What is Doctor, please explain?
Doctor, please explain is a brief explanation of medical disorders treated by the physicians at Southwest Ohio ENT Specialists, Inc. This page is not intended to be a complete source of information, but merely an introduction to some of the common ENT medical problems. For additional information please ask your doctor or consult one of the recommended medical websites.
An infection of the lymphatic tissue in the back of the nose, above the mouth. These infections are more common in children as the adenoid pad tends to regress with age.
A condition where sinonasal symptoms are produced by inhaled irritants. The local manifestations include: nasal congestion, runny nose, sneezing, posterior nasal drip, itchy/watery eyes and cough. This condition can be caused by seasonal allergens, perennial allergens or chemicals such as fumes, smoke, or strong perfumes. This condition can be treated with antihistamines, nasal steroids, decongestants or combinations thereof.
Ankyloglossia or tongue tie
A condition seen mainly in children. This occurs when the frenulum or soft tissue band from the tongue to the floor of the mouth is congenitally too short. This may cause feeding difficulties in the young child or speech problems in the older child. A simple operative procedure can be performed where the band is incised allowing full mobility of the tongue.
Conductive Hearing Loss
When the normal transmission of sound waves from the ear drum to the inner ear is disrupted. Possible examples include: a hole in the ear drum, ear wax or foreign body in the ear canal, ear infection or ear fluid, and scaring, fracture or loss of the ear bones.
A condition where the tympanic membrane, or ear drum, has pulled back upon itself. This negative pressure behind the ear drum is secondary to long-standing Eustachian tube dysfunction. This flask shape structure now has trouble handling the sloughing skin and it collects in the "flask" and continues to grow. With the addition of water, bacteria and natural enzymes this "sack of skin cells" can become aggressive and destroy normal ear structures. The hearing mechanism, balance organ or facial movement can all be affected by this process. In untreated cases a brain abscess can form. The mainstay of treatment in the healthy individual is surgical removal and prevention.
Deviated Nasal Septum
An anatomical description of the normal septum being malpositioned. Usually, the septum should divide the nasal passages equally. If in utero, during birth or as a result of trauma, the septum fractures or grows crooked, breathing can be hampered. Many times this will lead to sinus problems even if the restricted breathing has gone unnoticed. Surgical correction of the septum attempts to replace and remove the cartilage and bone that become misaligned.
The medical term to describe trouble swallowing. It can occur from many different causes. These are divided into intrinsic and extrinsic factors. Intrinsic factors would include tumors, loss of muscular coordination or edema from reflux disease. Extrinsic factors would include pressure from thyroid masses, enlarged lymph nodes and pulling secondary to scarring in the neck.
The medical term for nosebleeds. These are divided into anterior and posterior. Anterior bleeding is the most common and the easiest to treat. Posterior bleeding can be caused by atherosclerosis (hardening of the arteries) and is many times much more difficult to treat. Nasal packing or cautery is the mainstay of treatment.
Eustachian tube dysfunction
A condition where the natural function of the eustachian tube is temporarily or permanently non-functional. This common problem of children is due to anatomic problems in the eustachian tube angle. Most of the time, this problem resolves around nine or ten years of age. It occasionally recurs with allergic rhinitis or a severe upper respiratory infection. Often, it progresses into adulthood and requires medical therapy or tympanostomy tube placement. If ignored severe retraction of the tympanic membrane can occur leading to a Cholesteatoma.
An abbreviation for Fine Needle Aspiration. This is performed by a pathologist or a radiologist with a special ultrasound or CT equipment. A very small piece of a head and neck mass is removed and observed under a microscope for diagnosis. This test is about 95% accurate.
Gastroesophageal reflux disease or GERD
GERD occurs when stomach acid escapes the stomach to irritate the lining of the esophagus. This common phenomenon can cause changes in the lining of the esophagus over time. Increased intra-abdominal pressure or lowered esophageal pressure are two mechanisms of this "reflux" action.
A term to describe an enlarged thyroid gland. The enlarged gland may have many nodules (multinodular goiter), just one or none. This condition is caused when the thyroid is told to grow from chemicals in the brain. The actual thyroid chemical levels in the blood may be low (Hypothyroidism), high (Hyperthyroidism) or just right. The low and high conditions usually require treatment to prevent complications. Examinations in the office and with special ultrasound waves will help the doctor observe any new or growing nodules. If a nodule grows larger than the rest, FNA biopsy would be indicated to rule out a thyroid cancer.
A condition usually discovered after noting a high blood calcium level. It can also be diagnosed after a suspicious history of kidney or gall stones. The parathyroid glands are located behind and near the thyroid gland. The number ranges from four to as many as eight. These small secreting glands are responsible for maintaining body calcium levels. Often an enlargement causes symptoms of high calcium levels. Treatment of an enlarged gland is surgical removal. Cancer of these glands has been reported to be 1% or less.
