Q & A

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I am a teacher with a vocal cord polyp. What can I do to reduce it?

Question: I have been teaching for 24 years. I suffer with laryngitis. March 5th, 2014, the ENT told me I have a vocal cord polyp in my throat and by April 23rd, 2014 he said it had grown a little bigger. What can I do to reduce it? If I can’t reduce and need surgery, what would be the cost?

Answer:

Thank you for your question. A vocal cord polyp is a growths on the vocal cords. It is first, most important, to make sure that these are not tumors or cancers. Often, your ENT doctor can tell pretty well by the examination- but not always. If there is any question, a vocal cord polyp needs to be removed and biopsied- This is generally done in the operating room, with a microscope and a lighted tube in the throat, and takes but a few minutes to do in the operating room as an outpatient. Generally, but not always, the voice will improve from this procedure.

Benign vocal cord polyps and nodules may be caused by vocal abuse- and are quite frequent in teachers. It your doctor feels that is the case, he or she would likely recommend voice/speech therapy. Additionally, we might recommend vocal rest (difficult for teachers) and sometimes a brief course of prednisone to bring down swelling. Speech therapy is to help train you to project your voice in the suboptimal acoustic environment that is the classroom, without as much trauma as you may be having. We may also treat for reflux, as gastric acid can irritate the vocal cords and predispose you to forming polyps and nodules. Of course, smoking and alcohol are also risk factors for developing growths on the vocal cords- and can predispose to both benign and cancerous growths.

Most benign vocal cord polyps and nodules are medically treatable, and do not frequently require removal- especially since they are likely to come back if the cause has not been resolved.

Robert Pincus MD, FACS
NY Otolaryngology Group- NY Voice Center
Associate Professor Otolaryngology NY Medical College

Q & A

Do I need revision stapes surgery?

Question:

Many years ago I was diagnosed at Mass Eye and Ear with otosclerosis. I was operated on by Dr. Joseph Nadol. Over the past few years, my hearing has once again diminished and I wonder if its possible to do a revision? Also, my other ear was never been operated on. I am 68 years old, female, and a medical librarian, and my loss of hearing is obviously impinging on my work and life. I would prefer to not have to travel back to Boston…is this something you can help me with?

Answer:

Thank you for your inquiry regarding your hearing loss. It is often possible to regain excellent hearing with revision stapes surgery. It all depends on the nature of the hearing loss that you have. The first step would be to re-test your hearing. I would be happy to help you if you’d like. You can make an appointment online or by calling our office. Best of luck.

Neil M Sperling, MD

Associate Professor
SUNY Downstate
Brooklyn, NY

Q & A

My mother has a hole in her septum. What can we do?

Question: My mom lives in Ocala, FL. My mom’s problem is a hole up in her sinus that seperates the left and right nostril (perforated septum). She has had a ‘button’ put in but it had to be removed about a week later, due to the hole , in her nose, being too big. She then had a filter put in but it became infected and ,also, had to be removed and her nose cleaned by suction. Every day she is blowing her nose with alot of mucus being discharged. I am very concerned because nothing seems to work and the doctor, she is seeing, doesn’t seem to know whatelse to do.

Answer: The septum is the room divider, dividing the nose into two passages. While it is never completely straight, a deviated (twisted) septum can block air flow in the nose. Sometimes in surgery, or often after trauma or certain medications (cocaine quite commonly), a hole (perforation) develops from one side of the nose to the other. When small, this may cause no symptoms, or perhaps a whistling sound with breathing. Large holes disrupt the smooth flow of air through the nose and create drying, crusting and bleeding which often cause the hole to get larger over time. Small holes may be fixed surgically, but surgery is much less successful with large ones.

Generally, a septal button will fix a perforated septum when the holes are too large to close (plastic prosthetic septum). It allows for a normal, smooth flow of air, and the button is generally not felt by the patient. If the hole is too big for the usual sizes that are available, your Ear Nose and Throat Doctor or Rhinologist (Sinus Specialist) may be able to measure and have a special order one made to fit. Sometimes, surgery may be only partially successful, that is by making the hole smaller and then more amenable to a septal prosthesis.

At times, there is no way to really get this closed. Should that be the case, the use of nasal saline sprays, topical moisturizing with nasal ointments, and seeing your ENT doctor for cleaning of the area should make things better.

We, of course, would be happy to see your mom here at the NY Sinus Center.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology

Co-Director NY Sinus Center

Q & A

I have a cyst on my arytenoid (in the larynx or voice box)

Question: I have been diagnosed with a mucosal retention larynx cyst on my arytenoid process. I know it has been there at least 1.5 yrs (I could feel it when breathing hard – it restricted my breathing) but I just had it checked out recently. The CAT scan showed it was @1.1 cm in diameter. My Dr. says I should have it removed and that it is a “simple” procedure. I am most worried about the general anesthesia and possible damage to my teeth or trachea or wherever else the breathing tube goes. So 2 questions: 1) Do you think I should get a 2nd opinion? and 2), is a larynx cyst ever aspirated instead of cut out? Thanks you so much for your thoughts.

