John Austin, MD, FACS

Brownsville & Harlingen ENT Physician

Thyroid Surgery and Choosing a Thyroid Surgeon

Thyroid Surgery

Many people have masses in their thyroid gland known as nodules. Most thyroid nodules are benign. Nodules are more common in women than men and are usually discovered on the 4th and 5th decade of life. Some are noted during a routine physical exam, many are detected with a screening ultrasound.

Depending on the size of the lesion and whether or not it is associated with multiple nodules or is just a single nodule determines how much of an evaluation is needed. Most nodules do not affect the function of the thyroid gland. Some doctors will test thyroid hormone levels when a nodule is detected, while others will not.

Between 5 to 15% of solitary thyroid nodules are malignant. Because of this risk most nodules over 1 cm in size need to be biopsied to determine if they are malignant. Risk factors associated with a nodule being cancer include: a hard nodule, a painful nodule, a rapidly enlarging nodule, age over 50 years, known radiation exposure and a family history of thyroid cancer.

Detecting malignant thyroid nodules and determining the need for thyroid surgery

The most common way to detect if a nodule is malignant is with an ultrasound guided needle biopsy of the nodule. A skilled physician can anesthetize the neck over the nodule and with the direction of the ultrasound can guide a needle into the nodule and sample the cells.

The sampled tissue is then examined by a cytopathologist skilled in the evaluation of thyroid disease. Most times the pathologist can provide a diagnosis of what type of tumor is present. This includes if is benign or malignant, and if malignant what type of malignancy of the thyroid it is.

If there is diagnosis of malignancy then thyroid surgery is recommended for most patients. Thyroid surgery will entail removal of the entire thyroid gland and usually the associated lymph nodes that drain from the thyroid gland. Sometimes if the needle biopsy is equivocal then most thyroid surgeons will recommend just removing the half of the thyroid gland that the nodule is in. This is called a thyroid lobectomy.

Choose the right surgeon for your thyroid surgery

When choosing a thyroid surgeon a patient with a thyroid nodule should find a thyroid surgeon skilled in all types of surgery of the neck. A patient should want a thyroid surgeon who has performed thyroid surgery hundreds if not thousands of times.  Most ear, nose, and throat (ENT) surgeons are skilled in all types of neck surgery, including thyroid surgery. Some ENT doctors are further trained in a subspecialty known as Head & Neck Surgery which is a 1 or 2 year fellowship level training after residency.

Dr. John Austin has extensive thyroid surgery experience

Dr. John Austin performed his Fellowship in Head and Neck Surgery at the prestigious University of Texas MD Anderson Cancer Center in Houston, Texas. After his training he served as an Assistant Professor for four years in the Head and Neck Surgery Department, at MD Anderson.  He has performed an extensive amount of thyroid operations through his combined training in Los Angeles, Houston, and his clinical practice in Austin, Texas.

If your primary physician, surgeon, or endocrinologist has recommended thyroid surgery and you want to work with an Austin ear, nose and throat doctor, make an appointment with Dr. John Austin, please call us to schedule an appointment.

Tonsillectomy – Should You Have Your Tonsils Removed?

Tonsillectomy - Have tonsils removed?

A common question I am asked is; Doctor why do I need to have my tonsils removed? Or, why does our pediatrician say my son or daughter should have their tonsils removed? The answer is always complex and includes many different factors all of which play an important role in the answer.

The tonsil is lymphoid tissue that helps in the development of the body’s immune antibody development. In most people as they age the function and the size of the tonsils will decrease. In some people the tonsils continue to enlarge and they can become continually infected or harbor subclinical bacterial contamination. Sometimes if they continue to enlarge they can produce difficulty with speech, swallowing and breathing. Large tonsils can be a precursor to obstructive sleep apnea (OSA).

Tonsillectomy In Adults

Adults, for this discussion someone 25 years of age or older, often times have their tonsils removed for reasons of repetitive strep throat infections, obstructive symptoms, snoring, swallowing problems, bad breath, or possibly even a severe tonsil infection called a peritonsil abscess. Sometimes adults who have suffered repetitive viral pharyngeal infections will develop chronic pain in their throat which is improved with a tonsillectomy.

