What Is Sinusitis?

Sinus Pain

Sinus infections are one of the common conditions with which adults may be diagnosed. Sinus infections affect millions of adults in the United States each year. The sinuses are a group of hollow spaces that surround the nose and are also found above and between the eyes. Sinus infections include cloudy or colored runny nose with nasal blockage or clogging, facial pain/pressure, or both. Other symptoms include fever, cough, loss of energy, lack of or reduced sense of smell, tooth pain, and ear fullness. The symptoms can be severe enough to disturb your quality of life or general well-being.

What Causes Sinus infections?

 Sinus infections can be caused by viruses, bacteria, or fungi. A viral sinus infection has similar symptoms as bacterial infections but improves within 10 days and does not get worse. A bacterial sinus infection is defined by how long the symptoms last. The 3 types are acute (short course), recurrent (repeated), or chronic (long lasting). An acute bacterial sinus infection is one that either fails to get better within 10 days or has suddenly gotten worse after an initial period of getting better. Acute bacterial sinus infection lasts less than 4 weeks. See Figure 1 for more information on acute sinus infections. Recurrent bacterial sinus infections are when an acute sinus infection occurs 4 or more times in a 1-year period. A chronic sinus infection is when 2 or more symptoms and swelling lasts for 12 weeks or longer. A fungal sinus infection is one that is linked with chronic symptoms. Fungal sinus infections usually occur with people who have weak immune systems. Fungal sinus infections can also occur with people who have used long-term antibiotics.

What Causes Adult Sinusitis?

A sinus infection is typically caused by a viral upper respiratory infection, like a cold. A viral infection does not get better from taking antibiotics. Acute bacterial sinus infections are caused by a bacterial infection. Some people with bacterial infections can benefit from the use of antibiotics, although antibiotics are not necessary for everyone.

What Can You Do About Sinusitis?

You should see a healthcare provider soon after symptoms occur. Early diagnosis may help avoid misdiagnosis or delayed treatment and worse results. There are several types of sinus infections, so it is important to get the correct diagnosis for proper treatment. Treatment options should be discussed with the healthcare provider after diagnosis. Antibiotics do not work for viral sinus infections. Antibiotics are not recommended for all types of bacterial infections.

How Is Sinusitis Diagnosed?

A healthcare provider can diagnose a sinus infection by reviewing the medical history and doing a physical exam. The exam should review and document the conditions in your medical record. A healthcare provider will take note of how long symptoms have been present.

The healthcare provider should decide between acute bacterial sinus infection from viral sinus infection or noninfectious conditions. Your healthcare provider should diagnose an acute bacterial sinus infection when (1) symptoms (facial pain-pressure-fullness, nasal blockage) or signs (cloudy or colored nasal drainage) or both continue without getting better for at least 10 days after the onset of upper respiratory symptoms like a cold or (2) symptoms or signs of a sinus infection worsen within 10 days after getting better (double worsening).

Other conditions can seem like a sinus infection. For instance, a headache alone may not mean a sinus infection. With a sinus infection, there is usually cloudy or colored nose drainage.

An acute sinus infection is diagnosed when there are up to 4 weeks of colored or cloudy runny nose with nasal blockage, facial pain-pressure-fullness, or both. A healthcare provider should decide between chronic and recurrent sinus infections from single-incident of acute bacterial sinus infections and other causes of sinonasal (nose and sinus) symptoms.

The healthcare provider cannot diagnose chronic sinus infection based on symptoms alone. The healthcare provider will also need to see nasal swelling or inflammation on exam. The healthcare provider may use tools such as cameras (an endoscope or rhinoscope). These types of tools can offer a better view of your sinuses. The healthcare provider may also order a special radiology test called a CT (CAT) scan to view sinonasal swelling. The CT scan may confirm a diagnosis of chronic sinus infections. For chronic sinus infections, the healthcare provider should confirm whether nasal polyps are present. Nasal polyps are harmless growths. Having nasal polyps will modify care of your symptoms.

Instead of prescribing antibiotics right away for your acute bacterial sinus infection, your healthcare provider may suggest a treatment option known as watchful waiting. This option usually includes a 7-day waiting period without antibiotics to see if you get better on your own.

You may be tested for allergies and immune function. This testing will help tell chronic or recurrent sinus infections from allergies.

