Ear, Nose, and Throat Care
Ear, Nose, and Throat Care covers a lot of ground. When you have issues with your ears, nose, throat, sinuses, face, neck, larynx, we are who you should see to get you feeling better.
We help adult and pediatric patients with a wide variety of head and neck disorders. These can affect more than you realize. Our centers for the diagnosis and treatment of dizziness, balance disorders, and ringing in the ears are distinguished across the state.
Our expertise in both surgical and non-surgical treatments give patients the most options for care, treatment, and return to being fully active again.
The ears, nose, and throat are located near each other and have separate but related functions. The ears and nose are sensory organs, which are necessary for the senses of hearing, balance, and smell.
The throat mainly functions as a pathway through which food and fluids travel to the esophagus (the hollow tube that leads from the throat to the stomach) and air passes to the lungs.
Primary care doctors often diagnose and treat disorders involving these organs, but doctors called otolaryngologists specialize in them.
Don’t ignore that ringing in your ears, or that dizzy spell, or any concern you might have. Let us work with you to develop an accurate diagnosis and a treatment plan just for you.
We understand how isolating hearing loss can be. Our team of doctors and audiologists works closely with infants, children, and adults to diagnose and treat a wide variety of ear-related disorders.
Hearing care services we provide include:
- Auditory brain response testing (ABR) – tests are able to be completed in a natural sleep or using conscious sedation
- Comprehensive audio exams
- Hearing Aid fitting
- Immittance testing
- Newborn hearing screenings
- Otoacoustic emissions
Pediatric Ear, Nose, and Throat Care
Our pediatric Otolaryngologists specialize in the ear, nose, and throats of your little ones. Those returning sore throats or earaches that never seem to go away need special attention. We are here to help you.
Pediatric Ear, Nose, and Throat Care services we provide include:
- Pediatric adenoidectomy
- Pediatric and adult ear surgery
- Pediatric ear, nose, and throat
- Pediatric tonsillectomy
What Is an ENT Specialist?
An ear, nose, and throat (ENT) specialist is a medical doctor trained in managing illnesses related to the ears, nose, nasal passage, sinuses, larynx, oral cavity, upper pharynx, as well as structures of the neck and face. ENT specialists are experts in both medical and surgical management of the following:
Deafness is a condition where the ability to detect certain sound frequencies is partially or completely impaired. A person may need to see an ENT specialist if they are suffering from partial or full deafness. Furthermore, an ear disorder, such as an ear infection, hearing impairment, diseases that affect balance, tinnitus (ringing in the ears), or pain in the ear are also treated by an ENT.
The experts in our ENT hospital specialize in performing Cochlear Implant (CI) Surgery on patients who are profoundly deaf or hard of hearing. Cochlear Implants are primarily designed to mimic natural hearing. Often referred to as bionic ear, it works by using special technologies that mimic the non-working parts in the ear.
ENT specialists manage and treat issues that affect the nose, sinuses, and nasal cavity. These issues can affect breathing, cause loss of smell, as well as change the physical appearance.
Disorders that affect the throat can disrupt speech, eating, digestion, swallowing, and singing. ENT specialists can identify, manage, and treat such problems.
Head and Neck
ENT specialists are trained to manage tumors, diseases, trauma, and defects in the head, neck, and face. An ENT specialist can perform cosmetic and reconstructive surgery in all of these areas. They can also manage issues with the nerves in the head and neck that control smell, sight, hearing, as well as facial movements.
Conditions Treated by An ENT Specialist
- Swollen Adenoids: Frequent throat infections can lead to enlarged adenoids. Enlarged adenoids can cause difficulty in breathing and block the eustachian tubes, which connect the middle ear to the back of the nose.
- Sinusitis: Inflammation of the sinuses resulting in a plugged nose and thick nasal mucus accompanied by pain in the face.
- Tinnitus: A condition wherein an individual hears sound when no external sound is present.
