Allergy Shots:Allergy shots are the most effective way to treat nasal allergy problems. They act by desensitizing the body to allergens such as dust and pollen that cause symptoms such as nasal congestion, eye itching and runny nose. Ask your Fairfax ENT physician about allergy testing and treatment.
A: Tonsils & adenoids are most often removed when they become enlarged and block the airway, restricting breathing. This can lead to loud snoring, restless sleep and gasping. They are also removed if certain illnesses such as strep throat and tonsil infections cannot be treated with antibiotics.
A: Yes, the procedure is performed under general anesthesia, which means you are asleep, and will not feel a thing. With young children one parent is allowed in the operating room while the child goes to sleep. For young children it is often possible to put them too sleep before the IV is placed so the child does not experience any pain.
A: Young patients will typically require 10-14 days of recovery. Most children will be out of school for 1-2 weeks. We recommend avoiding exercise and strenuous activity for 3 weeks after surgery.
A: In most cases, a tonsillectomy is an outpatient procedure. Patients younger than 2 years of age or those with severe apnea may require an overnight hospital stay.
A: Sometimes, patients vomit after surgery, but vomiting should cease about 24 hours after surgery. It is not unusual to have a low grade fever. You should call your doctor is the temperature exceeds 101.5°F
A: Many parents become concerned when their child continues to snore after surgery. Especially if the reason for surgery was to correct loud snoring and obstructive breathing. Don’t worry it is very normal for your child to continue to snore for several days after surgery because of swelling. When the swelling resolves you will frequently see that your child no longer snores. In fact they are sometimes so quite that parents wonder if they are still breathing.
A: Scabs in the area where the tonsils and adenoids were removed will appear white and cause bad breath. They will often break away in pieces about a week after surgery. While this looks like pus it is not a sign of infection and is not reason for concern.
A: Yes, children will often complain of ear pain after tonsillectomy. Sometimes the ears actually hurt more than the throat even thought the ears were not operated on. This is because the same nerve provides sensation to the throat and the ear.
A: Weight loss is very typical in tonsillectomy. Patents should not worry about calories or nutrition for the first two weeks after surgery. The most important thing is that your child drinks plenty of liquids and stays well hydrated. This not only prevents dehydration but it helps keep the throat from drying out which. When the pain resolves your child will begin eating again and are back at the normal weight in no time.
A: Minor bleeding from the nose or in the mouth is very typical, but if you experience flowing blood from the mouth or nose, contact your physician and go to the emergency room right away.
A: It is very important that patients drink plenty of fluids, such as water and apple juice, to recover quickly. It is also important that patients try not to rush to get back to school or work and get plenty of rest.
A: The swelling of the surgical area has not yet happened, therefore no pain is felt. The first few days after surgery there tends to be less pain. About 3 days after surgery the pain will increase and will continue for 10 – 14 days.
Dr Egan will be one the of first doctors in Northern Virginia to implant the new Inspire device. 
OSA is a condition where patients repetitively stop breathing during the night. The muscles of the throat relax when we fall asleep and in some patients this can lead to collapse of the upper airway which prevents airflow.
The Inspire device is an implanted stimulator used to treat obstructive sleep apnea. The device continually monitors your breathing throughout the night and provides a gentle stimulation to the muscles of the upper airway. The muscle stimulation prevents the throat from collapsing. The device is implanted so there a no visible or removable parts. It is controlled by a small remote control. Simply turn on the device at night and turn it off in the morning.
CPAP remains the first line treatment for OSA. If you are unable to tolerate CPAP schedule an appointment to see if inspire is right for you.
Before receiving FDA approval the inspire devices underwent rigorous testing to make sure that it is both safe and effective. A recent study in the New England Journal of Medicine found that patients treated with the Inspire had:
For more information visits www.inspiresleep.com
After the long cold snowy winter most people look forward to warm spring days. However, nothing ruins a spring day quicker than allergy symptoms. Allergies occur when the body is exposed to substances that trigger an inflammation in the eyes, nose and throat. In allergy patients the immune system is hypersensitive and overreacts when exposed to the substance that causes allergies.
Allergies occur year round but are typically worse in the spring and fall when the plants are pollinating. In the spring the trees produce pollen, a fine powdery substance that can travel miles. Many trees can cause allergies but in the DC area the most common are oak tree and maple tree. The pollen tends to be worse on warm windy days and better when it is raining. However the benefit of the rain doesn’t last long. Almost as soon as it stops raining the pollen dries out and starts blowing again.
The symptoms of seasonal allergies are: sneezing, runny nose, nasal congestion, and itchy watery eyes, nose and throat. If the nasal congestion goes on to long you may develop a sinus infection. In fact many patients only get one sinus infection a year during the spring allergy season.
