Hearing and Speech Center

The Weill Cornell Medical College Hearing and Speech Center in the Department of Otolaryngology - Head and Neck Surgery, under the direction of Joseph Montano, Ed.D., is designed to provide state-of-the-art diagnostic and rehabilitative services for disorders of hearing, speech, language, voice and swallowing. The professional staff consists of seventeen licensed and ASHA-certified audiologists and speech language pathologists that hold a minimum of a Master's degree.

Diagnostic audiology services include: complete assessment of auditory function, hearing measurement, central auditory processing evaluations, vestibular evaluations and electrophysiological testing, including auditory brainstem response testing (ABR) and otoacoustic emissions testing (OAE). Our Audiologic Rehabilitation programs allows individuals with hearing loss direct access to the most current technology including digital hearing aids, assistive listening devices and personal amplification systems. Rehabilitative services include speechreading, auditory training, cochlear implants, tinnitus management and hearing aid orientation.

Speech-Language Pathology services include complete treatment and assessment of speech, language, voice and swallowing disorders. A special emphasis is on the treatment of professional voice as well as the evaluation and management of oral and pharyngeal phase dysphagia, specifically with the use of endoscopy. The Clinical Voice Laboratory has been equipped with the most technologically advanced instrumentation to provide dynamic acoustic measurement of the voice. Clinicians in the Hearing and Speech Center have long been recognized for the quality of their skills. In addition to expertise in voice and swallowing, the Center provides programs for the treatment of speech and language disorders in adults, voice rehabilitation following laryngectomy, resonance disorders, swallow therapy and accent reduction.

If you are scheduled to see one of our audiologists as a new patient, please print and complete the Patient Packet (adult) (child) and bring it with you on the day of your appointment. Thank you.

For further information, please call the Center directly at (646) 962-2231.

Acne

What is acne?

Acne is a disorder of the hair follicles and sebaceous glands. With acne, the sebaceous glands are clogged, which leads to pimples and cysts. Acne is very common - nearly 17 million people in the US are affected by this condition. Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active - resulting in increased production of sebum. Sebaceous glands are located in the dermis (the middle layer of skin) and secrete oil onto the skin.

How does acne develop?

The sebaceous glands produce oil (sebum) which normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the oil coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation. Acne progresses in the following manner:

  1. Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug).
  2. Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug).
  3. Infection and irritation cause whiteheads to form.

Eventually, the plugged follicle bursts, spilling oil, skin cells, and the bacteria onto the skin surface. In turn, the skin becomes irritated and pimples or lesions begin to develop. The basic acne lesion is called a comedo.

Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

What causes acne?

Rising hormone levels during puberty may cause acne. In addition, acne is often inherited. Other causes of acne may include the following:

  • hormone level changes during the menstrual cycle in women
  • certain drugs (such as corticosteroids, lithium, and barbiturates)
  • oil and grease from the scalp, mineral or cooking oil, and certain cosmetics
  • friction or pressure from helmets, backpacks, or tight collars
  • environmental conditions (such as pollution or humid conditions)

Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard.

What are the symptoms of acne?

Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands, including the following:

  • face
  • chest
  • upper back
  • shoulders
  • neck

The following are the most common signs/symptoms of acne. However, each adolescent may experience symptoms differently. Symptoms may include:

  • blackheads
  • whiteheads
  • pus-filled lesions that may be painful
  • nodules (solid, raised bumps)

The symptoms of acne may resemble other skin conditions. Always consult your child's physician for a diagnosis.

Treatment of acne:

The goal of acne treatment is to minimize scarring and improve appearance. Specific treatment will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • severity of the acne
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment for acne will include topical or systemic drug therapy. Depending upon the severity of acne, topical medications (medications applied to the skin) or systemic medications (medications taken orally) may be prescribed by your child's physician. In some cases, a combination of both topical and systemic medications may be recommended.

Topical medications to treat acne:

Prescription topical medications are often prescribed to treat acne. Topical medication can be in the form of a cream, gel, lotion, or solution. Examples include:

benzoyl peroxide kills the bacteria (P. acnes)
antibiotics helps stop or slow down the growth of P. acnes and reduces inflammation
tretinoin stops the development of new acne lesions (comedones) and encourages cell turnover, unplugging pimples
adapalene decreases comedo formation

Systemic medications to treat acne:

Systemic medications, or oral antibiotics, are often prescribed to treat moderate to severe acne and include the following:
  • doxycycline
  • erythromycin
  • tetracycline

Treatment for severe, cystic, or inflammatory acne:

Isotretinoin, an oral drug, may be prescribed for individuals with severe, cystic, or inflammatory acne to prevent extensive scarring. Isotretinoin reduces the size of the sebaceous glands that produce the skin oil, increases skin cell shedding, and affects the hair follicles, thereby reducing the development of acne lesions. Isotretinoin can clear acne in 90 percent of patients. However, the drug has major unwanted side effects. It is very important to discuss this medication with your child's physician.

Antibiotics and Acne

Antibiotics are one of the few effective treatments for acne. However, new research indicates that one specific bacterium associated with severe acne, Propionibacterium acnes, is becoming increasingly resistant against antibiotic treatment. This trend may lead to decreased effectiveness of antibiotics in the treatment of future acne, according to the researchers. The researchers recommend that dermatologists restrict their use of antibiotic treatment for acne and test other regimens, including different antibiotics and alternative therapies. 

Always consult your child's physician for more information.

Acne Scar Removal

Treatment for acne scars:

Specific dermatological procedures to minimize acne scars will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the scar
  • type of scar
  • your tolerance for specific medications, procedures, or therapies
  • your opinion or preference

Although acne often is a chronic condition, even if it lasts only during adolescence, acne can leave life-long scars. Acne scars typically look like "ice pick" pit scars or craterlike scars. Although proper treatment for acne may help minimize scarring, several dermatological procedures may help to further minimize any acne scars, including the following:

  • dermabrasion
    Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that abrades the skin. As the skin heals from the procedure, the surface appears smoother and fresher.
  • chemical peels
    Chemical peels are often used to minimize sun-damaged skin, irregular pigment, and superficial scars. The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving its appearance.
  • collagen injections
    A type of collagen that is derived from purified bovine (cow) collagen is injected beneath the skin to replace the body's natural collagen that has been lost. Injectable collagen is generally used to treat wrinkles, scars, and facial lines.
  • laser resurfacing
    Laser resurfacing uses high-energy light to burn away damaged skin. Laser resurfacing may be used to minimize wrinkles and fine scars.
  • punch grafts
    Punch grafts are small skin grafts used to replace scarred skin. A hole is punched in the skin to remove the scar, which is then replaced with unscarred skin (often from the back of the earlobe). Punch grafts can help treat deep acne scars.
  • autologous fat transfer
    An autologous fat transfer uses fat taken from another site on your own body and it is injected into your skin. The fat is placed beneath the surface of the skin to elevate depressed scars. This method is used to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat may be reabsorbed into the skin over a period of months, there may be a need for the procedure to be repeated.

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Acoustic Neurinoma

Balance

The vestibular system controls balance and posture; regulates locomotion and other movements; provides conscious awareness of orientation in space; and provides conscious awareness of visual fixation in motion.

Balance can be impaired by disease, altered gravity, aging, and exposure to unusual motion.

When balance is impaired, normal movement is affected, as well as motivation, concentration, and memory.

Source: National Institute on Deafness and Other Communication Disorders (NIDCD)

What is acoustic neurinoma?

Acoustic neurinoma, also referred to as acoustic neuroma or vestibular schwannoma, is a non-cancerous tumor that may develop from an overproduction of Schwann cells that press on the hearing and balance nerves in the inner ear. Schwann cells are cells that normally wrap around and support nerve fibers. If the tumor becomes large, it can press on the facial nerve or brain structure.

What are the symptoms of acoustic neurinoma?

The following are the most common symptoms of acoustic neurinoma. However, each individual may experience symptoms differently.

When a neurinoma develops, it may cause any/all of the following:

  • hearing loss
  • tinnitus
  • dizziness
  • paralysis of a facial nerve
  • life-threatening problems in the brain

The symptoms of acoustic neurinoma may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

What are the different types of acoustic neurinomas?

There are two types of acoustic neurinomas:

  • Unilateral acoustic neurinomas - affect only one ear, and account for 8 percent of all tumors inside the skull. This tumor may develop at any age, but most often occurs between the ages of 30 and 60. Acoustic neurinoma may be the result of gene damage caused by environmental factors.
  • Bilateral acoustic neurinomas - affect both ears and are hereditary, caused by a genetic disorder called neurofibromatosis-2 (NF2). This tumor develops in the teens or early adulthood.

How are acoustic neurinomas diagnosed?

Because symptoms of acoustic neurinomas resemble other middle and inner ear conditions, they may be difficult to diagnose. Preliminary diagnostic procedures include ear examination and hearing test. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans help to determine the location and size of the tumor.

Early diagnosis offers the best opportunity for successful treatment.

Treatment for acoustic neurinoma:

Specific treatment for acoustic neurinoma will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include surgery to remove small acoustic neurinomas. Surgery for larger tumors is complicated by the probable damage to hearing, balance, and facial nerves. Another treatment option is radiosurgery, often called the "gamma knife," using carefully focused radiation to reduce the size or limit the growth of the tumor.

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Age-Appropriate Hearing Milestones

Hearing problems may be suspected in children who are not responding to sounds or who are not developing their language skills appropriately. The following are some age-related guidelines that may help to decide if your child is having hearing problems. It is important to remember that not every child is the same, and children reach milestones at different ages. Consult your child's physician if you are suspicious that your child is not hearing appropriately. The National Institute on Deafness and Other Communication Disorders (NIDCD) and other experts list the following age-appropriate hearing milestones.

Milestones related to hearing:

Birth to 3 months
  • reacts to loud sounds with startle reflex
  • is soothed and quieted by soft sounds
  • turns head to you when you speak
  • is awakened by loud voices and sounds
  • smiles in response to voices when spoken to
  • seems to know your voice and quiets down if crying
3 to 6 months
  • looks or turns toward a new sound
  • responds to "no" and changes in tone of voice
  • imitates his/her own voice
  • enjoys rattles and other toys that make sounds
  • begins to repeat sounds (such as ooh, aah, and ba-ba)
  • becomes scared by a loud voice or noise
6 to 10 months
  • responds to his/her own name, telephone ringing, someone's voice, even when not loud
  • knows words for common things (cup, shoe) and sayings (bye-bye)
  • makes babbling sounds, even when alone
  • starts to respond to requests such as "come here"
  • looks at things or pictures when someone talks about them
10 to 15 months
  • plays with own voice, enjoying the sound and feel of it
  • points to or looks at familiar objects or people when asked to do so
  • imitates simple words and sounds; may use a few single words meaningfully
  • enjoys games like peek-a-boo and pat-a-cake
  • follows one-step commands when shown by a gesture
15 to 18 months
  • follows simple directions, such as "give me the ball" without being shown
  • uses words he/she has learned often
  • uses two to three word sentences to talk about and ask for things
  • knows 10 to 20 words
  • points to some body parts when asked
18 to 24 months
  • understands simple "yes-no" questions (Are you hungry?)
  • understands simple phrases (in the cup, on the table)
  • enjoys being read to
  • points to pictures when asked
24 to 36 months
  • understands "not now" and "no more"
  • chooses things by size (big, little)
  • follows two-step commands, such as "get your shoes and come here"
  • understands many action words (run, jump)

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Online Resources of Ear, Nose, & Throat

Age-Appropriate Speech and Language Milestones

Hearing problems may be suspected in children who are not responding to sounds or who are not developing their language skills appropriately. The following are some age-related guidelines that may help to decide if your child is having hearing problems. It is important to remember that not every child is the same, and children reach milestones at different ages. Consult your child's physician if you are suspicious that your child is not developing speech and language skills correctly. The National Institute on Deafness and Other Communication Disorders (NIDCD) and other experts list the following age-appropriate speech and language milestones.

Milestones related to speech and language:

Birth to 5 months
  • coos
  • vocalizes pleasure and displeasure sounds (laughs, giggles, cries, or fusses)
  • makes noise when talked to
6 to 11 months
  • understands "no-no"
  • babbles (says "ba-ba-ba")
  • says ma-ma or da-da without meaning
  • tries to communicate by actions or gestures
  • tries to repeat your sounds
  • says first word
12 to 17 months
  • answers simple questions nonverbally
  • says two to three words to label a person or object (pronunciation may not be clear)
  • tries to imitate simple words
  • vocabulary of four to six words
18 to 23 months
  • correctly pronounces most vowels and n, m, p, h, especially in the beginning of syllables and short words - also begins to use other speech sounds
  • vocabulary of 50 words, pronunciation is often unclear
  • asks for common foods by name
  • makes animal sounds such as "moo"
  • starting to combine words such as "more milk"
  • begins to use pronouns such as "mine"
  • uses two-word phrases
2 to 3 years
  • knows some spatial concepts such as "in," "on"
  • knows pronouns such as "you," "me," "her"
  • knows descriptive words such as "big," "happy"
  • vocabulary of 250 to 900 words
  • uses three word sentences
  • speech is becoming more accurate but may still leave off ending sounds - strangers may not be able to understand much of what is said
  • answers simple questions
  • begins to use more pronouns such as "you," "I"
  • uses question inflection to ask for something such as "my ball?"
  • begins to use plurals such as "shoes" or "socks" and regular past tense verbs such as "jumped"
3 to 4 years
  • groups objects such as foods, clothes, etc.
  • identifies colors
  • uses most speech sounds but may distort some of the more difficult sounds such as l, r, s, sh, ch, y, v, z, th - these sounds may not be fully mastered until age 7 or 8
  • uses consonants in the beginning, middle, and ends of words - some of the more difficult consonants may be distorted, but attempts to say them
  • strangers are able to understand much of what is said
  • able to describe the use of objects such as "fork," "car," etc.
  • has fun with language - enjoys poems and recognizes language absurdities such as, "is that an elephant on your head?"
  • expresses ideas and feelings rather than just talking about the world around him/ her
  • uses verbs that end in "ing," such as "walking" and "talking"
  • answers simple questions such as "What do you do when you are hungry?"
  • repeats sentences
4 to 5 years
  • understands spatial concepts such as "behind," "next to"
  • understands complex questions
  • speech is understandable but makes mistakes pronouncing long, difficult, or complex words such as "hippopotamus"
  • vocabulary of about 1500 words
  • uses some irregular past tense verbs such as "ran," "fell"
  • describes how to do things such as painting a picture
  • defines words
  • lists items that belong in a category such as animals, vehicles, etc.
  • answers "why" questions
5 years
  • understands more than 2,000 words
  • understands time sequences (what happened first, second, third, etc.)
  • carries out a series of three directions
  • understands rhyming
  • engages in conversation
  • sentences can be eight or more words in length
  • uses compound and complex sentences
  • describes objects
  • uses imagination to create stories

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Allergens: Dust and Dust Mites

What are dust allergens?

Dust allergens are substances found in dust, and may include:

  • fabric fibers
  • lint
  • feathers
  • stuffing materials
  • animal protein (dander, saliva, urine, body oils)
  • bacteria
  • mold and fungus spores
  • food particles
  • plants
  • insects and their waste

What is a dust mite allergen?

Dust mites are microscopic organisms that can live and thrive throughout homes and businesses. The mites and their waste products thrive in:

  • dust
  • bedding
  • upholstered furniture
  • carpets
  • air

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Allergens: Mold

What is mold?

Mold is a member of the fungus family. It is a branching-type of growth called hyphae. It rarely dies from heat or cold exposure, but remains dormant until a particular season, such as spring or fall, when it grows and thrives.

Where does mold grow?

Mold lives in moist conditions where there is oxygen and other chemicals. Places mold may be found are:

Outside:

  • on dead or dying vegetation
  • moist, shady areas
  • rotting leaves and logs

Inside:

  • damp basements and closets
  • bathrooms
  • food storage areas
  • refrigerators
  • house plants
  • air conditioners and humidifiers
  • mattresses
  • upholstered furniture
  • garbage containers

What is mold allergy?

Mold spores or fragments may be inhaled through the nose and into the lungs where they cause allergic reactions or asthma.

Mold may also be eaten in foods, such as:

  • cheeses processed by fungi
  • mushrooms
  • dried fruits
  • foods containing yeast
  • soy sauce
  • vinegar

[There is no known relationship between allergy to the mold Penicillium and allergy to the antibiotic penicillin, which is made from the mold.]

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Allergic Rhinitis

Picture of young boy sitting in a field of wild flowers

What is allergic rhinitis?

Rhinitis is a reaction that occurs in the nose when airborne irritants (allergens) trigger the release of histamine. Histamine causes inflammation and fluid production in the fragile linings of nasal passages, sinuses, and eyelids.

There is usually a family history of allergic rhinitis.

What are the types of allergic rhinitis?

The two categories of allergic rhinitis include:

  • seasonal - occurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after six years of age.
  • perennial - occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.

What are the causes of allergic rhinitis?

The most common causes of allergic rhinitis include the following:

  • pollen
  • dust mites
  • mold
  • animal dander

What are the symptoms of allergic rhinitis?

The following are the most common symptoms of allergic rhinitis. However, each child may experience symptoms differently. Symptoms may include:

  • sneezing
  • congestion
  • runny nose
  • itchy nose, throat, eyes, and ears
  • nosebleeds
  • clear drainage from the nose

Children with perennial allergic rhinitis may also have the following:

  • recurrent ear infections
  • snoring
  • mouth breathing
  • fatigue
  • poor performance in school
  • "allergic salute" - when a child rubs his/her hand upward across the bridge of the nose while sniffing. This may cause a line or crease to form across the bridge of the nose.

The symptoms of allergic rhinitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is allergic rhinitis diagnosed?

Typically, the diagnosis is made by your child's physician based on a thorough medical history and physical examination. In addition to the above symptoms, your child's physician may find, upon physical examination, dark circles under the eyes, creases under the eyes, and swollen tissue inside the nose.

Treatment for allergic rhinitis:

Specific treatment for allergic rhinitis will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the reaction
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the reaction
  • your opinion or preference

Treatment options may include:

  • avoidance of the allergens
    Avoidance of the allergens that are causing the problem is the best treatment.
  • over-the-counter antihistamines
    Antihistamines help to decrease the release of histamine, possibly decreasing the symptoms of itching, sneezing, or runny nose. Some examples of antihistamines are diphenhydramine (Benadryl®) or hydroxyzine (Atarax®). These medications may cause drowsiness. Consult your child's physician to determine the proper dosage for your child.
  • nonsedating prescription antihistamines
    Nonsedating antihistamines work like antihistamines but without the side effect of drowsiness. Nonsedating antihistamines may include cetirizine (Zyrtec®), loratadine (Claritin®), or fexofenadine (Allegra®). Consult your child's physician to determine the proper dosage for your child.
  • anti-inflammatory nasal sprays
    Anti-inflammatory nasal sprays help to decrease the swelling in the nose. Consult your child's physician to determine the proper dosage for your child.
  • corticosteroid nasal sprays
    Corticosteroid nasal sprays also help to decrease the swelling in the nose. Corticosteroid nasal sprays work best when used before the symptoms start, but can also be used during a flare-up. Consult your child's physician to determine the proper dosage for your child.
  • decongestants
    Decongestants help by making the blood vessels in the nose smaller, thus, decreasing congestion. Decongestants can be purchased either over-the-counter or by prescription. Consult your child's physician to determine the proper dosage for your child.
  • anti-leukotrienes
    These are a relatively new type of medication being used to control the symptoms of asthma. These medications help to decrease the narrowing of the lung and to decrease the chance of fluid in the lungs. These are usually given by mouth.

If your child does not respond to avoidance or to the above medications, your child's allergist then may recommend allergy shots or immunotherapy based on the findings. Immunotherapy usually involves a three- to five-year course of repeated injections of specific allergens to decrease the reaction to these allergens when your child comes into contact with them. Consult your child's physician for more information.

How is allergic rhinitis prevented?

Preventive measures for avoiding allergic rhinitis include:

  • environmental controls, such as air conditioning, during pollen season
  • avoiding areas where there is heavy dust, mites, molds
  • avoiding pets

The link between allergic rhinitis and asthma:

Controlling asthma may mean controlling allergic rhinitis in some patients, according to allergy and asthma experts. The majority of asthma patients have rhinitis, and patients with rhinitis have a much higher prevalence of asthma than those who do not have rhinitis.

Guidelines from the World Health Organization (WHO) recognize the link between allergic rhinitis and asthma. Although the link is not fully understood, one theory asserts that rhinitis makes it difficult to breathe through the nose, which hampers the normal function of the nose. Breathing through the mouth does not warm the air, or filter or humidify it before it enters the lungs, which can make asthma worse.

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Allergies and the Immune System

Allergies and the immune system:

Allergies are disorders of the immune system. Most allergic reactions are a result of an immune system that responds to a "false alarm." When a harmless substance such as dust, mold, or pollen is encountered by a person who is allergic to that substance, the immune system may react dramatically, by producing antibodies that "attack" the allergen (substances that produce allergic reactions). The result of an allergen entering a susceptible person's body may include wheezing, itching, runny nose, and watery or itchy eyes, and other symptoms.

What is the immune system?

The purpose of the immune system is to keep infectious microorganisms, such as certain bacteria, viruses, and fungi, out of the body, and to destroy any infectious microorganisms that do invade the body. The immune system is made up of a complex and vital network of cells and organs that protect the body from infection.

The organs involved with the immune system are called the lymphoid organs, which affect growth, development, and the release of lymphocytes (a certain type of white blood cell). The blood vessels and lymphatic vessels are important parts of the lymphoid organs, because they carry the lymphocytes to and from different areas in the body. Each lymphoid organ plays a role in the production and activation of lymphocytes. Lymphoid organs include:

  • adenoids (two glands located at the back of the nasal passage)
  • appendix (a small tube that is connected to the large intestine)
  • blood vessels (the arteries, veins, and capillaries through which blood flows)
  • bone marrow (the soft, fatty tissue found in bone cavities)
  • lymph nodes (small organs shaped like beans, which are located throughout the body and connect via the lymphatic vessels)
  • lymphatic vessels (a network of channels throughout the body that carries lymphocytes to the lymphoid organs and bloodstream)
  • Peyer's patches (lymphoid tissue in the small intestine)
  • spleen (a fist-sized organ located in the abdominal cavity)
  • thymus (two lobes that join in front of the trachea behind the breast bone)
  • tonsils (two oval masses in the back of the throat)

Disorders of the immune system:

When the immune system does not function properly, it leaves the body susceptible to an array of diseases. Allergies and hypersensitivity to certain substances are considered immune system disorders. In addition, the immune system plays a role in the rejection process of transplanted organs or tissue. Other examples of immune disorders include:

  • cancer of the immune system
  • autoimmune diseases, such as juvenile diabetes, rheumatoid arthritis, and anemia
  • immune complex diseases, such as viral hepatitis and malaria
  • immunodeficiency diseases, such as acquired immunodeficiency syndrome (AIDS)

How does a person become "allergic?"

Allergens can be inhaled, ingested, or enter through the skin. Common allergic reactions such as hay fever, certain types of asthma, and hives are linked to an antibody produced by the body called immunoglobulin E (IgE). Each IgE antibody can be very specific, reacting against certain pollens and other allergens. In other words, a person can be allergic to one type of pollen, but not another. When a susceptible person is exposed to an allergen, the body starts producing a large quantity of corresponding IgE antibodies. Subsequent exposure to the same allergen may result in an allergic reaction. Symptoms of an allergic reaction will vary depending on the type and amount of allergen encountered and the manner in which the body's immune system reacts to that allergen.

Allergies can affect anyone, regardless of age, gender, race, or socioeconomic status. Generally, allergies are more common in children. However, a first-time occurrence can happen at any age, or recur after many years of remission. Allergies tend to run in families. Hormones, stress, smoke, perfume, or environmental irritants may also play a role in the development or severity of allergies.

What is anaphylactic shock?

Anaphylactic shock, also called anaphylaxis, is a severe, life-threatening reaction to certain allergens. Body tissues may swell, including tissues in the throat. Anaphylactic shock is also characterized by a sudden drop in blood pressure. The following are the most common symptoms for anaphylactic shock. However, each individual may experience symptoms differently. Other symptoms may include:

  • itching and hives over most of the body
  • swelling of the throat and tongue
  • difficulty in breathing
  • dizziness
  • headache
  • stomach cramps, nausea, or diarrhea
  • shock
  • loss of consciousness

Anaphylactic shock can be caused by an allergic reaction to a drug, food, serum, insect venom, allergen extract, or chemical. Some people, who are aware of their allergic reactions or allergens, carry an emergency anaphylaxis kit which contains epinephrine (a drug that stimulates the adrenal glands and increases the rate and force of the heartbeats).

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Diagnostic Procedures for Allergy

Diagnostic tests for allergy may include any/all of the following:

  • nasal smears
    Nasal smears are tests performed to check the amount of eosinophils in the nose. Eosinophils are a type of white blood cell that increases in number during an allergic reaction.
  • blood tests
    Blood tests for allergies measure IgE (immunoglobin E) antibodies to specific allergens in the blood. The blood test most commonly used is called RAST (radioallergosorbent test). Blood tests may be used when skin tests cannot be performed. As with skin testing, it is important to remember that a positive blood test does not always mean you are allergic to that allergen.
  • skin tests
    The skin test is a very accurate test that measures your level of IgE antibodies in response to certain allergens or triggers. Using small amounts of solution that contain different allergens, the physician will either inject under the skin or apply the allergens with a small scratch. A reaction would appear as a small red area. A reaction to the skin test does not always mean you are allergic to the allergen that caused the reaction. This will be determined by your physician.

    Skin testing is usually not performed on children who have had a severe life-threatening reaction to an allergen or have severe dry skin (eczema).

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Allergy Overview

Picture of an elderly man clenching his aching head

What is allergy?

Allergy is a physiological reaction caused when the immune system mistakenly identifies a normally harmless substance as damaging to the body.

Normally, the human body defends itself against harmful substances such as viruses or bacteria, but sometimes the defenses aggressively attack usually innocuous substances such as dust, mold, or pollen.

The immune system generates large amounts of the antibodies called immunoglobin E (IgE), a complex chemical weapon, to attack and destroy the supposed enemy. Each IgE antibody specifically targets a particular allergen - the substance that causes the allergy. In this disease-fighting process, inflammatory chemicals like histamines, cytokines, and leukotrienes are released or produced, and some unpleasant (and, in extreme cases, life-threatening) symptoms may be experienced by an allergy-prone person.

What are allergic reactions?

An allergic reaction may occur anywhere in the body, in the skin, eyes, lining of the stomach, nose, sinuses, throat, and lungs - places where immune system cells are located to fight off invaders that are inhaled, swallowed, or come in contact with the skin. Reactions may result in:

  • rhinitis - nasal stuffiness, sneezing, nasal itching, nasal discharge, itching in ears or roof of mouth
  • allergic conjunctivitis - red, itchy, watery eyes
  • atopic dermatitis - red, itchy, dry skin
  • urticaria - hives or itchy welts
  • contact dermatitis - itchy rash
  • asthma (airway problems such as shortness of breath, coughing, wheezing)

What causes allergic reactions?

Although hundreds of ordinary substances could trigger allergic reactions, the most common triggers - called allergens - include the following:

  • pollens
  • molds
  • household dust, dust mites and their waste
  • animal protein (dander, urine, oil from skin)
  • industrial chemicals
  • foods
  • medicines
  • feathers
  • insect stings
  • cockroaches and their waste

Who is affected by allergy?

Allergies can affect anyone, regardless of age, gender, race, or socioeconomic status. Generally, allergies are more common in children. However, a first-time occurrence can happen at any age, or recur after many years of remission.

There is a tendency for allergies to occur in families, although the exact genetic factors that cause it are not yet understood. In susceptible people, factors such as hormones, stress, smoke, perfume, or other environmental irritants may also play a role. Often, the symptoms of allergies develop gradually over a period of time.

Allergy sufferers may become so accustomed to chronic symptoms such as sneezing, nasal congestion, or wheezing, that they do not consider their symptoms to be unusual. Yet, with the help of an allergist, these symptoms can usually be prevented or controlled and quality of life greatly improved.

How is allergy diagnosed?

In addition to performing a clinical examination and taking a medical history, a physician may also use:

  • skin test
    The skin test is a method of measuring the patient's level of IgE antibodies to specific allergens. Using diluted solutions of specific allergens, the physician either injects the patient with the solutions, or applies them to a small scratch or puncture. Reaction appears as a small red area on the skin. Reaction to the skin test does not always mean that the patient is allergic to the allergen that caused the reaction.
  • blood test
    The blood test is used to measure the patient's level of IgE antibodies to specific allergens. One common blood test is called RAST (radioallergosorbent test).

Treatment for allergy:

Specific treatment for allergy will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

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Statistics

Statistics related to asthma and allergies:

According to the latest information available from the American Lung Association, the Centers for Disease Control and Prevention (CDC), and the National Institute of Allergy and Infectious Diseases (NIAID):

Asthma:

  • Approximately 22.2 million people in the US have been diagnosed with asthma, with at least 6.8 million of them children under the age of 18.
  • Asthma is one of the leading, serious, chronic illness among children in the US.
  • Asthma accounts for 13 million absences from school each year.
  • Asthma is the third-ranking cause of childhood hospitalizations under the age of 15.

Allergy:

  • Allergies affect more than 50 million people in the US.
  • Pollen allergy (hay fever or allergic rhinitis) affects nearly 8.6 percent of adults in the US (18.7 million people), not including those with asthma.
  • Allergies are the sixth leading cause of chronic disease in the US.
  • Urticaria (hives; raised areas of reddened skin that become itchy) and angioedema (swelling of throat tissues) together affect approximately 10 percent to 20 percent of the US population at some time in their lives.
  • Chronic sinusitis, most often caused by allergies, affects nearly 37 million people in the US.

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Audiology

What is audiology?

Audiology is the clinical evaluation and management of hearing and balance problems in people of all ages. It also involves the fitting and management of hearing aids and other hearing assistive devices.

The specialist who practices audiology is called an audiologist.

Signs that may indicate the need to see an audiologist for a hearing evaluation:

  • problems hearing over the telephone
  • trouble following conversations when two or more people speak at once
  • trouble following conversations in a setting with a noisy background
  • confusion about where sounds are located
  • having to ask people to repeat themselves
  • problems hearing or understanding speech of children or women
  • most people seem to mumble or not speak clearly
  • problems with misunderstanding others and making inappropriate responses
  • others notice that television volume is high
  • missing sounds of telephone or doorbell ringing
  • avoiding activities because of problems with hearing and understanding speech

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Bell's Palsy

What is Bell's palsy?

Bell's palsy is an unexplained episode of facial muscle weakness or paralysis that begins suddenly and worsens over three to five days. This condition results from damage to the 7th (facial) cranial nerve, and pain and discomfort usually occurs on one side of the face or head.

It can strike anyone at any age, but it occurs most often in pregnant women, and people who have diabetes, influenza, a cold or another upper respiratory ailment. This nerve disorder affects about 40,000 US adults and children each year. Bell's palsy strikes men and woman equally. It is less common before age 15 or after age 60.

Bell's palsy is not considered permanent, but in rare cases it does not disappear. Currently, there is no known cure for Bell's palsy; however, recovery usually begins two weeks to six months from the onset of the symptoms. The majority of people with Bell's palsy recover full facial strength and expression.

What are the symptoms of Bell's palsy?

The following are the most common symptoms of Bell's palsy. However, each individual may experience symptoms differently. Symptoms may include:

  • loss of feeling in the face
  • headache
  • tearing
  • drooling
  • loss of the sense of taste on the front two-thirds of the tongue
  • hypersensitivity to sound in the affected ear
  • inability to close the eye on the affected side of the face
  • affects the muscles that control facial expressions such as smiling, squinting, blinking, or closing the eyelid

The symptoms of Bell's palsy may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

What causes Bell's palsy?

A specific cause of Bell's palsy is unknown, however, it has been suggested that the disorder may be inherited. It also may be associated with:

  • diabetes
  • high blood pressure
  • trauma
  • toxins
  • Lyme disease
  • Guillain-Barré syndrome
  • sarcoidosis
  • myasthenia gravis
  • infection

Treatment for Bell's palsy:

One uniformly recommended treatment for Bell's palsy is protecting the eye from drying at nighttime or while working at a computer. Eye care, which may include eye drops during the day, ointment at bedtime, or a moisture chamber at night, helps to protect the cornea from scratching, which is crucial to the management of Bell's palsy.

Your physician will establish an appropriate treatment protocol for your condition based on the severity of your symptoms and your medical profile. Other treatment options include:

  • steroid medications - to reduce inflammation
  • antiviral medications - such as acyclovir
  • analgesics or moist heat - to relieve pain
  • physical therapy to stimulate the facial nerve

Some individuals may choose to use alternative therapies in the treatment of Bell's palsy. Such treatment may include:

  • relaxation
  • acupuncture
  • electrical stimulation
  • biofeedback training
  • vitamin therapy, including B12, B6, and the mineral zinc

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Birthmarks

What are birthmarks?

Picture of a mother and child

Birthmarks are areas of discolored and/or raised skin that are apparent at birth or within a few weeks of birth. Birthmarks are made up of malformed pigment cells or blood vessels. About 10 in every 100 babies have vascular birthmarks (birthmarks made up of blood vessels).

Although the cause of birthmarks is not known, most of them are benign (non-cancerous) and do not require treatment. Babies with birthmarks should be examined and diagnosed by a physician.

What are the most common types of vascular birthmarks?

The following are the most common types of vascular birthmarks:

  • flat not elevated stains ("angel's kisses" or "stork bites") - the most common type of vascular birthmark, characterized by pink to red marks that may appear anywhere on the body.
    • "angel's kisses" - marks located on the forehead and eyelids, which usually disappear after age 2 years.
    • "stork bites" - marks on the back of the neck, which may last into adulthood.
  • hemangioma - a common vascular birthmark. Hemangiomas become visible within the first few weeks of life and continue to grow rapidly for about six to nine months. Then, they gradually lose this red color and also shrink. They are called strawberry hemangiomas.
  • port-wine stains - a port-wine stain, also called a nevus flammeus, is a flat, pink, red, or purple mark that appears at birth, often on the face, arms, and legs, and continues to grow as the child grows. Port-wine stains do not go away and often require treatment if located on the eyelid or forehead. Port-wine stains involving the face may cause eye problems.

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Blepharoplasty

What is eyelid surgery?

The medical term for an eyelid lift is blepharoplasty. This procedure can remove puffiness or bags under the eyes. It can also correct droopy eyelids.

In this procedure, the physician surgically removes excess fat, muscle, and skin from both the upper and lower eyelids to redefine the shape of the eye.

Possible complications associated with eyelid surgery:

Possible complications associated with eyelid surgery may include, but are not limited to, the following:

  • temporary vision problems
    Double or blurred vision may occur after undergoing eyelid surgery. This typically lasts for just a few days following the surgery.
  • eye closure problems
    Some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent.
  • swelling or asymmetry changes
    Temporary swelling and a slight imbalance of one eye in relation to the other may occur during the healing or scarring process.
  • acne
    After the stitches are removed, tiny whiteheads may appear. The surgeon can remove the whiteheads with a very fine needle.
  • ectropion
    This extremely rare complication is the pulling down of the lower lids. Further surgery may be required in order to correct this symptom.

Who are candidates for eyelid surgery?

Candidates for eyelid surgery are men and women who meet the following criteria:

  • physically healthy
  • psychologically stable
  • realistic in their expectations
  • age 35 or older

Some medical conditions make eyelid surgery more risky, including, but not limited to, the following:

  • thyroid problems
  • dry eyes
  • lack of sufficient tears
  • high blood pressure
  • circulatory disorders
  • cardiovascular disease
  • diabetes
  • detached retina
  • glaucoma

About the procedure:

Although each procedure varies, generally, eyelid surgeries follow this process:

  • Location options may include:
    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient
  • Anesthetic options may include:
    • general anesthesia
    • local anesthesia, combined with a sedative (allows the patient to remain awake but relaxed) for adults
  • Average length of procedure:
    • several hours or longer
  • Some possible short-term side effects of surgery:
    • eyelids may feel tight
    • eyelids may feel sore

Branchial Cleft Abnormalities

What is a branchial cleft abnormality?

A branchial cleft abnormality is a mass of abnormally formed tissues within the neck. These tissues may form pockets called cysts that contain fluid, or they may form passages that drain to an opening in the skin surface. Branchial cleft abnormalities are usually located near the front edge of the sternocleidomastoid muscle, which is the neck muscle that extends from the jawbone (mastoid) to the clavicle (collarbone) and sternum (breastbone). Different types of branchial cleft abnormalities include the following:

  • cysts or sinuses - deep tissue pockets or cavities containing fluid.
  • fistulas - drainage passage from internal tissues to the skin surface.

Branchial cysts are more common in older adolescents and adults, especially males, while branchial fistulas are more commonly seen in young infants.

What causes a branchial cleft abnormality?

A branchial cleft abnormality is a congenital (present from birth) defect that occurs during early embryonic development when the structures and tissues that form the neck and throat do not properly grow together. The tissues form pockets and pathways that contain cells from other parts of the neck and throat. Branchial cleft cysts are lined with skin and lymph cells and contain fluid that is secreted by these cells. Branchial cleft fistulas also contain skin cells but drain mucus and fluids from other internal areas of the neck and throat.

What are the symptoms of a branchial cleft abnormality?

Branchial cleft abnormalities are usually small, but can enlarge enough to cause difficulty swallowing and breathing. The following are the most common symptoms of a branchial cleft abnormality. However, each child may experience symptoms differently. Symptoms may include:

  • small lump or mass to the side of the neck near the front edge of the sternocleidomastoid muscle (usually only on one side of the neck, rarely on both sides; usually painless unless infected)
  • small opening in the skin that drains mucus or fluid near the front edge of the sternocleidomastoid muscle

The symptoms of a branchial cleft abnormality may resemble other neck abnormalities or medical problems. Always consult your child's physician for a diagnosis.

How is a branchial cleft abnormality diagnosed?

Branchial cleft abnormalities are diagnosed by physical examination. Generally, the specific location of the mass or the fistula opening on the skin can help in the diagnosis. A branchial cleft cyst may not be noticed unless it becomes infected and is painful. The skin opening of a branchial cleft fistula drains mucus, and often pulls back into the skin with swallowing movement.

In addition to a complete medical history and physical examination, diagnostic procedures for a branchial cleft abnormality may include the following:

  • computed tomography scan (Also called a CT or CAT scan.) - to determine the exact location and extent of the abnormality; a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope.
  • fine needle aspiration of the fluid (for further examination)

Treatment of a branchial cleft abnormality:

Specific treatment of a branchial cleft abnormality will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include surgery to remove the mass. A small percentage of branchial cysts may regrow.

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Chemical Peel

Considerations Before Having a Chemical Peel

It is very important to find a physician who has adequate training and experience in skin resurfacing.

In some states, a medical degree is not required to perform a chemical peel - even the strongest phenol peels - and many states have laws that permit non-physicians to administer certain peel solutions but regulate the strengths which they are permitted to apply.

What is a chemical peel?

Chemical peeling uses a chemical solution to improve the skin's appearance. It can reduce or eliminate fine lines under the eyes and around the mouth, correct uneven skin pigmentation, remove precancerous skin growths, and soften acne or treat scars caused by acne. The procedure can also treat wrinkles caused by sun damage and scarring, as well as skin blemishes common with age and heredity. Chemical peels can be performed on the face, neck, chest, hands, arms, and legs.

Possible complications associated with chemical peels:

Possible complications associated with chemical peels may include but are not limited to the following:

  • change in skin tone color
    For certain skin types, there is a risk of developing a temporary or permanent skin color change. Taking birth control pills, being pregnant, or having a family history of brownish discoloration on the face may increase the possibility of developing the abnormal pigmentation.
  • scarring
    Chemical peels can cause scarring. However, if scarring occurs, it can usually be treated effectively.
  • cold sores and fever blisters
    Those who are susceptible to cold sores, or herpes simplex infections, may have a reactivation of cold sores or fever blisters following a chemical peel.

A chemical peel is most commonly performed for cosmetic reasons to enhance appearance and self-confidence and may be performed in conjunction with a facelift. However, a chemical peel is not a substitute for a facelift and does not prevent or slow the aging process.

What substances are used for chemical peels?

Phenol, trichloroacetic acid (TCA), and alphahydroxy acids (AHAs) are used for chemical peels. The precise formula used may be adjusted for each patient.

  • alphahydroxy acids (AHAs)
    Alphahydroxy acids (AHAs) such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels that can often provide smoother, brighter-looking skin. AHA peels may be used to accomplish the following:
    • reduce fine wrinkling
    • treat areas of dryness
    • reduce uneven pigmentation
    • aid in control of acne
    • smooth rough, dry skin
    • improve texture of sun-damaged skin

    AHA peels may cause the following:
    • stinging
    • redness
    • irritation
    • crusting, flaking, or scaling
    • dryness

    Generally, no anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.

