Allergy Testing Treatment Center Plano Dallas Fort Worth Texas
General Topics







Sinusitis
Ear Tubes
About Otolaryngology
Allergies
Balance
Ears
Head & Neck Surgery
Hearing
Nose
Sinuses
Snoring & Sleep Disorders
Throat, Voice, Swallowing
Thyroid / Parathyroid
Tobacco and Cancer
General Topics
Kids E.N.T. Health


General Topics


Fever Blisters and Canker Sores
Know the Score on Facial Sports Injuries
Skin Cancer
Doctor, What is Bell's Palsy?
Smell and Taste Disorders
Doctor, what is TMJ?
Doctor, Explain GERD and LPR




Fever Blisters and Canker Sores


If you have been bothered by a sore in your mouth that made it painful to eat and talk, you are not alone. Many otherwise healthy people suffer from recurrent mouth sores.

Two of the most common recurrent oral lesions are fever blisters (also called cold sores) and canker sores (aphthous ulcers). When they occur in the mouth, it may be difficult to distinguish one from the other. Since the treatment and cause of these two sores are completely different, it is extremely important to know which is which.

What Are Fever Blisters (Cold Sores)?

These are common names for fluid filled blisters that commonly occur on the lips. They also can occur in the mouth, particularly on the gums and roof of the mouth (hard palate), but this is rare. Fever blisters are usually painful; in fact, the pain may precede the appearance of the lesion by a few days. The blisters rupture within hours, then crust over. They last about 7-10 days.

canker sore

Causes

Fever blisters result from a herpes simplex virus which becomes active. This virus is latent (dormant) in afflicted people, but can be activated by conditions such as stress, fever, trauma, hormonal changes, and exposure to sunlight. When lesions reappear, they tend to form in the same location.

Can Fever Blisters Be Spread?

Yes, the time from blister rupture until the sore is completely healed is the time of greatest risk for spread of infection. The virus can spread to your own eyes and genitalia, as well as to other people.

Prevention Tips:

avoid mucous membrane contact when a lesion is present
do not squeeze, pinch or pick at the blister
wash hands carefully before touching your eyes or genital area, or another person

Despite all caution, it is important to remember that it is possible to transmit herpes virus even when no blisters are present.

Treatment

Treatment consists of coating the lesions with a protective barrier ointment containing an antiviral agent, for example 5% acyclovir ointment. Presently, there is no cure, but there is much research activity underway in this field. Contact your doctor or dentist for the latest information.

What are Canker Sores?

Canker sores (also called aphthous ulcers) are small, shallow ulcers occurring on the tongue, soft palate, or inside the lips and cheeks. They are quite painful, and usually last 5-10 days.

Cause

The best available evidence suggests that canker sores result from an altered local immune response associated with stress, trauma, or local irritants, such as eating acidic foods (i.e., tomatoes, citrus fruits and some nuts.)

Can Canker Sores Be Spread?

No, since they are not caused by bacteria or viral agents, they cannot be spread locally or to anyone else.

Treatment

The treatment is directed toward relieving discomfort and guarding against infection. A topical corticosteroid preparation such as triamcinolone dental paste (Kenalog in Orabase 0.1%®) is helpful. Unfortunately, no cure exists at present.

What About Other Sores?

For any mouth lesion that does not heal in two weeks, you should see your physician or dentist.



<BACK TO TOP>





Know the Score on Facial Sports Injuries


catchPlaying catch, shooting hoops, bicycling on a scenic path or just kicking around a soccer ball have more in common than you may think. On the up side, these activities are good exercise and are enjoyed by thousands of Americans. On the down side, they can result in a variety of injuries to the face.

Many injuries are preventable by wearing the proper protective gear, and your attitude toward safety can make a big difference. However, even the most careful person can get hurt. When an accident happens, it's your response that can make the difference between a temporary inconvenience and permanent injury.

When Someone Gets Hurt: What First Aid Supplies Should You Have on Hand in Case of An Emergency?

sterile cloth or pads
scissors
ice pack
tape
sterile bandages
cotton tipped swabs
hydrogen peroxide
nose drops
antibiotic ointment
eye pads
cotton balls
butterfly bandages

Ask "Are you all right?" Determine whether the injured person is breathing and knows who and where they are.

Be certain the person can see, hear and maintain balance. Watch for subtle changes in behavior or speech, such as slurring or stuttering. Any abnormal response requires medical attention.

Note weakness or loss of movement in the forehead, eyelids, cheeks and mouth.

Look at the eyes to make sure they move in the same direction and that both pupils are the same size.

If any doubts exist, seek immediate medical attention.

When Medical Attention Is Required, What Can You Do?

Call for medical assistance (911).

Do not move the victim, or remove helmets or protective gear.

Do not give food, drink or medication until the extent of the injury has been determined.

Remember HIV...be very careful around body fluids. In an emergency protect your hands with plastic bags.

