Ventilating Ear Tubes | Tonsillectomy - Adenoidectomy | Tongue Tie
Foreign Bodies of the Ear, Nose and Airway

Ventilating Ear Tubes

Tympanostomy tubes are tiny tubes that are placed in the eardrum. Also called "ear tubes", they are usually placed for these reasons:
* If your child has repeated ear infections that do not get better with antibiotics
* If your child has fluid in his or her middle ear space for 3 months or more.

The middle ear space is normally filled with air. If the middle ear is filled with fluid instead of air, hearing is muffled or garbled. This is what happens with ear infections. By draining fluid, tympanostomy tubes allow the middle ear to fill with air again and ventilate properly.

The main concern about fluid in the ear is that it makes sound garbled. This can interfere with your child's learning to speak because children imitate the sounds they hear. Hearing usually improves soon after the tubes are placed. Your doctor or an audiologist should check to make sure that your child's hearing is normal.

How are tubes placed in your child's ears?

Tubes are placed during surgery. Most children will go home the same day of the surgery. Your child is briefly put to sleep during the procedure. When you schedule the surgery, we will tell you that your child cannot ear or drink (including water) for a certain number of hours before the surgery. It is very important to have an empty stomach so that he or she doesn't vomit and inhale it in while asleep.

After your child is asleep, your doctor makes a tiny surgical opening under a microscope in your child's eardrum. Any fluid present in the middle ear is then suctioned out. Next, the tube is put in the small opening in the eardrum. Most tubes look like a small spool, generally the size of the tip of a pen.

It is normal for your child to be tired, irritable or feel sick to his or her stomach for a few hours after surgery. If your child continues to feel sick or vomits after you go home, call your doctor. There may be persistent watery ear drainage, sometimes blood-tinged, for the next 48 hours. This is normal.

When your child is ready to eat, offer clear liquids such as juice, broth, or popsicles, and if tolerated offer a light diet such as toast, crackers, or applesauce. When your child eats these foods without problems, he or she can resume a normal diet.

Activity Restrictions

Most children resume their normal routine shortly after surgery. Watch for unsteadiness during the first 24 hours after surgery. If your child does seem unsteady or dizzy, encourage quiet activities such as reading, watching TV or coloring. Traveling by airplane or to the mountains (elevation changes) will not hurt your child's ears.

More Ear Infections?

Although the risk is lowered, ear infections can still happen, usually occurring with a cold. Infections may start with drainage, but generally have little (or no) pain or fever. The drainage is usually thick and sticky with noticeable odor. Call your doctor if this happens. Most infections can be successfully treated with ear drops alone.

Water Precautions After Surgery

After tubes are placed, some children may get ear infections from water entering the ear canal and going through the tube. This seems to happen more often with older children. To protect the ears from water take a piece of cotton, place it snugly in the outer ear, then cover it generously with Vaseline to make it waterproof. We also make custom "????? Plugs" that are comfortable and provide the best protection against water exposure. Please ask your doctor about these if you are interested.

Follow Up

Please schedule a follow up visit for 2-3 weeks after surgery. Further follow up visits are needed for every six months thereafter. Your child's ears need to be examined regularly for the status of the tube and health of the middle ear.

The tube will work its way out of the eardrum and into the ear canal on its own. This usually happens 6-12 months after surgery. In most children the remaining hole in the ear drum will slowly close. Less than 20% of all children with tympanostomy tubes need a second set of tubes.

Call Your Doctor If...
* An ear infection develops after surgery and can not be successfully treated by your family doctor or pediatrician.
* If you have any other questions.


Tonsillectomy - Adenoidectomy

The tonsils are located on each side of the back wall of the throat, just above and behind the tongue. The adenoids are found above and behind the soft palate (roof of the mouth) where the nose and mouth join. When they are overcome by chronic infections, or when marked enlargement blocks breathing, tonsils and/or adenoids may need to be removed. During surgery, the tonsils and adenoids are removed from the wall of the throat. The adenoids are reached by lifting the soft palate. The operation takes about 30 minutes.

What to Expect After Surgery

After this operation, your child may lack energy for several days. Many children are restless and don't sleep through the night. This will gradually improve over 7-14 days. Constipation may also occur. This is due to less food and fluids taken and/or the use of pain medications with codeine. To avoid nausea, give your child food and drink with this type of medication.

Bleeding

No new bleeding (BRIGHT RED blood) is expected from the nose or mouth after you return home. Please check your child for bleeding during the night after the operation. If fresh bleeding occurs after you have returned home, try gargling with ice water for 10-15 minutes and if it does not resolve, call the surgeon or go to the nearest emergency room. If the adenoids are removed do not allow your child to blow his or her nose for 3 days. This may cause bleeding. It is safe to sniff gently as needed. 5-10 days after the operation your child may spit up a small amount of dark, bloody material. The white membrane that formed across the back of the throat has broken away. If the bleeding does not stop within a few minutes, take your child to the closest emergency room.

Diet

Encourage your child to drink clear, cold liquids every waking hour for the first 2 days. Good choices include cold water, fruit juice, Jell-O, popsicles, slush, Gatorade, and Pedialyte. You may advance the diet to soft, the sold foods at any time after surgery. If your child is nauseated and vomits DO NOT provide any food or drink for 30-45 minutes. Then begin with clear liquids again, progressing to solid foods once your child tolerated clear liquids without vomiting.

Temperature

A slight fever is NORMAL for 24-48 hours after surgery. Giving your child plenty of fluids will help keep the fever down. If the fever rises above 101.5 F, contact your doctor.

Pain

Throat pain and/or ear pain can be severe after a tonsillectomy. Expect your child to experience pain in the ears between the 3rd and 7th day after the operation. The nerve that goes to the tonsil also goes to the ear causing pain to be felt in the ear. After the operation give pain medication 4-5 times a day. Do NOT use aspirin, medications containing aspirin, or ibuprofen (Motrin, Advil) - they increase the chance of bleeding. Acetaminophen (Tylenol, Tempra) of a prescription item advised by your physician can be used. Sometimes a short course of prescription steroids may help with pain and swelling. Other ways to decrease throat pain are:
* Give you child cold liquids. They moisten the throat and reduce the swelling.
* Cool compresses and ice collars on the neck.
* Ice chips also moisten the throat.

