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General Otolaryngology

Hoarsness or any abnormal changes in voice can be caused by a wide range of problems including laryngitis, excessive speaking, and poor speaking techniques.  Occasionally these can lead to formation of vocal cord nodules or vocal fold hemorrhage.  Other common causes are gastroesophageal reflux and smoking which can be diagnosed and treated by a Laryngologist.  In adults, it is important to be evaluated because of the concern of cancer.

Recurrent tonsillitis is a common disease that affects a wide range of ages.  Tonsillectomy is indicated when a patient has 3 or more infections in 1 year, a previous peritonsillar abscess, hypertrophy causing abnormal dental-facial growth or swallowing problems, and especially for hypertrophy that causes obstructive sleeping problems. 

Ear infections are common in children for a wide variety of problems.  Recurrent infections and hearing loss greater than 30 dB in patients for more than 3 months are an indication for placement of pressure equalization ear tubes. This may prevent speech and developmental delay. 

Snoring and Sleep apnea is a very common problem among children and adults.  The treatment and diagnosis of this is multidisciplinary.  Diagnosis often is made with a polysomnogram (sleep study).  Treatment can range from nonoperative dental appliances and continuous positive pressure devices (CPAP or BiPAP), to minimally invasive office procedures such as soft palate implants and and nasal radiofrequency, and finally operative interventions including tonsillectomies with uvulopalatopharyngoplasty, geniohyoid advancement, and maxillomandibular advancement.

Nasal Obstruction is a common complaint that is often caused by inflammatory or structural problems of the nose.  Seasonal allergies may inflame the turbinates that can swell and cause inflammation.  This can often be corrected with medical therapy or minimally invasive in office procedures at the Loma Linda University Sinus Center.  Other common causes of structural abnormalities include septal deviation and external nasal vault deformities.  The structural problems are best treated with surgical intervention including a septoplasty and if needed- osteotomies of the nasal bones.

Dysphagia or swallowing difficulties have a wide range of causes, starting from problems in the mouth, pharynx or esophagus.  The Loma Linda University Voice and Swallowing center has a wide range of diagnostic and therapeutic options available in the office setting.  Neuromuscular diseases can also cause dysphagia.  Zenker's Diverticulum is a pouch in the throat from an overactive upper esophageal sphincter. Symptoms from this can include swallowing problems, regurgitation of undigested food hours after eating, coughing and clearing of the throat after eating, bad breath and sensation of food sticking in the throat.

Traditional surgery for this includes an incision on the left neck with removal of the pouch and relaxing incisions on the upper esophageal sphincter muscle. This includes several days in the hospital with a nasal feeding tube.

New minimally invasive techniques have been developed to decrease postoperative healing time. With transoral endoscopic Zenker's Surgery, patients routinely are discharged home the following day taking nutrition by mouth. This is the preferred approach at Loma Linda University for patients with previous open surgery for Zenker's diverticulum.

Transoral Endoscopic Zenker's Surgery video (.wmv - 13MB)