Nose & Sinus

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Middle Ear Infections (Otitis Media) Middle ear infections typically occur in infants and toddlers with many children outgrowing the infections by age 3 years old. Eighty percent (80%) of children will have two or more episodes of otitis media by their second birthday. Otitis media is an infection involving the middle ear space, which is behind the eardrum. Usually, this space is dry, but when the Eustachian tube (a small passage that connects the back of the nose to the actual middle ear) doesn’t work well, mucus or thick fluid develops in the middle ear space. This fluid can cause pressure in the ear, mild to moderate temporary hearing loss, and viral or bacterial infections. Symptoms can include fussiness, irritability, fever, changes in dietary and sleep habits and problems with hearing and balance. Occasionally the fluid and the infection will resolve without intervention, but usually examination and treatment by a doctor is needed. Treatment of Ear Infections The first line of therapy is typically antibiotics and treatment of the nasal congestion. Whatever treatment is given, it can take more than a few days for the infection to resolve and weeks for the fluid to resolve. When the infections become very frequent, repetitively painful, or the fluid is persistent and the hearing loss not improving, then additional intervention is usually needed and a procedure called tympanostomy tube insertion may be recommended. This is where a small pinhole is made in the eardrum and a 3 mm soft silicone or plastic tube is inserted into the eardrum, allowing air to enter the middle ear space and fluid to drain outward. The procedure only takes about five to 10 minutes and is done under a light general anesthetic in a carefully monitored operating room. The child experiences no discomfort during the procedure and, at most, only mild irritation for a few hours afterwards. A single dose of Tylenol is usually adequate to eliminate this. The tubes last for about six to twelve months, after which they typically fall out by themselves. During the time that the tubes are in place, it is recommended that water exposure to the ears be minimized by using earplugs, ear putty or similar ear protection. Please discuss any specific issues regarding tympanostomy tube insertion with your physician. Outer Ear Infections/Swimmer’s Ear Swimmer’s ear is an infection of the outer ear structures. It may occur from water trapped in the ear canal due to swimming, bathing or showering, or moisture from earplugs. Even hearing aids may cause this common infection. It may also be caused by scratching the ear canal (often with a Q-tip). Bacteria that normally inhabit the skin of the ear canal multiply, causing infection and irritation of the skin of the ear canal. If the infection progresses it may involve the outer ear. Symptoms include pain, ear blockage, drainage, and occasionally fever. Infection may be more serious in people who have diabetes. Treatment of Outer Ear Infections The treatment for mild infections can include drying of the canal and applications of slightly acidic drops or even antibiotic drops that are prescribed by a medical professional. More significant infections usually require an ENT specialist to clean the canal and, in some cases, suction the infected material out of the canal or put a tiny sponge in the canal soaked with special medication for 24 or 48 hours. Advanced infections may require even more medical intervention.

