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Archive for 2013

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Hear for the Holidays Contest

Tuesday, November 5th, 2013

Dear Friends,

This holiday season, Dallas ENT Group is hosting an event as a way to give back to our community. It’s called Hear for the Holidays and we are giving away a free pair of hearing aids to a derserving community member just in time for the holidays.

Large family gatherings can be a difficult and uncomfortable situation for a person who has hearing difficult. Don’t let your friend or family member stress through another holiday season! Give them the gift of hearing this year by nominating them for the Hear for the Holidays contest.

All you have to do is:

1. Fill out the application completely. Hear for the Holidays Application PDF

2. Mail, fax, or email the completed application.

3. Repeat for every friend and family member that you know who could use a pair of hearing aids.

The deadline for the applications is December 1, 2013.

This event is only successful when you help us find deserving members of our community to gift hearing aids. Thank you for your help in giving back to our community.

Happy Holidays!

Dr. Liberio and the entire Dallas ENT Group staff

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Tuesday, October 8th, 2013


For Botox clients (those of you who have always been curious and never tried it, or those of you who haven’t come to us yet for Botox, or those of you who haven’t had a touch-up in a while), we are offering a limited-time special on Botox for $10/unit! Bring a friend in with you to get Botox and its only $9/unit (Minimum 20 units)!!!

BOTOX for only $10/unit! Bring a friend and you will both receive it for $9/unit (minimum 25units)

RESTYLANE for only $400 for 1st syringe and $325 each additional syringe.

Call to schedule, space is limited
(972) 566-8300

Botox cosmetics must be done on Friday October 25th 2013.
No discount on partial areas.

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All about Sinus infection/Sinusitis

Thursday, May 30th, 2013

Sinus Infection Diagnosis | Dallas ENT Group | Dallas, TX

This is the time of year when many people are getting sick with a cold or flu and then develop nasal congestion and pressure. How do you know when you have a sinus infection? Do you need to see a doctor? This will attempt to help answer those questions.

Sinusitis: Swelling of the lining of the sinuses and nose. The sinuses are the hollow areas within the facial bones that are connected to the nasal openings. The sinuses are lined with mucous membranes, similar to the inside of the nose.

Symptoms: Nasal congestion, purulent discharge, dental pain, facial pain, especially if it’s worse when bending forward. Other signs include fever, fatigue, cough, ear pressure/fullness, bad breath and headache.

When to get help immediately: High fever > 102.5, sudden severe pain in the face or head, double vision or difficulty seeing, confusion or difficulty thinking clearly, swelling or redness around one or both eyes, stiff neck or shortness of breath.

Diagnosis: Highly predictive symptoms of a sinus infection include purulent rhinorrhea and nasal congestion with facial pressure/pain. The diagnosis is supported by the sensation of ear fullness, cough, difficulty smelling and headache. Symptoms that may suggest a bacterial sinus infection include: worsening of symptoms after initial improvement of symptoms. It is generally not possible to distinguish between viral and bacterial sinus infections in the first 10 days of illness even based on history, examination or radiology studies.

Most of the time radiologic tests such as x-rays or CT/Cat scans are not indicated for acute sinus infections. These radiological tests may show sinus fluid levels in both viral and bacterial sinus infections but it cannot distinguish between the two.

In general acute rhinosinusitis (ARS) is the most common type that we see in the medical clinic. It is a symptomatic inflammation of the nasal passages and paranasal sinuses lasting less than 4 weeks.

There are different classifications of sinusitis that are based on the length of symptoms.

1) Acute rhinosinusitis: symtpoms for less than 4 weeks

2) Subacute rhinosinusitis: symptoms for 4-12 weeks

3) Chronic rhinosinusitis: symptoms persist greater than 12 weeks

4) Recurrent acute rhinosinusitis: 4 or more episodes of ARS per year with resolution of symptoms in-between these episodes.

A sinus infection can be either viral or bacterial. Viral sinus infections usually last 7-10 days and most sinus infections are this type. Bacterial sinus infections usually (75%) go away on their own as well, but can take a month or more. In rare cases, patients with a bacterial sinus infection can develop a complication called orbital cellulitis.

