Ear Nose Throat | Mount Sinai Today

Can Balloon Sinuplasty Help Relieve Chronic Rhinosinusitis?

Jan 27, 2021 | Ear Nose Throat, Your Health

Approximately 15 percent of adults in the United States experience debilitating symptoms of chronic rhinosinusitis (CRS), which include congestion, runny nose, and headache. Far fewer, however, seek the advice of a physician. Satish Govindaraj, MD, Chief of Rhinology and Sinus Surgery, at the Mount Sinai Health System, discusses a variety of innovative treatments that have significantly improved the quality of life for tens of thousands of patients each year.

Satish Govindaraj, MD, Chief of Rhinology and Skull Base Surgery at the Mount Sinai Health System

What is chronic rhinosinusitis?

Most of us have had a runny or stuffy nose at some point in our lifetime. When these symptoms last for a few days or even weeks you may be diagnosed with a condition known as acute sinusitis. Chronic rhinosinusitis (CRS), however, occurs when the sinuses passages—four pairs of hollow cavities in the nose and head—swell and are unable to properly drain for a period of three months or longer.

What are the symptoms?

Patients with CRS typically experience persistent nasal drainage, congestion that impacts their ability to breathe, headache, facial pain or pressure, fatigue, and difficulty smelling or tasting. These symptoms can have a tremendous impact on your ability to work and enjoy leisure time.

What treatments are available?

When the sinus passages swell and are unable to drain, mucus gets stuck and can become infected. The key to treating CRS is to reduce this inflammation. The first line of defense is always medical management, including nasal saline irrigations that flush out the nasal passageways, topical steroids sprayed into the nose to reduce swelling, and oral antibiotics which treat infection. If medical management fails, numerous surgical options are also available. Mount Sinai’s ear, nose, and throat specialists (otolaryngologists) are highly trained in a variety of minimally invasive procedures that can be performed in the office setting without making an incision.

Am I a candidate for balloon sinuplasty?

We partner with patients to develop an individualized treatment plan based on their unique anatomy, symptoms, procedure tolerance, and medical history. Patients with CRS are typically eligible for balloon sinuplasty if their symptoms have not improved with medical management and they have had four or more sinus infections in one year.

How does balloon sinuplasty work?

Balloon sinuplasty opens up the nasal passageways. During this in-office procedure, a thin wire or probe with an attached balloon is guided through the nose into the swollen sinus cavity. When the balloon is in the correct spot, it is inflated and dilates the blocked passageway—similar to the way a stent is used to open up a clogged artery. The sinus cavity is then irrigated or flushed with salt water to allow the trapped mucus to drain out.

What distinguishes Mount Sinai with balloon sinuplasty treatment?

Many of our ear, nose, and throat physicians are fellowship trained in sinus surgery and receive additional education in performing the balloon sinuplasty procedure. Mount Sinai surgeons also specialize in using image-guided CT scans to precisely navigate tiny instruments through the nasal passageways. As a large, tertiary medical center reputable for managing complex cases, patients can feel safe knowing there is a multidisciplinary team at every surgeon’s fingertips. We have multiple locations throughout New York City, making it easy to find care close to home.

What are the benefits of balloon sinuplasty?

Research shows numerous advantages to having a balloon sinuplasty, compared to traditional sinus surgery. These include:

Faster recovery time — patients report fewer missed days of work or school
Use of local sedation rather than general anesthesia — the procedure is performed in a doctor’s office rather than an operating room using numbing agents and IV sedation when necessary
Shorter operating time — depending on how many sinus cavities are affected, the procedure typically takes one hour
Comparable outcomes to more invasive sinus surgeries in patients with mild to moderate chronic sinusitis
Fewer side effects, including pain, soreness, and congestion — the surgery does not require an incision or any tissue or bone to be removed
Minimal follow-up care — there is no nasal packing after the operation

What is the follow-up treatment? Will my CRS return?

A balloon sinuplasty procedure causes minimal disruption to daily life—most patients return to work the next day. In an abundance of caution, individuals who have sinus surgery should not exert themselves physically for a few days. Follow-up appointments are typically made in one to two weeks. The overwhelming majority of patients who have balloon sinuplasty notice a significant improvement in their symptoms. The length of time individuals experience benefit depends on the severity of their disease and whether or not they have other compromising disorders such as allergies or immune system conditions. To ensure success, it is important that patients continue to take their medication regularly after surgery and properly irrigate their sinuses with nasal rinses.

