Welcoming a baby into the world is an incredible experience. But finding out your sweet new baby has a tongue tie can quickly send any parent into a whirlwind of stress and anxiety.

Fortunately, in most cases, a doctor can fix a child’s tongue tie quickly and easily with a minor procedure called a frenotomy. 

If you’re considering a frenotomy for your child’s tongue tie, here’s what you need to know.

What Is a Tongue Tie and When Does It Require Treatment?

A tongue tie (also called ankyloglossia) involves a small piece of tissue called the lingual frenulum, which connects the underside of the tongue to the bottom of the mouth. A normal frenulum allows the tongue to move fairly freely, but sometimes people are born with their frenulum in a position that hinders the tongue’s range of motion, “tying” the tongue to the floor of the mouth.

To be clear, when a person has a tongue tie, there’s nothing wrong with the tongue itself. It’s simply anchored too tightly, and that anchor won’t let the tongue move up or forward like it should. You can think of it like a rope holding the tongue down. As soon as that rope is cut, the tongue is free to function normally.

Parents often notice a tongue tie when their child has trouble breastfeeding or learning to speak clearly. A doctor can diagnose a tongue tie with a physical exam, but depending on the severity, it may or may not require surgical treatment.

If you know or suspect your child has a tongue tie, you may wonder whether they need surgical intervention. Generally speaking, here’s the rule of thumb we follow:

• If a person can extend their tongue about five millimeters past their teeth and the condition doesn’t cause any issues with function, we don’t recommend surgery.
• If the tongue tie is more severe and interferes with necessary oral functions, we recommend correcting it surgically with a frenotomy.

What Is a Frenotomy?

A frenotomy is a simple surgical cut that releases the tongue, allowing it to move freely.

It’s also sometimes called a frenulotomy, frenulectomy, or frenuloplasty, all Latin terms that refer to very similar things:

• Frenulotomy means dividing the frenulum.
• Frenulectomy means removing the frenulum.
• Frenuloplasty means rearranging the frenulum.

During a frenotomy, we use sterile scissors to gently snip the frenulum under the tongue. Since the tissue has minimal nerves and blood flow, it barely bleeds, and the patient feels minimal discomfort.

Although it might be difficult to imagine your baby or young child undergoing any surgical procedure, it really is quick and simple. In fact, it’s a lot like getting their ears pierced! It’s over within seconds and doesn’t require anesthesia — just holding their head still for a few moments.

Afterward, you can immediately nurse your child to help calm and comfort them. Older children can have a drink right away.

Can a Doctor Complete a Frenotomy In-Office?

We typically perform frenotomies in the office. Newborns and infants tolerate a frenotomy very well, and we can easily hold them still for the few moments it takes to safely snip the frenulum. 

A five-year-old may not be as cooperative. If a child isn’t able to sit still for the procedure, it could be dangerous for us to attempt it. In these cases, we can administer lidocaine to numb the area and help calm the child, ensuring their safety.

If a patient is already scheduled for another surgical procedure, like a tympanoplasty (ear tube placement) or tonsillectomy (tonsil removal), we can complete the frenotomy at the same time in the operating room while they’re under anesthesia.

What About an Upper Lip Frenulectomy?

The lingual frenulum isn’t the only frenulum of the body. Another frenulum sits where the center of your upper lip meets your gum. (If you lift your tongue above your front two teeth, you can feel the small, stretchy band of tissue there.)

When this tissue attaches to the upper lip in a way that limits movement or interferes with the teeth, it’s called an upper lip tie.

Unlike a tongue tie, an upper lip tie doesn’t usually cause problems with oral functions like swallowing or speaking. Since a labial (lip) frenulectomy — the surgery to fix an upper lip tie — is more complex than a lingual (tongue) frenotomy, involving more bleeding and a less certain outcome, treatment isn’t necessary or helpful in the absence of symptoms.

In some cases, however, a very large upper lip tie can interfere with nursing or cause unwanted spacing or cosmetic issues between the upper front teeth.

Because properly correcting an upper lip tie involves raising a mucosal flap and removing some tissue between the teeth, we recommend seeing an experienced oral surgeon or pediatric dentist for assessment and treatment. They have specific medical expertise in these oral structures and offer the best path toward a successful outcome.

