An occasional stuffy nose due to allergies or infection can be annoying or difficult to manage. But if you are experiencing chronic nasal congestion that is also impacting your sleep and ability to breathe, it may be a sign of something more serious—nasal polyps. However, it is easy to mistake the symptoms of nasal polyps for other conditions, including allergies, a deviated septum, or chronic sinusitis.
Madeleine Schaberg, MD, Director of Rhinology and Skull Base Surgery
In this Q&A, Madeleine Schaberg, MD, Director of Rhinology and Skull Base Surgery at New York Eye and Ear Infirmary of Mount Sinai, defines nasal polyps, the indications you might have them, and why it’s important to seek a diagnosis and treatment quickly.
“There is a lot of overlap between symptoms,” explains Dr. Schaberg, who is also Assistant Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai. “Furthermore, polyps tend to grow gradually, which means the symptoms can be somewhat insidious until you reach a tipping point. Many people live with nasal polyps for years before receiving a diagnosis.”
What are nasal polyps? Nasal polyps are benign, inflammation-related growths that occur in the nose and sinuses. One of the most common causes is environmental allergies, but they are also associated with diseases such as aspirin exacerbated respiratory disease and eosinophilic granulomatosis with polyangiitis. In some cases, nasal polyps can also be the result of caustic environmental exposures, such as construction sites or toxins exposures. Although nasal polyps are often soft and painless, they can become swollen or irritated and result in sinus blockages that can have serious impacts on your quality of life.
How do I know if I have nasal polyps? Two prominent symptoms are associated with nasal polyps: congestion and loss of smell. The degree of congestion is often serious enough that it becomes difficult to breathe through the nose. Human beings are obligate nasal breathers, which means we are much more comfortable breathing through the nose. Polyps create an obstruction, which typically leads to breathing through the mouth, which is very uncomfortable. It can also lead to several issues that can affect your overall health and well-being, such as sleep apnea, frequent sinus infections, and increased frequency of asthma attacks.
How are nasal polyps diagnosed? If you think the symptoms that you are experiencing are associated with nasal polyps, see an ear, nose and throat (ENT) specialist for a consultation. This will typically involve an examination, a review of your medical history, and a nasal endoscopy. Endoscopy is the best in-office diagnostic tool we have to determine what is going on. It enables us to evaluate all the structures of the nasal cavity in a safe, easy manner without causing discomfort and then proceed based on what we find.
What are my treatment options for nasal polyps? There are several treatment options depending on the severity of your polyps:
For mild cases, a steroid spray is often effective in reducing polyp size and relieving symptoms.
For more severe cases, oral steroids may be prescribed.
If topical and oral steroid treatments are not effective, and the nasal polyps are extensive, surgical removal may be recommended as a therapeutic approach. This is typically done in an outpatient center through minimally invasive endoscopic surgery.
There is also the option of treatment with a biologic medication, such as Dupixent® (dupilumab), which is administered by injection under the skin once every two weeks.
In many cases, patients will receive some combination of these treatments, and then continue treatment with a topical steroid or biologic medication following surgical removal. It is best to think of nasal polyps as a kind of long-term problem, like having high blood pressure. It will be different for every patient, but many require topical steroids, oral steroids, and surgery as an adjunct, along with a biologic medication.
How can I prevent nasal polyps from recurring? For the most part, maintenance medications, such as topical steroids and biologics, provide the best protection against recurrence. However, nasal polyps are a chronic condition, one that requires regular follow-ups with an ENT specialist to check for signs of regrowth. Furthermore, patients who use topical steroids for maintenance should also be assessed annually by an ophthalmologist for changes in eye pressure related to their medication. As with any condition, early detection and treatment of nasal polyps is ideal. However, a later diagnosis or extreme severity in disease should not ultimately affect the outcomes that you can achieve. The medications, treatments, surgery—everything we offer for polyps—works well at many stages in the course of the disease. The important thing is to see your primary care provider or an ENT specialist if you think you have symptoms.
Both psychiatric disorders and disorders of the reproductive system are common in women of reproductive age. Often, they co-occur. “There is a lot of overlap between these two disease classes—but very little research into why that is,” says Nina Zaks, MS, Clinical Research Scientist in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.
She wanted to learn more about that overlap. Together with Magdalena Janecka, PhD, Assistant Professor, Psychiatry, and Genetics and Genomic Sciences, and other colleagues, she spearheaded a systematic review and meta-analysis to probe the association between mental health and reproductive system disorders in women. Their paper was published in JAMA Network Open in April.
