Antihistaminika lindern Niesen, Juckreiz und tränende Augen. Kortisonhaltige Nasensprays reduzieren die Entzündung der Nasenschleimhaut und verbessern die Atmung. Bei Beteiligung der Bronchien kommen inhalative Medikamente zum Einsatz. Die Auswahl erfolgt individuell und orientiert sich an Ihrem Beschwerdebild.

Bestimmte Maßnahmen können die Allergenbelastung senken. Dazu zählen tierfreie Schlafräume, häufiges Lüften, das Entfernen von Teppichen oder der Einsatz von HEPA-Filtern. Regelmäßiges Reinigen von Polstermöbeln und Textilien trägt ebenfalls zur Entlastung bei. Diese Schritte ersetzen keine Therapie, können sie jedoch sinnvoll ergänzen.

Die sog. Hyposensibilisierung setzt an der Ursache an. Dabei erhält der Körper über einen längeren Zeitraum kontrollierte Mengen des relevanten Allergens. Ziel ist es, die überschießende Immunreaktion schrittweise zu regulieren und die Beschwerden deutlich zu reduzieren.

Diese Therapie eignet sich jedoch nicht für jede Form der Tierhaarallergie. Für einige Tierallergene stehen keine standardisierten oder ausreichend wirksamen Präparate zur Verfügung. Zudem kann der Therapieerfolg bei Tierallergien teilweise weniger zuverlässig ausfallen als etwa bei Pollenallergien. Voraussetzung ist außerdem, dass die Beschwerden klar einem bestimmten Allergen zugeordnet sind und keine medizinischen Gegenanzeigen bestehen.

Ob eine spezifische Immuntherapie in Ihrem Fall sinnvoll ist, lässt sich erst nach einer differenzierten allergologischen Abklärung in unserer HNO-Praxisklinik in Frankfurt entscheiden.

The triggers enter the body via the air we breathe and irritate the nose, eyes and bronchial tubes in particular.

Typical examples:

• Pollen (e.g. grasses, birch, hazel, alder)
• House dust mites (more precisely: mite allergens from faecal particles, e.g. in mattresses)
• Animal allergens (mainly from cat/dog saliva, dander and urine, not „the hair“ itself)
• Mould spores (e.g. Alternaria or Cladosporium)

Certain proteins in food can also trigger an immune reaction. The symptoms often affect the skin, gastrointestinal tract or respiratory tract.

Frequent triggers:

• Pulses and nuts such as peanuts, hazelnuts or walnuts
• Cow's milk protein
• Chicken egg white
• Wheat
• Fish
• Crustaceans and shellfish
• Soya
• Celery
• Apple or stone fruit with existing pollen allergy (cross allergy)

In addition, certain protein components in insect venom can lead to an excessive immune reaction. The symptoms range from localised swelling to severe general reactions.

Typical triggers:

• Bee venom
• Wasp venom
• Hornet venom

It is important to distinguish between a „normal“ local reaction and a genuine allergic general reaction with circulatory involvement. The latter requires immediate medical clarification.

Direct skin contact with certain substances can be accompanied by a delayed immune reaction. The symptoms usually appear hours to days after contact in the form of redness, itching, blisters or scaly skin.

Frequent triggers:

• Nickel (e.g. in jewellery or buttons)
• Fragrances in cosmetics or care products
• Preservatives in creams or cleaning agents
• Latex (e.g. in gloves)

Active substances or their degradation products can trigger an immunological reaction. The symptoms range from skin rash and itching to shortness of breath or severe general reactions.

Examples:

• Antibiotics, especially penicillins
• Pain and inflammation inhibitors (e.g. ASA, ibuprofen)
• Contrast agent
• Certain anaesthetics

It is important to differentiate between a genuine allergy and an intolerance. Careful diagnostics clarify which active ingredient is responsible and which alternatives are possible.

In this form, you receive the allergen in the form of an injection under the skin. Treatment begins with a top-up phase. During this time, we gradually increase the dose until we have reached the individually appropriate maintenance dose.
We then continue the therapy at regular intervals over several years.

The injections are usually given every four to six weeks. This continuous immune stimulation promotes stable tolerance development and has a lasting effect on the course of the disease.

This variant is particularly suitable for pollen, house dust mite, animal hair or insect venom allergies.

With short-term immunisation, we concentrate the dosing on a shorter period of time. You will receive several injections in increasing doses within a few weeks.

This approach is particularly suitable for seasonal allergies such as hay fever.

The aim is to build up sufficient protection before the start of the pollen season. Despite the compressed treatment phase, the principle remains the same: your immune system should develop a different way of reacting.

This form of specific immunotherapy additionally accelerates the dosing phase. On individual treatment days, you will receive several injections at short intervals in succession.

This bundling allows us to reach the maintenance dose more quickly than with the classic approach. This does not necessarily shorten the overall duration of treatment, but it does significantly reduce the time it takes to reach a stable dose.

Typical indications are pollen allergies (e.g. grass, birch or herb pollen), house dust mite allergies and sometimes also animal hair allergies.

Tablet preparations are available for certain pollen allergies, particularly against grass and rye pollen. There are also authorised preparations for birch and related tree pollen. This sublingual therapy can also be used for house dust mite allergies.

Place the tablet under the tongue every day. The oral mucosa absorbs the allergen and activates mechanisms that promote immunological tolerance. After the first dose under medical supervision, you continue the treatment independently at home.

This form of therapy is particularly suitable for patients with:

• seasonal allergic rhinitis caused by grass or tree pollen
• Year-round house dust mite allergy
• mild to moderate symptoms without unstable asthma

• The immune system classifies pollen, house dust mites, animal dander or mould as a threat.
• It forms specific antibodies against these substances.
• On renewed contact, the body releases histamine and other inflammatory messengers.
• The nasal mucosa swells and produces more secretions. Other characteristic signs of allergy (see below) are also present.

