601 West Highway 6, Suite 106 – Waco, TX 76710
Phone: 254-776-7744 Fax: 254-751-9206
What We Treat
Waco Ear, Nose & Throat is prepared to treat all of your otolaryngology needs, as well as providing audiology and speech pathology services.
Below is an in-depth look into what we treat and how we treat it. To begin, click on a title below to see what we treat related to that title.
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Acute & Chronic Sinusitis
Sinusitis is an inflammation of the sinus cavities, typically called a sinus infection. There are two types of sinusitis: acute and chronic. Acute, just like the name implies, lasts up to several weeks (but not longer than 3 months), whereas chronic is any sinus infection that lasts for longer than three months. If you have any type of facial pressure, colored mucus, or any congestion, you may have some form of sinusitis. Some patients with chronic sinusitis also have nasal polyps which chronically prevent the sinuses from draining. Other patients may have narrow drainage outflow tracts that predispose them to chronic or acute sinusitis. Medications are the main form of treatment for this condition. However, some home treatments, such as humidifiers and nasal irrigation, may help to alleviate sinus infection symptoms. The sinusitis experts at Waco Ear, Nose & Throat can assist in alleviating the symptoms of sinusitis.
Nasal congestion can occur when your nasal tissues become inflamed and enlarged. Alternatively, it can be due to the shape and structure of a patient’s nose. For instance, a deviated septum, inferior turbinate hypertrophy or enlarged adenoids can all cause nasal congestion or obstruction. Those with nasal congestion may feel “stuffy”, thus the common symptom called “stuffy nose”. Infections and even allergies can cause this condition. It is essential to determine if your symptoms are due to allergies, anatomy, or infection in order to determine the best course of treatment. However, home remedies, such as an over-the-counter antihistamine, nasal irrigations, or humidifier, may help relieve symptoms.
Deviated Nasal Septum
A deviated septum is when your nasal septum is deformed to one or both sides. These deformities can cause obstruction of the nostrils, nosebleeds, and interrupted sleep. The septum can be deviated due to nasal trauma, but often can be deviated due to no known injury (simply born that way). Many ENT doctors will recommend managing the symptoms with decongestants, antihistamines, or nasal steroid sprays. If these remedies do not alleviate the symptoms, sometimes surgery is warranted. This is typically referred to as a septoplasty.
Inferior Turbinate Hypertrophy
Inferior turbinate hypertrophy is when the inferior turbinate (directs airflow, moistens, heats, and filters air coming into the nasal cavity) are enlarged. This can be caused by allergies, chronic sinusitis, or any irritants, such as pollen or smoke. Often patients are simply born with large turbinates and it has no relationship to allergies. This can be treated with nasal steroids, antihistamines (if the patient has allergies), or surgery.
Septoplasty is a surgical procedure to straighten the septum. Surgery is only needed when breathing problems or snoring do not get better with non-surgical treatments. Sometime a septoplasty is needed when the patient needs sinus surgery. This is because a severely deviated septum may make it difficult to perform the sinus surgery.
This operation usually takes 60-90 minutes and most people have a quick recovery time.
Inferior Turbinate Reduction
Inferior turbinate reduction is a procedure to shrink the size of the inferior turbinate. There are numerous methods intended to treat turbinate hypertrophy; these methods are performed through the nostrils so that there’s no scarring. Such methods include directly cutting a portion off the bottom, removing bone from below, using electric devices (radio-frequency ablation) to remove tissue, fracturing the turbinate outward, or a combination of the aforementioned treatments. Typically we perform what is called a ‘submucosal inferior turbinate reduction” where a microdebrider is used to remove submucosal tissue and bone from the enlarged turbinate with minimal damage to the mucosa, or lining of the inferior turbinate.
Rhinitis is when the lining of your nasal cavity is inflamed, causing a runny/congested nose. Typically, rhinitis is caused by viruses, bacteria, or allergens; the most common being allergens. Depending on the type of rhinitis, the duration of symptoms can last anywhere from a few days to a few weeks. Avoiding triggers, such as dust mites, mold, and smoke can help prevent the onset of rhinitis. Rhinitis can also be caused by non allergic causes such as temperature changes. Some patients also can have gustatory rhinitis, where their nose will run when they eat or drink.
Post Nasal Drip
Post nasal drip occurs when excess mucus runs down the back of your nose to your throat. The excess mucus can be caused by having a cold, the flu, allergies, a sinus infection, changes in weather, or certain irritants. Post nasal drip is often not actually caused by the nose. Many patients actually have laryngopharyngeal reflux (LPR) that causes the throat to be more sensitive to normal, physiologic amounts of post nasal drip. The nose normally makes about a liter of mucous a day that is supposed to trickle down the throat without the patient being aware of the drainage. If you have LPR, then the patient’s throat can be overly sensitive and it feels like they have excessive postnasal drainage, when in fact they do not. Even though LPR is a type of reflux, patients often have this without the traditional signs of reflux (heartburn, indigestion, etc) which is why some people refer to it as “silent reflux”.
If you find yourself clearing your throat more often than normal, you may have post nasal drip, or you could have LPR. Medications, such as antihistamines and decongestants, using saline nasal sprays, and a humidifier can help alleviate your symptoms of postnasal drip, but will not help if you have LPR. If you have LPR, it is typically treated with dietary modifications as well as traditional reflux medications such as prilosec (omeprazole). An ENT doctor in Waco may also assist.
