FACIAL PLASTIC & RECONSTRUCTIVE SURGERY
Ear, Nose & Throat
Common areas of treatment that Dr. Milgrim excels in are:
Ear pain is the most common complaint heard by otolaryngologists. It is most commonly seen in diseases and infection of the outer ear canal (often called swimmer’s ear). . A common source of the infection is increased moisture trapped in the ear canal, bathing, or showering, increased humidity or living in warm moist climates.
Symptoms of this type of ear infection include swelling, tenderness of the ear, redness, hearing loss, clogged feeling and or discharge from the ear canal.Ear pain caused by external ear infections can be severe. Ear drops with antibiotics and steroids are the most frequently used medication for treating these infections as well as pain relievers. Sometimes the canal is so swollen that drops can not get in to do their work. Dr. Milgirm may want to place a piece of cotton soaked in the medicine inside the canal and ask that you leave it there for one to two days. This is called a wick. ENT Doctors in New York and New Jersey have found this to be necessary in the cold and wet climates where they often treat their patients
Other than swimmers ear, ear pain can come from outside sources such as the jaw, TMJ (temporal mandibular joint syndrome), throat pain, and nerve pain from other disorders.
Itchy ear can be a maddening symptom. Sometimes it is caused by a fungus or allergy, but more often it is from chronic dermatitis (skin inflammation) of the ear canal, such as eczema. Canals that do not make a lot of wax can also itch as the hairs in our ears touch one another.A steroid cream, antifungal cream, or drop is usally given as treatment when the ears itch. There is no long-term cure, but it can be kept controlled
Cerumen or earwax is healthy in normal amounts and serves as a self-cleaning agent with protective, lubricating, and antibacterial properties. The absence of earwax may result in dry, itchy ears. Most of the time the ear canals are self-cleaning; the ear will push out the wax little by little with the use of the hair in our ear and the natural sloughing of dead skin from the canal.
Wax blockage is one of the most common causes of hearing loss. This is often caused by attempts to clean the ear with cotton swabs. Most cleaning attempts merely push the wax deeper into the ear canal, causing a blockage. When wax is built up too much and home remedies do not work, manual removal of earwax is also effective. This is most often performed by an otolaryngologist using suction, special miniature instruments, and a microscope to magnify the ear canal. There are no proven ways to prevent cerumen impaction. Certainly avoid inserting anything in the ear, such as Q tips, pins, sticks. These will push more wax inside than take out and may lead to serious injury of the ear drum.
Eustachian tube dysfunction is that feeling of clogging of the ear and a feeling of muffled hearing when there is no wax or infection present, like being on an airplane. Dr. Milgrim can perform a special type of maneuver at your visit to clear your eustachian tubes and hear again.
Otitis Media, or Inflammation of the tissue inside the middle ear and accumulation of pus when a cold, allergy or upper respiratory infection, causes accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube. Although otitis media is most common in young children, it occasionally affects adults and occurs most commonly during the winter and early spring. The mainstay of treatment is antibiotics if it is believed to be a bacterial infection. In some cases, surgery may be the only effective treatment for chronic ear infections. Surgeyr, or myringotomy with or without tube placement is one of the most common procedures performed today in the hands of an ENT doctor. Otitis media is generally not serious if it is promptly and properly treated. With the help of your physician, you and/or your child can feel and hear better very soon.
Perforated ear drum or hole in the eardrum is often accompanied by decreased hearing and occasional discharge. Most common feeling and symptom with a hole is hearing loss. You may feel a clogged sensation or a true decrease in your hearing. Pain is usually not a symptom. Perforated eardrums are usually caused by infection such as otitis media or trauma such as a slap on the outer ear, or putting a foreign object in the era (i.e. bobby pin, stick, etc).
Most eardrum perforations heal on their own within weeks of rupture, although some may take several months to heal. During the healing process the ear must be protected from water and trauma. Eardrum perforations that do not heal on their own may require surgery such as placing a sticky paper “patch” over small or medium holes in the office. Larger ones will require a true surgical procedure .
