York ENT Blog

Welcome Karen

Comments Off on Welcome Karen
March 26  |  Blog, York ENT Blog  |   James Rejowski

Welcome Karen

Karen Heidinger joined our practice last year, taking a position as our office manager. She comes to us from Suburban Cardiology, and brings a wealth of experience in all aspects of this position, including billing, finance, personnel, scheduling, and strategic planning.

Karen began her career in the medical field after completing the medical assisting program at Robert Morris College.  She has worked with a variety of practices over the years in the areas of Primary Care, Allergy, and Cardiology.

She has enjoyed the interaction with the people that she encountered every day in those practices along with the feeling of being able to help them, whether it was with the physical aspect of their medical condition or assisting them with navigating their insurance benefits.

The majority of her career was working in Cardiology. She began working for a six physician group as a medical assistant and was subsequently promoted to the front end supervisor position. Her efforts there resulted in her being appointed Practice Manager, a position she held for more than ten years.

She joined York ENT Surgical Consultants, a member of Amita Health Medical Group, in May of 2015 and she looks forward to the opportunities it presents for her.

In her free time she enjoys spending time with her family and volunteering with Special Olympics.

We enjoy working with her and look forward to our future together.

 

 

Noisy Toys 2015

Comments Off on Noisy Toys 2015
December 15  |  Blog, York ENT Blog  |   James Rejowski

Noisy Toys List 2015

 

Each year the Sight & Hearing Association publishes a list of the loudest toys available for sale this holiday season. This year the Animal Babies Nursery: Jumpin’ Lil Monkeys tops the list at 103.4 dB of potential inner ear damaging sound presentation.

The top five are rounded out by:

Disney Frozen: Cool Tunes Sing-Along Boombox at 100.4 dB

Little Tykes Lil’Ocean Explorers Push’n Glow Fish at 93.8 dB

FurReal Friends Dancing Penguin at 93.7 dB

Disney Pixar Inside Out: Bing Bong Musical at 93.6 dB

Prolonged exposure to sound at these levels can be damaging to a child’s hearing and it goes without saying that proper parental supervision is necessary.

I would be remiss if I did not give credit and thanks to Dr. Dawn Violetto for providing these lists each year. Dawn is the Director of Audiology at Child’s Voice. She works with the children there as an educational and diagnostic audiologist. She also runs the Pediatric Early Detection and Intervention program in the surrounding communities and serves on the Illinois New Born Hearing Collaborative and the Illinois New Born Hearing Advisory Committee. Many thanks.

 

Facial Frostbite

Comments Off on Facial Frostbite
March 1  |  Blog, York ENT Blog  |   James Rejowski

Facial Frostbite

For anyone living in Chicago it’s no surprise to hear that this past February was one of the coldest on record.  Such conditions carry the risk of frostbite to those who venture outside.

Frostbite is basically the freezing of skin and the underlying tissues. In the head and neck area, the ears and nose are especially susceptible. It can range from frostnip, a superficial injury, to deeper levels of involvement. This freezing compromises the blood vessels, stopping blood flow, and can lead to tissue death if it is prolonged. Paradoxically, in this respect, it is similar to a burn. Individuals with vascular disease, diabetics, and young children are especially susceptible.

It can occur following either brief or prolonged exposures, depending upon the temperature and wind. Symptoms include numbness and a woody feeling of the skin. Skin color changes ranging from redness to whitish/gray and purple discoloration can occur. Blistering suggests a more severe injury.

The preferred treatment is to get out of the cold and gently rewarm the involved areas to restore blood flow. Warm water is preferable as opposed to aggressive re-heating measures. It can be painful as the feeling comes back. Blisters if present should be left intact. Medical attention should be sought urgently if significant discolorations of the skin or persistent numbness are present. Rubbing of snow on the skin will damage the skin further. Conditions that cause frostbite can lead to hypothermia which should be suspected if slurred speech and sleepiness are present.

