General Ear, Nose, and Throat Doctors

What is facial trauma?
The term facial trauma means any injury to the face or upper jaw bone. Facial traumas include injuries to the skin covering, underlying skeleton, neck, nasal (sinuses), orbital socket, or oral lining, as well as the teeth and dental structures. Sometimes these types of injuries are called maxillofacial injury. Facial trauma is often recognized by lacerations (breaks in the skin); bruising around the eyes, widening of the distance between the eyes (which may indicate injury to the bones between the eye sockets); movement of the upper jaw when the head is stabilized (which may indicate a fracture in this area); and abnormal sensations on the cheek.

In the U.S., about three million people are treated in emergency departments for facial trauma injuries each year. Of the pediatric patients, five percent have suffered facial fractures. In children less than three years old, the primary cause of these fractures is falls. In children more than five years old the primary cause for facial trauma is motor vehicle accidents.

Our fast paced world of ultra sports and increasing violence puts children at risk for facial injury. But, children’s facial injuries require special attention. A child’s future growth plays a big role in treatment for facial trauma. So, one of the most important issues as a care giver is to follow a physician’s treatment plan as closely as you can until your child is fully recovered.

Why is facial trauma different in children than adults?
Facial trauma can range between minor injury to disfigurement that lasts a lifetime. The face is critical in communicating with others, so it is important to get the best treatment possible. Pediatric facial trauma differs from adult injury because the face is not fully formed and future growth will be a factor in how the child heals and recovers. Certain types of trauma may cause a delay in the growth or further complicate recovery. Difficult cases require physicians with great skill to make a repair that will grow with your child.

Types of facial trauma
New technology, such as CT scans, have improved physicians ability to evaluate and manage facial trauma. In some cases, immediate surgery is needed to realign fractures before they heal incorrectly. Other injuries will have better outcomes if repairs are done after cuts and swelling have improved. A new study has shown that even when injury does not require surgery, it is important to a child’s health and welfare to continue to follow up with a physicians care.

Soft tissue injuries
Injuries such as cuts (lacerations) may occur on the soft tissue of the face. In combination with suturing the wound, the provider should take care to inspect and treat any injures to the facial nerves, glands, or ducts.

Bone injuries
When a fracture of the bones in the face occurs, the treatment process is similar to that of a fracture in other parts of the body. Factors that affect how the fracture should be dealt with are the location of the fracture, the severity of the fracture, and the age and general health of the patient. It is important during treatment of facial fractures to be careful that the patient’s facial appearance is minimally affected.

Injuries to the teeth and surrounding dental structures style
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Because of the specific needs of the dental structures, certain actions and precautions should be taken if a child has received an injury to his or her teeth or surrounding dental structures.

• If a tooth is “knocked out”, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible.
• Never attempt to “wipe the tooth off” since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth.

References: Stewart MG, Chen AY. Factors predictive of poor compliance with follow-up after Facial trauma: A prospective study. Otolaryngic Head and Neck Surgery 1997: 117:72-75
Kim MK, Buchman R, Szeremeta. Penetratin neck trauma in children: an urban hospital’s experience. Otolaryngic Head and Neck Surgery 2000: 123: 439-43

Children put many things in their mouths (including food) that can cause trouble. When you know that a child has ingested a foreign object, consider this a medical emergency and seek immediate attention. If your child is choking – cannot breathe, is gasping, cannot talk, or is turning blue – call 911 or an ambulance immediately.

Parents should be alert for these commonly ingested items:

• Pebbles
• Hot Dogs
• Grapes
• Seeds
• Small button-shaped batteries
• Nuts
• Toy parts
• Buttons
• Marbles
• Coins

Aside from choking, trouble may happen if the object becomes lodged in the “airway” tube (trachea) instead of the “eating” tube (esophagus), which may make the child’s distress harder to see. Children may experience symptoms differently; some children can even have vague symptoms that do not immediately suggest ingestion. While most swallowed foreign objects pass harmlessly through the esophagus, the stomach and intestines, a foreign body may also cause harm if it has associated toxicity or becomes lodged in the gastrointestinal tract.

Parents should suspect their child might have swallowed a foreign object if breathing or swallowing difficulties persist longer than two weeks despite medical treatment. For example, continuing asthma or upper respiratory treatment without seeing improvement.

If you know that your child has swallowed a foreign object look for these symptoms of choking first, and then look next for signs of obstruction:

• Not breathing, unconscious;
• Choking or gagging when the object is first inhaled;
• Inability to speak;
• Blueness around the lips.

Signs of airway obstruction:

• Stridor (a high pitched sound usually heard when the child breathes)
• Cough that gets worse
• Inability to speak
• Pain in the throat area or chest
• Hoarse voice
• Blueness around the lips
• Not breathing, unconscious
• Unexplained fever.

