Frequently Asked Questions


Ear & Hearing
Audiologists

An Audiologist is a professional who evaluates and treats people with hearing loss and balance disorders. Audiologists have extensive training (at least a Masters level degree) to evaluate infants to adults to determine the best intervention, whether it be medical or amplification.

Audiologists perform comprehensive audiological evaluations for people of all ages, counseling, evaluating for and fitting of hearing aids and other assistive listening devices, cochlear implant rehabilitation, hearing conservation, balance testing, brainstem testing, and newborn hearing screenings.

Audiologists have a Masters or Doctoral degree from accredited universities with special training in the prevention, identification, assessment, and non-medical treatment of hearing and balance disorders.

Hearing in Children

Otoacoustic Emissions (OAEs) are sounds generated within the cochlea of nearly all normal hearing ears by active biomechanical processes within the outer hair cells. OAEs are present in all normal ears, therefore it can be assumed that the absence is a sign of irregular cochlear function which could result in a hearing loss. Otoacoustics are used to screen infants and difficult to test patients to determine if a hearing loss is present.

Each child develops at his/her own pace. Below are some guidelines to your baby's hearing and speech development. Birth to 3 months: startles at sudden noise, recognizes your voice, and quiets when spoken to. 3 months to 6 months: turns towards interesting sounds and appears to listen, awakes easily to sounds. 6 months to 12 months: turns head towards soft sounds, understands no and bye-bye, begins to imitate speech sounds. 12 months + :says first words i.e. da-da, bye-bye, and ma-ma.

  • Family member with permanent hearing loss since childhood. 
  • Serious infection present at birth (i.e. herpes, syphilis, German measles) 
  • Difficult birth or delivery which affected baby's breathing 
  • Cranio-facial abnormalities (i.e. cleft palate, malformed ears) 
  • Baby requiring NICU for 2 or more days following birth 
  • Disorder or infection of the brain (i.e. meningitis) 
  • Blood exchange or transfusion
Hearing Aids

More than 24 million Americans have some type of hearing problem. Hearing difficulties are often unrecognized by the person involved. Children and teenagers seldom complain about the symptoms of hearing loss, and adults may lose their hearing so gradually, they do not realize it is happening.

The first step in determining the need of a hearing aid is a comprehensive evaluation by an Audiologist. The Audiologist will ask you a series of questions, look in your ears with an otoscope and complete a comprehensive evaluation of your hearing. With all these results in hand, it will be determined if your hearing loss warrants a medical evaluation or a hearing aid.

There are different causes of hearing loss. Some can be treated with medication or surgery. Others can be helped through hearing aids. A complete hearing test should be performed by a certified audiologist to determine the nature and degree of hearing loss. The audiologist will determine if hearing aids can be of benefit. You should have your hearing evaluated if:

  1. The TV volume has to be increased beyond the comfort level  of others in the household;
  2. You have difficulty understanding voices over the telephone;
  3. It is hard to understand words when background noise is present;
  4. Friends and family appear to be mumbling.

Hearing aids can improve speech understanding in various listening situations and, thus, improve one's quality of life. Although older hearing aids were not liked, new digital and programmable technology permits many patients to wear them comfortably.

If your hearing loss is in both ears, two hearing aids are better than one. A hearing aid in each ear results in: better speech understanding in noisy places, better sound localization, better sound quality, improved distance hearing, improved sound identification, less exertion to hear, and a feeling of balance.

Research shows that when only one ear is aided, the unaided ear's ability to understand speech and tolerate sound deteriorates. This is also true if the hearing loss is in only one ear.

First of all, you should make sure you see a licensed Audiologist or dispenser with a reputable history in your area. Once you have chosen whom you wish to work with, the following questions should be addressed.

  • Are several types or brands available?
  • Is there a trial period?
  • Is my money refundable if I decided not to keep my hearing aids?
  • Is there a contract with clearly addressed prices and return policies?
  • Is in office servicing available or will my hearing aid have to return to the manufacturer for repairs?
  • Is there a warranty including loss and damage included in the purchase price of the hearing aid?

That can vary from office to office. There are many hearing aids available for a couple of hundred dollars. Those hearing aids are typically not customized to an individual's ear or hearing loss, therefore should be avoided. Most professional offices offer hearing aids from $700 up to a few thousand dollars per aid. The more technologically advanced the hearing aid (i.e. computer programmable and completely in the canal), the higher the cost. One thing to keep in mind is not every hearing aid is suited for every individual. Even the most expensive aid may not be the right hearing aid for you.

