Treating ear, nose and throat infections

ENT diseases are serious public health problems with universal distribution affecting all age groups. The knowledge of the ear, nose, throat, head and neck diseases is very important because of the type of morbidities which they cause due to impairment of the inherent physiologic functions that usually take place in the head and neck region. These include problems of hearing, breathing, swallowing, phonation, speech, olfaction, taste, protection of the lower respiratory tract and clearance of secretions.
Aesthetic problem of the face and psychological problem may occur in neoplasm and neurologic diseases of the head and neck region.Below are some examples of ENT disorders:

Tonsillitis
When the tonsils become inflamed for long periods of time, they may have to be surgically removed. This procedure is called a “tonsillectomy.” Though tonsillitis used to be treated with tonsillectomy frequently, it is no longer the practice and is now only done in specific instances. When inflammation is severe enough, it can interfere with swallowing and breathing.
Tonsil removal is indicated in cases of extreme obstruction of the airways or swallowing. Often tonsils are enlarged, swollen and painful during tonsillitis. Less absolute indications for tonsillectomy include: recurrent acute throat infections, chronic tonsillitis that does not improve with antibiotics, obstruction leading to bad breath or changes in voice. There are many causes of tonsillitis.

Ear infection
Ear infections are one of the most prevalent ENT disorders. They occur when germs become trapped inside the inner ear. The Eustachian tube, a tiny tube that originates in the ear and drains in to the back of the throat, usually keeps unwanted germs out. If this tube is too small or becomes clogged by fluid and mucus, bacteria or other microbes may be able to enter the ear and cause an infection. Signs and symptoms of an ear infection include:
* recent history of an upper respiratory infection
* pain and pressure
* fever
* loss of balance
* difficulty hearing
* nausea and vomiting
* fluid discharge from the ear (this indicates perforation of the tympanic membrane)

Ear infections are more common in children. If your child has an ear infection, it may be difficult to detect. Here are some things you may notice about your child:
* pulling or tugging on the ears
* increased fussiness, especially at bedtime
* fails to startle at loud noises or does not consistently respond to name
* eating or drinking abnormally

Strep throat
Strep is an abbreviation for a family of bacteria called “streptococci.” Strep throat occurs when the throat and surrounding structures become infected with this germ. While strep throat is a common infection, many other infections have the same symptoms. You must have an actual strep test at your doctor’s office to be certain that your symptoms are associated with a streptococcal infection versus a different bacterial or viral infection. Symptoms are usually abrupt in onset, including:
* red, sore throat
* difficulty swallowing
* enlarged tonsils
* enlarged lymph nodes
* white patches on the tonsils or in the back of the throat
* fever
* body aches
* fatigue
* skin rash (rare)

Notably absent in strep throat are a runny nose and cough. You may also suspect strep throat if you have been exposed to someone with a strep infection in the last two weeks. Children between the ages of 5 and 15 are most at risk. You are also more likely to get a strep infection during the winter months.

Sinusitis
Sinusitis occurs when a germ finds its way in to the hollow recesses of the skull that surrounds your eyes and nose. The infection can then become trapped there, causing inflammation, pressure and pain. Acute sinusitis is often secondary to a common cold, so you are more likely to get sinusitis during the winter months.
Chronic sinusitis is sometimes an inflammatory disorder caused by untreated allergies or conditions, such as bronchial asthma. Sinusitis can last from weeks to years, if left untreated. Symptoms of sinusitis are:
* headache
* cough
* nasal discharge of various colours and consistency
* congestion
* toothache
* fever
* fatigue

Sleep apnoea
Apnoea is a medical term, meaning to stop breathing. Sleep apnoea is a disorder causing one to stop breathing for brief periods of time while sleeping. Sleep apnoea is a common disorder and can cause severe health problems, if left untreated. If you suspect that you have sleep apnoea, see a doctor. Symptoms include:
* waking up frequently in the middle of the night
* feeling unrefreshed upon awakening
* daytime drowsiness
* mood swings
* depression
* waking up with a dry, sore throat
* morning headaches

In addition to these symptoms, many individuals with sleep apnoea have often been told by a spouse or other family member that they snore, gasp or choke while sleeping. Family members may have observed an episode in which you stopped breathing while asleep. You are more likely to have sleep apnoea if you are overweight, have enlarged tonsils, take sedatives at bedtime or have inherited a shorter airway than the general population. People who are obese and have uncontrolled hypertension are more likely to have obstructive sleep apnoea.
The majority of people will experience one or more of these disorders in their lifetime. While visiting with your physician, discussion of your symptoms may help your doctor to come up with a diagnosis of an ENT disorder.

