Vernick & Gopal LLC

Hearing Aids Hearing aids are a common non-invasive treatment option for hearing loss. A hearing aid is a small electronic device worn in or behind the ear to amplify sounds. While hearing aids are useful in improving listening and communication, they do not cure hearing impairment or make the ear function normally. A hearing aid includes three components: a microphone, an amplifier and a speaker. Sounds are received through the microphone, intensified by the amplifier, and transmitted to the ear through the speaker. The microphone, which picks up sounds from the air, converts them into electrical signals. Once these sounds have been made more powerful by the amplifier, they are changed back into acoustic signals to be heard by the person wearing the hearing aid. In addition to these three components of hearing aids, digital hearing aids also make use of a small computer. As hearing aids amplify sounds, hair cells within the ear detect these sounds and convert them into signals to pass to the brain. Hearing aids do not work for every person with a hearing impairment. The issues of those with receptive hearing difficulties may not be resolved by hearing aids since the devices are only able to increase volume, not reception. For those individuals, the problem is akin to listening to a radio with static. No matter how loud you turn the volume up, the static remains. Types of Hearing Aids There are three basic styles of hearing aids that vary in size, placement and degree of amplification. Determining which style is best for the individual depends on the severity of the hearing loss. Behind the Ear (BTE) These hearing aids are worn behind the ear and connected to a plastic mold that is placed inside the outer ear. They are utilized by individuals with mild to profound hearing loss. New technology has introduced a smaller BTE aid consisting of only a small tube placed into the ear canal. This has the advantages of keeping the canal open and protecting the device from damage due to wax buildup. This smaller BTE also provides a clearer sound. In the Ear (ITE) These hearing aids are smaller devices that fit inside the outer ear. They can be used for mild to severe hearing loss but are not typically used for children since they will be quickly outgrown. Canal Canal aids are the smallest type of aid and fit either in the canal, ITC, or completely in the canal, CIC. Because canal aids are so small, they may be hard to adjust and have very limited space for batteries and other devices. Canal aids, therefore, are most frequently recommended for individuals with mild to moderate hearing loss. Regardless of style, hearing aids work in two different ways depending on how they are electronically programmed. Analog Hearing Aids These aids convert sound waves into electrical signals which are then amplified and transmitted back to the ear. They can be custom-made to fit each patient's hearing needs. They can altered by the patient and customized for different listening environments. Analog aids can be used in any style of hearing aid. Digital Hearing Aids Digital hearing aids convert sound waves into numerical codes and then amplify them. Some frequencies can be amplified more than others. Digital aids can also be programmed to focus on sounds coming from a certain direction. These aids tend to be more expensive than the analog variety. Individuals considering the purchase of hearing aids should consult with their doctors in order to make the most sensible choice. Since hearing aids are a costly investment, most manufacturers allow a 30-60 day trial period after purchase to make sure the devices are beneficial for the particular patient. Hearing aids are often a very worthwhile investment for many individuals, resulting in improved hearing and the ability to communicate and socialize. Assistive Listening Devices (ALDs) Assistive Listening Devices (ALDs) and other Hearing Accessories ALDs are devices, other than hearing aids, that help the hearing impaired in various situations. Some of these devices work in tandem with the user's hearing aid. Others work independently of hearing aids. Some of the following items are accessories useful for persons without hearing loss. EH® This is an adapter for hearing aids which allows a person to use blue tooth devices, like a mobile phone, in a hands-free fashion. Custom Earmold for Cell Phones or MP3 Players A custom mold attaches to wireless cell phone adapters or personal earbuds. This offers better retention, greater comfort, and superior sound quality. Hearing Protection We offer many types of hearing protection for people who work or play near excessive noise levels. Custom Swim Molds Custom molds keep ears dry in the pool or in the shower. These are often used by children or adults with chronic middle ear problems or PE tubes. TV Ears® This is a wireless headset used for television viewing.

Patients who suffer from hearing loss, or other hearing-related conditions, may benefit from audiologic testing. Comprehensive diagnostic exams can determine the causes and severity of, and best treatment for, hearing-related conditions. Audiologic tests are usually performed after other diagnostic tests have indicated the presence of a possible hearing problem. Diagnostic audiological evaluations for children and adults commonly include: Diagnostic Audiogram This hearing test uses sounds of specific frequencies and intensity levels to determine what a person can hear in each ear. The sounds are heard through headphones, and the patient is asked to identify each sound and the ear in which it was heard. The sounds become fainter and fainter, ultimately determining the lowest level at which a patient can hear. An audiogram may also include speech in the form of two-syllable words to determine how well a patient can comprehend what is being heard. Play Audiometry A modified version of the diagnostic audiogram, play audiometry is sometimes used when working with preschool and younger school-age children. The sounds are heard through headphones, but rather than raising a hand to indicate hearing a sound, the child places a toy in a container. Tympanometry This form of testing examines and diagnoses problems in the middle ear by varying air pressure in the ear canal to see how the ear responds. A probe is inserted into the ear to change the air pressure, produce a tone and measure the responses. The patient may not speak, move or swallow during the test because doing so can affect ear pressure. Tympanometry measures the functionality of the eardrum (tympanic membrane). Abnormal findings may be the result of fluid in the middle ear, a perforated ear drum or impacted ear wax. Brainstem Auditory Evoked Response Test The brainstem auditory evoked response test (BAER) examines brain waves that have been stimulated by a clicking sound in order to evaluate the auditory pathways in the brain. Electrodes are placed on the scalp and earlobes, and the patient listens to a clicking noise through headphones. The BAER test is commonly conducted to diagnose hearing loss in infants or children. Otoacoustic Emissions Testing (OAE) Otoacoustic emissions testing (OAE) measures response to a sound from the cochlea, or the inner part of the ear. The hair cells inside the cochlea vibrate in response to sound. These vibrations produce a nearly inaudible sound that echoes back into the middle ear. This test is performed by inserting a microphone and two speakers into the ear to emit a sound and then record the response signal. The test is often performed on children when hearing loss is a possibility. An OAE may also be conducted as part of the newborn hearing screening process. Absent or very soft response signals may be a sign of hearing loss, fluid behind the ears or damage to the cochlea.

