WHAT IS ACID REFLUX?

Acid reflux is also known as GERD (gastro-esophageal reflux disease). GERD that comes all the way up to the back of the throat and voice-box area is called "laryngopharyngeal reflux" (LPR).  Laryngopharyngeal reflux is the regurgitation of stomach secretions (acids) from the stomach up into the esophagus (food pipe) and then up into the laryngopharynx (throat and voice box area). Many things contribute to acid reflux...the final problem being looseness of the muscle between theesophagus and stomach. LPR can lead to "chronic laryngitis" or "chronic laryngopharyngitis."

Possible Symptoms

-voice change 

-hoarseness 

-burning

-soreness 

-bad breath 

-chronic cough

-a need to clear the throat

-a sense that there is a foreign body or mass in the throat (globus)

Oftentimes there is no heartburn or stomach upset!

Kevin Ende MD, a top ENT Surgeon in Bergen County will use a state of the art telescope to look at the throat and voice box to evaluate the changes that the stomach acid may have made to the surface lining. This may include irritative swelling, redness, or hardening. It would also rule out any concerning growths or movement problems. The vocal cords are in the voice box, so they are visualized at the same time. It does not look into the esophagus.

How is reflux treated?

Essential lifestyle changes

 -STOP SMOKING!!

 -avoid alcohol

 -limit caffeine, chocolate, fatty/spicy foods, mints, carbonated drinks

-eat smaller meals, more frequently

-elevate the head of your bed 6 inches 

-nothing to eat or drink 3 hours before bedtime (unless medically

-indicated to do so such as certain diabetic or ulcer patients)

-avoid tight fitting clothing

-weight reduction

Medicine management

A strong acid-suppression medicine called a "proton-pump inhibitor" has likely been prescribed for you. There are many kinds and some work better than others for different patients (brand names include Prilosec, Nexium, Aciphex, and Prevacid.) It takes a longer time and higher doses for these medicines to help with the throat and voice box symptoms than it does to help with heartburn.  There are other medicines as well that can be tried in conjunction with these.  If your symptoms do not respond appropriately to this medicine, you may be sent for further testing to see if you are eligible for an actual surgery to help with this condition.

Acoustic neuroma

Also known as a Vestibular schwannoma; Cerebellopontine angle tumor; Angle tumor; Hearing loss tumor; acoustic tumor; Tinnitus tumor. An acoustic neuroma is a tumor that grows very slowly of the nerve between the ear and the brain. This hearing nerve is called the vestibular cochlear nerve. The location is behind the ear, and beneath the brain. An acoustic neuroma is benign so it does not spread anywhere else. However, it can put a tremendous amount of pressure issues since it is growing in such a small confined space.  An acoustic neuroma can also damage several other nerves in the area as it grows.

Causes

Acoustic neuromas can just occur spontaneously.  Acoustic neuromas have also been linked with the genetic disorder neurofibromatosis type 2(NF2).  Although acoustic neuromas are uncommon, your doctor will not want to miss this diagnosis.  Kevin Ende, MD has diagnosed many acoustic neuromas at NJ Eye and Ear in Englewood New Jersey.

Symptoms The symptoms of an acoustic neuroma vary, based on the size and location of the tumor. The tumor grows very slowly, so symptoms most often start after age 30.

Common symptoms of an acoustic neuroma include:

• Abnormal feeling of movement or spinning dizziness, aka vertigo

• Assymetrical hearing loss that makes it hard to hear conversations and difficult to comprehend the direction that a sound is coming from

• Ringing aka tinnitus

Other symptoms of an acoustic neuroma include:

• Headache

• Numbess in the face or one ear

Pain in the face or one ear

• Weakness of the face or facial asymmetry

Exams and Tests

The patient may look and feel normal when the tumor is diagnosed. However than can be the following signs on examination:

• Decreased feeling on one side of the face

Drooping on one side of the face

The most commonly used test to look for an acoustic neuroma is an MRI.  Other options for tests to diagnose an acoustic neuroma in Englewood, NJ are:

• Hearing test aka audiogram

• Test of equilibrium and balance electronystagmography aka ENG

• ABR (brainstem auditory evoked response)

Treatment

NJ Eye and Ear has access to the best treatment for acoustic neuroma in Englewood, NJ.  Although surgical removal is possible, one may also choose to follow the tumor for a while depending on their life circumstances.  Patients may also choose different forms of minimally invasive or noninvasive treatments like Gamma Knife for acoustic neuromas.

The larger a tumor gets, the more difficult that it will be to remove.  

If the tumor is not treated, some acoustic neuromas can:

• Damage the nerves involved in hearing and balance

• Place pressure on nearby brain tissue

• Harm the nerves responsible for movement and feeling in the face

• Lead to a buildup of fluid in the brain (with very large tumors)

Surgical removal of an acoustic neuroma is more commonly done for:

• Larger tumors

• Tumors that are causing symptoms

• Tumors that are growing quickly

• Tumors that are pressing on the brain

Although the hearing may or may not be preserved with surgery or radiation, the tumor may still need to be removed for the reasons above.

The surgical technique to remove an acoustic neuroma is called microsurgery. A special microscope and small, precise instruments are used. This technique offers a higher chance of cure. Radiotherapy can be used to slow down the growth and shrink the tumor as an alternative to surgery.

Prognosis

If the tumor is small and slow-growing, it may not need treatment. Hearing loss present before treatment is not likely to return after surgery or radiosurgery.  Most people with small tumors will have no permanent weakness of the face after surgery. However, people with large tumors are more likely to have some permanent weakness of the face after surgery. Signs of nerve damage such as loss of hearing or weakness of the face may be delayed after radiosurgery. In most cases, brain surgery can completely remove the tumor.

Inner ear injury; Trauma to the inner ear; Noise induced hearing loss. Acoustic trauma is an insult to the hearing structures in the inner ear due to a very loud noise.

Causes

Acoustic trauma is a common cause of sensorineural hearing loss or loss of hearing due to the nerves.  Examples of loud noises that cause hearing loss suddenly or due to repeated exposure are:

• Explosions

• Firing a gun repeatedly without proper protection

• Long-term an repeated exposure to loud noises such as loud music or heavy machinery

Symptoms include:

• Hearing loss which may slowly get worse.

• Noises, ringing in the ear, also known as tinnitus.

Exams and Tests

At NJ Eye and Ear we will most often suspect acoustic trauma if hearing loss occurs after noise exposure. A physical exam will determine if the eardrum is damaged.  The audiologist may determine how much hearing has been lost.

Treatment

The hearing loss may not be treatable but we can help you prevent further damage.  We can fit you for a hearing aid. Lip reading skills can be worked on.

Outlook (Prognosis)

Hearing loss is usually permanent. At this point, it is best to protect your ears from loud sounds to prevent further hearing loss. Wear protective ear plugs or earmuffs to prevent hearing damage from loud equipment. Avoid loud concerts and avoid turning the volume on your iphone loudner than needed to hear.  Avoid guns, using chain saws, or driving motorcycles unless ear protection is used.

Adenoid Removal 

Also Known As: Adenoidectomy

Adenoidectomy is a surgery to take out the adenoid glands which sit in the back of your nose and  above the roof of your mouth in the nasopharynx. When you breath through your nose, air must pass by these glands or you will feel that your nose is blocked. Adenoidectomy is often performed at the same time as a tonsillectomy.  Adenoidectomy is most commonly performed in children but can be performed in adults.

Description of an Adenoidectomy:

During an adenoidectomy at NJ Eye and Ear in Englewood New Jersey, your child will be given general anesthesia in order to perform the surgery while they are asleep and unable to feel any pain. The surgeon uses a small retractor in your child's mouth to open it.  We will remove the adenoid gland using a curette or through electrosurgery or coblation. Your child will stay in the recovery room after surgery. You will be allowed to take your child home when your child is awake and can breathe easily, cough, and swallow. In most cases, this will be a few hours after surgery.

Why is an Adenoidectomy performed?

NJ Eye and Ear may recommend an adenoidectomy at Englewood Hospital if:

• The adenoids are enlarged and blocking the nasal airway.  This usually presents as an obstructed nose, snoring, and/or episodes of not breathing at night.
• There are chronic ear infections despite the use of antibiotics, cause hearing loss, or cause the child to miss a significant number of school days.
• Adenoidectomy along with tonsillectomy is usually recommended in cases of chronic tonsillitis.
• The adenoids are the largest between the ages of 2-5. Adults rarely need to have them removed.

Adenoidectomy Risks

• Bleeding
• Infection
• Need for further surgery
• See the adenoidectomy consent form for further information

What should I expect from an adenoidectomy?

• To breath better through the nose
• Less bouts of tonsillitis and sore throats
• Less ear infections with increased ability for the ear to drain fluid

Allergies affecting the Ear, Nose and Throat

Allergy, Allergens

An allergy is a reaction to substances that are usually not harmful. Your immune system normally protects your body against harmful bacteria and viruses. With seasonal allergies this same system reacts to pollens and other environmental items.  Allergy symptoms include cough, scratchy or sore throat, puffy or watery eyes, sneezing, nasal drainage or blockage, tiredness, and headache. 

Causes

Allergies are extremely common in Englewood NJ. Both genes and environment may be the cause.  Allergies definitely run in families.

Diagnosis

At NJ Eye and Ear we can perform tests to find out what causes your allergies.  Although RAST testing was used in the past, ELISA testing is the more common method.   Skin tests are also possible.

Treatment

Common medicines include antihistamines, corticosteroids, and decongestants. Treatments are available over-the-counter and by prescription. At NJ Eye and Ear we will recommend a medicine based on what you are allergic to, how severe your allergies, and what areas of your body they affect.   Allergy shots can treat severe seasonal allergies that are not resolved with medications.

