Procedures & Treatments

Ears - There are many conditions that affect the inner, middle, and outer portions of the ear. We treat common problems such as dizziness, hearing loss, ringing (tinnitus), infections, trauma, wax accumulation, and surfer's ear. Listed are just a few of the surgical procedures we offer to correct many problems related to the ears.

• Tympanoplasty (repair of a perforated ear drum)
• Removal of exostoses (aka surfer's ear)
• Laser surgery of the middle ear for improved hearing (stapedotomy)
• Otoplasty to correct 'lop' or 'protruding' ears
• Ossicular chain reconstruction (repair of damaged ear bones)
• Removal of middle ear cholesteatoma and other mastoid conditions

Nerve (sensorineural) hearing loss is a problem that affects many people. Noise exposure and aging are the most common reasons for nerve hearing loss. At our office, you will have a complete audiogram (hearing test) performed by a licensed audiologist. The physician will then review the test results and perform a complete ear examination. Although we do not dispense hearing aids, our staff can help you understand the benefits and problems with hearing amplification.

Nose/Sinus - We treat a variety of conditions affecting the nose and sinuses. Often times difficulty breathing through one's nose can be the result of allergies, a deviated septum, nasal polyps, or a crooked nose that may have resulted from trauma or injury to the nose. Other common problems that we treat include nose bleeds (epistaxis), chronic drainage (rhinitis), and loss of the sense of smell (anosmia). State-of-the-art diagnostic tools and endoscopy are used to assist in the accurate diagnosis of sinonasal diseases and maximal medical therapy is then implemented. If medical therapy is not satisfactory, surgical procedures can be performed such as:

• straightening the nasal septum (septoplasty)
• making the turbinates smaller (partial turbinectomy or Coblation of the turbinates)
• removing nasal polyps
• improving the appearance and function of a traumatically injured nose (rhinoplasty)

Sinus problems also fall within the realm of treatment of the ENT physician. Sinus problems are multifactorial and can often best be managed both medically and surgically. Again, an accurate diagnosis is essential in the proper management of sinus diseases. In addition to a thorough history and physical examination, the use of CAT scans and sinonasal endoscopy provide invaluable information to the Otolaryngologist. Sinus conditions that do not respond to vigorous medical therapy may improve with sinus surgery.

Endoscopic sinus surgery (ESS) has replaced older procedures such as sinus windows or in-office lavages. ESS is designed to improve the natural outflow tracts of the sinuses to allow for better aeration and drainage. We also use computer assisted endoscopy for the treatment of diffuse sinonasal polyps or for revision sinus surgery patients.

Throat/Voice/Swallowing- Many conditions exist that affect our throats, voice, and the way we swallow. We diagnose and treat a wide variety of problems including:

• chronically sore throats
• hoarseness
• 'fullness' in the throat
• difficulty swallowing 

We are able to visualize the larynx (voice box) in the office with our fiberoptic endoscopes that enable us to more accurately diagnose conditions related to the voice and throat. Some voice and swallowing problems can be conservatively treated with the help of speech and language pathologists in our community. Many of our patients have problems with acid reflux (laryngopharyngeal reflux) and respond to medications.

Voice and throat problems that fail or are not amenable to conservative therapy can often be treated surgically. We use state-of-the art laryngeal instrumentation, lasers and microscopes in the operating room for treatment of these conditions. Procedures include: 

• tonsillectomy
• botox injection for spasmodic voice conditions
• microscopic laryngeal surgery to remove vocal cord polyps/nodules/cysts
• laser or endoscopic shaving of papillomas from the vocal cords

Thyroid and Parathyroid Disease - Otolaryngologists are trained in the diagnosis and surgical treatment of thyroid and parathyroid gland disorders. Our practice is one of the most experienced groups on the central coast for the surgical treatment of thyroid and parathyroid gland disorders. Common examples of these conditions include:

• thyroid goiters (enlarged glands)
• thyroid nodules
• thyroid cancer
• parathyroid adenomas (an enlarged parathyroid gland)
• parathyroid hyperplasia (more than one overactive parathyroid gland)
• parathyroid cancer

To help us diagnose a condition, we may use fine needle aspiration biopsy, ultrasound, laboratory tests, and sestamibi technetium imaging. Our training helps us identify important structures in the neck, including the recurrent laryngeal nerve, which travels to and innervates the voice box. Some problems of the thyroid and parathyroid glands are related to their function, and these disorders are often treated by an Endocrinologist.

Facial Plastics and Reconstructive Surgery - Our practice treats patients with facial fractures, lacerations, and other deformities of the head and neck resulting from injuries. We perform operations to realign and stabilize facial fractures as well as close complex facial wounds that involve important facial aesthetic units including the lips, ears, and nose. We also remove and repair defects resulting from the treatment of skin cancers.

Head and Neck Cancer - The Otolarygologist is specifically trained to diagnose and treat cancers of the voice box (larynx), neck, throat, salivary glands, and sinuses. We are able to understand the complex issues of function, aesthetic concerns, and successful cancer therapy. Most small tumors can be successfully treated with limited surgery or radiation therapy. Advanced tumors require a multidisciplinary approach that not only includes the head and neck surgeon, but radiation oncologists, medical oncologists, oral surgeons, and speech pathologists. Many of our patients can be treated locally, but we will refer patients to medical centers that may have additional expertise in the treatment of a patient's specific type of tumor.

Sleep Disordered Breathing/Snoring - Otolaryngologists frequently see patients for the evaluation of snoring or sleep disordered breathing. These problems are highly complex and involve the interaction of many factors including a patient's lifestyle and their upper airway anatomy. The evaluation of a snoring patient involves a thorough history and physical exam and sometimes the use of endoscopy for complete examination of the upper airway. A sleep study is often obtained and treatment is then based on the findings of both the physical exam and the sleep study.

We have several in office treatments available for socially disruptive snoring. These include:

• injection of sodium tetradectyl into the palate
• cautery assisted palatal stiffing procedures

Salivary Glands - The salivary glands are glands responsible for the production of saliva. There are four 'major' salivary glands and millions of 'minor' salivary glands. The major salivary glands are the parotid and submandibular glands which are paired glands in the cheeks and under the jaw, respectively. The minor salivary glands exist in the mouth and lips. Occasionally, these glands can become blocked with small 'stones' that cause swelling and may result in infection. The glands may also develop tumors, both malignant and benign, which can result in a growth on the face, mouth, or neck. Otolaryngologists are trained in both the anatomy and physiology of the salivary glands and are able to treat infections and remove tumors that may develop in these glands.

Botox - Botox is a drug used by many specialties in medicine for various purposes. In the field of Otolaryngology, we use botox for both medical and cosmetic reasons. It is used in the treatment of:

• spasmodic voice conditions (spasmodic dysphonia)
• facial muscular spasm (clenching of the jaws, twitching and spasm of the muscles around the eyes)
• neck muscular spasm (tightening and twisting of the muscles of the neck)

We also use Botox for cosmetic reasons, too, which diminishes the presence of:

• crows feet
• furrowing brow lines
• forehead wrinkles