Signs of gastrointestinal (GI) blockage
If you are fairly sure that a foreign body has been swallowed and your child is not experiencing an airway obstruction, continue to watch for the following:

• Vomiting
• Blood in the stool
• Unexplained fever
• Abdominal distention/pain

Toxicity is another consequence of ingestion that may cause problems. Coins (for instance newer copper-coated zinc pennies) and batteries may cause system-wide reactions because some metals are extremely toxic and may cause inflammation.

Treatment for foreign bodies in the airway
Treatment of the problem varies with the degree of airway blockage. If the object is completely blocking the airway, the child will be unable to breath or talk and his/her lips will become blue. This is a medical emergency and you should seek emergency medical care.

Sometimes, surgery is necessary to remove the object. Children that are still talking and breathing but show other symptoms also need to be evaluated by a physician immediately.

Follow these steps if your child is unconscious:

• Call 911 or an ambulance.
• Lay the child on the floor on his/her back.
• Place one hand on the child’s abdomen and cover it with your other hand, then press on the abdomen four times. (This should release the object that is obstructing the airway.)
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Repeat this life saving procedure until the ambulance arrives. Make sure you tell the medical team immediately what caused the child to choke or what obstructs the breathing so that proper treatment can be administered.

Everyone has gastroesophageal reflux (GER), the backward movement (reflux) of gastric contents into the esophagus. Extraesophageal Reflux (EER) is the reflux of gastric contents from the stomach into the esophagus with further extension into the throat and other upper aerodigestive regions. In infants, more than 50 percent of children three months or younger have at least one episode of regurgitation a day. This rate peaks at 67 percent at age four months. But an infant’s improved neuromuscular control and the ability to sit up will lead to a spontaneous resolution of significant GER in more than half of infants by age ten months and four out of five at age 18 months.

Researchers have found that 10 percent of infants (younger than 12 months) with GER develop significant complications. The diseases associated with reflux are known collectively as Gastro-Esophageal Reflux Disease (GERD). Physically, GERD occurs when a muscular valve at the lower end of the esophagus malfunctions. Normally, this muscle closes to keep acid in the stomach and out of the esophagus. The continuous entry of acid or refluxed materials into areas outside the stomach can result in significant injury to those areas. It is estimated that some five to eight percent of adolescent children have GERD.

What symptoms are displayed by a child with GERD?
GER and EER in children often cause relatively few symptoms until a problem exists (GERD). The most common initial symptom of GERD is heartburn. Heartburn is more common in adults, whereas children have a harder time describing this sensation. They usually will complain of a stomach ache or chest discomfort, particularly after meals.

More frequent or severe GER and EER can cause other problems in the stomach, esophagus, pharynx, larynx, lungs, sinuses, ears and even the teeth. Consequently, other typical symptoms could include crying/irritability, poor appetite/feeding and swallowing difficulties, failure to thrive/weight loss, regurgitation (“wet burps” or outright vomiting), stomach aches (dyspepsia), abdominal/chest pain (heartburn), sore throat, hoarseness, apnea, laryngeal and tracheal stenosis, asthma/wheezing, chronic sinusitis, ear infections/fluid and dental caries. Effortless regurgitation is very suggestive of GER. However, recurrent vomiting (which is not the same) does not necessarily mean a child has GER.

Unlike infants, the adolescent child will not necessarily resolve GERD on his or her own. Accordingly, if your child displays the typical symptoms of GERD, a visit to a pediatrician is warranted. However, in some circumstances, the disorder may cause significant ear, nose, and throat disorders. When this occurs, an evaluation by an otolaryngologist is recommended.

How is GERD diagnosed?
Most of the time, the physician can make a diagnosis by interviewing the caregiver and examining the child. There are occasions when testing is recommended. The tests that are most commonly used to diagnose gastroesophageal reflux include:

