According to the American Hearing Loss Association, approximately 20 percent of people in the U.S. suffer from some form of hearing deficit. The World Health Organization (WHO) estimates that approximately 538 million people worldwide are afflicted with this condition. The WHO also estimates that unaddressed hearing loss imposes a global cost of $750 billion annually as a result of productivity loss as well as health and educational support costs.

There are three basic types of hearing loss. Conductive hearing loss occurs when there is some form of limitation of external sound accessing the structures of the inner ear. Sensorineural hearing loss involves dysfunction at the level of the cochlea (hearing organ) and/ or the hearing nerve itself. Mixed hearing loss is the third classification that occurs when components of sensorineural and conductive hearing loss are both present.

There are many facets to management of patients with irreversible hearing loss. One of the first considerations is to determine if a patient may benefit from instrumentation that can facilitate hearing. An example is a hearing aid which functions to amplify sound for the wearer. Cochlear implantation is considered for those with severe to profound hearing loss of both ears, and it involves surgical placement of an electrode that directly stimulates the hearing organ.

One remarkably effective method of hearing rehabilitation is the bone-anchored hearing device (BAHD) procedure. Historically, the concept of this procedure arose from dental implant experimentation dating back to the mid-1970s. In attempts to test the integrity of bone integration of the implants with sound-producing instruments, it was noted that the subject incidentally perceived sound very clearly. This concept is based on stimulation of the cochlea via direct conduction of signal through bone. Essentially, these systems bypass the external and middle ear and transfer sound energy straight to the fluids of the inner ear. In 1977, the first BAHD prototype was manufactured, and implantation began with great success. By mid-2009, the global number of patients with these devices was estimated to exceed 70,000.

Magnet-based implantable devices are relatively recent developments within the spectrum of BAHD technology. The Sophono implant, developed in Germany in 2006, was approved for use in the United States in May 2011. The device consists of a bi-lobed magnetic titanium implant that is affixed to the skull during a short surgical procedure. One month later, the patient returns for placement of the external component of the device, which consists of a sound processor and a magnetic baseplate. Essentially, the sound processor is held in place by the baseplate, which, in turn, is held to the skin by the implanted titanium magnet. The processor is thus able to transmit vibrations through skin to bone and ultimately to the inner ear.

There are many applications of BAHD technology for hearing rehabilitation. Patients who have irreversible conductive hearing loss can benefit from this procedure because the bone-anchored system completely bypasses the site causing the conductive loss (i.e., the outer and middle ear). Patients with mixed hearing loss may also benefit from the procedure. Another indication is for patients who suffer from single-sided deafness. In this situation, the implant may be placed on the side of the deaf ear. Sound is then transmitted via bone to the side of the good ear such that the patient essentially “hears” from both sides through one good ear. The Sophono implant is approved for ages 5 years and older.

I had the privilege of performing the first-ever Sophono implant procedure in the Shreveport-Bossier City area inSeptember 2016 on a patient who suffered from a sudden hearing loss in one ear that could not be helped with a traditional hearing aid. Since then, we have had continued success with subsequent patients, as well.

Magnetic-based implantable device technology can provide a very effective means of hearing rehabilitation. This is an exciting tool in our armamentarium as ENT specialists, and it is now available in the Shreveport-Bossier City area.

Dr. Chuka Ifeanyi is an ear, nose & throat specialist at Highland Clinic. Dr. Ifeanyi specializes in the diagnosis and treatment of disorders affecting the ear, nose, throat, and the head and neck of both children and adults. He is accepting new patients and can be reached at 798-4440; located at 1455 East Bert Kouns Industrial Loop, Suite 206, Shreveport, LA 71105.

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Snoring Can Indicate a Serious Condition

If you snore, it’s likely you are familiar with the nightly jabs in the ribs, grumbling from your bed partner, and maybe even separate bedrooms. Snoring happens when air cannot flow freely through the passage in your throat. As you probably know, the resulting rasps and rattles and disrupt the sleep of those around you. What you may not know, however, is that snoring can disrupt your own sleep and may be a sign of a serious condition called sleep apnea.

Signs and Signals

When a person has sleep apnea, the throat becomes blocked at night, stopping breathing for short periods of time. If you have sleep apnea, your partner may hear you alternate between snoring very loudly and being very quiet. You may not even gasp or snort in your sleep. Other symptoms of sleep apnea include

• Waking up tired, even after a full night’s sleep,
• Waking up with a headache,
• Feeling very sleepy or falling asleep at inappropriate times (for instance, at work or while driving),
• Irritability and short temperedness,
• Problems with concentration or memory.

