Bell's Palsy
Children and Facial Paralysis
Dizziness and Motion Sickness
Facial Plastic Surgery
Facial Sports Injuries
Children and Facial Trauma
Cleft Lip and Cleft Palate
Pediatric Head and Neck Tumors
Sinus Pain: Can Over-the-Counter Medications Help?
Sinusitis: Special Considerations for Aging Patients
Fall Prevention
Sinus Headaches
Thyroid Disorders and Surgery

Head and Neck Cancer
Are We Through with Chew Yet?
Common Problems that Can Affect your Voice
Laryngeal (Voice Box) Cancer
Pediatric Head and Neck Tumors
Pediatric Thyroid Cancer
Rhabdomyosarcoma
Quitting Smokeless Tobacco: Tip Sheet
Second Hand Smoke and Children
Secondhand Smoke
Skin Cancer
Smokeless Tobacco

Bell's Palsy

Insight into facial nerve disorders

• How does the facial nerve affect facial expression?
• What causes sudden facial paralysis?
• How are facial nerve disorders treated?
• and more...

Disorders of the facial nerve can occur to men, women, and children, but they are more prominent among men and women over 40 years of age, people with diabetes, upper respiratory ailments, weak immune systems, or pregnant women. Cases of facial paralysis can be permanent or temporary, but in all circumstances there are treatments designed to improve facial function.

What is the facial nerve?

The facial nerve resembles a telephone cable and contains 7,000 individual nerve fibers. Each fiber carries electrical impulses to a specific facial muscle. Information passing along the fibers of this nerve allows us to laugh, cry, smile, or frown, hence the name, “the nerve of facial expression.”

When half or more of these individual nerve fibers are interrupted, facial weakness occurs. If these nerve fibers are irritated, then movements of the facial muscles appear as spasms or twitching. The facial nerve not only carries nerve impulses to the muscles of the face, but also to the tear glands, to the saliva glands, and to the muscle of the stirrup bone in the middle ear (the stapes). It also transmits taste from the front of the tongue.

Since the function of the facial nerve is so complex, many symptoms may occur when the fibers of the facial nerve are disrupted. A disorder of the facial nerve may result in twitching, weakness, or paralysis of the face, dryness of the eye or the mouth, or disturbance of taste.

How does the facial nerve affect facial expression?

The facial nerve passes through the base of the skull in transit from the brain to the muscles that control facial expressions. After leaving the brain, the facial nerve enters the temporal bone through the internal auditory canal, a small bony tube, in very close association with the hearing and balance nerves. Along its inch-and-a-half course through a small canal within the temporal bone, the facial nerve winds around the three middle ear bones, in back of the eardrum, and then through the mastoid (the bony area behind the part of the ear that is visible).

After the facial nerve leaves the mastoid, it passes through the salivary or parotid gland and divides into many branches. The facial nerve has four components with several distinct functions: facial expression, taste sensation, skin sensation, and saliva and tear production.

What causes sudden facial paralysis?

Infections, injuries, or tumors can cause facial nerve disorders, but the most common cause of facial weakness is Bell’s palsy. This disorder, which often comes on suddenly and reaches its peak within 48 hours, is probably due to the body’s response to a virus. When there is a virus, the facial nerve within the ear (temporal bone) swells, and this pressure on the nerve in the bony canal damages it.

The paralysis is likely to affect only one side of the face, but in rare cases it affects both sides of the face at once. Bell’s palsy may last from two to three weeks or longer. An early sign of improvement, such as getting a sense of taste back, is often a good indication that there will be a complete recovery.

How are facial nerve disorders treated?

Since otolaryngologists—head and neck surgeons have special training and experience in managing facial nerve disorders, they are the most qualified physicians to perform an in-depth evaluation of abnormal movement or paralysis of the face. An evaluation will include an examination of the head, neck, and ears, as well as a series of tests.

Some of the most commonly used tests are:

• Hearing Test—Determines if the cause of damage to the nerve has involved the hearing nerve, inner ear, or delicate hearing mechanism.
• Balance Test—Evaluates balance nerve involvement.
• Tear Test—Measures the eye’s ability to produce tears. Eye drops may be necessary to prevent drying of the surface of the eye (cornea).
• Imaging CT (computerized tomography) or MRI (magnetic resonance imaging)—Determines if there is an infection, tumor, bone fracture, or other abnormality in the area of the facial nerve.
• Electrical Test—Stimulates the facial nerve to assess how badly the nerve is damaged. This test may have to be repeated at frequent intervals to see if the disease is progressing.

The results of diagnostic testing will determine treatment. The goal of the treatment is to eliminate the source of the nerve damage. Patients with less nerve damage have better chances of recovery. Medications are often used as part of the treatment:

• If infection is the cause, then an antibiotic to fight bacteria (as in middle ear infections) or antiviral agents (to fight syndromes caused by viruses like Ramsay Hunt) may be used.
• If swelling is believed to be responsible for the facial nerve disorder, then steroids are often prescribed.
• In certain circumstances, surgical removal of the bone around the nerve (decompression surgery) may be appropriate.

What treatments are recommended for permanent facial paralysis?

Patients with a permanent facial paralysis may be rehabilitated through a variety of procedures including:

• Eyelid weights or springs
• Muscle transfers and nerve substitutions
• A special form of physical therapy called facial retraining
• Weakening the paralysis by chemical injection

How does the facial nerve affect the health of the eye?

Remember, when the facial nerve is paralyzed, considerable attention must be given to maintaining a healthy eye through a constant flow of tears. Tears are spread out over the eye by blinking. Since blinking is diminished or eliminated when facial nerve paralysis is present, special care must be given to prevent drying, erosion, and ulcer formation on the cornea which may result in possible loss of the eye.

What are the common signs or symptoms?

• Twitching
• Weakness or paralysis of face
• Dryness of the eye or mouth
• Disturbance or loss of taste
• Drooping eyelid or corner of the mouth
• Difficulty in speaking
• Dribbling when drinking or after cleaning teeth
• Ear pain

Tips to help recovery

• Exercise the facial muscles in front of a mirror.
• Massage the face.
• Apply gentle heat to reduce pain.
• Using a finger, regularly close the eye to keep it moist.
• Tape the eye closed for sleeping.
• Use protective glasses or clear eye patches to keep the eye moist and to keep foreign materials from entering the eye.
• Use doctor-recommended artificial tears or an ointment to keep the eye moist.

Children and Facial Paralysis

About 40,000 people in the United States develop facial paralysis each year with children comprising a small percentage of that population. There are more than 50 known causes of facial paralysis but the most common in children is “Bell’s palsy,” the cause of which is not certain. This disorder effects one side of the facial muscles due to dysfunction of the seventh cranial nerve, usually thought to stem from a viral infection; Bell’s palsy is found in 20 out of 100,000 Americans, with the incidence increasing with each decade of life.

What causes Bell’s palsy?

In Bell’s palsy, facial paralysis results from damage (e.g., possibly from viral infection) to the facial nerve. Adults and children will either wake up to find they have facial paralysis or palsy, or have symptoms such as a dry eye or tingling around their lips that progress to Bell’s palsy during that same day. Occasionally symptoms may take a few days to progress to facial weakness or paralysis. Physical trauma to the head and neck region at birth and during childhood may cause facial paralysis. Other causes are:

• Chicken pox: Chicken pox and shingles are both caused by a single virus of the herpes family known as varicella-zoster virus (VZV). Varicella is the primary infection that causes chickenpox; Herpes zoster is the reactivation of the virus that causes shingles. Research studies suggest that Bell’s palsy may be due to a reactivation of herpes simplex virus (HSV). Between 75 percent and 90 percent of chickenpox cases occur in children under 10 years of age. According to a 2001 study, about 10 percent of children between ages five and nine and about two percent of 10 to 14 year olds get chicken pox each year.
• Infectious mononucleosis: This condition, with a peak incidence in the 15- 17 age group, can be caused by several different viruses. The leading causes are the Epstein-Barr virus and cytomegalovirus, both members of the herpes virus family. The infection is transmitted by saliva, sexual contact, respiratory droplets, and blood transfusions.
• Lyme disease: Lyme disease is an infection that’s spread by Ixodes ticks (black-legged or deer ticks in the eastern United States, and western black-legged ticks in the west). The second stage of Lyme disease usually appears two to three months after the tick bite, and may include facial palsy or paralysis among other symptoms.

