Common ENT conditions

Bell’s palsy is a rapid, one-sided paralysis of the facial nerve of unknown cause. It leads to partial (paresis) or complete (paralysis) inability to move the muscles of the face on the affected side. Although usually temporary, a paralysed face can cause significant difficulty keeping the mouth closed and an inability to close the eyelid. This can lead to corneal problems, which can be devastating for the patient. Treatments are generally designed to improve facial function, support recovery and prevent eye complications.

A tonsillectomy is surgery to remove the tonsils, the soft tissues on either side at the back of the throat. An adenoidectomy is surgery to remove the adenoids, also soft tissue in the throat but higher than the tonsils. Enlarged adenoids readily block the nose.

There are several reasons a child may need a tonsillectomy or an adenoidectomy. For example:

• Difficulty breathing — enlarged tonsils or adenoids can prevent a child from breathing normally through the mouth or nose. If the child stops breathing for short periods during sleep, this is called obstructive sleep apnea.
• Difficulty swallowing normally.
• Frequent throat or ear infections.

Cancers of the oral cavity include cancers of the lips, gums, tongue, inner cheeks, floor of the mouth and the area behind the wisdom teeth. The risk factors for these cancers are also tobacco and alcohol.

Salivary gland conditions fall into the following categories:

Obstruction of the gland: salivary obstruction occurs most often in the submandibular and parotid glands. It is usually caused by a “stone”, a small calculus. Symptoms therefore occur mainly when you eat: saliva is produced but cannot leave the gland, and the gland swells and becomes painful.

Inflammation of the gland: if the stones are not completely obstructing, the glands swell during meals and gradually return to normal afterwards. Infection develops in the stagnant saliva that cannot drain. Salivary gland enlargement can also be caused by autoimmune diseases that provoke significant inflammation. This can occur alongside other systemic conditions such as rheumatoid arthritis and diabetes.

Infection of the gland: a virus can infect the salivary glands. A common parotid infection is caused by mumps. Although more frequent in children, the infection can also occur in adults. As noted, infection can also follow salivary obstruction.

Tumours: benign and malignant salivary gland tumours usually present as painless swelling. These swellings must be examined by an otolaryngologist – head and neck surgeon. At times they can even cause loss of movement in part of the face.

The sinuses are air-filled spaces in the bones of the face and head. They connect with the inside of the nose through small openings. The sinuses matter for the drainage of mucus from the nose into the throat and for the way we breathe through the nose.

When the sinuses are infected or inflamed, this is called sinusitis. Sinusitis is caused by blocked, inflamed or infected sinuses. Patients present with a blocked nose, pressure over the nose and face, and increased, discoloured nasal secretions. Other symptoms are loss of smell and headache.

Most of the time, patients with sinusitis recover without antibiotics, responding well to corticosteroid sprays and saline rinses. A small number will need antibiotics and some will even require surgery. In rare cases, untreated sinusitis can lead to complications, with infection spreading into the orbit or into the cerebrospinal fluid around the brain.

It can be frightening to see blood coming from your nose or your child’s nose. Nosebleeds, however, are usually not serious. They are very common, but they can be very inconvenient. The most frequent causes are dry air and nose picking. To prevent nosebleeds, using a humidifier in the bedroom to keep humidity around 50% is recommended. Lubricating nasal gels and sprays can also help.

What to do during a nosebleed

With the right technique, most nosebleeds stop within a few minutes. Here is what to do:

• Blow your nose. This may increase the bleeding briefly, which is normal.
• Stay seated and lean slightly forward. Do not put your head between your legs or tilt it backwards.
• Pinch the soft part of your nose. Do not grip the bridge (the hard bones), as that will not work. Press firmly on both sides at the same time.
• Pinch for at least 15 minutes (5 minutes in children). Use a clock to time it. Do not release the pressure early, or you must start over. Apply pressure for a total of at least 30 minutes (10 minutes in children). If you are still bleeding, go to the emergency department or a specialized clinic.

