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Inspire Therapy for Sleep Apnea

Mon, 19 Nov 2018 15:48:00 GMT

Start treating your Sleep Apnea today with the help of Dr. Demetroulakos here at North Shore Ear Nose & Throat and the new Inspire Therapy!

Inspire Therapy drives clinically proven results as a treatment option now available to help restore restful sleep for those suffering from sleep apnea.

The therapy works inside your body focusing on your body's natural breathing process in order to treat obstructive sleep apnea. The system monitors your breathing as you sleep and provides mild stimulation to your muscles that keep your airway open as you sleep throughout the night. Try Inspire Therapy today to get relief from snoring and start waking up alert and refreshed after a good nights sleep!

Learn more from InspireSleep.com and contact us at 978-624-4029 for your consultation!

Pediatric ENT

Tue, 04 Sep 2018 20:22:00 GMT

EAR INFECTIONS

Middle Ear Infections (Otitis Media) Middle ear infections typically occur in infants and toddlers with many children outgrowing the infections by age 3 years old. Eighty percent (80%) of children will have two or more episodes of otitis media by their second birthday. Otitis media is an infection involving the middle ear space, which is behind the eardrum. Usually, this space is dry, but when the Eustachian tube (a small passage that connects the back of the nose to the actual middle ear) doesn’t work well, mucus or thick fluid develops in the middle ear space. This fluid can cause pressure in the ear, mild to moderate temporary hearing loss, and viral or bacterial infections. Symptoms can include fussiness, irritability, fever, changes in dietary and sleep habits and problems with hearing and balance. Occasionally the fluid and the infection will resolve without intervention, but usually examination and treatment by a doctor is needed.

Treatment of Ear Infections The first line of therapy is typically antibiotics and treatment of the nasal congestion. Whatever treatment is given, it can take more than a few days for the infection to resolve and weeks for the fluid to resolve. When the infections become very frequent, repetitively painful, or the fluid is persistent and the hearing loss not improving, then additional intervention is usually needed and a procedure called tympanostomy tube insertion may be recommended. This is where a small pinhole is made in the eardrum and a 3 mm soft silicone or plastic tube is inserted into the eardrum, allowing air to enter the middle ear space and fluid to drain outward. The procedure only takes about five to 10 minutes and is done under a light general anesthetic in a carefully monitored operating room. The child experiences no discomfort during the procedure and, at most, only mild irritation for a few hours afterwards. A single dose of Tylenol is usually adequate to eliminate this. The tubes last for about six to twelve months, after which they typically fall out by themselves. During the time that the tubes are in place, it is recommended that water exposure to the ears be minimized by using earplugs, ear putty or similar ear protection. Please discuss any specific issues regarding tympanostomy tube insertion with your physician.
Outer Ear Infections/Swimmer’s Ear Swimmer’s ear is an infection of the outer ear structures. It may occur from water trapped in the ear canal due to swimming, bathing or showering, or moisture from earplugs. Even hearing aids may cause this common infection. It may also be caused by scratching the ear canal (often with a Q-tip). Bacteria that normally inhabit the skin of the ear canal multiply, causing infection and irritation of the skin of the ear canal. If the infection progresses it may involve the outer ear. Symptoms include pain, ear blockage, drainage, and occasionally fever. Infection may be more serious in people who have diabetes.
Treatment of Outer Ear Infections The treatment for mild infections can include drying of the canal and applications of slightly acidic drops or even antibiotic drops that are prescribed by a medical professional. More significant infections usually require an ENT specialist to clean the canal and, in some cases, suction the infected material out of the canal or put a tiny sponge in the canal soaked with special medication for 24 or 48 hours. Advanced infections may require even more medical intervention.

HEARING LOSS

More than three million American children have hearing loss. An estimated 1.3 million of these children are under the age of three. Good hearing is essential for proper language development. If a child is not meeting his or her developmental milestones for speech and language, accurate diagnosis and timely hearing intervention are critical to ensure that the child has an opportunity for normal speech.Parents and grandparents are usually the first to discover hearing loss in a baby, because they spend the most time with them.
Signs that your child may have a hearing loss include:

does not startle, move, cry or react in any way to unexpected loud noises,
does not awaken to loud noises,
does not turn his/her head in the direction of your voice, or
does not freely imitate sound

If at any time you suspect your baby has a hearing loss, discuss it with your doctor. He or she may recommend evaluation by an ear, nose and throat doctor (an Otolaryngologist) such as those with North Shore Ear, Nose & Throat Associates.
Treatment of Hearing Loss in Children Temporary hearing loss can be caused by ear wax or middle ear infections and many children with temporary hearing loss can have their hearing restored through medical treatment or minor surgery.
Sudden hearing loss can be urgent and requires physician and audiologic evaluation and sometimes medical management. Proper workup of gradual hearing loss is necessary to identify potentially treatable causes and attempt to restore lost hearing function. Clinical history, audiograms, otoacoustic emissions, tympanometry, auditory brainstem responses, and radiographic imaging are utilized to diagnose potential causes.
Sensorineural hearing loss (sometimes called nerve deafness) is permanent. A medical evaluation should be undertaken to determine the potential cause of the hearing loss and any potential genetic implications. A continuously increasing ability to evaluate the genetic causes of hearing loss is available through laboratory testing. Most children with this type of hearing loss have some remaining hearing and children as young as three months of age can be fitted with hearing aids. Early diagnosis, early fitting of hearing or other prosthetic aids, and an early start on special education programs can help maximize a child’s existing hearing to give your child a head start on speech and language development.
All children, including newborns, can be given accurate hearing tests. The physicians and audiologists at North Shore ENT Associates offer comprehensive evaluation of your child’s hearing needs.

