A Little About
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Preparing for your ENT visit
There are things you should consider before visiting an ENT Doctor or any Doctor for that matter.
Find out by direct questioning how many years he/she has been in practice.
Ask if he/she is board-certified. Board certification is a rigorous process in ENT & most specialties.
Never hesitate to ask your doctor how many of these procedures he or she has done. Do not consider it insulting or overly personal; he or she is obligated to tell you what percent of these cases has resulted in complications.
Before leaving, ask your doctor what the recommended treatment’s success rate is and what eventual alternatives may be necessary. Make sure the Doctor has explained potential side effects of any prescribed medications.
The key is to not feel rushed. Listen to your instincts & determine your inherent comfort level with the Doctor. Always consider a second opinion if you’re not 100% comfortable. As a physician, I myself have gone for a second opinion, even within my own specialty!
Find out by direct questioning how many years he/she has been in practice.
Ask if he/she is board-certified. Board certification is a rigorous process in ENT & most specialties.
Never hesitate to ask your doctor how many of these procedures he or she has done. Do not consider it insulting or overly personal; he or she is obligated to tell you what percent of these cases has resulted in complications.
Before leaving, ask your doctor what the recommended treatment’s success rate is and what eventual alternatives may be necessary. Make sure the Doctor has explained potential side effects of any prescribed medications.
The key is to not feel rushed. Listen to your instincts & determine your inherent comfort level with the Doctor. Always consider a second opinion if you’re not 100% comfortable. As a physician, I myself have gone for a second opinion, even within my own specialty!
Kantu's Corner ENT tips
Tips to approach Tinnitus
Tinnitus is the perception of noise when there is none. Studies show that one in five people have experienced tinnitus and that over 10 million Americans currently experience it.
Age-related high frequency nerve hearing loss or presbycusis is likely the most common cause. People in their 60s and 70s are more likely to hear a ringing or buzzing sound. Ginkoba or niacin may provide partial relief whereas a digital hearing aid or tinnitus masking device are more effective in the right circumstances.
Other common causes include noise-induced hearing loss, concussion & head injuries, medication side effects, ear wax, ear infection, and temporomandibular joint syndrome (TMJ).
Noise-induced hearing loss is more prevalent in musicians, transit authority personnel, and police officers. Concussion and head injury may result in fracture of the temporal bone, resulting in both hearing loss and tinnitus. Radiologic imaging becomes critical in this scenario. Daily aspirin or nonsteroidal anti-inflammatory use as well as excessive caffeine constitute the most common medications resulting in tinnitus. Withdrawal from benzodiazepine pain medicine can also result in ringing of the ears. Ear wax, middle ear and ear canal infections can also alter hearing and cause persistent muffled noises.
TMJ impacts over 3 million people every year, incurring crackling and popping sounds adjacent to the ear. Grinding of the teeth at night and/or clenching of the jar with stress can lead to arthritic pain or simply sounds referred to as objective tinnitus.
Less common causes include Meniere’s disease, tumors, vascular conditions, patulous eustachian tube, myocolonus, and emotional stress.
Meniere’s disease is characterized by the triad symptoms of roaring tinnitus, aural fullness, and fluctuating hearing loss. Abnormal salt concentrations of the inner ear are responsible.
Tumors of the inner ear nerve sheath, blood vessels, or brain can present with tinnitus alongside more debilitating symptoms. Vascular conditions such as carotid aneurysm, arteriovenous malformation, giant cell arteritis, or idiopathic intracranial hypertension may result in pulsatile tinnitus. Rather than ringing or buzzing, a beating sound is experienced. Magnetic resonance angiography and/or carotid doppler ultrasound are useful in diagnosis.
Rapid fluttering or flapping noise is often experienced in both patulous eustachian tube as well as palatal or stapedial myoclonus. Myoclonus refers to involuntary rapid contractions of the muscles in these areas.
