Condition – Head & Neck Disorders
There are multiple issues that can occur within the glands, soft tissue structures, and cavities of the head and neck. These disorders can range from common infections and injuries to more serious conditions such as cancer and airway obstruction. The physicians at CornerStone Ear, Nose & Throat can help evaluate and treat the multiple and varied problems and conditions that can arise in this area of the body.

Head and Neck Cancer

The majority (about 90 percent) of head and neck cancers are due to long-term exposure to well-known risk factors such as tobacco, alcohol and sunlight. Most cancers of the mouth, tongue, throat and voice box are caused by tobacco use (cigarettes, cigars, chewing tobacco and snuff) and consumption of excessive amounts of alcohol. Throat cancer can also result from the human papilloma virus (HPV), while ongoing exposure to sunlight is directly linked to cancer of the skin and lip.

Head and neck cancers can usually be successfully treated and in most cases cured if caught in the early stages. Thus, recognizing the signs of head and neck cancer and immediately bringing them to the attention of an otolaryngologist (ENT doctor) can save your life.

Signs Of Head And Neck Cancer

The symptoms listed below can be related to head and neck cancer. These symptoms can also occur when no cancer is present. The only way to know the difference is to be examined by an otolaryngologist.

A lump in the neck – A lump that lasts more than two weeks should prompt a patient to be seen by a physician. It could be an early sign of mouth, throat, voice box, thyroid gland or blood cancer. These lumps are usually painless and will continue to increase in size. Many benign lumps can also exist in the neck and can persist well beyond two weeks. These lumps typically are due to benign growths, cysts and reactive lymph nodes. Otolaryngologists are the best-trained physicians to evaluate, diagnose and treat any mass or lump in the head and neck area.

Voice changes – If you are hoarse or have changes in your voice that last for more than a month, it is important to see an ENT doctor.

Sore in the mouth – A sore or swelling in the mouth or on the tongue that does not go away after two weeks should be examined by a physician. A sore accompanied by a lump in the neck should also be cause for immediate concern, especially if there are known risk factors for cancer.

Bleeding in the mouth – There are many causes for blood in the mouth other than cancer. But if you have blood in your saliva for more than a few days, consult a physician.

Problems swallowing – Difficulty swallowing food or liquids could be a sign of cancer in the throat or esophagus. Examination by an ENT physician is definitely recommended if you have continual problems swallowing.

Constant earache – Referred pain in or around the ear when swallowing can be caused by a tumor in the throat, especially if there is also difficulty swallowing, hoarseness or a lump in the neck. This combination is cause for examination by a physician.

Patches on the skin – If you have had extensive sun exposure, it’s important to watch for changes in your skin. Basal cell cancers, the most common type of head and neck cancer, usually begin as a small, pale patch on the skin. The basal cell cancer then continues to enlarge, creating a dimple in the center. Sometimes there is a change in color. Squamous cell cancers look similar to basal cell cancers, but more often appear on the lip or ear. Malignant melanoma creates a blue or black patch on the skin, much like an irregular-appearing mole. Any blue-black or black spot on the skin that changes size or shape, or any mole that changes size, shape or color or begins to bleed, should be examined by a physician.

Treatment For Head And Neck Cancer

The primary treatment options for head and neck cancer include surgery, radiation therapy, chemotherapy and targeted therapy. The recommended treatment plan will depend on the specific type and stage of cancer, the patient’s overall state of health, and potential side effects of treatment. Prior to treatment, all cancers must be diagnosed specifically by biopsy, and the patient must then be “staged” to determine the extent of the spread of the cancer. Staging typically involves CT scans or CT/PET scans and is painless for the patient in most cases.

Bell’s Palsy

Although this condition is rare, Bell’s Palsy is the most common type of facial nerve disorder. This condition occurs when the facial nerve on one side of the face is damaged due to pressure or swelling. The result is paralysis that makes the face appear to be sagging or have a frozen expression. The onset of this paralysis can be very sudden, with some patients surprised to see that one side of their face has changed. For others, the onset can take several days to gradually develop.

It’s important to see a physician as soon as possible when you notice the symptoms of Bell’s Palsy or have any kind of facial paralysis. Conditions such as stroke, certain tumors, Lyme disease, infection, injury/trauma or other disorders could be causing the paralysis. Bell’s Palsy is by definition a diagnosis of exclusion, which means all other potential causes must be ruled out before the diagnosis can be confirmed. This can readily be done by an otolaryngologist. Unfortunately, some patients and even physicians may assume that a particular case of facial paralysis is due to Bell’s Palsy, only to later find out that a cancer was the cause and that treatment was unnecessarily delayed, or that a more serious condition such as herpes zoster oticus is to blame and permanent damage was unnecessarily incurred.

There is no known cause for Bell’s palsy or specific steps you can take to avoid it. The condition occurs in both males and females, most often between the ages of 15 and 45. Those who are pregnant, have severe preeclampsia, are obese, or have high blood pressure, diabetes or upper respiratory ailments are at greatest risk for Bell’s palsy.

