What are ear tubes?
Ear tubes, also known as PE tubes or Pressure Equalization tubes, are small cylindrical silicone or plastic tubes that are surgically placed into the ear drum.
When are ear tubes necessary?
Ear tubes are typically placed for 4 reasons:
1. Recurrent Otitis Media. This is the most common reason for ear tube placement for children between the ages of 1 and 6 years old. Tubes are generally considered for patients who are having 5 or more ear infections per year.
2. Persistent Acute Otitis Media. Antibiotic resistant bacteria are becoming more prevalent and we are seeing more and more ear infections that will not clear with oral antibiotics. If an acute infection is not clearing with 2-3 courses of broad spectrum antibiotics, ear tubes are frequently recommended.
3. Otitis Media with Effusion. Middle ear fluid is common for several weeks following an ear infection. If however, fluid persists for 3 or more months, ear tubes are frequently recommended.
4. Eustachian tube dysfunction. While most children will outgrow their tendency towards ear infections around the age of 6, some go on to have chronic Eustachian tube problems. This typically manifests as frequent middle ear fluid, ear pressure, and ear infections. Adults with these issues often have tubes placed to alleviate their symptoms.
Why do young children have frequent ear infections?
Between the birth and the age of 6, the Eustachian tube is slow to mature. As a result, children develop middle ear fluid more readily than adults. Children are also exposed to frequent upper respiratory infections. Both of these factors cause an increased risk of developing an ear infection. Additional risk factors include exposure to large numbers of children (day care or pre-school) , exposure to tobacco smoke, and congenital abnormalities of the palate (cleft palate).
How do ear tubes work?
Ear tubes act as a ventilation device, preventing pressure build up behind the eardrum. In doing so, they prevent the build up of fluid, thus minimizing the chance of developing an ear infection. Tubes also serve as a drain, allowing fluid or infection that is present at the time of surgery to be drained from the ear.
How long do tubes last?
Ear tubes generally stay in the eardrum between 6 months and 3 years. The duration is based on the type of tube used and individual variation from patient to patient.
Can I swim if I have ear tubes?
Yes. For bathing and swimming on the surface of a swimming pool, no precautions are necessary. For older children and adults who may dive deeper than 2 feet under water, ear plugs are recommended.
Is anesthesia required for tube placement?
A brief general anesthesia is required for tube placement in children. Adults can have ear tubes placed in an office setting using topical anesthesia (numbing drops on the eardrum).
Who performs ear tube placement?
Ear, Nose, and Throat specialists are trained to perform ear tube placement for both children and adults.
Thursday, August 11, 2011
Thursday, June 23, 2011
Summer ENT Care
With the arrival of summer this week, summer activities are in full swing, including regular swimming, diving and more active water sports such as water skiing, wakeboarding and tubing. While much attention is directed to safety in and on the water, we see water related ear problems every year, most of which are entirely unavoidable and random. It can be confusing as a patient trying to decide whether an ear needs to be seen and how quickly that is necessary.
Otitis externa (“swimmer’s ear”), is easily the most frequently seen ENT problem related to water activities. It accounts for numerous office visits in a specialty ENT practice, as well as in primary care offices and urgent care centers. Pain in the ear (often quite severe) with blockage and often drainage are hallmarks of this problem. The ear is often exquisitely sensitive to pressure or pulling on the visible outside portion of the ear. While this condition often responds well to antibiotic eardrops, especially when discovered early in its course, it can occasionally be difficult to resolve and may require careful cleaning with an ENT specialist employing a microscope. It is essentially a localized infection in and on the skin of the ear canal, and it can involve bacteria or fungi. Rarely, additional preventive measures may be recommended, such as preventive drops or earplugs, but that is not routinely required.
With diving, body surfing and high-speed activities such as water skiing, traumatic water injuries (especially to the ear drum) can occur, and we see and treat them regularly. The surface of a body of water (pool, lake or ocean) can effectively “slap” the ear when someone lands wrong, especially at greater speeds or from greater heights, and send a pressure wave toward the eardrum, which can injure it. This does not always produce a perforation or hole in the eardrum, but often it does. If an injury of this type is associated with lingering alteration of hearing, pain or drainage beyond 24 hours, it is wise to be seen by an ENT specialist for a careful examination of the ears, often including an audiogram. The vast majority of injured eardrums will heal on their own and do not require any treatment; however, the drum will occasionally require attention at the time of injury to avoid failed healing and a bigger procedure later.
