CCENT Fresno
1351 East Spruce
Suite 100
Fresno, CA. 93720
Fresno: 559-432-3303
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Head & Neck Surgery Pediatric Otolaryngology ENT Facial Surgery Center
Sinus Surgery Sleep Disorders & Snoring Tinnitus
Allergy Vertigo & Dizziness Thyroid Gland
Hearing Loss Acid Reflux (GERD) (LPR) Parotid Gland
Sore Throat Cholesteatoma Swallowing Disorders
Bells Palsy Nosebleeds Dysphagia
Mouth Sores        


About Central California Ear Nose & Throat

CCENT is Central California's respected source for Ear Nose & Throat care. Our Ear Nose & Throat practice was established in 1966 and enjoys being the premiere practice between Los Angeles and San Francisco. We have eight ENT physicians with general otolaryngology and sub-specialty expertise. CCENT is affiliated with the University of California at San Francisco (UCSF). We also benefit from our community's five major hospitals and their excellent support services.

Central California Ear Nose and Throat is a comprehensive service provider. Our full on-site ambulatory surgery center with Image-Guidance technology is a cornerstone to our broad otolaryngology support services. Add together our comprehensive services, facilities and excellent administrative management and you'll see why CCENT is the only choice for your ENT care in the San Joaquin Valley.

Doctor, What Is an Otolaryngologist—Head and Neck Surgeon?

Insight into ear, nose, and throat specialists

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, and 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.

Reprinted with permission of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, copyright © 2006. All rights reserved.

Head & Neck Surgery and Sinus Surgery

CCENT provides a full spectrum of Head & Neck and Sinus Surgery options. Our Board Certified physicians will determine whether surgery is an option for treatment and we offer comprehensive service by way of our ENT Facial Surgery Center. Our Sinus Surgery options include FESS (Functional Endoscopic Sinus Surgery), Image Guided Surgery, and Minimally Invasive Sinus Surgery.

Doctor, Please Explain Head and Neck Cancer

More than 55,000 Americans will develop cancer of the head and neck (most of which is preventable) this year; nearly 13,000 of them will die from it.

Find It Early and Be Cured

Tobacco is the most preventable cause of these deaths. In the United States, up to 200,000 people die each year from smoking-related illnesses. The good news is that this figure has decreased due to the increasing number of Americans who have quit smoking. The bad news is that some of these smokers switched to smokeless or spit tobacco, assuming it is a safe alternative. This is untrue - they are merely changing the site of the cancer risk from their lungs to their mouth. While lung cancer cases are down, cancers in the head and neck appear to be increasing. Cancer of the head and neck is curable if caught early. Fortunately, most head and neck cancers produce early symptoms. You should know the possible warning signs so you can alert your doctor to your symptoms as soon as possible. Remember - successful treatment of head and neck cancer can depend on early detection. Knowing and recognizing the signs of head and neck cancer can save your life.

Here's What You Should Watch for:

A lump in the neck...Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a physician as soon as possible. Of course, not all lumps are cancer. But a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voicebox (larynx), thyroid gland, or of certain lymphomas or blood cancers. Such lumps are generally painless and continue to enlarge steadily.

Change in the voice...Most cancers in the larynx cause some change in voice. Any hoarseness or other voice change lasting more than two weeks should alert you to see your physician. An otolaryngologist is a head and neck specialist who can examine your vocal cords easily and painlessly. While most voice changes are not caused by cancer, you shouldn't take chances. If you are hoarse more than two weeks, make sure you don't have cancer of the larynx. See your doctor.

A growth in the mouth...Most cancers of the mouth or tongue cause a sore or swelling that doesn't go away. These sores and swellings may be painless unless they become infected. Bleeding may occur, but often not until late in the disease. If an ulcer or swelling is accompanied by lumps in the neck, be very concerned. Your dentist or doctor can determine if a biopsy (tissue sample test) is needed and can refer you to a head and neck surgeon to perform this procedure.

Bringing up blood...This is often caused by something other than cancer. However, tumors in the nose, mouth, throat or lungs can cause bleeding. If blood appears in your saliva or phlegm for more than a few days, you should see your physician.

Swallowing problems...Cancer of the throat or esophagus (swallowing tube) may make swallowing solid foods difficult. Sometimes liquids can also be troublesome. The food may "stick" at a certain point and then either go through to the stomach or come back up. If you have trouble almost every time you try to swallow something, you should be examined by a physician. Usually a barium swallow x-ray or an esophagoscopy (direct examination of the swallowing tube with a telescope) will be performed to find the cause.

