Throat and Neck
Throat and Neck
What are the functions of the tonsils and adenoids?
Is it recommended to remove tonsils and adenoids?
When should tonsils/adenoids be removed?
Explain the procedure, risks and recovery after removing tonsils/adenoids?
What is obstructive sleep apnea?
How is sleep apnea diagnosed?
Is snoring serious?
Is there any solution for my snoring?
Are snoring procedures covered by insurance?
What are the treatment options for snoring without sleep apnea?
What are the treatment options for obstructive sleep apnea?
What are the warning signs of throat cancer?
How is throat cancer treated?
How should a lump in the neck be treated?
What causes difficulty swallowing and voice problems?
How can reflux affect my throat?
How can reflux be treated?
What causes vocal cord polyps and how are they treated?
What are the signs of overactive thyroid?
What are the signs of underactive thyroid?
What is a thyroid nodule and when should it be removed?
What is a goiter and how is it treated?
What effects does smoking have on the ear, nose and throat?
What are the harmful effects of oral tobacco use?
How does smoking affect the immune system?
What is nerve stimulation and how does it treat depression and seizures?
Tonsils/Adenoids
What are the functions of the tonsils and 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.
Is it recommended to remove tonsils and adenoids?When should tonsils/adenoids be removed?
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.
Explain the procedure, risks and recovery after removing tonsils/adenoids?
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
What is obstructive 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.
How is sleep apnea diagnosed?
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.
Is snoring serious?
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.
Is there any solution for my snoring?What are the treatment options for snoring without sleep apnea?
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.
Are snoring procedures covered by insurance?
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.
What are the treatment options for obstructive sleep apnea?
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
What are the warning signs of throat cancer?
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.
How is throat cancer treated?
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.
How should a lump in the neck be treated?
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.
What causes difficulty swallowing and voice problems?
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.
How can reflux affect my throat?
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.
How can reflux be treated?
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.
What causes vocal cord polyps and how are they treated?
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.
What are the signs of overactive 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.
What are the signs of underactive thyroid?
Hypothyroidism can cause weakness, lethargy, cold intolerance, swelling, coarse dry skin, and hearing loss.
What is a thyroid nodule and when should it be removed?
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.
What is a goiter and how is it treated?
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.
What effects does smoking have on the ear, nose and throat?
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.
What are the harmful effects of oral tobacco 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.
How does smoking affect the immune system?What is nerve stimulation and how does it treat depression and seizures?
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.