Spokane Ear, Nose and Throat Center
Spokane ENT is comprised of a team of specialists who concentrate on disorders and diseases of the ear, nose and throat. Over the years this specialty has grown to include treatments for conditions of the larynx, head and neck, respiratory tract, trachea, and endocrine glands. The clinic provides care for both adults and children.
Ear & Hearing
Ear disorders include a variety of conditions such as hearing loss, ear infections, tinnitus, Meniere’s disease, benign positional vertigo, perforated eardrum, otosclerosis, hyperacusis, impacted earwax, Eustachian tube dysfunction, cholesteatoma and more. An otolaryngologist working in conjunction with an audiologist is the best team for addressing your ear disorder.
A cochlear implant is a surgically implanted device that bypasses damaged hair cells in the ear and provides electrical stimulation directly to the auditory nerve, giving patients who are severely hearing impaired or profoundly deaf the ability to hear. It is most beneficial for those who cannot be helped with a traditional hearing aid.
A cochlear implant works differently than a hearing aid. Hearing aids amplify sounds so that a person with nerve damage can hear more clearly. Cochlear implants generate an electrical signal that the brain interprets as sound. The implant has an external portion that sits behind the ear, consisting of a microphone, a speech processor and a transmitter. These work in tandem with the internal components, a receiver and array of electrodes, which have been implanted in the ear. The microphone picks up sound and sends it to the speech processor, which converts these signals to digital impulses and sends them to the transmitter. The transmitter, in turn, sends the processed audio signals to the receiver. From there, they are transmitted directly to the brain through the auditory nerve. While a cochlear implant does not cure deafness or restore hearing loss, it does allow a patient to perceive sound, and can help him or her to converse again.
Those experiencing severe to profound sensorineural hearing loss (the result of nerve damage to the inner ear) who can’t benefit from conventional hearing aids are prime candidates for cochlear implants. These implants are most helpful in patients with solid language and communication skills and a hearing loss that occurred later in life. Younger children (typically between the ages of two and six) also benefit, since a cochlear implant exposes them to sounds during their formative learning years, while they are developing speech and language skills. Post-implantation therapy is a crucial component in the success of cochlear implants; learning to use them correctly takes time and effort.
Hearing loss is a common condition that affects one out of three people by the age of 65. It’s not just a disease of the elderly, however; it’s becoming increasingly common in younger people who are exposed to excessive noise levels. Taking steps early to protect hearing can prevent individuals from developing a hearing impairment in the future.
Hearing loss is any degree of impairment in the ability to comprehend sound. For hearing to occur, sound waves pass through the external, middle and inner ear, where they are translated into nerve impulses and sent to the brain, which then interprets those signals as sound. Any interruption to this process can cause a partial or total loss of hearing.
The main factors that contribute to hearing loss are natural aging (presbycusis) and exposure to loud noises. Other conditions that can cause hearing impairment include earwax buildup, ear infections, injury, medical conditions such as Meniere’s disease and otosclerosis, heart disease, hypertension and diabetes.
Signs of hearing loss include muffled speech, difficulty understanding words (especially when background noise is a distraction), frequently asking others to repeat themselves, turning up the volume on the television or radio and social withdrawal. Symptoms often appear so gradually patients are unaware of a problem until a family member or friend points it out.
Hearing loss is divided into two categories: conductive and sensorineural. Conductive hearing loss is the result of problems that involve the middle ear and is usually curable. It is caused by ear infections, earwax accumulations, trauma to the ear and abnormalities or growths. Medications, surgery and earwax removal may all be effective, depending on the circumstances.
Sensorineural hearing loss involves damage to the inner ear and, while rarely curable, is often successfully treated with hearing aids (or, in some cases, cochlear implants). It is the result of nerve damage from noise exposure, viruses and diseases and hereditary factors. A third type – mixed hearing loss – occurs when patients experience a combination of the other two types.
Taking measures to prevent hearing loss now can pay off down the road. While there is little an individual can do about presbycusis, protecting the ears from noise exposure in the workplace and in social settings (e.g., concerts and sporting events) is easily accomplished using earplugs and other types of hearing protection. Prompt treatment of ear infections and keeping current on immunizations can help prevent hearing loss in children. Swimmers and surfers should take extra care to keep their ears free of water with custom earplugs designed to prevent moisture from entering the ear canals.
Comprehensive Hearing Evaluations: Available for children of all ages and adults.
Cochlear Implants: Spokane Ear, Nose & Throat Clinic has been providing cochlear implant services since 1993. Cochlear implants are designed to provide sound to people with severe to profound sensorineural hearing loss in both ears. Typically the implant is presented as an option to patients who get either no benefit or very limited benefit from properly fitted hearing aids. Please follow this link to a video regarding Cochlear Implants.
Videonystagmography (VNG): Including ocularmotor tests, vestibular-ocular reflex testing, bi-thermal water caloric irrigations, Dix-Hallpike maneuver, and positional nystagmus testing. Parilymph fistula testing also available upon request from referring physician.
