Download Fact Sheet: Better Ear Health Many medical conditions, such as

Fact Sheet: Better Ear Health
Many medical conditions, such as those listed below, can affect your hearing health.
Treatment of these and other hearing losses can often lead to improved or restored
hearing. If left undiagnosed and untreated, some conditions can lead to irreversible
hearing impairment or deafness. If you suspect that you or your loved one has a problem
with their hearing, ensure optimal hearing healthcare by seeking a medical diagnosis
from a physician.
Otitis Media
The most common cause of hearing loss in children is otitis media, the medical term for a
middle ear infection or inflammation of the middle ear. This condition can occur in one
or both ears and primarily affects children due to the shape of the young Eustachian tube
(and is the most frequent diagnosis for children visiting a physician). When left
undiagnosed and untreated, otitis media can lead to infection of the mastoid bone behind
the ear, a ruptured ear drum, and hearing loss. If treated appropriately, hearing loss
related to otitis media can be alleviated.
Tinnitus
Tinnitus is the medical name indicating “ringing in the ears,” which includes noises
ranging from loud roaring to clicking, humming, or buzzing. Most tinnitus comes from
damage to the microscopic endings of the hearing nerve in the inner ear. The health of
these nerve endings is important for acute hearing, and injury to them brings on hearing
loss and often tinnitus. Hearing nerve impairment and tinnitus can also be a natural
accompaniment of advancing age. Exposure to loud noise is probably the leading cause
of tinnitus damage to hearing in younger people. Medical treatments and assistive hearing
devices are often helpful to those with this condition.
Swimmer’s Ear
An infection of the outer ear structures caused when water gets trapped in the ear canal
leading to a collection of trapped bacteria is known as swimmer’s ear or otitis externa. In
this warm, moist environment, bacteria multiply causing irritation and infection of the ear
canal. Although it typically occurs in swimmers, bathing or showering can also contribute
to this common infection. In severe cases, the ear canal may swell shut leading to
temporary hearing loss and making administration of medications difficult.
Earwax
Earwax (also known as cerumen) is produced by special glands in the outer part of the ear
canal and is designed to trap dust and dirt particles keeping them from reaching the
eardrum. Usually the wax accumulates, dries, and then falls out of the ear on its own or is
wiped away. One of the most common and easily treatable causes of hearing loss is
accumulated earwax. Using cotton swabs or other small objects to remove earwax is not
recommended as it pushes the earwax deeper into the ear, increasing buildup and
affecting hearing. Excessive earwax can be a chronic condition best treated by a
physician.
Autoimmune Inner Ear Disease
Autoimmune inner ear disease (AIED) is an inflammatory condition of the inner ear. It
occurs when the body's immune system attacks cells in the inner ear that are mistaken for
a virus or bacteria. Prompt medical diagnosis is essential to ensure the most favorable
prognosis. Therefore, recognizing the symptoms of AIED is important: sudden hearing
loss in one ear progressing rapidly to the second and continued loss of hearing over
weeks or months, a feeling of ear fullness, vertigo, and tinnitus. Treatments primarily
include medications but hearing aids and cochlear implants are helpful to some.
Cholesteatoma
A cholesteatoma is a skin growth that occurs in the middle ear behind the eardrum. This
condition usually results from poor eustachian tube function concurrent with middle ear
infection (otitis media), but can also be present at birth. The condition is treatable, but can
only be diagnosed by medical examination. Over time, untreated cholesteatoma can lead
to bone erosion and spread of the ear infection to localized areas such as the inner ear and
brain. If untreated, deafness, brain abscess, meningitis, and death can occur.
Perforated Eardrum
A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that separates
the ear canal and the middle ear. A perforated eardrum is often accompanied by
decreased hearing and occasional discharge with possible pain. The amount of hearing
loss experienced depends on the degree and location of perforation. Sometimes a
perforated eardrum will heal spontaneously, other times surgery to repair the hole is
necessary. Serious problems can occur if water or bacteria enter the middle ear through
the hole. A physician can advise you on protection of the ear from water and bacteria
until the hole is repaired.
Fact Sheet: Child Screening
Why Is Early Childhood Hearing Screening Important For Your Child?
Approximately two to four of every 1,000 children in the United States are born deaf or
hard-of-hearing, making hearing loss the most common birth disorder. Many studies have
shown that early diagnosis of hearing loss is crucial to the development of speech,
language, cognitive, and psychosocial abilities. Treatment is most successful if hearing
loss is identified early, preferably within the first month of life. Still, one in every four
children born with serious hearing loss does not receive a diagnosis until age three or
older.
When Should A Child’s Hearing Be Tested?
The first opportunity to test a child’s hearing is in the hospital shortly after birth. If your
child’s hearing is not screened before leaving the hospital, it is recommended that
screening be done within the first month of life. Should test results indicate a possible
hearing loss, seek further evaluation as soon as possible; preferably within the first three
to six months of life.
Is Early Hearing Screening Mandatory?
In recent years, health organizations across the country, including the AmericanAcademy
of Otolaryngology – Head and Neck Surgery, have worked to highlight the importance of
screening all newborns for hearing loss. These efforts are working. In 2003, more than 85
percent of all newborns in the United States were screened for hearing loss. In fact, some
39 states have passed legislation requiring some form of hearing screening of newborns
before they leave the hospital. This still leaves more than a million babies who are not
screened for hearing loss before leaving the hospital.
How Is Screening Done?
Two tests are used to screen infants and newborns for hearing loss. They are:
Otoacoustic emissions (OAE)involves placement of a sponge earphone in the ear
canal to measure whether the ear can respond properly to sound. In normalhearing children, a measurable “echo” should be produced when sound is emitted
through the earphone. If no echo is measured, it could indicate a hearing loss.
Auditory brain stem response (ABR) is a more complex test. Earphones are placed
on the ears and electrodes are placed on the head and ears. Sound is emitted
through the earphones while the electrodes measure how your child’s brain
responds to the sound.
If either test indicates a potential hearing loss, your physician may suggest a follow-up
evaluation by an otolaryngologist.
Signs of Hearing Loss In Children
Hearing loss can also occur later childhood, after a newborn leaves the hospital. In these
cases, parents, grandparents, and other caregivers are often the first to notice that
something may be wrong with a young child’s hearing. Even if your child’s hearing was
tested as a newborn, you should continue to watch for signs of hearing loss including:
• Not reacting in any way to unexpected loud noises,
• Not being awakened by loud noises,
• Not turning his/her head in the direction of your voice,
• Not being able to follow or understand directions,
• Poor language development, or
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Speaking loudly or not using age-appropriate language skills.
If your child exhibits any of these signs, report them to your doctor.
What Happens If My Child Has A Hearing Loss?
Hearing loss in children can be temporary or permanent. It is important to have hearing
loss evaluated by a physician who can rule out medical problems that may be causing the
hearing loss, such as otitis media (ear infection), excessive earwax congenital
malformations, or a genetic hearing loss.
If it is determined that your child’s hearing loss is permanent, hearing aids may be
recommended to amplify the sound reaching your child’s ear. Ear surgery may be able to
restore or significantly improve hearing in some instances. For those with certain types of
profound hearing loss who do not benefit sufficiently from hearing aids, a cochlear
implant may be considered. Unlike a hearing aid, a cochlear implant bypasses damaged
parts of the auditory system and directly stimulates the hearing nerve and allows the child
to hear louder and clearer sound.
You will need to decide whether or not your deaf child will communicate primarily with
oral speech and/or sign language, and seek early intervention to prevent language delays.
Research indicates that habilitation of hearing loss by age six months will prevent
subsequent language delays. Other communication strategies such as auditory verbal
therapy, lip reading, and cued speech may also be used in conjunction with a hearing aid
or cochlear implant, or independently.
Fact Sheet: Hyperacusis ? An increased sensitivity to everyday sounds
What Is Hyperacusis?
Hyperacusis is a condition that arises from a problem in the way the brain’s central
auditory processing center perceives noise. It can often lead to pain and discomfort.
Individuals with hyperacusis have difficulty tolerating sounds which do not seem loud to
others, such as the noise from running faucet water, riding in a car, walking on leaves,
dishwasher, fan on the refrigerator, shuffling papers. Although all sounds may be
perceived as too loud, high frequency sounds may be particularly troublesome.
As one might suspect, the quality of life for individuals with hyperacusis can be greatly
compromised. For those with a severe intolerance to sound, it is difficult and sometimes
impossible to function in an every day environment with all its ambient noise.
Hyperacusis can contribute to social isolation, phonophobia (fear of normal sounds), and
depression.
Prevalence And Causes Of Hyperacusis
Many people experience sensitivity to sound, but true hyperacusis is rare, affecting
approximately one in 50,000 individuals. The disorder can affect people of all ages in one
or both ears. Individuals are usually not born with hyperacusis, but may develop a narrow
tolerance to sound, most commonly from traumatically loud noises, which can be sudden
or cumulative over time. Other common causes include:
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Head injury
Ear damage from toxins or medication
Lyme disease
Air bag deployment
Viral infections involving the inner ear or facial nerve (Bell’s palsy)
Temporomandibular joint (TMJ) syndrome
There are a variety of neurologic conditions that may be associated with hyperacusis,
including:
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Post-traumatic stress disorder
Chronic fatigue syndrome
Tay-Sach's disease
Some forms of epilepsy
Valium dependence
Depression
Migraine headaches
Hyperacusis is also more common in children with: central auditory processing disorder,
learning disabilities, attention deficit disorder (ADD), head injury, autism, and autisticlike behaviors.
Diagnosis Of Hyperacusis
Individuals who suspect they may have hyperacusis should seek an evaluation by an
otolaryngologist (ear, nose, and throat doctor). The initial consultation is likely to include
a full audiologic evaluation (with a hearing test), a recording of medical history, and a
medical evaluation by a physician. Counseling about evaluation findings and treatment
options may also be provided at that time.
