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Do I need a referral to see an ENT doctor?

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You usually don’t need a referral to see an ENT doctor. However, your insurance plan may require a referral for coverage of specialty services. Therefore, verifying with your insurance if a referral is needed for specialty care is crucial prior to your appointment date.

Provider Referral vs Insurance Referral

The term “referral” is often used broadly. There are two specific types of referrals: provider referrals and insurance referrals. 

A provider referral is a document sent by a healthcare provider (often a primary care doctor) to a specialist that formally refers a patient for further evaluation and treatment. It typically contains demographic information about the patient and a portion of their medical record that the specialist can review. 

After receiving the referral, the specialist should reach out to the patient to schedule their appointment. Unfortunately, this often does not occur and a patient has to call themselves to set up the appointment. Specialists utilizing referral management software (such as JumpMD) tend to be more proactive in contacting patients to schedule an appointment.

Specialists may require a provider referral to validate that specialized care is appropriate. In other cases, a specialist may have a limited volume of appointment slots and require a provider referral in an attempt to better allocate scarce availability. 

Regardless, the vast majority of ENT clinics do not require a provider referral because many patients are aware when they have a chronic ENT issue that may require surgical intervention. However, many other specialties, such as neurology, typically require a provider referral and do not allow self-referrals. This is because it’s harder for patients to recognize when they need specialized care in these areas.

An insurance referral (also referred to as an insurance authorization or a “paper referral”) is a document sent by an insurance company authorizing coverage for specialty services. If your insurance plan requires a referral and you do not secure one, you could be liable for the full cost of medical services. Thus, it is very important to verify that the specialist has received an insurance referral prior to the date of your appointment.

It’s important to note that determining if your insurance plan requires a referral is the responsibility of the patient, not the specialist. Furthermore, referrals are usually valid for seeing one specific specialist, such as an ENT doctor, and do not cover consultations with all types of specialists.

Insurance referrals are typically obtained by your primary care provider on your behalf. These referrals come with an authorization number that the specialist uses when submitting claims to your insurance company. They also typically specify a date range during which the coverage is valid. 

The following types of plans are most likely to require an insurance referral:

  • HMO
  • POS
  • VA Community Care
  • Medicaid (depending on the state & plan)

What if I see an ENT without an insurance referral?

Insurance companies generally do not approve “retro authorization” for specialty care after services have been rendered. This means that if you see a specialist without the necessary prior authorization, the insurance company is likely to deny the specialist’s claim and put the full cost of the visit as patient responsibility.

If you lack insurance coverage for a visit, some ENT offices may provide “self-pay rates,” which are often lower than standard rates charged to insurance. This option can help reduce the financial impact for patients without the required referral or authorization.

Common misconceptions about insurance referrals

  • An insurance referral does not mean that all services performed by a specialist will be covered at 100%. You may still be subject to deductibles, copays, or coinsurance.
  • Referrals are not permanent. They include either a defined number of visits allowed or a date range during which visits are authorized. 
  • You can still see an ENT even if you cannot obtain an insurance referral. Many practices allow self-referred patients and offer self-pay rates.

How to Clean Your Home without Aggravating Your Allergies

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Do you suffer from debilitating migraines, itchiness, burning sensations, and trouble breathing while trying to clean your home? You’re not alone – our allergy specialists frequently see patients who struggle to effectively clean their homes without bothersome symptoms.

Unfortunately, it’s easy for allergy sufferers stuck in a vicious cycle regarding home cleaning. While cleaning is necessary to alleviate allergy symptoms, it’s easy to skip it because of the discomfort it brings. The thought of going through the sneezing, itching, and other allergy symptoms that cleaning can trigger makes it challenging to stay motivated.

That’s why we’ve put together our list of the best tips to follow when cleaning to minimize the impact of allergy symptoms. 

1. Take Antihistamines Before Cleaning

Over-the-counter antihistamines take around 30 minutes to begin taking effect and peak in efficacy around 1 to 2 hours after being taken. Thus, taking antihistamines before the start of your cleaning may lessen or prevent your allergy symptoms from occurring. Otherwise, you may prolong your symptoms if you wait until after the cleaning has begun. 

2. Open Windows & Doors

Opening your windows and doors while cleaning will help increase the ventilation while cleaning and “can also reduce risks from particles resuspended during cleaning,” per the EPA. However, if you have seasonal allergies, check your area’s pollen and mold counts before cleaning to prevent outside air from triggering your allergies and making things worse.

3. Wear a N95 Respirator

Dust accumulates and settles in a home over time and becomes airborne when disturbed. An N95 respirator protects you from inhaling dust and other allergens by capturing them on the outside of your mask. An N95 respirator provides a high level of protection against airborne allergens because of its tight seal around the mouth and nose.  

It’s important to clarify that an N95 respirator differs from a surgical mask. A typical face mask (like a surgical mask) does not fit as tightly on one’s face and can allow particles to leak in around the edge of the mask. Some masks also advertise themselves as “dust masks” but do not provide the same level of protection against smaller particles than dust, such as mold. 

4. Use HEPA Filter Vacuums

Sweeping with a broom is not an effective way to trap and eliminate dust. Worse, regular vacuums can suck up dust and simply blow it out the other end of the vacuum. 

A HEPA vacuum filters harmful particles out of the air passing through the vacuum. Put simply, HEPA filters help prevent dust from being released back into your home and triggering your allergic response. There are similar benefits to using a HEPA filter in your HVAC system.

5. Swap Cleaning Products

Those with severe allergies may unknowingly be allergic to their cleaning products, particularly those used in the kitchen and bathroom. Scented cleaning products such as Febreze and Lysol cleaning wipes can be particularly problematic for those with sensitivities due to their strong odor.