What are the symptoms of Bell’s palsy in children?

Not all children react the same to this disorder. However, recorded symptoms include:

• The child may complain of headache or pain behind or in front of the ear a few days prior to the onset of Bell’s palsy.
• Swelling or drooping on one side of the face.
• Drooling, excessive, or reduced production of saliva.
• An inability to blink or completely close one eye.
• The child has either excessive tears or marked dryness and inability to make tears in one eye.
• Sounds seem louder than they really are.
• The child is experiencing sensitivity to light.
• Episodes of dizziness.

Treatments for Facial Paralysis:

If infection is the cause, then an antibiotic to fight bacteria (as in middle ear infections) or antiviral agents (to fight syndromes caused by viruses like herpes zoster (Ramsay Hunt Syndrome) may be used. The prognosis for children with facial paralysis is generally very good. The extent of nerve damage determines the extent of recovery. With or without treatment, studies indicate that most pediatric patients with the disorder begin to get better within two weeks after the initial onset of symptoms and recover completely within three to six months. Adults may find residual symptoms remaining for an indefinite period of time.

What happens during the diagnosis?

After an examination, the otolaryngologist- head and neck surgeon may conduct a hearing test to determine if the cause of damage to the nerve has involved the hearing nerve, inner ear, or delicate hearing mechanism. Additional tests in the physician’s office include a balance test and a tear test, to measure the eye’s ability to produce tears. Eye drops may be necessary to prevent drying of the surface of the eye cornea. In some circumstances, the physician may recommend a CT (computerized tomography) or MRI (magnetic resonance imaging) test to determine if there is infection, tumor, bone fracture, or other abnormality in the area of the facial nerve. An additional diagnostic tool is the Electro neuronography (ENOG), which stimulates the facial nerve to assess how badly the nerve is damaged. This test may have to be repeated at frequent intervals to see if the disease is progressing.

Sources:

National Institute of Neurological Disorders and Stroke

Bell’s Palsy Research Foundation

Dizziness and Motion Sickness

Insight into causes and prevention

• What is dizziness?
• What causes dizziness?
• How will my dizziness be treated?
• and more…

Feeling unsteady or dizzy can happen due to poor circulation, vertigo, injury, infection, allergies, or neurological disease. Dizziness is treatable but it is important for your doctor to help you determine the cause so that the correct treatment is used. While each person will be affected differently, symptoms that warrant a visit to the doctor include a high fever, severe headache, convulsions or ongoing vomiting, chest pain, heart palpitations, shortness of breath, inability to move an arm or leg, a change in vision or speech, or hearing loss.

What is dizziness?

Dizziness can be described in many ways, such as feeling lightheaded, unsteady, or giddy. Vertigo is a type of dizziness experienced as an illusion of movement of self or the environment and is usually unpleasant. Others experience dizziness associated with motion sickness, a nauseating feeling brought on by the motion of riding in an airplane, on a roller coaster, or aboard a boat. Dizziness, vertigo, and motion sickness all relate to the sense of balance and equilibrium. Your sense of balance is maintained by a complex interaction of the following parts of the nervous system:

• The inner ears (also called the labyrinth), which monitor the directions of motion, such as turning, rolling, forward-backward, side-to-side, and up-and-down motions.
• The eyes, which monitor where the body is in space (i.e., upside down, right side up, etc.) and also directions of motion.
• The skin pressure receptors in the joints and spine, which tell what part of the body is down and touching the ground.
• The muscle and joint sensory receptors, which tell what parts of the body are moving. T
• The central nervous system (the brain and spinal cord), which processes all the bits of information from the four other systems to make some coordinated sense out of it all.

The symptoms of motion sickness and dizziness appear when the central nervous system receives conflicting messages from the other four systems.

What causes dizziness?

• Circulation: If your brain does not get enough blood flow, you feel lightheaded. Almost everyone has experienced this on occasion when standing up quickly from a lying down position. But some people have light-headedness from poor circulation on a frequent or chronic basis. This could be caused by arteriosclerosis or hardening of the arteries, and it is commonly seen in patients who have high blood pressure, diabetes, or high levels of blood fats (cholesterol). It is sometimes seen in patients with inadequate cardiac (heart) function, hypoglycemia (low blood sugar), or anemia (low iron). Certain drugs also decrease the blood flow to the brain, especially stimulants such as nicotine and caffeine. Excess salt in the diet also leads to poor circulation. Sometimes circulation is impaired by spasms in the arteries caused by emotional stress, anxiety, and tension. If the inner ear fails to receive enough blood flow, the more specific type of dizziness occurs, that is, vertigo. The inner ear is very sensitive to minor alterations of blood flow and all of the causes mentioned for poor circulation to the brain also apply specifically to the inner ear.
• Vertigo: Benign paroxysmal positional vertigo (BPPV), labyrinthitis, and Ménière’s syndrome (fluctuating hearing usually in one ear, pressure in the ear, ringing in one ear, and attacks of spinning), and some forms of migraine are all causes of vertigo. BPPV occurs when you change the position of your head (typically lying down or sitting up), while inner ear infections can cause labyrinthitis.
• Injury: A skull fracture that damages the inner ear produces a profound and incapacitating vertigo with nausea and hearing loss. The dizziness will last for several weeks, and then slowly improve as the normal (other) side takes over.
• Infection: Viruses can attack the inner ear and its nerve connections to the brain. This can result in severe vertigo, but hearing is usually spared. However, a bacterial infection such as mastoiditis that extends into the inner ear will completely destroy both the hearing and the equilibrium function of that ear. The severity of dizziness and recovery time will be similar to that of a skull fracture.
• Allergy: Some people experience dizziness and/or vertigo attacks when they are exposed to foods or airborne particles (such as dust, molds, pollens, dander, etc.) to which they are allergic.
• Neurological diseases: A number of diseases of the nerves can affect balance, such as multiple sclerosis, syphilis, tumors, etc. These are uncommon causes, but your doctor will think about them during the examination.

When should I seek medical attention?

Call 911 or go to an emergency room if you experience:

• a head injury,
• fever over 101°F, headache, or very stiff neck,
• convulsions or ongoing vomiting,
• chest pain, heart palpitations, shortness of breath, weakness, a severe headache, inability to move an arm or leg, or change in vision or speech, or
• fainting and loss of consciousness for more than a few minutes.

Consult your doctor if you:

• have never experienced dizziness before,
• experience a difference in symptoms you have had in the past,
• suspect that medication is causing your symptoms, or
• experience hearing loss.

How will my dizziness be treated?

The doctor will ask you to describe your dizziness and answer questions about your general health. Along with these questions, your doctor will examine your ears, nose, and throat. Some routine tests will be performed to check your blood pressure, nerve and balance function, and hearing. Possible additional tests may include a CT or MRI scan of your head, special tests of eye motion after warm or cold water or air is used to stimulate the inner ear (ENG—electronystagmography or VNG—videonystagmography), and in some cases, blood tests or a cardiology (heart) evaluation. Your doctor will determine the best treatment based on your symptoms and the cause of them.

Prevention Tips:

• Avoid rapid changes in position, especially from lying down to standing up or turning around from one side to the other.
• Avoid extremes of head motion (especially looking up) or rapid head motion (especially turning or twisting).
• Eliminate or decrease use of products that impair circulation, e.g. nicotine, caffeine, and salt.
• Minimize your exposure to circumstances that precipitate your dizziness, such as stress and anxiety or substances to which you are allergic.
• Avoid hazardous activities when you are dizzy, such as driving an automobile or operating dangerous equipment, or climbing a step ladder, etc.
• Get enough fluids.
• Treat infections, including ear infections, colds, flu, sinus congestion, and other respiratory infections.