Most people put off getting hearing aids for several years. We have all heard the stories of how Aunt Bea's hearing aids just sit in her drawer or how Uncle Ed still can't hear with his hearing aids. Unfortunately, these stories are told all the time, so why should one rush out and order hearing aids? Recent advances in hearing aid technology have made them easier to use and provide better hearing. The newer technology allows for: automatic volume control, elimination of feedback, smaller size and improved speech understanding in noise. The latest digital technology incorporates a mini computer so adjustments can be made for a change in hearing loss or to tailor your hearing aids to match your lifestyle or hearing needs. Newer hearing aids are advancing us towards restoring hearing and allowing one to be involved in the extra activities once avoided because of poor hearing.

Hearing Protection

Typically individuals who are exposed to excessive noise demonstrate a high frequency hearing loss affecting the hearing nerve.

If a situation is in question, you should probably wear ear protection. Shooting a rifle one can have affects on your hearing down the road. People who work in noisy environments, i.e. factories, railroads, construction, etc. as well as those who expose themselves to loud noises at home, i.e. lawn mowers, drills, saws, chainsaws, etc., should always wear ear protection.

Exposure to sounds over 85dB are dangerous to the auditory system. These sounds may be generated by: lawnmowers, shop tools, truck traffic, rock concerts, automobile horns, jet engines, and gunfire.

OSHA has determined it is in the best interest of the employer and employee to enforce the use of hearing protection device in situations of 85dB of noise or greater over an 8 hour period. Louder sounds can do damage in a much shorter period of time.

There are several over the counter hearing protection devices available at local pharmacies and sporting goods stores. Most available have a Noise Reduction Rating (NRR) of 15 to 30 dB listed on the package. This rating is valid only if the ear plugs are properly inserted and continuously worn. Earmuffs which fit over the entire outer ear create a seal around the ear keeping the harmful effects of noise out. Earplugs and earmuffs may be used in conjunction with each other in instances of extreme noise (>105dB) and typically provide 10-15dB additional protection.

Electronic ear protection is available for those hunters with a hearing loss or those wanting to hear the sounds of the environment. The hearing protection device resembles a behind the ear or in the ear hearing aid and will amplify the sounds around although as soon as a shot is fired or loud noise is present, the circuit will shut down acting as a ear plug. Typically this electronic ear protection is available through hearing healthcare professionals and is custom made to the ear.

Audiological Tests

An ENG evaluates the balance function of the inner ear. It is a test pertinent to the recording of involuntary eye movements, nystagmus, and helps to determine the origin of the problem.

An ABR is a test which measures the speed of electrical impulses along the acoustic nerve from the inner ear to the brainstem.

EcoG is a measure of the electrical potentials within the auditory system. As the auditory system is stimulated by an acoustic signal, it causes a change in the electrical potentials of the sensorineural mechanism that can be monitored through electrodes placed on the head and in the ears. This test is used to identify cochlear/endolymphatic hydrops for patients with dizziness.

An Epley maneuver, also known as canalith repositioning, is a therapeutic procedure which relieves symptoms for patients who have periods of brief spinning dizziness associated with position changes. These patients are identified as having benign paroxysmal positional vertigo (on the ENG) before this procedure is performed.

A tympanogram is a measurement of ear canal volume, middle ear pressure and compliance. A tympanogram will detect fluid, a perforation in the eardrum, function of a pressure equalization tube, ossicular disarticulation, as well as a healthy middle ear.

The audiogram is a graphic representation of the ability to hear tones. The hearing is tested from 250 Hz to 8000 Hz (low frequency to high frequency tones). The left ear's responses are noted with an "X" and the right ear's responses are noted with a "O". There are varying degrees of hearing loss. Normal range is from 0-25dB, mild hearing loss range is 25-40 dB, moderate hearing loss range 40-60dB, moderate-severe hearing loss range 60-75dB, severe hearing loss range 75-90dB, and above 90dB is the profound hearing loss range. The ability to understand a list of 25 words is measured at a comfortable listening level and then the % of words correct is recorded. This test is the speech discrimination score. The speech recognition threshold score is the softest level at which words can be repeated 50% of the time.

Tinnitus

Tinnitus is the name for noise in the head. It is commonly described as ringing, crickets, and buzzing which may be constant or intermittent. Nearly 36 million American suffer from tinnitus and more than 7 million people can not lead normal lives due to these head noises.