Treatment For Hyperacusis
There are no specific corrective surgical or medical treatments for hyperacusis. However,
sound therapy may be used to “retrain” the auditory processing center of the brain to
accept every day sounds. This involves the use of a noise-generating device worn on the
affected ear or ears. Those suffering from hyperacusis may be uncomfortable with
placing sound directly in their ear, but the device produces a gentle static-like sound
(white noise) that is barely audible. Completion of sound therapy may take up to 12
months, and usually improves sound tolerance.
Because social situations are often painfully loud for those with hyperacusis, withdrawal,
social isolation, and depression are common. For this reason, appropriate counseling may
also be an important aspect of treatment.
Hearing Loss
Surprisingly, individuals with hyperacusis have little or no detectable hearing loss. In
fact, hearing tests usually indicate normal hearing sensitivity and often register at minus
decibel levels. Counter to what one might think, this does not mean that those with
hyperacusis hear better than others. Instead, it is a clear indication of a problem in the
way the brain processes sound.
Hearing loss coupled with low tolerance to sound is termed recruitment, a condition
where soft sounds cannot be heard and loud sounds are intolerable (or distorted). For
example, a person with recruitment may have hearing loss below 50 decibels while at the
same time; sound above 80 decibels may be intolerable. The result is a narrow range of
comfortable hearing.
Relation To Tinnitus
Hyperacusis is strongly associated with tinnitus, a condition commonly referred to as
“ringing in the ears.” Nearly 36 million Americans suffer from tinnitus; an estimated one
of every thousand also has hyperacusis. Individuals can have tinnitus and hyperacusis at
the same time, or hyperacusis may be a precursor to the development of tinnitus. If both
occur at the same time, hyperacusis is generally treated first.
Fact Sheet: Know the Power of Sound
Sound is measured in decibels (dB). Each decibel is one tenth of a bel, which is a unit
that measures the intensity of sound. For every six decibels, the intensity of the sound
doubles. At 90 dB of uninterrupted sound, the limit of safe noise exposure is eight
hours. For each six dB increase of uninterrupted sound thereafter, the limit of safe
exposure is reduced by half.
It is important to know the approximate intensity of sound around you to protect your
hearing. Click here to use the Interactive Loudness Scale.
Fact Sheet: What you should know about otosclerosis
What Is Otosclerosis?
The term otosclerosis is derived from the Greek words for "hard" (scler-o) and "ear"
(oto). It describes a condition of abnormal growth in the tiny bones of the middle ear,
which leads to a fixation of the stapes bone. The stapes bone must move freely for the ear
to work properly and hear well.
Hearing is a complex process. In a normal ear, sound vibrations are funneled by the outer
ear into the ear canal where they hit the ear drum. These vibrations cause movement of
the ear drum that transfers to the three small bones of the middle ear, the malleus
(hammer), incus (anvil), and stapes (stirrup). When the stapes bone moves, it sets the
inner ear fluids in motion, which, in turn, start the process to stimulate the auditory
(hearing) nerve. The hearing nerve then carries sound energy to the brain, resulting in
hearing of sound. When any part of this process is compromised, hearing is impaired.
Who Gets Otosclerosis And Why?
It is estimated that ten percent of the adult Caucasian population is affected by
otosclerosis. The condition is less common in people of Japanese and South American
decent and is rare in African Americans. Overall, Caucasian, middle-aged women are
most at risk.
The hallmark symptom of otosclerosis, slowly progressing hearing loss, can begin
anytime between the ages of 15 and 45, but it usually starts in the early 20’s. The disease
can develop in both women and men, but is particularly troublesome for pregnant women
who, for unknown reasons, often experience a rapid decrease in hearing ability.
Approximately 60 percent of otosclerosis cases are genetic in origin. On average, a
person who has one parent with otosclerosis has a 25 percent chance of developing the
disorder. If both parents have otosclerosis, the risk goes up to 50 percent.
Symptoms Of Otosclerosis
Gradual hearing loss is the most frequent symptom of otosclerosis. Often, individuals
with otosclerosis will first notice that they cannot hear low-pitched sounds or whispers.
Other symptoms of the disorder can include dizziness, balance problems, or a sensation
of ringing, roaring, buzzing, or hissing in the ears or head known as tinnitus.
How Is Otosclerosis Diagnosed?
Because many of the symptoms typical of otosclerosis can also be caused by other
medical conditions, it is important to be examined by an otolaryngologist (ear, nose and
throat doctor) to eliminate other possible causes of the symptoms. After an ear exam, the
otolaryngologist may order a hearing test. Based on the results of this test and the exam
findings, the otolaryngologist will suggest treatment options.
Treatment For Otosclerosis
If the hearing loss is mild, the otolaryngologist may suggest continued observation and a
hearing aid to amplify the sound reaching the ear drum. Sodium fluoride has been found
to slow the progression of the disease and may also be prescribed. In most cases of
otosclerosis, a surgical procedure called stapedectomy is the most effective method of
restoring or improving hearing.
What Is A Stapedectomy?
A stapedectomy is an outpatient surgical procedure done under local or general
anesthesia through the ear canal with an operating microscope. (No outer incisions are
made.) It involves removing the immobilized stapes bone and replacing it with a
prosthetic device. The prosthetic device allows the bones of the middle ear to resume
movement, which stimulates fluid in the inner ear and improves or restores hearing.
Modern-day stapedectomies have been performed since 1956 with a success rate of 90
percent. In rare cases (about one percent of surgeries), the procedure may worsen hearing.
Otosclerosis affects both ears in eight out of ten patients. For these patients, ears are
operated on one at a time; the worst hearing ear first.
What Should I Expect After A Stapedectomy?
Most patients return home the evening after surgery and are told to lie quietly on the unoperated ear. Oral antibiotics may be prescribed by the otolaryngologist. Some patients
experience dizziness the first few days after surgery. Taste sensation may also be altered
for several weeks or months following surgery, but usually returns to normal.
Following surgery, patients may be asked to refrain from nose blowing, swimming, or
other activities that may get water in the operated ear. Normal activities (including air
travel) are usually resumed two weeks after surgery.
Notify your otolaryngologist immediately if any of the following occurs:
• Sudden hearing loss
• Intense pain
• Prolonged or intense dizziness
• Any new symptom related to the operated ear
Since packing is placed in the ear at the time of surgery, hearing improvement will not be
noticed until it is removed about a week after surgery. The ear drum will heal quickly,
generally reaching the maximum level of improvement within two weeks.
Fact Sheet: Your Genes and Hearing Loss
One of the most common birth defects is hearing loss or deafness (congenital), which can
affect as many as three of every 1,000 babies born. Inherited genetic defects play an
important role in congenital hearing loss, contributing to about 60 percent of deafness
occurring in infants. Although exact data is not available, it is likely that genetics plays
an important role in hearing loss in the elderly. Inherited genetic defects are just one
factor that can lead to hearing loss and deafness, both of which may occur at any stage of
a person’s lifespan. Other factors may include: medical problems, environmental
exposure, trauma, and medications.
The most common and useful distinction in hearing impairment is syndromic versus nonsyndromic.
Non-syndromic hearing impairment accounts for the vast majority of inherited
hearing loss, approximately 70 percent. Autosomal- recessive inheritance is
responsible for about 80 percent of cases of non-syndromic hearing impairment,
while autosomal-dominant genes cause 20 percent, less than two percent of cases
are caused by X-linked and mitochondrial genetic malfunctions.
Syndromic (sin-DRO-mik) means that the hearing impairment is associated with
other clinical abnormalities. Among hereditary hearing impairments, 15 to 30
percent are syndromic. Over 400 syndromes are known to include hearing
impairment and can be classified as: syndromes due to cyotgenetic or
chromosomal anomalies, syndromes transmitted in classical monogenic or
Mendelian inheritance, or syndromes due to multi-factorial influences, and
finally, syndromes due to a combination of genetic and environmental factors.
Variable expression of different aspects of syndromes is common. Some aspects may be
expressed in a range from mild to severe or different combinations of associated
symptoms may be expressed in different individuals carrying the same mutation within a
single pedigree. An example of variable expressivity is seen in families transmitting
autosomal dominant Waardenburg syndrome. Within the same family, some affected
members may have dystopia canthorum (an unusually wide nasal bridge due to sideways
displacement of the inner angles of the eyes), white forelock, heterochromia irides (two
different-colored irises or two colors in the same iris), and hearing loss, while others with
the same mutation may only have dystopia canthorum.
How Do Genes Work?
Genes are a road map for the synthesis of proteins, which are the building blocks for
everything in the body: hair, eyes, ears, heart, lung, etc. Every child inherits half of its
genes from one parent and half from the other parent. If the inherited genes are defective,
a health disorder such as hearing loss or deafness can result. Hearing disorders are
inherited in one of four ways:
Autosomal Dominant Inheritance: For autosomal dominant disorders, the
transmission of a rare allele of a gene by a single heterozygous parent is sufficient
to generate an affected child. A heterozygous parent has two types of the same
gene (in this case, one mutated and the other normal) and can produce two types
of gametes (reproductive cells). One gamete will carry the mutant form of the
gene of interest, and the other the normal form. Each of these gametes then has an
equal chance of being used to form the offspring. Thus the chance that the
offspring of a parent with an autosomal dominant gene will develop the disorder
is 50 percent. Autosomal dominant traits usually affect males and females
equally.
Autosomal Recessive Inheritance: An autosomal recessive trait is characterized
by having parents who are heterozygous carriers for mutant forms of the gene in
question but are not affected by the disorder. The problem gene that would cause
the disorder is suppressed by the normal gene. These heterozygous parents (A/a)
can each generate two types of gametes, one carrying the mutant copy of the gene
(a) and the other having a normal copy of the gene (A). There are four possible
combinations from each of the parents, A/a, A/A, a/A, and a/a. Only the offspring
that inherits both mutant copies (a/a) will exhibit the trait. Overall, offspring of
these two parents will face a 25 percent chance of inheriting the disorder.