If you are subject to motion sickness:

Always ride where your eyes will see the same motion that your body and inner ears feel, e.g. sit in the front seat of the car and look at the distant scenery; go up on the deck of the ship and watch the horizon; sit by the window of the airplane and look outside. In an airplane choose a seat over the wings where the motion is the least.

• Do not read while traveling.
• Do not sit in a seat facing backward.
• Do not watch or talk to another traveler who is having motion sickness.
• Avoid strong odors and spicy or greasy foods immediately before and during your travel.
• Talk to your doctor about medications.

Some of these medications can be purchased without a prescription (i.e., Dramamine®, Bonine®, Marezine®, etc.) Stronger medicines such as tranquilizers and nervous system depressants will require a prescription from your physician. Some are used in pill or suppository form.

Remember: Most cases of dizziness and motion sickness are mild and self-treatable disorders. But, severe cases and those that become progressively worse, deserve the attention of a physician with specialized skills in diseases of the ear, nose, throat, equilibrium, and neurological systems.

Facial Plastic Surgery

Insight into procedures

• Why consider facial plastic surgery?
• What kinds of problems are treated?
• and more...

Facial expressions are a way to interact with others. How we look has an impact on how others perceive us, so most of us are concerned about our face’s appearance.

Some would like to change certain things about their face. Others are born with facial abnormalities such as a cleft lip, a birthmark, or other birth defects. Many of us notice the effects of aging, sun damage, or previous facial trauma. Fortunately, many of these conditions can be corrected through surgical procedures performed by a surgeon.

Why consider facial plastic surgery?

The range of conditions that otolaryngologists diagnose and treat are widely varied and can involve the whole face, nose, lips, ears, and neck. Facial plastic surgery treats a specific component of these conditions and can be divided into two types—reconstructive and cosmetic. Reconstructive plastic surgery is performed for patients with conditions that may be present from birth, such as birthmarks on the face, cleft lip and palate, protruding ears, and a crooked smile. Other conditions that are the result of accidents, trauma, burns, or previous surgery are also corrected with this type of surgery. In addition, some reconstructive procedures are required to treat existing diseases like skin cancer. Cosmetic facial plastic surgery is surgery performed to enhance visual appearance of the facial structures. Typical procedures include facelifts, eye lifts, rhinoplasty, and liposuction. An otolaryngologist surgeon is well trained to address all of these problems.

What training is necessary?

An otolaryngologist can receive up to 15 years of college and post-graduate training in plastic surgery, concentrating on procedures that reconstruct the elements of the face.

Post-graduate training includes a year of general surgery, four years of residency in otolaryngology (disorders of the ears, nose, and throat), and may also include one to two years in a fellowship dedicated to facial plastic surgery.

After passing a rigorous set of exams given by the American Board of Otolaryngology, otolaryngologists may become board-certified in the specialty of Otolaryngology—Head and Neck Surgery. Because they study the complex anatomy, physiology, and pathology of the entire head and neck, these specialists (sometimes called ENTs) are uniquely qualified to perform the procedures that affect the whole face.

What kinds of problems are treated?

The following are examples of procedures:

Rhinoplasty/Septoplasty—Surgery of the external and internal nose in which cartilage and bone are restructured and reshaped to improve the appearance and function of the nose.

Blepharoplasty—Surgery of the upper and/or lower eyelids to improve the function and/or look of the eyes.

Rhytidectomy—Surgery of the skin of the face and neck to tighten the skin and remove excess wrinkles.

Browlift—Surgery to improve forehead wrinkles and droopy eyebrows.

Liposuction—Surgery to remove excess fat under the chin or in the neck.

Facial implants—Surgery to make certain structures of the face (cheek, lips, chin) more prominent and well defined.

Otoplasty—Surgery to reshape the cartilage of the ears so they protrude less.

Skin surface procedures—Surgery using lasers, chemical peels, or derma-abrasion to improve the smoothness of the skin.

Facial reconstruction—Surgery to reconstruct defects in facial skin as a result of prior surgery, injury, or disease. This includes reconstruction of defects resulting from cancer surgery, scar revision, repair of lacerations to the face from prior trauma, removal of birth marks, and correction of congenital abnormalities of the skull, palate, or lips.

Non-surgical procedures—Techniques such as chemical peels, microdermabrasion, and injectables. Injectables are medications that can be placed under the skin to improv the appearance of the face, such as botox, collagen, Restylane, and other fillers.

How do I find a surgeon?

The Academy can recommend a board-certified otolaryngologist in your area who has a specific interest in facial plastic surgery. A reputable surgeon will take a thorough patient history and advise you on the best procedure for you. Patients should also be cautious not to be swayed by doctors who have the latest equipment, but should instead focus on finding the provider who possesses the skills, expertise, and experience necessary to choose the right treatment method for each individual.

What should you know prior to facial plastic surgery?

Your surgeon should discuss the procedure, risks, and recovery with you. Knowing what to expect will put you more at ease. You should ask how many of the particular type of procedures the surgeon has performed, and how often. You should also know what sort of preparation plans you need to make, how long the procedure will take, and any associated risks. Your surgeon should advise you about any medications you should avoid before your surgery.

Some risks might include: nausea, numbness, bleeding, blood clots, infection, and adverse reactions to the anesthesia. Additionally, if you smoke, you should avoid doing so for two weeks before your surgery in order to optimize healing following your procedure.

You will also want to understand all associated costs and payment options before undergoing any procedure. Insurance will usually cover reconstructive plastic surgery, but check with your provider. If you will be paying for the procedure, find out what payment options are available and if there is a payment plan.

What will recovery be like?

Most plastic surgery will not require a long hospital stay. Depending on the extent of your surgery, some procedures can be completed on an outpatient basis, meaning you would not require a hospital stay. Other procedures may require a hospital stay overnight or for a day or two. Either way, before you are released from the hospital, your surgeon will discuss with you any special care to take while you’re recovering at home. You will be provided with gauze and other types of dressings to tend to your incision area. Permanent sutures and surgical staples will be removed in the office about a week after the procedure. Your surgeon should also explain any special diet you should follow, medications you should take or avoid, and any restriction on activities.

Following your surgery, generally, you should:

• Avoid aerobic exercise for two weeks.
• Refrain from weight lifting and contact sports for one month.
• Talk with your surgeon about medication to manage pain and swelling.
• Avoid aspirin because it can cause bleeding and make bruising worse.

Most patients feel comfortable returning to work one to two weeks following their surgery, when swelling and bruising are reduced and their appearance has improved.

Facial Sports Injuries

Playing catch, shooting hoops, bicycling on a scenic path or just kicking around a soccer ball have more in common than you may think. On the up side, these activities are good exercise and are enjoyed by thousands of Americans. On the down side, they can result in a variety of injuries to the face.

Many injuries are preventable by wearing the proper protective gear, and your attitude toward safety can make a big difference. However, even the most careful person can get hurt. When an accident happens, it's your response that can make the difference between a temporary inconvenience and permanent injury.

When Someone Gets Hurt:

What First Aid Supplies Should You Have on Hand in Case of An Emergency?

• sterile cloth or pads
• scissors
• ice pack
• tape
• sterile bandages
• cotton tipped swabs
• hydrogen peroxide
• nose drops
• antibiotic ointment
• eye pads
• cotton balls
• butterfly bandages

• Ask "Are you all right?" Determine whether the injured person is breathing and knows who and where they are.

• Be certain the person can see, hear and maintain balance. Watch for subtle changes in behavior or speech, such as slurring or stuttering. Any abnormal response requires medical attention.

• Note weakness or loss of movement in the forehead, eyelids, cheeks and mouth.

• Look at the eyes to make sure they move in the same direction and that both pupils are the same size.

• If any doubts exist, seek immediate medical attention.

When Medical Attention Is Required, What Can You Do?

• Call for medical assistance (911).

• Do not move the victim, or remove helmets or protective gear.

• Do not give food, drink or medication until the extent of the injury has been determined.

• Remember HIV...be very careful around body fluids. In an emergency protect your hands with plastic bags.