Nose problems make things worse and may even cause snoring or sleep apnea. If the dividing wall in your nose is crooked (a deviated septum) or if you have allergies or polyps, the airflow can be blocked and contribute to the obstruction.

Not only can sleep apnea leave you constantly tired, but it is also associated with health problems such as high blood pressure, heart attack, and stroke.

Your physician can help. Snoring and sleep apnea rarely go away on their own, but they are treatable. Your physician can evaluate you and recommend a treatment plan to help you sleep quietly and breathe freely. This plan may include changes that you make yourself, medical devices, or surgery that your physician prescribes.

Every Breath You Take

Breathing often seems like the easiest thing in the world. Most of the time, you don’t even think about it. However, if you have ever had a stuffy nose, you know the feeling of breathing through a very narrow passageway.

This constriction is what happens in your throat when you snore. While you sleep, structures in your throat partially block your air passage, making it narrow and hard to breathe through. If the entire passage becomes blocked and you can not breathe at all, you have sleep apnea.

When you breathe in, air passes through your nose and throat on its way to your lungs. Your nose warms, filters, and humidifies the air that goes to your lungs. The air travels past soft, flexible structures in the throat, such as the soft palate, uvula, tonsils, and tongue. The soft palate is the tissue at the back of the roof of your mouth. It helps block off your nose when you swallow. The uvula is the long flap of tissue that hangs from the soft palate. Tonsils are the balls of tissue that rest in the sides of your throat. The tongue helps you swallow, talk, and chew.

Simple Solutions

Whether or not your have sleep apnea, your snoring may get better by making a few simple changes in your sleeping habits. These changes may be all that is necessary to improve or even cure your snoring or sleep apnea. Some of these changes include

• Not sleeping on your back (sleep on either side instead),
• Avoiding alcohol and certain medication that may cause sedation,
• Losing weight,
• Exercising regularly, and
• Unblocking your nose with either medicine or surgery.

Nose problems make things word and may even cause snoring or sleep apnea. If the dividing wall in your nose is crooked (a deviated septum) or if you have allergies or polyps, the airflow can be blocked and contribute to the obstruction.

So if snoring is a problem in your house, you should check with your physician. He or she may be able to help or refer you to a specialist to diagnose why you snore or if you have possibly have sleep apnea. Until then, have a good night’s sleep!

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The Medtronic Fusion System gives surgeons a picture-perfect view of the sinus.

Picture this scenario – you’re driving on a dark and winding road. You cannot see the road or any signs, but your map indicates that the path ahead is filled with twists and turns. Obstacles mar the road, and the lines have been rubbed away, due to years of use. Besides that, venturing too far over to the edge could result in some dire consequences. Feeling your way is the only alternative. While such a complicated and dangerous driving situation is unlikely to occur, sinus surgeons have been forced for years to navigate sinuses using only their knowledge of anatomy. Sinus surgery once was a complicated task for doctors who had to guide their instruments by feeling their way through he maze of air chambers known as the sinus. Now, a breakthrough in guided sinus surgery, the Medtronic Fusion System, provides surgeons with an inside view of the sinuses that makes surgery safer and reduces complications.

More than 30 million Americans suffer from sinus disease, experiencing symptoms such as facial pain or a feeling of fullness in the face, difficulty breathing through the nose, a persistent bad smell in the nose, post nasal discharge and headaches. While many of these sinus problems can be successfully treated with antibiotics or other medications, about 400,000 sinus surgeries are still necessary each year. Doctors recommend sinus surgery for people who have an infection or inflammation that will not respond to treatment with antibiotics or if the infection repeatedly returns after the course of antibiotics is completed. For many, endoscopic sinus surgery allows a more accurate removal of diseased tissues as well as less removal of normal tissues. Often, this surgery can be performed on an outpatient basis without the necessity of long-term nasal packing. After surgery, two or three follow-up visits are required.

The Highland Clinic and Christus Highland Medical Center have become the first health-care providers in the Shreveport area to utilize a state-of-the-art computer system designed for pinpoint accuracy and to minimize complications during sinus surgery. The Medtronic Fusion System allows the surgeon to see the exact position of his instruments and their movements through the sinuses on a video screen. Dr. J. William Parker, Jr., M.D., FACS, brought the breakthrough Medtronic Fusion technology to the Highland Clinic and Christus Highland Medical Center after exploring many different systems. He says that 97 percent of the ENTs in the worldwide market choose this system. “Surgical navigation has been used in other surgical disciplines for years. The technology has just now become available in the ENT community,” he explains.

January 18, 2001 was a landmark day for otolaryngologist Dr. Parker as he performed surgery using their new Medtronic Fusion System for the first time. Using CT scans made prior to the procedure plus a specialized headset placed on the patient, the new system produces a three-dimensional computerized model of the patient’s skull. The CT scans are positioned and synchronized to perfectly match the anatomy of each patient’s skull.