Answer:

The arytenoids are paired cartilages that attach to the back of the vocal cords. By moving the arytenoids, we move the vocal cords- apart for breathing and together for speaking. While there can be a cyst (mucous containing sac) on an arytenoid- one more commonly sees granulomas- which are areas of inflammation. Granulomas usually come from reflux- and treatment for reflux will often get these to resolve without intervention. A larynx cyst comes from tissue getting filled with mucous from one of the many many mucous secreting tiny glands throughout the airway. Usually after some type of trauma to the tissues- swallowing the wrong way, acid reflux or some other unknown cause.

While a larynx cysts can be a tumor or even a cancer, this one clearly is felt to be nothing worrisome. If there is a question of there being a tumor or cancer, clearly one should have it removed.

Otherwise, I would suggest removing this should it be growing or causing symptoms- such as hoarseness, difficulty breathing or discomfort. Removing the cyst is a relatively easy, quick, simple procedure and can be done by most Ear Nose and Throat surgeons- or by a Laryngologist (subspecialist in voice) It almost always is done with general anesthesia- and the risks are basically as you describe- but they are quite rare-

Removing the cyst involves taking the top off, so that it drains and heals open. Usually, this would take a couple of minutes, total. There is no advantage to to aspirating (suctioning out the cyst) as it is likely to refill- and is not really much less of a procedure.

In general, it never hurts to get another opinion…

I hope this helps clear things up.

Robert Pincus MD
Associate Professor Otolaryngology
NY Otolaryngology Group/ NY Voice Center

Q & A

I work at a loud club and it is affecting my hearing

Question: I am a bartender at a loud club. Even though I am constantly asking the DJs to turn down the music, we have an old sound system that is not that sensitive to small adjustments, and it is a club after all and people like it loud. Not only do I have trouble hearing people ordering drinks, but I feel that working there has permanently and detrimentally affected my hearing. I wanted to see about getting earplugs that would block out the most harmful frequencies while still allowing me to hear patrons’ orders over the bar. I believe I have noise-induced hearing loss. Do you have any recommendations? Is this something insurance would cover? If not, how much would this service cost? Thank you so much! –

Answer: Noise can definitely affect the hearing. When you have a ringing in the ears after noise exposure, that is a sign of damage to the hearing nerve. Prolonged loud exposure- or even a single loud blast- can cause permanent noise-induced hearing loss. The government regulations (OSHA) limits noise to 85 dB over an 8 hour period- but even that has been shown to cause losses.

Certain things can be done- relatively easily- even at most clubs. We used to see musicians with horrible hearing losses. They typically placed the amps behind them- Today we know that the amps should be placed stage forward, and the musicians can use either small monitors- or in the ear systems to hear themselves.

Clearly, this is not what is going on at your bar- However, changing the placement of the speakers, so that they are away from the bar, or lowering the sound on speakers near the bar can help. Placing a small baffle (soundproof divider) can also significantly lower the noise exposure.

Alternatively, you can have earplugs made professionally, to help. They are molded to your ear canals and can help lower the noise level significantly. They should help further by lessening the high pitches more than the sounds used for speech. Hopefully, they will not interfere significantly with your hearing for speech.

You should probably have your hearing monitored, to make sure you are not developing a significant hearing loss from your job.

We make noise attenuating earplugs at the NY Hearing Center. These are usually not covered by insurance- (?- not sure why) and can run about $200 or so.

I hope this clears things up.

Robert Pincus MD

Q & A

My nose crusts after resection of my inferior turbinates

Question: I am from the area in Connecticut. I had submucous resection of my inferior turbinates in ’12, as a 27 year old male. Only tissue removed, no bone, anterior to posterior. Since, air flows too quickly, I have dry nasal passages and my nose crusts and bleeds like crazy. It has been the worst decision of my life.

I’m wondering if you gentlemen have seen folks like me, and if you have any experience in implant procedures (alloderm, acell) or PRP application, or if you are interested in exploring regenerative techniques to help those of us with this difficult problem. Many ENTs I have seen post surgery have turned me away.

Answer: I wish I could offer a cure for your problem. We know, that the nose is a filter- and by the time air reaches the back of the nose, the air should be 100% humid and 98.6 degrees. A crucial part of this function is due to the inferior turbinates. These are structures on the side wall of the nasal cavities. At times, though, they can become enlarged and block the airway. When we want to shrink down these structures, we now know that it is important to keep their mucous membrane (outer surface) intact, and just reduce the inside tissue.

If the mucous membranes are lost- either through surgery, infection, or trauma- it is hard to replace effectively. One name for this is the “empty nose syndrome” which manifests as dry nasal passages.

We usually find that moisturizing the nasal cavities with topical ointments at the tip and saline drops- and sometimes a nasal atomizer (mist)- helps the vast majority.