The most common allergens in Bergan County New Jersey include:

• Drugs

• Dust

• Food

• Mold

• Pet and other animal dander

• Pollen and grasses

Allergies may make certain medical conditions worse, such as sinus problems, eczema, and asthma.  At NJ Eye and Ear we treat sinus conditions both medically and surgically.

Treatment

Severe allergic reactions can be life-threatening and are treated by calling 911 and using an epi-pen if available.

Allergy avoidance works better than any medication if the allergy is avoidable.

There are several different classes of medications to help with allergies.

Antihistamines are available OTC and by prescription. Many different types of antihistamines are available including:

• Capsules and pills

• Eye drops

• Injection

• Liquid

• Nasal spray

CORTICOSTEROIDS

Corticosteroid nasal sprays are the most commonly used medications for treating nasal symptoms.  Pill versions treat total body allergies, while creams can help with skin reactions to allergies. 

DECONGESTANTS

Decongestants such as oxymetazolone help relieve a stuffy nose. Do not use decongestant nasal spray for more than 5 days because they can cause a rebound effect and make the congestion worse. They are also very addictive after the 5 day period.  Pills do not cause rebound. Patients with high blood pressure, heart problems, or prostate enlargement should discuss other options with us.

OTHER MEDICINES

Leukotriene inhibitors block the substances that trigger allergies and may be added on to other treatments.

ALLERGY SHOTS

Allergy shots are recommended when the above options fail to relieve the allergic symptoms

SUBLINGUAL IMMUNOTHERAPY TREATMENT (SLIT)

Instead of shots, medicine put under the tongue may help for grass, ragweed, and dust mite allergies.

Prognosis

At NJ Eye and Ear we will work with you to help figure out the best combination of allergy medicine at avoidance tactics.  Most allergies can be easily treated with medicine, but we will recommend shots if necessary.

Injection laryngoplasty; Botox - larynx: spasmodic dysphonia;  Essential voice tremor; Guided botulinum toxin treatment; Adductor dysphonia; Onabotulinumtoxin A-larynx; Abobotulinumtoxin A, Percutaneous indirect laryngoscopy - guided botulinum toxin treatment; Botulinum toxin or Botox blocks nerves. 

Botox blocks nerve signals to relax muscles and is safe when used in small doses even though it is technically a toxin. Botox is injected near the vocal cords. This injection weakens the muscles and improves voice quality. In most cases at NJ Eye and Ear in Englewood New Jersey, you will have the Botox injections in the office. There are two common ways to inject Botox to help the voice box.

Through the neck:

• You may have local anesthesia to numb the area.

• You may lie down on your back or remain sitting up. 

• An EMG machine records the movement of your vocal cord muscles through tiny electrodes placed on your skin. This helps guide the needle to the correct area but is usually not necessary.

• Another method involves using a flexible laryngoscope inserted through the nose to help guide the needle.

Through the mouth:

• You may have general anesthesia so you are asleep during this procedure.

• You may also have numbing medicine sprayed into your nose, throat, and larynx.

• Your provider will use a long, curved needle to inject directly into the vocal cord muscles.

• You provider may place a small camera (endoscope) into your mouth to guide the needle.

Side Effects:

• A breathy sound to your voice

• Hoarseness

• Weak cough

• Trouble swallowing

• Pain 

• Flu-like symptoms

Prognosis

Botox can improve your voice quality for about 3 to 4 months. To maintain your voice, you may need injections every few months.  The treatment is not guaranteed to work, and is usually not continued if there is no benefit from the first injection.

Choking and emergency airway

Needle cricothyrotomy, tracheotomy

Emergency airway puncture is the placement of a hollow needle into the airway in the throat. It is done to treat life-threatening choking when the Heimlich maneuver has not worked and it is not possible to place an advanced airway.

Dr. Kevin Ende at NJ Eye and Ear has been called upon many times over the last 17 years to perform this life-saving procedure on children and adults.

Emergency airway puncture is done in an emergency situation, when someone is chocking and all other efforts to assist with breathing have failed.

•       A hollow needle or tube can be inserted into the throat, just below the Adam's apple (thyroid cartilage), into the airway. The needle passes between the thyroid cartilage and the cricoid cartilage.

•        A cricothyrotomy is an emergency procedure to relieve an airway obstruction until surgery can be done to place a breathing tube aka tracheotomy or another advanced airway.

Risks for this procedure include:

•       Injury to the voice box (larynx), thyroid gland, or esophagus, bleeding, infection, and of course that it will not work since the obstruction could be lower down.

How well the person does depends on the cause of the airway blockage and how quickly the person receives proper breathing support. Emergency airway puncture provides enough breathing support for only a very short period of time.

Chronic ear infection; Chronic otitis

A cholesteatoma is a skin cyst that is located in the middle ear and mastoid bone.

Causes

Cholesteatoma can be present at birth, but it more commonly results from chronic ear infecton.  The eustachian tube equalizes pressure in the middle ear. When the eustachian tube is blocked or not functioning, negative pressure builds and suck in the eardrum. This phenomenon can create a cyst that fills with dead skin cells and other debris.  Because this cyst may become infected or get bigger, this often causes erosion of the middle ear bones or other parts of the middle ear. This can affect hearing, balance, taste, and facial movement.

Symptoms include:

• Dizziness
• Ear Drainage long term
• Hearing loss
• Ear fullness or pressure
• Exams and Tests

At NJ Eye and Ear in Englewood New Jersey we will examine your ear with the latest technology.

A CT scan may be ordered to look at the extent of the cholesteatoma 

Causes

Cholesteatomas usually continue to grow and destroy surrounding structures if they are not removed with surgery.  Regular cleanings and checkups after surgery are necessary to best avoid another trip to the OR.  Another surgery may be needed if the cholesteatoma comes back.

Possible Complications

Complications of not having surgery may include:

• Brain abscess
• Facial nerve damage and facial paralysis
• Meningitis
• Further hearing loss

Prevention

The best way to prevent a cholesteatoma is early treatment of chronic ear infections

Ear infection - chronic

Middle ear infection - chronic; Serous Otitis media - chronic; Serous Chronic otitis media; Chronic ear infection

A chronic ear infection is long-term fluid, swelling, or an infection behind the eardrum that does not go away or keeps coming back. It can cause permanent damage to the ear and hearing. Many chronic ear infections have a hole in the eardrum that does not heal.

Causes

A chronic ear infection may be caused by:

•         An ear infection that does not go away

•         Repeated ear infections

•         Dysfunction of the eustacian tube

"Suppurative chronic otitis" is a phrase used to describe an eardrum that keeps rupturing, draining, or swelling in the middle ear or mastoid area and does not go away.

Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults. Chronic ear infections are much less common than acute ear infections.

Symptoms

Symptoms of a chronic ear infection may be less severe than symptoms of an acute infection. The problem may go unnoticed and untreated for a long time.

Symptoms may include:

•         Ear pain or discomfort 

•         Fever, usually low-grade

•         Fussiness in infants

•         Long-term ear drainage 

•         Loss of hearing

Symptoms may continue or come and go. They may occur in one or both ears.

Exams and Tests

At NJ Eye and Ear, we will examine the ears. This may reveal:

•         Dullness, redness in the middle ear

•         Air bubbles in the middle ear

•         Thick fluid in the middle ear

•         Retracted eardrum that sticks to the bones in the middle ear

•         Draining fluid from the eardrum

•         A hole (perforation) in the eardrum

•         An eardrum that bulges out or pulls back inward (collapses)

Tests may include:

•         Cultures of the fluid may show bacteria

•         A CT Scan of the temporal bone may show that the infection has spread beyond the middle ear.

•         Hearing tests may be needed.

Treatment

Kevin Ende MD may prescribe oral antibiotics or antibiotic drops if the infection is caused by bacteria. Other ear drops may also be prescribed.  We may need to clean out (debride) tissue that has gathered inside the ear.

Other surgeries that may be needed include:

•         Surgery to clean the infection out of the mastoid bone called mastoidectomy

•         Surgery to repair or replace the small bones in the middle ear

•         Repair of the eardrum - Tympanoplasty

•         Tympanostomy tube placement

Prognosis

Chronic ear infections have become less common in recent decades and most often respond to treatment. 

Chronic ear infections are not life threatening. However, they can be uncomfortable and may result in hearing loss and other serious complications.

Complications

A chronic ear infection may cause permanent changes to the ear and nearby bones, including:

•         Infection of the mastoid bone behind the ear mastoiditis

•         Chronic drainage from a hole in the eardrum that does not heal, or after the ear tubes are inserted

•         Cyst in the middle ear cholesteatoma

•         Scarring of the eardrum (tympanosclerosis)

•         Erosion of the bones of the middle ear, which help with hearing

•         Facial nerve paralysis

•         Brain 

•         Balance and vertigo issues

•         Hearing loss

When to Contact NJ Eye and Ear

Call us if:

•         You or your child has signs of a chronic ear infection

•         An ear infection does not respond to treatment

•         New symptoms develop during or after treatment

Ear drainage; Otorrhea; Bleeding from ear, Ear bleeding. Ear discharge is leakage of one or more of the following: blood, ear wax, pus, or fluid

An eardrum that is ruptured can cause a colored or colorless, slightly bloody, or yellow discharge from the ear. Dry crusted material on a child's pillow can be a sign of a ruptured eardrum. The eardrum or ear canal may also bleed.

What causes a ruptured eardrum?