Diagnosis of ENT disorders
Many tests are used to diagnose ENT disorders. Regardless of your particular ailment, there is specific information you should always have ready for your physician to help him diagnose your problem. Here are some of the questions your doctor may ask:

* What are your symptoms and when did they start?
* Have you been taking any medications (over-the-counter, including vitamin and herbal supplements or prescription)? If so, your doctor will want to know the dosage.
* Are you allergic to any medications? If so, what are they and what kind of reaction did you have?
* Do you have a previous history of ENT disorders?
* Do you have a family history of ENT disorders?
* Do you have any other medical conditions?
* Have you been running a fever?

Here are additional questions if the patient is a small child:
* Has the child had nausea and vomiting? If so, has the child continued to have wet diapers?
* Has the child been abnormally fussy or lethargic?
* Has the child had balance problems?
* Has the child’s eating and drinking habits changed?
* Has the child shown signs of decreased hearing, such as not responding to their name immediately or not startling at loud noises?

Diagnosis of ear infections
If you have signs and symptoms of an ear infection, your doctor will use an otoscope to visualise the outer ear and eardrum. If an infection is present, the ear may appear red and swollen. There may also be a fluid discharge. Unlike other infections, the exact bacterium that is responsible cannot always be determined. As such, doctors choose antibiotics that will cover the most likely organisms when they suspect a bacterial source. This is because it can be difficult to obtain a sample from the ear for a culture. Antibiotics will not cure a viral infection, and it can take as long as three weeks for your body to fight off the virus.

Diagnosis of swimmer’s ear
With swimmer’s ear, the outer ear and ear canal may be red. Upon examination, the doctor may notice pus in the ear canal, and the skin may be scaly or shedding. The doctor may be able to obtain a fluid sample for culture.

Diagnosis of sinus infections
If a sinus infection is suspected, an endoscope may be used to go up the nose and visualise the opening in to the sinus cavity and take a direct sinus culture. Nasal swabs are not useful due to false positive results that do not reflect the sinus pathogen. By endoscope, the doctor will be looking for inflammation and/or discharge. Four view x-rays or a CT scan may be indicated, if other tests are inconclusive.

Diagnosis of strep throat
Strep throat causes enlarged reddened tonsils that sometimes have white patches on them; however, many viral infections can cause this as well. If strep throat is suspected, a throat culture will be taken and sent to the lab. This test is quick and easy to perform with only mild discomfort as it may cause a gagging sensation. A cotton swab is brushed against the back of the throat then sent to the lab to test for streptococcal bacteria, the cause of strep throat. The standard test can take one to two days; however, a rapid strep test can also be performed, which only takes a few minutes.
If the rapid strep test is positive, antibiotics will be started. If the rapid strep test is negative, you will be sent home and the standard culture will still be performed. About 20 per cent of negative rapid strep tests will become positive after a day or two in the laboratory. Sometimes your doctor may make the diagnosis based on classic symptoms and signs to treat you presumptively even without a swab.

Diagnosis of sleep apnoea
Sleep apnoea is a disorder causing one to stop breathing for brief periods of time while sleeping. In your first visit, the doctor will begin by obtaining a comprehensive medical history. Before ordering a sleep study, he or she will likely ask some of these questions:
* Have you ever been told that you snore?
* Have you ever been told that you have stopped breathing while asleep?
* Do you awake refreshed in the morning or do you suffer from daytime drowsiness?
* Do you suffer from mood swings or depression?
* Do you wake up frequently in the middle of the night?

