What are nasal polyps? How are allergies treated? What causes nosebleeds? When should tonsils be removed? What is sleep apnea? What are the signs of throat cancer? What are the harmful effects of oral tobacco use? Find the answers to your ENT questions here.
Sinusitis is inflammation of the sinuses caused by infections (bacterial, viral, or fungal) and/or allergies. Acute sinusitis is very common and usually lasts less than 2 weeks, where chronic sinusitis can last months and is much more difficult to treat.
Nasal polyps are grape-like outpouchings from the nasal sinus linings that are usually indicative of an allergic component to the sinus disease. They can obstruct the normal sinus drainage and airflow, creating more congestion, infections, and decreased sense of smell.
In general, the treatment of sinusitis depends on the duration and severity of the symptoms. Most often multiple medications such as an antibiotic (fights bacterial infections), decongestant (allows drainage), mucolytic (thins mucus), corticosteroid (reduces inflammation), and nasal irrigation are prescribed. There are many appropriate medications in each of these categories and the best treatment plan must be individualized. Infrequently, sinus surgery is needed for acute uncomplicated sinusitis.
Sinus CAT scan or CT is used to evaluate patients with recurrent or chronic sinus symptoms who are not responding to medical treatment. These symptoms may include nasal congestion, sinus drainage, facial pain or pressure, and headaches. Your doctor may also order a sinus CT if an abnormality is identified in physical examination. A sinus CT provides detailed information about sources of nasal obstruction, sinus drainage pathways, and the presence of infection. Specific anatomic abnormalities, which may be causing sinus symptoms, can be easily identified.
Surgery is most beneficial in symptomatic patients with mechanical obstruction to sinus drainage and those with persistent infections that have failed medical therapy. More urgent sinus surgery may be indicated when the eye or brain (which surround the sinuses) are affected by the sinus disease.
When the above indications are met, sinus surgery usually has a dramatic impact on the patients’ symptoms. The patient may still require medication and irrigation to prevent further inflammation and the re-development of sinus obstruction. In the unusual case where the symptoms are not relieved or they recur quickly, the ENT surgeon may investigate other causes such as allergy or Immune-system problems that may be underlying these refractory cases.
The majority of contemporary ENT sinus surgeons use a technique in which small telescopes are placed in the nose for precise visualization of the sinus obstruction, removal of the diseased tissue, and opening the natural sinus drainage holes, with less trauma to the normal tissues, allowing quicker healing, less packing, and no facial incisions, as compared with traditional sinus surgery. Surgery is often ambulatory, pain is usually minimal, and most patients return to work in less than a week. Nasal cleaning and irrigation are done frequently for about the first month after surgery until the nasal lining is clean and well healed.
Endoscopic sinus surgery has advanced the treatment of many nasal problems without external incisions and with little or no packing needed. New CT scan guided visualization systems have been developed to more safely visualize and treat more advanced or difficult sinus problems.
Based on your ENT evaluation, history, examination, x-rays, or environmental issues, your doctor might suggest that allergy could be a cause. A complete allergy work-up and allergy management program may be right for you.
A common allergy test is called IDT (Intradermal Titration). This test is done on your upper arms or back using tiny needles that go right under the top layer of skin. The test takes approximately 2-3 hours to complete. It will tell us how sensitive you are to the positive allergens. If your doctor determines you are a candidate for allergy shots, this information is needed to make the serum for you. After testing is completed, treatment for your allergies can begin. This process takes time to work and may often be continued for years, but will often bring long lasting relief.
Other treatments are less specific and include antihistamines, decongestants, and corticosteroid medicines that fortunately today are very safe and effective when used appropriately.
The best treatment for allergies is avoidance of the particular pollen, mold, dust, food, or chemical that is causing the problems. Unfortunately, avoidance is easy to prescribe but not often very practical. Self-help suggestions such as frequent changing of air filters, wearing pollen masks, enclosing mattresses in plastic barriers, keeping windows closed during heavy pollination seasons, removing feather pillows and wool blankets, and ridding the home of indoor plants that grow mildew may be very effective. Some more difficult but important measures include: avoidance of tobacco products and animals that produce dander.