What Are Cochlear Implants? Cochlear implants are small electronic devices used to assist individuals who are completely deaf or severely hearing-impaired. Unlike hearing aids which amplify sound, cochlear implants bypass damaged areas of the ear, sending sounds directly through the auditory nerve to the brain. How do Cochlear Implants Work? Cochlear implants are designed to correct sensorineural hearing loss, which is damage to the tiny hair cells in the circular portion of the inner ear known as the cochlea. Due to this damage, sound waves cannot reach the auditory nerve. With a cochlear implant, the auditory nerve can be stimulated directly, bypassing the dysfunctional hairs of the inner ear. The cochlear implant is made up of fours basic parts: a microphone, a speech processor, a transmitter, a receiver and an array of electrodes. Implanted in the inner ear through the skull behind the ear, the cochlear implant is controlled by a part of the device outside the ear. The cochlear implant does not restore normal hearing, but it helps deaf individuals interpret environmental sounds and conversation. Patients require training after the devices are implanted since hearing with a cochlear implant is a task that must be learned, like a new language. Sounds transmitted through the implants are considerably different from those naturally heard. When Should I Consider Cochlear Implants? Cochlear implants are useful to individuals who cannot be helped by hearing aids. They can be implanted in anyone older than one year of age. The original implantation takes place as an outpatient surgical procedure under general anesthesia. About one month later, other parts of the cochlear implant are connected to the original implant and patients can begin therapy to assist them in interpreting the sounds they are now receiving. Who Can Benefit From Cochlear Implants? Cochlear implants are extremely useful tools, enabling deaf or severely hearing impaired individuals to lead more normal, self-sufficient lives. The extent to which cochlear implants are helpful depends, in large part, on the following factors: The age of the recipient Whether the hearing loss was congenital If not, at what age the patient lost hearing The patient's motivation to participate as fully as possible in the hearing world The support of the patient's family Extensive rehabilitation from audiologists and speech-language pathologists is very important in improving the listening and speaking skills of cochlear implant recipients.

What is Cerumen? Cerumen, also known as earwax, is a natural substance produced by glands in the ear canal to protect the eardrum from damage and infections. Earwax accumulates naturally, and then dries up and falls out of the ear canal. It functions to rid the ear of dust or sand particles, and repel water, which may contain bacteria and can cause infections. Without earwax, ears would be dry, itchy and unprotected. Earwax is made up of various different materials, and may be soft and almost liquid, or firm and solid. It is composed of dead skin cells, bacteria, sweat, oil and water. The production and clearing of earwax is natural and self-regulating so, under ordinary circumstances, the vast majority of people need never clean their ears. Causes of Earwax Impaction Earwax impaction (blockage) occurs when earwax gets pushed deep within the ear canal. Although for most people this is an uncommon occurrence, it is one of the most frequent ear problems treated by physicians, and is a recurring problem for about 6 percent of the population. Everyone makes earwax, but the amount and type are genetically determined. Reasons for an excessive accumulation of earwax include: Small or oddly shaped ear canals, which make drainage more difficult Ear canals narrowed by infection Genetic predisposition to the production of more, or more solid, wax Frequent use of hearing aids or earplugs may block drainage and cause an accumulation of ear wax. Symptoms of Earwax Blockage There are many symptoms of earwax impaction. They may include: Decreased hearing Dizziness Drainage from the ear canal Ear pain Itching in the ear canal Ringing in the ears Sensation that the ear is full or plugged When any of these symptoms is present, a physician should be consulted. How to Remove Earwax Many people attempt to clean out earwax with Q-tips, bobby pins or other small objects, but doing so is one of the most frequent causes of earwax impaction. This is because the objects used may remove small amounts of wax, but push the rest further into the ear canal or, in some cases, puncture the eardrum. For people troubled by earwax, a few drops of mineral oil weekly, an over-the-counter preparation for ear wax removal, or prescribed ear drops, may be helpful. If there is an extreme buildup of wax in the ear canal, a doctor should be consulted. Dr. David Vernick and Dr. Harsha Gopal perform professional cleanings (lavages), and can safely assist with earwax removal.

Swimmer's ear (otitis externa) is an ear infection caused when bacteria found in water penetrates the ear canal. Occasionally, fungi or viruses may also cause this condition. Swimmer's ear usually only affects one ear and is most common among children, young adults and people who suffer from chronic middle ear infections. Causes of Swimmer's Ear Swimmer's ear derives its name from the fact that prolonged exposure to water from swimming, bathing, showering, or increased humidity may cause water to become trapped in the ear canal, resulting in this condition. Excessive moisture provides an environment conducive to bacterial growth and sets the stage for infection of the ear canal. Swimmer's ear can also be triggered by a cut or abrasion, or any skin condition like eczema that allows bacteria to penetrate the skin. Normally, the ear is protected by the wax, known as cerumen, secreted by its glands and by its natural downward slope. When the area has been cut, however, or when excess moisture accumulates there, the body's natural defenses are not sufficient to keep infection from occurring. Certain sensitivity reactions, such as allergies to hair products or jewelry, may increase the possibility of swimmer's ear. Symptoms of Swimmer's Ear Early symptoms of swimmer's ear include pain or itching of the outer ear and a feeling that the ear is stuffed. If the infection is allowed to progress, the patient may experience a worsening of pain that occurs in the face or neck as well as the ear. Pus may begin to drain from the ear and the patient may develop a fever and swollen lymph nodes in the neck. A doctor should always be consulted for swimmer's ear that doesn't resolve quickly. While swimmer's ear is not in itself a serious condition, left untreated it can lead to serious consequences including temporary hearing loss, recurring infections and bone and cartilage damage. Diagnosis and Treatment of Swimmer's Ear Swimmer's ear is diagnosed by a physical examination of the ear with an otoscope. The ear canal commonly appears red and swollen from the infection. Depending on the severity of the problem, the doctor may recommend a thorough cleaning, known as lavage or irrigation, or may prescribe oral or topical antibiotics. Usually the patient with swimmer's ear is advised to avoid swimming and to bathe or shower with care during the period of treatment. Keeping the ears dry and being careful to prevent foreign objects from entering the ear canal can help protect against future infections. Ear drops may also be useful in preventing swimmer's ear.