Sub Lingual Immunotherapy
Sub lingual immunotherapy is an alternative way to treat allergies without shots. The treatment itself requires the patient to be given a small dose of the allergen (substance that patient reacted to on allergy testing) under the tongue to boost immunity to the irritant. Patients who take the drops can do so in the convenience of their own homes instead of going to a doctor’s office.
In-Office Balloon Sinuplasty
In-office balloon sinuplasty is a procedure to treat sinusitis. The procedure itself opens up blocked sinus passages, improving drainage and restoring normal function. Those who suffer from chronic sinusitis (sinus infections), facial pressure, recurrent sinus infections, or decreased sense of smell, may benefit from this procedure. Recovery time is minimal – most patients return to work or school within a day or two. Waco Ear, Nose, and Throat offer balloon sinuplasty in their office.
Traditional Sinus Surgery
Traditional sinus surgery is used to treat chronic sinusitis by creating an opening into the sinus. Surgery is usually done if regular medications or home treatments have failed, and if in-office balloon sinuplasty is not an option or has failed.
Nasal polyps are growths that form in the nose or sinuses. Those with nasal polyps might experience a runny nose, loss of taste, a stuffy nose, postnasal drip, facial pain, and even itching around the eyes. They most commonly cause chronic sinusitis and this sinusitis will not resolve until the polyps are removed. Polyps typically develop as a reaction to nasal inflammation, either from chronic infection, allergies or other irritants. Polyps will recur but the recurrence is less likely if the patient stays on nasal steroids postoperatively. In patients with known allergies, immunotherapy (sublingual or traditional allergy shots) also help prevent polyp regrowth. Patients with nasal polyps often require a second or even third sinus surgery years later after the polyps have regrown and begun blocking the sinuses again.
Visit your Waco ENT doctor for treatment.
Nasal masses are abnormal growths inside the nose and nasal cavity; they come in two forms: benign and malignant. However, most nasal masses are benign. Those with a nasal mass may experience frequent nasal drainage, nosebleeds, headaches, nasal congestion, and numbness or swelling in the face. Surgery is the most common treatment for these masses.
Inverted papillomas are nasal tumors that begin in the mucous membrane of the nasal cavity and sinuses. Those with inverted papillomas may experience a runny nose, nasal obstruction, reoccurring sinus infections, headaches, and even nosebleeds. Treatment includes surgery to remove the inverted papilloma.
Complicated Epistaxis (Nosebleeds)
Complicated epistaxis is commonly referred to as a nosebleed. Nosebleeds happen when a blood vessel bursts within the nose. There are two types of nosebleeds – anterior and posterior. Anterior nosebleeds are the most common and usually happen after a blood vessel bursts on the nasal septum. Posterior nosebleeds are less common, as they happen after an artery bursts in the back part of the nose; this usually requires a referral to an ENT specialist to get managed. Most nosebleeds occur during the winter months and can be treated at home with proper care.
Treatment of Foreign Bodies in Nose
Foreign bodies can be categorized as inorganic or organic. Inorganic materials typically include plastic or metal objects, whereas organic materials refer to food, rubber, wood, and sponge. Those with a foreign body in their nose may experience nasal discharge, difficulty breathing through the nose, and pain. Treatment includes blowing the nose and if that fails, having your health care provider remove the foreign body. If left untreated, the foreign body could cause a nose infection, sinus infection, nose bleed, or ear infection.
Nasal trauma occurs after an injury to your nose and the surrounding area. Such trauma includes nosebleeds, fractures, chemical irritation, or obstruction by a foreign object. Those with nasal trauma may experience pain in the nose, swelling of the face, loss of sense of smell, disfiguration of the nose, or trouble breathing through the nose. Many times the cause of nasal trauma is due to sports injuries, falls, auto accidents, or physical assault. Treatment depends on the severity of the trauma. For minor trauma, at home care, such as an ice pack or painkillers, is recommended. For more severe trauma, surgery may be necessary.
Adenoidectomy is the surgical removal of the adenoids. This surgery is performed when a patient experiences chronic ear infections or if they block breathing through the nose. The surgery itself involves removing the adenoids through the mouth using a tool that uses heat to remove the tissue. Recovery time is usually a couple of days and typically only requires Tylenol or ibuprofen for pain control.
Ankyloglossia (Tongue Tie, typically in infants)
Ankyloglossia, also known as tongue tie, occurs when they tongue’s range of motion is restricted. Usually present at birth, tongue tie can affect the way a child breastfeeds, typically causing more pain to the mother and less milk for the infant. It is very unusual for it to cause speech problems. Although tongue tie may resolve on its own, surgical treatment (frenotomy or frenuloplasty) may be required to correct the problem.
Dysphagia (Difficulty Swallowing)
Dysphagia occurs when you have a difficult time swallowing. Many symptoms include drooling, choking when eating, regurgitation, recurrent heartburn, unexplained weight loss, etc. The cause of dysphagia varies. It is often due to physical malformations, GERD, tumors, stroke, caffeine intake, poor dietary habits, and neuromuscular conditions. Tools often used to diagnose this include modified barium swallow as well as flexible laryngoscopy. Treatments depend on the cause of the swallowing problem. Treatments can includes different medicines, speech therapy (really swallowing therapy), and surgery. The type of surgery depends on the cause of the swallowing problem.