Prevention is the key. Alcohol should be avoided. Children’s time outside should be monitored. Those who need to be outside should anticipate the weather, keep the face and ears covered, dress in layers, and keep moving.  Common sense always applies.

 

 

A Possible Link Between Hearing Loss and Mental Decline

Comments Off on A Possible Link Between Hearing Loss and Mental Decline
February 1  |  Blog, York ENT Blog  |   James Rejowski

There was an interesting article written by Anne Stein in the Health and Family Section of the Chicago Tribune on Wednesday, January 28, 2015. She references the work of Dr. Frank Lin, an ear specialist at Johns Hopkins University, and Dr. Richard Gurgel from the University of Utah. Their research has suggested that there may be an association between hearing loss, reduction in cognitive ability, and dementia.

The article cites their research, which demonstrates several findings in this regard. One investigation showed a 30-40% faster decline in mental acuity in patients 75-84 years old over six years in those with hearing loss than in those without.

Another work showed that in a group of seniors followed over time, those with hearing loss at the beginning of the study were more likely to develop dementia. More severe losses were associated with a greater likelihood.

The exact mechanisms of these associations are not completely clear and further research is ongoing.

The article points out that many people who could benefit from amplification do not pursue it, either due to the perceived stigma of hearing aids or acceptance of hearing loss as a normal consequence of aging. The results of these efforts may well change this and have positive impact on the quality of people’s lives.

Auditory Services of York ENT Surgical Consultants, serving Hinsdale, La Grange, Bolingbrook, and the surrounding communities, offers comprehensive evaluation of hearing disorders in adults and children as well as a full complement of hearing aid services and fittings.

Self Help For Summer Allergies

Comments Off on Self Help For Summer Allergies
July 16  |  Blog, York ENT Blog  |   Dr James Rejowski

Photo of allergy season in ChicagoWe are now entering the middle of summer here in the Midwest and, taking the good with the bad, we are well into the allergy season.  Everyone is familiar with the typical symptoms of environmental allergies: sneezing, congestion, postnasal discharge, plugged ears, itchy eyes, and scratchy throat.

Allergies occur because of an interaction between the pollens and what are called IgE antibodies.  These are present on certain cells within the nasal lining.  The interaction between the proteins within the pollens and these antibodies on the surface of mast cells and basophils cause the cells to release chemicals called cytokines and histamine.  These are the elements which cause the allergic symptoms.  The chemicals cause release of fluid into the nasal and sinus tissues, increased secretion and mucus, swelling, and congestion.

The diagnosis of an allergic response is frequently easy to make.  Following exposure to cut grass, hikes through the woods, animals, insect bites, and molds, the symptoms will develop.  Over the course of a given year, the trees pollenate first, usually in the early to middle spring.  These are followed by the grasses and then the weeds.  The most common offender in the weed family is ragweed.

Unlike a cold or respiratory infection, allergy symptoms can wax and wane from day to day.  Often this depends upon the weather and the amount of rain.  There are many Apps such as weather.com which will document the pollen counts in a given area.  People will find that these will often correlate with their symptoms.

There are many agents available to assist in managing the symptoms of allergy.  Antihistamines have a long track record of benefit.  These agents block receptor sites for the histamine molecule within the nasal lining, preventing actions such as itching, swelling, discharge, and headache.  The older agents, such as chlorpheniramine, work, but they are associated with a short duration of action and sleepiness.  The newer agents such as loratadine, cetirizine, and fexofenadine have all day benefit without causing sleepiness.

Decongestants are agents that shrink the blood vessels within the nasal lining.  This improves the nasal airway, facilitating better breathing, and they also cut down on discharge.  Although strictly speaking they don’t react against the allergic process, they are helpful for symptomatic control.

Nasal steroids such as Nasacort were once only available by prescription.  They are now becoming increasingly available over-the-counter.  The mechanism of nasal steroids against allergies is not completely clear, but clinical experience has shown that they’re helpful in reducing not only the nasal symptoms but also itching in the eyes.  The onset of action is a bit longer than the antihistamines or decongestants, but they do not carry the potential for side effects such as sleepiness or insomnia.

