Q & A

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Hi, during the removal of a brain meningioma, the surgeon cut my hearing nerve on the left side, I was wondering, is there a procedure that can be done to restore the hearing in my left ear.

Question:

Answer:

Loss of the hearing nerve (cochlear portion of the 8th cranial nerve) results in profound sensorineural hearing loss. Standard hearing aids cannot overcome this loss. However, there are new technologies that exist to re-route the sound from the deafened side to the functional side. There are several such technologies that may assist you.

We offer all of these options and sometimes, it is best to try each out to know what to expect.

Thank you for your question! I hope this clears things up.

Neil Sperling, MD

New York Otolaryngology Group

36A East 36th Street

New York, New York

Associate Professor, Dept of Otolaryngology SUNY Downstate Brooklyn, New York

Q & A

My 5 month’s voice has gone hoarse after a long crying episode

Question: My 5 month’s voice has gone hoarse after a long crying episode. It happened about two days ago and I think his voice sounds raspy now and not as hoarse. He seems to have a hard time making the same high pitched sounds he used to be able to make during spontaneous vocalizations and during vocal play. What should I do, is this kind of hoarseness in infants common? Any help from your specialists would be greatly appreciated. Thank you!

Answer: Thanks for your question. Hoarseness for infants is not uncommon. It i quite comon for anyone, babies included, to develop hoarseness after vocal abuse. Certainly a long crying episode would fit.

When we breath- our vocal cords open to allow air to pass. When we speak or make noise, the vocal cords come together. They must come together smoothly for us to have a normal voice. However, when we speak loudly, or yell (or cry) – we are often banging the vocal cords together. This causes swelling, so that the closure becomes uneven and we percieve hoarseness. Most often, this is temporary, until the swelling goes down. Sometimes, we can develop a nodule or a polyp from this- which is really like a callus on the vocal cords. This would cause the poor voice to persist.

Using your voice minimally (modified voice rest) would help in the healing process. However, it is really impossible to get your baby to do so.

Almost always, his voice will come back to normal over the next few days or a week. If not, he should have an ear nose and throat doctor take a look at the vocal cords, (laryngoscopy) to make sure there has been no significant damage.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology NY Medical College

NY Otolaryngology Group

Q & A

My throat closes and I have difficulty breathing in

Question: I am a 56 yr old female in healthy condition. I stopped smoking 25 yrs ago. I have noticed that my throat feels like it is closing and I have difficulty breathing in. It seems like I am smelling a smoking type smell. I have had this happen in the car, lying in bed and even at my workplace. No one is either around or smoking when this occurs. I have asked people at work if they smell anything and they say no. I do have a sensitivy when someone is smoking my throat closes up and feels like I can’t breath.

Any recommendations or suggestions?

Answer:

When we breath our vocal cords open, to allow air to pass through. They close when we speak. Difficulty breathing in implies that the vocal cords are closing when you inhale, instead of opening. With asthsma, one tends to have trouble breathing out. The vocal cords can close inappropriately from reflux- when acid gets up from the stomach to the level of the voice box- as well as from nerve injuries that cause the vocal cords to not work correctly. (paradoxical vocal cord motion). Mucous dripping on the vocal cords can cause them to close as well. Finally, a growth on the vocal cords may present like this.

This type of problem really requires a thorough ear nose and throat examination and visualization of the vocal cords (laryngoscopy) to determine the cause and treatment.

I hope this helps clear things up..

Robert Pincus MD

Co-Director NY Sinus Center

NY Otolaryngology Group

Q & A

I have lost the sense of smell (anosmia)

Question: I have been suffering from anosmia since approximately July 2012. I had no illness around that time (have not had the flu since 2002), and had no injury of any kind. I do have strong hay fever allergies, but those have been present all my life. I have had an MRI done, and no one has ever identified anything wrong with it, nor has looking up my nose with an endoscope revealed anything. The reason for my email is this: All the doctors I have seen so far, once they are up to speed on the above information, have given up surprisingly quickly on the idea of trying anything. Are there any anosmia treatment options available?

