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Author: admin, 29.09.2015. Category: Cure Ringing Ears

As a physician, I believe that each doctor and patient become a team for treating an individual's ear, nose and throat problems. I want my patients to be informed about ear, nose and throat issues and treatments, because informed patients make better decisions about their health and well being. After 11 years of practicing both adult and pediatric ENT, and gaining experience in all areas of this speciality, I am currently limiting my practice to pediatric ENT only. Receive Allergy Updates Via Email:Receive allergy counts, news and information on allergy testing via email by joining our e-newsletter list.
Did you know?Two-thirds of all physician office visits are for ear, nose, throat or allergic problems!
Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. This happens primarily during the first few years of life, becoming less important as we get older. The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing and swallowing problems. Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. You should see your doctor when you or your child suffer the common symptoms of infected or enlarged tonsils or adenoids.
Your physician will ask about problems of the ear, nose, and throat and examine the head and neck. Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics.
Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children. Chronic infection can affect other areas such as the eustachian tube – the passage between the back of the nose and the inside of the ear.
Recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion). In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids.
In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. If you or your child’s adenoids are enlarged, it may be hard to breathe through the nose.
For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. If the patient or patient’s family has had any problems with anesthesia, the surgeon should be informed. Generally, after midnight prior to the operation, nothing (chewing gum, mouthwashes, throat lozenges, toothpaste, water) may be taken by mouth.
When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient’s history. Your ENT specialist will provide you with the details of pre-operative and postoperative care and answer any questions you may have. Any questions or concerns you have should be discussed openly with your surgeon, who is there to assist you. 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. ObstructionObstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because stones have formed.
InfectionThe most common salivary gland infection in children is mumps, which involves the parotid glands.
TumorsPrimary benign and malignant salivary gland tumors usually show up as painless enlargements of these glands.
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. If a mass is found in the salivary gland, it is helpful to obtain a CT scan or a MRI (magnetic resonance imaging).
A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases.
The same general principles apply to masses in the submandibular area or in the minor salivary glands within the mouth and upper throat. Viruses: Most viral sore throats accompany flu or colds along with a stuffy, runny nose, sneezing, and generalized aches and pains.
Sore throats accompany other viral infections such as measles, chicken pox, whooping cough, and croup. Bacteria: Strep throat is an infection caused by a particular strain of streptococcus bacteria.
Because of these possible complications, a strep throat should be treated with an antibiotic. 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.
Allergy: The same pollens and molds that irritate the nose when they are inhaled also may irritate the throat.
Irritation: During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings.
Pollutants and chemicals in the air can irritate the nose and throat, but the most common air pollutant is tobacco smoke. 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. Tumors: Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long-time use of tobacco and alcohol.
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. When a strep test is positive, many experts recommend treatment or culturing of other family members. Take over-the-counter pain relievers such as acetaminophen (Tylenol Sore Throat, Tempra) or ibuprofen (Motrin IB, Advil). Vocal Nodules: More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. 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.
Other Causes: Many unusual causes for hoarseness include allergies, thyroid problems, neurological disorders, trauma to the voice box, and occasionally, the normal menstrual cycle. Hoarseness due to a cold or flu may be evaluated by family physicians, pediatricians, and internists (who have learned how to examine the larynx). An otolaryngologist will obtain a thorough history of the hoarseness and your general health.
Voice problems arise from a variety of sources including voice overuse or misuse, cancer, infection, or injury.
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.
To reduce or minimize voice abuse or misuse use non-vocal or visual cues to attract attention, especially with children. Minimize throat clearing: Clearing your throat can be compared to slapping or slamming the vocal cords together. 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). Your voice is an extremely valuable resource and is the most commonly used form of communication. Vocal cord lesionsBenign noncancerous growths on the vocal cords are caused by voice misuse or overuse and from trauma or injury to the vocal cords.


Gastroesophageal reflux disease and laryngopharyngeal reflux diseaseReflux (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.
