- Nose & Sinus
- Ears & Infections
- Hearing loss & hearing aids
- Sore Throats/Tonsils & Adenoids/Hoarseness & LPR (laryngopharyngeal reflux)
- Head & Neck Cancer
- Sleep Apnea/Snoring
- Adult/Pediatric Otolaryngology
- Plastic & Reconstructive
- Neck Mass (thyroid, parathyroid,salivary gland)
Nose and Sinus
What is a septoplasty ?
This is an operation to repair a deviation in the nasoseptum—the “partition” dividing one nostril from the other. An incision is made inside the nostril and the appropriate correction is made. The operation is performed under general anesthesia. The cartilaginous septum, which separates the two sides of the nose, is invariably not straight and regular, and so-called septal deviations are common. These deviations are either congenital ones (present from birth) or are caused by injury. Most go unnoticed or cause no problems. Only when the deviation is a serious one, causing nasal obstruction, is surgery recommended. Often, nasal obstruction is found on both sides of the nose; on one side due to the deviation itself, and on the other due to overgrowth of the fleshy “shelves” (turbinates) projecting from the side of the wall of the nose. Besides being unable to breath properly through the nose, the sufferer may experience ulceration, swelling, and bleeding in one or both nostrils. Also, since drainage from the nasal sinuses can be impaired, there may be chronic infection. Sometimes septoplasty is indicated to allow exposure to other areas of the nose and sinus during surgery and may be indicated to remove “pressure contact points” between the septum and the turbinates.
Surgical intervention of the sinuses is performed only after it has been determined that medical management has been unsuccessful.
Ethmoid Sinus. The ethmoid sinus(es) are one of a group of sinuses located in the front of the head/facial area. They are often involved in the disease process known as “sinusitis”. They may be infected, they may be obstructed, they may have growths in them and they may be impairing your sense of smell.
Maxillary Sinus. The maxillary sinus(es) are also located in the front of the head and face area, specifically below your eyes or cheek area. They too, can be infected, obstructed and have growths in them . They should have openings in them that allow for drainage. Disease, allergies, and infections can cause these openings to be swollen shut, scarred closed and to be non-functional.
Sphenoid Sinus. The sphenoid sinus(es) are located in the middle of the head and face area, specifically below your eyes and behind the ethmoid sinuses. They too, can be infected, obstructed and have growths in them . They should have openings in them that allow for drainage. Disease, allergies, and infections can cause these openings to be swollen shut, scarred closed and to be non-functional.
Frontal Sinus. The frontal sinus(es) are also located in the front of the head and face area, specifically above your eyes. They too, can be infected, obstructed and have growths in them . They should have openings in them that allow for drainage. Again, disease, allergies, and infections can cause these openings to be swollen shut, scarred closed and to be non-functional.
Turbinates. Turbinates are the portion of the nasal anatomy for filtering dust, pollens, and microscopic particles from the air before it enters the airway and lungs. They also moisturize the air before it enters out lungs. Disease, infections and allergies often cause the turbinates to swell and obstruct the nasal passage. A turbinectomy is the removal of an abnormally enlarged turbinate to improve breathing, complaints of nasal stuffiness, and snoring.
Ears & Infections
The ear is made up of three sections: the outer ear, middle ear and inner ear. Each of these areas is susceptible to infections, which can be painful. Young children have a greater tendency to get earaches. While most ear pain resolves itself in a matter of days, you should get a physical examination to understand the type of infection, prevent it from spreading and obtain treatment to help alleviate the pain. If medical treatment fails surgical intervention may be the next step. You may need to have a procedure where a tube is inserted in the tympanic membrane to help you. This is known as a myringotomy with possible tube placement.
What is otitis media?
Inflammation of the middle ear” resulting from an infection. It can occur in one or both ears. Although most common in children it also affects adults. The most common complaint is earache or a feeling of pressure or blockage in the ear.
What is a myringotomy?
A myringotomy is the incision of the tympanic membrane, either to improve ventilation to the middle ear, to permit drainage of the middle ear fluid, or to obtain cultures. The procedure is performed under the microscope using either general or local anesthesia. Most often a general anesthetic is used. Myringotomy is performed for treatment of otitis media which has been unresponsive to medical intervention. The myringotomy incision, when done as a solo procedure, often heals within a couple of days. To overcome the problem of the incision healing before all the fluid has drained the doctor may insert a tube into the incision. This helps to equalize air pressure in the middle ear space, prevents accumulation of the ear fluid and improves hearing.
Myringotomy with or without tympanostomy tube insertion is the most commonly performed ear operation. It is extremely safe and effective. Complications are minor and usually in the form of infection, which may be treated with antibiotics. The tube usually remains in place for several months, although it may be rejected sooner or remain in place for years. As long as there is a tube in the ear, care should be taken to avoid water contamination, especially bath water, by the use of ear plugs or a bathing cap. Occasionally the ear drum fails to heal after tubes have been removed, and the resulting perforation may require surgical repair. In some cases, particularly when there is a family history of chronic ear disease, tympanostomy tubes may need to be replaced. Hearing improvement is usually immediate after fluid has been removed from the ear. Failure to improve hearing indicates a second problem in the middle or inner ear.
