FAQ

“Swimmer’s Ear” is a common reference to painful swelling of the outer ear canal.

The medical term for “swimmer’s ear” is acute otitis externa (AOE). Chronic otitis externa (COE) is a term used for patients with persistent infection for several weeks. Acute OE is common in swimmers who sustain frequent water contamination of the ear canals. Any trauma to the skin of the canal or ear drum can lead to an infection. Some people like diabetics are prone to AOE or COE without trauma.

Causes

The causes of AOE and COE are usually bacterial, fungal, or both. Debris and wax impaction along with tissue swelling can lead to temporary hearing loss. Pain is usually significant. Other symptoms may include disequilibrium, drainage or bleeding, pressure, or ringing.

Treatment

Treatment of AOE and COE is focused on three areas. First, careful non traumatic cleaning and removal of wax and debris is very important toward the resolution of infection. This should be done without scratching or irrigating the ear canal. Ear “candling” is dangerous and should be avoided. The best technique is meticulous canal suctioning or curetting under microscopic examination in the office.

The second part of treating canal infections is the use of medications. Antibiotic and antifungal ear drops are the mainstay of treatment. The proper ear drop will kill the appropriate bacteria causing the infection. Several different antibiotic ear drops exist:

• Fluoroquinolone drops (Ciprodex, Cipro Otic HC, Floxin Otic) are the best option for broad, aggressive, and safe treatment.
• Aminoglycosides (Gentamycin, Tobramycin, Tobradex, etc.) are very effective against many bacteria. They can, however, potentially cause hearing loss if they access the middle ear (through an eardrum perforation or a ventilating tube).
• Cortisporin and Neosporin Otic drops can be effective, but dosing is usually at least three times per day. Also, they tend not to be as effective against resistant bacteria as the other drops mentioned. A skin reaction (dermatitis) and pain are very common with the use of these particular drops. Fungal infections also need aggressive cleaning.
• Ear drops are limited to Lotrimin solution.
• Antifungal cream can be carefully applied to the outer canal. 

Several other ear drop choices exist. Acetic acid with a weak steroid (VoSol HC Otic) can be effective at drying the canal and killing bacteria and fungi. A simple one to one mixture of white vinegar and rubbing alcohol, 3-5 drops in the infected ear(s) will often help and can be used on a regular basis. In diabetics and very sick patients, an oral antibiotic can be added.

The third arm in the treatment of “swimmer’s ear” is avoiding trauma. Care should be used with exposure to water (bathing, swimming). If water contamination is likely, a water resistant earplug should be employed. The use of cotton swabs, fingers, keys, and other objects to clean the canal should be avoided. This “scratching the itch” can actually damage protective wax and oils made by canal skin and exacerbate the infection.

With detailed cleaning, appropriate ear drop treatment, and trauma avoidance, most patients with acute otitis externa are treatable. Hearing and pain will usually improve.

Globus is a term often used in the medical community signifying an unusual feeling in the back of the throat.

“Throat clearing” and “a lump in the throat” are common complaints. Other symptoms include sore throat, hoarseness, difficulty swallowing, and painful swallowing in some patients. There are many possible causes of globus. Varied treatment regimens have been used to manage globus.

Causes

To identify possible causes of globus, a thorough exam of the back of the throat and vocal cords is necessary. This is sometimes done with a small flexible fiberoptic scope passed through the nostril. Rarely a lesion is found. More commonly, scarring and swelling in the vocal cord area is identified and may be the cause of the throat symptoms.

Treatment

Treatment of globus is based on identifying the presumed cause. Acid reflux from the stomach is the overwhelming cause in most patients. Terms often used for this include gastroesophageal reflux disease (GERD) and laryngoesophageal reflux disease (LPRD). This problem is very common in an otolaryngologist’s (ENT) practice. Management of LPRD is based on elevation of the head of bed, raising from the waist by using cinder blocks, a wedge (about 10-12 inches at the neck), or multiple pillows. Some patients even sleep in a recliner to maximize elevation, which can keep the stomach contents from rising up to the throat. The second treatment regimen involves diet modification. Patients with LPRD should eat small meals and avoid snacking after the evening meal. Patients should avoid spicy food, citrus, tomatoes, coffee, tea, soda, caffeine, alcohol, cigarettes and tobacco, and greasy food. All of these can aggravate reflux disease both in the stomach and the throat.

Multiple medications have been used for reflux disease. Tums, Mylanta, Maalox, Carafate, and the acid blocking medications (Zantac, Pepcid, etc.) will work in some patients. For LPRD, which can be a more severe problem in spite of rare “heartburn,” proton pump inhibitors (PPIs: Aciphex, Nexium, Prilosec, Prevacid, Protonix) are the drugs of choice. These are activated by food and should be taken up to 30 minutes before breakfast. Treatment for LPRD should be continued for at least 3-6 months. In some patients, twice daily treatment is more effective. A gastroenterologist evaluation is recommended for refractory patients.

