FAQs

Most treatments for allergies are aimed at preventing or minimizing symptoms. Steroid nasal sprays, antihistamines and other medical treatments work on different steps in the reaction of allergens and inflammatory cells to prevent certain chemicals (e.g., histamine) from being able to cause their effects and therefore, your symptoms.

The only method to cure allergy problems is via immunotherapy, which is designed to “train” your body to change how it reacts to those allergens it is sensitive to. What is allergy testing?

The first step in treating allergies effectively is to accurately identify exactly which allergens are causing the problems. Traditionally, this was done with skin testing, where a small amount of allergen (e.g., ragweed extract, dust mite extract, etc.) was place just underneath the skin with a small needle. This was performed for the most common allergens and any other suspected allergens based on the patient’s history. Based on the amount of swelling and redness that formed, the patient’s was deemed “allergic” or not to each allergen. This technique was time consuming and uncomfortable patients but reliable and accurate.

Alternatively, in vitro testing (done in the lab, not on the patient) has become our standard testing method. Radio-Allergo-Sorbent Testing (RAST) involves drawing a vial of the patient’s blood , which is then sent to a laboratory that can determine which allergens the patient will cross-react to.

Category: Allergy FAQs

An allergic reaction occurs when a particle (pollen, certain foods, etc.) called an allergen attaches to certain cells in your nose, throat, intestines, etc. and causes a certain effects. These effects are the symptoms we associate with allergies — runny nose, sneezing, post-nasal drip, itchy water eyes, gastrointestinal upset, rashes or hives, etc.

Category: Allergy FAQs

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Balloon sinuplasty is a procedure designed for selected patients with chronic sinusitis due to blocked openings of their sinus cavities (usually due to swelling caused by allergy, infections, etc.). A balloon is guided into the small opening of the sinus cavity where it is inflated, thereby enlarging the opening, thereby allowing the sinus to drain. It is often performed as an outpatient procedure and, in properly selected patients has long-lasting improvement.

For more on Balloon Sinuplasty, visit:

http://www.balloonsinuplasty.com

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Holes in the eardrum (perforations) can be caused by infection or by trauma. Infections can cause perforations by simply eating a hole in the eardrum. Trauma causes perforations by tearing the eardrum. Common types of trauma include poking a hole in the eardrum with a Q-tip or bobby pin while trying to clean the ear and sudden pressure changes caused by being accidentally hit in the ear (falling off water skis or being hit in the side of the head by a basketball for example).

The eardrum separates the outside world and its air pressure from what is called the middle ear space. Inside your head is a small passage from the back of the nose to the middle ear space called the Eustachian tube. Normally, this tube keeps the pressure inside your ear equal to the pressure outside. Sometimes, often in association with a cold or allergy attack the tube does not work well. When you are flying, there are pressure changes on takeoff and landing even in a pressurized airplane. If your Eustachian tube is not working properly, you may have pain, pressure, popping and clicking. In some people the Eustachian tube does not work well and they have popping and clicking all the time.

The most common way ear infections cause hearing loss is related to the buildup of fluid in the ear. The fluid that develops in the ear as a result of the infection makes it much harder for sound to vibrate the eardrum. This hearing loss is usually reversible with removal of the fluid using medicine or a small ear tube in the eardrum. Sometimes though the infection can damage the eardrum, the tiny bones in the ear that carry sound from the eardrum to the inner ear, or the inner ear itself. These types of hearing losses are sometimes irreversible.

Fluid can accumulate in the space between the ear drum and inner ear and cause hearing loss and a sensation of fullness and pressure. Sometimes, people report hearing fluid “slosh around”. The fluid is usually a result of infection or of pressure changes from swimming or flying. Usually the fluid can be eliminated with medication or placement of a small tube in the ear drum.

Although ear infections are much more common in children, they occur in adults as well. Most can be treated with antibiotics, either by mouth, using ear drops, or both. Sometimes, just as in children, tiny ear tubes placed in the eardrum are needed to stop infections. Tubes in adults can almost always be placed in the office without need for general anesthesia (the procedure involves only minimal discomfort, and adults rarely get up and try to run away). Rarely, some infections will become bad enough to need more surgery than just a tube to drain the ear, clear the infection, and attempt to restore hearing.

