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Frequently Asked Questions

What is Otolaryngology?

Did you know that otolaryngology (ENT - Ear, Nose Throat) is one of the oldest medical specialties practiced in the United States? It's true! Ear aches, hearing problems, headaches and sinus pain - are age-old common maladies that have been sending people to their ENT physician for many years. While these are common complaints that we treat, we also do so much more!

Pediatric

Why does my child's ear ache?

The most common cause of earache in a child is "Otitis Media", or inflammation of the middle ear. It is the most frequent diagnosis recorded for children who visit physicians for illness. It is the most common cause of hearing loss in children, and 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.

What are the symptoms?

In infants and toddlers look for:

  • Pulling or scratching at the ear (especially if accompanied by the following)
  • Hearing problems
  • Crying, irritability
  • Fever
  • Vomiting
  • Ear drainage

In young children, adolescents, and adults look for:

  • Earache
  • Feeling of fullness or pressure
  • Hearing problems
  • Dizziness, loss of balance
  • Nausea, vomiting
  • Ear drainage
  • Fever

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, 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 ear tubes?

Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, further treatment may be recommended by your physician. 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 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.

When do tonsils have to be removed?

All children will have some infections in their tonsils or adenoids in their lives. Two main problems that can occur with this tissue are swelling, which can make breathing and eating difficult, and repeated infections. If they swell permanently and cause sleep apnea often surgery is indicated.

If surgery is necessary, it can be done safely on an outpatient basis. Your child will miss about one week of school following surgery. Chronic infections in the adenoids can also cause recurrent ear infections, and recent studies have indicated that an adenoidectomy can be very helpful in those situations. Allergies or intolerances to antibiotics may influence the exact number of infections required prior to surgery.

The decision for surgery involves many factors, including the evaluation of the throat, the ears, lymph nodes in the neck, a history of allergies to antibiotics or a peritonsillar abscess, and possibly the results of other tests such as x-rays and throat swabs.

What should I expect if my child is scheduled for surgery?

Initially, you and your doctor will discuss where the surgery will be done. This will be dependent not only on you and the doctor's preferences, but also on your insurance plans. Our office staff will help you in determining what facility fits within your insurance plan.

Nasal and Sinus Disorders

What causes a nosebleed?

Recurring nosebleeds can be attributed to several causes:

  • Allergies, infections, or dryness that cause itching and lead to picking of the nose.
  • Vigorous nose blowing that ruptures superficial blood vessels in the elderly and in the young.
  • Clotting disorders that run in families or are due to medications.
  • Fractures of the nose or of the base of the skull that can cause bleeding and should be regarded seriously when the bleeding follows a head injury.
  • Rarely, tumors (both malignant and nonmalignant) have to be considered, particularly in the older patient or in smokers.

Most nosebleeds (epistaxis) are minor nuisances. But some are quite alarming, and a few are even life threatening. Nose bleeds are classified into two different types.

1) Anterior Nosebleed

Most nosebleeds begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose.
Nosebleeds in children are almost always the anterior type.

2) 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 to the back of the nasal cavity, 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). 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 may recommend cauterization (sealing) of the blood vessel that is causing the trouble.

What causes smell and taste disorders?

The tissue lining the upper one-third of the nose contains sensory cells for our sense of smell. 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, nasal allergies, sinusitis, or nasal obstruction from polyps or a deviated nasal septum are often blamed for smell and taste disorders. Sometimes a certain medication is the cause of the disorder, and improvement occurs when that medicine is stopped or changed. Although certain medications can cause these disorders, others - particularly anti-allergy drugs - seem to improve the senses of taste and smell.

The loss of the sense of smell and taste may often be restored by eliminating the sinusitis, septal deviation or polyps, or controlling the allergies that caused the disorder.

What is sinusitis?

Sinusitis is an inflammation of the membrane lining of any sinus. 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. Signs and symptoms of sinusitis may include facial pain or pressure, nasal obstruction, discolored nasal discharge, headache, fatigue, diminished sense of smell, pain in the upper teeth, cough, fever, bad breath, and an aggravation of asthma.

What is the treatment for sinusitis?

The initial treatment for sinusitis is usually two weeks of antibiotic therapy accompanied by decongestants. Inhaling steam or nasal saline spray is often recommended to alleviate the sinus congestion and help moisturize the nasal passages. Warm compresses are also useful in relieving facial pain.

Patients who experience a repeated pattern of infections in their sinuses may have chronic sinusitis. These patients require a full examination in our office by one of our physicians, and may be referred for other diagnostic tests including allergy testing, nasal endoscopy, or a CT scan of the sinuses.

When is sinus surgery necessary?

Inflammation of the mucous membrane lining in the sinuses can cause swelling and narrowing of the sinus opening, thereby blocking the flow of mucus. If antibiotics, decongestants, nasal sprays and other therapies prescribed by your doctor are not effective, sinus surgery is often needed to correct the problem.

What does sinus surgery accomplish?

Sinus surgery enlarges the natural opening to the sinuses and removes areas of obstruction, resulting in the normal flow of mucus.

What does sinus surgery entail?

