EAR CARE

John R. Bennett, MD
801-328-2522
1255 East 3900 South #301, Millcreek, Utah 84124
756 East 12200 South, Draper, Utah 84020 22 South 900 East, Salt Lake City, Utah 84102

Updated 7/4/17

EAR CARE

Generally speaking, the ears are designed to take care of themselves. Ear wax is only made in the outer 1/3 of the ear canal, and it naturally drifts outwards, where it dries and flakes at the opening to the ear. Q-tips should only be used at the openings of the ears, and in a circular motion. Never push the Q-tip deep into the ear canal, as this only pushes the wax deep, and the Q-tip becomes a ‘ramrod’. Do not allow bath water or shower water into the ears, as this irritates the ear lining. If the ear does become packed with wax, you can purchase ear wax softening drops, such as Debrox, to soften and partially dissolve the wax. Most kits also come with irrigation to flush out the ear after softening the wax. This may get rid of smaller particles of wax, but is unlikely to get rid of large cerumen impactions. When the ear gets plugged with wax, please make an appointment with us, and let us clean out the ear in the office. As we age, the wax gets thicker, and it is harder for the wax to come out on its own, especially for men who grow more hair in their ear canals as they age. Some people need to come in every year or so for ear cleaning.

Itchy ears are usually caused by fungal and bacterial growth in the ear canal, but can also sometimes be caused by allergies. White vinegar is a weak acid that, mixed 50:50 with water in an empty dropper bottle (available at drug stones), destroys most fungal and bacterial growth in the ears. Several drops of half-strength vinegar several times a day in the ears takes care of most itchy ears. If your ear is moist and itchy, mix vinegar 50:50 with rubbing alcohol. This will take care of the itch, and also dries out the ear. Hydrogen peroxide to dissolve wax can also be mixed with the vinegar and alcohol, giving you an inexpensive home-made treatment that gets rid of the itch, dries the ears, and dissolves wax.

Swimmer’s Ear is an infection of the ear canal. Although a moist ear is more likely to become infected, the main culprit in Swimmer’s Ear is actually Q-tips, which can rough up the delicate skin of the ear canal, and other attempts to scratch the ear canal. The ear canal skin is paper thin and right over bone, and even scratching with a Q-tip causes enough trauma to allow the fungus and bacteria normally in our ear canals to get under the skin of the ear canal, causing Swimmer’s Ear, also known as otitis externa. Caught early, the home-made drops of vinegar and alcohol may correct it, but people often need prescription antibiotic drops. The infection can get so swollen and painful, that sometimes a sponge wick needs to be placed in the ear canal for several days to allow the antibiotic drops to reach all the way in.

Another risk of putting Q-tips and bobby pins into the ear is that you may traumatize the ear drum, or even poke a hole right through the ear drum. This is of course exceedingly painful, and often occurs when someone is cleaning their ear with a Q-tip, and someone else opens the bathroom door and bumps into you, driving the Q-tip through the ear drum. This hole will sometime heal on its own, but we may have to perform a surgery to fix the perforation.

Eustachian tube dysfunction is common in early childhood, but can occur in adults, particularly with the onset of a cold or allergies. The Eustachian tube connects the back of the nose to the air-filled middle ear space, behind the ear drum. The Eustachian tube is normally closed, and the air in the middle ear space is slowly absorbed by the surrounding tissue. Within several hours, a vacuum forms in the middle ear, stretching and pulling in the ear drum. Most of the time, we subconsciously yawn when we feel this. The yawn tugs on the muscles of the Eustachian tube, allowing air to rush back up the Eustachian tube, giving a gentle pop. We do this every several hours our entire life, and most of us don’t even realize we are doing it. If the Eustachian tube becomes blocked with a cold, hay fever, etc., a simple yawn may not open the ear. In this situation, we should perform a valsalva: close the mouth, pinch the nose, and puff the cheeks out. If the ears still don’t pop, continue puffing the cheeks out, but jut out the chin, and wriggle the jaw side-to-side. Keep trying. Consider over-the-counter nasal sprays such as Afrin, Sudafed pills, and nasal steroid sprays (Nasacort, Rhinocort, Flonase) to decongest the nose and the Eustachian tubes. Try again to pop the ears. If you are unable to pop the ears for several days, then fluid can collect behind the ear drum, and bacteria could grow in this, causing a painful middle ear infection, or otitis media. At this point you will need to go see your doctor.