Computerized Dynamic Posturography (CDP): May be ordered as part of a balance or dizziness assessment.
Electrocochleography (ECoG): May be ordered as part of a balance or dizziness assessment.
Cervical Vestibular-Evoked Myogentic Potential (cVEMP):May be ordered by your ENT as part of a balance or dizziness assessment.
Auditory Brianstem Response (ABR or BAER): Including frequency specific testing, retrocochlear evaluation, bone conduction, and/or assessment of auditory neuropathy/dyssynchrony. Testing under sedation is also available.
Newborn Hearing Evaluations: Completed in office while the child is sleeping. Testing follows WA State EHDDI best practice testing protocol, and includes tympanometry, DP OAE, and diagnostic ABR.
Auditory Steady-State Response (ASSR): May be used as part of the infant hearing evaluation.
Tinnitus Management: Comprehensive approach to the evaluation & management of patients with tinnitus. While there is no single cure for tinnitus, research has shown that many patients can benefit from one or a combination of management options. Tinnitus management can provide many patients with relief and much needed control over the condition. A tinnitus management group class is offered quarterly.
Acoustic Immittance: Including tympanometry, acoustic reflex and acoustic reflex decay testing.
Otoacoustic Emissions testing: Including DP OAE, TE OAE and spontaneous OAE
High frequency audiometry: May be part of a comprehensive hearing evaluation.
Sinusitis is inflammation and swelling of the tissues that line the sinuses. This interferes with normal mucus drainage, leading to breathing difficulties, pain and pressure. When the condition persists for 12 weeks or longer, it is considered chronic.
Sinusitis is the number one reported chronic condition in the United States, affecting an estimated 37 million Americans. It’s most often caused by an infection brought on by a cold or allergies, but may also be the result of nasal polyps, a deviated septum, trauma to the face, hay fever, complications from immune system disorders or tumors.
In addition to a physical examination and a review of the patient’s medical history, the doctor will inspect the nasal passages for polyps and other abnormalities and check for inflammation and a buildup of fluid. Additional tests utilizing nasal endoscopy, CT scans, MRIs and allergy tests can be used to help confirm the diagnosis.
Individuals suffering from sinusitis experience a variety of cold-like symptoms such as nasal congestion and discharge, postnasal drip, sore throat, facial pressure and swelling, loss of smell and taste, headache, fever, fatigue and bad breath.
Treatments will vary depending upon the severity of sinusitis and whether it’s an acute or chronic condition. The treating physician will determine whether you are suffering from an acute or chronic sinus infection.
Acute: generally this condition involves management of inflammation with or without infection. There are over-the-counter meds such as decongestants, mucolytics, steroid nasal sprays, saline rinses, NSAIDS, antihistamines etc.
*Clinical studies suggests the use of antibiotics for bacterial infections, or symptoms following an acute head cold or allergy flare up that last for greater than 10 days. Symptoms usually include facial pain or pressure, pain in the upper teeth, or purulent nasal discharge.
Chronic: as the name implies, the sinuses have difficulty staying clear. They often experience sinus mucosal thickening, and retained sinus secretions, leading to chronic congestion. These patients can experience either frequent or prolonged infections.
*In some patients chronic inflammation may lead to nasal polyps, or scarring after surgery. These patients may benefit from the use of new technology such as the Propel sinus implant, or Sinuva.
-In some patients, long term management may include immunotherapy (allergy shots) to help reduce sinus inflammation related to their environmental allergies.
Depending on the patient and their sinus condition, there are several surgical sinus procedures available. Below is a list of common sinus surgeries.
Functional endoscopic sinus surgery (FESS)
This procedure involves use of a nasal endoscope and instrumentation to open the natural pathways to the sinuses, and subsequently “improve” sinus function. In most cases, the procedure is completed entirely through the nasal passages (endoscopic), so no external scars are left behind. Swelling is limited, and pain or discomfort is mild. It is usually an outpatient procedure.
Endoscopic sinus surgery with CT navigation (Image guidance)
In addition to removing sinonasal obstruction, this procedure relies on a 3D mapping system using preoperative CT scans. This allows for more accurate instrument use throughout the complex sinus passages and is especially helpful for those with significantly altered surgical anatomy.
Extended endoscopic sinus surgery (Usually with Image guidance)
There are specific conditions, ie. revisions, tumors, polyps where techniques involve the use of powered instrumentation. Often this involves the removal of normal bone boundaries. These surgeries may be scheduled at the hospital with possible overnight stay.
In this surgical procedure, a balloon catheter is inserted through the nostrils into the sinus passages, and gently inflated. This causes the sinus cavity to expand, allowing for easier drainage. The balloon is then deflated and removed. This operation is minimally invasive, provides immediate relief, and results in a much quicker recovery. Many patients are able to return to work the next day.