A myringotomy is a surgical procedure in which a small incision is made in the tympanic membrane (eardrum) to remove fluid such as blood, pus or water from the middle ear. A myringotomy is performed to relieve pressure buildup in the middle ear, usually due to chronic middle ear infections which are resistant to other treatments. There may also be excessive fluid present due to severe allergies. Reasons for a Myringotomy When adults require this operation it is usually as a result of barotrauma, or sudden change in ear pressure, which may be caused by scuba-diving, air travel, mountain climbing or explosion. Adults may also require a myringotomy when they develop mastoiditis, an infection of the bone behind the ear, that has spread, or is in danger of spreading. Most doctors do not suggest a myringotomy for children's ear infections unless: There are recurrent ear infections in a short period of time Fluid buildup persists for over 6 months in one ear Fluid buildup persists for over 3 months in both ears Hearing is badly affected There is a speech delay It is necessary to remove fluid for laboratory examination A myringotomy is nearly always successful and provides immediate relief from symptoms. Most children on whom this procedure is performed do not suffer any hearing loss or speech delays. Risks of a Myringotomy While a myringotomy is considered an extremely safe procedure, there are risks involved in any type of surgery. Risks of surgery in general may include: Excessive bleeding Infection Breathing difficulties Adverse reactions to anesthesia or medications Risks of a myringotomy in particular may include continuing drainage from the ear or a hole in the eardrum that does not heal. In the case of the latter, the eardrum will need to be surgically repaired.

What Is Tinnitus? Tinnitus is a sensation of noise in the ears which may manifest itself as ringing, clicking, or hissing. Tinnitus is extremely common, experienced by as many as one in five individuals. Usually not a serious medical problem, tinnitus can nonetheless be extremely intrusive, affecting the patient's quality of life. It is often considered a symptom, caused by an underlying condition such as a problem with the inner or middle ear. Although it is often not a serious health problem, if tinnitus persists, it can cause fatigue, depression, anxiety, and problems with memory and concentration. Causes of Tinnitus There are many potential underlying causes of this condition, one of the most preventable of which is exposure to loud noise. Other possible causes of tinnitus include: Age-related hearing loss Otosclerosis, or abnormal bone growth in the ear Disorder of the circulatory system Neurological dysfunction Injury or damage to the ear Middle ear infection Head and neck injuries Brain tumor Muscle spasms of the middle ear Side effect of certain medications Tinnitus may be caused by something as simple as a piece of earwax blocking the ear canal. In some cases, people develop tinnitus for no obvious reason. What Are The Symptoms of Tinnitus? Almost all cases of tinnitus are subjective, meaning the noises heard by the patient are phantom, generated by the patient's own body and not audible to anyone else. Subjective tinnitus is most often caused by a dysfunction of the auditory nerves or a neurological problem in the brain. In extremely rare cases, tinnitus is objective, meaning the doctor performing a physical examination can hear the noises as well through a stethoscope or ear tube. Objective tinnitus is usually the result of a broken blood vessel or a problem with one of the small bones of the inner ear bone, known as ossicles. Sounds may be heard as: Ringing Buzzing Roaring Clicking Hissing The noises may vary in pitch and may be heard in one or both ears. Diagnosis of Tinnitus Tinnitus is diagnosed through a physical examination and an audiological examination. Imaging tests may include MRI or CT scans to view the inner ear. It is important that a proper diagnosis be made, not only so that the tinnitus can be treated successfully, but so that any serious underlying condition can be addressed. How Can Vernick & Gopal Treat Tinnitus? Treatment for tinnitus initially focuses on treating any underlying conditions that may be causing symptoms. Additional treatments may include: Removal of impacted ear wax Hearing aids Cochlear implants White noise devices to mask the phantom noise Prescribed medications Acoustic neural stimulation is a technique that is sometimes used to treat chronic tinnitus. This treatment stimulates a change in the neural circuits in the brain, which helps to desensitize the individual to the tinnitus. In severe cases, surgical repair may be necessary.

Patient Testimonial "I have been to Doctor Gopal and his colleagues for over a decade now. He is an excellent surgeon and treated my illness with care. He can run a bit later but that is only because he is so thorough in his care and takes the time to really listen and understand underlying issues. He always makes time to see me when an issue arises and his staff call me if there is a cancellation so I can take that spot." Reasons for Tympanic Membrane Perforation There are several reasons for a ruptured eardrum to occur. Among these are the following: Fluid buildup behind the eardrum due to infection Sudden changes in ear pressure, or barotrauma Extremely loud noise as from an explosion An object inserted into the ear Injury, like a slap to the ear Ruptured Eardrum Symptoms A ruptured eardrum is often a sudden occurrence, resulting in extreme pain in the ear. If the perforation is the result of a middle ear infection, however, the puncture may cause some relief from pain and result in a discharge of pus. Other symptoms of a ruptured eardrum may include: Bleeding from the ear Partial or total hearing loss in the affected ear Buzzing or other noises in the ear Facial weakness or dizziness Diagnosis of Tympanic Membrane Perforation Tympanic membrane perforation is diagnosed by a medical examination during which the doctor uses a small tube with a light, called an otoscope, to look inside the patient's ear. The doctor may also administer a hearing test to assess whether the patient has any hearing loss. Ruptured Eardrum Treatment Many times a ruptured eardrum will heal on its own in a couple of months. During the healing period, the patient may need to take over-the-counter or prescribed analgesics, either orally or as ear drops. It is also recommended that the affected ear be kept dry while the eardrum repairs itself because bacteria may grow in any accumulated fluid. Since there is now a hole in the tympanic membrane, the bacteria can penetrate the middle ear and cause an infection. Antibiotics may be prescribed prophylactically or if a bacterial infection is already present. For rare cases when the eardrum does not heal within 2 months, surgery may be performed to repair the eardrum. There are two possible surgeries that may be performed: a myringoplasty or a tympanoplasty. The myringoplasty is a fairly simple operation to repair a small hole. The tympanoplasty is a somewhat more complex procedure to repair a larger perforation. A tympanoplasty requires a lengthier surgery and may include a repair of the fractured small bones of the inner ear. Untreated Ruptured Eardrum Risks When a ruptured eardrum is suspected, the patient should always consult a medical professional. Untreated, this condition may lead to serious complications which may include an infection of the bone behind the ear called mastoiditis, vertigo, or even permanent hearing loss. Schedule a Consultation Today! If you are looking for highly-qualified ENT Doctors in Chestnut Hill to assist with your health needs or if you would like to have a medical consultation with one of our physicians call (617) 383-6800 today! We will discuss your needs and concerns, and determine your best course of action.