- Nasal Airway Obstruction: A condition in which the airflow in and out of the nose is hindered and affects one or both nasal passages. It is caused by either swelling of the nasal tissue or an anatomical blockage which results in narrowing of the nasal cavity and congested sensation in the nasal passage.
- Tonsillitis: Swelling of the tonsils caused due to a viral infection or bacterial infections such as strep throat.
- Eardrum Perforation: A tear or hole in the eardrum which can result in hearing loss. This condition can also make the middle ear more prone to infections or injury.
Facts Of Ear, Nose, and Throat
What is the ear?
- External or outer ear, consisting of:
- Pinna or auricle. This is the outside part of the ear.
- External auditory canal or tube. This is the tube that connects the outer ear to the inside or middle ear.
- Tympanic membrane (also called the eardrum). The tympanic membrane divides the external ear from the middle ear.
- Middle ear (tympanic cavity), consisting of:
- Ossicles. These are the three small bones that are connected and transmit the sound waves to the inner ear. The bones are called:
- Eustachian tube. A canal that links the middle ear with the back of the nose. The eustachian tube helps to equalize the pressure in the middle ear. Having the same pressure allows for the proper transfer of sound waves. The eustachian tube is lined with mucous, just like the inside of the nose and throat.
- Ossicles. These are the three small bones that are connected and transmit the sound waves to the inner ear. The bones are called:
- Inner ear, consisting of:
- Cochlea (contains the nerves for hearing)
- Vestibule (contains receptors for balance)
- Semicircular canals (contain receptors for balance)
What is the nose?
The nose is the organ of smell and is part of the peripheral nervous system. The nose consists of:
- External nose. A triangular-shaped projection in the center of the face.
- Nostrils. These are two chambers divided by the septum.
- Septum. This is made up primarily of cartilage and bone and covered by mucous membranes. The cartilage also gives shape and support to the outer part of the nose.
- Nasal passages. Passages that are lined with mucous membranes and tiny hairs (cilia) that help to filter the air.
- Sinuses. Four pairs of air-filled cavities that are also lined with mucous membranes.
What is the throat?
The throat is a ring-like muscular tube that acts as the passageway for air, food, and liquid. The throat also helps in forming speech. The throat consists of:
- Larynx. This houses the vocal cords and is crucial to speech and breathing. The larynx also serves as a passageway to the trachea (windpipe to the lung).
- Epiglottis. This is located above the larynx and works with the larynx and vocal cords to push the food into the esophagus, therefore keeping food from entering the windpipe.
- Tonsils and adenoids. These are made up of lymph tissue and are located at the back and sides of the mouth. They protect against infection, but generally have little purpose beyond childhood.
Ear, Nose and Throat Examination
Examination of the ear
This includes an assessment of hearing as well as the appearance of the ear.
The following issues should be included:
- Classic symptoms of ear disease: deafness, tinnitus, discharge (otorrhoea), pain (otalgia) and vertigo.
- Previous ear surgery, or head injury.
- Family history of deafness.
- Systemic disease (eg, stroke, multiple sclerosis, cardiovascular disease).
- Ototoxic drugs (antibiotics (eg, gentamicin), diuretics, cytotoxics).
- Exposure to noise (eg, pneumatic drill or shooting).
- History of atopy and allergy in children.
Inspecting the external ear
Inspect the external ear before examination with an otoscope/auriscope. Swab any discharge and remove any wax. Look for obvious signs of abnormality.
- Size and shape of the pinna.
- Extra cartilage tags/pre-auricular sinuses or pits.
- Signs of trauma to the pinna.
- Suspicious skin lesions on the pinna, including neoplasia.
- Skin conditions of the pinna and external canal.
- Infection/inflammation of the external ear canal, with discharge.
- Signs/scars of previous surgery.
Inspecting the ear canal and eardrum
A modern electric otoscope/auriscope with its own light source is primarily used to examine the ear. An otoscope also has its own magnification, which gives a good view of the tympanic membrane (TM). Batteries need to be fully operational to allow optimal light during examination.