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A Facial Plastic Surgeon is a licensed physician that, following medical school, has completed a residency in either Otolaryngology-Head and Neck Surgery or Plastic Surgery and Reconstructive Surgery, followed by certification by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS). The certification process includes completion of an American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) accredited fellowship, passing a rigorous written and oral board exam, and demonstration of clinical practice consistent with the standards of the ABFPRS.

Dr. Pero completed a fellowship with Dean M. Toriumi, MD, a world-renowned Facial Plastic Surgeon with the University of Illinois at Chicago Medical School, an institution with a long history of excellence in Facial Plastic And Reconstructive Surgery. His special interests include primary and revision rhinoplasty (nasal reshaping), nasal reconstruction after skin cancer removal, and aging face surgery (e.g., facelifting, eyelid surgery, browlifting, chin augmentation, etc.).

Dr. Pero is one of only a handful of Facial Plastic Surgeons comfortable with the use of rib grafting for revision rhinoplasty and nasal reconstruction. For more questions about Facial Plastic & Reconstructive Surgery, visit the following:

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Almost all tonsil, adenoid, ear, and sinus procedures in children can be done on an outpatient basis without hospitalization. This is our preference, as both the child and family are usually much more comfortable at home than in a hospital. In those rare cases where hospitalization is needed it can be arranged.

Category: Pediatric FAQs

Ear, nose and throat surgery is no more dangerous or difficult than similar surgeries in adults. In most cases, the decision for surgery involves weighing the risk of surgery against the risks of continuing to be sick. For example, repeated tonsil infections, especially when strep.(+), can be associated with serious health problems such as rheumatic fever and kidney failure. These problems are rare, but if infections are occurring often the risk of not doing surgery becomes greater than the risks involved in removing the tonsils.

However, children are not just little adults, and special attention is required. Dr. Wyatt, Dr. Wyll and Dr. Pero have had extensive training and experience with children’s ENT problems. We work with anesthesiologists who also have extensive training and experience with children and the special issues involved in children’s ENT surgery. The operating rooms at the hospitals and surgery centers we use have the specialized pediatric equipment needed to care for children.

Category: Pediatric FAQs

It is not normal for children to snore, particularly if the snoring is loud and can be heard easily from outside their room. If the snoring stops by age 2 or so it usually requires no treatment, but if it continues it is associated with significant problems.

Children who snore have a higher rate of attention deficit hyperactivity disorder, and in many children snoring is caused by enlarged tonsils and adenoids. In children with ADHD and enlarged tonsils and adenoids, removal of the tonsils and adenoids often will significantly improve the learning disability. For this reason, the major national organization of pediatricians recommends tonsillectomy and adenoidectomy in children with snoring and enlarged tonsils and adenoids. Snoring with stopping breathing at night is a potentially much more serious problem. Stopping breathing, gasping or choking can be caused by obstructive sleep apnea and will usually need to be corrected by removing the tonsils and adenoids.

Category: Pediatric FAQs

In children, most sinus infections are treated with antibiotics, decongestants and other medicines. In children with frequent or severe infections, removing the adenoids will often help a great deal. In a small number of children with frequent or severe infections removing the adenoids does not solve the problem and other measures may need to be considered. These include extra-long courses of antibiotics and consideration of sinus surgery.

Sinus surgery in children is something we will often do as we specialize in this area, but most children, even those with significant sinus problems, do not need surgery. A special case is children with asthma. In some cases asthma can be very difficult to control due to frequent sinus infections. In these children, when medication fails to help, we will move a little more quickly toward sinus surgery because clearing the sinusitis will help control the asthma most of the time.