The most common causes of tinnitus are age-related hearing loss and loud noise exposure. Tinnitus my be a symptom of a serious middle ear infection, a hole in the eardrum, fluid in the middle ear, or stiffening in the ossicles (middle ear bones). It may also be a symptom of a more serious head or neck aneurysm or tumor. Tinnitus may also be caused by allergies, high or low blood pressure, depression, diabetes, and damage to the auditory nerve.

There usually is no specific treatment for noises in the ear or head. Most causes of tinnitus can not be readily identified therefore treatment is difficult. However, examination by your ENT physician and audiologist is important to check for treatable and serious causes tinnitus.

Make every effort to: avoid exposure to loud sounds; have blood pressure checked, if high seek medical attention; decrease intake of salt; avoid caffeine and nicotine; rest and avoid overexertion; reduce stress; and try your best to ignore the noises.

Hearing aids may help reduce the head noise and occasionally they will go away. Often times a person with a hearing impairment will be hearing speech and environmental sounds much better with the hearing aids so the tinnitus takes a back seat and is less noticeable, although it may still be there.

Swimmer's Ear

Inflammation or infection of the ear canal is external otitis (swimmer’s ear). Swimming pool chemicals as well as lakes, rivers and oceans can irritate the canal lining causing swelling, itching, pain and the overgrowth of bacteria in the ear canal. Cotton tip applicators (e.g. Q-tips) and frequent cleaning of the ear can destroy the normal protection mechanism of the ear canal. Treatment consists of avoiding the cause of the irritation and then usually ear drops are prescribed, which may have an antibiotic, anti-inflammatory, adjusted to a pH that will deter further germ growth. For more severe swelling the doctor may place a small cotton "wick" in the ear to keep the canal open and allow the drops to penetrate better.

Otitis Media

The Eustachian tube which allows ventilation of the middle ear from the nose does not function as well in childhood until the skull matures allowing easier clearance of fluid and better ventilation of the ear in later childhood.

Children or adults with eustachian tube problems are more prone to ear infections, persistent fluid behind the ear drum and hearing loss. Fixing the eustachian tube itself is difficult because of its location at the skull base and proximity to the carotid artery. Therefore a way to bypass this dysfunction and allow proper ventilation of the middle ear, releasing the fluid and improving the hearing is by placing a small tube into the ear drum.

Tubes can be inserted by your ENT physician in most adults and older children in the office with local anesthesia. Younger children will require a brief general anesthetic while a small incision is made in the ear drum, the fluid is then removed and a tube is place within the incision. Results are often immediate with improved hearing and less ear discomfort shortly after surgery.

If ear infections are not treated and followed until completely resolved the persistent fluid will often cause hearing loss which can delay speech development in young children. Also, if the fluid remains infected and appropriate antibiotic therapy is not initiated, the infection can advance to injure the bones for hearing, the balance center, the nerves for hearing, taste and facial movement, and most seriously can infect the brain.

Immediately after the tubes are placed thick or even bloody drainage is fairly common for a few days. Using the prescribed drops after surgery will help, and if not, you should contact the office. Later on (weeks or months) drainage may recur especially if the patient has a cold, stuffy nose, or ear infection. The drainage is a sign that the tubes are working. Drops should be restarted, and you should contact the office or your primary care doctor.

Eardrum Perforation

An eardrum perforation alone may not be harmful if there are no signs of infection, drainage, or hearing loss. Most eardrum perforations heal without any surgery.

If a perforated eardrum does not spontaneously heal or shows signs of infection or damage to hearing. An ENT surgeon will often surgically explore the ear, and try to find the underlying cause of the perforation, and repair the eardrum with a thin layer of tissue taken from the patient.

Cochlear Implants

Cochlear implants are surgically implanted devices to provide sound information by directly stimulating the cochlea's remaining healthy nerve fibers. People who use cochlear implants received little to no benefit from hearing aids and without their implants are profoundly hearing impaired. With their implants these individuals can detect sound at conversational levels.

French researchers stimulated the auditory nerve in the late 1950's . Since then, implants have been in development around the world. They have evolved from a single electrode to a multichannel electrode.

Adults: a severe to profound sensorineural hearing loss (>70dB), unable to understand speech through the use of hearing aids, 18 years or older, deafened after learning oral speech and language, desire and are motivated to be part of the hearing world.

Children: profound sensorineural hearing loss in both ears (>90dB), age 2 to 17 years, little or no useful benefit from hearing aids, high motivation and appropriate expectations (both family and child), placement in an educational program that emphasizes auditory skills.