• pH probe: A small wire with an acid sensor is placed through the nose down to the bottom of the esophagus. The sensor can detect when acid from the stomach is “refluxed” into the esophagus. This information is generally recorded on a computer. Usually, the sensor is left in place between 12 and 24 hours. At the conclusion of the test, the results will indicate how often the child “refluxes” acid into his or her esophagus and whether he or she has any symptoms when that occurs.
• Barium swallow or upper GI series: The child is fed barium, a white, chalky, liquid. A video x-ray machine follows the barium through the upper intestinal tract and lets doctors see if there are any abnormal twists, kinks or narrowing of the upper intestinal tract.
• Technetium gastric emptying study: The child is fed milk mixed with technetium, a very weakly radioactive chemical, and then the technetium is followed through the intestinal tract using a special camera. This test is helpful in determining whether some of the milk/technetium ends up in the lungs (aspiration). It may also be helpful in determining how long milk sits in the stomach.
• Endoscopy with biopsies: This most comprehensive test involves the passing down of a flexible endoscope with lights and lenses through the mouth into the esophagus, stomach, and duodenum. This allows the doctor to get a directly look at the esophagus, stomach, and duodenum and see if there is any irritation or inflammation present. In some children with gastroesophageal reflux, repeated exposure of the esophagus to stomach acid causes some inflammation (esophagitis). Endoscopy in children usually requires a general anesthetic.
• Fiber Optic Laryngoscopy: A small lighted scope is placed in the nose and the pharynx to evaluate for inflammation.

What treatments for GERD are available?
Treatment of reflux in infants is intended to lessen symptoms, not to relieve the underlying problem, as this will often resolve on its own with time. A useful simple treatment is to thicken a baby’s milk or formula with rice cereal, making it less likely to be refluxed.

Several steps can be taken to assist the older child with GERD:

• Lifestyle changes: Raise the head of the child’s bed about 30 degrees while they sleep and have the child eat smaller, more frequent meals instead of large amounts of food at one sitting. Avoid having the child eat right before they go to bed or lie down; instead, let two or three hours pass. Try a walk or warm bath or even a few minutes on the toilet. Some researchers believe that certain lifestyle changes such as losing weight or dressing in loose clothing my assist in alleviating GERD. Even chewing sugarless gum may help.
• Dietary changes: Avoid chocolate, carbonated drinks, caffeine, tomato products, peppermint, and other acidic foods as citrus juices. Fried foods and spicy foods are also known to aggravate symptoms. Pay attention to what your child eats and be alert for individual problems.
• Medical Treatment: Most of the medications prescribed to treat GERD either break down or lessen intestinal gas, decrease or neutralize stomach acid, or improve intestinal coordination. Your physician will prescribe the most appropriate medication for your child.
• Surgical Treatment: It is rare for children with GERD to require surgery. For the few children who do require surgery, the most commonly performed operation is called Nissen fundoplication. With this procedure, the top part of the stomach (the fundus) is wrapped around the bottom of the esophagus to create a collar. After the operation, every time the stomach contracts, the collar around the esophagus contracts preventing reflux.

Laryngeal cancer is not as well known by the general public as some other types of cancer, yet it is not a rare disease. The American Cancer Society estimates that in 2005 almost 10,000 new cases of laryngeal cancer will be diagnosed, and close to 3,800 people will die from laryngeal cancer in the United States. Even for survivors, the consequences of laryngeal cancer can be severe with respect to voice, breathing, or swallowing. It is fundamentally a preventable disease though, since the primary risk factors for laryngeal cancer are associated with modifiable behaviors.

Risk Factors Associated With Laryngeal Cancer

Development of laryngeal cancer is a process that involves many factors, but approximately 90 percent of head and neck cancers occur after exposure to known carcinogens (cancer causing substances). Chief among these factors is tobacco. Over 90 percent of laryngeal cancers are a type of cancer called squamous cell carcinoma (SCCA), and over 95 percent of patients with laryngeal SCCA are smokers. Smoking contributes to cancer development by causing mutations or changes in genes, impairing clearance of carcinogens from the respiratory tract, and decreasing the body’s immune response.

Tobacco use is measured in pack-years, where one pack per day for one year is considered one pack-year. Two pack-years is defined as either one pack per day for two years, or two packs per day for one year (Longer terms of pack years are determined using a similar ratio.) Depending upon the number of pack-years smoked, studies have reported that smokers are about 5 to 35 times more likely to develop laryngeal cancer than non-smokers. It does seem that the duration of tobacco exposure is probably more important overall to cancer causing effect, than the intensity of the exposure.

Alcohol is another important risk factor for laryngeal cancer, and acts as a promoter of the cancer causing process. The major clinical significance of alcohol is that it potentiates the effects of tobacco. Magnitude of this effect is between an additive and a multiplicative one. That is, people who smoke and drink alcohol have a combined risk that is greater than the sum of the individual risks. The American Cancer Society recommends that those who drink alcoholic beverages should limit the amount of alcohol they consume, with one drink per day considered a limited alcohol exposure.

Other risk factors for laryngeal cancer include certain viruses, such as human papilloma virus (HPV), and likely acid reflux. Vitamin A and beta-carotene may play a protective role.