Bad Breath

Bad breath is common after a tonsillectomy. It is caused by the white-yellowish membrane that forms in the throat where the surgery took place. Bad breath may be improved by gargling with a mild salt-water solution. This is made by adding a teaspoon of table salt to 8-ounces (1 Cup) of warm tap water.

Nausea | Vomiting

Promethazine (Phenergan), or prochlorperazine (Compazine) suppositories may be used to control nausea and vomiting. The dose may be repeated after 4-6 hours. If vomiting continues after the 2nd dose, call your child's doctor or the local hospital emergency room.

Activity

Your child can be up and dressed after going home. But do NOT allow your child to resume normal activity for about one week. Your child may experience alternating "good" and "bad" days for 2 weeks after surgery. It is a good idea to keep your child away from crowds and ill people for 7 days, since the throat is highly susceptible to infections during this period.


Tongue-Tie

Most of us think of tongue-tie as a situation we find ourselves in when we are too excited to speak. Actually, tongue-tie is the non-medical term for a relatively common physical condition that limits the use of the tongue, ankyloglossia.

Before we are born, a strong cord of tissue that guides development of mouth structures is positioned in the center of the mouth. It is called a frenulum. After birth, the lingual frenulum continues to guide the position of incoming teeth. As we grow, it recedes and thins. This frenulum is visible and easily felt if you look in the mirror under your tongue. In some children, the frenulum is especially tight or fails to recede and may cause tongue mobility problems.

The tongue is one of the most important muscles for speech and swallowing. For this reason having tongue-tie can lead to eating or speech problems, which may be serious in some individuals.

When Is Tongue-tie a Problem That Needs Treatment?

In Infants

Feeding - A new baby with a too tight frenulum can have trouble sucking and may have poor weight gain. Such feeding problems should be discussed with your child's pediatrician who may refer you to an otolaryngologist-head and neck surgeon (ear, nose, and throat specialist) for additional treatment.

NOTE: Nursing mothers who experience significant pain while nursing or whose baby has trouble latching on should have their child evaluated for tongue tie. Although it is often overlooked, tongue tie can be an underlying cause of feeding problems that not only affect a child's weight gain, but lead many mothers to abandon breast feeding altogether.

In Toddlers and Older Children

Speech - While the tongue is remarkably able to compensate and many children have no speech impediments due to tongue-tie, others may. Around the age of three, speech problems, especially articulation of the sounds - l, r, t, d, n, th, sh, and z may be noticeable. Evaluation may be needed if more than half of a three-year-old child's speech is not understood outside of the family circle. Although, there is no obvious way to tell in infancy which children with ankyloglossia will have speech difficulties later, the following associated characteristics are common:
* V-shaped notch at the tip of the tongue
* Inability to stick out the tongue past the upper gums
* Inability to touch the roof of the mouth
* Difficulty moving the tongue from side to side

As a simple test, caregivers or parents might ask themselves if the child can lick an ice cream cone or lollipop without much difficulty. If the answer is no, they cannot, then it may be time to consult a physician.

Appearance - For older children with tongue-tie, appearance can be affected by persistent dental problems such as a gap between the bottom two front teeth. Your child's physician can guide you in the diagnosis and treatment of tongue-tie. If he/she recommends surgery, an otolaryngologist-head and neck surgeon (ear, nose, and throat specialist), can perform a surgical procedure called a frenulectomy.

Tongue-tie Surgery Considerations

Tongue-tie surgery is a simple procedure and there are normally no complications. For very young infants (less than six-weeks-old), it may be done in the office of the physician. General anesthesia may be recommended when frenulectomy is performed on older children. But in some cases, it can be done in the physician's office under local anesthesia. While frenulectomy is relatively simple, it can yield big results. Parents should consider that this surgery often yields more benefit than is obvious by restoring ease of speech and self-esteem.


Foreign Bodies in the Ear, Nose and Airway

Foreign bodies in the ear, nose, and breathing tract (airway) sometimes occur in children. Foreign bodies refer to any object that is placed in the ear, nose, or mouth that is not meant to be there and could cause harm without immediate medical attention.

Foreign bodies in the ear

Foreign bodies can either be in the ear lobe or in the ear canal. Objects usually found in the ear lobe are earrings, either stuck in the lobe from infection or placed too deep during insertion. Foreign bodies in the ear canal can be anything a child can push into his/her ear. Some of the items that are commonly found in the ear canal include the following:
* food
* insects
* toys
* buttons
* pieces of crayon
* small batteries

It is important for parents to be aware that children may cause themselves or other children great harm by placing objects in the ear. The reason children place things in their ears is usually because they are bored, curious, or copying other children. Sometimes, one child may put an object in another child's ear during play. Insects may also fly into the ear canal, causing potential harm. It has also been noted that children with chronic outer ear infections tend to place things in their ears more often.

What are the symptoms of foreign bodies in the ear?

Some objects placed in the ear may not cause symptoms, while other objects, such as food and insects, may cause pain in the ear, redness, or drainage. Hearing may be affected if the object is blocking the ear canal.

Treatment for foreign bodies in the ear

The treatment for foreign bodies in the ear is prompt removal of the object by your child's physician. The following are some of the techniques that may be used by your child's physician to remove the object from the ear canal:
* instruments may be inserted in the ear
* magnets are sometimes used if the object is metal
* cleaning the ear canal with water
* a machine with suction to help pull the object out

After removal of the object, your child's physician will then re-examine the ear to determine if there has been any injury to the ear canal. Antibiotic drops for the ear may be prescribed to treat any possible infections.