Tonsillectomy in infants and children under the age of 4

A tonsillectomy in an infant or child under the age of 4 is uncommon and requires a special evaluation by the pediatrician and otolaryngologist. Often times other physicians are involved in the decision to perform a tonsillectomy in a child this young. These may include a pediatric: neurologist, pulmonologist and infectious disease expert.

Tonsillectomy in children over the age of 4

Children over the age of 4 most commonly have their tonsils removed because of repetitive throat infections most often from the bacteria streptococcus. This is commonly referred to as strep throat. Strep throat is most often associated with a very sore throat, malodorous breath, a high fever, and difficulty with drinking and eating. Strep throat is most often diagnosed with a rapid strep test, or a throat culture. It is almost always treated with antibiotics and can be very contagious affecting other family members.

Other reasons children over the age of 4 have their tonsils removed can include heavy snoring with obstructive type symptoms. Sometimes these children will have a sleep study that documents obstructive breathing patterns during sleep. If children have had multiple treatments with various antibiotics there is a concern that they may develop bacteria that are resistant to antibiotics. More and more antibiotic resistant infection mount a serious health challenge to clinicians and patients.

Tonsillectomy Surgery

Having tonsils removed is done through a surgical procedure called a tonsillectomy. It is often accompanied by removal of the adenoid tissue. The adenoid is lymph tissue in the back of the nose. Surgical removal of the tonsil and adenoid is always done with general anesthesia. Surgery takes about 30 minutes and is most often done as an outpatient. Both adults and children over the age of 4 can usually go home the same day as surgery.

Recovery after a Tonsillectomy

The recovery after surgery takes about seven to ten days. Younger children will recuperate quicker than an adult. Physical activity and travel is strictly limited after surgery. Most surgeons recommend 2 weeks of no travel and restricted activity.

Diet after a tonsillectomy is predominantly hydration drinks and cool soft foods. Hot food and hard chewy food or spicy food is to be avoided. A liquid narcotic pain medicine is prescribed after surgery and most patients will use a narcotic medication for about 10 days, although younger children do recuperate quicker. Adults are recommended to not drive while taking prescription pain medicine and to avoid important business and personal decision making situations.

Once completely recovered from surgery patients are most often free from future bacterial infections of the pharynx. The tonsil and adenoid do not grow back, although some people may develop some lymphoid tissue in the same location as the tonsils and adenoid.

Chronic Ear Infections (Otitis Media)

Commonly seen in children, ear infections – also known as otitis media – can also affect adults.

Symptoms of Chronic Ear Infections

As most people can tell you, ear infections are no fun. Ear infections are common and quite uncomfortable. If you are experiencing an earache and think it may be an ear infection, check your symptoms against this list.

Symptoms of chronic ear infections in adults include:

  • Earache – a sharp, sudden pain or a dull, continuous pain
  • Warm drainage from the ear canal
  • A feeling that one’s ear is clogged or full
  • Nausea
  • Muffled hearing

Symptoms of chronic ear infections in children include:

  • Tugging at the ear
  • Sleeping poorly
  • Fever
  • Ear drainage
  • Being irritable, restless, or crying while lying down

What distinguishes an ear infection as being acute or chronic is the number of times one experiences the symptoms. If this is your first time experiencing these symptoms, you likely have an acute ear infection. If you have these symptoms multiple times per year or if your symptoms last for weeks on end, you are likely experiencing chronic ear infections.

Causes of Chronic Ear Infections

The ear canal is a part of your sinuses. When your ears are healthy and working properly, air is allowed to flow freely from behind your nose and through the Eustachian tube, which keeps the middle ear clean and dry. When the Eustachian tube is blocked, moisture can become trapped in the middle ear and cause bacteria to collect. This leads to a most unpleasant ear infection.

Ear infections become chronic when moisture repeatedly gets trapped in the middle ear. This is most common in adults and children who swim frequently or have persistent allergies.

What Can I Do?

If you are experiencing any of the symptoms listed above, visit your doctor. He or she will likely take a look inside your ears. If the middle ear is red and inflamed, your doctor will likely diagnose you with an ear infection.