Some nosebleeds are more dangerous, and you should seek care immediately if:

• the blood is making it hard to breathe;
• you feel very tired or confused;
• the bleeding will not stop despite the steps above;
• the bleeding starts after nasal surgery;
• you take medication that prevents blood clotting (Coumadin, Plavix, Pradaxa, Aspirin, etc.).

Cancer of the larynx is a type of throat cancer. The larynx is the upper part of the windpipe and contains the vocal cords. As with other head and neck cancers, tobacco and alcohol are the main risk factors. Your ENT physician can assess your larynx with a simple in-office procedure. Speak with your physician for more information.

Laryngitis is the medical term used when the vocal cords are inflamed.

It can be caused by:

• a cold or other throat infections;
• overusing the voice (shouting, singing);
• inhaling corrosive chemicals;
• alcohol and tobacco;
• acid reflux.

Other medical problems besides laryngitis can make your voice hoarse or make you lose your voice. For example:

• abnormal growths on the vocal cords;
• a muscle disorder affecting the larynx (for example, spasmodic dysphonia);
• cancer of the larynx.

Acid reflux is stomach acid rising back into the esophagus, and it can even reach the mouth. Another term for acid reflux is gastro-esophageal reflux disease (GERD). Reflux symptoms include:

• a burning sensation in the chest;
• a burning sensation in the throat and a sour taste in the mouth;
• difficulty swallowing;
• a hoarse voice or sore throat;
• an unexplained cough.

Most of the time you can improve your symptoms by changing daily habits. You may feel better by:

• losing weight, if overweight;
• raising the head of the bed by 6 to 8 inches (placing blocks of wood or rubber under the bed);
• avoiding foods that worsen reflux (coffee, chocolate, alcohol, mint, fatty foods);
• reducing how much alcohol you drink;
• quitting smoking;
• eating smaller meals.

Certain medications can also improve reflux symptoms — for example antacids, histamine blockers and proton pump inhibitors. All of these work by reducing or blocking stomach acid.

Thyroid nodules are round or oval growths in the thyroid gland, which sits in the middle of the neck. Thyroid nodules are common and are usually not a danger to health. Sometimes, however, they are caused by a serious condition such as cancer.

Some people have no symptoms: their nodule is found when a physician feels the neck during a routine examination, or on an imaging test done for another reason. Others have symptoms caused by the nodule — they may feel or see a lump in the neck, and sometimes have symptoms of an overactive thyroid.

The work-up includes blood tests and thyroid ultrasound. Some people need further tests such as a fine-needle biopsy or a thyroid scan.

Treatment options for thyroid nodules include:

• Monitoring — not every nodule is treated. A nodule can be followed for a long time if it is small and does not look concerning on ultrasound.
• Radioactive iodine — iodine is given as a pill you swallow, and a small amount of radiation destroys part of the thyroid gland. It is used only for nodules that produce too much thyroid hormone. This treatment is dangerous for women who are pregnant or breastfeeding.
• Surgery to remove the thyroid nodule.

Tinnitus is the sensation of noise or ringing in the ears or head when no sound is present. Some tinnitus resolves on its own, while other tinnitus persists long term and can affect quality of life. The sounds heard may include whistling, roaring, buzzing, clicking, pulsing and others.

Tinnitus can improve on its own, especially when it has lasted less than six months. When treatment is needed, patients benefit from individualized approaches to help manage their symptoms. Hearing aids can improve symptoms and correct a hearing loss. Cognitive behavioural therapy is a form of psychotherapy that can help patients with very bothersome tinnitus. Sound therapy is sometimes a good option as well.

Studies have shown that products such as ginkgo biloba, melatonin and zinc do not help patients with tinnitus. These natural products are therefore not recommended as treatment. There is currently not enough evidence to recommend for or against acupuncture for tinnitus.