The doctor will look inside your mouth for evidence of enlarged tonsils, uvula(a bell-like piece of tissue that hangs down from the roof of the mouth toward the back of the throat) or other structures that may be blocking the airway. The uvula contains some glands and affects vocal resonance. If the doctor suspects sleep apnoea, they may order a sleep study. Sleep studies are usually conducted at a sleep centre. After you fall asleep, a monitor, which measures the oxygen concentration in your blood, will be placed on your finger. Normal oxygen saturation during sleep in otherwise healthy men and women is 95 per cent to 100 per cent. If you stop breathing while asleep, this number will drop.
Another sleep study used to diagnose sleep apnoea is called a “polysomnogram.” It measures not only the amount of oxygen in your blood, but brain activity, eye movement and muscle activity, as well as your breathing and heart rate.
Based on your present symptoms, your doctor may choose to use a combination of these tests to diagnose your specific disorder. He will then use this information to create an effective treatment plan.

ENT treatment
ENT treatment can be handled by either a general practitioner or an otolaryngologist (ENT). Though general practitioners treat a number of ENT disorders, your family doctor may not feel comfortable treating you and may refer you to an ENT specialist. Seeking out a specialist on your own may also be helpful, if you are unhappy with the care you have received, need a second opinion or want more information than your general practitioner can provide.

How can I find an ENT specialist?
If you have been referred to an ENT specialist by your family doctor, he or she probably already has a specific doctor in mind. If not, you can use the to find a list of ENT specialists in your area.

What ENT treatments are available?
The best ENT treatment will vary according to what type of problems or symptoms you are having. In the early stages of a disorder, surgical procedures may not be warranted, as in tonsillitis, for example. Early treatments will also depend on whether or not the disorder is related to an infection. If an infection is suspected, tests may be performed to determine whether the cause is bacterial or viral. Viral infections will not respond to antibiotics.
If surgical procedures are indicated, the doctor or nurse will give you instructions to follow before the surgery, including when you need to stop eating solid foods, when to stop drinking clear liquids and whether or not you will need to start or stop any medications before the surgery.

By 

 Adebayo Folorunsho-Francis

RECENT ADVANCES IN OTORHINOLARYNGOLOGY

INTRODUCTION

Otolaryngology has advanced in a dramatic and rapid manner in the last decade. The advent of the operating microscope has facilitated the refinement of microsurgical techniques. A new era was started by functional endoscopic sinus surgery, skull base surgery, and phonological surgery. The surgical advances proceeded hand in hand along with diagnostic audio vestibular and radiological investigations.

DIAGNOSTIC ADVANCES

Laryngeal photography : Photographic documentation has become more and more important in the upper respiratory tract. Documentation is necessary for recording  • Natural history of the illness. • Effect of treatment on the disease. • Medicolegal purposes. The modern method of photography is done with a 35 mm single frame, single lens reflex camera with Hopkins telescopes fibreglass light conducting cable provides continuous light for visualisation.1,2 Otoscopic photography : This is required to record the status of the eardrum and the middle ear contents, binocular microscope makes it easier for a clinical photograph.

Techniques for visualisation of the vocal cords

• Stroboscopy : It enables us to see slowed sequence of the vocal cord movements. Modern stroboscope is an extremely essential part of the voice clinic. Xenon light source is usually preferred. The most important advantage of the stroboscope is that it shows mucosal as well as ground movements of the vocal cords.9 • Fibre optic laryngoscopy : It is often used in the out patient department. The larynx can be visualised under good magnification. The cord movements can be recorded and local anaesthesia is used.8

Advances in Imaging Techniques

• Contrast enhancement CT Scan : This procedure is useful in imaging metastatic nodal disease and high resonance scanning of the temporal bone. Gadolinium enhancement is very useful for temporal bone lesions such as tumours like neuromas, paragangliomas, carcinomas and inflammatory lesions and carcinomas. • Magnetic resonance imaging : This is the investigation of choice for retrocochlear pathology. Gadolinium enhancement helps to distinguish between tumours of the sinuses. Soft tissue masses are better seen on MRI. The efficacy of magnetic resonance angiography is fast increasing and is fast replacing the conventional catheter angiography. Newer advances in MRI like fast spin-echo very well demonstrate the normal anatomy in Otolaryngology.5

