What Is Adenoid Surgery?

Adenoid surgery is a procedure that removes the adenoid glands. These are small lumps of tissue that sit behind the nose above the roof of your mouth and are usually removed when your tonsils are removed. They are a part of your immune system and are designed to help you fight against infections and protect your body from bacteria and viruses.

Only children have adenoids. At the age of 3, the adenoids are usually at their largest. Once a child grows to age 7, they usually shrink in size to around half. During the early teenage years, the adenoids will have shrunk so much that they are barely visible. Once a child reaches their late teenage years, they will eventually disappear.

When Do Adenoids Need To Be Removed?

Adenoids only need to be removed when they are swollen or enlarged. This often happens as a result of an infection, or via a substance that causes an allergic reaction in your child. Swollen adenoids usually cause discomfort in your child and it’s not enough to warrant surgery. However, some children may find that it causes a lot of annoyance and can even interfere with their daily activities.

If your child suffers from the following issues, then it would be wise to consult a doctor about adenoid surgery:

  • Sleeping difficulties – If your child has trouble sleeping at night, then it could be an issue with their adenoid glands. This can start with just snoring but can develop into sleep apnea, which is irregular breathing during sleep and tiredness throughout the day. It would be best to contact a certified otolarygonologist, or ear nost and throat doctor, if this is the case to diagnose the issue.
  • Ear infections – If ear infections and glue ear (sticky fluid filling the ear) are common for your child, then you’ll want to notify your doctor to see if it’s a problem with their adenoid glands.
  • Breathing issues – Your child will find it difficult to breathe and may experience a dry mouth if their adenoid glands are causing issues with their daily life.

What Does Adenoid Surgery Involve?

As mentioned before, adenoid surgery typically occurs at the same time as tonsil surgery. An ENT surgeon will carry out the procedure and it usually takes around half an hour. Your child will need to wait until the anesthesia wears off before being able to return home (usually an hour or two).

Your child will be put under general anesthesia so they won’t feel any pain. Their mouth will be propped open to locate the adenoids. Once found, the surgeon will remove them by scraping away with a curette. Alternatively, the ENT surgeon might also use a diathermy instrument to apply heat to burn the adenoids. Once removed, cauterization might be used to stop the bleeding, or a pack made out of gauze will be applied to the skin of the mouth.

Once the bleeding has stopped, the procedure is finished and your child can start to recover.

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External Otitis (Swimmer’s Ear)

External otitis is an infection of the skin of the ear canal.

  • External otitis is caused by bacteria or, less commonly, fungi.

  • Typical symptoms are pain and discharge.

  • A doctor looks in the ear with an otoscope for redness, swelling, and pus.

  • Debris removal, antibiotic ear drops, keeping water and cotton swabs out of the ear, and pain relievers are the most common forms of treatment.

External otitis may involve the entire canal, as in generalized or acute external otitis, or just one small area, as when pus accumulates in a boil (furuncle) or pimple. Malignant external otitis is a rare, very severe external ear infection that has spread to the temporal bone of the skull, causing a bone infection (osteomyelitis).

Clinical Calculator: External Otitis



A variety of bacteria, such as Pseudomonas aeruginosa or Staphylococcus aureus, can cause external otitis. Fungal external otitis (otomycosis), typically caused by Aspergillus niger or Candida albicans, is less common. Boils are usually caused by Staphylococcus aureus. Certain people, including those who have allergies, psoriasiseczema, or seborrheic dermatitis, are particularly prone to external otitis. Injuring the ear canal while cleaning it (using cotton swabs) or getting water or irritants, such as hair spray or hair dye, in the canal often leads to external otitis.


External otitis is particularly common after swimming, which is why it is sometimes called swimmer’s ear. Earplugs and hearing aids make external otitis more likely, particularly if these devices are not properly cleaned. Use of cotton swabs is a very common risk factor for external otitis. Cotton swabs should not be placed in the ear canal.



Symptoms of external otitis are pain, redness, and discharge. The discharge is unpleasant-smelling and white or yellow and drains from the ear. The ear canal may have no swelling or slight swelling, or in severe cases, it may be swollen completely closed. If the ear canal swells or fills with pus and debris, hearing is impaired. Usually, the canal is tender and hurts if the external ear (pinna or auricle) is pulled or tugged or if pressure is placed on the fold of skin and cartilage in front of the ear canal (tragus).


Fungal external otitis causes more intense itching than pain, and people have a feeling of fullness in the ear. Fungal external otitis caused by Aspergillus niger usually causes grayish black or yellow dots (called fungal conidiophores) surrounded by a cottonlike material (called fungal spores) to form in the ear canal. Fungal external otitis caused by Candida albicans does not cause any visible fungi to form but usually causes a thick, creamy white discharge.


Boils cause severe pain. When they rupture, a small amount of blood and pus may leak from the ear.



  • A doctor’s examination of the ear canaL
  • Sometimes culture of a sample from the ear canal


The doctor bases the diagnosis on the symptoms and an examination of the ear canal. To a doctor looking into the ear canal through an otoscope (a device for viewing the canal and eardrum), the skin of the canal appears red and swollen and may be littered with pus and debris. An infection caused by a fungus is also diagnosed based on examination or culture (a sample of the pus and debris is grown in a laboratory to identify the microorganisms). Sometimes fungal spores can be seen in the ear canal.


