With a specialty in both ENT and dentistry, Jerome List, MD, DDS, with Alaska Ear Nose & Throat in Anchorage, Alaska, has a unique perspective on conditions such as sinusitis. Acute and chronic sinusitis affect most adults at some point in their lives. Finding the right treatment for both the infection and underlying risk factors is the key to preventing complications from this potentially life-threatening condition.
What is sinusitis?
Sinusitis is a very common problem that affects the cavities, or empty spaces, around your nose and eyes. The reason people have sinuses is unclear. Most professionals believe they serve to reduce the weight of the skull while humidifying the air you breathe.
A diagnosis of sinusitis means the nasal passages that line these cavities become inflamed, usually due to infection or growths called polyps. In some cases, the irritation is related to a physical defect such as a deviated nasal septum.
Who is at risk for sinusitis?
Anyone can contract this inflammation, but it tends to affect adults more than children. Risk factors include:
- A nasal abnormality
- Sensitivity to aspirin
- Hay fever or being prone to allergies
- Constant exposure to pollutants like smoke
You may also be at risk for sinusitis if you have an immune system disorder that puts you at risk for infections such as AIDS.
What are the symptoms of sinusitis?
The four primary symptoms of sinusitis include:
- Thick discharge from the nose or postnasal drip
- Nasal congestion
- Tenderness around the eyes, cheeks, forehead, and bridge of the nose
- Reduced smell and taste
There may be other symptoms, as well, especially if the condition is chronic or goes untreated. Patients with sinusitis might experience ear pain, for example, or develop an ache in the jawbone. Sinusitis is often accompanied by bad breath, fatigue, and a sore throat. You might develop a persistent cough that gets worse at night.
What is the treatment for sinusitis?
The treatment will vary based on factors such as the underlying cause of the inflammation. The goal is to reduce swelling and open up your passages regardless of what’s causing the condition. This usually means sinus nasal irrigation and possibly treatment with corticosteroids -- oral, nasal, or injected. For some people, surgery is recommended to remodel the bone around the cavities to prevent further sinus difficulties.
Dr. List will exam your nose and face and possibly order imaging to confirm the diagnosis. If he suspects an infection, he’ll order a culture to pinpoint the microorganism involved to provide a more accurate treatment plan.
Jerome List, MD, DDS, with Alaska Ear Nose & Throat in Anchorage, Alaska, is board certified in otolaryngology-head and neck surgery, which includes the removal of the tonsils. Tonsillectomies are not as common as they used to be but still are required in some cases. Dr. List evaluates each patient individually and creates a custom treatment plan that, for some, will include this procedure.
What are tonsils?
Tonsils are pads of lymphoid tissue that rest at the back of your throat. There are actually several different tonsils, and the combination is called the Waldeyer’s tonsillar ring. These include the:
- Adenoid tonsil
- Tubal tonsils
- Palatine tonsils
- Lingual tonsil
A tonsillectomy is usually the surgical removal of the palatine tonsils.
What do tonsils do?
Tonsils help protect your body from pathogens entering through your throat. They are the sentries of the immune system, which is one reason doctors try not to remove them unless absolutely necessary. Tonsils have an antigen on the surface of the cells that detects certain pathogens and initiates an immune system response.
Why would someone need a tonsillectomy?
A tonsillectomy is a treatment option for infected or inflamed tonsils. Although once performed routinely on children, today, tonsillectomies are only performed after other treatment options fail or if the swelling is interfering with breathing. Dr. List may recommend this surgery for patients who have recurring tonsillitis, enlarged tonsils or bleeding that will not stop from the tonsil surface.
What is tonsillitis?
Tonsillitis is the inflammation of the tonsils. It often happens in response to bacterial or viral infections. The location and function of the tonsils make them vulnerable to infection and irritation that can lead to swelling or tonsillitis.
Physicians will often suggest surgical removal if the patient experiences tonsillitis more than seven times a year with more cases reported in previous years. The procedure is also recommended if there’s a bacterial infection that fails to respond to treatment or if pus builds up behind the tonsil creating an abscess. Your tonsils can also become cancerous, although that’s rare.
What should you expect with a tonsillectomy?