Ear infections are caused by either bacteria or a virus. If the cause is bacterial, your doctor may prescribe you with antibiotics. However, if the cause is viral, your only option is to treat the symptoms of your ear infection as there is no cure against viruses.

To ease the discomfort of an ear infection, you can:

  • Take acetaminophen or ibuprofen to reduce fever
  • Apply gentler heat from a heating pad to reduce pain
  • Do something to help you relax or take your mind off of the pain such as lighting a candle and resting your eyes, or reading

To prevent another ear infection from happening, be sure to have good personal hygiene habits such as washing your hands. Stopping the spread of bacteria and viruses will go a long way to reducing your risk of getting another ear infection. Talk to your doctor about any ideas he or she might have that are tailored to your specific situation such as wearing ear plugs while swimming.

Sleep Apnea and Snoring: What your Body is Telling You

Sleep Apnea and Snoring

Does your spouse complain of your snoring? Your sleeping partner isn’t the only one. Snoring is a sign that your body is suffering as well.

Learn about Somnoplasty

Causes of Sleep Apnea

Sleep apnea is a medical condition in which one stops breathing briefly while sleeping. When you are awake, the muscles in your throat and neck are rigid and provide a nice open channel for you to breath through. When you sleep, these muscles naturally relax, which causes that channel to narrow. Normally, this is not a problem as your heart rate and breathing slow when you are sleeping. However, for some people this channel becomes closed or blocked, which can lead to sleep apnea.

Common causes for this channel to become blocked include:

  • Most Common: being overweight – if you are carrying excess weight around your chin and neck, this weight can put pressure on your throat, causing it to close
  • Moderately Common: having large tonsils or a large tongue – larger than average organs in your throat can cause a blockage while you sleep
  • Rare: the presence of a neurological disorder in which your brain fails to tell the muscles in your throat to stay open while you sleep

Causes of Snoring

Snoring is much more common than sleep apnea and has many more potential causes. Snoring occurs when there is a full or partial obstruction in the airway. As one inhales and exhales, the air is forced around the obstruction, making the sound of a snore.

Some of these causes include:

  • Having an obstructed nasal passage – nasal passages that are inflamed due to allergies or having a cold, or the presence of a deviated septum could cause an obstruction in the nasal passages
    Poor muscle tone in the throat – for some people the muscles of the throat and the tongue become too relaxed while they sleep, causing a narrower channel through which to breathe
  • Larger than average tissue – some people have larger than average throat muscles, tonsils, or tongue; all of which can narrow the breathing channel and cause snoring
  • Drinking alcohol – alcohol is a sedative and can cause the muscles in the throat to relax too much, causing an obstruction
  • Being overweight – excess tissue around the chin and throat can put unnecessary pressure on your throat and cause it to become more narrow

What Can I Do?

Now that you know what the potential causes of sleep apnea and snoring are, speak with your doctor about which one is likely plaguing you. Many doctors will recommend a sleep study in order to properly diagnose sleep apnea. Sleep studies allow doctors to see what a typical night of sleep is like for you.

Your doctor will likely refer you to a sleep lab where you will be assigned to a private bedroom and monitored by special machines. The machines will detect changes in your breathing, brain activity, muscle activity, and heart rate. While it may seem like a lot of uncomfortable equipment, most sleep study patients state that they fall asleep rather quickly.

In the morning your doctor will have a print out of what your body was doing while you were sleeping. If at any point during the night you stopped breathing, your doctor may diagnose you with sleep apnea.

Many treatments for sleep apnea also help patients with snoring. Your doctor may recommend any number of the following non-medication treatments:

  • quitting smoking
  • avoiding alcohol, sleeping pills, and other sedatives before bed
  • avoiding heavy meals within two hours of laying down to sleep
  • avoiding caffeine after about 4pm
  • maintaining a regular sleep schedule
  • sleeping on your side
  • propping up your head with some comfortable pillows or blankets
  • opening your nasal passages before bed by using a nasal dilator, saline spray, breathing strips, or a neti pot

If none of these home remedies seem to work, you and your doctor may decide to try medical treatment options. Dr. Austin recommends an appointment with an Ear, Nose, and Throat physician at the initial concern over sleep apnea. A thorough examination of the nose, mouth, and throat will help make sure that an anatomic or medical condition is addressed, and treated before ancillary testing is performed. This examination is thorough, painless, and may include the use of flexible fiber-endoscopy to evaluate the anatomy of the patient’s airway.