Pediatric otolaryngology, or ear, nose and throat (ENT), is a subspecialty designed to deal with the particular ear, nose and throat problems of children. While children are often affected by the same ENT conditions as adults, they may require special care to treat their complex conditions. Certain medical issues of the ear, nose and throat are handled almost exclusively by otolaryngologists who specialize in pediatrics. Common Childhood Ailments Pediatric otolaryngologists are trained specifically to diagnose and treat diseases that appear much more frequently in children than in adults. One example of such a medical condition is a middle ear infection, or otitis media, since anatomical differences in the ears of children make them much more susceptible to this problem. Another example is tonsillitis, which, along with adenoiditis is a much more common ailment in children than in adults, perhaps because of their immature immune systems. In addition to be tuned in to the particular disorders of pediatric otolaryngology, pediatric ENT doctors are trained to interact with their young patients in ways that make the children feel comfortable and safe. Congenital Abnormalities Congenital abnormalities, such as a cleft lip, cleft palate or congenital deafness are conditions best addressed as soon as possible in early childhood, so that speech development will be impacted as little as possible. For this reason, pediatric otolaryngologists are more likely to consulted for assistance with congenital medical problems than other physicians. Other Problems Treated by Pediatric Otolaryngologists Pediatric otolaryngologists treat a wide variety of childhood illnesses and conditions. These may include the following conditions when they are present during childhood: Breathing disorders Ear infections, hearing loss Nose and sinus problems Tonsils and adenoid infections or inflammations Speech and language disorders Congenital abnormalities of the ear, nose, sinuses, tongue Head and neck tumors Craniofacial abnormalities, including cleft lip, cleft palate Facial Paralysis Food allergies Sleep apnea Gastroesophageal reflux disease, or GERD Pediatric otolaryngologists are trained not only to treat medical problems of the ear, nose and throat with medications and non-invasive procedures, but are also qualified to perform complex surgeries of the area.

Head and neck cancers affect the mouth, nose, throat and surrounding areas. They can cause facial and neck disfigurement; impair speech and vision; and affect the sense of smell and the ability to swallow. Each year, more than 50,000 Americans are diagnosed with head and neck cancers, which account for 3 to 5 percent of all cancers. Highly treatable, many head and neck cancers can be prevented through lifestyle changes alone. Types of Head and Neck Cancers Cancers of the head and neck are usually categorized by the areas in which they originate. Areas that may be affected include: Oral cavity Salivary glands Nasal cavity Pharynx (including nasopharynx, oropharynx and hypopharynx) Larynx Lymph nodes Most head and neck cancers begin in the linings of the moist, mucosal surfaces of the mouth, nose and throat. The cells in the linings are squamous cells, which are vulnerable to carcinomas. Like other types of cancers, head and neck cancers can spread to other areas of the body, leading to serious complications. Prompt, thorough treatment is essential to either eradicate the cancer or keep it in check. Causes of Head and Neck Cancers Head and neck cancers, especially cancers of the oral cavity and larynx, are most often caused by tobacco and alcohol use. When tobacco and alcohol are used in combination, they are linked to 75 percent of head and neck cancers. The exception is salivary gland cancer, which is not linked to their use. Many risk factors can be reduced or eliminated through simple lifestyle changes, such as quitting smoking and abstaining from alcohol. Other risk factors may include: Infection with human papillomavirus (HPV) Exposure to radiation Childhood consumption of certain salted/preserved foods Poor oral hygiene and/or missing teeth Ingestion of paan (betel quid) Drinking maté (tealike beverage) Occupational exposure to harmful substances Previous infection with Epstein-Barr virus Asian ancestry (elevated risk of nasopharyngeal cancer) Those at increased risk for developing head and neck cancers should be screened regularly. Early detection can significantly improve the effectiveness of treatment. Symptoms of Head and Neck Cancers Head-and-neck-cancer symptoms often manifest themselves early, and vary depending on the type of cancer. Symptoms may include: Lump in the neck Hoarseness or trouble speaking Swelling and/or white/red patches on the gums, tongue or mouth Blood in saliva Difficulty swallowing Swelling under the chin and around the jawline Earache New or changed growths on skin Although these symptoms can be caused by a wide range of nonserious conditions, medical attention should be sought as soon as they appear. Diagnosis of Head and Neck Cancers Patients experiencing head-and-neck-cancer symptoms will have their medical histories taken and be given complete physical examinations. Various diagnostic tests, including endoscopy, biopsy, and blood, urine and imaging tests, will be performed. A definitive diagnosis of cancer will be given only after a tissue sample has been biopsied. If cancer is diagnosed, it is important to determine the stage (severity) of the disease, which includes whether or not it has spread to other areas of the body. To determine a cancer's stage, imaging tests are usually performed. Until the stage has been determined, an effective treatment plan cannot be devised. Treatment of Head and Neck Cancers Treatment for head and neck cancer depends on the type and location of the tumor, as well as the patient's age and overall health. Treatment often includes surgery to remove the cancer, as well as chemotherapy or radiation therapy. Surgery involves the removal of the cancerous tissue and some surrounding healthy tissue to ensure thorough eradication of the disease. Surgery may cause swelling and bruising, and affect the patient's ability to chew, swallow or talk. Chemotherapy is often administered after surgery; it uses medication to kill cancer cells. Radiation therapy, on the other hand, uses targeted high-energy X-rays to destroy cancer cells. It is important to discuss treatment options with a doctor, because certain treatment methods may have long-term effects on the way the patient looks, talks, eats or breathes. Making healthy lifestyle changes will help prevent a head and neck cancer from recurring, as well as reduce the risk for other diseases.

