Ear, Nose & Throat - Otolaryngology

The GBMC Department of Otolaryngology specializes in treating a variety of disorders of the ears, nose and throat.

Voice & Throat Disorders

Disorders of the throat, or pharynx, and voice box, or larynx, can take many forms, including:

• Cancers and Tumors
• Epiglottitis — Bacterial infection of the epiglottis.
• Gastroesophageal Reflux (GERD / Heartburn) and Laryngopharyngeal Reflux (LPRD) — Backflow of stomach acid into the esophagus can cause hoarseness, swallowing problems and pain.
• Laryngitis — Inflammation of the voice box from the common cold, bronchitis, overuse of the voice, allergies or irritants.
• Laryngoceles — Air or mucus-filled, inward or outward bulgings of the voice box lining. Most common in wind instrument players.
• Mononucleosis
• Pharyngitis (Sore Throat) & Streptococcal Pharyngitis (Strep Throat)
• Tonsillitis (Swelling of the tonsils), Tonsillar Cellulitis (Bacterial infection of the tonsils) and Tonsillar Abscesses (Pus collection around the tonsils).
• Vocal Cord Paralysis — Loss of movement of the muscles that control one or both vocal cords. Paralysis of one vocal cord leaves the voice breathy or hoarse; paralysis of both weakens the voice and makes breathing difficult when exercising.
• Vocal Cord Nodules and Polyps — Benign (non-cancerous) growths that form from overuse of the voice, smoking, irritants or acid reflux.
• Vocal Cord Contact Ulcers — Sores in the cartilage around the vocal cords caused by straining the voice, frequent talking, smoking, coughing or acid reflux.

Changes in the voice are often indicative of a medical problem; patients experiencing hoarseness or other voice changes should see a physician to determine the cause.

Sinus, Allergy and Nasal Disorders

Sinus and Allergy

The sinuses are small, hollow chambers inside the nose and head that reduce the weight of the facial bones, give the bones shape and support, assist in mucus drainage from the nose, and help the voice resonate. Healthy sinuses are filled with air. When their mucous membranes swell from allergies, the common cold, infection or another cause, the sinuses become blocked, the pressure inside them drops, and they can fill with fluid, which easily leads to bacterial infection (called sinusitis, or rhinosinusitis if the nasal tissues are also affected). Blocked, inflamed or infected sinuses can be very painful. 

There are four groups of sinuses:

• Maxillary (in the cheekbones)
• Ethmoid (along the nose)
• Frontal (above the eyes)
• Sphenoid (behind the ethmoids).

Any or all of these may be involved in an allergy or sinus infection. Pain or discomfort may occur in many areas of the face and head, including the cheeks, eyes, forehead and teeth. 

Sinusitis may be acute (short-term, after a cold or flu) or chronic (more than 8-12 weeks). Acute sinusitis symptoms include:

• Thick yellow or green discharge from the nose
• Sharp pain
• Headache and fever.

Symptoms of chronic sinusitis are less obvious and may include:

• Nasal blockage or congestion
• Post-nasal drip
• Reduced sense of smell
• Malaise

A diagnosis of sinusitis is made after a description of symptoms, a physical examination and potentially one or more imaging tests such as an x-ray, CT scan, or endoscopic examination under local anesthesia. Treatment may include a nasal spray, antibiotic, corticosteroid or antihistamine. In some cases the patient may wish to undergo surgery to clean the sinuses, improve drainage or realign a deviated septum. 

Allergies are a common cause of inflamed sinuses and headaches as well as runny or itchy nose, sneezing, itchy or watery eyes, blocked or itchy ears, rashes, and wheezing. Allergies are, in essence, an overreaction by the body's immune system to one or more objects in the environment. Nasal endoscopy, blood tests or skin "scratch" tests are often all that is needed to determine the presence and cause of an allergy. The physician and patient can work together to plan treatment and management of symptoms. 

