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Dr Kendall Dicairano graduated cum laude with a Bachelors of Science in communication sciences and disorders from James Madison University in Virginia. She then earned her Doctor of Audiology (Au.D.) degree from Montclair State University in New Jersey. Dr Kendall Dicairano is a NY State licensed audiologist at the New York Otolaryngology Group with two locations in NYC.
Dr. Dicairano completed her fourth-year residency at Robert Wood Johnson University Hospital, where she focused on a variety of diagnostic testing for adults and pediatric populations and led the program for newborn hearing screenings in the well baby nursery and NICU. She most recently practiced at JFK Johnson Rehabilitation Institute during which she gained extensive experience in vestibular/balance testing, complete audiological evaluations, and hearing aid selection, fitting, and verification. Dr. Dicairano is currently a licensed Audiologist and Hearing Aid Dispenser in the State of New York.
6154
Recurring hoarseness comes and goes, is there an issue with the vocal cords?
QUESTION: I have acid reflux, small hiatal hernia, and GERD. I am a female senior and I have been suffering from recurring hoarseness. When I feel stressed I believe it tightens up my vocal cords and I sound raspy, and it is very embarrassing. What can I do? Is there anything to permanently cure this? Have my vocal cords atrophied?
ANSWER: First of all, thank you for your question. There are many reasons that one can have problems with your voice- as you describe.
The vocal cords are muscles, covered with a thin membrane. When we breathe the vocal cords open and when we speak the vocal cords come together. They must come together smoothly and close completely for a normal voice. Anything that keeps the vocal cords from coming together smoothly will affect your voice quality. The first thing one needs to be certain of is that there is no tumor, nodule or polyp on one or both cords. This will keep the cords from closing completely, and leave the speaker with a hoarse or raspy voice. At times one can push through this by forcing the cords closed- but the more this is done, the more hoarse one gets.
A hiatal hernia, or a weakness in the valve that keeps acid in the stomach, can cause reflux of acid contents as high as the voice box. Should the acid – even a small amount- hit the vocal cords, it causes irritation, swelling of the cords and hoarseness. It often causes the feeling that we have to clear our throat- and clearing the throat bangs the cords together and actually makes the swelling and voice worse. Treatment for reflux- diet, positional and at times medication can help this.
The vocal cords are muscles, and like any muscle, they can lose bulk. In that case, which is quite common, the vocal cords do not close completely without forcing- and this can also cause symptoms as you describe. At times one can force through this, but then the muscles fatigue and the voice gives out. This may respond to vocal exercises- and sometimes your ENT voice specialist may recommend a procedure to “bulk up” the cords so that they can close more readily.
Other less common causes include neurologic issues (stroke, Parkinson’s, neuropathies) that can cause similar complaints. Obviously, I cannot tell you if the problem is one or more of these issues. Clearly, the most important first step is to have your ENT doctor closely examine you and your vocal cords and figure out the cause of your vocal problems- and then together with you figure out how to help.
I hope this helps clears things up.
Robert L Pincus MD NY Otolaryngology Group
5561
Am I a candidate for Laryngeal Framework (pitch lowering) Surgery?
QuestionI am a 38 year-old male with a high-pitched voice, especially over the phone. I found out about you while searching for answers to fixing high pitched voice for men. I saw on your website your replied to a 19 year-old man with a high-pitched voice suggesting Pitch Lowering Surgery.
I live in California and went to a speech therapist, and they told me my voice can be fixed with the surgery. When I went to an ENT doctor he mentioned that my vocal cords seem normal. He said I just have to live with the high-pitched voice and surgery can damage my voice.
But I was somewhat relieved when I found you can fix this.
I wanted to ask you if I can be a candidate for Laryngeal Frame Work Surgery and if there are any risks associated with it ?
Also, I was not able to find out any doctor in California that performs this kind of surgery. Would you know any doctor here in California who is good at performing this surgery ? If not, then I don’t mind coming to NY for this surgery. Thank you.
Answer
It sounds like you would be a candidate for the pitch lowering surgery. We do recommend evaluation first by a speech therapist with testing of your vocal frequency (natural pitch).
Laryngeal framework surgery is done with local anesthesia as an outpatient.
It involves removing one or two strips of cartilage from the larynx or voice box and allows the vocal folds to relax thereby lowering the pitch.
Certainly, any surgery has risks, and these include that of having a breathy or weaker voice among other unlikely problems. But these should be discussed further with your surgeon time when it’s time to have the procedure done.
I am unsure who does surgery on the west coast. However, I would speak to someone who specializes in laryngology or voice problems rather than a general ear nose and throat physician.
I have lost my sense of smell and my doctor says it cannot be treated
Question:
I have a question for Dr. Robert Pincus. I was prescribed oral steroids (methylprednisolone 4mg) due to loss of smell. I took the 7 day regime of oral steroids. About 10 days after completing this treatment I again lost my sense of smell. My doctor said this could not be treated. I am seeking a second opinion from you. Thank you for any information you can provide.
