Sinus Surgery

The ear, nose, and throat specialist will prescribe many medications (antibiotics, decongestants, nasal steroid sprays, antihistamines) and procedures (flushing) for treating acute sinusitis. There are occasions when physician and patient find that the infections are recurrent and/or non-responsive to the medication. When this occurs, surgery to enlarge the openings that drain the sinuses is an option. A recommendation for sinus surgery in the early 20th century would easily alarm the patient. In that era, the surgeon would have to perform an invasive procedure, reaching the sinuses by entering through the cheek area, often resulting in scarring and possible disfigurement. Today, these concerns have been eradicated with the latest advances in medicine. A trained surgeon can now treat sinusitis with minimal discomfort, a brief convalescence, and few complications. A clinical history of the patient will be created before any surgery is performed. A careful diagnostic workup is necessary to identify the underlying cause of acute or chronic sinusitis, which is often found in the anterior ethmoid area, where the maxillary and frontal sinuses connect with the nose. This may necessitate a sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected blood tests to determine an operative strategy. Note: Sinus X–rays have limited utility in the diagnosis of acute sinusitis and are of no value in the evaluation of chronic sinusitis. Sinus Surgical Options Include: Functional endoscopic sinus surgery (FESS): Developed in the 1950s, the nasal endoscope has revolutionized sinusitis surgery. In the past, the surgical strategy was to remove all sinus mucosa from the major sinuses. The use of an endoscope is linked to the theory that the best way to obtain normal healthy sinuses is to open the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa has an opportunity to return to normal. FESS involves the insertion of the endoscope, a very thin fiber-optic tube, into the nose for a direct visual examination of the openings into the sinuses. With state of the art micro-telescopes and instruments, abnormal and obstructive tissues are then removed. In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort. The advantage of the procedure is that the surgery is less extensive, there is often less removal of normal tissues, and can frequently be performed on an outpatient basis. After the operation, the patient will sometimes have nasal packing. Ten days after the procedure, nasal irrigation may be recommended to prevent crusting. Image guided surgery: The sinuses are physically close to the brain, the eye, and major arteries, always areas of concern when a fiber optic tube is inserted into the sinus region. The growing use of a new technology, image guided endoscopic surgery, is alleviating that concern. This type of surgery may be recommended for severe forms of chronic sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult. Image guidance is a near-three-dimensional mapping system that combines computed tomography (CT) scans and real-time information about the exact position of surgical instruments using infrared signals. In this way, surgeons can navigate their surgical instruments through complex sinus passages and provide surgical relief more precisely. Image guidance uses some of the same stealth principles used by the United States armed forces to guide bombs to their target. Caldwell Luc operation:Another option is the Caldwell-Luc operation, which relieves chronic sinusitis by improving the drainage of the maxillary sinus, one of the cavities beneath the eye. The maxillary sinus is entered through the upper jaw above one of the second molar teeth. A “window” is created to connect the maxillary sinus with the nose, thus improving drainage. The operation is named after American physician George Caldwell and French laryngologist Henry Luc and is most often performed when a malignancy is present in the sinus cavity.

Deviated Septum

The shape of your nasal cavity could be the cause of chronic sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size. Estimates are that 80 percent of all nasal septums are off-center, a condition that is generally not noticed. A “deviated septum” occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections. Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma. A deviated septum may cause one or more of the following: -Blockage of one or both nostrils -Nasal congestion, sometimes one-sided -Frequent nosebleeds -Frequent sinus infections -At times, facial pain, headaches, postnasal drip -Noisy breathing during sleep (in infants and young children) In some cases, a person with a mildly deviated septum has symptoms only when he or she also has a “cold” (an upper respiratory tract infection). In these individuals, the respiratory infection triggers nasal inflammation that temporarily amplifies any mild airflow problems related to the deviated septum. Once the “cold” resolves, and the nasal inflammation subsides, symptoms of a deviated septum often resolve, too. Diagnosis of A Deviated Septum: Patients with chronic sinusitis often have nasal congestion, and many have nasal septal deviations. However, for those with this debilitating condition, there may be additional reasons for the nasal airway obstruction. The problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof. A trained specialist in diagnosing and treating ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal obstruction. Your First Visit: After discussing your symptoms, the primary care physician or specialist will inquire if you have ever incurred severe trauma to your nose and if you have had previous nasal surgery. Next, an examination of the general appearance of your nose will occur, including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril. Surgery may be the recommended treatment if the deviated septum is causing troublesome nosebleeds or recurrent sinus infections. Additional testing may be required in some circumstances. Septoplasty: Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery. The time required for the operation averages about one to one and a half hours, depending on the deviation. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. After the surgery, nasal packing is inserted to prevent excessive postoperative bleeding. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose. If a deviated nasal septum is the sole cause for your chronic sinusitis, relief from this severe disorder will be achieved.

Post Nasal Drip

Glands in your nose and throat continually produce mucus (one to two quarts a day). Mucus moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although it is normally swallowed unconsciously, the feeling of it accumulating in the throat or dripping from the back of your nose is called post-nasal drip. This sensation can be caused by excessively thick secretions or by throat muscle and swallowing disorders. What causes abnormal secretions? Thin secretions: Increased thin clear secretions can be due to colds and flu, allergies, cold temperatures, bright lights, certain foods/spices, pregnancy, and other hormonal changes. Various drugs (including birth control pills and high blood pressure medications) and structural abnormalities can also produce increased secretions. These abnormalities might include a deviated or irregular nasal septum (the cartilage and bony dividing wall that separates the two nostrils). Thick secretions: Increased thick secretions in the winter often result from dryness in heated buildings and homes. They can also result from sinus or nose infections and allergies, especially to foods such as dairy products. If thin secretions become thick, and turn green or yellow, it is likely that a bacterial sinus infection is developing. In children, thick secretions from one side of the nose can mean that something is stuck in the nose such as a bean, wadded paper, or piece of toy. If these symptoms are observed, seek a physician for examination. How is swallowing affected? Swallowing problems may result in accumulation of solids or liquids in the throat that may complicate or feel like post-nasal drip. When the nerves and muscles in the mouth, throat, and food passage (esophagus) aren’t interacting properly, overflow secretions can spill into the voice box (larynx) and breathing passages (trachea and bronchi), causing hoarseness, throat clearing, or coughing. Several factors contribute to swallowing problems: With age, swallowing muscles often lose strength and coordination, making it difficult for even normal secretions to pass smoothly into the stomach. During sleep, swallowing occurs much less frequently, and secretions may gather. Coughing and vigorous throat clearing are often needed upon waking. When nervous or under stress, throat muscles can trigger spasms that make it feel as if there is a lump in the throat. Frequent throat clearing, which usually produces little or no mucus, can make the problem worse by increasing irritation. Growths or swelling in the food passage can slow or prevent the movement of liquids and/or solids. Swallowing problems may also be caused by gastroesophageal reflux disease (GERD). This is a backup of stomach contents and acid into the esophagus or throat. Heartburn, indigestion, and sore throat are common symptoms. GERD may be aggravated by lying down, especially following eating. Hiatal hernia, a pouch-like tissue mass where the esophagus meets the stomach, often contributes to the reflux. How is the throat affected? Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling that there is a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms. How is it treated? A correct diagnosis requires a detailed ear, nose, and throat exam, and possibly laboratory, endoscopic (procedures that use a tube to look inside the body), and x-ray studies. Treatment varies according to the following causes: Bacterial infections are treated with antibiotics. These drugs may only provide temporary relief. In cases of chronic sinusitis, surgery to open the blocked sinuses may be required. Allergies are managed by avoiding the causes. Antihistamines and decongestants, cromolyn and steroid (cortisone type) nasal sprays, and other forms of steroids may offer relief. Immunotherapy, either by shots or sublingual (under the tongue drops) may also be helpful. However, some older, sedating antihistamines may dry and thicken post-nasal secretions even more; newer nonsedating antihistamines, available by prescription only, do not have this effect. Decongestants can aggravate high blood pressure, heart, and thyroid disease. Steroid sprays may be used safely under medical supervision. Oral and injectable steroids rarely produce serious complications in short-term use. Because significant side-effects can occur, steroids must be monitored carefully when used for more than one week.

Balloon Sinuplasty

The procedure utilizes small balloons placed in key places in the nose and sinus, which are then dilated to expand the sinus pathways. It may be an effective, lasting option for some patients whose symptoms do not resolve with medication. The benefits of office sinus dilation include: -Delivers instant, lasting relief -Convenient, comfortable office procedure -Quick recovery—most patients return to normal activity in 24 hours -May reduce healthcare costs Discuss office sinus dilation with Dr. Daneshrad today! Dr. Daneshrad is a trained and experienced user of office sinus dilation technologies. Make an appointment at our Torrance or Santa Monica office today to determine if balloon sinus dilation is right for you.

Nasal Obstruction after Surgery

It is not uncommon for me to see a patient with nasal obstruction who needs surgery for a deviated septum only to have them tell me of a friend or family member who has had surgery and feels that their breathing didn’t improve. Why is it that a simple surgery, that is supposed to help you breathe better through your nose by opening the nasal passages, would not work? The nose is a dynamic structure. Allergies or cold air exposure can make the turbinates swell. A head cold can lead to more mucous production. The overall structure of the nose may be weak and cause the sidewalls of the nose to collapse with a deep breath. Often, the reason that patients have nasal obstruction after surgery of the nose is because the structural weakness of the nose has not been addressed. These include patients who have had a cosmetic rhinoplasty or patients who have had a septoplasty. During an initial consultation for nasal congestion and obstruction, I always pay attention to the nose as a whole. Time is taken to evaluate the septum, the turbinates, underlying allergies, sinus infection history, and the lateral nasal wall. For the patient that is undergoing surgery for the first time, this is the best way to assure the best results. Cartilage from the patient’s own nose can be used during this surgery to strengthen the lateral wall while straightening out the septum and reducing the turbinates. In the patient who has already undergone surgery, where there might not be adequate cartilage for grafting or who doesn’t want to risk changing an already altered cosmetic nose, a Latera implant is the perfect option. It is a resorbable implant spring that can be placed in the office under local anesthesia.

