Dr. Colden awarded North Shore Magazine + Castle Connolly “Top Doctors” for fourth consecutive year

The Colden Ear, Nose, Throat and Allergy team is proud to announce that our own, Dr. Daryl Colden, has been awarded the top Otolaryngology award in the North Shore for the fourth consecutive year. Castle Connolly Medical Ltd. is a healthcare research and information company that guides consumers to America’s top doctors and hospitals. Castle Connolly’s established nomination, survey, research, screening, and selection guidelines all process under the direction of an MD. It involves thousands of physicians as well as academic medical centers, specialty hospitals, and community hospitals all across the nation. Castle Connolly’s physician-led team of researchers follows a rigorous screening process to select top doctors on both the national and regional levels. We are proud of Dr. Colden’s accomplishment, and look forward passing down his expertise to our patients.

What is Vertigo? What can cause it?

Feeling dizzy is a very common complaint in medicine. Dizziness can be described in several ways, including being lightheaded, unsteady, or woozy. On some occasions, patients will experience a specific type of dizziness called vertigo. Vertigo is the sensation of whirling, often described as a “room spinning ” feeling. Unlike most types of dizziness, vertigo is typically caused by disorders of the inner ear (labyrinth). Three of the most common causes of vertigo include BPPV, Meniere’s Disease, and Labyrinthitis.

BPPV, or benign paroxysmal positional vertigo, is characterized by acute vertigo lasting approximately 30 seconds. Episodes are triggered by positional changes of the head, such as rolling over in bed, looking up, or stooping over. BPPV is thought to be caused by loose particles (otoliths) in the inner ear. It can be identified by an easy in-office test called the Dix-Hallpike test. In most cases, the patient’s dizziness improves when keeping the head steady. If the dizziness persists, at-home exercises called the Brandt-Daroff exercises can be performed which often improves the condition. Sometimes a patient will require a repositioning maneuver known as an Epley procedure to help resolve the positional vertigo.

Labyrinthitis is another common cause of acute vertigo. Unlike BPPV, patients with labyrinthitis experience constant vertigo, lasting several hours, sometimes days. Associated symptoms may include nausea, vomiting, headaches, hearing loss, and ringing in the ears. Symptoms begin acutely and gradually improve. Sometimes patients will experience residual symptoms lasting up to a month before completely resolving. Labyrinthitis is caused by inflammation of the vestibular nerve, thought to be caused by a viral infection. It is not uncommon for patients to experience labyrinthitis in the setting of an upper respiratory tract infection or cold. Although there are no definitive cures for labyrinthitis, certain medications such as Meclizine can be provided that help calm the vestibular system of the inner ear. If symptoms persist after an extended period of time, physical therapy can also be performed.

Patients with Meniere’s Disease experience episodic vertigo – lasting minutes to hours, ringing in the ears, and fluctuating hearing loss. Although the cause of Meniere’s Disease is not well understood, it is thought to be related to a fluid imbalance in the inner ear(endolymph) . Meniere’s Disease can sometimes become a chronic condition , and may affect a patient for many years after onset. Coping with Meniere’s can be challenging, as attacks are unpredictable. In many cases, first line treatments such as a low-salt diet and a diuretic can be helpful to control or eliminate symptoms.

If you are experiencing symptoms of vertigo, it is helpful to be seen by an Ear Nose and Throat specialist (Otolaryngologist) to rule out inner ear disorders. During the visit, your physician may recommend obtaining a comprehensive audiogram (hearing test). Many conditions associated with vertigo are also associated with hearing loss. In certain circumstances, your physician may also recommend obtaining a specialized balance test called an electronystagmography (ENG). ENGs can be performed in the office and measure the normal eye movement and involuntary eye movement (nystagmus) following exposure to various stimuli. The test can be helpful for identifying the potential cause of a patient’s vertigo/dizziness.

If you or family members have concerns regarding dizziness, please do not hesitate to contact Colden Ear, Nose, Throat, and Allergy to set up an appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for a medical evaluation performed by a medical provider.

What are Ear Tubes? Why do we need them?

