Author: entmaster

Provided by: Roger Friedman, MD (Allergist/Immunologist)

Oral Immunotherapy, also called OIT, has been a life-changing therapy for patients, parents and physicians. Food allergies have been dramatically increasing over the last 25 years and affect 8% of the population. Most concerning has been the severe food allergies, especially to peanuts and tree nuts.
 
One year ago, we began a program at Ohio ENT and Allergy Physicians for OIT.  Since that time, we have enrolled 50 patients, and seven of them are now graduates of the program.

There are three parts to the program; Day-one; in which the patient spends about five hours with us receiving increasing microscopic quantities of the food they are allergic to. The patient then continues to eat the final day-one dose at home for the next 1-2 weeks. They then return for an up-dose at the office. This continues for about 6-8 months. Eventually, our patients reach a maintenance dose of between 2-8 peanuts or tree nuts a day.
 
Although the patient is not cured, they are desensitized, and it is much safer for them, especially if they inadvertently ingest a small quantity of their allergy. We have now expanded the treatment to include other foods such as egg and wheat. The treatment involves a great deal of time and effort for the families and our healthcare providers but has been incredibly rewarding for everyone, and we are finally on the road to making the world a safer place for food-allergic patients.

Provided by: David Hauswirth, MD (Allergist / Immunologist)

Often we are asked to evaluate someone with ear problems and asked, “do allergies cause ear problems?” The simple answer is yes. The Eustachian tube drains the middle ear into the back of the nose. In someone suffering from allergies, the Eustachian tube can swell or not work correctly. This lack of function and drainage will cause fluid to build in the middle ear, leading to temporary hearing loss and sometimes ear infections.

Patients with allergies will often have ear symptoms. Sometimes the ears will itch, feel full, pop or have pressure. Manytimes clear fluid is found in the middle ear when someone has allergies. This fluid will often drain as allergies are treated. However, if allergies are not treated, this fluid can stay in the middle ear and become infected. Once someone develops an ear infection, the cause and the infection must both be treated.

Children are unique, and they will naturally have more issues with their Eustachian tubes. In a young child, the Eustachian tube is in a more horizontal or flat position. This positioning decreases natural drainage by gravity. When allergies and allergic inflammation are added, kids can have even more trouble clearing fluid. Sometimes when the fluid does not clear and recurrent ear infections are an issue, external drainage tubes (“ear tubes”) are necessary to help clear fluid from the middle ear to prevent infection.

In children, it is important to determine the cause of ear problems. It may simply be upper respiratory infections, young age, and anatomy or allergies. It is important to talk to your doctor if you think allergies are causing symptoms, and if you have ear infections, they may be related.

Provided by: Michael Goodman, MD (Allergist/Immunologist)

Sinusitis is a common problem seen in both ENT and allergy offices. Sinusitis is inflammation of the sinuses, air-filled cavities located in facial bones around the nose. Sinusitis is often due to an infection in these cavities. It can feel like a bad cold with facial pain, runny nose (rhinorrhea), headache, nasal congestion, and a sore throat. While the common cold is a viral infection, sinus infections are often bacterial and treated with antibiotics (antibiotics are not of help in the treatment of viruses).

Many conditions can contribute to the onset of a sinus infection. Many of them involve blockage of the natural drainage of the sinuses and the nose. When this drainage is blocked, bacteria present in the nose have an easier time replicating and increasing their numbers to the point that a sinus infection occurs. Inflammation that starts as a cold can increase the chances of a sinus infection starting. Allergic rhinitis (allergic inflammation of the nose) can also create inflammation that results in blockage and increase the likelihood that a bacterial infection will take hold and cause sinusitis.

Allergists at Ohio ENT and Allergy Physicians are trained to diagnose sinus infections and many of the conditions that can lead to sinus infections. Allergy testing can help determine a patient’s allergic sensitivities and what allergens may be causing inflammation in the nose. In some cases, an examination of the immune system checks for immune deficiencies. Recurrent sinus infections are sometimes an initial presentation of an immune deficiency. We frequently partner with our ENT colleagues in the care of sinusitis patients, as an ENT physician can perform a thorough evaluation of anatomical abnormalities that can increase the likelihood of a sinus infection

Provided by: Roger Friedman, MD (Allergist/Immunologist)

This is a unique and challenging time for all of us! A question I often hear is, “Could this be COVID-19 or is it my allergies?” First of all, allergies, asthma and COVID-19 do have some similar symptoms, including a runny nose, sneezing and cough. Allergies will often also cause itchy nose, eyes and throat; COVID-19 does not. In addition, most allergy sufferers know they are allergic to the tree pollen that is currently out, so their symptoms will be worse after being outside.

With COVID-19, patients will often have a fever which doesn’t occur with allergies. The sudden loss of the senses of smell and taste is a newly discovered symptom of COVID-19.

