To understand earaches you must first know about the Eustachian tube, a narrow channel connecting the inside of the ear to the back of the throat, just above the soft palate. The tube allows drainage -- preventing fluid in the middle ear from building up and bursting the thin ear drum. In a healthy ear, the fluid drains down the tube, assisted by tiny hair cells, and is swallowed.

The tube maintains middle ear pressure equal to the air outside the ear, enabling free eardrum movement. Normally, the tube is collapsed most of the time in order to protect the middle ear from the many germs residing in the nose and mouth. Infection occurs when the Eustachian tube fails to do its job. When the tube becomes partially blocked, fluid accumulates in the middle ear, trapping bacteria already present, which then multiplies. Additionally, as the air in the middle ear space escapes into the bloodstream, a partial vacuum is formed that absorbs more bacteria from the nose and mouth into the ear.

Why do children have more ear infections than adults?

Children have Eustachian tubes that are shorter, more horizontal, and straighter than those of adults. These factors make the journey for the bacteria quick and relatively easy. A child’s tube is also floppier, with a smaller opening that easily clogs.

Inflammation of the middle ear is known as “otitis media.” When infection occurs, the condition is called "acute otitis media." Acute otitis media occurs when a cold, allergy or upper respiratory infection, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube.

When fluid forms in the middle ear, the condition is known as "otitis media with effusion," which can occur with or without infection. This fluid can remain in the ear for weeks to many months. When infected fluid persists or repeatedly returns, this is sometimes called “chronic middle ear infection.” If not treated, chronic ear infections have potentially serious consequences such as temporary or permanent hearing loss.

How are recurrent acute otitis media and otitis media with effusion treated?

Some child care advocates suggest doing nothing or administering antibiotics to treat the infection. More than 30 million prescriptions are written each year for ear infections, accounting for 25 percent of all antibiotics prescribed in the United States. However, antibiotics are not effective against viral ear infections (30 to 50 percent of such disorders), may cause uncomfortable side effects such as upset stomach, and can contribute to antibiotic resistance. Medical researchers believe that 25 percent of all pneumococcus strains, the most common bacterial cause of ear infections, are resistant to penicillin, and ten to 20 percent are resistant to amoxicillin.

What is the most common surgical treatment for ear infections?

The most common surgical procedure administered to children under general anesthesia is myringotomy with insertion of tympanostomy tubes (TT). A tube is inserted in the middle ear to allow continuous drainage of fluid. The procedure is recommended for treatment of: chronic otitis media with effusion (lasting longer than three months), recurrent acute otitis media (more than three episodes in six months or more than four episodes in 12 months), severe acute otitis media, otitis media with effusion and a hearing loss greater than 30 dB, non-responsiveness to antibiotics, and impending mastoiditis or intra-cranial complication due to otitis media.

If the patient is age six or younger, it is recommended that tubes remain in place for up to two years. Most tubes will fall out without assistance. Otherwise, the specialist will determine when the tubes should be removed.

Your ENT physician will recommend the most effective treatment for your child’s ear infection.

Before the Procedure

Prior to the procedure, the Otolaryngologist will examine the patient for a description of the tympanic membrane (eardrum) and the middle ear space. An audiometry may be performed to assess patient hearing. A tympanometry will be performed that tests compliance of the tympanic membrane at various levels of air pressure. This test provides a measurement of the extent of middle ear effusion, Eustachian tube function, and otitis media.

The Procedure

During the procedure, a small incision is made in the eardrum, the fluid is suctioned out, and a tube is placed. In young children, this is usually done under a light, general anesthesia; older patients may have the procedure performed under local anesthesia. There are over 50 different tube designs, all in different shapes, color, and composition. In general, smaller tubes stay in for a shorter duration, while large inner flanges hold the tube in place for a longer time. Some recent tubes have special surface coatings or treatments that may reduce the likelihood of infection.

After the Procedure

Immediately after the procedure, the surgeon will examine the patient for persistent or profuse bleeding or discharge. After one month, the tube placement will be reviewed, and the patient’s hearing may be tested. Later, the physician will assess the tube’s effectiveness in alleviating the ear infection.

What are tonsils?

Tonsils are the two pink lumps of tissue found on each side of the back of your throat. (Open your mouth wide and say ‘ahhhh’ in front of a mirror to see them.) Each grape-size lump fights off the bad bacteria or germs living in your body.

What is tonsillitis?

Bacteria (bad germs) are tiny living things that can cause sickness and infection. Too many bad germs on your tonsils can make you sick. This is what your doctor calls tonsillitis (ton-sil-lie-tis), or an infection in one or both of your tonsils.

Do you think you have tonsillitis? A symptom is a signal that something is wrong with your body. Talk with Mom and Dad if you see or feel:

Will I have to visit the doctor?

If you have tonsillitis symptoms, your parents will probably take you to see a doctor usually a pediatrician, or doctor for children. During your visit, the doctor will:

Once your doctor examines the results, he or she will decide if you have tonsillitis.

What happens after the doctor says I have tonsillitis?

If your doctor decides you have tonsillitis, he will probably give you an antibiotic, a medicine that gets rid of bad bacteria. If you have tonsillitis a lot, your doctor will contact an otolaryngologist (oh-toe-lair-in-goll-oh-gist), a doctor who specializes in taking care of the ears, nose, and throat. This doctor might tell you to take some more antibiotics but if your throat continues to hurt, you might be told you need a tonsillectomy.

What is a tonsillectomy?

A tonsillectomy (ton-seh-leck-teh-me) is an operation where your tonsils are taken out of your throat. If you have tonsillitis a lot, or if your tonsils get really big and you have trouble breathing, your doctor and parents may decide they need to be removed.

What happens when I have a tonsillectomy?

After dinner the night before your tonsillectomy, you won’t be allowed to eat or drink anything -- even water!

When you arrive at the hospital, you’ll put on a special bracelet with your name on it and hospital clothes. Then you will meet the doctors and nurses that will be helping you. When the doctor is ready, you’ll be given a special medicine that makes you fall asleep. Then, the doctor and nurses will use special tools to remove your tonsils. It doesn’t take very long – just about 20 minutes!

When you wake up, you will be with your Mom or Dad and the operation will be all over. Your throat will hurt but the nurses and doctors will keep an eye on you to make sure you’re okay. In a few hours you will be ready to go home. Your throat will be sore for a few weeks, but your tonsils won’t bother you ever again!

What happens after I get home?

When you get home, be sure to drink a lot and get lots of rest. It will help to keep your throat moist and your body energized. You can eat non-dairy popsicles and other cold treats or soft food that makes your throat feel better, but save ice cream for the next day. Ice cream and other milk products can make your throat worse right after the operation. Within two weeks, you’ll be back to school and better than ever!

What is tonsillitis? Tonsillitis refers to inflammation of the pharyngeal tonsils. The inflammation may involve other areas of the back of the throat including the adenoids and the lingual tonsils (areas of tonsil tissue at the back of the tongue). There are several variations of tonsillitis: acute, recurrent, and chronic tonsillitis and peritonsillar abscess.

Viral or bacterial infections and immunologic factors lead to tonsillitis and its complications. Nearly all children in the United States experience at least one episode of tonsillitis. Because of improvements in medical and surgical treatments, complications associated with tonsillitis, including mortality, are rare. 

Who gets tonsillitis?

Tonsillitis most often occurs in children; however, the condition rarely occurs in children younger than two years. Tonsillitis caused by Streptococcus species typically occurs in children aged five to 15 years, while viral tonsillitis is more common in younger children. A peritonsillar abscess is usually found in young adults but can occur occasionally in children. The patient's history often helps identify the type of tonsillitis (i.e., acute, recurrent, chronic) that is present.

What causes tonsillitis?

The herpes simplex virus, Streptococcus pyogenes (GABHS) and Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute pharyngitis and acute tonsillitis. Bacteria cause 15-30 percent of pharyngotonsillitis cases; GABHS is the cause for most bacterial tonsillitis.

What are the symptoms of tonsillitis?

The type of tonsillitis determines what symptoms will occur:

What happens during the physician visit?

Your child will undergo a general ear, nose, and throat examination as well as a review of the patient’s medical history.

A physical examination of a young patient with tonsillitis may find:

Treatment

Tonsillitis is usually treated with a regimen of antibiotics. Fluid replacement and pain control are important. Hospitalization may be required in severe cases, particularly when there is airway obstruction. When the condition is chronic or recurrent, a surgical procedure to remove the tonsils is often recommended.

Unfortunately, there may be a time when medical therapy (antibiotics) fails to resolve the chronic tonsillar infections that affect your child. In other cases, your child may have enlarged tonsils, causing loud snoring, upper airway obstruction, and other sleep disorders. The best recourse for both these conditions may be removal or reduction of the tonsils and adenoids. The American Academy of Otolaryngology—Head and Neck Surgery recommends that children who have three or more tonsillar infections a year undergo a tonsillectomy; the young patient with a sleep disorder should be a candidate for removal or reduction of the enlarged tonsils.

The tonsillectomy today

The first report of tonsillectomy was made by the Roman surgeon Celsus in 30 AD. He described scraping the tonsils and tearing them out or picking them up with a hook and excising them with a scalpel. Today, the scalpel is still the preferred surgical instrument of many ear, nose, and throat specialists. However, there are other procedures available – the choice may be dictated by the extent of the procedure (complete tonsil removal versus partial tonsillectomy) and other considerations such as pain and post-operative bleeding. A quick review of each procedure follows:

Consult with your specialist regarding the optimum procedure to remove or reduce your child’s tonsils and adenoids.

he tonsils are two pads of tissue located on both sides of the back of the throat. Adenoids sit high on each side of the throat behind the nose and the roof of the mouth. Tonsils and adenoids are often removed when they become enlarged and block the upper airway, leading to breathing difficulty. They are also removed when recurrence of tonsil infections or strep throat cannot be successfully treated by antibiotics.

The procedure to remove the tonsils is called a tonsillectomy; excision of the adenoids is an adenoidectomy. Both are usually performed concurrently; hence the procedure is known as a tonsillectomy and adenoidectomy or T&A.

T&A is an outpatient surgical procedure lasting between 30 and 45 minutes and performed under general anesthesia. Normally, the young patient will remain at the hospital or clinic for about four hours after surgery for observation. An overnight stay may be required if there are complications such as excessive bleeding or poor intake of fluids.

When the tonsillectomy patient comes home

Most children require seven to ten days to recover from the surgery. Some may recover more quickly; others can take up to two weeks for a full recovery. The following guidelines are recommended:

Specific Instructions:
Minimal fluid intake for the first 24 hour period is:
 
Weight of Patient Minimal Fluid Intake
Over 20 pounds 34 Ounces
Over 30 pounds 42 Ounces
Over 40 pounds 50 Ounces
Over 50 pounds 58 Ounces
Over 60 pounds 68 Ounces

If you are troubled about any phase of your child’s recovery, contact your physician immediately.

Your child’s sinuses are not fully developed until age 20. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms can be subtle and the causes complex.

How do I know when my child has sinusitis?

The following symptoms may indicate a sinus infection in your child:

Young children have immature immune systems and are more prone to infections of the nose, sinus, and ears, especially in the first several years of life. These are most frequently caused by viral infections (colds), and they may be aggravated by allergies. However, when your child remains ill beyond the usual week to ten days, a serious sinus infection is likely.

You can reduce the risk of sinus infections for your child by reducing exposure to known allergens and pollutants such as tobacco smoke, reducing his/her time at day care, and treating stomach acid reflux disease.

How will the doctor treat sinusitis?

When is surgery necessary?

Only a small percentage of children with severe or persistent sinusitis require surgery to relieve symptoms that do not respond to medical therapy. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of your child's sinuses and makes the narrow passages wider. This also allows for culturing so that antibiotics can be directed specifically against your child's sinus infection. Opening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infections.

Your doctor may advise removing adenoid tissue from behind the nose as part of the treatment for sinusitis. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis, or obstruction of the back of the nose, can cause many of the symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough, and headache.

Sinusitis in children is different than sinusitis in adults. Children more often demonstrate a cough, bad breath, crankiness, low energy, and swelling around the eyes along with a thick yellow-green nasal or post-nasal drip. Once the diagnosis of sinusitis has been made, children are successfully treated with antibiotic therapy in most cases. If medical therapy fails, surgical therapy can be used as a safe and effective method of treating sinus disease in children.

What is laryngopharyngeal reflux (LPR)?

Food or liquids that are swallowed travel through the esophagus and into the stomach where acids help digestion. Each end of the esophagus has a sphincter, a ring of muscle that helps keep the acidic contents of the stomach in the stomach or out of the throat. When these rings of muscle do not work properly, you may get heartburn or gastroesophageal reflux (GER). Chronic GER is often diagnosed as gastroesophageal reflux disease or GERD.

Sometimes, acidic stomach contents will reflux all the way up to the esophagus, past the ring of muscle at the top (upper esophageal sphincter or UES), and into the throat. When this happens, acidic material contacts the sensitive tissue at back of the throat and even the back of the nasal airway. This is known as laryngopharyngeal reflux or LPR.

During the first year, infants frequently spit up. This is essentially LPR because the stomach contents are refluxing into the back of the throat. However, in most infants, it is a normal occurrence caused by the immaturity of both the upper and lower esophageal sphincters, the shorter distance from the stomach to the throat, and the greater amount of time infants spend in the horizontal position. Only infants who have associated airway (breathing) or feeding problems require evaluation by a specialist. This is most critical when breathing-related symptoms are present.

What are symptoms of LPR?

There are various symptoms of LPR. Adults may be able to identify LPR as a bitter taste in the back of the throat, more commonly in the morning upon awakening, and the sensation of a “lump” or something “stuck” in the throat, which does not go away despite multiple swallowing attempts to clear the “lump.” Some adults may also experience a burning sensation in the throat. A more uncommon symptom is difficulty breathing, which occurs because the acidic, refluxed material comes in contact with the voice box (larynx) and causes the vocal cords to close to prevent aspiration of the material into the windpipe (trachea). This event is known as “laryngospasm.”

Infants and children are unable to describe sensations like adults can. Therefore, LPR is only successfully diagnosed if parents are suspicious and the child undergoes a full evaluation by a specialist such as an Otolaryngologist. Airway or breathing-related problems are the most commonly seen symptoms of LPR in infants and children and can be serious. If your infant or child experiences any of the following symptoms, timely evaluation is critical:

What are the complications of LPR?

In infants and children, chronic exposure of the laryngeal structures to acidic contents may cause long term airway problems such as a narrowing of the area below the vocal cords (subglottic stenosis), hoarseness, and possibly eustachian tube dysfunction causing recurrent ear infections, or persistent middle ear fluid, and even symptoms of “sinusitis.” The direct relationship between LPR and the latter mentioned problems are currently under research investigation.

How is LPR diagnosed?

Currently, there is no good standardized test to identify LPR. If parents notice any symptoms of LPR in their child, they may wish to discuss with their pediatrician a referral to see an Otolaryngologist for evaluation. An Otolaryngologist may perform a flexible fiberoptic nasopharyngoscopy/laryngoscopy, which involves sliding a 2 mm scope through the infant or child’s nostril, to look directly at the voice box and related structures or a 24-hour pH monitoring of the esophagus. He or she may also decide to perform further evaluation of the child under general anesthesia. This would include looking directly at the voice box and related structures (direct laryngoscopy), a full endoscopic look at the trachea and bronchi (bronchoscopy), and an endoscopic look at the esophagus (esophagoscopy) with a possible biopsy of the esophagus to determine if esophagitis is present. LPR in infants and children remains a diagnosis of clinical judgment based on history given by the parents, the physical exam, and endoscopic evaluations.

How is LPR treated?

Since LPR is an extension of GER, successful treatment of LPR is based on successful treatment of GER. In infants and children, basic recommendations may include smaller and more frequent feedings and keeping an infant in a vertical position after feeding for at least 30 minutes. A trial of medications including H2 blockers or proton pump inhibitors may be necessary. Similar to adults, those who fail medical treatment, or have diagnostic evaluations demonstrating anatomical abnormalities may require surgical intervention such as a fundoplication.

Sleep disordered breathing (SDB) is a common problem for adults leading to hypertension, heart attack, stroke, and early death. Other consequences are bedroom disharmony, excessive daytime sleepiness, weight gain, poor performance at work, failing personal relationships, and increased risk for accidents, including motor vehicle accidents.

Sleep disordered breathing in children, from infancy through puberty, is in some ways a similar condition but has different causes, consequences, and treatments. A child with SDB does not necessarily have this condition as an adult.

Pediatric obstructive sleep apnea

The premiere symptom of sleep disordered breathing is snoring that is loud, present every night regardless of sleep position, and is ultimately interrupted by complete obstruction of breathing with gasping and snorting noises. Approximately 10 percent of children are reported to snore. Ten percent of these children (one percent of the total pediatric population) have obstructive sleep apnea.

When an individual, young or old, obstructs breathing during sleep, the body perceives this as a choking phenomenon. The heart rate slows, the sympathetic nervous system is stimulated, blood pressure rises, the brain is aroused, and sleep is disrupted. In most cases a child’s vascular system can tolerate the changes in blood pressure and heart rate. However, a child’s brain does not tolerate the repeated interruptions to sleep, leading to a child that is sleep deprived, cranky, and ill behaved.

Consequences of untreated pediatric sleep disordered breathing:

Diagnosis of sleep disordered breathing

The first diagnosis of sleep disordered breathing in children is made by the parent’s observation of snoring. Other observations may include obstructions to breathing, gasping, snorting, and thrashing in bed as well as unexplained bedwetting. Social symptoms are difficult to diagnose but include alteration in mood, misbehavior, and poor school performance. (Note: Every child who has sub par academic and social skills may not have SDB, but if a child is a serious snorer and is experiencing mood, behavior, and performance problems, sleep disordered breathing should be considered.)

A child with suspected SDB should be evaluated by an otolaryngologist – head and neck surgeon. If the symptoms are significant and the tonsils are enlarged, the child is strongly recommended for T&A, or tonsillectomy and adenoidectomy (removal of the tonsils and adenoids). Conversely, if the symptoms are mild, academic performance remains excellent, the tonsils are small, and puberty is eminent (tonsils and adenoids shrink at puberty), it may be recommended that SDB be treated only if matters worsen. The majority of cases fall somewhere in between, and physicians must evaluate each child on a case-by-case basis.

There are other pediatric sleep disorder diagnoses. Sudden infant death syndrome (SIDS) and apparent life threatening episode (ALTE) are considered forms of sleep disordered breathing. Children with these conditions warrant thorough evaluation by a pediatric sleep specialist. Children with craniofacial abnormalities, primarily abnormalities of the jaw bones, tongue, and associated structures, often have sleep disordered breathing. This must be managed and the deformities treated as the child grows.

The sleep test is the standard diagnostic test for sleep disordered breathing. This test can be performed in a sleep laboratory or at home. Sleep tests can produce inaccurate results, especially in children. Borderline or normal sleep test results may still result in a diagnosis of SDB based on parental observation and clinical evaluation.

Treatment for sleep disordered breathing

Enlarged tonsils are the most common cause for SDB, thus tonsillectomy/adenoidectomy is the most effective treatment for pediatric sleep disordered breathing. T&A achieves a 90 percent success rate for childhood SDB. Of the nearly 400,000 T&As performed in the U.S. each year, 75 percent are performed to treat sleep disordered breathing.

Not every child with snoring should undergo T&A. The procedure does have risks and possible complications. Aside from the mental anguish experienced by the parent and child, potential problems include: anesthesia risks, bleeding, and infection.

Who is in day care?

The 2000 census reported that of among the nation's 19.6 million preschoolers, grandparents took care of 21 percent, 17 percent were cared for by their father (while their mother was employed or in school); 12 percent were in day care centers; nine percent were cared for by other relatives; seven percent were cared for by a family day care provider in their home; and six percent received care in nursery schools or preschools. More than one-third of preschoolers (7.2 million) had no regular child-care arrangement and presumably were under maternal care.

Day care establishments are defined as those primarily engaged in care of infants or children, or in providing pre-kindergarten education, where medical care and/or behavioral correction are not a primary function or major element. Some may or may not have substantial educational programs, and some may care for older children when they are not in school.

What are your child’s risks of being exposed to a contagious illness at a day care center?

Medline, a service of the National Library of Medicine and the National Institutes of Health, reports that day care centers do pose some degree of an increased health risk for children, because of the exposure to other children who may be sick.

When your child is in a day care center, the risk is greatest for viral upper respiratory infection (affecting the nose, throat, mouth, voice box) and the common cold, ear infections, and diarrhea. Some studies have tried to link asthma to day care. Other studies suggest that being exposed to all the germs in day care actually IMPROVES your child's immune system.

Studies suggest that the average child will get eight to ten colds per year, lasting ten - 14 days each, and occurring primarily in the winter months. This means that if a child gets two colds from March to September, and eight colds from September to March, each lasting two weeks, the child will be sick more than over half of the winter.

At the same time, children in a day care environment, exposed to the exchange of upper respiratory tract viruses every day, are expected to have three to ten episodes of otitis media annually. This is four times the incidence of children staying at home.

When should your child remain at home instead of day care or school?

Simply put, children become sick after being exposed to other sick children. Some guidelines to follow are:

Can you prevent your child from becoming sick at a day care center?

  1. The short answer is no. Exposure to other sick children will increase the likelihood that your child may “catch” the same illness, particularly with the common cold. The primary rule is to keep your own children at home if they are sick. However, you can:
  2. Teach your child to wash his or her hands before eating and after using the toilet. Infection is spread the most by children putting dirty toys and hands in their mouths, so check your day care's hygiene cleaning practices.

    Have your child examined by a physician before enrollment in a day care center or school. During the examination, the physician will:
    • Look for otitis (inflammation) in the ear. This is an indicator of future ear infections.
    • Review with you any allergies your child may have. This will assist in determining if the diet offered at the day care center may be harmful to your child.
    • Examine the child’s tonsils for infection and size. Enlarged tonsils could indicate that your child may not be getting a healthy sleep at night, resulting in a tired condition during the day.
  3. Alert the day care center manager when your child is ill, and include the nature of the illness.

Day care has become a necessity for millions of families. Monitoring the health of your own child is key to preventing unnecessary sickness. If a serious illness occurs, do not hesitate to have your child examined by a physician.

Your child has been diagnosed with allergic rhinitis, a physiological response to specific allergens such as pet dander or ragweed. The symptoms are fairly simple -- a runny nose (rhinitis), watery eyes, and some periodic sneezing. The best solution is to administer over-the-counter antihistamine, and the problem will resolve on its own … right?

Not really – the interrelated structures of the ears, nose, and throat can cause certain medical problems which trigger additional disorders – all with the possibility of serious consequences.

Simple hay fever can lead to long term problems in swallowing, sleeping, hearing, and breathing. Let’s see what else can happen to a child with a case of hay fever:

Seasonal allergic rhinitis may resolve after a short period. Administration of the proper over-the-counter antihistamines may alleviate the symptoms. However, if your child suffers from perennial (year round) allergic rhinitis, an examination by specialist will assist in preventing other ear, nose, and throat problems from occurring.

Pediatric Obesity and Ear, Nose, and Throat Disorders

Today in the United States, studies estimate that 34 percent of U.S. adults are overweight and an additional 31 percent (approximately 60 million) are obese. Combined, approximately 127 million Americans are overweight or obese. Some 42 years ago, 13 percent of Americans were obese, and in 1980 15 percent were considered obese.

Alarmingly, the number of children who are overweight or obese has doubled in the last two decades as well. Currently, more than 15 percent of 6- to 11-year-olds and more than 15 percent of 12- to 19-year-olds are considered overweight or obese.

What is the difference between designated “obese” versus “overweight?”

Unfortunately, the words overweight and obese are often interchanged. There is a difference:

Obesity can present significant health risks to the young child. Diseases are being seen in obese children that were once thought to be adult diseases. Many experts in the study of children’s health suggest that a dysfunctional metabolism, or failure of the body to change food calories to energy, precedes the onset of disease. Consequently, these children are at risk for Type II Diabetes, fatty liver, elevated cholesterol, SCFE (a major hip disorder), menstrual irregularities, sleep apnea, and irregular metabolism. Additionally, there are psychological consequences; obese children are subject to depression, loss of self-esteem, and isolation from their peers.

Pediatric obesity and otolaryngic problems

Otolaryngologists, or ear, nose, and throat specialists, diagnose and treat some of the most common children’s disorders. They also treat ear, nose, and throat conditions that are common in obese children, such as:

Research conducted by otolaryngologists found that:

Morbid obesity was a contributing factor for requiring an overnight hospital admission for a child undergoing removal of enlarged tonsils. Most children who were diagnosed as obese with sleep apnea required a next-day physician follow-up.

A study from the University of Texas found that morbidly obese patients have a significant increase of additional medical disorders following tonsillectomy and adenoidectomy for obstructive sleep apnea or sleep-disordered breathing when compared to moderately obese or overweight patients undergoing this procedure for the same diagnosis. On average they have longer hospital stays, a greater need for intensive care, and a higher incidence of the need for apnea treatment of continuous positive airway pressure upon discharge from the hospital. The study found that although the morbidly obese group had a greater degree of sleep apnea, they did benefit from the procedure in regards to snoring, apneic spells, and daytime somnolence.

What you can do

If your child has a weight problem, contract your pediatrician or family physician to discuss the weight’s effect on your child’s health, especially prior to treatment decisions. Second, ask your physician about lifestyle and diet changes that will reduce your child’s weight to a healthy standard.

Your child has an earache. After your first visit to a physician you may hear some of the following terms related to the diagnosis and treatment of this common childhood disorder.

Do not hesitate to seek clarification from your physician if he or she uses a term that you do not fully understand.

Pediatric GERD (Gastro-Esophageal Reflux Disease) and Your Otolaryngologist

Everyone has gastroesophageal reflux (GER), the backward movement (reflux) of gastric contents into the esophagus. Extraesophageal Reflux (EER) is the reflux of gastric contents from the stomach into the esophagus with further extension into the throat and other upper aerodigestive regions. In infants, more than 50 percent of children three months or younger have at least one episode of regurgitation a day. This rate peaks at 67 percent at age four months. But an infant’s improved neuromuscular control and the ability to sit up will lead to a spontaneous resolute ion of significant GER in more than half of infants by age ten months and four out of five at age 18 months.

Researchers have found that 10 percent of infants (younger than 12 months) with GER develop significant complications. The diseases associated with reflux are known collectively as Gastro-Esophageal Reflux Disease (GERD). Physically, GERD occurs when a muscular valve at the lower end of the esophagus malfunctions. Normally, this muscle closes to keep acid in the stomach and out of the esophagus. The continuous entry of acid or refluxed materials into areas outside the stomach can result in significant injury to those areas. It is estimated that some five to eight percent of adolescent children have GERD.

What symptoms are displayed by a child with GERD?

GER and EER in children often cause relatively few symptoms until a problem exists (GERD). The most common initial symptom of GERD is heartburn. Heartburn is more common in adults, whereas children have a harder time describing this sensation. They usually will complain of a stomach ache or chest discomfort, particularly after meals.

More frequent or severe GER and EER can cause other problems in the stomach, esophagus, pharynx, larynx, lungs, sinuses, ears and even the teeth. Consequently, other typical symptoms could include crying/irritability, poor appetite/feeding and swallowing difficulties, failure to thrive/weight loss, regurgitation (“wet burps” or outright vomiting), stomach aches (dyspepsia), abdominal/chest pain (heartburn), sore throat, hoarseness, apnea, laryngeal and tracheal stenoses, asthma/wheezing, chronic sinusitis, ear infections/fluid, and dental caries. Effortless regurgitation is very suggestive of GER. However recurrent vomiting (which is not the same) does not necessarily mean a child has GER.

Unlike infants, the adolescent child will not necessarily resolve GERD on his or her own. Accordingly, if your child displays the typical symptoms of GERD, a visit to a pediatrician is warranted. However, in some circumstances, the disorder may cause significant ear, nose, and throat disorders. When this occurs, an evaluation by an Otolaryngologist is recommended.

How is GERD diagnosed?

Most of the time, the physician can make a diagnosis by interviewing the caregiver and examining the child. There are occasions when testing is recommended. The tests that are most commonly used to diagnose gastroesophageal reflux include:

What treatments for GERD are available?

Treatment of reflux in infants is intended to lessen symptoms, not to relieve the underlying problem, as this will often resolve on its own with time. A useful simple treatment is to thicken a baby's milk or formula with rice cereal, making it less likely to be refluxed.

Several steps can be taken to assist the older child with GERD:

It is a well-known fact among parents that children sometimes put things such as dried beans, small toys, or beads in their ears, nose, or mouth. Such inappropriate objects may cause harm if immediate medical attention is not provided. Often, caregivers are unaware that a child has taken in such an object and this makes getting the right treatment more difficult.

The symptoms caused by these objects range from discomfort and pain, to decreased hearing, changes or noises from breathing, difficulty swallowing or choking and sometimes drainage especially from objects in the ear or nose. If there is difficulty breathing, the object could cause serious problems and immediate action should be taken.

Doctors call these objects foreign bodies. A recent medical study has shown that with some people it is hard to see certain types of foreign bodies with the naked eye. It recommends that “these cases should be referred directly to otolaryngologists for otomicroscopic removal or removal with special light scopes.” In other words, an ear, nose, and throat specialist physician should remove such objects to avoid further harm.

Facts about foreign bodies in the ear, nose, and airway

Foreign bodies in the ear

Children usually place things in their ear canal because they are bored, curious, or copying other children. Sometimes one child may put an object in another child's ear during play. It is important for parents to be aware that children may cause themselves or other children great harm by placing objects in the ear. There may also be a link between chronic outer ear infections and children who tend to place things in their ears. Insects may also fly into the ear canal, causing potential harm. Any child with a chronically draining ear should be evaluated for a foreign body.

Some of the items that are commonly found in the ear (usually the canal) of young children include the following: food, insects, toys, buttons, pieces of crayon, and small button-shaped batteries. Teenagers sometimes have objects imbedded in the ear lobe due to an infection from a pierced ear or a poorly healed piecing.

Treatment

The treatment for foreign bodies in the ear is prompt removal of the object by your child's physician. The following are some of the techniques that may be used by your child's physician to remove the object from the ear canal:

After removal of the object, your child's physician will re-examine the ear to determine if there has been any injury to the ear canal. Antibiotic drops for the ear may be prescribed to treat any possible infections.

Foreign bodies in the nose

Objects that are put into the child's nose are usually, but not always, soft things like tissue, clay, and pieces of toys or erasers. Harder objects, much like those commonly put in the ear, may also be put into the nose. From time to time, a foreign body may enter the nose while the child is trying to smell the object.

Symptoms

The most common symptom of a foreign body in the nose is nasal drainage. The drainage often has a bad odor. Parents should suspect a foreign body and not a “cold” when drainage is from only one nostril. In some cases, the child may also have a bloody nose.

Treatment

Foreign objects in your child’s nose should be removed promptly. Sedating the child is sometimes necessary in order to remove the object successfully. This may necessitate a trip to the hospital, depending on the extent of the problem and the cooperation of the child. Some of the techniques that your child's physician may use to remove the object from the nose include suction machines with tubes attached or instruments such as small tweezers called forceps.

After removal of the object, your child's physician may re-examine the nose with a special fiberoptic light looking for another foreign body or may prescribe nose drops or antibiotic ointments to treat any possible infections.