Please wear hearing protection around loud noises such as concerts, mowing the lawn, and other machinery. If you are around very loud noises such as gun fire, consider using double protection, with ear plugs AND ear muffs. Even a single loud noise close to the ears can cause permanent hearing loss. Once you have lost some of your hearing, it is gone forever. The noise damage is cumulative, and often the effects are not seen until many years later. Protect your hearing, as you will need your ears for the rest of your life!

The first range of hearing loss that most people experience is the high frequency, where the consonant sounds of ‘th,’ ‘f,’ ‘s,’ and ‘k’ are. Most people’s first realization of their hearing loss is in a loud restaurant, and the consonant sounds of the person across the table are washed out by the background noise. You often will still hear the vowel sounds, and it will sound like the other person is mumbling. Please schedule a hearing test if you have noticed hearing loss when there is lots of background noise. We recommend a baseline hearing test at the age of 50.

People with hearing loss, who do not get hearing aids, find they often stop going to social events they used to enjoy, as it is too frustrating for them and the people around them. This leads to loneliness and depression. Recent evidence from Johns Hopkins also shows that people with uncorrected hearing loss are more likely to suffer from dementia, probably from decreased brain stimulation of conversation. The nerve of hearing is a “use it or lose it” nerve, meaning if you wait a long time to get hearing aids, you may lose some of the hearing pathways in the brain that allow you to understand speech. In this case, you might get hearing aids that are turned up high enough to hear the words, but the brain may have lost the ability to understand what you are hearing. Hearing aids would then be much less satisfying. Do not delay getting hearing aids when you need them. When your family says you need hearing aids, they are usually right! Hearing aids are constantly getting better and better. The hearing aids of today are dramatically better than the hearing aids of 5-10 years ago. Our Audiologists have better selection, service, and prices of hearing aids than anyone else in town, work closely with our Physicians, and they will let you try out the hearing aids for a month for free.

When you lose hearing, the brain replaces the missing sound with a ringing or buzzing noise, called tinnitus. Tinnitus does not cause hearing loss. Hearing loss often causes the phantom signal or noise of tinnitus. Many medicines can cause tinnitus, especially Aspirin and other anti-inflammatories. Nicotine and caffeine also can cause tinnitus. Anyone with tinnitus should have a hearing test. The vast majority of tinnitus is completely benign, but some tinnitus can be a sign of a more serious problem, especially one sided tinnitus, rapidly worsening tinnitus, tinnitus with dizziness or any other nerve change, or the sound of your heart beating or fluid pulsing through the ear. These require a careful work up by your Physician. Tinnitus is best dealt with by avoiding complete silence, especially when trying to go to sleep at night. Having the soft noise of a fan, or an alarm clock set to ‘ocean waves’ or ‘mountain stream’ can be quite helpful. There are a number of herbal and vitamin therapies available on line, but these have not been proven to be very helpful, and most tinnitus tends to come and go over time, anyhow. Melatonin and antidepressants have been shown to help people with tinnitus fall asleep better, but their side effects prevent most people from staying on them. Tinnitus training devices or ‘masking’ devices can be built into a hearing aid, or can be purchased from our Audiologists separately. There are also ‘apps’ on smart phones that train you not to notice the tinnitus as much.

Please call Dr. Bennett at 801-328-2522 if you have any questions, problems, or concerns.

