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Hot summer months and cooling off in cool water means Swimmer’s Ear to many doctors including Emergency Departments, Primary Care offices, to Ear, Nose & Throat offices.

Anyone can get this annoying problem. Known causes of swimmer’s ear include: swimming in contaminated water from improperly chlorinated pools, hot tubs, or natural bodies of water; excessive cleaning of the ear canals; contact with chemicals such as hair care products or swimming pool chemicals; or other skin conditions affecting the ear canal such as eczema.

 

 

What are the Symptoms of Swimmer’s Ear?

  • Ear pain.
  • A sensation of water in the ears or ear fullness.
  • Drainage from the ear.
  • Itchy ears.
  • Decreased hearing or hearing loss.
  • Pain around the ear, or pain to touch the ear.

What is the Treatment for Swimmer’s Ear?

The unfortunate reality of Swimmer’s Ear is that you cannot treat it at home with home remedies or over the counter medications! The nature of a swimmer’s ear infection required that the ear canal be manually cleaned by a professional who can visualize the anatomy and remove the bulk of the bacterial or fungal infection. The provider will then prescribe an antibiotic ear drop or a fungal ear drop for the infection, as this medication can then reach the infection source at a higher concentration. Oral antibiotics for ear infections are usually only used for middle ear infections (infections that occur in a different part of the ear behind the ear drum) and very severe swimmer’s ear where other tissues are affected such as cellulitis of the skin surrounding the ear. Failure to treat a swimmer’s ear appropriately can be very dangerous, leading to bone and cartilage damage also known as malignant otitis externa. This type of infection is a swimmer’s ear infection that has spread to the skull base, brain or cranial nerves. Diabetics and older adults are at a higher risk for this dangerous complication.

 

How Soon Can I get in to ENT Consultants if I Think I Might Have Swimmer’s Ear?

If you currently are experiencing ear pain, itchy ears, ear fullness, ear drainage, or hearing loss, we recommend being seen as soon as possible for treatment, as this could be swimmer’s ear. Throughout the summer months, we are taking same or next day appointments at our main office in Omaha, Nebraska! While you can request an appointment online for scheduled services, we do recommend that you call the office for same/next day services at 402-778-5250!

 

TOP 5 WAYS SWIMMING POOLS CAN BE HARMFUL TO YOUR HEALTH – NOT JUST SWIMMER’S EAR!

                                   

Swimming is a great way to stay in shape and live a healthy lifestyle. However, before you go jumping in to cool off during these hot summer months, it’s important to understand the risks of public pools and water parks.

1.    FECES.

The Center for Disease Control (CDC) sites that an average swimmer (not just children but also adults) contributes at least 0.14 grams of fecal matter to pool water within the first 15 minutes of entering. Improperly potty-trained children and children in diapers are often blamed, but when adults and older children forgo washing with soap and water prior to entering the pool, they also introduce fecal matter into the water.

2.    CRYPTOSPORIDIUM (CRYPTO).

Cryptosporidium is a parasite that causes cryptosporidiosis and transmitted through fecal matter. This parasite can survive up to 10 days in chlorine-treated water. Crypto has become the leading cause of diarrheal illness related to swimming pools, and according to the CDC that in recent years these infections have increased over 200%.

3.    GIARDIA.

This is a bacteria that, due to its ability to live outside of the body for long periods of time, is also tolerant of chlorine. This bacteria is transmitted through both animal and human feces – and is a good reason not to allow pets in pools with humans!

4.    URINE…PEE IN THE POOL.

According to a survey conducted by the Water Quality and Health Council some years ago, ONE in FIVE American ADULTS admit to peeing in the pool. And…nearly 100% of elite competitive swimmers are reported to pee in the pool regularly!!! Furthermore, human sweat contains urea – the same chemical that is harmful in urine, which is another reason why showering prior to swimming is important.

But why is peeing in the pool or sweat in the pool so harmful?

5.    CHLORINE BY-PRODUCT.

Chlorine is intended to kill bacteria and germs in the pool; however, when the chemical combines with urine, sweat, and feces, irritants called chloramines are produced using up the chlorine intended to kill the germs. Chloramines give off a strong chlorine odor. A survey by the Water Quality and Health Council found that three-quarters of Americans incorrectly believe that the strong, chemical smell is a sign of too much chlorine in the water, and this is the cause of red eyes and sore throat. The reality of the situation is that the strong smell is a sign of a poorly chlorinated pool; a well-chlorinated pool should in fact have little odor.