Changes in the skin...The most common head and neck cancer is basal cell cancer of the skin. Fortunately, this is rarely a major problem if treated early. Basal cell cancers appear most often on sun-exposed areas like the forehead, face, and ears, although they can occur almost anywhere on the skin. Basal cell cancer often begins as a small, pale patch that enlarges slowly, producing a central "dimple" and eventually an ulcer. Parts of the ulcer may heal, but the major portion remains ulcerated. Some basal cell cancers show color changes. Other kinds of cancer, including squamous cell cancer and malignant melanoma, also occur on the skin of the head and neck. Most squamous cell cancers occur on the lower lip and ear. They may look like basal cell cancers and, if caught early and properly treated, usually are not much more dangerous. If there is a sore on the lip, lower face, or ear that does not heal, consult a physician. Malignant melanoma classically produces dense blue-black or black discolorations of the skin. However, any mole that changes size, color, or begins to bleed may be trouble. A black or blue-black spot on the face or neck, particularly if it changes size or shape, should be seen as soon as possible by a dermatologist or other physician.

Persistent Earache...Constant pain in or around the ear when you swallow can be a sign of infection or tumor growth in the throat. This is particularly serious if it is associated with difficulty in swallowing, hoarseness or a lump in the neck. These symptoms are best evaluated by an otolaryngologist.

Identifying High Risk of Head and Neck Cancer

As many as 90 percent of head and neck cancers arise after prolonged exposure to specific factors. Use of tobacco (cigarettes, cigars, chewing tobacco or snuff) and alcoholic beverages are closely linked with cancers of the mouth, throat, voice box and tongue. (In adults who neither smoke nor drink, cancer of the mouth and throat are nearly nonexistent.) Prolonged exposure to sunlight is linked with cancer of the lip and is also an established major cause of skin cancer.

What You Should Do...All of the symptoms and signs described here can occur with no cancer present. In fact, many times complaints of this type will be due to some other condition. But you can't tell without an examination. So, if they do occur, see your doctor–and be sure.

REMEMBER: When found early, most cancers in the head and neck can be cured with relatively little difficulty. Cure rates for these cancers could be greatly improved if people would seek medical advice as soon as possible. So play it safe. If you think you have one of the warning signs of head and neck cancer, see your doctor right away.

BE SAFE: See your doctor early! And practice health habits which will make these diseases unlikely to occur.

Reprinted with permission of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, copyright © 2006. All rights reserved.

Cholesteatoma:  A Serious Ear Condition

What is a cholesteatoma?
Why did it occur in the ear?
How does it occur?
What are the symptoms?
How is it dangerous?
What treatment can be done?
When should something be done about it?
If nothing is done, what can happen?
Will I always have this problem?
Can it be removed or cured?


What is a cholesteatoma?

A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually due to repeated infection, which causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth.


How does it occur?

A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure (“clear the ears”). When the eustachian tubes work poorly perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body, and a partial vacuum results in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.


What are the symptoms?

Initially, the ear may drain, sometimes with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. (An ache behind or in the ear, especially at night, may cause significant discomfort.) Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any, or all, of these symptoms are good reasons to seek medical evaluation.


Is it dangerous?

Ear cholesteatomas can be dangerous and should never be ignored. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and rarely death can occur.


What treatment can be provided?

An examination by an otolaryngologist-head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated.

Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone next to the ear), and CAT scans (3-D x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused.

Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection and achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; and therefore, a second operation may be performed six to twelve months later. The second operation will attempt to restore hearing and, at the same time, inspect the middle ear space and mastoid for residual cholesteatoma.

Admission to the hospital is usually done the morning of surgery, and if the surgery is performed early in the morning, discharge may be the same day. For some patients, an overnight stay is necessary. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Time off from work is typically one to two weeks.  Follow-up office visits after surgical treatment are necessary and important, because cholesteatoma sometimes recurs. In cases where an open mastoidectomy cavity has been created, office visits every few months are needed in order to clean out the mastoid cavity and prevent new infections. In some patients, there must be lifelong periodic ear examinations.

Summary

Cholesteatoma is a serious but treatable ear condition which can only be diagnosed by medical examination. Persisting earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness signals the need for evaluation by an otolaryngologist-head and neck surgeon.

Reprinted with permission of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, copyright © 2006. All rights reserved.

Sore Throats:  Insight into causes and treatments of sore throats

What Causes a Sore Throat?

Sore throat is a symptom of many medical disorders. Infections cause the majority of sore throats and are contagious. Infections are caused either by viruses such as the flu, the common cold, mononucleosis, or by bacteria such as strep, mycoplasma, or hemophilus.  While bacteria respond to antibiotic treatment, viruses do not.

Viruses: Most viral sore throats accompany flu or colds along with a stuffy, runny nose, sneezing, and generalized aches and pains.  These viruses are highly contagious and spread quickly, especially in winter. The body builds antibodies that destroy the virus, a process that takes about a week.   Sore throats accompany other viral infections such as measles, chicken pox, whooping cough, and croup. Canker sores and fever blisters in the throat also can be very painful.

