What is allergy testing?
If you are “allergic”, you are reacting to a particular substance. Any substance that can trigger an allergic reaction is called an allergen. To determine which specific substances are triggering your allergies, your allergist will safely and effectively test your skin or blood, using tiny amounts of commonly troublesome allergens. Allergy tests are designed to gather the most specific information possible so your doctor can determine what you are allergic to and provide the best treatment.
Which allergens will I be tested for?
Because your physician has made a diagnosis of allergies, you know that one or more allergens is causing your allergic reaction,itching, swelling, sneezing, wheezing, and other symptoms. Your symptoms are probably caused by one of these common allergens: products from dust mites (tiny bugs you can’t see) that live in your home; proteins from furry pets, which are found in their skin secretions (dander), saliva and urine (it’s actually not their hair); molds in your home or in the air outside; tree, grass and weed pollen; and/or cockroach droppings. More serious allergic reactions can be caused by: venoms from the stings of bees, wasps, yellow jackets, fire ants and other stinging insects; foods; natural rubber latex, such as gloves or balloons; or drugs, such as penicillin. All of these allergens are typically made up of proteins. Allergy tests find which of these proteins you may be reacting to. The allergen extracts or vaccines used in allergy tests are made commercially and are standardized according to U.S. Food and Drug Administration (FDA) requirements. Your allergist is able to safely test you for allergies to substances listed above using these allergen extracts.
Who can be tested for allergies?
Adults and children of any age can be tested for allergies. Because different allergens bother different people, your allergist will take your medical history to determine which test is the best for you. Some medications can interfere with skin testing. Antihistamines, in particular, can inhibit some of the skin test reactions. Use of antihistamines should be stopped one to several days prior to skin testing. Reasons for allergy testing: To help you manage your allergy symptoms most effectively, your allergist must first determine what is causing your allergy. For instance, you don’t have to get rid of your cat if you are allergic to dust mites but not cats, and you don’t need to take medication all year if you have a seasonal allergy to ragweed. Allergy tests provide concrete information. And once you know the specific allergens causing your symptoms, you can try to: avoid exposure to the allergens; get specific medical treatment; and if necessary, consider specific vaccination with the allergen, or “allergy shots.”
What are specific types of allergy tests?
Blood (RAST) test: Your practitioner may initially choose to do a blood test, called a RAST (radioallergosorbent) test. Since this test involves drawing blood, the results are not available immediately. Lab results may take several days, but this method is the easiest way to screen for common allergens. Scratch or puncture test: These tests are done on the surface of the skin. A tiny amount of allergen is scratched across or lightly pricked into the skin. If you have an allergy, the specific allergens that you are allergic to will cause a chain reaction to begin in your body. People with allergies have an allergic antibody called IgE (immunoglobulin E) in their body. This chemical, which is only found in people with allergies, activates special cells called mast cells. These mast cells release chemicals called mediators, such as histamine, the chemical that causes redness and swelling. With testing, this swelling occurs only in the spots where the tiny amount of allergen to which you are allergic has been scratched onto your skin. So, if you are allergic to ragweed pollen but not to cats, the spot where the ragweed allergen scratched your skin will swell and itch a bit, forming a small dime-sized hive. The spot where the cat allergen scratched your skin will remain normal. This reaction happens quickly within your body. Test results are available within 15 minutes of testing, so you don’t have to wait long to find out what is triggering your allergies. And you won’t have any other symptoms besides the slightly swollen, small hives where the test was done; this goes away within 30 minutes. Intradermal test. This test is related to the scratch or puncture test, but is slightly more sensitive. It involves injecting a tiny amount of allergen under the skin, usually on the upper arms. Your allergist may do this test when your reaction to the scratch test cannot be clearly determined.
Hearing & Hearing Aids
How does hearing work?
To understand the various types of hearing loss, you must first know how your hearing system works. Sound waves pass through the auditory canal and beat against the eardrum causing vibrations in the chain of three small bones in the middle ear. The third bone, called the stapes or stirrup, is the smallest bone in the human body. It fits into an area called the oval window, located between the middle ear and the inner ear. When the stapes vibrates with the sound waves passing through, fluid in the inner ear carries the vibrations into the canal of a delicate, spiral structure called the cochlea. Thousands of hair cells in one part of the cochlea are connected to fibers that make up the auditory nerve. Each hair cell has many microscopic hairs at one end. Movements of the fluid, with the aid of an overlying membrane, bend the tiny hairs. Movement of the hairs stimulates the hair cells to generate electrical impulses, which are carried up the auditory nerve to the brain.
What if I have hearing loss?
