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Ear, Nose, Throat & Allergy Specialists Now Offering Appointments via Internet

Living in the North Georgia mountains often brings a sense of welcomed isolation from the crowds and busy roads of Atlanta.  Ear, Nose, Throat, and Allergy Specialists is a 3-office team of 2 surgeons, 3 nurse practitioners, and 2 audiologists that serve a wide geographical area in North Georgia.  Even though we are rural, we have realized we cannot avoid the growing presence of the corona virus, COVID 19, which is affecting the most of the United States and world to some degree.

            As a practice, we have had to quickly learn and adapt to keep patients and staff safe.  Hospitals have dedicated personnel to develop and implement isolation and infectious disease protocols which help reduce the chance of spread of infection.  Fortunately, most of our providers including myself, have lots of hospital experience in dealing with isolation protocols and procedures and applying them to infectious or potentially infectious patients.  Over the past 2 weeks, we have began implementing these practices in all of our office locations with success.  Our goal is to continue to provide needed care to our patients and eliminate the risk of our patients coming to our offices for treatment.

            First, all of our patients are pre-screened on the telephone to ensure they do not have any symptoms of acute cough, cold, or fever.  Patients that do have these symptoms are encouraged to increase fluids and rest as well as to use common cold remedies, and reschedule their appointment after they recover.  If needed, we help direct them to locations where flu and COVID 19 screening are provided. 

           When patients arrive for their appointment, our dedicated and knowledgeable staff perform in-person screening for illness and fever which allows us to quickly isolate any potential infectious person.  Our diligent phone screening has nearly eliminated the chance of an infectious person coming to the office, but we feel this helps ensure a healthy environment for our patients to be treated in. 

           To accommodate the needs of our patients, we have now implemented live, one-on-one, Telehealth appointments.  If you are an existing patient and do not feel comfortable physically coming to the office, our staff will help you set up a virtual appointment using your computer at home.  This allows our patients to remain in contact with us and communicate their needs so we can continue to provide the high level of care we enjoy giving.  Please visit this page to learn more information.

            On behalf of all of our providers and staff at ENT Specialists, we want to let our patients know that we will continue to provide ongoing support and do our part to keep you safe and healthy.  We extend you and your family best wishes, for a safe and healthy experience, as we continue to provide both in-person and virtual visits to our office.

-Josh Snearly, NP-C

Nurse Practitioner

Allergy Testing and Immunotherapy

The Bottom Line

Allergy problems are extremely prevalent in the United States. The American Academy of Otolaryngic Allergy (AAOA) estimates that allergies significantly affect about 50 million Americans, and allergies represent some of the most common types of chronic illness in the US. Allergy issues can range from seasonal allergies, such as allergic reactions to certain types of pollen, to environmental allergies like problems with pet dander and dust mites. Allergic responses to insect stings, like bee venom, can also be severe and even life-threatening.

Types of Allergies

There are several common types of allergies, classified according to the kind of allergen or substance that triggers the allergy. These allergy types include:

Seasonal allergies – This type of allergy is triggered by exposure to pollen. As the name implies, seasonal allergies are usually limited to one or two seasons of the year. For example, ragweed pollen is a frequent cause of seasonal fall allergies, and pollen from trees is often the source of spring and seasonal summer allergies. Seasonal allergies are usually minimized in the winter due to low pollen counts.

Mold allergies – Many species of mold can trigger allergies. These species include Penicillium, Aspergillus, and Alternaria. While it is possible to suffer mold allergies from outdoor exposure, most mold allergy cases occur from indoor exposure due to a higher concentration of mold spores.  

Insect allergies – Insect stings can be painful and annoying for anyone, but around 5 – 7.5% of the population suffers from allergic reactions to bee, wasp, yellow jacket, and other insect stings. The severity of reactions ranges from intense swelling and discomfort near the site of the sting to difficulty breathing, which may lead to death without immediate treatment.

Food allergies – Allergies to certain foods have increased in recent decades. The most common foods that cause allergic reactions include cow’s milk, shellfish, tree nuts, peanuts, and eggs.

Latex allergies – Latex is a type of rubber frequently used in healthcare. Latex allergies are most common in healthcare workers who experience frequent exposure to latex gloves and other latex products.

Environmental allergies – This is a broad group of allergies that can include mold allergies as well as allergies to animal dander, dust mites, and other irritants.

Allergy Symptoms

Allergy symptoms vary according to the type of allergy. A runny nose, watery and red eyes, sneezing, coughing, and congestion are the hallmarks of seasonal, mold, and environmental allergies. If allowed to continue, these symptoms may worsen into a case of sinusitis or bronchitis.

An allergic reaction to certain foods usually manifests as stomach upset, diarrhea, and nausea and vomiting. In addition to these gastrointestinal symptoms, food allergies can cause hives, itching of the mouth and skin, and facial and throat swelling. A latex allergy also causes a localized reaction of hives and itching along with swelling and sometimes a runny nose.

