Medical & Surgical Services

Ear

Common Conditions

Ear infections – Ear infections can affect children and adults of any age.  They are usually described according to which part of the ear is infected.  Ear canal infections (AKA otitis externa or swimmer’s ear) involve the external auditory canal between the ear opening and ear drum, and are usually treated with antibiotic ear drops.  Middle ear infections involve the middle ear space, which is beyond the ear drum.  These infections often are treated with oral antibiotics, but sometimes ear drops may be prescribed if the ear drum is ruptured.

Hearing loss – Hearing is a complex process which relies on proper function of many parts of the ear. The ear has three separate regions: the outer ear or pinna (the visible portion of the ear), the middle ear (the air-filled space between the ear drum and the inner ear), and the inner ear (the hearing portion of which is the cochlea, located within the skull bones).

Problems with any part of the ear have the potential to cause hearing loss. Examples of conditions which can cause hearing loss include a hole in the ear drum, fluid in the middle ear, or problems with the inner ear related to noise exposure or aging. If you or your doctor are concerned about hearing loss, your doctor will examine your ears and order a hearing test (audiogram).

Ringing in the Ear (Tinnitus) – Tinnitus is a sensation of noise in the ears or head in the absence of any external source. It is commonly perceived as a high-pitched whining or hissing, but may vary in pitch and sometimes sound like a humming, chirping or clicking noise.  One of the most common causes of tinnitus is hearing loss, but there are many other potential causes. A full head and neck examination and hearing test (audiogram) are important parts of an evaluation for tinnitus.

Eustachian tube dysfunction – The Eustachian tubes (pronounced “you-station”) are small passages within the head that connect the middle ear space to the back of the nose. Their purpose is to allow air to flow in and out of the middle ear space. If they are not functioning properly, negative pressure can build up in the middle ear space and allow fluid to accumulate, sometimes causing a drop in the hearing. Pressure changes across the ear drum can also result in a sensation of fullness or pressure in the ear.

Perforated ear drum – A hole in the ear drum (perforation) can be caused by trauma to the ear or a severe ear infection. Drainage from the ear or hearing changes can sometimes result.

Dizziness – Dizziness is a common problem evaluated by ear, nose and throat doctors. People may feel light headed, imbalanced or have vertigo (an abnormal sensation of movement). Problems with the brain or brainstem, cardiovascular system, vision, muscles and joints, sensory nerves, or inner ears are some of the possible causes of dizziness. A typical evaluation involves a history and physical exam by the doctor and a hearing test (audiogram). Additional testing may include MRI and vestibular testing.

 

Common Surgical Procedures

Tympanostomy Tubes (AKA: ear tubes, PE tubes, pressure equalization tubes) – Ear tubes are placed in both children and adults for a variety of reasons. The most common reasons for placement of ear tubes are Eustachian tube dysfunction and recurrent ear infections. For adults, the procedure usually involves local anesthesia, and children usually receive a general anesthesia. The surgeon makes a small slit or hole in the ear drum and places a small plastic or metal tube within the ear drum. This tube stays in place for an average of 6-8 months, but some types are designed to come out sooner or stay in longer. The purpose of the tube is to allow air to freely flow into the middle ear space. Patients receiving ear tubes need to be followed at regular intervals while the tubes are in place. If you or your child need ear tubes, your surgeon will discuss the procedure with you in detail.

Tympanoplasty – Tympanoplasty is a surgical procedure to rebuild the ear drum (tympanic membrane). There are different reasons why this may be recommended, and the techniques used may vary depending on the indications for the procedure. Your surgeon will explain the process in detail if you are a candidate.

Nose

Common Conditions

Chronic sinusitis – Chronic sinusitis refers to inflammation of the lining of the sinuses typically present for more than 12 weeks. Patients with chronic sinusitis may have problems with recurrent sinus infections and may also have issues with symptoms of facial pain/pressure, headache, stuffiness, nasal drainage, or diminished sense of smell. Your doctor may recommend a CT scan of the sinuses to help make a diagnosis.

