Otolaryngology

What is an Otolaryngologist?
Otolaryngology is the oldest medical specialty in the United States. Otolaryngologists are physicians trained in the medical and surgical management and treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structures of the head and neck. They are commonly referred to as ENT physicians.
Otolaryngologists are ready to start practicing medicine after completing up to 15 years of college and post-graduate training.

What types of medical problems do otolaryngologists treat?
The Ears – Otolaryngologists are trained in both the medical and surgical treatment of hearing loss, ear infections, balance disorders, ear noise (tinnitus), nerve pain, and facial and cranial nerve disorders.

• The Nose – Care of the nasal cavity and sinuses is one of the primary skills of otolaryngologists including sinus disease, allergies, nosebleeds, and nasal deformities (both functional and cosmetic).
• The Throat – Otolaryngologists manage tonsils and adenoid infections, diseases of the larynx (voice box) and esophagus including voice and swallowing disorders, airway problems including obstructive sleep apnea and snoring.
• The Head and Neck – Otolaryngologists are trained to treat infectious diseases of the head and neck area, both benign and malignant (cancerous) tumors including the thyroid, facial trauma, and deformities of the face (both cosmetic and reconstructive).
  

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What causes an ear infection (otitis media)?
An ear infection is caused by improper drainage of fluid that collects behind the ear
drum during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses. The build up of pressurized pus in the middle ear causes an earache, swelling, and redness. Since the eardrum cannot vibrate properly, the individual may experience hearing problems.

What causes swimmer’s ear?
Swimmer’s ear (otitis externa) is typically a bacterial infection of the ear canal; this differs from otitis media which involves fluid behind the eardrum. Otitis externa is most commonly caused by water getting trapped in the ear canal. It also follows injury to the skin of the ear canal caused by aggressive “cleaning” with Q-tips, bobby pins, match sticks and other devices.

What does the doctor mean when he/she says my child would benefit from “tubes?”
Most of the time, otitis media clears up with proper medication. When it doesn’t, further treatment may be recommended by your physician. This treatment may be the surgical placement of a ventilation tube in the eardrum. This “tube” allows fluid to drain from behind the eardrum preventing fluid accumulation. .The individual will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.

Why do I have ear wax?
Ear wax (cerumen) is normal in healthy ears. The purpose of cerumen is to moisturize and protect the skin of the ear canal and to trap dust and particles before they reach the ear drum. Cerumen is formed in the outer part of the ear canal. Normally, wax makes its way to the outer opening of the ear canal, flakes up, and falls out.

How do I remove ear wax?
In most cases, swabbing the opening of the ear canal with the corner of a twisted damp washcloth will remove excessive ear wax. Avoid too much moister or going too deep since prolonged moisture in the ear canal can lead to an infection. Probing with bobby pins, match sticks, Q-tips, etc. is strongly discouraged.

What’s wrong with Q-tips?
The problem with Q-tips is that they pack the ear wax from the outer ear canal deep into the ear canal until it jams against the ear drum, much like a cannon being packed with black powder and a tamping rod. Cerumen lodged against the ear drum is much more difficult and painful to get out and can cause a temporary hearing loss.

What is tinnitus (ringing or roaring in the ears)? (go to tinnitus)
Tinnitus is very common and can be annoying and distracting. Almost 37 million Americans have tinnitus in their ear or ears. It may come and go or might be a constant bother. It might be soft or loud, low pitched (roaring), or high-pitched (ringing) kind of sound. More than 7 million people are so badly afflicted that they can’t lead normal lives.

What might cause tinnitus? (go to tinnitus)
There are various causes including a plug of wax, allergy, ear infection, circulatory problems, certain medications, and prolonged exposure to loud noise.

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Dizziness, Vertigo & Meniere’s Disease

What is dizziness? (go to dizziness)
Some people describe their balance problem by saying that they feel dizzy, unsteady or giddy. This feeling of imbalance without the sensation of turning or spinning is called disequilibrium and is sometimes due to an inner ear problem.

What is vertigo?
The word vertigo comes from the Latin verb “to turn.” Individuals with vertigo often say that they or their surroundings are turning or spinning. Vertigo is often due to an inner ear problem.

Each year more than 2 million people visit a doctor for dizziness or vertigo.

What is Meniere’s disease? (go to meniere's disease)
Meniere’s disease is a disorder that produces a group of symptoms: sudden attacks of whirling dizziness, tinnitus or head noise, a feeling of pressure or fullness in the ear, and a fluctuating hearing loss. While the underlying cause is not known, it is believed to result from a fluctuation in the pressure of fluid that fills the inner ear. An attack may last from a few hours to several days. Following a severe attack, most people find that they are so exhausted that they must lie down or sleep for several hours. The attacks vary in frequency from every few weeks to every few years. The disorder affects five out of ten thousand people, most of whom are over 35 years old.