Hoarseness refers to abnormal changes in the voice. When a person's voice becomes hoarse, it may sound raspy, scratchy or husky. Hoarseness is usually caused by a swelling of the vocal cords, which are part of the voice box, or larynx, in the throat. Hoarseness may occur in anyone, including children. Hoarseness is generally a symptom of an underlying condition and not actually a disease itself. Fortunately, hoarseness does not usually last long, nor is it typically a sign of a serious condition. Most cases of hoarseness can be treated at home. However, if hoarseness lasts for longer than two weeks, it may be necessary to visit a doctor since persistent hoarseness is sometimes considered a warning sign of throat or laryngeal cancer. Symptoms of Hoarseness Hoarseness is usually characterized by the voice developing a raspy, weakened or harsh quality, as well as noticeable changes to the pitch or volume of the voice. In very young children, hoarseness is often accompanied by drooling. Because hoarseness is considered a symptom of another condition, patients may need to undergo an examination to determine what exactly is causing the hoarseness. Causes of Hoarseness Hoarseness may result when the vocal cords have become infected or develop inflammation as they tend to swell. Hoarseness most commonly occurs following a cold or sinus infection. Some of the most common causes of hoarseness include: Allergies Heavy smoking or drinking, especially the two in combination Thyroid problems, including an underactive thyroid gland Exposure to second-hand smoke Lung or throat cancer Inhalation of an irritating substance Chronic coughing Gastroesophageal reflux (GERD) Upper respiratory infection Overuse of the voice, as in shouting or singing Injury or irritation from a breathing tube, or bronchoscope Damage to the nerves or muscles around the larynx Presence of a foreign object or substance in the esophagus or trachea Ingesting a harmful or irritating substance Benign growths, or polyps, on the vocal cords Diagnosis of Hoarseness Patients who are experiencing hoarseness may need to consult a doctor if the condition lasts for longer than 2 weeks. It is usually recommended that a patient consult an otolaryngologist, a doctor who specializes in diagnosing and managing diseases of the ears, nose, throat, mouth and sinuses. An otolaryngologist has specialty training that helps to determine the reason behind a patient's hoarseness, as well as rule out other potential causes of the condition. A physical examination and review of the patient's medical history will be conducted to evaluate the condition and discover the cause of the hoarseness. The examination focuses on the head and the neck and may include such tests as a throat culture, laryngoscopy or X-rays. During the examination, a direct visualization of the vocal cords will take place. Treatment for Hoarseness In most cases, hoarseness is only temporary and may be treated with at-home care. Further treatment may be necessary for patients who have longer term cases of hoarseness. Usually, the methods of treatment will depend on the underlying cause of the hoarseness. Treatments may include: Using a vaporizer to keep the airways moist Resting the voice Speaking only when needed Avoiding actions that place extra strain on the vocal cords such as singing, shouting, whispering or crying Drinking plenty of fluids Refraining from cigarette smoking and limiting exposure to second-hand smoke Medication If growths or polyps are discovered on a patient's vocal cords, surgery may be necessary to remove them. Additionally, if the presence of lung or throat cancer is detected, further treatment will be required. Prevention of Hoarseness There are many ways to prevent mild cases of hoarseness, including: Hydrating the body by drinking eight glasses of water and other fluids each day Avoiding beverages that dehydrate the body, such as those containing caffeine or alcohol Quitting smoking and avoiding exposure to second-hand smoke Maintaining a healthy diet and avoiding spicy foods Attempting not to overuse the voice or place strain on the vocal cords

Laryngology is a subspecialty within otolaryngology. Laryngologists specialize in the treatment of disorders of the throat and larynx (voice box), including communication and swallowing disorders. Patients who require the care of a laryngologist are often individuals who use their voices professionally, such as singers, actors, public speakers or teachers. Other patients who seek laryngological treatment are individuals troubled by perpetual hoarseness, chronic cough or sore throat, difficulty swallowing or problems with voice projection. Causes of Laryngological Disorders Laryngologists are trained to diagnose and treat the underlying causes of throat and voice problems. These causes may include: Overuse or abuse of the voice Anatomical abnormalities Polyps, nodules or cysts of the vocal cords Vascular lesions Gastroesophageal reflux Cancer of the larynx Laryngological Diagnosis Most frequently, a laryngoscopy is necessary for accurate diagnosis, but this procedure can often take place during a short period of time right in the doctor's office. This diagnostic test may be done a number of ways, but always involves the insertion of some type of endoscope into the mouth or nose and down the back of the throat. Depending on the nature of the problem, a flexible or rigid tube may be used. The laryngoscope will always be fitted with a miniature camera so that the targeted area can be visualized and photographed for later analysis. At times, a tiny video camera, a miniature mirror or a pulsating strobe light may also be used during the examination. The laryngoscope, in addition to being a diagnostic tool, provides treatment options since the doctor can insert tiny surgical instruments through the scope in order to remove tissue for biopsy. In certain cases, other diagnostic testing is necessary. When the patient is troubled by difficulty swallowing, for example, the laryngologist may administer a barium swallowing study. Laryngological Treatments In addition to surgical excisions performed during laryngoscopies, doctors have several other methods for treating disorders of the throat and larynx. At times, simple noninvasive treatments, such as breathing exercises, voice therapy, or medication for acid reflux may be all that is necessary to relieve symptoms. At other times, surgery may be necessary. It is possible that a tonsillectomy will be required to alleviate pressure and inflammation in the throat or that a thyroplasty, during which a patch of synthetic mesh is placed on the vocal cords, will be recommended. Frequently injection laryngoplasty (vocal cord injections) are of help, although the injections may have to be repeated. In more serious cases of injury or disease, particularly when there is a malignancy present, a full or partial removal of the larynx (laryngectomy) may be performed. The type of surgery performed depends on the nature and severity of the patient's condition.