Some patients with sleep apnea require supplemental oxygen while sleeping while other patients decide to use breathing devices. If your sleep apnea is caused by a heart or neuromuscular disorder, you and your doctor may need to discuss treatment options for the underlying condition.

Sinusitis Causes Symptoms and Treatment Options

sinusitis causes symptoms and treatment

Sinusitis is a common complaint. According to the CDC, over 37 million Americans will have at least one bout of sinusitis every year.

A Rose by any Other Name Would Smell as Sweet

Unless, that is, you have a sinusitis. Then you may not be able to smell anything. Sinusitis can do more than make you feel bad; it can actually lead to a full-blown, chronic sinus infection that lasts for weeks at a time. In short, sinusitis can make you truly miserable and lead to other problems.

What is Sinusitis?

Sinusitis is an inflammation (and or infection) of the sinuses. The sinuses are air-filled cavities that are located above your eyebrows and below your eyes.

Sinusitis Causes Symptoms and Treatment Options

What Causes Sinusitis?

The most common cause of sinusitis is a viral infection. Viruses, allergens or other environmental irritants cause an irritation to the delicate mucosal lining of the sinuses. The body then responds by rushing fluid to the affected area (causing swelling).

Moreover, when irritated, the natural response of the sinuses is to produce larger quantities of mucus (in order to flush out the irritant or viral agent). However, if the sinuses become overwhelmed and cannot drain, the pressure continues to build, causing pain.

Secondary Infections

Furthermore, because the area is moist and warm, bacteria may be able to increase in number, leading to a sinus infection that can become chronic or extend for four or more weeks.

Other underlying causes may also make patients more susceptible to sinusitis. These include fungal infections, allergies, nasal polyps, and the presence of a deviated septum (which can block nasal passages and or slow the normal drainage).

What are the Symptoms?

Symptoms of sinusitis include:

  • Swelling of the nasal passageways
  • Fever
  • Sinus pain and pressure
  • Excessive mucus or mucus that appears cloudy, yellow or greenish
  • A feeling of increased pressure or pain when leaning forward
  • Dental pain

What Treatments are Available?

Your doctor can diagnose and treat sinusitis. He or she will determine the underlying cause and then prescribe a course of treatment. This may include medications to relieve the congestion, decrease mucus production, or antibiotics to fight the infection.

He or she may also prescribe other medications to reduce the reaction to allergens or corticosteroids to reduce the swelling. In some cases, such as when polyps are present, he or she may recommend a surgical procedure in order to treat and or prevent future infections.

If you are Experiencing the Pain of Sinusitis

You may be able to gain some temporary relief of your symptoms by using over-the-counter medications and nasal sprays. If, however, the symptoms worsen, you begin to run a fever, or you begin to notice a change in the color of the mucus (yellow or green), or the symptoms simply interfere with your daily life, contact your doctor for an appointment.

Image Credit for Sinusitis Causes Symptoms and Treatment Options: Spring Dew

Ears Ringing? It might be Tinnitus

Ears Ringing?Tinnitus can cause an almost non-stop ringing, clicking, hissing, roaring or buzzing sound in the ears. It may be present in both ears or just in one.

Ericka kept having the sensation of ears ringing

Erika’s ears were always buzzing and not because someone was talking about her. She had a constant, almost non-stop sensation of her ears ringing that was making her life miserable. “I thought I would go nuts,” she said, “I just needed it to stop.”

She made an appointment with an ENT (an ear, nose and throat specialist) and, after a few tests, found that her problem had been caused by a buildup of cerumen (earwax). Erika was relieved to find out that there was a simple treatment. “I felt so silly. I had put off going for weeks and all it was, was a buildup of wax.”