One viral infection takes much longer than a week to be cured: infectious mononucleosis, or “mono.” This virus lodges in the lymph system, causing massive enlargement of the tonsils, with white patches on their surface and swollen glands in the neck, armpits, and groin. It creates a severely sore throat and, sometimes, serious breathing difficulties. It can affect the liver, leading to jaundice—yellow skin and eyes. It also causes extreme fatigue that can last six weeks or more.  “Mono,” a severe illness in teenagers but less severe in children, can he transmitted by saliva. So it has been nicknamed the “kissing disease,” but it can also be transmitted from mouth-to-hand to hand-to-mouth or by sharing of towels and eating utensils.

Bacteria: Strep throat is an infection caused by a particular strain of streptococcus bacteria. This infection can also damage the heart valves (rheumatic fever) and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections. Because of these possible complications, a strep throat should be treated with an antibiotic. Strep is not always easy to detect by examination, and a throat culture may be needed. These tests, when positive, persuade the physician to prescribe antibiotics. However, strep tests might not detect other bacteria that also can cause severe sore throats that deserve antibiotic treatment. For example, severe and chronic cases of tonsillitis or tonsillar abscess may be culture negative. Similarly, negative cultures are seen with diphtheria, and infections from oral sexual contacts will escape detection by strep culture tests.

Tonsillitis is an infection of the lumpy tissues on each side of the back of the throat. In the first two to three years of childhood, these tissues “catch” infections, sampling the child’s environment
to help develop his immunities (antibodies). Healthy tonsils do not remain infected. Frequent sore throats from tonsillitis suggest the infection is not fully eliminated between episodes. A medical study has shown that children who suffer from frequent episodes of tonsillitis (such as three- to four- times each year for several years) were healthier after their tonsils were surgically removed.

Infections in the nose and sinuses also can cause sore throats because mucus from the nose drains down into the throat and carries the infection with it.  The most dangerous throat infection is epiglottitis, caused by bacteria that infect a portion of the larynx (voice box) and cause swelling that closes the airway. This infection is an emergency condition that requires prompt medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult. A strep test may miss this infection.

Allergy: The same pollens and molds that irritate the nose when they are inhaled also may irritate the throat. Cat and dog danders and house dust are common causes of sore throats for people with allergies to them.

Irritation: During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need examination and treatment of the nose. Pollutants and chemicals in the air can irritate the nose and throat, but the most common air pollutant is tobacco smoke. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods. A person who strains his voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain but also from the rough treatment of his throat membranes.

Reflux: An occasional cause of morning sore throat is regurgitation of stomach acids up into the back of the throat. To avoid reflux, tilt your bedframe so that the head is elevated four- to six- inches higher than the foot of the bed. You might find antacids helpful. You should also avoid eating within three hours of bedtime, and eliminate caffeine and alcohol. If these tips fail, see your doctor.

Tumors: Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long-time use of tobacco and alcohol. Sore throat and difficulty swallowing—sometimes with pain radiating to the ear—may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Other important symptoms include hoarseness, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.

When should I take antibiotics?

Antibiotics are drugs that kill or impair bacteria. Penicillin or erythromycin (well-known antibiotics) are prescribed when the physician suspects streptococcal or another bacterial infection that responds to them. However, a number of bacterial throat infections require other antibiotics instead. Antibiotics do not cure viral infections, but viruses do lower the patient’s resistance to bacterial infections. When such a combined infection occurs, antibiotics may be recommended.

When an antibiotic is prescribed, it should be taken as the physician directs for the full course (usually 10 days). Otherwise the infection will probably be suppressed rather than eliminated, and it can return.
Some children will experience recurrent infection despite antibiotic treatment. When some of these are strep infections or are severe, your child may require a tonsillectomy.

Should other family members be treated or cultured?

When a strep test is positive, many experts recommend treatment or culturing of other family members. Practice good sanitary habits; avoid close physical contact; and sharing of napkins, towels, and utensils with the infected person. Handwashing makes good sense.

What if my throat culture is negative?

A strep culture tests only for the presence of streptococcal infections. Many other infections, both bacterial and viral, will yield negative cultures and sometimes so does a streptococcal infection. Therefore, when your culture is negative, your physician will base his/her decision for treatment on the severity of your symptoms and the appearance of your throat on examination.

How Can I Treat My Sore Throat?

A mild sore throat associated with cold or flu symptoms can be made more comfortable with the following remedies.