• Apply pressure to bleeding wounds with a clean cloth or pad, unless the eye or eyelid is affected or a loose bone can be felt in a head injury. In these cases, do not apply pressure but gently cover the wound with a clean cloth.

• Apply ice or a cold pack to areas that have suffered a blow (such as a bump on the head) to help control swelling and pain.

• Remember to advise your doctor if the patient has HIV or hepatitis.

Facial Fractures

Sports injuries can cause potentially serious broken bones or fractures of the face. Common symptoms of facial fractures include:

• swelling and bruising, such as a black eye

• pain or numbness in the face, cheeks or lips

• double or blurred vision

• nosebleeds

• changes in teeth structure or ability to close mouth properly

It is important to pay attention to swelling because it may be masking a more serious injury. Applying ice packs and keeping the head elevated may reduce early swelling.

If any of these symptoms occur, be sure to visit the emergency room or the office of a facial plastic surgeon (such as an otolaryngologist-head and neck surgeon) where x-rays may be taken to determine if there is a fracture.

Upper Face

When you are hit in the upper face (by a ball for example) it can fracture the delicate bones around the sinuses, eye sockets, bridge of the nose or cheek bones. A direct blow to the eye may cause a fracture, as well as blurred or double vision. All eye injuries should be examined by an eye specialist (ophthalmologist).

Lower Face

When your jaw or lower face is injured, it may change the way your teeth fit together. To restore a normal bite, surgeries often can be performed from inside the mouth to prevent visible scarring of the face; and broken jaws often can be repaired without being wired shut for long periods. Your doctor will explain your treatment options and the latest treatment techniques.

Soft Tissue Injuries

Bruises cuts and scrapes often result from high speed or contact sports, such as boxing, football, soccer, ice hockey, bicycling skiing, and snowmobiling. Most can be treated at home, but some require medical attention.

You should get immediate medical care when you have:

• deep skin cuts

• obvious deformity or fracture

• loss of facial movement

• persistent bleeding

• change in vision

• problems breathing and/or swallowing

• alterations in consciousness or facial movement

Bruises

Also called contusions, bruises result from bleeding underneath the skin. Applying pressure, elevating the bruised area above the heart and using an ice pack for the first 24 to 48 hours minimizes discoloration and swelling. After two days, a heat pack or hot water bottle may help more. Most of the swelling and bruising should disappear in one to two weeks.

Cuts and Scrapes

The external bleeding that results from cuts and scrapes can be stopped by immediately applying pressure with gauze or a clean cloth. When the bleeding is uncontrollable, you should go to the emergency room.

Scrapes should be washed with soap and water to remove any foreign material that could cause infection and discoloration of the skin. Scrapes or abrasions can be treated at home by cleaning with 3% hydrogen peroxide and covering with an antibiotic ointment or cream until the skin is healed. Cuts or lacerations, unless very small, should be examined by a physician. Stitches may be necessary, and deeper cuts may have serious effects. Following stitches, cuts should be kept clean and free of scabs with hydrogen peroxide and antibiotic ointment. Bandages may be needed to protect the area from pressure or irritation from clothes. You may experience numbness around the cut for several months. Healing will continue for 6 to 12 months. The application of sunscreen is important during the healing process to prevent pigment changes. Scars that look too obvious after this time should be seen by a facial plastic surgeon.

Nasal Injuries

The nose is one of the most injured areas on the face. Early treatment of a nose injury consists of applying a cold compress and keeping the head higher than the rest of the body. You should seek medical attention in the case of:

• breathing difficulties

• deformity of the nose

• persistent bleeding

• cuts

Bleeding

Nosebleeds are common and usually short-lived. Often they can be controlled by squeezing the nose with constant pressure for 5 to 10 minutes. If bleeding persists, seek medical attention.

Bleeding also can occur underneath the surface of the nose. An otolaryngologist/facial plastic surgeon will examine the nose to determine if there is a clot or collection of blood beneath the mucus membrane of the septum (a septal hematoma) or any fracture. Hematomas should be drained so the pressure does not cause nose damage or infection.

Fractures

Some otolaryngologist-head and neck specialists set fractured bones right away before swelling develops, while others prefer to wait until the swelling is gone. These fractures can be repaired under local or general anesthesia, even weeks later.

Ultimately, treatment decisions will be made to restore proper function of the nasal air passages and normal appearance and structural support of the nose. Swelling and bruising of the nose may last for 10 days or more.

Neck Injuries

Whether seemingly minor or severe, all neck injuries should be thoroughly evaluated by an otolaryngologist -- head and neck surgeon. Injuries may involve specific structures within the neck, such as the larynx (voicebox), esophagus (food passage), or major blood vessels and nerves.

Throat Injuries

The larynx is a complex organ consisting of cartilage, nerves and muscles with a mucous membrane lining all encased in a protective tissue (cartilage) framework.

The cartilages can be fractured or dislocated and may cause severe swelling, which can result in airway obstruction. Hoarseness or difficulty breathing after a blow to the neck are warning signs of a serious injury and the injured person should receive immediate medical attention.

Prevention Of Facial Sports Injuries

The best way to treat facial sports injuries is to prevent them. To insure a safe athletic environment, the following guidelines are suggested:

• Be sure the playing areas are large enough that players will not run into walls or other obstructions.

• Cover unremoveable goal posts and other structures with thick, protective padding.

• Carefully check equipment to be sure it is functioning properly.

• Require protective equipment - such as helmets and padding for football, bicycling and rollerblading; face masks, head and mouth guards for baseball; ear protectors for wrestlers; and eyeglass guards or goggles for racquetball and snowmobiling are just a few.

• Prepare athletes with warm-up exercises before engaging in intense team activity.

• In the case of sports involving fast-moving vehicles, for example, snowmobiles or dirt bikes - check the path of travel, making sure there are no obstructing fences, wires or other obstacles.

• Enlist adequate adult supervision for all children's competitive sports.

Children and Facial Trauma

What is facial trauma?

The term facial trauma means any injury to the face or upper jaw bone.  Facial traumas include injuries to the skin covering, underlying skeleton, neck, nasal (sinuses), orbital socket, or oral lining, as well as the teeth and dental structures. Sometimes these types of injuries are called maxillofacial injury.  Facial trauma is often recognized by lacerations (breaks in the skin); bruising around the eyes, widening of the distance between the eyes (which may indicate injury to the bones between the eye sockets); movement of the upper jaw when the head is stabilized (which may indicate a fracture in this area); and abnormal sensations on the cheek.

In the U.S., about three million people are treated in emergency departments for facial trauma injuries each year. Of the pediatric patients, five percent have suffered facial fractures. In children less than three years old, the primary cause of these fractures is falls. In children more than five years old the primary cause for facial trauma is motor vehicle accidents.

Our fast paced world of ultra sports and increasing violence puts children at risk for facial injury.  But, children’s facial injuries require special attention.  A child’s future growth plays a big role in treatment for facial trauma. So, one of the most important issues as a care giver is to follow a physician’s treatment plan as closely as you can until your child is fully recovered.

Why is facial trauma different in children than adults?

Facial trauma can range between minor injury to disfigurement that lasts a lifetime. The face is critical in communicating with others, so it is important to get the best treatment possible. Pediatric facial trauma differs from adult injury because the face is not fully formed and future growth will be a factor in how the child heals and recovers. Certain types of trauma may cause a delay in the growth or further complicate recovery. Difficult cases require physicians with great skill to make a repair that will grow with your child.

Types of facial trauma

New technology, such as CT scans, have improved physicians ability to evaluate and manage facial trauma. In some cases, immediate surgery is needed to realign fractures before they heal incorrectly.  Other injuries will have better outcomes if repairs are done after cuts and swelling have improved. A new study has shown that even when injury does not require surgery, it is important to a child’s health and welfare to continue to follow up with a physicians care.

Soft tissue injuries

Injuries such as cuts (lacerations) may occur on the soft tissue of the face.  In combination with suturing the wound, the provider should take care to inspect and treat any injures to the facial nerves, glands, or ducts.