Apply pressure to bleeding wounds with a clean cloth or pad, unless the eye or eyelid is affected or a loose bone can be felt in a head injury. In these cases, do not apply pressure but gently cover the wound with a clean cloth.

Apply ice or a cold pack to areas that have suffered a blow (such as a bump on the head) to help control swelling and pain.

Remember to advise your doctor if the patient has HIV or hepatitis.

Facial Fractures

Sports injuries can cause potentially serious broken bones or fractures of the face. Common symptoms of facial fractures include:

swelling and bruising, such as a black eye

pain or numbness in the face, cheeks or lips

double or blurred vision

nosebleeds

changes in teeth structure or ability to close mouth properly

It is important to pay attention to swelling because it may be masking a more serious injury. Applying ice packs and keeping the head elevated may reduce early swelling.

If any of these symptoms occur, be sure to visit the emergency room or the office of a facial plastic surgeon (such as an otolaryngologist-head and neck surgeon) where x-rays may be taken to determine if there is a fracture.

Upper Face


When you are hit in the upper face (by a ball for example) it can fracture the delicate bones around the sinuses, eye sockets, bridge of the nose or cheek bones. A direct blow to the eye may cause a fracture, as well as blurred or double vision. All eye injuries should be examined by an eye specialist (ophthalmologist).

Lower Face

When your jaw or lower face is injured, it may change the way your teeth fit together. To restore a normal bite, surgeries often can be performed from inside the mouth to prevent visible scarring of the face; and broken jaws often can be repaired without being wired shut for long periods. Your doctor will explain your treatment options and the latest treatment techniques.

Soft Tissue Injuries


Bruises cuts and scrapes often result from high speed or contact sports, such as boxing, football, soccer, ice hockey, bicycling skiing, and snowmobiling. Most can be treated at home, but some require medical attention.

You should get immediate medical care when you have:

deep skin cuts

obvious deformity or fracture

loss of facial movement

persistent bleeding

change in vision

problems breathing and/or swallowing

alterations in consciousness or facial movement

Bruises


Also called contusions, bruises result from bleeding underneath the skin. Applying pressure, elevating the bruised area above the heart and using an ice pack for the first 24 to 48 hours minimizes discoloration and swelling. After two days, a heat pack or hot water bottle may help more. Most of the swelling and bruising should disappear in one to two weeks.

Cuts and Scrapes


The external bleeding that results from cuts and scrapes can be stopped by immediately applying pressure with gauze or a clean cloth. When the bleeding is uncontrollable, you should go to the emergency room.

Scrapes should be washed with soap and water to remove any foreign material that could cause infection and discoloration of the skin. Scrapes or abrasions can be treated at home by cleaning with 3% hydrogen peroxide and covering with an antibiotic ointment or cream until the skin is healed. Cuts or lacerations, unless very small, should be examined by a physician. Stitches may be necessary, and deeper cuts may have serious effects. Following stitches, cuts should be kept clean and free of scabs with hydrogen peroxide and antibiotic ointment. Bandages may be needed to protect the area from pressure or irritation from clothes. You may experience numbness around the cut for several months. Healing will continue for 6 to 12 months. The application of sunscreen is important during the healing process to prevent pigment changes. Scars that look too obvious after this time should be seen by a facial plastic surgeon.

Nasal Injuries


The nose is one of the most injured areas on the face. Early treatment of a nose injury consists of applying a cold compress and keeping the head higher than the rest of the body. You should seek medical attention in the case of:

breathing difficulties

deformity of the nose

persistent bleeding

cuts

Bleeding

Nosebleeds are common and usually short-lived. Often they can be controlled by squeezing the nose with constant pressure for 5 to 10 minutes. If bleeding persists, seek medical attention.

Bleeding also can occur underneath the surface of the nose. An otolaryngologist/facial plastic surgeon will examine the nose to determine if there is a clot or collection of blood beneath the mucus membrane of the septum (a septal hematoma) or any fracture. Hematomas should be drained so the pressure does not cause nose damage or infection.

Fractures

Some otolaryngologist-head and neck specialists set fractured bones right away before swelling develops, while others prefer to wait until the swelling is gone. These fractures can be repaired under local or general anesthesia, even weeks later.

Ultimately, treatment decisions will be made to restore proper function of the nasal air passages and normal appearance and structural support of the nose. Swelling and bruising of the nose may last for 10 days or more

Neck Injuries

Whether seemingly minor or severe, all neck injuries should be thoroughly evaluated by an otolaryngologist -- head and neck surgeon. Injuries may involve specific structures within the neck, such as the larynx (voicebox), esophagus (food passage), or major blood vessels and nerves.

Throat Injuries

The larynx is a complex organ consisting of cartilage, nerves and muscles with a mucous membrane lining all encased in a protective tissue (cartilage) framework.

The cartilages can be fractured or dislocated and may cause severe swelling, which can result in airway obstruction. Hoarseness or difficulty breathing after a blow to the neck are warning signs of a serious injury and the injured person should receive immediate medical attention.