  • Increase your liquid intake. Warm tea with honey is a favorite home remedy.
  • Use a steamer or humidifier in your bedroom.
  • Gargle with warm salt water several times daily: ¼ tsp. salt to ½ cup water.
  • Take mild pain relievers such as acetaminophen (Tylenol Sore Throat®, Tempra®) or ibuprofen (Advil®).

When Should I See a Doctor?

Whenever a sore throat is severe, persists longer than the usual five- to seven- day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your physician:

  • Severe and prolonged sore throat
  • Difficulty breathing
  • Difficulty swallowing
  • Difficulty opening the mouth
  • Joint pain
  • Earache
  • Rash
  • Fever (over 101N)
  • Blood in saliva or phlegm
  • Frequently recurring sore throat
  • Lump in neck
  • Hoarseness lasting over two weeks

Doctor, I have trouble Swallowing

Insight into dysphagia:  swallowing problems

Swallowing Disorders

Difficulty in 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. This may be caused by many factors, most of which are not threatening and temporary. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself, in a short period of time, you should see an otolaryngologist–head and neck surgeon.

How you swallow

People normally swallow hundreds of times a day to eat solids, drink liquids, and swallow the normal saliva and mucus that the body produces. The process of swallowing has four stages:

  1. The first is oral preparation, where food or liquid is manipulated and chewed in preparation for swallowing.
  2. During the oral stage, the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
  3. The pharyngeal stage begins as food or liquid is quickly passed through the pharynx (the canal that connects the mouth with the esophagus) into the esophagus or swallowing tube.
  4. In the final, esophageal stage, the food or liquid passes through the esophagus into the stomach.

Although the first and second stages have some voluntary control, stages three and four occur by themselves, without conscious input.

What causes swallowing disorders?

Any interruption in the swallowing process can cause difficulties. It may be due to simple causes such as poor teeth, il-fitting dentures, or a common cold. One of the most common causes of dysphagia is gastroesophageal reflux. This occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort. Other causes may include: stroke; progressive neurologic disorder; the presence of a tracheostomy tube; a paralyzed or unmoving vocal cord; a tumor in the mouth, throat, or esophagus; or surgery in the head, neck, or esophageal areas.

Symptoms of swallowing disorders may include:

  • drooling,
  • a feeling that food or liquid is sticking in the throat,
  • discomfort in the throat or chest (when gastroesophageal reflux is present),
  • a sensation of a foreign body or “lump” in the throat,
  • weight loss and inadequate nutrition due to prolonged or more significant problems with    swallowing, and
  • coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing, and being sucked into the lungs.

Who evaluates and treats swallowing disorders?

When dysphagia is persistent and the cause is not apparent, the otolaryngologist–head and neck surgeon will discuss the history of your problem and examine your mouth and throat. This may be done with the aid of mirrors or a small tube (flexible laryngoscope), which provides vision of the back of the tongue, throat, and larynx (voice box). If necessary, an examination of the esophagus, stomach, and upper small intestine (duodenum) may be carried out by the otolaryngologist or a gastroenterologist. These specialists may recommend X-rays of the swallowing mechanism, called a barium swallow or upper G-I, which is done by a radiologist.

If special problems exist, a speech pathologist may consult with the radiologist regarding a modified barium swallow or videofluroscopy. These help to identify all four stages of the swallowing process. Using different consistencies of food and liquid, and having the patient swallow in various positions, a speech pathologist will test the ability to swallow. An exam by a neurologist may be necessary if the swallowing disorder stems from the nervous system, perhaps due to stroke or other neurologic disorders.

Possible Treatments

Many of these disorders can be treated with medication. 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.

Gastroesophageal reflux can often be treated by changing eating and living habits — for example:

            • Eat a bland diet with smaller, more frequent meals,
            • Eliminate alcohol and caffeine,
            • Reduce weight and stress,
            • Avoid food within three hours of bedtime, and
            • Elevate the head of the bed at night.

If these don’t help, antacids between meals and at bedtime may provide relief.

Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or restimulating 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.

Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary.

Surgery is used to treat certain problems. If a narrowing or stricture exists, the area may need to be stretched or dilated. If a muscle is too tight, it may need to be dilated or even released surgically. This procedure is called a myotomy and is performed by an otolaryngologist–head and neck surgeon.

Many causes contribute to swallowing disorders.  If you have a persistent problem swallowing, see an otolaryngologist–head and neck surgeon.
 
Once the cause is determined, swallowing disorders may be treated with:

               • Medication
               • Swallowing therapy
               • Surgery

Reprinted with permission of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, copyright © 2006. All rights reserved.


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A team of professionals providing a full range of otolaryngology services to the residents of the Central San Joaquin Valley . Our physicians bring the best in care through our expert centers - The ENT Facial Surgery Center, Physicians Hearing Services, and the Aesthetic Plastic Surgery Pavilion. Meet Our ENT Physicians & Professional Staff