Category: Pediatric FAQs

The tonsils and adenoids are lumps of lymphatic tissue (like lymph nodes) in the back of the throat. There are two tonsils, one on each side of the throat, and one adenoid located at the very top of the throat at the back of the nose. Their function, like all lymph nodes, is to help fight infection. However, the normal human adult or child has far more than enough lymph tissue in other parts of the body to fight infection and to remain entirely healthy without the tonsils and adenoids. Sometimes, for reasons that are not entirely clear, the tonsils and adenoids get chronically infected. If the infections become frequent or severe, than removal of the tonsils and adenoids is recommended to eliminate the infections. It is not known for certain why some children have this problem and others do not, but the problem does tend to run in families.

Adults can have the same problem, although it is much more common in children. Also, sometimes tonsils and adenoids become so large that they interfere with breathing, especially at night. When this occurs, removal is also recommended. In some cases enlarged tonsils and adenoids can cause difficulty swallowing. Although cancer in the tonsils and adenoids is very rare, sometimes tonsils and adenoids are removed for this reason also.

Category: Pediatric FAQs

Hearing in older children can be evaluated almost as easily as adults, but in small children a technique called “conditioning play audiometry” is used. It requires special equipment that we have in our office. Using robotic toys, the audiologist essentially plays a game with the child. He will make one of the toys move after a tone sounds at a calibrated loudness, and the child will rapidly realize that the robot will move shortly after the tone. So, if the child turns to look at the toy when the tone sounds, the child can hear the tone at that level. The game is repeated at different frequencies and loudness levels until the test is completed, usually in less than 15 minutes. If the child will cooperate with wearing headphones, even more accurate results can be obtained.

Category: Pediatric FAQs

Children are more susceptible to upper-respiratory and ear infections, and it’s during cold and flu season that upper-respiratory infections crop up, which can lead to ear infections. Symptoms include fever, pain, fussiness, pulling on the ears, and even vomiting and nausea. These infections can lead to temporary hearing loss, but if they happen very often in the most extreme cases there can be permanent hearing loss. Treatment includes antibiotics plus a decongestant, or numbing and antibiotic eardrops, or surgery.

A typical case would be a child with multiple ear infections we will call Amanda. Antibiotics took care of her first, second and third infections. But four different antibiotics, including antibiotic shots, couldn’t cure her most recent infection. At that point, the pediatrician recommended evaluation by an ear, nose and throat specialist. At the time of the examination, hearing was also tested, and a hearing loss was present due to the infected fluid in the ears. Therefore, Dr. Wyatt recommended that tubes be placed in Amanda’s ears to help ventilate and drain the fluid trapped in her ears. In most cases, this will eliminate the infection, prevent it from returning, and correct the hearing loss. Following the surgery, a number of improvements in the child’s behavior are often seen. Having fluid in the ears can hinder the development of a child’s vocabulary and cause balance problems that slow the progress of learning to walk. Many ear infections, which can be caused by a virus or bacteria, happen in the middle ear. The infection happens when fluid cannot drain from the middle ear and becomes stagnant.

One reason children are more susceptible to recurring infections is because the anatomy of their ears makes it difficult for fluid to drain. The fluid drains out of the Eustachian tube, which connects the middle ear to the throat. The tube also helps ventilate the ear. The angle of the tube is more horizontal in kids than in adults; that can hinder drainage and create a breeding ground for infection. Children’s immune systems aren’t fully developed and have trouble fighting off infections.

The first “peak” in ear infections is in babies 13 to 15 months, and a second peak between 4 and 6 years old. Studies suggest that children who are exposed to cigarette smoke and those who go to day care have a greater risk for ear infections. Children are usually sent to an ear, nose and throat specialist if they have had five or six ear infections in less than 12 months, or if they are becoming resistant to antibiotics or are having overlapping ear infections. Any symptoms of hearing loss also need to be evaluated.

Category: Pediatric FAQs

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Sinus polyps can be cancerous, but the benign form of sinus polyps is much more common. Sinus cancer is rare, and fortunately only very rarely a problem in the patient with polyps.

Category: Sinus FAQs

There are several reasons, often called “indications”, for performing sinus surgery. The most common reason is years of repeated infections or an infection that will not respond to medications such as repeated antibiotics. Another is blockage that cannot be treated successfully with medicine, such as large polyps or a deviated septum. Other more rare reasons for surgery include cancerous sinus polyps and infections that are so severe they have invaded the eye or brain and require emergency or near-emergency drainage.

