EAR, NOSE and Throat

Tempero-mandibular Joint Dysfunction

​Causes      

  • Major and minor trauma to the jaw
  • Teeth grinding
  • Excessive gum chewing
  • Stress and other psychological factors
  • Improper bite or malpositioned jaws
  • Poor posture .ie sitting at a computer or on a cell phone. for long hours
  • Arthritis


Symptoms

  • Ear pain  -   may be sharp  occurring each time you swallow, yawn, talk, or chew, or  may be dull and constant Many patients are convinced their pain is from an ear infection
  • Jaw popping/clicking
  • Difficulty in opening the mouth fully
  • Frequent headaches 
  • Neck pain


T​MJ disorders can often be missed by a physician as it can often be referred to by the patient as an earache, ear ringing, sinus pressure or pain or sinus headache , and/or a fullness sensation in the throat or a post nasal drip feeling


Treatment


  • soft foods.no chewing gum or foods like apples, carrots and bagels
  • avoid clenching or tensing.
  • Icing  the joints
  • moist heat (1/2 hour at least twice daily). To relax muscles 
  • Anti-inflammatory medications eg. Ibuprofen, naproxen
  • Muscle relaxers
  • Dental  occlusal splint to prevent wear and tear on the joint, improving the alignment of the teeth.
  • ​ Physical therapy , oral surgeon referral if severe to facilitate further management of TMJ syndrome.


Mouth Sores

Fever blisters

What are fever blisters?

 fluid-filled blisters that commonly occur on the lips. And gums sually painful;  pain may 

precede the appearance of the lesion by a few days. blisters rupture within hours, then crust over.  last about seven to ten days.

Cause

Herpes simplex virus that becomes active. This virus is dormant.

In afflicted people can be activated by stress, fever, trauma, hormonal changes and exposure to sunlight. When lesions reappear, they tend to form in the same location.

fever blisters are  contagious?, the time from blister rupture until the sore is completely healed is the time of greatest risk for spread of infection.

The virus can spread to the afflicted person’s eyes and genitalia, as well as to other people.

Treatment

Coating the lesions with a protective barrier ointment containing an antiviral agent, eg. 5% acyclovir ointment. 

Tips to prevent spreading fever blisters

· Avoid mucous membrane contact when a lesion is present.

· Do not squeeze, pinch or pick the blisters.

· Wash hands carefully before touching eyes, genital area or another person.

NOTE: Despite all caution, it is possible to transmit herpes virus even when no blisters are present.

Canker sores

Canker sores (also called aphthous ulcers) are different than fever blisters. 

Are  small, red or white shallow ulcers occurring on the tongue, soft palate or inside the lips and cheeks; do not occur in the roof of the mouth or the gums. 

They are quite painful, and usually last 5-10 days.

Because they are not caused by bacteria or viral agents, they are not contagious 


cause 

 Altered local immune response associated with stress, trauma or irritation

 Acidic foods (e.g., tomatoes, citrus fruits and some nuts) 

Treatment

Directed toward relieving discomfort and guarding against infection.

- A topical corticosteroid preparation such as triamcinolone dental paste (Kenalog in Orabase 0.1%®) is helpful. 

- Chemical cautery of the lesion can speed healing.

Tips to prevent mouth sores

· Stop smoking.

· Reduce stress.

· Avoid injury to the mouth caused by hard tooth brushing, hard foods, braces or dentures.

· Chew slowly.

· Practice good dental hygiene, including regular visits to the dentist.

· Eat a well-balanced diet.

· Identify and eliminate food sensitivities.

· Drink plenty of water.

· Avoid very hot food or beverages.

· Follow nutritional guidelines for multivitamin supplements.

·  ​ Be aware of Oral Cancer

​May appear as a white or red patch of tissue in the mouth, or a small ulcer that looks like a common canker sore. 

Other than the lips, the most common areas for oral cancer to develop are on the tongue and the floor of the mouth. 

Other symptoms include a lump felt inside the mouth or neck,

pain or difficulty in swallowing, speaking or chewing

, , hoarseness that lasts for more than two weeks

 numbness in the oral/facial region.

​Voice Disorders

​Laryngitis

​Is an inflammation of the (larynx). 

Symptoms are an unnatural change of voice, such as hoarseness, or even loss of voice that develops within hours to a day or so. Symptoms vary with the severity of the inflammation

​Vocal cord nodules/polyps

​Vocal cord nodules are small growths on both vocal folds that are caused by vocal abuse. 

​Vocal cord paralysis

​Everyone has two vocal cords in his or her larynx. If one or both vocal cords are paralyzed, and are unable to move, then the person will experience voice problems and possibly breathing and swallowing problems.

 Treatment

​The treatment of hoarseness depends on the cause

. Most hoarseness can be treated by simply resting the voice or modifying how it is used.

​What can I do to prevent and treat mild hoarseness?

· ​If you smoke, quit.

· Avoid agents which dehydrate the body, such as alcohol and caffeine.

· Avoid secondhand smoke.

· Drink plenty of water.

· Humidify your home.

· Watch your diet: Avoid spicy foods.