The analysis revealed some interesting patterns—and shone a light on how much more remains to be discovered.
Psychiatric and Reproductive System Disorders: Increased Odds
Nina Zaks, MS
The analysis included 50 qualitative and quantitative studies, each of which explored co-occurring psychiatric diagnoses and reproductive system disorders. The research team cast a wide net, considering a range of psychiatric diagnoses including depression, anxiety, psychosis, and neurodevelopmental disorders such as autism. On the reproductive system side, the team looked into diagnoses such as inflammatory diseases of the female pelvic organs, non-inflammatory disorders of the genital tract, and ovarian dysfunction.
The overlap between the disease classes, they found, is significant. In women with polycystic ovary syndrome (PCOS) and chronic pelvic pain, for instance, the odds of affective disorders were approximately 1.7 to almost four times greater than in women without the disorders. But the team also showed that the overlap between many other psychiatric and reproductive disorders simply has not been studied yet, revealing a considerable gap in knowledge, with potentially serious implications for women’s health.
Overall, the literature shows that women with reproductive system disorders have two to three times the odds of having psychiatric disorders compared to women without those conditions. “We see comorbidity between psychiatric and reproductive disorders everywhere we look,” Dr. Janecka says. “Despite that, there is so much about that comorbidity that has not yet been studied. It’s an urgent research priority to address this.”
Looking for Links in Mental Health and the Reproductive System
What can account for the overlap? Unfortunately, most studies in this area don’t dig into the possible causes, according to the researchers.
Scientists have suggested a number of possible explanations for the association between reproductive system and mental health disorders. For example, stress and quality of life factors associated with mental illness could affect menstrual cycles and reproductive function. Psychiatric medications might interfere with reproductive function. It’s also possible that some underlying genetic causes contribute to both types of disorders.
Though much more research is needed, there are reasons to suspect biological causes for the connection, at least in some cases. “From a mechanism standpoint, it makes sense. Many psychiatric diagnoses present differently between females and males, possibly due to a hormonal component,” Dr. Janecka notes. “Better understanding this connection will provide us with some insight into these mechanisms, while also improving quality of life for patients.”
Polycystic Ovary Syndrome: PCOS and Depression
Magdalena Janecka, PhD
Among the studies that Dr. Janecka’s team analyzed, the largest portion focused on PCOS. Those studies showed that women with PCOS have an increased rate of depression, anxiety disorders, and bipolar disorder.
PCOS is relatively common, affecting as many as 5 to 10 percent of women of reproductive age. The condition is associated with symptoms such as infertility, obesity, acne, and excessive hair growth. One explanation for the increased risk of psychiatric diagnoses in women with PCOS is that those symptoms interfere with quality of life or body satisfaction and self-esteem. However, some emerging evidence suggests that is only part of the story, the researchers found.
The studies suggest that obesity and infertility appear to exacerbate psychiatric symptoms in women with PCOS, but don’t fully explain them. Indeed, genetic factors may play a role in both conditions. In a twin study, for instance, researchers found that the risk of depression was higher not only in people with PCOS, but also in the twin who did not have the syndrome. That implies a possible genetic cause that might increase the risk of both conditions.
Chronic Pelvic Pain
Another subset of the research the team examined focused on chronic pelvic pain. The condition affects one in seven women in the United States. In some cases, the pain can be traced to problems such as endometriosis. But for many women, the cause of their chronic pelvic pain remains elusive.
Unsurprisingly, chronic pelvic pain is associated with significantly higher rates of depression, the researchers found. Physical pain may not be the only explanation, however. “A number of studies showed that women who had chronic pelvic pain had an increased rate of childhood sexual trauma,” Ms. Zaks says. “This might point toward an environmental explanation for the increased rate of psychiatric diagnoses.”
Psychiatric Research at Mount Sinai and Beyond
Learning more about the shared mechanisms might help researchers better understand the development of both psychiatric and reproductive system disorders and could point to new directions for treatment.
The findings also suggest that physicians should do more to screen for and treat co-occurring disorders. “It may be that if you address a patient’s reproductive problems, psychiatric treatments may be more successful,” Dr. Janecka says.
The two researchers plan to continue exploring some of these associations in greater detail, but they hope they won’t be the only ones to dig deeper. “We know this association exists, and we know there’s a gap in the research. The data are there, just waiting to be studied,” Ms. Zaks says.
“One of the main things that struck us is how little is known,” Dr. Janecka adds. “This is just the starting point.”
