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Practice Update

We will be moving late September or early October:
Our New Address will be:

6010 Hidden Valley Road, Suite 210
Carlsbad, CA. 92011

Pacific ENT of San Diego County's Solana Beach * Treating Sinusitis * Sinus Surgery * Sleep *  Snoring * Sleep Apnea * Allergies * Ear Hearing & Balance * Voice * Head & Neck Surgical Care Allergist ENT Sinus Doctors of San Diego County California

Mouth / Throat Services & Treatments

Pacific ENT Medical Group is dedicated to providing our patients with advanced mouth and throat care. Dr. Davis also provides patient education throughout her web site, she believes a better educated patient leads to better overall care.

Mouth, Voice and Throat Treatments in San DiegoMouth & Throat Conditions:


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What is Reflux?

REFLUX comes from a Greek word that means “backflow”, and it usually refers to “the back flow of stomach contents”. Normally, once the things that we eat reach the stomach, digestion should begin without the contents of the stomach coming back up again…refluxing.

The term LARYNGOPHARYNGEAL REFLUX (LPR) refers to the backflow of food or stomach acid all of the way back up into the larynx (the voice box) or pharynx (the throat).

REFLUX comes from a Greek word that means “backflow”, and it usually refers to “the back flow of stomach contents”. Normally, once the things that we eat reach the stomach, digestion should begin without the contents of the stomach coming back up again…refluxing.

The term LARYNGOPHARYNGEAL REFLUX (LPR) refers to the backflow of food or stomach acid all of the way back up into the larynx (the voice box) or pharynx (the throat).

Treatment for LPR includes:

  • Changing lifestyle habits and diet to reduce reflux
  • Medications to reduce stomach acid
  • Surgery to prevent reflux if medical treatment is ineffective

Tips for Reducing Reflux include:

  • QUIT smoking. The use of tobacco may make you reflux
  • Don’t wear clothing that is too tight, especially around the waist
  • If overweight, lose excess weight as this puts more pressure on your stomach
  • Do not lie down just after eating. Avoid eating within three hours of bedtime
  • Avoid caffeine, soda pop, chocolate, alcohol and mints as they may increase reflux

TMJ (Temporo-Mandibular Joint) Disorders

Symptoms:

  • Ear pain
  • Sore jaw muscles
  • Temple/cheek pain
  • Jaw popping/clicking
  • Locking of the jaw
  • Difficulty in opening the mouth fully
  • Frequent head/neck aches


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Dysphagia / Swallowing Disorders

Difficulty swallowing (dysphagia) may occur at any age but is more common in the elderly. An individual may have difficulty swallowing liquids, solid foods or both.

Symptoms of Swallowing Disorders:

  • A feeling that food or liquid is sticking in the throat
  • Discomfort in the throat or chest
  • Drooling
  • Sensation of a foreign body or “lump” in the throat
  • Weight loss and inadequate nutrition due to prolonged difficulty swallowing
  • Coughing or choking when eating
  • Drooling

Swallowing is a very complex process and any interruption in the swallowing process can lead to dysphagia. Some 50 pairs of muscles controlled by several nerves help an individual to swallow. There are 3 stages of swallowing:

  1. Oral preparation –The food is chewed, mixed with saliva and the tongue collects the prepared food or liquid for swallowing.
  2. Pharyngeal stage – The tongue pushes the food or liquid to the back of the mouth, triggering a swallowing reflex that pushes the food into the pharynx (throat). The voice box (larynx) closes tightly and breathing stops to prevent food or liquid from entering into the lungs.
  3. Esophageal stage – The food or liquid passes into the esophagus and then into the stomach. It takes about 3 seconds for food to pass into the stomach.

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Causes of Swallowing Disorders:

There are many causes. Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. Examples of disease of the nervous system include patients with Parkinson’s disease, cerebral palsy or a history of stroke. Difficulty chewing food because of poor teeth or ill fitting dentures may cause dysphagia. An infection or irrigation of the esophagus, such as gastroesophageal reflux is another cause. Narrowing of the esophagus caused by a stricture or a tumor of the head, neck or chest, may also create swallowing problems.

