Transmenu powered by JoomlArt.com - Mambo Joomla Professional Templates Club

Hay fever describes the symptoms of runny nose, itchy eyes and throat, uncontrollable sneezing and sometimes itching of the skin. It is not caused by hay, and does not produce fever. The correct name for the condition is seasonal allergic rhinitis. Many seasonal "colds" are actually allergic rhinitis and will not respond to antibiotics. Seasonal allergic rhinitis happens when pollens and/or particles of plant or animal dander, mold spores, etc., come into contact with the lining of the nose, eyes, or throat. The body's immune system recognizes their presence and starts a reaction to prevent their invasion. In most people this is not a problem. However, in some patients the immune system is overactive and identifies normally harmless particles as dangerous, producing an excessive reaction that actually causes inflammation. This is known as allergy and the substances causing it are allergens. People are allergic to only certain substances, and the reaction does not usually appear until after several exposures to that substance.

Hay fever is caused by pollens. Certain allergens are always present. These include house dust, household pet danders, foods, wool, various chemicals used around the house, and more. Symptoms from these are frequently worse in the winter when the house is closed up. Mold spores cause at least as many allergy problems as pollens. Molds are present all year long, and grow outdoors and indoors. Dead leaves and farm areas are common sources for outdoor molds. Indoor plants, old books, bathrooms, and damp areas are common sources of indoor mold growth. Molds are also common in foods, such as cheese.

Allergic patients show reduced resistance to respiratory infections, and more severe symptoms when infections occur. Allergies are rarely life threatening, but often cause lost work days, decreased work efficiency, poor school performance, and a negative effect on the enjoyment of life. Considering the millions spent in anti-allergy medications and the cost of lost work time, allergies cannot be considered a minor problem.

A number of medications are useful in the treatment of allergy including antihistamines, decongestants, cromolyn, and cortisone-type preparations. The medical management of allergy also includes counseling in proper environmental control. Based on a detailed history and thorough examination, your doctor may advise testing to determine the specific substances to which you are allergic. The methods employed by your otolaryngologists will indicate the materials to which you are allergic, and the degree of your sensitivity to them. The only "cure" available for inhalant allergy is the administration of injections that build up protective antibodies to specific allergens (pollens, molds, animal danders, dust, etc.). Your physician will oversee your progress throughout the course of treatment and care for any other nasal and sinus disorders that may contribute to your symptoms.

Some people describe a balance problem by saying they feel dizzy, lightheaded, unsteady, or giddy. This feeling of imbalance or disequilibrium, without a sensation of turning or spinning, is sometimes due to an inner ear problem.

A few people describe their balance problem by using the word vertigo, which comes from the Latin verb "to turn". They often say that they or their surroundings are turning or spinning. Vertigo is frequently due to an inner ear problem.

Some people experience nausea and even vomiting when riding in an airplane, automobile, or amusement park ride, and this is called motion sickness. Many people experience motion sickness when riding on a boat or ship, and this is called seasickness even though it is the same disorder. Motion sickness or seasickness is usually just a minor annoyance and does not signify any serious medical illness, but some travelers are incapacitated by it, and a few even suffer symptoms for a few days after the trip.

The symptoms of motion sickness and dizziness appear when the central nervous system receives conflicting messages from the other four systems. For example, suppose you are riding through a storm, and your airplane is being tossed about by air turbulence. But your eyes do not detect all this motion because all you see is the inside of the airplane. Then your brain receives messages that do not match with each other. You might become "air sick." Or suppose you are sitting in the back seat of a moving car reading a book. Your inner ears and skin receptors will detect the motion of your travel, but your eyes see only the pages of your book. You could become "car sick." Or, to use a true medical condition as an example, suppose you suffer inner ear damage on only one side from a head injury or an infection. The damaged inner ear does not send the same signals as the healthy ear. This gives conflicting signals to the brain about the sensation of rotation, and you could suffer a sense of spinning, vertigo, and nausea.

Circulation: If your brain does not get enough blood flow, you feel light headed. Almost everyone has experienced this on occasion when standing up quickly from a lying down position. But some people feel light headed from poor circulation on a frequent or chronic basis. This could be caused by arteriosclerosis or hardening of the arteries, and it is commonly seen in patients who have high blood pressure, diabetes, or high levels of blood fats (cholesterol). It is sometimes seen in patients with inadequate cardiac (heart) function or with anemia. Certain drugs also decrease the blood flow to the brain, especially stimulants such as nicotine and caffeine. Excess salt in the diet also leads to poor circulation. Sometimes circulation is impaired by spasms in the arteries caused by emotional stress, anxiety, and tension. If the inner ear falls to receive enough blood flow, the more specific type of dizziness occurs-that is-vertigo. The inner ear is very sensitive to minor alterations of blood flow and all of the causes mentioned for poor circulation to the brain also apply specifically to the inner ear. Injury: A skull fracture that damages the inner ear produces a profound and incapacitating vertigo with nausea and hearing loss. The dizziness will last for several weeks, then slowly improve as the normal (other) side takes over Infection: Viruses, such as those causing the common "cold" or "flu," can attack the inner ear and its nerve connections to the brain. This can result in severe vertigo, but hearing is usually spared. However, a bacterial infection such as mastoiditis that extends into the inner ear will completely destroy both the hearing and the equilibrium function of that ear. The severity of dizziness and recovery time will be similar to that of skull fracture. Allergy: Some people experience dizziness and/or vertigo attacks when they are exposed to foods or airborne particles (such as dust, molds, pollens, danders, etc.) to which they are allergic. Neurological diseases: A number of diseases of the nerves can affect balance, such as multiple sclerosis, syphilis, tumors, etc. These are uncommon causes, but your physician will think about them during the examination.

Avoid rapid changes in position, especially from lying down to standing up or turning around from one side to the other. Avoid extremes of head motion (especially looking up) or rapid head motion (especially turning or twisting). Eliminate or decrease use of products that impair circulation, e.g., nicotine, caffeine, and salt. Minimize your exposure to circumstances that precipitate your dizziness, such as stress and anxiety or substances to which you are allergic. Avoid hazardous activities when you are dizzy, such as driving an automobile or operating dangerous equipment, or climbing a step ladder, etc.

Always ride where your eyes will see the same motion that your body and inner ears feel, e.g., sit in the front seat of the car and look at the distant scenery; go up on the deck of the ship and watch the horizon; sit by the window of the airplane and look outside. In an airplane choose a seat over the wings where the motion is the least. Do not read while traveling if you are subject to motion sickness, and do not sit in a seat facing backward. Do not watch or talk to another traveler who is having motion sickness. Avoid strong odors and spicy or greasy foods immediately before and during your travel. Medical research has not yet investigated the effectiveness of popular folk remedies such as soda crackers and & Seven Up, or cola syrup over ice. Take one of the varieties of motion sickness medicines before your travel begins, as recommended by your physician. Some of these medications can be purchased without a prescription (i.e., Dramamine?, Bonine?, Marezine?, etc.) Stronger medicines such as tranquilizers and nervous system depressants will require a prescription from your physician. Some are used in pill or suppository form.

A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually due to repeated infection, which causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth.

A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure ("clear the ears"). When the eustachian tubes work poorly perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body, and a partial vacuum results in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.

Initially, the ear may drain, sometimes with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. (An ache behind or in the ear, especially at night, may cause significant discomfort). Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any, or all, of these symptoms are good reasons to seek medical evaluation.

Ear cholesteatomas can be dangerous and should never be ignored. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and rarely death can occur.

An examination by an otolaryngologist, head and neck surgeon, can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated. Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone next to the ear), and CAT scans (3-D x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused. Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection and achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; and therefore, a second operation may be performed six to twelve months later. The second operation will attempt to restore hearing and, at the same time, inspect the middle ear space and mastoid for residual cholesteatoma. Admission to the hospital is usually done the morning of surgery, and if the surgery is performed early in the morning, discharge maybe the same day. For some patients, an overnight stay is necessary. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Time off from work is typically one to two weeks. Follow-up office visits after surgical treatment are necessary and important, because cholesteatoma sometimes recurs. In cases where an open mastoidectomy cavity has been created, office visits every few months are needed in order to clean out the mastoid cavity and prevent new infections. In some patients, there must be lifelong periodic ear examinations.

Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded for children who visit physicians for illness. It is also the most common cause of hearing loss in children. Although otitis media is most common in young children, it also affects adults occasionally. It occurs most commonly in the winter and early spring months.

Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal. Otitis media is also serious because the infection can spread to nearby structures in the head, especially the mastoid. Thus, it is very important to recognize the symptoms (see list) of otitis media and to get immediate attention from your doctor. The outer ear collects sounds. The middle ear is a pea sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three tiny ear bones. When sound waves strike the eardrum, it vibrates and sets the bones in motion that transmit to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. It also helps maintain balance. A healthy middle ear contains air at the same atmospheric pressure as outside of the ear, allowing free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear. When you yawn and hear a pop, your eustachian tube has just sent a tiny air bubble to your middle ear to equalize the air pressure.

Blockage of the eustachian tube during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum. This is the infection called acute otitis media. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, you or your child may have hearing problems. Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This condition makes one subject to frequent recurrences of the acute infection and may cause difficulty in hearing.

In infants and toddlers look for: pulling or scratching at the ear, especially if accompanied by the following... 1. hearing problems 2. crying, irritability 3. fever 4. vomiting 5. ear drainage In young children, adolescents, and adults look for: earache, feeling of fullness or pressure, hearing problems, dizziness, loss of balance, nausea, vomiting, ear drainage, fever Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.

The doctor may prescribe one or more medications. It is important that all the medication(s) be taken as directed and that any follow-up visits be kept. Often, antibiotics to fight the infection will make the earache go away rapidly, but the infection may need more time to clear up. So, be sure that the medication is taken for the full time your doctor has indicated. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both. Sometimes the doctor may recommend a medication to reduce fever and/or pain. Analgesic ear drops can ease the pain of an earache. Call your doctor if you have any questions about you or your child's medication or if symptoms do not clear. Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, further treatment may be recommended by your physician. An operation, called a myringotomy may be recommended. This involves a small surgical incision (opening) into the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days with practically no scarring or injury to the eardrum. In fact, the surgical opening can heal so fast that it often closes before the infection and the fluid are gone. A ventilation tube can be placed in the incision, preventing fluid accumulation and thus improving hearing. The surgeon selects a ventilation tube for your child that will remain in place for as long as required for the middle ear infection to improve and for the eustachian tube to return to normal. This may require several weeks or months. During this time, you must keep water out of the ears because it could start an infection. Otherwise, the tube causes no trouble, and you will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections. Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted.

Wax is not formed in the deep part of the ear canal near the eardrum, but only in the outer part of the canal. So when a patient has wax blocked up against the eardrum, it is often because he has been probing his ear with such things as cotton-tipped applicators, bobby pins, or twisted napkin corners. These objects only push the wax in deeper. Also, the skin of the ear canal and the eardrum is very thin and fragile and is easily injured. Earwax is healthy in normal amounts and serves to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of earwax may result in dry, itchy ears. Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of ear canal skin from the eardrum to the ear opening. Old earwax is constantly being transported from the ear canal to the ear opening where it usually dries, flakes, and falls out. Under ideal circumstances, you should never have to clean your ear canals. However, we all know that this isn't always so. If you want to clean your ears, you can wash the external ear with a cloth over a finger, but do not insert anything into the ear canal.

A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear. The medical term for eardrum is tympanic membrane. The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear. A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.

The causes of perforated eardrum are usually from trauma or infection. A perforated eardrum can occur: If the ear is struck squarely with an open hand, with a skull fracture, after a sudden explosion, if an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal. As a result of hot slag (from welding) or acid entering the ear canal Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the ear-drum resulting in a perforation. In this circumstance, there maybe infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation. On rare occasions a small hole may remain in the eardrum after a previously placed PE tube (pressure equalizing) either falls out or is removed by the physician. Most eardrum perforations heal spontaneously within weeks after rupture, although some may take up to several months. During the healing process the ear must be protected from water and trauma. Those eardrum perforations which do not heal on their own may require surgery.

Usually, the larger the perforation, the greater the loss of hearing. The location of the hole (perforation) in the eardrum also effects the degree of hearing loss. If severe trauma (e.g., skull fracture) disrupts the bones in the middle ear which transmit sound or causes injury to the inner ear structures, the loss of hearing maybe quite severe. If the perforated eardrum is due to a sudden traumatic or explosive event, the loss of hearing can be great and ringing in the ear (tinnitus) may be severe. In this case the hearing usually returns partially, and the ringing diminishes in a few days. Chronic infection as a result of the perforation can cause major hearing loss.