The salivary glands are found in and around the mouth and throat. The major salivary glands are the parotid, submandibular, and sublingual glands. The parotid secretes saliva near the upper teeth, the submandibular from under the tongue, and the sublingual through the floor of the mouth. Additionally, many other minor salivary glands are located in the lips,inner cheeks, and throat. Saliva aids in digestion, oral lubrication and hygiene, and protection against tooth decay. Symptoms and Causes of Salivary Gland Disorders Disorders of the salivary glands can cause dry mouth, pain, swelling, and tenderness. Many salivary gland disorders may be caused by underlying conditions or illness. Conditions that may affect the salivary glands may include: HIV Rheumatoid arthritis Diabetes Sjogren's syndrome Cancer Mumps Alcoholism Types of Salivary Gland Disorders Obstruction Salivary gland obstruction usually occurs because stones have formed within the glands, blocking the flow of saliva. Chemicals in the saliva may crystallize and form stones that create this blockage. This leads to swelling and pain and in some cases an infection may develop. If left untreated, the salivary glands may become abscessed. Infection Salivary gland infections may be caused by underlying conditions, and may cause pain and swelling. Mumps is a common salivary gland infection caused by a viral illness. Most people are immunized for the mumps infection as infants. Secondary Infection from Lymph Nodes Salivary glands may become infected from enlarged lymph nodes which are close in proximity within the neck and jaw. The lymph nodes are located in the upper neck and often become tender and swollen during a respiratory illness or common sore throat. Many lymph nodes are located within the parotid gland or near the submandibular glands. When these lymph nodes enlarge through infection, patients experience painful swelling in the salivary glands. Tumors Tumors usually appear as enlargements of, or growths within the salivary glands. Benign tumors are usually painless and rarely involve more than one gland. Malignant salivary gland tumors may be painful and grow quickly. These tumors may cause loss of movement of part or all of the affected side of the face. Treatment of Salivary Gland Disorders Treatment of salivary gland disorders may involve treating the underlying condition or illness. Salivary gland disorders that are caused by infection may be treated with antibiotics and obstructed salivary glands may subside with increased fluid intake. In some cases, a doctor may use an instrument to open blocked ducts. If a mass has developed within the salivary gland, it may be surgically removed. Cancerous tumors that are removed may also be followed by additional radiation treatment. Doctors will create a customized treatment plan for each individual condition.

Sleep apnea is a common sleep disorder that involves repeated breathing interruptions during sleep. These interruptions may occur hundred of times each night, and may be the result of structural abnormalities or brain malfunctions. During normal breathing, air passes through the nose, past the flexible structures in the back of the throat, including the soft palate, uvula and tongue. When a person is awake, the muscles hold this airway open. When they are asleep, these muscles relax and the airway usually stays open. Sleep apnea occurs when the upper airway and airflow are blocked, causing the oxygen levels to drop in both in the brain and the blood, resulting in shallow breathing or breathing pauses during sleep. What causes sleep apnea Sleep apnea occurs as a result of a partial or fully blocked airway passage in the throat. Certain factors may put certain people at risk for developing sleep apnea, which include: Enlarged tonsils or adenoids Obesity Cardiovascular problems Smoking Family history Nasal congestion Throat and tongue muscles that are more relaxed than normal Adults over the age of 60 may be more at risk of developing sleep apnea because the aging process may limit the brain's ability to keep the throat muscles stiff during sleep. Heavy use of alcohol or sedatives may also contribute to sleep apnea because these substances may relax the muscles of the throat. Our physicians will work to diagnose your specific cause before delivering treatment options. Types of Sleep Apnea There are different types of sleep apnea that have different causes. Obstructive Obstructive sleep apnea (OSA) is the most common form of sleep apnea. It occurs when the soft tissue at the back of the throat closes, blocking or obstructing the airway. CentraL In patients with central sleep apnea the airway remains open but the brain does not send signals to the muscles involved in breathing. Patients with heart-related conditions may suffer from central sleep apnea. Mixed Mixed sleep apnea combines aspects of the obstructive and central types of apnea. A common warning sign of mixed sleep apnea is snoring, especially interspersed with gasps or lack of breathing. Patients who are overweight, have high blood pressure, are older, smoke or have a family history of sleep apnea may have an increased risk of developing obstructive sleep apnea, while those with heart disease or a stroke are at an increased risk for central sleep apnea. Symptoms of Sleep Apnea Patients with sleep apnea may wake up with a headache in the morning and experience excessive daytime sleepiness. Additional symptoms may include: Loud snoring Waking up with a dry mouth or sore throat Insomnia Abrupt awakenings during the night Individuals with sleep apnea may experience shortness of breath that awakens them from sleep. Diagnosis of Sleep Apnea Sleep Apnea is diagnosed through a physical examination and a review of symptoms. Individuals may be referred to a sleep specialist who performs various diagnostic tests to confirm a diagnosis of sleep apnea or another sleep disorder. Some evaluations often involve overnight monitoring of breathing and other body functions during sleep. Additional diagnostic tests may include home sleep tests and a nocturnal polysomnography, which monitors heart and lung function, brain activity, breathing patterns, and blood oxygen levels during sleep. Sleep Apnea treatment options Sleep apnea may be treated with lifestyle changes such as losing weight, cutting down on alcohol consumption and quitting smoking. Nasal training devices are also commonly used to treat sleep apnea. Other treatment for sleep apnea may include continuous positive airway pressure, or CPAP, which involves the patient wearing a pressurized mask over their nose while they sleep. The mask pumps air through the airway to keep it open. If conservative treatment is unsuccessful in treating sleep apnea, there are other options available. Individuals who suffer from severe cases of sleep apnea that may lead to serious medical conditions, may benefit from surgery. The goal of most surgical procedures is to remove the excess tissue from the nose or throat and open upper air passages to facilitate breathing. Uvulopalatopharyngoplasty Uvulopalatopharyngoplasty surgery treats obstructive sleep apnea by tightening the tissue in the throat and palate to expand the passageways. It may also include the removal of the tonsils and adenoids. Maxillomandibular Advancement During a maxillomandibular advancement procedure, the upper and lower part of the jaw are moved forward to create more space behind the tongue and soft palate and reduce the risk of obstruction during sleep. Breathing is restored as the path for airflow is cleared. Tracheostomy Often performed after other treatments have failed, a tracheostomy involves inserting a metal or plastic tube into the throat to help the patient breathe during sleep.