    Protecting skin from the sun is important following AHA peels.

  • trichloracetic acid (TCA)
    Trichloroacetic acid (TCA) can be used in many concentrations and is used to accomplish the following:
    • smooth fine surface wrinkles
    • remove superficial blemishes
    • correct pigment problems

    TCA can be used on the neck or other body areas, and may require pretreatment with Retin-A or AHA creams. This procedure is preferable for darker-skinned patients.

    Anesthesia is not usually required for TCA peels because the chemical solution acts as an anesthetic. Although, sedation may be used before and during the procedure to help the patient relax. Two or more TCA peels may be needed over several months to obtain the desired result, although mild TCA peels may be repeated more frequently.

    The results of a TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. More than one TCA peel may be needed to achieve the desired result.

    TCA-peel patients are advised to avoid sun exposure for several months. The procedure also may produce some unintended color changes in the skin.

  • phenol
    Phenol is the strongest of the chemical solutions and produces a deep peel. A phenol peel is mainly used to accomplish the following:
    • correct blotches caused by sun exposure, birth control pills, or aging
    • smooth out coarse wrinkles
    • remove precancerous growths

    Phenol:
    • should be used on the face only, as scarring may result if used on the neck or other body areas.
    • is not recommended for darker-skinned individuals.
    • may pose risk for patients with heart problems.
    • may permanently remove facial freckles.
    • may cause permanent skin lightening.
    • may leave lines of demarcation.

    Recovery may be slow and complete healing may take several months.

    After a phenol peel, new skin may lose its ability to produce pigment. The skin will be lighter and will always have to be protected from the sun.

About the procedure:

The procedure involves a chemical solution that is applied to the skin. The solution causes a layer of skin to separate and peel off. The new, regenerated skin underneath is usually smoother, less wrinkled, and more even in color than the old skin.

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Collagen / Fat Injectable Fillers

What is soft tissue augmentation?

Collagen/fat injectable fillers, also called soft-tissue augmentation, is a cosmetic plastic surgery procedure performed to correct wrinkles, depressions in the skin, and/or scarring. The procedure involves injecting a substance (collagen and/or fat) into the skin in order to plump or fill-up the area being treated. The result of the procedure is usually not permanent and touch-up injections may be needed every three to 12 months. For some, however, the collagen injections can stimulate the body's own production of collagen, lengthening the time necessary between follow-up injections.

What is injectable collagen?

Similar to collagen, a natural protein found in humans, injectable collagen is made from cows. This protein gives support and structure to skin, bones, ligaments, and other body parts. Collagen-related fillers from tissue donors or self-donated are generally utilized to treat wrinkles, scars, and facial lines.

What is injectable fat?

Injecting one's own fat to correct skin defects is called microlipoinjection. It includes the transfer or recycling of fat from one body area to another allowing the surgeon to recontour the skin. With a tiny needle, the fat is extracted and then re-injected into the selected site. This is often a favored treatment choice since it involves the use of one's own fat, reducing the risk of allergic reactions.

Possible complications associated with collagen treatments:

An allergic collagen reaction is a possible complication of a collagen treatment. Therefore, in order to avoid an allergic reaction, skin tests are performed to determine if the patient is allergic to collagen.

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Congenital Laryngeal Stridor / Laryngomalacia

What is congenital laryngeal stridor?

Congenital laryngeal stridor (also called laryngomalacia) results from a congenital (present at birth) anomaly of the larynx (voice box). A weakness in the structures in the larynx, can cause stridor. Stridor is a high-pitched sound that is heard best when the child breaths in (inspiration).

What causes congenital laryngeal stridor?

Congenital laryngeal stridor is a defect that is present at birth. During fetal development, the structures in the larynx may not fully develop. As a result, there is a weakness in these structures at birth, causing them to collapse during breathing. In children, congenital laryngeal stridor is the most common cause of chronic stridor. Sixty percent of infants born with congenital laryngeal stridor will have symptoms in the first week of life. Most other infants will show symptoms by 5 weeks old.

What are the symptoms of congenital laryngeal stridor?

The major symptom of this disorder is the stridor that is heard as the infant breathes. The stridor is usually heard when the infant breathes in (inspiration), but can also be heard when the infant breaths out (expiration). Other characteristics of the stridor may include:

  • The stridor changes with activity.
  • The stridor is usually less noisy when the child is laying on his/her stomach.
  • The stridor gets worse if the infant has an upper respiratory infection.

The symptoms of congenital laryngeal stridor may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is congenital laryngeal stridor diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for congenital laryngeal stridor may include bronchoscopy of the airways - a procedure which involves a tube being passed into the airways to allow your child's physician to observe the airways during breathing.

Treatment for congenital laryngeal stridor:

In most cases, congenital laryngeal stridor is a harmless condition that resolves on its own, without medical intervention. The condition usually improves by the time the infant is 18 months old and has no long-term complications. In some cases, the stridor is apparent until about the age of 5. Each child's case is unique. A small percentage develop severe respiratory problems which require medical and surgical interventions.

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Congenital Muscular Torticollis

What is congenital muscular torticollis?

Congenital muscular torticollis is a condition in which an infant's neck muscle is shortened causing the neck to twist. Congenital means present at birth and torticollis means twisted neck. The condition is sometimes called "wryneck."

What causes congenital muscular torticollis?

Congenital muscular torticollis may occur following a difficult birth, especially if the infant is very large or is delivered breech. During the delivery, if the sternocleidomastoid muscle, the neck muscle that extends from the jawbone (mastoid) to the clavicle (collarbone) and sternum (breastbone), is stretched or pulled, it may tear, causing bleeding and bruising within the muscle. The injured muscle develops fibrosis (scar tissue) which causes the muscle to shorten and tighten, pulling the infant's head to one side. The fibrosis forms a mass or lump that sometimes can be felt on the side of the neck.

Occasionally, congenital muscular torticollis occurs because of a defect in the development of the sternocleidomastoid muscle, or because of an abnormal fetal position in the uterus.

What are the symptoms of congenital muscular torticollis?

Congenital muscular torticollis may be visible at birth or it may not become evident until several weeks later. The following are the most common symptoms of congenital muscular torticollis. However, each child may experience symptoms differently. Symptoms may include:

  • tilting of the infant's head to one side
  • the infant's chin turns toward the opposite side
  • firm, small, one to two centimeter mass in the middle of the sternocleidomastoid muscle

The symptoms of congenital muscular torticollis may resemble other neck masses or medical problems. Always consult your child's physician for a diagnosis.

How is congenital muscular torticollis diagnosed?

Generally, physical examination of the infant may show the characteristic tilting of the head and tension of the sternocleidomastoid muscle, as well as presence of a mass in the middle portion of the muscle. In addition to a complete medical history and physical examination, diagnostic procedures for congenital muscular torticollis may include the following:

  • x-rays - to check for abnormalities in the bones of the neck and shoulders; a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • ultrasound examination - to evaluate the muscle around the mass; a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

Treatment of congenital muscular torticollis:

If the condition is not corrected, the infant will be unable to move his/her head properly. Permanent muscle tightening with asymmetry (uneven development) of the neck and face can result. Specific treatment of congenital muscular torticollis will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include:

  • gentle stretching exercise program (to help relieve the tension and lengthen the sternocleidomastoid muscle)
  • infant stimulation (to help the infant learn to move and stretch the muscle)
  • surgery (to correct the shortened muscle)

The neck mass may enlarge during the first month of life, then gradually get smaller, usually disappearing by age 5 to 8 months.

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Cosmetic Plastic Surgery Overview

What is cosmetic plastic surgery?

Cosmetic plastic surgery is performed in order to change one's appearance. For some, it may mean redesigning the body's contour and shape, the elimination of wrinkles, or eliminating balding areas. Others may choose varicose vein treatment or breast augmentation. There are a number of cosmetic surgery procedures that men and women can choose from in order to create an image that makes them feel more confident and comfortable with their appearance. In 2006, more than 11 million people had cosmetic surgery.

Although health insurance rarely covers the cost of cosmetic procedures, the number of individuals deciding to undergo cosmetic plastic surgery continues to grow. The top five cosmetic surgeries include liposuction, breast augmentation, eyelid surgery, nose reshaping, and tummy tuck. More than 1.9 million women had one or more of these surgeries in 2006.

Further, it is not just women who are opting to enhance their appearance through surgery. According to the American Society of Plastic Surgeons, 12 percent of all liposuction procedures and 9 percent of all facelift procedures in 2006 were performed on men.

What are the most common plastic surgery procedures?

According to the American Society of Plastic Surgeons, the most common cosmetic procedures (invasive and minimally-invasive) are listed here by their common or descriptive names. The medical term for the procedure is enclosed in parentheses.

  • breast augmentation or enlargement (augmentation mammaplasty)
  • breast implant removals
  • breast lift
  • buttock lift
  • chin, cheek, or jaw reshaping (facial implants or soft tissue augmentation)
  • dermabrasion
  • eyelid lift (blepharoplasty)
  • facelift
  • forehead lift
  • hair replacement/transplantation
  • lip augmentation
  • liposuction (lipoplasty)
  • lower body lift
  • nose reshaping (rhinoplasty)
  • thigh lift
  • tummy tuck (abdominoplasty)
  • upper arm lift
  • Botox injections
  • cellulite treatment
  • chemical peel
  • plumping/collagen or fat injections (facial rejuvenation)
  • laser skin resurfacing
  • laser treatment of leg veins
  • vaginal rejuvenation

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Dermabrasion / Dermaplaning

What is dermabrasion?

Similar to a chemical peel, dermabrasion is a procedure that removes fine wrinkles and/or minimizes scars on the skin. The difference between a chemical peel and dermabrasion, however, is the method used. Dermabrasion involves the surgeon utilizing a high speed rotating brush to remove the top layer of skin. The size and depth of the scars, as well as the degree of wrinkling, determine the appropriate level of skin that will be surgically sloughed.

Possible complications associated with dermabrasion:

Possible complications associated with dermabrasion may include, but are not limited to, the following:

  • fever blisters
    Dermabrasion can cause fever blisters to reappear in those who are prone to frequent herpes simplex infections. Anti-viral medications are often used to treat this symptom.
  • pigmentation changes
    Some individuals may develop a change in the pigmentation of their skin after undergoing the procedure. Treatment for this symptom may include the use of bleaching creams, as prescribed by a physician. A decrease in pigmentation can be permanent.
  • thickened skin
    Thickening of the skin can develop. This symptom may be treated with cortisone creams or injections which help the skin return to its normal state.

What is dermaplaning?

Dermaplaning is used to treat deep acne scars with a hand-held instrument called a dermatome. The dermatome resembles an electric razor and has an oscillating blade that moves back and forth to evenly "skim" off the surface layers of skin that surround the craters, or other facial defects.

Both dermabrasion and dermaplaning can be performed on small areas of skin, or on the entire face. They can be used alone, or in conjunction with other procedures. Neither treatment, however, will remove all scars and flaws, or prevent aging.

Who can benefit from dermabrasion or dermaplaning?

Men and women of all ages can benefit from dermabrasion and dermaplaning. Important factors that help to determine the effectiveness of both treatments include the following:

  • skin type
  • skin coloring
  • medical history

About the procedure:

Although each procedure varies, generally, dermabrasion and dermaplaning surgeries follow this process:

  • Location options may include:
    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient
  • Anesthetic options may include:
    • local anesthesia, combined with a sedative (allows the patient to remain awake but relaxed)
    • a numbing spray, such a Freon, may be used along with or instead of local anesthesia
    • general anesthesia
  • Average length of procedure:
    • from a few minutes to an hour or more, depending on the size of the area of skin to be refinished. The procedure may be performed more than once, or in stages.
  • Some possible short-term side effects of surgery:
    • The skin may be red and swollen.
    • Eating and talking may be difficult for a few days following the procedure.
    • Tingling, burning, or aching may occur.
    • Swelling and scabbing may occur.

    As the new skin begins to grow, it may appear and feel swollen. The skin may also be sensitive and bright pink in color, which may take about three months to fade. Protection from the sun is very important following this type of procedure.

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Dermoid Cyst

What is a dermoid cyst?

A dermoid cyst is a pocket or cavity under the skin that contains tissues normally present in the outer layers of the skin. The pocket forms a mass that is sometimes visible at birth or in early infancy but often is not seen until later years. Dermoid cysts are usually found on the head or neck, and sometimes on the face.

What causes a dermoid cyst?

A dermoid cyst is a congenital defect (present from birth) that occurs during embryonic development when the skin layers do not properly grow together. A dermoid cyst is lined with epithelium, which contains tissues and cells normally present in skin layers, including hair follicles, sebaceous (skin oil), and sweat glands. These glands and tissues secrete their normal substances which collect inside the cyst, causing it to grow and enlarge.

What are the symptoms of a dermoid cyst?

The following are the most common symptoms of a dermoid cyst. However, each child may experience symptoms differently. Symptoms may include a small, often painless, lump in the mid-line of the neck (in which the skin over the lump can easily be moved). The lump may be skin-colored, or may have a slight yellow tinge.

The symptoms of a dermoid cyst may resemble other neck masses or medical problems. Always consult your child's physician for a diagnosis.

How is a dermoid cyst diagnosed?

Dermoid cysts are diagnosed by physical examination. Generally, the mass can be easily moved beneath the skin. In addition to a complete medical history and physical examination, diagnostic procedures to determine if the cyst is connected to other tissues in the head and neck may include:

  • computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Treatment of a dermoid cyst:

Specific treatment of a dermoid cyst will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include surgery to remove the cyst.

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Deviated Septum

What is a deviated septum?

The nasal septum is made of cartilage, and divides the nose into two separate chambers. A deviated septum is an abnormal configuration of the cartilage that divides the two sides of the nasal cavity, which may cause problems with proper breathing or nasal discharge. Estimates are that 80 percent of all nasal septums are off center. A deviated septum is when the septum is severely shifted away from the midline.

The most common symptom from a deviated septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and in some cases the drainage of the sinuses is curtailed and results in repeated sinus infections. A deviated septum may be present at birth, caused by an injury, or result from damage from previous medical treatments.

What is septoplasty?

Septoplasty is a reconstructive plastic surgery performed to correct an improperly formed nasal septum. The procedure is performed entirely through the nostrils. During the procedure, badly deviated portions of the septum may be removed entirely or they may be readjusted and reinserted into the nose.

In addition to correcting a deviated nasal septum, septoplasty may also be performed to correct other problems such as cleft defects that affect the nose and nasal cavity, and a fistula in the maxillary sinuses.

What are the complications associated with nasal surgery?

Individuals vary greatly in their anatomy and healing ability, and the outcome is never completely predictable. Complications may occur, including:

  • infection
  • nosebleed
  • reaction to the anesthesia

About the procedure:

Septoplasty may be performed with the traditional open surgical technique from inside the nose. When open surgery is performed, small scars will be located on the base of the nose, but they usually are not noticeable. Scarring is not visible when internal surgery is performed. Depending on the severity of the deviation, septoplasty may be performed in:

  • a surgeon's office
  • an outpatient surgery center
  • a hospital - outpatient
  • a hospital - inpatient

The surgeon will provide guidelines for resuming normal activities. Many patients are up and around within a few days and able to return to school or sedentary work in a week or so.

Short-term side effects of surgery may include:

  • splint applied to nose to help maintain new shape
  • nasal packs or soft plastic splints may be placed in nostrils to stabilize septum
  • face will feel puffy
  • nose may ache
  • dull headache
  • swelling around the eyes
  • bruising around the eyes
  • small amount of bleeding in first few days
  • small burst blood vessels may appear as tiny red spots on the skin's surface

Healing is a slow and gradual process. Some swelling may be present for months, especially in the tip of the nose. Final results of nasal surgery may not be apparent for a year or more.

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Deviated Septum

What is a deviated septum?

The nasal septum is made of cartilage, and divides the nose into two separate chambers. A deviated septum is an abnormal configuration of the cartilage that divides the two sides of the nasal cavity, which may cause problems with proper breathing or nasal discharge. Estimates are that 80 percent of all nasal septums are off center. A deviated septum is when the septum is severely shifted away from the midline.

The most common symptom from a deviated septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and in some cases the drainage of the sinuses is curtailed and results in repeated sinus infections. A deviated septum may be present at birth, caused by an injury, or result from damage from previous medical treatments.

What is septoplasty?

Septoplasty is a reconstructive plastic surgery performed to correct an improperly formed nasal septum. The procedure is performed entirely through the nostrils. During the procedure, badly deviated portions of the septum may be removed entirely or they may be readjusted and reinserted into the nose.

In addition to correcting a deviated nasal septum, septoplasty may also be performed to correct other problems such as cleft defects that affect the nose and nasal cavity, and a fistula in the maxillary sinuses.

About the procedure:

Septoplasty may be performed with the traditional open surgical technique from inside the nose. When open surgery is performed, small scars will be located on the base of the nose, but they usually are not noticeable. Scarring is not visible when internal surgery is performed. Depending on the severity of the deviation, septoplasty may be performed in the following settings:

  • a surgeon's office
  • an outpatient surgery center
  • a hospital as an outpatient
  • a hospital as an inpatient

The surgeon will provide guidelines for resuming normal activities. Many children are up and around within a few days and able to return to school in a week or so.

What are the complications associated with nasal surgery?

Children vary greatly in their anatomy and healing ability, and the outcome is never completely predictable. Complications may occur, including, but not limited to, the following:

  • infection
  • nosebleed
  • reaction to the anesthesia

Short-term side effects of surgery may include:

The following short-term side effects may occur. If symptoms do not subside, consult your child's physician.

  • splint applied to nose to help maintain new shape
  • nasal packs or soft plastic splints placed in nostrils to stabilize septum
  • face will feel puffy
  • nose may ache
  • dull headache
  • swelling around the eyes
  • bruising around the eyes
  • small amount of bleeding in first few days
  • small burst blood vessels may appear as tiny red spots on the skin's surface

Healing is a slow and gradual process. Some swelling may be present for months, especially in the tip of the nose. Final results of nasal surgery may not be apparent for a year or more.

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Ear, Nose, and Throat Facts

What is the ear?

  • external or outer ear, consisting of:
    • pinna or auricle - the outside part of the ear.
    • external auditory canal or tube - the tube that connects the outer ear to the inside or middle ear.
  • tympanic membrane - also called the eardrum. The tympanic membrane divides the external ear from the middle ear.
  • middle ear (tympanic cavity), consisting of:
    • ossicles - three small bones that are connected and transmit the sound waves to the inner ear. The bones are called:
      • malleus
      • incus
      • stapes
    • eustachian tube - a canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the outer ear and the middle ear. Having the same pressure allows for the proper transfer of sound waves. The eustachian tube is lined with mucous, just like the inside of the nose and throat.
  • inner ear, consisting of:
    • cochlea (contains the nerves for hearing)
    • vestibule (contains receptors for balance)
    • semicircular canals (contain receptors for balance)

What is the nose?

The nose is the organ of smell and is part of the peripheral nervous system. The external part of the nose lies above the roof of the mouth. The nose consists of:

  • external meatus - triangular-shaped projection in the center of the face
  • external nostrils - two chambers divided by the septum
  • septum - made up primarily of cartilage and bone and covered by mucous membranes. The cartilage also gives shape and support to the outer part of the nose.
  • nasal passages - passages that are lined with mucous membranes and tiny hairs (cilia) that help to filter the air
  • sinuses - four pairs of air-filled cavities that are also lined with mucous membranes

What is the throat?

The throat is a ring-like muscular tube that acts as the passageway for air, food, and liquid. The throat also helps in forming speech. The throat consists of:

  • larynx - houses the vocal cords and is crucial to speech and breathing. The larynx also serves as a passageway to both the trachea (windpipe to the lung) and the esophagus (canal to the stomach).
  • epiglottis - located above the larynx and works with the larynx and vocal cords to push the food into the esophagus, therefore keeping food from entering the windpipe.
  • tonsils and adenoids - made up of lymph tissue and are located at the back and the sides of the mouth. They protect against infection, but generally have little purpose beyond childhood.

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Anatomy and Physiology of the Ear

What is the ear?

The ear is the organ of hearing. The parts of the ear include:

  • external or outer ear, consisting of:
    • pinna or auricle - the outside part of the ear.
    • external auditory canal or tube - the tube that connects the outer ear to the inside or middle ear.
  • tympanic membrane - also called the eardrum. The tympanic membrane divides the external ear from the middle ear.
  • middle ear (tympanic cavity), consisting of:
    • ossicles - three small bones that are connected and transmit the sound waves to the inner ear. The bones are called:
      • malleus
      • incus
      • stapes
    • eustachian tube - a canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the outer ear and the middle ear. Having the same pressure allows for the proper transfer of sound waves. The eustachian tube is lined with mucous, just like the inside of the nose and throat.
  • inner ear, consisting of:
    • cochlea (contains the nerves for hearing)
    • vestibule (contains receptors for balance)
    • semicircular canals (contain receptors for balance)

How do we hear?

Hearing starts with the outer ear. When a sound is made outside the outer ear, the sound waves, or vibrations, travel down the external auditory canal and strike the eardrum (tympanic membrane). The eardrum vibrates. The vibrations are then passed to three tiny bones in the middle ear called the ossicles. The ossicles amplify the sound and send the sound waves to the inner ear and into the fluid-filled hearing organ (cochlea).

Once the sound waves reach the inner ear, they are converted into electrical impulses which the auditory nerve sends to the brain. The brain then translates these electrical impulses as sound.

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Ear Pinning

What is ear pinning?

Ear surgery, or otoplasty, is a type of cosmetic plastic surgery procedure aimed at setting prominent ears closer to the head, or reducing the size of larger ears. However, there are other ear problems that can be helped with surgery, including the following:

  • lop ear - when the tip of the ear folds down and forward.
  • cupped ear - a very small ear.
  • shell ear - when the curve in the outer rim, as well as the natural folds and creases, are missing.
  • large or stretched earlobes
  • lobes with large creases and wrinkles

Surgeons can even build new ears for those who were born without them or who lost them through injury.

Who are candidates for ear pinning?

The operation is usually performed on children between the ages of 5 and 6; however, ear surgery for adults does occur.

Possible complications associated with ear pinning:

Possible complications associated with ear pinning may include, but are not limited to, the following:

  • blood clots on the ears
  • infection in the cartilage, which can cause a formation of scar tissue

About the procedure:

Although each procedure varies, generally, ear pinning surgeries follow this process:

  • Location options may include:
    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient
  • Anesthetic options may include:
    • general anesthesia for children
    • local anesthesia, combined with a sedative (allows the patient to remain awake but relaxed) for adults
  • Average length of procedure:
    • several hours or longer
  • Some possible short-term side effects of surgery:
    • throbbing in the ears
    • aching

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Ears and Airplane Travel, Ear Wax, and Ear Cleaning

The experience of "popping" ears when flying on an airplane is the most common medical complaint of airplane passengers. Due to an air pocket in the middle ear that is sensitive to air pressure changes, the changing altitude as the plane takes off or lands can cause discomfort in the ears. The middle ear consists of the ear drum and the ossicles (three bones that are joined together).

Swallowing or yawning usually can help "pop" the ears (activating the muscle that opens the Eustachian tube, which connects the middle ear with the nasopharynx) and ease the discomfort. However, ears that are already blocked (by a cold, for example) cannot equalize the air pressure in the middle ear adequately, therefore, creating a vacuum that sucks the eardrum in and stretches it. When the eardrum cannot vibrate, sound is muffled and the stretched eardrum can be very painful.

If swallowing or yawning do not relieve the ears, the American Academy of Otolaryngologists recommends trying the following ear-clearing technique:

  • Pinch the nostrils shut.
  • Breathe in through the mouth.
  • Force the air into the back of the nose as if trying to blow your nose.

Small children are especially vulnerable to blocked ear canals because their Eustachian tubes are narrower. Use of a bottle or pacifier during take-off and landing may help pop their ears. Do not allow a baby to sleep as the plane is descending.

What is ear wax?

Earwax, also called cerumen, is naturally produced by the outer part of the ear canal to keep the ear clean. It performs this task by trapping dust and sand particles before they reach the eardrum. Wax also coats the fragile skin of the ear canal and acts as a water repellent. Accumulated wax usually migrates to the ear opening, dries up, and falls out.

How should ears be properly cleaned?

Normally, ears canals are self-cleaning and should not need cleaning with any devices or cotton-tipped applicators. Cleaning the ear can cause problems by pushing the ear wax deeper into the ear canal and against the eardrum. However, sometimes wax can accumulate excessively, resulting in a blocked ear canal. In the case of a blocked ear canal, consult your physician. He/she may recommend one or more of the following:

  • an irrigation of the ear canal to wash out the wax
  • a vacuuming of the ear canal to remove the wax
  • the use of a special instrument(s) to remove the wax
  • prescription eardrops or mineral oil to soften the wax

Always consult your physician for a diagnosis and for additional information.

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Egg Allergy Diet

General guidelines for egg allergy:

The key to an allergy free diet is to avoid foods or products containing the food to which you are allergic.

Eggs are a commonly used food that may cause food sensitivity reactions. Persons with egg sensitivity may not find it difficult to eliminate visible eggs, but may not be aware of the variety of food products that contain eggs. In order to avoid foods that contain eggs, it is important to read food labels.

FOODS ALLOWED NOT ALLOWED
Breads & Starches Plain enriched white, whole wheat, rye bread, or buns (without egg products or brushing with egg for glazing)

Biscuits made from egg-free baking powder

Crackers and homemade breads made with allowed ingredients

All cereals and grains, such as rice

Commercially prepared pancakes, waffles, donuts, and muffins

Zwieback, soda crackers, bread crumbs, and pretzels

Egg noodles or pasta

Baking mixes, fritter batter or batter-fried foods, French toast

Fried rice containing eggs

Any commercial bread or bread product made with egg products or brushed with egg for glazing

Vegetables All fresh, frozen, dried, or canned Any vegetables prepared in a casserole or with sauces or breading that contain eggs in any form (such as hollandaise sauce, vegetable soufflé or batter-fried vegetables)
Fruit All fresh, frozen, dried, or canned fruits and juices Any fruit served with a sauce containing egg such as custard sauce

Fruit whips

Meat, Meat Substitutes & Eggs Any baked, broiled, boiled, or roasted beef, veal, pork, ham, chicken, turkey, lamb, fish, or organ meats

Meats breaded and fried with egg-free breading

Eggs in any form, from any animal including egg powders, or commercial egg substitutes

Soufflés

Commercially breaded meats, fish, or poultry

Meatballs, meat loaf, croquettes, some sausages

Milk & Milk Products Whole, low-fat or skim milk, buttermilk

Cheese, cottage cheese, or yogurt

Cocomalt, eggnog, malted beverages, boiled custard, Ovaltine, protein drinks containing egg, egg products or egg protein

Pudding, custard, or ice cream

Soups & Combination Foods Any soup or broth prepared with allowed ingredients Any stock cleared with egg (consommé, broth, bouillon)

Turtle or mock turtle soup, egg drop soup, any soup with egg noodles or macaroni

Prepared entrees or combination foods that contain eggs in any form

Desserts & Sweets Gelatin, fruit crisp, popsicles, fruit ice

Homemade desserts prepared with allowed ingredients

Hard candy

Cakes, cookies, cream-filled pies, meringues, whips, custard, pudding, ice cream, sherbet

Chocolate candy made with cream or fondant fillings, marshmallow candy, divinity, fudge, icing or frostings, chocolate sauce

Dessert powders

Pie crust or jelly beans brushed with egg whites

Fat-free desserts made with Simplesse™

Fats & Oils Butter, margarine, vegetable oil, shortening, cream gravy, oil & vinegar dressing, eggless mayonnaise, bacon Salad dressings and mayonnaise (unless egg free)

Tartar sauce

Fat-free products made with Simplesse™

Beverages Water, fruit juice, fruit drinks

Tea

Carbonated beverages

Root beer, wine, or coffee if clarified with egg
Condiments & Miscellaneous Sugar, honey, jam, jelly

Salt, spices

Cream sauces made with eggs

Hollandaise sauce, tartar sauce, marshmallow sauce

Baking powder containing egg white or egg albumin

Any product made with Simplesse™

How to read a label for an egg-free diet:

Be sure to avoid foods that contain any of the following ingredients:

  • albumin
  • egg white
  • egg yolk
  • dried egg
  • egg powder
  • egg solids
  • egg substitutes
  • eggnog
  • globulin
  • livetin
  • lysozyme (used in Europe)
  • mayonnaise
  • meringue
  • ovalbumin
  • ovomucin
  • ovomucoid
  • ovovitellin
  • Simplesse™

Other possible sources of eggs or egg products:

  • A shiny glaze or yellow baked goods may indicate the presence of egg.
  • Simplesse™ is used as a fat substitute and is made from either egg or milk protein.
  • Egg white and shells may be used as clarifying agents in soup stocks, consommés, bouillons, and coffees.

Caution should be used if consuming these products.

Information for using egg substitutes:

For each egg, one of the following may be substituted in recipes:

  • 1 tsp baking powder, 1 Tbsp water, 1 Tbsp vinegar
  • 1 tsp yeast dissolved in 1/4 cup warm water
  • 1 Tbsp apricot puree
  • 1 1/2 Tbsp water, 1 1/2 Tbsp oil, 1 tsp baking powder
  • 1 packet gelatin, 2 Tbsp warm water (do not mix until ready to use)

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Endoscopic Sinus Surgery

The purpose of endoscopic sinus surgery is to open the passages of the sinuses allowing for proper drainage to the nose. It is called an endoscopic procedure because the physician uses an endoscope (a small, flexible tube with a light and a camera lens at the end) to view the inside of the nose. Small incisions or cuts are made to allow the scope to pass. The cuts are usually made inside of the nose. The physician may create new passages or open existing ones by removing polyps, cysts, or thickened mucous membranes.

Endoscopic sinus surgery:

  • Endoscopic sinus surgery usually takes between one and three hours and is done in the operating room with the child under general anesthesia.
  • Most young children spend the night in the hospital, but some older children may stay for only a couple of hours after surgery.
  • Depending on the surgeon's preference and the needs of the child, endoscopic sinus surgery may be performed at the same time as another operation such as septoplasty, tonsillectomy, adenoidectomy, or insertion of ear tubes.

What to expect after surgery:

  • Your child will have intravenous (IV) fluids until time of discharge. Clear liquids for your child to drink are available in the Post Anesthesia Care Unit (PACU), also called the recovery room.
  • Your child may complain of a sore nose, not being able to breathe through the nose, and difficulty swallowing.
  • A pain reliever may be given for pain. An antibiotic is occasionally prescribed to prevent infection.
  • The head of the bed will be raised in the PACU to help with swelling, breathing, and drainage. At home you should have pillows or a recliner chair available to help your child stay comfortable with his/her head elevated above the level of the chest.
  • There may be packing in the nose to prevent bleeding. Sometimes, this packing is dissolvable. The physician may remove this packing in one or two weeks or it may dissolve on its own. If the packing needs to be removed, it may be done in the physician's office for older, cooperative children, or may be done in the operation room under anesthesia.
  • If a septoplasty (straightening of the bone and cartilage in the center of the nose) is performed, then splints will be placed inside the nose at the end of the operation. These will be removed at the physician's office in one to two weeks and may cause some discomfort while they are in place.
  • If packing is used, your child may be able to feel it in his/her nose. Your child should be told before surgery that they may feel like they have something in their nose when they wake up. If packing is not used, swelling may cause this feeling. Your child should know that he/she will not be allowed to forcefully blow his/her nose for a week or two.
  • At first, there may be some drainage from the nose. You may see a small piece of gauze taped under your child's nose. This is called a "drip pad." This is usually only needed for the first day, if at all. The drainage from the nose will probably be tinged with blood. Your child may cough or spit up some pink or brown mucus.
  • Most children are fussy the first few hours after this procedure.
  • Your child may begin normal play after several days, but may need to stay home from school until the discomfort improves. Consult your child's physician for more specific recommendations.
  • Your child's physician may recommend the use of nasal ointment, salt water spray, or nasal steroid spray after surgery. Follow instructions carefully.

When to call your child's physician:

The following are some of the symptoms that may indicate a need for you to promptly contact your child's physician:

  • bright red bleeding from the nose or mouth
  • double or impaired vision
  • a persistent leak of clear fluid from the nose
  • if your child vomits bright red blood or a coffee ground-like material
  • if your child develops a croupy (barky) cough/cry or wheezing
  • if your child's temperature rises greater than 101.5º F rectally or greater than 100.5º F orally
  • vomiting (or if the vomiting becomes severe)
  • signs of dehydration (a child can become dehydrated when he/she has prolonged or severe vomiting and is not able to drink enough fluid)

Follow-up:

A visit with your child's physician will be scheduled for one to two weeks after surgery and then again several more times in the months after surgery to make sure that the nose is healing properly. Consult your child's physician if you have any questions.

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Facelift

What is a facelift?

Rhytidectomy, a surgical procedure commonly known as a facelift, involves the removal of excess facial fat, the tightening of facial muscles, and the stretching of facial skin to approximate a smoother, firmer facial appearance. The procedure takes place on either the face, neck, or both.

Depending on the area of the face or neck where the "lift" is to take place, the surgeon will separate the skin from the fat and muscle. The fat is then removed and the skin is pulled back into place with any excess removed.

Possible complications associated with facelifts:

Possible complications associated with facelifts may include, but are not limited to, the following:

  • nerve injury
    Nerves that control the facial muscles could be damaged. This is usually a temporary post-operative condition.
  • infection and anesthesia reaction
    As with any type of surgery, there is a risk of infection and a reaction to the anesthesia.
  • hematoma
    A hematoma, blood that collects under the skin, could occur. They are generally removed by the physician.
  • slower healing process (for some people)
    Smokers, in particular, may find that the healing process following a facelift is slower than normal.

Who are candidates for facelift?

The best candidates for a facelift are those whose face and/or neck have begun to sag, but whose skin still has some elasticity. The procedure also works best on persons whose bone structure is strong and well-defined.

About the procedure:

Although each procedure varies, generally, facelift surgeries follow this process:

  • Location options may include:
    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient
  • Anesthetic options may include:
    • general anesthesia
    • local anesthesia, combined with a sedative (allows the patient to remain awake but relaxed) for adults
  • Average length of procedure:
    several hours or longer, if more than one procedure is being performed
  • Some possible short-term side effects of surgery:
    • significant discomfort after surgery is not unusual
    • temporary numbness of the skin

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Food Allergies

What is food allergy?

A food allergy is an abnormal response of the body to a certain food. It is important to know that this is different than a food intolerance, which does not affect the immune system, although some of the same symptoms may be present.

What causes food allergy?

Before having a food allergy reaction, a sensitive child must have been exposed to the food at least once before, or could also be sensitized through breast milk. It is the second time your child eats the food that the allergic symptoms happen. At that time, when IgE antibodies react with the food, histamines are released, which can cause your child to experience hives, asthma, itching in the mouth, trouble breathing, stomach pains, vomiting, and/or diarrhea.

What is the difference between food allergy and food intolerance?

Food allergy causes an immune system response, causing symptoms in your child that range from uncomfortable to life threatening. Food intolerance does not affect the immune system, although some symptoms may be the same as in food allergy.

What foods most often cause food allergy?

Approximately 90 percent of all food allergies are caused by the following six foods:

  • milk
  • eggs
  • wheat
  • soy
  • tree nuts  
  • peanuts

Eggs, milk, and peanuts are the most common causes of food allergies in children, with wheat, soy, and tree nuts also included. Peanuts, tree nuts, fish, and shellfish commonly cause the most severe reactions. About 6 percent to 8 percent of children under the age of six years have food allergies. Although most children "outgrow" their allergies, allergy to peanuts, tree nuts, fish, and shellfish may be life-long.

What are the symptoms of food allergy?

Allergic symptoms may begin within minutes to an hour after ingesting the food. The following are the most common symptoms of food allergy. However, each child may experience symptoms differently. Symptoms may include:

  • vomiting
  • diarrhea
  • cramps
  • hives
  • swelling
  • eczema
  • itching or swelling of the lips, tongue, or mouth
  • itching or tightness in the throat
  • difficulty breathing
  • wheezing
  • lowered blood pressure

According to the National Institute of Allergy and Infectious Disease, it does not take much of the food to cause a severe reaction in highly allergic people. In fact, as little as 1/44,000 of a peanut kernel can cause an allergic reaction for severely allergic individuals.

The symptoms of food allergy may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

Treatment for food allergy:

There is no medication to prevent food allergy. The goal of treatment is to avoid the foods that cause the symptoms. After seeing your child's physician and finding foods to which your child is allergic, it is very important to avoid these foods and other similar foods in that food group. If you are breastfeeding your child, it is important to avoid foods in your diet to which your child is allergic. Small amounts of the food allergen may be transmitted to your child through your breast milk and cause a reaction.

It is also important to give vitamins and minerals to your child if he/she is unable to eat certain foods. Discuss this with your child's physician.

For children who have had a severe food reaction, your child's physician may prescribe an emergency kit that contains epinephrine, which helps stop the symptoms of severe reactions. Consult your child's physician for further information.

Some children, under the direction of his/her physician, may be given certain foods again after 3 to 6 months to see if he/she has outgrown the allergy. Many allergies may be short term in children and the food may be tolerated after the age of 3 or 4.

Milk and soy allergy:

Allergies to milk and soy are usually seen in infants and young children. Often, these symptoms are unlike the symptoms of other allergies, but, rather, may include the following:

  • colic (fussy baby)
  • blood in your child's stool
  • poor growth

Often, your child's physician will change your baby's formula to a soy formula or breast milk if it is thought he/she is allergic to milk. If your child has problems with soy formula, your child's physician might change him/her to an easily digested hypoallergenic formula.

The symptoms of a milk or soy allergy may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

Prevention of food allergies:

The development of food allergies cannot be prevented, but can often be delayed in infants by following these recommendations:

  • If possible, breastfeed your infant for the first 6 months.
  • Do not give solid foods until your child is 6 months of age or older.
  • Avoid cow's milk, wheat, eggs, peanuts, and fish during your child's first year of life.

Dining out with food allergies:

If your child has one or more food allergies, dining out can be a challenge. However, it is possible to have a healthy and satisfying dining-out experience - it just takes some preparation and persistence on your part.

The American Dietetics Association offers these tips for dealing with food allergies when your family is eating away from home:

  • Know what ingredients are in the foods at the restaurant where you plan to eat. When possible, obtain a menu from the restaurant ahead of time and review the menu items.
  • Let your server know from the beginning about your child's food allergy. He or she should know how each dish is prepared and what ingredients are used. Ask about preparation and ingredients before you order. If your server does not know this information or seems unsure of it, ask to speak to the manager or the chef.
  • Avoid buffet-style or family-style service, as there may be cross-contamination of foods from using the same utensils for different dishes.
  • Avoid fried foods, as the same oil may be used to fry several different foods.

Another strategy for dining out with food allergies is to give your server or the manager a food allergy card. A food allergy card contains information about the specific items your child is allergic to, along with additional information, such as a reminder to make sure all utensils and equipment used to prepare your meal is thoroughly cleaned prior to use. You can easily print these cards yourself using a computer and printer. If your child is eating out with friends and you are not going to be present, give your child a food allergy card (or make sure the adult in charge has one) to give to the server.

Alternately, there are several types of allergy cards available on the internet that can be customized with your child's personal information. One example is the "Food Allergy Buddy" Dining Card, promoted by the National Restaurant Association.

The Food Allergy Initiative, in conjunction with the National Restaurant Association and the Food Allergy and Anaphylaxis Network, has developed the Food Allergy Training Program for Restaurants and Food Services. This training program was developed to help restaurants and other foodservice outlets to ensure their customers, including those with food allergies, will receive a safe meal prepared to customer specifications.

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Forehead Lift

What is a forehead lift?

A forehead lift is the surgical removal of excess fat and skin, as well as a tightening of the muscles in the forehead area. It can correct sagging brows or deep furrows between the eyes. It is often done in conjunction with a facelift, in order to create a smoother facial appearance overall.

There are two types of surgical techniques available for a forehead lift, including the classic forehead lift and the endoscopic forehead lift:

  • classic forehead lift
    In the classic forehead lift, the surgeon will make an incision that is similar to a headphone-like pattern. This incision is called a coronal incision and starts at about ear level and continues across the top of the forehead to the other ear. The surgeon then carefully lifts the skin of the forehead removing any excess tissue and fat and, if necessary, realigns the muscles. During the procedure, the eyebrows may also be repositioned at a higher level, and any excess skin is trimmed.
  • endoscopic forehead lift
    The difference between the endoscopic forehead lift and the classic forehead lift is the size of the incision. With the endoscopic forehead lift, the surgeon makes three to five short scalp incisions that are each less than an inch long. An endoscope is then inserted through one of the incisions allowing the surgeon to see the muscles and tissues underneath. In a different incision, the surgeon inserts another instrument that lifts the forehead skin. Excess tissue and fat are then removed and, if necessary, muscles are realigned. Like the classic forehead lift, the eyebrows may also be repositioned at a higher level. The recovery period and scarring is minimal, in comparison to the classic forehead lift.

