I hesitate to add to the cacophony surrounding the corona virus, but these are ‘unprecedented’ times, or so that’s what I’ve heard and read a thousand times.

If I ever see that word again it will be too soon.

Challenging? Yes

Unusual? Of course

Unprecedented?Aabsolutely not. And not even unpredicted.

This pandemic was preceded by H1N1 flu virus (1918 flu pandemic, 2009 swine flu), SARS (2003) and MERS (2012), both corona viruses.

The 1918 flu pandemic killed 50 million people worldwide, with 675,000 Americans. With Covid-19 to date about there are 338,000 deaths worldwide, with 96,000 in the US.

It is partly through experience and lab work with SARS and MERS that we know what we do about corona viruses.

So any novel viral outbreak in the world (not to mention Ebola (2014-2016), and current outbreaks as we speak) has the potential with our world wide travel to cross continents and the world in days to infect every human.

Such is the reason for official surveillance organizations, such as WHO and threat organizations in the US. But recent funding cuts have decimated their abilities to research and communicate.

And even when the siren call went out, it went unheeded. Disregarded, quashed even, because “There will be no bad news on our watch!!!! It might affect the stock market and even worse chances for re-election”.

As far as combating the virus, every nation was on their own, and in our nation every state was on their own. No UN, WHO or other coordinated international effort. No national plan for supplies or resources to address the most needy areas. Not even leadership that demonstrates proper behavior and responsible use of medication.

To combat an international problem requires international cooperation, not name calling or finger pointing. National problems require a national plan to limit damage and death as much as possible.

This will pass, or so they say. But this will not be the last novel virus. History will judge our response to this one, and God help us to be prepared for the next. Cause it’s coming.

Big Cancer Cases

“You’re a bad ass” he said as I walked into his hospital room, making post op rounds from the previous day’s surgery.

Yesterday I spent five hours excavating this huge tumor from his neck. A local spread from a poorly differentiated squamous cell skin cancer previously removed from the back portion of his neck, just behind and below his left ear.

These poorly differentiated cells are the worst; wild cancer cells running amok in the lymphatic system, multiplying and invading locally, infiltrating into surrounding muscle and skin.

Pre op exam revealed an 8 x 5 x 3 cm mass, firm, fixed, right up under his ear. Big and stuck!

I told him there were no options other than cutting that monster out, and he gave a big thumbs up.

In the OR, I placed a nerve monitor with subcutaneous electrodes about his eye and mouth, just in case I needed to dissect around his facial nerve. We prepped and draped his neck for a big procedure.

I excised the scar from his previous skin cancer removal, cut in front and below his ear and looped the incision into his neck below his jaw line, raised skin flaps, and started dissecting the mass from surrounding tissue, including many lymph nodes in the neck below it and in front of it (technically what we call a supraomohyoid neck dissection). It had invaded the sternocleidomastoid muscle and totally compressed his jugular vein. Both of these structures needed to be removed along with the mass. I carefully preserved his carotid artery and vagus nerve (to the vocal cords), dissected the hypoglossal nerve (motor to the tongue) and the parotid gland from the superior extent of the tumor. I went through the deep fascia into the levator muscles which support the cervical vertebrae. Any further removal would have left his neck weak and unstable. This level of invasion could never be handled with surgery alone, and there was no surprise that microscopic remnants of the cancer were seen in the pathology specimen. Post op radiation therapy should be able to kill the residual tumor cells.

I put in a drain to collect tissue fluid post op for a few days, sewed him up nicely, using his own expanded skin from the tumor mass to cover the area excised, and then on to recovery. All nerves working fine, eating and drinking well with a good night, and then the next morning: “you’re a bad ass.”

So I had him clarify that statement. He had been seen at the VA, and referred to me, because “No one else there wanted to handle this. And you could, and you did!! I feel so much better with that goose egg thing out of my neck”. Actually more like an ostrich egg.

Years of study at Univ of Iowa, doing big tumor work. Years of experience taking care of federal inmates referred cross country with their large, growing tumors, had put me in a great place to help out this Vet.

Cut and sew right, preserve the vital important structures, and all will be well. Great anesthesia, experienced nursing crew. My team was ready, and we performed.

Shingles, or another virus demanding attention

While we are focusing so much attention on the coronavirus, we mustn’t lose focus on our other healthcare needs.

