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NMSI is committed to providing the highest quality of care in the most efficient and safest manner. Our in-office scanner is less expensive for most of our patients, can be done immediately on-site, and offers far less radiation than traditional CT scans performed in the hospital. Our MiniCAT™ scanner is a small, upright CT scanner that creates fast, quality images of sinuses and ears. New Mexico Sinus Institute (Rio Rancho clinic) has been granted a 3-year accreditation in CT in the areas of Sinus and Temporal Bone CT by the IAC (Intersocietal Accreditation Commission).
Your current symptoms, exam and testing demonstrate degree of improvement that the base of your tongue is contributing to your airway obstruction. You will be escorted to our procedure suite where you will visit with the surgeon prior to the procedure. Once the procedure is complete, the back of your tongue and throat will feel numb and it may be difficult to talk normally. If you have sinus disease, the chances are pretty likely that you have underlying allergies. Medications to stop before testing:  Antihistamines, both prescription and over the counter negatively affect the results of skin tests. What to bring:  Please bring any medical forms that we asked you to fill out prior to testing. Allergy immunotherapy can lead to the long-lasting relief of allergy symptoms after your treatment is done. Immunotherapy is a treatment used to relieve the symptoms of “hay fever” or allergic asthma. 85-90% of patients receiving immunotherapy improve and shots are continued for a period of 3-5 years. We require all patients to wait in the office for 30 minutes after receiving an allergy injection. Prior to allergy testing, we will be asking for patients to stop using common allergy and cold medications, H2 blockers and anti emetics.Patients that are on tricyclic antidepressants (TCAs) should discontinue two weeks prior to testing. For questions about allergy injections, please feel free to ask the allergy technician or your provider.
Known to most people as hay fever, allergic rhinitis is a very common medical problem affecting more than 15 percent of adults and children. Some people may experience both types of rhinitis, with perennial symptoms getting worse during specific pollen seasons. The nose normally produces mucus to trap substances (like dust, pollen and pollution) and germs (bacteria and viruses). In most people, nasal congestion moves from side to side of the nose, in a cycle lasting several hours long. Some known complications include ear infections, sinusitis, recurrent sore throats, cough, headache, altered sleep patterns, fatigue, irritability and poor school performance.
The most common condition causing rhinitis is the common cold, an example of infectious rhinitis. Colds usually begin with a sensation of congestion, rapidly followed by runny nose and sneezing.
Your allergist may begin by taking a detailed history, looking for clues in your lifestyle that will help pinpoint the cause of your symptoms.
A preauricular sinus or cyst is a common congenital malformation that usually occurs at the anterior margin of the ascending limb of the helix of the external ear.
The developing auricular tubercles or it may be a remnant of the first branchial groove epithelium, which has failed to resorb. Most preauricular sinuses are asymptomatic and remain untreated unless they become infected too often.
Recurrence in preauricular sinus excision is due to incomplete excision of the sinus tract and presence of residual viable squamous epithelium. Operation in a virgin case will not be difficult but the epithelial tracts can go any where. Once infected and drained, the excision in toto will be extremely challenging and gives recurrence.
Magnification with an operating microscope enables precise dissection without any epithelial breach. Dr Paulose FRCS, DLO is a Consultant ENT Plastic & Laser Surgeon with over 38 years of world class experience in Ear, Nose, Throat and Laser Surgery treating patients across the world from UK, US, Middle East to Asia. A patient presented with a slowly progressive left facial palsy as well as left sided vestibular and hearing loss. One of the important benefits of an endoscope compared to the microscope is the wide-field view of the middle ear afforded by the location of the light source at the tip of the endoscope and the availability of angled lenses.
In many cases of pediatric ears even with small ear canals, a large incision or cut behind the ear can be avoided during tympanoplasty or cholesteatoma surgery. The image below was taken using 3mm 0 degree, 14cm long endoscope placed through the left ear external auditory canal. The modern era of otoendoscopy was pioneered by Dennis Poe MD and endoscopic ear surgery (EES) has been the focus of Muaaz Tarabichi MD at the American Hospital in Dubai for over 20 years. At the Massachusetts Eye and Ear Infirmary both pediatric and adult otologists perform endoscopic ear surgery in hundreds of children and adults with routine and complex middle ear disease. BOTH microscopic and endoscopic ear surgery are complementary approaches that are used alone or together to ensure that our patients in Boston receive the best possible surgical outcomes. Our active program on EES at MEEI and Harvard Medical School is committed to 1) determining the clinical and radiologic indications for EES in children and adults, 2) understanding the surgical and audiologic outcomes following EES, 3) improving instrumentation for EES, 4) developing novel teaching tools to enhance the educational experience of residents, fellows, and surgeons in practice when learning EES, and 5) offering Harvard CME courses on endoscopic ear dissection. Middle ear procedures that employ a rigid endoscope for visualization may reduce the need to drill for enhanced exposure to the operative field.