Swimmer’s ear may be prevented by putting drops of a solution containing half rubbing alcohol and half white vinegar (acetic acid) in the ear immediately after swimming (as long as there is no hole [perforation] in the eardrum).

Attempting to clean the canal with cotton swabs or other objects is strongly discouraged because such action interrupts the ear’s normal, self-cleaning mechanism and can push debris and earwax further inward. Also, this action may cause minor damage to the delicate skin of the canal, providing a site for bacteria to infect.



  • Removal of infected debris from the ear canal and dry ear precautions
  • Ear drops containing vinegar and corticosteroids
  • Sometimes ear drops containing antibiotics
  • Rarely antibiotics taken by mouth

To treat external otitis due to any cause, a doctor first removes the infected debris from the canal with suction or dry cotton wipes. After the ear canal is cleared, hearing often returns to normal.

Usually, a person with mild external otitis is given ear drops containing vinegar and drops containing a corticosteroid such as hydrocortisone or dexamethasone to use several times a day for up to a week. Vinegar is helpful because bacteria do not grow as well once the normal acidity of the ear canal is restored.

With moderate or severe infection, antibiotic ear drops also are prescribed. If the ear canal is very swollen, a doctor inserts a small wick into the ear canal to allow the antibiotic/corticosteroid ear drops to penetrate. The wick is left in place for 24 to 72 hours, after which time the swelling may have gone down enough to allow the drops to go directly into the ear canal.

People who have severe external otitis (extends beyond the ear canal) may need to take antibiotics by mouth, such as cephalexin or ciprofloxacin.

Pain relievers such as acetaminophen or ibuprofen may help reduce pain for the first 24 to 48 hours, until the inflammation begins to subside.

People should keep the ear dry by practicing dry ear precautions (such as wearing a shower cap and avoiding swimming) until the infection clears up.

To treat fungal external otitis, doctors thoroughly clean the ear canal and insert antifungal ear drops. Repeated cleanings and treatments may be needed. Some doctors believe that a combination of rubbing alcohol and white vinegar is particularly effective in fungal external otitis. Rubbing alcohol dries the ear canal and white vinegar creates an acidic environment that does not allow fungus to grow as well.

Treatment of boils depends on how advanced the infection is. In an early stage of infection, a heating pad can be applied for a short time and pain relievers, such as oxycodone with acetaminophen, can be given to help relieve pain. The heat may also help speed healing. An antibiotic is given by mouth. A boil that has come to a head is cut open (incised) to drain the pus.

By Bradley W. Kesser,

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What is labyrinthitis?

Labyrinthitis is an inner ear infection that can affect a person’s balance and hearing. It may occur when a cold, the flu, or a middle ear infection spreads to the inner ear.

This article will cover the causes, symptoms, diagnosis, and treatment of labyrinthitis.


Diagram of labyrinthitis

Labyrinthitis can affect hearing and balance.

The inner ear, also known as the labyrinth, is responsible for both hearing and balance. The labyrinth consists of two main parts:

  • The cochlea is a small, snail-shaped structure that converts sound vibrations into nerve impulses that travel to the brain.
  • The vestibular system consists of a complex network of semicircular canals that play an important role in maintaining balance by providing information about the body’s spatial orientation.

Both the cochlea and vestibular system send information to the brain via the vestibulocochlear nerve.

Labyrinthitis is an infection of the inner ear. It causes inflammation that can affect the structures of this part of the ear and disrupt the flow of sensory information from the ear to the brain. This disruption can result in a range of symptoms, including dizziness, vertigo, and even hearing loss.

Viral infections are the most common cause of labyrinthitis, but the condition can sometimes result from a bacterial infection.

While both types of infection can cause similar symptoms, bacterial labyrinthitis is generally more severe than viral labyrinthitis. The treatments for the two are very different, so it is important that a person gets the correct diagnosis from a doctor.

Risk factors

Anyone can develop labyrinthitis, but some conditions can increase the risk. These include:

  • upper respiratory infections, such as the common cold and the flu
  • middle ear infections
  • meningitis
  • head injuries
  • respiratory illnesses, such as bronchitis
  • viral infections, including herpes and measles
  • autoimmune conditions

Other factors that may increase the likelihood of labyrinthitis include:

  • smoking
  • heavy alcohol consumption
  • a history of allergies
  • stress
  • use of specific medications

Symptoms of labyrinthitis

                                                                                                                                              Woman with an ear ache caused by labyrinthitis
Symptoms of labyrinthitis can include tinnitus, hearing problems, dizziness, and nausea.

The symptoms of labyrinthitis can appear suddenly and without warning. Some people with this infection may experience symptoms that last for a few weeks but then disappear on their own.

However, other people may experience long-term or reoccurring symptoms that appear when they move their head suddenly.

Symptoms of labyrinthitis include:

  • dizziness
  • vertigo, which gives a person the sensation of spinning or the world spinning around them
  • tinnitus, which is ringing in the ears
  • nausea
  • loss of balance
  • hearing or vision problems


Types of labyrinthitis

There are several different types of labyrinthitis, which we cover in more detail below.

Viral labyrinthitis

Most cases of labyrinthitis are due to viral infections, such as a cold or the flu, spreading to the inner ear. Viral labyrinthitis typically results in sudden vertigo, nausea, and vomiting. Sometimes, it also leads to hearing loss.