Suffering, But Certainly Not in Silence

According to the National Institute of Deafness and Other Communications Disorders, over 22 million adults in the US suffer from some form of tinnitus[1]. Some researchers put the number as high as 36 million Americans.

Beyond being simply annoying, tinnitus can interfere with daily activities. It can also be a warning that there is a more serious medical issue (such as hearing loss) that needs attention.

What Causes Tinnitus (ears ringing)?

Tinnitus is a relatively common ailment. Sometimes it is a side effect of taking a particular medication (either an over-the-counter medication, or a prescription given by your doctor to treat some other problem).

It can also be linked to an ear infection or environmental factors (for instance, loud noises at a concert or workplace). Even an obstruction within the ear canal, such as in the case of Erika, can bring on the symptoms of tinnitus. Sometimes it is a complication of a viral or bacterial infection.

Other typical reasons for ringing in the ears include:

  • Issues or obstructions in or around the blood vessels of the ear
  • The first signs of hearing loss
  • Problems with the auditory nerve or the cochlea
  • High blood pressure

In rare cases, the underlying cause may not be readily apparent. Doctors often refer to this as an “idiopathic condition,” meaning that the reason for the symptom cannot be determined.

Whatever the cause, most patients just want relief. The best course of action is to make an appointment with your  ENT doctor. He or she can perform the necessary tests, determine a plan of action and provide the required treatment for your tinnitus.

Dealing with the Noise

Treatments vary, but often include medications such as ear drops, antibiotics, antivirals, steroids or other prescription medications as needed. Sometimes it may include changes in the patient’s diet. Or a recommendation in stopping certain medications like aspirin or NSAIDS.

If the cause is a hearing loss, hearing aids may help with the tinnitus. Also hearing protection is very important in patients with tinnitus secondary to noise induced hearing loss. Continued loud noises can make tinnitus worse.

Remember, symptoms are like the check engine lights on your car. They are the only way your body has to get your attention.

Most of the time, tinnitus does not mean that you have a serious illness, but you still need to get it checked out.

[1] https://www.nidcd.nih.gov/health/hearing/pages/tinnitus.aspx

What is Vertigo?

What is vertigo?A lot of people will experience a balance disturbance at some time in their life. Many patients will come to an ENT physician with a complaint of vertigo. The role of the ENT doctor in the evaluation of patients with a balance disturbance is to determine if the balance problem is because of an abnormality of the ear. What is vertigo? The term vertigo generally means a sensation of spinning; whether the patient feels like they are spinning or the environment is spinning. Often movement makes the sensation worse.

The System of Balance

There are four parts of the nervous system that play a role in balance. The eyes, ears, peripheral nervous system, and the brain.  The eyes generally relay information to the brain where our body is relation to the world around us. The ears tell the brain where the body is in relation to rotary, linear and vertical motion. The peripheral nervous system sends information about the position of our body from various receptors in the muscles, bones, and joints. The brain then acts as the super computer that puts all the information together and regulates how our body responds to the stimulus. Anything that affects any part of the previous systems can cause our balance to be disturbed.

The Vestibular System

The human ear has two parts the cochlea and the vestibular system. The cochlea is the mechanism of hearing. The vestibular system is the mechanism of balance. When the vestibular system is not functioning normally the symptom the patient describes is usually one of spinning. Either they are spinning or the environment is spinning. Usually movement makes the symptom worse. Being motionless and keeping the eyes open generally decreases the symptoms. Onset of symptoms may be quite sudden, or sometimes it can be a gradual increase in frequency and severity.

Evaluating the vestibular system

Because the vestibular system and the cochlea are one sensory organ patients that come to an ENT physician with a complaint of vertigo will always get a thorough evaluation of the ear, nose and throat, and the cranial nerves. They will also be examined for beating of the eyes called nystagmous. Their peripheral balance system will also be checked with tests of movement and gait. A hearing test will be performed. If indicated, further test may include test of the , vestibular system, cochlea,  auditory nerve, and possibly blood test. Fortunately, none of these test are painful, they include an electronystagmogram, (ENG), electrocochleography (ECOG), and an auditory brainstem response (ABR). Some clinics even perform test of posturography.