The potential causes of a common symptom like tinnitus are far-reaching. It is critical to see a board-certified otolaryngologist who can perform a complete history and physical in addition to a comprehensive audiologic evaluation. The type of imaging that may be necessary depends on whether the tinnitus is pulsatile or non-pulsatile. Avoid the mistake of thinking your tinnitus or that of a loved one does not merit a full work-up.
Tips to handle Snoring and Sleep Apnea
If you or your companion snores, you're not alone; 40% of middle-aged people do too. The question becomes how to approach such a common yet daunting problem. Keep in mind that this is a multifaceted issue, one that must be carefully teased apart and deconstructed. Let’s start with the symptoms. Snoring may just be the audible manifestation of turbulent airflow or it may represent the tip of the iceberg. Underneath heavy snoring lies the possibility of central or obstructive sleep apnea, a condition characterized by episodes of breathlessness while sleeping. Undiagnosed, this condition increases the risk for congestive heart disease, heart attack, stroke, pulmonary hypertension, and automotive accident. Ask yourself the following:
Do you sometimes wake up gasping for air?
Are you exhausted or sleepy during the day?
Have you been told your breathing is interrupted when you sleep?
These are common telltale signs of sleep apnea. A complete ENT evaluation and sleep study are indicated. Other less ominous symptoms include:
Chronic nasal congestion
Awakening with dry mouth
Halitosis from chronic mouth breathing
Alternating stuffy nose
Choking spells with colds or throat infections
Factors to definitely look at include:
Excessive Weight
-Weight should be kept close to ideal body weight for height which can be found on Calculator.net
Blood Pressure & Thyroid Function
-Hypertension & Hypothyroidism are known risk factors for sleep apnea
Alcohol & pain medication usage
-Nightcaps as well as benzodiazepines and opioids depress central nervous system tone, thereby increasing airway resistance during sleep
Craniofacial issues
-Facial or upper airway injuries alongside development head-and-neck anomalies need to be considered
Treatment
Start by mentioning your concerns to your primary care physician and consider consultation by a board-certified ENT doctor. Because this is a broad and nebulous problem, the first step is to carefully look at all risk factors & consider quantifying the snoring by way of a sleep study.
A thorough head and neck exam which includes full evaluation of the nose, mouth, throat, neck, and voicebox is crucial. A list of medications as well as any relevant blood work such as thyroid function tests proves extremely helpful.
Treatment for snoring generally includes lifestyle changes such as weight loss, sleeping in a supine position, and avoiding hypnotics. Medications such as nasal sprays or allergy pills may be indicated and rarely office-based procedures to improve nasal airflow or trim the uvula can be performed with great success.
Sleep apnea requires more aggressive measures ranging from a dental appliance to a CPAP (continuous positive airway pressure) mask. Unfortunately roughy two out of three people cannot tolerate wearing the cumbersome mask or appliance. I can’t stress enough the importance of a thorough exam by an Otolaryngologist. Calculation of BMI (body mass index) alongside a complete history and physical is warranted. Depending on anatomic findings, imaging of the nose and sinuses may be necessary. Special areas of concern include the nasal turbinates and septum, adenoid and tonsils, as well as uvula and tongue base.
Surgery for sleep apnea is individualized for patients failing lifestyle changes & medical strategies including CPAP. Given the right indications and the right surgeon, results can be outstanding.
Because the impact of undiagnosed sleep apnea is so all-encompassing, successful treatment yields incredible outcomes. The one caveat I remind all my patients before surgery is that they must commit to maintaining or losing weight. A sizable weight gain down the road may necessitate the use of a dental appliance or CPAP machine years later.
Tips to prevent winter nosebleed
Nosebleeds are four times more common in the winter months due to the combined effects of cold air and dry heat. Having a cool mist humidifier in the bedroom while sleeping helps prevent nasal crusting, dryness, and bleed. Aspirin products as well as NSAIDs such as Motrin, Advil, and Ibuprofen increase the risk of nosebleed when taken on a daily basis. Forceful nose blowing and nose picking are common causes. Moisturizing saline nose sprays including Ocean, Pretz, Ayr, and Rhinaris are excellent preventive measures. Using any of these sprays as often as necessary to keep the inner lining of the nose moist carries no downside. Lastly, high blood pressure and rare bleeding disorders need to be considered. Uncontrolled hypertension and familial blood dyscrasias can occasionally first manifest with a severe nosebleed.
