EAR, NOSE AND THROAT DISEASES:

TOP 3 SIGNS AND SYMPTOMS, DIAGNOSIS AND TREATMENT

I. EAR

A. TINNITUS B. EAR INFECTIONS C. VERTIGO

II. NOSE

A. NASAL CONGESTION/ SINUSITIS B. NOSEBLEED C. ALLERGIC RHINITIS

III. THROAT/ NECK

A. THROAT PAIN B. SLEEP APNEA C. NECK MASS

The ear is composed of 3 parts. The Outer ear which includes the visible part of the ear and the ear canal. This leads into the eardrum. The middle ear is the air filled cavity behind the ear drum. It contains 3 small bones (ossicles) which conducts sound. It is also connected to the upper throat (nasopharynx) by the Eustachian tube which functions for pressure equalization. The inner ear includes the nerves which take the sound to the brain as well as the vestibular system which is responsible for balance.

E A R

Tinnitus is a condition in which the patient hears ringing, buzzing, crickets, roaring, clicking, whistling, hissing, or squealing noises which may be low- or high-pitched. It is not a disease in itself but is usually a symptom of an underlying condition. Some of the causes of tinnitus are hearing loss, foreign objects in the ear, noise exposure, ear infections, sinus infections, Meniere’s disease, ear or head injury, circulatory system problems, certain medications, anxiety or stress, heavy smoking, and thyroid disorders, and sometimes brain tumors.

To diagnose tinnitus, your ENT doctor will conduct a thorough medical history and physical examination. A doctor will check for ear wax, or foreign objects that may be obstructing the ear canal or rubbing against the eardrum.

http://tinnitusart.com/wp-content/uploads/2011/10/Tinnitus_relief.jpg It is important to let your doctor know if the noises are constant or intermittent, pulsating or non-pulsating, and if you have vertigo or hearing loss. Additional tests such as an audiogram (hearing test), blood tests, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) scan may be requested to determine potential causes of tinnitus or to locate tumors. Though it rarely progresses into a serious problem, it usually is a nuisance and interferes with the patient's ability to concentrate and may lead to fatigue, stress, sleep problems, memory problems, depression, anxiety and irritability. Treatment of tinnitus is usually directed at treatment of the underlying cause. This may include removing foreign bodies in the ear, treating cardiovascular disease, changing medication regimens. However, the underlying cause cannot be identified in most cases.. Currently, there is no specific treatment for tinnitus. Treatment options may include certain medications, Tinnitus Retraining Therapy, white noise machines, hearing aids, and masking devices which may suppress the ringing sounds and make the tinnitus less annoying.

T I N N I T U S

Outer Ear Infections Outer ear infections, frequently called “swimmer’s ear” may cause tenderness, pain, redness, swelling, crusting, itching in the ear canal and fluid discharge. Otoscopy done by your ENT doctor will visualize the ear canal and eardrum. He or she will carefully clean or suction discharge from your ear, and if there is swelling, he or she may insert an antibiotic-soaked ear wick into the canal to allow the medicine to seep into the swollen affected area. Ear drops or cream may be prescribed to be used several times a day and oral antibiotics may be added to the regimen if you have a severe infection. Middle Ear Infections A middle ear infection is an infection of the air-filled space in the ear behind the eardrum. This space is connected to the nasopharynx (back of the nose) by the Eustachian tube. Middle ear infections usually begin with an infection of the nose and throat or when you have allergies. Usual presenting symptoms include earache, hearing loss, feeling of fullness or heaviness in the ear, fever, and dizziness. The physician will check for fluid behind the eardrum, and a hearing test may also be recommended if you are experiencing hearing loss. Many doctors would recommend antibiotics for middle ear infections. However, recent studies have shown that the symptoms of ear infections often go away in a couple of days without antibiotics. Your provider may recommend a decongestant (tablets or a nasal spray) to help clear the eustachian tube and encourage drainage of the middle ear discharge.