An allergic reaction to an insect sting will cause swelling at the site of the sting and may also cause swelling in other parts of the body. Insect allergies may also result in hives, flushing, redness of the skin, and anaphylaxis.

Anaphylaxis

In certain individuals, food, insect, and latex allergies can lead to a condition called anaphylaxis. Anaphylaxis is potentially life-threatening and constitutes an extreme medical emergency. Characteristics of anaphylaxis include swelling of the throat and face, skin reactions like hives and flushing, difficulty breathing, fainting and dizziness, low blood pressure, and a rapid pulse. Anaphylaxis requires an immediate injection of epinephrine, also called adrenaline, and professional medical attention.  

What Causes Allergies?

An inappropriate immune response is the source of allergy symptoms. Specifically, a foreign substance like wasp venom or pollen triggers the immune system. The immune system identifies this foreign substance as an invasive microorganism like bacteria or a virus. In turn, the immune system produces antibodies and other factors that cause inflammation.

In reality, allergens do not pose a major threat to the body. It is the immune system’s overblown response to allergens that causes allergy symptoms from a mildly runny nose to deadly anaphylaxis.

Risk Factors

Allergies can strike anyone. However, there are a few risk factors that can make an individual more likely to experience allergies.

Family history – A family history of allergies or related conditions such as hives, asthma, and eczema may increase the likelihood of allergy problems.

Age – Children are more likely to experience allergies than adults. Sometimes children will “grow out” of childhood allergies as they mature.

Frequent exposure – Repeated and prolonged exposure to certain allergens can cause allergies to develop. For example, healthcare workers who often wear latex gloves may develop a latex allergy. Similarly, beekeepers have a higher rate of bee sting allergies than the general population.

Preventing Allergies

Once allergies surface, avoidance of allergens is among the most effective measures to prevent allergy symptoms. For instance, being careful concerning a diet is important for those with food allergies. Likewise, wearing good quality filter masks when doing yard work and taking measures to limit exposure to outside air may help significantly with seasonal allergies.

Lifestyle changes are sometimes necessary to control allergies. Those with allergies to cat dander may need to consider a different choice of pet, for example. Also, latex allergy triggers can be avoided by switching to a different material, like nitrile protective gloves.

Of course, avoidance is not always possible. Those with severe allergies need to be prepared. Individuals who suffer from severe allergic reactions should always carry an epinephrine delivery device (brand names include EpiPen and Adrenaclick) and a medical identification alert. They should also ensure that those close to them are aware of their allergy and the symptoms of anaphylaxis. Fortunately, there are also desensitization immunotherapy treatments available for some types of allergies, discussed in the section below.

Allergy Treatment

In the case of mild seasonal or environmental allergies, over-the-counter medications are often sufficient to control symptoms. Effective medications include antihistamines for nasal symptoms and cortisone creams for skin problems. Symptoms of moderate severity may require prescription medications such as corticosteroids.

When allergy symptoms are severe or interfere with daily life and avoidance of triggers is not feasible, allergy testing and immunotherapy can be quite beneficial. Doctors perform allergy testing to identify the specific allergens causing the symptoms. A patient may only know that they develop allergy symptoms during the spring. They may not realize that oak tree pollen is the offending substance. Allergy testing pinpoints the problem while eliminating other potential causes.

Allergy testing can be done in several ways. The modified quantitative testing (MQT) protocol is an allergy diagnostic that is dependable, minimally invasive, and proven safe. This protocol is a combination of skin prick testing and intradermal testing (IDT) that is quite comfortable and causes no pain. Ear, nose, and throat (ENT) specialists use MQT to identify moderate to severe allergies. MQT can be performed safely in-office and does not require a hospital visit.

Blood testing for allergies, called RAST, may be an option for individuals who have severe skin conditions, take medications that interfere with MQT testing, or are otherwise not good candidates for the MQT protocol. RAST testing involves a simple blood draw. The blood sample is analyzed in a laboratory, and the results are provided to the ENT physician.

Immunotherapy, commonly called allergy shots, can often be done when more conservative measures like allergen avoidance and medications have failed. Immunotherapy involves injecting minute amounts of an allergen to desensitize the immune system to that allergen.

Only certain types of allergies respond to immunotherapy. Unfortunately, food allergies and latex allergies cannot currently be controlled through immunotherapy. However, insect, environmental, and seasonal allergies often show good responses to immunotherapy treatments. For instance, about 85% of people experience excellent results from immunotherapy for hayfever (allergic rhinitis).

In immunotherapy, the ENT creates a customized vial for each patient. The vial contains a mixture of allergens to which testing has demonstrated the patient has a sensitivity. The patient receives an injection each week, gradually advancing the dose at a safe rate. Over time, this treatment will cause the immune system to create antibodies to the offending allergens. Ultimately, immunotherapy will result in immunity to the offending allergen, and the patient will have no symptoms when they are around the allergen.