Opt instead for unscented or natural alternatives specifically formulated for those with allergies. For example, vinegar, rubbing alcohol, baking soda, and hydrogen peroxide are all safe and unscented alternatives.

6. Steps After Cleaning

Dust kicked up during the cleaning process may stay airborne for a period of time after the cleaning is complete. Thus, consider leaving your environment for a few hours before removing your mask and settling back in.

During cleaning, dust may settle on your skin and clothes, especially after cleaning hard-to-reach areas. It’s crucial to avoid redistributing this dust throughout your home. To do so, consider changing your clothes and taking a shower after cleaning is complete.

7. Preventative Tips

Here are some tips to help prevent the accumulation of allergens in your home in the first place: 

  • Hire a cleaning service: If cleaning is still problematic for your allergies, consider hiring a professional cleaning service. Sophia Kennan, Vice President of Client Experience at Transcend Home Cleaning, emphasizes that “a cleaning service can improve your personal wellness, reduce stress, and keep your environment free of harmful allergens.” By entrusting your cleaning needs to experts, you can ensure your home is thoroughly cleaned and free of allergens without compromising your health.
  • Clean more frequently: To prevent the accumulation of irritants like dust, it’s best to clean more frequently. By increasing your cleaning frequency, you can effectively reduce the amount of dust and other allergens in your home, resulting in a cleaner and healthier environment.
  • Skip carpeting – If possible, limit the amount of carpeting in your living environment. A vacuum can only do so much to rid allergens trapped in carpeting. Amazingly, it’s estimated that carpeting can contain up to one pound per square foot of dirt. Smooth flooring (like hardwoods) are considerably easier to clean.
  • Declutter: Clutter in your home creates more surface area for dust and allergens to accumulate. Additionally, it’s difficult to clean certain items if they are buried under clutter. 
  • Washing bedding frequently: Those with dust mite allergies can benefit greatly from regularly washing their linens every seven days. 


Dr. Lawrence Robinson Completes First Inspire Implants at Piedmont Hospital

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Congratulations to Dr. Lawrence Robinson for completing the first Inspire implants at Piedmont Hospital! The procedures were performed at Piedmont Mountainside Hospital by Dr. Robinson and patients will be followed by Dr. Nagamalar Raju.

The Inspire outpatient procedure is aimed at those who have been diagnosed with moderate to severe obstructive sleep apnea who are unable to obtain a consistent benefit from CPAP. Inspire works by stimulating key airway muscles, which allows the airway to remain open during sleep. For more information, contact our office for an appointment. This procedure is being offered by Dr. Lawrence Robinson.

What is Eustachian Tube Dilation?

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The eustachian tube connects the middle ear to the back of the nose and throat, in the nasopharynx. About one-third of its length is bony (this portion enters into the middle ear), and about 2/3 cartilaginous (this portion enters the back of the nose and throat). The cartilaginous portion periodically opens and closes to allow air to flow into the middle ear from the nasopharynx. This can also occur vice-versa, where air flows from the middle ear back into the nasopharynx to equilibrate the pressure between the middle ear and the outside environment.

Eustachian tube dysfunction causes many types of ear problems, including frequent infections in the middle ear (otitis media), persistent fluid in the middle ear (otitis media with effusion and others. Eardrum skin may become trapped into a retracted pocket and develop into an expanding skin cyst in the middle ear and beyond (cholesteatoma). Eustachian tube dysfunction that doesn’t respond to medical management is currently treated by placement of a ventilating tube through the eardrum.

Ventilation tubes allow air pressure to passively equalize between the middle ear space and the outside environment to try to limit further middle ear problems. Ventilation tubes are usually effective if/when they remain open, but most tubes will eventually fall out of the eardrum or become clogged. Ventilation tubes may need to be replaced multiple times over one’s lifetime. Potential complications of ventilation tubes include further weakening of the eardrum and persistent hole in the eardrum which may need additional surgery to close. Ventilation tubes however do not address the root of the problem, the Eustachian tube dysfunction.

Balloon dilation of the eustachian tube attempts to restore normal function of the eustachian tube, with the goal of no longer needing ventilation tubes. The procedure is FDA approved for use in adults 18 years of age and older. It is typically performed under general anesthesia, and is often performed in conjunction with other procedures. It has been determined that the cause of Eustachian tube dysfunction is in the cartilaginous portion of the eustachian tube. This is the site of dilation with the instrument.

How does the Procedure Work?

To perform this procedure, Ear, Nose, Throat & Allergy Specialist uses endoscopic tools in patients under general anesthesia to thread a balloon catheter through the nose and into the dynamic cartilaginous portion of the Eustachian tube. The catheter is designed so that the balloon can’t enter the bony part of the tube, preventing risks associated with entering that passage.

With the balloon in place, the surgeons inflate it to 12 atmospheres of pressure for two minutes, then remove the catheter. The entire procedure takes just 20 minutes from beginning to end.

Follow-up of patients in the weeks and months after this procedure suggest that their Eustachian tubes remain open more appropriately, allowing better aeration for the middle ear and preventing the recurrent ear infections that are typically prevalent for patients with obstructive Eustachian tube dysfunction. Although the mechanism behind this effect isn’t completely clear, biopsy data from patients after surgery suggests that the balloon dilation crushes the lining of the tube, leading it to heal with a thin layer of fibrous scar tissue that helps prop it open and increases the size of the lumen.

What Should Be Done Before Surgery?