• Foreign body in the ear canal

• Trauma to the head, foreign object, very loud noises, or sudden pressure changes (such as in airplanes)

• Inserting cotton-tipped swabs or other small objects into the ear

• Middle ear infection

What causes ear discharge without a ruptured eardrum?

Eczema and other irritations in the ear canal

Infection of the ear canal also known as swimmer’s ear which gives symptoms such as

 itching, scaling, a red or moist ear canal, and pain that increases when you touch the 

earlobe

Call NJ Eye and Ear in Bergan County if:

• The discharge is white, yellow, clear, or bloody.

• The discharge is the result of an injury.

• There is pain.

• The discharge is associated with other symptoms, such as fever or headache.

• There is loss of hearing.

• There is redness or swelling coming out of the ear canal.

• Facial weakness or asymmetry

What to Expect at NJ Eye and Ear in Englewood NJ

Kevin Ende, MD will perform a physical exam and look inside the ears. You may be asked questions, such as:

• When did the ear drainage begin?

• What does it look like?

• How long has it lasted?

• Does it drain all the time or off-and-on?

• What other symptoms do you have (for example, fever, ear pain, headache)?

Kevin Ende, MD may take a sample of the ear drainage and send it to a lab for examination.

Kevin Ende, MD may recommend anti-inflammatory or antibiotic medicines, which are placed in the ear. Antibiotics may be given by mouth if a ruptured eardrum from an ear infection is causing the discharge.

Ear Emergencies

Kids often place objects into their ears and they may not tell their parents.  These objects can get stuck in the ear canal. It is important to remove the object since infection, pain, irritation, and conductive hearing loss is most likely to occur.  At NJ Eye and Ear, we will use specialized ear instruments to examine the ear and remove the foreign object with the least trauma possible.  The eardrum can be ruptured by the foreign body.  If this occurs, the child may have discharge, hearing loss, pain and ringing in the ear.  Usually the eardrum heals by itself, but foreign bodies can cause other damage to the middle ear as well.

Why are ear foreign bodies painful?

The ear canal is a tube of solid bone in the inner part, and cartilage for the outer portion that is lined with sensitive skin. If a foreign body is pressed against the skin, it can be very painful.

What are the most common foreign bodies and objects/circumstances causing trauma to the ear?

 Qtips, toothpicks, pens, pins, sudden changes in pressure, explosions, trauma to the head, scuba diving, flying, slapped on the ear, Pain, hearing loss, dizziness, ringing in the ear.

What are the symptoms of an ear trauma?

·         Bleeding from the ear

·         Bruising or redness

·         Clear liquid coming out of the ear (brain fluid)

·         Dizziness 

·         Earache 

·         Hearing loss

·         Nausea and vomiting 

·         Noises or ringing in the ear, also known as tinnitis 

·         Sensations of an object in the ear

·         Swelling

·         Visible object in the ear

·         Fever

What Not To Do Before Coming to NJ Eye and Ear in Englewood NJ

·         DO NOT block any drainage coming from the ear.

·         DO NOT try to clean or wash the inside of the ear canal.

·         DO NOT put any liquid into the ear.

·         DO NOT attempt to remove the object by probing with a cotton swab, a pin, or any other tool. To do so will risk pushing the object farther into the ear and damaging the middle ear.

·         DO NOT reach inside the ear canal with tweezers.

How to prevent injury to the ear/ear trauma

·         Never put anything in the ear canal 

·         Never hit the head to try to correct an ear problem.

·         Teach children not to put things in their ears.

·         Avoid cleaning the ear canals altogether.

·         After an ear injury, avoid nose blowing and getting water in the injured ear.

·         Treat ear infections right away.

If you tend to feel pain and pressure in your ears when flying:

·         Drink a lot of fluid before and during the flight.

·         Avoid the use of alcohol, caffeine, or tobacco on the day of the flight.

·         Chew gum, suck on hard candy, or yawn during take-off and landing.

·         Talk to Kevin Ende, MD about taking a decongestant or using a nasal spray before you fly.

Ear examination

Otoscopy, Otoscope

At NJ Eye and Ear in Englewood NJ, an ear exam is performed by our Otolaryngologist, Kevin Ende, ,MD by looking inside your ear with an otoscope.

How is the ear examination performed?

You will be asked to sit back on the chair with your head turned to the side.  For small children, your child's head may rest against your chest.

Kevin Ende, MD will pull up, back, or forward on the ear to straighten the ear canal. The tip of the otoscope will then be placed into the outer part of your ear. The otoscope shines light and magnifies the view of the ear canal. Kevin Ende, MD will carefully move the scope in different directions to see the inside of the ear and eardrum. Ear wax may need to be removed to get a better view. If Kevin Ende, MD needs a better view, he will use a microscope.  Sometimes a puff of air into the outer ear canal is needed to assess for fluid.

Why does an Otolaryngologist also known as an ENT perform this test?

Kevin Ende, MD an Otolaryngologist in Bergan County New Jersey will perform an ear exam as part of a routine head and neck exam, but also to look for ear infections, causes of ear ache, hearing loss, dizziness, ringing in the ears or tinnitus, or any condition which he feels is related to the ear.

Additional Testing

Not all ear problems can be seen by looking through a microscope or otoscope. Other ear tests may be needed, such as:

• Audiogram
• Tympanogram
• Other tests for dizziness

Earwax

Ear impaction; Cerumen impaction; Ear blockage; Hearing loss - earwax

Each ear canal has hair follicles. The ear canal aka external auditory canal also has glands that produce waxy oil called cerumen. The wax will most often make its way to the opening of the ear. There it will fall out or be removed by washing.

Wax can build up and block the ear canal. Wax blockage is one of the most common causes of hearing loss, tinnitus or fullness of the ear.

Earwax is not really a bad thing and it actually protects the ear by:

•       Trapping and preventing dust, bacteria, and other germs and small objects from entering and damaging the ear

•       Protecting the delicate skin of the ear canal from getting irritated when water is in the canal

Some people do overproduce earwax. If left untouched, this extra wax may harden in the ear canal and block the ear. When you try to clean the ear, you may instead push wax deeper and block the ear canal.   Many patients cause ear infections by trying to remove their own wax and can even make holes in their eardrum.  For this reason, health care providers recommend against trying to reach into your own ear to clean it.

When earwax builds up, the common symptoms are:

•       Pain in the ear

•       Fullness in the ear or a sensation that the ear is plugged

•       Noises in the ear such as ringing or tinnitus

•       Preexisting hearing loss that gets worse

Treatment

Most cases of earwax blockage can be treated at home. The following remedies can be used to soften wax in the ear:

•       Baby oil

•       Commercial drops

•       Glycerin

•       Mineral oil

•       Water

To avoid damaging your ear or causing an infection:

•       Never irrigate or use drops to soften the wax in the ear if the eardrum may have a hole in it or you have had recent ear surgery.

•       Do not irrigate the ear with a jet irrigator designed for cleaning teeth (such as a WaterPik).

•       Don’t use Qtips or pins

If you cannot remove the wax plug or you have discomfort, consult a health care provider, who may remove the wax by:

•       Repeating the irrigation attempts

•       Suctioning the ear canal

•       Using a small device called a curette

•       Using a microscope to help

Follow-up

The ear may become blocked with wax again in the future. Hearing loss is often temporary. In most cases, hearing returns completely after the blockage is removed. Hearing aid users should have their ear canal checked for excess wax every 3 to 6 months.

Rarely, trying to remove earwax may cause an infection in the ear canal. This can also damage the eardrum.

At NJ Eye and Ear, and Otolaryngology office, Kevin Ende MD an Ear Nose and Throat Surgeon will evaluate your ear, remove the wax, and test your hearing.  Make an appointment for evaluation today instead of trying dangerous home methods of earwax removal.

Ear tube insertion

Myringotomy; Tympanostomy; Ear tube surgery; Pressure equalization tubes; Ventilating tubes; Otitis - tubes; Ear infection - tubes; Otitis media - tubes

Tympanostomy or ear tube insertion involves placing tubes through the eardrums. The eardrum is the thin layer of tissue that separates the external and middle ear.  Ear tubes are most commonly placed in children but some adults also need them.

Description

Under anesthesia (asleep) a small surgical cut is made in the eardrum. Any pus or fluid that is trapped behind the eardrum is removed with suction through this cut. Then, a small tube is placed through the cut in the eardrum.  The eardrum itself is what holds the tube in and there are no stitches.  The tube allows air to flow in so that pressure is the same on both sides of the eardrum. Also, trapped fluid can flow out of the middle ear. This prevents hearing loss and reduces the risk of ear infections.

Why the Procedure Is Performed

Fluid trapped behind the eardrum may cause hearing loss and speech delay.   Tympanostomy tube insertion may be done when fluid builds up behind your child's eardrum.  Infections that do not go away with treatment or that keep coming back are also reasons for placing an ear tube. If an infection does not go away with treatment, or if a child has many ear infections over a short period of time, the Kevin Ende MD at NJ Eye and Ear in Bergan County  may recommend ear tubes.

Ear tubes are also sometimes used for people of any age who have:

•       A severe ear infection that spreads to nearby bones (mastoiditis) or the brain, or that damages nearby nerves

•       Injury to the ear after sudden changes in pressure from flying or deep sea diving

Risks

Risks of ear tube insertion include:

•       Drainage from the ear but this is a good thing since the fluid is not getting trapped. 

•       Hole in the eardrum that does not heal after the tube falls out.

Most of the time, these problems do not last long. They also do not often cause problems in children. Kevin Ende MD can explain these complications in more detail.