Children put many things in their mouths (including food) that can cause trouble. When you know that a child has ingested a foreign object, consider this a medical emergency and seek immediate attention. If your child is choking – cannot breathe, is gasping, cannot talk, or is turning blue – call 911 or an ambulance immediately.

Parents should be alert for these commonly ingested items:

Aside from choking, trouble may happen if the object becomes lodged in the "airway" tube (trachea) instead of the "eating" tube (esophagus), which may make the child’s distress harder to see. Children may experience symptoms differently; some children can even have vague symptoms that do not immediately suggest ingestion. While most swallowed foreign objects pass harmlessly through the esophagus, the stomach, and intestines, a foreign body may also cause harm if it has associated toxicity or becomes lodged in the gastrointestinal tract.

Parents should suspect their child might have swallowed a foreign object if breathing or swallowing difficulties persist longer than two weeks despite medical treatment. For example, continuing asthma or upper respiratory treatment without seeing improvement.

If you know that your child has swallowed a foreign object look for these symptoms of choking first, and then look next for signs of obstruction:

Signs of airway obstruction:

Signs of gastrointestinal (GI) blockage

If you are fairly sure that a foreign body has been swallowed and your child is not experiencing an airway obstruction, continue to watch for the following:

Toxicity is another consequence of ingestion that may cause problems. Coins (for instance newer copper-coated zinc pennies) and batteries may cause system-wide reactions because some metals are extremely toxic and may cause inflammation.

Treatment for foreign bodies in the airway

Treatment of the problem varies with the degree of airway blockage. If the object is completely blocking the airway, the child will be unable to breath or talk and his/her lips will become blue. This is a medical emergency and you should seek emergency medical care.

Sometimes, surgery is necessary to remove the object. Children that are still talking and breathing but show other symptoms also need to be evaluated by a physician immediately.

Follow these steps if your child is unconscious:

Repeat this life saving procedure until the ambulance arrives. Make sure you tell the medical team immediately what caused the child to choke or what obstructs the breathing so that proper treatment can be administered.

What is facial trauma?

The term facial trauma means any injury to the face or upper jaw bone. Facial traumas include injuries to the skin covering, underlying skeleton, neck, nasal (sinuses), orbital socket, or oral lining, as well as the teeth and dental structures. Sometimes these types of injuries are called maxillofacial injury. Facial trauma is often recognized by lacerations (breaks in the skin); bruising around the eyes, widening of the distance between the eyes (which may indicate injury to the bones between the eye sockets); movement of the upper jaw when the head is stabilized (which may indicate a fracture in this area); and abnormal sensations on the cheek.

In the U.S., about three million people are treated in emergency departments for facial trauma injuries each year. Of the pediatric patients, five percent have suffered facial fractures. In children less than three years old, the primary cause of these fractures is falls. In children more than five years old the primary cause for facial trauma is motor vehicle accidents.

Our fast paced world of ultra sports and increasing violence puts children at risk for facial injury. But, children’s facial injuries require special attention. A child’s future growth plays a big role in treatment for facial trauma. So, one of the most important issues as a care giver is to follow a physician’s treatment plan as closely as you can until your child is fully recovered.

Why is facial trauma different in children than adults?

Facial trauma can range between minor injury to disfigurement that lasts a lifetime. The face is critical in communicating with others, so it is important to get the best treatment possible. Pediatric facial trauma differs from adult injury because the face is not fully formed and future growth will be a factor in how the child heals and recovers. Certain types of trauma may cause a delay in the growth or further complicate recovery. Difficult cases require physicians with great skill to make a repair that will grow with your child.

Types of facial trauma

New technology, such as CT scans, have improved physicians ability to evaluate and manage facial trauma. In some cases, immediate surgery is needed to realign fractures before they heal incorrectly. Other injuries will have better outcomes if repairs are done after cuts and swelling have improved. A new study has shown that even when injury does not require surgery, it is important to a child’s health and welfare to continue to follow up with a physicians care.

Soft tissue injuries

Injuries such as cuts (lacerations) may occur on the soft tissue of the face. In combination with suturing the wound, the provider should take care to inspect and treat any injures to the facial nerves, glands, or ducts.

Bone injuries

When a fracture of the bones in the face occurs, the treatment process is similar to that of a fracture in other parts of the body. Factors that affect how the fracture should be dealt with are the location of the fracture, the severity of the fracture, and the age and general health of the patient. It is important during treatment of facial fractures to be careful that the patient's facial appearance is minimally affected.

Injuries to the teeth and surrounding dental structures style

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Because of the specific needs of the dental structures, certain actions and precautions should be taken if a child has received an injury to his or her teeth or surrounding dental structures:

References

What is GERD?

Gastroesophageal reflux, often referred to as 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 and throat, 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.

In some cases, reflux can be SILENT, with no symptoms until a problem arises. Almost all individuals have experienced reflux (GER), but the disease (GERD) occurs when reflux happens on a frequent basis often over a long period of time.

What is LPR?

During gastroesophageal reflux, the acidic stomach contents may reflux all the way up the esophagus, beyond the upper esophageal sphincter (a ring of muscle at the top of the esophagus), and into the back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux (LPR), which can affect anyone. Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning, or something “stuck.” Some may have difficulty breathing if the voice box is affected.

In infants and children, LPR may cause breathing problems such as: cough, hoarseness, stridor (noisy breathing), croup, asthma, sleep disordered breathing, feeding difficulty (spitting up), turning blue (cyanosis), aspiration, pauses in breathing (apnea), apparent life threatening event (ALTE), and even a severe deficiency in growth. Proper treatment of LPR, especially in children, is critical.

What are the symptoms of GERD and LPR?

The symptoms of GERD may include persistent heartburn, acid regurgitation, nausea, hoarseness in the morning, or trouble swallowing. Some people have GERD without heartburn. Instead, they experience pain in the chest that can be severe enough to mimic the pain of a heart attack. GERD can also cause a dry cough and bad breath. Some people with LPR may feel as if they have food stuck in their throat, a bitter taste in the mouth on waking, or difficulty breathing although uncommon.

If you experience any symptoms on a regular basis (twice a week or more) then you may have GERD or LPR. For proper diagnosis and treatment, you should be evaluated by your primary care doctor for GERD or an Otolaryngologist—head and neck surgeon (ENT doctor).

Who gets GERD or LPR?

Women, men, infants, and children can all have GERD. This disorder may result from physical causes or lifestyle factors. Physical causes can include a malfunctioning or abnormal lower esophageal sphincter muscle (LES), hiatal hernia, abnormal esophageal contractions, and slow emptying of the stomach. Lifestyle factors include diet (chocolate, citrus, fatty foods, spices), destructive habits (overeating, alcohol and tobacco abuse) and even pregnancy. Young children experience GERD and LPR due to the developmental immaturity of both the upper and lower esophageal sphincters.

Unfortunately, GERD and LPR are often overlooked in infants and children leading to repeated vomiting, coughing in GER and airway and respiratory problems in LPR such as sore throat and ear infections. Most infants grow out of GERD or LPR by the end of their first year; however, the problems that resulted from the GERD or LPR may persist.

What role does an ear, nose, and throat specialist have in treating GERD and LPR?

A gastroenterologist, a specialist in treating gastrointestinal orders, will often provide initial treatment for GERD. But there are ear, nose, and throat problems that are either caused by or associated with GERD, such as hoarseness, laryngeal (singers) nodules, croup, airway stenosis (narrowing), swallowing difficulties, throat pain, and sinus infections. These problems require an Otolaryngologist—head and neck surgeon, or a specialist who has extensive experience with the tools that diagnose GERD and LPR. They treat many of the complications of GERD, including: sinus and ear infections, throat and laryngeal inflammation and lesions, as well as a change in the esophageal lining called Barrett’s esophagus, which is a serious complication that can lead to cancer.

Your primary care physician or pediatrician will often refer a case of LPR to an Otolaryngologist—head and neck surgeon for evaluation, diagnosis, and treatment.

Diagnosing and treating GERD and LPR

In adults, GERD can be diagnosed or evaluated by a physical examination and the patient’s response to a trial of treatment with medication. Other tests that may be needed include an endoscopic examination (a long tube with a camera inserted into the nose, throat, windpipe, or esophagus), biopsy, x-ray, examination of the throat and larynx, 24 hour pH probe, acid reflux 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 or in a hospital setting. Endoscopic examinations can often be performed in your ENT’s office, or may require some form of sedation and occasionally anesthesia.

Symptoms of GERD or LPR in children should be discussed with your pediatrician for a possible referral to a specialist.

Most people with GERD respond favorably to a combination of lifestyle changes and medication. On occasion, surgery is recommended. Medications that could be prescribed include antacids, histamine antagonists, proton pump inhibitors, pro-motility drugs, and foam barrier medications. Some of these products are now available over-the-counter and do not require a prescription.

Children and adults who fail medical treatment or have anatomical abnormalities may require surgical intervention. Such 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.

Adult lifestyle changes to prevent GERD and LPR

How does the TMJ work?

When you bite down hard, you put force on the object between your teeth and on the joint. In terms of physics, the jaw is the lever and the TMJ is the fulcrum. Actually, more force is applied (per square foot) to the joint surface than to whatever is between your teeth. To accommodate such forces and to prevent too much wear and tear, the cartilage between the mandible and skull normally provides a smooth surface, over which the joint can freely slide with minimal friction.

Therefore, the forces of chewing can be distributed over a wider surface in the joint space and minimize the risk of injury. In addition, several muscles contribute to opening and closing the jaw and aid in the function of the TMJ.

Symptoms:

How does TMJ dysfunction feel?

The pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew, or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head (the temple), the cheek, the lower jaw, and the teeth.

A very common focus of pain is in the ear. Many patients come to the ear specialist quite convinced their pain is from an ear infection. When the earache is not associated with a hearing loss and the eardrum looks normal, the doctor will consider the possibility that the pain comes from a TMJ dysfunction.

There are a few other symptoms besides pain that TMJ dysfunction can cause. It can make popping, clicking, or grinding sounds when the jaws are opened widely. Or the jaw locks wide open (dislocated). At the other extreme, TMJ dysfunction can prevent the jaws from fully opening. Some people get ringing in their ears from TMJ trouble.

How can things go wrong with the TMJ?

In most patients, pain associated with the TMJ is a result of displacement of the cartilage disc that causes pressure and stretching of the associated sensory nerves. The popping or clicking occurs when the disk snaps into place when the jaw moves. In addition, the chewing muscles may spasm, not function efficiently, and cause pain and tenderness.

Both major and minor trauma to the jaw can significantly contribute to the development of TMJ problems. If you habitually clench, grit, or grind your teeth, you increase the wear on the cartilage lining of the joint, and it doesn't have a chance to recover. Many persons are unaware that they grind their teeth, unless someone tells them so.

Chewing gum much of the day can cause similar problems. Stress and other psychological factors have also been implicated as contributory factors to TMJ dysfunction. Other causes include teeth that do not fit together properly (improper bite), malpositioned jaws, and arthritis. In certain cases, chronic malposition of the cartilage disc and persistent wear in the cartilage lining of the joint space can cause further damage.

What can be done?

Because TMJ symptoms often develop in the head and neck, otolaryngologists are appropriately qualified to diagnose TMJ problems. Proper diagnosis of TMJ begins with a detailed history and physical, including careful assessment of the teeth occlusion and function of the jaw joints and muscles. If the doctor diagnoses your case early, it will probably respond to these simple, self-remedies:

In cases of joint injury, ice packs applied soon after the injury can help reduce swelling. Relaxation techniques and stress reduction, patient education, non-steroidal anti-inflammatory drugs, muscle relaxants or other medications may be indicated in a dose your doctor recommends.

Other therapies may include fabrication of an occlusal splint to prevent wear and tear on the joint. Improving the alignment of the upper and lower teeth and surgical options are available for advanced cases. After diagnosis, your Otolaryngologist may suggest further consultation with your dentist and oral surgeon to facilitate effective management of TMJ dysfunction.

Smell and taste problems can have a big impact on our lives. Because these senses contribute substantially to our enjoyment of life, our desire to eat, and be social, smell and taste disorders can be serious. When smell and taste are impaired, life loses some zest. We eat poorly, socialize less, and as a result, feel worse. Many older people experience this problem.

Smell and taste also warn us about dangers, such as fire, poisonous fumes, and spoiled food. Certain jobs require that these senses be accurate-chefs and firemen rely on taste and smell. One study estimates that more than 200,000 people visit a doctor with smell and taste disorders every year, but many more cases go unreported.

Loss of the sense of smell may be a sign of sinus disease, growths in the nasal passages, or, in rare circumstances, brain tumors.

How do smell and taste work?

Smell and taste belong to our chemical sensing system (chemosensation). The complicated processes of smelling and tasting begin when molecules released by the substances around us stimulate special nerve cells in the nose, mouth, or throat. These cells transmit messages to the brain, where specific smells or tastes are identified.

Olfactory (small nerve) cells are stimulated by the odors around us-the fragrance from a rose, the smell of bread baking. These nerve cells are found in a tiny patch of tissue high up in the nose, and they connect directly to the brain.

Gustatory (taste nerve) cells react to food or drink mixed with saliva and are clustered in the taste buds of the mouth and throat. Many of the small bumps that can be seen on the tongue contain taste buds. These surface cells send taste information to nearby nerve fibers, which send messages to the brain.

The common chemical sense, another chemosensory mechanism, contributes to our senses of smell and taste. In this system, thousands of free nerve endings-especially on the moist surfaces of the eyes, nose, mouth, and throat-identify sensations like the sting of ammonia, the coolness of menthol, and the "heat" of chili peppers.

Flavor

We can commonly identify four basic taste sensations:

Certain combinations of these tastes-along with texture, temperature, odor, and the sensations from the common chemical sense-produce a flavor. It is flavor that lets us know whether we are eating peanuts or caviar.

Many flavors are recognized mainly through the sense of smell. If you hold your nose while eating chocolate, for example, you will have trouble identifying the chocolate flavor, even though you can distinguish the food's sweetness or bitterness. This is because the familiar flavor of chocolate is sensed largely by odor. So is the well-known flavor of coffee. This is why a person who wishes to fully savor a delicious flavor (e.g., an expert chef testing his own creation) will exhale through his nose after each swallow.

Taste and smell cells are the only cells in the nervous system that are replaced when they become old or damaged. Scientists are examining this phenomenon while studying ways to replace other damaged nerve cells.

What causes smell and taste disorders?

Scientists have found that the sense of smell is most accurate between the ages of 30 and 60 years. It begins to decline after age 60, and a large proportion of elderly persons lose their smelling ability. Women of all ages are generally more accurate than men in identifying odors.

Some people are born with a poor sense of smell or taste. Upper respiratory infections are blamed for some losses, and injury to the head can also cause smell or taste problems.

Loss of smell and taste may result from polyps in the nasal or sinus cavities, hormonal disturbances, or dental problems. They can also be caused by prolonged exposure to certain chemicals such as insecticides and by some medicines.

Tobacco smoking is the most concentrated form of pollution that most people will ever be exposed to. It impairs the ability to identify odors and diminishes the sense of taste. Quitting smoking improves the smell function.

Radiation therapy patients with cancers of the head and neck later complain of lost smell and taste. These senses can also be lost in the course of some diseases of the nervous system.

Patients who have lost their larynx (voice box) commonly complain of poor ability to smell and taste. Laryngectomy patients can use a special "bypass" tube to breathe through the nose again. The enhanced airflow through the nose helps smell and taste sensation to be re-established.

How are smell and taste disorders diagnosed?

The extent of loss of smell or taste can be tested using the lowest concentration of a chemical that a person can detect and recognize. A patient may also be asked to compare the smells or tastes of different chemicals, or how the intensities of smells or tastes grow when a chemical concentration is increased.

Can smell and taste disorders be treated?

Sometimes a certain medication is the cause of smell or taste disorders, and improvement occurs when that medicine is stopped or changed. Although certain medications can cause chemosensory problems, others-particularly anti-allergy drugs-seem to improve the senses of taste and smell. Some patients, notably those with serious respiratory infections or seasonal allergies, regain their smell or taste simply by waiting for their illness to run its course. In many cases, nasal obstructions, such as polyps, can be removed to restore airflow to the receptor area and can correct the loss of smell and taste. Occasionally, chemosenses return to normal just as spontaneously as they disappeared.

What can I do to help myself?

If you experience a smell or taste problem, try to identify and record the circumstances surrounding it. When did you first become aware of it? Did you have a "cold" or "flu" then? A head injury? Were you exposed to air pollutants, pollens, danders, or dust to which you might be allergic? Is this a recurring problem? Does it come in any special season, like hay fever time?

Bring all this information with you when you visit a physician who deals with diseases of the nose and throat (an Otolaryngologist-head and neck surgeon). Proper diagnosis by a trained professional can provide reassurance that your illness is not imaginary. You may even be surprised by the results. For example, what you may think is a taste problem could actually be a smell problem, because much of what you think you taste you really smell.

Diagnosis may also lead to treatment of an underlying cause for the disturbance. Many types of smell and taste disorders are reversible. But, if yours is not, it is important to remember that you are not alone. Thousands of other patients have faced the same situation.

Insight into facial nerve problems

Twitching, weakness, or paralysis of the face are symptoms of a disorder involving the facial nerve, not a disease in itself. Abnormal movement or paralysis of the face can result from infection, injury, or tumors, and an evaluation by your physician is needed to determine the cause. An Otolaryngologist-head and neck surgeon has special training and experience in managing facial nerve disorders. 

What is the Facial Nerve?

The facial nerve resembles a telephone cable and contains 7,000 individual nerve fibers. Each fiber carries electrical impulses to a specific facial muscle. Information passing along the fibers of this nerve allows us to laugh, cry, smile, or frown, hence the name, "the nerve of facial expression."

When half or more of these individual nerve fibers are interrupted, facial weakness occurs. If these nerve fibers are irritated, then movements of the facial muscles appear as spasms or twitching. The facial nerve not only carries nerve impulses to the muscles of the face, but also to the tear glands, to the saliva glands, and to the muscle of the stirrup bone in the middle ear (the stapes). It also transmits taste from the front of the tongue. Since the function of the facial nerve is so complex, many symptoms may occur when the fibers of the facial nerve are disrupted. A disorder of the facial nerve may result in twitching, weakness, or paralysis of the face, in dryness of the eye or the mouth, or in disturbance of taste.

How Does It Work?

The anatomy of the facial nerve is very complex. The facial nerve passes through the base of the skull in transit from the brain to the muscles of facial expression. After leaving the brain, the facial nerve enters the bone of the ear (temporal bone) through a small bony tube (the internal auditory canal) in very close association with the hearing and balance nerves. Along its inch-and-a-half course through a small canal within the temporal bone, the facial nerve winds around the three middle ear bones, in back of the eardrum, and then through the mastoid (the bony area behind the part of the ear that is visible). After the facial nerve leaves the mastoid, it passes through the salivary gland in the face (parotid gland) and divides into many branches, which supply the various facial muscles. The facial nerve gives off many branches as it courses through the temporal bone: to the tear gland, to the stapes muscle, to the tongue (for taste sensation), and to the saliva glands.

Bell's palsy and other causes

The most common cause of facial weakness that comes on suddenly is referred to as "Bell's palsy." This disorder is probably due to the body's response to a virus: in reaction to the virus the facial nerve within the ear (temporal) bone swells, and this pressure on the nerve in the bony canal damages it.

In order to be sure that this is the cause of the facial weakness, and not something else, a special set of questions will be asked. After an examination of the head, neck, and ears, a series of tests may be performed. The most common tests are:

Diagnosis, Prognosis and Treatment

The three questions most often asked by the patient are: What is the cause (diagnosis)?, When can I expect recovery (prognosis)?, and What can be done to bring about the best recovery at the earliest possible moment (treatment)? In order to answer these questions, your doctor must perform an extensive evaluation to determine the cause and which area of the facial nerve is involved, so that the best treatment can be prescribed.

Treatment

The results of diagnostic testing will determine treatment:

Help your recovery

When the facial nerve is paralyzed, considerable attention must be given to maintaining a healthy eye, which requires a constant flow of tears. These tears are spread out over the eye by blinking, but blinking is diminished or eliminated in facial nerve paralysis. Diminished blinking and the absence of tearing together can reduce or eliminate the flow of tears across the eyeball, resulting in drying, erosion, and ulcer formation on the cornea and possible loss of the eye.

Closing the eye with a finger is an effective way of keeping the eye moist. Use the back of the finger to ensure that the eye is not injured with the fingertip. Protective glasses or clear eye patches are often used to keep the eye moist, and to keep foreign materials from entering the eye.

If the eye is dry, you may be advised to use artificial tears to keep it moist. The drops should be used as directed by your doctor. You may have to put one or two drops in the affected eye every hour while you are awake, and place ointment in your eye at bedtime.

Rehabilitation

Patients with permanent facial paralysis may be rehabilitated through a variety of surgical procedures including eyelid weights or springs, muscle transfers and nerve substitutions. Some patients may benefit from a special form of physical therapy called facial retraining. Other medical treatments for complications of facial paralysis including excessive motion of the face or muscle spasm may involve surgical division of overactive muscles or weakening them by chemical injection. If these procedures are needed, your physician will discuss them with you.

Conclusion

Disorders of the facial nerve, including paralysis, are not rare and have a variety of causes. The appropriate diagnosis and treatment are very important to achieving the best possible recovery of facial nerve function. Even patients with permanent facial nerve injury can be helped by surgical procedures designed to improve facial function.

The skin is the largest organ in our body. It provides protection against heat, cold, light, and infection. The skin is made up of two major layers (epidermis and dermis) as well as various types of cells. The top (or outer) layer of the skin-the epidermis-is composed of three types of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and melanocytes, cells that provide skin its color and protect against skin damage. The inner layer of the skin-the dermis-is the layer that contains the nerves, blood vessels, and sweat glands.

What Is Skin Cancer?

Skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of your skin. There are several types of cancer that originate in the skin. The most common types are basal cell carcinoma (70 percent of all skin cancers) and squamous cell carcinoma (20 percent). These types are classified as nonmelanoma skin cancer. Melanoma (five percent of all skin cancers) is the third type of skin cancer. It is less common than basal cell or squamous cell skin cancer, but potentially much more serious. Other types of skin cancer are rare.

Basal Cell Carcinoma

Basal cell carcinoma is the most common type of skin cancer. It typically appears as a small raised bump that has a pearly appearance. It is most commonly seen on areas of the skin that have received excessive sun exposure. These cancers may spread to the skin around the cancer but rarely spread to other parts of the body.

Squamous Cell Carcinoma

Squamous cell carcinoma is also seen on the areas of the body that have been exposed to excessive sun (nose, lower lip, hands, and forehead). Often this cancer appears as a firm red bump or ulceration of the skin that does not heal. Squamous cell carcinomas can spread to lymph nodes in the area.

Melanoma

Melanoma is a skin cancer (malignancy) that arises from the melanocytes in the skin. These cancers typically arise as pigmented (colored) lesions in the skin with an irregular shape, irregular border, and multiple colors. It is the most harmful of all the skin cancers, because it can spread to other sites in the body. Fortunately, most melanomas have a very high cure rate when identified and treated early.

Who Gets Skin Cancer?

Skin cancer is a disease that has shown a steady increase over the past 20 years. Fortunately, with early diagnosis and treatment, it remains a very curable disease. A variety of factors have been identified that place a person at a higher risk to develop skin cancer (see "Am I at risk?").

How Is Skin Cancer Diagnosed?

The vast majority of skin cancers can be cured if diagnosed and treated early. Aside from protecting your skin from sun damage, it is important to recognize the early signs of skin cancer:

If you notice any of the factors listed above see your doctor right away. If you have a spot or lump on your skin, your doctor may remove the growth and examine the tissue under the microscope. This is called a biopsy. A biopsy can usually be done in the doctor's office and usually involves numbing the skin with a local anesthetic. Examination of the biopsy under the microscope will tell the doctor if the skin lesion is a cancer (malignancy).

How is Skin Cancer Treated?

There are varieties of treatments available, including surgery, radiation therapy, and chemotherapy, to treat skin cancer. Treatment for skin cancer depends on the type and size of cancer, your age, and your overall health.

Surgery is the most common form of treatment. It generally consists of an office or outpatient procedure to remove the lesion and check edges to make sure all the cancer was removed. In many cases, the site is then repaired with simple stitches. In larger skin cancers, your doctor may take some skin from another body site to cover the wound and promote healing. This is termed skin grafting. In more advanced cases of skin cancer, radiation therapy or chemotherapy (drugs that kill cancer cells) may be used with surgery to improve cure rates.

Am I At Risk?

People with any of the factors listed below have a higher risk of developing skin cancer and should be particularly careful about sun exposure:

Early identification of skin cancer can save your life.

How Can I Lower My Risk?

The single most important thing you can do to lower your risk of skin cancer is to avoid direct sun exposure. Sunlight produces ultraviolet (UV) radiation that can directly damage the cells (DNA) of our skin. People who work outdoors (farming, construction, boating, outdoor sports) are at the highest risk of developing a skin cancer. The sun's rays are the most powerful between 10 am and 2 pm, so you must be particularly careful during those hours. If you must be out during the day, wear clothing that covers as much of your skin as possible, including a wide-brimmed hat to block the sun from your face, scalp, neck, and ears. In addition to protective clothing, the use of a sunscreen can reflect light away from the skin and provide protection against UV radiation.

When selecting a sunscreen, choose one with a Sun Protection Factor (SPF) of 15 or more. Sunscreen products do not completely block the damaging rays, but they do allow you to be in the sun longer without getting sunburn. In addition to being sun-smart, it is critical to recognize early signs of trouble on your skin. The best time to do self-examination is after a shower in front of a full-length mirror. Note any moles, birthmarks, and blemishes. Be on the alert for sores that do not heal or new nodules on the skin. Any mole that changes in size, color, or texture should be carefully examined. If you notice anything new or unusual, see your physician right away. Catching skin cancer early can save your life.

Ultraviolet Index: What You Need to Know

The new Ultraviolet (UV) Index provides important information to help you plan your outdoor activities and avoid overexposure to the damaging rays of the sun. Developed by the National Weather Service and the Environmental Protection Agency, the UV Index is issued daily as a national service.

The UV Index gives the next day's amount of exposure to UV rays. The Index predicts UV levels on a 0-10+ scale (see chart).

Always take precautions against overexposure, and take special care when the UV Index predicts exposure levels of moderate to above (5 - 10+).

Index Number Exposure Level

0–2 Minimal
3–4 Low
5–6 Moderate
7–9 High
10+ Very High

 

Playing catch, shooting hoops, bicycling on a scenic path or just kicking around a soccer ball have more in common than you may think. On the up side, these activities are good exercise and are enjoyed by thousands of Americans. On the down side, they can result in a variety of injuries to the face.

Many injuries are preventable by wearing the proper protective gear, and your attitude toward safety can make a big difference. However, even the most careful person can get hurt. When an accident happens, it's your response that can make the difference between a temporary inconvenience and permanent injury.

When Someone Gets Hurt:

When Medical Attention Is Required, What Can You Do?

What First Aid Supplies Should You Have on Hand in Case of An Emergency?:

Facial Fractures

Sports injuries can cause potentially serious broken bones or fractures of the face. Common symptoms of facial fractures include:

It is important to pay attention to swelling because it may be masking a more serious injury. Applying ice packs and keeping the head elevated may reduce early swelling.

If any of these symptoms occur, be sure to visit the emergency room or the office of a facial plastic surgeon (such as an Otolaryngologist-head and neck surgeon) where x-rays may be taken to determine if there is a fracture.

Upper Face

When you are hit in the upper face (by a ball for example) it can fracture the delicate bones around the sinuses, eye sockets, bridge of the nose or cheek bones. A direct blow to the eye may cause a fracture, as well as blurred or double vision. All eye injuries should be examined by an eye specialist (ophthalmologist).

Lower Face

When your jaw or lower face is injured, it may change the way your teeth fit together. To restore a normal bite, surgeries often can be performed from inside the mouth to prevent visible scarring of the face; and broken jaws often can be repaired without being wired shut for long periods. Your doctor will explain your treatment options and the latest treatment techniques.

Soft Tissue Injuries

Bruises cuts and scrapes often result from high speed or contact sports, such as boxing, football, soccer, ice hockey, bicycling skiing, and snowmobiling. Most can be treated at home, but some require medical attention.

You should get immediate medical care when you have:

Bruises

Also called contusions, bruises result from bleeding underneath the skin. Applying pressure, elevating the bruised area above the heart and using an ice pack for the first 24 to 48 hours minimizes discoloration and swelling. After two days, a heat pack or hot water bottle may help more. Most of the swelling and bruising should disappear in one to two weeks.

Cuts and Scrapes

The external bleeding that results from cuts and scrapes can be stopped by immediately applying pressure with gauze or a clean cloth. When the bleeding is uncontrollable, you should go to the emergency room.

Scrapes should be washed with soap and water to remove any foreign material that could cause infection and discoloration of the skin. Scrapes or abrasions can be treated at home by cleaning with 3% hydrogen peroxide and covering with an antibiotic ointment or cream until the skin is healed. Cuts or lacerations, unless very small, should be examined by a physician. Stitches may be necessary, and deeper cuts may have serious effects. Following stitches, cuts should be kept clean and free of scabs with hydrogen peroxide and antibiotic ointment. Bandages may be needed to protect the area from pressure or irritation from clothes. You may experience numbness around the cut for several months. Healing will continue for 6 to 12 months. The application of sunscreen is important during the healing process to prevent pigment changes. Scars that look too obvious after this time should be seen by a facial plastic surgeon.

Nasal Injuries

The nose is one of the most injured areas on the face. Early treatment of a nose injury consists of applying a cold compress and keeping the head higher than the rest of the body. You should seek medical attention in the case of:

Bleeding

Nosebleeds are common and usually short-lived. Often they can be controlled by squeezing the nose with constant pressure for 5 to 10 minutes. If bleeding persists, seek medical attention.

Bleeding also can occur underneath the surface of the nose. An Otolaryngologist/facial plastic surgeon will examine the nose to determine if there is a clot or collection of blood beneath the mucus membrane of the septum (a septal hematoma) or any fracture. Hematomas should be drained so the pressure does not cause nose damage or infection.

Fractures

Some Otolaryngologist/head and neck specialists set fractured bones right away before swelling develops, while others prefer to wait until the swelling is gone. These fractures can be repaired under local or general anesthesia, even weeks later.

Ultimately, treatment decisions will be made to restore proper function of the nasal air passages and normal appearance and structural support of the nose. Swelling and bruising of the nose may last for 10 days or more

Neck Injuries

Whether seemingly minor or severe, all neck injuries should be thoroughly evaluated by an Otolaryngologist -- head and neck surgeon. Injuries may involve specific structures within the neck, such as the larynx (voicebox), esophagus (food passage), or major blood vessels and nerves.

Throat Injuries

The larynx is a complex organ consisting of cartilage, nerves and muscles with a mucous membrane lining all encased in a protective tissue (cartilage) framework.
The cartilages can be fractured or dislocated and may cause severe swelling, which can result in airway obstruction. Hoarseness or difficulty breathing after a blow to the neck are warning signs of a serious injury and the injured person should receive immediate medical attention.

Prevention

The best way to treat facial sports injuries is to prevent them. To insure a safe athletic environment, the following guidelines are suggested:

If you have been bothered by a sore in your mouth that made it painful to eat and talk, you are not alone. Many otherwise healthy people suffer from recurrent mouth sores.