Here are a few things you can do before surgery to help things go more smoothly:

  • Eliminate all medications that thin your blood for two (2) weeks before surgery, unless directed otherwise by your surgeon.
  • Cease smoking at least 3 weeks before your surgery date.
  • Notify your doctor if you get a chest cold or fever during the 5 days before the surgery. A cold may increase the risk from anesthesia.
  • Sometimes blood counts and clotting are checked before surgery to make sure you are not at risk of increased bleeding.
  • No food 8 hours prior to surgery.  No liquids for 4 hours prior to surgery.
  • Arrange for a ride home after the procedure

What Can Be Expected After Surgery?

After surgery, the following should be expected:

  • Discomfort is typically minimal after the procedure.
  • A small amount of nose bleeding may occur
  • A sore throat might be expected for a few days.
  • Avoid any strenuous activity, exercise, lifting more than 10 pounds, excessive bending or straining for 1-2 weeks following surgery to prevent bleeding.
  • Use mild non-aspirin pain relievers (Tylenol) as first line treatment for pain and prescription pain medication as directed by your doctor for breakthrough pain.

Success Rates

There are many studies that have demonstrated symptomatic as well as objective clinical improvement in patients undergoing balloon dilation of the Eustachian tube for Eustachian tube dysfunction. Studies have shown the success rate range between 64% to 97% with a complication rate of approximately 2%.

A peer-reviewed study in the August 2018 edition of the Otology & Neurotology journal has also found that “Eustachian tube balloon dilation is a safe and effective treatment for persistent Eustachian tube dysfunction”. Additionally, the study found that “procedures are well tolerated in the office setting under local anesthesia.”

RhinAer® Procedure: Benefits & Risks

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RhinAer® Procedure

At the Ear, Nose, Throat & Allergy Specialist, we use the RhinAer® procedure to treat and provide long-lasting relief from chronic rhinitis — a condition that impacts millions of Americans.

What is Chronic Rhinitis?

Chronic rhinitis is an inflammation and swelling of the lining of the nose. Its symptoms can be pesky, including runny nose, sneezing, nasal itching, post-nasal drip, congestion, and chronic cough.

What Causes Chronic Rhinitis?

While the exact cause is not yet known, abnormal nerve (posterior nasal nerve) signals within your nose are thought to trigger chronic inflammation (aka rhinitis) and excessive mucus production.

It is this posterior nasal nerve that contains the mucus-secreting glands. When this nerve (and its related glands) becomes overactive, it conveys misleading signals to your brain, such as if it’s battling an illness. This, in turn, causes the tissue lining of your nose to become inflamed (stuffiness) and churn out watery mucus (runny nose), leading to the never-ending symptoms of chronic sinusitis.

Traditional Treatments may not Work for All

First-line treatments like antihistamines, nasal sprays, and steroids, may not work for everyone, or work only temporarily, leaving the patients feeling miserable and worn out. In another subset of patients, while these treatments do work, they need to be used regularly, creating a hassle. Hence, some patients may want to cut down on these medications.

In such instances, the RhinAer® procedure can help you find relief from the exasperating rhinitis symptoms.

Who is a Candidate for the RhinAer® Procedure?

We use the RhinAer® procedure in patients with:

  • intractable symptoms of chronic rhinitis that fail to respond to optimal first-line treatments
  • persistent drainage after allergy immunotherapy shots
  • uncontrolled rhinitis after functional endoscopic sinus surgery (surgery for people with chronic sinus problems who fail to respond to medical treatments)
  • inability to achieve remission of symptoms after septoplasty (a surgical procedure to straighten the septum or bridge) and/or turbinectomy (removal of the turbinates or bony structures inside your nose)

How is the RhinAer® Procedure Done?

Our group of experts at the Ear, Nose, Throat & Allergy Specialist use RhinAer® to address the root cause of chronic rhinitis — i.e., the abnormal nerve (posterior nasal nerve) signals within your nose that trigger chronic inflammation (aka rhinitis) and excessive mucus production. It is the posterior nasal nerve that encloses these mucus-secreting glands, so altering the nerve’s function can lessen mucus production whenever you have a rhinitis flare-up.

With the help of the RhinAer® stylus, we apply temperature-controlled radiofrequency energy to access the lining of your nose and tweak the function of your dysfunctional posterior nasal nerve. This largely curbs the amount of mucus generated in your nose, minimizing the drainage and stuffiness and providing significant relief.

What are the Benefits of the RhinAer® Procedure?


The RhinAer® technology involves no cutting, but only minimal disruption to target the problematic area that stimulates excess mucus production (i.e., the posterior nasal nerve).

Surgical treatments, on the other hand, often require general anesthesia with extensive cutting yet still carry a risk of relapse.

Simple, In-office Procedure

It is a simple, quick, outpatient procedure.

An Excellent Surgery-free Alternative for Chronic Rhinitis

The RhinAer® procedure provides a surgery-free alternative to help alleviate the wearisome symptoms of chronic rhinitis in patients who wish to avoid surgery and the long recovery period.

Zero Downtime

You can resume your routine activities right away after the procedure. In contrast to surgery, there is no recovery period for the RhinAer® procedure.

Clinically Proven and Effective

The RhinAer® procedure improves symptoms in >90% of patients. It is clinically proven to provide long-lasting relief from the symptoms of chronic rhinitis. This lasting relief means substantially reduced need for tissues and over-the-counter allergy medicines, and thus an overall improved quality of life.

What are the Potential Risks of the RhinAer® Procedure?