Should you have an active nosebleed, make sure to follow these first few steps:
Tinnitus is the perception of noise when there is none. Studies show that one in five people have experienced tinnitus and that over 10 million Americans currently experience it.
Age-related high frequency nerve hearing loss or presbycusis is likely the most common cause. People in their 60s and 70s are more likely to hear a ringing or buzzing sound. Ginkoba or niacin may provide partial relief whereas a digital hearing aid or tinnitus masking device are more effective in the right circumstances.
Other common causes include noise-induced hearing loss, concussion & head injuries, medication side effects, ear wax, ear infection, and temporomandibular joint syndrome (TMJ).
Noise-induced hearing loss is more prevalent in musicians, transit authority personnel, and police officers. Concussion and head injury may result in fracture of the temporal bone, resulting in both hearing loss and tinnitus. Radiologic imaging becomes critical in this scenario. Daily aspirin or nonsteroidal anti-inflammatory use as well as excessive caffeine constitute the most common medications resulting in tinnitus. Withdrawal from benzodiazepine pain medicine can also result in ringing of the ears. Ear wax, middle ear and ear canal infections can also alter hearing and cause persistent muffled noises.
TMJ impacts over 3 million people every year, incurring crackling and popping sounds adjacent to the ear. Grinding of the teeth at night and/or clenching of the jar with stress can lead to arthritic pain or simply sounds referred to as objective tinnitus.
Less common causes include Meniere’s disease, tumors, vascular conditions, patulous eustachian tube, myocolonus, and emotional stress.
Meniere’s disease is characterized by the triad symptoms of roaring tinnitus, aural fullness, and fluctuating hearing loss. Abnormal salt concentrations of the inner ear are responsible.
Tumors of the inner ear nerve sheath, blood vessels, or brain can present with tinnitus alongside more debilitating symptoms. Vascular conditions such as carotid aneurysm, arteriovenous malformation, giant cell arteritis, or idiopathic intracranial hypertension may result in pulsatile tinnitus. Rather than ringing or buzzing, a beating sound is experienced. Magnetic resonance angiography and/or carotid doppler ultrasound are useful in diagnosis.
Rapid fluttering or flapping noise is often experienced in both patulous eustachian tube as well as palatal or stapedial myoclonus. Myoclonus refers to involuntary rapid contractions of the muscles in these areas.
The potential causes of a common symptom like tinnitus are far-reaching. It is critical to see a board-certified otolaryngologist who can perform a complete history and physical in addition to a comprehensive audiologic evaluation. The type of imaging that may be necessary depends on whether the tinnitus is pulsatile or non-pulsatile. Avoid the mistake of thinking your tinnitus or that of a loved one does not merit a full work-up.
Tips to handle Snoring and Sleep Apnea
If you or your companion snores, you're not alone; 40% of middle-aged people do too. The question becomes how to approach such a common yet daunting problem. Keep in mind that this is a multifaceted issue, one that must be carefully teased apart and deconstructed. Let’s start with the symptoms. Snoring may just be the audible manifestation of turbulent airflow or it may represent the tip of the iceberg. Underneath heavy snoring lies the possibility of central or obstructive sleep apnea, a condition characterized by episodes of breathlessness while sleeping. Undiagnosed, this condition increases the risk for congestive heart disease, heart attack, stroke, pulmonary hypertension, and automotive accident. Ask yourself the following:
Do you sometimes wake up gasping for air?
Are you exhausted or sleepy during the day?
Have you been told your breathing is interrupted when you sleep?
