Transnasal Esophagoscopy (TNE)

“Anyone with acid reflux or who has chronic hoarseness, heartburn, indigestion,sore throat, difficulty swallowing, or chronic cough should have a screening transnasal esophagoscopy performed to rule out Barrett’s esophagus or esophageal cancer.”  Dr. Jamie A. Koufman

Transnasal esophagoscopy (TNE) is a technology that allows for examination of the esophagus, the swallowing tube between the throat and stomach, without the patient being put to sleep. Most commonly, this is done to check for cancer and other esophageal disorders. Indeed, the technology has changed. Doctors can now look inside while patients are awake, comfortable, and without pain, using TNE. The idea that you can only be checked for cancer in a special facility and under anesthesia is archaic. Anyone who has difficulty swallowing, painful swallowing, or who had acid reflux, should have a TNE examination. TNE is currently the best method for “screening” the esophagus for trouble. Depending on the findings of the TNE, other diagnostics may be needed.

Transnasal esophagoscopy (TNE) literally means through-the-nose examination of the esophagus (the swallowing tube that connects the throat and the stomach). This is done by numbing one side of the nose with xylocaine and then sliding a small, soft flexible tube through the nose, bypassing the throat area, and going straight into the opening of the esophagus behind the larynx (voice box). TNE can be performed with patients awake and comfortable without putting them out (asleep or sedated) in any way. The TNE examination is every bit as comprehensive and thorough as older more expensive and invasive methods that require sedation in a special endoscopy facility. In 2001, Dr. Koufman first reported a series of TNE patients.

In the years since its introduction, TNE has not proliferated as rapidly as it should have. Unfortunately, the reasons for this have more to do with turf wars between medical specialists than the needs of patients. At this point, there may be  as many as 125 million Americans who need esophageal screening, and at present about 10 million esophageal examinations are performed each year, mostly by gastroenterologists in expensive facilities with the patients under sedation.  The sedated (GI) endoscopy industry costs America more than $50 billion per year! TNE is the safer, less-expensive, and more accurate alternative.

Epidemic Acid Reflux, Barrett’s Esophagus, and Esophageal Cancer

Acid reflux is a high-prevalence disease, which comes in two forms, laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD). Typically, LPR patients have reflux during the day without having heartburn or esophagitis; whereas GERD patients tend to have heartburn and to reflux more at night than during the day.

Acid reflux disease (GERD and LPR) has increased dramatically in the past 50 years; it has increased on average 4% per year. In 2010, we did a study to estimate the prevalence of reflux (GERD and LPR) in America. We found that 40% had reflux disease with 22% having GERD and another 18% (118/656) having LPR. One of the most striking findings was that 37% of the 21-30 year-old age group had reflux. In the past, reflux was primarily a disease of overweight, middle-aged people.

During the same 50 year period, esophageal cancer increased 800%; and in addition, it is now seven-times more deadly. Equally important, Barrett’s esophagus, the precursor to esophageal cancer) is now being seen in 7%-10% of people with LPR and GERD, that is patients with hoarseness, chronic cough, sore throat, and heartburn. Routine esophageal screening for both LPR and GERD patients is recommended.

(Source: http://transnasalesophagoscopy.com/)

Tonsils And Adenoids

Insight Into Tonsillectomy and Adenoidectomy

Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or glands found in the neck, groin, and armpits. Tonsils are the two masses on the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments. Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections, leading to tonsillitis. They sample bacteria and viruses and can become infected themselves. Scientists believe they work as part of the body’s immune system by filtering germs that attempt to invade the body, and that they help to develop antibodies to germs. This happens primarily during the first few years of life, becoming less important as we get older. Children who must have their tonsils and adenoids removed suffer no loss in their resistance.

What Affects Tonsils And Adenoids?

The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing and swallowing problems. Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. Tumors are rare, but can grow on the tonsils.

When Should I See My Doctor?

You should see your Atlanta ENT doctor when you or your child suffer the common symptoms of infected or enlarged tonsils or adenoids.

The Exam

The primary methods used to check tonsils and adenoids are:

  • Medical history
  • Physical examination
  • Throat cultures/Strep tests
  • X-rays
  • Blood tests

What Should I Expect At the Exam?

Your Atlanta physician will ask about problems of the ear, nose, and throat and examine the head and neck. He or she will use a small mirror or a flexible lighted instrument to see these areas. Cultures/strep tests are important in diagnosing certain infections in the throat, especially strep throat. X-rays are sometimes helpful in determining the size and shape of the adenoids. Blood tests can determine problems such as mononucleosis.