Good vocal hygiene is also important for LPRD and globus patients. Good hydration (water and sports drinks only) and vocal restraint (avoiding whispering, coughing, yelling) are imperative for recovery. Singing can be very hard on vocal cords and should be done sparingly and under a vocal coach’s supervision.

Globus can also be caused less commonly from post nasal drainage (“sinus drainage”). Management of sinus and allergy symptoms should be addressed in these patients. Stress and anxiety are other causes of globus. These should be considered when other possibilities have been exhausted. Several rare causes of these throat symptoms have been identified and will need to be ruled out during your office visit. Follow up is typically within 3-6 months to ensure that the treatment regimen is appropriate and working well. With attention to detail, most patients with globus and throat clearing can be managed successfully.

Snoring is a common problem that may occur alone or in combination with obstructive sleep apnea.

Primary snoring: Snoring typically is caused by vibration of tissues within the oral pharynx (the uvula and palate). Nasal obstruction can be another cause. In mild snoring, these measures may help: losing weight, sleeping on your side rather than your back, avoiding sedatives and alcohol. Surgery can reduce the size of the soft tissue of uvula and palate, and also relieve nasal obstruction. Dr. Janning performs several technologically advanced procedures to treat snoring and sleep apnea.

Obstructive Sleep Apnea: Obstructive apnea is a cessation of breathing that last ten seconds or more. Repeated episodes can significantly disrupt sleep. Manifestations of sleep apnea include snoring, restless sleep, and daytime fatigue. Many advances have been made in treatment of sleep apnea.

Hoarseness, due to irritation of the larynx, is commonly caused by upper respiratory infections, reflux of stomach acid, and/or postnasal drip. Upper respiratory infections: People frequently develop a persistent cough following a common cold. A cycle may develop in which episodic coughing results in throat irritation, which causes more coughing and more irritation. The larynx then becomes even more susceptible to other irritants such as acid reflux and posterior drainage from the nose. It is important to break the coughing cycle by maintaining adequate hydration, taking throat lozenges, and avoiding throat clearing.

Gastrointestinal Reflux Disease (GERD): Acid from the stomach can reflux up through the esophagus to the larynx. The resulting acid exposure can cause a multitude of symptoms, including hoarseness, throat discomfort, swallowing problems and a feeling of a foreign body caught in the throat.

Acid reflux may occur at night, so that sleeping patients do not notice symptoms of heartburn. Treatment of GERD includes antacids, elevating the head of the bed, changing the diet, and avoiding caffeine and alcohol.

Postnasal drainage: Mucous drainage from the nose can cause throat irritation and hoarseness. Nasal steroid sprays and nonsedating antihistamines may help reduce the amount of drainage.

Less common causes of hoarseness and voice change include decreased thyroid function, vocal cord paralysis, vocal cord nodules or polyps, and tumors of the larynx. Hoarseness lasting more than four-six weeks should be evaluated by a physician. Otolaryngologists can visualize the both mirrors and flexible fiberoptic telescopes.

Surgical removal of the tonsils and adenoids in children is performed for two primary reasons: recurrent tonsil/adenoid infections and snoring with associated sleep apnea.

Tonsil infections: As a general guideline, a tonsillectomy is recommended in patients with seven or more tonsil infections in one year, five infections a year for two years, or three infections for three or more years.

Sleep apnea: Enlargement of tonsil and adenoid tissue in children can obstruct airways during sleep. Children with sleep apnea typically are mouth breathers who snore loudly and can be heard to stop breathing or make gasping noises during sleep. Sleep apnea results in fragmented sleep that can lead to daytime fatigue or hyperactivity, failure to thrive, difficulties in concentrating, and occasional problems with bedwetting.

Surgical procedure: Tonsils and adenoids are removed through the mouth with no external scars. In most children, this is outpatient surgery.

CHRONIC ADENTONSILLITIS AND COBLATION ASSISTED (ADENO)TONSILLECTOMY (CAT)

Management of chronic adenotonsillitis or tonsillitis can involve both medical and surgical options. Medically, oral rinsing, water pick, and gargling with salt water or other cleansers can improve symptoms. Long term antibiotic use has shown in some patients to reduce the size and symptoms of tonsillitis. Unfortunately, length of treatment is not well established. Antibiotic resistance is also a serious problem with long term use. Stomach acid reflux and post nasal sinus drainage are other relatively common afflictions that can occasionally complicate a chronic sore throat or pharyngitis.