Allergies can lead to infection. When the lining inside the nose is exposed to substances to which a person is allergic, the lining swells. The swelling blocks the drainage openings of the sinuses, leading to mucous accumulation. As mucous lies trapped, it becomes infected, leading to sinusitis. Controlling allergies with medicines or allergy shots can treat the symptoms and may prevent sinus infections. People who have suffered from long term allergies may have tissue damage that leads to chronic sinus infections. In this instance, sinus surgery can remove thickened obstructive tissue which prevents nasal drainage.
Nosebleeds are caused most frequently by the common irritants (colds, sinusitis, dryness, nose- picking, nasal medications, and trauma). High blood pressure is a very common cause in the elderly. Bleeding disorders, foreign bodies and malignancies are much less common causes, but can be serious if not diagnosed and treated correctly.
The first thing to realize is that most nosebleeds will stop easily without losing a harmful amount of blood, even though it looks like a lot of bleeding. Start by pinching all the soft parts of your nose together between your thumb and two fingers, press firmly towards the face, compressing the pinched parts of the nose against the bones of the face. Keep your head upright (NOT leaning back, as this will cause blood to be swallowed, which can irritate the stomach) and pinch for at least 5 minutes. If bleeding persists, clear the nose of the clots by sniffing forcefully, apply Afrin or Neo-Synepherine decongestant spray and pinch again for another 5 minutes. If this is not successful, call your doctor and continue to hold pressure.
Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. They sample bacteria and viruses and can become infected themselves. Scientists believe they work as part of the body’s immune system by filtering out germs that attempt to invade the body. They also help to develop antibodies to germs and viruses. This happens primarily within the first few years of life, becoming less important as we grow older. Children who must have their tonsils and adenoids removed suffer no loss in their resistance.
Tonsillectomy (removal of tonsils) is recommended for people who experience frequent throat infections. Adenoidectomy (removal of adenoids) is recommended for recurrent ear or nasal infections. Other reasons to remove tonsils and adenoids is if they are enlarged, as this can cause obstructive symptoms, such as sleep apnea, swallowing difficulties, nasal sounding speech, dental malocclusion, and even heart failure. Recent reports also link enlarged tonsils and adenoids to obstructive breathing and sleep apnea, which can cause poor concentration and irritability during the day. This can be confused with ADHD. These patients often improve significantly after removal of their tonsils and adenoids.
The two most common reasons for removal of tonsils and adenoids are recurrent infection despite antibiotic therapy, and difficulty breathing due to enlarged tonsils and/or adenoids. Some orthodontists believe chronic mouth breathing from large tonsils causes malformations of the face and poor teeth alignment. Adenoids are very close to the Eustachian tube and when infected or enlarged can contribute to ear disease. Much more rarely, tonsils are removed to check for the possibility of cancer in patients with very asymmetric tonsils or other signs of malignancy.
Patients having tonsillectomy and/or adenoidectomy are usually discharged the same day or within 24 hours after surgery. The general technique for removal is fairly consistent between ENT surgeons with the difference being in the instruments used to remove the tonsils and to prevent bleeding. Overall the operation is very safe with the main major risk being bleeding. This happens in less that 5% of patients and usually very easy to control, but needs to be brought to the attention of our surgeon when it happens. Other risks such as anesthesia reactions, infection, scarring, and voice change are quite unusual.
The recovery after tonsillectomy/adenoidectomy varies between patients. If tonsils are removed for breathing problems, the effects can be often noticed the first night. The main complaint after surgery is throat and/or referred ear pain. Pain medicine usually relieves this discomfort until the wound is healed, which can take up to two weeks. Patients are encouraged to drink plenty of liquids to avoid dehydration and then slowly advance their diet back to normal.