Possible complications associated with forehead lifts:

Possible complications associated with forehead lift surgeries may include, but are not limited to, the following:

  • scar formation
    Although rare, the formation of a scar may occur. It can be treated surgically by removing the wide scar tissue, allowing a new, thinner scar to appear.
  • eyebrow movement problems
    Also uncommon is injury to the nerves that control movement of the eyebrows. This can cause the loss of ability to raise the eyebrows or wrinkle the forehead. Surgery may be necessary to correct this problem.
  • sensation loss
    The loss of sensation around the incision is especially common with the classic forehead lift. Although it is usually temporary, it can be permanent.
  • complications during procedure
    During the endoscopic forehead lift, there is a slight chance of complications arising causing the surgeon to switch techniques and proceed with the classic forehead lift. This can result in a more extensive scar and a longer recovery period.

Who are candidates for forehead lift?

A forehead lift can help people of any age who have developed furrows or frown lines due to stress, muscle activity, or inherited conditions, such as a low, heavy brow or furrowed lines above the nose. However, it is most commonly performed on people ages 40 to 60, to minimize the visible effects of aging.

Forehead lift is often performed in conjunction with a facelift or eyelid lift surgery.

About the procedure:

Although each procedure varies, generally, forehead lift surgeries follow this process:

  • Location options include:
    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient
  • Location options may include:
    • general anesthesia
    • local anesthesia, combined with a sedative (allows the patient to remain awake but relaxed) for adults
  • Some possible short-term side effects of surgery:
    • numbness and temporary discomfort around the incision(s)
    • swelling that may affect the cheeks and eyes
    • numbness on the top of the scalp may eventually be replaced by itching
    • pain is usually minimal
    • bruising

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Foreign Bodies in the Ear, Nose, and Airway

Foreign bodies in the ear, nose, and breathing tract (airway) sometimes occur in children. Foreign bodies refer to any object that is placed in the ear, nose, or mouth that is not meant to be there and could cause harm without immediate medical attention.

Foreign bodies in the ear:

Foreign bodies can either be in the ear lobe or in the ear canal. Objects usually found in the ear lobe are earrings, either stuck in the lobe from infection or placed too deep during insertion. Foreign bodies in the ear canal can be anything a child can push into his/her ear. Some of the items that are commonly found in the ear canal include the following:

  • food
  • insects
  • toys
  • buttons
  • pieces of crayon
  • small batteries

It is important for parents to be aware that children may cause themselves or other children great harm by placing objects in the ear.

The reason children place things in their ears is usually because they are bored, curious, or copying other children. Sometimes, one child may put an object in another child's ear during play. Insects may also fly into the ear canal, causing potential harm. It has also been noted that children with chronic outer ear infections tend to place things in their ears more often.

What are the symptoms of foreign bodies in the ear?

Some objects placed in the ear may not cause symptoms, while other objects, such as food and insects, may cause pain in the ear, redness, or drainage. Hearing may be affected if the object is blocking the ear canal.

Treatment for foreign bodies in the ear:

The treatment for foreign bodies in the ear is prompt removal of the object by your child's physician. The following are some of the techniques that may be used by your child's physician to remove the object from the ear canal:

  • instruments may be inserted in the ear
  • magnets are sometimes used if the object is metal
  • cleaning the ear canal with water
  • a machine with suction to help pull the object out

After removal of the object, your child's physician will then re-examine the ear to determine if there has been any injury to the ear canal. Antibiotic drops for the ear may be prescribed to treat any possible infections.

Foreign bodies in the nose:

Objects that are put into the child's nose are usually soft things. These would include, but are not limited to, tissue, clay, and pieces of toys, or erasers. Sometimes, a foreign body may enter the nose while the child is trying to smell the object. Children often place objects in their noses because they are bored, curious, or copying other children.

What are the symptoms of foreign bodies in the nose?

The most common symptom of a foreign body in the nose is nasal drainage. The drainage appears only on the side of the nose with the object and often has a bad odor. In some cases, the child may also have a bloody nose.

Treatment for foreign bodies in the nose:

Treatment of a foreign body in the nose involves prompt removal of the object by your child's physician. Sedating the child is sometimes necessary in order to remove the object successfully. This may have to be performed in the hospital, depending on the extent of the problem and the cooperation of the child. The following are some of the techniques that may be used by your child's physician to remove the object from the nose:

  • suction machines with tubes attached
  • instruments may be inserted in the ear

After removal of the object, your child's physician may prescribe nose drops or antibiotic ointments to treat any possible infections.

Foreign bodies in the airway:

A foreign body in the airway (choking) constitutes a medical emergency and requires immediate attention. The foreign body can get stuck in many different places within the airway. According to the American Academy of Pediatrics, death by choking in children occurs most often in children younger than 5 years. Infants younger than 1 year old account for two-thirds of child choking victims.

As with other foreign body problems, children tend to put things into their mouths when they are bored or curious. The child may then inhale deeply and the object may become lodged in the "airway" tube (trachea) instead of the "eating" tube (esophagus). Food may be the cause of obstruction in children who do not have a full set of teeth to chew completely, or those children who simply do not chew their food well. Children also do not have complete coordination of the mouth and tongue which may also lead to problems. Children between the ages of 7 months and 4 years are in the greatest danger of choking on small objects, including, but not limited to, the following:

  • seeds
  • toy parts
  • grapes
  • hot dogs
  • pebbles
  • nuts
  • buttons

Children need to be watched very closely to avoid a choking emergency.

What are the symptoms of foreign bodies in the airway?

Foreign body ingestion requires immediate medical attention. The following are the most common symptoms that may indicate a child is choking. However, each child may experience symptoms differently. Symptoms may include:

  • choking or gagging when the object is first inhaled
  • coughing at first
  • wheezing (a whistling sound, usually made when the child breathes out)

Although the initial symptoms listed above may subside, the foreign body may still be obstructing the airway. The following symptoms may indicate that the foreign body is still causing an airway obstruction:

  • stridor (a high pitched sound usually heard when the child breathes)
  • cough that gets worse
  • child is unable to speak
  • pain in the throat area or chest
  • hoarse voice
  • blueness around the lips
  • not breathing
  • the child may become unconscious

Treatment for foreign bodies in the airway:

Treatment of the problem varies with the degree of airway blockage. If the object is completely blocking the airway, the child will be unable to breathe or talk and his/her lips will become blue. This is a medical emergency and you should seek emergency medical care. Sometimes, surgery is necessary to remove the object. Children that are still talking and breathing but show other symptoms also need to be evaluated by a physician immediately.

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Glossary - Otolaryngology

A | B | C | D | E | F | G | H | I | J | K | L | M
N | O | P | Q | R | S | T | U | V | W | X | Y | Z

A

acoustic neurinoma - a tumor, usually benign, which develops on the hearing and balance nerves and can cause gradual hearing loss, tinnitus, and dizziness.

acquired deafness - loss of hearing that occurs or develops over the course of a lifetime; deafness not present at birth.

ageusia - loss of the sense of taste.

Alport's syndrome - A hereditary condition characterized by kidney disease, sensorineural hearing loss, and some difficulties with eye defects.

American Sign Language (ASL) - Manual (hand) language with its own syntax and grammar used primarily by people who are deaf.

anosmia - absence of the sense of smell.

aphasia - total or partial loss of ability to use or understand language; usually caused by stroke, brain disease, or injury.

aphonia - complete loss of voice.

apraxia - inability to make a voluntary movement in spite of being able to demonstrate normal muscle function.

articulation disorder - inability to correctly produce speech sounds (phonemes) because of imprecise placement, timing, pressure, speed, or flow of movement of the lips, tongue, or throat.

assistive devices - technical tools and devices such as alphabet boards, text telephones, or text-to-speech conversion software used to assist people with physical or emotional disorders in performing certain actions, tasks, and activities.

audiologist - a healthcare professional trained to identify and measure hearing impairments and related disorders using a variety of tests and procedures.

auditory brainstem response (ABR) test - test used for hearing in infants and young children, or to test for brain functioning in unresponsive patients.

auditory nerve - eighth cranial nerve that connects the inner ear to the brainstem.

auditory perception - ability to identify, interpret, and attach meaning to sound.

auditory prosthesis - device that substitutes or enhances the ability to hear.

augmentative devices - tools that help individuals with limited or absent speech to communicate.

aural rehabilitation - techniques used with people who are hearing impaired to improve ability to speak and to communicate.

autism - brain disorder that begins in early childhood and persists throughout adulthood; affects three crucial areas of development: communication, social interaction, and creative or imaginative play.

autoimmune deafness - hearing loss in an individual that may be associated with a tissue-causing disease, such as rheumatoid arthritis or lupus.

B

balance - biological system that enables individuals to know where their bodies are in the environment and to maintain a desired position; normal balance depends on information from the labyrinth in the inner ear, and from other senses such as sight and touch, as well as from muscle movement.

balance disorder - disruption in the labyrinth, the inner ear organ that controls the balance system allowing individuals to know where their bodies are in the environment.

barotrauma - injury to the middle ear caused by a reduction of air pressure.

benign paroxysmal positional vertigo (BPPV) - balance disorder that results in a sudden onset of dizziness, spinning, or vertigo that occurs when suddenly moving the head from one position to another.

brainstem implant - auditory prosthesis that bypasses the cochlea and auditory nerve to help individuals who cannot benefit from a cochlear implant because the auditory nerves are not working.

C

captioning - text display of spoken words presented on a television or a movie screen that allows a deaf or hard-of-hearing viewer to follow the dialogue and the action of a program simultaneously.

central auditory processing disorder - inability of individuals with normal hearing and intelligence to differentiate, recognize, or understand sounds.

chemosensory disorders - disorders or diseases of smell or taste.

cholesteatoma - accumulation of dead cells in the middle ear caused by repeated middle ear infections.

cochlea - snail-shaped structure in the inner ear that contains the organ of hearing.

cochlear implant - medical device that bypasses damaged structures in the inner ear and directly stimulates auditory nerve to allow some deaf individuals to learn to hear and interpret sounds and speech.

computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

conductive hearing impairment - hearing loss caused by dysfunction of the outer or middle ear.

cued speech - method of communication that combines speech reading with a system of handshapes placed near the mouth to help deaf or hard-of-hearing individuals differentiate words that look similar on the lips.

cytomegalovirus (congenital) - one group of herpes viruses that infect humans and can cause a variety of clinical symptoms including deafness or hearing impairment; infection with the virus may be either before or after birth.

D

decibel - unit that measures the intensity or loudness of sound.

dizziness - physical unsteadiness, imbalance, and lightheadedness associated with balance disorders.

dysarthria - group of speech disorders caused by disturbances in the strength or coordination of the muscles of the speech mechanism as a result of damage to the brain or nerves.

dysequilibrium - any disturbance of balance.

dysfluency - disruption in the smooth flow or expression of speech.

dysgeusia - distortion or absence of the sense of taste.

dysosmia - distortion or absence of the sense of smell.

dysphagia - difficulty swallowing.

dysphonia - any impairment of the voice or difficulty speaking.

dyspraxia of speech - partial loss of the ability to consistently pronounce words in individuals with normal muscle tone and coordination of the speech muscles.

dystonia - abnormal muscle tone of one or more muscles.

E

ear infection - presence and growth of bacteria or viruses in the ear.

ear wax - yellow secretion from glands in the outer ear (cerumen) that keeps the skin of the ear dry and protected from infection.

endolymph - fluid in the labyrinth - the organ of balance located in the inner ear.

F

G

gustation - act or sensation of tasting.

H

hair cells - sensory cells of the inner ear, which are topped with hair-like structures (stereocilia), which transform the mechanical energy of sound waves into nerve impulses.

hearing - series of events in which sound waves in the air are converted to electrical signals that are sent as nerve impulses to the brain where they are interpreted.

hearing aid - electronic device that brings amplified sound to the ear.

hearing disorder - disruption in the normal hearing process; sound waves are not converted to electrical signals and nerve impulses are not transmitted to the brain to be interpreted.

hoarseness - abnormally rough or harsh-sounding voice caused by vocal abuse and other disorders.

hypogeusia - diminished sensitivity to taste.

hyposmia - diminished sensitivity to smell.

I

inner ear - part of the ear that contains both the organ of hearing (the cochlea) and the organ of balance (the labyrinth).

J

K

L

labyrinth - organ of balance located in the inner ear. The labyrinth consists of three semicircular canals and the vestibule.

labyrinthine hydrops - excessive fluid in the organ of balance (labyrinth) that can cause pressure or fullness in the ears, hearing loss, dizziness, and loss of balance.

labyrinthitis - viral or bacterial infection or inflammation of the inner ear that can cause dizziness, loss of balance, and temporary hearing loss.

Landau-Kleffner syndrome - A childhood disorder of unknown origin that can be identified by gradual or sudden loss of the ability to understand and use spoken language.

language - system for communicating ideas and feelings using sounds, gestures, signs, or marks.

language disorders - problems with verbal communication and the ability to use or understand the symbol system for interpersonal communication.

laryngeal neoplasms - abnormal growths in the larynx (voice box) that can be cancerous or noncancerous.

laryngeal nodules - noncancerous, callous-like growths on the inner parts of the vocal folds (vocal cords).

laryngeal paralysis - loss of function or feeling of one or both of the vocal folds.

laryngectomy - surgery to remove part or all of the larynx or voice box.

laryngitis - hoarse voice or the complete loss of the voice because of irritation to the vocal folds (vocal cords).

larynx - valve structure between the trachea (windpipe) and the pharynx (the upper throat) that is the primary organ of voice production.

M

magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

mastoid - back portion of the temporal bone behind the ear.

mastoid surgery - surgical procedure to remove infection from the mastoid bone.

Meige syndrome - A movement disorder that can involve excessive eye blinking (blepharospasm) with involuntary movements of the jaw muscles, lips, and tongue (oromandibular dystonia).

Ménière's disease - An inner ear disorder that can affect both hearing and balance; can cause vertigo, hearing loss, tinnitus, and the sensation of fullness in the ear.

meningitis - inflammation of the meninges, the membranes that envelop the brain and the spinal cord; may cause hearing loss or deafness.

middle ear - part of the ear that includes the eardrum and three tiny bones of the middle ear, ending at the round window that leads to the inner ear.

misarticulation - inaccurately produced speech sound (phoneme) or sounds.

motion sickness - dizziness, sweating, nausea, vomiting, and generalized discomfort experienced when an individual is in motion.

motor speech disorders - group of disorders caused by the inability to accurately produce speech sounds (phonemes).

N

neural plasticity - ability of the brain and/or certain parts of the nervous system to change in order to adapt to new conditions, such as an injury.

neural prostheses - devices that substitute for an injured or diseased part of the nervous system to enhance the function.

neural stimulation - to activate or energize a nerve through an external source.

neurofibromatosis - a group of inherited disorders in which noncancerous tumors grow on several nerves that may include the hearing nerve.

neurogenic communication disorder - inability to exchange information with others because of hearing, speech, and/or language problems caused by impairment of the nervous system.

noise-induced hearing loss - hearing loss that is caused either by a one-time or repeated exposure to very loud sound(s) or sounds at various loudness levels over an extended period of time.

nonsyndromic hereditary hearing impairment - hearing loss or deafness that is inherited and is not associated with other inherited clinical characteristics.

O

odorant - substance that stimulates the sense of smell.

olfaction - the act of smelling.

olfactometer - device for estimating the intensity of the sense of smell.

open-set speech recognition - understanding speech without visual clues.

otitis media - inflammation of the middle ear caused by infection.

otitis externa - inflammation of the outer part of the ear extending to the auditory canal.

otoacoustic emissions - low-intensity sounds produced by the inner ear that can be quickly measured with a sensitive microphone placed in the ear canal.

otolaryngologist - physician/surgeon who specializes in diseases of the ears, nose, throat, and head and neck.

otologist - physician/surgeon who specializes in diseases of the ear.

otosclerosis - abnormal growth of bone in the inner ear, which prevents structures within the ear from working properly, resulting in a gradual loss of hearing.

ototoxic drugs - drugs that can damage the hearing and balance organs located in the inner ear.

outer ear - external portion of the ear, consisting of the pinna, or auricle, and the ear canal.

P

parosmia - any disease or perversion of the sense of smell, especially the subjective perception of odors that do not exist.

perception (hearing) - process of knowing or being aware of information through the ear.

perilymph fistula - leakage of inner ear fluid to the middle ear that occurs without apparent cause or is associated with head trauma, physical exertion, or barotrauma.

phonology - study of speech sounds.

positron emission tomography (PET) scan - a computer-based imaging technique that uses radioactive substances to examine body processes. For example, a PET scan of the heart provides information about the flow of blood through the coronary arteries to the heart.

postlingually deafened - individual who becomes deaf after having learned language.

prelingually deafened - individual who is either born deaf or who lost hearing early in childhood, before learning language.

presbycusis - loss of hearing that gradually occurs because of changes in the inner or middle ear in individuals as they grow older.

Q

R

round window - membrane separating the middle ear and inner ear.

S

sensorineural hearing loss - hearing loss caused by damage to the sensory cells and/or nerve fibers of the inner ear.

sign language - language of hand shapes, facial expressions, and movements used as a form of communication.

smell - to perceive odor or scent through stimuli affecting the olfactory nerves.

smell disorder - inability to perceive odors that may be temporary or permanent.

sound vocalization - ability to produce voice.

spasmodic dysphonia - momentary disruption of voice caused by involuntary movements of one or more muscles of the larynx or voice box.

specific language impairment (or SLI) - difficulty with the organized-symbol-system communication in the absence of problems such as mental retardation, hearing loss, or emotional disorders.

speech - making definite vocal sounds that form words to express thoughts and ideas.

speech disorder - defect or abnormality that prevents an individual from communicating by means of spoken words.

speech processor - part of a cochlear implant that converts speech sounds into electrical impulses to stimulate the auditory nerve.

speech-language pathologist - health professional trained to evaluate and treat people who have voice, speech, language, or swallowing disorders, including hearing impairment, that affect their ability to communicate.

stuttering - frequent repetition of words or parts of words that disrupts the smooth flow of speech.

sudden deafness - loss of hearing that occurs quickly from such causes as explosion, a viral infection, or the use of some drugs.

swallowing disorders - any of a group of problems that interfere with the transfer of food from the mouth to the stomach.

syndromic hearing impairment - hearing loss or deafness that is inherited or passed through generations of a family.

T

taste - sensation produced by a stimulus applied to the gustatory nerve endings in the tongue; the four tastes are salt, sour, sweet, and bitter; some say there is a fifth taste described as savory.

taste buds - groups of cells located on the tongue that enable one to recognize different tastes.

taste disorder - inability to perceive different flavors.

throat disorders - disorders or diseases of the larynx (voice box) or esophagus.

thyroplasty - surgical technique to improve voice by altering the cartilages of the larynx. Also known as laryngeal framework surgery.

tinnitus - sensation of a ringing, roaring, or buzzing sound in the ears or head; often associated with various forms of hearing impairment.

tongue - large muscle on the floor of the mouth that manipulates food for chewing and swallowing; the main organ of taste, and assists in forming speech sounds.

Tourette syndrome - Neurological disorder characterized by recurring movements and sounds (called tics).

tracheostomy - surgical opening into the trachea (windpipe) to help someone breathe who has an obstruction or swelling in the larynx (voice box) or upper throat.

tympanoplasty - surgical repair of the eardrum (tympanic membrane) or bones of the middle ear.

U

Usher's syndrome - A hereditary disease that affects hearing and vision.

V

velocardiofacial syndrome - inherited disorder characterized by cleft palate, heart defects, characteristic facial appearance, minor learning problems, and speech and feeding problems.

vertigo - illusion of movement; sensation that the external world is revolving around an individual (objective vertigo) or that the individual is revolving in space (subjective vertigo).

vestibular neuronitis - infection at the vestibular nerve.

vestibular system - system in the body that is responsible for maintaining the body's orientation in space, balance, and posture; also regulates locomotion and other movements and keeps objects in visual focus as the body moves.

vestibule - bony cavity of the inner ear.

vibrotactile aids - mechanical instruments that help individuals who are deaf detect and interpret sound through the sense of touch.

vocal cords (vocal folds) - muscularized folds of mucous membrane that extend from the larynx (voice box) wall; enclosed in elastic vocal ligament and muscle that control the tension and rate of vibration of the cords as air passes through them.

vocal cord paralysis - inability of one or both vocal folds (vocal cords) to move because of damage to the brain or nerves.

vocal tremor - trembling or shaking of one or more of the muscles of the larynx resulting in an unsteady-sounding voice.

voice - sound produced by air passing out through the larynx and upper respiratory tract.

voice disorders - group of problems involving abnormal pitch, loudness, or quality of the sound produced by the larynx (voice box).

W

Waardenburg syndrome - Hereditary deafness that is characterized by hearing impairment, a white shock of hair, and/or distinctive blue color to one or both eyes, as well as wide-set inner corners of the eyes; balance problems are also associated with some types of Waardenburg syndrome.

X

Y

Z

Hearing Aids

What are hearing aids?

Hearing loss affects nearly 30 million people in the US each year. Hearing aids can help improve hearing and speech especially in persons with sensorineural hearing loss (hearing loss in the inner ear due to damaged hair cells or a damaged hearing nerve). Sensorineural hearing loss can be caused by noise, injury, infection, aging, certain medications, birth defects, tumors, problems with blood circulation or high blood pressure, and stroke.

Hearing aids are electronic or battery-operated devices that can amplify and change sound. A microphone receives the sound and converts it into sound waves. The sound waves are then converted into electrical signals.

What are the different types of hearing aids?

The type of hearing aid recommended for the individual depends on the person's home and work activities, his/her physical limitations and medical condition, and personal preference. There are many different types of hearing aids on the market, with companies continuously inventing newer, improved hearing aids everyday. However, there are four basic types of hearing aids available today. Consult your physician for additional information on each of the following types:

In-the-ear (ITE) hearing aids

Picture of an in-the-ear hearing aid

These hearing aids come in plastic cases that fit in the outer ear. Generally used for mild to severe hearing loss, ITE hearing aids can accommodate other technical hearing devices, such as the telecoil, a mechanism used to improve sound during telephone calls. However, their small size can make it difficult to make adjustments. In addition, ITE hearing aids can be damaged by ear wax and drainage.
Behind-the-ear (BTE) hearing aids

Picture of a behind-the-ear hearing aid

Behind-the-ear hearing aids, as the name implies, are worn behind the ear. This type of hearing aid, which is in a case, connects to a plastic earmold inside the outer ear. These hearing aids are generally used for mild to severe hearing loss. However, poorly fitted BTE hearing aids can cause feedback, an annoying "whistling" sound, in the ear.
Canal aids Canal aids fit directly in the ear canal and come in two sizes: in-the-canal (ITC) aid and completely-in-canal (CIC) aid. Customized to fit the size and shape of the individual's ear canal, canal aids are generally used for mild to moderate hearing loss. However, because of their small size, removal and adjustment may be more difficult. In addition, canal aids can be damaged by ear wax and drainage.
Body aids Generally reserved for profound hearing loss, or if the other types of hearing aids will not accommodate, body aids are attached to a belt or pocket and connected to the ear with a wire.

Who may be a candidate for hearing aids?

Anyone who has hearing loss that may be improved with hearing aids can benefit from these devices. The type of hearing aid recommended may depend on several factors, including, but not limited to:

  • the shape of the outer ear (deformed ears may not accommodate behind-the-ear hearing aids)
  • depth of depression near the ear canal (too shallow ears may not accommodate in-the-ear hearing aids)
  • the type and severity of hearing loss
  • the manual dexterity of the individual to remove and insert hearing aids
  • the amount of wax build-up in the ear (excessive amounts of wax or moisture may prevent use of in-the-ear hearing aids)
  • ears that require drainage may not be able to use certain hearing aid models

Wearing a hearing aid:

Once the hearing aids have been fitted for the ears, the individual should begin to gradually wear the hearing aid. Because hearing aids do not restore normal hearing, it may take time to get used to the different sounds transmitted by the device. The American Academy of Otolaryngology recommends the following when beginning to wear hearing aids:

  • Be patient and give yourself time to get used to the hearing aid and the sound it produces.
  • Start in quiet surroundings and gradually build up to noisier environments.
  • Experiment where and when the hearing aid works best for you.
  • Keep a record of any questions and concerns you have, and bring those to your follow-up examination.

Taking care of hearing aids:

Hearing aids need to be kept dry. Methods for cleaning hearing aids vary depending on the style and shape. Other tips for taking care of hearing aids include:

  • Keep the hearing aids away from heat.
  • Batteries should be replaced on a regular basis.
  • Avoid the use of hairspray and other hair products when the hearing aid is in place.

Considerations when purchasing a hearing aid:

A medical examination is required before purchasing a hearing aid. Hearing aids can be purchased from an otolaryngologist (a physician who specializes in disorders of the ear, nose, throat, and related structures of the head and neck), an audiologist (a specialist who can evaluate and manage hearing and balance problems), or an independent company. Styles and prices vary widely. The National Institute on Deafness and other Communication Disorders recommends asking the following questions when buying hearing aids:

  • Can the hearing loss be improved with medical or surgical interventions?
  • Which design will work best for my type of hearing loss?
  • May I "test" the hearing aids for a certain period?
  • How much do hearing aids cost?
  • Do the hearing aids have a warranty and does it cover maintenance and repairs?
  • Can my audiologist or otolaryngologist make adjustments and repairs?
  • Can any other assistive technological devices be used with the hearing aids?

Hearing aids typically need to be replaced after about five years. New programmable and digital hearing aids which can be adjusted as the level of hearing changes may reduce the need for replacement.

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Hearing Aids

What are hearing aids?

Approximately 2 to 3 out of every 1,000 children born in the US are either deaf or have hearing loss. More children will lose their hearing later in childhood. Hearing aids can help improve hearing and speech, especially in children with sensorineural hearing loss (hearing loss in the inner ear due to damaged hair cells or a damaged hearing nerve). Sensorineural hearing loss can be caused by noise, injury, infection, certain medications, birth defects, tumors, and problems with blood circulation.

Hearing aids are electronic or battery-operated devices that can amplify and change sound. A microphone receives the sound and converts it into sound waves. The sound waves are then converted into electrical signals. Children as young as two months can be fitted with hearing aids.

What are the different types of hearing aids?

The type of hearing aid recommended for your child will depend on several factors, including his/her physical limitations, medical condition, and personal preference. There are many different types of hearing aids on the market, with companies continuously inventing newer, improved hearing aids. However, there are four basic types of hearing aids available today. Consult your child's physician for additional information on each of the following types:

In-the-ear (ITE) hearing aids

Picture of an in-the-ear hearing aid

These hearing aids come in plastic cases that fit in the outer ear. Generally used for mild to severe hearing loss, ITE hearing aids can accommodate other technical hearing devices, such as the telecoil, a mechanism used to improve sound during telephone calls. However, their small size can make it difficult to make adjustments. In addition, ITE hearing aids can be damaged by ear wax and drainage.
Behind-the-ear (BTE) hearing aids

Picture of a behind-the-ear hearing aid

Behind-the-ear hearing aids, as the name implies, are worn behind the ear. This type of hearing aid, which is in a case, connects to a plastic earmold inside the outer ear. These hearing aids are generally used for mild to severe hearing loss. However, poorly fitted BTE hearing aids can cause feedback, an annoying "whistling" sound, in the ear.
Canal aids Canal aids fit directly in the ear canal and come in two styles: in-the-canal (ITC) aid and completely-in-canal (CIC) aid. Customized to fit the size and shape of the individual's ear canal, canal aids are generally used for mild to moderate hearing loss. However, because of their small size, removal and adjustment may be more difficult. In addition, canal aids can be damaged by ear wax and drainage.
Body aids Generally reserved for profound hearing loss, or if the other types of hearing aids will not accommodate, body aids are attached to a belt or pocket and connected to the ear with a wire.

Who may be a candidate for hearing aids?

Nearly all children who have a hearing loss that may be improved with hearing aids can benefit from these devices. The type of hearing aid recommended may depend on several factors, including, but not limited to, the following:

  • the shape of the outer ear (deformed ears may not accommodate behind-the-ear hearing aids)
  • depth of depression near the ear canal (too shallow ears may not accommodate in-the-ear hearing aids)
  • the type and severity of hearing loss
  • the manual dexterity of the child to remove and insert hearing aids
  • the amount of wax build-up in the ear (excessive amounts of wax or moisture may prevent use of in-the-ear hearing aids)
  • ears that require drainage may not be able to use certain hearing aid models

Wearing a hearing aid:

Once the hearing aids have been fitted for the ears, your child should begin to gradually wear the hearing aid. Because hearing aids do not restore normal hearing, it may take time to get used to the different sounds transmitted by the device. The American Academy of Otolaryngology recommends the following when beginning to wear hearing aids:

  • Be patient and give your child time to get used to the hearing aid and the sound it produces.
  • Start in quiet surroundings and gradually build up to noisier environments.
  • Experiment where and when the hearing aid works best for your child.
  • Keep a record of any questions and concerns you have, and bring those to your child's follow-up examination.

Taking care of hearing aids:

Hearing aids need to be kept dry. Methods for cleaning hearing aids vary depending on the style and shape. Other tips for taking care of hearing aids include the following:

  • Keep the hearing aids away from heat.
  • Batteries should be replaced on a regular basis.
  • Avoid the use of hairspray and other hair products when the hearing aid is in place.

Considerations when purchasing a hearing aid:

A medical examination is required before purchasing a hearing aid. Hearing aids can be purchased from an otolaryngologist (a physician who specializes in disorders of the ear, nose, throat, and related structures of the head and neck), an audiologist (a specialist who can evaluate and manage hearing and balance problems), or an independent company. Styles and prices vary greatly. The National Institute on Deafness and other Communication Disorders recommends asking the following questions when buying hearing aids:

  • Can the hearing loss be improved with medical or surgical interventions?
  • Which design will work best for my child's type of hearing loss?
  • May my child "test" the hearing aids for a certain period of time?
  • How much do hearing aids cost?
  • Do the hearing aids have a warranty and does it cover maintenance and repairs?
  • Can my child's audiologist or otolaryngologist make adjustments and repairs?
  • Can any other assistive technological devices be used with the hearing aids?

Hearing aids typically need to be replaced after about five years. New, programmable and digital hearing aids, that can be adjusted as the level of hearing changes, may reduce the need for replacement.

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Hearing Loss

Sudden Hearing Loss

Sudden hearing loss or deafness can happen quickly or over period of days. A hearing loss of 30 decibels or more is considered sudden sensorineural hearing loss. Sudden hearing loss is a medical emergency and requires immediate medical attention.

Most often, the sudden hearing loss only affects one ear. Although most patients and their physicians do not know exactly what caused the sudden hearing loss, some causes may include trauma; abnormal tissue growth; infectious or immunological diseases; certain medications; toxic causes, such as a snake bite; problems with circulation; neurological causes; or other disorders of the ear.

Most people recover from sudden hearing loss, especially if they receive medical treatment immediately. Treatment may include antibiotics (if a specific disease is identified); steroids (to reduce inflammation); cessation of any medication that may have caused the hearing loss; and a low-salt diet.

What is hearing loss?

Hearing loss is a medical disorder that affects nearly 30 million people in the United States. Impaired hearing may be caused by many things.

  • Older people are the largest group affected by hearing loss. The contributors range from excessive noise, drugs, toxins, and heredity. One in three older adults over age 60 has hearing loss. Half of people over age 75 have hearing loss.
  • In children, the most common cause of hearing loss is otitis media (middle ear infections).
  • Diseases and disorders that contribute to hearing loss include tinnitus, presbycusis, and Usher's syndrome, among others.

Treatment for hearing loss:

In some patients, hearing loss can be surgically corrected. For others, medical devices and rehabilitation therapies often can help reduce hearing loss.

To determine the exact cause of your hearing loss, and how it can be managed, contact your physician for a complete medical examination. If you suspect you have hearing loss, answer these questions suggested by the National Institutes of Health:

  • Do you have a problem hearing over the telephone?
  • Do you have trouble following the conversation when two or more people are talking at the same time?
  • Do people complain that you turn the TV volume up too high?
  • Do you have to strain to understand conversation?
  • Do you have trouble hearing in a noisy background?
  • Do you find yourself asking people to repeat themselves?
  • Do many people you talk to seem to mumble or not speak clearly?
  • Do you misunderstand what others are saying and respond inappropriately?
  • Do you have trouble understanding the speech of women and children?
  • Do people get annoyed because you misunderstand what they say?

If you answered yes to three or more of these questions, you may want to see an otolaryngologist (an ear, nose, and throat specialist), or an audiologist for a hearing evaluation.

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Management of Hearing Loss

Early intervention and detection of hearing loss is necessary to prevent additional problems with speech and language development. A healthcare team approach is normally used when a child is diagnosed with some degree of hearing loss. Team members include the following:

  • audiologist - a professional who specializes in the evaluation and management of hearing and balance problems in people of all ages. Audiologists are also involved with the fitting and management of hearing aids and other assistive devices.
  • otolaryngologists - a physician with special training in medical and surgical treatment for children who have disorders of the ear, nose, and throat.
  • speech pathologist - a professional who helps evaluate and manage speech, language, and hearing problems in your child.

Specific treatment for hearing loss will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Management of hearing loss may include one or more of the following:

  • use of hearing aids - electronic or battery-operated devices that can amplify and change sound. A microphone receives the sound and converts it into sound waves. The sound waves are then converted into electrical signals.
  • cochlear implants - a surgically placed appliance that helps to transmit electrical stimulation to the inner ear. Only certain children are candidates for this type of device. Consult your child's physician for more information.
  • training in sign language and lip reading

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Hearing Loss in Babies

Picture of a hospital nursery

Hearing loss in babies occurs infrequently in the United States. However, without screening or testing, hearing loss may not be noticed until the baby is more than one year old. If hearing loss is not detected until later years, there will not be stimulation of the brain's hearing centers. This can affect the maturation and development of hearing, and can delay speech and language. Social and emotional development and success in school may also be affected.

Most hearing loss is congenital (present at birth), but some babies develop hearing loss after they are born. Hearing loss is more likely in premature babies and babies with respiratory problems who have required long-term use of breathing machines, those with previous infections, and those taking certain medications.

Because of these risks, many health organizations including the National Institutes of Health (NIH) and the American Academy of Pediatrics (AAP) now recommend universal infant hearing screening. This means all newborn babies should be screened for hearing loss. Most often, the parents are the first to detect hearing loss in their child.

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Hearing Loss

What are the different types of hearing loss?

Hearing loss can be categorized by many different types. Two types of hearing loss are sensorineural and conductive. Both types of hearing loss can be congenital (present at birth) or acquired.

  • sensorineural - a loss of function within the inner ear or with the connection to the brain. Causes of this type of hearing loss include:
    • congenital factors - conditions present at birth, such as:
      • infection by the mother with toxoplasmosis, rubella, cytomegalovirus, herpes, or syphilis
      • genetic factors and syndromes the child has at birth
      • low birthweight
      • hereditary - in the family
    • acquired
      • loud noise exposure
      • trauma
      • infections
      • damage from certain medications that can be harmful to the ears
  • conductive hearing loss - a problem in the outer or middle ear where sound waves are not sent to the inner ear correctly. Conductive hearing loss is the most common type of hearing loss in children and is usually acquired. Factors that may cause this type of hearing loss are:
    • congenital factors - conditions present at birth, such as:
      • anomalies of the pinna (the outside of the ear)
      • anomalies of the tympanic membrane (eardrum)
      • anomalies of the external ear canal
      • anomalies of the ossicles (the three tiny bones that deliver the sound waves to the middle ear)
    • acquired
      • excessive wax
      • foreign bodies in the ear canal, such as beads or popcorn kernels
      • tumors of the middle ear
      • problems with the eustachian tube
      • ear infections such as otitis media
      • chronic ear infections with fluid in the middle ear
      • perforation of the eardrum

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Noise-Induced Hearing Loss

Noise and hearing loss:

When the ears are exposed to extremely loud noises, or to prolonged loud noises, inner ear structures can be damaged, leading to noise-induced hearing loss. Noise-induced hearing loss is quite common, affecting about one-third of the nearly 30 million Americans who suffer from hearing loss.

What constitutes a loud noise?

Noise, or sound intensity, is measured in decibels. Normal conversation levels occur at about 60 decibels. Anything above 120 decibels can harm the ears and lead to hearing loss. Examples of noises that reach 120 decibels or above include firecrackers, gunshots, and motorcycles. According to the American Academy of Otolaryngology, noise is damaging if:

  • you have to shout to be heard.
  • your ears hurt.
  • your ears ring.
  • you have difficulty hearing for a couple of hours after the exposure.

What is pitch?

Another measurement of noise, pitch, is the frequency of sound vibrations per second. The lower the pitch (deeper sound), the fewer vibrations per second. Pitch is measured in Hertz (Hz), which means cycles per second. Small children tend to have better hearing than adults and can hear sounds as low as 20 Hz (a large pipe organ) or as high as 20,000 Hz (a special dog whistle that most humans cannot hear). When hearing loss begins, a person will, generally, first have trouble hearing high-pitched noises.

How does a loud noise cause hearing loss?

Loud noises can cause damage to the hair cells in the inner ear and to the hearing nerve, called sensorineural hearing loss or nerve deafness. (Sensorineural hearing loss also can be caused by infection, head injury, aging, certain medications, birth defects, tumors, problems with blood circulation or high blood pressure, and stroke.)

Damage can occur from a brief, intense noise such as an explosion, or from continuous loud noises such as noises in a loud work environment. Hearing loss from loud noises may be immediate or occur slowly over years of continuous exposure.

Immediate hearing loss is often accompanied by tinnitus, or ringing in the ears or head. Immediate hearing loss can occur in one or both ears and often involves severe damage to the inner ear structure.

Prolonged exposure to noise can actually change the structure of the hair cells in the inner ear, resulting in hearing loss. Tinnitus, which is the sound of ringing, roaring, buzzing, or clicking inside the head, often occurs with prolonged noise exposure damage, as well.

Hearing loss from noise can be permanent or temporary. If the hearing loss is temporary, hearing usually recovers within 16 hours of loud noise exposure.

Noises that cause hearing loss:

Hearing loss can occur after a one-time exposure to a loud noise or after repeated exposure to varying loud noises. Exposure to loud noises can occur at work, at home, or at play. Examples of noises that can cause hearing loss either immediately or over time include:

  • Recreational activities
    • firing guns and other weapons
    • snowmobiles
    • go-carts
    • motorcycles
    • power horns
    • model airplanes
    • cap guns
  • At home
    • garbage disposal
    • vacuum cleaner
    • lawn mower
    • leaf blower
    • shop tools
  • At work
    • woodworking equipment
    • chain saws
    • sandblasting
    • heavy construction
    • jet engine
    • other noisy machinery

Preventing noise-induced hearing loss:

When you know you will be exposed to loud noises, either temporarily or over a longer period, using ear plugs or ear muffs can help prevent hearing loss. Ear plugs, which fit into the outer ear canal, and ear muffs, which fit over the entire outside of the ear, decrease the intensity of the sound that reaches the eardrum. Properly fitted ear plugs and ear muffs can reduce noise by 15 to 30 decibels. Other preventive measures include:

Did you know?

Gradual hearing loss may occur after prolonged exposure to 90 decibels or above.

Exposure to 100 decibels for more than 15 minutes can cause hearing loss.

Exposure to 110 decibels for more than a minute can cause permanent hearing loss.

  • Protect small children from loud noises.

  • Be aware of hazardous noises in your environment.

  • Know which noises are too loud and can cause damage.

  • Undergo a medical examination to measure hearing.

In addition, the Occupational Safety and Health Administration (OSHA) requires hearing conservation programs in noisy work environments. Workers exposed to 85 decibels or more each day are required to have an annual hearing test. If more than 10 decibels of hearing loss are indicated by the annual hearing test, the employee must be informed and is required to wear some type of hearing protectors.

Which noises can affect hearing?

Level of safety Decibels (Approximately) Type of noise
Danger: Permanent hearing loss may occur 140 Firecrackers; rock concert
120 Snowmobiles
110 Chain saw
100 Wood shop
Warning: Gradual hearing loss may occur over time 90 Lawnmower; motorcycle
Safe 80 Traffic noise
60 Normal conversations
40 Refrigerator humming
20 Whispering
Source: National Institute on Deafness and other Communication Disorders

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Types of Hearing Tests

What are the different types of hearing tests?

In order to evaluate your child's hearing, your child's physician will perform a complete medical history and physical examination. In addition, there are many different types of hearing tests that can be used to check your child's hearing. Some of them may be used on all ages, while others are used based on your child's age and level of understanding.

Hearing tests for the newborn:

There are two primary types of hearing screening methods for newborns. These may be used alone or together.

