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Have you had difficulty swallowing foods or liquids? Do you cough or clear your throat after meals?
These are common complaints heard by an ENT (Ear, Nose, and Throat) physician. Swallowing difficulty is common in all ages and is caused by many different factors. In children, this is often the result of enlarged tonsils. In adults, it can be from acid reflux, tumors in the throat, or degenerative changes.
Have you noticed a sudden or gradual change in your voice? This is an important reason to seek the care of an otolaryngologist or ear, nose, and throat doctor. The medical conditions that can contribute to voice changes include:
- age related changes
- vocal misuse
- acid reflux
- postnasal drip
- upper respiratory infection
- vocal cord paralysis
- benign vocal lesions
- vocal cord cancer
An otolaryngologist can help you identify and treat the source of your voice problem. Often your ENT will perform flexible, fiberoptic laryngoscopy, which is a commonly performed procedure that allows your doctor to look directly at your vocal cords. This procedure is quick and painless. During this procedure, a small flexible scope is inserted through the nose and follows the contours of the nose into the upper throat. This allows very clear visualization of the vocal cords. The nose is usually decongested and numbed so that the patient feels very little. Another procedure that is commonly used is called videostroboscopy. In this procedure, a camera is placed in the mouth and the vocal cords are recorded using a high speed camera. This allows excellent evaluation of the movement and anatomy of the vocal cords and can be reviewed in great detail and in slow-motion.
Voice changes are common with age and can simply be a degenerative change. Our larynx, or voice box, is made of multiple muscles. This includes the vocal cords themselves. The vocal cords can become thinner with age and as a result, your voice can become breathier or weaker. Voice change, however, can be a sign of a more serious medical problem and should be evaluated. Identifying and treating medical conditions, such as reflux or postnasal drip, will improve the quality of your voice. In some cases, excessive or misuse of the voice by people that have a high vocal demand (such as singers or coaches) can cause damage to their vocal cords. These people often develop vocal nodules. Vocal nodules are essentially calluses that form where there is friction between the vocal cords. It is important to identify and treat these early, otherwise they can become difficult to treat. Treatment for vocal nodules is typically voice therapy, the purpose of which is to optimize your voice production and minimize muscle strain and vocal cord friction.
The biggest concern with voice change is the possibility of cancer. Often, hoarseness is the presenting symptom of a vocal cord cancer. Occasionally, there are other symptoms such as difficulty swallowing or throat pain. It is especially important to have evaluation with a history of tobacco use or a family history of cancer. Early detection and treatment significantly improves the chances of treatment and cure.
Do you suspect that you or a loved one has hearing loss?
People will often wonder if they have hearing loss because they have greater trouble using the telephone or turning the television volume higher over time. In social settings, people find themselves asking others to repeat themselves or struggling to understand when multiple people are speaking. The only way to be sure that you have hearing loss is to have a hearing test or audiogram. Because hearing loss is often very gradual, many people have significant hearing loss before becoming aware of it and seeking care. What I often see in my office, is a patient that is blissfully ignorant of hearing loss, but who comes in at the insistence of a frustrated spouse or other family members. Ringing in the ears, or tinnitus, is a form of "static" that becomes apparent when hearing declines and is also a common way hearing loss is discovered.
What causes hearing loss?
It may be as simple as ear wax. Other common conditions include ear infections that cause fluid build-up behind the ear drum, which is more common in children, but can occur in adults. Hearing loss can also be genetic and occur at an early age or earlier in life than expected. Long term noise exposure and degenerative changes from aging also are also common reasons. If you suffer sudden hearing loss of any kind, it is very important that you seek care as soon as possible. This could be the result of the ear infection or drop in bloodflow to the ear and could potentially cause permanent harm if untreated.
How is it treated?
Your doctor can easilty remove wax from your ears. In cases of infection, treating these infections will typically restore hearing to normal. It is important that you protect your ears whenever you are in noisy environments .In most cases, if your hearing has declined with age, hearing aids are very helpful. Many people are emotionally unwillling to seek hearing aids because of social stigma and the association with aging. There have been many advancements in hearing aids that have made them very discreet. Many elderly people that do not seek care for hearing loss may become socially isolated because they are not a part of conversation. Hearing aids can provide significant improvement in quality of life by enabling greater freedom and social interaction with friends and loved ones.
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