Answer:
Thank you for your question. It is not hopeless when you have lost your sense of smell. There are two main reasons that we lose the sense of smell. The first and most common is that there is congestion in the nose at the area of the cribriform plate (the top of the nasal cavity) where the smell fibers are located. This happens when we have a cold or often from a sinus infection or nasal polyps. Obviously, these are not only treatable, but will almost always get better.
Damage to the smell fibers themselves, either after a viral infection, trauma, breathing in certain toxins, or other causes are more difficult to treat.
At the NY Sinus Center we believe it is important to find out what has caused your loss of smell and aim our treatments at the particular cause of your problem.
The fact that your smell improved temporarily with oral steroids is an EXCELLENT sign that your sense of smell is both treatable and more likely to be regained. We would be happy to try to help.
I hope this helps clear things up.
Robert Pincus MD
Co-Director NY Sinus Center
NY Otolaryngology Group ” Care beyond excellence”
5168
Are Steroids the right treatment for Sudden Sensor Hearing Loss?
Question: Hello, my little sister who is 20 just got diagnosed with sudden sensor neural hearing loss (SSHL) and I just wanted to get some expert opinion on what she is supposed to do and what the appropriate treatment is. She has completely lost hearing in one ear. She is taking steroids, but she has not seen any improvement since she got diagnosed. Is there anything else she can do to increase her chance of recovery?
Answer:
The next step to treating sudden sensor neural hearing loss is usually an intratympanic injection of a steroid medication. This is a usually painless procedure done in the office with topical anesthesia where a liquid steroid medication is injected through the eardrum into the middle ear space.
If she is in the New York area I suggest she Dr. Neil Sperling at our practice.
Hope this clears things up,
Dr. Scott Gold
5144
Developed Sinusitis After Lefort Procedure
Question: Hello, I have been experiencing sinus problems after undergoing jaw surgery last year. I had a Lefort 3 procedure for temporomandibular joint dysfunction (TMJ) and a maligned jaw in October 2014. Almost immediately after surgery, I felt a tract from my nose running into my cheek, and my cheek on that side of my face was definitely more swollen. Then I developed a case of sinusitis and have been on numerous courses of antibiotics since then, with little or no relief. Due to my post-surgery issues, I have seen 2 ENT surgeons to get some answers and help, as I need relief from this. I had two endoscopy sinus biopsies done and both came back negative. After everything, I now have pressure and pain on my nasal bridge. I still just don’t feel well and have been experiencing sinus headaches.
Can you suggest anything? Even possibly consider a second opinion? I have had an endodontist visit to check out my root canals and they came back fine. I also have had two CT scans done, and they both were apparently negative. Please help me!
Answer:
Unfortunately, it is difficult to give you a definitive answer to why this has happened without performing an in-person evaluation and looking at your medical history. However, complications and sinus problems after jaw surgery, such as sinusitis, can occur. But the answer as to why this happens also varies on the individual and the variables at hand. I would suggest another ENT and possibly get an OMFS consultation/opinion. If you are in the New York City area I suggest seeing Dr. Robert Pincus or myself (Dr. Scott Gold) at our practice. If you are not in the New York area we might be able to suggest an expert closer to you.
Hope this clears things up!
Scott Gold, MD
The New York Otolaryngology Group
5135
Is my son’s Speech Therapy causing more harm than good?
Question: I am concerned that while my son (aged 5) is attending a Speech and Language Therapist (SALT) for voice retraining for over a year, I feel it is causing more harm than good.
He had a nodule removed about a year ago. He continues to talk deep and hoarse and becomes high pitched when self-conscious, especially when with SALT.
Very concerned as he knows she not only thinks he talks wrong but watches how he walks, etc as attending physio for tippy toe walking.
My child is bright but has little developmental problems due to prematurity. Born at 26weeks. He is extremely social and totally tuned in. But as soon as he goes into the clinic his voice changes and the poor child tries to walk correctly as feels she is checking that out as well.
I am a Nurse and am increasingly concerned. I do not want my son to stop going if he will benefit but feel the negative effect will outweigh any possible benefit at this stage. Do you think his therapy is causing him more harm than good? Any suggestions?
Answer: I would suggest a fresh ENT and SALT evaluation. New opinions can always help.
If you are in the New York area I would start with Dr. Robert Pincus at our practice.
Hope this clears things up!
Dr. Scott Gold
5118
I haven’t been able to smell my entire life. Do I have congenital anosmia?
Diagnosed with Congenital Anosmia
Question: I haven’t been able to smell my entire life (I put my birthday as the onset date). A doctor I went to diagnosed it as “congenital anosmia” but couldn’t do anything more for me. He prescribed an oral corticosteroid plan but I had no change in my ability to smell, so he said there’s nothing else he can do. I’m hoping there are more resources out there. I put severe migraines as a symptom because as a young child I used to get terrible migraines so bad I would randomly fall over. I got tests done though, and there was nothing out of the ordinary, and they no longer occur, so I’m not sure if that’s relevant, but I wanted to put it regardless. I’ve tried taste testing because I know that smell greatly affects taste. When I did a blind taste test, I had absolutely no idea what I was eating. However, I have favorite foods, and there are things I don’t like so I know I have a sense of taste, but I just can’t recognize any specific flavors.
