Here is a collection of many commonly asked questions related to ear, nose and throat and our practice.

FAQs – General and Practice-Related

What is an ENT doctor?

An ENT, or Otolaryngologist, is a medical doctor who has completed highly specialized training in the medical and surgical management of disorders of the ears, nose, throat, head and neck. Otolaryngologists treat both adults and children.

What conditions does an ENT treat?

Although variations may exist with individual physicians in terms of what conditions they are comfortable treating, otolaryngologists in general treat all conditions affecting the ears, nose, sinuses, mouth, throat, face, head and neck, with the exception of strictly dental disorders, disorders of the eyes, or disorders of the brain or spine.

What training does one need to become an ENT?

Like other doctors, ENTs complete four years of medical school after obtaining a college degree. Following medical school, ENTs receive specialized training in an Otolaryngology – Head and Neck Surgery residency, which typically requires an additional five years after medical school.

Can a general ENT treat kids, or do I need to see a specialized pediatric ENT?

Absolutely yes. All otolaryngologists receive extensive training in treating common ear, nose and throat problems in children. Certain more complicated pediatric patients may be better served by a specialized pediatric ENT, such as those with unusual syndromes or needing advanced airway reconstruction.

What does it mean to be a board certified ENT?

Board certified otolaryngologists have successfully met strict standards of excellence set forth by the American Board of Otolaryngology. They must first successfully complete an Accreditation Council for Graduate Medical Education (ACGME) – accredited residency program. After completing this training, a candidate must be approved by their residency Program Director to sit for the board examinations. Candidates must then pass both written and oral examinations to receive board certification, as well as participate in ongoing Maintenance of Certification.

Where do you perform surgery?

We perform surgery most commonly at Sky Ridge Surgical Center, Sky Ridge Medical Center, and Summit View Surgery Center. Dr. Mills also performs surgery at Castle Rock Adventist Hospital.

What is an Audiologist?

An audiologist is a professional trained in the evaluation and treatment of hearing and balance disorders. All audiologists undergo extensive graduate level training. They are not medical doctors (they do not attend medical school), but often have a Doctorate level degree in their field. Audiologists often work closely with ENTs to treat patients with hearing and balance problems, as their expertise is complimentary.

How much will my surgery cost me?

This is a complicated question. The cost of your surgery includes essentially three components: 1) the surgeon’s fee, 2) the anesthesiologist’s fee, and 3) the facility (hospital or surgery center) fee. Your out-of-pocket cost depends heavily on your particular insurance plan, especially the size of your deductible. While we can provide you with our charges and contact information to obtain estimates of the other fees, you will need to check with your insurance company to figure out the specifics of your particular plan.

FAQs – Ears

Why do children get ear infections?

The Eustachian tubes are passageways connecting the middle ear space (air-filled space deep to the eardrum) and the back of the nose. These tubes function as valves, opening periodically when you swallow or yawn, which allows the pressure in the middle ear space to equalize with the pressure in the outer environment. These tubes do not work as well in young children because of the immature anatomy of the base of the skull. This can allow negative pressure to develop in the middle ear, with subsequent buildup of fluid. This fluid can get infected, causing acute otitis media (an ear infection).

What are ear tubes?

Ear tubes are very tiny tubes that are placed through an incision in the eardrum using a microscope. They remain in the eardrum for an extended period of time (usually 8-12 months for most kinds of tubes), allowing a direct passage for air pressure to equalize between the middle ear space and the outer environment. The tubes also allow any fluid buildup or infection in the middle ear to drain out. There are many different styles of ear tubes. Most are made of some type of plastic, but a few are made of metal (titanium).

Does my child need ear tubes?

Ear tubes are placed most commonly for one of three reasons:

Infections. Recurring ear infections (acute otitis media) requiring antibiotic after antibiotic are a common reason to place ear tubes, especially in young children. Typically 3 or more infections in a 6 month period, or 4 or more infections in a 12 month period is too many, and tubes should be considered.
Hearing loss. In young children, good hearing is vital for proper development of language. Even mild hearing losses are treated in children because they can lead to delays in speech and language. A very common cause of hearing loss in children is a middle ear effusion, or fluid underneath the eardrum. Although transient fluid is common after an upper respiratory infection (cold), if fluid persists for a long period of time (usually 3 months or longer), it is much less likely to clear on its own, and tubes may be recommended.
Eustachian tube dysfunction. This is a more common reason to place tubes in older children and adults. Longstanding Eustachian tube dysfunction can lead to bothersome ear discomfort, hearing loss, an eventually can cause permanent damage to the eardrum.