An ear infection is a condition that can cause pain, fever and reduced hearing. Ear infections are common in children. They often occur after a cold or another upper respiratory infection.

In some children, a little fluid can remain in the middle ear (behind the eardrum) for weeks or months after the infection. This fluid can cause a hearing loss that is usually mild and temporary. If the hearing loss lasts a long time, however, it can lead to language and speech difficulties.

Physicians can treat ear infections with antibiotics. These medications do not always help, since many ear infections are caused by viruses — not bacteria — and antibiotics do not kill viruses.

Physicians usually prescribe antibiotics for ear infections in babies under 2 years old. For children aged 2 and over, treatment is guided by the child’s symptoms.

If your child has many ear infections, several things can be done to prevent repeated infections and their complications. The first is to make sure all routine vaccines are up to date, to keep good nasal hygiene and to limit exposure to infection as much as possible. The next step is to discuss the risks and benefits of a small operation to place a drainage tube in your child’s eardrum (see the section on ventilation tubes).

Ear tubes are tiny tubes that an ENT specialist places in a child’s eardrum to create a drainage opening. The eardrum is the thin layer of tissue between the ear canal (outer ear) and the middle ear.

Placing ear tubes requires a small operation. In adults it is done in the clinic; in children it is done in the operating room. The tubes are also called tympanostomy tubes or PE tubes (short for pressure equalization).

Children may need ear tubes if they:

• have many ear infections — this includes children with 3 or more ear infections in 6 months, or 4 or more in a year. Tubes can help prevent infections.
• have fluid behind the eardrum for several months — tubes let the fluid drain out of the middle ear. This matters because fluid in the middle ear can cause significant hearing loss.

A hearing assessment usually has several steps. First, a visit with an audiologist to determine the nature and severity of your hearing loss. Then a visit with an ENT specialist to establish why you have a hearing loss and to offer treatment options.

There are three types of hearing loss:

• Sensorineural hearing loss — this occurs when the nerves of the ear that register sound and send signals to the brain are damaged.
• Conductive hearing loss — this occurs when sound can no longer reach the inner ear because of a problem in the middle or outer ear (for example earwax, infection, otosclerosis, a perforated eardrum).
• Mixed hearing loss — this occurs when both of the above types are present at the same time.

Depending on the type of hearing loss, you may need surgery or a hearing aid. Your ENT specialist can discuss the best option and whether you are a surgical candidate.

A hearing aid is a battery-powered electronic device that makes sounds louder for the wearer. Unfortunately, only 20% of the people who could benefit from a hearing aid actually wear one.

When people speak of age-related hearing loss, they usually mean a condition called presbycusis. It becomes more common with age and affects more than half of all adults by the time they reach 75.

Sudden sensorineural hearing loss affects 5 to 20 people per 100,000. It is defined as:

• a sudden loss of hearing with rapid onset (occurring over less than 72 hours);
• the audiometric criterion most often used is a drop in hearing of 30 decibels (dB) or more, affecting at least 3 consecutive frequencies.

Between 32% and 65% of cases of sudden hearing loss may recover spontaneously. Clinical studies suggest even that recovery rate may be an overestimate. The prognosis for recovery depends on a number of factors, including the patient’s age, the presence of vertigo at onset, the degree of hearing loss and the time between the onset of the loss and treatment.

Treatment options are varied and include systemic or topical steroids, antiviral agents, rheologic agents, diuretics, hyperbaric oxygen therapy and middle ear surgery to repair fistulas.

In every case, a hearing test and treatment with steroids as soon as possible (oral or given through the eardrum) is the first-line treatment of choice.

“Dizziness” is a feeling that can be hard to describe. It can feel as though you are about to fall or faint. It can also make it hard to walk straight.

“Vertigo” is a type of dizziness that makes you feel as if you were on a fairground ride — a spinning sensation, as though everything in the room were moving around you. These sensations can last seconds, hours or days.

Some people find their vertigo is made worse by head movements, changes in body position, coughing or sneezing.