Bone injuries

When a fracture of the bones in the face occurs, the treatment process is similar to that of a fracture in other parts of the body.  Factors that affect how the fracture should be dealt with are the location of the fracture, the severity of the fracture, and the age and general health of the patient.  It is important during treatment of facial fractures to be careful that the patient's facial appearance is minimally affected.

Injuries to the teeth and surrounding dental structures style

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists.  Because of the specific needs of the dental structures, certain actions and precautions should be taken if a child has received an injury to his or her teeth or surrounding dental structures.

• If a tooth is "knocked out", it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible.
• Never attempt to "wipe the tooth off" since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth.

References:

Stewart MG, Chen AY. Factors predictive of poor compliance with follow-up after Facial trauma: A prospective study. Otolaryn Head and Neck Surg 1997: 117:72-75

Kim MK, Buchman R, Szeremeta. Penetratin neck trauma in children: an urban hospital’s experience. Otolaryn Head and Neck Surg 2000: 123: 439-43

Cleft Lip and Cleft Palate

What is cleft lip and cleft palate?

We all start out life with a cleft lip and palate. During normal fetal development between the 6th and 11th week of pregnancy, the clefts in the lip and palate fuse together. In babies born with cleft lip or cleft palate, one or both of these splits failed to fuse.

A “cleft” means a split or separation; the palate is the “roof” of the mouth. A cleft palate or lip then is a split in the oral (mouth) structure. Physicians call clefting a “craniofacial anomaly.” A child can be born with both a cleft lip and cleft palate or a cleft in just one area. Oral clefts are one of the most common birth defects.

Clefts in the lip can range from a tiny notch in the upper lip to a split that extends into the nose. A cleft palate can range from a small malformation that results in minimal problems to a large separation of the palate that interferes with eating, speaking, and even breathing. Clefts are often referred to as unilateral, a split on one side, or bilateral, one split on each side. There are three primary types of clefts:

• Cleft lip/palate refers to the condition when both the palate and lip are cleft. About one in 1,000 babies are born with cleft lip/palate.
• • About 50 percent of all clefts
  • More common in Asians and certain groups of American Indians
  • Occurs less frequently in African-Americans
  • Up to 13 percent of cases present with other birth defects
  • Occurs more often in male children
• Isolated cleft palate is the term used when a cleft occurs only in the palate. About one in 2,000 babies are born with this type of cleft (the incidence of submucous cleft palate, a type of isolated cleft palate, is one in 1,200).
• • About 30 percent of all clefts
  • All racial groups have similar risk
  • Occurs more often in female children
• Isolated cleft lip refers to a cleft in the lip only accounting for 20 percent of all clefts.

What causes clefts?

No one knows exactly what causes clefts, but most believe they are caused by one or more of three main factors: an inherited characteristic (gene) from one or both parents, environment (poor early pregnancy health or exposure to toxins such as alcohol or cocaine), and genetic syndromes. A syndrome is an abnormality in genes on chromosomes that result in malformations or deformities that form a recognizable pattern. Cleft lip/palate is a part of more than 400 syndromes including Waardenburg, Pierre Robin, and Down syndromes. Approximately 30 percent of cleft deformities are associated with a syndrome, so a thorough medical evaluation and genetic counseling is recommended for cleft patients.

How is a cleft diagnosed?

Clefting of the lip and palate is usually visible during the baby’s first examination. One exception is a submucous cleft where the palate is cleft, but remains covered by smooth, unbroken lining of the mouth. A child with cleft lip or palate is often referred to a multidisciplinary team of experts for treatment. The team may include: an otolaryngologist (ear, nose, and throat specialist), plastic surgeon, oral surgeon, speech pathologist, pediatric dentist, orthodontist, audiologist, geneticist, pediatrician, nutritionist, and psychologist/social worker.

How are clefts treated?

Treatment of clefts is highly individual, depending on the overall health of the child and the severity and location of the cleft(s). Multiple surgeries and long-term follow-up are often necessary. Because clefts can interfere with physical, language and psychological development, treatment is recommended as early as possible. Surgery to repair a cleft lip is usually done between 10 and 12 weeks of age. A cleft palate is repaired through a procedure called palatoplasy, which is done between nine and 18 months. Additional surgeries are often needed to achieve the best results. In addition to surgery, the child may receive follow-up care from members of the multidisciplinary team on issues of speech, hearing, growth, dental, and psychological development.

What are the complications of clefts?

The complications of cleft lip and cleft palate can vary greatly depending on the degree and location of the cleft. They can include all or some or all of the following:

• Breathing: When the palate and jaw are malformed, breathing becomes difficult. Treatments include surgery and oral appliances.
• Feeding: Problems with feeding are more common in cleft children. A nutritionist and speech therapist that specializes in swallowing may be helpful. Special feeding devices are also available.
• Ear infections and hearing loss: Any malformation of the upper airway can affect the function of the Eustachian tube and increase the possibility of persistent fluid in the middle ear, which is a primary cause of repeat ear infections. Hearing loss can be a consequence of repeat ear infections and persistent middle ear fluid. Tubes can be inserted in the ear by an otolaryngologist to alleviate fluid build-up and restore hearing.
• Speech and language delays: Normal development of the lips and palate are essential for a child to properly form sounds and speak clearly. Cleft surgery repairs these structures; speech therapy helps with language development.
• Dental problems: Sometimes a cleft involves the gums and jaw, affecting the proper growth of teeth and alignment of the jaw. A pediatric dentist or orthodontist can assist with this problem.

Pediatric Head and Neck Tumors

Tumors or growths in the head and neck region may be divided into those that are benign (not cancerous) and malignant (ie., cancer).  Fortunately, most growths in the head and neck region in children are considered to be benign. These benign growths can be related to infection, inflammation, fluid collections, swellings, or neoplasms (tumors) that are non life-threatening.  The malignant growths, on the other hand, may be life-threatening and cause other problems related to their growth and spread.  Even the malignant growths in the head and neck are usually treatable.

Benign Tumors

It is very common for children to have enlarged tonsils and adenoids.  These are almost always from an infection or inflammation.  It is very rare that children develop a cancer, lymphoma, or sarcoma of these areas.  When the tonsils, adenoids, or other areas of the mouth or throat remain enlarged or are enlarged on only one side, it is important to have an evaluation by a specialist in ear, nose and throat or otolaryngology-head and neck surgery.

The lymph nodes of the neck region may become enlarged during childhood.  Most of the time, this is reactive in nature and related to inflammation or infection.  However, if the lymph nodes remain enlarged for a period of time without going away, it is important to have an otolaryngologist-head and neck surgeon evaluate the problem.

Other benign growths in the face and neck include cysts (fluid collection) such as branchial cleft cyst, thyroglossal duct cyst, cystic hygroma, and dermoid cysts.  These often require removal due to their continued growth and potential for infection.  Growths of blood vessels often are seen in the face and neck and these are often referred to as hemangiomas, vascular malformations, lymphatic and arteriovenous malformations (AVM).  Some of these may require removal or treatment depending upon the type and location.

Sinus and Nose Growths

Although most children have nose bleeds and occasional allergies and sinus infection, sometimes tumors of the nose and sinus present with similar symptoms.  It is generally recommended that a child with continuous sinus problems or nose bleeds be evaluated by an otolaryngologist-head and neck surgeon to be sure it is not a tumor or other treatable condition.

Non-epithelial neoplasms constitute the majority of sinonasal (sinus) tumors in children and adolescents.  Among these, rhabdomyosarcoma (RMS) or undifferentiated sarcoma and non-Hodgkin lymphoma account for the majority of cases. Among head and neck RMS 14 percent arise from the nasal cavity and 10 percent from the paranasal sinuses.  Nasopharyngeal carcinoma accounts for one third of the nasopharyngeal neoplasms in children.  As is the case in adult patients, it is associated with Epstein-Barr virus (EBV) infection as demonstrated by EBV DNA presence in malignant cells.  Less frequently, Ewing’s sarcoma/PNET can present in this location. These tumors have also been described as secondary malignancies following treatment of retinoblastoma and other neoplasms. Esthesioneuroblastoma is a rare sinonasal tumor historically related to Ewing/PNET, although more recently comparative genomic hybridization analysis disputes this relation.  Other less common sinonasal tumors presenting in children include hemangioma and hemagiopericitoma, fibroma and fibrosarcoma, malignant fibrous histiocytoma, and desmoid fibromatosis.