What is the purpose of earwax?

Earwax is secreted by tiny glands in the skin of the outer part of the ear canal. It lubricates the ear and helps the ear clean itself of dead skin and debris. It also has qualities that protect the ear canal from infection due to bacteria and fungus. Earwax can buildup and block the ear canal in some cases – called a cerumen impaction – which can cause discomfort, equilibrium problems, and hearing loss.

Do adults ever need ear tubes?

Yes! Although less commonly than children, many adults with longstanding Eustachian tube dysfunction also benefit from ear tubes. This procedure can almost always be accomplished with a simple, brief procedure in the office under local anesthesia.

What are the best ways to clean earwax?

The best, most efficient, and safest way is to see your ENT, who will use delicate instruments and a microscope to remove impacted wax from your ears.

If you may have an ear infection, are experiencing pain, have a significant decrease in your hearing, are dizzy, have had ear surgery, or may have a perforated eardrum, you should NOT attempt to clean your ears on your own.

If you are not prone to cerumen impactions, you really don’t have to do anything. The ears are naturally self-cleaning in most people.

If you are prone to hard wax buildup, you can try a couple of maintenance measures to lessen the buildup:

Once or twice a week, place several drops of mineral oil into the ear canal with the head tilted to one side. Let it sit for several minutes, then allow it to drain out. This will make the wax softer and allow it to work its way out on its own.
Once or twice a week, take some lukewarm saline solution and gently flush the ear canal with a bulb syringe. After doing this, be sure to dry the ears out with either a hairdryer held at arm’s length, or by placing a mixture of rubbing alcohol and white vinegar in the ear and letting it drain.

What causes tinnitus (ringing in the ears)?

Some potentially serious causes of tinnitus exist, and your doctor may recommend specific testing if one of these causes is suspected. The vast majority of tinnitus cases, however, are thought to be related to some degree of damage to the delicate hair cells within the inner ear, which are responsible for hearing. This damage can occur as a result of the normal aging process, exposure to loud noise, exposure to toxins or certain medications, and other less common disorders. When these cells are damaged, which usually (but not always) results in a detectible hearing loss, the signals they send to the brain are altered. The brain misinterprets this altered signal and “creates” its own perceived sound.

How do I know if I need hearing aids?

First, you should have your hearing tested and your ears examined. After reviewing your hearing test and examining your ears, an ENT can determine if there is a reversible cause of your hearing loss. The ENT and audiologist can then counsel you on the severity of your hearing loss and whether hearing aids would benefit you.

What is vertigo?

Vertigo is a particular type of dizziness sensation that refers to a sensation of movement when no movement is occurring. This can be a sensation that you are moving or that the room is moving. Commonly, the sensation is described as “spinning.” True vertigo as described above often indicates a problem with the balance portion of the inner ear.

Is an eardrum perforation harmful?

An eardrum perforation is not necessarily harmful. Most perforations will heal without intervention, but some may need surgery. Repairing an eardrum perforation is recommended if there is ongoing drainage from the ear or repeated infections, or if the perforation is causing a hearing loss.

How is an eardrum perforation treated?

Surgery to repair an eardrum perforation usually involves harvesting a thin tissue graft from the patient and using it to patch the hole.

What is a Baha/Ponto?

Baha and Ponto are both brands that refer to an osseointegrated auditory implant (also called bone-anchored hearing aid). This is a screw-type device that is surgically implanted in the skull and “integrates” with the surrounding bone. There is an “abutment” that attaches to the implant and protrudes up through the skin, allowing easy attachment of a sound processor.

How is a Baha/Ponto different than a conventional hearing aid?

A conventional hearing aid works by receiving sounds from the environment, amplifying them, and transmitting the sound through the air, through the patient’s ear canal, to the ear. A Baha or Ponto transmits the processed sound by vibrating the bone of the patient’s skull, transmitting it directly to the patient’s inner ear.

FAQs – Nose and Sinus

What causes nasal obstruction?

Common causes of nasal obstruction include:

Deviated septum. The septum is the wall that divides the inside of your nose into two halves. If this wall is significantly warped or deviated, this can cause one side of your nose to be much smaller than the other on the inside, which causes the sensation of obstruction. Additionally, a deviated septum can lead to turbulent airflow during breathing, which further exacerbates the feeling of obstruction.