An overactive thyroid gland. Symptoms include heart palpitations, sweating, weight loss, anxiety and jitteriness.
An under active thyroid gland. Symptoms include fatigue, weight gain, dry skin and brittle hair.
Laryngopharyngeal Reflux or LPR
A similar condition to GERD. Patients with LPR may not have the typical “heartburn” symptoms, but often complain about a sore throat, throat clearing, voice loss or difficulty swallowing. In severe forms this may cause nocturnal laryngospasm and a “smothering” or “choking” sensation that awakens the patient from sleep. This condition is more easily identified by an Otolaryngologist than by a Gastroenterologist.
A term to describe “white patches” in the mouth or laryngeal area. These areas occur as a result of chronic irritation by mechanical sources such as dentures or chemicals from tobacco products. The early stages of this condition are usually benign, but can become malignant. When the color changes from only white to red and white, the lesion is more worrisome. Treatment includes close observation for changes or growth and biopsy to rule out early cancer when appropriate.
A condition of multiple symptoms that occur in “episodes” or “spells”. The classic grouping of symptoms include fluctuating hearing loss, true spinning dizziness (vertigo) and a ringing, buzzing or humming sound in the ear (tinnitus). The dizziness will last from several minutes to hours. The ear symptoms usually occur and abate with the spinning sensation. Often patients describe a fourth symptom of a clogged up or fullness in the ear. Association with weather changes, menstrual cycles, allergies, stress and upper respiratory infection has been noted. Medical management consists of monitored salt intake and water diuretic use. Surgical intervention is reserved for refractory cases.
Mixed Hearing Loss
When both sensorineural and conductive components exist simultaneously.
A traumatic event where the nasal bones have been broken. The bones can be displaced and crooked or still in their normal position. The diagnosis is most often made with the clinical exam. Typically, bleeding and edema resolve around day 5 after the trauma. This is the best time for evaluation. If the clinical exam indicates a fracture and the appearance is altered, “resetting” the nose may be advised. If the appearance has not been altered conservative therapy is indicated and surgery can be avoided. Septal hematoma and cartilage fracture must also be ruled out in this scenario.
Medical term for painful swallowing. See dysphagia also.
A condition where one or more of the ear bones fuse and cause a conductive hearing loss. It is more common in females in their 20’s to 30’s, but can be seen in both sexes and at all ages. The diagnosis is made with a normal ear exam and hearing loss on the audiogram. Often tuning fork tests are done to confirm the suspected diagnosis. Treatment consists of either hearing amplification or surgical repair of the fused bones. Often this process becomes bilateral resulting in severe hearing deterioration.
These are irritants found year round. They include dust mites, cat/dog dander and mold. Often, patients are sensitive to perennial allergens at baseline and will have additional reactions to the seasonal allergens. These patients experience problems all year with "flare-ups" in the spring and fall.
An abscess from a tonsillar infection in the space between the tonsil itself and the muscular back wall. The pus material collects in this area and does not have a route of escape. Often, the soft palate and uvula are swollen. Symptoms include: pain, fever, foul taste in mouth, bad breath, and difficulty opening the mouth. Treatment for this condition includes incision and drainage of the abscess and oral antibiotics. Often after experiencing an abscess your doctor will recommend removal of the tonsils to prevent recurrence.
Posterior Nasal Drip
The increased passage of mucus from the nasal area into the oropharynx, or posterior mouth and throat. Normally, mucus drains into the stomach at a rate of two quarts per day. When the production or clearing of mucus exceeds that rate the sensation is felt as “extra” mucus. This condition is often caused by allergic rhinitis or vasomotor rhinitis.
Nerve hearing loss occurring as a result of the aging process. The degree of loss is often variable and can occur at different age levels.
The loss of normal stability due to the incremental and age-related changes of the inner ear balance system.
Allergens occurring with outdoor exposure. They include flower pollen, grasses, tree pollen and weeds. They are worse in the spring and fall seasons. These irritants are usually gone by the first “hard frost” when plants die from the low temperatures.
Sensorineural Hearing Loss
Often called “nerve” deafness. This type of loss occurs when the sound reaches the ear nerve, but doesn't travel effectively to the brain. This problem is known to occur with aging and is called Presbycusis. The higher frequencies are usually the first to be affected. Sometimes the ability to understand speech in a crowded environment or on the phone will be the first signs of a change in the hearing. There is currently no medical or surgical solution to regain normal hearing. Amplification in the form of hearing aids is usually recommended based on the degree of the loss. Cochlear Implant technology is a new form of hearing restoration currently limited to those adults and children with complete bilateral hearing loss.
A condition where blood collects between the coverings of the septal cartilage and bone. This problem demands urgent evaluation and drainage. If the blood supply to the cartilage is denied for a period of time the cartilage will die and a poor cosmetic result will occur. This can be accomplished in an office setting for adults, but usually requires operative intervention for children.