How are Swallowing Disorders Evaluated:

Most problems with swallowing are temporary and not threatening. If your symptoms persist, then we recommend an evaluation by an Otolaryngologist, such as Dr. Davis. The initial evaluation includes an examination of the head and neck region, including the mouth and throat. Next, the back of the throat is examined with mirrors or a flexible lighted tube called a fiberoptic laryngoscope. Additional tests may be ordered, including an xray study called a barium swallow or esophagram, which examines a patient with xrays while swallowing.

A referral to a speech pathologist for a swallowing evaluation may also be ordered. The speech pathologist may perform a modified barium swallow with a radiologist to determine if there are problems with any of the four stages of swallowing, using different food consistencies.

You may be referred to a gastroenterologist to evaluate the esophagus or a neurologist to determine if there is a disorder of the nervous system.

How Are Swallowing Disordered Treated?

Many disorders of swallowing can be treated with medication, swallowing therapy or surgery.

Medications that reduce stomach acid production, muscle relaxants, and antacids may help patients with gastroesophageal relux disease.

Gastroesophageal reflux may be treated with lifestyle changes as well as medications. Some of those changes include:

  • Avoid alcohol, caffeinated beverages, nicotine and chocolate.
  • Eat small meals and avoid food within 3 hours of bedtime
  • Elevate the head of the bed at night
  • Avoid tight fitting clothes.
  • Reduce you weight.

Swallowing therapy is performed by the Speech Pathologist. Therapy consists of special exercises to strengthen weak swallowing muscles or to improve coordination. Some individuals may benefits from changing the consistency of their diet or to eat with their head turned to one side. Restimulating the nerves that trigger the swallow reflex may also be helpful.

Surgery is used to treat certain problems. If there is narrowing of the esophagus, the area may need to be stretched or dilated. If a muscle is too tight, it may need to be released surgically (myotomy). Surgical treatment may also be helpful if there is weakness of one of vocal cords of the voice box.


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Mouth Sores

There are various types of sores that can appear anywhere within the mouth, including the inner cheeks, gums, tongue, lips or palate.

Stomatitis: This is inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips and roof or floor of the mouth. It can be caused by poor oral hygiene, poorly fitted dentures, mouth burns from hot foods/drinks, medications, allergic reactions or infections. Stomatitis is associated with redness, swelling and occasional bleeding as well as bad breath. Canker sores are a type of stomatitis.

Aphthous Ulcers (Canker Sores): These mouth sores are NOT contagious and can appear as a pale or yellow ulcer with a red outer ring. They can appear alone or in clusters. These are very painful and can last 5-10 days. The cause is not clear but may be related to: a virus; temporary weakness in the immune system (like a cold); hormonal changes; mechanical irritation; stress; or low levels of vitamins/minerals. The treatment does not provide a cure but is aimed towards relieving discomfort and prevention from infection. A topical corticosteroid such as Kenalog, may be prescribed.

Cold Sores: Also known as fever blisters, these sores are caused by the herpes simplex virus and are very contagious. This virus is usually dormant but can be activated by conditions such as stress, fever and trauma. Usually there is tenderness, tingling or burning before the sore actually appears. The sores begin as blisters and then crust over and last about 7-10 days. Although there is no cure, treatment includes using an antiviral ointment, such as acyclovir.

Oral Candidiasis (Thrush): Thrush is a yeast infection of the mucous membranes of the mouth and tongue and is caused by forms of a fungus called Candida. This is a normal organism that lives in your mouth and is kept in check by healthy organisms that also live there. When your resistance to infection is low, the fungus can grow, leading to the lesions in your mouth or on your tongue.

Taking antibiotics or steroid medications, being very old or young, poor health, having diabetes, being on chemotherapy or having HIV/AIDS can increase your chance of getting thrush. Thrush appears as whitish, velvety lesions in the mouth and on the tongue. Under the white there is red tissue that may bleed. There are antifungal mouthwashes or lozenges that can be used to treat this infection. The long term out-look for thrush is dependent on your immune status and cause of the immune deficit.