X-linked Inheritance: A male offspring has an X chromosome and a Y
chromosome, while a female has two copies of the X chromosome only. Each
female inherits an X chromosome from her mother and her father. On the other
hand, each male inherits an X chromosome from his mother and a Y chromosome
from his father. In general, only one of the two X chromosomes carried by a
female is active in any one cell while the other is rendered inactive. This is why
when a female inherits a defective gene on one X chromosome, the normal gene
on the other X chromosome can usually compensate. As males only have one
copy of the X chromosome, any defective gene is more likely to manifest into a
disorder.
Mitochondrial Inheritance: Mitochondrias, small powerhouses within each cell,
also contain their own DNA. Interestingly, the sperm does not have any
mitochondria, and consequently, only the mitochondria in the egg from the
mother can be passed from one generation to the next. This leads to an interesting
inheritance pattern where only affected mothers (and not affected fathers as their
sperms do not have mitochondria) can pass on a disease from one generation to
the next. Sensitivity to aminoglycoside antibiotics can be inherited through a
defect in mitochondrial DNA and is the most common cause of deafness in
China!
In the last decade, advances in molecular biology and genetics have contributed
substantially to the understanding of development, function, and pathology of the inner
ear. Researchers have identified several of the various genes responsible for hereditary
deafness or hearing loss, most notably the GJB2 gene mutation. As one of the most
common genetic causes of hearing loss, GJB2-related hearing loss is considered a
recessive genetic disorder because the mutations only cause deafness in individuals who
inherit two copies of the mutated gene, one from each parent. A person with one mutated
copy and one normal copy is a carrier but is not deaf. Screening tests for the GJB2 gene
are available for at risk individuals to help them determine their risk of having a child
with hearing problems.
Fact Sheet: About Your Voice
What Is Voice?
“Voice” is the sound made by vibration of the vocal cords caused by air passing out
through the larynx bringing the cords closer together. Your voice is an extremely
valuable resource and is the most commonly used form of communication. Our voice is
invaluable for both our social interaction as well as for most people’s occupation. Proper
care and use of your voice improves the likelihood of having a healthy voice for your
entire lifetime.
How Do I Know If I Have A Voice Problem?
Voice problems occur with a change in the voice, often described as hoarseness,
roughness, or a raspy quality. People with voice problems often complain about or notice
changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain
associated with voice use. Other voice problems may accompany a change in singing
ability that is most notable in the upper singing range. A more serious problem is
indicated by spitting up blood or when blood is present in the mucus. These require
prompt attention by an otolaryngologist.
What Is The Most Common Cause Of A Change In Your Voice?
Voice changes sometimes follow an upper respiratory infection lasting up to two weeks.
Typically the upper respiratory infection or cold causes swelling of the vocal cords and
changes their vibration resulting in an abnormal voice. Reduced voice use (voice rest)
typically improves the voice after an upper respiratory infection, cold, or bronchitis. If
voice does not return to its normal characteristics and capabilities within two to four
weeks after a cold, a medical evaluation by an ear, nose, and throat specialist is
recommended. A throat examination after a change in the voice lasting longer than one
month is especially important for smokers. (Note: A change in voice is one of the first
and most important symptoms of throat cancer. Early detection significantly increases the
effectiveness of treatment.)
Six Tips To Identify Voice Problems
Ask yourself the following questions to determine if you have an unhealthy voice:
Has your voice become hoarse or raspy?
Does your throat often feel raw, achy, or strained?
Does talking require more effort?
Do you find yourself repeatedly clearing your throat?
Do people regularly ask you if you have a cold when in fact you do not?
Have you lost your ability to hit some high notes when singing?
A wide range of problems can lead to changes in your voice. Seek out a physician’s care
when voice problems persist.
Hoarseness or roughness in your voice is often caused by a medical problem.
Contact an otolaryngologist—head and neck surgeon if you have any sustained
changes to your voice.
Fact Sheet: Effects of Medications on Voice
Could Your Medication Be Affecting Your Voice?
Some medications including prescription, over-the-counter, and herbal supplements can
affect the function of your voice. If your doctor prescribes a medication that adversely
affects your voice, make sure the benefit of taking the medicine outweighs the problems
with your voice.
Most medications affect the voice by drying out the protective mucosal layer covering the
vocal cords. Vocal cords must be well-lubricated to operate properly; if the mucosa
becomes dry, speech will be more difficult. This is why hydration is an important
component of vocal health.
Medications can also affect the voice by thinning blood in the body, which makes
bruising or hemorrhaging of the vocal cord more likely if trauma occurs, and by causing
fluid retention (edema), which enlarges the vocal cords. Medications from the following
groups can adversely affect the voice:
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Antidepressants
Muscle relaxants
Diuretics
Antihypertensives (blood pressure medication)
Antihistamines (allergy medications)
Anticholinergics (asthma medications)
High-dose Vitamin C (greater than five grams per day)
Other medications and associated conditions that may affect the voice include:
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Angiotensin-converting-enzyme (ACE) inhibitors (blood pressure medication)
may induce a cough or excessive throat clearing in as many as 10 percent of
patients. Coughing or excessive throat clearing can contribute to vocal cord
lesions.
Oral contraceptives may cause fluid retention (edema) in the vocal cords because
they contain estrogen.
Estrogen replacement therapy post-menopause may have a variable effect.
An inadequate level of thyroid replacement medication in patients with
hypothyroidism.
Anticoagulants (blood thinners) may increase chances of vocal cord hemorrhage
or polyp formation in response to trauma.
Herbal medications are not harmless and should be taken with caution. Many have
unknown side effects that include voice disturbance.
NOTE: Contents of this fact sheet are based on information provided by The Center for
Voice at Northwestern University.
Fact Sheet: Laryngeal (Voice Box) Cancer
The American Cancer Society estimates that approximately 38,000 new cases of head
and neck cancer were diagnosed in the United States in 2002; about 9,000 of these were
in the larynx (voice box).Experts anticipate similar statistics for 2003.
An estimated 3,700 people died of laryngeal cancer in 2002 representing approximately
two thirds of one percent of all cancer deaths in this country. Even for disease survivors,
the consequences of laryngeal cancer are often severe. Laryngeal cancer is a preventable
disease because the risk factors are associated with modifiable behaviors.
The Causes Of Laryngeal Cancer
Development of this deadly disease is a process which involves many factors, but
approximately 90 percent of head and neck cancers occur after exposure to known
carcinogens (cancer causing substances) causing a type of the disease called squamous
cell carcinoma (SCCA).
Smoking: More than 95 percent with laryngeal SCCA are smokers. Smoking
contributes to cancer by causing mutations or changes in genes, impairing
clearance of carcinogens from the respiratory tract, and decreasing the body’s
immune response. Tobacco use is measured in pack-years, where one pack per
day for one year is one pack-year (or one pack per day for two years, or two packs
per day for one year, equals two pack-years).Depending upon the number of packyears smoked, studies have reported that smokers are about five to 35 times more
likely to develop laryngeal cancer than nonsmokers. Other research findings
indicate that the duration of tobacco exposure is probably more important overall
to the cancer causing effect than the intensity of the exposure.
Alcohol: This acts as a promoter of the cancer causing process making it another
important risk factor for laryngeal cancer. The major clinical significance of
alcohol is that it enhances the harmful effects of tobacco at a magnitude that is
more than just additive. Essentially, people who smoke and drink alcohol have a
combined risk that is greater than the sum of the individual risks. The American
Cancer Society recommends that those who drink alcoholic beverages should
limit the amount, and one drink per day is considered a limited alcohol exposure.
Other Risk Factors: Certain viruses, such as human papilloma virus (HPV), acid
reflux, and occupational exposure to asbestos likely contribute to causing
laryngeal cancer. Vitamin A and beta-carotene may play a protective role in the
disease process.
Signs And Symptoms Of Laryngeal Cancer Include:
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Progressive or persistent hoarseness
Difficulty swallowing
Persistent sore throat or pain with swallowing
Difficulty breathing
Pain in the ear
Lump in the neck
Anyone with these signs or symptoms, and having risks for laryngeal cancer,
should be evaluated by an otolaryngologist (ear, nose, and throat specialist).The
primary treatment options include surgery, radiation therapy, chemotherapy, or a
combination of these treatments.
Remember that this is a preventable disease in the vast majority of cases, because
the main risk factors are associated with modifiable behaviors. Do not smoke and
do not abuse alcohol.
Hoarseness or roughness in your voice is often caused by a medical problem.
Contact an otolaryngologist—head and neck surgeon if you have any
sustained changes to your voice.
Fact Sheet: Nodules, Polyps, and Cysts
The term vocal cord lesion (physicians call them vocal “fold” lesions) refers to a group of
noncancerous (benign), abnormal growths (lesions) within or along the covering of the
vocal cord. Vocal cord lesions are one of the most common causes of voice problems and
are generally seen in three forms; nodules, polyps, and cysts.
Vocal Cord Nodules (also called Singer's Nodes, Screamer's Nodes)
Vocal cord nodules are also known as “calluses of the vocal fold.” They appear on both
sides of the vocal cords, typically at the midpoint, and directly face each other. Like other
calluses, these lesions often diminish or disappear when overuse of the area is stopped.
Vocal Cord Polyp
A vocal cord polyp typically occurs only on one side of the vocal cord and can occur in a
variety of shapes and sizes. Depending upon the nature of the polyp, it can cause a wide
range of voice disturbances.
Vocal Cord Cyst
A vocal cord cyst is a firm mass of tissue contained within a membrane (sac). The cyst
can be located near the surface of the vocal cord or deeper, near the ligament of the vocal
cord. As with vocal cord polyps and nodules, the size and location of vocal cord cysts
affect the degree of disruption of vocal cord vibration and subsequently the severity of
hoarseness or other voice problem. Surgery followed by voice therapy is the most
commonly recommended treatment for vocal cord cysts that significantly alter and/or
limit voice.