SINUS DISEASE

An antibiotic is a soluble substance derived from a mold or bacterium that inhibits the growth of other microorganisms. The first antibiotic was Penicillin, discovered by Alexander Fleming in 1929, but it was not until World War II that the effectiveness of antibiotics was acknowledged, and large-scale fermentation processes were developed for their production. Acute sinusitis is one of many medical disorders that can be caused by a bacterial infection. However, it is important to remember that colds, allergies, and environmental irritants, which are more common than bacterial sinusitis, can also cause sinus problems. Antibiotics are effective only against sinus problems caused by a bacterial infection. The following symptoms may indicate the presence of a bacterial infection in your sinuses: Pain in your cheeks or upper back teeth A lot of bright yellow or green drainage from your nose for more than 10 days No relief from decongestants, and/or Symptoms that get worse instead of better after your cold is gone. Most patients with a clinical diagnosis of acute sinusitis caused by a bacterial infection improve without antibiotic treatment. The specialist will initially offer appropriate doses of analgesics (pain-relievers), antipyretics (fever reducers), and decongestants. However if symptoms persist, a treatment consisting of antibiotics may be recommended. Antibiotic Treatment For Sinusitis Antibiotics are labeled as narrow-spectrum drugs when they work against only a few types of bacteria. On the other hand, broad-spectrum antibiotics are more effective by attacking a wide range of bacteria, but are more likely to promote antibiotic resistance. For that reason, your ear, nose, and throat specialist will most likely prescribe narrow-spectrum antibiotics, which often cost less. He/she may recommend broad-spectrum antibiotics for infections that do not respond to treatment with narrow-spectrum drugs. Acute Sinusitis In most cases, antibiotics are prescribed for patients with specific findings of persistent purulent nasal discharge and facial pain or tenderness who are not improving after seven days or those with severe symptoms of rhinosinusitis, regardless of duration. On the basis of clinical trials, amoxicillin, doxycycline, or trimethoprim–sulfamethoxazole are preferred antibiotics. Chronic Sinusitis Even with a long regimen of antibiotics, chronic sinusitis symptoms can be difficult to treat. In general, however, treating chronic sinusitis, such as with antibiotics and decongestants, is similar to treating acute sinusitis. When antibiotic treatment fails, allergy testing, desensitization, and/or surgery may be recommended as the most effective means for treating chronic sinusitis. Research studies suggest that the vast majority of people who undergo surgery have fewer symptoms and better quality of life. Pediatric Sinusitis Antibiotics that are unlikely to be effective in children who do not improve with amoxicillin include trimethoprim-sulfamethoxazole (Bactrim) and erythromycin-sulfisoxazole (Pediazole), because many bacteria are resistant to these older antibiotics. For children who do not respond to two courses of traditional antibiotics, the dose and length of antibiotic treatment is often expanded, or treatment with intravenous cefotaxime or ceftriaxone and/or a referral to an ENT specialist is recommended.

SINUS HEADACHES

Not every headache is the consequence of sinus and nasal passage problems. For example, many patients visit an ear, nose, and throat specialist to seek treatment for a sinus headache and learn they actually have a migraine or tension headache. The confusion is common, a migraine can cause irritation of the trigeminal or fifth cranial nerve (with branches in the forehead, cheeks and jaw). This may produce pain at the lower-end branches of the nerve, in or near the sinus cavity. Symptoms Of Sinusitis Pain in the sinus area does not automatically mean that you have a sinus disorder. On the other hand, sinus and nasal passages can become inflamed leading to a headache. Headache is one of the key symptoms of patients diagnosed with acute or chronic sinusitis. In addition to a headache, sinusitis patients often complain of: -Pain and pressure around the eyes, across the cheeks and the forehead -Achy feeling in the upper teeth -Fever and chills -Facial swelling -Nasal stuffiness Yellow or green discharge However, it is important to note that there are some cases of headaches related to chronic sinusitis without other upper respiratory symptoms. This suggests that an examination for sinusitis be considered when treatment for a migraine or other headache disorder is unsuccessful. Treatment For A Sinus Headache Sinus headaches are associated with a swelling of the membranes lining the sinuses (spaces adjacent to the nasal passages). Pain occurs in the affected region – the result of air, pus, and mucus being trapped within the obstructed sinuses. The discomfort often occurs under the eye and in the upper teeth (disguised as a headache or toothache). Sinus headaches tend to worsen as you bend forward or lie down. The key to relieving the symptoms is to reduce sinus swelling and inflammation and facilitate mucous drainage from the sinuses. There are several at-home steps that help prevent sinus headache or alleviate its pain. They include: Breathe moist air: Relief for a sinus headache can be achieved by humidifying the dry air environment. This can be done by using a steam vaporizer or cool-mist humidifier, steam from a basin of hot water, or steam from a hot shower. Alternate hot and cold compresses: Place a hot compress across your sinuses for three minutes, and then a cold compress for 30 seconds. Repeat this procedure three times per treatment, two to six times a day. Nasal irrigation: Some believe that when nasal irrigation or rinse is performed, mucus, allergy creating particles and irritants such as pollens, dust particles, pollutants and bacteria are washed away, reducing the inflammation of the mucous membrane. Normal mucosa will fight infections and allergies better and will reduce the symptoms. Nasal irrigation helps shrink the sinus membranes and thus increases drainage. There are several over-the-counter nasal rinse products available. Consult your ear, nose, and throat specialist for directions on making a home nasal rinse or irrigation solution. Over-the-counter medications: Some over-the-counter (OTC) drugs are highly effective in reducing sinus headache pain. The primary ingredient in most OTC pain relievers is aspirin, acetaminophen, ibuprofen, naproxen, or a combination of them. The best way to choose a pain reliever is by determining which of these ingredients works best for you. Decongestants: Sinus pressure headaches caused by allergies are usually treated with decongestants and antihistamines. In difficult cases, nasal steroid sprays may be recommended. Alternative medicine: Chinese herbalists use Magnolia Flower as a remedy for clogged sinus and nasal passages. In conjunction with other herbs, such as angelica, mint, and chrysanthemum, it is often recommended for upper respiratory tract infections and sinus headaches, although its effectiveness for these problems has not been scientifically confirmed. If none of these preventative measures or treatments is effective, a visit to an ear, nose, and throat specialist may be warranted. During the examination, a CT scan of the sinuses may be ordered to determine the extent of blockage caused by chronic sinusitis. If no chronic sinusitis were found, treatment might then include allergy testing and desensitization (allergy shots). Acute sinusitis is treated with antibiotics and decongestants. If antibiotics fail to relieve the chronic sinusitis and accompanying headaches, endoscopic or image-guided surgery may be the recommended treatment.

Fungal Sinusitis

What Is A Fungus? Fungi are plant-like organisms that lack chlorophyll. Since they do not have chlorophyll, fungi must absorb food from dead organic matter. Fungi share with bacteria the important ability to break down complex organic substances of almost every type (cellulose) and are essential to the recycling of carbon and other elements in the cycle of life. Fungi are supposed to “eat” only dead things, but sometimes they start eating when the organism is still alive. This is the cause of fungal infections; the treatment selected has to eradicate the fungus to be effective. In the past 30 years, there has been a significant increase in the number of recorded fungal infections. This can be attributed to increased public awareness, new immunosuppressive therapies (medications such as cyclosporine that “fool” the body’s immune system to prevent organ rejection) and overuse of antibiotics (anti-infectives). When the body’s immune system is suppressed, fungi find an opportunity to invade the body and a number of side effects occur. Because these organisms do not require light for food production, they can live in a damp and dark environment. The sinuses, consisting of moist, dark cavities, are a natural home to the invading fungi. When this occurs, fungal sinusitis results. There Are Four Types Of Fungal Sinusitis Mycetoma Fungal Sinusitis produces clumps of spores, a “fungal ball,” within a sinus cavity, most frequently the maxillary sinuses. The patient usually maintains an effective immune system, but may have experienced trauma or injury to the affected sinus(es). Generally, the fungus does not cause a significant inflammatory response, but sinus discomfort occurs. The noninvasive nature of this disorder requires a treatment consisting of simple scraping of the infected sinus. An anti-fungal therapy is generally not prescribed. Allergic Fungal Sinusitis (AFS) is now believed to be an allergic reaction to environmental fungi that is finely dispersed into the air. This condition usually occurs in patients with an immunocompetent host (possessing the ability to mount a normal immune response). Patients diagnosed with AFS have a history of allergic rhinitis, and the onset of AFS development is difficult to determine. Thick fungal debris and mucin (a secretion containing carbohydrate-rich glycoproteins) are developed in the sinus cavities and must be surgically removed so that the inciting allergen is no longer present. Recurrence is not uncommon once the disease is removed. Anti-inflammatory medical therapy and immunotherapy are typically prescribed to prevent AFS recurrence. Note: A 1999 study published in the Mayo Clinic Proceedings asserts that allergic fungal sinusitis is present in a significant majority of patients diagnosed with chronic rhinosinusitis. The study found 96 percent of the study subjects with chronic rhinosinusitis to have a fungus in cultures of their nasal secretions. In sensitive individuals, the presence of fungus results in a disease process in which the body’s immune system sends eosinophils (white blood cells distinguished by their lobulated nuclei and the presence of large granules that attract the reddish-orange eosin stain) to attack fungi, and the eosinophils irritate the membranes in the nose. As long as fungi remain, so will the irritation. Chronic Indolent Sinusitis is an invasive form of fungal sinusitis in patients without an identifiable immune deficiency. This form is generally found outside the US, most commonly in the Sudan and northern India. The disease progresses from months to years and presents symptoms that include chronic headache and progressive facial swelling that can cause visual impairment. Microscopically, chronic indolent sinusitis is characterized by a granulomatous inflammatory infiltrate (nodular shaped inflammatory lesions). A decreased immune system can place patients at risk for this invasive disease. Fulminant Sinusitis is usually seen in the immunocompromised patient (an individual whose immunologic mechanism is deficient either because of an immunodeficiency disorder or because it has been rendered so by immunosuppressive agents). The disease leads to progressive destruction of the sinuses and can invade the bony cavities containing the eyeball and brain. The recommended therapies for both chronic indolent and fulminant sinusitis are aggressive surgical removal of the fungal material and intravenous anti-fungal therapy.

Allergic Rhinitis, Sinusitis, and Rhinosinusitis

Inflammation of the nasal mucous membrane is called rhinitis. The symptoms include sneezing and runny and/or itchy nose, caused by irritation and congestion in the nose. There are two types: allergic rhinitis and non-allergic rhinitis. Allergic Rhinitis: This condition occurs when the body’s immune system over-responds to specific, non-infectious particles such as plant pollens, molds, dust mites, animal hair, industrial chemicals (including tobacco smoke), foods, medicines, and insect venom. During an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast cells (cells that release histamine) in the lungs, skin, and mucous membranes. Once IgE connects with the mast cells, a number of chemicals are released. One of the chemicals, histamine, opens the blood vessels and causes skin redness and swollen membranes. When this occurs in the nose, sneezing and congestion are the result. Seasonal allergic rhinitis or hayfever occurs in late summer or spring. Hypersensitivity to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75 percent of all Americans who suffer from this seasonal disorder. People with sensitivity to tree pollen have symptoms in late March or early April; an allergic reaction to mold spores occurs in October and November as a consequence of falling leaves. Perennial allergic rhinitis occurs year-round and can result from sensitivity to pet hair, mold on wallpaper, houseplants, carpeting, and upholstery. Some studies suggest that air pollution such as automobile engine emissions can aggravate allergic rhinitis. Although bacteria is not the cause of allergic rhinitis, one medical study found a significant number of the bacteria Staphylococcus aureus in the nasal passages of patients with year-round allergic rhinitis, concluding that the allergic condition may lead to higher bacterial levels, thereby creating a condition that worsens the allergies. Patients who suffer from recurring bouts of allergic rhinitis should observe their symptoms on a continuous basis. If facial pain or a greenish-yellow nasal discharge occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment. Non-Allergic Rhinitis: This form of rhinitis does not depend on the presence of IgE and is not due to an allergic reaction. The symptoms can be triggered by cigarette smoke and other pollutants as well as strong odors, alcoholic beverages, and cold. Other causes may include blockages in the nose, a deviated septum, infections, and over-use of medications such as decongestants. Rhinosinusitis: Clarifying The Relationship Between The Sinuses And Rhinitis Recent studies by otolaryngologist–head and neck surgeons have better defined the association between rhinitis and sinusitis. They have concluded that sinusitis is often preceded by rhinitis and rarely occurs without concurrent rhinitis. The symptoms, nasal obstruction/discharge and loss of smell, occur in both disorders. Most importantly, computed tomography (CT scan) findings have established that the mucosal linings of the nose and sinuses are simultaneously involved in the common cold (previously, thought to affect only the nasal passages). Otolaryngologists, acknowledging the inter-relationship between the nasal and sinus passages, now refer to sinusitis as rhinosinusitis. The catalyst relating the two disorders is thought to involve nasal sinus overflow obstruction, followed by bacterial colonization and infection leading to acute, recurrent, or chronic sinusitis. Likewise, chronic inflammation due to allergies can lead to obstruction and subsequent sinusitis. Other medical research has supported the close relationship between allergic rhinitis and sinusitis. In a retrospective study on sinus abnormalities in 1,120 patients (from two to 87 years of age), thickening of the sinus mucosa was more commonly found in sinusitis patients during July, August, September, and December, months in which pollen, mold, and viral epidemics are prominent. A review of patients (four to 83 years of age) who had surgery to treat their chronic sinus conditions revealed that those with seasonal allergy and nasal polyps are more likely to experience a recurrence of their sinusitis.

