Do you feel tired during the day despite sleeping 7-8 hours per night? Does your spouse complain about your snoring, or note that you “stop breathing” while sleeping? It is possible that you may suffer from obstructive sleep apnea (OSA).
OSA, considered one of the most common sleep disorders in the US, is caused by complete or partial obstruction of the upper airway. After falling asleep, the muscles in the roof of the mouth (palate), tongue, and throat begin to relax and collapse. This can result in repetitive episodes of shallow or paused breathing while sleeping. Such episodes are called “apneas”, and can cause a patient’s oxygen levels to decrease. Common symptoms of OSA include heavy snoring, excessive daytime sleepiness, gasping while asleep, frequent awakening, and/or trouble sleeping. OSA is an important condition to recognize and diagnose; if untreated, OSA can increase the risk for cardiac and pulmonary-related disease (hypertension and heart disease).
The first step in getting evaluated for OSA is to see an otolaryngologist, who can perform a complete head and neck examination to identify anatomical risk factors for OSA. In many cases, the next appropriate test would be a sleep study, or polysomnogram. A sleep study typically consists of 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. Pending the results, some patients may be considered candidates for continuous positive airway pressure, or CPAP. CPAP is a small device that has a mask attached to it which improves patient breathing 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) before bedtime.
If you or family members have concerns regarding obstructive sleep apnea, 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.
Does your nose constantly feel stuffy or congested? Do you always feel like you have a cold that doesn’t go away? It’s possible that your symptoms may be related to nasal polyps. Nasal polyps are typically benign (noncancerous) “grape-like” growths that develop within the lining of the nasal passages or sinus cavities.
Although the cause of nasal polyps is not always known, in many cases they are triggered by chronic inflammation/swelling of the nasal mucosa . Recurrent sinus infections, chronic sinus swelling (chronic sinusitis), and allergic rhinitis (allergies) can all cause inflammation/swelling in the nose. Another condition associated with nasal polyps is Samter’s triad. Samter’s triad is a condition characterized by asthma, aspirin sensitivity, and nasal polyps. This condition is thought to affect roughly 10% of nasal polyp patients.
Nasal polyps can vary in size. Smaller polyps might not cause any symptoms while larger nasal polyps can completely obstruct the nasal passages and make it extremely difficult to breathe thru the nose. Typical complaints include nasal congestion, facial pressure, decreased sense of smell (hyposmia), runny nose (rhinorrhea), sneezing, and postnasal drip.
Nasal polyps may be difficult to visualize in the nasal or sinus passages in many cases. A quick and painless in-office procedure called a nasal endoscopy can often identify nasal polyps and help to determine treatment options. During this procedure, a Ear Nose Throat physician will guide a thin, flexible endoscope into the nasal and sinus passages to help determine the presence and type of nasal polyps. Other abnormalities in the nose and sinuses can also be identified, such as a nasal septal deviation, enlarged adenoids, or sinus cysts. Sometimes a CT scan of the sinuses may be ordered to determine the exact size and location of the nasal polyps. If surgery is indicated to remove the nasal polyps, the CT scan can also be used to help facilitate image guided surgery to improve accuracy and decrease any potential risk.
At times, nasal polyps may represent cancerous disorders or be a manifestation of a systemic disease process, such as Sarcoidosis and should be biopsied.
Medications that reduce inflammation in the nose are often used for treating nasal polyps. Intranasal steroid sprays (Flonase, Rhinocort, Nasonex), sinus irrigations with steroids (Pulmicort/Budesonide), and periodic courses of oral steroids are commonly used. If nasal polyps do not improve with medications, surgical removal can be considered. This is called a polypectomy and is often performed using endoscopes either in the office or operating room. Other common procedures done in the same setting as nasal polypectomy include: sinus balloon dilation (dilation of blocked or narrow sinuses) ,endoscopic sinus surgery (opening blocked sinus passages), & septoplasty (straightening a deviated nasal septum).
If you or family members have concerns regarding nasal polyps, please do not hesitate to contact Colden Ear, Nose, Throat, and Allergy to set up and 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.
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.
The thyroid gland is a small organ located at the front of the neck right below the larynx (Adam’s apple). The gland is shaped like a butterfly with two separate lobes and wraps itself around the trachea (windpipe). As a component of the endocrine system, the thyroid is responsible for releasing hormones (T3, T4, and calcitonin) into the bloodstream which help regulate metabolism, heart rate, body temperature, and blood calcium levels.