Two of the most common recurrent oral lesions are fever blisters (also called cold sores) and canker sores (aphthous ulcers). When they occur in the mouth, it may be difficult to distinguish one from the other. Since the treatment and cause of these two sores are completely different, it is extremely important to know which is which. 

What Are Fever Blisters (Cold Sores)?

These are common names for fluid filled blisters that commonly occur on the lips. They also can occur in the mouth, particularly on the gums and roof of the mouth (hard palate), but this is rare. Fever blisters are usually painful; in fact, the pain may precede the appearance of the lesion by a few days. The blisters rupture within hours, then crust over. They last about 7-10 days.

Causes

Fever blisters result from a herpes simplex virus which becomes active. This virus is latent (dormant) in afflicted people, but can be activated by conditions such as stress, fever, trauma, hormonal changes, and exposure to sunlight. When lesions reappear, they tend to form in the same location.

Can Fever Blisters Be Spread?

Yes, the time from blister rupture until the sore is completely healed is the time of greatest risk for spread of infection. The virus can spread to your own eyes and genitalia, as well as to other people.

Prevention Tips:

Despite all caution, it is important to remember that it is possible to transmit herpes virus even when no blisters are present.

Treatment

Treatment consists of coating the lesions with a protective barrier ointment containing an antiviral agent, for example 5% acyclovir ointment. Presently, there is no cure, but there is much research activity underway in this field. Contact your doctor or dentist for the latest information.

What are Canker Sores?

Canker sores (also called aphthous ulcers) are small, shallow ulcers occurring on the tongue, soft palate, or inside the lips and cheeks. They are quite painful, and usually last 5-10 days.

Cause

The best available evidence suggests that canker sores result from an altered local immune response associated with stress, trauma, or local irritants, such as eating acidic foods (i.e., tomatoes, citrus fruits and some nuts.)

Can Canker Sores Be Spread?

No, since they are not caused by bacteria or viral agents, they cannot be spread locally or to anyone else.

Treatment

The treatment is directed toward relieving discomfort and guarding against infection. A topical corticosteroid preparation such as triamcinolone dental paste (Kenalog in Orabase 0.1%®) is helpful. Unfortunately, no cure exists at present.

What About Other Sores?

For any mouth lesion that does not heal in two weeks, you should see your physician or dentist.

Las amígdalas y los adenoides son masas de tejido que se parecen a los nudos linfáticos o las glándulas del cuello, del ingle o de las axilas. Las amígdalas son las dos masas de la parte posterior de la garganta. Los adenoides se encuentran en la parte superior de la garganta detrás de la nariz y el techo de la boca (paladar blando) y no se ven por la boca sin instrumentos especiales.

Las amígdalas y los adenoides están cerca de la entrada de la vía respiratoria donde pueden atrapar los gérmenes que causan las infecciones. Agarran "muestras" de las bacteria y de los virus y pueden infectarse ellos mismos. Los científicos creen que funcionan como parte del sistema inmunológico del cuerpo al filtrar los gérmenes que tratan de invadir el cuerpo y que ayudan a desarrollar los anticuerpos contra los gérmenes.

Esta función se realiza durante los primeros años de la vida, volvíendose menos importante a medida que el niño crece. Los niños operados de las amígdalas y los adenoides no sufren ninguna disminución de la inmunidad.

¿Cuándo Debería Consultar a Mi Médico?

Ud. debe ver a su médico cuando Ud. o su niño sufre los síntomas comunes de las amígdalas o los adenoides infectados o agrandados.

¿Qué Afecta Las Amígdalas Y Los Adenoides?

Los problemas más comunes que afectan las amígdalas y los adenoides son las infecciones repetidas de la garganta o del oído y la hipertrofia u obstrucción significativa que causa problemas de la respiración o la deglución.

Asimismo, los abscesos alrededor de las amígdalas, la amigdalitis crónica y las infecciones de las cavidades dentro de las amígdalas que producen materia cremosa y maloliente pueden afectar las amígdalas y los adenoides, dejándolos adoloridos e hinchados. Aunque poco frecuentes, puede haber tumores en las amígdalas.

¿Qué Debo Esperar Del Examen?

Su médico le hará preguntas sobre los problemas del oído, la nariz y la garganta y examinará la cabeza y el cuello. Para ver estas áreas, utilizará un espejo pequeño o un instrumento flexible con luz.

Para diagnosticar ciertas infecciones de la garganta, los cultivos o las pruebas de estreptococo son importantes.

Las radiografías pueden ser útiles para determinar el tamaño y la forma de los adenoides. Los análisis de sangre pueden identificar problemas tales como la mononucleosis.

El Examen

Los métodos principales de chequear las amígdalas y los adenoides son

¿Cómo Se Tratan Las Enfermedades De Las Amígdalas Y Los Adenoides?

En primer lugar, se tratan las infecciones de las amígdalas, especialmente las causadas por el estreptococo, con los antibióticos. En algunos casos, se recomienda la extirpación de las amígdalas o los adenoides. Las dos razones principales para la extirpación son (1) las infecciones repetidas a pesar de la terapia de antibióticos y (2) problemas con la respiración debido a las amígdalas o los adenoides crecidos. Tal obstrucción respiratoria produce el ronquido y el sueño alterado que conducen a la soñolencia durante el día en los adultos y problemas de conducta en los niños. Algunos ortodontistas creen que la respiración bucal crónica debida a las amígdalas o los adenoides agrandados causa la malformación de la cara y la alineación mala de los dientes.

La infección crónica puede afectar a otras estructuras como la trompa de Estaquio que vincula la parte posterior de la nariz con el interior del oído, lo que conduce a las infecciones frecuentes del oído y la pérdida auditiva posible.

Los estudios recientes indican que la extirpación de los adenoides puede ser un tratamiento positivo para los niños con dolores crónicos del oído acompañado de fluído en el oído medio (otitis media con efusión).

En los adultos, la posibilidad de cáncer o un tumor también puede justificar la extirpación de las amígdalas y los adenoides.

En algunos pacientes, especialmente con mononucleosis infecciosa, el agrandamiento marcado de los adenoides puede bloquear la vía respiratoria. Para ellos, el tratamiento con esteroides-por ejemplo, cortisona-puede ser útil.

La Amigdalitis Y Sus Síntomas

La amigdalitis es una infección de una o las dos amígdalas. Otras indicaciones o síntomas son

Los Adenoides Agrandados Y Sus Síntomas

Si se agrandan los adenoides, la respiración puede ser díficil. Otras señales del agrandamiento son

La Cirugía

Su hijo: Converse con su hijo sobre sus sentimientos, y dele confianza y apoyo por todo el proceso. Promueva la idea que el paso beneficiará la salud. Acompañe a su hijo el mayor tiempo posible antes y después de la cirugía. Avísele que le va a doler la garganta después de la cirugía. Asegúrele que la operación no quita ninguna parte importante del cuerpo ni cambiará la apariencia. Si su hijo tiene un amigo que ha tenido esta cirugía, el hablar con ese amigo puede ayudar a su hijo.

Los adultos y los niños: Por lo menos quince días antes de cualquier cirugía, el paciente debe dejar de tomar aspirina u otros medicamentos que contienen aspirina. (AVISO: Nunca se debe dar aspirina a los niños dado el riesgo del síndrome de Reye.)

Cuando el paciente se interna, el anestesiólogo o un enfermero puede reunirse con el paciente y su familia para repasar la historia del paciente. Luego se le lleva a la sala de operaciones donde se le da la anestesia. Generalmente, se dan sueros intravenosos durante y después de la cirugía.

Después de la operación, el paciente pasará a la sala de recuperación donde el personal le observará hasta darle de alta. El tiempo necesario para la recuperación del paciente puede variar de unas horas hasta un día. Ciertos casos pueden necesitar cuidado intensivo.

Su médico le proporcionará todos los detalles de su tratamiento antes y después de la cirugía, y contestará todas sus preguntas.

Después de la Cirugía

Hay varias síntomas que pueden surgir después de la operación, inclusive problemas para tragar, vómitos, fiebre, dolor de garganta y dolor del oído. En algunos casos, puede haber desangramiento después de la cirugía. En tal caso, hay que avisar al cirujano en seguida.

Se debe conversar abiertamente cualquier pregunta o preocupación con el cirujano, que está para ayudarle.

A Veces Siento un Ruido en el Oído. ¿Es Esto Raro?

De ninguna manera. Este ruido en el oído (tinnitus o zumbido) es muy común. Cerca de 36 millones de norteamericanos sufren de esta molestia. El zumbido puede aparecer o desaparecer o Ud. puede sentirlo en forma permanente. Puede variar en tono desde muy grave a muy agudo, y Ud. lo puede sentir en uno o los dos oídos. Cuando el ruido es constante, puede ser molestoso y perturbador. Más de siete millones de personas están tan severamente afectadas que no pueden llevar una vida normal.

¿Pueden Otros Sentir el Ruido de Mis Oídos?

Generalmente no, pero a veces otros pueden percibir cierto tipo de zumbido. Esto es el llamado tinnitus objetivo, causado tanto por anormalidades en los vasos sanguíneos alrededor del oído como por espasmos musculares, que pueden sonar como clics o crujidos dentro del oído medio.

¿Cuál Es La Causa Del Zumbido?

Hay muchas causas para el tinnitus subjetivo, aquel que sólo Ud. puede oír. Algunos no son tan graves, por ejemplo, un pequeño tapón de cera. Puede ser también el síntoma inicial de una enfermedad más seria del oído medio como una infección, una perforación del tímpano, una acumulación de líquido, o un aumento de la rigidez (otoesclerosis) de la cadena de huesos del oído medio.

Otras causas del ruído pueden ser alergia, presión alta o baja, problemas circulatorios, un tumor, diabetes, problemas de los tiroides, lesiones de la cabeza y el cuello, y una variedad de otras causas incluyendo medicamentos tales como antiinflamatorios, sedantes/antidepresivos, y la aspirina. Si Ud. toma aspirina y siente ruído en los oídos, llame a su médico y consúltelo sobre la dosis.

El tratamiento será muy diferente en cada caso. Es muy importante consultar a un otolaringólogo para que investigue la causa del ruído y así indicarle el mejor tratamiento.

¿Qué Es Lo Más Común?

Para todas las edades: La mayoría de los zumbidos provienen de un daño en las microscópicas terminaciones nerviosas en el oído interno. La salud de éstas es importante para mantener una excelente audición, y su daño trae disminución auditiva y, en muchos casos, el ruido.Si Ud. es mayor de edad:

La edad avanzada generalmente se acompaña de cierto grado de pérdida nerviosa de la audición y el zumbido.

Si Ud. es joven: La exposición a los intensos ruidos es probablemente la causa más importante y en muchos casos también daña la audición.

¿Cuál Es El Tratamiento?

En la mayoría de los casos, no hay un tratamiento específico para los ruidos de la cabeza o el oído. Si su otolaringólogo encuentra una causa específica, podrá eliminar el ruido, pero esta determinación puede requirir estudios más complejos, incluyendo radiografías, pruebas del equilibrio, y análisis de laboratorio.

Sin embargo, se pueden identificar muchas causas. Se usan varios medicamentos, y hay que probarlos para identificar los que sirven.

La Siguiente Es Una Lista De Medidas Que Pueden Ayudar a Aliviar El Zumbido:

  1. Evite la esposición a los sonidos y ruidos intensos
  2. Controle la presión arterial. Si la presión es alta, consiga la ayuda de su médico para bajarla.
  3. Disminuya la cantidad de sal que ingiere, lo que afecta la circulación.
  4. Evite estimulantes como el café, té, cola y tabaco.
  5. Haga ejercicios diarios para mejorar la circulación.
  6. Duerma lo suficiente y evite la fatiga.
  7. Deje de preocuparse por el ruido. Reconózcalo como una molestia y haga lo posible por no prestarle atención (vea más adelante).

¿Qué Me Puede Ayudar a Soportarlo?

Ejercicios de concentración y relajación: Estos ejercicios pueden ayudar a controlar grupos de músculos y mejorar la circulación en todo el cuerpo. En algunos pacientes esta mejoría reduce la intensidad del zumbido.

Enmascaramiento: El zumbido es más molestoso en los ambientes silenciosos. Un sonido competitivo constante, como un reloj con tictac o la estática de una radio (ruido blanco), puede tapar el zumbido y hacerlo menos evidente. Se venden aparatos que generan ruido blanco. Emiten un sonido competitivo pero agradable que puede distraer al paciente y quitarle la atención del ruido. En algunos pacientes el zumbido aun desaparece por varias horas después de usarlo, pero esto no sucede en todos los casos.

Audífonos: Se pueden combinar los enmascaradores con los audífonos. Si Ud. tiene una pérdida auditiva, el audífono le puede reducir el zumbido mientras lo usa y a veces lo elimina provisionalmente. Es importante no usar los audífonos a mucho volumen porque esto podría empeorar el zumbido. Sin embargo, es aconsejable seleccionar el audífono con mucho cuidado si su primer objetivo es el alivio del zumbido.

Resumen

Antes de realizar cualquier tratamiento para los ruidos de la cabeza o del oído, es muy importante que su otolaringólogo le haga un examen y evaluación muy cuidadoso.

Alrededor del 45% de los adultos normales roncan al menos ocasionalmente, y 25% son roncadores habituales. El ronquido patológico es más frecuente en los hombres y en las personas con sobrepeso; eneralmente empeora con la edad.

Se han registrado más de 300 inventos en la Oficina de Marcas y Patentes de los Estados Unidos como curas para el ronquido. Algunos son variaciones de la idea vieja de la pelota de tenís cosida en la espalda del pijama para forzar al que ronca a dormir de costado. (Casi siempre es peor si duerme boca arriba). Los soportes para la cabeza, los collares para el cuello y los objetos que se insertan en la boca habitualmente desalientan como tratamientos del ronquido. Se han inventado muchos aparatos eléctricos que producen estímulos desagradables o dolorosos cuando el paciente ronca. Se presumiá que se podía entrenar o condicionar a las personas para no roncar. Desafortunadamente, las personas no pueden controlar el ronquido; y si esos aparatos llegaran a funcionar probablemente sería porque mantienen despierto al que ronca.

¿Cuál Es La Causa Del Ronquido?

El ruidoso sonido del ronquido sucede cuando el flujo libre del aire encuentra una obstrucción al pasar por detrás de la boca y la nariz. Esta es la parte colapsable de la vía respiratoria (vea la ilustración) en donde la lengua y la parte superior de la garganta se encuentran con el paladar blando y la úvula (la estructura carnosa colgada del techo de la boca hacia la garganta). Cuando estas estructuras chocan entre sí y vibran durante la respiración, producen el ronquido.

Las personas que roncan tienen al menos uno de lo siguientes problemas:

Las deformidades de la nariz o del tabique también pueden causar obstrucciones. "Desviación del tabique" es un término común que describe una deformidad de la membrana que separa las ventanas de la nariz.

Apnea Del Sueño

La forma más exagerada del ronquido es la apnea del sueño en la cual hay frecuentes episodios de paro respiratorio por obstrucción. Los episodios serios duran más de 10 segundos y ocurren más de 7 veces por hora. Los pacientes con apnea pueden experimentar de 30 a 300 episodios obstructivos por noche, reduciendo el nivel de oxígeno en la sangre. El corazón tiene que bombear más fuerte para que la sangre circule más rápido. Después de muchos años esto puede llevar a un aumento de la presión arterial y el agrandamiento cardíaco.

El resultado inmediato de la disminución del oxígeno es un sueño más superficial con los músculos suficiente tensos para mantener la vía respiratoria abierta y así permitir que entre aire en los pulmones.

A las personas con apnea del sueño les falta un buen descanso de noche y pueden quedarse con sueño una gran parte del día. Pueden dormirse fácilmente al conducir o al manejar equipo en el trabajo.

¿Es Grave Roncar?

Socialmente - si. Puede ser cuando hace ridículo al que ronca, quita sueño a los demas y les provoca resentimiento.

Medicamente - si. Perturba los patrones de sueño del roncador, quitándole el descanso necesario. Cuando el ronquido es severo, puede producir problemas de salud de largo plazo.

Autoayuda Para El Roncador Liviano

A los roncadores moderados u ocasionales les conviene probar las siguientes medidas de autoayuda:

  1. Adoptar un estilo de vida atlético y realizar ejercicios diarios para tonificar los músculos y bajar de peso.
  2. Evitar los tranquilizantes, las píldoras para dormir, y los antihistamínicos antes de acostarse.
  3. Evitar las bebidas alcohólicas las 4 horas y las comidas pesadas las 3 horas antes de acostarse.
  4. Establecer pautas de descanso regulares.
  5. Dormir de costado en lugar de espaldas.
  6. Levantar la cabecera de la cama 4 pulgadas.

¿Se Cura El Ronquido Severo?

Los roncadores severos, aquellos que roncan en cualquier posición o alteran la vida familiar, deben buscar el consejo médico para asegurar que la apnea obstructiva del sueño no sea un problema. El otolaringólogo le hará un examen cuidadoso de la nariz, la boca, el paladar, la garganta, y el cuello. Un estudio en un laboratorio de sueño puede ser necesario para determinar la severidad del ronquido y las consecuencias para la salud.
El tratamiento depende del diagnóstico. Un examen puede revelar si el ronquido se debe a una alergia nasal, o una infección, una deformidad, o las amígdalas y los adenoides. El ronquido puede responder mejor a la cirugía de la garganta y el paladar para ajustar los tejidos fláccidos y ampliar la vía respiratoria, una operación que se llame uvulopalatofaringoplastia (UPPP). Si no se desea la cirugía o presenta riesgos excesivos, el paciente puede dormir todas las noches con una máscara nasal que introduce presión de aire a la garganta (CPAP).

Se debe examinar a todo niño roncador cuidadosamente. Puede ser necesario extirpar las amígdalas y los adenoides para devolverle la salud completa.

Recuerde que el ronquido significa la respiración obstruída, y la obstrucción puede ser grave. No es gracioso, pero tampoco queda sin esperanza.

Secondhand Smoke And Children 

Secondhand smoke is a combination of the smoke from a burning cigarette and the smoke exhaled by the smoker. Also known as environmental tobacco smoke (ETS), it can be recognized easily by its distinctive odor. ETS contaminates the air and is retained in clothing, curtains and furniture. Many people find ETS unpleasant, annoying, and irritating to the eyes and nose. More importantly, it represents a dangerous health hazard. Over 4,000 different chemicals have been identified in ETS, and at least 43 of these chemicals cause cancer.

Is Exposure to Environmental Tobacco Smoke Common?

Approximately 26% of adults in the United States currently smoke cigarettes, and 50 to 67% of children under five years of age live in homes with at least one adult smoker.

Who Is At Risk?

Although ETS is dangerous to everyone, fetuses, infants and children are at most risk. This is because ETS can damage developing organs, such as the lungs and brain.

Its Effect On:

...the Fetus and Newborn

Maternal, fetal, and placental blood flow change when pregnant women smoke, although the long-term health effects of these changes are not known. Some studies suggest that smoking during pregnancy causes birth defects such as cleft lip or palate. Smoking mothers produce less milk, and their babies have a lower birth weight. Maternal smoking also is associated with neonatal death from Sudden Infant Death Syndrome, the major cause of death in infants between one month and one year of age.

...Children's Lungs and Respiratory Tracts

Exposure to ETS decreases lung efficiency and impairs lung function in children of all ages. It increases both the frequency and severity of childhood asthma. Secondhand smoke can aggravate sinusitis, rhinitis, cystic fibrosis, and chronic respiratory problems such as cough and postnasal drip. It also increases the number of children's colds and sore throats. In children under two years of age, ETS exposure increases the likelihood of bronchitis and pneumonia. In fact, a 1992 study by the Environmental Protection Agency says ETS causes 150,000 to 300,000 lower respiratory tract infections each year in infants and children under 18 months of age. These illnesses result in as many as 15,000 hospitalizations. Children of parents who smoke half a pack a day or more are at nearly double the risk of hospitalization for a respiratory illness.

...the Ears

Exposure to ETS increases both the number of ear infections a child will experience, and the duration of the illness. Inhaled smoke irritates the eustachian tube, which connects the back of the nose with the middle ear. This causes swelling and obstruction which interferes with pressure equalization in the middle ear, leading to pain, fluid and infection. Ear infections are the most common cause of children's hearing loss. When they do not respond to medical treatment, the surgical insertion of tubes into the ears is often required.

...the Brain

Children of mothers who smoked during pregnancy are more likely to suffer behavioral problems such as hyperactivity than children of non-smoking mothers. Modest impairment in school performance and intellectual achievement have also been demonstrated.

Secondhand Smoke Causes Cancer

You have just read how ETS harms the development of your child, but did you know that your risk of developing cancer from ETS is about 100 times greater than from outdoor cancer-causing pollutants? Did you know that ETS causes more than 3,000 non-smokers to die of lung cancer each year? While these facts are quite alarming for everyone, you can stop your child's exposure to secondhand smoke right now.

What Can You Do?

  1. Stop smoking, if you do smoke. Consult your physician for help, if needed. There are many new pharmaceutical products available to help you quit.
  2. If you have household members who smoke, help them stop. If it is not possible to stop their smoking, ask them, and visitors, to smoke outside of your home.
  3. Do not allow smoking in your car.
  4. Be certain that your children's schools and day care facilities are smoke free.

Acknowledgment is made to the American Academy of Pediatric Otolaryngology for contributions to this article.

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:

Why Is It 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 It 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 This 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.

Sean Marsee of Ada, OK, lifted weights and ran the 400-meter relay. By the time he was 18 years of age he had won 28 medals. To keep his body strong, he did not smoke or drink.

But he did use smokeless tobacco, because he thought it wasn't harmful to his health.

When oral cancer was discovered, part of Sean's tongue was removed. But the cancer spread. More surgeries followed, including removal of his jaw bone. In his last hours, Sean wrote - he could no longer speak - a plea to his peers; "Don't dip snuff". He died at age 19.

What Is Spit Tobacco?

There are two forms of spit tobacco: chewing tobacco and snuff. Chewing tobacco is usually sold as leaf tobacco (packaged in a pouch) or plug tobacco (in brick form) and both are put between the cheek and gum. Users keep chewing tobacco in their mouths for several hours to get a continuous high from the nicotine in the tobacco.

Snuff is a powdered tobacco (usually sold in cans) that is put between the lower lip and the gum. Just a pinch is all that's needed to release the nicotine, which is then swiftly absorbed into the bloodstream, resulting in a quick high. Sounds ok, right? Not exactly, keep reading.

What's in Spit Tobacco?

Chemicals. Keep in mind that the spit tobacco you or your friends are putting into your mouths contains many chemicals that can have a harmful effect on your health. Here are a few of the ingredients found in spit tobacco:

The chemicals contained in chew or snuff are what make you high. They also make it very hard to quit. Why? Every time you use smokeless tobacco your body adjusts to the amount of tobacco needed to get that high. Then you need a little more tobacco to get the same feeling. You see, your body gets used to the chemicals you give it. Pretty soon you'll need more smokeless tobacco, more often or you'll need stronger spit tobacco to reach the same level. This process is called addiction.

Some people say spit tobacco is ok because there's no smoke, like a cigarette has. Don't believe them. It's not a safe alternative to smoking. You just move health problems from your lungs to your mouth.

Physical and Mental Effects

If you use spit tobacco, here's what you might have to look forward to:

Early Warning Signs

Check your mouth often, looking closely at the places where you hold the tobacco. See your doctor right away if you have any of the following:

Tips To Quit

You've just read the bad news, but there is good news. Even though it is very difficult to quit using spit tobacco, it can be done. Read the following tips to quit for some helpful ideas to kick the habit. Remember, most people don't start chewing on their own, so don't try quitting on your own. Ask for help and positive reinforcement from your support groups (friends, parents, coaches, teachers, whomever...)

  1. Think of reasons why you want to quit. You may want to quit because:
    • You don't want to risk getting cancer.
    • The people around you find it offensive.
    • You don't like having bad breath after chewing and dipping.
    • You don't want stained teeth or no teeth.
    • You don't like being addicted to nicotine.
    • You want to start leading a healthier life.
  2. Pick a quit date and throw out all your chewing tobacco and snuff. Tell yourself out loud every day that you're going to quit.
  3. Ask your friends, family, teachers, and coaches to help you kick the habit by giving you support and encouragement. Tell friends not to offer you smokeless tobacco. You may want to ask a friend to quit with you.
  4. Ask your doctor about a nicotine chewing gum tobacco cessation program.
  5. Find alternatives to spit tobacco. A few good examples are sugarless gum, pumpkin or sunflower seeds, apple slices, raisins, or dried fruit.
  6. Find activities to keep your mind off of spit tobacco. You could ride a bike, talk or write a letter to a friend, work on a hobby, or listen to music. Exercise can help relieve tension caused by quitting.
  7. Remember that everyone is different, so develop a personalized plan that works best for you. Set realistic goals and achieve them.
  8. Reward yourself. You could save the money that would have been spent on spit tobacco products and buy something nice for yourself.

The American Cancer Society estimates that approximately 38,000 new cases of head and neck cancer were diagnosed in the United States in 2002; about 9,000 of these were in the larynx (voice box). Experts anticipate similar statistics for 2003.

An estimated 3,700 people died of laryngeal cancer in 2002 representing approximately two thirds of one percent of all cancer deaths in this country. Even for disease survivors, the consequences of laryngeal cancer are often severe. Laryngeal cancer is a preventable disease because the risk factors are associated with modifiable behaviors. 

The causes of laryngeal cancer

Development of this deadly disease is a process which involves many factors, but approximately 90 percent of head and neck cancers occur after exposure to known carcinogens (cancer causing substances) causing a type of the disease called squamous cell carcinoma (SCCA).

Smoking: More than 95 percent with laryngeal SCCA are smokers. Smoking contributes to cancer 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 one pack-year (or one pack per day for two years, or two packs per day for one year, equals two pack-years). Depending upon the number of pack-years smoked, studies have reported that smokers are about five to 35 times more likely to develop laryngeal cancer than nonsmokers. Other research findings indicate that the duration of tobacco exposure is probably more important overall to the cancer causing effect than the intensity of the exposure.

Alcohol: This acts as a promoter of the cancer causing process making it another important risk factor for laryngeal cancer. The major clinical significance of alcohol is that it enhances the harmful effects of tobacco at a magnitude that is more than just additive. Essentially, 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, and one drink per day is considered a limited alcohol exposure.

Other risk factors: Certain viruses, such as human papilloma virus (HPV), acid reflux, and occupational exposure to asbestos likely contribute to causing laryngeal cancer. Vitamin A and beta-carotene may play a protective role in the disease process.

Signs and symptoms of laryngeal cancer include:

Anyone with these signs or symptoms, and having risks for laryngeal cancer, should be evaluated by an Otolaryngologist (ear, nose, and throat specialist). The primary treatment options 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.

Hoarseness or roughness in your voice is often caused by a medical problem. Contact an Otolaryngologist—head and neck surgeon if you have any sustained changes to your voice.

Voice problems usually are associated with hoarseness (also known as roughness), instability, or problems with voice endurance. If you are unsure if you have an unhealthy voice, ask yourself the following:

Voice problems arise from a variety of sources including voice overuse or misuse, cancer, infection, or injury. Here are steps that can be taken to prevent voice problems and maintain a healthy voice:

Drink water (stay well hydrated): Keeping your body well hydrated by drinking plenty of water each day (6-8 glasses) is essential to maintaining a healthy voice. The vocal cords vibrate extremely fast even with the most simple sound production; remaining hydrated through water consumption optimizes the throat’s mucous production, aiding vocal cord lubrication. To maintain sufficient hydration avoid or moderate substances that cause dehydration. These include alcohol and caffeinated beverages (coffee, tea, soda). And always increase hydration when exercising.

Do not smoke: It is well known that smoking leads to lung or throat cancer. Primary and secondhand smoke that is breathed in passes by the vocal cords causing significant irritation and swelling of the vocal cords. This will permanently change voice quality, nature, and capabilities.

Do not abuse or misuse your voice: Your voice is not indestructible. In every day communication, be sure to avoid habitual yelling, screaming, or cheering. Try not to talk loudly in locations with significant background noise or noisy environments. Be aware of your background noise—when it becomes noisy, significant increases in voice volume occur naturally, causing harm to your voice. If you feel like your throat is dry, tired, or your voice is becoming hoarse, stop talking.

To reduce or minimize voice abuse or misuse use non-vocal or visual cues to attract attention, especially with children. Obtain a vocal amplification system if you routinely need to use a “loud” voice especially in an outdoor setting. Try not to speak in an unnatural pitch. Adopting an extremely low pitch or high pitch can cause an injury to the vocal cords with subsequent hoarseness and a variety of problems.

Minimize throat clearing: Clearing your throat can be compared to slapping or slamming the vocal cords together. Consequently, excessive throat clearing can cause vocal cord injury and subsequent hoarseness. An alternative to voice clearing is taking a small sip of water or simply swallowing to clear the secretions from the throat and alleviate the need for throat clearing or coughing. The most common reason for excessive throat clearing is an unrecognized medical condition causing one to clear their throat too much. Common causes of chronic throat clearing include gastroesophageal reflux, laryngopharyngeal reflux disease, sinus and/or allergic disease.

Moderate voice use when sick: Reduce your vocal demands as much as possible when your voice is hoarse due to excessive use or an upper respiratory infection (cold). Singers should exhibit extra caution if one’s speaking voice is hoarse because permanent and serious injury to the vocal cords are more likely when the vocal cords are swollen or irritated. It is important to “listen to what your voice is telling you.”

Your voice is an extremely valuable resource and is the most commonly used form of communication. Our voices are invaluable for both our social interaction as well as for most people’s occupation. Proper care and use of your voice will give you the best chance for having a healthy voice for your entire lifetime.

Hoarseness or roughness in your voice is often caused by a medical problem. Contact an Otolaryngologist—head and neck surgeon if you have any sustained changes to your voice.

Most changes in the voice result from a medical disorder. Failure to seek a physician’s care can lead to hoarseness and more serious problems. They include:

Laryngitis

Laryngitis is a swelling of the vocal cords usually due to an infection. A viral infection (a “cold”) of the upper respiratory track is the most common cause for infection of the voice box. When the vocal cords swell in size, they vibrate differently, leading to hoarseness. The best treatment for this condition is to rest or reduce your voice use and stay well hydrated. Since most of these infections are caused by a virus, antibiotics are not effective. It is important to be cautious with your voice during an episode of laryngitis, because the swelling of the vocal cords increases the risk for serious injury such as blood in the vocal cords or formation of vocal cord nodules, polyp, or cysts.

Vocal cord lesions

Benign noncancerous growths on the vocal cords are caused by voice misuse or overuse and from trauma or injury to the vocal cords. These lesions (“bumps”) on the vocal cord(s) alter vocal cord vibration. This abnormal vibration results in hoarseness and a chronic change in one’s voice quality, including roughness, raspiness, and an increased effort to talk. The most common vocal cord lesions include vocal nodules also known as “singer’s nodes” or “nodes” which are similar to “calluses ” of the vocal cords. They typically occur on both vocal cords opposite each other. These lesions are usually treated with voice rest and speech therapy (to improve the speaking technique thus removing the trauma on the vocal cords). Vocal cord polyp(s) or cyst(s) are other common vocal cord lesions caused by misuse, overuse, or trauma to the vocal cords and frequently require surgical removal after all nonsurgical treatment options (i.e., speech therapy) have failed.