Recovery from sinus surgery varies depending on the procedure and the patient. The vast majority are performed as outpatient procedures and require several post-op visits for sinus debridement to remove blood clots, dissolvable packing and tissue debris. Time off after surgery is typically three to five days unless other factors require the patient to take off more time. Balloon sinuplasty involves no cutting of tissue or bone, and patients generally recover more quickly.
Nasal polyps are small, noncancerous growths that form on the lining of the nasal passages or sinuses. Small polyps may go unnoticed and require no treatment, but larger ones can obstruct the sinuses and lead to infections and breathing problems.
Chronic sinusitis, allergies, and asthma are all frequently associated with nasal polyps. Symptoms include runny nose, congestion, postnasal drip, loss of smell and taste, facial pain and pressure, headache, pain in the upper teeth, itchy eyes, and snoring. If symptoms last longer than ten days and are not associated with a cold or allergies, make an appointment with the doctor. If left untreated, nasal polyps can cause complications such as obstructive sleep apnea, asthma attacks, meningitis, aneurysms, and blood clots.
It is unclear what causes nasal polyps. Some people are prone to chronic inflammation of the sinuses, and many of those individuals are predisposed toward developing polyps (while others never do). There is speculation that the immune systems of people with nasal polyps behave differently.
The doctor can diagnose polyps based on feedback regarding the patient’s symptoms and a visual examination of the nose. Diagnostic tests including nasal endoscopy, CT scan, MRI, and allergy tests can help pinpoint the size and location of nasal polyps, and whether they are being caused by allergies.
To treat polyps, the doctor or an ENT specialist will attempt to shrink them down to a manageable size through the use of medications to relieve inflammation, or the underlying condition responsible. Common drugs include nasal, oral, or injectable corticosteroids, antihistamines, and antibiotics. When medical treatment doesn’t work, surgery may be an option. Polyps are removed during an outpatient procedure called a polypectomy, or via more in-depth endoscopic sinus surgery.
Loss of smell, known medically as anosmia, is an inability to perceive odors. It can be partial or complete and, while rarely the symptom of a serious condition, can still cause misery for those suffering from its effects. It is usually temporary, the result of a cold or upper respiratory infection, but in some cases – especially for the elderly – may be permanent and signal a serious condition.
Anosmia occurs when the sinuses become swollen and inflamed. The most common causes include colds, flu, allergies, sinusitis and nonallergic rhinitis. Nasal obstructions, such as polyps, tumors and other deformities, can block the flow of air through the nose and lead to a loss of smell. There are many other possible causes including Alzheimer’s disease, brain tumor, aneurysm, diabetes, cocaine use, chemical exposure, malnutrition, hormonal imbalances, medications, Parkinson’s disease, rhinoplasty and radiation therapy, among others.
Treating anosmia depends on what is causing it. If a cold or allergies are to blame, treatment is unnecessary; your sense of smell should return in a few days as symptoms improve. If a polyp or other growth is blocking your nasal passages, surgery may be necessary. For bacterial infections, antibiotics are prescribed. Other conditions may require more specialized medical treatment. Occasionally, the sense of smell returns automatically, without any type of treatment.
Loss of smell can’t always be treated effectively, especially if it is the result of age. In these cases, it’s important to take extra precautions to ensure your safety. Make sure the batteries in your smoke detectors are all functioning properly and change them often. Take care when eating leftovers; your sense of smell directly affects your ability to taste, and consuming spoiled food can cause serious health problems.
Allergy and sinus conditions are common in children, whose sinuses continue to develop well into the teen years. Allergy and sinus symptoms are similar, making a proper diagnosis a bit challenging. Symptoms of allergy and sinus conditions include runny nose, sneezing, stuffiness, coughing, sore throat, wheezing, headaches, snoring and itchy eyes and nose.
When allergies are to blame, the immune system responds to a perceived threat by flooding the bloodstream with chemicals called histamines, which attack the offending substance but cause inflammation and swelling of the airways in the process. Common allergy triggers include pollen, mold, animal dander, dust mites, chemicals, medications and certain foods.
Pediatric sinusitis is usually the result of cold viruses and may be aggravated by allergies. It can be either acute or chronic (lasting longer than 12 weeks and/or recurring frequently). Distinguishing whether your child’s symptoms are the result of allergies or a sinus condition is the key to successful treatment.
In addition to a physical examination, your child’s doctor will carefully inspect the ears, nose and throat for signs of infection. Skin and blood tests will likely be administered to determine whether an allergen trigger is responsible.
When your child is diagnosed with allergies and avoiding the allergen trigger isn’t possible, treatment consists of a variety of medications. These include antihistamines, decongestants, nasal corticosteroid sprays, eye drops and prescription drugs. Severe cases that don’t respond to medical treatment may require immunotherapy, usually delivered through weekly shots or drops. This enables the body to build up a tolerance to the allergen over time, bringing long-term symptom relief.
Sinusitis can be treated with home remedies (e.g. warm compresses, drinking lots of liquids, using a humidifier to moisten dry air, etc.) and medications to relieve symptoms. Chronic cases may require surgery.