SURGICAL ADVANCES

Reconstructive prosthesis in the ear

There have been great advances in the surgical techniques of tympanoplasty, mastoidectomy and stapedectomy. Various implants have been used after these surgeries to give the patient a good hearing. Metallic : These implants are bio-inert and have One of the major problems in this surgery is the cost. A multi-channel implant does cost several lakhs. Thus a reduction in cost in India will surely make a light visible at the end of the tunnel and enable more people to have access to this surgery.18

Lasers in ENT

The introduction of laser into routine ear, nose and throat surgery has gradually given way to a more balanced and realistic attitude to its uses and limitations. The major advantage of laser is its precise incision, haemostasis achieved and reduced post operative fibrosis and scarring. The Carbon dioxide and Neodymium - YAG laser offer the Otolaryngologist a new perspective in the management of difficult tracheal and oesophageal problems. The CO2 laser is used extensively in most ENT lesions. The spot size has been reduced to less than 1 mm diameter, which greatly reduces any damage to the surrounding areas. The Neodymium - YAG laser offers a vehicle for the treatment of endotracheal lesions including tracheal stenosis. This laser is of vital importance for the management of urgent respirator obstruction. The laser emission can be targeted even by a flexible endoscope. The Argon laser has shown to be extremely useful in making the footplate opening in stapedotomy. It is especially useful in revision cases, which require safe removal of scar tissue over the oval window. Laser surgery for the oral cavity and the larynx has an extremely good precision because of the facility for the attachment of the laser beam to the microscope in ENT disease.

Common indications for laser in ENT

1 Oral leucoplakia : Leucoplakia is strikingly responsive to the CO2 laser. Recurrence of new patches of leucoplakia after laser treatment are also less likely. The operating microscope enables one to see much more of the targeted field. The reduced ground tissue reaction adds to the advantage of laser. 2 Oral Verrucous carcinoma : Lesions, which are 2 cms or less, are amenable to laser treatment. The results of treating small-circumscribed oral verrucous carcinomas are excellent, especially if adjacent epithelial dysplasia is limited. 3 Oral carcinomas : Removal of intra-oral carcinomas by CO2 laser is much preferred these days due to the more rapid and less painful process. Some surgeons do advocate leaving the wound open to facilitate better healing and reduced pain. Other conditions where laser has been advocated in diseases of the Oral cavity are. • Oral and Oropharyngeal haemangiomas. • Pleomorphic adenomas. • Tonsillectomy • Uvulo-palato-pharyngoplasty. Nasal indications : Listed are some of the commonly encountered indications in the nose which can be dealt very effectively with laser. Nasopharyngeal Angiofibromas : These are extremely aggressive and vascular tumours of the nose and paranasal sinuses. The CO2 laser attains markedly reduced blood loss and precise incision. Familial haemorrhagic telangiectasia : This disease has lesions which cause bleeding in the nose due to capillary dilatations. Ablation of the mucosa by laser is extremely useful to control the bleeding. However, there have been some cases of recurrence after laser. Choanal atresia : The major advantage of the CO2 laser in these conditions in infants is the minimal tissue trauma and the bleeding. The laser beam is directed along the axis close to the floor of the nose using the inferior turbinate as a landmark. The bleeding is usually minimal and an indwelling elastic or polyvinylchloride tube can be used to prevent contraction of the new orifice.The surgery may need to be repeated at times.12 Nasal polyposis : Polyps in the nose are usually avascular and have a restricted area of the disease. Ethmoidal polyps have a high recurrence rate and laser surgery is very useful to reduce it.10

