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Conditions and Treatments

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Comprehensive ENT Services

Ear Nose Throat (ENT) specialists provide comprehensive medical and surgical treatment for patients with illnesses of the ears, nose, throat and related structures of the head and neck.

They offer consultation, diagnostic and therapeutic services for a range of conditions, including treatment of:

Ear and Balance
Ear Infection Graphic

Swimmer’s Ear or an External Ear Infection
: can often be treated with antibiotic ear drops. Severe infections, however require evaluation by an ear nose and throat specialist who may perform debridement and institute other specialized treatment regimens.

Middle Ear Infections (or Otitis Media):  is very common in childhood and in some adults and is often treated with oral antibiotics. Severe or recurrent middle ear infections require ENT evaluation and treatment. This may at times involve placement of a small tube to help ventilate the middle ear space (ear tube or tympanostomy tube).

Ear Infection Graphic
Ear Drum or the Tympanic Membrane
: can be damaged by infections or other diseases of the middle ear. This damage could consist of a hole (tympanic membrane perforation), or poor movement due to fluid or vacuum behind the ear drum. This can result in significant ear loss.

Treatments for Ear Drum Disorders: can consist of placing an ear tube or other surgeries to repair the ear drum. Alternatively, better ventilation of the middle ear can be established by improving function of the Eustachian tube which connects the ear to the back of the nose. Eustachian tube dysfunction therapy consists of use of nasal anti-inflammatory medications and occasionally anti-acid reflux medications. Damage from acid reflux and allergies can cause dysfunction of the Eustachian tube and the middle ear.

Hearing Loss: can happen to everyone with age and when it causes problems in terms of social functioning, an evaluation by an audiologist and an ENT specialist is advised prior to considering hearing aids. Certain patterns of hearing loss (such as sudden hearing loss or asymmetric hearing loss) require immediate attention by an ENT specialist. In some cases there are reversible causes for these problems. Special testing such as an MRI may be required as well. Tinnitus or ringing in the ear is often a by-product of hearing loss. Certain types of tinnitus, however, may be due to other causes. A thorough evaluation by an ENT professional can rule out concerning causes and help with management.

Audiology services can help with evaluation and dispensing and repair of hearing aids and custom ear plugs.

Balance is a complex function that is controlled by the brain, eyes and the inner ear organs of balance. Disruption in the function of any of these organs can cause a disturbance in balance and at times dizziness and a room spinning sensation known as vertigo. Comprehensive balance testing can often isolate the source of the disorder and allow appropriate treatment.

Voice and Swallowing
Voice Box - larynx

Voice Changes: can be temporary and due to a cold or laryngitis. If a breathy or raspy voice persists for more than a few weeks, a more serious condition such as vocal cord paralysis, nodule or polyp may be present. Endoscopic evaluation can rule out these and other serious conditions of the larynx including cancer and allow for appropriate treatment. Laryngoscopy can be performed in the convenience of an ENT office under local anesthesia. Recent advancements have allowed rapid restoration of normal voice in many cases, including even cases of vocal cord paralysis. Talk to an ENT professional about your options.

Swallowing Dysfunction: Can be associated with certain conditions of the larynx and/or muscles of the mouth and throat. A comprehensive swallowing evaluation involves laryngoscopy as well as evaluation of swallowing by a speech and swallowing pathologist.

Nose & Sinus

Nose Diagram

Nasal Allergies and Congestion: can lead to blockage of the nose and the drainage pathways of the sinuses. Physicians at MultiCare Ear Nose and Throat can help with various disorders of the nose and sinuses including nasal congestion, frequent sinus infections (sinusitis), prolonged sinus infections (chronic sinusitis). Treatment modalities offered include advanced medical therapy, environmental allergy testing and treatment, as well as endoscopic and minimally invasive sinus surgery.

Allergy Testing: includes environmental and food allergy testing, as well as immunotherapy and allergy consultation/education.

When the nose is blocked and breathing through it is impeded, this may indicate an anatomic blockage of air flow in the nose. This can result from deviation of the middle wall of the nose (septal deviation) or narrowing of nasal passages for other reasons. These deformities are often in-born or caused by trauma to the nose. Fortunately, surgical treatment of deviated septum (septoplasty) and other nasal deformities (rhinoplasty) using modern techniques can significantly improve breathing.

Head & Neck

There are multiple saliva glands in the body. These include two large glands in the cheeks (parotid glands), two medium-sized glands under the jaw (submandibular glands) and several smaller glands throughout the mouth. When the ducts of these glands become blocked by stones or scarring or other disease process, glands can development painful swelling and become infected. In addition to antibiotics, evaluation of the glands for possible dilation of the ducts or removal of the stones should be done by an ENT specialist.

When swellings of the glands do not respond to traditional treatments, a benign or malignant tumor may be present. Removal of all or part of the gland while preserving the delicate underlying nerves of the face (facial nerve) may be indicated (parotidectomy, excision of submandibular gland etc). ENT surgeons use meticulous techniques to safely remove these glands while preserving function of normal structures surrounding them.