Before the Procedure

At NJ Eye and Ear, Kevin Ende MD, director of Otolaryngology, will ask for a medical history and physical exam of your child before the procedure is done. A hearing test is also recommended before the procedure is done.

Always tell us:

•       What drugs your child is taking, including drugs, herbs, and vitamins you bought without a prescription.

•       What allergies your child may have to any medicines, latex, tape, or skin cleaner.

On the day of the surgery:

•       Your child will be asked not to drink or eat anything after midnight the night before the surgery.

•       Give your child a small sip of water with any drugs you have been told to give your child.

•       NJ Eye and Ear will tell you when to arrive at the hospital.

•       The provider will make sure your child is healthy enough for surgery. This means your child has no signs of illness or infection. If your child is ill, the surgery may be delayed.

After the Procedure

Children most often stay in the recovery room for a short time and leave the hospital the same day as the ear tubes are inserted. Your child may be groggy and fussy for an hour or so while waking up from anesthesia. Dr. Ende may prescribe ear drops or antibiotics for a few days after the surgery. We may also ask that you keep the ears dry for a specific period of time.

Learn what to expect and when to contact Dr. Ende after your child's ear tube surgery.

Outlook (Prognosis)

After this procedure, most parents report that their children:

•       Have fewer ear infections

•       Recover more quickly from infections

If the tubes do not fall out on their own in a few years, Dr. Ende may have to remove them. If ear infections return after the tubes fall out, another set of ear tubes can be inserted.

At NJ Eye and Ear  we may recommend ear tube insertion for children or adults based on many factors discussed elsewhere on the website.   

Make sure to read the postoperative instructions provided by Dr. Kevin Ende which discusses just about everything you can think of in terms of postoperative care and questions.   

• Young children may want to take a favorite toy or stuffed animal with them to the hospital.  This is perfectly fine and helpful   
• Giving your child a reward afterwards is great too.  Discuss taking them out for ice cream or something special that gives them something to look forward to.   
• Comfortable and familiar clothes that you child likes can also be helpful.  
• Having your child undergo surgery can be scary, but the surgery has been offered to make your child better! 

Some common questions that parents ask are: 

Why does my child need ear tubes? -Some kids have chronic ear infections or recurrent ear infections but there are also other reasons that you would discuss with Dr. Kevin Ende, the Director of Otolaryngology at NJ Eye and Ear in Englewood NJ.

Can we try other treatments? What are the risks of the surgery?  Yes, by now we have discussed repeated antibiotic treatments, but we may have also discussed removing your adenoid tissue

Is it safe to wait before getting ear tubes?  Waiting can affect speech and language as well as cause long-term issues with hearing or extension of the ear infections.

What type of anesthesia will my child need? Will my child feel any pain? What are the risks of the anesthesia?  We use general anesthesia so the child is asleep and this is usually done with a mask rather than a breathing tube since the surgery does not typically take long.  There is no pain during general anesthesia.  Your anesthesiologist can discuss the specific risks.

How long will the tubes stay in? How do the tubes come out? Do the holes where the tubes are placed close up?  Tubes typically stay in for about a year and the holes typically close fairly quickly.  

Will my child still have ear infections while the tubes are in place? Will my child have ear infections again after the ear tubes come out?  Although ear infections can still happen, the infectious fluid will be able to leak out rather than staying in and causing pressure and pain.  When the tubes come out, it is possible that your child will need another set put in.  

Can my child swim or get the ears wet with tubes in?  We recommend keeping the ear dry with ear plugs after ear tube insertion.

When will my child need to follow up after surgery? We will schedule you a postoperative visit

Eardrum Repair

Myringoplasty; Tympanoplasty; Ossiculoplasty; Ossicular reconstruction; Tympanosclerosis - surgery; Ossicular discontinuity - surgery; Ossicular fixation - surgery

Eardrum repair refers to a variety of surgical procedures that are performed in many different ways to fix a hole in the eardrum aka tympanic membrane.

Ossiculoplasty is the repair of the small bones in the middle ear which can be performed at the same time.

General anesthesia with an Anesthesiologist at Englewood Hospital is used to perform the surgery by Kevin Ende MD, an Otolaryngologist at NJ Eye and Ear in Bergan County so you will be asleep and won’t remember or feel anything. Local anesthesia is also used to decrease bleeding and for postoperative pain. 

Kevin Ende, MD will make a cut behind the ear or inside the ear canal.

Depending on the problem, the Dr. Ende will:

•       Clean out any infection or dead tissue on the eardrum or in the middle ear.

•       Patch the eardrum with a piece of the patient's own tissue taken from a vein or muscle sheath (called tympanoplasty). This procedure will usually take 2 to 3 hours.

•       Remove, replace, or repair 1 or more of the 3 little bones in the middle ear (called ossiculoplasty).

•       Repair smaller holes in the eardrum by placing either gel or a special paper over the eardrum (called myringoplasty). This procedure will usually take 10 to 30 minutes.

Dr. Ende will use an operating microscope at Englewood Hospital to view and repair the eardrum or the small bones.

The eardrum is between the external ear and the middle ear. It vibrates when sound waves hit it. When the eardrum is damaged or has a hole in it, hearing may be reduced and ear infections may be more likely.

Causes of holes or openings in the eardrum include:

•       Ear infections

•       Penetrating trauma with a needle or cotton swap

•       Surgery to place ear tubes 

•       Trauma

If the eardrum has a small hole, myringoplasty may work to close it. Most of the time, Dr. Ende will wait at least 6 weeks after the hole developed before suggesting surgery.

Tympanoplasty may be done if:

•       The eardrum has a larger hole or opening

•       There is a chronic infection in the ear, and antibiotics do not help

•       There is a buildup of extra tissue around or behind the eardrum

These same problems can also harm the very small bones (ossicles) that are right behind the eardrum. If this happens, your surgeon may perform an ossiculoplasty.

Gingivostomatitis

Cold sores, herpes simplex 1, oral herpes

Gingivostomatitis is a viral or bacterial infection of the mouth and/or gums that leads to swelling and sores. 

Gingivostomatitis is common among children and adults. It may occur after infection with the herpes simplex virus type 1 (HSV-1), which also causes cold sores or coxsackie virus (Hand Foot and Mouth Disease).  It occurs more commonly in people with poor oral hygiene.

The symptoms can be mild or severe and may include:

•       Bad breath

•       Fever

•       Bleeding gums

•       General discomfort, uneasiness, or ill feeling (malaise)

•       Sores on the inside of the cheeks or gums

•       Very sore mouth with no desire to eat

At NJ Eye and Ear, Kevin Ende MD an Ear Nose and Throat Surgeon in Englewood NJ will check your mouth for small ulcers. These sores are similar to mouth ulcers caused by other conditions. Cough, fever, or muscle aches may indicate other conditions.

Most of the time, no special tests are needed to diagnose gingivostomatitis. However, Kevin Ende, MD may take a small piece of tissue from the sore to check for a viral or bacterial infection. This is called a culture. A biopsy may be done to rule out other types of mouth ulcers.

The goal of treatment is to reduce symptoms.

Things you can do at home include:

•       Practice good mouth care.   Brush your gums well to reduce the risk of getting another infection.

•       Use mouth rinses such as prescription Peridex

•       Rinse your mouth with salt water or mouthwashes with hydrogen peroxide or Xylocaine to relieve pain.

•       Eat a healthy diet. Soft, bland (non-spicy) foods may reduce discomfort during eating.

You may need to take antibiotics.

You may need to have the infected tissue removed by the dentist (called debridement).

Gingivostomatitis infections range from mild to severe and painful. The sores often get better in 2 or 3 weeks with or without treatment. Treatment may reduce discomfort and speed healing.

Gingivostomatitis may disguise other, more serious mouth ulcers and cancer.

The sooner you call NJ Eye and Ear to see the Ear Nose and Throat doctor, Kevin Ende, MD, the faster you will get better from this condition.

Hoarseness

No Voice; Harsh Voice, Voice strain; Dysphonia; Loss of voice

Hoarseness refers to a difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or quality of the voice may change.

Considerations

Hoarseness is most often caused by a problem with the vocal cords. The vocal cords are part of your voice box (larynx) located in the throat. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness.

The most common cause of hoarseness is a cold or sinus infection, which most often goes away on its own within 2 weeks.

A rare but serious cause of hoarseness that does not go away in a few weeks is cancer of the voice box.

Causes

Hoarseness may be caused by:

•         Acid reflux 

•         Allergies

•         Breathing in irritating substances

•         Cancer of the throat or larynx

•         Chronic cough

•         Colds or upper respiratory infections

•         Smoking or drinking

•         Overuse or abuse of the voice (as in shouting or singing), which may cause swelling or growths on the vocal cords called nodules

Less common causes include:

•         Injury or irritation from a breathing tube or bronchoscopy

•         Damage to the nerves of the voice box (from trauma or surgery such as thyroid surgery)

•         Esophageal foreign body

•         Swallowing a harsh chemical liquid

•         Changes in the larynx during puberty

•         Thyroid or lung cancer 

•         Paralysis of one or both vocal cords

Evaluation

Hoarseness may be short-term acute or long-term chronic. Rest and time may improve hoarseness. Hoarseness that continues for weeks or months should be checked by Kevin Ende MD at NJ Eye and Ear in Englewood NJ.  We have brand new state of the art equipment to evaluate your vocal cords and even show you a picture of them which most ENT surgeons do not have access to.   We will perform a complete exam, explain the results, and provide either medical recommendations or surgical options.

