Medical Treatments

If you are experiencing symptoms affecting the ears, nose or throat that are difficult to control with medications alone, your primary doctor may refer you to an Ear, Nose and Throat (ENT) specialist. As an ENT specialist, Dr. Young can determine the best course of treatment, including further medication therapy or surgery to open the sinus passage ways.

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Rhinitis

What are the symptoms of Rhinitis?

Symptoms of Rhinitis may include:

  • Nasal blockage
  • Sneezing
  • Runny nose or postnasal drainage
  • Itchy nose

Rhinitis may occur before a case of sinusitis or with sinusitis, a condition where infection or inflammation affects the sinuses. If you have facial pressure, decreased sense of smell, or a greenish-yellow nasal drainage, you may also have sinusitis.

What are the treatment options?

Treating rhinitis depends on the specific cause or diagnosis. If there is a specific trigger that can be avoided, this may be a successful treatment.

Often, medications are used to control symptoms. Depending on the specific cause of the rhinitis symptoms, some of the medications that may be used include:

  • Intranasal saline spray or rinse
  • Antihistamines (oral or intranasal)
  • Corticosteroids (usually applied as an intranasal spray)
  • Ipratropium bromide intranasal spray

For severe runny nose or nasal obstruction/congestion that does not respond to medications, Dr. Young may consider additional office procedures or surgery appropriate to your situation.

Sinusitis

What are the symptoms of Sinusitis?

You have acute sinusitis when you have had cloudy or colored drainage from your nose for up to four weeks, plus one or more of the following symptoms:

  • Stuffy, congested, or blocked nose
  • Pain, pressure, or fullness in the face, head, or around the eyes
  • Long-lasting cold symtpoms
  • Itchy nose

Symptoms that do not improve within 10 days of getting sick, or initially get better then worsen again (“Double Worsening”)

  • Thickened nasal drainage
  • Decreased sense of smell

What are the treatment options?

Sinusitis is treated differently based on the cause. Most cases of acute sinusitis, about 98 percent, are caused by a virus, not bacteria, and should not be treated with antibiotics.

Chronic sinusitis is treated differently than acute sinusitis. Because chronic sinusitis is caused more by inflammation than infection, the treatments for chronic sinusitis aim to control the inflammation. Salt water nasal irrigation and/or nasal steroid sprays are the main treatments for the symptoms of chronic sinusitis. Antibiotics may sometimes be helpful but not always.

If Dr. Young suspects a complication or if you have repeated episodes or prolonged sinus symptoms, a CT scan of your sinuses may be needed.

Surgery

Surgery is not recommended for acute sinusitis except in rare circumstances. Sometimes the sinus infection can spread to the eye, face, or brain; this would be considered an emergency, and surgery may be needed to reverse the infection and keep it from spreading.

For chronic sinusitis, surgery is an option when the symptoms cannot be controlled with medications and other treatments. The most common type of surgery for the sinuses is called endoscopic sinus surgery. The surgery widens the natural drainage pathways between the sinuses and the nose, allowing mucus to get out of the sinuses and air to get in. Medications that are delivered into the nose and sinuses, like sprays and irrigations, can also get into the sinuses better after surgery.

Balloon Sinus Dilation

Balloon sinus ostial dilation (BSOD) is a newer treatment option where an endoscope is also used, but instead of carefully removing the bone and tissue that may be blocking a sinus, a balloon is used to make the sinus openings bigger. Balloon dilation may not be appropriate for every type of chronic sinusitis and cannot be used on all of your sinuses, but can be helpful depending on your circumstances.

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Ménière’s Disease

What are the symptoms of Ménière’s Disease?

Ménière’s disease symptoms may include:

  • Dizziness or vertigo (attacks of a spinning sensation)
  • Hearing Loss
  • Tinnitus (a roaring, buzzing, or ringing sound in the ear)
  • Sensation of fullness in the affected ear
  • Symptoms tend to come and go together

What are the treatment options?