Learn more about ENT services at Mount Sinai

Make an appointment with Dr. Govindaraj

Thyroid Cancer: Total Thyroidectomy or Hemithyroidectomy – Which is Right for You?

Updated on Jun 30, 2022 | Ear Nose Throat, Your Health

Physicians are taught to make recommendations based on research and experience. But Marita Teng, MD, Professor of Otolaryngology – Head and Neck Surgery at Mount Sinai, often finds herself telling patients that decisions in thyroid cancer surgery are becoming as much personal as medical. The ‘right’ decision regarding whether to biopsy a thyroid nodule, or how much surgery to have, she explains, is different for every patient.

Marita Teng, MD, Professor of Otolaryngology – Head and Neck Surgery at Mount Sinai

This is particularly true in the field of thyroid cancer, where so much of the thinking and approach has changed in the last five years. The American Thyroid Association (ATA) published more than 100 new recommendations for the treatment of thyroid cancer in 2015. One of the most remarkable changes, and difficult decisions for patients, is determining what type of surgery to have.

“We are living in an age of information being at people’s fingertips and a culture where shared decision-making is more prevalent,” explains Dr. Teng. “Many times, there is not simply one right treatment path. Clinical outcomes are important, but decisions also depend on what feels right to the patient.”

Choosing between Total Thyroidectomy and Hemithyroidectomy

For decades, total thyroidectomy—a surgical procedure which removes the entire thyroid gland—was considered the gold standard treatment for most thyroid cancers. However, the latest ATA guidelines advocate that removing half of the thyroid gland, a procedure known as hemithyroidectomy, is as beneficial as having a total thyroidectomy in patients with well-differentiated cancerous growths measuring up to four centimeters.

“Some individuals who have thyroid cancer want the entire organ out of their body, so they do not have to worry about having problems with the other side. Other patients want to have as little surgery as possible. After I give these options to my patients, they frequently know exactly which one resonates with them,” explains Dr. Teng.

The Consideration of Thyroid-Stimulating Hormone Post Surgery

There are pros and cons to both hemi- and total thyroidectomy. One of the most important differences is the need for thyroid-stimulating hormone after surgery. The thyroid produces hormones that help regulate important body functions such as the heart rate and metabolism. When the entire thyroid is surgically removed, patients must take synthetic thyroid hormone for the rest of their lives. When half of the thyroid remains intact, close to 90 percent of patients can maintain normal thyroid function without medication.

“Some people shrug it off when I tell them they have to take medicine every day; others absolutely do not want to take a pill,” Dr. Teng says. “I also explain that some patients can be more difficult to regulate with medication than others. It really depends on how much that inconvenience strikes them.”

What Are the Risks of Thyroid Surgery?

The surgical risks of any thyroid procedure are small. But the likelihood of the rare complication, such as injury to the nerve that controls the voice, is cut in half with hemithyroidectomy because the procedure involves only one side as opposed to both. The recovery for both operations is about the same.

One potential downside to hemithyroidectomy, however, is that the remaining side will require monitoring and may potentially need to be removed later. In a small number of patients, a later biopsy finds cancer in the side that was thought to be unaffected.

“We can predict a fair amount before we operate. When I counsel patients, I try not to give them a recommendation that could bring them back to the operating room again,” explains Dr. Teng. “But by taking out the entire gland you never have to worry about that small chance you may need another thyroid operation.”

Dr. Teng says it is important that patients are informed, because implementing new guidelines into widespread practice can be a challenge. In fact, it takes an average of 17 years for an established medical guideline to become common practice. That means it could be be 2032 by the time these 2015 ATA guidelines are consistently followed throughout the country. Patients who were told total thyroidectomy was their only option often see her for a second opinion.

Mount Sinai Provides Patients with a Personalized Approach

“At Mount Sinai, we provide a personalized approach to every case and are up to date on current practice guidelines. We have a multidisciplinary team; for complex cases, our recommendations are evaluated carefully as a group of surgeons, endocrinologists, nuclear medicine specialists, and sometimes even medical and radiation oncologists. We are thankful to be able to engage our patients in this collaborative decision-making process,” says Dr. Teng.