NECK MASSES

Neck masses are fairly common and often the source of significant concern. They may occur in children of all ages as well as in adults. There are a variety of causes for neck masses including infectious and/or inflammatory diseases which result in swollen glands. They may also be due to congenital cysts which have their origins from birth, traumatic in origin (i.e., caused by an injury) or malignant disease. Whatever the cause of the neck mass, a thorough evaluation by a board-certified ear, nose and throat specialist (an otolaryngologist) is recommended.Diagnosing the cause of the neck mass can sometimes be made after a simple history and a complete physical examination has been completed in the physician’s office. If additional testing is required we will be arrange it for you. Once the diagnosis has been obtained, your doctor will discuss treatment options with you. Fortunately most neck masses are benign (non-cancerous). Nonetheless it is imperative that all persistent neck masses be evaluated by an otolaryngologist for diagnosis and treatment.

NOISY BREATHING

The airway is the pathway from the nose to the lungs, and disease can affect any portion of this pathway. Most diseases of the airway are manifested by noisy or obstructed breathing and this can be caused by nasal masses, narrowing of the back of the nostrils (choanal atresia), large adenoids, large tonsils, immaturity of the voice box (larynx) or trachea (laryngo/tracheomalacia), masses or paralysis of the vocal cords, and narrowing of the airway below the larynx (subglottic stenosis). Evaluation in the doctor’s office usually includes flexible fiberoptic examination of the airway from the nostrils to the larynx, and treatment may include endoscopic (through telescopes) procedures and open neck surgery performed in the operating room.

NOSE BLEEDS

Nosebleeds are commonly seen in children. Most episodes resolve spontaneously and represent nothing more than a nuisance to the parent and child. Occasionally nosebleeds become recurrent or persistent and may require specific treatment. Rarely, a nosebleed may be the presenting symptom of a serious local or generalized disease.Nosebleeds are often the result of extremely dry nasal linings which lose the protective layer of mucus. This leads to fragility of the membranes which then has a tendency to bleed following the slightest trauma. Nosebleeds are most common during the winter because of the increased incidence of colds which leads to swollen nasal membranes with engorged blood vessels. In addition, central heating during the winter months tends to dry the nasal linings.
When a nosebleed occurs, help the child remain calm and then:

Pinch all the soft part of the nose together, below the bones, between your thumb and the side of your index finger or soak a cotton ball with Afrin or Neo-Synephrine spray and place into the nostril.
Press firmly but gently with your thumb and the side of your index finger toward the face, compressing the pinched parts of the nose against the bones of the face.
Hold that position for a full five minutes by the clock.
Keep the head higher than the level of the heart. Sit up or lie back a little with the head elevated.
Apply ice – crushed in a plastic bag or washcloth – to the nose and cheeks.

More severe cases with frequent bleeding and significant blood loss may require additional treatment. A chemical cauterization of the enlarged blood vessels using silver nitrate can be performed in the doctor’s office. This is usually done after the application of topical anesthetic. If bleeding recurs after an attempt at chemical cautery, more aggressive measures may be required including electrical cautery or surgery to tie off the bleeding blood vessel, however, surgical intervention is extremely rare in children.

PEDIATRIC SINUSITIS

A child’s sinuses are not fully developed until age 20. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms can be subtle and the causes varied.Symptoms which may indicate a sinus infection include:

a “cold” lasting more than 10 to 14 days, sometimes with a low-grade fever
thick yellow-green nasal drainage
post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
headache, usually in children age six or older
irritability or fatigue
swelling around the eyes

Young children have immature immune systems and are more prone to infections of the nose, sinus, and ears. These are most frequently caused by viral infections (colds), and they may be aggravated by allergies. However, when your child remains ill beyond the usual week to ten days, a sinus infection should be considered. The occurrence of sinus infections may be decreased by reducing your child’s exposure to known environmental allergies and pollutants such as tobacco smoke, reducing his/her time at day care, and treating stomach acid reflux disease.
Treating Sinus Infections For acute sinusitis, most children respond very well to antibiotic therapy. Nasal decongestants or topical nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function.
If your child suffers from one or more symptoms of sinusitis for at least twelve weeks, he or she may have chronic sinusitis. Although more unusual in children, chronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year, are indications that you should seek consultation with an ear, nose, and throat (ENT) specialist. Appropriate evaluation may reveal the underlying cause of the problem.
If your child sees an ENT specialist, the doctor will examine his/her ears, nose, and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the office visit. A computerized x-ray called a CT scan may help to determine how your child’s sinuses are formed, where the blockage has occurred, and the accuracy of the diagnosis.
When Is Surgery Necessary For Sinusitis? Surgery is considered for the small percentage of children who have severe or persistent sinusitis symptoms despite medical therapy. Typically, the first surgical option considered is an adenoidectomy (i.e., removing the adenoid tissue from behind the nose). This is typically a day surgical procedure and recovery is generally mild with full return to normal in 3-4 days. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue (adenoiditis) or obstruction of the back of the nose can mimic sinusitis with runny nose, stuffy nose, post-nasal drip, bad breath, cough, and headache.
If allergy treatment and an adenoidectomy fail to control the sinusitis, functional endoscopic sinus surgery would be a second surgical option. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of the child’s sinuses and makes the narrow passages wider. Opening the sinuses and facilitating their drainage usually results in a reduction in the number and the severity of sinus infections.

TONSILS & ADENOIDS

Millions of children are evaluated yearly for enlarged tonsils and/or adenoids which can cause problems ranging from obstructive sleep apnea to recurrent throat infections and even ear infections. Symptoms usually include snoring and loud breathing, open-mouthed breathing, restless sleep, and pauses in breathing during sleep. Obstructive sleep apnea can lead to daytime sleepiness and crankiness, or may paradoxically lead to hyperactivity. In fact, some children diagnosed with behavioral disorders such as attention deficit-hyperactivity disorder, or ADHD, may actually have obstructive sleep apnea underlying this behavior.
Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or “glands” found in the neck and the rest of the body. Tonsils are the two masses on the back of the throat. Adenoids are higher in the throat above the roof of the mouth (soft palate), behind the nose. They are not visible through the mouth without special instruments.
Infections Another common problem affecting the tonsils and adenoids is recurrent infection. Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. If infections become frequent or severe, removal of the tonsils and/or adenoids may be recommended.
Surgery for Tonsils and Adenoids The two primary reasons for tonsil and/or adenoid removal are:

Recurrent infection despite antibiotic therapy, and
Difficulty breathing due to enlarged tonsils and/or adenoids.

