Ear, Nose and Throat (ENT)

Common ear, nose, and throat conditions:


Signs and symptoms:
Include ear and throat pain, difficulty chewing/swallowing, ear drainage/bleeding and swelling, hearing loss, ringing, dizziness. Patients may complain of congestion or fullness in the ear and of hearing themselves talk more loudly than normal (autophony).
+ Causes:

  • Infection or trauma of the outer ear
  • Infection in the ear canal (otitis externa)
  • Infection in the middle ear, behind the eardrum (otitis media)
  • Referred pain from the jaw joint (bite problems, TMJ). Referred pain from the tonsils or throat (infection or cancer)
  • Barotrauma (air flight or scuba diving)

Treatment options:
Depending on the cause, treatment can include oral antibiotics, eardrops, pain management and occasionally surgery.


Conductive Hearing Loss:

+ Signs and symptoms:
Patients notice an impaired ability to hear voices or localize sound. Depending on the cause, drainage, pain and fullness of the ear may be present. Ringing in 1 or both ears may be high pitched or pulsatile (beating).

+ Causes:

  • Blocked ear canal from foreign body or wax
  • Fluid in the middle ear
  • Perforation of the eardrum
  • Problems with the bones of the middle ear
  • Blocked Eustachian tube

+ Treatment:
Simple removal of wax or foreign body may relieve the loss or treatment may require antibiotics, ear drops/ nasal sprays or surgery to repair the eardrum or middle ear bones.

Sensorineural Hearing Loss:

+ Signs and symptoms:
Patterns of hearing loss can be in one or both ears and the onset may be progressive or sudden. It may be associated with ringing, dizziness, or facial weakness.

+ Causes:

  • Presbyacusis (loss with age)
  • Noise induced
  • Drug induced
  • Genetic
  • Infectious/ Viral/ Syphilis
  • Meniere’s disease
  • Acoustic neuroma (tumor on the hearing/balance nerve)

+ Diagnosis & Treatment:
A hearing test is conducted to help determine the type of loss. Imaging or blood tests may be indicated as well. The treatment is based on the type and cause of the hearing loss. Amplification with the use of hearing aids or cochlear implants are very effective in certain types of hearing losses.


+ Signs and symptoms:
Vertigo is an illusion of movement. Patients may describe the sensation of the room spinning or an imbalance. The most common causes of vertigo stemming from the balance center in the ear are Meniere’s disease, benign paroxysmal positional vertigo (BPV) and interruption of the blood supply to the balance center causing failure. Associated symptoms of Meniere’s may include hearing loss, ringing and a pressure sensation in the ear. Vertigo with BPV is provoked by movement of the head, such as turning in bed or looking upwards.
+ Causes:

  • Peripheral disorders (problem with the balance center in the ear)
  • Central disorders (problem in the brain)
  • External influences (drugs, anemia, infection, low blood pressure or low sugar)

+ Diagnosis & Treatment:
The patient is assessed for the various causes of dizziness. Positional testing may help to determine if the balance center is involved. Meniere’s disease may be treated with medication or surgery and BPV symptoms may be improved with repositioning maneuvers.


+ Signs and symptoms:
Weakness of 1 or many muscles on 1 side of the face during voluntary and involuntary (emotional) movement occurs with injury to the facial nerve. Associated findings include a change in tear production, taste and hearing.

+ Causes:

  • Bell’s Palsy
  • Parotid tumor
  • Intracranial tumor/infection/infarct/trauma
  • Ear infection (bacterial, herpes, mono, Lyme disease)
  • Sarcoidosis

+ Diagnosis and Treatment:
A thorough exam of the face, ears and neurological system is necessary to determine the cause of the weakness. Imaging (CT scans or MRIs) or neurological testing may be indicated. Treatment is based on the cause of the lesion that may include antibiotics, antivirals, steroids or surgery.


+ Signs and symptoms:
Viral, bacterial or fungal infections in the throat can present with a fever, sore throat, difficulty swallowing, drooling and ear pain. The glands in the neck are commonly swollen and tender. The tonsils and back of the throat may appear enlarged, red and have the appearance of having pus in the area.

