Head and neck cancers usually begin in the cells that line the moist, mucosal surfaces inside the head and neck. These surfaces include the mouth, the nose, and the throat, although can include other structures like the salivary glands, thyroid gland, lymph nodes, and skin. Head and neck cancers account for approximately 3% of cancers in the U.S. each year.
Risk factors for head and neck cancer include: History of smoking or excessive alcohol use. Smoking cigarettes, cigars, or pipes; chewing tobacco are the largest risk factors for head and neck cancer. Roughly 85% of head and neck cancers are linked to tobacco use. Individuals who drink two alcoholic beverages per day increase their risk twenty times. A newly recognized risk factor is exposure to Human Papilloma Virus (HPV). HPV, which is sexually transmitted, has been linked with the development of head and neck cancers particularly in the tonsil region and base of tongue. This same virus is also a causative factor in certain types of cervical cancer in women .
Signs and symptoms of Head & Neck Cancer MAY include a sore in the mouth or throat that does not heal, persistent pain, red or white patches in the mouth, changes in voice, pain around teeth as well as loosening of teeth. Other common symptoms include trouble swallowing or abnormal bleeding. It is not unusual for these types of cancer to present as a painless lump in the neck or throat. Symptoms tend to differ depending on location and advanced stage of disease. If a patient has any of these symptoms or perhaps has identified risk factors, you should consider an evaluation with a trained medical professional .Evaluation often includes a thorough evaluation in the office of an Ear Nose Throat Specialist, imaging (CT or MRI), lab testing, and biopsy .Early detection of these cancers can lead to a high cure rate for many patients.
Treatment options for patients with head and cancer will vary, and depend on many factors, such as the disease location, cancer type, size, and any local spread to lymph nodes or more distant spread to other body regions such as the lung. All our Head and Neck Cancer patients are first evaluated in our multi-disciplinary cancer center affiliated with Beth Israel and Dana Farber so that patients have the most up to date and comprehensive testing and treatment available. Many head and neck cancers that are diagnosed early and are localized to a specific area may be treated with surgery and/or radiation therapy. For cancers that are larger or have spread to other regions, chemotherapy may be used in combination with other treatment options .
If you, a family member, or friend have any concerning signs or symptoms in the head & neck, please contact our office for an appointment.
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.
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.
Recurrent nose bleeds are very common and can range in severity from being a nuisance to being on rare occasions life threatening. The clinical term for bleeding from the nose is epistaxis.
Nose bleeds occur due to the bursting of tiny blood vessels known as capillaries that are found throughout the nasal cavity. Roughly 90% of bleeds start near the front of the nose in a small region called Kisselbach’s plexus. Kisselbach’s plexus is a collection of fragile blood vessels on the surface of the nasal septum (the wall that divides the left and right nasal passages) that is exposed to irritants, such as cold weather, dry heat, digital manipulation and trauma. These blood vessels can be easily broken by simple trauma such as excessive nose blowing, or they can on occasion rupture for no apparent reason. Bleeding that occurs towards the back of the nose (posterior) is less common and may be more difficult to control. If bleeding occurs on one side of the nose, it can sometimes drip to the back of the throat and be coughed up, or even pass through to the other side of the nose through the back of the throat or breaks in the septum.
Causes of nose bleeds can be divided into three categories, local, systemic, and idiopathic (unknown). Local causes, which are the most common, include nasal trauma, nasal dryness, and septal abnormalities. Trauma of the nose might be related to a nasal fracture, frequent nose picking, excessive nose blowing, or nasal surgery. Nasal dryness mostly occurs during winter months when patients live in warmer and dryer environments. When the nose is dry and irritated becomes more susceptible to bleeding. Abnormalities of the nasal septum include septal deviations (bending of the wall that separates the passages) and septal perforations (a hole in the septum). Such abnormalities can cause turbulent airflow in the nose which may contribute to nasal irritation, and subsequent nasal bleeding.
Systemic causes include various blood disorders and certain types of medications that may thin the blood. Patients with high or poorly controlled blood pressure are at higher risk for nasal bleeding because the blood vessels are more likely to burst when they are under high pressure. In addition, patients who take anticoagulants (blood thinning medications) are also at a higher risk. Some of the more common prescribed medications include Coumadin and Plavix, but there are many others. Many over the counter medications taken in high quantities can thin the blood, such as Advil/Motrin or aspirin. Other conditions associated with nose bleeds include liver disease (which makes platelets that are necessary for clotting not as effective), and primary bleeding disorders, such as Von Willebrand’s disease.
It is very important to know what other medical problems co-exist, what medications a patient may be taking, and family or personal history of bleeding or bruising to best determine the potential cause and treatment of nose bleeds. No matter what the cause of a nosebleed, one should apply pressure to the front of the nose when an active nosebleed is occurring. Holding pressure in this area for 10 minutes will put pressure on the capillaries that commonly bleed (Kisselbach’s plexus), and is the most effective way to stop the bleeding. Nasal decongestants such as oxymetazoline or neosynephrine may also be used, either directly sprayed in the nose or applied to a cotton ball then placed in the nasal cavity. Ice to the nasal regions can also reduce bleeding in some cases. If bleeding persists, medical intervention is recommended. One common procedure that can be done in the office setting is cauterization, whereby a chemical called silver nitrate is applied to the nasal vessels to help seal them up. If bleeding still doesn’t resolve, either an electrical cautery can be used, or various types of nasal packing can be applied to tamponade the blood vessels and stop bleeding. Usually these nasal packs need to remain in place for a few days, and although they may be uncomfortable, they typically have a 95% chance of stopping a nosebleed. Because nasal packs can sometimes cause infections, it is very important that patients be placed on an oral antibiotic at the same time. Nasal packing can be absorbable or non-absorbable.
Preventative measures include nighttime humidification, avoiding digital manipulation of the nose, and applying daily moisturizers to the inner nose. Common moisturizers that are effective are Vaseline, nasal emollients, and saline nasal sprays. Minimizing aspirin and Motrin as well as controlling your high blood pressure may also help to reduce nose bleeds. Resting and avoiding undue force in the nasal cavity can be effective, so we usually recommend 2-3 days of light activity and avoiding bending or lifting. If you experience recurrent nose bleeds, or have had a severe one that is difficult to stop, please consider an evaluation by a trained expert, i.e. Ear Nose Throat specialist, that can better evaluate the entire nasal cavity by performing a quick painless in office procedure called a nasal endoscopy to better determine potential causes and treatment options.
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.