Other evaluations of balance

If indicated the ENT physician may make a referral to an ophthalmologist or a neurologist if testing indicates that the peripheral nervous system, eyes, or brain are abnormal. Sometimes an MRI of the brain and auditory nerve may be performed.

Treatment of vertigo

Once the source of the balance disturbance is determined and if it is confirmed to be vestibular in origin there are several treatments that the ENT doctor may use to treat vertigo. These can include vestibular suppressants, antivirals, steroids, dietary changes, diuretics, physical therapy, and possibly intratympanic injections or even surgery.

More “What is vertigo?” Resources

http://www.medicalnewstoday.com/articles/160900.php
http://en.wikipedia.org/wiki/Vertigo
http://www.ncbi.nlm.nih.gov/pubmed/14994924

Ear Infections in Children

Ear infections in children, especially young children usually in the pre-elementary school age, is a common problem and many parents wonder why it affects their children, will it hurt their child’s hearing, and what can be done to help it resolve.

Ear infections in children can start at any age but are usually uncommon under the age of 6 months. Common symptoms in young children are fussiness, poor sleep, low grade fevers, runny nose and pulling or tugging at the ears. Drainage from the ears is not common in this age range.

Why causes ear infections in children?

Child's ear - ear infections in children are common.

Although the cause of ear infections in young children can be multifactorial the most common cause is poor functioning of the Eustachian tube. The Eustachian tube equalizes pressure in the ear. When you feel your ear pop in an elevator this is the Eustachian tube at work. In some small children the anatomy of the Eustachian tube does not equalize pressure efficiently.

If the Eustachian tube fails to equalize pressure fluid will build up in the ear. If the fluid stays long enough it can become infected with both viruses and bacteria. Although treatment with antibiotics and some other medications can eradicate some bacterial infections, fluid buildup due to allergies and infections due to viruses will persist. Repeat ear infections in children may occur if the fluid does not resolve.

Children who attend day care regularly are more at risk for repeat infections because their exposure to viruses and bacteria is increased. Children with bad nasal allergies are also at increased risk for repetitive ear infections.

Do ear infections in children affect hearing and speech?

The simple answer is yes. When fluid builds up in the ear a conductive hearing loss occurs. Basically this means that the ear does not transmit the entire spectrum of sound to the brain. Children develop speech based upon hearing spoken words and repeating what they have heard.

The fortunate thing is conductive hearing loss is reversible with appropriate recognition and treatment. Very infrequently does a permanent hearing loss occur when ear infections are diagnosed and treated appropriately.

How do ear tubes work?

It’s a common misperception that the purpose of ear tubes is to allow the ears to drain. Ear, Nose and Throat doctors place ear tubes to allow the pressure in the ear to equalize so that fluid will quit building up in the ear. If the fluid quits accumulating the sequence of repetitive infections can be broken.

What are the indications for ear tubes?

Common indications are the following:

  • Repetitive ear infections
  • Fevers associated with ear infections
  • Need for a parent or care giver to repeatedly miss work to attend to a sick child with an ear infection
  • Multiple trips to the doctor for diagnosis and treatment with antibiotics
  • Complications from antibiotics including rashes, diarrhea, yeast infections, and inability of your child to take an antibiotic
  • Allergies to antibiotics
  • Expense of multiple antibiotics
  • Possibility of developing antibiotic resistant bacteria
  • Conductive hearing loss with evidence of speech delay

Does my child need surgery to have ear tubes placed?

Yes, ear tubes are performed in an operating room with the benefit of anesthesia. It is a very short operation, usually less than 5 minutes.

Will my child’s hearing improve after ear tubes are placed?

If the hearing loss is only a conductive loss then yes, the hearing will improve after ear tube surgery

If you have questions about your child, please call our office to set-up a consultation at one of our three convenient locations.

More Information on Ear Infections in Children

http://www.nidcd.nih.gov/health/hearing/pages/earinfections.aspx

Brownsville ENT

(956) 350-8787
4770 North Expy.
Suite 304
Brownsville, TX 78526

Harlingen ENT

(956) 428-4221
510 Victoria Ln.
Suite 5
Harlingen, TX 78550

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