Updated: May 6
Dear friends, welcome back to TGIF Dr Euan's blogpost!
This week we are looking at how smoking affects your UPPER airways e.g. your nose and throat areas.
As soon as you inhale tobacco smoke, it starts to irritate your whole upper airway. Irritating gases like ammonia and formaldehyde cause your nose and sinuses to produce more mucus. You become more susceptible to colds and allergies and, eventually, to cancer of the throat and lungs.
Q: What Harmful Substances Does Tobacco Smoke Contain?
In the last century, smoking was widespread and even promoted by doctors for good health! Tobacco companies reaped huge profits selling tobacco and tobacco related products.
Little did they know then, that cigarette smoke contains various harmful / irritants / and what we call carcinogens (cancer causing substances).
Tobacco smoke contains irritating gasses such as ammonia and formaldehyde, which can irritate your airways. This makes your body produce more mucus in response and makes you more likely to develop allergies or a cold, which can increase your chances of also having sinusitis.
Q: What Effect Does Smoking Have On My Nose And Sinuses?
Research has linked not only direct smoking with sinusitis but also second-hand smoke. Smoking can make you more likely to get a sinus infection and also inhibit your body’s ability to fight the illness, and this effect can last for months or even years after you quit smoking.
Your nose and sinuses are lined with tiny hair-like structures called cilia. They move in a rhythmic beat that moves mucus harmlessly down the back of your throat, where it’s swallowed.
Smoking causes cilia to become paralysed, which stops mucus from being able to drain freely. Since your nose and sinuses produce a quart or two of mucus a day, it can quickly build up and create a breeding ground for germs that can cause a sinus infection.
This, combined with your body’s attempt to fight the infection, can cause cilia to be lost. Fortunately, if the microbes are removed and the infection is brought under control, the cilia can regrow and resume their normal function.
A sinus infection can be much more than a short-term annoyance. In cases of chronic sinusitis, symptoms last for 12 weeks or more, despite attempts to treat them, and can cause lingering symptoms including fatigue.
Also, there are additional ENT-related hazards linked to smoking:
1. Chronic sinusitis. If you continue to smoke when you have a sinus infection, you are more likely to develop chronic sinusitis
2. Compromised surgical results. If you need surgery for sinus disease, the results are much worse for smokers
3. Negative effects on senses. Smoking can lead to a decreased sense of taste and smell.
4. Cancer. Prolonged exposure to smoking has been linked to nose and sinus cancers.
5. Second-hand smoke. Secondhand smoke has been linked to snoring, respiratory infections, and ear infections in children.
Q: How Does Smoking Affect My Throat?
Most people who smoke tend to think of smoking as causing heart or lung problems, but that's not all.
Many forget to think about the damage it can also do to the throat.
Smoking irritates the throat, causing it to become dry, red and inflamed. It is also responsible for the development of vocal polyps – small growths on the vocal cords which alter the tone and pitch of the voice. This is serious in itself but even more so if you are a singer or have an occupation that relies on using your voice.
And, on a more serious level, it can lead to oral cancer.
It doesn’t matter whether you smoke cigarettes, cigars, and a pipe or chew tobacco; all of these are harmful and will damage your throat although in varying degrees. The level of damage depends upon the amount of nicotine, tar and other chemicals present in the brand you are smoking.
One of the main side effects of smoking is coughing: you are probably familiar with the term ‘smoker’s cough’ and this is exactly what it means. Cigarette smoke irritates the lining of the throat and airways to the lungs which cause you to cough. It also dries the throat out which makes it difficult to swallow.
And the heat generated from these products burns the throat lining thereby damaging it further.
Another under-recognised problem is the effect of smoking on your voice. Smoking irritates the tissues of the larynx (voice box), causing them to become sore and inflamed. This leads to the condition called laryngitis which can alter the sound of the voice to a hoarse ‘croak’ or a loss of voice altogether.
Q: What about the risk of my developing oral and throat cancer with smoking?
The worst aspect of smoking is the cancer risk it carries.
