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Persistent Sore Throat Infection? Here’s What To Do

What started as a little tickle in the back of your throat can quickly become incredibly painful.

Sore throat pain can simply remain an annoyance, or it can worsen to the point of interfering with eating, drinking, and even swallowing.

What Causes a Sore Throat?

Sore throats have many different causes.

Some sore throats are signs of contagious diseases, like those caused by viral or bacterial infections. At other times, a sore throat is more of a nuisance than a health concern.

Viral and Bacterial Infection

By and large, the most common cause of throat pain is an acute throat infection. These sore throats are caused by a virus or bacteria.

Usually, you can identify this as the cause when you also have symptoms like a fever, a runny nose, and just not feeling like yourself.

Your doctor might perform a throat culture by rubbing a cotton swab across the tissue in your throat and sending this swab to a lab to see which bacteria or virus is causing your infection.

These acute infections don’t usually turn into recurrent throat infection. Most resolve in a few days with or without treatment.

Recurrent throat infection is usually caused by strep. Strep throat is an infection caused by a bacteria called Streptococcus pyogenes. The bacteria gets stuck in the tonsils and causes swelling, pain, and fever.

persistent-sore-throat

Other Causes of Sore Throat

Seasonal or environmental allergies can cause a persistent sore throat, especially when pollen counts are high. Environmental allergies are a leading cause of sore throats in the spring and early summer.

Sore throats are common with any type of runny nose. The mucus dripping down the back of the throat can result in irritation and pain.

In patients who deal with gastroesophageal reflux disease (GERD), their stomach acid causes a burning pain their throat.

When a Sore Throat Is More Serious

Though this is rare, a persistent sore throat can be the first sign of oropharyngeal cancer (throat cancer).

In the past, most people believed that throat cancer only affected lifelong smokers and heavy drinkers.

Throat cancer wasn’t considered something younger adults needed to worry about. Avoiding smoking and alcoholism were viewed as surefire ways to avoid throat cancer.

In the past several years, though, we’ve seen an uptick in younger adults diagnosed with throat cancers. Most of these cancers are due to the human papilloma virus (HPV), a common virus that is usually sexually transmitted.

If you have a persistent sore throat, it’s best to see an ENT doctor to rule out more serious causes, like oropharyngeal cancer.

What To Do if You Have a Throat Infection

Most sore throats only last a few days. If you have other symptoms of a viral infection (runny nose, watery eyes, cough), your illness will likely run its course in a few days.

Home remedies can help alleviate some of your misery in the meantime.

What If I’m Not Better in a Few Days?

Using a flashlight and a mirror, look in the back of your throat (or have a family member do this for you). Is there any yellow pus in your throat or on your tonsils? This is a hallmark sign of strep throat, especially when you also have a fever.

If you think you have strep throat, or if home remedies just aren’t cutting it after a couple days, don’t hesitate to contact your doctor. They’ll be able to tell you what’s really going on.

Ask Your Doctor if You Need Antibiotics

It’s important to see a doctor soon when you have signs of strep throat. Even though this infection is easy to treat with antibiotics, untreated strep can be dangerous.

Left untreated, strep infections can spread to other parts of the body. This can lead to more serious issues, like rheumatic fever, heart problems, kidney failure, and severe joint pain.

Tonsillectomy for Recurrent Throat Infection

If you’ve had strep throat six or more times in one year, you and your doctor may need to consider removing your tonsils. This can also help if you’ve had strep more than three or four times a year for several years in a row.

If you receive antibiotics for strep several times and it keeps recurring, discuss a tonsillectomy with your ENT doctor.

A tonsillectomy is usually an outpatient procedure that lasts about 20-30 minutes. It’s performed under general anesthesia, so you’ll be asleep the whole time.

A tonsillectomy leaves no visible scare, since the tonsils are removed through the mouth. But there will be some scabbing in the throat while the area heals.

You’ll also need to be careful to stay hydrated after the procedure. You’ll want to stick to soft foods until your throat is feeling better. (Ice cream and mashed potatoes for the win!)

Most cases of strep throat involve the tonsils, so this surgery can drastically cut down on the number of sore throats you get each year.

What’s the Outlook for Someone with Recurrent Throat Infections?

Even though recurrent throat infections are miserable in the moment, there’s a light at the end of the tunnel! The outlook is excellent.

The vast majority of cases of strep throat are successfully treated with antibiotics. More chronic cases are almost always successfully treated with tonsillectomy.

Dealing with a Persistent Sore Throat?

At ENT Associates of Lubbock, we treat the whole family, from children on up through Grandma and Grandpa!

No matter what’s causing your recurrent sore throat, we can help you get to the bottom of it so you can get back to your life! Whether your recurrent throat infection is caused by strep, allergies, reflux, or something else, we’re here to help.

Give us a call to schedule a consult today!

How To Stop Snoring: A Doctor’s Comprehensive Guide

If you’re a chronic snorer, you’re probably used to ribbing from your spouse about how long they had to listen to your snores at night. You might have even earned an endearing nickname — like Tyranno-SNORE-us Rex.

In our ENT practice, it’s extremely common for patients to ask how to stop snoring because someone else is fed up. In fact, it’s much more common for snoring to bother household members rather than the snorer, who is usually blissfully unaware!

If it’s not interfering with your sleep, is snoring anything to worry about? Is snoring itself harmful?

Or has snoring become a relationship problem, more than a medical one, for you?

Is Snoring a Medical Problem?

Snoring isn’t necessarily a sign of a severe medical problem. In lots of cases, snoring really is more of a social problem than a medical one.

Making a bit of noise while sleeping is natural. This happens because the airway collapses a little when we lay down. As a general rule, men tend to snore more than women, though of course there are exceptions!

Sometimes, though, snoring can be a sign of sleep apnea. Sleep apnea is a sleep disorder that means you stop breathing many times per hour every night and can be accompanied by loud snoring.

Sleep apnea can make you feel really groggy during the day. Some patients don’t even realize how serious their exhaustion is until they doze off behind the wheel!

What Causes That Ruckus?

So you know that you snore, and you want to learn how to stop snoring. But what causes that maddening sound in the first place?

Snoring is just the sound of the tissues in your upper airway vibrating against each other. This happens when airflow becomes limited.

When you’re awake, your body is usually upright. Your muscles keep your airway open without you having to think about it.

But when you sleep, your muscles relax and your airway collapses slightly inward. Your tongue can fall to the back of your throat as well.

Common Causes of Snoring

This airway collapse and tongue movement can happen to anyone, but some people are more susceptible to snoring than others.

Probably the most common cause of snoring is weight gain. As we age, it’s easy to put on a few pounds without noticing much. But being heavier means more weight pressing on your airways when you lie down, and that can mean a more noisy snooze.

Additionally, some people like to have a couple beers or glasses of wine before bed to help them relax. But studies show that drinking alcohol in the evening actually leads to poorer sleep quality. So you may find that your snoring is worse after you knock a few back.

Blocked nasal passages also tend to worsen snoring. Nasal blockage can be due to allergies, nasal polyps, or the common cold.

And like many other physical symptoms, genetics can play a role in snoring too. Some people are just born with anatomical differences in the ways their jaws are shaped that can lead to snoring. People with larger tongues are also more prone to become snorers.

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How To Stop Snoring

If you’re a chronic snorer who wants to stop, it’s best to see your ENT doctor to make sure the snoring is harmless. Your doctor can help you rule out sleep apnea as the cause of your snoring.

Once you know you’re dealing with run-of-the-mill snoring, you can make some lifestyle changes to help you snooze silently.

Weight Loss

Losing weight can decrease snoring by taking pressure off your upper airway.

Reduce Alcohol Consumption

Specifically, cut back on evening drinking. If you’d like to enjoy an adult beverage, try to cut yourself off four or five hours before bed so you can sleep well.

Consider a Visit to Your Dentist

Your dentist may recommend a dental splint for your snoring. Dental splints are small devices that fit inside your mouth to pull your tongue away from the back of your throat.