Snoring Treatment

Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age. Snoring is an indication of obstructed breathing. Therefore, it should not be taken lightly. An otolaryngologist can help you to determine where the encumbrance may be and offer solutions for this noisy and often embarrassing behavior. What causes snoring? The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway (see illustration) where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing. In children, snoring may be a sign of problems with the tonsils and adenoids. A chronically snoring child should be examined by an otolaryngologist, as a tonsillectomy and adenoidectomy may be required to return the child to full health. Why is snoring serious? Socially – It can make the snorer an object of ridicule and causes others sleepless nights and resentfulness. Medically – It disturbs sleeping patterns and deprives the snorer of appropriate rest. When snoring is severe, it can cause serious, long-term health problems, including obstructive sleep apnea. What is obstructive sleep apnea? When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea. Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder. The immediate effect of sleep apnea is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur. Is there a cure for heavy snoring? Heavy snorers, those who snore in any position or are disruptive to the family, should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is and what effects it has on the snorer’s health. What treatments are available? Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal allergy, infection, deformity, or tonsils and adenoids. Snoring or obstructive sleep apnea may respond to various treatments now offered by many otolaryngologist—head and neck surgeons: Uvulopalatopharyngoplasty (UPPP) is surgery for treating obstructive sleep apnea. It tightens flabby tissues in the throat and palate, and expands air passages. Thermal Ablation Palatoplasty (TAP) refers to procedures and techniques that treat snoring and some of them also are used to treat various severities of obstructive sleep apnea. Different types of TAP include bipolar cautery, laser, and radiofrequency. Laser Assisted Uvula Palatoplasty (LAUP) treats snoring and mild obstructive sleep apnea by removing the obstruction in the airway. A laser is used to shrink the uvula and tighten a specified portion of the palate in a series of small procedures in a doctor’s office under local anesthesia. Radiofrequency ablation—some with temperature control approved by the FDA—utilizes a needle electrode to emit energy to shrink excess tissue in the upper

Stuffy Nose Treatment

Insight into the many causes of nasal congestion What are the causes of nasal congestion? Are there any risks when treating congestion? Where can I find out more? Nasal congestion, stuffiness, or obstruction to nasal breathing is one of the oldest and most common human complaints. For some, it may only be a nuisance; for others, nasal congestion can be a source of considerable discomfort. Medical writers have established four main causes of nasal obstruction: infection, structural abnormalities, allergic, and nonallercic (vasomotor) rhinitis. Patients often have a combination of these factors which vary from person to person. What are the causes of nasal congestion? Infection An average adult suffers a “common cold” two to three times per year. These viral infections occur more often in childhood because immunity strengthens with age. A cold is caused by one of many different viruses, some of which are airborne, but most are transmitted by hand-to-nose contact. Once the virus is absorbed by the nose, it causes the body to release histamine, a chemical which dramatically increases blood flow to the nose and causes nasal tissue to swell. This inflames the nasal membranes which become congested with blood and produce excessive amounts of mucus that “stuffs up” the nasal airway. Antihistamines and decongestants help relieve the symptoms of a cold, but no medication can cure it. Ultimately, time is what is needed to get rid of the infection. During a viral infection, the nose has poor resistance to bacteria, which is why infections of the nose and sinuses often follow a “cold.” When the nasal mucus turns from clear to yellow or green, it usually means that a bacterial infection has set in. In this case, a physician should be consulted. Acute sinus infections produce nasal congestion and thick discharge. Pain may occur in cheeks and upper teeth, between and behind the eyes, or above the eyes and in the forehead, depending on which sinuses are involved. Chronic sinus infections may or may not cause pain, but usually involve nasal obstruction and offensive nasal or postnasal discharge. Some people develop polyps (fleshy growths in the nose) from sinus infections, and the infection can spread to the lower airways, leading to a chronic cough, bronchitis, or asthma. Acute sinus infections generally respond to antibiotic treatment; chronic sinusitis may require surgery. Structural abnormalities These include deformities of the nose and nasal septum; the thin, flat cartilage and bone that divides the two sides of the nose and nostrils. These deformities are usually the result of an injury, sometimes having occurred in childhood. Seven percent of newborn babies suffer significant nasal injury in the birth process. Nasal injuries are common in both children and adults. If they obstruct breathing, surgical correction may be helpful. One of the most common causes of nasal obstruction in children is enlargement of the adenoids. These are a tonsil-like tissue located in the back of the nose, behind the palate. Children with this problem may experience noisy breathing at night and may snore. Children who are chronic mouth breathers may develop a sagging face and dental deformities. In this case, surgery to remove the adenoids and/or tonsils may be advisable. Other causes in this category include nasal tumors and foreign bodies. Children are often known to insert small objects into their noses. If a foul-smelling discharge is observed draining from one nostril, a physician should be consulted. Allergies Hay fever, rose fever, grass fever, and summertime colds are various names for allergic rhinitis. Allergy is an exaggerated inflammatory response to a substance which, in the case of a stuffy nose, is usually pollen, mold, animal dander, or some element in house dust. Pollen may cause problems during spring, summer, and fall, whereas house dust allergies are often most evident in the winter. Molds may cause symptoms year-round. In the allergic patient, the release of histamine and similar substances results in congestion and excess production of watery nasal mucus. Antihistamines help relieve the sneezing and runny nose of allergy. Typical antihistamines include Benadryl®, Chlortrimetron®, Claritin®, Teldrin®, Dimetane®, Hismanal®, Nolahist®, PBZ®, Polaramine®, Seldane®, Tavist®, Zyrtec®, Allegra®, and Alavert®, which are often available without a prescription and are available in several generic forms. Combinations of antihistamines with decongestants are also available.

Sleep Apnea and Children

Sleep apnea is known to affect 1 to 3 percent of children, but because there may be many unreported cases, could actually affect more. Sleep apnea can affect your child’s sleep and behavior and if left untreated can lead to more serious problems. Because sleep apnea can be difficult to diagnose, it is important to monitor your child for the symptoms and have a doctor see her if she exhibits any. What is sleep apnea? Obstructive sleep apnea occurs when breathing is disrupted during sleep. This occurs when the airway is blocked, resulting in choking that causes a slower heart rate and increased blood pressure, alerting your child’s brain and causing him to wake up. What are the symptoms? The first sign that your child may have sleep apnea is loud snoring that occurs regularly. You may also notice behavioral changes. Due to a lack of sleep, he or she may be more cranky, have more or less energy, and have difficulty concentrating in school. How is sleep apnea diagnosed? If you notice that your child has any of those symptoms, have him or her checked by an otolaryngologist— head and neck surgeon, who can use a sleep test to determine sleep apnea. For the test, electrodes are attached to the head to monitor brain waves, muscle tension, eye movement, breathing, and the level of oxygen in the blood. The test is not painful and can be performed in a sleep laboratory or at home. Results can vary, so it is important to have the otolaryngologist determine whether your child needs treatment. Often, in mild cases, treatment will be delayed while you are asked to monitor your child and let the doctor know if the symptoms worsen. In severe cases, the doctor will determine the appropriate treatment. What are the dangers if sleep apnea is left untreated? Because sleep apnea can lead to more serious problems, it is important that it be properly treated. When left untreated, sleep apnea can cause: -snoring -sleep deprivation -increased bed wetting -slowed growth -attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) -breathing difficulty -heart trouble What causes sleep apnea? In children, sleep apnea can occur for several physical reasons, including enlarged tonsils and adenoids, and abnormalities of the jaw bone and tongue. These factors cause the airway to be blocked, resulting in vibration of the tonsils, or snoring. Overweight children are at increased risk for sleep apnea. Of the 37 percent of children who are considered overweight, 25 percent of them likely have sleeping difficulties that may include sleep apnea. This is because extra fat around the neck and throat block the airway, making it difficult for these children to sleep soundly. Studies have shown that after three months of exercise, the number of children at risk for sleep apnea dropped by 50 percent. How is sleep apnea treated? Because enlarged tonsils and adenoids are a common cause of sleep apnea in children, routine treatment often involves an adenotonsillectomy, an operation to remove the tonsils and adenoids. This is a routine operation with a 90 percent success rate. Studies published in Otolaryngology—Head and Neck Surgery (October 2005) and presented at the Academy’s 2006 annual meeting in Toronto showed that when children with sleep apnea were tested one to five months after their surgery, they showed extreme improvement in their sleep and behavior, and that these improvements remained nearly a year and a half later.

CPAP - Continuous Positive Airway Pressure

Snoring Problems Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons and it usually grows worse with age. Snoring sounds are caused when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. Only recently have the adverse medical effects of snoring and its association with Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) been recognized. Various methods are used to alleviate snoring and/or OSA. They include behavior modification, sleep positioning, Continuous Positive Airway Pressure (CPAP), Uvulopalatopharyngoplasty (UPPP), and Laser Assisted Uvula Palatoplasty (LAUP), and jaw adjustment techniques. What Is Continuous Positive Airway Pressure (CPAP)? Nasal CPAP delivers air into your airway through a specially designed nasal mask or pillows. The mask does not breathe for you; the flow of air creates enough pressure when you inhale to keep your airway open. CPAP is considered the most effective nonsurgical treatment for the alleviation of snoring and obstructive sleep apnea. If your otolaryngologist determines that the CPAP treatment is right for you, you will be required to wear the nasal mask every night. During this treatment, you may have to undertake a significant change in lifestyle. That change could consist of losing weight, quitting smoking, or adopting a new exercise regimen. Before the invention of the nasal CPAP, a recommended course of action for a patient with sleep apnea or habitual snoring was a tracheostomy, or creating a temporary opening in the windpipe. The CPAP treatment has been found to be nearly 100 percent effective in eliminating sleep apnea and snoring when used correctly and will eliminate the necessity of a surgical procedure. So, If I Use A Nasal CPAP I Will Never Need Surgery? With the exception of some patients with severe nasal obstruction, CPAP has been found to be nearly 100 percent effective, although it does not cure the problem. However, studies have shown that long¬term compliance in wearing the nasal CPAP is about 70 percent. Some people have found the device to be claustrophobic or have difficulty using it when traveling. If you find that you cannot wear a nasal CPAP each night, a surgical solution might be necessary. Your otolaryngologist will advise you of the best course of action. Should You Consider CPAP? If you have significant sleep apnea, you may be a prime for CPAP. Your otolaryngologist will evaluate you and ask the following questions: -Do you snore loudly and disturb your family and friends? -Do you have daytime sleepiness? -Do you wake up frequently in the middle of the night? -Do you have frequent episodes of obstructed breathing during sleep? -Do you have morning headaches or tiredness? Suitability for CPAP use is determined after a review of your medical history, lifestyle factors (alcohol and tobacco intake as well as exercise), cardiovascular condition, and current medications. You will also receive a physical and otorhinolaryngological (ear, nose, and throat) examination to evaluate your airway. Before receiving the nasal mask, you would need to have the proper CPAP pressure set during a “sleep study.” This will complete the evaluation necessary for prescribing the appropriate treatment for your needs.

