Management of Ear, Nose, & Throat

People often think of allergy as only “hay fever,” with sneezing, runny nose, nasal stuffiness and itchy, watery eyes. However, allergies can also cause symptoms such as chronic “sinus” problems, excess nasal and throat drainage (post nasal drip), head congestion, frequent “colds,” hoarse voice, eczema (skin allergies), recurring ear infections, hearing loss, dizziness, chronic cough and asthma. Even stomach and intestinal problems as well as excessive fatigue can be symptoms of allergy. Symptoms of ear, nose, and throat allergies may include:

• Repeated sneezing
• Nasal itching and rubbing
• Nasal congestion
• Runny nose
• Dark circles under the eyes
• Crease across bridge of nose
• Frequent throat clearing
• Mouth breathing
• Diminished/lost sense of smell/taste
• Recurrent, unexplained nosebleeds
• Recurrent ear infections
• Recurrent sinus infections
• Fluctuating hearing loss
• Cold-like symptoms more than 10 days Symptoms recur same time each year
• Chronic fatigue
• Symptoms can range from minor to severe

The greater the frequency and/or amount of exposure, the greater the chance that the susceptible person will develop an allergic problem that will require treatment.

There is no “usual” way for an allergy to begin; the onset may be sudden or gradual. Often, symptoms develop following an unusual stress to the immune symptom, such as a severe viral infection.

The initial or presumptive diagnosis of allergy is made by history and physical examination. If one wishes to be certain of the diagnosis and proceed to treat the patient effectively, the findings must be confirmed by tests that identify the specific offending allergens.

Tonsils and Adenoids
Tonsils and adenoids are the body’s first line of defense as part of the immune system. They sample bacteria and viruses that enter the body through the mouth or nose, but they sometimes become infected. At times, they become more of a liability than an asset and may even cause airway obstruction or repeated bacterial infections.

The two most common problems affecting the tonsils and adenoids are recurrent infections of the nose and throat, and significant enlargement that causes nasal obstruction and/or breathing, swallowing, and sleep problems.

Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling white deposits can also affect the tonsils and adenoids, making them sore and swollen. Cancers of the tonsil, while uncommon, require early diagnosis and aggressive treatment.

Tonsillitis is an infection of the tonsils. One sign is swelling of the tonsils. Other symptoms are:

• Redder than normal tonsils
• A white or yellow coating on the tonsils
• A slight voice change due to swelling
• Sore throat, sometimes accompanied by ear pain.
• Uncomfortable or painful swallowing
• Swollen lymph nodes (glands) in the neck
• Fever
• Bad breath

If your child’s adenoids are enlarged, it may be hard to breathe through the nose. If the tonsils and adenoids are enlarged, breathing during sleep may be disturbed. Other signs of adenoid and or tonsil enlargement are:

• Breathing through the mouth instead of the nose most of the time
• Nose sounds blocked when the person speaks
• Chronic runny nose
• Noisy breathing during the day
• Recurrent ear infections
• Snoring at night
• Restlessness during sleep, pauses in breathing for a few seconds at night(may indicate sleep apnea).

Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy) may be recommended if there are recurrent infections despite antibiotic therapy, and/or difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness, and may even cause behavioral or school performance problems in some children.

Chronic infections of the adenoids can affect other areas such as the eustachian tube the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and buildup of fluid in the middle ear that may cause temporary hearing loss. Studies also find that removal of the adenoids may help some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).
In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. Need more education, call us now

Dizziness
A general term that refers to an abnormal sense of balance and equilibrium.

Imbalance/ Dysequilibrium
Inability to keep one’s balance especially when on the feet, e.g. standing or walking.

Lightheadedness
A near pass-out or faint-like sensation, similar to the feeling if one breath-holds for a prolonged period.

Vertigo
Vertigo is defined as a sensation of movement and does not always involve a perception of spinning. In some patients the symptoms may be subtle and involve only a sensation of “swaying” or of an “inability to focus”. Some patients will experience movement of their surroundings or may feel like the ground is unstable. Sensations of vertigo typically are produced by an abnormality of the inner. Maintenance of balance requires that multiple organ systems in the body execute perfect coordination.

The brain is the central processing center that manages incoming balance information from the various Sense organs and outgoing information directed to the muscles and skeleton. Sensory input comes from three main areas: vision, inner ear, and touch (from the feet and joints). Vision is an important cue to the brain and allows us to determine if we are moving relative to our surroundings.

The most important part of each evaluation is the history of the problem. A detailed description of symptoms is the key element used in directing the appropriate tests required for diagnosis of the problem. Important questions which will likely be asked include:

• How often are you “dizzy” and how long does it last (seconds, minutes, hours, days)
• Do you have spells or are your symptoms constant
• Have you had blood pressure of heart problems in the past
• Do you have hearing loss, ringing or fullness of the ears, headache, severe allergies
• Do you get worse with changes in position, weather changes, mental stress, exertion
• Do you have difficulty maintaining your balance in the dark or on soft surfaces
• Do you have short term memory loss or a lack of concentration
• Have you had panic attacks or depression
• Is there a family history of vertigo, imbalance, tremor, Alzheimer’s, Parkinson’s, etc.
• Do you have a history of stroke, migraines, TIAs, seizures
• Have you fallen or nearly fallen recently
• Have you had any recent vaccinations
• Do you have a history of problems with insulin metabolism (Diabetes, hypoglycemia)

At Newstar Ear Centre, our clinicians specialize in making the correct diagnosis for your dizziness or balance disorder and on recommending the best course of treatment. We are glad to help you attain that sound health you deserve.