Arrange an office visit with one of our ENT doctors. During your appointment, the ENT will examine the health of your ear and the audiologist will test your hearing. If a hearing loss is present, the audiologist can set up a Hearing Aid Evaluation appointment.
What are the steps to be fit with a hearing aid?
Call our offices to set up a Hearing Aid Evaluation appointment with one of our Doctors of Audiology. During that first appointment, you will review your hearing loss and how a hearing aid can help you to hear the sounds you have been missing. An ear impression (if needed) will be taken and hearing aids will be ordered. When your hearing aids arrive in our office, we will set up a Hearing Aid Delivery appointment, at which you will be fit with your new hearing aids. Follow-up appointments will be set-up to fine tune the instruments and answer any questions you might have.
What types of hearing aids are available?
We offer state of the art technology in all styles of hearing aids. We work with a variety of manufacturers. There is a style to fit every hearing loss from the invisible IIC hearing aids to open-fit receiver-in-the-canal aids. We also fit the Lyric Extended Wear Hearing Aids.
Why should I get my hearing aids at The Feldman Hearing Studio?
We are one of the few practices that carry multiple hearing aid brands for you to choose from, so you are not locked into one manufacturer. We carry the largest selection of hearing aids, from the most reputable manufactures that provide the latest in technology.
The Feldman Hearing Studio is staffed with Doctors of Audiology that are backed by 10 Board Certified ENT Physicians. This allows you to receive the best possible care and treatment for your hearing. We offer comprehensive hearing tests, balance testing, hearing aid evaluations and services, along with custom-made earplugs.
When you purchase a hearing aid from us, ALL of our services are included for the life of the hearing aid.
Otitis Media is the medical term for inflammation of the middle ear. When the middle ear is infected, the condition is known as Acute Otitis Media. Acute otitis media occurs when a cold, allergy or upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the eustachian tube. This causes earache, swelling and redness. When fluid forms in the middle ear the condition is known as Otitis Media with Effusion. This is usually associated with a recovering ear infection or one that is about to occur. Fluid can remain in the ear for weeks to many months. When an ear problem persists or repeatedly returns, this is sometimes called chronic middle ear infection, also known as glue ear. If left untreated, ear infections can have potentially serious consequences.
What is tinnitus?
Tinnitus can be described as “ringing” ears and other head noises that are perceived in the absence of any external noise source. Tinnitus is classified into two types: Objective Tinnitus, the rarer form, consists of head noises audible to other people in addition to the sufferer. The noises are usually caused by vascular anomalies, repetitive muscle contractions, or inner ear structural defects. The sounds are heard by the sufferer and are generally external to the auditory system. This form of tinnitus means that an examiner can hear the sound heard by the sufferer by using a stethoscope. Benign causes, such as noise from TMJ, openings of the Eustachian tubes, or repetitive muscle contractions may be the cause of objective tinnitus.
The sufferer might hear the pulsatile flow of the carotid artery or the continuous hum of normal venous outflow through the jugular vein when in a quiet setting. It can also be an early sign of increased intracranial pressure and is often overshadowed by other neurological abnormalities. The sounds may arise from a turbulent flow through compressed venous structures at the base of the brain. Subjective Tinnitus. This form of tinnitus may occur anywhere in the auditory system and is much less understood, with the causes being many and open to debate. Anything from the ear canal to the brain may be involved. The sounds can range from a metallic ringing, buzzing, blowing, roaring, or sometimes similar to a clanging, popping, or nonrhythmic beating. It can be accompanied by audio-metric evidence of deafness which occurs in association with both conductive and sensorineural hearing loss. Other conditions and syndromes which may have tinnitus in conjunction with the condition or syndrome, are otosclerosis, Meniere’s Disease, and cochlear or auditory neve lesions. Hearing loss, hyperacusis, recruitment, FMS, and balance problems may or may not be present in conjunction with tinnitus.
What could possibly cause tinnitus?
Noise Exposure: Repeated exposure to loud noises such as guns, artillery, aircraft, lawn mowers, movie theaters, amplified music, heavy construction, etc, can cause permanent hearing damage. Anybody regularly exposed to these conditions should consider wearing ear plugs or other hearing protection. Allergic reactions to certain foods: It is widely reported, and widely debated, that some forms of tinnitus may be caused by certain foods such as Growths, tumors, or acoustic neuromas: Otosclerosis: Wax/Dirt Build-up in the Ear Canal: If you’re experiencing tinnitus, this is one of the first things you should check for. NEVER try digging or suctioning the ear canal yourself or allow a physician to do it as SERIOUS damage may result. Numerous over-the-counter chemical washes are available from your drugstore which will clean the ear canal in a safe and gentle manner. Severe Ear Infections: Many tinnitus cases onset after severe ear infections. But this may also be related to the use of ototoxic antibiotics. High Blood Cholesterol: High blood cholesterol clogs arteries that supply oxygen to the nerves of the inner ear.
