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    ENT Frequently Asked Questions

    A tonsil infection is an infection of the tonsils causing a sore throat. There are many germs that can cause a tonsil infection. These include bacteria, viruses and others. Unfortunately we have no good means of treating viral infections of the tonsils. Viral infections need to run their course. A strep is a bacteria really called streptococcus. Strep is readily treatable with antibiotics.If an individual has a sore throat, a throat culture or strep test is usually done to try to tell if the infection is treatable with antibiotics. There is no way to know for sure if a tonsil or throat infection is strep by simply looking at it. So, actually, a strep throat is the same thing as a tonsil infection (tonsillitis) when the germ is a strep. Even if the tonsils have been removed you can still have a strep throat. That occurs when the strep germ infects the lining of the back of the throat. Strep throat is not necessarily more painful than a viral throat infection. Both can cause fever.
    Reflux occurs when stomach acid leaks into the esophagus from the stomach. The esophagus is the tube that leads from the mouth into the stomach. It has 2 valves that help it work correctly. The lower valve is meant to keep acid in the stomach and the upper valve keeps acid out of the upper throat. If a little acid creeps up into the esophagus it may not cause heartburn because the lining of the esophagus is built to withstand it. If lots of acid gets past the valve it will cause heartburn. When only a little acid gets past both valves it may irritate the back of the voice box. The voice box cannot tolerate any acid so even a little can cause problems. This is called silent reflux and is very common. Some of the symptoms of silent reflux are dry cough, throat clearing, hoarseness and the sensation of a lump in the throat. Silent reflux may be treatable with simple dietary changes, elevating the head of the bed, weight loss or medication.

    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.

    ENT / Head & Neck Surgery services are available at our Danbury, New Milford, Norwalk, Ridgefield and Southbury offices.

    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.

    If the septum is crooked enough to cause symptoms such as those previously mentioned, it can be surgically straightened. The operation that accomplishes this is called a septoplasty. In essence, the mucus membranes are peeled off the underlying cartilage and bone by working through the nostrils. No incisions are made on the outside of the nose. Once the underlying septum is exposed, portions of it can be removed and/or moved back towards the middle. The linings can then be stitched back into their normal position covering the septum again.
    If the septum is crooked, it may block one or both sides of the nose to a variable degree. Many people have a mildly deviated septum that they are unaware of, as it is causing no problem. The more deviated the septum, the more problem it becomes. Probably the most obvious difficulty a deviated septum may cause is blockage to the breathing on one or both sides of the nose. This is a simple architectural problem with part of the septum being pushed into the normal opening. The more the septum is pushed into the airway, the more blockages it creates.

    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.
    Myringotomy tubes are small tubes inserted into your child’s eardrum. The procedure is for draining fluid that has built up behind a child’s eardrums. The purpose of the procedure is to restore the normal functioning of the ear.
    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!