The need for my wife and me this week was our second shingles vaccine. That very nasty shingles attack is caused by the chickenpox virus (varicella zoster, a type of herpes virus different from the cold sore or genital type) that lives dormantly in our nerve roots, just waiting for who knows what conditions to break out along that nerve’s distribution and cause awful pain, blisters, loss of nerve function with facial paralysis (if it happens along the facial nerve), and possible post eruption pain (post herpetic neuralgia). That means when the virus attack resides and the blisters heal, you’re left with terrible pain along the area affected. It’s an anti gift that keeps on giving. Like that unwanted relative who is always coming for dinner or your neighbor who attacks his landscaping with any loud engine based device at any time (esp Sat and/or Sun at AM, or wine on the back porch time near dusk). But much worse, not just uncomfortable, I mean excruciating pain.

But, like with most viruses, there is a vaccine!!!! Several years ago (2006) a vaccine was developed that unfortunately was only about 50% effective. So another has been developed (2017) that is a 2-time shot, separated by 2 to 6 months, but 90% effective. Age 50 is the start date for this vaccine.

I like those numbers much better.

The problem is this: those 2 shots kick your butt, with about 36 hours of feeling lousy, really lousy, headache, muscle pain, sore arm at the injection site, and ready to do nothing but stay in bed and take some Motrin. With the first shot, I was uninformed (even as a doc) and had a full day the next day. I made it through, but it wasn’t easy. So this time we planned a Friday evening shot, picked up comfort food from a local restaurant, and went home to chill. 36 hours later we are resurfacing to the living world.

Shingles stinks. The shingles vaccine stinks. But shingle stinks a whole lot more. Just be prepared to weather the prevention. Try a good book, it was Hamilton for me.

Spring Is the Season for Allergy Symptoms

Spring Is the Season for Allergy Symptoms

Spring weather brings so many beautiful changes to Raleigh, North Carolina. But for all of the blooming flowers and sprouting leaves, people across our region suffer seasonal allergies. So, what can you do to ease your spring allergy symptoms?

What causes springtime allergy symptoms?

Pollen is the biggest issue in springtime allergy symptoms. Pollen comes from trees, weeds, grasses and flowers. Nature designed these tiny grains to float through the air, from one plant to another. Often, they get into our noses, instead. When people with allergies breathe them in, their body gets defensive.

It is your immune system that fights pollen, working to attack the allergens with antibodies. This triggers release of histamines into your blood. Histamines are chemicals the body produces. But these helpful substances also trigger your itchy eyes, runny nose and other allergy symptoms.

The highest pollen counts in the air tend to occur on windy days. The wind carries these tiny grains through the air. Rain washes the allergens away.

The top symptoms of allergies include runny nose, sneezing, coughing, watery eyes, itchy eyes, an itchy nose and dark circles beneath your eyes. How much you suffer these allergy symptoms depends on your individual body and its allergies, as well as the environment in which you live.

Diagnosing Your Spring Allergy Symptoms

Some people have bearable allergies that simply cause a stuffy nose or dry cough. Other people cannot function without medication, due to the extreme nature of their allergy symptoms. Talk to your ENT doctor for allergy testing and to get treatment for your symptoms.

Your ENT allergy specialist provides a skin test that simply pricks the surface of your skin with a tiny amount of an allergen. This prick test is one option, whereas another is injecting a tiny amount of the allergen under your arm or back skin. These tests indicate your allergy when small red bumps called hives or wheals form where pricked or injected. A blood test works for some types of allergies, too.

Treatment Using Medication

Many medications exist to ease your allergy symptoms. These range from over-the-counter (OTC) drugs to those prescribed by your ENT doctor. The key types include:

  • Antihistamines to reduce histamines in your body
  • Oral decongestants relieve symptoms like swelling and congestion
  • Antihistamine/decongestant combines the above effects
  • Nasal spray decongestants clear your clogged nasal passages with fewer side effects than oral decongestants
  • Steroid nasal sprays to reduce inflammation, with some preventing hay fever
  • Eye drops to relieve your itchy or watery eyes

Before starting any medication, whether OTC or prescribed, talk to your doctor about your allergy symptoms. Many of these drugs make users sleepy and can disrupt your daytime schedule. But some are non-drowsy medications that do not provide this result. You especially need to talk to your doctor if you need allergy symptom relief for more than a few days at a time.

Options to OTC medications for longer term treatment include allergy shots, prescription medication, sublingual immunotherapy tablets and steroid nasal sprays.

Immunotherapy helps your body build up resistance by exposing you to gradually increasing amounts of your allergen. This usually helps people for longer periods of time than using allergy medication. But it is not the right treatment option for everyone.