Obstructive sleep apnea is diagnosed when loud snoring is interrupted by episodes of completely obstructed breathing. This condition can be serious and sometimes fatal if not treated. The cumulative effects of these obstructed breathing episodes is reduced blood oxygen levels to the brain, forcing the patient to stay in a lighter sleep stage and preventing them from getting the rest benefit only achieved by a deeper sleep. This can lead to a tendency to fall asleep during daytime hours, on the job, or worse, at the wheel of a car. Also, over time the heart needs to work harder and other body systems are affected by sleep apnea.
One out of four people is a habitual snorer. The problem is more frequent in males and the overweight, and worsens with age. Socially snoring can the source of resentfulness causing others to have sleepless nights. Medically snoring can disturb the sleep pattern and if severe, may be an indicator of sleep apnea.
Throat cancer usually occurs in smokers and hoarseness is usually noticed early. Some other signs such as weight loss, difficulty swallowing, sore throat, referred ear pain, and lump in the neck might occur too.
If diagnosed early, throat cancer can often be cured by radiation therapy or limited surgery. If the disease has progressed and is not too far gone, good results can still be obtained, but will often require surgical removal of the voice box followed by radiation therapy. Fortunately, today ENT surgeons and speech pathologists have ways of restoring some vocal ability after removal of the voice box.
Depending on the age of the patient the most common causes of neck masses change. In children, most masses are related to infections or inflammatory cysts. The treatment therefore usually starts with antibiotics and if the mass persists or enlarges it should be biopsied. During adulthood, when cancer becomes much more common, lumps in the neck should be evaluated by a physician’s thorough examination of the head and neck and possibly a biopsy.
Swallowing problems can be related to many causes including anatomic obstruction (e.g. cancer), neurologic disease (e.g. stroke), infection (e.g. candida), reflux, muscle tone problems, diabetes, alcoholism, vitamin deficiency, foreign bodies, caustic ingestion, aging, and many other possibilities. The swallowing mechanism is complex and any disorder affecting from the tongues to the stomach can create swallowing difficulties. In addition to the routine head and neck exam studies such as esophagoscopy (direct view of the esophagus), Barium swallow (x-ray observation of dye being swallowed, pH probe (detects acid reflux), and manometry (monitors muscle coordination and swallowing), may be ordered by the physician and swallowing therapist to assist in diagnosis and treatment. Patients may require comprehensive video testing (video stroboscopy) to determine the underlying pathology of voice disorder.
Reflux of acid from the stomach most commonly causes acid indigestion. The acid can travel further up the esophagus and into the throat, especially while lying flat on the back. Symptoms such as lump in the throat, frequent throat clearing, burning sensation, chronic cough, and hoarseness have all been occasionally attributed to reflux.
Initially lifestyle modifications like avoiding fatty foods, citrus foods, garlic, onion, caffeine, chocolate, and peppermint will decrease reflux. Eating meals further from bedtime, elevating the head while sleeping, losing weight, and quitting tobacco use will also help. Antacid medications and now more potent acid production blockers are often prescribed with great success.
Hyperthyroidism and Graves’ disease can cause nervousness, tremors, mood swings, rapid heart beating, high blood pressure, diarrhea, insomnia, heat intolerance, thickened skin, and bulging eyes.
Hypothyroidism can cause weakness, lethargy, cold intolerance, swelling, coarse dry skin, and hearing loss.
The cause of multiple thyroid nodules is not completely understood, but is thought to be related to changes in thyroid hormone and iodine metabolism. Solitary nodules are more worrisome for the possibility of a tumor in the thyroid gland. These tumors are usually benign, but in order to make the diagnosis, your ENT surgeon often performs surgical removal to be sure that there is no evidence of malignancy.
Goiter simply means enlargement of the thyroid gland. Most often, no therapy is required after full evaluation to look for signs of overactive or underactive thyroid activity as well as ruling out any evidence of malignant growth, or compression on the airway or esophagus.
