ENT (Ear, Nose, Throat)
Ear, Nose, and Throat Services
- Same-Day Appointments
- Over 25 Years of Experience
Your Local ENT Specialists
At Bosco E Noronha, MD, PC, we specialize in the medical and surgical treatment of disorders and diseases of the ear, nose and throat, in both adults and children. Our ear nose and throat services include:
- Comprehensive, full-service care for adults and children
- Sinusitis/Nasal Polyps Therapy
- General Otolaryngologic Problems
- LPR Reflux - Stomach Acid in the Throat
- GERD (Gastroesophageal reflux disease)
- Cancers of the head and neck
- Disorders and diseases of the ear, nose and throat
Are You Suffering From Sinus Symptoms?
Chronic and recurrent sinusitis can be a very frustrating and debilitating condition. Patients are initially treated with medical therapy, but when this fails, surgical procedures are often the next step. Fortunately, there is now a new option offered in Dr. Noronha’s office that can be performed under local anesthesia with very quick recovery. Most patients return to their usual activities the next day. Call
for details!
What Causes Sinusitis?
A number of factors can cause irritation and contribute to sinusitis, including:
- Bacteria
- Viruses
- Fungus
In addition, some studies have shown that structural issues such as narrowed drainage pathways may lead to sinusitis outbreaks.
Sinusitis symptoms include:
- Loss of smell or bad breath
- Cough
- Headache
- Nasal congestion and discharge
- Facial pain or tenderness
- Fatigue
- Fever
- Lack of energy
- Sore throat and postnasal drip
- Generally not feeling well
Acute, Chronic, and Recurrent Acute Sinusitis
Sinusitis can be acute, chronic or recurrent acute. Every patient is unique and requires a personal approach to therapy. Our typical treatment options include:
- Acute – symptoms last 10-12 days – typically addressed via self-care or medical therapy
- Chronic – symptoms last 3 months or longer – can be addressed via medical therapy, an office procedure such as balloon sinus dilation, or functional endoscopic sinus surgery
- Recurrent Acute – multiple acute sinusitis breakouts in calendar year – can be addressed via medical therapy, an office procedure such as balloon sinus dilation, or functional endoscopic sinus surgery
Want to find out which treatment option is the best for you? Request an appointment
today to learn more about the sinusitis treatment options offered by Dr. Noronha.
General Otolaryngologic Problems Treated
- Tonsillitis
- Tongue-tie (frenular band)
- Otitis media (ear infections/ear fluid)
- Snoring
- Sialadenitis (submandibular infection)
- Obstructive sleep apnea
- Submandibular stones
- Mouth breathing
- Parotitis
- Septal deviation
- Parotid gland tumors
- Nasal congestion
- Submandibular gland tumors
- Rhinitis
- Enlarged lymph nodes
- Adenoiditis
- Branchial cleft abnormalities
- Adenoid hypertrophy
- Thyroid problems
- Septoplasty
- Uvulopalatopharyngoplasty (UPPP)
- Sinus surgery
- Snoring surgery
- Submandibular gland surgery
- Sleep apnea surgery
- Excision of neck mass
- Tonsillectomy
- Thyroid surgery
- Adenoidectomy
- Frenular (tongue tie )release
- Parathyroid surgery
- Head and Neck Surgery
- Tonsillitis
- Snoring
- Sleep Apnea
- Sinusitis
- Nasal breathing disorders
- Head and Neck Cancer
- Parathyroid problems (hyperparathyroidism)
Who should be seen?
We offer comprehensive evaluation and treatment of all medical conditions that affect difficulty swallowing, Gerd, Reflux, change in voice, in both adults and children.
Anyone experiencing these symptoms:
- Difficulty Swallowing
- Regurgitation of Food
- Heartburn
- Burning in the Throat
- Sensation of something stuck in the Throat
- Chronic Cough
- Hoarseness
- Changes in the Voice
- Noisy Breathing
- Difficulty Breathing
- Lump in the Throat
- Phlegm in the Throat
Anyone with diagnosis of:
- Reflux (GERD or LPR)
- Cricopharyngeal muscle spasm
- Vocal fold paralysis
- Vocal Fold Dysfunction (VCD) or Paradoxical Vocal Fold Motion (PVFM)
- Dystonia
- Laryngeal cancer
- Sarcoidosis
- Cough variant asthma
- Thyroid problems
- Tongue tie
LPR Reflux - Stomach Acid in the Throat
LPR Can Cause: hoarseness, trouble swallowing, too much throat mucus, a ‘Lump’ in the throat, chronic cough and heartburn.