Foreign bodies in the nose

Objects that are put into the child's nose are usually soft things. These would include, but are not limited to, tissue, clay, and pieces of toys, or erasers. Sometimes, a foreign body may enter the nose while the child is trying to smell the object. Children often place objects in their noses because they are bored, curious, or copying other children.

What are the symptoms of foreign bodies in the nose?

The most common symptom of a foreign body in the nose is nasal drainage. The drainage appears only on the side of the nose with the object and often has a bad odor. In some cases, the child may also have a bloody nose.

Treatment for foreign bodies in the nose

Treatment of a foreign body in the nose involves prompt removal of the object by your child's physician. Sedating the child is sometimes necessary in order to remove the object successfully. This may have to be performed in the hospital, depending on the extent of the problem and the cooperation of the child. The following are some of the techniques that may be used by your child's physician to remove the object from the nose:
* suction machines with tubes attached
* instruments such as small tweezers called forceps

After removal of the object, your child's physician may prescribe nose drops or antibiotic ointments to treat any possible infections.

Foreign bodies in the airway

Foreign bodies in the airway constitute a medical emergency and require immediate attention. The foreign body can get stuck in many different places within the airway. Foreign bodies in the airway account for nearly 9 percent of all home accidental deaths in children under 5 years of age.

As with other foreign body problems, children tend to put things into their mouths when they are bored or curious. The child may then inhale deeply and the object may become lodged in the "airway" tube (trachea) instead of the "eating" tube (esophagus). Food may be the cause of obstruction in children who do not have a full set of teeth to chew completely, or those children who simply do not chew their food well. Children also do not have complete coordination of the mouth and tongue which may also lead to problems. Children between the ages of 7 months and 4 years are in the greatest danger of choking on small objects, including, but not limited to, the following:
* seeds
* toy parts
* grapes
* hot dogs
* pebbles
* nuts
* buttons

Children need to be watched very closely to avoid a choking emergency.

What are the symptoms of foreign bodies in the airway?

Foreign body ingestion requires immediate medical attention. The following are the most common symptoms that may indicate a child is choking. However, each child may experience symptoms differently. Symptoms may include:
* choking or gagging when the object is first inhaled
* coughing at first
* wheezing (a whistling sound, usually made when the child breathes out)

Although the initial symptoms listed above may subside, the foreign body may still be obstructing the airway. The following symptoms may indicate that the foreign body is still causing an airway obstruction:
* stridor (a high pitched sound usually heard when the child breathes)
* cough that gets worse
* child is unable to speak
* pain in the throat area or chest
* hoarse voice
* blueness around the lips
* not breathing
* the child may become unconscious

Treatment for foreign bodies in the airway

Treatment of the problem varies with the degree of airway blockage. If the object is completely blocking the airway, the child will be unable to breath or talk and his/her lips will become blue. This is a medical emergency and you should seek emergency medical care. Sometimes, surgery is necessary to remove the object. Children that are still talking and breathing but show other symptoms also need to be evaluated by a physician immediately.

Sinus Disease

Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. Normally, sinuses are filled with air, but when sinuses become blocked and filled with fluid, germs (bacteria, viruses, and fungi) can grow and cause an infection.

Conditions that can cause sinus blockage include the common cold, allergic rhinitis (swelling of the lining of the nose), nasal polyps (small growths in the lining of the nose), or a deviated septum (a shift in the nasal cavity).

There are different types of sinusitis, including:
* Acute sinusitis: A sudden onset of cold-like symptoms such as runny, stuffy nose and facial pain that does not go away after 7-10 days. Acute sinusitis typically lasts 4 weeks or less.
* Subacute sinusitis: An inflammation lasting 4 to 8 weeks.
* Chronic sinusitis: A condition characterized by sinus inflammation symptoms lasting 8 weeks or longer.
* Recurrent sinusitis: Several attacks within a year.

Who Gets Sinusitis?

About 37 million Americans suffer from at least one episode of sinusitis each year. People who have the following conditions have a higher risk of sinusitis:
* Nasal mucous membrane swelling as from a common cold
* Blockage of drainage ducts
* Structure differences that narrow the drainage ducts
* Conditions that result in an increased risk of infection such as immune deficiencies or taking medications that suppress the immune system.

In children, common environmental factors that contribute to sinusitis include allergies, illness from other children at day care or school, pacifiers, bottle drinking while lying on one's back, and smoke in the environment.

In adults, the contributing factors are most frequently infections and smoking.What Are the Signs and Symptoms of Acute Sinusitis?

The primary symptoms of acute sinusitis include:
* Facial pain/pressure
* Nasal stuffiness
* Nasal discharge
* Loss of smell
* Cough/congestion

Additional symptoms may include:
* Fever
* Bad breath
* Fatigue
* Dental pain

Acute sinusitis may be diagnosed when a person has two or more symptoms and/or the presence of thick, green, or yellow nasal discharge.

What Are the Signs and Symptoms of Chronic Sinusitis?

People with chronic sinusitis may have the following symptoms for 8 weeks or more:
* Facial congestion/fullness
* A nasal obstruction/blockage
* Pus in the nasal cavity
* Fever
* Nasal discharge/discolored postnasal drainage

Additional symptoms of chronic sinusitis may include:
* Headaches
* Bad breath
* Fatigue
* Dental pain

How Is Sinusitis Diagnosed?

To diagnose sinusitis, your doctor will review your symptoms and give you a physical examination.

The exam may include the doctor feeling and pressing your sinuses for tenderness. He or she may also tap your teeth to see if you have an inflamed paranasal sinus.

Other diagnostic tests may include a study of the mucus culture, nasal endoscopy (see below), X-rays, allergy testing, CT scan of the sinuses, or blood work.

What Is Nasal Endoscopy?

A nasal endoscope is a special tube-like instrument equipped with tiny lights and cameras used to examine the interior of the nose and sinus drainage areas.