I have given you a few helpful ideas but if you’re worried or unsure please call us, we are all available! With your safety in mind, we have found new ways to care for our patients. (IE: phone calls and/or telemedicine) Request an appointment at OhioENTandAllergy.com today! 

Provided by: Roger Friedman, MD (Allergist)

Hay Fever Season is Here – What Can You Do?

Ragweed pollen is the cause of allergic rhinitis that begins in early August and lasts until it frosts a few times, which kills the weed. Ragweed pollen is everywhere – especially in the woods, fields and in the center strip of highways. The pollen counts can be over a thousand, especially during the heavy pollination times (early in the morning and late afternoons).

The first strategy is avoidance of the pollen. You can do this by keeping the windows in the house closed and using the AC. When you exercise try to avoid early am and dusk.

We use a variety of medications to treat hay fever, including antihistamines, nasal steroids, nasal antihistamines and Singulair®. Each patient responds to these differently, so if one fails another may succeed. If these work then no further evaluation may be needed, but if patients continue to suffer it’s time to see your Allergist.

The diagnosis is usually confirmed by a visit to your Allergist where skin testing can guarantee that the proper problem is being treated. Immunotherapy or allergy shots are our most effective treatments, and can actually cure the problem.

Provided by Ashish Shah, MD

Nosebleeds (epistaxis) are one of the most common issues seen by Ear, Nose and Throat doctors. Patients with recurrent nosebleeds have a strong desire to rid themselves of this issue, given that nosebleeds often occur at inopportune times and places and ruin clothing! The main risk factor is dryness, but the increasing use of blood thinning medication is also a strong risk factor. High blood pressure, allergic rhinitis, chronic sinus disease, nasal trauma and bleeding disorders are other possible factors.

Most commonly, nosebleeds arise from small pinpoint areas of mucous membrane blood vessel disruption, even in the case of a gushing nosebleed. You would be surprised how much bleeding can occur from a blood vessel the size of a pencil tip! You should be reassured that it is very rare that nosebleeds – even when severe – would represent any concerning intranasal process. The vast majority of nosebleeds occur on the septum, the cartilage structure that divides the nose into two passages. Nosebleeds in the back of the nose which drain primarily down to the throat are more commonly related to high blood pressure. Some of these nosebleeds can be severe and more difficult to manage.

The main treatment of nosebleeds is prevention. Consistent use of moisturizing products on the mucous membrane of the septum is key. Any number of products can be effective, including petroleum jelly and saline gel using a cotton swab. Alternatively, nasal saline spray can be used at least a few times daily. A humidifier is also advised when you have the heat on since all heat is dry. Encourage children to limit digging in their nose and moisturize scabs in the nose instead of trying to remove them.

An active nosebleed should be treated with pressure for about fifteen minutes by pinching the nostrils against the septum. Holding the bony upper nose is ineffective. Stuffing tissue paper in the nose will only pull a scab off when the paper is removed, causing the nosebleed to recur.

If a nosebleed is recurrent or persistent, then nasal cautery or packing may be necessary. An ENT physician at Ohio ENT and Allergy Physicians can often cauterize the offending source with chemical cautery using silver nitrate or electrocautery. Most children will tolerate chemical cautery in the office. If a nosebleed is profuse, sometimes packing the nose with a sponge-like material is necessary for a few days. Severe nosebleeds may need to undergo surgery or an interventional radiology procedure called embolization to occlude the blood vessel internally. The Otolaryngologists at Ohio ENT and Allergy Physicians are able to see patients with a history of nosebleeds in a timely manner to determine the best management for this troublesome issue.

Provided by Mehmet Basaran, MD (Allergist)

Western medicine that we practice in the United States is currently based on observation, testing, diagnosis and treatment. Observation includes physical examination and a thorough history. Testing is selected based on the patient’s history and suspected causes of the patient’s problems. At Ohio ENT and Allergy Physicians, the board certified Allergist uses testing techniques and laboratory techniques that are proven to be safe and relevant, based on scientific study and published in peer-reviewed journals. Then the results, correlated with observations and physical examination, and plans of therapy are discussed with the patient.

Allergy prick skin testing is still the most physiologic form of testing for allergy. Blood tests such as RAST and Immunocap testing are helpful in that they determine if there is sensitization to a particular allergen. It must be correlated with physical and clinical symptoms. Another proven method of testing for allergies is a challenge. This can be an environmental challenge and done in research settings where patients are exposed to known allergens by breathing it in, or a food challenge when patients ingest a small increasing amounts of the food in question.

There are many other tests available. Many have not been proven to be of any clinical significance. For example, IgG4 is touted as a test for food sensitivities. However, IgG4 to foods can be found in many people who have absolutely no problems with foods. Testing for food sensitivities using IgG4 has no proven clinical benefit, and often leads to very strict restrictive diets that are totally unnecessary and may be emotionally or physically harmful.