Deviated septum – The septum is the structure that divides the right side of the nose from the left. It is made of cartilage and bone, and is covered by nasal mucous membrane. Deviation refers to bowing of the septum to one side or the other, and can sometimes lead to a feeling of blockage in the nose. Some people are born with deviations of the septum. Trauma to the nose is sometimes a contributing factor. Some people may require surgery to straighten the septum.

Nasal polyps – Nasal polyps are abnormal growths of the lining of the nose which can expand to fill the nasal passage and/or block drainage of the sinuses. Many patients with polyps also have nasal allergies. Symptoms typically include a blocked sensation in the nose and often decreased sense of smell. Small polyps may not cause any noticeable symptoms. Treatment can include a combination of steroids (steroid nose spray and/or pills) and sometimes surgery to remove the polyps.

Common Surgical Procedures

Endoscopic sinus surgery – Endoscopic sinus surgery is performed with the patient under general anesthesia in an operating room, and involves the use of small telescopes and surgical instruments placed through the nose. The normal sinus openings are widened, and partitions separating certain sinuses are taken down. Most patients go home the same day of surgery.

Balloon sinuplasty – Balloon sinuplasty is a newer technique which involves the use of small catheters and balloons (similar to those used to open blocked blood vessels in an angioplasty procedure) to widen the openings of the sinuses. Your doctor will advise you if you are a candidate for this procedure.

Septoplasty – Septoplasty is a surgical procedure to straighten the nasal septum. It is usually performed under general anesthesia with patients going home the same day. Often splints are left in the nose for about one week.

Throat

Common Conditions

Tonsil & adenoid problems – The tonsils and adenoids are parts of the immune system, and are similar to lymph nodes located throughout the neck and body.  The tonsils are ball-like masses of tissue on either side of the back of the throat, and the adenoids are a mass of tissue high in the throat behind the nose.  The adenoids cannot normally be seen through the nose or mouth.  Large tonsils can cause obstruction of the throat which can cause breathing problems or swallowing difficulty in both children and adults.  Similarly, large adenoids may cause a blockage of nasal airflow or even cause fluid to build up in the middle ears.  Tonsil and adenoid infections can be frequent and severe, causing pain, swelling and difficulty breathing or swallowing.

Snoring / obstructive sleep apnea (OSA) – Snoring and obstructive sleep apnea are common problems that can affect adults and children.Snoring can disrupt sleep for the person snoring or their bed partner.  Snoring is often, but not always, associated with sleep apnea.  Sometimes surgical intervention can help certain patients, but there are also non-surgical ways to help alleviate snoring.  Your doctor can counsel you further.Sleep apnea is a condition in which a person temporarily stops breathing during sleep.  When this is caused by blockage of the airway, it is termed obstructive sleep apnea.  Possible causes of airway obstruction include deviation of the nasal septum, large tonsils, a long soft palate, and enlargement of the base of the tongue.  OSA is often diagnosed with a sleep study (polysomnogram). Treatment options include a continuous positive pressure airway (CPAP) machine, surgery, and jaw repositioning devices.

Vocal cord disease – The vocal cords serve two main functions: protecting the airway during swallowing, and voice production.  Swallowing problems and voice changes can sometimes be a sign of problems with the vocal cords.  Otolaryngologists diagnose and treat a wide range of vocal cord and laryngeal (“voice box”) problems.

Laryngopharyngeal reflux – Gastroesophageal reflux disease (GERD) occurs when acid and digestive enzymes from the stomach back up into the esophagus.  If the reflux backs up all the way to the throat and back of the nasal airway, it is termed laryngopharyngeal reflux (LPR).  Symptoms of LPR can include sore throat, voice hoarseness, cough, difficulty swallowing, frequent throat clearing, or a feeling of a lump in the throat.  Usually a combination of medication and lifestyle changes is recommended.

Common Surgical procedures

Tonsillectomy & adenoidectomy – Removal of the tonsils and adenoids may be recommended for a variety of reasons. Common indications for surgery include large tonsils and adenoids causing obstruction of the nose and throat, and frequent infections.  Tonsillectomy and adenoidectomy are performed under general anesthesia in the operating room, and most patients go home the same day.