Viral labyrinthitis usually goes away on its own. Medications for this form of labyrinthitis aim to relieve symptoms, such as dizziness and nausea.

Bacterial labyrinthitis

There are two main types of bacterial labyrinthitis:

Serous labyrinthitis

Also called toxic labyrinthitis, serous labyrinthitis commonly results from a bacterial infection in the middle ear, which doctors refer to as chronic otitis media (COM). COM causes a fluid buildup in the middle ear, which can progress to the inner ear if a person does not receive treatment.

Serous labyrinthitis is the less severe type of bacterial labyrinthitis, and hearing loss only affects high-frequency sounds. The symptoms of serous labyrinthitis include:

  • mild vertigo
  • nausea or vomiting

Suppurative labyrinthitis

This form of labyrinthitis occurs when bacteria in the middle ear enter the inner ear. The symptoms are more severe than those of serous labyrinthitis, and they typically affect just one of the ears.

Symptoms of suppurative labyrinthitis include:

  • severe vertigo
  • nausea and vomiting
  • tinnitus
  • nystagmus, which is a condition that causes repetitive and uncontrolled eye movements
  • hearing loss

A person should see a doctor as soon as any symptoms of labyrinthitis appear. Labyrinthitis can resolve without treatment, but determining the cause of the condition is key to preventing long-lasting complications.

A doctor can determine whether a viral or bacterial infection is responsible for the symptoms. They may prescribe antibiotics for bacterial labyrinthitis.

Even if the labyrinthitis clears on its own, it is a good idea to ask a doctor to assess whether or not the condition has caused any permanent damage.


There are no specific tests to diagnose labyrinthitis. A doctor will usually carry out a thorough physical examination and neurological evaluation to rule out any other conditions, such as:

Rarely, structural abnormalities inside a person’s head can cause symptoms of labyrinthitis. To rule these out, a doctor may recommend imaging tests, such as a CT or MRI scan.


Over-the-counter antihistamines may ease some of the symptoms of viral labyrinthitis.

The purpose of labyrinthitis treatment is to relieve symptoms. A person can take over-the-counter antihistamines to ease some of the symptoms of viral labyrinthitis, such as nausea or dizziness. Stronger antihistamines, such as meclizine or promethazine, are available on prescription.

A doctor may also prescribe corticosteroids or sedatives for people with more severe symptoms. In cases where a bacterial infection is responsible for labyrinthitis, they may prescribe antibiotics.

If symptoms persist for several months, the doctor may need to check the individual for signs of permanent hearing damage. Following this, they can advise on whether or not a hearing aid may be helpful.

When labyrinthitis is chronic, or long-term, a person may benefit from a type of physical therapycalled vestibular rehabilitation. This therapy involves exercises that aim to improve balance and reduce dizziness.

Therapists typically tailor vestibular rehabilitation to an individual’s specific needs, but some common exercises include:

  • moving the eyes up and down and from side to side
  • bending the head forward and backward
  • turning the head from side to side
  • bending the torso forward
  • leaning the torso over to each side
  • catching and throwing a ball
  • walking up and down on an incline

Most people can perform vestibular rehabilitation exercises at home, but a specialized physical therapist will monitor their progress and make any necessary modifications to the exercises.


Early diagnosis and treatment of labyrinthitis can reduce the risk of permanent damage to the inner ear. Severe cases of labyrinthitis can result in permanent damage to the vestibular system and varying degrees of hearing loss.

Labyrinthitis can also lead to a condition known as benign paroxysmal positional vertigo (BPPV). BPPV is a type of vertigo that results from sudden movements of the head. This condition is not life-threatening, but it can increase a person’s risk of falls.


Labyrinthitis is not life-threatening. In most cases, hearing and balance return to normal over time. Symptoms of vertigo and dizziness usually only last for a few days.

Most people make a full recovery provided that they receive proper treatment, especially for bacterial labyrinthitis. Recovery from labyrinthitis usually takes a few weeks.

While recovering from labyrinthitis, a person should rest and avoid any sudden movements of the head. As this condition can significantly affect a person’s balance and coordination, it is also essential to avoid driving and operating potentially dangerous machinery.

During a vertigo attack, a person should try to remain calm and avoid unnecessary movement. It is best to avoid bright lights and television or computer screens during an attack. Instead, find a quiet place to sit down and wait for it to pass.

People who experience chronic labyrinthitis should speak with their doctor about other treatment options, such as vestibular rehabilitation.

By Jamie Eske

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Difference between a Cold and Sinus Infection

Sinus infections cause 73 million days of restricted activity in the United States each year, according to a report from the Centers for Disease Control and Prevention. However, this finding is questionable because people with colds often believe they have sinus infections.

With similar symptoms, a cold and sinus infection can be hard to tell apart. Sinus infections can also follow common colds. While many symptoms overlap, there are ways you can tell the difference and receive appropriate treatment.

“Infections lasting longer than 7 to 10 days may have progressed to a bacterial sinus infection,” states Dr. Garrett Bennett, New York City sinus and nasal surgeon. “Only a small percentage of sinus infections will actually benefit from antibiotics.”

What is a cold?

Common colds are viral infections that usulally clear up within one week. They are usually most severe between days 3 and 5, after which symptoms typically subside. Nasal discharge starts off clear and watery, but becomes thicker with a white, yellow or greenish color. After a few days, nasal discharge becomes clear again and dries.