Ear infections affect both children and adults, though their presentation can vary with age. Ear infections can involve either the outer ear, middle ear, or the inner ear.

An outer ear infection: is an infection in the tube that connects the opening of the ear to the eardrum. It is medically known as otitis externa and is commonly referred to as “swimmer’s ear.” These outer ear infections sometimes result from exposure to moisture. They are common in children and young adults who spend a lot of time swimming. An infection can also occur if the thin layer of skin that lines the outer ear is ruptured. Intense scratching or using headphones or cotton swabs can create a rupture. When the layer of skin becomes damaged, it can provide a foothold for bacteria.

Cerumen, or earwax, is the ear’s natural defense against infection, but constant exposure to moisture and scratching can deplete the ear of cerumen, making infections more likely.

Symptoms of otitis externa include: swelling, redness, heat, pain or discomfort in the ear, pus discharge, itching, excessive fluid drainage, muffled or diminished hearing. Severe pain in the face, head, or neck can signify that the infection has advanced considerably. Symptoms accompanied by a fever or swollen lymph nodes may also indicate advancing infection.

Ear canal infections are best treated with cleaning of the ear canal under a microscope and, in conjunction with an ear wick. An ear wick is a small sponge that is placed into the canal, and allows the drops to remain in the ear canal, bathing and soothing the infected canal. The wicks are changed frequently to help the infection resolve faster.

An infection of the middle ear: referred to as 'acute otitis media'. The small space behind the eardrum in the middle ear is normally filled with air. It is connected to the back of the throat by a tiny channel called the Eustachian tube. The middle ear space sometimes becomes filled with mucus (fluid), often during a cold. The mucus may then become infected by germs (bacteria or viruses). Children with glue ear who have mucus behind their eardrum are more prone to ear infections. Sometimes an ear infection occurs 'out of the blue' for no apparent reason.

What are the symptoms of middle ear infection?
Earache is common but does not always occur. Dulled hearing may develop for a few days. High temperature (fever) is common. Children may feel sick or vomit and can be generally unwell. Young babies cannot point to their pain. One of the causes of a hot, irritable, crying baby is an ear infection. Sometimes the eardrum bursts (perforates). This lets out infected mucus and the ear becomes runny for a few days. As the pain of earache is due to a tense eardrum, a burst eardrum often relieves the pain. A perforated eardrum usually heals within a few weeks after the infection clears.

A note about earache: Earache is a common symptom of ear infection. However, not all earaches are caused by an ear infection. If a child has earache but is otherwise well, an ear infection is unlikely. A common cause of mild earache is a build-up of mucus in the middle ear after a cold. This usually clears within a few days. Sometimes pain that you can feel in the ear is due to referred pain from other causes such as teeth problems etc. Contact us today if you are experiencing any of the symptoms listed above.

What are sinuses? There are four pairs of sinuses in the head that assist the control of temperature and humidity of the air reaching the lungs. Sinuses begin as pea-sized pouches in the newborn extending outward from the inside of the nose to the bones of the face and skull. They expand and grow throughout childhood and into young adulthood. Eventually they become air pockets or cavities that are lined with the same kind of lining that lines the nose. They are connected to the inside of the nose through smaller openings called ostia.

Types of sinusitis
Sinus infection occurs in two types. Acute sinusitis gives rise to severe symptoms but is usually short-lived. Acute sinusitis usually occurs following a cold. Typically a green-yellow nasal discharge occurs a week or more after the onset of the cold and this is associated with severe pain around the cheeks, eyes and/or forehead. This may be associated with swelling and a high fever along with toothache. Chronic sinusitis is sinusitis that continues for many weeks. Chronic sinusitis may be caused by an acute sinus infection which fails to resolve or as a result of an underlying allergy affecting the lining membranes of the nose and sinuses. Common symptoms include nasal obstruction, headache, nasal discharge, low grade fever, reduced sense of smell, facial pain and halitosis.

Diagnosis and treatment of sinusitis.
Acute sinusitis is usually treated with antibiotics and medication to reduce the swelling of the nasal lining e.g. decongestants. Chronic sinusitis may need long term treatment. Medical treatment options include antibiotics, decongestants and other treatments to reduce the swelling of the lining such as nasal steroid sprays. Antihistamines will have a place in patients who have an underlying allergy. In the vast majority of cases sinusitis can be managed effectively with medical treatment. Occasionally symptoms will persist despite ongoing use of medicines in which case surgery may be necessary. The diagnosis of sinusitis by a specialist will involve the use of a nasal endoscope which the doctor can use to examine the nasal lining and the sinus openings.

Sinus surgery Surgery is normally only considered if medical treatment fails. When surgery is needed the ENT specialist can choose from a number of different options depending on the severity of the sinus disease. Most sinus operations are performed without an external incision. Most surgeons will ask for a scan of the sinuses to assist with the planning of the operation. You may change your mind about the operation at any time, and signing a consent form does not mean that you have to have the operation.