Labyrinthitis and Vertigo

Bacterial labyrinthitis; Serous labyrinthitis; Neuronitis - vestibular; Vestibular neuronitis; Viral neurolabyrinthitis; Vestibular neuritis; Labyrinthitis - vertigo: Labyrinthitis - dizziness; Labyrinthitis - vertigo; Labyrinthitis - hearing loss

Labyrinthitis is irritation and swelling of the inner ear. It can cause vertigo and hearing loss.

Causes

Labyrinthitis is typically caused by a virus or bacteria. Having a cold or the flu can trigger the vertigo. Any ear infection may lead to labyrinthitis. Other causes include allergies or certain chemicals or drugs.

Your inner ear is important for both hearing and balance. When you have labyrinthitis, the inner ear can become irritated and swollen. This can make you lose your balance, have vertigo, and cause hearing loss.

These factors raise your risk for labyrinthitis:

•         Alcohol 

•         Allergies

•         Recent viral illness 

•         Smoking

•         Stress

•         Prescription or nonprescription drugs (such as aspirin)

Symptoms

Symptoms may include any of the following:

•         Vertigo

•         Dancing Eyes

•         Dizziness.

•         Hearing loss in one ear.

•         Loss of balance 

•         Nausea and vomiting.

•         Ringing or tinnitus 

Exams and Tests

At NJ Eye and Ear, Kevin Ende MD, Director of Otolaryngology, ENT in Englewood, NJ, Bergan County will perform a complete examination and may recommend testing such as EEG, ENG, Electronystagmography, CT scan, MRI, Hearing Test, Otoacoustic Emissions. 

Treatment

Labyrinthitis usually goes away within a few weeks. Treatment can help reduce vertigo and other symptoms. Medicines that may be recommended by Kevin Ende MD at NJ Eye and Ear in Bergan County NJ are:

•         Antihistamines

•         Medicines to control nausea and vomiting

•         Medicines to relieve dizziness, such as meclizine

•         Sedatives, such as diazepam (Valium)

•         Steroids

•         Antiviral medicines

Laryngoscopy and Endoscopic Nasopharyngolaryngoscopy

Laryngopharyngoscopy; Indirect laryngoscopy; Flexible laryngoscopy; Mirror laryngoscopy; Direct laryngoscopy; Fiberoptic laryngoscopy; Laryngoscopy using strobe (laryngeal stroboscopy)

Laryngoscopy is an exam of the back of your throat, including your voice box (larynx). Your voice box contains your vocal cords.

At NJ Eye and Ear, Kevin Ende MD, our Director of Ear Nose and Throat Surgery in Bergan County New Jersey will use the latest equipment to perform this exam.  

How the Test is Performed

Laryngoscopy may be done in different ways:

•         Indirect laryngoscopy uses a small mirror held at the back of your throat. The health care provider shines a light on the mirror to view the throat area. This is a simple procedure. Most of the time, it can be done in the provider's office while you are awake. A medicine to numb the back of your throat may be used.

•         Fiberoptic laryngoscopy (nasolaryngoscopy) uses a small flexible telescope. The scope is passed through your nose and into your throat. This is the most common way that the voice box is examined. You are awake for the procedure. Numbing medicine will be sprayed in your nose. This procedure typically takes less than 1 minute.  You can view the results on the computer screen during or after the exam.

•         Laryngoscopy using strobe light can also be done. Use of strobe light can give the provider more information about problems with your voice box

•         Direct laryngoscopy uses a tube called a laryngoscope. The instrument is placed in the back of your throat. The tube may be flexible or stiff. This procedure allows the doctor to see deeper in the throat and to remove a foreign object or sample tissue for a biopsy. It is done in a hospital or medical center under general anesthesia, meaning you will be asleep and pain-free.

•          Fiberoptic laryngoscopy can be done in children. 

Why the Test is Performed

This test can help your provider diagnose many conditions involving the throat and voice box. Your provider may recommend this test if you have:

•         Bad breath that does not go away

•         Breathing problems, including noisy breathing (stridor)

•         Long-term (chronic) cough

•         Coughing up blood

•         Difficulty swallowing

•         Ear pain that does not go away

•         Feeling that something is stuck in your throat

•         Long-term upper respiratory problem in a smoker

•         Mass in the head or neck area with signs of cancer

•         Throat pain that does not go away

•         Voice problems that last more than 3 weeks, including hoarseness, weak voice, raspy voice, or no voice

A direct laryngoscopy may also be used to:

•         Remove a sample of tissue in the throat for closer examination under a microscope (biopsy)

•         Remove an object that is blocking the airway (for example, a swallowed a marble or coin)

Risks

Laryngoscopy is a safe procedure. Risks depend on the specific procedure, but may include:

•         Allergic reaction to anesthesia, including breathing and heart problems

•         Infection

•         Major bleeding

•         Nosebleed

•         Spasm of the vocal cords, which causes breathing problems

•         Ulcers in the lining of the mouth/throat

•         Injury to the tongue or lips

Mastoiditis

Mastoiditis is an infection of the mastoid bone of the skull. The mastoid is located just behind the ear.

Causes

Mastoiditis is most often caused by a middle ear infection aka acute or chronic otitis media. The infection may spread from the ear to the mastoid bone. The bone has a honeycomb-like structure that fills with infected material and may break down.

The condition is most common in children. Before antibiotics, mastoiditis was one of the leading causes of death in children. The condition does not occur very often today. It is also much less dangerous.

Symptoms

Symptoms include:

•         Ear drainage

•         Ear pain

•         Fever

•         Unilateral headache

•         Hearing loss

•         Redness of the ear or behind the ear

•         Swelling behind the ear, may cause ear to stick out or feel as if it is filled with fluid.

Exams and Tests

At NJ Eye and Ear in Englewood NJ, we will perform a complete exam.  We may order a CT scan or culture any drainage.

Treatment

Mastoiditis may be hard to treat because the medicine may not reach deeply into the bone. The condition sometimes requires repeated or long-term treatment. The infection is treated with antibiotic injections, followed by antibiotics taken by mouth.  Kevin Ende MD, the Otolaryngologist, may place a tube in your ear drum to help drain the fluid.

Surgery to remove part of the bone and drain the mastoid by performing a mastoidectomy may be needed if antibiotic treatment and the ear tube does not work. 

Possible Complications

Complications may include:

•         Destruction of the mastoid bone

•         Vertigo or dizziness

•         Brain abscess

•         Facial Paralysis

•         Meningitis

•         Hearing loss

•         Spread of infection to the brain or throughout the body

As always, you should contact NJ Eye and Ear in Bergan County to NJ for any issues related to the ear.

Ménière disease

Meniere’s disease, Hydrops - self-care; Endolymphatic hydrops - self-care; Dizziness - Ménière self-care; Vertigo - Ménière self-care; Loss of balance - Ménière self-care

Meniere’s disease is a triad of hearing loss, tinnitus and vertigo and is a diagnosis of exclusion, meaning other causes of these entities have been ruled out by Kevin Ende, MD, Director of Ear Nose and Throat Surgery at NJ Eye and Ear in Englewood, NJ.  There are treatments which can be used to help with this disease but surgery is typically not the solution.

Diet

Eating a low-salt (sodium) diet helps reduce the fluid pressure in your inner ear. This can help control symptoms of Ménière disease. 

Other Lifestyle Changes

Making the following changes may also help:

•         Some over-the-counter medicines, such as antacids and laxatives, have a lot of salt in them. If you need these medicines, ask your provider or pharmacist what brands contain little or no salt.

•         Home water softeners add salt to water. If you have one, limit how much tap water you drink. Drink bottled water instead.

•         Avoid caffeine and alcohol

•         Quite smoking

•         Some people find that managing allergy symptoms and avoiding allergy triggers helps decrease Meniere disease symptoms.

•         Get plenty of sleep and take steps to reduce stress.

Medicines

For some people, diet alone will not be enough. If needed, your provider may also give you water pills (diuretics) to help reduce the fluid in your body and fluid pressure in your inner ear. You should have regular follow-up exams and lab work as suggested by your provider. Antihistamines may also be prescribed. These medicines may make you sleepy, so you should first take them when you do not have to drive or be alert for important tasks.

Nasal endoscopy

Rhinoscopy

Nasal endoscopy is a test to view the inside of the nose and sinuses

How the Test is Performed

The test takes about 1 to 5 minutes. Kevin Ende MD, ENT at NJ Eye and Ear in Bergan County will:

•         Spray your nose with a medicine to reduce swelling and numb the area.

•         Insert the nasal endoscope into your nose. This is a state of the art, long flexible or rigid tube with a camera at the end to look inside the nose and sinuses. You will see the image on the computer screen if you want to, but you can close your eyes if you prefer

•         Examine the inside of your nose and sinuses.

•         Remove polyps, mucus, or other masses from the nose or sinuses.

 How the Test will Feel

This test does not typically hurt.

•         You may feel discomfort or pressure as the tube is put into your nose.

•         The spray numbs your nose. It can numb your mouth and throat, and you may feel like you cannot swallow. This numbness goes away in 20 to 30 minutes.  It is ok to swallow the spray.

•         You might sneeze during the test. If you feel a sneeze coming on, let Kevin Ende MD, ENT Surgeon know.

Why the Test is Performed

You may have a nasal endoscopy to figure out what is causing problems in your nose and sinuses.

During the procedure we will:

•         Look at the inside of your nose and sinuses

•         Take a sample of tissue for a biopsy if necessary

•         Do small surgeries to remove polyps, excess mucus, or other masses

Kevin Ende MD may recommend nasal endoscopy if you are having:

•         A lot of sinus infections

•         Lots of drainage from your nose

•         Face pain or pressure

•         Sinus headaches

•         A hard time breathing through your nose

•         Nose bleeds

•         Loss of sense of smell

Depending on what we find, either medical treatment or surgical treatment may be provided.  Please call NJ Eye and Ear in Englewood NJ for any nasal related issues.