Answer:

The loss of the sense of smell can be quite debilitating. The sense of smell is important for our day to day safety (to determine if food has gone bad or if there is a gas leak), for our enjoyment of life in general, and can be a precursor or indicator of other neurologic problems.

Evaluation includes a thorough history, quantification by smell testing, ear nose, and throat evaluation and nasal endoscopy, and imaging studies such as an MRI.

Many times, but not always, the loss of smell can be reversed or improved. Obstructing polyps can be shrunken or removed, inflammation- such as after a viral infection may be treated with steroids, orally or in the nose. Infection can be treated with appropriate antibiotics if needed.

More recently, several studies have shown that in those people whose loss of smell persists, other newer therapies may be helpful.

Theophylline has been used orally and often can be of help.

Smell therapy- also has been shown to be a benefit in many people as well.

Unfortunately, oral theophylline has many side effects. We have been using a topical nasal spray with theophylline for such patients. The study results have been promising.

We’d be happy to see you at the NY Sinus Center to review your previous studies and treatments to see if we could suggest other therapies- such as intranasal theophylline or smell therapy- and to make sure that no other treatable cause has been missed.

Robert Pincus MD Associate Professor Otolaryngology

Co-Director NY Sinus Center

Q & A

Is bloody mucus a sign of a sinus infection?

Question: I have this head cold and blow my nose there is blood in the mucus which I think is a sinus infection. Is bloody mucus a sign of a sinus infection?

Answer:

Bloody mucus is a sign of irritation in the nose. This can come from trauma, dryness (quite common in cold weather with the heat on), chemical inflammation, infection- viral or bacterial, and least likely from a tumor or other growth. While it is quite common with a sinus infection, there are other causes and if you have this persisting, it should be evaluated by an Ear, Nose and Throat Doctor or Sinus Specialist, using a lighted telescope in the nose to evaluate.

I hope this clears things up.

Robert Pincus MD

Co-Director NY Sinus Center

Q & A

Can you send any encouraging word?

Question:

On 10/1, my 41 yo daughter had surgery for removal of a moderate-sized nasal polyp and sinus surgery. For months prior to the procedure, she received antibiotic & steroid therapy in an attempt to help with chronically infected & painful frontal sinuses & a blocked passage.

Unfortunately, on the second post-op day, she developed excruciating headache and eye pain on the side of surgery (R). It became so severe that she was told to see the surgeon yesterday, 10/5, when she reported stabbing pain along the right cheek, into her eye & head. The surgeon suctioned her of quite a bit of debris, started her on saline rinses and told her to take two Vicodin q 6 h, and one Aleve at the midway point of the Vicodin doses. Additionally, she is on 30 mg of Prednisone daily x5 days, to decrease tomorrow to 20 mg daily x 5d, then 10 mg daily x5d, then discontinue.

My apprehension about her pain has grown tremendously since googling sinus post-procedural pain & the rare risk of eye or brain issue following this procedure. My daughter had an MRI in addition to the normal CT scan prior to procedure since the surgeon felt he needed to more definitively tell whether or not the lesion in her nose was a polyp vs encephalocele, due to its position. Following surgery, he did state that it definitely was not an encephalocele. Although it is the weekend, my daughter was told to call (the surgeon) if any vision problems at all occurred, which thankfully has not happened.

I would so appreciate any information or tips you may give. I assume it is too early to think about having my daughter see an ENT or other specialist (?) at the Univ. of Miami at Jackson Memorial, a 1-2 hr trip from home. I am not sure how soon she could be seen either, but am afraid of “waiting this out” to see if her vision becomes affected???? Any help would be MOST appreciated.

Can you send any encouraging word?

Answer:

Thanks for your note.

I wish I could answer completely without knowing your daughter and her surgery more personally. However, as you know, complications with the eye and even intra-cranial (brain) complications are possible, but quite rare with nasal and sinus surgery. As a surgeon, I would be quite concerned should my patient have significant pain after surgery (it is rare as well). However, it sounds like the surgeon checked to see that there was no complication at the visit. Should there have been a complication with the eye, one would be most concerned about visual loss, double vision, getting black and blue around the eye or loss of vision. It sounds like she has not had any of those issues. Intracranial complications (brain fluid leaks, etc) rarely cause such pain either. One would most likely see a clear fluid discharge- Headache would be possible if there were meningitis- but one would expect other findings as well, such as a stiff neck.