SINUSITIS

John R. Bennett, MD
801-328-2522
1255 East 3900 South #301, Millcreek, Utah 84124
756 East 12200 South, Draper, Utah 84020 22 South 900 East, Salt Lake City, Utah 84102

Updated 7/4/17

SINUSITIS

Symptoms of sinusitis are sinus pressure, nasal congestion, thick discolored drainage anteriorly, and thick post-nasal drip. There is often a cough at night when the post-nasal drip is worse as you lay flat. Fevers typically are low, if any. Sinusitis generally isn’t very painful, but it may trigger a painful headache. Sinusitis feels a lot like a viral cold, but lasts longer. Our immune systems can usually get rid of a cold in a week or so, but the viral cold may trigger a bacterial infection. Any “cold” that lasts more than 7-10 days is probably a bacterial sinus infection. Anything that causes swelling in the nose may pinch off the sinus openings, causing the sinuses to fill with fluid and leading to infection. Viral colds, allergies, air irritants, and smoking are common irritants that trigger sinusitis. Our sinuses constantly secrete mucus, which drips down the back of our noses, cleaning our nasal passages and lubricating our throats. When this mucus gets stuck in our sinuses it quickly becomes a great place for bacteria to grow. Sinusitis is treated by first facilitating drainage, and second, sterilization with antibiotics if improved drainage isn’t enough to return the sinuses to good health.

When the nose becomes congested and the sinuses become blocked, conservative measures can often get the sinuses draining, and sinusitis can be avoided. Two things have clearly been shown to get the sinuses draining again- nasal steroid sprays and salt water irrigations (flushes). Nasal steroid sprays such as Flonase (fluticasone), Nasacort (triamcinolone), and Rhinocort (budesonide) are available over-the-counter. These should be used daily, but they take several days to build up and become effective. They may be used for weeks, months, and possibly years, but will ultimately dry out the nose, cause nosebleeds, and may even contribute to cataract formation in the eyes over many years. Although fluticasone (Flonase) is the most popular and widely advertised of the three steroid sprays, it is the only one that is alcohol based, and it tends to dry out the nose more than the other two (especially here in Utah with our high dry desert air). Nasal flushes like Neti pot and Neil-med saline nasal rinses decongest the nose while physically removing debris from the nose, and do a great job getting the sinuses to drain. They should be used twice a day when the sinuses are symptomatic. They are squirted up each side of the nose, and they drain out the opposite side of the nose and also out of the mouth. Nasal rinses usually take several tries before you get used to them!

The following medications have not been clearly shown to help sinusitis despite many studies, so at best these are all optional. Over-the-counter nasal decongestants like Afrin and Neosynephrine work immediately and can be used several times a day but must be stopped after three days as they diminish blood flow in the nasal lining, damage the nasal lining after 3-5 days of use, cause rebound congestion when stopped, and can even cause a hole to form in the septum. Nasal saline mist spray every several hours (while awake) naturally decongests the nose, keeps the nose healthy and moist, and allows debris to drain out. Mucinex (guaifenesin) is an over-the-counter pill that thins mucus, allowing the sinuses to drain easier. Mucinex-D has Sudafed to also decongest, but as this keeps most people awake at night, consider using Mucinex-D in the morning, and plain Mucinex at night. Sudafed should be avoided by those with high blood pressure, heart rhythm irregularities, enlarged prostates, and people who don’t tolerate the feeling of anxiety that Sudafed can cause. Antihistamines should be avoided as they dry out and thicken the nasal mucus, which make it harder for our sinuses to drain. If allergies are suspected, an allergy test and treatment can be very helpful.

The first goal in helping our sinuses is to get them to drain, which is what the conservative measures do. If symptoms persist beyond 7-10 days, then you may need antibiotics. If you haven’t had any antibiotics for 6 months, you may do well with just high-dose Amoxicillin (for adults, 2000 mg twice a day for 5-10 days), but often more aggressive antibiotics are needed, such as high-dose Augmentin (Amoxicillin plus Clavulanic acid, 875 mg, PLUS another 1000mg of Amoxicillin twice a day) or Levaquin. A number of other antibiotics are often employed. A five-ten day course of antibiotics may be inadequate for curing sinusitis, so refills may be necessary. If no improvement is noticed, it may be wise to get a sinus CT. Some apparent sinusitis can actually be something else, such as a migraine or tension headache, allergic rhinitis, or even a deviated nasal septum pushing into the lateral nasal wall causing constant congestion, irritation, and drainage.