The Medtronic Fusion System is a momentous breakthrough. In many cases sinus disease surrounds the eye and lies up against the brain.
-Dr. J. William Parker

In the operating room, the computer surgeon displays four views for the surgeon – the video view from the endoscopic instrument actually in the skull as well as the axial, sagittal, and coronal views of the skull. The precise location of the doctor’s instruments in these areas is indicated by cross hairs on the screen to ensure accuracy. The endoscope performs as a miniature telescope to illuminate the surgeon’s view of the sinuses and provides a detailed view of the immediate surface area. “It’s like a GPS in your head,” explains Dr. Parker and adds that the system gives both the patient and the doctor confidence and a safety mechanism for difficult or revision cases. Many patients face the possibility of additional procedures no matter how well the preceding surgery was done, simply because of the nature of the ailments. “After the second time, you begin to lose your landmarks,” notes Parker, due to scar tissue and the condition of the sinus tissue.

The Medtronic Fusion System is a momentous breakthrough. “In many cases sinus disease surrounds the eye and lies up against the brain,” says Parker. “This system makes the surgery much safer.” The system allows the doctor to work more thoroughly and closer to the edge of the sinuses to remove as much as the diseased tissue as possible. Also, the system reduces time for certain sinus procedures by as much as 25 percent.

Although this new type of equipment is still considered optional, Parker feels that it will quickly become the gold standard. The majority of leading medical schools are using the technology to train future ENT surgeons. As training centers train residents to use this system, it will become more prevalent in sinus surgeries.

Parker notes that Medtronic Fusion increases precision. “It shows both my instrument and where it is in the sinus,” Parker says. “You can get lost in there if you can’t see anything. This is the best way to have an operation on your sinuses.”

For more information or to find out if you are a candidate for Medtronic Fusion, call (318) 798-4500.

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Improve sleep quality, daytime function, decrease risk of potential complications

At its core, sleep apnea is the interruption of normal breathing during sleep. The two primary forms of sleep apnea are obstructive sleep apnea (OSA) and central sleep apnea. OSA is caused by repeated physical obstruction of the upper airway that either partially impedes or completely blocks proper airflow (figure 1). It is the most common form of sleep apnea and is the focus of this article.

OSA is a relatively common condition. The American Academy of Sleep Medicine estimates that approximately 30 million adults in the United States suffer from this disorder. It is known to be two to three times more common in men. In addition to gender, other risk factors for OSA include advanced age, obesity, and physical and/or anatomic abnormalities of the skull, face, neck and/ or throat. Certain medical conditions may also predispose one to OSA including congestive heart failure, end-stage kidney disease, chronic lung disease and low thyroid hormone levels. In the United States, OSA is more common among African-Americans, Hispanics and Native Americans. Often, patients also have family members who suffer from OSA, suggestive of a possible hereditary component.

Snoring is a common symptom of OSA; however, not all people who snore have OSA. Daytime fatigue is another common finding in people with this sleep disorder, but, as with snoring, it is a relatively nonspecific finding, given the fact that many other disorders may also result in daytime fatigue. Commonly, the spouse of a potential OSA sufferer can offer helpful clues to the clinician. Observed nocturnal gasping or choking during sleep is more specific for true OSA, and a history of this usually dictates further evaluation. Other symptoms of OSA include early morning headaches, frequent body movements that disrupt sleep, nonrestorative sleep, frequent nighttime urination, depression, irritability, cognitive dysfunction and sexual dysfunction. OSA sufferers are also at higher risk for motor vehicle accidents and job-related accidents.

If clinical suspicion of OSA remains after a thorough history and physical examination, patients are often referred for a sleep study. Several types of sleep studies are available.

The gold standard form is performed overnight in a sleep lab with a technician present. Several parameters are monitored during this form of sleep study, including brain waves, heart rhythms, blood oxygen levels, chest and abdominal movements, incidents of snoring, nasal and oral airflow, body position and many others. In certain patients with seemingly uncomplicated OSA, a home sleep study may be appropriate and is often performed instead.

Ultimately, a sleep study will stratify OSA patients into three categories, namely mild, moderate and severe.

