At the Ear Nose and Throat Clinic, we offer a variety of special services on-site, such as CT scanning and videostroboscopy, for the convenience and better care of our patients. In most cases, we are able to perform these diagnostic tests immediately, which saves our patients the time and hassle of an additional appointment at a separate location. This technology also allows us to arrive at a diagnosis and begin treatment more quickly.
If you are in need of an ENT specialist, we encourage you to request a consultation or call (907) 456-7768 to meet with one of the physicians at Ear, Nose and Throat.
We treat the following conditions:
Millions of Americans suffer from nasal allergies, commonly known as hay fever. Often fragrant flowers are blamed for the uncomfortable symptoms, yet they are rarely the cause; their pollens are too heavy to be airborne. An ear, nose, and throat specialist can help determine the substances causing your discomfort and develop a management plan that will help make life more enjoyable.
At The Ear, Nose & Throat Clinic we only test for alder, aspen, birch, cottonwood, poplar, spruce, and willow. We do not test for chemicals, drugs and penicillin. A blood test is required for these types of allergy testing.
Why does the body develop allergies?
Allergy symptoms appear when the immune system reacts to an allergic substance that has entered the body as though it were an unwelcome invader. The immune system will produce special antibodies capable of recognizing the same allergic substance if it enters the body at a later time.
When an allergen reenters the body, the immune system rapidly recognizes it, causing a series of reactions. These reactions often involve tissue destruction, blood vessel dilation, and production of many inflammatory substances, including histamine. Histamine produces common allergy symptoms such as itchy, watery eyes, nasal and sinus congestion, headaches, sneezing, scratchy throat, hives, shortness of breath, etc. Other less common symptoms are balance disturbances, skin irritations such as eczema, and even respiratory problems like asthma.
What are common allergens?
Many common substances can be allergens. Pollens, food, mold, dust, feathers, animal dander, chemicals, drugs such as penicillin, and environmental pollutants commonly cause many to suffer allergic reactions.
One of the most significant causes of allergic rhinitis in the United States is ragweed. It begins pollinating in late August in most of the U.S. and continues until the first frost. Late springtime pollens come from grasses like timothy, orchard, red top, sweet vernal, Bermuda, Johnson, and some bluegrasses. Early springtime hay fever is most often caused by pollens of trees such as elm, maple, birch, poplar, beech, ash, oak, walnut, sycamore, cypress, hickory, pecan, cottonwood, and alder. Flowering plants rarely cause allergy symptoms.
Certain allergens are present all year long. These include house dust, pet danders, and some foods and chemicals. Symptoms caused by these allergens often worsen in the winter when the house is closed up, due to poor ventilation.
Mold spores also cause allergy problems. Molds are present all year long and grow both outdoors and indoors. Dead leaves and farm areas are common sources for outdoor molds. Indoor plants, old books, bathrooms, and damp areas are common sources of indoor mold growth. Mold is also common in foods.
How can allergies be managed?
Allergies are rarely life-threatening, but often cause lost work days, decreased work efficiency, poor school performance, and a negative effect on the quality of life. Considering the millions of dollars spent on antiallergy medications and the cost of lost work time, allergies cannot be considered a minor problem.
For some allergy sufferers, symptoms may be seasonal, but for others they produce year-round discomfort. Symptom control is most successful when multiple approaches are used simultaneously to manage the allergy. They may include minimizing exposure to allergens, desensitization with allergy shots or drops, and medications. If used properly, medications, including antihistamines, nasal decongestant sprays, steroid sprays, saline sprays, and cortisone-type preparations, can be helpful. Even over-the-counter drugs can be beneficial, but some may cause drowsiness.
When should a doctor be consulted?
The most appropriate person to evaluate allergy problems is an otolaryngologist (ear, nose, and throat specialist). Aside from gathering a detailed history and completing a thorough examination of the ears, nose, throat, head, ENT doctors will offer advice on proper environmental control. They will also evaluate the sinuses to determine if infection or structural abnormality (deviated septum, polyps) is contributing to the symptoms.
In addition, the doctor may advise testing to determine the specific allergen that is causing discomfort. In some cases subcutaneous immunotherapy (allergy shots) or sublingual immunotherapy (allergy drops) may be recommended. Immunotherapy is a method of treating allergies by desensitizing individuals to allergens over time, in many cases with the goal that they be cured of their allergies.
Acute Ear Infections
Ear infections are one of the most common reasons parents take their children to the doctor. While there are different types of ear infections, the most common is called otitis media, which means an inflammation and infection of the middle ear. The middle ear is located just behind the eardrum.
An acute ear infection is a short and painful ear infection. For information on an ear infection that lasts a long time or comes and goes, see Chronic Ear Infections below.
The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. If the Eustachian tube becomes blocked, fluid can build up. This can lead to infection.
Ear infections are common in infants and children, because the Eustachian tubes become easily clogged.
Ear infections may also occur in adults, although they are less common than in children.
Anything that causes the eustachian tubes to become swollen or blocked causes more fluids to build up in the middle ear behind the eardrum. These causes include:
- Colds and sinus infections
- Excess mucus and saliva produced during teething
- Infected or overgrown adenoids
- Tobacco smoke or other irritants
Ear infections are also more likely if a child spends a lot of time drinking from a sippy cup or bottle while lying on his or her back. However, getting water in the ears will not cause an acute ear infection, unless the eardrum has a hole from a previous episode.
Acute ear infections occur most often in the winter. You cannot catch an ear infection from someone else, but a cold may spread among children and cause some of them to get ear infections.
Risk factors for acute ear infections include:
- Attending daycare (especially those with more than 6 children)
- Changes in altitude or climate
- Cold climate
- Exposure to smoke
- Genetic factors (susceptibility to infection may run in families)
- Not being breastfed
- Pacifier use
- Recent ear infection
- Recent illness of any type (lowers resistance of the body to infection)
In infants, the main sign is often irritability and inconsolable crying. Many infants and children with an acute ear infection have a fever or trouble sleeping. Tugging on the ear is not always a sign that the child has an ear infection.
Symptoms of an acute ear infection in older children or adults include:
- Ear pain or earache
- Fullness in the ear
- Feeling of general illness
- Hearing loss in the affected ear
The ear infection may start shortly after having a cold. Sudden drainage of yellow or green fluid from the ear may mean a ruptured eardrum.
All acute ear infections include fluid behind the eardrum. You can use an electronic ear monitor, such as EarCheck, to detect this fluid at home. The device is available at pharmacies, but you still need to see your doctor to confirm any possible ear infection.
Exams and Tests
The health care provider will look inside the ears using an instrument called an otoscope. This may show:
- Areas of dullness or redness
- Air bubbles or fluid behind the eardrum
- Bloody fluid or pus inside the middle ear
- A hole (perforation) in the eardrum
A hearing test may be recommended if the person has a history of ear infections.