Although there is no cure for Ménière’s disease, the attacks of vertigo can be controlled in nearly all cases. Treatment options include:

  • A low salt diet and a diuretic (water pill)
  • Anti-vertigo medications
  • Intratympanic injection with either dexamethasone or gentamicin
  • An air pressure pulse generator
  • Surgery

To help prevent an attack, avoid stress and excess salt ingestion, caffeine, smoking, and alcohol. Get regular sleep and eat properly. Remain physically active, but avoid excessive fatigue. Consult Dr. Young about other treatment options.

Deviated Septum

What are the symptoms of a Deviated Septum?

The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose, which is usually worse on one side. In some cases, a crooked septum can interfere with sinus drainage and cause repeated sinus infections. You may experience one or more of the following:

  • Difficulty breathing through one or both nostrils
  • Nosebleeds
  • Sinus Infections
  • Noisy breathing during sleeping in infants and young children
  • Mouth-breathing during sleep in adults

Discuss your symptoms and any known nose damage or surgeries with your primary care provider or an ENT (ear, nose, and throat) specialist, or otolaryngologist. They will examine your nose inside and out, and might recommend additional tests based on your individual needs. When there is clearly a crooked/deviated septum, and the symptoms are severe enough to warrant intervention, the ENT specialist may suggest surgery as an option if medical treatment fails.

What are the treatment options?

Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is typically not performed on young children. Septoplasty is a surgical procedure that is usually performed through the nostrils, so there is no bruising or outward sign of surgery; however, each case is different and special techniques may be required depending on the individual patient.  Surgery may be combined with a rhinoplasty that changes the outward shape of the nose; in this case swelling and bruising may occur. Septoplasty may also be combined with sinus surgery.

Post Nasal Drip

What are the symptoms of Post Nasal Drip?

Symptoms of post-nasal drip can include:

  • Feeling of mucus drainage into the throat
  • Frequent swallowing
  • Throat clearing
  • Raspy or gurgling speech
  • Sore irritated throat
  • Feeling a lump in the throat

Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling that there is a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.

What are the treatment options?

Diagnosing post-nasal drip may include a detailed ear, nose, and throat exam, endoscopy (using a camera to look inside the nose and throat). Post-nasal drip can be difficult to cure, and treatment varies according to the cause:

Bacterial Infections

Bacterial infections are usually treated with antibiotics, nasal spray, decongestants, and nasal saline irrigations. For chronic sinusitis, surgery to open the blocked sinuses may be required.

Allergies

Allergies are best managed by avoiding the causes. Antihistamines, decongestants, cromolyn and steroid nasal sprays, or oral steroids may offer relief. Some older, sedating antihistamines may dry and thicken post-nasal secretions more; newer non-drowsy antihistamines do not have this effect. Immunotherapy (desensitization) using allergy shots or drops under the tongue may help. Talk to your doctor before starting any of these medications.

Gastroesophageal Reflux

Gastroesophageal reflux treatment includes elevating the head of the bed six to eight inches, avoiding food and beverages for at least three hours before bedtime, weight loss, and eliminating alcohol and caffeine from the diet. Antacids such as TUMS®, Mylanta®, and Gaviscon®, or acid blockers such as Zantac® or Pepcid® also provide benefit. If the reflux does not get better, you should see your primary care provider, or Dr. Young for further treatment recommendations.

Sinus Headaches

What are the symptoms of Sinus Headaches

Patients with migraines or tension headaches commonly have sinus and nasal symptoms during their headaches, including sinus pressure, sinus pain, nasal congestion or runny nose. Studies of patients who have self-diagnosed or been diagnosed with sinus headaches were found to have migraines or tension headaches in more than 80 percent of cases; only three to five percent of these patients had sinusitis.