These are common telltale signs of sleep apnea. A complete ENT evaluation and sleep study are indicated. Other less ominous symptoms include:
Chronic nasal congestion
Awakening with dry mouth
Halitosis from chronic mouth breathing
Alternating stuffy nose
Choking spells with colds or throat infections
Factors to definitely look at include:
Excessive Weight
-Weight should be kept close to ideal body weight for height which can be found on Calculator.net
Blood Pressure & Thyroid Function
-Hypertension & Hypothyroidism are known risk factors for sleep apnea
Alcohol & pain medication usage
-Nightcaps as well as benzodiazepines and opioids depress central nervous system tone, thereby increasing airway resistance during sleep
Craniofacial issues
-Facial or upper airway injuries alongside development head-and-neck anomalies need to be considered
Treatment
Start by mentioning your concerns to your primary care physician and consider consultation by a board-certified ENT doctor. Because this is a broad and nebulous problem, the first step is to carefully look at all risk factors & consider quantifying the snoring by way of a sleep study.
A thorough head and neck exam which includes full evaluation of the nose, mouth, throat, neck, and voicebox is crucial. A list of medications as well as any relevant blood work such as thyroid function tests proves extremely helpful.
Treatment for snoring generally includes lifestyle changes such as weight loss, sleeping in a supine position, and avoiding hypnotics. Medications such as nasal sprays or allergy pills may be indicated and rarely office-based procedures to improve nasal airflow or trim the uvula can be performed with great success.
Sleep apnea requires more aggressive measures ranging from a dental appliance to a CPAP (continuous positive airway pressure) mask. Unfortunately roughy two out of three people cannot tolerate wearing the cumbersome mask or appliance. I can’t stress enough the importance of a thorough exam by an Otolaryngologist. Calculation of BMI (body mass index) alongside a complete history and physical is warranted. Depending on anatomic findings, imaging of the nose and sinuses may be necessary. Special areas of concern include the nasal turbinates and septum, adenoid and tonsils, as well as uvula and tongue base.
Surgery for sleep apnea is individualized for patients failing lifestyle changes & medical strategies including CPAP. Given the right indications and the right surgeon, results can be outstanding.
Because the impact of undiagnosed sleep apnea is so all-encompassing, successful treatment yields incredible outcomes. The one caveat I remind all my patients before surgery is that they must commit to maintaining or losing weight. A sizable weight gain down the road may necessitate the use of a dental appliance or CPAP machine years later.
Tips to prevent winter nosebleed
Nosebleeds are four times more common in the winter months due to the combined effects of cold air and dry heat. Having a cool mist humidifier in the bedroom while sleeping helps prevent nasal crusting, dryness, and bleed. Aspirin products as well as NSAIDs such as Motrin, Advil, and Ibuprofen increase the risk of nosebleed when taken on a daily basis. Forceful nose blowing and nose picking are common causes. Moisturizing saline nose sprays including Ocean, Pretz, Ayr, and Rhinaris are excellent preventive measures. Using any of these sprays as often as necessary to keep the inner lining of the nose moist carries no downside. Lastly, high blood pressure and rare bleeding disorders need to be considered. Uncontrolled hypertension and familial blood dyscrasias can occasionally first manifest with a severe nosebleed.
Should you have an active nosebleed, make sure to follow these first few steps:
- Pinch the lower half or your nose tight with two fingers for at least two minutes. The vast majority of nosebleeds resolve with this measure
- Pinch for another two minutes if the bleeding has improved but not resolved
- Petroleum jelly on a cotton ball can be placed into each nostril if minor trickling of blood persists
- Check your blood pressure if possible; make sure you have taken your blood pressure pills
- Contact your doctor or go to your local emergency room based on how active the nosebleed is following these measures
Get In Touch.
Born in Brooklyn to hard-working parents who emigrated from India in 1964, I was blessed to observe my father perform ENT procedures at an early age. I would like to share my knowledge with you and your loved ones in the same way my father shared his knowledge with me.
Feel free to check out my website nycent.com regarding sinus relief and all things ears, nose, and throat. |