An earache is a commonly used term for ear pain or discomfort. Pain in the ear may come from many sources and can be a symptom of problems in the ear, mouth, nose, or throat. Infants or very young children with earaches may be unable to say that they are in pain, but increased irritability or pulling at the ears can be a sign of ear pain in infants. Causes of ear pain A very common cause of an earache is a buildup of pressure in the eustachian tube. Among other functions, the eustachian tube drains fluids out of the middle ear via the back of the throat. A cold, allergy or sore throat can cause the eustachian tube to swell shut. Infants and young children are especially susceptible to earaches caused by problems with the eustachian tube, since the structure is still underdeveloped in that age group. When the normal drainage of fluid is prevented, it can accumulate in the middle ear, causing pressure, pain, stagnation and possibly infection. An earache may be due to a perforated or broken eardrum. The eardrum can be broken as a result of a blow to the head, infection in the inner ear, suction applied to the ear, or the insertion of a foreign object into the ear. Earaches are also associated with: Infections of the middle and outer ears Obstruction of the ear canal, excessive ear wax or boils in the ear canal Tumors Rapid descent from high altitudes during air travel or travel in the mountains Sinus infections Arthritis of the jaw or dysfunction of the temporomandibular joint (TMJ) Throat pain If you experience an earache it may be advisable to see an ear, nose and throat (ENT) doctor for appropriate evaluation and treatment. TINNITUS Tinnitus is a condition where patients experience noises they can hear that are not produced by an external source. This disorder can occur in one or both ears, range in pitch from a low roar to a high squeal, and may be continuous, pulsating, or sporadic. This often debilitating condition is commonly associated with hearing loss. Reasons for hearing loss include ear injuries, circulatory system problems, noise-induced hearing loss, wax build-up in the ear canal, medications harmful to the ear, ear infections, head and neck trauma, Ménière’s disease, and an abnormal growth of bone of the middle ear.In rare cases, slow-growing tumors on auditory, vestibular, or facial nerves can cause tinnitus as well as deafness, facial paralysis, and balance problems. The American Tinnitus Association estimates that more than 50 million Americans have tinnitus problems to some degree and approximately 12 million people have symptoms severe enough to seek medical care. This condition is not uncommon in the pediatric population. The good news is that most children seem to outgrow the condition.What can be done for tinnitus? Tinnitus should be evaluated by an ear, nose & throat (ENT) doctor. The ENT doctor examines you and will likely recommend a hearing test. Based on the results of the hearing test, other tests may be indicated, including balance testing, a special radiologic examination of your ear and brain called a magnetic resonance image (MRI), laboratory work, or a complicated hearing test called brainstem auditory evoked response (ABR or BAER) to evaluate the cause of the tinnitus. If a specific cause is not identified, the following list of suggestions may help lessen the severity of the tinnitus: Try to avoid things that make you anxious as they stimulate an already stressed hearing system Try to get adequate rest and keep from becoming overly tired Cut down or eliminate the use of nerve stimulants like caffeine and nicotine. Remember that coffee, tea, many soft drinks, chocolate and aspirin-containing drugs contain caffeine. Check with your family doctor to find out if any medicines you are taking can make your head noise worse. Get your blood pressure checked by your family doctor. If it is high, seek your doctor’s help to get it under control. Limit your intake of sodium. This improves your circulation. Avoid salty foods and do not add salt to your food when you cook or at the table. Protect your ears from excessive noise by using earplugs that can be obtained from our group or almost any drugstore. Noise can also cause a hearing loss that can’t be corrected with surgery. A person with hearing loss sometimes finds that a hearing aid will reduce head noise and occasionally make it go away. Even someone with a minor hearing loss might find that a hearing aid will relieve tinnitus. However, a thorough trial before the purchase of a hearing aid is recommended if the primary goal is to relieve tinnitus. Sedatives sometimes give temporary relief from tinnitus, particularly when someone is anxious. The use of sedatives over a long period of time can be habit forming and is strongly discouraged by our group. The use of sedatives is not a cure for tinnitus. Consider using tinnitus retraining therapy if your tinnitus is annoying. Tinnitus is usually more bothersome when you are in a quiet room. We recommend using a low-level background noise generator. The continuous use of background noise at a level below your head noise will eventually help habituate, or decrease the intensity of the tinnitus sound that you hear. Most people prefer using a natural sound such as a babbling brook or the sound of rain. Noise machines are sold in a variety of stores and catalogs. Others find that using a fan or humidifier will provide enough noise to help decrease their tinnitus. There is no cure for tinnitus, even when it might be caused by pressure from a tumor. When the tumor is removed, about 50% of the time the head noise present before surgery is still present after surgery. Some people with a hearing loss notice the intensity of their tinnitus is decreased when their hearing loss is improved by surgery, or more frequently, when they get a hearing aid. Occasionally tinnitus may be so severe that it may cause or worsen a patient’s depression. Antidepressants have been shown to help severe tinnitus sufferers, and we often refer patients to skilled therapists who will manage the depression and the medications used for its treatment. DIZZINESS Dizziness and faintness are common problems that in most cases are not indicators of serious health problems. It is important to look for a reason for these symptoms and attempt to identify treatable causes.Vision, joint sensation and inner ear information are processed in the brain to give us a sense of motion, and where we are in space. If these sources of input do not match up, or there is a processing problem, we feel off balance. Often, the sense of spinning, or vertigo may indicate involvement in the inner ear or brainstem. Specific questions in the clinical history are the most important data when trying to identify the cause of the misinformation.Hearing testing, balance testing, and radiographic imaging are often needed to identify treatable causes of vertigo. Most often, even if a specific cause cannot be identified, therapies can be initiated that will strengthen the balance system and reduce self injury. These therapies may include physical therapy, assessment of fall risk, ambulation assistance, hearing rehabilitation, and referral for further cardiovascular, brain and neck evaluation. With proper management, the impact of an injury to our balance system can be substantially reduced.