Symptoms of sinusitis and migraine headaches can be similar, which can be confusing about what is causing sinus pain and pressure. Migraines and headaches can cause the following nasal symptoms:

  • Pain and pressure around the eyes, across the cheeks, and the forehead
  • Nasal congestion
  • Runny nose
  • Eye redness, tearing, or eyelid swelling
  • Symptoms on one or both sides of the face

Sinusitis is associated with nasal congestion or obstruction and a thick nasal discharge, sometimes with facial pain, pressure, or a feeling of fullness. However, facial pain or pressure or fullness without cloudy or colored nasal discharge is most likely not a sinus infection.

What are the treatment options?

Sinus headaches caused by migraines or tension headaches should not be treated with antibiotics. Because there are similar symptoms between acute sinusitis and migraine headaches with nasal and sinus symptoms, it can be difficult to tell if your symptoms are truly a sinus infection. Sinus pain and pressure without discolored nasal discharge is most likely not a sinus infection. If you have been diagnosed with frequent sinus infections and have been treated with repeated episodes of antibiotics without improvement, migraines or tension headaches could be causing your sinus pain and pressure. Seek evaluation by Dr. Young to help you find the true cause of your headaches.

Benign Paroxsymal Positional Vertigo (BPPV)

What are the symptoms of BPPV?

BPPV is the most common cause of vertigo. Vertigo is the unpleasant (often, very frightening) sensation of the world rotating, often associated with nausea and sometimes even with vomiting. What distinguishes BPPV from other causes of vertigo include:

  • Vertigo that is experienced after a change in head position such as lying down flat, turning over in bed, tilting back to look up, or tilting down to stoop
  • No associated hearing loss or fullness feeling in the ear
  • Some nausea, but usually not sever and usually not associated with vomiting
  • Vertigo stops as soon as you turn your dead away from the provoking position and back to where it was

What are the treatment options?

The treatment for BPPV involves moving those misplaced rocks or crystals from the active portion of the inner ear to the inactive portion of the inner ear, where they won’t cause dizziness. These treatments are office procedures called Canalith Repositioning Procedures, or CRP. They may be called Epley or Semont maneuvers as well. These are done either in your doctor’s office or by the physical therapist, and involve putting you into a position that causes vertigo, allowing it to pass, and then turning your head carefully to move those tiny crystals in your inner ear to a portion of the inner ear where they won’t do any harm.

The success rates for these office treatments, which take only several minutes, are very high.

What is the wrong treatment for BPPV?

Many times, patients go to the emergency room or urgent care setting with vertigo that is BPPV, but they are given a vestibular suppressant like meclizine or benzodiazepene instead of being offered CRP. The problem with taking the medication is that it does not address the cause of the problem, and it delays your brain’s ability to compensate and recover.

Conductive Hearing Loss

What are the symptoms of Conductive Hearing Loss?

Symptoms of conductive hearing loss can vary depending on the exact cause and severity (see below), but may include or be associated with:

  • Muffled hearing
  • Sudden or steady loss of hearing
  • Full or “stuffy” sensation in the ear
  • Dizziness
  • Draining of the ear
  • ain or tenderness in the ear

What are the treatment options?

If you are experiencing hearing loss, you should see Dr. Young who can make a specific diagnosis for you, and talk to you about treatment options, including surgical procedures. A critical part of the evaluation will be a hearing test (audiogram) performed by an audiologist (a professional who tests hearing function) to determine the severity of your loss as well as determine if the hearing loss is conductive, sensorineural, or a mix of both.

The treatment options can include:

  • Observation with repeat hearing testing at a subsequent follow up visit
  • Evaluation and fitting of a hearing aid(s) and other assisting listening devices
  • Preferential seating in class for school children
  • Surgery to address the cause of hearing loss
  • Surgery to implant a hearing device

Earwax (Cerumen Impaction)

What are the symptoms of Earwax Blockage?