Before attempting any correction of the perforation, a hearing test should be performed. The benefits of closing a perforation include prevention of water entering the ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and diminished tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures. If the perforation is very small, otolaryngologists may choose to observe the perforation over time to see if it will dose spontaneously. They also might try to patch a cooperative patient's ear-drum in the office. Working with a microscope, your doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. Usually, with closure of the tympanic membrane, improvement in hearing is noted. Several applications of a patch (up to three or four) may be required before the perforation doses completely. If your physician feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or attempts with paper patching do not promote healing, surgery is considered. There are a variety of surgical techniques, but all basically place tissue across the perforation allowing healing. The name of this procedure is called tympanoplasty. Surgery is typically quite successful in closing the perforation permanently, and improving hearing. It is usually done on an outpatient basis. Your doctor will advise you regarding the proper management of a perforated eardrum.

Not at all. Tinnitus is the name for these head noises, and they are very common. Nearly 36 million Americans suffer from this discomfort. Tinnitus may come and go, or you may be aware of a continuous sound. It can vary in pitch from a low roar to a high squeal or whine, and you may hear it in one or both ears. When the ringing is constant, it can be annoying and distracting. More than seven million people are afflicted so severely that they cannot lead normal lives.

Not usually, but sometimes they are able to hear a certain type of tinnitus. This is called "objective tinnitus," and it caused either by abnormalities in blood vessels around the outside of the ear or by muscle spasms, which may sound like clicks or crackling inside the middle ear.

Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. If you are older, advancing age is generally accompanied by a certain amount of hearing nerve impairment and tinnitus. If you are younger, exposure to loud noise is probably the leading cause of tinnitus, and often damages hearing as well. There are many causes for "subjective tinnitus," the noise only you can hear. Some causes are not serious (a small plug of wax in the ear canal might cause temporary tinnitus). Tinnitus can also be a symptom of stiffening of the middle ear bones (otosclerosis). Tinnitus may also be caused by allergy, high or low blood pressure (blood circulation problems), a tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other causes including medications such as anti-inflammatorie drugs, antibiotics, sedatives, antidepressants, and aspirin. If you take aspirin and your ears ring, talk to your doctor about dosage in relation to your size.

In most cases, there is no specific treatment for ear and head noise. If your otolaryngologist finds a specific cause of your tinnitus, he or she may be able to eliminate the noise, but this determination may require extensive testing including X-rays, balance tests, and laboratory work. However, most causes cannot be identified. Occasionally, medicine may help the noise. The medications used are varied, and several may be tried to see if they help. The following list of DOs and DON'Ts can help lessen the severity of tinnitus: - Avoid exposure to loud sounds and noises. -Get your blood pressure checked. If it is high, get your doctor's help to control it. - Decrease your intake of salt. Salt impairs blood circulation. - Avoid stimulants such as coffee, tea, cola, and tobacco. - Exercise daily to improve your circulation. - Get adequate rest and avoid fatigue. - Stop worrying about the noise. Recognize your head noise as an annoyance and learn to ignore it as much as possible.

Concentration and relaxation exercises can help to control muscle groups and circulation throughout the body. The increased relaxation and circulation achieved by these exercises can reduce the intensity of tinnitus in some patients. Masking. Tinnitus is usually more bothersome in quiet surroundings. A competing sound at a constant low level, such as a ticking clock or radio static (white noise), may mask the tinnitus and make it less noticeable. Products that generate white noise are also available through catalogs and specialty stores. Hearing Aids. If you have a hearing loss, a hearing aid(s) may reduce head noise while you are wearing it and sometimes cause it to go away temporarily. It is important not to set the hearing aid at excessively loud levels, as this can worsen the tinnitus in some cases. However, a thorough trial before purchase of a hearing aid is advisable if your primary purpose is the relief of tinnitus. Tinnitus maskers can be combined within hearing aids. They emit a competitive but pleasant sound that can distract you from head noise. Some people find that a tinnitus masker may even suppress the head noise for several hours after it is used, but this is not true for all users.

A cochlear implant is an electronic device that restores partial hearing to the deaf. It is surgically implanted in the inner ear and activated by a device worn outside the ear. Unlike a hearing aid, it does not make sound louder or clearer. Instead, the device bypasses damaged parts of the auditory system and directly stimulates the nerve of hearing, allowing individuals who are profoundly hearing impaired to receive sound.

Your ear consists of three parts that play a vital role in hearing, the external ear, middle ear, and inner ear. ? Conductive hearing: Sound travels along the ear canal of the external ear causing the ear drum to vibrate. Three small bones of the middle ear conduct this vibration from the ear drum to the cochlea (auditory chamber) of the inner ear. ? Sensorineural hearing: When the three small bones move, they start waves of fluid in the cochlea, and these waves stimulate more than 16,000 delicate hearing cells (hair cells). As these hair cells move, they generate an electrical current in the auditory nerve. It travels through inter-connections to the brain area that recognizes it as sound.

If you have disease or obstruction in your external or middle ear, your conductive hearing may be impaired. Medical or surgical treatment can probably correct this. An inner ear problem, however, can result in a sensorineural impairment or nerve deafness. In most cases, the hair cells are damaged and do not function. Although many auditory nerve fibers may be intact and can transmit electrical impulses to the brain, these nerve fibers are unresponsive because of hair cell damage. Since severe sensorineural hearing loss cannot be corrected with medicine, it can be treated only with a cochlear implant.

Cochlear implants bypass damaged hair cells and convert speech and environmental sounds into electrical signals and send these signals to the hearing nerve. The implant consists of a small electronic device, which is surgically implanted under the skin behind the ear and an external speech processor, which is usually worn on a belt or in a pocket. A microphone is also worn outside the body as a headpiece behind the ear to capture incoming sound. The speech processor translates the sound into distictive electrical signals. These 'codes' travel up a thin cable to the headpiece and are transmitted across the skin via radio waves to the implanted electrodes in the cochlea. The electrodes' signals stimulate the auditory nerve fibers to send information to the brain where it is interpreted as meaningful sound.

Implants are designed only for individuals who attain almost no benefit from a hearing aid. They must be two years of age or older (unless childhood meningitis is responsible for deafness). Otolaryngologists (ear, nose, and throat specialists) perform implant surgery, though not all of them do this procedure. Your local doctor can refer you to an implant clinic for an evaluation. The evaluation will be done by an implant team (an otolaryngologist, audiologist, nurse, and others) that will give you a series of tests: Ear (otological) evaluation: The otolaryngologist examines the middle and inner ear to ensure that no active infection or other abnormality precludes the implant surgery. Hearing (audiological) evaluation: The audiologist performs an extensive hearing test to find out how much you can hear with and without a hearing aid. ? X-ray (radiographic) evaluation: Special X-rays are taken, usually computerized tomography (CT) or magnetic resonance imaging (MRI) scans, to evaluate your inner ear bone. ? Psychological evaluation: Some patients may need a psychological evaluation to learn if they can cope with the implant. ? Physical examination: Your otolaryngologist also gives a physical examination to identify any potential problems with the general anesthesia needed for the implant procedure.

Implant surgery is performed under general anesthesia and lasts from two to three hours. An incision is made behind the ear to open the mastoid bone leading to the middle ear. The procedure may be done as an outpatient, or may require a stay in the hospital, overnight or for several days, depending on the device used and the anatomy of the inner ear.

About one month after surgery, your team places the signal processor, microphone, and implant transmitter outside your ear and adjusts them. They teach you how to look after the system and how to listen to sound through the implant. Some implants take longer to fit and require more training. Your team will probably ask you to come back to the clinic for regular checkups and readjustment of the speech processor as needed.

Cochlear implants do not restore normal hearing, and benefits vary from one individual to another. Most users find that cochlear implants help them communicate better through improved lip-reading, and over half are able to discriminate speech without the use of visual cues. There are many factors that contribute to the degree of benefit a user receives from a cochlear implant, including: - How long a person has been deaf -The number of surviving auditory nerve fibers, and a patient's motivation to learn to hear. Your team will explain what you can reasonably expect. Before deciding whether your implant is working well, you need to understand clearly how much time you must commit. A few patients do not benefit from implants.

Most nosebleeds (epistaxis) are mere nuisances. But some are quite frightening, and a few are even life threatening. Physicians classify nosebleeds into two different types.

Most nosebleeds begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. This type of nosebleed comes from the front of the nose and begins with a flow of blood out one nostril when the patient is sitting or standing.

More rarely, a nosebleed can begin high and deep within the nose and flow down the back of the mouth and throat even if the patient is sitting or standing.

Obviously, when the patient is lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow posteriorly, especially if the patient is coughing or blowing his nose. It is important to try to make the distinction since posterior (back of nasal cavity) nosebleeds are often more severe and almost always require a physician's care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face. Anterior nosebleeds are common in dry climates or during the winter months when heated, dry indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented if you place a bit of lubricating cream or ointment about the size of a pea on the end of your fingertip and then rub it inside the nose, especially on the middle portion of the nose (the septum).

If you or your child has an anterior nosebleed, do the following steps: - Help the patient stay calm, espicially a young child. A person who is agitated may bleed more profusely. - Pinch all the soft parts of the nose between your thumb and the side of your index finger. Or soak a cotton ball with Afrin and insert it into the nostril. - Press firmly but gently toward the face compressing the pinched parts of the nose against the bones of the face. - Hold that position for full 5 minutes by the clock. - Keep the head higher than level of the heart. Sit up or lie back a little with the head elevated. - Apply ice-crushed in a plastic bag or washcloth to nose and cheeks .

Many physicians suggest any of the following lubricating creams or ointments. They can all be purchased without a prescription: Bacitracin, A and D Ointment, Eucerin, Polysporin, and Vaseline. Up to three applications a day may be needed, but usually every night at bedtime is enough. A saline nasal spray will also moisten dry nasal membranes. If the nosebleeds persist, you should see your doctor. Using an endoscope, a tube with a light for seeing inside the nose, your physician may find a problem within the nose that can be fixed. He or she may recommend cauterization (sealing) of the blood vessel that is causing the trouble.

The glands in your nose and throat continually produce mucus (one to two quarts a day). It moistens and cleans the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Although mucus normally is swallowed unconsciously, the feeling that it is accumulating in the throat or dripping from the back of your nose is called post-nasal drip. This feeling can be caused by excessive or thick secretions or by throat muscle and swallowing disorders.

- Increased thin clear secretions can be due to colds and flu, allergies, cold temperatures, bright lights, certain foods/spices, pregnancy, and other hormonal changes. Various drugs (including birth control pills and high blood pressure medications) and structural abnormalities can also produce increased secretions. These abnormalities might include a deviated or irregular nasal septum (the cartilage and bony dividing wall that separates the two nostrils). - Increased thick secretions in the winter often result from too little moisture in heated buildings and homes. They can also result from sinus or nose infections and some allergies, especially to certain foods such as dairy products. If thin secretions become thick and green or yellow, it is likely that a bacterial sinus infection is developing. In children, thick secretions from one side of the nose can mean that something is stuck in the nose (such as a bean, wadded paper, or piece of toy, etc.). - Sinuses are air-filled cavities in the skull. They drain into the nose through small openings. Blockages in the openings from swelling due to colds, flu, or allergies may lead to acute sinus infection. A viral "cold" that persists for 10 days or more may have become a bacterial sinus infection. With this infection you may notice increased post-nasal drip. If you suspect that you have a sinus infection, you should see your physician for antibiotic treatment. - Chronic sinusitis occurs when sinus blockages persist and the lining of the sinuses swell further. Polyps (growths in the nose) may develop with chronic sinusitis. Patients with polyps tend to have irritating, persistent post-nasal drip. Evaluation by an otolaryngologist may include an exam of the interior of the nose with a non-allergic scope and CAT scan x-rays. If medication does not relieve the problem, surgery may be recommended. - Vasomotor rhinitis describes a non-allergic "hyperirritable nose" that feels congested, blocked, or wet. - Swallowing Problems Swallowing problems may result in accumulation of solids or liquids in the throat that may complicate or feel like post-nasal drip. When the nerve and muscle interaction in the mouth, throat, and food passage (esophagus) aren't working properly, overflow secretions can spill into the voice box (larynx) and breathing passages (trachea and bronchi) causing hoarseness, throat clearing, or cough. Several factors contribute to swallowing problems: ? With age, swallowing muscles often lose strength and coordination. Thus, even normal secretions may not pass smoothly into the stomach. ? During sleep, swallowing occurs much less frequently, and secretions may gather. Coughing and vigorous throat clearing are often needed when awakening. ? When nervous or under stress, throat muscles can trigger spasms that feel like a lump in the throat. Frequent throat clearing, which usually produces little or no mucus, can make the problem worse by increasing irritation. ? Growths or swelling in the food passage can slow or prevent the movement of liquids and/or solids. Swallowing problems may be caused also by gastroesophageal reflux disease (GERD). This is a return of stomach contents and acid into the esophagus or throat. Heartburn, indigestion, and sore throat are common symptoms. GERD may be aggravated by lying down especially following eating. Hiatal hernia, a pouch-like tissue mass where the esophagus meets the stomach, often contributes to the reflux. Chronic Sore Throat: Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling of a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.