A hearing aid amplifies sounds. A cochlear implant provides useful sound information by directly stimulating the surviving auditory nerve fibers in the cochlea by bypassing the damaged parts of the ear.

The internal components are surgically implanted completely under the skin and consist of an electrode array inserted into the cochlea and a receiver attached to the electrode array. The external components include a speech processor (a little larger than a pager), a headset with microphone, a transmitting coil, and cables which attach all external components together.

Sounds are picked up by the microphone and via a thin cable, the sound is sent to the speech processor. The speech processor amplifies, filters, and digitizes sound into coded signals. These coded signals are then sent to the transmitting coil via the cables and the transmitting coil send the signal across the skin to the implanted receiver. The receiver stimulates the electrode array and the nerve fibers are stimulated. The electrical impulses are delivered to the brain and interpreted as sound.

BAHA System

The BAHA system is an implantable prosthetic device specifically designed for patients age five and older with mixed or conductive hearing loss as well as those with Single Sided Deafness.

No. The BAHA system combines a sound processor (worn externally) with a small titanium fixture implanted behind the ear. The BAHA system does not have in-the-ear components that can often contribute to and aggravate inner ear infections and/or block sound.

The BAHA System is the only implanted treatment for hearing loss that works through direct bone conduction. It uses bone tissue to transfer sound to a functioning cochlea. It does not rely on amplification to improve sound tone or quality.

Nose & Sinus
Sinus

Sinusitis is inflammation of the sinuses caused by infections (bacterial, viral, or fungal) and/or allergies. Acute sinusitis is very common and usually lasts less then 2 weeks, where chronic sinusitis can last months and is much more difficult to treat.

Nasal polyps are grape-like outpouchings from the nasal sinus linings that are usually indicative of an allergic component to the sinus disease. They often obstruct the normal sinus drainage and airflow creating more congestion, infections and decreased sense of smell.

In general, the treatment of sinusitis depends on the duration and severity of the symptoms. Most often multiple medications such as an antibiotic(fights bacterial infections), decongestant (allows drainage), mucolytic (thins mucus), corticosteroid (reduces inflammation), and nasal irrigation are prescribed. There are many appropriate medications in each of these categories and the best treatment plan must be individualized. Infrequently, sinus surgery is needed for acute uncomplicated sinusitis.

Sinus CAT scan or CT is used to evaluate patients with recurrent or chronic sinus symptoms who are not responding to medical treatment. These symptoms may include nasal congestion, sinus drainage, facial pain or pressure and headaches. Your doctor may also order a sinus CT if an abnormality is identified in physical examination. A sinus CT provides detailed information about sources of nasal obstruction, sinus drainage pathways and the presence of infection. Specific anatomic abnormalities' which may be causing sinus symptoms can be easily identified. The information obtained from a sinus CT is critical to effective treatment. Changes in medical therapy or safe, well-tolerated outpatient surgery to correct anatomic abnormalities often lead to improvement in your symptoms. With the latest technology, your sinus CT can be linked with a computer-guided system that makes surgery even safer and more effective.

CT scans are very helpful in patients with chronic refractory sinusitis, complications of sinusitis and suspected malignancy. In addition, it is helpful for the evaluation of anatomy prior to sinus surgery.

Surgery is most beneficial in symptomatic patients with mechanical obstruction to sinus drainage and those with persistent infections that have failed medical therapy. More urgent sinus surgery may be indicated when the eye or brain (which surround the sinuses) are affected by the sinus disease.

When the above indications are met, sinus surgery usually has a dramatic impact on the patients’ symptoms. The patient may still require medication and irrigation to prevent further inflammation and the re-development of sinus obstruction. In the unusual case where the symptoms are not relieved or they recur quickly, the ENT surgeon may investigate other causes such as allergy or Immune-system problems that may be underlying these refractory cases.

The majority of contemporary ENT sinus surgeons use a technique in which small telescopes are placed in the nose for precise visualization of the sinus obstruction, removal of the diseased tissue, and opening of the natural sinus drainage holes, with less trauma to the normal tissues, allowing quicker healing, less packing, and no facial incisions, as compared to traditional sinus surgery.

Surgery is often ambulatory, pain is usually minimal, and most patients return to work in less than one week. Nasal cleaning and irrigation are done frequently for about the first month after surgery until the nasal lining is clean and well healed.