A nasal endoscopy allows your doctor to view the accessible areas of the sinus drainage pathways. Your nasal cavity may first be numbed using a local anesthetic (some cases do not require any anesthetic). A rigid or flexible endoscope is then placed in position to view the middle bone structure of the nasal cavity.

The procedure is used to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic exam, the doctor also looks for any structural abnormalities that would cause you to suffer from recurrent sinusitis.

How Is Sinusitis Treated?

Treatment for sinusitis depends on the severity.
* Acute sinusitis. If you have a simple sinus infection, your health care provider may recommend treatment with decongestants like Sudafed and steam inhalations alone. Use of nonprescription decongestant nasal drops or sprays may also be effective in controlling symptoms. However, these medicines should not be used beyond their recommended use, usually four to five days, or they may actually increase congestion. If antibiotics are given, they are usually given for 10 to 14 days. With treatment, the symptoms usually disappear and antibiotics are no longer required.
* Chronic sinusitis. Warm moist air may alleviate sinus congestion. A vaporizer or inhaling steam from a pan of boiling water (removed from heat) may also help. Warm compresses are useful to relieve pain in the nose and sinuses. Saline nose drops are also safe for home use. Use of nonprescription decongestant nasal drops or sprays might be effective in controlling symptoms, however, they should not be used beyond their recommended use. Antibiotics may also be prescribed.

Other Treatment Options for Sinusitis

To reduce congestion due to sinusitis, your doctor may prescribe nasal sprays (some may contain steroid sprays), nose drops, or oral decongestant medicine. If you suffer from severe chronic sinusitis, oral steroids might be prescribed to reduce inflammation -- usually only when other medications have not worked. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). An antihistamine may be recommended for the treatment of allergies. Antifungal medicine may be prescribed for a fungal sinus infection. Immunoglobulin (antibodies) may be given if you have certain immune deficiencies.

Will I Need to Make Lifestyle Changes?

Smoking is never recommended, but if you do smoke, you should refrain during treatment for sinus problems. No special diet is required, but drinking extra fluids helps to thin secretions.

Is Sinus Surgery Necessary?

Mucus is developed by the body to moisten the sinus walls. In the sinus walls, the mucus is moved across tissue linings toward the opening of each sinus by millions of cilia (a hair-like extension of a cell). Irritation and swelling from an allergy can narrow the opening of the sinus and block mucus movement. If antibiotics and other medicines are not effective in opening the sinus, surgery may be necessary. Also, if there is a structural abnormality of the sinus such as nasal polyps, which can obstruct sinus drainage, surgery may be needed.

Surgery is performed under local or general anesthesia using an endoscope. Most people can return to normal activities within five to seven days following surgery. Full recovery usually takes about four to six weeks.

A procedure called a "turbinectomy" may also be performed to permanently shrink the swollen membranes of the nose. This is done in the doctor's office and takes only a few minutes. The anesthetic used is very similar to that used in routine dental procedures.

What Happens If Sinusitis Is Not Treated?

Delaying treatment for sinusitis will result in suffering from unnecessary pain and discomfort. In rare circumstances, untreated sinusitis can lead to meningitis or brain abscess and infection of the bone.

Nasal Obstruction

The nasal septum is the wall between the nostrils that separates the two nasal passages. It supports the nose and directs airflow. The septum is made of thin bone in the back and cartilage in the front. A deviated septum occurs when the cartilage or bone is not straight. A crooked septum can make breathing difficult. The condition also can lead to snoring and sleep apnea.

The septum can bend to one side or another as a part of normal growth during childhood and puberty. Also, the septum can be deviated at birth (congenital) or because of an injury, such as a broken nose. Very few people have a perfectly straight septum.

Surgery to straighten the septum is called septoplasty, submucous resection of the septum, or septal reconstruction. The surgery may be done along with other procedures to treat chronic sinusitis, inflammation, or bleeding, or to correct sleep apnea. Septoplasty also may be done to allow access into the nose to remove nasal polyps. In general, septoplasty is needed only when breathing problems or snoring do not get better without surgery. For more information on surgery to treat chronic sinusitis, see the topic Sinusitis.

Before surgery, the doctor may use a thin, lighted instrument (endoscope) to look at your nasal passages and to see the shape of your septum. In some cases, the endoscope may be used during surgery. You will receive local or general anesthesia for the 60- to 90-minute operation, which is usually done in an outpatient surgery center.

The septum and nasal passages are lined with a layer of soft tissue called the nasal mucosa. To repair the septum, the surgeon works through the nostrils, making an incision to separate the mucosa from the underlying cartilage and bone. The doctor trims or straightens the bent cartilage and then replaces the mucosa over the cartilage and bone.

Inferior Turbinate Reduction

Inferior turbinoplasty is a minor surgical procedure to decrease the size of the inferior turbinates in those patients who have not responded to medical therapy. In the past, reduction of the turbinates was performed by using a variety of methods including cautery or laser reduction, injection with steroids, cryotherapy (freezing) or surgical resection. These methods were either incapable of providing long-term relief (steroid injection and cryotherapy) or were associated with prolonged recovery or chronic nasal crusting (surgical resection, cautery and laser). Recently, techniques were developed to preserve the important function of the mucus membrane overlying the turbinate while still allowing for turbinate reduction.

Powered inferior turbinoplasty uses a specialized instrument called a microdebrider, which is also used in sinus surgery (FESS). This small rotating blade is placed underneath the turbinate mucus membrane to remove the extra bulk of the turbinate from within. This technique has many advantages including more complete removal of turbinate bulk from the back part of the turbinate and a quicker healing time than other techniques. Powered inferior turbinoplasty is performed in a surgery center as a twenty-minute outpatient procedure.

Coblation of the inferior turbinates is performed by inserting a radiofrequency probe underneath the turbinate mucus membrane to shrink the underlying tissue. This ten-minute procedure has the advantage of being able to be performed in an office setting.