Signs and Symptoms of Laryngeal Cancer

Signs and symptoms of laryngeal cancer include: progressive or persistent hoarseness, difficulty swallowing, persistent sore throat or pain with swallowing, difficulty breathing, pain in the ear, or a lump in the neck. Anyone with these signs or symptoms should be evaluated by an Otolaryngologist (Ear, Nose and Throat Doctor). This is particularly important for people with risk factors for laryngeal cancer.

Treatment of Laryngeal Cancer

L.P.R. ~ Laryngopharyngeal Reflux

What is laryngopharyngeal reflux (LPR)?
Food or liquids that are swallowed travel through the esophagus and into the stomach where acids help digestion. Each end of the esophagus has a sphincter, a ring of muscle, that helps keep the acidic contents of the stomach in the stomach or out of the throat. When these rings of muscle do not work properly, you may get heartburn or gastroesophageal reflux (GER). Chronic GER is often diagnosed as gastroesophageal reflux disease or GERD.

Sometimes, acidic stomach contents will reflux all the way up to the esophagus, past the ring of muscle at the top (upper esophageal sphincter or UES), and into the throat. When this happens, acidic material contacts the sensitive tissue at back of the throat and even the back of the nasal airway. This is known as laryngopharyngeal reflux or LPR.



During the first year, infants frequently spit up. This is essentially LPR because the stomach contents are refluxing into the back of the throat. However, in most infants, it is a normal occurrence caused by the immaturity of both the upper and lower esophageal sphincters, the shorter distance from the stomach to the throat, and the greater amount of time infants spend in the horizontal position. Only infants who have associated airway (breathing) or feeding problems require evaluation by a specialist. This is most critical when breathing-related symptoms are present.

What are symptoms of LPR?
There are various symptoms of LPR. Adults may be able to identify LPR as a bitter taste in the back of the throat, more commonly in the morning upon awakening, and the sensation of a “lump” or something “stuck” in the throat, which does not go away despite multiple swallowing attempts to clear the “lump.” Some adults may also experience a burning sensation in the throat. A more uncommon symptom is difficulty breathing, which occurs because the acidic, refluxed material comes in contact with the voice box (larynx) and causes the vocal cords to close to prevent aspiration of the material into the windpipe (trachea). This event is known as “laryngospasm.”

Infants and children are unable to describe sensations like adults can. Therefore, LPR is only successfully diagnosed if parents are suspicious and the child undergoes a full evaluation by a specialist such as an otolaryngologist. Airway or breathing-related problems are the most commonly seen symptoms of LPR in infants and children and can be serious. If your infant or child experiences any of the following symptoms, timely evaluation is critical.

• Chronic cough
• Hoarseness
• Noisy breathing (stridor)
• Croup
• Reactive airway disease (asthma)
• Sleep disordered breathing (SDB)
• Frank spit up
• Feeding difficulty
• Turning blue (cyanosis)
• Aspiration
• Pauses in breathing (apnea)
• Apparent life threatening event (ALTE)
• Failure to thrive (a severe deficiency in growth such that an infant or child is less than five percentile compared to the expected norm)

What are the complications of LPR?
In infants and children, chronic exposure of the laryngeal structures to acidic contents may cause long term airway problems such as a narrowing of the area below the vocal cords (subglottic stenosis), hoarseness, and possibly eustachian tube dysfunction causing recurrent ear infections, or persistent middle ear fluid, and even symptoms of “sinusitis.” The direct relationship between LPR and the latter mentioned problems are currently under research investigation.

How is LPR diagnosed?
Currently, there is no good standardized test to identify LPR. If parents notice any symptoms of LPR in their child, they may wish to discuss with their pediatrician a referral to see an otolaryngologist for evaluation. An otolaryngologist may perform a flexible fiber optic nasopharyngoscopy/laryngoscopy, which involves sliding a 2 mm scope through the infant or child’s nostril, to look directly at the voice box and related structures or a 24 hour pH monitoring of the esophagus. He or she may also decide to perform further evaluation of the child under general anesthesia. This would include looking directly at the voice box and related structures (direct laryngoscopy), a full endoscopic look at the trachea and bronchi (bronchoscopy), and an endoscopic look at the esophagus (esophagoscopy) with a possible biopsy of the esophagus to determine if esophagitis is present. LPR in infants and children remains a diagnosis of clinical judgment based on history given by the parents, the physical exam, and endoscopic evaluations.

How is LPR treated?
Since LPR is an extension of GER, successful treatment of LPR is based on successful treatment of GER. In infants and children, basic recommendations may include smaller and more frequent feedings and keeping an infant in a vertical position after feeding for at least 30 minutes. A trial of medications including H2 blockers or proton pump inhibitors may be necessary. Similar to adults, those who fail medical treatment, or have diagnostic evaluations demonstrating anatomical abnormalities may require surgical intervention such as a fundoplication.