Other tests have absolutely no basis in science. These include ALCAT testing, NuTron testing, Mediator release test, sublingual testing, provocative testing, food immune complex testing, applied kinesiology, electro-dermal testing, Neurological Stress Reduction Therapy, and laser testing and treatment. This is by no means a complete list. Many of these techniques cloak themselves in scientific jargon and claim to be cutting-edge, but really depend upon a poor understanding of physiology and science in general.

Provided by Darryl Willett, MD

At OhioENT and Allergy Physicians, we see a tremendous number of referrals for thyroid nodules. Many times, the patients are told by their primary care physician that they need a Fine Needle Aspiration Biopsy of their thyroid nodules to determine if they are cancerous or not. We do perform many Fine Needle Biopsies the same day as their initial appointment, but oftentimes, we may defer the biopsy or bypass the biopsy and go straight to surgery. This may confuse the patients who simply assumed that it was mandatory to see the surgeon for a Fine Needle Biopsy.

I would like to educate the public on the rationale that the thyroid surgeon goes through in their mind to determine what the best protocol might be for each patients’ needs. Understanding that in general, only 5% of all thyroid nodules are malignant may put the patient at ease, but there are certain nodule characteristics that may be more alarming and raise the index of suspicion for cancer than others.

1. Nodules that for sure should be considered for Fine Needle Biopsy the same day as initial office visit with ENT Surgeon:
   • any single nodule between 1.0-1.5 cm in size (when there are not multiple nodules present in the remainder of the thyroid) that can be easily palpated or felt on exam
   • a large, purely cystic nodule (nodule consisting of fluid only) > 1.5 cm that can be easily palpated on exam
   • any single nodule on unhealthy patients whom the surgeon feels would not tolerate surgery well and would be better off monitored for nodule growth (elderly, sickly, significant cardiac/pulmonary/renal disease, etc.)
2. Nodules that should bypass a Fine Needle Biopsy and go straight to surgery:
   • any nodule > 1.5 cm (the rationale is that once nodules grow larger than 1.5 cm, there is too much sampling error with a skinny little needle which may miss a cancer)
   • patient with a family history of thyroid cancer
   • patients with a history of radiation therapy to their neck region
   • patients that have multiple nodules throughout their thyroid gland where any of the nodules are > 1.5 cm (there are too many nodules to biopsy)
   • nodules that have microcalcifications (especially if the microcalcifications are in the rim of the nodule) since this has a much higher incidence of being cancerous
   • nodules > 1.5 cm that are considered “complex” (contains both a solid and fluid component) since this has a higher incidence of being cancerous
3. Nodules that can be simply followed with repeat ultrasounds and can bypass Fine Needle Biopsy:
   • elderly or sickly patients (as noted above) and patients on blood thinners who would be too high risk for surgery and do not have a history of radiation to neck, family history of thyroid cancer, no microcalcifications in the rim of the nodule
   • single nodules < 1.0 cm
   • multiple nodules in the thyroid with all of them < 1.0 cm
4. Patients who need to be scheduled for an Ultrasound-Guided Fine Needle Biopsy through the Radiology Department:
   • nodules that are > 1.0 cm, but cannot be felt on exam by the surgeon
   • nodules that are too close to the carotid artery to be safely biopsied in the office

*These guidelines are the opinion of a thyroid surgeon with 25-years experience and should only serve as a suggestion for planned treatment – each case should be considered individually.

Provided by Darryl Willett, MD

Pediatric Tonsillectomy and Adenoidectomy (known as a T&A) is the second most common pediatric surgical procedure performed. There may be a variety of reasons your child might be referred to one of our Ear, Nose and Throat Specialists here at Ohio ENT and Allergy Physicians.

The more common reasons to be referred by your child’s Pediatrician, Family Physician or Dentist are: chronic tonsillitis (or strep throat), snoring, obstructive sleep apnea (where your child has pauses in their nighttime breathing, breath holding and gasping episodes), swallowing problems where they appear to be choking on food, chronic halitosis (bad breath), and chronic mouth breathing which can lead to misaligned teeth.

Complications are uncommon, but fewer than 1% of children can have bleeding after surgery. Most of the time, this is self-limiting and nothing further needs to be done, but on a rare occasion, your child may need to go back to surgery to have the bleeding stopped. Most children should expect to miss 1 week of school to recover.

Thousands of these procedures are performed annually in Central Ohio. The Surgeons at OhioENT and Allergy Physicians, collaborating with the finest Anesthesiologists, have performed nearly 21,000 pediatric tonsillectomies over the past 20 years at The Ohio Surgery Center.

The Ohio Surgery Center was the first-of-its-kind Single Specialty All-Ear, Nose and Throat Surgery Center in the country. Their safety record is unsurpassed, receiving only the highest accolades from the national governing board, JCAHO (Joint Commission on Accreditation of Healthcare Organizations). Our surgeons are Board Certified and have received an extensive 5 years of tonsillectomy training of all age groups in their residencies and work alongside anesthesiologists who have also received pediatric training with Board Certified Pediatric Fellowship Trained Anesthesiologists on staff.