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Ear, Nose & Throat Care

Specializing in treating disorders of the ear, nose & throat. Skilled in the latest surgical advancements for head and neck surgery.

Ear, Nose and Throat (ENT)

What is an ENT doctor?

An ear, nose and throat specialist (ENT) is a physician trained in the medical and surgical treatment of the ears, nose throat, and related structures of the head and neck. They have special expertise in managing diseases of the ears, nose and nasal passage sinuses, larynx (voice box), oral cavity and upper pharynx (mouth and throat), as well as structures of the neck and face. ENT is the oldest medical specialty in the United States.

EAR

Diseases of the Ear
Our ears give us the ability to hear and help us with balance, especially while moving.  The ear has many different parts, including the ear canal, the middle ear, and the inner ear, where nerves deliver sound signals and feelings associated with balance to the brain. All of these parts are susceptible to trauma and infection, which can result in minor or severe damage to the ears.
Otitis Externa (Swimmer's Ear)

Swimmer’s ear is an inflammation and infection of the ear canal. It occurs when the protective film that covers the ear canal is removed. Symptoms of swimmer’s ear include itching, pain, and a feeling of fullness in the ear. Your ear canal may be red and swollen.

Risk Factors

  • Very narrow or hairy ear canal
  • Live in a warm and humid climate
  • Impacted earwax
  • Head injury had also injured your ear
  • Previous case of swimmer’s ear

Causes of Swimmer’s Ear

Most common cause of swimmer’s ear is when water, sand, dirt, or other debris gets into the ear canal. Other causes of inflammation and infection include:

  • Allergies
  • Bubble baths, soaps, and shampoos
  • Cleaning the ear canal harshly or with a sharp object
  • Headphones inserted into the ear
  • Sweating
  • Skin problems
Otitis Media

Otitis Media is an inflammation of the middle ear. It occurs in the area between the tympanic membrane (the end of the outer ear) and the inner ear. It also includes a duct known as the eustachian tube.

Types of Otitis Media

  • Acute otitis media occurs when pus and pressure build-up in the middle ear. Hearing loss is present but normally goes away when the infection clears. Acute otitis media is usually sudden in onset and is often associated with sudden obstruction of the eustachian tube at the same time infections bacteria are present. It is also associated with sudden hole of the eardrum, with drainage from the ear. Often the eardrum will heal over after the infection clears, but a hole can be left and damage to the middle ear and /or inner ear can accompany the infection. The eardrum may be bright red or the creamy color of the fluid can sometimes be seen through the eardrum. It sometimes looks “soggy.”
  • Serous otitis is where fairly clear fluid fills the middle ear and mastoid. It occurs with fairly sudden obstructions of the eustachian tube. Two of the most common causes are a bad cold or a sudden descent of an airplane with poor pressurization.
  • Secretory otitis is where somewhat thicker fluid fills the middle ear and mastoid. It is most common in small children and often outgrown by the time they reach their teens. The thick fluid has components that are actually secreted by the mucous glands of the middle ear. There are actually tissue breakdown enzymes in this fluid that can gradually eat away bone and cause chronic hearing loss/damage.
  • Chronic otitis media occurs when chronic infection fills the middle ear space and mastoid cavity. Most cases are almost always a form of chronic mastoiditis, where the bone of the mastoid cavity is chronically infected along with the tissues of the middle ear space.

Causes of Otitis Media

Otitis media is most commonly caused by infection with viral, bacterial, or fungal pathogens. A major risk factor for developing otitis media is Eustachian tube dysfunction, which leads to the ineffective clearing of bacteria from the middle ear.  Also children under the age of seven are more prone to otitis media due to shorter eustachian tubes which are at a more horizontal angle than in the adult ear.

Treatment Options

Many suggest the delay of antibiotics for acute bacterial otitis media for one to three days if pain is manageable by oral or topical analgesics. In chronic cases, a myringotomy is sometimes performed to insert a tympanostomy tube into the eardrum to allow air to pass through into the middle ear, and thus release any pressure buildup and help clear excess fluid within

Perforation of the Ear

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Acoustic Neuroma

An acoustic neuroma is a benign tumor of the balance nerve between the inner ear and the brain. It grows slowly over a period of years. Although they do not invade the brain, they can push on it as they grow causing damage. Some symptoms for acoustic neuroma are gradual hearing loss in one ear, tinnitus, vertigo, balance problems, facial weakness, difficulty swallowing and hoarseness, headaches, confusion, and clumsiness.

Types of Acoustic Neuroma

  • In Neurofibromatosis type I, an acoustic neuroma may involve the 8th nerve, but also could involve any other cranial nerve or the spinal root. It is usually found in adults.
  • In Neurofibromatosis type II, bilateral acoustic neuromas are present. It is usually found before the age of 21. These tumors tend to involve the entire extent of the nerve and show a strong genetic inheritance.