What are the symptoms of a cold?

Most of us have had so many colds that we know these symptoms by heart:

  • Sore throat
  • Cough
  • Headache
  • Stuffy nose
  • Mucus buildup
  • Sneezing
  • Fatigue
  • Swollen sinuses
  • Fever (more common in children)

Colds can cause the nasal lining to swell, preventing mucus from draining properly. This can in turn lead to sinusitis. If you are prone to sinus infections, take care to treat your cold as soon as possible.

How to treat your cold

Despite what most people may think, antibiotics do not help against the common cold, which is caused by many different types of viruses. Over-the-counter medications, on the other hand, are designed to combat the annoying symptoms the cold virus, and may help you feel better faster.

What is a sinus infection?

Sinusitis, also termed rhinosinusitis, is inflammation of the mucosal lining of the nose and sinuses. The infection can begin from a viral infection or “cold”, which leads to a narrowing of the nasal passageways. Symptoms include thick colored nasal discharge, headaches, and facial pressure lasting more than 10 days without improvement.

What are the symptoms of a sinus infection?

At first, there may not be a way to differentiate between a common cold and a bacterial sinus infection. There are multiple overlapping symptoms, that are not specific to viral or bacterial sinus infections:

  • Sinus pressure behind the eyes and cheeks
  • Runny and stuffy nose
  • Headache
  • Fever
  • Cough
  • Bad breath
  • Thick yellow or green mucus
  • Fatigue
  • Decreased sense of smell

nasal pain sign of a broken noseThe biggest giveaway to determining if a sinus infection is bacterial is duration. Bacterial sinus infections tend to linger much longer than the common cold, and can last over a week or more.

Avoid these when you have a sinus infection

Don’t fly if you can avoid it. A flight can raise your chances of ear pain and other complications.  If not flying is not an option, yawn and swallow  or “pop your ears” when the flight is taking off and landing. Drink plenty of fluids and keep your head upright. You may benefit from a decongestant like “Afrin” or pseudoephedrine. Avoid drinking alcohol, which can cause dehydration and make your sinuses and the lining of the nose swell further. Finally, avoid smoking, being around smokers, and air pollution in general.

How to treat sinus infections

Sinus infections much of the time will resolve with rest, fluids and symptomatic treatment. Sometimes, sinusitis can last for a very long time or come back frequently. If you miss work or other activities due to sinus infections or if symptoms occur frequently, see your doctor for an evaluation.

Be sure to see an ear, nose, and throat specialist if your sinus infection does not go away. Some people are prone to sinus infections regularly or may have a chronic sinus infection. For these people, sinus surgery may be the best option and can greatly improve their quality of life.

How to Treat Congestion

Because colds and sinus infections share similar symptoms, it’s not surprising that they so share similar treatments. The following are popular ways to relieve your congestion and alleviate symptoms:

  • Nasal Sprays: both steroid and antihistamine. Oxymetazoline is effective but may worsen congeston if used for more than 3 days.
  • Neti Pots
  • Oral antihistamines: you need to show the pharmacist an ID to get the larger doses behind the counter. Pseudoephedrine is effective.
  • Warm compresses
  • Hydration and Steam




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Tonsillitis refers to inflammation of the pharyngeal tonsils (glands at the back of the throat, visible through the mouth). The inflammation may involve other areas of the back of the throat, including the adenoids and the lingual tonsils (tonsil tissue at the back of the tongue). There are several variations of tonsillitis: acute, recurrent, and chronic tonsillitis, and peritonsillar abscess.

Viral or bacterial infections and immunologic factors lead to tonsillitis and its complications. Nearly all children in the United States experience at least one episode of tonsillitis. Due to improvements in medical and surgical treatments, complications associated with tonsillitis, including mortality, are rare.

Who gets tonsillitis?
Tonsillitis most often occurs in children, but rarely in those younger than two years old. Tonsillitis caused by bacteria (streptococcus species) Streptococcus species typically occurs in children aged 5 to 15 years, while viral tonsillitis is more common in younger children. A peritonsillar abscess is usually found in young adults but can occur occasionally in children. The patient’s history often helps identify the type of tonsillitis present (i.e., acute, recurrent, chronic).

What causes tonsillitis?
The herpes simplex virus, Streptococcus pyogenes (GABHS), Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute pharyngitis and acute tonsillitis. Bacteria cause 15-30 percent of pharyngotonsillitis cases; GABHS is the cause for most bacterial tonsillitis. (i.e., “strep throat”).

What are the symptoms of tonsillitis?

The type of tonsillitis determines what symptoms will occur.

  • Acute tonsillitis: Patients have a fever, sore throat, foul breath, dysphagia (difficulty swallowing), odynophagia (painful swallowing), and tender cervical lymph nodes. Airway obstruction due to swollen tonsils may cause mouth breathing, snoring, nocturnal breathing pauses, or sleep apnea. Lethargy and malaise are common. These symptoms usually resolve in three to four days, but may last up to two weeks despite therapy.
  • Recurrent tonsillitis: This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year.
  • Chronic tonsillitis: Individuals often have chronic sore throat, halitosis, tonsillitis, and persistently tender cervical nodes.
  • Peritonsillar abscess: Individuals often have severe throat pain, fever, drooling, foul breath, trismus (difficulty opening the mouth), and muffled voice quality, such as the “hot potato” voice (as if talking with a hot potato in his or her mouth).