Reactive Vocal Cord Lesion
A reactive vocal cord lesion is a mass located opposite an existing vocal cord lesion, such
as a vocal cord cyst or polyp. This type of lesion is thought to develop from trauma or
repeated injury caused by the lesion on the opposite vocal cord. A reactive vocal cord
lesion will usually decrease or disappear with voice rest and therapy.
What Are The Causes Of Benign Vocal Cord Lesions?
The exact cause or causes of benign vocal cord lesions is not known. Lesions are thought
to arise following "heavy" or traumatic use of the voice, including voice misuse such as
speaking in an improper pitch, speaking excessively, screaming or yelling, or using the
voice excessively while sick.
What Are The Symptoms Of Benign Vocal Cord Lesions?
A change in voice quality and persistent hoarseness are often the first warning signs of a
vocal cord lesion. Other symptoms can include:
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Vocal fatigue
Unreliable voice
Delayed voice initiation
Low, gravelly voice
Low pitch
Voice breaks in first passages of sentences
Airy or breathy voice
Inability to sing in high, soft voice
Increased effort to speak or sing
Hoarse and rough voice quality
Frequent throat clearing
Extra force needed for voice
Voice "hard to find"
When a vocal cord lesion is present, symptoms may increase or decrease in degree, but
will persist and do not go away on their own.
How Is The Diagnosis Of A Benign Vocal Cord Lesion Made?
Diagnosis begins with a complete history of the voice problem and an evaluation of
speaking method. The otolaryngologist will perform a careful examination of the vocal
cords, typically using rigid laryngoscopy with a stroboscopic light source. In this
procedure, a telescope-tube is passed through the patient's mouth that allows the
examiner to view the voice box (images are often recorded on video). The stroboscopic
light source allows the examiner to assess vocal fold vibration. Sometimes a second exam
will follow a trial of voice rest to allow the otolaryngologist an opportunity to assess
changes in the vocal cord lesion.
Other associated medical problems can contribute to voice problems, such as: reflux,
allergies, medication’s side effects, and hormonal imbalances. An evaluation of these
conditions is an important diagnostic factor.
How Are Benign Vocal Cord Lesions Treated?
The most common treatment options for benign vocal cord lesions include: voice rest,
voice therapy, singing voice therapy, and phonomicrosurgery, a type of surgery involving
the use of microsurgical techniques and instruments to treat abnormalities on the vocal
cord.
Treatment options can vary according to the degree of voice limitation and the exact
voice demands of the patient. For example, if a professional singer develops benign vocal
cord lesions and undergoes voice therapy, which improves speaking but not singing
voice, then surgery might be considered to restore singing voice. Successful and
appropriate treatment is highly individual and includes consideration of the patient’s
vocal needs and the clinical judgment of the otolaryngologist.
Fact Sheet: Tips for Healthy Voices
Do people regularly ask you if you have a cold when in fact you do not?
Have you lost your ability to hit some high notes when singing?
Voice problems arise from a variety of sources including voice overuse or misuse,
cancer, infection, or injury. Here are steps that can be taken to prevent voice problems
and maintain a healthy voice:
Drink water (stay well hydrated): Keeping your body well hydrated by drinking plenty
of water each day (6-8 glasses) is essential to maintaining a healthy voice. The vocal
cords vibrate extremely fast even with the most simple sound production; remaining
hydrated through water consumption optimizes the throat’s mucous production, aiding
vocal cord lubrication. To maintain sufficient hydration avoid or moderate substances
that cause dehydration. These include alcohol and caffeinated beverages (coffee, tea,
soda). And always increase hydration when exercising.
Do not smoke: It is well known that smoking leads to lung or throat cancer. Primary
and secondhand smoke that is breathed in passes by the vocal cords causing significant
irritation and swelling of the vocal cords. This will permanently change voice quality,
nature, and capabilities.
Do not abuse or misuse your voice: Your voice is not indestructible. In every day
communication, be sure to avoid habitual yelling, screaming, or cheering. Try not to talk
loudly in locations with significant background noise or noisy environments. Be aware
of your background noise—when it becomes noisy, significant increases in voice
volume occur naturally, causing harm to your voice. If you feel like your throat is dry,
tired, or your voice is becoming hoarse, stop talking.
To reduce or minimize voice abuse or misuse use non-vocal or visual cues to attract
attention, especially with children. Obtain a vocal amplification system if you routinely
need to use a “loud” voice especially in an outdoor setting. Try not to speak in an
unnatural pitch. Adopting an extremely low pitch or high pitch can cause an injury to
the vocal cords with subsequent hoarseness and a variety of problems.
Minimize throat clearing: Clearing your throat can be compared to slapping or
slamming the vocal cords together. Consequently, excessive throat clearing can cause
vocal cord injury and subsequent hoarseness. An alternative to voice clearing is taking a
small sip of water or simply swallowing to clear the secretions from the throat and
alleviate the need for throat clearing or coughing. The most common reason for
excessive throat clearing is an unrecognized medical condition causing one to clear their
throat too much. Common causes of chronic throat clearing include gastroesophageal
reflux, laryngopharyngeal reflux disease, sinus and/or allergic disease.
Moderate voice use when sick: Reduce your vocal demands as much as possible when
your voice is hoarse due to excessive use or an upper respiratory infection (cold).
Singers should exhibit extra caution if one’s speaking voice is hoarse because
permanent and serious injury to the vocal cords are more likely when the vocal cords are
swollen or irritated. It is important to “listen to what your voice is telling you.”
Your voice is an extremely valuable resource and is the most commonly used form of
communication. Our voices are invaluable for both our social interaction as well as for
most people’s occupation. Proper care and use of your voice will give you the best
chance for having a healthy voice for your entire lifetime.
Hoarseness or roughness in your voice is often caused by a medical problem.
Contact an otolaryngologist—head and neck surgeon if you have any sustained
changes to your voice.
Fact Sheet: Tonsillectomy Procedures
Unfortunately, there may be a time when medical therapy (antibiotics) fails to resolve the
chronic tonsillar infections that affect your child. In other cases, your child may have
enlarged tonsils, causing loud snoring, upper airway obstruction, and other sleep
disorders. The best recourse for both these conditions may be removal or reduction of the
tonsils and adenoids. The American Academy of Otolaryngology—Head and Neck
Surgery recommends that children who have three or more tonsillar infections a year
undergo a tonsillectomy; the young patient with a sleep disorder should be a candidate for
removal or reduction of the enlarged tonsils.
The Tonsillectomy Today
The first report of tonsillectomy was made by the Roman surgeon Celsus in 30 AD. He
described scraping the tonsils and tearing them out or picking them up with a hook and
excising them with a scalpel. Today, the scalpel is still the preferred surgical instrument
of many ear, nose, and throat specialists. However, there are other procedures available –
the choice may be dictated by the extent of the procedure (complete tonsil removal versus
partial tonsillectomy) and other considerations such as pain and post-operative bleeding.
A quick review of each procedure follows:
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Cold knife (steel) dissection: Removal of the tonsils by use of a scalpel is the
most common method practiced by otolaryngologists today. The procedure
requires the young patient to undergo general anesthesia; the tonsils are
completely removed with minimal post-operative bleeding.
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Electrocautery: Electrocautery burns the tonsillar tissue and assists in reducing
blood loss through cauterization. Research has shown that the heat of
electrocautery (400 degrees Celsius) results in thermal injury to surrounding
tissue. This may result in more discomfort during the postoperative period.
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Harmonic scalpel: This medical device uses ultrasonic energy to vibrate its blade
at 55,000 cycles per second. Invisible to the naked eye, the vibration transfers
energy to the tissue, providing simultaneous cutting and coagulation. The
temperature of the surrounding tissue reaches 80 degrees Celsius. Proponents of
this procedure assert that the end result is precise cutting with minimal thermal
damage.
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Radiofrequency ablation (Somnoplasty): Monopolar radiofrequency thermal
ablation transfers radiofrequency energy to the tonsil tissue through probes
inserted in the tonsil. The procedure can be performed in an office setting under
light sedation or local anesthesia. After the treatment is performed, scarring
occurs within the tonsil causing it to decrease in size over a period of several
weeks. The treatment can be performed several times. The advantages of this
technique are minimal discomfort, ease of operations, and immediate return to
work or school. Tonsillar tissue remains after the procedure but is less prominent.
This procedure is recommended for treating enlarged tonsils and not chronic or
recurrent tonsillitis.
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Carbon dioxide laser: Laser tonsil ablation (LTA) finds the otolaryngologist
employing a hand-held CO2 or KTP laser to vaporize and remove tonsil tissue.
This technique reduces tonsil volume and eliminates recesses in the tonsils that
collect chronic and recurrent infections. This procedure is recommended for
chronic recurrent tonsillitis, chronic sore throats, severe halitosis, or airway
obstruction caused by enlarged tonsils.
The LTA is performed in 15 to 20 minutes in an office setting under local
anesthesia. The patient leaves the office with minimal discomfort and returns to
school or work the next day. Post-tonsillectomy bleeding may occur in two to five
percent of patients. Previous research studies state that laser technology provides
significantly less pain during the post-operative recovery of children, resulting in
less sleep disturbance, decreased morbidity, and less need for medications. On the
other hand, some believe that children are adverse to outpatient procedures
without sedation.
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Microdebrider: What is a “microdebrider?” The microdebrider is a powered
rotary shaving device with continuous suction often used during sinus surgery. It
is made up of a cannula or tube, connected to a hand piece, which in turn is
connected to a motor with foot control and a suction device.
The endoscopic microdebrider is used in performing a partial tonsillectomy, by
partially shaving the tonsils. This procedure entails eliminating the obstructive
portion of the tonsil while preserving the tonsillar capsule. A natural biologic
dressing is left in place over the pharyngeal muscles, preventing injury,
inflammation, and infection. The procedure results in less post-operative pain, a
more rapid recovery, and perhaps fewer delayed complications. However, the
partial tonsillectomy is suggested for enlarged tonsils – not those that incur
repeated infections.