A term to describe infection or inflammation of the salivary gland. It most often occurs in the glands below the mandible or jawbone called the submandibular glands. It also occurs (less commonly) in the large salivary glands in front of the ears called the parotid glands. Dehydration, infection and stones are commonly found causes.
An infection of the nasal sinuses that can be acute or chronic. Acute symptoms include facial tenderness of pain, headache, thick nasal drainage and fever. These symptoms are usually easily treatable with a course of antibiotics and symptomatic relief. Causative factors include allergies, the common cold and structural deformities of the nose. These problems cause blockage of the nasal passages resulting in stasis of secretions and infection. Chronic sinusitis is a condition where acute symptoms flare up periodically over at least a three month period. These patients require frequent doctor visits for antibiotics and have many days out of work or school. Special x-rays and surgery are many times needed to help reverse this condition.
A condition which can be described as obstructive or central. Central apnea is a brain functioning problem where the brain forgets to tell the body to breath during sleep. This is treated by Neurologists. Obstructive apnea is caused by a blockage of the normal airways when relaxation occurs during sleep. This may be due to large tonsils, a long palate, tongue collapse or obesity. Children and adults are treated differently. Most often in children large tonsils are responsible for blocking the airways. Therefore, a tonsillectomy is the treatment of choice. In adults, the tonsils have usually regressed and are rarely the main cause of the problem. CPAP or continuous positive airway pressure is the gold standard treatment for obstructive apnea in adults. When this fails or is not tolerated, surgical intervention can be considered. Treatment directed at the most likely source or sources of obstruction is most likely to be curative.
Irritation or infection of the tongue or oral soft tissues. It is a non-specific term to describe all of the possible etiologies that can occur in that area.
Temporomandibular Joint Disorder
A condition of irritation of the jaw hinge joint. It is most often caused by bruxism, or teeth grinding. It can cause pain in the ear or jaw area. It is also associated with a sensation of fullness or decreased hearing in one or both ears. The mainstay of treatment is anti-inflammatories such as ibuprofen. Often a dentist will suggest a bite device or surgery to correct the problem.
A term to describe a ringing, buzzing or humming sound in the ear. It can be heard in one or both ears together. Most often it is a static sound, but occasionally patients describe a pulsating character. This symptom is characteristic of many different problems. Rarely, it can lead to the diagnosis of a more severe condition. ENT examination and audiometrics should be performed to facilitate the diagnosis of the underlying problem.
An infection of the lymphatic tissue in the back of the throat area. It can be bacterial or viral. The most common bacterial infection is Streptococcus and can easily be tested for with a throat swab. One of the common viral etiologies is the mononucleosis virus.
An inflammatory condition of the thyroid gland. It can have many causes, but Hashimoto’s thyroiditis is the most common. Painful palpation of the gland is often a chief complaint. In this condition antibodies attack the thyroid and create an inflammatory response. The blood levels of thyroid hormone usually are high in the early phases of disease. As the gland begins to lose function, the hormone levels become normal then finally low. Thyroid hormone supplementation is necessary for symptomatic patients. Surgery is rarely necessary and no specific treatment to avoid this condition has been developed. Many times the diagnosis is made after FNA biopsy or surgical biopsy when cancer has been a concern.
These are small artificial grommets that fit in the ear drum. They are primarily used in children, but are many times needed in adults. There are many different shapes, colors and styles of tubes. Some tubes are designed to last for a standard time, others are meant to last for many years. Nevertheless, the same tube in two different children might fall out sooner or later based on many factors. Generally, the tube should last between six months and one year. The purpose of the tube is to equilibrate the pressure on either side of the ear drum. The most common indication for placement is eustachian tube dysfunction that causes chronic otitis media or persistent serous otitis media.
A condition of nasal congestion, runny nose and/or posterior nasal drip. It is not thought to be allergen mediated, but more a problem with “leaky” mucous lakes in the nose. “Squeezing” these lakes closed may treat the symptoms. Medications used include nasal steroids, decongestants and “anti-mucous” nasal sprays. Each individual patient may require a different medication for symptom resolution.
A term to describe a sensation of spinning. Vertigo can make the patient feel that he or she is spinning or that the world is spinning around them. This symptom usually implicates an inner ear problem. Work up should include ear evaluation with inspection and audiometrics. Many times balance testing or radiology studies are necessary to determine the cause of the vertigo. One should remember that vertigo is a symptom of a problem, NOT a diagnosis itself.
Vocal Cord Paralysis
A condition where one or both of the vocal cords do not move effectively. This may be caused by an upper respiratory infection, a tumor of the vocal nerve, a tumor pressing against the nerve or by previous surgery in the neck. Many times CT scans or vocal cord analyses are necessary to find the cause of the problem. Even with extensive investigations, the cause sometimes remains undetermined.