Symptoms of an earwax problem may include:

  • Earache
  • Feeling of plugged hearing or fullness in the ear
  • Partial hearing loss that gets worse
  • Tinnitus, ringing, or noises in the ear
  • Itching, odor, or discharge
  • Coughing
  • Pain
  • Infection

What are the treatment options?

Cleaning a working ear can be done by washing it with a soft cloth, but do not insert anything into the ear. Ideally, the ear canals should never have to be cleaned. However, that isn’t always the case. The ears should be cleaned when enough earwax gathers to cause symptoms or to prevent a needed assessment of the ear by your doctor. This condition is call cerumen impaction.

Most cases of ear wax blockage respond to home treatments used to soften wax. Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial drops in the ear. Detergent drops such as hydrogen peroxide or carbamide peroxide (available in most pharmacies) may also aid in the removal of wax.

Manual removal of earwax is also effective and safe. This is most often performed by an ENT (ear, nose, and throat) specialist, such as Dr. Young, using suction or special miniature instruments, and a microscope to magnify the ear canal.

Sensorineural Hearing Loss (SNHL)

What are the symptoms of SNHL?

Symptoms of SNHL may include:

  • Muffled hearing
  • Difficulty understanding speech
  • Sudden or steady loss of hearing
  • Full or “stuffy” sensation in the ear
  • Ringing in the ear
  • Dizziness

If you are experiencing hearing loss, you should see Dr. Young who can make the correct diagnosis. This is important because the treatment for hearing loss depends on the cause. A critical part of the evaluation will be a hearing test (audiogram) performed by an audiologist to determine the severity of your hearing loss, as well as whether it is conductive, sensorineural, or a combination of both.

What are the treatment options?

Dr. Young may recommend specific treatment options based on the results of your hearing test, or other potential tests such as a CT or MRI imaging scan. Treatment options can include:

  • Continuing observation with repeated hearing tests
  • Medical Therapy— corticosteroids (oral or injection through the eardrum) may be used to reduce cochlear hair cell swelling and inflammation after exposure to loud noises; diuretics may be used for Ménière’s disease
  • Low-sodium diet
  • Evaluation and fitting of a hearing aid(s) or other assisting listening devices 
  • Preferential seating in class for school children
  • Surgery to correct the cause of the hearing loss
  • Surgery to implant a hearing device

SNHL can be treated with the use of conventional hearing aids or an implantable hearing device. Again, your Dr. Young and/or audiologist can help you decide which device may work best for you depending on your hearing test results and your lifestyle.

Tinnitus

What are the symptoms of Tinnitus?

Tinnitus is not a disease per se, but a common symptom, and because it involves the perception of hearing sound or sounds in one or both ears, it is commonly associated with the hearing system. In fact, various parts of the hearing system, including the inner ear, are often responsible for this symptom. At times, it is relatively easy to associate the symptom of tinnitus with specific problems affecting the hearing system; at other times, the connection is less clear.

Common symptoms of tinnitus include:

  • Constant high or low-pitched ringing in ears
  • Intermittent or constant roaring in ears
  • Pulsation or beating noises in ears
  • Associated with or without hearing loss

What are the treatment options?

When you are evaluated for tinnitus, the first thing the doctor will do is obtain a complete history and perform a thorough, targeted physical examination. If your tinnitus is one-sided (unilateral), associated with hearing loss, or persistent, a hearing test, or audio-gram, should be ordered.

Although there is no one “cure” for tinnitus, there are several options available that can help patients with tinnitus.

Some patients with hearing loss and tinnitus have improvement with the use of hearing aids, with or without built-in ear-level maskers. The effects of tinnitus on quality of life may also be improved by cognitive behavioral therapy (CBT) counseling, which usually involves a series of weekly sessions led by a trained professional.

Tinnitus can be so bothersome in some patients that it causes depression or anxiety; additionally, in a patient with depression and/or anxiety, it may be very difficult to tolerate tinnitus. Consultation with a psychiatrist or psychologist with treatment directed to the underlying condition can be beneficial.