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Bipolar Radiofrequency Ablation (Coblation): This procedure produces an
ionized saline layer that disrupts molecular bonds without using heat. As the
energy is transferred to the tissue, ionic dissociation occurs. This mechanism can
be used to remove all or only part of the tonsil. It is done under general anesthesia
in the operating room and can be used for enlarged tonsils and chronic or
recurrent infections. This causes removal of tissue with a thermal effect of 45-85
C°. The advantages of this technique are less pain, faster healing, and less post
operative care.
Consult with an otolaryngologist regarding the optimum procedure to remove or
reduce your tonsils and adenoids.
Fact Sheet: Vocal Cord Paralysis
What Is Vocal Fold (cord) Paresis And Paralysis?
Vocal fold (or cord) paresis and paralysis result from abnormal nerve input to the voice
box muscles (laryngeal muscles). Paralysis is the total interruption of nerve impulse
resulting in no movement of the muscle; Paresis is the partial interruption of nerve
impulse resulting in weak or abnormal motion of laryngeal muscle(s).
Vocal fold paresis/paralysis can happen at any age – from birth to advanced age, in males
and females alike, from a variety of causes. The effect on patients may vary greatly
depending on the patient’s use of his or her voice: A mild vocal fold paresis can be the
end to a singer's career, but have only a marginal effect on a computer programmer's
career.
What Nerves Are Involved In Vocal Fold Paresis/Paralysis?
Vocal fold movements are a result of the coordinated contraction of various muscles.
These muscles are controlled by the brain through a specific set of nerves. The nerves
that receive these signals are the:
Superior laryngeal nerve (SLN), which carries signals to the cricothyroid muscle, located
between the cricoid and thyroid cartilages. Since the cricothyroid muscle adjusts the
tension of the vocal fold for high notes during singing, SLN paresis and paralysis result in
abnormalities in voice pitch and the inability to sing with smooth change to each higher
note. Sometimes, patients with SLN paresis/paralysis may have a normal speaking voice
but an abnormal singing voice.
The recurrent laryngeal nerve (RLN) carries signals to different voice box muscles
responsible for opening vocal folds (as in breathing, coughing), closing vocal folds for
vocal fold vibration during voice use, and closing vocal folds during swallowing. The
recurrent laryngeal nerve goes into the chest cavity and curves back into the neck until it
reaches the larynx. Because the nerve is relatively long and takes a "detour" to the voice
box, it is at greater risk for injury from quite different causes – such as infections and
tumors of the brain, neck, chest, or voice box; as well as complications during surgical
procedures in the head, neck, or chest regions – that directly injure, stretch, or compress
the nerve. Consequently, the recurrent laryngeal nerve is involved in majority of cases of
vocal fold paresis or paralysis.
What Are The Causes Of Vocal Fold Paralysis/Paresis?
The cause of vocal fold paralysis or paresis can indicate whether the disorder will resolve
over time or whether it is most likely permanent. When a reversible cause is present,
surgical treatment will most likely not be recommended given the likelihood of
spontaneous resolution of the paresis or paralysis. Despite advances in diagnostic
technology, physicians are unable to detect the cause in about half of all vocal fold
paralyses. These cases are referred to as idiopathic (due to unknown origins). In
idiopathic cases, paralysis or paresis might be due to a viral infection affecting the voice
box nerves (RLN or SLN) or the vagus nerve, but this cannot be proven in most cases.
Known reasons for injury can include:
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Inadvertent injury during surgery: Surgery in the neck (e.g., surgery of thyroid
gland, carotid artery) or surgery in the chest (e.g., surgery of the lung, esophagus,
heart, or large blood vessels) may inadvertently result in RLN paresis or paralysis.
The SLN may also be injured during head and neck surgery.
Complication from endotracheal intubation: Injury to the RLN may occur when
breathing tubes are used for general anesthesia and/or assisted breathing (artificial
ventilation). However, this type of injury is rare, given the large number of
operations done under general anesthesia.
Blunt neck or chest trauma: Any type of penetrating, hard impact on the neck or
chest region may injure the RLN; impact to the neck may injure the SLN.
Tumors of the skull base, neck, and chest: Tumors (both cancerous and noncancerous) can grow around nerves and squeeze them, resulting in varying
degrees of paresis or paralysis.
Viral infections: Inflammation from viral infections may directly involve and
injure the vagus nerve or its nerve branches to the voice box (RLN and SLN).
Systemic illnesses affecting nerves in the body may also affect the nerves to the
voice box.
What Are The Symptoms Of Vocal Fold Paralysis/Paresis?
Both paresis and paralysis of voice box muscles result in voice changes and may also
result in airway problems and swallowing difficulties.
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Voice changes: Hoarseness (croaky or rough voice); breathy voice (a lot of air
with the voice); effortful phonation (extra effort on speaking); air wasting
(excessive air pressure required to produce usual conversational voice); and
diplophonia (voice sounds like a "gargle").
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Airway problems: Shortness of breath with exertion, noisy breathing (stridor), and
ineffective or poor cough.
Swallowing problems: Choking or coughing when swallowing food, drink, or
even saliva, and food sticking in throat.
How Is Vocal Fold Paralysis/Paresis Diagnosed?
The otolaryngologist—head and neck surgeon will conduct a general examination and
then question you regarding your symptoms and lifestyle (voice use, alcohol/tobacco
consumption). The examination of the voice box will be undertaken to determine whether
one or both vocal folds (cords) is/are abnormal. Determining whether one or both vocal
folds are affected is important in the treatment plan. Other tests may be required:
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Laryngeal electromyography (LEMG): LEMG measures electrical currents in the
voice box muscles that are the result of nerve inputs. Measuring and looking at
the pattern of the electric currents will indicate whether there is recovery or repair
of nerve inputs (re-innervation) and the degree of the nerve input problem. The
test involves the insertion of small needles that can measure electrical currents in
the vocal fold muscles. During LEMG patients perform a number of tasks that
would normally elicit characteristic actions in the tested muscles.
Other tests: Because there is a wide list of diseases that may cause a nerve to be
injured, further testing is usually necessary (blood tests, x-rays, CT scans, MRI,
etc.) to identify the cause(s) of vocal fold paresis/paralysis.
What Is The Treatment For Vocal Fold Paralysis/Paresis?
The two treatment strategies to improve vocal function are voice therapy, the equivalent
of physical therapy for large muscle paresis/paralysis; and phonosurgery, an operation
that repositions and/or reshapes the vocal fold(s) to improve voice function. Normally,
voice therapy is a first treatment option. After voice therapy, the decision for surgery is
dependent on the severity of the symptoms, vocal needs of the patient, position of
paralyzed vocal folds, prognosis for recovery, and cause of paresis/paralysis if known.
If you have notice any change in voice quality, immediately contact an
otolaryngologist—head and neck surgeon.
Fact Sheet: Voice Disorders
Most changes in the voice result from a medical disorder. Failure to seek a physician’s
care can lead to hoarseness and more serious problems.
Laryngitis
Laryngitis is a swelling of the vocal cords usually due to an infection. A viral infection (a
“cold”) of the upper respiratory track is the most common cause for infection of the voice
box. When the vocal cords swell in size, they vibrate differently, leading to hoarseness.
The best treatment for this condition is to rest or reduce your voice use and stay well
hydrated. Since most of these infections are caused by a virus, antibiotics are not
effective. It is important to be cautious with your voice during an episode of laryngitis,
because the swelling of the vocal cords increases the risk for serious injury such as blood
in the vocal cords or formation of vocal cord nodules, polyp, or cysts.
Vocal Cord Lesions
Benign noncancerous growths on the vocal cords are caused by voice misuse or overuse
and from trauma or injury to the vocal cords. These lesions (“bumps”) on the vocal
cord(s) alter vocal cord vibration. This abnormal vibration results in hoarseness and a
chronic change in one’s voice quality, including roughness, raspiness, and an increased
effort to talk. The most common vocal cord lesions include vocal nodules also known as
“singer’s nodes” or “nodes” which are similar to “calluses ” of the vocal cords. They
typically occur on both vocal cords opposite each other. These lesions are usually treated
with voice rest and speech therapy (to improve the speaking technique thus removing the
trauma on the vocal cords). Vocal cord polyp(s) or cyst(s) are other common vocal cord
lesions caused by misuse, overuse, or trauma to the vocal cords and frequently require
surgical removal after all nonsurgical treatment options (i.e., speech therapy) have failed.
Gastroesophageal Reflux Disease And Laryngopharyngeal Reflux Disease
Reflux (backflow of gastric contents) into the throat of stomach acid can cause a variety
of symptoms in the esophagus (swallowing tube) as well as in the throat. Hoarseness
(chronic or intermittent), swallowing problems, a foreign body sensation, or throat pain
are common symptoms of gastric acid irritation of the throat, called laryngopharyngeal
reflux disease (LPRD). LPRD is difficult to diagnose because approximately half of the
patients with this disorder have no heartburn symptoms which traditionally accompany
gastroesophageal reflux disease (GERD).
Your gastric acid can flow up to the throat at any time. The at-night aspect of LPRD is
thought to be the hardest to diagnose because there are usually no specific symptoms
while the reflux occurs. Consequently, patients will awake with throat irritation,
hoarseness, and throat discomfort without knowing the cause. An examination of the
throat by an otolaryngologist will determine if stomach acid is causing irritation of the
throat and voice box.
Poor Speaking Technique
Improper or poor speaking technique is caused from speaking at an abnormally or
uncomfortable pitch, either too high or too low, and leads to hoarseness and a variety of
other voice problems. Examples of this condition are when young adult females, in a
work environment, consciously or subconsciously choose to speak at a lower than
appropriate pitch and with a heavy voice. Percussive speaking, a voice too loud or
focusing on the first syllable of each word, is another improper speaking technique that
may result in injury or trauma to the vocal cords and muscles causing “vocal fatigue”.
