EARS

Autoimmune Inner Ear Disease
 

Autoimmune inner ear disease (AIED) is an inflammatory condition of the inner ear. It occurs when the body's immune system attacks cells in the inner ear that are mistaken for a virus or bacteria. The symptoms of AIED are sudden hearing loss in one ear, progressing rapidly to the second ear. The hearing loss can progress over weeks or months. Patients may feel fullness in the ear and experience vertigo. In addition, a ringing, hissing, or roaring sound in the ear may be experienced. Diagnosis of AIED is difficult and is often mistaken for otitis media until the patient develops a loss in the second ear.


Cholesteatoma
 

A cholesteatoma is a benign growth of skin that occurs in an abnormal location, usually in the middle ear behind the eardrum. It is usually caused by repeated infections or improper healing of perforated eardrum. Symptoms of cholesteatoma include hearing loss and recurring discharge from the ear.


Dizziness
 

Some people describe a balance problem by saying they feel dizzy, lightheaded, unsteady, or giddy. This feeling of imbalance or dysequilibrium, without a sensation of turning or spinning, is sometimes described as a mere rocking sensation or mere light-headedness.


Ear Infections and Earache
 

Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection, and can occur in one or both ears. Otitis media is one of the most frequent diagnoses recorded for children who visit physicians for illness. Symptoms include fever, ear drainage, hearing problem, irritability, feeling of fullness and pressure in the ear, and vomiting.


Ears and Altitude
 

Air travel, deep sea diving, or even elevator ride are sometimes associated with rapid changes in air pressure and altitude. These situations may create a feeling of blocked ears causing discomfort. While they are usually simple, minor annoyances, they occasionally result in temporary pain and hearing loss. Swallowing, chewing gum, or yawning may relieve pressure in the middle ears. If earache persists, seek the help of Dr. Eng.


Infant Hearing Loss
 

If your newborn child:
• does not startle, move, cry or react in any way to unexpected loud noises,
• does not awaken to loud noises,
• does not turn his/her head in the direction of your voice, or
• does not freely imitate sound,
he or she may have some degree of hearing loss.

Parents and grandparents are usually the first to discover hearing loss in a baby, because they spend the most time with them. This hearing loss can be temporary, caused by ear wax or middle ear infections. Many children with temporary hearing loss can have their hearing restored through medical treatment or minor surgery. However, some children have sensori-neural hearing loss (sometimes called nerve deafness), which is permanent. Most of these children have some usable hearing, and children as young as three months of age can be fitted with hearing aids. Early diagnosis, early fitting of hearing or other prosthetic aids, and an early start on special education programs can help maximize a child's existing hearing. This means your child will get a head start on speech and language development.


Hyperacusis
 

Individuals with hyperacusis have increased sensitivity to everyday sounds and have difficulty tolerating normal sounds which do not seem loud to others. Examples are the noise from running water, riding in a car, walking on leaves, dishwasher, fan on the refrigerator, and shuffling papers. Although all sounds may be perceived as too loud, high frequency sounds may be particularly troublesome. As one might suspect, the quality of life for individuals with hyperacusis can be greatly compromised. For those with a severe intolerance to sound, it is difficult and sometimes impossible to function in an every day environment with all its ambient noise. Hyperacusis can contribute to social isolation, phonophobia (fear of normal sounds), and depression.


Meniere's Disease
 

Meniere's disease, also called idiopathic endolymphatic hydrops, is a disorder of the inner ear. Although the cause is unknown, it probably results from an abnormality in the fluids of the inner ear. Meniere's disease is one of the most common causes of dizziness originating in the inner ear. In most cases only one ear is involved, but both ears may be affected in about 15 percent of patients. Meniere's disease typically starts between the ages of 20 and 50 years.

The symptoms of Meniere's disease are episodic rotational vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Tinnitus and fullness of the ear in Meniere's disease may come and go with changes in hearing, may occur during or just before attacks, or be constant.