The examination technique involves grasping the pinna and pulling it up and backward (posteriorly and superiorly), which helps to straighten the ear canal and for inspection of the TM. (In infants, only pull the pinna posteriorly not superiorly for examination.)
Hold the otoscope near to the eyepiece rather than at the end; this helps to reduce the patient’s discomfort due to hand movements, which are exaggerated in the ear. Modern otoscopes are designed to use a disposable speculum.
It is necessary to fit the correct size of speculum to achieve the best view; it is tempting to use a small piece for ease of insertion, but this simply restricts the image available.
Note the condition of the canal skin, and the presence of wax, foreign tissue, or discharge. The mobility of the eardrum can be evaluated using a pneumatic speculum, which attaches to the otoscope. The drum should move on squeezing the balloon.
Inspecting the tympanic membrane
Move the otoscope in order to see several different views of the drum; it is not always possible to see the whole drum in one single view using an otoscope. The drum is roughly circular (~ 1 cm in diameter). In a normal drum the following structures can be identified:
- Handle/lateral process of the malleus.
- Light reflex/cone of light.
- Pars tensa and pars flaccida (attic).
Occasionally, in a healthy, thin drum, it is possible to see the following:
- Long process of incus.
- Chorda tympani.
- Eustachian opening.
- Promontory of the cochlea.
Common pathological conditions related to the ear include:
- Perforations (note size, site, and position).
- Glue ear/middle-ear effusion.
- Retractions of the drum.
- Haemotympanum (blood in the middle ear).
Check facial nerve function if ear pathology is serious.
Basic hearing tests
Detailed hearing tests are usually performed in audiology clinics.
A patient with normal hearing should hear equally as well in both ears.
- Tuning fork tests: Weber’s test and Rinne’s test:
- Weber ‘s test – this is performed in conjunction with Rinne’s test. The vibrating fork is placed in the middle of the forehead and the patient is asked whether any sound is heard and, if so, whether it is equally heard in both ears or not. In a patient with normal hearing, the tone is heard centrally. If the patient has unilateral hearing loss and the sound is louder in the weaker ear, this suggests a conductive hearing loss. If the sound is louder in the better ear, it is more likely to be a sensorineural hearing loss.
- Rinne’s test – strike a tuning fork and hold it vertically with its nearest prong about 1 cm away from the patient’s external auditory meatus, making sure that it is not touching any hair. Then immediately transfer it to the mastoid process and hold it firmly there (applying counter pressure to the opposite side of the head) for two seconds. The patient is asked to report on which of the two positions was the louder.
- Normally, the patient should hear the air conduction better than the bone conduction (ie first position better than the second). This is a positive Rinne’s test. If the Rinne’s test is positive and there is hearing impairment, it is a sensorineural and not a conductive problem. If there is a negative Rinne’s test with hearing loss, then the problem is a conductive one.
- Free field voice testing (whisper from 40 cm).
Examination of the nose
Full nose examinations assess the function, airway resistance and occasionally sense of smell. It includes looking into the mouth and pharynx. Common symptoms of nasal disease include:
- Airway obstruction.
- Rhinorrhoea (runny nose).
- Loss of smell (anosmia).
- Facial pain caused by sinusitis.
- Snoring (associated with nasal obstruction).
The following issues should be covered:
- Allergies/atopic disease.
- Pets at home.
- History of previous surgery.
- Previous trauma.
- General medical history.
- Seasonal or daily variation in symptoms.
Inspection of the nose
First, look at the external nose. Ask the patient to remove any glasses. Look at the nose from the front and side for any signs of the following:
- Size and shape.
- Obvious bend or deformity: a deviated nose is often best looked at from above.
- Scars or abnormal creases.
- Redness (evidence of skin disease).
- Discharge or crusting.
- Offensive smell.