On many occasions, abnormal growths or lumps can develop on the thyroid gland. These are called thyroid nodules. Thyroid nodules can be solid or fluid filled. They can be found isolated or grouped with other nodules. Under most circumstances, thyroid nodules do not cause symptoms and go unnoticed to the patient. In rare cases, a nodule will become excessively large, and symptoms will develop, including difficulty swallowing, hoarseness, neck pain, or enlargement of the neck. Thyroid nodules are often found incidentally during routine examination or on imaging studies (MRI, CT, US) that are obtained for unrelated reasons, but these nodules will still need to be evaluated to ensure that they will not cause any problems. An abnormal thyroid function test may also indicate whether a nodule is present. Thyroid function tests measure the blood levels of T3, T4, and thyroid stimulating hormone (TSH). It is also important to know whether the thyroid hormone levels are normal, or higher or lower than expected, which can affect body function.
Although most thyroid nodules are consistent with benign disease (>90%), additional evaluation is important to ensure that that there is not anything more worrisome occurring. The first step in evaluation after physical examination is obtaining a neck/thyroid ultrasound, which gives accurate measurements of the size, shape and other important characteristics of the thyroid gland and any nodules that may be present. An ultrasound is a quick painless procedure that will give detailed information about the presence, number, size, and location of any thyroid nodules. Depending on the results, additional evaluation may be necessary. For nodules that are consider large (typically greater than 1-1.5 centimeter), a specialized biopsy technique called a fine needle aspirate (FNA) is often recommended to rule out worrisome findings. In many cases, an FNA is performed under ultrasound guidance, ensuring better accuracy. FNA results will often demonstrate whether or not a nodule is benign (harmless) or malignant (cancerous). When FNA results are indeterminate (uncertain), additional assessment is often necessary. A new technique that has recently been used to better determine the chance of malignancy in this situation is a specialized “genetic test”, which can help us place patients in low or high risk categories when previously we were unable to make an assessment. In those patients with nodules that are cancerous or high risk, we would recommend surgical removal of part or all of the thyroid gland.
Recent guidelines from the American Thyroid Association has shown that for some less aggressive thyroid cancers, removing only part of the thyroid gland may be appropriate, allow for quicker healing, less need for medications postoperatively, and afford similarly high cure rates.
If you or a family member have any concern regarding head and neck symptoms, please do not hesitate to contact Colden Ear, Nose, Throat, and Allergy to schedule and examination.
Humans are exposed to all kinds of sounds on a daily basis; including cars, engines, televisions, or radios. Under most circumstances, these sounds are at safe levels and do not affect our hearing. However, when we are exposed to loud noises, sensitive structures inside the inner ear can be damaged. This condition is referred to as noise induced sensorineural hearing loss.
Hearing is a complex mechanism which requires several structures to work together. The outer ear includes the pinna and external auditory canal. The pinna functions to collect sound waves and direct them into the auditory canal. Because of its unique structure, sounds are amplified as they travel towards the back of the auditory canal. The captured sound waves then reach the tympanic membrane (eardrum) at the back of the canal, causing it to vibrate back and forth. The eardrum represents the separating barrier between the outer and the middle ear. As the eardrum vibrates, three tiny bones behind it begin to shift with it. These tiny bones are considered the smallest in the body, and are called ossicles. The last tiny bone, commonly referred to as the stapes, then transfers the vibrating motion to the organ of hearing, the cochlea. It is inside the cochlea where tiny structures called “hair cells” convert the vibrating energy into an electrical signal. The signal travels to the brain where perception occurs.
When noises are too loud, the tiny hair cells within the inner ear are damaged and eventually die. This results in decreased hearing. Noise induced hearing loss can be caused by a one-time exposure to an intense sound (such as a blast) or by continuous exposure to loud sounds over an extended period of time (working in a loud shop). Leisure activities can also put one at risk for noise induced hearing loss. This might include listening to MP3 players at high volumes or attending loud rock concerts.
There are many other causes of hearing loss besides noise, and these causes include aging (presbycusis), genetics, disease (history of recurrent middle ear infections, viral inner ear infections, and Meniere’s disease), and trauma .The severity of hearing loss depends on all of these factors , which can co-exist and be additive. Individuals with a mild hearing loss might only experience difficulty hearing with background noises. Individuals with a severe hearing loss may experience difficulty during normal conversation, which can impact their personal and professional life significantly. Another common symptom of hearing loss is ringing or buzzing in the ear, which is referred to as tinnitus. Tinnitus will often come and go, and can be extremely bothersome to patients. Machines that create masking sounds (white noise) can be used to “cancel-out” the tinnitus in many cases.