Common Laryngeal indications for laser

Juvenile laryngeal papillomatosis : The major advantage of laser in these conditions is a very low recurrence rate and an acceptable voice after surgery. If the papillomas are beyond the larynx, then a bronchoscopic coupler is used to deflect the laser beam. Laryngeal polyps and granulomas : Polyps or granulomas of the vocal cords can be excised by laser or can even be vapourised. The precise incision and good post-operative voice are the main reasons why laser is mostly used in these conditions. Congenital subglottic haemangioma : Formerly, excision of the subglottic haemangioma had a high operative mortality and likelihood of recurrence. Laser surgery has brought a totally new perspective to treatment of this condition. It provides a simple endoscopic one stage removal, minimal bleeding and may avert a tracheostomy. The absence of post-surgical laryngeal oedema facilitates early extubation. Carcinoma in situ of the vocal cords : Laser is a satisfactory method of local control of carcinoma with a good post-operative voice and provides a quick treatment to the patient. Invasive carcinoma of the vocal cords : The technique of CO2 laser helps in excision of the lesion for frozen section. The results of this method are comparable to radiation therapy. However, a proper case selection is required.11 Bilateral Abductor cord palsy : The surgery of cordectomy achieved a big milestone after the introduction of laser. One can do a simple cordectomy (partial or total) or an arytenoidectomy depending on the airway available between the two vocal cords. The procedure is extremely precise and with relatively minimal blood loss . Other laryngeal indications of laser are: Reinke’s Oedema. Congenital subglottic stenosis. Laryngeal stenosis.

Bronchoscopic applications of CO2 laser

Lesions further down the trachea require the use of a bronchoscope. Special bronchoscopic couplers have been designed for projecting the laser beam. The coupler contains mirrors for altering the angle of the beam from the laser arm. Ventilation is maintained via the sidearm of the bronchoscope and trachea viewed through the eyepiece coupler. The newer neodymium - YAG laser is excellent especially for bronchial granulomas, papilomas, web-stenosis, and for palliative purposes in endotracheal neoplasm.13

Lasers in ear surgery

Laser in ear surgery was tried in 1979. Escuderol was first to describe the use of laser in seven cases of tympanoplasty. In 1980, Perkias performed laser surgery in 11 cases of otosclerosis. Laser surgery especially for otosclerosis provides pinpoint accuracy and instantaneous cauterisation minimising tissue trauma.14 The Argon laser has been more commonly used in stapedectomy as compared to the other lasers as it 1. Has a visible wavelength. 2. Accuracy of the argon laser helps to prevent inner ear damage and also causes photocoagulation. 3. A large stapedial artery transversing the oval window can be encountered with an argon laser. Uses of laser in Ear surgery are • Perilymphatic gusher. • Revision stapedectomy.

Functional Endoscopic Sinus Surgery (FESS)

Functional endoscopic sinus surgery (FESS) is considered one of the most exciting development in Otolaryngology since the introduction of the operating microscope. Nasal endoscopy allows the accurate assessment of diseases and anatomical abnormalities. Endoscopes may be used to perform a wide variety of nasal surgeries like nasal polypectomy, frontoethmoidectomy, orbital decompression, hypophysectomy and surgery of the choanal atresia. Messerklinger in 1978, was one of the pioneers of this surgery and explained the aim of the surgery as restoring the natural mechanism and maintaining as much normal anatomy as possible.15 In the past decade FESS has been performed with greater accuracy in a minimally invasive fashion, also attempting to restore normal function with very encouraging results.

Indications

FESS is indicated in the management of those patients with a circumscribed pathology causing obstruction of the osteomeatal complex. The disease may be in the maxillary, ethmoid, frontal or sphenoid sinuses or any area beyond the sinuses, which can be used as an approach. The common indications are: 1. Nasal polyposis. 2. Chronic sinusitis. 3. Removal of impacted foreign bodies 4. Dacryocystorhinostomy. 5. Closure of CSF leak. 6. Vidian neurectomy. 7. Optic nerve decompression. 8. Biopsy of nasal masses.. 9. Cauterization of bleeding points in epistaxis. The major advantage of the endoscope is the different angulations (30 and 70 degrees) enabling the visualisation of the different parts of the complex nasal anatomy. 0 degree Hopkins rod telescope is used in a majority of the surgery. Diagnostic endoscopy is increasing popular procedure in the out patient department.16

Soft tissue shavers in endoscopy

Powered instrumentation (soft tissue shavers and microdebrides) represent the newest advances in endoscopic surgery. These instruments offer precision in soft tissue resection. The advantage exists not only for routine sinus surgery but also removal of nasal polyps, scar tissue, septal spurs, choanal atresia and obstructive adenoids in the nose.