Enlarged Tonsils and Adenoids
Tonsils and adenoids are part of the immune system and are basically lymph nodes that line the throat. Tonsils can be enlarged for a number of reasons. Some patients are simply born with large tonsils and adenoids. Alternatively they can become enlarged due to infection, either viral or bacterial. That being said, just because a tonsil is small, does not mean that it isn’t infected.
Enlarged adenoids can cause problems with chronic rhinitis, sinusitis, nasal obstruction, chronic ear infections and eustachian tube dysfunction. Enlarged tonsils and adenoids can cause obstructive sleep apnea.
Enlarged tonsils or adenoids that are not causing problems with infection or obstructive sleep apnea need no treatment. If patient is having enough strep throats or pharyngitis to meet criteria for surgery should have the tonsils and adenoids removed. If the child or patient only has nasal symptoms, typically would only remove the adenoids. Adenoids typically regress/shrink as a child turns into an adult. Because of this, it is fairly rare that an adult requires an adenoidectomy.
Evaluation of Chronic Cough, Throat Clearing
Evaluation of a chronic cough in adults begins with knowing a patient’s history and completing a thorough physical exam. If the patient is a non-smoker and has not been exposed to any known irritants, then a chest radiograph should be performed. An abnormal chest radiograph will show conditions such as bronchiectasis. However, a normal chest radiograph will not show conditions such as post nasal drip, asthma, or LPR.
Flexible laryngoscopy is a thin, flexible tube that allows your health care provider to inspect the nose, throat, and larynx for any abnormalities. With a flexible laryngoscopy, the doctor inserts the scope through one nostril to closely inspect your nose, throat, and larynx. The procedure itself takes less than 10 minutes.
Hoarseness is a change in voice, typically low in volume and raspy. The cause of hoarseness can be a wide variety of things, although inflammation of the vocal cords caused by an upper respiratory infection is the most common. Other causes include – allergies, smoking, cancer of the larynx, laryngopharyngeal reflux, benign vocal cord nodules, inhalation of irritants, poor vocal hygiene etc. Resting your vocal cords, cough suppressants, and humidifiers can sometimes help relieve hoarseness.
Hoarseness is also sometimes caused by vocal cord paralysis. This can be caused by a complication from thyroid, carotid or anterior spine surgery. It can also be caused by cancer along the path of the nerve that goes to the vocal cords. Because the nerve travels from the skull base into the lungs and then turns back to head up to the vocal cords, lung cancer can also cause hoarseness. Also sometimes patients develop a paralyzed vocal cord for no identifiable reason, much like some patients develop facial paralyisis for no identifiable reason (Bells Palsy).
Hoarseness can also be caused by vocal cord atrophy (thinning of the vocal cords) often seen as a result of aging, or as a result of neurological conditions such as parkinson’s disease.
However, if continued hoarseness persists, seeing your health care provider is recommended.
Laryngopharyngeal reflux (LPR), also known as silent reflux, results from the stomach backing up. In children, symptoms include hoarseness, trouble gaining weight, trouble feeding, chronic cough, etc. However, in adults, symptoms include complaints of frequent postnasal drainage, frequent throat clearing, trouble swallowing, hoarseness and feeling like something is stuck in their throat. Occasionally patients complain of a sore throat. While some patients may have some traditional heartburn symptoms (heartburn, belching, indigestion etc.), most patients with LPR do not have these symptoms. Treatment usually include dietary modfications such as avoiding big meals right before going to bedtime, limiting caffeine intake, limiting chocolate intake, avoiding spicy foods, avoiding carbonated beverages, etc. Alcohol also can exacerbate this as well. Also typically treat this with proton pump inhibitors (PPI)such as prilosec, prevacid, nexium, etc. Can treat with H2 blockers such as pepcid or zantac, however they typically are not as effective as PPI are. Patients typically have to take PPI or H2 blockers for 3-4 weeks before they notice improvement.
Obstructive Sleep Apnea
Obstructive sleep apnea occurs when something blocks your upper airway during sleep. Symptoms include restlessness during sleep, snoring, night sweats, fatigue during the day, sore throat when you wake up, headaches etc. In children it can result in behavioral problems, fatigue, bed wetting, headaches (especially in morning). Obstructive sleep apnea is more common in men than women. However, being overweight can put you at more risk. In adults, untreated sleep apnea is thought to cause or increase the risk of developing diabetes, hypertension, elevated cholesteral, heart disease, and stroke. Treatment includes avoiding alcohol and sleeping pills, nasal sprays, CPAP machine, maintaining a healthy weight, and surgery.
Removal of Foreign Bodies from Throat
Removal of foreign bodies from the throat often need to be removed endoscopically. Typically, these foreign bodies are plastic, metal, coins, nuts, etc. These particular foreign bodies can cause complete airway obstruction, choking and aspiration.