Ear Infections and Earache

Ear Infection and Vaccines Researchers continue to look for help for children and parents of children who suffer from the most common type of ear infection, called middle ear infection or otitis media (OM). About 62 percent of children in developed countries will have their first episode of OM by the age of one, more than 80 percent by their third birthday, and nearly 100 percent will have at least one episode by age five. In the U.S. alone, this illness accounts for 25 million office visits annually with direct costs for treatment estimated at $3 billion. Health economists add that when lost wages for parents are included, the total cost of estimated treatments mount to $6 billion. This is a big problem. Treatments The usual treatment options for children with middle ear infections include 1) antibiotics; and 2) surgical insertion of pressure equalizing tubes in the ears. While studies have shown that antibiotics can be helpful in certain cases, excessive use can lead to bacterial resistance, making infections more difficult to treat. Tubes sometimes do not equalize pressure enough or may need reinsertion over time. What about vaccines? A vaccine is a preparation administered to stimulate the body’s own defense system to combat specific bacteria or viruses. The first vaccine was introduced in the 18th century for the prevention of smallpox. Today, each vaccine is designed to resemble a particular virus or bacteria (or group of viruses and bacteria). When administered, the vaccine triggers the defense system without actually causing illness. This helps the body to develop a defense (antibodies) against the virus or bacteria so that if they enter the body, you will not get sick. Today, vaccines exist to combat a wide range of viruses and some bacteria. One of the most common and potentially serious bacteria to cause ear and sinus infections and pneumonia and meningitis is the pneumococcus. Recently a vaccine was developed that is effective against several common strains of pneumococcus. Your child’s physician will advise you on appropriate vaccines for your child. If the pneumococcal vaccine is offered to your child, you may want to know: The conjugate pneumococcal vaccine: This latest advance in pediatric healthcare prevents diseases caused by seven of the most common types of pneumococcal bacteria. It is safe and effective. It protects against serious forms of the disease up to 97 percent of the time, depending on the person. The vaccine is given by a needle. The side effects, which are usually minor and temporary, include some redness, swelling or tenderness from the injection, and a mild fever. Serious side effects, including allergic reactions, are quite rare. It can be given to infants, and there is no other vaccine to prevent pneumococcal disease in children less than two years of age. In 2002 the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommended the vaccine for infants and toddlers under the age of five. See http://www.cdc.gov/nip for more information. Conjugate vaccines are effective against otitis media in children under the age of five because they have a polysaccharide component linked to a protein component that an infant’s immature defense system can recognize. Children older than five, whose defense systems have matured, may receive a pneumococcal polysaccharide vaccine without the protein component. How does this relate to otitis media?Here are issues to consider. Streptococcus pneumoniae bacteria (commonly known as pneumococcus) are thought to cause 50 to 60 percent of cases of otitis media. Before this vaccine was available, each pneumococcal infection caused: about five million ear infections; more than 700 cases of meningitis; 13,000 blood infections (septicemia); and other health problems including pneumonia, deafness, and brain damage. Haemophilus influenzae (NTHi) and Moraxella catarrhalis vaccine Two other common bacteria that cause ear and sinus infections are nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. Recently, the National Institutes of Health has issued a license for the first clinical trials for a nontypeable Haemophilus influenzae (NTHi) vaccine. Vaccines to prevent viral infections like the flu that can eventually lead to ear infections should be considered for children with recurring ear infections. These vaccines are usually administered in the fall.

Swimmer's Ear

Affecting the outer ear, swimmer’s ear is a condition causing pain resulting from inflammation, irritation, or infection. These symptoms are experienced when water gets trapped in your ear allowing bacteria to spread, causing a painful sensation. Because this condition commonly affects swimmers it is known as swimmer’s ear. Swimmer’s ear affects mostly children and teenagers, but can also affect those with eczema (a condition that causes the skin to itch), or excess earwax. Your doctor will prescribe treatment to reduce your pain. What causes swimmer’s ear? A common source of the infection is increased moisture trapped in the ear canal, bathing, or showering, increased humidity or living in warm moist climates may also contribute to this common infection. When water is trapped in the ear canal. Bacteria that normally inhabit the skin and ear canal multiply, causing infection and irritation of the ear canal. If the infection gets worse it may affect other areas of the ear. Swimmer’s ear needs to be treated to reduce pain and eliminate any effect it may have on your hearing. Other factors that may contribute to swimmer’s ear include: contact with excessive bacteria that may be present in hot tubs or polluted water excessive cleaning of the ear canal with cotton swabs contact with certain chemicals such as hair spray or hair dye (Avoid this by placing cotton balls in your ears when using these products.) damage to the skin of the ear canal following water irrigation to remove wax a cut in the skin of the ear canal other skin conditions affecting the ear canal such as eczema or seborrhea What are the signs and symptoms? The most common symptoms of swimmer’s ear are an itchy ear and mild to moderate pain that gets worse when you tug on the auricle (outer ear). Other signs and symptoms may include any of the following: sensation that the ear is blocked or full drainage fever decreased hearing intense pain that may radiate to the neck, face, or side of the head the auricle may appear to be pushed forward or away from the skull swollen lymph nodes (located in your neck) redness and swelling of the skin around the ear If left untreated, complications resulting from swimmer’s ear may include: Hearing loss. When the infection clears up, hearing usually returns to its normal state. Recurring ear infections (chronic otitis externa). Without treatment, infection can occur. Bone and cartilage damage (malignant otitis externa). When ear infections spread to the base of your skull, brain, or cranial nerves they become painful and dangerous. Diabetics and older adults are more at risk. To evaluate you for swimmer’s ear, your doctor will look for redness and swelling in your ear. Your doctor also may take a sample of any abnormal fluid or discharge in your ear to test for the presence of bacteria or fungus (ear culture) if you have recurrent infections. How is swimmer’s ear treated? Treatment for the early stages of swimmer’s ear includes careful cleaning of the ear canal and eardrops that inhibit bacterial growth. Mild acid solutions such as boric or acetic acid are effective for early infections. How should ear drops be applied? Drops are more easily administered if done by someone other than the patient. The patient should lie down with the affected ear facing upwards. Drops should be placed in the ear until the ear is full. After drops are administered, the patient should remain lying down for a few minutes so that the drops can be absorbed. Cotton balls should not be placed in the ear.The ear needs to absorb the drops and dry naturally. If you do not have a perforated eardrum (an eardrum with a hole in it), you can make your own eardrops using rubbing alcohol or a mixture of half alcohol and half vinegar. These eardrops will evaporate excess water and keep your ears dry. Before using any drops in the ear, it is important to verify that you do not have a perforated eardrum. Check with your otolaryngologist if you have ever had a perforated, punctured, or injured eardrum, or if you have had ear surgery. For more severe infections, your doctor may prescribe antibiotics to be applied directly to the ear. If the ear canal is swollen shut, a sponge or wick may be placed in the ear canal so that the antibiotic drops will be effective. Pain medication may also be prescribed. If you have tubes in your eardrum, a non oto-toxic (will not affect your hearing) topical treatment should be used. Topical antibiotics are effective for infection limited to the ear canal. Oral antibiotics may also be prescribed if the infection

Exostoses

Exostosis is the medical term for an abnormal growth of bone within the ear canal. It is more commonly referred to as surfer’s ear. This common name derives from the fact that the most common cause of exostosis is frequent exposure to cold water, making this a condition that affects surfers at a higher rate than the average population. Exposure to wind and cold water causes the bone surrounding the ear canal to thicken and constrict the ear canal, sometimes to the point of complete blockage (known as “occlusion”) which can lead to substantial conductive hearing loss. An exostosis growth can result from any activity that exposes the participant to cold, wet and windy conditions such as skiing, kayaking, fishing, sailing or diving. Most patients who develop an exostosis are in their mid-to-late 30s but those with significant cold water exposure such as surfers can develop the condition earlier. This is due to the slow progression of bone growth from years of cold weather exposure. WHAT IS A NORMAL EAR CANAL? The normal ear canal is 5-8mm in diameter (about as thick as a pencil). As the narrowing of the canal from exostosis progresses, this diameter gets substantially reduced, to the point of total closure if the exostosis remains untreated. Exostosis in not necessarily harmful by itself, but the ear canal construction from the bony growth can trap cerumen (ear wax) and other debris within the ear canal, which may lead to repeated ear infections. WHAT ARE THE SYMPTOMS AND TREATMENT OF EXOSTOSIS? Exostosis symptoms of include a decrease in hearing sensitivity possibly combined with an increased prevalence of ear infections. Early symptoms include water trapping in the ear canal after swimming. Sometime thereafter, debris trapping and infections make surgery necessary. Exostosis is most commonly treated by a surgical procedure to remove the growth. There are two different approaches to the surgery, the first uses a small incision behind the ear and the excess bone growth is removed using a surgical drill, and the second uses a drill to remove the bone growth from inside of the ear canal itself. After the surgery, it is important for the patient to avoid any cold water activities for 2-6 weeks in order to prevent complications or infections. CAN EXOSTOSIS RETURN EVEN AFTER SURGERY? Repeated cold water exposure can cause regrowth of bone, but after surgical removal it is extremely rare to need the procedure a second time. WILL EXOSTOSIS IMPROVE IF LEFT UNTREATED? No. The bone growth is irreversible once formed. IS EXOSTOSIS PREVENTABLE? Exostosis is preventable by following some basic safety precautions. Avoid activity during extremely cold or windy conditions; Use custom ear protection to prevent cold water exposure if cold or windy conditions are going to be common experiences such as with surfing or sailing. Custom ear plugs are created by making an impression of the ear canal and creating a plug that is customized to the individual patient. These plus are more comfortable and work better than over-the-counter one-size-fits-all solutions. Use a swim cap or hood in addition to the ear plugs mentioned above; EXOSTOSIS FACTS: In general, one ear may be much worse than the other. If so, this may be due to the prevailing wind direction in the areas most visited by the patient. The widespread use of better wetsuits and dry suit technology has allowed people to participate in water sports in much colder waters, likely increasing the incidence and severity of exostosis for those who do not use proper ear protection. Cold water surfers experience exostosis at a rate 600 % higher than warm water surfers. The colder the water, the quicker exostoses grow.