How Are Tonsil And Adenoid Diseases Treated In Atlanta?

Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Sometimes, removal of the tonsils and/or adenoids may be recommended. The two primary reasons for tonsil and/or adenoid removal are (1) recurrent infection despite antibiotic therapy and (2) difficulty breathing due to enlarged tonsils and/or adenoids.

Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children. Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes malformations of the face and improper alignment of the teeth.

Chronic infection can affect other areas such as the eustachian tube – the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and potential hearing loss.

Recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion). In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., cortisone) is sometimes helpful.

Tonsillitis And Its Symptoms

Tonsillitis is an infection in one or both tonsils. One sign is swelling of the tonsils. Other signs or symptoms are:

  • Redder than normal tonsils
  • A white or yellow coating on the tonsils
  • A slight voice change due to swelling
  • Sore throat
  • Uncomfortable or painful swallowing
  • Swollen lymph nodes (glands) in the neck
  • Fever
  • Bad breath

Enlarged Adenoids And Their Symptoms

If you or your child’s adenoids are enlarged, it may be hard to breathe through the nose. Other signs of constant enlargement are:

  • Breathing through the mouth instead of the nose most of the time
  • Nose sounds “blocked” when the person speaks
  • Noisy breathing during the day
  • Recurrent ear infections
  • Snoring at night
  • Breathing stops for a few seconds at night during snoring or loud breathing (sleep apnea)

Surgery For Tonsils and Adenoids

Your child: Talk to your child about his/her feelings and provide strong reassurance and support throughout the process. Encourage the idea that the procedure will make him/her healthier. Be with your child as much as possible before and after the surgery. Tell him/her to expect a sore throat after surgery. Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward. If your child has a friend who has had this surgery, it may be helpful to talk about it with that friend.

Adults and children: For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome).

  • If the patient or patient’s family has had any problems with anesthesia, the surgeon should be informed. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed.
  • A blood test and possibly a urine test may be required prior to surgery.
  • Generally, after midnight prior to the operation, nothing (chewing gum, mouthwashes, throat lozenges, toothpaste, water) may be taken by mouth. Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous.

When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.

After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient until discharged. Every patient is special, and recovery times vary for each individual. Many patients are released after 2-10 hours. Others are kept overnight. Intensive care may be needed for select cases.

Your ENT specialist in the Atlanta area will provide you with the details of pre-operative and postoperative care and answer any questions you may have.

After Surgery

There are several postoperative symptoms that may arise. These include (but are not limited to) swallowing problems, vomiting, fever, throat pain, and ear pain. Occasionally, bleeding may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately.

Any questions or concerns you have should be discussed openly with your surgeon, who is there to assist you.

If you believe you may be in need of one of these treatments please contact us or schedule an appointment to see one of our Atlanta ENT physicians in the Buckhead – East Cobb area.

Tinnitus

Treating Tinnitus In Atlanta

Do you hear a roaring, clicking, hissing sound, or ringing in the ears? Do you hear this sound often or all the time? Does the sound bother you a lot? If you answer yes to these questions, you may have tinnitus (tin-NY-tus). Tinnitus is a symptom associated with many forms of hearing loss. It can also be a symptom of other health problems. According to estimates by the American Tinnitus Association, at least 12 million Americans have tinnitus. Of these, at least 1 million experience it so severely that it interferes with their daily activities. People with severe cases of tinnitus may find it difficult to hear, work, or even sleep.

What causes tinnitus?

  • Hearing loss. Doctors and scientists have discovered that people with different kinds of hearing loss also have tinnitus.
  • Loud noise. Too much exposure to loud noise can cause noise-induced hearing loss and tinnitus.
  • Medicine. More than 200 medicines can cause tinnitus. If you have tinnitus and you take medicine, ask your doctor or pharmacist whether your medicine could be involved.
  • Other health problems. Allergies, tumors, and problems in the heart and blood vessels, jaws, and neck can cause tinnitus.

What should I do if I have tinnitus?

The most important thing you can do is to go see your Atlanta ENT doctor. Your doctor can try to determine what is causing your tinnitus. He or she can check to see if it is related to blood pressure, kidney function, diet, or allergies. Your doctor can also determine whether your tinnitus is related to any medicine you are taking. To learn more about what is causing your tinnitus, your doctor may refer you to an otolaryngologist (oh-toe-lair-in-GAH-luh-jist), an ear, nose, and throat doctor. He or she will examine your ears and your hearing to try to find out why you have tinnitus. Another hearing professional, an audiologist (aw-dee-AH-luh-jist), can measure your hearing. If you need a hearing aid, an audiologist can fit you with one that meets your needs.