Avoid Spring Allergens and See Your ENT Doctor

To prevent allergy symptoms this spring, follow these seven tips:

  • Stay indoors on high pollen count days, particularly in mornings
  • Keep doors and windows closed
  • Clean your home air filters
  • Use an air purifier in main rooms of your house
  • Clean bookshelves, tables and vents frequently to remove pollen
  • Wash your air after being outside
  • Vacuum twice weekly while wearing a mask

For clear diagnosis of your allergy symptoms and to obtain proper medication or immunotherapy, schedule your visit with ENT & Audiology Associates in Raleigh, North Carolina, today. Call (919) 782-9003 to set an appointment with our friendly staff.


COVID-19 Policies & Thoughts

For urgent or compelling needs, our office is open for face-to-face (with a mask), hands-on (with gloves) good old fashioned in-person office visits and examinations for the most accurate diagnosis and the most effective treatment. If and when you need us for urgent issues, we will take your temperature, have you wear a mask, and gel your hands. And when you leave the exam room it will be disinfected with 70% alcohol. Dr. Holmes is seeing patients with urgent needs in the office on Monday and Wednesday mornings and afternoons as well as Friday mornings. Please call 919-782-9003 to schedule an appointment.


In these COVID-19 days, it is very challenging being an ENT or any surgical subspecialist. The conditions of the virus are limiting patients coming to see us and patients having needed procedures.

What most surgeons do is necessary of course, but most is also elective, meaning it can wait a few weeks. Now breathing problems, bleeding, or pain move these issues to the front of the line.

To preserve masks and other PPE, operating rooms and hospitals are limiting surgery to only urgent cases, defined as needing to be done in next 30 days or there will be harm to the patient’s health.

A special nuance of this virus is that it lives in the lining membranes (mucosa) of the nose and sinuses, as does any respiratory virus. This one then goes down into the lungs. Any procedure done in the nose or sinuses can potentially release the virus into the air and infect any unprotected healthcare worker in the room. We have learned this the hard way in China, Italy, and France with many ENT docs getting severe infections and dying. For this reason, most of the nasal and sinus procedures we do routinely are being delayed until this crisis is over. If urgent or emergent, the patient must undergo testing that shows that they are COVID-19 free. And just now rapid tests have been developed. We will see how long it takes to produce and disseminate them. So far I haven’t had an emergency case, but I do have an urgent case this week and will wear appropriate N95 mask.

For these very important reasons, ENT docs in the country are closing or severely limiting their practices to prevent viral spread. We, at ENT & Audiology Associates, are open for urgent appointments, in other words, it just can’t wait.

Back in 1918 when the flu was pandemic, most docs were general practitioners and were overwhelmed with patients. But in 2020, unless and until we are needed to staff COVID-19 hospitals (like what happened in China), we ENT docs
and other surgery specialists (neurosurgery, orthopedics, plastics, urology, ophthalmology, etc) are wondering when this will end and what will be the status of our practice and our employees (nurses, receptionists, billing, etc.) when the dust clears.

So, bottom line is we will be there for you if necessary. Call first if you have cough or fever or shortness of breath or recent loss of smell (due to virus zapping your smelling nerves), so we can advise you properly. Please note that we will take your temperature upon arrival, and that all staff will be wearing masks, and we’ll ask you to put one on also.

Also please note that audiology support is the bare minimum.

Stay at home if you can, stay safe always.

Book Club, or Docs Read

One of the challenges of practicing medicine today is the relative isolation of doctors from other doctors, especially referral sources and recipients of those referrals.

In times past, a new doctor in town would join the local medical society to meet the other community docs, and express their desire to join into the medical community (primary care and specialists alike). The specialists would present their availability for consultations and referrals, while the primary care docs would pull shifts in the emergency room (now emergency department) to make their presence known and gather unassigned (those without a doctor of their own) to recruit to their new office.

And many of the doctors in the community would round on their inpatients and see each other in the physician lounge. Or take part in grand rounds (lectures, talks, medical education) to meet and greet.

And the third avenue for collegiality was the local medical society dinner meetings with one’s spouse. I assume many practices did business on the strength of the relationship of the spouses (most likely women suiting the era, who may or may not have had professional careers of their own).

But of course, times have changed. Many aspects of medicine have changed. Forever altered by hospitalists (relegating most docs to their office only and never coming to the hospital), emergency physicians (a specialty of their own), change of demographics with many more female physicians and of course doubly employed spousal partners (and the rise of the male medical spouse).

This leaves the local medical society to find relevance. Many have not and have folded. Some have embraced the need for docs to meet together and sponsor quality quarterly educational meetings.

