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What could be causing problems with my swallowing?

There can be nothing more uncomfortable than to have issues swallowing or a have feeling like there is a “lump” in your throat.  This feeling is termed a “globus” sensation. There are multiple reasons why you could be experiencing this sensation and providing us with a detailed explanation of when and where can help us determine your treatment.

The medical term for “problem swallowing” is dysphagia.  If you feel like food is getting caught in your throat or chest, this can often be a symptom of a narrow esophagus.  Specialized radiological studies can help to determine if you have this and, if needed, our surgeons can perform a special procedure that can dilate the esophagus back to normal size.

Gastro-esophageal reflux (GERD) is another reason why someone can also have a globus sensation.  When gastric acids travel back up into the throat, it can cause inflammation which can contribute to having that irritating feeling.  This condition is normally treated with anti-reflux medications designed to reduce the amount of acids your stomach produces.

Allergies and chronic post nasal drip can also cause throat irritation. When nasal drainage is in excess, it frequently travels down the back of a person’s throat and can cause a burning feeling and discomfort.  Post nasal drip is treated with antihistamines and certain nasal sprays.  Allergy testing and immunotherapy treatment can also be useful to improve this condition long term.

Other problems like throat cancer and thyroid issues can also cause a globus sensation which is a reason why we take swallowing problems seriously at ENT Specialists.

All of our providers are capable of performing a relatively simple in office procedure called a “Flex Laryngoscopy” to help determine the cause of your swallowing problem and can also order specialized testing if needed.  Flex laryngoscopy also can determine the cause of chronic hoarseness and voice issues.

We hope that you better understand why you should have your swallowing problem checked out soon and that getting you feeling better is our primary focus at ENT Specialists.

Josh Snearly, NP-C

I just got hearing aids, now what do I do?

You, family members, or friends may have noticed that you had difficulty following conversation, especially at the dinner table, or when in a noisy environment. You may have also suffered from tinnitus or “ringing in the ears’. Whatever your difficulties were, you are now on the path to better hearing by wearing hearing aids.

Now that you are wearing hearing aids, there are several steps to take to ensure successful hearing aid use. The first step is being a ‘full time’ hearing aid wearer. Consistency is key when it comes to hearing. We hear with our brains so the more you wear your hearing aids, the quicker your brain will adjust to hearing sounds that you haven’t heard before or in a long time. If you only wear your hearing aids for an hour a day, the adjustment process will take longer. The more consistently you wear your hearing aids, the more natural they will sound.

The next step is understanding how to handle and use your hearing aids. As an audiologist, we will thoroughly review how to insert and remove your hearing aids along with the cleaning, care, and maintenance procedures. We want to make the transition from the office to home as easy and seamless as possible.

The final step in successful hearing aid use is proper follow up care. The typical follow up care schedule includes one appointment a week after your initial fitting. This allows the audiologist to ensure you are comfortable, satisfied, and receiving the benefit you need from your hearing aids. After that, a follow-up appointment every six months is recommended or if needed sooner. This follow up schedule is a general guideline, every individual and hearing loss is different and unique. In order to meet everyone’s needs you can be seen as frequently or infrequently as you prefer.

Overall, following these steps will allow the audiologist to ensure that you are successful with your hearing aids. After all, the goal is for you to be part of the conversation again. Hearing aids are meant to provide audibility, comfort, and effortless hearing.

Sarah Dryanski, Au.D

Thyroid Cancer Awareness Month

“Thyroid Cancer Awareness Month is a worldwide observance, sponsored and initiated by ThyCa: Thyroid Cancer Survivors’ Association. It began in 2000, as a week in September. In 2003, it expanded to the whole month of September.

Thyroid Cancer Awareness Month listed in directories and references, including the American Hospital Association’s Calendar of Health Observances & Recognition Days.

Thyroid Cancer Awareness Month promotes thyroid cancer awareness for early detection, as well as care based on expert standards, and increased research to achieve cures for all thyroid cancer.”

http://www.thyca.org/home/

This has been a busy year for our practice with respect to thyroid cancer.  We have managed many patients with newly diagnosed thyroid cancer.  Thyroid cancer is not very common (only about 60,000 new cases annually in the U.S), but is increasing in incidence.  Fortunately, most thyroid cancers fall under the category of well-differentiated thyroid cancers, meaning that they are not typically as aggressive as the poorly-differentiated thyroid cancers.

