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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.

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.

Provided by Carolyn Gigliotti, Au.D.


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.

Provided by John Eickholt, MD

Home sleep apnea tests have become increasingly popular over the past several years. Testing for obstructive sleep apnea in the home can be more convenient and can save money. Unfortunately, home sleep testing is not for everybody and is not for every situation. Home sleep tests are appropriate in selected patients when moderate to severe obstructive sleep apnea is suspected and there are no other medical or sleep issues that might preclude their accuracy or safety. Information obtained from home testing tends to be less reliable than traditional sleep tests. Further, they are not as thorough as tests performed in a sleep lab. They are prone to false negatives and cannot tell you that you do not have sleep apnea. Additionally, these tests are sometimes provided by companies not certified in sleep medicine or the interpretations are generated by physicians who are not part of our local community.

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.

Provided by Megan Goebel, MD

Hives are one of the most common reasons for a visit to an Allergist, with up to a quarter of the population experiencing hives at some point in their life. Hives, or welts, are red or white raised areas on the skin that itch. The itching can interfere with school, work and sleep. There are many causes for hives including allergic reactions to foods, medications, animal dander, insect stings or bites, or pollen. Typically with a food allergy, a patient will develop hives within 30 minutes of eating. This may be accompanied by swelling, throat tightness, trouble breathing, or vomiting which is called anaphylaxis. The most common food allergens are peanuts, tree nuts, fish, shellfish, cow’s milk, eggs, wheat and soy. If your symptoms are suggestive of a food or environmental allergy, your Allergist may perform skin prick testing to help diagnose this. In children, hives often develop during an infection which may occur with fever, runny nose, sore throat, vomiting, diarrhea or burning with urination. These hives will resolve on their own as your immune system fights the infection.

Provided by Erica Glancy, MD

I developed a rash while taking amoxicillin for a childhood ear infection. I was told to avoid all penicillins because I might be allergic. Am I likely to have an allergy to penicillin? 

The penicillin family of antibiotics includes over a dozen chemically-related drugs, one common example being amoxicillin. Immediate allergic reactions to these antibiotics typically occur quickly after receiving a dose, and often include skin symptoms, such as hives. Labels of penicillin allergy are commonly attached in childhood with up to 10% of the population being labeled as penicillin allergic. Fortunately, over 90% of these individuals will actually be able to tolerate penicillin drugs. 

Why do so many people think they are allergic to penicillin if they really aren’t? 

Two potential reasons for the discrepancy between reported penicillin allergy and the ability to tolerate penicillin drugs are the mislabeling of side effects of penicillin as true allergies (e.g. stomach upset) and the occurrence of coincident events that aren’t actually due to allergy (e.g. hives related to the illness for which the antibiotic is being prescribed). Another very important factor is the loss of allergy with avoidance over time. Even in those with true allergy, over 90% will lose sensitivity over a 10 year period. 

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.

Provided by Michael J. Loochtan, MD

Ear infections are one of the most common disorders to that affect children. These can often be managed with medication without the need for further intervention. Sometimes, however, your child’s doctor may recommend that your child have an evaluation with an otolaryngologist. Below is an explanation of what ENTs are, a discussion of normal ear anatomy, and an explanation of when ear infections may warrant consideration for ear tube placement.

An ENT is a doctor who is specially trained to diagnose and treat disorders of the ears, nose, and throat medically or surgically if needed. Therefore, they are also called head & neck surgeons. It’s a mouthful to say “Otolaryngologist – Head & Neck Surgeon” therefore usually we just go by “ENT.” ENT training is quite rigorous and entails 4 years of medical school after college, followed by 5 years of residency training. Some ENTs pursue additional specialized training after residency. This extra training is called a fellowship and is usually 1-2 years in length.

Provided by Evan Tobin, MD
and Roger Friedman, MD

If your child has tried antihistamines and/or nasal steroids but their symptoms did not improve, the pediatrician may send a referral to a specialist.

Which specialist? An Allergist or an ENT (Ear, Nose and Throat)?

At Ohio ENT & Allergy Physicians, both specialties work together to sort these problems out.  At one of our 10 convenient locations, a pediatric patient with chronic nasal and sinus symptoms can be evaluated for both adenoid problems and allergies. Testing will include routine allergy testing, a thorough physical exam and sometimes the use of a small flexible endoscope to evaluate the nasal passages and check the size of the adenoids. This scope also allows diagnosis of other problems such as a nasal foreign body, a polyp, or a deviated nasal septum (which is rare in children).

Medical treatment may be tried again by our specialists. This may include stronger nasal sprays, antihistamines, antibiotics or allergy shots (immunotherapy).

If this treatment is still not effective, surgical treatment may be offered. This may include removal of the adenoids and treatment of the nasal swellings called “turbinates”.  Sometimes tonsillectomy or ear tube insertion may be necessary, as well. (These will be discussed in a future blog.)