  • evoked otoacoustic emissions (EOAE) - a test that uses a tiny, flexible plug that is inserted into the baby's ear. Sounds are sent through the plug. A microphone in the plug records the otoacoustic emissions (responses) of the normal ear in reaction to the sounds. There are no emissions in a baby with hearing loss. This test is painless and is usually completed within a few minutes, while the baby sleeps.
  • auditory brainstem response (ABR) - a test that uses electrodes (wires) attached with adhesive to the baby's scalp. While the baby sleeps, clicking sounds are made through tiny earphones in the baby's ears. The test measures the brain's activity in response to the sounds. As in EOAE, this test is painless and takes only a few minutes.

If the screening tests identify that your child has a hearing loss, further testing is needed. It is recommended that all babies with hearing loss be identified by 3 months of age so that treatment can begin before the baby is 6 months old, an important time for speech and language development.

Hearing tests for the infant:

Evaluation of hearing in the infant may include the use of the above mentioned EOAE and ABR tests. Also, the following may be used:

  • behavioral audiometry - a screening test used in infants to observe their behavior in response to certain sounds. Additional testing may be necessary.

Hearing tests for the toddler:

Evaluation of hearing may include the above mentioned tests, along with the following:

  • play audiometry - a test that uses an electrical machine to transmit sounds at different volumes and pitches into your child's ears. Your child usually wears some type of earphones. This test is modified slightly in the toddler age group and made into a game. The toddler is asked to do something with a toy (i.e., touch a toy, move a toy) every time the sound is heard. This test relies on the cooperation of the child, which may not always be given.
  • visual reinforcement audiometry (VRA) - a test where the child is trained to look toward a sound source. When the child gives a correct response, the child is "rewarded" through a visual reinforcement such as a toy that moves or a flashing light. The test is most often used for children between six months to two years of age.

Hearing tests for the older child:

Evaluation of hearing for the child older than 3 to 4 years may include the above mentioned tests, along with the following:

  • pure tone audiometry - a test that uses an electrical machine that produces sounds at different volumes and pitches in your child's ears. The child usually wears some type of earphones. In this age group, the child is simply asked to respond in some way when the tone is heard in the earphone.
  • tympanometry (also called impedance audiometry) - a test that can be performed in most physician offices to help determine how the middle ear is functioning. It does not tell if the child is hearing or not, but helps to detect any changes in pressure in the middle ear. This is a difficult test to perform in younger children because the child needs to sit very still and not be crying, talking, or moving.

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Hearing and Speech Communication Services and Devices

What are hearing and speech communication services and devices?

Aside from medical intervention and hearing aids, there are many devices and services available to help improve communication in daily life. This includes, as of 1993, the Americans with Disabilities Act (ADA) that requires all telephone companies to provide telecommunications relay services. Other options available to people with hearing loss and other communication disorders range from telephone amplifiers to visual alarm systems.

What is a telecommunication relay service?

A telecommunication relay service helps persons with a hearing loss or speech impairment communicate with people who have a regular phone. The hearing-impaired person calls another person with the help of a communications assistant (CA). The hearing-impaired person calls using a text telephone (TTY), which the CA then verbally relays to the other caller. The CA then types the person's response back to the TTY caller.

There are two types of telecommunication relay services: voice carry-over (VCO) and hearing carry-over (HCO). With VCO, the caller speaks directly to the other person, but reads the response typed by the CA. With HCO, the caller listens to the other caller, but types in his/her response.

Telecommunication relay services are free of charge and may be reached through an 800 or other toll-free number.

Other assistive communication devices:

Some other assistive communication devices for the hearing or speech impaired include:

Telephone devices for the deaf (TDD) TDDs allow the caller to call another person who has a TDD and type messages that are displayed on a visual screen. TDDs come in a variety of models and can also be used with telecommunication relay services.

Another telephone device, a telecoil, can be used with certain hearing aids. The telecoil, which is a small magnetic coil in the hearing aid, helps improve sound during telephone calls.

Telephone amplifiers Amplifiers that are portable or built into the receiver of the telephone can help increase the volume for the listener. In addition, for those persons who have difficulty hearing the high-pitched ring of the telephone, the sound can be replaced with a lower tone bell or buzzer, or with a visual alert.
Radio, stereo, and television amplifiers Instead of turning the radio, stereo, or television up loud, certain devices can connect with hearing aids to directly send the audio signal via a receiver. Whether using headphone devices or wireless devices, these amplifiers allow a hearing-impaired person to listen to radio, stereo, or TV at a comfortable level without interference of background noise.
Signaling devices Visual signaling devices can alert a hearing-impaired person to auditory signals he/she cannot hear. Visual signaling devices that flash a light can be purchased for telephones, doors, alarms, baby monitors, and more. Other signaling devices include a vibrating option that can awaken the hearing-impaired person.
Captions for the hearing impaired Captions are the words displayed on a television screen that follow along with the audio portion of the program. Viewers who are hearing impaired can read the captions to follow the dialogue and action at the same time. Captions also describe sound effects that are important to the story line.

Captions can be "open" or "closed." Open captions appear on every television set. Closed captions require a set-top decoder or built-in decoder circuitry. Since closed-caption technology is so widely available now, open-caption technology is rarely utilized.

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Hearing, Speech, and Language

Speech, language, and hearing are an important part of a healthy child's life. Speech means the ability to make sounds, while language goes beyond this and refers to the ability to understand and use the sounds. Hearing is necessary for the proper development of speech and language.

There are many conditions that affect hearing that require clinical care by a physician or other healthcare professional. Listed in the directory below are some of the conditions, for which we have provided a brief overview.

If you cannot find the condition in which you are interested, please visit the Ear, Nose, and Throat Online Resources page in this Web site for an Internet/World Wide Web address that may contain additional information on that topic.

Hodgkin Lymphoma

What is Hodgkin lymphoma?

Hodgkin lymphoma is a type of cancer in the lymphatic system. The lymphatic system is part of the immune system and functions to fight disease and infections.

The lymphatic system includes the following:

  • lymph - fluid containing lymphocyte cells.
  • lymph vessels - thin tubes that carry lymph fluid throughout the body.
  • lymphocytes - white blood cells that fight infection and disease.
  • lymph nodes - bean-shaped organs, found in the underarm, groin, neck, chest, and abdomen, that act as filters for the lymph fluid as it circulates through the body.

Hodgkin lymphoma causes the cells in the lymphatic system to abnormally reproduce, eventually making the body less able to fight infection and cause the lymph nodes to swell. Hodgkin lymphoma cells can also spread (metastasize) to other organs and tissue. It is a rare disease, accounting for 3.5 percent of all cases of cancer in the US. Hodgkin lymphoma accounts for a small percentage of childhood cancers. Hodgkin lymphoma occurs most often in people between the ages of 15 and 40, and in people over age 55. The disease, for unknown reasons, affects males more often than females.

What causes Hodgkin lymphoma?

The specific cause of Hodgkin lymphoma is unknown. It is possible that a genetic predisposition and exposure to viral infections may increase the risk for developing Hodgkin lymphoma. There is a slightly increased chance for Hodgkin lymphoma to occur in siblings and cousins of patients.

There has been much investigation into the association of the Epstein-Barr virus (EBV), which causes the infection mononucleosis; as well as with human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS). Both of these infectious viruses have been correlated with a greater incidence of children diagnosed with Hodgkin lymphoma, although the direct link is unknown.

There are many individuals, however, who have infections related to EBV and HIV that do not develop Hodgkin disease.

What are the symptoms of Hodgkin lymphoma?

The following are the most common symptoms of Hodgkin lymphoma. However, each child may experience symptoms differently. Symptoms may include:

  • painless swelling of the lymph nodes in neck, underarm, groin, and chest
  • difficulty breathing (dyspnea) due to enlarged nodes in the chest
  • fever
  • night sweats
  • tiring easily (fatigue)
  • weight loss/decreased appetite
  • itching skin (pruritus)
  • frequent viral infections (i.e., cold, flu, sinus infection)

The symptoms of Hodgkin lymphoma may resemble other blood disorders or medical problems. Always consult your child's physician for a diagnosis.

How is Hodgkin lymphoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for Hodgkin lymphoma may include:

  • blood and urine tests
  • x-rays of the chest - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • lymph node biopsy - a sample of tissue is removed from the lymph node and examined under a microscope.
  • computed tomography scan of the abdomen, chest, and pelvis (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • positron emission tomography (PET) scan - radioactive-tagged glucose (sugar) is injected into the bloodstream. Tissues that use the glucose more than normal tissues (such as tumors) can be detected by a scanning machine. PET scans can be used to find small tumors or to check if treatment for a known tumor is working.
  • lymphangiogram (LAG) - dye is injected into lymphatic system to determine the extent of lymphatic involvement in areas that are otherwise difficult to visualize.
  • bone marrow aspiration and/or biopsy - a procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.

How is Hodgkin lymphoma staged?

Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging systems that are used for Hodgkin lymphoma. Always consult your child's physician for information on staging. One method of staging Hodgkin lymphoma is the following:

  • stage I - usually involves a single lymph node region or structure.
  • stage II - involves two or more lymph node regions or structures on the same side of the body.
  • stage III - involves lymph node regions or structures on both sides of the body and is further classified depending on the organs and areas involved.
  • stage IV - involves the disease in other areas (metastasis), in addition to the lymphatic system involvement

Stages are also noted by the presence or absence of symptoms of the disease:

  • asymptomatic (A)
  • symptomatic (B)

For example, stage IIIB is disease that is symptomatic, involves lymph node regions or structures on both sides of the body, and is further classified depending on the organs and areas involved.

Treatment of Hodgkin lymphoma:

Specific treatment for Hodgkin lymphoma will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent/stage of the disease
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include (alone or in combination):

  • chemotherapy
  • radiation
  • surgery
  • bone marrow transplant
  • supportive care (for pain, fever, infection, and nausea/vomiting)
  • continued follow-up care (to determine response to treatment, detect recurrent disease, and manage side effects of treatment)

Aggressive therapy, while increasing long-term survival, also carries some serious side effects. Discuss with your child's physician a complete list of known side effects for treatment plans and therapies.

Long-term outlook for a child with Hodgkin lymphoma:

Prognosis greatly depends on:

  • the extent of the disease.
  • presence or absence of metastasis.
  • the response to therapy.
  • age and overall health of the child.
  • your child's tolerance of specific medications, procedures, or therapies.
  • new developments in treatment.

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis is structured around the child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for the child diagnosed with Hodgkin lymphoma. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of Hodgkin lymphoma. New methods are continually being discovered to improve treatment and to decrease side effects.

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Landau-Kleffner Syndrome

What is language?

Language is the expression of human communication. It allows a person to express, experience, explain, and share knowledge, thoughts, observations, questions, needs, values, beliefs, and behaviors.

It is a specific method, style, or form of communicating for individuals or groups of individuals. Most language is vocal, however, it may also be expressed by symbols, as in letters and numbers; gestures; and sounds.

When language is impaired, problems can occur in all areas of a person's life, including social development; academic performance; personal relationships; employment opportunities; and self-sufficiency

Source: National
Institute on Deafness and Other Communication Disorders (NIDCD)

What is Landau-Kleffner syndrome?

Landau-Kleffner syndrome (also called infantile acquired aphasia, acquired epileptic aphasia, or aphasia with convulsive disorder) is a language disorder. It frequently occurs in normally-developing children, usually between three and seven years of age, and is characterized by the gradual or sudden loss of the ability use or comprehend spoken language.

It is a rare disorder, with approximately 160 cases diagnosed between 1957, when the syndrome was first identified, and 1990.

What are the signs of Landau-Kleffner syndrome?

The following are the most common indicators of Landau-Kleffner syndrome. However, each individual may experience symptoms differently.

  • Early signs may be referred to as auditory agnosia, which includes the child:
    • suddenly having problems understanding what is said.
    • appearing to have problems with hearing - deafness may be suspected.
    • appearing to be autistic or developmentally delayed.
  • Spoken language is eventually affected, which may lead to complete loss of the ability to speak.
  • Some children develop their own method of communicating, such as with gestures or signs.

Approximately 80 percent of children with Landau-Kleffner syndrome have a history of one or more epileptic seizures that usually occur at night.

All children with Landau-Kleffner syndrome have abnormal electrical brain wave activity on both sides of the brain.

Hearing and intelligence usually are confirmed to be normal in children with Landau-Kleffner syndrome. However, the disorder may be accompanied by behavior or psychological problems such as:

  • hyperactivity
  • aggressiveness
  • depression

The symptoms of Landau-Kleffner syndrome may resemble other conditions or medical problems, such as deafness or learning disabilities. Always consult your physician for a diagnosis.

How is Landau-Kleffner syndrome diagnosed?

Landau-Kleffner syndrome is commonly diagnosed using an electroencephalogram (EEG), a scan that shows the brain's electrical waves, as well as other diagnostic tests.

Treatment for Landau-Kleffner syndrome:

Specific treatment for Landau-Kleffner syndrome will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include medication for seizures, convulsions, and language ability. Sign-language instruction may also be suggested.

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Laryngeal Cancer (Cancer of the Larynx)

What is laryngeal cancer?

Laryngeal cancer includes cancerous cells found in any part of the larynx - the glottis, the supraglottis, or the subglottis.

The larynx, often referred to as the voice box, is a two-inch long tube-shaped organ located in the neck at the top of the trachea (windpipe). The cartilage in front of the larynx is sometimes called the "Adam's apple."

The vocal cords (or vocal folds) are two bands of muscle that form a "V" shape inside the larynx.

The area of the larynx where the vocal cords are located is called the glottis. The area above the cords is called the supraglottis, and the area below the cords is called the subglottis. The epiglottis is a flap at the top of the trachea that closes over the larynx to protect it from food that is swallowed into the esophagus.

Breath enters the body through the nose or mouth, and then travels to the larynx, trachea, and into the lungs. It exits along the same path. Normally, no sound is made by the vocal cords during breathing or exhaling.

When a person talks, the vocal cords tighten, move closer together, and air from the lungs is forced between them. This makes them vibrate and produces sound.

Approximately 12,250 people are expected to be diagnosed with laryngeal cancer in the US in 2008. Close to 3,670 deaths are expected to occur this year, reports the American Cancer Society. About 2,400 cases of hypopharyngeal cancer are expected in 2008.

What are the symptoms of laryngeal cancer?

The following are the most common symptoms of laryngeal cancer. However, each individual may experience symptoms differently. Symptoms may include:

  • a cough that lasts
  • a sore throat that lasts
  • feeling of a lump in the throat
  • hoarseness/voice change
  • trouble swallowing
  • frequent choking on food
  • pain when swallowing
  • trouble breathing
  • noisy breathing
  • ear pain that lasts
  • a lump in the neck
  • unplanned weight loss
  • bad breath

The symptoms of laryngeal cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

What causes laryngeal cancer?

The exact cause of laryngeal cancer is not known, however, there are certain risk factors that may increase a person's chance of developing cancer.

Risk factors for laryngeal cancer:

Risk factors include:

  • tobacco use
  • alcohol abuse
  • poor nutrition
  • GERD - gastroesophageal reflux disease
  • human papillomavirus
  • weakened immune system
  • gender - laryngeal cancer is more common in men than in women
  • age - average age is 62
  • race - more common in African Americans

How is laryngeal cancer diagnosed?

In addition to a complete medical history and physical examination, the physician may carefully feel the neck to check for lumps, swelling, tenderness, and other changes.

Two types of laryngoscopy may be performed:

  • indirect laryngoscopy - a small, long-handled mirror is inserted into the throat so parts of the larynx can be examined.
  • direct laryngoscopy - an instrument called a laryngoscope is inserted through the nose or mouth. The scope is a lighted tube, which provides a better view of the area than the indirect laryngoscopy.

A biopsy, removal of a sample of tissue to be evaluated under a microscope by a pathologist, may also be performed.

If cancerous cells are found, imaging procedures may be used to determine the extent, or stage of the cancer.

Treatment of laryngeal cancer:

Specific treatment for laryngeal cancer will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include one, or a combination of, the following:

  • radiation therapy (to kill cancerous cells or keep them from growing)
  • surgery (to remove the cancerous cells or tumor)
  • chemotherapy (to kill cancerous cells)

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Laser Surgery for Skin Conditions

Laser surgery for lesions and skin conditions:

There are many different types of lesions and skin conditions that can be treated with laser surgery. Your physician will decide if you are a candidate for the particular surgery. The following is a brief overview of some of the skin conditions that can be treated with laser surgery:

  • port-wine stains
    Port-wine stains are congenital (present at birth) capillary malformations. The color of this birthmark is usually pink, red, or purple. About 0.3 percent of children are born with port-wine stains. As the child grows, the mark may become darker. Port-wine stains can appear on any part of the body and can vary in size. The type of laser usually used for this condition is the pulsed dye laser.

    A pulsed dye laser is a type of laser that has a high electric lamp which produces a short, high-energy flash of light. The light is colored when it passes through a dye. The color of the dye can be changed, depending upon the type of pigmented skin spots that are being treated. Adults may have this procedure performed on an outpatient basis with only local anesthesia. Children or persons with large port-wine stains, may be treated under general anesthesia. Multiple treatments may be necessary.
  • hemangiomas
    Hemangiomas are a common type of vascular birthmark. About 10 percent of Caucasians have hemangiomas. Hemangiomas may vary in appearance, from red, raised patches to deeper, purple areas. Hemangiomas usually appear within the first month of life, grow rapidly for the first year, and may start to go away by the time the child is 5 years old. Fifty percent of hemangiomas become smaller naturally by age 5. Hemangiomas are either superficial or deep. Surgery may be indicated for large or growing hemangiomas, or hemangiomas that are causing problems because of their location. The type of laser usually used for this condition is the pulsed dye laser. Multiple treatments may be necessary.
  • café au lait macules
    These are tan-colored lesions that may appear anywhere on the body. The size of the lesions varies. Some of the lesions can be very large, and cosmetic removal may be desired. A variety of lasers may be used for removal of these spots. Recurrence is common.
  • telangiectasias
    Telangiectasias are small blood vessels that are located under the surface of the skin. The vessels may appear red, purple, or blue. The most common places these are seen include the face, upper chest, and neck. Related vessels can be found in the legs, called spider veins. Removal is usually for cosmetic reasons.

    There are many causes of telangiectasia, including heredity, sun damage, hot and spicy foods, emotions, hormones, some medications, and adult acne. Treatment of these lesions may include lasers or sclerotherapy. Sclerotherapy is a procedure in which a small needle is used to inject medication into the vessels, causing them to shrink. New vessels may continue to develop throughout the person's life, depending on the underlying cause of the lesions.
  • wrinkles
    The use of lasers to help remove wrinkles is one of the great advances in cosmetic plastic surgery. The term used to describe this procedure is a laser peel. This type of wrinkle removal process is safer than other methods of wrinkle removal when performed by an experienced surgeon. There is less of a chance of scaring, swelling, and crusting with the laser peel. Prior to the actual surgery, your physician may prescribe facial medications for you to use to help prepare your skin. These medications may be used for four to six weeks prior to the laser peel. After the laser peel, your physician will explain proper skin care to prevent crust formation and infection. Many different types of lasers may be used for laser peels.
  • warts
    Warts are growths of skin or membrane that are not malignant (cancerous). Warts are caused by the human papilloma virus and are often hard to destroy. Many different types of treatments have been used for wart removal, including surgical excision, application of medications to the wart, or freezing the wart. As a result of the side effects of these treatment modalities, use of the laser has been warranted. The type of laser used is usually the pulsed dye laser. Multiple treatments may be necessary until the wart is gone.
  • scars
    Scars may be formed for many different reasons, including infections, surgery, injuries, or inflammation of tissue. A scar is the body's natural way of healing and replacing lost or damaged skin. Scars may appear anywhere on the body. The composition of a scar may vary - the scar may be flat, lumpy, sunken, colored, painful, and/or itchy. Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is performed in conjunction with other treatments such as injections of steroids, use of special dressings, and the use of bandages. Multiple treatments may be necessary.
  • tattoo removal
    There are several types of tattoos: decorative tattoos, which are placed for decorative purposes; cosmetic tattoos, which are known as permanent cosmetics, such as permanent eyeliner or lipstick; traumatic tattoos, which are a result of a trauma that embeds a foreign substance, such as dirt, in the skin; medical tattoos, such as those placed by a physician as landmarks for radiation therapy; and amateur tattoos, done by individuals on themselves or by nonprofessionals. There are many factors that determine the outcome of laser surgery on removing tattoos. These include the patient's age, skin type, type of tattoo, age of the tattoo, color of the tattoo, size and depth of the tattoo, and whether the tattoo was performed by a professional or an amateur. Some ink colors may be completely resistant to laser treatment. Laser removal of tattoos breaks up the color without damaging normal skin. The body then absorbs the pieces of pigment without leaving a scar as previous tattoo removal methods did. Multiple treatments may be necessary.

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Liposuction

What is liposuction?

Liposuction is a procedure that removes excess fat through a suctioning process. Although it is not a substitute for weight loss, it is a way of changing the body's shape and contour.

Liposuction can be used to remove excess fat that does not respond to exercise and dieting, including fat around the thighs, stomach, upper arms, buttocks, or the waistline. The Food and Drug Administration has not approved the use of the procedure on the neck or face.

In 2006, liposuction was the second most common cosmetic surgery procedure for women and the most common cosmetic surgery for men.

What are some different liposuction techniques?

Some of the different liposuction techniques include the following:

  • tumescent technique
    The tumescent technique involves the injection of a large quantity of a medical solution into a fatty area. The medical solution is a combination of drugs that numb the area, as well as shrink the capillaries and prevent blood loss. After the injection, a small incision is made into the skin and a tube connected to a vacuum is inserted into the fatty mass. The fat is then suctioned out.
  • super-wet technique
    Similar to the tumescent technique, the super-wet procedure uses a smaller amount of the injected medical solution. After the injection, a small incision is made into the skin and a tube connected to a vacuum is inserted into the fatty mass. The fat is then suctioned out.
  • ultrasound-assisted lipoplasty
    In the ultrasound-assisted lipoplasty, a special tube that produces ultrasound energy is used. This ultrasound energy breaks down the walls of the fat cells turning them to liquid. The fat is then suctioned out.

Possible complications associated with liposuction techniques:

Possible complications associated with liposuction techniques may include, but are not limited to, the following:

  • injury to the skin or deeper tissues
    In the ultrasound-assisted lipoplasty, there is the potential of damaging the skin or deeper tissues from the heat transmitted from the ultrasound device.
  • irregular skin surface
    Changes in the skin surface can occur after liposuction, giving it an asymmetric or baggy look. There can also be changes in the skin pigmentation and areas that may become numb.
  • greater risks if large areas are treated
    The risk for infection, the formation of blood clots or fat clots, excessive fluid loss, and damage to the skin, nerves, or vital organs is greater when large areas are treated.
  • lidocaine toxicity or fluid in the lungs
    If the lidocaine content is too high, it may cause lidocaine toxicity. If too much fluid is injected, it may cause fluid build-up in the lungs.

Who are candidates for liposuction?

Generally, people of normal weight who have localized areas of protruding fat achieve the most desired results, however, persons who are slightly overweight can also benefit from liposuction. The best candidates for liposuction include the following:

  • normal-weight (or slightly-overweight) people
  • people with firm, elastic skin
  • people who have pockets of excess fat in certain areas
  • physically healthy and psychologically stable people
  • people with realistic expectations

Age is not a major factor, although older persons with diminished skin elasticity may not have the same results as persons with tighter skin.

About the procedure:

Although each procedure varies, generally, liposuction surgeries follow this process:

  • Location options may include:
    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient
  • Anesthetic options may include:
    • general anesthesia
    • local anesthesia, combined with a sedative (allows the patient to remain awake but relaxed)
  • Some possible short-term side effects of surgery:
    • Heat from the ultrasound device used to liquefy the fat cells may cause injury to the skin or deeper tissues.
    • The long-term effects of ultrasound energy on the body are not yet known.

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Lymphadenopathy

What is lymphadenopathy?

Lymphadenopathy is the term for swelling of the lymph nodes - the bean-shaped organs found in the underarm, groin, neck, chest, and abdomen that act as filters for the lymph fluid as it circulates through the body. Lymphadenopathy can occur in just one area of the body, such as the neck, or it may be generalized, with lymph node enlargement in several areas. The cervical lymph nodes found in the neck are the most common site of lymphadenopathy.

What causes lymphadenopathy?

The lymphatic system is part of the immune system and functions to fight disease and infections. As infection-fighting cells and fluid accumulate, the lymph nodes enlarge to many times their normal size. Nearly all children will develop lymphadenopathy at some time, as the condition commonly occurs in response to an infection from a virus such as an upper respiratory infection. Bacterial infections such as strep throat, caused by the streptococcus bacterium, can also cause lymphadenopathy.

Since enlarged lymph nodes are often near the source of infection, their location can help determine the cause. For example, an infant with a scalp infection may have enlarged lymph nodes at the back of the neck. Swollen lymph nodes around the jaw may be due to an infection in the teeth or mouth. However, the lymphadenopathy may be generalized, with lymph node enlargement in more than one area (typical of a viral illness).

Sometimes, the lymph nodes themselves can become inflamed and enlarged, a condition called lymphadenitis. Lymph nodes can also enlarge due to cancer in the lymphatic system such as Hodgkin disease.

What are the symptoms of lymphadenopathy?

In children, it is normal to be able to feel some lymph nodes as small, movable lumps under the skin. However, if the nodes become more enlarged than usual, there may be an underlying problem. The following are the most common symptoms of lymphadenopathy. However, each child may experience symptoms differently. Symptoms may include:

  • swollen, enlarged lumps in the neck, back of the head, or other locations of lymph nodes
  • tenderness of the nodes, although the nodes may not be painful if the child is no longer ill
  • warmth or redness of the skin over the lymph nodes
  • fever
  • history of illness

The symptoms of lymphadenopathy may resemble other neck masses or medical problems. Always consult your child's physician for a diagnosis.

How is lymphadenopathy diagnosed?

Diagnosis of lymphadenopathy is often based on the presence of other conditions, such as an infection. It is important to determine if the child has been exposed to any communicable diseases such as varicella (chickenpox), or has been bitten by an animal which may transmit an illness called cat-scratch fever. The size and location of the nodes, how long ago the swelling began, and the presence of pain are helpful in determining the cause. In addition to a complete medical history and physical examination, diagnostic procedures for lymphadenopathy may include a lymph node biopsy in which a sample of tissue is removed from the lymph node and examined under a microscope. Further tests may be necessary for specific diseases or infections that may be related to the lymphadenopathy.

Treatment of lymphadenopathy:

Specific treatment of lymphadenopathy will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include:

  • antibiotic medications (to treat an underlying bacterial infection)
  • continued evaluation (to check the size and location of the enlarged nodes)
  • medications or procedures (to treat other conditions that may have caused the lymph node enlargement)

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Lymphatic Malformations in Children

What is a lymphatic malformation?

A lymphatic malformation is a mass in the head or neck that results from an abnormal formation of lymphatic vessels. Lymphatic vessels are small canals that lie near blood vessels and help carry tissue fluids from within the body to the lymph nodes and back to the bloodstream.

There are two main types of lymphatic malformations:

  • lymphangioma - a group of lymphatic vessels that form a mass or lump. A cavernous lymphangioma contains greatly enlarged lymphatic vessels.
  • cystic hygroma - a large cyst or pocket of lymphatic fluid that results from blocked lymphatic vessels. A cystic hygroma may contain multiple cysts connected to each other by the lymphatic vessels.

Nearly all cystic hygromas occur in the neck, although some lymphangiomas can occur in the mouth, cheek, and tissues surrounding the ear, as well as other parts of the body. Over half of lymphatic malformations are congenital (present at birth), and most are detected by age 2. Some lymphatic malformations can spread into surrounding tissues and affect the proper development of the area. Lymphatic malformations may also enlarge and become infected following an upper respiratory infection.

Lymphatic malformations are sometimes seen in children with certain chromosome abnormalities and genetic conditions, including Down syndrome and Turner syndrome.

What causes a lymphatic malformation?

A lymphatic malformation is a congenital (present from birth) defect that occurs during early embryonic development when the lymphatic vessels do not properly form. The vessels may become blocked and enlarged as lymphatic fluid collects in the vessels, forming a mass or a cyst.

What are the symptoms of a lymphatic malformation?

An internal lymphatic malformation in the mouth or cheek may not be noticed until it becomes infected and enlarges. Cystic hygromas can grow very large and may affect breathing and swallowing. The following are the most common symptoms of a lymphatic malformation. However, each child may experience symptoms differently. Symptoms may include:

  • a mass or lump in the mouth, cheek, or tongue beneath the mucous membrane that lines the area
  • a large, fluid-filled mass to the lower side and back of the neck under the platysma muscle (a thin, flat muscle that extends from the upper chest to the jaw)

The symptoms of a lymphatic malformation may resemble other neck masses or medical problems. Always consult your child's physician for a diagnosis.

How is a lymphatic malformation diagnosed?

During pregnancy, a fetal ultrasound may detect some large lymphatic malformations. Ultrasound is a diagnostic tool used to evaluate organs and structures inside the body with high-frequency sound waves. After birth, diagnosis of a lymphatic malformation is generally determined by a physical examination. In addition to a complete medical history and physical examination, diagnostic procedures for a lymphatic malformation may include the following:

  • transillumination - a method of examination by the passage of light through tissues to assist in diagnosis. The light transmission changes with different tissues.
  • computed tomography scan (Also called a CT or CAT scan.) - to determine if other organs are connected to the malformation. A CT scan is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment of lymphatic malformation:

Specific treatment of lymphatic malformation will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include:

  • observation of the malformation (to watch for growth or changes)
  • antibiotic medications (to treat infection)
  • incision and drainage of the lesion
  • surgery (to remove the lymphatic malformation)

A small percentage of lymphangiomas can regrow and are often detectable within a year after surgery. Regrowth is more likely with larger and more complicated malformations.

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The Lymphatic System

What is the lymphatic system?

Neck masses in children often involve the lymphatic system, which is part of the immune system and functions to fight disease and infections. The lymphatic system goes through many changes throughout a child's growth and development. Before birth, a fetus relies on the mother's immune system for protection from infections. At birth, a newborn's lymphatic system begins to respond to the frequent exposure to new antigens (organisms and diseases). Lymphatic tissue grows steadily until puberty, when growth slows.

The lymphatic system includes the following:

  • lymph - fluid containing lymphocyte cells.
  • lymph vessels - thin tubes that carry lymph fluid throughout the body.
  • lymphocytes - white blood cells that fight infection and disease.
  • lymph nodes - bean-shaped organs, found in the underarm, groin, neck, chest, and abdomen, that act as filters for the lymph fluid as it circulates through the body.

Children are constantly fighting off new germs and infections and their lymphatic system quickly responds to these antigens. Because of this response, it is quite common for children to have slightly enlarged lymph nodes in certain areas of the body some of the time. However, changes in the lymph nodes can also indicate certain conditions or diseases that need special treatment. Always consult your child's physician for questions or concerns about any mass you notice in your child.

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Mastoiditis

What is mastoiditis?

Mastoiditis is an inflammation or infection of the mastoid bone, which is a portion of the temporal bone. The mastoid consists of air cells that drain the middle ear. Mastoiditis can be a mild infection or can develop into life-threatening complications. Mastoiditis is usually a complication of acute otitis media (middle ear infection).

What causes mastoiditis?

Mastoiditis is usually a result of an extension of the inflammation of the middle ear infection into the mastoid air cells. A child with mastoiditis usually has a history of having a recent ear infection or has middle ear infections that continue to reoccur. The risk of mastoiditis is reduced with the use of antibiotics for ear infections. Mastoiditis may be caused by various bacteria.

What are the symptoms of mastoiditis?

The following are the most common symptoms for mastoiditis. However, each child may experience symptoms differently. Symptoms may include:

  • pain behind the ear
  • swelling of the ear lobe
  • recent ear infection
  • fever
  • irritability
  • redness or swelling of the bone behind the ear
  • drainage from an ear infection

The symptoms of mastoiditis may resemble other medical conditions or problems. Always consult your child's physician for a diagnosis.

How is mastoiditis diagnosed?

In addition to a complete medical history and physical examination, your child's physician will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside of the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

Tympanometry, a test that can be performed in most physician offices to help determine how the middle ear is functioning. It does not tell if the child is hearing or not, but helps to detect any changes in pressure in the middle ear. This is a difficult test to perform in younger children because the child needs to sit very still and not be crying, talking, or moving.

Your child's physician may also order the following tests to help confirm the diagnosis:

  • blood work
  • x-rays of the head - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues and bones of the head onto film.
  • culture from the infected ear

If your child has symptoms of a brain abscess or other intracranial complication, your child's physician may order the following:

  • computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

If your child has symptoms of meningitis, your child's physician may order a:

  • lumbar puncture - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.

Treatment for mastoiditis:

Specific treatment for mastoiditis will be determined by your child's physician based on:

  • your child's age, overall health and medical history
  • extent of the disease
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment of mastoiditis usually requires hospitalization and a complete evaluation by a physician that specializes in the ear, nose, and throat disorders (otolaryngologist). Your child, in most cases, will receive antibiotics through an intravenous (IV) catheter. Surgery is sometimes needed to help drain the fluid from the middle ear.

Your child's physician may suggest a myringotomy, a surgical procedure which involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube may be placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to twelve months.

What are the effects of mastoiditis?

If the infection continues to spread, despite antibiotic therapy, the following complications may occur:

  • meningitis - an infection of the outside of the brain.
  • brain abscess - a pocket of pus and infection that may develop in the brain.

Early and proper treatment of mastoiditis is necessary to prevent the development of these life-threatening complications.

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Ménière's Disease

Balance

The vestibular system controls balance; controls posture; regulates locomotion and other movements; provides conscious awareness of orientation in space; and provides conscious awareness of visual fixation in motion.

Balance can be impaired by disease, altered gravity, aging, and exposure to unusual motion.

When balance is impaired, normal movement is affected, as well as motivation, concentration, and memory.

Source: National Institute on Deafness and Other Communication Disorders (NIDCD)

What is Ménière's disease?

Ménière's disease is a balance disorder caused by an abnormality found in a section of the inner ear called the labyrinth.

There are an estimated 615,000 people in the US who have Ménière's disease, with 45,500 new cases diagnosed each year.

What causes Ménière's disease?

The labyrinth has two parts:

  • bony labyrinth
  • membranous labyrinth

The membranous labyrinth is encased in bone and contains a fluid called endolymph.

When the head moves, the endolymph also moves, which causes nerve receptors in the membranous labyrinth to signal the brain about the body's motion.

When, for some reason, the endolymph increases, the membranous labyrinth balloons or dilates (a condition called endolymphatic hydrops).

If the membranous labyrinth ruptures, the endolymph mixes with another inner ear fluid called perilymph.

The mixing of the two fluids is believed to cause the symptoms of Ménière's disease.

What are the symptoms of Ménière's disease?

The following are the most common symptoms of Ménière's disease. However, each individual may experience symptoms differently. Symptoms can occur suddenly, or may happen daily or infrequently.

The most debilitating symptom is vertigo, which can cause the patient to have to lie down, as well as:

  • severe nausea
  • vomiting
  • sweating

Other symptoms may include:

  • tinnitus
  • loss of hearing
  • pressure in the affected ear
  • loss of balance
  • headaches
  • abdominal discomfort
  • diarrhea

The symptoms of Ménière's disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Diagnosis of Ménière's disease:

In addition to a complete medical history and physical examination, the physician may request:

  • hearing test
  • balance test
  • magnetic resonance imaging (MRI) scans (to determine if a tumor is present)
  • electrocochleography (to measure electrical activity of the inner ear)

Treatment for Ménière's disease:

Specific treatment for Ménière's disease will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include:

  • surgery
    Several types of surgery are effective for treating the balance problems of Ménière's disease. The most common surgical treatment is the insertion of a shunt (silicone tube) to drain of excess fluid.
  • medication
    Medications may be given to control allergies, reduce fluid retention, or improve the blood circulation in the inner ear.
  • change in diet
    Eliminating caffeine, alcohol, and salt may reduce the frequency and intensity of symptoms.
  • behavior therapies
    Reducing stress may lessen the severity of the disease symptoms.

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Milk Allergy Diet

General guidelines for milk allergy:

The key to an allergy-free diet is to avoid foods or products containing the food to which you are allergic. The items that you are allergic to are called allergens. A milk allergy is an abnormal response of the body to the proteins found in cow's milk. Milk allergy is most common among infants and young children. Milk and milk products are found in many foods. Obvious forms of milk are cream, cheese, butter, ice cream, and yogurt. Milk and milk products may also be hidden sources in commonly eaten foods. In order to avoid foods that contain milk products, it is necessary to read food labels.

Important information about avoiding milk and milk products:

  • The words "non-dairy" on a product label indicate it does not contain butter, cream, or milk. However, this does not necessarily indicate it does not have other milk-containing ingredients.
  • The Kosher food labeled "pareve" or "parve" almost always indicates food is free of milk and milk products. A "D" on a product label next to the circled K or U indicates the presence of milk protein. These products should be avoided.
  • Processed meats, including hot dogs, sausages, and luncheon meats, frequently contain milk or are processed on milk-containing lines. Carefully read all food labels.

FOODS

ALLOWED

NOT ALLOWED

Beverages Carbonated beverages

Coffee

Tea

Soy substitute-milk formulas, water

Fruit drinks

All milks (whole, low-fat, skim, buttermilk, evaporated, condensed, powdered, hot cocoa)

Yogurt, eggnog, milkshakes, malts

All beverages made with milk or milk products

Breads Milk-free breads

French bread

Wheat, white, rye, corn, graham, gluten, and soy breads made without milk or milk products

Graham cracker or rice wafers

Wheat, white, or rye breads

Biscuits, donuts, muffins, pancakes, waffles, zwieback, crackers, saltines, rusk

Most commercially prepared breads and rolls contain milk or milk products

French toast made with milk

Cereals Any cereal to which no milk or milk products have been added High-protein cereals

Prepared and precooked cereals with milk solids, casein, or other milk products added

Desserts Meringue, gelatin, popsicles, fruit ice, fruit whip, angel food cake

Cakes, cookies, and pie crusts made without milk or milk products

Cake, cookies, custard, pudding, cream desserts, or sherbet containing milk products

Ice cream, cream pie

Pastries brushed with milk, junket, popover

Eggs All prepared without milk Scrambled with milk, creamed eggs, egg substitutes
Fats Vegetable oil, meat fat, lard, bacon, shortening, milk free gravy

Peanut butter (made without milk solids)

Margarine without milk solids

Kosher margarine

Butter, cream, margarine

Salad dressing or mayonnaise containing milk, milk solids, or milk products

Some butter substitutes and non-dairy creamers

Fruits All fresh, frozen, or canned fruits and juices Any served with milk, butter, or cream
Meats, Fish, Poultry, and Cheese Baked, broiled, boiled, roasted or fried: beef, veal, pork, chicken, turkey, lamb, fish, organ meats, or tofu (prepared without milk or milk products)

Sausage, deli/luncheon meats, or ham if made without milk products

NOTE: A small number of persons with cow's milk allergy may develop a reaction to beef. Thus, those with cow's milk allergy should be careful when consuming beef or foods containing beef. 

All cheese, cottage cheese, cream cheese

Some sausage products, bologna, frankfurters

Breaded meats, meatloaf, croquettes, casseroles, hamburgers (unless made without milk)

Commercial entrees made with milk or milk solids

Potatoes and Substitutes Macaroni, noodles, spaghetti, rice

White or sweet potatoes prepared without milk, butter, cream, or allowed margarine

Au gratin, buttered, creamed, scalloped potato or substitutes

Macaroni and cheese

Mashed potatoes containing milk or butter

Frozen french fries sprayed with lactose

Soups Bouillon, broth, consommé or soups with broth base plain or with all allowed foods Bisques, chowders, creamed soups

All soups made with milk or milk products

Sweets Corn syrup, honey, jam, jelly

Hard candy, candy made without milk or milk products

Granulated, brown or powdered sugar

Candy made with milk such as chocolate, fudge, caramels, nougat
Vegetables All fresh, frozen, or canned vegetables without milk or milk products added

All vegetable juices

Au gratin, buttered, creamed, or escalloped vegetables

Batter and dipped vegetables

Vegetable soufflés

Miscellaneous Catsup, olives, pickles, nuts, herbs, chili powder, salt, spices, condiments

Any foods that are milk/ cheese/butter free or that do not contain powdered milk or whey

All items containing milk, cheese, butter, whey casein, caseinates, hydrolysates, lactose, lactalbumin, lactoglobulin or milk solids, artificial butter flavor

Non-dairy substitutes containing caseinate

How to read a label for a milk-free diet:

Be sure to avoid foods that contain any of the following ingredients:

  • artificial butter flavor
  • butter, butter fat
  • casein
  • caseinates (ammonium, calcium, magnesium, potassium, sodium)
  • cheese, cottage cheese, curds
  • cream
  • custard, pudding
  • ghee
  • Half and Half™
  • hydrolysates (casein, milk protein, protein, whey, whey protein)
  • lactalbumin, lactalbumin phosphate
  • lactoglobulin
  • lactose
  • milk (derivative, protein, solids, malted, condensed, evaporated, dry, whole, low fat, nonfat, skim)
  • nougat
  • rennet casein
  • sour cream
  • sour cream solids
  • whey (delactosed, deminderalixed, protein concentrate)
  • yogurt

Other possible sources of milk or milk products:

  • brown sugar flavoring
  • caramel flavoring
  • chocolate
  • high protein flour
  • margarine
  • natural flavoring
  • Simplesse™

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Molds in the Environment

What is mold?

