NECK AND CANCER AWARENESS
Authored by Jaclyn Sylvia, PA-C


Cancer is a group of many related diseases that begin in cells. These cells begin to grow abnormally forming a mass of tissue, called a growth or a tumor. There are two types of tumors: benign and malignant. Benign tumors are not cancer. Malignant tumors are cancer. Their growth invades normal structures near the tumor and can spread to other parts of the body. Most head and neck cancers begin in the cells that line the mucosal surfaces in the head and neck area. These areas include lips, inside the mouth, tongue, salivary glands, nasal cavity, sinuses, pharynx, and the larynx (voice box).

Did You Know?

- Head and neck cancers, most of which are preventable, account for approximately 6% of all cancers in the United States
- More than 55,000 people in the U.S. will develop cancer of the head and neck in 2011; nearly 13,000 people will die from it
- Early detection and treatments are the keys to preventing these cancers
- Eighty-five percent of head and neck cancers are linked to tobacco use
- People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone
- Cigarette smoking increases your risk of head and neck cancer by 15 times compared to a non-smoker
- Over the past ten years, an increasing number of people with Human Papilloma Virus (HPV) who were young, non-smokers have developed oral, head and neck cancer

What Are the Common Symptoms of Head and Neck Cancer?

Symptoms of several head and neck cancer sites include a lump or sore that does not heal; a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice. Other symptoms may include the following:

- Oral Cavity: A white or red path on the gums, tongue or lining in the mouth, swelling of the jaw that causes dentures to fit poorly, or unusual bleeding or pain in the mouth
- Nasal Cavity and Sinuses: Sinuses that are blocked and do not clear, chronic sinus infections that do not respond to treatment with antibiotics, bleeding through the nose, frequent headaches, swelling or other trouble with the eyes, pain in the upper teeth
- Oropharynx and Hypopharynx: Ear pain and blood in your saliva or phlegm for more than a few days
- Nasopharynx: Trouble breathing or speaking, frequent headaches, persistent pain or ringing in the ears, trouble hearing
- Larynx: Pain with swelling, persistent ear pain, difficulty breathing

These symptoms may be caused by cancer or by other, less serious conditions. However, raising awareness of cancer symptoms and treatment options is crucial because an estimated 60% of patients fail to see doctors until their disease have gone into advanced states.

Call our office at 732-280-7855 to schedule an appointment or visit our website at Coastal Ear, Nose and Throat.

NOSEBLEEDS
Authored by Jaclyn Sylvia, PA-C

In the United States, one of every seven persons develop a nosebleed at some point during their lifetime. Nosebleeds do not exclude any age group, but are most commonly found in children aged 2 to 10 as well as adults aged 50 to 80 years. As inconvenient as nosebleeds may be, ninety percent of nosebleeds are able to be easily controlled without significant invasive procedures. Nosebleeds are classified on the basis of the primary bleeding site. The most common area that bleeds is the inside front portion of the nose. Most cases of nosebleeds do not have one easily identifiable cause; however, local trauma is one of the most common. Another very common cause of nosebleeds is excessive dryness in the nose, which is often seen in the winter months. Dry heated indoor air, topical nasal sprays, cigarette smoking, chronic oxygen use, or antihistamines contribute to nasal dryness. Therefore, if frequent nosebleeds are a problem, it is important to focus on hydrating the nasal tissue.

There are things that can be done at home to keep the lining of the nose moist with the use of a product three times a day:

- Saline spray
- Saline gel such as AYR
- Bacitracin ointment or A+D ointment
- Aquaphor

If you develop a nose bleed, here are some tips to prevent future bleeding:

- Limit physical activities such as bending, lifting or stooping
- Sneeze within the mouth open
- Avoid blowing the nose for roughly 24 hours and continue with gentle blowing after
- Quit smoking or, at the very least, cut down on the amount of cigarettes consumed

If re-bleeding occurs, there are some at home tips that may help to slow, if not stop, the bleeding:

- Immediately squeeze the soft part of the nostrils firmly together for five minutes (make sure the head is bent forward so that you do not swallow the blood)
- Should bleeding continue, blow the nose to remove any coagulated blood
- Follow by spraying a decongestant spray such as Afrin nasal spray in the nose four times on each side
- Repeat these steps if needed
- After thirty minutes, if the bleeding persists, the patient should be evaluated by a medical provider

At Coastal Ear, Nose and Throat we have professionally trained otolaryngologists and a physician assistant to address your nasal concerns. Please feel free to come visit us.