If your surgeon recommends removal of the tonsils and/or adenoids, be assured that the surgery can be done safely and effectively, often as an outpatient procedure. In preparing for the surgery, talk to your child about his/her feelings and provide strong reassurance and support throughout the process. Encourage the idea that the procedure will make him/her healthier. Be with your child as much as possible before and after the surgery. Tell him/her to expect a sore throat after surgery. Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward. If your child has a friend who has had this surgery, it may be helpful to talk about it with the friend.
Information for Patients and Parents
After Tonsil Surgery Detailed post-operative instructions will be provided by your surgeon. There are several post-operative symptoms that typically arise. These include, but are not limited to:

Painful or difficulty swallowing
Nausea and vomiting
Fever
Throat pain
White healing tissue in back of throat
Bad breath
Ear pain

Occasionally, delayed bleeding may occur after surgery. If this occurs, it is typically between the 5th and 10th day after the procedure. If the patient has any bleeding lasting more than 10 minutes or repeated episodes of brief bleeding, you should notify the surgeon immediately. In addition, any questions or concerns before or after the surgery should be discussed with the surgeon.

Snoring & Sleep Disorders

Tue, 04 Sep 2018 20:22:00 GMT

SLEEP APNEA

Sleep apnea is a condition where breathing obstruction actually leads to a lack of airflow for extended periods of time. Often sleep apnea is associated with early morning fatigue, daytime sleepiness, morning headache, high blood pressure, attention issues, sometimes worsening of depression. When extensive disease is present, sleep apnea can increase the risk of heart attack and stroke.
A diagnosis of sleep apnea is usually made through a clinical exam and a sleep study. The results might lead to the use of a short-term or long-term oxygen mask therapy. Surgical interventions such as removal of the tonsils, septal and turbinate surgery to improve nasal airflow, and/or trimming of the soft palate may also be considered if appropriate.
The Epworth Sleepiness Scale The ESS is a questionnaire designed to evaluate levels of excessive sleepiness. This test is a standardized screening tool used extensively by the American Association of Sleep Medicine (AASM) that will help you measure your general level of sleepiness. It asks you to rate the chances that you would doze off or fall asleep during different routine situations. Answers to the questions are based on a scale from 0-3, with 0 meaning you would never doze off or fall asleep in a given situation, and 3 meaning there is a very high likelihood you would doze or fall asleep in that situation.
Situation

Sitting and reading
Watching television
Sitting inactive in a public place, such as a theater or meeting
As a passenger in a car for an hour without a break
Sitting down to rest in the afternoon
Sitting quietly after lunch (when you’ve had no alcohol)
Sitting and talking to someone
In a car, stopped in traffic

Scoring the ESS 0= would never doze 1= slight chance of dozing 2= moderate chance of dozing 3= high chance of dozing
The Epworth Sleepiness Scale Key Total score of 10 or more suggests the you may need further evaluation by a physician to determine the cause of your excessive sleepiness and whether you have an underlying sleep disorder. A total score of 10 or less suggests that you may not be suffering from excessive sleepiness.

SNORING

Snoring can be more than just annoying While 45% of adults snore at least occasionally, it’s estimated that 25% of adults are more habitual “severe” snorers. Even if it doesn’t directly bother the snorer, snoring may disturb the sleep of others and can become a major cause of strain in family relationships. Snoring can be a medical problem as well, causing the snorer to sleep restlessly and causing difficulty staying alert and awake during the day. Loud snoring may be accompanied by episodes of obstructed breathing, a potentially serious condition known as sleep apnea.
What Causes Snoring? There are several areas in the upper air passageway which may cause or contribute to snoring, including difficulty breathing through the nose or a very large tongue, however, the most common cause is excessive vibration of the soft palate. A number of treatment alternatives are available to decrease this vibration including laser and radio-frequency ablation and injection snoreplasty. Each of these procedures are performed in the office under local anesthesia and typically takes about 20 minutes. Depending which treatment is utilized, recovery can be minimal require prescription pain medication. Results are often noticed within 4-6 weeks. If satisfactory results have not been achieved by that time, a repeat or alternative procedure may be indicated. Examination by our snore specialist will determine which treatment options would most likely be best for you.

Treatment Options for Snoring
LAUP (laser-assisted uvulopalateoplasty) is the most common procedure for treatment of snoring. This treatment involves removal of all or part of the soft palate and all or part of the uvula and recovery can take up to two weeks.
RFA (radio-frequency ablation) uses low heat cautery to reduce the size and thickness of the palate. Recovery time is short and usually involves only minimal discomfort during healing.
Injection Snoreplasty involves injection of a hardening agent into the soft palate to reduce its vibration. Recovery time is short and usually involves only minimal discomfort during healing.
Oral Appliance – The use of an oral appliance is another approach to snoring treatment, in which a mouth guard type of device called a Snoreguard is custom-fitted by our associated dental colleague to move the tongue and jaw forward during sleep. using this device can quiet 65-70% of disruptive snorers. The pros and cons of this device will be discussed with you during your consultation.
Tips to reduce snoring

Try to sleep on your side. The throat structures may tend to fall backward when some people sleep on their back. If you snore only when lying on your back, sew a pocket in the back of your pajamas and place a tennis ball in it to keep you from rolling over onto your back during the night.
If you are overweight, diet. Even partial weight loss is likely to improve noisy breathing during sleep. Regular exercise will help you to lose weight, and also help to tone muscles and improve lung function.
Avoid alcohol, tranquilizers, sedatives and sleeping pills within four hours of bedtime. These all reduce muscle tone and may worsen snoring.

Extra advice for snorers and their partners

An important part your snoring history is also often available only from your sleeping partner, especially observing for possible apnea.
Wearing ear plugs can sometimes be the simplest solution to the problem of a snoring partner.