Ask your dentist if this option could be right for you, but know that sometimes dental splints can cause teeth to shift and do not work for all types of snoring.

Change Your Sleep Position

Many patients (and patients’ spouses!) report that their snoring is more severe when they sleep on their backs. Most of us are pretty attached to our sleeping positions, but try sleeping on your side or stomach and see if that helps.

What if I Still Snore After Making All These Changes?

If you’ve tried the lifestyle changes in the last section and still struggle to get a good night’s sleep, talk with your ENT doctor about a sleep study. Sleep studies help doctors pinpoint the issue that’s causing your snoring.

If your care provider determines that sleep apnea is causing your snoring, they may prescribe a continuous positive airway pressure (CPAP) machine to keep your airways open at night.

Some surgical procedures can also help you stop snoring, depending on the cause. In children and adults, large tonsils can cause snoring. A tonsillectomy is a simple procedure that can help stop childhood snoring.

Removing anything that blocks your airflow can lead to more rest. A septoplasty procedure straightens your septum — the bone and cartilage that divides your nose into a right and left side — if it’s crooked and causing breathing problems.

Removing nasal polyps can also restore good airflow.

Very rarely, a procedure called uvulopalatopharyngoplasty (UPPP) can be a helpful option. This mouthful of a surgery is a little more invasive than the others and removes excess tissues in the throat, such as part of the soft palate in the roof of the mouth.

A newer procedure called Inspire might also be an option. Inspire is for snorers who can’t tolerate a CPAP machine.

Inspire is a very small device that’s placed in the upper chest (like a pacemaker). Every time you take a breath, a very small implanted wire stimulates the nerve that controls your tongue. This makes your tongue move just enough that air can easily pass through — silently.

Want To Stop Snoring?

Have you been wondering how to stop snoring? Give ENT Associates of Lubbock a call today today to find out what’s causing your snoring and what you can do about it.

Nasal Polyps: Causes, Symptoms & Treatment

If you’re an allergy sufferer, you probably know the feeling of waking up with nasal blockage on a regular basis. You’re no stranger to complaints about your snoring, and you dread the spring and summer because of all the hay fever!

Even those of us lucky enough not to be afflicted with seasonal allergies have developed our own nasal dilemma in the wake of the COVID-19 pandemic.

Is this runny nose just a cold? Is it an allergy to the high pollen count? Or is it triggered by all these lovely West Texas dust storms?

Is your decreased sense of smell just because of your stuffy nose, or is it a sign of COVID?

Nasal problems can be confusing because so many of them have similar symptoms. Nasal polyps are no different.

What Exactly Are Nasal Polyps, and Where Do They Come From?

Essentially, nasal polyps are just swollen tissue in the nose that blocks airflow. And they don’t always have one, specific cause.

About one third of the cases of nasal polyps we see in the office are in patients with allergies or asthma.

In other cases, the nasal tissue swells because the patient is sensitive to a nonsteroidal anti-inflammatory drug (an “NSAID”) like ibuprofen, taken for pain or fever. A syndrome called Samter’s triad includes three main symptoms: asthma, nasal polyps, and sensitivity to aspirin.

Less commonly, people who have autoimmune issues or difficulty regulating their immune systems can develop nasal polyps. Children with cystic fibrosis can as well. Churg-Strauss syndrome can also lead to the formation of nasal polyps, but this is an extremely rare disorder.

nasal polyps

What Kinds of Symptoms Do Nasal Polyps Cause?

Several common symptoms may indicate nasal polyps:

What Else Could This Be?

An ear, nose, and throat (ENT) doctor can diagnose nasal polyps by using a small lighted camera to look in your nostrils. Because nasal polyps are easy to diagnose, the risk of misdiagnosis is pretty low.

If you think you might have nasal polyps, it’s important to get them checked out by an ENT doctor. Swelling in the nose can have a few other (possibly more serious) causes.

Rarely, nasal swelling can indicate a benign (noncancerous) or malignant (cancerous) tumor in the nostril.

Even more uncommon, nasal encephaloceles occur when a portion of the brain tissue or brain lining descend down into the nostrils. Fortunately, nasal encephaloceles are extremely rare!

These rare but serious conditions show why it’s always good to see your doctor.

The good news is that nasal polyps are usually not dangerous at all. Generally, they’re just a result of too much inflammation in the nose.

What Are My Treatment Options for Nasal Polyps?

Nasal Spray Medications

Your ENT doctor may prescribe a topical steroid or a nasal antihistamine.

These medications come in a bottle, and you spray them up into your nose. They can control the inflammation caused by allergies and asthma and help the polyps decrease in size.

Allergy Injections

When polyps are a little more severe, receiving allergy shots is also an option for treatment. There are also new injectable biologic medications that have shown great promise in controlling extreme cases of nasal polyposis, often called polypoid sinus degeneration.

Endoscopic Sinus Surgery

When your nasal polyps block up your sinuses and make it impossible to breathe through your nose, endoscopic sinus surgery is usually the way to go.

Endoscopic sinus surgery is generally a quick and routine outpatient procedure.

While you’re under general anesthesia, the surgeon inserts a small scope with a tiny camera into your nose and back into your sinus cavities (the open spaces behind your nose and cheekbones.) Your surgeon then uses very tiny surgical tools to remove the polyps and restore airflow. 

Because this surgery is performed through the nostrils, there are no surgical scars. You can expect to be resting at home in your bed just a few hours later!

Often your doctor will prescribe a nasal spray treatment after the surgery to control the regrowth of nasal polyps.

Can I Do Something To Keep from Getting Nasal Polyps?

The best way to prevent nasal polyps is to be proactive about your allergy care.

Especially if you deal with asthma and seasonal allergies, be sure to check in regularly with your ENT doctor. Don’t skip out on doses of allergy shots to save time. These treatments can help keep inflammation at bay and sometimes prevent polyps from forming in the first place.

If you suspect you may be sensitive to nonsteroidal drugs and aspirin, avoid these. (Be sure to chat with your doctor about other ways to treat pain and fever.)

Unfortunately, there’s no magic bullet to prevent nasal polyps from forming or recurring. Some of us are simply more susceptible to polyps than others.

Do You Think You Might Have Nasal Polyps?

Have you noticed your nose becoming progressively more congested? Are you having a harder time identifying smells even though your COVID test was negative? Or do you have uncontrolled allergies or asthma?

Nasal polyps are fairly benign and harmless, but it’s always a good idea to rule out something more serious. Nasal polyps are also fairly easy to treat, so there’s nothing to lose!

If you blow your nose a few times and still feel like something is blocking your nasal passages, give us a call. An ENT Associates of Lubbock physician can examine your nose and see if nasal polyps are the culprit. We can also help you identify the nasal polyp treatment combination that’s right for you.

If you have uncontrolled allergies or asthma, we can help you treat those, too. Prompt treatment of allergies and asthma is key in preventing future polyps. Contact our office today to schedule a consultation.

When to Worry About Your Lingering Sinus Infection

Sinus infections have a way of making time stand still… in a bad way. When you’re constantly congested, battling headaches, and feeling sinus pressure, even a short duration of sickness can feel like it’s never going to end.

What if it doesn’t? If your lingering sinus infection becomes chronic, it may be time for more aggressive treatment.

Here’s what you need to know about sinus infections and when it’s time to take the next step in treatment.

Sinus Infections, Explained

Most infections in the nose are viral upper respiratory tract infections that resolve within 10 days.

However, if you have persistent colored nasal drainage coupled with extensive symptoms like facial pressure, headache, or fever for more than 10 days, it’s time to see your doctor. You may be experiencing a lingering sinus infection that requires medical treatment.

Lingering Sinus Infection or Chronic Runny Nose?

A lingering sinus infection is different from a chronic runny nose. Chronic runny nose typically comes from allergies or other irritants in the air. However, this can turn into an infection over time.