• Frequent sneezing fits
• Constantly runny nose with clear, watery secretion
• Restricted breathing due to swollen nose
• Itching in the nose, throat or around the eyes
• Watery, reddened eyes
• Sometimes coughing or a feeling of pressure in the head area

• Seasonal: symptoms occur mainly during the pollen season
• All year round: symptoms are permanent, for example in the case of a house dust mite or animal hair allergy

• Allergic rhinitis usually starts suddenly after contact with a specific trigger, e.g. after spending time outdoors during the pollen season. The nasal secretions remain clear and watery. Itching in the nose and eyes and repeated sneezing attacks are also common.
• One Cold often develops gradually and is accompanied by a general feeling of illness. The nasal secretions often become thick as the disease progresses. It usually also turns yellowish or greenish in colour. Fever, aching limbs or sore throat are also typical of an infection.
• Allergic symptoms last as long as there is contact with the trigger. A cold usually subsides within seven to ten days.

• The term allergic rhinitis describes allergy-related inflammation of the nasal mucosa, regardless of the trigger. It can occur all year round.
• Hay fever on the other hand, is a special form of allergic rhinitis. In this case, only pollen from trees, grasses or herbs trigger the symptoms. It therefore typically occurs seasonally, especially in spring and summer during the respective pollen season.
• All hay fever therefore counts as allergic rhinitis, but not every allergic rhinitis is automatically hay fever.

We enquire about the type, duration and frequency of your symptoms. The temporal correlation with seasons, places of residence or animal contact provides us with important information. Familial allergies, asthma or neurodermatitis also play a role.

We assess your nasal mucosa by means of an ENT examination. A pale to bluish discoloured, clearly swollen nasal mucosa indicates an allergic cause. In the case of an acute cold, the mucous membrane usually appears reddened, as there is an infectious inflammation. If necessary, an endoscopy of the nose and paranasal sinuses is performed to identify other causes such as Nasal polyps to be excluded.

If an allergic rhinitis is suspected following a medical history and examination, specific test procedures are carried out. These help to clearly identify the triggering substances and categorise the symptoms. The combination of test result and clinical symptoms is always important. At our ENT clinic in Frankfurt, we use tried and tested procedures that are based on international standards.

• Skin test
  Here we apply special allergen extracts to the skin of your forearm. We use a fine lancet to lightly scratch the top layer of skin so that the various allergens can penetrate the skin. If a wheal with redness appears within 15 to 20 minutes, the immune system is already reacting to this substance with specific antibodies.
• Blood test
  As part of a blood test, the laboratory determines the amount of specific IgE antibodies. The immune system produces these antibodies in response to certain allergens. An elevated value shows that the body is sensitised to this substance. The blood test is particularly useful if a skin test is not an option, e.g. in the case of pronounced skin diseases or if certain medications could falsify the test result. It also provides additional information for the precise categorisation of symptoms in the case of unclear findings.

As soon as we have clearly identified the triggering allergen, you should reduce your contact with this substance as much as possible. Only if it is clear what is causing the symptoms can you effectively reduce the stress in your everyday life.

If you are allergic to house dust mites, for example, special protective covers for mattresses and bed linen as well as a low-dust bedroom design can provide noticeable relief. Regular ventilation and the avoidance of „dust traps“ also support this effect.

If your body reacts to animal hair, giving up the animal often leads to a significant improvement in symptoms.

If you are allergic to pollen, adjusting ventilation times, pollen screens on the windows or nasal rinsing after spending time outdoors can help. Changing your clothes after returning home can also reduce the pollen load.

Complete avoidance is not possible in every case. Nevertheless, a conscious and consistent reduction in allergens makes a decisive contribution to alleviating symptoms and reducing the need for medication.

If contact with the allergen cannot be completely avoided or your symptoms are more severe, drug treatment can help to reduce the symptoms. The aim of this so-called symptom therapy is to weaken the excessive immune reaction and quickly improve your quality of life.

Antihistamines inhibit the effect of the neurotransmitter histamine, which is largely responsible for sneezing, itching and a runny nose. As a result, these symptoms often subside noticeably. Nasal sprays containing cortisone reduce the inflammatory reaction in the nasal mucosa and facilitate nasal breathing. They act directly at the site of the problem and are particularly suitable for persistent nasal congestion.

If necessary, anti-allergic eye drops or temporary decongestants supplement the treatment.

However, it is important to note that these medications effectively alleviate the symptoms, but they do not change the underlying allergic cause.

In contrast to pure symptom treatment, hyposensitisation directly addresses the cause of your allergy. It aims to gradually acclimatise the immune system to the triggering allergen and permanently reduce the excessive reaction.

We recommend this type of therapy in particular if your symptoms are still very pronounced despite consistent allergen avoidance and drug treatment or if you would like to take less medication in the long term.

At the beginning, you will receive the identified allergen in a very low dosage. We increase the amount at regular intervals up to the so-called maintenance dose. Subsequently, the dose is administered at fixed intervals over a longer period of time, usually several years. In this way, the immune system learns to tolerate the allergen.

The therapy is particularly suitable for pollen, house dust mite, animal hair and insect venom allergies. Many patients report significantly reduced symptoms and a reduced need for medication over the course of the treatment.

At the beginning, some sufferers experience a slight scratching or pressure sensation in the throat, which becomes stronger or more constant over time. It is typical to feel as if a small lump or foreign object is lodged in the throat, even though nothing is visible there. The discomfort can occur on one side and sometimes radiates into the ear.

Unlike a common sore throat, the pain does not subside after a few days, but persists for weeks. Medication, gargle solutions or household remedies do not bring any improvement in this case. This persistent discomfort arises because the tumour irritates the surrounding tissue and exerts pressure on the nerves or mucous membrane.

At the beginning, swallowing is often only occasionally difficult, e.g. if the food is very firm/chewy or with larger bites. Over time, the discomfort increases and even swallowing soft foods or liquids can be uncomfortable or painful.

The cause is that a growing tissue change in the throat impedes the swallowing process or exerts pressure on the surrounding nerves. Some sufferers avoid eating as a result, which can lead to weight loss and exhaustion.

Sometimes Earache although the ear itself is inconspicuous. This is because the pharynx and middle ear are connected via the eustachian tube. Irritations or tumours in the throat can transmit pain signals to the ear via shared nerve pathways.

Those affected then feel a dull aching or stinging sensation, usually only on one side. As no inflammation or injury can be seen on examination of the ear, the actual cause often remains hidden at first. If such unilateral ear pain occurs over a longer period of time without any clear findings, you should also have the throat area checked carefully.

If the sound of the voice changes permanently, this may be an indication of a change in the pharynx or throat. Larynx area be. If the tumour is close to the vocal folds or spreads to the larynx, this disrupts the vibrations of the vocal folds. Vocal cords. The voice then sounds raspy, brittle or overheated and loses power.