Nose & Sinus

Tue, 04 Sep 2018 20:22:00 GMT

At North Shore ENT, we specialize in all medical and surgical aspects of the nose and sinuses, which cause difficulty with nasal breathing, sinusitis, hearing loss, and dizziness.

NASAL OBSTRUCTION

Nasal obstruction is a common problem affecting many people. Loss of sense of smell, mouth breathing or difficulty breathing through the nose, nasal congestion and runny nose are some of the many symptoms that contribute to blocked nasal passages. Causes of nasal obstruction include allergies, chronic sinus infections, deviated septum, or nasal polyps. Our physicians will evaluate your nasal problem and suggest a medical treatment that suits your diagnosis. When standard medical therapy fails, surgical treatment may be recommended to correct the underlying problem and restore airflow through the nasal passages.

SINUS INFECTIONS

Nasal congestion, yellowish or greenish nasal drainage, facial pressure and pain, and chronic post nasal drainage– these are all signs that you may have a sinus infection. Sinus infections typically are caused by a prior upper respiratory infection. However, any disorder that causes inflammation of the nasal passages, such as allergies, may predispose you to a sinus infection. Inflammatory nasal polyps, which result from chronic inflammation of the nasal passages, can also block nasal breathing and cause sinus drainage, resulting in symptoms of chronic sinusitis.When standard medical therapy fails to relieve symptoms, it may be time to consult the physicians at North Shore Ear, Nose, and Throat Associates. After a complete examination using advanced fiberoptic tools to clarify the cause of your chronic symptoms, our physicians can recommend the best treatment options for you. This may include aggressive medical therapy, allergy treatment, or surgical intervention. Our physicians are trained in endoscopic sinus surgery, which is the gold standard for establishing permanent drainage pathways for the sinus cavities to relieve the symptoms of persistent sinusitis.

NOSE BLEEDS

Nosebleeds are commonly seen in children. Most episodes resolve spontaneously and represent nothing more than a nuisance to the parent and child. Occasionally nosebleeds become recurrent or persistent and may require specific treatment. Rarely, a nosebleed may be the presenting symptom of a serious local or generalized disease.Nosebleeds are often the result of extremely dry nasal linings which lose the protective layer of mucus. This leads to fragility of the membranes which then has a tendency to bleed following the slightest trauma. Nosebleeds are most common during the winter because of the increased incidence of colds which leads to swollen nasal membranes with engorged blood vessels. In addition, central heating during the winter months tends to dry the nasal linings.When a nosebleed occurs, help the child remain calm and then:

Pinch all the soft part of the nose together, below the bones, between your thumb and the side of your index finger or soak a cotton ball with Afrin or Neo-Synephrine spray and place into the nostril.
Press firmly but gently with your thumb and the side of your index finger toward the face, compressing the pinched parts of the nose against the bones of the face.
Hold that position for a full five minutes by the clock.
Keep the head higher than the level of the heart. Sit up or lie back a little with the head elevated.
Apply ice – crushed in a plastic bag or washcloth – to the nose and cheeks.

NASAL FRACTURES

If you or your child has experienced a nose injury, it is important that you treat the fracture in a timely manner to avoid more serious problems later. Typically, the nose should be evaluated within 3-7 days of the injury after the swelling subsides and before the bones begin to heal. Initial swelling can be minimized with ice and elevation. If surgery is indicated, it should be performed between 10 days and two weeks from the date of injury. If this treatment window is missed, the nose can still be repaired, but rhinoplasty may be required.
Benefits from Surgery Cartilage or bone may be broken, out of place, or injured. To restore your appearance, these may need realignment. Many individuals have prior injuries, distortions, or asymmetries that have gone unnoticed. We ask that you bring a pre-injury photograph to help see what your nose was like before injury. A fracture reduction will not improve old deformities. Even if the nose is made symmetrical it may drift back into the pre-injury position. After the structures have healed, a rhinoplasty (surgery on the nose) can help correct deformities.
Alternative Care The choice is either no evaluation or evaluation, treatment or no treatment. You could let an injured nose just heal as it is. Deformities would not be corrected and problems that might be improved would not be not addressed.

Head & Neck

Tue, 04 Sep 2018 20:22:00 GMT

As otolaryngologists, we specialize in diagnosing and treating diseases of the head and neck. This includes the medical and surgical management of many problems that affect the delicate structures of the neck.

LYMPH NODES

Lymph nodes are located throughout the body and function like filters for the immune system. When the lymph nodes in the neck are enlarged there is usually some sort of inflammation responsible such as an infection. They can also be enlarged in the presence of a tumor. At North Shore ENT, we will evaluate you to find the cause of the inflammation and make testing and treatment recommendations.

NECK MASSES

Neck masses are fairly common and are often the source of significant concern. These may occur in children of all ages as well as in adults. There are a variety of possible causes for neck masses including infectious and/or inflammatory diseases which can result in swollen glands. They may also be congenital cysts which have been present since birth, traumatic in origin (i.e., caused by an injury) or neoplastic disease. Whatever the cause of the neck mass, a thorough evaluation by a North Shore ENT otolaryngologist is recommended.Diagnosing the neck mass can sometimes be made after a simple history and a complete physical examination in our office. If additional testing is required we will arrange it for you. Once the diagnosis has been obtained, your doctor will discuss this and treatment options with you.
Fortunately, most neck masses are benign (non-cancerous). Nonetheless it is imperative that all persistent neck masses be evaluated by an otolaryngologist for diagnosis and treatment.

THYROID & PARATHYROID DISORDERS

The thyroid gland is located in the center of the neck above the sternum and functions to regulate metabolism. Most thyroid problems are caused by thyroid glands that work too hard or not hard enough and can be helped with medication. However, sometimes patients will develop nodules or lumps in their thyroid gland. Needle aspiration, usually done in the office but sometimes with radiology assistance, can usually tell if the nodule is suspicious. Further testing may be recommended, and surgery can easily eliminate this problem.The parathyroid glands are located in the neck attached to the thyroid gland. They are partially responsible for controlling the level of calcium in the bloodstream, bones and muscles. Many times these glands malfunction and require either medical or surgical treatment. If the calcium level in your blood is too high, symptoms such as tiredness, muscle aches, nausea, and mood changes can occur. A simple blood test is all that is required to diagnose parathyroid disease and surgery can usually eliminate the problem.

