Thyroid nodules are lumps or cysts that form in the thyroid. Many are simply an overgrowth of normal thyroid tissue. These lumps can be buried deep in thyroid tissues or may be located near the edge and feel like a lump in the skin. In some cases, they can even be visible in the front of the neck. Most of the time they are found and identified during routine checkups.

Nodules may have no symptoms but are simply felt or seen by the patient or doctor. In some cases, they can cause pain or difficulty swallowing. Many thyroid nodules are benign. However, it is important to have nodules evaluated by a doctor right away so that if they are cancerous or precancerous, treatment can begin as soon as possible.

There are three questions the doctor will consider to determine if the thyroid nodules require treatment or removal:

• Is the nodule possibly cancerous or precancerous?
• Is the nodule pressing on other systems in the neck or causing symptoms?
• Does the nodule secrete too much thyroid hormone?

If the answer to any of these questions is yes, the doctor might recommend medical or surgical treatment.

An ultrasound-guided biopsy uses soundwave imaging to guide a needle into the thyroid tumors or other tumors of the head or neck and remove a small tissue sample. This procedure is generally much safer and less invasive than a surgical biopsy.

The procedure normally takes less than thirty minutes. It can be performed with local anesthesia. The doctor will lay the patient down with their head tipped back. When the neck is extended, the thyroid gland is pushed forward, making it easier to see with ultrasound technology.

An ultrasound is a safe and painless way to get a picture of something inside the body using sound waves. It is performed by placing ultrasound gel on the skin and rubbing a small transductor against it. The transductor emits high-frequency soundwaves through the gel and into the body. It collects the waves that bounce back, and a computer uses those captured waves to create an image. The ultrasound shows what is happening in the body in real time, including the internal structures, movements and blood flow of the body’s organs.

The next step of the biopsy, once the ultrasound displays the thyroid, is to insert a thin needle into the thyroid gland and extract a small amount of tissue or fluid. A bandage is placed over the area where the needle was inserted and the patient is free to go home and resume normal activities. The pathologist examines the sample under a microscope to help determine if any malignant cells are present.

The thyroid and parathyroid are endocrine glands near the throat that secrete hormones throughout the body. The thyroid is bowtie-shaped and rests in front of the trachea (windpipe). It uses iodine from food to regulate the body’s energy. The parathyroid is a cluster of smaller glands located on the back of the thyroid. Their role is to control the amount of calcium in the blood.

The most common thyroid disease is hyperthyroidism. Hyperthyroidism is defined as an overproduction of thyroid hormones, and there are several ways it can present: Graves’ disease, which is the production of too much thyroid hormone; toxic adenomas, or small nodules that develop in the thyroid gland that also produce hormones, disrupting the body’s chemical balance; subacute thyroiditis, which is inflammation of the thyroid that causes the gland to “leak” excess hormones, lasting a few weeks to a few months and hyperthyroidism developed from pituitary gland malfunctions or cancerous growths. Hypothyroidism, by contrast, is the underproduction of thyroid hormones. It is caused by certain drugs, autoimmune disorders and removal of the thyroid.

The primary disease of the parathyroid glands, like with the thyroid, is overproduction of hormones. This is called hyperparathyroidism. The most common way this occurs is the development of benign tumors in one or more of the parathyroid glands. The tumors produce hormones too, which causes calcium imbalances in the body. The parathyroid glands can also grow cancerous tumors, but this is very rare.

CPAP

A continuous positive airway pressure device (CPAP) is a treatment option for those with sleep apnea or other breathing problems. The CPAP consists of three major parts: a mask that fits over the mouth and nose with straps to hold it in place, a tube that connects the mask to the motor and the motor itself, which generates airflow. The pressure from the CPAP prevents the patient’s airway from becoming blocked so that they can sleep with less snoring and pausing in their breathing.

Oral Appliances
An oral appliance is another treatment option for those with mild or moderate sleep apnea or chronic snoring. The device resembles an athletic mouth guard and is custom-fit to the patient’s mouth. It works by supporting the jaw in a forward position to ensure the airway remains open. The advantages of an oral appliance are that it is usually comfortable, easy to wear, convenient and simple to care for, portable and doesn’t make noise like a CPAP. Your ENT will work alongside your dentist to ensure your oral appliance is effective and well-fitting.

