ENT Patient Education

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Common Diseases and Disorders

Ohio Head and Neck Surgeons are experts in the diagnosis and treatment of head, neck, and throat disorders and diseases. We treat a wide range of conditions and provide a variety of treatment options. The articles in this section are designed to help you better understand the conditions we treat and the procedures used for diagnosis and management.

Allergies

Allergies are a very common disorder in northeast Ohio, affecting as many as 40% of children and 20% of adults. In recent years, allergy has become far more common than it was in the past. The exact reason why allergies are more common today is not known for sure, but evidence points towards an increase in pollution and the widespread use of antibiotics as possible causes for this phenomenon.

One of the most common allergic disorders is allergic rhinitis. This is often referred to as "hay fever" although hay (timothy grass) is not always the underlying cause and fever is not a symptom. Symptoms include sneezing, nasal congestion, runny nose, and itchy or watery eyes. These symptoms can be seasonal or perennial depending on what the underlying trigger is. Other allergic disorders include asthma, rashes or hives (urticaria), and food sensitivities. The specific irritant that causes an allergic reaction is called an antigen. Some of the more common antigens are: foods, animal dander, dust, mold, and grass, tree, or weed pollens. Less common antigens might also include insect venoms, drugs, and skin contactants such as nickel or latex.

Often when a patient presents to our office an allergic disorder, we will recommend or perform allergy testing. This can be done by applying various antigens on the patient's skin (scratch testing) or by ordering blood tests (RAST testing). Once the offending antigens are identified, treatment recommendations can be made. One of the easiest ways to treat allergies is to simply avoid the antigen that is causing the allergic reaction. This is not always practical however, especially if the causative antigen is a mold, pollen, beloved pet, or something else that cannot be eliminated from the living environment. If avoidance is impractical, the next step is medication. Some patients can get relief by taking over the counter non-sedating antihistamines. Some require prescription strength medications such as steroid or antihistamine nasal sprays. If medication is not helpful, allergy desensitization shots can be administered. These shots are given regularly over a period of several years in order to build up a tolerance to the antigen and essentially cure or eliminate the allergic condition.

At Ohio Head and Neck Surgeons, we are able to provide all of the necessary services for allergy testing and treatment. Our Canton Allergy Lab has been in operation since 1974. Our doctors and nurses have extensive expertise in treating allergy and have helped countless numbers of patients with their allergy problems. Please do not hesitate to call and inquire further if you have a need for any of our services.

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Acid Reflux

Heartburn is a very common problem in the United States. It is estimated that one in ten Americans experience the symptoms of heartburn at least one time per week. Some of the symptoms of heartburn include: difficulty swallowing, hoarseness, frequently clearing the throat, chest pain, burning in the chest and throat, the sensation of something stuck in your throat and a sour or bitter taste in your mouth.

Heartburn, or acid reflux, is caused by stomach acid splattering out of the stomach into the esophagus. There is a muscle at the end of the esophagus (lower esophageal sphincter) that controls the flow of material into and back out of the stomach. If the muscle does not close completely, or opens too often, this will allow the acid to leak out into the esophagus causing heartburn. Usually this acid reflux is not a serious problem, but if it becomes a long-term, untreated problem known as gastro esophageal reflux disease (GERD) it can lead to serious problems. Scarring of the esophagus may result in narrowing (stricture) of the esophagus with worsening in swallowing and possible cancer.

There are certain types of foods that can make your acid reflux worse: citrus, chocolate, caffeine, fried foods, alcohol, tomatoes, spearmint and peppermint. Obesity and pregnancy are also common causes of acid reflux. If you notice some of the symptoms of acid reflux you could try diet modification, weight loss, over the counter antacids (Maalox, Mylanta, Tums) and over the counter heartburn medication (Tagamet, Axid, Zantac, Prilosec). You should also try to avoid heavy lifting and frequently bending over. The elevation of the head of the bed at night is also helpful.

If none of these simple remedies mentioned help you, then you should immediately contact your physician. There is a complete set of tests including a physical exam that can be done to evaluate this problem. These include: upper endoscopy, esophageal pH testing and esophageal manometry. Depending on what your doctor finds, he/she will treat you with diet modification and possible prescription medications (Nexium, Protonix, Prevacid, etc). Lifestyle changes will also need to be discussed. If all of this fails then a surgical option is a last resort to control the acid reflux. There are now endoscopic techniques to tighten the lower esophageal sphincter (LES) and thereby prevent acid splashing into the esophagus.

Please remember that most cases of acid reflux are easily treated with diet modification and lifestyle changes and possible medications. Don’t hesitate to call your doctor if you have any questions or concerns.

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Otitis Externa (Swimmer’s Ear)

Ear infections are a common problem among people of all ages and are seen very frequently in an ENT practice. There are three main categories of ear infection: outer ear, middle ear, and inner ear infections. Outer and middle ear infections are far more common and result in countless trips to the doctor’s office every year.