ENT physicians can almost always find some visible abnormality in patients that smoke and often in those exposed to second hand smoke. Children have increased risk of ear disease and airway troubles when their parents smoke. The major risk factor for the majority of head and neck cancers is seen as clearly coming from smoking or oral tobacco use. These risks are worsened when combined with frequent alcohol use.
Chewing tobacco or snuff can cause cancer of the cheeks, gums, and throat, along with staining teeth, causing bad breath, and elevating blood pressure.
Most people know that smoking causes cancer, What some people don’t know is that smoking contributes to other illnesses. Noxious fumes and chemicals from cigarette smoke (including second hand smoke exposure) reduce the effectiveness of the body’s protective immune system. A young child whose parents smoke will be prone to more ear infections. Smokers have more frequent and worse sinus and lung infections. Cigarette smoke may lead to hoarseness and in its worse case, cancer of the vocal cords. All persons who have been hoarse for over six weeks should have an endoscopic evaluation of their vocal cords. Protect the health of yourself and others and STOP SMOKING TODAY! See your primary care physician and learn of the variety of prescription products that may help you in your endeavor to quit.
An Audiologist is a professional who evaluates and treats people with hearing loss and balance disorders. Audiologists have extensive training (at least a Masters level degree) to evaluate infants to adults to determine the best intervention, whether it be medical or amplification.
Audiologist perform comprehensive audiological evaluations for people of all ages, counseling, evaluating for and fitting of hearing aids and other assistive listening devices, cochlear implant rehabilitation, hearing conservation, balance testing, brainstem testing, and newborn hearing screenings.
Audiologists have a Masters or Doctoral degree from accredited universities with special training in the prevention, identification, assessment, and non-medical treatment of hearing and balance disorders.
More than 24 million Americans have some type of hearing problem. Hearing difficulties are often unrecognized by the person involved. Children and teenagers seldom complain about the symptoms of hearing loss, and adults may lose their hearing so gradually, they do not realize it is happening.
The first step in determining the need of a hearing aid is a comprehensive evaluation by an Audiologist. The audiologist will ask you a series of questions, look in your ears with an otoscope and complete a comprehensive evaluation of your hearing. With all these results in hand, it will be determined if your hearing loss warrants a medical evaluation or a hearing aid.
There are different causes of hearing loss. Some can be treated with medication or surgery. Others can be helped through hearing aids. A complete hearing test should be performed by a certified audiologist to determine the nature and degree of hearing loss. The Audiologist will determine if hearing aids can be of benefit. You should have your hearing evaluated if:
Hearing aids can improve speech understanding in various listening situations and, thus, improve one’s quality of life. Although older hearing aids were not liked, new digital and programmable technology permits many patients to wear them comfortably.
If your hearing loss is in both ears, two hearing aids are better than one. A hearing aid in each ear results in: better speech understanding in noisy places, better sound localization, better sound quality, improved distance hearing, improved sound identification, less exertion to hear, and a feeling of balance.
First of all, you should make sure you see a licensed Audiologist with a reputable history in your area. Once you have chosen whom you wish to work with, the following questions should be addressed.
They can vary from office to office. There are many hearing aids available for a couple of hundred dollars. Those hearing aids are typically not customized to an individual’s ear or hearing loss, therefore should be avoided. Most professional offices offer hearing aids from several hundred dollars up to a few thousand dollars per hearing aid. The more technologically advanced the hearing aid (i.e. computer programmable and / or completely in the ear canal), the higher the cost. One thing to keep in mind is not every hearing aid is suited for every individual. Even the most expensive aid may not be the right hearing aid for you.