What happens during the physician visit?

Your child will undergo a general ear, nose, and throat examination as well as a review of the patient’s medical history. A physical examination of a young patient with tonsillitis may find:

  • Fever and enlarged inflamed tonsils covered by pus.
  • Group A beta-hemolytic Streptococcus pyogenes (GABHS) can cause tonsillitis (“strep throat”) associated with the presence of palatal petechiae (tiny hemorrhagic spots, of pinpoint to pinhead size, on the soft palate). Neck nodes may be enlarged. A fine red rash over the body suggests scarlet fever. GABHS pharyngitis usually occurs in children 5-15 years old.
  • Open-mouth breathing and muffled voice resulting from obstructive tonsillar enlargement. The voice change with acute tonsillitis usually is not as severe as that associated with peritonsillar abscess.
  • Tender cervical lymph nodes and neck stiffness (often found in acute tonsillitis).
  • Signs of dehydration (found by examination of skin and mucosa).
  • The possibility of infectious mononucleosis due to EBV in an adolescent or younger child with acute tonsillitis, particularly when cervical, axillary, and/or groin nodes are tender. Severe lethargy, malaise, and low-grade fever accompany acute tonsillitis.
  • A grey membrane covering tonsils that are inflamed from an EBV infection. (This membrane can be removed without bleeding.) Palatal petechiae (pinpoint spots on the soft palate) may also be seen with an EBV infection.
  • Red swollen tonsils that may have small ulcers on their surfaces in individuals with herpes simplex virus (HSV) tonsillitis.
  • Unilateral bulging above and to the side of one of the tonsils when peritonsillar abscess exists. A stiff jaw, difficulty opening the mouth, and pain referred to the ear may be present in varying severity.


Tonsillitis is usually treated with a regimen of antibiotics. Fluid replacement and pain control are important. Hospitalization may be required in severe cases, particularly when there is airway obstruction. When the condition is chronic or recurrent, a surgical procedure to remove the tonsils is often recommended. Peritonsillar abscess may need more urgent treatment to drain the abscess.


Ear, Nose and Throat Specialists of Wisconsin

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Can Modern Treatments And New Technology Really Help Hearing Loss

Hearing is an important sensory organ because it helps us interact more easily with the environment. Loss of hearing can be challenging when it happens, and especially when you do not know the treatment alternatives that you are open to. Here is what you need to know about types of hearing loss and how modern treatments and technology can help in the rehabilitation process.

Types Of Hearing Loss

There are two major types of hearing loss:

· Conductive hearing loss

· Sensorineural hearing loss

Conductive Hearing Loss

The first affects the outer ear, the eardrum and the middle of the ear. This hearing loss type happens when sound dissipates as it travels through the outer year and to the middle of the ear and the eardrum. There are a number of issues that can lead to it. These include tumors in the ear, holes in the eardrum or trauma to the ear.

Sensorineural Hearing Loss

The second type of hearing loss is caused by damages to the nerve pathways which facilitate hearing. Most of the times, this is the kind of loss of hearing which happens as you grow older. When you have a sensorineural hearing loss, the hearing signal that will be getting to the inner ear will be strong but becomes weak when being converted into a signal by the brain. In most cases, people with sensorineural hearing loss will hear something, but it will be muffled or incoherent.

How To Treat Hearing Loss

treat hearing loss with hearing aids

The modern treatments and rehabilitation offered for loss of hearing are dependent on the type of hearing loss that you are suffering from. If you have a conductive hearing loss, surgery is one of the treatment alternatives that can help you make a full recovery. One of the main reasons why sound distortion occurs in the outer to the middle of the ear is when the bones that transmit sound between your ear canal and the inner ear no longer line up. In this case, a simple surgery to correct the bones will help restore hearing ability.

On the other hand, when you have sensorineural loss of hearing, you will need a hearing aid to help amplify the sound that gets muffled as it is getting converted into signals. When the hearing aids technology started, it was simple and the devices used to hang outside the earlobe. However, the gadgets have now been refined and are smaller and very effective. There is also the cochlear implants technology where the implants which are currently the most effective way for people with hearing loss to effectively have the sound waves transmitted into electrical signals for the brain.

The technology that is used in treating both types of hearing loss has evolved a lot over the years, and currently, even kids who are born with hearing impairment can get implants and benefit from having a replacement of their missing auditory sense. The most important step in getting treatment is a proper diagnosis of the condition. A competent ear doctor will help correctly diagnose the condition and offer options on how to treat hearing loss.

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How does your voice box (larynx) work?                                                                                                                                                                   what causes hoarseness

Your larynx produces sound like this: First, air is pushed out the vocal cords. Then, passing air causes these cords to vibrate, which in turn produces sound and speech, according to the Mayo Clinic. An irritated throat or vocal cords interfere with this process.

What causes hoarseness?

It’s important to remember that hoarseness itself is not a disease but the symptom of a disease. Effectively treating  symptoms won’t resolve the underlying cause. This is why it’s so important to see your local ear, nose and throat physician—such as those at Raleigh Capitol ENT—who will be able to get at the heart of the matter and create an effective treatment plan.