Salivary Gland Disease (Parotitis, Salivary Gland Stones)
Salivary gland disease occurs when the salivary glands can’t function properly or the ducts are blocked to where they can’t drain saliva. Sometimes the salivary gland gets blocked by salivary gland stones, but sometimes it occurs simply due to decreased salivary flow. Salivary gland stones are buildups of crystallized saliva deposits. Another cause is parotitis, which is an infection of the largest salivary gland. Treatment depends on the severity of the condition. The goal of treatment is to increase saliva flow to help flush out the salivary gland duct. To this end, patients are encouraged to increase fluid intake. They are also encouraged to suck on sour candies or lemon wedges which stimulates the gland to produce more saliva. Also the patient can milk the gland/massage the gland to try and express more saliva out of the gland. If these don’t work, treatment with an oral (or in severe cases intravenous) antibiotic is needed. Even in the case when antibiotics re needed, it is still important to increase fluid intake, suck on sour candies and milk the gland. Sometimes hot compresses help as well. Rarely do patients fail to respond to this regimen, but if that happens, then surgery may be required.
Thyroglossal Duct Cysts
Thyroglossal duct cysts occurs when a pocket in the front part of the neck is filled with fluid. Typically found when an upper respiratory infection is present, these cysts were formed from leftover tissue of the thyroid gland. Symptoms include a soft round lump on the front of the neck, tenderness, and difficulty swallowing. Many times, antibiotic medicine clears up the infection and the cyst will decrease in size or pain will decrease but the cyst will not resolve or go away without surgical intervention.
Tonsillectomy is the surgical removal of the tonsils. This surgery is performed when a patient has reoccurring tonsillitis, complications of enlarged tonsils, or other diseases of the tonsils. The surgery itself involves either using a scalpel to cut out the tonsils or using a tool that uses heat to remove the tissue. Recovery time takes several days and includes taking pain medications, drinking plenty of fluids, eating soft foods, and avoiding vigorous activity.
Tracheal Stenosis, Tracheal Dilations
Tracheal stenosis occurs when the trachea is narrowed. There are two types of tracheal stenosis – acquired and congenital. Acquired tracheal stenosis can occurs from an injury such as irritation from a breathing tube or injury from external factors (inhalation of irritants). Alternatively it can occur without any identifiable cause. This is often referred to as idiopathic (medical jargon for we don’t know why). Congenital tracheal stenosis occurs from a birth defects such as complete tracheal rings or other congenital abnormalities.
Video stroboscopy is used to examine the vocal cords by placing a viewing scope with a tiny camera through the nose and into the throat. A physician uses this method to detect any abnormalities of the larynx, such as swelling, scar tissue, polyps, or irritations. It is similar to Flexible Laryngoscopy, but also utilizes a strobe light that allows for more detailed evaluation of the motion of the vocal cords. The exam itself takes less than 15 minutes and patients are able to resume normal activities afterwards.
Vocal Cord Atrophy
Vocal cord atrophy occurs when the vocal muscles are thinned out. The cause of vocal cord atrophy varies, but the most common is age. However, nerve injuries such as tumors, viruses, and trauma can result in the thinning of these muscles as well. Vocal fatigue, decreased vocal range, breathy voice, and the inability to hold a note can indicate vocal cord atrophy. Treatment can involve either surgery or voice therapy depending on the cause.
Vocal Cord Nodules
Vocal cord nodules are growths on the vocal cords. These growths are benign and are caused from vocal abuse (strain or injury to the cords). The cause of these nodules includes excessive talking, coughing, inhaling irritants, smoking, screaming, etc. Many of the symptoms include hoarseness, a decrease in the volume of your voice, and slightly breathy. The treatment for vocal cord nodules can be either voice therapy and in some cases, surgery.
Vocal Cord Medialization Procedures
Vocal cord medialization procedures include restoring function to the larynx by moving the vocal folds to the middle. There are two types of procedures – injection and implant. Injection involves injecting a filler material lateral to the the vocal fold which pushes the vocal cord closer together. The material is usually injected through the mouth under anesthesia. Implantation involves placing an implant through an external incision to move the vocal fold into the proper place. After the procedure, you will notice a difference in your voice.
Vocal Cord Spasms
Vocal cord spasms happen when the flow of air is limited through the larynx; this makes it difficult to breath or speak. The cause of the spasms is often not known, but conditions such as laryngopharyngeal reflux, and stress can contribute to these spasms. Certain breathing techniques may relieve symptoms and prevent future spasms. Some neurological causes, such as spasmodic dysphonia can be treated by injections of botox around the nerves that control the larynx.
Base of Tongue Cancer
What is it?
Cancer of the base of the tongue (back side of tongue that is difficult to see when you look in the mouth).
Lump or sore that doesn’t go away, pain in your tongue, trouble swallowing, bad breath, ear pain, difficulty breathing (in advanced cases), ear pain, pain with swallowing.
Surgery, radiation therapy, and chemotherapy.
Evaluation of cervical lymphadenopathy and neck masses
Evaluation of cervical lymphadenopathy and neck masses begins with the medical history of the patient and a physical exam. Often further workup can include CT scan of the neck, ultrasound of the neck or thyroid, lab work, or fine needle biopsy. If diagnosis is still unknown, may require an excisional lymphnode biopsy.