Snoring affects al least 90 million adults in the USA, regularly bothering 37 million Americans and their bed partners. Snoring usually indicates a narrowing or partial obstruction of the airway, most pronounced while sleeping, but also often apparent on an awake examination in the office. Snoring may also be an indication of a more serious condition; such as sleep apnea, in which the airway completely or nearly completely obstructs several times during the night. Losing sleep because you or your bed partner snores is more than just a frustrating inconvenience, it may also affect your health. Getting enough sleep each night is a physical necessity and is crucial to general well-being. Our office provides comprehensive evaluations for snoring and sleep apnea, searching for anatomic or physiologic causes, and helpiing to determine the best treatment options. Causes Of Snoring Snoring occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe, which creates these inconvenient sounds. Snoring may also be a sign of a more serious problem such as obstructive sleep apnea (OSA), a medical condition that should be assessed urgently. During sleep, people with OSA may stop breathing 10 seconds or more, 10 or more times an hour. This creates serious health risks if not diagnosed and treated, including stroke, diabetes, high blood pressure, heart disease, depression, fatigue and many other conditions. Snoring Treatment Options Many medical treatments for snoring exist. Something as simple as modifying the sleeping position works for many patients. Sometimes, nasal and throat sprays are helpful. Also, a minimally invasive in-office procedure called The Pillar Procedure can treat the soft palate component of snoring and mild to moderate OSA. This procedure is designed to help patients sleep better, feel better, and live better. Sometimes, with OSA, when appropriate, other surgical treatments are recommended. Our physicians are experienced with every aspect of surgical care of the ear, nose and throat. Our office also coordinates with area sleep labs and Sleep Medicine physicians and dentists to arrange CPAP (or similar treatments) and oral appliance therapy.

The tonsils are two masses of tissue found on either side of the back of the throat. The adenoids are located high in the throat behind the nose and roof of the mouth. Together they form part of the ring of glandular tissue at the back of the throat. The tonsils and adenoids assist the body in defense against infection by "sampling" entering bacteria and viruses and becoming infected themselves. They then help form antibodies to resist and fight future infections. However, the tonsils and adenoids often become susceptible to recurrent bacterial infections and obstruction that may lead to breathing, swallowing and sleep problems. These conditions are most common in children. Tonsillitis Tonsillitis is an inflammation of the tonsils, the fleshy areas at the back of the throat, caused by a virus or bacteria. This condition is common in children and spreads through contact with throat or nasal fluids. The tonsils become swollen, red and painful and may be coated with a yellow or white substance. Tonsillitis Symptoms Most cases of tonsillitis are caused by a virus, although it can sometimes be caused by the same bacteria that causes strep throat. Tonsillitis symptoms are similar to those of strep throat or a common cold and may include: Sore throat Red, swollen tonsils Difficulty swallowing Fever Headache Swollen lymph nodes Laryngitis This condition can be diagnosed through a rapid strep test. Enlargement of Tonsils and Adenoids The tonsils and adenoids may become enlarged as a result of bacterial infection. Enlargement may lead to obstructions within the airway, which as a result can cause problems with sleeping or breathing. While most cases of enlarged tonsils or adenoids return to their normal size once the infection has been treated, they may remain enlarged in patients with frequent or chronic infections. This condition often causes a sore throat and discomfort during swallowing, as well as creating a nasally sound to the voice. If not managed properly, enlarged tonsils and adenoids may lead to chronic ear infections, hearing loss, obstructive sleep apnea and other serious complications. Chronic tonsillitis or persistent infection of the tonsils Peritonsillar abscess, a collection of pus behind the tonsils that can lead to life-threatening complications if left untreated Enlargement of (hypertrophic) tonsils and adenoids, which can obstruct breathing and lead to sleep irregularities, among other problems Bacterial infections of the tonsils and adenoids can be treated with various antibiotics. Patients can also help relieve symptoms by getting rest and drinking plenty of liquids. Surgical removal is considered when conditions are resistant to medical therapy or frequently recur. Surgery may be recommended for patients experiencing six to seven episodes per year, four to five episodes a year for a two-year period, or three episodes per year for a three-year period. Tonsillectomy and Adenoidectomy Surgical removal of these structures is performed through a tonsillectomy or adenoidectomy. These procedures are performed on an outpatient basis under general anesthesia, and may be performed separately or together as an adenotonsillectomy. Your doctor will decide which treatment is best for you after a thorough evaluation of your individual condition. In addition to reducing the frequency of recurring infections, tonsillectomy and adenoidectomy can also make eating and speaking easier, reduce snoring and treat obstructive sleep apnea in patients suffering from these complications.