Reducing your cholesterol level may reduce your tinnitus. Vascular Abnormalities: Arteries may press too closely against the inner ear machinery or nerves. This is sometimes correctable by delicate surgery. Stress: Stress is not a direct cause of tinnitus, but it will generally make an already existing case worse. Diet and Other Lifestyle Choices: Like stress above, a poor diet can worsen an existing case of tinnitus. Alcohol, tobacco, caffeine, quinine/tonic water, high fat, high sodium can all make tinnitus worse in some people. Drugs: Many prescription and over-the-counter drugs may cause tinnitus and/or hearing loss that may be permanent or may disappear when the dosage is reduced or eliminated. Before starting treatment with any prescription drug, tinnitus sufferers should always ask their physician and/or pharmacist about the potential for ototoxic side effects. These drugs include; salicylate analgesics (higher doses of aspirin), naproxen sodium (Naprosyn, Aleve), ibuprofen, many other non-steroidal anti-inflammatories, aminoglycoside antibiotics, anti-depressants, loop-inhibiting diuretics, quinine/anti-malarials, oral contraceptives, and chemotherapy.
Ear Tubes — What should I expect?
Before surgery, the doctor performing the procedure will want to know if you or your child has any known allergies or respiratory problems related to anesthesia. While adults may only need local anesthesia, general anesthesia is usually given to children. When having general anesthesia, you or your child should not eat or drink anything for eight to twelve hours before the operation. Oral antibiotics may be prescribed to begin before surgery and continue afterward to guard against any infection. In addition, no other medications should be taken unless specifically recommended by the doctor performing the procedure.
Because myringotomy is such a simple operation, it is usually performed in an out-patient surgery facility with the patient going home the same day. After the surgery, be sure you understand how to take care of yourself or your child at home to speed recovery and prevent any complications from developing. Your doctor’s instructions for self care may include: allowing the ears to drain freely by not putting cotton in them unless instructed to do so by the doctor, keeping the outer ear clean and dry, keeping hands washed and clean to prevent spread of new infection from the hands to the ears, and taking precautions to keep water out of the ears while bathing and to avoid swimming.
Sinus & Nasal
What measures can be taken at home to relieve sinus congestion?
Warm moist air may alleviate sinus congestion. A vaporizer or steam from a pan of boiled water (removed from the heat) are both recommended (humidifiers should have a clear filter to preclude spraying bacteria or fungal spores into the air). Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are safe for use at home.
How effective are non-prescription nose drops?
Use of nonprescription drops or sprays might help control symptoms. However, non-prescription drops should not be used beyond their label recommendation.
When is sinus surgery necessary?
Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell). Inflammation from an allergy causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus surgery can correct the problem.
Why does a physician specialist carry out nasal endoscopy?
Nasal endoscopy offers the physician specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. First, the patient’s nasal cavity is anesthetized; a rigid or flexible endoscope is then placed in a position to view the structure of the nasal cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the physician specialist also looks for pus as well as polyp formation and structural abnormalities that will cause the patient to suffer from recurrent sinusitis.
What is sinusitis?
Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the para-nasal sinuses. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants; chronic sinusitis is characterized by at least four recurrences of acute sinusitis. Either medication or surgery is a possible treatment.
How common is sinusitis?
More than 37 million Americans suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade due to increased pollution, urban sprawl, and increased resistance to antibiotics.
How is acute sinusitis treated?
Acute sinusitis is generally treated with 10 to 14 days of antibiotic care. With treatment, the symptoms disappear and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms.
What are the signs and symptoms of acute sinusitis?
For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough not due to asthma (in children). Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain, and cough (in adults). Acute sinusitis can last four weeks or more. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection.
What are the signs and symptoms of chronic sinusitis?
Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: facial pain/pressure, facial congestion/fullness, nasal obstruction/ blockage, thick nasal discharge/ discolored post-nasal drainage, pus in the nasal cavity, and at times, fever. They may also have headache, bad breath, and fatigue.
What can be done about primary snoring?
First of all, it is absolutely necessary to rule out obstructive sleep apnea or other sleep disorders. Be wary of any doctor who says it is not necessary. Behavioral and lifestyle changes may be suggested. Losing weight, sleeping on your side, refraining from alcohol and sedatives are often recommended.