Pride Month, which fell on June, was a time for celebration, reflection, and remembrance of LGBTQ+ struggles and achievements. Throughout the United States’ history, the LGBTQ+ community has faced various health challenges and inequities, from the HIV/AIDS epidemic in the 1980s to the mpox outbreak last year.
Although LGBTQ+ individuals’ access to health care has improved compared to decades prior, various health concerns and disparities remain pertinent, says Erick Eiting, MD, MPH, Medical Director for the Emergency Department at Mount Sinai Beth Israel and for the Urgent Care Center at Mount Sinai-Union Square.
During Pride Month, Dr. Eiting and Antonio Urbina, MD, Medical Director of the Institute of Advanced Medicine, discussed health topics LGBTQ+ individuals should keep in mind, even as they celebrate the progress that has been made.
STI Testing: What’s Important?
Who should be thinking about getting tested for sexually transmitted infections (STIs)? Anyone who is sexually active should be considered for sexual health screening, although some groups may be more at risk, says Dr. Urbina.
While there is no hard rule for how often one should get tested, health providers at Mount Sinai offer screening every three months. These should include not only testing at genital sites, but also others including the throat and anal/rectal regions.
“That’s especially important because oftentimes, someone can have an STI in those compartments and they don’t have any symptoms at all,” says Dr. Urbina, “so the only way that you’re going to be able to detect them is if you actually swab or screen those areas as well.”
Common tests for gonorrhea, chlamydia, and syphilis help detect infection and initiate treatment if needed. But other important tests include those for HIV, meningococcal meningitis, and human papillomavirus for vaccination and preventive purposes, Dr. Urbina adds.
HIV: Counseling, Testing, Treatment, Management
As it is hard to know, through initial conversations, which patients might be at risk for HIV, it is incredibly important for health providers to make sure they are not using judgmental language or biases during their interactions, says Dr. Eiting.
“It’s really important for everybody to know their status,” notes Dr. Eiting.
Telling someone that they are HIV-positive when they don’t already know is probably one of the most difficult conversations to have, he adds.
It is really important for people to know that having HIV is considered by the medical community these days as a chronic disease that is oftentimes well-managed with medication, Dr. Eiting says. It is also important for them to have a support system in place so that they may transition into living their lives with the condition, since HIV isn’t the same kind of disease that it was decades ago.
It is important for people who test negative for HIV to consider the possibility of being on pre-exposure prophylaxis, or PrEP. In addition to a daily pill that can be taken, there is now a long-acting injectable PrEP that is given every two months by intramuscular injection into the buttocks.
“I think it’s all about empowering patients to taking steps that best fit their lifestyles for prevention,” says Dr. Urbina.
As a result of advancements in modern medicine, there are now people with HIV living into their 90s, and more attention needs to be placed on this elderly group. They tend to exhibit a little more physical vulnerability and frailty due to having lived with the virus for so long, says Dr. Urbina. More aggressive screening for malignancies or bone density loss are recommended too.
Mental Health and Substance-Use Disorders
LGBTQ+ people have been observed to have higher rates of psychosocial issues, including depression and substance-use disorder, and health institutions need to reach out to serve these communities better, says Dr. Urbina.
What is PrEP?
Pre-exposure prophylaxis, or PrEP, is a pill or injection that lowers the risk of getting HIV from sex by about 99 percent, according to the Centers for Disease Control and Prevention. Using PrEP, however, does not prevent other sexually transmitted infections (STIs).
“I think it’s important for us to sometimes take pause and take stock and remember that even though Pride Month is a month of celebration, and to acknowledge how far we’ve come, we have to remind ourselves that it can often be a time when it really enhances isolation for patients who are feeling that as well,” says Dr. Eiting.
Seeking help for mental health or addiction can be daunting for patients due to stigma. But health providers at clinics across the city, including at Mount Sinai, are being trained to make access comfortable and judgment-free, and so patients should not hesitate to tap those resources when needed, Dr. Eiting says.
Affirming Across the Entire Spectrum
Even though the L in LGBTQ+ comes first, the lesbian community can sometimes be forgotten with respect to health care, notes Dr. Eiting. It is important for health providers to be aware of things like breast cancer or cervical cancer screening for this population.
Studies suggest that some lesbian and bisexual women get less routine health screenings than their heterosexual counterparts due to various factors, including fear of discrimination or low rates of health insurance.
Transgender health care encompasses not just gender-affirming surgeries, but also primary care. For transgender patients, sometimes seeking health care can be stressful because if the conversations are not conducted in a respectful way, they can cause dysphoria.