Nasal polyps

Nasal polyps are soft, sac-like growths on the lining of the nose or sinuses.

Causes

Nasal polyps can grow anywhere on the lining of the nose or the sinuses. They often grow where the sinuses open into the nasal cavity. Small polyps may not cause any problems. Large polyps can block your sinuses or nasal airway.

Nasal polyps are not cancer typically but some can actually be more serious and are called inverting papilloma. They seem to grow due to long-term swelling and irritation in the nose from allergies, asthma, or infection.

No one knows exactly why some people get nasal polyps. If you have any of the following conditions, you may be more likely to get nasal polyps:

•       Aspirin sensitivity 

•       Asthma

•       Sinus infections

•       Cystic Fibrosis

•       Allergies

Symptoms

If you have small polyps, you may not have any symptoms. If polyps block nasal passages, a sinus infection can develop.

Symptoms include:

•       Runny nose

•       Sneezing

•       Nasal Obstruction 

•       Loss of smell

•       Loss of taste

•       Headache and pain

Exams and Tests

At NJ Eye and Ear in Englewood New Jersey, Kevin Ende MD our director of Otolaryngology will provide a full exam including a nasal endoscopy if necessary.  A CT scan may also be necessary.

Treatment

Nasal steroid sprays shrink polyps but typically do not cure them. They help clear blocked nasal passages and runny nose. Symptoms return if treatment is stopped.

•       Corticosteroid pills or liquid may also shrink polyps, and can reduce swelling and nasal congestion. The effect lasts a few months in most cases.

•       Allergy medicines can help prevent polyps from growing back.

•       Allergy shots can help prevent polyps from growing back.

•       Antibiotics can treat a sinus infection caused by bacteria. They can't treat polyps or sinus infections caused by a virus.

If medicines don't work, or you have very large polyps, you may need surgery to remove them.

•       Endoscopic sinus surgery is often used to treat polyps. With this procedure, at Englewood Hospital, Kevin Ende MD uses an endoscope and shaves the polyps.

•       Usually you can go home the same day.

•       Often, polyps come back, even after surgery, and another surgery is necessary

Outlook (Prognosis)

Removing polyps with surgery often makes it easier to breathe through your nose. Over time, however, nasal polyps often return.

Loss of smell or taste does not always improve following treatment with medicine or surgery.

Possible Complications

Complications may include:

•       Bleeding

•       Infection

•       Polyps coming back after treatment

Call NJ Eye and Ear if you have any nasal obstruction or notice something growing in your nose.  Most patients will not notice the masses when they are small and the above symptoms will usually come before the masses are noticed.  Call us if your primary doctor in Englewood NJ says you have nasal polyps.  

Nosebleed

Bleeding from the nose; Epistaxis

A nosebleed is loss of blood from the tissue lining the nose.  Nosebleeds are very common. Most nosebleeds occur because of minor irritations, nose picking, nasal dryness, or colds. The nose has a vast blood supply with many small blood vessels that bleed easily. Air moving through the nose can dry and irritate the membranes lining the inside of the nose. Crusts can form that bleed when irritated. Nosebleeds occur more often in the winter, when cold viruses are common and indoor air tends to be drier.

Most nosebleeds occur on the front of the nasal septum with is the dividing point of the nose from right to left. Some nosebleeds are  life-threatening.

Causes

Nosebleed can be caused by:

•       Irritation due to allergies, colds, sneezing or sinus problems

•       Very cold or dry air

•       Blowing the nose very hard, or picking the nose

•       Nasal fracture or an object stuck in the nose

•       Sinus or pituitary surgery (transsphenoidal)

•       Deviated septum

•       Chemical irritants including medicines or drugs that are sprayed or snorted

•       Overuse of decongestant nasal sprays

•       Oxygen treatment through nasal cannulas

Repeated nosebleeds may be a symptom of another disease such as high blood pressure, a bleeding disorder, or a tumor of the nose or sinuses. Blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, may cause or worsen nosebleeds.

Home Care

To stop a nosebleed:

•       Sit down and gently squeeze the soft portion of the nose between your thumb and finger (so that the nostrils are closed) for a full 10 minutes.

•       Lean forward to avoid swallowing the blood and breathe through your mouth.

•       Wait at least 10 minutes before checking if the bleeding has stopped. Be sure to allow enough time for the bleeding to stop.

It may help to apply cold compresses or ice across the bridge of the nose. Do not pack the inside of the nose with tissue paper or gauze.

Lying down with a nosebleed is not recommended. You should avoid sniffing or blowing your nose for several hours after a nosebleed. If bleeding persists, a nasal spray decongestant (Afrin, Neo-Synephrine) can sometimes be used to shrink small vessels and control bleeding.

Things you can do to prevent frequent nosebleeds include:

•       Keep the home cool and use a vaporizer to add moisture to the inside air.

•       Use nasal saline spray and water-soluble jelly (such as Ayr gel) to prevent nasal linings from drying out in the winter.

When to Contact a Medical Professional

Go to Englewood Hospital ER and ask for Kevin Ende MD the director of ENT from NJ Eye and Ear in Bergan County if:

•       Bleeding does not stop after 20 minutes.

•       Nose bleeding occurs after a head injury. This may suggest a skull fracture, and x-rays should be taken.

•       Your nose may be broken (for example, it looks crooked after a hit to the nose or other injury).

Call NJ Eye and Ear if:

•       You or your child has frequent nosebleeds

•       Nosebleeds are not associated with a cold or other minor irritation

•       Nosebleeds occur after sinus or other surgery

What to Expect at Your Office Visit

Kevin Ende MD will perform a physical exam. In some cases, you may be watched for signs and symptoms of low blood pressure from losing blood, also called hypovolemic shock.

You may have the following tests:

•       CBC

•       Nasal endoscopy (examination of the nose using a camera)

•       Bleeding time/Coagulation profile

•       CT scan of the nose and sinuses

The type of treatment used will be based on the cause of the nosebleed. Treatment may include:

•       Controlling blood pressure

•       Closing the blood vessel using heat, electric current, or silver nitrate sticks

•       Nasal packing

•       Reducing a broken nose or removing a foreign body

•       Reducing the amount of blood thinner medicine or stopping aspirin

•       Treating problems that keeps your blood from clotting normally

Many of the above treatments can actually be performed in the chair at NJ Eye and Ear, but some require the operating room at Englewood Hospital.  

Obstructive Sleep Apnea

Sleep apnea, sleep disordered breathing; loud snoring

Obstructive sleep apnea is a serious disorder in which breathing repeatedly stops along with loud snoring. If you snore loudly and feel tired even after a full night's sleep, you might have sleep apnea and should call NJ Eye and Ear.

The main types of sleep apnea are:

• Obstructive sleep apnea, the more common form that occurs when throat muscles relax

• Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing

Kevin Ende MD at NJ Eye and Ear has authored Ear Nose and Throat literature on sleep apnea that is often quoted by other surgeons writing about sleep apnea.  Treatment can ease your symptoms and might help prevent heart problems and other complications.

Symptoms

The most common signs and symptoms of obstructive sleep apnea includes:

• Loud snoring

• Episodes in which you stop breathing during sleep — which would be videoed or reported by another person

• Gasping for air

• Enuresis

• Awakening with a dry mouth

• Morning headache

• Difficulty staying asleep (insomnia)

• Excessive daytime sleepiness (hypersomnia)

• Difficulty paying attention while awake

• Irritability

Factors that increase the risk of this form of sleep apnea include:

• Obesity.  Being overweight greatly increases the risk of sleep apnea. Fat deposits around your upper airway can obstruct your breathing.

• Neck circumference. People with thicker necks might have narrower airways.

• A narrowed airway. You might have inherited a large tongue or narrow throat due to redundant tissue on your soft palate or other issues. Tonsils or adenoids also can enlarge and block the airway, particularly in children.

• Being male. Men are two to three times more likely to have sleep apnea than women. 

• Age. Sleep apnea occurs significantly more often in older adults.

• Family history. Having family members with sleep apnea increases your risk.

• Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat, which can worsen obstructive sleep apnea.

• Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who've never smoked. 

• Nasal congestion. If you have difficulty breathing through your nose — whether from an anatomical problem or allergies — you're more likely to develop obstructive sleep apnea.

Complications

Sleep apnea is a serious medical condition. Complications can include:

• Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible, making severe daytime drowsiness, fatigue and irritability likely.

You might have difficulty concentrating and find yourself falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents.

You might also feel quick-tempered, moody or depressed. Children and adolescents with sleep apnea might perform poorly in school or have behavior problems.

• High blood pressure or heart problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Having obstructive sleep apnea increases your risk of high blood pressure (hypertension).

Obstructive sleep apnea might also increase your risk of recurrent heart attack, stroke and abnormal heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.

• Type 2 diabetes. Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.

• Metabolic syndrome. This disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference, is linked to a higher risk of heart disease.

• Complications with medications and surgery. Obstructive sleep apnea is also a concern with certain medications and general anesthesia. People with sleep apnea might be more likely to have complications after major surgery because they're prone to breathing problems, especially when sedated and lying on their backs.

Before you have surgery, tell your doctor about your sleep apnea and how it's being treated.

Sleep-deprived partners. Loud snoring can keep anyone who sleeps near you from getting good rest. It's not uncommon for a partner to have to go to another room, or even to another floor of the house, to be able to sleep.

