Adult and Pediatric

  ENT

Pediatric ENT

Recurrent Ear infections -- Because the immune system and eustachian tubes have not matured, children are prone to middle ear infections. Further exposure to cigarette smoke, daycare, or allergens just to name a few; make middle ear infections even more common. Antibiotics are effective, however the fluid may remain in the middle ear and either become reinfected or cause hearing loss. PE tubes are small tubes placed in the ear drum that act as a eustachian tube by "ventilating" the middle ear. A general guideline  for the indications of PE tube placement are 3 infections in the last 6 months or retained fluid in the middle ear for 3 months.

Snoring and Obstructive Sleep Pattern -- Obstructive sleep apnea (OSA) is a syndrome where breathing while sleeping is impaired. Over time (similiar to hypertension) it can cause problems with the heart and lungs. OSA can also impair growth and development, lead to behavioral disturbances, and can be associated with poor performance in school. It is often caused by large tonsils and adenoids but not always. Struggling or gasping to breathe, choking spells or pausing of breath can all be signs of sleep apnea. Snoring by itself may or may not be associated with sleep apnea. It implies atleast a partial obstruction; the significance of which depends on a careful history and physical by your physician. 

Mouth Breathing and Chronic nasal congestion -- There can be several reasons behind this problem. The two most common are chronic allergies and adenoid enlargement. The adenoids are lymphoid tissue in the back of the nose, that when enlarged, make it difficult to breathe through the nose. They can also be chronically infected causing chronic nasal infections and drainage or cause inflammation of the eustachian tube openings which in turn causes middle ear problems. One option is to have the adenoids removed surgically  Allergic Rhinits is inflammation of the nasal tissues and sometimes the adenoids caused by environmental allergies. This can often be treated very effectively with medicines  alone.           

Hearing Problems -- Often caused by middle ear fluid, Dr Ruggiero will perform a careful examination of the ear under the microscope to make the diagnosis. If the middle ear is clear then a hearing test will be performed: the type of which is determined by the age of the child. If the hearing is abnormal, further testing and treatment will depend on the type and extent of hearing loss.

Neck Mass -- A lump in the neck may be nothing more than a temporarily inflammed lymph node . However it may also be a congenital neck mass which is usually benign but often problematic. Although rare  other causes including malignancy (cancer) can occur. For this reason a neck mass persisting more than 3 weeks should be evaluated by a specialist.

Tonsillitis and Recurrent Strep Throat -- Recurrent bacterial infections of the throat can be quitie problematic. They are often treated succesfully with antibiotics. However, sometimes the tonsils can be scarred, cryptic and easily reinfected. Recurrent infections can also be the result of being a chronic streptococcal bacteria (strep) carrier. An evaluation will help determine if having the tonsils removed will be beneficial.

Wide Set or Prominent ears. Sometimes a child's or even an adult's ears can be wide set. This can be quite troublesome and psychologically difficult for a child. A child's ears will have nearly reached adult size by age seven and because of this, the operation is usually not done before this age. The operation involves pinning the ears back  through a hidden incision behing the ear. This  is a same day surgery and for children, the surgery is often covered by insurance.  

Adult ENT

Recurrent Sinus Problems---Sinusitis is a very common problem and is usually characterized by nasal congestion, sinus pressure, and a yellow nasal discharge. A clear nasal discharge is usually  a result of allergies or a viral upper respiratory infection. However, the inflammation caused by allergies or a virus can lead to a secondary bacterial infection. Some people have dysfunctional sinus anatomy (meaning the small holes that drain the sinuses are poorly positioned, abnormally small, or easily obstructed by the surrounding tissue or structures). Any insult to the nasal lining (ie. virus or allergies) can cause swelling around these small holes that drain the sinuses. Because the sinuses then don't drain effectively,  a bacterial infection can develop. Antibiotics will usually cure the infection but the infection can recur easily because of the person' s dysfunctional sinus anatomy. This is recurrent sinusitis and can sometimes be treated medically if the underlying problem (like allergies) can be controlled. Recurrent sinusitis is typically described as 4 or more infections per year. Sometimes surgery is needed to make the holes draining the sinus' larger.

Chronic sinusitis---Often a very difficult problem to treat. The lining inside the nose and sinuses becomes thickened and inflammed due to chronic infection or allergies. Chronic inflammation can lead to polyps, chronic nasal congestion, facial pressure, and nasal discharge. This can be treated medically with prolonged antibiotics, nasal rinsing, and nasal steroids. However surgery is sometimes necessary, along with medical therapy, to remove polyps or to enlarge the holes draining the sinuses. Treatment by an experienced ENT doctor can make a dramatic improvement  in the lifestyle of someone with chronic sinusitis.

Runny nose, chronic nasal congestion, and nasal obstruction---this is a very common problem in the south where allergies are rampid. Fortunately, there are now a wide variety of non sedating antihistamines and nasal sprays that are very effective with few side effects. An ENT doctor will carefully examine the inside of your nose to properly diagnose the cause of your symptoms and prescribe the best medicine for you. Sometimes the shelves of tissue inside the nose called turbinates remain swollen despite medical therapy. This can cause significant difficulty when breathing through the nose. However, Dr Ruggiero can perform a procedure in the office to reduce the size of the turbinates with  little discomfort and essentially no down time. Finally the midline structure in the nose called the septum can be "deviated" or crooked causing significant obstructive symptoms. This can also be corrected with a surgery in the operating room and can be very satisfying for the patient.

Hoarseness--- this has many causes including post nasal drip, gastroesophageal reflux, chronic cough, upper respiratory infections, and overuse of the voice just to name a few. Dr Ruggiero will carefully examine the voice box and vocal cords to determine the cause. Sometimes an actual lesion on the vocal cords will be the problem. This may be a benign polyp or nodule but may be a more serious problem as well. Vocal cord cancer has an extremely good prognosis IF it is discovered early. If you have hoarseness for 3 weeks or more, you should be evaluated by an ENT physician.

Snoring and Obstructive Sleep Apnea --- Snoring is a common adult and sometimes childhood problem. It can be a source of marital discourt. It can also be a symptom of a more serious problem like sleep apnea. Sleep apnea is an obstruction of breathing while sleeping. Over time it can cause problems with the heart and blood pressure. Short term it can be the cause of excessive daytime fatigue and sleepiness. The source of the obstruction can be the palate, the tonsils, the base of the tongue or the nose. Dr Ruggiero will carefully examine you to determine the most likely cause of the obstruction and the treatment most likely to be effective.