Poor speaking techniqueImproper 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. Vocal cord paralysisHoarseness and other problems can occur related to problems between the nerves and muscles within the voice box or larynx. Throat cancerThroat cancer is a very serious condition requiring immediate medical attention.
Voice problems occur with a change in the voice, often described as hoarseness, roughness, or a raspy quality. I spend most of my time listening to you, to understand your concerns and responding with the best treatment options for you. That is why I've included an extensive section on this website covering common topics associated with ear, nose and throat diagnostics and treatments.
In these web pages you'll find information about my office, including directions to our Fort Worth office, hours, insurance policies and appointment scheduling. Children who must have their tonsils and adenoids removed suffer no loss in their resistance.
Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes malformations of the face and improper alignment of the teeth. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed.
These include (but are not limited to) swallowing problems, vomiting, fever, throat pain, and ear pain. Salivary glands produce the saliva used to moisten your mouth, initiate digestion, and help protect your teeth from decay. 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. Benign diseases are best treated by conservative measures or surgery, whereas malignant diseases may require surgery and postoperative irradiation.
However, radiation therapy to the mouth can cause the unpleasant symptoms associated with reduced salivary flow. This infection can also damage the heart valves (rheumatic fever) and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections. Cat and dog danders and house dust are common causes of sore throats for people with allergies to them. To avoid reflux, tilt your bedframe so that the head is elevated four- to six- inches higher than the foot of the bed.
Sore throat and difficulty swallowing-sometimes with pain radiating to the ear-may be symptoms of such a tumor. Penicillin or erythromycin (well-known antibiotics) are prescribed when the physician suspects streptococcal or another bacterial infection that responds to them. Practice good sanitary habits; avoid close physical contact, and sharing of napkins, towels, and utensils with the infected person. Many other infections, both bacterial and viral, will yield negative cultures and sometimes so does a streptococcal infection.
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). 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). Since smoking is the major cause of throat cancer, if smokers are hoarse, they should see an otolaryngologist.
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).
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.
In some cases, special tests (known as acoustic analysis) designed to evaluate the voice, may be recommended. Patients who have developed bad habits, such as smoking or overuse of their voice by yelling and screaming, benefit most from this conservative approach. Primary and secondhand smoke that is breathed in passes by the vocal cords causing significant irritation and swelling of the vocal cords.
Consequently, excessive throat clearing can cause vocal cord injury and subsequent hoarseness. 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. Our voices are invaluable for both our social interaction as well as for most people’s occupation. Contact an otolaryngologista€”head and neck surgeon if you have any sustained changes to your voice.
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).
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.
When cancer attacks the vocal cords, the voice changes in quality, assuming the characteristics of chronic hoarseness, roughness, or raspiness. People with voice problems often complain about or notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. Typically the upper respiratory infection or cold causes swelling of the vocal cords and changes their vibration resulting in an abnormal voice.
With the help of our professional staff, I also follow up to make sure problems are resolved and your health improves.
I encourage you to look through these pages whenever you have an interest or concern related to ear, nose and throat health.
Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments. Scientists believe they work as part of the body’s immune system by filtering germs that attempt to invade the body, and that they help to develop antibodies to germs. 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. 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.
Rarely, dye will be injected through the parotid duct before an x-ray of the gland is taken (a sialogram). If it is due to systemic diseases (diseases that involve the whole body, not one isolated area), then the underlying problem must be treated.
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.
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. Your doctor can prescribe medication or other conservative treatments that may reduce the dryness in these instances. Treatment is readily managed by an otolaryngologist–head and neck surgeon with experience in this area. Infections are caused either by viruses such as the flu, the common cold, mononucleosis, or by bacteria such as strep, mycoplasma, or hemophilus. Frequent sore throats from tonsillitis suggest the infection is not fully eliminated between episodes.
Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult.
Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. 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).
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. Problems with the voice are best managed by a team of professionals who know and understand how the voice functions.
Videotaping the examination or using stroboscopy (slow motion assessment) may also help with the analysis. 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.