Salivary Gland Tumors

There are three paired sets of salivary glands in the head and neck region.  These include the ones in front of the ears (parotid), below the jaw (submandibular), and underneath the tongue (sublingual).  Additionally, there are numerous very small salivary glands throughout the mouth and throat.  Although tumors can arise in these areas, they are rare.  Thus, any child with a growth in these areas should be seen by an otolaryngologist-head and neck surgeon.

Thyroid Tumors

The thyroid gland is found in the front of the lower part of the neck just above the chest area but below the Adam’s apple on both sides.  Although tumors can arise in this area, they are rare.  Thus, any child with a growth in this area should be seen by an otolaryngologist-head and neck surgeon.

Sinus Pain: Can Over-the-Counter Medications Help?

Why Do We Suffer From Nasal And Sinus Discomfort?

The body's nasal and sinus membranes have similar responses to viruses, allergic insults, and common bacterial infections. Membranes become swollen and congested. This congestion causes pain and pressure; mucus production increases during inflammation, resulting in a drippy, runny nose. These secretions may thicken over time, may slow in their drainage, and may predispose to future bacterial infection of the sinuses.

Congestion of the nasal membranes may even block the eustachian tube leading to the ear, resulting in a feeling of blockage in the ear or fluid behind the eardrum. Additionally, nasal airway congestion causes the individual to breathe through the mouth.

Each year, more than 37 million Americans suffer from sinusitis, which typically includes nasal congestion, thick yellow-green nasal discharge, facial pain, and pressure. Many do not understand the nature of their illness or what produces their symptoms. Consequently, before visiting a physician, they seek relief for their nasal and sinus discomfort by taking non-prescription or over-the-counter (OTC) medications.

What Is The Role Of OTC Medication For Sinus Pain?

There are many different OTC medications available to relieve the common complaints of sinus pain and pressure, allergy problems, and nasal congestion. Most of these medications are combination products that associate either a pain reliever such as acetaminophen with a decongestant or an antihistamine. Knowledge of these products and of the probable cause of symptoms will help the consumer to decide which product is best suited to relieve the common symptoms associated with nasal or sinus inflammation.

OTC nasal medications are designed to reduce symptoms produced by the inflammation of nasal membranes and sinuses. The goals of OTC medications are to: (1) reopen to nasal passages; (2) reduce nasal congestion; (3) relieve pain and pressure symptoms; and (4) reduce potential for complications. The medications come in several forms.

Nasal Saline Sprays: Non-Medicated Nasal Sprays Nasal saline is an invaluable addition to the list of over-the-counter medications. It is ideal for all types of nasal problems. The added moisture produced by the saline reduces thick secretions and assists in the removal of infectious agents. There is no risk of becoming "addicted" to nasal saline. It should be applied as a mist to the nose up to six times per day. Nasal saline can also be made at home: contact your otolaryngologist for details.

Nasal Decongestant Sprays: Medicated Nasal Sprays

Afrin nasal spray, Neo-Synephrine, Otrivin, Dristan nasal spray, and other brands decongest the swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating the initial stages of a common cold or viral infection. Nasal decongestant sprays are safe to use, especially appropriate for preventing eustachian tube problems when flying, and to halt progression of sinus infections following colds. However, they should only be utilized for 3-5 days because prolonged use leads to rebound congestion or "getting hooked on nasal sprays." The patient with nasal swelling caused by seasonal allergy problems should use a cromolyn sodium nasal spray. The spray must be used frequently (four times a day) during allergy season to prevent the release of histamine from the tissues, which starts the allergic reaction. It works best before symptoms become established by stabilizing the nasal membranes and has few side effects.

Decongestant Medications

Pressure and congestion are common symptoms of nasal passage swelling. Decongestant medications are OTC products that relieve nasal swelling, pressure, and congestion but do not treat the cause of the inflammation. They reduce blood flow to the nasal membranes leading to improved airflow, less breathing through the mouth, decreased pressure in the sinuses and head, and subsequently less discomfort. Decongestants do not relieve drippy noses. Their side effects may include light headedness or giddiness and increased blood pressure and heart rate. (Patients with high blood pressure or heart problems should consult a physician before use.) In addition, other medications may interact with oral decongestants causing side effects. Both of these are available as single products or in combination with a pain reliever or an antihistamine. They are labeled as "non-drowsy" due to a side effect of stimulation of the nervous system.

Decongestant-Combination Products

Some medications are combined to reduce the number of pills. Tylenol® Sinus or Advil Cold and Sinus® exemplify products that join a pain reliever (acetaminophen or ibuprophen) with a decongestant (pseudoephedrine). These products relieve both sinus and cold/flu symptoms yet retain all the attributes of the individual drug including side effects.

Antihistamine Medications

Antihistamines combat allergic problems leading to nasal congestion. OTC antihistamines such as diphenhydramine (Benadryl®), or clemastine (Tavist®) may be used for relieving allergic symptoms of itching, sneezing, and nasal congestion. They relieve the drainage associated with the allergic inflammation but not obstruction or congestion. Antihistamines have a potential for sedation causing grogginess and dryness after use. Newer non-sedating antihistamines are available.

Antihistamine-Decongestant Combination Products Antihistamines and decongestant products are often combined to relieve multiple symptoms of congestion and drainage and reduce the side effects of both products. Antihistamines produce sedation; decongestants are added to make them "non-drowsy." The combined allergy product then relieves congestion and a runny nose.

Sinusitis: Special Considerations for Aging Patients

More than 20 percent of U.S. residents will be 65 or older in 2030. Of all Americans 65 and older, 14.1 percent report that they suffer from chronic sinusitis; for those 75 years and older, the rate declines to 13.5 percent.

Geriatric Rhinitis Complaints Are:

• Constant need to clear the throat
• A sense of nasal obstruction
• Nasal crusting
• Vague facial pressure
• Decreased sense of smell and taste

For the most part, sinusitis symptoms, diagnosis, and treatment are the same for the elderly as other adult age groups. However, there are special considerations for older Americans.

Changing Physiology:

With aging, the physiology and function of the nose changes. The nose lengthens, and the nasal tip begins to droop due to weakening of the supporting cartilage. This in turn causes a restriction of nasal airflow, particularly at the nasal valve region (where the upper and lower lateral cartilages meet). Narrowing in this area results in the complaint of nasal obstruction, often referred to as geriatric rhinitis.

Patients with geriatric rhinitis typically complain of constant “sinus drainage,” a chronic need to clear the throat or “hawk” mucus, and a sense of nasal obstruction, most often when they lie down. Other features include nasal crusting especially in the winter and in patients taking diuretics, vague facial pressure (attributed to “sinus trouble”), and a decreased sense of smell and taste.

However, it is a mistake to blame all upper respiratory problems on the aging process. Elderly patients with symptoms such as repeated sneezing, and watery eyes, nasal obstruction with clear profuse watery runny nose, and soft, pale turbinates (top-shaped bones in the nose) may have allergic rhinitis. Patients with this diagnosis will benefit from consultation with an otolaryngic allergist.

Patients with chronic sinusitis will have a long history of thick drainage that is often foul smelling and tasting and is associated with nasal obstruction, headaches, and facial pressure. These patients usually have pus drainage and nasal redness. In contrast, the geriatric rhinitis patient usually has a dry, irritated nose. The diagnosis of chronic sinusitis can be confirmed with a computed tomography scan (CT scan) of the sinuses.