When the sinuses become infected, the allergies, irritants, or viral cold have caused swelling in the nose that’s blocked the drainage pathways. Consequently, fluid and mucous accumulate in the sinuses, where it has become infected with bacteria.

If you’ve been sick more than 10 days and begin to experience other symptoms like facial pressure, headache, and fever, you’re dealing with more than a chronic runny nose.

What the Treatment for Sinus Infections?

In order to eradicate the infection, you’ll need an antibiotic.

Some people continue to experience a lingering sinus infection even after antibiotics. Sinuses are considered a closed cavity. Removing infection from a closed cavity can require more prolonged antibiotic usage compared to infections that occur in an open cavity (like strep throat).

A sinus infection might require 2-4 weeks of antibiotics plus additional methods to encourage drainage of the sinuses. For a sinus infection to clear completely, we often recommend saline sprays, topical steroid sprays (like Flonase), and decongestants in addition to an antibiotic.

How Long Do Sinus Infections Last?

Many variables affect the duration of sinus infections. Most last more than 10 days, but when a sinus infection lasts more than twelve weeks, it is considered chronic sinusitis.

If after 10 days, your symptoms have not improved, see your primary care doctor. You may have an acute sinus infection.

If it lasts four weeks, you potentially have a sub-acute sinus infection that needs more aggressive treatment.

If symptoms last over 12 weeks, you’re likely dealing with a chronic infection. After such prolonged symptoms, it can be difficult to distinguish sinus headaches from migraine headaches from severe allergies. After 12 weeks, diagnosing and treating the issue requires the medical expertise of an ENT.

lingering sinus infection

When To Visit an ENT

You may opt to visit an ENT if your sinus infection symptoms last more than one month. However, when a lingering sinus infection after antibiotics lasts more than 12 weeks, it’s definitely time to see a specialist.

If your doctor has treated you with antibiotics, saline, steroid sprays, antihistamines, and decongestants and you’re still not better, you’ve entered into a confusing area. You need a thorough exam of your sinus pathways with a fiberoptic scope and a CT scan to properly diagnose the problem.

Related: What Does An ENT Do At Your First Appointment?

If at any point you’re not sure what’s going on and your primary care doctor isn’t sure what’s causing the symptoms, see an ENT for a more specialized exam.

How to Treat A Sinus Infection At Home

In the first two weeks of a sinus infection, patients may use saline sprays, over-the-counter steroid sprays like Flonase, and over-the-counter decongestants.

After 10 days, if the drainage is still colored, an antibiotic is likely necessary. There’s no homeopathic alternative to antibiotics. However, saline spray, topical steroid sprays, and decongestants work well with antibiotics to clear most infections.

Will Sinus Infections Resolve If Left Untreated?

Lingering sinus infections should be treated before they escalate into a more serious issue. If a sinus infection is untreated, it may begin to impact the surrounding areas: the eyes and brain.

Untreated sinus infections can result in orbital and intracranial complications. Orbital refers to an infection that moves from the sinus into the eye. It can even result in an abscess in the eye area, which threatens vision.

Intracranial infections refer to infection in the brain. These can ultimately progress to become a brain abscess or meningitis if left untreated.

Because the sinuses are located close to the eye and brain, the most serious complications of an untreated sinus infection affect these important structures.

How An ENT Treats a Sinus Infection

If you have a lingering sinus infection after antibiotics, an ENT doctor often elects to be more aggressive in treatment than a primary care physician. They may prescribe longer courses of antibiotics, stronger medications, or recommend a procedure to open the sinuses.

If you have persistent sinus problems, the sinuses must first be unblocked. Sometimes, that’s done through a simple balloon sinuplasty and irrigation. Other times, unblocking the sinuses requires a more aggressive procedure like endoscopic sinus surgery. We opt for this procedure when the sinuses become so blocked, tissue and bone need to be removed to create a wider opening.

If you’re dealing with a lingering sinus infection, don’t let it progress to a more serious issue. Call your ENT so they can discover what’s at the root of your problem and find a treatment to bring you relief.

Tonsillectomy Scabs: A Surgeon’s Post-Op Guide

Prepping for your tonsillectomy is easy, but thinking about recovery is a little more complicated. Among the primary concerns of patients following this procedure are the tonsillectomy scabs that will form as their throat heals.

To help you navigate your post-op tonsillectomy journey, we’ve answered the top 10 questions we hear about tonsillectomy scabs:

What are tonsillectomy scabs anyway? Are they inevitable?

After a tonsillectomy, a scab is a necessary part of the healing process. The scab forms a layer of inflammatory cells as part of our immune response to a wound.

Tonsillectomy scabs form for the same reason scabs form on the outer layers of the body — to heal the wound. It’s similar to what would happen if you had an abrasion on your knee. A scab would form and eventually come off. When the scab comes off, it might bleed. Similarly, when a scab forms in your throat and then comes off, it may cause some bleeding.

Usually, minor bleeding from tonsillectomy scabs is not a major problem. It’s just the way your body heals the wound.

What do tonsillectomy scabs look like?

Scabs turn a shade of white after a tonsillectomy. Because it’s in the throat, it stays softer than a scab would when it’s exposed to air. Typically, the whitish scab is made of a coagulum of many different kinds of cells.

Related: Adult Tonsillectomy: What To Expect & How to Prepare

How long do tonsillectomy scabs last?

Most scabs only last 5-10 days. Then, they naturally flake off.

Tonsillectomy scabs may last longer on larger wounds created when large tonsils are removed. Also, people who have poor nutrition may heal slower than people who maintain a healthy diet.

tonsillectomy scabs

Can tonsils grow back?

While this may sound like a silly question, it’s actually legit.

Most ENT doctors completely remove the tonsils, including a surrounding capsule. However, there’s a different tonsil tissue on the base of your tongue called lingual tonsils. As the throat heals, the lingual tonsil can move into the lower area where the tonsil tissue was — and that’s what most people call a regrowth.

There is a less-popular technique of tonsil removal called sub-capsular dissection that purposefully leaves tonsil tissue behind. This method can lead to another form of tonsil regrowth.

While some regrowth is possible, tonsils will not completely return after a tonsillectomy.

Are tonsillectomy scabs painful?

Tonsillectomy scabs are not necessarily painful in their own right, but the healing process can be. The wound in the throat is uncomfortable as the body responds with inflammation and seeks to repair and re-cover nerve endings exposed in the procedure. This discomfort typically peaks around day seven after a tonsillectomy.

Will I see blood?

Most of the time, blood indicates the coagulum (or scab) has come off. When this happens, patients typically experience light bleeding. We recommend gargling ice water to constrict blood vessels and stop bleeding.

When should a patient call a doctor or visit the ER?

Post tonsillectomy bleeding can sometimes be severe. In these cases, it may be a small artery that’s bleeding (not the scabs). We consider bleeding severe when patients see enough bright red blood to fill a portion of a cup. If you experience a severe episode of bleeding, call your doctor immediately.

If bleeding happens once, it still may be a symptom of a scab separating from the throat. However, if severe bleeding happens twice, it’s likely an artery that’s bleeding.

If there are concerns about excessive bleeding, particularly if it happens twice, head to the emergency room. It’s always a good idea to call your ENT on the way to alert them to the issue.

What helps tonsillectomy scabs heal faster?

Good hydration and healthy nutrition help your body heal optimally. However, a healthy diet can be difficult while on a post-op liquid diet. As much as possible, opt for nutritional foods and beverages that are still gentle on the throat.

Typically, adults need 6-8 glasses of water a day. A child needs 3-4 glasses. If urine is dark or infrequent, you need more water. Beverages with electrolytes can be helpful with hydration as well.

While on a liquid diet, don’t forget to consider the nutritional value of what you drink. Smoothies and broth-based soups can help provide your body with the nutrition it needs to support healthy healing.

Also, avoid smoking, which delays healing.

Is bad breath normal after a tonsillectomy?

Bad breath is a normal post-op symptom. As the body responds to the wound in the throat, it typically produces bad breath.

Do patients need antibiotics after a tonsillectomy?

