Allergy & Asthma
- Explain your hearing test results
- Learn your communication needs (ie: social, occupational)
- Discuss different levels of technology and sizes of hearing aids
- Help you to establish realistic expectations
- Inform you of a 45-day trial period
It varies quite a bit from person to person. As hearing loss tends to occur gradually, so does readjusting to the world of sound. You may wish to progress from easier to more difficult listening situations as you get used to your hearing aids. Adjusting to hearing aids requires some patience and effort. It takes time to relearn hearing skills, longer for the more difficult situations, such as restaurants or parties. Your expectations must be realistic.
Noisy environments are tougher to hear in whether you wear hearing aids or not. Hearing aids do not eliminate background noise, but they can help the person with hearing loss to hear well. If you have hearing loss in both ears, most people will need two hearing aids. Noisy environments, in particular, can sound chaotic with only one ear. For certain situations, some people need more than hearing aids – a special adapter or pick-up for the telephone; doorbell and smoke alarm alerting devices; infrared television amplifiers as examples.
There are many styles of hearing aids – Completely in the canal hearing aid; in the canal hearing aid; in the ear hearing aid and behind the ear hearing aid. We can help determine which is better for you.
The best pair of skis will not make you an Olympic skier. Practice and the right coaching will get you there. Your natural abilities, however, are enhanced by better equipment. Hearing aid technology has improved dramatically over the past few years, especially in the way devices are adjusted to compensate for the natural patterns of hearing loss. The most sophisticated devices now use the same advanced technology as found in the microchips of computers.
If it’s not for yourself, accompany your loved one going for their appointment. Make sure they’ve understood what was said, and that the audiologist’s recommendations make sense. Offer your loved one plenty of encouragement and support all the way through, from initial consultation through the follow-up and adjustment period.
Yes, and here’s the good news: most hearing losses can be helped, medically, surgically, or with hearing aids. In fact hearing aids nowadays are specifically designed for sensorineural or ‘nerve loss’.
So, if I can go to the drugstore and buy some reading glasses off the rack, why can’t I do that with a hearing aid?
Hearing aids are dispensed by licensed professionals only. Fitting a hearing aid is much more complex than fitting eyeglasses. Ears and eyes work differently. And, similar to dentures, hearing aids are a substitute for a natural function of the body. Just like dentures, or even new shoes, it takes time to get adjusted to new sensations. It doesn’t happen overnight.
Ask your doctor! You are likely to be referred to one of our audiologists or ear, nose & throat physicians. Investigation of hearing loss begins with an examination of your hearing loss with the audiologist. Certain types of hearing losses may indicate a medically treatable cause, for which you’ll see the ear, nose & throat doctor.
If your family says you need a hearing aid… you probably do! Problems usually develop slowly and subtly, hardly noticeable to ourselves. It’s normal for people to go through a period of denial about their hearing problems. But you cannot hide your hearing loss… your loved ones, friends, clients and associates already know you have it!
Common warning signs include:
- not responding to someone talking out-of-view
- acting surprised when their name has been called
- using “what?” or “huh?” frequently
- intently watching the faces of speakers
- sitting close to the TV set when the volume is normal
- increasing the TV volume to unreasonably loud levels
- not responding to voices over the telephone
- not being startled by intense sounds
- The single most important sign of possible hearing loss in the very young child is the lack or delayed development of speech and language. If your child doesn’t seem to exhibit the above behavior, please call us for an appointment to test her/his hearing as this may indicate a hearing problem.
Detection of hearing loss in children should occur as early in life as possible. Ideally, infants born with hearing loss should be identified by three months of age. The first three years of life are critical to speech and language development. Unfortunately, while some children’s hearing losses are detected within the first year of life, many more are not detected until they enter school (five to six years of age). For this reason, it is now recommended that all infants be screened for hearing impairment.
3 months: a child should startle or cry at loud noises in the environment and respond to your voice
5 Months: babies seek the sound source. Try this with your five to six month old: make soft sounds from behind and to one side as your baby looks straight ahead. Whispering should elicit a head turn towards the sound. During the first year, your baby should look for the sources of common sounds such as the telephone ringing or a musical toy.
6 Months: Babies recognize familiar voices and experiment with speech and non-speech sounds.
9 Months: Babies demonstrate an understanding of simple words (“mommy,” “daddy”) and turn and look when you call his/her name. At this age a baby should respond to “no” and changes in your tone of voice.
10 months: a baby’s babbling should sound “speech-like” (“da-da-da-da”).
12 months:, one or more recognizable words emerge and a child should understand the names of some simple items like “ball” or “spoon”.
15 months: a child should respond to simple directions and say some simple words.
By 18 months, babies should understand simple phrases; retrieve familiar objects on command and point to body parts (“where’s your nose?”). They should have a spoken vocabulary of between 20-50 words and short phrases (“no more,” “go out,” “mommy up”).
By 24 months, a toddler’s spoken vocabulary should be 200-300 words coupled with simple sentences. A toddler should be able to sit and listen to read-aloud storybooks.
Between three and five, spoken language should be used constantly to express wants, reflect emotions, convey information, and ask questions. A preschooler should understand nearly all that is said. All speech sounds should be clear and understandable by the end of the preschool period. Be alert to situations where your child is not responding well, as this may be a sign of hearing impairment.
Advanced Specialty Care is proud to have had a neonatal hearing-screening program in effect at Danbury Hospital. As of July 1st, 2000, all babies born in Connecticut hospitals will have their hearing evaluated by state mandate before leaving the hospital.
Our audiologist are skilled in the diagnosis of hearing impairment in children of all ages. Our ear specialists have had intensive training in treating hearing loss. We can provide the most up to date hearing aids and assistive listening devices.
CAPD is generally evaluated by a series of behavioral tests in a sound treated room. Some of the tests include listening to a target signal in background noise and background speech, interpreting speech signals with degraded or missing auditory information, and identifying auditory tonal patterns and or/gaps in noise. The testing is approximately 1 ½ -2 hours, and breaks are given throughout testing as needed so the child or person being tested can relax and refocus. We evaluate Central Auditory Processing for individuals age 8 and older; younger children do not yet have the development of skills that are necessary to accurately evaluate their auditory processing abilities. After the evaluation, a full report detailing the test battery and areas of weakness is sent home, or to schools. The report includes recommendations that are tailored to individual needs and to strengthen auditory skills.
For more specific questions regarding an evaluation or CAPD, feel free to contact Dr. Melissa Tatton Lev at email@example.com or (203) 830-4705.
Some most common signs and behaviors associated with CAPD are:
- Difficulty hearing in noisy situations
- Difficulty following long conversations
- Difficulty hearing conversations on the telephone
- Difficulty learning a foreign language or challenging vocabulary words
- Difficulty remembering spoken information
- Difficulty taking notes
- Difficulty maintaining focus on an activity if other sounds are present; child is easily distracted by other sounds in the environment
- Difficulty with organizational skills
- Difficulty following multi-step directions
- Difficulty in directing, sustaining, or dividing attention
- Difficulty with reading and/or spelling
- Difficulty processing nonverbal information (for example, lack of music appreciation or tone deafness).
