Category: Practice News


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?

Help Our Patient Elizabeth Raise Money to Help Kids with Hearing Loss

Elizabeth is one of our amazing patients. She was diagnosed with hearing loss around age 4, and has been wearing hearing aids ever since. Next week is her birthday, and instead of presents, she wants to raise money for other kids like her to get hearing aids. We are so inspired by Elizabeth’s generosity, and proud to know her. Please consider donating to help her reach her birthday goal!

TO HELP ELIZABETH REACH HER GOAL

To help Elizabeth reach her birthday goal, please visit: https://support.starkeyhearingfoundation.org/fundraiser/1239076

What You Need to Know about Hearing Aids

If an audiologist has recently diagnosed you with hearing loss, you’re not alone. Hearing loss affects a significant number of Americans, so don’t be alarmed. With the help of ENT & Audiology’s Raleigh audiologists, you’ll be able to find the best solutions for your hearing loss.

If your audiologist confirms that your hearing problem stems from damaged hair cells found in the inner ear, you may have what is known as sensorial hearing loss, which is treated with hearing aids.

Why Do You Need Hearing Aids?

Hearing aids are small electronic devices worn inside or behind the ears, which consist of a microphone, speaker, and amplifier, and are useful for making sounds loud enough for the ears to hear clearly and the mind to comprehend in order for an individual to communicate effectively. Hearing aids also make it possible for people with hearing loss to hear clearly both in noisy and quiet environments.

As mentioned, hearing aids consist of three basic parts, each with a vital role to play.

i. Microphone – The microphone is what receives external sound. It then changes these sound waves into electrical signals before transferring them to the amplifier.
ii. Amplifier – Once the amplifier receives the electric signals, it multiplies the intensity of the signals accordingly.
iii. Speaker – The amplified sound is transferred to the ear through the speaker and once the remaining hair cells picks the sound, they convert them into neural signals which the brain is able to pick

The strength of a hearing aid amplification required by an individual is determined by the level of damage to the inner ear. However, there is a level at which even the largest amplification a pair of hearing aids can offer will not be of any assistance. In this case, your audiologist will make alternative recommendations e.g. having a cochlear implant.

Hearing Aid Styles

Hearing aids are classified into two major categories based on where they are worn.

  1. In-the-ear (ITE) Style Hearing Aids – These are designed to fit inside the outer ear and generally come with a hard plastic to house the hearing aid parts. They are ideal for mild to severe hearing loss complications with some having extra features such as a telecoli; a tiny magnet through which sound is received from the circuitry of the aid rather than through its microphone. They are good for telephone conversations and in places with induction loop systems.
  2. Behind-the-ear (BTE) Style Hearing Aids – BTEs on the hand are also designed with a hard plastic case that fits behind the ear. This case is attached to a plastic earmold which is what is fitted in the outer ear and transmits sound to the hair cells in the inner ear.  These too are ideal for mild to severe hearing loss cases.

Types of Hearing Aids

In-the-ear (ITE) Style Hearing Aids

ITE style hearing aids include:

  • In-the-canal Hearing Aids – these are placed on the lower side of the outer ear bowl. People prefer them because they are comfortable and do not block the ear canal.
  • Invisible-in-the-canal (IIC) and Completely-in-the-canal (CIC) Hearing Aids – These happen to be the smallest in size and as their names suggest, are not meant to be visible.
  • Low Profile Hearing Aids – unlike the IICs and CICs, the Low profile Hearing aids are for those who desire simple handling, therefore, they are slightly larger in size. They are designed to cover half or the entire outer ear bowl. A noteworthy advantage is that they can incorporate added features like volume controls and directional microphones.

Behind-the-ear (BTE) Style Hearing Aids

BTEs are more popular now than before because current hearing aids now come in a smaller size for those who prefer being discreet, which represents a significant percentage of people with hearing loss problems. Despite their size, they can still accommodate different features to suit specific hearing loss challenges.

Some include:

  • Mini BTEs – these come with a discreet ultra-slim tube to transmit sound into the ear.
  • Receiver-in-the-ear (RITE) or Receive-in-the-canal (RIC) hearing aids – The most distinct feature about the RITEs and the RICs is the fact that their speakers are designed to fit into the ear tip placing them at a closer distance to the eardrum.
  • BTEs with earmolds – these come with a longer shape and fits behind the entire outer ear. A distinctive advantage they have over the others is that they can accommodate more added features.

To ensure the best fit,  here are some things to consider:

Generally, hearing aids will vary with the extent of the hearing loss. However, other factors will certainly come into play.

These include:

  • Price
  • Ease of handling
  • Size Preference
  • The additional accessories required
  • Career

All in all, one needs to first get a recommendation from the doctor and then weigh the pros and cons of each option available before settling on what’s best for their specific needs.