This is an invasive surgical procedure, but it can be performed on an outpatient basis to avoid hospitalization unless there are complications. Dr. List will remove the tonsils with a blade, high-energy heat, or even sound waves while you’re under general anesthesia. You can expect to be in bed for several days after your procedure. At first, eating will be painful, so Dr. List will recommend soft foods that soothe your throat, such as broth or even ice cream.
As an ENT specialist, hearing problems are an essential part of the services offered by Dr. Jerome List, MD, DDS, with Alaska Ear Nose & Throat in Anchorage, Alaska. Hearing loss is very common in the U.S., especially as you grow older. Dr. List works with patients to identify the cause of hearing problems like tinnitus and create realistic solutions.
Hearing Problems: Hearing Loss & Tinnitus Q&A
What causes hearing loss?
Hearing is a very complex sense, so there’s no easy answer to this question. A patient experiencing a reduction in hearing might have anything from an earwax buildup to a more serious inner-ear condition. Aging and exposure to loud noise rank among the more common causes. That’s why you need a specialist to pinpoint your specific medical issue.
Why do you lose your hearing as you grow older?
Hearing loss and aging are often linked. Age-related hearing loss, called presbycusis, may simply be the result of years of exposure to loud noises. Some hearing loss is a symptom of chronic illnesses that tends to affect older people, such as high blood pressure or diabetes. For most, it will be a combination of factors including the mechanisms that allow you to hear, such as the hair cells in your inner ear, wearing out as you age.
What else causes hearing problems?
Aging isn’t the only risk factor for hearing loss. Hearing loss is categorized in three ways:
Each one comes with its own set of risk factors and causes. Conductive hearing loss means sound waves fail to reach the inner where they can be translated for the brain. Sensorineural hearing loss indicates that the nerves that usually do the translating are failing. Mixed hearing loss is a combination of conductive and sensorineural problems. Ear infection can cause conductive and sensorineural hearing loss: A gradual buildup of earwax blocks the ear canal, keeping sound waves from reaching their destination.
What is tinnitus?
Tinnitus is the medical term for ringing in your ears, which in itself is a phantom noise, meaning there is no external source for it. There are two forms of tinnitus:
Subjective, the most common form, describes tinnitus only the patient can hear. Objective is sound the doctor can also hear, usually related to blood vessel issues or a middle ear bone problem.
How is tinnitus treated?
The best course of treatment for tinnitus is to identify the underlying cause if possible. All it might take is for Dr. List to remove impacted ear wax. For more severe cases, Dr. List might look for ways to suppress the noise, instead.
In-Office Sinus Surgery
As a board certified otolaryngology-head and neck surgical specialist, Jerome List, MD, DDS, with Alaska Ear Nose & Throat in Anchorage, Alaska, has the extensive training needed to offer minimally invasive sinus surgery in his office. This advanced service saves patients time and money when they have chronic sinus problems.
In-Office Sinus Surgery Q&A
In-office sinus surgery refers to a procedure conducted using balloon technology. It’s designed as a permanent solution to chronic and persistent sinusitis. Dr. List performs this minimally invasive surgery in his office safely and quickly, allowing you to rest and recover in the comfort of your home, saving you from a stay in the hospital.
What are the advantages of in-office sinus surgery?
Traditional sinus surgery is much more invasive, opening a patient up to potential complications. The balloon sinus-dilation procedure does the same thing as traditional surgery, but without the same risks. Balloon technology has been used for decades as an intervention for cardiac patients. It allows surgeons to open clogged arteries without making a large incision.
In the ENT field, using the balloon technique means restoring ventilation and drainage without the need for cutting. Balloon technology also provides patients with clinical improvement of their sinus condition without a long recovery period.
How is the surgery done?
Dr. List inserts a guidewire catheter into one nostril and moves it up to the affected sinus passageway. The balloon on the tip of the catheter is then inflated with saline solution. By inflating the balloon, Dr. List is able to remodel the bone and open up your passageway. A wider nasal passage lowers your risk of blockage and potential infection. The balloon is then deflated and removed through the same nostril.
Since Dr. List is using your nostril to gain access to the problem sinus, this surgical procedure requires no incision, which means less bleeding and pain. Dr. List usually performs the procedure with a local anesthetic and completes it in just a few minutes.