How will hearing experts treat my tinnitus?

Although there is no cure for tinnitus, scientists and doctors have discovered several treatments that may give you some relief. Not every treatment works for everyone, so you may need to try several to find the ones that help. Treatments can include:

  • Hearing Aids. Many people with tinnitus also have a hearing loss. Wearing a hearing aid makes it easier for some people to hear the sounds they need to hear by making them louder. The better you hear other people talking or the music you like, the less you notice your tinnitus.
  • Maskers. Maskers are small electronic devices that use sound to make tinnitus less noticeable. Maskers do not make tinnitus go away, but they make the ringing or roaring seem softer. For some people, maskers hide their tinnitus so well that they can barely hear it. Some people sleep better when they use maskers. Listening to static at a low volume on the radio or using bedside maskers can help. These are devices you can put by your bed instead of behind your ear. They can help you ignore your tinnitus and fall asleep.
  • Medicine or drug therapy. Some medicines may ease tinnitus. If your doctor prescribes medicine to treat your tinnitus, he or she can tell you whether the medicine has any side effects.
  • Tinnitus retraining therapy. This treatment uses a combination of counseling and maskers. Otolaryngologists and audiologists help you learn how to deal with your tinnitus better. You may also use maskers to make your tinnitus less noticeable. After a while, some people learn how to avoid thinking about their tinnitus. It takes time for this treatment to work, but it can be very helpful.
  • Counseling. People with tinnitus may become depressed. Talking with a counselor or people in tinnitus support groups may be helpful.
  • Relaxing. Learning how to relax is very helpful if the noise in your ears frustrates you. Stress makes tinnitus seem worse. By relaxing, you have a chance to rest and better deal with the sound.

What can I do to help myself?

Think about things that will help you cope. Many people find listening to music very helpful. Focusing on music might help you forget about your tinnitus for a while. It can also help mask the sound. Other people like to listen to recorded nature sounds, like ocean waves, the wind, or even crickets.

Avoid anything that can make your tinnitus worse. This includes smoking, alcohol, and loud noise. If you are a construction worker, an airport worker, or a hunter, or if you are regularly exposed to loud noise at home or at work, wear ear plugs or special earmuffs to protect your hearing and keep your tinnitus from getting worse.

If it is hard for you to hear over your tinnitus, ask your friends and family to face you when they talk so you can see their faces. Seeing their expressions may help you understand them better. Ask people to speak louder, but not shout. Also, tell them they do not have to talk slowly, just more clearly. To schedule an appointment with the Ear, Nose and Throat Institute, please call 770-740-1860. We have offices all over the Atlanta area, from Buckhead to East Cobb, so don’t hesitate to contact us.

Speech Therapy

Your Speech Therapists In Atlanta

The Ear, Nose and Throat Institute in Atlanta is dedicated to providing speech and voice therapy services to patients of all ages. Using the latest in testing and treatment techniques, our experienced Atlanta, GA speech therapists specialize in assisting patients with speech, communication and swallowing disorders. Our speech therapy services includes:

  • Diagnostic evaluation
  • Treatment/speech therapy services
  • Consultations
  • Parent/family training

Without therapy, speech disorders can affect quality of life by interfering with learning and impairing social interaction. Regular sessions with an Atlanta, GA speech therapist can help you improve your confidence along with your communication skills . The number of therapy sessions needed depends on the severity of your condition. Some individuals experience an improvement after a few weeks while others may need years of therapy. Your therapist will determine the best course of treatment after a thorough evaluation.

More about Speech and Language Disorders

Speech disorders can occur in early childhood or may develop later in life as a result of trauma or injury and a speech pathologist may be needed to diagnose the issue. Although speech disorders can affect anyone, they are most prevalent in individuals with the following conditions:

  • Impaired hearing
  • Breathing or swallowing disorders
  • Cleft lip or palate
  • Autism

Common disorders include:

  • Articulation disorders (Speech)
  • Language disorders (Disorders of expression or comprehension)
  • Stuttering
  • Voice disorders

To learn more about speech disorders or The ENT Institute’s speech therapy programs, please call our Atlanta, GA Speech Therapy Doctors & Speech-Language Pathologists at (770) 740-1860 or contact us online.  Click here to Learn More about The Voice Center at ENT Institute.