The most common factors for development of thyroid malignancy are family history, a history of ionizing radiation to the neck, and autoimmune disease affecting the thyroid (Hashimoto’s thyroiditis).  Patients do not tend to have symptoms when they have a cancerous nodule, although they can often detect a mass or lump in the neck, difficulty swallowing, or hoarseness.  Occasionally, symptoms of underactive or overactive thyroid function may be present (including, but not limited to heat/cold intolerance, weight loss/gain, palpitations, anxiety, swelling in the extremities).

Thyroid cancers are typically diagnosed with fine needle aspiration biopsies or surgical removal of a gland that is causing symptoms.  After surgical removal, thyroid cancer can be further controlled by administration of radioactive iodine in order to ablate residual microscopic thyroid disease.  This is typically done in conjunction with an endocrinologist (physician specializing in disorders of the thyroid and other endocrine glands).

Surgery is performed in the hospital under general anesthesia via a small incision in the midline of the neck.  Most patients are discharged home the morning after surgery and return to their normal daily activities within a few days.  Thyroid surgery does not tend to be a painful operation, and many of my patients barely require much in the way of strong pain medication afterwards.  Healing is typically fairly quick and the incision tends to be completely healed over in about two weeks.

A recent patient of mine underwent surgery earlier this year and had just one major concern, in addition to cancer, of course: the patient wanted to be sure that there would be complete healing prior to the wedding.  The wedding was scheduled for 3 months after we initially met.  We were able to coordinate with the endocrinologist and get the patient cancer free in just a couple of months and in time for the nuptials!

If you would like to consult with our office concerning thyroid disease, including thyroid cancer, please contact us anytime at (770) 345-6600.  We look forward to meeting with you!

Lawrence L. Robinson, Jr., MD

 

Back to School

August is back to school month and an exciting time for kids to get new clothes and school supplies.  While crayons, paper, backpacks, and notebooks are all on the school supply list, going from the swimming pool to the back-to-school germ pool can be more messy than a leaky glue bottle.  By taking basic measures, you can help keep your child healthy which means less missed school days.

Hand hygiene:  If your child is old enough and the school allows it, pack their bag with hand sanitizer and teach them to wash their hands throughout the school day, especially before eating. This will help limit exposure to germs and help reduce the amount of colds.

Allergies:  In the late summer and fall, allergy season is still ongoing, with grass and weed pollens being predominant.  When your child breathes the pollen into their nose, it triggers a histamine reaction that can cause swelling and a runny nose.  This can lead to narrowing of the sinus openings contributing to sinusitis. By effectively controlling allergies, you can help reduce the number of sinus infections.   At ENT Specialists, we take allergies serious and can safely test and treat allergies so that your child is not the “runny nose kid” at school.

Hearing tests We frequently evaluate children who have had failed hearing screens at school.  Often, failed hearing screens are due to the child not testing well at the school or from active infections or fluid in the ear.  At ENT Specialists, we can help facilitate getting your child back on track.  Our offices all have an audiologist and audio booth for simple, accurate hearing testing and can make referral to speech therapists if needed.

Strep Throat and frequent tonsillitis:   Children with frequent tonsillitis and strep throat may be need to have their tonsils removed surgically. Other signs of enlarged tonsils are difficulty swallowing and snoring.  Should your child need to have their tonsils out, expect them to be out of school for two weeks so they can recover.  Most teachers and schools do a great job of providing school work and focused assignments so that your child does not get behind when they are recovering at home.

We hope that you and your family have the best healthy school year to date.  Should you need our services, our staff at ENT Specialists in Canton, Jasper, and Blue Ridge are all ready to evaluate and effectively treat your child, so you can get them back on the bus.

Josh Snearly, NP-C

Recurrent Ear Infections: How can tubes help?

By the age of 2 more than 80% of children will suffer from an ear infection. Ear infections are usually accompanied by an upper respiratory infection. The Eustachian tubes of children under the age of 3 are more horizontal than adults. This allows fluid to get trapped in the middle ear space which leads to infection. Acute ear infections are usually effectively treated with oral antibiotics. Tympanostomy tubes are a viable treatment option when infections become recurrent and/or unresponsive to conservative antibiotic treatment.

Myringotomy with tympanostomy tube placement is a common procedure for the management of chronic and recurrent ear infections. A small incision is made in the ear drum through which a small soft tube is placed. This tube provides drainage, ventilation and pressure equalization to the middle ear. This procedure can reduce occurrence infections and improve hearing.

