Symptoms: The nasal obstruction is characterized by the patient’s feeling of having difficulty in passing the air through his or her nose. Mucus may or may not be present, and often a patient’s head hurts or the patient feels pressure on his/her face around his/her eyes.
Causes: There are many causes of nasal obstruction. Among the most frequent we have deviations of the nasal septum, rhinitis, large turbinates, and nasal polyps. The turbinates are fleshy structures that are found in the nose and have very important function; they heat, humidify and filter the air, and put it in excellent conditions for its arrival in the lungs. However, sometimes due to allergic, environmental, or hormonal reasons these grow and cause great problems to the breathing.
Treatment: It will depend on the cause that causes the obstruction. It can be pharmacological or surgical. In the case of large nasal turbinates, turbinate surgery works in returning the patient’s breathing very quickly. This procedure can be performed in the office with local anesthesia or in the operating room with general anesthesia. We can do it with two techniques. One would be with radiofrequency, which is a painless technique that consists of applying a device inside the thicker wall of the turbinate and immediately reducing the size of it. The other technique is with a device called shaber. This device can only be used in the operating room, and it is a blade that is inserted into the thickness of the turbinate to remove the excess of tissue. Both techniques are very useful and the improvement is immediate. The recovery is not painful; no plugs are placed in the nose, the patient has to perform some nasal washes and attend a postoperative appointment a week after to check the results.
Symptoms: The nasal septum is a made of cartilage and bone and divides the nose internally in two sides, the right and the left. Ideally it should be a straight plate. However, this is not always the case and can be deviated to the right or to the left or towards both sides causing mainly nasal obstruction. In many occasions it can also present headache and oppressive face pain.
Causes: The main causes by which the septum is deviated is by trauma, but it can also be by manipulating the nose a lot, especially in the case of allergic patients who touch their nose throughout the day.
Treatment: If the deviation of the nasal septum causes symptoms, the only treatment is surgery. Medically, septal surgery is called septoplasty. This surgery is one of the most frequently performed in otolaryngology. The main objective is to remove the deviations and leave the nasal septum as straight as possible.
Symptoms: Rhinitis is the inflammation of the mucus membrane or lining of the internal structures of the nose. The most frequent symptoms are obstruction or nasal congestion, the increase in the production of mucus, which usually is watery, and itching and sneezing.
Causes: It can be caused by allergy (most common cause in our country), changes in temperature or environmental conditions, hormonal changes, and the intake of some medications.
Treatment: If the rhinitis is not accompanied by any deviation of the nasal septum or turbinates that do not respond to treatment, then the treatment is pharmacological.
Symptoms: Sinusitis is the inflammation / infection of the paranasal sinuses. The paranasal sinuses are hollow cavities that are in the face and that give lightness to the skull. Sinusitis can be acute or chronic. Acute Sinusitis is what usually occurs after the flu. In this case the patient will have a lot of nasal congestion, abundant purulent mucus, headache, and malaise. In the case of chronic sinusitis, a patient has more than 3 weeks with mucus inside the paranasal sinuses; the patient usually presents less nasal congestion than in the acute sinusitis, less production of mucus (in some cases imperceptible), but headache is frequent, and the main symptom is oppressive face pain that may occur behind or below the eyes.
Causes: Acute sinusitis is usually preceded by the flu that does not improve and ends up becoming infected. Chronic sinusitis is caused by accumulation of mucus in the paranasal sinuses as the result of the obstruction of the natural drainage orifice. This obstruction occurs due to inflammation of the nasal mucosa as the result of not being able to breathe normally, either from rhinitis, large turbinates, or deviated septum.
Treatment: Acute sinusitis is treated pharmacologically while chronic sinusitis is usually treated with surgery. The surgery that is performed for chronic sinusitis is called Endoscopic Nasal & Sinus Surgery wich is performed with endoscopy lenses with a camera and a light that allow us to approach the depths of the nasal structures entering via the nostrils. With special tweezers we can open the sinuses, clean them, and remove any kind of disease they may have.
Symptoms: The nose has a large number of blood vessels, so when it bleeds, it does in large quantities even if it is small vessel the one that bleeds. The bleeding can be in the anterior (front part of the nose) or posterior (back part of the nose). The blood vessels in the front of the nose bleed more easily than those in the posterior part. The amount of blood varies and it usually stops by itself, but it is common to have recurrent bleeding if not treated on time. Posterior bleeding bleed in large amounts and are often more dangerous because of the type of blood vessel that is affected.
Causes: anterior bleeding frequently occur due to dryness of the nasal mucosa that may be associated with rhinitis or septal deviations. With children, bleeding is frequent due to nose picking. Posterior bleeding usually occur frequently due to elevations in blood pressure.