Nasal saline rinses using a neti pot or a Neil med system are becoming increasingly popular.  The offending allergens can be trapped within the mucous of the nasal lining, and the gentle rinsing will help eliminate those thus preventing symptoms.

The suggestions above are frequently of benefit for allergy sufferers.  For more severe cases, however, formal evaluation with allergy skin testing and immunotherapy may be necessary.

To schedule an appointment with an allergy doctor in the Chicago suburbs to discuss your treatment options, please call: 630-654-1391 (for Hinsdale office) or 630-759-0065 (for Bolingbrook office).

The Head Mirror

Comments Off on The Head Mirror
May 31  |  Blog, York ENT Blog  |   James Rejowski

The Head Mirror

Luke: What is it?

Obi-Wan: Your father’s light saber.  This is a weapon of a Jedi Knight.  Not as clumsy or random as a blaster; an elegant weapon for a more civilized age…….

Star Wars: Episode IV- A New Hope (1977)

The head mirror, still in use with a design originally created more than 150 years ago, remains a symbol of physicians, second only to the stethoscope.  The current design is credited to Dr. Johann Czermak ,who developed a prototype in Budapest in 1857. Remarkably simple in design and effective in use, it has stood the test of time.  The head mirror consists of a small concave mirror with a hole in the center of it, secured by a headband.  When not in use the mirror is reflected upward.  A light source is placed behind the patient’s head, the mirror is flipped down, and the light is then reflected into the patient’s nose or mouth.  The intensity and size of the light beam reflected is adjusted by the physician moving his or her head back and forth.  It takes a bit of practice to do this.  The eye hole in the center of the mirror allows binocular vision by the examiner.  The light is bright and without shadows.  It frees up both hands for the examination since the doctor doesn’t have to hold a flashlight or penlight.

Although otolaryngologists of a certain generation generally still use the head mirror, its use is slowly being replaced by either fiberoptic or LED headlights.  These are currently used in most training programs.  At one time these were quite expensive, but the cost has come down considerably.  I still think that there is a certain panache to the humble head mirror, and seeing a look of amusement and interest on my patient’s faces when I bring it out suggests to me that they feel theMay 2014 017 same.May 2014 020

Medical Decision Making

Comments Off on Medical Decision Making
March 25  |  Blog, York ENT Blog  |   James Rejowski

Using Dr. House to explain medical decision makingParadigm: A group of ideas about how something should be done or thought about.

Although all parts of the patient’s visit to a physician are important, the concluding aspects carry a special significance.  Recommendations are made regarding evaluation and treatment.  It is also, most likely, the time where the patient feels the most vulnerable, since in effect they are being asked whether they agree or disagree with the advice being given.  It is easy to see how difficult it could be to discern the message from the messenger.  Who would dispute the words of these esteemed physicians?

The answer to this dilemma is to employ a deceptively straightforward scheme, or paradigm, of medical decision making.  It involves consideration of the following three elements:

  1. The illness
  2. The treatment
  3. The benefit

ENTT_2011_08_pp22_01It is important to get a feel for the significance of the medical problem itself.  Is it painful, like an ear infection or tonsillitis?  Does it interfere with normal activities?  If symptoms are not present now, as in hypertension or elevated cholesterol, will it cause health problems down the line?  Does it cause physical or aesthetic deformity, like a large benign tumor or a lipoma?  Could it be malignant?  Basically, before going forward, the illness has to pass the “worth it” test.

The recommended treatment has to be taken into account.  Even well-intended, treatments can be inconvenient, expensive, and not always without risk.  The relative risks of the treatment need to be weighed against the potential risks and downsides of the malady left to its own design.  It would be difficult to proceed if the treatment was worse than the illness.  Other perhaps less invasive treatment options, if available, should be considered.

Finally, the recommended treatment has to have a very substantial probability of success.  Inexpensive innocuous treatments without any chance of benefit don’t really have very much to offer.  If therapy is not much better than no therapy, go with no therapy.