Try not to talk loudly in locations with significant background noise or noisy environments.
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.
Proper care and use of your voice will give you the best chance for having a healthy voice for your entire lifetime.
This abnormal vibration results in hoarseness and a chronic change in one’s voice quality, including roughness, raspiness, and an increased effort to talk.
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.
Involvement of both vocal cords is rare and is usually manifested by noisy breathing or difficulty getting enough air while breathing or talking.
Our voice is invaluable for both our social interaction as well as for most people’s occupation. Other voice problems may accompany a change in singing ability that is most notable in the upper singing range. Reduced voice use (voice rest) typically improves the voice after an upper respiratory infection, cold, or bronchitis. We hope you'll find our practice offers the accessibility and personal commitment you look for from an ear, nose and throat specialist. Infection can develop in the pool of blocked saliva, leading to more severe pain and swelling in the glands.
These lymph nodes are the structures in the upper neck that often become tender during a common sore throat.
When malignant masses are in the parotid gland, it may be possible to surgically remove them and preserve most of the facial nerve. However, strep tests might not detect other bacteria that also can cause severe sore throats that deserve antibiotic treatment. 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. You should also avoid eating within three hours of bedtime, and eliminate caffeine and alcohol.
Antibiotics do not cure viral infections, but viruses do lower the patient’s resistance to bacterial infections. 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. Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. Be aware of your background noisea€”when it becomes noisy, significant increases in voice volume occur naturally, causing harm to your voice. Adopting an extremely low pitch or high pitch can cause an injury to the vocal cords with subsequent hoarseness and a variety of problems. The most common reason for excessive throat clearing is an unrecognized medical condition causing one to clear their throat too much. The best treatment for this condition is to rest or reduce your voice use and stay well hydrated.
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. 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. 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. 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).
Proper care and use of your voice improves the likelihood of having a healthy voice for your entire lifetime. A more serious problem is indicated by spitting up blood or when blood is present in the mucus. If voice does not return to its normal characteristics and capabilities within two to four weeks after a cold, a medical evaluation by an ear, nose, and throat specialist is recommended. 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. 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. If the disease process relates to salivary gland obstruction and subsequent infection, your doctor will recommend increased fluid intake and may prescribe antibiotics.
For example, severe and chronic cases of tonsillitis or tonsillar abscess may be culture negative. When speaking or singing, they come together, and as air leaves the lungs, they vibrate, producing sound. Voice disorders have many different characteristics that may give professionals a clue to the cause. If you feel like your throat is dry, tired, or your voice is becoming hoarse, stop talking.
Consequently, patients will awake with throat irritation, hoarseness, and throat discomfort without knowing the cause. Voice problems can also occur from using your voice in an unnatural position, such as talking on the phone cradled to your shoulder. A throat examination after a change in the voice lasting longer than one month is especially important for smokers. If your child has a friend who has had this surgery, it may be helpful to talk about it with that friend. These ducts can develop small constrictions, which decrease salivary flow, leading to infection and obstructive symptoms.
When these lymph nodes enlarge through infection, you may have a red, painful swelling in the area of the parotid or submandibular glands. This is typically administered four to six weeks after the surgical procedure to allow adequate healing before irradiation. Similarly, negative cultures are seen with diphtheria, and infections from oral sexual contacts will escape detection by strep culture tests. When an antibiotic is prescribed, it should be taken as the physician directs for the full course (usually 10 days).
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.
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. These lesions are usually treated with voice rest and speech therapy (to improve the speaking technique thus removing the trauma on the vocal cords). An examination of the throat by an otolaryngologist will determine if stomach acid is causing irritation of the throat and voice box. This requires excessive tension in the neck and laryngeal muscles, which changes the speaking technique and may result in a voice problem.
There is a possibility that the paralysis may become permanent, which may require surgical treatment. 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. Otherwise the infection will probably be suppressed rather than eliminated, and it can return.
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. When some of these are strep infections or are severe, your child may require a tonsillectomy. 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.



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