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Hearing Aids (go to hearing aid evaluation or hearing aid guide)

A family member obviously needs a hearing aid. Everyone asks him/her to schedule a hearing evaluation, but he/she refuses. What can we do?
There is an old saying, “when you are ready, you will know.” Unfortunately this often doesn’t apply to hearing aids. Hearing loss occurs slowly and is painless so the hearing loss may not be obvious to the person in question. Hearing aids often retain a stigma that a person is “old” or somehow “disabled: if they are used. This certainly is not true but people will often resist wearing a hearing aid because of this. Compound these factors with the number of complaints offered by disgruntled hearing aid users (or ex-users), and we can readily understand why only 10% of the hard-of-hearing population are fit with hearing aids.

There is another old saying that “a hearing aid is less conspicuous than your hearing loss.” We believe this is quite true. Encourage your family member to have his/her hearing tested without any discussion of hearing aids. Perhaps he/she will become more interested in his/her type and degree of hearing loss if he/she is assured that no one will be delivering a “sales pitch.” Hearing aid trials are generally possible at a minimal cost. If the person continues to resist testing, the family may have few options other than allow him/her to experience the consequences and frustrations of hearing loss.

How do I know if it’s time for a hearing aid or if I will benefit from one?
There are many self-assessment items to determine your level of hearing effectiveness. Having your hearing tested by an audiologist is a great starting point. If hearing aids are recommended, make sure there is a trial period offered which allows you to return the hearing aids at a low cost if the performance of the hearing aids is less than satisfactory.

How do I know if I’m choosing the right hearing aid for me, and if I am paying a fair price?
Discuss styles and circuitry options with your audiologist. Have the audiologist explain the advantages and disadvantages of each type. Together agree on a course of action. Comparison shopping can be a good idea. However, make certain that you are comparing the same styles and types of circuitry. This can be very misleading.

Does it matter where I go for a hearing aid?
Does it matter where you get your glasses or who you see for other health-related issues? Certainly. See someone that is highly trained so that he/she can offer you sufficient skill to meet your hearing needs. Also, see someone that you are comfortable with. Are they out to help you and meet your hearing needs or are they always out to “sell you something?” Hearing aids are extremely labor intensive. Hearing aids will not restore normal hearing functions and are subject to breakage. Will you audiologist or hearing aid dispenser present sufficient skill and be available when necessary to satisfy your needs? These are primary factors for patient satisfaction, and it may mean that you pay a little more for your hearing aid as these services are costly.

I can save money getting a hearing aid through the internet. Is this a good idea?
You can buy a steak at the grocery store for less money than it costs at a restaurant. Is it fair to bring your own steak to the restaurant and have them prepare it for you? Product without service is worth little or nothing. If you want to be fit well with a hearing aid, go to a place where you are comfortable and expect to pay a fair price. The audiologist will most likely be there for you long after you forgot the price you paid for the hearing aid.

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Nose (go to pediatric ENT)

What causes a nosebleed?

• The nose can bleed for a variety of reasons:
  
• Allergies, infections, or dryness can cause itching and lead to picking of the nose.
  
• Vigorous nose blowing can rupture superficial nasal blood vessels in the elderly and the young.
• Clotting disorders that run in families or are due to medications
• Fractures of the nose or the base of the skull can cause bleeding and should be regarded seriously when the bleeding follows a head injury.
• Rarely, tumors (both malignant and nonmalignant) have to be considered, particularly in the older patient or in smokers.

What can be done to stop a simple nosebleed?
First, help the person stay calm, especially a young child. A person who is agitated may bleed more than someone who’s been reassured and supported. Then:

1. Pinch all the soft parts of the nose together between your thumb and the side of your index finger or soak a cotton ball with Afrin, Neo-Synephrine or Dura-Vent spray and place this into the nostril.
   
2. Press firmly but gently with your thumb and the side of your index finger toward the face, compressing the pinched parts of the nose against the bones of the face.
   
3. Hold that position for a full five minutes by the clock.
   Keep the head higher than the level of the heart. Sit up or lie back a little with the head elevated.
   
4. Apply ice – crushed in a plastic bag or washcloth – to nose and cheeks.
   

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Sinus (go to sinus)

What are sinuses?
Sinuses are openings in the bones around your nose. Four pairs of sinuses are connected to the nose by small openings. These sinuses are located behind the cheekbones, alongside your nose, and above your eyebrows.

What do the sinuses do?
Humans produce one liter of fluid per day that cleanse the passageways and provide necessary moisture to the lining of each sinus. Tiny little hairs, called cilia, line the sinus membranes and flush the fluid through in a constant carwash-like motion. Under normal conditions, air passes in and out of the sinuses and mucous fluid drains from the sinuses into the nose.

What is sinusitis?
Sinusitis is the inflammation of the sinus cavities located on either side of your nose, and between and above your eyes. Inflammation occurs when there is an undrained collection of pus or mucus in one or more of the sinuses. Mucus production increases during inflammation resulting in a drippy, runny nose. This drainage thickens over time. If this mucus cannot drain out of the sinus due to a blockage, bacteria will grow and an infection occurs. This infected sinus is what produces the symptoms of sinusitis.