Speech Pathology

The ENT Institute is staffed by fully licensed speech pathologists dedicated to the clinical care of individuals with voice, swallowing, and speech/communication disorders.

We are committed to providing patients with the highest quality of diagnostic and therapeutic services in order to improve voice, swallowing, and communication abilities and overall quality of life. Our goals are to continuously strive to help you (or someone you know) communicate more clearly, easily, effectively, and confidently and/or swallow (eat/drink) more easily, confidently, and safely. At times, it can seem difficult to get direct answers about your voice, swallowing, or communication difficulties but here at the ENT Institute, you will have our full attention. We understand the fears and frustrations that may coincide with these types of disorders, and we are here to help you.

We recognize that even the minor symptoms you experience can be irritating and possibly interfere with daily life. Your concerns and questions are taken very seriously, no matter how small or large they might seem. And we LISTEN to you. The care you will receive at the ENT Institute is based upon the very latest research findings, and provided by extremely skilled and trained speech pathologists who maintain national and state certifications, competencies, and licenses, and further their expertise through continuing education courses and professional conferences. The speech pathology approach here at the ENT Institute involves consistent communication with you in order to arrive at an individually tailored treatment plan together that can easily fit into your daily life.

For professional singers and speakers, vocal nodules as well as other voice issues and pathologies are treated. Therapies are also available for singers recovering from cancer. In addition to medical intervention, instructions are given for exercises that strengthen the voice and protect vocal chords. Often, singers suffer damage simply from using the wrong part of the throat.

Speech pathologists are responsible for the vocal health and management of patients in order to prevent the occurrence/recurrence of a voice disorder, reduce or eliminate the voice disorder (if present), help the patient produce a voice of the best possible pitch, loudness, and quality in relation to the individual’s age and gender, and rehabilitate the voice to a level of function that enables the patient to fulfill his/her daily voice and/or speech communication needs. You may want to consider visiting the ENT Institute regarding your voice if you are experiencing any of the following symptoms or complaints:

  • voice changes lasting longer than two weeks (especially if you smoke)
  • pain in your throat when talking that is not from a cold or flu
  • a severe change in your voice (or complete loss of voice) lasting longer than a few days that is not associated with a cold or the flu
  • persistent voice changes that inhibit your ability to do your normal activities
  • vocal fatigue
  • hoarseness or other change in the pitch/timbre or quality of your voice
  • a loss in a portion of your speaking or singing range
  • tightness/discomfort or burning sensation in your throat
  • a sensation of something stuck in your throat
  • difficulty making your voice sufficiently loud or soft
  • breathlessness when you speak
  • tremor quality or abrupt starts and stops of your voice that you have difficulty controlling
  • a feeling of the need to cough or clear your throat frequently

Among others, here are some individuals that may benefit from voice therapy services:

  • Professional & vocational voice users
  • Presenters/Lecturers
  • TV/Radio Broadcasters
  • Actors/Singers
  • Ministers
  • Lawyers
  • Teachers
  • Receptionists
  • Telemarketers
  • Fitness Instructors/Cheerleaders
  • Police/Military Personnel
  • Anyone already diagnosed with a voice disorder/pathology

Speech pathologists are responsible for the dietary management of patients in order to prevent aspiration and limit its occurrence, prevent aspiration pneumonia, reduce the occurrence of weight loss from swallowing difficulty, and reduce swallowing problems overall – thus improving quality of daily life (as each day involves eating, drinking, and maintaining sufficient nutrition). You may want to consider visiting the ENT Institute regarding your swallowing if you are experiencing any of the following complaints or symptoms:

  • coughing during eating or drinking (or soon after)
  • increased congestion in the chest after eating
  • the need to swallow multiple times for one mouthful of food
  • fatigue or shortness of breath while eating/drinking
  • difficulty with pills
  • prolonged mealtimes
  • difficulty or increased effort to chew or swallow
  • a rise in temperature (fever)
  • a weight loss associated with increased slowness during eating/drinking
  • frequent pneumonia
  • runny nose or eyes during eating/drinking or afterwards

The Voice Center

Is using your voice an important part of your job?  Singers, actors, teachers, lawyers, preachers and other public speakers need to take special care of their voice — and attend quickly to any voice-related issues. The Voice Center at the ENT Institute provides that kind of specialized care. Services include various types of testing and evaluation for risk factors, as well as voice therapy and ‘vocal hygiene’ training. Professionals voice users can learn about preventative measures and vocal techniques that help reduce damage and keep their voice clear and strong over time.