The facial nerve resembles a telephone cable and contains 7,000 individual nerve fibers. Each fiber carries electrical impulses to a specific facial muscle. Information passing along the fibers of this nerve allows us to laugh, cry, smile, or frown, hence the name, "the nerve of facial expression". When half or more of these individual nerve fibers are interrupted, facial weakness occurs. If these nerve fibers are irritated, then movements of the facial muscles appear as spasms or twitching. The facial nerve not only carries nerve impulses to the muscles of the face, but also to the tear glands, to the saliva glands, and to the muscle of the stirrup bone in the middle ear (the stapes). It also transmits taste from the front of the tongue. Since the function of the facial nerve is so complex, many symptoms may occur when the fibers of the facial nerve are disrupted. A disorder of the facial nerve may result in twitching, weakness, or paralysis of the face, in dryness of the eye or the mouth, or in disturbance of taste.

The most common cause of facial weakness which comes on suddenly is referred to as "Bell's palsy." This disorder is probably due to the body's response to a virus: in reaction to the virus the facial nerve within the ear (temporal) bone swells, and this pressure on the nerve in the bony canal damages it. In order to be sure that this is the cause of the facial weakness, and not something else, a special set of questions will be asked. After an examination of the head, neck, and ears, a series of tests may be performed. The most common tests are: ? Hearing Test: Determines if the cause of damage to the nerve has involved the hearing nerve, inner ear, or delicate hearing mechanism. ? Balance Test: Evaluates balance nerve involvement. ? Tear Test: Measures the eye's ability to produce tears. Eye drops may be necessary to prevent drying of the surface of the eye cornea). ? Imaging: CT (computerized tomography) or MRI (magnetic resonance imaging) determines if there is infection, tumor, bone fracture, or other abnormality in the area of the facial nerve. ? Electrical Test: Stimulates the facial nerve to assess how badly the nerve is damaged. This test may have to be repeated at frequent intervals to see if the disease is progressing.

The results of diagnostic testing will determine treatment. ? If infection is the cause, then an antibiotic to fight bacteria (as in middle ear infections) or antiviral agents (to fight syndromes caused by viruses like Ramsay Hunt) may be used. ? If simple swelling is believed to be responsible for the facial nerve disorder, then steroids are often prescribed. ? In certain circumstances, surgical removal of the bone around the nerve (decompression) may be appropriate.

You may not have heard of it, but you use it hundreds of times every day. It is the Temporo-Mandibular Joint (TMJ), the joint where the mandible (the lower jaw) joins the temporal bone of the skull, immediately in front of the ear on each side of your head. A small disc of cartilage separates the bones, much like in the knee joint, so that the mandible may slide easily; each time you chew you move it. But you also move it every time you talk and each time you swallow (every three minutes or so). It is, therefore, one of the most frequently used of all joints of the body and one of the most complex. You can locate this joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way and shut it. The motion you feel is the TMJ. You can also feel the joint motion in your ear canal. These maneuvers can cause considerable discomfort to a patient who is having TMJ trouble, and physicians use these maneuvers with patients for diagnosis.

When you bite down hard, you put force on the object between your teeth and on the joint. In terms of physics, the jaw is the lever and the TMJ is the fulcrum. Actually, more force is applied (per square foot) to the joint surface than to whatever is between your teeth. To accommodate such forces and to prevent too much wear and tear, the cartilage between the mandible and skull normally provides a smooth surface, over which the joint can freely slide with minimal friction. Therefore, the forces of chewing can be distributed over a wider surface in the joint space and minimize the risk of injury. In addition, several muscles contribute to opening and closing the jaw and aid in the function of the TMJ.

? 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

The pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew, or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head (the temple), the cheek, the lower jaw, and the teeth. A very common focus of pain is in the ear. Many patients come to the ear specialist quite convinced their pain is from an ear infection. When the earache is not associated with a hearing loss and the eardrum looks normal, the doctor will consider the possibility that the pain comes from a TMJ dysfunction. There are a few other symptoms besides pain that TMJ dysfunction can cause. It can make popping, clicking, or grinding sounds when the jaws are opened widely. Or the jaw locks wide open (dislocated). At the other extreme, TMJ dysfunction can prevent the jaws from fully opening. Some people get ringing in their ears from TMJ trouble.

In most patients, pain associated with the TMJ is a result of displacement of the cartilage disc that causes pressure and stretching of the associated sensory nerves. The popping or clicking occurs when the disk snaps into place when the jaw moves. In addition, the chewing muscles may spasm, not function efficiently, and cause pain and tenderness. Both major and minor trauma to the jaw can significantly contribute to the development of TMJ problems. If you habitually clench, grit, or grind your teeth, you increase the wear on the cartilage lining of the joint, and it doesn't have a chance to recover. Many persons are unaware that they grind their teeth, unless someone tells them so. Chewing gum much of the day can cause similar problems. Stress and other psychological factors have also been implicated as contributory factors to TMJ dysfunction. Other causes include teeth that do not fit together properly (improper bite), mal-positioned jaws, and arthritis. In certain cases, chronic mal-position of the cartilage disc and persistent wear in the cartilage lining of the joint space can cause further damage.

Because TMJ symptoms often develop in the head and neck, otolaryngologists are appropriately qualified to diagnose TMJ problems. Proper diagnosis of TMJ begins with a detailed history and physical, including careful assessment of the teeth occlusion and function of the jaw joints and muscles. If the doctor diagnoses your case early, it will probably respond to these simple, self-remedies: ? Rest the muscles and joints by eating soft foods. ? Do not chew gum. ? Avoid clenching or tensing. ? Relax muscles with moist heat (1/2 hour at least twice daily). In cases of joint injury, ice packs applied soon after the injury can help reduce swelling. Relaxation techniques and stress reduction, patient education, non-steroidal anti-inflammatory drugs, muscle relaxants or other medications may be indicated in a dose your doctor recommends. Other therapies may include fabrication of an occlusal splint to prevent wear and tear on the joint. Improving the alignment of the upper and lower teeth and surgical options are available for advanced cases. After diagnosis, your otolaryngologist may suggest further consultation with your dentist and oral surgeon to facilitate effective management of TMJ dysfunction.

Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the para-nasal sinuses. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants; chronic sinusitis is characterized by at least four recurrences of acute sinusitis. Either medication or surgery is a possible treatment.

Millions around the world suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade possibly due to increased pollution, urban sprawl, and increased resistance to antibiotics.

For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough not due to asthma (in children). Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain, and cough. Acute sinusitis can last four weeks or more. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection.

Acute sinusitis is generally treated with ten to 14 days of antibiotic care. With treatment, the symptoms disappear, and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms.

Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: facial pain/pressure, facial congestion/fullness, nasal obstruction/blockage, thick nasal discharge/discolored post-nasal drainage, pus in the nasal cavity, and at times, fever. They may also have headache, bad breath, and fatigue.

Warm moist air may alleviate sinus congestion. Experts recommend a vaporizer or steam from a pan of boiled water (removed from the heat). Humidifiers should be used only when a clean filter is in place to preclude spraying bacteria or fungal spores into the air. Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are also helpful in moisturizing nasal passages.

To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral decongestants. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). Antihistamines may be recommended for the treatment of allergies.

Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell). Inflammation from allergy causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus surgery can correct the problem.

The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in place as possible. Otolaryngologist--head and neck surgeons have found endoscopic surgery to be highly effective in restoring normal function to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus.

Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and infection of the bone or bone marrow can occur.

Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age.

The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing. People who snore may suffer from: ? Poor muscle tone in the tongue and throat. When muscles are too relaxed, either from alcohol or drugs that cause sleepiness, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. This can also happen during deep sleep. ? Excessive bulkiness of throat tissue. Children with large tonsils and adenoids often snore. Overweight people have bulky neck tissue, too. Cysts or tumors can also cause bulk, but they are rare. ? Long soft palate and/or uvula. A long palate narrows the opening from the nose into the throat. As it dangles, it acts as a noisy flutter valve during relaxed breathing. A long uvula makes matters even worse. ? Obstructed nasal airways. A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat, and snoring results. So, snoring often occurs only during the hay fever season or with a cold or sinus infection. Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.

Socially, yes! It can be, when it makes the snorer an object of ridicule and causes others sleepless nights and resentfulness. Medically, yes! It disturbs sleeping patterns and deprives the snorer of appropriate rest. When snoring is severe, it can cause serious, long-term health problems, including obstructive sleep apnea.

When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea. Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder. The immediate effect of sleep apnea is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur.

Heavy snorers, those who snore in any position or are disruptive to the family, should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is and what effects it has on the snorer's health.

Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal allergy, infection, deformity, or tonsils and adenoids. Snoring or obstructive sleep apnea may respond to various treatments now offered by many otolaryngologist-head and neck surgeons: ? Uvulopalatopharyngoplasty (UPPP) is a surgery for treating obstructive sleep apnea. It tightens flabby tissues in the throat and palate, and expands air passages. ? Thermal Ablation Palatoplasty (TAP) refers to procedures and techniques that treat snoring and some of them also are used to treat various severities of obstructive sleep apnea. Different types of TAP include bipolar cautery, laser, and radio-frequency. Laser Assisted Uvula Palatoplasty (LAUP) treats snoring and mild obstructive sleep apnea by removing the obstruction in the airway. A laser is used to vaporize the uvula and a specified portion of the palate in a series of small procedures in a doctor's office under local anesthesia. Radio-frequency ablation?some with temperature control approved by the FDA?utilizes a needle electrode to emit energy to shrink excess tissue to the upper airway including the palate and uvula (for snoring), base of the tongue (for obstructive sleep apnea), and nasal turbinates (for chronic nasal obstruction). ? Genioglossus and hyoid advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway. Self-Help for the Light Snorer Adults who suffer from mild or occasional snoring should try the following self-help remedies: ? Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight. ? Avoid tranquilizers, sleeping pills, and antihistamines before bedtime. ? Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring. ? Establish regular sleeping patterns ? Sleep on your side rather than your back. ? Tilt the head of your bed upwards four inches. Remember, snoring means obstructed breathing, and obstruction can be serious. It's not funny, and not hopeless.

Obstruction: Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because stones have formed. Symptoms typically occur when eating. Saliva production starts to flow, but cannot exit the ductal system, leading to swelling of the involved gland and significant pain, sometimes with an infection. Unless stones totally obstruct saliva flow, the major glands will swell during eating and then gradually subside after eating, only to enlarge again at the next meal. Infection can develop in the pool of blocked saliva, leading to more severe pain and swelling in the glands. If untreated for a long time, the glands may become abscessed. It is possible for the duct system of the major salivary glands that connects the glands to the mouth to be abnormal. These ducts can develop small constrictions, which decrease salivary flow, leading to infection and obstructive symptoms. Infection: The most common salivary gland infection in children is mumps, which involves the parotid glands. While this is most common in children who have not been immunized, it can occur in adults. However, if an adult has swelling in the area of the parotid gland only on one side, it is more likely due to an obstruction or a tumor. Infections also occur because of ductal obstruction or sluggish flow of saliva because the mouth has abundant bacteria. You may have a secondary infection of salivary glands from nearby lymph nodes. These lymph nodes are the structures in the upper neck that often become tender during a common sore throat. In fact, many of these lymph nodes are actually located on, within, and deep in the substance of the parotid gland or near the submandibular glands. When these lymph nodes enlarge through infection, you may have a red, painful swelling in the area of the parotid or submandibular glands. Lymph nodes also enlarge due to tumors and inflammation. Tumors: Primary benign and malignant salivary gland tumors usually show up as painless enlargements of these glands. Tumors rarely involve more than one gland and are detected as a growth in the parotid, submandibular area, on the palate, floor of mouth, cheeks, or lips. An otolaryngologist-head and neck surgeon should check these enlargements. Malignant tumors of the major salivary glands can grow quickly, may be painful, and can cause loss of movement of part or all of the affected side of the face. These symptoms should be immediately investigated. Other Disorders: Salivary gland enlargement also occurs in autoimmune diseases such as HIV and Sjogren's syndrome where the body's immune system attacks the salivary glands causing significant inflammation. Dry mouth or dry eyes are common. This may occur with other systemic diseases such as rheumatoid arthritis. Diabetes may cause enlargement of the salivary glands, especially the parotid glands. Alcoholics may have salivary gland swelling, usually on both sides.