Prevention

The best way to treat facial sports injuries is to prevent them. To insure a safe athletic environment, the following guidelines are suggested:

Be sure the playing areas are large enough that players will not run into walls or other obstructions.

Cover unremoveable goal posts and other structures with thick, protective padding.

Carefully check equipment to be sure it is functioning properly.

Require protective equipment - such as helmets and padding for football, bicycling and rollerblading; face masks, head and mouth guards for baseball; ear protectors for wrestlers; and eyeglass guards or goggles for racquetball and snowmobiling are just a few.

Prepare athletes with warm-up exercises before engaging in intense team activity.

In the case of sports involving fast-moving vehicles, for example, snowmobiles or dirt bikes - check the path of travel, making sure there are no obstructing fences, wires or other obstacles.

Enlist adequate adult supervision for all children's competitive sports.



<BACK TO TOP>





Skin Cancer


The skin is the largest organ in our body. It provides protection against heat, cold, light, and infection. The skin is made up of two major layers (epidermis and dermis) as well as various types of cells. The top (or outer) layer of the skin-the epidermis-is composed of three types of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and melanocytes, cells that provide skin its color and protect against skin damage. The inner layer of the skin-the dermis-is the layer that contains the nerves, blood vessels, and sweat glands.

What Is Skin Cancer?

Skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of your skin. There are several types of cancer that originate in the skin. The most common types are basal cell carcinoma (70 percent of all skin cancers) and squamous cell carcinoma (20 percent). These types are classified as nonmelanoma skin cancer. Melanoma (five percent of all skin cancers) is the third type of skin cancer. It is less common than basal cell or squamous cell skin cancer, but potentially much more serious. Other types of skin cancer are rare.

Basal Cell Carcinoma

Basal cell carcinoma is the most common type of skin cancer. It typically appears as a small raised bump that has a pearly appearance. It is most commonly seen on areas of the skin that have received excessive sun exposure. These cancers may spread to the skin around the cancer but rarely spread to other parts of the body.

Squamous Cell Carcinoma

Squamous cell carcinoma is also seen on the areas of the body that have been exposed to excessive sun (nose, lower lip, hands, and forehead). Often this cancer appears as a firm red bump or ulceration of the skin that does not heal. Squamous cell carcinomas can spread to lymph nodes in the area.

Melanoma

Melanoma is a skin cancer (malignancy) that arises from the melanocytes in the skin. These cancers typically arise as pigmented (colored) lesions in the skin with an irregular shape, irregular border, and multiple colors. It is the most harmful of all the skin cancers, because it can spread to other sites in the body. Fortunately, most melanomas have a very high cure rate when identified and treated early.

Who Gets Skin Cancer?

Skin cancer is a disease that has shown a steady increase over the past 20 years. Fortunately, with early diagnosis and treatment, it remains a very curable disease. A variety of factors have been identified that place a person at a higher risk to develop skin cancer (see "Am I at risk?").

How Is Skin Cancer Diagnosed?

The vast majority of skin cancers can be cured if diagnosed and treated early. Aside from protecting your skin from sun damage, it is important to recognize the early signs of skin cancer.

Skin sores that do not heal,
Bumps or nodules in the skin that are enlarging, and
Changes in existing moles (size, texture, color).

If you notice any of the factors listed above see your doctor right away. If you have a spot or lump on your skin, your doctor may remove the growth and examine the tissue under the microscope. This is called a biopsy. A biopsy can usually be done in the doctor's office and usually involves numbing the skin with a local anesthetic. Examination of the biopsy under the microscope will tell the doctor if the skin lesion is a cancer (malignancy).

How Is Skin Cancer Treated?

There are varieties of treatments available, including surgery, radiation therapy, and chemotherapy, to treat skin cancer. Treatment for skin cancer depends on the type and size of cancer, your age, and your overall health.

Surgery is the most common form of treatment. It generally consists of an office or outpatient procedure to remove the lesion and check edges to make sure all the cancer was removed. In many cases, the site is then repaired with simple stitches. In larger skin cancers, your doctor may take some skin from another body site to cover the wound and promote healing. This is termed skin grafting. In more advanced cases of skin cancer, radiation therapy or chemotherapy (drugs that kill cancer cells) may be used with surgery to improve cure rates.

Am I At Risk?

People with any of the factors listed below have a higher risk of developing skin cancer and should be particularly careful about sun exposure.

long-term sun exposure
fair skin (typically blonde or red hair with freckles)
place of residence (increased risk in Southern climates)
presence of moles, particularly if there are irregular edges, uneven coloring, or an increase in the size of the mole
family history of skin cancer
use of indoor tanning devices
severe sunburns as a child
nonhealing ulcers or nodules in the skin.

Early identification of skin cancer can save your life.

How Can I Lower My Risk?

