EAR, NOSE AND THROAT (ENT)
Dr. Anthony Bittar has extensive experience in Otolaryngology – Head and Neck Surgery and is Board Certified by the American Board of Otolaryngology. Below is a basic list of ear-nose-throat procedures that he performs with the help of the Beau Visage Center staff in Austin, Texas. For a consultation with Dr. Bittar, call (512) 448-4422 or contact us online.
BILATERAL MYRINGOTOMY WITH PRESSURE EQUALIZATION TUBES (BMT)
This procedure, commonly performed on children, is performed when there is a history of recurrent middle-ear infections that are not resolving via treatments with antibiotics. Dr. Bittar makes incisions in both tympanic membranes (eardrums), suctions out infected fluid build-up behind the eardrum, and inserts pressure equalization tubes in the incision to keep the middle-ear space behind the eardrum open. This allows any subsequent build-up of fluid to safely drain out of the ear and prevents future middle-ear infection.
A cholesteatoma is an abnormal growth of skin cells in the middle-ear that expands and creates a physical impediment to the normal processing of sound, or a conductive hearing loss. Dr. Bittar diagnoses this condition by physical examination of the ear and a hearing test. The cholesteatoma is removed, since this growth can begin to eat away at the bones of the middle and inner ears, causing greater levels of hearing loss and becoming a more serious condition.
This procedure involves the removal of infected bone tissue from the mastoid bone, located behind the pinna or outer ear. A condition called mastoiditis, or infection of the mastoid bone can occur with a history of chronic, untreated middle-ear infections that begin to affect the surrounding bone tissue. The removal of the infected bone tissue will leave a larger space in the ear canal, or a mastoid cavity, that Dr. Bittar will have to regularly check and clean after the procedure.
SEPTOPLASTY (DEVIATED SEPTUM REPAIR)
This procedure is done to repair the septum, or the thin line of bone separating the two sides of the nose. A deviated or crooked septum is usually the result of a patient having broken his/her nose at some point in his/her life. This condition causes asymmetrical breathing, or breathing out of one side of the nose only, causing patients to not get adequate rest during sleep, or even stopping breathing while sleeping (sleep apnea). After the septum is repaired, patients are able to breathe more effectively.
SEPTOPLASTY – INNER NOSE RESHAPING
This non-cosmetic, corrective surgical procedure is done to straighten the nasal septum (the divide between the two nostrils). A deviated nasal septum can cause problems such as lack of air flow in the nose, mouth breathing, difficulty breathing during exercise and sleep apnea. A septoplasty is considered “medically necessary” therefore covered by most insurance companies.
STAPEDECTOMY/OSSICULAR CHAIN RECONSTRUCTION
This procedure is performed when the tiny bones located behind the eardrum (malleus, incus and stapes) have become fused together, typically via a condition called Otosclerosis. This condition creates a medically treatable hearing loss, or a conductive hearing loss, due to the hardening of the bones in the middle-ear creating a physical impediment to the normal processing of sounds to the brain. The hardened bones are broken and an artificial joint is inserted that will mimic the functioning of normal middle-ear bones which will restore a portion of hearing in the majority of cases.
This procedure involves the removal of the thyroid gland, which sits in the neck above the vocal cords. Removal of the thyroid gland becomes necessary when it becomes enlarged and begins to affect normal breathing and swallowing. Enlargement of the thyroid may be due to cancerous growth within the thyroid; to help in this diagnosis, Dr. Bittar will perform several studies including but not limited to thyroid ultrasound and fine-needle aspiration of thyroid cells.
This procedure is performed when there is a history of middle-ear infections and throat infections with a history of snoring and/or mouth breathing due to enlarged adenoid glands and tonsils. Dr. Bittar can perform this procedure in conjunction with bilateral BMT surgery, and it involves removing the adenoid glands, or pharyngeal tonsils that sit between the nasal passages and the back of the throat. When they are enlarged, they can block (partially or completely) the nasal passages preventing normal breathing necessitating their removal. The tonsil glands that sit in the back of the throat can also become infected through repeated infections and can cause chronic sore throat, bad breath and sleep apnea. Removal of both the tonsils and adenoids opens up the space between the nasal passages and the throat allowing for more effective breathing, better ability to sleep undisturbed, and removes the infected material within the enlarged adenoids and tonsils.
This procedure is often done in conjunction with a septoplasty, and it involves removing or reducing in size the turbinates, which are fleshy protrusions inside of the nasal cavities. These turbinates can become enlarged in size over time due to chronic nasal/sinus infections or via trauma, and when enlarged they create a physical impediment to the natural process of breathing. After surgery, Dr. Bittar places splints in the nose that remain there for one week while the nasal cavity heals, and once removed, the space in the nose is larger, allowing for better, more productive breathing through the nose.