How to Keep Your Hearing Aids in Good Condition

The most basic hearing aids maintenance practice is professional cleaning, you need to rid it of dust, moisture or wax using a soft dry cloth at least daily. Making regular appointments with your audiologist are also crucial to ensure your hearing aids are operating at the optimal levels.

2015 – A Year In Review

2015-a-year-in-review

The end of December is a natural time for reflection.

2015 has been such a great year at ENT & Audiology Associates.  Our practice has grown in size, and we have grown together as a team.

Dr. Holmes began performing in-office balloon sinuplasty surgeries, effectively turning our office into a fully functional operating room with his expert nurses, Andrea, Cheryl, and Amanda.  This has meant collaborating with new clinicians (mobile anesthesiologists and nurses), in addition to reformatting how our office runs on those days.  The audiology team has started working with new technologies, and we completely restructured our billing procedures for hearing aids gearing up for 2016.  We are looking forward to working in an “unbundled” pricing model, offering our patients instrument pricing and service transparency and lower cost hearing aids, with the hope of improving the lives of more people.

On a personal level, 2015 has brought great happiness to our employees.  Amanda had her third child, a beautiful baby girl named Elliotte Grace.  Julayne’s daughter, Natalie, finished her first year in college and returned as a very helpful summer intern for the office.  Our medical assistant, Marla, added a new puppy, Mazy, to her family.  Dr. Kyman was selected by the American Academy of Audiology Foundation to travel to Brazil to spend two weeks at a rural clinic fitting donated hearing aids.  And just a week ago, Carrie got engaged and will officially be the third Gee in our office.  Dr. Holmes’ mother moved up to North Carolina from her home in Florida, and his RN daughter, who is enrolled in a nurse practitioner program in TN, has been observing Dr. Holmes in the ENT clinic during her winter break.

The family connections are so strong in our office.  Randi and Dr. Holmes are so amazing to work for and with, and they really set the tone for a family environment.  Laura, her daughter Stacy, and future daughter-in-law, Carrie, always bring fun and flare to the office.  Tanya’s daughter, Dejah, has recently been providing much appreciated help at our front desk on her winter break from her senior year at Barton College.  Marcia, Dr. Quiller’s mother, has been a lovely addition to the front desk team.  Dr. Head’s daughter, Jessica, came in to help us out a few times last summer, and Dr. Kyman’s partner, Navarre, did some photography work for a dinner presentation Dr. Holmes gave.  We are all so blessed to work in such a friendly, family-oriented environment.

In conclusion, we want to wrap up 2015 with a huge thank you to our patients, our staff, our families, and our friends.  There is something special about our practice that is hard to put into words, but it keeps getting better and better; and we are looking forward to a great 2016!  Things to keep an eye out for: increased expansion of in-office sinus surgeries, unbundled hearing aid prices, HyperSound demo set up in our waiting room, and continuously evolving technology and improvements in patient care.

Audiology Abroad

This July, I was blessed with the opportunity to return to Antigua, Guatemala, on a volunteer audiology trip.

I first went to Antigua as a graduate student in 2010, and was able to visit schools and clinics, perform hearing screenings, and make referrals to appropriate sources for further evaluation.  Five years later, I had the opportunity to return and continue this work.

This trip, I was able to visit a local elementary school and perform hearing screenings on the children that teachers had concerns about.  Further, I was able to provide batteries, and do cleanings/listening checks on two students’ hearing aids.  Later in the week, we were able to visit one of the Universities, and instruct speech and hearing students on audiology basics, and how to perform otoscopy and hearing screenings.

Visiting another country is such an opportunity to learn and experience a different culture.  While I was there to provide a service, I definitely feel like I received more from the people there. We are so fortunate to have sound proof booths here, sometimes in other countries hearing screenings are performed in classrooms without doors, noisy hallways, and even in showers!  One of the children with hearing aids who I worked with had a broken battery door.  I did not have a replacement door with me; however, I was able to make one out of packing tape at the school.  A temporary solution at best, however it made the difference between hearing and not hearing.

Amongst all that work, I was able to have some fun too!  Antigua is a beautiful city, and I really enjoyed walking the streets and visiting the central park.  I got to hike Pacaya, an active volcano, and take a jade workshop at the home of a long-time jade miner.  An amazing experience, to say the least.

I look forward to returning again next year, hopefully with more donated supplies, and a larger team of students.  I want to thank ENT & Audiology Associates for their generosity in donating batteries and ear plugs, and allowing me to travel during such a busy time of the year.  Global audiology is a passion of mine, and I hope to make a difference, one ear at a time.

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 that 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.

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’.