What Treatments Are Available?

It is important to properly diagnose viral and bacterial sinusitis because antibiotics are not for a viral sinus infection. If you have heart, kidney, or liver disease, your healthcare provider may consider different treatment.

For a viral sinus infection: Talking with your healthcare provider can help you make decisions about the treatment of symptoms. To relieve symptoms, pain relievers, nasal steroid sprays, and/or nasal saline rinse (irrigation) may be recommended. Nasal saline rinse can be purchased or homemade. Nasal saline rinse involves using a bulb, squeeze bottle, or Neti pot with a mixture of water, baking soda, and a noniodized salt.

For an acute bacterial sinus infection: The healthcare provider should offer either watchful waiting without antibiotics or an antibiotic. If a decision is made to treat acute bacterial sinus infection with an antibiotic, amoxicillin will likely be prescribed. A combination of amoxicillin with clavulanate for 5 to 10 days may also be prescribed as a different treatment. If you feel worse or do not improve with the antibiotic treatment after 7 days, you should see your healthcare provider. The healthcare provider will review the diagnosis and will rule out other causes. The healthcare provider may also decide to change the antibiotic. To relieve your symptoms, your healthcare provider may recommend over-the-counter treatments. These treatments may include pain relievers, nasal steroid sprays, and/or nasal saline rinse. Nasal saline rinse can be purchased or homemade. Nasal saline rinse involves using a bulb, squeeze bottle, or Neti pot with a mixture of water, baking soda, and a noniodized salt.

For an apointment to see an ENT Specialists, click here: https://ent-specialist.org/contact.php or call 770-281-4487

What Causes Vertigo?

Benign paroxysmal positional vertigo, abbreviated BPPV, is the most common inner ear problem and cause of vertigo (a false sense of spinning). It is more common in older people. Many of us will experience BPPV at some time in our lives.

BPPV is a specific diagnosis, and each word describes the condition:

What Causes BPPV?

Most cases of BPPV happen for no reason. It can sometimes be associated with trauma, migraine, other inner ear problems, diabetes, osteoporosis, and lying in bed for long periods of time.

We have crystals of calcium carbonate in our inner ear that help us with our balance and body motion. These tiny rocklike crystals, or “otoconia”, are settled in the center of the inner ear. BPPV is caused by the crystals becoming “unglued” from their normal place. As they float around, they can get stuck on sensors in the wrong part or the wrong canal of the inner ear. BPPV symptoms are caused by the crystals being out of position.

The most intense part of BPPV symptoms relate to how long it takes the crystals or sensors to settle down after you move or change your head or body position. As the crystals move and settle in your inner ear, your brain is getting these (false) messages telling you that you are spinning, when all you may have done is lie down or roll over in bed.  

What Are Common Symptoms of Vertigo?

Everyone will experience BPPV differently, but there are common symptoms:

  • Distinct triggered spells of vertigo or spinning sensations
  • Nausea (sometimes vomiting)
  • Severe feeling of disorientation in space or instability

These symptoms will be intense for seconds to minutes. In some people, especially seniors, BPPV can seem more like an isolated feeling of instability that happens when changing body or head position. Sitting up, looking up, bending over, and reaching can trigger this feeling. BPPV does not cause constant severe dizziness and is usually triggered by movement. BPPV does not affect your hearing or cause you to faint. The dizziness episodes related to BPPV can increase your risk of falling.

How Is Vertigo Diagnosed?

Health care providers diagnose BPPV through a physical examination and review of your medical history. Normal medical imaging, such as scans and x-rays, or medical laboratory testing cannot confirm BPPV. Your health care provider or examiner will complete simple bedside testing to help to confirm your diagnosis. The bedside testing requires the examiner to move your head into a position that makes the crystals move, and it will make you dizzy. The testing may include hanging your head a little off the edge of the bed or rolling your head left and right while lying in bed. The examiner will be watching you for a certain eye movement to confirm your diagnosis.

How Do You Treat for Vertigo?

Medications may be used for the relief of immediate distress, such as nausea, but not for BPPV itself. Most BPPV cases can be corrected with repositioning procedures that will be performed bedside by your provider. These treatments usually take only a few minutes to complete. They have high success rates (around 80%), although sometimes the treatment needs to be repeated a few times.