Though no serious side effects are noted after the procedure, potential risks may include:

  • transient swelling
  • crusting and debris on the inside of your nose (saline rinse can help clean out the debris)
  • nasal stuffiness for the first few days
  • bleeding
  • infection

If you’re battling with the annoying symptoms of chronic rhinitis such as a runny nose, don’t let them get the best of you! Get in touch with the Ear, Nose, Throat & Allergy Specialist to help you find relief with the RhinAer® procedure.

What is the VivAer® Procedure? Benefits & Risks

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VivAer® Procedure

VivAer® Nasal Airway Remodeling is a cutting-edge technology that uses radiofrequency energy to remodel/reshape the cartilages of your nose and open the nasal valve without altering the outward look of your nose.

Your nasal valve is the narrowest, triangular-shaped area within your nasal passages that acts as a front door to your nose. This triangle is made up of:

  • The septum (the bridge): The firm wall between the left and right sides of your nostrils.
  • The lateral (side) wall: Tissue that forms the outer wall inside your nose.
  • The turbinates: Sausage-shaped fleshy structures within your nasal passages that warm, humidify, and cleanse the air that hits your nostrils.

Any further narrowing of this already narrowed nasal valve, can lead to increased resistance and reduced airflow, making it harder to breathe through your nose.

Symptoms of Nasal Obstruction

Chronic nasal (related to the nose) obstruction can have a significant impact on the quality of your life, as it causes:

  • difficulty breathing
  • difficulty getting enough air through your nose
  • loud snoring
  • interrupted sleep
  • day-time fatigue

Who is a Candidate for the VivAer® Procedure?

Our experts at the Ear, Nose, Throat & Allergy Specialist use the VivAer® procedure to improve the airflow in patients with chronic nasal obstruction — a condition that impacts millions of Americans.

The criteria for the VivAer® procedure include:

  • chronically persistent nasal obstruction, which has not responded to optimal medical therapy (4-6 weeks of steroids)
  • need to avoid traditional surgery and the hassle of a prolonged recovery
  • when the nasal valve is found to be a primary or significant contributor to nasal obstruction as determined by the:
  1. Use of nasal dilator strips (e.g., Breathe Right Strips)
  2. Use of nasal stents
  3. Q-Tip test (Transiently pushing your nasal valve to the side with a Q-tip to see if it improves breathing or not)
  4. Cottle’s Maneuver (Placing one or two fingertips on your cheeks, then gently pressing and pulling your cheeks outside. This maneuver will open the nasal valve if it’s collapsed, thereby temporarily improving your breathing).
  5. A minimum score of 6 in the Nasal Obstruction Symptom Evaluation (NOSE) score. The NOSE score comprises five features that evaluate problems pertinent to or arising from nasal obstruction as below:
  Not a Problem Very Mild Problem Moderate Problem Fairly Bad


Severe Problem
1. Nasal congestion or stuffiness 0 1 2 3 4
2. Nasal blockage or obstruction 0 1 2 3 4
3. Trouble breathing through my nose 0 1 2 3 4
4. Trouble sleeping 0 1 2 3 4
5. Unable to get enough air through my nose during exercise or exertion


0 1 2 3 4

How is the VivAer® Procedure Done?

Our ENT specialists first numb the inside of your nose with a local anesthetic (numbing) medicine. A VivAer, small hand-held stylus is then used to deliver controlled, low-temperature radiofrequency energy to your nasal valve area. The tip of the stylus gently reshapes the tissues of your collapsed nasal valve, creating more room inside your nose. You may feel a bit of pressure during the procedure, but that’s all about it.

With the help of the VivAer® device, we can also shrink the turbinates, which are swollen in most cases of nasal allergies.

The idea behind the VivAer Nasal Airway Remodeling is relevant to a Physics law known as the Poiseuille’s law:

“Even the slightest increase in the area of the nasal valve causes a noticeable reduction in the resistance within your nasal passages, and hence, greatly improves nasal breathing.”

What are the Benefits of the VivAer® Procedure?

Painless and Non-invasive

It involves no cutting, spares the nearby tissues, including the mucosal lining, and is thereby safe and pain-free. You may only feel slight pressure during the procedure.

Simple, Quick Alternative to Surgery

VivAer® provides a simple, outpatient, surgery-free alternative to get relief from nasal stuffiness and its ramifications. The procedure usually takes only around 15 minutes.

Preserves the External Appearance

Since there is no cutting or destruction involved, VivAer® doesn’t cause any outward change to your nose structure.

Clinically Proven

More than 90% of patients report dramatic improvement in breathing by around one month. This benefit tends to improve further in three months and lasts for up to 24 months.

Moreover, patients undergoing the VivAer® procedure report:

  • Improved sleep function
  • Better concentration
  • Better productivity
  • More energy and less fatigue during the day

There’s no Downtime

Following the VivAer® procedure, you’ll be able to resume your routine activities as soon as you leave our office.

What are the Potential Risks of the VivAer® Procedure?

While there is no evidence of adverse effects associated with the procedure, potential risks include:

  • temporary swelling around the bridge of the nose
  • crusting and debris on the inside of your nose (you can use the saline rinse to help clear out the debris)
  • nasal stuffiness in the initial two weeks
  • infection
  • bleeding

If you’re having chronic nasal obstruction, or are considering the VivAer® procedure or need more information about it, please consult the Ear, Nose, Throat & Allergy Specialist.

What Happens if you Let a Sinus Infection go Untreated?

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In most cases, sinus infection goes away on its own. However, if it lingers or keeps rearing its ugly head and you still keep overlooking it, a sinus infection can lead to potentially grave complications.

The possibility for serious health risks stems from the fact that your sinuses are too close to other parts of your body, especially your brain and eyes.

Here’s a list of some important complications that can arise as a result of an untreated sinus infection.