Taking antibiotics or steroid medications, being very old or young, poor health, having diabetes, being on chemotherapy or having HIV/AIDS can increase your chance of getting thrush. Thrush appears as whitish, velvety lesions in the mouth and on the tongue. Under the white there is red tissue that may bleed. There are antifungal mouthwashes or lozenges that can be used to treat this infection. The long term out-look for thrush is dependent on your immune status and cause of the immune deficit.

Oral Lichen Planus: This is an inflammatory condition that affects the lining of the mouth. It usually occurs on the inside of the cheeks but can affect the gums, tongue, lips and other parts of the mouth. This is not an infectious disease, and is not contagious, but may last weeks or months. There are often small, pale raised areas or bumps that form a lacy network on the tongue or inside the cheeks.

It may advance into a painful erosive lesion. The mouth may be sore, dry and have a metallic taste. The cause is not known but may be triggered by an allergic or immune reaction. There is no cure for oral lichen planus, so the treatment focuses on managing the symptoms.

Oral Cancer: Mouth cancer commonly involves the tissue of the lips or tongue but may also occur on the floor of the mouth, cheek lining, gums or roof of the mouth. Most oral cancers are called squamous cell carcinomas and may spread rapidly. Smoking cigarettes and other tobacco use is associated with 70-80% of oral cancer cases. Heavy alcohol use is another activity that increases one’s risk of developing oral cancer.

Oral cancer presents as a lump or ulcer, pale or dark in color and may be painless. Some individuals have tongue pain, swallowing difficulty, mouth sores or abnormal taste. A biopsy of the lesion confirms the diagnosis of cancer. Surgical excision is usually recommended. Radiation therapy and chemotherapy may be indicated when the tumor is larger or has spread to lymph nodes in the neck.

Keep your Mouth Healthy!  Oral Self-Care

  • Practice good oral hygiene. 
  • Limit alcohol consumption and don’t use tobacco products. 
  • Adjust your diet.
  • Have regular oral examinations. 


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Smell & Taste

Smell or taste disorders are relatively common and can have a significant impact on quality of life. The senses of smell and taste allow us to enjoy foods and serve as an early warning system against dangers such as fire, smoke, spoiled foods, chemicals and toxins. Smell and taste disorders, especially in the elderly, have been implicated in weight loss, malnutrition, impaired immunity and worsening of medical conditions.

 

Many individuals, who complain of problems with taste, actually are experiencing problems with their sense of smell.

Smell

Two nerves in the nose are responsible for the sense of smell. The olfactory nerve is located in the upper part of the nose and connects directly to the brain. The olfactory nerve is responsible for the quality of smells such as rose, lemon and grass. The second nerve, the trigeminal nerve, gives one the sensation of odors, warmth, coolness, sharpness and irritation (i.e. ammonia and alcohol).

Taste

The sense of taste comes from taste buds located on the tongue and throat. The basic taste sensations are sweet, sour, bitter, and salty. The trigeminal nerve also provides the sensation of foods such as stinging, burning, coolness and sharpness.

Causes of Smell and Taste Disorders

Smell Disorders

Common causes for smell disturbance are nasal and sinus disease (allergies, polyps, sinusitis and enlarged adenoids), upper respiratory infections (“colds”), head trauma (skull and nasal fractures) and cigarette smoking. Less common causes are medications, cocaine use, toxic chemicals (benzene, chlorine, paint

solvents, insecticides) and industrial agents (ashes, chromium, iron). Uncommon causes include tumors, psychiatric conditions (schizophrenia, depression) and endocrine disorders.

Taste Disorders

Common causes for taste disturbance include mouth infections (yeast, herpes, gum disease), medications, oral appliances (dentures), dental procedures (tooth extraction, root canal) and age. Less common causes are nutritional deficiencies (Zinc, Copper, B3 and B12), malnutrition, kidney and liver disease, cancer and HIV, tumors, head trauma, and toxic chemical exposure (benzene, chlorine, sulfuric acid). Uncommon causes include psychiatric conditions (depression, anorexia, bulimia), epilepsy, migraine headaches, multiple sclerosis, diabetes, hypothyroidism and Sjogren’s syndrome.