Our local Wake County Medical Society has decided that one of its major missions is to create venues for conversation and collegiality and communication between docs, and their families. Hence the many social programs of exploring the many cultural opportunities Raleigh and Wake County afford.

And then there is the BOOK CLUB!!! Ta da!!! Trumpet call please!!!

We have a solid group of docs, around 10 or so, that faithfully read the offering and bring insight, opinion, personal experience, enlightenment to a quarterly meeting, with a humble meal, comfort food.

Fiction and nonfiction.

Medical and anything but medical.

Purview the list:

Dopesick, Beth Macy
Underground Railroad, Colson Whitehead
Kids These Days, Malcolm Harris
The Immortal Life of Henrietta Lacks, Rebecca Skloot
Things That Matter, Charles Krauthammer
Astrophysics for People in a Hurry, Neil deGrasse Tyson
The Beekeeper of Aleppo, Christy Lefteri
The Great Influenza, John Barry

A quarterly meeting with a simple dinner, breaking bread and discussing themes and motif. And trust me all have read the book, it is after all a type A kind of club.

I have been inspired after reading Tyson’s book to study astronomy further with an online course from UNC, astronomy 101 with lab. Got an A in both.

The flu pandemic of 1918 puts our current Coronavirus in perspective, and begs us to ponder what is next, even as we struggle with this virus.

Dopesick, about the opioid crisis, which has taken a back seat to the virus.

Henrietta Lacks, whose breast cancer cells have advanced all forms of medical research.

Underground Railroad, facing our ugly past, personalized it seems, like no other portrayal of the beast of slavery.

Reading together and coming together, supping, and dissecting a book TOGETHER.

Such power, such meaning, such connection.

I look forward to every book and can’t imagine missing these times.

One day I will leave the office practice and the OR, and I will retire and not actively practice medicine, but I so look forward to continuing the exploration of literature and writing with my physician colleagues.

Anyone up for poetry?

Sinus Balloon Procedure

Sinusitis  101

It is uncommon for sinus infections to spread outside of the sinus into the eye or brain, but certainly the possibility exists and must be treated urgently.

This week I was called to assess a patient with infection spreading into the eye and causing thrombosis (clotting) of the veins draining the eye. All from a sphenoid sinusitis. The sphenoid is located smack in the middle of your head, right below your brain and between the area that the optic nerves and eye blood vessels enter and exit the skull.

The eye was extremely swollen and could not move well in the socket.

The treatment was to drain the sinus by enlarging the sinus opening with a balloon, under image guided conditions. Watch this video!!

We went to the OR for anesthesia, and I carefully led a balloon catheter into the sinus (sort of like using in heart vessels) using previous CT scans which allowed me to know that the balloon had entered the sinus. After inflating the balloon, I then looked with an endoscope and suctioned out infected material. In the recovery room the eye pressure and headache from the infection was immediately greatly improved.

Techniques such as balloon sinuplasty, used routinely on an elective basis (not urgent or emergent), have become quite useful to these emergency conditions.
The more routine balloon cases performed, the more prepared is the surgeon is to handle these more challenging cases.

I use sinus balloons often, and am ready for any challenge.

Glomus Tumor Case

In the OR, working through a speculum with an opening the size of a BIC pen, I surgically raised up the right ear drum to view the middle ear, and there it was.

A rather large impressive bright red tumor, sitting on the bony medial wall of the middle ear, creating pulsating sounds that brought the patient to me.

“Doctor, I can hear my heartbeat in my right ear”.  Examination showed the reddish mass behind the translucent ear drum (tympanic membrane or TM for short).  Only surgical excision would relieve this condition, and only surgery would stop it from expanding and growing.

It would need excision, with laser ablation of its feeding vessels, all under microscopic dissection, with intense concentration and coordinated movements between surgeon, anesthesia, and OR tech.  (too much drama, but of course it does, all procedures do!!!)

But this is special. It’s really neat.  To flip up the TM and stare the beast in the eyes.  Large, red, full of blood and bleeding potential, this is why God made me a doctor.  (ok, a bit more drama).

In any case, this is exciting surgery.  Remove the vascular mass.  I was first introduced to these vascular anomalies while a medical student, on neurosurgery rotation, assisting in removing an AVM (arteriovenous malformation) in a teenaged girl.  It looked like a big red spider on the surface of the brain.  But that was a big open procedure, with a big bone flap removed and later replaced.  Nothing like ENT ear surgery (we ENT’s are the best, most delicate, etc, the saying should be: “it’s not ENT surgery”, no lie or exaggeration here).