Effective OSA treatment is often multifaceted. The aim is to improve sleep quality and daytime function in addition to decreasing the risk of potential complications of sleep apnea. Lifestyle modifications generally play a role in OSA management. Such changes may include avoidance of alcohol and other sedating drugs. A healthy diet and regular exercise can help with weight loss, which, in turn, may help lessen the severity of OSA. Maintaining good sleep hygiene is also essential. This entails following a regular sleep schedule, resisting the urge to nap during the day, refraining from consumption of caffeine after lunchtime, avoiding light-emitting screens (e.g., televisions, phones, tablets) in bed, and making the bedroom conducive to sleep. OSA sufferers may also be prescribed a continuous positive airway pressure (CPAP) machine, typically considered as the first line treatment for OSA. CPAP works by maintaining a column of air pressure in the airway to keep it open during sleep. Other therapies that potentially benefit sufferers include oral appliances (designed to hold the jaw forward), upper airway surgery and stimulation of the nerve that powers the tongue. Usually, clinicians take an individualized approach to managing cases depending on several factors, including the severity of sleep apnea, ability to comply with or tolerate non-surgical measures, occupational duties and many other parameters.

The risk of leaving sleep apnea untreated may vary from vague cognitive problems to more immediately life-threatening complications such as an acute cardiac event. According to the American Sleep Association, more than 6% of people who suffer a fatal heart attack also have sleep apnea. It is also estimated that having sleep apnea increases the risk of developing high blood pressure by almost 50%. Figure 2 illustrates some of the other conditions that may result from sleep apnea.

In summary, OSA is a common condition that affects millions. Once diagnosed, it can often be treated effectively. Doing so may help the sufferer avoid several long-term complications, some of which may have a significant negative impact on the patient’s health.

Dr. Chuka Ifeanyi is an ear, nose & throat specialist at Highland Clinic in Shreveport, and now serving patients in Bossier City. Dr. Ifeanyi specializes in the diagnosis and treatment of disorders affecting the ear, nose, throat, and the head and neck of both children and adults. He is accepting new patients in both Shreveport and Bossier offices and can be reached at (318) 798-4440. Shreveport location: 1455 East Bert Kouns Industrial Loop, Suite 206 and now in Bossier at 2539 Viking Drive, Suite 103. Visit https://www.highlandclinic.com/staff/chuka-v-ifeanyi-m-d for more information.

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Source: https://theforumnews.com/article-3160-tubes-tubes-tubes_.html

A course of action for ear infections Why tubes in my kid’s ears? Well, for starters, antibiotics and other methods have failed to resolve the fluid behind the child’s eardrum. Therefore, most pediatricians are going to throw in the towel after three to four rounds of antibiotics, while your child is still sick with fever and pain, having trouble hearing, and you aren’t getting any sleep. So, how do you know when your child needs tubes? Nearly 500,000 sets of tubes are placed each year by ear, nose and throat specialists like me, for the above reasons. You may ask, why so many operations? Factors could include your child’s exposure to illnesses in a daycare setting, exposure to tobacco smoke, or even just nose, allergies, big tonsils and adenoids issues.

So, what’s the deal? The answer is the Eustachian tube; you know, that “thing” that pops when you’re on an airplane. For the above reasons, along with the anatomy of a little child’s Eustachian tube, it gets blocked from a swollen, infected, gross nose. It is the nose that causes the Eustachian tube not to work. What does the pediatrician do then? They prescribe antihistamines, decongestants, and antibiotics to the patient. If the fluid goes away, the problem is resolved, but sometimes the fluid can persist. After several rounds of the regimen, something else must be done! Thus, it’s time for tubes in your child’s ears. The fluid in your child’s ear is behind the eardrum. This fluid is removed microsurgically in the operating room with your child asleep. And, yes, anesthesia is safe, even for little children. The surgery begins in day surgery, where we sedate your child with oral medicine, no shot. I carry my babies to the operating room, where they go to sleep in my lap. If an IV is needed, it is placed after they are asleep. Then, using the operating microscope, a small 1/8 of an inch cut is made, the fluid is removed, and a tube inserted. So, what does the tube do? The tube lets air in and out of the middle ear. After placement, hearing returns. Fever, pain and late nights are relieved. My tubes usually stay in for one or two years, then they come out on their own, and the hole closes. So, if you’re tired of your child being in pain from an ear infection, ask your pediatrician about tubes. If you already have a regular ENT, great! If you do not, your pediatrician can refer you to one of us in Shreveport or Bossier. Remember, it is a safe procedure for your baby. Dr. J. William Parker Jr. is an ear, nose & throat / facial plastic and reconstructive surgery physician at Highland Clinic. He treats both children and adults and accepts most insurance plans. Dr. Parker specializes in disease and surgery in the area of the face, throat, sinuses and neck, with a specialty in chronic sinus patients. He now offers a new service known as Balloon Sinus Dilation. He is accepting new patients and can be reached at (318) 798-4565, located at 1455 East Bert Kouns Industrial Loop, Suite 207, Shreveport, LA 71105.

Visit https://www.parkersinuscenter.com for more information.