1. Reduced or Complete Loss of the Sense of Smell

Untreated sinus infection can diminish or completely deprive you of your sense of smell (called anosmia). This can be due to inflammation and blockage of your nasal passages, or damage to the olfactory nerve.

Though the loss of smell from a sinus infection is often transient, it can be permanent in severe cases, wreaking havoc on the quality of your life and overall wellbeing. 

2. Difficulty Breathing

Sinusitis causes nasal and sinus congestion, which can make it difficult for you to breathe through your nose. If the inflammation gets better and the blocked sinuses start to drain, the breathing will become easier.

Difficulty breathing from a long-standing sinus infection can also make you feel fatigued, as it interferes with the delivery of enough oxygen to your body.

3. Inflammation of your Voice Box, aka Larynx (Laryngitis)

Untreated sinusitis can cause the thickened mucus to continuously drip down the back of your throat, which, over time, can irritate your voice box and contribute to dry cough and hoarseness.

4. Dacryocystitis

It is an inflammation or infection of the tear sac usually due to blockage of your tear duct. Long-standing sinus infection can spread to your eyes, including your tear sac — a tiny chamber draining your tears, located in the inner corner of your eye. Tears drain through this sac as they exit the surface of your eyes.

Dacryocystitis causes tearing, along with pain, redness, and swelling in the inner corner of the affected eye and warrants antibiotic treatment.

5. Orbital cellulitis/abscess

Another rare but serious complication of an untreated sinus infection is an inflammation or infection of the eye socket (aka orbit) — a condition called orbital cellulitis. This sight-and-life-threatening condition may arise because of the direct spread of infection from your sinuses via their thin walls, or as a repercussion of dacryocystitis.

Infection of the ethmoid sinuses — that lie between your nose and eyes — is more likely to spread to your eye socket because of their thin walls.

While this condition typically affects kids and young adults, a delay in diagnosis and treatment is a threat to both vision and life in all age groups. Untreated orbital infection can spread to the protective coverings around your brain and spinal cord as well as past your brain.

Orbital cellulitis causes fever, along with extreme pain, swelling, redness, and bulging of your eyelid, and possibly eyebrow and cheek. It may also lead to the formation of pus inside the eye socket.

Orbital cellulitis requires prompt hospitalization and may even necessitate surgery if the response to appropriate antibiotics has been poor within 24-48 hours.

6. Cavernous sinus thrombosis

When the sinus infection spreads to your brain, your body’s defense mechanisms create a clot in an attempt to contain the infection.

Though a very rare complication of chronic sinusitis, cavernous sinus thrombosis is a threat to life when it does emerge. It is a condition in which a blood clot forms inside the cavernous sinus — a hollow space at the base of the brain that functions to drain blood from your brain and face.

Cavernous sinus thrombosis presents with:

  •   a sharp, severe headache that worsens progressively, and often occurs with tearing
  •   facial pain, more localized around your eyes
  •   high-grade fever
  •   double vision
  •   paralysis of eye muscles, resulting in an inability to move your eyes or causing your eyelids to droop
  •   a bulging and swollen eyelid
  •   loss of vision
  •   seizures and death (in severe cases)

The cornerstone of treatment for cavernous sinus thrombosis is early and aggressive antibiotic therapy.

7. Meningitis

Left untreated, a sinus infection has the potential to spread to your meninges (the protective coverings around your brain and spinal cord), causing them to become inflamed — a condition called meningitis.

Meningitis gives rise to the following signs and symptoms:

  •   Sudden, high-grade fever
  •   Neck stiffness
  •   Extremely severe headache, often accompanied by nausea and vomiting
  •   Unusual sensitivity to bright light
  •   Drowsiness and lethargy
  •   Seizures

The condition requires intervention by a neurologist and is diagnosed by its clinical signs and symptoms. Meningitis is confirmed by withdrawing the clear fluid that bathes your brain and spinal cord — a procedure called lumbar puncture, in addition to imaging modalities, such as CT and MRI scans.

While the early institution of antibiotic therapy can help address the problem, sinusitis complicated by meningitis may still pose a serious threat.

8. Subdural Abscess

A chronic sinus infection can often lead to the collection of pus (aka abscess) in a potential space between the outer and middle layers of your meninges (the subdural space), defining a condition known as the subdural abscess.

Subdural abscess gives rise to signs and symptoms that resemble meningitis, along with changes in mental status, such as confusion and irritability. The condition progresses rapidly and calls for prompt diagnosis, treatment, and often surgical drainage to stave off coma and death from the rapidly rising pressure within your brain.

9. Frontal bone osteomyelitis

The frontal bone is a bone of your skull that occupies the forehead region. Osteomyelitis is an infection of a bone. Frontal bone osteomyelitis (aka Pott’s puffy tumor) is a potential local complication of a sinus infection of the paired frontal sinuses, located in the frontal bones above your eyebrows.

When infection from your frontal sinuses extend to the bones in which they lie, signs and symptoms that mimic meningitis arise. However, it’s imperative to distinguish between the two conditions, as lumbar puncture cannot be done with frontal bone infection due to the growing pressure within your brain.

Thanks to the antibiotic era, owing to which we rarely see cases of frontal bone osteomyelitis today. The key is timely diagnosis and treatment.

10. Brain abscess

A brain abscess is a localized collection of pus within your brain substance. It occurs because of the direct spread of infection from your paranasal sinuses.

As is obvious, brain abscess is a potentially lethal condition that can lead to coma and death if not addressed right away.

Seek Consultation

Untreated sinus infection can take a heavy toll on your wellbeing. The good news is that with advancements in medical and surgical treatments today, almost all complications of sinusitis are preventable.