There are three ways to treat seasonal allergies: (1)medical treatment,(2) avoidance and (3)immunotherapy also known as allergy shots. Medical treatment involves giving the patients medicine to block the effect of the allergies. It controls the symptoms but does not produce long-term results. Antihistamines block the effect of histamine, which is released by the body when exposed to the substance that causes allergies. Common antihistamines include Benadryl, Claritin, Zyrtec and Allegra. Most patients have tried several antihistamines before coming to see the doctor. It is important to realize that antihistamines have no effect on nasal congestion and nasal obstruction. The symptoms of nasal congestion and nasal obstruction are not caused by histamine but by other chemicals released by your body.
To treat nasal congestion you need to block the chemicals that lead to those symptoms. To do this we rely on inhaled nasal steroids. There are many nasal steroids two common ones are Flonase and Nasonex. The nasal steroids work topically on the nasal mucosa to reduce inflammation. Very little of the steroid is absorbed by the body so there is little if any risk to other parts of the body. It is a good idea to rinse the nose with a nasal saline rinse prior to using the nasal steroids. This washes away the mucus so the steroids can act directly on the lining of the nose.
The second option to treat allergies is avoidance. Avoidance means limiting your contact with the substance that causes your allergies. With seasonal allergies this is harder than it sounds because whenever you are outside you are exposed. There are however some tricks to help reduce your exposure. First, remember to close the windows to your home and car. Second, you should always shower prior to bed to rinse the pollen off. Finally, if you have been outside for an extended period of time you should shower, change your clothes and rinse your nose to flush out the pollen.
The most effective treatment for allergies is immunotherapy or allergy shots. This is the only treatment that actually reduces your body’s tendency to be allergic. The first step is to test you to see what you are allergic to and how severe your allergies are. This information is used to create a customized allergy serum, which contains very precise amounts of the substances that you are allergic to. The dose for the shot is gradually increased to the point where your body no longer over reacts when exposed to the substance that causes your allergies. It typically takes 1-2 years to reach your goal known as maintenance dose. Once at maintenance dose the shots will be spread out to once a month or so. It takes time to build up level for the allergy shots so you will not notice improvement immediately. Most patients begin to notice the benefits of allergy shots after 3-4 months and continue to see improvement for 1-2 years.
Allergy shots are a great option for patients whose symptoms are not controlled by medications or who wish to limit their use of chronic medications.
The DC area is notorious for having bad allergies particularly in the spring. Don’t let your symptoms prevent you from enjoying the beautiful weather. Let us work with you to control you allergy symptoms.
While everyone will experience an acute sinus infection at some point in their lives, only a few will go on to develop chronic rhinosinusitis (CRS). There is great interest in figuring out why some people are prone to developing CRS while others are not. The fact is that there are probably multiple factors that work together to contribute to the formation of CRS. While many people think of CRS as an infection it is becoming increasingly more obvious that CRS is actually an inflammatory process and bacterial infections are a result. The presence of inflammation in the lining of the sinus, the mucosa, leads to increased mucus production, thickening of the mucus, blockage of the natural sinus drainage pathway. A healthy sinus is lined by tiny hair cells that sweep the mucus out through the natural opening. This keeps the sinus clean and prevents the buildup of bacteria. When there is a blockage of the drainage pathway and thickened mucus the bacteria is allowed to grow unchecked and eventually leads to an infection.
One of the single most important and readily treatable causes of CRS is nasal allergies. Patients with nasal allergies, also known as allergic rhinitis, have an increased sensitivity to substances in their environment. When these substances enter the nose during breathing they come in contact with inflammatory cells in the nasal mucosa. These cells, known as mast, cells have receptors on their surface for airborne allergens. When the allergen binds to the receptor the cell releases the inflammatory mediators that are stored inside and begins the inflammatory process. There are many different chemical or inflammatory mediators that are released during this process, the most well-known is histamine.
A small subset of patients with CRS will develop nasal polyps. Nasal polyps are small soft non-cancerous growths of the lining of the nose. Polyps are just the lining of the nose that has become severely inflamed from allergies or chronic infection. When they are very small polyps may go unnoticed by the patients. However as they get larger they can block the natural sinus drainage pathway and lead to infection. They can also block that air passages of the nose and lead to nasal obstruction.
CRS occurs when the sinuses cannot drain properly so it makes sense that treatment of CRS would involve improving the drainage of the sinuses. If medical treatment of allergic rhinitis and infection does not improve the symptoms a procedure may be required. There are two procedures available to treat CRS. The first is a Balloon Sinuplasty. This is a procedure that is done in the office under local anesthesia. There is little to no recovery and in the right patients the results are excellent. During the procedure a small flexible catheter is placed into the natural opening of the sinus. A balloon is than inflated to increase the size of the opening to 6mm. The balloon is removed and studies have shown that the results are long acting.
The second option is endoscopic sinus surgery also known as FESS. This is performed in an operating room under general anesthesia. The surgeon with remove the inflamed and damaged tissue and enlarge the natural sinus openings. The choice of the two procedures will depend on how severe your chronic sinusitis is, which sinuses are involved, and whether there are polyps. Don’t suffer with chronic sinusitis come in and see what can be done to relieve your symptoms.