EAR INFECTIONS

Infections may also be from a perforation in the eardrum. When this happens, any nasal discharge can easily backflow into the ear via the Eustachian tube. This disruption of the pathway of sound reception may cause affect hearing. Your doctor may advise you to apply drops or take oral medications. Persistence of the ear discharge despite medical treatment or presence of any unusual symptoms such as imbalance or a presence of a mass in the ear may warrant further imaging studies such as a CT scan to rule out cholesteatomas ( epithelial growths which can cause recurrent infections and erode the mastoid process and parts of the middle and inner ear) FIGURE: Dr Estimar with a patient she treated in the clinic

Did you, as a child try spinning for a period of time and then stopping quickly? Do you remember the sensation that the spinning continues for a few seconds after stopping? Or the spinning sensation persisting after an amusement park ride? That is the sensation of vertigo. Vertigo is the sensation of spinning of the patient around his or her surroundings or the surroundings around the patient. Many ENT disorders can cause vertigo. Benign Paroxysmal Positional Vertigo is one of the most common causes of vertigo in adults. Patients usually describe it as a spinning sensation after rapid changes in head position such as after rising up in the morning, lying down in bed, pickin up something from the floor or looking up to the ceiling. The symptoms usually last seconds to minutes before resolving.

(http://orthobalancept.com/wp-content/uploads/2013/12/PHOTO-VESTIBULAR-ANIMATION.gif) The inner ear has compartments which contain microscopic crystals, called otoconia, floating around. Abrupt head movements sometimes cause these crystals to be displaced from their normal location. The movement of these particles stimulate the sensory endings of the vestibular (balance) nerve, producing vertigo. The good news is that BPPV responds well to physical therapy maneuvers. Medications are rarely used as adjunctive therapy. A trained ENT doctor or vestibular therapist can perform the repositioning therapy maneuvers which can rapidly eliminate the symptoms of dizziness. These maneuvers are designed to bring the crystals to a part of the inner ear where they will not produce vertigo. Symptoms usually disappear within one to 2 sessions.

VERTIGO

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The sinuses are air-filled spaces in the bones of your face and skull that connect with the nose through small openings. Sinusitis is swollen, inflammed mucosal linings of the sinuses. The term rhinosinusitis is presently expanded to rhinosinusitis because the contiguous lining of the nose and sinuses are sually affected in this disease and one cannot be affected while the other is spared. Symptoms may include facial pain or pressure, headache, halitosis, facial congestion or fullness, nasal blockage, nasal disclare or post nasal discharge, tenderness around the eyes, difficulty in smelling, dental or jaw pain, and even ear pain or fullness, and sore throat Rhinosinusitis is diagnosed and treated by a physician.If a sinus infection is suspected, an endoscope may be used to go up the nose and visualize the opening in to the sinus cavity and look for inflammation and/or discharge. Sinus x-rays or a CT scan may be indicated if other tests are inconclusive. Medical therapy for rhinosinusitis may employ antibiotics, oral or intranasal steroid, antihistamines, decongestants, nasal irrigation and other therapies on a long-term basis Failure of medical management, and any anatomic deformities or sino-nasal masses seen on imaging studies may warrant surgical intervention.

NASAL CONGESTION/SINUSITIS

N O S E

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The nasal cavity has numerous blood vessels which are located close to the surface lining. They are fragile and prone to bleed easily.

The most common causes of nosebleeds are a

breakdown in the lining of the nose, trauma to the nose or face, high altitude, drug abuse involving the nose, high blood pressure, anti-clotting medications, and medical conditions that prevent your blood from clotting.

Epistaxis or nosebleeds are usually benign in

origin but may cause patients to worry. Treatment of the underlying cause, and immediate first aid maneuvers such as digital pressure on the nostrils, ice pack over the nose and chewing ice chips are usually enough to control the bleeding. Persistence of the bleeding may warrant a consult at the ER.

Recurrent epistaxis also warrants a consult with

an ENT specialist who may do nasal endoscopy to rule out any sino-nasal tumors causing the bleeding.

NOSE BLEED

Allergic rhinitis occurs when the nose and usually also the ears, eyes, sinuses, and throat come into contact with allergy-causing substances or allergens. The most common allergens are dust mites, cockroaches molds, pollent, and animal dander. When the body comes into contact with these allergens, it releases chemicals which causes allergy symptoms.Common symptoms include a stuffy, runny nose, sneezing, post-nasal drip, red, itchy, and watery eyes, swollen eyelids, itchy mouth, throat, ears, and face, sore and itchy throat, dry cough, and fatigue and lethargy.

Your doctor will perform a physical exam and ask about your symptoms. You will be asked how often your symptoms occur in a week, if they vary by time of day or season, and exposure to pets or other allergens, and how severe your symptoms affect your activities of daily living

Allergy testing may reveal the pollen or other substances that trigger your symptoms. Skin testing is the most common method of allergy testing. Special blood tests, like IgE RAST tests, can measure the levels of allergy-related substances. A complete blood count (CBC) test with a high eosinophil count may also help diagnose allergies.