Category: Sinus FAQs

Modern minimally-invasive sinus surgery as we carry it out is done through the nose. We use endoscopic telescopes to see and a variety of micro-instruments to remove and/or reshape tissue. Using this type of equipment the surgery can usually be very precise and limited to those areas causing infection, blockage or other problems. Will I look different after sinus surgery?

Only if unusual problems occur will the shape of the nose or face change following surgery. In the past, significant temporary facial bruising was very common, but although this can occur it is now rare. Since most minimally-invasive sinus surgeries do not involve breaking the nose it is rare for the shape of the outside of the nose to change.

One desirable change that does occur in some cases is related to the problems caused by chronic infection. Chronic infection can cause swelling under the eyes and problems with excess tearing due to obstruction of tear ducts. Following successful surgery, these problems will often, though not always, disappear.

Category: Sinus FAQs

Only in very rare and unusual cases does sinus surgery require hospitalization. Most sinus surgery can safely be done on a “day surgery” basis – in and out the same day. Hospitalization is usually reserved for patients who have not only chronic sinusitis but also other conditions such as severe asthma, heart problems or severe obstructive sleep apnea. Some of these patients are hospitalized in order to observe them closely after surgery to prevent problems with these other medical conditions.

Category: Sinus FAQs

Some people are uniquely susceptible to sinus infections. This can be because of problems with the drainage and ventilation of their sinuses, and surgery to relieve these blockages can be beneficial. In some people, the lining of the sinuses is simply more prone to infection. In others, blockages develop because of polyps, cysts or even tumors (although cancerous tumors are very rare). Some people have immune system weaknesses that make them more susceptible to all infections, including sinus infections.

Category: Sinus FAQs

As specialists in sinus disease, we evaluate each person we see with sinus problems and come up with a plan for making them better. The first treatment for almost everyone with sinus infections is antibiotics and other medicines designed to help with drainage. If these medicines do not work, or if the infections keep coming back over and over again, then surgery can be considered. We also consider surgery in very severe cases, such as where the infection has spread out of the sinuses and is out into the eye or up into the brain.

Modern sinus surgery is done using primarily minimally-invasive endoscopic techniques. With the patient asleep, a scope is passed into the nose so that we can see the problems and take care of them, usually without the need for breaking the nose or packing the nose as was done in the past.

Category: Sinus FAQs

Sinus infections and allergic sinus problems often overlap and are closely related. For this reason, it is often difficult to separate the two. Classic symptoms of allergy are seasonal episodes of clear drainage, nasal congestion, sneezing, and itching and watering eyes. These symptoms also occur when exposed to something you are allergic to, such as a dog or cat. Classic symptoms of infection are nasal congestion, yellow-green drainage, headache and face pain, tooth pain, eye pain and pressure, and mild fever. In many cases, these symptoms will follow a cold or flare in allergy symptoms.

The overlap between the two often comes up because people with allergies are more likely to have problems with infections. The allergies can cause blockage of the sinuses, inflammation and accumulation of fluid that forms a great “Petri dish” for germs to grow.

It is important to determine what each person suffers from because treatment can be very different. For example, in a patient with no allergy but with chronic infection allergy treatment will be of little to no benefit. On the other hand, for a patient with both allergy and infection treatment of the allergy can sometimes clear up the infections as well, or at least make them much less frequent.

Category: Sinus FAQs

Problems with the sinuses can cause a wide variety of head and face discomfort, but most of the time headaches related to sinus problems are a feeling of pressure or aching between and/or behind the eyes, in the temples, or in the face, cheek and teeth. Sinus problems can also cause ear pain and pressure. However, all headaches are not from sinusitis and migraine headaches in particular can sometimes closely mimic sinus headaches. Sinusitis can also trigger migraines in people with both problems.

Often careful examination can determine the true cause of headaches. Often careful examination combined with a CT scan is needed to accurately determine the cause of “sinus” headaches and plan effective treatment.

Category: Sinus FAQs

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