Gastroesophageal reflux disease and laryngopharyngeal reflux disease

Reflux (backflow of gastric contents) into the throat of stomach acid can cause a variety of symptoms in the esophagus (swallowing tube) as well as in the throat. Hoarseness (chronic or intermittent), swallowing problems, a foreign body sensation, or throat pain are common symptoms of gastric acid irritation of the throat, called laryngopharyngeal reflux disease (LPRD). LPRD is difficult to diagnose because approximately half of the patients with this disorder have no heartburn symptoms which traditionally accompany gastroesophageal reflux disease (GERD).

Your gastric acid can flow up to the throat at any time. The at-night aspect of LPRD is thought to be the hardest to diagnose because there are usually no specific symptoms while the reflux occurs. Consequently, patients will awake with throat irritation, hoarseness, and throat discomfort without knowing the cause. An examination of the throat by an Otolaryngologist will determine if stomach acid is causing irritation of the throat and voice box.

Poor speaking technique

Improper or poor speaking technique is caused from speaking at an abnormally or uncomfortable pitch, either too high or too low, and leads to hoarseness and a variety of other voice problems. Examples of this condition are when young adult females, in a work environment, consciously or subconsciously choose to speak at a lower than appropriate pitch and with a heavy voice. Percussive speaking, a voice too loud or focusing on the first syllable of each word, is another improper speaking technique that may result in injury or trauma to the vocal cords and muscles causing “vocal fatigue”.

Other factors leading to improper speaking technique include insufficient or improper breathing while talking, specifically breathing from the shoulders or neck area instead of from the lower chest or abdominal area. The consequence of this practice is increased tension in the throat and neck muscles, which can cause hoarseness and a variety of symptoms, especially pain and fatigue associated with talking. Voice problems can also occur from using your voice in an unnatural position, such as talking on the phone cradled to your shoulder. This requires excessive tension in the neck and laryngeal muscles, which changes the speaking technique and may result in a voice problem.

Vocal cord paralysis

Hoarseness and other problems can occur related to problems between the nerves and muscles within the voice box or larynx. The most common condition is a paralysis or weakness of one or both vocal cords. Involvement of both vocal cords is rare and is usually manifested by noisy breathing or difficulty getting enough air while breathing or talking. However, one vocal cord can become paralyzed or severely weakened (paresis) after a viral infection of the throat, after surgery in the neck or cheek, or for unknown reasons.

The immobile or paralyzed vocal cord typically causes a soft, breathy, weak voice due to poor vocal cord closure. Most paralyzed vocal cords will recover on their own within several months. There is a possibility that the paralysis may become permanent, which may require surgical treatment. Surgery for unilateral vocal cord paralysis involves positioning of the vocal cord to improve the vibration of the paralyzed vocal cord with the non-paralyzed vocal cord. There are a variety of surgical techniques used to reposition the vocal cord. Sometimes speech therapy may be used before or after surgical treatment of the paralyzed vocal cords or sometimes as the sole treatment. Treatment choices depend on the nature of the vocal cord paralysis as well as the patient’s voice demands.

Throat cancer

Throat cancer is a very serious condition requiring immediate medical attention. When cancer attacks the vocal cords, the voice changes in quality, assuming the characteristics of chronic hoarseness, roughness, or raspiness. These symptoms occur at an early stage in the development of the cancer. It is important to remember that prompt attention to changes in the voice facilitate early diagnosis thus early and successful treatment of vocal cord cancer can be obtained.

Persistent hoarseness or change in the voice for longer than two to four weeks in a smoker should prompt evaluation by an Otolaryngologist to determine if there is cancer of the larynx (voice box). Different treatment options for this cancer of the voice box include surgery, radiation therapy, and/or chemotherapy. When vocal cord cancer is found early, typically only surgery or radiation therapy is required, and the cure rate is high (greater than 90 percent).

Hoarseness or roughness in your voice is often caused by a medical problem. Contact an Otolaryngologist—head and neck surgeon if you have any sustained changes to your voice.

Insight into causes, prevention, and when to see an ENT

What Is It?

Hoarseness is a general term that describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to the vocal cords that are the sound producing parts of the voice box (larynx). While breathing, the vocal cords remain apart. When speaking or singing, they come together, and as air leaves the lungs, they vibrate, producing sound. Swelling or lumps on the vocal cords prevent them from coming together properly and changes the way the cords vibrate, which makes a change in the voice, altering quality, volume, and pitch.

What Are the Causes?

Acute Laryngitis: There are many causes of hoarseness. Fortunately, most are not serious and tend to go away in a short period of time. The most common cause is acute laryngitis, which usually occurs due to swelling 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.

Vocal Nodules: More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal nodules (singers’ nodes), which are callous-like growths, or may lead to polyps of the vocal cords (more extensive swelling). Both of these conditions are benign. Vocal nodules are common in children and adults who raise their voice in work or play.

Open Voice Box

Closed Voice Box

Gastroesophageal Reflux: A common cause of hoarseness is gastro-esophageal reflux, when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal cords. Many patients with reflux-related changes of voice do not have symptoms of heartburn. Usually, the voice is worse in the morning and improves during the day. These people may have a sensation of a lump in their throat, mucus sticking in their throat or an excessive desire to clear their throat.

Smoking: Smoking is another cause of hoarseness. Since smoking is the major cause of throat cancer, if smokers are hoarse, they should see an Otolaryngologist.

Other Causes: Many unusual causes for hoarseness include allergies, thyroid problems, neurological disorders, trauma to the voice box, and occasionally, the normal menstrual cycle.

Who Can Treat My Hoarseness?

Hoarseness due to a cold or flu may be evaluated by family physicians, pediatricians, and internists (who have learned how to examine the larynx). When hoarseness lasts longer than two weeks or has no obvious cause it should be evaluated by an Otolaryngologist--head and neck surgeon (ear, nose and throat doctor). Problems with the voice are best managed by a team of professionals who know and understand how the voice functions. These professionals are Otolaryngologist--head and neck surgeons, speech/language pathologists, and teachers of singing, acting, or public speaking. Voice disorders have many different characteristics that may give professionals a clue to the cause.

How Is Hoarseness Evaluated?

An Otolaryngologist will obtain a thorough history of the hoarseness and your general health. Your doctor will usually look at the vocal cords with either a mirror placed in the back of your throat, or a very small, lighted flexible tube (fiberoptic scope) may be passed through your nose in order to view your vocal cords. Videotaping the examination or using stroboscopy (slow motion assessment) may also help with the analysis.

These procedures are not uncomfortable and are well tolerated by most patients. In some cases, special tests (known as acoustic analysis) designed to evaluate the voice, may be recommended. These measure voice irregularities, how the voice sounds, airflow, and other characteristics that are helpful in establishing a diagnosis and guiding treatment

When should I see an Otolaryngologist (ENT doctor)?:

How Are Vocal Disorders Treated?

The treatment of hoarseness depends on the cause. Most hoarseness can be treated by simply resting the voice or modifying how it is used. The Otolaryngologist may make some recommendations about voice use behavior, refer the patient to other voice team members, and in some instances recommend surgery if a lesion, such as a polyp, is identified. Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. Drinking fluids and possibly using medications to thin the mucus are also helpful.

Specialists in speech/language pathology (voice therapists) are trained to assist patients in behavior modification that may help eliminate some voice disorders. Patients who have developed bad habits, such as smoking or overuse of their voice by yelling and screaming, benefit most from this conservative approach. The speech/language pathologist may teach patients to alter their method of speech production to improve the sound of the voice and to resolve problems, such as vocal nodules. When a patients' problem is specifically related to singing, a singing teacher may help improve the patients' singing techniques.

What can I Do to Prevent and Treat Hoarseness?

Insight into dysphagia-swallowing problems

Swallowing Disorders

Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are temporary and not threatening. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself in a short period of time, you should see an Otolaryngologist-head and neck surgeon.

How you swallow

People normally swallow hundreds of times a day to eat solids, drink liquids, and swallow the normal saliva and mucus that the body produces. The process of swallowing has four stages:

  1. The first is oral preparation, where food or liquid is manipulated and chewed in preparation for swallowing.
  2. During the oral stage, the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
  3. The pharyngeal stage begins as food or liquid is quickly passed through the pharynx, the canal that connects the mouth with the esophagus, into the esophagus or swallowing tube.
  4. In the final, esophageal stage, the food or liquid passes through the esophagus into the stomach. Although the first and second stages have some voluntary control, stages three and four occur by themselves, without conscious input.

Although the first and second stages have some voluntary control, stages three and four occur by themselves, without conscious input.

What causes swallowing disorders?

Any interruption in the swallowing process can cause difficulties. It may be due to simple causes such as poor teeth, ill fitting dentures, or a common cold. One of the most common causes of dysphagia is gastroesophageal reflux. This occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort. Other causes may include: stroke; progressive neurologic disorder; the presence of a tracheostomy tube; a paralyzed or unmoving vocal cord; a tumor in the mouth, throat, or esophagus; or surgery in the head, neck, or esophageal areas.

Symptoms

Symptoms of swallowing disorders may include:

Who evaluates and treats swallowing disorders?

When dysphagia is persistent and the cause is not apparent, the Otolaryngologist-head and neck surgeon will discuss the history of your problem and examine your mouth and throat. This may be done with the aid of mirrors or a small tube (flexible laryngoscope), which provides vision of the back of the tongue, throat, and larynx (voice box). If necessary, an examination of the esophagus, stomach, and upper small intestine (duodenum) may be carried out by the Otolaryngologist or a gastroenterologist. These specialists may recommend X-rays of the swallowing mechanism, called a barium swallow or upper G-I, which is done by a radiologist.

If special problems exist, a speech pathologist may consult with the radiologist regarding a modified barium swallow or videofluroscopy. These help to identify all four stages of the swallowing process. Using different consistencies of food and liquid, and having the patient swallow in various positions, a speech pathologist will test the ability to swallow. An exam by a neurologist may be necessary if the swallowing disorder stems from the nervous system, perhaps due to stroke or other neurologic disorders.

Possible Treatments

Many of these disorders can be treated with medication. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is tailored to the particular cause of the swallowing disorder.

Gastroesophageal reflux can often be treated by changing eating and living habits — for example:

If these don't help, antacids between meals and at bedtime may provide relief.

Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or restimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.

Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary.

Once the cause is determined, swallowing disorders may be treated with:

Surgery is used to treat certain problems. If a narrowing or stricture exists, the area may need to be stretched or dilated. If a muscle is too tight, it may need to be dilated or released surgically. This procedure is called a myotomy and is performed by an Otolaryngologist-head and neck surgeon.

Many causes contribute to swallowing disorders. If you have a persistent problem swallowing, see an Otolaryngologist-head and neck surgeon.

What Causes a Sore Throat?

Sore throat is a symptom of many medical disorders. Infections cause the majority of sore throats and are contagious. Infections are caused either by viruses such as the flu, the common cold, mononucleosis, or by bacteria such as strep, mycoplasma, or hemophilus.

While bacteria respond to antibiotic treatment, viruses do not.

Viruses

Most viral sore throats accompany flu or colds along with a stuffy, runny nose, sneezing, and generalized aches and pains. These viruses are highly contagious and spread quickly, especially in winter. The body builds antibodies that destroy the virus, a process that takes about a week.

Sore throats accompany other viral infections such as measles, chicken pox, whooping cough, and croup. Canker sores and fever blisters in the throat also can be very painful.

One viral infection takes much longer than a week to be cured: infectious mononucleosis, or "mono." This virus lodges in the lymph system, causing massive enlargement of the tonsils, with white patches on their surface and swollen glands in the neck, armpits, and groin. It creates a severely sore throat and, sometimes, serious breathing difficulties. It can affect the liver, leading to jaundice- yellow skin and eyes. It also causes extreme fatigue that can last six weeks or more.

"Mono," a severe illness in teenagers but less severe in children, can he transmitted by saliva. So it has been nicknamed the "kissing disease," but it can also be transmitted from mouth-to-hand to hand-to-mouth or by sharing of towels and eating utensils.

Bacteria

Strep throat is an infection caused by a particular strain of streptococcus bacteria. This infection can also damage the heart valves (rheumatic fever) and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections.

Because of these possible complications, a strep throat should be treated with an antibiotic. Strep is not always easy to detect by examination, and a throat culture may be needed. These tests, when positive, persuade the physician to prescribe antibiotics. However, strep tests might not detect other bacteria that also can cause severe sore throats that deserve antibiotic treatment. For example, severe and chronic cases of tonsillitis or tonsillar abscess may be culture negative. Similarly, negative cultures are seen with diphtheria, and infections from oral sexual contacts will escape detection by strep culture tests.

Tonsillitis is an infection of the lumpy tissues on each side of the back of the throat. In the first two to three years of childhood, these tissues "catch" infections, sampling the child's environment to help develop his immunities (antibodies). Healthy tonsils do not remain infected. Frequent sore throats from tonsillitis suggest the infection is not fully eliminated between episodes. A medical study has shown that children who suffer from frequent episodes of tonsillitis (such as three- to four- times each year for several years) were healthier after their tonsils were surgically removed.

Infections in the nose and sinuses also can cause sore throats, because mucus from the nose drains down into the throat and carries the infection with it.

The most dangerous throat infection is epiglottitis, caused by bacteria that infect a portion of the larynx (voice box) and cause swelling that closes the airway. This infection is an emergency condition that requires prompt medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult. A strep test may miss this infection.

Allergy

The same pollens and molds that irritate the nose when they are inhaled also may irritate the throat. Cat and dog danders and house dust are common causes of sore throats for people with allergies to them.

Irritation

During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need examination and treatment of the nose.

Pollutants and chemicals in the air can irritate the nose and throat, but the most common air pollutant is tobacco smoke. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods.

A person who strains his or her voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain but also from the rough treatment of his or her throat membranes.

Reflux

An occasional cause of morning sore throat is regurgitation of stomach acids up into the back of the throat. To avoid reflux, tilt your bed frame so that the head is elevated four- to six- inches higher than the foot of the bed. You might find antacids helpful. You should also avoid eating within three hours of bedtime, and eliminate caffeine and alcohol. If these tips fail, see your doctor.

Tumors

Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long-time use of tobacco and alcohol. Sore throat and difficulty swallowing-sometimes with pain radiating to the ear-may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Other important symptoms include hoarseness, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.

When Should I See a Doctor?

Whenever a sore throat is severe, persists longer than the usual five- to seven- day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your physician:

When should I take antibiotics?

Antibiotics are drugs that kill or impair bacteria. Penicillin or erythromycin (well-known antibiotics) are prescribed when the physician suspects streptococcal or another bacterial infection that responds to them. However, a number of bacterial throat infections require other antibiotics instead. Antibiotics do not cure viral infections, but viruses do lower the patient's resistance to bacterial infections. When such a combined infection occurs, antibiotics may be recommended. When an antibiotic is prescribed, it should be taken as the physician directs for the full course (usually 10 days). Otherwise the infection will probably be suppressed rather than eliminated, and it can return. Some children will experience recurrent infection despite antibiotic treatment. When some of these are strep infections or are severe, your child may require a tonsillectomy.

Should other family members be treated or cultured?

When a strep test is positive, many experts recommend treatment or culturing of other family members. Practice good sanitary habits; avoid close physical contact, and sharing of napkins, towels, and utensils with the infected person. Hand washing makes good sense.

What if my throat culture is negative?

A strep culture tests only for the presence of streptococcal infections. Many other infections, both bacterial and viral, will yield negative cultures and sometimes so does a streptococcal infection. Therefore, when your culture is negative, your physician will base his/her decision for treatment on the severity of your symptoms and the appearance of your throat on examination.

How Can I Treat My Sore Throat?

A mild sore throat associated with cold or flu symptoms can be made more comfortable with the following remedies:

Where Are Your Salivary Glands?

The glands are found in and around your mouth and throat. We call the major salivary glands the parotid, submandibular, and sublingual glands.

They all secrete saliva into your mouth, the parotid through tubes that drain saliva, called salivary ducts, near your upper teeth, submandibular under your tongue, and the sublingual through many ducts in the floor of your mouth.

Besides these glands, there are many tiny glands called minor salivary glands located in your lips, inner cheek area (buccal mucosa), and extensively in other linings of your mouth and throat. Salivary glands produce the saliva used to moisten your mouth, initiate digestion, and help protect your teeth from decay.

As a good health measure, it is important to drink lots of liquids daily. Dehydration is a risk factor for salivary gland disease.

What Causes 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 Does Your Doctor Make the Diagnosis?

Diagnosis of salivary gland disease depends on the careful taking of your history, a physical examination, and laboratory tests.

If your doctor suspects an obstruction of the major salivary glands, it may be necessary to anesthetize the opening of the salivary ducts in the mouth, and probe and dilate the duct to help an obstructive stone pass. Before these procedures, dental x-rays may show where the calcified stones are located.

If a mass is found in the salivary gland, it is helpful to obtain a CT scan or a MRI (magnetic resonance imaging). Sometimes, a fine needle aspiration biopsy in the doctor's office is helpful. Rarely, dye will be injected through the parotid duct before an x-ray of the gland is taken (a sialogram).

A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases.

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.

Removal of a salivary gland does not produce a dry mouth, called xerostomia. However, radiation therapy to the mouth can cause the unpleasant symptoms associated with reduced salivary flow. Your doctor can prescribe medication or other conservative treatments that may reduce the dryness in these instances.

Salivary gland diseases are due to many different causes. These diseases are treated both medically and surgically. Treatment is readily managed by an Otolaryngologist--head and neck surgeon with experience in this area.

The Mandibular Advancement Device (MAD) is a new solution available to those who snore or have sleep apnea.  It is a custom adjustable oral appliance, similar to an athletic mouth guard, that is worn while sleeping.  Developed with advanced dental technology, MAD holds the lower jaw forward, preventing the tongue and the soft tissue of the throat from collapsing into the airway.  Therefore, MAD reduces sleep apnea associated health risks without the need for surgery, medications or other more cumbersome therapy. There is a 96% success rate for people who are treated with MAD.

The Problem

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:

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.

What Is It?

Injection snoreplasty is a nonsurgical treatment for snoring that involves the injection of a hardening agent into the upper palate. Army researchers from Walter Reed Army Medical Center introduced this procedure at the 2000 Annual Meeting of the American Academy of Otolaryngology - Head and Neck Surgery Foundation. Their early findings indicate that this treatment may reduce the loudness and incidence of primary snoring (snoring without apnea, or cessation of breath). The Academy neither endorses nor discourages the use of injection snoreplasty for the treatment of snoring.

Those seeking injection snoreplasty to reduce snoring should first be screened for obstructive sleep apnea or OSA (frequent cessation of breathing due to upper airway obstruction) by undergoing a sleep test. If sleep apnea is confirmed, other treatment may be recommended.

Treatment

Injection snoreplasty is performed on an outpatient basis under local anesthesia. After numbing the upper palate with topical anesthetic, a hardening agent is injected just under the skin on the top of the mouth in front of the uvula (upper palate), creating a small blister. Within a couple of days the blister hardens, forms scar tissue, and pulls the floppy uvula forward to eliminate or reduce the palatal flutter that causes snoring.

In some patients, the treatment needs to be repeated for optimum benefits. If snoring occurs from vibrations beyond the palate and uvula and/or obstructive sleep apnea is suspected, further testing and alternative treatment options may be advised. A thorough examination by an ear, nose and throat specialist is recommended to diagnose the source and type of snoring, and determine whether injection snoreplasty may be helpful.

Post-Treatment Follow-Up

After injection of the hardening agent, patients are observed in the Otolaryngologist's office and then sent home. Tylenolâ and throat lozenges or spray are suggested for pain management. Patients can return to work the next day. Though snoring may continue for a few days, it should eventually lessen. A post-procedure sleep test may be administered to fully evaluate the effects of the procedure.

Possible Side Effects

A residual sore throat or feeling that something is "stuck" in the back of the mouth may occur. Suggestions for treatment of sore throat include Tylenol and/or throat lozenges or spray.

Statement on the Use of Sotradecol

Sotradecol, a trade name for sodium tetradecyl sulfate, is the most common hardening agent used in injection snoreplasty. This agent is indicated by the Food and Drug Administration (FDA) for "intravenous use only" and "for small uncomplicated varicose veins of the lower extremities that show simple dilation with competent valves." Warnings include: 1) "severe adverse local effects including tissue necrosis," and 2) "allergic reactions, including anaphylaxis, have been reported that led to death."

Snoring Is a Problem

Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Thirty percent of adults over age 30 are snorers. By middle age, that number reaches 40 percent. Clearly, snoring is a dilemma affecting spouses, family members and sometimes neighbors.

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. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. When these structures strike each other and vibrate during breathing, snoring results.

How Is Snoring Treated?

Snoring can be diagnosed as primary snoring (simple snoring) or obstructive sleep apnea. Primary snoring is characterized by loud upper airway breathing sounds during sleep without episodes of apnea (cessation of breath). Obstructive sleep apnea is a serious medical condition where individuals have frequent episodes of apnea during sleep, contributing to an overall lack of restful sleep and severe health risks including heart attack and stroke.

Various methods are used to alleviate primary snoring. They include behavior modification (such as weight loss), surgical and non-surgical treatments, and dental devices.

Surgical treatments for primary snoring include: laser assisted uvulopalatoplasty (LAUP), an outpatient treatment for primary snoring and mild OSA that involves use of a laser under local anesthesia to make vertical incisions in the upper palate, shortening the uvula and lessening airway obstruction; and radiofrequency volumetric reduction of the palate, a relatively new procedure performed in an Otolaryngologist's office that utilizes targeted radio waves to heat and shrink tissue in the upper palate.

Excessive body weight contributes to snoring and obstructive sleep apnea, in addition to being a major influence on general health and well being. Obstructive sleep apnea occurs in about 50-60% of those who are obese.

A recent report from the National Center for Health Statistics concludes that seven of 10 adults don't regularly exercise, and nearly four in 10 aren't physically active. Lack of exercise can increase the risk of diabetes, heart disease, and stroke. About 300,000 people in the U.S. die each year from diseases related to inactivity.

Proper diet and exercise are the mainstays for a healthy lifestyle, although many Americans turn to costly fad diets and exercise programs that fail to provide weight loss and a healthy lifestyle. The basic tenets to gradual weight loss and good health include developing healthy eating habits and increasing daily physical activity.

Self-help guidelines for healthy activity:

For those who are already regularly moderately active, increase the duration and intensity for additional benefits.

Weight loss tips:

The healthy weight approach to dieting:

Sleep Apnea is a common disorder that can be serious. In sleep apnea, your breathing stops or gets very shallow.  Each pause in breathing typically lasts 10 to 20 seconds or more.  These pauses can occur 20 to 30 times or more an hour.

The most common type is obstructive sleep apnea.  That means you are unable to get enough air through your mouth and nose into your lungs.  When that happens, the amount of oxygen in your blood may drop.  Normal breaths resume with a snort or choking sound.  People with sleep apnea often snore loudly.  However, not everyone who snores has sleep apnea.

When your sleep is interrupted throughout the night, you can be drowsy during the day.  People with sleep apnea are at higher risk for car crashes, work-related accidents and other medical problems.  If you have it, it is important to get 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.

More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. Some are variations on the old idea of sewing a sock that holds a tennis ball on the pajama back to force the snorer to sleep on his side. (Snoring is often worse when a person sleeps on his back). Some devices reposition the lower jaw forward; some open nasal air passages; a few others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs. But, if you snore, the truth is that it is not under your control whatsoever. If anti-snoring devices work, it is probably because they keep you awake.

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.

People who snore may suffer from:

Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.

Is Snoring Serious?

Socially, yes! It can be, when it makes the snorer an object of ridicule and causes others sleepless nights and resentfulness.

Medically, yes! 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.

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.

Can Heavy Snoring be Cured?

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.

Treatment

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:

If surgery is too risky or unwanted, the patient may sleep every night with a nasal mask that delivers air pressure into the throat; this is called continuous positive airway pressure or "CPAP".

A chronically snoring child should be examined for problems with his or her tonsils and adenoids. A tonsillectomy and adenoidectomy may be required to return the child to full health.

Self-Help for the Light Snorer

Adults who suffer from mild or occasional snoring should try the following self-help remedies:

Remember, snoring means obstructed breathing, and obstruction can be serious. It's not funny, and not hopeless.

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.

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:

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

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

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.

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:

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

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.

You may have sinusitis if you suffer from:

At-home treatments for sinusitis include:

A physician visit for your sinus pain will:

Question #1: How common is sinusitis?
Answer #1: More than 37 million Americans suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade due to increased pollution, urban sprawl, and increased resistance to antibiotics.

Question #2:  What is sinusitis?
Answer#2: Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants; chronic sinusitis is characterized by at least four recurrences of acute sinusitis. Either medication or surgery is a possible treatment.

Question #3:  What are the signs and symptoms of acute sinusitis?
Answer#3: For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough not due to asthma (in children). Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain, and cough (in adults).

Acute sinusitis can last four weeks or more. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection.

Question #4:  How is acute sinusitis treated?
Answer#4: Acute sinusitis is generally treated with 10 to 14 days of antibiotic care. With treatment, the symptoms disappear and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms.

Question #5:  What are the signs and symptoms of chronic sinusitis?
Answer#5: Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: facial pain/pressure, facial congestion/fullness, nasal obstruction/blockage, thick nasal discharge/discolored post-nasal drainage, pus in the nasal cavity, and at times, fever. They may also have headache, bad breath, and fatigue.

Question #6:  What measures can be taken at home to relieve sinus pain?
Answer#6: Warm moist air may alleviate sinus congestion. A vaporizer or steam from a pan of boiled water (removed from the heat) are both recommended (humidifiers should have a clear filter to preclude spraying bacteria or fungal spores into the air). Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are safe for use at home.

Question #7:  How effective are non-prescription nose drops or sprays?
Answer#7: Use of nonprescription drops or sprays might help control symptoms. However, non-prescription drops should not be used beyond their label recommendation.

Question #8: How does a physician determine the best treatment for acute or chronic sinusitis?
Answer#8: To obtain the best treatment option, the physician needs to properly assess the patient's history and symptoms and then progress through a structured physical examination.

Question #9:  What should one expect during the physical examination for sinusitis?
Answer#9: At a specialist's office, the patient will receive a thorough ear, nose, and throat examination. During that physical examination, the physician will explore the facial features where swelling and erythema (redness of the skin) over the cheekbone exists. Facial swelling and redness are generally worse in the morning; as the patient remains upright, the symptoms gradually improve. The physician may feel and press the sinuses for tenderness. Additionally, the physician may tap the teeth to help identify an inflamed paranasal sinus.

Question #10:  What other diagnostic procedures might be taken?
Answer#10: Other diagnostic tests may include a study of a mucus culture, endoscopy, x-rays, allergy testing, or CT scan of the sinuses.

Question #11: What is nasal endoscopy?
Answer#11: An endoscope is a special fiberoptic instrument for the examination of the interior of a canal or hollow viscus. It allows a visual examination of the nose and sinus drainage areas.

Question #12:  Why does a physician specialist carry out nasal endoscopy?
Answer#12: Nasal endoscopy offers the physician specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. First, the patient's nasal cavity is anesthetized; a rigid or flexible endoscope is then placed in a position to view the structure of the nasal cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the physician specialist also looks for pus as well as polyp formation and structural abnormalities that will cause the patient to suffer from recurrent sinusitis.

Question #13:  What course of treatment will the physician recommend?
Answer#13: To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral decongestants. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). Antihistamines may be recommended for the treatment of allergies. Antifungal medicine will be the treatment for any fungal infection.

Question #14:  Will any changes in lifestyle be suggested during treatment?
Answer#14: Smoking is never condoned, but if one has the habit, it is important to refrain during treatment for sinus problems. A special diet is not required, but drinking extra fluids helps to thin mucus.

Question #15:  When is sinus surgery necessary?
Answer#15: Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucus membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell). Inflammation from an allergy causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus surgery can correct the problem.

Question #16:  What does the surgical procedure entail?
Answer#16: The basic endoscopic surgical procedure is performed under local or general anesthesia. The patient returns to normal activities within four days; full recovery takes about four weeks.

Question #17:  What does sinus surgery accomplish?
Answer#17: The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in place as possible. Otolaryngologist-head and neck surgeons have found endoscopic surgery to be highly effective in restoring normal functioning to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus.

Question #18:  What are the consequences of not treating infected sinuses?
Answer#18: Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and infection of the bone or bone marrow can occur.

Question #19:  Where should sinus pain sufferers seek treatment?
Answer#19: If you suffer from severe sinus pain, you should seek treatment from a physician who can treat your condition with medical and/or surgical remedies.

An Otolaryngologist-head and neck surgeon will, for the most part, advocate surgery when antibiotics and other medical treatments fail to alleviate chronic sinusitis or multiple episodes of acute sinus infection. Before considering surgery, the Otolaryngologist will typically prescribe four to six weeks of antibiotics plus sprays, decongestants, and possibly antihistamines and steroids.

There are circumstances when immediate sinus surgery is warranted. Malignant tumors in the sinus cavity, although rare, sometimes do not respond to radiation and chemotherapy and require surgical removal. Surgery may be the only option for some patients whose sinus condition aggravates other medical problems such as asthma. Cancer patients, having a poor immune system, will require drainage at the onset of a sinus infection (to determine the exact organism causing the infection and aid in choosing the antibiotic). 

Surgery for Acute Sinusitis

Antibiotics are generally effective for most cases of acute sinusitis resulting in severe facial pain and pressure. Other treatments for lingering symptoms include sinus irrigation, which requires the placement of an instrument in the maxillary sinus to flush out that cavity with salt water.

Two types of acute sinus infection require special attention from a specialist. A severe infection of the frontal (forehead) or sphenoid sinus (behind the eyes) can be very serious. If oral or intravenous antibiotics are not effective, surgical drainage of the sinus may be undertaken. The sphenoid sinus can be accessed surgically through the nose or through an incision under the eyebrow. The latter procedure requires hospitalization.

Surgery for Chronic Sinusitis

Most surgeries on the sinuses are conducted to relieve a chronic condition. In the past, operations on the sinuses were conducted externally through incisions on the face. Incisions were made under the upper lip through the gum (the Caldwell-Luc operation) or an external ethmoidectomy, a removal of the sinuses between the eyes through an incision in the face. However, most surgical procedures for the sinuses are now carried out using endoscopic sinus surgery.

Endoscopic Sinus Surgery

Twenty years ago, Otolaryngologist -head and neck surgeons would perform surgery on the individual sinuses that had become infected, leading to the use of procedures such as the Caldwell-Luc operation.

Since then, the development of endoscopic sinus surgery (ESS) ushered in a new philosophy allowing the surgeon to target the ostiomeatal complex (OMC), an area in the anterior ethmoid sinus region. Obstruction in the OMC can lead to subsequent infection of the maxillary, frontal, and sphenoid sinuses. Accordingly, endoscopic sinus surgery, a procedure through the nose, removes thickened and diseased tissue that blocks the OMC. Most of the healthy tissue in the sinuses is undisturbed allowing rapid recovery.
Endoscopic surgery can also be utilized for removal of polyps and to straighten the septum thus restoring a normal flow from the sinuses. Unlike other sinus surgical procedures, endoscopic sinus surgery has minimal and usually temporary effect on the patient's appearance.

What to expect from endoscopic surgery

The endoscopic procedure usually lasts from one to three hours and is performed using general or local anesthesia. Generally, the patient goes home after surgery unless other medical conditions complicate recovery.