Sore throat is a symptom of many medical disorders. Infections cause the majority of sore throats and are contagious. Infections are caused either by viruses such as the flu, the common cold, mononucleosis, or by bacteria such as strep, mycoplasma, or haemophilus. While bacteria respond to antibiotic treatment, viruses do not. Viruses: Most viral sore throats accompany flu or colds along with a stuffy, runny nose, sneezing, and generalized aches and pains. These viruses are highly contagious and spread quickly, especially in winter. The body builds antibodies that destroy the virus, a process that takes about a week. Sore throats accompany other viral infections such as measles, chicken pox, whooping cough, and croup. Canker sores and fever blisters in the throat also can be very painful. One viral infection takes much longer than a week to be cured: infectious mononucleosis, or "mono." This virus lodges in the lymph system, causing massive enlargement of the tonsils, with white patches on their surface and swollen glands in the neck, armpits, and groin. It creates a severely sore throat and, sometimes, serious breathing difficulties. It can affect the liver, leading to jaundice? yellow skin and eyes. It also causes extreme fatigue that can last six weeks or more. "Mono," a severe illness in teenagers but less severe in children, can he transmitted by saliva. So it has been nicknamed the "kissing disease," but it can also be transmitted from mouth-to-hand to hand-to-mouth or by sharing of towels and eating utensils. Bacteria: Strep throat is an infection caused by a particular strain of streptococcus bacteria. This infection can also damage the heart valves (rheumatic fever) and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections. Because of these possible complications, a strep throat should be treated with an antibiotic. Strep is not always easy to detect by examination, and a throat culture may be needed. These tests, when positive, persuade the physician to prescribe antibiotics. However, strep tests might not detect other bacteria that also can cause severe sore throats that deserve antibiotic treatment. For example, severe and chronic cases of tonsillitis or tonsillar abscess may be culture negative. Similarly, negative cultures are seen with diphtheria, and infections from oral sexual contacts will escape detection by strep culture tests. Tonsillitis is an infection of the lumpy tissues on each side of the back of the throat. In the first two to three years of childhood, these tissues "catch" infections, sampling the child's environment to help develop his immunities (antibodies). Healthy tonsils do not remain infected. Frequent sore throats from tonsillitis suggest the infection is not fully eliminated between episodes. A medical study has shown that children who suffer from frequent episodes of tonsillitis (such as three- to four- times each year for several years) were healthier after their tonsils were surgically removed. Infections in the nose and sinuses also can cause sore throats, because mucus from the nose drains down into the throat and carries the infection with it. The most dangerous throat infection is epiglottitis, caused by bacteria that infect a portion of the larynx (voice box) and cause swelling that closes the airway. This infection is an emergency condition that requires prompt medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult. A strep test may miss this infection. Allergy: The same pollens and molds that irritate the nose when they are inhaled also may irritate the throat. Cat and dog danders and house dust are common causes of sore throats for people with allergies to them. Irritation: During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need examination and treatment of the nose. Pollutants and chemicals in the air can irritate the nose and throat, but the most common air pollutant is tobacco smoke. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods. A person who strains his or her voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain but also from the rough treatment of his or her throat membranes. Reflux: An occasional cause of morning sore throat is regurgitation of stomach acids up into the back of the throat. To avoid reflux, tilt your bed frame so that the head is elevated four- to six-inches higher than the foot of the bed. You might find antacids helpful. You should also avoid eating within three hours of bedtime, and eliminate caffeine and alcohol. If these tips fail, see your doctor. Tumors: Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long-time use of tobacco and alcohol. Sore throat and difficulty swallowing, sometimes with pain radiating to the ear, may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Other important symptoms include hoarseness, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.

Whenever a sore throat is severe, persists longer than the usual five- to seven- day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your physician: -Severe and prolonged sore throat -Difficulty breathing -Difficulty swallowing -Difficulty opening the mouth -Joint pain -Earache - Rash -Fever (over 101?) -Blood in saliva or phlegm -Frequently recurring sore throat -Lump in neck -Hoarseness lasting over two weeks

Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or "glands" found in the neck, groin, and armpits. Tonsils are the two masses on the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments. Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. They "sample" bacteria and viruses and can become infected themselves. Scientists believe they work as part of the body's immune system by filtering germs that attempt to invade the body, and that they help to develop antibodies to germs. This happens primarily during the first few years of life, becoming less important as we get older. Children who must have their tonsils and adenoids removed suffer no loss in their resistance.

The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing and swallowing problems. Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. Tumors are rare, but can grow on the tonsils.

Tonsillitis is an infection in one or both tonsils. One sign is swelling of the tonsils. Other signs or symptoms are: -Redder than normal tonsils -A white or yellow coating on the tonsils -A slight voice change due to swelling -Sore throat -Uncomfortable or painful swallowing -Swollen lymph nodes (glands) in the neck -Fever -Bad breath

If your or your child's adenoids are enlarged, it may be hard to breathe through the nose. Other signs of constant enlargement are: -Breathing through the mouth instead of the nose most of the time -Nose sounds "blocked" when the person speaks -Noisy breathing during the day -Recurrent ear infections -Snoring at night - Breathing stops for a few seconds at night during snoring or loud breathing (sleep apnea)

Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Sometimes, removal of the tonsils and/or adenoids may be recommended. The two primary reasons for tonsil and/or adenoid removal are (1) recurrent infection despite antibiotic therapy and (2) difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children. Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes malformations of the face and improper alignment of the teeth. Chronic infection can affect other areas such as the eustachian tube, the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and potential hearing loss. Recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion). In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., cortisone) is sometimes helpful.

Your child: Talk to your child about his/her feelings and provide strong reassurance and support throughout the process. Encourage the idea that the procedure will make him/her healthier. Be with your child as much as possible before and after the surgery. Tell him/her to expect a sore throat after surgery. Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward. If your child has a friend who has had this surgery, it may be helpful to talk about it with that friend. Adults and children: For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye's syndrome). ? If the patient or patient's family has had any problems with anesthesia, the surgeon should be informed. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed. ? A blood test and possibly a urine test may be required prior to surgery. ? Generally, after midnight prior to the operation, nothing (chewing gum, mouthwashes, throat lozenges, toothpaste, water) may be taken by mouth. Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous. When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient's history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery. After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient until discharged. Every patient is special, and recovery times vary for each individual. Many patients are released after 2?10 hours. Others are kept overnight. Intensive care may be needed for select cases. Your ENT specialist will provide you with the details of pre-operative and postoperative care and answer any questions you may have. After surgery, there are several postoperative symptoms that may arise. These include (but are not limited to) swallowing problems, vomiting, fever, throat pain, and ear pain. Occasionally, bleeding may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately. Any questions or concerns you have should be discussed openly with your surgeon, who is there to assist you.

Early detection simply means discovering a hearing loss at a very early age - hopefully in the first few days of life. Advances in research and technology have created the means for this to happen. Previously, children's hearing could only be tested by observing a child's behavioral responses to sounds. Today's automated hearing-screening machines do all of the work, so even a sleeping baby's hearing can be measured. Many hospitals now screen a newborn's hearing before he/she is discharged from the hospital. (The sidebar describes the types of hearing tests used with infants and young children.) These early exams are referred to as "screenings" rather than "tests", because their results are not definitive. They can only screen out those babies who are likely to have a hearing loss from those likely not to have a hearing loss. If an initial screening comes back "positive", then a second screening and follow-up testing are performed to confirm whether a hearing loss is present and, if so, the type and nature of the loss. In the hospital, nurses, aides, or other hospital personnel may do the screening, but the test interpretation and follow-up evaluation should be performed by an audiologist (i.e., someone with an advanced degree and appropriate license/certification in evaluating hearing). If a hearing loss is suspected, your pediatrician should refer your child to an ear, nose and throat doctor (otolaryngologist), to rule out any cause of hearing loss which could be medically or surgically corrected. Some parents also decide to seek genetic counseling because, of the many causes of hearing loss, some are hereditary. You may want to know whether you or your spouse carry a gene for hearing loss, or whether the hearing loss is part of a "syndrome" (cluster of symptoms), which may cause related medical problems. The next step after the diagnosis is to find an audiologist whom you feel comfortable with, and who you feel confident will help you manage your child's hearing loss. It is entirely within your rights to "shop" for an audiologist by scheduling initial meetings with several practitioners. You can locate audiologists in your area by asking for referrals from your pediatrician and/or otolaryngologist, as well as by asking other parents of children with hearing loss who they use. When seeking an audiologist for your child, inquire whether your practitioner has experience working with pediatric patients and be sure to observe during your initial visits his/her level of rapport with your child.

Newborns and infants can be tested without their cooperation. There are two commonly used measures-both can be performed on a sleeping infant-that require no response from your baby and are not painful or uncomfortable. ABR (Automated Brain Stem Response): Sounds are presented through earphones while the baby rests quietly or sleeps. Brainstem responses to sound are measured through small electrodes, which are taped on the baby's head. These responses are processed by a computer. OAE (Otoacoustic Emissions): A small probe tip is inserted into the baby's ear canal. It measures the function of the inner ear, or cochlea. Behavioral Testing: These types of tests are used when children are old enough to turn their head in response to sound, or play a game. These tests measure the quietest sounds your child can hear, your child's ability to understand words, and whether fluid or some other obstruction is present in the middle ear. Acoustical Impedance tests can be administered to children of all ages and can help identify middle ear problems (e.g., presence of fluid and status of eardrum) through a non-invasive and computerized technique.

Treatment of salivary diseases falls into two categories: medical and surgical. Selection of treatment depends on the nature of the problem. If it is due to systemic diseases (diseases that involve the whole body, not one isolated area), then the underlying problem must be treated. This may require consulting with other specialists. If the disease process relates to salivary gland obstruction and subsequent infection, your doctor will recommend increased fluid intake and may prescribe antibiotics. Sometimes an instrument will be used to open blocked ducts. If a mass has developed within the salivary gland, removal of the mass may be recommended. Most masses in the parotid gland area are benign (non-cancerous). When surgery is necessary, great care must be taken to avoid damage to the facial nerve within this gland that moves the muscles face including the mouth and eye. When malignant masses are in the parotid gland, it may be possible to surgically remove them and preserve most of the facial nerve. Radiation treatment is often recommended after surgery. This is typically administered four to six weeks after the surgical procedure to allow adequate healing before irradiation. The same general principles apply to masses in the submandibular area or in the minor salivary glands within the mouth and upper throat. Benign diseases are best treated by conservative measures or surgery, whereas malignant diseases may require surgery and postoperative irradiation. If the lump in the vicinity of a salivary gland is a lymph node that has become enlarged due to cancer from another site, then obviously a different treatment plan will be needed. An otolaryngologist-head and neck surgeon can effectively direct treatment. Removal of a salivary gland does not produce a dry mouth, called xerostomia. However, radiation therapy to the mouth can cause the unpleasant symptoms associated with reduced salivary flow. Your doctor can prescribe medication or other conservative treatments that may reduce the dryness in these instances. Salivary gland diseases are due to many different causes. These diseases are treated both medically and surgically. Treatment is readily managed by an otolaryngologist-head and neck surgeon with experience in this area.

Difficulty in swallowing (dysphasia) is common among all age groups, especially the elderly. The term dysphasia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are temporary and not threatening. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself in a short period of time, you should see an otolaryngologist? Head and neck surgeon.

Any interruption in the swallowing process can cause difficulties. It may be due to simple causes such as poor teeth, ill fitting dentures, or a common cold. One of the most common causes of dysphasia is gastro esophageal reflux. This occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort. Other causes may include: stroke; progressive neurological disorder; the presence of a tracheotomy tube; a paralyzed or unmoving vocal cord; a tumor in the mouth, throat, or esophagus; or surgery in the head, neck, or esophageal areas.

Symptoms of swallowing disorders may include: ? Drooling; ? A feeling that food or liquid is sticking in the throat; ? Discomfort in the throat or chest (when gastro esophageal reflux is present); -A sensation of a foreign body or "lump" in the throat; -Weight loss and inadequate nutrition due to prolonged or more significant problems with swallowing; and -Coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing, and being sucked into the lungs.

Many of these disorders can be treated with medication. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is tailored to the particular cause of the swallowing disorder. Gastro esophageal reflux can often be treated by changing eating and living habits, for example: -eat a bland diet with smaller, more frequent meals; -eliminate alcohol and caffeine; -reduce weight and stress; -avoid food within three hours of bedtime; and elevate the head of the bed at night. If these don't help, antacids between meals and at bedtime may provide relief. Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or re-stimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully. Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary. Once the cause is determined, swallowing disorders may be treated with: -medication -swallowing therapy -surgery Surgery is used to treat certain problems. If a narrowing or stricture exists, the area may need to be stretched or dilated. If a muscle is too tight, it may need to be dilated or released surgically. This procedure is called a myotomy and is performed by an otolaryngologist, head and neck surgeon. Many causes contribute to swallowing disorders. If you have a persistent problem swallowing, see an otolaryngologist, head and neck surgeon.

Hoarseness is a general term that describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to the vocal folds that are the sound producing parts of the voice box (larynx). While breathing, the vocal folds remain apart. When speaking or singing, they come together, and as air leaves the lungs, they vibrate, producing sound. The more tightly the vocal folds are held and the smaller the vocal folds, the more rapidly they vibrate. More rapid vibration makes a higher voice pitch. Swelling or lumps on the vocal folds prevent them from coming together properly, which makes a change in the voice.

Acute Laryngitis: There are many causes of hoarseness. Fortunately, most are not serious and tend to go away in a short period of time. The most common causes are acute laryngitis, which usually occurs due to swelling from a common cold, upper respiratory tract viral infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert. Vocal Nodules More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal nodules (singers nodes), which are callous-like growths, or may lead to polyps of the vocal folds (more extensive swelling). Vocal nodules are common in children and adults who raise their voice in work or play. Uncommonly, polyps or nodules may lead to cancer. Gastro esophageal reflux: A common cause of hoarseness in older adults is gastro esophageal reflux, when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal folds. Many patients with reflux related changes of voice do not have symptoms of heartburn. Usually, the voice is worse in the morning and improves during the day. These people may have a sensation of a lump in their throat, mucous sticking in their throat or an excessive desire to clear their throat. Smoking: Smoking is another cause of hoarseness. Since smoking is the major cause of throat cancer, if smokers are hoarse, they should see an otolaryngologist. Other Causes: Many unusual causes for hoarseness include allergies, thyroid problems, neurological disorders, trauma to the voice box, and occasionally, the normal menstrual cycle. Many people experience some hoarseness with advanced age.