Endoscopic sinus surgery has advanced the treatment of many nasal problems without external incisions and with little or no packing needed. New CT scan guided visualization systems have been developed to more safely visualize and treat more advanced or difficult sinus problems. Charleston ENT Associates are the first physicians to have this technology available in the Charleston area.

Allergies

Based on your ENT evaluation, history, examination, x-rays, and other positive things in your environment your doctor has suggested that allergy is probably a major cause of your problems. Therefore, a complete allergy work-up and allergy management program needs to be started for you.

The first phase of testing is a prick test. A multi-prick device is used on your forearms. It will test you for 32 of the most common allergens in our area. This test takes 20-30 minutes.

The second phase of testing is called IDT (Intradermal Titration). This test is done on your upper arms using tiny needles that go right under the top layer of skin. This test takes approximately 1 hour to complete. It will tell us how sensitive you are to the positive antigens. If your doctor determines you are a candidate for allergy shots, this information is needed to make the serum for you. After testing is completed, treatment for your allergies can begin. This process takes time to work and may often be continued for years, but will often bring long lasting relief.

Other treatments are less specific and include antihistamines, decongestant, and corticosteroid medicines that fortunately today are very safe and effective when used appropriately.

The best treatment for allergies is avoidance of the particular pollen, mold, dust, food or chemical that is causing the problems. Unfortunately, avoidance is easy to prescribe but not often practical. Self-help suggestions such as frequent changing of air filters, wearing pollen masks, enclosing mattresses in plastic barriers, keeping windows closed during heavy pollination seasons, removing feather pillows and wool blankets, ridding home of indoor plants that grow mildew. Some more difficult but important measures include avoidance of tobacco products and animals that produce dander.

Allergies can lead to infection. When the lining inside the nose is exposed to substances, to which a person is allergic, the lining swells. The swelling blocks the drainage openings of the sinuses, leading to mucous accumulation. As mucous lies trapped, it becomes infected, leading to sinusitis. Controlling allergies with medicines or allergy shots can treat the symptoms and may prevent sinus infections. In addition, an office-based procedure, radiofrequency turbinate reduction, can improve the nasal congestion caused by allergies. People who have suffered with long term allergies may have tissue damage that leads to chronic sinus infections. In this instance, Sinus Surgery can remove thickened obstructive tissue which prevents nasal drainage. The newest technology utilizes computer-guidance sinus surgery, significantly increasing the safety and effectiveness of this procedure.

Septum/Turbinates/Nasal Congestion

A "straight" septum is rather unusual, where a deviated septum is very common. It becomes a matter of degree of deviation and severity of nasal symptoms for which we consider fixing a deviated septum. Difficult nasal breathing, snoring, excessive drainage, sinusitis, headaches, nosebleeds and decreased sense of smell may be partly caused by septal deviation and can often be relieved by your ENT surgeon removing the deviated portion of the septum. The surgery is usually ambulatory with quick recovery and minimal pain.

The nose has 3-4 turbinates on each side. Their function is to humidify, warm and "filter" the air we inhale on its way to our lungs. Sometimes due to allergies or other inflammatory processes they become congested and swell to take up a lot of our nasal airway space. Often removal of the offending inflammatory cause will relieve this swelling, but if medical therapy fails surgical reduction of the turbinates may be needed. This can be performed by your ENT physician as an ambulatory procedure with minimal pain and recovery time.

A new procedure "radiofrequency reduction of the turbinates" has been developed recently to shrink the volume of the turbinates. By working under the surface of the turbinate, this can be safely performed in the office with little, if any, bleeding or pain, and the patient can go back to work the same day.

Surgery Center of Charleston is a JCAHO (the organization that inspects and accredits hospitals) accredited ambulatory surgery facility utilized for outpatient ENT surgical procedures such as ventilation tube placement, sinus surgery, ear surgery, tonsillectomy and adenoidectomy and throat and vocal surgery.

The facilities and equipment have been specifically designed to provide complete otolaryngology care in an efficient, "state-of-the-art" center.

The "InstaTrak" sinus technology for the surgical treatment of advanced, more difficult sinus disease is available in the Charleston area only in this facility.

Nasal stuffiness is caused by infections, allergies or anatomic blockages. Often the swelling inside the nose is temporary and symptoms improve. Decongestants, nasal sprays and nasal-opening, adhesive strips can help. If the congestion is constant or recurs, an evaluation by an Ear, Nose and Throat specialist is recommended. The anatomical blockage could be related to a fixed obstruction like a deviated septum that maybe corrected as an outpatient procedure. Packing is no longer used, so the procedure is less uncomfortable. Polyps and chronic sinus disease can often be helped with new computer guided sinus surgery. (More details in upcoming articles.) Finally, congestion could include being related to allergies, recurrent infections or environmental sensitivities that cause swelling of the turbinate tissue in the nose. A newer procedure, Radiofrequency Turbinate Reduction, can be performed in the office in about 15 minutes, and you can return to your regular activities immediately.