A variety of tumors can grow in the salivary glands of the head and neck. These tumors are more commonly benign, however they need to be approached with the same caution as cancers arising from the glands.

What is Salivary Glands Cancer?

Cancer of the salivary glands is a disease in which cancer (malignant) cells are found in the tissues of the salivary glands. The salivary glands make saliva, the fluid that is released into the mouth to keep it moist and to help dissolve food.

Major clusters of salivary glands are found below the tongue, on the sides of the face just in front of the ears, and under the jawbone. Smaller clusters of salivary glands are found in other parts of the upper digestive tract. The smaller glands are called the minor salivary glands.

Many growths in the salivary glands do not spread to other tissues and are not cancer. These tumors are called “benign” tumors and are not usually treated the same as cancer.

Salivary duct stones may present as a “benign” salivary tumor. We are equipped to remove these stones using a small camera that enter the duct and extract the stone (sialoendoscopy).

Prognosis of Cancer of the Salivary Glands

The chance of recovery (prognosis) depends on where the cancer is in the salivary glands, whether the cancer is just in the area where it started or has spread to other tissues (the stage), how the cancer cells look under a microscope (the grade), and the patient’s general state of health.

Symptoms

A doctor should be seen if there is a swelling under the chin or around the jawbone, the face becomes numb, muscles in the face cannot move, or there is pain that does not go away in the face, chin, or neck.

Diagnosis

If there are symptoms, a doctor will examine the throat and neck using a mirror and lights. The doctor may order a special x-ray called a computed tomographic or CT scan, which uses a computer to make a picture of the inside of parts of the body. Another type of scan, called a magnetic resonance imaging or MRI scan, uses magnetic waves to make a picture of the head may also be ordered. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy.

Salivary Glands Cancer Staging

Once cancer of the salivary glands is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. Salivary glands cancers are also classified by “grade,” which tells how fast the cancer cells grow, based on how the cells look under a microscope. Low-grade cancers grow more slowly than high-grade cancers.

• Stage I. The cancer is 2 centimeters or less in diameter and has not spread outside the salivary glands.
• Stage II. The cancer is larger than 2 centimeters but not larger than 4 centimeters in diameter and has not spread outside the salivary glands.
  Stage III. Any of the following may be true: The cancer is larger than 4 centimeters in diameter and has spread into the skin, soft tissue, bone, or nerve around the gland. The cancer may have spread to a single lymph node.
• The cancer is less than 4 centimeters in size, and has spread to a single lymph node.
• Stage IVA. Any of the following may be true:
• The cancer has spread into the skin, soft tissue, bone, or nerve around the salivary gland, may be as large as 6 centimeters, and may have spread to 1 or more lymph nodes, but has not spread to other parts of the body.
• The cancer is any size and has spread to nearby tissue and has spread to a single lymph node on the same side of the neck as the cancer, to lymph nodes on either side of the neck, or to any lymph node.
• Stage IVB. Any of the following may be true:
• The cancer has spread into the bones of the skull and/or surrounded the carotid artery, the main (right and left) artery of the neck which carries blood to the head and brain, and may have spread to 1 or more lymph nodes.
• The cancer is greater than 6 centimeters and may have spread to nearby tissues, and has spread to at least 1 lymph node.
• Stage IVC. The cancer may be of any size and may have spread to nearby tissues and lymph nodes, and has spread to other parts of the body.

Risk Factors

There is no way to know for sure if you’re going to get cancer of the salivary glands. Certain factors can make you more likely than someone else to get it. These are called risk factors. However, just because you have one or more risk factors doesn’t mean you will get salivary glands cancer. In fact, you can have all the risk factors and still not get it. Or you can have no known risk factors and get it.

Source: Stanford Medicine Cancer Institute

Insight into detection, prevention, and treatment

• What is skin cancer?
• How is skin cancer diagnosed?
• Am I at risk for skin cancer?
• and more…

The skin is the largest organ in our body. It provides protection against heat, cold, light, and infection. The skin is made up of two major layers (epidermis and dermis) as well as various types of cells. The top (or outer) layer of the skin-the epidermis-is composed of three types of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and melanocytes, cells that provide skin its color and protect against skin damage. The inner layer of the skin-the dermis-is the layer that contains the nerves, blood vessels, and sweat glands.

What is Skin Cancer?

Skin cancer is a disease in which cancerous (malignant) cells are found in the outer layers of your skin. There are several types of cancer that originate in the skin. The most common types are basal cell carcinoma (70 percent of all skin cancers) and squamous cell carcinoma (20 percent). These types are classified as nonmelanoma skin cancer. Melanoma (5 percent of all skin cancers) is the third type of skin cancer. It is less common than basal cell or squamous cell skin cancer, but potentially much more serious. Other types of skin cancer are rare.