Nasal Disorders

Deviated Septum 
The septum is made of bone and cartilage and spans the nasal cavity from the nostrils to the back of the throat. Ideally, the septum is straight and equally divides the two sides of the nasal cavity. However, in many people the septum has a slight bend, making one side of the cavity smaller than the other. In some cases the deviation is significant enough to cause problems such as congestion, sinusitis (inflammation of the sinuses), nosebleeds and breathing difficulties. Surgery to repair the deviation may be elected if symptoms are severe. 

Perforations of the Septum 
Perforations, or holes, in the septum can form after nasal surgery, injury, repeated picking of the nose, diseases or drug use. Symptoms include frequent nosebleeds, crusting around the nostrils and a whistling noise when breathing. These can be treated with Bacitracin and pinching the nose to stop bleeding; however, patients may choose to undergo surgery in which skin grafts or plastic membranes are used to repair the perforation(s). 

Nasal Polyps 
Nasal polyps are small, soft, teardrop-shaped growths that form around the openings to the sinuses. They are not tumors or cancer (although the physician may study a sample to confirm the diagnosis) but merely indicate that the nose or sinuses are inflamed. Symptoms that may occur along with polyps include congestion, drainage (runny nose), blockage and infection. 

Nasal Vestibulitis 
Nasal vestibulitis is caused by infection with the bacteria staphylococcus (the same organism that causes strep throat) in the area just inside the nostrils, otherwise known as the nasal vestibule. Typical symptoms are swelling, redness, tenderness, pimples around nasal hairs, and/or crusting. In most cases simple application of Bacitracin ointment and hot washcloths or antibiotics are sufficient to treat the infection. Occasionally, infections can cause boils, spread beneath the skin (cellulitis), and rarely, spread through facial veins to the brain in a condition called cavernous sinus thrombosis. For this reason infections that persist should be examined by a physician. 

Nosebleed (Epistaxis) 
Nosebleeds are quite common and hardly ever indicate the presence of a serious problem. Typical causes include nose picking, injury, dry air, and anticoagulant drugs such as aspirin. Thus many nosebleeds can be prevented by keeping fingers and other objects out of the nose, humidifying air in winter or moistening the front of the nostrils with petroleum jelly (e.g. Vaseline). If a bleed occurs, the best at-home treatment is to pinch the nose closed firmly for 5-10 minutes without letting go. This tends to be more effective than icing, placing tissue in the nose or tilting the head. Severe or frequent bleeds may be treated by a physician with a temporary sponge or nasal packing or with cauterization. More extensive care needs to be given in rare cases where bleeding originates in the back of the nose (posterior nosebleed). 

Swallowing Problems (Dysphagia)

There are many possible causes for a person to suffer difficulty or pain when swallowing food or liquid. The most common causes include:

• Conditions that narrow the esophagus — Sore, swollen or infected throat; esophageal strictures caused by lodged pills or other objects; gastroesophageal reflux disease (heartburn); tumors or cancers.
• Conditions that compress the esophagus from the outside - Goiter (enlarged thyroid gland), tumors, cancers or other abnormalities of the throat, larynx, spine and neck.
• Dry mouth — Sjogren syndrome, nerve or brain damage, medication side-effects.
• Muscle weakness — Autoimmune or nerve disorders, nerve or brain damage such as ALS or stroke.

Patients with dysphagia will be asked about the exact sensations they feel when swallowing, how quickly the problem appeared and how long it has been occurring. They will also be asked what medications they are taking, what other symptoms they are experiencing, and whether there is a family history of such problems. If a physical exam is not enough to make a diagnosis, other tests may be ordered. Treatment and recovery depend on the underlying condition.

Hearing & Balance Disorders

Hearing loss and deafness affect almost 30 million people in the U.S. Possible causes of hearing loss are divided into three groups:

• Sensorineural (aging, drugs, tumors, current or past infections, congenital or genetic abnormalities, loud noises, sudden changes in air pressure)
• Conductive (ear infection or obstruction, perforated eardrum, cholesteatoma, otosclerosis)
• Mixed causes

Whatever the cause, hearing problems can be frustrating and even harmful, especially for children who are undergoing language acquisition and developing speech habits. Most hearing loss is neither preventable nor curable, but hearing aids or cochlear implants may help patients understand speech better and hear quieter or higher-pitched sounds.