? hoarseness lasts longer than 2-3 weeks; -hoarseness is associated with any of the following symptoms: pain not from a cold or flu, coughing up blood, difficulty swallowing, or a lump in the neck; -loss or severe change in voice lasting longer than a few days.

An otolaryngologist will obtain a thorough history of the hoarseness and your general health. Your doctor will usually look at the vocal folds with a mirror placed in the back of your throat. Occasionally a very small lighted flexible tube (fiberoptic scope) may need to be passed through your nose (or in some cases, a rigid scope may be used which is placed in the back of your mouth) in order to view your vocal folds. Videotaping the examination may also help with the analysis. These procedures are not uncomfortable and are well tolerated by most patients. In some cases, special tests (known as acoustic analysis) designed to evaluate the voice, may be recommended. These measure voice irregularities, how the voice sounds, airflow, and other characteristics that are helpful in establishing a diagnosis and guiding treatment.

The treatment of hoarseness depends on the cause. Most hoarseness can be treated by simply resting the voice or modifying how it is used. The otolaryngologist may make some recommendations about voice use behavior, refer the patient to other voice team members, and in some instances recommend surgery if a lesion, such as a nodule or polyp, is identified. Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. Drinking fluids is also helpful. Specialists in speech/language pathology are trained to assist patients in behavior modification that may help eliminate some voice disorders. Sometimes, patients have developed bad habits, such as smoking or overuse of their voice by yelling and screaming. The speech/language pathologist may teach patients to alter their method of speech production to improve the sound of the voice and to resolve problems, such as vocal nodules. When a patient's problem is specifically related to singing, a singing teacher may help improve the patients' singing techniques.

-If you smoke, quit. -Avoid agents that dehydrate the body, such as alcohol and caffeine. Avoid secondhand smoke. -Drink plenty of water. -Humidify your home. -Watch your diet?avoid spicy foods. -Try not to use your voice too long or too loudly. -Seek professional voice training. -Avoid speaking or singing when your voice is injured or hoarse.

Every year, half a million people who are interested in improving the appearance of their noses seek consultation with facial plastic surgeons. Some are unhappy with the noses they were born with, and some with the way aging has changed their nose. For others, an injury may have distorted the nose, or the goal may be improved breathing. But one thing is clear: nothing has a greater impact on how a person looks than the size and shape of the nose. Because the nose is the most defining characteristic of the face, a slight alteration can greatly improve one's appearance. If you have wondered how nose surgery, or Rhinoplasty, could improve your looks, self-confidence, or health, you need to know how Rhinoplasty is performed and what you can expect. No pamphlet can answer all your concerns, but this one can provide answers to many of the questions you may have. Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Your surgeon can answer specific questions about your specific needs.

As with all facial plastic surgery, good health and realistic expectations are prerequisites. Understanding nose surgery is also critical. Since there is no ideal in Rhinoplasty, the goal is to improve the nose aesthetically, making it harmonize better with other facial features. Skin type, ethnic background, and age are important factors to be considered in discussions with your surgeon prior to surgery. Before the nose is altered, a young patient must reach full growth, usually around age fifteen or sixteen. Exceptions are cases in which breathing is severely impaired. Before deciding on Rhinoplasty, ask your facial plastic surgeon if any additional surgery might be recommended to enhance the appearance of your face. Many patients have chin augmentation in conjunction with Rhinoplasty to create a better balance of features.

The definition of Rhinoplasty is, literally, shaping the nose. First, incisions are made and the skin of the nose is lifted from its underlying bone and cartilage support system. The majority of incisions are made inside the nose, where they are invisible. In some cases, an incision is made in the area of skin separating the nostrils. Next, certain amounts of underlying bone and cartilage are removed or rearranged to provide a newly shaped structure. For example, when the tip of the nose is too large, the surgeon can sculpt the cartilage in this area to reduce it in size. The angle of the nose in relation to the upper lip can be altered for a more youthful look or to correct a distortion. The skin is then re-draped over the new frame and the incisions are closed. A splint is applied to the outside of the nose to help retain the new shape while the nose heals. Soft, absorbent material may be used inside the nose to maintain stability along the dividing wall of the air passages called the septum. Risk factors in Rhinoplasty are generally minor, and your facial plastic surgeon will discuss these prior to surgery.

Immediately after surgery, a small splint will be placed on your nose to protect it and to keep the structure stable for at least five to eight days. If packing is placed inside the nose during surgery, it is removed the morning following the surgery. Your face will feel puffy, especially the first day after surgery. Pain medication may be required. Your surgeon will advise you to avoid blowing your nose for seven days after surgery. In the immediate days following surgery, you may experience bruising and minor swelling in the eye area. Cold compresses often reduce the bruising and discomfort. Absorbable sutures are usually used that do not have to be removed. Nasal dressing and splints are usually removed six or seven days after surgery. It is crucial that you follow your surgeon's directions, especially instructions to keep your head elevated for a certain period after surgery. Some activities will be prohibited in the weeks after the procedure. Sun exposure, exertion, and risk of injury must be avoided. If you wear glasses, special arrangements must be made to ensure that the glasses do not rest on the bridge of the nose. Tape and other devices are sometimes used to permit wearing glasses without stressing the area where surgery was performed. Follow-up care is vital for this procedure to monitor healing. Obviously, anything unusual should be reported to your surgeon immediately. It is essential that you keep your follow-up appointments with your surgeon

Probably no other physical characteristic cries out for facial plastic surgery more than protruding ears. Children, long the victims of cruel nicknames like "Dumbo" or "Mickey Mouse", are the most likely candidates for Otoplasty, but this surgery can be performed at any age after the ears have reached full size, usually around five to six years of age. Even if the ears are only mildly distorted, the condition can lead to self-consciousness and poor adaptation to school. When it comes to Otoplasty, conventional wisdom is the earlier the better. Adults may also benefit from this procedure, which improves self-esteem with relative ease. Often, adults choose this surgery in conjunction with other facial plastic surgical procedures. Not only is it possible to "pin back" ears, but ears can also be reshaped, reduced in size, or made more symmetrical. If you are wondering how Otoplasty can improve the way you look, you need to know how Otoplasty is performed and what you can expect from this procedure. This pamphlet can address many of your concerns. Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Your surgeon can answer specific questions about your specific needs.

General good health and realistic expectations are prerequisites. It is also important to understand the surgery. Otoplasty will not alter hearing ability. What is important for successful Otoplasty is that the ears be in proportion to the size and shape of the face and head. When considering Otoplasty, parents must be confident that they have their child's best interests at heart. A positive attitude toward the surgery is an important factor in all facial plastic surgery, but it is especially critical when the patient is a child or adolescent. Adult candidates for Otoplasty should understand that the firmer cartilage of fully developed ears does not provide the same molding capacity as in children. A consultation with a facial plastic surgeon can help parents decide what is best for their child, not only aesthetically, but also psychologically and physically. Timing is always an important consideration. Having the procedure at a young age is highly desirable in two respects: the cartilage is extremely pliable, thereby permitting greater ease of shaping; and secondly, the child will experience psychological benefits from the cosmetic improvement.

Surgery begins with an incision just behind the ear, in the natural fold where the ear is joined to the head. The surgeon will then remove the necessary amounts of cartilage and skin required to achieve the right effect. In some cases, the surgeon will trim the cartilage, shaping it into a more desirable form and then pin the cartilage back with permanent sutures to secure the cartilage. In other instances, the surgeon will not remove any cartilage at all, using stitches to hold the cartilage permanently in place. After sculpting the cartilage to the desired shape, the surgeon will apply sutures to anchor the ear until healing occurs to hold the ear in the desired position.

Soft dressings applied to the ears will remain for a few days. Most patients experience some mild discomfort. If you are accustomed to sleeping on your side, your sleep patterns may be disrupted for a week or so because you cannot put any pressure on the ear areas. Headbands are sometimes recommended to hold the ears in the desired position for two weeks after the surgery. The risks are minimal. There will be a thin white scar behind the ear after healing. Because this scar is in a natural crease behind the ear, the problem of visibility is inconsequential. Anything unusual should be reported to the surgeon immediately. Facial plastic surgery makes it possible to correct many facial flaws that can often undermine one's self-confidence. By changing how you look, cosmetic surgery can help change how you feel about yourself.

Stuttering is a disorder of speech fluency that interrupts the forward flow of speech. All individuals are not fluent at times, but what differentiates the person who stutters from someone with normal speech disfluencies is the kind and amount of the disfluencies.

? Repetition of sounds (e.g., b-b-b-ball), syllables (e.g., mo-mo-mommy), parts of words (e.g., basket-basket-basketball), whole words, and phrases -Prolongation, or stretching, of sounds or syllables (e.g., r-----abbit) -Tense pauses, hesitations, and/or no sound between words ? Speech that occurs in spurts, as the client tries to initiate or maintain voice -Related behaviors: reactions that accompany stuttering such as tense muscles in the lips, jaw, and/or neck; tremor of the lips, jaw, and/or tongue during attempts to speak; foot tapping. eye blinks, head turns, etc. [to try to escape from the stuttering]; etc. There are many related behaviors that can occur and vary from person to person. -Variability in stuttering behavior, depending on the speaking situation, the communication partner(s), and the speaking task. A person who stutters may experience more fluency in the speech-language pathologist' s office than in a classroom or workplace. There may be no difficulty making a special dinner request at home, but extreme difficulty ordering a meal in a restaurant. Conversation with a spouse may be easier, and more fluent, than that with a boss. A person may be completely fluent when singing, but experience significant stuttering when talking on the telephone. -A feeling of loss of control. The person who stutters may experience sound and word fears, situational fears, anticipation of stuttering, embarrassment, and a sense of shame. Certain sounds or words may be avoided. One word may be substituted for another that is thought to be harder to say, or certain speaking situations may be avoided altogether. For example, a person who stutters may always wait for someone else to answer the phone, or he or she may walk around a store for an hour rather than ask sales staff where an item can be found. These reactions to stuttering occur in more advanced stages.

Every one be lacking in fluency at times and may sometimes have repetitions and prolongations. However, the disfluencies of people who do not stutter are not as frequent as those who do. The kind of disfluencies are also generally different. Normal disfluencies tend to be a repetition of whole words or the interjection of syllables like um and er. while stuttering tends to be repetition and prolongation of sounds and syllables.

Almost all children go through a stage of frequent disfluency in early speech development, usually between the ages of 2 and 5. Speech is produced easily in spite of the disfluencies. As children mature and sharpen their communication skills, these disfluencies typically disappear, but not always. Stuttering usually starts during this same time period, but may occasionally appear for the first time in a school-age child and, more rarely, in an adult. As a parent, seek the advice of an ASHA-certified speech-language pathologist if: you or your child are concerned about his or her speech, disfluencies begin to occur more often, disfluencies begin to sound effortful or strained.

The goals of speech-language pathology treatment are improved fluency and success in communication. There are a variety of successful approaches for accomplishing these goals. There are no published scientific data that indicate the general superiority of any one approach. Prior to treatment, the speech-language pathologist will conduct a detailed evaluation. This assessment may include: ? a developmental and behavioral history of speech and language by interviewing family members and/or the person who stutters ? a structured speech sample (e.g., a recording of the person describing a picture, reading a passage aloud, or describing a job or favorite activity), speech samples in different everyday communication situations, determination of variables that may affect speech fluency through interviews and review of video, and/or audiotapes experimentation with different fluency strategies to assess how they may improve speech, observation of articulation, expressive and receptive language skills, cognitive skills, voice, hearing and vision and information from other professionals, as necessary, to help plan treatment. Fluency strategies may include: reducing the rate of speech and using slow, smooth speech movements, easing into voicing of speech sounds, voicing continuously during utterances articulating lightly, starting air flow for speech before any other muscle movement and other techniques Special equipment or a computer may be used to teach these strategies or give immediate feedback on how well these strategies are being used. The person who stutters may also be taught different things to do when he or she has a stuttering block or feels that one is about to occur. Reducing tension in specific muscle groups and substituting a bouncing kind of speech are examples of this kind of strategy. The speech-language pathologist may also provide suggestions and counseling on modifying the speaking situation. Parents and other communication partners may be asked to modify their behaviors by talking more slowly or not interrupting. The person who stutters may want to tell a stranger, "I stutter. It may take me longer to say a sentence than what you are used to." Such a statement reduces the time pressure to speak and makes it easier to use slower, more relaxed speech. In general, the speech-language pathologist and the person who stutters will discuss different speaking situations and determine together the best way to handle them, even those that are feared or have been avoided by the person who stutters.