It is very challenging for the doctor to determine whether a sinus infection is viral (like a common cold) or bacterial. Antibiotics may be helpful for the bacterial kind of sinus infection but won’t help the viral infection. Even though about most of the sinus infections are viral, 85-98% of the patients with sinus infections in the US are prescribed an antibiotic when seen in the clinic.

Acute bacterial infection occurs in only 0.5 to 2.0 percent of patients with sinus infections and virus is causing the symptoms 98-99.5% of the time.

How do you get a sinus infection? Viral sinusitis begins with direct contact of the virus into the eyes or nasal mucosa by respiratory droplets from someone else. Symptoms usually develop within the next day after exposure from someone else. Bacterial sinus infections occur when bacteria secondarily infect the inflamed sinus cavity. Most of the time this is a complication of a viral sinus infection but can also be a complication from with allergies, mechanical obstruction of the nose, swimming, intranasal cocaine use, impaired mucociliary clearance due to cystic fibrosis, or immunodeficiency.

You are more likely to develop a sinus infection if you smoke or you already have an impaired respiratory tract such as in cystic fibrosis.

Treatment: Since viral sinus infections usually resolve within 10 days, most of the time we use medications to treat symptoms with these symptoms without the use of antibiotics. An exception would be in the case of a patient who is getting worse after initial improvement or patients with severe symptoms are who are clearly worsening or are immunocompromised. For viral sinusitis, treatment aims to relieve the symptoms of nasal pressure/obstruction and runny nose. The medications do not shorten the duration of the illness in viral infections.

Options for treatment include:

1) Analgesics such as ibuprofen, naproxen or Tylenol

2) Topical steroid nasal spray such as Flonase, Rhinocort or Nasonex

3) Oral decongestant such as Sudafed or anti-inflammatory medication such as prednisone

4) Antihistamines such as Benadryl, Zyrtec, Allegra or Claritin

5) Zinc preparations have been used, but if sprayed in the nose they way cause difficulty with smell are not recommended.

6) Nasal saline rinses

Treatment of bacterial sinus infections may include antibiotics, however 40-60% of patients with bacterial sinus infections will clear their infection without antibiotics.

Antibiotics: Studies have shown nearly identical results in adults with the use of amoxicillin, Bactrim or erythromycin compared to other antibiotics. Most of the time we use Amoxicillin, either 875mg twice a day or 500mg three times a day for 10-14 days. If someone has an allergy to penicillin, Bactrim, doxycycline or other antibiotics might be chosen. There are some strains of S. pneumonia bacteria that are becoming resistant to amoxicillin.

This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.

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Botox Day July 5th!!

Wednesday, May 29th, 2013

For Botox clients (those of you who have always been curious and never tried it, or those of you who haven’t come to us yet for Botox, or those of you who haven’t had a touch-up in a while), we are offering a limited-time special on Botox for $10/unit! Bring a friend in with you to get Botox and its only $9/unit (Minimum 20 units)!!!

For filler clients we will be offering Restylane for only $400 for the 1st syringe and $325 each additional.

Call to schedule, space is limited
(972) 566-8300

Botox cosmetics must be done on Friday July 5th 2013.
No discount on partial areas.

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Swimming Season is Almost Here!!

Tuesday, April 30th, 2013

Excessively exposing your ears to water, such as when swimming, can lead to infections, commonly called swimmer’s ear. Choosing appropriate earplugs for your child is the first line of defense against these painful infections. There are a variety of commercially produced earplugs. But only those made of certain materials are truly effective at preventing water buildup in your ears. No two ears are the same, so why continue to put “one size fits all” earplugs in them. Dallas ENT Group offers fast, expert and reasonably priced custom ear plug molding services. These plugs are custom molded to your ear to provide sure fit and comfort.
These custom plugs, made of hydrophobic floating silicone, make excellent swimming ear plugs. (No more plugs at the bottom of the pool!)

Please see coupon below for a $10 savings towards a pair of Custom Ear Plugs.

Call today to set up your appointment (972) 566-8300!

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Botox Day, Friday May 3rd!!

Wednesday, April 10th, 2013

Friday May 3rd
DALLAS, TX 75230

BOTOX for only $10/unit! Bring a friend and you BOTH get it for $9/unit (minimum 25 units)
RESTYLANE for only $400 for 1st syringe, and $325 each additional
Call to schedule (972) 566-8300

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Tuesday, April 9th, 2013

As temperatures heat up, so do cases of swimmer’s ear (otitis externa)—a painful condition that increases during summer months as kids spend hours in the pool.