Who is a good candidate for in-office sinus surgery?
The ideal candidate for this procedure is healthy and free of other serious conditions. This procedure is usually recommended for people who have:
- Recurring sinus infections that fail to respond to drug treatment
- Develop frequent headaches around the eyes
- Have difficulty breathing due to blocked nasal passages that have not responded to other treatment modalities
Since balloon sinuplasty is noninvasive, it tends to be the better choice for most patients with chronic sinus conditions.
You might not equate epilepsy treatment with an ENT specialist, but Jerome List, MD, DDS, with Alaska Ear Nose & Throat in Anchorage, Alaska, has the surgical training required for one of the most cutting-edge treatment options available for this condition. Vagus nerve stimulator implantation is a type of neck surgery that helps those with poorly controlled epilepsy to prevent a seizure.
Surgical Treatment Options for Epilepsy Q&A
What is epilepsy?
Epilepsy is a disorder of the central nervous system that disrupts nerve cell activity in the brain, leading to seizures or periods of strange behavior. This condition is often associated with grand mal seizures, but people with epilepsy can stare blankly, fall asleep, or simply have a mild twitch in their legs or arms. These are also seizures but are less obvious than a grand mal.
The diversity of the condition creates a very dangerous situation for patients with epilepsy because they have no control over the behavior. It’s hard to predict when a seizure will hit or how it will manifest. This prohibits them from driving, perhaps playing certain sports or even swimming for pleasure.
What causes epilepsy?
The underlying cause of the epilepsy isn’t always clear and varies from patient to patient. For some, it’s a condition linked to specific genes, so it runs in families. For others, head trauma is the culprit. There are also brain conditions and diseases that can bring on sudden epilepsy such as a tumor, stroke, or infection. Seizure disorders like epilepsy appear to be closely linked to developmental disorders, as well, such as autism.
While doctors may not understand epilepsy fully, there are risk factors to consider such as:
- Age -- the condition usually affects those who are very young or over 60
- Family history
- Previous head trauma
- Vascular disease
- Brain infection
- History of febrile seizures in childhood combined with another risk factor
What is vagus nerve stimulator implantation?
The vagus nerve stimulator is sometimes called a pacemaker for the brain; a vagus nerve stimulator implantation might be an effective treatment for some patients with epilepsy. The vagus nerve is the longest nerve of your autonomic system, meaning it helps control subconscious functions such as your heartbeat and breathing. Your neck serves as a conduit for this large nerve, as it travels from your brain to your chest. This makes it easily accessible with surgery.
With a vagus nerve stimulator implantation, Dr. List places a device near that nerve and threads wires to connect with it. Once activated, the device sends electrical signals to the brain to reduce the frequency of epileptic seizures. This is a practical solution for patients who don’t respond to any other medical intervention to control their epilepsy.
Often, sleep disorders involve more than just poor bedtime habits or lifestyle issues. As a board certified specialist in otolaryngology-head and neck surgery, Jerome List, MD, DDS, with Alaska Ear Nose & Throat in Anchorage, Alaska, looks at the medical issues that might disrupt your sleep such as bruxism or apnea to find permanent solutions.
Sleep Disorders Q&A
What is a sleep disorder?
A sleep disorder is any medical problem that interferes with normal sleep patterns. There are many possible issues, so the term is very broad. Often, when someone refers to a sleep disorder, though, they are talking about sleep apnea or insomnia. Sleep apnea is of particular concern because it can be potentially severe and even life-threatening.
What is sleep apnea?
A person with sleep apnea stops breathing repeatedly while sleeping. There are three types of sleep apnea:
Obstructive sleep apnea, the most common type, results from your throat muscles relaxing. Central sleep apnea is a neurological problem that involves the brain sending improper messages of the muscles that control breathing. Complex sleep apnea syndrome is a combination of both obstructive and central sleep apnea.
What is the treatment for sleep disorders?
Treatments vary based on the underlying cause. For some people, the most effective option for obstructive sleep apnea is surgery. This type of sleep disorder occurs because the muscles of your throat relax, allowing your soft palate -- the triangular area of soft tissue that makes up the back of the throat -- to close off your airway. When your brain senses a lack of oxygen, it sends a signal that wakes you up enough to trigger a contraction of the muscles, opening your airway.