Typically, in our practice, we perform a four-month trial of immunotherapy, and if there is a significant reduction in symptoms, we will continue with the full course of immunotherapy. The course consists of injections weekly for the first year, twice monthly for the second year, and monthly for the last year. Over-the-counter and prescription allergy medications only help to mask the symptoms of allergies. Immunotherapy is the only method of actually eliminating symptoms by acclimating the body to allergens and stimulating antibody production.

Immunotherapy through desensitization injections can allow allergy sufferers to experience a greatly improved quality of life. Often, they are able to enjoy the outdoors again and are no longer limited by their symptoms. In the case of insect allergies, immunotherapy can even be potentially lifesaving.

Tinnitus: Causes, Risk Factors & Treatment

What Causes Ringing in the Ears?

Tinnitus is a pervasive problem in the United States. According to both the Mayo Clinic and the American Tinnitus Association, about 15 to 20% of Americans suffer from daily tinnitus. This number represents approximately 50 million people. There are various causes of tinnitus, and fortunately, several treatments are available for this condition.

We’ll take a look at the different possible causes of tinnitus below. We will also explore risk factors, prevention, and treatment options for tinnitus. Remember, although this article provides valuable information about tinnitus, your ear, nose, and throat (ENT) specialist is always your best source of tinnitus advice and guidance. 

What is Tinnitus?

Tinnitus is a ringing or buzzing in the ears. These sounds can be heard only by the patient and are not generated by an external source. While almost everyone has experienced at least one episode of tinnitus during their life, people with chronic tinnitus may suffer from daily bouts.

The nature of tinnitus varies from person to person. While most patients report their tinnitus as ringing or buzzing, tinnitus may also take the form of a hissing, clicking, or whooshing sound. Some people experience tinnitus only in quiet conditions, such as at night when preparing for bed. For others, tinnitus is near-constant and also occurs in a noisy environment.

Pulsatile tinnitus is a common variant of the condition. In pulsatile tinnitus, the patient feels a pulsing sensation that occurs along with the noise of tinnitus. The condition may feel like blood rushing in the ears and often produces a whooshing sound.

Tinnitus may occur in one or both ears. The severity of tinnitus cases also varies. Tinnitus may be mild and only an occasional annoyance. However, tinnitus can also manifest as a severe condition that interferes with sleep, focus, and the ability to hold a conversation.

Causes of Tinnitus

Tinnitus has many possible causes, and some of these causes respond better to treatment than others. To understand the origins of tinnitus, it is necessary to give an overview of how hearing works. In summary, sound waves stimulate cells in the inner ear called hair cells. In turn, these cells generate electrical impulses that travel along the auditory nerve to the brain, where the impulses are interpreted as sound. Any damage or blockage of this process can result in tinnitus.

Here are some specific causes of tinnitus:

Loud noise exposure – Exposure to loud noise is one of the most common tinnitus causes. High-decibel sounds can result in hearing damage, which leads to tinnitus. Both brief and extended exposure to loud noises can be triggers for tinnitus. Tinnitus that results from a brief or single exposure to loud sound will usually resolve spontaneously. However, tinnitus arising from repeated exposures may be chronic or long-lasting.

Examples of sound sources that can cause tinnitus include jet engines, heavy equipment, loud music, gunshots, and more. It is important to always wear ear protection when exposed to high-volume sounds to avoid problems with both hearing loss and tinnitus.

Age-related tinnitus – As people age, their propensity for tinnitus increases. Those older than 60 have the highest incidence of tinnitus. The high rate of tinnitus among seniors is due to a lifetime of noise exposure as well as age-related degeneration in the structures of the inner ear. Additionally, build-up of plaque in the arteries can lead to higher-than-normal pressure in the blood flow of the inner ear. This phenomenon can cause tinnitus or pulsatile tinnitus.

Earwax accumulation – Earwax, also called cerumen, protects the skin of the ear canal and helps to guard against harmful microorganisms. However, earwax can accumulate to the point that it blocks the ear canal and reduces hearing acuity. When this happens, tinnitus can result.

Acoustic neuroma – This is a benign tumor that grows on the nerves in the inner ear responsible for hearing and balance. Also called a vestibular schwannoma, the tumor may lead to balance issues and tinnitus in one ear only.

Ménière’s disease – Ménière’s is a disease characterized by abnormal inner ear pressure. In some cases, patients experience tinnitus as an early symptom of Ménière’s.

Eustachian tube dysfunction – The Eustachian tube connects the middle ear to the back of the throat. Eustachian tube dysfunction occurs when this tube stays open even when it should close. This condition can cause a sensation of fullness in the ear and is often mistaken for an earwax blockage by patients. Tinnitus is another common symptom of Eustachian tube dysfunction.

Head and neck trauma – Injuries to the head, face, and neck may result in problems with tinnitus. These injuries do not have to be sound-related but can result from automobile crashes, sports accidents, and workplace incidents.

Low zinc levels – Zinc, a common mineral, is normally present in the human bloodstream. Research suggests that some tinnitus patients have low zinc levels, a condition called hypozincemia. Studies have been contradictory as to whether taking zinc supplements can help lessen tinnitus symptoms, and the findings remain controversial.