Full recovery may take several weeks. Dry blood, mucus, and crusting in the nose may occur, presenting symptoms of a severe cold or sinus infection. Nasal irrigation or salt-water sprays and antibiotic lubricants as recommended by the surgeon to facilitate normal sinus activity. Proper post-operative care is essential to prevent scar formation and allow normal healing. The surgeon performing the procedure will generally perform all required follow-up procedures.

Patients who depend on their voice for their livelihood should be warned that endoscopic sinus surgery may have an effect on their resonance. Additionally, some patients may have underlying nasal mucosal problems that remain after surgery. This is seen in highly allergic individuals or asthmatics.

The information contained in this fact sheet was drawn from The Sinus Source Book, written by Deborah Rosin, MD, an Otolaryngologist-head and neck surgeon. The book is published by Lowell House; ISBN 1-56565-643-1.

Why do we suffer from nasal and sinus discomfort?

The body's nasal and sinus membranes have similar responses to viruses, allergic insults, and common bacterial infections. Membranes become swollen and congested. This congestion causes pain and pressure; mucus production increases during inflammation, resulting in a drippy, runny nose. These secretions may thicken over time, may slow in their drainage, and may predispose to future bacterial infection of the sinuses.

Congestion of the nasal membranes may even block the eustachian tube leading to the ear, resulting in a feeling of blockage in the ear or fluid behind the eardrum. Additionally, nasal airway congestion causes the individual to breathe through the mouth.

Each year, more than 37 million Americans suffer from sinusitis, which typically includes nasal congestion, thick yellow-green nasal discharge, facial pain and pressure. Many do not understand the nature of their illness or what produces their symptoms. Consequently, before visiting a physician, they seek relief for their nasal and sinus discomfort by taking non-prescription or over-the-counter (OTC) medications.

What is the role of OTC medication?

There are many different OTC medications available to relieve the common complaints of sinus pain and pressure, allergy problems, and nasal congestion. Most of these medications are combination products that associate either a pain reliever such as acetaminophen with a decongestant or an antihistamine. Knowledge of these products and of the probable cause of symptoms will help the consumer to decide which product is best suited to relieve the common symptoms associated with nasal or sinus inflammation.

OTC nasal medications are designed to reduce symptoms produced by the inflammation of nasal membranes and sinuses. The goals of OTC medications are to: (1) reopen nasal passages; (2) reduce nasal congestion; (3) relieve pain and pressure symptoms; and (4) reduce potential for complications. The medications come in several forms.

Nasal saline sprays: non-medicated nasal sprays

Nasal saline is an invaluable addition to the list of over-the-counter medications. It is ideal for all types of nasal problems. Humidification alone has been shown to restore the function of the mucosa (skin) inside your nose. Your sinuses will drain easier, and you can breath easier. The added moisture produced by the saline reduces thick secretions and assists in the removal of infectious agents. The nasal saline is buffered salt water. You cannot overdose on this medication and there is no risk of becoming "addicted" to nasal saline.  You can purchase nasal saline at your local pharmacy or you can mix your own saline at home. 

Nasal decongestant sprays: medicated nasal sprays

Afrin nasal spray, Neo-Synephrine, Otrivin, Dristan nasal spray, and other brands decongest the swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating the initial stages of a common cold or viral infection. Nasal decongestant sprays are safe to use, especially appropriate for preventing eustachian tube problems when flying, and to halt progression of sinus infections following colds. However, they should only be utilized for 3-5 days because prolonged use leads to rebound congestion or "getting hooked on nasal sprays." The patient with nasal swelling caused by seasonal allergy problems should use a cromolyn sodium nasal spray. The spray must be used frequently (four times a day) during allergy season to prevent the release of histamine from the tissues, which starts the allergic reaction. It works best before symptoms become established by stabilizing the nasal membranes and has few side effects.

Decongestant medications

Pressure and congestion are common symptoms of nasal passage swelling. Decongestant medications are OTC products that relieve nasal swelling, pressure, and congestion but do not treat the cause of the inflammation. They reduce blood flow to the nasal membranes leading to improved airflow, less breathing through the mouth, decreased pressure in the sinuses and head, and subsequently less discomfort. Decongestants do not relieve drippy noses. Their side effects may include light headedness or giddiness and increased blood pressure and heart rate. (Patients with high blood pressure or heart problems should consult a physician before use.) In addition, other medications may interact with oral decongestants causing side effects. Both of these are available as single products or in combination with a pain reliever or an antihistamine. They are labeled as "non-drowsy" due to a side effect of stimulation of the nervous system.

Decongestant-combination products

Some medications are combined to reduce the number of pills. Tylenol-Sinus or Advil Cold and Sinus exemplify products that join a pain reliever (acetaminophen or ibuprofen) with a decongestant (pseudoephedrine). These products relieve both sinus and cold/flu symptoms yet retain all the attributes of the individual drug including side effects.

Antihistamine medications

Antihistamines combat allergic problems leading to nasal congestion. OTC antihistamines such as diphenhydramine (Benadryl), or clemastine (Tavist) may be used for relieving allergic symptoms of itching, sneezing, and nasal congestion. They relieve the drainage associated with the allergic inflammation but not obstruction or congestion. Antihistamines have a potential for sedation causing grogginess and dryness after use. Newer nonsedating antihistamines are available.

Antihistamine-decongestant combination products

Antihistamines and decongestant products are often combined to relieve multiple symptoms of congestion and drainage and reduce the side effects of both products. Antihistamines produce sedation; decongestants are added to make them "non-drowsy." The combined allergy product then relieves congestion and a runny nose.

Sinusitis is inflammation of the lining membrane of any sinus. Take the following quiz to see if you have sinusitis.

Choose "yes" if you have any of the following symptoms for ten days or longer; otherwise, choose "no."

  1. Facial pressure/pain?
  2. Headache pain?
  3. Congestion or stuffy nose?
  4. Thick, yellow-green nasal discharge?
  5. Low fever (99-100°)?
  6. Bad breath?
  7. Pain in the upper teeth?

If you answered "Yes" to three or more of the symptoms listed above, you may have a sinus infection resulting from allergies, bacteria, or a response to fungi. An examination by an ear, nose, and throat specialist may be warranted.

Your child's sinuses are not fully developed until age 20. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms can be subtle and the causes complex.

How do I know when my child has sinusitis?

The following symptoms may indicate a sinus infection in your child:

Young children have immature immune systems and are more prone to infections of the nose, sinus, and ears, especially in the first several years of life. These are most frequently caused by viral infections (colds), and they may be aggravated by allergies. However, when your child remains ill beyond the usual week to ten days, a serious sinus infection is likely.

You can reduce the risk of sinus infections for your child by reducing exposure to known environmental allergies and pollutants such as tobacco smoke, reducing his/her time at day care, and treating stomach acid reflux disease.

How will the doctor treat sinusitis?

Acute sinusitis

Most children respond very well to antibiotic therapy. Nasal decongestants or topical nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function. If your child has acute sinusitis, symptoms should improve within the first few days. Even if your child improves dramatically within the first week of treatment, it is important that you continue therapy until all the antibiotics have been taken.

Your doctor may decide to treat your child with additional medicines if he/she has allergies or other conditions that make the sinus infection worse.

Chronic sinusitis

If your child suffers from sinus symptoms that last for twelve weeks, two major symptoms or one major symptom and two minor symptoms, this is known as chronic sinusitis. If your child has chronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year, you should seek consultation with an ear, nose, and throat (ENT) specialist. The ENT may recommend surgical treatment of the sinuses.

Diagnosis of sinusitis

If your child sees an ENT specialist, the doctor will examine his/her ears, nose, and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the office visit. An x-ray called a CT scan may help to determine how your child's sinuses are formed, where the blockage has occurred, and the reliability of a sinusitis diagnosis.

When is surgery necessary?

Surgery is considered for the small percentage of children with severe or persistent sinusitis symptoms despite medical therapy. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of your child's sinuses and makes the narrow passages wider. This also allows for culturing so that antibiotics can be directed specifically against your child's sinus infection. Opening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infections.

Also, your doctor may advise removing adenoid tissue from behind the nose as part of the treatment for sinusitis. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis, or obstruction of the back of the nose can cause many of the symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough, and headache.

Summary

Sinusitis in children is different than sinusitis in adults. Children more often demonstrate a cough, bad breath, crankiness, low energy, and swelling around the eyes along with a thick yellow-green nasal or post-nasal drip. Once the diagnosis of sinusitis has been made, children are successfully treated with antibiotic therapy in most cases. If medical therapy fails, surgical therapy can be used as a safe and effective method of treating sinus disease in children.

To build your own sinus mask, print this page on heavy paper and cut it out. Attach a popsicle stick or drinking straw in the middle for a "mardi-gras" mask, or use a piece of string attached to each ear and tie behind the head.

Allergic Rhinitis, Sinusitis, and Rhinosinusitis

What is rhinitis?

Inflammation of the nasal mucous membrane is called rhinitis. The symptoms include sneezing, runny nose, and itching, caused by irritation and congestion in the nose. There are two types: allergic rhinitis and non-allergic rhinitis.

Allergic rhinitis 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. Essentially, during an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast cells 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, house plants, 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.

Non-allergic 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 the cold. Other causes may include blockages in the nose, a deviated septum, infections (in children), 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 sought to better define 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. The resulting nasal obstruction leads to acute, recurrent, or chronic sinusitis; conversely, 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 2 to 87 years of age), thickening of the sinus mucosa was more commonly found in sinusitis patients during July, August, September, and December, in which pollen, mold, or 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.

Patients who suffer from recurring bouts of allergic rhinitis should observe their symptoms on a continuous basis. If facial pain or a green-yellowish nasal discharge occur, a qualified ear, nose, and throat specialist can provide appropriate sinusitis treatment.

Sinusitis: Special Considerations for Aging Patients

People older than 65 represent the fastest-growing segment of the population. More than 20 percent of U.S. residents will be 65 or older in 2030. Of all Americans 65 and older, 14.1 percent report that they suffer from chronic sinusitis; for those 75 years and older, the rate declines to 13.5 percent. The prevalence of this condition among the elderly ranks behind arthritis, hypertension, hearing impairments, heart disease, cataracts, and orthopedic impairments. However, more Americans report having sinusitis than diabetes.

Geriatric Rhinitis Complaints are:

For the most part, sinusitis symptoms, diagnosis, and treatment are the same for the elderly as other adult age groups. However, there are special considerations in older Americans:

Changing physiology

With aging, the physiology and function of the nose changes. The nose lengthens, and the nasal tip begins to droop due to weakening of the supporting cartilage. This in turn causes a restriction of nasal airflow, particularly at the nasal valve region (where the upper and lower lateral cartilages meet). Narrowing in this area results in the complaint of nasal obstruction, often referred to as geriatric rhinitis.

Patients with geriatric rhinitis typically complain of constant "sinus drainage," a chronic need to clear the throat or "hawk" mucus, and a sense of nasal obstruction, most often when they lie down. Other features include nasal crusting especially in the winter and in patients taking diuretics, vague facial pressure (attributed to "sinus trouble"), and a decreased sense of smell and taste.

However, it is a mistake to blame all upper respiratory problems on the aging process. Elderly patients with symptoms such as repeated sneezing, and watery eyes, nasal obstruction with clear profuse watery runny nose, and soft, pale turbinates (top-shaped bones in the nose) may have allergic rhinitis. Patients with this diagnosis will benefit from consultation with an otolaryngic allergist.

Patients with chronic sinusitis will have a long history of thick drainage that is often foul smelling and tasting and is associated with nasal obstruction, headaches, and facial pressure. These patients usually have pus drainage and nasal redness. In contrast, the geriatric rhinitis patient usually has a dry, irritated nose. The diagnosis of chronic sinusitis can be confirmed with a screening coronal CT of the sinuses.

Recent studies by Otolaryngologist-head and neck surgeons have sought to better define 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 fluids within these cavities are dynamic and are related to dynamic pathologic changes in the bone and soft tissues of the nasal cavity and paranasal sinuses. Symptoms associated with rhinosinusitis include nasal obstruction, nasal congestion, nasal discharge, nasal purulence, postnasal drip, facial pressure and pain, alteration in the sense of smell, cough, fever, halitosis, fatigue, dental pain, pharyngitis, otologic symptoms (e.g., ear fullness and clicking), and headache.

Osteoporosis

Osteoporosis is a significant health problem in the United States affecting approximately 24 million Americans, 15 to 20 million of whom are women over 45 years of age. Because of the concerns regarding prolonged estrogen use in postmenopausal women, a nasal calcitonin spray is often prescribed to prevent bone loss in perimenopausal women who cannot tolerate estrogen. The most common side effect reported with nasal calcitonin spray is a runny nose. Other symptoms that may occur include nasal crust, dryness, redness, irritation, sinusitis, nose bleeds, and headache. Sinusitis sufferers using a nasal calcitonin spray should advise their physicians.

Medications

Treatment for this age group needs to be more individualized to meet the patient's slower metabolism and the increasing potential for side effects. The majority (80 to 85 percent) of the nation's elderly have chronic diseases and take multiple drugs including over-the-counter medications, and risk drug interactions more often than other patients.

Surgery

Nasal and sinus surgery is occasionally advised for older patients. Patients with structural abnormalities, such as a deviated septum or nasal valve collapse causing severe nasal problems, should be referred to an Otolaryngologist for evaluation and possible surgical management. Patients with documented chronic sinusitis unresponsive to medications also should be referred to an Otolaryngologist.

Sources

Administration on Aging (Ana), U.S. Department of Health and Human Services; Geriatrics.

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. 

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:

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.

What to Do 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:

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.

You might not think your nose is a “vital organ,” but indeed it is! To understand its importance, all that most people need to experience is a bad cold. Nasal congestion and a runny nose have a noticeable effect on quality of life, energy level, ability to breathe, ability to sleep, and ability to function in general.

Why is your nose so important?

It processes the air that you breathe before it enters your lungs. Most of this activity takes place in and on the turbinates, located on the sides of the nasal passages. In an adult, 18,000 to 20,000 liters of air pass through the nose each day.

TIP: Keep a list of all your medications; know all the potential side effects; and discuss possible interactions with your doctors.

Your nose protects your health by:

For these and many other reasons, normal nasal function is essential. Do your lungs a favor; take care of your nose.

Because the connection between the nose and lungs is so important, paying attention to problems in the nose--allergic rhinitis for instance – can reduce or avoid problems in the lungs such as bronchitis and asthma. Ignoring nasal symptoms such as congestion, sneezing, runny nose, or thick nasal discharge can aggravate lung problems and lead to other problems:

So, it is important to treat nasal symptoms promptly to prevent worsening of lung problems.

Tips to improve the health of your nose and lungs:

Medications prescribed to treat nasal problems:

Be sure you understand their purpose. Each one is important and plays a separate role in treating nasal symptoms.

The foundation of the treatment of chronic nasal conditions is the regular use of an anti-inflammatory prescription nasal spray, which address all types of nose and sinus inflammation. These sprays should be used only as directed by your doctor. This is in contrast to medications that are inhaled by mouth into the lungs, which often have high levels of absorption into the blood stream. Always aim nasal sprays to the side of the nose; spraying into the center of the nose can cause too much dryness.

Antihistamines effectively relieve sneezing, itching and runny nose, but they have no effect on nasal congestion at least in the short term. Over-the-counter antihistamines cause drowsiness, slow the cleaning function of the cilia, and increase the stickiness of nasal mucus--causing germs and pollens to stay in the nose longer. There are prescription antihistamines that do not have any of these side effects. To achieve this safety, the relief is often slower starting, so patience is required.

Decongestants help to unclog stopped up noses but do very little for runny noses and sneezing. They work much faster to unclog the nose, but to achieve this quick action, there are often side-effects such as dry mouth, nervousness, and insomnia. The correct dose often has to be customized to get the benefit without the side-effects.

Be aware of medication side effects; no medicine works well for all people, and all medications can cause side effects.

Be aware of the nasal effects of other medications:

Each year thousands of people undergo surgery of the nose. Nasal surgery may be performed for cosmetic purposes, or a combination procedure to improve both form and function. It also may alleviate or cure nasal breathing problems, correct deformities from birth or injury, or support an aging, drooping nose.

Patients who are considering nasal surgery for any reason should seek a doctor who is a specialist in nasal airway function, as well as plastic surgery. This will ensure that efficient breathing is as high a priority as appearance.

Can Cosmetic Nasal Surgery Create a "Perfect" Nose?

Aesthetic nasal surgery (rhinoplasty) refines the shape of the nose, bringing it into balance with the other features of the face. Because the nose is the most prominent facial feature, even a slight alteration can greatly improve appearance. (Some patients elect chin augmentation in conjunction with rhinoplasty to better balance their features.) Rhinoplasty alone cannot give you a perfect profile, make you look like someone else, or improve your personal life. Before surgery, it is very important that the patient have a clear, realistic understanding of what change is possible as well as the limitations and risks of the procedure.

Skin type, ethnic background, and age will be among the factors considered preoperatively by the surgeon. Except in cases of severe breathing impairment, young patients usually are not candidates until their noses are fully-grown, at 15 or 16 years of age. The surgeon will also discuss risk factors, which are generally minor, as well as where the surgery will be performed-in a hospital, freestanding outpatient surgical center, or a certified office operating room.

To reshape the nose, the skin is lifted, allowing the surgeon to remove or rearrange the bone and cartilage. The skin is then re-draped and sutured over the new frame. A nasal splint on the outside of the nose helps retain the new shape during healing. If soft, absorbent material is placed inside the nose to stabilize the septum, it will normally be removed the morning after surgery. External nasal dressings and splints are usually removed five to seven days after surgery.

When Should Surgery Be Considered to Correct a Chronically Stuffy Nose?

Millions of Americans perennially suffer the discomfort of nasal stuffiness. This may be indicative of chronic breathing problems that don't respond well to ordinary treatment. The blockage may be related to structural abnormalities inside the nose or to swelling caused by allergies or viruses.

There are numerous causes of nasal obstruction. A deviated septum (the partition between the nostrils) can be crooked or bent as the result of abnormal growth or injury. This can partially or completely close one or both nasal passages. The deviated septum can be corrected with a surgical procedure called septoplasty. Cosmetic changes to the nose are often performed at the same time, in a combination procedure called septorhinoplasty.

Overgrowth of the turbinates is yet another cause of stuffiness. (The turbinates are the tissues that line the inside of the nasal passages.) Sometimes the turbinates need treatment to make them smaller and expand the nasal passages. Treatments include injection, freezing, and partial removal. Allergies, too, can cause internal nasal swelling, and allergy evaluation and therapy may be necessary.

Can Surgery Correct a Stuffy, Aging Nose?

Aging is a common cause of nasal obstruction. This occurs when the cartilage in the nose and its tip are weakened by age and droop because of gravity. This causes the sides of the nose to collapse inward, obstructing airflow. Mouth breathing or noisy and restricted breathing are common.

Try lifting the tip of your nose to see if you breathe better. If so, the external adhesive nasal strips that athletes have popularized may help. Or talk to a facial plastic surgeon/otolaryngolgist about septoplasty, which will involve trimming, reshaping or repositioning portions of septal cartilage and bone. (This is an ideal time to make other cosmetic improvements as well.) Internal splints or soft packing may be placed in the nostrils to hold the septum in its new position. Usually, patients experience some swelling for a week or two. However, after the packing is removed, most people enjoy a dramatic improvement in breathing.

What Treatment is Needed for a Broken Nose?

Bruises around the eyes and/or a slightly crooked nose following injury usually indicate a fractured nose. If the bones are pushed over or out to one side, immediate medical attention is ideal. But once soft tissue swelling distorts the nose, waiting 48-72 hours for a doctor's appointment may actually help the doctor in evaluating your injury as the swelling recedes. (Apply ice while waiting to see the doctor.) What's most important is whether the nasal bones have been displaced, rather than just fractured or broken.

For markedly displaced bones, surgeons often attempt to return the nasal bones to a straighter position under local or general anesthesia. This is usually done within seven to ten days after injury, so that the bones don't heal in a displaced position. Because so many fractures are irregular and won't "pop" back into place, the procedure is successful only half the time. Displacement due to injury often results in compromised breathing so corrective nasal surgery, typically septorhinoplasty, may then be elected.

This procedure is typically done on an outpatient basis, and patients usually plan to avoid appearing in public for about a week due to swelling and bruising.

Will Insurance Cover Nasal Surgery?

Insurance usually does not cover cosmetic surgery. However, surgery to correct or improve breathing function, major deformity, or injury is frequently covered in whole or in part. Patients should obtain cost information from their surgeons and discuss with their insurance carrier prior to surgery.

Insight into normal and abnormal secretions

The glands in your nose and throat continually produce mucus (one to two quarts a day). It moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although mucus normally is swallowed unconsciously, the feeling that it is accumulating in the throat or dripping from the back of your nose is called post-nasal drip.

This feeling can be caused by excessive or thick secretions or by throat muscle and swallowing disorders.

What Causes Abnormal Secretions - Thin and Thick

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).

Increased thick secretions in the winter often result from too little moisture in heated buildings and homes. They can also result from sinus or nose infections and some allergies, especially to certain foods such as dairy products. If thin secretions become thick and 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, etc.).

Sinuses are air-filled cavities in the skull. They drain into the nose through small openings. Blockages in the openings from swelling due to colds, flu, or allergies may lead to acute sinus infection. A viral "cold" that persists for 10 days or more may have become a bacterial sinus infection. With this infection you may notice increased post-nasal drip. If you suspect that you have a sinus infection, you should see your physician for antibiotic treatment.

Chronic sinusitis occurs when sinus blockages persist and the lining of the sinuses swell further. Polyps (growths in the nose) may develop with chronic sinusitis. Patients with polyps tend to have irritating, persistent post-nasal drip. Evaluation by an Otolaryngologist may include an exam of the interior of the nose with a fiber optic scope and CAT scan x-rays. If medication does not relieve the problem, surgery may be recommended.

Vasomotor rhinitis describes a nonallergic "hyperirritable nose" that feels congested, blocked, or wet.

Swallowing Problems

Swallowing problems may result in accumulation of solids or liquids in the throat that may complicate or feel like post-nasal drip. When the nerve and muscle interaction in the mouth, throat, and food passage (esophagus) aren't working properly, overflow secretions can spill into the voice box (larynx) and breathing passages (trachea and bronchi) causing hoarseness, throat clearing, or cough.

Several factors contribute to swallowing problems:

Chronic Sore Throat

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 of a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.

Treatment

A correct diagnosis requires a detailed ear, nose, and throat exam and possible laboratory, endoscopic, and x-ray studies. Each treatment is different:

Insight into care and prevention of epistaxis (nosebleeds)

What causes a nosebleed?

Most nosebleeds (epistaxis) are mere nuisances. But some are quite frightening, and a few are even life threatening. Physicians classify nosebleeds into two different types.

Anterior nosebleed: Most nosebleeds begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. This type of nosebleed comes from the front of the nose and begins with a flow of blood out one nostril when the patient is sitting or standing.

Posterior nosebleed: More rarely, a nosebleed can begin high and deep within the nose and flow down the back of the mouth and throat even if the patient is sitting or standing.

Which type of nosebleed did I have?

Obviously, when the patient is lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow posteriorly, especially if the patient is coughing or blowing his nose.

It is important to try to make the distinction since posterior (back of nasal cavity) nosebleeds are often more severe and almost always require a physician's care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face.

Anterior nosebleeds are common in dry climates or during the winter months when heated, dry indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented if you place a bit of lubricating cream or ointment about the size of a pea on the end of your fingertip and then rub it inside the nose, especially on the middle portion of the nose (the septum).

To stop an anterior nosebleed

If you or your child has an anterior nosebleed, you may be able to care for it yourself using the following steps:

First, help the patient stay calm, especially young child.  A person who is agitated may bleed more profusely 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 indext finger.
    or
    Soak a cotton ball with Afrin, Neo-Synephrine, or Dura-Vent spray and place this into the nostril.
  2. Presss 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 the position for a full five minutes by the clock.
  4. Keep head higher than the level of the heart.  Stire up or lie back a little with the head elevated.
  5. Apply ice - crushed in a plastic bag or washcloth - to nose and checks.

What are my treatment options?

Many physicians suggest any of the following lubricating creams or ointments. They can all be purchased without a prescription: Bacitracin, A and D Ointment, Eucerin, Polysporin, and Vaseline. Up to three applications a day may be needed, but usually every night at bedtime is enough. A saline nasal spray will also moisten dry nasal membranes.If the nosebleeds persist, you should see your doctor. Using an endoscope, a tube with a light for seeing inside the nose, your physician may find a problem within the nose that can be fixed. He or she may recommend cauterization (sealing) of the blood vessel that is causing the trouble.

What about re-bleeding?

To prevent re-bleeding after initial bleeding has stopped:

If re-bleeding occurs:

What causes my nose to bleed?

Secondhand smoke is a combination of the smoke from a burning cigarette and the smoke exhaled by the smoker. Also known as environmental tobacco smoke (ETS), it can be recognized easily by its distinctive odor. ETS contaminates the air and is retained in clothing, curtains and furniture. Many people find ETS unpleasant, annoying, and irritating to the eyes and nose. More importantly, it represents a dangerous health hazard. Over 4,000 different chemicals have been identified in ETS, and at least 43 of these chemicals cause cancer.

Is Exposure to Environmental Tobacco Smoke Common?

Approximately 26% of adults in the United States currently smoke cigarettes, and 50 to 67% of children under five years of age live in homes with at least one adult smoker.

Who Is At Risk?

Although ETS is dangerous to everyone, fetuses, infants and children are at most risk. This is because ETS can damage developing organs, such as the lungs and brain.

Its Effect On:

...the Fetus and Newborn

Maternal, fetal, and placental blood flow change when pregnant women smoke, although the long-term health effects of these changes are not known. Some studies suggest that smoking during pregnancy causes birth defects such as cleft lip or palate. Smoking mothers produce less milk, and their babies have a lower birth weight. Maternal smoking also is associated with neonatal death from Sudden Infant Death Syndrome, the major cause of death in infants between one month and one year of age.

...Children's Lungs and Respiratory Tracts

Exposure to ETS decreases lung efficiency and impairs lung function in children of all ages. It increases both the frequency and severity of childhood asthma. Secondhand smoke can aggravate sinusitis, rhinitis, cystic fibrosis, and chronic respiratory problems such as cough and postnasal drip. It also increases the number of children's colds and sore throats. In children under two years of age, ETS exposure increases the likelihood of bronchitis and pneumonia. In fact, a 1992 study by the Environmental Protection Agency says ETS causes 150,000 to 300,000 lower respiratory tract infections each year in infants and children under 18 months of age. These illnesses result in as many as 15,000 hospitalizations. Children of parents who smoke half a pack a day or more are at nearly double the risk of hospitalization for a respiratory illness.

...the Ears

Exposure to ETS increases both the number of ear infections a child will experience, and the duration of the illness. Inhaled smoke irritates the eustachian tube, which connects the back of the nose with the middle ear. This causes swelling and obstruction which interferes with pressure equalization in the middle ear, leading to pain, fluid and infection. Ear infections are the most common cause of children's hearing loss. When they do not respond to medical treatment, the surgical insertion of tubes into the ears is often required.

...the Brain

Children of mothers who smoked during pregnancy are more likely to suffer behavioral problems such as hyperactivity than children of non-smoking mothers. Modest impairment in school performance and intellectual achievement have also been demonstrated.

Secondhand Smoke Causes Cancer

You have just read how ETS harms the development of your child, but did you know that your risk of developing cancer from ETS is about 100 times greater than from outdoor cancer-causing pollutants? Did you know that ETS causes more than 3,000 non-smokers to die of lung cancer each year? While these facts are quite alarming for everyone, you can stop your child's exposure to secondhand smoke right now.

What Can You Do?

  1. Stop smoking, if you do smoke. Consult your physician for help, if needed. There are many new pharmaceutical products available to help you quit.
  2. If you have household members who smoke, help them stop. If it is not possible to stop their smoking, ask them, and visitors, to smoke outside of your home.
  3. Do not allow smoking in your car.
  4. Be certain that your children's schools and day care facilities are smoke free.

Acknowledgment is made to the American Academy of Pediatric Otolaryngology for contributions to this article.

Sean Marsee of Ada, OK, lifted weights and ran the 400-meter relay. By the time he was 18 years of age he had won 28 medals. To keep his body strong, he did not smoke or drink.

But he did use smokeless tobacco, because he thought it wasn't harmful to his health.

When oral cancer was discovered, part of Sean's tongue was removed. But the cancer spread. More surgeries followed, including removal of his jaw bone. In his last hours, Sean wrote - he could no longer speak - a plea to his peers; "Don't dip snuff". He died at age 19.

What Is Spit Tobacco?

There are two forms of spit tobacco: chewing tobacco and snuff. Chewing tobacco is usually sold as leaf tobacco (packaged in a pouch) or plug tobacco (in brick form) and both are put between the cheek and gum. Users keep chewing tobacco in their mouths for several hours to get a continuous high from the nicotine in the tobacco.

Snuff is a powdered tobacco (usually sold in cans) that is put between the lower lip and the gum. Just a pinch is all that's needed to release the nicotine, which is then swiftly absorbed into the bloodstream, resulting in a quick high. Sounds ok, right? Not exactly, keep reading.

What's in Spit Tobacco?

Chemicals. Keep in mind that the spit tobacco you or your friends are putting into your mouths contains many chemicals that can have a harmful effect on your health. Here are a few of the ingredients found in spit tobacco:

The chemicals contained in chew or snuff are what make you high. They also make it very hard to quit. Why? Every time you use smokeless tobacco your body adjusts to the amount of tobacco needed to get that high. Then you need a little more tobacco to get the same feeling. You see, your body gets used to the chemicals you give it. Pretty soon you'll need more smokeless tobacco, more often or you'll need stronger spit tobacco to reach the same level. This process is called addiction.

Some people say spit tobacco is ok because there's no smoke, like a cigarette has. Don't believe them. It's not a safe alternative to smoking. You just move health problems from your lungs to your mouth.

Physical and Mental Effects

If you use spit tobacco, here's what you might have to look forward to:

Early Warning Signs

Check your mouth often, looking closely at the places where you hold the tobacco. See your doctor right away if you have any of the following:

Tips To Quit

You've just read the bad news, but there is good news. Even though it is very difficult to quit using spit tobacco, it can be done. Read the following tips to quit for some helpful ideas to kick the habit. Remember, most people don't start chewing on their own, so don't try quitting on your own. Ask for help and positive reinforcement from your support groups (friends, parents, coaches, teachers, whomever...)

  1. Think of reasons why you want to quit. You may want to quit because:
    • You don't want to risk getting cancer.
    • The people around you find it offensive.
    • You don't like having bad breath after chewing and dipping.
    • You don't want stained teeth or no teeth.
    • You don't like being addicted to nicotine.
    • You want to start leading a healthier life.
  2. Pick a quit date and throw out all your chewing tobacco and snuff. Tell yourself out loud every day that you're going to quit.
  3. Ask your friends, family, teachers, and coaches to help you kick the habit by giving you support and encouragement. Tell friends not to offer you smokeless tobacco. You may want to ask a friend to quit with you.
  4. Ask your doctor about a nicotine chewing gum tobacco cessation program.
  5. Find alternatives to spit tobacco. A few good examples are sugarless gum, pumpkin or sunflower seeds, apple slices, raisins, or dried fruit.
  6. Find activities to keep your mind off of spit tobacco. You could ride a bike, talk or write a letter to a friend, work on a hobby, or listen to music. Exercise can help relieve tension caused by quitting.
  7. Remember that everyone is different, so develop a personalized plan that works best for you. Set realistic goals and achieve them.
  8. Reward yourself. You could save the money that would have been spent on spit tobacco products and buy something nice for yourself.