There are several possible causes of hoarseness, the most common of which is a cold or upper respiratory infection. Other causes include:

  • Heartburn
  • Laryngitis, the inflammation of the vocal cords
  • Voice overuse
  • Inflammation from allergies
  • Side effects of medication
  • Vocal cord spasms
  • Smoking or exposure to secondhand smoke
  • Intubation – this is the process of passing a tube through the mouth in order to assist breathing

Hoarseness is more common in those who use their voice in their everyday careers, such as call-center operators, singers, coaches and teachers.  It’s also seen a lot in those over 65 or boys between the ages of 8 and 14, according to the American Academy of Otolaryngology.

While many cases of hoarseness are mild, it can be associated with serious diseases such as:

  • Head and neck cancer
  • Parkinson’s disease
  • Cancer of the larynx
  • Rheumatoid arthritis
  • Multiple sclerosis
  • Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease

How long should hoarseness last?

If your hoarseness is related to an allergy, cold or upper respiratory infection, it should go away within seven to 10 days. However, if it does not get better within two weeks, you should schedule an appointment with your ENT, as this could be a sign of a more complex problem. Other indicators of a more serious disorder are:

Effective remedies for hoarseness


  1. Resting your voice
  2. Humidifying your home
  3. Drinking plenty of water, particularly if you live in a dry area
  4. Avoiding excessive coughing and throat clearing
  5. Voice therapy to modify how the voice is used, and this may be especially helpful to those who use their voice extensively in their daily careers

However, depending upon the underlying cause, surgery might be necessary, particularly if you have a mass in your neck, in which case, our doctor may order an MRI, CT scan or a biopsy

Can you prevent hoarseness?


  • Avoiding spicy food
  • Avoiding any type of tobacco product
  • Stopping smoking or eliminate your exposure to secondhand smoke
  • Avoiding dehydrating beverages, such as beer, wine and caffeinated drinks.
  • Avoiding overusing your voice
  • Seeking allergy treatment to help you avoid seasonal sinus infections

Only an ENT can determine the exact cause of your hoarseness

There are so many potential causes of hoarseness. While most are benign, some can carry life-threatening consequences if left undiagnosed. Our ear, nose and throat physicians have the extensive experience that enables us to accurately pinpoint the cause of your problems and offer customized solutions to help you.

By:Raleigh Capitol Ear, Nose and Throat

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Everything you need to know about vertigo

What is vertigo?

Vertigo is a sensation of spinning dizziness. It is not, as many people maintain, a fear of heights.

It is often associated with looking down from a great height but can refer to any temporary or ongoing spells of dizziness caused by problems in the inner ear or brain.

Many conditions can cause vertigo.


                                                                                                            [ear problems can lead to vertigo]

A person with vertigo will have a sense that their head, or their surrounding environment, is moving or spinning.

Vertigo can be a symptom of other conditions, and it can also have its own set of related symptoms.

These include:

  • balance problems and lightheadedness
  • a sense of motion sickness
  • nausea and vomiting
  • tinnitus
  • a feeling of fullness in the ear
  • headache

Vertigo is not just a general feeling of faintness. It is a rotational dizziness.


Some types of vertigo resolve without treatment, but any underlying problem may need medical attention, for example, a bacterial infection that would likely need antibiotic therapy.

Drugs can relieve some symptoms, for example, and may include antihistamines or anti-emetics to reduce motion sickness and nausea. If you want to buy antihistamines, then there is an excellent selection available online.

Patients with an acute vestibular disorder associated with a middle ear infection may be prescribed steroids, antiviral drugs, or antibiotics.

Nystagmus is an uncontrolled eye movement, usually from side to side. It can happen when a person has vertigo, due to dysfunction of the brain or inner ear.

Sometimes, inner surgery is carried out to treat patients with intractable benign paroxysmal positional vertigo (BPPV). The surgeon inserts a bone plug into the inner ear to block the area where vertigo is being triggered.

The plug prevents this part of the ear from responding to particle movements inside the semicircular canal of the inner ear or head movements that could lead to vertigo.

Treatment of Ménière’s disease

Prescription drugs, such as meclizine, glycopyrrolate, or lorazepam, can be used to relieve the dizziness experienced with Ménière’s disease.

Other options include:

  • restricting salt and taking diuretic therapy to reduce the volume of fluid retained in the body that could build up in the inner ear
  • avoiding caffeine, chocolate, alcohol, and smoking tobacco
  • pressure pulse treatment, in which a device fitted to the outer ear delivers air pressure pulses to the middle ear, reducing vertigo
  • surgery to decompress the endolymphatic sac or cutting the vestibular nerve, if nothing else works

Some people have tried acupuncture, acupressure, and herbal supplements such as gingko biloba. However, there is no scientific evidence showing that these are effective.

Patients should discuss any alternative treatments with their doctor before using them.


Anyone who experiences vertigo or other types of dizziness should not drive or use a ladder. It may be a good idea to make adaptations in the home to prevent falls. Getting up slowly may alleviate the problem. People should also take care when looking upward and not make sudden changes in head position.


There is a range of different diseases and conditions that can lead to vertigo.

Vertigo often occurs as the result of an imbalance in the inner ear. Less commonly, problems in parts of the brain can cause vertigo.

Conditions that can cause the different types of vertigo include:

Labyrinthitis: This is an inflammation of the inner ear labyrinth, and the nerve within that is responsible for encoding the body’s head motion and position as well as sound, known as the vestibulocochlear nerve. It is usually caused by a viral infection.