Eustachian Tube Dysfunction

Eustachian Tube Dysfunction The ear is divided into three parts: the external ear includes the visible part of the ear (the pinna) and the ear canal; the middle ear is the air-filled space behind the eardrum that contains the three middle ear bones (the ossicles); and the inner ear contains the sensory organs of hearing (cochlea) and balance (semicircular canals). The Eustachian tube is a narrow tube that connects the middle ear to the back of the nose. Normally, the Eustachian tube opens with every swallow or yawn to act as a pressure-equalizing valve for the middle ear. It also serves to drain the mucus produced by the lining of the middle ear. Blockage of the Eustachian tube isolates the middle ear space from the outside environment. The lining of the middle ear absorbs the trapped air and creates a negative pressure that pulls the eardrum inward. The eardrum is thin and pliable, like plastic wrap, and is densely innervated. When it becomes stretched inward, patients often experience pain, pressure, and hearing loss. Long-term blockage of the Eustachian tube leads to the accumulation of fluid in the middle ear space that further increases the pressure and hearing loss. This is called serous otitis media. Should bacteria contaminate this fluid, a middle ear infection may result, called acute otitis media. Chronic blockage of the Eustachian tube is called Eustachian tube dysfunction. This can occur when the lining of the nose becomes irritated and inflamed, narrowing the Eustachian tube opening or its passageway. Illnesses like the common cold or influenza are often to blame. Pollution and cigarette smoke can also cause Eustachian tube dysfunction. In many areas of the country, nasal allergy (allergic rhinitis) is the major cause of Eustachian tube dysfunction. Obesity can also predispose a patient to Eustachian tube dysfunction because of excess fatty deposits around the passageway of the Eustachian tube. Rarely, Eustachian tube blockage may be the sign of a more serious problem such as nasal polyps, a cleft palate, or a skull base tumor. Young children (especially ages one to six years) are at particular risk for Eustachian tube dysfunction, serous otitis media, and acute otitis media because they have very narrow Eustachian tubes. Also, they may have adenoid enlargement that can block the opening of the Eustachian tube. Since children in daycare are highly prone to getting upper respiratory tract infections, they tend to get more ear infections compared to children that are cared for at home. Medical Treatment Allergic Treatment and Nasal Decongestion. Identification and treatment of nasal allergies may also help to reduce the swelling in the lining of the Eustachian tube. Identifying the particular allergen a patient is sensitive to and eliminating it from the environment may reduce the patient’s symptoms. Allergy shots may also provide some help, although it may take a long time to notice beneficial effects. Intranasal steroids act to reduce inflammation of the mucosal lining of the nose and may provide some benefit to patients with Eustachian tube dysfunction. A trial of four weeks of daily usage is recommended to see if the medication is helpful. Nasal steroids take two weeks to begin to work. The onset of their effects is gradual, so patients have to use it every day. One does not typically notice an immediate improvement after spraying it in their nose. Decongestants constrict blood vessels and help open the Eustachian tube by reducing swelling of the lining of the nose. These medications work immediately and can be taken as needed. Oral preparations work for about four hours and should not be used around bedtime because they may make it difficult to get to sleep. Nasal spray preparations work quite well and directly decongest the nose; however, because the body rapidly gets used to the medication, they should only be used for up to three days in a row. Antihistamines work to reduce the body’s inflammatory response to allergens. These medications may be helpful for some patients, although in my experience, not as reliably as nasal steroids or decongestants. Antihistamines can be taken as needed. Self-Inflation of the Ears. It is possible to forcibly blow air through the Eustachian tube into the middle ear by pinching the nose closed and “popping the ear. Self-Inflation of the Ears. It is possible to forcibly blow air through the Eustachian tube into the middle ear by pinching the nose closed and “popping the ear.” Another way to do this is to blow up balloons. The pressure required to expand a balloon is usually enough to push air up the Eustachian tube. This is a very useful maneuver and may be repeated as often as necessary, whenever a sense of pressure or fullness in the ear develops. This should not be performed when a cold or nasal discharge is present as this may drive infected mucous into the middle ear and cause an ear infection.

Tinnitus

Nearly 36 million Americans suffer from tinnitus or head noises. It may be an intermittent sound or an annoying continuous sound in one or both ears. Its pitch can go from a low roar to a high squeal or whine. Prior to any treatment, it is important to undergo a thorough examination and evaluation by your otolaryngologist. An essential part of the treatment will be your understanding of tinnitus and its causes. What causes tinnitus? Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. If you are older, advancing age is generally accompanied by a certain amount of hearing nerve impairment and tinnitus. If you are younger, exposure to loud noise is probably the leading cause of tinnitus, and often damages hearing as well. There are many causes for “subjective tinnitus,” the noise only you can hear. Some causes are not serious (a small plug of wax in the ear canal might cause temporary tinnitus). Tinnitus can also be a symptom of stiffening of the middle ear bones (otosclerosis). Tinnitus may also be caused by allergy, high or low blood pressure (blood circulation problems), a tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other causes including medications such as anti-inflammatories, antibiotics, sedatives, antidepressants, and aspirin. If you take aspirin and your ears ring, talk to your doctor about dosage in relation to your size. Treatment will be quite different in each case of tinnitus. It is important to see an otolaryngologist to investigate the cause of your tinnitus so that the best treatment can be determined. How is tinnitus treated? In most cases, there is no specific treatment for ear and head noise. If your otolaryngologist finds a specific cause of your tinnitus, he or she may be able to eliminate the noise. But, this determination may require extensive testing including X-rays, balance tests, and laboratory work. However, most causes cannot be identified. Occasionally, medicine may help the noise. The medications used are varied, and several may be tried to see if they help. What are some other tinnitus treatment options? Alternative treatments Amplification (hearing aids) Cochlear implants or electrical stimulation Cognitive therapy Drug therapy Sound therapy TMJ treatment Can other people hear the noise in my ears? Not usually, but sometimes they are able to hear a certain type of tinnitus. This is called “objective tinnitus,” and it caused either by abnormalities in blood vessels around the outside of the ear or by muscle spasms, which may sound like clicks or crackling inside the middle ear. Can children be at risk for tinnitus? Yes, children are at risk too. However, it is not a common complaint. Like people of all ages, children who are exposed to loud noises are at a higher risk for tinnitus. High-decibel recreational events, like car races, music concerts, or sports games, can damage children’s ears. Hearing protection devices should always be worn. Tips to lessen the severity of tinnitus: Avoid exposure to loud sounds and noises. Get your blood pressure checked. If it is high, get your doctor’s help to control it. Decrease your intake of salt. Salt impairs blood circulation. Avoid stimulants such as coffee, tea, cola, and tobacco. Exercise daily to improve your circulation. Get adequate rest and avoid fatigue. Stop worrying about the noise. Recognize your head noise as an annoyance and learn to ignore it as much as possible. What can help me cope? Concentration and relaxation exercises can help to control muscle groups and circulation throughout the body. The increased relaxation and circulation achieved by these exercises can reduce the intensity of tinnitus in some patients. Masking out the head noise with a competing sound at a constant low level, such as a ticking clock or radio static (white noise), may make it less noticeable. Tinnitus is usually more bothersome in quiet surroundings. Products that generate white noise are available through catalogs and specialty stores. Hearing aids may reduce head noise while you are wearing them and sometimes cause the noise to go away temporarily, if you have a hearing loss It is important not to set the hearing aid at excessively loud levels, as this can worsen the tinnitus in some cases. However, a thorough trial before purchase of a hearing aid is advisable if your primary purpose is the relief of tinnitus. Tinnitus maskers can be combined within hearing aids. They emit a competitive but pleasant sound that can distract you from head noise. Some people find that a tinnitus masker may even suppress the head noise for several hours after it is used, but this is not true for all users.

Dizziness and Motion Sickness

What causes dizziness? Circulation: If your brain does not get enough blood flow, you feel lightheaded. Almost everyone has experienced this on occasion when standing up quickly from a lying down position. But some people have light-headedness from poor circulation on a frequent or chronic basis. This could be caused by arteriosclerosis or hardening of the arteries, and it is commonly seen in patients who have high blood pressure, diabetes, or high levels of blood fats (cholesterol). It is sometimes seen in patients with inadequate cardiac (heart) function, hypoglycemia (low blood sugar), or anemia (low iron). Certain drugs also decrease the blood flow to the brain, especially stimulants such as nicotine and caffeine. Excess salt in the diet also leads to poor circulation. Sometimes circulation is impaired by spasms in the arteries caused by emotional stress, anxiety, and tension. If the inner ear fails to receive enough blood flow, the more specific type of dizziness occurs, that is, vertigo. The inner ear is very sensitive to minor alterations of blood flow and all of the causes mentioned for poor circulation to the brain also apply specifically to the inner ear. Vertigo: Benign paroxysmal positional vertigo (BPPV), labyrinthitis, and Ménière’s syndrome (fluctuating hearing usually in one ear, pressure in the ear, ringing in one ear, and attacks of spinning), and some forms of migraine are all causes of vertigo. BPPV occurs when you change the position of your head (typically lying down or sitting up), while inner ear infections can cause labyrinthitis. Injury: A skull fracture that damages the inner ear produces a profound and incapacitating vertigo with nausea and hearing loss. The dizziness will last for several weeks, and then slowly improve as the normal (other) side takes over. Infection: Viruses can attack the inner ear and its nerve connections to the brain. This can result in severe vertigo, but hearing is usually spared. However, a bacterial infection such as mastoiditis that extends into the inner ear will completely destroy both the hearing and the equilibrium function of that ear. The severity of dizziness and recovery time will be similar to that of a skull fracture. Allergy: Some people experience dizziness and/or vertigo attacks when they are exposed to foods or airborne particles (such as dust, molds, pollens, dander, etc.) to which they are allergic. Neurological diseases: A number of diseases of the nerves can affect balance, such as multiple sclerosis, syphilis, tumors, etc. These are uncommon causes, but your doctor will think about them during the examination. When should I seek medical attention? Call 911 or go to an emergency room if you experience: a head injury, fever over 101°F, headache, or very stiff neck, convulsions or ongoing vomiting, chest pain, heart palpitations, shortness of breath, weakness, a severe headache, inability to move an arm or leg, or change in vision or speech, or fainting and loss of consciousness for more than a few minutes. Consult your doctor if you: have never experienced dizziness before, experience a difference in symptoms you have had in the past, suspect that medication is causing your symptoms, or experience hearing loss. How will my dizziness be treated? The doctor will ask you to describe your dizziness and answer questions about your general health. Along with these questions, your doctor will examine your ears, nose, and throat. Some routine tests will be performed to check your blood pressure, nerve and balance function, and hearing. Possible additional tests may include a CT or MRI scan of your head, special tests of eye motion after warm or cold water or air is used to stimulate the inner ear (ENG—electronystagmography or VNG—videonystagmography), and in some cases, blood tests or a cardiology (heart) evaluation. Your doctor will determine the best treatment based on your symptoms and the cause of them. Prevention tips Avoid rapid changes in position. Avoid rapid head motion (especially turning or twisting). Eliminate or decrease use of products that impair circulation, e.g., tobacco, alcohol, caffeine, and salt. Minimize stress and avoid substances to which you are allergic. Get enough fluids Treat infections, including ear infections, colds, flu, sinus congestion, and other respiratory infections If you are subject to motion sickness: Do not read while traveling. Do not sit in a seat facing backward. Do not watch or talk to another traveler who is having motion sickness. Avoid strong odors and spicy or greasy foods immediately before and during your travel. Talk to your doctor about medications. Remember: Most cases of dizziness and motion sickness are mild and self-treatable. But, severe cases and those that become progressively worse deserve the attention of a doctor with specialized skills in diseases of the ear, nose, throat, equilibrium, and neurological systems.

