Twin Lakes ENT Services
- Pediatric Ear, Nose and Throat Care
- Tonsillectomy, adenoidectomy, insertion of eardrum tubes
- Nasal and Sinus Surgery for adults and children
- Surgery to improve breathing and treat sinus infections
- Hearing Evaluation and Hearing Aid Fitting
- Evaluation and treatment of snoring, including the Pillar Procedure
- Botox treatments and dermal fillers
- Restylane, Perlane, Radiesse
- We also provide general ENT diagnosis and care
We do not provide evaluation and treatment of dizziness. Only a history will be taken for patients who are experiencing dizziness, vertigo or balance problems. These patients will be referred for comprehensive diagnosis and treatment options elsewhere.
Are you or your child a loud snorer and disrupting the sleep of yourself or someone else?
Do you or your child have an attention problem, sleeps restlessly, and snore loudly?
Have you or your child been diagnosed with strep throat repeatedly?
Do you cough up chunks of foul smelling debris? Do you see “cheese” around your tonsils? This is cryptic tonsillitis. Tonsillectomy cures cryptic tonsillitis.
Having your tonsils removed is one of the most common operations performed in America. In the time when rheumatic fever was common, this was the most common surgical procedure in America. Now, with the widespread use of antibiotics for strep throat infections, rarely does rheumatic fever or scarlet fever follow an episode of strep throat.
Children are most commonly affected by strep throat, also called acute exudative tonsillopharyngitis; yet, adults of all ages may still be affected.
The main reason that we suffer from middle ear infections and persistent middle ear fluid is eustachian tube malfunction -- this opening ventilates and drains the middle ear into the back of the nose. Ear disease is very common in children under approximately three years of age, and is the number one disease which requires medical care in sick children. Any condition that leads to a stuffy nose, such as recurrent colds or allergies, may worsen eustachian tube function. The result of this process is that frequently negative pressure (a vacuum) builds up in the middle ear. Fluid fills the middle ear to relieve the vacuum. Ear tubes relieve this negative pressure; that is, they ventilate the middle ears in times of eustachian tube stress, such as colds or allergies.
The second function of ear tubes is drainage. When the eardrum bulges with fluid under pressure, as it may with an ear infection (acute otitis media) - the tympanostomy tube allows drainage of middle ear fluid. No pressure can build up, but fluid can drain. This prevents the earache that signals increased fluid pressure. This drainage is an event not ordinarily seen without tubes unless the eardrum ruptures. When ear tubes are present, middle ear drainage may be seen with a routine cold -- this is a normal occurrence with tubes. In fact, drainage is one of the main functions of tubes. Ear drops are used to keep the tubes open, and relieve inflammation in the middle ear.
The sinuses (paranasal sinuses) are four, paired cavities within the bones of the face. They amplify our voices and protect our faces from impact. Other functions are a guess, but likely allowing each of us to talk and sound different from one another is their key function.
The openings into our nostrils are lined with a delicate membrane. This membrane serves the function of warming and humidifying all of the air that we breathe. In addition, the special sense of smell is provided by nerves high in the roof of the nose. The sinuses drain into the nose, and are affected by the same diseases that affect the function of the nose. Each of these eight sinus cavities is lined by mucous membrane. All of the membranes of the nasal passages and the sinus cavities secrete mucus -- an estimated two quarts of mucus per day.
Sinusitis develops when the nasal and sinus openings become clogged, usually by swelling of the mucous membrane in the condition called rhinosinusitis.
The sinuses are four, paired hollow spaces within the facial bones:
1. Frontal -- in the forehead, above the eyes
2. Ethmoid -- between the eyes
3. Maxillary -- in the facial bones below the eyes
4. Sphenoid -- behind the ethmoid sinuses, behind and between the eyes
Anything that causes the nasal membranes to swell, and block breathing, may affect the ability of the sinuses to drain properly. An inflammation of the nose is called “rhinitis”, and literally means an “itis -- or inflammation of the “rhino” -- or nose. Causes of rhinitis are the common viral cold, bacterial infections, allergies, or common irritants, such as smoke. Variations in temperature, humidity and barometric pressure (the most important) may also affect the health of the nasal membranes.
Anytime the nasal membranes swell for more than a few days, the sinuses may drain poorly, and fill up with mucus. If this blockage continues, this mucus may start to serve as a “culture tube” for the bacteria that live in the nose. One statement here deserves clarification, namely, every time the mucus changes colors, we don’t need to be on antibiotics. If we can restore the drainage mechanism, the color will go away on it’s own. When we are unable to restore this drainage, antibiotics may be required in conjunction with treatment to restore the normal function of the nose.
Sinusitis means the sinuses have an “itis” or inflammation and are filled with fluid or swollen, poorly cleansing membranes. This invariably follows a sudden case of rhinitis or as a flare-up in a person with a chronic stuffy nose when another irritant, infection, or allergen is present.