Most people put off getting hearing aids for several years. We have all heard the stories of how Aunt Mary’s hearing aids just sit in her drawer or how Uncle Fred still can’t hear with his hearing aids. Unfortunately, these stories are told all the time, so why should anyone rush out and order hearing aids? Recent advances in hearing aid technology have made them easier to use and provide better hearing. The newer technology allows for: automatic volume control, elimination of feedback, smaller size and improved speech understanding in noise. The latest digital technology incorporates a miniature computer so adjustments can be made for a change in hearing loss or to tailor your hearing aids to match your lifestyle or hearing needs. Newer hearing aids are advancing us towards restoring hearing and allowing folks to be involved in the extra activities of life once avoided because of poor hearing.
An VNG evaluates the balance function of the inner ear. It is a test pertinent to the recording of involuntary eye movements, nystagmus, and helps to determine the origin of the problem.
An ABR is a test which measures the speed of electrical impulses along the acoustic nerve from the inner ear to the brainstem.
EcoG is a measure of the electrical potentials within the auditory system. As the auditory system is stimulated by an acoustic signal, it causes a change in the electrical potentials of the sensorineural mechanism that can be monitored through electrodes placed on the head and in the ears. This test is used to identify cochlear/endolyphatic hydrops for patients with dizziness.
An Epley maneuver, also known as canalith repositioning, is a therapeutic procedure which relieves symptoms for patients who have periods of brief spinning dizziness associated with position changes. These patients are identified as having benign paroxysmal positional vertigo (during the VNG) before this procedure is performed.
A tympanogram is a measurement of ear canal volume, middle ear pressure and compliance. A tympanogram will detect fluid, a perforation in the eardrum, function of a pressure equalization tube, ossicular disarticulation, as well as a healthy middle ear.
The audiogram is a graphic representation of the ability to hear tones. Hearing is typically tested from 250 Hz to 8000 Hz (low frequency to high frequency tones). The left ear’s responses are noted with an “X” and the right ear’s responses are noted with an “O”. There are varying degrees of hearing loss. Normal range is from 0-25dB, mild hearing loss range is from 25-40dB, moderate hearing loss range is from 40-60dB, moderately-severe hearing loss range is from 60-75dB, severe hearing loss range is from 75-90dB, and above 90dB is the profound hearing loss range. The ability to understand a list of 25 words is measured at a comfortable listening level and then the % of words correct is recorded. This test is the word recognition score. The speech reception threshold score is the softest level at which words can be repeated 50% of the time.
Speech-language pathologists (SLP), sometimes called speech therapists, assess, diagnose, treat and help to prevent disorders related to speech, language, cognitive-communication, voice, swallowing and fluency. Speech-language pathologists work with people who cannot produce speech sounds or cannot produce them clearly; those with speech rhythm and fluency problems, such as stuttering; people with voice disorders, such as inappropriate pitch or harsh voice; those with problems understanding and producing language; and those with cognitive communication impairments, such as attention, memory and problem solving disorders. They also work with people who have swallowing difficulties.
Several diseases, conditions, or surgical interventions can result in swallowing problems.General signs may include:
As a result, adults may have:
A speech-language pathologist (SLP) who specializes in swallowing disorders can evaluate individuals who are experiencing problems eating and drinking. The SLP will
Treatment depends on the cause, symptoms, and type of swallowing problem.
A speech-language pathologist may recommend:
NMES is routinely used by physical and occupational therapists to help restore muscle function. The VitalStim® Therapy device was specifically developed in 2002 for the small muscles on the throat used for swallowing. The FDA has mandated that only clinicians that are VitalStim certified may use this treatment for swallowing therapy. VitalStim® Therapy administers a small, carefully calibrated electrical impulse to the swallowing muscles in the throat through electrodes attached to the skin. The electrical current stimulates the nerves that make the muscles contract. By applying this current during exercise, NMES can cause a greater number of muscle fibers to contract during the exercise which in turn can make the therapy more effective. VitalStim® Therapy is painless, and patients describe that it feels similar to the tingly sensation when a part of the body, like the foot “falls asleep”. The use of NMES in swallowing treatment is well supported by clinical research. Studies have shown that using this equipment during swallowing exercise greatly improves the effectiveness of the treatment.