An outer ear infection, or Otitis Externa, is defined as an infection of the ear canal as opposed to an infection of the middle ear on the other side of the eardrum. A common slang term for this type of infection is "swimmer’s ear" given the increased risk of an outer ear infection with exposure to water. It is a very common infection occurring in about 4 of every 1,000 people annually. The main risk factors for acquiring an external ear infection are water exposure in the ear canal and scratching of the canal with q-tips or other objects placed in the ear canal. Given its association with water exposure and swimming, it is more common in the summer months, but can occur at any time. The most striking symptom is generally ear pain that can be quite severe. Other symptoms include: itching, drainage from the ear, and hearing loss. It is usually not possible to tell the difference between an outer and middle ear infection based on symptoms because the symptoms are very similar for both types of ear infection. The only reliable way to make the diagnosis is examining the ear canal. The majority of external ear infections are caused by bacteria including Pseudomonas, Staph, and Strep. A smaller number of cases are caused by fungus.

Once Otitis Externa is diagnosed by a Primary Care Physician, it is treated with antibiotic eardrops rather than oral antibiotics. Placing the antibiotic drops directly into the ear canal much more effectively eliminates the infection. Adding a topical steroid to the antibiotic drop will often result in a speedier recovery. The ear pain is usually treated with Tylenol and/or Ibuprofen. However, occasionally the pain can be so severe as to require a narcotic pain medication. It is also important to avoid further water exposure to the affected ear, since that will likely prolong the infection. Generally, outer ear infections improve within 2 or 3 days after starting the eardrops.

Occasionally, these infections will persist despite the drops. In this situation a referral to an ENT physician is necessary to address these more severe cases. One thing that can be offered by an ENT physician is a thorough cleaning of the ear canal. Sometimes the simple action of removing all the debris is all that is needed to allow the prescribed eardrops to be successful. The most severe infections can result in swelling of the ear canal so that the eardrops will not reach the entire canal. In this case, an ENT doctor may place a cotton "wick" in the ear canal for a few days to allow the antibiotic drop to get to where it needs to cure the infection. A culture of the drainage may also be helpful if a resistant bacteria is suspected. Another valuable tool is using a microscope to examine the ear. The microscope can reveal evidence of a fungal infection or more serious problems. Since many resistant outer ear infections are caused by fungal organisms that do not respond to the "normal" antibiotics, it is critical to identify fungal disease so that appropriate antifungal drops can be prescribed.

Most outer ear infections respond well to treatment, but rare complications can occur. The infection can potentially spread to the soft tissues of the face and neck, which requires oral or even IV antibiotics. In patients with diabetes or a compromised immune system, the infections can become aggressive and invade the bone of the skull and ear. This is a very infrequent occurrence but needs to be managed with an emergent surgical procedure.

"How can I avoid getting swimmer’s ear?" is a common question in any ENT practice. The answer is to keep your ears as dry as possible and to avoid manipulation with anything smaller than your elbow (Just like your Mom used to tell you!). Drying your ears with a hairdryer after swimming can be helpful. For those people that continue to have problems, placing a mixture of rubbing alcohol and white vinegar in the ear canal after swimming can minimize the chance of ear canal infection.

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Sinus Trouble

Troubles with the nose or sinuses are very common reasons for people to seek medical treatment. There are wide ranges of problems that can affect these areas, ranging from allergies to cancers, but in general there are several common symptoms that arise no matter what the underlying cause. They can include one or more of the following: trouble breathing through the nose (or nasal congestion), facial pain and pressure, headache, post-nasal drip or runny nose, sneezing, chronic coughing, and trouble smelling or tasting. These types of symptoms can be the result true sinus infection, but can also simply result from nasal allergies, eye strain, migraine headaches, stress, or viral colds or flu. Ultimately, Ears, Nose, and Throat (ENT) doctors are the experts in sorting out what the underlying cause of these problems may be, and whether or not nasal or sinus surgery is needed. ENT doctors also perform the surgeries aimed at improving the overall health and function of the nose and sinuses. This article will focus on the structure and function of the sinuses, when sinus surgery may be required, and what patients can usually expect if indeed they require such measures.

Where Are the Sinuses? What Do They Do and How Do They "Go Bad"?

Sinuses are normally air-filled cavities within the skull that are lined with the same tissues that line the nose. There are two important elements within this tissue: cells that produce mucus, and hair cells that move mucus across the surface of the tissue so we can swallow or spit out these secretions. In the nose, mucus fluid helps trap debris, bacteria, or viruses that we inhale from the outside world. Mucus in the nose also helps to aid in the detection of odor molecules in foods that we enjoy, chemicals we want to avoid, or smoke that could warn us of fire. Since the sinuses are not typically thought to help fend off bacteria or viruses, and they are not for the most part exposed to the air that we breathe, it is unclear what role they play in this regard. At the least they serve to lighten the weight of our heads and absorb a good amount of force during face-first collisions, and thus help to protect deeper structures like the brain.