Chronic sinusitis is sinusitis that lasts more than three months. A sinus infection resistant to multiple antibiotics, or someone who has recurrent sinusitis (such as three bad episodes a year for three years, five episodes a year for two years) may need to consider sinus surgery. Endoscopic sinus surgery is performed through the nostrils. The natural sinus openings are enlarged to facilitate nasal drainage, making it harder for the sinuses to block off and get infected, and easier for nasal medications to penetrate into the sinuses. Someone who has had sinus surgery can use medicated rinses to put antibiotics and steroids directly into the sinuses, avoiding antibiotic and steroid pills, and their side effects. Sinus openings may scar down after surgery, requiring a revision surgery. Image guided sinus surgery allows the surgeon to see exactly where the instruments are during surgery, making the surgery safer, as sinus surgery is performed between the eyes and below the brain. Balloon sinuplasty uses catheters with balloons to safely enlarge sinus openings in certain situations, either in the clinic or in the OR.

The conservative measures described earlier will often stop sinusitis from getting started or from worsening, and should be regularly used by those with chronic and recurrent sinusitis.

Please call Dr. Bennett at 801-328-2522 if you have any questions, problems, or concerns.

Temporomandibular Joint (TMJ) Disorder

John R. Bennett, MD
801-328-2522
1255 East 3900 South #301, Millcreek, Utah 84124
756 East 12200 South, Draper, Utah 84020 22 South 900 East, Salt Lake City, Utah 84102

Updated 7/4/17

Temporomandibular Joint (TMJ) Disorder

The TMJ, or jaw joints, become easily inflamed when over-used, typically from clenching one’s teeth when stressed, and grinding teeth while asleep. As the nerve to the jaw joints is the same nerve as to the ear, jaw pain and ear pain can become virtually indistinguishable. TMJ pain radiates into the ear, down the jaw and neck, and up into the scalp. There is often grinding and popping in the joints, or one or both joints can become less mobile as the individual protects the joint, often unconsciously. There is pain with yawning and chewing. Stress can often trigger the pain, or it can become chronic.

The first step to stopping the pain is stopping the contact of the teeth. The teeth should never touch unless you are chewing, and the teeth should just barely come together while chewing. To break the habit, you must start paying attention to the teeth. I recommend a quick mental check every hour to see if the teeth are touching, and teach yourself to relax the jaw, even as the lips are kept together. When you are feeling stress, check and see if the teeth are touching. It may take months to break the habit, but it is a habit that can be overcome. The lips should be closed, but the teeth should never touch.

While breaking the clenching habit, a soft diet should be used. No hard breads, no hard vegetables, no hard meats, and no gum. Eat only soft foods. Warm soaks to the area of the jaw joint, and massaging the surrounding muscles is helpful. Anti-inflammatories such as Motrin are helpful. Prescription muscle relaxants such as Flexeril help some people, but as they make most people very sleepy, they usually are only helpful at bedtime. Getting help for stress and anxiety often prove very helpful. Working with a Physical Therapist is very helpful.

If you wake up with ear/jaw pain, or your spouse has noticed you grinding your teeth at night, the only thing that helps this is a bite block. Cheap ones can be purchased at all drug stores. They tend to be bulky, but if they work for you, that may be all you need. Dentists and Oral Surgeons can also make a much nicer form-fitted bite block, but these can get expensive.

If these measures do not help you, and other causes of the pain have been ruled out, then a referral to an Oral Surgeon or Dentist who treats TMJ dysfunction is the next step.

Remember: the teeth should never touch! Please call Dr. Bennett at 801-328-2522 if you have any questions, problems, or concerns.

Laryngopharyngeal Reflux Disease

Laryngopharyngeal Reflux Disease

and Recommendations to Prevent Acid Reflux

Updated 7/4/17

What is Reflux?

When we eat something, the food reaches the stomach by traveling down the muscular tube called the esophagus. Once food reaches the stomach, the stomach adds acid and pepsin (a digestive enzyme) so that the food can be digested. The esophagus has two sphincters (bands of muscle fiber that close off the tube) that help keep the contents of the stomach where they belong. One sphincter is at the top of the esophagus (at the junction with the upper throat) and one is at the bottom of the esophagus (the junction with the stomach). The term REFLUX means “a backward return of flow”, and refers to the backward flow of stomach contents up through the sphincters and into the esophagus or throat.