Other factors leading to improper speaking technique include insufficient or improper
breathing while talking, specifically breathing from the shoulders or neck area instead of
from the lower chest or abdominal area. The consequence of this practice is increased
tension in the throat and neck muscles, which can cause hoarseness and a variety of
symptoms, especially pain and fatigue associated with talking. Voice problems can also
occur from using your voice in an unnatural position, such as talking on the phone
cradled to your shoulder. This requires excessive tension in the neck and laryngeal
muscles, which changes the speaking technique and may result in a voice problem.
Vocal Cord Paralysis
Hoarseness and other problems can occur related to problems between the nerves and
muscles within the voice box or larynx. The most common condition is a paralysis or
weakness of one or both vocal cords. Involvement of both vocal cords is rare and is
usually manifested by noisy breathing or difficulty getting enough air while breathing or
talking. However, one vocal cord can become paralyzed or severely weakened (paresis)
after a viral infection of the throat, after surgery in the neck or cheek, or for unknown
reasons.
The immobile or paralyzed vocal cord typically causes a soft, breathy, weak voice due to
poor vocal cord closure. Most paralyzed vocal cords will recover on their own within
several months. There is a possibility that the paralysis may become permanent, which
may require surgical treatment. Surgery for unilateral vocal cord paralysis involves
positioning of the vocal cord to improve the vibration of the paralyzed vocal cord with
the non-paralyzed vocal cord. There are a variety of surgical techniques used to
reposition the vocal cord. Sometimes speech therapy may be used before or after surgical
treatment of the paralyzed vocal cords or sometimes as the sole treatment. Treatment
choices depend on the nature of the vocal cord paralysis as well as the patient’s voice
demands.
Throat Cancer
Throat cancer is a very serious condition requiring immediate medical attention. When
cancer attacks the vocal cords, the voice changes in quality, assuming the characteristics
of chronic hoarseness, roughness, or raspiness. These symptoms occur at an early stage in
the development of the cancer. It is important to remember that prompt attention to
changes in the voice facilitate early diagnosis thus early and successful treatment of vocal
cord cancer can be obtained.
Persistent hoarseness or change in the voice for longer than two to four weeks in a
smoker should prompt evaluation by an otolaryngologist to determine if there is
cancer of the larynx (voice box). Different treatment options for this cancer of the voice
box include surgery, radiation therapy, and/or chemotherapy. When vocal cord cancer is
found early, typically only surgery or radiation therapy is required, and the cure rate is
high (greater than 90 percent).
Hoarseness or roughness in your voice is often caused by a medical problem.
Contact an otolaryngologist—head and neck surgeon if you have any sustained
changes to your voice.
Fact Sheet: 20 Questions about Your Sinuses
Q. How common is sinusitis?
A. More than 37 million Americans suffer from at least one episode of acute sinusitis
each year. The prevalence of sinusitis has soared in the last decade possibly due to
increased pollution, urban sprawl, and increased resistance to antibiotics.
Q. What is sinusitis?
A. Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the
paranasal sinuses. Acute sinusitis is a short-term condition that responds well to
antibiotics and decongestants; chronic sinusitis is characterized by at least four
recurrences of acute sinusitis. Either medication or surgery is a possible treatment.
Q. What are the signs and symptoms of acute sinusitis?
A. For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal
discharge, diminished sense of smell, and cough not due to asthma (in children).
Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain,
and cough.
Acute sinusitis can last four weeks or more. This condition may be present when the
patient has two or more symptoms and/or the presence of thick, green or yellow nasal
discharge. Acute bacterial infection might be present when symptoms worsen after five
days, persist after ten days, or the severity of symptoms is out of proportion to those
normally associated with a viral infection.
Q. How is acute sinusitis treated?
A. Acute sinusitis is generally treated with ten to 14 days of antibiotic care. With
treatment, the symptoms disappear, and antibiotics are no longer required for that
episode. Oral and topical decongestants also may be prescribed to alleviate the
symptoms.
Q. What are the signs and symptoms of chronic sinusitis?
A. Victims of chronic sinusitis may have the following symptoms for 12 weeks or more:
facial pain/pressure, facial congestion/fullness, nasal obstruction/blockage, thick nasal
discharge/discolored post-nasal drainage, pus in the nasal cavity, and at times, fever.
They may also have headache, bad breath, and fatigue.
Q. What measures can be taken at home to relieve sinus pain?
A. Warm moist air may alleviate sinus congestion. Experts recommend a vaporizer or
steam from a pan of boiled water (removed from the heat). Humidifiers should be used
only when a clean filter is in place to preclude spraying bacteria or fungal spores into the
air. Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose
drops are also helpful in moisturizing nasal passages.
Q. How effective are non-prescription nose drops or sprays?
A. Use of nonprescription drops or sprays might help control symptoms. However,
extended use of non-prescription decongestant nasal sprays could aggravate symptoms
and should not be used beyond their label recommendation. Saline nasal sprays or drops
are safe for continuous use.
Q. How does a physician determine the best treatment for acute or chronic sinusitis?
A. To obtain the best treatment option, the physician needs to properly assess the patient's
history and symptoms and then progress through a structured physical examination.
Q. What should one expect during the physical examination for sinusitis?
A. At a specialist's office, the patient will receive a thorough ear, nose, and throat
examination. During that physical examination, the physician will explore the facial
features where swelling and erythema (redness of the skin) over the cheekbone exist.
Facial swelling and redness are generally worse in the morning; as the patient remains
upright, the symptoms gradually improve. The physician may feel and press the sinuses
for tenderness. Additionally, the physician may tap the teeth to help identify an inflamed
paranasal sinus.
Q. What other diagnostic procedures might be taken?
A. Other diagnostic tests may include a study of a mucous culture, endoscopy, x-rays,
allergy testing, or CT scan of the sinuses.
Q. What is nasal endoscopy?
A. An endoscope is a special fiber optic instrument for the examination of the interior of
a canal or hollow viscus. It allows a visual examination of the nose and sinus drainage
areas.
Q. Why does an ear, nose, and throat specialist perform nasal endoscopy?
A. Nasal endoscopy offers the physician specialist a reliable, visual view of all the
accessible areas of the sinus drainage pathways. First, the patient' s nasal cavity is
anesthetized; a rigid or flexible endoscope is then placed in a position to view the nasal
cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal
polyps hidden from routine nasal examination. During the endoscopic examination, the
physician specialist also looks for pus as well as polyp formation and structural
abnormalities that may cause recurrent sinusitis.
Q. What course of treatment will the physician recommend?
A. To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral
decongestants. Antibiotics will be prescribed for any bacterial infection found in the
sinuses (antibiotics are not effective against a viral infection). Antihistamines may be
recommended for the treatment of allergies.
Q. Will any changes in lifestyle be suggested during treatment?
A. Smoking is never condoned, but if one has the habit, it is important to refrain during
treatment for sinus problems. A special diet is not required, but drinking extra fluids
helps to thin mucus.
Q. When is sinus surgery necessary?
A. Mucus is developed by the body to act as a lubricant. In the sinus cavities, the
lubricant is moved across mucous membrane linings toward the opening of each sinus by
millions of cilia (a mobile extension of a cell). Inflammation from allergy causes
membrane swelling and the sinus opening to narrow, thereby blocking mucus movement.
If antibiotics are not effective, sinus surgery can correct the problem.
Q. What does the surgical procedure entail?
A. The basic endoscopic surgical procedure is performed under local or general
anesthesia. The patient returns to normal activities within four days; full recovery takes
about four weeks.
Q. What does sinus surgery accomplish?
A. The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in
place as possible. Otolaryngologist--head and neck surgeons have found endoscopic
surgery to be highly effective in restoring normal function to the sinuses. The procedure
removes areas of obstruction, resulting in the normal flow of mucus.
Q. What are the consequences of not treating infected sinuses?
A. Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In
rare circumstances, meningitis or brain abscess and infection of the bone or bone marrow
can occur.
Q. Where should sinus pain sufferers seek treatment?
A. If you suffer from severe sinus pain, you should seek treatment from an
otolaryngologist--head and neck surgeon, a specialist who can treat your condition with
medical and/or surgical remedies.
Fact Sheet: Allergic Rhinitis, Sinusitis, and Rhinosinusitis
Inflammation of the nasal mucous membrane is called rhinitis. The symptoms include
sneezing and runny and/or itchy nose, caused by irritation and congestion in the nose.
There are two types: allergic rhinitis and non-allergic rhinitis.
Allergic Rhinitis: This condition occurs when the body’s immune system over-responds
to specific, non-infectious particles such as plant pollens, molds, dust mites, animal hair,
industrial chemicals (including tobacco smoke), foods, medicines, and insect venom.
During an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast
cells (cells that release histamine) in the lungs, skin, and mucous membranes. Once IgE
connects with the mast cells, a number of chemicals are released. One of the chemicals,
histamine, opens the blood vessels and causes skin redness and swollen membranes.
When this occurs in the nose, sneezing and congestion are the result.
Seasonal allergic rhinitis or hayfever occurs in late summer or spring. Hypersensitivity
to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75 percent of all
Americans who suffer from this seasonal disorder. People with sensitivity to tree pollen
have symptoms in late March or early April; an allergic reaction to mold spores occurs in
October and November as a consequence of falling leaves.
Perennial allergic rhinitis occurs year-round and can result from sensitivity to pet hair,
mold on wallpaper, houseplants, carpeting, and upholstery. Some studies suggest that air
pollution such as automobile engine emissions can aggravate allergic rhinitis. Although
bacteria is not the cause of allergic rhinitis, one medical study found a significant number
of the bacteria Staphylococcus aureus in the nasal passages of patients with year-round
allergic rhinitis, concluding that the allergic condition may lead to higher bacterial levels,
thereby creating a condition that worsens the allergies.
Patients who suffer from recurring bouts of allergic rhinitis should observe their
symptoms on a continuous basis. If facial pain or a greenish-yellow nasal discharge
occurs, a qualified ear, nose, and throat specialist can provide appropriate sinusitis
treatment.
