Otolaryngology

Otolaryngology (pronounced oh/toe/lair/in/goll/oh/jee) is one of the oldest medical specialties in the United States. Otolaryngologists are physicians trained in the medical and surgical management and treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structures of the face and head and neck. They are commonly referred to as ENT physicians. Their special skills include diagnosing and managing diseases of the sinuses, larynx (voice box), oral cavity, and pharynx (mouth and throat), as well as structures of the face and neck. Otolaryngologists diagnose, treat, and manage specialty-specific disorders as well as many primary care problems in both children and adults. Otolaryngologists treat the following medical conditions:

The Ears-Hearing loss affects one in ten North Americans. The unique domain of otolaryngologists is the treatment of ear disorders. They are trained in both the medical and surgical treatment of hearing, ear infections, balance disorders, ear noise (tinnitus), nerve pain, and facial and cranial nerve disorders. Otolaryngologists also manage congenital (birth) disorders of the outer and inner ear.

The Nose-About 35 million people develop chronic sinusitis each year, making it one of the most common health complaints in America. Care of the nasal cavity and sinuses is one of the primary skills of otolaryngologists. Management of the nasal area includes allergies and sense of smell. Breathing through, and the appearance of, the nose are also part of otolaryngologists expertise.

The Throat-Communicating (speech and singing) and eating a meal all involve this vital area. Also specific to otolaryngologists is expertise in managing diseases of the larynx (voice box) and the upper aero-digestive tract or esophagus, including voice and swallowing disorders.

The Head and Neck-This center of the body include the important nerves that control sight, smell, hearing, and the face. In the head and neck area, otolaryngologists are trained to treat infectious diseases, both benign and malignant (cancerous) tumors, facial trauma, and deformities of the face. They perform both cosmetic plastic and reconstructive surgery.

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Functional Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is the most common type of surgery for chronic sinus inflammation. FESS is performed using a small rigid endoscope inserted through patient's nostril to open the natural ventilation and drainage areas of sinuses. (An endoscope is a tube with a camera and light at the end) This relieves sinus pressure pain and headache as well as congestion, improves nasal breathing, removes polyps or other growth in the nose when present, and often enhances sense of smell and taste. FESS is minimally invasive, which means that it is done without an open skin incision and is much less invasive than older surgery methods. 

Serious complications are very rare with FESS, but not risk-free. It is critical to have a CT scan of your nose and sinus structures before your surgery, since nose and sinus anatomy varies somewhat from person to person.

Overall, FESS has improved the sinus surgery, thus sinus symptoms in 90 percent of patients, because it offers the following advantages:

• Minimally invasive
• Shorter recovery times
• Reduced risk of infection and bleeding
• Less scarring
• Decreased postoperative pain

Even though FESS has an excellent chance of improving your symptoms, you still may need ongoing medical therapy to control underlying causes of inflammation, depending on the original reason for your sinus surgery.

Septoplasty

Nasal obstruction is usually easily repaired via outpatient septoplasty and/or partial turbinectomy. These outpatient operations straighten deformed or twisted cartilage inside the nasal septum, and reduce the bulk of the tissues that line the inside of the nose. Rhinoplasty is offered to repair cosmetic deformities of the nose, caused by trauma or congenital irregular growth. Children may require adenoidectomy to solve the breathing problem. Adults may benefit from an in-office technique (Coblation) to shrink the turbinates under local anesthesia.

Turbinate Reduction Surgery

Enlarged inferior turbinates are often the cause of chronic nasal congestion. Even after the underlying problem is addressed, such as chronic infection or allergy, the enlargement may remain. There are various ways to reduce the size of the turbinate, from radiofrequency ablation (coblation) done in the office under local anesthesia (no down time for the patient), to submucous resection or even partial turbinectomy done in the operating room as an outpatient. Each has advantages and disadvantages over the other choices. The best approach for each patient would be discussed at the time of the office visit.

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Stuffy Nose

Congested sinuses, trouble breathing, sore throats, bouts of asthma and bronchitis - with so many of the ENT complaints possibly caused by allergy, diagnosis of allergic rhinitis is integral part of otolaryngology practice. Some histories are classic for allergy; others are buried behind years of inconsistent symptoms and inadequate therapies. When the pieces of the allergy puzzle begin to fall into place, thorough testing and treatment will be offered, often employing the super efficient skin-endpoint-titration testing, and always covered with the most effective and least sedating of medicines.