Basal cell carcinoma is the most common type of skin cancer. It typically appears as a small raised bump that has a pearly appearance. It is most commonly seen on areas of the skin that have received excessive sun exposure. These cancers may spread to the skin around the cancer but rarely spread to other parts of the body.

Squamous cell carcinoma is also seen on the areas of the body that have been exposed to excessive sun (nose, lower lip, hands, and forehead). Often this cancer appears as a firm red bump or ulceration of the skin that does not heal. Squamous cell carcinomas can spread to lymph nodes in the area.

Melanoma is a skin cancer (malignancy) that arises from the melanocytes in the skin. Melanocytes are the cells that give color to our skin. These cancers typically arise as pigmented (colored) lesions in the skin with an irregular shape, irregular border, and multiple colors. It is the most harmful of all the skin cancers, because it can spread to other sites in the body. Fortunately, most melanomas have a very high cure rate when identified and treated early.

What Causes Skin Cancer?

Most skin cancers occur on sun-exposed areas of our skin, and there is a lot of scientific evidence to support UV radiation as a causative factor in most types of skin cancer. Family history is also important, particularly in melanoma. The lighter your skin type, the more susceptible you are to UV damage and to skin cancer.

How is Skin Cancer Diagnosed?

The vast majority of skin cancers can be cured if diagnosed and treated early. Aside from protecting your skin from sun damage, it is important to recognize the early signs of skin cancer.

• Skin sores that do not heal,
• Bumps or nodules in the skin that are enlarging, and
• Changes in existing moles (size, texture, color).

If you notice any of the factors listed above, see your doctor right away. If you have a spot or lump on your skin, your doctor may remove the growth and examine the tissue under the microscope. This is called a biopsy. A biopsy can usually be done in the doctor’s office and usually involves numbing the skin with a local anesthetic. Examination of the biopsy under the microscope will tell the doctor if the skin lesion is a cancer (malignancy).

How is Skin Cancer Treated?

Am I at Risk for Skin Cancer?

How Can I Lower My Risk of Skin Cancer?

The single most important thing you can do to lower your risk of skin cancer is to avoid direct sun exposure. Sunlight produces ultraviolet (UV) radiation that can directly damage the cells (DNA) of our skin. People who work outdoors are at the highest risk of developing a skin cancer. The sun’s rays are the most powerful between 10 am and 2 pm, so you must be particularly careful during those hours. If you must be out during the day, wear clothing that covers as much of your skin as possible, including a wide-brimmed hat to block the sun from your face, scalp, neck, and ears.

The use of a sunscreen can provide protection against UV radiation. When selecting a sunscreen, choose one with a Sun Protection Factor (SPF) of 15 or more. For people who live in the Southern U.S., a SPF of 30 or greater should be used during summer and when prolonged exposure is anticipated. Sunscreen should be applied before exposure and when the skin is dry. If you will be sweating or swimming, most sunscreens will need to be reapplied. Sunscreen products do not completely block the damaging rays, but they do allow you to be in the sun longer without getting sunburn.

It is also critical to recognize early signs of skin trouble. The best time to do self-examination is after a shower in front of a full-length mirror. Note any moles, birthmarks, and blemishes. Be on the alert for sores that do not heal or new nodules on the skin. Any mole that changes in size, color, or texture should be carefully examined. If you notice anything new or unusual, see your physician right away. If you have a strong family history of skin cancer, particularly melanoma, an annual examination by a physician skilled at diagnosing skin cancer is recommended. Catching skin cancer early can save your life.

Ultraviolet Index: What You Need to Know

The thyroid gland is located in the front of the neck at the base of the throat. Thyroid tumors are either benign (noncancerous) or malignant (cancerous) growths. Examples of benign tumors are adenomas, which secrete thyroid hormone. Malignant tumors are more rare and are more common in women than in men. According to the American Cancer Society (ACS), about 22,000 cases of thyroid cancer will be diagnosed in the US in 2003.

What Are Thyroid Adenomas?

Thyroid adenomas grow from the cell layer that lines the inner surface of the thyroid gland. The adenoma itself secretes thyroid hormone. If the adenoma secretes enough thyroid hormone, it may cause hyperthyroidism. Thyroid adenomas may be treated if they cause hyperthyroidism. Treatment may include surgery to remove part of the thyroid (the overactive nodule).

What Are Cancerous Thyroid Tumors?