We still do not know what causes stuttering. It may be caused by different factors for different people, or it may occur when a combination of elements comes together. Furthermore, what causes stuttering may be very different from what makes the behavior continue or get worse. Possible conditions that may cause stuttering are in coordination of the speech muscles, the way people talk to a child, the rate of language development, and life stresses. We do know that children who stutter are no more likely to have psychological problems than children who do not stutter. In general, there is no reason to believe that emotional trauma causes stuttering.

-Try not to finish sentences or fill in words. No one likes words put in his or her mouth. Problems can also multiply if you guess wrong. - Avoid suggestions such as "Slow down," "Relax," of "Take a Breath." If these suggestions worked, the person wouldn't stutter. - Wait patiently until your conversational partner is finished speaking. Maintain eye contact and try not to look embarrassed or alarmed. -Talk about stuttering openly. It should not be a taboo subject. Your friend or family member will appreciate your interest in the subject. -Do not be afraid to say, "I' m sorry, I didn' t understand what you said." No matter how much of a struggle your communication partner had with stating a point or idea, it is preferable to say something rather than to guess what you think was being said. -Talk in a relaxed, slower than normal manner. -Try not to interrupt. -Do not criticize or correct the speech.

Your son is 2 years old and is still not talking. He says a few words, but in comparison to his peers, you think he's way behind. You remember that his sister could put whole sentences together at this age. Hoping he will catch up, you postpone seeking professional advice. Some kids are early walkers and some are early talkers, you tell yourself. Nothing to worry about This scenario is common among parents of children who are slow to speak. Unless they observe other areas of "slowness" in the early development of their child, parents may hesitate to seek advice. They may excuse their child's not talking by reassuring themselves that "he'll outgrow it" or "he's just more interested in physical things." Don't Wait to Evaluate Children as young as 12 to 18 months should probably be seen by a professional if their parents suspect delayed communication skills. Parents should also seek help if their child of any age does not respond to sound. An early evaluation is important if there is a problem. And if there's no problem, parents' fears can be eased. The result may be that parents' expectations are simply too high. Educational materials that outline developmental stages and milestones may help them look at their child more realistically. In other cases, parents can be taught to enrich the home environment to foster the development of language skills. When speech, language, hearing, or developmental deficits do exist, early intervention will help the child get the help he needs to avoid future learning problems. There is a distinction between speech and language. Speech is pronunciation; it refers to how well a person can articulate sounds in words. Language means expressing and receiving information in a way that is meaningful. It is understanding and being understood through communication. A child with a language problem may be able to pronounce words well but unable to put more than two words together. Conversely, another child's speech may be difficult to understand, but he uses words and phrases to express his ideas. Problems in speech and language differ but frequently overlap.

There are many reasons for delays in speech and language development. Speech delays in an otherwise normally developing child are rarely caused by oral impairments, such as problems with the tongue or palate. Being "tongue-tied" (when the frenulum - the fold beneath the tongue - is too tight) is almost never a cause of delayed speech. However, hearing deficits are commonly related to delayed speech. If a child has trouble hearing, he may have trouble understanding, imitating, and using language. Ear infections, especially chronic infections, can affect hearing ability. That's why it's important for parents to aggressively pursue treatment of ear infections in babies and young children. Simple ear infections that have been adequately treated, though, should have no effect on speech. A number of children with speech delays have oral-motor problems, meaning there is inefficient communication in the areas of the brain responsible for speech production. The child encounters difficulty using his lips, tongue, and jaw to produce speech sounds. Speech may be the only problem or may be accompanied by other oral-motor deficits such as feeding difficulties. A speech delay may also indicate a more global developmental delay.

When parents have a better understanding of why their child isn't talking, they can learn many ways to encourage speech development. Like so many other things, speech development is a mixture of nature and nurture. A child's genetic makeup will in part determine his intellect and capacity for speech and language. However, much depends on his environment. Is the child adequately stimulated at home or at child care? Does he have opportunities for communication exchange and participation? What kind of feedback does he get? Parents should begin communicating with their children during infancy; this includes reading. You don't have to finish a whole book; in fact, an 18- to 24-month-old probably won't sit still for it. Try starting with a short book such as Pat the Bunny, where the child imitates the patting motion. Use high-pitched sounds when reading - babies are known to respond to these. Then go on to nursery rhymes, which have rhythmic appeal. Progress to predictable books where the child can anticipate what happens and understand why it happens.

-your 2- to 3-year-old can only imitate speech or actions and does not produce words or phrases spontaneously -he says only certain sounds or words repeatedly -his voice quality seems unusual, or it is very difficult for others to understand his speech -he cannot use oral language to communicate more than his immediate needs -he cannot follow simple directions In conducting an evaluation, a speech-language pathologist will look at your child's speech and language skills within the context of his total development. Standardized tests and scales are used, along with observations of your child and the professional's knowledge of landmarks in speech and language development. Receptive and expressive communication skills, hearing, and oral-motor status are explored. If speech therapy is required, you should be very involved. You can observe therapy sessions and learn to participate in the process.

Developmental Stages It may be difficult to tell whether your child is immature in his ability to communicate or if he has a problem that requires professional attention. The following developmental norms may provide clues: -Before 12 months: You should observe your child for signs that he is using his voice to relate to his environment. At this age, children should also be attentive to sound. Babies who watch intently but do not react to sound may be showing signs of hearing loss. -By 12 to 15 months: Children should have a wide range of speech sounds in their babbling and one or more true words. Usually nouns emerge first. Your child should also be able to understand and follow single directions ("Give me the toy," for example). -From 18 to 24 months: Children should have a vocabulary of 50 or more word approximations by the time they turn 2 and should be learning to combine words, such as "baby crying" or "Daddy big." At this age, your child should also begin to understand concepts, such as spatial concepts (in, out, off, for example). -From 2 to 3 years: Parents often witness an "explosion" in their child's speech. Your child's vocabulary should increase and he should routinely combine three or more words into sentences. The child's comprehension should increase - he will begin to understand what it means to "put it on the table" or "put it under the bed" as well as descriptive concepts (big versus little, for example) and color identification.

Most people recognize dental amalgams as silver fillings. Dental amalgam is a mixture of mercury, and an alloy of silver, tin and copper. Mercury makes up about 45-50 percent of the compound. Mercury is used to bind the metals together and to provide a strong, hard durable filling. After years of research, mercury has been found to be the only element that will bind these metals together in such a way that can be easily manipulated into a tooth cavity.

Mercury in dental amalgam is not poisonous. When mercury is combined with other materials in dental amalgam, its chemical nature changes, so it is essentially harmless. The amount released in the mouth under the pressure of chewing and grinding is extremely small and no cause for alarm. In fact, it is less than what patients are exposed to in food, air, and water. Ongoing scientific studies conducted over the past 100 years continue to prove that amalgam is not harmful. Claims of diseases caused by mercury in amalgam are anecdotal, as are claims of miraculous cures achieved by removing amalgam. These claims have not been proven scientifically.

Dental amalgam has withstood the test of time, which is why it is the material of choice. It has a 150-year proven track record and is still one of the safest, durable and least expensive materials to a fill a cavity. It is estimated that more than 1 billion amalgam restorations (fillings) are placed annually. Dentists use dental amalgams because it is easier to work with than other alternatives. Some patients prefer dental amalgam to other alternatives because of its safety, cost-effectiveness, and ability to be placed in the tooth cavity quickly.

Alternatives to amalgam, such as cast gold restorations, porcelain, and composite resins are more costly. Gold and porcelain restorations take longer to make and can require two appointments. Composite resins, or white fillings, are esthetically appealing, but require a longer time to place the restoration. It should also be known that these materials, with the exception of gold, are not as durable as amalgam.

The incidence of allergy to mercury is less than one percent of the population. People suspected of having an allergy to mercury should receive tests by qualified physicians, and, when necessary, seek appropriate alternatives. Should patients have amalgams removed? No. To do so, without need, would result in unnecessary expense, and potential injury to teeth.

A dental implant is an artificial tooth root (synthetic material) that is surgically anchored into your jaw to hold a replacement tooth or bridge in place. The benefit of using implants is that they don't rely on neighboring teeth for support, they are permanent and stable. Implants are a good solution to tooth loss because they look and feel like natural teeth. Implant material is made from different types of metallic and bone-like ceramic materials that are compatible with body tissue. There are different types of dental implants: the first is placed directly into the jaw bone, like natural tooth roots; the second is used when the jaw structure is limited, therefore, a custom-made metal framework fits directly on the existing bone.

Strategically placed, implants can now be used to support permanently cemented bridges, eliminating the need for a denture. The cost tends to be greater, but the implants and bridges more closely resemble real teeth.

Talk with your dentist about whether you are an implant candidate. You must be in good health and have the proper bone structure and healthy gums for the implant to stay in place. People who are unable to wear dentures may also be good candidates. If you suffer from chronic problems, such as clenching or bruxism, or systemic diseases, such as diabetes, the success rate for implants decreases dramatically. Additionally, people who smoke or drink alcohol may not be good candidates.

The dentist must perform surgery to anchor the "artificial root" into or on your jaw bone. The procedure is done in the dental office with local anesthesia. Medications may be prescribed for soreness.

The process can take up to nine months to complete. Technology, however, is trying to decrease the healing time involved. Each patient heals differently, so times will vary. After the screws and posts are placed surgically, the healing process can take up to six months and the fitting of replacement teeth no more than two months.

The success rate for implants depends on the tooth's purpose and location in the mouth. The success rate is about 95 percent for those placed in the front of the lower jaw and 85 percent for those placed in the sides and rear of the upper jaw.

Your overall health may affect the success rate of dental implants. Poor oral hygiene is a big reason why some implants fail. It is important to floss and brush around the fixtures at least twice a day, without metal objects. Your dentist will give you specific instructions on how to care for your new implants. Additional cleanings of up to four times per year may be necessary to ensure that you retain healthy gums.

Plaque is a sticky layer of material containing germs that accumulates on teeth, including places where toothbrushes can't reach. This can lead to gum diseases. The best way to get rid of plaque is to brush and floss your teeth carefully every day. The toothbrush cleans the tops and sides of your teeth. Dental floss cleans in between them. Some people use water-picks, but floss is the best choice.

Yes. Floss removes plaque and debris that adhere to teeth and gums in between teeth, polishes tooth surfaces, and controls bad breath. Floss is the single most important weapon against plaque, perhaps more important than the toothbrush. Many people just don't spend enough time flossing or brushing and many have never been taught to floss or brush properly. When you visit your dentist or hygienist, ask to be shown.

Flossing is the one most important step in oral care that people forget to do or claim they don't have time for. By flossing your teeth daily, you increase the chances of keeping your teeth a lifetime and decrease your chance of having periodontal or gum disease. Flossing cleans away the plaque from between your teeth, decreases the chance of interproximal decay and increases blood circulation in the gums.

Dental floss comes in many forms: waxed and unwaxed, flavored and unflavored, wide and regular. Wide floss, or dental tape, may be helpful for people with a lot of bridgework. Tapes are usually recommended when the spaces between teeth are wide. They all clean and remove plaque about the same. Waxed floss might be easier to slide between tight teeth or tight restorations. However, the unwaxed floss makes a squeaking sound to let you know your teeth are clean. Bonded unwaxed floss does not fray as easily as regular unwaxed floss, but does tear more than waxed floss.

There are two flossing methods: the spool method and the loop method. The spool method is suited for those with manual dexterity. Take an 18-inch piece of floss and wind the bulk of the floss lightly around the middle finger. (Don't cut off your finger's circulation!) Wind the rest of the floss similarly around the same finger of the opposite hand. This finger takes up the floss as it becomes soiled or frayed. Maneuver the floss between teeth with your index fingers and thumbs. Don't pull it down hard against your gums or you will hurt them. Don't rub it side to side as if you're shining shoes. Bring the floss up and down several times forming a "C" shape around the tooth being sure to go below the gum line. The loop method is suited for children or adults with less nimble hands, poor muscular coordination or arthritis. Take an 18-inch piece of floss and make it into a circle. Tie it securely with three knots. Place all of the fingers, except the thumb, within the loop. Use your index fingers to guide the floss through the lower teeth, and use your thumbs to guide the floss through the upper teeth, going below the gum line forming a "C" on the side of the tooth.

At least once a day. To give your teeth a good flossing, spend at least two or three minutes.

In a pinch, toothpicks are effective at removing food between teeth, but for daily cleaning of plaque between teeth, floss is recommended. Toothpicks come round and flat, narrow and thick. When you use a toothpick, don't press too hard as you can break off the end and lodge it in your gums.

More than 90 million people suffer from chronic halitosis or bad breath. In most cases it originates from the gums and tongue. The odor is caused by bacteria from the decay of food particles, other debris in your mouth, and poor oral hygiene. The decay and debris produce a sulfur compound that causes the unpleasant odor.