Some patients also report that they become hoarse more quickly or that their voice fails after a short period of exertion. Unlike a cold or laryngitis, hoarseness does not improve after a few days, but persists or gradually worsens.

An unusually strong or foul odour from the mouth can occur when pathologically altered tissue forms in the throat. In such cases, even thorough tooth brushing or mouthwashes are of little help.

The cause is not in the mouth, but deeper down - where the tumour is located. Small bleedings, dead cells or bacterial decomposition processes in the tumour tissue produce odours that are perceptible when breathing or speaking.

A medical examination can clarify whether the symptom is a harmless inflammation or a more serious change.

Some sufferers notice that the sputum contains small traces of blood when coughing. This occurs when the mucous membrane in the throat is irritated or injured by the tissue change and fine blood vessels break open. The blood then mixes with saliva or mucus and becomes visible when spitting out.

Throat cancer can also be characterised by swelling in the neck. This often occurs when lymph nodes enlarge - either as a reaction of the immune system or because tumour cells have settled there.

The lumps usually feel firm, are difficult to move and generally cause no pain.

If a tumour in the throat persists for a long time, it can put a noticeable strain on the entire body. Many sufferers lose weight without consciously changing their diet. One reason for this is that swallowing becomes increasingly difficult and food intake is restricted.

On the other hand, the body itself consumes more energy due to the tumour disease, while the appetite can decrease at the same time. Persistent tiredness or weakness can also set in.

Surgery is one of the most important forms of treatment for a malignant tumour in the throat, especially if it is still localised. The aim is to completely remove the malignant tissue while preserving as much healthy tissue as possible. Different surgical procedures are used depending on the location of the tumour.

Smaller tumours can often be removed in a minimally invasive way, e.g. using an endoscope or a laser. These gentle techniques enable precise tumour removal through the mouth without the need for large external incisions. In the case of more advanced findings, however, an open surgical approach may be necessary so that the tumour tissue can be completely removed.

In some cases, neighbouring lymph nodes in the neck area are also removed during the procedure to rule out possible metastases.

Radiotherapy is a key treatment option for throat cancer and can be used as a stand-alone therapy or in combination with surgery or chemotherapy. Its aim is to destroy cancer cells while sparing the surrounding healthy tissue.

Modern radiotherapy methods - such as intensity-modulated radiotherapy (IMRT) - allow the radiation dose to be controlled with pinpoint accuracy. This allows the radiation to be concentrated precisely on the tumour area. Sensitive structures such as the salivary glands, spinal cord or larynx remain largely protected.

In early tumour stages, radiotherapy can often completely eliminate the cancer and make surgery unnecessary. In more advanced cases, it is used to destroy remaining tumour cells after an operation or to slow down tumour growth.

Temporary side effects may occur during treatment - for example, difficulty swallowing, irritation of the mucous membrane or temporary loss of taste. Careful accompanying therapy and regular aftercare help to alleviate these symptoms and support the healing process.

Chemotherapy is often used to treat throat cancer in addition to radiotherapy or surgery. It uses special drugs (known as cytostatics) that inhibit the growth and division of cancer cells or kill them completely. As tumour cells divide faster than healthy cells, they are particularly sensitive to these drugs.

As a rule, chemotherapy is used as an accompanying treatment to radiotherapy (radiochemotherapy), for example. This combination allows the two procedures to reinforce each other: the radiation directly destroys the tumour tissue, while the medication makes the cancer cells more sensitive to the radiation. This significantly increases the effectiveness of the therapy.

In the case of advanced or metastatic tumours, chemotherapy also serves to slow tumour growth, alleviate symptoms and maintain quality of life.

Typical side effects such as nausea, tiredness, irritation of the mucous membranes or hair loss occur because healthy cells can also be affected for a short time.

The therapy is always customised and closely monitored in order to keep the burden as low as possible.

These concepts are becoming increasingly important in the fight against throat cancer. They are directed against certain properties of cancer cells or activate the body's own defence system. This can often fight the tumour cells particularly effectively.

So-called checkpoint inhibitors are used in immunotherapy. These drugs block signalling pathways that cancer cells use to "switch off" the immune system. If this blockade is removed, the body's own defence cells can recognise and attack the tumour cells again. Immunotherapy is primarily used for advanced or recurring tumours when other treatments have been exhausted or are not sufficiently effective.

Targeted therapies work differently: they attack specific structures or growth mechanisms of the cancer cells, e.g. certain receptors on their surface. A well-known example is the use of antibodies against the so-called EGFR (Epidermal Growth Factor Receptor), which is overactive in many head and neck tumours.

Both forms of therapy are considered important advances because they are even more precise and largely spare healthy cells. Regular check-ups and careful medical supervision are crucial in order to optimally control the effect and possible side effects.

Functional rehabilitation plays a crucial role following treatment for throat cancer - especially after surgery or radiotherapy and chemotherapy. The aim is to gradually restore natural abilities such as swallowing, speaking and adequate food intake.

Swallowing therapy helps you to train the muscles in the throat and pharynx area. Through special exercises, you will learn to safely coordinate movements when eating and drinking and reduce the risk of choking.

Speech therapy (speech therapy) helps to compensate for changes in the voice or articulation. This allows you to regain your vocal resilience and intelligibility when speaking. This is an important step towards being able to communicate actively again in everyday life.

If swallowing is still restricted or there is weight loss, additional nutritional counselling may be useful. Specialists will show you how a balanced, well-tolerated diet can support your recovery and provide you with new energy.

These rehabilitative measures make a significant contribution to maintaining your quality of life after cancer treatment and gradually returning to your normal everyday life.

The skin in the outer ear and at the entrance to the ear canal is sensitive and depends on a balanced interaction between moisture and earwax. If this natural balance is disturbed, the skin dries out, becomes tight and starts to itch. After frequent showering, bathing or swimming in particular, too much earwax can be rinsed out, resulting in a lack of protective film.

Dry room air, frequent wearing of in-ear headphones or hearing aids and intensive ear cleaning put additional strain on the skin. Typical symptoms are a fine feeling of tension, tiny flakes of skin or a tingling sensation in the ear canal.

The so-called. Cerumen fulfils an important protective function in the ear. It keeps the skin in the ear canal supple, traps dust and dirt particles and has a slight antibacterial effect. Normally, the cerumen is slowly transported outwards through natural chewing movements, where it dries up and falls off.