Certain medications – Taking certain classes of medications may increase the chances of developing tinnitus, at least in the short term.

Risk Factors

The following are major risk factors for tinnitus:

Loud noise exposure – Prolonged exposure to loud noises often leads to tinnitus. Individuals who work in heavy industry, construction, and music are particularly at-risk.

Age – Those older than 60 have a greater risk of tinnitus than the general population.

Male sex – Men are more likely to experience tinnitus than women, although the reasons for this fact are still unknown.

Other medical conditions – Conditions such as cardiovascular disease, Ménière’s disease, and previous head trauma can increase the likelihood of tinnitus.

Smoking status – Smokers suffer from a huge variety of medical conditions at a higher rate than non-smokers, including tinnitus.

Preventing Tinnitus

The most effective way to prevent tinnitus is to protect against loud noise exposure. Hearing protection should always be worn in noisy environments, and music should be enjoyed at a reasonable volume. It is also important to have hearing checked on a regular basis so that any hearing loss or other problems can be identified early.

Other than sound protection, patients should also safeguard their ears in other ways. For example, earwax removal should never be attempted on one’s own. Instead, a visit to the ENT can safely remove excess earwax while checking for any problems. Also, protected the ear from water can prevent irritation and infections, which could lead to tinnitus. Consulting an ENT about earplugs or other ways of avoiding swimmer’s ear is an excellent idea.

Another effective method of tinnitus prevention is keeping in good general health. Good diet and exercise are crucial for overall health, but these measures can also cut the risk of cardiovascular disease that can contribute to tinnitus. Also, quitting smoking is paramount for both tinnitus prevention and longevity.

Tinnitus Treatment

Treatment of tinnitus largely depends on the underlying cause of the problem. For instance, if the tinnitus is due to an earwax obstruction, the treatment may be as simple as an ear cleaning by an ENT. Likewise, a doctor may decide zinc supplementation is the best course of action if a patient’s zinc levels are low.

Surgery is usually necessary to resolve tinnitus caused by an acoustic neuroma. If the tinnitus is due to medication, a physician may decide to discontinue that medication or switch to an alternate drug. This point illustrates the importance of keeping the entire healthcare team up-to-date on a patient’s entire medication list, both prescription and over-the-count.

In cases of age-related tinnitus or tinnitus resulting from noise exposure, the latest hearing aids can be quite helpful. Some degree of hearing loss usually accompanies these types of tinnitus, and patients often have trouble understanding conversational speech or audio from devices like phones and televisions. The latest hearing aids are “smart” devices that do more than merely amplify sound.

These smart hearing aids contain microprocessors that also filter out noise, such as background sounds and the buzz of tinnitus. This feature can be invaluable for patients dealing with severe tinnitus, enhancing their quality of life and allowing them to take part in social interactions. Many smart hearing aids also have Bluetooth connectivity so that they can interface with smartphones, smart TVs, etc.

First Steps

Consulting an ENT specialist should be the first action for anyone experiencing lasting tinnitus or suspected hearing loss. A proper diagnosis is necessary for meaningful treatment, and ENTs are experts in all forms of hearing issues. Tinnitus can be frustrating and even debilitating, but help is available.

How do Sinus Infections Become Chronic?

Data from the Centers for Disease Control and Prevention (CDC) show that chronic sinusitis is quite common among Americans. In 2018, over 28 million American adults suffered from chronic sinusitis, and this number represents greater than 10% of all the adults in the US. In 2016, sinusitis was the chief reason for more than 4 million doctor’s visits. 

Obviously, chronic sinusitis is a huge problem for many people. But what exactly is chronic sinusitis, and what role do sinus infections play in sinusitis? We will take a deeper look at what constitutes sinusitis, reveal facts about sinus infections, and outline the prevention and treatment of these illnesses.

What is Sinusitis?

Simply put, sinusitis is an inflammation of the sinuses. The sinuses are spaces in the skull near the nose and around the eyes. Normally, sinuses contain only air. However, the sinuses fill with fluid during a case of sinusitis. This change presents an opportunity for infection and causes pain, a sensation of pressure, a runny nose, and multiple other symptoms.

A variety of factors can inflame the sinuses and lead to sinusitis. The causes include allergic rhinitis (inflammation of the nasal lining due to allergies), airborne irritants, structural abnormalities with the nose, and infections from microorganisms. Some people are especially sensitive to airborne irritants, such as environmental pollution and tobacco smoke. These individuals may encounter sinusitis triggered by exposure to automobile exhaust, smog, secondhand smoke, and other substances.

However, microorganism infections are the most common cause of sinusitis, with viral infections being the most frequent culprit. In fact, since infections are the source of so many sinusitis cases, many physicians and healthcare workers use the terms “sinusitis” and “sinus infections” interchangeably. This condition may also be called rhinosinusitis because it causes nasal symptoms as well as sinus problems.