FNA (Fine Needle Aspiration) of Neck Masses
Fine needle aspiration (FNA) of neck masses is a biopsy procedure. This type of procedure is typically performed when cancer is a possible diagnosis. The procedure itself involved a thin needle attached to a syringe which is then inserted into the skin; the FNA takes less than 10 minutes. After the procedure, patients may find the biopsy site to be swollen or painful. There are usually no complications with this procedure, but minor bleeding, bruising and infection can occur in rare cases.
Hemiglossectomy is a procedure to remove part of the tongue and the adjacent tissues. It is mainly performed when a cancerous mass is found on the tongue. Risks of the surgery include infection, possible bleeding of the tongue, difficulty swallowing, recurrance of the cancer, and difficulty talking. Recovery time is a few weeks and involves good oral hygiene, a soft foods diet, speech therapy, and rest.
What is it?
Cancer of the larynx (“voice box”)
Difficulty swallowing, persistent cough, sore throat, earaches, persistent hoarseness, breathy voice, lump in neck, difficulty breathing, ear pain, bad breath etc.
Surgery, radiation therapy, and chemotherapy.
Neck dissections are a surgical procedure in which lymphatic tissue (lymph nodes) of the neck are removed. In most cases, neck dissections are performed to remove malignant (cancerous) masses. Risks of the surgery include damage to the nerves, muscles, and veins in the neck, possible bleeding, and infection.
Oral Cavity Cancer
What is it?
Cancer of the oral cavity, including the mouth, tongue, and lips.
White or red patches in the mouth, mass or ulcer in mouth, a lump in your neck, pain with swallowing, earaches, bad breath.
Surgery, radiation therapy, and chemotherapy.
What is it?
Cancer of the oropharynx, including the soft palate, tonsils, and back end of tongue.
Ulcer, mass in tonsil, throat, uvula or base of tongue, Lump in the neck and sore throat, difficulty swallowing, difficulty breathing (in advanced cases), ear pain, bad breath.
Surgery, radiation therapy, chemotherapy, or combination of the above.
Parotid Gland Masses
Parotid gland masses are masses in the parotid gland (largest salivary glands). Symptoms of parotid gland masses typically include painless lump in the parotid gland. Sometimes the lump can be painful but typically not. It can sometimes cause difficulty opening and closing the mouth if it is a deep tumor. If patient also has facial paralysis on the same side, this significantly increases the likelihood that the tumor is cancerous. Typically, an FNA (fine needle aspiration) is performed to determine whether or not the mass is cancerous or not. Not all parotid tumors are cancer. Treatment depends on whether or not the lesion is benign or malignant (cancer). Typically treatment includes surgical excision of the mass (parotidectomy). If it is cancerous, then typically will also perform a neck dissection, where the lymph nodes where the cancer is likely to have spread are removed as well. Sometimes after the patient recovers from surgery, they will undergo radiation therapy depending on the type of cancer.
Post Laryngectomy Speech Prosthesis Placement (TEP)
Post laryngectomy speech prosthesis placement is a device (tracheoesophageal voice prosthesis) that allows air to be sent from the lungs into the esophagus and through the mouth. It is used to allow patients who have had their larynx (voice box) removed to talk. As the air passes from the esophagus to the mouth, a vibration of the tissues is produced, resulting in sound. The device itself is not permanent and voice restoration occurs within 2 weeks post-op but typically requires significant amount of speech therapy and practice to master.
Skin Cancer Excision and Reconstruction
Skin cancer excision involves removing the cancerous tissue or growth from the skin. Once the cancer has been extracted, the doctor will reconstruct the skin by either a skin graft (piece of skin from another area of the body) or a flap (adjacent healthy tissue). With any procedure, there are risks. Such risks include bleeding, infection, recurrence of skin cancer, change in skin sensation, and damage to deeper structures (nerves and muscles). Also there is always risk that the cancer will recur.
Submandibular Gland Masses
Submandibular gland masses are masses that are a part of the major salivary glands. More than half off all tumors that arise in the submandibular gland are found to be cancerous. Treatment includes surgery to remove the gland as well as regional lymph nodes associated with the gland.
What is it?
Cancer that begins in the tissues above the vocal cords.
Difficulty swallowing, persistent cough, sore throat, earaches, persistent hoarseness, breathy voice, lump in neck, difficulty breathing, ear pain, bad breath etc.
Surgery, radiation therapy, and chemotherapy.
What is it?
Cancer of the tongue, including in the mouth and in the throat.
Mass or ulcer on tongue, pain on tongue, difficulty talking, swallowing, Cough, sore throat, lump in neck, bad breath, ear pain
Surgery, radiation therapy, chemotherapy, or combination of the above.
What is it?
Cancer of the tonsils.
Difficulty swallowing and the feeling of something stuck in your throat, mass or ulcer on one of the tonsils, tonsil assymetry (one tonsil significantly larger than the other), bad breath, weight loss, ear pain, throat pain.
Surgery, radiation therapy, and chemotherapy.
Total laryngectomy is a procedure for patients with advanced stage laryngeal cancer or supraglottic cancer. The surgery itself removes the whole larynx. Risks include breathing problems, bleeding, infection, fistulas, problems swallowing, damage to other parts of the trachea and recurrence of the cancer. Patients typically spend at least a week in the hospital with tube feedings, speech therapy, and light activity for 6 weeks.