But stigma should not get in the way of having people live their fullest lives, and transgender individuals should take stock of what their health needs are and have conversations with their doctors, says Dr. Urbina.
Given the current climate of anti-transgender sentiment and legislation across the country, health providers should acknowledge that these developments do leave an impact on their transgender patients. “It’s just important for us to acknowledge that that’s out there… and to make sure that we’re using principles of trauma-informed care whenever we’re talking to our patients about their health care,” says Dr. Eiting.
Read more about how Mount Sinai is empowering health care for LGBTQ+ communities
How to Find an LGBTQ+ Experienced Medical Provider and Why That’s Important
Clearing Misconceptions About Gender-Affirming Care for Transgender and Gender-Diverse People
It’s the time of year when you and your kids may head to the pool to beat the heat. But for some people, swimmer’s ear may ruin the fun. Aldo Londino, MD, Assistant Professor of Pediatric Otolaryngology at the Mount Sinai Health System and Chief of the Division of Pediatric Otolaryngology at the Mount Sinai Kravis Children’s Hospital, explains the pesky condition, its treatment, and how parents can best guard against it.
What is swimmer’s ear and how would my child contract it?
Swimmer’s ear is the name commonly given to an infection of the ear canal, also known as acute otitis externa. This infection can happen at any time of the year but tends to peak in the summer months as people spend more time in the water. Lingering moisture in the ear canal after swimming can create an environment in which bacteria love to grow. Swimming can also wash away healthy ear wax that protects the ear canal from infections.
How is swimmer’s ear different than a ‘regular’ ear infection?
When people mention an ear infection, they are often speaking of a middle ear infection. Also known as acute otitis media, this is an infection behind the eardrum. It is often treated with antibiotics by mouth unless the child has ear tubes, is most common in very young children, and is often associated with an upper-respiratory-tract infection. A middle ear infection is not caused by bath water or pool water getting into the ears because the eardrum keeps the water from getting inside the body.
How do I know if my child has swimmer’s ear or a middle ear infection?
Children may have swimmer’s ear if they complain of pain and the ear canal has drainage or appears swollen. Often a light tug backwards and upwards on the outer ear will produce pain in the ear canal. Swimmer’s ear infections usually do not cause a fever.
Your child may have a middle ear infection if there is pain with a bulging ear drum on your pediatrician’s exam. There can sometimes also be drainage if the build-up of pus has leaked through the eardrum; however, the ear canal should not be swollen. Children with a middle ear infection also often have a fever or a cold associated with the infection.
Is the treatment for swimmer’s ear different?
Yes. Swimmer’s ear should be treated with ear drops alone. In fact, the ear drops often help faster and do a much better job at treating the infection than antibiotics taken by mouth. From time to time, the ear canal may be too swollen or have too much drainage for the ear drops to enter. A trip to the ear, nose, and throat doctor may be necessary in these instances to help remove excess drainage or place a small sponge in the ear to allow the ear drops to enter and work effectively. If your child is in pain, you can give them acetaminophen or ibuprofen.
What can I do to prevent my child from contracting swimmer’s ear?
If your child suffers from frequent swimmer’s ear, you may want to consider using earplugs to limit the amount of water getting into the ear canal. A hairdryer on a low cool setting after swimming can also help dry up excess water and reduce the frequency of swimmer’s ear infections.
Aldo Londino, MD, is an Assistant Professor of Pediatric Otolaryngology at the Mount Sinai Health System and is Chief of the Division of Pediatric Otolaryngology at the Mount Sinai Kravis Children’s Hospital.
Uterine fibroids are very common, becoming more common as women age into their 30s and 40s. Fibroids are benign muscle knots or muscle tumors in the uterus, and they may or may not cause any symptoms depending on their size and their location. By age 50, between 20 to 80 percent of women will have developed fibroids, according to the U.S. Office on Women’s Health.
In this Q&A, Anne Hardart, MD, Co-Director of Urogynecology at Mount Sinai West, answers frequently asked questions about fibroids and treatment options.
Q: What are the symptoms?
The symptoms of fibroids depend on their size and their location. Very small fibroids in the muscle or on the outside of the uterus may never cause any symptoms. Fibroids that are large— they can get up to the size of a melon or even more—may cause pressure symptoms. Fibroids that are inside the uterus can cause heavy periods, irregular bleeding, and cramping. As fibroids grow, they can be uncomfortable or make a person urinate more frequently. However, if fibroids are not causing symptoms, they may not require any treatment, and they are very common, probably present in about 50 percent of women.