So I introduced the CO2 laser fiber into the middle ear and coagulated feeding vessels from above and below, but there might also be some feeding the mass that I couldn’t see, underneath the mass.  The only thing to do was to remove the mass with cup forceps and deal with the bleeding.  And so I did.  But that’s not the additional lesson here.  Most younger surgeons in the face of bleeding here would have sucked and lasered and sucked and lasered without effect, but the senior surgeon (like me) would place a cotton ball with some type of vessel constrictor like epinephrine or Afrin ( I use afrin, it is safer) to initially stop the bleeding and then go back and laser.  So what does the surgeon do while waiting for the cotton soaked ball to work?  Absolutely nothing, and that is the hardest part!

I learned from my wonderful mentors during ENT residency at the University of Iowa, especially chairman Dr. Bruce Gantz, that there is great benefit to pushing back from the scope and taking a few moments to compose oneself, take a few deep cleansing breaths, and then carry on.

And that’s what I did to great success. After removal of the afrin cotton ball, all bleeding had stopped and the tissue was ready for further coagulation and ablation with the laser.

TM replaced intact, case closed.

Now for some coffee (none yet to prevent caffeine tremors under the magnification of the microscope), talk with the family, and a little post-op EMR computer work.

Can You Hear Me Now? If You Can’t Make That ENT Appointment

Around 18% of adults report that they struggle with some type of hearing difficulty. An ENT (ear nose and throat doctor) is an expert that can help. Improving your hearing starts with an accurate diagnosis.

Using state of the art hearing tests an ENT doctor can quickly diagnose hearing problems and provide you with the tools to improve your hearing. A Raleigh ENT doctor is the specialist you need to see for all your ear, nose, and throat needs.

Your Ears, Your Nose, And Your Throat

Many people do not realize that the ears, nose, and throat are all one system. They are part of the upper respiratory system and share one membrane. There is a wide range of conditions and illnesses that will affect the ENT system that can cause hearing problems, headaches, and more.

Seasonal allergy sufferers know during allergy season exactly how relative each part is to the other. When one part is affected by allergies all parts are affected. The same is true of a sinus infection or a disease of the throat. Each part affects the other parts’ ability to function.

An ear nose and throat medical practice focus on treating disease and dysfunction of this system including providing corrective action for hearing loss. ENT care for both children and adults is available.

Hearing Loss

There are several different types of hearing loss that an ENT doctor can help to correct. Congenital hearing loss is hearing loss that you are born with. This type of hearing loss is largely related to malformations in the ear.

Infections can also cause hearing damage that can result in hearing loss. For older people, exposure can cause hearing loss. Aging in and of itself can cause hearing loss.

What Can You Do About Hearing Loss

The good news is that hearing loss can be correctable. Using digital technology customizing your hearing aid can be an easy way to improve your hearing. Hearing loss can make you feel isolated, impact your social life and personal relationships.

An ENT doctor can help to improve your hearing. Make your appointment today and learn more about hearing loss correction.

How Can Hearing Aid Customization Help You?

No one wants to wear a hearing aid but, like glasses, this can be a necessary aspect of life. Hearing loss is actually a very common problem that can affect people of any age. Sometimes, it’s caused by illness or disease. Sometimes, it’s caused by years of exposure to loud noises. It may even be an occupational hazard. In fact, around two to three out of every 1,000 children in the U.S. have a detectable hearing loss in one or both ears when they are born. Hearing aid customization makes it much easier for anyone to comfortably wear hearing aids. They make it possible to hear perfectly without discomfort and sometimes, without others even being able to see the hearing aids.

What’s Possible With Hearing Aid Customization?

Hearing aids have a bit of a bad reputation because of their past. Older hearing aids made years ago were big, clunky devices that were difficult to wear. They were unwieldy, uncomfortable and highly visible. But hearing aids have changed a great deal in more recent years. They have become streamlined, comfortable, easy to wear and sometimes, even invisible to others. Individual hearing aids and comfortable hearing aids are possible with customization.

Customizing your hearing aid isn’t that much more difficult or expensive than buying a generic model. In fact, it’s easier to get hearing aid customization than most people even realize. Today’s modern hearing aids are carefully designed based on very precise measurements of your ears. They can fit into the ear canal or right behind the ear, depending on the specific style you choose.

