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Scroll through the topics below to find answers to commonly asked questions.
Southern Crescent, ENT PC
What does an initial allergy evaluation involve?
The initial visit includes a complete medical history and a focused physical examination. In some instances the upper airway is assessed with examination scopes. In some cases pulmonary function tests may be performed. In most instances tests for specific allergies are performed.
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How are allergy tests performed?
Testing for specific causes is usually done by skin testing. Drops of extracts of the substances known to cause allergic reactions are placed on the back and a plastic device is pressed into the drops to allow them to soak into the skin. Reactions occur at the site within 20 minutes if the person is allergic to the material. When results on the back are not conclusive, a few tests may be performed on the arm. Solutions of allergens are injected into the skin and the sites are observed for 20 minutes for the appearance of allergic reactions.
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How are allergic diseases treated?
There are three approaches to dealing with allergic disorders:
- Avoidance of the causes
- Medications to suppress the reactions
- Allergy vaccines that decrease the person's reactions to the allergens
In order to intelligently apply these measures we must establish that the problem is an allergy, and then identify the causes.
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What are the advantages and disadvantages of taking allergy vaccines?
The likelihood that allergic rhinitis or asthma will spontaneously go away is approximately 1% per year. That means medications usually will be needed for many years. The main advantage of allergy vaccines is that they greatly diminish the severity of a person's allergic reactions, reducing the need for medications while further reducing symptoms. The disadvantages of allergy vaccine are that several injections are needed to build up to the monthly maintenance injections, and the person might have an allergic reaction to an injection. Many people would rather have monthly injections for 3 years than take medications for an indefinite period of time.
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Is it a common occurrence for my ears to have pressure and fullness on descent of an aircraft?
Yes, this is common and often people with chronic allergic Eustachian tube congestion have this pressure worsened by what we call barotitis, a condition with which I have dealt frequently in my previous experience as a flight surgeon in the Air Force.
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Are headaches strictly allergy and sinus headaches?
Certainly in the Atlanta area with our high incidence of allergies we do see patients suffering from chronic nose and sinus congestion with associated headaches, often above their eyes but sometimes also below their eyes. However, there are many different causes of headaches and one can have not just one type of headache but additional types as well. For instance, it is not uncommon for people to have ocular migraine headaches worsened by their chronic sinus headaches. People may also have tension headaches associated with the above. Headaches from hypertension and so forth are also things to consider.
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Is my snoring at night really sleep apnea?
Some snoring is indeed more than just that and represents sleep apnea. There is a big difference in terms of the stress on the heart and the lungs and the decreased oxygen to the brain if you indeed suffer from sleep apnea. There is a very easy sleep study that can be done to help answer that question. About 10% of people that are finally diagnosed with sleep apnea are diagnosed after they have fallen asleep at the wheel of their car and crashed into a utility pole. Most people with sleep apnea that have treatment feel more refreshed and have more energy during the day, especially in the afternoons.
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Is my intermittent hoarseness a sign of cancer?
People that suffer from hoarseness can certainly be that way from just postnasal discharge and/or swelling of the larynx from a current infection, either bacterial or viral. Some people with chronic allergic sinusitis with postnasal discharge have intermittent hoarseness. Certainly people who have a cigarette smoking habit of one pack of cigarettes per day or more and who have hoarseness for more than ten days should have an examination of their larynx in the office, either by mirror exam and/or direct fiberoptic nasopharyngolaryngoscopy. Some people benefit from further evaluation of their voice box by videostroboscopy tests performed by speech therapists. An early diagnosis of cancer is highly treatable. The reverse is true for those people who let their cancer go on without treatment.
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Is the bump in my neck a cancer?
Most bumps in the neck are not cancer. We have lymph nodes in our neck, 200 on average, and these lymph nodes are designed to enlarge and trap viruses, bacteria and cancer cells. We usually see people with various neck masses and will start an antibiotic to see if that will affect the size and/or decrease the size. Some answers can be obtained by CAT scans of the neck, showing the various enlarged lymph nodes or other areas of abnormalities. We also have types of biopsies, including fine needle aspiration biopsies (FNA) or excisional biopsies.
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Do I need packing in my nose after sinus surgery?
Usually nasal sinus surgery can be done without packing the nose. Packing the nose has been a source of major discomfort.
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Do I have to stay in the hospital if I have sinus surgery or to have my tonsils out?
Both can be safely done in an outpatient environment without a hospital stay.
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What causes ringing in my ears?
Ringing in the ears, or tinnitus, is caused by injury or irritation of the inner ear. Causes may be benign, such as age or noise exposure. Tinnitus can also be a presentation for brain tumors and thus should always be investigated with a hearing test.
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Can I do something about my snoring?
We specialize in the diagnosis and treatment of surgical and non-surgical sleep disorders.
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Do you take my insurance?
We accept most forms of insurance, including most managed care plans. Please call us in order to ensure we take your specific plan.
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What can I do about my breathing and sinus problems?
We listen and talk to the patient about his/her concerns. The causes can be due to obstruction from allergic swelling or internal nasal mechanical obstruction of bone and cartilage. Environmental problems also occur, due to the environment of the Atlanta area, which has a disturbing level of pollution and allergens. Medications can be a solution to your breathing/sinus problems. If patients are looking for alternatives to medications to help further resolve their sinus problems, then a referral to an allergist for assessment and possibly allergy injection is an option, realizing that this can be a long-term commitment to allergy injections. Another option is to visualize the sinuses with flexible video cameras (called sinus endoscopes) in the office or to evaluate the sinuses radiographically (CAT scan), a technique which could be helpful in determining whether surgery may be an option.