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:

Why Is It 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 It 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 This 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.

Protruding and drooping ears or torn earlobes can be surgically corrected. Exceptionally large ears or those that stick out make children vulnerable to teasing. These procedures do not alter the patient's hearing, but they may improve appearance and self-confidence.

What Is Involved In "Pinning Back" The Ears?

Corrective surgery, called otoplasty, should be considered on ears, which stick out more than 4/5 of an inch (2 cm) from the back of the head. It can be performed at any age after the ears have reached full size, usually at five or six years of age. Having the surgery at a young age has two benefits: the cartilage is more pliable, making it easier to reshape, and the child will experience the psychological benefits of the cosmetic improvement. However, a patient may have the surgery at any age.

The surgery begins with an incision behind the ear, in the fold where the ear joins the head. The surgeon may remove skin and cartilage or trim and reshape the cartilage. In addition to correcting protrusion, ears may also be reshaped, reduced in size, or made more symmetrical. The cartilage is then secured in the new position with permanent stitches, which will anchor the ear while healing occurs.

Typically otoplasty surgery takes about two hours. The soft dressings over the ears will be used for a few weeks as protection, and the patient usually experiences only mild discomfort. Headbands are sometimes recommended to hold the ears in place for a month following surgery or may be prescribed for nighttime wear only.

Can Ear Deformities Be Corrected?

The "fold" of hard, raised cartilage that gives shape to the upper portion of the ear does not form in all people. This is called "lop-ear deformity," and it is inherited. The absence of the fold can cause the ear to stick out or flop down. To correct this problem, the surgeon places permanent stitches in the upper ear cartilage and ties them in a way that creates a fold and props the ear up. Scar tissue will form later, holding the fold in place.

Some infants are born without an opening in their middle ear. These ears can be surgically opened, and the outer ear reshaped to look like the other ear. This procedure will restore hearing if the inner ear is intact.

Those who are born without an ear, or lose an ear due to injury, can have an artificial ear surgically attached for cosmetic reasons. These are custom formed to match the patient's other ear. Alternatively, rib cartilage or a biomedical implant, in addition to the patient's own soft tissue, can be used to construct a new ear.

What About Torn Earlobes?

Many mothers have had their earlobes torn by a baby's tug on their earrings. Earrings also catch on clothing and other objects, resulting in torn earlobes. These tears can be easily repaired surgically, usually in the doctor's office. In severe cases, the surgeon may cut a small triangular notch at the bottom of the lobe. A matching flap is then created from tissue on the other side of the tear, and the two wedges are fitted together and stitched.

Earlobes usually heal quickly with minimal scarring. In most cases, the earlobe can be pierced again four to six weeks after surgery to receive lightweight earrings.

Does Insurance Pay for Cosmetic Ear Surgery?

Insurance usually does not cover surgery solely for cosmetic reasons. However, insurance may cover, in whole or in part, surgery to correct a congenital or traumatic defect. Before cosmetic ear surgery, discuss the procedure with your insurance carrier to determine what coverage, if any, you can expect.

What Is Otitis Media?

Otitis media refers to inflammation of the middle ear. When infection occurs, the condition is called "acute otitis media." Acute otitis media occurs when a cold, allergy, or upper respiratory infection, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube. This causes earache and swelling.

When fluid forms in the middle ear, the condition is known as "otitis media with effusion." This occurs in a recovering ear infection or when one is about to occur. Fluid can remain in the ear for weeks to many months. When a discharge from the ear persists or repeatedly returns, this is sometimes called chronic middle ear infection. Fluid can remain in the ear up to three weeks following the infection. If not treated, chronic ear infections have potentially serious consequences such as temporary or permanent hearing loss.

How Does Otitis Media Affect A Child’s Hearing?

All children with middle ear infection or fluid have some degree of hearing loss. The average hearing loss in ears with fluid is 24 decibels- equivalent to wearing ear plugs. (Twenty-four decibels is about the level of the very softest of whispers.) Thicker fluid can cause much more loss, up to 45 decibels (the range of conversational speech).

Your child may have hearing loss if he or she is unable to understand certain words and speaks louder than normal. Essentially, a child experiencing hearing loss from middle ear infections will hear muffled sounds and misunderstand speech rather than incur a complete hearing loss. Even so, the consequences can be significant – the young patient could permanently lose the ability to consistently understand speech in a noisy environment (such as a classroom) leading to a delay in learning important speech and language skills.

If you believe your child has a hearing loss, the young patient should be examined by an ear, nose, and throat specialist at the earliest opportunity.

Types Of Hearing Loss

Conductive hearing loss is a form of hearing impairment due to a lesion in the external auditory canal or middle ear. This form of hearing loss is usually temporary and found in those ages 40 or younger. Untreated chronic ear infections can lead to conductive hearing loss; draining the infected middle ear drum will usually return hearing to normal.

The other form of hearing loss is sensorineural hearing loss, hearing loss due to a lesion of the auditory division of the 8th cranial nerve or the inner ear. Historically, this condition is most prevalent in middle age and older patients. However, extended exposure to loud music can lead to sensorineural hearing loss in adolescents.

When Should A Hearing Test Be Performed?

A hearing test should be performed for children who have frequent ear infections, hearing loss that lasts more than six weeks, or fluid in the middle ear for more than three months. There are a wide range of medical devices now available to test a child’s hearing, Eustachian tube function, and reliability of the ear drum. They include the otoscopy, tympanometer, and audiometer.

Do Children Lose Their Hearing For Reasons Other Than Chronic Otitis Media?

Children can incur temporary hearing loss for other reasons than chronic middle ear infection and Eustachian tube dysfunction. They include:

WARNING: If you already have an ear infection, or if you have ever had a perforated or otherwise injured eardrum, or ear surgery, you should consult an ear, nose, and throat specialist before you go swimming and before you use any type of ear drops. If you do not know if you have or ever had a perforated, punctured, ruptured, or otherwise injured eardrum, ask your ear doctor.

Causes

Swimmer’s ear is an infection of the outer ear structures. It typically occurs in swimmers, but since the cause of the infection is water trapped in the ear canal, bathing or showering may also cause 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 progresses it may involve the outer ear.

Signs And Symptoms

The most common symptoms of swimmer’s ear are mild to moderate pain that is aggravated by tugging on the auricle and an itchy ear. Other symptoms may include any of the following:

Treatment

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.

For more severe infections, if you do not have a perforated ear drum, ear cleaning may be helped by antibiotics. 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.

Follow-up appointments with your physician are very important to monitor progress of the infection, to repeat ear cleaning, and to replace the ear wick as needed. Your Otolaryngologist has specialized equipment and expertise to effectively clean the ear canal and treat swimmer’s ear.

Prevention

A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture after swimming or bathing. Q-tips should not be used for this purpose, because they may pack material deeper into the ear canal, remove protective earwax, and irritate the thin skin of the ear canal creating the perfect environment for infection.

The safest way to dry your ears is with a hair dryer. If you do not have a perforated eardrum, rubbing alcohol or a 50:50 mixture of alcohol and vinegar used as 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.

People with itchy ears, flaky or scaly ears, or extensive earwax are more likely to develop swimmer’s ear. If so, it may be helpful to have your ears cleaned periodically by an Otolaryngologist.

Why Do Ears Itch?

An itchy ear is a maddening symptom. Sometimes it is caused by a fungus or allergy, but more often it is a chronic dermatitis (skin inflammation) of the ear canal. One type is seborrhea dermatitis, a condition similar to dandruff in the scalp; the wax is dry, flaky, and abundant. Some patients with this problem will do well to decrease their intake of foods that aggravate it, such as greasy foods, carbohydrates (sugar and starches), and chocolate.

Doctors often prescribe a cortisone eardrop at bedtime when the ears itch. There is no long-term cure, but it can be kept controlled.

A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear. The medical term for eardrum is tympanic membrane. The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear.

A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.

Causes Of Eardrum Perforation

The causes of perforated eardrum are usually from trauma or infection. A perforated eardrum can occur:

Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the eardrum resulting in a perforation. In this circumstance, there maybe infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation.

On rare occasions a small hole may remain in the eardrum after a previously placed PE tube (pressure equalizing) either falls out or is removed by the physician.

Most eardrum perforations heal spontaneously within weeks after rupture, although some may take up to several months. During the healing process the ear must be protected from water and trauma. Those eardrum perforations that do not heal on their own may require surgery.

Effects On Hearing From Perforated Eardrum

Usually, the larger the perforation, the greater the loss of hearing. The location of the hole (perforation) in the eardrum also effects the degree of hearing loss. If severe trauma (e.g. skull fracture) disrupts the bones in the middle ear which transmit sound or causes injury to the inner ear structures, the loss of hearing may be quite severe.

If the perforated eardrum is due to a sudden traumatic or explosive event, the loss of hearing can be great and ringing in the ear (tinnitus) may be severe. In this case the hearing usually returns partially, and the ringing diminishes in a few days. Chronic infection as a result of the perforation can cause major hearing loss.

Treatment Of The Perforated Eardrum

Before attempting any correction of the perforation, a hearing test should be performed. The benefits of closing a perforation include prevention of water entering the ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and diminished tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures.

If the perforation is very small, otolaryngologists may choose to observe the perforation over time to see if it will close spontaneously. They also might try to patch a cooperative patient's eardrum in the office. Working with a microscope, your doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. Usually with closure of the tympanic membrane improvement in hearing is noted. Several applications of a patch (up to three or four) may be required before the perforation closes completely. If your physician feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or attempts with paper patching do not promote healing, surgery is considered.

There are a variety of surgical techniques, but all basically place tissue across the perforation allowing healing. The name of this procedure is called Tympanoplasty. Surgery is typically quite successful in closing the perforation permanently, and improving hearing. It is usually done on an outpatient basis.

Your doctor will advise you regarding the proper management of a perforated eardrum.

Have you ever wondered why your ears pop when you fly on an airplane? Or why, when they fail to pop, you get an earache? Have you ever wondered why the babies on an airplane fuss and cry so much during descent?

Ear problems are the most common medical complaint of airplane travelers, and while they are usually simple, minor annoyances, they occasionally result in temporary pain and hearing loss.

The Ear And Air Pressure

It is the middle ear that causes discomfort during air travel, because it is an air pocket inside the head that is vulnerable to changes in air pressure.

Normally, each time (or each second or third time) you swallow, your ears make a little click or popping sound. This occurs because a small bubble of air has entered your middle ear, up from the back of your nose. It passes through the Eustachian tube, a membrane-lined tube about the size of a pencil lead that connects the back of the nose with the middle ear. The air in the middle ear is constantly being absorbed by its membranous lining and re-supplied through the Eustachian tube. In this manner, air pressure on both sides of the eardrum stays about equal. If and when the air pressure is not equal, the ear feels blocked.

Blocked Ears And Eustachian Tubes

The Eustachian tube can be blocked, or obstructed, for a variety of reasons. When that occurs, the middle ear pressure cannot be equalized. The air already there is absorbed and a vacuum occurs, sucking the eardrum inward and stretching it. Such an eardrum cannot vibrate naturally, so sounds are muffled or blocked, and the stretching can be painful. If the tube remains blocked, fluid (like blood serum) will seep into the area from the membranes in an attempt to overcome the vacuum. This is called "fluid in the ear," serous otitis, or aero-otitis.

The most common cause for a blocked Eustachian tube is the common cold. Sinus infections and nasal allergies (hay fever, etc.) are also causes. A stuffy nose leads to stuffy ears because the swollen membranes block the opening of the Eustachian tube.

Children are especially vulnerable to blockages because their Eustachian tubes are narrower than adults.

The Ear Is Divided Into Three Parts:

How Can Air Travel Cause Problems?

Air travel is sometimes associated with rapid changes in air pressure. To maintain comfort, the Eustachian tube must open frequently and wide enough to equalize the changes in pressure. This is especially true when the airplane is landing, going from low atmospheric pressure down closer to earth where the air pressure is higher.

Actually, any situation in which rapid altitude or pressure changes occur creates the problem. You may have experienced it when riding in elevators or when diving to the bottom of a swimming pool. Deep-sea divers are taught how to equalize their ear pressures; so are pilots. You can learn the tricks too.

How To Unblock Your Ears

Swallowing activates the muscle that opens the Eustachian tube. You swallow more often when you chew gum or let mints melt in your mouth. These are good air travel practices, especially just before take-off and during descent. Yawning is even better. Avoid sleeping during descent, because you may not be swallowing often enough to keep up with the pressure changes. (The flight attendant will be happy to awaken you just before descent.)

If yawning and swallowing are not effective, unblock your ears as follows:

When you hear a loud pop in your ears, you have succeeded. You may have to repeat this several times during descent.

Babies' Ears

Babies cannot intentionally pop their ears, but popping may occur if they are sucking on a bottle or pacifier. Feed your baby during the flight, and do not allow him or her to sleep during descent.

Precautions

What About Decongestants And Nose Sprays?

Many experienced air travelers use a decongestant pill or nasal spray an hour or so before descent. This will shrink the membranes and help the ears pop more easily. Travelers with allergy problems should take their medication at the beginning of the flight for the same reason.

Decongestant tablets and sprays can be purchased without a prescription. However, people with heart disease, high blood pressure, irregular heart rhythms, thyroid disease, or excessive nervousness should avoid them. Such people should consult their physicians before using these medicines. Pregnant women should likewise consult their physicians first.

If Your Ears Will Not Unblock

Even after landing you can continue the pressure equalizing techniques, and you may find decongestants and nasal sprays to be helpful. (However, avoid making a habit of nasal sprays. After a few days, they may cause more congestion than they relieve.) If your ears fail to open, or if pain persists, you will need to seek the help of a physician who has experience in the care of ear disorders. He/she may need to release the pressure or fluid with a small incision in the eardrum.

Insight into otitis media and treatments

What Is Otitis Media?

Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded for children who visit physicians for illness. It is also the most common cause of hearing loss in children.

Although otitis media is most common in young children, it also affects adults occasionally. It occurs most commonly in the winter and early spring months.

Is It Serious?

Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal.

Otitis media is also serious because the infection can spread to nearby structures in the head, especially the mastoid. Thus, it is very important to recognize the symptoms (see list) of otitis media and to get immediate attention from your doctor.

How Does The Ear Work?

The outer ear collects sounds. The middle ear is a pea sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three tiny ear bones. When sound waves strike the eardrum, it vibrates and sets the bones in motion that transmit to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. It also helps maintain balance.

A healthy middle ear contains air at the same atmospheric pressure as outside of the ear, allowing free vibration. Air enters the middle ear through the narrow Eustachian tube that connects the back of the nose to the ear. When you yawn and hear a pop, your Eustachian tube has just sent a tiny air bubble to your middle ear to equalize the air pressure.

What Causes Otitis Media?

Blockage of the Eustachian tube during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum. This is the infection called acute otitis media. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, you or your child may have hearing problems.

Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed Eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This condition makes one subject to frequent recurrences of the acute infection and may cause difficulty in hearing.

What Are The Symptoms?

In infants and toddlers look for:

In young children, adolescents, and adults look for:

Fever

Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.

What Will Happen At The Doctor's Office?

During an examination, the doctor will use an instrument called an otoscope to assess the ear's condition. With it, the doctor will perform an examination to check for redness in the ear and/or fluid behind the eardrum. With the gentle use of air pressure, the doctor can also see if the eardrum moves. If the eardrum doesn't move and/or is red, an ear infection is probably present.

Two other tests may be performed for more information.

An audiogram tests if hearing loss has occurred by presenting tones at various pitches.

A tympanogram measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.

The Importance of Medication

The doctor may prescribe one or more medications. It is important that all the medication(s) be taken as directed and that any follow-up visits be kept. Often, antibiotics to fight the infection will make the earache go away rapidly, but the infection may need more time to clear up. So, be sure that the medication is taken for the full time your doctor has indicated. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both.

Sometimes the doctor may recommend a medication to reduce fever and/or pain. Analgesic eardrops can ease the pain of an earache. Call your doctor if you have any questions about you or your child's medication or if symptoms do not clear.

What Other Treatment May Be Necessary?

Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, your physician may recommend further treatment. An operation, called a myringotomy may be recommended. This involves a small surgical incision (opening) into the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days with practically no scarring or injury to the eardrum. In fact, the surgical opening can heal so fast that it often closes before the infection and the fluid are gone. A ventilation tube can be placed in the incision, preventing fluid accumulation and thus improving hearing.

The surgeon selects a ventilation tube for your child that will remain in place for as long as required for the middle ear infection to improve and for the Eustachian tube to return to normal. This may require several weeks or months. During this time, you must keep water out of the ears because it could start an infection. Otherwise, the tube causes no trouble, and you will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.

Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted.

Allergies May Also Require Treatment

So, remember, otitis media is generally not serious if it is promptly and properly treated. With the help of your physician, you and/or your child can feel and hear better very soon.
Be sure to follow the treatment plan, and see your physician until he/she tells you that the condition is fully cured.

Insight into causes and treatment of earwax buildup

Never put anything smaller than your elbow in your ear! Cotton swabs are for cleaning bellybuttons—not ears. You have probably heard these admonitions from relatives and doctors since childhood ... read on to find out what they meant.

The Outer Ear and Canal

The outer ear is the funnel-like part of the ear you can see on the side of the head, plus the ear canal (the hole which leads down to the eardrum).

The ear canal is shaped somewhat like an hourglass-narrowing part way down. The skin of the outer part of the canal has special glands that produce earwax. This wax is supposed to trap dust and dirt particles to keep them from reaching the eardrum. Usually the wax accumulates a bit, dries out and then comes tumbling out of the ear, carrying dirt and dust with it. Or it may slowly migrate to the outside where it can be wiped off. The ear canal may be blocked by wax when attempts to clean the ear push wax deeper into the ear canal and cause a blockage. Wax blockage is one of the most common causes of hearing loss.

Should You Clean Your Ears?

Wax is not formed in the deep part of the ear canal near the eardrum, but only in the outer part of the canal. So when a patient has wax blocked up against the eardrum, it is often because he has been probing his ear with such things as cotton-tipped applicators, bobby pins, or twisted napkin corners. These objects only push the wax in deeper. Also, the skin of the ear canal and the eardrum is very thin and fragile and is easily injured.

Earwax is healthy in normal amounts and serves to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of earwax may result in dry, itchy ears.

Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of ear canal skin from the eardrum to the ear opening. Old earwax is constantly being transported from the ear canal to the ear opening where it usually dries, flakes, and falls out.

Under ideal circumstances, you should never have to clean your ear canals. However, we all know that this isn't always so. If you want to clean your ears, you can wash the external ear with a cloth over a finger, but do not insert anything into the ear canal.

What Are The Symptoms Of Wax Buildup?

Self Treatment

Most cases of earwax blockage respond to home treatments used to soften wax if there is no hole in the eardrum. Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial drops, such as Debrox®, or Murine® Ear Drops in the ear. These remedies are not as strong as the prescription wax softeners but are effective for many patients. Rarely, people have allergic reactions to commercial preparations. Detergent drops such as hydrogen peroxide or carbamide peroxide may also aid in the removal of wax. Patients should know that rinsing the ear canal with hydrogen peroxide (H2O2) results in oxygen bubbling off and water being left behind; wet, warm ear canals make good incubators for growth of bacteria. Flushing the ear canal with rubbing alcohol displaces the water and dries the canal skin. If alcohol causes severe pain, it suggests the presence of an eardrum perforation.

When Should I See My Doctor?

If you are uncertain whether you have a hole (perforation or puncture) in your eardrum, consult your physician prior to trying any over-the-counter remedies. Putting eardrops or other products in your ear in the presence of an eardrum perforation may cause an infection. Certainly, washing water through such a hole could start an infection. In the event that the home treatments discussed in this leaflet are not satisfactory, or if wax has accumulated so much that it blocks the ear canal (and hearing), your physician may prescribe eardrops designed to soften wax, or he may wash or vacuum it out. Occasionally, an Otolaryngologist (ENT specialist) may need to remove the wax using microscopic visualization.

What Are Other Possible Causes Of Hearing Loss?

Insight into an implantable device to help you hear

A cochlear implant is an electronic device that restores partial hearing to the deaf. It is surgically implanted in the inner ear and activated by a device worn outside the ear. Unlike a hearing aid, it does not make sound louder or clearer. Instead, the device bypasses damaged parts of the auditory system and directly stimulates the nerve of hearing, allowing individuals who are profoundly hearing impaired to receive sound.

What is normal hearing?

Your ear consists of three parts that play a vital role in hearing-the external ear, middle ear, and inner ear.

How is hearing impaired?

If you have disease or obstruction in your external or middle ear, your conductive hearing may be impaired. Medical or surgical treatment can probably correct this.

An inner ear problem, however, can result in a sensorineural impairment or nerve deafness. In most cases, the hair cells are damaged and do not function. Although many auditory nerve fibers may be intact and can transmit electrical impulses to the brain, these nerve fibers are unresponsive because of hair cell damage. Since severe sensorineural hearing loss cannot be corrected with medicine, it can be treated only with a cochlear implant.

How do cochlear implants work?

Cochlear implants bypass damaged hair cells and convert speech and environmental sounds into electrical signals and send these signals to the hearing nerve.

The implant consists of a small electronic device, which is surgically implanted under the skin behind the ear and an external speech processor, which is usually worn on a belt or in a pocket. A microphone is also worn outside the body as a headpiece behind the ear to capture incoming sound. The speech processor translates the sound into distinctive electrical signals. These 'codes' travel up a thin cable to the headpiece and are transmitted across the skin via radio waves to the implanted electrodes in the cochlea. The electrodes' signals stimulate the auditory nerve fibers to send information to the brain where it is interpreted as meaningful sound.

Who can benefit from an implant?

Implants are designed only for individuals who attain almost no benefit from a hearing aid. They must be two years of age or older (unless childhood meningitis is responsible for deafness).
Otolaryngologists (ear, nose, and throat specialists) perform implant surgery, though not all of them do this procedure. Your local doctor can refer you to an implant clinic for an evaluation. The evaluation will be done by an implant team (an Otolaryngologist, audiologist, nurse, and others) that will give you a series of tests:

What about surgery?

Implant surgery is performed under general anesthesia and lasts from two to three hours. An incision is made behind the ear to open the mastoid bone leading to the middle ear. The procedure may be done as an outpatient, or may require a stay in the hospital, overnight or for several days, depending on the device used and the anatomy of the inner ear.

Is there care and training after the operation?

About one month after surgery, your team places the signal processor, microphone, and implant transmitter outside your ear and adjusts them. They teach you how to look after the system and how to listen to sound through the implant. Some implants take longer to fit and require more training. Your team will probably ask you to come back to the clinic for regular checkups and readjustment of the speech processor as needed.

What can I expect from an implant?

Cochlear implants do not restore normal hearing, and benefits vary from one individual to another. Most users find that cochlear implants help them communicate better through improved lip-reading, and over half are able to discriminate speech without the use of visual cues. There are many factors that contribute to the degree of benefit a user receives from a cochlear implant, including:

Your team will explain what you can reasonably expect. Before deciding whether your implant is working well, you need to understand clearly how much time you must commit. A few patients do not benefit from implants.

How are new implant devices approved?

The Food and Drug Administration (FDA) regulates cochlear implant devices for both adults and children and approves them only after thorough clinical investigation.
Be sure to ask your Otolaryngologist for written information, including brochures provided by the implant manufacturers. You need to be fully informed about the benefits and risks of cochlear implants, including how much is known about how safe, reliable, and effective a device is, how often you must come back to the clinic for checkups, and whether your insurance company pays for the procedure.

How much does an implant cost?

More expensive than a hearing aid, the total cost of a cochlear implant including evaluation, surgery, the device, and rehabilitation is around $30,000. Most insurance companies provide benefits that cover the cost. (This is true whether or not the device has received FDA clearance or is still in trial.)

What Is A Cholesteatoma?

A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually due to repeated infection, which causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth.

How Does It Occur?

A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure ("clear the ears"). When the eustachian tubes work poorly perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body, and a partial vacuum results in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.

What Are The Symptoms?

Initially, the ear may drain, sometimes with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. (An ache behind or in the ear, especially at night, may cause significant discomfort.) Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any, or all, of these symptoms are good reasons to seek medical evaluation.

Is It Dangerous?

Ear cholesteatomas can be dangerous and should never be ignored. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and rarely death can occur.

What Treatment Can Be Provided?

An examination by an Otolaryngologist-head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated.

Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone next to the ear), and CAT scans (3-D x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused.

Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection and achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; and therefore, a second operation may be performed six to twelve months later. The second operation will attempt to restore hearing and, at the same time, inspect the middle ear space and mastoid for residual cholesteatoma.

Admission to the hospital is usually done the morning of surgery, and if the surgery is performed early in the morning, discharge maybe the same day. For some patients, an overnight stay is necessary. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Time off from work is typically one to two weeks.

Follow-up office visits after surgical treatment are necessary and important, because cholesteatoma sometimes recurs. In cases where an open mastoidectomy cavity has been created, office visits every few months are needed in order to clean out the mastoid cavity and prevent new infections. In some patients, there must be lifelong periodic ear examinations.

Summary

Cholesteatoma is a serious but treatable ear condition that can only be diagnosed by medical examination. Persisting earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness signals the need for evaluation by an Otolaryngologist-head and neck surgeon.

If vertigo attacks are not controlled by conservative measures and are disabling, one of the following surgical procedures might be recommended:

  1. The endolymphatic shunt or decompression procedure is an ear operation that usually preserves hearing. Attacks of vertigo are controlled in one-half to two-thirds of cases, but control is not permanent in all cases. Recovery time after this procedure is short compared to the other procedures.
  2. Selective vestibular neurectomy is a procedure in which the balance nerve is cut as it leaves the inner ear and goes to the brain. Vertigo attacks are permanently cured in a high percentage of cases, and hearing is preserved in most cases.
  3. Labryrinthectomy and eighth nerve section are procedures in which the balance and hearing mechanism in the inner ear are destroyed on one side. This is considered when the patient with Meniere's disease has poor hearing in the affected ear. Labryrinthectomy and eighth nerve section result in the highest rates for control of vertigo attacks.

Other operations or treatments may be advised in some cases. If surgical treatment is needed, it would require a referral to a neurologist.  Surgicical treatment for Meniere's Disease has substantial risks. Both the risks and benefits should be thoroughly discussed with your surgeon. Although there is no cure for Meniere's disease, the attacks of vertigo can be controlled in nearly all cases.

Recovering from a severe injury to the balance system requires rehabilitation. The balance system itself does not get better, but rather the dizziness resolves as a result of compensation by other parts of the central nervous system. It may be several months before you are fully recovered. Don’t get discouraged. Push yourself and try to extend your limits each day. If at any time you have any questions at all, call (920) 965-4800 or toll free at 866-965-4800. 

These exercises are designed to help you get better by providing a series of gentle activities that stimulate the balance system. Do the exercises at least three times each day. The order of the exercises is important: the easier exercises are listed first and the more stimulating tasks are last. Do each exercise at least 10 times before going on to the next one. If you get dizzy don’t get discouraged. Try to go a little further the next time. 

In Bed- laying down (slow at first, then faster)

Sitting in a Chair

Standing

Moving (It may be necessary for you to have assistance to keep from falling)



Download a printable version.

For Benign Paroxysmal Positional Vertigo


Upon rising in the morning: 

  1. Look up, down, right and left in succession 10 times.
  2. Turn head up, down, right and left in succession 10 times.
  3. While on back, roll to the right, then the left 10 times.
  4. While standing, bend over, then stand upright 10 times.

You may substitute any maneuver that brings on your dizziness for any of the above, as anything that brings on the dizziness will cause the symptoms to “fatigue out” if repeated enough. 

During the performance of any of the above, you should stop for a while if you get dizzy and then continue when the dizziness subsides.

Daily performance of these maneuvers will usually allow you to go throughout the day without getting dizzy when you turn your head or make rapid body movements. 


Download a printable version.

Every year more than two million Americans fall and sustain serious injury, costing in excess of 3 billion dollars. Hidden costs include pain, disability, lawsuits, deterioration in general well-being, and the impact on other family members. Falls and the resulting injuries have become one of the Senior Citizens most serious health issues. As our senior population continues to grow, falls and their consequences will increase in the future.

The accumulation of injuries throughout life change or damage the central nervous system (CNS) and the body as a whole, and our bodies deteriorate through inactivity. Vision diminishes with advancing age, and this directly effects the sensory systems involved with movement. The sensory cells in the ears' balance system change, gradually decrease and cannot be replaced. The nerves that carry sensory information to the brain from the muscles, joints and skin can also deteriorate with age, and the complex brain interconnections lose connecting fibers and nerve cells. The ability of nerve endings to generate the chemicals responsible for the transmission of information also seems to be affected by aging. This process accelerates after the age of 50.

Many diseases affect the CNS and sense organs. Hardening of the arteries (atherosclerosis) is probably the worst; it is accelerated by hypertension, smoking, and diabetes. Although it gradually increases during middle age, there is a point at which a slight additional decrease in blood flow causes serious vascular impairment such as a stroke.

Head injuries, sometimes caused by falls, can damage the sense organs in the inner ears, or the brain itself. The worst disability occurs when both sense organs and CNS structures are damaged simultaneously. Physical activity is very important for recovery from injury to the sensory systems. The general debility of aging can negatively affect recovery if it results in a decreased level of activity.

Diseases of the eyes, such as glaucoma and cataracts, decrease visual sensory function and are a common problem in old age. Injuries to the knees, hips, and back often do not completely heal, leaving some limitation of motion. Arthritis can cause permanent crippling, nonreversible effects. Osteoporosis leads to bone weakness and increases the probability of serious injury from a fall, or might cause a spontaneous fracture and lead to a fall. Muscle strength gradually decreases with age. Joint tendons and ligaments lose their flexibility and limit motion. The combined ravages of bone and joint injury, arthritis, and inactivity can result in a body that cannot carry out motion commands initiated by the brain.

Prevention

As many of the problems responsible for falling develop during early and middle age, initial efforts to prevent injuries must be aimed at younger age groups. Many of the changes in muscle, bone and the central nervous system are not inevitable results of aging, but are brought on by inactive lifestyles and self-inflicted damage from smoking, poor diet, and lack of exercise. Although hardening of the arteries is occasionally hereditary, in most cases it can be reduced by diets low in cholesterol and saturated fatty acids, as well as regular physical exercise. This stimulates the muscles as well as the cardiovascular system and could greatly reduce this problem. If there is a family history of hardening of the arteries, medications to lower cholesterol are available. Early diagnosis and treatment of diabetes mellitus and hypertension can make a difference in the progression of arthrosclerosis. Smoking cessation might also help reduce this disorder.