Treatment: With anterior bleeding the ENT Specialist often cauterizes the blood vessel that is causing problems and also treats the underlying condition to permanently correct the problem. With posterior bleeding, the main cause must be treated, such as controlling blood pressure. In the case that the patient has active bleeding, there are two options: one is to place a posterior nasal tamponade or to take the patient to the operating room to control the bleeding.
Symptoms: Palatine tonsils are two masses of lymphatic tissue or defense that are in the back and side of the throat. In the first years of life they are very important because they are part of the defense tissue against microorganisms that can enter the mouth. Tonsillitis occurs when this tissue becomes infected. The patient will present mainly pain, difficulty swallowing, and in some cases fever. It is a very common condition in children.
Causes: Tonsillitis may be caused by a virus and the symptoms will be milder, usually a small sore throat. It can also be of bacterial origin, in this case the patient will have a lot of pain, great difficulty swallowing and usually fever. In addition, white spots can also be observed on the tonsils.
Treatment: Both tonsillitis are treated pharmacologically.
The medical name for surgery is tonsillectomy and it is performed in some cases: recurrent tonsillitis, wich is more than 4 episodes in 1 a year, when the patient has suffered from an abscess, or in cases of very large tonsils that can cause obstruction of the respiratory tract. The surgery is performed under general anesthesia. Nowadays the most modern way is to remove the tonsils with a device that emits radio-frequency waves. It is important to mention that you do not have to dismantle the jaw to perform such surgery. In the postoperative period the patient is instructed to ingest many cold foods and liquids; it is normal that pain occurs and for this reason several analgesics and anti-inflammatories are prescribed.
Symptoms: Just like the tonsils the adenoids are part of the body’s defense tissue. They are located in the back of the nose and are unique to children. When the adenoids become inflamed they can obstruct breathing and cause oral breathing, produce mucus that goes down the throat and manifests as a persistent cough and bad respiration. Enlarged adenoids affect the ventilation of the ears so they can cause ear recurrent infections or accumulation of mucus in the ears.
Causes: Infections can cause the adenoids to grow.
Treatment: If the adenoids do not cause obstruction problems, ear infections or hearing problems, nothing is done to them or pharmacological treatment is given. On the contrary, if they cause symptoms, then in this case a surgery would be recommended. Adenoidectomy is the scraping of the adenoid tissue, which is done orally, and it is a very short surgery followed by a fast and painless recovery and an impressive improvement of the symptoms.
Symptoms: The human ear is divided into three parts: the outer, the middle, and the inner ear. The outer ear is where the cerumen (ear wax) lodges. It provides protection and channels sound. The middle ear is behind the tympanic membrane and is an air space that communicates with the nose and contains 3 small bones. Finally, the inner ear contains the hearing organ and operates the body’s sense of balance with its respective nerves. Hearing disorders can manifest as deafness, tinnitus, and difficulty to understand words.
Causes: Hearing loss can originate in any part of the ear and the causes could vary from a wax plug to a damage in the auditory nerve. We rely on audiology specialists to find the origin of the problem through the different diagnostic tests that exist.
Treatment: The treatment of hearing loss will depend on the cause that causes the loss. Because deafness is the most frequent hearing loss, our audiologists are at the forefront in adapting the newest hearing aids. Hearing aids are not only used by patients who have hearing loss but also by patients with intense tinnitus who use them to reduce the sound.
Symptoms: The voice is produced by vibration of our two vocal cords. The vocal cords are found in the larynx, in the lower portion of the throat. The most common symptom found in patients with vocal cord disorders is dysphonia or hoarse voice (hoarseness).
Causes: Dysphonia can be caused by nodules, polyps, hemorrhages, scars, and cancer. If a patient suffers from dysphonia for more than 2 weeks it is recommended to have an otolaryngologist to check it out. To correctly assess the vocal cords we have two studies in our clinics: nasofibroscopy (laringoscopy), which consists of introducing an endoscope (a small camera) through the nose or through the mouth, down the throat to reach the cords to observe them in real time. The other study is called videostroboscopy, which is a much more professional method to study the proper functioning of the vocal cords, often used by voice professionals such as singers, journalists, etc.
Treatment: Treatment always depends on the cause of dysphonia. In many cases it is pharmacological and in other cases the patient may need surgery.
Symptoms: Otitis is inflammation / infection of the outer ear or middle ear. Usually the patient goes through a lot of pain that intensifies gradually and is accompanied by a feeling of a blocked ear sensation.
Causes: External otitis (swimmer’s ear) occurs in the outer ear canal after having been in the water (river, pool, or sea). An otitis media (middle ear infection) is an infection that occurs in the middle ear and is a side-effect of a bacterial infection, very often after the flu or nasal congestion. There is another not-infectious otitis called serous otitis, which occurs due to the presence of mucus in the middle ear, commonly happening to children with large adenoid problems or big nasal congestion.