Vestibular neuronitis: This is also thought to occur as a result of inflammation of the vestibular nerve, usually due to a viral infection.

Cholesteatoma: This is a skin growth that occurs in the middle ear, usually as a result of repeated infection. If the growth becomes larger, it can damage the ear, leading to hearing loss and dizziness.

Ménière’s disease: A buildup of fluid in the inner ear can lead to attacks of vertigo with ringing in the ears and hearing loss. It tends to affect people between the ages of 40 and 60 years.

The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that the prevalence of people in the United States currently diagnosed with Ménière’s Disease 615,000. It may stem from blood vessel constriction, a viral infection, or an autoimmune reaction, but this is not confirmed.

BPPV: This is thought to stem from a disturbance in the otolith particles. These are the crystals of calcium carbonate within inner ear fluid that touch the sensory hair cells inside the semicircular canals during movement. They stimulate the vestibular nerve to send information to the brain about a person’s position.

In people with BPPV, movement of the endolymph fluid continues after head movement has stopped because of the presence of otolith crystals in the semicircular canals.

BPPV normally affects older adults, and the cause is usually unknown. It has been linked todementia and twice as common in women as in men.

Vertigo can also be caused by or related to:

  • migraine headaches
  • head injuries or trauma
  • taking certain medication
  • ear surgery
  • prolonged bed rest
  • perilymphatic fistula, a tear in one or both of the membranes separating the middle and inner ear causing leakage of inner ear fluid into the middle ear
  • herpes zoster oticus, acute viral infection of shingles close to the ear affecting the facial nerve, also known as Ramsay Hunt syndrome
  • otosclerosis, a middle ear bone problem that causes hearing loss
  • side effects of medication or drug toxicity
  • syphilis
  • stroke
  • transient ischemic attack
  • cerebellar or brainstem disease, such as a tumor or stroke
  • acoustic neuroma, a benign growth on the vestibular nerve that traverses between the inner ear to the brain
  • multiple sclerosis



There are different types of vertigo, depending on the cause.

Peripheral vertigo usually occurs when there is a disturbance in the balance organs of the inner ear.

Central vertigo occurs as the result of a disturbance in one or more parts of the brain, known as sensory nerve pathways.

Peripheral vertigo

This type of vertigo is typically linked to the inner ear.

The labyrinth of the inner ear has tiny organs that enable messages to be sent to the brain in response to gravity.

These messages tell the brain when there is movement from the vertical position. This is what enables people to keep their balance when they stand up.

Disturbance to this system produces vertigo.

This can happen because of a source of inflammation, often due to a viral infection.

Various conditions are associated with peripheral vertigo.

Central vertigo

Central vertigo is linked to problems with the central nervous system.

It usually involves a disturbance in one of the following areas:

  • the brainstem
  • the cerebellum

These parts of the brain deal with the interaction between a person’s perception of vision and balance.

Symptoms can involve disrupted balance, dizziness, or both, at some time.



                                                                                                                         [the doctor will examine the ears when a patient has vertigo ]

A doctor will carry out a physical examination, and they will ask the patient how their dizziness makes them feel. This will enable the doctor to find out what kind of dizziness a patient has.

The doctor will ask about ask about the patient’s medical history, including any history of migraine headache or a recent head injury or ear infection.

The person may undergo a head CT or MRI scan.

Nystagmus testing

The doctor may also try to provoke nystagmus, as this can occur with vertigo.

Similar eye movement happens when you try to fix your eyes on one position while looking at something that is passing quickly by, for example, when looking out from a train window.

To check for nystagmus, the doctor may carry out the following exercise:

  1. The doctor rapidly moves the patient from a sitting position to lying down on the examination bench.
  2. The head is turned and held 45 degrees toward the affected side before this quick maneuver, and moved 30 degrees down at the end of it, over the end of the bench, below the horizontal position of the rest of the body.

If the patient experiences vertigo shortly after, and if the doctor observes specific eye movements, those of nystagmus, this can indicate that the patient has vertigo.

This is achieved through a number of tests, including:

  • Electronystagmography (ENG): This can electronically record the nystagmus. The patient wears a headset that places electrodes around the eyes. The device measures eye movements.
  • Videonystagmography (VNG): This is a newer technology can provide a video recording of the nystagmus.

The person with vertigo puts on a pair of special glasses that contain video cameras. These record horizontal, vertical and torsional eye movements using infrared light. Computer processing can analyze the data collected.

The head impulse test

The patient is asked to fix their gaze on the tip of the doctor’s nose while the head is moved quickly to one side.

If the patient can keep their eyes on the nose of the examiner during this movement, the test is negative. The cause is not an inner ear problem, so the doctor may then carry out tests to see if the symptoms are due to a central nervous system issue, such as blood vessel narrowing or blood clots in the brain.

The test gives a positive result if the patient cannot keep the eyes on the examiner’s nose during the quick head movement and quickly moves their eyes back to look at the nose.

By determining if this effect is seen when the head is moved to the left or the right, this may assist the doctor in finding out which side’s inner ear is affected, should the patient have vestibular dysfunction. However, a positive test could be due to a central nervous system problem.

Romberg’s test

A person who is steady standing in place with arms at the sides and feet together when they have their eyes open is asked to shut their eyes. If they become unsteady, this could be a sign of an inner ear problem. The side they fall toward is typically the side on which the inner ear is affected.