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Article source link https://theforumnews.com/article-3062-do-you-just-snore-or-is-it-sleep-apnea.html

Sleep study can determine course of action

Does your bed partner elbow you during the night to wake you up and tell you to turn over? Do you wake up after eight hours of sleep feeling as tired as when you went to bed? Is it just snoring that is your problem, or is your snoring so bad that you quit breathing? I’m asked this question in my ear, nose and throat practice almost every day.

The symptoms of sleep apnea, noted by many non-snoring bed partners, include the following: loud and frequent snoring, periods of no breathing, and choking or gasping sounds repeatedly throughout the night.

Twenty-five million people are diagnosed with obstructive sleep apnea every year. How many of you out there who snore have the symptoms but may not be diagnosed with OSA? The symptoms that patients notice are daytime sleepiness, fatigue and unrefreshing sleep. Others may have morning headaches.

The results of sleep apnea include high blood pressure, heart irregularities, heart attack, stroke, diabetes, chronic headache, congestive heart failure and depression. So, when I’m asked a question, “Is it just snoring, or is it sleep apnea?” this is my usual response. There is this spectrum of snoring. On one end of the spectrum, you have a social problem in bed at night with your snoring. On the other end, you have a patient who snores so badly that they have a medical problem: OSA.

So how in the world do you know where you stand in that spectrum of snoring patients? You get a sleep study. I order mine at Well Necessities on Line Avenue, as I have for over 30 years. While it sounds scary, it is not. It’s a friendly environment. Your blood pressure, pulse, EKG and oxygen saturation are measured while you sleep. Also measured are airflow and brain activity and leg jerks or movement. So, what now? If you have apnea, that’s where I come in.

My job as an ear, nose and throat specialist is to determine the level, or levels, and/ or areas where the obstruction to breathing occurs. It can be at one or all of three levels.

It can be in the nasal cavity or the oral cavity, or deeper in the throat. Anything that stops up the nose creates obstructed breathing at this level. For instance, allergies, polyps, deviations in the anatomy and swelling from sinus infection can all be the culprit. In the oral cavity, large tonsils and large tongue, long palate and long uvula are the usual offenders. Below the oral cavity is where the tongue hooks up with the throat. This is the overweight level. I then must determine which level(s) of obstruction each patient has.

When the sleep study shows sleep apnea, something must be done! Every patient has two options. One is to use a form of nasal CPAP, which stands for controlled positive air pressure. This treatment blows air through the nose, or nose and mouth, to keep the tissues from collapsing, thereby preventing the patient from having apnea periods. The second is to remove the obstruction or fix the obstruction surgically. While surgical results are usually effective, CPAP is 100 percent. When I operate on this type of patient, it’s after they have failed at the use of the CPAP.

Well Necessities obtains the equipment for you and will help you with any fitting or other issues you may have. I personally have friends that swore that they would never be able to wear the CPAP mask, but now swear by it. Wherever they travel, their CPAP equipment travels with them.

So, if you think you may have it, you must do something. See me. See your doctor. See someone who can order you a sleep study. It’s not scary. It’s not painful, and it may save your life. Get tested for OSA! Both you and your family will be glad you did.

Dr. J. William Parker, Jr., is an ear, nose & throat / facial plastic and reconstructive surgery physician at Highland Clinic. He treats both children and adults and accepts most insurance plans. Dr. Parker specializes in disease and surgery in the area of the face, throat, sinuses and neck, with a specialty in chronic sinus patients. He now offers a new service known as Balloon Sinus Dilation. He is accepting new patients and can be reached at (318) 798-4565, located at 1455 East Bert Kouns Industrial Loop, Suite 207, Shreveport, LA 71105. Visit http://www.parkersinuscenter.com for more information.

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Article source link https://theforumnews.com/article-2927-sinus-surgery.html

New instrument reduces complications

“Picture if you will,” as Rod Serling would say. Driving the streets of downtown Shreveport, there are no street signs, no stop lights and no names on buildings! You are driving on a dark and confusing trip; but this time you are trying to navigate through your patient’s sinus passages, and obstacles mar your drive. The patient’s sinus roadmap has changed secondary to polyps, infection and deviations that you hadn’t planned for. Besides that, venturing too far over the edge could result in dire consequences.

Feeling your way is the only alternative. While searching this complicated and dangerous driving situation is unlikely to occur, sinus surgeons have been forced for years to navigate the sinuses using only their knowledge of the anatomy. Sinus surgery was once a complicated task for doctors who had to guide their instruments by feeling their way through the maze of hair chambers known as the sinuses. Now, there is a breakthrough in sinus surgery. The Fiagon, a new, computerguided instrument, provides surgeons with an inside view of the sinuses that makes surgery safer and reduces complications!