Nasal obstructions are blockages of the nasal cavity that impede airflow in and out of the nose. Either one or both nostrils may be affected. Most nasal obstructions are temporary, caused by colds, allergies, sinus infections, or medications, while others require medical intervention.
There are several different types of nasal obstruction. These include deviated nasal septum, inferior turbinate hypertrophy, choanal atresia, nasal polyps, foreign objects in the nose, oversized adenoids and swelling of the nasal lining due to allergies.
The nasal septum is the wall-like structure that divides the left and right nostrils. A deviated septum refers to one that is crooked. This is hardly rare; it is estimated that 80% of people have septal deviations to some degree. Symptoms include difficulty breathing through the nose (especially one nostril) and a runny nose. The nasal cavity contains bony structures called turbinates. These are susceptible to irritation from allergies and dust, which cause swelling and breathing difficulties. This is a congenital defect in which excess tissue in the nasal airway causes a partial or full blockage, resulting in difficulty breathing.
The doctor will carefully examine the nose using a lighted scope and may use a CT scan or MRI in order to diagnose the nasal obstruction. The first step in treating nasal obstructions is getting the symptoms under control. Medications or nasal steroid sprays are often helpful in reducing inflammation of the nose and turbinates and providing immediate, short-term relief.
Septoplasty is a surgical procedure used to correct a deviated septum. When the bone and cartilage making up the septum – the wall that divides the nostrils – is crooked, it causes obstruction of the nasal airways and makes breathing difficult. This can lead to nosebleeds, snoring, sleep apnea and chronic sinusitis. Surgery to straighten the septum can eliminate these conditions and improve one’s quality of life.
The procedure to remove the adenoids, known as an adenoidectomy, is routine and performed on an outpatient basis. It is often recommended that a tonsillectomy (surgery to remove the tonsils) be performed at the same time, since tonsillitis and adenoiditis often occur simultaneously.
Rhinoplasty is a surgical procedure to repair or reshape the nose. It can make your nose larger or smaller, straighten the bridge, reshape the tip, narrow the opening of the nostrils, and change the angle between your nose and upper lip. It can also be used to correct defects resulting from trauma or birth, and may be used to help individuals with breathing difficulties. It is one of the most common plastic surgery procedures, and offers excellent results.
A rhinoplasty can change the size, width and profile of your nose. It can smooth out depressions or bumps on the bridge, and fix an imperfect nasal tip (one that is too large, droopy or curves upward). Large or wide nostrils may be reshaped, and a deviated septum can be corrected. Rhinoplasty is a common and safe procedure, but there are risks inherent with any surgery. These include infection, bleeding, pain, bruising, swelling, numbness, nasal asymmetry, skin contour irregularities, and perforations in the nasal septum.
Surgery is performed using either a local or general anesthetic. It typically takes an hour or two, but when more complex restructuring is required the procedure may last longer. An incision is made – usually inside the nostrils – and the nose is either reduced or augmented using cartilage from other parts of the body. If a deviated septum needs to be corrected, it is straightened. Once the nasal structure has been reshaped, the incisions are closed and the patient is given a splint and packing to help support the nose as it heals.
Most patients return home the same day, though more complicated procedures may require a brief hospital stay. The patient will be asked to rest in bed immediately after the surgery, keeping their head elevated in order to reduce swelling and bleeding. Dressings usually come off after a week. The patient may experience puffiness in the face and minor bruising for a few days while they heal. Rhinoplasty usually offers permanent results, though it may take up to a year for these to be fully noticeable.
Snoring is a common condition that affects about half of all adults. It occurs when air flow through the nose and mouth is obstructed. This causes the airway tissue to vibrate and make the snoring sound. This condition disturbs sleep patterns and prevents adequate sleep.
Symptoms include noise during sleep, excessive daytime sleepiness, difficulty concentrating, morning headaches, sore throat, restless sleep, very loud snoring and waking up choking or gasping.
There are different factors that can cause snoring, but it can also be a sign of a more serious medical condition called sleep apnea.
Sleep apnea is a sleep breathing disorder that affects one in 15 Americans, with most cases undiagnosed. It occurs when a person experiences one or more pauses in breathing or shallow breathing while asleep. These pauses can last a few seconds to a few minutes. Generally, breathing begins again and is sometimes accompanied by snorting or choking.
The types of sleep apnea are obstructive sleep apnea, which is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep, and central sleep apnea, which is caused when the brain fails to signal the muscles to breathe.
Symptoms include loud snoring, episodes of breathing pauses during sleep, abrupt awakenings accompanied by shortness of breath, waking with a dry mouth or sore throat, morning headache, difficulty staying asleep, excessive daytime sleepiness, attention problems and irritability.
Sleep apnea may lead to serious complications such as daytime fatigue, high blood pressure or heart problems, type two diabetes, metabolic syndrome, stroke or liver problems.