Acute vs. Chronic

In medicine, an acute condition usually lasts for a relatively brief time. Common colds, for example, are typically acute. On the other hand, chronic disease or illness lasts for an extended period. Diabetes mellitus is one example of a chronic condition.

The symptoms of acute sinusitis usually arrive suddenly and resolve within 12 weeks. The limited lifespan of acute sinusitis does not affect the problem’s intensity. Acute sinusitis may feel like it will last forever, but it does eventually clear up. Conversely, the duration of chronic sinusitis is 12 weeks or longer. Chronic sinusitis originates from acute sinusitis, often from repeated episodes of acute sinusitis called recurrent acute sinusitis.

Recurrent acute sinusitis, as well as other problems like nasal polyps, can cause lasting damage to the sinuses. Furthermore, if the sinuses are frequently filled with fluid, they become a breeding ground for infectious viruses and bacteria. Chronic sinusitis can develop as a result of this microorganism growth.

Risk Factors

The risk factors of acute sinusitis are similar to those of chronic sinusitis. These risk factors include the presence of nasal polyps, frequent upper respiratory infections, a deviated nasal septum, or environmental allergies to substances like animal dander and pollen. Additionally, people who have suffered facial or nasal injuries have a higher likelihood of sinusitis than the general population.

Another risk factor for sinusitis is a compromised immune system. This state may results from HIV infections, taking immunosuppressant medications, or chronic disease. To decrease sinusitis risk, the immune system must be able to fight off harmful microorganisms effectively. Other risk factors include prolonged oxygen use for medical conditions and lying in a supine position (on the back) for extended periods. Oxygen administration may dry out and irritate the nasal passages, and lying down for long periods can allow fluid to accumulate in the sinuses.   

Symptoms

The most common sinusitis symptoms are:

Nasal inflammation – The inflammation can manifest as sore, swollen, and red nasal passages. Rhinitis, more commonly called a runny nose, is also a common sign and can cause nasal congestion. The nasal discharge may be colored white, green, or yellow.

Postnasal drainage – Also called postnasal drip, this is the discharge that runs down the back of the throat. Postnasal drainage is often foul-tasting and can cause nausea, frequent coughing, and the need for throat clearing.

Ear pain – Sinusitis may lead to ear pain, pressure, or a sensation of fullness or blockage in the ears.

Facial aching and pain – Pain from sinusitis usually focus on the forehead, cheeks, eyes, upper jaw, and even the teeth. Full body aches are uncommon, but patients may notice pain in the ears and into the neck area.

Sore throat – A sore throat during sinusitis is usually the result of irritation from postnasal drip and coughing. However, a sore throat can also be caused by a concurrent infection, such as strep throat.

Fever – Fever is not a frequent symptom of chronic sinusitis, but fever may be present during cases of acute sinusitis.

Preventing Sinus Infections

There are several simple measures that can effectively inhibit many cases of acute sinusitis, and, in turn, help to avoid chronic sinus infections. Perhaps chief among these is preventing upper respiratory infections. Frequent handwashing and avoidance of sick individuals can go a long way toward infection prevention.

Management of allergy problems is also important for sinus infection prevention. Patients with environmental allergies should work with their healthcare team to avoid allergens and keep their symptoms under control. All patients, whether they have allergies or not, should refrain from smoking and limit their exposure to secondhand smoke whenever possible. People who are particularly sensitive to environmental allergens can also reduce their sinusitis risk by staying indoors on days with high pollen counts or poor air quality. Exposure to mold can also be a sinusitis trigger, so everyone should be on guard against mold problems in their homes and workplaces.

It may seem counterintuitive, but dry air can actually irritate nasal passages and sinus, leading to fluid-filled sinuses. Using air humidifiers can help, especially during cold and dry winter months. However, patients should be careful as humid environments can also breed mold, which can contribute to sinus infections.

Sinus Infection Treatment

Treatment of acute sinusitis may consist of only over-the-counter medications and time off work to recover. These medications may include decongestants, anti-inflammatory drugs like acetaminophen, and saline nasal sprays and rinses to soothe the nasal passages and keep them moist. Many patients with acute sinusitis do not need to visit their doctors. However, persistent or recurrent symptoms may mean a larger problem is at hand, and the development of a fever is a reason to schedule a doctor’s appointment immediately.

Recurrent acute sinusitis or chronic sinusitis usually indicates an underlying problem. Patients suffering from these conditions may have a deviated nasal septum, an immune system issue, or sinus obstruction. Ear, nose, and throat specialists (ENTs) and other physicians usually first try prescription medications, such as steroids and/or antibiotics, to resolve the issue. However, a doctor may forgo these measures if they suspect the sinus infection is due to another cause.

Tests to determine the origin of sinusitis can include MRI scans or x-rays of the sinuses, allergy testing, and cultures of nasal discharge or sinus fluid to identify harmful microorganisms. ENTs may also perform a sinuscopy where they pass a tiny scope into the sinuses to inspect their condition.