Thyroid cancer is cancer that begins in the thyroid gland. Symptoms typically include a painless lump in the neck. Less frequent symptoms can include difficulty swallowing, persistent cough, and hoarseness. Risk factors for thyroid cancer include strong family history as well as history of exposure to radiation (either from radiation therapy for other cancers, or occupational exposure). Initial treatment of this cancer includes surgery to remove the thyroid, followed by radioactive iodine. Postoperatively patients will require thyroid hormone replacement.
A thyroid goiter is abnormal enlargement of the thyroid gland. A goiter is typically present with both hyperthyroidism and hypothyroidism. Symptoms include coughing, difficulty breathing (rare) and swallowing, visible swelling at the base of the neck, etc. Risk factors include an iodine deficiency, Grave’s disease, Hashimoto’s disease, pregnancy, and thyroiditis.
Thyroid Nodules are lumps filled with fluid that form in your thyroid. Most nodules are asymptomatic, however large nodules can compress the trachea which can cause some shortness of breath. Treatment depends on the size of the nodules, the appearance on ultrasound, as well as family history. Small nodules can be observed with yearly repeat thyroid ultrasounds. In nodules larger than 1 cm, often an ultrasound guided FNA can be performed to determine the nature of the nodule.
Ultrasound Guided FNA of Thyroid Nodules
Ultrasound guided FNA of thyroid nodules are performed when a nodule cannot be felt or if the nodule is cystic and correct placement of the needle is important to obtain a sample of the solid, not cystic component. An ultrasound is used to guide the needle to the abnormal nodule.
Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV) is a condition that results in brief room spinning vertigo that mainly happens when the patient is lying down. Patients notice dizziness worsens when they roll over to one direction, but typically don’t have the symptoms if they roll the other way. The room spinning typically lasts for less than a minute, but the patient can be profoundly off balance the rest of the day (not always present). BPPV is NOT usually associated with any ear pain, ear pressure, tinnitus, or hearing loss. Typically BPPV is treated with a procedure called an Epley procedure. If this fails to work, patient typically can benefit from vestibular rehabilitation.
Bone Anchored Hearing Aids
Bone anchored hearing aids are titanium implants that are placed in the skull behind the ear. They contain an external sound processor and after a few months, they fuse together with the bone. Patients with conductive hearing loss benefit the most from this device, however it can also be used to treat single sided deafness. The procedure itself can present some risks such as failure of osseointegration, infection, bleeding, persistent pain, etc. The procedure itself is minimally invasive and requires the drilling of a hole to mount the device. The device works by vibrating the implant that then conducts the sound through the bone to the middle ear.
Evaluation and Management of Hearing Loss as a Cause for Speech Delay
Children often have speech delay for a variety of reasons. Before undergoing speech therapy, it is best to have the child’s hearing checked. Often patients with speech delay have some form of hearing loss, and if this can be corrected, often the speech delay resolves. Most children are tested for their hearing when they are a few days old. Even if they pass that hearing screening, they can develop hearing loss later in childhood and repeat testing is warrented in the case of children with speech delay. Often the child has a persistent middle ear fluid that is causing a conductive hearing loss. If this is found, placing tubes helps the fluid drain out and resolves the conductive hearing loss. If the hearing test comes back normal, then the speech delay is not related to hearing loss and the child should then proceed to being evaluated by a Speech-Language Pathologist.
Hearing Loss – Sensorineural
Sensorineural hearing loss involves damage to the inner ear, consisting of the cochlea (hearing organ), the auditory nerve, or the auditory centers of the brain. Sensorineural hearing loss can occur from exposure to loud noise, age related hearing loss, sudden sensorineural hearing loss, labyrinthitis, meneire’s disease, viral infections, acoustic neuroma’s, head trauma, as well as drugs known to damage the inner ear, etc. Typically sensorineural hearing loss is not reversible. The typical treatment for sensorineural hearing loss is hearing aids. If the hearing loss is severe enough that hearing aids are no longer helpful, the patient may benefit from a cochlear implant. This is an electrode that is surgically placed into the cochlea and electrically stimulates the cochlea to generate sound.
As a patient diagnosed with sensorineural hearing loss, you will likely visit the Physicians Hearing Center adjacent to Waco ENT.
Hearing Loss – Conductive
Conductive hearing loss is where something is blocking the conduction of sound from the environment to the inner ear. This can be caused by wax impactions, outer or middle ear infections, holes in the ear drum, congenital abnormalities to the outer ear, ear canal or middle ear, or abnormalities to the hearing bones. Typically conductive hearing loss is reversible by removing whatever is preventing sound from conducting to the inner ear.
Labyrinthitis is thought to be due to an inner ear virus. On physical exam, the ear looks normal, as the infection involves the inner ear which is not visible on exam. Typically the patient has profound room spinning vertigo that can last longer than Meniere’s attacks, often lasting for more than a day. It usually only affects one ear and presents with ear pain, pressure, hearing loss, tinnitus in addition to the vertigo. Even after the room spinning ceases, often the patient can be profoundly off balance for weeks. Unlike Meniere’s, patients typically only have one attack of this. Sometimes the patient’s hearing loss (sensorineural hearing loss) returns after the attack, but often it does not. Some reasarch suggests that treatment with steroids, if done within the first couple of weeks, can sometimes increase the chance of the hearing returning. When severe, the symptoms of spinnig can be treated with vestibular suppressants such as meclizine and valium. Patients may require vestibular rehabilitation afterwards to help with feeling off balance.