The nose can be inspected from the front to examine the anterior nares by lifting the tip of the nose up and looking inside without a speculum. Check patency of each side and ask the patient to sniff. To assess the nasal airway hold a cold metal tongue compressor under the nose while the patient exhales and note the condensation under both nostrils, or occlude one nostril whilst the patient sniffs to give a reasonable idea of airway patency.
Most otolaryngologists use either a head mirror or illuminated spectacles with a Thud chum speculum to open up the nose, which allows examination of the nasal cavity. Holding the instrument comfortably can take practice at first. Insert the Thud chum speculum gently, and identify the nasal septum medially; turbines laterally; inferior turbinate (nearly always possible to see); the middle turbinate is often difficult to see as it is small.
Check for inflammation (rhinitis), position of the septum, and presence of polyps (touch to check sensitivity; it should be insensitive to touch). A foreign body, usually accompanied by an offensive unilateral discharge, may be seen inside the nose of a child.
A mirror and headlight or an endoscope instrument are used to view the nasopharynx (the postnasal space, which contains the Eustachian tube orifices and pharyngeal recess (of Rosenmüller) and may contain adenoids or nasopharyngeal cancer), but this is not always possible during a routine examination. Finally, examine the palate. Look for large nasal polyps and tumors arising from the soft palate.
Examination of the throat
This includes a thorough examination of the oral cavity.
General history, plus ask the patient about tobacco or alcohol use and dental history.
Ask the patient to remove dentures, and examine their mouth systemically (use a bright torch): tongue, hard and soft palate, tonsillar fossa, gingivolabial/gingivobuccal sulci, floor of mouth/undersurface of tongue as follows:
- Examine the mouth and note the condition of the tongue.
- Examine the back of the tongue and tonsils (press down on the tongue with a tongue depressor).
- Palpate the base of the tongue (look for tumors that may not be easily visible).
- Inspect the uvula and soft palate.
- Inspect the hard palate (ask the patient to tip their head backward, until the whole hard palate is visible).
- Examine the buccal area and the gingivolabial (gingivobuccal) sulcus (the space between cheek and gums).
- Examine the floor of the mouth, check for submandibular duct stones or masses (ask the patient to stick their tongue out).
- Examine the nasopharynx and larynx with a mirror or flexible fibrotic nasendoscope.
What Is an Otolaryngologist?
Otolaryngologists focus on the evaluation, management, and treatment of diseases and disorders of the ear, nose, and throat.
If you have a health problem with your head or neck, your doctor might recommend that you see an otolaryngologist. That’s someone who treats issues in your ears, nose, or throat as well as related areas in your head and neck. They’re called ENT’s for short.
In the 19th century, doctors figured out that the ears, nose, and throat are closely connected by a system of tubes and passages. They made special tools to take a closer look at those areas and came up with ways to treat problems. A new medical specialty was born.
Common problems include ear infections, tonsillitis, asthma, and allergies. Pediatric ENT’s also care for children with birth defects of the head and neck. They also can help figure out if your child has a speech or language problem.
- Rhinology: These doctors focus on your nose and sinuses. They treat sinusitis, nose bleeds, loss of smell, stuffy nose, and unusual growths.
- Sleep medicine: Some ENT’s specialize in sleep problems that involve your breathing, for instance snoring or sleep apnea. Your doctor may order a sleep study to see if you have trouble breathing at times during the night.
How Do I Find an Otolaryngologist?
Ask your primary care doctor or go to the American Academy of Otolaryngology-Head and Neck Surgery website to find one in your area. Look for one that specializes in your specific problem.