These repositioning treatments (referred to as “maneuvers”) are designed to guide the crystals back to their original location in your inner ear. You may be treated during the same office visit when the diagnosis testing is performed. You might be sent to a health professional (medical provider, audiologist, or physical therapist) who can perform these maneuvers, especially if any of the following apply:

  • You have severe disabling symptoms.
  • You are a senior with history of past falls or fear of falling.
  • You have difficulty moving around, such as joint stiffness (especially in your neck and back) and/or weakness.

You can also be taught to perform these maneuvers by yourself with supervision, which is called “self-repositioning.” Discuss learning these maneuvers with your health care provider.

Does Vertigo Go Away on Its Own?here is evidence that if BPPV is left untreated, it can go away within weeks. The natural course of BPPV is to become less severe over time. People will often report that their very first BPPV spinning episode was the worst and the following episodes were not as bad. However, remember that while the crystal is out of place, in addition to feeling sick and sensitive to motion, your unsteadiness can increase your risk for falling. You will need to take precautions not to fall. You are at a higher risk for injury if you are a senior or have another balance issue. Seniors are encouraged to seek professional help quickly to resolve symptoms.

How Long Will It Take before I Feel Better?

During the BPPV treatment, you may experience brief distress from vertigo, nausea, and feelings of disorientation. After treatment, some people report that their symptoms start to clear right away. Others report that they have continuing motion sickness–type symptoms and mild instability. You can still feel a little bit sensitive to movement even after successful treatments for BPPV. These symptoms can take a few days to a few weeks to slowly go away. Once your symptoms are slowly going away, it is important to return to normal activities that you can do safely. Exposure to motion and movement will help to speed your healing. You should discuss these activities with your provider. Seniors with a history of falls or fear of falling may need further exercises or balance therapy to clear BPPV completely.

Can Vertigo Come Back? Can I Prevent It?

Unfortunately, BPPV is a condition that can sometimes return. Your risk for BPPV returning can shift from low risk (few experiences in your lifetime) to a higher risk, which is often caused by some other factor, such as trauma (physical injury), other inner ear or medical conditions, or aging. Medical research has not found any way to stop BPPV from coming back, but it can be treated with a high rate of success. It is very important to follow-up with your health care provider if you continue to have symptoms. You may be sent for further testing to confirm your diagnosis and/or discuss other treatment o

Do You Think You Have Swimmer's Ear?

Understanding Swimmer's Ear

A condition that often occurs in the summer months is Swimmer's Ear (also called: acute otitis externa). It is a painful condition resulting from inflammation, irritation, or infection of the outer ear.

Swimmer's ear happens when bacteria grows in the ear canal. The ear canal is a passageway to the eardrum, so this can impact you in many ways. In that canal, there is delicate skin that is protected by a thin coating of earwax. Most of the time, water can run in and out of the ear canal without causing a problem. Usually, you don’t get swimmer's ear from taking baths or showers.

Bacteria can grow when water stays in the ear canal. A lot of swimming can lead to these wet conditions in the ear canal. If bacteria grows, the ear canal gets red and swollen. Sometimes people can get an infection in the ear canal even if they haven't been swimming. A scratch or other irritation to the ear canal can also lead to swimmer's ear.

Ear pain is the most common sign of swimmer's ear. Swimmer's ear may start with some itching, and then scratching can make the infection worse. Even touching or bumping the outside of the ear can hurt when it is infected. The infection also could make it harder to hear because of the swelling that happens in the ear canal.

It is very important to see an ENT if you think you have swimmer's ear. The ENT can help you get rid of the infection. The doctor can prescribe ear drops that contain an antibiotic to kill the bacteria.

What is Rhinitis? How Can I Tell if I have This Sinus Problem?

Rhinitis is an inflammation of the nasal membranes. It causes sneezing, nasal congestion and nasal itching in any combination.

Although allergic rhinitis itself is not life-threatening, it is difficult to go on throughout the day if you are suffering from this condition. People who are sufferning from this condition often seek medical care just to be able to feel better and breathe better. 