Hearing is assessed before and after tube placement. A post-operative appointment is made a few weeks after surgery and periodically thereafter. During these follow up appointments we will check for any changes in hearing, the condition of the tubes and the eardrum. The tubes stay in place for an average of 12 months. The body then begins to reject the tube and it is pushed out of the ear drum. Usually by the time the tubes are extruded, the child has outgrown the need for tubes and a second set is not necessary.

Crystal Rice, NP

Hearing Aids and the Difference Between Hearing and Listening

Choosing the correct hearing aids can be confusing. There are so many brands of hearing aids, as well as many places you can buy hearing aids. Hearing aids can be purchased at retail stores such as Sams Club, private audiology practices, medical practices, and even online or over the counter. But where is the best place to purchase hearing aids that will best meet your communication needs? Can purchasing hearing aids online, over the counter or at retail stores be just as effective as being fit professionally at a medical practice?

Yes, you can save some money going to a retail store, or find hearing aids online at a reduced cost… .. initially. But will they really improve your communication and lifestyle? Perhaps knowing the difference between “hearing” and “listening” will help you make the correct decision. Finding a quality product, and most importantly, PROFESSIONAL CARE, is what should assist you in making a decision on purchasing hearing aids that will indeed improve your way of life. That is, finding appropriate hearing aids and a professional team that will allow you to “LISTEN” rather than just merely “HEARING”.

First, let’s differentiate “hearing” from “listening.

Hearing can be defined as “perceiving and being aware that a sound is present”. Sounds can be amplified so they can be heard more easily. The television can be turned to a higher volume so it can be heard. Hearing aids that just amplify sounds, especially those purchased on line or over the counter, can make everything around you louder and easier to hear. But just merely making everything louder doesn’t necessarily address the other concept…”LISTENING”.

Listening is a far more sophisticated process that is much more complex than just hearing and being aware of sounds. Listening means “being able to attribute meaning to sound”. In research by Dr. Douglas L. Beck, AUD, Beck stated that “Listening is Where Hearing Meets Brain”. In order to improve your communication with hearing aids, people need to be able to make sense of sound, not just hear it. Listening involves cognitive abilities, such as working memory, processing directionality of sounds, speed of sounds, and being able to compare and contrast auditory information. The brain must interperet interaural loudness differences and interaural timing differences to know where to listen. Listening involves the brain being able to orient, separate, focus, and recognize sounds to apply meaning to them. If we just made everything louder, which is what amplifiers and older hearing aid technology will do, the ability to actually “listen” is greatly diminished. This results in increased listening effort, which in turns cause people with hearing loss and inferior hearing aids to become exhausted and extremely frustrated at the end of the day, leading to social withdrawal and in many cases, depression.

Ultimately, the goal of our Professional Team of physicians and audiologists is to provide the brain, or the auditory cortex, with the best possible acoustic signals so the auditory cortex, or the brain can “LISTEN” rather than just merely hearing. Or to quote Dr. Douglas Beck, we want “hearing to meet brain”. To accomplish the goal of listening, we continually research the best products that will provide the brain with the best auditory cues, improving signal to noise ratios (enhancing speech in the presence of background noise), reducing background noise, enhancing the ability to locate speech, and the ability to tell where important sounds are coming from. And as important as the hearing instruments we provide to meet the objective of “listening”, it is just as important to provide you with our expertise and help along the way in achieving your goal of listening. From continual maintenance of your instruments, to evaluating the functioning of your hearing aids, and to medically monitor your hearing, we want to make sure you continue to achieve the goal of “listening” for as long as you wear your hearing instruments. Which of course leads to the ultimate goal of improving your communication and way of life, and to prevent you from becoming “exhausted at the end of the day”.

Steven Sick, M.S., CCC-A

Are you managing your allergies or are they managing you?

The birds are chirping, flowers are blooming and the sun is shining.  Spring should be a time of beautiful new beginnings and colorful new life all around.  Unfortunately, many of us associate spring with sneezing, itchy watery eyes, nasal congestion, runny nose and postnasal drip.  Seasonal allergy symptoms are most evident in the spring and fall and are caused by the inhalation of pollen that comes from trees, grasses and weeds.  Perennial allergy symptoms last year round and are often due to dust mites, mold, animal dander and cockroach debris.  There are a few ways to manage these allergy symptoms that make so many people miserable.