Hence, our experts at the Ear, Nose, Throat & Allergy Specialist, recommend seeking treatment if you have symptoms of sinusitis lasting longer than ten days, or symptoms that keep coming back. These symptoms include fever, runny or blocked nose, congestion, facial pain, and tenderness.

A plethora of medical and lifestyle options are available to help address a sinus infection. Moreover, if conventional measures don’t help, our experts at the ENT & Allergy Specialist are also adept at performing a cutting-edge procedure to widen blocked sinuses, known as balloon sinuplasty.  

Balloon Sinuplasty

The steps of this procedure are as follows:

  •   You’ll be given medicine to relax.
  •   We first insert a thin, flexible tube known as an endoscope into your nose. This tube has a camera and light on its end, which is used to visualize the sinus cavity.
  •   Another small tube termed as a catheter with a balloon at its end is next advanced over the guiding endoscope.
  •   Our specialists then open up the inflamed sinuses by inflating the balloon.
  •   The balloon is finally deflated and taken out.  

The success rates of a balloon sinuplasty are well over 90%. Most patients report a long-term, significant improvement in their sinus symptoms.

Balloon sinuplasty is minimally invasive (doesn’t involve any cutting) and doesn’t require placing a packing inside after the surgery. Thus, the recovery from the procedure is also relatively easy and quick.

Balloon sinuplasty has minimal to no risks, and in the majority of cases, this procedure helps you get off all your anti-allergy and steroid medicines as well as antibiotics that you might be taking for very long.

If you’re experiencing a sinusitis flare-up or are having symptoms of a chronic sinus infection, get one-on-one consultation by booking an appointment with one of our experts at the Ear, Nose, Throat & Allergy Specialist.


Tympanomastoidectomy: What Is it & Are You a Candidate?

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What is Tympanomastoidectomy?

A tympanomastoidectomy is a combination surgery that is done to fix middle ear problems both in the eardrum (aka tympanic membrane) and the hard bump right behind your ear (called the mastoid bone) that is filled with air cells and resembles a honeycomb. 

Hence, tympanomastoidectomy entails both: 

  • repair of the eardrum called tympanoplasty
  • removal of the infected mastoid air cells called mastoidectomy

Who Are the Candidates for Tympanomastoidectomy?

Surgical treatment is not always the first step when it comes to treating middle ear and eardrum problems. However, surgery becomes imperative when more conservative treatments fail or when complications stem from other non-surgical treatments. 

Conditions that necessitate tympanomastoidectomy include: 

  • Chronic or recurrent middle ear infections 
  • Cholesteatoma (a noncancerous skin growth in the middle ear behind the eardrum, or in the mastoid bone—can weaken and erode the eardrum, causing it to rupture)
  • Chronic/recurrent eardrum perforations
  • To place a cochlear implant in patients with severe hearing loss 
  • As part of another ear surgery to gain access to the middle ear, such as surgery on the three tiny ossicles (bones) of the middle ear 
  • Removal of skull base tumors

Types of Mastoidectomy

There are different versions of mastoidectomy:

  1. Simple mastoidectomy

This type of mastoid surgery entails opening your mastoid bone, drilling out the infected air cells, and draining your middle ear. 

  1. Radical mastoidectomy

This involves removing your mastoid air cells, middle ear components, your eardrum, and your ear canal. Patients with more complicated mastoid disease are usually the candidates for this type of mastoid surgery. 

  1. Modified radical mastoidectomy

This is a less intense form of radical mastoidectomy that entails drilling out and removing the diseased mastoid air cells. With this type, however, some middle ear bones are preserved, and the eardrum is reconstructed (tympanoplasty).

The goal of this type of mastoidectomy is to remove the diseased parts while preserving as much hearing as possible by restructuring the hearing mechanism at the same time or in second-stage operation. This type of surgery is often reserved for patients with a cholesteatoma in their better hearing ear. 

Both types of radical mastoidectomies result in less than normal hearing. 

How is a Tympanomastoidectomy Done?

When performing a tympanomastoidectomy, our specialists at the Ear, Nose, Throat & Allergy Specialist will decide which option is the best for each case. This may vary with the cause of the condition, the severity of the problem, and whether or not there’s an infection. 

After the necessary preparations, you will be placed under general anesthesia (i.e., you will be unconscious during the entire procedure). 

The surgery is split into two parts:

1. Mastoidectomy

During mastoidectomy, our experts use a less invasive approach called the post-auricular approach by making a cut behind your ear instead of accessing the mastoid bone from within the ear.

Once exposed, the mastoid bone is then drilled to gain access to the interior of your middle ear while taking care not to injure the facial nerve. 

Suction irrigation is used intermittently to keep the view clear and allow us to work on the targeted site. 

We then drill out the infected mastoid air cells and remove any growth. The incision is not closed until your eardrum is also repaired as follows: 

2. Tympanoplasty

Inside the ear, we get rid of any surplus or scar tissue with the help of laser. The rim around the perforated eardrum is tidied with an instrument. After making cuts in the ear canal skin, it is elevated, along with any healthy remnant your eardrum. 

We then cover the hole in your eardrum with a sheet of tissue called fascia. The canal skin is then replaced, and the canal packed with gauze piece.. We then stitch up the incision. Sterile bandage is finally placed over the operated site. 

The goal of this surgical procedure is not only to seal the hole but also to improve hearing. 

How is the Recovery after Tympanomastoidectomy?

When you wake up, you can expect to have bandages over your ear and stitches behind your ear. You may also experience some ear pain, headache, and some skin  numbness. That is why we prescribe painkillers, give you antibiotics ear drops and pills to prevent or treat any infection, and ask you to schedule a follow-up appointment for a wound check and to remove any bandages and stitches.