Non-Allergic Rhinitis: This form of rhinitis does not depend on the presence of IgE and
is not due to an allergic reaction. The symptoms can be triggered by cigarette smoke and
other pollutants as well as strong odors, alcoholic beverages, and cold. Other causes may
include blockages in the nose, a deviated septum, infections, and over-use of medications
such as decongestants.
Rhinosinusitis: Clarifying The Relationship Between The Sinuses And Rhinitis
Recent studies by otolaryngologist–head and neck surgeons have better defined the
association between rhinitis and sinusitis. They have concluded that sinusitis is often
preceded by rhinitis and rarely occurs without concurrent rhinitis. The symptoms, nasal
obstruction/discharge and loss of smell, occur in both disorders. Most importantly,
computed tomography (CT scan) findings have established that the mucosal linings of the
nose and sinuses are simultaneously involved in the common cold (previously, thought to
affect only the nasal passages). Otolaryngologists, acknowledging the inter-relationship
between the nasal and sinus passages, now refer to sinusitis as rhinosinusitis.
The catalyst relating the two disorders is thought to involve nasal sinus overflow
obstruction, followed by bacterial colonization and infection leading to acute, recurrent,
or chronic sinusitis. Likewise, chronic inflammation due to allergies can lead to
obstruction and subsequent sinusitis.
Other medical research has supported the close relationship between allergic rhinitis and
sinusitis. In a retrospective study on sinus abnormalities in 1,120 patients (from two to 87
years of age), thickening of the sinus mucosa was more commonly found in sinusitis
patients during July, August, September, and December, months in which pollen, mold,
and viral epidemics are prominent. A review of patients (four to 83 years of age) who had
surgery to treat their chronic sinus conditions revealed that those with seasonal allergy
and nasal polyps are more likely to experience a recurrence of their sinusitis.
Fact Sheet: Antibiotics and Sinusitis
An antibiotic is a soluble substance derived from a mold or bacterium that inhibits the
growth of other microorganisms.
The first antibiotic was Penicillin, discovered by Alexander Fleming in 1929, but it was
not until World War II that the effectiveness of antibiotics was acknowledged, and largescale fermentation processes were developed for their production.
Acute sinusitis is one of many medical disorders that can be caused by a bacterial
infection. However, it is important to remember that colds, allergies, and environmental
irritants, which are more common than bacterial sinusitis, can also cause sinus problems.
Antibiotics are effective only against sinus problems caused by a bacterial infection.
The following symptoms may indicate the presence of a bacterial infection in your
sinuses:
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Pain in your cheeks or upper back teeth
A lot of bright yellow or green drainage from your nose for more than 10 days
No relief from decongestants, and/or
Symptoms that get worse instead of better after your cold is gone.
Most patients with a clinical diagnosis of acute sinusitis caused by a bacterial infection
improve without antibiotic treatment. The specialist will initially offer appropriate doses
of analgesics (pain-relievers), antipyretics (fever reducers), and decongestants. However
if symptoms persist, a treatment consisting of antibiotics may be recommended.
Antibiotic Treatment For Sinusitis
Antibiotics are labeled as narrow-spectrum drugs when they work against only a few
types of bacteria. On the other hand, broad-spectrum antibiotics are more effective by
attacking a wide range of bacteria, but are more likely to promote antibiotic resistance.
For that reason, your ear, nose, and throat specialist will most likely prescribe narrowspectrum antibiotics, which often cost less. He/she may recommend broad-spectrum
antibiotics for infections that do not respond to treatment with narrow-spectrum drugs.
Acute Sinusitis
In most cases, antibiotics are prescribed for patients with specific findings of persistent
purulent nasal discharge and facial pain or tenderness who are not improving after seven
days or those with severe symptoms of rhinosinusitis, regardless of duration. On the basis
of clinical trials, amoxicillin, doxycycline, or trimethoprim–sulfamethoxazole are
preferred antibiotics.
Chronic Sinusitis
Even with a long regimen of antibiotics, chronic sinusitis symptoms can be difficult to
treat. In general, however, treating chronic sinusitis, such as with antibiotics and
decongestants, is similar to treating acute sinusitis. When antibiotic treatment fails,
allergy testing, desensitization, and/or surgery may be recommended as the most
effective means for treating chronic sinusitis. Research studies suggest that the vast
majority of people who undergo surgery have fewer symptoms and better quality of life.
Pediatric Sinusitis
Antibiotics that are unlikely to be effective in children who do not improve with
amoxicillin include trimethoprim-sulfamethoxazole (Bactrim) and erythromycinsulfisoxazole (Pediazole), because many bacteria are resistant to these older antibiotics.
For children who do not respond to two courses of traditional antibiotics, the dose and
length of antibiotic treatment is often expanded, or treatment with intravenous cefotaxime
or ceftriaxone and/or a referral to an ENT specialist is recommended.
Fact Sheet: Deviated Septum
The shape of your nasal cavity could be the cause of chronic sinusitis. The nasal septum
is the wall dividing the nasal cavity into halves; it is composed of a central supporting
skeleton covered on each side by mucous membrane. The front portion of this natural
partition is a firm but bendable structure made mostly of cartilage and is covered by skin
that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline,
separating the left and right sides of the nose into passageways of equal size.
Estimates are that 80 percent of all nasal septums are off-center, a condition that is
generally not noticed. A "deviated septum" occurs when the septum is severely shifted
away from the midline. The most common symptom from a badly deviated or crooked
septum is difficulty breathing through the nose. The symptoms are usually worse on one
side, and sometimes actually occur on the side opposite the bend. In some cases the
crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus
infections.
Septoplasty is the preferred surgical treatment to correct a deviated septum. This
procedure is not generally performed on minors, because the cartilaginous septum grows
until around age 18. Septal deviations commonly occur due to nasal trauma.
A deviated septum may cause one or more of the following:
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Blockage of one or both nostrils
Nasal congestion, sometimes one-sided
Frequent nosebleeds
Frequent sinus infections
At times, facial pain, headaches, postnasal drip
Noisy breathing during sleep (in infants and young children)
In some cases, a person with a mildly deviated septum has symptoms only when he or
she also has a "cold" (an upper respiratory tract infection). In these individuals, the
respiratory infection triggers nasal inflammation that temporarily amplifies any mild
airflow problems related to the deviated septum. Once the "cold" resolves, and the nasal
inflammation subsides, symptoms of a deviated septum often resolve, too.
Diagnosis Of A Deviated Septum: Patients with chronic sinusitis often have nasal
congestion, and many have nasal septal deviations. However, for those with this
debilitating condition, there may be additional reasons for the nasal airway obstruction.
The problem may result from a septal deviation, reactive edema (swelling) from the
infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic
abnormalities, or combinations thereof. A trained specialist in diagnosing and treating
ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal
obstruction.
Your First Visit: After discussing your symptoms, the primary care physician or
specialist will inquire if you have ever incurred severe trauma to your nose and if you
have had previous nasal surgery. Next, an examination of the general appearance of your
nose will occur, including the position of your nasal septum. This will entail the use of a
bright light and a nasal speculum (an instrument that gently spreads open your nostril) to
inspect the inside surface of each nostril.
Surgery may be the recommended treatment if the deviated septum is causing
troublesome nosebleeds or recurrent sinus infections. Additional testing may be required
in some circumstances.
Septoplasty: Septoplasty is a surgical procedure performed entirely through the nostrils,
accordingly, no bruising or external signs occur. The surgery might be combined with a
rhinoplasty, in which case the external appearance of the nose is altered and
swelling/bruising of the face is evident. Septoplasty may also be combined with sinus
surgery.
The time required for the operation averages about one to one and a half hours,
depending on the deviation. It can be done with a local or a general anesthetic, and is
usually done on an outpatient basis. After the surgery, nasal packing is inserted to prevent
excessive postoperative bleeding. During the surgery, badly deviated portions of the
septum may be removed entirely, or they may be readjusted and reinserted into the nose.
If a deviated nasal septum is the sole cause for your chronic sinusitis, relief from this
severe disorder will be achieved.
Fact Sheet: Injection Snoreplasty
What Is Injection Snoreplasty?
Injection snoreplasty is a nonsurgical treatment for snoring that involves the injection of a
hardening agent into the upper palate. Army researchers from Walter Reed Army
Medical Center introduced this procedure at the 2000 Annual Meeting of the American
Academy of Otolaryngology – Head and Neck Surgery Foundation. Their early findings
indicate that this treatment may reduce the loudness and incidence of primary snoring
(snoring without apnea, or cessation of breath). The Academy neither endorses nor
discourages the use of injection snoreplasty for the treatment of snoring.
Those seeking injection snoreplasty to reduce snoring should first be screened for
obstructive sleep apnea or OSA (frequent cessation of breathing due to upper airway
obstruction) by undergoing a sleep test. If sleep apnea is confirmed, other treatment may
be recommended.
Treatment For Injection Snoreplasty
Injection snoreplasty is performed on an outpatient basis under local anesthesia. After
numbing the upper palate with topical anesthetic, a hardening agent is injected just under
the skin on the top of the mouth in front of the uvula (upper palate), creating a small
blister. Within a couple of days the blister hardens, forms scar tissue, and pulls the floppy
uvula forward to eliminate or reduce the palatal flutter that causes snoring.
In some patients, the treatment needs to be repeated for optimum benefits. If snoring
occurs from vibrations beyond the palate and uvula and/or obstructive sleep apnea is
suspected, further testing and alternative treatment options may be advised. A thorough
examination by an ear, nose and throat specialist is recommended to diagnose the source
and type of snoring, and determine whether injection snoreplasty may be helpful.
Post-Treatment Follow-Up For Injections Snoreplasty
After injection of the hardening agent, patients are observed in the otolaryngologist’s
office and then sent home. Tylenol and throat lozenges or spray are suggested for pain
management. Patients can return to work the next day. Though snoring may continue for
a few days, it should eventually lessen. A post-procedure sleep test may be administered
to fully evaluate the effects of the procedure.