For those experiencing snoring or sleep apnea, it’s important to see a doctor. Primary care physicians or sleep specialists such as otolaryngologists (ear, nose and throat specialists) can help evaluate symptoms and provide a diagnosis. It may be necessary to do a sleep study overnight in a lab or at home with special equipment.
Depending on the diagnosis, the doctor may suggest one of many treatments. Treatments that may help snoring include losing weight, avoiding alcohol, staying hydrated and changing the pillow or sleep position. Sleep apnea may require more advanced treatments such as continuous positive airway pressure (CPAP), expiratory positive airway pressure (EPAP) or an oral appliance.
Most individuals have experienced a change in their voice at some point in their life. This could be something as simple as singing too loudly and waking up the next day to a scratchy throat. On the other end of the spectrum a change in voice can be a symptom of a nasal polyp. Many conditions have similar symptoms. This is why at the first sign of trouble you should schedule an appointment with one of our experienced ENT physicians.
The salivary glands, located in the mouth and throat, are responsible for producing saliva to keep food moist, making it easier to chew and swallow. Saliva also aids in digestion, keeps teeth from decaying and contains antibodies that keep the mouth clean and germ-free. Disorders of the salivary glands can interfere with these processes and lead to a variety of health problems.
When the salivary glands become swollen and inflamed, symptoms such as dry mouth, difficulty swallowing, a bad taste in the mouth, pain in the face or mouth, swelling of the jaw and neck, muscle weakness or numbness and trouble opening one’s mouth widely can occur.
Disorders of the salivary glands may be related to a variety of factors. Infections such as mumps are common, especially in children. Obstructions that limit the flow of saliva, causing it to build up in the ductal system and cause swelling, may lead to infection and, if left untreated, abscessed glands. Tumors can affect the salivary glands themselves or other areas nearby such as the palate, mouth, cheeks or lips. Other disorders affecting these glands include autoimmune diseases, diabetes and excessive alcohol consumption.
A doctor will usually take either a medical or surgical approach for treatment of a salivary gland disorder, depending on the underlying cause and its progression. Any abnormal lump or swelling will require a biopsy to rule out the possibility of cancer. If a patient is diagnosed with a tumor, then surgery, radiation therapy, chemotherapy or a combination will probably be recommended. Surgery might involve removing a portion or all of the salivary gland and any cancerous lymph nodes.
An otolaryngist familiar with salivary gland diseases is best equipped to come up with a suitable treatment plan and will make a recommendation based on the symptoms and condition.
Welcome to the Columbia Thyroid Center. We’re here to help you treat thyroid diseases like thyroid cancer, hypothyroidism, hyperthyroidism and more. Our dedicated thyroid experts and subspecialists will partner with you to form a comprehensive treatment plan, and we offer unique services to fit your needs.
The parathyroid is another gland in the neck responsible for producing hormones. It controls the levels of calcium in the body and is also prone to disorders involving abnormal amounts of hormone production.
Hyperparathyroidism occurs when excess hormone is produced, leading to an overabundance of calcium in the blood. Symptoms include osteoporosis, lack of energy, abdominal pain, kidney stones, bone and joint pain, depression, loss of concentration, nausea and vomiting. Surgery is the most common treatment, which is successful in more than 90 percent of cases.
When the parathyroid glands produce too little hormone, the condition is known as hypoparathyroidism. Low calcium levels in the blood cause an increase in phosphorous and a tingling or burning sensation in the fingertips, toes and lips; muscle aches and cramps; fatigue; weakness; anxiety; headaches; muscle spasms in the hands, arms, throat and around the mouth; depression; mood swings and memory loss. Calcium supplements and Vitamin D are useful in treating this condition.
The thyroid is a butterfly shaped gland in the neck that is responsible for producing hormones. It regulates the body’s metabolism, but is prone to disorders involving abnormal amounts of hormone production.
When the thyroid produces too much hormone, a condition called hyperthyroidism occurs. Metabolism speeds up and causes a rapid or irregular heartbeat, nervousness, irritability, sweating, sensitivity to heat and weight loss. This is typically treated with beta-blockers, iodide, methimiaole or radioactive iodine therapy.
Conversely, when too little hormone is produced, the condition is called hypothyroidism and is marked by a slowed-down metabolism that causes fatigue, constipation, muscle aches and pains, facial puffiness, dry skin, sensitivity to cold and weight gain. Treatment with synthetic hormone replacement therapy is the usual course of action.
Thyroid nodules are lumps in the thyroid gland that may be solid or filled with fluid. They are usually noncancerous and rarely cause problems. In some cases, they may enlarge to the point of causing breathing and swallowing difficulties or stimulating overproduction of thyroid hormone.
Though relatively rare, thyroid cancer occurs when abnormal cells multiply in the thyroid gland. Fortunately, patients with thyroid cancer frequently do well because it is usually detected early and responds well to treatment. It is important to seek medical attention as soon as possible if you experience any symptoms of the disease.