Meet Our Physician Assistant

Jaclyn Sylvia, our Physician Assistant, is committed to excellence in patient care. She received her bachelor’s degree in Health Services and Biology at Quinnipiac University in 2005. She continued on to obtain her Master’s degree in Health Science Physician Assistant at Quinnipiac University in 2007. She has been a practicing licensed medical professional working in otolaryngology and facial plastic surgery for over three years providing care for both adults and pediatric patients. She is also on the Board of Directors for the Society of Physician Assistants in Otolaryngology/Head and Neck Surgery as well as an active member of the American Academy of Physician Assistants in order to promote growth and development of Physician Assistants in the ENT field.

Medications and Their Effect on Hearing

Medications that can damage the ear, resulting in hearing loss and/or balance disorders are considered ototoxic. (Mudd, Edmunds, Glatz, Campbell, & Rybak, 2008) Literally, ototoxic means “ear poison.” There are over 100 known ototoxic prescription and over-the-counter medications on the market today. (Mudd, Edmunds, Glatz, Campbell, & Rybak, 2008) These include, but are not limited to, medicines used to treat serious bacterial infections, cancers, and heart disease.
What are the Effects of Ototoxic Medications?
The first sign of ototoxicity is most often ringing in the ears (tinnitus). Permanent, high frequency hearing loss may also occur. Although uncommon, hearing loss as a result of ototoxic medications may be temporary. The hearing loss often remains unnoticed by a person until speech understanding is affected.
In addition to hearing loss, a person may also experience a loss of balance and the feeling of bouncing vision from the medication. These side effects are often temporary as the human body can learn to adapt to theses deficits. (Guthrie, 2008)
Who is affected by Ototoxic Medications?
Use of ototoxic medications can have serious affects on its users’ quality of life. Not being able to hear conversation, or perhaps always feeling dizzy, may cause a person to stop participating in their usual activities. Therefore, it is important that the pros and cons be weighed before the start of a treatment plan.
All people who take ototoxic medications should be aware of its side effects. However, there are those who are at greater risk than others. Infants who are born prematurely are at a greater risk of ototoxicity than adults when taking medications known as aminoglycosides, which treat serious bacterial infections. Children are also at a greater risk for ototoxicity when using cisplatin (a drug used to treat cancer). (Garcia, Martinez, Agusti, Mencia, & Asenjo, 2001)
The elderly, those with kidney disorders, people who already have hearing loss, those who have previously used ototoxic medications, those using multiple ototoxic medications at one time, and those who have genes linked to ototoxic weakness, are also at a higher risk for experiencing ototoxic effects than others. (Garcia et al., 2001; Mudd et al., 2008; Vasquez & Mattucci, 2003)
The “who” is not the only factor to consider when thinking of vulnerability to ototoxic medications. The “how”is also important. The way that medications are delivered can play a role in severity of ototoxic effects. For example, medications put directly into the blood stream by intravenous injection may be more severe than those applied by liquid drops on the eardrum. (Guthrie, 2008)
Can a person protect themselves against ototoxicity?
There is a lot of research being done to develop ways of protecting a person from ototoxic medications. Animal experimentation shows promising results. However, the extent that the animal study results extend to humans is unknown at this time and human studies have not yet been performed. Therefore no protective strategy has been formally approved. (Guthrie, 2008)
What should a person do if they are going to begin using an ototoxic medication?
Monitoring the hearing and balance systems are very important. By thorough monitoring, if a change occurs, adjustments can be made by the doctor to try to save as much hearing and/or balance as possible. Adjustments in treatment can include, but are not limited to, changing the dose, the schedule of treatment, a switch to a less ototoxic medication, or possibly stopping the treatment temporarily. (Vasquez & Mattucci, 2003)
Prior to starting the treatment plan, a baseline evaluation should be conducted which includes a conventional hearing test, high frequency hearing test, word recognition test, otoacoustic emission test, and an electronystagmography or videonystagmography test when possible. Throughout the course of treatment, weekly tests should be performed consisting of at least conventional and high frequency hearing tests and the otoacoustic emission test. Post-treatment tests should also be performed as reactions to the drugs make not take affect right away and cannot be predicted. (Vasquez & Mattucci, 2003)
What can be done when treatment has ended and a person has hearing loss and/or balance problems?
Unfortunately, even with careful monitoring, ototoxic effects may be unavoidable as the primary concern is the treatment of the disease which requires the drug in the first place. If a person is left with tinnitus, hearing loss, imbalance, and/or dizziness, an audiologist can work to develop a rehabilitation plan. This plan may include lessons on better hearing strategies, hearing aids, and/or balance therapy.
If you suspect that you may have, or had, problems related to ototoxic medications, please feel free to make an appointment with our team of physicians and audiologists at Coastal Ear, Nose and Throat.

Coastal Hearing and Balance Center

3700 Route 33

Neptune, NJ 07753

www.coastalhearing.com

(732) 280-7855