Nasal turbinate hypertrophy. There are 3 (sometimes 4) turbinates on each side of the inside of the nose. They arise from the outer wall of the nasal cavity and project into the air-filled space of the nasal cavity, serving to warm and moisturize the air we breathe. The inferior, or lower, turbinates are the largest and most directly in the path of airflow. They swell in response to many factors, such as allergies, other causes of inflammation, or hormonal changes. When two swollen or large, they obstruct airflow through the nose.

Concha bullosa. The middle turbinates are usually thin and do not obstruct airflow. Sometimes, there can be an “extra” sinus or airspace that fills one or both middle turbinates, causing them to be much larger and obstructive.
Nasal polyps. These are grape-like swellings in the mucosa (lining of the nose/sinuses), which commonly occur due to allergies or sinus inflammation. These occupy space inside your nose and lead to obstruction of airflow.
Nasal valve narrowing. The nasal valves are formed by the angle between the sidewalls of your nose and the nasal septum. If this angle is too narrow, the airflow is restricted. There may also be “dynamic” collapse of the nasal valves due to weak or malformed cartilage in the sidewalls of the nose, causing the sides of your nose/nostrils to collapse inward when you breathe in.

A thorough exam by an ENT physician at Rocky Mountain ENT can determine the cause(s) of your blocked nose and recommend medical and/or surgical treatments based on your individual situation.

What causes nosebleeds?

The inside of the nose is home to a rich blood supply. Certain areas, such as the front portion of your nasal septum (the wall that divides the inside of your nose in half) are especially rich in blood vessels. Sometimes these blood vessels can become dilated and very close to the surface. When the thin surface of the nasal lining is disrupted, such as with minor trauma or nose picking, one of these blood vessels can open up and a brisk nosebleed can result. Here in Colorado, with our low relative humidity, the nose can become quite dry, which makes the nasal lining fragile and prone to cracking open. The most common source of nosebleeds is as described above, in the front part of the nose. Though messy and at times frightening, these nosebleeds tend to be easier to control. A more rare source of nosebleeds is a blood vessel in the back of the nose. When this is the case, nosebleeds can be a lot harder to stop, and some even require hospitalization. People who take blood-thinning medications, such as aspirin, Plavix, warfarin and others, tend to have more severe nosebleeds that are more difficult to stop.

How do I stop a nosebleed?

A few simple steps can stop most nosebleeds in their tracks. This technique is for adults and older children. Ask your doctor before using Afrin in young children or in adults with a heart condition.

Keep a bottle of over-the-counter Afrin (oxymetazoline) nasal spray handy.

Soak a cotton ball in the Afrin. Place the soaked cotton into the side of the nose that is bleeding. If no cotton ball is available, simply spray the Afrin a few times into the nose.

Squeeze/pinch the soft part of your nose together. Do not squeeze the hard bony portion – this does nothing. Hold the squeeze tightly for 10 minutes…without peeking!

During the process, lean forward. Leaning your head back will only encourage the blood to go down your throat, which can make you nauseated!

What are the sinuses?

The sinuses are air-filled spaces within the skull and facial skeleton. These consist of paired maxillary (cheek), frontal (forehead), ethmoid (roof of the nose between the eye sockets), and sphenoid (middle of the skull behind the eye sockets) sinuses. The sinuses are lined with mucosa, which normally secretes a thin layer of mucus and has microscopic hairs (cilia) that beat in a coordinated fashion to move mucus and any particles (allergens, bacteria, etc.) out of the sinuses and into the nose. The sinuses empty into the nasal cavity through openings called ostia (pleural of ostium).

Why do we have sinuses?

There is no one accepted answer to this question. There are many theories, any or all of which may be correct:

They lighten the skull.
They form a buffer, or “crumple zone” protecting the brain against trauma.
They create a “resonance chamber” for the voice.
They help humidify and warm air.

What is a sinus infection (sinusitis)?

Acute sinusitis is very common, and is what most people refer to as a “sinus infection.” It typically lasts less than two weeks and is commonly associated with facial pressure and pain, dental pain, nasal drainage, congestion, low-grade fevers, and feeling run down. It often starts with a viral upper respiratory infection (cold) or flare-up of allergies. This can cause swelling of the nasal lining that obstructs the ostium of one or more sinuses, which allows fluid buildup and overgrowth of bacteria. Antibiotics will usually clear these acute infections up. Chronic sinusitis lasts much longer (months, if not indefinitely), and can be much harder to treat. Sometimes sinus surgery may be needed to improve chronic sinusitis.

FAQs – Throat and Neck

What are the purpose of tonsils and adenoids?