Treatment: Treatment is usually pharmacological. In some cases, for example in recurrent otitis and serous otitis, it is necessary to place Tympanostomy tubes into the eardrum. This is a procedure that requires general anesthesia to prevent the child from moving and it is painless during recovery. It is important to prevent the ears from coming into contact with the water after the procedure.
Symptoms: Vertigo is the feeling a patient has that things revolve around him or that he turns. Sometimes the patient may feel imbalance, dizziness (feeling as if he had just gotten off a boat) or some other disturbance of balance. The duration of the symptoms are variable and can range from minutes to days.
Causes: There are many causes. The causes can originate in the ear or the brain. The most common causes are in the ear, which is why the head and neck surgeon is the most knowledgeable doctor to assess the patient at the beginning. The most common cause is related to the detachment of crystals in the inner ear that is known as Benign Postural Vertigo.
To determine the specific cause of vertigo we have a study called videonystagmography in our clinic, during which through a series of painless tests we can find the source of the problem. This study is very helpful, because many times the examination performed in the office is very incomplete and imaging studies do not help us in the diagnosis.
Treatment: Treatment can be pharmacological in most of the cases, but in other cases it is necessary to perform a series of exercises to accommodate some crystals that are the origin of the problem. Sometimes we need to use Vestibular Rehabilitation Therapy.
Symptoms: Snoring is an unpleasant noise that occurs during sleep respiration as a result of the vibration of different structures of the upper airway such as the soft palate, tonsils, lateral walls of the pharynx, and tongue base. It is most worrisome when it is accompanied by sleep apnea, which is when the patient pauses breathing and there is a decrease in oxygen in the blood. Other symptoms are: night awakenings with sensations of choking and palpitations during sleep.
Causes: Overweight, throat weakness, enlarged tonsils, enlarged uvula and soft palate, and any nasal problem (congestion) that causes obstruction in breathing. Sometimes we refer the patient to a respiratory polygraphy to see how much he snores and how many apneas he has.
Treatment: Before being able to treat the patient, it is necessary to diagnose the cause and see if it is simple snoring or if there is sleep apnea associated. In a great majority of patients the cause of the vibration originates in the area of the tonsils and the soft palate where the uvula is. In some cases we can perform a tonsils and palate surgery to try to firm it and thus prevent it from vibrating. Another treatment that has seen very good results is the use of Continuous Positive Airway Pressure therapy (CPAP).
There are many conditions that happen much more frequently to children than to adults such as: acute and chronic tonsillitis, adenoiditis, infectious otitis and serous otitis (mucus inside the ear), nose bleeds, foreign objects in the nose and ears of children, and deafness due to accumulation of mucus inside the ear. We specialize in the pharmacological treatment of these conditions, and if these conditions are recurrent or pharmaceutics fail, we also specialize in the surgical treatment.
It is essential to detect or rule out deafness in the newborn and the infant by early exploration of hearing, we do perform the test necessary to rule out deafness.
If the diagnosis is positive, it is important to carry out treatment immediately to avoid the negative consequences that deafness has on language development, learning, and on the intellectual capacity of the child. To newborn children or infants with hearing loss, we perform the Auditory Evoked Potentials of the Cerebral Artery. To children older than 3 years we can perform a tonal audiometry with the help of sound toys to assess the hearing level. In addition, we can perform a Tympanometry test to all children, which allows us to rule out the presence of mucus inside the ear.
Symptoms: in each nostril we have 3 turbinates (lower, middle and upper). The lower one is the one that has more functions in terms of heating, humidifying and having the air in optimal conditions. Sometimes the inferior turbinate grows more than the size considered normal and then it will cause obstruction or nasal congestion, increased mucous secretion and in some other occasions sneezing, itching of the nose, among others.
Causes: the causes are many, the most common are: allergic rhinitis, vasomotor rhinitis, hormonal rhinitis, deviations of the nasal septum. Treatment: medication can be given based on nasal sprays, but these treatments do not cure, only in some patients they reduce symptoms. Once the spray is stopped the symptoms return. The only treatment that has proven to be 100% effective is turbinates surgery. This procedure can be performed under local anesthesia in the office or under general anesthesia in the operating room. There are two technologies to perform this procedure:
- Radiofrequency, it causes fibrosis or scarring inside the turbinate allowing it to retract and therefore ends up making it smaller. This type of technology can be applied both in the office and in the operating room.
- Shaver, it consists of a device that has a small shaver at the tip. It is inserted into the thickness of the turbinate and “eats” the excess tissue inside the turbinate, leaving of course enough turbinate to perform the necessary nasal functions. This type of technology can only be performed in the operating room because it is a more aggressive technique. It is not a procedure that is characterized by pain during recovery, it does not require the placement of tamponade or gauze. The patient only has to perform a few nasal washes and go to an appointment once a week for 3 weeks with the doctor. After the procedure the patient can be integrated to work at most 2 days after.