Bad breath is primarily caused by poor oral hygiene, but can also can be caused by retained food particles or gum disease. Proper brushing including brushing the tongue, cheeks, and the roof of the mouth will remove bacteria and food particles. Flossing removes accumulated bacteria, plaque and food that may be trapped between teeth. Mouth rinses are effective in temporary relief of bad breath. Consult your dentist and/or physician if the condition persists.

Bad breath also may occur in people who have a medical infection, gum disease, diabetes, kidney failure, or a liver malfunction. Xerostomia (dry mouth) and tobacco also contribute to this problem. Cancer patients who undergo radiation therapy may experience dry mouth. Even stress, dieting, snoring, age and hormonal changes can have an effect on your breath. An odor that comes from the back of your tongue may indicate post-nasal drip. This is where the mucus secretion, which comes from the nose and moves down your throat, gets stuck on the tongue and causes an odor. Bad breath originating in the stomach, however, is considered to be extremely rare.

Saliva is the key ingredient in your mouth that helps keep the odor under control because it helps wash away food particles and bacteria, the primary cause of bad breath. When you sleep, however, salivary glands slow down the production of saliva allowing the bacteria to grow inside the mouth. To alleviate "morning mouth," brush your teeth and eat a morning meal. Morning mouth also is associated with hunger or fasting. Those who skip breakfast, beware because the odor may reappear even if you've brushed your teeth.

Very spicy foods, such as onions and garlic, and coffee may be detected on a person's breath for up to 72 hours after digestion. Onions, for example, are absorbed by the stomach and the odor is then excreted through the lungs. Studies even have shown that garlic rubbed on the soles of the feet can show up on the breath.

It is important to practice good oral hygiene, such as brushing and flossing your teeth at least twice a day. To alleviate the odor, clean your tongue with your toothbrush or a tongue scraper, a plastic tool that scrapes away bacteria that builds on the tongue. Chewing sugar-free gum also may help control the odor. If you have dentures or a removable appliance, such as a retainer or mouthguard, clean the appliance thoroughly before placing it back in your mouth. Before you use mouth rinses, deodorizing sprays or tablets, talk with your dentist because these products only mask the odor temporarily, and some products work better than others.

Visit your dentist regularly because checkups will help detect any physical problems. Checkups also help get rid of the plaque and bacteria that build up on your teeth. If you think that you suffer from bad breath, your dentist can help determine its source. He or she may ask you to schedule a separate appointment to find the source of the odor, or if your dentist believes that the problem is caused from a systemic source (internal), such as an infection, he or she may refer you to your family physician or a specialist to help remedy the cause of the problem.

Generally, bleaching is successful in at least 90 percent of patients, though it may not be an option for everyone. Consider tooth bleaching if your teeth are darkened from age, coffee, tea or smoking. Teeth darkened with the color of yellow, brown or orange respond better to lightening. Other types of gray stains caused by fluorosis, smoking or tetracycline are lightened, but results are not as dramatic. If you have very sensitive teeth, periodontal disease, or teeth with worn enamel, your dentist may discourage bleaching.

First, the dentist will determine whether you are a candidate for tooth bleaching and what type of bleaching system would provide the best results. If you're in a hurry for whiter teeth, you may decide to have your teeth lightened immediately. Your dentist will use either an in-office bleaching system or laser bleaching while you sit in the dental chair. However, most patients choose dentist-supervised at-home bleaching, which is more economical and provides the same results. At the next appointment if you don't choose laser bleaching, the dentist or hygienist will make impressions of your teeth to fabricate a mouthguard appliance for you. The mouthguard is custom made for your mouth and is lightweight so that it can be worn comfortably while you are awake or sleeping. The mouthguard is so thin that you should even be able to talk and work while wearing your mouthguard. Along with the mouthguard, you'll receive the bleaching materials. You'll be given instructions on how to wear the mouthguard. Some bleaching systems recommend bleaching your teeth from two to four hours a day. Generally this type of system requires three to six weeks to complete, and works best on patients with sensitive teeth. Other systems recommend bleaching at night while you sleep. This type of system usually requires only 10-14 days to complete.

Lightness should last from one to five years, depending on your personal habits such as smoking and drinking coffee and tea. At this point you may choose to get a touch up. This procedure may not be as costly because you can probably still use the same mouthguard. The re-treatment time also is much shorter than the original treatment time.

The active ingredient in most of the whitening agents is 10 percent carbamide peroxide (CH4N2O2), also known as urea peroxide; when water contacts this white crystal, the release of hydrogen peroxide lightens the teeth.

Several studies, during the past five years, have proven bleaching to be safe and effective. The American Dental Association has granted its seal of approval to some tooth bleaching products. Some patients may experience slight gum irritation or tooth sensitivity, which will resolve when the treatment ends.

Dry mouth is caused by a decrease in the amount of salvia in the mouth when the salivary glands do not work properly. The salivary glands help keep your mouth moist, which helps prevent decay and other oral health problems. Dry mouth may be a sign of a serious health condition or may occur when a person is upset or experiences stress. It can also be caused by aging, radiation therapy and chemotherapy, medications, or diseases such as AIDS, diabetes or Sjogren's Syndrome. Even patients with Alzheimer's disease or who suffer a stroke may experience dry mouth. Studies show that up to 400 medications, prescriptions and over-the-counter, can contribute to symptoms associated with dry mouth. The most common troublemakers are anti-hypertensives, anti-depressants, painkillers, tranquilizers, diuretics, and antihistamines.

Yes, it can cause health problems. You want to prevent dry mouth if possible because it causes difficulty in tasting, chewing or swallowing. It also allows plaque to build up on your teeth faster, leading to a higher risk of cavities. In certain cases, a lack of moisture can make your tongue become very sensitive, causing a condition called burning tongue syndrome.

Saliva helps wash away cavity-causing bacteria, provides enzymes to help digest food, protects teeth from decay and keeps oral tissues healthy. Without saliva, you would lose your teeth much faster.

Your dentist will want to know if you have difficulty swallowing, difficulty with speech, oral soreness or a dry throat. Help your dentist to diagnose the problem by recognizing the symptoms associated with dry mouth. If you have any questions about this condition, ask your dentist. There are many treatments that can help ease the symptoms, including over-the-counter saliva substitutes. To ease discomfort, your dentist may recommend the following: - Brush and floss twice-a-day - Chew sugarless gum - Avoid alcohol and caffeine - Avoid smoking - Avoid citrus juices (tomato, orange, grapefruit) - Avoid dry foods, such as toast or crackers - Avoid overly salty foods - Drink plenty of water - Use over-the-counter moisture replacement therapies - Regular dentist visits.

A dental sealant is a thin plastic film painted on the chewing surfaces of molars and premolars (the teeth directly in front of the molars). Sealants have been shown to be highly effective in the prevention of cavities. They were developed through dental research in the 1950s and first became available commercially in the early 1970s.

Scientific studies have proven that properly applied sealants are 100 percent effective in protecting the tooth surfaces from caries. Because sealants act as a physical barrier to decay, protection is determined by the sealants' ability to adhere to the tooth. As long as the sealant remains intact, small food particles and bacteria that cause cavities cannot penetrate through or around a sealant. In fact, research has shown that sealants actually stop cavities when placed on top of a slightly decayed tooth by sealing off the supply of nutrients to the bacteria that causes a cavity. Sealant protection is reduced or lost when part or all of the bond between the tooth and sealant is broken. However, clinical studies have shown that teeth that have lost sealants are no more susceptible to tooth decay than teeth that were never sealed.

Sealant application involves cleaning the surface of the tooth and rinsing the surface to remove all traces of the cleaning agent. An etching solution or gel is applied to the enamel surface of the tooth, including the pits and grooves. After 15 seconds, the solution is thoroughly rinsed away with water. After the site is dried, the sealant material is applied and allowed to harden by using a special curing light. Other sealants are applied and allowed to harden much the same way nail polish is applied to fingernails. Sealant treatment is painless and could take anywhere from five to 45 minutes to apply, depending on how many teeth need to be sealed. Sealants must be applied properly for good retention.

Sealants should last five years, but can last as long as 10 years. One study reported that seven years after application, an impressive 49 percent of treated teeth were still completely covered. Sealants should not be considered permanent. Regular dental check-ups are necessary to monitor the sealants' bond to the tooth.

Children, because they have newly erupted, permanent teeth, receive the greatest benefit from sealants. The chewing surfaces of a child's teeth are most susceptible to cavities and the least benefitted by fluoride. Surveys show that approximately two-thirds of all cavities occur in the narrow pits and grooves of a child's newly erupted teeth because food particles and bacteria cannot be cleaned out. Other patients also can benefit from sealant placement, such as those who have existing pits and grooves susceptible to decay. Research has shown that almost everybody has a 95 percent chance of eventually experiencing cavities in the pits and grooves of their teeth.

Bruxism is the technical term for grinding and clenching that abrades teeth and may cause facial pain. People who grind and clench, called bruxers, unintentionally bite down too hard at inappropriate times, such as in their sleep. In addition to grinding teeth, bruxers also may bite their fingernails, pencils and chew the inside of their cheek. People usually aren't diagnosed with bruxism until it is too late because so many people don't realize they have the habit. Others mistakenly believe that their teeth must touch at all times. About one in three people suffer from bruxism, which can easily be treated by a dentist.

People who have otherwise healthy teeth and gums can clench so often and so hard that over time their teeth become sensitive. They experience jaw pain, tense muscles and headaches along with excessive wear on their teeth. Forceful biting when not eating may cause the jaw to move out of proper balance.

When a person has bruxism, the tips of the teeth look flat. Teeth are worn down so much that the enamel is rubbed off, exposing the inside of the tooth which is called dentin. When exposed, dentin may become sensitive. Bruxers may experience pain in their temporomandibular joint (TMJ), the jaw which may manifest itself as popping and clicking. Women have a higher prevalence of bruxism possibly because they are more likely to experience tissue alterations in the jaw resulting from clenching and grinding. Tongue indentations are another sign of clenching. Stress and certain personality types are at the root of bruxism. For as long as humankind has existed, bruxism has affected people with nervous tension. Anger, pain and frustration can trigger bruxing. People who are aggressive, competitive and hurried also may be at a greater risk for bruxism.

During regular dental visits, the dentist automatically checks for physical signs of bruxism. If the dentist or patient notices signs of bruxism, the condition may be observed over several visits to be sure of the problem before recommending and starting therapy. The objective of therapy is to get the bruxer to change behavior by learning how to rest the tongue, teeth and lips properly. When some people become aware of their problem, simply advising them to rest their tongue upward with teeth apart and lips shut may be enough to change their behavior and relieve discomfort. However, the dentist can make a plastic mouth appliance, such as a night guard that's worn to absorb the force of biting. This appliance can prevent future damage to the teeth and helps change the patient's destructive behavior. Biofeedback is used to treat daytime clenchers by using electronic instruments to measure muscle activity and to teach patients how to reduce muscle activity when the biting force becomes too great. Researchers are looking for other ways of treating bruxism, especially for those who tend to clench in their sleep. One researcher developed an experimental lip simulator that electrically stimulates the lip when a person bites down too hard while sleeping. However, that method is being refined because the stimulation can wake sleepers several times in a night.

Fluoride is a compound of the element fluorine, which is found universally throughout nature in water, soil, air and in most foods. Existing abundantly in living tissue as an ion, fluoride is absorbed easily into tooth enamel, especially in children's growing teeth. Once teeth are developed, fluoride makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage is even visible. "Systemic" fluoride is ingested when added to public and private water supplies, soft drinks and teas, and is available in dietary supplement form. Once systemic fluoride is absorbed via the gastrointestinal tract, the blood supply distributes it throughout the entire body. Most fluoride not excreted is deposited in bones and hard tissues like teeth.

"Topical" fluoride is found in products containing strong concentrations of fluoride to fight tooth decay. These products, including toothpastes and mouth rinses, are applied directly to the teeth and are then expectorated or rinsed from the mouth without swallowing. Dentists recommend brushing with a fluoride toothpaste at least twice a day or after every meal, combined with a regimen of flossing and regular dental checkups. Professionally-administered topical fluorides such as gels or varnishes are applied by the dentist and left on for about four minutes, usually during a cleaning treatment. For patients with a high risk of dental caries, the dentist may prescribe a special gel for daily home use, to be applied with or without a mouth tray for up to six weeks.

Gum disease or periodontal disease, a chronic inflammation and infection of the gums and surrounding tissue, is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life.

Bacterial plaque - a sticky, colorless film that constantly forms on the teeth - is recognized as the primary cause of gum disease. Specific periodontal diseases may be associated with specific bacterial types. If plaque isn't removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar). Toxins (poisons) produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets which fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, puss between the gum and tooth, persistent bad breath, change in the way teeth fit together when the patient bites, and a change in the fit of partial dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That's why patients are advised to get frequent dental exams.

In the early stages, most treatment involves scaling and root planing-removing plaque and calculus around the tooth and smoothing the root surfaces. Antibiotics or antimicrobial drugs may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums, and removing the hardened plaque build-up and re-contouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.

Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. Your dentist can design a personalized program of home oral care to meet your needs. If a dentist doesn't do a periodontal exam during a regular visit, the patient should request it. Children also should be examined.