When patients are clinically disabled enough by recurrent sore throat and “strep tonsillitis,” surgery may be helpful. Typically, a patient will have several infections and may miss several days of school or work The patient may have difficulty with swallowing, may have choking or gagging, and at times, a peritonsillar abscess. Airway compromise, sleep disordered breathing, restless sleep, and obstructive sleep apnea are currently more common reasons to consider tonsillectomy and adenoidectomy than simple infections. Left untreated, obstructive sleep apnea can be a dangerous disease.

Tonsillectomy/adenoidectomy can be done with traditional sharp cutting for removal, and burning (cautery) to control bleeding. This is traditionally a very painful operation. I have been using a newer technique called COBLATION ASSISTED TONSILLECTOMY (CAT) for the last several years. In fact, I have used this technique longer than essentially all other surgeons in Minnesota. CAT employs radiofrequency to “coblate” or disintegrate the tonsil and adenoid tissue. This is a safer and cleaner operation. Blood loss tends to minimal (occasionally absent!) and pain in the recovery period is often greatly reduced compared to traditional tonsillectomy. Tonsillectomy/adenoidectomy is generally straightforward, often taking only 10 to 15 minutes.

There are some risks to the surgery. General intubation through the vocal cords to control the airway is necessary. A general anesthesia is used. Complications of anesthesia are very rare but can include death, airway obstruction, allergic reactions, and others. Bleeding after surgery is rare. Immediate postoperative bleeding may necessitate returning to the operating room. Bleeding can occur anytime within the first 2 weeks when the scabs come off. The risk is about 1 to 2 percent. Occasionally, very mild bleeding will resolve with inactivity and observation. Avoid aspirin, herbals, and other blood thinners for 10 days prior to and several days after surgery. Ear pain is very common after tonsillectomy. This is a referred pain, not an ear infection. It is treated with analgesics or narcotics. After one week, yawning may be the most traumatic part of the day. Voice change and increased resonance is possible. Rarely, liquids will come out of the nose and the voice will sound very “nasal” (especially after adenoidectomy in small children). This usually resolves on its own. Speech therapy and surgery are rarely needed to correct these problems. Infections after surgery are possible. A slight fever and fatigue are common for 1 to 2 weeks. Generally, antibiotics are not indicated.

Activity should be limited and a soft diet should be employed for 2 weeks after surgery. This includes ice cream, popsicles, pudding, and other soft food. Avoid very spicy or scratchy foods like toast, chips, or popcorn. Also avoid using a straw. After two weeks, most symptoms resolve and any diet or activity restrictions are lifted. Follow up is usually after 2 weeks.

In the case of emergency, the patient should go straight to his or her local emergency department. Call my office anytime during working hours at 320.231.3277 or Rice Hospital ER at 320.231.4560 to contact me.

Infection of the sinus cavities often occurs due to inflammation and obstruction of the sinus drainage pathways.

Typical symptoms of a sinus infection include facial pain and pressure, nasal obstruction, yellow or green nasal drainage, fatigue and fever. Treatment of a sinus infection may include nasal decongestants and antibiotics. People with chronic sinus drainage may benefit from endoscopic sinus surgery.

At Janning ENT Center we pride ourselves on effective treatment of the sinus patient. We employ leading edge technology with creative medical and surgical solutions. We also boast a caring and enthusiastic staff. I you would like to learn more about our treatment of sinusitus and it’s complications.

Common causes of nasal obstruction include a deviated nasal septum, turbinate enlargement, and nasal polyps (benign growths.)

Deviated nasal septum: The midline of the nose consists of a cartilage and bony nasal septum that separates the two sides of the nasal cavity. A deviation or bend in this structure can be present at birth or can occur following a nasal fracture. The obstruction caused by such a deviation can be corrected by surgically straightening the septum, called a septoplasty.

A septoplasty is a commonly performed outpatient surgery done through incisions within the nasal cavity, removing the obstructing portion of bone and cartilage.

Nasal turbinate enlargement: The nasal turbinates are three bony and soft-tissue structures lining the sides of the nasal cavity. As part of the normal nasal cycle, the turbinates alternately swell and enlarge. In some persons, the turbinates can be excessively large, resulting in significant nasal obstruction. Allergy treatment, typically with nasal steroid sprays, may help to decrease this swelling. When allergy management does sufficiently relieve nasal obstruction, the inferior turbinates can be surgically reduced. In many cases this can be done as an office procedure.

Nasal polyps: Nasal polyps are a type of inflammatory tissue that can grow in the nasal cavity and sinuses. They occur more frequently in persons with allergies and/or asthma. Nasal obstruction is the most common symptom. The sinus drainage tracts may also be blocked, resulting in chronic sinus disease. Nasal polyps are controlled with steroid sprays as well as removal by endoscopic surgery. Persons whose polyps arise from asthma may have serious allergic reactions to aspirin.