Voice conservation techniques in Carcinoma of the larynx

Carcinoma of the larynx is one of the commonest cancers seen in Otolaryngology. Numerous procedures have been described by Oncologists all over the world. Recent advances towards voice conservation surgeries without compromising on oncological safety are greatly appreciated. A wide range of partial laryngectomy procedures have been introduced depending on the site, extent, and staging of the disease. Partial laryngectomy can be done in glottic, supraglottic and transglottic cancers. Glottic cancers : These malignancies are resected in a vertical plane across the glottis. The voice conservation procedures for glottic carcinomas include: 1. Laryngo fissure with cordectomy. 2. Vertical partial laryngectomy. 3. Crico-hyoido-epiglottopexy (CHEP). 4. Supracricoid laryngectomy Supraglottic cancers : They are resected in a horizontal plane above the vocal cords without disturbing the latter part of the valeculae, pyriform fossae or arytenoids are resected depending on the extent of the disease. Transventricular (Transglottic) cancers : These lesions are more advanced and often extend into supraglottic region or vice-versa. A wide resection is often necessary. The most commonly done procedures are 1. Supra-cricoid laryngectomy with crico-hyoidopexy. 2. Three-fourths laryngectomy. It must be remembered that prior to any voice conservation procedure, accurate clinical assessment of the disease is most important. A CT scan or an MRI surely helps in the assessment. BY: Manish Juveker

Insight into Sleeping Disorders and Sleep Apnea

Forty-five percent of normal adults snore at least occasionally and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight people and usually worsens with age. Snoring may be an indication of obstructed breathing and should not be taken lightly. Melnick, Moffitt, and Mesaros ENT Associates can help you to determine where the anatomic source of your snoring may be, and offer solutions for this noisy and often embarrassing behavior.
If you are looking for an Ear, Nose, and Throat Doctor, please contact Melnick, Moffitt, and Mesaros ENT Associates for a comprehensive consultation.

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What causes snoring?

The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.
In children, snoring may be a sign of problems with the tonsils and adenoids. A chronically snoring child should be examined by an otolaryngologist, who may recommend a tonsillectomy and adenoidectomy to return the child to full health.

People who snore may suffer from

• Poor muscle tone in the tongue and throat: When muscles are too relaxed, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. Some relaxation is natural during deep sleep, but may become a problem if exacerbated by alcohol or drugs that cause sleepiness
•  Excessive bulkiness of throat tissue: Children with large tonsils and adenoids often snore. Overweight people may have excess soft tissue in the neck that can lead to airway narrowing. Cysts or tumors are rare causes of airway narrowing.
•  Long soft palate and/or uvula: A long palate narrows the opening from the nose into the throat. The excessive length of the soft palate and/or uvula acts as a noisy flutter valve during relaxed breathing.
• Obstructed nasal airways: A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat that pulls together the floppy tissues of the throat, and snoring results. So snoring may only occur during the hay fever season or with a cold or sinus infection. Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.

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Why is snoring serious?

Socially – Snoring can make the snorer an object of ridicule and can cause the bed partner to experience sleepless nights and fatigue.
Medically – It disturbs sleeping patterns and deprives the snorer of adequate rest. It may be a sign of obstructive sleep apnea (OSA), which can lead to serious, longterm health problems.

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What is obstructive sleep apnea?

Snoring may be a sign of a more serious condition known as obstructive sleep apnea (OSA). OSA is characterized by multiple episodes of breathing pauses greater than 10 seconds at a time, due to upper airway narrowing or collapse. This results in lower amounts of oxygen in the blood, which causes the heart to work harder. It also causes disruption of the natural sleep cycle, which makes people feel
poorly rested despite adequate time in bed. Apnea patients may experience 30 to 300 such events per night.
The immediate effect of sleep apnea is that the snorer must sleep lightly and keep the throat muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he or she may be sleepy during the day, which impairs job performance and makes him or her a hazardous driver or equipment operator. Untreated obstructive sleep apnea increases the risk of developing heart attacks, strokes, diabetes, and many other medical problems.