This surgery is done to repair a damaged tympanic membrain (eardrum) that has a perforation due to trauma or chronic middle-ear infection. Dr. Bittar patches the perforation which will keep fluid out of the middle-ear space and restores any hearing loss that might have occurred due to the hole in the eardrum (conductive hearing loss).
If your own snoring inhibits the amount and quality of sleep you are getting, laser-assisted uvuloplasty (LAUP) may be an effective option. LAUP is a surgical procedure that removes sections of the uvula and surrounding tissue to open the airway in the space behind the palate, relieving snoring as a result. It can also be used to treat sleep apnea, a condition that causes periodic lapses in breathing during sleep. LAUP is performed under local anesthesia as an outpatient procedure with little down time.
Dr. Bittar employs an audiologist, Mira D’Souza Au.D, CCC-A, to help him diagnosis hearing loss in patients. Our office uses standardized testing equipment and procedures to determine the exact cause of your hearing loss, including:
To evaluate your hearing, our office uses pure tone air and bone conduction audiometry, speech audiometry and middle-ear analysis. These procedures are done on adults and children, with modified play and observational audiometry used on our youngest patients. These tests help us to differentiate the cause of your hearing loss and whether it can be treated with surgery or hearing aids. The different types of hearing loss are:
–Sensorineural Hearing Loss – This type of hearing loss is the result of damage to the inner ear, the cochlea, but can also include damage or pathology of the auditory nerve and brainstem. This type of hearing loss is permanent and can only be treated with hearing aids.
–Conductive Hearing Loss – This kind of hearing loss is the result of an ear infection or other active disease or condition affecting the middle-ear, either the tympanic membrane (eardrum) or the ossicles (middle-ear bones). This kind of hearing loss, while seen primarily in children, can also occur in adults, and can usually be treated effectively with medication or surgery.
–Mixed Hearing Loss – This type of hearing loss occurs when someone has a permanent or sensorineural hearing loss, and also has a middle-ear condition causing a medically treatable worsening of hearing, or conductive component. This can be caused by an active middle-ear infection, or Otosclerosis, or the hardening of the ossicles (middle-ear bones). While the conductive components can be treated, the person will still have a lingering, sensorineural (permanent) hearing loss that can be treated with hearing aids.
In addition, we also test patients suffering from dizziness/vertigo and balance disorders via Videonystagmography testing (VNG). This test procedure involves computerized measurements of eye-movement via goggles, positional testing, including Dix-Hallpike maneuvers, and caloric stimulation of the ear canals with warm and cool water to measure how your balance system is functioning. These tests allow Dr. Bittar to determine the cause of your dizziness/vertigo problems and help him to determine the correct course of action to help you feel better.
AUDITORY BRAINSTEM RESPONSE (ABR)
For patients that have an asymmetrical hearing loss (a greater degree of hearing loss in one ear versus the other ear), or a unilateral hearing loss, further testing may be required to rule out a benign growth on the brainstem, going from the ears to the brain; this may be the underlying cause of the different degrees of hearing loss. This test uses electrodes connected to various points on your forehead to measure the responses coming off of the auditory brainstem. Dr. Bittar uses these results to determine if further testing is required, including CT scan and/or MRI to further evaluate the auditory pathways going from the ears to the brain.
Many of our patients come in complaining about ringing or buzzing in their ears, a condition known as tinnitus. This condition is most often seen in conjunction with hearing loss, either in both or only one ear, and it is often the result of a history of noise exposure a person may have had throughout their life. While there is no “cure” for tinnitus, Dr. Bittar and our audiologist can offer effective counseling and coping strategies for dealing with tinnitus. Since tinnitus is often seen with a sensorineural hearing loss, many hearing aids on the market today offer tinnitus masking therapy as a program in the hearing aid. Two such hearing aids on the market are the Widex Mind with Zen and the Siemens Micon.
Our office offers the full line of hearing aid technology, from the top of the line to entry level hearing aids, all designed to accommodate any lifestyle. All hearing aids sold in our office, including the entry level technology, come with a three year warranty, covering repairs and loss and damage, and a three year supply of batteries. Hearing aid manufacturers that we work with include Siemens, Widex, Phonak, Unitron and Starkey. Our audiologist stays informed and is constantly being trained in new advances in technology, as every hearing aid manufacturer updates their lines of products annually. So, if you’ve been diagnosed with hearing loss that can be helped with hearing aids, you can rest assured that our office will be able to fit you with the most up-to-date technology on the market. We also offer financing options via Care Credit.