Some ear infections will safely clear up on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed. But, if there is no improvement or symptoms get worse, schedule an appointment with your health care provider to determine whether antibiotics are needed.
If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes.
- In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily. Tympanostomy tube insertion is done under general anesthesia.
- Usually the tubes fall out by themselves. Those that don’t fall out may be removed in your doctor’s office.
If the adenoids are enlarged, surgical removal of the adenoids may be considered, especially if you continue to have ear infections. Removing tonsils does not seem to help with ear infections.
Ear infections can be treated but may occur again in the future. They can be quite painful. If you or your child are prescribed an antibiotic, it is important to finish all your medication as instructed.
Chronic Ear Infections
Chronic ear infection is fluid, swelling, or an infection behind the eardrum that does not go away or keeps coming back, and causes long-term or permanent damage to the ear.
Causes, incidence, and risk factors:
The eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. When this happens, infection can occur.
A chronic ear infection occurs when fluid or an infection behind the eardrum does not go away. A chronic ear infection may be caused by:
- An acute ear infection that does not clear completely
- Repeated ear infections
“Suppurative chronic otitis” is a phrase doctors use to describe an eardrum that keeps rupturing, draining, or swelling in the middle ear or mastoid area and does not go away.
Ear infections are more common in children because their Eustachian tubes are shorter, narrower, and more horizontal than in adults. Chronic ear infections are much less common than acute ear infections.
The usual treatment options are antibiotics, steroids and surgical insertion of pressure equalizing tubes in the ears. While studies have shown that antibiotics can be helpful in certain cases, excessive use can lead to bacterial resistance, making infections more difficult to treat. Tubes sometimes do not equalize pressure enough or may need reinsertion over time.
The first step in treating otitis media is a thorough evaluation by a physician. This will include a history and examination of the ear, nose, and throat. Depending on the individual situation, further testing will include a hearing test, tympanometry (a test that measures the pressure in the middle ear) and CT or MRI scan.
Treatment depends upon the stage of the disease. Initially, efforts to control the causes of eustachian tube obstruction, such as allergies or other head and neck infectious problems, may prevent progression of chronic otitis media. Uncomplicated chronic ear fluid is treated with antibiotics, steroids, and/or placement of ventilation tubes. Many children with chronic or recurrent ear infections have ventilation tubes inserted in their eardrums to allow normal air exchange in the middle ear until the eustachian tube matures.
Once the disease has progressed to the point of significant damage to the eardrum or ossicles, more intensive treatment is needed. If active infection is present in the form of ear drainage, antibiotic eardrops are prescribed. Occasionally, these may be supplemented with oral antibiotics.
Once the active infection is controlled, surgery is usually recommended. There are three objectives of surgery for COM:
- Eradication of the disease
- Remodeling of the middle ear and mastoid bone, located just behind the external ear, to prevent recurrence
- Preservation or improvement in hearing
Surgeries to achieve these objectives include tympanoplasty, mastoidectomy, or typanomastoidectomy. The ENT doctor or otologist makes an incision within the ear canal or behind the external ear. Part of the mastoid bone is then drilled away to gain access to the middle ear space. The abnormal tissues are removed. If possible, efforts are made to rebuild the eardrum and the sound-conducting bones. It is sometimes necessary, however, to complete the hearing reconstruction at a later date (a second stage) rather than at the same time as removal of the infected or damaged parts. Patients are usually discharged from the hospital on the same day or one day after surgery.
This information was adapted from Medline Plus.
Many words are used to describe dizziness. These include disorientation, imbalance, light-headedness and swaying but true vertigo is characterized by a spinning sensation. Vertigo can be accompanied by nausea, vomiting and sweating. For some sufferers, dizziness can last only a few short seconds while others may experience dizziness for much longer periods. Imbalance symptoms can afflict all age groups, but it is most common in older people.
Our vestibular system helps us maintain the orientation of our bodies in space and helps us keep our posture and sense of balance. It helps us regulate our movements and focus visually while our bodies are in motion. The balance system uses sensory information from the vestibular organs (balance organs in the inner ear), the visual system, and the proprioceptive system (muscles). Sensory nerves associated with our eyes, muscles, and joints send their signals to the spinal cord and brain. All these parts work together to help us keep our balance.
The inner ear contains three semicircular canals that are responsible for gathering information about the position and movement of the head and body. Inside the canals is a fluid called endolymph. When you move your head, the endolymph moves, causing information to be sent to the brain about the body’s position.
ClariFix® Cryotherapy for Chronic Rhinitis
Patients who experience the following symptoms frequently or on a regular basis may suffer from chronic rhinitis:
- Watery runny nose
- Nasal congestion
- Congestion in the morning
- Post-nasal drip
- Need to clear the throat
We offer an FDA-cleared, minimally invasive treatment called ClariFix for healthy adults who are frequently bothered by a stuffy, runny, drippy nose. Chronic rhinitis can occur when the nerves in the back of the nose become out of balance and send unnecessary signals to the nose, causing the lining to swell and produce mucus as if it’s protecting the body from an illness.
The ClariFix procedure uses intense cold (cryotherapy) to interrupt the nerve signals and stop the sinuses from overreacting. We perform this simple procedure in our office. First, the inside of the nose is numbed with a local anesthetic. Next, the ClariFix device is inserted into the nose ,and the cooling is activated. Patients typically feel pressure, cold, and mild discomfort during the treatment.
treatment, patients may return to their regular daily activities the same day. It is normal for the nose to feel sensitive, congested, and sore as it heals. Within 2 to 6 weeks, patients typically notice a reduction in their symptoms and can breathe more freely—and put away the tissue box.
Computed tomography imaging, or CT scanning, is an important diagnostic tool for visualizing internal structures of the body. It is an X-ray technique, but unlike traditional 2-D X-rays, which produce overlapping images, it produces images in cross section, offering 3-D visualization. CT scans provide valuable information that we use when planning for sinus surgery or ear surgery. They are more likely to detect conditions which can be missed a significant percentage of the time on conventional X-ray films.
ENT has a Xoran MiniCAT™ scanner in our office to provide ENT-specialized CT scanning services directly to our patients. It is a compact, upright CT scanning system designed for high-resolution bone window imaging of the sinuses, temporal bones and skull base. MiniCAT provides immediate access to images at the patient’s point-of-care, resulting in a faster diagnosis and treatment.
This device has a lower radiation dose than conventional (full-body) CT scanners, and scans in less than 20 seconds. Patients can sit upright in an open design, rather than lying down in the tightly enclosed spaces of conventional CT scanners.
The shape of your nasal cavity could be the cause of chronic sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.