What is reflux and what is LPR?
The term REFLUX comes from a Greek word that means “backflow”, and it usually refers to “the backflow of stomach contents.” Normally, once the things that we eat reach the stomach, digestion should begin without the contents of the stomach coming back up again (refluxing).
The term LARYNGOPHARYNGEAL REFLUX (LPR) refers to the backflow of food or stomach acid all of the way back up into the larynx (the voice box) or the pharynx (the throat). LPR can occur during the day or night, even if a person who has LPR hasn’t eaten a thing during the last couple of hours.
Not everyone who has reflux has LPR. Some people have reflux just into the esophagus (the swallowing tube that joins the throat to the stomach). If this happens a lot, a person may develop heartburn (a painful, burning sensation in the chest).
Many people with LPR don't have heartburn...Why is that?
Some people with LPR have a lot of heartburn, but people who have LPR usually don’t have heartburn very often. In fact, half of the people who have LPR never have heartburn at all. This is because the material that refluxes does not stay in the esophagus for very long. In other words, the acid does not have enough time to irritate the esophagus.
However, if even small amounts of refluxed material come all of the way up into the throat, other problems can occur. This is because, compared to the esophagus, the voice box and throat are much more sensitive to injury and irritation from stomach acid.
How do I know if I have LPR?
Chronic hoarseness, throat clearing, and cough, as well as a feeling of a lump in the throat or difficulty swallowing, may be signs that you have LPR. Some people do have heartburn, too. Some people have hoarseness that comes and goes, and others have a problem with too much nose mucus or phlegm.
If you have any of these symptoms, and especially if you smoke, you should ask your doctor about LPR. The specialist who most often treats people with LPR is the Otolaryngologist (Ear, Nose, and Throat Physician).
If your doctor thinks that you could have LPR, he or she will probably perform a throat exam first and look at the voice box and the lower throat. If this area looks swollen and/or red, you may have LPR. At that point, your doctor may order some tests or recommend specific treatment.
What tests might my doctor order?
If your doctor orders tests, this is to be sure about your diagnosis, to make sure that you don’t have any complications of LPR, and to help pick the best type of treatment for you.
The two most common tests for LPR are pH monitoring, also called pH-metry, and a barium swallow. These two tests are different, and it is common to have both tests done.
The barium swallow is an x-ray test in which you must swallow a chalky, liquid material that can be seen on the x-rays. This test shows abnormalities in the throat or esophagus and is a good test to evaluate the entire swallowing mechanism.
What is it like to have a pH-Metry?
pH-metry takes about 24 hours to complete. People are not usually admitted to the hospital for this test. pH-metry is used to actually measure acid in your esophagus. Some people say this test is annoying, but is usually not painful.
To do this test, you will have a small, soft, flexible tube inserted in your nose for placement in your throat. The tube will be left in place for a recommended 24 hours. The tube, called a “pH probe,” is connected to a small computer (a box that you wear around your waist) that measures acid in your esophagus and in your throat. pH-metry is the best test for LPR, and it can help your doctor determine the best treatment for you.
How is LPR Treated?
Treatment for LPR should be individualized, and your doctor will suggest the best treatment for you. Generally, there are several treatments for LPR:
- Changing lifestyle habits and diet to reduce reflux
- Medications to reduce stomach acid
- Surgery to prevent reflux
Most people with LPR need to modify how and when they eat, as well as take some medication to get well.
Control your lifestyle and your diet!
- If you use tobacco, QUIT. Smoking may make your reflux worse.
- Don’t wear clothing that is too tight, especially around the waist (trousers, corsets, belts)
- Avoid caffeine (especially coffee and tea), soda pop (especially cola), and mints, if they increase your symptoms.
Will I need LPR treatment forever?
Most patients with LPR require some treatment, most of the time, and some people need medicine all of the time. Some people recover completely for months or years, and then may have a relapse.
For people with severe LPR, or people who cannot take reflux medicine, “anti-reflux” surgery (to create a new and better stomach valve) may be recommended. In people who have this surgery, most get good relief for LPR for many years.
What kind of problems can LPR cause, and are they serious?
LPR can cause serious problems. LPR can cause noisy breathing, choking episodes, breathing problems (such as asthma or bronchitis), and very uncommonly, cancer of the esophagus, throat, or voice box. (For cancer to develop as a result of LPR, the LPR must be very severe
and go untreated for many years.)
Can children get LPR?
Yes, throat and lung breathing problems in infants and children can be caused or worsened by LPR. LPR is more difficult to diagnose in children, so infants and children who may have LPR should be taken to specialists for pH-metry and other tests.