Patients need to involve themselves in this process.  Second or even third opinions are often helpful.  One should never hesitate to bring a list of questions to their visit.  There are no silly questions.  Self-research online has some potential pitfalls, because information there is more readily available than knowledge, but people are comforted when they find that the advice they are receiving is consistent with the accepted prevailing medical opinions posted.

External Otitis, Then and Now

Comments Off on External Otitis, Then and Now
March 1  |  Blog, York ENT Blog  |   James Rejowski

The American Academy of Otolaryngology- Head and Neck Surgery published a monograph last month regarding the evidence based proper treatment of external otitis, or outer ear infections.  The goal was to promote increased recognition and proper treatment of this common disorder.  Almost one half billion dollars are spent each year in the treatment of such infections.  Among other things, the aim was to avoid the inappropriate use of oral antibiotics, which are prescribed from 20-40% of the time as treatment, and in most cases are unnecessary and ineffective.

External otitis, frequently called swimmer’s ear, is an acute inflammatory disorder of the outer ear.  It is more common in the summer months.  The illness is characterized by the rapid onset of ear pain and itching.  Ear fullness and jaw discomfort are frequently present.  The examination will demonstrate redness and swelling in the ear canal and tenderness of the adjacent cartilages.

The conclusions of the study were as follows:

1) Adequate pain relief should be delivered.

2) Systemic antibiotic treatments should be avoided unless there is infection beyond the ear, or the patient has serious underlying health issues.

3) Other sources of ear discharge and inflammation should be excluded.

4) An assessment of other factors that would influence management such as the presence of tubes or a tympanic membrane perforation should be performed.

5) Topical treatments with antimicrobials should be delivered.

6) The patient should be educated regarding the proper methods of delivering the drops into the ear, including placing a wick into the area to bring the medicines within the canal.

7) In the presence of a perforation of the eardrum or a tube, medicines that could damage the inner ear should be avoided.

8) The patient should be reassessed within 48-72 hours if there is no significant improvement.

This is an elegant and detailed study which will be of great benefit to clinicians treating patients with this disorder.

When I was a medical student, I received a Manual of Otolaryngology originally written by Dr. Stanton A. Friedberg, the Professor and Chairman of the Department of Otolaryngology and Bronchoesophagology at Presbyterian St. Luke’s Medical Center in Chicago.  It was first printed in 1955 and was revised by Dr. Friedberg and Dr. Jim Hutchinson in the 1970s.  It was a practical, carry in your lab coat pocket, type of guide that would be of value to students and junior house officers early in their careers.  Many of the recommendations present in the current review were detailed by Dr. Friedberg and Dr. Hutchinson in their monograph. I apologize for the tiny print.

Sometimes the more things change the more they stay the same.

Dr. F jpeg 1Dr F jpeg 2Dr F jpeg 3Dr F jpeg 4

Ham the Space Monkey and the Affordable Care Act

Comments Off on Ham the Space Monkey and the Affordable Care Act
January 5  |  Blog, York ENT Blog  |   Dr James Rejowski

I spent my grammar school years from the late 1950s to the mid-1960s, and as such grew up during the development of the American space program. Rocket ships and astronauts were of great interest to young boys like me. My brother and I received a Kenner slide show for Christmas one year. It had a small projector with some slides and came with a record that we played while we watched them and signaled when we should advance the slides. I’m dating myself but people my age will remember things like this.
We had a presentation on dinosaurs and another on the Alamo, but one of our favorites involved a trip into suborbital space by a chimpanzee named Ham.

Leaving the earth seems almost routine now but at that time that it was not a given that Ham the Space Monkeyone could survive in space, and if they did, would be able to perform any tasks related to piloting a space craft. Ham was trained to respond to simple commands and he was launched in a predecessor to the Mercury capsules to see whether this could be done. His mission was successful. He returned safely and spent his remaining years at the zoo in Washington DC.