Dietary supplements for tinnitus treatment are frequently advertised on the internet, television, and radio, but there is no evidence that supplements such as ginkgo biloba, melatonin, zinc, Lipoflavonoid, and vitamin supplements are beneficial for tinnitus.

Acupuncture may or may not be help your tinnitus; there are not enough quality studies of this type of treatment to make a recommendation.

Swimmer's Ear (Otitis Externa)

What are the symptoms of Swimmer's Ear?

Signs and symptoms of swimmer’s ear may include:

  • Itching inside the ear (common)
  • Sensation that the ear is blocked or full
  • Drainage from the ear
  • Fever
  • Decreased hearing
  • Intense pain that may spread to the neck, face, or side of the head
  • Swollen lymph nodes around the ear or in the upper neck
  • Redness or swelling of the skin around the ear

If left untreated, a certain amount of hearing loss may occur. When the infection clears up, hearing usually returns to normal.

What are the treatment options?

Treatment for the early stages of swimmer’s ear includes careful cleaning of the ear canal and use of eardrops that inhibit bacterial or fungal growth and reduce inflammation. Mildly acidic solutions containing boric or acetic acid are often effective for early infections.

For more severe Infections

For more severe infections, your doctor may prescribe antibiotics to be applied directly to the ear. If the ear canal is swollen shut, your doctor may place a sponge or wick in the canal so the antibiotic drops will enter the swollen canal more effectively. Pain medication may also be prescribed. If you have tubes in your eardrum, a non-ototoxic (do not damage your hearing) topical treatment should be used. Topical antibiotics are effective for infection limited to the ear canal. Oral antibiotics may also be prescribed if the infection goes beyond the skin of the ear canal.

Follow Up

Follow-up appointments are very important to monitor your condition, to clean the ear again, and to replace the ear wick as needed. Your ENT specialist has specific equipment and expertise to effectively clean the ear canal and treat swimmer’s ear. With proper treatment, most infections should clear up in seven to 10 days.

Hoarseness

What are the symptoms of Hoarseness?

If you have any of these symptoms for hoarseness, you should see an ENT (ear, nose, and throat) specialist, or otolaryngologist, as soon as you can:

  • Hoarseness that lasts more than four weeks, especially if you smoke
  • Severe changes in voice lasting more than a few days
  • Voice changes, such as raspy, strained, breathy, weak, higher or lower in pitch, inconsistent, fatigued, or shaky voice
  • Difficulty breathing
  • Pain when speaking
  • Vocal professionals (singer, teacher, public speaker) who cannot do their job

What are the treatment options?

Dr. Young needs to obtain your medical history and look at the voice box (larynx) with special equipment before he can determine what’s causing your hoarseness and recommend treatment options. He may pass a very small, lighted flexible tube with a camera (called a fiberoptic scope) through your nose to view your vocal cords. Most patients tolerate these procedures extremely well.

Appropriate treatment depends on the cause of your hoarseness.

Acute Laryngitis

Supportive care and voice rest are usually the recommended courses of action for acute laryngitis. Antibiotics and steroids are often not needed, however, if your hoarseness lasts beyond typical cold symptoms, however, you should see Dr. Young.

Non-cancerous vocal cord lesions

Treatment for non-cancerous vocal cord lesions includes learning proper voicing technique with voice therapy, adequate hydration, and sometimes surgery.

Pre-cancerous or cancerous lesions

Surgery is needed to diagnose and treat pre-cancerous or cancerous lesions. Sometimes, other cancer treatments are needed, such as radiation therapy or chemotherapy.

Neurological diseases

Determining why your vocal cords are paralyzed helps Dr. Young decide the best course of action which may include botox injections and/or neurology referral.

GERD / LPR / REFLUX

What are the symptoms of GERD & LPR?