If this self-cleaning mechanism is disrupted, earwax can accumulate and harden. This happens, for example, if the ear canals are narrowed, the ear skin is very hairy or if earplugs, headphones or hearing aids are used frequently. Cotton buds also often push wax deeper into the ear canal instead of removing it.

Those affected often feel a dull itch, a foreign body sensation or slight pressure in the ear. In some cases, there is also a temporary loss of hearing or a crackling sensation when chewing.

The skin in the ear reacts sensitively to certain substances that come into contact with it. Metals in earrings or ingredients in cosmetics, shampoos and skin care products are often the triggers for itching. If such substances come into contact with the sensitive skin of the pinna or the ear canal, the immune system can react with a Contact allergy The skin reddens, swells slightly and begins to itch intensely.

Typically, the itching occurs suddenly, often accompanied by a warm or burning sensation. Sometimes a slight rash develops or the skin appears sore and irritated. If contact with the trigger persists, the symptoms can worsen.

Otitis externa is one of the most common causes of persistent itching in the ear. The sensitive skin that lines the ear canal becomes inflamed - usually due to bacteria or, more rarely, fungi. Even tiny injuries caused by cleaning or scratching can pave the way for germs.

Typical symptoms include intense itching, which can quickly develop into burning or pain, as well as a feeling of warmth in the ear. Some sufferers also notice that the ear canal is swollen or oozes clear or purulent fluid. In severe cases, hearing may be impaired because the ear canal is constricted by the swelling.

Otitis externa often occurs after swimming or bathing, when moisture remains in the ear and the environment becomes favourable for germs. This is why it is also known colloquially as "swimmer's ear".

Eczema, neurodermatitis or psoriasis change the structure of the skin: it becomes drier, flakier and loses its protective function. As a result, it reacts to even minor irritations with itching or redness.

A persistent or recurring itch is typical, which often manifests itself with fine scales or cracked skin. Those affected often describe that the ear canal is tight or feels sore. In the case of psoriasis, small, silvery, shiny skin flakes may also be visible, while atopic dermatitis tends to be characterised by red, itchy areas.

Scratching or cleaning usually worsens the symptoms because the already sensitive skin is further injured.

Fungi can also infect the external auditory canal and cause severe itching. This form of inflammation is called otomycosis. Yeasts or moulds are often involved, which feel particularly at home in the ear in a warm and humid climate. This is the case, for example, if water remains in the ear after swimming or showering or if you are in tropical regions.

A fungal infection is typically characterised by an intense, deep-seated itch that can intensify from day to day. Some sufferers experience a feeling of pressure or a slight burning sensation, others notice a change in odour or crumbly, discoloured deposits in the ear.

Hearing is often impaired because the ear canal is partially blocked by the fungal material.

Not all itching in the ear arises directly from the skin. In some cases, the ear canal reacts reflexively to stimuli from neighbouring nerves or organs. The vagus nerve, for example, which also supplies parts of the ear, is connected to the throat, larynx and even internal organs. If it is stimulated at another point, this can be perceived as itching or tingling in the ear.

Such sensations occur, for example, when the mucous membranes in the nasopharynx are inflamed, when there are pressure changes in the ear (e.g. due to colds or travelling by plane) or also due to tense jaw and neck muscles. The itching then often feels deeper - as if it is coming from inside. However, the skin in the ear remains completely inconspicuous.

At the beginning we ask for important details:

• How long has the itching been present?
• Does it occur on one or both sides?
• Are there accompanying symptoms such as Painpressure, oozing or hearing loss?
• Do you regularly use headphones, earplugs or hearing aids?
• Do you have allergies, skin diseases or frequent ear infections?

Next, we use an otoscope/ear microscope to look at the external auditory canal and the eardrum. We recognise this:

• whether earwax deposits are present,
• whether the skin is irritated, reddened or swollen,
• whether there is secretion or debris in the ear canal.

If an infection is suspected, we will take a swab. We have this analysed in the laboratory to identify possible bacteria or fungi.

In order to clarify whether it is an allergic reaction or a chronic skin disease, a Allergy test or a dermatological co-assessment may be useful.

Recurrent infections of the nose can severely weaken the mucous membrane. In many cases, the bacterium Klebsiella ozaenae is involved. It belongs to the so-called gram-negative germs. This refers to bacteria that have a special cell wall structure and are therefore often more resistant to certain antibiotics.

Klebsiella ozaenae is not uncommon in the nose and throat. However, if the mucous membrane is damaged or dried out, the bacterium can multiply rapidly and exacerbate the inflammation.

Over time, the mucous membrane regresses and the nasal cavity expands. These changes pave the way for new infections - a vicious circle that favours the typical changes of a stinky nose.

Some people naturally have a more sensitive nasal mucosa, which produces less secretion and dries out more quickly. This is comparable to the dry skin type, which is characterised by a lack of moisture and too little sebum production. As a result, the skin is also rough and flaky.

In addition, the mucous membrane can lose its protective and barrier function over the course of a lifetime - e.g. due to frequent infections, environmental stress or operations. Metabolic diseases such as diabetes, hormonal changes during the menopause and certain deficiencies can also affect the condition of the nasal mucosa.

Without sufficient moisturisation, fine injuries occur that pave the way for inflammation. In the long term, the tissue retracts and the nasal cavity widens. These changes significantly favour the development of a stinky nose.

Excessive and long-term use of decongestant nasal sprays can cause considerable damage to the nasal mucosa. The constant constriction of the blood vessels causes the tissue to dry out, lose its resistance and become more susceptible to inflammation. In the long term, such changes favour the development of a stinky nose

You can find out more about this in our blog post: Nasal spray addiction: What are the consequences?

The shape and condition of the nasal cavity can also play a role. Some people have naturally wide nasal passages in which the air flows too quickly and the mucous membrane dries out more.

In other cases, changes only occur in the course of life. After operations (e.g. when Reduced turbinates or after accidents, it can happen that parts of the nasal mucosa or turbinates are permanently damaged. However, the turbinates are important because they moisturise, warm and filter the inhaled air.

If they recede too much, the nasal cavity becomes unnaturally wide. This allows air to flow through unchecked and the mucous membrane dries out more quickly. As a result, the natural protective function of the nose is lost. It is precisely these conditions that favour the development of ozaena.