Estimates are that 80 percent of all nasal septums are off-center, a condition that is generally not noticed. A “deviated septum” occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.
Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma.
A deviated septum may cause one or more of the following:
- Blockage of one or both nostrils
- Nasal congestion, sometimes one-sided
- Frequent nosebleeds
- Frequent sinus infections
- At times, facial pain, headaches, postnasal drip
- Noisy breathing during sleep (in infants and young children)
In some cases, a person with a mildly deviated septum has symptoms only when he or she also has a “cold” (an upper respiratory tract infection). In these individuals, the respiratory infection triggers nasal inflammation that temporarily amplifies any mild airflow problems related to the deviated septum. Once the “cold” resolves, and the nasal inflammation subsides, symptoms of a deviated septum often resolve, too.
Diagnosis Of A Deviated Septum:
Patients with chronic sinusitis often have nasal congestion, and many have nasal septal deviations. However, for those with this debilitating condition, there may be additional reasons for the nasal airway obstruction. The problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof. A trained specialist in diagnosing and treating ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal obstruction.
Your First Visit:
After discussing your symptoms, the primary care physician or specialist will inquire if you have ever incurred severe trauma to your nose and if you have had previous nasal surgery. Next, an examination of the general appearance of your nose will occur, including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril.
Surgery may be the recommended treatment if the deviated septum is causing troublesome nosebleeds or recurrent sinus infections. Additional testing may be required in some circumstances.
Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery.
The time required for the operation averages about one to one and a half hours, depending on the deviation. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. After the surgery, nasal packing is inserted to prevent excessive postoperative bleeding. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.
If a deviated nasal septum is the sole cause for your chronic sinusitis, relief from this severe disorder will be achieved.
Myringotomy with Tubes
Painful ear infections are a rite of passage for children – by the age of five, nearly every child has experienced at least one episode. Most ear infections either resolve on their own (viral) or are effectively treated by antibiotics (bacterial). But sometimes ear infections and/or fluid in the middle ear may become a chronic problem leading to other issues, such as hearing loss, or behavior and speech problems. In these cases, insertion of an ear tube by an ear, nose, and throat specialist) may be considered.
What are ear tubes?
Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes.
These tubes can be made out of various materials and may have a coating intended to reduce the possibility of infection. There are two basic types of ear tubes: short-term and long-term. Short- term tubes are smaller and typically stay in place for six months to a year before falling out on their own. Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long-term tubes may fall out on their own, but removal by an otolaryngologist may be necessary.
Who needs ear tubes and why?
Ear tubes are often recommended when a person experiences repeated middle ear infection (acute otitis media) or has hearing loss caused by the persistent presence of middle ear fluid (otitis media with effusion). These conditions most commonly occur in children, but can also be present in teens and adults and can lead to speech and balance problems, hearing loss, or changes in the structure of the ear drum. Other less common conditions that may warrant the placement of ear tubes are malformation of the ear drum or eustachian tube, Down Syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure, usually seen with altitude changes as in flying and scuba diving).
Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia. The average age for ear tube insertion is one to three years old. Inserting ear tubes may:
- Reduce the risk of future ear infection;
- Restore hearing loss caused by middle ear fluid;
- Improve speech problems and balance problems; and
- Improve behavior and sleep problems caused by chronic ear infections.
How are ear tubes inserted in the ear?
Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to an incision (small hole) in the ear drum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel, but it can also be accomplished with a laser. If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation).
What happens during surgery?
A general anesthetic is administered for young children. Some older children and adults may be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops may be administered after the ear tube is placed and may be prescribed for a few days. The procedure usually lasts less than 15 minutes and patients awaken quickly.
Sometimes the otolaryngologist will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed. This is often considered when a second or third tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infections and the need for repeat surgery.
What happens after surgery?
After surgery, the patient is monitored in the recovery room and will usually go home within an hour or two if no complications occur. Patients usually experience little or no postoperative pain, but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily.
Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery.
The otolaryngologist will provide specific postoperative instructions, including when to seek immediate attention and to set follow-up appointments. He or she may also prescribe antibiotic ear drops for a few days. An audiogram should be performed after surgery, if hearing loss is present before the tubes are placed. This test will make sure that hearing has improved with the surgery.
To avoid the possibility of bacteria entering the middle ear through the ventilation tube, physicians may recommend keeping ears dry by using ear plugs or other water-tight devices during bathing, swimming, and water activities. However, recent research suggests that protecting the ear may not be necessary. Parents should consult with the treating physician about ear protection after surgery.
Consultation with an otolaryngologist (ear, nose, and throat specialist) may be warranted if you or your child has experienced repeated or severe ear infections, ear infections that are not resolved with antibiotics, hearing loss due to fluid in the middle ear, barotrauma, or have an anatomic abnormality that inhibits drainage of the middle ear.
Myringotomy with insertion of ear tubes is an extremely common and safe procedure with minimal complications. When complications do occur, they may include:
- Perforation – This can happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (ear drum) does not close. The hole can be patched through a surgical procedure called a tympanoplasty or myringoplasty.
- Scarring – Any irritation of the ear drum (recurrent ear infections), including repeated insertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this causes no problem with hearing.
- Infection – Ear infections can still occur in the middle ear or around the ear tube. However, these infections are usually less frequent, result in less hearing loss, and are easier to treat – often only with ear drops. Sometimes an oral antibiotic is still needed.
- Ear tubes come out too early or stay in too long – If an ear tube expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long may result in perforation or may require removal by an otolaryngologist.
Get more information on myringotomy with insertion of ear tubes at The American Academy of Otolaryngology.
Head and Neck Cancer & Tumors
Learning You Have a Tumor
You or your doctor may have found a tumor (growth) in your mouth or throat. It’s normal to have concerns, and many questions. So find out how your health care team can help-and how important you are to your own recovery. This booklet can show you more.
Concerns About the Future
Finding out you have a tumor is scary. You may wonder what effect it will have on your life. As you and your doctors decide on your treatment, some of your concerns will be resolved. And, moving forward, your health care team can help you learn ways to help yourself.
What Is a Tumor?
A tumor is a mass of abnormal cells. It is either benign (slow growing, not cancerous) or malignant (fast growing, cancerous). Some tumors, especially cancerous ones, can be life-threatening. But most tumors can be treated.
Risk Factors for a Cancerous Tumor
You are more likely to get a tumor of the mouth or throat if you:
- Smoke cigarettes, pipes, or cigars
- Use chewing tobacco or snuff
- Drink alcohol
- Take poor care of your teeth
- Have poor-fitting dentures that irritate your mouth
- Are exposed to certain industrial chemicals
- Had a mouth or throat tumor in the past
Working with Your Health Care Team
Your health care team will explain your options and can answer your questions. They’ll work with you during all stages of your treatment. Members of your health care team may include:
- A primary care physician, a doctor who oversees your health needs
- A head and neck surgeon, a doctor who performs mouth and throat surgery. He or she may be an otolaryngologist (also called an EN1′), who treats ear, nose, and throat diseases, or a general surgeon, who also performs other kinds of surgery.