 

Here are the common signs and symptoms of allergic rhinitis:

  • Sneezing
  • Itching: Nose, eyes, ears
  • Postnasal drip
  • Nasal congestion
  • Headache
  • Earache
  • Tearing of the Eyes
  • Red eyes
  • Fatigue and Drowsiness

 

Complications of this allergic rhinitis include the following:

  • Acute or chronic sinusitis (swollen nose and sinuses)
  • Otitis media (ear ache)
  • Sleep disturbance or apnea (trouble sleeping)

Managing the symptoms of allergic rhinitis consists of three treatment strategies:

  1. Allergen avoidance: Minimize the exposure to allergens such as pollen, dust mites, and other triggers.
  2. Medicines: Patients can find successful treatment with oral antihistamines, decongestants, or both; regular use of an intranasal steroid spray may be more appropriate for patients with chronic symptoms.
  3. Immunotherapy: This treatment could be considered if conditions are found in addition to other diseases, poor response to other management options, and the presence deeper conditions or complications.

If you are suffering with any of the symptoms, call our ENT office for an appointment. 

Spirox Latera Offers Non-Surgical Methods for Better Breathing

A new non-surgical way to alleviate nasal obstruction is here, by using the Spirox Latera™  an FDA approved implant. It’s only been in the United States market for a few months, but it is an excellent alternative to some surgical methods.

It's a dissolvable implant that is easily inserted in the lateral wall of the nose without any cutting required. It is thinner than a pin and is about an inch in length.

It strengthens the walls of the nose to keep them from collapsing when inhaling. For patients needing rhinoplasty because of functional issues resulting from narrowing of their nose, it could improve their breathing.

Patients who have experienced temporary improvement in breathing from breathe rite strips could experience a more permanent solution with Spirox. Only in a few cases, patients could feel the implant after placement, but this issue resolved within three weeks of placement.

The placing of the device can be done in office setting with the patient asleep or awake. Another great benefit for the Spirox Latera implant is that there is no downtime from work or activity, after the implant placement.

The Spirox Latera™ implant is covered by most insurance companies and by Medicare.

To test whether the Spirox Latera™ implant might be an option for you, pull the cheek skin where the nose meets the face in the direction of the outside corner of the eye. If that significantly improves breathing, then Spirox Latera™ might be a nonsurgical option for you. Call your North Georgia Ent-Specialist to make an appointment.

What Causes a Post-Nasal Drip?

Nasal Allergies Does your nose seem to run all the time? Glands in the nose and throat continually produce mucus. Sometimes it over-produces, and it's a problem.

The normal production of mucus moistens and cleans the nasal membranes, clears inhaled foreign matter, and fights infection. The feeling of mucus accumulating in the throat or dripping from the back of your nose is called post-nasal drip. This is caused by increased secretions that can be thin or thick in consistency.

Increased mucus production can be due to colds and flu, allergies, cold temperatures, certain foods or spices, pregnancy, and other hormonal changes or abnormalities. These abnormalities might include a deviated or irregular nasal septum. An increase of thick secretions in the winter is often the result from dryness in heated buildings and homes. Sometimes food allergies, especially dairy products, can cause thickening of the mucous.

Another cause of post nasal drip can be blockages in the openings of the sinuses from swelling due to colds, flu, or allergies. This may lead to an acute sinus infection. If the secretions turn yellow or green, this is usually a sign of a sinus infection. A viral cold that persists for 7 days or more may have become a bacterial sinus infection and may increase post-nasal drip. A sinus infection needs antibiotic treatment by your doctor.

A person with chronic sinusitis may develop polyps (growths in the nose) which is causes by persistent blockages, causing the lining of the sinuses to swell further. Patients with polyps tend to have irritating, persistent post-nasal drip.

Post-nasal drip often leads to a sore, irritated throat due to the tonsils and other tissues. The throat may swell when it is irritated and cause pain. This can cause a feeling that there is a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.

If you are experiencing any of these symptoms, it is important to have an exam by an otolaryngologist (ENT) to advise you of the causes of the symptoms and correctly assess the course of treatment. Call our office to make an appointment! 

Get Instant Sinus Relief with Balloon Sinuplasty

Sinus problems and chronic sinusitis impact millions of Americans. Many people just try to live with the symptoms and never find any real relief. Some people rely on daily medications or shots to relieve the sinus pressure, headaches, or limited air flow. But there is a better way! If you, or someone you know, has been living with this type of sinus condition for years, we have great news for you!

