Head & Neck
What Is an Otolaryngologist
Mouth Sores
Temporo-Mandibular Joint (TMJ) Dysfunction
What Is an Otolaryngologist—
Head and Neck Surgeon?
Insight into ear, nose, and throat specialist
— What do otolaryngologists treat?
— How are ear, nose, and throat specialists trained?
— Why should I see an otolaryngologists?
— and more…
Otolaryngology (pronounced oh/toe/lair/in/goll/oh/jee) is the oldest medical specialty in the United States. Otolaryngologists are physicians trained in the medical and surgical management and treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structures of the head and neck. They are commonly referred to as ENT physicians.
What do otolaryngologists treat?
Otolaryngologists diagnose and manage diseases of the sinuses, larynx (voice box), oral cavity, and upper pharynx (mouth and throat), as well as structures of the neck and face, as well as many ENT primary care problems in both children and adults.
The ears—Hearing loss affects one in ten North Americans. The unique domain of otolaryngologists is the treatment of ear disorders. They are trained in both the medical and surgical treatment of hearing, ear infections, balance disorders, ear noise (tinnitus), nerve pain, and facial and cranial nerve disorders. Otolaryngologists also manage congenital (birth) disorders of the outer and inner ear.
The nose—About 35 million people develop chronic sinusitis each year, making it one of the most common health complaints in America. Care of the nasal cavity and sinuses is one of the primary skills of otolaryngologists. Management of the nasal area includes allergies and sense of smell. Breathing through, and the appearance of, the nose are also part of otolaryngologists’ expertise.
The throat—Communicating (speech and singing) and eating a meal all involve this vital area. Also specific to otolaryngologists is expertise in managing diseases of the larynx (voice box) and the upper aero-digestive tract or esophagus, including voice and swallowing disorders.
The head and neck—This center of the body includes the important nerves that control sight, smell, hearing, and the face. In the head and neck area, otolaryngologists are trained to treat infectious diseases, both benign and malignant (cancerous) tumors, facial trauma, and deformities of the face. They perform both cosmetic plastic and reconstructive surgery.
How are ear, nose, and throat specialists trained?
Otolaryngologists are ready to start practicing after completing up to 15 years of college and post-graduate training. To qualify for certification by the American Board of Otolaryngology, an applicant must first complete college, medical school (usually four years), and at least five years of specialty training. Next, the physician must pass the American Board of Otolaryngology examination. In addition, some otolaryngologists pursue a one- or two- year fellowship for more extensive training in one of seven subspecialty areas.
These subspeciality areas are pediatric otolaryngology (children), otology/neurotology (ears, balance, and tinnitus), allergy, facial plastic and reconstructive surgery, head and neck, laryngology (throat), and rhinology (nose). Some otolaryngologists limit their practices to one of these seven areas.
Why should I see an otolaryngologist?
These specialists differ from many physicians in that they are trained in both medicine and surgery. Otolaryngologists do not need to refer patients to other physicians when ear, nose, throat, or head/neck surgery is needed and, therefore, can offer the most appropriate care for each individual patient. Therefore, otolaryngologists are the most appropriate physicians to treat disorders of the ears, nose, throat, and related structures of the head and neck.
What are the seven areas of expertise in the field of otolaryngology?
Otology/Neurotology: diseases of the ear, including trauma (injury), cancer, and nerve pathway disorders, which affect hearing and balance.
Examples: ear infection; swimmer’s ear; hearing loss; ear, face, or neck pain; dizziness, ringing in the ears (tinnitus).
Pediatric Otolaryngology: diseases in children with special ENT problems including birth defects in the head and neck and developmental delays.
Examples: ear infection (otitis media), tonsil and adenoid infection, airway problems, Down’s syndrome, asthma and allergy/sinus disease.
Head and Neck: cancerous and noncancerous tumors in the head and neck, including the thyroid and parathyroid.
Examples: lump in the neck or thyroid, cancer of the voice box.
Facial Plastic and Reconstructive Surgery: cosmetic, functional, and reconstructive surgical treatment of abnormalities of the face and neck.
Examples: deviated septum, rhinoplasty (nose), face lift, cleft palate, drooping eyelids, hair loss.
Rhinology: disorders of the nose and sinuses.