The whole process is repeated numerous times as you sleep. It can occur as many as 30 times an hour but usually has little effect because you don’t wake up enough to notice. For some patients, though, the constant disruption in sleep impairs their waking hours, leaving them feeling poorly rested and cranky.
These patients may benefit from a surgical correction designed to increase the size of the airway. By removing and repositioning tissue, Dr. List is able to open up the airway, so the muscle relaxation has less effect.
What type of surgical correction is available?
It will be up to Dr. List to decide what procedure best suits each patient. For some, it will mean the removal of their tonsils as well as reconstruction surgeries on the soft palate, such as:
- Expansion sphincter pharyngoplasty
- Lateral pharyngoplasty
- Uvulopalatal flap
- Palatal advancement pharyngoplasty
- Relocation pharyngoplasty
Dr. List may opt for a combination of procedures to cure your sleep disorder.
Specializing in both dentistry and otolaryngology, Jerome List, MD, DDS, with Alaska Ear Nose & Throat in Anchorage, Alaska, is uniquely qualified to diagnose and treat TMJ disorders causing pain to your jaw and face. Treatment for TMJ involves a combination of medical interventions and self-care plans that take stress off the joint and allow for healing.
What is TMJ?
TMJ stands for temporomandibular disorder or dysfunction: It’s an irritation and inflammation of the temporomandibular joint, which allows your jawbone to move. This joint works as a hinge that opens and closes your mouth. You have one joint on each side of your face to stabilize your jawbone and allow for movement.
The pain comes from the connective tissue around the joint. The temporomandibular joint is protected by a dense fibrous membrane, called a capsule, and an articular disc that works as a cushion between the bones. There are also ligaments and muscle tissue that hold the joint in place and allow it to move. Damage to any one of these components will interfere with the working of your joint, causing pain and reducing mobility.
What causes TMJ?
It’s unclear why some people experience this condition, but it might be a combination of factors including genetics, jaw health, and lifestyle. TMJ is actually an umbrella term that describes many different conditions -- such as arthritis -- that affect your jaw joint. It might also be a complication of trauma or surgery to the joint.
Specific risk factors include:
- A history of rheumatoid arthritis
- A history of osteoarthritis
- Jaw trauma
- Teeth grinding
- Connective tissue disease
TMJ may be a symptom of another problem that requires treatment.
What are the symptoms of TMJ?
Symptoms vary based on the underlying cause of the disorder, but most patients complain of:
- Facial tenderness around the jaw joint on one or both sides
- Aching around the ear
- Ear pain
- Difficulty chewing food
- Clicking of the joint when eating
- Locking of the joint, so it is difficult to open the mouth
You might also notice a grating sensation when you talk or eat. This may indicate mild TMJ that will resolve without treatment, especially if there is no pain.
How is TMJ treated?
Treatment methods depend on why your joint is causing problems. For persistent cases, Dr. List will examine the joint and create a comprehensive care plan designed to provide relief. It might include medication to manage pain and reduce inflammation such as a nonsteroidal anti-inflammatory. Muscle relaxants can often provide temporary relief.
A splint and mouth guard can reduce stress on the joints, especially at night when people often grind their teeth. Combined with physical therapy to strengthen the muscles around the joint, the guard may prevent recurrences of TMJ.
Facial and Mandible Fractures
Jerome List, MD, DDS, with Alaska Ear Nose & Throat in Anchorage, Alaska, is board certified in otolaryngology-head and neck surgery, so treating fractures to the facial bones and mandible is an essential part of his training. The mandible is frequently injured because of its prominence on the face and lack of support to protect it.
Facial and Mandible Fractures Q&A
What does it mean to have a facial fracture?
A facial fracture refers to a broken bone anywhere on the face, such as a broken nose. Other possible injury sites include your cheekbones, eye orbits, and your upper and lower jaw. These are injuries you see commonly in car accidents, falls, and sports accidents. They can also occur in people with poor dental architecture due to a procedure or disease.
Is a mandible fracture the same thing as a facial fracture?