Our Dallas ENT Group doctors treat swimmer’s ear cases year round. But we typically see a spike during the summer. Today we’re answering 5 questions about swimmer’s ear.

Swimmer's Ear Treatment | Dallas ENT Group | Dallas, TX

1. What is Swimmer’s Ear?
Swimmer’s ear is an outer-ear infection. That’s an important distinction since inner-ear infections are more common. We typically see swimmer’s ear in patients who regularly swim—usually a few days after swimming in a pool.
But you don’t have to swim to get swimmer’s ear. Water trapped in the ear canal is the cause of the infection. When water gets trapped in the ear canal, bacteria can multiply within the ear and that causes infection and irritation. If the infection progresses it may involve the outer ear and cause pain. That means any water in the ear can cause infection and it’s possible to get swimmer’s ear without ever swimming in a pool. You may contract the infection after bathing or showering, too.

2. What are Swimmer’s Ear Symptoms?
Like most infections, pain or discomfort is the most obvious symptom. In the case of swimmer’s ear, that pain can be mild to moderate or even intense and radiate to your neck, face or side of your head. If you tug on your ear (pull it downward) and pain intensifies, you may have swimmer’s ear.
Other symptoms of swimmer’s ear include an itchy ear, a feeling or sensation that your ear is clogged, fever, decrease in hearing and swollen lymph nodes.
Here is a quick way you can tell if you have swimmer’s ear or an inner-ear infection: wiggle the outside of your ear. If it’s painful, you may have swimmer’s ear. If it doesn’t hurt, you more likely have an inner-ear infection.
If you notice any of these symptoms, we recommend you contact a Dallas ENT doctor or our office at Medical City Dallas to set up an appointment to diagnose and treat your infection.

3. Is Swimmer’s Ear Infectious?
The short answer is: no. Swimmer’s ear is an infection but not infectious.
You can’t “catch” swimmer’s ear from another person. If you or one of your children is diagnosed with swimmer’s ear, you don’t need to quarantine that person. Just make sure they keep their ears dry and follow your doctor’s recommendation to treat swimmer’s ear.
The bacteria that leads to swimmer’s ear is often found in public pools. Polluted waters are another common source of swimmer’s ear and, as you might expect, we don’t recommend people swim in polluted waters—ever.

4. How Do You Treat Swimmer’s Ear?
Once our ENT doctors diagnose swimmer’s ear, we quickly move into treating swimmer’s ear. Antibiotic eardrops are the most common way to cure swimmer’s ear. If swimmer’s ear is in the early stages, we may recommend careful cleaning of the ear canal and use of eardrops. If the swimmer’s ear infection is severe—and the patient doesn’t have a perforated eardrum—your ENT doctor may prescribe antibiotics. If the ear canal is swollen shut, your otolaryngologist (that’s the official name for an ENT doctor) may place a sponge or wick in the ear canal to help ensure the eardrops are effective in eliminating the infection. We may also prescribe pain medications.
Although you can purchase over-the-counter swimmer’s ear eardrops, we urge you to contact an ENT doctor and allow them to prescribe the best treatment plan. In some cases, the eardrops may inflame the condition rather than help it.

5. How Can I Prevent Swimmer’s Ear?
Swimmer’s ear prevention is fairly easy but not always an attractive option for children. The best advice is to keep ears as dry as possible. That means a swim cap or custom fitted ear plugs will help avoid swimmer’s ear infections. We are excited to offer custom fitted ear plugs in an array of colors here at Dallas ENT Group. We recommend our patients thoroughly dry their ears after swimming or showering. The less moisture in your ear, the better. And be sure to leave some earwax since it helps prevent swimmer’s ear.

Contact Us for Swimmer’s Ear Treatment where our Dallas ENT Group doctors are ready to diagnose and treat swimmer’s ear. Call us at 972-566-8300 today to set an appointment with our ENT doctors.

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Help, I have a sore throat! Is it Strep? Understanding pharyngitis

Tuesday, March 26th, 2013

Sore throat is one of the most common problems that people have in the winter when they come to the medical clinic. There are many different causes of a sore throat, including bacterial or viral infections. Although a sore throat usually resolves without any complications, there are times that antibiotic treatment is required. There are very rare causes of sore throat pain that can be serious or life threatening.