A mold is a microscopic fungus that grows and lives on plant or animal matter or on non-organic objects. Most molds are made up of filaments and reproduce through the production of spores, which spread by air, water, or insects. There are many thousands of species of fungi. Common indoor molds include:

  • Alternaria
  • Aspergillus
  • Cladosporium
  • Mucor
  • Penicillium

Molds are found everywhere in the environment, both indoors and outdoors, and throughout the year.

Reactions to mold:

Molds cause allergic symptoms in many people. Common reactions to molds include nasal stuffiness, eye irritation, or wheezing when breathing.

More severe reactions may occur among workers, such as farmers, who are exposed to large amounts of molds in occupational settings, including fever or shortness of breath. Mold infections may occur in the lungs of persons with obstructive lung disease.

How to decrease mold exposure:

  • outside, avoid areas that are likely to have mold, such as:
    • compost piles
    • cut grass
    • wooded areas
    • damp, mossy areas
    • greenhouses
    • antique shops
  • inside:
    • keep humidity levels between 40 percent and 60 percent
    • ventilate showers and cooking areas with exhaust fans
    • use an air conditioner or a dehumidifier during humid months
    • do not use carpet in susceptible areas such as bathrooms or basements
    • dispose of, or thoroughly dry and clean, objects that accidentally become wet such as carpets or upholstery
    • fix leaks in roofs, walls, and/or plumbing to eliminate moisture
    • add a mold inhibitor to paint when painting
    • use mold-killing products to clean bathrooms

According to the Federal Emergency Management Agency (FEMA), one of the most serious results of water damage from a hurricane or severe floods are molds. Molds can grow within 24-48 hours after water damage and continue until proper measures are applied to stop it. The Centers for Disease Control and Prevention (CDC) states molds can be recognized from sight, wall or ceiling discoloration, and/or a bad odor or musty smell.

FEMA and CDC warn returning to water damaged homes after a disaster may pose serious health threat, especially to people who already have preexisting respiratory conditions, pregnant women, children, elderly, and those persons with immuno-compromised diseases.

FEMA and CDC have developed specific guidelines for clean-up of water related disasters.

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Myringotomy Tubes

What are myringotomy tubes (also called ear tubes, tympanostomy tubes, or ventilation tubes)?

Myringotomy tubes are small tubes that are surgically placed into your child's eardrum by an ear, nose, and throat surgeon. The tubes may be made of plastic, metal, or Teflon®. The tubes are placed to help drain the fluid out of the middle ear in order to reduce the risk of ear infections. During an ear infection, fluid gathers in the middle ear, which can affect your child's hearing. Sometimes, even after the infection is gone, some fluid may remain in the ear. The tubes help drain this fluid, and prevent it from building up. The most common ages are from one to three years old. By the age of five years, most children have wider and longer eustachian tubes (a canal that links the middle ear with the throat area), thus, allowing better drainage of fluids from the ear.

Who needs ear tubes?

The insertion of ear tubes may be recommended by your child's physician and/or a ear, nose, and throat physician if several of the following conditions are present:

  • fluid in the ears for more than three or four months following an ear infection
  • fluid in the ears and more than three months of hearing loss
  • changes in the actual structure of the eardrum from ear infections
  • a delay in speaking
  • repeated ear infections that do not improve with antibiotics over several months

What are the risks and benefits of ear tubes?

The risks and benefits will be different for each child. It is important to discuss this with your child's physician and surgeon. The following are some of the possible benefits that may be discussed:

  • Ear tubes help to reduce the risk of future ear infections.
  • Hearing is restored in some children who experience hearing problems.
  • Speech development is not harmed.
  • Ear tubes allow time for the child to mature and for the eustachian tube to work more efficiently. (By the age of 5 years, the eustachian tube becomes wider and longer, thus, allowing for better drainage of fluids from the ears.)
  • Children's behavior, sleep, and communication may be improved if ear infections were causing problems.

The following are some of the risks that may be discussed:

  • Some children with ear tubes continue to develop ear infections.
  • There may be problems with the tubes coming out:
    • The tubes usually fall out in about one year. After they fall out, if ear infections recur, they may need to be replaced.
    • If they remain in the ear too long, the surgeon may need to remove them.
    • After they come out, they may leave a small scar in the eardrum. This may cause some hearing loss.
  • Some children may develop an infection after the tubes are inserted.
  • Sometimes, after the tube comes out, a small hole may remain in the eardrum. This hole may need to be repaired with surgery.

How are ear tubes inserted?

Myringotomy is the surgical procedure that is performed to insert ear tubes. Insertion of the tubes is usually an outpatient procedure. This means that your child will have surgery, and then go home that same day. Before the surgery, you will meet with different members of the healthcare team who will be involved in your child's care. These may include:

  • nurses - day surgery nurses prepare your child for surgery. Operating room nurses assist the physicians during surgery. Recovery room (also called the Post-Anesthesia Care Unit) nurses care for your child as he/she emerges from general anesthesia.
  • surgeon - a physician who specializes in the placement of the tubes.
  • anesthesiologist - a medical physician with specialized training in anesthesia. He/she will perform a history and physical examination and formulate a plan of anesthesia for your child. The plan will be discussed with you and your questions will be answered. Insertion of myringotomy tubes requires general anesthesia in children.

Myringotomy involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to twelve months. Your child's recovery will be monitored closely. Your child must meet all discharge criteria in order to go home. Follow-up care is needed for your child based on the surgeon's recommendations. Usually, you will return in about two to four weeks, then four to six months after the tubes have been inserted, and then approximately one year later. Your child's physician will help manage the care of your child in-between these visits, in agreement with the surgeon.

Care of the child after the ear tubes are inserted:

The following are some of the instructions that may be given to you following the placement of ear tubes in your child:

  • Your child's surgeon may order antibiotic ear drops to be placed after the initial insertion of the tubes, to prevent infection.
  • You will be instructed to call your child's physician if your child experiences any of the following symptoms:
    • drainage from the ear
    • ear pain
    • fever
    • myringotomy tube displaced (out of ear)
  • You will be instructed on the use of earplugs while your child is in the water, based on the opinion of your child's physician. Different physicians have different recommendations regarding the use of earplugs.

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Nasal Surgery

What is nasal surgery?

Nasal surgery includes any surgery performed on the outside or inside of the nose. A common type of reconstructive and cosmetic surgery, nasal surgery may be performed to accomplish the following:

  • improve breathing
  • correct congenital or acquired deformities
  • change size or shape of nose (cosmetic)
  • repair nasal injuries

What are the different types of nasal surgery?

The following are some of the different types of nasal surgery:

  • septoplasty
    Septoplasty is the surgical correction of defects and deformities of the nasal septum (the partition between the nostrils). Examples of septoplasty include the following:
    • correction of a deviated septum
      A deviated septum is a condition in which the partition (septum) between the nostrils is not in a straight vertical alignment. A deviated septum can cause obstructed airflow. A deviated septum can be caused by a birth defect or injury.
    • correction of cleft defects that affect the nose and nasal cavity
  • rhinoplasty
    Rhinoplasty is the surgical repair of a defect of the nose, including reshaping or resizing the nose. Rhinoplasty may be performed to accomplish the following:
    • change the size of the nose
    • change the shape of the nose
    • narrow the nostrils
    • change the angle between the nose and lips

Possible complications associated with nasal surgery:

Possible complications associated with nasal surgery may include, but are not limited to, the following:

  • infection
  • nosebleed
  • anesthesia problems

Preparing for nasal surgery:

The specific type of surgery will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the deformity
  • your tolerance of specific medications, procedures, or therapies
  • your opinion or preference

About the procedure:

Although each procedure varies, generally, nasal surgeries follow this process:

  • Location options may include:
    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient
  • Anesthetic options may include:
    • local anesthesia
    • general anesthesia
  • Average length of procedure: about two hours
  • Recuperation period:
    • usually up and around in a few days
    • usually return to school or sedentary work a week or so after surgery
    • surgeon will provide guidelines for resuming normal activities
  • Some possible short-term side effects of surgery:
    • A splint may be applied to nose to help maintain the new shape.
    • Nasal packs or soft plastic splints may be placed inside the nostrils to stabilize the septum.
    • The face will feel puffy.
    • The nose may ache.
    • You may experience a dull headache, swelling around the eyes, and/or bruising around the eyes.
    • A small amount of bleeding is normal in the first few days.
    • Small burst blood vessels may appear as tiny red spots on the skin's surface.
  • Final results:
    • Healing is a slow and gradual process. Some swelling may be present for months, especially in the tip of the nose. Final results of nasal surgery may not be apparent for a year or more.
    • When a traditional open surgical technique is used, or surgery is performed to narrow flared nostrils, small scars will be located on the base of the nose. The scars usually are not noticeable. Scarring is not visible when rhinoplasty is performed from inside the nose.

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Neck Abscess

What is a neck abscess?

A neck abscess is a collection of pus from an infection in spaces between the structures of the neck. As the amount of pus increases, the soft tissue spaces expand and push against the structures in the neck, such as the throat, tongue, and, in extreme cases, the trachea (windpipe). Neck abscesses are sometimes called cervical abscesses or deep neck infections.

There are several types of neck abscesses that are found in children, including the following:

  • retropharyngeal abscess - an abscess that forms behind the pharynx (back of the throat) often following an upper respiratory infection. In children, the lymph nodes in this area can become infected and break down, forming pus. Retropharyngeal abscesses are most common in young children, because these lymph nodes atrophy (get smaller) by the time a child reaches puberty.
  • peritonsillar abscess - an abscess that forms in the tissue walls beside the tonsils (the lymph organs in the back of the throat). Peritonsillar abscesses are most common in adolescents and young adults and are rarely seen in young children. A peritonsillar abscess is sometimes called quinsy.
  • Ludwig's angina - an abscess beneath the tissues in the floor of the mouth. Pus collects under the tongue, pushing it upwards and toward the back of the throat, which can cause breathing and swallowing problems. Ludwig's angina is not common in young children but may occur in older adolescents, especially after a dental infection.

What causes a neck abscess?

A neck abscess occurs during or just after a bacterial or viral infection in the head or neck such as a cold, tonsillitis, sinus infection, or otitis media (ear infection). As an infection worsens, it can spread down into the deep tissue spaces in the neck or behind the throat. Pus collects and builds up in these spaces forming a mass. Sometimes, a neck abscess occurs following an inflammation or infection of a congenital (present at birth) neck mass such as a branchial cyst or thyroglossal duct cyst.

What are the symptoms of a neck abscess?

The following are the most common symptoms of a neck abscess. However, each child may experience symptoms differently. Symptoms may include:

  • fever
  • red, swollen, sore throat, sometimes just on one side
  • bulge in the back of the throat
  • tongue pushed back against throat
  • neck pain and/or stiffness
  • ear pain
  • body aches
  • chills
  • difficulty swallowing, talking, and/or breathing

The symptoms of a neck abscess may resemble other neck masses or medical problems. Always consult your child's physician for a diagnosis.

How is a neck abscess diagnosed?

Generally, diagnosis is made by physical examination. In addition to a complete medical history and physical examination, diagnostic procedures for a neck abscess may include the following:

  • throat culture - a procedure that involves taking a swab of the back of the throat and monitoring it in the laboratory to determine the type of organism causing an infection.
  • blood tests - to measure the body's response to infection.
  • biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope.
  • x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment of a neck abscess:

Specific treatment of a neck abscess will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include:

  • antibiotic medications (to treat the infection)
    Often, antibiotics must be given intravenously (in the vein) and hospitalization may be required.
  • drainage of the abscess using a needle
    This procedure may require hospitalization.

Your child's physician will give specific instructions to help your child's symptoms, which may include gargling and pain-relieving medications.

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Overview of Neck Masses

What are neck masses?

Neck masses are common problems in infants and children. Some neck masses are congenital (present at birth) and result from abnormal formation during embryonic development. Many neck masses appear with an upper respiratory infection such as a cold or sinus infection. Some are not found until they become enlarged and painful from infection. Although a neck mass can involve other structures in the head and neck area, most are benign (non-cancerous). Cancerous neck masses are rare in young infants and children, but occasionally a mass is diagnosed as Hodgkin or non-Hodgkin disease - both cancers of the lymphatic system.

Your child's physician will consider many factors when diagnosing a neck mass, including the following:

  • the age of child
  • how long the mass has been present, and whether other masses are present
  • family history of masses
  • any prior or ongoing illnesses, ear infections, and/or animal bites

Examination of neck masses may include the following:

  • careful visualization and palpation (feeling with the fingers) of the child's neck
  • identifying the specific location of the mass
  • checking for movement of the neck and the mass itself
  • observing for swelling, redness, warmth, tenderness, drainage, or fluid in the mass

Further tests may be needed to completely diagnose the type of neck mass and whether other tissues and structures in the neck are involved. Treating neck masses depends on the type of mass and whether there is infection. Often, surgical removal of the mass is needed.

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Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma (NHL)?

Non-Hodgkin lymphoma is cancer in the lymphatic system. According to estimates by the Leukemia and Lymphoma Society, 88 percent of lymphomas diagnosed in the US in 2007 were non-Hodgkin lymphoma. The lymphatic system is part of the immune system and functions to fight disease and infections.

The lymphatic system includes the following:

  • lymph fluid - fluid containing lymphocyte cells.
  • lymph vessels - thin tubes that carry lymph fluid throughout the body.
  • lymphocytes - specific white blood cells that fight infections and disease.
  • lymph nodes - bean-shaped organs, found in the underarm, groin, neck, chest, and abdomen, that act as filters for the lymph fluid as it circulates through the body.

Non-Hodgkin lymphoma causes the cells in the lymphatic system to abnormally reproduce, eventually causing tumors to grow. Non-Hodgkin disease cells can also spread to other organs and tissues in the body.

Lymphomas are the fifth most common childhood cancer in the US. They occur most often in children between the ages of seven and 11, but can occur at any age from infancy to adulthood.

Non-Hodgkin lymphoma affects males more often than females, and is more common among Caucasian children than among African-American children and children of other races.

Staging and classification of non-Hodgkin lymphoma is based on the extent of the disease and the specific cells involved.

What are the different types of non-Hodgkin lymphoma?

Non-Hodgkin lymphoma in children is almost always one of three types:

  • lymphoblastic non-Hodgkin lymphoma
    Lymphoblastic non-Hodgkin lymphoma accounts for about 30 percent of the cases, involves the T-cells, and usually presents with a mass in the chest, swollen lymph node(s), with or without bone marrow and central nervous system involvement.
  • Burkitt's or non-Burkitt's lymphoma
    Burkitt's or non-Burkitt's lymphoma is a non-Hodgkin disease in which the cells are undifferentiated and diffuse. This has also been referred to as small non-cleaved cells. Burkitt's and non-Burkitt's lymphoma accounts for about 40 to 50 percent of the cases and is usually characterized by a large abdominal tumor and may have bone marrow and central nervous system involvement.
  • large cell or diffuse histiocytic non-Hodgkin lymphoma
    Large cell or diffuse histiocytic non-Hodgkin involves the B-cells and T-cells and accounts for about 25 percent of the cases. Children with this type of non-Hodgkin lymphoma usually have lymphatic system involvement, as well as a non-lymph structure (such as lung, jaw, brain, skin, and bone) involvement.

Large cell anaplastic lymphoma is a less common type of lymphoma in children. Treatment for this type is the same as for large cell lymphoma.

How is non-Hodgkin lymphoma staged?

Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging symptoms that are used for non-Hodgkin lymphoma. Always consult your child's physician for information on staging. One method of staging non-Hodgkin lymphoma is the following:

  • stage I - involves the tumor at one site, either nodal or elsewhere in the body.
  • stage II - involves the tumor at two or more sites on the same side of the body.
  • stage III - involves tumors in any number that occur on both sides of the body, but does not involve bone marrow or the central nervous system.
  • stage IV - any stage of tumor that also has bone marrow and/or central nervous system involvement. Stage IV is also subdivided depending on the amount of blasts (cancer cells) present in the bone marrow.

What causes non-Hodgkin lymphoma?

The specific cause of non-Hodgkin lymphoma is unclear. It is possible that genetics and exposure to viral infections may increase the risk for developing this malignancy. Non-Hodgkin lymphoma has also been linked to chemotherapy and radiation therapy. Non-Hodgkin may be a second malignancy as a result of the treatment for certain cancers.

There has been much investigation into the association of the Epstein-Barr virus (EBV) that causes the mononucleosis infection; as well as the human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS). Both of these infectious viruses have been linked to the development of Burkitt's lymphoma.

The majority of Burkitt's lymphoma cases result from a chromosome rearrangement between chromosome #8 and #14, which causes genes to change positions and function differently, promoting uncontrolled cell growth. Other chromosome rearrangements have been seen in non-Hodgkin lymphoma (all types) that are also thought to promote excessive cell growth.

Children and adults with other hereditary abnormalities have an increased risk of developing non-Hodgkin lymphoma, including patients with ataxia telangiectasia, X-linked lymphoproliferative disease, or Wiskott-Aldrich syndrome.

What are the symptoms of non-Hodgkin lymphoma?

Most children have stage III or IV disease at the time of diagnosis because of the sudden onset of symptoms. The disease can progress quickly from a few days to a few weeks. A child can go from otherwise healthy to having multi-system involvement in a short time period.

Some children with non-Hodgkin lymphoma have symptoms of an abdominal mass and have complaints of abdominal pain, fever, constipation, and decreased appetite - due to the pressure and obstruction a large tumor in this area can cause.

Some children with non-Hodgkin lymphoma have symptoms of a mass in their chest and have complaints of respiratory problems, pain with deep breaths (dyspnea), cough, and/or wheezing.

Because of the rapid onset of this malignancy, any respiratory symptoms can quickly worsen, causing a life-threatening emergency.

The following are the most common symptoms of non-Hodgkin lymphoma. However, each child may experience the symptoms differently. Symptoms may include:

  • painless swelling of the lymph nodes in neck, chest, abdomen, underarm, or groin
  • fever
  • sore throat
  • fullness in groin area from node involvement
  • bone and joint pain
  • night sweats
  • tiring easily (fatigue)
  • weight loss/decreased appetite
  • itching of the skin
  • recurring infections

The symptoms of non-Hodgkin lymphoma may resemble other blood disorders or medical problems. Always consult your child's physician for a diagnosis.

How is non-Hodgkin lymphoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for non-Hodgkin lymphoma may include:

  • blood and urine tests
  • x-rays of the chest - use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • computed tomography scan of the abdomen, chest, and pelvis (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • positron emission tomography (PET) scan - radioactive-tagged glucose (sugar) is injected into the bloodstream. Tissues that use the glucose more than normal tissues (such as tumors) can be detected by a scanning machine. PET scans can be used to find small tumors or to check if treatment for a known tumor is working.
  • lymph node biopsy - a sample of tissue is removed from the lymph node and examined under a microscope.
  • lymphangiogram - an imaging study that can detect cancer cells or abnormalities in the lymphatic system and structures. It involves a dye being injected into the lymph system.
  • bone marrow aspiration and/or biopsy - a procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.
  • lumbar puncture (to evaluate central nervous system disease for cancer cells ) - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing. CSF is the fluid which bathes the brain and spinal cord.

Treatment of non-Hodgkin lymphoma:

Specific treatment for non-Hodgkin lymphoma will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the disease
  • your child's tolerance for specific medications, procedures, or therapies
  • the expectations for the course of the disease
  • your opinion or preference

Treatment may include (alone or in combination):

  • chemotherapy
  • radiation therapy
  • surgery
  • close monitoring of blood work
  • bone marrow transplant
  • bone marrow examinations
  • lumbar punctures/spinal taps
  • antibiotics (to prevent or treat infections )
  • supportive care (for side effects of treatment )
  • long-term follow up care (to determine response to treatment, detect recurrent disease, and manage late effects of treatment)

Long-term outlook for a child with non-Hodgkin lymphoma:

Prognosis greatly depends on:

  • the extent of the disease.
  • the presence or absence of metastasis.
  • the response to therapy.
  • age and overall health of the child.
  • your child's tolerance of specific medications, procedures, or therapies.
  • new developments in treatment.

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis is structured around the child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for the child diagnosed with non-Hodgkin lymphoma. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of non-Hodgkin lymphoma. New methods are continually being discovered to improve treatment and to decrease side effects.

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Nose Reshaping

What is nose reshaping?

Cosmetic nose reshaping is also known as rhinoplasty. The procedure can reduce or increase the size of the nose, narrow the span of the nostrils, change the angle between the nose and upper lip, and/or change the tip or bridge of the nose. It can also correct some breathing problems.

Rhinoplasty involves the resculpting of the bone and cartilage. When operating on the nose, the surgeon can either work from within the nose by making an incision inside the nose, or work from the outside by making a small incision across the tissue that separates the nostrils. The latter is known as an "open" procedure.

Possible complications associated with rhinoplasty:

Possible complications associated with rhinoplasty may include, but are not limited to, the following:

  • repetitive surgery
    Although not common, sometimes, a second procedure may be required to correct a minor deformity that occurs as a result of the initial rhinoplasty.
  • surgery complications
    As in any surgery, there is a risk of infection or reaction to the anesthesia. Nosebleeds can also occur after surgery.
  • burst blood vessels
    Sometimes, small blood vessels may burst causing tiny red spots on the nose to surface. The spots are usually minor in appearance but can be permanent.
  • scarring
    With the "open" procedure, there is the possibility of scarring on the base of the nose.

About the procedure:

Although each procedure varies, generally, nose reshaping surgeries follow this process:

  • Location options may include:
    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient
  • Anesthetic options may include:
    • local anesthesia
    • general anesthesia
  • Average length of procedure: about two hours
  • Recuperation period:
    • usually up and around in a few days
    • usually return to school or sedentary work in a week or so
    • surgeon will provide guidelines for resuming normal activities
  • Some possible short-term side effects of surgery:
    • A splint may be applied to the nose to help maintain the new shape.
    • Nasal packs or soft plastic splints may be placed inside the nostrils to stabilize the septum.
    • The face will feel puffy.
    • The nose may ache.
    • You may experience a dull headache, swelling around the eyes, and/or bruising around the eyes.
    • A small amount of bleeding is normal in the first few days.
    • Small burst blood vessels may appear as tiny red spots on the skin's surface.
  • Final results:
    • Healing is a slow and gradual process. Some swelling may be present for months, especially in the tip of the nose. Final results of nasal surgery may not be apparent for a year or more.
    • When a traditional open surgical technique is used, or surgery is performed to narrow flared nostrils, small scars will be located on the base of the nose. The scars usually are not noticeable. Scarring is not visible when rhinoplasty is performed from inside the nose.

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Anatomy and Physiology of the Nose and Throat

What is the nose?

The nose is the organ of smell located in the middle of the face. The internal part of the nose lies above the roof of the mouth. The nose consists of:

  • external meatus - triangular-shaped projection in the center of the face.
  • external nostrils - two chambers divided by the septum.
  • septum - made up primarily of cartilage and bone and covered by mucous membranes. The cartilage also gives shape and support to the outer part of the nose.
  • nasal passages - passages that are lined with mucous membranes and tiny hairs (cilia) that help to filter the air.
  • sinuses - four pairs of air-filled cavities, also lined with mucous membranes.

What are sinuses?

The sinuses are cavities, or air-filled pockets, near the nasal passage. As in the nasal passage, the sinuses are lined with mucous membranes. There are four different types of sinuses:

  • ethmoid sinus - located inside the face, around the area of the bridge of the nose. This sinus is present at birth, and continues to grow.
  • maxillary sinus - located inside the face, around the area of the cheeks. This sinus is also present at birth, and continues to grow.
  • frontal sinus - located inside the face, in the area of the forehead. This sinus does not develop until around 7 years of age.
  • sphenoid sinus - located deep in the face, behind the nose. This sinus does not develop until adolescence.

What is the throat?

The throat is a ring-like muscular tube that acts as the passageway for air, food, and liquid. The throat also helps in forming speech. The throat consists of:

  • larynx - also known as the voice box, the larynx is a cylindrical grouping of cartilage, muscles, and soft tissue which contains the vocal cords. The vocal cords are the upper opening into the windpipe (trachea), the passageway to the lungs.
  • epiglottis - a flap of soft tissue located just above the vocal cords. The epiglottis folds down over the vocal cords to prevent food and irritants from entering the lungs.
  • tonsils and adenoids - made up of lymph tissue and are located at the back and the sides of the mouth. They protect against infection, but generally have little purpose beyond childhood.

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Nosebleeds

Nosebleeds can be a scary occurrence, but are usually not dangerous. The medical term for nosebleed is epistaxis. They are fairly common in children, especially in dry climates or during the winter months when dry heat inside homes and buildings can cause drying, cracking, or crusting inside the nose. Many times, children outgrow the tendency for nosebleeds during their teenage years.

The front part of the nose contains many fragile blood vessels that can be damaged easily. Most nosebleeds in children occur in the front part of the nose close to the nostrils.

What causes a nosebleed?

Nosebleeds are caused by many factors, but some of the most common causes include the following:

  • picking the nose
  • blowing the nose too hard
  • injury to the nose
  • over-dry air
  • colds and allergies
  • foreign body in the nose

Many times no apparent cause for a nosebleed can be found.

First-aid for nosebleeds:

  • Calm your child and let him/her know you can help.
  • Pinch the nostrils together for five to 10 minutes without checking to see if bleeding has stopped.
  • Have your child sit up and lean forward to avoid swallowing blood.
  • Apply ice or a cold water compress to the bridge of the nose.
  • If bleeding does not stop, try the above steps one more time.
  • Do not pack your child's nose with tissues or gauze.

When should I call my child's physician?

Specific treatment for nosebleeds, that require more than minor treatment at home, will be determined by your child's physician. In general, call your child's physician for nosebleeds if:

  • you are unable to stop the nosebleed or if it recurs.
  • your child also has a nose injury that may indicate a more serious problem (such as a fractured nose or other trauma to the head).
  • there is a large amount or rapid loss of blood.
  • your child feels faint, weak, ill, or has trouble breathing.
  • your child has bleeding from other parts of the body (such as in the stool, urine, or gums) or bruises easily.
  • there is a foreign body stuck in your child's nose.

Prevention of nosebleeds:

If your child has frequent nosebleeds, some general guidelines to help prevent nosebleeds from occurring include the following:

  • Use a cool mist humidifier in your child's room at night if the air in your home is dry. Be sure to follow the manufacturer's advice for cleaning the humidifier so that germs and mold do not grow in it.
  • Teach your child not to pick his/her nose or blow it too forcefully.
  • Apply petroleum jelly inside the nostrils several times a day, especially at bedtime, to help keep the area moist.
  • Use saline (salt water) drops or a saline nose spray, as directed by your child's physician.
  • See your child's physician for treatment of allergies that may contribute to frequent nosebleeds.

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Obstructive Sleep Apnea

What is obstructive sleep apnea?

Obstructive sleep apnea occurs when a child stops breathing during periods of sleep. The cessation of breathing usually occurs because of a blockage (obstruction) in the airway. Tonsils and adenoids may grow to be large relative to the size of a child's airway (passages through the nose and mouth to the windpipe and lungs). Inflamed and infected glands may grow to be larger than normal, thus causing more blockage. The enlarged tonsils and adenoids block the airway during sleep, for a period of time. The tonsils and adenoids are made of lymph tissue and are located at the back and to the sides of the throat.

During episodes of blockage, the child may look as if he/she is trying to breath (the chest is moving up and down), but no air is being exchanged within the lungs. Often these episodes conclude with a period of awakening and compensation for lack of breathing. Periods of blockage occur regularly throughout the night and result in a poor, interrupted sleep pattern.

Sometimes, the inability to circulate air and oxygen in and out of the lungs results in lowered blood oxygen levels. If this pattern continues, the lungs and heart may suffer permanent damage.

Obstructive sleep apnea is most commonly found in children between three to six years of age. It occurs more commonly in children with Down syndrome and other congenital conditions affecting the upper airway (i.e., conditions causing large tongue, small jaw, etc.).

What causes obstructive sleep apnea?

In children, the most common cause of obstructive sleep apnea is enlarged tonsils and adenoids in the upper airway. Infections may cause these glands to enlarge. Large adenoids may completely block the nasal passages and make breathing through the nose difficult or impossible.

There are many muscles in the head and neck that help to keep the airway open. When a person (child or adult) falls asleep, muscle tone tends to decrease, thus, allowing tissues to fold closer together. If the airway is partially closed (by enlarged glands) while awake, falling asleep may result in a completely closed passage.

Obesity may cause obstructive sleep apnea. While a common cause in adults, obesity is a far less common reason for obstructive sleep apnea in children.

A rare cause of obstructive sleep apnea in children is a tumor or growth in the airway. Certain syndromes or birth defects, such as Down syndrome and Pierre-Robin syndrome, can also cause obstructive sleep apnea.

What are the symptoms of obstructive sleep apnea?

The following are the most common symptoms of obstructive sleep apnea. However, each child may experience symptoms differently. Symptoms may include:

  • loud snoring or noisy breathing during sleep
  • periods of not breathing - although the chest wall is moving, no air or oxygen is moving through the nose and mouth into the lungs. The duration of these periods is variable and measured in seconds.
  • mouth breathing - the passage to the nose may be completely blocked by enlarged tonsils and adenoids.
  • restlessness during sleep (with or without periods of being awake)
  • excessive daytime sleepiness or irritability (because the quality of sleep is poor, the child may be sleepy or irritable in the daytime)
  • hyperactivity during the day

The symptoms of obstructive sleep apnea may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is obstructive sleep apnea diagnosed?

Your child's physician should be consulted if noisy breathing during sleep or snoring becomes noticeable. Your child may be referred to an ear, nose, and throat (ENT) physician (otolaryngologist) for further evaluation.

In addition to a complete medical history and physical examination, diagnostic procedures for obstructive sleep apnea may include:

  • sleep history - report from parents or caretaker
  • evaluation of the upper airway
  • sleep study (Also called polysomnography.) - the best test available for diagnosing obstructive sleep apnea. The test requires a high level of collaboration on the part of the child and may not be possible in younger and/or uncooperative children. Two types of tests are available. In the first type, the child will sleep in a specialized sleep laboratory. In the second type, the child has on similar monitors but sleeps in his/her own bed. During the sleep study a variety of testing occurs to evaluate the following:
  • brain activity
  • electrical activity of the heart
  • oxygen content in the blood
  • chest and abdominal wall movement
  • muscle activity
  • amount of air flowing through the nose and mouth

During the sleep study, episodes of apnea and hypopnea will be recorded:

  • apnea - complete airway obstruction.
  • hypopnea - the partial airway obstruction combined with a significant decrease in the oxygen content of the blood.

Based on the laboratory test, sleep apnea is generally considered significant in children if more than 10 apnea episodes occur per night, or one or more occur per hour. Some experts define the problem as significant if a combination of one or more episodes of apnea and/or hypopnea occur per hour of sleep.

Symptoms of obstructive sleep apnea may resemble other conditions or medical problems. Consult your child's physician for more information.

Treatment for obstructive sleep apnea:

Specific treatment for obstructive sleep apnea will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • cause of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

The treatment for obstructive sleep apnea is based on the cause. Since enlarged tonsils and adenoids are the most common cause of airway blockage in children, the treatment is surgery and removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy). Your child's otolaryngologist will discuss the treatment options, risks, and benefits with you. This surgery requires general anesthesia. Depending on the health of the child, surgery may be performed on an outpatient basis.

If the cause of the disorder is obesity, less invasive treatments may be appropriate, including weight loss and wearing a special mask while sleeping to keep the airway open. This mask delivers continuous positive airway pressure (CPAP). The device itself is often clumsy, and it may be difficult to convince a child to wear such a mask. Surgery may be necessary.

What happens during tonsillectomy and adenoidectomy?

Tonsillectomy and adenoidectomy (T&A) surgery is a common major surgery performed on children in the US. About 400,000 surgeries are performed each year. The need for a T&A will be determined by your child's ear, nose, and throat surgeon and discussed with you. Most T & A surgeries are done on an outpatient basis. This means that your child will have surgery and then go home the same day. Some children may be required to stay overnight, such as, but not limited to, children who:

  • are not drinking well after surgery.
  • have other chronic diseases or problems with seizures.
  • have complications after surgery, such as bleeding.
  • are younger than 3 years of age.

Before the surgery, you will meet with different members of the healthcare team who are going to be involved with your child's care. These may include:

  • day surgery nurses - nurses who prepares your child for surgery. Operating room nurses assist the physicians during surgery. Recovery room (also called the Post Anesthesia Care Unit) nurses care for your child as he/she emerges from general anesthesia.
  • surgeon - a physician who specializes in surgery of the ear, nose, and throat.
  • anesthesiologist - a physician with specialized training in anesthesia. He/she will complete a medical history and physical examination and formulate a plan of anesthesia for your child. The plan will be discussed with you and your questions will be answered. This surgery requires a general anesthesia.

During the surgery, your child will be anesthetized in the operating room. The surgeon will remove your child's tonsils and adenoids through the mouth. There will be no cut on the skin.

In most cases, after the surgery, your child will go to a recovery room where he/she can be monitored closely. After the child is fully awake and doing well, the recovery room nurse will bring the child back to the day surgery area.

At this point, if everything is going well, you and your child will be able to go home. If your child is going to stay the night in the hospital, the child will be brought from the recovery room to his/her room. Usually, the parents are in the room to meet the child.

Bleeding is a complication of this surgery and should be addressed immediately by the surgeon. If the bleeding is severe, the child may return to the operating room.

At home after a T&A:

The following are some of the instructions that may be given to you to help care for your child:

  • increased fluid intake
  • pain medication, as prescribed
  • no heavy or rough play for a duration of time recommended by the surgeon

What are the risks of having a T&A?

Any type of surgery poses a risk to a child. About 4 percent of the children begin bleeding from the surgery within the first two weeks after the surgery, and may require additional blood and/or surgery. Some children may have a change in the sound of their speech due to the surgery. The following are some of the other complications that may occur:

  • bleeding (may happen during surgery, immediately after surgery, or at home)
  • dehydration (due to decreased fluid intake; if severe, fluids through an intravenous, or IV, catheter in the hospital may be necessary)
  • fever
  • difficulty breathing (swelling of the area around the surgery; may be life threatening if not treated immediately)

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Otitis Externa

What is otitis externa (swimmer's ear)?

Swimmer's ear, also called otitis externa, is an infection of the outer ear canal. Swimmer's ear is either caused by a fungus or bacteria. Water that remains trapped in the ear canal (when swimming, for example) can provide a breeding ground for bacteria and fungi.

What causes swimmer's ear?

Many different factors can increase the chance of developing swimmer's ear. As the name implies, one of the factors is excessive wetness as with swimming, although it can occur without swimming. Other possible causes of this infection include the following:

Ear Infections

Ear infections can occur due to a variety of medical conditions and can occur in the external and internal ear areas. The external ear includes the visible portion (called the auricle) and the external auditory canal or tube.

The inner ear includes the cochlea (which contains the sensory hearing nerves); vestibule (which contains the sensory receptors for balance); and semicircular canals (which also contain sensory receptors for balance).

Ear infections cause painful earaches and, if left untreated, may lead to hearing loss. Two of the more common types of ear infections are infection of the middle ear infection, or otitis media, and infection of the outer ear canal, or otitis externa (swimmer's ear).

  • being in warm, humid places
  • harsh cleaning of the ear canal
  • trauma to the ear canal
  • dry ear canal skin
  • foreign body in the ear canal
  • lack of cerumen (ear wax)
  • eczema and other forms of dermatitis

What are the symptoms of swimmer's ear?

The following are the most common symptoms of swimmer's ear. However, each individual may experience symptoms differently. Symptoms may include:

  • redness of the outer ear

  • itching in the ear

  • pain, especially when touching or wiggling the ear lobe

  • drainage from the ear

  • swollen glands in the neck

  • swollen ear canal

  • conductive hearing loss

The symptoms of swimmer's ear may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is swimmer's ear diagnosed?

Swimmer's ear may be diagnosed with a complete medical history and physical examination by your physician. Your physician may use an otoscope, a lighted instrument that helps to examine the ear and to aid in the diagnosis of ear disorders. This will help your physician know if there is also an infection in the middle ear, called otitis media. Although this infection usually does not occur with swimmer's ear, some individuals may have both types of infections.

Your physician may also take a culture of the drainage from the ear to help determine proper treatment.

Treatment of swimmer's ear:

Swimmer's ear, when properly treated by a physician, usually clears up within seven to 10 days. Specific treatment for swimmer's ear will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the condition
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference
Treatment may include:
  • antibiotic ear drops or oral antibiotics

  • corticosteroid ear drops (to help decrease the swelling)

  • pain medication

  • keeping the ear dry, as directed by your physician

  • a wick (a piece of sponge may be placed in your ear if there is a lot of swelling. This wick helps the antibiotic drops work more effectively in the ear canal.)

Preventing swimmer's ear:

The following are some hints to help prevent swimmer's ear:

  • Place two to three drops of a mixture of vinegar/isopropyl alcohol/water into your ear after the ears come in contact with water.

  • Use ear plugs for swimming or bathing.

  • Do not aggressively clean your ear canal.

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Otitis Externa (Swimmer's Ear)

What is otitis externa?

Picture of two young girls giggling by the side of the pool

Otitis externa, also called swimmer's ear, is an inflammation of the external ear canal. Swimmer's ear is caused by fungi or bacteria. Water that remains trapped in the ear canal (when swimming, for example) may provide a source for the growth of bacteria and fungi.

What causes swimmer's ear?

Many different factors can increase your child's chance of developing swimmer's ear. As the name implies, one of the factors is excessive wetness as with swimming, although it can occur without swimming. Other possible causes of this infection include the following:

  • being in warm, humid places
  • harsh cleaning of the ear canal
  • trauma to the ear canal
  • dry ear canal skin
  • foreign body in the ear canal
  • lack of cerumen (ear wax)
  • eczema and other forms of dermatitis

What are the symptoms of swimmer's ear?

The following are the most common symptoms of swimmer's ear. However, each child may experience symptoms differently. Symptoms may include:

  • redness of the outer ear
  • itching in the ear
  • pain, especially when touching or wiggling the ear lobe
  • drainage from the ear
  • swollen glands in the neck
  • swollen ear canal
  • conductive hearing loss

The symptoms of swimmer's ear may resemble other medical conditions or problems. Always consult your child's physician for a diagnosis.

How is swimmer's ear diagnosed?

Swimmer's ear may be diagnosed with a complete medical history and physical examination by your child's physician. Your child's physician may use an otoscope, a lighted instrument that helps to examine the ear and to aid in the diagnosis of ear disorders. This will help your child's physician know if there is also an infection in the middle ear, called otitis media. Although this infection usually does not occur with swimmer's ear, some children may have both types of infections.

Your child's physician may also take a culture of the drainage from the ear to help determine proper treatment.

Treatment of swimmer's ear:

Swimmer's ear, when properly treated by a physician, usually clears up within seven to 10 days. Specific treatment for swimmer's ear will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include:

  • antibiotic ear drops or oral antibiotics
  • corticosteroid ear drops (to help decrease the swelling)
  • pain medication
  • keeping the ear dry, as directed by your child's physician
  • a wick (a piece of sponge may be placed in your child's ear if there is a lot of swelling. This wick helps the antibiotic drops work more effectively in the ear canal.)

Preventing swimmer's ear:

The following are some hints to help prevent swimmer's ear:

  • Place two to three drops of a mixture of vinegar/isopropyl alcohol/water into your child's ear after the ears come in contact with water.
  • Use ear plugs for swimming or bathing.
  • Do not aggressively clean your child's ear canal.

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Otitis Media (Middle Ear Infection)

What is otitis media (OM)?

Otitis media is inflammation located in the middle ear. Otitis media can occur as a result of a cold, sore throat, or respiratory infection.

Facts about otitis media:

  • More than 80 percent of children have at least one episode of otitis media by the time they are three years of age.
  • Nearly half of these children have three or more episodes by the time they are three years of age.
  • Otitis media can also affect adults, although it is primarily a condition that occurs in children.
  • Otitis media is the most common diagnosis for children in the US.
  • Otitis media occurs more often in the winter and early spring.

Who is at risk for getting ear infections?