SALIVARY GLAND DISORDERS

There are four major glands that produce saliva. The parotid glands are in front of and slightly below the ear on both sides and the submandibular glands are underneath the jaw on both sides. In addition, there are hundreds of tiny minor salivary glands throughout the mouth and throat. The major glands can occasionally get infected and swell, requiring a course of antibiotics as treatment.Sometimes the salivary glands can develop stones that are similar to kidney stones. Persistent swelling may signal the presence of a tumor, which is generally benign but can occasionally be malignant. When lumps of the salivary gland develop, a diagnostic workup will be completed and medical treatments and surgical options will be discussed if indicated. When a persistent mass of the salivary gland develops, a diagnostic work-up may include CT or MRI, needle-aspiration, and/or surgery to remove the mass.

CANCER

Cancers involving the structures of the head and neck are very common, especially in patients who use tobacco and/or alcohol. Tumors can form in the mouth, throat and voice box due to tobacco and alcohol, and occasionally for no apparent reason. Symptoms of head and neck cancer can include ear pain, hoarseness, difficulty opening the mouth, painful or difficult swallowing, or may not have any symptoms at all except a mass in the neck. Cancers also can be located in the saliva glands, thyroid, sinuses and lymph nodes, such as in lymphoma.If a person develops cancer of the head and neck, our doctors will organize a multifaceted approach to care in order to streamline the evaluation and treatment process. Cancer treatment will frequently involve several different types of medical doctors such as medical oncologist, radiation therapist, family doctors and other specialists as indicated.

Ear, Balance & Dizziness

Tue, 04 Sep 2018 20:22:00 GMT

EARACHE

An earache is a commonly used term for ear pain or discomfort. Pain in the ear may come from many sources and can be a symptom of problems in the ear, mouth, nose, or throat. Infants or very young children with earaches may be unable to say that they are in pain, but increased irritability or pulling at the ears can be a sign of ear pain in infants.
Causes of ear pain
A very common cause of an earache is a buildup of pressure in the eustachian tube. Among other functions, the eustachian tube drains fluids out of the middle ear via the back of the throat. A cold, allergy or sore throat can cause the eustachian tube to swell shut. Infants and young children are especially susceptible to earaches caused by problems with the eustachian tube, since the structure is still underdeveloped in that age group. When the normal drainage of fluid is prevented, it can accumulate in the middle ear, causing pressure, pain, stagnation and possibly infection. An earache may be due to a perforated or broken eardrum. The eardrum can be broken as a result of a blow to the head, infection in the inner ear, suction applied to the ear, or the insertion of a foreign object into the ear. Earaches are also associated with:

Infections of the middle and outer ears
Obstruction of the ear canal, excessive ear wax or boils in the ear canal
Tumors
Rapid descent from high altitudes during air travel or travel in the mountains
Sinus infections
Arthritis of the jaw or dysfunction of the temporomandibular joint (TMJ)
Throat pain

If you experience an earache it may be advisable to see an ear, nose and throat (ENT) doctor for appropriate evaluation and treatment.
TINNITUS Tinnitus is a condition where patients experience noises they can hear that are not produced by an external source. This disorder can occur in one or both ears, range in pitch from a low roar to a high squeal, and may be continuous, pulsating, or sporadic. This often debilitating condition is commonly associated with hearing loss. Reasons for hearing loss include ear injuries, circulatory system problems, noise-induced hearing loss, wax build-up in the ear canal, medications harmful to the ear, ear infections, head and neck trauma, Ménière’s disease, and an abnormal growth of bone of the middle ear.In rare cases, slow-growing tumors on auditory, vestibular, or facial nerves can cause tinnitus as well as deafness, facial paralysis, and balance problems. The American Tinnitus Association estimates that more than 50 million Americans have tinnitus problems to some degree and approximately 12 million people have symptoms severe enough to seek medical care. This condition is not uncommon in the pediatric population. The good news is that most children seem to outgrow the condition.What can be done for tinnitus?
Tinnitus should be evaluated by an ear, nose & throat (ENT) doctor. The ENT doctor examines you and will likely recommend a hearing test. Based on the results of the hearing test, other tests may be indicated, including balance testing, a special radiologic examination of your ear and brain called a magnetic resonance image (MRI), laboratory work, or a complicated hearing test called brainstem auditory evoked response (ABR or BAER) to evaluate the cause of the tinnitus.
If a specific cause is not identified, the following list of suggestions may help lessen the severity of the tinnitus:

Try to avoid things that make you anxious as they stimulate an already stressed hearing system
Try to get adequate rest and keep from becoming overly tired
Cut down or eliminate the use of nerve stimulants like caffeine and nicotine. Remember that coffee, tea, many soft drinks, chocolate and aspirin-containing drugs contain caffeine.
Check with your family doctor to find out if any medicines you are taking can make your head noise worse.
Get your blood pressure checked by your family doctor. If it is high, seek your doctor’s help to get it under control.
Limit your intake of sodium. This improves your circulation. Avoid salty foods and do not add salt to your food when you cook or at the table.
Protect your ears from excessive noise by using earplugs that can be obtained from our group or almost any drugstore. Noise can also cause a hearing loss that can’t be corrected with surgery.
A person with hearing loss sometimes finds that a hearing aid will reduce head noise and occasionally make it go away. Even someone with a minor hearing loss might find that a hearing aid will relieve tinnitus. However, a thorough trial before the purchase of a hearing aid is recommended if the primary goal is to relieve tinnitus.
Sedatives sometimes give temporary relief from tinnitus, particularly when someone is anxious. The use of sedatives over a long period of time can be habit forming and is strongly discouraged by our group. The use of sedatives is not a cure for tinnitus.
Consider using tinnitus retraining therapy if your tinnitus is annoying.

