Ear, Nose, Throat, & Allergy

What is Vertigo? What can cause it?

Posted on March 28th, 2017

Feeling dizzy is a very common complaint in medicine. Dizziness can be described in several ways, including being lightheaded, unsteady, or woozy. On some occasions, patients will experience a specific type of dizziness called vertigo. Vertigo is the sensation of whirling, often described as a “room spinning ” feeling. Unlike most types of dizziness, vertigo is typically caused by disorders of the inner ear (labyrinth). Three of the most common causes of vertigo include BPPV, Meniere’s Disease, and Labyrinthitis.

BPPV, or benign paroxysmal positional vertigo, is characterized by acute vertigo lasting approximately 30 seconds. Episodes are triggered by positional changes of the head, such as rolling over in bed, looking up, or stooping over. BPPV is thought to be caused by loose particles (otoliths) in the inner ear. It can be identified by an easy in-office test called the Dix-Hallpike test. In most cases, the patient’s dizziness improves when keeping the head steady. If the dizziness persists, at-home exercises called the Brandt-Daroff exercises can be performed which often improves the condition. Sometimes a patient will require a repositioning maneuver known as an Epley procedure to help resolve the positional vertigo.

Labyrinthitis is another common cause of acute vertigo. Unlike BPPV, patients with labyrinthitis experience constant vertigo, lasting several hours, sometimes days. Associated symptoms may include nausea, vomiting, headaches, hearing loss, and ringing in the ears. Symptoms begin acutely and gradually improve. Sometimes patients will experience residual symptoms lasting up to a month before completely resolving. Labyrinthitis is caused by inflammation of the vestibular nerve, thought to be caused by a viral infection. It is not uncommon for patients to experience labyrinthitis in the setting of an upper respiratory tract infection or cold. Although there are no definitive cures for labyrinthitis, certain medications such as Meclizine can be provided that help calm the vestibular system of the inner ear. If symptoms persist after an extended period of time, physical therapy can also be performed.

Patients with Meniere’s Disease experience episodic vertigo – lasting minutes to hours, ringing in the ears, and fluctuating hearing loss. Although the cause of Meniere’s Disease is not well understood, it is thought to be related to a fluid imbalance in the inner ear(endolymph) . Meniere’s Disease can sometimes become a chronic condition , and may affect a patient for many years after onset. Coping with Meniere’s can be challenging, as attacks are unpredictable. In many cases, first line treatments such as a low-salt diet and a diuretic can be helpful to control or eliminate symptoms.

If you are experiencing symptoms of vertigo, it is helpful to be seen by an Ear Nose and Throat specialist (Otolaryngologist) to rule out inner ear disorders. During the visit, your physician may recommend obtaining a comprehensive audiogram (hearing test). Many conditions associated with vertigo are also associated with hearing loss. In certain circumstances, your physician may also recommend obtaining a specialized balance test called an electronystagmography (ENG). ENGs can be performed in the office and measure the normal eye movement and involuntary eye movement (nystagmus) following exposure to various stimuli. The test can be helpful for identifying the potential cause of a patient’s vertigo/dizziness.

If you or family members have concerns regarding dizziness, please do not hesitate to contact Colden and Seymour Ear, Nose, Throat, and Allergy to set up an appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for a medical evaluation performed by a medical provider.

It is Head and Neck Cancer Awareness Month

Posted on March 2nd, 2017
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.

Dr. Colden awarded North Shore Magazine + Castle Connolly “Top Doctors 2017”

Posted on February 27th, 2017
Dr. Colden awarded North Shore Magazine + Castle Connolly “Top Doctors 2017” The Colden & Seymour team is proud to announce that our own Dr. Daryl Colden has been awarded as the top Otolaryngology award in the North Shore. Castle Connolly Medical Ltd. is a healthcare research and information company to help guide consumers to America’s top doctors and top hospitals. Castle Connolly’s established nomination survey research screening and selection process under the direction of an MD involves many hundreds of thousands of physicians as well as academic medical centers specialty hospitals and regional and community hospitals all across the nation. Castle Connolly’s physician-led team of researchers follows a rigorous screening process to select top doctors on both the national and regional levels. We are proud of Dr. Colden’s accomplishment, and look forward passing down his expertise to our patients.

What are Ear Tubes? Why do we need them?

Posted on February 14th, 2017

If your child has persistent ear infections or difficulty hearing at home, your pediatrician may suggest seeing an otolaryngologist (ENT) for ear tube placement. Ear tubes, or tympanostomy tubes, are tiny cylinders that are temporarily inserted into the eardrum. The tubes measure about 2mm in length and stay in the eardrum for approximately 9 to 15 months. Eventually the tubes fall out (usually on their own) and the small hole in the eardrum quickly heals.