Post-operative antibiotics have been a debated issue among ENTs. In the past, some studies showed these to be beneficial in decreasing fever and bad breath while increasing wound healing rates.

More current research shows antibiotics are not completely necessary after surgery. Consequently, most doctors have an individual recommendation based on their experience with patients and what typically produces the best results.

Related: The Top 3 Reasons You May Need to Remove Your Tonsils

After your tonsillectomy, scabs are an inevitable part of the healing process. However, with the right care, hydration, nutrition, and awareness, your body will heal and you’ll be fully recovered within two weeks.

Have any other questions? Give us a call and we’ll help you navigate your tonsillectomy.

Chronic Runny Nose: At What Point Should You Worry?

You shouldn’t have to deal with a constantly runny nose.

Sure, it’s a minor inconvenience compared to other health issues. But when the snot won’t stop, a chronic runny nose can be extremely frustrating. You constantly have to sniff in, clear your throat, blow your nose, and keep a tissue on hand to manage the drainage.

Some people also deal with a sore throat, itchy eyes, and an itchy nose.

When kids experience a constantly runny nose, they start practicing the “allergic salute.” We’ve all seen it – it’s when they compulsively catch their nasal drainage with the back of their hand. Some kids wipe their noses so often, they actually create a crease in the nose.

Fortunately, we have ways to help eliminate the drainage — for kids and adults. If you’re dealing with a chronic runny nose, we’ll identify the source of the problem and find a treatment that puts a stop to it.

Causes of a Chronic Runny Nose

A runny nose can be a symptom of infections or allergies. When you discuss your symptoms with an ENT, they may use words like rhinorrhea or rhinitis to describe what you’re experiencing. Let’s start breaking down the words:

Rhino: Nose

Rhea: Drainage

Itis: Infection

Rhinorrhea, or nasal drainage, describes all mucous drainage from the nose — allergies or infection.

Clear drainage typically is triggered by allergies. When environmental elements like dust, cigarette smoke, perfume, or pollen irritate your nasal cells, your immune system responds with drainage. Essentially, as your body tries to attack the irritants, it produces mucous and results in a runny nose.

Colored drainage usually indicates infection and could also be called rhinitis. Infections occur when your nasal cavity becomes infected with bacteria or a virus. As your body tries to fight the infection, it produces colored mucous.

While most drainage indicates infection or allergies, ENTs are also alert to rare cases of CSF rhinorrhea. Cerebrospinal fluid rhinorrhea occurs when people spontaneously develop drainage of brain fluid through the nose. Although extremely rare, your ENT will check for this as well and follow a specific course of treatment if they suspect it.

Treatments for a Runny Nose

Depending on the cause of the drainage, we then progress with a specific treatment. The main treatment for either allergies or infection is medicine.

For allergies, the occasional dose of a mild antihistamine (Claritin, Zyrtec, Allegra) helps block the body’s allergic response. But we don’t recommend taking these medications daily, as these medicines can overly dry out the sinuses. If you dry your secretions too much, you’ll actually promote sinus infection. We want our patients to gain relief from the drainage without interfering with the body’s ability to flush out the irritants when necessary.

If an occasional antihistamine isn’t enough, we add a topical steroid spray to the medication regimen. Until recently, these were only available by prescription, but very effective medicines like Flonase and Nasacort are now available over-the-counter. When patients use these medications during allergy season, they effectively block the allergic reaction. These topical steroid sprays deliver great results without putting the stress of steroids on the rest of your body.

Both antihistamines and topical steroid sprays can be used for adults and children (under the direction of a doctor).

For infections, an ENT will work to identify what caused the infection. If the infection was induced by allergies, they’ll not only treat the infection but work to help you manage allergies to prevent a recurrence. Additionally, some of the same medications that help manage allergies may also help reduce the symptoms of infection until it clears.

chronic runny nose

How to Relieve A Chronic Runny Nose… Starting Now

You don’t have to wait for a doctor’s visit to deal with your runny nose. You can begin managing your symptoms at home immediately.

Start by avoiding your triggers. If you’ve been to an allergist and identified what’s causing an allergic reaction in the past, you know what you need to avoid. It could be a pet or a type of pollen. Avoiding it is the first step.

If you’re unable to avoid your triggers (or unable to avoid all of them!), mild antihistamines and topical steroid sprays are your next step. These are readily available over-the-counter.

You can also begin to identify what’s happening with your child. If your child is always rubbing their nose, they likely have allergies (not an infection). Rather than turn to an antibiotic, try a more appropriate allergy medication to address their issue. Consider using children’s forms of the medications listed above — even the topical steroid sprays.

But don’t overdo it. Remember, a runny nose isn’t bad.

In fact, some drainage is good. For the nose to stay healthy, it needs moisture. A daily dose of an antihistamine can dry out the nasal cavity too much. If these medications seem too strong, try saline as a way to moisturize (and decongest) the sinuses without drying them out.

When to call the ENT

It’s smart to call an ENT if you think you may have a problem — then you’ll learn how to most appropriately treat it.

Is it allergies?

Do you have an anatomic issue like a deviated septum, polyps, or swollen turbinates?

Are you dealing with a chronic sinus infection?

We’ll help you figure out what’s causing the issue so we know the best treatment. If medications don’t fully address your problem, we also have procedural treatments to help alleviate chronic runny nose like Clarifix and RhinAer. Clarifix, a minimally invasive treatment for chronic drainage, targets the source of the symptoms using liquid nitrogen to deactivate some of the nerves that carry the impulses for the nose to swell, drain, congest, and run. Similarly, RhinAer, uses radiofrequency technology to target the same nerves and help reduce your runny nose.

If you’re dealing with an anatomic issue, we have other procedures to open the nose and help you breathe better. Depending on the issue, we can straighten the septum or shrink turbinates to open the passageways. If you have obstructions like these in the nose, you can’t tolerate even mild allergies.

There’s no need to keep carrying tissues or compulsively have to blow, sniff, or cough to manage your drainage. If you’re dealing with a chronic runny nose, an ENT can find a solution to provide you relief.

How to Tell if Your Tooth Extraction is Causing Your Sinus Problem

Recovering from a tooth extraction is quite a process. You have to carefully navigate what to eat, how to drink, and how much activity you should do as you allow your body to heal. But you also may need to pay attention to how your sinuses are reacting, especially if you had upper molars removed.

A sinus infection after tooth extraction occurs most commonly when the maxillary molars are removed. These upper teeth in the back project into the sinus cavity. When you need any of these teeth extracted, or if you have an infection or cavity in a maxillary molar, you may notice your sinuses react.

Infections can spread from the mouth to the sinuses for several reasons. For some, a cavity may extend into the center of the tooth — which holds the tissue that connects it to the root. This decay then spreads into the sinuses and causes an infection. Other people may develop an abscess at the base of the tooth. When it’s in the right location, the bacterial infection can spread to the sinuses.

A sinus infection after tooth extraction can also occur because a connection between the mouth and sinus cavity was opened.

If you’re dealing with a sinus issue after dealing with a dental issue, the two problems may be connected. Here’s how to tell:

Symptoms of a Sinus + Tooth Problem

It’s fairly common to have a tooth cause a serious sinus infection, but the symptoms aren’t always what people expect. Many people come in because they feel tooth pain along with their sinus symptoms. But tooth pain doesn’t necessarily indicate the sinus infection is from a tooth.

The most common complaints of those with a sinus infection after tooth extraction are:

  • Congestion on only one side of their nose
  • Yellow drainage
  • Pressure in the cheek
  • Odor in their nose

Dental infections are created by something called anaerobic bacteria — they don’t need oxygen, but they have a pungent odor. Patients typically report a strong smell that never seems to leave.

Also, these infections are often one-sided and isolated to an area above the teeth that caused the dental issue. If an X-ray shows that only the sinuses above these specific teeth are involved, the source is often a dental infection.

Interestingly, tooth pain isn’t typically a symptom. When the tooth is infected to this extent, the root dies and you don’t feel pain.