Smoking causes a wide range of cancers in many areas of the body including the mouth & throat. These upper airway cancers include:
Throat / Oral Cavity
Throat and oral cancers can be caused by many things but by far the biggest risk factor is smoking. And this is even worse when smoking is combined with alcohol. Many smokers enjoy a smoke when having a drink and tend to find that they smoke more when they do so, especially in the company of others. Such behaviour is commonly seen in the pubs and bars where people gather to "Smoke & Drink" to relax and have a good time!
An image of a pack of cigarettes warning of the increased risk of cancer from smoking
But the combination of the two insults (Alchohol & Smoke) to the body further increases the risk of throat or oral cancer.
Basically, it’s the chemicals present in cigarette smoke that contain known carcinogens that are responsible for causing cancer to develop.
Also, smoking has been shown to decrease immune function, which is your body's defence mechanism against diseases. Once you stop smoking, it can take the nose and sinuses several months to several years to get back to normal.
The statistics speak for themselves:
On average, smokers spend 25 per cent more time in the hospital than non-smokers, are twice as likely to die before age 65, and may lose up to 20 minutes of life for every cigarette they smoke.
We ENT doctors see the up-close results of smoking on the nose, sinuses, and throat, so our advice is based on experience:
Smoking and good health don't mix.
Dear friends, smoking is harmful to your overall health, in addition to your nose and sinuses.
If you are experiencing symptoms of sinusitis or laryngitis or prolonged sore throat, do make an appointment today with your GP or ENT Specialist. They can help diagnose the underlying cause of your sinusitis/ laryngitis, which will allow effective treatment of your condition and help you to breathe easier.
If you would like to lookup more detailed studies on the effects of smoking on your health, here are some useful references.
Till next time, have a relaxing SMOKE FREE weekend! TGIF :-)
2. Ridge J. Head and Neck Tumors. 2016 http://www.cancernetwork.com/cancer-management/head-and-neck-tumors.
3. Global Burden of Disease Cancer C. Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2017;3(4):524–548. doi: 10.1001/jamaoncol.2016.5688. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
5. Borio G. Tobacco Timeline. 2004 http://archive.tobacco.org/History/Tobacco_History.html.
10. [Accessed 1/24/2017];The 1964 report on smoking and health. https://profiles.nlm.nih.gov/ps/retrieve/Narrative/NN/p-nid/60.
11. Office on Smoking and Health, N. C. f. C. D. P. a. H. P. [Accessed 1/24/2017];History of the surgeon generals reports on smoking and health. https://www.cdc.gov/tobacco/data_statistics/sgr/history/
12. Medicine, T. I. o. Ending the tobacco problem: A blueprint for the nation. The National Academic Press; 2007. [Google Scholar]
13. Office on Smoking and Health, N. C. f. C. D. P. a. H. P. Current Cigarette Smoking Among Adults in the United States. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/
14. Data, G. H. O. Prevalance of Tobacco Smoking. [Accessed 1/24/2017]. [Google Scholar]
16. Franck C, Budlovsky T, Windle SB, Filion KB, Eisenberg MJ. Electronic cigarettes in North America: history, use, and implications for smoking cessation. Circulation. 2014;129(19):1945–1952. doi: 10.1161/circulationaha.113.006416. [PubMed] [CrossRef] [Google Scholar]
17. Rigotti NA. e-Cigarette Use and Subsequent Tobacco Use by Adolescents: New Evidence About a Potential Risk of e-Cigarettes. Jama. 2015;314(7):673–674. doi: 10.1001/jama.2015.8382. [PubMed] [CrossRef] [Google Scholar]
18. Zhou J, Michaud DS, Langevin SM, McClean MD, Eliot M, Kelsey KT. Smokeless tobacco and risk of head and neck cancer: evidence from a case-control study in New England. Int J Cancer. 2013;132(8):1911–1917. doi: 10.1002/ijc.27839. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
19. Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. Jama. 2014;311(2):183–192. doi: 10.1001/jama.2013.284692. [PubMed] [CrossRef] [Google Scholar]
20. Smokeless Tobacco and Public Health: A Global Perspective. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Institutes of Health; 2014. (NIH Publication No. 14-7983) [Google Scholar]
21. Siddiqi K, Shah S, Abbas SM, Vidyasagaran A, Jawad M, Dogar O, et al. Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries. BMC Med. 2015;13:194. doi: 10.1186/s12916-015-0424-2. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
23. Hashibe M, Brennan P, Benhamou S, Castellsague X, Chen C, Curado MP, et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst. 2007;99(10):777–789. doi: 10.1093/jnci/djk179. [PubMed] [CrossRef] [Google Scholar]
24. Khariwala SS, Carmella SG, Stepanov I, Fernandes P, Lassig AA, Yueh B, et al. Elevated levels of 1-hydroxypyrene and N′-nitrosonornicotine in smokers with head and neck cancer: A matched control study. Head Neck. 2013;35(8):1096–1100. doi: 10.1002/hed.23085. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
25. Winn DM, Lee YC, Hashibe M, Boffetta P. The INHANCE consortium: toward a better understanding of the causes and mechanisms of head and neck cancer. Oral Dis. 2015;21(6):685–693. doi: 10.1111/odi.12342. [PubMed] [CrossRef] [Google Scholar]
26. Wyss A, Hashibe M, Chuang SC, Lee YC, Zhang ZF, Yu GP, et al. Cigarette, cigar, and pipe smoking and the risk of head and neck cancers: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Am J Epidemiol. 2013;178(5):679–690. doi: 10.1093/aje/kwt029. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
27. Wyss AB, Hashibe M, Lee YA, Chuang SC, Muscat J, Chen C, et al. Smokeless Tobacco Use and the Risk of Head and Neck Cancer: Pooled Analysis of US Studies in the INHANCE Consortium. Am J Epidemiol. 2016 doi: 10.1093/aje/kww075. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
28. Hashibe M, Hunt J, Wei M, Buys S, Gren L, Lee YC. Tobacco, alcohol, body mass index, physical activity, and the risk of head and neck cancer in the prostate, lung, colorectal, and ovarian (PLCO) cohort. Head Neck. 2013;35(7):914–922. doi: 10.1002/hed.23052. [PubMed] [CrossRef] [Google Scholar]
29. Hashibe M, Brennan P, Chuang SC, Boccia S, Castellsague X, Chen C, et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev. 2009;18(2):541–550. doi: 10.1158/1055-9965.epi-08-0347. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
30. Dal Maso L, Torelli N, Biancotto E, Di Maso M, Gini A, Franchin G, et al. Combined effect of tobacco smoking and alcohol drinking in the risk of head and neck cancers: a re-analysis of case-control studies using bi-dimensional spline models. Eur J Epidemiol. 2016;31(4):385–393. doi: 10.1007/s10654-015-0028-3. [PubMed] [CrossRef] [Google Scholar]
31. Khariwala SS, Hatsukami D, Hecht SS. Tobacco carcinogen metabolites and DNA adducts as biomarkers in head and neck cancer: potential screening tools and prognostic indicators. Head Neck. 2012;34(3):441–447. doi: 10.1002/hed.21705. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
33. Balbo S, James-Yi S, Johnson CS, O’Sullivan MG, Stepanov I, Wang M, et al. (S)-N’-Nitrosonornicotine, a constituent of smokeless tobacco, is a powerful oral cavity carcinogen in rats. Carcinogenesis. 2013;34(9):2178–2183. doi: 10.1093/carcin/bgt162. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
34. Yuan JM, Koh WP, Murphy SE, Fan Y, Wang R, Carmella SG, et al. Urinary levels of tobacco-specific nitrosamine metabolites in relation to lung cancer development in two prospective cohorts of cigarette smokers. Cancer Res. 2009;69(7):2990–2995. doi: 10.1158/0008-5472.can-08-4330. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
35. Yuan JM, Knezevich AD, Wang R, Gao YT, Hecht SS, Stepanov I. Urinary levels of the tobacco-specific carcinogen N’-nitrosonornicotine and its glucuronide are strongly associated with esophageal cancer risk in smokers. Carcinogenesis. 2011;32(9):1366–1371. doi: 10.1093/carcin/bgr125. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