Treatment offered at NJ Eye and Ear by Kevin Ende MD director Of ENT Surgery:

• Weight loss
• Nasal Steroids
• CPAP Mask
• Tonsillectomy
• Adenoidectomy
• Tongue base reductions
• Uvulopalatopharyngoplasty

Otosclerosis

Otosclerosis is an abnormal bone growth in the middle ear that causes hearing loss.

Causes

The exact cause of otosclerosis is unknown but there appears to be a genetic component.  Otosclerosis causes a sponge-like bony growth in the middle ear space. This growth prevents the ear bones from vibrating in response to sound waves. These vibrations are needed in order for you to hear.

Otosclerosis is the most common cause of middle ear hearing loss in young adults when there is no fluid present. It typically begins in early to mid-adulthood. It is more common in women than in men. The condition may affect one or both ears.

Risks for this condition include pregnancy and a family history of hearing loss. 

Symptoms

Symptoms include:

•       Hearing loss (slow at first, but worsens over time)

•       Tinnitus

•       Vertigo or dizziness

Exams and Tests

A hearing test showing a conductive hearing loss with normal eardrum compliance may help determine the severity of hearing loss.

A special imaging test of the head called a temporal bone CT may be used to look for other causes of hearing loss.

Treatment

Otosclerosis may slowly get worse. The condition may not need to be treated until you have more serious hearing problems.

Using some medicines such as fluoride, calcium, or Vitamin D may help to slow the hearing loss. However, the benefits of these treatments have not yet been proven.

A hearing aid may be used to treat the hearing loss. This will not cure or prevent hearing loss from getting worse, but it may help with symptoms and allow you to avoid surgery for a while.

Surgery can cure or improve conductive hearing loss. Either all or part of one of the small middle ear bones behind the eardrum (stapes) is removed and replaced with a prosthesis.

•       A total replacement is called a stapedectomy.

•       Sometimes only part of the stapes is removed and a small hole is made in the bottom of it. This is called a stapedotomy. Sometimes a laser is used to help with the surgery.

Outlook (Prognosis)

Otosclerosis gets worse without treatment. Surgery can restore some or all of your hearing loss. Pain and dizziness from the surgery go away within a few weeks for most people.

When it comes time that you choose to have surgery, a specialized ENT called an Otologist should perform your surgery, but up until that point, Kevin Ende MD Director of Otolaryngology in Englewood NJ can treat you.   If surgery does not work, you may have total hearing loss. Treatment for total hearing loss involves developing skills to cope with deafness, and using hearing aids to transmit sounds from the non-hearing ear to the good ear.

Peritonsillar Abscess

Quinsy; Abscess - peritonsillar; Tonsillitis - abscess

Peritonsillar abscess is a collection of pus in a pocket next to the tonsils.

Causes

Peritonsillar abscess is a complication of tonsillitis. It is most often caused by a type of bacteria called group A beta-hemolytic streptococcus.  Peritonsillar abscess most often occurs in older children, adolescents, and young adults. The condition isles common now that antibiotics are used to treat tonsillitis, but is still one of the most common reasons why Kevin Ende MD gets called to see patients at the Englewood Hospital ER.

Symptoms

One or both tonsils become infected. The infection most often spreads to around the tonsil. It can then spread down into the neck and chest. Swollen tissues can block the airway. This is a life-threatening medical emergency.

The abscess can break open (rupture) into the throat. The content of the abscess can travel into the lungs and cause pneumonia.

Symptoms of peritonsillar abscess include:

•       Fever and chills

•       Severe throat pain that is usually on one side

•       Ear pain on the side of the abscess

•       Difficulty opening the mouth, and pain with opening the mouth

•       Swallowing problems

•       Drooling or inability to swallow saliva

•       Facial or neck swelling

•       Fever

•       Chills

•       Muffled or hot Potatoe voice

•       Tender glands of the jaw and throat

Exams and Tests

An exam of the throat often shows swelling on one side and on the roof of the mouth.

The uvula in the back of the throat may be shifted away from the swelling. The neck and throat may be red and swollen on one or both sides.

The following tests may be done:

•       Aspiration of the abscess using a needle

•       CT Scan

Treatment

The infection can be treated with antibiotics if it is caught early. If an abscess has developed, it will need to be drained with a needle or by cutting it open. You will be given local anesthesia medicine before this is done.

Outlook (Prognosis)

Peritonsillar abscess goes away with treatment in most cases. The infection has about a 50 percent chance that it may return in the future.

When to Contact NJ Eye and Ear 

Go to Englewood Hospital ER and ask for Kevin Ende MD if you believe that you have symptoms of peritonsillar abscess.

Prevention

Quick treatment of tonsillitis, especially if it is caused by bacteria, may help prevent this condition.

Tonsillectomy at Englewood Hospital will prevent future peritonsillar abscesses

Salivary gland infections

Parotitis; Sialadenitis; Parotid Infection; Submandibular infection

Salivary gland infections affect the glands that produce spit (saliva). The infection may be due to bacteria or viruses.

There are 3 pairs of major salivary glands:

•       Parotid glands -- These are the two largest glands. One is located in each cheek over the jaw in front of the ears. Inflammation of one or more of these glands is called parotitis, or parotiditis.

•       Submandibular glands -- These two glands are located just under both sides of the lower jaw and carry saliva up to the floor of the mouth under the tongue.

•       Sublingual glands -- These two glands are located just under the floor of the mouth.

All of the salivary glands empty saliva into the mouth. The saliva enters the mouth through ducts that open into the mouth in different places.

Causes

Salivary gland infections are somewhat common, and they can return in some people.

Viral infections, such as mumps, often affect the salivary glands. (Mumps most often involves the parotid salivary gland). Mumps is a rare problem today because of the MMR vaccine.

Bacterial infections are most often the result of a:

•       Blockage from salivary duct stones 

•       Poor cleanliness in the mouth (oral hygiene)

•       Dehydration

•       Smoking

•       Chronic illness

Symptoms

Symptoms include:

•       Foul or abnormal taste

•       Decreased ability to open the mouth

•       Dry mouth

•       Fever

•       Mouth or pain especially when eating

•       Redness over the side of the face or the upper neck

•       Swelling, particularly in front of the ears, below the jaw, or on the floor of the mouth.

Exams and Tests

Kevin Ende MD at NJ Eye and Ear in Englewood New Jersey will do an exam to look for enlarged glands. You may also have pus that drains into the mouth. The gland is often painful.

A CT scan, MRI scan, or ultrasound may be done if the Kevin Ende MD the ENT Surgeon, suspects an abscess, or to look for stones.

We may suggest a mumps blood test if multiple glands are involved.

Treatment

In some cases, no treatment is needed.

Treatment may include:

•       Antibiotics if you have a fever or drainage, or if the infection is caused by bacteria. Antibiotics are not useful against viral infections.

•       Surgery or aspiration to drain an abscess

•       A new technique, called sialoendoscopy, uses a very small camera and instruments to diagnose and treat infections and other problems in the salivary glands. 

Self-care steps you can take at home to help with recovery include:

•       Practice good oral hygiene. Brush your teeth and floss well at least twice a day. This may help with healing and prevent an infection from spreading.

•       Rinse your mouth with warm saltwater rinses (one half teaspoon or 3 grams of salt in 1 cup or 240 milliliters of water) to ease pain and keep the mouth moist.

•       To speed up healing, stop smoking if you are a smoker.

•       Drink lots of water and use sugar-free lemon drops to increase the flow of saliva and reduce swelling.

•       Massaging the gland.

•       Using warm compresses on the inflamed gland.

Outlook (Prognosis)

Most salivary gland infections go away on their own or are cured with treatment. Some infections will return. Complications are not common.

Possible Complications

Complications may include:

•       Abscess of salivary gland

•       Infection returns

•       Spread of infection such as cellulitis or Ludwig’s Angina

If you believe that you have an infection in your Parotid Gland or Submandibular Gland, or any issues with your glands, make an appointment to see the Otolaryngologist at NJ Eye and Ear in Bergen County NJ.

Sinusitis

Acute sinusitis; Sinus infection; Sinusitis - acute; Sinusitis - chronic; Rhinosinusitis

Sinusitis occurs when the tissue lining the sinuses is swollen or inflamed. It begins with an infection from a virus, bacteria, or fungus.

Causes

The sinuses are air-filled spaces in the skull. They are located behind the forehead, nasal bones, cheeks, and eyes.   Most of the time, mucus is able to drain out and air flows through the sinuses.

When the sinus openings become narrowed or blocked or too much mucus builds up, bacteria can build up.

Sinusitis can occur from one of these conditions:

•       Small hairs (cilia) in the sinuses fail to properly move mucus out. This may be due to some medical conditions.

•       Colds and allergies may cause too much mucus to be made or cause swelling and block the opening of the sinuses.

•       A deviated nasal septum, nasal bone spur, or nasal polyps may block the opening of the sinuses.

There are two types of sinusitis:

•       Acute sinusitis is when symptoms are present for 4 weeks or less. It is caused by bacteria growing in the sinuses.

•       Chronic sinusitis is when the swelling of the sinuses is present for longer than 3 months. It may be caused by bacteria or a fungus.

