It is Head and Neck Cancer Awareness Month

Posted in Uncategorized on March 2nd, 2017 with No Comments
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.

What is Obstructive Sleep Apnea?

Posted in Uncategorized on November 21st, 2016 with No Comments
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.

MMMM…..Wax Buildup

Posted in Uncategorized on June 27th, 2016 with No Comments
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.

Noise Induced Hearing Loss- What?????

Posted in Uncategorized on May 9th, 2016 with No Comments
Humans are exposed to all kinds of sounds on a daily basis; including cars, engines, televisions, or radios. Under most circumstances, these sounds are at safe levels and do not affect our hearing. However, when we are exposed to loud noises, sensitive structures inside the inner ear can be damaged. This condition is referred to as noise induced sensorineural hearing loss. Hearing is a complex mechanism which requires several structures to work together. The outer ear includes the pinna and external auditory canal. The pinna functions to collect sound waves and direct them into the auditory canal. Because of its unique structure, sounds are amplified as they travel towards the back of the auditory canal. The captured sound waves then reach the tympanic membrane (eardrum) at the back of the canal, causing it to vibrate back and forth. The eardrum represents the separating barrier between the outer and the middle ear. As the eardrum vibrates, three tiny bones behind it begin to shift with it. These tiny bones are considered the smallest in the body, and are called ossicles. The last tiny bone, commonly referred to as the stapes, then transfers the vibrating motion to the organ of hearing, the cochlea. It is inside the cochlea where tiny structures called “hair cells” convert the vibrating energy into an electrical signal. The signal travels to the brain where perception occurs. When noises are too loud, the tiny hair cells within the inner ear are damaged and eventually die. This results in decreased hearing. Noise induced hearing loss can be caused by a one-time exposure to an intense sound (such as a blast) or by continuous exposure to loud sounds over an extended period of time (working in a loud shop). Leisure activities can also put one at risk for noise induced hearing loss. This might include listening to MP3 players at high volumes or attending loud rock concerts. There are many other causes of hearing loss besides noise, and these causes include aging (presbycusis), genetics, disease (history of recurrent middle ear infections, viral inner ear infections, and Meniere’s disease), and trauma .The severity of hearing loss depends on all of these factors , which can co-exist and be additive. Individuals with a mild hearing loss might only experience difficulty hearing with background noises. Individuals with a severe hearing loss may experience difficulty during normal conversation, which can impact their personal and professional life significantly. Another common symptom of hearing loss is ringing or buzzing in the ear, which is referred to as tinnitus. Tinnitus will often come and go, and can be extremely bothersome to patients. Machines that create masking sounds (white noise) can be used to “cancel-out” the tinnitus in many cases. Noise induced hearing loss is the only type of hearing loss that can be completely prevented. The best way to do so is to avoid loud noises. If one cannot avoid excessive noise, hearing protection is recommended. Ear plugs or ear muffs are frequently used to help decrease loud noises. Proper assessment of hearing loss requires a hearing evaluation. If one suspects that their hearing has decreased it is important to see an otolaryngologist (Ears, Nose, and Throat physician) or licensed hearing professional who can perform a specialized hearing test. Depending on the results and exam, a patient may be a candidate for a hearing aid or other assistive listening devices. Other modalities include fabricating a custom ear plug that can minimize additional noise exposure if one is routinely exposed to loud noises at work or during hobbies (i.e. musicians). If a patient wishes to pursue hearing aids, a hearing aid evaluation is set up. During a hearing aid evaluation a trained audiologist or hearing instrument specialist will meet with the patient and help them find a hearing aid model which works best for them. If you have any questions about Noise Induced Hearing Loss or want to set up an evaluation with one of our Board Certified Ear Nose Throat specialists, or licensed audiologists or hearing instrument specialists, please contact us at Colden & Seymour Ear Nose Throat and Allergy at 978-997-1550, or through our website.

Springtime Allergies…Ahhh…those allergies!

