Patient Education Information

An infection of the middle ear (acute otitis media)can affect one or both ears and is the cause of most ear aches especially in children.   Otitis media can be serious because the infection can spread to nearby structures in the head, especially the mastoid located behind the ear. Otitis media may also cause hearing loss; in children, it may impair learning ability and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal.

Many cases of otitis media can be treated by your pediatrician or family doctor; more serious cases may need attention from an ENT (ear, nose, and throat) specialist, or otolaryngologist.

Ear infections are often due to eustachian tube dysfunction. Inside your ear you have something called an eustachian tube that equalizes pressure behind the ear drum and naturally clears middle-ear secretions. In children, the anatomy of the Eustachian tube affects the risk of ear infections.  As children mature, the Eustachian tube matures and the child begins to have fewer middle ear infections.   When the eustachian tube becomes blocked due to a cold, allergy, upper respiratory infection (URI), bacteria, or a virus, negative pressure can develop and mucus can collect behind the eardrum causing pain, swelling, and redness.

In adults, common causes of earaches include otitis externa or swimmer’s ear and TMJ dysfunction. Swimmer’s ear (which also occurs in children) is an infection of the ear canal and results from swimming in contaminated water or as a result of cotton swab use. In people with diabetes, otitis externa can spread far beyond the ear canal and can be life threatening. Therefore, prompt treatment with antibiotic ear drops as well as cleaning of the ear canal with specialized tools available to an ENT specialist is critical. Occasionally, the ear canal may swell shut and the ENT physician has to place a wick to get the medication down into the canal.  Another common cause of ear pain is due to referred pain from the jaw joint. This is usually due to grinding of teeth during sleep. TMJ pain can be treated with ibuprofen, eating softer food, avoiding chewing gum, and using a night guard.

An avoidable cause of earache is the use of cotton swabs or other instruments to clean wax from the ear, which can damage the ear canal and ear drum.  Following the old adage that “nothing smaller than an elbow goes in the ear” can avoid dangerous injury to the ear canal and the eardrum. A rare cause of earache is referred pain from infection or cancer of the throat as both structures have the same nerve pathway.

Symptoms of earaches

Symptoms of earaches in infants and toddlers may include:

• Hearing problems
• Pulling or scratching the ear
• Crying or irritability
• Ear drainage
• Fever

Symptoms of earaches in young children, adolescents, and adults may include:

• Pain
• Hearing problems
• Full or “stuffy” sensation in the ear
• Dizziness or loss of balance
• Nausea, vomiting
• Ear drainage
• Fever

So what happens when you are seen for ear pain?

During an examination, your ENT specialist will use an otoscope to look inside and assess your ear. They check for redness in the ear, and/or fluid behind the eardrum, and to see if the eardrum moves. These are the signs of an ear infection. If your hearing is decreased, Valley ENT may also perform an audiogram to test for any potential hearing loss by presenting tones at various pitches, or a tympanogram, which measures the air pressure in your middle ear to see how well your eustachian tube is working.

Your provider at Valley ENT  may also prescribe medications. An antibiotic may be used to fight the infection and will make your earache go away rapidly, but the infection may need more time to clear up. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both. Sometimes ibuprofen or Tylenol may be added to reduce fever and/or pain. Special ear drops can also help ease the pain.

Children who experience multiple episodes of acute otitis media within a short time, chronic otitis media that lasts for more than three months, and/or hearing loss may require the insertion of ventilation tubes, also called pressure-equalization (PE) tubes. This is a short surgical procedure in which a small incision is made in the eardrum, any fluid is suctioned out, and a tube is placed in the eardrum. This tube will eventually fall out on its own, and the eardrum heals.

Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss as well as more severe infections to the surrounding important structures.

Almost everyone has had a sore throat.  When you have a sore throat, it can affect speaking, swallowing, breathing.  Causes of sore throats can be VIRAL or BACTERIAL.  Allergies and sinus infections can also contribute.  If you have a sore throat that lasts more than 5-10 days (or worsens drastically after the 5th or 6th day), you should see your doctor.

Here is a list of symptoms that may help guide whether you contact us for medical care.