Tinnitus is usually more bothersome when you are in a quiet room. We recommend using a low-level background noise generator. The continuous use of background noise at a level below your head noise will eventually help habituate, or decrease the intensity of the tinnitus sound that you hear. Most people prefer using a natural sound such as a babbling brook or the sound of rain. Noise machines are sold in a variety of stores and catalogs. Others find that using a fan or humidifier will provide enough noise to help decrease their tinnitus.
There is no cure for tinnitus, even when it might be caused by pressure from a tumor. When the tumor is removed, about 50% of the time the head noise present before surgery is still present after surgery. Some people with a hearing loss notice the intensity of their tinnitus is decreased when their hearing loss is improved by surgery, or more frequently, when they get a hearing aid. Occasionally tinnitus may be so severe that it may cause or worsen a patient’s depression. Antidepressants have been shown to help severe tinnitus sufferers, and we often refer patients to skilled therapists who will manage the depression and the medications used for its treatment.
DIZZINESS Dizziness and faintness are common problems that in most cases are not indicators of serious health problems. It is important to look for a reason for these symptoms and attempt to identify treatable causes.Vision, joint sensation and inner ear information are processed in the brain to give us a sense of motion, and where we are in space. If these sources of input do not match up, or there is a processing problem, we feel off balance. Often, the sense of spinning, or vertigo may indicate involvement in the inner ear or brainstem. Specific questions in the clinical history are the most important data when trying to identify the cause of the misinformation.Hearing testing, balance testing, and radiographic imaging are often needed to identify treatable causes of vertigo. Most often, even if a specific cause cannot be identified, therapies can be initiated that will strengthen the balance system and reduce self injury. These therapies may include physical therapy, assessment of fall risk, ambulation assistance, hearing rehabilitation, and referral for further cardiovascular, brain and neck evaluation. With proper management, the impact of an injury to our balance system can be substantially reduced.

Voice & Throat

Tue, 04 Sep 2018 19:37:00 GMT

VOICE DISORDERS

The larynx (voicebox) is composed of a cartilage framework with intrinsic and extrinsic muscles that provide motion for both speech and swallowing. The vocal cords are made up of muscles with a layer of mucous membrane. These muscles and mucous membranes vibrate with contractions that produce sounds, or voice, that your mouth then forms into speech. The motion of the vocal cords is under neurologic control and they can vibrate up to 800 times per second.

The signs and symptoms of voice disorders include:

Hoarseness (dysphonia)
Vocal fatigue
Weak or breathy voice
Loss of singing range
Loss of voice (aphonia)
Pitch breaks or abnormally high or low-pitched voice
Strained voice
Vocal tremor
Pain while speaking or singing

Common conditions which may cause changes in the voice include:

Laryngitis (viral, bacterial or inflammatory)
Gastroesophageal reflux disease
Vocal cord nodules or polyps
Growths, tumors or cancer of the voicebox
Paralysis of the vocal cords
Disorders of the thyroid
Sinusitis
Myasthenia gravis
Spastic dysphonia (involuntary movements or muscle spasms of the vocal cords)
Paradoxical vocal cord dysfunction (the vocal cords move inward with breathing when they are supposed to move outward)

Di agnosis and treatment of voice and throat problems
To evaluate your condition your physician will attempt to look at the vocal cords, which is sometimes done using a mirror. The physician may also perform a flexible fiber-optic examination of the larynx to identify any growths, inflammation, infection, ulcerations or paralysis of the vocal cords. Because the vocal cords vibrate so rapidly, a special examination called videostroboscopy may be recommended. These procedures are done in our office.
Because there are many different underlying causes and reasons for vocal dysfunction, treatment options vary depending on the nature of the disorder. Treatment options may be very simple such as voice rest, simple medical management, control of environmental or behavioral causative factors, or speech therapy. More severe problems may require surgery, biopsy or other treatments. Diagnosis is the most important initial step after which your physician will make treatment recommendations to you.
Flexible Fiberoptic Examination of the Larynx
A flexible fiberoptic examination involves placing a small, flexible tube through the nose and down the throat to visualize the vocal cords. It is a quick and simple procedure performed safely and effectively in the office and painless with use of a simple topical analgesia.
Videostroboscopy
Videostroboscopy is one of the most practical techniques currently available for recording and observing the motion of the vocal cords. It allows for easy examination of vibrations of the vocal cords while speaking or singing. Videostroboscopy creates visual images of vocal cord vibration in either stop action or slow motion to allow minute abnormalities which influence the voice to be seen. From the resulting visual images, an accurate diagnosis of conditions and diseases of the vocal cords, including masses or lesions, abnormal motion, inflammation, broken blood vessels, scarring and other disorders can be made.
Videostroboscopy is a simple and painless procedure that is done in the office by an otolaryngologist with just an anesthetic spray applied to the throat and the nose. To help the physician view the vocal cords, a small angled telescope is placed into the mouth or a flexible telescope placed through the nose. The patient is asked to repeat several words and make specific sounds to make the vocal cords vibrate and vocal cord actions are recorded. The examination lasts only a few minutes and is not painful, allowing the patient to talk throughout the examination and view what is happening on a video monitor. The examination is conducted with a speech pathologist in conjunction with an otolaryngologist in order to formulate the best treatment plan for the patient. Treatment options may include medication, vocal exercises, speech therapy, and in some cases, surgery.