It should be noted that these behaviors are not unique to CAPD! Many of these behaviors are seen in other learning disabilities such as dyslexia, speech and language disorders, and attention deficit disorders. Therefore, it is recommended that other learning disabilities and weaknesses are ruled out before evaluating for CAPD.
A Central Auditory Processing Disorder (CAPD or APD) is a weakness in the brain’s ability to process the more complex auditory and verbal signals. A child or individual with CAPD cannot process information that they hear the same way as others because their brains are not accurately recognizing and interpreting auditory information.
People with CAPD are thought to hear normally because they can usually detect pure tones that are delivered one by one in a very quiet environment, such as the usual hearing test or hearing screening. Furthermore, all of the organs and structures required for hearing, such as the eardrum and cochlea, are healthy and intact.
However, the ability to detect the presence of sounds is only the first step in hearing and processing. People with CAPD do not have a loss of hearing sensitivity, but have a hearing problem in the sense that they do not process auditory information effectively.
Cosmetic Plastic Surgery
Since the damage comes from sun exposure strict sun protection is necessary. Additionally a skin rejuvenation cream such as Neocutis Journee or SkinMedica TNS complex is recommended to continue the rejuvenation process. A maintenance IPL treatment once or twice a year can also be helpful.
The IPL is a complex machine and if used incorrectly can cause adverse effects. In skilled hands the IPL treatment is very safe. All IPL treatments at Advanced Specialty Care are evaluated by a physician and are performed under physician supervision.
The IPL is a complex machine and if used incorrectly can cause adverse effects. In skilled hands the IPL treatment is very safe. All IPL treatments at Advanced Specialty Care are evaluated by a physician and are performed under physician supervision.
First a cool gel is applied to the skin. Then there is a series of light pulses that feel like a mild heating of the skin. The treatment takes 15- 20 minutes. Afterwards there is often a mild redness of the skin that lasts for a few hours. Discomfort is minimal and patients return to their daily activities immediately. The treated blood vessels and brown spots may appear temporarily darker and will fade over 1-2 weeks. Sun protection before and after the treatment is very important.
The IPL targets the enlarged blood vessels and abnormal brown pigment in the skin. It can destroy this damage gradually reducing it over a series of 3-4 treatments. Patients see a 70-90% improvement in redness, brown color and skin tone.
Cosmetic & Plastic Surgery services are available at our Danbury, New Milford, Norwalk, Ridgefield and Stamford offices.
While there are many laser treatments, most will address either brown pigmentation or broken capillaries. IPL technology allows both vascular and benign pigmented lesions to be addressed in a single treatment without interruption in your busy lifestyle.
Many people report seeing visible skin refinement and an even, radiant skin tone after just one treatment. The smooth results and hydration may last five to seven days or even longer. A series of six treatments are recommended for improving the appearance of fine lines, wrinkles, hyperpigmentation, acne and oily skin. After your first series of treatments, you may want to maintain your results with a HydraFacial treatment every two to four weeks.
Eye redness may occur immediately after use, but should usually last only for a short period of time. Eye redness alone is not an allergic reaction or inflammation, and does not mean that your eyes are being harmed. Please use the LATISSE applicators as instructed to help to minimize the occurrence of eye redness.
There is a potential for increased brown iris pigmentation that is likely to be permanent.
Active ingredient: bimatoprost
Inactive ingredients: benzalkonium chloride; sodium chloride; sodium phosphate, dibasic; citric acid; and purified water. Sodium hydroxide and/or hydrochloric acid may be added to adjust pH. The pH during its shelf life ranges from 6.8-7.8
A clinical trial of LATISSE was conducted on patients who applied the product to the base of their upper lashes only. Applied nightly, the transfer of LATISSE solution from the upper to lower eyelid may occur naturally because the eyelids are closed and the eyelashes touch each other. Over application may increase the chance of experiencing side effects. To ensure safety and maximize effectiveness, please follow the directions provided.
LATISSE solution is a prescription treatment for hypotrichosis used to grow eyelashes, making them longer, thicker and darker.
Typically, you will feel warmth on your skin and another sensation, which feels much like a soft rubber-band snap. This second sensation is the absorption of the laser energy by the follicle. Your practitioner will explain these sensations in detail during your consultation and throughout your treatment sessions.
You should not wax, use electrolysis or lightening products for at least one month prior to consult or treatment. Depending on the treatment area, you may shave or clip the hair a day or two before your first treatment. You cannot be tan during any phase of treatment; this includes usage of tanning products as well.
A skin test is performed on all patients in order to determine your therapeutic dosage and treatment range. Your laser practitioner will discuss all elements of what to expect with you prior, during and after the skin test. Typically, you will return in 2-4 weeks to evaluate the results of the skin test and administer the first treatment.
All of our chemical peels are performed in our office by our Board Certified Plastic Surgeons (TCA Peel) or by our aestheticians at the Skincare & Laser Clinic.
Chemical peels are performed on the face, neck or hands. They can be used to:
- Reduce fine lines under the eyes and around the mouth
- Treat wrinkles caused by sun damage, aging and hereditary factors
- Improve the appearance of mild scarring
- Treat certain types of acne
- Reduce age spots, freckles and dark patches (melasma) due to pregnancy or taking birth control pills
- Improve the look and feel of skin that is dull in texture and color
A compression garment is worn at the end of the procedure to reduce swelling. Pain is typically well controlled with medication. Any swelling or bruising will subside over the first week or two. The results will continue to improve over the following weeks as any residual swelling subsides and the skin shrinks to fit the body’s new contour. Normal activities can be resumed after several weeks.
The scars from liposuction alone are very small and well accepted. More severe problems require direct excision through longer incisions. The scars from this are placed around the areola and are well hidden after they fade.
Most insurance plans do not pay for the surgery at this time. We encourage you to check with your own company to review their policies.
Gynecomastia surgery is performed on an outpatient basis. A compressive garment must be worn post-operatively. Most patients resume normal activities in a day or two. Upper body exercise is not permitted for 4 weeks.
Breast reduction does not increase the risk of developing breast cancer. Mammograms can still be performed in the future.
In most situations, it is possible to have radiation and/or chemotherapy. However, patients should ask their surgeon and/or oncologist this question directly. It is also imperative that members of the health care team communicate on this issue so that everyone understands the full treatment plan.
There are some common things to expect after any type of surgical procedure that leaves a scar somewhere on the body. Depending on the type of reconstruction, the scar can be located in several different areas. For most patients, scars heal well and become faint with time. However, in some patients the scar can remain red and thickened. In addition, sometimes, small nerves, which provide sensation to the skin, are damaged during the procedures. This may cause changes in sensation, including numbness. Of course, there is always some degree of pain after these reconstructive procedures, but most times it only lasts for a few days and is well managed with analgesics (i.e. “pain killers”).
There are also some possible complications that are associated with surgery in general. All surgical procedures carry the possibility of considerable blood loss, requiring a blood transfusion. Fortunately, this occurs very rarely in reconstructive breast surgery. Since surgery involves opening the skin, all surgical procedures also have a risk of infection. Again, this is rare in breast reconstruction and when it does occur, it is often treated adequately with antibiotics. Other more rare, but serious complications include a blood clot or embolus, pneumonia, or an unexpected response (or allergic reaction) to certain drugs or anesthetics.