Hearing loss has a lot of different causes and manifestations. It can be sudden or gradual. It can occur in one ear or both ears. It can be temporary or permanent. It happens to people of all ages and is associated with the aging process. Before discussing causes and treatments for hearing loss, it is important to understand how hearing works.
The nose serves three primary functions: to warm, humidify and filter air as it passes into the body. Breathing problems may impact one or multiple of these functions. Breathing problems can be temporary or chronic, mild or severe, but they usually increase with age.
What is an otolaryngic allergist?
He is a specialist in diagnosing and treating disorders of the head and neck, including allergy of the upper respiratory system. Because he is a specialist of the head and neck, the otolaryngic allergist is able to diagnose and treat other diseases often associated with irritation. Because he is also a surgeon, he is able to provide complete care of your upper airway problem, including the correction of structural obstructions and deformities, the treatment of infections, and improved drainage. This is important, because allergies are often accompanied by sinus or other infections, and are often associated with obstructive problems such as nasal polyps or a deviated septum. In approaching the diagnosis and treatment of your allergies, the otolaryngic allergist uses methods that are time proven to not only identify specific allergens, but to also achieve effective control of allergies quickly and effectively.
Inhalant allergies can cause a multitude of symptoms involving any of the body's systems but mainly the upper respiratory tract. Persistent and recurrent "colds," "hay fever," "catarrh," and "sinus" are typical examples of allergic symptoms. Inhalant allergies man be triggered by any substance that can be inhaled and absorbed by the body. The primary problem inhalants are pollens, molds, and environments, including dust, dander, and mites.
Allergy treatment is based upon three general modalities: environmental control or avoidance of offending substances, medications, and immunotherapy (allergy shots). Patients may require one, two, or three modalities for success. Treatment is generally begun with avoidance—progresses through various medications and, if these fail or are not satisfactory for the patient, immunotherapy is instituted.
The type and length of therapy required is quite variable and depends on many factors. For example, a patient may experience dramatic symptomatic improvement simply by careful environmental control, such as removing a cat from the household. Antigen avoidance becomes less important as immunotherapy is established, but overwhelming exposure may produce symptoms even after symptom control with immunotherapy. Similarly, the need for allergy medication may decrease or disappear as immunotherapy is instituted. A typical course of immunotherapy encompasses three to five years, although some patients may require immunotherapy for an indefinite period of time.
Sore Throats/Tonsils & Adenoids/Hoarseness & LPR (laryngopharyngeal reflux)
Everyone experiences sore throats when they have a cold or flu. But there are other reasons for sore throats that may be symptomatic of more serious problems.
Tonsillectomy & Adenoidectomy
The tonsils and adenoid are related structures of lymphoid tissue. They are three of the hundreds of lymph nodes in the body. In children, the adenoid often become so inflamed that it interferes with swallowing and can also hinder breathing. It can also lead to middle ear infections resulting in hearing loss, thereby causing hindered speech development. The operation can be performed for other reasons such as sleep apnea, recurrent tonsillitis and abscesses. In adults the reasons are similar with an occasional biopsy for tumor development. The symptoms associated with the need for a T & A vary from snoring, chronic ear and/or throat infections, persistent swollen glands in the neck or other reasons and special indications discussed with you by Dr. Isenberg.
The larynx is the medical term for the structure of the body located at the upper end of the trachea (windpipe) that contains the vocal cords. Our speech comes from the vocal cords along with our tongue. Anything affecting the condition of the vocal cords can affect the quality of our speech. Hoarseness is often the first sign of a change to our vocal cords. Many conditions can affect our voice quality: chronic cough; vocal cord abuse (screaming); acid reflux; abnormal growths (singers nodules or tumors); and, other medical conditions like a vocal cord paralysis. The treatment for all of these varies.
LPR (laryngopharyngeal reflux)
Acid reflux is a very common cause for throat irritation. Do you clear your throat a lot? Are you hoarse? Do you cough often? You may suffer from Laryngopharyngeal Reflux disease—LPR. The simple explanation of LPR is: the stomach acid is “washing up” and irritating your throat. The problem is not life-threatening but can be bothersome and troubling. Here is a list of more symptoms that you may or may not experience:
· Trouble swallowing
· Choking sensation
· “Lump in the throat” sensation
· Heartburn or sour taste in your mouth
· Frequent clearing of throat
· Ear pain, ringing, popping sounds or feelings of pressure in one or both ears.