Swimming pools are just one way people can contact a recreational water illness – illnesses caused by germs that are swallowed during recreational water activities. Other contaminated sources that are often worse than swimming pools include hot tubs, water parks, lakes, and oceans. While the most common infections cause diarrhea other recreational water illnesses include:

Ear infection – Swimmer’s Ear

Respiratory illness

Eye infection – Conjunctivitis

Neurologic illness – illnesses related to the brain and spinal cord

Skin infection that result is breakdown and wounds

Summer months at ENT Consultants lead to many people coming in for ear infection, ear pain, ear drainage, fungal ear infection, and swimmer’s ear. Later this month, we plan to blog a bit more about Swimmer’s Ear prevention and treatment, and don’t forget to check out Dr. Jessica Moran-Hansen’s video on Swimmer’s Ear as well under Patient Education on our site or on our YouTube Channel.

If you have symptoms of itchy ears, ear pain, or ear drainage, whether you have been swimming or not, you should be checked out by an ENT to rule out an external ear infection such as fungal external otitis or swimmer’s ear. Early detection and treatment of these conditions make them a lot easier to manage! You can call for an appointment at 402-778-5250 or request an appointment online!

 

REFERENCES:

LaKind J, Richarson S, Blount B. The good, the bad, and the volatile – Can we have both healthy pools and healthy people? Environmental Science & Technology. 2010.

Richardson S, DeMarini D, Kogevinas M, et al. What’s in the Pool? A Comprehensive Identification of Disinfection By-products and Assessment of Mutagenicity of Chlorinated and Brominated Swimming Pool Water. Environmental Health Perspectives. 2010.

Pond K. Water Recreation and Disease. Plausibility of Associated Infections: Acute Effects, Sequelae and Mortality. http://www.who.int/water_sanitation_health/bathing/recreadis.pdf. 2005.

 

May 17, 2017
Category: Uncategorized
Tags: Untagged

These are Tonsils

 

They are the two round lumps in the back of the throat, that like other lymph tissue in the body, can change in size and appearance with sickness, age, etc. The adenoids, which are not pictured are located between the nose and throat behind the “hangy ball” structure known as the uvula and the soft part of your palate.

With the school year coming to an end, we often see a rush of parents bringing their children in to be evaluated for tonsillectomy due to frequent sore throats, missed school, snoring and various other issues. The tonsils are blamed in children for a lot of issues that may or may not even be related, and it is important to be evaluated by an ENT to determine if tonsillectomy is even necessary, since there are many risks of this type of surgery. Because of these risks, the guidelines for tonsillectomy have been revised in recent years. Even with the stricter guidelines, tonsillitis and issues related to large tonsils/adenoids remain the main reasons for tonsillectomy and adenoidectomy surgery. Below are the symptoms of tonsillitis and enlarged tonsils/adenoids as well as the guidelines that determine if surgery is indicated. For those who qualify for surgery, it is important to know what to expect after surgery.

 

Symptoms of Tonsillitis

  • Redder than normal tonsils
  • White or yellow coating on the tonsils
  • Sore throat, sometimes accompanied by ear pain
  • Uncomfortable or painful swallowing
  • Swollen lymph nodes (glands) in the neck
  • Fever
  • Bad breath

Symptoms of Enlarged Tonsils/Adenoids

  • Breathing through the mouth instead of the nose most of the time
  • Nasal-sounding voice
  • Chronic runny nose
  • Recurrent ear infections
  • Snoring
  • Sleep apnea

Guidelines for Tonsillectomy When Tonsillitis or Infections are the Indication:

Duration of 1 year or less

7 or more infections during that time

Duration of 2 years

5 or more infections per year over a 2-year period

Duration of 3 or more years

3 or more infections per year for each year the disease processes have been present

Other Indications for Tonsillectomy

  • Witnessed Sleep Apnea in Children
  • Sleep Apnea in Adults or Children Proven with Positive Sleep Study
  • Complicated Tonsillitis Such as Peritonsillar Abscess
  • Airway obstruction due to extreme size
  • Tonsil masses or abnormal tonsil growths

What to Expect After Tonsillectomy

PAIN. There is a great deal of pain expected post-operatively. Pain may radiate into the ears and neck, which is common. Your surgeon will prescribe pain medication to dull the pain (it will not take it away completely). DO NOT mix these medications with over the counter pain relievers unless instructed otherwise by your surgeon, and take your pain medication as prescribed! Weening off of pain medications prematurely after tonsillectomy surgery can lead to dehydration and other complications, so it is best to take the medications until your doctor instructs otherwise.

Dehydration was mentioned in the previous quip about pain. Hydration is extremely important to recovery. Dehydration may lead to increased pain and fever. Clear liquids are preferred, but anything that goes down easily will do. Dairy products are discouraged, as they cause excess mucus production.

Eating is generally not as important as drinking during the post-operative period; however, some feel that the pain medication is easier tolerated with less nausea with some soft diet items. Hard or crunchy foods are discouraged.