Examples: sinus disorder, nose bleed, stuffy nose, loss of smell.
Laryngology: disorders of the throat, including voice and swallowing problems.
Examples: sore throat, hoarseness, swallowing disorder, gastroesophageal reflux disease (GERD).
Allergy: treatment by medication, immunotherapy (allergy shots) and/or avoidance of pollen, dust, mold, food, and other sensitivities that affect the ear, nose, and throat.
Examples: hay fever, seasonal and perennial rhinitis, chronic sinusitis, laryngitis, sore throat, otitis media, dizziness.
Mouth Sores —
What are fever blisters?
Fever blisters are fluid-filled blisters that commonly occur on the lips. They also can occur on the gums and roof of the mouth (hard palate), but this is rare. Fever blisters are usually painful; pain may precede the appearance of the lesion by a few days. The blisters rupture within hours, then crust over. They last about seven to ten days.
Why do fever blisters reoccur?
Fever blisters result from a herpes simplex virus that becomes active. This virus is latent (dormant) in afflicted people, but can be activated by conditions such as stress, fever, trauma, hormonal changes, and exposure to sunlight. When lesions reappear, they tend to form in the same location.
Are fever blisters contagious?
Yes, the time from blister rupture until the sore is completely healed is the time of greatest risk for spread of infection. The virus can spread to the afflicted person’s eyes and genitalia, as well as to other people.
How are fever blisters treated?
Treatment consists of coating the lesions with a protective barrier ointment containing an antiviral agent, for example 5% acyclovir ointment. While there is no cure now, scientists are working on trying to develop one and hopefully fever blisters will be a curable disorder in the future.
Tips to prevent spreading fever blisters
— Avoid mucous membrane contact when a lesion is present.
— Do not squeeze, pinch, or pick the blisters.
— Wash hands carefully before touching eyes, genital area, or another person.
Note: Despite all caution, it is possible to transmit herpes virus even when no blisters are present.
What are canker sores?
Canker sores (also called aphthous ulcers) – are different than fever blisters. They are small, red or white, shallow ulcers occurring on the tongue, soft palate, or inside the lips and cheeks; they do not occur in the roof of the mouth or the gums. They are quite painful, and usually last five–ten days.
Who is most likely to get canker sores?
Eighty percent of the U.S. population between the ages of ten to 20 years of age, most often women, get canker sores.
What causes canker sores?
The best available evidence suggests that canker sores result from an altered local immune response associated with stress, trauma, or irritation. Acidic foods (i.e., tomatoes, citrus fruits, and some nuts) are known to cause irritation in some patients.
Are canker sores contagious?
No, because they are not caused by bacteria or viral agents, they cannot be spread locally or to anyone else.
How are canker sores treated?
The treatment is directed toward relieving discomfort and guarding against infection. A topical corticosteroid preparation such as triamcinolone dental paste (Kenalog in Orabase 0.1%®) is helpful.
When should a physician be consulted?
Consider consulting a physician if a mouth sore has not healed within two weeks. Mouth sores offer an easy way for germs and viruses to get into the body. Therefore, it is easy for infections to develop.
People who consume alcohol, smokers, smokeless tobacco users, chemotherapy or radiation patients, bone marrow or stem cell recipients, or patients with weak immune systems should also consider having regular oral screenings by a physician. The first sign of oral cancer is a mouth sore that does not heal.
What kind of screenings are performed?
The physician will most likely examine the head, face, neck, lips, gums, and high-risk areas inside the mouth, such as the floor of the mouth, the front and sides of the tongue, and the roof of the mouth or soft palate. If a suspicious lesion is found, the physician may recommend collecting and testing soft tissue from the oral cavity.
What are other types of oral lesions to be concerned about?
Leukoplakia—Thick, whitish-color patch that forms on the inside of the cheeks, gums, or tongue. These patches are caused by excess cell growth and are common among tobacco users. They can result from irritations such as an ill-fitting denture or the habit of chewing on the inside of the cheek. Leukoplakia can progress to cancer.
Candidiasis—A fungal infection (also called moniliasis or oral thrush) that occurs when yeast reproduce in large numbers. It is common among denture wearers and most often occurs in people who are very young, elderly, debilitated by disease, or who have a problem with their immune system. People who have dry mouth syndrome are very susceptible to candidiasis. Candida may flourish after antibiotic treatment, which can decrease normal bacteria in the mouth.