- A dentist, a doctor who treats tooth and gum diseases and injuries ·
- Nurses, who care for you and teach you how to care for yourself
- An oncologist, a doctor who specializes in treating cancer
- An anesthesiologist, a doctor who gives medication to prevent pain during and after surgery
- A pathologist, a doctor who identifies diseases by studying cells and tissues with a microscope
- The radiation team, doctors and therapists who use high energy x-rays to treat diseases
- Speech pathologists, occupational therapists, and physical therapists, who help you recover after treatment.
- Dietitians, who help plan your diet during and after treament.
Inside Your Mouth and Throat
Tumors can form anywhere in your mouth or throat. A tumor may change how you talk, breathe, chew, or swallow. Learning more about your mouth and throat can help you understand your treatment.
Signs and Symptoms of a Tumor in the Mouth
If you have a mouth tumor, you or your doctor may have noticed one or more of the following:
- White or red patches on tissues or gums
- Pain that doesn’t go away
- A sore that doesn’t heal in a week or two
- Bleeding that doesn’t stop after a few days
- A swelling or lump that doesn’t go away
- Problems with your teeth, dentures, or chewing
Signs and Symptoms of a Tumor in the Throat
If you have a throat tumor, you or your doctor may have noticed one or more of the following:
- Hoarseness that doesn’t go away
- Trouble swallowing
- A lump in your neck
- Pain that doesn’t go away
- Aching, pain, or pressure in your ear
- Persistent coughing with or without bloody sputum
To learn more about your tumor and your health, your doctor will evaluate you. Your evaluation includes a history, a physical exam, and some tests. Results of your evaluation help your health care team plan the best treatment for you.
Your Health History
Your doctor will take your health history. During this history, you’re asked about your health problems, your symptoms, and any treatment you’ve already had. Your doctor may refer you to a specialist for more evaluation and treatment.
Your Physical Exam
The physical exam is done in the doctor’s office. Your exam may include indirect laryngoscopy, where a hand-held mirror is used to view the throat. You may also have an endoscopy, where a flexible tube (endoscope) is put into your mouth or nose and sometimes down into your throat. You may have local anesthesia (medication to keep you comfortable) during these exams.
You may have one or more imaging tests to give your doctor more information about the tumor. You’ll be told how to prepare for these tests. Some common imaging tests are:
- An x-ray, a picture of tissues inside the body using high-energy beams
- A CT (computed tomography) scan, a computer-enhanced x-ray
- An MRI (magnetic resonance imaging), a test using strong magnets and_computers to form images
For a closer look at your throat, larynx, and other nearby tissues, direct laryngoscopy may be used. During the procedure, a lighted tube called a laryngoscope may be placed into your throat. Direct laryngoscopy may be done in the hospital or in the doctor’s office. If it is done in the hospital, you may receive general anesthesia (medication to help you relax and sleep).
If you have a biopsy, a small sample of your tumor will be removed and studied. This helps show whether or not the tumor is cancerous. The tumor sample may be removed in the doctor’s office or in the hospital. The sample is then studied in a lab. Sometimes a biopsy is done during direct laryngoscopy.
During fine-needle aspiration (FNA), a very thin needle is inserted into the tumor to remove a tissue sample. This biopsy procedure may be done in the doctor’s office.
Deciding on Treatment
The treatment you receive depends on the tumor’s size, type, and location, and
whether it is cancerous. You may be treated with one or more of these options:
- Radiation Therapy
Preparing for Your Treatment
You and your doctor will choose the best treatment for you. Before treatment begins, you can do some things to get ready. Follow your health care team’s instructions. Also be sure to ask any questions you have.
Leading Up to Treatment
In the weeks before treatment, you should do the following:
- Stop smoking or using tobacco.
- Have dental work done if your doctor requests it.
- Tell your doctor if you take any medications, especially aspirin or an anticoagulant (“blood thinner”).
- If you drink alcoholic beverages, tell your doctor how often and how much you drink.
- Fill out insurance, consent, and other forms as requested by your doctor.
Preparing for Surgery
Before surgery, prepare by doing the following:
- Make sure you will be able to arrive at the hospital on time.
- Ask an adult friend or family member to give you a ride home when you’re ready to leave the hospital.
- Don’t eat or drink anything after midnight the night before your surgery, even water, candy, or gum. If you eat or drink after midnight, your surgery may be cancelled.
- If you’ve been told to keep taking a medication, take it with small sips of water.
- If you feel ill, call your doctor. Your surgery may need to be rescheduled.
If You Have Surgery
Surgery may be done to remove either a benign or a cancerous tumor. Your health care team will let you know what to expect. They’ll also discuss the possible risks and complications of the surgery.
The Surgical Plan
Your surgery may take from a few minutes to several hours. At the start, you’ll receive anesthesia to keep you comfortable. Depending on the size and location of the tumor, surgery can include:
Removing the tumor. If the tumor is benign, you may need no furthertreatment after it’s removed. If the tumor is cancerous, you may also need radiation or chemotherapy.
Helping you breathe while the tumor is removed. To do this, a small hole may be made in the front of your throat. A tracheostomy (trach) tube may be inserted through this hole to help you breathe.
Removing some lymph nodes from your neck if your tumor is cancerous. This procedure (called neck dissection) can help keep the cancer from spreading.
Using tissue from your back or chest to replace tissue removed during the surgery. If necessary, this can help you regain better use of your mouth, throat, or neck after treatment.
Possible Risks and Complications
Some of the possible risks and complications of surgery include:
- Difficulty speaking or swallowing
- Pain or numbness at the incision site
- Loss of muscle tone or range of motion in your face, neck, or arm
- Reduced sense of taste, smell, or feeling
- Change in appearance
Recovering from Surgery
You may go home the same day as your surgery, or you may need to stay in the hospital longer. These first few days after your surgery can be a challenge. You’ll have lots of help from your health care team. And you’ll learn how to care for yourself once you’re home.
Right After Surgery
An IV (intravenous) line may be in your arm to provide fluids. You may have an air tube in your nose or a trach tube in your throat. You may also have a tube in your stomach to provide food. You may feel tired, confused, or groggy. Your mouth or throat may feel dry or sore. Talking may be hard, so something to write with may be at your bedside.
Before Leaving the Hospital
Your doctors and nurses will check on you after your surgery. They’ll explain what you need to do to recover at home. You may be given medications to take after you leave the hospital. Make sure an adult friend or family member is available to drive you home.