Balloon Sinuplasty is a new procedure that is offering relief. It can help you breathe freely during your allergy season and all year long. Balloon Sinuplasty can open the nasal passages by creating room to breathe within the airways of the sinuses.

Balloon Sinuplasty opens your nasal passages using a tiny tube with a balloon at the end. The tube is inserted into the blocked nasal airway. The tiny balloon expands and opens the blocked sinuses. By creating the larger opening, it re-opens airways and restores normal (or better than normal) breathing.

This minor procedure offers quick healing and recovery, as it is minimally invasive. There is very little swelling, bruising or bleeding, and most people report being pain-free within a day. Most people can return to work or normal activities within 1 week.

At ENT-Specialists, we have performed this procedure on hundreds of patients and have many success stories that we can share! Make an appointment and see if you are a good candidate for this nasal procedure.

Call us today to see if Balloon Sinuplasty Right for You. 770-345-6600

 

Nasal Obstruction and Mouth Breathing

child breathing with mouth openDoes your child breathe through his/her mouth? Does your child have difficulty sleeping at night? Is there a history of recurrent or constant sinus/upper respiratory infections?

Does any of this sound familiar to you?

I have a young toddler who used to snore and who was a very difficult sleeper. I remember waking up several times nightly in response to audible cries from his bedroom. It seemed as if we could not feed the child enough food to keep him asleep. As a result of poor sleep, he was irritable, tired, and frankly miserable during the day. He did not breathe through his nose, so he did not want to eat, as he struggled to eat and breathe simultaneously. If these things were not enough, he had constant congestion in his nose and required antibiotics for a sinus or ear infection every 4-6 weeks. After consultation with his pediatrician, a referral was made to an otolaryngologist for evaluation of possible adenoid enlargement.

I am an ENT doctor myself, but I do not consider myself to be my children’s doctor, rather I simply try to be a good father. I consulted with Dr. Van Tuyl who performed my son’s adenoidectomy. He had an outpatient procedure and was his normal, bouncing, boisterous self the very next day. He is now a much improved, healthier, and happier version of himself, and his parents are enjoying his new sleep habits as much as he is!

Adenoid tissue is the same type of tissue as the tonsils that line the back of the throat. The adenoid is located in the nasopharynx, the throat in the back of the nasal passages. The normal adenoid tissue is where the infection fighting capability of the immune system matures. This important tissue is found along the length of the respiratory and gastrointestinal tracts.

When the adenoid enlarges, the result is blockage of the nasal passages which can lead to mouth breathing, nasal congestion, sinusitis, snoring, sleep disturbances, and ear infections. The abnormal tissue can be identified by examining the nasopharynx with a mirror, endoscope, or an x-ray or CT scan. Once adenoid hypertrophy is diagnosed, it can be alleviated with a simple procedure known as an adenoidectomy. Fortunately there is redundant tissue throughout the body and the procedure does not lead to immune system deficiency. The procedure is typically performed through the oral cavity under general anesthesia in an outpatient setting. Typically, children can return to their normal diet and activities the day of surgery.

It is rare that I have the opportunity to report on a procedure as a surgeon and as a father. I am glad that I could share my experience with the community. Please come and have a discussion with us if we can be helpful to your child!

- Lawrence L. Robinson, Jr., MD

Make A New Years Resolution With Better Hearing!

Do you want to stay active? Vibrant? socially engaged?

Maybe it’s time to do something about your hearing….

Chances are, you’ve enjoyed many years of fun, concerts, parties, and noisy recreational activities. You’ve been enjoying life….but it has been loud! Let’s face it. All that enthusiastic living has taken a toll on your ears. Now you’re having trouble hearing conversations at the dinner table, at parties, and family events. You may be having difficulty communicating with clients at work. Now your ears are screaming for your attention!

Make a New Year’s Resolution! Do something about your hearing. Addressing hearing loss is one of the best things you can do to improve your quality of life! Fortunately for most people with hearing loss, today’s state-of-the-art hearing aids can help. Research by Better Hearing Institute indicates that 8 out of 10 hearing aid wearers say they’re satisfied with the changes that have occurred in their lives due to better hearing provided by their hearing aids.

So go ahead! Make that New Years Resolution!