Hearing aid customization is actually necessary when it comes to getting aids for children. They have small ears and don’t want to wear something that’s uncomfortable. You don’t want a very young child to reach up and pull out their hearing aids, for example. Luckily, there are doctors who specialize in creating pediatric hearing aids that are made for children to wear comfortably.

Should You Be Wearing Hearing Aids?

Do you suspect that you have some form of hearing loss? Even a little hearing loss probably isn’t going to get better and will, in fact, probably get worse over time. Don’t wait for that to happen. Get your hearing checked immediately and find out if you’re a candidate for hearing aids.

Hearing tests can be done by many types of doctors. Sometimes, you can even find clinics and mobile medical facilities that test hearing. The tests are pretty standard. Sometimes, you can even get your hearing checked by a mobile booth at a fair or carnival! For children’s hearing tests, you may want to consult with a pediatrician or pediatric audiology specialist.

After your hearing evaluations are over, consult with a specialist to find out if you’re a candidate for hearing aids. Be sure to bring the results of your hearing tests so they have all the information about your hearing loss. Once you determine that you’re a candidate to wear hearing aids. you can find out more about customizing your hearing aid to perfectly suit your ears. With hearing aid customization, you can begin hearing perfectly again.

4 Signs Your Child May Be Suffering from Hearing Problems

Hearing loss is not something that is widely talked about or widely discussed. Approximately 15% of American adults over the age of 18 report that they experience problems hearing things in either one or both ears. Sometimes these problems arise after childhood, but chances are there were issues or problems during their childhood years that might have been overlooked. Parents don’t overlook simple small signs that their child may have a hearing problem on purpose though, it could easily be brushed off as something else such as stubbornness or distractions. Knowing specific signs to look for in children can help parents notice these issues and address them an ENT for children before the problem gets worse. Below we will explore some of these commonly overlooked signs of hearing problems in children.


Any parent that has had a newborn knows that there is a phase when they get startled at noises. Sometimes even slight noises will startle them, it doesn’t always have to be a loud noise. Once your baby is around the age of three months, they should successfully recognize the voice of their mother, father and other people that are around them on a regular basis. If you find that your infant is still startled by your voice or the voice of someone else they should be used to by now then it may be time to talk to your child’s doctor about a recommendation to a pediatric ENT specialist.

Sounds and Words

There are certain milestones that children reach and while there is some wiggle room for these milestones you should still see your child progressing more and more towards them. If you notice, by the time your child is close to one year of age, that you child is not mimicking noises and sounds or starting to say simple words such as “mama” or “dada” then it might be time to talk to your child’s doctor to see if they can perform a series of hearing tests. This test will help ensure that your child is hearing okay and there are no issues with their ears.


Babies have a habit of turning their heads when they hear noises, especially noises that they are used to such as the voice of the mother or father. Parents should pay close attention to the movement of their child’s head. If you notice that your child is constantly turning their head one way and never the other then that could be a sign that their other ear is not working properly. If they are having a problem hearing out of one ear they will not favor that ear, but will favor the other ear that hears well. If you notice that your child shows these signs it would be a good time to discuss your concerns with your child’s doctor so they can schedule some hearing evaluations to further address any issues.


Many parents will notice if their child abnormally starts talking louder than normal as this can sometimes signal an ear infection. It’s well known that children talk louder when they aren’t able to hear how loud they are. Some parents, however, don’t ever take this into consideration when their child has always been loud. Some parents may assume that they just have an overactive or extra loud child, but there could be an underlying issue that only an ENT for children can diagnose. If they test hearing capabilities and discover an issue, they can start early treatment that could possibly remedy the issue or direct the parents to the proper medical professionals for treatment.

No parent ever wants to hear that something is wrong with their child, but a diagnosis from an ENT for children is not the end of the world. A specialized ENT for children is there to help your child and help you as the parent. There are huge advancements that have been made to help children who have problems hearing hear better and an ENT for children can share these advancements with you. Keeping an eye on these common signs can help you spot problems early and begin treatment as soon as possible.

Pediatric ENT for Ear, Nose and Throat Care

A pediatric ENT is a doctor that specializes in treating children with ear, nose, and throat conditions. They specialize in providing an accurate diagnosis for children experiencing hearing loss, throat problems, and ear conditions including chronic ear infections.

Around four out of every 1000 children are born with measurable hearing impairment. The pediatric ENT is the doctor that provides the care in cases of hearing loss. Experts agree that the sooner hearing impairment is diagnosed the better the outcome for treatment.

What Causes Hearing Impairment In Children?