Hearing Loss

Genes and Hearing Loss One of the most common birth defects is hearing loss or deafness (congenital), which can affect as many as three of every 1,000 babies born. Inherited genetic defects play an important role in congenital hearing loss, contributing to about 60 percent of deafness occurring in infants. Although exact data is not available, it is likely that genetics plays an important role in hearing loss in the elderly.Inherited genetic defects are just one factor that can lead to hearing loss and deafness, both of which may occur at any stage of a person’s lifespan. Other factors may include: medical problems, environmental exposure, trauma, and medications. The most common and useful distinction in hearing impairment is syndromic versus non-syndromic. Non-syndromic hearing impairment accounts for the vast majority of inherited hearing loss, approximately 70 percent. Autosomal- recessive inheritance is responsible for about 80 percent of cases of non-syndromic hearing impairment, while autosomal-dominant genes cause 20 percent, less than two percent of cases are caused by X-linked and mitochondrial genetic malfunctions. Syndromic (sin-DRO-mik) means that the hearing impairment is associated with other clinical abnormalities. Among hereditary hearing impairments, 15 to 30 percent are syndromic. Over 400 syndromes are known to include hearing impairment and can be classified as: syndromes due to cyotgenetic or chromosomal anomalies, syndromes transmitted in classical monogenic or Mendelian inheritance, or syndromes due to multi-factorial influences, and finally, syndromes due to a combination of genetic and environmental factors.Variable expression of different aspects of syndromes is common. Some aspects may be expressed in a range from mild to severe or different combinations of associated symptoms may be expressed in different individuals carrying the same mutation within a single pedigree. An example of variable expressivity is seen in families transmitting autosomal dominant Waardenburg syndrome.Within the same family, some affected members may have dystopia canthorum (an unusually wide nasal bridge due to sideways displacement of the inner angles of the eyes), white forelock, heterochromia irides (two different-colored irises or two colors in the same iris), and hearing loss, while others with the same mutation may only have dystopia canthorum. How Do Genes Work? Genes are a road map for the synthesis of proteins, which are the building blocks for everything in the body: hair, eyes, ears, heart, lung, etc. Every child inherits half of its genes from one parent and half from the other parent. If the inherited genes are defective, a health disorder such as hearing loss or deafness can result.Hearing disorders are inherited in one of four ways: Autosomal Dominant Inheritance: For autosomal dominant disorders, the transmission of a rare allele of a gene by a single heterozygous parent is sufficient to generate an affected child. A heterozygous parent has two types of the same gene (in this case, one mutated and the other normal) and can produce two types of gametes (reproductive cells).One gamete will carry the mutant form of the gene of interest, and the other the normal form. Each of these gametes then has an equal chance of being used to form the offspring. Thus the chance that the offspring of a parent with an autosomal dominant gene will develop the disorder is 50 percent. Autosomal dominant traits usually affect males and females equally. Autosomal Recessive Inheritance: An autosomal recessive trait is characterized by having parents who are heterozygous carriers for mutant forms of the gene in question but are not affected by the disorder. The problem gene that would cause the disorder is suppressed by the normal gene. These heterozygous parents (A/a) can each generate two types of gametes, one carrying the mutant copy of the gene (a) and the other having a normal copy of the gene (A). There are four possible combinations from each of the parents, A/a, A/A, a/A, and a/a. Only the offspring that inherits both mutant copies (a/a) will exhibit the trait. Overall, offspring of these two parents will face a 25 percent chance of inheriting the disorder. X-linked Inheritance: A male offspring has an X chromosome and a Y chromosome, while a female has two copies of the X chromosome only. Each female inherits an X chromosome from her mother and her father. On the other hand, each male inherits an X chromosome from his mother and a Y chromosome from his father. In general, only one of the two X chromosomes carried by a female is active in any one cell while the other is rendered inactive. This is why when a female inherits a defective gene on one X chromosome, the normal gene on the other X chromosome can usually compensate. As males only have one copy of the X chromosome, any defective gene is more likely to manifest into a disorder.

Tonsils and Adenoids

What are tonsils and adenoids? Two masses of tissue that are similar to the lymph nodes or “glands” found in the neck, groin, and armpits. Tonsils are the two masses on the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments. What affects tonsils and adenoids? The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing, swallowing, and sleep problems. Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. Tumors are rare, but can grow on the tonsils. When should I see a doctor? You should see your doctor when you or your child suffer the common symptoms of infected or enlarged tonsils or adenoids. Your physician will ask about problems of the ear, nose, and throat and examine the head and neck. He or she will use a small mirror or a flexible lighted instrument to see these areas. Other methods used to check tonsils and adenoids are: Medical history Physical examination Throat cultures/Strep tests – helpful in determining infections in the throat X-rays – helpful in determining the size and shape of the adenoids Blood tests – helpful in determing infections such as mononucleosis How are tonsil and adenoid diseases treated? Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Sometimes, removal of the tonsils and/or adenoids may be recommended if there are recurrent infections despite antibiotic therapy, and/or difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children. Chronic infection can affect other areas such as the eustachian tube – the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and potential hearing loss. Recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion). In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., cortisone) is sometimes helpful. How to prepare for surgery Children Talk to your child about his/her feelings and provide strong reassurance and support • Encourage the idea that the procedure will make him/her healthier. Be with your child as much as possible before and after the surgery. Tell him/her to expect a sore throat after surgery. Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward. If your child has a friend who has had this surgery, it may be helpful to talk about it with that friend. Adults and children For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome). If the patient or patient’s family has had any problems with anesthesia, the surgeon should be informed. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed. A blood test and possibly a urine test may be required prior to surgery. Generally, after midnight prior to the operation, nothing may be taken by mouth (including chewing gum, mouthwashes, throat lozenges, toothpaste, water.) Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous. When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery. After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient until discharged. Every patient is unique, and recovery time may vary. Your ENT specialist will provide you with the details of preoperative and postoperative care and answer any questions you may have.

Thyroid Disorders and Surgery

Your thyroid gland is one of the endocrine glands that makes hormones to regulate physiological functions in your body, like metabolism. Other endocrine glands are the pancreas, the pituitary, the adrenal glands, and the parathyroid glands. The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and wraps around the front half of the trachea (windpipe). It is shaped like a bow tie, just above the collarbones, having two halves (lobes) which are joined by a small tissue bar (isthmus.). You can’t always feel a normal thyroid gland. What is a thyroid disorder? Diseases of the thyroid gland are very common, affecting millions of Americans. The most common thyroid problems are: an overactive gland, called hyperthyroidism (e.g., Graves’ disease, toxic adenoma or toxic nodular goiter) an underactive gland, called hypothyroidism (e.g., Hashimoto’s thyroiditis) thyroid enlargement due to overactivity (as in Graves’ disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a “goiter”. Patients with a family history or who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy. If you develop significant swelling in your neck or difficulty breathing or swallowing, you should call your surgeon or be seen in the emergency room. What treatment may be recommended? Depending on the nature of your condition, treatment may include the following: Hypothyroidism treatment: thyroid hormone replacement pills Hyperthyroidism treatment: medication to block the effects of excessive production of thyroid hormone radioactive iodine to destroy the thyroid gland surgical removal of the thyroid gland Goiters (lumps): If you experience this condition, your doctor will propose a treatment plan based on the examination and your test results. He may recommend: a fine needle aspiration biopsy—a safe, relatively painless procedure. With this procedure, a hypodermic needle is passed into the lump, often after administration of local anesthesia into the skin, and tissue fluid samples containing cells are taken. Often several passes with the needle are required. Sometimes ultrasound may be used to guide the needle into the nodule. There is little pain afterward and very few complications from the procedure occur. This test gives the doctor more information on the nature of the lump in your thyroid gland and specifically may help to differentiate a benign from a malignant thyroid mass. thyroid surgery—may be required when: the fine needle aspiration is reported as suspicious for or suggestive of cancer the trachea (windpipe) or esophagus are compressed because both lobes are very large Historically, some malignant thyroid nodules have shown a reduction in size with the administration of thyroid hormone. However, this treatment, known as medical “suppression” therapy, has proven to be an unreliable treatment method. What is thyroid surgery? Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anesthesia is usually required. Typically the operation removes the lobe of the thyroid gland containing the lump and possibly the isthmus. A frozen section (an immediate microscopic reading) may or may not be used to determine if the rest of the thyroid gland should be removed. Sometimes, based on the result of the frozen section, the surgeon may decide not to remove any additional thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck. This is a decision usually made in the operating room by the surgeon, based on findings at the time of surgery. Your surgeon will discuss these options with you preoperatively. There may be times when the definite microscopic answer cannot be determined until several days after surgery. If a malignancy is identified in this way, your surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedure. If you have specific questions about thyroid surgery, ask your otolaryngologist and he or she will answer them in detail. What happens after thyroid surgery? During the first 24 hours: After surgery, you may have a drain (a tiny piece of plastic tubing), which prevents fluid and blood from building up in the wound. This is removed after the fluid accumulation has stabilized, usually within 24 hours after surgery. Most patients are discharged later the same day or the day following the procedure. Complications are rare but may include: bleeding a hoarse voice difficulty swallowing numbness of the skin on the neck vocal cord paralysis low blood calcium At home: Following the procedure, if it is determined that you need to take any medication, your surgeon will discuss this with you, prior to your discharge.

Fine Needle Aspiration

What Is FNA? Fine needle aspiration (FNA) is a technique that allows a biopsy of various bumps and lumps. It allows your otolaryngologist to retrieve enough tissue for microscopic analysis and thus make an accurate diagnosis of a number of problems, such as inflammation or even cancer. FNA Is Used for Diagnosis In: Neck lymph nodes Neck cysts Parotid gland Thyroid gland Inside the mouth Any lump that can be felt Why Is FNA Important? A mass or lump sometimes indicates a serious problem, such as a growth or cancer*. While this is not always the case, the presence of a mass may require FNA for diagnosis. Your age, sex, and habits, such as smoking and drinking, are also important factors that help diagnosis of a mass. Symptoms of ear pain, increased difficulty swallowing, weight loss, or a history of familial thyroid disorder or of previous skin cancer (squamous cell carcinoma) may be important as well. * When found early, most cancers in the head and neck can be cured with relatively little difficulty. Cure rates for these cancers are greatly improved if people seek medical advice as soon as possible. So play it safe. If you have a lump in your head and neck area, see your otolaryngologist right away. What Are Some Areas That Can Be Biopsied In This Fashion? FNA is generally used for diagnosis in areas such as the neck lymph nodes or for cysts in the neck. The parotid gland (the mumps gland), thyroid gland, and other areas inside the mouth or throat can be aspirated as well. Virtually any lump or bump that can be felt (palpated) can be biopsied using the FNA technique. How Is FNA Done? Your doctor will insert a small needle into the mass. Negative pressure is created in the syringe, and as a result of this pressure difference between the syringe and the mass, cellular material can be drawn into the syringe. The needle is moved in a to and fro fashion, obtaining enough material to make a diagnosis. This procedure is generally accurate and frequently prevents the patient from having an open, surgical biopsy, which is more painful and costly. The procedure generally does not require anesthesia. It is about as painful as drawing blood from the arm for laboratory testing (venipuncture). In fact, the needle used for FNA is smaller than that used for venipuncture. Although not painless, any discomfort associated with FNA is usually minimal. What Are The Complications Of The FNA Procedure? No medical procedure is without risks. Due to the small size of the needle, the chance of spreading a cancer or finding cancer in the needle path is very small. Other complications are rare; the most common is bleeding. If bleeding occurs at all, it is generally seen as a small bruise. Patients who take aspirin, Advil®, or blood thinners, such as Coumadin®, are more at risk to bleed. However, the risk is minimal. Infection is rarely seen.