What does sinus surgery accomplish?
The surgery enlarges the natural opening to the sinuses. Additionally, the procedure should leave as many cilia (tiny little hairs in the sinus), in place as possible. Endoscopic sinus surgery is particularly successful in removing areas of obstruction and allowing the normal flow of mucus.

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Throat (go to pediatric ENT)

What causes laryngitis?
Swelling of the vocal cords prevents them from coming together properly which makes a change in the voice. Acute laryngitis usually occurs due to swelling of the vocal cords from a common cold, upper respiratory tract viral infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert.

What can you do to prevent and treat mild hoarseness?

• If you smoke, quit.
  
• Avoid substances that dehydrate the body, such as alcohol and caffeine. Avoid secondhand smoke.
  
• Drink plenty of water.
  
• Humidify your home.
  
• Watch your diet – avoid spicy foods.
  
• Try not to use your voice too long or too loudly.
  
• Seek professional voice training.
  
• Avoid speaking or singing when your voice is injured or hoarse.

Are there specific risk factors for head and neck cancer?
Yes, as many as 90 percent of head and neck cancers arise after prolonged exposure to specific factors. Use of tobacco (cigarettes, cigars, chewing tobacco or snuff) and alcoholic beverages are closely linked with cancers of the mouth, throat, voice box, and tongue. (In adults who neither smoke nor drink, cancers of the mouth and throat are nearly nonexistent.) Prolonged exposure to sunlight is linked with cancer of the lip and is also an established major cause of skin cancer.

What are the symptoms of tonsillitis?

• Swelling of the tonsils
  
• Redder than normal tonsils
  
• A white or yellow coating on the tonsils
  
• A slight voice change due to swelling
  
• Sore throat
  
• Uncomfortable or painful swallowing
  
• Swollen lymph nodes (glands) in the neck
  
• Fever
  
• Bad breath
  

What are the symptoms of enlarged adenoids?

• Breathing through the mouth instead of the nose most of the time
  
• Nose sounds “blocked” when the person speaks
  
• Noisy breathing during the day
  
• Recurrent ear infections
  
• Snoring at night
  
• Breathing stops for a few seconds at night during snoring or loud breathing (sleep apnea)
  

When is the removal of tonsils and/or adenoids recommended?
The two primary reasons for removal of tonsils and/or adenoids are (1) recurrent infection despite antibiotic therapy and (2) difficulty breathing due to enlarged tonsils and/or adenoids. Recent studies also indicate the removal of adenoids is a beneficial treatment for some children with fluid in the middle ear.

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Allergy (go to allergy)

When does an allergy begin?
Allergies occur after a person with allergic tendencies is repeatedly exposed to the substance in his/her environment or his/her diet. It is estimated that at least 20% of the population is likely to develop some kind of allergy.

What causes a person to develop an allergy?
There is no standard way for an allergy to begin, and the onset may be sudden or gradual. For a person to become allergic to a substance, he/she must be exposed to it more than once, and generally that exposure is quite frequent. Often symptoms develop after an unusual stress to the immune system such as following a severe viral infection.

What is hay fever?
“Hay fever” was named because of nasal symptoms developing during hay season, but most nasal allergies are called “hay fever.” “Hay fever” occurs most frequently during the spring, summer or fall when trees, grasses and weeds produce pollen. One of the principal offenders is the ragweed plant which produces pollen from late summer until frost.

What substances from pets cause allergic symptoms?
Animals produce various substances that can cause an allergic reaction. The main culprits are proteins in the urine, saliva, or dander (dead skin flakes). In cats, for example, the main substances that cause problems are proteins found in cat saliva which often mixes with house dust. In rodents such as mice, rats or guinea pigs, it appears that urine contains the substance that most commonly causes allergy.

Should an otolaryngologist (ear, nose & throat doctor) treat my allergies?
An otolaryngologist is a doctor specializing in the treatment of ear, nose and throat diseases. Half of the problems these physicians encounter are probably due, either directly or indirectly to allergy. Chronic nasal congestion and post nasal drip, seasonal or constant, is often allergic and may be complicated by chronic sinus and middle ear disease. Hearing loss, dizziness, headaches, weeping ear canals, and chronic sore throats may be due to an allergy. The otolaryngologist who does his/her own allergy treatment is able to follow the patient’s progress with specialized examinations and nose and throat medical and surgical treatment. An otolaryngologist not providing allergy care may refer you to a colleague for such care.

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Snoring (go to snoring)

What causes snoring?
Snoring occurs when floppy tissue in the airway relaxes during sleep and vibrates. 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.

What can you do to help “light” snoring?”
Adults who suffer from mild or occasional snoring should try the following self-help remedies:

• Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
  
• Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.
  
• Avoid alcohol for at least four hours and heavy meals or snacks for three hours before bedtime.
  
• Establish regular sleep patterns
  
• Sleep on your side rather than your back
  
• Tilt the head of your bed upwards four inches.

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