The term reflux comes from a Greek word that means “backflow”. It usually refers to the backflow of stomach contents. Normally, once the things we eat reach the stomach, digestion should begin without stomach contents coming back up again……..refluxing.

Laryngopharyngeal Reflux (LPR) refers to the backflow of food or stomach acid coming all the way back up into the larynx (the voice box) or the pharynx (the throat). LPR can occur day or night, even if a person hasn’t eaten a thing.

Many People With LPR Don’t have Heartburn…..Why Is That?

Some people experience discomfort such as heartburn, but not everyone with reflux has a lot of heartburn or indigestion. In fact, many people with LPR usually do not have heartburn. This is because the material that refluxes does not stay in the esophagus for very long. In other words, the acid does not have enough time to irritate the esophagus and cause heartburn. This is why LPR is called “Silent Reflux”.

However, if even small amounts of refluxed material come all the way up into the throat, other problems can occur. This is because, compared to the esophagus, the voice box and throat are much more sensitive to injury and irritation from stomach acid. LPR is difficult to diagnose because the symptoms are different than those associated with gastroesophageal reflux disease (GERD).

How Do I Know If I Have LPR?

Chronic hoarseness, throat clearing, and cough, a feeling of a lump in the throat or difficulty swallowing may be signs that you have LPR. Some people have hoarseness that comes and goes, and others have a problem with too much nose and throat drainage; that is, too much mucus or phlegm.

Some people have heartburn too. If you have any of these symptoms, and especially if you smoke, you should ask your doctor about LPR. The specialist who most often treats people with LPR is the Otolaryngologist (Ear, Nose and Throat physician).

If your doctor thinks that you have LPR, they will probably perform a throat exam first and look at the voice box. If this area looks swollen and/or red, you may have LPR. At that point, your doctor may order some tests or recommend a specific treatment.

Posted by H. Craig Price, MD

Diagnosis can be made in the office or at home. Your physician can easily make the diagnosis during your visit, but often patients can diagnose this problem at home. You may have nasal valve collapse if:
a) your breathing is improved when the cheek skin is pushed towards the ear,or
b) your breathing is improved with Breathe-Right(or similar) strips

Treatment is both non-surgical and surgical. Non-surgical treatment involves use of allergy medicines(such as antihistamines and nasal steroid sprays) as well as breathe- right strips. Surgical treatment includes reconstructing the tip cartilages to improve their tensile strength, often with straightening of the septum. This is performed through a small incision at the base of the nose, and frequently septal and/or ear cartilage is used in the reconstruction.

In summary , nasal valve collapse is a relatively common cause of nasal obstruction. There are both non-surgical and surgical treatments for this problem.

Article posted by David A. Clark, MD, FACS

The most common cause of cerumen impaction is placing some object in the ear to try to remove the wax (Q-tip, bobby pin, or the top of a pen). In addition, water may sometimes get around the impacted cerumen and the warm and dark environment may lead to a bacterial of fungal infection.

The Physicians at Capitol Ear, Nose, & Throat recommend that the first time you experience cerumen impaction, you should be evaluated by a physician to make sure there is not another more serious reason for you to have decrease hearing or fullness in the outer ear. If you have a history of cerumen impaction and know that you do not have a hole in your eardrum, you may use some of the commercially available products from the Pharmacy such as Murine Ear Drops Rx or Debrox Rx. The drops should remain in the ear for 10-15 minutes. We also recommend using ½ part white vinegar (acetic acid) and ½ part water that has been boiled and allowed to cool to room temperature as the solution to “flush” out the ear. As a preventive, some patients do these measures on a routine basis every 1-2 months and that works very well for them. Placing a few drops of mineral oil or glycerin periodically every month or so may also soften the wax so that it can come out on its own.

Remember nothing smaller than you elbow or a football should be placed in your external ear canal!

Article posted by Stanley A. Wilkins, Jr., MD

At Capitol ENT, we constantly strive to provide comprehensive services for our patients with sinonasal disorders, and are now pleased to offer several new procedures that can be performed in the office under local anesthesia. These include balloon sinuplasty for chronic sinusitis, turbinate reduction for nasal congestion, and nasal polypectomy.

Performing these procedures in the office provides many benefits including minimally invasive techniques, reduced bleeding, very quick recovery time, preservation of future treatment options, eliminating the need for general anesthesia, and reducing the financial burden for eligible patients.

Sinusitis is one of the most common chronic healthcare problems in the U.S., afflicting about 37 million Americans annually. Sinusitis significantly impacts patients physically, functionally, and emotionally and takes a toll on quality of life.

Treatment for chronic sinusitis consists initially of medical therapy, including antibiotics, steroids, nasal saline, and treatment of comorbidities such as allergies. However, for over 20% of patients, medical therapy does not provide adequate symptom relief, and endoscopic sinus surgery is often the next step in the treatment algorithm. Typically, this type of surgery is performed in the operating room under general anesthesia, but now, patients have the option of a minimally invasive treatment in the office.