What is GERD and what is LPRD?

Some people have an abnormal amount of reflux of stomach acid up through the lower sphincter and into the esophagus. This is referred to as GERD or Gastroesophageal Reflux Disease. If the reflux makes it all the way up through the upper sphincter and into the back of the throat it is called LPRD or Laryngopharyngeal Reflux Disease. The structures in the throat (pharynx, larynx, and trachea) are much more sensitive to stomach acid and digestive enzymes, so small amounts of reflux into the area can result in more damage.

Why Don’t I have heartburn of stomach problems?

This is a question that is often asked by people with LPRD. The fact is that only one third of patients with LPRD experience significant heartburn. Heartburn occurs when the tissue in the esophagus becomes irritated. Most of the reflux events that can cause damage happen without the patient ever knowing that they are occurring, and is called ‘silent’ reflux.

Common Symptoms of LPRD:

  • Hoarseness
  • Chronic (ongoing) cough
  • Frequent throat clearing
  • Burning, pain or sensation in the throat
  • Lump in the throat feeling
  • Problems while swallowing
  • Bad/bitter taste in mouth
  • Dry throat
  • Asthma-like symptoms
  • Referred ear pain
  • Post nasal drip
  • Singing: Difficulty with high notes, difficulty with soft notes, delayed onsets or decreased clarity.

Diagnosis of LPRD:

The following signs seen by the patient are strong indicators of LPRD

  • Swollen, red, irritated arytenoids (structures at the back of the vocal cords)
  • Red, irritated vocal cords
  • Small laryngeal ulcers
  • Swelling of the vocal cords
  • Granulomas in the voice box
  • Evidence of hiatal hernia (may or may not be associated with reflux).
  • Significant laryngeal pathology of any type.

Testing for LPRD:

Esophageal endoscopy, Barium Esophagram, and a 24 hour pH probe monitoring are some of the tests that may be used to evaluate for LPRD. However, the reflux does not always show up in these tests, but is present enough to irritate the voice or throat. Often, a 3-6 month trial of a reflux medication, along with the following behavioral strategies, is the best test for LPRD.

Behavioral Strategies:

  1. Stress: Take significant steps to reduce your stress! Make time in your schedule to do activities that lower your stress level. Even moderate stress can dramatically increase the amount of reflux.
  2. Smoking: If you smoke, STOP! This dramatically causes reflux and many other damaging effects to your body.
  3. Tight Clothing: Avoid tight belts and other restrictive clothing.
  4. Body Weight: Being over weight can dramatically increase reflux. Try to maintain a healthy body weight.
  5. Exercise: Exercise regularly. However, avoid exercising immediately after eating. Do not lift heavy things after eating. Sit-ups and abdominal crunches can put pressure on your lower esophageal sphincter and worsen reflux.
  6. Nighttime Reflux: Recent studies have shown that LPRD often occurs during the day. However, if you experience some of your symptoms more in the morning, you may be having some reflux at night. Do not prop the body up with extra pillows. This may increase the reflux by kinking the stomach. Do elevate the head of your bed 4-6 inches with books, bricks, or boards to achieve a 10 degree slant. Or, purchase a foam wedge that is made specifically for this purpose. Your entire torso must be elevated from the hips up.
  7. Foods: You should pay close attention to how your system reacts to various foods. Each person will discover which foods cause an increase in reflux. The following foods have been shown to cause reflux in many people. It may be necessary to avoid of minimize some of the following foods.
    1. Spicy, acidic and tomato-based foods like Mexican or Italian food.
    2. Acidic fruit juices such as orange juice, grapefruit juice, cranberry juice etc..
    3. Fast foods and other high fat foods, especially fried foods.
    4. Caffeinated beverages (coffee, tea, soft drinks) and chocolate.
    5. Alcohol, peppermint, nuts.
    6. Carbonated beverages.
    7. Limit dairy product consumption, especially late at night. Dairy products digest slowly, which encourages acid reflux.
  8. Mealtime:
    1. Don’t gorge yourself at mealtime.
    2. Eat sensibly (moderate amount of foods)
    3. Eat meals three hours before bedtime
    4. Avoid bedtime snacks
    5. Drink at least 8 ounces of water each day, but do not drink too much before bedtime
    6. If you do eat a spicy meal, don’t have alcohol or caffeine with it. Instead, drink water.
    7. Learn to moderate the foods that may cause reflux. You don’t have to give up ice cream forever, but if you have heartburn when you eat it, don’t have a bowl of ice cream just before you go to bed. Learn what your body can and cannot handle.

