Johnson City, Tennessee
Frequently Asked Questions
Nose and Sinus
Sinus
-What is sinusitis?
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 than 2 weeks, where chronic sinusitis
can last months and is much more difficult to treat.
-What are nasal polyps?
Nasal polyps are grape-like outpouchings from the nasal sinus linings that are usually indicative of an
allergic component to the sinus disease. They can obstruct the normal sinus drainage and airflow,
creating more congestion, infections, and decreased sense of smell.
-How is sinusitis treated?
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.
-When should I have a sinus CAT scan?
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.
-When is surgery useful for sinusitis?
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.
-Does sinus surgery always work?
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.
-Explain sinus surgery and the recovery
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 the natural sinus drainage holes, with less trauma to the normal tissues, allowing quicker
healing, less packing, and no facial incisions, as compared with traditional sinus surgery.
Surgery is often ambulatory, pain is usually minimal, and most patients return to work in less than a
week. Nasal cleaning and irrigation are done frequently for about the first month after surgery until the
nasal lining is clean and well healed.
-Are there any new advances in sinus surgery?
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.
Allergies
-How are allegies treated?
Based on your ENT evaluation, history, examination, x-rays, or environmental issues, your doctor
might suggest that allergy could be a cause. A complete allergy work-up and allergy management
program may be right for you.
A common allergy test is called IDT (Intradermal Titration). This test is done on your upper arms or
back using tiny needles that go right under the top layer of skin. The test takes approximately 2-3
hours to complete. It will tell us how sensitive you are to the positive allergens. 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, decongestants, 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 very 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, and ridding the home of indoor plants that grow mildew may be very
effective. Some more difficult but important measures include: avoidance of tobacco products and
animals that produce dander.
-Do allergies cause recurrent sinus infections?
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.
People who have suffered from 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.
Nosebleeds
-What causes nosebleeds?
Nosebleeds are caused most frequently by the common irritants (colds, sinusitis, dryness, nose-
picking, nasal medications, and 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.
-What is the best way to stop a nosebleed?
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 your head upright (NOT leaning back, as this
will cause blood to be swallowed, which can irritate the stomach) and pinch for at least 5 minutes. If
bleeding persists, clear the nose of the clots by sniffing forcefully, apply Afrin or Neo-Synepherine
decongestant spray and pinch again for another 5 minutes. If this is not successful, call your doctor
and continue to hold pressure.
Throat and Nose
Tonsils/Adenoids
-What are the functions for 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 out germs
that attempt to invade the body. They also help to develop antibodies to germs and viruses. This
happens primarily within the first few years of life, becoming less important as we grow older. Children
who must have their tonsils and adenoids removed suffer no loss in their resistance.
-Is it recommended to remove tonsils and adenoids?
Tonsillectomy (removal of tonsils) is recommended for people who experience frequent throat
infections. Adenoidectomy (removal of adenoids) is 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.
-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 other signs of malignancy.
-Explain the procedure, risks and recovery after removing tonsils/adenoids
Patients having tonsillectomy and/or adenoidectomy are usually discharged the same day or within 24
hours after surgery. The general technique for removal is fairly consistent 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 that 5% of
patients and usually very easy to control, but needs to be brought to the attention of our surgeon when
it happens. Other risks such as anesthesia reactions, 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 by a 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.
-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 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.
Throat Disease
-What are the 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 will often 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 change. 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 biopsied. During adulthood, when
cancer becomes much more common, lumps in the neck should be evaluated by a physician’s
thorough examination of the head and neck and possibly a biopsy.
-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 tongues 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 and
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 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, onion, caffeine, chocolate,
and peppermint will decrease reflux. Eating meals further from bedtime, elevating the head while
sleeping, losing weight, and quitting tobacco use will also help. Antacid medications and now more
potent acid production blockers are often prescribed with great success.
Thyroid
-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 overactive or underactive thyroid activity as well as ruling out any
evidence of malignant growth, or compression on the airway or esophagus.
Smoking
-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
seen as clearly coming from 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 teeth,
causing bad breath, and elevating blood pressure.
-How does smoking affect the immune system?
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 smoke exposure) reduce the effectiveness of the body’s protective immune system. 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 worse 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.
Ear and Hearing
Audiologists
-What is an Audiologist?
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.
-What do Audiologists do?
Audiologist 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.
-Why should I see an Audiologist?
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 Aids
-How common is hearing loss?
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.
-Do I need a hearing aid?
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.
-When do I need hearing aids?
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.
-Do I need one hearing aid or two?
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.
-What should I look for when purchasing a hearing aid?
First of all, you should make sure you see a licensed Audiologist 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 trail period offered?
- Is a portion of 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 aid be returned to the manufacturer for repairs?
- Is there a warranty included in the purchase price of the hearing aid?
-How much do hearing aids cost?
They 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 several hundred dollars
up to a few thousand dollars per hearing aid. The more technologically advanced the hearing aid (i.e.
computer programmable and / or completely in the ear 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.
-How has hearing aid technology improved?
Most people put off getting hearing aids for several years. We have all heard the stories of how Aunt
Mary’s hearing aids just sit in her drawer or how Uncle Fred still can’t hear with his hearing aids.
Unfortunately, these stories are told all the time, so why should anyone 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
miniature 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 folks to be involved in the extra activities of life once avoided because of poor
hearing.
Audiological Tests
-What is Videonystagmography (VNG) test?
An VNG 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.
-What is an Auditory Brainstem Response (ABR) test?
An ABR is a test which measures the speed of electrical impulses along the acoustic nerve from the
inner ear to the brainstem.
-What is Electrocochleography (EcoG)?
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/endolyphatic hydrops for patients with dizziness.
-What is an Epley maneuver?
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 (during the VNG) before
this procedure is performed.
-What is a tympanogram?
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.
-What does the hearing (Audiogram) test mean?
The audiogram is a graphic representation of the ability to hear tones. Hearing is typically 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 an “O”. There are varying degrees of hearing loss.
Normal range is from 0-25dB, mild hearing loss range is from 25-40dB, moderate hearing loss range is
from 40-60dB, moderately-severe hearing loss range is from 60-75dB, severe hearing loss range is
from 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 word recognition score. The speech reception threshold score is the softest level at
which words can be repeated 50% of the time.