Balloon sinuplasty is a minimally invasive procedure used to treat chronic and recurrent acute sinusitis. This FDA-approved technology has been available for use in the operating room since 2005, and we are proud to be the first ENT practice inRaleigh to offer and perform this treatment in the office.

Similar to a dental procedure, candidates for balloon sinuplasty are anesthetized with topical and local anesthetics. The sinus ostia are then visualized with an endoscope and camera while a lighted guide-wire is positioned atraumatically into the sinus to be dilated. A small balloon catheter is then threaded over the wire, inflated for 5 to 10 seconds, and the sinus dilation is complete. The next sinus is then treated in the same fashion. If necessary, the sinus can simultaneously be irrigated with saline. Almost all patients tolerate this procedure very well, especially when properly selected. There is no removal of tissue, so bleeding is minimal. The procedure is very safe with very low risk for complication. Return to normal daily activities is almost immediate. Patients return for a follow-up visit so the dilated sinus openings can be visualized and post -operative cleanings or debridements are generally unnecessary.

This procedure has undergone rigorous clinical validation, which has shown:

• 90% sinus ostial patency rate at 1 year
• No serious adverse events at 2 years
• Symptom improvement for 85% of patients at 2 years post-operatively

In addition to balloon sinuplasty, we are also offering turbinate reduction in the office for patients with nasal congestion due to turbinate hypertrophy. Again, the patient is anesthetized with a topical and local anesthetic, and the turbinates are coblated by delivering radiofrequency energy to the tissue, effectively shrinking the turbinates and opening the nasal airway. Finally, for patients with recurrent nasal polyps causing nasal obstruction, we are offering nasal polypectomy in the office under local anesthesia.

If you are suffering from chronic or recurrent acute sinusitis and have not found adequate relief from medical therapy, you may be a candidate for balloon sinuplasty. For those who are not, we offer comprehensive medical and surgical treatments for sinusitis that will be individually tailored to fit your needs. Please visit http://www.capitolent.net/sinus-surgery-raleigh.html for more information about our sinonasal services and call 919-787-1374 for an appointment. Don’t forget to follow us on Facebook and Twitter!

Article posted by Jeevan Ramakrishnan, MD

Evaluation usually includes a blood test to determine the overall level of thyroid gland hormone production.  A thyroid ultrasound scan is almost always done to assess the size, location, consistency of the nodule(s), and relationship to nearby structures.  A needle biopsy is frequently performed to obtain cells for analysis and this may be done in conjunction with ultrasound to improve the accuracy of the biopsy.  The results of these various tests should lead to a diagnosis and a recommendation for treatment if any is needed.  Sometimes surgery is needed to remove the nodule because either the tests were inconclusive or they indicated a suspicion of cancer.  Space does not permit a thorough discussion of all of the possibilities but there are many factors that have to be taken into consideration when deciding how to deal with a lump in the thyroid.  The physicians at Capitol Ear, Nose, and Throat are happy to work with you, your primary physician, and/or an endocrinologist to help you reach a correct diagnosis and treatment plan should you ever develop this common condition.

Posted by Steven H. Dennis, MD

Nosebleeds can be divided into two types: anterior and posterior. Anterior epistaxis represents about 90% of nosebleeds and tend to be easier to manage. With an anterior nosebleed the blood will tend to come out the front of the nose. Bleeding that is more profuse and going down the back of the throat is more likely to be posterior.

The nasal mucous membranes warm and humidify air as it passes through the nose. To accomplish this, the nose has a very rich vascular supply. There is a collection of blood vessels on the anterior septum called Kiesselbach’s plexus where the vast majority of nosebleeds occur. Often, there is no obvious cause for the bleeding and it may seem very random. Some factors that may cause bleeding include dry air, trauma either from an injury or from picking the nose, chemical irritants, nasal septal deformities, allergies, upper respiratory infections, medications such as aspirin and other anti-coagulants, and medical illnesses such as hypertension and vascular disease.

Most nosebleeds can be managed at home. Humidifying the air and applying nasal saline sprays may help preventively. Avoid hard nose blowing and picking the nose. Avoid hot and spicy foods and hot showers and avoid aspirin and other anti-coagulants unless medically necessary. If bleeding occurs, sit down and lean forward and relax. Pinch the nose firmly on the soft part of the nose so that pressure is applied against the septum. Apply ice or cold cloths to the nose. Pinch the nose for 5 minutes watching the clock. If it is still bleeding then pinch the nose for another 10-15 minutes. If bleeding continues then medical attention may be necessary. Topical over-the-counter nasal sprays containing oxymetazoline or phenylephrine may help to decrease bleeding.

If bleeding persists or recurs or is severe then medical attention may be necessary. Anterior bleeding can sometimes be managed with chemical cauterization using silver nitrate. Occasionally, persistent bleeding will require nasal packing and, more rarely, surgical management or embolization.

Posted by R. Glen Medders, MD

When the Eustachian tube is working perfectly, it is closed and opens only very briefly when we swallow or yawn. There is a pulley-like muscle above the roof of our mouth that pulls it open when we swallow or yawn. Some people can actually hear a “crackling” sound every time this happens. Others hear it only sometimes, while some never hear it. Almost everyone becomes aware of this air movement when their ears finally “pop” during altitude changes such as during airplane flights or while ascending or descending a mountain or high elevator shaft. During these altitude changes, before the Eustachian tube opens to equalize the pressure, one can experience pain in the ear because the difference in air pressure on each side of the eardrum actually stretches the eardrum, which is quite sensitive.