Basic sinus surgery is performed through the insertion of an endoscope, a very thin fiber-optic tube, into the nose. In the majority of cases, the surgical procedure is performed entirely through the nostrils. leaving no external scars.

The procedure is usually performed under general anesthesia and is done as a same day surgery, not requiring an overnight stay. The patient usually returns to normal activities within four to seven days; full recovery takes about four weeks.

What is new in sinus surgery?

Northland Ear Nose and Throat is now offering this new technology:

Balloon SinuplastyTM technology is a FDA-cleared, endoscopic, catheter-based system for patients suffering from sinusitis. The technology uses a small, flexible, Sinus Balloon Catheter to open up blocked sinus passageways, restoring normal sinus drainage and function. When the sinus balloon is inflated, it gently restructures and widens the walls of the passageway while maintaining the integrity of the sinus lining.

For more information on this technology, see Balloon Sinuplasty.

When is nasal surgery needed?

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

Some patients suffer from chronic nasal stuffiness that may be due to chronic breathing problems that don't respond well to standard medical treatment. The blockage may be related to structural abnormalities inside the nose or to swelling caused by allergies or viruses.

There are several 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.

Overgrowth of the turbinates is 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. Allergies may also cause internal nasal swelling, and allergy evaluation and therapy may be necessary.

What treatment is needed for a broken nose?

Bruises around the eyes 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 if the 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. Evaluation is necessary to determine whether the nasal bones have been displaced, or just fractured or broken. If the nasal bones are markedly displaced, surgeons often will attempt to realign the bones into a straighter position under local or general anesthesia. This is usually done shortly after the injury, so that the bones don't heal in a displaced position. If the fracture doesn't "pop" back into place, corrective nasal surgery may be required so that the injury doesn't compromise breathing. This procedure is typically done on an outpatient basis.

Hearing

What causes hearing loss?

There are many different causes of hearing loss, which can affect all ages. Some common causes are heredity, trauma, disease, noise exposure and the aging process.

What are the types of hearing loss?

There are three types of hearing loss:

1) Conductive Hearing Loss occurs when the transmission of sound through the outer and/or middle ear is interrupted. The common causes are wax buildup in the ear canal, a perforated eardrum, fluid in the middle ear, or damaged ossicles.

2) Sensorineural Hearing Loss occurs in the inner ear affecting the transmission of sound. Common causes are exposure to loud noise, trauma, the normal aging process, and disease.

3) Mixed Hearing Loss occurs in the outer and/or middle ear and the inner ear. It is a combination of a conductive and sensorineural hearing loss. A mixed hearing loss can occur when a person has wax blockage in the ear canal and damage to the cochlea.

Conductive hearing losses can be treated in a variety of ways, depending on the problem. For example, adequate hearing can often be restored by removal of wax from the ear canal, drainage of fluid from the middle ear (placement of tubes in the eardrum), repair of a perforated eardrum, or middle ear bone reconstruction. However, there are times when medical intervention cannot restore hearing adequately and the patient is referred for evaluation for a hearing aid.

Sensorineural losses are usually treated with hearing aids.

Mixed hearing losses are treated with a combination of medical treatment and hearing aids.

How is a hearing aid selected?

The process of choosing a hearing aid usually begins with medical and hearing examinations. Either your family doctor, or one of our otolaryngologists does the medical exam. The hearing test will be carefully administered by one of our audiologists, a health professional who specializes in evaluation and non-medical treatment of hearing loss. The test results, called an audiogram, will show whether your ears are healthy, what type of hearing loss you have, and exactly what you can and cannot hear.

After your hearing evaluation, you and your audiologist are ready to select your hearing aid. Together you will decide which style of aid is really best for you, which features you need, and whether you need one or two hearing aids. Most of the hearing aids fitted today fall into one of four styles that range from behind-the-ear models to the smallest units that fit right into the ear. Thanks to electronic technology, many revolutionary valuable features are available for hearing aids. Some of these may be right for you. Discuss your options with the professionals at Northland Ear, Nose, and Throat.

Should I clean the earwax out of my ears?

The ear forms wax to trap dust and dirt particles, keeping them from reaching the eardrum. Usually the wax accumulates a bit, dries out, and falls out of the ear canal carrying the dirt and dust with it. The ear canal may be blocked by wax when attempts to clean the ear push wax deeper into the canal and cause a blockage. Wax blockage is one of the most common causes of hearing loss.

When a patient has been probing his ears with such things as cotton-tipped applicators, bobby pins, or other objects, it only pushes the wax deeper into the ear canal. Everyone has heard the old admonition - Never put anything smaller than your elbow in your ear? This old saying is still relevant today because the skin of the ear canal and eardrum is very thin and fragile and is easily injured.

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.

If you suffer from earwax blockage, our physicians can prescribe various numbers of home treatments that can be used to soften the wax. If those are not effective, he may prescribe eardrops designed to soften the wax, or he may wash or vacuum it out. Occasionally, our ENT specialists may need to remove the wax using microscopic visualization.

What are the symptoms of wax buildup?

  1. Partial hearing loss, may be progressive
  2. Ringing or other noises in the ear
  3. Earache
  4. Fullness in the ear or a feeling of the ear being plugged