Category: ENT

Sublingual Immunotherapy – Alternative to Allergy Shots

Less than five percent of US allergy sufferers receive immunotherapy. The other 95% take medications to temporarily reduce symptoms, try to avoid their allergens, or just continue to suffer.

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Tinnitus Evaluations

tinnitus-evaluationWhat is a Tinnitus Evaluation?

It is important to have your tinnitus evaluated by a professional who can help you manage the irksome symptoms. Primary Tinnitus is a medical symptom that is characterized by persistent noise in one or both ears that can only be heard by the affected individual.

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Are Sinus Infections Contagious?

If It looks like a cold, it feels like a cold, and it sounds like a cold, then you should avoid it like a cold, right?
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What is Sleep Apnea?


Over the past decade, Obstructive Sleep Apnea (OSA) has become more well-known due to the associated health risks and deaths associated with untreated sleep apnea. Almost fifty percent of healthy adults snore occasionally, while half of them are habitual snorers. Many times, the problem afflicts individuals who are overweight. If the problem is not treated it typically gets worse with age. Douglas Holmes, MD, founder and medical director of ENT and Audiology Associates in Raleigh has been helping treat patients who suffer from snoring and sleep apnea for the past 15 years.

Sleep apnea is a common disorder that causes affected individuals to stop breathing for short periods of time while asleep. While the effects are the same, there are two primary varieties of the condition: obstructive sleep apnea (OSA) and central sleep apnea (CSA), which differentiate in their root causes. Regardless of the type of sleep apnea from which you suffer, it is important to be professionally diagnosed and treated to avoid further complications.

What happens when you fall asleep?

When you fall asleep your body undergoes many physiological changes during your sleep cycle including changes that affect your breathing. Obstructive sleep apnea (OSA) occurs when the soft palate sags and the tongue relaxes while sliding back, which can partially obstruct the upper airway. When the obstruction is severe enough to decrease the amount of air obstructing the lungs, it is called hypopnea. If the upper airway collapses, blocking the airflow by 80% or more, it is called an apnea. Hypopnea and apneas last 10 seconds or more and can greatly reduce the amount of oxygen in your blood despite your continued efforts to breath.

What are some symptoms of sleep apnea?

The most noticeable symptom of OSA is loud, chronic snoring. During an apneic episode, there is an increase in the level of carbon dioxide in the blood. This build up triggers a defense mechanism in the brain which jolts the body into resuming normal breathing. In mild sleep apnea, the number of apneas is 10 per hour on average. In severe sleep apnea, it can be 40 or more per hour.

Are there any risks to not treating sleep apnea?

Sleep disorders, like sleep apnea, have become a significant health issue in the United States. It is estimated that 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed.

If left untreated, sleep apnea can lead to a higher risk of life-threatening conditions such as high blood pressure, heart disease, stroke and type 2 diabetes. and is a factor in many traffic accidents and accidents with heavy machinery, owing to the persistent drowsiness suffered by many sleep apnea patients before the disease is recognized and treated.

What treatment options are available for snoring and sleep apnea sufferers?

Until recently, treatment options have been limited to painful and invasive nose and throat surgeries and bulky CPAP and oral appliances which require patients to wear every time they sleep. At ENT and Audiology Associates, Douglas Holmes, MD will meet with you to individualize a treatment plan that is right for you and your condition. At ENT and Audiology Associates, we believe in finding the least invasive ways to help improve a patient’s quality of life. One procedure, Radiofrequency Ablation of the Tongue Base, has been found to be superior to any other treatment for sleep apnea. The procedure was developed 10 years ago and continues to be performed with great success.

What is Ear Wax?


Ear wax is not really a “wax” but a water-soluble mixture of secretions, plus hair and dead skin. Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of ear wax and skin cells from the eardrum to the ear opening. Old ear wax is constantly being transported, assisted by chewing and jaw motion, from the ear canal to the ear opening where it usually dries, flakes, and falls out.