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The first step in treating allergies is to try to avoidance of allergic triggers. Medical treatment may include various topical and oral medicines such as anti-histamines, steroids, decongestants, etc depending on the frequency and severity of your symptoms, age, and other medical conditions such as asthma. The throat is the tube behind the nose and oral cavity which brings air into the lungs and food into the esophagus. The medical term for throat is pharynx.

ALLERGIC RHINITIS

N E C K / T H R O A T

Sore throat is usually caused by contagious viral or bacterial infections, though allergies and sinus infections may also be contributory. Sore throat symptoms include pain, burning or scratching sensations at the back of the throat, pain when swallowing, and tenderness in the neck. Sore throat symptoms may be accompanied by coughing, sneezing, fever, and swollen lymph nodes. Most sore throats are not serious and pass within three to seven days without the need for medical treatment. However, whenever a sore throat is severe, persists longer than the usual five-to-seven day duration of a cold or flu, and is not associated with an allergy or irritation, you should see your physician. The following are things to watch out for:

Severe and prolonged sore throat Difficulty breathing/swallowing/opening the mouth Joint pain Earache Rash Fever (over 101°) Blood in saliva or phlegm Frequently recurring sore throat Lump in neck Hoarseness lasting over two weeks

Your doctor will then diagnose sore throat based on history taking and physical examination. HE or she may do a throat swab if strep throat is suspected. However, as some of these tests may turn out negative despite your symptoms, your doctor may make the diagnosis based on classic symptoms and signs to treat you presumptively even without a swab. If the infection is bacterial, he will prescribe antibiotics usually for 3-7 days. Make sure to take the antibiotics as instructed by your physician otherwise the bacteria will not be completely eliminated and could return.

Obstructive sleep apnea (OSA) is a common disorder resulting from collapse of the upper airway during sleep. This airway collapse causes decreases in the body’s oxygen content and frequent awakenings with subsequent long-term adverse health consequences. It is considered a major public health problem. At the clinic, your doctor may ask:

• Have you ever been told that you snore? • Have you ever been told that you have stopped breathing or you choke while asleep? • Do you awake refreshed or do you feel tired in the morning? • Do you suffer from daytime drowsiness? Does it affect work or school? • Do you have memory or learning and concentration problems? • Do you feel always irritable or have mood swings or depression? • Do you wake up frequently in the middle of the night?

SLEEP APNEA

DIFFICULTY SWALLOWING/ SORE THROAT

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The doctor will look inside your mouth for evidence of enlarged tonsils, uvula (the midline bell-like tissue that hangs from the palate) inside of the nose for obstruction or other structures that may be blocking the airway such as a small jaw, a short neck, obesity and other factors. The standard for the diagnosis of obstructive sleep apnea (OSA) is a sleep study or polysomnography. Sleep studies are usually conducted at a sleep center. While you sleep, monitors placed over your body will monitor the oxygen saturation in your body. Normal oxygen saturation during sleep in otherwise healthy men and women is 95% to 100%. If you stop breathing while asleep, this number will drop. The monitors will also measure brain activity, eye movement, breathing and heart rate, muscle activity. Other studies such as cephalometric xrays, CT scan, MRI, endoscopy etc may be requested by your doctor to guide him or her in creating an effective treatment plan Based on your present symptoms, your doctor may choose to use a combination of these tests to diagnose your specific disorder. He will then use this information to create an effective treatment plan. Treatment options for sleep apnea include weight loss, positional therapy, positive airway pressure devices, oral applicances, and surgery.

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The neck contains many structures: skin, blood vessels, endocrine glands like the thyroid and parathyroid glands, lymph nodes, muscles, the bony skeleton, nerves, etc. Tumors may arise from any of these structures.

NECK MASS

(http://www.aokainc.com/neck-anatomy-images/)

A good history taking and physical examination may direct the physician in the right diagnosis. It is therefore important to tell your ENT doctor the following: When did the mass start to grow? Has it been there since birth? How fast is the progression in size? Do you feel the mass pulsating? Do you have any palpitations or tremors? Have you rapidly lost or gained weight? Do you feel a lump in your throat or any changes in your voice?

He will then proceed to palpate your neck for the size and character and consistency and movability of the mass, as well as to see if there are any lymph nodes affected or any overlying skin changes. Further diagnositic procedures may include an ultrasound, CT sonography, or MRI, fine needle aspiration biopsy thyroid function tests and other blood work-ups as warranted. Treatment options may vary from medical to surgical depending on the physician’s diagnosis.