His successful venture was ultimately followed by Alan Shepherd in Freedom 7, built in part upon the knowledge gained during Ham’s earlier flight.
The continued accumulation of knowledge and technology obtained during the Mercury, Gemini, and early Apollo programs allowed the Apollo mission to be successful in 1969 when Neil Armstrong and Buzz Aldrin were able to land on the moon. Each step along the way contributed substantial building blocks to the final outcome. Even taking the greatest minds of that generation, it would not have been possible for scientists to sit down and develop a Saturn V rocket and a lunar module in one step.
And that little story reflects my concerns regarding the Affordable Care Act.

The healthcare system in the United States was not going in a good direction. Changes needed to be made. Coverage was becoming increasingly expensive and increasingly unpredictable. Rationing by economics prevailed. People either got excellent care or too frequently, no care.

Unfortunately, by trying to do things in one fell swoop, I don’t think the ACA is going to have much to offer over the previous system. Its website rollout has been inauspicious to say the least. I think it’s going to be a challenge to get healthy people to buy policies with high monthly premiums when the penalty for not doing this is minimal. There will be an incentive for businesses to drop employer sponsored coverage altogether and direct their employees into the exchanges, which may well offer Medicaid type of programs, not accepted by many providers. Maybe there is no reason to obtain insurance at all, since there are no pre-existing condition exclusions. One could make the argument that you should wait until you get sick and then purchase it.

It probably would have been better, in retrospect, to do things in steps, as the space program did. Perhaps the politics and the partisanship would not have allowed it. It is now 2014, however, and the ACA is here to stay. It’s going to be an interesting ride.

Posterior Epistaxis

Comments Off on Posterior Epistaxis
October 23  |  Blog, York ENT Blog  |   James Rejowski

Epistaxis, or nosebleed, is a common problem that we see and treat in our practice.  60% of the population will suffer a nosebleed at some time in their life.  Most the bleeding is anterior, or from the front of the nose.  This is usually treated in the office with simple cautery or packing.

Posterior epistaxis, or bleeding from the back of the nose, presents more of a problem.  It is frequently seen in older people with underlying health problems such as diabetes or vascular disease.  This type of bleeding can require admission to the hospital for treatment, but fortunately this occurs only in a small percentage of patients.

A recent study compared different modalities of treatment for posterior epistaxis.  Using a national data base of over 50,000 admissions, outcome results for nasal packing, surgical ligation of bleeding vessels, and endovascular embolization were obtained.  Nasal packing involves the placement of a Vaseline gauze, tampon, or balloon in the nasal cavity, leaving it in place for 48-72 hours.  Arterial surgical ligation is usually done with an operation done through a person’s mouth, in the area above the canine teeth.  Dissection proceeds through the maxillary sinus until the arterial feeding vessels are identified and clips are placed on them.  Arterial embolization is done by interventional radiologists, who will place a catheter through the arterial system from the groin and perform very selective occlusions of the vessels behind the nose in order to stop the bleeding.

The length of stay in the hospital for each of these treatments was quite comparable to each other.  The cost of treatment for the embolization group was highest.  There was an increased risk of stroke with the embolization procedures compared to packing, which is not surprising given the fact that particulate matter was injected into the arterial circulation in the former group.

The data in this study was extracted from the discharge diagnosis that was coded following these hospitalizations.  It was not actually done by a review of the individual charts, so it needs to be taken with a grain of salt.  None of the treatments is intrinsically better than the others.  Practically speaking, when we see patients presenting with bleeding it is more efficacious to place a pack and wait a bit to determine its success or failure, rather than go right to the operating room or the angiography suite with a bleeding patient.  The latter treatments are a fall back when the packing, a less invasive procedure, isn’t successful in controlling the bleeding, or if the epistaxis recurs following this initial treatment.

Reference: Recent Trends in Epistaxis Management in the United States 2008-2010, Drs. Vilwock and Jones, JAMA Otolaryngology/Head and Neck Surgery, 2013