Tinnitus: Nearly 36 million Americans suffer from tinnitus or head noises. It may be an intermittent sound or an annoying continuous sound in one or both ears.We have all experienced some form of ear noise, but when it is continuous, it can be downright maddening. Its can be as simple as a low roar to a high squeal or whine.
Most tinnitus comes from loud noise exposure, hearing loss either from trauma or heredity or exposure to sharp loud sounds. Tinnitus may a be caused by simple things such as wax on your eardrum. Allergy, high or low blood pressure (blood circulation problems), tumor, diabetes, thyroid problems, injury to the head or neck, trauma and various other causes including medications, aspirin, sedatives, antibiotics, antidepressants, can all cause tinnitus.
way. Talk to your Ear doctor and audiologist about these issues and what can be done about them.
Hearing Loss : You may have hearing loss, and not even be aware of it. People of all ages experience gradual hearing loss, often due to the natural aging process or long exposure to loud noise. Other causes of hearing loss include viruses or bacteria, heart conditions or stroke, head injuries, tumors, and certain medications. Treatment for hearing loss will depend on your diagnosis. The first step is to see Dr. Milgrim and get a hearing test. Then the right treatment options can be discussed. Hearing loss from infections or trauma or wax are certainly reversible and not permanent.
Stuffy Nose Nasal congestion, stuffiness, or obstruction to nasal breathing is one of the most common human complaints. For some, it may only be a nuisance; for others, nasal congestion can be a source of considerable discomfort and a cornerstone of treatment given by Ear, Nose and Throat (ENT) doctors. New Jersey is filled with allergens and environmental issues that can lead to this uncomfortable symptom. The Stuffy nose can be a complaint associated with any of the rest of these issues
The Common Cold: An average adult suffers a “common cold”, or viral infection two to three times per year. Infected, the nasal membranes release histamine, causes nasal tissue to swell. This inflames the nasal membranes which become congested with blood and produce excessive amounts of mucus that “stuffs up” the nasal airway. This can be a sign of other issues such as allergies, chronic sinusitis and upper respiratory issues that are common in New Jersey.
Nasal Congestion: There is a difference between nasal stuffiness and nose congestion. Congestion is the feeling of being able to breathe and then all of a sudden, the breathing shuts down. It also is accompanied sometimes with pressure feeling around the side walls of the nose and on the cheeks. You feel you can breathe but there is something blocking it. The most common causes are turbinate hypertrophy ( turbinate swelling), allergies, overuse of medication especially over the counter ones such as Aftrin, Dristan, Neosynephrine, or an “ cold preparation” drugs.
Turbinate Hypertrophy (Swollen nasal membranes): This is by far the most common finding on anyone who feels nasal congestion or obstruction. When the membranes of the nose swell, either due to allergies, non-allergic issues such as smog, environment, bad air, medications, moldy environment, we feel our nose if just stuffed as if the air can not get to our lungs. Thankfully it is just a feeling and you are breathing ! This problem is helped by a 3 prong approach: look for allergies and treat it , find the problem inside the nose and use some medication to stop the swelling and lastly an office procedure to shrink them. The procedure is literally 5 minutes with no or minimal side effects. Dr. Milgrim is well versed at turbinate hypertrophy treatment and diagnosis.
Deviated Septum: The most common causes of the ‘stuffy nose’ complaint. Is a structural abnormaly. Every one has one. The question is does it bother you. If you feel you can not breathe through one nostril constantly, that can be caused by a deviated septum . It is the most common complaint and treatment afforded by Dr. Milgrim. The Septum is cartilege. It can not be altered except with surgery. But….with modern techniques, correction of a deviated septum or septoplasty is easily done within 20 minutes, out-patient and most people are back to work or school in less than 5 days.