When to Call Your Doctor
Call your doctor right away if you have any of these problems after surgery:
- Bleeding ot swelling in the mouth or throat
- Fever over 101 F
- Shortness ofhreath
- Swelling in the legs and feet
- Pain that’s not relieved by medication
If You Have a New Airway
If your surgeon has given you a new airway during surgery, it may be in place only a short time while you heal. Or, if your larynx has been removed, you’ll continue breathing through this new airway. In either case, your health care team will help you adjust.
If You Have a Trach Tube
Your trach tube has been chosen to fit well and work right for you. You’ll learn how to keep it clean and clear. Often, a trach tube is needed only a short time. Your surgeon will tell you how long to use the tube. If you don’t need a new airway after surgery, the hole in the front of your throat will close on its own once the tube is no longer needed.
If You Have a Stoma
If your larynx was removed during surgery, you’ll continue to breathe through the hole in your throat. This hole is called a stoma or permanent tracheostomy. You’ll be shown how to care for your stoma. Support groups can help you adjust to having a new airway. And you can return to work, family life, and many of the activities you enjoyed before surgery.
When to Call Your Doctor
Call your doctor right away if you have any of these problems:
- A red, painful, or bleeding stoma
- Pain while cleaning your airway
- Yellow, smelly, bloody, or thick mucus around or inside your stoma
- Swelling near the trach tube or stoma
If you ever have trouble breathittg, call 9·1·1 (emergency) right away. Tell the dispatcher that you use a trach tube or stoma to breathe.
If You Have Radiation Therapy
During radiation treatment, beams of high energy destroy cancer cells in the tumor. The radiation may come from a machine or from small “seeds” placed in the tumor. Radiation may be used alone or with other treatment.
Planning for Treatment
You and your radiation team will meet to plan your treatment. You may need to have dental work done before starting treatment. The team will decide how best to position you and direct the energy beams. You may be fitted with a flexible mask to wear during the sessions. Because you may have several radiation sessions over many weeks, be sure to plan for extra help at home and work during your treatment period.
First, a therapist will prepare you for treatment. Then he or she leaves the room. You’ll need to lie as still as you can. During treatment, a large machine sends x-ray beams into the tumor site and nearby affected tissues. This is called local treatment. You’ll hear the equipment working, but you won’t feel the radiation on your skin .
Possible Side Effects of Radiation Therapy
Radiation may affect the normal tissue near the cancer cells. This may cause side effects. These don’t mean that the cancer is worse or that the therapy isn’t working. Ask your health care team how to mange these or other side effects:
- Weight loss
- Dry, itchy, red, darkening, or peeling skin
- Fungal infections in the mouth
- Sore in the mouth
- Eating difficulties
- Loss of or decrease taste
- Dry mouth or thick saliva
- Dental cavities
If You Have Chemotherapy
During chemotherapy (also called chemo), one or more medications travel through your bloodstream. When they reach the tumor, these medications kill cancer cells. You may receive chemo by itself or with other treatment.
Planning for Treatment
Chemo affects your entire body. This is called systemic treatment. You may receive chemo many times over a few months, with breaks of several days between treatments. Your treatment schedule depends on what type of chemo medications you receive. Talk with your health care team about how to plan and prepare for chemo treatments.
Chemo is most often given by IV infusion (through a tube placed in a vein). It can also be given by pill or by a shot. Sometimes it is sent right into the tumor site. You may receive chemo at your doctor’s office, at a clinic, at a hospital, or from a portable pump that you wear.
Possible Side Effects of Chemotherapy
Chemotherapy may cause side effects anywhere in the body. Side effects don’t mean that the cancer is worse or that the therapy isn’t working. Ask your health care team how to manage these or other side effects:
- Nausea or vomiting
- Hair loss
- Weakened immune system
- Mouth sores
- Dry mouth
- Sinus or other infections
- Diarrhea or constipation
Adjusting After Treatment
Treatment for a tumor may change the way you speak, chew, or eat. If so, your health care team will show you new ways to do these important tasks. Family, friends, and other people you trust can also help you adjust.
Help with Daily Tasks
Surgery to remove a tumor may make simple tasks harder to do for a while. If needed, your therapists can help you relearn how to chew or swallow food. If you have a stoma or a feeding tube, your health care team will show you how to care for it. If you have dentures, you may need to get new ones. And you may need to practice moving muscles in your neck or face. Members of your health care team can help. If you need help at home, ask them about home nurses and health aides. A dietitian can work with you to plan healthy meals after treatment.
Help with Speaking
If you have your larynx removed, it will change the way you speak. But you can learn to speak again. A speech pathologist can help you use one or more of the following
- An electrolarnyx, a device like a microphone that you hold up to your throat when you want to talk
- Esophageal speech, which creates speech using air forced up from your esophagus
- A voice prosthesis, a special valve placed inside your throat to help you speak. The procedure to place the valve is called a tracheoesophageal puncture (TEP).
In the future, you may need more exams, x-rays, tests, or treatment. So be sure to follow up with your health care team as directed. It’s also important to do what you can to improve your health. Talk with your health care team about what lies ahead.
Improving Your Life
Now is the time to take control of your health. Cancer can recur, but you can do a lot to keep it from coming back. If you haven’t stopped smoking or using tobacco, stop now. If you drink alcohol, ask your doctor how to cut back. Take good care of your teeth and gums. Eat well, exercise, and get plenty of sleep. Your lifestyle choices can help keep you healthy. Talk to your health care team about what else you can do.
Life after treatment for a tumor can be a challenge. At first, how you look or speak may concern or depress you. If you had cancer, you may be afraid that the cancer might come back. But you can find ways to cope. Therapists and counselors can do a lot for you. Look to your family, friends, clergy, and support groups for more help.
The groups below can give you more information and support. To find out more, contact:
American Cancer Society (ACS)
Cancer Information Service (CIS)
(National Cancer Institute)
American Academy of Otolaryngology – Head and Neck Surgery
International Association of Laryngectomees (IAL) (“Lost Chord” or “New Voice” clubs)
National Coalition for Cancer Survivorship (NCCS)
Support for People with Oral and Head and Neck Cancer (SPOHNC)
The Yul Brynner Head and Neck Foundation
Hearing loss can affect anyone, and it can occur at any point during a person’s life. It affects different people to varying degrees and for different reasons, and can be triggered by a number of environmental and biological factors.
Sinus infections are one of the most common reasons people see an ENT specialist. Sinus infections are typically treated by a primary care doctor, but persistent or prolonged sinus infections should be evaluated by an ENT specialist. A specialist can help determine whether symptoms are from a sinus infection or from other conditions such as allergies or migraines.
We proudly offer our patients the convenience and comfort of an on-site CT scanner, the Xoran MiniCAT™. People appreciate that they don’t have to make a second appointment at a different facility, and that our machine allows them to sit upright in an open design. This technology provides timelier imaging, a faster diagnosis, and the ability to begin your treatment more quickly.