Uvulopalatopharyngoplasty (UPPP) – UPPP is the most common surgical procedure performed for obstructive sleep apnea in the U.S.  It involves removal of the tonsils (unless they’ve been previously removed) and removal of a portion of the soft palate, including the uvula (the punching bag-like structure which hangs from the soft palate).  Removal of these structures provides more space in the back of the throat.  Snoring usually improves, and some patients may even be cured of their sleep apnea with this procedure.  Your doctor can advise you further if you are found to be a candidate for this procedure.

Laryngoscopy – Laryngoscopy is a diagnostic procedure during which the surgeon examines the voice box (larynx).

Head & Neck / Thyroid

Common Conditions

Head/neck cancer – There are many types of cancer that can involve structures of the head or neck.  The most common type of head and neck cancer is squamous (pronounced skway-mus) cell cancer, which can arise from the surfaces of the nose, mouth and throat.  Common risk factors for this type of cancer are smoking and alcohol consumption, but other factors like genetics and exposure to certain viruses also can impact a person’s chance of developing squamous cell cancer.  Common symptoms/signs associated with head and neck cancer include: painless lumps in the neck (in adults), swallowing problems, voice changes, coughing up blood, and unexplained weight loss.

Thyroid disease – The thyroid gland is a butterfly-shaped organ that sits low in the front the neck.  Its main function is to produce thyroid hormone, which helps control the metabolism of cells in the body.  Thyroid disease is very common, and can include alteration in the hormone production of the thyroid gland (ie. too much or too little hormone production), an enlarged thyroid gland (goiter), nodules (lumps within the gland), or thyroid cancer.  Evaluation of the thyroid gland usually involves physical examination by your doctor, bloodwork to assess the function of the gland, and sometimes an ultrasound to examine the structure of the gland.  For more information about thyroid disease, consult the American Thyroid Association (www.thyroid.org) or American Academy of Otolaryngology – Head & Neck Surgery (www.entnet.org ).

Parathyroid disease – The parathyroid glands are small, pea-sized glands that reside next to the thyroid gland low in the neck.  Most people have four parathyroid glands.  They secrete a hormone (parathyroid hormone) which helps regulate calcium levels in the body.  Abnormalities of these glands can result in a variety of problems including kidney stones and osteoporosis.  Sometimes surgery is needed to remove one or more abnormal parathyroid glands.

Salivary gland disease – There are three sets of major salivary glands: the parotid glands (in front of the ears within the cheeks), the submandibular glands (walnut-sized glands under the jawline in the chin area) and the sublingual glands (under the lining of the mouth beneath the tongue).  The lining of the mouth also contains hundreds of small, minor salivary glands beneath the surface.  Problems that can occur in the salivary glands include: infections, tumors, and “stones” (similar to kidney stones) which can block the flow of saliva into the mouth.

Common Surgical Procedures

Thyroidectomy – Removal of all or part of the thyroid gland may be performed for a number of reasons, including: the presence of a nodule (mass), thyroid cancer, or enlargement of the gland. Thyroid surgery is performed under general anesthesia in the operating room, and patients usually spend the night in the hospital.

Parathyroidectomy – The most common reason for removal of a parathyroid gland is the overproduction of parathyroid hormone, which is often due to a single, overly-active gland called an adenoma.  Surgery is performed under general anesthesia in the operating room, and patients stay in the hospital overnight in order to closely monitor blood calcium levels after the procedure.

Salivary gland excision

  • Parotidectomy – Common reasons to remove all or part of the parotid gland include the presence of tumors or chronic inflammation of the gland.  Parotid surgery is performed under general anesthesia.  The nerve that controls most of the facial movement on each side (facial nerve) exits the skull and branches within the substance of the parotid gland.  Surgery of the parotid gland, therefore, involves careful identification of the facial nerve and its branches in order to keep them safe.  Often a special device called a nerve monitor is used to help provide an additional measure of safety.
  • Submandibular gland excision – The roughly walnut-sized submandibular glands sit below the jawline in the chin area.  There is one gland on either side of the chin/neck.  Common reasons to remove one or both of these glands include chronic inflammation, tumors within the gland, or the presence of stones within the ducts that drain the saliva from the glands (similar to kidney stones).  The surgery is performed under a general anesthesia, and involves an incision below the jawline on the side of the neck.