+ Causes:

  • Tonsillitis
  • Pharyngitis
  • Laryngitis
  • Abscess of the pharynx or tonsils
  • Enlarged neck glands/ neck masses

+ Diagnosis and Treatment:

Examination of the throat delineates the location and severity of the problem. A culture or imaging can be obtained to determine the type of infection and medication can commonly be used for treatment. If the infection spreads, surgery may be indicated.


+ Signs and symptoms:
Patients may experience voice changes, swallowing and breathing difficulties, cough, sore throats, runny nose and weight loss.

+ Causes:

  • Laryngitis from infection/trauma
  • Swelling of the vocal cords (infection/ tumor/post-nasal drip/reflux)
  • Neurologic disorders
  • Airway foreign bodies

+ Diagnosis and Treatment:
Examination of the vocal cords is performed with a variety of techniques including using a mirror, a camera or X-Rays. The treatment is based on the cause, which may include medications for post-nasal drip or reflux disease or antibiotics. Smoking cessation or voice rest may also help the condition. Surgery may be needed for removal of lesions on the vocal cords. If the condition progresses and worsens, emergency surgery may be necessary.


+ Signs and symptoms:
Difficulty swallowing can be caused from a wide variety of problems and the severity will determine the extent of the symptoms. If the difficulty progresses, patients may experience pain, weight loss, drooling or swollen glands in the neck.

+ Causes:

  • Neuromuscular disorders
  • Head and neck cancer
  • Foreign bodies
  • Pharyngeal pouches or strictures
  • Gastroesophageal reflux disease

+ Diagnosis and Treatment:
The history and examination will help determine the cause of the problem. Imaging with the use of CT scans or MRI’s are commonly used. Treatment will be based on the cause and may include medication or surgery.


+ Signs and symptoms:
Difficulty breathing through the nose with inspiration, runny nose, post-nasal drip, difficulty with smell, snoring, facial pressure or pain, cough, headache, excessive daytime sleepiness.
+ Causes:

  • Vasomotor rhinitis (allergic)
  • Nasal polyps
  • Deviated nasal septum
  • Enlarged turbinates
  • Sinusitis
  • Nasal tumor
  • Drug induced (nasal decongestant spray, cocaine use)
  • Obstructive sleep apnea

+ Diagnosis and Treatment:
History and examination of the nose and commonly imaging of the sinuses is necessary to provide information to make a diagnosis for patient presenting with these symptoms. Treatment is based on the problem and includes decongestants, antihistamines, antibiotics, steroids and surgery.


+ Signs and symptoms:
Occasional or frequent bleeding from the nose, nasal obstruction, pain, bruising, coughing.

+ Causes:

  • Dry nose
  • Trauma
  • Drug induced (blood thinners)
  • Spontaneous
  • Foreign bodies
  • High blood pressure

+ Diagnosis and Treatment:
Treatment is based on the cause of the nosebleed, which may stop with pressure or require medical intervention with packs or surgery.


Nasal fracture, 
Mandible fracture (jaw), 
Orbital fracture (bones around the eyes), 
Frontal bone fracture (forehead), 
Midface fracture (cheek bones) 
Facial lacerations (eyelids, nose, lips, cheeks, ears, neck) 
Foreign body in the ear, 
Inhaled foreign bodies, 
Swallowed foreign bodies
+ Diagnosis and Treatment:
Examination and Imaging with X-rays, CT scans or MRIs are used to determine the extent of the problems. Surgery is commonly needed to repair fractures or remove foreign bodies.

Schedule your consultation with Dr. John Rachel, a board certified otolaryngologist.

American Board of Cosmetic Surgery FACS American Board of Facial Plastic and Reconstructive Surgery Alpha Omega Alpha Accreditation Association for Ambulatory Health Care American Board of Otolaryngology Phi Beta Kappa American Academy of Facial Plastic Surgery