Ear, Nose, and Throat (ENT)

Allergic rhinitis occurs when the body’s immune system over-responds to specific, non-infectious particles such as plant pollens, molds, dust mites, animal hair, industrial chemicals (including tobacco smoke), foods, medicines, or insect venom. Seasonal allergic rhinitis or hayfever occurs in late summer or spring. Hypersensitivity to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75 percent of all Americans who suffer from this seasonal disorder. People with sensitivity to grass pollen have symptoms throughout the summer, while those with sensitivity to tree pollen have symptoms in late March or early April; an allergic reaction to mold spores can occur in October and November as a consequence of falling leaves.

Your allergy problems are diagnosed using a thorough history and physical in our office. This may also include a nasal endoscopy exam (this exam is performed by placing a small fiberoptic scope in the nose after numbing the nasal tissue with a spray. The exam is quick and painless), and you may be scheduled for allergy testing.

Skin testing is preferable, as it is more sensitive to picking up mild to moderate allergies. Sometimes blood testing for allergies is also indicated.

Skin testing is a safe and fairly easy way for us to determine your allergies.

Skin tests use a concentrated liquid form of common allergens like pollen, mold, dust mites, animal dander, and foods. Once the allergen gets in your skin, it may trigger a small reaction, like a rash. Your skin will get irritated and may itch. This reaction is how we can tell you’re allergic to a substance. When you have an allergy, your immune system will make antibodies and set off chemicals to fight the unwelcome invader.

Immunotherapy is the only method that treats the underlying allergic disease.  It is an excellent form of treatment for those who have tried medications or environmental control and are not getting the relief that they would like.  It requires frequent, regular exposure to very small amounts of  allergen(s) over the course of several  years.   Immunotherapy comes in two forms:  subcutaneous, also called SCIT or ‘allergy shots’, and sublingual also known as SLIT or ‘allergy drops’.

Injection immunotherapy is an effective treatment, yet many allergy sufferers are not willing or able to consider this treatment. Sublingual immunotherapy, or allergy drops, is an off-label use of the same antigens used in allergy shots. Due to the better safety profile of allergy drops, more allergic individuals can benefit from a treatment approach that addresses the cause of the allergies.

There are many benefits to consider with allergy drop treatment including reduced time spent for physician visits, the convenience of taking immunotherapy at home or on the go, the ability to treat a broader array of allergic patients and conditions, and the reduced need for allergy medications.

Hearing loss is a pervasive problem affecting an estimated 48 million Americans. It is largely focused in the 55+ population, but it can affect patients of all ages from a lifetime of exposure to loud noises, from music to industry. Untreated hearing loss has profoundly negative effects including:

• Clinical Depression
• Acceleration of Dementia and Alzheimer's Symptoms
• Anger Management Problems
• Social Withdrawal and Isolation
• Increase in Fears and Phobias

We routinely screen hearing function as part of our normal workup for patients at no charge.  For patients who need it, we provide comprehensive hearing exams at our 222 Medical Office Building, Cool Springs, Green Hills, Summit Medical Center, Saint Thomas West and Grassland locations.  If you suspect that you or a family member are having problems with your hearing, please contact your primary care physician so that we may schedule a complete exam.

Allergic rhinitis occurs when the body’s immune system over-responds to specific, non-infectious particles such as plant pollens, molds, dust mites, animal hair, industrial chemicals (including tobacco smoke), foods, medicines, or insect venom. Seasonal allergic rhinitis or hayfever occurs in late summer or spring. Hypersensitivity to ragweed, not hay, is the primary cause of seasonal allergic rhinitis in 75 percent of all Americans who suffer from this seasonal disorder. People with sensitivity to grass pollen have symptoms throughout the summer, while those with sensitivity to tree pollen have symptoms in late March or early April; an allergic reaction to mold spores can occur in October and November as a consequence of falling leaves.

Your allergy problems are diagnosed using a thorough history and physical in our office. This may also include a nasal endoscopy exam (this exam is performed by placing a small fiberoptic scope in the nose after numbing the nasal tissue with a spray. The exam is quick and painless), and you may be scheduled for allergy testing.

Skin testing is preferable, as it is more sensitive to picking up mild to moderate allergies. Sometimes blood testing for allergies is also indicated.

Skin testing is a safe and fairly easy way for us to determine your allergies.

Skin tests use a concentrated liquid form of common allergens like pollen, mold, dust mites, animal dander, and foods. Once the allergen gets in your skin, it may trigger a small reaction, like a rash. Your skin will get irritated and may itch. This reaction is how we can tell you’re allergic to a substance. When you have an allergy, your immune system will make antibodies and set off chemicals to fight the unwelcome invader.

