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. 

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 mean 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 Miami. 

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, 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

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 

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

Recurrent sinus infections affect at least 30 million people in the United States. The symptoms of sinus infection include facial pain or fullness, purulent, or discolored nasal drainage , cough, and nasal blockage. The majority of sinus infection are from a viral infection and are self limited and do not require antibiotics. In some instances the infection is from a bacteria primarily or from a bacterial infection that occurs after the initial viral infection. Another factor that can cause sinus infection is allergies.

Typically bacterial sinus infections are treated with antibiotics, nasal steroid sprays, and saline irrigations. Sometimes oral steroids may be used to reduce swelling to unblock sinus drainage pathways or “sinus ostia”. In the majority of cases this is effective. In some patients the sinus drainage remains blocked and the infection becomes chronic, requiring multiple courses of treatment.

When a sinus infection becomes chronic a workup is typically done to determine the severity of the infection and the cause , so treatment can be adjusted appropriately. A CT scan of the sinuses will image the internal anatomy of the sinuses and demonstrate which sinuses are more severely affected. Nasal endoscopy, using a small telescope to examine the inside of the nose, allows the physician to obtain a culture of the bacteria causing the infection. Also, other anatomic abnormalities such as nasal polyps or a deviated nasal septum can be identified.

Also allergy skin testing can be done if inhalant allergies are suspected

When conservative treatment fails and the work up indicates that a blocked sinus ostia is the cause of the chronic infection then ballon sinuplasty may be the appropriate treatment. With this treatment option a small 6mm nasal balloon is used to remodel the blocked sinus openings. This can be done in the office under local anesthesia. Studies have shown that outcomes are the same as invasive sinus surgery with much less healing time. Typically patients are back to work the day after the procedure. Total healing is typically over in 1 week. If allergies were identified as a cause of the infection in the workup then allergy treatment continues after the procedure to prevent recurrence. Insurance typically covers the Balloon Sinuplasty procedure however a copay may apply.

Ronald Van Tuyl, MD

Hearing loss in one ear, or single-sided deafness (SSD) can cause much difficulty in hearing and communicating. Even if the better hearing ear has excellent hearing. Severe to profound Hearing loss in one ear can lead to increased stress and anxiety, especially causing much difficulty in localization of sounds, and being unable to hear conversation when a loved one or friend is speaking from the side with the profound hearing loss. As a result, a person suffering from single-sided deafness may avoid social interaction, causing social withdrawal, decreased self-esteem, and even loss of income due to difficulty communicating in the work place. In many cases, a hearing test by an audiologist and evaluation by an otolaryngologist may indicate that the severe to profound hearing loss in the poor ear cannot be assisted by hearing aids. Unfortunately, many physicians will indicate that nothing can be done to help that person suffering from single-sided deafness. Now, what options does a hard of hearing person with profound hearing loss in one ear have? Does s/he simply just have to “live with it” and suffer the consequences?  

GOOD NEWS!!!! Hearing aid devices ARE indeed available for treatment of single-sided deafness! Digital CROS (Contralateral Routing Of Signal) hearing aid devices are now available, and are designed so that people with single-sided deafness can have access to sound from their poor hearing side. CROS hearing devices have been available in the past. However, these hearing devices were bulky, required wires to cross from one instrument to the other, and plugged the better hearing or normal hearing ear, making them uncomfortable and ineffective. But with the introduction of open fit hearing aids and wireless audio streaming using Bluetooth technology, todays CROS hearing aid devices are extremely successful in providing single-sided deafness sufferers with the best possible quality sound, which is transferred from the poorer hearing ear to the better hearing ear. Hence, the term contralateral routing of signal – sounds from the poorer ear are transmitted wirelessly via Bluetooth to the better hearing ear, allowing the listener to hear and understand speech successfully in noisy environments, while also allowing for improved localization of environmental safety sounds.

The CROS hearing aid system consists of two very small hearing devices that fit on top of the outer ear (pinnae), with a small, practically invisible wire and ear tip that fits comfortably into the outer third of the ear canal. The CROS device, worn on the poorer hearing ear, is not actually a full hearing aid, as it has a digital amplifier chip but no speaker or receiver. Instead, this device has a transmitter that sends the sound wirelessly to a receiving hearing aid on the better hearing ear. It may seem strange to wear a hearing aid on your better hearing ear, but all the hearing device on the poor ear is doing is delivering sound from your poor hearing side, and not necessarily amplifying sounds in the better ear. This system now allows you to have access to sound from both sides of your head, which makes a tremendous amount of difference. And because the hearing aid devices are wireless and so discrete, no one can see them!

So if you suffer from single-sided deafness and were told that “nothing can be done”, don’t get discouraged. We have a solution for you! An appointment with an audiologist and otolaryngologist for a hearing test would be a great first step in evaluating your hearing and communication needs, and determining the best hearing aids for your hearing loss. CROS hearing aid devices can be fit to meet your communication needs, and can also be connected to iPhones and Androids for improved communication on your phone. CROS hearing aids can also be rechargeable as well. Call us today at (770) 345-6600 and discover for yourself how we can help you overcome issues caused by single-sided deafness

– YES, SOMETHING CAN BE DONE TO HELP YOUR CONDITION!