Treatment Options

Treatment options depend on your age, size of the tumor and whether or not it is growing, the severity of your symptoms, and any other medical conditions you may have. The different options include:

  • Radiation therapy works by causing tumor cells to die. The tumor’s growth may slow or stop or it may even shrink. However, radiation doesn’t completely remove the tumor.
  • Observation is also called watchful waiting. Because acoustic neuromas are not cancerous and grow slowly, immediate treatment may not be necessary. During observation, the tumor is monitored regular with MRI scans.
  • Surgery for acoustic neuromas may involve removing all or part of the tumor. There are three main approaches:
    • Translabyrinthine involves making an incision behind the ear and removing the bone behind the ear and some of the middle ear. An advantage to this approach is that it allows the surgeon to see an important cranial nerve (the facial nerve) clearly before removing the tumor. On the other hand, this technique is that it results in permanent hearing loss.
    • Retrosigmoid/sub-occipital involves exposing the back of the tumor by opening the skull near the back of the head. This approach is used for removing large tumors and a chance of preserving hearing.
    • Middle fossa involves removing a small piece of bone above the ear canal to access and remove small tumors confined to the internal auditory canal, the narrow passageway from the brain to the middle and inner ear. This approach allows the surgeons to preserve a patient’s hearing.
Otosclerosis

Otosclerosis is a condition where there is an overgrowth of bone in the space behind the eardrum and the inner ear. Symptoms include tinnitus, dizziness, and some hearing loss, with severe hearing loss developing as the middle and inner ear become less functional.

Types of Otosclerosis

  • When the overgrowth develops at the edge of the stapes footplate, the stapes bone cannot move like it should and sound is not passed properly from the middle ear to the inner ear. This causes conductive hearing loss and can often be repaired.
  • When the overgrowth replaces bone in other parts of the otic capsule, a sensorineural hearing loss results. The nerve hearing loss can’t be repaired.

Treatment Options

  • Hearing Aids are usually very effective early in the course of the diseases.
  • A surgery called a stapedectomy may be required for a more definitive treatment. A stapedectomy consists of removing a portion of the sclerotic stapes footplate and replacing it with an implant that is secured to the incus. It restores continuity of ossicular movement and allows passage of sound waves from the eardrum to the inner ear.
Cholesteatoma

Cholesteatoma is a destructive and expanding growth that consist of skin cells in the wrong places of the middle ear and mastoid. If left untreated, it can eat into the three small bones that are located in the middle ear. Cholesteatoma can also affect and erode the thin bone structure that isolates the top of the ear from the brain, as well as lay the covering of the brain open to infections. Common symptoms include: hearing loss, discharge from the ear with a strong odor, bleeding from the ear, dizziness, vertigo, balance disruption, ear ache, headaches, and tinnitus.

Types of Cholesteatoma

  • Acquired cholesteatoma is the most common type. It can be caused by a tear or retraction of the ear drum. Acquired cholesteatomas usually arise from the pars flaccida region of the ear drum in the posterior-superior area of the ear drum.
  • Congential cholesteatoma is less common. They are most often found in the anterior area of the ear drum.

Treatment Options

Congenital cholesteatomas of the middle ear can be removed through the ear canal. The majority of cholesteatomas require that an incision be made behind the ear to expose the affected area adequately. These masses are not cancerous but must be removed to prevent the ear from being severely damaged.

Meniere's Disease

Meniere’s disease is caused by an imbalance in the fluid in the sacs of the inner ear. It can affect hearing and balance to a certain degree. Some symptoms of Meniere’s Disease include vertigo, unilateral or bilateral hearing loss, unilateral or bilateral tinnitus, and a sensation of fullness or pressure in one or both ears.

Treatment Options

Treatment for Meniere’s is focused on treating and preventing the symptoms. Some people may be able to have fewer attacks by: eating a low-salt diet, using medicines to get rid of extra fluids and to reduce the symptoms of vertigo, doing exercises to improve balance, and avoiding caffeine, alcohol, tobacco, and stress.

Persistent Ear Noise (Tinnitus)

Tinnitus is characterized as ringing in the ears that does not improve or go away. In some patients it can take the form of high pitched sounds. It is very common in people over the age of 40. It has also been found that men suffer from tinnitus more often than women.

Causes of Tinnitus

Tinnitus is not a disease; it is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. The most common cause of tinnitus is hearing loss that occurs with aging. It may also be a symptom of almost any ear disorder. Other possible causes of tinnitus include:

  • A buildup of earwax
  • Noise-induced hearing loss
  • Ear and Sinus Infections
  • Diseases of the heart or blood vessels
  • Hormonal changes in women
  • Thyroid abnormalities

NOSE

Sinusitis

Symptoms of sinus problems include nasal congestion, fullness in ears, green, yellow or bloody drainage from the nose, trouble tasting food, frequent headaches, facial pain and cough. Interference with the natural drainage of mucus may lead to sinusitis.

Reasons for Blocked Sinuses

sinusitisColds and  Infections – a cold may cause your sinus and nasal passages to swell causing sinus openings to become blocked and mucus to back up which can cause bacterial or fungal infections.

Allergic Rhinitis -. An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen or dust, the body releases chemicals, including histamine. This causes allergy symptoms.