Sleep Apnea Surgery
Surgery may be necessary if you have sleep apnea that has not been effectively treated with an oral appliance or CPAP or if there is a significant anatomic obstruction. The surgery required varies depending on what is causing the sleep apnea. In children, sleep apnea is commonly caused by enlarged tonsils or adenoids; in this case, the patient would undergo a tonsillectomy and/or adenoidectomy. Other types of surgery can correct a collapsing soft palate, a poorly set jaw, a swollen tongue, excessive throat tissue or other structural problems that may cause blockage in the airway.

Tonsils & Adenoids
The tonsils and adenoids are lymph glands made up of tissues, fibers and white blood cells in the body’s immune system. Tonsils are the two round lumps in your throat that the doctor examines when he tells you to stick out your tongue and say “ah.” Tonsils are prone to swelling, soreness and abscesses when they become infected. Swollen tonsils can obstruct the throat and make swallowing, breathing and sleeping difficult.
Adenoids have the same function as tonsils, but they are located in the throat behind the nose and above the soft palate. Adenoids are prone to the same conditions as tonsils, but they can cause additional problems with the ear, because the adenoids are located near the Eustachian tubes. Symptoms of adenoid and tonsil infections may include sore throat, stuffy nose, bad breath, earache, fever, swallowing difficulties and snoring.
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As many as forty-five percent of adults report occasional snoring, and over twenty-five percent snore every night. Snoring occurs when there is an obstruction in air flow in the throat, mouth and/or nose. The sound we hear is the result of the tongue or upper throat vibrating against the soft palate and uvula during breathing.

Snoring most commonly occurs in adults, and it usually worsens with age. Chronic snoring can be caused by poor muscle strength in the tongue and throat, resulting in the tongue falling backward and obstructing the throat, excessive throat tissue or soft tissue in the neck or a long soft palate and/or uvula. Snoring can also be caused by stuffy nose from sinus infection, hay fever, or a cold; this type of snoring should go away after recovery from the illness. When children have chronic snoring, it often indicates enlarged tonsils or adenoids or nasal blockage.

Snoring can be the symptom of a more serious condition, such as sleep apnea. When snoring is interrupted by pausing, choking or gasping, sleep apnea is a high probability. Obstructive sleep apnea (OSA) is characterized by episodes of breathing pauses that are caused by collapse of the upper airway.

Symptoms of sleep apnea include chronic snoring, morning headaches, memory and learning problems, irritability, depression, mood swings, waking up frequently, bed wetting, dry mouth, sore throat and sleepiness during the day. Sleep apnea disrupts the natural sleep cycle, which causes many of the above symptoms despite having “slept” most of the night.

Home Sleep Testing
In order to diagnose sleep apnea, your ENT may have you conduct an at-home sleep study. At one time, all testing was done in the lab; however, patients have a harder time falling and staying asleep when they are not in the comfort of their own home. Home sleep testing consists of measuring nasal and oral airflow by way of a thin wire taped near the nose and mouth, evaluating respiratory effort by strapping an elastic belt band around the chest and abdomen and using an oximeter figure probe, which is a small clip that attaches to the fingertip and evaluates oxygen levels in the blood.

In Lab Sleep Testing
An in-lab sleep test is an overnight exam that allows doctors to monitor you as you sleep to diagnose sleep apnea or other sleep disorders. You’ll be asked to arrive about two hours before bedtime so the test can be set up. Although you can sleep in your own pajamas, sensors and electrodes will be placed on your head and body to monitor your physical activity during sleep. There will not be other patients in the room.