· Try not to use your voice too long or too loudly.

· Use a microphone in situations where you need to protect your voice.

· Seek professional voice training. Avoid speaking or singing when your voice is injured or hoarse. Don’t sing when you are sick.


When Should I See an Otolaryngologist (ENT doctor)?

· ​Hoarseness lasting longer than two weeks, especially if you smoke.

· Pain not from a cold or flu.

· Coughing up blood.

· Difficulty swallowing.

· Lump in the neck.

· Loss or severe change in voice lasting longer than


Dizzyness

​Feeling unsteady or dizzy can happen due to poor circulation, vertigo, injury, infection, allergies, or neurological disease.

Dizziness is treatable but it is important for your doctor to help you determine the cause so that the correct treatment is used.

Causes 

  •  Poor circulation: 
  • Certain drugs 
  •  Sometimes circulation is impaired by spasms in the arteries caused by emotional stress, anxiety, and tension.
  • True vertigo 
  • Benign paroxysmal positional vertigo (BPPV), labyrinthitis, occurs when you change the position of your head (typically lying down or sitting up)
  • Ménière’s syndrome (fluctuating hearing usually in one ear, pressure in the ear, ringing in one ear, and attacks of spinning),
  • Migraine  Some forms cause vertigo. while inner ear infections can cause labyrinthitis.
  • Skull fracture: that damages the inner ear produces a profound and incapacitating vertigo with nausea and hearing loss. The dizziness will last for several weeks, and then slowly improve as the normal (other) side takes over.
  • Infection: Viruses can attack the inner ear and its nerve connections to the brain. This can result in severe vertigo, but hearing is usually spared. 
  • Neurological diseases: A number of diseases of the nerves can affect balance, such as multiple sclerosis, syphilis, tumors, etc. These are uncommon causes, but your doctor will think about them during the examination.

Consult your doctor if you:

· ​have never experienced dizziness before,

· experience a difference in symptoms you have had in the past,

· suspect that medication is causing your symptoms

· experience hearing loss.

​Tinnitis (Ear ringing)


cause:

  • Damage to the microscopic endings of the hearing nerve in the inner ear. 
  • Advancing age is generally accompanied by a certain amount of hearing nerve impairment and tinnitus
  • Exposure to loud noise is probably the leading cause of tinnitus, and often damages hearing as well.
  • ​​ TMJ (jaw joint) problems
  • Allergy
  • High or low blood pressure, 
  • Tumor
  • Diabetes
  • Thyroid problems
  • Injury to the head or neck, 
  • Medications such as anti-inflammatories, antibiotics, sedatives, antidepressants, and aspirin

By finding a specific cause of your tinnitus, you may be able to eliminate the noise. But, this determination may require extensive testing including X-rays, balance tests, and laboratory work.

However, most causes cannot be identified. 

Occasionally, medicine may help the noise. The medications used are varied, and several may be tried to see if they help.

​Tips to lessen the severity of tinnitus

· ​Avoid exposure to loud sounds and noises.

· Get your blood pressure checked. If it is high, get your doctor’s help to control it.

· Decrease your intake of salt. Salt impairs blood circulation

· Avoid stimulants such as coffee, tea, cola, and tobacco

· Exercise daily to improve your circulation

· Get adequate rest and avoid fatigue.

· Stop worrying about the noise. Recognize your head noise as an annoyance and learn to ignore it as much as possible.


​Hearing Loss

​Loss of hearing is described by varying degrees, not percentages.

. Hearing loss may be mild, moderate, or profound and vary across pitches.

 It is determined by a simple hearing test 

​Conductive Hearing Loss

​ there is a problem with the way sound is conducted to the inner ear or cochlea. 

The problem may lie in the outer ear (lobe or ear canal), eardrum (tympanic membrane), or the middle ear (ossicles and eustachian tube). 

The inner ear remains unaffected in this type of hearing loss.

​ 

​Conductive hearing losses may be temporary or permanent, depending on the source of the problem. 


Medical management can correct some cases of conductive hearing loss, while amplification may be a recommended treatment option in more long-standing or permanent cases.

​Sensory-neural Hearing Loss

​Occurs when there is a problem with the sensory receptors, in the cochlea of the inner ear.

Result of an abnormality or damage to the hair cells in the cochlea. This abnormality prevents sound from being transmitted to the brain normally, resulting in a hearing loss.

The hair cells may have been abnormal since birth (congenital)

,

damaged as a result of, infection, drugs, trauma or over-exposure to noise, or 

as a result of the aging process, a kind of hearing loss known as presbycusis (pres-be-cue-sis).

Sensorineural hearing losses are generally permanent and may stay stable or worsen over time.

Routine hearing tests are needed to monitor the hearing loss. 

Amplification, including hearing aids or cochlear implants in the most severe cases, is a common treatment recommendation.

​Individuals with sensorineural hearing loss may report muffled speech, ringing in the ears (tinnitus), difficulty hearing in background noise or that others do not speak clearly.nd it, it doesn’t exist. Clearly list and describe the services you offer. Also, be sure to showcase a premium service.