Surgery of benign or malignant tumors of the thyroid gland is a challenging operation. Fortunately, MultiCare ENT surgeons, use their extensive subspecialty experience and knowledge of the anatomy of the head and neck to carefully remove affected portions of this glands while preserving the delicate nerve that moves the vocal cords (recurrent laryngeal nerve) and the parathyroid glands. If you need to have a thyroidectomy for a tumor of the thyroid gland (thyroid goiter or cancer) or a poorly functioning gland, ask for a referral to an Ear Nose Throat surgeon with expertise and familiarity with modern techniques and technology for safe thyroid surgery.

Skin Cancer: If you have a skin lesion in the head and neck that is growing, changing size, crusts or bleeds and does not seem to heal, have your doctor check it. ENT surgeons have expertise in not only removing skin cancers and but also in use of surrounding tissues and reconstructing the subsequent defects that may occasionally be quiet large.

Head and Neck Tumors: Other masses in the head, neck and throat can also be evaluated by ENT specialists. Call for evaluation that may include biopsy and imaging studies.

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Unsightly scars or keloids from prior surgery and trauma do not have to be permanent. ENT surgeons can address these scars using various techniques to help leave a less noticeable mark on your body.

Facial Nerve Disorders (Bell's Palsy): Paralysis of one side of the face that can be caused by tumors, viruses, stroke and, at times,  unknown causes. Careful evaluation by an Ear Nose and Throat specialist can help rule out treatable causes while administering anti-inflammatory and anti-viral medications to help restore facial motion. In cases of permanent paralysis, surgical procedures and administration of Botox™ can help to partially restore the function and appearance of the face.

Sleep Apnea & Pediatric ENT Disorders

Sleep Apnea: With adults, it often presents with excessive daytime sleepiness, loud snoring, episodes of breathing stoppage during sleep, frequent awakenings accompanied by shortness of breath, awakening with a dry mouth or sore throat, morning headache, difficulty staying asleep (insomnia) and attention problems.

Diagnosis of sleep apnea is made with an overnight sleep study that can be done at home or at a sleep center. Once the diagnosis is made, evaluation with an ENT specialist is important to rule out anatomic causes of obstruction. Often mild sleep apnea can resolve with nose and throat surgical correction and moderate sleep apnea can be significantly improved.

Patients with severe sleep apnea will almost always require CPAP (high pressure breathing machines) to prevent long-term effects of sleep apnea (headaches, diabetes, high blood pressure, severe heart and lung disease as well as other life-threatening conditions). Surgical management of the throat and nose can at times help improve the use of a CPAP machine by opening passageways of the nose and reducing pressure requirements of the CPAP machine.

Chronic or recurrently infected tonsils can be problematic in adults and children. Missing numerous days of school and work, the misery of living with infected tonsils and the threat of the next infection always in the horizon are primary reasons for considering removal of tonsils (tonsillectomy).

Severe infections and abscess formation is another reason to see a MultiCare ENT specialist to consider tonsillectomy. When tonsils and adenoids are enlarged in children, this can lead to obstruction of breathing during sleep. When symptoms of mouth breathing, snoring, frequent awakening, stoppage of breathing and gasping for air are present, a condition called obstructive sleep apnea may be present. Sleep apnea can cause oxygen deprivation during sleep which adversely affects growth and development of the body and the brain of children.

Poor attention and hyperactivity have also been attributed to obstructive sleep apnea. It is important to seek consultation to discuss possible treatment options.

A wide variety of pediatric disorders such as pediatric feeding, breathing, hearing and infectious disorders are treated by MultiCare ENT specialists, in conjunction with other experts at Mary Bridge Children's Hospital.

For more information or an appointment contact any MultiCare ENT Clinic.
Facial Plastic Surgery
We also offer facial plastic surgery services at our MultiCare ENT, Allergy & Med Aesthetics locations in Puyallup, Auburn & Gig Harbor, including:

Cosmetic lifting of a drooping forehead. Raising the eyebrow position a subtle 1- 1.5 cm may rejuvenate the upper eyelids and smooth wrinkles of the forehead.

Cosmetic reshaping of the eyelids, often for heavy or sagging eyelid skin. May also be needed for bulges around the eyes due to small fat pad protrusions that worsen with age. This surgery helps reverse signs of age and fatigue.

Cosmetic reshaping of the external nose. This procedure may be used to reduce a hump on the nasal dorsum, make a wide tip more narrow, or make a crooked nose straight.

Insertion of an implant to make the chin appear larger or more symmetric. This procedure is often done with a rhinoplasty, or lower facelift to balance the facial profile.

Implantation of sterile medical grade material to make the lips, or portions of the lip appear larger.  This may also be done with injection of a filler material, such as Juvederm™ or Restylane™.

Cosmetic surgery to lift sagging of the skin and soft tissue of the cheeks, jowls, and upper neck.  Generally performed by lifting a SMAS flap, but may also be done in a deeper tissue plane.  This procedure is often combined with liposuction of the neck, and jowls if needed.

Cosmetic reshaping of the ears. This is frequently done for ears that 'stick out too far'. May be done on one or both ears.

Tumescent micrcannula liposuction is often done in the office for small volume regions of the body.