Sinusitis, (infection in the nasal sinuses), can occur if the cold does not resolve. When the nasal mucus turns from clear to yellow or green, it usually means that a bacterial infection has set in. Sinuses are air-filled cavities in the skull. They drain into the nose through small openings. Blockages in the openings from swelling due to colds, flu, or allergies may lead to acute sinus infection.Acute sinus infections produce nasal congestion and thick discharge. Pain may occur in cheeks and upper teeth, between and behind the eyes, or above the eyes and in the forehead, depending on which sinuses are involved.
Chronic sinus infections, or iChronic sinusitis occurs when sinus blockages persist, lasting more than months, causing the lining of the sinuses to swell further.. Sympotms include chronic post nasal drip, headaches, persistent facial pressure without pain, stuffy nose and sometimes eye pressures. It will cause a chronic stuffy nose as the membranes in the nose and sinuses are constantly swollen. Allergies are common in New York and New Jersey. ENT doctors, such s Dr. Milgrim are well aware of the effects of allergies and stuffy noses. Some people develop nasal polyps from chronic sinus infections or allergies, and the infection can spread to the lower airways, leading to a chronic cough, bronchitis, or asthma.
Allergies and allergic rhinitis: Allergy accounts for over 70% of nasal congestion, stuffiness, and chronic sinusits. Allergy shots and now allergy drops are specific and successful treatment methods. Skin prick test and RAST blood tests are used to determine what you are allergic to and design treatment.
Post Nasal Drip: Post Nasal Drip (PND) is the sensation of mucus accumulation in the back of the throat., . You area totally unaware of this but when other issues set in you can be aware of this mucus and it is call Post Nasal Drip.. Post Nasal Drip is caused by either thick or thin secretions. These can be caused by illnesses such as colds and flu, allergies, chronic sinus inflammation or environmental issues such as cold temperatures in the winter, dryness in heated buildings and homes, bright lights, certain foods/spices, pregnancy, and various drugs and other hormonal changes. Nasal structural abnormalities, such as a deviated septum can also produce increased secretions.Successful treatment of the post-nasal drip will also usually clear up these throat symptoms. Post nasal drip needs a physician’s diagnosis and treatment with an antibiotic , drugs that break up the mucus or even surgery if it is due to chronic sinusitis or chronic sinus problems in New Jersey may be the answer.
Sinus Surgery, or Functional endoscopic sinus surgery (FESS) is recommended for certain types of sinus disease. With the endoscope, the surgeon can look directly into the nose, while at the same time, removing diseased tissue and polyps and clearing the narrow channels between the sinuses.There are occasions when physician and patient find that the infections are recurrent and/or non-responsive to medication. When this occurs, surgery to enlarge the openings that drain the sinuses is an option.Before surgery your ENT doctor will obtain a CT scan of your sinuses. He will typically review the results of the scan with you and show you which of the sinuses are involved. Functional endoscopic sinus surgery (FESS) was developed in the 1950 with the introduction of the endoscope but has only been revolutionized in the past few decades.. The use of an endoscope has allowed us to remove only the infected tissue rather than the whole sinus mucosa. This has led to decreased recovery time and fewer complications compared to the older methods.
Balloon Sinuplasty in New Jersey is an innovative new procedure which only recently became part of the armamentarium of the sinus surgeon. It does not require incisions and cutting or the removal of bone and tissue. There is generally less pain, risk of infection, blood loss, bruising and swelling and many patients are often able to return to their normal activities in less time than they would. Benefits include short recovery time, no removal of tissue so minimal discomfort, short anesthesia time. It can be done in an office at a visit and you can go home immediately with relief in days. Check with Dr. Milgrim if Balloon sinuplasty is an option for you.
Nosebleeds: Most nosebleeds (epistaxis) begin in the lower part of the septum, th central cartilage that separates the nostrils. Nose bleeds (nosebleeds), known as epistaxis, are typically caused by irritation or damage to the septum. More often than not, they are simply a nuissance and require no intervention. Some may be very severe and need immediate medical attention. The two types are anterior and posterior. The anterior type are the most common and can be stopped quickly. The posterior type are more serious and will need medical help to stop.
