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.
What are the sinuses?
The sinuses are air filled spaces in the head and face. There are four paired sinuses, the frontal, ethmoid, maxillary, and sphenoid sinuses. The lining of the sinuses is called the mucosa, which is composed of microscopic hair cells called cilia, and is covered by a layer of mucus. This is part of our immune defense. The mucus traps germs and debris, which is moved by the cilia into our digestive system where it is destroyed. Other important structures include the septum and the turbinates. All of these structures increase the surface area of our nasal cavity and sinuses. As we breathe, air flows over and through these structures and is moistened and warmed before entering our lungs.
Where does it all go wrong?
People often have anatomic abnormalities that cause difficulty breathing. Septal deviations are very common. This may be from birth or the result of trauma. If the septum is crooked, it can prevent proper airflow through the nose. The turbinates can become chronically swollen in response to allergies or frequent infection. This can also cause blockage of the nasal cavity and trouble breathing. Treating these conditions will usually reverse this, but occasionally these problems need to be surgically corrected.
Allergies can develop at any point in your life. Your body is constantly developing new immune cells. These cells react to “antigens” such as pollen, molds, dust, and pet dander in the environment. The immune system is stimulated and causes inflammation of the sinuses, sneezing, nasal congestion, runny nose, and itchy eyes. These are typically treated with antihistamines and nasal steroid or antihistamine sprays. If allergies are severe, they can be identified with skin testing. You can then be desensitized to these allergens by receiving injections or sublingual treatment with increasing doses of these antigens until your body becomes unresponsive to them. This is called immunotherapy.
What is sinusitis?
Sinusitis is infection of the sinuses. Most infections are viral and will resolve without treatment. Medications can be used to treat the symptoms. Decongestants (pseudoephedrine, phenylephrine) can be used for difficulty breathing. Nasal saline rinses are used to remove excess mucus. Mucolytics (Guaifenesin) are used to thin mucus. If infection does not resolve, antibiotics may be used. Typically,This is reserved for infections that do not clear for 7-10 days. Antibiotics are only effective against bacterial infections and are often wrongly used to treat viral infections or allergies. This is potentially harmful. Overuse of antibiotics has led to antibiotic resistant bacteria. Overuse of antibiotics can also destroy the “normal” bacteria in our bodies that serve important functions. This can allow overgrowth of “bad” bacteria that can cause harmful infection.
Sinus infections can be difficult to treat because of less effective delivery of medication to this part of the body. Sinus infections can become chronic when symptoms last over 12 weeks. This can occur when the small openings of the sinuses become blocked by swelling, preventing proper drainage of mucus and infection. This often requires longer courses of antibiotics. If the infection does not resolve with antibiotics, surgery is sometimes required to open the sinuses and allow drainage and resolution of infection.
Balloon Sinuplasty – This is a newer, less invasive method. It is usually done in the office with local anesthesia with discomfort similar to dental procedures. A balloon is used to stretch open the sinuses in a similar way to angioplasty for blood vessels. This method cannot be used for polyps or fungal disease.
Functional Endoscopic Sinus Surgery – This method is done under general anesthesia and used to remove polyps, fungal disease, or severe blockage. It allows for better exposure for the surgeon, but greater risk of complication, bleeding, and scarring and requires more postoperative care.
Daily saline irrigations are a good way to remove antigens and germs from our sinuses. Regular use can potentially prevent triggering the immune response, allergy symptoms, and infection. It is very important to use clean (bottled or boiled) water to prevent infection. It is also very important to clean and replace the containers regularly avoid the accumulation of bacteria. Avoidance of allergens is helpful when possible. Measures to reduce environmental allergens includes dust mite covers for bedding and mattresses, air filters, and removal of carpeting.
Doc, I'm dizzy. Can you help me?
Why am I dizzy?
Unfortunately, that's complicated. There are many kinds of dizziness and many different causes. The good news is, we can help. Your brain interprets information from all the different parts of your body to coordinate your movements. It gets feedback from your arms, legs, eyes, and inner ear. Underneath it all, your brain is fueled by your heart and lungs. If any part of these is not working properly, it can result in dizziness or imbalance.
What do I do first?
The most important thing is to make sure it's not a life-threatening condition. The other associated symptoms are very important. If you're dizzy and have accompanying symptoms such as chest pain, shortness of breath, severe headache, loss of memory, weakness in your arms or legs, or difficulty thinking, you may be having a heart attack or stroke and should seek immediate care. Otherwise, you should see an Otolaryngologist, or ENT (Ear, Nose, and Throat) doctor for evaluation.
What is vertigo?
Vertigo is the false perception of movement, most commonly the sensation that the room is spinning. Often, this is the result of loose crystals in the inner ear. This condition is called Benign Paroxismal Positional Vertigo or BPPV. This typically will go away with time, but occasionally needs to be treated with a maneuver to reposition the crystals. Another cause can be viral infections of the inner ear. If this is the case, it can also result in hearing loss that can be permanent if not treated. It is important to seek care as soon as possible to have your hearing checked and prevent permanent hearing loss. Other causes include degenerative changes of the eye, spine, cardiovascular system, diabetes, and other musculoskeletal problems.
What should I expect?
Typically a CT or MRI of the brain is ordered to make sure there is no stroke or brain tumor. This is extremely unlikely in most circumstances. A study called a VNG is also occasionally ordered. This is a test of the function of the inner ear and coordination of movement of the eyes. This will show if anything has damaged the inner ear. If so, physical therapy can be used to rehabilitate your balance and prevent falls.
Am I getting old?
Yes. Just kidding. Sort of. Dizziness can affect all ages, but is much more common as we age. Age-related decline in our vision, brain, muscles and bones, and general health can affect our balance. Unfortunately, in the elderly this often leads to falls that result in serious injury. Fractures of the hip or other bones can lead to significant disability, pain, and social isolation. Seeking care for dizziness or imbalance prior to significant injury is very helpful in preventing long term health consequences.
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