A similar blow to the ear with associated significant dizziness can represent a far more serious condition requiring immediate attention. While mild disorientation and brief dizziness may seem normal after wiping out on a wakeboard or with similar incidents, any severe and persistent dizziness should be evaluated as promptly as possible, to be certain a potentially dangerous injury behind the eardrum has not occurred. Fortunately, these more severe episodes are far less frequent.
Enjoy a healthy and active summer!
Mark W. Clarkson, MD
Raleigh ENT, Head & Neck Surgery
Otitis externa (“swimmer’s ear”), is easily the most frequently seen ENT problem related to water activities. It accounts for numerous office visits in a specialty ENT practice, as well as in primary care offices and urgent care centers. Pain in the ear (often quite severe) with blockage and often drainage are hallmarks of this problem. The ear is often exquisitely sensitive to pressure or pulling on the visible outside portion of the ear. While this condition often responds well to antibiotic eardrops, especially when discovered early in its course, it can occasionally be difficult to resolve and may require careful cleaning with an ENT specialist employing a microscope. It is essentially a localized infection in and on the skin of the ear canal, and it can involve bacteria or fungi. Rarely, additional preventive measures may be recommended, such as preventive drops or earplugs, but that is not routinely required.
With diving, body surfing and high-speed activities such as water skiing, traumatic water injuries (especially to the ear drum) can occur, and we see and treat them regularly. The surface of a body of water (pool, lake or ocean) can effectively “slap” the ear when someone lands wrong, especially at greater speeds or from greater heights, and send a pressure wave toward the eardrum, which can injure it. This does not always produce a perforation or hole in the eardrum, but often it does. If an injury of this type is associated with lingering alteration of hearing, pain or drainage beyond 24 hours, it is wise to be seen by an ENT specialist for a careful examination of the ears, often including an audiogram. The vast majority of injured eardrums will heal on their own and do not require any treatment; however, the drum will occasionally require attention at the time of injury to avoid failed healing and a bigger procedure later.
A similar blow to the ear with associated significant dizziness can represent a far more serious condition requiring immediate attention. While mild disorientation and brief dizziness may seem normal after wiping out on a wakeboard or with similar incidents, any severe and persistent dizziness should be evaluated as promptly as possible, to be certain a potentially dangerous injury behind the eardrum has not occurred. Fortunately, these more severe episodes are far less frequent.
Enjoy a healthy and active summer!
Mark W. Clarkson, MD
Raleigh ENT, Head & Neck Surgery
Wednesday, April 20, 2011
CT Scan
At Raleigh ENT we strive to provide excellent care. We also know that our patients are busy and appreciate convenience. We are pleased to be able to offer in office CT (CAT) scans for evaluation of the sinuses.
What is a CT scan?
CT scanning, sometimes called CAT scanning, is a noninvasive medical test that helps physicians diagnose and treat medical conditions. CT scanning combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body.
X-rays are not needed for all patients, and your doctor will suggest what is appropriate when you are in for your visit. However, if a CT scan is needed, it can often be done during your visit.
When is a CT scan needed?
For example, sometimes a patient has been suffering with sinusitis for months. The primary care physician has provided appropriate treatment, yet nothing seems to work. After talking to her and examining her, her physician at Raleigh ENT decides more information is needed. A CT scan can be done to show all of the sinuses and nasal passages. Results are available within minutes and can be reviewed with you in the office. Perhaps the sinuses are free of infection and alternative diagnoses like allergies or migraines can be considered. Perhaps she has polyps or some other blockage that needs to be addressed. Or maybe chronic sinusitis is found and more antibiotics or surgery are needed.
This convenient test (when appropriate) can help you and your doctor make the most informed decision about treatment.
Does it hurt?
