Japan probably 25 years ago and I had the opportunity to participate in his first teaching course in this country.  He developed the idea of “laryngeal framework surgery”.  Basically, for a high pitched voice- without other cause- we surgically remove a thin strip of cartilage from the voice box, as an outpatient procedure under local anesthesia.  This allows the vocal cord to relax and lowers the pitch of the voice.  Its results are immediate and gratifying.

Robert L. Pincus MD

Thank you for the question and I hope your son is feeling better.

Unfortunately, all of the symptoms you describe can be caused by trauma to the ear and side of the head.

It is not uncommon for a blow to the ear to cause damage to the structures of the ear.  One can suffer a ruptured ear drum from the direct air pressure against the ear- and hearing loss from that.  A blow to the side of the head can cause a concussive injury to the head and damage to the inner ear .  Either may result in ringing in the ears, with or without problems with balance.

Finally, one can suffer fractures to the temporal bone (bone behind the ear) and/or to the mandible or jaw bone.  A small fracture to the mandible can cause headaches, jaw pain and pain behind the ear.  I would suggest that your son be seen by an Otolaryngologist (ENT doctor), have his hearing checked and have xrays or CT done, if this has not been done already.  He may need to see an oral surgeon, depending on the findings.  I would not suggest that his problems are psychological until he has been well evaluated.  It would seem unlikely for someone to have all of these symptoms purely on a pscyhological basis.

Robert L. Pincus MD

Associate Professor Otolaryngology

NY Otolaryngology Group

Hi,
I am a 21-year old male Bangladeshi. I’ve had a problem with the pitch of my voice for at least the past 10 years, and I am quite desperate to get rid of the problem. My voice is quite high-pitched and my voice cracks whenever I try to speak louder. It’s like almost no sound comes out, a few squeaky syllables get out…
My doctor told me it is from a post-nasal drip, but I don’t know the specific details. I feel that the problem gets amplified whenever I’m outside, so it might be dust-induced since our country’s air is quite unclear.
I study in a business school, so I’m having a lot of trouble with this problem. I also get teased a lot for the girlish voice. My parents are against a certain surgery to remove the lump, they consider it impractical.
Please advise me how may I improve my voice on my own. If you need any further information, please ask me. I await your reply.

-Ishtiaq

Thank you for your question.  As we age our voices change.  There is a specific change in a male teenager’s voice as the cartilage of the larynx (voice box) gets thicker around puberty.  However, sometimes this does not occur as one would like, leaving the voice with a high pitch.  A high pitched voice can be quite a social problem for a young man- just as a low pitched voice can be an issue for a woman in our society.

A high pitched voice is not usually caused by a lump in the throat or a post nasal drip.   The problem can be from using one’s voice incorrectly- such as in a falsetto- which should respond to voice therapy.  Vocal cord paralysis or vocal cord nodules or polyps can result in a high pitched voice which is also usually breathy.  Comprehensive evaluation of these areas by an ear nose and throat physician should readily determine the cause.

However, often a high pitched voice is due to the vocal cords being stretched too tightly by the failure to develop a thickening of the voice box with puberty.  If one pictures a string instrument, we  raise the pitch by tightening the string and lower it by loosening the string.  Groundbreaking work was done by Professor Ishiiki from Japan probably 25 years ago and I had the opportunity to participate in his first teaching course in this country.  He developed the idea of “laryngeal framework surgery”.  Basically, for a high pitched voice- without other cause- we surgically remove a thin strip of cartilage from the voice box, as an outpatient procedure under local anesthesia.  This allows the vocal cord to relax and lowers the pitch of the voice.  Its results are immediate and gratifying.

Unfortunately, trying to raise the pitch by tightening the vocal cords has been less successful.

I am not sure who in your area does this type of work, but I would check with the local ENT societies.

Robert L. Pincus MD

Associate Professor Otolaryngology

New York Sinus Center

Thanks for the question.  Much has changed with the easy use and availability  of endoscopes- small lighted telescopes- in medicine.  As a sinus doctor, we use an endoscope frequently as part of our examination.  It allows us to painlessly see areas of the nose and sinus drainage passages that we could only guess at without them.

In looking through the telescope, we look at both nasal passages.   We examine the septum, to see if it is straight or twisted (deviated) and whether this is blocking a patient’s breathing or blocking sinus drainage.   We look at the turbinates, which are thin bones covered with membranes.  They add surface area to the nose and improves it’s role as nature’s filter and humidifier of the air we breath.

We then look at the area where the sinuses drain.   The most important area for this is called the “middle meatus”.  Through this space the maxillary (cheek), ethmoid (between the eyes) and the frontal (forehead) sinuses all drain.  The sphenoid sinuses (behind the eyes) drain further back.  We can see whether this area is draining pus and/or is obstructed by swelling, a deviated septum or growths, such as polyps.  When we see pus in this area, we can readily make a diagnosis of sinusitis. We typically would culture the drainage to see which bacteria may be causing the infection and which antibiotic would be most effective in treatment, if any.

However, the sinus openings are too small to enter with our current nasal endocscopes in most cases, unless one has had previous surgery.   Therefore, there ARE areas that are not well seen by nasal endoscopy-  most typically the frontal sinuses. An infection, as you suggest, could easily persist in an area we cannot see.   If, as sinus specialists, we continue to be concerned about a patient’s symptoms, we would suggest imaging (by CT scan without contrast) to view any such areas.  The combination of nasal endoscopy and CT imaging would get the answer for us.

I hope this helps-

Robert Pincus MD

Associate Professor Otolaryngology

NY Sinus Center

I have allergies as well as acid reflux.  I find during night nose stuffs up and a large amount of mucus collects in the throat effecting the quality of my sleep and I am coughing up clear mucus.

Answer

First of all, thank you for your question.  Waking up at night with large amounts of mucous in the throat can be quite uncomfortable, as you know.   There are several possible causes for this, and you highlight two of them. 

The nasal cavities and sinuses make mucous, which helps trap potentially harmful particles in the nose.  The natural cleaning mechanism of the upper respiratory tract then takes this mucous and brings it back down the throat into the stomach, where stomach acid destroys these particles.  (Dust, bacteria, viruses, mold, etc).  We normally make about a quart of mucous a day.  It should be like motor oil, a thin layer of protection that we rarely feel.  However, when the mucous is either the wrong consistency (thick and dry- or sometimes too watery) or too much (made in response to irritation or allergies)- then we feel this mucous and are uncomfortable. 

Treatment of your problem with mucous needs to be directed at the cause.  Quite commonly, stomach contents can reflux up the esophagus all the way to the nose and sinus cavities.  This irritates the lining and causes the tissues to make more mucous as a protective layer.  Lying down can increase reflux, especially after a late meal.  If that is the cause, then treatments such as antihistamines would be not only not necessarily beneficial, but could make the symptoms worse by drying this mucous.

I would suggest following a good “reflux” diet-  please see our site, but you should really be evaluated with a thorough ENT exam.    I would probably suggest testing for reflux with a 24 nasal pH monitoring.  This evaluation would accurately indicate whether acid is coming up that high and causing your symptoms and help tailor the appropriate therapy for your symptoms.

Robert L. Pincus MD

Associate Professor Otolaryngology

NY Sinus Center

NY Otolaryngology Group