Low grade fever is common up to a day or two after surgery. Contact your physician for fevers over 102 degrees.

Little to no activity is expected 7-10 days and for some up to 14 days. Activity may be increased slowly after normal eating and drinking resumes and pain medication is no longer required.

Gross looking scabs will form where the tonsils once were. They look like thick white patches and smell terrible. These are a normal part of the healing process that dissolve away on their own. DO NOT pick at them as this can lead to severe bleeding.

Some patients to get specks of blood from the nose or in their saliva; however SUBSTANTIAL AMOUNTS OF BRIGHT RED BLOOD IS AN ISSUE! If this is seen contact your surgeon immediately and straight to your closest emergency room! Surgery may be needed to control this type of bleeding.

So, if you or your child is suffering from chronic infections or has issues with airway obstruction due to large tonsils/adenoids, make an appointment today with one of our surgeons to discuss if tonsillectomy or adenoidectomy is an option. You can either call us during normal business hours at 402-778-5250 or request an appointment online.

Reference:

American Academy of Otolaryngology Head & Neck Surgery. www.ent.org

Baugh et al. Clinical Practice Guideline. “Tonsillectomy in Children.” Otolaryngology Head and Neck Surgery. January 2011 vol 144 no. 1 suppl S1-S30.

 

Healthcare and insurance is a tortuous and confusing part of all of our lives, and it only seems to get more befuddling. First, there is all the Latin that comes out of your doctor and nurse’s mouths. Then, you have to read the Sanskrit from the insurance company and finally when you get your bill it will have you saying, “It’s Greek to me!”

At ENT Consultants, we want to make your healthcare experience excellent, so we are here to help you every step of the way. We encourage you to ask questions to your healthcare providers to fully get the translation from their jargon to actual meaningful information that you understand.  And, secondly, our billing specialists (such as our billing manager, Melisa, here in the video to the right) are here to help each and every one of our patients understand their financial obligations to our office.

Explanation of Benefits (EOB)

The first piece of information you should receive after your visit with your healthcare provider (not directly related to your treatment) should be your Explanation of Benefits from your insurance company detailing your service and how it was billed. This document is all legal gibberish designed to confuse and divert you from the fact that your insurance coverage probably isn’t what you thought it was. Don’t worry – no one’s is and hardly any of us have a choice – so we sympathize with you!!!

Here are the basics of reading the Sanskrit example below…

  1. The government requires us to report on a few different health measures – there is no charge to you.
  2. Office visit costs are based on a few things but to simplify for better understanding: Were you new (haven’t been seen at the clinic in the last 3 years) or established? More than one complaint (did you come in for your sinuses but also have complaints about your ears or throat)? Comorbidities that affect your treatment (obesity, diabetes, auto-immune disorders, blood thinners, etc.)?
  3. “Surgery” or procedure charges. These are charges over and above the office visit charges for procedures done at the time of the visit (VERY common to our surgical specialty).
  4. Injections and other therapy/testing charges are for other required therapies and tests that were needed to treat your condition.

5.Charges on all of the above are determined by insurance companies and their allowed amounts.

  1. These charges are discounted for you if we are in network with your insurance – it is important to check to see if your provider is in network prior to ever seeing a provider!
  2. The amount you owe is determined by your insurance contract and will be listed as deductible, coinsurance, or copay amounts – this does not mean that your insurance did not cover the service it means that you have to pay before your insurance will pay.

Your ENT Consultants Bill is in Greek!

Ok, so now you are conversational in Sanskrit, but then you receive this piece of Greek from our office like the one below telling you that you owe us money. What about your insurance plan? Didn’t they pay for anything? Can you get a discount? How are you going to afford this? Well, let’s get some of the pesky translation out of the way, and then we can discuss your options.

The first trick to this is to remember that Greek and Sanskrit are the same, but the layout is different! All the information that was in your EOB is now laid out for you basically detailing what we charged your insurance company, what they paid, what we’ve discounted already, and how much you owe but unlike your EOB our lawyers have added even more mumbo jumbo about legal and contractual obligations we have with your insurance as well as legal and contractual obligations that you have with us.

Now that we have that out of the way, let’s translate!

  1. The amount that is due and the due date is in the box at the top right of your bill.
  2. Because we have a contract with your insurance company, just like you do, we have to bill what they tell us to bill and discount what they tell us to discount. Anything different is considered insurance fraud and is no joke to any of us because we are not looking to go to jail!
  3. Because you have a contract with your insurance company, you have to pay a certain amount before they will, that is what you will be billed. This is the part that really stinks, because in order for ENT Consultants to pay the staff, keep equipment clean and up to date, and basically keep the lights on, we will have to collect this.