Learn more about ENT services at Mount Sinai

Make an appointment with Dr. Teng

I Think I Have a Sinus Infection. What Should I Do?

Oct 15, 2020 | Ear Nose Throat, Urgent Care, Your Health

Each year, nearly 30 million Americans are diagnosed with a sinus infection. Commonly referred to as “acute sinusitis,” sinus infections occur when inflammation of the lining of the nose and sinus cavities develop. As one of the most common illness in the country, they are a very frequent reason for patients to seek urgent medical care. In this Q & A, Catherine Spaulding, MD, a physician at Mount Sinai Urgent Care, explains how to identify a sinus infection and how best to treat your symptoms.

How do I know if I have a sinus infection?

Look for the common symptoms such as a runny or congested nose, headaches, as well as pain and pressure in the sinuses — which are located above and below the eyes and on either side of the nose.

Frequently, sinus infections also cause a sore throat and coughing that is worse at night or the first thing in the morning. This is caused by post nasal drip and occurs when mucus drains down the back of the throat—most common when lying flat—resulting in irritation of the throat, a scratchy or hoarse voice, and/or a cough.

Symptoms of a sinus infection typically last between three to ten days.

What causes acute sinusitis?

The large majority of cases of acute sinusitis are caused by viruses similar to those that cause the common cold. Inflammation of the sinuses from other triggers can also result in similar symptoms to that of a virus such as environmental allergies, smoke, or dry air, as well as extreme changes in pressure that can occur when scuba diving or on an airplane. Additionally, patients with abnormal nasal anatomy, such as a deviated septum or nasal polyps, are at increased risk of developing an infection.

How do I tell the difference between COVID-19 and a sinus infection?

Distinguishing between COVID-19 and a sinus infection can be difficult since both can cause nasal congestion, a sore throat, headaches and sinus pain or pressure. However, COVID-19 is more commonly associated with a fever, cough, body aches, chills, chest tightness, shortness of breath and occasionally with diarrhea. It is best to share all of your symptoms with your doctor to help determine if you should be tested for COVID-19.

Do I need to take antibiotics to get rid of my sinus infection?

Typically, no. While antibiotics are useful in treating bacterial infections, they are powerless against viruses. Taking antibiotics when they are not necessary or indicated can lead to resistant bacterial infections and unwanted medication side effects. Because of this, it is important to discuss whether an antibiotic is really needed when treating any infection.

Only around two percent of sinus infections are caused by bacteria. However, there are several instances in which your doctor might recommend antibiotics for treatment. This includes:

If your symptoms persist beyond 10 days without any improvement
If your illness worsens after day seven
If you have fevers with a temperature greater than 102 F at the start of symptoms
If you have a history of immunocompromising conditions—such as cancer, a history of an organ transplant, poorly controlled HIV or an immunodeficiency —or use of immunosuppressant medications—such as high doses of corticosteroids or chemotherapy
If you have undergone sinus surgery

What should I take to treat my symptoms?

Like the common cold, most sinus infections will go away on their own. Treatment should be aimed at relieving congestion in the nose and sinus passages. Doing so not only improves symptoms of the infection but reduces the possibility of developing a secondary bacterial infection. Here are some things to try at home:

Rinse your nasal passages with saline. Use a nasal saline rinse or spray twice daily to remove the mucus from the sinus cavities. This will allow you to breathe much easier.
Use a nasal steroid spray. After rinsing out your nose with saline, use a nasal steroid spray such as Fluticasone—one spray in each nostril twice daily— to reduce post nasal drip and congestion.
Try an over the counter decongestant. Medications such as pseudoephedrine provide additional help in relieving your stuffy, runny nose. But keep in mind that pseudoephedrine is a mild stimulant that can cause insomnia, so avoid taking right before bedtime. Additionally, it can raise your blood pressure so those with hypertension should not take this and should try Coricidin instead.
Use a bedside humidifier. Running a humidifier while you sleep can help to moisten the nasal passages and throat which will improve the flow of mucus by thinning it . If you do not have a humidifier, try taking a steam shower before bed for the same effect.
Take preventative measures. If you have a history of seasonal allergies, consider starting a daily antihistamine to prevent inflammation and mucus production.