Hairy tongue—A relatively rare condition caused by the elongation of the taste buds. It can be caused by poor oral hygiene, chronic oral irritation, or smoking.
Torus palatinus—A hard bony growth in the center of the roof of the mouth (palate). It commonly occurs in females over the age of 30 and rarely needs treatment. A torus palatinus is often seen in patients who suffer with tooth grinding. Occasionally it is removed for the proper fitting of dentures.
TMJ Dysfunction—
Insight into causes and treatments
— How does the Temporo
— Mandibular Joint work?
— What causes TMJ dysfunction?
— How is TMJ dysfunction treated
— and more…
Open your jaw all the way and shut it. This simple movement would not be possible without the Temporo-Mandibular Joint (TMJ). It connects the temporal bone (the bone that forms the side of the skull) and the mandible (the lower jaw). Even though it is only a small disc of cartilage, it separates the bones so that the mandible may slide easily whenever you talk, swallow, chew, kiss, etc. Therefore, damage to this complex, triangular structure in front of your ear, can cause considerable discomfort.
Where is the Temporo-Mandibular Joint?
You can locate this joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way and close it. You can also feel the joint motion in your ear canal.
How does the Temporo-Mandibular Joint work?
When you bite down hard, you put force on the object between your teeth and on the Temporo-Mandibular Joint. In terms of physics, the jaw is the lever and the TMJ is the fulcrum. Actually, more force is applied (per square foot) to the joint surface than to whatever is between your teeth because the cartilage between the bones provides a smooth surface, over which the joint can freely slide with minimal friction.
Therefore, the forces of chewing can be distributed over a wider surface in the joint space and minimize the risk of injury. In addition, several muscles contribute to opening and closing the jaw and aid in the function of the TMJ.
What causes TMJ dysfunction?
In most patients, pain associated with the TMJ is a result of displacement of the cartilage disc that causes pressure and stretching of the associated sensory nerves. The popping or clicking occurs when the disk snaps into place when the jaw moves. In addition, the chewing muscles may spasm, not function efficiently, and cause pain and tenderness.
Damage to the TMJ is often caused by:
—Major and minor trauma to the jaw
—Teeth grinding
—Excessive gum chewing
—Stress and other psychological factors
—Improper bite or malpositioned jaws
—Arthritis
What are the symptoms?
—Ear pain
—Sore jaw muscles
—Temple/cheek pain
—Jaw popping/clicking
— Locking of the jaw
—Difficulty in opening the mouth fully § Frequent head/neck aches
The pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew, or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head (the temple), the cheek, the lower jaw, and the teeth.
A very common focus of pain is in the ear. Many patients come to the ear specialist quite convinced their pain is from an ear infection. When the earache is not associated with a hearing loss and the eardrum looks normal, the doctor will consider the possibility that the pain comes from a TMJ dysfunction.
There are a few other symptoms besides pain that TMJ dysfunction can cause. It can make popping, clicking, or grinding sounds when the jaws are opened widely. Or the jaw locks wide open (dislocated). At the other extreme, TMJ dysfunction can prevent the jaws from fully opening. Some people get ringing in their ears from TMJ trouble.
How is TMJ dysfunction treated?
Because TMJ symptoms often develop in the head and neck, otolaryngologists are appropriately qualified to diagnose TMJ problems. Proper diagnosis of TMJ begins with a detailed history and physical, including careful assessment of the teeth occlusion and function of the jaw joints and muscles. An early diagnosis will likely respond to simple, self-remedies:
—Rest the muscles and joints by eating soft foods.
—Do not chew gum.
—Avoid clenching or tensing.
— Relax muscles with moist heat (1/2 hour at least twice daily).
In cases of joint injury, apply ice packs soon after the injury to reduce swelling. Relaxation techniques and stress reduction, patient education, non-steroidal anti-inflammatory drugs, muscle relaxants or other medications may also offer relief.
Other treatments for advanced cases may include fabrication of an occlusal splint to prevent wear and tear on the joint, improving the alignment of the upper and lower teeth, and surgery. After diagnosis, your otolaryngologist may suggest further consultation with your dentist and oral surgeon to facilitate effective management of TMJ dysfunction.