It sounds like she is in good hands (appropriate to have checked to see with MRI as well as CT that this was not an encephalocele) and I would follow up as your daughter’s surgeon suggests.
Should she have questions or concerns, of course we’d be happy to see her up here at the NY Sinus Center. One wonderful sinus specialist closer to you is Donald Lanza- in Tampa. But by your description alone, I do not see anything that makes me feel your daughter’s care has been anything but good or that she needs other urgent intervention.

I hope this helps clear things up.

Robert Pincus MD
NY Sinus Center

Q & A

I have a deviated septum and a crooked nose. My surgery did not help. Is it safe to perform surgery again?

Question: I have deviated nasal septum besides a crooked nose with a minor sinus infection and had septoplasty to correct it. Nothing changed after I had treatment for a crooked nose, and sinus infection got worse from then. Will a septorhinoplasty help solve my problem? Is it safe to perform surgery again?

Answer:

Thanks for your question.

First of all, while revision surgery is quite common and may solve your problem, one should try to find out why the surgery didn’t help in the first place before having another procedure.

The septum is a dividing wall that separates the nasal airway into to separate passageways. While the septum is never completely straight, the septum can be “deviated” or twisted enough to block the flow of air through one – (if the septum is over to one side)- or through both passages (if the septum has a shape like the letter S). Straightening the septum should be expected to improve breathing through the nose, but sinus infections usually will need to be further treated – either through opening the sinuses wider, or finding out the cause of the infections and treating them medically. Fixing a crooked nose requires breaking the bones of the nose- or rhinoplasty- and is a cosmetic procedure to improve the appearance of the nose. This can be done at the time of septoplasty and/or sinus surgery- or sometimes alone. I am not sure what problems you were having before and are continuing to have.

But, we frequently are called on to treat patients who have had nasal or sinus surgery before that did not fix their problem. Usually, that is because the problem causing the symptoms was not accurately identified, and less common because the surgical results were not as successful as we’d like.

Before I would say to have the procedure repeated, I would suggest having another opinion- certainly something we do a lot of here at the NY Sinus Center.

If revision sinus or rhinoplastic surgery is needed, we have significant experience in helping.

Robert Pincus MD
Co-Director NY Sinus Center
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Q & A

Pain while swallowing and turning my head after dental infection

Question: I have pain while swallowing and turning my head, what could it be? I had an abscessed wisdom tooth that caused my lymph nodes to swell and cause dysphagia several times within the last year and a half; it has always gone completely away leaving me asymptomatic. Feb of 2013 I became ill and the dysphagia began again. I was given antibiotics for suspected strep throat and pharyngitis. 2 weeks later I had my wisdom teeth extracted and developed necrosis of the bone and was subsequently put on a total of 5 weeks of antibiotics. The pain while swollowing has not gone away as of today. I have had a Laryngoscopy, Esophogram, Endoscopy, CT of the neck checking for an abscess and was diagnosed with a hetial hernia, gastritis and dyskinesia of the esophagus. My Gastroenterologist and PCP both have urged me to get a second opinion with another ENT saying the dysphagia is a separate problem. I was also sent for a Esophageal Motility Study that I was not able to tolerate. I was not able to swallow any saline without vomitting. What could be wrong for so long? I am very desperate, any info would be greatly appreciated. Thank you

Answer: Dental infections may often lead to infections elsewhere in the head and neck. Dental infections in the upper jaw (maxilla) may cause sinus infections, head and neck abscesses (pus pockets) and rarely even brain abscesses. Infections of the lower teeth can spread to the floor of the mouth- causing a potentially dangerous infection known as Ludwig’s Angina, or swollen infected lymph nodes or even potentially life threatening abscesses in the neck.

While I cannot say for sure, it seems likely that the infection of the lymph nodes you developed has resolved- or at least to your doctors’ best ability to determine. A CT scan with contrast should be able to detect any persistent infected lymph node.