If you suspect that you have a sinus infection and would like to speak with a doctor about your symptoms, schedule a walk in or virtual appointment with a Mount Sinai Urgent Care physician.

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My Child May Have Trouble Hearing. Will Remote Learning Hurt Their Progress in School?

Oct 8, 2020 | Children's Health, COVID-19, Ear Nose Throat, Your Health

This academic year, many children have returned to school virtually. While remote education may be a safer option for some, it is not without its drawbacks—particularly for children who are hearing impaired.

Enrique R. Perez, MD, MBA, an expert in managing adult and child’s hearing disorders and Director of Otology at The Mount Sinai Hospital, provides advice for parents who are concerned about their child’s hearing when learning remotely.

What are the signs my child may have trouble hearing?

To figure out if your child has hearing issues, I recommend that parents or guardians ask themselves a series of questions:

Do you find yourself raising your voice or calling out your child’s name several times before they respond?
Is your child not startled by loud noises?
Do you notice that your child often turns their head or shifts their body position when listening to others or the TV?
Does your child raise the volume on the television, computer, or their phone to an uncomfortable level?
Is your child struggling with academic work?
Is your toddler not learning to speak at the expected rate?
Does your child have a history of recurring ear infections?

If the answer to any of these questions is yes, your child may be struggling to hear. Pediatricians often perform routine screening for hearing loss and they may be able to uncover even subtle degrees of hearing loss.

I am concerned about taking my child for a check-up during the COVID-19 pandemic. Can I delay their hearing exam?

Deciding whether to seek medical care during the pandemic can be difficult, but delaying care always comes with some risk. Delaying a hearing check-up is especially worrisome for children with significant hearing loss who are not being aided with a hearing aid or other hearing device. This is true for children of all ages. Young children, learning to speak may experience delays in achieving appropriate communication milestones, and those who are speaking well but cannot hear properly may fall behind in school. Studies have shown that these setbacks may be irreversible and may limit your child’s academic achievement.

However, I understand the concern, especially if your child has a condition that makes them more vulnerable to COVID-19. Fortunately, most healthcare facilities follow strict guidelines to screen for and minimize the risk of contracting the virus. If you are apprehensive, I suggest that you contact the facility and ask about their protocols.

How can I help my child who is struggling with hearing issues?

The first step in helping your child is to schedule a proper evaluation by a doctor. You might start with your child’s pediatrician, who can screen for hearing issues, and then, if appropriate, can refer you to a specialist for diagnosis and treatment.

Additional ways that you can help a child struggling with hearing issues include:

Minimizing background noise when you are speaking to your child.
When talking to your child, face them directly and speak slowly and clearly. Try not to shout as that can distort your speech and make your child feel uncomfortable.
Make sure your child’s teachers and school are aware of your child’s hearing issue so that they can help.
Address any insecurity your child may feel regarding their hearing issues as stigma could prevent them from using devices, such as hearing aids. You want to help your child to be comfortable and confident when used a hearing assistive device, especially during these formative years.

How should I set up my child’s space for remote learning?

Remote learning can create new challenges—and some opportunities—for educating children with difficulty hearing. With the proper set-up and equipment, remote learning may be easier than in-person schooling for a child with hearing difficulties.

The first step is to give your child a quiet area in the home for schooling. They will also need a computer with a reliable internet connection and the ability to adjust the volume.

A strong, stable connection enables your child to see the teacher clearly. Importantly, it allows them to see visual cues—such as facial expressions—which are important communication tools for everyone, especially those with hearing loss. And, being able to adjust the volume enables your child to mute other students, allowing them to focus on the teacher. Your child may also benefit from using headphones, including noise cancelling ones, which are normally not allowed in a classroom.

How else can I help my child with remote learning?

I encourage parents and guardians to build a relationship with their child’s teacher. Often, teachers are the first to notice that a child may be struggling to hear. But fostering a connection with your child’s teacher may be easier with in-person schooling than remote learning. Additionally, it helps to stay involved with your child’s education so that you don’t miss any of the early signs of hearing loss that could compromise their ability to learn.