Both Coblation and powered inferior turbinoplasty are associated with minimal discomfort post-operatively. These procedures can produce a dramatic improvement in nasal breathing for patients who have previously been unable to get relief. They are also helpful for patients who have difficulty utilizing CPAP for their sleep apnea secondary to nasal obstruction.

Standard Surgical Treatments for Nasal Obstruction

Cautery (burning) of enlarged turbinates can be done with an electrosurgical probe or a laser and is usually performed as an office procedure. Both electrocautery and laser surgery are performed on either the surface of the turbinate tissue or sub-mucosally. Surface cautery results in edema and crusting in the nose which can last three weeks or longer, while sub-mucosal cautery can cause swelling for up to 10 days.

Another method for improving nasal obstruction is outward fracture of the turbinate bone(s), which moves the turbinate away from its obstructive position in the airway. This approach, however, does not address the usual source of obstruction---enlarged sub-mucosal tissue, and the fractured turbinate often returns to its previous position. Turbinate resection (removal of the bone and/or soft tissue) and excision (removal of the soft tissue only) can be performed with surgical scissors or a laser. Physicians can reduce nasal obstruction by cutting away excess tissue from the surface of the turbinate with angled scissors. Following treatment, the nose must be packed for several days with gauze containing anantibiotic ointment.

Risks Associated with Standard Surgeries for Nasal Obstruction

Bleeding, which can usually be managed by packing the nose, is the greatest risk for patients undergoing standard turbinate resection. Over-resection of the turbinates has been reported as the cause of excessive, irreversible drying of the turbinates. Resection, excision and surface cautery can all be associated with prolonged crusting and healing, which occurs over a four- to six-week period.

Laser Surgery

Laser resection of the turbinates uses light energy that reaches temperatures of 750°C to 900°C (1,400°F to 1,700°F) to vaporize the turbinate mucosa. Safety issues related to the use of the laser require specialized training and experience in laser procedures. The crusting and bleeding rates with laser surgery are similar to cautery procedures.

How do I get a broken nose?

You can break your nose during play, sports, accidents, fights, and falls. But it may be hard to tell if your nose is broken. Swelling can make your nose look crooked even if it is not broken. When the swelling goes down after a few days, it is easier to tell if your nose is really crooked and possibly broken.

What are the symptoms?

Symptoms of a broken nose include:
* Nose pain.
* Swelling of the nose.
* A crooked or bent appearance.
* Bruising around the nose or eyes.
* A runny nose or a nosebleed.
* A grating sound or feeling when the nose is touched or rubbed.
* Blocked nasal passages.

Possible complications of a broken nose include:
* Change in the appearance of the nose or the tip of the nose.
* A large amount of blood in the nasal septum (nasal septal hematoma).
* A hole in the nasal septum (septal perforation) or causing the bridge of the nose to collapse (saddle nose deformity).
* Crooked (deviated) nasal septum. The nasal septum is the structure that divides the nose into two parts. See a picture of a deviated nasal septum.
* Permanent breathing difficulty.
* Persistent drainage from one or both nostrils. This may be caused by cerebral spinal fluid draining from the brain into the nose (CSF rhinorrhea) and can occur after a head injury or after surgery on the nose or ears.
* Infection of the nose, sinuses, or facial bones.
* A change in or loss of sense of smell.

How is a broken nose diagnosed?

A broken nose is diagnosed through a physical examination and medical history. An X-ray of the nose is not usually needed or helpful if only a broken nose is suspected. If other facial injuries or fractures are suspected, a CT scan will be done. Your doctor may wish to delay evaluation until the swelling has gone down. This may take several days.

How is it treated?

Immediately after the fracture, apply ice and keep your head elevated. You may need pain medicine, such as acetaminophen (for example, Tylenol). Do not take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin) or aspirin, for 48 hours after a nose injury. Do not take aspirin if you are younger than 20 because of the risk of Reye syndrome.

Immediate treatment is needed for some injuries that occur with a broken nose, such as:
* A large amount of blood in the nasal septum (nasal septal hematoma).
* A nosebleed that you cannot stop (epistaxis).
* Clear drainage from one or both nostrils (CSF rhinorrhea).

Treatment, if needed, usually is done within 7 to 14 days of breaking your nose. Most broken noses do not require treatment other than controlling pain and other symptoms.
* Your doctor may treat a simple fracture by straightening the bone or cartilage in your nose, if it is crooked. Splints or nasal packing (packing the nose with gauze) also may be necessary.
* Surgery may be needed to treat a more complicated fracture. Your doctor may need to move the bone or cartilage back into place. Splints or nasal packing may be necessary. Antibiotics are usually given to prevent infection. Your nose may be rechecked and the packing may be removed in 48 to 72 hours.

What is Your Thyroid Gland?

Your thyroid gland is one of the endocrine glands, which make hormones to regulate physiological functions in your body. The thyroid gland manufactures thyroid hormone, which regulates the rate at which your body carries on its necessary functions. Other endocrine glands are the pancreas, the pituitary, the adrenal glands, the parathyroid glands, the testes, and the ovaries.

The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and just above your clavicles (collarbones). It is shaped like a "bow tie," having two halves (lobes): a right lobe and a left lobe joined by an "isthmus.". You can't always feel a normal thyroid gland.

When Is a Thyroid Gland Abnormal?

Diseases of the thyroid gland are very common, affecting millions of Americans. The most common diseases are an over- or under-active gland. These conditions are called hyperthyroidism (e.g., Grave's disease) and hypothyroidism. Sometimes the thyroid gland can become enlarged from over-activity (as in Grave's disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a "goiter." Sometimes an inflammation of the thyroid gland (Hashimoto's disease) will cause enlargement of the gland.

Patients may develop "lumps" or "masses" in their thyroid glands. They may appear gradually or very rapidly. Patients who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy. A doctor should evaluate all thyroid "lumps" (nodules).

How Does Your Doctor Make the Diagnosis?