Medications for LDRP:

  1. Take one dose (as recommended on the label) at meals and at bedtime of and over the counter antacid such as Tums or Mylanta. Tums has the added benefit of containing calcium.
  2. Medications such as H2 Blockers (Axid, Pepcid, Tagamet, Zantac), and Proton pump inhibitors (Prilosec [omeprazole], Prevacid, Aciphex, Protonix, or Nexium) may be prescribed or recommended by your physician. These medicines are usually taken for at least several weeks at a time, and often several months. If you need to take these medicines for longer periods of time, you will be referred to a Gastroenterologist. Prolonged use of reflux medicines has been linked to pneumonia, diarrhea with C. difficile bacteria, increased risks of fractures, and low levels of calcium, Vit B12, and magnesium.

Ear Nose and Throat Surgery Center Testimonials

Having surgery is stressful. We understand you may be nervous about an upcoming procedure and we want you to know that the entire team at the Ear, Nose and Throat Surgery Center is committed to ensuring your comfort and a successful outcome.

Our patients rave about the quality of care and compassion at the surgery center and we’re pleased to share their testimonials about the center and our team.

Our Doctors

  • Dr. Dahl is amazing! He was great at answering all my questions even after surgery and on a Sunday night!
  • Dr. Johnson and Dr. Sharma are amazing. So happy I had them to do my anesthesia and surgery.
  • Dr. Bennett is the BEST!
  • Every person there was extremely caring and kind. Everything was wonderful. Dr. Tagge did an amazing job and recovery went perfect. I was so impressed with the entire experience.

Our Staff

  • It was convenient, easy, and the staff was friendly.
  • Very attentive + friendly staff. They seemed genuinely interested in us and helpful at every step.
  • Staff was cheerful and upbeat. The nurse in the operating room helped me relax by chatting with me before anesthesia took effect. The recovery nurse was kind and patient. I enjoyed working with all of you.
  • Pam is excellent. Michelle is amazing. The Recovery Nurse was too sweet for words!
  • Very friendly. Staff worked hard to help me get my tonsils out on short notice.

Our Personal Approach

  • The thing I most liked about the facility was the kindness they showed my son as he was waking up. They were very patient to let him get readjusted. I was pleased with the entire staff and I don’t think it could have gone any better.
  • The thing I liked most about the facility is the size—small and intimate. Everyone was sweet and friendly and positive and informative.
  • Amazing staff! The fact that the nurses sang “Twinkle Twinkle Little Star” to my son to soothe him touched me.
  • Everyone was so sweet and caring to our baby.
  • They were all friendly, caring and professional.

Our Clean, Professional Surgery Center

  • Very professional in every way. Everyone is just great. All medical practices should run this way.
  • Facility was clean. Staff was friendly and efficient.
  • Good service, organized, efficient, well run by sharp people.
  • Efficient, helpful, kind and a great facility. Everyone was extremely caring, patient and knowledgeable. Thank you.

Regular, Ongoing Communication

  • What I liked best was the friendliness, privacy and thorough explanations. The prep nurses were awesome- very caring and the anesthesiologist was very warm and confident, as well as the doctor.
  • Everyone was very communicative, answered questions and showed concern for the patient. Everyone was great. Pam was exceptionally friendly and helped put our daughter at ease.
  • They are great with kids and explain everything in detail that we need to know.
  • They were great to answer all our questions.