Noise & Hearing Loss
 

Excessive noise exposure is the most common cause of hearing loss. Hearing loss usually develops over a period of several years. Since it is painless and gradual, you might not notice it. What you might notice is a ringing or other sound in your ear (called tinnitus), which could be the result of long-term exposure to noise that has damaged the hearing nerve. If you have trouble understanding what people say and they may seem to be mumbling, especially when you are in a noisy place such as in a crowd, consult Dr. Eng for a hearing test.


Otosclerosis
 

Otosclerosis describes a condition of abnormal growth in the tiny bones of the middle ear, which leads to a fixation of the stapes bone. The stapes bone must move freely for the ear to work properly and hear well. Gradual hearing loss is the most frequent symptom of otosclerosis. Often, individuals with otosclerosis will first notice that they cannot hear low-pitched sounds or whispers. Other symptoms of the disorder can include dizziness, balance problems, or a sensation of ringing, roaring, buzzing, or hissing in the ears or head.


Perforated Eardrum
 

A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear. A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent. The causes of perforated eardrum are usually from trauma or infection.


Swimmer's Ear
 

Swimmer’s ear is an infection of the outer ear. The cause of the infection is water trapped in the ear canal while swimming, bathing or showering. When water is trapped in the ear canal for a long period of time, the bacteria that normally inhabit the ear canal may multiply, causing infection and irritation. Symptoms may include a sensation of plugged ear, decreased hearing, drainage, intense earache, swollen lymph nodes, and fever.


Tinnitus
 

Tinnitus is the name for ringing in the ears. These head noises are very common. Tinnitus may come and go, or you may be aware of a continuous sound. It can vary in pitch from a low roar to a high squeal or whine, and you may hear it in one or both ears. When the ringing is constant, it can be annoying and distracting. Some causes of tinnitus re not serious as in a small plug of wax in the ear canal. Tinnitus can also be a symptom of stiffening of the middle ear bones (otosclerosis). Tinnitus may also be caused by allergy, high or low blood pressure (blood circulation problems), a tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other causes including medications such as anti-inflammatories, antibiotics, sedatives, antidepressants, and aspirin.


Vertigo
 

A few people describe their balance problem by using the word vertigo, which comes from the Latin verb "to turn". Vertigo is not a disease by itself, but rather, a symptom that can have various causes. It is defined as a sensation in which the external world seems to revolve around the individual or in which the individual seems to revolve in space. It usually occurs without a warning; comes and goes unpredictably; and is usually accompanied by nausea and vomiting. They often say that they or their surroundings are turning or spinning. The most common causes of vertigo are benign paroxysmal positional vertigo (BPPV) or Meniere’s disease. If accompanied by other symptoms (such as blurred vision, hearing loss, severe headache, speech problems, weakness in arms or legs, fainting, and numbness), a more serious underlying health problem may exist.



NOSE

Allergies and Hay Fever
 

Symptoms of allergies and hay fever are runny nose, itchy eyes and throat, uncontrollable sneezing, and sometimes itching of the skin. Other symptoms are nasal stuffiness, nasal congestion and drainage, and sometimes headache. Some people may also experience hearing changes, scratchy sore throats, hoarseness, and cough.


Nosebleeds
 

The nose is the part of the body that has lots of blood vessels. As a result, any trauma to the face can cause a lot of bleeding. Nosebleeds can occur spontaneously when the nasal membranes dry out, crust, and crack. This is common in dry climates or winter time when upper respiratory infections are more frequent, and the temperature and humidity fluctuate more dramatically. People are also more susceptible to bleeding if they are taking anti-blood clotting or anti-inflammatory medications.


Post-nasal Drip
 

The glands in your nose and throat continually produce mucus (one to two quarts a day). It moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although mucus normally is swallowed unconsciously, the feeling that it is accumulating in the throat or dripping from the back of your nose is called post-nasal drip.

This feeling can be caused by excessive or thick secretions due to cold, allergies and sinus infections, or by disorders in the throat muscle and swallowing difficulty.