Posted in Uncategorized on April 25th, 2016 with No Comments
Springtime has arrived and so have spring allergies. The spring is notoriously referred to as the “tree allergy season”. With warmer weather comes the onslaught of tree pollination. Billions of tiny airborne pollen particles are released into the environment and are carried great distances by the winds. As the pollen particles waft through the air they are easily inhaled by allergy sufferers which trigger a series of bothersome symptoms. This condition is sometimes referred to as “Hay Fever,” or seasonal allergic rhinitis, and affects roughly 30 to 60 million people in the United States on an annual basis. Seasonal allergies can cause a variety of symptoms. The most common include recurrent sneezing, a runny nose, watery/itchy eyes, and nasal or throat congestion. Severe allergies may cause polyps to form in the nose and sinus, further blocking the ability to breathe comfortably through the nose and triggering recurrent sinus infections. Conditions associated with hay fever include asthma, eczema, conjunctivitis, nasal polyps, sinusitis, sleep apnea, laryngitis, and ear infections. Individuals with asthma may become more symptomatic when exposed to tree allergens, and often report increased wheezing, shortness of breath, or coughing. Another strange symptom that may indicate that you have seasonal allergies is itchiness of the mouth and throat after eating raw fruits (apples, bananas). This condition is called oral allergy syndrome and is highly prevalent in individuals with tree allergies such as birch. The first step in minimizing spring allergies is to determine which trees you are sensitized (or allergic) to. An allergy test determines whether your body has an allergic reaction to a specific substance in the environment, in this case tree pollen. Because tree pollen particles have very unique proteins (and therefore have less cross-over between different types of trees), patients are often tested for several different tree species, usually dependent on which trees are found in their region. A tree allergy test panel for New England may include oak, elm, maple, sycamore, and birch to name a few of the more common tree pollen offenders. Allergy testing can be performed either via a quick pain-free skin test or by a blood test. Both types of testing are safe and can be effective for diagnosing tree allergies, as well as other types of allergies. Skin testing has the advantage of being performed in the office setting, and other benefits may include: immediately available results, the ability to test for multiple tree allergens, and the immediate patient feedback regarding how they react to certain tree pollens in their environment. In preparation for skin testing, patients are advised to discontinue taking antihistamines and other types of medications that may interfere with test results. Tree allergies can be treated in variety of ways. Firstly, environmental modifications are recommended for anyone who is allergic to pollen. This includes keeping home windows closed, staying indoors on high pollen days, not drying clothing outside, and showering before bedtime. If environmental modifications are not enough, medical management may be necessary. This includes over the counter antihistamines (e.g. Claritin, Zyrtec) and intranasal steroid sprays (e.g. Flonase). Other types of medications include nasal inhaled antihistamines, mast cell stabilizer nasal sprays, and oral decongestants. For patients who are interested in additional improvement and decreasing their usage of allergy medications, immunotherapy should be considered. Immunotherapy can be given in two different ways, including subcutaneous immunotherapy (SCIT or allergy shots) and sublingual immunotherapy (SLIT or allergy drops). SCIT (allergy shots) has shown repeatedly over the past 50 years to be a very safe and effective way to minimize both seasonal and year round allergies. SLIT (allergy drops) is the most common form of allergy treatment in Europe, and has been shown to be as effective and safe as traditional allergy shots, but has the added benefit of being able to do this treatment in the convenience of your home (you can self-administer the drops daily). The major disadvantage of SLIT is that it is currently not FDA approved in the USA (although the drops are made from the exact same allergy extracts that are used to create the allergy shots), and therefore this treatment would not be covered through medical insurance. If you or a family member have any concerns regarding spring allergies, please do not hesitate to contact Colden & Seymour Ear Nose Throat and Allergy and schedule an allergy evaluation as your first step towards symptom relief. Opinions expressed here are those of Dr. Daryl Colden and Christopher Jayne, BA. They are not intended as medical advice and cannot substitute for the advice of your personal physician.

What causes nose bleeds?

Posted in Uncategorized on April 19th, 2016 with No Comments
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.

What is Ear Fluid and What Can We Do?

Posted in Uncategorized on April 4th, 2016 with No Comments
The ear is made up of three major parts: the outer, middle, and inner ear. All of these various areas are essential for hearing, and when there is an abnormality in one area, it can affect hearing adversely. The outer ear consists of the pinna (the rigid cartilage covered by bone that we can see) and the auditory canal (a short tube from the pinna to the eardrum, or tympanic membrane). The middle ear contains the eardrum (tympanic membrane), and a small air-filled cavity behind it which contains three tiny bones, known as ossicles. These ossicles transmit sound to the inner ear, or the organ of hearing (cochlea), which will then transmit impulses via a major nerve (acoustic nerve) to the brain, which completes the hearing loop. The middle ear periodically becomes swollen (inflamed) and fluid accumulates in the air-filled region behind the eardrum. This condition is called otitis media with effusion (or middle ear fluid). Viral and bacterial infections are the most common cause of middle ear infections and the subsequent middle ear fluid that may accumulate. Children are more prone to infections and fluid buildup due to a variety of factors, including frequent exposure to others with illness, poor Eustachian tube function, or an immature immune system. Often, this middle ear fluid will result in a “blocked ear” feeling with decreased hearing. Under acute and more severe circumstances, patients will experience a localized ear pain, fever, irritability, and upper respiratory symptoms. Children with chronic middle ear fluid or recurrent ear infections may present with hearing deficits, poor attention, and even speech and language delays. Middle ear fluid can be diagnosed through a variety of methods. This includes use of a pneumatic otoscope (a small device that visualizes the ear canal and blows air towards the eardrum), a tympanogram (a test to evaluate eardrum mobility), and a specialized hearing test. Treatment options depend on the duration or frequency of ear symptoms. For patients experiencing their first ear infection, antibiotics and ibuprofen are usually the treatment of choice. If there are nasal or allergy symptoms occurring with the ear issues, it would be helpful to evaluate and treat these potential triggers. If a patient experiences recurrent ear infections or chronic middle ear fluid, ventilation ear tube insertion may be considered (ear tubes). These microscopic tubes are placed to remove ear fluid, reduce or eliminate ear infections, and restore the ability to equalize pressure between the middle ear and outside atmosphere (for example: no ear pressure when flying). Placing ear tubes is a short and painless procedure which can sometimes be done in the office setting but other times may require anesthesia in the hospital.
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