Mastoiditis is an infection of the mastoid bone. This condition can affect children as well as adults. Symptoms include fever, swelling of the area behind the ear, drainage of the ear, and tenderness behind the ear. The main cause of this condition can be linked to a middle ear infection. Treatment includes antibiotics (oral, or in severe cases intravenous), myringotomy and tube placement, or a mastoidectomy. A mastoidectomy is where the mastoid (boney area behind the ear), is opened up so that the infection can drain out.
Meniere’s Disease is a condition where the inner ear periodically “short circuits”. Patients with Meniere’s disease typically have repeated attacks of room spinning vertigo that is associated with ear pain, ear presssure, hearing loss and tinnitus in one ear. It is possible to have Meniere’s involving both ears, but typically it starts out only affecting one side. The room spinning can be severe and even cause “drop attacks” where the patient falls to the ground suddenly. The room spinning typically lasts no more than 4-8 hours, but they can be off balance for a few days after the attack. The hearing loss, ear pain, pressure and tinnitus typically resolve as the vertigo resolves, however, after each attack the patient usually loses some hearing permantly (sensorineural hearing loss). Eventually over years of attacks, patients with Meniere’s disease will lose all the hearing in the affected ear. It has been shown that salt intake can trigger Meniere’s attacks in patients. Because of this, patients with Meniere’s are typically treated with low salt diets and diuretics. Some recent research has shown some benefit from transtympanic (injecting through the eardrum) steroid injections for patients with Meniere’s disease. These interventions do not cure the disease, but often decrease the severity and/or frequency of the attacks. If these interventions fail, there are some surgical procedures that can be performed.
Myringoplasty is a procedure that repairs a hole in the eardrum. Most of the time, the hole in the eardrum heals without any treatment. However, in certain cases, surgery may be required. The procedure itself takes anywhere from 10 to 30 minutes.
Myringotomy and Tympanostomy Tube Placement
Myringotomy is a procedure where the doctor creates an incision in the eardrum. The procedure itself allows for a plastic tube (tympanostomy tube) to be inserted, thus helping prevent recurrent ear infections. Risks of the surgery include persistent infection, ear drainage, failure to prevent ear infections, scarring of the eardrum, and hearing loss. Rarely, when the tube falls out (usually occurs after 12-18 months) the hole in the eardrum fails to close, leaving the patient with a perforated eardrum. When this occurs, the patient has to keep water out of the ear and they may require a surgery to close the perforation. After a patient has tubes placed, typically they are treated with antibiotic ear drops for 5-7 days.
Otalgia is a pain in the ear. The cause of otalgia includes ear infections (both middle and outer ear infections), trauma to the ear, TMJ, referred pain from the throat or teeth. Treatment depends on the cause for the pain. If the patient has an ear infection, antibiotics and pain medications can relieve symptoms. If the pain is referred from teeth or TMJ, antibiotics typically do not have a role in treatment. If ear infections fail to resolve with antibiotics, or recur often, patient may benefit from having tubes placed.
Otitis externa is another name for swimmer’s ear. It’s an infection of the outer ear canal and external ear. Symptoms include itchy ears, redness, pain that occurs when you tug on your ear, drainage, muffled hearing, etc. Most commonly seen after swimming or exposure to water, however it can also occur without exposure to water. Risk factors include diabetes, moisture in the ear, using a hearing aid, and use of q-tips, etc. Treatment typically involves topical antibiotic ear drops (significantly stronger than oral antibiotics), and pain medications. Sometimes if ear canal is obstructed by pus or infected cerumen, having the ear cleaned out will help clear the infection. Patient should keep water out of the infected ear as this can prolong the infection.
Otitis media is another name for a middle ear infection. Symptoms include fever, earache, hearing loss, and pressure in the ear. It is more often seen in childhood, but can be seen in adults as well. It can be triggered by colds, allergies, sinus infections or other upper respiratory infections. One of the main risk factors for middle ear infections is exposure to second hand smoke. Some ear infections will resolve without antibiotics, and if symptoms are not severe, it is acceptable to simply observe for a while before starting on an antibiotic. Treatment includes antibiotics and if they are recurring, your doctor may suggest ear tubes.
Removal of Foreign Bodies from Ears
Removal of foreign bodies from the ears include beads, plastic toys, pebbles, popcorn kernels, etc. Sometimes, children don’t know they have an object in their ear. However, most adults will experience symptoms of pain, hearing loss, and pressure in the ear. There are many ways to remove a foreign body from the ear – water irrigation, forceps removal, cerumen loops, and suction catheters.
Sudden Sensorineural Hearing Loss
Sudden sensorineural hearing loss occurs when you lose your hearing without any notice. It is thought to be due to an inner ear virus that causes sudden drop in a patient’s hearing for no other identifiable cause. The symptoms include hearing loss and tinnitus, muffled sounds, etc. Without treatment, some patients hearing returns completely, some patients get partial return of their heairng, and some patients fail to get any improvement in their hearing. If this is detected within two weeks of onset, treatment with high dose corticosteroids increases the likelihood of return of a patient’s hearing. Treatment with steroids outside of this two week window has not been shown to help. Some research has shown benefit with transtympanic steroid injections as well.