Sinusitis
 

Sinuses are air-filled cavities in the skull. They drain into the nose through small openings. Blockages in the openings from swelling due to colds, flu, or allergies may lead to acute sinus infection. A viral "cold" that persists for 10 days or more may have become a bacterial sinus infection. With this infection you may notice increased post-nasal drip. If you suspect that you have a sinus infection, call Dr. Eng for appropriate treatment.

Chronic sinusitis occurs when sinus blockages persist and the lining of the sinuses swell further. Polyps (growths in the nose) may develop with chronic sinusitis. Patients with polyps tend to have irritating, persistent post-nasal drip.

Pain in the sinus area does not automatically mean that you have a sinus disorder. On the other hand, sinus and nasal passages can become inflamed leading to a headache. Headache is one of the key symptoms of patients diagnosed with acute or chronic sinusitis. In addition to a headache, sinusitis patients often complain of:

• Pain and pressure around the eyes, across the cheeks and the forehead
• Achy feeling in the upper teeth
• Fever and chills
• Facial swelling
• Nasal stuffiness
• Yellow or green discharge

However, it is important to note that there are some cases of headaches related to chronic sinusitis without other upper respiratory symptoms. This suggests that an examination for sinusitis be considered when treatment for a migraine or other headache disorder is unsuccessful.

SINUSITIS TREATMENT:

Dr. Eng uses an emerging technology that has a lot of appeal to patients who are struggling with their chronic sinusitis symptoms but concerned about longer recoveries associated with traditional surgical procedure. Since its introduction in 2005, Balloon Sinuplasty™ technology has emerged as a new complement to existing approaches in treating sinusitis. Balloon Sinuplasty™ has been utilized in over 84,000 patients and 252,000 sinuses. Each day approximately 200 sinus surgeries are being performed with this technology. This technology uses a small, flexible, sinus balloon catheter to open up blocked sinus passageways, restoring normal sinus drainage. When the sinus balloon is inflated, it gently restructures and widens the walls of the passageway while maintaining the integrity of the lining of the sinuses, allowing faster return to normal daily activities—often in 24 hours.

VIDEO: Click here to watch Balloon SinuplastyTechnology.



Snoring and Sleep Disorders
 

Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age. The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.

People who snore may suffer from:
• Poor muscle tone in the tongue and throat. When muscles are too relaxed, either from alcohol or drugs that cause sleepiness, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. This can also happen during deep sleep.
• Excessive bulkiness of throat tissue. Children with large tonsils and adenoids often snore. Overweight people have bulky neck tissue, too. Cysts or tumors can also cause bulk, but they are rare.
• Long soft palate and/or uvula. A long palate narrows the opening from the nose into the throat. As it dangles, it acts as a noisy flutter valve during relaxed breathing. A long uvula makes matters even worse.
• Obstructed nasal airways. A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat, and snoring results. So, snoring often occurs only during the hay fever season or with a cold or sinus infection.

In addition, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can also cause such an obstruction.

The adverse medical effects of snoring and its association with Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) have now been recently recognized. Various methods are used to alleviate snoring and/or OSA. Depending on the diagnosis, Dr. Eng may recommend the following surgical techniques to correct the problem.

Laser Assisted Uvula Palatoplasty (LAUP) allows treatment of snoring and mild OSA by removing the obstruction in your airway in an outpatient setting under local anesthesia. A laser is used to vaporize the uvula and a specified portion of the palate in a series of small procedures. LAUP is performed while you are positioned in an upright sitting position. LAUP usually requires up to five treatments spaced four to eight weeks apart.

Uvulopalatopharyngoplasty (UPPP) tightens the tissue at the back of the throat and the palate. This tightening expands the air passage.

Genioglossus and hyod advancement (GHA) prevents the throat tissues from collapsing, and pulls the tongue muscles forward to open the airway.



THROAT

Tonsils and Adenoids
 

Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or "glands" found in the neck, groin, and armpits. Tonsils are the two masses on the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments.
Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. They "sample" bacteria and viruses and can become infected themselves. Scientists believe they work as part of the body's immune system by filtering germs that attempt to invade the body, and that they help to develop antibodies to germs. The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing and swallowing problems.

Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. Tumors are rare, but can grow on the tonsils.

You should see Dr. Eng when you or your child suffers the common symptoms of infected or enlarged tonsils or adenoids.


Trouble Swallowing
 

Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are temporary and not threatening. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself in a short period of time, you should see Dr. Eng.


Laryngeal (Voice Box) Cancer
 

Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx (voice box). The larynx is situated just below the pharynx (throat) in the neck. The larynx contains the vocal cords, which vibrate and make sound when air is directed against them. The sound echoes through the pharynx, mouth and nose to make a person’s voice. Symptoms of laryngeal cancer include a sore throat or cough that does not go away, trouble or pain when swallowing, ear pain, a lump in the neck or throat, a change or hoarseness in the voice. Use of tobacco products and excessive drinking of alcohol can increase the risk of developing laryngeal cancer. It is, therefore, a preventable disease because the risk factors are associated with modifiable behaviors.


Salivary Gland Problem
 

Salivary gland problems that cause clinical symptoms include:

Obstruction: Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because stones have formed. Symptoms typically occur when eating. Saliva production starts to flow, but cannot exit the ductal system, leading to swelling of the involved gland and significant pain, sometimes with an infection. If untreated for a long time, the glands may become abscessed.

Infection: The most common salivary gland infection in children is mumps, which involves the parotid glands. While this is most common in children who have not been immunized, it can occur in adults. However, if an adult has swelling in the area of the parotid gland only on one side, it is more likely due to an obstruction or a tumor. Infections also occur because of ductal obstruction or sluggish flow of saliva because the mouth has abundant bacteria.

Tumors: Primary benign and malignant salivary gland tumors usually show up as painless enlargements of these glands. Tumors rarely involve more than one gland and are detected as a growth in the parotid, submandibular area, on the palate, floor of mouth, cheeks, or lips.

Other Disorders: Salivary gland enlargement also occurs in autoimmune diseases such as HIV and Sjogren's syndrome where the body's immune system attacks the salivary glands causing significant inflammation. Dry mouth or dry eyes are common. This may occur with other systemic diseases such as rheumatoid arthritis. Diabetes may cause enlargement of the salivary glands, especially the parotid glands. Alcoholics may have salivary gland swelling, usually on both sides.


Vocal Cord Paralysis
 

Vocal fold (or cord) paresis and paralysis result from abnormal nerve input to the voice box muscles (laryngeal muscles). Paralysis is the total interruption of nerve impulse resulting in no movement of the muscle; Paresis is the partial interruption of nerve impulse resulting in weak or abnormal motion of laryngeal muscle(s).

Vocal fold paresis/paralysis can happen at any age - from birth to advanced age, in males and females alike, from a variety of causes. The effect on patients may vary greatly depending on the patient's use of his or her voice: A mild vocal fold paresis can be the end to a singer's career, but have only a marginal effect on a computer programmer's career.


Hoarseness
 

Hoarseness is a general term that describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to the vocal cords that are the sound producing parts of the voice box (larynx).

There are many causes of hoarseness. Fortunately, most are not serious and tend to go away in a short period of time. The most common cause is acute laryngitis, which usually occurs due to swelling from a common cold, upper respiratory tract viral infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert.

More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal nodules (singers' nodes), which are callous-like growths, or may lead to polyps of the vocal cords (more extensive swelling). Both of these conditions are benign. Vocal nodules are common in children and adults who raise their voice in work or play.
A common cause of hoarseness is gastro-esophageal reflux, when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal cords. Many patients with reflux-related changes of voice do not have symptoms of heartburn. Usually, the voice is worse in the morning and improves during the day. These people may have a sensation of a lump in their throat, mucus sticking in their throat or an excessive desire to clear their throat.

Smoking is another cause of hoarseness. Smoking is the major cause of throat cancer.

Other unusual causes for hoarseness include allergies, thyroid problems, neurological disorders, trauma to the voice box, and occasionally, the normal menstrual cycle.


