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.
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.
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.
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.
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.
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.
The nasal septum is a structure partially composed of bone and cartilage which divides the right and left nasal passages. When the septum is shifted or “deviated,” it can lead to a variety of symptoms including nasal blockage, congestion, bloody noses (epistaxis), snoring and also be a trigger for sinus problems.
Deviated nasal septum’s can occur for many reasons, the most common being related to trauma. Many times people are born with a deviated septum and may not notice the symptoms until later in life.
A deviated nasal septum may be seen in conjunction with deformities of the nasal bones (nasal fracture), but many times a deviated septum is not visible to the naked eye. A deviated septum may be detected on imaging such as an Xray or CAT scan, but it may be best evaluated by a simple painless in office examination called a nasal endoscopy ,usually done by an Ear Nose Throat Specialist.
Although there is no specific medical treatment for a nasal septum deviation, many specialists will use various medications to treat co-existing conditions that can cause similar symptoms, such as environmental allergies and chronic sinusitis (inflammation). If symptoms are significant enough, a routine surgical procedure may be considered , which is known as a septoplasty. When performing a septoplasty, the crooked cartilage and bony is straightened to improve nasal breathing and reduce other symptoms. This outpatient surgical procedure has a high success rate with minimal recovery and discomfort. A septoplasty may be performed in conjunction with other surgical procedures, such as sinus surgery, balloon sinus dilation, nasal fracture repair and also rhinoplasty (cosmetic refinement of the external nasal structures).
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.