Before considering sinus or nasal surgery, patients need to have appropriate complaints, symptoms or structural abnormalities. Most should have been unsuccessfully treated with decongestants, antihistamines, antibiotics or nasal sprays. Prior to considering surgery both a complete endoscopic examination and CT scan evaluation of the nose and sinuses are imperative. At the SC Sinus Institute, we take your surgery seriously. Most nasal and sinus surgery is performed at our own accredited Surgery Center of Charleston, with state of the art instrumentation, including a computer guided surgery system and using only board certified anesthesiologists. Due to the precision of endoscopic surgery, usually no packing is needed, and patients often return to their normal routine in a few days. If you feel we may help you, please contact one of our offices.

Nosebleeds

Nosebleeds are caused most frequently by the common irritants (colds, sinusitis, dryness, nose-picking, for nasal medications, trauma). High blood pressure is a very common cause in the elderly. Bleeding disorders, foreign bodies and malignancies are much less common causes, but can be serious if not diagnosed and treated correctly.

The first thing to realize is that most nosebleeds will stop easily without losing a harmful amount of blood, even though it looks like a lot of bleeding. Start by pinching all the soft parts of your nose together between your thumb and two fingers, press firmly towards the face, compressing the pinched parts of the nose against the bones of the face. Keep head upright (not leaning back as this will cause blood to be swallowed which is irritating to your stomach) and pinch for at least 5 minutes. If bleeding persists clear the nose of the clots by sniffing forcefully, apply Afrin or Neo-Synephrine decongestant spray and pinch again for another 5 minutes. If this is not successful call your doctor and continue to hold pressure.

Throat & Neck
Tonsils/Adenoids

Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. They sample bacteria and viruses and can become infected themselves. Scientists believe they work as part of the body’s immune system by filtering germs that attempt to invade the body, an that they help develop antibodies to germs. This happens primarily during the first few years of life, becoming less important as we get older. Children who must have their tonsils and adenoids removed suffer no loss in their resistance.

Tonsillectomy (removal of tonsils) is recommended for people who experience frequent throat infections. Adenoideciomy (removal of adenoids) are recommended for recurrent ear or nasal infections. Other reasons to remove tonsils and adenoids is if they are enlarged, as this can cause obstructive symptoms, such as sleep apnea, swallowing difficulties, nasal sounding speech, dental malocclusion and even heart failure. Recent reports also link enlarged tonsils and adenoids to obstructive breathing and sleep apnea, which can cause poor concentration and irritability during the day. This can be confused with ADHD. These patients often improve significantly after removal of their tonsils and adenoids. This procedure rarely requires hospitalization and can be safely done in our surgery center.

The two most common reasons for removal of tonsils and adenoids are recurrent infection despite antibiotic therapy, and difficulty breathing due to enlarged tonsils and /or adenoids. Some orthodontists believe chronic mouth breathing from large tonsils causes malformations of the face and poor teeth alignment. Adenoids are very close to the Eustachian tube and when infected or enlarged can contribute to ear disease. Much more rarely tonsils are removed to check for the possibility of cancer in patients with very asymmetric tonsils or others signs of malignancy.

Patients having tonsillectomy and adenoidectomy are usually discharged the same day or within 24 hours after surgery. The general technique for removal is fairly constant between ENT surgeons with the difference being in the instruments used to remove the tonsils and to prevent bleeding. Overall the operation is very safe with the main major risk being bleeding. This happens in less than 5% of patients and is usually easy to control, but needs to be brought to the attention of your surgeon when it happens. Other risks such as anesthesia reaction, infection, scarring, and voice change are quite unusual.

The recovery after tonsillectomy/adenoidectomy varies between patients. If tonsils are removed for breathing problems the effects can be often noticed the first night The main complaint after surgery is throat and/or referred ear pain. Pain medicine usually relieves this discomfort until the wound is healed which can take up to two weeks. Patients are encouraged to drink plenty of liquids to avoid dehydration and then slowly advance their diet back to normal.