The following may increase the risk that an adult or child will develop sinusitis:

•       Allergies

•       Going to day care

•       Diseases that prevent the cilia from working properly

•       Changes in altitude (flying or scuba diving)

•       Adenoid enlargement

•       Smoking

•       Weakened immune system from HIV or chemotherapy 

•       Abnormal shape of sinuses or abnormal anatomy

Symptoms

The symptoms of acute sinusitis in adults follows a cold that does not get better or that gets worse after 5 to 7 days. Symptoms include:

•       Bad breath or loss of sense of smell

•       Cough, often worse at night

•       Fatigue and general feeling of being ill

•       Fever

•       Headache

•       Pressure-like pain, pain behind the eyes, toothache, or tenderness of the face

•       Nasal stuffiness and discharge

•       Sore throat and postnasal drip

Symptoms of chronic sinusitis are the same as those of acute sinusitis. However, the symptoms tend to be milder and last longer than 12 weeks.

Symptoms of sinusitis in children include:

•       Cold or respiratory illness that has been getting better and then begins to get worse

•       High fever, along with a darkened nasal discharge, that lasts for at least 3 days

•       Nasal discharge, with or without a cough, that has been present for more than 10 days and is not improving

Exams and Tests

At NJ Eye and Ear in Bergen County New Jersey, Kevin Ende MD the ENT Surgeon will examine you or your child for sinusitis by:

•       Looking in the nose for signs of polyps

•       Shining a light against the sinus (transillumination) for signs of inflammation

•       Tapping over a sinus area to find infection

Kevin Ende MD may view the sinuses through a fiberoptic scope (called nasal endoscopy or rhinoscopy) to diagnose sinusitis. This is often done by ear, nose, and throat surgeons(ENTs).

Imaging tests that may be used to decide on treatment are:

•       CT Scan of the sinuses

•       MRI of the sinuses if there might be a tumor or fungal infection

•       Allergy testing

•       Blood tests for HIV or other tests for poor immune function

•       Ciliary function test

•       Nasal culture

•       Nasal Cytology 

•       Sweat Chloride Test for Cystic Fibrosis

Treatment

SELF-CARE

First try the following home remedies for your sinuses:

•       Apply a warm, moist washcloth to your face several times a day.

•       Drink plenty of fluids to thin the mucus.

•       Inhale steam 2 to 4 times per day (for example, while sitting in the bathroom with the shower running).

•       Spray with nasal saline several times per day.

•       Use a humidifier.

•       Use a Neti pot or saline squeeze bottle to flush the sinuses.

Be careful with use of over-the-counter spray nasal decongestants such as oxymetazoline (Afrin) or neosynephrine. They may help at first, but they become addictive and using them for more than 3 to 5 days can make nasal stuffiness worse.

To help ease sinus pain or pressure:

•       Avoid flying when you are congested.

•       Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.

•       Try acetaminophen or ibuprofen.

MEDICINE AND OTHER TREATMENTS

Acute sinusitis should be treated for 10 to 14 days with antibiotics. Chronic sinusitis should be treated for 3 to 4 weeks. Some people with chronic sinusitis may need antifungals.

 Other treatments for sinusitis include:

•       Allergy shots (immunotherapy) 

•       Allergen avoidance

•       Nasal corticosteroid sprays and antihistamines

•       Surgery to enlarge the sinus opening and drain the sinuses at Englewood Hospital with either traditional endoscopic sinus surgery or balloon sinusplasty.  

Outlook (Prognosis)

Most sinus infections can be cured with self-care measures and medical treatment. If you are having repeated attacks, you should be checked for causes such as nasal polyps or other problems, such as allergies.

Possible Complications

Although very rare, complications may include:

•       Brain abscess

•       Bone infection (osteomyelitis)

•       Meningitis

•       Skin infection around the eye (orbital cellulitis)

Speech Disorders and Voice Disorders

Tongue Tie; Articulation deficiency; Articulation disorder; Phonological disorder; Voice disorders; Vocal disorders; Disfluency; Communication disorder - speech disorder; Speech disorder - stuttering

A speech disorder is a condition in which a person has problems creating or forming the speech sounds needed to communicate with others.

Common speech disorders are:

•       Articulation disorders

•       Phonological disorders

•       Disfluency

•       Voice disorders

Speech disorders are different from language disorders.  Language disorders refer to someone having difficulty with:

•       Getting their meaning or message across to others (expressive language)

•       Understanding the message coming from others (receptive language)

Causes

Disfluencies are disorders in which a person repeats a sound, word, or phrase.  Stuttering may be the most serious disfluency.

Articulation disorders may have no clear cause. They may also occur in other family members.

Other causes include:

•       Problems or changes in the structure or shape of the muscles and bones used to make speech sounds. These changes may include cleft palate and tooth problems.

•       Damage to parts of the brain or the nerves (such as from cerebral palsy that control how the muscles work together to create speech.

•       Hearing loss.

Voice disorders are caused by problems when air passes from the lungs, through the vocal cords, and then through the throat, nose, mouth, and lips. A voice disorder may be due to:

•       Acid from the stomach moving upward (GERD)

•       Throat Cancer

•       Cleft palate or other problems with the palate

•       Vocal cords nerve issues

•       Laryngeal webs or clefts (a birth defect in which a thin layer of tissue is between the vocal cords)

•       Noncancerous growths (polyps, nodules, cysts, granulomas, papillomas, or ulcers) on the vocal cords

•       Overuse of the vocal cords from screaming, constantly clearing the throat, or singing

•       Hearing loss

•       Tongue Tie

Exams and Tests

Speech Screen Tools

• A hearing test (audiogram)
• Endoscopy to evaluate the vocal cords
• Treatment
• Children may outgrow milder forms of speech disorders.
• Speech therapy may help with more severe symptoms or any speech problems that do not improve.
• Release of Tongue Tie
• Vocal Fold Surgery
• Hearing aids

At NJ Eye and Ear, Kevin Ende MD our director of Ear Nose and Throat Surgery in Englewood NJ will perform a complete evaluation typically including an endoscopy and audiogram.  Kevin Ende MD will recommend one of the above treatments depending on his findings.

Tonsillectomy

Tonsils removal; Tonsillitis - tonsillectomy; Pharyngitis - tonsillectomy; Sore throat - tonsillectomy

Tonsillectomy is a very common surgical procedure to remove the tonsils.  The tonsils are paired glands at the back of your throat. The tonsils are often removed along with the adenoid glands. That surgery is called adenoidectomy and is most often done in children.

Description

The surgery is done while the child is under general anesthesia. Your child will be asleep and pain-free.

•       Kevin Ende MD will place a small tool into your child's mouth to hold it open at Englewood Hospital.

•       Kevin Ende MD then removes the tonsils. The wounds heal naturally without stitches.

After surgery, your child will stay in the recovery room until he or she is awake and can breathe easily, cough, and swallow. Many children go home several hours after this surgery, but others stay overnight.  You should be prepared for either one.  

Why the Procedure Is Performed

The tonsils help protect against infections, but there is actually plenty of other lymphoid tissue in the area. But children with large tonsils may have problems breathing at night. The tonsils may also trap excess bacteria, which can lead to frequent, or very painful sore throats. In either of these cases, the child's tonsils have become more harmful than protective.

You and Kevin Ende MD the Director of Otolaryngology at NJ Eye and Ear in Bergen County NJ may consider a tonsillectomy if:

•       Your child has infections often (7 or more times in 1 year, or 5 or more times over 2 years).

•       Your child misses a lot of school.

•       Your child has trouble breathing and does not sleep well because the tonsils block the airway (obstructive sleep apnea).

•       Your child has an abscess or a growth on the tonsils.

After the Procedure

Complete recovery takes about 1 to 2 weeks. At first expect your child not going to be feeling great for a week or two, especially that first week they may still have pretty significant throat pain and may feel lower energy. So plan a pretty easy week or maybe 2 weeks after the surgery. When it comes to diet one of the most important things is getting plenty to drink. So you want lots of popsicles, fluids, juices, but avoid real citrusy or acidic juices. This isn't the time for lemonade. You also want foods that are soft going down and not crunchy or spicy. So things like jello can be good, ice cream.  Pasta can be good, mashed potatoes, you want to avoid though toast and chips that can be really scratchy on the raw throat after a tonsillectomy. Also want to avoid really spicy foods. Make sure to review the comprehensive postoperative instructions that are provided to you by NJ Eye and Ear.

Tracheostomy

Tracheotomy; trach; surgical airway; cricothyrotomy; 

A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is most often placed through this opening to provide an airway and to remove secretions from the lungs. This tube is called a tracheostomy tube or trach tube.

Description

General anesthesia is preferred to be used, unless the situation is critical and Kevin Ende MD the ENT Surgeon in Englewood New Jersey has been called upon many times year after year to do this procedure emergently and awake. If that happens, a numbing medicine is placed into the area to help you feel less pain during the procedure. Other medicines are also given to relax and calm you (if there is time).

The neck is cleaned and draped. Surgical cuts are made to reveal the tough cartilage rings that form the outer wall of the trachea. Then Kevin Ende MD creates an opening into the trachea and inserts a tracheostomy tube.

Why the Procedure Is Performed

A tracheostomy may be done if you have:

•       A large object blocking the airway

•       An inability to breathe on your own

•       An inherited abnormality of the larynx or trachea

•       Breathed in harmful material such as smoke, steam, or other toxic gases that swell and block the airway

•       Cancer of the neck, which can affect breathing by pressing on the airway

•       Paralysis of the muscles that affect the vocal cords or swallowing

•       Severe neck or mouth injuries

•       Surgery around the voice box (larynx) that prevents normal breathing and swallowing

After training and practice, most people can learn to talk with a tracheostomy tube. People or family members learn how to take care of the tracheostomy during the hospital stay. Home-care service may also be available.  You should be able to go back to your normal lifestyle. When you are outside, you can wear a loose covering (a scarf or other protection) over the tracheostomy stoma (hole). Use safety precautions when you are exposed to water, aerosols, powder, or food particles.