Allergies are a widespread condition that affects approximately one out of every five Americans. They occur throughout the year in all types of climates, and can be triggered by pollen, mold spores, dust mites, animal dander, food, chemicals, medications and other environmental irritants. With so many possible causes, finding the source of an allergic response is crucial to treating the symptoms.
Allergies are an exaggerated immune system response to a substance that is otherwise harmless. Identifying the trigger is necessary in order to formulate a treatment plan. This requires allergy testing. A doctor will review the patient’s medical history, ask questions about their symptoms and administer either a skin or blood test. Once the allergen trigger is found, treatment can begin.
There are three types of allergy treatment available.
- Avoiding Triggers. The least invasive treatment method for allergies is avoiding the triggers responsible for the patient’s symptom. This is most effective if the patient is suffering from food or pet allergies, but less likely to succeed for those allergic to pollen, molds and dust mites. Steps can be taken to reduce exposure, but it’s difficult to completely eliminate these substances from someone’s life. Strategies include running the air conditioner during hot, dry weather; limiting outdoor activities during peak pollen-producing times; buying allergy-proof bedding and using a dehumidifier.
- Medication. Certain medications can be effective in reducing the severity of allergy symptoms. These include antihistamines, decongestants, corticosteroids, nasal sprays, eye drops and mast cell inhibitors. While these don’t cure allergies, they may at least make life tolerable.
- Immunotherapy. This option may be helpful for individuals who are unable to avoid allergens and do not find relief from medications. Immunotherapy, often referred to as allergy shots, involves introducing small amounts of the allergen into the body, allowing it to build up a tolerance. Small doses are gradually increased until a maintenance level is reached; treatment then continues for three to five years, until immunity is achieved. The procedure is considered safe and effective, and has been approved by the FDA. A new, alternative form of treatment called sublingual immunotherapy relies on droplets of extract instead of injections, and can be self-administered at home. It has not yet been approved by the FDA, but studies show it is every bit as effective and has fewer risks of side effects.
Shot Hours By Location This Week
|Monday, 11/11||8:00 – 4:00|
|Tuesday, 11/12||8:00 – 4:00|
|Wednesday, 11/13||8:30 – 4:15|
|Thursday, 11/14||8:00 – 4:00|
|Monday, 11/11||8:30 – 11:00||1:15 – 3:30|
|Tuesday, 11/12||8:30 – 11:00||1:15 – 3:30|
|Wednesday, 11/13||8:30 – 11:30||1:15 – 3:00|
|Thursday, 11/14||8:30 – 11:00||1:15 – 3:00|
|Friday, 11/15||8:30 – 11:30||NO SHOTS|
|Monday, 11/11||NO SHOTS||NO SHOTS|
|Tuesday, 11/12||8:30 – 11:30||1:00 – 3:30|
|Wednesday, 11/13||8:30 – 11:00||1:00 – 3:30|
|Thursday, 11/14||9:00 – 11:30||1:15 – 2:45|
|Friday, 11/15||9:00 – 11:30||1:15 – 3:00|
Shot Hours By Location Next Week
|Monday, 11/18||7:45 – 4:00|
|Tuesday, 11/19||8:00 – 4:00|
|Wednesday, 11/20||8:00 – 4:15|
|Thursday, 11/21||8:00 – 4:00|
|Monday, 11/18||NO SHOTS||NO SHOTS|
|Tuesday, 11/19||8:30 – 11:30||1:15 – 3:30|
|Wednesday, 11/20||8:30 – 11:30||1:15 – 3:30|
|Thursday, 11/21||NO SHOTS||NO SHOTS|
|Friday, 11/22||NO SHOTS||NO SHOTS|
|Monday, 11/18||NO SHOTS||NO SHOTS|
|Tuesday, 11/19||9:00 – 11:30||1:15 – 3:30|
|Wednesday, 11/20||8:30 – 11:00||1:15 – 3:30|
|Thursday, 11/21||9:00 – 11:30||1:15 – 2:45|
|Friday, 11/22||9:00 – 11:30||1:15 – 2:45|
Facial Plastic Surgery
Welcome to the Spokane Center for Facial Plastic Surgery!
Jordan P. Sand, M.D. is the Director of the Spokane Center for Facial Plastic Surgery. He is board-certified, fellowship-trained and a member of the American Academy of Facial Plastic and Reconstructive Surgery.
His career has spanned the country to many prestigious institutions including: University of California, Los Angeles, Washington University, Harvard and University of Washington. Dr. Sand has received national awards, served in multiple leadership roles, and contributed to dozens of chapters, publications and presentations.
He brings a refined skillset to the Inland Northwest, with unique expertise in nasal surgery, facial rejuvenation, eyelid surgery, hair restoration, facial reconstruction and minimally/non-invasive procedures. Dr. Sand is dedicated to providing his patients with safe and effective care while meeting their aesthetic goals with a natural and youthful look.