Evaluation for Smell and Taste Disorders

A physical examination may detect the cause for a taste or smell disorder. The nose and mouth is examined to look for evidence of infections, inflammations or other disorders. Tests to detect loss of smell include a “scratch-and-sniff” test. Laboratory and imaging studies such as a CT scan or MRI may be ordered to detect abnormalities of the nose, sinuses, mouth, brain and nervous system.

Treatments for Smell and Taste Disorders

Smell disorders may be successfully treated if there is blockage of the nasal passages from polyps, allergies or infections. Medications such as nasal sprays, decongestants and oral steroids may be helpful in improving the sense of smell. Improvement may be noted if one stops certain medications that are affecting one’s sense of smell or taste.

Quitting cigarette smoking will often lead to improvement in the sense of smell and taste. In general, if loss of smell is caused by head injury, the prognosis for recovery is poor. Most individuals that regain their sense of smell after head trauma do so within 12 weeks of injury.

Individuals with permanent loss of smell need to be aware of issues of personal hygiene (body odor), safety (smoke alarms, spoiled food), health and appetite. Improving the appearance and flavor of food with salt, spice, texture, temperature and color, is helpful in making eating more enjoyable.


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Sore Throats


A sore throat, or pharyngitis, is a common reason why people visit their doctors. It is not a disease but is more often a symptom of another illness. It can occur with a variety of viral and bacterial illnesses. Most sore throats are caused by viruses, as seen in the common cold and flu. A smaller number are caused by bacterial infections.

 

 

Viruses that can cause a sore throat include: the common cold virus, influenza, mononucleosis, and other childhood diseases.

Bacteria that can cause a sore throat include: Streptococcus (“Strep throat”), diphtheria, Mycoplasma, and some sexually transmitted diseases.

Other common causes of sore throat include: allergies, dryness, pollution/irritants, reflux of stomach acid (heartburn).

Some things you can do to help ease your sore throat: increase your fluid intake, gargle with warm salt water, use honey and lemon in warm water/tea, suck on throat lozenges, humidify the air, avoid smoke/pollutants, and rest your voice.

BACTERIAL VS. VIRAL INFECTIONS

Bacteria and viruses cause many common infections, many that are seen here in our office. Bacteria and viruses are not the same: bacteria can be found both inside and outside the human body whereas viruses are smaller than bacteria and cannot long survive outside the body’s cells.

Antibiotics are medications that are used to treat bacterial infections. They do not work for any infections caused by viruses. If you have a viral infection, antibiotics will not help cure your infection, make you feel better or prevent you from spreading your infection.

It is difficult to tell if an illness is caused by a virus or bacteria. But here are some guidelines regarding common illnesses.

  • Colds and flu – These are caused by viruses. Children and adults should consider being vaccinated with the influenza vaccine before the flu season starts.
  • Cough or bronchitis – Viruses almost always cause these but if you have a problem with breathing or the illness lasts a long time, bacteria may be the cause.
  • Sore throat – Most sore throats are caused by viruses, however, strep throat is caused by bacteria. A throat swab is usually needed before the doctor prescribes an antibiotic for strep throat.
  • Ear infections – There are many types of ear infections caused by either bacteria, a virus or fungus.
  • Sinus infections – A runny nose and discolored mucus does not necessarily mean you need an antibiotic. It is normal for mucus to become thick and change color during a course of a viral infection. After physical exam, which may include using a scope to see inside your nose, or culturing the discharge, the doctor may decide to use an antibiotic.

Antibiotics are important medications that kill bacteria or stop them from growing. Antibiotic resistance happens when bacteria adapt or change in ways that makes a specific antibiotic less able to do their job. These “resistant” bacteria survive and multiply, causing more harm. One could have a longer or more severe illness, leading to more doctor visits or need for treatment with a more expensive and powerful antibiotic. Over time, more and more bacteria are becoming resistant to some of the commonly used antibiotics. In turn, fewer antibiotics are able to treat common, severe and even rare illnesses caused by bacteria. In order for this not to happen, available antibiotics must be used appropriately.

To help avoid antibiotic resistant infections: don’t demand an antibiotic when your healthcare provider determines that one is not appropriate; when given an antibiotic, take it exactly as instructed; do not save any antibiotics for the next time you are sick and never take someone else’s antibiotic.

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