Noise induced hearing loss is the only type of hearing loss that can be completely prevented. The best way to do so is to avoid loud noises. If one cannot avoid excessive noise, hearing protection is recommended. Ear plugs or ear muffs are frequently used to help decrease loud noises.
Proper assessment of hearing loss requires a hearing evaluation. If one suspects that their hearing has decreased it is important to see an otolaryngologist (Ears, Nose, and Throat physician) or licensed hearing professional who can perform a specialized hearing test. Depending on the results and exam, a patient may be a candidate for a hearing aid or other assistive listening devices. Other modalities include fabricating a custom ear plug that can minimize additional noise exposure if one is routinely exposed to loud noises at work or during hobbies (i.e. musicians). If a patient wishes to pursue hearing aids, a hearing aid evaluation is set up. During a hearing aid evaluation a trained audiologist or hearing instrument specialist will meet with the patient and help them find a hearing aid model which works best for them.
If you have any questions about Noise Induced Hearing Loss or want to set up an evaluation with one of our Board Certified Ear Nose Throat specialists, or licensed audiologists or hearing instrument specialists, please contact us at Colden Ear Nose Throat and Allergy at 978-997-1550, or through our website.
Have your ears ever felt blocked while flying on an airplane, climbing up a mountain, or scuba diving underwater? This sensation is a common response of the Eustachian tube following changes in atmospheric pressure.
The Eustachian tube is a narrow canal located deep inside of your ear behind the eardrum. The tube is about 3 to 4 centimeters long in adults and connects the middle ear space to the back of the nose (known as the nasopharynx). The primary function of the Eustachian tube is to equalize the pressure of the middle ear. Under normal circumstances, the tube is closed at rest and rapidly opens when yawning or swallowing. When the tube opens, it allows for an air exchange to occur between the middle ear and the back of the nose (where the pressure is close to the external environment).
Blockage of the Eustachian tube, or inability to open, causes the middle ear space to become isolated from the exterior environment. This condition is called Eustachian tube dysfunction (ETD). When the tube fails to open, the lining of the middle ear may absorb the trapped air and create a negative pressure which pulls the eardrum inward. As a result, the patient may experience a blocked sensation, pain, pressure, or hearing loss. Long-term blockage of the Eustachian tube may result in the accumulation of fluid in the middle ear space. Younger children are more susceptible to middle ear fluid, ear infections, and Eustachian tube dysfunction because their eustachian tubes are shorter and more narrow, therefore causing decreased function. In addition, children often have enlarged adenoids in the back of the nose (nasopharynx), which can block the opening of the Eustachian tube and cause increased ear symptoms. Most children will eventually develop better eustachian tube function as they mature, but if eustachian tube dysfunction causes repeated ear infections, persistent ear fluid, or hearing loss related to ear fluid then certain types of surgical procedures can be considered, such as ear tube placement and/or removal of enlarged adenoids. Ear tube placement is shown to be a very safe and effective treatment for ear infections, ear fluid and hearing loss caused by eustachian tube dysfunction, and the ear tubes are designed to fall out on their own usually within 1 year.
There are a variety of ways to test the function and patency of the Eustachian tube. This includes a pneumatic otoscope (a small device that visualizes the ear canal and blows air towards the eardrum), a tympanogram (a test to evaluate eardrum motility), and a specialized hearing test. Also, a quick and painless in-office procedure called a nasopharyngoscopy allows physicians to evaluate the nose, sinuses and nasopharynx to insure that there is no blockage of Eustachian tube opening, usually caused by enlarged adenoids or nasal polyps.
Self-inflation of the ears is perhaps the easiest treatment for ETD. This can be accomplished by pinching the nose closed and “popping the ear”, also known as the Valsalva maneuver. ETD is often made worse by underlying allergies or sinus issues. Identification and treatment of allergic rhinitis and/or sinusitis may help reduce inflammation of the Eustachian tube and improve overall function. For patients with chronic ETD, treating underling sinus and allergy disease will often be helpful to reduce symptoms. For patients who will be flying and are prone to ETD, use of an oral decongestant (sudafed) or a nasal decongestant spray known as oxymetazoline (Afrin) should be considered in the short term. These medications are most effective if used during ascent and descent. Depending on severity of symptoms, some severe or chronic cases of ETD in adults may be treated by placement of an ear tube in the office setting, which can help equalize pressure in the middle ear.
Daryl Colden, MD FACS and Christopher Jayne, BS
Opinions expressed here are those of myself, Dr. Daryl Colden. They are not intended as medical advice and cannot substitute for the advice of your personal physician.