The single most important thing you can do to lower your risk of skin cancer is to avoid direct sun exposure. Sunlight produces ultraviolet (UV) radiation that can directly damage the cells (DNA) of our skin. People who work outdoors (farming, construction, boating, outdoor sports) are at the highest risk of developing a skin cancer. The sun's rays are the most powerful between 10 am and 2 pm, so you must be particularly careful during those hours. If you must be out during the day, wear clothing that covers as much of your skin as possible, including a wide-brimmed hat to block the sun from your face, scalp, neck, and ears. In addition to protective clothing, the use of a sunscreen can reflect light away from the skin and provide protection against UV radiation. When selecting a sunscreen, choose one with a Sun Protection Factor (SPF) of 15 or more. Sunscreen products do not completely block the damaging rays, but they do allow you to be in the sun longer without getting sunburn. In addition to being sun-smart, it is critical to recognize early signs of trouble on your skin. The best time to do self-examination is after a shower in front of a full-length mirror. Note any moles, birthmarks, and blemishes. Be on the alert for sores that do not heal or new nodules on the skin. Any mole that changes in size, color, or texture should be carefully examined. If you notice anything new or unusual, see your physician right away. Catching skin cancer early can save your life.

Ultraviolet Index: What You Need to Know

The new Ultraviolet (UV) Index provides important information to help you plan your outdoor activities and avoid overexposure to the damaging rays of the sun. Developed by the National Weather Service and the Environmental Protection Agency , the UV Index is issued daily as a national service.

The UV Index gives the next day's amount of exposure to UV rays. The Index predicts UV levels on a 0-10+ scale (see chart).

Always take precautions against overexposure, and take special care when the UV Index predicts exposure levels of moderate to above (5 - 10+).


--------------------------------------------------------------------------------

Index Number Exposure Level

0 - 2 Minimal
3 - 4 Low
5 - 6 Moderate
7 - 9 High
10+ Very High

<BACK TO TOP>


Doctor, What is Bell's Palsy?


Insight into facial nerve problems

Twitching, weakness, or paralysis of the face are symptoms of a disorder involving the facial nerve, not a disease in itself. Abnormal movement or paralysis of the face can result from infection, injury, or tumors, and an evaluation by your physician is needed to determine the cause. An otolaryngologist-head and neck surgeon has special training and experience in managing facial nerve disorders.

What Is the Facial Nerve?

The facial nerve resembles a telephone cable and contains 7,000 individual nerve fibers. Each fiber carries electrical impulses to a specific facial muscle. Information passing along the fibers of this nerve allows us to laugh, cry, smile, or frown, hence the name, "the nerve of facial expression."

When half or more of these individual nerve fibers are interrupted, facial weakness occurs. If these nerve fibers are irritated, then movements of the facial muscles appear as spasms or twitching. The facial nerve not only carries nerve impulses to the muscles of the face, but also to the tear glands, to the saliva glands, and to the muscle of the stirrup bone in the middle ear (the stapes). It also transmits taste from the front of the tongue. Since the function of the facial nerve is so complex, many symptoms may occur when the fibers of the facial nerve are disrupted. A disorder of the facial nerve may result in twitching, weakness, or paralysis of the face, in dryness of the eye or the mouth, or in disturbance of taste.

How Does It Work?

The anatomy of the facial nerve is very complex. The facial nerve passes through the base of the skull in transit from the brain to the muscles of facial expression. After leaving the brain, the facial nerve enters the bone of the ear (temporal bone) through a small bony tube (the internal auditory canal) in very close association with the hearing and balance nerves. Along its inch-and-a-half course through a small canal within the temporal bone, the facial nerve winds around the three middle ear bones, in back of the eardrum, and then through the mastoid (the bony area behind the part of the ear that is visible). After the facial nerve leaves the mastoid, it passes through the salivary gland in the face (parotid gland) and divides into many branches, which supply the various facial muscles. The facial nerve gives off many branches as it courses through the temporal bone: to the tear gland, to the stapes muscle, to the tongue (for taste sensation), and to the saliva glands.


Bell's palsy and other causes

The most common cause of facial weakness which comes on suddenly is referred to as "Bell's palsy." This disorder is probably due to the body's response to a virus: in reaction to the virus the facial nerve within the ear (temporal) bone swells, and this pressure on the nerve in the bony canal damages it.

In order to be sure that this is the cause of the facial weakness, and not something else, a special set of questions will be asked. After an examination of the head, neck, and ears, a series of tests may be performed. The most common tests are:

Hearing Test: Determines if the cause of damage to the nerve has involved the hearing nerve, inner ear, or delicate hearing mechanism.
Balance Test: Evaluates balance nerve involvement.
Tear Test: Measures the eye's ability to produce tears. Eye drops may be necessary to prevent drying of the surface of the eye (cornea).
Imaging: CT (computerized tomography) or MRI (magnetic resonance imaging) determine if there is infection, tumor, bone fracture, or other abnormality in the area of the facial nerve.
Electrical Test: Stimulates the facial nerve to assess how badly the nerve is damaged. This test may have to be repeated at frequent intervals to see if the disease is progressing.