Call (770) 281-4487 or contact us via email to schedule an appointment for a free demonstration. And if you do purchase hearing aids, you receive a $400.00 discount off each hearing aid. Plus a 30 day trial period with no obligation or trial period charge, allowing you to determine for yourself if our state-of-the-art hearing aids can

Revitalize your life with better hearing!

This offer is good through March 31st, 2015.

We Hear With Our Brains

Good news! Our brains are always changing, which means we are always learning!

Research indicates that the brain continually reorganizes itself by forming NEW CONNECTIONS between brain cells called neurons. This happens throughout our entire lifetimes! This process is known as BRAIN PLASTICITY. Now, what does brain plasticity have to do with hearing?

The answer is “WE HEAR WITH OUR BRAINS!” Auditory signals are collected into the outer ear, transmitted through the middle and inner ears, and travel through the central auditory pathway to the auditory cortex, and eventually into cortical areas of the brain. The auditory cortex and cortical areas within the brain are where sound processing occur. For example, the auditory cortex processes pitch, volume, and rhythm, while cortical regions such as the middle temporal gyrus and frontotemporal systems allow for speech perception, music and noise recognition.

People with hearing loss frequently complain that they “hear but cannot understand”. This is due to the brain failing to receive critical speech information needed for sound recognition. Hearing aids can provide the brain with those missing signals, but the brain has to “relearn” by reorganizing itstelf, restoring old connections and developing new connections for successful sound processing to occur.

Even with todays most advanced technology in hearing aids, BRAIN PLASTICITY, or “learning to listen” is still the most important process determining successful use of hearing aids, leading to better understanding.

Steven W. Sick M.S., CCC-A

Director of Audiology

Thyroid Disease and Difficulty Swallowing

“Doctor, there is a lump in my throat.” I hear these words from patients nearly every day that I am in the office. There are many causes of difficulty swallowing and an abnormal sensation in the throat. Sometimes the discomfort is caused by an enlarged thyroid or a thyroid nodule. A thyroid nodule is an abnormal growth within the thyroid gland. A large thyroid nodule or an enlarged gland can place pressure on the esophagus, windpipe and spine. The spine is resilient because it is made of bone and the trachea is made of cartilage. However, the esophagus and pharynx (throat) are composed only of muscle and soft tissue and can be compressed with much less force. This is the reason that difficulty swallowing occurs before patients have difficulty breathing or neck pain.

Several of the last few patients that have had removal of all or an abnormal part of the thyroid gland tell me that it is a great relief to not have the constant feeling that a ball is being swallowed or that a vice is around the neck. The thyroid gland is a very important gland, but fortunately the thyroid’s hormones can be replaced with a daily pill. As was mentioned previously, there can be other more common causes of difficulty swallowing, such as acid reflux. Typically patients will be screened or treated for a more common condition if there is suspicion that one of these conditions is present. In the properly selected candidate, removal of an enlarged gland or an abnormal portion can make an positive difference in one’s quality of life.

-Lawrence Robinson, Jr., MD

For more information on thyroid disease and thyroid surgery, please see information on thyroid disease.

Ear Infections and Tubes

I’m sure many will agree there is nothing more upsetting and frustrating then seeing your child sick all the time. Unfortunately I see this often with infants and toddlers that have recurring ear infections. Many times parents of these children are already suffering from lack of sleep and then to deal with a child who has recurrent ear infections that is fussy, uncomfortable, waking up at night crying in pain and with fever can be exhausting. Also, many times these kids have already been treated with multiple rounds of antibiotics, which in itself can cause problems i.e. diaper rash from excessive diarrhea to name the most common, and so parents are left wondering what to do.

The best thing for these kids when medical treatments fail is to have a short outpatient procedure to have tubes inserted. I know surgery is scary especially for the new parent with a 6 month old, but I can’t tell you how many times afterwards I hear things like, “he’s a new baby” “She’s finally sleeping through the night” “It’s the best thing we did”. I am also speaking not only as a medical provider but as a parent of a child that has tubes. My now 22 month old son had recurring ear infections that were unresponsive to antibiotics by mouth and injection. Unlike the kids I talked about earlier he was a very happy baby but always had fluid behind his eardrums. The fluid persisted for 3 months and probably had 2-3 infections during that time. Working in the ENT field I was able to check his hearing and that was the deciding factor for me. The fluid behind his ears was causing hearing loss, which could affect his speech.