Immunotherapy is the only method that treats the underlying allergic disease.  It is an excellent form of treatment for those who have tried medications or environmental control and are not getting the relief that they would like.  It requires frequent, regular exposure to very small amounts of  allergen(s) over the course of several  years.   Immunotherapy comes in two forms:  subcutaneous, also called SCIT or ‘allergy shots’, and sublingual also known as SLIT or ‘allergy drops’.

Injection immunotherapy is an effective treatment, yet many allergy sufferers are not willing or able to consider this treatment. Sublingual immunotherapy, or allergy drops, is an off-label use of the same antigens used in allergy shots. Due to the better safety profile of allergy drops, more allergic individuals can benefit from a treatment approach that addresses the cause of the allergies.

There are many benefits to consider with allergy drop treatment including reduced time spent for physician visits, the convenience of taking immunotherapy at home or on the go, the ability to treat a broader array of allergic patients and conditions, and the reduced need for allergy medications.

The Powered Intracapsular Tonsillectomy and Adenoidectomy (PITA) is a different way of performing a T&A procedure. The principle of the PITA technique is to remove the maximum amount of disease-causing tissue to treat the problem, while leaving a very small amount of tissue intact to protect the delicate throat muscles, decrease postoperative pain, and shorten the convalescent period. The precision of the PITA technique relies upon a powered instrument called a microdebrider . The microdebrider has a tiny rotating tip that allows the surgeon to remove tissue more carefully than traditional T&A surgery tools can.

With a more precise tool like the microdebrider, the surgeon can effectively treat the problem and prevent damage to nearby tissues at the same time. Consequently, the PITA technique offers most patients:

• less postoperative pain,
• a more rapid recovery and return to school or work,
• a faster return to normal diet, and
• fewer postoperative complications.

The recovery time with PITA surgery is usually less than four days and may be as little as one or two days. This means parents can go back to work sooner after their child's surgery, and children can go back to school and play. Most children who have PITA surgery also need less pain medicine.

• Proton pump inhibitors (such as Prilosec, Prevacid, Aciphex, Protonix, Zegerid, Kapidex, or Nexium) to reduce gastric acid
• H2 blockers (Axid, Pepcid, Tagamet, or Zantac) to reduce gastric acid
• Prokinetic agents to increase the forward movement of the GI tract and increase the pressure of the lower esophageal sphincter. These medications are not as commonly used because they have been linked to adverse effects on heart rhythm and diarrhea.
• Sucralfate to protect injured mucous membranes 
• Antacids to help neutralize acid. This is more to help with symptoms of heartburn.

 Some people respond well to self-care and medical management. However, others need more aggressive and lengthy treatment. If this is not effective or if symptoms recur, your doctor may suggest surgery. Fundoplication is a type of surgery which involves wrapping the upper part of the stomach around the lower esophagus to create a stronger valve between the esophagus and stomach. It is usually done laparoscopically, with small surgical incisions and use of small surgical equipment and a laparoscopic to help them see inside. Fundoplication can also be done as a traditional open surgery with large incision.

Sleep apnea occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils and the tongue. When the muscles relax, your airway narrows or closes as you breathe in, and breathing momentarily stops. This may lower the level of oxygen in the blood, and the brain senses this and briefly rouses you from sleep to reopen the airway. This can be so brief that you cannot remember it, but you may make a snorting, choking or gasping sound. This pattern can repeat itself five to thirty times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, which makes you feel tired during waking hours.

Up to one-half of normal adults snore at least occasionally, with worsening occurring with age and weight gain. Snoring occurs when there is an obstruction to airflow through the passages at the back of the mouth and nose.  Because these areas are collapsible, they may vibrate during sleep due to relaxation of the tissues when air passes by during breathing.  In children, snoring is often a sign of enlargement of the tonsils and adenoids.

Anatomically, there are a few areas that contribute to the obstruction in the upper airway. When sleeping, muscle tone in the tongue and throat naturally decreases. When these muscles relax, the tongue falls backward into the airway, and the throat muscles may collapse in from the sides. This phenomenon can be exacerbated by alcohol and drugs. Excessive bulkiness of the throat tissue from enlarged tonsils and adenoids, cysts or tumors in the airway, or excess soft tissue of the neck in overweight people can also lead to airway narrowing. Elongation of the soft palate and/or uvula may additionally contribute to soft tissue blockage.  Finally, obstructed nasal airways (from a deviated septum, nasal polyps, or enlarged turbinates) require extra effort to pull air through it. This creates an exaggerated vacuum in the throat that pulls together the floppy tissues of the throat, and snoring or apnea results. This explains why snoring may worsen when allergy or sinus problems occur.