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How is heavy snoring evaluated?

Heavy snorers should seek medical advice to ensure that sleep apnea is not a problem. Heavy snorers include people who snore constantly in any position or who negatively impact a bed partner’s sleep. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck, often using a fiberoptic scope. An examination can reveal if the snoring is caused by nasal allergy, infection, nasal obstruction, or enlargement of tonsils and adenoids. A sleep study in a laboratory or at home may be necessary to determine if snoring is due to OSA. All snorers with any of the following symptoms should be evaluated for possible obstructive sleep apnea:

•  Witnessed episodes of breath pauses or apnea during sleep
•  Daytime sleepiness or fatigue
•  High blood pressure
•  Heart disease
•  History of a stroke

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What treatments are available?

Treatment depends on the diagnosis and level(s) of upper airway narrowing. In some cases, more than one area may be involved.
Snoring or OSA may respond to various treatments offered by many otolaryngologist—head and neck surgeons:

•  Obstructive sleep apnea is most often treated with a device that opens the airway with a small amount of positive pressure. This pressure is delivered via a nasal mask worn during sleep. This treatment is called CPAP; it is currently the initial treatment of choice for patients with OSA.
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•  Uvulopalatopharyngoplasty (UPPP) is surgery for treating snoring and obstructive sleep apnea. It removes excess soft palate tissue and opens the airway. In addition, the remaining tissue stiffens as it heals, thereby minimizing tissue vibration. The size of the air passage may be further enlarged when a tonsillectomy is added to the procedure.
•  Thermal ablation procedures reduce tissue bulk in the nasal turbinates, tongue base, and/or soft palate. These procedures are used for both snoring and OSA. Different methods of thermal ablation include bipolar cautery, laser, and radiofrequency. These procedures may be done in the operating room or during an office visit. Several treatments may be required.
•  Methods to increase the stiffness of the soft palate without removing tissue include injecting an irritating substance that causes stiffness in the injected area near the uvula. Another method is inserting stiffening rods (Pillar implants) into the soft palate.
•  Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.
•  A custom-fit oral appliance, which repositions the lower jaw forward, may also be considered for certain patients with snoring/ OSA. This should be fitted by an otolaryngologist, dentist, or oral surgeon with expertise in sleep dentistry.
•  In some patients, significant weight loss can also improve snoring and OSA.

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Do you recommend the use of over-the-counter devices?

There is no specific device recommended. More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. Different methods include products that help a person avoid sleeping on their back, since snoring is often worse in that position. Some devices open nasal air passages; others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs. While a person may find a product that works for him or her, underlying poor sleep quality may remain.

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Self-help for the light snorer

Adults who suffer from mild or occasional snoring should try the following self-help remedies:

•  Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
•  Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.
•  Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring.
•  Establish regular sleeping patterns.
•  Sleep on your side rather than your back.
•  Elevate the head of your bed four inches.

What Is an Otolaryngologist—Head and Neck Surgeon?

What Is an Otolaryngologist—Head and Neck Surgeon?

Insight into ear, nose, and throat specialists

·         What do otolaryngologists treat?

·         How are ear, nose, and throat specialists trained?

·         Why should I see an otolaryngologist?

·         and more...

Otolaryngology (pronounced oh/toe/lair/in/goll/oh/jee) is the oldest medical specialty in the United States. Otolaryngologists are physicians trained in the medical and surgical management and treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structures of the head and neck. They are commonly referred to as ENT surgeons.

What do otolaryngologists treat?

Otolaryngologists diagnose and manage diseases of the ears, nose, sinuses, larynx (voice box), mouth, and throat, as well as structures of the neck and face.

The ears—Hearing loss affects one in ten North Americans. The unique domain of otolaryngologists is the treatment of ear disorders. They are trained in both the medical and surgical treatment of hearing loss, ear infections, balance disorders, ear noise (tinnitus), and some cranial nerve disorders. Otolaryngologists also manage congenital (birth) disorders of the outer and inner ear.