Sleep apnea is a condition where breathing obstruction actually leads to a lack of airflow for extended periods of time. Often sleep apnea is associated with early morning fatigue, daytime sleepiness, morning headache, high blood pressure, attention issues, sometimes worsening of depression. When extensive disease is present, sleep apnea can increase the risk of heart attack and stroke. A diagnosis of sleep apnea is usually made through a clinical exam and a sleep study. The results might lead to the use of a short-term or long-term oxygen mask therapy. Surgical interventions such as removal of the tonsils, septal and turbinate surgery to improve nasal airflow, and/or trimming of the soft palate may also be considered if appropriate. The Epworth Sleepiness Scale The ESS is a questionnaire designed to evaluate levels of excessive sleepiness. This test is a standardized screening tool used extensively by the American Association of Sleep Medicine (AASM) that will help you measure your general level of sleepiness. It asks you to rate the chances that you would doze off or fall asleep during different routine situations. Answers to the questions are based on a scale from 0-3, with 0 meaning you would never doze off or fall asleep in a given situation, and 3 meaning there is a very high likelihood you would doze or fall asleep in that situation. Situation Sitting and reading Watching television Sitting inactive in a public place, such as a theater or meeting As a passenger in a car for an hour without a break Sitting down to rest in the afternoon Sitting quietly after lunch (when you’ve had no alcohol) Sitting and talking to someone In a car, stopped in traffic Scoring the ESS 0= would never doze 1= slight chance of dozing 2= moderate chance of dozing 3= high chance of dozing The Epworth Sleepiness Scale Key Total score of 10 or more suggests the you may need further evaluation by a physician to determine the cause of your excessive sleepiness and whether you have an underlying sleep disorder. A total score of 10 or less suggests that you may not be suffering from excessive sleepiness.

As otolaryngologists, we specialize in diagnosing and treating diseases of the head and neck. This includes the medical and surgical management of many problems that affect the delicate structures of the neck.

The larynx (voicebox) is composed of a cartilage framework with intrinsic and extrinsic muscles that provide motion for both speech and swallowing. The vocal cords are made up of muscles with a layer of mucous membrane. These muscles and mucous membranes vibrate with contractions that produce sounds, or voice, that your mouth then forms into speech. The motion of the vocal cords is under neurologic control and they can vibrate up to 800 times per second. The signs and symptoms of voice disorders include: Hoarseness (dysphonia) Vocal fatigue Weak or breathy voice Loss of singing range Loss of voice (aphonia) Pitch breaks or abnormally high or low-pitched voice Strained voice Vocal tremor Pain while speaking or singing Common conditions which may cause changes in the voice include: Laryngitis (viral, bacterial or inflammatory) Gastroesophageal reflux disease Vocal cord nodules or polyps Growths, tumors or cancer of the voicebox Paralysis of the vocal cords Disorders of the thyroid Sinusitis Myasthenia gravis Spastic dysphonia (involuntary movements or muscle spasms of the vocal cords) Paradoxical vocal cord dysfunction (the vocal cords move inward with breathing when they are supposed to move outward) Di agnosis and treatment of voice and throat problems To evaluate your condition your physician will attempt to look at the vocal cords, which is sometimes done using a mirror. The physician may also perform a flexible fiber-optic examination of the larynx to identify any growths, inflammation, infection, ulcerations or paralysis of the vocal cords. Because the vocal cords vibrate so rapidly, a special examination called videostroboscopy may be recommended. These procedures are done in our office. Because there are many different underlying causes and reasons for vocal dysfunction, treatment options vary depending on the nature of the disorder. Treatment options may be very simple such as voice rest, simple medical management, control of environmental or behavioral causative factors, or speech therapy. More severe problems may require surgery, biopsy or other treatments. Diagnosis is the most important initial step after which your physician will make treatment recommendations to you. Flexible Fiberoptic Examination of the Larynx A flexible fiberoptic examination involves placing a small, flexible tube through the nose and down the throat to visualize the vocal cords. It is a quick and simple procedure performed safely and effectively in the office and painless with use of a simple topical analgesia. Videostroboscopy Videostroboscopy is one of the most practical techniques currently available for recording and observing the motion of the vocal cords. It allows for easy examination of vibrations of the vocal cords while speaking or singing. Videostroboscopy creates visual images of vocal cord vibration in either stop action or slow motion to allow minute abnormalities which influence the voice to be seen. From the resulting visual images, an accurate diagnosis of conditions and diseases of the vocal cords, including masses or lesions, abnormal motion, inflammation, broken blood vessels, scarring and other disorders can be made. Videostroboscopy is a simple and painless procedure that is done in the office by an otolaryngologist with just an anesthetic spray applied to the throat and the nose. To help the physician view the vocal cords, a small angled telescope is placed into the mouth or a flexible telescope placed through the nose. The patient is asked to repeat several words and make specific sounds to make the vocal cords vibrate and vocal cord actions are recorded. The examination lasts only a few minutes and is not painful, allowing the patient to talk throughout the examination and view what is happening on a video monitor. The examination is conducted with a speech pathologist in conjunction with an otolaryngologist in order to formulate the best treatment plan for the patient. Treatment options may include medication, vocal exercises, speech therapy, and in some cases, surgery.