Dear Doctors: My nose has been plugged up for a few weeks from a sinus infection. Now my left ear is feeling full, and sounds are muffled. Can that be related? My dad says yes. (He has GERD, and he says it has affected his hearing.) GERD is so different from a sinus infection that I don’t see the connection.

Dear Reader: You are correct that GERD and a sinus infection are different conditions. Gastroesophageal reflux disease, commonly called GERD, is a digestive disorder. When the acidic contents of the stomach come back up into the esophagus and beyond, it can irritate the delicate tissues. A sinus infection is an upper respiratory condition. The hollow, air-filled spaces in the bones above and around the nose become inflamed. This can be due to a viral or bacterial infection, or in response to allergens or other airborne irritants.

However, your father is also correct. Both GERD and a sinus infection can have an adverse effect on hearing. The upper respiratory and upper digestive tracts cross paths anatomically with the middle ear in the nasopharynx, an area in the upper part of the throat. The structures of the middle ear connect to the nasopharynx by the eustachian tubes. These are narrow, hollow canals that help regulate air pressure in the middle ear. As you swallow, chew or yawn, a pair of muscles located in the soft palate contract. This briefly opens a valve within the eustachian tubes. This allows air to flow in or out, depending on the atmospheric pressure.

The acid reflux of GERD can surge beyond the esophagus and reach the throat. When this occurs, the corrosive liquids can cause inflammation and swelling at the opening to the eustachian tubes. In addition to equalizing pressure, the eustachian tubes allow mucus and fluids that collect in the ear to drain into the throat. The narrowing of the tubes associated with GERD can cause the tubes to become blocked, muffling sound and setting the stage for infection.

The same principles apply to a sinus infection. The inflammation and buildup of mucus that occurs in a sinus infection can block the tubes. This type of blockage is known as obstructive eustachian tube dysfunction. Symptoms include the sensation of fullness and diminished hearing that you describe. Some people hear popping or clicking sounds, develop tinnitus, have problems with balance, or experience discomfort or even pain. A prolonged blockage increases the risk of middle ear infections.

Clogged eustachian tubes can respond to home remedies. These include chewing gum, yawning, the use of a saline spray or rinse, or decongestants or antihistamines. If symptoms continue for more than two weeks, it would be a good idea to seek medical care. Clinical evaluation may include tests to assess whether the tubes are functioning properly. If a sinus infection is causing the obstruction, medications may be prescribed to treat the infection.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: We have three kids in school, and they’re not always happy with the lunches I’ve been packing. Our 7-year-old is the easiest -- he loves his PB&J. But his 9- and 13-year-old brothers are a lot harder. You have mentioned you are parents. How do you deal with school lunch?

Dear Reader: As moms who plan and pack school lunches, your question resonates with both of us. Making sure that kids eat a nutritious and well-balanced lunch is important. A good midday meal supports physical growth, provides energy, improves mood and focus, and bolsters cognitive development. It can also be a pleasurable bright spot in an otherwise long and regimented school day. Yet cracking the code of a healthful lunch that kids will actually enjoy can be a challenge.

The school lunch dilemma is not surprising. Children’s food preferences typically expand and change as they grow older. Don’t be surprised if one day your 7-year-old suddenly rejects the peanut butter and jelly sandwiches keeping him happy right now. The environment of the lunchroom, which can be noisy, chaotic and sometimes rushed, can also make mealtime less than appetizing. Add in the dictates of peer pressure, social media food fads and the siren call of ultra-processed foods, and getting your kids to eat a good lunch can feel like an uphill battle.

We have found it can be helpful to give kids a say in planning their own menus. When they have skin in the game, they are more likely to consume their lunches. Try taking them shopping so they can choose their preferred foods. Then get them involved in the prep and assembly side of things, as well. It can be as simple as washing fruit, portioning out veggies or assembling sandwiches. When packing the lunch, make sure portion sizes are reasonable and that the foods themselves are easy to eat. It’s also important to remember that each element of a packed lunch must be able to survive the bumpy and unrefrigerated journey from home kitchen to school cafeteria without wilting, melting, breaking, leaking or falling apart.

When you’re making a family favorite for dinner, consider doubling the portions. That way, everyone can pack up the extras for a special midday meal the next day. And don’t discount the school’s own lunch programs. If it’s affordable for your family, this is a great way to slip a few days of variety into the lunchtime routine. You and your kids can peruse the menus together and choose the days they will buy their lunches. Whether homemade or purchased, talking over the components of lunch can be a stealth lesson in the basics of nutrition.

Finally, we know we’re talking about lunch here. However, don’t forget about the power of breakfast. Kids who start the day with something balanced and filling are more likely to reach the lunch hour without the kind of hunger that makes you brush aside the healthy options and rip into a bag of chips.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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Dear Doctors: I am a 29-year-old woman, and I am concerned that I might have mites in my areola. I found one when I tried to squeeze what I thought was a whitehead and saw a demodex mite come out. I went to my primary doctor, and he did not believe me. What can I do?

Dear Reader: Demodex mites are microscopic parasites that live and feed on mammals. More specifically, they are what are known as ectoparasites. Unlike parasites that can live and reproduce in tissues and organs throughout the body, ectoparasites typically occupy or infect only the topmost layers of their host’s skin. There are about 65 known species of demodex mites, each of which is specific to a particular animal. Of those 65, two make their homes on humans.

The thought of playing host to microscopic mites can be upsetting. However, they are quite common and are present in up to 90% of adults. The most numerous are Demodex folliculorum, which live primarily in hair follicles on the face, including the eyelashes, and to a lesser extent, on the neck and chest. They feed on dead skin cells. Not as widespread are Demodex brevis, a smaller mite that lives inside of the sebaceous glands that lubricate the hair follicles. They feed on sebum, which is the oily lubricant the glands produce. It is possible for them to be present in the oil glands around the areola.

These tiny arachnids are nocturnal. They spend their days tucked into the hair follicle or oil gland. At night, they emerge to the surface of the skin to consume dead skin cells and to mate. For most people, because the immune system keeps their numbers in check, demodex mites are not a problem. But when someone is immunocompromised, whether due to illness or medical treatment, the colonies of mites can grow out of control. This overgrowth is a condition known as demodicosis. Symptoms can include redness, itching or burning on the affected skin; patches of rough or scaly skin; and the sudden appearance of tiny white bumps.

An overgrowth of mites near the eyes can cause an inflammation of the eyelids known as blepharitis. It usually appears at the front edge of the eyelid, where the eyelashes emerge from the skin. Symptoms include dry or red eyes; eyelids that are swollen; sticky eyelashes; itching, burning or stinging; grittiness in the eyes; and crustiness around the outer edge of the eyelid.

Demodex mites are microscopic, which may be why your doctor was skeptical that you had seen one. And because they are so common, anything less than an overgrowth that is leading to symptoms would not be a cause for concern. If you are experiencing the symptoms associated with demodex overgrowth, you should let your doctor know. Diagnosis includes the use of a powerful magnifying lens to examine the skin, and perhaps a skin scraping or biopsy to identify the species of mites. Treatment often involves a routine of rigorous skin cleansing, along with medications to address the overgrowth.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)