June, 2016
Earwax, also known as cerumen, is the brownish-yellow substance that accumulates in the outer ear canal. Produced by small glands in the ear, cerumen has protective, lubricating and antimicrobial properties. When present in moderation, cerumen is considered healthy for the ear. The ear is considered “self-cleaning”, meaning the ear canal slowly pushes cerumen out of the ear on its own. Old cerumen is constantly being moved, assisted by chewing and jaw motion. Once it reaches the exterior ear, the wax dries up and flakes out.
Cerumen is only formed in the outer third of the ear canal, not the deeper portion close to the eardrum (tympanic membrane). Therefore it is imperative for patients to avoid sticking fingers or objects (especially Q-tips!) into the ear canal. By doing so, patients may accidentally push cerumen towards the back of the ear, further impacting it. This condition is called cerumen impaction, and sometimes causes hearing loss, blocked ears, ear pain, itching, ringing, or sensation of fullness.
If you or a family member is experiencing any of these symptoms it is important to be seen by an Ear, Nose, and Throat physician (otolaryngologist) for a routine examine. Cerumen impaction can diagnosed by visualizing the ear canal with a tiny microscopy (otoscope). A variety of quick and painless methods in-office can be used to remove cerumen; including use of suction (a tiny vacuum cleaner), forceps, or curette. On many occasions special ear drops are used to soften the wax, making it easier to remove.
There are no proven ways to prevent cerumen buildup in the ears, but not inserting Q-tips or other objects is strongly recommended to avoid impaction. Over the counter ear drops such as Debrox, or hydrogen peroxide can be helpful to prevent excessive cerumen from developing in the ear canal. Patients who are prone to recurrent cerumen impaction should see an Ear, Nose, and Throat physician (otolaryngologist) every 6-12 months for routine cleaning and examination.
If you or family members have concerns regarding cerumen impaction, please do not hesitate to contact Colden Ear, Nose, Throat, and Allergy to schedule an examination. Opinions expressed here are those of Daryl Colden, MD, FACS and Christopher Jayne, BA. They are not substituted for the advice of your personal physician.
Just about everyone has had some experience with a person who snores. Snoring is very common among adults, affecting 90 million Americans. Although snoring may not be bothersome to the patient, his or her bed partner might feel differently as it can prevent them from obtaining a good night sleep.
Snoring refers to a low-pitched, rattling sound that a person makes while they breathe during sleep. The noise is caused by obstruction of airflow through the passages at the back of the mouth and nose. After falling asleep, the muscles in the roof of the mouth (palate), tongue, and throat begin to relax and collapse. This causes narrowing of the airway and obstruction of free air flow during inhalation and exhalation. As a result, structures in the nose/mouth begin to vibrate, creating the bothersome rattling noise that keeps people up at night. Patients with a large uvula (the thing that hangs down in the back of the throat), tongue, tonsils, and adenoids are more likely to snore at night. Excessive weight gain can be another cause of snoring.
Not only can snoring be annoying, but it might also be an indicator of a more serious health condition known as obstructive sleep apnea (OSA). OSA is a disorder in which a person’s breathing pauses while they are asleep. If untreated, OSA can increase the risk for cardiac and pulmonary related disease, such as high blood pressure and heart disease. The best way to get evaluated for OSA is obtain a complete head and neck examination (usually done by a Otolaryngologist-Head and Neck Surgeon) to identify anatomical risk factors for OSA (as well as snoring) .The next appropriate test in many situations is a sleep study (polysomnogram). A sleep study is usually performed by spending a night in the hospital while the patient’s sleep habits are recorded. In some situations, it is also possible to have an at-home sleep study, although the results underestimate the degree of sleep disturbance. If OSA is present, patients may be considered candidates for continuous positive airway pressure, or CPAP. CPAP is a small machine that has a mask attached to it which helps patients breathe at night. If no OSA is present, conservative measures are usually recommended. This includes exercise and weight loss, avoid sleeping in the supine position (laying on back), and avoid sedatives and stimulants (alcohol and coffee) right before bedtime. If snoring doesn’t improve conservatively and patients are extremely bothered by it, there are surgical procedures that can be performed which may help. One procedure is called a somnoplasty, in which the uvula is treated with a specialized energy source known as radiofrequency, whereby reducing the size and floppiness of this anatomical area, thereby reducing the sound known as snoring. For patients who snore and have OSA, a tonsillectomy and adenoidectomy may also be considered.
If you or family members have concerns regarding snoring or sleep apnea, please do not hesitate to contact Colden Ears, Nose, Throat, and Allergy and set up an appointment today. Opinions expressed here are those of Daryl Colden, MD, FACS and Christopher Jayne, BA. They are not intended as medical advice and cannot substitute for the advice of your personal physician.
Tonsillectomy is the surgical removal of the tonsils, which are the paired glands located in the back of the throat. Although long practiced, the tonsillectomy is still one of the most common major surgeries in the US, with over 500,000 cases performed annually. Reasons to have a tonsillectomy tend to vary. The most common reasons include recurrent tonsil infections (tonsillitis) that don’t respond to antibiotics, sleep apnea, difficulty breathing or swallowing or concern for malignancy (cancer).
Having large tonsils does not necessarily indicate that surgery is needed. When the tonsils are so large that they are touching each other, they are considered “kissing tonsils”. Unless a patient experiences trouble breathing or difficulty swallowing, large tonsils that are not infected are usually observed. Sometimes this condition can be treated medically.
Recurrent tonsil infections (including streptococcal type infections) are very common in younger children. Symptoms typically include throat pain, difficulty swallowing, and enlarged lymph nodes. Under most circumstances, surgery should be considered after 5-7 infections in 1 year, 5 infections per year for two years in a row, or 3 infections per year for 3 years in a row. It should also be considered after missing a substantial amount of school or work (>2 weeks per year). Sometimes patients experience a severe infection in which an abscess develops on the tonsil, also known as a peritonsillar abscess (PTA). Tonsillectomy should be considered for patients who experience multiple PTA’s.
Sleep apnea is another indication for sleep apnea. Large tonsils (usually with enlarged adenoids) can obstruct the airway and cause difficulty breathing at night. By removing the tonsils ( and adenoids at times) patients may experience improved sleep quality, less snoring, and less daytime fatigue.This is a very common, effective treatment for children with pediatric sleep apnea.
If you or family members have concerns regarding tonsil or throat symptoms, please do not hesitate to contact Colden Ear, Nose, Throat, and Allergy to schedule an examination.