When a child is born with a hearing impairment there is a range of potential causes including:

  • Birth injuries
  • Preeclampsia, maternal diabetes, drug, and alcohol abuse during pregnancy, anoxia genetics
  • Genetic defects

Other causes can be ototoxic drugs during pregnancy. Some genetic conditions can cause deafness in a child including Down syndrome, Usher syndrome, Treacher Collins syndrome, Crouzon syndrome, Alport syndrome, and Waardenburg syndrome. A pediatric ENT is an expert that can test your baby for hearing problems very early on.

Hearing Loss In Older Children

Hearing loss can occur in older children from chronic ear infections. Otis Media, other illnesses can also impact a child’s hearing permanently. Measles, meningitis, encephalitis, and flu. Your child’s hearing can be impacted by a wide range of diseases.

The Pediatric ENT can diagnose any hearing problems and develop a custom treatment plan specifically for your child. If you suspect that a recent illness has impacted your child’s hearing it is always best to get it checked by a specialist.

Accurate Diagnosis Is Vital to Successful Treatment

Early diagnosis is vital to early intervention which can help to improve the success of the treatment. The pediatric ENT can test hearing on newborns, and children of all ages. In cases of suspected congenital hearing loss experts agree that diagnosis before the age of three months provides the best opportunity for creating an effective treatment plan.

Hearing impairment can affect speech development and other areas of development. A pediatric audiologist Raleigh NC parents take their children to for care, can help with all the symptoms of hearing loss. Speech therapy, hearing aids, and other treatment options can help your child to overcome hearing impairment.

If You Suspect Something is Wrong

If you suspect that your child is struggling to hear, make an appointment with the ENT. It is always best to have the testing done and to be proven wrong than to not having the testing done and find out down the road you were right.

Lyric Hearing Aids: Everything You Need To Know

Hearing aids consist of three basic parts to make hearing easier: a microphone, an amplifier, and a speaker. Hearing aids aren’t one-size-fits-all and come in a variety of styles and sizes with customizability a key factor in their comfort.

One of the most popular types of hearing aids are Lyric hearing aids. But what makes this hearing aid popular in the first place? And is it a good choice for me or my child?

Here’s what you need to know about Lyric hearing aids.

What is Lyric?

Lyric is the first and only completely invisible extended-wear hearing aid that can be worn 24 hours a day, seven days a week, for months at a time. The hearing aid is comfortably placed in the ear canal by a professional audiologist.

Lyric is positioned completely inside the ear canal. This makes it so the hearing aid uses the ear’s anatomy to provide localization cues and natural sound quality.

How do Lyric hearing aids work?

Lyric has a core that’s stored safely inside a biocompatible, soft foam seal. This seal contours to the ear canal and makes sure that there’s stable placement and natural ventilation.

The Lyric battery is designed to withstand your deep ear environment for long periods of time. The hearing aid uses the natural mechanisms of your ear to amplify sounds and the microphone and receive further enhance this experience.

Is it safe to wear a Lyric hearing aid?

Lyric is completely safe to wear. Since 2001, Lyric has been cleared by the FDA and has been studied extensively in clinical research for over 15 years.

There have been no reports of serious complications with Lyric hearing aids. Lyric has been safely worn by hundreds of thousands of people since 2007 when the hearing aid was commercially launched.

How do I know if I’m a good candidate for Lyric?

Lyric hearing aids can be purchased through an authorized Lyric partner. Lyric is designed for people who have mild to moderately-severe hearing loss.

If you’re interested in a Lyric hearing aid, your authorized Lyric partner will assess your hearing loss, your ear shape, ear size, medical conditions, and lifestyle to determine whether the Lyric hearing aid is the right choice for you.

Looking for Lyric hearing aids Raleigh NC residents trust?

If you’re interested in Lyric hearing aids, hearing tests, or hearing aid customizations, ENT and Audiology Associates is the place for you. For more information about our hearing evaluations and hearing aids, contact ENT and Audiology Associates today.

Are You Beginning to Experience Hearing Loss?

Hearing loss is a condition that can happen to anyone. However, it usually presents early symptoms that can be diagnosed in order to lead to early treatment. These symptoms may appear gradually, making hearing loss difficult to spot in yourself or in those you love. If you notice symptoms, you should speak to an audiologist who can perform hearing evaluations to help determine the best treatment option.

Muffled Voices

When people are speaking to you, especially children, you find yourself straining to understand them. Their voices will often sound muffled. This is because as your hearing loss progresses, the part of your ear that processes high pitched noises is typically the first to experience damage. This may also happen if you find yourself unable to concentrate on the conversation, as the background noise is seemingly louder than what someone is saying to you. This may be a sign that it is time to visit an audiologist to provide an accurate diagnosis, which may include treatment with the use of hearing aids.