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Smiling for Two—The Importance of Oral Health in Prenatal Care

Updated on Jun 30, 2022 | BFWHRI, Dental and Oral Health, OB/GYN, Women's Health

Pregnancy is a special time in the life span to secure the oral health of mothers and their young children. Pregnant women often experience changes in oral health due to increased inflammatory response to dental plaque. Uncontrolled and untreated, inflammation in the gums and bones in the mouth (periodontal disease) can induce a systematic inflammation response, affecting the health of both mom and baby. Prior research suggests a potential association between periodontal disease in pregnant women and adverse birth outcomes. Additionally, pregnant women with untreated dental caries—tooth decay—can increase the risk of dental caries for young children by transferring caries-generating germs like Streptococcus mutans, from her mouth to the baby’s mouth. In young children, dental caries may require extensive treatment involving sedation or even general anesthesia if the child cannot tolerate chair-side procedures. The costs associated with such procedures often create major financial and psychosocial burden in families.

Oral Health is Prenatal Health

Preventive, diagnostic, and restorative dental procedures are safe throughout pregnancy and effective in improving and maintaining oral health. However, more than half of mothers do not receive periodic dental cleaning during pregnancy. Education, race/ethnicity, dental insurance, and household income have all been associated with the usage of dental services and oral health outcomes. Some women are misinformed that all dental treatments should be delayed after delivery, and sometimes they worry about potential adverse effects of routine dental care to the fetus. Given the importance of oral health during pregnancy for the health and well-being of mothers and their babies, the American College of Obstetricians and Gynecologists (ACOG) in 2013 stated that ‘women should routinely be counseled about the safety and importance of oral health care during pregnancy, and should be referred for dental care as would be the practice with referrals to any medical specialists.’ ACOG made it clear that oral health is an integral part of prenatal care. Healthcare providers from both medicine and dentistry acknowledge that preventive, diagnostic, and restorative dental treatment is safe throughout pregnancy and is effective in improving and maintaining oral health.

As a mother of a young child and pediatric dentist, I believe oral health knowledge among pregnant women is the key to securing the oral health of both women at childbearing age and their young children. In 2014, I was a pediatric dental resident at The Mount Sinai Hospital ; I was also pregnant. I had begun a prenatal oral health education program with prenatal coordinators in East Harlem and the Bronx that integrated oral health education and care coordination into CenteringPregnancy, their prenatal group oral health education model. Before I joined Mount Sinai in 2014, I was involved in the publication of the national oral health guidelines for pregnant women as a dental officer at the Department of Health and Human Services. Three years after this publication, I found that the majority of clinicians, both physicians and dentists, were not aware of these guidelines. Most of my pregnant friends in prenatal groups were told to go to the dentist after delivery, unless they had a dental emergency. I was surprised by the gap between science and practice and decided to investigate the root causes. Three levels of issues generated this gap: provider training, patient education, and practice coordination.

Bridging the Gap to Improve Prenatal Dental Care

First, dental providers, primary care providers, and administrative staff need to be trained based on the most updated guidelines to advance the oral health of expecting mothers and their babies. Pregnancy should not be a reason to avoid necessary dental care, but rather it needs to be seen as a teachable moment, empowering mothers to secure their oral health as well as their baby’s healthy smile. With the current national guidelines and published best practices, we can achieve this.

Secondly, we need to acknowledge that mothers, not the pediatric dentist, are often the primary care providers. They decide what to put in the bottle, which snacks to give, and how often to brush their child’s teeth. Because of this, pregnant women and mothers should be educated on the relationship between mother’s oral health and baby’s oral health and be encouraged to receive necessary dental care, and practice home oral hygiene activities along with a low-sugar diet.

Finally, we need to build a system that is meaningful and sensible to pregnant women and connect them to oral health care. Even if care providers know the importance of oral health and are willing to provide appropriate and necessary dental services and referrals, and even if pregnant women value oral health for themselves and their babies, low-income pregnant women may not be able to access dental services without system-level support. New York is one of the states that provides comprehensive dental care for pregnant women enrolled in Medicaid. However, how many of these low-income pregnant women actually know about this coverage? How many know how to find dental facilities who accept their insurance during pregnancy? These are the questions we need to consider. Coverage is important, but patients may need help in the interpretation and utilization of such coverage.