Stinky nose occurs more frequently in some families, which indicates a genetic predisposition. Presumably, both the sensitivity of the nasal mucosa and the tendency to infections are inherited. As a result, several family members may develop similar problems with dehydration, crust formation or recurring infections.

Even if the exact genes have not yet been identified, the following applies: anyone with a family history may have an increased risk of developing stinky nose.

With a long-lasting inflammation of the paranasal sinuses purulent secretions accumulate and flow out through the nose. This secretion can cause an unpleasant odour that sometimes resembles that of a stinky nose.

In addition, those affected often suffer from pressure pain in the face, blocked nose and an impaired sense of smell. Through a thorough examination, often supplemented by imaging procedures, we can distinguish chronic sinusitis from ozaena.

It is not uncommon for children to push small objects into their nose while playing, which then remain there unnoticed. This irritates the mucous membrane and causes an inflammatory reaction.

This can result in a foul-smelling, often purulent discharge, which initially occurs on one side. This finding is an important indication for us, as a stinky nose usually affects both sides of the nose. We can recognise and remove the foreign body with a simple examination using a nasal mirror.

Benign or malignant Tumours in the nose and the neighbouring sinuses can cause symptoms similar to a stinky nose. These include foul-smelling discharge, crust formation or changes in the sense of smell.

Other symptoms often occur in addition, such as recurring Nasal haemorrhagesa one-sided nasal congestion or pain in the facial area.

As these signs can initially be unspecific, a precise examination is crucial. With the help of modern imaging and, if necessary, tissue samples, it is possible to clarify whether a tumour is the cause of the symptoms.

Daily care of the nose plays a central role in the treatment of ozaena. Rinsing with saline solutions (so-called Nasal showers) help to gently loosen stuck crusts and rinse out germs.

Special nasal oils or ointments provide the mucous membrane with additional moisture, prevent it from drying out again and help to reduce the typical odour. This consistent care helps to stabilise the nasal environment.

If the nose is heavily colonised with bacteria, special antibiotics can help to reduce the germs and alleviate acute symptoms.

Vitamin supplements or regenerating agents that strengthen the mucous membrane can also be used. This makes the tissue more resistant and reduces the risk of recurring infections.

In severe cases, it may be useful to narrow the nasal cavity in order to normalise the airflow and protect the mucous membrane.

Air humidification, avoidance of irritants and good general health care support the success of the treatment.

The WatchPAT is a compact measuring system consisting of three parts: a wristband with an integrated sensor, a small probe on the finger and a flat sensor patch on the chest. Unlike in a sleep laboratory, it does not require nasal cannulas, straps or complex wiring. This means that sleep remains as natural as possible. This also lowers the inhibition threshold for many patients to have themselves examined.

The measurement takes place during a normal night in your familiar surroundings. The device records various parameters such as oxygen saturation, pulse, snoring, breathing pauses and even the sleep phases. This is done using peripheral arterial tonometry (PAT). This method detects the smallest changes in vascular tension and allows very precise analysis of nocturnal breathing.

The next morning, you remove the screening device and bring it back to our ENT practice clinic. Here we carefully analyse the recorded data.

The informative value of the procedure has been compared with classic polysomnography in the sleep laboratory in several studies - and shows a very high level of agreement:

High diagnostic accuracy with the apnoea-hypopnoea index (AHI)

In a clinical study at the Chinese PLA General Hospital (Beijing), the WatchPAT delivered very reliable measurement results. The results were almost equivalent to those of conventional polysomnography. The WatchPAT system proved to be an excellent diagnostic aid, particularly with regard to the apnoea-hypopnoea index (AHI) and the assessment of the severity of sleep apnoea.

The AHI indicates how many breathing pauses (apnoeas) and shallow breaths (hypopnoeas) occur per hour of sleep. It is a key measurement for assessing sleep-related breathing disorders.

Click here for the study: Li W., Wang R., Huang D., Liu X., Jin W., Yang S. (2013). Assessment of a portable monitoring device WatchPAT 200 in the diagnosis of obstructive sleep apnea hypopnea syndrome. European Archives of Oto Rhino Laryngology, 270(12), 3099-3105. DOI:10.1007/s00405-013-2555-4

Reliable alternative to classic polysomnography with reliable differentiation between central and obstructive sleep apnoea

A comprehensive multi-centre study led by Dr Giora Pillar was conducted at eleven sleep centres in the USA, Israel and Germany. The WatchPAT system was used in combination with a body position tracker. A total of 84 adults with suspected sleep-related breathing disorders took part in the study.

The results confirm the high diagnostic performance of the WatchPAT. The measured values corresponded almost completely with those of classic polysomnography. Particularly noteworthy is the reliable differentiation between central and obstructive respiratory disorders. This aspect is crucial for choosing the appropriate therapy.

This shows that the WatchPAT is suitable as a sound, convenient and scientifically validated alternative to conventional diagnostics in the sleep laboratory - even under real conditions in everyday clinical practice.

Read more: Pillar et al. (2019). Detecting central sleep apnea in adult patients using WatchPAT - a multicentre validation study. Sleep and Breathing, 24(5). DOI:10.1007/s11325-019-01904-5

The WatchPAT is primarily aimed at people with suspected obstructive sleep apnoea who are looking for an uncomplicated diagnostic option that is suitable for everyday use.

The procedure is particularly suitable for these people:

• Patients who find an examination in the sleep laboratory stressful
• People with little time or a long journey to the Centre for Sleep Medicine
• Affected people who want to organise their night's sleep as naturally as possible

Those affected have the impression that their body swings slightly back and forth or sways - similar to being on a boat in waves. The field of vision remains completely stable: nothing rotates, nothing blurs and the surroundings do not visibly change either. Nevertheless, there is a feeling of being off balance or not standing securely on your feet.

This sensation often occurs suddenly or intensifies when walking, in crowds or when looking into larger rooms. Some also describe it as "bottomlessness" or the feeling that the floor is giving way under your feet.

Many sufferers feel unstable, as if they are not fully "grounded" or as if they could lose their balance at any time. When walking, they often have the impression that they cannot control their legs properly or that the ground beneath them is uneven, even though everything is actually normal. This insecurity is often exacerbated in open spaces, on bridges, escalators or in the dark.