Ear tubes are typically used to treat chronic and/or recurrent middle ear infections (otitis media). Under rare circumstances, tubes may be recommended for chronic eustachian tube dysfunction. During a middle ear infection, fluid builds up behind the eardrum and gets stuck in the middle ear. Patients often experience ear blockage, hearing loss, ear pressure, and/or a popping noise. When ear tubes are placed, the middle ear space becomes aerated and the fluid drains out. Benefits of ear tubes include – improved hearing, less ear infections, and less treatment with oral antibiotics.

Ear tubes can be placed in both children and adults, but are more common in children due to underdeveloped eustachian tubes. The eustachian tubes are responsible for equalizing pressure and allowing middle ear fluid to drain. In children, immature eustachian tubes result in decreased fluid clearance and accumulation in the middle ear space.

Ear tube placement is a quick, painless, and safe procedure which can be performed by an otolaryngologist (ENT). The procedure can be performed in-office with local anesthesia or in a hospital setting with general anesthesia. Due to age and level of cooperation, children typically have ear tubes placed under general anesthesia. Brief exposure to general anesthesia in an otherwise healthy child does not have any long-term consequences and allows the procedure to be done safely and painlessly. During the procedure, the surgeon makes a tiny hole in the eardrum and removes fluid from the ear using suction. A small tympanostomy tube is then inserted into the hole. In total, the procedure takes ~10-15 minutes. After the tubes have been placed, it is important to keep water out of the ear. A long-held theory suggests that water exposure to the middle ear may cause infection. Therefore, patients with ear tubes should use ear plugs when showering or swimming.

If you or family members have concerns regarding recurrent ear infections or ear tubes, please do not hesitate to contact Colden and Seymour Ear, Nose, Throat, and Allergy to set up an appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for a medical evaluation performed by a medical provider.

What is an inferior turbinate??

Posted on November 29th, 2016
The inferior nasal turbinate is an important structure located in the nasal cavity. Often described as a “finger-like projection”, the inferior nasal turbinate extends from deep inside the nose towards the anterior (front) nasal cavity. It is one of three pairs of nasal turbinates that are orientated in “shelf-like” fashion within the nose. Functionally, the inferior nasal turbinates are responsible for directing air into the nasal cavity and cleaning/humidifying it. Sometimes the turbinates are large enough to cause difficulty with nasal breathing. This condition is called, “inferior turbinate hypertrophy”. Enlarged nasal turbinates can be caused by a variety of issues, including seasonal allergies, chronic sinusitis, or anatomical factors such as a deviated nasal septum. Common symptoms of inferior turbinate hypertrophy include nasal congestion, difficulty breathing through the nose, chronic sinus infections, and snoring at night. Diagnosis of the condition usually requires examination by an Ears, Nose, and Throat specialist (otolaryngologist). To further investigate, a quick and painless in-office procedure called a nasal endoscopy will likely be performed. This includes the physician guiding a thin, flexible endoscope into the nasal and sinus cavities to evaluate if nasal turbinates are enlarged. Often other abnormalities of the nose can also be identified, such as a nasal septal deviation, chronic sinus swelling, sinus cysts, or enlarged adenoids. Medications that reduce inflammation in the nose are often used to treat inferior turbinate hypertrophy. These include intranasal steroid sprays (Flonase, Rhinocort, Nasonex), sinus irrigations with steroids (Pulmicort/Budesonide), and periodic courses of oral steroids. Over the counter antihistamines such as Claritin or Zyrtec may also be helpful. If inferior turbinate hypertrophy does not improve with medical therapy, surgical procedures can be considered. One procedure, called the inferior turbinate reduction, is performed to reduce the size of the nasal turbinates. This can be performed in both the office and hospital operating room setting. If you or family members have concerns regarding hypertrophy of the nasal turbinates, please do not hesitate to contact Colden and Seymour Ear, Nose, Throat, and Allergy to set up an appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for a medical evaluation performed by a medical provider.

What is Obstructive Sleep Apnea?