The ear, nose, and throat specialist will prescribe many medications (antibiotics, decongestants, nasal steroid sprays, antihistamines) and procedures (flushing) for treating acute sinusitis. There are occasions when physician and patient find that the infections are recurrent and/or non-responsive to the medication. When this occurs, surgery to enlarge the openings that drain the sinuses is an option.
A recommendation for sinus surgery in the early 20th century would easily alarm the patient. In that era, the surgeon would have to perform an invasive procedure, reaching the sinuses by entering through the cheek area, often resulting in scarring and possible disfigurement. Today, these concerns have been eradicated with the latest advances in medicine. A trained surgeon can now treat sinusitis with minimal discomfort, a brief convalescence, and few complications.
A clinical history of the patient will be created before any surgery is performed. A careful diagnostic workup is necessary to identify the underlying cause of acute or chronic sinusitis, which is often found in the anterior ethmoid area, where the maxillary and frontal sinuses connect with the nose. This may necessitate a sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected blood tests to determine an operative strategy. Note: Sinus X–rays have limited utility in the diagnosis of acute sinusitis and are of no value in the evaluation of chronic sinusitis.
Sinus Surgical Options Include:
Functional endoscopic sinus surgery (FESS): Developed in the 1950s, the nasal endoscope has revolutionized sinusitis surgery. In the past, the surgical strategy was to remove all sinus mucosa from the major sinuses. The use of an endoscope is linked to the theory that the best way to obtain normal healthy sinuses is to open the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa has an opportunity to return to normal.
FESS involves the insertion of the endoscope, a very thin fiber-optic tube, into the nose for a direct visual examination of the openings into the sinuses. With state of the art micro-telescopes and instruments, abnormal and obstructive tissues are then removed. In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort.
The advantage of the procedure is that the surgery is less extensive, there is often less removal of normal tissues, and can frequently be performed on an outpatient basis. After the operation, the patient will sometimes have nasal packing. Ten days after the procedure, nasal irrigation may be recommended to prevent crusting.
Image guided surgery: The sinuses are physically close to the brain, the eye, and major arteries, always areas of concern when a fiber optic tube is inserted into the sinus region. The growing use of a new technology, image guided endoscopic surgery, is alleviating that concern. This type of surgery may be recommended for severe forms of chronic sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult.
Image guidance is a near-three-dimensional mapping system that combines computed tomography (CT) scans and real-time information about the exact position of surgical instruments using infrared signals. In this way, surgeons can navigate their surgical instruments through complex sinus passages and provide surgical relief more precisely. Image guidance uses some of the same stealth principles used by the United States armed forces to guide bombs to their target.
Caldwell Luc operation: Another option is the Caldwell-Luc operation, which relieves chronic sinusitis by improving the drainage of the maxillary sinus, one of the cavities beneath the eye. The maxillary sinus is entered through the upper jaw above one of the second molar teeth. A “window” is created to connect the maxillary sinus with the nose, thus improving drainage. The operation is named after American physician George Caldwell and French laryngologist Henry Luc and is most often performed when a malignancy is present in the sinus cavity.
Obstructive sleep apnea (OSA) is a serious health condition characterized by a repetitive stopping or slowing of breathing that can occur hundreds of times during the night. This often leads to poor quality sleep and excessive daytime sleepiness. Risks of untreated sleep apnea include high blood pressure, stroke, heart disease, and motor vehicle accidents. It is estimated that 1 in 5 Americans have at least mild OSA.
A variety of surgical and non-surgical options are available for the treatment of snoring and sleep apnea. Medical options include positive pressure (i.e. CPAP), oral appliances, and weight loss. Many of these treatment options depend on regular, long-term adherence to be effective. In patients having difficulty with other treatments, surgical procedures for the nose and throat can be a beneficial alternative. Surgical therapy can also be effective when used as an adjunct to improve tolerance and success with CPAP or an oral appliance.
Increased nasal congestion has been shown to cause or contribute to snoring, disrupted sleep, and even sleep apnea. It is also a leading cause of failure of medical treatments for OSA, such as CPAP or an oral appliance. Nasal obstruction may result from many causes including allergies, polyps, deviated septum, enlarged adenoids, and enlarged turbinates.
Medical treatment options, such as a nasal steroid spray or allergy management, may be helpful in some patients. Structural problems, such as a deviated septum, often benefit from surgical treatment. One surgical option, known as radiofrequency turbinate reduction (RFTR), can be performed in the office under local anesthesia. RFTR uses radiofrequency to shrink swollen tissues in each side of the nose.
Upper throat (palate, tonsils, uvula)
In many patients with OSA, airway narrowing and collapse occurs in the area of the soft palate (back part of the roof of the mouth), tonsils, and uvula. The specific type and combination of procedures that are indicated depend on each individual’s unique anatomy and pattern of collapse. Therefore the procedure selection and surgical plan must be customized to each patient. In general, these procedures aim to enlarge and stabilize the airway in the upper portion of the throat.
The surgery is performed in an operating room under general anesthesia, either as an outpatient or with an overnight hospital stay. The recovery varies depending on the patient and the specific procedures performed. Many patients return to school/work in approximately one week and return to normal diet and activity at two weeks. Throat discomfort, particularly with swallowing, is common in the first two weeks and usually managed with medications for pain and inflammation. Risks include bleeding, swallowing problems, and anesthesia complications, although serious complications are uncommon.
The tonsils and adenoids may be the sole cause of snoring and sleep apnea in some patients, particularly children. In children, and in select adults, with OSA and enlarged tonsils/adenoids , tonsillectomy/adenoidectomy alone can provide excellent resolution of snoring, sleep apnea, and associated symptoms.
Lower throat (back of tongue and upper part of voice box)
The lower part of the throat is also common area of airway collapse in patients with OSA. The tongue base may be larger than normal, especially in obese patients, contributing to blockage in this area. The tongue may also collapse backward during sleep as the muscles of the throat relax, particularly when some patients sleep on their back. The epiglottis, or upper part of the voice box, may also collapse and contribute to airway obstruction.
Multiple procedures are available to reduce the size of the tongue base or advance it forward out of the airway. Other procedures aim to advance and stabilize the hyoid bone which is connected to the tongue base and epiglottis. A more recent technology involves implantation of a pacemaker for the tongue (‘hypoglossal nerve stimulator’) which stimulates forward contraction of the tongue during sleep. As with palatal surgery, the most appropriate type of procedure varies from one individual to another, and is primarily determined by each patient’s anatomy and pattern of obstruction.
The procedures are done under general anesthesia, often with overnight hospital observation. Recovery and risks vary depending on the procedure(s) performed, but are generally similar to procedures in the upper throat.