How COVID-19 Has Impacted Dental Care

Currently, we have a new challenge – dental care during and after the COVID-19 crisis. At the beginning of this outbreak, the New York Times published, “The Workers Who Face the Greatest Coronavirus Risk.” Dentists and dental hygienists were at the far-right corner of the graph were depicting that those in the profession have the most frequent exposure to COVID-19 and the closest proximity to others during their workdays. As dental settings have unique challenges that require specific infection control strategies, CDC published “Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response” to resume non-emergency dental care, which was on hold during the initial outbreak of COVID-19 by state order. It recommends balancing the need to provide necessary services while minimizing risk to patients and dental health care personnel.

Mount Sinai dental clinics have been serving patients with emergency dental cases during the pandemic, and we are in the process of providing routine dental care.

Although we face many challenges, this can be a time of opportunity as well. Dentistry has centered on a “drill-fill-bill” model, where definitive treatments are incentivized. However, as dentists work to minimize aerosol exposure while preventing oral health diseases, dental procedures that focus on disease management and prevention are on the spot. These procedures include silver diamine fluoride application to arrest dental caries and indirect pulp cap with Hall technique crowns—which may not require high-speed dental drills. There are also many efforts within the Mount Sinai Health System to integrate oral health into its existing primary care and prenatal care strategies.

Since 2019, the CenteringPregnancy programs at The Mount Sinai Hospital and the Mount Sinai Adolescent Health Center have embraced an interactive oral health education model where pregnant women are connected to Mount Sinai dental facilities if they do not have a dental provider. Mount Sinai OBGYN providers, pediatricians, and prenatal care nurses plan to integrate oral health education and care navigation into their existing care models. While we continue to provide our patients with excellent, up-to-date dental care, we are committed to focusing on these upstream approaches where the new norm for children’s oral health becomes no caries. Furthermore, this new norm will include the systems of care that value health as well as health care.

Hyewon Lee, DMD, MPH is a former U.S. Public Health Service officer at the Department of Health and Human Services, a member of the Blavatnik Family Women’s Health Research Institute and an Assistant Clinical Professor at the Department of Dentistry at The Mount Sinai Hospital. Her goal is to integrate oral health into primary and prenatal care to advance the oral health of mothers and young children.

I Have A Cavity. Is It Safe to See My Dentist?

May 4, 2020 | COVID-19, Dental and Oral Health, Health Hub, Your Health

Although many are under stay at home measures due to the novel coronavirus pandemic, there are still some everyday issues that cannot be avoided—like dental pain. But, can you see a dentist during this time? John L. Pfail, DDS, Chief of the Department of Dentistry at the Icahn School of Medicine at Mount Sinai, explains which procedures can be addressed and which will have to wait.

Are dental procedures still being done in the office?

Currently, the American Dental Association (ADA) and the New York State Dental Society will only allow emergency procedures. COVID-19 is spread through respiratory droplets from the nose and throat. Some dental procedures can create large amounts of these droplets in the air, for example through cleanings and fillings, which could spread the virus.

Out of an abundance of caution, elective surgery, routine restorations like fillings and all procedures involving the use of an ultrasonic scaler—which is used to clean teeth as well as remove stains and plaque—have been postponed. If patients are experiencing mild discomfort, they should contact their dentist who can evaluate and advise if they should wait until a possible reopening of offices in late May.

What types of procedures are considered an emergency?

Emergency procedures depend upon the level of pain or discomfort the patient is experiencing. However, these procedures would include the following:

Emergency treatment for pain and swelling

Depending on severity these would include medicated restorations—fillings, drainage of swellings and infections, as well as the removal of the inflamed nerve tissue of a tooth—pulpotomy

Extraction of severely mobile, fractured, or decayed teeth

Denture adjustments of sore spots

These spots should be attended to as they can lead to open wounds that may become further complicated, causing infection.

Refilling prescription medications

Please consult with your dentist. With the advent of telemedicine, you may not need to come in to the office to be seen.

I have an emergency dental procedure. Is the office safe?

Yes, it is very safe as dental offices follow strict protocols on infection control and asepsis–being free of any disease causing organisms, this includes viruses and bacteria.

Additionally, the ADA is currently completing new guidance for when dental offices reopen for all procedures. Social distancing will be maintained, patients will be screened with temperature checks, and visitors will be limited. These are just a few of the changes that will be noticed in the dental office.

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