Pharyngitis Treatment | Dallas ENT Group | Dallas, TX

When to call the doctor: Since it’s tough to know your sore throat is caused by a virus or bacteria, I encourage you to call your doctor if one or more of the following are present: temperature > 101 degrees F or 38 degrees C, season is late fall, winter or early spring, you don’t have a cough, the age of the patient is between 5-15 years old, recent exposure to someone with strep throat, difficulty breathing/swallowing, your voice sounds muffled, they have a stiff neck or difficulty opening their mouth.

Causes of sore throat: Viruses are the most common cause of sore throat, but bacteria are another common cause. The causes of sore throat depend on the age of the patient as well as the season and geographic location. Many different viruses can cause swelling and throat pain. Most common viruses that cause sore throat also cause the common cold, but others include influenza, adenovirus, and Epstein-Barr virus (the cause of mononucleosis).

Symptoms of viral pharyngitis: Usually with a viral infection, the patient will have runny nose, nasal congestion and can even have irritation and/or redness of the eyes, cough, hoarseness, skin rash and even diarrhea. Viral infections can also cause fever that makes you feel miserable. A high fever does not mean that your you have a bacterial infection.

Group A streptococcus – (GAS): The bacteria that causes strep throat. Other bacteria can also cause sore throat, but group a strep is the most common. Up to 30% of children with sore throat will have strep throat. Winter and early spring are the most common times of the year when it occurs. It is the most common in school-age children and their young siblings.

Symptoms of Strep Throat: Sudden development of fever (temperature > 100.4 degrees F), headache, abdominal pain, nausea and vomiting, swollen glands in the neck, white patches of pus in the back or sides of throat, small red spots on the roof of the mouth. A cough and cold are not usually seen with strep throat.

Diagnosis: Most of the time the cause of the sore throat is a virus and does not require treatment with antibiotics. It is, however important to recognize and treat kids with strep throat to prevent complications of strep throat which can cause rheumatic fever. There are two types of tests that can help diagnose strep throat. One is a rapid strep test and the other is a throat culture. Both of these tests require a swab of the back of the throat to look for the strep bacteria. The throat culture is more accurate, but it takes 24-48 hours to get the results back. The rapid test isn’t quite as accurate but the benefit is that you know the results before going home from the clinic.

Treatment: The treatment of sore throat depends on the cause; strep throat is treated with antibiotic while viral pharyngitis is treated with rest, pain relievers and measure to make the patient more comfortable while the body heals. It is important to monitor for dehydration because some children with sore throat are reluctant to drink or eat due to pain.
Strep throat is usually treated with an antibiotic such as penicillin or similar antibiotic. After 24 hours of treatment, children can return to school most of the time. If they are having trouble swallowing or eating, they should not go to school and should be re-evaluated. The antibiotic is usually continued for a full 10 day course.

Anti-inflammatory medications such as naproxen, ibuprofen, dexamethasone or prednisone can be helpful to reduce the pain of sore throat. Oral rinses such as salt-water gargles, sprays, lozenges, and sipping warm liquids can also be helpful for sore throat pain.

Complications of strep throat: Most of the time strep throat itself isn’t dangerous. It can, however lead to serious complications such as the spread of the bacteria to the sinuses, skin, blood and middle ear. Strep throat can also lead to Scarlet fever (illness with rash), inflammation of the kidney (post-streptococcal glomerulonephritis), and even Rheumatic fever, which is a serious condition that can affect the heart, joints, nervous system and skin.

This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.

If you would like to schedule an appointment at Dallas ENT Group please feel free to call us at (972) 566-8300 or visit our website to book an appointment online at www.dallasentgroup.com

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Sports Endurance/ Nasal Airway

Thursday, March 21st, 2013

The ability to continue exercise during high-intensity sports such as cycling is dependent on both physiologic factors and the perception of fatigue.

Sports Endurance/ Nasal Airway | Dallas ENT Group | Dallas, TX

In 2008 Ansley, et al (1) showed that head cooling significantly decreased the perception of fatigue and increased the exercise time to fatigue by 51%. Not only were athletes able to exercise dramatically longer with head cooling, but their production of a stress hormone thought to be involved in feeling fatigue, prolactin, was nearly eliminated.