Diagnosis, Prognosis and Treatment

The three questions most often asked by the patient are: What is the cause (diagnosis)?, When can I expect recovery (prognosis)?, and What can be done to bring about the best recovery at the earliest possible moment (treatment)? In order to answer these questions, your doctor must perform an extensive evaluation to determine the cause and which area of the facial nerve is involved, so that the best treatment can be prescribed.


Treatment

The results of diagnostic testing will determine treatment.

If infection is the cause, then an antibiotic to fight bacteria (as in middle ear infections) or antiviral agents (to fight syndromes caused by viruses like Ramsay Hunt) may be used.
If simple swelling is believed to be responsible for the facial nerve disorder, then steroids are often prescribed.
In certain circumstances, surgical removal of the bone around the nerve (decompression) may be appropriate.

Help your recovery

When the facial nerve is paralyzed, considerable attention must be given to maintaining a healthy eye, which requires a constant flow of tears. These tears are spread out over the eye by blinking, but blinking is diminished or eliminated in facial nerve paralysis. Diminished blinking and the absence of tearing together can reduce or eliminate the flow of tears across the eyeball, resulting in drying, erosion, and ulcer formation on the cornea and possible loss of the eye.

Closing the eye with a finger is an effective way of keeping the eye moist. Use the back of the finger to ensure that the eye is not injured with the fingertip. Protective glasses or clear eye patches are often used to keep the eye moist, and to keep foreign materials from entering the eye.

If the eye is dry, you may be advised to use artificial tears to keep it moist. The drops should be used as directed by your doctor. You may have to put one or two drops in the affected eye every hour while you are awake, and place ointment in your eye at bedtime.


Rehabilitation

Patients with permanent facial paralysis may be rehabilitated through a variety of surgical procedures including eyelid weights or springs, muscle transfers and nerve substitutions. Some patients may benefit from a special form of physical therapy called facial retraining. Other medical treatments for complications of facial paralysis including excessive motion of the face or muscle spasm may involve surgical division of overactive muscles or weakening them by chemical injection. If these procedures are needed, your physician will discuss them with you.


Conclusion

Disorders of the facial nerve, including paralysis, are not rare and have a variety of causes. The appropriate diagnosis and treatment are very important to achieving the best possible recovery of facial nerve function. Even patients with permanent facial nerve injury can be helped by surgical procedures designed to improve facial function.


<BACK TO TOP>




Smell and Taste Disorders


Smell and taste problems can have a big impact on our lives. Because these senses contribute substantially to our enjoyment of life, our desire to eat, and be social, smell and taste disorders can be serious. When smell and taste are impaired, life loses some zest. We eat poorly, socialize less, and as a result, feel worse. Many older people experience this problem.

Smell and taste also warn us about dangers, such as fire, poisonous fumes, and spoiled food. Certain jobs require that these senses be accurate-chefs and firemen rely on taste and smell. One study estimates that more than 200,000 people visit a doctor with smell and taste disorders every year, but many more cases go unreported.

Loss of the sense of smell may be a sign of sinus disease, growths in the nasal passages, or, in rare circumstances, brain tumors.

How do smell and taste work?

Smell and taste belong to our chemical sensing system (chemosensation). The complicated processes of smelling and tasting begin when molecules released by the substances around us stimulate special nerve cells in the nose, mouth, or throat. These cells transmit messages to the brain, where specific smells or tastes are identified.

Olfactory (small nerve) cells are stimulated by the odors around us-the fragrance from a rose, the smell of bread baking. These nerve cells are found in a tiny patch of tissue high up in the nose, and they connect directly to the brain.

Gustatory (taste nerve) cells react to food or drink mixed with saliva and are clustered in the taste buds of the mouth and throat. Many of the small bumps that can be seen on the tongue contain taste buds. These surface cells send taste information to nearby nerve fibers, which send messages to the brain.

The common chemical sense, another chemosensory mechanism, contributes to our senses of smell and taste. In this system, thousands of free nerve endings-especially on the moist surfaces of the eyes, nose, mouth, and throat-identify sensations like the sting of ammonia, the coolness of menthol, and the "heat" of chili peppers.

Flavor

We can commonly identify four basic taste sensations:

sweet
sour
bitter
salty

Certain combinations of these tastes-along with texture, temperature, odor, and the sensations from the common chemical sense-produce a flavor. It is flavor that lets us know whether we are eating peanuts or caviar.

Many flavors are recognized mainly through the sense of smell. If you hold your nose while eating chocolate, for example, you will have trouble identifying the chocolate flavor, even though you can distinguish the food's sweetness or bitterness. This is because the familiar flavor of chocolate is sensed largely by odor. So is the well-known flavor of coffee. This is why a person who wishes to fully savor a delicious flavor (e.g., an expert chef testing his own creation) will exhale through his nose after each swallow.

Taste and smell cells are the only cells in the nervous system that are replaced when they become old or damaged. Scientists are examining this phenomenon while studying ways to replace other damaged nerve cells.
What causes smell and taste disorders?