Hearing Loss

The young and the old suffer the most from decreased hearing, children from chronic infections and adults from age-related nerve loss. Both can be very annoying; both need proper evaluation and treatment. More annoying, perhaps, even frightening, are Vertigo and Imbalance, which plague many of our senior citizens, but can strike people of any age. Our facility offers full audiological evaluation and treatment for all ear related diseases. Our audiologist is an expert in helping patients select the proper hearing aids when there is no other way of improving the hearing.

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Hearing Aids

Hearing aids are a common non-invasive treatment option for hearing loss.  A hearing aid is a small electronic device that is worn in or behind your ear and amplifies sounds so they can be heard better and listening and communicating with others is made simpler.  The device consists of a microphone, amplifier and speaker.  The sounds are received through the microphone and then increased in power by the amplifier, which then sends the signals to the ear through a speaker. 

Hearing aids magnify sounds based on the severity of a patient's hearing loss.  Hair cells within the ear detect these magnified sounds and convert them into signals to pass to the brain.  There is a limit on how much amplification can be given to sounds, so hearing aids are not for everyone.

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Vocal Cords

The Vocal Cords play a key role in diagnosing and treating the common complaints of voice change, trouble swallowing, and a sense of acid burn in the stomach or throat. Fiberoptic laryngoscopy, performed painlessly in the office, helps diagnose and treat the many conditions that can affect voice, swallowing, and comfort of the lower throat. A number of different conditions can cause hoarseness, including cancer of the vocal cords and spilling of stomach acids into the throat. Endoscopic exam is critical in making the correct diagnosis and planning the proper treatment.

Sleep Disorders

Poor sleep affects more and more people, possibly an unhappy side effect of the increasing obesity in America. The most common complaints include insomnia, snoring, and sleep apnea. Apnea involves obstructive breathing, with heavy snoring, tossing and turning through the night, and feeling tired through the day. "If I could just get another hour of sleep!"

Unhappy spouses often cannot sleep in the same room as the snorer. Many patients obtain help non-surgically with medicines, a change of sleep habits, weight loss, oral devices, and use of pressure-masks (CPAP). But a number of patients cannot tolerate CPAP or refuse it, and have surgically correctable conditions in their nose and throat.

Procedures for sleep apnea are outpatient based and range from nasal septoplasty and turbinectomy, to palate reconstruction (which may include tonsillectomy and adenoidectomy), and may also involve simple procedures to shrink fullness at the back of the tongue. Careful exams are performed to pinpoint the exact problem in each patient, and for adults sleep studies are usually ordered to characterize the type and severity of the disorder.

Reports of increased vitality and well-being are commonly reported by these patients, whether treated with surgery or without.

Growths

Many kinds of growths appear in the head and neck, including benign and malignant-cancerous-tumors. These involve lesions in the salivary glands, thyroid, sinuses, vocal cords, lymph nodes, facial and neck skin, and in the mucous membranes that line the throat.

Some growths are benign and require little or no treatment and others can be excised in an outpatient procedure. But cancers are always a possibility in the head and neck, and careful exams should always be performed to determine the true nature of the swelling. Often scans are obtained as part of the workup.

Our physicians have extensive training and experience in major head and neck surgery. In some cases they may work together as a team, but often other specialists including oncologists or radiation therapists are brought into the care to maximize the chance of cure with the least morbidity for the patient.

Fear and anxiety often are experienced with the evaluations, and family members are encouraged to participate from the beginning as diagnostic and treatment plans unfold.

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Ear and Tonsil

Ear and Tonsil infections are among the most common problems of childhood. Add strep throats, stuffy and runny noses, and swollen glands and it's easy to see why children are such a large part of the ENT practice. Almost every kid gets some of these problems from time to time, but the trouble should go away in a week or two. Persistent or recurrent problems should be evaluated by an otolaryngologist. A number of congenital malformations can also be seen in children, including cleft palates, tethered tongues, branchial cleft cysts, thyroglossal duct cysts, malformed ears, and various vascular or lymphatic growths. Special medicines or tests may be indicated, and with some diagnoses surgery may be the best answer. This is almost always done in consultation with your pediatrician

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Ear Tubes

The surgical procedure for placing tubes in the ears has become one of the most commonly performed operations of any kind. A tiny hollow tube is slipped through an incision in the eardrum, allowing fluid or infection to be drained, and ending congestion in the middle ear space. Adults can be helped in the office; children are usually treated as outpatients.

Tympanoplasty

Perforations can occur in the eardrum from many causes, including infection, trauma, and chronic middle ear disease. Many heal spontaneously. Those that don't heal usually require microscopic repair, using small tissue grafts, to protect against hearing loss and infection. This surgery is done as an outpatient.

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