Otolaryngology services available include:
- Balance disorders evaluation, diagnosis, and treatment
- Bone anchored hearing aids (BAHA) and cochlear implants
- Ear infection treatments
- Ear surgery (otology)
- Ear Tube Placement
- Full hearing amplification services (hearing aids)
- Hearing disorders and testing
- Medical and surgical treatment of all aspects of ear disease
- Perforated Eardrum Repair (Tympanoplasty)
- Tinnitus retraining therapy
Nose and Sinus
- Ablation or Excision of Nasal Turbinates
- Antrostomy and Antrotomy (Sinus Surgery)
- Balloon Sinuplasty
- Balloon sinus dilation
- Diagnostic Nasal and/or Sinus Endoscopy
- Image-guided endoscopic sinus surgery
- Intranasal or Sinus Procedure
- Medical and surgical treatment of sinus diseases
- Nasal-septal surgery (Septoplasty)
- Nose Plastic Surgery (Rhinoplasty)
- Sinus Surgery (Ethmoidectomy)
- Sinusitis (medical and surgical treatment)
- Sphenoidotomy (Sinus Surgery)
Mouth, Lips, and Tongue
- Excision or Destruction of Palate or Uvula Lesion; Pharynx Lesion; Tongue Lesion
- Excision of Parotid, Sublingual or Submandibular gland
- Lip, Excision or Resection
- Salivary disorders including minimally invasive treatment
- Vestibule and floor of mouth – Excision or Destruction
- Evaluation and treatment of voice disorders
- Laryngology and voice disorders
- Laryngoscopy – Laryngotomy -Laryngectomy Pharyngolaryngectomy – Pharyngectomy
- Office examination of the larynx (voice box) and treatment of voice problems
- Speech and swallowing disorders
- Thyroid and Parathyroid surgery
- Thyroid Lobectomy or Thyroidectomy
- Thyroid surgery
- Tonsil surgery
- Tracheal Surgery
- Treatment of smell and taste, throat and swallowing disorders
- Diagnosis and treatment of snoring and sleep apnea
- Sleep disorders
- Snoring and sleep apnea surgery
Head and Neck
- Excision and reconstruction of skin cancers of the head and neck
- Excisional Biopsies of Skin Lesions
- Head and neck surgery, including treatment of head and neck cancer patients
- Skin Cancer treatment of Face, Ears, and Neck
- Lymph Node Biopsy or Excision
What Conditions Do Otolaryngologists Treat?
ENT’s can do surgery and treat many different medical conditions. You would see one if you have a problem involving:
- An ear condition, such as an infection, hearing loss, or trouble with balance
- Nose and nasal issues like allergies, sinusitis, or growths
- Throat problems like tonsillitis, difficulty swallowing, and voice issues
- Sleep trouble like snoring or obstructive sleep apnea, in which your airway is narrow or blocked and it interrupts your breathing while you sleep
- Infections or tumors (cancerous or not) of your head or neck
Some areas of your head are treated by other kinds of doctors. For example, neurologists deal with problems with your brain or nervous system, and ophthalmologists care for your eyes and vision.
How Are ENT Doctors Trained?
Otolaryngologists go to 4 years of medical school. They then have at least 5 years of special training. Finally, they need to pass an exam to be certified by the American Board of Otolaryngology.
Some also get 1 or 2 years of training in a subspecialty:
- Allergy: These doctors treat environmental allergies (like pollen or pet dander) with medicine or a series of shots called immunology. They also can help you find out if you have a food allergy.
- Facial and reconstructive surgery: These doctors do cosmetic surgery like facelifts and nose jobs. They also help people whose looks have been changed by an accident or who were born with issues that need to be fixed.
- Head and neck: If you have a tumor in your nose, sinuses, mouth, throat, voice box, or upper esophagus, this kind of specialist can help you.
- Laryngology: These doctors treat diseases and injuries that affect your voice box (larynx) and vocal cords. They also can help diagnose and treat swallowing problems.
- Otology and Neurology: If you have any kind of issue with your ears, these specialists can help. They treat conditions like infections, hearing loss, dizziness, and ringing or buzzing in your ears (tinnitus).
- Pediatric ENT: Your child might not be able to tell his doctor what’s bothering him. Pediatric ENT’s are specially trained to treat youngsters, and they have tools and exam rooms designed to put kids at ease.