Patients who have a large amount of skin laxity in the breast cannot undergo placement of an implant alone (augmentation). Sometimes, these patients also require removal of extra skin and placement of the nipple in a more desirable position.
Although patients go home following surgery, most feel tired for the next 24 to 48 hours. Any pain is usually controlled by the medications prescribed. Stitches are removed at 7-10 days. Patients can normally return to work in a few days, although exercise and strenuous activity may not be allowed for several weeks.
Breast augmentation is most commonly performed using general anesthesia, so patients can sleep through the operation. Some patients may also be candidates for sedation and local anesthesia.
The surgery is performed by placing an implant beneath the breast tissue on the chest. There are several incisions that can be used. Incisions can be made in the lower part of the skin of the breast, around the areola, or in the armpit. Your surgeon can discuss with you the advantages of each incision.
The implants can be placed either above or below the pectoralis muscle on the chest wall. There may be specific anatomic reasons or conditions where one approach is superior to another. Again, speak to your surgeon about each approach. The procedure usually takes one to two hours to complete. Patients go home the same day.
The majority of patients experience no change in breast sensation following surgery.
Before surgery, patients are screened for breast cancer. Having implants does not increase a patient’s risk of developing breast cancer.
Mammograms can be performed after surgery using specialized techniques that allow for excellent visualization of the breasts.
Currently available implants are very safe. No connection has been found to any chronic conditions.
The recovery period depends on the specific surgery performed. Patients can resume normal activities usually within a week following arm lifts and breast lifts. Abdominoplasties and thigh lifts require an additional week or two of recuperation.
In general, patients should be at a stable weight for three to six months prior to undertaking surgery.
Patients will notice improvement in body shape shortly after surgery. They typically report that clothes fit better, and they have more confidence about their appearance.
A compression garment is placed at the end of the procedure to reduce swelling. Pain is typically well controlled with medication. Any swelling or bruising will subside over the first week or two. The results will continue to improve over the following weeks as any residual swelling subsides and the skin shrinks to fit the body’s new contour. Normal activities can be resumed after several weeks.
Liposuction can be performed under local or general anesthesia, depending on the extent of surgery. First, one or more incisions are made near the area to be treated. A solution containing local anesthetic, saline, and adrenaline is then infused into the area. Next, the fat cells are suctioned away permanently. Finally, the incisions are closed.
Liposuction is extremely safe when performed by a qualified surgeon in a well-equipped operating room.
The best candidate for liposuction is someone who is close to his or her desired weight and who has localized fat deposits resistant to diet and exercise. Multiple areas of fat can be treated at the same setting. Unfortunately, it is not a treatment for obesity.
Overall, you can expect improved balance and proportion in the contour of the arm. A natural and presentable appearance will become more visible after the first week and will gradually improve further over the next three to six months.
Please note that the natural aging process will eventually affect the whole body, including the area treated in this procedure. Still, the contouring effects of arm lifts are typically long lasting, and most people are very pleased with their results.
After the procedure you may feel a little groggy. Your arm will be placed in a special compression garment to help the newly sculpted skin adhere to the tissue underneath. You will probably have several layers of stitches on the upper arm, possibly with a drain inserted to help the skin to adhere to the underlying tissue. Some of the stitches will be absorbable, and some may have to be removed during a follow-up visit. After a brief stay in the recovery room, you will be allowed to go home.
For the first week following surgery, avoid strenuous activity, including bending and lifting. You will be able to shower on the third day after surgery. The swelling is mild to moderate, and peaks at two to three days. Any stitches that are not absorbed will be removed after about a week. Some grogginess may persist for 5-7 days.
While each person’s recovery is unique, the recovery period after an arm lift generally lasts one to two weeks. You’ll probably be able to return to work in a week, and resume exercise within two weeks. Strenuous workouts and contact sports can be engaged in after about four weeks.
An arm lift is typically performed in an ambulatory surgical facility.
An arm lift typically takes about two hours. You will then be monitored in the recovery room and allowed to go home the same day.
An arm lift improves the contours of the upper arm with incisions typically placed in the inner arm area. Firming is achieved through liposuction and skin removal.
A tight fitting garment is worn around the waist to reduce swelling. Drains may also be used for one week to reduce swelling and bruising. Post-operative pain is well controlled by analgesics. Most people can return to work within a week. Patients should avoid strenuous activities for 4-6 weeks following the procedure. The scars fade with time and are well hidden.
Abdominoplasty is performed by making a horizontal incision just above the pubis. The length of the incision varies depending on the amount of excess skin to be removed. The excess skin and fat is pulled down and excised. An incision may also be necessary around the navel. The abdominal muscles are examined through the incision and can be tightened to improve the contour of the waistline. Liposuction can also be performed as an adjunct to the procedure.
There is very little to no downtime involved in a Radiesse procedure. In fact, most patients return to their normal, daily activities right after their visit. Every patient is unique, so be sure to discuss your plans with your physician during your consultation.
Just like any injection, you may experience mild irritation, swelling, itching, redness, bruising or tenderness at the injection site. These typically resolve on their own. If any of these side effects persist, contact us immediately.
Radiesse wrinkle filler is FDA approved, and has undergone rigorous testing in clinical studies to prove its safety. Our office has safely and effectively used Radiesse on many patients and highly recommends this product.
Radiesse is FDA approved to mix with lidocaine (an anesthetic). That means you can experience a more comfortable wrinkle treatment. In fact, in a clinical study, using Radiesse wrinkle filler mixed with lidocaine significantly reduced pain in 90% of patients treated.
Not only does Radiesse provide immediate correction, the natural, beautiful results may last a year or more in many patients.
Instantly! Immediately upon injection, Radiesse restores volume to smooth out the signs of aging.
Once injected, Radiesse wrinkle filler fills or replenishes volume lost over time for a more refreshed looking you. Then it goes to work stimulating your body to produce its own natural collagen. Over time, your body absorbs the product and leaves behind only your own natural collagen for long-lasting results.
Radiesse® filler is the only calcium-based filler that stimulates collagen production for long-lasting results. It also has the unique ability to treat a broad range of patients no matter how moderate or severe their wrinkles are. Just one Radiesse syringe can provide the full correction you need!
Radiesse wrinkle filler is injected into the skin in a simple, safe, quick procedure that can even be done over your lunch hour. Injections are more comfortable because Radiesse has been FDA approved for mixing with lidocaine, a kind of anesthetic.
Radiesse wrinkle filler is made of tiny calcium-based microspheres that are suspended in a natural, water-based gel. These calcium-based microspheres are similar to a mineral that is found naturally in your body so allergy testing is not required. Over time, your body absorbs these tiny microspheres and the gel and leaves behind only your natural collagen.
Radiesse® wrinkle filler is an injectable filler that works by immediately restoring facial volume to smooth out signs of aging. Once injected, it works with your body to stimulate the production of your own natural collagen for results that may last a year or more in many patients.
Juvederm Voluma XC instantly adds volume to the cheek area with natural-looking results
To reduce pain during the procedure, Juvederm Voluma XC contains a numbing agent called Lidocaine.
Juvederm Voluma XC is injected under the skin with a small needle. It works instantly to add volume and subtly lift the cheek area, temporarily reversing this sign of aging.