What does sinus surgery accomplish?
The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in place as possible. Otolaryngologist head and neck surgeons have found endoscopic surgery to be highly effective in restoring normal functioning to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus.
Snoring & Sleep Apnea
What is Snoring?
What is Snoring? I’m sure just about everyone is somewhat familiar with snoring. You probably know at least one person who snores. It could be your bed partner, your parents, or even your child. Some laugh and make jokes about it, but it can be a symptom of a serious disorder called obstructive sleep apnea. If it is obstructive sleep apnea, then it is no laughing matter. That individual needs to be evaluated by a sleep specialist. Snoring is a noise produced when an individual breathes (usually produced when breathing in) during sleep which in turn causes vibration of the soft palate and uvula. All snorers have incomplete obstruction ( a block) of the upper airway. Many habitual snorers have complete episodes of upper airway obstruction where the airway is completely blocked for a period of time, usually 10 seconds or longer. This silence is usually followed by snorts and gasps as the individual fights to take a breath. When an individual snores so loudly that it disturbs others, obstructive sleep apnea is almost certain to be present. There is snoring that is an indicator of obstructive sleep apnea, and there is also primary snoring. Primary Snoring, also known as simple snoring, snoring without sleep apnea, noisy breathing during sleep, benign snoring, rhythmical snoring and continuous snoring is characterized by loud upper airway breathing sounds in sleep without episodes of apnea (cessation of breath).
What is Sleep Apnea?
The Greek word “apnea” literally means “without breath.” There are three types of apnea: obstructive, central, and mixed; of the three, obstructive is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.
Sleep apnea is very common, as common as adult diabetes, and affects more than twelve million Americans, according to the National Institutes of Health. Risk factors include being male, overweight, and over the age of forty, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences. Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues.
Head & Neck
What are some symptoms of head and neck cancer?
Early symptoms of head and neck cancer include (but are not limited to) a sore in the throat that does not heal, a growth in the mouth, a lump in the neck, a cough or hoarseness, a sore throat that does not improve, coughing up blood. It is important to realize that illnesses other than cancer can cause these symptoms, and that cancer may arise even in the absence of these symptoms. If you are concerned about and abnormality, it is important to go to an Ear Nose and Throat specialist for a complete examination.
How is head and neck cancer diagnosed?
Head and neck cancer is diagnosed by a combination of the history and physical examination, various imaging studies (CAT scans, MRI scans), and biopsies of the tumor. The biopsy is often the most important piece of information. It involves cutting a small piece of the tumor and sending this piece to the pathologist for microscopic examination. If the suspicious region is in the mouth, the biopsy can often be done in the office. However, if there are concerns about regions deeper in the throat, the biopsy will probably be done in the operating room under a general anesthetic. Along with biopsies of suspicious lesions, it is also important to examine the entire throat for any sign of other cancers. This is usually done with a general anesthetic in the operating room in a procedure called “endoscopy”. Endoscopy consists of a careful examination of the lining of the mouth, throat, esophagus and lungs. In some cases, imaging studies can be done in place of the endoscopy, but this may vary according to each institution’s or each physician’s preference.
How is head and neck cancer treated?
Treatment for head and neck cancer is very dependent on the type of tumor, where is has occured, and how large the tumor is. The goal in all cancer treatment is to remove the tumor with as little damage as possible to important structures in the head and neck. For many tumors treatment involves a combination of surgery and radiation therapy. There are some tumors that are treated best with only radiation therapy, and others that can be totally cured with surgery alone. There are too many variables to describe in general how a head and neck tumor is best treated, and each case must be considered on an individual basis by your physicians.
What does the evaluation of a neck lump entail?
The evaluation of a neck lump, nodule, or mass is performed by the Otolaryngologist. It is important to assess a history of smoking in a patient with a neck nodule. A complete head and neck exam is essential to view the entire upper aerodigestive tracts (breathing/swallowing passage). During the ENT office exam, the location of the nodule can often given a clue as to its identity. CT and MRI scanning and other radiographic evaluation is sometimes necessary. Fine needle aspiration (please see thyroid nodule above) is often a centrally important test in the work-up of a neck nodule and represents a microscopic biopsy that usually provides definitive diagnosis without surgery.
What causes a sore throat?
Many things can cause a sore throat. These causes include infections with viruses or bacteria, or sinus drainage and allergies, among others. You should see your doctor right away if you have a sore throat with a high fever, if you have problems breathing or swallowing, or if you feel very faint. If you have a sore throat and a fever, but you just feel mildly ill, you should visit your doctor within the next few days if it persists or worsens. If you have a cold with sinus drainage, you may use over-the-counter medicines for short-term relief.. Visit your doctor if the cold lasts for more than two weeks, or if it gets worse.