More than 30 million Americans suffer from sinus disease, experiencing symptoms such as facial pain, feeling of fullness in the face, difficulty breathing through the nose, persistent bad smell in the nose, postnasal discharge and headaches. How many of these sinus problems can be successfully treated with antibiotics? And about 5,000 sinus surgeries are still necessary each year. Doctors recommend sinus surgery for people who have an infection or inflammation that will not respond to treatment without antibiotics, nose spray and other pills to reduce inflammation. These patients return over and over with the above complaints. For many, sinus surgery using the Fiagon Surgical Navigation System allows a more accurate removal of disease tissues and less removal of normal tissue. This translates to more gentle operation for the patient. I can do this surgery on an outpatient basis without the necessity of long-term or short-term packing. Certainly, a more gentle sinus operation for my patients.

Christus Highland Medical Center and Parker Sinus Center have become the first health-care providers in the Ark-La-Tex to utilize a state-of-the-art computer system designed for pinpoint accuracy and minimal complications during sinus surgery. The Fiagon system allows the surgeon to see the exact position of his instruments and their movement in the sinuses on the computer video screen. Dr. J. William Parker Jr., MD FACS, brought the breakthrough technology to Highland in 2017. Fiagon Navigation System is now available for the entire ENT community.

Using the patient’s CT scan made prior to the procedure, the patient’s anatomy is calibrated as they are asleep in the operating room to an accuracy of .25 mm. The new Fiagon system produces a threedimensional computer model of the patient’s sinuses. The scans are a perfect match to the patient’s anatomy. In the operating room, the computer displays the video view from the endoscopic camera, as well as the axial sagittal and coronal CT views of the sinuses. Size and location of the doctor’s instruments in these areas are indicated by crosshairs on the screen to ensure accuracy. I tell my patients that it is like having a GPS in your sinuses during surgery. The system gives the surgeon confidence and a safety mechanism for difficult or revision cases. Many patients face the possibility of additional procedures no matter how well the preceding surgery was done, simply because of the nature of the ailment. I believe with difficult operations or revision operations you can lose your landmarks because of scar tissue or recurrent polyps. The Fiagon System is a momentous breakthrough for Shreveport-Bossier and surrounding Ark-La-Tex. “In many cases, sinus disease surrounds the eye and lies up against the brain,” says Dr. Bill Parker. “This system allows the surgeon to work more thoroughly and closer to the edge of the senses to remove as much of the diseased tissue as possible. Also, the Fiagon System reduces time for certain sinus procedures by as much as 25 percent.

This technology is becoming the gold standard for sinus surgery. It is being taught by leading medical schools to try and future ENT surgeons. “It’s the best way to have an operation on your sinuses,” says Parker.

Parker Sinus Center is located within the Highland Clinic.

Dr. J. William Parker Jr. is an ear, nose & throat / facial plastic and reconstructive surgery physician at Highland Clinic. He treats both children and adults and accepts most insurance plans. Dr. Parker specializes in disease and surgery in the area of the face, throat, sinuses and neck, with a specialty in chronic sinus patients. He now offers a new service known as Balloon Sinus Dilation. He is accepting new patients and can be reached at (318) 798-4565, located at 1455 East Bert Kouns Industrial Loop, Suite 207, Shreveport, LA 71105. Visit http://www.parkersinuscenter.com for more information.

The post Sinus Surgery appeared first on Ear, Nose & Throat.

A common occurrence you should know about

The thyroid is a large, butterflyshaped gland located at the front part of the neck in the midline. It usually drapes over the windpipe and mostly sits above the collarbone and below the Adam’s apple. It produces and stores a vital hormone that has wide-ranging metabolic effects in the body. Thyroid nodules are abnormal growths that develop within, but separate from, the normal surrounding thyroid gland tissue. At present, it is unclear why most thyroid nodules develop. However, certain inflammatory conditions of the thyroid and iodine deficiency are two ailments that may predispose an individual to the development of a nodule.

Thyroid nodules are quite common.

According to the American Thyroid Association, it is estimated that roughly half of the general population will develop at least one thyroid nodule by age 60. Nodules can be identified via physical examination or by imaging (e.g., ultrasound). Most thyroid nodules will not produce any symptoms initially. Symptoms usually develop once the nodule gets large enough to push on other structures in the neck including the esophagus (causing swallowing difficulty) or the windpipe (causing breathing problems). At this point, the nodule would likely be large enough to be observed through the neck. Changes in the voice are also of some concern because that may suggest that the nodule is not benign (not noncancerous).