No. The scanning takes less than five minutes. We can accommodate children, adults, and older patients. We use advanced technology (Siemens CARE dose) to deliver maximum image quality with minimized radiation doses.
What is a CT scan?
CT scanning, sometimes called CAT scanning, is a noninvasive medical test that helps physicians diagnose and treat medical conditions. CT scanning combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body.
X-rays are not needed for all patients, and your doctor will suggest what is appropriate when you are in for your visit. However, if a CT scan is needed, it can often be done during your visit.
When is a CT scan needed?
For example, sometimes a patient has been suffering with sinusitis for months. The primary care physician has provided appropriate treatment, yet nothing seems to work. After talking to her and examining her, her physician at Raleigh ENT decides more information is needed. A CT scan can be done to show all of the sinuses and nasal passages. Results are available within minutes and can be reviewed with you in the office. Perhaps the sinuses are free of infection and alternative diagnoses like allergies or migraines can be considered. Perhaps she has polyps or some other blockage that needs to be addressed. Or maybe chronic sinusitis is found and more antibiotics or surgery are needed.
This convenient test (when appropriate) can help you and your doctor make the most informed decision about treatment.
Does it hurt?
No. The scanning takes less than five minutes. We can accommodate children, adults, and older patients. We use advanced technology (Siemens CARE dose) to deliver maximum image quality with minimized radiation doses.
Tuesday, November 30, 2010
Sudden Sensorineural Hearing Loss
This month’s blog will cover Sudden Sensorineural Hearing Loss (SSNHL), which is defined as sensorineural hearing loss of at least 30 dB in 3 sequential frequencies that occurs over 3 days or less. The incidence of SSNHL is 5-30 cases per 100,000 per year. Tinnitus is an associated symptom approximately 80% of the time.
Hearing loss can cause significant limitations on activities of daily living and communication. Any significant hearing loss should be evaluated by a physician. Your primary care physician can evaluate for cerumen, otitis media, and middle ear fluid. If no clear cause of the hearing loss is identified, prompt referral to an otolaryngologist is the next step in the evaluation to confirm or exclude a diagnosis of SSNHL. A thorough history and neuro-otologic exam is then performed. In SSNHL, typically the outer ear and middle ear exam are normal and the diagnosis is confirmed with comprehensive audiogram.
The list of possible causes of SSNHL is fairly long and broad. The more common etiologies that can cause SSNHL include viral/infectious (eg. Mumps, varicella, HIV, etc.), vascular (blood flow problems to the inner ear), immune-mediated, neurological, and medication related etiologies. Typically, it is difficult to determine the exact cause in most patients.
Prognosis for hearing recovery is generally good but can be highly variably and some patients do not recover any hearing no matter the treatment.
Treatment recommendations are made depending on the underlying cause of the SSNHL. Studies have shown that the chances for hearing improvement increase when treatment is given within 2 weeks of the onset of the hearing loss. In the absence of a definitive cause, oral prednisone (10-14 days) is the most common recommended treatment. Intratympanic steroid injections can also be considered, particularly when oral steroids are contraindicated (eg. some diabetics). Antiviral medications have been utilized in certain circumstances, but are generally not helpful. Patients then require close follow up exams and audiometric testing to measure their improvement. Audiometric rehabilitation is considered when the hearing stabilizes. Other symptoms such as tinnitus or vertigo may require special attention and treatment.
In summary, Sudden Sensorineural Hearing Loss, though not common, can cause significant morbidity and impact on one’s lifestyle. Prompt diagnosis and treatment can increase the chances for a full recovery. The physicians and audiologists at Raleigh ENT are available to help patients who may have SSNHL or related concerns.
Hearing loss can cause significant limitations on activities of daily living and communication. Any significant hearing loss should be evaluated by a physician. Your primary care physician can evaluate for cerumen, otitis media, and middle ear fluid. If no clear cause of the hearing loss is identified, prompt referral to an otolaryngologist is the next step in the evaluation to confirm or exclude a diagnosis of SSNHL. A thorough history and neuro-otologic exam is then performed. In SSNHL, typically the outer ear and middle ear exam are normal and the diagnosis is confirmed with comprehensive audiogram.