The Eustachian tube works well for most people most of the time. Its diameter is only about as big as a pencil lead, so its surprising it works as well as it does. However, there are two very common Eustachian tube problems that can cause ear symptoms. One is when the Eustachian tube remains in the open position. The other is when the Eustachian tube fails to open with swallowing. Oddly, BOTH of these problems cause the ear to feel stopped up. Sometimes its difficult to sort out which of these two problems is causing the symptom.

The Eustachian tube can fail to open due to a virus, cold, allergy, sinus infection, scar tissue, or sometimes for no particular identifiable reason. Fortunately, it usually eventually returns to normal function without any treatment, but it can sometimes last for a very long time. If it stays completely closed for long enough, the air behind the eardrum in the middle ear can eventually be absorbed by the lining of the middle ear. This can create enough vacuum to cause the ear lining to produce a mucus-like fluid that fills the middle ear space. When this happens, one will experience hearing loss similar to that produced by putting an earplug in the ear. Even this will frequently resolve without treatment. If it does not, your doctor can suggest treatment.

The opposite problem, a Eustachian tube that stays in the open position, is called a “Patulous Eustachian Tube”. It can be caused by weight loss, by hormonal changes from pregnancy, menopause, pre-menopause, hormone medication, or for no identifiable reason. Most of the time no specific cause is identified. Even though this makes the ear feel “full” or “stopped up”, the hearing stays normal. The full feeling is bothersome, but it does not cause pain and it is no threat to your ear. Fortunately, this will usually go away by itself. Unfortunately, treatment of this benign but bothersome condition is very limited. We physicians are better at explaining the “patulous Eustachian tube” and ruling out more serious ear conditions than we are at curing it. The body is good at eventually recalibrating the opening and closing of the Eustachian tube, but your doctor cannot predict how long this will take. Sometimes, for reasons that are hard to explain, making a small opening in the eardrum and placing a tube to keep it open can help. On the other hand, sometimes this procedure can actually make the symptom worse. This procedure is usually reserved for patients who have symptoms that do not resolve on their own after a very long time.

Posted by  Mark Brown, MD.

Allergic rhinitis can cause symptoms such as sneezing, nasal drainage and congestion, itchy watery eyes, headache, fatigue, and many other symptoms that can significantly affect your quality of life. Fortunately, there are many good, safe medications that can be used to help alleviate symptoms, such as antihistamines, nasal steroids sprays, and leukotriene blockers. For most patients, these medications will control allergy symptoms and improve the quality of your life. But for some patients with severe allergies, these medications are not enough and symptoms persist despite medical therapy.

For patients with severe allergies and persistent symptoms despite medical therapy, allergy immunotherapy is indicated for symptom relief. This involves allergy testing to see what you are allergic to, and using these results to formulate a mixture of allergen extracts. This extract mixture is then administered to you on a regular basis for an average of 2-3 years, resulting in a significant improvement in allergy symptoms for approximately 90% of patients. The exact mechanism for how this treatment works is highly complex, but essentially, it “desensitizes” your body to the pollens and irritants in the air that you are usually allergic to, resulting in a decreased inflammatory response and improvement in symptoms.

Traditionally, allergy immunotherapy has been administered in the form of subcutaneous immunotherapy, otherwise known as SCIT or allergy shots. There are many protocols for administering this, but typically this involves a weekly subcutaneous injection starting at a low potency and gradually increasing the potency of the injection until a maintenance level is reached over the period of a few months. While this is a very safe and effective treatment for allergies, some patients choose not to undergo this, or are simply unable to for one reason or another.

We at Capitol ENT are pleased to offer another option for patients who do not want to or cannot undergo treatment with allergy shots. This is called sublingual immunotherapy, or SLIT. With SLIT, instead of administering the allergen extract as a weekly injection, the extract can be administered as daily drops under the tongue, by you, at home. SLIT has been used effectively in Europe for decades, and is now gaining popularity in the United States as well. This option provides many benefits, such as the convenience of administering the treatment at home, the lack of needles or injections, and an excellent safety profile. In addition, while there is still some debate, numerous studies show that sublingual immunotherapy (SLIT) is just as effective as allergy shots.

Your Capitol ENT physician will be happy to talk more with you about whether sublingual immunotherapy (SLIT) is a good treatment option for you or your child. If you are interested, do not hesitate to ask us at your next appointment, or call 919-787-1374 to make an appointment at your convenience. Below are some helpful links for more information. Don’t forget to “Like” us on Facebook and follow us on Twitter!

www.capitolent.net/sublingual-immunotherapy.html

www.entnet.org/HealthInformation/allergicRhinitis.cfm

www.aaoaf.org

www.aaaai.org/conditions-and-treatments/allergies.aspx

www.pollen.com

Posted by  Jeevan Ramakrishnan, MD.