Unfortunately, approximately 20% of chronic sinusitis cases do not respond to medication and saline rinse therapies. These patients usually have sinuses that cannot freely drain because the passages are blocked by tissue or bone. Older treatment for this condition consisted of invasive sinus surgery where the ENT surgeon would shave excess tissue from the sinuses, opening them so that they could drain. This surgery generally has a recovery time of at least three to five days and can leave scarring in the sinus cavities.

Newer Treatment

However, a more attractive alternative to traditional sinus surgery is now available. Called balloon sinuplasty, the Food and Drug Administration (FDA) approved this treatment for chronic sinusitis in 2005. Balloon sinuplasty is much less invasive than traditional sinus surgery and results in less bleeding and an average of just two days off work. It is an outpatient procedure, meaning it does not require hospital admission and can be performed in an ENT’s office or hospital outpatient surgery center.

During balloon sinuplasty, the ENT guides a small catheter containing a balloon through the nose to the sinuses. They then gradually inflate the balloon, gently enlarging the sinuses so that they can drain. Studies have shown that the number of positive outcomes from balloon sinuplasty meets or exceeds those from traditional sinus surgery. Balloon sinuplasty is generally non-traumatic and does not cause nearly as much bleeding or scarring as older sinus surgery techniques.

Balloon sinuplasty may be available without general anesthesia, using only local anesthetic. The vast majority of patients who undergo balloon sinuplasty experience results that last an average of nine months to two years. The procedure requires evaluation prior to evaluation by an ENT, and the outcomes can be incredibly beneficial for patients who struggle with chronic sinusitis and want a minimally-invasive solution.

North Georgia Allergy Season

North Georgia is renowned for its fall season with its colorful leaf changes and cooler temperatures.  With a dense tree and vegetation population, North Georgia is also considered to be one of the leading areas in regard to allergens like pollens and molds.  Most associate allergy season with the springtime tree blooms and summertime grass pollens, however, fall allergens can cause discomfort and irritation for many people.

Fall allergens are most typically characterized by weed and mold allergies.  Weed allergies include the common ragweed, sheep sorrel, and pigweed.  There are many types of molds in the air and they mostly originate from damp conditions under leaves and dirt and also grow on the north side of many trees here in North Georgia. 

It can be difficult for individuals to be able to discern if they are having a sinus infection or an acute allergy exacerbation because the symptoms can be similar.  Patients are often treated with antibiotics for sinus infection when they are actually having an allergic reaction.  Symptoms of an allergy flare-up include sinus pain and pressure, nasal drainage, sneezing, itchy watery eyes, and even asthma flair ups. 

At Ear, Nose, Throat, and Allergy Specialists, we can evaluate your symptoms and perform an in-office allergy test to discover what allergens are causing your symptoms.  Allergy testing is also beneficial and lets you know what times of the year you will experience the majority of your symptoms, helping guide your individual therapy.  Medication options for treatment include various nasal sprays and antihistamines.  ENT Specialists also provide custom-tailored immunotherapy for patients that de-sensitizes you to the specific things you are allergic to lead to an overall improvement in allergy symptoms.

On behalf of all of us here at ENT Specialists, we hope you have a wonderful fall season and stay healthy.  Should you need help with your allergies, we would be glad to get you an appointment for an evaluation. 

Back to School ENT Health

It is back to school time again. That wonderful time of year that our kids start sharing germs that lead to illness. One of the most common complaints of school-age kids is a sore throat or tonsillitis. Tonsillitis can be caused by several things including postnasal drainage, allergic rhinitis, and viral or bacterial infections.

ENT evaluation is recommended if episodes of tonsillitis become recurrent. If your child begins to snore or have difficulty sleeping ENT evaluation is also important. Recurrent tonsillitis (6+ times per year) or obstructive sleep apnea combined with enlarged tonsils warrant a discussion about tonsillectomy.

A tonsillectomy is a surgical procedure to remove the tonsils. This procedure will likely improve sleep quality and eliminate the recurrence of strep throat. The recovery time for tonsillectomy varies from 10-14 days.

– Crystal Rice, MSN, FNP-C

Best Places to Live with Allergies [Ranked]

Suffering from chronic allergies means dealing with daily pain and discomfort due to your environment Wouldn’t it be great if you could live somewhere where you could breathe a little bit easier? Well, the Asthma and Allergy Foundation of America recently released a comprehensive report which ranks the best places to live for allergy sufferers. 

The best places to live in the United States for allergy sufferers are as follows:

  1. Denver. CO
  2. Provo, UT
  3. Boise, ID
  4. Portland, OR
  5. Colorado Springs, CO
  6. Seattle, WA
  7. Salt Lake City, UT
  8. Raleigh, NC
  9. Spokane, WA
  10. San Jose, CA
  11. San Diego, CA
  12. San Francisco, CA
  13. Sarasota, FL
  14. Daytona Beach, FL
  15. Sacramento, CA
  16. Palm Bay, FL
  17. Washington, DC
  18. Boston, MA
  19. Milwaukee, WI
  20. Bakersfield, CA

One thing you’ll immediately notice about the above list is that a majority of cities are in the Midwest and the Pacific Northwest. These regions’ colder seasons means that they produce less pollen and the pollen stays in the air for shorter periods of time. Dry and high-altitude environments also mean that there are fewer plants and fungi, which creates less pollen and spores than in humid and wet environments.