The treatment of sinusitis tries to restore the nose to a moist, open state. Treating sinusitis without addressing nasal disease will fail as sure as “the sun is coming up tomorrow”. We must treat the rhinitis to help prevent sinusitis.
Rhinitis is a medical disease, that is, surgery will not cure the stuffy, weeping nose of allergies or tobacco abuse or sensitivity to change in barometric pressure. We all have felt a “sinus” attack before the weather changes, or after being exposed to noxious fumes.
Four treatments exist for chronic or recurrent rhinosinusitis:
1. Avoidance -- move to “Minnesota” or quit smoking
2. Allergy -- diagnosis and management with avoidance, medications, or allergy shots. If you suspect allergies are playing a major role, please let us know
3. Medications -- that is antihistamines, decongestants, nose sprays, mucus-loosening drugs, or antibiotics
4. Surgery – usually an endoscopic (inside the nose with magnified lighting) approach
Prior to considering surgery, most patients should be treated with intensive medical care that includes medications to promote drainage and decrease inflammation. The main goal of surgery is to decrease symptoms and make patients responsive to medicines. This can be accomplished the great majority of the time. However, treatment of chronic rhinitis, or stuffy nose, may continue well beyond surgery.
In patients who have failed medications, we will often perform a special examination of the nasal passages to assess anatomic problems that may be leading to “nasal and sinus failure” -- nasal endoscopy. This means a magnified view of the nose and sinus passages with lighted, magnifying lenses. This is performed in the exam chair with a numbing nose spray.
A Special X-Ray called a CT (computerized tomogram) will also be ordered. This allows us to see precisely the anatomy of the face and sinuses. This is usually performed either in our office or at one of the x-ray centers nearby.
If the endoscopy and CT scan shows disease that has not responded to medications, then surgery may be recommended.
Nasal and sinus surgery is performed to open nasal and sinus passages so that they can drain themselves. This operation is performed through the nose using the same instruments (endoscopes) that we use in the office. All incisions are made inside the nose, and no external signs of the operation are generally visible.
The operation is accomplished using an anesthetic that sedates the patient to the point of sleep, or a general anesthetic, in which the patient is rendered unconscious. Please discuss the type of anesthetic preferred, if you elect to proceed with surgery.
The operations are named after the sinuses that are drained: all include “-ectomy” or “ -otomy” meaning to partially remove or open:
1. Maxillary antrostomy = enlarging the natural opening into the maxillary sinus
2. Ethmoidectomy = enlarging the sinus cavities between the eyes. Key to other sinus drainage
3. Frontal sinusotomy = enlarging the opening above the ethmoids to drain the frontal sinuses
4. Sphenoid sinusotomy = creating a larger drainage hole into the sphenoid sinus
Often a nasal septoplasty is performed to straighten a crooked, or deviated partition between the two nasal cavities. The lining membranes of the nose may be “reduced” by turbinate reductions or partial turbinectomies. These two procedures are performed at the same time as sinus surgery if needed, and improve breathing through the nose.
The surgery generally requires 1 - 2 hours for completion, and is performed as an outpatient procedure in ~99% of cases.
Complications, other than stuffy nose and excessive drainage are uncommon, but may include:
Excessive bleeding usually can be managed without surgical treatment, but in about 1 in 100 patients will require nasal packing to be inserted into the nose in the first two weeks after surgery. We place a sponge pack into the nose in about 1 % of patients. Most surgery is performed without packing. The risk of needing a blood transfusion is rare.
The eye structures are located just outside the ethmoid sinus. Damage to the eye muscles can lead to double vision, or damage to the optic nerve can lead to blindness in extremely rare cases (estimated at 1 in 10,000 cases). Excessive tearing occurs for a few weeks in about 1 in 100 patients, but may be permanent or require further surgery in rare cases. Eye problems will require evaluation and management by an eye specialist.
The frontal lobes of the brain are located immediately above the ethmoid and sphenoid sinus. Opening the bone above these sinuses may lead to brain fluid leaking into the nose (cerebrospinal fluid leak), or severe, even life threatening bleeding or infection. The risk of these complications is estimated at 1 in 10,000 cases. Further care is needed if brain complications result from sinus surgery.
Nasal or sinus scarring may require further surgery in about five percent of patients. The close relationship to vital structures may prevent the surgeon from accomplishing all of the planned surgery in one operation. Repeat surgery is needed about five percent of the time.
Most patients will want to be off work for two or three days after surgery, but some can return the day after if no packing is required and no heaving lifting is required by the job. Most should plan to limit themselves to light activity for two weeks, that is no physical activity that is considered “exercise”.
Sinus surgery is now very much an accepted part of the management of troublesome disease. Expect an improvement in nasal breathing, and a decrease in the need for antibiotics. The surgery is extremely effective for the stuffy nose in about 90% of cases. As usual, results may vary by patient, and no guarantees of success can be given. There are just too many variables to guarantee this surgery.