More common than dryness, New York and New Jersey ENT doctors see local trauma, ( picking your nose) medications, allergies, infection, tumors (although rare), soot, car exhaust as other causes of nose bleeds. Lubricating creams or ointments can also be helpful in preventing rebleeding. A saline nasal spray with or without aloe vera, Bacitracin, A and D Ointment, Eucerin, and Polysporin all have been used to aid in moisturizing the nose.
Cough and Chronic Cough is a cough lasting more than 2 months that unresponsive to rest or medication. A chronic cough usually has multiple causes. Treatment requires medication as well as psychological management.
Chronic Cough is a common problem seen in the our voice center at our Ear, Nose and Throat doctor practice in New Jersey. Chronic cough can be draining and psychologically debilitating It is usually tossed of as chronic asthma, chronic obstructive lung disease, or a nervous cough, but a thorough evaluation will expose the real cause in most cases. Cough can be caused by a multitude of things including reaction to medication, allergies, sinusitis, reflux, neurologic disorders, cancers as well as a host of psychological issues such as stress.
Acid Reflux: Everyone has gastroesophageal reflux (GERD), the backward movement (reflux) of gastric juices into the esophagus. Gastroesophageal reflux disease, or GERD, occurs when acid from the stomach backs up into the esophagus and throat. Normally, food travels from the mouth, down through the esophagus and into the stomach. A ring of muscle at the bottom of the esophagus, the lower esophageal sphincter (LES), contracts to keep the acidic contents of the stomach . When the acid goes past the esophagus and comes into the throat causing throat pain burning, tongue swelling, tongue burning, loss of taste or abnormal taste, bitter or sour taste, repetitive omitting, persistent heartburn, nausea, we call in GERD.
Snoring and Sleep Apnea Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age. Snoring can be associated with obstructed night breathing know as apnea. So although you only hear the sound it could be a sign of something more serious.
Signs of snoring include poor muscle tone in the tongue and throat, long palate and uvula, excessive tissue in the throat, septal deviations, allergies, swollen turbinates in the nose. Anything that can lead to obstruction of the oral or nasal airway can cause snoring. It can also occur in children known as OSA or Obstructive Sleep Apnea. This is typically caused by enlarged tonsils and adenoids which do not let air flow by them when sleeping.
When snoring to leads to apnea ( loss of breathing while sleeping) in an adult , other medical issues may follow such as sleepy during the day, elevated blood pressure and heart enlargement may occur, lung hypertension and possible death during sleep.
Numerous treatments are available for this including removal of tonsils and adenoids ( mainly for children), Uvulopalatopharyngoplasty (UPPP).Thermal Ablation Palatoplasty (TAP) ,Pillar Plasty—the Pillar procedure is best for snorers without apnea. It involves the placement of stents which look like pipe cleaners into the soft palate in order to strengthen it so it is not so floppy and CPAP/BIPAP which is machinery that is designed to push air past the obstruction , voiding surgerywhile you are sleeping to relieve the apnea and snoring.
The newest technique for apnea is INSPIRE apnea surgery is innovative and works in a select patient. Ask Dr. Milgirm is you qualify as he is an expert in this field.
Difficulty swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. Symptoms of swallowing disorders may include drooling, feeling that food or liquid is sticking in the throat (globus), Discomfort, sensation of a foreign body or “lump” in the throat, Coughing or choking, Voice change
Many of the disorders found can be treated with medication but some need surgical intervention. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is tailored to the particular cause of the swallowing disorder. Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or stimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.
Hoarseness and Vocal Cord Disorders: It may come as a surprise to you the variety of medical conditions that can lead to vocal cord problems. The most common causes of hoarseness and vocal difficulties are outlined below. Treatment and evaluation options are also discussed.