Unfortunately, many people mistakenly believe that ear wax should be routinely removed for personal hygiene. This is not so. In fact, attempting to remove ear wax with cotton-tipped swabs or other probing devices can result in damage to the ear, including trauma, impaction of the ear wax, or even temporary deafness. These objects only push the wax in deeper, and can block the ear canal entirely.

Under ideal circumstances, the ear canals should never have to be cleaned. However, that isn’t always the case. The ears should be cleaned when enough ear wax accumulates to cause symptoms or to prevent a needed assessment of the ear by your doctor. This condition is called cerumen impaction, and may cause one or more of the following symptoms:

  • Earache, fullness in the ear, or a sensation the ear is plugged
  • Partial hearing loss, which may be progressive
  • Tinnitus, ringing, or noises in the ear
  • Itching, odor, or discharge
  • Coughing


If you or a loved one are experiencing any of these ear wax symptoms, please call the ENT & Audiology Associates in Raleigh at 919-782-9003 to confirm that ear wax is the cause. Do not attempt to remove the wax yourself.

Changing Perspectives

I recently had a unique experience in the ENT & Audiology Associates office, as I went from being a clinician, to being a patient.  While I can talk all day about how great it is to work here with Dr. Holmes and our amazing staff, I didn’t fully understand how amazing this practice is until last week.

I had just returned from a whitewater kayaking trip in northern California.  It took me three flights to get back home, flying overnight and coming straight to work Monday morning.  I had a sore ear at work on Monday, but attributed it to sleep deprivation, the black eye I had gotten from paddling, and all the pressure changes on the flight, so I didn’t think much of it.  The next day though, the pain had increased.  I did a tympanogram on myself, saw that my eardrum was still moving normally, so tried to still brush it off.  Later in the day however, it had gotten worse, and I asked Dr. Holmes to look in my ear.  He noted IMG_0374that my eardrum on that side was red and inflamed, and gave me some drops for what looked like the start of an outer ear infection (made sense, as I had just spent a week on a river).  Unfortunately, what looked like the beginning of an external ear infection was actually the onset of acute otitis media, and that night my middle ear filled with fluid, so that by the time I got to the office on Wednesday, my eardrum was bulging.  (I have never had an ear infection my whole, life, and now that I’m almost 30, I get my first one!)  Dr. Holmes came to my side of the office first thing in the morning, to see how I was doing, immediately diagnosed the problem, he and the nurses were able to call me in an antibiotic to start right away.

Later in the day, it had gotten to the point where it was so painful and there was so much pressure, it was determined that a myringotomy was the best option to relieve the pressure and remove the fluid.  While I was nervous (as I was about to have a incision cut into my eardrum), I tried my best to act tough, knowing that some of my colleagues wanted to watch.  The nurses were incredibly empathetic, and made me feel very comfortable.  Dr. Holmes talked me through the whole procedure (all two minutes of it), and I was immediately feeling better.  That night I slept better than I had all week, and by the next day, I was feeling completely healthy again.  Every time I saw a nurse in the hallway, they would ask to make sure I’m feeling better.  I felt so supported and cared for by everyone in the office. DrKymanPic  I definitely have new empathy for the patients I see, and can say without hesitation that Dr. Holmes and the staff at ENT & Audiology Associates provide excellent care, difficult to find elsewhere.  My eardrum is already healed, and I’ll be back on the water in no time thanks to Dr. Holmes.
Lena Kyman is a clinical audiologist at ENT & Audiology Associates, and patient of Dr. Holmes’.



We Love Hearing From Our Patients


We love hearing feedback from our patients!  While Twitter is a very public forum and not everyone will want to share a hospital recover picture there, we still love engaging with our patients on social media.  So please, ‘Like’, ‘Share’, and ‘Tweet’ with us!