Voice therapy has been demonstrated to be effective for hoarseness across the lifespan from children to older adults (Ramig & Verdolini, 1998; Thomas & Stemple, 2007). Voice therapy is the first line of treatment for vocal fold lesions like vocal nodules, polyps, or cysts (Anderson & Sataloff, 2002; Johns, 2003. These lesions often occur in people with vocally intense occupations like teachers, attorneys, or clergymen (Roy et al., 2001). Another possible cause of these lesions is vocal overdoing often seen in sports enthusiasts; in socially active, aggressive, or loud children; or in high-energy adults who often speak loudly (Boone et al., 2005; Rubin et al., 2006; Stemple et al., 2000; Trani et al., 2007).
Voice therapy, specifically the Lee Silverman Voice Treatment method, has been demonstrated to be the most effective method of treating the lower volume, lower energy, and rapid rate of speech in persons with Parkinson’s disease (Dromey et al., 1995; Fox et al., 2006). Voice therapy has been used to treat hoarseness concurrently with other medical therapies like botulinum toxin injections for spasmodic dysphonia and/or tremor (American Academy of Otolaryngology-Head and Neck Surgery, 2005; Murry & Woodson, 1995; Pearson & Sapienza,2003).
Voice therapy has been used alone in the treatment of unilateral vocal fold paralysis (Miller, 2004; Schindler et al., 2008) and has been used to improve the outcome of surgical procedures as in vocal fold augmentation (Rosen, 2000) or thyroplasty (Billiante et al., 2002). Voice therapy is an important component of any comprehensive surgical treatment for hoarseness (Branski & Murray, 2008).
Voice therapy is a program designed to reduce hoarseness through guided change in vocal behaviors and lifestyle changes. Voice therapy consists of a variety of tasks designed to eliminate harmful vocal behavior, shape healthy vocal behavior, and assist in vocal fold wound healing after surgery or injury. Voice therapy for hoarseness generally consists of one to two therapy sessions each week for 4–8 weeks (Hapner et al., 2009). The duration of therapy is determined by the origin of the hoarseness and severity of the problem, co-occurring medical therapy, and, importantly, patient commitment to the practice and generalization of new vocal behavior outside the therapy session (Behrman, 2006).
Certified and licensed speech-language pathologists are the health care professionals with the expertise needed to provide effective behavioral treatment for hoarseness (American Speech- Language-Hearing Association, 2005).
Vocal cord nodules are benign (non-cancerous) growths on both vocal cords that are caused by vocal abuse. Over time, repeated abuse of the vocal cords results in soft, swollen spots on each vocal cord. These spots develop into harder, callous-like growths called nodules. The nodules will become larger and stiffer the longer the vocal abuse continues. Polyps can take a number of forms. They are sometimes caused by vocal abuse. Polyps appear on either one or both of the vocal cords. They appear as a swelling or bump (like a nodule), a stalk-like growth, or a blister-like lesion. Most polyps are larger than nodules and may be called by other names, such as polypoid degeneration or Reinke’s edema. The best way to think about the difference between nodules and polyps is to think of a nodule as a callous and a polyp as a blister.
Nodules and polyps cause similar symptoms:
If you have experienced a hoarse voice for more than 2 to 3 weeks, you should see a physician. A thorough voice evaluation should include:
The team will evaluate vocal quality, pitch, loudness, ability to sustain voicing, and other voice characteristics. An instrumental examination may take place that involves inserting an endoscope into the mouth or nose to look at the vocal cords and larynx in general. A stroboscope (flashing light) may be used to watch the vocal cords as they move.
Videostroboscopy is one of the most practical methods for viewing and recording the motion of the vocal cords during speaking or singing. A digital computer and strobe light are used to make the images of the vocal cord vibrations appear in slow motion, so that any abnormal patterns of vibration may be detected.