Many of the medications used to treat hypertension, heart disease, allergy, insomnia, stomach acidity, and depression have side effects which influence brain function and can increase the likelihood of falling. In this time of specialization it is possible for one patient to receive prescriptions from several physicians that might have additive side effects on brain and sensory function. Patients should keep a complete list of all their medications and dosages, and make this list available to each physician they consult. Coordination of all medications through a single primary care physician would help avoid adverse drug reactions. Many pharmacies use computer systems to warn the pharmacist about potential drug interactions. This requires that the patient purchase all medications from the same pharmacy or list all medications with each pharmacy. Unfortunately some over-the-counter medications such as antihistamines, sleeping medications, analgesics, and cough suppressants can add to the side effects of prescription medications. Alcohol also affects movement and judgment and adversely interacts with many medications.

Prevention Tips:

Health

Home

Rehabilitation

What about patients who have already fallen? Although rehabilitation is not perfected, much can be done.

All correctable problems should be treated. Visual correction with proper eyeglasses, improvement of hearing by hearing aids, adjustment or elimination of medications, and correction of hypertension or any other disease that could impair balance must be accomplished.

Rehabilitation includes increasing the range of motion as well as physical strength. A very important part of rehabilitation is helping patients overcome their fear of falling and thus avoid further injury. Walkers and canes can aid stability, and adaptations in the home are important. Simple changes such as installing hand holds in bathrooms or along walls could decrease the likelihood of falling and increase patient confidence. Removing the patient from a familiar environment, or drastically changing it, often hampers recovery.

As soon as possible, rehabilitation should be moved to an outpatient setting with participation of family members and home support groups. Rapid return to physical activity and social interaction with family and community can often stop the vicious spiral into inactivity, reclusiveness, and progressive deterioration.

The Anatomy of Balance

Dizziness, vertigo, and motion sickness all relate to the sense of balance and equilibrium. Researchers in space and aeronautical medicine call this sense spatial orientation, because it tells the brain where the body is "in space:" what direction it is pointing, what direction it is moving, and if it is turning or standing still.

Your sense of balance is maintained by a complex interaction of the following parts of the nervous system:

The symptoms of motion sickness and dizziness appear when the central nervous system receives conflicting messages from the other four systems.

For example, suppose you are riding through a storm, and your airplane is being tossed about by air turbulence. But your eyes do not detect all this motion because all you see is the inside of the airplane. Then your brain receives messages that do not match with each other. You might become "air sick."

Or suppose you are sitting in the back seat of a moving car reading a book. Your inner ears and skin receptors will detect the motion of your travel, but your eyes see only the pages of your book. You could become "car sick."

Or, to use a true medical condition as an example, suppose you suffer inner ear damage on only one side from a head injury or an infection. The damaged inner ear does not send the same signals as the healthy ear. This gives conflicting signals to the brain about the sensation of rotation, and you could suffer a sense of spinning, vertigo, and nausea.

Meniere's Disease: What is Meniere's Disease?

Meniere's disease, also called idiopathic endolymphatic hydrops, is a disorder of the inner ear. Although the cause is unknown, it probably results from an abnormality in the fluids of the inner ear. Meniere's disease is one of the most common causes of dizziness originating in the inner ear. In most cases only one ear is involved, but both ears may be affected in about 15% of patients. Meniere's disease typically starts between the ages of 20 and 50 years. Men and women are affected in equal numbers.

What are the Symptoms?

The symptoms of the Meniere's disease are episodic rotational vertigo (attacks of a spinning sensation), hearing loss, tinnitus, (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear.

Vertigo is usually the most troublesome symptom of Meniere's disease. It is defined as a sensation of movement when no movement is occurring. Vertigo is commonly produced by disorders of the inner ear, but may also occur in central nervous system disorders. The vertigo of Meniere's disease occurs in attacks of a spinning sensation and is accompanied by disequilibrium (an off- balance sensation), nausea, and sometimes vomiting. The vertigo lasts for 20 minutes to two hours or longer. During attacks, patients are usually unable to perform activities normal to their work or home life. Sleepiness may follow for several hours, and the off-balance sensation may last for days.

There may be an intermittent hearing loss early in the disease, especially in the low pitches, but a fixed hearing loss involving tones of all pitches commonly develops in time. Loud sounds may be uncomfortable and appear distorted in the affected ear.

The tinnitus and fullness of the ear in Meniere's disease may come and go with changes in hearing, occur during or just before attacks, or be constant.

The symptoms of Meniere's disease may be only a minor nuisance, or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning.

How is a Diagnosis Made?

The physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. You may be asked whether there is history of syphilis, mumps, or other serious infections in the past, inflammations of the eye, an autoimmune disorder or allergy, or ear surgery in the past. You may be asked questions about your general health, such as whether you have diabetes, high blood pressure, high blood cholesterol, thyroid, and neurologic or emotional disorders. Tests may be ordered to look for these problems in certain cases. The physical examination of the ears and other structures of the head and neck are usually normal, except during an attack.

An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in affected ear. Speech discrimination (the patient's ability to distinguish between words like "sit" and "fit") is often diminished in the affected ear. An ENG (electronystagmograph) may be performed to evaluate balance function. This is done in a darkened room. Recording electrodes are placed near the eyes. Wires from the electrodes are attached to a machine similar to a heart monitor. Warm and cool water or air is gently introduced into each ear canal. Since the eyes and ears work in a coordinated manner through the nervous system, measurement of eye movements can be used to test the balance system. In about 50% of patients, the balance function is reduced in the affected ear. Other balance tests, such as rotational testing or balance platform, may also be performed to evaluate the balance system.

Other tests may be done. Electrocochleography (ECoG) may indicate increased inner ear fluid pressure in some cases of Meniere's disease. The auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computed tomography (CT) or, magnetic resonance imaging (MRI) might be needed to rule out a tumor occurring on the hearing and balance nerve. Such tumors are rare, but they can cause symptoms similar to Meniere's disease.

What Treatment Will the Physician Recommend?

Diet and Medication

A low salt diet and a diuretic (water pill) may reduce the frequency of attacks of Meniere's disease in some patients. In order to receive the full benefit of the diuretic, it is important that you restrict your intake of salt and take the medication regularly as directed. Anti-vertigo medications, e.g., Antivert® (meclizine generic), or Valium® (diazepam generic), may provide temporary relief. Anti-nausea medication is sometimes prescribed. Anti-vertigo and anti-nausea medications may cause drowsiness.

Life Style

Avoid caffeine, smoking, and alcohol. Get regular sleep and eat properly. Remain physically active, but avoid excessive fatigue. Stress may aggravate the vertigo and tinnitus of Meniere's disease. Stress avoidance or counseling may be advised.

Precautions

If you have vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and others. Safety may require you to forego ladders, scaffolds, and swimming.

When is Surgery Recommended?

If vertigo attacks are not controlled by conservative measures and are disabling, one of the following surgical procedures might be recommended:

  1. The endolymphatic shunt or decompression procedure is an ear operation that usually preserves hearing. Attacks of vertigo are controlled in one-half to two-thirds of cases, but control is not permanent in all cases. Recovery time after this procedure is short compared to the other procedures.
  2. Selective vestibular neurectomy is a procedure in which the balance nerve is cut as it leaves the inner ear and goes to the brain. Vertigo attacks are permanently cured in a high percentage of cases, and hearing is preserved in most cases.
  3. Labryrinthectomy and eighth nerve section are procedures in which the balance and hearing mechanism in the inner ear are destroyed on one side. This is considered when the patient with Meniere's disease has poor hearing in the affected ear. Labryrinthectomy and eighth nerve section result in the highest rates for control of vertigo attacks.

Other operations or treatments may be advised in some cases. If surgical treatment seems to be needed, the risks and benefits should be thoroughly discussed with your surgeon. Although there is no cure for Meniere's disease, the attacks of vertigo can be controlled in nearly all cases.

Insight into decongestants and cold remedies

Drugs for stuffy nose, sinus trouble, congestion, and the common cold constitute the largest segment of the over-the-counter market for America's pharmaceutical industry. When used wisely, they provide welcome relief for at least some of the discomforts that affect almost everyone occasionally and that affect many people chronically. Drugs in these categories are useful for relief of symptoms from allergies, upper respiratory infections (i.e., sinusitus, colds, flu), and vasomotor rhinitis (a chronic stuffy nose caused by such unrelated conditions as emotional stress, thyroid disease, pregnancy, and others). These drugs do not cure the allergies, infections, etc.; they only relieve the symptoms, thereby making the patient more comfortable.  For the best results they should be taken regularly and faithfully.

Antihistamines, Decongestants, and "Cold" Remedies

Antihistamines

Histamine is an important body chemical that is responsible for the congestion, sneezing, and runny nose that a patient suffers with an allergic attack or an infection. Antihistamine drugs block the action of histamine, therefore reducing the allergy symptoms. For the best result, antihistamines should be taken before allergic symptoms get well established.

The most annoying side effect that antihistamines produce is drowsiness. Though desirable at bedtime, it is a nuisance to many people who need to use antihistamines in the daytime. To some people, it is even hazardous. These drugs are not recommended for daytime use for people who may be driving an automobile or operating equipment that could be dangerous. Newer non-sedating antihistamines do not have this effect. The first few doses cause the most sleepiness; subsequent doses are usually less troublesome.

Typical antihistamines include Benadryl,®* Chlor-Trimetron,®* Claritin,® Dimetane,®* Allegra,® PBZ,®* Polaramine,® Tavist,®* Teldrin,® Zyrtec,® etc.

Decongestants

Congestion in the nose, sinuses, and chest is due to swollen, expanded, or dilated blood vessels in the membranes of the nose and air passages. These membranes have an abundant supply of blood vessels with a great capacity for expansion (swelling and congestion). Histamine stimulates these blood vessels to expand as described previously.

Decongestants, on the other hand, cause constriction or tightening of the blood vessels in those membranes, which then forces much of the blood out of the membranes so that they shrink, and the air passages open up again.

Decongestants are chemically related to adrenalin, the natural decongestant, which is also a type of stimulant. Therefore, the side effect of decongestants is a jittery or nervous feeling. They can cause difficulty in going to sleep, and they can elevate blood pressure and pulse rate. Decongestants should not be used by a patient who has an irregular heart rhythm (pulse), high blood pressure, heart disease, or glaucoma. Some patients taking decongestants experience difficulty with urination. Furthermore, decongestants are often used as ingredients in diet pills. To avoid excessively stimulating effects, patients taking diet pills should not take decongestants.

Typical decongestants are phenylephrine (Neo-Synephrine®*), and pseudoephedrine (Novafed,®* Sudafed,®* etc.)

* May be available over-the-counter without a prescription. Read labels carefully, and use only as directed.

Combination remedies

Theoretically, if the side effects could be properly balanced, the sleepiness sometimes caused by antihistamines could be cancelled by the stimulation of decongestants. Numerous combinations of antihistamines with decongestants are available: Actifed,®* Allegra-D,® Chlor-Trimetron D,®* Claritin D,® Contac,®* Co-Pyronil 2,®* Deconamine,® Demazin,®* Dimetapp,®* Drixoral,®* Isoclor,®* Nolamine,® Novafed A,® Ornade,® Sudafed Plus,® Tavist D,®* Triaminic,®* and Trinalin,® to name just a few.

A patient may find one preparation quite helpful for several months or years but may need to switch to another one when the first loses its effectiveness. Since no one reacts exactly the same as another to the side effects of these drugs, a patient may wish to try his own ideas on adjusting the dosages. One might take the antihistamine only at night and take the decongestant alone in the daytime. Or take them together, increasing the dosage of antihistamine at night (while decreasing the decongestant dose) and then doing the opposite for daytime use.

For example: Antihistamine (Chlor-Trimetron,®* 4mg)-one tablet three times daily and two tablets at bedtime.

Plus: Decongestant (Sudafed,®* 30mg)-two tablets three times daily and one tablet at bedtime.

Medicine Symptoms Relieved Possible Side Effects
Antihistamines Sneezing
Runny Nose
Stuffy Nose
Itchy Eyes
Congestion
Drowsiness
Dry Mouth & Nose
Decongestants Stuffy Nose
Congestion
Stimulation
Insomnia
Rapid Heart Beat
Combinations of above All the above Any of above (more or less)

"Cold" remedies

Decongestants and/or antihistamines are the principal ingredients in "cold" remedies, but drying agents, aspirin (or aspirin substitutes) and cough suppressants may also be added. The patient should choose the remedy with ingredients best suited to combat his own symptoms. If the label does not clearly state the ingredients and their functions, the consumer should ask the pharmacist to explain them.

Nose sprays

The types of nose sprays that can be purchased without a prescription usually contain decongestants for direct application to nasal membranes. They can give prompt relief from congestion by constricting blood vessels. However, direct application creates a stronger stimulation than decongestants taken by mouth. It also impairs the circulation in the nose, which after a few hours, stimulates the vessels to expand to improve the blood flow again. This results in a "bounce-back" effect. The congestion recurs. If the patient uses the spray again, it starts the cycle again. Spray-decongestion-rebound-and more congestion.

In infants, this rebound rhinitis can develop in two days, whereas in adults, it often takes several more days to become established. An infant taken off the drops for 12 to 24 hours is cured, but well-established cases in adults often require more than a simple "cold turkey" withdrawal. They need decongestants by mouth, sometimes corticosteroids, and possibly (in patients who continuously have used the sprays for months and years) a surgical procedure to the inside of the nose. For this reason, the labels on these types of nose sprays contain the warning "Do not use this product for more than three days." Nose sprays should be reserved for emergency and short-term use.

The nasal saline is extremely important. Humidification alone has been shown to restore the function of the mucosa (skin) inside your nose. Your sinuses will drain easier, and you can breath easier. You should use this medication at least four times a day and more often if your doctor feels it is necessary. The nasal saline is buffered salt water. You cannot overdose on this medication. Some people buy one spray bottle and refill it as necessary with the 500 ml or one liter bottle of normal saline which you can buy at your pharmacy. If you wish, you can mix your own saline at home. 

(The above description and advice does not apply to the type of prescription anti-allergy nose sprays that may be ordered by your physician.)

A Brief History of the American Academy of Otolaryngology-Head and Neck Surgery and its Foundation

The American Academy of Otolaryngology--Head and Neck Surgery/Foundation traces its roots back to 1896. In that year, in response to an invitation by Dr. Hal Foster, a group of men practicing ophthalmology and/or otolaryngology in the central and southern part of the United States gathered in Kansas City. A two-day program of scientific papers was held followed by the formation of a new society, the Western Ophthalmological, Otological, Laryngological and Rhinological Association.

Over the next 82 years the Association changed its name twice. It also helped establish the first specialty boards in America. First was the American Board of Ophthalmology, created in 1917. In 1924 the American Board of Otolaryngology was established. In addition, the concept of formal instruction courses was introduced during the annual meetings of the Association. These innovations were pivotal factors in the development of continuing medical education in this country.

By 1978, the diverging interests of ophthalmology and otolaryngology had reached a stage where separation seemed inevitable. A planned and orderly separation of the Association was carried out with the formation of two new organizations--the American Academy of Ophthalmology and the American Academy of Otolaryngology.

In 1980, the American Academy of Otolaryngology added Head and Neck Surgery to its name to become the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). This name change reflected the expanded scope of the specialty from ears, nose, and throat to include the head and neck region, e.g. treatment of benign and malignant tumors, cosmetic and reconstructive facial plastic surgery, and upper respiratory allergy and immunology.

In the 1960s the federal government became a new presence in the practice of medicine, especially with the passage of Medicare in 1965. Socioeconomic changes created a need for national representation of the specialty in non-educational issues. In response, the American Council of Otolaryngology (ACO) was formed in 1968. However, the need for the specialty to speak with a single voice resulted in the 1982 merger of the AAO-HNS with the ACO.

The socioeconomic and government relations responsibilities of the Council are carried out by the Academy, and the educational responsibilities of the old Academy predecessor are now the task of the educational Foundation. Today, the American Academy of Otolaryngology-Head and Neck Surgery and its Foundation sponsor continuing medical education, professional meetings, new scientific research, and practice management guidance for more than 11,000 ear, nose, and throat specialists in the United States and abroad. The Academy also monitors all federal medical-related legislation and educates legislators and policy makers about the needs and concerns of otolaryngologists. The Foundation maintains both the John Q. Adams Center for the History of Otolaryngology-Head and Neck Surgery and the National Center for the Promotion of Research in Otolaryngology.

For a detailed history of the Academy and its predecessor organizations, see A Century of Excellence, Loring W. Pratt, MD, Jerome C. Goldstein, MD, Sharon A. Bryan, and T. Susan Hill, Editor. (c) 1996 American Academy of Otolaryngology-Head and Neck Surgery Foundation, ISBN 1-56772-051-X.

The Internet is a powerful tool and an excellent source for all types of information. Many Internet sites contain information about medical conditions and health care.

A good site can provide additional and valuable information about your condition, and enhance understanding of your diagnosis or your treatment. By learning more about your condition, you can spend more time with your physician discussing details of your care and more effectively participate in the medical decision making process.

While the Internet is very useful for finding health care information, it is important to be aware of its limitations and potential risks. Here are some facts to consider:

How do I know if medical information on the Internet is accurate and reliable?

Determining whether health information on the Internet is accurate and reliable can be difficult, even for practicing physicians. Professional appearing sites may contain inaccurate information, or may be biased towards commercial interests that support the site. Meanwhile, unprofessional appearing sites may potentially contain accurate information.

There are several keys to finding and using accurate health care information on the Internet:

How can I access my Otolaryngologist's website?

If a member of the AAO-HNS maintains a practice website, it is listed with his or her address and fax number through the easy-to-use "Find an Otolaryngologist" search engine. Patients can search for physicians in their area using a variety of search options.

Otolaryngology - Fact and Fiction

Test your knowledge of common ear, nose and throat disorders and their treatment.

Question #1: Cotton swabs are a safe and easy way to clean wax from inside your ears.

Answer #1: Fiction!
Remember, never stick anything smaller than your elbow in your ear! When you insert cotton-tipped applicators or tissues in your ear, the wax is just pushed deeper into the ear canal. When wax begins to block your ears (and hearing), seek medical advice. Your doctor may remove the wax, or suggest special wax-softening ear drops.

Question #2: Reading in a moving car can cause motion sickness (make you "car sick").

Answer #2: Fact!
Motion sickness relates to your sense of balance and equilibrium. Your sense of balance is maintained by a complex interaction of your inner ears, eyes, skin pressure receptors, muscle and joint sensory receptors, and the brain and spinal cord. Motion sickness can appear when the central nervous system receives conflicting messages from these four key bodily systems. When you read a book in a moving car, your inner ears and skin receptors detect the motion of travel, but your eyes see only the pages of your book.

Question #3: Hay fever is not caused by hay and does not cause a fever.

Answer #3: Fact!
"Hay fever" is a commonly used term for seasonal allergic rhinitis, which can produce such symptoms as runny nose, itchy eyes and throat, uncontrollable sneezing, and sometimes itching of the skin. Some people have an over-active immune system which identifies normally harmless particles, such as pollens or animal dander, as dangerous. This causes an excessive reaction that actually causes inflammation -- an allergy. The substances causing it are allergens.

Question #4: Tonsils and adenoids filter bacteria out of what we swallow and breathe.

Answer #4: Fiction!
Any filter that could strain out microscopic material would not allow the passage of any food particles and would make eating impossible. Tonsils and adenoids are strategically located near the entrance to the breathing passages where they catch incoming infections. They "sample" bacteria and viruses and can become infected themselves. It is thought that they then help form antibodies to those "germs" as a part of the body's immune system to resist and fight future infections.

Question #5: A person can be trained or conditioned not to snore.

Answer #5: Fiction!
Unfortunately, you have no conscious control over snoring. More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring, including head straps, neck collars and mouth pieces. If these devices work, it is probably because they keep the snorer awake.

Snoring is often a sign of obstructed breathing, and this obstruction can be serious. However, the majority of snorers can be helped through lifestyle changes and medical treatment. Contact an otolaryngologist-head and neck surgeon for a complete evaluation.

Question #6: You can "toughen up" your ears by continued exposure to loud noise.

Answer#6: Fiction!
If you think you have grown used to a loud noise, it has already damaged your ears. When noise is too loud, it begins to kill the sensitive nerve endings in your inner ear. Remember, there is no way to restore life to dead nerve endings; the damage is permanent. Consult an otolaryngologist for appropriate hearing protectors if you work in an excessively noisy environment, or use power tools, noisy yard equipment, or firearms.

Question #7: You should avoid speaking or singing when your voice is hoarse.

Answer #7: Fact!
When your voice is injured or hoarse, you should "rest" your vocal folds, just as you would avoid walking on a sprained ankle. And remember, whispering (instead of speaking) does not rest your vocal folds.

If you are hoarse longer than 2-3 weeks, or have a complete loss or severe change in voice lasting longer than a few days, consult an Otolaryngologist. Prolonged hoarseness may be a sign of a serious health problem requiring medical treatment.

Question #8: You don't have to go swimming to get "swimmer's ear."

Answer #8: Fact!
Whenever water gets into the ear--from swimming, showering, or hair washing-- it can bring in bacterial or fungal particles. Usually, the water runs back out of your ear. But sometimes water is trapped in your ear canal, allowing bacteria and fungi to grow and infect the outer ear.

You may have "swimmer's ear" (otitis externa) if you experience the following symptoms: your ear feels blocked and itches; your ear canal is swollen; your ear drains a runny, milky liquid; or your ear is very painful and tender to touch. If you experience these symptoms, or if your glands become swollen, see your doctor.

AG Bell would like to thank Susan Coffman, Director of Professional Programs and Services from 1986 to 1998, for volunteering her time in writing the first draft of this booklet. Current Director of Member Services Rebecca Parlakian's work in building upon and expanding the original draft has been invaluable as well.

We would also like to thank:

A selected list of organizations follows; for a more complete listing, contact AG Bell directly.

Organizations Serving Parents of Children Using Auditory Approaches:

Alexander Graham Bell Association for the Deaf and Hard of Hearing
3417 Volta Place, NW
Washington, DC 20007-2778
(202) 337-5220 (v)
(202) 337-5221 (TTY)
(202)-337-8314 (fax)

The Alexander Graham Bell Association for the Deaf and Hard of Hearing is an information center on hearing loss, emphasizing the use of technology, speech, speechreading, residual hearing and written and spoken language. AG Bell focuses specifically on children with hearing loss, providing ongoing support and advocacy for parents, professionals and other interested parties.

We publish books and brochures on the subject of hearing loss, auditory approaches in education, advocacy, employment and advances in hearing technology. AG Bell also publishes a magazine, Volta Voices, and a scholarly journal, The Volta Review. We offer resource/referral services to individuals with questions about hearing loss and auditory approaches.

AG Bell provides financial aid to qualifying applicants for mainstreamed, auditory-based education at pre-school, school-age and university levels. Regional conferences and biennial conventions are held to educate both members and non-members on issues relating to hearing loss. Finally, AG Bell provides governmental and education advocacy services through its state chapters, children's rights coordinators and international affiliates.

Auditory-Verbal International, Inc.
2121 Eisenhower Avenue, Suite 402
Alexandria, VA 22314
(703)739-1049 (v)
(703)739-0874(tty)

National Cued Speech Association
23970 Hermitage Road
Shaker Heights, OH 44122
(800) 459-3529

Option Schools (private oral programs)
(877) 672-5332 (v)
(877) 672-5889 (tty)
Interested parents can receive a free copy of "Dreams Spoken Here," a video profiling education using auditory approaches.

Organizations Providing General Information about Hearing Loss:

American Academy of Audiology
8300 Greensboro Drive, Suite 750
McLean, VA 22102
(800) 222-2336 (v/tty)
(703) 610-9022 (v/tty)
(703) 610-9005 (f)
Email: molek@audiology.org

American Academy of Otolaryngology-Head and Neck Surgery
1 Prince Street
Alexandria, VA 22314-3357
(703) 836-4444 (v)
(703) 519-1585 (tty)
(703) 683-5100 (f)
Email: info@entnet.org

American Speech-Language-Hearing Association
10801 Rockville Pike
Rockville, MD 20852
(800) 638-8255 (v/tty)
(301) 897-7355 (f)
Email: actioncenter@asha.org

Cochlear Implant Club International
5335 Wisconsin Avenue, NW Suite 440
Washington, DC 20015-2034
202-895-2781 (v/tty)

National Institute on Deafness and Other Communication Disorders Information Clearinghouse
1 Communications Ave
Bethesda, MD 20892-3456
(800)241-1044 (v)
(800)241-1055 (tty)

Self-Help for Hard of Hearing People
7910 Woodmont Avenue Suite 1200
Bethesda, MD 20814
301-657-2248 (v)
301-657-2249 (tty)
301-913-9413 (f)
Email: national@shhh.org

Organizations Serving Families Using Manual Approaches:

National Association of the Deaf
814 Thayer Avenue
Silver Spring, MD 20910-4500
(301) 587-1788 (v)
(301) 587-1789 (tty)
(301) 587-1791 (f)
Email: nadinfo@nad.org

American Society for Deaf Children
1820 Tribute Road, Suite A
Sacramento, CA 95815
(800) 942-ASDC (v/tty)
(916) 641-6084 (v/tty)
(916) 641-6085 (f)
Email: ASDC1@aol.com

Regional Organizations:

Contact AG Bell to learn which of our more than 30 state chapters are closest to you! Additionally, in most areas of the country there exist specific centers devoted to providing a comprehensive set of services for children with hearing loss. Please contact AG Bell to identify one in your area.

Life cannot be all work! Friends, hobbies, travel, art, sports, family outings, part-time jobs, etc. all make life richer and more interesting.

When it comes to hobbies and extra-curricular activities, follow your children's interests, and don't impose any limits or restrictions. Heather Whitestone, a former Miss America who is deaf, is an accomplished ballet dancer. Her stunning dance performance during the Miss America pageant helped clinch the title for her. Curtis Pride, also hearing impaired, is a professional baseball player. Evelyn Glennie is considered the world's finest concert drummer, and happens to have a hearing loss. The fact that there is an association of private pilots who are deaf is further proof that a hearing loss is not a barrier to one's passions in life. The Americans With Disabilities Act has helped make most public facilities accessible to people with disabilities while advances in technology continue to open doors.

While children should not be limited by hearing loss, they may also enjoy joining groups or involving themselves in an activity primarily for children who are deaf or hard of hearing. Being with other children who have a hearing loss can provide a comfortable communication setting surrounded by people who may have a special camaraderie with one another. AG Bell's national mentoring program and leadership conferences for young adults are designed to facilitate exactly these sorts of interactions. Mentoring activities provide children with opportunities to socialize, as well as to meet successful young adults with hearing loss.

Activities with others who are deaf or hard of hearing

Continue to look to A.G. Bell as a resource providing both you and your child with the best information available on topics ranging from schools offering the auditory approach to hearing technology to summer camps. Take advantage of the wonderful friendships that can be built through our mentoring program, get involved in an AG Bell state chapter and meet other families like yours, become adept at negotiating IFSPs and IEPs by turning to AG Bell for advocacy tips, and join us at our summertime biennial conventions to learn more about innovations in the field of hearing loss.

Most importantly, watch your children grow, explore, laugh and sing and speak-using their own beautiful voices.

In order for your child to have a successful mainstream experience, the whole school - from the principal to the physical education teacher to the students - needs to be involved. Most faculty in your neighborhood school will have had little experience with teaching children with hearing loss, and you will find that the level of enthusiasm for working with your child often depends on the tone set by the principal.

Children should not be placed in a regular neighborhood classroom unless it is fairly certain that they have the skills and background to succeed there. Your child's teacher will need extra support, training, and time to work with auxiliary staff (i.e., a hearing resource teacher, speech/language pathologist). All of the school faculty, including custodians and cafeteria workers, should be alerted well before the new term begins that your child will be entering school. This helps to ensure that your child's academic year goes smoothly.

Before the school year begins, you and your child should meet with the classroom teacher a few times. As children get older, they can meet with the teacher alone. This will provide an opportunity for you and your child to discuss previous academic achievements, strengths and weakness, as well as information about communication techniques, classroom supports, etc. You can also check to make sure that support staff have shown the classroom teacher how to check a hearing aid, use an FM system, order captioned videos and so forth. Throughout the year, it helps if you provide encouragement to the staff, and maintain some "oversight" as the school year progresses.

All of the staff should be aware of how to best communicate with your child, even though they may interact on a limited basis, such as at assemblies, break time or after-school activities. The students need an orientation, too. This can be handled tactfully, giving them a sense of participation rather than making it seem like a burden. Most people want to be helpful, if they know what to do. If your child and the teacher feel comfortable, it is often helpful for the teacher to give a unit on communication awareness, introducing the concept of hearing loss, its effect on communication, and information about exciting technology, such as captioned videos, relay systems and hearing technology. The overall goal for success is to achieve commitment and enthusiasm, emphasizing the fact that good communication techniques will benefit all students, not just the child with a hearing loss.

For more information on partnering with mainstream teachers, contact AG Bell to request a free copy of our brochure titled How to Have a Winning Year Teaching Your Student with Hearing Loss.

There are lots of ways you can make your home communication-friendly for your family and your child's friends. In fact, technology is going to make a huge difference in your child's life, equalizing the playing field between those who have normal hearing and those who do not. One of the exciting aspects is that much of this is "mainstream" technology, used by everyone, not just people with hearing loss.

You probably already have some of this equipment at home. Do you have a computer and access to the Internet? This will become your child's lifeline! Email has become ubiquitous and it is one of the simplest ways for people with and without hearing loss to communicate. Every year millions of people open Internet and email accounts, as the price of computers and Internet services decrease. In fact, people with hearing loss are usually the first to use new services, such as instant messaging or "chat rooms". Additionally, the Internet is a "no hassle" way to conduct research for school projects. There are also computer programs that are excellent for stimulating language and speech skills.

If you have a fax machine, you have another device that is excellent for non-verbal communication. One of the good features of faxes is that you have a "hard copy" of your communication. This way, both parties can be certain they have understood one another, avoiding mix-ups and misunderstandings that can occur in conversations where communication is difficult.

If you have a television set manufactured after 1993 with a screen that is 13 inches or larger, your child has instant visual access to TV. You may have noticed the number of programs that are captioned, designated with a "CC" in every television program guide. Television captioning is similar to the written text line you see running across the bottom of foreign movies. You may have also seen the captioning line used on televisions in noisy places like airports and restaurants.

You will need to use the closed captioning button on your T.V. to access the caption line. Check your T.V. instruction booklet if you are unsure how to activate closed captioning. Older televisions do not have a closed captioned button, but you can buy a separate closed captioned decoder from specialty catalogs featuring assistive devices. However, it may be a better investment to purchase a new television, rather than a caption decoder.

Your child can use a telephone, too. Children with mild-moderate losses, or even severe-to-profound losses (if they are well-aided or have a cochlear implant, and have been taught to use residual hearing), may be able to use the regular telephone. As a first step, ensure that your phone has a volume control option so that your child may amplify the caller's voice as necessary. Also, your child needs a hearing aid with a telephone ("t") switch, and a hearing-aid compatible telephone. Newer phones are all manufactured to be compatible with t-switches. If you have an older phone, your child will have to try it out with the t-switch turned on. Some of the digital wireless phones will emit a loud, squealing sound if used with a "t" switch. If you are going to purchase a digital wireless phone that your child will use, you need to have him/her try it out before committing to the purchase.

A TTY machine can be attached to your regular phone to turn the auditory signal into a visual print-out. In order to use a TTY, your child needs to know how to type and to read. The phone set is not held up to one's ear, but placed on the TTY machine. The person types in the message, and the words are transmitted to the person on the other end who also has a TTY machine. The message is read, one line at a time, on a small screen. There are a variety of TTY machines - some are very small and portable, others are desk units with the capability of printing a "hard copy" of the conversation. TTY machines can be ordered through specialty catalogs.