Thyroid / Parathyroid
 

Your thyroid gland is one of the endocrine glands, which make hormones to regulate physiological functions in your body. The thyroid gland manufactures thyroid hormone, which regulates the rate at which your body carries on its necessary functions.

Diseases of the thyroid gland are very common, affecting millions of Americans. The most common diseases are an over- or under-active gland. These conditions are called hyperthyroidism (e.g., Grave's disease) and hypothyroidism. Sometimes the thyroid gland can become enlarged from over-activity (as in Grave's disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a "goiter." Sometimes an inflammation of the thyroid gland (Hashimoto's disease) will cause enlargement of the gland.

Patients may develop "lumps" or "masses" in their thyroid glands. They may appear gradually or very rapidly. Patients who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy. Dr. Eng can evaluate all thyroid "lumps" (nodules).



HEAD AND NECK

Cancers and Tumors
 

A lump in the neck... Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by Dr. Eng as soon as possible. Of course, not all lumps are cancerous. But a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voicebox (larynx), thyroid gland, or of certain lymphomas or blood cancers. Such lumps are generally painless and continue to enlarge steadily.

Change in the voice... Most cancers in the larynx cause some change in voice. Any hoarseness or other voice change lasting more than two weeks should alert you to see Dr. Eng. While most voice changes are not caused by cancer, you shouldn't take chances. If you are hoarse more than two weeks, make sure you don't have cancer of the larynx. See Dr. Eng.

A growth in the mouth... Most cancers of the mouth or tongue cause a sore or swelling that doesn't go away. These sores and swellings may be painless unless they become infected. Bleeding may occur, but often not until late in the disease. If an ulcer or swelling is accompanied by lumps in the neck, be very concerned. Dr. Eng can determine if a biopsy (tissue sample test) is needed.

Bringing up blood... This is often caused by something other than cancer. However, tumors in the nose, mouth, throat or lungs can cause bleeding. If blood appears in your saliva or phlegm for more than a few days, you should see Dr. Eng.

Swallowing problems... Cancer of the throat or esophagus (swallowing tube) may make swallowing solid foods difficult. Sometimes liquids can also be troublesome. The food may "stick" at a certain point and then either go through to the stomach or come back up. If you have trouble almost every time you try to swallow something, you should be examined by Dr. Eng.

Changes in the skin... The most common head and neck cancer is basal cell cancer of the skin. Fortunately, this is rarely a major problem if treated early. Basal cell cancers appear most often on sun-exposed areas like the forehead, face, and ears, although they can occur almost anywhere on the skin. Basal cell cancer often begins as a small, pale patch that enlarges slowly, producing a central "dimple" and eventually an ulcer. Parts of the ulcer may heal, but the major portion remains ulcerated. Some basal cell cancers show color changes. Other kinds of cancer, including squamous cell cancer and malignant melanoma, also occur on the skin of the head and neck. Most squamous cell cancers occur on the lower lip and ear. They may look like basal cell cancers and, if caught early and properly treated, usually are not much more dangerous. If there is a sore on the lip, lower face, or ear that does not heal, consult Dr. Eng. Malignant melanoma classically produces dense blue-black or black discolorations of the skin. However, any mole that changes size, color, or begins to bleed may be alarming. A black or blue-black spot on the face or neck, particularly if it changes size or shape, should be seen as soon as possible by Dr. Eng.

 

EARS
•Autoimmune Inner Ear Disease
Cholesteatoma
Dizziness
Ear Infections and Earache
Ears and Altitude
Infant Hearing Loss
Hyperacusis
Meniere's Disease
Noise & Hearing Loss
Otosclerosis
Perforated Ear Drum
Swimmer's Ear
Tinnitus
Vertigo
NOSE
Allergies and Hay Fever
Nosebleeds
Post-nasal Drip
Sinusitis
Snoring and Sleep Disorders
THROAT
Tonsils and Adenoids
Trouble Swallowing
Laryngeal (Voice Box) Cancer
Salivary Gland Problem
Vocal Cord Paralysis
Hoarseness
Thyroid/Parathyroid
HEAD & NECK
Cancers & Tumors