Instead, those with a link between their tooth and sinus issues might have a dental history of a crown on the tooth, cracked tooth, or deep filling. When we do the CT scan, we’ll see an abscess at the base of the tooth. If the tooth is extracted, the CT scan will show a connection between the sinuses and the mouth.

sinus infection after tooth extraction

How to Treat a Sinus + Tooth Infection

We typically begin treatment with antibiotics. However, once there’s an infection from the tooth in the sinuses, it’s difficult to eradicate with antibiotics alone.

If antibiotics are ineffective, a person may need to have surgery to open and drain the sinuses.

Additionally, they may need a root canal on the tooth to remove the abscess or a surgical repair to close the connection between the mouth and nose.

How to Distinguish a Tooth Problem from a Sinus Problem

It’s really difficult to identify if dental and sinus problems are related on your own. Sinus infections and allergies can cause tooth pain. Dental problems can trigger sinus problems. Some people have dental pain due to a bad tooth. After the tooth is pulled, they still feel pain because there’s an underlying sinus infection.

To distinguish between the two often takes a good ENT doctor. We’ll ask questions to understand your sinus and dental history, examine your sinuses with a scope, and use a CT scan (typically in-office) to get a better picture of what’s happening.

Related: What Does An ENT Do At Your First Appointment?

In fact, that’s where our expertise is — distinguishing between anatomic, allergy, sinus, and dental problems. These issues have many of the same symptoms. In order to find the real issue, we look at a patient’s history, conduct an exam, and interpret the CT scan to put together the reasons for the problems.

People who don’t get better, and still have the same symptoms recur, need an accurate diagnosis. Only then, can we really treat the symptoms in a way that will actually work.

How to Avoid a Sinus Infection After Tooth Extraction

After your extraction, the dentist will typically alert you if they see the potential for a problem to occur that would result in a hole between your mouth and sinuses. As a precaution, avoid forcibly blowing your nose so you don’t open a connection after your tooth extraction. If you blow your nose and feel air escape in the mouth, you know there’s a connection. If a hole opens up, it may have to be surgically closed.

Sinus problems can cause dental pain… and dental problems can cause sinus pain. There are a lot of nerves in the same area, and they present with many of the same symptoms. Whether you suspect a dental or sinus issue is at the root of your discomfort, an ENT will be able to help you move forward on your road to recovery.

Thyroid Surgery Scars: Everything You Need To Know

Do you fear a thyroid surgery scar more than the surgery itself?

If you’re like most patients, once they realize how rare it is to experience more serious complications in the hands of a high-volume thyroid surgeon, they start to dread the scar that will be left behind more than the operation.

After all, no one wants an ugly scar running down their neck and chest for the rest of their lives… and rightly so! Fortunately, it doesn’t have to be like that anymore. Now, with the right placement, length, and surgical closure, we keep thyroid surgery scars to a minimum.

If you’re facing thyroid surgery, here’s what you need to know about what’s happening and how your scar will heal:

Where Is The Thyroid and What Does it Do?

The thyroid is the gland in the lower neck responsible for our metabolism. There are two lobes (right and left), connected across the windpipe by a bridge called the Thyroid Isthmus.

The gland makes thyroid hormone — a hormone that’s vital to life. You literally can’t live without it. This hormone maintains our energy level. If hormone production decreases, the metabolism slows, causing people to gain weight and become sluggish.

Autoimmune thyroiditis and other thyroid issues come when people’s thyroids stop working. When this happens, we can easily replace thyroid hormone. Even if they haven’t had the gland removed, these patients take a thyroid hormone supplement. If the entire gland is removed, thyroid hormone is a necessity.

Who’s Most Susceptible to Thyroid Problems?

Women experience more thyroid problems, autoimmune thyroiditis, and thyroid nodules than men. In fact, if a man has a thyroid nodule, we can become more concerned because it’s less common and may indicate the potential for thyroid cancer.

How Will You Minimize Scarring?

We now make thyroid incisions higher and shorter to minimize the appearance of a scar. Years ago, people had long scars in the chest area from thyroid surgery. Now, we like to make the incision higher in the neck. The higher the better and often hiding it in a skin crease to reduce visibility. As we age, the skin naturally drops. The higher we place the incision, the less likely it falls to the chest area.

We also make a straight, short incision, closing the 4-5 centimeter incision with sutures below the skin. By doing so, we give our patients the finest, thinnest scar possible.

By placing the incision in a good location with a plastic surgery closure, the scar appearance ages well and very few people opt for any scar revisions later on.

Who Is Most Likely To See Thyroid Surgery Scars?

People with a history of keloids (excess scar tissue) may experience more scarring after thyroid surgery. However, the location on the neck minimizes the likelihood of keloids.

Also, people with darker skin tones may seem to have more noticeable scars due to the contrasting color of pigmentation in scar tissue and skin color. However, all scars improve with time. After our inflammatory response and collagen boost, they progress from red to white over the course of the year. As the skin continues to heal, the scar eventually will almost disappear.

Children and young adults may actually notice more prominent scarring due to their active immune systems. As people age, they won’t notice much redness or scarring because the skin doesn’t have the same degree of inflammatory reaction.

Will I Experience Swelling?

After thyroid surgery, expect mild swelling in the neck.

Some surgeons may opt to use a small drain depending on the patient’s needs. If a drain is used, there will be less fluid and swelling. Without a drain, patients may notice mild swelling which the body will eventually absorb.

To reduce swelling, patients may opt to sleep propped on a pillow or use ice packs on the incision. Swelling will resolve within two weeks.

Related: Minimally Invasive Thyroid & Parathyroid Surgery FAQ

thyroid surgery scar

Post-Op Tips For the Best Healing

After your procedure, protect the area from the sun for a few months to allow for optimal healing.

Also, only apply creams and ointments to the scar that your doctor has approved. We often see allergic rashes develop over scars when patients experiment with creams on fresh scars. Even antibiotic ointment (like Neosporin) can cause a reaction. These ointments create a problem that otherwise wouldn’t have existed.

In reality, scar care is basic. We apply Steri-Strips immediately after surgery and leave them on for one week. You will want to avoid pulling at the Steri-Strips, scrubbing the area vigorously or focusing a harsh jet of water directly on the surgical site when bathing in the week following surgery. Once the Steri-Strips are removed, patients can opt to apply vitamin E cream to help minimize scars if they choose.

Otherwise, just keep the scar clean and give it time to heal.

Don’t let fears of a thyroid surgery scar make you apprehensive about your coming procedure. Because of the way we operate and locate the incision, most patients are very happy with the thyroid scar’s appearance all in good time.

Why You Experience Vertigo & How to Know if You Need an ENT

Feeling the dizzy experience of vertigo can quickly have you reaching for the phone to call your doctor, ENT, or anyone who can help you regain your sense of stability again!

But before you call, you may want to consider what’s actually happening so you visit the right specialist who can offer the right treatment for you.

If you’re dizzy and feeling unstable, it’s time to take a look at what the real problem may be. Here’s what you need to know:

What is Vertigo and What Causes It?

Vertigo describes any abnormal sensation of movement. Many people experience whirling vertigo, a spinning sensation that makes them feel like they’re trapped on a merry-go-round. It can also affect balance.

With patients experiencing any abnormal movement sensations, an ENT will look for possible ear causes. We’re trying to determine if something may be happening in the inner ear to cause vertigo. Most often, when vertigo is caused by the ear, it comes from one of these two causes:

1. Benign Positional Vertigo

This vertigo occurs when people have little crystals that float around the inner ear. When these patients roll over or move their heads quickly, they feel a severe whirling sensation.

Benign positional vertigo is fairly common and is resolved with a simple treatment. To alleviate the dizziness, we guide the patient through a series of head positions. These positions move the crystals to a different part of the ear where they aren’t problematic.

