Question:

I have had Sjögren’s for over twenty years and every year I get sinus infections that last for several weeks at a time.  Are sinus infections common in Sjögren’s and is there anything that I can do to prevent them?

Answer:

Nasal dryness is often seen in patients with Sjögren’s.  This may lead to nasal crusting and/or nosebleeds.  Nearly one half of patients with Sjögren’s syndrome have thinning of the skin/lining of the inside of the nose.  Septal perforation may also occur which may exacerbate problems with crusting and bleeding.  Patients may also notice a diminished sense of smell and/or taste.  An increased incidence of chronic sinusitis may occur secondary to dried secretions blocking sinus outflow tracts.

Treatment is aimed at re-establishing clearance of secretions using nasal saline irrigations.  Nasal moisturizing agents such as sesame oil and other commercially available products may also be useful to treat and prevent crusting and nosebleeds. Some patients have had success by moisturizing with petroleum based products e.g. Vaseline, Polysporin/Polytopic ointments.  However, these should be used in limited quantities.

Question:

My voice is hoarse more often than not and frequently my throat hurts when I talk.  It doesn’t take much talking before I lose my voice.  It has affected my work negatively.  I’ve been told by my Rheumatologist that hoarseness and throat soreness is expected in Sjögren’s because of dryness and there is nothing that can be done for me.  Are there any tips that can improve my hoarseness and relieve some of the pain in my throat?

Answer:

Hoarseness and voice problems are not uncommonly seen in patients with Sjögren’s syndrome.  Often patients have complaints of diminished voice quality but clinical examination reveals little or no significant pathology.  This type of intermittent hoarseness is believed to be caused by immune complex deposition in the submucosa of the vocal cords.  Rarely, various types of nodules are seen on laryngoscopy including various granulomatous and non-granulomatous nodules.  A classic finding termed a bamboo node is occasionally encountered on laryngoscopy as a white transverse sub-mucosal lesion in the middle third of the vocal cord.  Hoarseness in Sjögren’s patients may also be related to decrease mucosal secretions/dryness as well as some findings which may be related to laryngopharyngeal reflux.

Therapy is often aimed at treatment of the systemic cause as well as symptomatic treatment such as hydration and vocal hygiene (hydration, limiting overuse, limiting harmful activities such as forceful coughing and throat clearing and staying away from harmful substances such as caffeine, smoke , alcohol, etc.)

*excerpt taken from SjSC “Connections” Newsletter, Volume 1, Issue 1*

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