When practical, avoidance of allergy triggers is an effective way to eliminate symptoms.  Some ways to avoid these troublesome allergens include:

  • Use a vacuum with a HEPA filter to reduce the amount of exposure to allergens while vacuuming
  • Wash all bedding with hot water at least weekly
  • Use dust mite proof pillow cases and mattress covers
  • Do not allow pets to sleep in the bedroom
  • Keep house and car windows closed during times of high pollen and mold
  • Use a HEPA filter in HVAC systems

Another way to manage allergy symptoms is the use of daily medications.  Oral and nasal antihistamines are an effective way to block the body’s response to allergens.  Nasal corticosteroids reduce intranasal inflammation and block the body’s response to allergens.  Leukotriene receptor antagonists block the action of other chemical messengers involved in allergic response.

The most effective and long lasting way to manage allergy symptoms is immunotherapy.  Immunotherapy is an effective way to modify the body’s immune response to allergens.  The first step in initiating immunotherapy is allergy testing.  Testing can be done in the office and tells us not only the presence of an allergy, but also the degree to which an individual responds to various allergens. These results are used to mix an allergy serum unique to each individual.  This serum can either be given in the form of weekly subcutaneous injections or daily sublingual drops.  Immunotherapy can be life changing by preventing or drastically reducing the body’s allergic response.

Are you are ready to positively change your life and start enjoying the outside again?  If the answer is yes call ENTAS today to schedule your allergy testing.

Crystal Rice, MSN, FNP-C

Chronic Sinusitis and Balloon Sinuplasty

Runny nose? Sinus pain and pressure? Sneezing? Is this a cold, allergies, or is something wrong with my sinuses? These are common symptoms and questions that many patients encounter and come to ENT Specialists looking for answers.

Chronic sinusitis is swelling and infection of the sinuses for at least 12 weeks. Often times, patients have tried several rounds of antibiotics without any relief. The openings to the inflamed sinuses get narrowed or blocked off resulting in the body unable to completely rid itself of the infection. This is why many patients experience an improvement of symptoms while they are taking an antibiotic but soon return to being sick soon after finishing the medicine.

Through the use of specialized endoscopes and utilizing specialized CT imaging, we can evaluate your sinuses and check for chronic sinusitis. If you indeed do have chronic sinusitis, you may need a procedure called Balloon Sinuplasty. This specialized procedure is performed by the ENT surgeon and uses a small wire that is guided into the opening of the closed sinus. A small balloon is inflated which helps to open up the sinus. The balloon is deflated then removed leaving a nicely opened sinus, which can now allow airflow and nasal sprays in, and the infection you have been fighting for so long out. By using special techniques, our surgeons keep you comfortable and pain free during your in office procedure.

It is important to realize that Balloon Sinuplasty does not cure allergies, however treating chronic sinusitis and controlling allergies is important. Often, patients struggle with allergies over a long period of time which can help lead to chronic sinusitis. Allergy testing with ENT Specialists is a great way to evaluate the severity of your allergies to help guide your treatment and keep sinusitis away. Balloon Sinuplasty and allergy testing are just some of the ways that ENT Specialists can help improve your wellness and keep you healthy!

Josh Snearly, NP-C

What is High Frequency Sensorineural Hearing Loss?

The way that we hear and the system that process the sounds that come to our ear are complex. Our hearing system is comprised of 4 distinct areas and 4 distinct modes to help transmit the signal in order for us to process the sound. Those areas are as follows: 1) Outer Ear 2) Middle Ear 3) Inner Ear and 4) The Brain. The outer ear is comprised of what you see on the outside, also called the pinna, and the ear canal. The middle ear has 3 small bones called the malleus, incus, and stapes. The inner ear is comprised of the cochlea (snail shell shaped organ) and the nerve that transmits the signals to our brain. When a sound signal like an alarm or speech is happening, it moves the air molecules from the source of the sound to our ear. It then travels through the ear canal which vibrates the ear drum and pushes on the 3 bones in the middle ear, which in turn pushes on the cochlea. The cochlea is fluid filled and the movement of that fluid vibrate hair cells that are lining the cochlea. Those vibrations of hair cells sends an electrical signal to the brain to be processed.

A sensorineural hearing loss is a hearing loss that is a result from damage to the cochlea hair cells and/or the nerve that runs those signals to the brain, generally this type of hearing loss is a permanent condition. The hair cells that line the cochlea are what we call tonotopic, meaning the high frequencies (pitches) line the outside of the snail shell shaped organ, middle frequencies are lining the middle area of the organ, and low pitches are lining the very center of the organ. It is most common for the high frequencies to be damaged first due the placement of the hair cells on the outside turns of the organ and the middle and low frequencies are more protected from the shape of the organ wrapping around itself.