2. Meniere’s Syndrome

Meniere’s syndrome can also indicate ENT-related vertigo. This fluid imbalance in the inner ear causes:

  1. Pressure in the ear
  2. Intermittent vertigo
  3. Hearing loss

Other Ear Related Causes of Vertigo

We also consider viral inner ear infections (called Labyrinthitis) and blood flow problems in the ear as potential causes of dizziness and imbalance.

The only way to adequately treat vertigo is to correctly identify what’s causing it. We start by understanding the patient’s history— often the most important part of the process. We also typically perform a hearing test and may recommend an MRI for some patients.

causes of vertigo

Vertigo, Imbalance, and Dizziness: What’s the Difference?

How do you know when vertigo is an ENT issue, or when something else is causing the problem?

Start by examining your own balance. Many people who come to see us for vertigo are actually dealing with balance problems. We call it a multi-sensory deficit. Balance difficulties increase with age. You lose your core strength as you get older. Plus, if you had a knee replacement or another injury, you likely feel more unsteady.

To determine if you’re dealing with a balance issue, we ask, “How do you manage in the grocery store?” If you do well, you’re likely dealing with a balance problem. When you hold on to a cart, you walk better because it’s like holding on to a walker. If balance is your primary issue, we’ll refer you to physical therapy to work on stability. We can typically recognize imbalance quickly and connect patients with the right treatment to resolve the issue.

While imbalance most often occurs from a lack of muscular stability, dizziness and vertigo have a wide range of causes.

Dizziness, an abnormal sensation of movement, can be an attribute of vertigo but can also stem from anything from medication side effects, dehydration, low blood pressure and even anxiety.

Vertigo, a whirling, spinning sensation, is abrupt and intermittent. It has a wide range of causes and can last anywhere from a few minutes to a few hours. Typically, vertigo is triggered by a change in head position.

The hallmark of inner ear or ENT vertigo is how symptoms fluctuate. Symptoms worsen, improve, then flare up again. Balance, however, tends to remain consistently difficult until therapy. If you’re dealing with vertigo, the whirling, spinning sensation is abrupt and intermittent.

In some cases, vertigo is related to neurological issues. For these patients, we eliminate other causes and provide a reference to a neurologist.

ENTs are great at finding the differences between these various problems. On the surface, it can be difficult to tell what’s going on. We work to distinguish between inner ear, balance, and neurological issues. Then, we can either begin treatment or make the referral to the right specialist.

When to Seek Help for Vertigo

If your dizziness is mild and resolves on its own, there’s not necessarily a need to seek medical help.

However, if it continues to occur or you notice other symptoms, talk to your doctor. Symptoms such as hearing loss, facial numbness, difficulty walking, or anything besides just dizziness needs to be checked out by a professional.

Not sure who to see? Visiting an ENT doctor is a good place to start, but it is often helpful to check with your primary care physician to rule out other factors of dizziness (i.e. medication issues, poor circulation, stress or anxiety). ENTs see many patients with these issues — and most of us can figure out the true source of the problem relatively fast.

ENT Vertigo Treatments

For patients dealing with ENT-related vertigo, we offer a wide variety of treatments from steroid injections to various minor and major surgeries depending on the exact needs of the patient. For patients with Meniere’s syndrome, we might recommend surgical treatments to address the fluid imbalance. For other patients, an inner ear steroid injection resolves their issue. Some patients also benefit from medications that ease the symptoms.

If your vertigo isn’t improving on its own, come see an ENT. We’ll figure out what’s going on and find the treatment that’s best for you.

The Parents’ Guide to Pediatric Myringotomy (Ear Tubes)

Only a parent who’s dealt with a child struggling with ear pain fully understands the significance of a promise of relief. The constant ear infections, discomfort, and sleepless nights leaves you looking at any and every solution that might alleviate your child’s pain. 

If you’re considering a pediatric myringotomy to relieve your child’s chronic ear trouble, here’s what you need to know. 

What is a Pediatric Myringotomy? 

Myringotomy means “lancing the eardrum” — it’s the process of making a small incision in the eardrum to drain the fluid out. Without tube placement, this incision would heal within two weeks and the problems would quickly return. When we couple a myringotomy with a tube placement, we more effectively treat the problem and prevent the return of an infection. 

In a pediatric myringotomy, we place very small tubes (slightly over 1 mm in diameter) in this small incision to keep the eardrum open for 6-12 months. These tubes ventilate the ear, making it healthier and drastically decreasing the chance of infection. 

Why Some Babies Need Ear Tubes

Chronic fluid and infection in the middle ear that doesn’t clear with antibiotics is the primary reason for a tube placement. If we continue to leave this fluid or only address it with antibiotics, we see three potential negative results: 

  1. Hearing loss, which results in language loss (especially during these early years of language acquisition)
  2. Middle ear bone and ear drum damage 
  3. GI issues or oral thrush from repeated antibiotic use

Tubes are not specifically meant to drain fluid. Instead, as they ventilate the ear, it gets healthier and the ear drum resumes normal function. By placing a tube in the ear, we hope to ventilate for a long enough period that the child grows out of this stage of repeated infections.

How To Know If You Should Consider a Pediatric Myringotomy

As with any child health concern, start with the guidance of a trusted pediatrician. Pediatricians are conservative, giving ample time for the ears to heal with antibiotics before making a reference for tube placement. 

Once your pediatrician refers you to an ENT, we’ll be persistent in looking for fluid on the ear and signs of multiple infections. We conduct pediatric diagnostic tests for a myringotomy such as pressure testing, flat tracings, and conductive hearing loss to check for fluid. We look for confirmatory evidence in these pediatric diagnostic tests to validate the diagnosis of recurring ear infections before we consider a myringotomy. 

Benefits of Ear Tubes 

If a child has chronic fluid and infections, the pain can last for months. After a tube placement, these children experience improved hearing and decreased damage to the ear. 

Plus, they’re finally able to stop taking the antibiotics that may be causing additional issues.  

Risks of Ear Tubes

This is a short procedure with minimal risk. The procedure only takes about ten minutes. 

During the procedure, we use a mask for anesthesia. Any use of anesthesia comes with risks; however, we minimize these risks by conducting the procedure at a surgical center under careful monitoring of an experienced Anesthesiologist.

We do not intubate or use an IV for a myringotomy. 

what to expect from pediatric myringotomy

How to Prepare for Your Child’s Pediatric Myringotomy

We like to start these procedures early in the morning as patients cannot eat or drink for several hours prior to surgery. We don’t want children to wait and get fussy as the day progresses, so we usually begin surgery at 7 am. Be ready to get up early and feel free to pack a bottle, snack or juice to give your child immediately after surgery!

Other specifics will be addressed by the surgical center. Make sure to complete all paperwork and discuss any other questions you may have before the procedure. 

What to Expect During a Myringotomy

The procedure is very quick. We place a mask on the face, and the child goes to sleep. Using a microscope, we clean the ear of wax and prep it with rubbing alcohol. 

We make a small incision in the front lower quadrant of the eardrum to allow for optimal healing. After we make the incision, we suction the infected fluid out and slip the tube in. We use a small grommet tube that typically remains about one year before they work their way out of the ear on their own.

If a child has more chronically diseased ears the tubes may come out sooner and may require repeat tube placement. Long-term tubes that will eventually require removal are also an option for a very small number of patients, but we like to avoid these for as long as possible.

Is a Myringotomy Painful? 

The procedure is not painful, but children may wake up disoriented and fussy. This is typically more from anesthesia than pain. Typically this disorientation lasts about 15 minutes, then they feel normal later in the day. 

What to Expect For Your Child’s Recovery 

Recovery is rather simple for a pediatric myringotomy. Contrary to expectations, there’s no need to keep water out of the ear. The tube has such a small diameter, water can’t enter the tube or cause infection. Because of this, a child can bathe or swim as normal. 

However, if a child has another infection in the body, they might experience a middle ear infection as well. They’re actually more likely to get an infection from within themselves than from water. If the ear has drainage, we treat that with an antibiotic steroid. For the most part, drainage is a sign of infection and requires treatment. 