Epworth Sleepiness Scale
The Epworth Sleepiness Scale is a questionnaire that gauges daytime sleepiness. The patient evaluates on a zero to three scale whether they are likely to feel sleepy or doze off during various daytime activities. The total score of all eight activities is added up and graphed on a sleepiness scale. A score of less than ten is considered normal, but a score between eleven and twenty-four could indicate a sleep disorder. Epworth Sleepiness Scale

Good Sleep Hygiene
Good sleep hygiene is important for having quality sleep and feeling rested during the day. The best form of sleep hygiene is keeping a regular schedule for going to bed and getting up in the morning. The amount of sleep needed and the sleep schedule vary greatly from person to person; the most important thing is to be consistent. Some other habits for good sleep hygiene include avoiding naps during the day, refraining from caffeine in the evening, exercising regularly, not eating close to bedtime and using your bed only for sleep.

Of all the facial plastic surgery procedures Dr. Manning performs, facelift surgery (rhytidectomy) provides perhaps the most dramatic and impressive improvement. Not surprisingly, it is also the procedure that requires the most time and work. Patients concerned about the aged appearance of their cheeks, jowls, jawline and neck are the best candidates for rhytidectomy.

The popularity of rhytidectomy and its evolution have resulted in the development of a variety of different incisions and techniques. Dr. Manning uses an incision that minimizes the movement of any facial hair (especially in the temple region), and with a meticulous closure technique, leave an imperceptible scar. The operation involves four stages: the incision, the elevation of the skin, the repositioning of the facial muscles and fat and closure. Dr. Manning often addresses both the cheek/jowl and neck area during the third stage of the procedure to maximize improvement in both areas.

His primary goal is to ensure a natural-looking appearance by camouflaging scars while maximizing surgical improvement. Because of the ability of facelift surgery to dramatically improve the appearance of the face, it is one of the most satisfying procedures Dr. Manning performs. However, facelift surgery is not for everyone. The best results are seen with properly-selected candidates who enter the surgical process psychologically prepared with realistic expectations.

The best way to treat allergy symptoms is to completely avoid allergens. Although this may be impossible, certain behaviors, called non-pharmacologic therapy, can help minimize them. Here are a few simple things you can do to reduce the presence of allergens in your home:

o Encase your mattress and pillows in dust mite-proof cases. Wash all your bedding in hot water at least once a week.
o Remove carpeting from your home and replace it with an easy-to-clean material such as hardwood or linoleum. If the carpeting cannot be removed, vacuum and shampoo it regularly.
o Use only washable window coverings, such as cotton or synthetic curtains.
o During pollen season, keep your windows closed.
o Get rid of clutter, including any knickknacks that sit on tables collecting dust.
o Invest in a HEPA air filtration system to remove small allergen particles from the air.
o Do not keep potted plants in the house.
o Avoid using a wood-burning fireplace or stove; the smoke will worsen respiratory allergies.
o Wash the sink regularly and don’t let dishes pile up. Dirty dishes and food buildup can create a breeding ground for mold.
o Wash or replace moldy shower curtains and bathmats.
o Keep your house below 72 degrees Fahrenheit. Dust mites and mold breed best in hot, humid conditions.
o Don’t allow smoking inside your home.
o If possible, rehome your pet. If not, make sure to bathe them once a week and keep them out of your bedroom and off the furniture.

Allergy drops, also known as sublingual immunotherapy, are overall safer than allergy shots, called subcutaneous immunotherapy, because they aren’t administered with a needle.

The principle of allergy drops is the same as allergy shots. It is a long-term treatment that decreases symptoms by increasing the body’s immunity. The patient drips liquid that contains allergens under the tongue and holds it there for one to two minutes before swallowing. This is a more convenient option than allergy shots for many patients because allergy drops can be safely administered at home rather than at the doctor’s office.

The dose varies by patient depending on several factors, including severity of allergies and sensitivity to allergy drop dosages. Patients generally self-administer treatments between three and seven days per week for an average of three to five years. The goal is to build up the body’s immunity to allergens so the patient no longer experiences symptoms once the treatment is over.

Like all medical procedures, there are possible risks and side effects. However, these are generally mild, ranging from localized itching in the mouth to intestinal discomfort, which often goes away after several weeks.