We recommend: 

  • not to put pressure on the operated ear
  • sleep with the operated ear up 
  • refrain from all strenuous activity, especially lifting anything heavy, for at least two to four weeks afterward, and as advised
  • not to swim or fly in an airplane until healing occurs (which can take anywhere from 4 to 6 weeks after surgery).


Avoid getting water in your ear until you’re advised. When you take a shower or bath, use a cotton ball lightly moistened in petroleum jelly to keep water out. You may also place earplugs in the very outside of your ear, but be sure NOT to place anything inside your ear canal. Also, if you use earplugs, choose the ones of the silicone variety. Plastic earplugs can go inside the ear canal. The goal is to keep your ear dry while avoiding any pressure on the dressing at the same time. 

Potential Complications of Tympanomastoidectomy

The surgery is generally safe and uncomplicated. However, it’s important to be aware of the risks of the procedure. 

  1. Bleeding 

The packing in the ear is left for 1 to 2 weeks. During this time, it will keep absorbing some blood-stained fluid until it’s removed. Hence, it’s normal to experience some bloody fluid draining from your ear for 1 to 2 days after the gauze is taken out.

  1. Nausea and vomiting

Nausea & vomiting is a rare and unpleasant complication that may occur after surgery, but not in all people.. We, however, make every effort to prevent or at least reduce its intensity.

  1. Unsteadiness

It’s common to feel unsteady and dizzy for the first few days following surgery. This should subside over the next few weeks.

  1. Hearing loss

Hearing is likely to get affected after surgery, especially if the hearing bones were affected but failed to be reconstructed during surgery. Some patients may require a second procedure to improve hearing, this is called an ossiculoplasty. 

  1. Tinnitus

Tinnitus, which is the ringing or buzzing in your ears, may also become more noticeable after tympanomastoid surgery. 

  1. Infection 

Infection may rarely develop after surgery. While we take all precautions to prevent it, should an infection occur, long-term antibiotics become mandatory. The ear infection can spread to your brain, causing meningitis (an infection of the coverings called meninges surrounding your brain and spine). 

  1. Facial nerve weakness 

Our highly trained experts make every effort to avoid damaging your facial nerve. Nonetheless, this nerve is at risk to some extent in all forms of middle ear or mastoid surgeries, causing weakness of your facial muscles. During the surgery the facial nerve is monitored to prevent injury.

  1. Altered taste 

Taste disturbances, such as a metallic taste, are common after middle ear surgeries. This is because of the damage to the small taste nerve that traverses your ear-drum. Most taste disturbances resolve on their own.  


How to Solve a Sinus Infection That Won’t Go Away

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Sinus infection is a common problem that can affect any age group. It represents the fifth most common condition that requires an antibiotic prescription.

Sinuses are four paired air-filled spaces in your skull and face bones surrounding your nose. Their main function is to produce mucus that forms a layer inside the sinuses to humidify inhaled air and keep the interior of your nose moisturized. This mucus layer can trap dust particles, other pollutants, or bad germs and brush them out through your nose. Each sinus drains into your nose through small openings to keep these passages clear of excess mucus and the trapped particles.

However, sometimes, such as when the weather changes and you catch a cold, it can turn into a sinus infection. This causes inflammation of your sinuses, known as sinusitis. Usually, sinusitis should go away in a few days or a week. But sometimes that sinus infection can stick around for a long time.

What is Chronic Sinus Infection?

Chronic sinusitis is a long-standing inflammation of your sinuses that lasts for 12 weeks or longer at a time. Sinusitis is also known as rhinosinusitis (rhino means nose). So, we use the two terms interchangeably. When inflamed, nasal passages and sinuses become swollen and blocked. Chronic sinusitis interferes with the normal drainage of the mucus. Too much mucus builds up in your nose and sinuses, making them stuffy.

What Causes Chronic Sinus Infection?

Multiple factors acting together usually contribute to chronic sinusitis.

People with allergies are more prone to develop chronic sinusitis. About one in five people with chronic sinusitis also have asthma. This is because the linings of your nose and sinuses are in continuation with the linings of your lungs. These people are also likely to have nasal polyps (benign growths in your nose containing mucus).

A bacterial or viral infection can also trigger the condition. The infection is often low grade. The bacteria confine themselves in stubborn “biofilms,” making it difficult for your immune system or antibiotics to find and attack them.

An overlap of additional factors such as smoking, environmental pollutants, and deviated septum, further complicate the picture of chronic sinusitis.

It would be more appropriate to say that if you’re already prone to allergies and nasal polyps, it becomes easier for harmful bugs, especially fungi (molds) to penetrate your sinuses. Likewise, a weak immune system makes you more susceptible to catch bacterial, viral, or fungal sinus infection.

A sinus that is inflamed and swollen can no longer sweep away the excess mucus and harmful agents due to the blockage of tiny hairs that facilitate this function.

What are the Signs and Symptoms of Chronic Sinus Infection?

Chronic sinusitis emerges more insidiously than acute sinusitis. At times, however, the symptoms start suddenly and may resemble that of the common cold or acute sinusitis that just won’t go away.

Chronic sinusitis is most likely if you have two or more of the following symptoms:

  • Nasal congestion or stuffy nose
  • Mucus and pus-like discharge (yellow fluid draining out of your nose)
  • Postnasal drip (mucus dripping at the back of your throat)
  • Facial pain, pressure around your eyes and nose, or fullness
  • Partial or complete loss of your sense of smell

Chronic cough, sore throat, and fatigue may also be seen in a chronic sinus infection. That said, these symptoms are not required for the diagnosis of chronic rhinosinusitis.