Salivery Gland Disease

What Causes Salivary Gland Problems? Salivary gland problems that cause clinical symptoms include: Obstruction: Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because stones have formed. Symptoms typically occur when eating. Saliva production starts to flow, but cannot exit the ductal system, leading to swelling of the involved gland and significant pain, sometimes with an infection. Unless stones totally obstruct saliva flow, the major glands will swell during eating and then gradually subside after eating, only to enlarge again at the next meal. Infection can develop in the pool of blocked saliva, leading to more severe pain and swelling in the glands. If untreated for a long time, the glands may become abscessed. It is possible for the duct system of the major salivary glands that connects the glands to the mouth to be abnormal. These ducts can develop small constrictions, which decrease salivary flow, leading to infection and obstructive symptoms. Infection: The most common salivary gland infection in children is mumps, which involves the parotid glands. While this is most common in children who have not been immunized, it can occur in adults. However, if an adult has swelling in the area of the parotid gland only on one side, it is more likely due to an obstruction or a tumor. Infections also occur because of ductal obstruction or sluggish flow of saliva because the mouth has abundant bacteria. You may have a secondary infection of salivary glands from nearby lymph nodes. These lymph nodes are the structures in the upper neck that often become tender during a common sore throat. In fact, many of these lymph nodes are actually located on, within, and deep in the substance of the parotid gland or near the submandibular glands. When these lymph nodes enlarge through infection, you may have a red, painful swelling in the area of the parotid or submandibular glands. Lymph nodes also enlarge due to tumors and inflammation. Tumors: Primary benign and malignant salivary gland tumors usually show up as painless enlargements of these glands. Tumors rarely involve more than one gland and are detected as a growth in the parotid, submandibular area, on the palate, floor of mouth, cheeks, or lips. An otolaryngologist-head and neck surgeon should check these enlargements. Malignant tumors of the major salivary glands can grow quickly, may be painful, and can cause loss of movement of part or all of the affected side of the face. These symptoms should be immediately investigated. Other Disorders: Salivary gland enlargement also occurs in autoimmune diseases such as HIV and Sjögren’s syndrome where the body’s immune system attacks the salivary glands causing significant inflammation. Dry mouth or dry eyes are common. This may occur with other systemic diseases such as rheumatoid arthritis. Diabetes may cause enlargement of the salivary glands, especially the parotid glands. Alcoholics may have salivary gland swelling, usually on both sides. How Is Salivary Gland Disease Treated? Treatment of salivary diseases falls into two categories: medical and surgical. Selection of treatment depends on the nature of the problem. If it is due to systemic diseases (diseases that involve the whole body, not one isolated area), then the underlying problem must be treated. This may require consulting with other specialists. If the disease process relates to salivary gland obstruction and subsequent infection, your doctor will recommend increased fluid intake and may prescribe antibiotics. Sometimes an instrument will be used to open blocked ducts. If a mass has developed within the salivary gland, removal of the mass may be recommended. Most masses in the parotid gland area are benign (noncancerous). When surgery is necessary, great care must be taken to avoid damage to the facial nerve within this gland that moves the muscles face including the mouth and eye. When malignant masses are in the parotid gland, it may be possible to surgically remove them and preserve most of the facial nerve. Radiation treatment is often recommended after surgery. This is typically administered four to six weeks after the surgical procedure to allow adequate healing before irradiation. The same general principles apply to masses in the submandibular area or in the minor salivary glands within the mouth and upper throat. Benign diseases are best treated by conservative measures or surgery, whereas malignant diseases may require surgery and postoperative irradiation. If the lump in the vicinity of a salivary gland is a lymph node that has become enlarged due to cancer from another site, then obviously a different treatment plan will be needed. An otolaryngologist—head and neck surgeon can effectively direct treatment.

GERD

Gastroesophageal reflux disease, or GERD, occurs when acid from the stomach backs up into the esophagus. Normally, food travels from the mouth, down through the esophagus and into the stomach. A ring of muscle at the bottom of the esophagus, the lower esophageal sphincter (LES), contracts to keep the acidic contents of the stomach from “refluxing” or coming back up into the esophagus. In those who have GERD, the LES does not close properly, allowing acid to move up the esophagus. When stomach acid touches the sensitive tissue lining the esophagus, it causes a reaction similar to squirting lemon juice in your eye. This is why GERD is often characterized by the burning sensation known as heartburn. Occasional heartburn is normal. However, if heartburn becomes chronic, occurring more than twice a week, you may have GERD. Left untreated, GERD can lead to more serious health problems. Who gets GERD? Anyone can have GERD. Women, men, infants and children can all experience this disorder. Overweight people and pregnant women are particularly susceptible because of the pressure on their stomachs. Recent studies indicate that GERD may often be overlooked in infants and children. In infants and children, GERD can cause repeated vomiting, coughing, and other respiratory problems such as sore throat and ear infections. Most infants grow out of GERD by the time they are one year old. Tips to Prevent GERD Do not drink alcohol Lose weight Quit smoking Limit problem foods such as: Caffeine Carbonated drinks Chocolate Peppermint Tomato and citrus foods Fatty and fried foods Wear loose clothing Eat small meals and slowly What are the symptoms of GERD? The symptoms of GERD may include persistent heartburn, acid regurgitation, and nausea. Some people have GERD without heartburn. Instead, they experience pain in the chest that can be sever enough to mimic the pain of a heart attack, hoarseness in the morning, or trouble swallowing. Some people may also feel like they have food stuck in their throat or like they are choking. GERD can also cause a dry cough and bad breath. What causes GERD? Physical causes of GERD can include: a malfunctioning or abnormal lower esophageal sphincter muscle (LES), hiatal hernia, abnormal esophageal contractions, and slow emptying of the stomach. Lifestyle factors that contribute to GERD include: alcohol use obesity pregnancy smoking Certain foods can contribute to GERD, such as: citrus fruits chocolate caffeinated drinks fatty and fried foods garlic and onions mint flavorings (especially peppermint) spicy foods tomato-based foods, like spaghetti sauce, chili, and pizza When should I see a doctor? If you experience heartburn more than twice a week, frequent chest pains after eating, trouble swallowing, persistent nausea, and cough or sore throat unrelated to illness, you may have GERD. For proper diagnosis and treatment, you should be evaluated by a physician. How is GERD diagnosed? GERD can be diagnosed or evaluated by clinical observation and the patient’s response to a trial of treatment with medication. In some cases other tests may be needed including: an endoscopic examination (a long tube with a camera inserted into the esophagus), biopsy, x-ray, examination of the throat and larynx, 24 hour esophageal acid testing, esophageal motility testing (manometry), emptying studies of the stomach, and esophageal acid perfusion (Bernstein test). Endoscopic examination, biopsy, and x-ray may be performed as an outpatient in a hospital setting. Light sedation may be used for endoscopic examinations. While most people with GERD respond to a combination of lifestyle changes and medication. Occasionally, surgery is recommended. Lifestyle changes include: losing weight, quitting smoking, wearing loose clothing around the waist, raising the head of your bed (so gravity can help keep stomach acid in the stomach), eating your last meal of the day three hours before bed, and limiting certain foods such as spicy and high fat foods, caffeine, alcohol. Medications your doctor may prescribe for GERD include: antacids (such as Tums, Rolaids, etc.), histamine antagonists (H2 blockers such as Tagamet,), proton pump inhibitors (such as Prilosec, Prevacid, Aciphex, Protonix, and Nexium), pro-motility drugs (Reglan), and foam barriers (Gaviscon). Some of these products are now available over-the-counter and do not require a prescription. Surgical treatment includes: fundoplication, a procedure where a part of the stomach is wrapped around the lower esophagus to tighten the LES, and endoscopy, where hand stitches or a laser is used to make the LES tighter.

Nodules, Polyps, and Cysts

The term vocal cord lesion (physicians call them vocal “fold” lesions) refers to a group of noncancerous (benign), abnormal growths (lesions) within or along the covering of the vocal cord. Vocal cord lesions are one of the most common causes of voice problems and are generally seen in three forms; nodules, polyps, and cysts. Vocal Cord Nodules (also called Singer’s Nodes, Screamer’s Nodes) Vocal cord nodules are also known as “calluses of the vocal fold.” They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped. Vocal Cord Polyp A vocal cord polyp typically occurs only on one side of the vocal cord and can occur in a variety of shapes and sizes. Depending upon the nature of the polyp, it can cause a wide range of voice disturbances. Vocal Cord Cyst A vocal cord cyst is a firm mass of tissue contained within a membrane (sac). The cyst can be located near the surface of the vocal cord or deeper, near the ligament of the vocal cord. As with vocal cord polyps and nodules, the size and location of vocal cord cysts affect the degree of disruption of vocal cord vibration and subsequently the severity of hoarseness or other voice problem. Surgery followed by voice therapy is the most commonly recommended treatment for vocal cord cysts that significantly alter and/or limit voice. Reactive Vocal Cord Lesion A reactive vocal cord lesion is a mass located opposite an existing vocal cord lesion, such as a vocal cord cyst or polyp. This type of lesion is thought to develop from trauma or repeated injury caused by the lesion on the opposite vocal cord. A reactive vocal cord lesion will usually decrease or disappear with voice rest and therapy. What Are The Causes Of Benign Vocal Cord Lesions? The exact cause or causes of benign vocal cord lesions is not known. Lesions are thought to arise following “heavy” or traumatic use of the voice, including voice misuse such as speaking in an improper pitch, speaking excessively, screaming or yelling, or using the voice excessively while sick. What Are The Symptoms Of Benign Vocal Cord Lesions? A change in voice quality and persistent hoarseness are often the first warning signs of a vocal cord lesion. Other symptoms can include: Vocal fatigue Unreliable voice Delayed voice initiation Low, gravelly voice Low pitch Voice breaks in first passages of sentences Airy or breathy voice Inability to sing in high, soft voice Increased effort to speak or sing Hoarse and rough voice quality Frequent throat clearing Extra force needed for voice Voice “hard to find” When a vocal cord lesion is present, symptoms may increase or decrease in degree, but will persist and do not go away on their own. How Is The Diagnosis Of A Benign Vocal Cord Lesion Made? Diagnosis begins with a complete history of the voice problem and an evaluation of speaking method. The otolaryngologist will perform a careful examination of the vocal cords, typically using rigid laryngoscopy with a stroboscopic light source. In this procedure, a telescope-tube is passed through the patient’s mouth that allows the examiner to view the voice box (images are often recorded on video). The stroboscopic light source allows the examiner to assess vocal fold vibration. Sometimes a second exam will follow a trial of voice rest to allow the otolaryngologist an opportunity to assess changes in the vocal cord lesion. Other associated medical problems can contribute to voice problems, such as: reflux, allergies, medication’s side effects, and hormonal imbalances. An evaluation of these conditions is an important diagnostic factor. How Are Benign Vocal Cord Lesions Treated? The most common treatment options for benign vocal cord lesions include: voice rest, voice therapy, singing voice therapy, and phonomicrosurgery, a type of surgery involving the use of microsurgical techniques and instruments to treat abnormalities on the vocal cord. Treatment options can vary according to the degree of voice limitation and the exact voice demands of the patient. For example, if a professional singer develops benign vocal cord lesions and undergoes voice therapy, which improves speaking but not singing voice, then surgery might be considered to restore singing voice. Successful and appropriate treatment is highly individual and includes consideration of the patient’s vocal needs and the clinical judgment of the otolaryngologist.