Tympanic Membrane Perforations
Tympanic membrane (TM) perforations occur when there is a hole in the ear drum. These perforations can be from infections, injury, and certain surgeries. When the eardrum ruptures, it can cause pain, but otherwise TM perforations are painless. Other symptoms include hearing loss, muffled hearing, and ringing in the ear. If a middle ear infection is present, the patient will have drainage as the infection is draining through the perforation into the ear canal. If a patient with a TM perforation gets water in their ear, the water will cross the perforation into the middle ear, which then can cause a middle ear infection. For this reason, patients with TM perforations should keep water out of the affected ear. Most acute TM perforations will heal spontaneously on their own without the need for surgical intervention. If the perforation has not healed after 6 weeks, then it likely will not heal on its own. TM perforations can be closed surgically by performing a myringoplasty or tympanoplasty. A myringoplasty is less invasive and often can be done in the office (on adults), while a tympanoplasty is a little more invasive. When to do a myringoplasty versus a tympanoplasty depends on a variety of factors. An untreated TM perforation can cause hearing loss and potentially make the patient more prone to middle ear infections (from water exposure).
Tympanoplasty is a procedure that repairs the tympanic membrane. The surgery itself requires an incision to be made into the ear canal or behind the ear and the eardrum is then moved away from the bony ear canal and lifted up. The purpose of Tympanoplasty is to restore the patient’s hearing and function.
Your vestibular system helps you keep your balance. Many disorders associated with this disease include benign paroxysmal positional vertigo, labyrinthitis (inner ear infection), vestibular neuritis (viral inner ear infection), and Meniere’s disease.
Vestibular neuronitis is very similar to Labyrinthitis, with the exception that these patients typically do not have the hearing loss that patients with labyrinthitis have. Otherwise symptoms and treatment are similar to labyrinthitis. Again, this is thought to be caused by an inner ear virus.
Post Laryngectomy Speech Training with TEP Prosthesis
Following the laryngectomy surgery, patients should meet with a speech pathologist to begin their speech rehabilitation. During the first part of the training, patients are encouraged to speak using the synthetic larynx. Then, they are introduced to breathing techniques, such as how to push air from the trachea into the esophagus via the TEP. The final part includes learning how to clean, take out, and reinsert the TEP prosthesis, as well as learning to speak with an almost normal voice.
Speech Therapy for Vocal Cord Nodules
Speech therapy for vocal cord nodules involves teaching good vocal hygiene, reducing vocal abusive behaviors (yelling, whispering, vocal overuse, etc), and treatment to alter pitch. Speech therapy is typically recommended before surgery. If patients have the vocal cord nodules removed before they correct their bad habits, the nodules will likely recur soon after surgery. Many times, a speech therapist will customize a treatment plan around the patient’s issues, including recognizing and stopping harmful voice techniques.
Swallow Therapy for Dysphagia from Multitude of Etiologies
Swallow therapy for dysphagia includes exercises to help improve, strengthen, and coordinate muscles and nerves involved in swallowing. Such exercises include the shaker exercise, hyoid life maneuver, effortful swallow, and supraglottic swallow. Many of the exercises do not require food to swallow, but instead, help you exert control over your swallowing muscles without using your hands.
Treatment of Vocal Cord motion abnormalities.
Patients can have a variety of vocal cord motion abnormalities. These include laryngospasms, spasmodic dysphonia as well as muscle tension dysphonia.
- Vocal cord spasms, also referred to as laryngospasm, occurs when the vocal cords suddenly close when you take a breath. This causes a person to be unable to speak or breath for a brief moment. Triggers can include allergies, irritants in the environment, anxiety, and LPR. Treatment of this condition may include treatment for LPR. However, there are some measures a person can take to prevent future vocal cord spasms, including avoiding heartburn triggers, limiting alcohol intake and avoiding smoke, breathing techniques, and propping yourself up at night.
- Spasmodic dysphonia is a neurological condition that causes the vocal cords to move erratically when a patient is trying to talk. This can lead to patients voices having a broken/interrupted sound. The treatment for this condition typically involves injections of botox into the muscles involved in phonation. Unfortunately the botox only lasts for about 3 months, so patients frequently have to receive injections 3-4 times per year. Speech therapy also helps some with this, but botox is the primary method of treatment.
- Muscle tension dysphonia is a common cause of voice problems. It is abnormal patterns of muscle activation and movement. It is referred to by many names, including muscle misuse dysphonia, vocal hyperfunction, or muscle tension dysphonia (MTD). It can be worsened by irritants such as smoke, laryngopharyngeal reflux, as well as stress. It is typically treated by trying to eliminate triggers such as LPR and other irritants, but also speech therapy is essential in helping treat patients with muscle tension dysphonia.
Vocal hygiene refers to taking care of your voice. In order to prevent voice problems, you should – avoid smoking, drink plenty of fluids, control your vocal loudness, humidify your room, and attend voice therapy sessions to improve your voice.
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