Polyps
nasal polyps are sac-like growths of inflamed tissue lining the nose (nasal mucosa) or sinuses

Deviated Septum – 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.

Acute & Chronic Sinusitis

Acute – often associated with a viral or bacterial upper respiratory infection that spreads to the sinuses. Common symptoms include facial pain, headache, fever, postnasal drip, and nasal congestion. Acute sinusitis is usually treated with antihistamines and decongestants to reduce inflammation and decrease fluid production. Bacterial infections can be treated with antibiotic medication.

Chronic – is when a sinus problem keeps coming back or won’t go away. This is often caused by nasal allergies, and nasal obstruction. Symptoms include facial pain and pressure, headache and sinus pain, nasal congestion, postnasal drip, reduced smell and taste, cough and sore throat. Chronic sinusitis can be treated with medications to relieve congestion and reduce fluid secretion, irrigation to clear out old mucus and antibiotics to treat any bacterial infections.

Treatment Options

  • Antibiotics
  • Nasal Steroid Sprays
  • Oral and Nasal Decongestants
  • Oral and Injectable Steroids
  • Septoplasty
  • Endoscopic Sinus Surgery
  • Balloon Sinuplasty (outpatient and in office)

Why Choose Balloon Sinuplasty? Typical treatment for sinusitis begins with medication; however, up to 60% of chronic sinusitis sufferers don’t get relief with medication. For these patients a surgical procedure may be recommended.

Balloon Sinuplasty is a minimally invasive procedure that opens sinus passages. It relieves the pain and pressure associated with chronic sinusitis.

How Does Balloon Sinuplasty Work? Inflammed sinuses are opened in the same way that doctors open up blocked arteries during balloon angioplasty. After Balloon Sinuplasty, the sinuses remain open, allowing the return of normal sinus drainage and relief of sinus pressure.

Deviated Septum

A deviated septum is a condition where the bone and cartilage that divide the nasal cavity of the nose in half is either off center or crooked making it hard to breathe. Some of the most common symptoms include: nasal congestion, headaches, nosebleeds, facial pain, postnasal drip, and loud breathing and snoring during sleep. A deviated septum can also cause sleep apnea and chronic sinus infections.

Treatment Options

A septoplasty is performed to repair a deviated septum and improve breathing. During the procedure, a surgeon enters through the nostrils and makes a small incision in the septum to remove the excess bone and cartilage to even out the breathing space. Internal splints or soft packing material may be placed in the nose to stabilize the septum as it heals.

THROAT

Tonsillitis and Adenoiditis

Tonsillitis is an infection or inflammation of the tonsils, which is most commonly caused by viral or bacterial infection. Symptoms of tonsillitis include red and/or swollen tonsils, white or yellow patches on the tonsils, tender or stiff neck, bad breath, sore throat, painful or difficultly swallowing, fever, headaches, and cough.

Types of Tonsillitis

  • Acute Tonsillitis is caused by both bacteria and viruses and is accompanied by symptoms of ear pain when swallowing, bad breath, and drooling along with sore throat and fever. In this case, the surface of the tonsils may be bright red or have a grayish-white coating, while the lymph nodes in the neck may be swollen.
  • Chronic or Recurrent cases are categorized the same as an acute tonsillitis except that they are generally defined by seven episodes in the previous year, five episodes in each of the previous two years, or three episodes in each of the previous three years.

Causes of Tonsillitis

In most cases tonsillitis is caused by a virus such as the common cold. while in other cases it can be caused by the same bacteria that causes strep throat. In rare cases, a fungus or a parasite can cause it.

Preventing Tonsillitis

The best prevention for tonsillitis is to follow the basic health and hygiene precautions, such as: avoid close contact with others who are sick, wash and disinfect surfaces and toys, wash hands frequently, and cover your mouth when you cough or sneeze.

Treatment Options

In most acute and chronic cases, treatment is focused on reducing the discomfort of symptoms, such as: pain relief and fever reducing medication, gargles, hydration, and rest.  Antibiotics will be prescribed if tonsillitis is caused by bacteria.   Another treatment option for chronic cases would include a tonsillectomy, surgical removal of tonsils.

Pharyngitis (sore throat)

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Laryngitis

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Hoarseness

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Dysphagia (difficulty swallowing)

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Vocal Cord Paralysis

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Esophageal Reflux

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Oral Lesions

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Laryngeal Cancer

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Tongue Tie

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Smell and Taste Disorders
  • Anosmia is an inability to detect odors.
  • Hyposmia is a reduced ability to smell and to detect odors.
  • Hyperosmia is an increased ability to smell.
  • Dysosmia is a distorted identification of smell. There are three types:
    • Parosmia is an altered perception of smell in the presence of an odor.
    • Phantosmia is the perception of smell without an odor present
    • Agnosia is the inability to classify or contrast odors, although able to detect odors.

 Taste Disorders

  • Ageusia is the inability to taste.
  • Hypogeusia is a reduced ability to taste.
  • Dysgeusia is a distorted ability to taste.
Partoid Gland

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Salivary Gland Disorders

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