Vocal Cord Paralysis

What Is Vocal Fold (cord) Paresis And Paralysis? Vocal fold (or cord) paresis and paralysis result from abnormal nerve input to the voice box muscles (laryngeal muscles). Paralysis is the total interruption of nerve impulse resulting in no movement of the muscle; Paresis is the partial interruption of nerve impulse resulting in weak or abnormal motion of laryngeal muscle(s). Vocal fold paresis/paralysis can happen at any age – from birth to advanced age, in males and females alike, from a variety of causes. The effect on patients may vary greatly depending on the patient’s use of his or her voice: A mild vocal fold paresis can be the end to a singer’s career, but have only a marginal effect on a computer programmer’s career. What Nerves Are Involved In Vocal Fold Paresis/Paralysis? Vocal fold movements are a result of the coordinated contraction of various muscles. These muscles are controlled by the brain through a specific set of nerves. The nerves that receive these signals are the: Superior laryngeal nerve (SLN), which carries signals to the cricothyroid muscle, located between the cricoid and thyroid cartilages. Since the cricothyroid muscle adjusts the tension of the vocal fold for high notes during singing, SLN paresis and paralysis result in abnormalities in voice pitch and the inability to sing with smooth change to each higher note. Sometimes, patients with SLN paresis/paralysis may have a normal speaking voice but an abnormal singing voice. The recurrent laryngeal nerve (RLN) carries signals to different voice box muscles responsible for opening vocal folds (as in breathing, coughing), closing vocal folds for vocal fold vibration during voice use, and closing vocal folds during swallowing. The recurrent laryngeal nerve goes into the chest cavity and curves back into the neck until it reaches the larynx. Because the nerve is relatively long and takes a “detour” to the voice box, it is at greater risk for injury from quite different causes – such as infections and tumors of the brain, neck, chest, or voice box; as well as complications during surgical procedures in the head, neck, or chest regions – that directly injure, stretch, or compress the nerve. Consequently, the recurrent laryngeal nerve is involved in majority of cases of vocal fold paresis or paralysis. What Are The Causes Of Vocal Fold Paralysis/Paresis? The cause of vocal fold paralysis or paresis can indicate whether the disorder will resolve over time or whether it is most likely permanent. When a reversible cause is present, surgical treatment will most likely not be recommended given the likelihood of spontaneous resolution of the paresis or paralysis. Despite advances in diagnostic technology, physicians are unable to detect the cause in about half of all vocal fold paralyses. These cases are referred to as idiopathic (due to unknown origins). In idiopathic cases, paralysis or paresis might be due to a viral infection affecting the voice box nerves (RLN or SLN) or the vagus nerve, but this cannot be proven in most cases. Known reasons for injury can include: Inadvertent injury during surgery: Surgery in the neck (e.g., surgery of thyroid gland, carotid artery) or surgery in the chest (e.g., surgery of the lung, esophagus, heart, or large blood vessels) may inadvertently result in RLN paresis or paralysis. The SLN may also be injured during head and neck surgery. Complication from endotracheal intubation: Injury to the RLN may occur when breathing tubes are used for general anesthesia and/or assisted breathing (artificial ventilation). However, this type of injury is rare, given the large number of operations done under general anesthesia. Blunt neck or chest trauma: Any type of penetrating, hard impact on the neck or chest region may injure the RLN; impact to the neck may injure the SLN. Tumors of the skull base, neck, and chest: Tumors (both cancerous and non-cancerous) can grow around nerves and squeeze them, resulting in varying degrees of paresis or paralysis. Viral infections: Inflammation from viral infections may directly involve and injure the vagus nerve or its nerve branches to the voice box (RLN and SLN). Systemic illnesses affecting nerves in the body may also affect the nerves to the voice box. What Are The Symptoms Of Vocal Fold Paralysis/Paresis? Both paresis and paralysis of voice box muscles result in voice changes and may also result in airway problems and swallowing difficulties. Voice changes: Hoarseness (croaky or rough voice); breathy voice (a lot of air with the voice); effortful phonation (extra effort on speaking); air wasting (excessive air pressure required to produce usual conversational voice); and diplophonia (voice sounds like a “gargle”). Airway problems: Shortness of breath with exertion, noisy breathing (stridor), and ineffective or poor cough.

Upper Airway Cancers

Laryngeal (Voice Box) Cancer Laryngeal cancer is not as well known by the general public as some other types of cancer, yet it is not a rare disease. The American Cancer Society estimates that in 2005 almost 10,000 new cases of laryngeal cancer will be diagnosed, and close to 3,800 people will die from laryngeal cancer in the United States. Even for survivors, the consequences of laryngeal cancer can be severe with respect to voice, breathing, or swallowing. It is fundamentally a preventable disease though, since the primary risk factors for laryngeal cancer are associated with modifiable behaviors. Risk Factors Associated With Laryngeal Cancer Development of laryngeal cancer is a process that involves many factors, but approximately 90 percent of head and neck cancers occur after exposure to known carcinogens (cancer causing substances). Chief among these factors is tobacco. Over 90 percent of laryngeal cancers are a type of cancer called squamous cell carcinoma (SCCA), and over 95 percent of patients with laryngeal SCCA are smokers. Smoking contributes to cancer development by causing mutations or changes in genes, impairing clearance of carcinogens from the respiratory tract, and decreasing the body’s immune response. Tobacco use is measured in pack-years, where one pack per day for one year is considered one pack-year. Two pack-years is defined as either one pack per day for two years, or two packs per day for one year (Longer terms of pack years are determined using a similar ratio.) Depending upon the number of pack-years smoked, studies have reported that smokers are about 5 to 35 times more likely to develop laryngeal cancer than non-smokers. It does seem that the duration of tobacco exposure is probably more important overall to cancer causing effect, than the intensity of the exposure. Alcohol is another important risk factor for laryngeal cancer, and acts as a promoter of the cancer causing process. The major clinical significance of alcohol is that it potentiates the effects of tobacco. Magnitude of this effect is between an additive and a multiplicative one. That is, people who smoke and drink alcohol have a combined risk that is greater than the sum of the individual risks. The American Cancer Society recommends that those who drink alcoholic beverages should limit the amount of alcohol they consume, with one drink per day considered a limited alcohol exposure. Other risk factors for laryngeal cancer include certain viruses, such as human papilloma virus (HPV), and likely acid reflux. Vitamin A and beta-carotene may play a protective role. Signs and Symptoms of Laryngeal Cancer Signs and symptoms of laryngeal cancer include: progressive or persistent hoarseness, difficulty swallowing, persistent sore throat or pain with swallowing, difficulty breathing, pain in the ear, or a lump in the neck. Anyone with these signs or symptoms should be evaluated by an Otolaryngologist (Ear, Nose and Throat Doctor). This is particularly important for people with risk factors for laryngeal cancer. Treatment of Laryngeal Cancer The primary treatment options for laryngeal cancer include surgery, radiation therapy, chemotherapy, or a combination of these treatments. Remember that this is a preventable disease in the vast majority of cases, because the main risk factors are associated with modifiable behaviors. Do not smoke and do not abuse alcohol!

BOTOX

What will Botox do for me? Have you ever looked in the mirror and felt that your reflection has wrinkles that make your face look aged and tired? Do you have the wrinkles between your eyebrows that gives the impression that you are constantly annoyed? Have your eyebrows begun to droop, giving your eyes a constant hood? Botox is a natural chemical that has been harvested and purified that when injected causes the muscles that lead to these wrinkles to relax. Botox is administered by Dr. Daneshrad in a number of small injections directly into each of these muscles to allow for a smooth, youthful appearance of the face while at the same time allowing you to be able to make normal facial expressions.

ThermiSmooth™

Non-invasive Skin Smoothing PRECISE, GENTLE EPIDERMAL HEATING ThermiSmooth™ is performed using a specially designed thermistor regulated hand piece, which is supplied with the ThermiRF™ system. ThermiSmooth delivers precise heating to the skin’s surface. ThermiSmooth treatments are gentle and patients often say it feels like receiving a warm massage. ThermiSmooth™ Science Clinical studies show that the collagen in skin will shrink when heated to a sustained temperatures in excess of 40°C. Further, it has been shown that when the skin is heated to this level, an inflammatory process is engaged which can stimulate fibroblasts to produce new collagen over a period of time. Therefore, the challenge is to deliver precise amounts of heat, without risking overheating the tissues and causing patient discomfort. How ThermiSmooth™ Works After applying a small amount of coupling gel, the ThermiSmooth™ hand piece is applied to the skin’s surface. The ThermiRF™ system is set to a specific target temperature (i.e.., 42°C – 45°C). The hand piece is gently moved in a sweeping or circular fashion while gradually heating up the skin surface. As the skin’s temperature rises to the targeted temperature, the ThermiRF computer automatically adjusts the energy output to ensure precision of heating. A small zone is treated for about 5 minutes to achieve the goal of sustained heating to the target tissues. Treatments are repeated several times to achieve the desired cosmetic result.

Daneshrad Clinic ENT and Facial Plastic Surgery

Description

Reviews

Opening hours

Bios

Dr. Payam Daneshrad

Products And Services

Sinus Surgery

Deviated Septum

Post Nasal Drip

Balloon Sinuplasty

Nasal Obstruction after Surgery

SINUS DISEASE

SINUS HEADACHES

Fungal Sinusitis

Allergic Rhinitis, Sinusitis, and Rhinosinusitis

Snoring Treatment

Stuffy Nose Treatment

Sleep Apnea and Children

CPAP - Continuous Positive Airway Pressure

Ear Infections and Earache

Swimmer's Ear

Exostoses

Eustachian Tube Dysfunction

Tinnitus

Dizziness and Motion Sickness

Hearing Loss

Tonsils and Adenoids

Thyroid Disorders and Surgery

Fine Needle Aspiration

Salivery Gland Disease

GERD

Nodules, Polyps, and Cysts

Vocal Cord Paralysis

Upper Airway Cancers

BOTOX

ThermiSmooth™

Images

Categories

Map 1304 15th St. #407

Daneshrad Clinic ENT and Facial Plastic Surgery

Description

Reviews

Your review for Daneshrad Clinic ENT and Facial Plastic Surgery

Opening hours

Bios

Dr. Payam Daneshrad

Products And Services

Sinus Surgery

Deviated Septum

Post Nasal Drip

Balloon Sinuplasty

Nasal Obstruction after Surgery

SINUS DISEASE

SINUS HEADACHES

Fungal Sinusitis

Allergic Rhinitis, Sinusitis, and Rhinosinusitis

Snoring Treatment

Stuffy Nose Treatment

Sleep Apnea and Children

CPAP - Continuous Positive Airway Pressure

Ear Infections and Earache

Swimmer's Ear

Exostoses

Eustachian Tube Dysfunction

Tinnitus

Dizziness and Motion Sickness

Hearing Loss

Tonsils and Adenoids

Thyroid Disorders and Surgery

Fine Needle Aspiration

Salivery Gland Disease

GERD

Nodules, Polyps, and Cysts

Vocal Cord Paralysis

Upper Airway Cancers

BOTOX

ThermiSmooth™

Images

Categories

Map 1304 15th St. #407