Volume Levels Off

Some people around you may comment that you are turning up the volume higher than what they perceive to be a normal level. If more than a few people have spoken up about the volume that you listen to the radio or tv, it may be time to visit a professional that can perform hearing tests. They may deem that you need hearing aids to help correct your hearing loss.

Tired Easily

When you are experiencing hearing loss, your brain tries to fill in the blanks. This can cause your brain to be working extra hard when you are in social situations, causing you to become tired more frequently. Evaluations that test hearing can be given by an audiologist to rule out any hearing loss situations.

Types of Hearing Loss

While the symptoms of hearing loss can range drastically, all issues generally fall under three different categories.


Sensorineural hearing loss occurs when the inner ear, called the cochlea, has difficulty functioning. This is the nerve that connects to the brain. Damage to the cochlea can occur due to natural aging, infection, or loud noises. Those who are suffering from sensorineural hearing loss often hear voices as distorted or muffled. Sensorineural hearing loss is irreversible, but can be treated with hearing aids.


Conductive hearing loss is when someone experiences damage to the middle ear. This is when sound can not be conducted properly, but typically due to a physical issue. The causes of conductive hearing loss could be fluid or wax in the middle ear, as well as a damaged ear drum. Normally, conductive hearing loss can be corrected by an audiologist without the need for hearing aids.


Mixed hearing loss occurs when the inner ear and middle ear are both experiencing damage, which is a combination of sensorineural and conductive hearing loss. Although the middle ear issue may be able to be corrected, a person may still require hearing aids to help treat the damage to their inner ear.

Tips to Prevent Loss of Hearing

Around thirty-seven million American adults experience some type of hearing loss. Early detection is the key to early treatment when it comes to hearing loss. Knowing how to prevent hearing loss will help you to protect one of your most precious senses for years to come.

Avoid Loud Noises

Prolonged exposure to loud noises can have a significant impact on your hearing. If you are in a loud environment, consider measures to help protect your hearing. This may include headphones or earplugs.

Have Routine Check Ups

Visit an audiologist regularly to keep your hearing in check. Some issues are better treated if they are caught early. Staying on top of your hearing health will help your audiologist catch any symptoms that appear abnormal.

A professional audiologist can perform hearing tests and evaluations to assess your hearing loss and any treatment options that may be available to you. Proper ear care helps to improve your overall health and could help prevent other issues from developing down the road. If you notice symptoms of hearing loss, get in touch with a professional audiologist that can perform an evaluation.

Pediatric ENT -What You Need To Know About Hearing Loss In Children

Every year around 3 out of 1000 children are born with some type of detectable level of hearing loss. In many cases, hearing loss is missed or not diagnosed. A pediatric ENT specializes in hearing evaluations, hearing tests, and hearing aids for children.

The first step in treating hearing loss is an accurate diagnosis. Hearing loss in children can affect everything from speech development to their ability to learn. It is important that you are able to recognize the signs of a child struggling with hearing problems.

What Causes Hearing Loss in Children?

There are several things that can cause hearing loss in children including:

  • Congenital hearing loss is when a child is born with hearing loss. It can stem from a wide range of reasons.
  • Hearing loss that is acquired through infections, ototoxic medications, injury to the ear, exposure to noise, and other incidents that damage the hearing.
  • Transient loss of hearing occurs due to infection of the middle ear. Transient means it can come and go and can resolve itself without the intervention of a hearing device. In some cases, it does evolve into permanent hearing loss.

There are many risks to hearing in children. From untreated infections to injuries to listening to headphones, there are many risks out there.

Recognizing the Signs of Hearing Loss In Your Child

Many parents are not aware of what to look for to determine if they need to make an appointment with a pediatric ENT. Hearing tests are the only way to confirm the hearing loss. Symptoms of hearing loss can include:

  • Speech delays, speech impediments
  • Often inattentive, non-responsive when being spoken to
  • Learning delays

There are other signs that your child may be struggling with hearing loss that your pediatric ENT will review with you. If you suspect that your child cannot hear or is experiencing some level of hearing loss, it is time to make an appointment for hearing tests. A hearing test Raleigh NC parents have found can be a very helpful diagnostic tool in making sure their child is getting the right care.

If you suspect there is a problem the best way to find out for sure is by making an appointment for an evaluation. Once you have an accurate diagnosis you can get the care that your child deserves.