There are four major pairs of sinuses surrounding the nasal cavities. They are 1) the frontal sinuses in the forehead area, 2) the maxillary sinuses behind our cheeks, 3) the ethmoid (pronounce ethmoyd) sinuses between our eyes, and 4) the sphenoid (pronounced sfenoyd) sinuses behind our nose and eyes, beneath the front portion of the brain.

The natural draining pathways of the sinuses are relatively small openings that are hidden within narrow corridors. While this may be an advantage in that foreign particles or insects that we inhale don’t end up getting inside our sinuses, it also means that it doesn’t take much swelling in the nose before these passageways are blocked. A blockage can mean that the mucus fluids that are normally swept up and out of the sinuses by the hair cells become trapped within the sinuses and become infected. Conditions that cause swelling in the nose such as allergies or colds and flues can therefore impair the sinus drainage and lead to trapped secretions in the sinuses. If trapped long enough, bacterial infection can lead to "sinusitis" or sinus infection. Even after the initial cold or allergy attack has subsided, infected secretions can spark enough inflammation as to keep the sinuses from draining, thereby setting up a cycle of continued sinus blockage and inflammation.

Diagnosing Nasal or Sinus Disorders and Sinus Infection

Determining the underlying causes of sinus complaints depends on a careful history and physical examination. Historical pieces such as timing of the onset of symptoms, relieving factors, coincident upper respiratory illnesses (URI) such as a cold, trauma or surgery in the nose or sinuses, and allergy triggers all help to influence an ENT doctor’s suspicion that sinus infection is truly a concern. Examining the nose and sinuses typically involves looking up in the nose with a small camera after numbing the area with a nasal spray. In this way, ENT doctors can evaluate for the presence of pus indicating active infection, inflammatory masses known as nasal polyps, or overt signs of anatomic blockage of sinus drainage such as scar tissue, other types of masses or tumors, or fungal infection. Depending on these findings, your doctor may recommend a sinus computed tomography (CT) scan to further evaluate the insides of the sinus cavities-as these areas are not generally visible during the camera examination. There may be some instances wherein your doctor may want a sinus CT scan right away, but usually the best time to get one is after a good course of medicines to optimize the health and natural draining abilities of the sinuses. These medicines usually include strong antibiotics, anti-swelling medicines such steroids, and sinus saline rinses. A sinus CT scan after 2-3 weeks of a regimen like this may show the sinuses to be clear, making the need for surgery less likely. However, if the CT scan shows trapped secretions within the sinuses even after these ‘optimal’ conditions, surgery to help open up the drainage pathways and wash out the sinuses may be indicated.

Sinus Surgery: What Does That Mean?

Sinus surgery has evolved over the past three decades as our understanding of how healthy sinuses function has grown. Again, even though the natural draining pathways of the sinuses are very small, most people will never need sinus surgery. When sinus surgery was first developed, doctors tried to optimize their abilities to drain by creating extra pathways from the sinuses into the nose with the idea that if one path is good, two or three paths are even better! What’s more, it was routine to strip the sinuses of that mucus-producing tissue in an effort to prevent trapped secretions from building up again. It turns out that these patients often continued to be troubled by recurrent sinus infections or crusting and bleeding in the nose. This is because those hair cells that line the sinuses all move together in a specific, coordinated fashion to move secretions only toward the area of the natural openings, no matter how many other exit paths there are in the sinus.

Strategies in sinus surgery have therefore turned to optimizing the natural openings while preserving the tissue lining whenever possible. Currently, this is the accepted method of sinus surgery and involves using cameras in the nose to expand the natural drainage paths, wash out secretion, and removing infected material only. In some instances, ENT surgeons can pass a small balloon into the sinus openings and inflate the balloon to expand the pathways—much like a heart doctor can open a blockage in a heart vessel. The vast majority of sinus surgery is done on an outpatient basis, and involves 2-3 visits to the doctor so he or she can check and clean the areas involved.

Conclusion

In summary, not all nasal complaints can be attributed to sinus disease, and not all sinus disease will require sinus surgery. It is important to consider other causes of nasal congestion or headache such as nasal allergies, stress, visual changes and many others. What's more, even in the event of true sinus infection, appropriate timing of a CT scan may help to avoid unnecessary sinus surgery. Nevertheless, sinus surgery itself has never been safer or less invasive that it is today, and is usually an outpatient procedure.

Your best bet is to seek consultation with a qualified ENT doctor who can assess and treat nasal and sinus problems, interpret sinus findings on CT scan in the context of when the scan was obtained (i.e. during symptoms but before treatment, or after optimal medical treatment), and offer safe and effective surgical intervention if that is required to break the cycle of repeated inflammation and impaired sinus drainage.

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