While any child may develop an ear infection, the following are some of the factors that may increase your child's risk of developing ear infections:

  • being around someone who smokes
  • family history of ear infections
  • a poor immune system
  • spends time in a daycare setting
  • absence of breastfeeding
  • having a cold
  • bottle fed while laying on his/her back

What causes otitis media?

Middle ear infections are usually a result of a malfunction of the eustachian tube, a canal that links the middle ear with the throat area. The eustachian tube helps to equalize the pressure between the outer ear and the middle ear. When this tube is not working properly, it prevents normal drainage of fluid from the middle ear, causing a buildup of fluid behind the eardrum. When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to acute otitis media. The following are some of the reasons that the eustachian tube may not work properly:

  • a cold or allergy which can lead to swelling and congestion of the lining of the nose, throat, and eustachian tube (this swelling prevents the normal flow of fluids)
  • a malformation of the eustachian tube

What are the different types of otitis media?

Different types of otitis media include the following:

  • acute otitis media (AOM) - the middle ear infection occurs abruptly causing swelling and redness. Fluid and mucus become trapped inside the ear, causing the child to have a fever, ear pain, and hearing loss.
  • otitis media with effusion (OME) - fluid (effusion) and mucus continue to accumulate in the middle ear after an initial infection subsides. The child may experience a feeling of fullness in the ear and hearing loss.

What are the symptoms of otitis media?

The following are the most common symptoms of otitis media. However, each child may experience symptoms differently. Symptoms may include:

  • unusual irritability
  • difficulty sleeping or staying asleep
  • tugging or pulling at one or both ears
  • fever
  • fluid draining from ear(s)
  • loss of balance
  • hearing difficulties
  • ear pain
  • nausea and vomiting
  • diarrhea
  • decreased appetite
  • congestion

The symptoms of otitis media may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is otitis media diagnosed?

In addition to a complete medical history and physical examination, your child's physician will inspect the outer ear(s) and eardrum(s) using an otoscope. The otoscope is a lighted instrument that allows the physician to see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement.

Tympanometry, is a test that can be performed in most physicians' offices to help determine how the middle ear is functioning. It does not tell if the child is hearing or not, but helps to detect any changes in pressure in the middle ear. This is a difficult test to perform in younger children because the child needs to remain still and not cry, talk, or move.

A hearing test may be performed for children who have frequent ear infections.

Treatment for otitis media:

Specific treatment for otitis media will be determined by your child's physician based on the following:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include:

  • antibiotic medication by mouth or ear drops
  • medication (for pain)

If fluid remains in the ear(s) for longer than three months, your child's physician may suggest that small tubes be placed in the ear(s). This surgical procedure, called myringotomy, involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear. A small tube is placed in the opening of the eardrum to ventilate the middle ear and to prevent fluid from accumulating. The child's hearing is restored after the fluid is drained. The tubes usually fall out on their own after six to twelve months.

Your child's surgeon may also recommend the removal of the adenoids (lymph tissue located in the space above the soft roof of the mouth, also called nasopharynx) if they are infected. Removal of the adenoids has shown to help some children with otitis media.

Treatment will depend upon the type of otitis media. Consult your child's physician regarding treatment options.

What are the effects of otitis media?

In addition to the symptoms of otitis media listed above, untreated otitis media can result in any/all of the following:

  • infection in other parts of the head
  • permanent hearing loss
  • problems with speech and language development

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Otolaryngology

What is otolaryngology?

Otolaryngology is the medical specialty that focuses on medical and surgical treatment for patients who have disorders of the:

  • ear, which may include:
    • hearing problems
    • ear infections
    • balance disorders
    • tinnitus
    • nerve pain
    • facial nerve disorders
    • cranial nerve disorders
  • nose, which may include:
    • allergies
    • problems with smelling
    • appearance of the nose
  • throat, which may include:
    • diseases of the larynx (voice box)
    • upper aero-digestive tract disorders
    • disorders involving the esophagus
    • voice disorders
    • swallowing disorders
  • related structures of the head and neck, which may include:
    • nerves that control sight, smell, hearing, and the face
    • infectious diseases
    • benign and malignant tumors
    • trauma to the face
    • deformities of the face
    • cosmetic and reconstructive plastic surgery

Physicians who specialize in otolaryngology are called otolaryngologists. Sometimes they are referred to as ENT (ear, nose, and throat) specialists.

Otolaryngologists may also choose to specialize in any of the following:

  • pediatric otolaryngology (children's disorders)
  • otology / neurotology (ears, balance, and tinnitus)
  • allergy
  • facial cosmetic and reconstructive plastic surgery
  • head and neck diseases
  • laryngology (throat)
  • rhinology (nose)

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Peanut Allergy Diet

General guidelines for peanut allergy:

The key to an allergy free diet is to avoid all foods or products containing the food you are allergic to. A peanut allergy is an abnormal response of the body to the proteins found in peanuts. In order to avoid foods that contain peanuts, it is important to read food labels.

How to read a label for an peanut-free diet:

Be sure to avoid foods that contain any of the following ingredients:

  • cold pressed, expressed, or expelled peanut oil
  • ground nuts
  • mixed nuts
  • Nu-Nuts® artificial nuts
  • peanuts
  • peanut butter
  • peanut flour

Foods that may indicate the presence of peanut protein include:

  • African, Chinese, Thai, and other ethnic dishes
  • baked goods
  • candy
  • cereals
  • chili, spaghetti sauce
  • chocolate (candy, candy bars)
  • crackers
  • egg rolls
  • hydrolyzed plant protein
  • hydrolyzed vegetable protein
  • ice creams, frozen yogurts, tofutti
  • marzipan
  • nougat

Other possible sources of peanuts or peanut products:

  • Studies show that most allergic individuals can safely eat foods containing peanut oil, unless it is cold pressed, expressed, expelled peanut oil. Avoid cold pressed, expressed, and expelled peanut oil.
  • Peanuts are very allergenic and have the potential to cause fatal reactions if ingested by peanut allergic individuals.
  • Ethnic foods, commercially prepared baked goods, and candy can be cross-contaminated with peanuts since peanuts are frequently used in these types of foods.
  • Peanut butter and/or peanut flour have been used in homemade chili and spaghetti sauce as thickeners.
  • Hydrolyzed plant and vegetable protein may be peanut in imported foods, but is typically soy in foods from the US.
  • Nu-Nuts artificial nuts are peanuts that have been deflavored and reflavored with a nut like pecan or walnut.

Glossary - Ear, Nose, and Throat

A | B | C | D | E | F | G | H | I | J | K | L | M | N
O | P | Q | R | S | T | U | V | W | X | Y | Z

A

American Sign Language (ASL) - Manual (hand) language with its own syntax and grammar used primarily by people who are deaf.

anti-inflammatory drugs - drugs that reduce the symptoms and signs of inflammation.

assistive devices - technical tools and devices such as alphabet boards, text telephones, or text-to-speech conversion software used to assist people with physical or emotional disorders in performing certain actions, tasks, and activities.

audiologist - a healthcare professional trained to identify and measure hearing impairments and related disorders using a variety of tests and procedures.

audiology - the study of hearing and hearing disorders.

auditory brainstem response (ABR) test - test used for hearing in infants and young children, or to test for brain functioning in unresponsive patients.

auditory nerve - eighth cranial nerve that connects the inner ear to the brainstem.

autism - brain disorder that begins in early childhood and persists throughout adulthood; affects three crucial areas of development: communication, social interaction, and creative or imaginative play.

autoimmune deafness - hearing loss that may be associated with an autoimmune disease, such as rheumatoid arthritis or lupus.

B

balance - biological system that enables individuals to know where their bodies are in the environment and to maintain a desired position; normal balance depends on information from the labyrinth in the inner ear, and from other senses such as sight and touch, as well as from muscle movement.

benign - a term used to describe non-cancerous tumors which tend to grow slowly and do not spread.

biopsy - a sample of tissue is removed and examined under a microscope.

blasts - immature blood cells.

blood - the life-maintaining fluid which is made up of plasma, red blood cells (erythrocytes), white blood cells (leukocytes), and platelets; blood circulates through the body's heart, arteries, veins, and capillaries; it carries away waste matter and carbon dioxide, and brings nourishment, electrolytes, hormones, vitamins, antibodies, heat, and oxygen to the tissues.

bone marrow - the soft, spongy tissue found inside bones. It is the medium for development and storage of about 95 percent of the body's blood cells.

bone marrow aspiration and biopsy - the marrow may be removed by aspiration or a needle biopsy under local anesthesia. In aspiration biopsy, a fluid specimen, is removed from the bone marrow. In a needle biopsy, marrow cells (not fluid) are removed. These methods are often used together.

C

cancer - cancer is not just one disease but rather a group of diseases. All forms of cancer cause cells in the body to change and grow out of control. Most types of cancer cells form a lump or mass called a tumor. The tumor can invade and destroy healthy tissue.

cancer care team - the group of healthcare professionals who work together to find, treat, and care for people with cancer.

cancer cell - a cell that divides and multiplies uncontrollably and has the potential to spread throughout the body, crowding out normal cells and tissue.

carcinogen - an agent (chemical, physical, or viral) that causes cancer. Examples include tobacco smoke and asbestos.

chemotherapy - a medicine that can help fight cancer.

chromosome - structures in our cells that carry genes, the basic units of heredity. Humans have 23 pairs of chromosomes, one member of each pair inherited from the mother, the other from the father. Each chromosome can contain hundreds or thousands of individual genes.

chronic myelogenous leukemia (CML) - a slowly progressing cancer of the blood in which too many white blood cells are produced in the bone marrow.

clinical trial - a research study that compares many children from around the world with the same type of cancer and evaluates their treatment, side effects, and survival.

cochlea - snail-shaped structure in the inner ear that contains the organ of hearing.

cochlear implant - medical device that bypasses damaged structures in the inner ear and directly stimulates auditory nerve to allow some deaf individuals to learn to hear and interpret sounds and speech.

complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood.

complementary therapy - therapies used in addition to standard therapy.

computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

conductive hearing impairment - hearing loss caused by dysfunction of the outer or middle ear.

congenital - present at birth.

constrict - tighten; narrow.

cytomegalovirus (CMV) - one group of herpes viruses that infect humans and can cause a variety of clinical symptoms including deafness or hearing impairment; infection with the virus may be either before or after birth.

D

decibel - unit that measures the intensity or loudness of sound.

dizziness - physical unsteadiness, imbalance, and lightheadedness associated with balance and other disorders.

E

ear infection - presence and growth of bacteria or viruses in the ear.

ear wax - yellow secretion from glands in the outer ear (cerumen) that keeps the skin of the ear dry and protected from infection.

edema - swelling due to buildup of fluid.

endolymph - fluid in the labyrinth (the organ of balance located in the inner ear).

eustachian tube - a canal that links the middle ear with the throat area. The eustachian tube helps to keep the pressure between the outer ear and the middle ear the same. Having the same pressure allows for the proper transfer of sound waves. The eustachian tube is lined with mucous, just like the inside of the nose and throat.

F

G

grade - the grade of a cancer reflects how abnormal it looks under the microscope. There are several grading systems for different types of cancer.

H

hair cells - sensory cells of the inner ear, which are topped with hair-like structures (stereocilia), which transform the mechanical energy of sound waves into nerve impulses.

hearing - series of events in which sound waves in the air are converted to electrical signals and are then sent as nerve impulses to the brain where they are interpreted.

hearing aid - electronic device that brings amplified sound to the ear.

hearing disorder - disruption in the normal hearing process; sound waves are not converted to electrical signals and nerve impulses are not transmitted to the brain to be interpreted.

hemoglobin - a type of protein in the red blood cells that carries oxygen to the tissues of the body.

herpes virus - a virus which can affect the skin and central nervous system.

hoarseness - abnormally rough or harsh-sounding voice caused by vocal abuse and other disorders.

Hodgkin lymphoma - a type of lymphoma, a cancer in the lymphatic system; Hodgkin disease causes the cells in the lymphatic system to abnormally reproduce, eventually making the body less able to fight infection. Steady enlargement of lymph glands, spleen, and other lymphatic tissue occurs.

I

inflammation - redness, swelling, heat, and pain in a tissue due to chemical or physical injury, infection, or allergic reaction.

inner ear - part of the ear that contains both the organ of hearing (cochlea) and the organ of balance (labyrinth).

J

K

L

labyrinth - organ of balance located in the inner ear. The labyrinth consists of three semicircular canals and the vestibule.

language - system for communicating ideas and feelings using sounds, gestures, signs, or marks.

language disorders - problems with verbal communication and the ability to use or understand the symbol system for interpersonal communication.

laryngitis - inflammation and swelling of the lining of the larynx that usually leads to a hoarse voice, or loss of voice.

larynx (Also called the voice box.) - a cylindrical grouping of cartilage, muscles, and soft tissue which contains the vocal cords. The vocal cords are the upper opening into the windpipe (trachea), the passageway to the lungs.

lymph - part of the lymphatic system; a thin, clear fluid that circulates through the lymphatic vessels and carries blood cells that fight infection and disease.

lymph nodes - part of the lymphatic system; bean-shaped organs, found in the underarm, groin, neck, and abdomen, that act as filters for the lymph fluid as it passes through them.

lymph vessels - part of the lymphatic system; thin tubes that carry lymph fluid throughout the body.

lymphangiogram (LAG) - an imaging study that can detect cancer cells or abnormalities in the lymphatic system and structures. It involves a dye being injected to the lymph system.

lymphatic system - part of the immune system; includes lymph, ducts, organs, lymph vessels, lymphocytes, and lymph nodes, whose function is to produce and carry white blood cells to fight disease and infection.

lymphocytes - part of the lymphatic system; white blood cells that fight infection and disease.

M

malignant - a term used to describe cancerous tumors which tend to grow rapidly, can invade and destroy nearby normal tissues, and can spread.

mastoid - back portion of the temporal bone behind the ear.

medical oncologist - a physician who is specially trained to diagnose and treat cancer with chemotherapy and other medications.

meningitis - inflammation of the meninges, the membranes that envelop the brain and the spinal cord; may cause hearing loss or deafness.

metastasis - the spread of tumor cell in other areas of the body.

middle ear - part of the ear that includes the eardrum and three tiny bones of the middle ear, ending at the round window that leads to the inner ear.

myringotomy - surgical procedure to remove infection from the mastoid bone.

N

nasal polyp - a small rounded piece of the lining of the nose that can extend into the passages of the nose.

noise-induced hearing loss - hearing loss that is caused either by a one-time or repeated exposure to very loud sound or sounds at various loudness levels over an extended period of time.

non-Hodgkin lymphoma - a type of lymphoma, a cancer in the lymphatic system; causes the cells in the lymphatic system to abnormally reproduce, eventually causing tumors to grow. Non-Hodgkin lymphoma cells can also spread to other organs.

O

oncologist - a physician with special training in the diagnosis and treatment of cancer.

oncology - the branch of medicine concerned with the diagnosis and treatment of cancer.

oncology clinical nurse specialist - a registered nurse with a Master's degree in oncology nursing who specializes in the care of cancer patients.

oncology social worker - a health professional with a Master's degree in social work who is an expert in coordinating and providing non-medical care to patients.

otitis externa - inflammation of the outer part of the ear extending to the auditory canal.

otitis media - inflammation of the middle ear caused by infection.

otoacoustic emissions - low-intensity sounds produced by the inner ear that can be quickly measured with a sensitive microphone placed in the ear canal.

otolaryngologist - a physician who specializes in diseases of the ears, nose, throat, and head and neck.

otologist - a physician who specializes in diseases of the ear.

outer ear - external portion of the ear, consisting of the pinna, or auricle, and the ear canal.

P

pain specialist - oncologists, neurologists, anesthesiologists, neurosurgeons, and other physicians, nurses, or pharmacists who are experts in pain. A team of healthcare professionals may also be available to address issues of pain control.

pathologist - a physician who specializes in diagnosis and classification of diseases by laboratory tests such as examination of tissue and cells under a microscope. The pathologist determines whether a tumor is benign or cancerous and, if cancerous, the exact cell type and grade.

pediatric oncologist - a physician who specializes in cancers of children.

pediatrician - a physician who specializes in the care of children.

pharynx - back of the throat.

phonology - study of speech sounds.

posterior - referring to the back part of a structure.

primary site - the place where cancer begins. Primary cancer is named after the organ in which it starts. For example, cancer that starts in the kidney is always kidney cancer even if it spreads (metastasizes) to other organs such as bones or lungs.

prognosis - a prediction of the course of disease; the outlook for the cure of the patient.

protocol - a formal outline or plan, such as a description of what treatments a patient will receive and exactly when each should be given.

purulent - having or making pus.

Q

R

radiation oncologist - a physician who specializes in using radiation to treat cancer.

radiation therapist - a professional specially trained to operate equipment that delivers radiation therapy.

radiation therapy - treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside of the body (external radiation) or from radioactive materials placed directly in the tumor (internal or implant radiation).

radiologist - a physician with special training in diagnosing diseases by interpreting x-rays and other types of imaging studies, for example, CT scans and magnetic resonance imaging.

round window - membrane separating the middle ear and inner ear.

S

sensorineural hearing loss - hearing loss caused by damage to the sensory cells and/or nerve fibers of the inner ear.

sign language - language of hand shapes, facial expressions, and movements used as a form of communication.

smell - to perceive odor or scent through stimuli affecting the olfactory nerves.

sound vocalization - ability to produce voice.

speech - making definite vocal sounds that form words to express thoughts and ideas.

speech disorder - defect or abnormality that prevents an individual from communicating by means of spoken words.

speech-language pathologist - a health professional trained to evaluate and treat people who have voice, speech, language, or swallowing disorders, including hearing impairment, that affect their ability to communicate.

staging - the process of determining whether cancer has spread and, if so, how far. There is more than one system for staging.

stuttering - frequent repetition of words or parts of words that disrupts the smooth flow of speech.

sudden deafness - loss of hearing that occurs quickly from causes such as explosion, a viral infection, or the use of some drugs.

suppurative - something that makes pus.

syphilis - a disease usually transmitted by sexual contact, that can cause serious injury to an unborn baby.

T

taste - sensation produced by a stimulus applied to the gustatory nerve endings in the tongue; the four tastes are salt, sour, sweet, and bitter; some say there is a fifth taste described as savory.

taste buds - groups of cells located on the tongue that enable one to recognize different tastes.

throat culture - a procedure that involves taking a swab of the back of the throat and monitoring it in the laboratory to determine the type of organism causing an infection.

throat disorders - disorders or diseases of the larynx (voice box) or esophagus.

tongue - large muscle on the floor of the mouth that manipulates food for chewing and swallowing; the main organ of taste, and assists in forming speech sounds.

toxoplasmosis - an infectious disease caused by a parasite that can be harmful to an unborn baby.

transillumination - a method of examination by the passage of light through tissues to assist in diagnosis. The light transmission changes with different tissues.

tumor - an abnormal lump or mass of tissue. Tumors can be benign (not cancerous) or malignant (cancerous).

tympanic membrane (Also called eardrum.) - a thin membrane that in the middle ear that carries sound vibrations to the inner ear.

tympanoplasty - surgical repair of the eardrum (tympanic membrane) or bones of the middle ear.

U

ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

V

vestibule - bony cavity of the inner ear.

vocal cords (vocal folds) - muscularized folds of mucous membrane that extend from the larynx (voice box) wall; enclosed in elastic vocal ligament and muscle that control the tension and rate of vibration of the cords as air passes through them.

voice - sound produced by air passing out through the larynx and upper respiratory tract.

W

X

x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Y

Z

Pharyngitis / Tonsillitis

What is pharyngitis and tonsillitis?

Pharyngitis and tonsillitis are infections in the throat that cause inflammation. If the tonsils are primarily affected, it is called tonsillitis. If the throat is primarily affected, it is called pharyngitis. A person might even have inflammation and infection of both the tonsils and the throat. This would be called pharyngotonsillitis. These infections are spread by close contact with other individuals. Bacterial infections are more common during the winter. Viral infections are more common in summer and fall.

What causes pharyngitis and tonsillitis?

There are many causes of infections in the throat. The following are the most common:

  • viruses - this infection is the most common in all age groups, and may include:
    • Adenovirus
    • Influenza virus
    • Epstein-Barr virus
    • Herpes simplex virus
  • bacteria
    • Group A Beta Hemolytic Streptococci (GABHS)
    • Neisseria Gonorrhea
    • Hemophilus Influenza Type B
    • Mycoplasma
  • fungal infections
  • parasitic infections
  • cigarette smoke
  • other causes

What are the symptoms of pharyngitis and tonsillitis?

The symptoms of pharyngitis and tonsillitis depend greatly on the cause of the infection and the person affected. For some people, the onset of symptoms may be quick; for others, symptom onset is slow. The following are the most common symptoms of pharyngitis and tonsillitis. However, each individual may experience symptoms differently. Symptoms may include:

  • sore throat
  • fever - either low grade or high
  • headache
  • decrease in appetite
  • not feeling well
  • nausea
  • vomiting
  • stomach aches
  • painful swallowing
  • visual redness or drainage in the throat

The symptoms of pharyngitis and tonsillitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How are pharyngitis and tonsillitis diagnosed?

In most cases, it is hard to distinguish between a viral sore throat and a strep throat based on physical examination. It is important, though, to know if the sore throat is caused by GABHS, as this requires antibiotic treatment to help prevent the complications that can occur with these bacteria.

As a result, most people, when they have the above symptoms, will receive a strep test and throat culture to determine if it is an infection caused by GABHS. This usually involves a quick throat swab in the physician's office.

Quick tests, called rapid strep tests, may be performed. This may also immediately become positive for GABHS and antibiotics will be started. If it is negative, part of the throat swab will be kept for a throat culture. This will further identify, in two to three days, if there is any GABHS present. Your physician will decide the treatment plan based on the findings.

Treatment for pharyngitis and tonsillitis:

Specific treatment for pharyngitis and tonsillitis will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the condition
  • cause of the condition
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

If bacteria is not the cause of the infection, then the treatment is usually directed more for comfort. Antibiotics will not help treat viral sore throats. Treatment may include:

  • acetaminophen (for pain)
  • increased fluid intake
  • throat lozenges
  • antibiotics (if the cause of the infection is bacterial, not viral)

Click here to view the
Online Resources of Respiratory Disorders

Pharyngitis and Tonsillitis

Picture of a female physician examining a young girl

What is pharyngitis and tonsillitis?

Pharyngitis and tonsillitis are infections in the throat that cause inflammation. If the tonsils are primarily affected, it is called tonsillitis. If the throat is primarily affected, it is called pharyngitis. A child might even have inflammation and infection of both the tonsils and the throat. This would be called pharyngotonsillitis. These infections are spread by close contact with other individuals. Bacterial infections are more common during the winter. Viral infections are more common in summer and fall.

Facts about pharyngitis and tonsillitis:

  • Pharyngitis and tonsillitis are most commonly seen in children between the ages of six and eight.
  • Children under age 3 rarely develop group A ß-hemolytic streptococcus (GABHS), or strep throat.

What causes pharyngitis and tonsillitis?

There are many causes of infections in the throat. The following are the most common infectious agents:

  • viruses:
    • adenovirus
    • influenza virus
    • Epstein-Barr virus
    • herpes simplex virus
  • bacteria:
    • group A ß-hemolytic streptococci (GABHS)
    • Neisseria gonorrhea
    • Haemophilus influenzae Type B
    • mycoplasma
  • fungal infections
  • parasitic infections
  • cigarette smoke

What are the symptoms of pharyngitis and tonsillitis?

The symptoms of pharyngitis and tonsillitis depend greatly on the cause of the infection and the person affected. For some children, the onset of symptoms may be quick; for others, symptom onset is slow. The following are the most common symptoms of pharyngitis and tonsillitis. However, each child may experience symptoms differently. Symptoms may include:

  • sore throat
  • fever (either low-grade or high)
  • headache
  • decrease in appetite
  • not feeling well
  • nausea
  • vomiting
  • stomach aches
  • painful swallowing
  • visual redness or drainage in the throat

How are pharyngitis and tonsillitis diagnosed?

In most cases, it is hard to distinguish between a viral sore throat and a strep throat based on physical examination. It is important, though, to know if the sore throat is caused by GABHS, as this requires antibiotic treatment to help prevent the complications associated with these bacteria.

As a result, most children, when they have the above symptoms, will receive a strep test and throat culture to determine if it is an infection caused by GABHS. This usually involves a throat swab (called quick tests or rapid strep tests) in the physician's office.

This may immediately become positive for GABHS and antibiotics will be started. If it is negative, part of the throat swab will be kept for a throat culture. This will further identify, in two to three days, if there is any GABHS present. Your child's physician will decide the treatment plan based on the findings.

Treatment for pharyngitis and tonsillitis:

Specific treatment for pharyngitis and tonsillitis will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • cause of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

If bacteria do not cause the infection, then the treatment is focused on comfort of your child. Antibiotics will not help treat viral sore throats. Treatment may include:

  • acetaminophen (for pain)
  • increased fluid intake
  • throat lozenges
  • antibiotics (if the cause of the infection is bacterial, not viral)

Click here to view the
Online Resources of Ear, Nose, & Throat

Pilomatrixoma

What is pilomatrixoma?

Pilomatrixoma is a slow-growing, hard mass found beneath the skin. It is most common on the face and neck, but is sometimes found on the scalp, eyelids, and arms. Pilomatrixoma is usually a single lump, but, occasionally, multiple masses are seen. Most cases of pilomatrixoma occur in children under the age of 10, and the condition is twice as common in females as males. Other names for pilomatrixoma include pilomatricoma and calcifying epithelioma of Malherbe.

What causes pilomatrixoma?

Pilomatrixomas develop from an abnormal formation of cells that are similar to hair cells, which become hardened or calcified. The calcified cells form a mass beneath the skin.

Other members of a child's family may also have pilomatrixoma, suggesting a genetic component.

What are the symptoms of pilomatrixoma?

The following are the most common symptoms of pilomatrixoma. However, each child may experience symptoms differently. Symptoms may include a small, hard mass beneath the skin of the face, head, neck, or arms. The mass is usually less than 3 centimeters in diameter and the skin covering the mass appears normal, or may feel firm or hardened. Usually, the mass is painless, unless it becomes infected.

The symptoms of pilomatrixoma may resemble other neck masses or medical problems. Always consult your child's physician for a diagnosis.

How is pilomatrixoma diagnosed?

Generally, pilomatrixoma is diagnosed by physical examination. In addition to a complete medical history and physical examination, diagnostic procedures for pilomatrixoma may include a biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.

Treatment of pilomatrixoma:

Specific treatment of pilomatrixoma will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include surgery to remove the mass and some of the surrounding tissue. Pilomatrixomas cysts usually do not regrow.

Click here to view the
Online Resources of Ear, Nose, & Throat

Overview of Plastic Surgery

What is plastic surgery?

It is a popular misconception that the word plastic in plastic surgery means artificial. Rather, the word is derived from the ancient Greek word plastikos, which means "to mold or give form." Plastic surgery is a surgical specialty involved with the reconstruction of facial and body tissue defects due to illness, trauma, or birth disorders.

Plastic surgery restores and improves function, as well as appearance. It can involve surgery on any portion of the anatomy, except the central nervous system, including, but not limited to, the following:

  • skin (including skin cancer, scars, burns, birthmarks, tattoo removal)
  • maxillofacial (the facial skeleton)
  • congenital anomalies (including deformed ears, cleft palate, cleft lip)
Picture of female physician

Physicians who perform plastic surgery:

It is important for patients to select physicians who are certified in plastic surgery by the American Board of Plastic Surgery. Generally, a surgeon who is board-certified in plastic surgery has graduated from an accredited medical school and has completed at least five years of graduate medical education - usually three years of general surgery and two years of plastic surgery. In addition, the surgeon must practice plastic surgery for two years and pass comprehensive written and oral examinations to become board-certified.

What does plastic surgery include?

Plastic surgery includes both reconstructive and aesthetic (cosmetic) procedures:

  • reconstructive plastic surgery
    In general, reconstructive surgery is performed on abnormal structures of the body that may be caused by the following:
    • trauma
    • infection
    • developmental abnormalities
    • congenital (present at birth) anomalies
    • disease
    • tumors

    This type of surgery is usually performed to improve function, but may also be performed to approximate a normal appearance.

  • cosmetic (aesthetic) plastic surgery
    Cosmetic surgery is performed to repair or reshape otherwise normal structures of the body, generally, to improve appearance.

Click here to view the
Online Resources of Plastic Surgery

Statistics

Plastic surgery statistics:

Consider the following statistics are from the American Society of Plastic Surgeons (ASPS):

  • The top five cosmetic surgery procedures in 2006 were nose reshaping, liposuction, breast augmentation, eyelid surgery, and tummy tuck.
  • From 2000 to 2006, the number of reconstructive plastic surgery patients has decreased 15 percent.
  • Liposuction procedures have increased more than fourfold between 1992 and 2006.
  • Breast augmentation surgery increased almost ninefold between 1992 and 2006.
  • Minimally-invasive cosmetic procedures have increased 66 percent between 2000 and 2006.

Top cosmetic plastic surgery procedures in 2006:

  • nose reshaping
  • liposuction
  • breast augmentation
  • eyelid surgery
  • tummy tuck

Top female cosmetic plastic surgery procedures in 2006:

  • liposuction
  • breast augmentation
  • nose reshaping
  • eyelid surgery
  • tummy tuck

Top male cosmetic plastic surgery procedures in 2006:

  • nose reshaping
  • eyelid surgery
  • liposuction
  • hair transplantation
  • breast reduction

Top reconstructive plastic surgery procedures in 2006:

  • tumor removal
  • laceration repair
  • scar revision
  • hand surgery
  • breast reduction
  • maxillofacial surgery

Click here to view the
Online Resources of Plastic Surgery

Plastic Surgery Techniques

Surgical techniques used in plastic surgery:

There are many different techniques used to perform cosmetic and reconstructive plastic surgery procedures, including the following:

  • endoscopic surgery
    Endoscopic surgery is performed with an endoscope, a tubular probe that has a tiny camera and a bright light, which is inserted into a small incision. Images from the camera are transmitted back to a screen, which the surgeon watches while manipulating the endoscope inside the body. The endoscope is a device to assist the surgeon during surgical procedures. Instruments to actually perform the surgery are inserted through a different incision(s).
  • flap surgery
    Flap surgery involves transporting healthy, live tissue from one location of the body to another - often to areas that have lost skin, fat, muscle movement, and/or skeletal support. There are several different types of flap surgery methods that may be utilized, depending upon the location of the flap and the structures that need to be repaired. The types include the following:
local flap - is located next to the wound; the skin remains attached at one end in order that the blood supply is left intact.
regional flap - uses a section of tissue that is attached by a specific blood vessel.
bone/soft tissue flap - this type of flap is often used when bone and the overlying skin are transported to a new location.
musculocutaneous flap (muscle and skin flap) - this type of flap is often used when the area to be covered needs more bulk and an increased blood supply. This type of flap is often used to rebuild a breast following a mastectomy.
microvascular free flap - involves detaching and reattaching skin and blood vessels from one site of the body to another site. Microsurgery is used to attach the blood vessels.
  • laser technology
    Lasers used in plastic surgery often provide for minimal bleeding, bruising, and scarring. There are many different types of lasers that may be utilized, depending upon the purpose and location of the surgery to be performed. Consult your physician/surgeon to determine if laser surgery, and which type, is most appropriate for you.
    • skin grafts
      A skin graft may be used to cover skin that has been damaged and/or is missing. This surgical procedure involves removing healthy portions of skin from one part of the body to restore normal appearance and/or function to another portion of the same body. The place where the skin is removed is called the donor site. There are three different types of skin grafts that may be utilized, depending upon the size and location of needed skin. These include the following:

Split-thickness skin graft

  • commonly used to treat burn wounds
  • uses only the layers of skin closest to the surface
  • donor location site will be chosen based on size, type, and pigment of skin needed

Full-thickness skin graft

  • used to treat deep and large wounds or scars
  • used when maximum skin elasticity is needed
  • uses all layers (not only the surface layer) of skin from the donor site

Composite skin graft

  • provides the repaired skin with the most underlying support
  • involves lifting all layers of skin, fat, and sometimes the underlying cartilage from the donor site
  • tissue expansion
    A tissue expansion is a surgical procedure that involves inserting a balloon-like device (called an expander) under the skin. The expander then slowly secretes liquid into the area to be repaired to actually stretch and expand the skin. This serves the function of "growing" extra skin to repair nearby lost or damaged skin.

Click here to view the
Online Resources of Plastic Surgery

Allergens: Pollen

What is pollen?

Pollen is the tiny egg-shaped male cells of flowering plants, including trees, grasses, and weeds. Pollen is microscopic in size.

Pollen is the most common cause of seasonal allergic rhinitis, sometimes known as "hay fever."

Which plants produce pollen that cause allergic reactions?

Plants that have powdery granules of pollen that are easily blown by the wind, such as:

  • Trees: oak, western red cedar, elm, birch, ash, hickory, poplar, sycamore, maple, cypress, walnut, and others.
  • Grasses: timothy, Bermuda, orchard, sweet vernal, red top, some blue grasses, and others.
  • Weeds: ragweed, sagebrush, pigweed, tumbleweed, Russian thistle, cockleweed, and others.

Most flowering plants, such as roses, have heavier, waxy pollens that are not as easily wind-blown.

When is "pollen season?"

Each plant has a pollen season. It usually starts in the spring, but may begin as early as January in the southern areas of the US. The season usually lasts until October.

Can allergic rhinitis in pollen season be prevented?

To lessen the effects of allergic rhinitis during pollen season, the American Academy of Allergy, Asthma, and Immunology suggests the following:

  • Keep windows closed at night and use air conditioning - which cleans, cools, and dries the air.
  • Minimize outdoor activities early in the morning, between 5:00 and 10:00 a.m., when pollen is most prevalent.
  • Keep car windows closed when traveling.
  • Take a vacation to an area where pollen is not as prevalent - such as to the ocean.
  • Take the medications prescribed by your physician.
  • Don't spend much time outdoors when the pollen count is high.
  • Don't rake leaves during pollen season.
  • Don't hang bedding or clothing outside to dry.
  • Don't grow too many indoor plants.

Click here to view the
Online Resources of Allergy & Asthma

Post-Mastectomy Prosthesis

What is a prosthesis?

There are various types of post-mastectomy and lumpectomy prostheses, also called breast forms. Manufacturers make a wide selection of types, shapes, sizes, and colors.

The type of prosthesis required is determined by the amount of breast tissue that is removed. A prosthesis can be worn against the skin, inside the pocket of a mastectomy bra, or attached to the chest wall. Prosthetic devices are designed to look feminine while ensuring comfort.

What are the various types of prosthetic devices?

External silicone breast prosthesis An external silicone breast prosthesis is a weighted prosthesis, made of silicone, which is designed to simulate natural breast tissue. Because this type of breast prosthesis is weighted, it may help your posture, prevent shoulder drop, and problems with balance.
Non-silicone breast prosthesis A non-silicone breast prosthesis is a light-weight breast form, made of foam or fiberfill, which may be worn following a mastectomy. Non-silicone breast prostheses may be worn during exercise, swimming, and hot weather.
Attachable breast An attachable breast is a self-adhesive breast form that attaches securely to the chest wall with adhesive strips.
Post-surgical soft form in camisole A post-surgical soft form in camisole is a light-weight, removable breast form that fits into a camisole garment (a soft, stretchy garment with lace elastic straps that can be pulled up over the hips if raising the arms is difficult). Post-surgical camisole is often worn immediately following a mastectomy, lumpectomy, radiation therapy, or during reconstruction breast surgery.
Partial breast prosthesis, also called a shaper or shell Partial breast prosthesis, also called shaper or shell is a breast form made of foam, fiberfill, or silicone. This type of breast prosthesis is designed to be worn over your own breast tissue to enhance the overall size of the breast and to create a fuller appearance. A partial breast prosthesis can be worn with a regular bra or a post-mastectomy bra.

What is a post-mastectomy bra?

Post-mastectomy (or simply mastectomy) bras resemble regular bras but with one important difference - they have spandex stretch pockets on the inside which help hold and keep the breast prosthesis in place. Mastectomy bras can be purchased at specialty shops or mastectomy boutiques. A certified mastectomy fitter, who is trained and experienced, can assist you in selecting and fitting the appropriate prosthesis and mastectomy bra that meets your individual needs.

Some mastectomy shops, upon request, will sew in pockets to your regular bras, swimsuits, and nightgowns.

Frequently asked questions about prostheses:

Q: Where do I go to be fitted for a prosthesis and a post-mastectomy bra?

A: There are many mastectomy boutiques and specialty shops that carry all types of prostheses and post-mastectomy garments. Most specialty shops employ certified fitters who are specially-trained to fit women for breast prostheses. Many mastectomy shops are owned by women who have had breast cancer themselves.

At your first fitting appointment, remember to wear a garment that fits properly (possibly a knit top), so that you can see the shape of your breast when trying on your new prosthesis.

Your physician, oncology nurse, local American Cancer Society Reach for Recovery program, or other breast cancer organization can recommend specialty shops and boutiques in your area that carry prosthetic devices and garments.

Q: How soon can I be fitted for a breast prosthesis after a mastectomy?

A: After surgery, your surgeon will recommend the appropriate time for you to start wearing a prosthesis. This will depend upon your medical condition, the post-operative healing process, and the type of mastectomy that was performed.

A physician's prescription for your breast prosthesis and mastectomy bras is necessary for insurance purposes.

Q: Will my insurance pay for my prosthesis and mastectomy bras?

A: There is some variance among insurance companies regarding coverage of prosthetic devices and mastectomy bras. Medicare, and some other insurance plans, will pay for one breast prosthesis per year. Most insurance companies will cover 2 to 4 mastectomy bras per year, provided that you submit a prescription from your physician.

During the month of October, National Breast Cancer Awareness Month, many mastectomy shops have sales on mastectomy bras and other items.

Always check with your insurance company to determine which post-mastectomy products are covered under your plan. Mastectomy bathing suits are generally not covered by insurance companies.

Q: Will people be able to tell that I am wearing a prosthesis?

A: No. With a proper fit, no one will be able to tell you are wearing a prosthesis.

Q: How long does a breast prosthesis last?

A: Always check first, as this will vary with the type of breast prosthesis and by the manufacturer. However, most breast prostheses have a two-year warranty.

Q: What happens if my body changes in size and my prosthesis no longer fits properly? Can I get a replacement, and is it covered by my insurance?

A: Most insurance companies will cover breast prosthesis replacements for this reason, provided there is a prescription from your doctor stating the reason for the replacement. Always check with your insurance company to determine what is covered under your plan.

Click here to view the
Online Resources of Breast Health

Presbycusis

What is presbycusis?

Presbycusis is the gradual loss of hearing that occurs as people age. It is a common disorder associated with aging. One in three older adults over age 60 has hearing loss. Half of people over age 75 have hearing loss.

Presbycusis usually occurs gradually, with some people not immediately aware of the change.

What causes presbycusis?

There may be many causes for presbycusis, but it most commonly occurs because of age-related changes in the following locations:

  • within the inner ear
  • within the middle ear
  • along the nerve pathways to the brain

Contributors to presbycusis include:

  • cumulative effects of environmental noises
  • loss of hair cells (sensory receptors in inner ear)
  • hereditary factors
  • aging
  • health
  • side effects of some medications

What are the symptoms of presbycusis?

The following are the most common symptoms of presbycusis. However, each individual may experience symptoms differently. Symptoms may include:

  • speech of others sounds mumbled or slurred
  • high-pitched sounds, such as "s" or "th" are hard to distinguish
  • conversations are difficult to understand, particularly when there is background noise
  • men's voices are easier to hear than women's
  • some sounds seem overly loud and annoying
  • tinnitus may occur in one or both ears

The symptoms of presbycusis may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Treatment for presbycusis:

Specific treatment for presbycusis will be determined by the physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment options for presbycusis may include the following:

  • avoiding loud noises and reducing noise exposure
  • wearing ear plugs or special fluid-filled ear muffs (to prevent further damage to hearing)
  • hearing aid(s)
  • assistive devices such as telephone amplifiers
  • training in speechreading - using visual cues to determine what is being said

Click here to view the
Online Resources of Otolaryngology


Advances in surgical techniques such as bone grafting allow surgeons to achieve excellent results in correcting cosmetic as well as functional aspects of a patient's maxillofacial deformity, in order to provide compassionate treatment that takes into account the patient's self-image.

Reconstructive Plastic Surgery Overview

What is reconstructive plastic surgery?

Reconstructive plastic surgery is performed to correct facial and body abnormalities caused by birth defects, trauma, disease, or aging.

More than one million reconstructive plastic surgeries are performed each year in the US. Usually, the goal of reconstructive plastic surgery is to improve body function. However, reconstructive plastic surgery may also be performed to create a more normal appearance and improve self-esteem (this may also be called cosmetic surgery). Abnormal structures of the body may result from the following:

  • trauma
  • infection
  • developmental abnormalities
  • congenital (present at birth) anomalies
  • disease
  • tumors

Who are candidates for reconstructive plastic surgery?