You need to discuss the following important treatment considerations with your physician in order to help avoid unsatisfactory results and complications:
- Patients who are using substances that can prolong bleeding, such as aspirin or ibuprofen, as with any injection, may experience increased bruising or bleeding at the injection site. You should inform your physician before treatment if you are using these types of substances.
- If laser treatment, chemical peeling, or any other procedure based on active dermal response is considered after treatment with Juvederm® Injectable gel, there is a possible risk of an inflammatory reaction at the treatment site
- Juvederm should be used with caution in patients on immunosuppressive therapy, or therapy used to decrease the body’s immune response, as there may be an increased risk of infection
- The safety of Juvederm for use during pregnancy, in breastfeeding females, or in patients under 18 years has not been established
- The safety of Juvederm in patients with a history of excessive scarring (e.g., hypertrophic scarring and keloid formations) and pigmentation disorders has not been studied.
Your physician will ask about your medical history to determine if you are an appropriate candidate for treatment. Juvederm should not be used in patients who have:
- Severe allergies marked by a history of anaphylaxis or history or presence of multiple severe allergies
- A history of allergies to Gram-positive bacterial proteins
Most side effects are mild or moderate in nature, and their duration is short lasting (7 days or less). The most common side effects include, but are not limited to, temporary injection-site reactions such as: redness, pain/tenderness, firmness, swelling, lumps/bumps, bruising, itching, and discoloration. As with all skin-injection procedures, there is a risk of infection.
Juvederm injectable gel is injected into areas of facial tissue where moderate to severe facial wrinkles and folds occur to temporarily adds volume to facial tissue and restores a smoother appearance to the face. Juvederm® Ultra injectable gel temporarily adds volume to the skin and may give the appearance of a smoother surface. Most patients need one treatment to achieve optimal wrinkle smoothing, and the results last about 9 months to 1 year.
Juvederm® injectable gel is a colorless hyaluronic acid gel that is injected into facial tissue to smooth wrinkles and folds, especially around the nose and mouth. Hyaluronic acid is a naturally occurring sugar found in the human body. The role of hyaluronic acid in the skin is to deliver nutrients, hydrate the skin by holding in water, and to act as a cushioning agent.
Only our Board Certified Plastic Surgeons will administer your Botox® Cosmetic treatment.
Visible results have been shown to last up to 4 months. Your own results may vary.
Within days, you may see a marked improvement in the moderate to severe frown lines between your brows. Lines continue to improve for up to 30 days, and results can last for up to 4 months. Individual results may vary.
Botox® Cosmetic is administered by our Board Certified Plastic Surgeons as a simple, nonsurgical treatment. It is a prescription medicine that is injected into directly into muscles between the brows and used to improve the look of moderate to severe frown lines between the eyebrows in people 18 to 65 years of age for a short period of time. Botox works by blocking nerve impulses to the injected muscles. This reduces muscle activity that causes moderate to severe lines to form between the brows.
While BELOTERO BALANCE® Dermal Filler is made of the same material (hyaluronic acid) as some other dermal fillers, it has unique properties that allow it to adapt within the skin for soft and even correction. Its versatility makes it strong enough to handle deep treatment areas such as nasolabial folds (smile lines around the mouth), yet soft enough to treat more delicate areas such as vertical lip lines (thin lines that appear above the lip line).
BELOTERO BALANCE® Dermal Filler is made of a material called hyaluronic acid or HA. HA naturally exists as a component of your skin. By binding to water, it plumps and fills in wrinkles and folds, allowing immediate and smooth correction.
BELOTERO BALANCE® Dermal Filler is an injectable filler that quickly integrates into your skin. Once injected, it instantly smoothes the lines and wrinkles in your face.
When your procedure is completed, your forehead may be taped and your head may be loosely wrapped to minimize swelling and bruising. A thin tube may be present to drain any excess blood or fluid that may collect under the skin. Initial wound healing may take 5 to 10 days, at which time any sutures or clips will be removed, if necessary. You will be ready to return to work and normal activities at this time. Healing will continue for several weeks as the swelling disappears and the incision lines start to fade away. Sun protection will be essential during your recovery until your healing process is fully complete.
A brow lift may take two hours or more depending on the extent of the rejuvenation and methods used. Results appear gradually as swelling and bruising subside to reveal smoother forehead skin and a more youthful, restful appearance.
A cosmetic improvement can be performed at the same time as functional nasal surgery. There is usually an additional fee for the cosmetic portion. We can give you more information regarding your particular situation following a consultation.
Insurance does not usually cover the cost of surgery that is purely for cosmetic reasons. Surgery to correct or improve nasal function or surgery to correct a deformity or injury may be covered. We try our best to be your advocate to obtain insurance coverage for legitimate functional problems of the nose.
There is some discomfort following surgery, but this is well controlled with medications.
There is some swelling and bruising around the eyes following surgery. Ice is applied to the area for 24 hours to reduce swelling. Patients typically do not experience much pain following the procedure. They can resume day-to-day activities within a short time. The swelling and bruising subsides over the first week and patients can begin applying makeup at that time. Exercise can be resumed after several weeks.
Eyelid surgery is usually performed using local anesthetic supplemented by sedation. The incisions are well hidden in the natural creases of the eyelids. Any excess skin, fat, and hypertrophied muscle is removed. Very fine sutures are used to close the incisions.
There are other cosmetic problems that contribute to the overall appearance of the eyes. These may not be corrected by eyelid surgery alone. For example, a sagging brow may require a forehead lift. Fine wrinkles (crow’s feet) around the eyes can be improved with chemical peels or laser resurfacing. Also, bleaching agents can be used to lighten the appearance of dark circles.
It is difficult to predict exactly how long the results of a facelift will last, although patients are usually pleased with their appearance for many years after surgery.
Patients are advised to rest at home with their head elevated for the first 24 hours after surgery. Pain is usually well controlled with prescribed medications. The swelling in the face normally peaks within the first several days and then gradually subsides over one to two weeks. The bandage will be changed within the first week and any external sutures will be removed. Makeup can be worn to conceal any discoloration. Patients usually return to light activity within a few days and can begin strenuous exercise after 4-6 weeks.
A facelift is commonly performed under general anesthesia or local anesthesia with sedation. Incisions are made above the hairline in the temple and extend down in front of the ear and around the ear to the lower scalp. The scars, once healed are well hidden in natural creases. The skin and other tissues of the face and neck are separated, tightened, and re-sutured to achieve the desired result. The muscle in the neck may also be tightened. A soft bandage is placed around the face after the procedure.
Rosacea is a very common acne-like facial eruption that is more common in people over thirty and in those of Celtic origin. However, people of any ethnic background can also have it. One component is vascular (red face, blushing, flushing and enlarged capillaries) and one is a breakout that looks like that of acne. There are a variety of triggers that cause the breakouts to be worse. It can also include watery or gritty feeling eyes and in rare cases (but rarely in women), a thickening of the nose called rhinophyma. Some people find that their facial skin burns, stings, or itches, even when they do not have a breakout.
It is considered normal for us to lose about 50-100 hairs a day. If you experience bald patches or thinning hair, this could be hair loss. Childbirth, stress, some diseases and medical treatments can cause hair loss. Hereditary hair loss is the most common reason for hair loss with about 80 million men and women experiencing this type of hair loss. When you experience hair loss, you should seek the advice of a dermatologist as many of these causes are treatable. Our dermatologists specialize in the treatment of skin, hair, and nails.