Possible Side Effects Of Injection Snoreplasty
A residual sore throat or feeling that something is “stuck” in the back of the mouth may
occur. Suggestions for treatment of sore throat include Tylenol and/or throat lozenges or
spray.
Statement On The Use Of Sotradecol
Sotradecol, a trade name for sodium tetradecyl sulfate, is the most common hardening
agent used in injection snoreplasty. This agent is indicated by the Food and Drug
Administration (FDA) for “intravenous use only” and “for small uncomplicated varicose
veins of the lower extremities that show simple dilation with competent valves.”
Warnings include: 1) “severe adverse local effects including tissue necrosis,” and 2)
“allergic reactions, including anaphylaxis, have been reported that led to death.”
Snoring Is A Problem
Forty-five percent of normal adults snore at least occasionally, and 25 percent are
habitual snorers. Thirty percent of adults over age 30 are snorers. By middle age, that
number reaches 40 percent. Clearly, snoring is a dilemma affecting spouses, family
members and sometimes neighbors.
Snoring sounds are caused when there is an obstruction to the free flow of air through the
passages at the back of the mouth and nose. This area is the collapsible part of the airway
where the tongue and upper throat meet the soft palate and uvula. When these structures
strike each other and vibrate during breathing, snoring results.
Treatment For Snoring
Snoring can be diagnosed as primary snoring (simple snoring) or obstructive sleep apnea.
Primary snoring is characterized by loud upper airway breathing sounds during sleep
without episodes of apnea (cessation of breath). Obstructive sleep apnea is a serious
medical condition where individuals have frequent episodes of apnea during sleep,
contributing to an overall lack of restful sleep and severe health risks including heart
attack and stroke.
Various methods are used to alleviate primary snoring. They include behavior
modification (such as weight loss), surgical and non-surgical treatments, and dental
devices.
Surgical treatments for primary snoring include: laser assisted uvulopalatoplasty
(LAUP), an outpatient treatment for primary snoring and mild OSA that involves use of a
laser under local anesthesia to make vertical incisions in the upper palate, shortening the
uvula and lessening airway obstruction; and radiofrequency volumetric reduction of the
palate, a relatively new procedure performed in an otolaryngologist’s office that utilizes
targeted radio waves to heat and shrink tissue in the upper palate.
Fact Sheet: Sinus Surgery
The ear, nose, and throat specialist will prescribe many medications (antibiotics,
decongestants, nasal steroid sprays, antihistamines) and procedures (flushing) for treating
acute sinusitis. There are occasions when physician and patient find that the infections are
recurrent and/or non-responsive to the medication. When this occurs, surgery to enlarge
the openings that drain the sinuses is an option.
A recommendation for sinus surgery in the early 20th century would easily alarm the
patient. In that era, the surgeon would have to perform an invasive procedure, reaching
the sinuses by entering through the cheek area, often resulting in scarring and possible
disfigurement. Today, these concerns have been eradicated with the latest advances in
medicine. A trained surgeon can now treat sinusitis with minimal discomfort, a brief
convalescence, and few complications.
A clinical history of the patient will be created before any surgery is performed. A careful
diagnostic workup is necessary to identify the underlying cause of acute or chronic
sinusitis, which is often found in the anterior ethmoid area, where the maxillary and
frontal sinuses connect with the nose. This may necessitate a sinus computed tomography
(CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology),
smell testing, and selected blood tests to determine an operative strategy. Note: Sinus X–
rays have limited utility in the diagnosis of acute sinusitis and are of no value in the
evaluation of chronic sinusitis.
Sinus Surgical Options Include:
Functional endoscopic sinus surgery (FESS): Developed in the 1950s, the nasal
endoscope has revolutionized sinusitis surgery. In the past, the surgical strategy was to
remove all sinus mucosa from the major sinuses. The use of an endoscope is linked to the
theory that the best way to obtain normal healthy sinuses is to open the natural pathways
to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa
has an opportunity to return to normal.
FESS involves the insertion of the endoscope, a very thin fiber-optic tube, into the nose
for a direct visual examination of the openings into the sinuses. With state of the art
micro-telescopes and instruments, abnormal and obstructive tissues are then removed. In
the majority of cases, the surgical procedure is performed entirely through the nostrils,
leaving no external scars. There is little swelling and only mild discomfort.
The advantage of the procedure is that the surgery is less extensive, there is often less
removal of normal tissues, and can frequently be performed on an outpatient basis. After
the operation, the patient will sometimes have nasal packing. Ten days after the
procedure, nasal irrigation may be recommended to prevent crusting.
Image guided surgery: The sinuses are physically close to the brain, the eye, and major
arteries, always areas of concern when a fiber optic tube is inserted into the sinus region.
The growing use of a new technology, image guided endoscopic surgery, is alleviating
that concern. This type of surgery may be recommended for severe forms of chronic
sinusitis, in cases when previous sinus surgery has altered anatomical landmarks, or
where a patient’s sinus anatomy is very unusual, making typical surgery difficult.
Image guidance is a near-three-dimensional mapping system that combines computed
tomography (CT) scans and real-time information about the exact position of surgical
instruments using infrared signals. In this way, surgeons can navigate their surgical
instruments through complex sinus passages and provide surgical relief more precisely.
Image guidance uses some of the same stealth principles used by the United States armed
forces to guide bombs to their target.
Caldwell Luc operation:Another option is the Caldwell-Luc operation, which relieves
chronic sinusitis by improving the drainage of the maxillary sinus, one of the cavities
beneath the eye. The maxillary sinus is entered through the upper jaw above one of the
second molar teeth. A “window” is created to connect the maxillary sinus with the nose,
thus improving drainage. The operation is named after American physician George
Caldwell and French laryngologist Henry Luc and is most often performed when a
malignancy is present in the sinus cavity.
Fact Sheet: Sinusitis: Special Considerations for Aging Patients
More than 20 percent of U.S. residents will be 65 or older in 2030. Of all Americans 65
and older, 14.1 percent report that they suffer from chronic sinusitis; for those 75 years
and older, the rate declines to 13.5 percent.
Geriatric Rhinitis Complaints Are:
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Constant need to clear the throat
A sense of nasal obstruction
Nasal crusting
Vague facial pressure
Decreased sense of smell and taste
For the most part, sinusitis symptoms, diagnosis, and treatment are the same for the
elderly as other adult age groups. However, there are special considerations for older
Americans.
Changing Physiology: With aging, the physiology and function of the nose changes. The
nose lengthens, and the nasal tip begins to droop due to weakening of the supporting
cartilage. This in turn causes a restriction of nasal airflow, particularly at the nasal valve
region (where the upper and lower lateral cartilages meet). Narrowing in this area results
in the complaint of nasal obstruction, often referred to as geriatric rhinitis.
Patients with geriatric rhinitis typically complain of constant “sinus drainage,” a chronic
need to clear the throat or “hawk” mucus, and a sense of nasal obstruction, most often
when they lie down. Other features include nasal crusting especially in the winter and in
patients taking diuretics, vague facial pressure (attributed to “sinus trouble”), and a
decreased sense of smell and taste.
However, it is a mistake to blame all upper respiratory problems on the aging process.
Elderly patients with symptoms such as repeated sneezing, and watery eyes, nasal
obstruction with clear profuse watery runny nose, and soft, pale turbinates (top-shaped
bones in the nose) may have allergic rhinitis. Patients with this diagnosis will benefit
from consultation with an otolaryngic allergist.
Patients with chronic sinusitis will have a long history of thick drainage that is often foul
smelling and tasting and is associated with nasal obstruction, headaches, and facial
pressure. These patients usually have pus drainage and nasal redness. In contrast, the
geriatric rhinitis patient usually has a dry, irritated nose. The diagnosis of chronic
sinusitis can be confirmed with a computed tomography scan (CT scan) of the sinuses.
Sinusitis or rhinosinusitis, which is it? In recent studies, otolaryngologist–head and neck
surgeons have concluded that sinusitis is often preceded by rhinitis and rarely occurs
without concurrent rhinitis. The symptoms, nasal obstruction/discharge and loss of smell,
occur in both disorders. Symptoms associated with rhinosinusitis include nasal
obstruction, nasal congestion, nasal discharge, nasal purulence, postnasal drip, facial
pressure and pain, alteration in the sense of smell, cough, fever, halitosis, fatigue, dental
pain, pharyngitis, otologic symptoms (e.g., ear fullness and clicking), and headache.
Patients with documented chronic sinusitis unresponsive to medications should be
referred to an otolaryngologist.
Osteoporosis: Osteoporosis is a significant health problem in the United States affecting
approximately 24 million Americans, 15 to 20 million of whom are women over 45 years
of age. Because of the concerns regarding prolonged estrogen use in postmenopausal
women, a nasal calcitonin spray is sometimes prescribed to prevent bone loss. The most
common side effect reported with nasal calcitonin spray is a runny nose. Other symptoms
that may occur include nasal crust, dryness, redness, irritation, sinusitis, nosebleeds, and
headache. Sinusitis sufferers using a nasal calcitonin spray should inform their
physicians.
Medications For Geriatric Rhinitis: Treatment for this age group needs to be more
individualized to meet the patient’s slower metabolism and the increasing potential for
side effects. The majority (80 to 85 percent) of the nation’s elderly have chronic diseases
and take multiple drugs including over-the-counter medications, placing them at higher
risk for drug interactions than other patients.
Surgery For Geriatric Rhinitis: Nasal and sinus surgery is occasionally advised for
older patients. Patients with structural abnormalities, such as a deviated septum or nasal
valve collapse causing severe nasal problems, should be referred to an otolaryngologist
for evaluation and possible surgical management.
Sources For Aging Patients: Administration on Aging (AoA), U.S. Department of
Health and Human Services; Geriatrics.