Snoring/Sleep Apnea

Obstructive sleep apnea is diagnosed when loud snoring is interrupted by episodes of completely obstructed breathing. This condition can be serious and sometimes fatal if not treated. The cumulative effects of these obstructed breathing episodes is reduced blood oxygen levels to the brain, forcing the patient to stay in a lighter sleep stage and preventing them from getting the rest benefit only achieved during deeper sleep. This can lead to a tendency to fall asleep during daytime hours, on the job, or worse at the wheel of a car. Also, over time the heart needs to work harder and other body systems are affected by sleep apnea.

The patients symptoms and physical examination often point to the diagnosis and then a sleep study (polysomnogram) is performed to confirm the diagnosis and to provide more details on the severity of the sleep apnea, which will then help in deciding the best treatment.

One out of four people is a habitual snorer. The problem is more frequent in males and the overweight and worsens with age. Socially snoring can be the source of resentfulness causing others to have sleepless nights. Medically snoring can disturb the sleep pattern and if severe may be an indicator of sleep apnea.

Snoring is a very common problem which results from the disturbance of air flow. Vibration of the uvula and soft palate creates most of the unpleasant noise. Treatment centers around stiffening and/or removal of these structures. Before treatment is applied, it is very important to rule out sleep apnea, a condition in which snorers stop breathing while asleep. Sleep apnea is a serious condition that may lead to heart, lung or brain problems. Treatment options to reduce snoring include: 1) Injection Snoreplasty; injection into the soft palate leads to subsequent stiffening; 2) Somnoplasty: Radiofrequency stiffening treatments of the soft palate; 3) Radiofrequency Turbinate Reduction; shrinks nasal tissue that may also contribute to sound production; 4) Other procedures that involve tissue removal (uvula, palate, and/or tonsils). Many of these newer procedures can be performed in our office with minimal discomfort.

Self-help remedies such as weight loss, exercise, regular sleeping hours, avoidance of heavy meals, alcohol or sedatives at bedtime work well for the light snorer. Sleeping on your side and with the head elevated often help too. Surgical treatments aimed at shrinking the palate and uvula have been advanced recently. Surgical treatments, such as the new Pillar® Procedure (soft-palate insert system), help to alleviate some of the anatomic obstruction in the nose or throat, and can be done safely in the physician's office.

Most procedures for the treatment of sleep apnea are covered by insurance with appropriate documentation by sleep studies. However, snoring procedures are not routinely covered presently.

Depending on the severity of the sleep apnea, the age and other medical conditions, sleep apnea is usually able to be controlled. Self-help remedies such as weight loss, exercise, regular sleeping hours, avoidance of heavy meals, alcohol or sedatives at bedtime are important.. Sleeping on your side and with the head elevated often help too. Breathing devices (e.g. CPAP-continuous positive airway pressure breathing) are very successful when tolerated by the patient and requires wearing a small mask over the nose at bedtime to provide a steady column of airflow and preventing collapse of the "floppy" airway. Dental appliances have been used to pull the tongue forward, again opening the air passages that collapse in sleep apnea. Surgical therapies by your ENT surgeon are aimed at opening the nasal and oral airway. In children removing the tonsils and adenoids often provides dramatic relief. In adults removing the tonsils, tightening the loose palatal tissues and expanding the airway are usually successful in decreasing apnea. Certain patients may have a retrusive jaw/tongue which can be corrected also. Lastly, for those with severe apnea at high risk a tracheotomy can be life saving.

Throat Disease

Throat cancer usually occurs in smokers and hoarseness is usually noticed early. Some other signs such as weight loss, difficulty swallowing, sore throat, referred ear pain, and lump in the neck might occur too.

If diagnosed early throat cancer can often be cured by radiation therapy or limited surgery. If the disease has progressed and is not too far gone, good results can still be obtained but often will require surgical removal of the voice box followed by radiation therapy. Fortunately, today ENT surgeons and speech pathologists have ways of restoring some vocal ability after removal of the voice box.

Depending on the age of the patient the most common causes of neck masses changes. In children, most masses are related to infections or inflammatory cysts. The treatment therefore usually starts with antibiotics and if the mass persists or enlarges it should be removed. During adulthood cancer becomes much more common and needs to be excluded as a possibility, often requiring a biopsy by your ENT physician along with a thorough head and neck exam.