Symptoms Of Bell’s Palsy

  • Paralysis (total immobility due to nerve dysfunction) or paresis (weakness) and distortions of the face on one side only (sagging, frozen expressions, frowns, droopiness)
  • Facial “numbness”
  • Drooling
  • Pain around the ear on the same side as the weakness
  • Loss of the sense of taste
  • Eyelid that does not fully close
  • Feeling of heaviness in the affected half of the face

Treatment Of And Recovery From Bell’s Palsy

It is important to be evaluated and diagnosed by a physician if you experience Bell’s Palsy symptoms. While some patients will recover from Bell’s Palsy without treatment, others benefit from a prescribed oral steroid or a combination of oral steroids. Experimental treatments, including electronic nerve stimulation and hyperbaric therapy, have also been used with mixed success.

Most patients partially or fully recover from Bell’s Palsy, but recovery time and the severity of the symptoms can vary. Some patients get better in a few weeks or months. Others may have long-term paralysis. Others may recover full movement of the face but develop synkinesis of the facial muscles, a condition where the muscles on one side of the face move at the same time due to the healing process crossing up the nerve paths. Because this condition affects a person’s appearance, people with Bell’s Palsy often start avoiding social situations and begin to isolate themselves. Counseling and support groups can often be very helpful for these patients.

Thyroid Disorders

Disorders of the thyroid gland affect millions of Americans each year. This gland is located in the middle of the lower neck. It sits below the larynx (voice box) and wraps around the front half of the trachea (windpipe). The thyroid is an endocrine gland. It makes hormones that regulate physiological functions in your body such as heart rate, sweating and energy consumption.

Types Of Thyroid Disorders

Hyperthyroidism

Patients with an overactive thyroid gland have a condition know as hyperthyroidism. Treatment for hyperthyroidism includes medication to block the effects of excessive thyroid hormone, radioactive iodine to destroy the thyroid gland and surgical removal of the thyroid gland. Symptoms of hyperthyroidism include:

  • Weight loss
  • Increased heart rate and high blood pressure
  • More frequent bowel movements
  • Muscle weakness
  • Lighter or shorter menstrual periods

Hypothyroidism

Patients with an underactive thyroid gland have hypothyroidism. Typical treatment for hypothyroidism includes the use of hormone replacement pills. Symptoms of hypothyroidism include:

  • Lethargy
  • Depression
  • Reduced heart rate
  • Tingling or numbness in the hands
  • Constipation
  • Heavier menstrual periods
  • Dry skin

Goiter

An enlarged thyroid gland that creates a visible lump is called a goiter. These lumps can be cancerous but more commonly are just a benign enlargement of the gland. To determine the best treatment approach, an ultrasound (or in some cases a CT or MRI) is needed to determine the size and location of nodule(s) in the gland. A fine-needle aspiration of cells from any suspicious nodule can help determine whether the goiter is benign or malignant. If the mass is cancerous or is large enough to compress the patient’s windpipe or esophagus, surgery may be necessary. While most medical thyroid problems are well managed by a primary care physician or an endocrinologist, lumps, nodules or tumors of the thyroid gland should be evaluated by an otolaryngologist or endocrine surgeon.

TMJ Pain

The condition of “TMJ” refers to disorders in the temporomandibular joint. When this joint is damaged, the pain can be unrelenting and hard to diagnose. Patients who suffer from TMJ often experience intense, dull pain deep in the ear or on the side of the head, the cheek, the lower jaw and the teeth, which may worsen when they swallow, yawn, talk or chew. For some patients, TMJ results in a dull and constant pain.

Common Causes Of TMJ Damage

  • Major and minor trauma to the jaw
  • Teeth grinding
  • Excessive gum chewing or other repetitive movements of the jaw
  • Stress
  • Improper occlusion of the teeth
  • Other arthritis conditions
  • Poor dentition (teeth in poor health)

Symptoms Of TMJ

Ear pain is often the first symptom of TMJ. It is not uncommon for patients with TMJ to think that they have an ear infection. The ENT physicians at CornerStone Ear, Nose & Throat can perform a physical examination to determine the exact cause of the ear pain. When the eardrum looks normal, our doctors then consider the possibility that the pain comes from TMJ or other conditions. Unfortunately, due to its proximity to the temporomandibular joint, the eardrum may become inflamed, suggesting to a doctor the presence of infection. If you suffer from the following symptoms and other treatments such as antibiotics have not helped, see an otolaryngologist for an evaluation:

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

Treatment Of TMJ Pain

The otolaryngologists (ENT doctors) at CornerStone Ear, Nose & Throat are uniquely qualified to diagnose TMJ problems. If TMJ problems are diagnosed early, patients often respond to simple self-remedies such as resting the muscles and joints by eating soft food, avoiding chewing gum, avoiding clenching the teeth and tensing facial muscles, and relaxing muscles with moist heat. If these initial treatments prove ineffective or if the condition is more severe, other treatment options may be needed, including:

  • Relaxation techniques and stress reduction
  • Nonsteroidal anti-inflammatory drugs
  • Muscle relaxants
  • An occlusal splint (to prevent wear and tear on the joint)
  • Surgery
  • Inserts in the ear to provide back pressure to the joint