When standing, for example in a queue or in the shower, it can feel as if you have to hold on tight to avoid falling over. This constant feeling of instability leads to avoidance behaviour and severe psychological stress for many people.

In situations in which the balance system is under greater strain - for example when walking on cobblestones, on grass or in sand - the symptoms are often particularly noticeable.

Those affected report that they feel as if they are about to tip over or lose their footing at such times. Darkness or poor visibility can also affect balance, as visual stimuli are no longer an important orientation aid. Without this visual stabilisation, it is more difficult for the body to reliably perceive its own position in space, which often further increases the feeling of insecurity.

The unpleasant feeling of dizziness can not only affect your balance, but also your general well-being. Some sufferers experience mild to moderate nausea during periods of dizziness - similar to travel sickness.

This effect can be particularly pronounced when moving or changing position quickly. Drowsiness often accompanies this: a diffuse, wobbly state in which everything slows down or feels "as if in a fog".

This sensation is not a circulatory problem in the classic sense, but is related to the disturbed processing of balance stimuli in the brain. The combination of dizziness, nausea and light-headedness can be very unsettling and severely restrict your ability to cope with everyday stress.

Swaying vertigo can also increase significantly under mental stress. The feeling of instability can increase in stressful moments or busy environments - for example in shopping centres, train stations or at events.

The body reacts to stress with increased muscle tension and heightened alertness, which can also influence the perception of balance disorders.

In crowds, this is aggravated by the fact that visual landmarks are constantly in motion. This overstrains the already sensitive balance system. The result: the feeling of swaying increases, combined with inner restlessness or even panic. This connection between dizziness and mental stress often leads to a cycle of uncertainty and avoidance.

The persistent feeling of unsteadiness when standing or walking can quickly lead to a deep-seated fear - namely that of suddenly falling or no longer being able to control oneself properly. This concern not only affects older people, but also younger people who normally move around safely.

It is particularly stressful that there is often no objective reason for a fall, but the feeling of instability is very real. Many people therefore withdraw from everyday life, avoiding public transport or longer journeys, for example.

The fear of losing control can become so strong that it triggers other symptoms - such as palpitations, sweating or breathlessness. This often results in a spiral of reciprocal stress: the anxiety intensifies the dizziness, and the dizziness in turn feeds the anxiety.

Many people with vertigo experience persistent tension in the neck, shoulders and upper back. This muscle tension can be both the cause and the consequence of vertigo.

On the one hand, they impair blood circulation and nerve supply in the head and neck area, which can have a direct impact on the balance system. On the other hand, the constant feeling of insecurity often unconsciously leads to a cramped posture - for example by permanently tensing the shoulders or a cautious gait. This posture puts additional strain on the muscles and exacerbates the symptoms.

Many sufferers experience a mental void or a kind of "trance state" during or after a period of dizziness. Many sufferers describe how they find it difficult to concentrate, find it hard to grasp thoughts and even everyday tasks take a lot of energy.

This sensation is often described as "like being beside oneself" or "not quite being there". The result is a feeling of alienation from one's own body or surroundings - without loss of consciousness, but with significantly reduced alertness.

Such symptoms can be the result of constant inner tension or overstimulation of the vestibular system. Psychological factors such as anxiety, stress or exhaustion also often contribute to this type of impairment. The experience not only affects performance, but often also self-confidence in everyday life.

The Balance system is located in the inner ear and consists of three semicircular canals and the vestibule with the utricle and saccule. It registers movements and changes in the position of the body. The sensory impressions are transmitted to the brain via the vestibular nerve. There they are compared with impressions from the eyes and the muscles. Only this interaction enables a stable posture and safe orientation in space.

If there is a disruption within this system, the signals become unbalanced. The brain receives contradictory or incorrect information, which leads to feelings of dizziness.

The most common causes of vertigo in the area of the inner ear include

Vestibular neuritis

A sudden, usually unilateral inflammation of the vestibular nerve, which can occur after a viral infection, for example. It leads to severe dizziness, initially often with nausea and vomiting. Later, some sufferers are left with diffuse vertigo.

Meniere's disease

This disease of the inner ear causes excess pressure due to fluid accumulation (endolymph hydrops). Typical for Meniere's disease are paroxysmal rotary vertigo, hearing loss and Ringing in the ears. Persistent vertigo may persist between attacks.

Age-related changes

With age, the function of the vestibular system deteriorates - often accompanied by Hearing loss. These gradual changes often lead to increasing unsteadiness when walking, especially on uneven surfaces or at dusk.

Other diseases of the inner ear - such as a perilymphatic fistula, benign tumours (e.g. vestibular schwannoma) or labyrinthitis - can also disrupt the vestibular system and cause vertigo. A thorough diagnosis in our ENT clinic in Frankfurt is important in order to determine the exact cause and initiate targeted treatment.

Blockages or tension in the cervical spine or neck muscles can disrupt the processing of signals between the body and brain. This form of dizziness occurs particularly when sitting for long periods, in poor posture or after accidents (e.g. whiplash).

Reduced blood flow to certain areas of the brain - e.g. due to low blood pressure, cardiac arrhythmia or vasoconstriction - can affect balance. This can manifest itself in the form of non-specific vertigo.

Certain drugs such as tranquillisers, antihypertensives, antidepressants or strong analgesics can cause a feeling of dizziness as a side effect.

Anxiety disorders, depression or chronic stress play a central role in many people with vertigo. In these cases, there is no organic cause - but the feeling of dizziness is nevertheless real and stressful. Diffuse dizziness is typical, which intensifies under stress or in stressful situations.

In rare cases, vertigo can be the first sign of diseases such as multiple sclerosis, Parkinson's disease or a cerebellar disorder. A thorough neurological examination is therefore important if the symptoms are unclear or persistent.

With increasing age, vision, muscle strength and the ability of the balance system to react deteriorate. The interplay of sensory stimuli becomes less precise - the feeling of insecurity when walking or standing becomes more frequent.

At our ENT clinic in Frankfurt, we are happy to be your first port of call for vertigo - especially if there is a suspected disorder of the vestibular organ in the inner ear.

If you have an inflammation of the vestibular nerve (neuritis vestibularis), for example, drug therapies with anti-inflammatory preparations or antivertiginosa are used. We can also prescribe special medication for symptom control in diseases such as Menière's disease.