Operations our ENT surgeons perform
Removal of tonsils and adenoids primarily to treat infection or sleep disturbed breathing.
Surgery for chronic ear infections, placement of ear tubes.
Use of a scope to examine the larynx, trachea, or esophagus.
Endoscopic sinus surgery using a guided image system.
Removal of the thyroid gland.
Treatment of nasal septum deformity or injury.
Our team of ENT Providers
HOW TO GET STARTED
Otolaryngology is the oldest medical specialty in the United States. Otolaryngologists are physicians trained in the medical and surgical management and treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structures of the head and neck. They are commonly referred to as ENT physicians.
Otolaryngologists are ready to start practicing medicine after completing up to 15 years of college and post-graduate training.
The Ears – Otolaryngologists are trained in both the medical and surgical treatment of hearing loss, ear infections, balance disorders, ear noise (tinnitus), nerve pain, and facial and cranial nerve disorders.
The Nose – Care of the nasal cavity and sinuses is one of the primary skills of otolaryngologists including sinus disease, allergies, nosebleeds, and nasal deformities (both functional and cosmetic).
The Throat – Otolaryngologists manage tonsils and adenoid infections, diseases of the larynx (voice box) and esophagus including voice and swallowing disorders, airway problems including obstructive sleep apnea and snoring.
The Head and Neck – Otolaryngologists are trained to treat infectious diseases of the head and neck area, both benign and malignant (cancerous) tumors including the thyroid, facial trauma, and deformities of the face (both cosmetic and reconstructive).
An ear infection is caused by improper drainage of fluid that collects behind the ear drum during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses. The build up of pressurized pus in the middle ear causes an earache, swelling, and redness. Since the eardrum cannot vibrate properly, the individual may experience hearing problems.
Swimmer’s ear (otitis externa) is typically a bacterial infection of the ear canal; this differs from otitis media which involves fluid behind the eardrum. Otitis externa is most commonly caused by water getting trapped in the ear canal. It also follows injury to the skin of the ear canal caused by aggressive “cleaning” with Q-tips, bobby pins, match sticks and other devices.
Most of the time, otitis media clears up with proper medication. When it doesn’t, further treatment may be recommended by your physician. This treatment may be the surgical placement of a ventilation tube in the eardrum. This “tube” allows fluid to drain from behind the eardrum preventing fluid accumulation. The individual will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.
Ear wax (cerumen) is normal in healthy ears. The purpose of cerumen is to moisturize and protect the skin of the ear canal and to trap dust and particles before they reach the ear drum. Cerumen is formed in the outer part of the ear canal. Normally, wax makes its way to the outer opening of the ear canal, flakes up, and falls out.
In most cases, swabbing the opening of the ear canal with the corner of a twisted damp washcloth will remove excessive ear wax. Avoid too much moisture or going too deep since prolonged moisture in the ear canal can lead to an infection. Probing with bobby pins, match sticks, Q-tips, etc. is strongly discouraged.
The problem with Q-tips is that they pack the ear wax from the outer ear canal deep into the ear canal until it jams against the ear drum, much like a cannon being packed with black powder and a tamping rod. Cerumen lodged against the ear drum is much more difficult and painful to get out and can cause a temporary hearing loss.
Tinnitus is very common and can be annoying and distracting. Almost 37 million Americans have tinnitus in their ear or ears. It may come and go or might be a constant bother. It might be soft or loud, low pitched (roaring), or high-pitched (ringing) kind of sound. More than 7 million people are so badly afflicted that they can’t lead normal lives.
There are various causes including a plug of wax, allergy, ear infection, circulatory problems, certain medications, and prolonged exposure to loud noise.
Dizziness, Vertigo & Meniere’s Disease FAQ
Some people describe their balance problem by saying that they feel dizzy, unsteady or giddy. This feeling of imbalance without the sensation of turning or spinning is called disequilibrium and is sometimes due to an inner ear problem.
The word vertigo comes from the Latin verb “to turn.” Individuals with vertigo often say that they or their surroundings are turning or spinning. Vertigo is often due to an inner ear problem.
Each year more than 2 million people visit a doctor for dizziness or vertigo.
Meniere’s disease is a disorder that produces a group of symptoms: sudden attacks of whirling dizziness, tinnitus or head noise, a feeling of pressure or fullness in the ear, and a fluctuating hearing loss. While the underlying cause is not known, it is believed to result from a fluctuation in the pressure of fluid that fills the inner ear. An attack may last from a few hours to several days. Following a severe attack, most people find that they are so exhausted that they must lie down or sleep for several hours. The attacks vary in frequency from every few weeks to every few years. The disorder affects five out of ten thousand people, most of whom are over 35 years old.