A mandible fracture is a type of facial fracture. Your mandible is the lower bone of your jaw. It connects to your face on both sides via a hinge joint. The mandible is responsible for the movement of your mouth and the support of your lower teeth. A fracture of this kind may involve at least two distinct breaks. The initial one adds stress to the remaining bone causing a second fracture that disconnects the mandible completely from the face.
What are the symptoms of a facial fracture?
Symptoms depend on the location of the break. A nasal fracture manifests as:
- Bleeding from one or both nostrils
- Difficulty breathing
A frontal bone fracture usually looks like the forehead has been pushed in. With a mandible fracture, the jaw might appear swollen and you might have problems opening or shutting your mouth.
What is the treatment for a face or mandible fracture?
Diagnosis and treatment depend on a number of factors. Dr. List will examine the injury site first and probably order imaging tests to get a sense of the extent of the fracture. The goal is to force the bone back into place to promote proper healing and manage any potential complication such as infection.
Reducing the bone, or putting it in the right place, can require surgery. Dr. List may need to insert plates, screws or wires to stabilize the affected bones. You may also have to wear external devices to secure the bones while they heal.
Fractures of the mandible can also involve your teeth, so part of the treatment process will be to ensure proper dental alignment and possibly reconstruction of missing teeth.
If you hear ringing, buzzing, or other sounds in your ears that others don’t, you may suffer from tinnitus. Jerome O. List, DDS, MD, offers cutting-edge comprehensive tinnitus treatment with the Levo® System at Alaska Ear Nose & Throat in Anchorage, Alaska. To find out if you’re a good candidate for Levo sound therapy, call the office or book an appointment online today.
Tinnitus- Levo Therapy Q & A
What is tinnitus?
Commonly called “ringing in your ears,” tinnitus is when you hear a noise when there isn’t actually any external sound. In addition to ringing, tinnitus may create perceptions of hissing, buzzing, or whooshing noises.
Tinnitus isn’t a condition in and of itself, but instead may be a symptom of an underlying issue, such as age-related hearing loss. Although tinnitus rarely indicates a severe problem, it can be extremely bothersome. Sometimes, the perceived noise can be so distracting and loud that you miss sounds that actually exist.
Fortunately, tinnitus often improves with treatment. Dr. List is a tinnitus specialist who offers the innovative Levo System, a neuroscience-based technique that trains your brain to stop hearing the interfering noise while you sleep.
What causes tinnitus?
Tinnitus is a common problem that affects about one in five people. Possible causes of tinnitus include inner ear damage and certain health conditions, including:
- Age-related hearing loss
- Exposure to loud noise, such as chainsaws and firearms
- Earwax blockage
- Temporomandibular joint (TMJ) disorders
- Head or neck injuries
Sometimes, tinnitus is temporary or goes away after treating its underlying cause. In many cases, the exact source of tinnitus remains unknown.
What is the Levo System?
The Levo System is an FDA-cleared tinnitus treatment that uses patented, neuroscience-based technology. The system creates a personalized sound tailored to your unique tinnitus condition.
You listen to the sound while you sleep and, over time, your brain gets used to it and stops responding. This process is called habituation. With continued Levo therapy, your mind stops perceiving the tinnitus noise, which means you stop hearing it.
How does the Levo System work?
First, Dr. List carefully evaluates your condition to determine whether Levo therapy is right for you. If so, he fits you for custom earbuds to wear comfortably while you sleep.
Then, Dr. List helps you perform a sound match with the Levo System to generate your personalized tinnitus sound. You attach the earbuds to an Apple iPod Touch equipped with the user-friendly Levo software and listen to your sound while sleeping.
After about three months of Levo therapy, your brain should habituate to your tinnitus sound. You may continue using the Levo System as needed after that.
To learn more about the Levo System for tinnitus therapy, call Alaska Ear Nose & Throat or book an appointment online today.
With Botox injections, we are able to freeze the targeted facial muscles allowing for a temporary smooth, wrinkle free and younger look.
Botox injections is a quick 10-minute treatment, and you’ll notice a difference in just a few days. Your Botox injections will last you somewhere around 3-6 months, depending on how well your body reacts to the injection.
Please note that Botox injections is not a permanent treatment; after about 3-6 months, your facial lines will gradually reappear and additional injections will be needed.