So, How Can We Help?

Well, let’s get this out of the way first and foremost, we are not looking to bankrupt anyone! We understand that the insurance coverage of today is HORRIBLE at best, and we are people just like you looking to help other people while still surviving this mess. ENT Consultants will work with you to find a mutually agreeable payment plan to help you budget in your ENT bill. However, remember that legal mumbo jumbo on your bill, well that limits us from giving you any further discounts, so we will have to find creative ways to help you pay your bill in full. WE WANT TO HELP YOU, so the worst thing you can do is ignore your financial obligation. We strongly encourage you to face this head on and call someone in our billing office right away rather than letting the bill go past due or even final notice. Let’s work together to make our experience together a healthier, happier one!

What is a deviated septum? How do I know if I have a deviated septum? I have nasal congestion all the time and medications do not help! I have a cpap but I can’t tolerate my cpap because I can’t breathe through my nose! I always have drainage down the back of my throat!

What is a deviated septum?

The septum a structure of the nose made up of bone and cartilage that divides the nose into two sides, right and left. When this structure is not straight and is pushed to the side (can veer to the right, left or both sides – like a letter too big for an envelope), we call this a deviated septum. This type of structural abnormality can be the result of growth spurts or simply from injury. It is estimated that seven percent of newborn babies suffer significant nasal injury during the birth process. Other individuals can recall a particular injury during childhood or adulthood that they can attribute to the cause of their deviated septum3.

Symptoms

Many people go through their entire lives with any symptoms of a deviated septum. The most common complaints for people with a deviated septum are 1. Nasal congestion or obstruction; 2. Frequent nosebleeds; and 3. Post nasal drainage or drainage from the nose down the back of the throat. Other symptoms such as runny nose, facial pressure, colored nasal drainage, and headaches are more often than not related to allergies or chronic sinusitis and not a deviated septum. It is important to note that almost 60% of people with a deviated septum also have some form of chronic sinusitis, and even more exhibit signs of allergic rhinitis3.

Diagnosing a Deviated Septum

Many times a deviated septum can be diagnosed by your ENT by just looking into the nostrils with a light and speculum. Oftentimes, nasal endoscopy is necessary to assess the degree of deviation or other possible causes of obstruction in the nose prior to surgery. We often see a deviation and obstruction on rhinoscopy that we did not see on an anterior exam.

While a CT scan is unnecessary to diagnose a deviated septum, it may be required to diagnose other nasal and sinus problems in patients with symptoms that cannot be explained by a deviated septum1.

Fixing your Deviated Septum or Septoplasty Surgery

Risks of the surgery include bleeding, infection, changes to sense of smell, septal perforation, failure to cure a feeling of congestion, change in the external nasal appearance, nasal numbness. These risks are very rare, but we disclose these to all patients considering septoplasty3.

What to Expect after Septoplasty Surgery

Forget all the horror stories you have ever heard about packing! Septoplasty surgery often requires the surgeon to place soft plastic splints to protect against residual deformity after surgery, hematoma formation (collection of blood under the tissues) or intranasal adhesions (scarring to the side of the nose). Studies show that patients that have splints have less pain, fewer instances of bleeding, less nasal obstruction, and less post-operative complications than patients that had packing2. Anywhere from 2-7 days, our surgeons will have their patients come back to the office to have their splints removed (watch video about septal splint removal). This visit alone can be an “Ah Ha” moment for patients who suffer from a deviated septum.

How can Septoplasty Benefit Me?

Patients that can breathe through their nose have a better quality of life. Also, if a nose is open, it is easier to treat other conditions such as allergies and sinusitis medically. And last but not least, for patients who struggle to use a cpap for sleep apnea due to their nasal obstruction, an open nose can mean smaller masks or lower pressures that are more easily tolerated resulting in better controlled apnea and reduced comorbidities associated with chronic apnea. Septoplasty is not a guaranteed cure for sleep apnea!

If you or someone you know has issues with nasal congestion, persistent nasal drainage, or doesn’t tolerate their cpap due to nasal obstruction, we may be able to help! You can schedule a consult with our ENT specialists in Omaha, Bellevue, Blair, or Harlan, Iowa by calling our office at 402-778-5250 or request an appointment online. Candidates for septoplasty surgery are determined by an ENT surgeon.

References

1.Collins R. (2015). Clinical consensus statement on septoplasty released. ENTToday. http://www.enttoday.org/article/clinical-consensus-statement-on-septoplasty-released/

2.Ghai A. et al. (2014). Comparative study of intranasal septal splints and nasal packs in patients undergoing nasal septal surgery. ENTJournal.

American Academy of Otolaryngology Head & Neck Surgery. http://www.entnet.org/content/deviated-septum





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