Best Areas for Allergies by Region

It’s important to keep in mind that no place is safe from allergens. There’s a good chance that you’ll have some level of allergies regardless of where you are. Some of the proteins found in pollen are similar among plant families and are often highly cross-reactive. This means that you may develop an allergy to a new plant even after moving because it’s in the same plant family.

It’s prudent to get allergy tested so that you are aware of what triggers your allergies, as different regions of the country have different levels of allergens. For example, the Pacific Northwest has lower amounts of ragweed pollen but the same amount of grass and tree pollen.

West 

Tree pollen: March to May

Grass pollen: April to July

Ragweed: Early June to October

The western United States is the best place to live for allergy sufferers. Arid and mountainous regions prevent the proliferation of airborne allergens. Dust mites are also sparsely found in the West. You may want to consider moving to cities like Portland, San Francisco, and Seattle.

Midwest 

Tree pollen: Mid-Spring

Grass pollen: Beginning of summer

Ragweed: Middle of August

Generally, the further north you go the better. Ragweed is found in the largest quantities here and will be your biggest enemy. Additionally, some of the crops planted in the Midwest may produce bothersome allergens. You’ll have the best shot in cities like Boise and Milwaukee.

South

Tree pollen: Early Spring

Grass pollen: Early May to Summer

Ragweed: Early September

The South is, unfortunately, the worst place to live for those who suffer from allergies. Its wet and humid climate creates long and hot spring months which allow tree pollen to easily spread and mold to grow. However, there are a few areas known to be less of a problem. Consider moving to Atlanta or Raleigh. 

Northeast 

Tree pollen: Middle of Spring

Grass pollen: Early June 

Ragweed: Middle of August

The northeast benefits from a colder climate which considerably mitigates their pollen season. However, climate change is creating hotter spring months in the Northeast and this is creating a worsening allergy problem in the area. Cities such as Washington DC and Boston would be your best bet.

Okay, but what about the best overall states for allergies? Here they are:

  • California
  • Utah
  • Florida
  • Colorado
  • Washington

Worst Cities for Allergies

If allergies are an issue for you, you might want to avoid the following cities:

  • McAllen, TX
  • Lousiville, KY
  • Jackson, MS
  • Memphis, TN
  • San Antonio, TX

One thing you’ll notice is that all of these cities are located in the South and are known for their hot and humid climates. Texas also appears most frequently in the above list due to the abnormal amount of dust in the air. 

Methodology

You might be wondering how these cities and states were even picked. The Asthma and Allergy Foundation looked at the top 100 metropolitan areas in the lower 48 states and looked at three factors: seasonal pollen score, allergy medication use, and the number of allergy specialists. These factors were not weighted equally and the composite score was used to rank each of the cities.

Mitigating Your Allergies

We’ve established that allergy sufferers will be impacted by allergies practically anywhere they go. However, there are steps you can take to help mitigate the potential impact of allergies on your life:

  • Limit the amount of time you spend outdoors
  • Put a filter on your air conditioning unit
  • Take a shower before bed in order to remove any residual pollen and other allergens
  • Change and wash your clothes upon entering your home if you spent time outdoors
  • Remove your shoes upon entering your home
  • Vacuum and clean floors frequently
  • Flush your nasal passages regularly to remove any allergens in your sinuses
  • Try over-the-counter medications.
  • Consider getting allergy shots (immunotherapy) so your body can better handle allergens

Ronald Van Tuyl, MD 

Epistaxis

Epistaxis, which is better known as a nose bleed, can be mild and irritating or potentially severe and life threatening.   If you experience frequent nose bleeds or you are having a nose bleed that will not stop, you should seek medical treatment.  Knowing why nose bleeds happen, where they usually occur, and what to do about them can be beneficial should an epistaxis happen to you or a loved one.

Nose bleeds can happen for a variety of reasons.  Elevated blood pressure contributes to bleeding because the increase in pressure in your blood vessels puts pressure on them and can cause them to ooze and bleed. If you are a patient on blood thinners, you are also at an increased risk for nose bleeds and should take care to seek treatment immediately if you see any blood coming from your nose.  Chronic irritation from allergies, runny nose, or even dry air can also increase your chance of having a nose bleed.

Nose bleeds most frequently come from an area on the nasal septum which is the tissue that separates the left and right nostril.  This area is called Little’s area, but can cause a “big” problem.  If you are having nose bleeds, we can perform a nasal endoscopy in the office to determine where the bleeding is coming from and also perform a simple cautery procedure to stop the bleeding.  

Perhaps your nose is bleeding from one side and you are wondering what to do.  First, remain upright and use your thumb and first finger to squeeze your nostrils together and compress them against your nasal septum (the cartilage in the middle).   By applying constant pressure for 10 minutes, you may be able to stop the bleeding.  If the bleeding will not stop, you should seek immediate medical attention. 