Acute laryngitis is the most common cause of hoarseness and voice loss that starts suddenly. Most cases of acute laryngitis are caused by a viral infection that leads to swelling of the vocal cords. The best treatment for this condition is to stay well hydrated and to rest or reduce your voice use Since most acute laryngitis is caused by a virus, antibiotics are not effective. Any problems breathing during an illness warrants emergency evaluation.
Chronic laryngitis can be caused by acid reflux disease, allergies, medications, exposure to irritating substances such as smoke, and by low grade infections such as yeast infections of the vocal cords in people using inhalers for asthma. The vocal cords are either chronically red, thick and the surface is commonly irritated.
Reflux of stomach juice into the throat can cause a variety of symptoms in the esophagus (swallowing tube) as well as in the throat. Hoarseness (chronic or intermittent), swallowing problems, a lump in the throat sensation, or throat pain are common symptoms of stomach acid irritation of the throat. The vocal cords can be chronically irritated and can actually be the only symptom.
Voice Misuse: It should come as no surprise that, just like in any other physical task, there are efficient and inefficient ways of using your voice. Excessively loud, prolonged, and/or inefficient voice use can lead to vocal difficulties. Excessive tension in the neck and laryngeal muscles, along with poor breathing technique during speech leads to vocal fatigue, increased vocal effort, and hoarseness. Voice misuse and overuse puts you at risk for developing benign vocal cord lesions or vocal cord hemorrhages.
Benign non-cancerous growths on the vocal cords are most often caused by voice misuse or overuse, which causes trauma to the vocal cords. These lesions (or “bumps”) on the vocal cord(s) alter vocal cord vibration and lead to hoarseness. The most common vocal cord lesions are nodules, polyps, and cysts. Vocal nodules (also known as nodes or singer’s nodes) are similar to “calluses” of the vocal cords. They occur on both vocal cords opposite each other at the point of maximal wear and tear, and are usually treated with voice therapy to eliminate the vocal trauma that is causing them. Contrary to common myth, vocal nodules are highly treatable and intervention leads to improvement in most cases. Vocal cord polyps and cysts are the other common benign lesions. These are sometimes related to voice misuse or overuse, but can also occur in people who don’t use their voice improperly. These types of problems typically require microsurgical treatment for cure, with voice therapy employed in a combined treatment approach in some cases.
Vocal Cord hemorrhage can come from a sudden loss of voice following yelling, shouting, or other strenuous vocal tasks. Vocal cord hemorrhage results when one of the blood vessels on the surface of the vocal cord ruptures and the soft tissues of the vocal cord fill with blood. It is considered a vocal emergency and is treated with absolute voice rest until the hemorrhage resolves.
Vocal Cord Paralysis or Paresis is hoarseness related to problems between the nerves and muscles within the voice box or larynx. The most common neurological condition that affects the larynx is a paralysis or weakness of one or both vocal cords. Involvement of both vocal cords is rare and is usually manifested by noisy breathing or difficulty getting enough air while breathing or talking. When one vocal cord is paralyzed or weak, voice is usually the problem rather than breathing. One vocal cord can become paralyzed or weakened (paresis) from a viral infection of the throat, after surgery in the neck or chest, from a tumor or growth along the laryngeal nerves, or for unknown reasons. Vocal cord paralysis typically presents with a soft and breathy voice. Many cases of vocal cord paralysis will recover within several months. In some cases however, the paralysis will be permanent, and may require active treatment to improve the voice. Treatment choice depends on the nature of the vocal cord paralysis, the degree of vocal impairment, and the patient’s vocal needs.
Laryngeal cancer is a very serious condition requiring immediate medical attention. Chronic hoarseness warrants evaluation by an otolaryngologist to rule out laryngeal cancer. It is important to remember that prompt attention to changes in the voice facilitate early diagnosis. Remember to listen to your voice because it might be telling you something. Laryngeal cancer is highly curable if diagnosed in its early stages.