The parathyroid glands are four small glands in the neck that are part of the endocrine system. They produce parathyroid hormone (PTH), which maintains calcium and phosphorus levels in the blood. The most common disease associated with the parathyroid glands is overproduction of PTH, known as hyperparathyroidism. Twice as many women as men suffer from this condition and the risk of developing hyperparathyroidism increases with age, more common in patients over the age of 60. Risk factors for hyperparathyroidism include having had radiation treatment to the head or neck. Rarely, cancer may be the cause of the condition. Causes of Hyperparathyroidism There are two types of hyperparathyroidism: primary and secondary. Either type may result in the elevation of the level of calcium in the blood, known as hypercalcemia. Primary hyperparathyroidism originates in the glands themselves, which enlarge and become overactive. The reason for this enlargement is unknown, although in a small percentage of cases there may be a genetic link. Secondary hyperparathyroidism is caused by some other disease process, such as kidney failure or a benign tumor. Other causes of secondary hyperparathyroidism are too much calcium in the diet, vitamin D disorders, and problems absorbing nutrients (malabsorption). Symptoms of Hyperparathyroidism While many patients with hyperparathyroidism report only vague symptoms, when too much PTH is secreted into the blood, every organ in the body is effected. Usually, abnormal blood levels are detected early, during routine medical testing, so the condition is not as dangerous as it once was. Nonetheless, the symptoms, if allowed to develop unabated, may be severe. These symptoms include: Osteoporosis, a loss of calcium in the bones Kidney stones resulting from increased levels of calcium in the urine Development of an adenoma, a benign tumor on one of the glands Abnormally low phosphorus levels in the blood Fatigue, malaise, weakness, depression Nausea, vomiting, constipation, loss of appetite Increased thirst and urination Heartburn High blood pressure Abdominal pain Cognitive impairment Sleep disturbances A serious, though rare, complication of hyperparathyroidism is a hypercalcemic crisis, in which a patient may suffer organ failure or coma. Diagnosis of Hyperparathyroidism Apart from blood tests for abnormal mineral levels, or elevated levels of PTH, urine tests are administered to detect how much calcium is being excreted in the urine. Bone density scans, ultrasounds, and CT scans of the kidneys or urinary tract may also be performed in order to diagnose hyperparathyroidism. Treatment of Hyperparathyroidism Hyperparathyroidism is treated in a number of ways, depending on its cause. Patients are usually advised to remain well-hydrated, to avoid the use of diuretics and to limit dietary phosphorus. In some cases, vitamin D, calcium, and medications to decrease PTH secretion may be prescribed. When hyperparathyroidism is the result of kidney failure, patients may also require dialysis or a kidney transplant. In most cases, surgery is necessary to successfully treat the condition. Parathyroid Surgery Parathyroidectomy, the surgical removal of one or more of the parathyroid glands, has an extremely high rate of success. When only one parathyroid gland is removed, a minimally invasive operation may be performed, either as a radio-guided parathyroid surgery, known as MIRP, or as an endoscopic procedure. In either of these cases, the patient can return home the day of the operation. If more than one parathyroid gland requires removal, the surgery will take longer and the patient will have to be hospitalized overnight. Some parathyroid tissue is usually left in place after surgery to help the patient maintain normal PTH and calcium levels. Parathyroid Surgery Risks and Complications There is a risk, although an extremely small one, that a patient may suffer vocal cord nerve damage during a parathyroidectomy, resulting in speech problems. While traditional surgery involves a greater risk than either of the minimally invasive procedures, all of the surgeries are considered quite safe. Patients requiring more extensive surgery may develop hypoparathyroidism and need to take prescribed calcium supplements of vitamin D after the operation. While minimal, there are also risks to any surgical procedure which may include: Excessive bleeding Blood clots Adverse reactions to anesthesia or medications Post-surgical infection Damage to adjacent organs Breathing problems

The thyroid gland, located in the neck just below the larynx, regulates the body's energy levels, releasing hormones to regulate metabolism. Thyroid hormones influence virtually every system in the body, regulating the rate at which organs function, as well as the body's consumption of oxygen and production of heat. When hyperthyroidism, the production of too much thyroid hormone, occurs, and cannot be adequately controlled with medication or other treatment, thyroid surgery is necessary. Reasons for Thyroid Surgery Thyroid surgery is used to treat a variety of thyroid conditions such as thyroid cancer, thyroid nodules, or Graves' disease, an immune disorder that results in hyperactivity of the gland. When the thyroid gland produces too much thyroid hormone for any reason, the condition is called hyperthyroidism. Hyperthyroidism results in the speeding up of the body's metabolism. This increased metabolic rate can have serious medical consequences, resulting in any or all of the following symptoms: Goiter, enlargement of the thyroid gland Rapid heartbeat Unexplained weight loss Diarrhea or frequent bowel movements Irritability, anxiety Intolerance to heat Visual problems Menstrual irregularities Infertility Surgery is rarely necessary to treat hyperthyroidism unless there is either a suspicion of cancer, a benign nodule that has grown large enough to interfere with swallowing or breathing, a cyst on the gland that refills after drainage, or if hyperthyroidism treatment with medication or radioactive iodine alone is not effective. Another reason for surgery is pregnancy, since it may not be safe for a pregnant woman to take the necessary medications or treatment. Thyroid Surgery Procedures There are several types of thyroid surgery, all involving partial or total removal of the gland. Which surgery is performed depends on the reasons for the procedure. The types of surgery for thyroid disease include: Biopsy, removal of a tissue sample for microscopic examination Lumpectomy, removal of a small diseased part of the thyroid gland Lobectomy, removal of one lobe and the isthmus which connects the lobes Subtotal thyroidectomy, removal of one lobe, the isthmus, and part of the second lobe Total thyroidectomy, removal of the entire gland and the surrounding lymph nodes Depending on several factors, especially how extensive the necessary procedure will be, the operation may be performed traditionally or with a minimally invasive video-assisted, sometimes robotic, procedure. The patient will have a breathing tube in the throat during surgery and a drain may remain in the neck for 12 hours after the procedure. The length of the surgery depends on how much needs to accomplished. Minimal operations may be performed outpatient, while for more complex surgeries the patient may be hospitalized for a night or two. Recovery from Thyroid Surgery After the operation, the patient's throat will be sore due to the breathing tube inserted during surgery. While most patients are able to return to their normal activities in one day or several, depending on the extent of the surgery, strenuous activities, such as heavy lifting or vigorous sports, must be avoided for at least 10 days after the operation. Most thyroid surgeries are very successful, but the majority of patients develop hypothyroidism as a consequence of the procedure. This will require ongoing treatment with hormone therapy, but is not usually problematic. The patient may also need follow-up treatment with radioactive iodine to shrink thyroid tissue either because hyperactivity of the gland continues to be an issue or in order to stem the growth of a thyroid cancer. Risks of Thyroid Surgery Thyroid surgery is generally a safe procedure, but complications may occur. In a very small number of cases, the nerves controlling the vocal cords may be damaged, resulting in hoarseness or other changes in voice quality. Laryngeal monitoring of the vocal cord nerves, however, enables the surgeon to be in careful control of the situation. Another possible cause for concern is that the parathyroid glands, which are tiny and difficult to differentiate from other tissue on the thyroid gland, may be inadvertently damaged during surgery. Other risks are the risks inherent in any surgical procedure. These include: excessive bleeding, abnormal blood clots, adverse reaction to anesthesia or medication, infection, or breathing problems.