If your child has persistent ear infections or difficulty hearing at home, your pediatrician may suggest seeing an otolaryngologist (ENT) for ear tube placement. Ear tubes, or tympanostomy tubes, are tiny cylinders that are temporarily inserted into the eardrum. The tubes measure about 2mm in length and stay in the eardrum for approximately 9 to 15 months. Eventually the tubes fall out (usually on their own) and the small hole in the eardrum quickly heals.

Ear tubes are typically used to treat chronic and/or recurrent middle ear infections (otitis media). Under rare circumstances, tubes may be recommended for chronic eustachian tube dysfunction. During a middle ear infection, fluid builds up behind the eardrum and gets stuck in the middle ear. Patients often experience ear blockage, hearing loss, ear pressure, and/or a popping noise. When ear tubes are placed, the middle ear space becomes aerated and the fluid drains out. Benefits of ear tubes include – improved hearing, less ear infections, and less treatment with oral antibiotics.

Ear tubes can be placed in both children and adults, but are more common in children due to underdeveloped eustachian tubes. The eustachian tubes are responsible for equalizing pressure and allowing middle ear fluid to drain. In children, immature eustachian tubes result in decreased fluid clearance and accumulation in the middle ear space.

Ear tube placement is a quick, painless, and safe procedure which can be performed by an otolaryngologist (ENT). The procedure can be performed in-office with local anesthesia or in a hospital setting with general anesthesia. Due to age and level of cooperation, children typically have ear tubes placed under general anesthesia. Brief exposure to general anesthesia in an otherwise healthy child does not have any long-term consequences and allows the procedure to be done safely and painlessly. During the procedure, the surgeon makes a tiny hole in the eardrum and removes fluid from the ear using suction. A small tympanostomy tube is then inserted into the hole. In total, the procedure takes ~10-15 minutes. After the tubes have been placed, it is important to keep water out of the ear. A long-held theory suggests that water exposure to the middle ear may cause infection. Therefore, patients with ear tubes should use ear plugs when showering or swimming.

If you or family members have concerns regarding recurrent ear infections or ear tubes, please do not hesitate to contact Colden Ear, Nose, Throat, and Allergy to set up an appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for a medical evaluation performed by a medical provider.

What is Silent Reflux?

Silent reflux, also known as laryngopharyngeal reflux (LPR), is a type of acid reflux that does not produce heartburn or indigestion. Often overlooked and misdiagnosed, silent reflux produces a variety of bothersome throat symptoms not associated with traditional reflux.

Silent reflux is characterized by the backflow of stomach acid into the esophagus/lower throat (laryngopharynx). Under normal circumstances, swallowed food travels down the esophagus (food pipe) towards the stomach. Between the stomach and esophagus is a small muscle which opens and closes, allowing food to pass. For patients with acid reflux, this muscle opens at inappropriate times, causing acid to “back up” into the esophagus and upper throat.

Common complaints of silent reflux include hoarseness, chronic cough, throat clearing, postnasal drip, sore or burning throat, acidic taste in mouth, or difficulty swallowing. Various risk factors can worsen symptoms. Some of which include eating spicy/acidic foods, not hydrating well, and eating meals right before bedtime.

Silent reflux can be diagnosed via a routine visit with an Ears, Nose, & Throat physician (otolaryngologist). To evaluate throat complaints, a quick and painless in-office procedure called a fiberoptic laryngoscopy is performed. This involves the physician guiding a thin, flexible tube with a light and camera attached to it into the nasal passages and down the back of the throat to visualize the upper airway. Patients with silent reflux may also be recommended to follow up with a gastroenterologist. Gastroenterologists can better evaluate the esophagus with an upper endoscopy, or EGD.

Acid reflux can be treated with both lifestyle modifications and reflux inhibiting medications. Symptoms that are mild and intermittent can be treated with; avoiding spicy/acidic foods, avoiding meals before bedtime, limiting exercise immediately after eating, sleeping with head elevated, and eating moderate amounts of food during one sitting. If symptoms are more persistent, reflux medications can be considered. Reflux medications are broken into two major classes, Proton pump inhibitors (Prilosec) and H₂ antagonists (Zantac). Both are proven to be safe and effective ways in managing silent reflux.

If you or family members have concerns regarding silent reflux, please do not hesitate to contact Colden Ears, Nose, Throat, and Allergy to set up and appointment. 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.