So, what do you do if the person being called doesn't own a TTY? Thanks to another federal law, the Americans With Disabilities Act, a nation-wide relay system has been set up. The person with the TTY first calls a relay operator. The relay operator gets the second party on the line. Now the person with the TTY starts typing in the conversation. The relay operator reads the message over his/her TTY and relays that message verbally to the second party. The second party answers verbally, the operator types in that message and it is relayed to the person with the TTY. The parties can talk as long as they wish. The rates for long-distance are reduced for relay calls, because they take longer than regular calls. The relay number for your state is located in the front pages of your telephone book.

There are other pieces of equipment that make communication helpful-for example, vibrating pagers with digital readouts, watches with vibrating alarms, visual alarm clocks-and dozens of gadgets and accessories helpful for enhancing communication. Keep your eyes and ears open for new technology and new ways of using existing technology. Consult AG Bell and other organizations serving the deaf and hard of hearing, and send for some of the specialty catalogs on assistive devices. Attend the AG Bell convention to learn more about advances in technology through our technology forums and research symposia.

Classroom support aids enhance the listening and learning environment for your child. Aids can refer to pieces of equipment or strategies for learning. Not all of the support aids listed below are necessary for every child, and some are needed only as your child reaches middle school age. You can work with the classroom teacher to set up a supportive classroom environment for your child. Whatever you and the IEP team decide is important to meet your child's needs, document in writing.

Possible Classroom Support Aids under IDEA for Children who use Auditory Approaches:

Preferential, or favorable, Seating
Sitting close to the teacher or other speakers, in order to optimize listening and visual clues.

Sound Field System
An assistive device that improves listening in noisy or reverberant environments (like classrooms). Like a mini loud-speaker system, a sound field system amplifies the decibel level of a teacher's voice. Small speakers in the classroom bring the enhanced loudness to all students. Teachers enjoy using the sound field system because it saves wear and tear on their voice.

FM System
An assistive device that improves listening in noisy environments (like classrooms). The teachers voice is transmitted by a microphone worn on his/her lapel via radio waves to the student, who receives the sound through a receiver that connects to the child's hearing aids or cochlear implant. For most children in the mainstream, an FM system is an important supplement to hearing aids and cochlear implants. Can be provided by the school for classroom use.

Note taker
A person with normal hearing takes classroom notes for the student; often the note taker is another classmate with good note-taking skills. Note taking becomes increasingly important at the middle school level.

Captioned Videos
A caption line, similar to printed English subtitles. Captioned videos can be played on any T.V. manufactured after 1993, or with older sets using a separate device called a closed caption decoder. Teachers need to check that videos are captioned; unfortunately, most videos are not and it is very difficult for anyone with a significant hearing loss to follow an uncaptioned video. For help in finding these captioned videos, see the reference section.

Oral Interpreter
A qualified professional who serves as a link between the speaker and the student. The oral interpreter silently mouths the words of the speaker, augmented with natural gestures. Supports understanding with the use of these strong visual cues. OI is usually introduced at the middle school level. The student has the right to the provision of an oral interpreter; however the lack of trained OIs limits availability. The school may need to train someone to provide this service.

C-Print Captioning
C-Print is a speech-to-print system in which a hearing captionist (transcriber) types the words of the teacher and other students as they are being spoken into a lap-top computer. Students who are deaf or hard of hearing can read these real-time exchanges on a second lap-top computer or TV monitor. Additionally, the text file is stored and can be edited, printed and distributed to students after class. C-Print is designed to replace both interpreters and notetakers in the classroom. Contact AG Bell to learn more about C-Print.

Cued Speech Interpreter
A qualified professional who serves as a link between the speaker and the student. The cued speech interpreter silently mouths the words of the speaker and simultaneously uses handshapes to cue the child as to what sounds are being spoken. Students have the right to a cued speech interpreter; however the lack of trained CSIs limits availability. The school may need to train someone to provide this service.

Acoustical Improvements
This refers to minor changes/additions to classrooms designed to reduce ambient noise; acoustical improvements include: carpeting, acoustic ceiling tiles, double-paned windows, installation of a lower, sound-absorbing, suspended ceiling in older, higher-ceiling classrooms, use of thick draperies at windows, elimination of background music, rubber tips on chair, table and desk legs, repair of heating/cooling/ventilation-associated noise, and avoidance of open-plan classrooms.

Real-time captioning
"Real-time" (instant) transcription of speech by a real-time captioner (someone using courtroom stenographer equipment). The real-time captioner enters the lecture or classroom dialogue into a computer which shows up on a video screen or laptop computer which the student then reads. Currently the cost of classroom transcription is high and some schools oppose its use for this reason. However, a number of parents have been successful in obtaining its use in the classroom.

Master the Special Education Maze

Every child with a disability enrolled in the public school system is guaranteed a free, appropriate education under a federal law called the Individuals with Disabilities Education Act (IDEA). Federal law stipulates that the education be individually tailored to the child's needs. Unlike regular education where "one curriculum fits all", IDEA specifies that special education must be individually tailored to your child's needs. The law also stipulates that the student should be placed in the "least restrictive environment." The meaning of "least restrictive environment" has been a source of debate and controversy since IDEA was passed. To some it simply means an environment where a child is most likely to thrive, but to others it denotes an environment most similar to the regular classroom and regular curriculum. Either definition may be applicable. For example, students who are able to compete in a regular classroom (usually with support through tutors, speech/language therapy, etc.) may be best prepared to enroll in higher education or compete in mainstream society. On the other hand, a child who attends a small private school for hearing-impaired children (i.e., a restricted environment) may blossom with the individual attention and support.

In theory, children's special education services are supposed to be tailored to their needs. In practice, children are apt to receive a generic set of services based on their disability, rather than on their individual strengths and weaknesses. As a result, parents must be aggressive in requesting accommodation for their child(ren). Unfortunately, schools have been known to discourage the use of technology or other supports that would help a student with hearing loss due to their financial cost. However, unlike general education, special education allows parents to have some say in their child's educational programming and supplementary services. You can help your child receive appropriate educational services, if you know what to ask for. Before you can influence your child's educational program, however, you must master the special education maze, and learn to play under the special education rules. For example, you may request a particular service for your child, and the school may agree on it; however, if it does not appear in writing in your child's special education plan, your request may not be legally binding.

The foundation of your child's education is the Individualized Education Plan, known as the IEP. An IEP is a legal, written plan that specifies special education and related services necessary to meet the individualized needs of a student with a disability. You must become familiar with the IEP process, and the way an IEP plan is written. You can influence your child's education through your participation in this process.

Either the school or the student's parent(s)/guardian(s) may request an IEP meeting. The meeting occurs at a mutually convenient time and place. Those attending will share the results of your child's evaluation and discuss its findings. Parent(s)/guardian(s) will have an opportunity to ask questions.

The Report of the Commission on the Education of the Deaf provides that an IEP for a child who is deaf or hard of hearing should consider the following:

  1. The student's communication needs;
  2. The family's preferred mode of communication;
  3. The student's linguistic needs;
  4. The severity of the student's hearing loss and his or her potential for using residual hearing;
  5. The student's academic level; and
  6. The student's social, emotional, and cultural needs.

The IEP must include plans for behavioral intervention and discipline as well as a statement of the supplementary aids and services needed in regular education classes. The IEP becomes effective as soon as possible following the meeting. Reviews of the IEP must be conducted at least on an annual basis but you will likely want more frequent reviews if it appears that your child's needs are not being met. As a parent, you are not required to sign the IEP. You have the right to refuse services if you determine them to be inappropriate. The school district can then go to a hearing, or you as a parent can request a hearing.

For more information about the IDEA, contact AG Bell and request a free copy of our brochure titled A Great IDEA: I.D.E.A., the I.E.P. Process and Your Child.

Some Things You Never Want to See in an IEP:

  1. Progress made on the current IEP is not documented.
  2. No information is given about the student's level of performance.
  3. Too many goals are listed (four or five are usually enough).
  4. Objectives are vague and immeasurable.
  5. The same goals are repeated year after year.
  6. Amounts and types of services needed, such as speech-language therapy, are not specified.
  7. Goals are unrelated to curriculum or to activities.
  8. Placement is determined before needs are established.
  9. A regular classroom is not considered as an option.
  10. Goals are written for school staff rather than for the student.

A poorly written IEP can lead to vague programming and lack of accountability. (Source: COPE, 300 I St. N.E. Washington, DC 20002.)

School systems use a number of systems of communication for children who are deaf or hard of hearing. As a parent, you will find the information on communication options often conflicting and confusing, and one of your most difficult tasks will be to decide on the best option for your child. This may, in part, be dictated by what is available in your community. Large metropolitan area may offer several options.

Auditory/Oral - These programs teach children to make maximum use of their residual hearing through amplification (hearing aids or cochlear implants), to augment their residual hearing with speech (lip) reading, and to speak. This approach excludes the use of sign language. The philosophy behind the Auditory/Oral method is to prepare children to work and live in a predominately hearing society.

Auditory/Verbal - The auditory/verbal approach is similar to the auditory/oral approach, except it does not encourage lip-reading. This method emphasizes the exclusive use of auditory skills through one-on-one teaching. It excludes the use of sign language, while emphasizing the importance of placing children in the regular classroom ("mainstream education") as soon as possible.

Cued Speech - This is a visual communication system combining eight handshapes (cues) that represent different sounds of speech. These cues are used simultaneously with speaking. The hand shapes help the child distinguish sounds that look the same on the lips-such as "p" and "b". The use of cues significantly enhances lip-reading ability. It is a particularly good system for a child who may not be able to learn entirely though amplified hearing.

Total Communication - Total communication uses a combination of methods to teach a child, including a form of sign language, finger spelling, speech reading, speaking and amplification. The sign language used in total communication (SEE sign) is not a language in and of itself, like American Sign Language, but an artificially-constructed language following English grammatical structure.

American Sign Language (Bilingual/Bicultural) - In this method, American Sign Language is taught as the child's primary language, and English as a second language. American Sign Language is recognized as a true language in its own right and does not follow the grammatical structure of English. This method is used extensively within the Deaf community, a group that views itself as having a separate culture and identity from mainstream society.

If you feel confused at this point, you are having a normal parental reaction! Ninety percent of parents who have a child with a hearing loss possess normal hearing themselves. Your knowledge of hearing loss probably extends to having seen it profiled occasionally on television or in the movies. The variety of educational options may make little sense to you right now. Which education methodology should you choose for your child? Should you enroll your child in the public program or with a private therapist or in a private school?

These decisions will be clearer after you've done some homework. As you gain knowledge, the right decision for you and your family will be clearer. We suggest that you take the following steps to help in gathering information in order to make an informed decision:

  Communication Options Checklist  
  Available in my Community? My Impression
Auditory - Oral    
Auditory - Verbal    
Cued Speech    
Total Communication    
American Sign Language    

Perhaps you have decided on an educational option that is not available in your community, or does not seem to have quality staffing and programming. If so, are you willing to relocate? As your child gets older, would you consider a residential program?

Most states offer early intervention parent/infant programs through the local school system for parents and children with disabilities up to age three. These programs are free of charge as required by federal law. The school system evaluates your child and then develops a plan with your family for your child based on the evaluation. This plan is named the Individual Family Service Plan, or IFSP.

A good parent/infant program provides consultation on acquiring hearing aids and assistive listening devices, parent counseling, explanation of the various communication options for children with hearing loss, and training in the communication option selected on the advice of professionals and the preference of the family. It is important to note that under these federally mandated parent/infant programs, parents are entitled to help select the communication option for their child. The emphasis in these programs is on working with the family unit, not just the child with the hearing loss.

In addition to the public school, there may be a private parent/infant program for children with hearing loss in your community. If you are interested in privately run programs emphasizing oral communication, contact AG Bell for more information.

When children turn three, they are ready for transition to a pre-school program. Transitions from one school program to another can be bumpy. Remember your first day in kindergarten? Or your first day of high school? This experience will be even more intense for you child with a hearing loss. Preparation in the form of visiting the new program, working with your current IFSP team to prepare for the transition, and having a clear idea of what you are looking for in a quality educational program will help smooth this passage for you and your child.

To help parents evaluate educational programs, AG Bell's Public School Caucus published guidelines of what constitutes an ideal program for children pursing some form of an oral option. AG Bell has many publications on this subject and frequently includes related articles in its bi-monthly magazine for members, Volta Voices. For information about educational programming for children pursuing forms of manual communication, (i.e., Bilingual-Bicultural or Total Communication), contact the National Association of the Deaf or the American Society for Deaf Children.

AG Bell's guidelines outline eleven components of an ideal program for children who are learning to use, maintain, and improve all aspects of their verbal communication to the greatest extent possible. A summary of these guidelines follows. For a complete set of these guidelines, contact AG Bell.

Guidelines for an Auditory Education that Works

  1. Obtain an Individualized Education for Your Child:
    A commitment to individualizing educational programming to fit the child's strengths and needs, including initial and on-going assessment, goal-setting, and documentation of progress-all with parental involvement.
  2. Commit to Aggressive Audiological Management to Promote the Use of Residual Hearing:
    The education program, school or district will have immediate access to audiological services which must include periodic audiological testing, assurance that the student is wearing appropriate hearing aids and/or other assistive devices, teacher/parent education regarding the use of amplification, daily monitoring of hearing aids in the classroom, easy and fast access to minor repair services, and availability of batteries, loaner aids, and FM systems.
  3. Maximize the Development of Spoken Language:
    A commitment to helping children with hearing loss develop intelligible spoken language to the greatest extent possible.
  4. Provide Support and Guidance to Parents:
    A commitment to providing support to parents through constant communication from the program's leaders and staff. This should include information on all aspects of hearing loss, opportunities for parents to share feelings and experiences with other parents, and informing parents of their rights.
  5. Employ Superior Educational Staff:
    A commitment to hiring and retaining well-trained, well-supported, available staff. Teachers, audiologists and speech-language pathologists should have appropriate licensing and/or certification in their area of expertise.
  6. Offer Options in Educational Settings:
    A commitment to providing a range of available educational settings including: full-time regular class; full-time regular class with supportive services; part-time regular class/part-time special class; full-time special class in a regular school; full-time special class in a special school; residential/day school; home or hospital services.
  7. Adhere to IDEA:
    A commitment to placement in one of the above settings that is in full compliance with all of the rules and regulations set forth by state law under the Individuals with Disabilities Education Act.
  8. Provide Services to Parents and Families:
    A commitment to providing a range of support services; examples include:
  9. Offer a Curriculum Mirroring (as closely as possible) the Mainstream Classroom:
    If the child is not enrolled in a regular classroom, a commitment to teaching a curriculum that is similar to that presented in the regular classroom.
  10. Ensure an Environment that Fosters Learning:
    A commitment to ensuring a physical environment conducive to listening and speech reading. That environment should be quiet, acoustically favorable, well-lit and equipped with assistive listening devices.
  11. Select Informed and Sensitive Teachers in Mainstream Settings:
    If a child is in the regular classroom, a commitment to providing teachers with a thorough orientation in working with children with hearing loss, and to offering teachers with assistance from, and access to, specialists in the field.

Two main types of electronics are used in hearing aids:

  1. Analog/Conventional-Your audiologist determines the volume and other specifications your child requires in a hearing aid and a laboratory builds an aid to meet these needs. This is generally the least expensive type of circuitry.
  2. Analog/Programmable-Your audiologist uses a computer to program your child's hearing aid. This circuitry can accommodate more than one program so that your child can change the program to receive better sound across different listening conditions.
  3. Digital/Programmable-Your audiologist uses a computer to program your child's hearing aid and can adjust the sound quality and response time on an individual basis. Digital hearing aids use a computer chip and, as a result, offer the most flexibility to your audiologist in making adjustments. Digital hearing aids also offer a number of settings that allow the user to manipulate the amplification of incoming sound in specific frequencies where it's difficult to hear. Digital circuitry is the most expensive of the above options.

Most of the time, two hearing aids are recommended for your child. Research studies on adults have shown that those people who have a hearing loss in both ears, but habitually wear only one aid, lose the ability to recognize speech in the other ear. This phenomenon is known as "auditory deprivation." Once the ability to recognize speech has been lost, it cannot be restored. If your child has a hearing loss in both ears, using two hearing aids prevents auditory deprivation and helps your child to localize sound and to hear better even in noise.

Hearing aids are expensive, so you will want to understand exactly your audiologist's terms of purchase. You will also want to know whether your audiologist has a variety of hearing aids for your child to try. Some good questions to ask your audiologist are found in the sidebar. While a few insurance companies include coverage of hearing aids, most exclude them. Check your policy before purchase. Some families have been successful in urging their employers, or lobbying insurance companies directly, to offer such coverage.

What can you do if you cannot afford hearing aids? Under the federal law supporting special education (entitled the Individuals with Disabilities Education Act, or IDEA) if your child is already enrolled in a public school education program. You will find further information about IDEA and special education later in this document.

For more information on hearing aids, see the AG Bell What are Hearing Aids online brochure.

If your child receives negligible benefit from hearing aids after wearing them for a reasonable time, has a severe-profound hearing loss, and is at least 18 months of age, he/she may be a candidate for a cochlear implant. At this writing, the desirability of earlier implantation is being considered and some research centers have begun implanting earlier.

A cochlear implant is an electronic device designed to provide sound detection as well as improved speech understanding and speech production. The cochlear implant is surgically implanted in the ear. It bypasses the damaged parts of the ear and sends electrical "sound" directly to the hearing nerve (the auditory nerve). Research suggests that implantation during the critical ages for speech and language development (between 2 and 5 years), is important for obtaining the best results. The earlier a child can be implanted within this "window of opportunity", the greater the likelihood that he/she will make optimal use of a cochlear implant and achieve good speech and hearing results. However, researchers are still not able to predict how well an individual child will do following a cochlear implant.

The surgery takes two to three hours and can be undertaken on an outpatient basis or, at most, an overnight stay. The procedure is covered by most insurance companies. For an eligible child with a severe-to-profound hearing loss, cochlear implantation can significantly improve a child's success with speech development and listening but only if parents are highly motivated, and there is a quality follow-up program available. The literature on cochlear implants is extensive. Additionally, there are a number of informative Web sites addressing all aspects of cochlear implantation.

For more information on cochlear implants, contact AG Bell to request a free copy of our brochure titled Kids and Cochlear Implants: Getting Connected. In addition, many books and informational materials are available from the AG Bell Publications department.

Will My Child Need Early Intervention?

All children with hearing loss require some degree of educational and rehabilitative intervention. Any level of loss can create challenges for a child, especially in an academic environment. Even a child with a mild to moderate loss-provided it goes undetected or untreated- has a higher likelihood of repeating a grade than does a child with normal hearing.

Mild Loss: A child with a mild loss may have subtle problems that are not obvious either to parents or teachers. In fact, in the past, mild hearing losses have generally been overlooked as a significant factor in a child's speech and language development or academic performance. Recent studies, however, debunk this myth. A child with a mild loss will benefit from favorable acoustics, hearing aids and/or a personal FM system. Soundfield amplification may be helpful if the classroom is noisy or reverberant (echoes). Favorable seating and lighting, as well as ongoing monitoring of language and speech development, is important as well. Depending on the level of loss, your child may benefit from speech-language therapy and speechreading skills.

Moderate Loss: A child with a moderate hearing loss will benefit from routine audiological evaluations and ongoing monitoring of speech and language development, reading, and written language. Amplification-hearing aids and assistive devices such as personal FM systems-are imperative. Classroom acoustics should also be addressed. A child with a moderate loss will benefit from speech-language therapy to work on any language delays or difficulty in pronouncing certain sounds. If your child is not yet school age and is showing speech and/or language delays, a parent-infant or preschool program with special emphasis on developing these skills is recommended.

Severe to Profound Loss: Children with severe or profound losses should be enrolled in a parent/infant program that addresses their specific needs as soon as possible. These types of programs are outlined in the next section. When school age, children in this category need ongoing monitoring of speech and language progress and routine audiology checks. Hearing aids and assistive listening devices (like FM systems) are essential, as is a favorable acoustical environment. Your child may also benefit from the use of an interpreter and/or note taker in the classroom.

Early detection simply means discovering a hearing loss at a very early age—hopefully in the first few days of life. Advances in research and technology have created the means for this to happen. Previously, children's hearing could only be tested by observing a child's behavioral responses to sounds. Today's automated hearing-screening machines do all of the work, so even a sleeping baby's hearing can be measured. Many hospitals now screen a newborn's hearing before he/she is discharged from the hospital. (The sidebar describes the types of hearing tests used with infants and young children.)

These early exams are referred to as "screenings" rather than "tests", because their results are not definitive. They can only screen out those babies who are likely to have a hearing loss from those likely not to have a hearing loss. If an initial screening comes back "positive", then a second screening and follow-up testing are performed to confirm whether a hearing loss is present and, if so, the type and nature of the loss.

In the hospital, nurses, aides, or other hospital personnel may do the screening, but the test interpretation and follow-up evaluation should be performed by an audiologist (i.e., someone with an advanced degree and appropriate licensure/certification in evaluating hearing). If a hearing loss is suspected, your pediatrician should refer your child to an ear, nose and throat doctor (Otolaryngologist), to rule out any cause of hearing loss which could be medically or surgically corrected. Some parents also decide to seek genetic counseling because, of the many causes of hearing loss, some are hereditary. You may want to know whether you or your spouse carry a gene for hearing loss, or whether the hearing loss is part of a "syndrome" (cluster of symptoms), which may cause related medical problems.

The next step after the diagnosis is to find an audiologist whom you feel comfortable with, and who you feel confident will help you manage your child's hearing loss. It is entirely within your rights to "shop" for an audiologist by scheduling initial meetings with several practitioners. You can locate audiologists in your area by asking for referrals from your pediatrician and/or Otolaryngologist, as well as by asking other parents of children with hearing loss who they use. When seeking an audiologist for your child, inquire whether your practitioner has experience working with pediatric patients and be sure to observe during your initial visits his/her level of rapport with your child. The American-Speech-Language-Hearing Association (ASHA) can refer you to an audiologist in your area via their Consumer Helpline (800-638-8255).

How Young Children's Hearing is Screened and Evaluated

Newborns and infants can be tested without their cooperation. There are two commonly used measures-both can be performed on a sleeping infant-that require no response from your baby and are not painful or uncomfortable.

There are three main types of hearing aids. Behind-the-ear hearing aids are used most frequently in infants and children.

  1. Behind the ear (BTE) hearing aids, not surprisingly, fit behind your child's ear. They are frequently used with pediatric patients as they tend to be most compatible with the physical characteristics of infants and young children. Additionally, a mini-FM system can be used in combination with BTEs to improve a child's ability to hear speech. BTEs are connected to earmolds, which are pieces of soft plastic custom-made to fit your child's ear. Earmolds help keep the hearing aid in place and provide the channel through which sound is delivered into the ear canals. As with clothing and shoes, children do outgrow their earmolds and will need to have them replaced once or twice per year. Infants' earmolds, however, will need to be replaced about once every two months due to your child's rapid growth across his or her first year. One symptom of children outgrowing their earmolds is the presence of "acoustic feedback". When the earmold isn't fitting well, sound will be able to escape the ear canal and will be re-amplified by the hearing aid microphone, producing feedback in the form of a high-pitched squealing sound.
  2. In the ear (ITE) hearing aids fit completely in the outer ear. The case, which holds the components, is made of plastic and must be replaced as the ear grows. For this reason, ITE aids are not used frequently with young children. This style of hearing aid is used most frequently for those with mild to severe hearing losses.
  3. In the canal (ITC) hearing aids fit into the ear canal and are customized to fit the size and shape of the user's ear canal. Like ITE aids, ITC aids must be replaced as the ear grows and, as a result, are not often selected for pediatric use. Like ITE aids, ITC aids are employed most frequently for mild to moderately severe hearing loss. The small size of both ITE and ITC aids make them difficult to adjust and/or to remove for young children.
  4. On the horizon: Implantable hearing aids (IHAs) comprise both bone-anchored hearing aids (BAHAs) and middle ear implants (MEIs). A BAHA is useful for those with either congenital atresia of the ear canal or chronic middle ear dysfunction (typically chronic otitis media) that prevents the optimal use of conventional hearing aids. Many of the candidates for a BAHA are those who have used bone conductors worn on the scalp with a spring-loaded device that exerts pressure on the skin. The BAHA offers a level of sensitive hearing not achievable with these conventional bone conductors. The FDA has approved the use of BAHAs for all age groups, including children as young as 2 years. The long-term experience with use of the BAHA in Sweden and England suggests that the device may be a preferred alternative to surgery to open the ear canal or repair the middle ear mechanism, particularly in children with the Treacher-Collins or Goldenhaar syndrome. MEIs are used for persons with purely sensorineural hearing losses.

Parents' Hearing Aid Survival Kit

  1. Hearing aid battery tester-to check the battery level each day
  2. Hearing aid stethoscope-to perform a daily listening check
  3. Forced-air stethoscope-to remove moisture and ear wax from the sound channel of the earmold
  4. Hearing aid dehumidifier-to store hearing aids overnight
  5. Earmold lubricant-to facilitate earmold insertion and reduce the likelihood of acoustic feedback
  6. Earmold disinfectant-to keep your child's ears healthy and happy!

So Your Child has a Hearing Loss: Next Steps for Parents

Your child with a hearing loss can succeed - in school, in work, and in life! It is important to keep this as your focus, whatever your child's age or degree of hearing loss. While you will have the support of many professionals, ultimately you as parents will make many decisions about what is in the best interest of your child. As with all children, there is no magic formula for raising a child with a hearing loss. It helps to maintain a positive attitude, educate yourself about hearing loss, seek out the best resources, and take an active role in your child's education. Most of all, keep in mind that your child is a child first, and a child with a hearing loss second.

This online booklet is written for parents of children of all ages and all degrees of hearing loss. With so much to cover, the information presented here is only a brief overview, supplemented with a variety of reference and resource materials so you can follow up on subjects more thoroughly. In addition, you are encouraged to join the Alexander Graham Bell Association for the Deaf and Hard of Hearing for access to a huge variety of resources, including educational programs for you and your child, a large inventory of books and other publications, video tapes, conferences, and a national support network.

Will your child have a "normal" life? While some mild-moderate losses can be surgically or medically corrected, most hearing loss is a permanent condition. Thus, your child's life will have its challenges. However, these challenges sometimes turn into advantages. For example, the ability to work hard and concentrate more, coupled with the routines of audiologic and language therapy, frequently produces children who are self-disciplined and focused. Moreover, the outcomes for children with hearing loss have greatly improved in the last two decades due to major advances in technology and emphasis on programs of early detection and early intervention.

Emotional Impact of the Diagnosis: Parents can benefit from counseling and support after the diagnosis of hearing loss. Grief, anger, fear and denial are natural responses for hearing parents to feel when they find out their child has a hearing loss. Their expected "normal" child has a problem and this problem is going to present many challenges. We convey love through our words and tone of voice as well as through hugs and kisses. We soothe a child through the sound of our voice, or by singing a lullaby. We teach children that the objects in their room, their toys, their food, and the people around them all have names. We show children how to pronounce words by our example. We discipline and warn children of danger through words as well as actions. How are we going to do this now?

Deaf parents of deaf children are not necessarily prone to grief because they are already familiar with living in a world without sound. Deaf parents may feel more comfortable with a child who is deaf, because this seems natural. But this isn't the case for most hearing parents, who probably know little or nothing about hearing loss and who may never have known a child with a hearing loss. Many deaf parents will teach their child sign language as naturally as hearing parents unconsciously teach their child to speak. But hearing parents must commit themselves to the goal of helping their child listen and speak in order to participate fully in a hearing world, or the equally arduous task of becoming fluent in sign language and learning about Deaf culture.

Grief is a common emotion and an honest expression of disappointment and fear of the unknown. Grief that is not acknowledged or dealt with can lead to denial of a child's problem, which in turn can lead to procrastination in taking constructive action. Unacknowledged grief can lead to unfocused and displaced anger on the part of parents that can last a lifetime. Acknowledging grief, painful as it may be, will clear away anger and denial, allowing parents to most effectively nurture their child.

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.

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:

In the last decade, advances in molecular biology and genetics have contributed substantially to the understanding of development, function, and pathology of the inner ear. Researchers have identified several of the various genes responsible for hereditary deafness or hearing loss, most notably the GJB2 gene mutation. As one of the most common genetic causes of hearing loss, GJB2-related hearing loss is considered a recessive genetic disorder because the mutations only cause deafness in individuals who inherit two copies of the mutated gene, one from each parent. A person with one mutated copy and one normal copy is a carrier but is not deaf. Screening tests for the GJB2 gene are available for at risk individuals to help them determine their risk of having a child with hearing problems.

I don't hear well. What should I do? What should I expect?

Because some hearing problems can be medically corrected, first visit a physician who can refer you to an Otolaryngologist (an ear, nose, and throat specialist). If you have ear pain, drainage, excess earwax, hearing loss in only one ear, sudden or rapidly progressive hearing loss, or dizziness, it is especially important that you see an Otolaryngologist. Then, get a hearing assessment from an audiologist. A screening test from a hearing aid dealer may not be adequate. Many otolaryngologists have an audiologist associate in their office who will assess your ability to hear pure tone sounds and to understand words. The results of these tests will show the degree of hearing loss and whether it is conductive or sensorineural and may give other medical information about your ears and your health.

Conductive Hearing Loss

A hearing loss is conductive when there is a problem with the ear canal, the eardrum and/or the three bones connected to the eardrum. Common reasons for this type of hearing loss are a plug of excess wax in the ear canal or fluid behind the eardrum. Medical treatment or surgery may be available for these and more complex forms of conductive hearing loss.

Sensorineural Hearing Loss

A hearing loss is sensorineural when it results from damage to the inner ear (cochlea) or auditory nerve, often as a result of the aging process and/or noise exposure. Sounds may be unclear and/or too soft. Sensitivity to loud sounds may occur. Medical or surgical intervention cannot correct most sensorineural hearing losses. However, hearing aids may help you reclaim some sounds that you are missing as a result of nerve deafness.

How expensive are hearing aids?

Hearing aids vary in price according to style, electronic features, and local market conditions. Price can range from many hundreds of dollars to more than $2,500 for a programmable, digitalized hearing aid. Purchase price should not be the only consideration in buying a hearing aid. Product reliability can save repair costs and the frustration of a malfunctioning hearing aid.

What kinds of hearing aids are available?

There are several styles of hearing aids:

Hearing aid options, which are appropriate for your particular hearing loss and listening needs, the size, and shape of your ear and ear canal, and the dexterity of your hands will all be considered in deciding what type of hearing aid is the best for you. Many hearing aids have special telecoil "T" switches to aid in use of the telephone and certain public sound systems. Discuss your need for a T-coil switch while you are considering hearing aid options.

Will I need a hearing aid for each ear?

Usually, if you have hearing loss in both ears, using two hearing aids is best. Listening in a noisy environment is difficult with amplification in one ear only, and it is more difficult to distinguish where sounds are coming from. If, however, the quality of hearing in one ear is very different from the other, one hearing aid may be better than two.

What other questions should I ask?

What will happen at my hearing aid fitting?

How should I begin wearing the aids?

Hearing aids in their various forms have provided needed amplification of sound for many persons experiencing hearing loss. Explore the virtual exhibit