Dr. Vaibhav Hebbalalu Ramprasad, MD

Nasal endoscopy is the use of a thin, flexible tube (called a 'scope') that is inserted into the nostril to examine the structures of the nose. The scope contains a fiber optic light and a camera that allow a physician to see much more of the nasal passages, airways, and sinuses than is possible with a standard nasal exam.

A nasal endoscopy is typically performed by an otolaryngologist (or ENT) in their office. It may be performed for a variety of reasons, but some common ones include:

• Sinus infections
• Nasal polyps
• Frequent nosebleeds
• Persistent stuffiness
• Obstruction in the nose
• Suspected tumor in the nasal passages

In most cases, a medication containing a decongestant and anesthetic is sprayed into the nose before the scope is inserted. The doctor uses the scope to examine any problem areas. If necessary, most scopes allow for tiny tools to be inserted and used to removed tissue or take samples. Nasal endoscopy is a very safe and relatively easy procedure.

Hashimoto's is the leading cause of hypothyroidism, which is when the thyroid does not produce enough hormones to stimulate adequate metabolism. The condition is diagnosed by blood tests that measure TSH (thyroid stimulating hormone) and detect Hashimoto's antibodies. Symptoms of hypothyroidism include sluggish metabolism, inflammation, fatigue, weight gain, brittle hair, dry skin, and sensitivity to cold. To supplement impaired thyroid function, patients with Hashimoto's are typically prescribed synthetic thyroid hormone pills. Such patients may need to consume synthetic thyroids for the rest of their lives. Other treatments may include dietary changes, such as the avoidance of certain foods and medication to reduce inflammation. Frequent blood tests can inform patients if their TSH levels are within a normal range.

Grave's disease is most frequently the cause of hyperthyroidism, which is when the thyroid produces too many hormones, overstimulating one's metabolism. The condition is also diagnosed by blood tests that measure TSH and detect Grave's antibodies. Elevated heart rate, high blood pressure, sweating, bulging eyes, and weight loss are common symptoms of hyperthyroidism. Treatments for hyperthyroidism include oral radioactive iodine, which slowly shrinks the thyroid, slowing the production of excess thyroid hormone. Other anti-thyroid medications such as methimazole (Tapazole) also reduce the production of thyroid hormones. Blood pressure medications known as beta blockers can ease the increased heart rate caused by hyperthyroidism. If treatments are unsuccessful, patients may be prescribed a thyroidectomy, or surgery to remove part or all of the thyroid. Some patients with hyperthyroidism may require ophthalmological (eye medicine) treatments such as eye drops, prednisone, and surgery to reduce eye swelling and bulging.

Untreated thyroid disorders frequently lead to goiters or thyroid nodules. A thyroid goiter is a large lump that can be felt near the base of the neck and is made of swollen thyroid tissue or nodules (excess cell growth). Nodules and goiters are diagnosed by CT scan or ultrasound. Obstructive goiters can cause pain, coughing, and abnormal breathing. The most common cause of goiters is hyperthyroidism (overactive thyroid). However, Hashimoto's is also known to cause goiters or nodules. Goiters develop from continued damage from antibodies to the thyroid over time. At times, a goiter can result from a cancerous thyroid tumor. Most goiters and nodules are themselves benign.

The exact causes of thyroid cancer are unknown. People who develop thyroid cancer may or may not have another thyroid problem such as Hashimoto's or Grave's disease. Symptoms of thyroid cancer include a nodule that can be felt on the neck, hoarseness, difficulty swallowing, swelling in the neck, and neck and throat pain. CT and MRI scans are used to diagnose thyroid cancer. There are four types of thyroid cancer which vary in intensity. Thyroidectomy (thyroid removal surgery) is usually prescribed to treat thyroid cancer.

Thyroid problems are often long-term conditions that require some form of treatment. With regular monitoring and medication, many people with thyroid problems are able to lead active and fulfilling lives.

Tracheostomy is performed for a variety of reasons when a bypass to the normal airway is needed. A patient may have an object lodged in their throat or have an injury that damaged their windpipe. They may have cancer or a swelling in their throat that stops air from moving freely. Sometimes tracheostomy is performed to make breathing easier when patients are paralyzed or have trouble coming off a ventilator.

A tracheostomy can be temporary or permanent. A temporary tracheostomy tends to heal over easily when the tube is removed, leaving a small scar. A permanent tracheostomy can make speech difficult at first. It takes time to learn how to use the throat and air in a new way.

Tracheostomy is a fairly simple procedure, but it can make all the difference in a life or death situation.