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Minimally Invasive Options for In-Office Sinus Surgery

At Raleigh Capitol ENT, our 14 Board-certified sinus surgeons 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. Read on to understand how all of these procedures are performed.

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Nosebleeds (Epistaxis)

Nosebleeds are a fairly common occurrence and the vast majority represent just a minor nuisance. They tend to be frightening because they can be profuse and dramatic but only rarely are they life-threatening. They can occur at any age but are most common under age 10 and over age 50. Nosebleeds can be divided into two types: anterior and posterior. Anterior epistaxis represents about 90% of nosebleeds and tend to be easier to manage. With an anterior nosebleed the blood will tend to come out the front of the nose. Bleeding that is more profuse and going down the back of the throat is more likely to be posterior. The nasal mucous membranes warm and humidify air as it passes through the nose. To accomplish this, the nose has a very rich vascular supply. There is a collection of blood vessels on the anterior septum called Kiesselbach’s plexus where the vast majority of nosebleeds occur. Often, there is no obvious cause for the bleeding and it may seem very random. Some factors that may cause bleeding inc ...

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How Acid Reflux Can Affect Your Throat

What Is Laryngopharyngeal Reflux (LPR)? The term reflux comes from a Greek word that means “backflow”. It usually refers to the backflow of stomach contents. Normally, once the things we eat reach the stomach, digestion should begin without stomach contents coming back up again……..refluxing. Laryngopharyngeal Reflux (LPR) refers to the backflow of food or stomach acid coming all the way back up into the larynx (the voice box) or the pharynx (the throat). LPR can occur day or night, even if a person hasn’t eaten a thing. Many People With LPR Don’t have Heartburn…..Why Is That? Some people experience discomfort such as heartburn, but not everyone with reflux has a lot of heartburn or indigestion. In fact, many people with LPR usually do not have heartburn. This is because the material that refluxes does not stay in the esophagus for very long. In other words, the acid does not have enough time to irritate the esophagus and cause heartburn. This is why LPR is call ...

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Nasal Valve Collapse

Nasal Valve Collapse is a relatively common cause of nasal obstruction.Although a deviated septum and enlarged turbinates are the most common causes of obstructed nasal breathing, nasal valve collapse can often contribute to blockage as well. The nasal valve is the narrow area of the tip of the nose composed of the tip cartilages and the septum. This is a small area and even a minor blockage can cause a big problem with breathing. Causes of collapse include nasal trauma, prior nasal surgery(especially rhinoplasty ), and congenitally weak nasal cartilages. Diagnosis can be made in the office or at home. Your physician can easily make the diagnosis during your visit, but often patients can diagnose this problem at home. You may have nasal valve collapse if: a) your breathing is improved when the cheek skin is pushed towards the ear,or b) your breathing is improved with Breathe-Right(or similar) strips Treatment is both non-surgical and surgical. Non-surgical treatment involves use of allergy medicines(such ...

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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

What is the Eustachian tube? 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. How does the Eustachian tube work? 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 th ...

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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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