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.
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.
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.