SORE THROAT

A sore throat is a symptom of many medical disorders. Most sore throats are caused by infections and are contagious. Infections are caused either by viruses such as the flu, the common cold, mononucleosis, or by bacteria such as strep. While bacteria respond to antibiotic treatment, viruses do not.
When should you see a doctor for a sore throat?
Whenever a sore throat is severe, persists longer than the usual five to seven day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your physician:

Severe and prolonged sore throat
Difficulty breathing
Difficulty swallowing
Difficulty opening the mouth
Joint pain
Earache
Rash
Fever (over 101°)
Blood in saliva or phlegm
Frequently recurring sore throat
Lump in neck
Hoarseness lasting over two weeks

What causes a sore throat?
Tonsillitis is an infection of the lumpy tissues on each side of the back of the throat. In the first two to three years of childhood, these tissues “catch” infections, sampling the child’s environment to help develop immunities (antibodies). Healthy tonsils do not remain infected. Frequent sore throats from tonsillitis suggest the infection is not fully eliminated between episodes. A medical study has shown that children who suffer from frequent episodes of tonsillitis (such as three- to four- times each year for several years) were healthier after their tonsils were surgically removed.
Infections in the nose and sinuses can also cause sore throats, because mucus from the nose drains down into the throat and carries the infection with it. The most dangerous throat infection is epiglottitis, caused by bacteria that infect a portion of the larynx (voice box) and cause swelling that closes the airway. This infection is an emergency condition that requires prompt medical attention. Suspect it when swallowing is extremely painful (causing drooling), speech is muffled, and breathing becomes difficult. A strep test may miss this infection.
Allergies may also be the root cause of a sore throat. The same pollens and molds that irritate the nose when they are inhaled also may irritate the throat. Cat and dog danders and house dust are common causes of sore throats for people with allergies to them.
Dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This problem often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose that causes mouth breathing may also suffer with a dry throat and may need examination and treatment of the nose to alleviate these symptoms.
Pollutants and chemicals in the air can irritate the nose and throat, but the most common air pollutant is tobacco smoke. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods.
Voice strain can also cause soreness in the throat, not only from muscle strain of yelling too loudly but also from the rough treatment of his or her throat membranes.
Acid Reflux can occasionally cause morning sore throat as stomach acids regurgitate up into the back of the throat. To avoid reflux, tilt your bed frame so that the head is elevated four to six inches higher than the foot of the bed. Antacids can also be helpful. Other tips include avoid eating within three hours of bedtime, and eliminating caffeine and alcohol. If these tips fail, see your doctor.
Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long-time use of tobacco and alcohol. Sore throat and difficulty swallowing, sometimes with pain radiating to the ear, may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Other important symptoms include hoarseness, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.

SWALLOWING DISORDERS

Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are temporary and not threatening. If the difficulty does not clear up by itself in a short period of time, you should see an ear, nose and throat physician.
People normally swallow hundreds of times a day to eat, drink and swallow the normal saliva and mucus that the body produces. Thus, any interruption in the swallowing process can be very problematic. Swallowing difficulty may be due to simple causes such as poor teeth, poorly-fitting dentures, or a common cold. One of the most common causes of dysphagia is gastroesophageal reflux. Other causes may include: stroke; progressive neurologic disorder; the presence of a tracheostomy tube; a paralyzed or unmoving vocal cord; a tumor in the mouth, throat or esophagus; or surgery in the head, neck or esophageal areas.
The symptoms of swallowing disorders may include:

drooling;
a feeling that food or liquid or a foreign body is stuck in the throat;
discomfort in the throat or chest (when gastroesophageal reflux is present);
weight loss and inadequate nutrition due to prolonged or more significant problems with swallowing; and
coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing, and being sucked into the lungs.

Diagnosis and treatment of swallowing disorders
When dysphagia is persistent and the cause is not apparent, the ENT physician will discuss the history of your problem and examine your mouth and throat. This may be done with the aid of mirrors or a small tube (flexible laryngoscope), which provides vision of the back of the tongue, throat, and larynx (voice box). The physician may also involve a speech pathologist in the assessment. Many swallowing disorders can be treated with medication. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available.

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Your stomach is filled with acid to help digest the food you eat. Believe it or not, this acid is as strong as battery acid. Although your stomach is built to handle stomach acid, your esophagus is not. When acid backs up into your esophagus, it can cause the burning sensation known as heartburn. Almost everyone has occasional heartburn, but if these symptoms occur two or more days a week for at least three months, you may have acid reflux disease (GERD). Acid reflux occurs when the lower esophageal sphincter – the valve separating the esophagus and stomach—does not close properly, allowing acid to back up into the esophagus. In short, acid reflux disease is chronic heartburn.
Treatment of GERD
A specialist in treating gastrointestinal orders (called a gastroenterologist) often provides initial treatment for GERD, but there are ear, nose, and throat problems that are either caused by or associated with GERD, such as hoarseness, vocal cord polyps or nodules, shortness of breath, swallowing problems, throat pain, sinus infections, and a sensation of a foreign body in the throat. These problems require an ear, nose and throat doctor (otolaryngologist)
GERD can often be treated by changing eating and living habits including:

eating a bland diet with smaller, more frequent meals;
eliminating alcohol and caffeine;
reducing weight and stress;
avoiding food within three hours of bedtime; and
elevating the head of the bed at night.

Most people with GERD respond favorably to a combination of lifestyle changes and medication. On occasion, surgery is recommended. Medications that could be prescribed include antacids, histamine antagonists, proton pump inhibitors, pro-motility drugs, and foam barrier medications. Some of these products are now available over-the-counter and do not require a prescription.

Total Hearing Care

Tue, 04 Sep 2018 19:37:00 GMT

TYPES OF HEARING LOSS

Hearing loss is unique to the individual, like a fingerprint. One treatment plan does not suit every individual. The otolaryngologists and audiologists at North Shore ENT work together closely to diagnose hearing loss and develop an appropriate management plan. The plan is developed using a combination of medical history, physical examination, and results from specialized auditory assessments.
Hearing loss is classified as conductive, sensory, neural, or central depending on the location of the defect within the hearing mechanism.

CONDUCTIVE HEARING LOSS

Conductive hearing loss occurs when sound fails to transmit through the outer or middle ear. Common causes of conductive hearing loss are:

Impacted earwax
Perforated eardrum
Middle ear fluid
Middle ear infections
Abnormalities involving the middle ear bones

Conductive hearing loss causes a reduction in the loudness of sound and are often medically or surgically correctable. Hearing aids can be helpful in cases where medical or surgical intervention is not preferred.