The most common complaint for people with high frequency sensorineural hearing loss is that they can hear but they cannot understand. The reason for this complaint is that low pitches give people a sense of volume, while the high frequencies give people a sense of clarity. Also, vowels generally are a low or middle frequency signal while a lot of consonants are high frequency signal. People with this type of hearing loss are receiving part of the signal or they are misinterpreting the type of consonant that is being spoken.

People with hearing loss of this nature tend to start to feel isolated from family and friends as they are having a difficult time understanding the full message that is being spoken. If you or a family member is suspected to have a hearing loss, contact our office in order to have a full audiological evaluation from a licensed audiologist. If you or the patient is a candidate for hearing aids, you can try our flex trial hearing aids at no cost to you for two weeks.

I hope this article answers your questions about how we hear and about hearing loss. If you have any questions please do not hesitate to speak with an audiologist.

Garrett Mayhugh, Au.D.

January is Thyroid Awareness Month!

January represents the beginning of a new year and it is also recognized as Thyroid Awareness Month by the American Thyroid Association. This provides a great opportunity to reflect on and share some of my recent experiences regarding thyroid health. Dysregulation of the thyroid hormone level can lead to hyperthyroidism (overactive function) or hypothyroidism (underactive function). Another common problem is the development of thyroid nodules (small growths within the substance of the thyroid gland).

One patient presented to my office with severe anxiety, agitation, nervousness, weight loss, and anorexia. She had hyperthyroidism secondary to an autoimmune problem called Graves’ disease. Most autoimmune conditions are managed medically, but some patients require surgical management. Her overactive thyroid could not be controlled with medication, and therefore she elected to have complete removal of her gland (termed total thyroidectomy).

She returned to my office in her words, “level-headed, rested, and sane.” When her thyroid function normalized, she was able to go back to functioning at a normal pace.

One of my favorite patients presented to my office with a golf ball-sized mass in her neck. She was a very nice 11 year-old girl with a thyroid nodule. She had been referred to a specialist and was told to just ignore it, because it was believed to be non-cancerous. However, she was very uncomfortable and they were not satisfied with the plan of action. Imagine feeling a constant lump in your throat every time that you swallow or turn your head. That was her reality.

Another patient reported a similar finding. She was a very nice 78 year-old woman who could no longer read her books before bed at night because her thyroid nodule produced discomfort when she tried to lower her head to read.

Both of these patient underwent surgical removal of the thyroid nodules and had alleviation of the symptoms that they experienced pre-operatively. The little girl is still one of my favorite patients to this day, because when I went to check on her a few hours after surgery, she (with surgical drain, bandage, and all) was doing her homework, citing that she had much to keep up with since she was going to miss some school because of her surgery. She wants to be a doctor (of course I am completely unbiased with respect to my admiration).

Medical treatment is always considered as an option, but surgery is often necessary to alleviate symptoms and remove abnormal tissue. I have been extremely fortunate to train with highly-respected and skilled thyroid surgeons and also continued to advance my own practice when I began working on my own. Due to experience and technology, our complication rates are very low.
One such advance that I am very satisfied with, is the use of continuous neurophysiologic monitoring during surgery. Vocal cord paralysis is probably the most dreaded complication of thyroid surgery, due to potential risks to the function of the larynx. With the use of continuous monitoring, a neurophysiologist monitors my patient’s nerve function throughout the entire procedure and immediately informs us if nerves under excess tension and stretch. We can then adjust our manipulation of the gland, which helps to avoid unnecessary and preventable nerve injuries.

As was state previously, some thyroid problems do not require the need for surgery and can be managed medically. Often times medication can help restore function and prevent weight gain, hair loss, and fatigue, among other symptoms.

How does one know about thyroid disease? Many of our patients are evaluated by a primary care physician and have testing. However, we also see many patients who come in on their own in order to initiate testing and treatment without having seen another doctor. We are available to help in whatever scenario that I patient arrives to our office.

I look forward to another post in the future with updates on Thyroid Cancer Awareness month later this year. If you would like more information on thyroid disease, visit our thyroid page at https://ent-specialist.org/thyroid-disease or the American Thyroid Association at https://www.thyroid.org.

Lawrence Robinson, Jr., MD