How Acid Affects your Throat
The esophagus is the tube that carries food from your throat to your stomach. Muscles at each end of the esophagus tighten and relax to allow food passage. When the muscle at the opening of the stomach becomes weak, then acid may “back-up” or reflux upward into the back of your throat. This recurring reflux may or may not cause you Gastroesophageal Reflux (GERD). If the muscle at the top of the esophagus is weak, the acid can travel even higher and wash into your throat (LPR). This is what gives you throat symptoms.
Head and Neck Cancers
Most head and neck cancers are relatively preventable since they are highly correlated with tobacco use and alcohol consumption. They are also generally curable if caught early. Symptoms to watch out for include pain swallowing, trouble breathing, ear pain, a lump in the neck that lasts longer than two weeks, a growth in the mouth and bleeding from the mouth, nose or throat. Most head and neck cancers are relatively preventable since they are highly correlated with tobacco use and alcohol consumption. They are also generally curable if caught early. Symptoms to watch out for include pain swallowing, trouble breathing, ear pain, a lump in the neck that lasts longer than two weeks, a growth in the mouth and bleeding from the mouth, nose or throat. Following is a description of cancers of the head and neck:
Malignant tissue in the bottom part of the pharynx is called hypopharyngeal cancer. The pharynx is a tube-like structure that goes from the back of the nose down to the windpipe and esophagus. Symptoms include sore throat and ear pain. Hypopharyngeal cancer is usually diagnosed through a physical examination, CT scan , MRI (magnetic resonance imaging), chest x-ray, esophogus x-ray or biopsy. Most hypopharyngeal cancers are squamous cell carcinomas â€“ thin flat cells that line the inside of the organ. Unfortunately, this cancer tends to be detected in later stages because early symptoms are rare. This cancer typically requires surgery to remove the malignant tissue, followed by radiation and/or chemotherapy treatment.
Laryngeal cancer occurs when there is malignant tissue in the larynx. Symptoms include pain swallowing, trouble breathing, ear pain, a lump in the neck, persistent coughing, hoarseness and/or a change in voice. Over 90 percent of laryngeal cancers are squamous cell carcinomas, which respond well to surgery and radiation and/or chemotherapy.Cancer of the lining of the nasal cavity and throat is known as nasopharyngeal cancer. This cancer usually appears in tandem with a virus affiliated with infectious mononucleosis. Because this cancer frequently spreads to the lymph nodes, it is often diagnosed from of a lump or swelling in the neck. This fast-growing cancer then spreads to the nose, mouth or pharynx, which can cause symptoms such as snoring, nosebleeds or hearing loss. In more advanced cases, the cancer spreads to the lungs, liver and bones of the skull. In addition to surgical removal of the cancerous tissue, this cancer typically requires radiation and/or chemotherapy treatment.
Oral cancers appear as red or white patches of mouth tissue or small ulcers that look like a canker sores, but are painless. Oral cancers usually form on the tongue or floor of the mouth, but can occur on any tissue in and around the mouth. This includes cancers of the tonsils, adenoids, uvula (soft palate), roof of the mouth (hard palate), inside the lining of the cheeks, the gums, teeth, lips, the area behind the wisdom teeth and salivary glands. Some of these lesions may be benign, others may be malignant, and still others are precancerous. The most common type of precancerous cells in the mouth are:
- Leukoplakias: Leukoplakias consist of thick, white lesions that most commonly form beneath or around the tongue, cheeks or gums. These mouth sores are most often seen in tobacco users.
- Erythroplakias: These lesions appear as a red, raised area in the mouth and have a higher incidence of becoming malignant than leukoplakias.
A biopsy is often needed to diagnose leukoplakias and erythroplakias.
Squamous cell carcinomas are the most common type of oral cancer. Less common are lymphoma and salivery gland cancers. Most oral cancers occur in people age 45 and older. When cancers of the mouth do metastasize, they are most likely to spread to the lymph nodes in the neck.
Thyroid cancer is usually recognized by thyroid nodules or swelling of the thyroid gland (goiter). A benign thyroid nodule is called an adenoma. Diagnostic techniques used to identify thyroid cancer are ultrasound, fine needle biopsy, nuclear medicine or CT scan. Other symptoms include hoarseness, difficulty breathing or swallowing, neck pain, swollen lymph nodes, weight loss or coughing. In addition to surgery to remove the cancerous tissue, your doctor may recommend a radioactive iodine treatment. In more serious cases, radiation and/or chemotherapy may be required. Note that if any or all of the thyroid is surgically removed, you will have to take replacement thyroid hormones in pill form for the remainder of your life to keep your metabolism functioning at an optimal level for your good health.
If you have lasting symptoms that are suggestive of one of these cancers, please contact our office right away and schedule an appointment with one of our otolaryngologists.
From sore throats and earaches to sinusitis or hearing loss, Steven Isenberg MD is equipped to handle all your otolaryngology needs. To help you understand your options, we've included descriptions of some of our leading services on this page.