Allergy drops are an important new treatment option for patients constantly refilling over-the-counter allergy medications or taking daily trips to the doctor’s office for allergy shots. Currently, allergy drops are effective for treating asthma related to dust mites, as well as allergies to grass, ragweed, pet dander and tree pollen.

Skin allergies
Skin allergies commonly present as bumps, redness, dryness and itchiness. Skin allergies can also overlap with food allergies as some people have contact allergies to certain foods. Common skin allergies include atopic dermatitis, which is a common form of eczema; hives, which can be caused by an allergen or an infection; contact dermatitis, which is a rash that can be caused by soaps, detergents, shampoos, nickel, adhesives and latex; and latex allergies, which can present as dermatitis (hives), itching, stuffy or runny nose and asthma.

Hay fever
Hay fever, also called allergic rhinitis, affects between 40 and 60 million Americans. It can be seasonal, only occurring during the spring and summer due to airborne pollen, or perennial, caused by dust mites, pet dander or mold. Hay fever symptoms may include runny nose, itchy eyes and skin, sneezing, runny or stuffy nose, fatigue or other allergies.

Our voices are essential for communication. Voice can be manipulated to convey emotion, alert someone of danger and create music. The human voice can create sounds and articulations used in thousands of languages across the world. We use our voices every day without even thinking about how they work.

The mechanism that generates the human voice is made up of three major parts: the lungs, the vocal cords and the articulators. The lungs act as the pump that supplies air flow and pressure to vibrate the vocal cords. The vocal cords, part of the larynx, are vibrating valves that dissect airflow into pulses (soundwaves). The larynx adjusts the length and tension of the vocal cords to affect pitch and tone. Articulators (tongue, palate, cheek and lips) filter soundwaves emanating from the larynx and turn them into words.

You may have a voice disorder if you have trouble controlling pitch, volume, tone or other voice qualities. It means there is something wrong with one of the parts listed above. Symptoms of voice disorders include quivering sound, hoarseness, choppiness, breathiness or unusual pitch. Other symptoms are physical, like feeling a lump in your throat when speaking, feeling tired in your throat or voice box and tenderness on the outside of your throat.

Treatment of voice disorders depends on the cause. Lifestyle changes could help with voice strain from yelling or singing regularly. Speech therapy with a speech-language pathologist (SLP) can help certain voice disorders where muscles are affected. Medicine can help voice disorders that are caused by hormone or thyroid problems. Surgery is also a possibility for those with growths on or near the vocal cords or larynx.

Vocal Cords
The vocal cords are two membranes that stretch horizontally across the larynx. They vibrate to create soundwaves. The cords are controlled by the vagus nerve, which opens the membranes for breathing and contracts them during swallowing and for speaking. Men generally have longer and thicker vocal cords than women, which is why they have deeper voices. Children’s vocal cords are much shorter than adults’, which is why their voices are higher but deepen as they grow. Genetic factors can also affect vocal cords and voice.

Hoarseness
Hoarseness is a symptom, not a disease in itself. It can be defined as any deviation from the voice’s normal quality such as raspiness, breathiness or strain. It is commonly caused by dry throat, dehydration, acid reflux, smoking, strain from excessive screaming or singing, allergies and coughs or colds. It can also, along with other side effects, suggest polyps on the vocal cords, throat or lung cancer, or thyroid conditions.

Laryngitis
Laryngitis is inflammation of the voice box due to vocal strain, irritation, inflammation or infection. Symptoms of laryngitis include hoarseness, voice loss, rawness of the throat, sore or dry throat and cough. Acute laryngitis generally heals on its own or with at-home remedies like rest and drinking warm fluids. Chronic laryngitis is defined as symptoms that persist more than two weeks, which could point to a more serious condition. Seek immediate medical attention if you experience fever, trouble swallowing, trouble breathing, coughing up blood and excessive drooling.

Chronic Cough
Chronic cough is defined as a cough that lasts at least eight weeks in adults or at least four weeks in children. This condition can interrupt sleep and cause vomiting, lightheadedness and even rib fractures. The most common causes of chronic cough are tobacco use, postnasal drip, asthma and acid reflux. Treating the underlying condition is the only way to completely eliminate chronic cough.