Melasma is a common skin problem causing patchy brown, tan, or blue-gray facial skin discoloration. It is mostly found on the upper cheeks, upper lip, forehead, and chin. It is most commonly found in women 20-50 years of age. One of the main causes of melasma is related to external sun exposure. It is common amongst pregnant women and hormones seem to trigger melasma. Your dermatologist can help you treat it with topical creams or laser.
Scars are fibrous tissues that replace normal skin after an injury such as a wound, burn or sore. Scarring is a natural part of the healing process and actually results from the process of wound repair in skin and other tissues. If a scar becomes thick and raised, or extends beyond the original injury area your dermatologist can treat it to soften it, making it more comfortable and attractive.
Psoriasis is a common skin disease that affects the life cycle of skin cells. Psoriasis causes cells to build up rapidly on the surface of the skin, forming thick silvery scales and itchy, dry, red patches that are sometimes painful. Genetics has a strong role in who will be affected by it.
Psoriasis is a chronic (long-lasting) disease. At times your psoriasis symptoms can improve or worsen. A dermatologist can treat psoriasis with both topical creams and systemic drugs, as well as counsel you on skin care and lifestyle factors that may affect it.
Psoriasis can be disabling for some people. Treatment by a dermatologist can improve a person’s quality of life.
Moles or “nevi” are very common. Some people have only a few but others have many; this in itself is not concerning. Moles come in various sizes and colors, can be raised or flat and may have a few hairs.
Moles are generally nothing to worry about but if your mole should change size, color or shape, become itchy or bleed, you should see our dermatologist.
Sclerotherapy treatments are simple quick outpatient procedures. Most treatments take between fifteen and forty five minutes. As the procedure is almost painless, anesthesia is not typically required.
During sclerotherapy, a chemical solution known as a sclerosing agent is injected at several points along spider veins. Sclerotherapy is commonly performed with a concentrated saline solution, although other chemical solutions or special foam may be used as well. The agent irritates the lining of the veins, which in combination with compression after treatment causes the vein walls to collapse. Over time, the veins will be absorbed by the body, restoring a smoother, more youthful appearance. Like other vein removal therapy, multiple treatments are usually required to achieve the desired results, but sclerotherapy can reduce the appearance of most spider veins and some small varicose veins significantly.
Non surgical modalities such as Botox Cosmetic & injectable fillers are being used to turn back time to restore volume & soften lines caused by the aging process.
Doctors have used Botox safely for years to treat various medical conditions. Botox Cosmetic is a natural purified protein that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults. It can also be used around the eyes and in a few other areas. Results have been shown to last up to four months.
Molluscum Contagiosum is a common skin disease caused by a virus*. The virus can be spread by direct skin-to-skin contact or by touching infected surfaces such as gym mats or towels recently used by an infected person. A dermatologist can treat the molluscum lesions. Although the virus is usually harmless, it can spread over the body and/or other people.
*It usually appears as small flesh covered bumps on the skin.
Rosacea is a common skin disease. It often begins with a tendency to blush or flush more easily than other people do.
With time, people who have rosacea may see permanent redness in the center of their face. The redness can slowly spread beyond the nose and cheeks to the forehead and chin.
Rosacea can cause more than redness. Rosacea can cause acne-like breakouts, visible blood vessels on the face, and dry irritated eyes.
Although rosacea cannot be cured, treatments can control and reduce signs and symptoms. A dermatologist can diagnose and offer proper treatment.
Eczema is a common skin disease that can affect all ages. Other names for eczema are dermatitis and atopic eczema. It is a type of skin rash characterized by itchy, red, irritated patches. In severe cases, the rash can ooze, flake, and cause the skin to thicken.
A dermatologist cannot cure eczema but can help you learn to control it. Treating eczema is important to calm the skin, relieve itching and pain, to prevent infections, and to stop the skin from thickening (which may cause the skin to itch constantly).
Poison Ivy is a rash you get from the oil found in the plants poison ivy, poison oak and poison sumac. The rash usually starts 12 to 72 hours after contact with these plants and the symptoms are redness, itching, swelling and blisters. It is not contagious and usually goes away in a few weeks. A dermatologist can make the skin more comfortable during this time period.
You should see a doctor immediately if you have a serious reaction such as swelling, trouble breathing or trouble swallowing. If you have trouble breathing or swallowing you should go to an emergency room.
Acne is a common skin condition and affects all age groups. Acne happens when the pores of our skin become clogged. Acne can be many things, such as blackheads, cysts, pimples, and whiteheads. To determine whether or not you have acne, you should be examined by a dermatologist. Once examined, there are many effective treatments for acne.
Dermatology specializes in treating conditions of the skin, hair and nails. A dermatologist takes care of both cosmetic and medical issues and treats all ages from infant to elderly.
ENT / Head & Neck Surgery
Allergies, deviated septums and sinus problems with nasal polyps are common causes of nasal obstruction. The septum is a wall that goes back the full length of the nasal passage dividing the inside of the nose into 2 equal passageways. If the septum is crooked, we call it deviated. A mild deviation will cause no problem breathing. The more crooked the septum is, the more it will block one or both sides of the nose. A crooked septum can be surgically corrected if the blockage is bad enough. A very common cause of nasal blockage is swelling of the linings of the nose by allergies. This can be seasonal or all year round depending on what causes the allergies. Pet dander would be all year while pollen would be seasonal. There are many ways to treat allergies including allergy pills, allergy sprays, avoidance of the allergy causing swelling and allergy desensitization. Nasal polyps are growths in the nose that usually come from the sinuses and project into the nose. The larger they are the more blockage they cause. Polyps can occur due to allergies or sinus disease amongst others. They are not cancerous like colon polyps might be. They may be treated with nasal sprays, allergy treatment, certain oral medications or surgery.
The main reasons tonsils and adenoids may need to be removed are recurring throat infections and snoring. General guidelines for removal based on recurring infection are seven or more tonsil infections in one year, five infections a year for two years, or three infections for three or more years. There can be factors in the child’s history that could lead to surgery without actually meeting these general numbers. The other reason a T&A is commonly performed is snoring with associated sleep apnea. Snoring and apnea may be related to enlargement of the child’s tonsils and/or adenoids. These children are usually mouth breathers during the day. They may exhibit daytime fatigue, poor school performance, bed wetting, and difficulty concentrating. Sleep apnea is usually apparent in a child who snores loudly and is seen to stop breathing during sleep or struggle to breath intermittently during sleep. A tonsil and adenoidectomy is very effective in treating many of these symptoms.