Cancer of the thyroid occurs more often in people who have undergone radiation to the head, neck, or chest. However, most thyroid cancer can be cured with appropriate treatment. Thyroid cancer usually appears as small growths (nodules) within the thyroid gland. Some signs that a nodule may be cancerous include:

• presence of a single nodule rather than multiple nodules
• thyroid scan reveals the nodule is not functioning
• nodule is solid instead of filled with fluid (cyst)
• nodule is hard
• nodule grows fast
  

What Are the Different Types of Thyroid Cancer?

What Are the Symptoms of Thyroid Cancer?

Treatment for Thyroid Cancer:

A tonsillectomy (ton-seh-leck-teh-me) is an operation in which the tonsils are taken out of the throat.

What is the procedure for having a tonsillectomy?
After dinner the night before the tonsillectomy, your child won’t be allowed to eat or drink anything — even water!

Upon arriving at the hospital, your child will receive a special bracelet with his/her name on it and hospital clothes. Your child will then meet the doctors and nurses that will be helping his/her. When the doctor is ready, your child will be given a special medicine that makes him/her fall asleep. Then, the doctor and nurses will use special tools to remove the tonsils. It doesn’t take very long – just about 20 minutes!

Upon waking up, the operation will be all over. Your child’s throat may hurt but the nurses and doctors will make sure everything is okay. In a few hours, your child will be ready to go home. Your child’s throat will be sore for a few weeks.

Once home, make sure your child drinks a lot and get lots of rest. It will help to keep his/her throat moist and your child’s body energized. It is okay for your child to eat non-dairy popsicles and other cold treats or soft food that makes the throat feel better, but save ice cream for the next day. Ice cream and other milk products can make your child’s throat worse right after the operation. Within approximately two weeks, your child should be ready to return to school and all normal activities

Tonsils are the two pink lumps of tissue found on each side of the back of the throat. Each grape-size lump fights off the bad bacteria or germs living in the human body. Tonsillitis refers to inflammation of the pharyngeal tonsils. The inflammation may involve other areas of the back of the throat including the adenoids and the lingual tonsils (areas of tonsil tissue at the back of the tongue). There are several variations of tonsillitis: acute, recurrent and chronic tonsillitis and peritonsillar abscess. Viral or bacterial infections and immunologic factors lead to tonsillitis and its complications. Nearly all children in the United States experience at least one episode of tonsillitis. Because of improvements in medical and surgical treatments, complications associated with tonsillitis, including mortality, are rare.

Who gets tonsillitis?
Tonsillitis most often occurs in children; however, the condition rarely occurs in children younger than two years. Tonsillitis caused by streptococcus species typically occurs in children aged five to 15 years, while viral tonsillitis is more common in younger children. A peritonsillar abscess is usually found in young adults but can occur occasionally in children. The patient’s history often helps identify the type of tonsillitis (i.e., acute, recurrent, chronic) that is present.

What causes tonsillitis?
The herpes simplex virus, streptococcus pyogenes (GABHS) and Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute pharyngitis and acute tonsillitis. Bacteria cause 15-30 percent of pharyngotonsillitis cases; GABHS is the cause for most bacterial tonsillitis.

What are the symptoms of tonsillitis?
The type of tonsillitis determines what symptoms will occur.

• Acute tonsillitis: Patients have a fever, sore throat, foul breath, dysphagia (difficulty swallowing), odynophagia (painful swallowing) and tender cervical lymph nodes. Airway obstruction due to swollen tonsils may cause mouth breathing, snoring, nocturnal breathing pauses, or sleep apnea. Lethargy and malaise are common. These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.
• Recurrent tonsillitis: This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year.
• Chronic tonsillitis: Individuals often have chronic sore throat, halitosis, tonsillitis and persistently tender cervical nodes.
• Peritonsillar abscess: Individuals often have severe throat pain, fever, drooling, foul breath, trismus (difficulty opening the mouth), and muffled voice quality, such as the “hot potato” voice (as if talking with a hot potato in his or her mouth).

What happens during the physician visit?
Your child will undergo a general ear, nose and throat examination as well as a review of the patient’s medical history.

A physical examination of a young patient with tonsillitis may find:

• Fever and enlarged inflamed tonsils covered by pus.
• Group A beta-hemolytic Streptococcus pyogenes (GABHS) can cause tonsillitis associated with the presence of palatal petechiae (minute hemorrhagic spots, of pinpoint to pinhead size, on the soft palate). Neck nodes may be enlarged. A fine red rash over the body suggests scarlet fever. GABHS pharyngitis usually occurs in children aged 5-15 years.
• Open-mouth breathing and muffled voice resulting from obstructive tonsillar enlargement. The voice change with acute tonsillitis usually is not as severe as that associated with peritonsillar abscess.
• Tender cervical lymph nodes and neck stiffness (often found in acute tonsillitis).
• Signs of dehydration (found by examination of skin and mucosa).
• The possibility of infectious mononucleosis due to EBV in an adolescent or younger child with acute tonsillitis, particularly when cervical, axillary and/or groin nodes are tender. Severe lethargy, malaise and low-grade fever accompany acute tonsillitis.
• A grey membrane covering tonsils that are inflamed from an EBV infection. (This membrane can be removed without bleeding.) Palatal petechiae (pinpoint spots on the soft palate) may also be seen with an EBV infection.
• Red swollen tonsils that may have small ulcers on their surfaces in individuals with herpes simplex virus (HSV) tonsillitis.
• Unilateral bulging above and to the side of one of the tonsils when peritonsillar abscess exists. A stiff jaw may be present in varying severity.

Treatment
Tonsillitis is usually treated with a regimen of antibiotics. Fluid replacement and pain control are important. Hospitalization may be required in severe cases, particularly when there is airway obstruction. When the condition is chronic or recurrent, a surgical procedure to remove the tonsils is often recommended.

The tonsils are two pads of tissue located on both sides of the back of the throat. Adenoids sit high on each side of the throat behind the nose and the roof of the mouth. Tonsils and adenoids are often removed when they become enlarged and block the upper airway, leading to breathing difficulty. They are also removed when recurrence of tonsil infections or strep throat cannot be successfully treated by antibiotics.

The procedure to remove the tonsils is called a tonsillectomy; excision of the adenoids is an adenoidectomy. Both are usually performed concurrently; hence the procedure is known as a tonsillectomy and adenoidectomy (T&A).

T&A is an outpatient surgical procedure lasting between 30 and 45 minutes and performed under general anesthesia. Normally, the young patient will remain at the hospital or clinic for about four hours after surgery for observation. An overnight stay may be required if there are complications such as excessive bleeding or poor intake of fluids.

When the tonsillectomy patient comes home
Most children require seven to ten days to recover from the surgery. Some may recover more quickly; others can take up to two weeks for a full recovery. The following guidelines are recommended:

Drinking: The most important requirement for recovery is for the patient to drink plenty of fluids. Milk products should be avoided in the first 24 hours after surgery. Offer juice, soft drinks, popsicles and gelatin. Pudding, yogurt, ice-cream and other milk products can be offered after 24 hours. Some patients experience nausea and vomiting after the surgery caused by the general anesthetic. This usually occurs within the first 24 hours and resolves on its own. Contact your physician if there are signs of dehydration (urination less than two to three times a day or crying without tears).

During first 24 hours

Weight of PatientMinimal Fluid Intake

over 20 pounds - 34 ounces

over 30 pounds - 42 ounces

over 40 pounds - 50 ounces

over 50 pounds - 58 ounces

over 60 pounds - 68 ounces

Eating: Generally, there are no food restrictions (other than milk products) after surgery. The sooner the child eats and chews, the quicker the recovery. Tonsillectomy patients may be reluctant to eat because of sore throat pain; consequently, some weight loss may occur, which is gained back after a normal diet is resumed.

Fever: A low-grade fever may be observed several days after surgery. Contact your physician if the fever is greater than 102º.

Activity: Bed rest is recommended for several days after surgery. Activity may be increased slowly, with a return to school after normal eating and drinking resumes, pain medication ceases, and the child sleeps through the night. Travel away from home is not recommended for two weeks following surgery.

Breathing: The parent may notice abnormal snoring and mouth breathing due to swelling in the throat. Breathing should return to normal when swelling subsides, 10-14 days after surgery.

Scabs: A scab will form where the tonsils and adenoids were removed. These scabs are thick, white, and cause bad breath. This is not unexpected. Most scabs fall off in small pieces five to ten days after surgery and are swallowed.

Bleeding: With the exception of small specks of blood from the nose or in the saliva, bright red blood should not be seen. If such bleeding occurs, contact your physician immediately or take your child to the emergency room. Bleeding is an indication that the scabs have fallen off too early, and medical attention is required.

Pain: Nearly all children undergoing a tonsillectomy/adenoidectomy will have mild to severe pain in the throat after surgery. Some may complain of an earache (because stimulation of the same nerve that goes to throat also travels to the ear), and a few may incur pain in the jaw and neck (due to positioning of the patient in the operating room).

Pain control: Your physician will prescribe appropriate pain medications for the young patient such as codeine, hydrocodone, Tylenol^® with codeine liquid, or Lortab^® (hydrocodone with Tylenol^®). Generally, an acetaminophen (Tylenol^®, Tempra^®, Panadol^®) teaspoon solution is recommended for regular administration to the patient for three or four days after surgery.

If you are troubled about any phase of your child’s recovery, contact your physician immediately.