The diagnosis of a thyroid abnormality in function or a thyroid mass is made by taking a medical history and a physical examination. Specifically, your doctor will examine your neck and ask you to lift up your chin to make your thyroid gland more prominent. You may be asked to swallow during the examination, which helps to feel the thyroid and any mass in it. Other tests your doctor may order include:
* An ultrasound examination of your neck and thyroid
* Blood tests of thyroid function
* A radioactive thyroid scan
* A fine needle aspiration biopsy
* A chest X-ray
* A CT or MRI scan

Fine Needle Aspiration

If a lump in your thyroid is diagnosed, your doctor may recommend a fine needle aspiration biopsy. This is a safe, relatively painless procedure. A hypodermic needle is passed into the lump, and samples of tissues are taken. Often several passes with the needle are required. There is little pain afterward and very few complications from the procedure occur. This test gives the doctor more information on the nature of the lump in your thyroid gland and specifically will help to differentiate a benign from a malignant thyroid mass.

Treatment of Thyroid Disease

Abnormalities of thyroid function (hyper or hypothyroidism) are usually treated medically. If there is insufficient production of thyroid hormone, this may be given in a form of a thyroid hormone pill taken daily. Hyperthyroidism is treated mostly by medical means, but occasionally it may require the surgical removal of the thyroid gland.

If there is a lump of the thyroid or a diffused enlargement (goiter), your doctor will propose a treatment plan based on the examination and your test results. Most thyroid "lumps" are benign. Often they may be treated with thyroid hormone, and this is called "suppression" therapy. The object of this treatment is to attempt shrinkage of the mass over time, usually three-six months. If the lump continues to grow during treatment when you are taking the medication, most doctors will recommend removal of the affected lump.

If the fine needle aspiration is reported as suspicious for or suggestive of cancer, then thyroid surgery is required.

What Is Thyroid Surgery?

Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anesthesia is usually required. Usually the operation removes the lobe of the thyroid gland containing the lump and possibly the isthmus. A frozen section (an immediate microscopic reading) may or may not be used to determine if the rest of the thyroid gland should be removed. Sometimes, based on the result of the frozen section, the surgeon may decide to stop and remove no more thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck. This is a decision usually made in the operating room by the surgeon, based on findings at the time of surgery. Your surgeon will discuss these options with you preoperatively.

After surgery, you may have a drain (a tiny piece of plastic tubing), which prevents fluid from building up in the wound. This is removed after the fluid accumulation is minimal. Most patients are discharged one to three days after surgery. Complications after thyroid surgery are rare. They include bleeding, a hoarse voice, difficulty swallowing, numbness of the skin on the neck, and low blood calcium. Most complications go away after a few weeks. Patients who have all of their thyroid gland removed have a higher risk of low blood calcium post-operatively.

Patients who have thyroid surgery may be required to take thyroid medication to replace thyroid hormones after surgery. Some patients may need to take calcium replacement if their blood calcium is low. This will depend on how much thyroid gland remains, and what was found during surgery. If you have any questions about thyroid surgery, ask your doctor and he or she will answer them in detail.

Snoring & Sleep Disorders

Many people consider snoring a minor annoyance, but it can signal a potentially serious condition called sleep apnea (temporary interruptions in breathing during sleep). An article in the June 13, 2001, issue of JAMA reports an association between sleep-disordered breathing and a generic marker called apolipoprotein E 4. The authors speculate that this marker may be one of the many genetic factors that make someone susceptible to developing sleep-disordered breathing.

What Is Sleep Apnea?

Sleep apnea is disturbed or interrupted breathing during sleep. For those affected by sleep apnea, there can be many temporary interruptions in breathing, each usually lasting about 10 seconds, throughout the sleep period. These interruptions in breathing can occur as often as 20 to 30 times per hour.

Symptoms of Sleep Apnea

Because some of the symptoms of sleep apnea occur during sleep, they may be recognized first by people with whom one shares living quarters.
* Heavy snoring, although not everyone who snores has sleep apnea
* Struggling to breathe during sleep<br>* Interruption in breathing during sleep followed by a snort when breathing begins again
* Being excessively sleepy during the day
* Falling asleep during activities that require attention and concentration, such as driving, working, or talking If you are experiencing these symptoms, see a doctor, you may have sleep apnea or some other condition that needs medical attention.

Causes of Sleep Apnea

* Obstructive - partial or complete obstruction of the airway, which can be caused by relaxation of the muscles of the throat, soft palate, and tongue during sleep
* Central - problems with signals from the brain that control breathing Risk factors for sleep apnea include
* Being overweight
* Having a physical abnormality in the nose, throat, or other parts of the upper respiratory tract
* Having high blood pressure

Treatment

For mild cases of sleep-disordered breathing one can
* Sleep on one's side instead of back
* Avoid drinking alcohol before sleeping
* Avoid using sleeping pills
* Avoid smoking or using other tobacco products
* Lose weight, if overweight

The most common medical treatment for sleep apnea is continuous positive airway pressure (CPAP) , which is a therapy that uses pressure from an air blower to circulate air through the nasal passages and upper airway. The patient wears a mask over the nose that is connected to the air pressure hose, and the air pressure is adjusted to keep the airway open during sleep. Other therapies include dental appliances that change the position of the jaw and tongue. Snoring or obstructive sleep apnea may respond to various surgical treatments now offered by many Otolaryngologist- Head and Neck surgeons:
* Uvulopalatopharyngoplasty (UPPP) is surgery for treating obstructive sleep apnea. This procedure removes soft tissue on the back of the throat and palate, thereby increasing the width of the airway at the throat opening.
* Laser-Assisted Uvula Palatoplasty (LAUP) treats snoring and mild obstructive sleep apnea by removing the obstruction in the airway. A laser is used to vaporize the uvula and a specified portion of the palate in a series of small procedures in a doctor's office under local anesthesia.
* Somnoplasty is a minimally invasive procedure that occurs in an outpatient environment. It utilizes a needle electrode to emit radiofrequency energy to shrink excess tissue to the upper airway including the palate and uvula (for snoring), base of the tongue (for obstructive sleep apnea), and nasal turbinates (for chronic nasal obstruction).
* 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.
* Nasal Surgery - Nasal obstructions such as a deviated septum may play a role in sleep apnea, and can be corrected through appropriate surgical procedures.