If there is also benign positional vertigo, we can use certain positioning manoeuvres to reduce the triggering symptoms. Crystals in the inner ear and significantly alleviate the symptoms.

Another important component is the prescription of vestibular rehabilitation exercises. These special balance exercises help your brain to better process disturbed stimuli and retrain your balance. In some cases, a referral to specialised physiotherapy can be useful if additional muscular or functional factors are present.

We also use audiometric procedures to check whether there is also a hearing loss or another inner ear problem that could influence the symptoms.

The aim of all these measures is to specifically stabilise the balance system, normalise the processing of stimuli in the brain and noticeably improve your quality of life.

Many sufferers benefit from targeted physical measures, especially if muscular tension or problems with the cervical spine are also causing the vertigo.

Physiotherapy and balance training improve body awareness, promote stability and help the brain to better regulate balance. In addition, heat treatments, manual therapy, massages and gentle posture training can relieve tension and improve postural stability. The exercises can usually be continued at home with professional guidance.

In the case of functional or stress-related vertigo, psychotherapeutic support is often effective. In the case of chronic complaints or accompanying anxiety, behavioural therapy can help to improve the handling of dizziness and reduce avoidance behaviour. Relaxation methods such as progressive muscle relaxation or mindfulness training can also provide relief.

A healthy lifestyle can support the treatment of vertigo. Regular exercise strengthens the circulation and improves body awareness - both important factors for a stable balance.

Sufficient sleep, conscious recovery phases in everyday life and the targeted reduction of stress are just as important. Avoiding nicotine and moderate consumption of alcohol and caffeine can also have a positive effect on the symptoms. A balanced diet and sufficient fluid intake also help to stabilise the body as a whole and promote well-being.

A particularly common and distressing symptom of nocturnal breathing pauses is pronounced tiredness during the day. Although those affected have supposedly slept long enough, they feel exhausted, listless and unrested in the morning - as if they have hardly slept at all. This is because sleep is repeatedly interrupted by repeated micro-awakenings and the body never gets enough of the deep sleep phases that are so important for regeneration.

This chronic fatigue not only affects general well-being, but can also have a significant impact on performance. Those affected often find it difficult to concentrate for long periods of time, react more slowly and feel mentally "foggy".

In particularly severe cases, it can even lead to involuntary microsleeps - short, sudden phases of falling asleep that occur without warning. This is not only unpleasant, but can also be dangerous in certain situations, such as when driving a car or operating machinery.

Interrupted breathing at night not only impairs sleep, but also has a noticeable effect on mental and physical performance during the day. Disturbed sleep means that the brain lacks the necessary recovery time to optimally prepare for the demands of the next day.

The result is reduced mental alertness: thinking becomes more difficult and concentration wanes more quickly. Even simple tasks require significantly more energy and attention.

In addition, the ability to react decreases, which is just as noticeable in everyday situations as in stressful phases at work. Many sufferers report increasing forgetfulness, inner restlessness and reduced resilience - both mentally and physically.

The ability to grasp complex relationships or react flexibly to new situations can also be significantly limited. These losses have an impact on professional life, social contacts and overall quality of life.

In the long term, this can develop into a feeling of chronic overload - with negative consequences for mental health.

Those who are deprived of restful deep sleep phases night after night due to breathing interruptions are often emotionally unbalanced the next day. After just a few nights of disturbed sleep, irritability often increases noticeably: small things trigger exaggerated reactions, patience and tolerance decrease. Added to this are inner restlessness, nervousness and the feeling of being under constant tension.

In the long term, this condition can have a negative effect on your mental state. The chronic lack of sleep drains energy, weakens emotional resilience and promotes depressive moods. Many sufferers report a lack of motivation, loss of interest or social withdrawal. Feelings of anxiety or a persistent feeling of being overwhelmed can also occur.

The psychological consequences of untreated apnoea are often underestimated - although they can have a significant impact on quality of life and interpersonal relationships.

Breathing pauses during sleep also pose a significant risk to the cardiovascular system. Each pause in breathing reduces the oxygen content in the blood - the body reacts with stress. The nervous system is activated and blood pressure rises briefly. As a result, the heart has to work harder to ensure the oxygen supply. These repeated nocturnal alarm reactions lead to the body remaining permanently in a state of increased tension.

In the long term, this mechanism can have serious consequences. The constantly changing blood pressure and increased heart rate during the night favour the development of high blood pressure (arterial hypertension) - one of the most common and most dangerous secondary diseases of obstructive sleep apnoea. Cardiac arrhythmias, such as atrial fibrillation, also occur much more frequently in those affected.

Studies also show an increased risk of heart attack and stroke, especially if sleep apnoea remains untreated:

Meta-analysis in "Neurological Sciences"

for people with obstructive sleep apnoea (OSA):

• a 71 % higher risk of cardiovascular disease,
• an increased risk of stroke by 86 %,
• an increase in mortality of 77 %,
• a 48 % higher risk of coronary heart disease (heart attack)

Source: "The effect of obstructive sleep apnea on the increased risk of cardiovascular disease: a systematic review and meta analysis" - based on 24 cohort studies

Triple the risk of heart attack and stroke

An analysis showed that people with untreated severe obstructive sleep apnoea have almost three times the risk of heart attack or stroke over a ten-year period.

Source: "Obstructive sleep apnea and risk ...: meta-analysis of prospective cohort studies"

As you can see: The nocturnal breathing interruptions not only put acute strain on the heart, but also damage it in the long term. It is therefore important to take warning signs such as constant snoring, unexplained daytime tiredness or high blood pressure in the morning seriously and have them checked out by a doctor.

In addition to the effects on the heart and circulation, untreated sleep apnoea can also significantly affect the metabolism. The sugar metabolism in particular reacts sensitively to continuous nocturnal breathing interruptions. Due to the lack of oxygen and the repeated stress reactions, the body releases increased amounts of stress hormones such as cortisol and adrenaline. These hormones have a negative effect on the glucose balance and promote the development of insulin resistance - i.e. a reduced effect of the body's own insulin. Insulin resistance is considered to be one of the main precursors of type 2 diabetes.

Studies confirm that patients with obstructive sleep apnoea have a significantly increased risk of developing this form of diabetes:

Meta-analysis in "Chest"

for people with obstructive sleep apnoea:

• an increased risk of developing type 2 diabetes by 35 % (regardless of body mass index or other concomitant factors)
• a clear correlation between the severity of OSA and diabetes risk

Source: "Obstructive sleep apnea and type 2 diabetes: a bidirectional relationship?"