For the most part, the above procedures involve surgical enlargement and stabilization inside the airway. For some patients, particularly those with developmental or structural changes of the jaw or other facial bones, surgical or orthodontic procedures on the bones of the face, jaw, or hard palate (roof of the mouth) may be beneficial.
Orthodontic procedures to widen the palate (palatal or maxillary expansion) may be useful treatment options in some pediatric patients. Maxillomandibular advancement surgery includes a number of procedures designed to move the upper jaw (maxilla) and/or lower jaw (mandible) forward, thus opening the upper and/or lower airway, respectively. Although full maxillomandibular advancement surgery can provide effective enlargement and stabilization of the airway, the potential benefits must be cautiously weighed against the potential increased risks of complications, longer recovery, and changes in the cosmetic appearance of the face.
What should I know before considering surgery?
Surgery is an effective and safe treatment option for many patients with snoring and sleep apnea, particularly those who are unable to use or tolerate CPAP. Proper patient and procedure selection is critical to successful surgical management of obstructive sleep apnea. Talk to your Ear, Nose and Throat doctor for a complete evaluation and to learn what treatment may be best for you.
Tonsils and Adenoids
Tonsils and adenoids are the body’s first line of defense as part of the immune system. They “sample” bacteria and viruses that enter the body through the mouth or nose, but they sometimes become infected. At times, they become more of a liability than an asset and may even cause airway obstruction or repeated bacterial infections. Your ear, nose, and throat (ENT) specialist can suggest the best treatment options.
What are tonsils and adenoids?
Tonsils and adenoids are similar to the lymph nodes or “glands” found in the neck, groin, and armpits. Tonsils are the two round lumps in the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth or nose without special instruments.
What affects tonsils and adenoids?
The two most common problems affecting the tonsils and adenoids are recurrent infections of the nose and throat, and significant enlargement that causes nasal obstruction and/or breathing, swallowing, and sleep problems.
Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling white deposits can also affect the tonsils and adenoids, making them sore and swollen. Cancers of the tonsil, while uncommon, require early diagnosis and aggressive treatment.
When should I see a doctor?
You should see your doctor when you or your child experience the common symptoms of infected or enlarged tonsils or adenoids.
Your physician will ask about problems of the ear, nose, and throat and examine the head and neck. He or she may use a small mirror or a flexible lighted instrument to see these areas.
Other methods used to check tonsils and adenoids are:
- Medical history
- Physical examination
- Throat cultures/Strep tests – helpful in determining infections in the throat
- X-rays – helpful in determining the size and shape of the adenoids
- Blood tests – helpful in diagnosing infections such as mononucleosis
- Sleep study, or polysomnogram-helpful in determining whether sleep disturbance is occurring because of large tonsils and adenoids.
Tonsillitis and its symptoms
Tonsillitis is an infection of the tonsils. One sign is swelling of the tonsils. Other symptoms are:
- Redder than normal tonsils
- A white or yellow coating on the tonsils
- A slight voice change due to swelling
- Sore throat, sometimes accompanied by ear pain.
- Uncomfortable or painful swallowing
- Swollen lymph nodes (glands) in the neck
- Bad breath
Enlarged tonsils and/or adenoids and their symptoms
If your or your child’s adenoids are enlarged, it may be hard to breathe through the nose. If the tonsils and adenoids are enlarged, breathing during sleep may be disturbed. Other signs of adenoid and or tonsil enlargement are:
- Breathing through the mouth instead of the nose most of the time
- Nose sounds “blocked” when the person speaks
- Chronic runny nose
- Noisy breathing during the day
- Recurrent ear infections
- Snoring at night
- Restlessness during sleep, pauses in breathing for a few seconds at night(may indicate sleep apnea).
How are tonsil and adenoid diseases treated?
Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy) may be recommended if there are recurrent infections despite antibiotic therapy, and/or difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness, and may even cause behavioral or school performance problems in some children.
Chronic infections of the adenoids can affect other areas such as the eustachian tube–the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and buildup of fluid in the middle ear that may cause temporary hearing loss. Studies also find that removal of the adenoids may help some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).
In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., prednisone) is sometimes helpful.
Thyroidectomy or Partial Thyroidectomy
Thyroid = a butterfly-shaped endocrine gland in the neck that is found on both sides of the trachea (windpipe). It secretes the hormone thyroxine, which controls the rate of metabolism.
-ectomy = removal of
Partial = not total or entire
This procedure involves removal of all or part of the thyroid gland. The thyroid gland produces hormones that help regulate your metabolism. This gland is located in the front of the neck below the voice box.
Purpose of Procedure
There are two reasons why this procedure is done: to remove a nodule to check for malignancy, and to remove the majority of the gland due to over activity.
As with any procedure using anesthesia, you will be asked not to eat or drink anything after midnight on the evening prior to your surgery . You may brush your teeth in the morning but not swallow the water. If you are on medications that must be taken, you will have discussed this with us and/or the anesthesiologist and instructions will have been given to you.
The procedure will not be performed if you are currently taking, or have recently taken any medication that may interfere with your ability to clot your blood (“blood thinners, aspirin, anti inflammatory medicines, etc … “). Please refer to the attached list and tell us if you took any of these within the past 10 days. If your medication is not on the list, alert us immediately so that we may ensure optimal procedure safety. We will have reviewed all of your medications with you during the pre-operative / pre-procedure consultation. You are obligated to inform us if anything has changed (medication or otherwise) since your previous visit. .
This procedure involves making an incision in the front of the neck below the thyroid gland. The incision is made along the natural skin lines to reduce the appearance of a scar. The incision is extended down through soft tissue in the neck to expose muscles that lie over the thyroid gland. These muscles are then retracted. Blood vessels to the thyroid gland are identified and cut. Other glands found on each side of the thyroid gland, called the parathyroid glands, are identified and protected. Nerves that travel under the thyroid gland and move the vocal cords are also identified and protected. The abnormal portions of the thyroid gland are then removed. Bleeding is controlled with suture material or electrocautery. In some instances, this surgery is performed for cancer, and the surrounding lymph nodes in that area may be check for any spread of the cancer. A drain is placed in the surgical site. The wound is closed in layers using absorbable and removable suture material. A surgical dressing will be applied.
You will be in the recovery room before being transferred to a regular hospital room. Pain medication will be prescribed to manage discomfort. Dressings will be changed daily until drainage is minimal and then the drain is removed. Discharge from the hospital will then be arranged. A follow-up appointment for suture removal will be scheduled. Water exposure on the site of the incision should be avoided until the sutures have been removed. Pain medication may be needed for up to 2 weeks. Post-operative pain medications may include a codeine type medication that may cause drowsiness. Operation of motor vehicles or machinery is not allowed while using this medication. Returning to work or school can occur as soon as pain medication is no longer needed during the day.