Scientists have found that the sense of smell is most accurate between the ages of 30 and 60 years. It begins to decline after age 60, and a large proportion of elderly persons lose their smelling ability. Women of all ages are generally more accurate than men in identifying odors.

Some people are born with a poor sense of smell or taste. Upper respiratory infections are blamed for some losses, and injury to the head can also cause smell or taste problems.

Loss of smell and taste may result from polyps in the nasal or sinus cavities, hormonal disturbances, or dental problems. They can also be caused by prolonged exposure to certain chemicals such as insecticides and by some medicines.

Tobacco smoking is the most concentrated form of pollution that most people will ever be exposed to. It impairs the ability to identify odors and diminishes the sense of taste. Quitting smoking improves the smell function.

Radiation therapy patients with cancers of the head and neck later complain of lost smell and taste. These senses can also be lost in the course of some diseases of the nervous system.

Patients who have lost their larynx (voice box) commonly complain of poor ability to smell and taste. Laryngectomy patients can use a special "bypass" tube to breathe through the nose again. The enhanced airflow through the nose helps smell and taste sensation to be re-established.

How are smell and taste disorders diagnosed?

The extent of loss of smell or taste can be tested using the lowest concentration of a chemical that a person can detect and recognize. A patient may also be asked to compare the smells or tastes of different chemicals, or how the intensities of smells or tastes grow when a chemical concentration is increased.

Smell. Scientists have developed an easily administered "scratch-and-sniff" test to evaluate the sense of smell.
Taste. Patients react to different chemical concentrations in taste testing; this may involve a simple "sip, spit, and rinse" test, or chemicals may be applied directly to specific areas of the tongue.

Can smell and taste disorders be treated?

Sometimes a certain medication is the cause of smell or taste disorders, and improvement occurs when that medicine is stopped or changed. Although certain medications can cause chemosensory problems, others-particularly anti-allergy drugs-seem to improve the senses of taste and smell. Some patients, notably those with serious respiratory infections or seasonal allergies, regain their smell or taste simply by waiting for their illness to run its course. In many cases, nasal obstructions, such as polyps, can be removed to restore airflow to the receptor area and can correct the loss of smell and taste. Occasionally, chemosenses return to normal just as spontaneously as they disappeared.

What can I do to help myself?

If you experience a smell or taste problem, try to identify and record the circumstances surrounding it. When did you first become aware of it? Did you have a "cold" or "flu" then? A head injury? Were you exposed to air pollutants, pollens, danders, or dust to which you might be allergic? Is this a recurring problem? Does it come in any special season, like hay fever time?

Bring all this information with you when you visit a physician who deals with diseases of the nose and throat (an otolaryngologist-head and neck surgeon). Proper diagnosis by a trained professional can provide reassurance that your illness is not imaginary. You may even be surprised by the results. For example, what you may think is a taste problem could actually be a smell problem, because much of what you think you taste you really smell.

Diagnosis may also lead to treatment of an underlying cause for the disturbance. Many types of smell and taste disorders are reversible. But, if yours is not, it is important to remember that you are not alone. Thousands of other patients have faced the same situation.



<BACK TO TOP>




Doctor, what is TMJ?


Insight into temporo-mandibular joint pain

Pain and the TMJ

What is the TMJ?

You may not have heard of it, but you use it hundreds of times every day. It is the Temporo-Mandibular Joint (TMJ), the joint where the mandible (the lower jaw) joins the temporal bone of the skull, immediately in front of the ear on each side of your head. A small disc of cartilage separates the bones, much like in the knee joint, so that the mandible may slide easily; each time you chew you move it. But you also move it every time you talk and each time you swallow (every three minutes or so). It is, therefore, one of the most frequently used of all joints of the body and one of the most complex.

You can locate this joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way and shut it. The motion you feel is the TMJ. You can also feel the joint motion in your ear canal.

These maneuvers can cause considerable discomfort to a patient who is having TMJ trouble, and physicians use these maneuvers with patients for diagnosis.

How does the TMJ work?

When you bite down hard, you put force on the object between your teeth and on the joint. In terms of physics, the jaw is the lever and the TMJ is the fulcrum. Actually, more force is applied (per square foot) to the joint surface than to whatever is between your teeth. To accommodate such forces and to prevent too much wear and tear, the cartilage between the mandible and skull normally provides a smooth surface, over which the joint can freely slide with minimal friction.

Therefore, the forces of chewing can be distributed over a wider surface in the joint space and minimize the risk of injury. In addition, several muscles contribute to opening and closing the jaw and aid in the function of the TMJ.

Symptoms:

Ear pain
Sore jaw muscles
Temple/cheek pain
Jaw popping/clicking
Locking of the jaw
Difficulty in opening the mouth fully
Frequent head/neck aches

How does TMJ dysfunction feel?

The pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew, or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head (the temple), the cheek, the lower jaw, and the teeth.

A very common focus of pain is in the ear. Many patients come to the ear specialist quite convinced their pain is from an ear infection. When the earache is not associated with a hearing loss and the eardrum looks normal, the doctor will consider the possibility that the pain comes from a TMJ dysfunction.