• Severe and prolonged sore throat
• Difficulty breathing
• Difficulty swallowing
• Swelling of the face or neck
• Joint Pain along with sore throat
• Earache
• Rash
• Fever (over 101°F)
• Blood in saliva or phlegm (what you cough up from your lungs)
• Frequently/recurring sore throat
• Lump in neck
• Hoarseness lasting over 2 weeks

What are the causes of sore throat?

Infections of the throat are caused by VIRUSES OR BACTERIA .

VIRAL INFECTIONS: Sore throats often accompany viral infections, including flu, colds, measles, chicken pox, whooping cough, croup, or mononucleosis.  Mononucleosis has the longest of symptoms, such as sore throat and extreme fatigue, and can last several weeks.  

BACTERIAL INFECTIONS: Strep throat is an infection caused by streptococcus bacteria. This type of bacterial infection can also cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections.  Symptoms of strep throat often include fever (greater than 101ºF), white patches on the throat, and swollen or tender lymph glands/nodes in the neck,  Children may also have headaches and stomach pain.

Epiglottitis is also a a throat infection (mostly caused by a bacteria) that can cause swelling of the epiglottis (at the base of your tongue).  Emergency medical attention is needed if the airway is nearly or fully swollen shut.  Some signs of Epiglottitis is  muffled speech, difficulty swallowing with drooling and breathing becomes difficult.  

Allergies and irritants can cause sore throats.  Things such as pollens, molds, dry heat, dehydration, pollutants, chemical exposure and/or straining your voice.

Reflux occurs when you regurgitate stomach content up into your throat.  The contents contain acidic material and causes irritation,  This may be called Laryngopharyngeal reflux (LPR) or Gastroesophageal reflux disease (GERD).

And finally, tumors of the throat, tongue, and larynx or voice box can cause sore throat and ear pain.  Other important symptoms can include hoarseness, difficulty swallowing, noisy breathing, a lump or mass in the neck, unexplained weight loss, and possibly spitting up blood in saliva or phlegm.

What are the treatment options?

Mild sore throat that is associated with cold/flu symptoms:

• Increase fluid intake
• Drink warm fluids such as tea with honey
• Use a personal steamer or humidifier in your bedroom
• Gargle with warm salt water several times a day.  Just place 1/4 tsp salt to 1/2 cup of warm water.
• Take over-the-counter pain relievers such as Tylenol or Ibuprofen.

For a more severe sore throat:

• A throat culture might be done to test for bacterial infection.
• If positive on throat culture, your doctor will recommend an appropriate antibiotic for that specific bacteria.  
• It is important to take your antibiotics as directed and you must FINISH all does even if your symptoms improve in a couple of days.
• If your symptoms do not improve with the antibiotics , be sure to call our office so we can inform the provider who saw you.

A thyroid nodule is an area of abnormal growth within the thyroid. The thyroid is a butterfly-shaped gland located at the base of the front of the neck. It produces thyroid hormone, which controls your metabolism, temperature regulation, and keeps your muscles and organs working properly.

Diseases of the thyroid, whether functional (hypothyroidism, hyperthyroidism) or structural (nodule, goiter, cancer), occur very commonly. Some people have a single nodule while others have multiple nodules within the gland. Thyroid nodules, which are particularly common in women, can be tiny to very large in size.

Most thyroid nodules are non-cancerous, do not cause symptoms, and do not need any treatment. In some cases, however, because of the size, appearance (on radiology tests), or symptoms caused by the nodule, additional evaluation and treatment may be needed.

Symptoms

Because many thyroid nodules are small, they may cause no symptoms. However, some nodules can cause the thyroid to grow (called a goiter), some can be overactive and lead to hyperthyroidism, and some can be thyroid cancers. If patients do experience symptoms they may include:

• A lump in the neck
• Difficulty swallowing
• Pressure in the neck

Treatments

Most thyroid nodules require no treatment. Depending on the type of nodule and related symptoms, different treatment options may be appropriate. In some cases, thyroid surgery is needed. Your endocrinologist or ENT (ear, nose, and throat) specialist, or otolaryngologist, may order or perform:

• Thyroid function tests, including thyroid stimulating hormone (TSH)
• Blood tests, or radiology examination
• An ultrasound to see the size and appearance of the nodule
• A fine needle aspiration (FNA) biopsy, which is a safe, relatively painless procedure. In this procedure, a small needle is passed into the lump, and tissue samples containing cells are taken and then sent to a pathologist for testing.