Expectations of Outcome
This procedure should result in removal of the abnormal tissue and restoration of a more normal thyroid function.
Possible Complications of the Procedure
This is a safe procedure, however, there are uncommon risks that may be associated with it. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may ask questions if you are still concerned. It is important that every patient be made aware of possible outcomes that may include, but are not limited to:
- Anesthesia complications: There is always a small risk with general anesthesia. This risk is increased if there is any family history of trouble with anesthesia. The risks can range from nausea and vomiting to very rare life threatening problems. You can discuss any questions with your anesthesiologist.
- Injury to the nerves that move the vocal cords, resulting in hoarseness or impaired speech
- An under active parathyroid with a lifelong need to supplemental calcium
- Lifelong need for thyroid medication
- Airway obstruction, although rare
We provide this information for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).
Vocal Cord Paralysis
What Is Vocal Cord (Fold) Paresis and Paralysis?
Vocal fold (or cord) paresis and paralysis result from abnormal nerve input to the voice box muscles (laryngeal muscles). Paralysis is the total interruption of nerve impulse, resulting in no movement; paresis is the partial interruption of nerve impulse, resulting in weak or abnormal motion of laryngeal muscles. Paresis/paralysis can happen at any age, from birth to advanced age, in males and females, from a variety of causes. The effect on patients may vary greatly, depending on the patient’s use of his or her voice: A mild vocal fold paresis can be the end to a singer’s career, but have only a marginal effect on a computer programmer. If you notice any change in your voice quality, immediately contact an otolaryngologist—head and neck surgeon.
What Nerves Are Involved?
Vocal fold movements are a result of the coordinated contraction of various muscles that are controlled by the brain through a specific set of nerves.
The superior laryngeal nerve (SLN) carries signals to the cricothyroid muscle. Since this muscle adjusts the tension of the vocal fold for high notes during singing, SLN paresis and paralysis result in abnormalities in voice pitch and the inability to sing with smooth change to each higher note. Sometimes patients with SLN paresis/paralysis may have a normal speaking voice but an abnormal singing voice.
The recurrent laryngeal nerve (RLN) carries signals to different voice box muscles responsible for opening vocal folds (as in breathing, coughing), closing the folds for vibration during voice use, and closing them during swallowing. The RLN goes into the chest cavity and curves back into the neck until it reaches the larynx. Because the nerve is relatively long and takes a “detour” to the voice box, it is at greater risk for injury from different causes–infections and tumors of the brain, neck, chest, or voice box. It can also be damaged by complications during surgery in the head, neck, or chest, that directly injure, stretch, or compress the nerve. Consequently, the RLN is involved in the majority of cases of vocal fold paresis/paralysis.
What Are the Causes?
The cause of vocal fold paralysis or paresis can indicate whether the disorder will resolve over time or whether it may be permanent. When a reversible cause is present, surgical treatment is not usually recommended, given the likelihood of spontaneous resolution of the problem. Despite advances in diagnostic technology, physicians are unable to detect the cause in about half of all vocal fold paralyses, referred to as idiopathic (due to unknown origins). In these cases, paralysis or paresis might be due to a viral infection affecting the voice box nerves (RLN or SLN), or the vagus nerve, but this cannot be proven in most cases. Known reasons can include:
Inadvertent injury during surgery: Surgery in the neck (thyroid gland, carotid artery) or in the chest (lungs, esophagus, heart, or large blood vessels) may inadvertently result in RLN paresis or paralysis. The SLN may also be injured during head and neck surgery.
Complication from endotracheal intubation: Injury to the RLN may occur when breathing tubes are used for general anesthesia or assisted breathing. However, this type of injury is rare, given the large number of operations done under general anesthesia.
Blunt neck or chest trauma: Any type of penetrating, hard impact on the neck or chest region may injure the RLN; impact to the neck may injure the SLN.
Tumors of the skull base, neck, and chest: Tumors (both cancerous and non-cancerous) can grow around nerves and squeeze them, resulting in varying degrees of paresis or paralysis.
Viral infections: Inflammation from infections may directly involve and injure the vagus nerve or its nerve branches to the voice box (RLN and SLN). Systemic illnesses affecting nerves in the body may also affect the nerves to the voice box.
What Are the Symptoms?
Both paresis and paralysis of voice box muscles result in voice changes and may also result in airway problems and swallowing difficulties.
Voice changes: Hoarseness; breathy voice; extra effort on speaking; excessive air pressure required to produce usual conversational voice; and diplophonia (voice sounds like a gargle).
Airway problems: Shortness of breath with exertion, noisy breathing, and ineffective cough.
Swallowing problems: Choking or coughing when swallowing food, drink, or even saliva, and food sticking in throat.
How Is Vocal Fold Paralysis/Paresis Diagnosed?
An otolaryngologist—head and neck surgeon conducts a general examination and then questions you about your symptoms and lifestyle (voice use, alcohol/tobacco use). Examining the voice box will determine whether one or both vocal folds are abnormal, and will help determine the treatment plan.
Laryngeal electromyography (LEMG) measures electrical currents in the voice box muscles that are the result of nerve inputs. Looking at the pattern of the electric currents will indicate whether there is recovery or repair of nerve inputs and the degree of the nerve input problem. During the LEMG test, patients perform a number of tasks that would normally elicit characteristic actions in the tested muscles. Because a wide list of diseases may cause nerve injury, further tests (blood tests, x-rays, CT scans, etc) are usually required to identify the cause.
What Is the Treatment?
The two treatment strategies to improve vocal function are voice therapy (like physical therapy for large muscle paralysis), and phonosurgery, an operation that repositions and/or reshapes the vocal folds to improve voice function. Voice therapy is normally the first treatment option. After voice therapy, the decision for surgery depends on the severity of the symptoms, vocal needs of the patient, position of paralyzed vocal folds, prognosis for recovery, and the cause of paresis/paralysis, if known.
Videostroboscopy achieves several key components of a complete voice examination. It collects useful, real-time information concerning the nature of vibration; captures an image to detect vocal pathology; and produces a permanent video record of the examination.
- A video strobe unit consists of:
- A stroboscopic unit (light source and microphone)
- A video camera
- An endoscope (long, slender optical instrument)
- A video recorder
Stroboscopy can be performed by using either rigid or flexible endoscopes; each has its own benefits and drawbacks.
MEET OUR PARTNERS IN THE AUDIOLOGY CLINIC
Our Fairbanks Hearing & Balance Clinic offers a variety of services that address specific conditions such as hearing loss, tinnitus and balance disorders. We also offer pediatric audiology services and patient education & counseling.
ANNOUNCING OUR NEW MED SPA PARTNERSHIP
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