Swallowing problems can be related to many causes including anatomic obstruction (e.g. cancer), neurologic disease (e.g. stroke), infection (e.g. candida), reflux, muscle tone problems, diabetes, alcoholism, vitamin deficiency, foreign bodies, caustic ingestion, aging and many other possibilities. The swallowing mechanism is complex and any disorder affecting from the tongue to the stomach can create swallowing difficulties. In addition to the routine head and neck exam studies such as esophagoscopy (direct view of the esophagus), Barium swallow (X-ray observation of dye being swallowed, pH probe (detects acid reflux), and manometry (monitors muscle coordination of swallowing), may be ordered by the physician and swallowing therapist to assist in diagnosis and treatment. Patients may require comprehensive video testing (video stroboscopy) to determine the underlying pathology of voice disorder.

Reflux of acid from the stomach most commonly causes acid indigestion. The acid can travel further up the esophagus and into the throat especially while lying flat on the back. Symptoms such as a lump in the throat, frequent throat clearing, burning sensation, chronic cough, and hoarseness have all been occasionally attributed to reflux.

Initially lifestyle modifications like avoiding fatty foods, citrus foods, garlic, onions, caffeine, chocolate and peppermint will decrease reflux. Eating meals further from bedtime, elevating the head of bed, losing weight and quitting tobacco use will also help. Antacid medications and now more potent acid production blockers are often prescribed with great success.

Vocal straining patterns (e.g. screaming, untrained singing) along with tobacco irritation, reflux or trauma to the vocal cords may cause the formation of polyps or nodules. They are often successfully treated by removing or treating the underlying cause sometimes in conjunction with voice therapy. If they persist and are causing voice, swallowing or airway symptoms they can be removed by precise surgical excision by your ENT surgeon.

Thyroid

Hyperthyroidism and Graves’ disease can cause nervousness, tremors, mood swings, rapid heart beating, high blood pressure, diarrhea, insomnia, heat intolerance, thickened skin, and bulging eyes.

Hypothyroidism can cause weakness, lethargy, cold intolerance, swelling, coarse dry skin, and hearing loss.

The cause of multiple thyroid nodules is not completely understood, but is thought to be related to changes in thyroid hormone and iodine metabolism. Solitary nodules are more worrisome for the possibility of a tumor in the thyroid gland. These tumors are usually benign, but in order to make the diagnosis your ENT surgeon often performs surgical removal to be sure that there is no evidence of malignancy.

Goiter simply means enlargement of the thyroid gland. Most often no therapy is required after full evaluation to look for signs of over- or underactive thyroid activity as well as ruling out evidence of malignant growth, or compression on the airway or esophagus.

Smoking

ENT physicians can almost always find some visible abnormality in patients that smoke and often in those exposed to second hand smoke. Children have increased risk of ear disease and airway troubles when their parents smoke. The major risk factor for the majority of head and neck cancers is clearly smoking or oral tobacco use. These risks are worsened when combined with frequent alcohol use.

Chewing tobacco or snuff can cause cancer of the cheeks, gums and throat along with staining the teeth, causing bad breath and elevating blood pressure.

Most people know that smoking causes cancer. What some people don't know is that smoking contributes to other illnesses. Noxious fumes and chemicals from cigarette smoke (including second hand exposure) reduce the effectiveness of the body's protective immune functions. A young child whose parents smoke will be prone to more ear infections. Smokers have more frequent and worse sinus and lung infections. Cigarette smoke may lead to hoarseness and in its worst case, cancer of the vocal cords. All persons who have been hoarse for over six weeks should have an endoscopic evaluation of their vocal cords. Protect the health of yourself and others and STOP SMOKING TODAY! See your primary care physician and learn of the variety of prescription products that may help you in your endeavor to quit.

Nerve Stimulation (VNS)

Chronic depression can be an illness that requires life-long management. Success rates in treating depression are sometimes low, and it is estimated that more than half of patients with depression have significant relapses. Drugs and electroconvulsive (shock therapy) treatment may not relieve symptoms in some patients.

Seizures also do not always respond to treatment. Some patients have tried two or more medications and still have seizures, as well as side effects from the drugs, both of which affect their quality of life.

Vagus nerve stimulation is a technique in which a small device is implanted under the skin of the chest. A small wire runs to the vagus nerve, which is then stimulated by the device, in much the same way a pacemaker works. Patients with depression usually experience an improvement in alertness and memory, plus have more energy and a better mood. These quality-of-life benefits improve over time. Vagus nerve stimulation has proven to be a safe and effective way to control seizures and improve depression. In addition, because drugs are not used, there are no side effects which are commonly associated with anti-depressant or seizure-control medications.

The Surgery Center of Charleston The South Carolina Sinus Institute