The nose—About 35 million people develop chronic sinusitis each year, making it one of the most common health complaints in America. Care of the nasal cavity and sinuses is one of the primary skills of otolaryngologists. Problems in the nasal area include allergies, smell disorders, polyps, and nasal obstruction due to a deviated septum. Otolaryngologists can also correct the appearance of the nose (rhinoplasty surgery).

The throat—Communicating (speech and singing) and eating a meal all involve this vital area. Specific to otolaryngologists is expertise in managing diseases of the throat, larynx (voice box), and the upper aero-digestive tract or esophagus, including voice and swallowing disorders.

The head and neck—This area of the body includes the important functions of sight, smell, hearing, and the appearance of the face. In the head and neck area, otolaryngologists are trained

to treat infections, benign (non-cancerous) and malignant (cancerous) tumors, facial trauma, and deformities of the face. They perform both cosmetic plastic and reconstructive surgery.

How are ear, nose, and throat specialists trained?

Otolaryngologists are ready to start practicing after completing up to 15 years of college and post-graduate training. To qualify for certification by the American Board of Otolaryngology, an applicant must first complete college (four years), medical school (four years), and at least five years of specialty training. Next, the physician must pass the American Board of Otolaryngology examination. In addition, some otolaryngologists pursue a one- or two-year fellowship for more extensive training in one of eight subspecialty areas.

These subspecialty areas are allergy, facial plastic and reconstructive surgery, head and neck, laryngology (throat), otology/neurotology (ears, balance, and tinnitus), pediatric otolaryngology (children), rhinology (nose), and sleep disorders. Some otolaryngologists limit their practices to one of these eight areas.

What are the seven areas of expertise in the field of otolaryngology?

·         Allergy: treatment by medication, immunotherapy (allergy shots) and/or avoidance of pollen, dust, mold, food, and other sensitivities that affect the ear, nose, and throat. Treating: hay fever, seasonal and perennial rhinitis, chronic sinusitis, laryngitis, sore throat, otitis media, dizziness.

·         Facial Plastic and Reconstructive Surgery: cosmetic, functional, and reconstructive surgical treatment of abnormalities of the face and neck and ear.
Treating: deviated septum, rhinoplasty (nose), face lift, cleft palate, drooping eyelids, hair loss, and other ear deformities.

·         Head and Neck: cancerous and noncancerous tumors in the head and neck (nose/sinuses, mouth, throat, voice box and upper esophagus), including the thyroid and parathyroid.
Treating: lump in the neck or thyroid, cancer of the voice box.

·         Laryngology: disorders of the throat, including voice and swallowing problems.
Treating: sore throat, hoarseness, swallowing disorder, gastroesophageal reflux disease (GERD), infections and tumors.

·         Otology/Neurotology: diseases of the ear, including trauma (injury), infection, benign tumors, cancer, and nerve pathway disorders, which affect hearing and balance.
Treating: ear infection; swimmer’s ear; hearing loss; ear, face, or neck pain; dizziness, ringing in the ears (tinnitus).

·         Pediatric Otolaryngology: diseases in children with special ENT problems, including birth defects of the head and neck and developmental delays.
Treating: ear infection (otitis media), tonsil and adenoid infection, airway problems, asthma and allergy/sinus disease, neck tumors.

·         Rhinology: disorders of the nose and sinuses.
Treating: sinus disorder, nose bleed, stuffy nose, loss of smell, polyps, tumors.

Why should I see an otolaryngologist?

These specialists differ from many physicians in that they are trained in both medicine and surgery. Otolaryngologists do not need to refer patients to other physicians when ear, nose, throat, or head/neck surgery is needed, and therefore can offer the most appropriate care for each individual patient. Otolaryngologists are the most appropriate physicians to treat disorders of the ears, nose, throat, and related structures of the head and neck.

What other criteria should I consider when choosing an otolaryngologist in my area?

·         Medical education and training

·         Licenses or board certification

·         Practice areas

·         Areas of specialty or subspecialties

·         Office locations

·         Physician availability

·         Insurance coverage