I’m not from New York, I’m from Pennsylvania, but I’m just hoping for some answers or some other resources or some clinical trial somewhere, or basically anything. Nobody else I’ve seen has been able to help.
Answer:
First of all, thank you for your question. As you obviously realize, the loss of smell can cause many problems. We use the sense of smell to detect danger—varying from a gas leak to rotting food. The loss of smell interferes with our enjoyment of food and our daily activities. While about 1/5 of cases of loss of smell have an unknown cause, most can be related to a viral infection, head trauma or infection. A small group is born without a sense of smell. This is called congenital anosmia.
The most common syndrome causing congenital anosmia
While this can be due to a mutation on chromosome 18, the most common syndrome causing congenital anosmia is Kallmann’s Syndrome. Kallmann’s Syndrome’s two most common findings are the congenital absence of smell and delayed puberty. While we are still not able to find a way to help with the lack of the sense of smell, once diagnosed, hormonal therapy will be successful in treating the delay or absence of sexual maturation.
One can usually differentiate congenital anosmia from the loss of smell that may have occurred in infancy by an MRI of the olfactory bulb. The olfactory bulb is an area in the brain, just above the sinuses, where the smell nerves are located. The olfactory bulb may be absent in people born without the sense of smell.
Promising therapies for congenital anosmia
While we have therapies that have been shown to help for acquired anosmia, so far we do not have a good therapy for its congenital absence. Work, though, is being done. A study at the University of Michigan a few years back showed good results in treating mice with congenital anosmia.
One of the nations leading centers for the study of the sense of smell is at the University of Pennsylvania Smell and Taste Center. While we’d be happy to see you at the NY Sinus Center for this, you might start by going there for an evaluation and to see whether you may be a candidate for one of their studies.
I hope this helps clear things up.
Robert Pincus MD
Co-Director NY Sinus Center
NY Smell and Taste Center
5109
I became dizzy and have lost hearing
Question: Please help me. On Tuesday, November 4th I decided to sign up to the local gym in my neighborhood and get back in shape. I got there in the morning I had and Omlete and some fresh squeezed OJ at the Cafe, then I started my workout. I was on the elliptical for about 35mins. Then I went upstairs to the weight room. I started using the weight machines, by the time I got to the 3rd machine for Shoulder press, I started getting Dizzy, feeling very hot, and nauseous, I was extremely weak. I was so dizzy I couldn’t get up to walk. I felt close to passing out. I had to sit there for about 30 mins. When I got outside I started vomiting up breakfast. My ears felt clogged and muffled. I felt so horrible. I finally made it back to my car. I had to lay down in the backseat until the dizziness wore off. It’s now November 25th and my hearing is still not back to normal. Is this low-frequency hearing loss? I still can’t hear any Bass (lows) in my right ear.
Please help me. This is a Disaster for me because I am a musician, that’s what I do for a living.
Answer:
There are several different problems that can cause dizziness and a hearing loss. The most common may be a viral infection in the inner ear. A virus can sometimes go to the nerves in the inner ear, causing dizziness and a hearing loss. While the dizziness will resolve, often, on its own- the hearing loss may not. Meniere’s Disease is recurrent episodes of dizziness, hearing loss and a sense of fullness in the ears. This may be consistent with the first episode of Meniere’s, but generally, the dizziness will last for a much longer time.
One can have a rupture of a membrane in the inner ear. This often will be accompanied by a popping sound, but usually will be caused by trauma or certainly can occur from strenuous exercise. There are also several other less common causes of your symptoms.
However, it is really quite important that you have your ears evaluated as soon as possible. If you have had damage to the hearing nerve, then the sooner it is treated, the better chance one has of getting the hearing back to normal.
I hope this helps clear things up.
Robert Pincus MD
NY Otolaryngology Group
5084
Dr Marc D’Aprile, Sc.D.
Dr Marc D’Aprile is a NY State licensed audiologist at the New York Otolaryngology Group with two locations in NYC.
Director of Audiology
Dr Marc D’Aprile, Sc.D. received a scientific doctorate in audiology from Seton Hall University in 2004. He completed his audiology residency at the Manhattan, Brooklyn and St.Albans veterans hospitals. Dr.D’Aprile then went on to work at a major hearing aid manufacturer, where he furthered his knowledge in audiology and advanced hearing aid technology. More recently, Dr. D’Aprile served as Assistant Professor of Audiology at Columbia University.
He is a fellow of the American Speech-language-Hearing Association (ASHA), a current holder of a Certificate of Clinical Competence in audiology (CCC-A), a NY state licensed Audiologist, and hearing aid dispenser.Dr. D’Aprile’s main areas of interest and expertise lie in the fitting and dispensing of state-of-the-art hearing aids, tinnitus management and custom hearing protection. His knowledge base has been maintained through regular attendance in continuing education seminars, national and state conventions, and through the direction of scholarly literature.
Dr Marc D’Aprile is committed to the success of each patient, which is achieved through the most up-to-date evidence based care. In addition, each of Dr. D’Aprile’s patients are provided custom aural rehabilitation plans which further their understanding of hearing loss and better helps in the acceptance of amplification devices.