Two weeks after the procedure, we schedule a follow-up appointment to repeat the hearing test to make sure hearing is normal. 

Then, every 6-12 months, we schedule a follow-up to check on the ears until the tubes come out and the ears have fully healed. For some children, these problems resolve around age two. For others, problems may last longer, even into adulthood for a select few. 

If you’re trying to determine the best solution to your child’s chronic ear infections, consider visiting an ENT to discuss your options. After they evaluate the pediatric diagnostic tests for a myringotomy, they’ll be able to make a recommendation that specifically addresses the needs of your child to provide them the relief you both need. 

Ask a Surgeon: Should I Get Septoplasty and Rhinoplasty Together?

Some things work better in pairs:

Peanut Butter and Jelly
Woody and Buzz
R2-D2 and C-3PO
Mario and Luigi
Mac and Cheese
Fred and George Weasley

But what about Septoplasty and Rhinoplasty? 

In many cases, yes! Septoplasty and rhinoplasty can complement each other extremely well. Septoplasty corrects the structure of the nose, allowing for a rhinoplasty that better modifies the external appearance.

Together, they can result in significant functional and cosmetic improvements. While some people may choose one or the other, in many cases, rhinoplasty and septoplasty are the perfect duo. 

Rhinoplasty Vs. Septoplasty

What is a septoplasty?

A septoplasty is the medical procedure that straightens the septum of the nose. The septum divides the nose into two halves — it’s like a flat wall made of bone and cartilage. Ideally, we want a straight septum, but the septum can be crooked to one side and result in sinus problems. 

A straight midline septum allows for smooth airflow in our nostrils, but a crooked septum can cause turbulence. Think of it like the airflow around an airplane. “Laminar” is a smooth airflow we all want when we’re flying. Turbulent air flow means the air moves in a circular motion and makes for the bumpy ride. In the nose, turbulence causes drying currents and breathing difficulties. This turbulence also creates snoring issues. Many people who get their septum straightened have a smoother “laminar” airflow. They snore less, breath better, and the sinuses work as they should… it’s a smoother flight. 

A septoplasty allows us to straighten the septum to improve the function of the sinuses. It’s done through a small incision in the front of the nose with minimal removal of bone and cartilage. 

What is a rhinoplasty?

This is the cosmetic procedure that allows us to change the external appearance of the nose. When someone wants to correct the hump, crookedness, or visible injury on their nose, we elect to use a rhinoplasty. This surgery on the outside of the nose can involve changing the shape of the cartilage at the tip of the nose or changing the nasal bones. Essentially, it’s a conservative re-breaking of the nose. 

The primary difference between rhinoplasty and septoplasty is the purpose. A septoplasty is a functional procedure while a rhinoplasty is cosmetic, but there is some crossover. 

How Septoplasty and Rhinoplasty Work Together

These procedures can complement each other well. To get a good result on the rhinoplasty, some patients need to have the septum straightened as well. There’s an old saying that may make more sense once you understand the septum: “As the septum goes, so goes the nose.” 

Essentially, straightening the septum inside helps the surgeon better straighten the outside as well. If the septum is crooked, the outside will be crooked. But that isn’t always the entire problem with the outside. You may need to remove a small hump, realign the bones of the outer nose, or work on the cartilages on the tip of the nose. But a key part of this procedure is first straightening the septum — which makes it logical to do these procedures together. 

A patient may opt not to have a septoplasty and rhinoplasty together for a few reasons:

1. They don’t want anything to change externally. 

2. The patient is young and shouldn’t have rhinoplasty, but the septum is causing severe sinus problems. 

You can do the septoplasty by itself. If the septum is straight, you could do the rhinoplasty by itself. But if the septum is not straight, a septoplasty should accompany the rhinoplasty.

Think of it like a home renovation. If you have a solid structure, you can focus on the cosmetic updates. But if the subfloor is weak and the walls aren’t plumb, you have to repair the structure before you can move to the decor and paint. 

Septoplasty and Rhinoplasty FAQs

Is septoplasty covered by insurance? 

Generally, a septoplasty is covered by insurance. 

Rhinoplasty procedures tend to not be covered by insurance because it’s considered a cosmetic procedure. This can be a hindrance for many patients. While we can do a septoplasty without a rhinoplasty, when a patient has a significant cosmetic deformity, we strongly recommend coupling these procedures together. If there are financial concerns, wait until it’s possible to do them together. If you fix one without the other, it’s never as ideal of a solution. 

How long does the procedure take? 

A septoplasty is a relatively quick procedure that takes 30 – 45 minutes.

A rhinoplasty can take a little longer because of the finesse involved. Even one millimeter can make a difference in the outward appearance. Expect this procedure to last 2-3 hours. 

What should I do to prepare before surgery?

Before surgery, we need a thorough understanding of the patient’s health history, particularly relating to the heart or lungs. Surgeons must be informed of previous cardiac procedures, including stents or pacemakers, or a history of blood clots. Patients who take blood thinners will need clearance from their prescribing doctor to stop medications before surgery. Patients should also avoid other substances (like fish oil or aspirin) that may cause excess bleeding during surgery. 

Also, all patients should complete a COVID-19 test and the necessary paperwork with the surgery center prior to the date of the procedure. Patients will get specific instructions from the office staff regarding when to stop eating, when to arrive, and who should accompany them to their procedure. If you have any remaining questions, be sure to ask the staff prior to your procedure. 

What should I expect during the procedure?

Expect a 45-minute procedure under general anesthesia for a septoplasty and a 2+ hour procedure for a rhinoplasty.With the septoplasty, we place small splints in the nose that help hold the septum straight. We also pack the nose with dissolvable packing. This packing can be lightly blown out of the nose after several days and irrigated with saline solution. 

What does a septoplasty and rhinoplasty recovery look like? 

Splints from a septoplasty are removed 4-6 days after the procedure. Once the splints are removed, the person recovers quickly and can return to work. 

External casts are sometimes placed for rhinoplasty. These are typically removed within 4-6 days as well. 

Expect an office appointment in this 4-6 day time period to remove splints or external casts. At that point, patients can start a saline regimen. For some rhinoplasty patients, we prescribe antibiotics for 7-10 days after the procedures. We also schedule a final follow up four weeks after the procedure. 

If you’re considering a rhinoplasty vs. septoplasty, discuss your best option with your ENT. You may find your best solution will be to have a septoplasty and rhinoplasty together. 

5 Things You Should Know When Choosing a Thyroid Surgeon

When it comes to thyroid surgeon, how do you know you’re in good hands? Most people choose because they were given a trusted reference. They found their thyroid surgeon via a friend who had a successful surgery and recommended the surgeon. Or, they were referred from their endocrinologist, primary care doctor, or internist. 

When patients come in, they’ve usually done their homework and asked another doctor about our credentials. Plus, they know their referring doctor doesn’t want to make a bad recommendation. 

Yet even with the trusted advice of other doctors or friends, patients should investigate the validity of their recommended surgeon for themselves. When it comes to choosing a thyroid surgeon, questions regarding their reputation, track record, number of surgeries, and frequency of complications are extremely valid. 

5 Questions to Help You Choose the Best Thyroid Surgeon

Here’s what you should ask to make the most informed decision regarding your upcoming thyroid surgery

1. Is this a procedure you do often? How many per week? How many per year? 

You want a high-volume doctor who conducts at least 50 thyroid surgeries per year.

2. How many years have you been doing this? 

There’s not an exact number you’re listening for, but use good judgement in evaluating the expertise of the surgeon. Do they seem to be a person with CANEI (constant and never ending improvement)? Choose a surgeon who strives to be the best. 

3. Where do you do the procedure — hospital or surgery center? If you don’t do it at the surgical center, is there a particular reason? 

Most doctors choose to do this procedure at a surgical center because of the low-incidence rate of complications with high-volume thyroid surgeons. If they choose a hospital, ask for more information. 