Snoring and sleep apnea are not the same thing although they may occur together. Snoring is very common and is caused by vibrations in the upper airway. When breathing, air should pass freely though the nose. If there’s any blockage to this flow, the palate and other structures in the throat may vibrate causing snoring. Snoring can be quiet or very loud. When sleeping, the structures in the throat relax and can vibrate more easily. The deeper you sleep the more relaxed the muscles and the more likely you will snore. That’s why alcohol, some antihistamines and sleeping medicines amongst other medicines are common causes of snoring. Excess weight is may be a significant causative factor. Large tonsils and adenoids are a frequent cause of snoring and apnea in children. They may collapse into the airway during sleep causing blockage to normal free breathing. A deviated nasal septum, allergies, common cold and nasal polyps are causes of snoring due to nasal obstruction. Sleep apnea may be caused by the same type of obstruction as snoring. It, however, isn’t just a social issue. Sleep apnea can cause significant health issues such as high blood pressure, stroke and heart disease if not adequately treated. With sleep apnea much less air may get through to your lungs reducing the amount of oxygen in your blood. With sleep apnea there are periods during which breathing stops for 10 or more seconds. Daytime fatigue and irritability are common symptoms or both snoring and sleep apnea. Disturbed sleep may result in the partner of the snoring individual causing daytime fatigue in them as well. This may cause difficulties in a relationship. Children may exhibit bed wetting and/or behavior problems at home and in school. There are many available options in treating snoring and sleep apnea. An adequate ear, nose and throat exam is key to diagnosing anatomical obstructions. Treatment could involve weight loss, dietary changes, medications or the elimination of certain medications. Surgery such as tonsil and adenoid removal or correction of a deviated septum might be necessary. CPAP machines to help with air flow while asleep may be needed. Sleep studies may be necessary to determine the presence of and severity of sleep apnea. Sleep studies may be performed in your home avoiding the need for sleeping in a lab for the procedure.
Yes, they’re one and the same. The nose has 2 bones that a form a sort of pyramid. If the nose is hit hard, one or both bones may break in one or more places. The broken bones will usually change the appearance of the nose by shifting it to the side or flattening it. Black eyes will also usually appear as well as swelling of the nose and face around the nose. The nose may bleed from the torn membranes in the nose. The septum may be broken as well, thereby causing a deviated septum. Sports injuries, falls, auto accidents and fist fights are common causes of a broken nose. It’s advisable to wear protective face gear in contact sports. Fastening your car seat belt may protect you from facial injury in an accident. Watch out for slips in snow and ice. If you injure your nose and suspect a fracture you should try the following first aid:
- Blow your nose gently to clear any clots from the nasal passages.
- If there’s bleeding from the nasal passages try pinching your nostrils together for 5 minutes.
- Put an ice pack on your nose for a few hours to reduce swelling.
- Go to the emergency room if the bleeding doesn’t stop in 15-20 minutes or if the skin of the nose is cut.
Your nose should be evaluated by an ear, nose and throat doctor within a day or two. Sometimes a hematoma (blood clot) forms under the surface of the septum. This will cause difficulty breathing through your nose. If it isn’t drained it could infect and cause permanent damage to the nose. Nasal fractures can readily be fixed if seen within 4-10 days. Once the bones have broken, they begin to heal and knit together in whatever position they’re in. During the first 7-10 days they can usually be manipulated back into more normal position. If not treated in that period, it may be necessary to re-break the bones to get them back in position. A fracture may be undisplaced in which case there’s no deformity or breathing problem and no treatment may be necessary.
Hoarseness describes a voice change from your normal voice to a raspy, breathy, cracking or rough sounding voice. There are many causes of hoarseness. Probably the most common cause is acute laryngitis as part of an upper respiratory infection. Improper voice use is another common cause. Something as simple as shouting at your child’s baseball game or trying to have a conversation at a noisy party could irritate your vocal cords enough to cause hoarseness. Vocal cord nodules and polyps are non-cancerous growths that can form on vocal cords from vocal abuse. Vocal cord nodules are tiny bumps like calluses that may form on vocal cords. They are sometimes called screamer’s nodes, teacher’s nodes or singer’s nodes. These names indicate the type of individual most likely to develop nodules due to voice abuse. Vocal cord polyps are more fleshy and usually larger growths. They also form from voice abuse. Smoking may cause vocal polyps as well. Acid reflux, if it goes high enough in the esophagus to reach the back of the voice box is another common cause of hoarseness. The reflux irritates the back of the voice box causing swelling that may interfere with normal vocal cord movement. Cancer of the larynx (voice box) is a less common but far more serious cause. Throat cancer is usually found in drinkers and smokers. Cancer of the larynx, if caught early is very curable. Since hoarseness occurs early on in the disease it’s very important to have it evaluated quickly. Determining the cause of hoarseness involves looking at the voice box with an endoscope, which is a small telescope, or mirror in the office. This is a very simple and quick procedure done by ear, nose and throat doctors. If hoarseness persists for more than a week or two, medical evaluation is needed. Treatment will depend on the diagnosis. Voice rest, speech therapy, certain medications and surgical removal are treatment options for benign disease. If cancer is suspected, a biopsy, usually under anesthesia,would be a likely next step.
Nose bleeds are very common in both children and adults. There are 2 basic kinds of nosebleed. An anterior nose bleed is one that is coming from the front part of the inside of the nose. Posterior nosebleeds are less frequent and more difficult to control, They come from the back of the nose. If you have a nose bleed there are some simple home remedies to try to control it. Try sitting with your head down in front of a sink. Blow your nose to clear any clots that are in the nose. Then pinch the nostrils together (not the top of the nose) and hold pressure for 5 minutes. If this is an anterior bleed the pressure will frequently stop the bleed. If this doesn’t work you can make a simple pack for your nose. Take a half of a cotton ball and saturate it with Vaseline. Use the same steps as above but before pinching insert the cotton into the bleeding side. If this works, leave the cotton in the nose for 24 hours before removing it. A posterior bleed will not respond to this treatment and may need packing or cautery by a physician. Posterior bleeds are more common in the elderly and those with high blood pressure or on blood thinners. If the bleeding continues for 20 minutes seek medical attention.
The septum is the wall in the middle of the nose that divides the nose into 2 equal passage ways. If the septum is deviated it means that it is crooked. A crooked septum will block one or both sides of the nose. The more crooked the septum the more blockage that results. This blockage can cause difficulty breathing through the nose and may lead to sinus problems as well. A septoplasty is the name of the operation used to correct a deviated septum. The operation is usually done under anesthesia in a hospital or surgery center. This is not the operation used to change the appearance of the nose. It is not cosmetic surgery. The procedure involves removing some of the crooked cartilage and bone of the septum. Some of the remaining cartilage may be re-positioned as well. This is done through the nostrils.The nose is not broken with this procedure and black eyes rarely if ever result.
Nasal polyps are growths in the nose. They usually have their roots in the sinuses and spill into the nose through the sinus openings. They are unlike other polyps such as in the colon as they do not become cancerous. If nasal polyps don’t resolve with medical treatment, they may need to be removed. Polyps originating on the lining of the nose may be removable in the office. Most often polyps in the nose are coming from the sinuses. In those cases simple removal in the office is not likely to help as leaving the roots in the sinuses will probably see the polyps recur. That’s why sinus surgery may be necessary.
Chronic sinusitis that doesn’t respond to medical management can be treated surgically. This has necessitated an anesthetic and admission to a hospital or surgical center in the past. A new procedure called a balloon sinuplasty may allow your surgeon to treat your chronic sinusitis as a brief office procedure using a local anesthetic without invasive open surgery. With balloon sinuplasty there’s no need to cut tissue or bone in your nose to enter the involved sinuses. A balloon is inserted through the nostril and into the sinus through its opening. By inflating the balloon the sinus opening is stretched, enlarging it for better drainage of sinus mucus. The sinus can be washed through the balloon at the time of sinuplasty thereby cleaning out pus and mucus previously trapped inside the sinus. Recovery from traditional sinus surgery may take up to 2 weeks. Most patients undergoing balloon sinuplasty return to normal activities in 2 days.