The primary question, once a thyroid nodule is detected, is whether that nodule harbors malignancy. Fortunately, approximately 90-95 percent of thyroid nodules are noncancerous. When a thyroid nodule is being evaluated, it is important to look for risk factors that may be associated with an increased possibility of a thyroid cancer. Such risk factors include the following: age (people younger than 20 or older than 60 are more likely to have cancerous nodules), size (nodules greater than four centimeters are more suspicious), rapid growth of the nodule, enlarged lymph nodes in the neck, and associated breathing, swallowing or voicing difficulties. Prior radiation exposure to the neck and having a first-degree relative with thyroid cancer are also potential red flags.

Once a thyroid nodule is detected on physical examination, the next step is to obtain imaging. There are many types of X-rays that can evaluate a thyroid nodule. The preferred modality, however, is ultrasound, which offers very useful information on the size and number of thyroid nodules. It can also offer some clues as to whether the nodule may be cancerous depending on certain ultrasound characteristics. Thyroid function blood work is also a key component of the workup. A misconception I have frequently encountered in my practice is the thought that normal thyroid function equates to a normal thyroid without any cancer. It is important to understand that thyroid function tests only provide information on whether the amount of hormone the thyroid is producing is adequate. It does not, however, offer any insight as to whether or not there are cancerous cells within a nodule. In fact, it is not unusual to find normal thyroid function in the setting of thyroid cancer.

Further evaluation of the thyroid nodule is directed by the results of the ultrasound and thyroid function testing. For nodules over 1-1.5 centimeters in size, a minimally invasive technique called fine needle aspiration (FNA) may be offered. This involves inserting a very small needle directly into the nodule, drawing cells out from the nodule and placing them on a microscope slide. The slides are then sent to a medical pathologist for evaluation. In some instances, ultrasound is used to guide the needle into the nodule. Studies have demonstrated that ultrasound guidance increases the diagnostic yield of FNA in some cases.

After obtaining an FNA result, I usually bring the patient back to my officeto discuss the findings and my recommendations. An important concept to understand is that while FNA is extremely reliable, it is by no means foolproof. If the FNA result suggests that the nodule is benign, and the patient is without obvious clinical risk factors for malignancy, it is usually reasonable to simply observe the nodule with serial ultrasound examinations. If the nodule is not changing in size or character over time, one can be more confident in the benign result suggested by the FNA. In some cases, the FNA result falls into the indeterminate category, at which time a diagnostic thyroid surgery may be offered in order to obtain a firm diagnosis. If the FNA result suggests a malignancy, further evaluation is usually recommended with surgical removal of the entire thyroid being the definitive treatment option in many cases.

In summary, thyroid nodules are a common finding. Fortunately, most nodules cause no significant symptoms and do not represent thyroid cancer. Of note, January is Thyroid Awareness Month, which makes for an appropriate time to see your ENT for evaluation if you have a suspected thyroid nodule.

Dr. Chuka Ifeanyi is an ear, nose and throat specialist at Highland Clinic. Dr. Ifeanyi specializes in the diagnosis and treatment of disorders affecting the ear, nose, throat, and the head and neck of both children and adults. He is accepting new patients and can be reached at (318) 798-4440; located at 1455 East Bert Kouns Industrial Loop, Suite 206, Shreveport, LA 71105. Visit http://www. highlandclinic.com/staff/chuka-v-ifeanyi-m-d for more information.

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As we enter prime ragweed season, those of us who suffer from chronic sinusitis may be faced with the unwelcome resurgence of a familiar foe.

According to a recent article in the Journal of the American Medical Association, chronic sinusitis affects 3-7 percent of the general population and accounts for more than $9 billion in health-care expenditures annually. Considering the broader impact of this condition, in terms of missed work and decreased productivity, the estimated costs balloon to approximately $13 billion per year. As we note the significant impact sinusitis has on the everyday lives of so many, a basic understanding of what sinuses are is in order.

The sinuses are hollow, air-filled spaces in the skull that surround the nasal cavity. Most people have four pairs of individually named sinuses. Their exact function is a topic of debate; however, commonly held assertions include lightening the weight of the skull, providing a “crumple zone” for the skull to cushion against facial trauma, and enhancing vocal resonance. The sinuses are covered with a mucus-producing lining that contain microscopic hairs called cilia. Cilia function to sweep mucus and debris out of the sinus. As one can imagine, any process that impedes their function would result in stagnation of mucus and debris within the sinus. Stagnation of material within the sinuses is, at its core, the underlying problem when someone suffers from sinusitis.