4. How many patients are admitted to the hospital after this procedure?  

This number should be extremely low. 

5. How will I be treated? 

This question you need to answer based on your observations. Look at the staff and office to evaluate: 

  • Is the staff helpful? 
  • How are you treated? 
  • Is the equipment updated? 
  • Is the facility clean? 
  • Are they following strict COVID protocols? 

The office should look like it runs well — and you should have a good feeling about who you’re trusting with your health. 

how to choose a thyroid surgeon

Possible Complications and Side Effects

With the right surgeon, complications are extremely rare. In fact, a high-volume thyroid surgeon should have no more than a 1% rate of vocal cord paralysis. In order to avoid this complication, the surgeon must correctly identify the recurrent laryngeal nerve (RLN) and avoid injuring it during the procedure. Otherwise, complications can be severe. The patient could experience severe hoarseness, difficulty swallowing, or even complete vocal cord paralysis. If the damage is permanent, you may need additional surgeries. 

Parathyroid complications should also be avoided. Injury to healthy parathyroid glands result in a decrease in calcium and permanent calcium deficiency. 

Bleeding problems are extremely rare after a thyroidectomy. It’s highly unlikely a patient will need to return to surgery for a bleeding problem. 

Infection is also very rare. Patients are given an oral antibiotic before the procedure, but none following the procedure.

Underlying health problems are complications that can’t necessarily be avoided. Patients should always inform the surgeon about pre-existing heart or lung issues. Thyroid surgery is often necessary despite other health problems, but we want to make sure we take precautions to minimize risk. For patients with preexisting conditions, we may elect to conduct the procedure in a hospital with an overnight stay. But even with these patients, the vast majority can go home the next day. 

Why Choosing the Right Surgeon Matters 

When you choose the right surgeon, you reduce your chance of complications significantly. You want your surgeon to be experienced enough to avoid any injury to the RLN and healthy glands, keeping you as safe as possible. 

Minimally Invasive Thyroid & Parathyroid Surgery FAQ

No one should go into surgery with unanswered questions. 

Before any surgery, you deserve a clear understanding of what’s happening. Whether you’re approaching a minimally invasive procedure or a major surgery, never hesitate to talk with your doctor about the specifics of your procedure and ask questions at will. 

When considering a thyroidectomy, many patients wonder what to expect after surgery and how long it takes to recover. To get you started, we’ve answered our patients’ top questions about minimally invasive parathyroid surgery and thyroid surgery.  

Why Are Thyroid and Parathyroid Surgeries Performed?

Thyroid surgery is performed in order to remove diseased glands. Parathyroid and thyroids are two different glands at the base of the neck. We take out these glands when we see one of two problems: 

  1. Cancer Suspicion: The vast majority of these procedures are done because of nodules suspicious of thyroid cancer. 
  2. Enlarged glands: Large glands producing too much thyroid hormone can cause compressive symptoms or difficultly swallowing. If these glands can’t be suppressed long-term with medications, we opt for removal. Enlarged glands may also indicate malignancy, making removal the safest option. 

How “Minimally Invasive” Is Thyroid or Parathyroid Surgery?

Surgeons are increasingly able to make smaller incisions for thyroid surgery. While these incisions were once quite large, now we’re able to create only small incisions located higher on the neck resulting in a better cosmetic appearance. We close incisions with a plastic surgery closure and sutures below the skin. These small incisions create a much improved cosmetic appearance. 

Parathyroid surgery is even more minimally invasive. When removing a localized parathyroid tumor, we can opt for an even smaller incision. 

Is Thyroid or Parathyroid Surgery a Major Surgery?

When your surgery is in the right hands, it’s not a major surgery. Medical literature recommends choosing a high-volume thyroid surgeon — meaning they conduct at least 50 surgeries per year. In our practice, Dr. Scolaro and Dr. Cuthbertson combined conduct 200-300 surgeries per year. Having this level of experience results in significantly fewer complications, particularly with vocal cord paralysis and permanent calcium problems. 

What Are the Risks of Thyroid or Parathyroid Surgery?

The main risk in thyroid surgery is working close to the recurrent laryngeal nerve that moves the vocal cords. The most important part of the surgery is for the surgeon to accurately locate the nerve and the parathyroid glands and then avoid injuring them.

If the nerve is injured, the patient may experience vocal cord paralysis and hoarseness. If the parathyroid glands are injured or removed, the patient may have issues with low calcium. An experienced, high-volume physician should have no more than a 1% rate of vocal cord paralysis.

Parathyroid surgery also poses the risk of lowered calcium levels. There are four parathyroid glands, two on each side near the nerve, each about the size of a grain of rice. Their exact location can be a little variable. Transient low calcium is expected after removal of a parathyroid adenoma. Calcium supplements will be provided temporarily after surgery to mitigate this issue.

When we remove the thyroid gland, it’s normal for the parathyroid glands to temporarily lose their blood supply and go into shock. During this time, they don’t produce as much parathyroid hormone. 

This commonly results in a temporary calcium decrease for the patient and is easily remedied with calcium supplements until the parathyroid glands recover. A permanent problem resulting from parathyroid gland damage is extremely rare in the hands of a high-volume surgeon. 

what to expect from thyroid surgery

How Should I Prepare for Thyroid or Parathyroid Surgery?

Before we initiate surgery, we need to look at health history — particularly relating to the heart or lungs. Surgeons must be informed of previous cardiac procedures, including stints or pacemakers, or a history of blood clots. Patients who take blood thinners will need clearance from their prescribing doctor to stop medications before surgery. Patients should also avoid other substances (like fish oil or aspirin) that may cause excess bleeding during surgery.  

All patients should complete a COVID-19 test and necessary paperwork with the surgery center prior to the date of the procedure. 

What Should I Expect During Surgery?

The length of the procedure depends on the surgeon. High-volume surgeons conduct the procedure in less time. Our thyroid surgeries may take 1-2 hours, sometimes a little longer for more complex cases. For less experienced doctors, this procedure may take several hours or more.

Parathyroid removal procedure times vary depending on what we need to accomplish. In minimally-invasive surgery for a localized parathyroid adenoma, the gland can sometimes be found in as little as 15-20 minutes. However, the surgery may be as prolonged if all of the glands need to be examined or if the parathyroid hormone levels are drawn during the operation. In very complex cases, it may last as long as several hours.

What Should I Expect After the Surgery?

Most thyroid and parathyroid surgeries are conducted in an outpatient surgery center. Patients have the procedure in the morning, stay a few hours for monitoring following the procedure, and then can return home that afternoon. We typically check them the next morning in our office to make sure there are no complications. 

How Long Does It Take to Recover From Thyroid or Parathyroid Surgery?

Recovery is rather quick after thyroid surgery. People can shower immediately, while taking care to avoid direct water pressure to the incision site, and can return to work within 3-4 days.

Patients on blood thinners should discuss how to restart their medication with their PCP or Cardiologist. Other blood thinning medications (such as aspirin or Ibuprofen) should be avoided for a week following surgery. 

What Am I Allowed to Eat After Thyroid or Parathyroid Surgery?

Thyroid surgery doesn’t typically affect eating. You may have a slight sore throat for a day or so due to being intubated during surgery. Soft foods may feel better if you find you have throat pain, but otherwise, most patients are able to eat a normal diet. 

How Will I Feel After a Thyroidectomy?

These types of procedures that involve a small skin incision do not typically cause much pain. We prescribe just a few pain pills — and even that is usually more than the patient needs. You may have a stiff neck from your head position following surgery, but this only lasts a day or so.

What Type of Doctor Does Thyroid and Parathyroid Surgery?

Historically, only General Surgeons operated on the thyroid, however, over the past 20-30 years, Otolaryngologists (ENTs) have begun to conduct most of these procedures. This transition is due to the fact that ENTs are generally more familiar with the delicate anatomy of the neck and throat. Whether you’re considering your General Surgeon or an ENT for your procedure, the primary concern is how many of these surgeries the doctor does annually. Never hesitate to ask!

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