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I have snoring and sleep problem, how can you help me?
Finding the cause is a first step as this is a common problem when people age (the tissues in their throat loses elasticity), experience weight changes or have fat deposits throughout their throat and soft palate. Snoring and sleep apnea can be a mechanical problem even in a child who has large tonsils/adenoids or nasal obstruction from allergies.
To evaluate sleep disorders, we include talking to the significant other, when appropriate, to determine if pauses in breathing (sleep apnea) exist. A sleep study is performed to determine if sleep apnea can be documented. If it is exclusively a snoring problem and not sleep apnea, we will discuss options to deal with this as more of a social problem. Should the problem be obstructive sleep apnea there are several corrective options, including the initial use of a non-surgical mechanical CPAP mask which can be tried at the patient's discretion. There are many surgical procedures that can also be considered, and the success rates have been greatly improved over the years. It is very important to determine if the snoring indeed is sleep apnea, since there is a high correlation between sleep apnea and more serious diseases such as coronary artery disease and stroke if left untreated.
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What can I do about my headaches?
Once again, determine the cause and investigate the source of the headache. Headaches that seem to have their origins with certain sinus disorders and breathing problems can usually be isolated and improved. An allergy referral may be indicated. It is sometimes indicated to see a patient during a severe headache to perform nerve blocks, that is, topically numbing the nerves that go to the sinuses to aid in diagnosing the source of the headache. We follow this up with sinus CAT scans when indicated, or office sinus flexible endoscopy. These techniques can determine if surgical intervention would be of benefit. We work very closely with other medical specialists, especially neurologists, in this evaluation and treatment for headaches.
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I have frequent sore throats and sinusitis, what can I do?
There are specific indications for the treatment of inflammatory diseases of the upper respiratory system. The primary care physician is the first defense in treating most acute URIs (Upper Respiratory Infections). If the antibiotics seem no longer effective, then a referral to the ENT physician may be in order to consider surgical removal of the tonsils and adenoids, or consider sinus surgery based on upon past treatment history, cultures, allergies, etc. We are now able to safely perform sinus surgery, even in children, with the latest developments in endoscopic surgery.
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Do you do plastic and reconstructive surgery?
Dr. Gadlage is board certified by the American Board of Otolaryngology- Head and Neck Surgery and the American Board of Facial Plastic and Reconstructive Surgery. The first priority is to determine the rationale for the patient wanting to a change of appearance and to make certain the expectations are realistic. Dr. Gadlage considers this aspect very seriously with the patient. A thorough physical assessment is completed, photographs are taken and a discussion of the anticipated surgery along with the expected results will be clearly reviewed. We encourage our patients to ask other patients or friends they know who have had similar procedures, or to ask their primary care physician who he/she would recommend doing this procedure on a family member. We believe that this would be more valuable in selecting a surgeon than any claims portrayed in an advertisement. Dr. Gadlage also works very closely with many referring surgeons (mostly his dermatological colleagues) in performing facial reconstruction after cancer surgery, giving the patient the best possible team approach.
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Hearing Health Care
What are the most common causes of hearing loss?
- Aging
- Noise exposure
- Hereditary factors
- Ototoxic medications
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What is an audiologist?
- An audiologist is a hearing care professional, trained specifically in hearing, communication, and balance disorders.
- The audiologists of the Hearing Health Care Centers, Inc., are state licensed, nationally certified, and hold either a master's degree or doctoral degree in audiology.
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Who is at risk for occupational noise exposure?
- A person that operates loud machinery
- Airplane engineers & airlines ground transportation personnel
- Printing press operators
- Noise of power tools
- Gunfire
- Military/ law enforcement
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What is recreational noise exposure?
- Music
- Lawn Equipment
- Gunfire
- Motorcycles
- Fireworks
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What styles do hearing aids come in?
- Behind-the-ear (BTE) the hearing aid components are encased behind the ear.
- In-the-ear (ITE) the components of the hearing aid are encased in a custom made shell that fills the entire bowl portion of the ear.
- In-the-canal (ITC) the components of the hearing aid are encased in a custom made shell that fills the canal portion of the ear.
- Completely-in-the-canal (CIC) the components of the hearing aid are encased in a custom made shell that fits deeply into the canal of the ear.
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Pediatric Hearing Health Care
What is the most common abnormality found in newborns?
Hearing loss is the most common abnormality found in newborns. The State of Georgia has mandated that hospitals perform hearing screenings prior to infant discharge.
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How many children have hearing loss?
Approximately 6 in 1000 babies are born with a significant hearing loss. Approximately 15 % of US children aged six to nineteen years of age have a measurable hearing loss in one or both ears.
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What happens if hearing loss isn't detected or treated?
Unmanaged hearing loss in children can affect their speech and language development, academic capabilities and educational and can also affect their self-image and social / emotional development.
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What causes hearing loss in children?
The most common type of hearing loss is sensorineural hearing loss. These causes include present at birth infections, medications, noise, and genetics. Sensorineural hearing loss can also develop later in life due to excessive exposure to loud noise. In 50 % of at birth hearing loss cases, a cause is never found
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How can I tell if my child has hearing loss?
Hearing loss is invisible, and the signs are subtle in young children. If children are not reaching the speech and language milestones at the appropriate levels, or you suspect your child has hearing difficulties, they should see their physician or audiologist to have their hearing tested.
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