This patient information guide on LPR was developed by The Center For Voice Disorders of Wake Forest University and The Department of Otolaryngology Bowman Gray School of Medicine.
Living with GERD
Controlling the symptoms of Heartburn due to GERD (Gastroesophageal Reflux Disease)
Keep your head up: elevating the head of your bed can be one of the most effective treatments for GERD. By elevating the head of your bed by 4 to 6 inches, you can significantly reduce the amount of acid that splashes up the esophagus. Block, bricks, or books under the head of the bed are more effective than using extra pillows under your head. However, if you sleep in a water bed, try using a foam wedge under your pillow.
Here's what your doctor can do...
Medication:
When lifestyle adjustments and antacid use alone are not enough, your doctor may prescribe an H2 receptor antagonist. This medication helps to reduce the amount of acid that is released in your stomach, which helps reduce the irritation. Sometimes patients stop taking their medication early because they tend to experience heartburn relief. However, it is very important that you continue to take all of your medicine, following your doctor’s dosage instructions exactly.
This type of medication is generally safe. A few things to keep in mind if you are taking this medication are:
- Side effects most frequently reported for some H2 antagonists include headache and diarrhea, among others in a minority of patients.
- Prescribing information for H2 antagonists recommends using these drugs upon being endoscopically diagnosed for GERD.
- These drugs are not used for complications commonly associated with or caused by untreated GERD, which may or may not be treatable by other means.
Eating:
- Keep meals small and low in fat
- Eliminate or cut down on some of the following foods:
- Caffeine-containing foods like coffee, tea, cola
- Tomatoes, citrus fruits, milk, peppermint, spearmint, chocolate
- Any food that upsets your stomach
Personal Habits:
- Avoid or reduce the use of:
- Cigarettes or any other tobacco
- Alcohol
- Lose weight, if needed
- Avoid tight fitting clothes
Sleeping:
- Allow your food to digest at least 3 hours before lying down
- Raise the head of the bed with 4 to 6-inch blocks
Medications:
- Take antacids and/or other GERD medication as directed by your physician
- Tell your doctor if you are taking any other medications
- Take the full course of medications exactly as prescribed by your doctor
Common Causes of GERD
Eat, drink, and be wary.
Like many other health care problems, GERD can be caused or made worse by an unhealthy lifestyle. GERD may be one way your body reacts to abnormal pressure inside or outside the stomach or to irritating substances. Different dietary, postural, and lifestyle factors can contribute to GERD in several different ways, such as:
- Large meals (especially before bedtime) put too much stress on the LES muscle.
- Being overweight, bending over, lying down, or wearing tight-fitting clothes can also put pressure on the LES muscle
- Certain foods can cause the LES muscle to relax at the wrong time
- Fatty foods can increase the time that food “sits” in your stomach
- Certain common foods increase acid production in the stomach
- Some foods can directly irritate the esophagus
A GERD Troubleshooting Guide
Factors that may cause improper LES muscle function and allow acid to flow up into the esophagus:
Foods:
- Large meals before bedtime
- Fried or fatty foods
- Chocolate
- Peppermint or Spearmint
Lifestyle:
- Overweight or pregnant
- Cigarette smoking
- Alcoholic beverages
- Tight-fitting clothes
- Certain medications
Dietary factors that may increase irritation:
Foods that may be irritating to the esophagus:
- Citrus juices: orange, grapefruit, or pineapple
- Coffee
- Tomatoes
Foods that may increase stomach acid:
- Caffeinated beverages
- Beer
- Milk
- It is important for GERD to be diagnosed and addressed early on, before complications are allowed to result.
- Your doctor might consider other classes of drugs, such as proton pump inhibitors or prokinetic agents.
Despite the fact that lifestyle adjustments and medication can be very effective in treating GERD, a small percentage of patients eventually require surgery.
Keeping things in perspective: Remember, the majority of patients with GERD are effectively treated with lifestyle adjustments and medication. Only if these measures fail does surgery become an option. Here's how you can help the healing process:
- Keep a positive mental attitude
- Set goals for yourself
- Follow your doctor's treatment advice
How do I know if I am getting better?
Listen to your body.
It’s important to be aware of the symptoms of GERD and not hide them from your doctor. For example, ask yourself these questions during your treatment and report the answers to your doctor during the next visit.
- How many days of the week or month do you have heartburn?
- How often do you use antacids?
- Are there any types of food that cause you to have more symptoms than normal?
- What time of day do you seem to have most of your symptoms?
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