The tonsils and adenoids are lymphoid tissue, which is part of the immune system. They are strategically located near the entrances to the body (tonsils in the back of the mouth, adenoids in the back of the nose) to sample bacteria and viruses as they enter the body. This helps the immune system learn about what you are exposed to so that antibodies can be made to fight specific bacteria and viruses. This is most important in the first few years of life. Fortunately, there is a great deal of redundancy build into our immune system. Children and adults that need their tonsils and/or adenoids removed do NOT suffer from a weakened immune system.

When do you recommend removing the tonsils and/or adenoids?

Tonsils and/or adenoids are removed generally for one of two reasons:

Infection. Recurrent (several episodes) or chronic (one long episode) infections of the tonsils and/or adenoids, are common reasons to recommend removal, especially in patients who have been on several rounds of antibiotics only to have their symptoms come back after stopping the antibiotic.
Obstruction. Large tonsils and adenoids can contribute to snoring and sleep apnea. When sleep apnea is suspected, especially in children, this is a common reason to remove the tonsils and adenoids.

How do you remove the tonsils and adenoids?

Both the tonsils and the adenoids are removed through the mouth, with no external incisions. The surgery is performed under a brief general anesthetic. The tonsils are removed most commonly with an electrocautery device, which cuts tissue and seals blood vessels to control bleeding. The areas where the tonsils used to be are left open – that is, no stitches are placed. This allows the areas to heal from the inside out, with virtually no risk of infection. While the tonsils are completely removed, the adenoids are reduced, either by sharply scraping the tissue out or by liquefying/vaporizing the tissue with a cautery device. This is why, in some uncommon cases, adenoids can “regrow” over time, while tonsils do not.

What is the thyroid?

The thyroid is a gland in the lower portion of your neck. It has two “lobes” with a small bridge between them. It straddles your trachea (windpipe), just below your larynx (voice box). It secretes a hormone into the bloodstream (thyroid hormone) that is important for many aspects of metabolism throughout the body.

What is a thyroid nodule and how do I know if it is bad?

A thyroid nodule is an area of the thyroid gland that has a different consistency than the rest of the gland. Sometimes this is felt on exam as a hard area in the gland. Other times it may be seen on an imaging study (CT scan, ultrasound, etc.) but not felt. Overall, most nodules are benign (about 90%). The nodule is more likely to be a cancer if it has certain features, such as large size, rapid growth, associated hoarse voice, if there is a family history of thyroid cancer, or a if there is a history of radiation exposure. Certain features on ultrasound can help identify possible cancers as well. Any thyroid nodule that has any suspicious features deserves a biopsy, which is often done with a small needle using ultrasound to guide the biopsy.

FAQs – Snoring and Sleep

What causes snoring?

Snoring is generated by vibration of soft tissues, most commonly the soft palate and uvula. Snoring is a sign of partial obstruction of the airway. As your throat muscles relax when you are sleeping, the tissue of your throat and tongue collapse into the airway, causing partial obstruction and turbulent rapid airflow, leading to vibration of the tissues and generation of the snoring sound. Snoring may be worse in people with nasal obstruction from a deviated septum or other cause, or in people with a thick and elongated uvula or large tonsils. Sedatives and alcohol will also make snoring worse.

Is snoring harmful?

Primary snoring, that is, snoring without sleep apnea, is not in itself a medical problem. In fact, snoring typically is more disruptive to a bed partner’s sleep than it is to the one who is snoring, and can put strain on relationships. It can also lead to throat dryness and irritation.

How do you treat snoring?

Your ENT will examine you to determine the likely contributors to snoring. If there is nasal obstruction, surgical correction of this can help reduce (but not necessarily eliminate) snoring. Removing the tonsils, trimming the palate, and/or removing the uvula are other surgical procedures that can reduce snoring, though typically these procedures are not performed solely to treat snoring. A simple office procedure that can significantly reduce snoring is Somnoplasty, which uses radiofrequency to induce areas of scarring in the palate, which reduces some of the tissue volume and stiffens the palate, thereby reducing vibration that occurs.

What is sleep apnea?

Sleep apnea means stopping breathing during sleep. The most common form of sleep apnea is obstructive sleep apnea (OSA) – that is, the pauses in breathing are caused by obstruction of airflow through the throat. OSA is a more severe disorder along the same spectrum as snoring, and snoring occurs in patients with sleep apnea. Untreated OSA can have long-term negative health consequences, such as high blood pressure, heart disease, and sudden death.