The list of possible causes of SSNHL is fairly long and broad. The more common etiologies that can cause SSNHL include viral/infectious (eg. Mumps, varicella, HIV, etc.), vascular (blood flow problems to the inner ear), immune-mediated, neurological, and medication related etiologies. Typically, it is difficult to determine the exact cause in most patients.
Prognosis for hearing recovery is generally good but can be highly variably and some patients do not recover any hearing no matter the treatment.
Treatment recommendations are made depending on the underlying cause of the SSNHL. Studies have shown that the chances for hearing improvement increase when treatment is given within 2 weeks of the onset of the hearing loss. In the absence of a definitive cause, oral prednisone (10-14 days) is the most common recommended treatment. Intratympanic steroid injections can also be considered, particularly when oral steroids are contraindicated (eg. some diabetics). Antiviral medications have been utilized in certain circumstances, but are generally not helpful. Patients then require close follow up exams and audiometric testing to measure their improvement. Audiometric rehabilitation is considered when the hearing stabilizes. Other symptoms such as tinnitus or vertigo may require special attention and treatment.
In summary, Sudden Sensorineural Hearing Loss, though not common, can cause significant morbidity and impact on one’s lifestyle. Prompt diagnosis and treatment can increase the chances for a full recovery. The physicians and audiologists at Raleigh ENT are available to help patients who may have SSNHL or related concerns.
Thursday, October 7, 2010
Tonsil Stones
This month’s blog deals with the common and often embarrassing problem of tonsil stones. Tonsils stones (or tonsilliths) are small clumps of whitish, odorous debris that collect in the surface crevices (crypts) of the tonsils. Many people think they are food particles, but they are primarily made up of shedded epithelium. The epithelium or surface lining of the tonsil will shed, much like skin sheds, and collect in the crypts of the tonsils. This epithelial debris may then mix with bacteria, resulting in a low grade sore throat and/or chronic bad breath. When the tonsilliths fill the crypt they may be coughed out or sometimes removed with pressure from a Qtip or the patient’s finger. After removal, they will generally recollect within weeks to months. They can be extremely annoying but are not dangerous, so if they are noticed infrequently and are only mildly symptomatic, they do not require treatment. However, for some patients, tonsilliths can be a weekly or even daily annoyance, and these patients often seek remedies.
The only permanent solution for tonsilliths is removal of the tonsils (tonsillectomy). Tonsillectomy is generally performed as an outpatient procedure under general anesthesia and the postoperative course is often quite painful. Usually the patient requires a week out of work or school. One alternative to complete tonsillectomy is cryptolysis or laser ablation of the tonsils. At Raleigh ENT this procedure is performed in the office under local anesthesia with the use of the carbon dioxide laser. The laser is used to remove enough of the tonsil to open up the crypts and therefore prevent reaccumulation of the tonsilliths. Generally, there is less pain than that associated with complete tonsillectomy and some patients may be able to return to work the next day. Not all patients may be appropriate for this procedure based on their anatomy as well as the activity of their gag reflex. A video demonstrating this procedure is available for review at www.thedoctorstv.com/main/procedure_list/279. Please call 787-7171 if you would like to schedule an appointment and discuss options of treatment with one of our physicians.
Stephen E. Boyce, MD, FACS
The only permanent solution for tonsilliths is removal of the tonsils (tonsillectomy). Tonsillectomy is generally performed as an outpatient procedure under general anesthesia and the postoperative course is often quite painful. Usually the patient requires a week out of work or school. One alternative to complete tonsillectomy is cryptolysis or laser ablation of the tonsils. At Raleigh ENT this procedure is performed in the office under local anesthesia with the use of the carbon dioxide laser. The laser is used to remove enough of the tonsil to open up the crypts and therefore prevent reaccumulation of the tonsilliths. Generally, there is less pain than that associated with complete tonsillectomy and some patients may be able to return to work the next day. Not all patients may be appropriate for this procedure based on their anatomy as well as the activity of their gag reflex. A video demonstrating this procedure is available for review at www.thedoctorstv.com/main/procedure_list/279. Please call 787-7171 if you would like to schedule an appointment and discuss options of treatment with one of our physicians.