Sinusitis or rhinosinusitis, which is it? In recent studies, otolaryngologist–head and neck surgeons have concluded that sinusitis is often preceded by rhinitis and rarely occurs without concurrent rhinitis. The symptoms, nasal obstruction/discharge and loss of smell, occur in both disorders. Symptoms associated with rhinosinusitis include nasal obstruction, nasal congestion, nasal discharge, nasal purulence, postnasal drip, facial pressure and pain, alteration in the sense of smell, cough, fever, halitosis, fatigue, dental pain, pharyngitis, otologic symptoms (e.g., ear fullness and clicking), and headache. Patients with documented chronic sinusitis unresponsive to medications should be referred to an otolaryngologist.

Osteoporosis:

Osteoporosis is a significant health problem in the United States affecting approximately 24 million Americans, 15 to 20 million of whom are women over 45 years of age. Because of the concerns regarding prolonged estrogen use in postmenopausal women, a nasal calcitonin spray is sometimes prescribed to prevent bone loss. The most common side effect reported with nasal calcitonin spray is a runny nose. Other symptoms that may occur include nasal crust, dryness, redness, irritation, sinusitis, nosebleeds, and headache. Sinusitis sufferers using a nasal calcitonin spray should inform their physicians.

Medications For Geriatric Rhinitis:

Treatment for this age group needs to be more individualized to meet the patient’s slower metabolism and the increasing potential for side effects. The majority (80 to 85 percent) of the nation’s elderly have chronic diseases and take multiple drugs including over-the-counter medications, Placing them at higher risk for drug interactions than other patients.

Surgery For Geriatric Rhinitis:

Nasal and sinus surgery is occasionally advised for older patients. Patients with structural abnormalities, such as a deviated septum or nasal valve collapse causing severe nasal problems, should be referred to an otolaryngologist for evaluation and possible surgical management.

Sources For Aging Patients:

Administration on Aging (AoA), U.S. Department of Health and Human Services; Geriatrics.

Fall Prevention

Insight into preventing injuries caused by falls

• Why are falls more likely during the senior years?
• How does lifestyle management affect fall prevention?
• and more…

Today’s society is more active than ever, but inevitably every year more than two million Americans fall and sustain serious injury, costing the healthcare system in excess of $3 billion dollars. Hidden costs affecting the individual include pain, disability, lawsuits, loss of independence, deterioration in well-being, and the impact on other family members. Nonetheless, falls are predictable and preventable, even for older adults.

Why are falls more likely during the senior years?

Falls and the resulting injuries are among the elderly’s most serious health issues caused by the body’s deterioration through inactivity and the central nervous system (CNS)’s damaged through injuries. For example, the sensory cells in the ears’ balance system gradually decrease and cannot be replaced, as well as the nerves carrying sensory information to the brain to perform complex brain interconnections lose fiber and nerve cells. In addition, nerve endings loose their ability to generate the chemicals responsible for the transmission of information. This process accelerates after the age of 50.

Many diseases affect the CNS and sense organs too. Also, muscle strength gradually decreases with age, joint tendons and ligaments lose their flexibility and limit motion. The combined ravages of bone and joint injury, arthritis, and inactivity can result in a body that cannot carry out motion commands initiated by the brain. Hardening of the arteries is probably the worst. It is accelerated by high blood pressure, smoking, and diabetes. Although artery hardening gradually increases during middle age, there is a point at which a slight additional decrease in blood flow causes serious vascular impairment such as stroke.

Head injuries, sometimes caused by falls, can damage the sense organs in the inner ears, or the brain itself. Therefore, physical activity is very important for injury recovery to the sensory systems. The general debility of aging can negatively affect recovery if it results in a decreased level of activity. Often, injuries to the knees, hips, and back do not completely heal, leaving some limitation of motion.

The worst disability occurs when both sense organs and CNS structures are damaged simultaneously, as is the case with Alzheimer’s Disease. Also, arthritis can cause permanent, crippling, nonreversible effects and osteoporosis can lead to bone weakness and increases the probability of serious injury from a fall or a spontaneous fracture that might lead to a fall.

How can medications affect my sensory functions?

In this time of specialization, it is possible for one patient to receive prescriptions from several physicians that might have additive side effects on the brain and sensory function. Therefore, patients should keep a complete list of all their medications and dosages, and make this list available to each physician they consult. Coordination of all medications through a single primary care physician would help avoid adverse drug reactions to the brain and sensory functions. The list should include:

• Over-the-counter medications, such as antihistamines, sleeping medications, analgesics, and cough suppressants.
• Medications used to treat high blood pressure, heart disease, allergy, insomnia, stomach acidity, and depression.
• Medications listing alcohol as an ingredient since it affects movement and judgment and adversely interacts with many medications.

How can I recover from an injury caused by a fall?

Rehabilitation

• A thorough and complete evaluation of sensory, CNS, muscles/joints, and balance function should be performed. This includes a search for causes of dizziness, such as inner ear diseases; an evaluation of the inner ear balance system, which might be adversely affected by certain drugs (such as a class of antibiotics known as aminoglycocides); trauma; and the aging process.
• Tests of higher mental function are important since falling may be a sign of serious mental deterioration.
• A careful review of all medications (both prescription and over-the-counter) is very important. If medication for anxiety or depression is used, switching from a long acting drug to one that is more quickly passed from the body seems to decrease the risk of falling.
• All correctable problems should be treated. Visual correction with proper eyeglasses, improvement of hearing by hearing aids, adjustment or elimination of medications, and any other disease, which could impair balance must be accomplished.

Rehabilitation includes increasing the range of motion as well as physical strength. A very important part of rehabilitation is overcoming the fear of falling and thus avoiding further injury. Walkers and canes can aid stability, while simple changes in the home, such as installing hand holds in bathrooms or along walls, could decrease the likelihood of falling and increase confidence. But keep in mind, drastically changing a familiar environment often hampers recovery. As soon as possible, rehabilitation should include family members and home support groups. Rapid return to physical activity and social interaction with family and community can often stop the vicious spiral into inactivity, reclusiveness, and progressive deterioration that falls and injuries cause.

How does lifestyle management affect fall prevention?

As many of the problems responsible for falling develop during early and middle age, initial efforts to prevent injuries should begin at a younger age. Many of the changes in muscle, bone, and the central nervous system are not inevitable results of aging, but are brought on by inactive lifestyles and self-inflicted damage from smoking, poor diet, and lack of exercise. Although hardening of the arteries is occasionally hereditary, in most cases it can be reduced by diets low in cholesterol and saturated fatty acids, as well as regular physical exercise.

Tips to prevent falls among seniors

Health

• Have hearing and vision check-ups regularly. If hearing and vision are impaired, important cues that help maintain balance can be lost.
• Get up slowly. A momentary drop in blood pressure can cause dizziness when standing up too quickly.
• Use a cane or walker to help maintain balance on uneven ground or slippery surfaces. Wear sturdy, low-heeled shoes with wide, nonslip soles.
• Exercise to improve your strength, muscle tone, and coordination. Walking is a good form of exercise.

Home

• Remove raised doorway thresholds in all rooms. Rearrange furniture to keep electrical cords and furniture out of walking paths. Fasten area rugs to the floor with tape or tacks.
• Never stand on a chair. Use nonskid floor wax
  and wipe up spills immediately.
• Be sure stairways have sturdy hand rails.
• Install grab handles and nonskid mats inside and outside your shower and tub.
• Use shower chairs and bath benches to minimize the risk of falling.
• Put a light switch by the bedroom door and by your bed so you don’t have to walk across the room to turn on a light. Night lights in your bedrooms, halls, and bathroom are a good idea.

Sinus Headaches

Not every headache is the consequence of sinus and nasal passage problems. For example, many patients visit an ear, nose, and throat specialist to seek treatment for a sinus headache and learn they actually have a migraine or tension headache. The confusion is common, a migraine can cause irritation of the trigeminal or fifth cranial nerve (with branches in the forehead, cheeks and jaw). This may produce pain at the lower-end branches of the nerve, in or near the sinus cavity.