Tooth decay is the disease known as caries or cavities. Unlike other diseases, however, caries is not life threatening and is highly preventable, though it affects most people to some degree during their lifetime. Tooth decay occurs when your teeth are frequently exposed to foods containing carbohydrates (starches and sugars) like soda pop, candy, ice cream, milk, cakes, and even fruits, vegetables and juices. Natural bacteria live in your mouth and form plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids damage tooth enamel over time by dissolving, or demineralizing, the mineral structure of teeth, producing tooth decay and weakening the teeth .

The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and remineralizing agent. Dentists often recommend chewing sugarless gum to stimulate your flow of saliva. However, though it is the body's natural defense against cavities, saliva alone is not sufficient to combat tooth decay. The best way to prevent caries is to brush and floss regularly. To rebuild the early damage caused by plaque bacteria, we use fluoride, a natural substance which helps to remineralize the tooth structure. Fluoride is added to toothpaste to fight cavities and clean teeth. The most common source of fluoride is in the water we drink. Fluoride is added to most community water supplies and to many bottled and canned beverages. If you are at medium to high risk for cavities, your dentist may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. Your dentist may also use professional strength anti-cavity varnish, or sealants-thin, plastic coatings that provide an extra barrier against food and debris.

Because we all carry bacteria in our mouths, everyone is at risk for cavities. Those with a diet high in carbohydrates and sugary foods and those who live in communities without fluoridated water are likely candidates for cavities. And because the area around a restored portion of a tooth is a good breeding ground for bacteria, those with a lot of fillings have a higher chance of developing tooth decay. Children and senior citizens are the two groups at highest risk for cavities.

The best way to combat cavities is to follow three simple steps: 1. Cut down on sweets and between-meal snacks. Remember, it's these sugary and starchy treats that put your teeth at extra risk. 2. Brush after every meal and floss daily. Cavities most often begin in hard-to-clean areas between teeth and in the fissures and pits, the edges in the tooth crown and gaps between teeth. Hold the toothbrush at a 45-degree angle and brush inside, outside and between your teeth and on the top of your tongue. Be sure the bristles are firm, not bent, and replace the toothbrush after a few weeks to safeguard against reinfecting your mouth with old bacteria than can collect on the brush. Only buy toothpastes and rinses that contain fluoride (antiseptic rinses also help remove plaque) and that bear the American Dental Association seal of acceptance logo on the package. Children under six should only use a small pea-sized dab of toothpaste on the brush and should spit out as much as possible because a child's developing teeth are sensitive to higher fluoride levels. Finally, because caries is a transmittable disease, toothbrushes should never be shared, especially with your children. 3. See your dentist at least every six months for checkups and professional cleanings. Because cavities can be difficult to detect a thorough dental examination is very important. If you get a painful toothache, if your teeth are very sensitive to hot or cold foods, or if you notice signs of decay like white spots, tooth discolorations or cavities, make an appointment right away. The longer you wait to treat infected teeth the more intensive and lengthy the treatment will be. Left neglected, cavities can lead to root canal infection, permanent deterioration of decayed tooth substance and even loss of the tooth itself.

Tooth sensitivity is caused by the stimulation of cells within tiny tubes located in the dentin (the layer of tissue found beneath the hard enamel that contains the inner pulp). When the hard enamel is worn down or gums have receded-causing the tiny tube surfaces to be exposed-pain can be caused by eating or drinking food and beverages that are hot or cold; touching your teeth; or exposing them to cold air. Hot and cold temperature changes cause your teeth to expand and contract. Over time, your teeth can develop microscopic cracks that allow these sensations to seep through to the nerves. Exposed areas of the tooth can cause pain and even affect or change your eating, drinking and breathing habits. Taking a spoonful of ice cream, for example, can be a painful experience for people with sensitive teeth.

Sensitive teeth is one of the most common complaints among dental patients. At least 45 million adults in the United States and 5 million Canadians, suffer at some time from sensitive teeth.

Some toothpastes contain abrasive ingredients that may be too harsh for people who have sensitive teeth. Ingredients found in some whitening toothpastes that lighten and/or remove certain stains from enamel, and sodium pyrophosphate, the key ingredient in tartar-control toothpastes may increase tooth sensitivity.

Tooth sensitivity can be reduced by using a desensitizing toothpaste, applying sealants and other desensitizing ionization and filling materials including fluoride by your dentist, and decreasing the intake of acid-containing foods. Tartar control toothpastes will sometimes cause teeth to be sensitive as well as drinking diet soft drinks throughout the day. Avoid using hard bristled toothbrushes and brushing your teeth too hard, which can wear down the tooth's root surface and expose sensitive spots. The way to find out if you're brushing your teeth too hard is to take a good look at your toothbrush. If the bristles are pointing in multiple directions, you're brushing too hard.

If a tooth is highly sensitive for more than three or four days, and reacts to hot and cold temperatures, it's best to get a diagnostic evaluation from your dentist to determine the extent of the problem. Before taking the situation into your own hands, an accurate diagnosis of tooth sensitivity is essential for effective treatment to eliminate pain. Because pain symptoms can be similar, some people might think that a tooth is sensitive, when instead, they actually have a cavity or abscess that's not yet visible.

There are a number of effective brushing techniques. Patients are advised to check with their dentist or hygienist to determine which technique is best for them, since, tooth position and gum condition vary. One effective, easy-to-remember technique involves using a circular or elliptical motion to brush a couple of teeth at a time, gradually covering the entire mouth. Place a toothbrush beside your teeth at a 45-degree angle and gently brush teeth in an elliptical motion. Brush the outside of the teeth, inside the teeth, your tongue and the chewing surfaces and in between teeth. Using a back and forth motion causes the gum surface to recede, or can expose the root surface or make the root surface tender. You also risk wearing down the gum line.

In general, a toothbrush head should be small (1" by 1/2") for easy access. It should have a long, wide handle for a firm grasp. It should have soft, nylon bristles with round ends. Some brushes are too abrasive and can wear down teeth. A soft, rounded, multi-tufted brush can clean teeth effectively. Press just firmly enough to reach the spaces between the teeth as well as the surface. Medium and hard bristles are not recommended.

It might be a good idea to brush with the radio on, since dentists generally recommend brushing 3-4 minutes, the length of an average song. Using an egg timer is another way to measure your brushing time. Patients generally think they're brushing longer, but most spend less than a minute brushing. To make sure you're doing a thorough job and not missing any spots, patients are advised to brush the full 3-4 minutes twice a day, instead of brushing quickly five or more times through the day.

Definitely, but most Americans don't brush during the workday. Yet a recent survey by Oral-B Laboratories and the Academy of General Dentistry shows if you keep a toothbrush at work, the chances you will brush during the day increase by 65 percent. Dentists recommend keeping a toothbrush at work. Getting the debris off teeth right away stops sugary snacks from turning to damaging acids, and catches starchy foods like potato chips before they turn to cavity-causing sugar. If you brush with fluoride toothpaste in the morning and before going to bed, you don't even need to use toothpaste at work. You can just brush and rinse before heading back to the desk. If you don't have a toothbrush, rinsing your mouth with water for 30 seconds after lunch also helps. The following tips may improve your work-time brushing habits: -Post a sticky note on your desk or computer at work as a reminder to brush teeth after lunch. -Brush teeth right after lunch, before you become absorbed in work. -Store your toothbrush and toothpaste at work in a convenient and handy place. -Make brushing your teeth part of your freshening up routine at work.

The ideal time is six months after your child's first (primary) teeth erupt. This time frame is a perfect opportunity for the dentist to carefully examine the development of your child's mouth. Because dental problems often start early, the sooner the visit the better. To safeguard against problems such as baby bottle tooth decay, teething irritations, gum disease, and prolonged thumb-sucking, the dentist can provide or recommend special preventive care.

Before the visit, ask the dentist about the procedures of the first appointment so there are no surprises. Plan a course of action for either reaction your child may exhibit-cooperative or non- cooperative. Very young children may be fussy and not sit still. Talk to your child about what to expect, and build excitement as well as understanding about the upcoming visit. Bring with you to the appointment any records of your child's complete medical history.

Many first visits are nothing more than introductory icebreakers to acquaint your child with the dentist and the practice. If the child is frightened, uncomfortable or non-cooperative, a rescheduling may be necessary. Patience and calm on the part of the parent and reassuring communication with your child are very important in these instances. Short, successive visits are meant to build the child's trust in the dentist and the dental office, and can prove invaluable if your child needs to be treated later for any dental problem. Child appointments should always be scheduled earlier in the day, when your child is alert and fresh. For children under 24-36 months, the parent may need to sit in the dental chair and hold the child during the examination. Also, parents may be asked to wait in the reception area so a relationship can be built between your child and the dentist. If the child is compliant, the first session often lasts between 15-30 minutes and may include the following, depending on age: -A gentle but thorough examination of the teeth, jaw, bite, gums and oral tissues to monitor growth and development and observe any problem areas; -If indicated, a gentle cleaning, which includes polishing teeth and removing any plaque, tartar build-up and stains; -X-rays; -A demonstration on proper home cleaning; and, -Assessment of the need for fluoride. The dentist should be able to answer any questions you have and try to make you and your child feel comfortable throughout the visit. The entire dental team and the office should provide a relaxed, non- threatening environment for your child.

1- Protect your baby's health with fluoride fluoride (said like floor-eyed) protects teeth from tooth decay and helps heal early decay. Fluoride is in the drinking water of some towns and cities. Ask your dentist or doctor if your water has fluoride in it. If it doesn't, talk to your dentist or doctor about giving you a prescription for fluoride drops for your baby. 2- Check and clean your baby's teeth. Healthy teeth should be all one color. If you see spots or stains on the teeth, take your baby to your dentist. as soon as they come in with a clean, soft cloth or a baby's toothbrush. Clean the teeth at least once a day. It's best to clean them right before bedtime. At about age 2, most of your child's teeth will be in. Now you can start brushing them with a small drop of fluoride toothpaste. 3- Feed your baby healthy food Choose foods that do not have a lot of sugar in them. Give your child fruits and vegetables instead of candy and cookies. 4- Prevent baby bottle teeth decay Do not put your baby to bed with a bottle at night or at nap time. (If you put your baby to bed with a bottle, fill it only with water). Milk, formula, juices, and other sweet drinks such as soda all have sugar in them. Sucking on a bottle filled with liquids that have sugar in them can cause tooth decay. Decayed teeth can cause pain and can cost a lot to fill. During the day, do not give your baby a bottle filled with sweet drinks to use like a pacifier. If your baby uses a pacifier, do not dip it in anything sweet like sugar or honey. Near his first birthday, you should teach your child to drink from a cup instead of a bottle. 5- Take your child to the dentist. Ask your dentist when to bring your child in for his first visit. Usually, the dentist will want to see a child between ages 1 and 2. At this first visit, your dentist can quickly check your child's teeth.

Sugary snacks taste so good, but they aren't so good for your teeth or your body. The candies, cakes, cookies, and other sugary foods that kids love to eat between meals can cause tooth decay. Some sugary foods have a lot of fat in them too. Kids who consume sugary snacks eat many different kinds of sugar every day, including table sugar (sucrose) and corn sweeteners (fructose). Starchy snacks can also break down into sugars once they're in your mouth.

Invisible germs called bacteria live in your mouth all the time. Some of these bacteria form a sticky material called plaque on the surface of the teeth. When you put sugar in your mouth, the bacteria in the plaque gobble up the sweet stuff and turn it into acids. These acids are powerful enough to dissolve the hard enamel that covers your teeth. That's how cavities get started. If you don't eat much sugar, the bacteria can't produce as much of the acid that eats away enamel.

Before your baby starts munching on a snack, ask yourself what's in the food you've chosen. Is it loaded with sugar? If it is, think again. Another choice would be better for his/her teeth. And keep in mind that certain kinds of sweets can do more damage than others. Gooey or chewy sweets spend more time sticking to the surface of his/her teeth. Because sticky snacks stay in their mouth longer than foods that you quickly chew and swallow, they give teeth a longer sugar bath. You should also think about when and how often to eat snacks. Do they nibble on sugary snacks many times throughout the day, or do they usually just have dessert after dinner? Damaging acids form in their mouth every time they eat a sugary snack. The acids continue to affect their teeth for at least 20 minutes before they are neutralized and can't do any more harm. So, the more times they eat sugary snacks during the day, the more often they feed bacteria the fuel they need to cause tooth decay. If they eat sweets, it's best to eat them as dessert after a main meal instead of several times a day between meals. Whenever they eat sweets, in any meal or snack, they should brush their teeth well with a fluoride toothpaste afterward. When you're deciding about snacks, think about: -The number of times a day they eat sugary snacks -How long the sugary food stays in the mouth -The texture of the sugary food (chewy? sticky?) If they snack after school, before bedtime, or other times during the day, they should pick something without a lot of sugar or fat. There are lots of tasty, filling snacks that are less harmful to their teeth -- and the rest of their body -- than foods loaded with sugars and low in nutritional value. Snack smart!