Balloon Sinuplasty™ for Chronic Sinusitis Relief

Balloon Sinuplasty is a breakthrough procedure that relieves the pain and pressure associated with chronic sinusitis. It is used by surgeons to safely and effectively treat chronic sinusitis patients who are not responding well to medications such as antibiotics, nasal steroids, or over-the-counter (OTC) drugs, and are seeking relief from uncomfortable and painful sinusitis symptoms.

Similar to how angioplasty uses balloons to open blocked arteries, Balloon Sinuplasty, a system of FDA-cleared, catheter-based instruments, opens blocked sinuses.

The procedure is less invasive than traditional sinus surgery. It allows most patients to return to normal activities quickly.

With Balloon Sinuplasty, a specially-designed catheter is inserted into the nose to reach the inflamed sinus cavity. A small balloon is slowly inflated, which widens and restructures the walls of the sinus passage, helping to drain mucus from the blocked sinus and restore normal sinus drainage without cutting and with minimal bleeding. This approach also preserves the natural structure of the sinuses.

Head & Neck Cancer

More than 55,000 Americans will develop cancer of the head and neck (most of which is preventable) this year; nearly 13,000 of them will die from it. Find It Early and Be Cured.

Tobacco is the most preventable cause of these deaths. In the United States, up to 200,000 people die each year from smoking-related illnesses. The good news is that this figure has decreased due to the increasing number of Americans who have quit smoking. The bad news is that some of these smokers switched to smokeless or spit tobacco, assuming it is a safe alternative. This is untrue - they are merely changing the site of the cancer risk from their lungs to their mouth. While lung cancer cases are down, cancers in the head and neck appear to be increasing. Cancer of the head and neck is curable if caught early. Fortunately, most head and neck cancers produce early symptoms. You should know the possible warning signs so you can alert your doctor to your symptoms as soon as possible. Remember - successful treatment of head and neck cancer can depend on early detection. Knowing and recognizing the signs of head and neck cancer can save your life.

Here's What You Should Watch for:

A lump in the neck...Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a physician as soon as possible. Of course, not all lumps are cancer. But a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voicebox (larynx), thyroid gland, or of certain lymphomas or blood cancers. Such lumps are generally painless and continue to enlarge steadily.

Change in the voice...Most cancers in the larynx cause some change in voice. Any hoarseness or other voice change lasting more than two weeks should alert you to see your physician. An otolaryngologist is a head and neck specialist who can examine your vocal cords easily and painlessly. While most voice changes are not caused by cancer, you shouldn't take chances. If you are hoarse more than two weeks, make sure you don't have cancer of the larynx. See your doctor.

A growth in the mouth...Most cancers of the mouth or tongue cause a sore or swelling that doesn't go away. These sores and swellings may be painless unless they become infected. Bleeding may occur, but often not until late in the disease. If an ulcer or swelling is accompanied by lumps in the neck, be very concerned. Your dentist or doctor can determine if a biopsy (tissue sample test) is needed and can refer you to a head and neck surgeon to perform this procedure.

Bringing up blood...This is often caused by something other than cancer. However, tumors in the nose, mouth, throat or lungs can cause bleeding. If blood appears in your saliva or phlegm for more than a few days, you should see your physician.

Swallowing problems...Cancer of the throat or esophagus (swallowing tube) may make swallowing solid foods difficult. Sometimes liquids can also be troublesome. The food may "stick" at a certain point and then either go through to the stomach or come back up. If you have trouble almost every time you try to swallow something, you should be examined by a physician. Usually a barium swallow x-ray or an esophagoscopy (direct examination of the swallowing tube with a telescope) will be performed to find the cause.

Changes in the skin...The most common head and neck cancer is basal cell cancer of the skin. Fortunately, this is rarely a major problem if treated early. Basal cell cancers appear most often on sun-exposed areas like the forehead, face, and ears, although they can occur almost anywhere on the skin. Basal cell cancer often begins as a small, pale patch that enlarges slowly, producing a central "dimple" and eventually an ulcer. Parts of the ulcer may heal, but the major portion remains ulcerated. Some basal cell cancers show color changes. Other kinds of cancer, including squamous cell cancer and malignant melanoma, also occur on the skin of the head and neck. Most squamous cell cancers occur on the lower lip and ear. They may look like basal cell cancers and, if caught early and properly treated, usually are not much more dangerous. If there is a sore on the lip, lower face, or ear that does not heal, consult a physician. Malignant melanoma classically produces dense blue-black or black discolorations of the skin. However, any mole that changes size, color, or begins to bleed may be trouble. A black or blue-black spot on the face or neck, particularly if it changes size or shape, should be seen as soon as possible by a dermatologist or other physician.

Persistent Earache...Constant pain in or around the ear when you swallow can be a sign of infection or tumor growth in the throat. This is particularly serious if it is associated with difficulty in swallowing, hoarseness or a lump in the neck. These symptoms are best evaluated by an otolaryngologist.

Identifying High Risk of Head and Neck Cancer

As many as 90 percent of head and neck cancers arise after prolonged exposure to specific factors. Use of tobacco (cigarettes, cigars, chewing tobacco or snuff) and alcoholic beverages are closely linked with cancers of the mouth, throat, voice box and tongue. (In adults who neither smoke nor drink, cancer of the mouth and throat are nearly nonexistent.) Prolonged exposure to sunlight is linked with cancer of the lip and is also an established major cause of skin cancer.

What You Should Do

All of the symptoms and signs described here can occur with no cancer present. In fact, many times complaints of this type will be due to some other condition. But you can't tell without an examination. So, if they do occur, see your doctor-and be sure.