Generally, two types of patients have reconstructive plastic surgery, including the following:

  • persons with congenital anomalies (including cleft lip, craniofacial anomalies, or hand deformities)
  • persons with developmental deformities (including those due to an accident, infection, disease, or aging)

Possible complications associated with reconstructive plastic surgery:

Any type of surgery carries some risk. Patients differ in their anatomy and their ability to heal. Some complications associated with reconstructive plastic surgery may include, but are not limited to, the following:

  • infection
  • excessive bleeding
  • bruising
  • difficulty in wound healing
  • anesthesia problems
  • surgery problems

Risk of complications may increase if a patient:

  • smokes.
  • has connective-tissue damage.
  • has skin damage from radiation therapy.
  • has decreased circulation at the surgery site.
  • has HIV (human immunodeficiency virus).
  • has an impaired immune system.
  • has poor nutritional habits.

How to prepare for reconstructive plastic surgery:

The specific type of surgery will be determined by your physician based on:

  • your age, overall health, and medical history 
  • severity of the deformity
  • your tolerance of specific medications, procedures, or therapies
  • location of the deformity
  • your opinion or preference

Reconstructive plastic surgery may require multiple procedures done in several stages.

There are a number of areas in plastic surgery that may be either or both reconstructive or cosmetic, depending on a patient's situation. For example, eyelid surgery (blepharoplasty) may be a procedure performed for cosmetic improvement, as well as to correct eyelids that are drooping severely and obscuring vision.

Rhinitis

What is rhinitis?

Picture of a woman using nasal spray

Rhinitis is a reaction that occurs in the eyes, nose and throat when airborne irritants (allergens) trigger the release of histamine. Histamine causes inflammation and fluid production in the fragile linings of nasal passages, sinuses, and eyelids.

What are the different types of rhinitis?

The two categories of rhinitis are:

  • allergic rhinitis
    • There are two types of allergic rhinitis:
      • seasonal - occurs particularly during pollen seasons
      • perennial - occurs throughout the year
    • The most common causes of allergic rhinitis are:
      • pollen
      • dust mites
      • mold
      • animal dander
    • Reactions from allergic rhinitis include:
      • sneezing
      • congestion
      • runny nose
      • itchy nose, throat, eyes, and ears
      • nosebleeds
      • clear drainage from the nose
    • Persons with perennial allergic rhinitis may also have the following:
      • recurrent ear infections
      • snoring
      • breathing through the mouth
      • fatigue
      • poor performance in school

    • Preventive measures for avoiding allergic rhinitis include:
      • environmental controls, such as air conditioning, during pollen season
      • avoiding areas where there is heavy dust, mites, molds
      • avoiding pets
  • nonallergic rhinitis
    • Types of nonallergic rhinitis are:
      • vasomotor rhinitis (irritant rhinitis)
      • eosinophilic
      • rhinitis medicamentosa
      • neutrophilic rhinosinusitis
      • structural rhinitis
      • nasal polyps
      • primary vasomotor instability
    • Causes of nonallergic rhinitis include:
      • fumes
      • odors
      • temperature
      • atmospheric changes
      • smoke
      • other irritants
    • Reactions from nonallergic rhinitis include:
      • sneezing
      • congestion
      • runny nose
      • itchy nose, throat, eyes, and ears
    • The preventive measure for avoiding nonallergic rhinitis is avoiding the primary cause.
    • Treatments for nonallergic rhinitis, as determined by your physician and based on your condition, may include:
      • oral medications
      • inhaled medications
      • immunotherapy
      • allergy injections
      • surgery (for some conditions)

How is allergic rhinitis diagnosed?

Typically, the diagnosis is made by your physician based on a thorough history and physical examination. In addition to the above signs, the physician may find on physical examination dark circles under the eyes, creases under the eyes, swollen tissue inside the nose, and mouth breathing.

Treatment for allergic rhinitis:

Avoidance of the allergens that are causing the problem is the best treatment. Specific treatment will be determined by your physician based on:

  • your overall health and medical history
  • extent of the reaction
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the reaction
  • your opinion or preference

Treatment may include:

  • antihistamines
    Antihistamines help to decrease the release of histamine, possibly decreasing the symptoms of itching, sneezing, or runny nose. Some examples of antihistamines are diphenhydramine (Benadryl) or hydroxyzine (Atarax). These medications may cause drowsiness.
  • nonsedating antihistamines
    Nonsedating antihistamines work like antihistamines but without the side effect of causing drowsiness. Nonsedating antihistamines may include cetirizine (Zyrtec) or loratadine (Claritin).
  • anti-inflammatory nasal sprays
    Anti-inflammatory nasal sprays help to decrease the swelling in the nose. Consult your physician about proper dosages.
  • steroid nasal sprays
    Steroid nasal sprays also help to decrease the swelling in the nose. Steroid nasal sprays work best when used before the symptoms start, but can also be used during a flare-up.
  • topical nasal decongestants
    Topical nasal decongestants are not recommended for children. In some cases, they cause symptoms to worsen for children.
  • decongestants
    Decongestants help by making the blood vessels in the nose smaller, thus, decreasing congestion. Decongestants can be purchased either over-the-counter or by prescription.
  • anti-leukotrienes
    These are a relatively new type of medication being used to control the symptoms of asthma. These medications help to decrease the narrowing of the lung and to decrease the chance of fluid in the lungs. These are usually given by mouth.

If you do not respond to avoidance or to the above medications, your physician may refer you to an allergist for testing. The allergist then may recommend immunotherapy based on the findings. Immunotherapy usually involves a three to five year course of repeated injections of specific allergens to decrease the reaction to these allergens when you come into contact with them. Consult your physician for more information.

The link between allergic rhinitis and asthma:

Controlling asthma may mean controlling allergic rhinitis in some patients, according to allergy and asthma experts. Allergic rhinitis is a common problem that may be associated with asthma.

Guidelines from the World Health Organization (WHO) recognize the link between allergic rhinitis and asthma. Although the link is not fully understood, one theory asserts that rhinitis makes it difficult to breathe through the nose, which hampers the normal function of the nose. Breathing through the mouth does not warm the air, or filter or humidify it before it enters the lungs, which can make asthma worse.

Click here to view the
Online Resources of Allergy & Asthma

Scar Revision

What is a scar?

A scar is the body's natural way of healing and replacing lost or damaged skin. A scar is usually composed of fibrous tissue. Scars may be formed for many different reasons, including as a result of infections, surgery, injuries, or inflammation of tissue. Scars may appear anywhere on the body, and the composition of a scar may vary - appearing flat, lumpy, sunken, or colored. It may be painful or itchy. The final look of a scar depends of many factors, including the skin type and location on the body, the direction of the wound, the type of injury, age of the person with the scar, and his/her nutritional status.

What is a scar revision?

A scar revision is a procedure performed on a scar to alter the appearance of the scar. The revision may improve the appearance of the scar or restore function to a part of the body that may have been restricted by the scar. It is important to remember that scars cannot be completely removed.

What are the different types of scars and treatment?

There are many different types of scars, including the following:

  • keloid scars
    These are thick, rounded, irregular clusters of scar tissue that grow at the site of a wound on the skin, but beyond the edges of the borders of the wound. They often appear red or darker in color, as compared to the surrounding normal skin. Keloids are formed from collagen that the body produces after a wound has healed. These scars may appear anywhere on the body. They occur more often in darker-skinned people. Keloid scars may occur up to one year after the original trauma to the skin.

    Treatment for keloid scars varies. There is no one simple cure for keloid scars. Recurrence after treatment is common. Treatment may include the following:

    • steroid injections
      Steroids are injected directly into the scar tissue to help decrease the itching, redness, and burning sensations that these scars may produce. Sometimes, the injections help to actually decrease the size of the scar.
    • cryotherapy
      Cryotherapy involves the scar being "frozen" off by a medication.
    • pressure therapy
      Pressure therapy involves a type of pressure appliance worn over the area of the scar. These may be worn day and night for up to four to six months.
    • surgery
      If the keloid scar is not responsive to nonsurgical management options, surgery may be performed. One type of surgery directly removes the scar formation with an incision, and stitches are placed to help close the wound. Sometimes, skin grafts are used to help close the wound. This involves replacing or attaching skin to an area that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area.

      Another option is laser surgery. Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is done in conjunction with other treatments, including injections of steroids, use of special dressings, and the use of bandages. Multiple treatments may be required, regardless of the initial type of therapy.
  • hypertrophic scars
    Hypertrophic scars are similar to keloid scars; however, their growth is confined within the boundaries of the original skin defect. These scars may also appear red, and are usually thick and elevated. Hypertrophic scars usually start to develop within weeks after the injury to the skin. Hypertrophic scars may improve naturally, although this process may take up to a year or more.

    In treating hypertrophic scars, steroids may be the first line of therapy with this type of scar, although there is not one simple cure. Steroids may be given as an injection or by direct application. These scars may also be removed surgically. Often, steroid injections are used along with the surgery and may continue up to two years after the surgery to help maximize healing and decrease the chance of the scar returning.

  • contractures
    Contractures are an abnormal occurrence that happens when a large area of skin is damaged and lost, resulting in a scar. The scar formation pulls the edges of the skin together, causing a tight area of skin. The decrease in the size of the skin can then affect the muscles, joints, and tendons, causing a decrease in movement. There are many different surgical treatment options for contractures. Some of which may include the following:
    • skin graft or skin flap
      Skin grafts or skin flaps are done after the scar tissue is removed. Skin grafts involve replacing or attaching skin to a part of the body that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. Skin flaps are similar to skin grafts, where a part of the skin is taken from another area, but with the skin flaps, the skin that is retrieved has its own blood supply. The section of skin used includes the underlying blood vessels, fat, and muscles. Flaps may be used when that area that is missing the skin does not have a good supply of blood because of the location or because of damage to the vessels.
    • Z-plasty
      A Z-plasty is a type of procedure that is used to revise a scar by using a Z-shaped incision to help decrease the amount of contractures of the surrounding skin. It also may attempt to relocate the scar so that the edges of the scar look more like the normal lines and creases of the skin. Small stitches may be used to help hold the skin in place.
    • tissue expansion
      Tissue expansion is a newer technique being used, and involves a process that increases the amount of existing tissue available for reconstructive purposes. This procedure is often used in addition to the flap surgery.

Recovery from scar revision surgery:

As with all surgeries, it is important to follow all instructions to help maximize recovery and healing. Your physician will advise you on all activity restrictions, depending on the type of surgery that was performed. Scars cannot be removed completely. Many factors will be involved in the degree of healing of your particular scar, with some scars taking more than a year to show improvement in appearance following surgery.

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Online Resources of Plastic Surgery

Scars

What is a scar?

A scar is the body's natural way of healing and replacing lost or damaged skin. A scar is usually composed of fibrous tissue. Scars may be formed for many different reasons, including as a result of infections, surgery, injuries, or inflammation of tissue. Scars may appear anywhere on the body, and the composition of a scar may vary - appearing flat, lumpy, sunken, or colored. It may be painful or itchy. The final look of a scar depends of many factors, including the skin type and location on the body, the direction of the wound, the type of injury, age of the person with the scar, and his/her nutritional status.

How can a scar be minimized?

Specific dermatological procedures to minimize scars will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the scar
  • type of scar
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Scars usually fade over time. Make-up can help cover the scar while it is healing. Some scars can be minimized by certain dermatological techniques. However, treatment can only improve the appearance of a scar, but cannot completely erase it.

The following are some of the more common scar-minimizing procedures:

  • dermabrasion
    Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that "abrades" the skin. As the skin heals from the procedure, the surface appears smoother and fresher.
  • chemical peels
    Chemical peel are often used to minimize sun-damaged skin, irregular pigment, and superficial scars. The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving the skin's appearance.
  • collagen injections
    One type of collagen, which is derived from purified bovine (cow) collagen, is injected beneath the skin to replace the body's natural collagen that has been lost. Injectable collagen is generally used to treat wrinkles, scars, and facial lines.
  • cortisone-like injections
    These types of injections can help soften and then shrink hard scars.
  • cryosurgery
    Cryosurgery can help reduce the size of scars by freezing the top skin layers. The freezing causes the skin to blister.
  • laser resurfacing
    Laser resurfacing uses high-energy light to burn away damaged skin. Laser resurfacing may be used to minimize wrinkles and fine scars.
  • punch grafts
    Punch grafts are small skin grafts to replace scarred skin. A hole is punched in the skin to remove the scar, which is then replaced with unscarred skin (often from the back of the earlobe). Punch grafts can help treat deep acne scars.
  • surgical scar revision
    Surgical scar revision involves removing the entire scar surgically and rejoining the skin. Although a new scar will form, the goal of the surgical technique is to create a less obvious scar. Surgical scar revision is usually reserved for wide or long scars, scars that healed in an unusual way, or scars in very visible places.
  • autologous fat transfer
    An autologous fat transfer uses fat taken from another site on your own body and it is injected into your skin. The fat is placed beneath the surface of the skin to elevate depressed scars. This method is used to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat may be reabsorbed into the skin over a period of months, there may be a need for the procedure to be repeated.

What are the different types of scars and treatment?

Abnormal scars sometimes form after the wound has healed. There are many different types of scars, including the following:

  • keloid scars
    These are thick, rounded, irregular clusters of scar tissue that grow at the site of a wound on the skin, but beyond the edges of the borders of the wound. They often appear red or darker in color, as compared to the surrounding normal skin. Keloids are formed from collagen that the body produces after a wound has healed. These scars may appear anywhere on the body. They occur more often in darker-skinned people. Keloid scars may occur up to one year after the original trauma to the skin.

    Treatment for keloid scars varies. There is no one simple cure for keloid scars. Recurrence after treatment is common. Treatment may include the following:

    • steroid injections
      Steroids are injected directly into the scar tissue to help decrease the itching, redness, and burning sensations that these scars may produce. Sometimes, the injections help to actually decrease the size of the scar.
    • cryotherapy
      Cryotherapy involves the scar being "frozen" off by a medication.
    • pressure therapy
      Pressure therapy involves a type of pressure appliance worn over the area of the scar. These may be worn day and night for up to four to six months.
    • surgery
      If the keloid scar is not responsive to nonsurgical management options, surgery may be performed. One type of surgery directly removes the scar formation with an incision, and stitches are placed to help close the wound. Sometimes, skin grafts are used to help close the wound. This involves replacing or attaching skin to an area that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area.

      Another option is laser surgery. Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is done in conjunction with other treatments, including injections of steroids, use of special dressings, and the use of bandages. Multiple treatments may be required, regardless of the initial type of therapy.
  • hypertrophic scars
    Hypertrophic scars are similar to keloid scars; however, their growth is confined within the boundaries of the original skin defect. These scars may also appear red, and are usually thick and elevated. Hypertrophic scars usually start to develop within weeks after the injury to the skin. Hypertrophic scars may improve naturally, although this process may take up to a year or more.

    In treating hypertrophic scars, steroids may be the first line of therapy with this type of scar, although there is not one simple cure. Steroids may be given as an injection or by direct application. These scars may also be removed surgically. Often, steroid injections are used along with the surgery and may continue up to two years after the surgery to help maximize healing and decrease the chance of the scar returning.
  • contractures
    Contractures are an abnormal occurrence that happens when a large area of skin is damaged and lost, resulting in a scar. The scar formation pulls the edges of the skin together, causing a tight area of skin. The decrease in the size of the skin can then affect the muscles, joints, and tendons, causing a decrease in movement.

    There are many different surgical treatment options for contractures, including the following:
    • skin graft or skin flap
      Skin grafts or skin flaps are done after the scar tissue is removed. Skin grafts involve replacing or attaching skin to a part of the body that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. Skin flaps are similar to skin grafts, where a part of the skin is taken from another area, but with the skin flaps, the skin that is retrieved has its own blood supply. The section of skin used includes the underlying blood vessels, fat, and muscles. Flaps may be used when that area that is missing the skin does not have a good supply of blood because of the location or because of damage to the vessels.
    • Z-plasty
      A Z-plasty is a type of procedure that is used to revise a scar by using a Z-shaped incision to help decrease the amount of contractures of the surrounding skin. It also may attempt to relocate the scar so that the edges of the scar look more like the normal lines and creases of the skin. Small stitches may be used to help hold the skin in place.
    • tissue expansion
      Tissue expansion is a newer technique being used, and involves a process that increases the amount of existing tissue available for reconstructive purposes. This procedure is often used in addition to the flap surgery.
  • adhesions
    Another type of scarring, called adhesions, may form between unconnected internal organs. Adhesions may cause complications during certain surgeries.

Recovery from scar revision surgery:

As with all surgeries, it is important to follow all instructions to help maximize recovery and healing. Your physician will advise you on all activity restrictions, depending on the type of surgery that was performed. Scars cannot be removed completely. Many factors will be involved in the degree of healing of your particular scar, with some scars taking more than a year to show improvement in appearance following surgery.

Click here to view the
Online Resources of Dermatology

Shellfish Allergy Diet

General guidelines for shellfish allergy:

The key to an allergy-free diet is to avoid giving your child the foods or products containing the food to which he/she is allergic. The items that your child is allergic to are called allergens.

A shellfish allergy is an abnormal response of the body to the proteins found in shellfish. In order to avoid foods that contain shellfish, it is important to read food labels.

How to read a label for an shellfish-free diet:

Be sure to avoid foods that contain any of the following ingredients:

  • abalone
  • clam (cherrystone, littleneck, pismo, quahog)
  • crab
  • crawfish, crayfish, ecrevisse
  • lobster, langouste, langousine, scampo, coral, tomalley
  • mussels
  • oyster
  • scallops
  • mollusks
  • shrimp, prawns, crevette
  • cockle, periwinkle, sea urchin

Click here to view the
Online Resources of Allergy, Asthma, & Immunology

Signs of Problems in Speech, Language, and Hearing Development:

Children develop speech, language, and hearing skills at different ages. However, hearing loss can lead to delays in your child's ability to make sounds, learn to speak, and communicate. Consult your child's physician if you are concerned about your child's hearing or speech, or if you notice any of the following:

  • no response to sound at any age
  • infant does not move or jump when a loud sound is made
  • no babbling by the time the infant is 9 months old
  • no words spoken by the age of 18 to 24 months
  • does not follow simple commands by 2 years old
  • stuttering continues past 5 years old
  • poor voice quality at any age

Click here to view the
Online Resources of Ear, Nose, & Throat

Sinusitis

What are sinuses?

The sinuses are cavities, or air-filled pockets, that are near the nasal passage. There are four different types of sinuses:

  • ethmoid sinus - located inside the face, around the area of the bridge of the nose. This sinus is present at birth, and continues to grow.
  • maxillary sinus - located inside the face, around the area of the cheeks. This sinus is also present at birth, and continues to grow.
  • frontal sinus - located inside the face, in the area of the forehead. This sinus does not develop until around seven years of age.
  • sphenoid sinus - located deep in the face, behind the nose. This sinus does not develop until adolescence.

The inside of the sinuses is similar to the inside of the nose.

What is sinusitis?

Sinusitis is an infection of the sinuses near the nose. These infections usually occur after a cold or after an allergic inflammation. There are four types of sinusitis:

  • acute - symptoms of this type of infection last less than four weeks and get better with the appropriate treatment.
  • subacute - this type of infection does not get better with treatment initially, and symptoms last four to eight weeks.
  • chronic - this type of infection happens with repeated acute infections or with previous infections that were inadequately treated. These symptoms last eight weeks or longer.
  • recurrent - three or more episodes of acute sinusitis a year.

What causes sinusitis?

Sometimes, a sinus infection happens after an upper respiratory infection (URI) or common cold. The URI causes inflammation of the nasal passages that can lead to obstruction of the opening of the paranasal sinuses, which can lead to infection in the sinuses. Allergic disease can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus. There are other possible conditions that can block the normal flow of secretions out of the sinuses and can lead to sinusitis. These may include:

  • abnormalities in the structure of the nose
  • enlarged adenoids
  • diving and swimming
  • infections from a tooth
  • trauma to the nose
  • foreign objects that are stuck in the nose
  • gastroesophageal reflux disease (GERD)
  • secondhand smoke

After the blockage of the flow of secretions from the sinuses, bacteria will sometimes begin to grow. This leads to a sinus infection, or sinusitis. The most common bacteria that cause sinusitis are:

  • Streptococcus pneumonia
  • Haemophilus influenzae
  • Moraxella catarrhalis

What are the symptoms of sinusitis?

The symptoms of sinusitis vary for each person, and depend greatly on the age of the individual. The following are the most common symptoms of sinusitis. However, each individual may experience symptoms differently. Symptoms may include:

younger children:

  • runny nose that lasts longer than seven to 10 days. The discharge is usually thick green or yellow, but can also be clear.
  • nighttime cough
  • occasional daytime cough
  • swelling around the eyes
  • children usually do not complain of headaches if less than 5 years of age

older children and adults:

  • runny nose or cold symptoms that last longer than seven to 10 days
  • complaints of drip in the throat from the nose
  • headaches
  • facial discomfort
  • bad breath
  • cough
  • fever
  • sore throat
  • swelling around the eye, worse in the morning

The symptoms of sinusitis may resemble other conditions or medical problems. Always consult a physician for diagnosis.

How is sinusitis diagnosed?

Usually, your physician can diagnosis sinusitis based on your symptoms and physical examination. In some situations, additional tests may be performed to confirm the diagnosis. These may include:

  • cultures from the nose
  • x-rays - diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. (X-rays are not typically used, but may help assist in the diagnosis.)
  • sinus x-rays
  • computed tomography (CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • cultures from the sinus fluid
  • blood tests

Treatment for sinusitis:

Specific treatment for sinusitis will be determined by your physician based on:

  • your age, health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference
  • medications to treat GERD
  • surgery

Treatment of sinusitis may include the following:

  • acetaminophen for pain or discomfort
  • nasal drops

Decongestants and antihistamines do not seem to help the symptoms of sinusitis.

Antibiotics may be withheld for 10 to 14 days, unless severe symptoms develop, such as fever, facial pain or tenderness, or swelling around the eye. Surgery should be considered only if other treatments have failed.

Referral to an allergist/immunologist is often needed, particularly for people with chronic or recurrent sinusitis and for patients who have had sinus surgery, but who still experience sinusitis.

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Sinusitis

What are sinuses?

The sinuses are cavities, or air-filled pockets, near the nasal passage. Like the nasal passage, the sinuses are lined with mucous membranes. There are four different types of sinuses:

  • ethmoid sinus - located inside the face, around the area of the bridge of the nose. This sinus is present at birth, and continues to grow.
  • maxillary sinus - located inside the face, around the area of the cheeks. This sinus is also present at birth, and continues to grow.
  • frontal sinus - located inside the face, in the area of the forehead. This sinus does not develop until around 7 years of age.
  • sphenoid sinus - located deep in the face, behind the nose. This sinus does not develop until adolescence.

What is sinusitis?

Sinusitis is an infection of the sinuses near the nose. These infections usually occur after a cold or after an allergic inflammation. There are four types of sinusitis:

  • acute - symptoms of this type of infection last less than four weeks and get better with the appropriate treatment.
  • subacute - this type of infection does not get better with treatment initially, and symptoms last four to eight weeks.
  • chronic - this type of infection happens with repeated acute infections or with previous infections that were inadequately treated. These symptoms last eight weeks or longer.
  • recurrent - three or more episodes of acute sinusitis a year.

What causes sinusitis?

Sometimes, a sinus infection happens after an upper respiratory infection (URI) or common cold. The URI causes inflammation of the nasal passages that can block the opening of the paranasal sinuses, and result in a sinus infection. Allergies can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus. There are other possible conditions that can block the normal flow of secretions out of the sinuses and can lead to sinusitis including the following:

  • abnormalities in the structure of the nose
  • enlarged adenoids
  • diving and swimming
  • infections from a tooth
  • trauma to the nose
  • foreign objects stuck in the nose
  • cleft palate
  • gastroesophageal reflux disease (GERD)
  • secondhand smoke

When the flow of secretions from the sinuses is blocked, bacteria may begin to grow. This leads to a sinus infection, or sinusitis. The most common bacteria that cause sinusitis include the following:

  • Streptococcus pneumonia
  • Haemophilus influenzae
  • Moraxella catarrhalis

What are the symptoms of sinusitis?

The symptoms of sinusitis depend greatly on the age of the child. The following are the most common symptoms of sinusitis. However, each child may experience symptoms differently. Symptoms may include:

younger children:

  • runny nose
    • lasts longer than seven to 10 days
    • discharge is usually thick green or yellow, but can be clear
  • nighttime cough
  • occasional daytime cough
  • swelling around the eyes
  • usually no headaches younger than 5 years of age

older children and adults:

  • runny nose or cold symptoms lasting longer than seven to 10 days
  • drip in the throat from the nose
  • headaches*
  • facial discomfort
  • bad breath
  • cough
  • fever
  • sore throat
  • swelling around the eye, often worse in the morning

The symptoms of sinusitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

*One 2002 study has found that nine out of 10 physician-diagnosed or self-described sinus headaches are actually migraine-related. The researchers found that the participants described the classic symptoms of pain in the front of the face and pressure under the eyes. However, the participants lacked other symptoms of a true sinus infection, including yellow or green discharge and fever. In addition, not every migraine has telltale symptoms of nausea, vomiting, and sensitivity to light. Always consult your child's physician for a diagnosis.

How is sinusitis diagnosed?

Generally, your child's physician can diagnose sinusitis based on your child's symptoms and physical examination. In some cases additional tests may be performed to confirm the diagnosis. These may include:

  • sinus x-rays - diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. (X-rays are not typically used, but may help assist in the diagnosis.)
  • computed tomography (Also called CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • cultures from the sinuses - laboratory tests that involve the growing of bacteria or other microorganisms to aid in diagnosis.

Treatment for sinusitis:

Specific treatment for sinusitis will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the infection
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the infection
  • your opinion or preference

Treatment of sinusitis may include the following:

  • antibiotics, as determined by your child's physician (antibiotics are usually given for at least 14 days)
  • acetaminophen (for pain or discomfort)
  • a decongestant (i.e., pseudoephedrine [Sudafed®]) and/or mucus thinner (i.e., guaifenesin [Robitussin®])
  • cool humidifier in your child's room
  • nasal spray to reduce inflammation
  • medications to treat GERD
  • surgery to remove the adenoids
  • endoscopic sinus surgery

Antibiotics may be withheld for 10 to 14 days, unless severe symptoms develop, such as: fever, facial pain or tenderness, or swelling around the eye. Surgery should be considered only if other treatments have failed.

Referral to an allergist/immunologist is often needed, particularly for people with chronic or recurrent sinusitis and for patients who have had sinus surgery, but still experience sinusitis.

Antihistamines do not help the symptoms of sinusitis unless an allergy is involved.

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Skull Base Tumors

Skull base surgery refers to surgical techniques required to obtain access to the floor of the cranial cavity. Due to the complexity of this region, this type of surgery is one of the more challenging procedures for a neurosurgeon to perform. The neurosurgeon often works in conjunction with ear,nose, and throat or plastic surgeons when performing skull base surgery because of the close proximity of the face and neck to the skull base.

Anatomy of the skull base

The skull base is a complex irregular bone surface on which the brain rests. Contained within this region are major blood vessels that supply the brain with essential nutrients and important nerves with their exiting pathways. The floor of the skull is divided into three regions from front to back: the anterior, the middle, and the posterior compartments. The anterior compartment is the region above a person's eyes, the middle compartment is the region behind the eyes and centered around the pituitary gland, an organ required for proper hormonal function.

The posterior compartment contains the brainstem and the cerebellum. The brainstem is the connection between the brain and spinal cord, containing the origin of nerves involved in the control of breathing, blood pressure, eye movements, swallowing, etc. This connection occurs through the large hole, known as the foramen magnum, within the center of the posterior compartment. The cerebellum, lying behind the foramen magnum, is involved with coordination and balance. The roof of the skull base is composed of the brain itself and a thick sheet of tissue on which the brain rests, called the tentorium. Adding to the complexity of this region is the fact that each compartment of the skull base is at a different level. The anterior compartment is highest and the posterior compartment lowest, when a person is standing and looking forward.

Symptoms of skull base disorders

The presentation of patients with diseases of the skull base is highly variable because of the many important structures contained in this area. These symptoms occur due to compression on important nerves or by blocking the normal flow of fluid around the brain. Various symptoms are specified to the compartment involved.
  • Diseases of the anterior compartment may produce headache, sinus congestion, or vision changes.
  • Those of the middle compartment may produce derangements of endocrine function or vision changes
  • Those of the posterior compartment produce neck pain, dizziness, tinnitus, hearing loss, and difficulties with swallowing and talking.

Surgery for skull base disorders

  • The main indication for skull base surgery is the removal of various brain tumors which may occur within this area. The diversity of these tumors is vast, and they may arise from various sources including the brain, the lining of the brain, the bones making up the skull base, or metastases. Although these tumors have unique individual characteristics, they may present in a similar fashion due to involvement of similar nervous structures. They can be grouped according to the area of the skull base from which they arise:
  • Tumors occurring in the anterior compartment (also see the orbital tumors page) include meningiomas, estheisoneuroblastomas, orbital gliomas, and nasopharyngeal carcinomas.
  • Those occurring in the middle compartment include meningiomas, pituitary adenomas, craniopharyngiomas, and schwannomas.
  • Those of the posterior compartment include brainstem gliomas, acoustic neuromas, cerebellar astrocytomas, ependymomas, medulloblastomas, hemangioblastomas, epidermoid tumors, chordomas, chondrosarcomas, and metastases.

The occurrence of these tumors varies with the age of the patient, his or her medical history, and family history.

In addition to removing tumors, skull base surgery also provides access to various aneurysms occurring within this region. An aneurysm is an abnormal dilatations of a blood vessel. Vessels included at the skull base are the internal carotid, ophthalmic, basilar arteries and the cavernous venous sinus.

Due to the complexity of skull base surgery, these procedures are best performed at a tertiary care facility where there is adequate ancillary services available to the neurosurgeon in the management of these patients. Both operative and post-operative care requires expertise not only in the area of neurosurgery but also in the areas of neurophysiology, neurology, neurological oncology, radiation oncology, and intensive care nursing. Phrases used to describe skull base surgery designate the approach the neurosurgeon uses and include midline, paramedian, and extreme far lateral suboccipital, presigmoid, subfrontal, and Dolenc.

Diseases of the skull base were at one time linked to a poor prognosis. Advances in microsurgical techniques, an increased understanding of both the skull base anatomy and behavior of these disease processes, and improvements in neuroimaging have allowed such lesions to be successfully treated.

Sleep Apnea

What is sleep apnea?

Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood. Sleep apnea occurs in all age groups and both genders. It is more common in men, although it may be under-diagnosed in women and young African-Americans. It is estimated that as many as 18 million Americans have sleep apnea.

Early recognition and treatment of sleep apnea is important, as it may be associated with:

  • irregular heartbeat
  • high blood pressure
  • heart attack
  • stroke

What are the different types of sleep apnea?

Sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. There are two types of sleep apnea:

  • central - occurs when the brain fails to send the appropriate signals to the muscles to initiate breathing. Central sleep apnea is less common than obstructive sleep apnea.
  • obstructive - occurs when air cannot flow into or out of the person's nose or mouth although efforts to breathe continue.

Who is affected by sleep apnea?

Sleep apnea seems to run in some families, suggesting a possible genetic basis. People most likely to have or develop sleep apnea include those who:

  • snore loudly.
  • are overweight.
  • have high blood pressure.
  • have some physical abnormality in the nose, throat, or other parts of the upper airway.

Use of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.

What are the characteristics of sleep apnea?

Sleep apnea is characterized by a number of involuntary breathing pauses or "apneic events" during a single night's sleep - may be as many as 20 to 30 or more events per hour. These events are almost always accompanied by snoring between apnea episodes (although not everyone who snores has sleep apnea). Sleep apnea may also be characterized by choking sensations. The frequent interruptions of deep, restorative sleep often lead to early morning headaches and excessive daytime sleepiness.

During the apneic event, the person is unable to breathe in oxygen and to exhale carbon dioxide, resulting in low levels of oxygen and increased levels of carbon dioxide in the blood. The reduction in oxygen and increase in carbon dioxide alert the brain to resume breathing and cause an arousal. With each arousal, a signal is sent from the brain to the upper airway muscles to open the airway; breathing is resumed, often with a loud snort or gasp. Frequent arousals, although necessary for breathing to restart, prevent a person from getting enough restorative, deep sleep.

What are the causes of sleep apnea?

Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. Apnea occurs:

  • when the throat muscles and tongue relax during sleep and partially block the opening of the airway.
  • when the muscles of the soft palate at the base of the tongue and the uvula relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether.
  • in obese people when an excess amount of tissue in the airway causes it to be narrowed.
  • with a narrowed airway, the person continues his/her efforts to breathe, but air cannot easily flow into or out of the nose or mouth.

How is sleep apnea diagnosed?

Diagnosis of sleep apnea is not simple because there can be many different causes. Primary care physicians, pulmonologists, neurologists, or other physicians with specialty training in sleep disorders may be involved in making a definitive diagnosis and initiating treatment. Several tests are available for evaluating a person for sleep apnea, including:

  • polysomnography - a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels.
  • Multiple Sleep Latency Test (MSLT) - a test that measures the speed of falling asleep. People without sleep problems usually take an average of 10 to 20 minutes to fall asleep. Individuals who fall asleep in less than 5 minutes are likely to require some type of treatment for sleep disorders.

Diagnostic tests usually are performed in a sleep center, but new technology may allow some sleep studies to be conducted in the patient's home.

How is sleep apnea treated?

Specific treatment will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Medications are generally not effective in the treatment of sleep apnea. Therapy for sleep apnea is specifically designed for each individual patient, and may include the following:

  • Oxygen administration may safely benefit certain patients, but does not eliminate sleep apnea or prevent daytime sleepiness. Its role in the treatment of sleep apnea is controversial.
  • Behavioral changes are an important part of a treatment program, and in mild cases of sleep apnea, behavioral therapy may be all that is needed. The patient may be advised to:
    • avoid the use of alcohol.
    • avoid the use of tobacco.
    • avoid the use of sleeping pills.
    • lose weight if overweight (even a 10 percent weight loss can reduce the number of apneic events for most patients).
    • use pillows and other devices to help sleep in a side position.
  • Physical or Mechanical Therapy
    Nasal continuous positive airway pressure (CPAP) is a procedure in which the patient wears a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages.

    Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild sleep apnea, or who snore but do not have apnea.
  • Surgery
    Some patients with sleep apnea may need surgery. Examples of these procedures include:
    • Common surgical procedures to remove of adenoids and tonsils, nasal polyps or other growths or tissue in the airway, and correction of structural deformities.
    • Uvulopalatopharyngoplasty (UPPP) - a procedure used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate).
    • Surgical reconstruction for deformities of the lower jaw may benefit some patients.
    • Surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.

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Overview of Sleep Problems

Why is sleep important?

Sleep is not just resting or taking a break from busy routines - it is essential to physical and emotional health. Adequate sleep may also play a role in helping the body recover from illness and injury. Inadequate sleep over a period of time is associated with obesity, diabetes, heart disease, and depression.

But, the emotional and mental benefits of sleep are also significant. Even occasional sleeping problems can make daily life feel more stressful and less productive. And, some people with chronic insomnia are more likely to develop psychiatric problems. In a recent survey, those who said they had trouble getting enough sleep reported impaired ability to perform tasks involving:

  • memory
  • learning
  • logical reasoning
  • mathematical calculation

Facts about sleep disorders:

Loss of sleep is believed to contribute to strained relationships at home, and unfulfilled potential on the job, and can also be dangerous, leading to serious or even fatal accidents. Consider these facts from the National Sleep Foundation, the National Commission of Sleep Disorders Research, and the National Transportation Safety Board:

  • Sleep problems increase with aging.
  • Health care expenses and lost productivity from sleep deprivation cost approximately 100 billion dollars a year.
  • Drowsy drivers take the blame for at least 100,000 police-reported crashes in the US annually.
  • Approximately 50 million to 70 million Americans suffer debilitating sleep disorders; the majority of them are undiagnosed.

How much sleep is needed?

Although sleep needs vary from person to person, generally, most healthy adults need no more than of 7 to 9 hours of sleep a night. If you have some of the following problems, you may need more sleep, or a better quality of sleep, than you are getting:

  • trouble staying alert during boring or monotonous activities
  • tendency to be unreasonably irritable with co-workers, family, or friends
  • difficulty concentrating or remembering facts

What are the different types of sleep problems?

There are many types of sleep problems. Disorders of sleeping and waking interfere with quality of life and personal health, and endanger public heath. These problems range from staying awake or staying with a regular sleep/wake cycle, sleepwalking, bedwetting, nightmares, insomnia, restless legs syndrome, snoring, and sleep apnea syndrome.

Help for sleep problems:

For those who suffer from sleep disorders, help is available from many sources.

Sleep problems may be caused by or the result of disorders in various systems of the body. Sleep apnea, for example, is a respiratory disorder while narcolepsy is a neurological disorder.

Sleep problems can be treated or managed by different medical specialties. For example, pulmonary medicine will offer help to people who suffer from sleep apnea, and neurology will provide treatment for narcolepsy.

However, other medical specialties also offer treatment for sleep disorders. Many rehabilitation facilities and anesthesiology departments sponsor comprehensive sleep disorder programs, as do mental health centers. The American Board of Sleep Medicine establishes standards and certification for physicians and scientists who wish to become certified in sleep medicine.

Talk with your physician about which sleep disorder program is right for you.

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Smell and Taste Disorders (Chemosensory Disorders)

The Senses of Smell and Taste

The senses of smell and taste are chemosenses and belong in the chemical sensing system.

The processes of smelling and tasting are complex. They begin when molecules are released by substances that stimulate the sensory cells in the nose, mouth, or throat.

Olfactory nerve cells are stimulated by odors. They are found in tissue located high inside the nose, and connect directly to the brain.

Gustatory nerve cells are stimulated by the taste of food and beverage. They are located in the taste buds of the mouth and throat.

These sensory cells transmit messages to the brain through the nerves, where specific tastes and smells are identified.

Another chemosensory process, called common chemical sense, also contributes to smell and taste. These cells alert the brain to sensations such as heat (as from peppers) or cool (as from menthol).

How do taste and smell interact?

The four basic taste sensations are sweet, sour, bitter, and salty.

When these tastes, along with texture, temperature, and information from the common chemical sense, combine with odors, the perception of flavor occurs. Flavor defines the food that is eaten, and is recognized mainly through the sense of smell.

Source: National Institute on Deafness and Other Communication Disorders

What are smell and taste disorders?

The loss of the senses of smell (anosmia) and taste (ageusia) are the most common chemosensory disorders.

The reduced ability to smell (hyposmia) or to taste sweet, sour, bitter or salty substances (hypogeusia) are also common.

In other disorders of the chemosenses, odors, tastes, or flavors may be misread or distorted, causing a person to detect an unpleasant odor or taste from something that is normally pleasant to taste or smell.

Smell disorders are serious because they damage the early warning system that can alert a person to such things as:

  • fire
  • poisonous fumes
  • leaking gas
  • spoiled food and beverages

Abnormalities in taste and smell can accompany or indicate the existence of diseases or conditions such as:

  • obesity
  • diabetes
  • hypertension
  • malnutrition
  • degenerative diseases of the nervous system such as:
    • Parkinson's disease
    • Alzheimer's disease

What causes smell and taste disorders?

Although some people are born with chemosensory disorders, most are caused by:

  • illness (i.e., upper respiratory infection, sinus infection)
  • injury to the head
  • hormonal disturbances
  • dental problems
  • exposure to certain chemicals
  • certain medications
  • exposure to radiation therapy for head or neck cancer

How are smell and taste disorders diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures may include:

  • measuring the lowest concentration of a chemical that a person can recognize
  • comparing tastes and smells of different chemicals
  • "scratch and sniff" tests
  • "sip, spit, and rinse" tests where chemicals are directly applied to specific areas of the tongue

Treatment for smell and taste disorders:

Specific treatment for smell and taste disorders will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disorder
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disorder
  • your opinion or preference

Treatment may include:

  • stopping or changing medications that contribute to the disorder
  • correction of the medical problem that is causing the disorder
  • surgical removal of obstructions that may be causing the disorder
  • counseling

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Snoring

What is snoring?

Snoring is the sound that occurs during sleep when flow of air is obstructed in the area where the tongue and upper throat meet the soft palate and uvula. Snoring noises occur when these structures vibrate against each other during breathing.

It is estimated that 45 percent of all adults snore occasionally, and 25 percent habitually snore. Snoring is more common in males and people who are overweight.

Snoring is obstructed breathing. In addition to disturbed sleep patterns and sleep deprivation, other serious health problems may result. Snoring may also be a symptom of other medical conditions.

What causes snoring?