Prospective cohort study

revealed the following results in three large US cohort studies with 146,519 participants:

• People with OSA had a 37 % increased risk of a type 2 diabetes diagnosis
• Effect was independent of BMI and waist circumference
• Significantly higher incidence of diabetes in OSA with excessive daytime sleepiness

Source: "A Population-Based Study of the Bidirectional Association Between Obstructive Sleep Apnea and Type 2 Diabetes in Three Prospective U.S. Cohorts"

Furthermore, if you already have diabetes, sleep apnoea can make it more difficult to control your blood sugar levels and therefore increase the risk of secondary damage.

Other metabolic processes are also impaired: The fat metabolism becomes unbalanced, which can lead to an increase in cholesterol and triglycerides. In combination with obesity - which is often present with sleep apnoea - this creates a vicious circle that endangers health in many ways. Early diagnosis and treatment of sleep apnoea can help to prevent or control these metabolic disorders.

Non-restorative sleep due to breathing interruptions at night has a direct impact on alertness and responsiveness during the day - with sometimes serious consequences for safety in everyday life. People with untreated sleep apnoea often suffer from severe daytime sleepiness and microsleep. This poses a particularly high risk in road traffic.

Reduced concentration can also be dangerous in the working environment - for example when working with machines, at heights or in safety-relevant professions such as transport, construction or care. The risk of accidents increases not only due to reduced reaction speed, but also due to limited decision-making ability and resilience.

The link between untreated sleep apnoea and an increased risk of accidents is so clear that it also has legal and insurance relevance - for example in terms of fitness to drive. Anyone who suffers from severe daytime sleepiness should definitely have a medical assessment carried out, not least to avoid putting themselves and others in unnecessary danger.

The effects of untreated sleep apnoea can also have a significant impact on sexuality. Those affected often report a loss of libido or a general decline in sexual performance. These problems do not occur in isolation, but are closely linked to the physical and hormonal changes caused by disturbed sleep.

The nocturnal breathing interruptions constantly disrupt sleep, which disrupts the production and release of important hormones - including testosterone, which plays a central role in sexual desire and erectile function. Men with obstructive sleep apnoea often have significantly lower testosterone levels. At the same time, the constant drops in oxygen levels and the activation of the stress system (sympathetic nervous system) have a negative impact on blood circulation - another factor that can lead to potency problems.

Psychological aspects also play a role: chronic fatigue, irritability and weakened self-esteem have an additional negative impact on sex life.

In women, sleep disorders can also lead to reduced sexual desire, vaginal dryness and arousal difficulties.

If the voice sounds rough, hoarse or brittle for more than 2-3 weeks and this does not improve, this can be a typical early symptom of a growing tumour in the vocal cord area. The change in voice is often initially dismissed as a "cold symptom", even though there are no signs of infection.

Many affected patients report a persistent feeling as if something is stuck in their throat - even though no foreign body can be objectively detected. This unpleasant sensation is often accompanied by a constant urge to clear the throat and the impression of not being able to swallow properly. This symptom is particularly typical of tumours that are located above the vocal cords in the so-called supraglottic area of the larynx.

Pain or an unpleasant feeling of pressure when swallowing are other possible indications of a larger or already advanced tumour in the larynx. In some cases, the pain radiates into the ear - a phenomenon caused by the fact that certain nerves in the neck and head area are connected to each other and can therefore transmit pain stimuli.

A subjective feeling of tightness in the larynx, which often occurs without any recognisable cause, can be an early warning sign of a pathological change. Many sufferers report that they repeatedly choke or have the feeling that they cannot breathe properly - symptoms which, on closer examination, may indicate a growing tumour in the larynx.

If the tumour narrows the airways, it can lead to noticeable shortness of breath - initially during physical exertion, and later also at rest. Stridor, an audible, whistling breathing noise that occurs when breathing in or out, also frequently occurs. Such symptoms usually indicate an advanced stage of the disease and require very rapid medical intervention.

A persistent, dry irritating cough can also be an early sign of laryngeal carcinoma - especially if there is no typical cause such as a Cold or an allergy can be found.

In advanced stages of cancer, non-specific general symptoms such as unintentional weight loss, persistent fatigue and loss of appetite may occur. These symptoms often indicate systemic involvement of the body or pronounced tumour activity.

If the laryngeal carcinoma forms metastases in the lymph nodes, firm, painless lumps can often be felt on the side or front of the neck. In some cases, these swellings can even be the first externally recognisable sign of the disease - even if the actual tumour in the larynx is not yet causing any noticeable symptoms.

Not all of these symptoms automatically mean cancer - but persistent symptoms, especially hoarseness over several weeks, should definitely be treated by a doctor at our ENT clinic in Frankfurt have it checked. Early diagnosis significantly improves the chances of recovery.

Surgical removal of the carcinoma is a key treatment method, especially for well-defined or smaller tumours. There are various surgical options:

• Transoral laser surgery
  Small tumours, especially on the vocal cords, can often be removed minimally invasively through the mouth using a laser - tissue-sparing and often preserving the voice.
• Partial laryngectomy
  In intermediate tumour stages, only part of the larynx is removed in order to preserve speech and breathing as much as possible.
• Total laryngectomy (complete removal of the larynx)
  In advanced cases, complete removal of the larynx may be necessary. Breathing then takes place permanently via a tracheostoma (artificial opening in the throat). In many cases, the voice can be restored with special aids (e.g. voice prosthesis).

Radiotherapy is particularly suitable for smaller tumours or if surgery is not possible or not desired. Radiotherapy may also be necessary after a surgical procedure if, for example, not all tumour cells could be removed.

Chemotherapy is often used in combination with radiotherapy (radiochemotherapy), especially for advanced tumours. It can attack tumour cells throughout the body and thus also combat microscopically small metastases. Chemotherapy alone is usually only used for inoperable or metastasised tumours.

New treatment methods such as immune checkpoint inhibitors can be used for advanced or incurable laryngeal cancer. They specifically strengthen the body's own immune system against the tumour cells and are mainly used in palliative treatment.

After treatment - especially after surgery - accompanying measures are often necessary to maintain or improve speech, swallowing and quality of life. Speech therapy in particular plays a central role here.