Stephen E. Boyce, MD, FACS
Monday, May 10, 2010
Sublingual Immunotherapy
As spring has arrived in the Triangle, we thought that sublingual immunotherapy (SLIT) would be a timely topic for our second blog post. As opposed to allergy shots, SLIT consists of allergy drops placed under the tongue. SLIT has been popular in Europe for years and is becoming increasingly popular in the United States. SLIT has an excellent safety profile so patients can do the treatment at home. The advantage for needle phobic patients is obvious.
While SLIT is an attractive option for some patients, there are also some disadvantages. SLIT is not yet FDA approved in the United States and most insurance companies consider SLIT an alternative treatment for allergies and asthma. Patients are responsible for the cost of the serum. Optimal dosing in SLIT is an area of controversy. At Raleigh ENT, we follow dosing protocols advocated by the American Academy of Otolargngic Allergy. Finally, while many studies show that SLIT is an effective treatment, there is still some question whether SLIT is equally as effective as allergy shots.
At Raleigh Ear, Nose, and Throat we offer allergy testing and treatment that ranges from medical treatment to immunotherapy (SLIT or allergy shots). We feel that SLIT is a nice option for some of our allergy patients.
While SLIT is an attractive option for some patients, there are also some disadvantages. SLIT is not yet FDA approved in the United States and most insurance companies consider SLIT an alternative treatment for allergies and asthma. Patients are responsible for the cost of the serum. Optimal dosing in SLIT is an area of controversy. At Raleigh ENT, we follow dosing protocols advocated by the American Academy of Otolargngic Allergy. Finally, while many studies show that SLIT is an effective treatment, there is still some question whether SLIT is equally as effective as allergy shots.
At Raleigh Ear, Nose, and Throat we offer allergy testing and treatment that ranges from medical treatment to immunotherapy (SLIT or allergy shots). We feel that SLIT is a nice option for some of our allergy patients.
Tuesday, February 23, 2010
First Blog Post
Welcome to Raleigh ENT’s first blog post. We want to use this space to provide updates about our practice. Mostly I anticipate this will be in the form of clinical information. We are excited about the new additions to our website and want to be able to connect to our patients through a variety of ways.
The first topic is balloon sinuplasty. This is a relatively new tool we have to deal with chronic sinus infections. Through the years there have been important advances in the surgical treatment of sinus infections. In the 1980’s endoscopic surgery provided an enhanced view of the sinus passages and improved the accuracy of the procedure. In the 1990’s image guided techniques provided an intraoperative road map of the sinuses. This gives us anatomical detail on the order of several millimeters during a procedure and helps us to safely dissect within the sinus passages.
Balloon sinuplasty is another important advancement. The goal of sinus surgery is to improve the natural drainage pathways. A balloon is advanced over a guide wire into the offending sinus. The balloon is then inflated which safely and relatively atraumatically enlarges the natural opening. This is a similar concept to angioplasty to help relieve clogged arteries.
Our goal is to continually evaluate how we practice medicine. We are constantly learning new techniques and evaluating their role in treating disease. We look forward to passing along what we learn.
The first topic is balloon sinuplasty. This is a relatively new tool we have to deal with chronic sinus infections. Through the years there have been important advances in the surgical treatment of sinus infections. In the 1980’s endoscopic surgery provided an enhanced view of the sinus passages and improved the accuracy of the procedure. In the 1990’s image guided techniques provided an intraoperative road map of the sinuses. This gives us anatomical detail on the order of several millimeters during a procedure and helps us to safely dissect within the sinus passages.
Balloon sinuplasty is another important advancement. The goal of sinus surgery is to improve the natural drainage pathways. A balloon is advanced over a guide wire into the offending sinus. The balloon is then inflated which safely and relatively atraumatically enlarges the natural opening. This is a similar concept to angioplasty to help relieve clogged arteries.
Our goal is to continually evaluate how we practice medicine. We are constantly learning new techniques and evaluating their role in treating disease. We look forward to passing along what we learn.
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