Hearing loss is detrimental, yet one of the most ignored medical symptom. Hearing loss can cause frustration in communicating with loved ones. Hearing loss can contribute to emotional problems, drop in self-esteem and confidence leading to social withdrawal. Hearing loss can also lead to fewer job opportunities and loss of income. Hearing loss can also be confused with other medical symptoms such as dementia. But perhaps the reason hearing loss is ignored by the sufferer is that pain is in most cases not a symptom associated with hearing loss. We typically go to a physician to find relief for pain. But if we don’t experience pain, we tend to believe “everything is okay”. Except with hearing loss, “everything is not okay”.

Since pain is not involved, a person who believes s/he is suffering from hearing loss may try to find the easy solution and avoid seeing a professional, such as an otolaryngologist or an audiologist. The simple, and least expensive solution, would to simply go to a retail store and by cheap over the counter hearing aids. They may cost somewhere between $50.00 to $250.00 – simply much cheaper than going to an otolaryngologist or an audiologist and investing much more on hearing aids. But research has shown that even though over the counter hearing aids are easily available, still only approximately 30% of estimated people with hearing loss seek hearing loss improvement. This is also the case in China, where hearing aids can be dispensed FOR FREE! Why is that? Perhaps, the fact that pain is not a symptom of hearing loss is a reason people don’t improve their hearing. And also, perhaps over the counter hearing aids just make surrounding noises louder and really don’t improve communication and hearing contributes to that statistic as well. Simply making everything louder doesn’t improve communication.

Hearing disorders are not always to same with each individual. Sometimes, hearing loss is just simply caused by ear wax. Hearing loss may also be due to middle ear infections. But most of the time, hearing loss that occurs gradually or without symptoms of pain is sensorineural, or “nerve loss” that may have occurred over a period of time due to noise exposure, aging, or simply “the outer hair cells and/or hearing nerve not working as well as it used to work”. In this case, the detriments of hearing loss that the sufferer may not be noticing – problems communicating with loved ones, social withdrawal, decreased self-esteem, loss of income – are occurring. Sensorieneural hearing loss affects each individual differently. If that wasn’t the case, simply purchasing a cheap over the counter amplification would fix everything! But as most individuals suffering from hearing loss unfortunately find out, the over the counter aid just didn’t fix their problems. And an unnecessary $250.00 was wasted.

Because each case of hearing disorder is individual, an appointment with an audiologist and otolaryngologist for a hearing test would be a great first step. Even if you are suspecting hearing loss, and especially when your loved ones suspect you are suffering from hearing loss. An audiologist will be able to evaluate your hearing and communication needs, and what will be needed to improve your communication and self-esteem. An otolaryngologist would also be able to treat medical conditions such as ear wax and infections if that were to be the cause of the hearing loss. Thus it is important to FIRST find the cause of hearing loss…which a clerk selling an over the counter hearing aid CANNOT DO. The audiologist will be able to find the appropriate hearing instruments and hearing services that will improve your communication, self-esteem, and enjoyment of life…and maybe even increase your income.

Now, this may mean you need to invest more for appropriate hearing aid systems, whether they be custom fit hearing aids or miniature behind the ear hearing aids, called “Receiver In The Canal” hearing aids, that are discrete that are the most effective and comfortable style today. The technology today is designed for YOUR INDIVIDUAL HEARING LOSS, as simply making everything louder is not effective. The fine tuning of higher technology allows the brain to effectively process incoming sound information needed for communicating, especially in background noise situations such as restaurants. The microphones and computerized technology NOT FOUND in over the counter hearing aids are critical in allowing a person to focus in on speech in noisy environments, and be able to localize speech. Localization is critical in understanding speech in background noise, as well as being able to detect and hear environmental safety sounds. Advanced hearing aids will also provide natural listening so you can enjoy the sounds of nature, such as birds chirping, music, and the laughter of your grandchildren.

We hear with our brain, with the auditory cortex analyzing incoming sound, providing the rest of the brain with information allowing us to communicate and enjoy life activities. If the auditory cortex does not receive accurate sound information, the brain will lose its ability to communicate. Thus, it is CRITICAL that hearing aid systems provide the brain and auditory cortex with accurate sound information needed for hearing, understanding, localizing, and in some cases, overcome the negative effects of tinnitus, a symptoms often associated with hearing loss. These are all things that require highly advanced hearing aid processing. Over the counter hearing aids simply can’t accomplish this. So if you are suffering from hearing loss, don’t think that because there is no pain involved, you can simply save some money and just make everything louder. You are important! Make an investment in better hearing loss improvement and healthcare, and get back in touch with the ones you love!