SENSORY HEARING LOSS

Sensory hearing loss occurs when there is damage to the receptor hair cells in the inner ear, or “cochlea.” When these cells are healthy, they increase the loudness of sound, contribute to the clarity of speech, allow for a separation of speech and noise, and help prevent loud sounds from becoming uncomfortable. A sensory hearing loss therefore results in a loss of loudness, difficulty with speech clarity, trouble separating speech from background noise, and increased sensitivity to loud noises. Sensory hearing losses often are the result of:

Heredity
Aging
Noise exposure
Certain illnesses
Some medications

Sensory hearing losses typically are not medically or surgically correctable and are often treated with hearing aids and other assistive devices. Cochlear implants can be used in cases of severe to profound sensory hearing loss. This type is often mistakenly labeled as “nerve loss” and is the most common type of hearing loss.

NEURAL HEARING LOSS

Neural hearing loss results when the auditory nerve fails to accurately transmit impulses from the receptor cells of the inner ear to the brainstem. Another possible cause is a failure in the chemical transmission between intact inner ear receptor cells and the auditory nerve. conditions that result in neural hearing loss are:

Auditory neuropathy/auditory dyssynchrony
Auditory nerve tumors

Neural hearing losses are not treatable with hearing aids. Auditory neuropathy is sometimes treatable with cochlear implants

CENTRAL HEARING LOSS

Central hearing loss refers to the inability of the brain to make appropriate use of auditory information. It results in difficulty with speech processing and understanding and can interfere with speech development in children. Auditory processing disorders in children may be mistaken for behavioral disorders.
Central hearing losses are not treatable with hearing aids but some may benefit from assistive listening devices that help to separate speech from background noise.

HEARING AIDS

North Shore ENT is pleased to offer our patients hearing aid services through Sound Choice Inc. Sound Choice is a privately-owned, independent hearing aid dispensing practice. We feel you will receive excellent care from our audiologists working with Sound Choice Inc. For more information about Sound Choice, please visit their website. What is the procedure for obtaining hearing aids?The first step in obtaining hearing aids is a comprehensive audiological evaluation. Your audiologist will make recommendations for hearing aids, if necessary, based on the degree and type of hearing loss you have.
The next step is to schedule a hearing aid evaluation. At that time, your audiologist will ask you about your lifestyle and your listening needs to determine the appropriate style and type of hearing aids. The audiologist will take impressions of your ears for the custom ear mold or hearing aid shell (if necessary, depending on the type of hearing instrument).
Approximately two weeks later, you will have a hearing aid fitting appointment. Your audiologist will program the hearing aids and show you how to use and care for them. Generally a follow-up appointment is scheduled for one or two weeks after the fitting.
Do I need to wear two hearing aids? When you have hearing loss in both ears, you will generally hear better with hearing aids in both ears. Your brain uses information from both of your ears in order to give you the best representation of the auditory information. There is a natural benefit for speech understanding in background noise when both ears are listening at the same level; we are able to “squelch” the unwanted noise. Finally, in order to be able to localize sound (tell where it is coming from), both ears need to be listening at the same level. This is not only a comfort issue, but a safety issue as well.
Which Hearing Aid is Best for Me? No one hearing aid solves the concerns that are unique to the hearing impaired population. Hearing aid manufacturers have different strengths: a power circuit for a severe hearing loss, a shell for someone with a tiny ear canal or high-frequency emphasis. It is important to choose a hearing health care professional who dispenses multiple brands of hearing aids.
Your hearing healthcare professional will help to choose the best aid for you by reviewing your hearing test, listening to your individual concerns and addressing your unique listening challenges.
The reactions to personal amplification are varied. Although it may not be possible to eliminate all of the issues related to your hearing loss, our goal is to tip the scales toward positive benefits. A satisfied patient is the best form of advertising!
As an independent company, Sound Choice utilizes a variety of the world’s finest hearing aid manufacturers. These working relationships are based on years of experience.
To learn more about hearing aids, please visit the Sound Choice website, or call Sound Choice at 978-777-2448.

ASSISTIVE DEVICES

Sensory hearing loss results in deficits that cannot always be addressed using hearing aids alone. In some cases a patient may not be a good candidate for hearing aids but can obtain benefit from assistive devices. In children especially, assistive devices such as FM listening systems are critical in the classroom. If you have a hearing loss and cannot wear hearing aids or do not obtain sufficient benefit from hearing aids alone, ask your audiologist about appropriate assistive devices. Assistive listening devices have the advantage of improving the listener’s ability to hear the desired signal in background noise or at a distance. Most hearing impaired people experience most of their difficulty in background noise, so assistive listening devices are useful for the majority of hearing aid patients.Here are some types of assistive devices:

FM Systems transmit the speaker’s voice via FM from a remote microphone directly to the listener’s ear. They can couple directly to hearing aids or can be used on their own without hearing aids.
Infrared Devices also transmit the desired signal directly to the listener’s ear using infrared light. Infrared technology is often used in TV listening devices and public theaters.
Hard wired Devices are useful for improving signal to noise ratio at close distances. They’re a good choice for patients with relatively inactive lifestyles who cannot use hearing aids due to poor speech understanding ability. They can also be used with television.
Telecommunication Devices include amplified, hearing compatible telephones, portable telephone amplifiers, telecoil-equipped hearing aids, neckloops, TTYs, and Bluetooth couplers for cellular telephones.

EAR PROTECTION

We offer a full line of protective devices for occupation and recreational noise exposure and water protection. Your audiologist will work with you to determine which device is most appropriate, based on your environment.Custom Noise ProtectionCustomized earplugs are essential for those patients (with and without hearing loss) who are exposed to loud levels of noise. Products are available for shooters, industrial workers, musicians, and more. Specialty Ear MoldsCustomized earplugs may be fit to prevent water from entering the ear canal. Patients with pressure-equalization tubes (“ear tubes”) and those who are prone to chronic infections will benefit from custom-made plugs. Customize your Bluetooth™ headset or iPod™ to improve your wearing comfort.