The other findings that you have- a hiatal hernia with reflux, gastritis and finally dysknesia (incoordination) of your esophagus all are causes of dysphagia (difficulty swallowing). Pain while swallowing and turning the head is not uncommon when acid reflux from the stomach comes up as high as the throat- and may well be the cause of your symptoms. This can be usually be found on an ENT exam, or by testing to see if acid from the stomach does in fact come up to the throat (pH testing).

I wish I could tell you more precisely, but if you’re in the NY area, would be happy to see you here and try to better clear things up. If you make an appointment, please try to bring the results of the studies done so far and any scans.

Robert Pincus MD
Associate Professor Otolaryngology
NY Otolaryngology Group

Our office number is 212-889-8575- or you can email for an appointment request

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Q & A

I have mucus in the nose after turbinate surgery

Question: Is it normal for an increased amount of nasal mucus and drainage into the back of my throat 2 months after turbinid reduction surgery? I also have no sense of smell in the morning with my ability to smell increasing during the day. Even at it’s best, my ability to smell is greatly diminished.

Thank You

Answer : Thanks for your question.

Turbinates are tubes on the side of the inside of the nose that help the nose serve its role as a humidifier and filter. At times these structures can become quite swollen and interfere with breathing. There are different procedures to shrink them, if other treatment fails, but today one almost never would remove them as their role is essential to the nose doing its job.

Anything that causes congestion in the nose can temporarily limit your ability to smell.
Typically turbinate surgery causes swelling and crusting and dried mucus in the nose- for a short term.
Usually, this lasts a month or two, but can last longer.

We tend to recommend nasal saline rinses, a humidifier in the bedroom at night- (if you are able to clean religiously)- and sometimes a nasal steroid spray (such as flonase/fluticason) for 2-3 months after the procedure to help bring down any swelling.

If your problems persist, please check with your surgeon.

I hope this clears things up.

Robert Pincus MD
Co-director NY Sinus Center

Q & A

I have trouble breathing through my nose and have a deviated septum. Can that be corrected?

Question: After always having trouble breathing through my nose (with my mouth closed) when sleeping on my right side, I asked my PCP to check, and he informed me that I have a deviated septum which could explain it. Since I can’t ever remember being able to breathe easily through my nose with my mouth closed while sleeping (and not snoring), I’m writing you to see what may be the issue and if I might be a candidate for some sort of deviated septum correction.

Answer: Thanks for your question.

The most likely cause of your breathing problem is a “deviated” septum. The septum is a wall that separates the nasal airway into two separate passages and is never completely straight. Unfortunately, either from birth or from trauma, this wall may be twisted and block either one or both sides of the nose. First, I would suggest an ENT examination to make sure that is the cause of your symptoms. Other problems, such as nasal polyps (benign nasal growths) can block one side or the other- or both, as well.

If a deviated septum is the cause, this can be readily fixed with a minor surgical procedure. Straightening the septum, by the way, does NOT change the appearance of the nose, nor should you get black and blue from this. Frequently, people have coupled cosmetic surgery (rhinoplasty) at the same time, which does both.

I hope this clears things up. We’d be happy to see you here at the Sinus Center and help figure out how to best improve your breathing.

Robert Pincus MD
Co-director NY Sinus Center
212-889-8575

ENT Doctor Archives - Page 3 of 5 - The New York Otolaryngology Group

Hi, during the removal of a brain meningioma, the surgeon cut my hearing nerve on the left side, I was wondering, is there a procedure that can be done to restore the hearing in my left ear.

My 5 month’s voice has gone hoarse after a long crying episode

My throat closes and I have difficulty breathing in

I have lost the sense of smell (anosmia)

Is bloody mucus a sign of a sinus infection?

Can you send any encouraging word?

I have a deviated septum and a crooked nose. My surgery did not help. Is it safe to perform surgery again?

Pain while swallowing and turning my head after dental infection

I have mucus in the nose after turbinate surgery

I have trouble breathing through my nose and have a deviated septum. Can that be corrected?