The image below was taken using a 0 degree endoscope following the elevation of the tympanomeatal flap, revealing the left middle ear, the three ossicles (malleus or hammer, incus or anvil, and stapes or stirrup), the cochlea, the round window, and the facial nerve.


The clinical indications for this powerful technique are currently evolving in the literature and the use of rigid endoscopes to perform ear surgery (rather than just to visualize the middle ear) is increasing and primed to expand as refined instrumentation and operative approaches become available.
The preoperative audiogram showed a conductive hearing loss in both ears, worse in the left ear.
The right ear was found to have an otitis media with serous effusion and this was addressed with a myringotomy and tympanostomy tube placement in the office. Computed tomography (CT) scans of the left ear temporal bone revealed a soft tissue process involving Prussak's space and the epitympanum (attic).
The left ear axial CT scan below shows a soft tissue density of the epitympanum abutting the ossicular heads of the malleus and incus. The left ear coronal CT scan below shows a soft tissue density filling Prussak's space and extending into the attic. This patient elected to undergo a left ear transcanal endoscopic ear surgery (TEES or EES) with resection of an attic cholesteatoma. The incus and malleus head were removed in order to successfully resect the retraction pocket and cholesteatoma. As the area injured is usually the ear, and the ear contains both hearing and vestibular apparatus, generally there are symptoms of both hearing disturbance AND dizziness at the same time, in post-traumatic hearing loss.
In our experience, positional vertigo (BPPV) can follow a relatively minor head injury, including (for example) whiplash.
While not a significant source of hearing loss or smell disturbance, post-traumatic migraine may also begin a few days later after a head injury. Pain medications given for bodily injuries can cause tinnitus and occasional hearing loss (e.g.
Depression and anxiety are very common after work disruption and the legal endeavors that often accompany trauma. Exaggeration of symptoms is also common in persons who are undergoing litigation related to a head injury, as due to the litigation process, they may have secondary gain. After a head injury, eardrum or ossicular chain damage, disruptions of intralabyrinthine fluid, cochlea, or 8th nerve may be damaged resulting in hearing loss. As there is often hearing disturbance and dizziness combined,  examination for both should be performed.
Because of this commitment, we now offer advanced technology to our patients for diagnosing sinus-related problems with our computed tomography (CT or CAT) scan. MiniCAT™ scans have a significantly lower radiation dose than sinus scans taken on a full-body CT scanner. We also offer a cash price for those without insurance or who have a high deductible health plan. The maneuver demonstrated below, Canalith Repositioning (CRP) maneuver, is the best way to reposition the loose crystals, helping alleviate the symptoms of dizziness and vertigo. During this time, you are given increasing doses of allergy extracts until a maintenance dose is reached. Improvement can be gauged by a decrease in symptoms, decrease in use of medications, and decrease in the size of skin tests.
Some people may notice this nasal cycle more than others, especially if their nasal passages are narrow. Most infections are relatively short-lived, with symptoms improving at three to seven days. Over the next few days, congestion becomes worse, the nasal mucus may become colored, and there may be a slight fever and cough.
They are inherited features and usually appear on one side, but may be bilateral in 70-80% of cases.
Preauricular cysts are treated with surgery which, because of their close proximity to the facial nerve should be left to an experienced ENT surgeon. Recurrence can manifest in the form of persistence of sepsis, resurgence of swelling, repeated sinus discharge or recurrence of a preauricular mass.
Copious local infiltration with adrenaline facilitates a bloodless field for the surgeon, making dissection more easy and fruitful. Function preserving surgery rather than obliteration of the middle ear has been growing in frequency (Kunzel et al, 2012). The panoramic view of the tympanic membrane (eardrum) provides the surgeon with a high definition view of the entire ear using a transcanal approach. In contrast, the traditional otologic operating microscopes typically require larger portals (e.g.
1: 55 year old woman who presented with progressive left ear (aural) fullness and hearing loss. An attic retraction pocket is defined by the black arrows collecting keratinaceous debris, and represents a small cholesteatoma.
