Barometric Sinus Headache

MSNBC published a story on April 26, 2012 regarding headaches that come and go with pressure changes such as when flying in an airplane.

The neurological researchers call it "airplane headache" and the story makes it sound like a newly discovered headache, but in actuality, it is something that has been known for a very long time.

Human sinus cavities are air-filled cavities. When outside pressure changes relative to the air pressure within the sinus cavity, air pressure literally increases or decreases within the sinus cavity which a patient may perceive as pain/pressure over the face. This barometric sinus pressure would occur ONLY if the sinuses are clogged shut. If they are open, no problems would occur.

This phenomenon is analogous to a balloon (sinus cavity) that increases in size with decreasing pressure (going up a mountain or ascending in a plane) or decreases in size with increasing pressure (going down a mountain or descending in a plane).

As such, just like the MSNBC story suggests, the principal way to prevent such barometric sinus headache is to take a medication that prevents sinuses from clogging shut. One of the most effective medication is afrin nasal decongestant nasal sprayto be used 30-60 minutes before ascent and descent.

If this issue is a persistent chronic problem, surgical procedures such as balloon sinuplasty can be performed to make the sinus openings larger to decrease the chance of closure from mucosal edema.

Akin to barometric sinus pressure, the ears undergo a similar process which is why people "pop" the ears with pressure changes.

The ear equivalent of a barometric sinus headache is eustachian tube dysfunction.

Source:
Is flying giving you an 'airplane headache'? MSNBC 4/26/12

Diagnosing Smell and Taste Disorders

This article is reprinted with kind permission from Dr. Robert Henkin of the Smell and Taste Clinic located in Washington DC.

Answers to the Four Questions Required to Determine Cause of Smell and Taste Disorders: 

Question 1. DETECTION THRESHOLD – Can you detect the least concentrated stimulus from among three presented stimuli – two of which are either water (tastants) or neutral (odorants) and one of which is different?

This answer tells us of the presence and character of functioning taste and/or smell receptors. If this threshold number is higher (less sensitive) than normal then the patient requires more tastant or odorant than normal to stimulate taste and/or smell receptors. If the number is higher than normal then the patient has lost sensory receptor function due to some pathology.

Question 2. RECOGNITION THRESHOLD – Can you recognize correctly the different stimulus you just detected?

This answer tells us of the interaction between taste and/or smell receptors and the brain which processes this information. If the threshold number is higher (less sensitive) than normal then the patient requires more tastant or odorant than normal both to stimulate receptors and for the brain to process the sensory information correctly. This means that the patient has either lost sensory receptor sensitivity and/or has brain impairment which inhibits processing of the sensory stimulus due to some pathology.

Question 3. MAGNITUDE ESTIMATION – Can you judge the intensity of the correct recognition you just made using a scale from 0-100?

This answer tells us of the number of functioning taste and/or smell receptors. Taste and smell receptor activation involves a “field effect”; the larger the field, the more functioning receptors, the higher the magnitude estimation number. Thus, if the magnitude estimation number is lower than normal then the receptor number (taste and/or smell) is diminished and indicates pathology of the sensory system related to decreased receptor number.

Question 4. HEDONIC ESTIMATION – Can you judge the unpleasantness on a scale of -100 – 0, or pleasantness on a scale from 0 – +100, of the stimulus you just correctly recognized?

This answer tells us of the interaction between sensory receptor and the brain with respect to intensity of distortions of the sensory stimulus. This test uses a scale from 0 - −100 to indicate unpleasantness and a scale from 0 - +100 to indicate pleasantness. If a sweet tastant stimulus is considered unpleasant (e.g., -50% at a moderate concentration of sucrose, 300mM) then this response indicates a sensory distortion and thereby pathology of the taste system. Similarly, if the fruity odorant stimulus of amyl acetate is considered unpleasant (e.g., -50% at a moderate concentration of 10-1M) then the response indicates a sensory distortion and thereby pathology of the smell system.


By use of answers to these four questions it is possible to determine the nature and character of the pathology affecting taste and smell dysfunction. Answers to each of these questions are essential to determine this pathology.

These tests are used at The Taste and Smell Clinic in Washington, DC to determine the nature and character of sensory abnormalities of patients with taste and smell dysfunction. Only by use of this entire test battery can the nature and character of sensory dysfunction be determined. Simpler tests cannot fulfill this requirement.

Dr. Robert Henken
The Taste and Smell Clinic
Phone: (202) 364-4180

Reference:
An open label controlled trial of theophylline for treatment of patients with hyposmia. American Journal of the Medical Sciences. Vol. 337, pp. 396-406, 2009.

Voice Sounds Different After Tonsillectomy and/or Adenoidectomy!

Every so often, I hear a parent state that their child's voice/speech sounds "different" after undergoing tonsillectomy and adenoidectomy. Beyond sounding less nasal which is expected, the other comment is sounding higher pitched or more feminine.

This observation is especially true when dealing with a male school-age child.

The reason for this voice (or really speech) change is because the upper airway is much larger and more resonant after the tonsils and adenoids are removed.

Just like a person's voice sounds different when talking in a closet versus a large auditorium, the larger opening through which the voice travels after surgery is much larger than before and as such, the voice/speech has to correspondingly change after surgery as well.

The change is also much more dramatic the larger the tonsils and adenoids are.

SO, do not be alarmed if your child sounds different after surgery, especially if the tonsils and adenoids were extremely large. It is actually an expected occurrence and not an indicator of anything bad, swelling, healing, etc.