There are a few other symptoms besides pain that TMJ dysfunction can cause. It can make popping, clicking, or grinding sounds when the jaws are opened widely. Or the jaw locks wide open (dislocated). At the other extreme, TMJ dysfunction can prevent the jaws from fully opening. Some people get ringing in their ears from TMJ trouble.

How can things go wrong with the TMJ?

In most patients, pain associated with the TMJ is a result of displacement of the cartilage disc that causes pressure and stretching of the associated sensory nerves. The popping or clicking occurs when the disk snaps into place when the jaw moves. In addition, the chewing muscles may spasm, not function efficiently, and cause pain and tenderness.

Both major and minor trauma to the jaw can significantly contribute to the development of TMJ problems. If you habitually clench, grit, or grind your teeth, you increase the wear on the cartilage lining of the joint, and it doesn't have a chance to recover. Many persons are unaware that they grind their teeth, unless someone tells them so.

Chewing gum much of the day can cause similar problems. Stress and other psychological factors have also been implicated as contributory factors to TMJ dysfunction. Other causes include teeth that do not fit together properly (improper bite), malpositioned jaws, and arthritis. In certain cases, chronic malposition of the cartilage disc and persistent wear in the cartilage lining of the joint space can cause further damage.


What can be done?

Because TMJ symptoms often develop in the head and neck, otolaryngologists are appropriately qualified to diagnose TMJ problems. Proper diagnosis of TMJ begins with a detailed history and physical, including careful assessment of the teeth occlusion and function of the jaw joints and muscles. If the doctor diagnoses your case early, it will probably respond to these simple, self-remedies:

Rest the muscles and joints by eating soft foods.
Do not chew gum.
Avoid clenching or tensing.
Relax muscles with moist heat (1/2 hour at least twice daily).

In cases of joint injury, ice packs applied soon after the injury can help reduce swelling. Relaxation techniques and stress reduction, patient education, non-steroidal anti-inflammatory drugs, muscle relaxants or other medications may be indicated in a dose your doctor recommends.

Other therapies may include fabrication of an occlusal splint to prevent wear and tear on the joint. Improving the alignment of the upper and lower teeth and surgical options are available for advanced cases. After diagnosis, Dr. Adelglass may suggest further consultation with your dentist and oral surgeon to facilitate effective management of TMJ dysfunction.


<BACK TO TOP>




Doctor, Explain GERD and LPR


What is GERD?


Gastroesophageal reflux, often referred to as GERD, occurs when acid from the stomach backs up into the esophagus. Normally, food travels from the mouth, down through the esophagus and into the stomach. A ring of muscle at the bottom of the esophagus, the lower esophageal sphincter (LES), contracts to keep the acidic contents of the stomach from “refluxing” or coming back up into the esophagus. In those who have GERD, the LES does not close properly, allowing acid to move up the esophagus.

When stomach acid touches the sensitive tissue lining the esophagus and throat, it causes a reaction similar to squirting lemon juice in your eye. This is why GERD is often characterized by the burning sensation known as heartburn.

In some cases, reflux can be SILENT, with no symptoms until a problem arises. Almost all individuals have experienced reflux (GER), but the disease (GERD) occurs when reflux happens on a frequent basis often over a long period of time.


What is LPR?

During gastroesophageal reflux, the acidic stomach contents may reflux all the way up the esophagus, beyond the upper esophageal sphincter (a ring of muscle at the top of the esophagus), and into the back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux (LPR), which can affect anyone. Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning, or something “stuck.” Some may have difficulty breathing if the voice box is affected.

In infants and children, LPR may cause breathing problems such as: cough, hoarseness, stridor (noisy breathing), croup, asthma, sleep disordered breathing, feeding difficulty (spitting up), turning blue (cyanosis), aspiration, pauses in breathing (apnea), apparent life threatening event (ALTE), and even a severe deficiency in growth. Proper treatment of LPR, especially in children, is critical.

What are the symptoms of GERD and LPR?

The symptoms of GERD may include persistent heartburn, acid regurgitation, nausea, hoarseness in the morning, or trouble swallowing. Some people have GERD without heartburn. Instead, they experience pain in the chest that can be severe enough to mimic the pain of a heart attack. GERD can also cause a dry cough and bad breath. Some people with LPR may feel as if they have food stuck in their throat, a bitter taste in the mouth on waking, or difficulty breathing although uncommon.

If you experience any symptoms on a regular basis (twice a week or more) then you may have GERD or LPR. For proper diagnosis and treatment, you should be evaluated by your primary care doctor for GERD or an otolaryngologist—head and neck surgeon (ENT doctor).

Who gets GERD or LPR?