How do you Diagnose Chronic Sinusitis?

The presence of two or more of the listed symptoms for at least three months raises the suspicion of a chronic sinus infection.

In such cases, we will evaluate you to confirm the diagnosis. This involves applying pressure on your sinuses to elicit tenderness. If the tenderness is positive, your sinuses are likely to be inflamed. We will then take a peek into your nose using a small flexible scope, and check for nasal polyps, pus-filled discharge, and deviated septum.

We may also recommend nasal endoscopy. This is an office procedure that enables us to view the interior of your nose and sinus passages. It’s done with an instrument called an endoscope, which is a thin, flexible tube with a tiny camera and a light. We will pass this scope into your nose and sinuses to look inside. Nasal endoscopy allows us to detect any swelling and polyps, as well as collect discharge from the infected area. This can help spot the cause of your infection and what’s the best way to treat it.

If need be, we may also perform imaging in the form of a computed tomography (CT) to look for further problems.

Allergy skin tests look for allergic causes and to check for problems within your immune system may also be done.

What is the Treatment for Chronic Sinus Infection?

When it comes to treating chronic sinusitis, there’s no one-size-fits-all solution. While several treatment options are available, what works for one person may not be appropriate for the other. Hence, we tailor the treatment to each individual’s’ needs, symptoms, and whether or not other conditions (such as allergies or asthma) are also at play.

The goals of treating chronic sinusitis are to address the allergic causes, minimize inflammation, promote free sinus drainage, and eradicate the infection (if there’s any).

Here are a few potential treatment options for chronic sinusitis. We will likely try out a combination of two or more of these options to see what works best for you.

Medical treatment

Saline Nasal Washes

Irrigating your nasal passages with salt water (saline) adds moisture to dry secretions, helps thin the trapped mucus, curbs postnasal drip, and thereby flush out mucus and allergens. It also helps control inflammation.

Glucocorticoid (aka steroid) nasal sprays, washes, and drops

Steroids are highly effective at limiting inflammation. They reduce mucus production and help shrink any polyps. When you use glucocorticoids in the form of nasal sprays or drops, the medicine works right where it is needed.

Nasal steroid sprays do not travel higher up into your sinuses. Instead, they stay and work inside your nose to limit swelling, thus easing sinus drainage into your nasal passages.

If the nasal spray doesn’t work well, we may suggest you adding a nasal steroid solution to the saline nasal wash. This mixture of saline nasal wash and steroid solution pushes the steroid solution higher up into your sinuses to relieve inflammation and ease sinus drainage.

Glucocorticoid pills

Sometimes, we may recommend taking glucocorticoids (steroids) by mouth (orally). These medications, unlike sprays and rinses, reach your circulation and can effectively address inflammation. Despite the dramatic improvement in symptoms with oral steroids, we only prescribe them when it’s necessary. This is because taking steroids by mouth carries some risks, such as suppressing your natural immune system.


Chronic rhinosinusitis is usually caused by inflammation rather than infection. Bacterial infections may still contribute to sinusitis in some cases. Therefore, some people need to take antibiotics. An adequate antibiotic trial in chronic sinus infection entails a minimum of 3-4 weeks of treatment, preferably culture-guided.

Leukotriene modifiers

We may occasionally prescribe a group of medications called leukotriene modifiers to reduce symptoms of chronic sinusitis. These medications include montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo). They also work by curtailing inflammation but in a different way than steroids.

Immunotherapy shots

If we suspect allergies to be a trigger for your sinusitis, an allergist will also be involved in your treatment strategy. In such cases, we give allergy shots (immunotherapy) that help suppress your body’s immune response to specific allergens (triggers).

Surgical Treatment for Chronic Sinusitis

Although medical therapy and lifestyle tweaks are the first-line treatment for chronic rhinosinusitis, some people may fail to respond to optimal therapy. In such cases, Ear, Nose Throat and Allergy Specialist performs a surgery to widen up the blocked sinuses and remove any trapped mucus or polyps.

Other situations in which surgery could be considered include:

  • When chronic sinusitis symptoms do not respond to the medical treatments listed above, and CT scan of your sinuses reveals complete blockage of one or more sinuses.
  • When nasal polyps fail to shrink enough with steroids.
  • When a severe deviation of the septum completely blocks your nose or hinders sinus drainage.
  • When there’s a suspicion of allergic fungal sinusitis. The sinuses in allergic fungal sinusitis get clogged with thick, dense mucus that is hard to remove in any way other than surgery.

Balloon Sinuplasty

Our surgeons prefer balloon sinuplasty instead of the traditional endoscopic surgery due to its safety profile, less invasive nature, and faster recovery. However, not all patients are good candidates for balloon sinuplasty. This type of surgery is not a suitable option in patients with nasal polyps or those with severe damage to their sinus openings.

A balloon sinuplasty is an in-office procedure that uses a thin, small, flexible catheter (tube) with an inflatable balloon at its end to reopen blocked sinuses. After passing a balloon catheter, we will slowly inflate it to widen out the sinus opening. We will then wash out all the mucus and pus from your sinus cavity with a saline solution. The balloon is then deflated and removed. This helps reform and widen out the sinuses while maintaining the natural structure of the sinus lining.

It works the same way as balloon angioplasty, in which heart surgeons open up blocked blood vessels.

Most patients can resume their regular activities within a day or two after balloon sinuplasty.

Are you located in the North Georgia area and have a sinus infection that just won’t go away? Contact our office today to schedule an appointment.