I have not seen any surgical procedure really help- although many have been tried and reported- and we’d be happy to review your options with you personally at the NY Sinus Center.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology

Co-Director, NY Sinus Center

Q & A

My voice has too high a pitch- what can I do?

Question: I am 19 years old, male. I have a high pitched male voice, I mean I am misunderstood as a lady most frequently when I answer the phone. this has been a great concern to me since most of my life but it really affected me after my friends got their voices roughen. And also once I am too tired or under a pressure situation words don’t come out, time to time once or two comes out, in these occasions people ask whether I am ill. Now I am fed up of this situation. Please……..can I know what the reason might be for this? Can I get a remedy for this, specially a non surgical one, please help me…….

Answer: As a young male enters puberty, there is a change in the voice box (or larynx) that general makes the voice become lower in pitch. This is the same change that makes a male’s “adam’s apple” more visible at this time. In some, the change comes earlier and in others, later.

Having a voice that is “too high” can be quite stressful for a young man. However, in most this will resolve- If not, we would first recommend speech therapy, to help change how you use your vocal cords.

If that should fail, there is a simple surgical procedure, a type of thryoplasty, which removes some of the tension on the vocal cords and is generally successful in lowering pitch of a high pitched male voice.

I hope this clears things up.

Robert Pincus MD

Q & A

I have a growth on my cheek. Is this something to worry about?

Question: I have a growth on my cheek. It is soft a fleshy in color. I am worried about it as it started out the size of a small pimple and has grown to the point where I am now accidentally buying it when I chew. Should I see my doctor or is this something to worry about?

Answer:

There are many different types of growths you could have on your cheek. Certainly, any growth- especially one that is getting bigger- should be evaluated by your doctor. Often, your doctor can tell by looking- but it may have to be biopsied ( having a piece taken to look at under the microscope)- or removed by an ear nose and throat doctor- to be sure.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology- Head and Neck Surgery

Q & A

I lost my sense of smell and taste- what can I do?

Question: I fell and I hit head on radiator, blacked out, hospital was vague and unhelpful, found that I have loss of smell and taste from trauma. Can you help? I have some taste of salt. It depresses me. Nobody seems to know anything about this, have any serious ideas. Everybody wants to meet me and charge for consultations. Stupid I am not. But tired of USA doctors. In other countries they will at least say “nothing known about cures for this” but here I get “buy this, eat that” – trivia, as if it were a minor issue.

Answer: Loss of the sense of smell (anosmia) is a major problem, as you well know. It is important for our safety (spoiled foods, smoke, gas) and for our enjoyment of every day life. Loss of smell can be a predictor of neurologic diseases, such as Parkison’s and early dementia.

We at the NY Sinus Center, take the loss of smell as a serious problem and are working to help people like you with the loss of smell and taste.

It is important to find the cause of one’s loss of smell- in this case it seems likely to be the head trauma.

Recent research has shown that early treatment may be beneficial. Studies have shown that in some cases, treatment of sinus disease may help and prednisone early in the loss may be effective. Some newer therapies that we are using include theophylline nasal sprays and smell therapy. They may be effective in later stages, but as time goes on, any treatment is less likely to help.

I wish we could say that a particular therapy will be effective in any individual- specifically in your problem.

I am attaching a power point of a recent continuing medical education lecture I gave to Ear Nose and Throat specialists on this problem.

olfaction 2014l

I hope this clears things up.

Robert Pincus MD

Co-Director NY Sinus Center.

Q & A

Can you help recalibrate my father’s hearing aid?

Question: My father purchased a pair of Phonak Solana in China. He really didn’t like how they were calibrated there. Now he is visiting me in New York. I was wondering if one of your doctors could help recalibrate a hearing device.

Answer: Hearing aids are like fine hearing computers today. While many can be bought in large stores and other outlets, to get the best results the hearing aid must be finely calibrated to each individual’s hearing. This is time and labor intensive and takes a hearing specialist who cares and knows about his or her patient and his or her hearing. Some hearing aids, unfortunately, like the ones at Costco are locked and do not allow outside recalibration.

However, we can certainly service your father and recalibrate a hearing device. I included our office coordinator/Liz on this email. Please call 1(212) 884-8283 to schedule an adjustment appointment. The audiologist will discuss the office visit fee at the time of your appointment.

Myra Berenson, Au D

Director of NY Hearing Center

ENT Doctor Archives - Page 2 of 5 - The New York Otolaryngology Group

I am a teacher with a vocal cord polyp. What can I do to reduce it?

Do I need revision stapes surgery?

My mother has a hole in her septum. What can we do?

I have a cyst on my arytenoid (in the larynx or voice box)

I work at a loud club and it is affecting my hearing

My nose crusts after resection of my inferior turbinates

My voice has too high a pitch- what can I do?

I have a growth on my cheek. Is this something to worry about?

I lost my sense of smell and taste- what can I do?

Can you help recalibrate my father’s hearing aid?