The specific treatment performed depends on each patient’s unique needs:
- CPAP (continuous positive airway pressure) This is a mask worn over the nose that is attached to an air compressor. The air pressure holds the airway open.
- Oral appliances: These can prevent the tongue from collapsing the airway.
- Surgery: The goal of surgery is to relieve the physical abnormalities that cause the airway to collapse.
Obstructive Sleep Apnea (OSA) is a disorder that is associated with significant medical and social problems. Apnea means lack of breathing.
People with sleep apnea do not breathe properly during sleep. The muscles at the back of the throat relax during sleep, obstructing the airway. Sleep is interrupted by the brain to “wake up”- just enough to unplug the airway. When this occurs the person sounds like he/she is gasping. The breathing improves but only until the next time the obstruction occurs. This cycle can last for ten seconds and can occur hundreds of times each night.
Radiofrequency Assisted Uvulopalatoplasty (RAUP) is a highly successful procedure to help your snoring. In RAUP, the vibrations of the soft tissues (palate) which cause snoring are reduced. A device using radiofrequency waves is inserted into the palate in several places. During the healing process, the normal tissue is replaced by a small amount of scar tissue. This new tissue is smaller and firmer; therefore, the vibrations of the palate are lessened and snoring is improved. This technique is called Radio Frequency Tissue Ablation (RFTA).
Nasal surgery, tonsillectomy and adenoidectomy or laser and radiofrequency surgery.
Avoidance strategies (partner uses earplugs, etc.); Conservative self treatments (Avoidance of alcohol, tobacco, sleeping pills, antihistamines, etc.); Devices such as continuous positive airway pressure (CPAP) devices.
Snoring affects up to 50% of men and 25% of women. It is due to the vibration of the soft tissues in the back of the throat. During sleep, the tissues of the palate relax causing vibrations that are heard as snoring. By itself, snoring is not a medical disease, however it can cause significant social and marital problems. Sometimes it is a sign of a serious medical disorder in which breathing is reduced during sleep.
Yes, throat and lung breathing problems in infants and children can be caused or worsened by LPR. LPR is more difficult to diagnose in children, so that infants and children who may have LPR should be taken to specialists for pH-metry and other tests.
Most patients with LPR require some treatment, most of the time, and some people need medicine all of the time. Some people recover completely for months or years, and then may have a relapse.
Treatment for LPR should be individualized, and your doctor will suggest the best treatment for you. Generally, there are several treatments for LPR:
- changing habits and diet to reduce reflux
- medications to reduce stomach acid, and
- surgery to prevent reflux
Chronic hoarseness, throat clearing, and cough as well as a feeling of a lump in the throat or difficulty swallowing may be signs that you have LPR. Some people do have heartburn, too. Some people have hoarseness that comes and goes, others have a problem with too much mucus or phlegm. If you have any of these symptoms, and especially if you smoke, you should ask your doctor about LPR. The specialist who most often treats people with LPR is the Otolaryngologist (Ear, Nose, and Throat Physician).
The term REFLUX comes from a Greek word that means “back flow”, and it usually refers to “the back flow of stomach contents”. Normally, once the things that we eat reach the stomach, digestion should begin without the contents of the stomach coming back up again… refluxing.
The term Laryngopharyngeal Reflux (LPR) refers to the back flow of food or stomach acid all of the way back up into the larynx (the voice box) or the pharynx (the throat). LPR can occur during the day or night, even if a person who has LPR hasn’t eaten a thing.
Not everyone with reflux has a lot of heartburn or indigestion. In fact, many people with LPR never have heartburn. This is why LPR is called SILENT REFLUX, and the terms “silent reflux” and “LPR” are often used interchangeably. Because LPR is silent, it is sometimes difficult to diagnose.
The septum is a wall that divides the nose into two passages. Normally these passages are equal in size. The septum is made of cartilage in the front and very thin bone in the back. It is covered on each side with a skin like lining called mucus membrane.
In simple terms, a deviated septum is a crooked septum. In other words, the septum, or part of the septum, is not in the middle of the nose. A deviation of the septum is caused by trauma. This could be birth trauma or an injury to the nose later in life.
Any child with obstructing tonsils or adenoids and frequent sinus, nose or ear infections or who has significant sleep apnea and has difficulty staying awake during the day is a potential candidate for a tonsil and/or adenoidectomy. If the tonsils and adenoids are large enough to cause heart or lung complications, they both should be removed, with rare exception. Once a tonsillar abscess has occurred, a tonsillectomy is usually indicated to prevent another abscess from forming.
Most specialists agree that six (6) tonsil infections in a year, or four (4) in each of two years or three (3) infections in each of three years, or a single strep infection that cannot be cured by appropriate antibiotics, or a patient acting as a strep carrier and infecting family members despite antibiotics, constitute some of the major indications for a T&A, subject to individual evaluation.
The tonsils are a pair of structures that are found on both sides of the mouth, in the back, by the base of the tongue. The adenoids are not usually visible by looking in the mouth. They are a mass of tissue located above the roof of the mouth at the back of the nose. Both the tonsils and adenoids are felt to be components of our immune system. When they’re healthy and functioning normally, they help fight infection that enters our body through our nose or mouth. Removing the tonsils and/or adenoids doesn’t make us more likely to catch infections, as there are many other immune defense structures in our upper airway that act in their place. As we get older, the tonsils usually shrink in size and the adenoids vanish entirely. There is a wide range of normal size for both of these organs.
Tinnitus is noise in the ear. It may be a whistling, humming, buzzing or other sounding noise and can be very distressing. Xylocaine is a local anesthetic commonly used in dental work. It is very useful in reducing or eliminating tinnitus in certain patients, especially those with tinnitus in one ear only.
Positional vertigo is another cause of dizzy spells. The dizziness is provoked by movement. There are tiny “stones” that form in the inner ear causing this dizziness. The attacks are usually caused by movement in a certain specific way such as rolling over to the right side in bed. When balance exercises and medical treatment do not stop the dizzy spells, perfusion may stop the dizzy spells and usually does not make the hearing worse.
Sudden hearing loss is a sudden nerve hearing loss that is commonly permanent. It is felt to be caused by autoimmune damage to the inner ear, viral infection of the inner ear as well as other factors. The hearing may be improved by perfusion with methylprednisolone if begun early on in the disease.
Meniere’s disease is a disease of the inner ear caused by an excess accumulation of fluid in the inner ear. Most patients have one or all of the following symptoms:
- ear fullness
- ear ringing (also called “tinnitus”)
- attacks of spinning dizziness (vertigo)
- fluctuating hearing loss
Most attacks of Meniere’s disease are preceded by a feeling of pressure or fullness in one or both ears. The hearing in the involved ear(s) generally fluctuates. A ringing sound called tinnitus may be heard in the problem ear. A Meniere’s episode generally involves severe vertigo (spinning), imbalance, nausea, and vomiting. The average attack lasts a few hours.
