Blog

Wax Impaction

Cerumen (wax) impaction occurs when the external ear canal becomes blocked by an excessive amount of normally occurring wax. Cerumen is made by tiny glands in the outer aspect of the ear canal. Wax is very beneficial and its purpose includes protecting the outer ear from moisture and other things which might enter the canal. In most people, the ear is self cleaning and the wax will come out periodically on its own. In others, cerumen may accumulate faster than it extrudes itself, leading to blockage and hearing loss or a feeling of fullness or pressure. The most common cause of cerumen impaction is placing some object in the ear to try to remove the wax (Q-tip, bobby pin, or the top of a pen). In addition, water may sometimes get around the impacted cerumen and the warm and dark environment may lead to a bacterial of fungal infection. The Physicians at Capitol Ear, Nose, & Throat recommend that the first time you experience cerumen impaction, you should be evaluated by a physician to make sure there is ...

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Minimally Invasive Options for Sinus Surgery in the Office

As a fellowship-trained rhinologist, Dr. Jeevan Ramakrishnan specializes in the medical and surgical treatment of patients with disorders of the nose and sinuses. After completing his Otolaryngology residency at the University of Arkansas, he completed additional fellowship training in the subspecialty of rhinology at the University of Pittsburgh, where he received specialized training in nasal and sinus surgery. He is pleased to bring his expertise to Raleigh and writes today about minimally invasive options for sinus surgery in the office. At Capitol ENT, we constantly strive to provide comprehensive services for our patients with sinonasal disorders, and are now pleased to offer several new procedures that can be performed in the office under local anesthesia. These include balloon sinuplasty for chronic sinusitis, turbinate reduction for nasal congestion, and nasal polypectomy. Performing these procedures in the office provides many benefits including minimally invasive techniques, reduced bleeding, ver ...

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Thyroid Nodules

The thyroid gland sits in the front part of the neck below and overlying the larynx or voice box. It secretes hormones that help regulate overall body metabolism and maintain calcium balance in the body. A common disorder of the thyroid is formation of a nodule. These can be solitary or multiple and may be solid or fluid-filled (cystic). Some nodules contain thyroid cancer but even benign ones can grow large enough to compress the trachea (windpipe) and/or esophagus (swallowing tube) causing difficulty breathing or swallowing. Fortunately the majority of thyroid nodules are noncancerous but the chance of a thyroid cancer is high enough that nodules should be addressed. Evaluation usually includes a blood test to determine the overall level of thyroid gland hormone production. A thyroid ultrasound scan is almost always done to assess the size, location, consistency of the nodule(s), and relationship to nearby structures. A needle biopsy is frequently performed to obtain cells for analysis and this may ...

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Eustachian Tube Problems

The Eustachian tube is a narrow tube-like passageway that connects the thimble-sized space behind the eardrum (the middle ear) to the space behind the nose. Its purpose is to provide a way for air to move in or out of the middle ear so that the air pressure in the ear is always equal to the air pressure around us, even with changes in external air pressure. When the Eustachian tube is working perfectly, it is closed and opens only very briefly when we swallow or yawn. There is a pulley-like muscle above the roof of our mouth that pulls it open when we swallow or yawn. Some people can actually hear a “crackling” sound every time this happens. Others hear it only sometimes, while some never hear it. Almost everyone becomes aware of this air movement when their ears finally “pop” during altitude changes such as during airplane flights or while ascending or descending a mountain or high elevator shaft. During these altitude changes, before the Eustachian tube opens to equalize the pressur ...

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Sublingual Immunotherapy (Allergy Drops)

Do you suffer from allergies or hay fever? You are not alone. Allergies, or allergic rhinitis, is an extremely common condition, affecting between 10% and 30% of adults and up to 40% of children. In total, allergic rhinitis is estimated to affect approximately 60 million people in theUnited States, resulting in more than 12 million visits to the doctor per year! In addition, the prevalence of allergic rhinitis has been increasing over the past decade! Allergic rhinitis can cause symptoms such as sneezing, nasal drainage and congestion, itchy watery eyes, headache, fatigue, and many other symptoms that can significantly affect your quality of life. Fortunately, there are many good, safe medications that can be used to help alleviate symptoms, such as antihistamines, nasal steroids sprays, and leukotriene blockers. For most patients, these medications will control allergy symptoms and improve the quality of your life. But for some patients with severe allergies, these medications are not enough and symptoms pe ...

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Ear Tubes

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: 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. 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. 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. Eustachian tube dysfunction. Whi ...

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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 ...

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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 ...

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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 etiol ...

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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 patie ...

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