Those of us who evaluate patients with sinusitis typically differentiate chronic sinusitis from acute sinusitis when considering our approach to treatment and this distinction can be drawn by considering the duration of symptoms. With regard to acute sinusitis, symptoms typically resolve in four weeks or less, whereas patients with symptoms that exceed 12 weeks duration are considered to have chronic sinusitis. Stratifying patients into acute versus chronic is essential because the underlying mechanisms between the two can be quite dissimilar. The vast majority of acute sinusitis cases are caused by rhinoviruses, the same infectious agent that brings about the common cold. Chronic sinusitis, however, is frequently the end-product of a multitude of conditions that result in a persistent inflammatory state within the sinuses with the underlying infectious agents more likely representing bacteria rather than viruses.

People who suffer from chronic sinusitis know the usual symptoms well. They include thick and discolored discharge from the nose, reduction in smell sensation, facial pain and/or pressure, and nasal obstruction and/or congestion. These symptoms can have a significant impact on the sufferer’s quality of life. In fact, a 1995 article published in the Journal of Otolaryngology- Head and Neck Surgery demonstrated that patients with chronic sinusitis report more significant bodily pain scores and lower social functioning scores than patients who suffer from other chronic conditions such as congestive heart failure and obstructive lung disease. The risk factors for developing chronic sinusitis are vast and include entities such as asthma, cigarette smoking, gastroesophageal reflux, prior facial trauma, deficiencies in immune system function, dental infections and anatomic or structural abnormalities (e.g., a deviated nasal septum or nasal polyps). Another major risk factor is having environmental allergies – a problem that heavily impacts our region of the country. According to the Asthma and Allergy Foundation of America’s 2016 report on the spring allergy capitals in the United States, seven of the top 30 worst cities for people afflicted with environmental allergies are actually within a 350-mile radius of the Shreveport-Bossier City area including Baton Rouge, New Orleans, Jackson, Little Rock and Dallas.

So, what is one supposed to do? Frankly, the spectrum of treatment approaches to sinusitis is as varied as the potential factors that may cause it in the first place. As previously discussed, most occurrences of acute sinusitis are caused by viruses. Most of these cases are expected to resolve on their own, and simple measures such as getting ample rest, drinking plenty of fluids, using a humidifier, performing nasal saline irrigation, and taking over-the-counter pain relievers and decongestants can help ease discomfort until symptoms abate. When symptoms have persisted for more than 7-10 days, however, a visit to your primary care physician or ENT specialist may be in order as these cases may be bacterial in nature, thus requiring more extensive medical treatment.

Antibiotics, such as Augmentin or Levaquin, are the mainstay treatment of bacterial sinusitis. Antibiotics are often prescribed along with adjunctive therapies including decongestants, mucus-thinning agents and steroids, which are powerful antiinflammatory drugs. In patients who suffer from chronic sinusitis, symptoms are likely to recur even after all the aforementioned actions have been taken if the underlying problem has not been properly addressed. For example, if the underlying problem is allergic disease, better control of allergies can help decrease the severity and recurrence of sinusitis. Allergies are usually managed by avoidance of known triggers and/or use of allergy medications such as steroid nasal sprays and antihistamines. Some allergy sufferers may even require desensitizing allergy shots to combat their condition. Another example of an underlying element that may contribute to persistent sinusitis is anatomic or structural abnormalities that hinder ventilation of the sinuses. Conditions such as a deviated nasal septum or nasal polyps may not respond adequately to medications alone and, in some instances, may only be corrected through surgery.

Unfortunately, some patients will continue to suffer from unrelenting sinusitis despite what is called “maximal medical therapy” which includes several rounds of antibiotics, administration of oral and nasal steroids, control of superimposed allergies and acid reflux and use of decongestants and mucus-thinning agents. These particular patients are usually referred to an ENT specialist for evaluation and consideration of possible surgical treatment. The goal of surgical intervention is to improve the ability of the involved sinuses to ventilate by widening their natural openings into the nasal cavity. This can be accomplished surgically in several ways, one of which is a newer, minimally invasive technique called balloon sinuplasty. This safe and effective procedure is a viable option for some chronic sinusitis patients, and in some cases, it can be performed without a trip to an operating room for general anesthesia.

In summation, sinusitis is a relatively common condition with varied causes that can negatively impact quality of life. While most cases can be managed well with control of underlying factors and use of both overthe-counter and prescription medications, evaluation by an ENT specialist is often required when these measures have proved unfruitful.

Dr. Chuka Ifeanyi, ENT Highland Clinic physician, is board-certified by the American Board of Otolaryngology. Dr. Ifeanyi specializes in the diagnosis and treatment of disorders affecting the ear, nose, throat, and the head and neck of both children and adults. Same-day appointments may be available for both new and established patient base. Dr. Ifeanyi can be reached at 318-798-4440 to schedule at his Highland Clinic Suite 206, or every other Thursday at the Minden Medical Center.

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