Snoring may be caused by many factors, including:

  • poor muscle tone
  • excessively bulky throat tissue
  • long soft palate
  • long uvula
  • stuffed or blocked nasal passages
  • deformities of the nose
  • deformities of the nasal septum

Can snoring be prevented?

Mild or occasional snoring may be helped by:

  • a healthy lifestyle that includes exercise and proper diet
  • losing weight
  • avoiding tranquilizers, sleeping pills, and antihistamines before bedtime
  • avoiding alcohol at least four hours before bedtime
  • avoiding heavy meals at least three hours before bedtime
  • establishing regular sleeping patterns
  • sleeping on your side
  • tilting the head of the bed up about 4 inches

Heavy or chronic snoring may require medical care.

Treatment for snoring:

Specific treatment for snoring will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disorder
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disorder
  • your opinion or preference

Treatment may include a nasal mask that provides continuous positive airway pressure (CPAP), or surgery.

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Spasmodic Dysphonia

Voice and Speech

Speech is a complex process that starts with muscle movement, which involves phonation (voice); respiration (breathing process); and articulation (throat, palate, tongue, lips, and teeth).

These muscle movements are initiated, coordinated, and controlled by the brain, and monitored through hearing and touch.

Voice production, or phonation, is generating and modulating sound as part of the speech process.

Voice is created in the vocal cords (or vocal folds) of the larynx.

The larynx, often referred to as the voice box, is a two-inch long tube-shaped organ located in the neck at the top of the trachea (windpipe). The cartilage in front of the larynx is sometimes called the "Adam's apple."

The vocal cords (or vocal folds) are two bands of muscle that form a "V" shape inside the larynx.

The area of the larynx where the vocal cords are located is called the glottis. The area above the cords is called the supraglottis, and the area below the cords is called the subglottis. The epiglottis is a flap at the top of the trachea that closes over the larynx to protect it from food that is swallowed into the esophagus.

Breath enters the body through the nose or mouth, and then travels to the larynx, trachea, and into the lungs. It exits along the same path. Normally, no sound is made by the vocal cords during breathing or exhaling.

When a person talks, the vocal cords tighten, move closer together, and air from the lungs is forced between them. This makes them vibrate and produces sound.

Source: National Institute on Deafness and Other Communication Disorders

What is spasmodic dysphonia?

Spasmodic dysphonia, also called laryngeal dystonia, is a voice disorder. It is characterized by involuntary spasms or movements in the muscles of the larynx, which causes the voice to break, and have a tight, strained, or strangled sound.

Difficulties that result from spasmodic dysphonia range from occasional problems with saying a word or two to complete inability to communicate.

Spasmodic dysphonia most often affects women, particularly between the ages of 30 and 50.

What are the different types of spasmodic dysphonia?

There are three types of spasmodic dysphonia:

  • adductor spasmodic dysphonia
    Characterized by sudden involuntary spasms that cause the vocal cords to slam together and stiffen. The spasms interfere with vibration of the vocal cords and production of sound is difficult. Stress can make spasms more severe.

    Speech sounds are strained and full of effort. Spasms do not occur when whispering, laughing, singing, speaking at a high pitch, or speaking while breathing in.
  • abductor spasmodic dysphonia
    Characterized by sudden involuntary spasms that cause the vocal cords to open. Vibration cannot occur when cords are open so production of sound is difficult. Also, the open position allows air to escape during speech.

    Speech sounds are weak, quiet, and whispery. Spasms do not occur when laughing or singing.
  • mixed spasmodic dysphonia
    Characterized by symptoms of both adductor and abductor spasmodic dysphonia.

What causes spasmodic dysphonia?

The exact cause of spasmodic dysphonia is not known. Most cases are believed to be caused by a nervous system disorder, and may occur with other movement disorders. Spasmodic dysphonia may be a genetic disorder, or may begin following an upper respiratory infection, injury to the larynx, a long period of voice use, or stress.

How is spasmodic dysphonia diagnosed?

In addition to a complete medical history and physical examination, examination of the vocal folds by fiberoptic nasolaryngoscopy may be performed. This procedure involves using a lighted tube, passed though the nose into the larynx to evaluate movement of the vocal folds during speech.

Treatment for spasmodic dysphonia:

Specific treatment for spasmodic dysphonia will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

The goal of treatment is to reduce symptoms of the disorder. Surgery to cut one of the nerves of the vocal fold has been used, as well as counseling. Some success has been achieved with the injection of the botulinum toxin directly into the affected muscles of the larynx. Speech therapy is also an important part of treatment of spasmodic dysphonia.

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Stridor

What is stridor?

Stridor is a high-pitched sound that is usually heard best when a child breaths in (inspiration). It is usually caused by an obstruction or narrowing in your child's upper airway. The upper airway consists of the following structures in the upper respiratory system:

  • nose
  • nasal cavity
  • sinuses - cavities, or air-filled pockets, that are near the nasal passage.
    • ethmoid sinus - located inside the face, around the area of the bridge of the nose. This sinus is present at birth, and continues to grow.
    • maxillary sinus - located inside the face, around the area of the cheeks. This sinus is also present at birth, and continues to grow.
    • frontal sinus - located inside the face, in the area of the forehead. This sinus does not develop until around seven years of age.
    • sphenoid sinus - located deep in the face, behind the nose. This sinus does not develop until adolescence.
  • larynx - also known as the voice box, the larynx is a cylindrical grouping of cartilage, muscles, and soft tissue which contains the vocal cords. The vocal cords are the upper opening into the windpipe (trachea), the passageway to the lungs.
  • trachea (windpipe) - a tube that reaches from the voice box to the bronchi in the lungs.

The sound of stridor depends on location of the obstruction in the upper respiratory tract. Usually, the stridor is heard when the child breathes in (inspiration), but can also be heard when the child breathes out (expiration).

What are the causes of stridor?

There are many different causes of stridor. Some of the causes are diseases, while others are problems with the anatomical structure of the child's airway. The upper airway in children is shorter and narrower than that of an adult, and, therefore, more likely to lead to problems with obstruction. The following are some of the more common causes of stridor in children:

  • Congenital causes (problems present at birth):
    • laryngomalacia
      Parts of the larynx are floppy and collapse causing partial airway obstruction. The child will usually outgrow this condition by the time he/she is 18 months old. This is the most common congenital cause of stridor. Very rarely children may need surgery.
    • subglottic stenosis
      The larynx (voice box) may become too narrow below the vocal cords. Children with subglottic stenosis are usually not diagnosed at birth, but, more often, a few months after, particularly if the child's airway becomes stressed by a cold or other virus. The child may eventually outgrow this problem without intervention. Most children will need a surgical procedure if the obstruction is severe.
    • subglottic hemangioma
      A type of mass that consists mostly of blood vessels. Subglottic hemangioma grows quickly in the child's first few months of life. The child will usually show signs around the age of three to six months. Some children may outgrow this problem, as the hemangioma will begin to get smaller after the first year of life. Most children will need surgery if the obstruction is severe. This condition is very rare.
    • vascular rings
      The trachea, or windpipe, may be compressed by another structure (an artery or vein) around the outside. Surgery may be required to alleviate this condition.
  • Infectious causes:
    • croup
      Croup is an infection caused by a virus that leads to swelling in the airways and causes breathing problems. Croup is caused by a variety of different viruses, most commonly the parainfluenza virus.
    • epiglottitis
      Epiglottitis is an acute life-threatening bacterial infection that results in swelling and inflammation of the epiglottis. (The epiglottis is an elastic cartilage structure at the root of the tongue that prevents food from entering the windpipe when swallowing.) This causes breathing problems that can progressively worsen which may, ultimately, lead to airway obstruction. There is so much swelling that air cannot get in or out of the lungs, resulting in a medical emergency. Epiglottitis is usually caused by the bacteria Haemophilus influenzae, and now is rare because infants are routinely vaccinated against this bacteria. The vaccine is recommended for all infants.
    • bronchitis
      Bronchitis is an inflammation of the breathing tubes (airways), called bronchi, which causes increased production of mucus and other changes. Acute bronchitis is usually caused by infectious agents such as bacteria or viruses. It may also be caused by physical or chemical agents - dusts, allergens, strong fumes - and those from chemical cleaning compounds, or tobacco smoke.
    • severe tonsillitis
      The tonsils are small, round pieces of tissue that are located in the back of the mouth on the side of the throat. Tonsils are thought to help fight infections by producing antibodies. The tonsils can usually be seen in the throat of your child by using a light. Tonsillitis is defined as inflammation of the tonsils from infection.
    • abscess in the back of the throat (retropharyngeal abscess)
      An abscess in the throat is a collection of pus surrounded by inflamed tissue. If the abscess is large enough, it may narrow the airway to a critically small opening.
  • Traumatic causes:
    • Foreign bodies in the ear, nose, and breathing tract may cause symptoms to occur. Foreign bodies are any objects placed in the ear, nose, or mouth that do not belong there. For example, a coin in the trachea (windpipe) may close off breathing passages and result in suffocation and death.
    • fractures in the neck
    • swallowing a harmful substance which may cause damage to the airways

How is stridor diagnosed?

Stridor is usually diagnosed solely on the medical history and physical examination of your child. It is important to remember that stridor is a symptom of some underlying problem or condition. If your child has stridor, your child's physician may order some of the following tests to help determine the cause of the stridor:

  • chest and neck x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • bronchoscopy - congenital, chronic, or severe stridor may require direct visualization of the airways with a flexible fiberoptic bronchoscope. This procedure is under sedation and local anesthesia, and may be performed on an outpatient, as well as an inpatient basis.
  • pulse oximetry - an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.
  • sputum culture - a diagnostic test performed on the material that is coughed up from the lungs and into the mouth. A sputum culture is often performed to determine if an infection is present.

Treatment of stridor:

Specific treatment of stridor will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • cause of the condition
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include:

  • referral to an ear, nose, and throat specialist (otolaryngologist) for further evaluation (if your child has a history of stridor)
  • surgery
  • medications by mouth or injection (to help decrease the swelling in the airways)

Hospitalization and emergency surgery may be necessary depending on the severity of the stridor.

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Stuttering

Voice and Speech

Speech is a complex process that starts with muscle movement,which involves phonation (voice); respiration (breathing process); and articulation (throat, palate, tongue, lips, and teeth).

These muscle movements are initiated, coordinated, and controlled by the brain, and monitored through hearing and touch.

Voice production, or phonation, is generating and modulating sound as part of the speech process.

Voice is created in the vocal cords (or vocal folds) of the larynx.

The larynx, often referred to as the voice box, is a two-inch long tube-shaped organ located in the neck at the top of the trachea (windpipe). The cartilage in front of the larynx is sometimes called the "Adam's apple."

The vocal cords (or vocal folds) are two bands of muscle that form a "V" shape inside the larynx.

The area of the larynx where the vocal cords are located is called the glottis. The area above the cords is called the supraglottis, and the area below the cords is called the subglottis. The epiglottis is a flap at the top of the trachea that closes over the larynx to protect it from food that is swallowed into the esophagus.

Breath enters the body through the nose or mouth, and then travels to the larynx, trachea, and into the lungs. It exits along the same path. Normally, no sound is made by the vocal cords during breathing or exhaling.

When a person talks, the vocal cords tighten, move closer together, and air from the lungs is forced between them. This makes them vibrate and produces sound.

Source: National Institute on Deafness and Other Communication Disorders

What is stuttering?

Stuttering, sometimes referred to as stammering or diffluent speech, is a speech disorder. As a person who stutters tries to speak, he/she may exhibit these characteristics:

  • frequent repetitions (prolongations) of speech sounds, syllables, or words
  • rapid blinking of the eyes
  • tremors in the lips or jaw
  • other struggling behaviors

Stuttering affects more than 3 million people in the United States. Although it most frequently occurs in children between the ages of 2 and 6, it can affect all age groups. It occurs three times more often in males than females.

What causes stuttering?

The exact mechanical causes of stuttering are not completely understood, but it is thought to be a hereditary condition.

What are the different types of stuttering?

There are several types of stuttering, including:

  • developmental
    This is the most common type of stuttering, which occurs in children. As their speech and language processes are developing, they may not be able to meet verbal demands.
  • neurogenic
    Neurogenic stuttering is also a common disorder that occurs from signal problems between the brain and nerves and muscles.
  • psychogenic
    Psychogenic stuttering is believed to originate in the area of the brain that directs thought and reasoning. This type of stuttering may occur in people with mental illness or who have experienced mental stress or anguish. However, although stuttering may cause emotional problems, it is not believed to the result of emotional problems.

How is stuttering diagnosed?

In addition to a complete medical history and physical examination, diagnosis of stuttering may also include:

  • detailed history of the development of the disorder
  • evaluation of speech and language abilities by a speech-language pathologist

Treatment for stuttering:

Specific treatment for stuttering will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disorder

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disorder

  • your opinion or preference

The goal of treatment is to focus on relearning how to speak, or to unlearn incorrect ways of speaking. Although there is no cure for stuttering, early intervention may keep stuttering from becoming a life-long problem. Speech and language evaluation is suggested for children who exhibit stuttering or struggle behaviors associated with speech for more than six months.

Medications and electronic devices to treat stuttering are sometimes used.

Parents of children who stutter may be encouraged to:
  • provide an atmosphere in the home that is relaxed and allows ample opportunity for the child to speak.
  • listen attentively to the child.
  • wait for the child to say the words without saying them for him/her.
  • speak slowly and in a relaxed manner, which may encourage the child to speak the same way.
  • talk openly about the stuttering if the child brings up the subject.
  • avoid criticizing, punishing, or asking the child to repeat words correctly.
  • avoid asking the child to speak for others.

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Thyroglossal Duct Cyst

What is a thyroglossal duct cyst?

A thyroglossal duct cyst is a neck mass or lump that develops from cells and tissues remaining after the formation of the thyroid gland during embryonic development. It is most commonly diagnosed in preschool-aged children or during mid-adolescence, and often appears after an upper respiratory infection when it enlarges and becomes painful.

What causes a thyroglossal duct cyst?

A thyroglossal duct cyst is a congenital (present from birth) defect. When the thyroid gland forms during embryonic development, it begins at the base of the tongue and moves down the neck through a canal called the thyroglossal duct. This duct normally disappears once the thyroid reaches its final position in the neck. Sometimes, portions of the duct remain leaving cavities or pockets called cysts. These cysts can fill with fluid or mucus, and may enlarge if they become infected. Very enlarged cysts can cause difficulty swallowing or obstruct breathing passages.

What are the symptoms of a thyroglossal duct cyst?

The following are the most common symptoms of a thyroglossal duct cyst. However, each child may experience symptoms differently. Symptoms may include:

  • a small, soft, round mass in the center front of the neck
  • tenderness, redness, and swelling of the mass, if infected
  • a small opening in the skin near the mass, with drainage of mucus from the cyst
  • difficulty swallowing or breathing

The symptoms of a thyroglossal duct cyst may resemble other neck masses or medical problems. Always consult your child's physician for a diagnosis.

How is a thyroglossal duct cyst diagnosed?

Generally, diagnosis is made by physical examination. The mass typically moves upward when the tongue is extended and with swallowing since the thyroglossal duct often connects at the base of the tongue. It is important to determine if the thyroglossal duct cyst contains thyroid tissues. In addition to a complete medical history and physical examination, diagnostic procedures for a thyroglossal duct cyst may include the following:

  • blood tests (to assess thyroid function)
  • ultrasound examination - to evaluate the muscle around the mass; a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
  • thyroid scans - a procedure that uses radioactive iodine or technetium (a radioactive metallic element) to reveal any physical abnormalities of the thyroid.

Treatment of a thyroglossal duct cyst:

Specific treatment of a thyroglossal duct cyst will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the condition
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include:

  • antibiotic medication (to treat the infection)
  • surgical removal of the cyst and the thyroglossal duct, called the Sistrunk procedure

A thyroglossal duct cyst has a small chance of regrowing if small portions of the tissues remain after surgery. Infection of the cyst prior to surgery can make the removal more difficult and increase the chance for regrowth. Always consult your child's physician for more information.

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Tinnitus

What is tinnitus?

Tinnitus is the sound of ringing, roaring, buzzing, or clicking that occurs inside the head. The sounds may come and go, be continuous, occur in one or both ears, and vary in pitch. Currently, more than 12 million people in the US suffer from some degree of tinnitus. Of these individuals, at least 1 million experience it so severely that it interferes with their daily activities, according to the National Institute on Deafness and Other Communications Disorders.

What causes tinnitus?

Tinnitus may result from a variety of causes, including:

  • damage to the nerve endings in the inner ear
  • stiffening of bones in the middle ear
  • advancing age
  • exposure to loud noises
  • allergy
  • high or low blood pressure
  • tumor
  • diabetes
  • thyroid problems
  • head or neck injury
  • reaction to certain medications

Treatment for tinnitus:

Specific treatment for tinnitus will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Currently, there is no known cure for tinnitus. However, experts suggest trying one of the following to find relief:

  • hearing aids - may benefit some people with tinnitus who have hearing loss. Using a hearing aid may help some people with tinnitus by making some sounds louder.
  • maskers - provide help for some individuals by making tinnitus less noticable. This small electronic device creates sound that may make the ringing or roaring seem softer.
  • medications - may ease tinnitus by addressing a problem related to the condition.
  • tinnitus retraining therapy - uses a combination of counseling and maskers. Otolaryngologists and audiologists can help a person learn how to deal with the tinnitus.
  • counseling - offers a person with tinnitus the opportunity to meet with a counselor or support group.
  • relaxing - provides relief for some people as stress may make tinnitus worse.

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Tonsillectomy and Adenoidectomy

What are the tonsils?

The tonsils are small, round pieces of tissue that are located in the back of the mouth on the side of the throat. Tonsils are thought to help fight infections by producing antibodies. The tonsils can usually be seen in the throat of your child by using a light.

Tonsillitis occurs when the tonsils become inflamed from infection.

What are adenoids?

Adenoids are similar to the tonsils. The adenoids are made up of lymph tissue and are located in the space above the soft roof of the mouth (nasopharynx) and cannot be seen by looking in your child's nose or throat. Adenoids also help to fight infections. Adenoids may cause problems if they become enlarged or infected.

Adenoiditis is when the adenoids become inflamed from infection.

What are the symptoms of tonsillitis?

The symptoms of tonsillitis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. The following are the most common symptoms of tonsillitis. However, each child may experience symptoms differently. Symptoms may include:

  • sore throat
  • fever (either low-grade or high-grade)
  • headache
  • decrease in appetite
  • not feeling well
  • nausea and vomiting
  • stomach aches
  • painful swallowing
  • visual redness or drainage in the throat

The symptoms of tonsillitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

What are the symptoms of adenoiditis, or enlarged adenoids?

The symptoms of adenoiditis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. The following are the most common symptoms of adenoiditis. However, each child may experience symptoms differently. Symptoms may include:

  • breathing through the mouth
  • noisy breathing
  • snoring
  • nasal speech
  • periods at night when breathing stops for a few seconds

The symptoms of adenoiditis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

Treatment for tonsillitis and adenoiditis:

Specific treatment for tonsillitis and adenoiditis will be determined by your child's physician based on:

  • your child's age, overall health, and medical history
  • extent of the infection
  • type of infection
  • your child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the infection
  • your opinion or preference

Your child's physician will decide the best treatment for your child. Treatment depends on the cause of the infection, the severity of the infection, and the number of times the child has developed infections. Your child's physician may order antibiotics to help with the infection.

Some children may be referred to an ear, nose, and throat surgeon to have the tonsils and adenoids removed. This surgery is called a tonsillectomy and adenoidectomy (T&A). Often, the tonsils and adenoids are removed at the same time, but, sometimes, only one is removed. Your child's physician will discuss this with you.

What are the reasons to have a tonsillectomy and adenoidectomy (T&A)?

The reasons for this surgery are not well defined, and many surgeons differ in their views. The following are some of the more widely accepted reasons for having a T&A:

  • sleep apnea, or periods at night when your child stops breathing
  • trouble swallowing
  • tumor in the throat or nasal passage
  • bleeding from the tonsils that cannot be stopped
  • significant blockage of the nasal passage and uncomfortable breathing

The following are T&A Guidelines from the American Academy of Otolaryngology:

  • seven sore throats in one year
  • five sore throats in each of two years
  • three sore throats in each of three years

The sore throats may be associated with the following:

  • fever above 101º F
  • discharge on the tonsils
  • positive strep throat culture

The following are additional reasons that are more controversial regarding the removal of the adenoids and tonsils:

  • bad snoring
  • recurrent infections or abscesses in the throat
  • recurrent ear infections
  • hearing loss
  • chronic sinusitis, or infection in the sinuses
  • constant mouth breathing
  • frequent colds
  • cough
  • bad breath

The following are some situations that DO NOT require removal of the tonsils, although each child will be evaluated on an individual basis:

  • large tonsils
    Some children have large tonsils. The tonsils will decrease in size after the ages of 8 to 12 years. This, in itself, is not a reason to remove the tonsils, in most cases.
  • school absence
    If your child seems to miss a lot of school due to different symptoms, such as a sore throat, removing the tonsils will not increase school attendance.
  • poor appetite, allergies, or seizures
    A T&A will not help any of these problems.

What happens during tonsillectomy and adenoidectomy?

The need for tonsillectomy and adenoidectomy (T&A) surgery will be determined by your child's ear, nose, and throat surgeon and discussed with you. Most T & A surgeries are done on an outpatient basis. This means that your child will have surgery and then go home the same day. Some children may be required to stay overnight, such as, but not limited to, children who:

  • are not drinking well after surgery.
  • have other chronic diseases or problems with seizures.
  • have complications after surgery, such as bleeding.
  • are younger than 3 years of age.

Before the surgery, you will meet with different members of the healthcare team who are going to be involved with your child's care. These may include:

  • day surgery nurses - nurses who prepares your child for surgery. Operating room nurses assist the physicians during surgery. Recovery room (also called the Post Anesthesia Care Unit) nurses care for your child as he/she emerges from general anesthesia.
  • surgeon - a physician who specializes in surgery of the ear, nose, and throat.
  • anesthesiologist - a physician with specialized training in anesthesia. He/she will complete a medical history and physical examination and formulate a plan of anesthesia for your child. The plan will be discussed with you and your questions will be answered. This surgery requires a general anesthesia.

During the surgery, your child will be anesthetized in the operating room. The surgeon will remove your child's tonsils and adenoids through the mouth. There will be no cut on the skin.

In most cases, after the surgery your child will go to a recovery room where he/she can be monitored closely. After the child is fully awake and doing well, the recovery room nurse will bring the child back to the day surgery area.

At this point, if everything is going well, you and your child will be able to go home. If your child is going to stay the night in the hospital, the child will be brought from the recovery room to his/her room. Usually, the parents are in the room to meet the child.

Bleeding is a complication of this surgery and should be addressed immediately by the surgeon. If the bleeding is severe, the child may return to the operating room.

At home after a T&A:

The following are some of the instructions that may be given to you to help care for your child:

  • increased fluid intake
  • pain medication, as prescribed
  • no heavy or rough play for a duration of time recommended by the surgeon

What are the risks of having a T&A?

Any type of surgery poses a risk to a child. About 5 percent of the children begin bleeding from the surgery site about five to eight days after the surgery, and may require additional blood and/or surgery. Some children may have a change in the sound of their speech due to the surgery. The following are some of the other complications that may occur:

  • bleeding (may happen during surgery, immediately after surgery, or at home)
  • dehydration (due to decreased fluid intake; if severe, fluids through an intravenous, or IV, catheter in the hospital may be necessary)
  • fever
  • difficulty breathing (swelling of the area around the surgery; may be life threatening if not treated immediately)

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Treating Sun-Damaged Skin

What is photoaging?

Excessive exposure to the sun early in life can make a person look older than he/she really is. Premature wrinkling and skin damage from sun exposure is also called photoaging. Photoaging, unlike natural aging, results in course, dry skin, freckling, skin discoloration, leathery skin, and deep wrinkles.

Treatment for sun-damaged skin:

To minimize the effects of photoaging, several treatment options are available for aging skin. Specific treatment for sun-damaged skin will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the skin damage
  • type of skin damage
  • your tolerance for specific medications, procedures, or therapies
  • your opinion or preference

Treatment may include:

  • botulinum toxin type A
    An injection of botulinum toxin (a complex type of protein) into specific muscles will immobilize those muscles, preventing them from forming wrinkles and furrows. The use of botulinum will also soften existing wrinkles.
  • chemical peels
    Chemical peels are often used to minimize sun-damaged skin, irregular pigment, and superficial scars. The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving the skin's appearance.
  • collagen injections
    One type of collagen, which is derived from purified bovine (cow) collagen, is injected beneath the skin to replace the body's natural collagen that has been lost. Injectable collagen is generally used to treat wrinkles, scars, and facial lines.
  • dermabrasion
    Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that "abrades" the skin. As the skin heals from the procedure, the surface appears smoother and fresher.

    A gentler version of dermabrasion, called microdermabrasion, uses small particles passed through a vacuum tube to remove aging skin and stimulate new skin growth. This procedure works best on mild to moderate skin damage and may require several treatments.
  • laser skin resurfacing
    Laser skin resurfacing uses high-energy light to burn away damaged skin. Laser resurfacing may be used to minimize wrinkles and fine scars. A newer treatment option is called non-ablative resurfacing, which also uses a laser as well as electrical energy without damaging the top layers of skin.
  • tretinoin treatment
    Tretinoin treatment, a prescription topical cream, can reduce wrinkles, rough skin, and discolored skin.

However, prevention is the key to retaining a youthful appearance. Practicing safe sun exposure habits, such as using sunscreens correctly, staying out of the sun as much as possible, and wearing protective clothing and hats, are essential to keeping the skin healthy. In addition, practicing sun safety may prevent the development of skin cancer later in life.

Tree Nut Allergy Diet

General guidelines for tree nut allergy:

The key to an allergy-free diet is to avoid all foods or products containing the food to which you are allergic. A tree nut allergy is an abnormal response of the body to the proteins found in tree nuts. In order to avoid foods that contain tree nuts, it is important to read food labels.

How to read a label for a tree nut-free diet:

Be sure to avoid foods that contain any of the following ingredients:

  • almonds
  • brazil nuts
  • cashews
  • chestnuts
  • filberts
  • hazelnuts
  • gianduja (a creamy mixture of chocolate and chopped toasted nuts found in premium or imported chocolate)
  • hickory nuts
  • macadamia nuts
  • marzipan/almond paste
  • nougat
  • Nu-Nuts® artificial nuts
  • nut butters, i.e. cashew butter, almond butter
  • nut oil
  • nut paste, i.e. almond paste
  • pecans
  • pine nuts (pignolia, pinion)
  • pistachios
  • walnuts
  • Nu-Nuts® artificial nuts are peanuts that have been deflavored and reflavored with a nut like pecan or walnut.
  • Filberts are hazelnuts.
  • Avoid Natural extracts such as pure almond extract, and natural wintergreen extract (for the filbert/hazelnut allergic).
  • Use imitation or artificially flavored extracts.
  • Ethnic foods, commercially prepared baked goods, and candy can be cross-contaminated with nuts since nuts are frequently used in these types of foods.
  • Tree nuts are being added to an increasing variety of foods such as barbecue sauces, cereals, crackers, and ice creams.

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Tummy Tuck

What is a tummy tuck?

Abdominoplasty, or "tummy tuck" as it is commonly known, is a procedure that minimizes the abdominal area. With this procedure, the surgeon makes a long incision from one side of the hipbone to the other. Excess fat and skin are surgically removed from the middle and lower abdomen, and the muscles of the abdomen wall are tightened.

A less complex procedure is called a "mini tummy tuck," or a partial abdominoplasty. This procedure is ideal for individuals who have fat deposits limited to the area below the navel.

Possible complications associated with abdominoplasty:

Possible complications associated with abdominoplasty may include, but are not limited to, the following:

  • visible scarring
    If the incision area does not heal properly, there is a chance for visible scarring. This can often be treated by a second operation.
  • blood clots and infection
    As in any surgery, there is a risk of infection, blood clots, or reaction to the anesthesia.

Who are candidates for tummy tuck?

The best candidates for abdominoplasty are men or women who are in good physical condition, but are bothered by large fat deposits or loose abdominal skin that does not respond to diet or exercise.

People who intend to lose weight, and women who plan future pregnancies, should postpone the surgery.

About the procedure:

Although each procedure varies, generally, tummy tuck surgeries follow this process:

  • Location options may include:
    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient
  • Anesthetic options may include:
    • local anesthesia
    • general anesthesia
  • Average length of procedure:

    Complete abdominoplasty usually takes several hours, depending on the extent of work required.
  • Some possible short-term side effects of surgery:
    • abdomen is swollen
    • abdomen is painful
  • Final results:

    • Healing is a slow and gradual process. It may take weeks or months to reach a full recovery.
    • Scars may appear to get worse during the first three to six months, as they heal. It may take up to a year for scars to flatten out and lighten in color, although they may never completely disappear.

Urticaria

What is urticaria?

Urticaria, or hives, is a condition in which red, itchy, and swollen areas appear on the skin - usually as an allergic reaction from eating certain foods or taking certain medicines.

What foods commonly cause hives?

  • nuts
  • tomatoes
  • shellfish
  • berries

What medicines commonly cause hives?

  • penicillin
  • sulfa
  • anticonvulsant drugs
  • phenobarbital
  • aspirin

Other causes of hives:

  • dermatographism - hives caused by scratching the skin, continual stroking of the skin, or wearing tight-fitting clothes that rub the skin.
  • cold-induced - hives caused by exposure to cold air or water.
  • solar hives - hives caused by exposure to sunlight or light-bulb light.
  • exercise
  • chronic urticaria - recurrent hives with no known cause.

What is angioedema?

Angioedema is an allergic reaction that causes swelling deeper in the layers of the skin. It most commonly occurs on the hands, feet, and face (lips and eyes).

Usher Syndrome

What is Usher syndrome?

Usher syndrome is an inherited disorder that involves both a hearing impairment and a vision impairment called retinitis pigmentosa. Some people also have varying problems with balance.

Usher syndrome is passed from parents to their children genetically.

What are the different types of Usher syndrome?

There are three types of Usher syndrome:

  • US type 1 (US1) - characteristics include:
    • profoundly deaf from birth
    • do not usually benefit from hearing aids
    • severe balance problems
    • vision problems begin by age 10
    • blindness eventually occurs
  • US type 2 (US2) - characteristics include:
    • moderate to severe hearing problems
    • usually benefit from hearing aids
    • use speech to communicate
    • normal balance
    • retinitis pigmentosa begins in teenage years
  • US type 3 (US3) - characteristics include:
    • born with normal hearing
    • hearing problems develop in teenage years
    • near normal balance
    • deafness by late adulthood
    • retinitis pigmentosa begins around puberty
    • blindness by mid-adulthood

How is Usher syndrome diagnosed?

Special tests assist in the diagnosis of Usher syndrome, including:

  • electronystagmography (ENG) to detect balance problems
  • electroretinography (ERG) to detect retinitis pigmentosa

Treatment for Usher syndrome:

Specific treatment for Usher syndrome will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

At present, there is no known cure for Usher syndrome. The best treatment, however, is early identification so that education programs can begin as soon as possible. Treatment may include:

  • adjustment counseling
  • career counseling
  • assistive devices, such as hearing aids
  • orientation and mobility training
  • communication services
  • independent living training
  • low vision services
  • auditory training

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Online Resources of Otolaryngology

Vocal Cord Disorders

What are vocal cord disorders?

The vocal cords (also called vocal folds) are two bands of smooth muscle tissue located in the larynx (voice box). The larynx is located in the neck at the top of the trachea (windpipe). Vocal cords produce the sound of your voice, by vibration and the air passing through the cords from the lungs. The sound the vocal cords produce is then sent through the throat, nose, and mouth, giving the sound "resonance." The sound of each individual voice is determined by the size and shape of the vocal cords and the size and shape of the throat, nose, and mouth (the resonating cavities).

Vocal cord disorders are often caused by vocal abuse or misuse, such as excessive use of the voice when singing, talking, smoking, coughing, yelling, or inhaling irritants. Some of the more common vocal cord disorders include laryngitis, vocal nodules, vocal polyps, and vocal cord paralysis.

laryngitis Laryngitis is often characterized by a raspy or hoarse voice due to inflammation of the vocal cords. Laryngitis can be caused by excessive use of the voice, infections, inhaled irritants, or gastroesophageal reflux (the backup of stomach acid into the throat).
vocal nodules Vocal nodules are benign (non-cancerous) growths on the vocal cords caused by vocal abuse. Vocal nodules are a frequent problem for professional singers. The nodules are small and callous-like and usually grow in pairs (one on each cord). The nodules usually form on areas of the vocal cords that receive the most pressure when the cords come together and vibrate (similar to the formation of a callous). Voice nodules cause the voice to be hoarse, low, and breathy.
vocal polyps A vocal polyp is a soft, benign (non-cancerous) growth, similar to a blister. A polyp usually grows alone on one vocal cord and is often caused by long-term cigarette smoking. Other causes of vocal polyps include hypothyroidism (underactive thyroid gland), gastroesophageal reflux, and continuous voice misuse. Voice polyps cause the voice to be hoarse, low, and breathy. Vocal polyps are also called Reinke's edemas or polypoid degeneration.
vocal cord paralysis Paralysis of the vocal cords may occur when one or both vocal cords or folds does not open or close properly. A common disorder, this condition can range from relatively mild to life threatening. When one or both vocal cords are paralyzed, the open cord(s) allows food or liquids to slip into the trachea and lungs. A person may experience difficulty swallowing and coughing. Vocal cord paralysis may be caused by the following:
  • head trauma
  • neck injury
  • stroke
  • tumor
  • lung or thyroid cancer
  • certain neurological disorders, such as multiple sclerosis or Parkinson's disease
  • viral infection

Treatment may include surgery and voice therapy. Sometimes, no treatment is necessary and a person recovers on his/her own.

What are some other vocal cord disorders?

Sometimes, less common disorders of the vocal cords occur due to voice misuse or disease, such as contact ulcers and laryngeal papillomatosis.

contact ulcers on the vocal cords
Contact ulcers on the vocal cords can occur when too much force is used in speech. When the vocal cords are excessively forced together, ulcerated sores may occur. Tissue may also wear away on or near the larynx cartilages. Ulcers sometimes are also caused by gastroesophageal reflux. Contact ulcers may cause the voice to tire easily and may cause a sore throat.
laryngeal papillomatosis
Laryngeal papillomatosis is a rare disease caused by the human papillomavirus (HPV). More than 60 HPVs exist. Laryngeal papillomatosis causes the growth of tumors inside the voice box, vocal cords, or the air passage from the nose to the lungs. Most laryngeal papillomas (tumors) occur in children before the age of three. The tumors are usually quick growing and can vary in size, causing breathing and swallowing problems. Other symptoms may include coughing and hoarseness.

Treatment for laryngeal papillomas may include surgery to remove the tumors. Other treatment options may include:

  • chemotherapy
  • antibiotics

Because the tumors tend to return, repeat surgery may be necessary. Always consult your physician for a diagnosis.

How are vocal cord disorders diagnosed?

Any hoarseness or change in voice that lasts longer than two weeks should be brought to the attention of your physician. (Sometimes the hoarseness may be indicative of laryngeal cancer.) In addition to a complete medical history and physical examination, the physician may examine the vocal cords internally with a small, long-handled mirror (a procedure called indirect laryngoscopy in which the mirror is inserted into the throat so parts of the larynx can be examined) or with a lighted tube (a procedure called direct laryngoscopy in which an instrument called a laryngoscope is inserted through the nose or mouth. The scope is lighted to provide a better view of the area than the indirect laryngoscopy.).

Treatment for vocal cord disorders:

Vocal cord disorders caused by abuse or misuse are easily preventable. In addition, most disorders of the vocal cords can be reversed. Specific treatment for vocal cord disorders will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent and type of vocal cord disorder
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include any of the following:

  • eliminating the behavior that caused the vocal cord disorder
  • a referral to a speech-language pathologist who has specialized training in treating voice, speech, language, or swallowing disorders that affect communication
  • medication
  • surgery to remove growths

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Online Resources of Otolaryngology

Wheat Allergy Diet

General guidelines for wheat allergy:

The key to an allergy-free diet is to avoid all foods or products containing the food to which you are allergic. A wheat allergy is an abnormal response of the body to the protein found in wheat. Wheat products are found in many foods. In order to avoid foods that contain wheat, it is important to read food labels.

FOODS ALLOWED NOT ALLOWED
Beverages Coffee, tea, fruit juices, decaffeinated coffee, carbonated beverages, all milks, cocoa Cereal beverages, coffee substitutes

Beverages made from wheat products: beer, ale, root beer

Instant chocolate drink mixes

Breads & Cereals Ry-Krisp, rice wafers

Pure corn, rice, arrowroot, barley, potato, or rye bread made without wheat flour or wheat products

Cornmeal, cornstarch, soybean flour, barley flour, oat flour, rice flour, potato starch, arrowroot flour

Oatmeal cream of rice, puffed rice, or other cereals made from pure corn, oats, or rice to which no wheat has been added

Whole wheat, enriched, or white bread, rolls, or bread crumbs

Graham or gluten bread

Donuts, sweet rolls, muffins, french toast, waffles, pancakes, dumplings, bread stuffing, rusk, popovers

Prepared mixes for pancakes, waffles, biscuits, breads, and rolls

Cornbread, potato, or soybean bread unless made without wheat flour or wheat products

Cereals made from farina, wheat, or those with wheat products or malt added

Pretzels, crackers

Semolina, spelt, or triticale

Desserts Custards, Bavarian creams

Oatmeal, arrowroot, rice, or rye cookies made without wheat products

Cornstarch, tapioca, or rice puddings

Water or fruit ices, meringues

Gelatin

Cakes, pastries, commercial frosting, icing, ice cream, sherbet, ice cream cones

Cookies, prepared mixes, or packaged pudding containing wheat flour

Graham crackers, donuts

Eggs Eggs prepared any way without wheat products Souffles or creamed eggs made with wheat products
Fats Butter, margarine, animal, or vegetable fats and oils, cream

Salad dressings or gravy prepared without wheat flour or products

Any salad dressing thickened or gravy with wheat flour or products
Fruit All fresh, canned, dried, or frozen fruits and fruit juices Strained fruits with added cereals
Meat, Fish, Poultry Baked, broiled, boiled, roasted or fried: beef, veal, pork, ham, chicken, turkey, lamb, or fish

"All meat" wieners or luncheon meats prepared without wheat flour fillers or wheat products

All breaded or floured meats, meats containing filler such as meatloaf, frankfurters, sausage, luncheon meats, bologna, or prepared meat patties
Milk & Milk Products Milk, buttermilk, yogurt, cheese, some cottage cheese Malted milk, milk drink containing powdered wheat cereal or products

Cottage cheese with modified starch or other wheat-containing ingredients

Potatoes & Substitutes White and sweet potatoes

Rice

Scalloped potatoes

Noodles, spaghetti, macaroni, and other pasta products prepared with wheat or semolina flour

Soup Clear bouillon, consommé, or broth

Homemade soups made without wheat products

Cream soups unless made without wheat flour

Soups with noodles, alphabets, dumplings, or spaghetti

Soup thickened with wheat flour

Sweets Corn syrup, honey, jams, jellies, molasses, sugar Chocolates, chocolate candy containing malt, candy with cereal extract
Vegetables All fresh, frozen, or canned vegetables, and vegetable juices Vegetables combined with wheat products

Breaded or floured vegetables

Miscellaneous Salt, chili powder, condiments, flavoring extracts, herbs, nuts, olives, pickles, popcorn, peanut butter Malt products, Worcestershire sauce, gravies thickened with wheat flour

Monosodium glutamate (MSG), meat tenderizers containing MSG, prepared oriental food seasoned with MSG, soy sauce

Information for using wheat substitutes:

1-cup wheat flour equals:

  • 1 cup rye meal
  • 1 - 1 1/4 cups rye flour
  • 1 cup potato flour
  • 1 1/3 cups rolled oats or oat flour
  • 1/2 cup potato four plus 1/2 cup rye flour
  • 5/8 cup potato starch
  • 5/8 cup rice flour plus 1/3 cup rye flour

How to read a label for an wheat-free diet:

Be sure to avoid foods that contain any of the following ingredients:

  • bread crumbs
  • bran
  • cereal extract
  • couscous
  • cracker meal
  • enriched flour
  • farina
  • gluten
  • graham flour
  • high gluten flour
  • high protein flour
  • spelt
  • vital gluten
  • wheat bran
  • wheat germ
  • wheat gluten
  • wheat malt
  • wheat starch
  • whole wheat flour

Other possible sources of wheat or wheat products:

Ingredients that may indicate the presence of wheat protein:

  • gelatinized starch
  • hydrolyzed vegetable protein
  • kamut
  • modified food starch
  • modified starch
  • natural flavoring
  • soy sauce
  • starch
  • vegetable gum
  • vegetable starch

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Online Resources of Allergy & Asthma

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