How does the doctor decide if I need antibiotics?
The decision to prescribe antibiotics might be based only on your history and physical exam. Antibiotics usually are prescribed only for patients who might have “strep throat,” an infection caused by a bacteria called Streptococcus. A patient with strep throat might have a sore throat with fever that starts suddenly, without a cough or cold symptoms. Strep throat is very common in children from 5 to 12 years of age. The exam might show a red throat, with pus on the tonsils and swollen neck glands. If you have these signs, the doctor may do other tests to see if you need an antibiotic.
What kind of tests might be done?
The two most common tests for strep throat are the throat culture and the rapid strep test. The throat culture is done using a swab to rub the back of your throat. Then the swab is put on a special gel that allows bacteria to grow. It takes about two days for the bacteria to grow. The rapid strep test also includes a swab of your throat. Then special chemicals are used on the swab to find bacteria. Depending on your symptoms, your doctor may also do a culture to make sure you don’t have strep throat. Other tests might include a blood test to check your white blood cell count. A blood test can also check for the virus that causes mononucleosis (mono).
What is a thyroid nodule, and how is it evaluated?
Nodules within the thyroid gland are very frequent in the adult population. Some studies suggest up to 50% of the adult population have thyroid nodules. Thyroid nodules commonly are benign, but may represent thyroid cancers. The risk of thyroid cancer is higher in an elderly age group, and is higher with a past history of radiation therapy. Also, the larger a thyroid nodule is, the higher the risk of malignancy for some nodules. Thyroid nodules may be identified during routine physical exams by general medical physicians, or may be identified by the patient during a shower or during shaving. Thyroid nodules, when they are large enough, can also be sensed as a lump in the neck, especially noticeable during swallowing.
The evaluation of the thyroid nodule involves a complete history and head and neck physical exam, including evaluation of vocal cord function. The nerve to the vocal cord travels just deep to the thyroid and can occasionally be affected by thyroid nodules. This requires a vocal cord evaluation after a complete history and physical exam. Testing is typically recommended, usually a blood test to assess the functioning of the thyroid and often a thyroid ultrasound to assess the exact nature and size of the thyroid nodule. This is a painless test which involves no radiation. The central test for work-up of the thyroid nodule is a fine needle aspiration. Fine needle aspiration (FNA) can be considered a microscopic needle biopsy. This often allows definitive diagnosis. Surgery is typically reserved for lesions that are identified as malignant or suspicious on fine needle aspiration. Other treatment options are available for lesions that are benign on fine needle aspiration. For large thyroid masses/goiter, additional evaluation is often necessary, and may include CT scanning, MRI scanning, or barium swallow. The purpose of these tests is to assess the relationship of the thyroid mass to the adjacent swallowing tube (esophagus) and breathing tube (trachea).
Why not just give everyone antibiotics?
Antibiotics have a small risk of causing an allergic reaction to some patients every time they are given. Some of these reactions are serious. Antibiotics can also cause other side effects, such as an upset stomach or diarrhea. The most serious problem however is that bacteria can become resistant to antibiotics if these medicines are used frequently in a lot of people when the are not truly necessary. If these resistances continue to build, antibiotics wouldn’t be able to cure people’s illnesses. To prevent this from happening, doctors try to prescribe antibiotics only when they know they will help. Antibiotics only help when a sinus infection is caused by bacteria. Antibiotics don’t help when sinus problems are due to viruses, which are the cause of the common cold, or certain fungal infections.
What if my Doctor doesn't give me antibiotics?
It could take several days for you to feel better, no matter what kind of sore throat you have. You can do several things to help your symptoms. If you have a fever or muscle aches, you can take an over-the-counter pain reliever like acetaminophin (Tylenol), aspirin, or ibuprofen (Advil). Your doctor can tell you which pain reliever will work best for you. Cough drops or throat sprays may help your sore throat. Sometimes gargling with warm salt water helps. Soft cold foods, such as ice cream and popsicles, often are easier to eat. Be sure to rest and to drink lots of water.. Don’t drink beverages that have caffeine in them (coffee, tea, or soda).
What is an Otolaryngologist?
An Otolaryngologist, or ear, nose, and throat doctor, is a specialist trained in the diagnosis and treatment of problems of the head and neck. Our physicians are among the finest in their field, and have been educated and trained at some of the finest medical schools in the world. All of our practitioners are board certified by the American Board of Otolaryngology-Head and Neck Surgery. Take a moment to read more about our doctors at Physicians and Staff.