In 1995 White and Cabanac found that this head cooling is achieved by the body during exercise via increased blood flow to the nose (2) and that improving nasal airflow increases cooling (3).

Taken together, these studies suggest that improving the nasal airway in athletes will dramatically improve their endurance. Its important to point out that there have been many misleading claims made over the years about how this works and attempts by not-so-reputable groups to sell useless products based on this information. A better nasal airway does not improve an athlete’s VO2 max (maximum exercise capacity of heart and lungs) or his/her oxygen intake. A better nasal airway does improve an athlete’s ability to continue exercise under conditions of heat and fatigue by measurably decreasing both.

So how can you achieve a “Better Nasal Airway”? One simple solution is Breathe Right Strips. They have been shown in studies to increase the internal cross-sectional area of the nose. However, if you have significant allergies, a deviated septum, or other nasal abnormalities these strips may have limited effectiveness. In that case, treating the allergies or nasal obstruction will give you a Better Nasal Airway.

With improvements in both allergy treatments (such as Sublingual Immunotherapy or Allergy Drops) and minimally invasive nasal surgery (turbinate reduction, septoplasty, nasal valve augmentation), a Better Nasal Airway can be achieved with little effort, downtime or discomfort. Visit our website for more information or an appointment; www.dallasentgroup.com.

1) Ansley L, Marvin G, Sharma A, Kendall MJ, Jones DA, Bridge MW The effects of head cooling on endurance and neuroendocrine responses to exercise in warm conditions. Physiol Res. 2008;57(6):863-72. Epub 2007 Nov 30.

2) White MD, Cabanac M. Eur J Appl Physiol Occup Physiol. Nasal mucosal vasodilatation in response to passive hyperthermia in humans. 1995;70(3):207-12.

3) White, M. D. and Cabanac, M. (1995). Physical dilation of the nostrils lowers the thermal strain of exercising humans. European Journal of Applied Physiology, 70, 200-206.

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Ear Wax (Cerumen) – The Ear Annoyance

Wednesday, March 13th, 2013

Ear Wax Accumulation Treatment | Ear Wax Accumulation Symptoms | Ear Wax Accumulation Causes | Dallas ENT Group | Dallas, TX

Ear wax, also called cerumen is a water resistant coating in the ear canal that protects the skin of the canal from water damage, infection, trauma and debris. If it accumulates it is usually not noticeable, but can lead to hearing loss as well as pain/infection. Normally it is supposed to migrate from near the ear drum along the canal and fall out of the ear.

Cerumen is a mixture made up of secretions of both sebaceous (oil), dried skin cells, and sometimes hair. It is identified in the ear canal in your doctor’s office with an instrument called an otoscope. It’s appearance and texture vary widely – sometimes it has the appearance and texture of a liquid, and other times it looks like clay or rock.

Causes of ear wax accumulation: Narrowing of the ear canal can make it difficult for the ear wax to fall out of the ear. Skin disorders such as eczema can cause excessive cerumen. Also as people age, they produce less fluid in the cerumen and it gets harder migrates slower out of the ear canal. Epithelial migration can also occur as a result of using cotton swabs in the ears. Q-tips tend to push ear wax deeper into the ear canal and over time can cause complete blockage of the ear canal in some people. Hearing aids, ear plugs and swim molds also after prolonged use can contribute to ceumen accumulation.

Overproduction: Some people produce more cerumen than others and this overcomes the ear canal’s ability to eliminate it.

Symptoms of ear wax accumulation: Hearing loss, earache, ear fullness, itchiness, dizziness, and/or ear ringing.

Removal methods: Ear wax is usually removed with one of three popular methods –medication to break down the wax, irrigation, and manual removal with a small ear spoon to scoop it out.

How to prevent cerumen accumulation: Many people have difficulty preventing ear wax accumulation, especially if they have predisposing conditions such as a narrow ear canal, eczema or produce more was than average. For many patients, topical drops such as mineral oil soaked on a cotton ball and left in the ear for about 10-20 minutes once a week while also not using a hearing aid overnight (if applicable) is helpful.

Routine cleaning of the ears by a healthcare provider every 6-12 months is also helpful to many people. If the wax becomes very difficult to remove, an Ear/Nose/Throat doctor can use a ear microscope and special instruments to help remove it more easily.

This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.

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