Symptoms Of Sinusitis

Pain in the sinus area does not automatically mean that you have a sinus disorder. On the other hand, sinus and nasal passages can become inflamed leading to a headache. Headache is one of the key symptoms of patients diagnosed with acute or chronic sinusitis. In addition to a headache, sinusitis patients often complain of:

• Pain and pressure around the eyes, across the cheeks and the forehead
• Achy feeling in the upper teeth
• Fever and chills
• Facial swelling
• Nasal stuffiness
• Yellow or green discharge

However, it is important to note that there are some cases of headaches related to chronic sinusitis without other upper respiratory symptoms. This suggests that an examination for sinusitis be considered when treatment for a migraine or other headache disorder is unsuccessful. 

Treatment For A Sinus Headache

Sinus headaches are associated with a swelling of the membranes lining the sinuses (spaces adjacent to the nasal passages). Pain occurs in the affected region – the result of air, pus, and mucus being trapped within the obstructed sinuses. The discomfort often occurs under the eye and in the upper teeth (disguised as a headache or toothache). Sinus headaches tend to worsen as you bend forward or lie down. The key to relieving the symptoms is to reduce sinus swelling and inflammation and facilitate mucous drainage from the sinuses.

There are several at-home steps that help prevent sinus headache or alleviate its pain. They include:

• Breathe moist air: Relief for a sinus headache can be achieved by humidifying the dry air environment. This can be done by using a steam vaporizer or cool-mist humidifier, steam from a basin of hot water, or steam from a hot shower.
  
• Alternate hot and cold compresses: Place a hot compress across your sinuses for three minutes, and then a cold compress for 30 seconds. Repeat this procedure three times per treatment, two to six times a day.
  
• Nasal irrigation: Some believe that when nasal irrigation or rinse is performed, mucus, allergy creating particles and irritants such as pollens, dust particles, pollutants and bacteria are washed away, reducing the inflammation of the mucous membrane. Normal mucosa will fight infections and allergies better and will reduce the symptoms. Nasal irrigation helps shrink the sinus membranes and thus increases drainage. There are several over-the-counter nasal rinse products available. Consult your ear, nose, and throat specialist for directions on making a home nasal rinse or irrigation solution.
  
• Over-the-counter medications: Some over-the-counter (OTC) drugs are highly effective in reducing sinus headache pain. The primary ingredient in most OTC pain relievers is aspirin, acetaminophen, ibuprofen, naproxen, or a combination of them. The best way to choose a pain reliever is by determining which of these ingredients works best for you.
  
• Decongestants: Sinus pressure headaches caused by allergies are usually treated with decongestants and antihistamines. In difficult cases, nasal steroid sprays may be recommended.
  
• Alternative medicine: Chinese herbalists use Magnolia Flower as a remedy for clogged sinus and nasal passages. In conjunction with other herbs, such as angelica, mint, and chrysanthemum, it is often recommended for upper respiratory tract infections and sinus headaches, although its effectiveness for these problems has not been scientifically confirmed.

If none of these preventative measures or treatments is effective, a visit to an ear, nose, and throat specialist may be warranted. During the examination, a CT scan of the sinuses may be ordered to determine the extent of blockage caused by chronic sinusitis. If no chronic sinusitis were found, treatment might then include allergy testing and desensitization (allergy shots). Acute sinusitis is treated with antibiotics and decongestants. If antibiotics fail to relieve the chronic sinusitis and accompanying headaches, endoscopic or image-guided surgery may be the recommended treatment.

Thyroid Disorders and Surgery

Insight into complications and treatment

• What is a thyroid disorder?
• What treatment may be recommended?
• What is thyroid surgery?
• and more...

Your thyroid gland is one of the endocrine glands that makes hormones to regulate physiological functions in your body, like metabolism. Other endocrine glands are the pancreas, the pituitary, the adrenal glands, and the parathyroid glands.

The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and wraps around the front half of the trachea (windpipe). It is shaped like a bow tie, just above the collarbones, having two halves (lobes) which are joined by a small tissue bar (isthmus.). You can’t always feel a normal thyroid gland.

What is a thyroid disorder?

Diseases of the thyroid gland are very common, affecting millions of Americans. The most common thyroid problems are:

• an overactive gland, called hyperthyroidism (e.g., Graves’ disease, toxic adenoma or toxic nodular goiter)
• an underactive gland, called hypothyroidism (e.g., Hashimoto’s thyroiditis)
• thyroid enlargement due to overactivity (as in Graves’ disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a “goiter”.

Patients with a family history or who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy.

If you develop significant swelling in your neck or difficulty breathing or swallowing, you should call your surgeon or be seen in the emergency room.

What treatment may be recommended?

Depending on the nature of your condition, treatment may include the following:

Hypothyroidism treatment:

• thyroid hormone replacement pills

Hyperthyroidism treatment:

• medication to block the effects of excessive production of thyroid hormone
• radioactive iodine to destroy the thyroid gland
• surgical removal of the thyroid gland

Goiters (lumps):

If you experience this condition, your doctor will propose a treatment plan based on the examination and your test results. He may recommend:

A fine needle aspiration biopsy—a safe, relatively painless procedure. With this procedure, a hypodermic needle is passed into the lump, often after administration of local anesthesia into the skin, and tissue fluid samples containing cells are taken. Often several passes with the needle are required. Sometimes ultrasound may be used to guide the needle into the nodule. There is little pain afterward and very few complications from the procedure occur. This test gives the doctor more information on the nature of the lump in your thyroid gland and specifically may help to differentiate a benign from a malignant thyroid mass.

Thyroid surgery—may be required when:

• the fine needle aspiration is reported as suspicious for or suggestive of cancer
• the trachea (windpipe) or esophagus are compressed because both lobes are very large

Historically, some malignant thyroid nodules have shown a reduction in size with the administration of thyroid hormone. However, this treatment, known as medical “suppression” therapy, has proven to be an unreliable treatment method.

What is thyroid surgery?

Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anesthesia is usually required. Typically the operation removes the lobe of the thyroid gland containing the lump and possibly the isthmus. A frozen section (an immediate microscopic reading) may or may not be used to determine if the rest of the thyroid gland should be removed.

Sometimes, based on the result of the frozen section, the surgeon may decide not to remove any additional thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck. This is a decision usually made in the operating room by the surgeon, based on findings at the time of surgery. Your surgeon will discuss these options with you preoperatively.

There may be times when the definite microscopic answer cannot be determined until several days after surgery. If a malignancy is identified in this way, your surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedure. If you have specific questions about thyroid surgery, ask your otolaryngologist and he or she will answer them in detail.

What happens after thyroid surgery?

During the first 24 hours:

After surgery, you may have a drain (a tiny piece of plastic tubing), which prevents fluid and blood from building up in the wound. This is removed after the fluid accumulation has stabilized, usually within 24 hours after surgery. Most patients are discharged later the same day or the day following the procedure.

Complications are rare but may include:

• bleeding
• a hoarse voice
• difficulty swallowing
• numbness of the skin on the neck
• vocal cord paralysis
• low blood calcium

At home:

Following the procedure, if it is determined that you need to take any medication, your surgeon will discuss this with you, prior to your discharge.

Medications may include:

• thyroid hormone replacement
• calcium and/or vitamin D replacement

Some symptoms may not become evident for two or three days after surgery. If you experience any of the following, call your surgeon:

• numbness and tingling around the lips and hands
• increasing pain
• fever
• swelling
• wound discharge

If a malignancy is identified, thyroid replacement medication may be withheld for several weeks. This allows a radioactive scan to better detect any remaining microscopic thyroid tissue, or spread of malignant cells to lymph nodes or other sites in the body.

How is a diagnosis made?

The diagnosis of a thyroid function abnormality or a thyroid mass is made by taking a medical history and a physical examination. Specifically, your doctor will examine your neck and ask you to lift up your chin to make your thyroid gland more prominent. You may be asked to swallow during the examination, which helps to feel the thyroid and any mass in it. Other tests your doctor may order include:

• evaluation of the larynx/vocal cords with a mirror or a fiberoptic telescope
• an ultrasound examination of your neck and thyroid
• blood tests of thyroid function
• a radioactive thyroid scan
• a fine needle aspiration biopsy
• a chest X-ray
• a CT or MRI scan