Many patients with LPR do not experience classic symptoms of heartburn related to GERD. And sometimes, adult patients may experience symptoms related to either GERD or LPR like:

  • Heartburn
  • Belching
  • Regurgitation (a surge or rush back) of stomach contents
  • Frequent throat clearing or coughing
  • Excess mucus
  • A bitter taste
  • A sensation of burning or throat soreness
  • Something “stuck” or a “lump” in the back of the throat
  • Hoarseness or change in the voice
  • Difficulty swallowing
  • Drainage down the back of the nose (post nasal Drip)
  • Choking episodes (can sometimes awaken from sleep)
  • Difficulty breathing, if the voice box is affected

What are the treatment options?

GERD and LPR are usually suspected based on symptoms, and can be further evaluated with tests such as an endoscopic examination (a tube with a camera inserted through the nose), biopsy, special X-ray exams, a 24-hour test that checks the flow and acidity of liquid from your stomach into your esophagus, esophageal motility testing (manometry) that measures muscle contractions in your esophagus when you swallow, and emptying of the stomach studies. Some of these tests can be performed in an office.

Options for treatment include lifestyle and dietary modifications, medications, and rarely surgery. Medications that can be prescribed include antacids, ulcer medications, and proton pump inhibitors.. To be effective, these medications are usually prescribed for at least one month, and may be tapered off later after symptoms are controlled. For some patients, it can take two to three months of taking medication(s) to see effects.

Sore Throat

What are the symptoms of a sore throat?

Whenever a sore throat is severe, lasts longer than the usual five- to ten-day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your physician:

  • Severe and prolonged sore throat
  • Difficulty breathing
  • Difficulty swallowing
  • Difficulty opening the mouth
  • Swelling of the face or neck
  • Joint Pain
  • Earache
  • Rash
  • Fever (over 101°F)
  • Blood in saliva or phlegm
  • Frequently recurring sore throat
  • Lump in neck
  • Hoarseness lasting over two weeks

What are the treatment options?

A mild sore throat associated with cold or flu symptoms can be made more comfortable with the following remedies:

Increase your liquid intake.

Drink warm tea with honey (a favorite home remedy).

Gargle with warm salt water several times daily: ¼ tsp salt to ½ cup water.

Take over-the-counter pain relievers such as acetaminophen (Tylenol Sore Throat®, Tempra®) or ibuprofen (Motrin IB®, Advil®).

For a more severe sore throat, Dr. Young may want to do a throat culture—swabbing the inside of your throat to see if there is a bacterial infection.

If you have a bacterial infection Dr. Young will likely recommend an that kills or impairs bacteria.

Neck Mass

What are the symptoms of a Neck Mass?

Common symptoms in patients with a neck mass at higher risk for cancer (see “What Causes a Neck Mass” below) include:

  • The mass lasts longer than two to three weeks
  • The mass gets larger
  • The mass gets smaller but does not completely go away
  • Voice change
  • Trouble or pain with swallowing
  • Trouble hearing or ear pain on the same side as the neck mass
  • Neck or throat pain
  • Unexplained weight loss
  • Nasal blockage in one side of the nose
  • Breathing difficulty
  • Bleeding from nose and oral cavity
  • Coughing up blood
  • Skin Lesion on the face or scalp that is growing or changing color

What are the treatment options?

While Dr. Young does NOT perform cancer surgery, he will ask about your medical history, and examine your head and neck. He may perform (or recommend) an endoscopy, which is a procedure that inserts a small tube with an attached camera through your nose to look inside your throat, voice box, and the opening of your esophagus.  In addition, he may order tests to help diagnose your neck mass, such as a CT, or MRI, (if needed) to get a more detailed picture. He or the primary physician will then coordinate the appropriate referral for definitive management.

Jay Young, MD

Dr. Young specializes in ear disease, nasal airway obstruction, voice and swallowing disorders, minimally invasive sinus surgery, sleep apnea surgery, facial plastic and reconstructive surgery and more.

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