The nose can bleed for a variety of reasons:
- Allergies, infections, or dryness can cause itching and lead to picking of the nostril
- Vigorous nose blowing can rupture superficial nasal blood vessels in the elderly and the young
- Clotting disorders that run in families or are due to medications
- Fractures of the nose or the base of the skull can cause bleeding and should be regarded seriously when the bleeding follows a head injury
- Rarely, tumors (both malignant and nonmalignant) have to be considered, particularly in the older patient or in smokers
First, help the person stay calm, especially a young child. A person who is agitated may bleed more than someone who’s been reassured and supported. Then:
- Pinch all the soft parts of the nose together between your thumb and the side of your index finger or soak a cotton ball with Afrin, Neo-Synephrine or Dura-Vent spray and place this into the nostril
- Press firmly but gently with your thumb and the side of your index finger toward the face, compressing the pinched parts of the nose against the bones of the face
- Hold that position for a full five minutes by the clock
- Keep the head higher than the level of the heart. Sit up or lie back a little with the head elevated.
- Apply ice – crushed in a plastic bag or washcloth – to nose and cheeks
Sinuses are openings in the bones around your nose. Four pairs of sinuses are connected to the nose by small openings. These sinuses are located behind the cheekbones, alongside your nose, and above your eyebrows.
Humans produce one liter of fluid per day that cleanse the passageways and provide necessary moisture to the lining of each sinus. Tiny little hairs, called cilia, line the sinus membranes and flush the fluid through in a constant carwash-like motion. Under normal conditions, air passes in and out of the sinuses and mucous fluid drains from the sinuses into the nose.
Sinusitis is the inflammation of the sinus cavities located on either side of your nose, and between and above your eyes. Inflammation occurs when there is an undrained collection of pus or mucus in one or more of the sinuses. Mucus production increases during inflammation resulting in a drippy, runny nose. This drainage thickens over time. If this mucus cannot drain out of the sinus due to a blockage, bacteria will grow and an infection occurs. This infected sinus is what produces the symptoms of sinusitis.
The surgery enlarges the natural opening to the sinuses. Additionally, the procedure should leave as many cilia (tiny little hairs in the sinus), in place as possible. Endoscopic sinus surgery is particularly successful in removing areas of obstruction and allowing the normal flow of mucus.
Swelling of the vocal cords prevents them from coming together properly which makes a change in the voice. Acute laryngitis usually occurs due to swelling of the vocal cords from a common cold, upper respiratory tract viral infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert.
- If you smoke, quit
- Avoid substances that dehydrate the body, such as alcohol and caffeine. Avoid secondhand smoke
- Drink plenty of water
- Humidify your home
- Watch your diet – avoid spicy foods
- Try not to use your voice too long or too loudly
- Seek professional voice training
- Avoid speaking or singing when your voice is injured or hoarse
Yes, 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, cancers 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.
- Swelling of the tonsils
- 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
- Bad breath
- 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)
The two primary reasons for removal of tonsils and/or adenoids are (1) recurrent infection despite antibiotic therapy and (2) difficulty breathing due to enlarged tonsils and/or adenoids. Recent studies also indicate the removal of adenoids is a beneficial treatment for some children with fluid in the middle ear.
Allergies occur after a person with allergic tendencies is repeatedly exposed to the substance in his/her environment or his/her diet. It is estimated that at least 20% of the population is likely to develop some kind of allergy.
There is no standard way for an allergy to begin, and the onset may be sudden or gradual. For a person to become allergic to a substance, he/she must be exposed to it more than once, and generally that exposure is quite frequent. Often symptoms develop after unusual stress to the immune system such as following a severe viral infection.
“Hay fever” was named because of nasal symptoms developing during hay season, but most nasal allergies are called “hay fever.” “Hay fever” occurs most frequently during the spring, summer or fall when trees, grasses and weeds produce pollen. One of the principal offenders is the ragweed plant which produces pollen from late summer until frost.
Animals produce various substances that can cause an allergic reaction. The main culprits are proteins in the urine, saliva, or dander (dead skin flakes). In cats, for example, the main substances that cause problems are proteins found in cat saliva which often mixes with house dust. In rodents such as mice, rats or guinea pigs, it appears that urine contains the substance that most commonly causes allergy.
An otolaryngologist is a doctor specializing in the treatment of ear, nose and throat diseases. Half of the problems these physicians encounter are probably due, either directly or indirectly to allergy. Chronic nasal congestion and post nasal drip, seasonal or constant, is often allergic and may be complicated by chronic sinus and middle ear disease. Hearing loss, dizziness, headaches, weeping ear canals, and chronic sore throats may be due to an allergy. The otolaryngologist who does his/her own allergy treatment is able to follow the patient’s progress with specialized examinations and nose and throat medical and surgical treatment. An otolaryngologist not providing allergy care may refer you to a colleague for such care.
Snoring occurs when floppy tissue in the airway relaxes during sleep and vibrates. Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age.
Adults who suffer from mild or occasional snoring should try the following self-help remedies:
- Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
- Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.
- Avoid alcohol for at least four hours and heavy meals or snacks for three hours before bedtime.
- Establish regular sleep patterns
- Sleep on your side rather than your back
- Tilt the head of your bed upwards four inches.