Balloon Friday

Many offices have casual Friday – jeans, golf shirts – no ties or coats, and many knock off early to start their weekend. Fridays at ENT & Audiology Associates could not be more different. Morning is devoted to a full clinic where many outpatient ENT and audiology needs are met. In the afternoon the audiologists are seeing hearing aid patients, while the nursing staff and Dr Holmes transition from clinic visits to preparing for Friday afternoon ENT & Audiology BALLOON SINUPLASTY. Yesterday four patients kissed their sinus problems good bye. They took an oral sedative, had local topical anesthetic cotton pledgets placed carefully and delicately in their nose, and with nasal endoscopy using small scopes had sinus catheter balloons widen the openings to their maxillary and frontal sinuses. Minimal discomfort, no bruising, no packing. Beats the Hell out of going to the OR. And cost savings for the patients is amazing – no facility fees or anesthesia bills. On average our patients save about $6000 by having their sinus issues addressed with in office balloon sinuplasty vs going to the OR. About one hour after walking in they were treated and wheeled out to their car (they could have walked, but we provide cadillac TLC treatment), on the path to a new life free of sinus pressure, headaches, and sinus infections.
It’s a great afternoon!!!

Collaboration Like No Other

Dr. Holmes and Randi are the perfect example of collaboration.  There aren’t many ENTs that would sit through an all day training learning about new hearing aid technology, and even program hearing aids himself for the first time!  This is one of the amazing benefits of working at a family-owned practice.  Randi and Dr. Holmes bring ENT and Audiology together in the best ways possible for our patients.  Make an appointment at our office to learn about the new technology we experienced today!

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5 Ways to Fight Sinus Infections

Men’s Health recently published this article on 5 Ways to Fight Sinus Infections.  See the content below!


Winter is prime time for sinus infections. You’re more apt to get colds and allergies, which make your nasal passages swell, trapping mucus and allowing bacteria to fester, says Jeffrey Terrell, M.D, a professor of otolaryngology at the University of Michigan.

How can you tell if your case of the sniffles has turned into a sinus infection? For starters, you’ll feel pressure around your forehead, nose, and eyes. You’ll also see green, yellow, or white mucus when you blow your nose, says Patrick Shinners, M.D., an ear, nose, and throat specialist at the Mayo Clinic.

Since a virus or cold is usually the culprit of a sinus infection, antibiotics won’t work because they only kill bacteria. That means you could be left to wait out your symptoms for a month or more. But you can at least speed up the process by taking steps to reduce swelling and encourage mucus to drain, Dr. Shinners says.

Here are five super-easy ways to expedite recovery and feel a little more comfortable while your immune system does its thing.

1. Hit the Showers

Inhaling steam in a hot shower will help open up your sinuses and loosen the crusty snot trapped inside, Dr. Shinners says. Take a rinse in the morning and evening to relieve pressure and breathe easier.

2. Use a Humidifier

Breathing humid air will help prevent the buildup of thick, dried gunk in your nose that allows bacteria to thrive, says Dr. Terrell. He recommends setting up a humidifier in your home or office and leaving it on all day. We like Honeywell’s HCM-350 model, which boasts 99.9 percent germ-free mist. ($55.19,

3. Drink Up

Drinking six to eight glasses of water every day can thin your mucus, helping it drain better, Dr. Shinners says.

4. Rinse Your Sinuses 

You can flush the gunk out your nasal cavity and reduce swelling with tools like neti pots or bulb syringes, Dr. Shinners says. Rinse two to three times per day, and make sure you use distilled or sterile water.

5. Rest Your Head

This may be the easiest remedy of all: Simply resting your head on your desk could help clear symptoms, recent Chinese research suggests. Twice a day for 20 minutes, study participants leaned forward in a chair, placing their heads on a flat surface. After 6 weeks, they had less congestion, sinus pressure, and postnasal drip than sinus infection sufferers who didn’t take the breaks. Tilting your head that way allows gravity to pull mucus out of your nasal passages, researchers say.  Additional reporting by Julie Stewart

Now, if your problems are still persisting, call Dr. Holmes for an appointment today.

Allergies, sinus makes asthma much worse

Douglas Holmes, MD‏@drdougholmes

Got asthma? Control much better if sinusitis treated, allergy eliminated. We can do both.