Unterberger’s test

The patient marches on the spot for 30 seconds with their eyes closed. If peripheral vertigo is present, there may be sideways rotation, toward the affected side.


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Hearing Loss: Myths Exposed


Myth Exposed: The most common cause of hearingloss is advancing age.

The truth is, exposure to loud noise is the number one cause of hearing loss; only 35% of people with hearing loss are older than age 64. There are nearly six million people in the U.S. between the ages of 18 and 44 with hearing loss, and more than one million are school age. Hearing loss affects all age groups.  Hereditary factors and health conditions like heart disease, high blood pressure, diabetes and other circulatory problems also cause hearing loss along with certain medications like aspirin, some antibiotics and chemotherapy drugs.

Myth Exposed: Only people with serious hearing loss need hearing devices.

The need for hearing amplification is dependent on your lifestyle, your degree of hearing loss and your need for a more sophisticated level of hearing. If you are a teacher or a lawyer, for example, refined hearing is necessary to understand the nuances of communication.  Therefore you may not be able to tolerate even a mild level of hearing loss. On the other hand, if you live alone or in a rural area and seldom socialize, then your tolerance level for moderate hearing loss may be higher.

Myth Exposed: If I had a hearing loss, my family doctor would have told me.

Incorrect, reports the Better Hearing Institute. Their studies indicate a mere 14% of physicians routinely screen for hearing loss during a physical. Besides, the quiet atmosphere in a doctor’s office makes hearing loss very difficult to detect. Audiology is a specialty that relies on training many doctors do not have, making them ill equipped to diagnose hearing loss.

Myth Exposed: Hearing devices will make me look older.

Hearing devices don’t make you look older; the fact that you cannot hear, understand and communicate normally with others make you look older. Those who cater to vanity pay the price when they are unable to function normally, and it’s next to impossible to hide the condition; smiling and nodding your head is bound to get you into trouble on occasion. If you are that concerned over appearance, many of today’s hearing devices are so tiny they fit into your ear canal and are virtually invisible to others.

Myth Exposed: Hearing devices aren’t worth the expense.

What price would you put on quality of life? Research studies indicate 9 out of 10 people with hearing devices believe their quality of life has improved. Overall satisfaction in people who have worn hearing devices for one year is 78%, close to satisfaction ratings for most consumer electronics. Effective communication is just one of the benefits of hearing devices; users report improvements in their relationships, emotional and physical well being, self-confidence, sense of humor, mental and cognitive skills, and sense of safety.



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Early Symptoms of Thyroid Problems in Murray, UT; Swelling or Discomfort in the Neck & More

Thyroid problems affect an estimated twenty million Americans and about 60% of those that do suffer from thyroid problems, goes un-diagnosed. The thyroid plays a major role in your body’s functions. The thyroid is a butterfly shaped gland located in the throat that helps our metabolism along with some minor and major bodily functions. Many people don’t even realize they have a thyroid problem. However, there are some common signs that can help alert people to thyroid problems. ENT Specialists would like to share some common signs of thyroid problems to help people become more aware of this ever growing medical condition and when to seek help.

Common Thyroid Symptoms

Depression – An over or under active thyroid can affect human moods. Hypothyroidism is a thyroid condition that can make a person feel tired, sluggish and depressed. Hypothyroidism is also known to cause restlessness and anxiety.
Constipation – Hypothyroidism cause hormonal production disruption that slows down the digestive system resulting in frequent constipation. For those who suffer from regular constipation, this is a common sign of hypothyroidism.
Over Sleeping – When your thyroid isn’t functioning correctly it can make a person feel sluggish and one’s activities can slow way down. Additionally, a person could feel very tired and sleepy any time during the day.
Hair Loss and Dry Skin – When a person begins to lose a lot of their hair, this could be due to the thyroid. The thyroid, when suffering from certain conditions, can interrupt hair growth due to an over production of certain hormones. This also has an effect on the skin as well. When the metabolism slows down it can cause skin to dry and even feel itchy. This is due to your body not producing enough sweat.
Weight Gain – For those who have sudden weight gain without changing their diet or slowing down their regular activities, this is also a sign of a thyroid problem. It’s expected that one will gain weight if a person eats more or is less active. However, when a person doesn’t change their habits then it may be due to a thyroid condition.
Muscle Pain – When the muscles in the arms, legs, hands, or feet begin to feel tight or numb, it may be caused by the thyroid. If a hormone is depleted or low it can damage the nerves. The majority of the nerves throughout the body sends signals to the brain. When the nerves become damaged, this can result in muscle pain and numbness.
High Blood Pressure – For those who have high blood pressure, usually diet and excise can correct this problem. However, for those who do diet and continue to suffer from high blood pressure or even bad cholesterol levels, the culprit could be the thyroid. If the thyroid is causing high blood pressure it can result in severe medical conditions such as an enlarged heart or heart failure.
Altered Taste or Increased Appetite – When food tastes different or your appetite increases, this is often caused by hypothyroidism or in other words an overactive thyroid.
Swelling or Discomfort in the Neck – If you notice a lump in your throat or swelling along with discomfort, this is a common sign of a thyroid disorder. Sometimes this can also affect the sound of a person’s voice.
Hot and Cold – A thyroid disorder can often disrupt the body’s ability to regulate body temperature. Those with hypothyroidism often feel colder than others while those with hyperthyroidism will feel hotter than others and even sweat more.

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