The procedure went excellent. It was quick, painless and he hasn’t had any fluid or infection issues since the tubes were placed a few months ago. I always tell parents that the surgery will be harder on them then it is for the child, especially now having experienced it myself.

If you would like more information about ear infections and ear tubes please check out our website under the pediatric tab the link for ear pain and ear tubes. If you have any comments or would like to share your experience feel free to chime in.

Jeff D’Ambrosio PA-C, MPAS

Physician Assistant

Pneumococcal Vaccine

As an adult, do I need the PPSV vaccine?

  • All adults 65 years of age and older.
  • Anyone 2 through 64 years of age who has a long-term health problem such as: heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of cerebrospinal fluid or cochlear implant.
  • Anyone 2 through 64 years of age who has a disease or condition that lowers the body’s resistance to infection, such as: Hodgkin’s disease; lymphoma or leukemia; kidney failure; multiple myeloma; nephrotic syndrome; HIV infection or AIDS; damaged spleen, or no spleen; organ transplant.
  • Anyone 2 through 64 years of age who is taking a drug or treatment that lowers the body’s resistance to infection, such as: long-term steroids, certain cancer drugs, radiation therapy.
  • Any adult 19 through 64 years of age who is a smoker or has asthma.
  • Residents of nursing homes or long-term care facilities.

PPSV may be less effective for some people, especially those with lower resistance to infection.

But these people should still be vaccinated, because they are more likely to have serious complications if they get pneumococcal disease.

Children who often get ear infections, sinus infections, or other upper respiratory diseases, but who are otherwise healthy, do not need to get PPSV because it is not effective against those conditions.

Please contact us for an appointment today.

Could My Child Have Sleep Apnea?

Sleep apnea is known to affect 1 to 3 percent of children, but because there may be many unreported cases, could actually affect more. Sleep apnea can affect your child’s sleep and behavior and if left untreated can lead to more serious problems. Many times sleep apnea goes undiagnosed because parents don’t believe their kids are bad sleepers and Pediatricians have too many things to evaluate during a 10 minute well-child check-up. Because sleep apnea can be difficult to diagnose, it is important to monitor your child for the symptoms and have a doctor see her if she exhibits any.

What is sleep apnea?
Obstructive sleep apnea occurs when breathing is disrupted during sleep. This occurs when the airway is blocked, resulting in choking that causes a slower heart rate and increased blood pressure, alerting your child’s brain and causing him to wake up.

What kids are at risk?

  • Those that were born premature
  • Kids that have enlarged tonsils and adenoids, nasal septal deviation, allergies or nasal polyps.
  • Kids that have asthma or recurrent upper respiratory infections.
  • Obesity
  • African American ethnicity
  • Kids whose parents have sleep apnea.


What are the symptoms?
The first sign that your child may have sleep apnea is loud snoring that occurs regularly. You may also notice behavioral changes. Due to a lack of sleep, he or she may be crankier, have more or less energy, and have difficulty concentrating in school. Your child may also want to sleep in unusual positions (with their neck hyper extended), sweat excessively, wet the bed, awake with a morning headache, have impaired growth and even exhibit or have been diagnosed with symptoms of ADHD (attention deficit hyperactivity disorder).

How is sleep apnea diagnosed?
If you notice that your child has any of those symptoms, has him or her checked by an otolaryngologist—head and neck surgeon, who can use a sleep test to determine sleep apnea. For the test, electrodes are attached to the head to monitor brain waves, muscle tension, eye movement, breathing, and the level of oxygen in the blood. The test is not painful and can be performed in a sleep laboratory or at home. Results can vary, so it is important to have the otolaryngologist determine whether your child needs treatment. Often, in mild cases, treatment will be delayed while you are asked to monitor your child and let the doctor know if the symptoms worsen. In severe cases, the doctor will determine the appropriate treatment.
What are the dangers if sleep apnea is left untreated?