The blue line represents sound detection in the left ear and the red line represents sound detection in the right ear. There is also erosion of the lateral wall of the epitympanum (or attic), a finding often seen in middle ear cholesteatoma. The tympanic membrane (eardrum) was reconstructed with a small perichondrium and cartilage graft taken from the conchal bowl. Additionally, according to Ilan et al (2015), in a study of 3438 patients, olfactory (smell) dysfunction occurs in about 12% of patients with a work related head injury. Falls with head contact to an unyielding surface, such as from a ladder to the floor, are more likely to be injurious than, for example, boxes falling on the head. The clinician must separate out reasonable and documented impairment from unreasonable and potentially amplified impairment. It is rare that there is a preexisting MRI or CT scan that can clearly related fluid to temporal proximity. Most often this is performed in persons with normal test results, but in whom there are cognitive disturbances after the head injury.


Such testing is often useful in sorting out the situation when patients are in litigation and could benefit from an appearence of ill health, or who have anxiety or depression related to life disturbance post trauma. Olfactory and Cochleovestibular dysfunction after head injury in the workplace: an updated series. CT scanners create 3 dimensional x-ray images of the anatomy, giving our providers valuable information for an accurate diagnosis. Because our scanner is located in our office, we can take your CT scan during your examination. You may have a floating, swaying sensation while walking or sitting for a few days after this procedure. Some patients have too much debris in the posterior semi-circular canal to clear without surgery. It is common to have some discomfort for which you will be provided some pain medication to use as needed. If you are taking one of these medications, you will be notified by one of our providers and a request will be made to your prescribing physician to authorize stopping the medication.
This happens because the cells that line the nose and airways release chemicals that cause these symptoms as a response to the allergic substance. Immunotherapy works to interfere with the actions of these cells and thereby reduce the effects of the chemicals that cause allergic symptoms. In a small percentage of patients, there is no improvement, and if this occurs, immunotherapy is discontinued after 12-18 months. Any changes to medical therapy involving TCAs or beta blockers would only be done in consultation with the patient’s prescribing provider.
An allergist has specialized training and expertise in managing allergies, allergic rhinitis and asthma.
When too much mucus is made, it can cause a runny nose from the front or post-nasal drip from the back.
Below are listed the three most common causes of rhinitis with some of their characteristics. In a single individual, allergic rhinitis could be complicated by non-allergic rhinitis, septal deviation (curvature of the bone and cartilage that separate the two sides of the nose) or nasal polyps (abnormal growths inside the nose and sinuses).
Blunt metal probing (lachrymal probe) to delineate the sinus ramifications, should be gentle and meticulous to avoid the creation of new false passages.
Generally, although not always, in cases with post-traumatic dizziness or hearing loss there is signs of head injury -- a skull fracture being the most obvious, but also bruises, swelling, abrasions are seen in head injuries that are associated with hearing loss or tinnitus. Someone who is exaggerating their symptoms, may still have an objective nystagmus or hearing disturbance.
Patients with closed post-traumatic conductive hearing loss, have roughly equal fractions of mixed and conductive hearing loss.
Then, an injectable anesthetic is used to provide a thorough loss of sensation in the areas of treatment. Injections should be given in a medical facility, under the supervision of a licensed physician.
Severe congestion can result in facial pressure and pain, as well as dark circles under the eyes. Children, particularly young children in school or day care centers, may have from eight to 12 colds each year. Cold symptoms that last longer may be due to other causes, such as non-infectious rhinitis or sinusitis. Your allergist may use skin testing, in which small amounts of suspected allergen are introduced into the skin. As most of these (excepting BPPV) depend on largely subjective measures, the clinician must be careful to combine subjective and objective measurements when available. In situations like this however, the credibility of the person reporting other symptoms becomes lower. Next, the necessary tissue will be treated using the most advanced Radiofrequency ablation (RFA) technology available. Once maintenance is reached, shots may be spread anywhere from every 1-3 weeks, depending on the time of year and your response to the injections. The goal will be to enable you to lead a life that is as normal and symptom-free as possible.
Fortunately, the frequency of colds lessens after immunity has been produced from exposure to many viruses. Nasal symptoms caused by more than one problem can be difficult to treat, often requiring the cooperation of an allergist and an otolaryngologist (a surgeon specializing in the ear, nose and throat).
Skin testing is the easiest, most sensitive and generally least expensive way of making the diagnosis. Fortunately, in BPPV, a specific nystagmus (jumping of the eyes) often makes the diagnosis very secure.
There are many methods of separating out feigned dizziness or hearing symptoms from objective deficits. Small amounts of targeted energy will be directed to the base of the tongue in the back of the throat using a minimally invasive device. A repeat sleep study 2 months after last session will be scheduled to determine improvement. One also wonders what the incidence is of visual disturbance such as retinal or vitreous detachment. In rare cases, it also may be necessary to do a special IgE allergy blood test for specific allergens.



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20.03.2015 admin



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