36. Khariwala SS, Carmella SG, Stepanov I, Bandyopadhyay D, Nelson HH, Yueh B, et al. Self-reported Tobacco use does not correlate with carcinogen exposure in smokers with head and neck cancer. Laryngoscope. 2015;125(8):1844–1848. doi: 10.1002/lary.25290. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
38. Lacko M, Braakhuis BJ, Sturgis EM, Boedeker CC, Suarez C, Rinaldo A, et al. Genetic susceptibility to head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2014;89(1):38–48. doi: 10.1016/j.ijrobp.2013.09.034. [PubMed] [CrossRef] [Google Scholar]
39. Riaz N, Morris LG, Lee W, Chan TA. Unraveling the molecular genetics of head and neck cancer through genome-wide approaches. Genes Dis. 2014;1(1):75–86. doi: 10.1016/j.gendis.2014.07.002. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
40. Lao Y, Yu N, Kassie F, Villalta PW, Hecht SS. Analysis of pyridyloxobutyl DNA adducts in F344 rats chronically treated with (R)- and (S)-N′-nitrosonornicotine. Chem Res Toxicol. 2007;20(2):246–256. doi: 10.1021/tx060208j. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
41. Hecht SS, Spratt TE, Trushin N. Evidence for 4-(3-pyridyl)-4-oxobutylation of DNA in F344 rats treated with the tobacco-specific nitrosamines 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone and N′-nitrosonornicotine. Carcinogenesis. 1988;9(1):161–165. [PubMed] [Google Scholar]
42. Wang M, Cheng G, Sturla SJ, Shi Y, McIntee EJ, Villalta PW, et al. Identification of adducts formed by pyridyloxobutylation of deoxyguanosine and DNA by 4-(acetoxymethylnitrosamino)-1-(3-pyridyl)-1-butanone, a chemically activated form of tobacco specific carcinogens. Chem Res Toxicol. 2003;16(5):616–626. doi: 10.1021/tx034003b. [PubMed] [CrossRef] [Google Scholar]
43. Stepanov I, Muzic J, Le CT, Sebero E, Villalta P, Ma B, et al. Analysis of 4-hydroxy-1-(3-pyridyl)-1-butanone (HPB)-releasing DNA adducts in human exfoliated oral mucosa cells by liquid chromatography-electrospray ionization-tandem mass spectrometry. Chem Res Toxicol. 2013;26(1):37–45. doi: 10.1021/tx300282k. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
44. Hecht SS, Stepanov I, Carmella SG. Exposure and Metabolic Activation Biomarkers of Carcinogenic Tobacco-Specific Nitrosamines. Acc Chem Res. 2016;49(1):106–114. doi: 10.1021/acs.accounts.5b00472. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
45. Zhang S, Wang M, Villalta PW, Lindgren BR, Upadhyaya P, Lao Y, et al. Analysis of pyridyloxobutyl and pyridylhydroxybutyl DNA adducts in extrahepatic tissues of F344 rats treated chronically with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone and enantiomers of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol. Chem Res Toxicol. 2009;22(5):926–936. doi: 10.1021/tx900015d. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
46. Ma B, Ruszczak C, Jain V, Khariwala SS, Lindgren B, Hatsukami DK, et al. Optimized Liquid Chromatography Nanoelectrospray-High-Resolution Tandem Mass Spectrometry Method for the Analysis of 4-Hydroxy-1-(3-pyridyl)-1-butanone-Releasing DNA Adducts in Human Oral Cells. Chem Res Toxicol. 2016;29(11):1849–1856. doi: 10.1021/acs.chemrestox.6b00254. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
47. Chen AM, Chen LM, Vaughan A, Sreeraman R, Farwell DG, Luu Q, et al. Tobacco smoking during radiation therapy for head-and-neck cancer is associated with unfavorable outcome. Int J Radiat Oncol Biol Phys. 2011;79(2):414–419. doi: 10.1016/j.ijrobp.2009.10.050. [PubMed] [CrossRef] [Google Scholar]
48. Hatcher JL, Sterba KR, Tooze JA, Day TA, Carpenter MJ, Alberg AJ, et al. Tobacco use and surgical outcomes in patients with head and neck cancer. Head Neck. 2016;38(5):700–706. doi: 10.1002/hed.23944. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
49. Marin VP, Pytynia KB, Langstein HN, Dahlstrom KR, Wei Q, Sturgis EM. Serum cotinine concentration and wound complications in head and neck reconstruction. Plast Reconstr Surg. 2008;121(2):451–457. doi: 10.1097/01.prs.0000297833.53794.27. [PubMed] [CrossRef] [Google Scholar]