Q: Can fibroids cause fertility issues?
While fibroids often are not cause for concern, fibroids can make it difficult to become pregnant for women who are trying to conceive. Not all fibroids cause infertility, but for fibroids that affect the inside cavity of the uterus, it is often recommended that the fibroids be removed if someone is experiencing infertility. Fibroids also can cause difficulties during pregnancy, such as significant pain and increasing the risk of preterm delivery or miscarriage in some cases.
Q: How are uterine fibroids diagnosed?
You may not even know you have fibroids, and that is okay because they are not dangerous or cause for concern if they are not causing any symptoms. However, if you are having symptoms such as abnormal bleeding or pain and you think it may be related to fibroids, your doctor will probably do a pelvic exam and may order an ultrasound or an MRI.
Q: What are the treatment options?
There are many types of treatments for fibroids, and your doctor will work with you to determine the best treatment plan for your situation. Treatment options depend partly on the symptoms.
If the symptoms are abnormal bleeding, that may mean hormonal treatment with low-dose birth control pills, a progesterone IUD, or other medications to help manage heavy bleeding and reduce cramping as well as slowing the growth of fibroids.
For symptoms that are moderate to severe, treatment may mean a surgical procedure, such as removing fibroids (myomectomy) or even the uterus (hysterectomy), often in a minimally invasive way. Minimally invasive surgical approaches include hysteroscopy, which involves inserting a camera into the uterus through the cervix, and laparoscopy, which involves inserting a camera into the abdomen through the belly button.
Symptoms related to pressure, or the bulk of large fibroids, can be managed with medications, a radiologic procedure called embolization, and surgery. Medications that shrink fibroids, such as gonadotropin releasing hormone agonists (GnRHa), are typically given by injection, but newer oral medications are also available. These medications also may be used prior to surgery to make fibroid removal easier. The surgical options for large fibroids are myomectomy and hysterectomy.
If you know you have fibroids, you should probably see your doctor every year, or more frequently if you are having symptoms such as heavy bleeding or pressure symptoms.
With children, it’s never too early to start practicing good sun protection behaviors. In fact, exposure to ultraviolet radiation and a history of sunburns during childhood greatly increases your risk of developing skin cancer later in life.
Nanette Silverberg, MD, Director of Pediatric Dermatology, Mount Sinai Health System, shares some tips for protecting your child’s skin, which is especially important during the warmer months when they may spend so much more time outside in the sun.
Nanette Silverberg, MD, Director of Pediatric Dermatology
Here are five basic steps you should take:
Look for sunscreens that have a sun protection factor (SPF) of 30-50+ and that say they provide “broad spectrum” coverage, meaning they protect against both UVA and UVB radiation. UVA rays have less energy and are mostly linked to long-term skin damage, such as wrinkles, while UVB rays are the ones that cause sunburns, which are thought to cause most skin cancers, according to the American Cancer Society.
Sunscreens should be applied 30 minutes before going outside for the day and then reapplied every two hours.
Sunscreens should be reapplied after swimming or heavy sweating, as they are not waterproof.
In addition to sunscreen, children should wear a wide-brimmed hat and sun protective clothing (UPF 50) such as swim shirts or rash guard shirts. These shirts typically block 98 percent of ultraviolet radiation, according to the Centers for Disease Control and Prevention.
Stay in the shade as much as possible, and avoid the mid-day sun during its peak hours of intensity from 10 am to 2 pm.
Even if you apply sunscreen and practice good sun care, your child may still get a sunburn. What should a parent do to minimize the sting?
Dr. Silverberg, suggests applying a cold compress, or bathing your child in cool water. Over-the-counter hydrocortisone one percent cream can also be helpful to ease red, itchy, or tender skin and help with inflammation. Hypoallergenic moisturizers can soothe the skin.
If the sunburn is painful or widespread, talk with your pediatrician about whether taking ibuprofen is appropriate for older children. If you notice any blistering, you should consider consulting with a pediatric dermatologist. Follow up to check for sun damage and be extra careful with sun protection on healing skin.
Post-pool skincare is also extremely important, especially for young children. Dr. Silverberg says most children tolerate chlorinated water, but she recommends rinsing off after the pool and applying light emollients when coming indoors.
Skincare also includes applying therapies afterwards for children with eczema, and reapplying sunscreen for outdoor play. Additionally, shirts with UPF should be rinsed with water and left to air dry to help maintain their potency and soft feel.