Posted on November 21st, 2016
Do you feel tired during the day despite sleeping 7-8 hours per night? Does your spouse complain about your snoring, or note that you “stop breathing” while sleeping? It is possible that you may suffer from obstructive sleep apnea (OSA). OSA, considered one of the most common sleep disorders in the US, is caused by complete or partial obstruction of the upper airway. After falling asleep, the muscles in the roof of the mouth (palate), tongue, and throat begin to relax and collapse. This can result in repetitive episodes of shallow or paused breathing while sleeping. Such episodes are called “apneas”, and can cause a patient’s oxygen levels to decrease. Common symptoms of OSA include heavy snoring, excessive daytime sleepiness, gasping while asleep, frequent awakening, and/or trouble sleeping. OSA is an important condition to recognize and diagnose; if untreated, OSA can increase the risk for cardiac and pulmonary-related disease (hypertension and heart disease). The first step in getting evaluated for OSA is to see an otolaryngologist, who can perform a complete head and neck examination to identify anatomical risk factors for OSA. In many cases, the next appropriate test would be a sleep study, or polysomnogram. A sleep study typically consists of 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. Pending the results, some patients may be considered candidates for continuous positive airway pressure, or CPAP. CPAP is a small device that has a mask attached to it which improves patient breathing 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) before bedtime. If you or family members have concerns regarding obstructive sleep apnea, please do not hesitate to contact Colden and Seymour Ear, Nose, Throat, and Allergy to set up an appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for a medical evaluation performed by a medical provider.

What is Silent Reflux?

Posted on September 12th, 2016

Silent reflux, also known as laryngopharyngeal reflux (LPR), is a type of acid reflux that does not produce heartburn or indigestion. Often overlooked and misdiagnosed, silent reflux produces a variety of bothersome throat symptoms not associated with traditional reflux.

Silent reflux is characterized by the backflow of stomach acid into the esophagus/lower throat (laryngopharynx). Under normal circumstances, swallowed food travels down the esophagus (food pipe) towards the stomach. Between the stomach and esophagus is a small muscle which opens and closes, allowing food to pass. For patients with acid reflux, this muscle opens at inappropriate times, causing acid to “back up” into the esophagus and upper throat.

Common complaints of silent reflux include hoarseness, chronic cough, throat clearing, postnasal drip, sore or burning throat, acidic taste in mouth, or difficulty swallowing. Various risk factors can worsen symptoms. Some of which include eating spicy/acidic foods, not hydrating well, and eating meals right before bedtime.

Silent reflux can be diagnosed via a routine visit with an Ears, Nose, & Throat physician (otolaryngologist). To evaluate throat complaints, a quick and painless in-office procedure called a fiberoptic laryngoscopy is performed. This involves the physician guiding a thin, flexible tube with a light and camera attached to it into the nasal passages and down the back of the throat to visualize the upper airway. Patients with silent reflux may also be recommended to follow up with a gastroenterologist. Gastroenterologists can better evaluate the esophagus with an upper endoscopy, or EGD.

Acid reflux can be treated with both lifestyle modifications and reflux inhibiting medications. Symptoms that are mild and intermittent can be treated with; avoiding spicy/acidic foods, avoiding meals before bedtime, limiting exercise immediately after eating, sleeping with head elevated, and eating moderate amounts of food during one sitting. If symptoms are more persistent, reflux medications can be considered. Reflux medications are broken into two major classes, Proton pump inhibitors (Prilosec) and H2 antagonists (Zantac). Both are proven to be safe and effective ways in managing silent reflux.

If you or family members have concerns regarding silent reflux, please do not hesitate to contact Colden and Seymour Ears, Nose, Throat, and Allergy to set up and appointment. 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.

What are Nasal Polyps? What???