On average, myringotomy tubes stay in the eardrum for six to twelve months, usually closer to twelve. With time, the eardrum “rejects” the tube, pushing it out into the ear canal. With rare exception, the eardrum incision closes in short order.
Antibiotics are the first line of defense against ear infections. Different germs are killed by different antibiotics, some being more difficult to kill than others. Since we cannot easily take cultures of the infection behind the eardrum, it may be necessary to use more that one antibiotic before finally obtaining an uninfected ear. Occasionally no antibiotic seems to work. When this happens it becomes necessary to puncture the eardrum to let the infection out before a complication occurs. Myringotomy tubes may be placed in the puncture site to keep the eardrum from healing before the infection has adequately cleared.
The major functions of the ear are hearing and helping to maintain our balance. If fluid fills a middle ear, our balance may be “off”. This may be especially apparent in a young child who is just learning to walk. Hearing is affected by fluid in the middle ear because the fluid deadens the transmission of sound through the ear. This is similar to what we experience when there’s water in our outer ears after swimming, although in that case water is on the outside of the eardrum.
Initially the hearing loss that middle ear fluid causes is a temporary problem. However, if middle ear fluid is permitted to remain in the ear for a prolonged period of time, permanent damage may result. In young children the hearing loss caused by the presence of fluid may affect speech and language development as well as certain learning processing skills. This is less significant in older children.
Middle ear fluid is a body fluid that forms in the space behind the ear drum. Normally there is air behind the ear drum. Middle ear fluid forms in an ear when air is unable to get into the middle ear through the eustachian tube. It is necessary for air to enter the middle ear through the eustachian tube to replace the air that the body is constantly absorbing from the middle ear.
Each time we swallow, muscles in our mouth pull open the eustachian tube entrance, permitting air from the back of the mouth to enter the middle ear. As long as our eustachian tubes (there are two of them, one on each side) act this way, there is a balance between the amount of air absorbed from the middle ear by the body and the amount entering to replace it.
For a variety of reasons, one or both eustachian tubes may not function well. When a eustachian tube isn’t working correctly, air doesn’t get into the middle ear. However, air is still absorbed from the ear. This results in a vacuum forming in the middle ear space. A vacuum in the middle ear is the same as suction in the middle ear. This suction draws fluid out of the lining membranes of the middle ear and mastoid. The result is middle ear fluid!
The term arthritis describes a condition characterized by degeneration of the cartilage around one or more joints. It can be caused by systemic illnesses, such as rheumatoid arthritis or gout. Osteoarthritis refers to the degeneration of cartilage around a joint which is not linked to a systemic illness. This is usually secondary to previous injury, infection, or just use of the joint over time.
At Advanced Hand Surgery we treat osteoarthritis in the joints of the hand: The prevalence of osteoarthritis of the hand increases with age. It is more common in men than women until women reach menopause. The most commonly affected joints are those in the fingers and the base of the thumb.
One does not have to suffer from the pain of osteoarthritis in the hand. There are a variety of successful surgical and nonsurgical modalities which can bring relief to patients suffering from this common disorder.
Following injury, changes occur to a nerve both proximal and distal to the area. Distal to the injury, the nerve undergoes degeneration. Damaged parts of the nerve begin to sprout and travel distally to try to repair the nerve.
The development of modern microsurgical techniques along with better understanding of nerve injury and regeneration has resulted in improvements in nerve repair following injury. There are three main nerves which provide motor control and sensation to the hand and forearm: Median, Ulnar, and Radial.
Several treatments are available for Dupuytren’s disease. However, surgery may not be indicated immediately upon making the diagnosis. Isolated nodules or knuckle pads may be followed if they do not interfere with hand function.
There are currently two non-surgical treatments for Dupuytren’s Disease: needle aponeurotomy and collagenase injection (Xiaflex).
Needle aponeurotomy-this is an office procedure where a needle is used to make multiple passes through the abnormal tissue in the palm to weaken it. Then, the Dupuytren’s cord can be ruptured. This procedure does not remove the diseased tissue but can be repeated if needed. It is most appropriate for patients with a small area of disease or those who cannot undergo surgery.
Collagenase injection (Xiaflex)-this is a procedure where and enzyme is injected into the diseased tissue. The enzyme breaks up the collagen in the cord, allowing finger extension after 24 hours. The risks of this procedure include bruising, numbness, and allergic reaction. Some patients require more than one injection for complete release. The enzyme is often covered by insurance.
The recurrence rate for both needle aponeurotomy and collagenase injection may be higher than surgery, as the diseased tissue is not removed.
Surgery is indicated when there is loss of function or progression of the disease. The functional disability usually results from flexion contractures of any or all of the three digital joints, especially the proximal interphalangeal. Patients with mainly cosmetic concerns are discouraged from having surgery.
Dupuytren’s disease (or “Dupuytren’s Contractures”) is characterized by the development of new tissues in the hand usually in the form of nodules or thick cords on the palm and fingers. Dupuytren’s disease occurs mainly in Caucasians with a high incidence in Anglo-Saxon populations. A strong family history may be present. Males are more commonly affected. Although Dupuytren’s disease has been linked with many other disorders a simple cause and effect relationship has never been demonstrated. It remains essentially an idiopathic disorder.
Certainly. Call our Hand Surgery center at (203) 830-4700. If you need a referral for insurance purposes we can help.
There is no single test that confirms the presence of Carpal Tunnel Syndrome. A good history in addition to several clinical tests can be helpful. In addition, nerve conduction studies can be performed if the diagnosis is not clear based on examination.
Patients with Carpal Tunnel Syndrome present with a wide variety of symptoms. The most common complaint is that of numbness and tingling in the hand localized to the thumb, index, middle, and half of the ring finger. These symptoms are often worse at night and may awaken patients. Symptoms may also occur while driving. Later on in the disease patients will complain of weakness or clumsiness of the hand, especially when grasping small objects. The numbness and tingling can even spread into the forearm or upper arm area. In the final stages of the disease, patients may start dropping things and may note wasting of the muscles at the base of the thumb.
The causes of carpal tunnel syndrome are varied. Compression has been linked to many factors, including trauma, tumors, Diabetes Mellitus, and pregnancy. The actual cause of the disease in many patients cannot be found; however, the treatment is the same.
One of the most common hand problems we see is Carpal Tunnel Syndrome (CTS). This term refers to a set of symptoms caused by compression of the median nerve as it crosses the wrist. The carpal tunnel is a space at the wrist through which travel nine tendons and the median nerve. This nerve carries sensation from the thumb, index, middle, and half of the ring finger. It also carries motor impulses to the muscles at the base of the thumb. Our doctors and our audiologists take the time necessary to perform a thorough, objective evaluation and make recommendations based strictly on your individual needs. Because we believe strongly in patient education, we explain the benefits and use of each type of hearing aid technology, so together we are able to make the right choice the first time. We also know your hearing aids need to be the right shape, the right size, and the right fit to be successful.
Skincare & Laser
You should not have a chemical peel if you:
- Are using Accutane
- Are using Retin-A (unless discontinued 1 week prior)
- Have allergies to aspirin and salicylates
- Have active cold sores
- Have dormant eczema
- Are pregnant or lactating