Our adult and pediatric ENT center in Houston can help diagnose and treat both common and uncommon problems in the ear, nose, and throat. Some disorders can be treated with medication, while others require surgical procedures. Some common problems include the following:

Tonsil Infections or Enlargement

  • The palatine tonsils are two lumps of tissue on either side of your throat that you may see when you open your mouth. These tonsils are part of a ring of similar tissue all around the back of the throat that also includes the lingual tonsils on the back of the tongue, the adenoids in the back of the nose, and the pharyngeal tonsils around the back of the throat.
  • When the palatine tonsils and the adenoids become too large due to repeat infections, they can cause blockages of the nose or throat and lead to loud snoring. This enlargement is very common in children. Sometimes the enlargement and airway obstruction is significant enough to disrupt sleep and can cause obstructive sleep apnea.
  • Enlarged tonsils and adenoids may block nasal breathing in children, causing elongation of the face and malocclusion of the teeth (leading to the need for orthodontic treatment) as the child grows.
  • Adenoid enlargement may also cause chronic ear infections by disrupting proper Eustachian tube function. The Eustachian tube allows you to equalize pressure on either side of the eardrum. When it is not functioning, you experience ear pressure or develop fluid behind the eardrum.
  • The tonsils and the adenoids may also become chronically or recurrently infected, resulting in repeated school or work absences.
  • The tonsils may develop small holes called crypts where anaerobic bacteria can sometimes live. These are called tonsilloliths or tonsil stones. The tonsilloliths may cause bad breath or chronic throat discomfort. They can usually be removed with a Q-tip or a soft bristle toothbrush.
  • Tonsillectomies (removal of the tonsils) and adenoidectomies (removal of the adenoids) are common, safe procedures that may be recommended to treat certain disorders. These procedures are performed through the mouth and do not cause any scars. They may be performed on both adults and children and will likely result in fewer infections after surgery.

Hoarseness and Other Vocal Cord Problems

  • Hoarseness is caused by a problem with the vocal cords. The diagnosis can usually be made by looking directly at the vocal cords using a fiberoptic telescope in the office.
  • Nodules can form on the cords with long-term overuse of the voice. They are similar to calluses and are not treated surgically.
  • Polyps can also form on the vocal cords and cause significant hoarseness. Polyps should be removed through surgery performed under anesthesia by using a microscope through the mouth.
  • Smoking can create lesions on the vocal cords. Some of these lesions can be cancerous. If found early, these cancerous lesion can be treated with minimal surgery or radiation therapy, sparing the voice box with a very high cure rate. Persistent hoarseness in smokers should be evaluated so cancerous tumors can be found and treated early for best results.
  • Persistent hoarseness may be caused by paralysis of the nerve controlling the vocal cord. This can be caused by prior surgery in the neck, tumors, or occasionally, by viruses. This should also be evaluated to diagnose malignant tumors early. In addition, there are surgical procedures available to improve the voice or swallowing in patients with vocal cord paralysis.
  • Hoarseness may be caused by post-nasal drip associated with allergy, nose, or sinus infections. The drainage causes swelling of the vocal cords, resulting in disorderly vibration of the vocal cords. Treatment will help resolve the problem.
  • One of the most common reasons for hoarseness is called laryngopharyngeal reflux (LPR). It is caused by the reflux of stomach acid and enzymes activated by the acidity up to the voice box and vocal cords. It may or may not be associated with gastroesophageal reflux (GERD). Symptoms include hoarseness, chronic dry cough, throat clearing, and a sensation that something is stuck in the throat. LPR can be treated with a combination of medications and dietary and behavioral changes.

Neck and Facial Masses

  • The most common masses found in the neck and face involve the parotid gland, the submandibular gland, the thyroid gland, or the lymph nodes.
  • Masses are evaluated by physical examination and imaging studies such as CT scans, MRIs, and ultrasounds.

Thyroid Disorders Including Goiter and Cancers

  • Thyroid masses are very common and are usually thyroid nodules. Most thyroid nodules are benign. A thyroid ultrasound is a good test for visualizing thyroid nodules and determining the odds of the nodule being malignant. A fine needle aspiration (FNA) is often ordered to sample some of the thyroid nodule tissue to determine if it is malignant.
  • The nerve that controls movement of the right and left vocal cord travel underneath the thyroid. A new, persistent hoarseness with an enlarging thyroid mass is potentially concerning for cancer.

Parathyroid Adenomas

  • The parathyroid glands control the level of calcium in the blood.
  • Calcium levels need to be maintained in a very narrow range in order for your muscles, including the heart, to work properly.
  • Parathyroid adenomas cause calcium levels to become too high, resulting in symptoms such as recurrent kidney stones.
  • Parathyroid adenomas can be removed with minimally invasive techniques.

Swollen Lymph Nodes

  • There are many lymph nodes throughout the neck. Lymph nodes are part of the body’s defense against infections. As a result, they tend to swell up in the presence of infection or inflammation. Usually, the lymph node swelling decreases after an infection resolves, so persistently enlarged lymph nodes should be evaluated.
  • Imaging studies such as a CT scan can be used to evaluate enlarged lymph nodes. If the lymph nodes are suspicious, they can be removed for pathology. Enlarged lymph nodes can be associated with low-grade infections such as tuberculosis, metastatic cancers, or lymphomas.

Salivary Gland Tumors Including Parotid and Submandibular Gland Growths

  • The parotid gland is a gland that makes saliva when you put food in your mouth. It is located in your cheek near the front of the ear and extends into your neck. The nerve that controls movements of the face travels through it.
  • Enlargement of the gland can occur with infections or with stones blocking the outflow of the gland.
  • Swelling or pain in the gland may become worse while eating.
  • Parotid tumors may also occur in the gland. Most of these are benign tumors and are not painful. Painful tumors can cause facial paralysis or may be malignant.
  • The submandibular gland is a salivary gland found on the underside of the jawbone on the right and left sides in the middle of the bone. It also makes saliva when you eat.
  • The submandibular gland can swell up with infection or if stone blocks the outflow.
  • Rarely, tumors can form in this gland. Tumors are more likely to form in the parotid gland than the submandibular gland.
  • There are many lymph nodes around the submandibular gland. These can often swell up from infection in the gums or with dental abscesses.

Ear Infections and Dizziness

  • Ear infections can occur in the outer ear, the middle ear, or the inner ear.
  • Infections of the outer ear cause swelling of the ear canal, itching, and pain. Purulent drainage may also occur and can cause some temporary hearing loss. This type of infection is called otitis externa but is commonly known as swimmer’s ear. It can usually be treated with antibiotic eardrops. Otitis externa in patients with diabetes can become very severe and life-threatening in rare cases.
  • Infections of the middle ear cause fluid to develop behind the eardrum. The fluid may be clear or purulent. These infections may be very painful and always cause hearing loss. Occasionally perforations of the eardrum occur. Middle ear infections are usually treated with antibiotic eardrops and/or oral antibiotics. Persistent clear fluid behind the eardrum may be treated with the placement of pressure equalization tubes (PE tubes). PE tubes are very small and are inserted with a microscope in the OR for children and in the office for adults.
  • Infections of the inner ear may cause dizziness and/or hearing loss. The dizziness can cause difficulty getting out of bed. The hearing loss can range from mild to profound and can recover spontaneously or become permanent. Most infections are probably viral, making treatment difficult. Patients with a new onset of unilateral hearing loss should be evaluated immediately so that treatment can be started.
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