Women, men, infants, and children can all have GERD. This disorder may result from physical causes or lifestyle factors. Physical causes can include a malfunctioning or abnormal lower esophageal sphincter muscle (LES), hiatal hernia, abnormal esophageal contractions, and slow emptying of the stomach. Lifestyle factors include diet (chocolate, citrus, fatty foods, spices), destructive habits (overeating, alcohol and tobacco abuse) and even pregnancy. Young children experience GERD and LPR due to the developmental immaturity of both the upper and lower esophageal sphincters.

Unfortunately, GERD and LPR are often overlooked in infants and children leading to repeated vomiting, coughing in GER and airway and respiratory problems in LPR such as sore throat and ear infections. Most infants grow out of GERD or LPR by the end of their first year; however, the problems that resulted from the GERD or LPR may persist.

What role does an ear, nose, and throat specialist have in treating GERD and LPR?

A gastroenterologist, a specialist in treating gastrointestinal orders, will often provide initial treatment for GERD. But there are ear, nose, and throat problems that are either caused by or associated with GERD, such as hoarseness, laryngeal (singers) nodules, croup, airway stenosis (narrowing), swallowing difficulties, throat pain, and sinus infections. These problems require an otolaryngologist—head and neck surgeon, or a specialist who has extensive experience with the tools that diagnose GERD and LPR. They treat many of the complications of GERD, including: sinus and ear infections, throat and laryngeal inflammation and lesions, as well as a change in the esophageal lining called Barrett’s esophagus, which is a serious complication that can lead to cancer.

Your primary care physician or pediatrician will often refer a case of LPR to an otolaryngologist—head and neck surgeon for evaluation, diagnosis, and treatment.

Diagnosing and treating GERD and LPR

In adults, GERD can be diagnosed or evaluated by a physical examination and the patient’s response to a trial of treatment with medication. Other tests that may be needed include an endoscopic examination (a long tube with a camera inserted into the nose, throat, windpipe, or esophagus), biopsy, x-ray, examination of the throat and larynx, 24 hour pH probe, acid reflux testing, esophageal motility testing (manometry), emptying studies of the stomach, and esophageal acid perfusion (Bernstein test). Endoscopic examination, biopsy, and x-ray may be performed as an outpatient or in a hospital setting. Endoscopic examinations can often be performed in your ENT’s office, or may require some form of sedation and occasionally anesthesia.

Symptoms of GERD or LPR in children should be discussed with your pediatrician for a possible referral to a specialist.

Most people with GERD respond favorably to a combination of lifestyle changes and medication. On occasion, surgery is recommended. Medications that could be prescribed include antacids, histamine antagonists, proton pump inhibitors, pro-motility drugs, and foam barrier medications. Some of these products are now available over-the-counter and do not require a prescription.

Children and adults who fail medical treatment or have anatomical abnormalities may require surgical intervention. Such treatment includes fundoplication, a procedure where a part of the stomach is wrapped around the lower esophagus to tighten the LES, and endoscopy, where hand stitches or a laser is used to make the LES tighter.

Adult lifestyle changes to prevent GERD and LPR

Avoid eating and drinking within two to three hours prior to bedtime
Do not drink alcohol
Eat small meals and slowly
Limit problem foods:
Caffeine
Carbonated drinks
Chocolate
Peppermint
Tomato and citrus foods
Fatty and fried foods
Lose weight
Quit smoking
Wear loose clothing



<BACK TO TOP>





Join the Allergy Testing and Treatment Center Mailing List

Enter Email:










ear nose throat information Allergy Testing Dallas Fort Worth Plano Texas Ear Nose & Throat
Find answers to questions you may have about common Ear, Nose and Throat ailments.

read more



Dustmite Allergy Information Allergy Testing Dallas Fort Worth Plano Texas Allergy Information
Learn about indoor, outdoor allergies and other helpful allergy advice here.

read more




Environment Control Hepa filter Allergy Testing Dallas Fort Worth Plano Texas
Environmental Control
Allergies out of control? Visit here to learn how to control your environment and beat the allergy out of your home!

read more



Pollen Count by Email Allergy Testing Dallas Fort Worth Plano Texas
Pollen Count By Email

Do you want to get the pollen count in your email box?


read more



Pollen Archives Allergy Testing Dallas Fort Worth Plano Texas Pollen Count Archives
We have several years worth of past pollen counts in our archives.


read more


Allergy Testing Allergy Testing
We offer the most up to date and accurate allergy skin testing available.

read more



Call our Allergy hotline 972-ALLERGY Allergy Hotline!
Quick and easy way to check the pollen count!
read more




Pollen Guide know what the values mean Pollen Count Guide
So what does the pollen numbers mean anyways?

read more


Air Quality Index Air Quality Index
Ozone is a gas that is formed in the atmosphere when three atoms of oxygen combine. Naturally occurring ozone is found high in the stratosphere surrounding the earth and in ground-level ambient air.

read more


Daily Pollen Count Daily Pollen Count
Here you will find the daily pollen count and other helpful allergy information for the Dallas Fort Worth Texas metroplex area.

read more



Call our Allergy Hotline
972-A.L.L.E.R.G.Y.

Visit our allergy site @ www.allergic.com