All of our locations at Ear, Nose, Throat, and Allergy Specialists have the ability to help you or loved one with your nose bleed issues should you need expert care. 

Josh Snearly, NP-C

The physician and audiologist team: The Leaders in Hearing Improvement

I have found that teamwork with a motivated and well trained team is the best way to accomplish goals. There Is a saying that I learned in high school sports that still rings true today:

Teamwork makes the dream work.

Hearing loss and tinnitus (ringing in your ears) comes from many different causes. Not one solution can improve all causes of hearing loss. The physician and audiology team at Ear, Nose , Throat and Allergy Specialists can accurately diagnose the cause of your hearing loss, or tinnitus, and implement a solution. And improve your quality of life with better hearing.

As ear nose and throat physicians we are trained to improve hearing loss that requires reconstructive eare surgery. This includes perforated eardrum’s, chronic mastoiditis, and cholesteatoma’s which are tumors of the middle ear that cause hearing loss and otorrhea (ear drainage). Other inner ear tumors like glomus tumor‘s or acoustic neuroma’s have the presenting symptoms of hearing loss and ringing. The physicians at Ear, Nose , Throat , and Allergy Specialist’s perform a physical examination which includes a microscopic ear exam, and a hearing test to determine if any of these problems are present. Further imaging may be ordered if there is a suspicion of a tumor or chronic infection. If surgery is required to improve hearing our physicians are board certified Otolaryngologists and can perform microscopic ear surgery.

If it is determined that surgery is not needed, many times hearing aids will improve hearing loss and tinnitus from nerve loss. This type of hearing loss can be from heredity, aging, or medications. An appropriately selected and programmed hearing aid will improve understanding and reduce tinnitus in all listening situations. Especially where background noise reduces understanding . Our Audiologists are experts in selecting and programming the appropriate hearing aid for optimal hearing improvement with the needs and capabilities of each patient carefully considered.

Close follow up and adjustment is key to successful use of hearing aids.
After hearing aids have been worn for several months ear wax can form and block the ear canal. This impedes the performance  hearing aids. This can carefully be removed under the microscope by the physician at the same visit that programming for the hearing aid is being done by the audiologist. Again, teamwork, with the ultimate goal of improving hearing for our most valuable asset: Our patients.

Through the whole experience the physicians and audiologists work as a team. Schedule a hearing test with us today and bring a loved one with you for a true learning experience.

Ronald Van Tuyl, MD 

Parathyroid Surgery

The human body never ceases to amaze me.  Ever since I was a medical student, I was attracted to surgery of the head and neck.  One of the most interesting aspects of head and neck surgery, in my opinion, is the management of parathyroid disease.  My staff can attest to my excitement when I have a new patient with whom I have the opportunity to discuss this complex issue.

The parathyroid glands are 2 pair of small endocrine glands nestled behind the thyroid gland in the middle of the neck.  They are diminutive, however they have a chief function in helping to regulate electrolyte balance.  In fact, the cells within the gland are called “chief cells.”  They secrete a hormone that helps to liberate calcium from the bony skeleton, so that the calcium can be used to power nerve and muscle function.  Without enough calcium in the bloodstream, nerve and muscle (including heart) function would cease and lead to death if left untreated.

Sometimes the parathyroid glands become overactive and cause symptoms as a result of having excess calcium in the blood (including, but not limited to fatigue, depression, abdominal pain, kidney stones, bone pain).  Also, the parathyroid hormone leeches calcium from the skeleton and can cause osteoporosis or brittle bones.  Overactive function can be due to a tumor (usually benign and rarely malignant) or due to unregulated activity in patients with kidney disease.

When a patient is found to have elevated calcium due to overactive parathyroid function, imaging is performed to help localize the gland.  Before imaging techniques became available, surgeons had to explore the entire neck to find an abnormal gland or tumor.  With current technology, we can precisely localize a gland and often can remove a tumor or enlarged gland in less than an hour.  We also utilize rapid hormone testing so that we can verify removal of the parathyroid gland while the patient is still in the operating room.

Just recently, I had the opportunity to help a young woman who had been suffering for years with bone fractures, osteoporosis, kidney stones, and fatigue.  She did not even know that she was depressed, but after surgery she reported to me that her energy had returned and that she wanted to do activities that she had not had the energy to perform in many years.  We were able to localize this patient’s tumor accurately before surgery, and therefore were able to remove it in about thirty minutes via a tiny incision just above the notch of the breastbone.

After surgery, she reported feeling better than she had in years.  As is the case with many patients, she had no idea how little energy she had and how fatigued she actually was because she had become used to the way that she felt.  She said she wished she had the procedure done a long time ago.

If you have been diagnosed with parathyroid disease and are in need of surgical management, look no further! Please contact us for an appointment so that we can help get you on the road to recovery.

Lawrence L. Robinson, Jr., MD