REMEMBER: When found early, most cancers in the head and neck can be cured with relatively little difficulty. Cure rates for these cancers could be greatly improved if people would seek medical advice as soon as possible. So play it safe. If you think you have one of the warning signs of head and neck cancer, see your doctor right away.

BE SAFE: See your doctor early! And practice health habits which will make these diseases unlikely to occur.

Audiology

The ability to hear and to interpret sound clearly and accurately is a source of great pleasure. The sounds of nature, music, the voices of friends and loved ones are all a part of the pleasure of living. Hearing is a principal tool for communicating with others, and if your hearing is normal you probably spend half your waking time just listening.

Hearing loss is one of the most common health problems in the United States. Unfortunately, more than 24 million Americans do not enjoy the full benefits of hearing in this world. Hearing difficulties are often unrecognized by the person involved. Children and teenagers seldom complain about the symptoms of hearing loss, and adults may lose their hearing so gradually that they do not realize it is happening.

The first step in treatment of a hearing problem after the medical evaluation is completed is an evaluation by an audiologist. An audiologist is the professional who specializes in evaluating and treating people with hearing loss. Audiologists have extensive training and skills to evaluate the hearing of adults, infants, and children of all ages. Audiologists conduct a wide variety of tests to determine the exact nature of an individual's hearing problem. Audiologists present a variety of treatment options to patients with hearing impairment. Audiologists dispense and fit hearing aids, administer tests of balance to evaluate dizziness, and provide hearing rehabilitation training.

How We Hear

The Structure of the Ear

The outer ear channels sound waves from the air around you inward through the ear canal. The ear canal terminates at a tightly stretched membrane, the eardrum, which is vibrated by the incoming sound waves.

Beyond the eardrum, in the middle ear chamber, are three tiny, linked bones called the middle ear or ossicles. The outer bone, the malleus (hammer), is attached to the eardrum. The inner bone, the stapes (stirrup), ends in a footplate which fits into the oval window, an opening in the wall of the bone which houses the inner ear. The center bone, the incus (anvil) connects the malleus and the stapes so that when one moves they all move.

The vibrations of the eardrum cause the bones in the middle ear to move back and forth like tiny levers. This lever action converts the large motions of the eardrum into the shorter, more forceful motions of the stapes. The movement of the stapes sets up motions in the fluid that fills the inner ear causing the hair cells immersed in the fluid to move. This movement stimulates the attached nerve cell to send a tiny impulse along the fibers of the auditory nerve to the brain where it is translated into the sensation we know as sound.

Sensori-Neural or Nerve Type Hearing Loss

A sensori-neural or nerve type hearing loss is caused by damage to the inner ear or the nerve of hearing which connects the inner ear with the brain. If the sound of words seems undiminished but you have trouble understanding what is being said, especially in a noisy environment, you may be suffering from a sensori-neural loss. You may be unable to hear high-pitched sounds such as the ticking of a watch, the dripping of a faucet, or the high notes of a violin. You may also hear a continuous "hissing" or "ringing" as a background to the real sounds in your environment. Words may have a rumbling, "fuzzy" quality, and you may think that people are mumbling or slurring their words.

Some of the more common causes of sensori-neural loss are:
* The aging process
* Exposure to high levels of noise
* Illnesses with high fever
* Drugs such as quinine, certain antibiotics, high dosages of aspirin, nicotine, alcohol.
* Childhood diseases such as measles, mumps, etc.
* Meniere's disease (caused by increased amounts of fluid in the inner ear).
* Vascular problems.
* Head injuries.
* Tumors.
* Metabolic disorders.
* Viral diseases.
* Birth defects.

Sensori-neural hearing losses are rarely treatable through surgery or medication. In many cases the only effective solution is a hearing aid. The process to determine this is called a hearing aid evaluation which can be arranged through your doctor or audiologist.

With or without a hearing aid, persons of both types of hearing loss can often benefit from special instruction in lipreading and learning to concentrate on the desired message while ignoring other competing sounds.

Conductive Hearing Loss

Conductive hearing loss occurs when either the outer ear, the eardrum, the middle ear, or the middle ear bones become diseased or injured. Your first warning of a conductive loss may be a subdued quality in the sounds you hear. Familiar sounds will not seem as loud as they once were, and less intense sounds may not attract your attention at all. The quality of sound may be about the same, but the loudness or intensity will be reduced. There are several possible causes for this type of hearing loss:
* The outer part of the ear or ear canal may be incomplete or partially blocked by a growth of bone.
* An accumulation of wax may be blocking the ear canal, preventing sound from entering.
* An infection of the skin tissues which line the canal walls can cause itching, rawness, swelling, and closure of the external ear canal (external otitis).
* The mastoid bone marrow and tissue may be infected (otitis Media).
* The eardrum may be ruptured.
* The middle ear bones may be disrupted, destroyed or immobilized.

Many of these conductive situations can be corrected either through surgery or through medical treatment .It is important to seek medical care whenever you notice hearing loss, ear pain, drainage from the ear, or a feeling of stuffiness Left untreated, many types of conductive hearing losses can progress and so immediate attention should be given to their care.

Hearing Aids

The benefits received from hearing aids can differ significantly from person to person. Your success will largely depend on your motivation and willingness to work at improving your hearing. Most people need an adjustment period--usually lasting from a few days to a few weeks--to experiment with various sound levels and various types of background noise before their amplified hearing becomes second nature. It is also common for your instruments to require minor adjustments from the laboratory when they are new. Experience has shown that with proper counseling and practice, most hearing losses can be successfully fit with hearing aids.

Recent advances in micro-technology have greatly improved the performance of today's hearing aids. New circuit options improve comfort and clarity in difficult listening situations and also allow the tailoring of instruments to match specific hearing needs.

Its no secret that today's hearing instruments look great! What's more impressive is that today's models also sound, feel and perform better than ever. The three types of hearing aid technologies available today are analog, programmable, and digital. Your audiologist can advise you which of the many models and/or circuit options would be best for your hearing needs.