Because sleep apnea can lead to more serious problems, it is important that it be properly treated. When left untreated, sleep apnea can cause:

  • snoring
  • sleep deprivation
  • Increased bed wetting
  • slowed growth
  • Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)
  • breathing difficulty
  • Heart trouble

What causes sleep apnea?
In children, sleep apnea can occur for several physical reasons, including enlarged tonsils and adenoids, and abnormalities of the jaw bone and tongue. These factors cause the airway to be blocked, resulting in vibration of the tonsils, or snoring. Overweight children are at increased risk for sleep apnea. Of the 37 percent of children who are considered overweight, 25 percent of them likely have sleeping difficulties that may include sleep apnea. This is because extra fat around the neck and throat block the airway, making it difficult for these children to sleep soundly. Studies have shown that after three months of exercise, the number of children at risk for sleep apnea dropped by 50 percent.

How is sleep apnea treated?
Because enlarged tonsils and adenoids are a common cause of sleep apnea in children, routine treatment often involves an adenotonsillectomy, an operation to remove the tonsils and adenoids. This is a routine operation with a 90 percent success rate. Studies published in Otolaryngology—Head and Neck Surgery (October 2005) and presented at the Academy’s 2006 annual meeting in Toronto showed that when children with sleep apnea were tested one to five months after their surgery, they showed extreme improvement in their sleep and behavior, and that these improvements remained nearly a year and a half later.

Benefits of proceeding with adenotonsillcetomy for the treatment of sleep apnea.

  • Improved ADHD like symptoms
  • Improvement in daytime sleepiness
  • Improvement in your child’s grades
  • Improved growth and decreased bed wetting

Night and Day

Pediatric otolaryngology or ENT is one of my favorite subspecialty practices. I consider myself a “general ENT” because I manage a decent portion of all of the subspecialty areas—Ears (otology), nasal and sinus (rhinology), voice and swallowing (laryngology), allergy, and head and neck oncology. However, a fair amount of my practices encompasses pediatrics. Children have always been one of my main focal points in pursuing a career in medicine. I began my career volunteering at a hospital in Toledo, Ohio, working with children with various types of cancer. I thought that I would be a pediatrician when I began medical school, but fell in love with the technical aspects of surgery.

As an ENT doctor who enjoys working with children, and as a parent myself, I understand the gravity of having a sick child. Many parents bring their children because they have chronic nasal obstruction, snoring, or difficulty sleeping. Many of these children have been in and out of their pediatrician’s offices for recurrent infections or concern about allergies and asthma. At the center of many of these children’s problems are a common thread, enlarged tonsils and adenoids.

Tonsils and adenoids are a type of tissue where the body processes and fights infected agents such as bacteria and viruses. This tissue is called lymphoid tissue and lines the entire gastrointestinal tract and is also present in the liver, spleen, and lymph nodes. When the tonsils and adenoids are enlarged, they can cause a myriad of problems. Some of these problems include recurrent ear infections, hearing loss due to chronic middle ear fluid, chronic sinusitis, mouth breathing, dental problems and facial growth abnormalities, chronic tonsillitis, snoring, and obstructive sleep apnea.

Obstructive sleep apnea or sleep-disordered breathing occur when the adenoid and/or tonsils contribute to reduced airflow through the airway when children attempt to sleep. When children fall into deep sleep and their brains attempt to reach the restorative phase of sleep, enlarged tonsils and adenoids can contribute to apnea, which is defined as a cessation of airflow. This can lead to frequent awakening as the brain senses that air exchange is inadequate. As a result, children do not rest well and can also have bedwetting, tossing and turning, and nightmares. The child then ends up waking up feeling tired and not well rested. During the day, the child may have behavioral problems, frequent napping, or headaches. Some children even may be diagnosed with attention deficit hyperactive disorder (ADHD) when they are actually starved for proper rest.

Removal of enlarged tonsils and adenoids can be curative in many children. After being cured of sleep-disordered breathing or sleep apnea, children and parents both can experience a new life. As a patient recently told one of my nurses after surgery, “it is like night and day. I have a new child.”

-Lawrence Robinson, Jr., M.D.

Child Sleep Apnea

I don’t know how many times a parent brings their child into our clinic and says something like; “he snores louder than his father” or, “I can hear him snoring from my room and I’m at the other end of the house! There are other times where a parent comes and tells me they get scared because their child is snoring and there’s a loud pause and they feel they need to go in and shake them to make sure they are breathing. These could all be signs of a real problem called sleep apnea. Sleep apnea affects 1 to 3 percent of children and can cause a slew of health issues. Sleep apnea has also been linked to ADHD problems in children.

If you would like more information about sleep apnea in kids, contact our ENT office.