Posted on July 26th, 2016
Does your nose constantly feel stuffy or congested? Do you always feel like you have a cold that doesn’t go away? It’s possible that your symptoms may be related to nasal polyps. Nasal polyps are typically benign (noncancerous) “grape-like” growths that develop within the lining of the nasal passages or sinus cavities. Although the cause of nasal polyps is not always known, in many cases they are triggered by chronic inflammation/swelling of the nasal mucosa . Recurrent sinus infections, chronic sinus swelling (chronic sinusitis), and allergic rhinitis (allergies) can all cause inflammation/swelling in the nose. Another condition associated with nasal polyps is Samter’s triad. Samter’s triad is a condition characterized by asthma, aspirin sensitivity, and nasal polyps. This condition is thought to affect roughly 10% of nasal polyp patients. Nasal polyps can vary in size. Smaller polyps might not cause any symptoms while larger nasal polyps can completely obstruct the nasal passages and make it extremely difficult to breathe thru the nose. Typical complaints include nasal congestion, facial pressure, decreased sense of smell (hyposmia), runny nose (rhinorrhea), sneezing, and postnasal drip. Nasal polyps may be difficult to visualize in the nasal or sinus passages in many cases. A quick and painless in-office procedure called a nasal endoscopy can often identify nasal polyps and help to determine treatment options. During this procedure, a Ear Nose Throat physician will guide a thin, flexible endoscope into the nasal and sinus passages to help determine the presence and type of nasal polyps. Other abnormalities in the nose and sinuses can also be identified, such as a nasal septal deviation, enlarged adenoids, or sinus cysts. Sometimes a CT scan of the sinuses may be ordered to determine the exact size and location of the nasal polyps. If surgery is indicated to remove the nasal polyps, the CT scan can also be used to help facilitate image guided surgery to improve accuracy and decrease any potential risk. At times, nasal polyps may represent cancerous disorders or be a manifestation of a systemic disease process, such as Sarcoidosis and should be biopsied. Medications that reduce inflammation in the nose are often used for treating nasal polyps. Intranasal steroid sprays (Flonase, Rhinocort, Nasonex), sinus irrigations with steroids (Pulmicort/Budesonide), and periodic courses of oral steroids are commonly used. If nasal polyps do not improve with medications, surgical removal can be considered. This is called a polypectomy and is often performed using endoscopes either in the office or operating room. Other common procedures done in the same setting as nasal polypectomy include: sinus balloon dilation (dilation of blocked or narrow sinuses) ,endoscopic sinus surgery (opening blocked sinus passages), & septoplasty (straightening a deviated nasal septum). If you or family members have concerns regarding nasal polyps, please do not hesitate to contact Colden and Seymour Ear, Nose, Throat, and Allergy to set up and appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for a medical evaluation performed by a medical provider.

Summertime Allergies – AAHH CCHHOO

Posted on July 19th, 2016
Do you feel that your allergy symptoms get worse during the late spring and early summer? It’s possible that you may have a grass allergy. The summer season is grass pollination season, causing an array of bothersome symptoms in individuals who are allergic to it. The condition is called seasonal allergic rhinitis. Common complaints of allergic rhinitis include recurrent sneezing, a runny nose, water/itchy eyes, postnasal drip, nasal congestion, or throat congestion. Those with severe grass allergies may report itchiness of the skin or urticaria (hives) after contact with grass. Other conditions that are associated with grass allergies include asthma, eczema, conjunctivitis, nasal polyps, sinusitis (sinus swelling), sleep apnea, laryngitis, and ear infections. Some individuals with grass allergies may also suffer from oral allergy syndrome (OAS), a condition marked by itchiness of the mouth and throat after consuming raw fruits and vegetables (tomatoes, potatoes, peaches). The first step in minimizing allergy symptoms is to see what grass pollens you are allergic to. This can be accomplished via allergy testing. Patients are often tested for several different grass species usually dependent on which grasses are found in their area. A typical New England panel may include Rye grass, Bermuda grass, Timothy grass, Bahia grass, and Johnson grass. Allergy testing can be performed via a quick, pain-free skin test or by a blood test, which is often sent away to a reference lab. Both testing methods are safe and effective for diagnosing grass, as well as other types of environmental allergies. Skin testing is advantageous in that it can be performed in the office setting, the results are readily available, and multiple grass allergens can be tested. Modifying your environment can be very effective way to decrease grass allergy symptoms. This includes keeping home windows closed, staying indoors on high pollen days, not drying clothing outside, showering before bedtime, and wearing appropriate clothing when mowing the lawn. Medical management includes over the counter antihistamines (e.g. Claritin, Zyrtec) and intranasal steroid sprays (e.g. Flonase), decongestants as well as some other otc type medications. For patients who are interested in long term improvement and decreased usage of allergy medications, immunotherapy can be considered. Immunotherapy is a method to improve the body’s immune system against those allergens that one is reacting to negatively. Immunotherapy can be administer subcutaneously (SCIT – “allergy shots”) or sublingually (SLIT – “allergy drops”). Multiple studies over the past 50 years have consistently demonstrated that SCIT is a safe and effective way to minimize allergy symptoms. SLIT is the most common form of allergy treatment in Europe and many studies have show it to be as safe and effective as traditional “allergy shots”. The major disadvantage for SLIT is that it is currently not FDA approved (although the drops are made from the exact same extract as allergy shots), and therefore this treatment would not be covered through medical insurance. Many of our patients have been successfully treated with both types of immunotherapy over the past 15 years. If you or family members have questions or concerns regarding grass allergies, please do not hesitate to contact Colden & Seymour Ear, Nose, Throat, and Allergy to schedule an examination. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for direct medical evaluation and advice.

MMMM…..Wax Buildup

Posted on June 27th, 2016
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 & Seymour 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.