Early Intervention Is Key 

A tongue tie often comes to light when a lactation consultant or speech therapist identifies it as the source of a child’s nursing or speech problems. If you or your child’s specialist notice a possible tongue, we recommend consulting your pediatrician and/or ENT as early as possible. Tongue ties can interfere with feeding and impact a child’s oral functions as they grow and develop, so it’s a good idea to get them assessed and treated promptly.

When all is said and done, a frenotomy is a simple and effective solution to tongue ties, and nothing to be worried about. It’s quick, it’s easy, and it gives your child perfectly normal tongue function without any long-term consequences.

Symptoms like weak bones, kidney stones, joint pain, and mental fog can make it very difficult to thrive in daily life. Few people realize an overactive parathyroid gland may be the culprit.

If you have one or more overactive parathyroid glands, you’ll likely need one of two types of surgery: parathyroid exploration or minimally invasive parathyroidectomy (MIP). Keep reading to find out if it may be necessary for you and what you can expect from the procedure and its outcome.

Why Do People Need Parathyroid Surgery?

First, let’s start with the basics:

Your thyroid is a butterfly-shaped gland located at the front of your neck. Behind it are four small glands called parathyroid glands. There are two on each side: an inferior (lower) and a superior (higher) gland.

Your parathyroid glands are about two to four millimeters in diameter, smaller than a grain of rice. Though tiny, they play a significant role in your bodily functions. These tiny glands make a hormone called parathyroid, which regulates the calcium levels in your bones and blood.

Sometimes, one or more of these glands (usually just one) can balloon to 20 or 30 times its normal size. That’s like growing from the size of a grain of rice to a marble, or larger! 

The enlarged gland — called a parathyroid adenoma — goes completely rogue, producing a nonstop supply of parathyroid hormone. The result is a condition called hyperparathyroidism, which is the most common reason we perform MIP or parathyroid exploration surgery. 

What Are Common Hyperparathyroidism Symptoms?

When you have hyperparathyroidism, all the excess parathyroid hormone in your body strips the calcium from your bones, which you then excrete in your urine. This can lead to a host of unpleasant symptoms, including:

• Osteoporosis
• Kidney stones
• Organ damage
• Depression
• Brain fog
• Other mental health issues

Hyperparathyroidism has earned quite a memorable nickname as “the illness of bones, stones, and abdominal groans.” Some people even add “psychic moans” to the list, since the excess hormone can affect a person’s mental health.

How Is Hyperparathyroidism Diagnosed?

To diagnose hyperparathyroidism, we conduct biochemical testing, which gives us more insight into your calcium, parathyroid hormone, and vitamin D levels. 

If these blood tests indicate hyperparathyroidism is present, we then use localization studies to find which parathyroid gland is enlarged. This process sometimes includes a thyroid ultrasound, a radioactive tracer study called a sestamibi (MIBI) scan, or a 4D CT scan.

Thankfully, our ability to find the enlarged gland has improved tremendously over the past several years, reducing the need for locating the offending gland during a parathyroid exploration.

MIP vs. Parathyroid Exploration

Whenever possible, we prefer to use minimally invasive parathyroid surgery (MIP) to treat hyperparathyroidism. This procedure is much more common now because of the improvements in our ability to pinpoint the location of the problem-causing gland.

MIP is a quick surgical procedure that allows us to use very small incisions and remove the enlarged gland with precision, all with minimal risk to you. 

Sometimes, however, we’re not able to locate the problematic parathyroid gland before surgery. In these cases, we may need to perform a parathyroid exploration surgery to look at all four glands and determine where the problem lies.

What to Expect Before the Procedure

Before parathyroid surgery, you’ll need biochemical testing to confirm hyperparathyroidism. If the results are positive, you’ll undergo localization studies like those mentioned above to pinpoint the gland(s) we need to remove.

What to Expect During the Procedure

Whether we use MIP or parathyroid exploration surgery, it’s usually an outpatient procedure. Depending on how many glands we need to look at, the surgery takes about 20 minutes to 1.5 hours. It’s always best to choose a high-volume surgeon; their familiarity with the procedure not only reduces the likelihood of complications but can also mean a quicker surgery.

For parathyroid exploration, we use a thyroidectomy incision in the front center of the neck to access your parathyroid glands. If we’re able to use MIP, then we can make much smaller incisions to remove the overactive gland.

After we remove the gland, we use invisible sutures to close the skin and apply Steri-Strips to securely bring both sides of the incision together and seal the opening. A wound drain is not necessary for this procedure.

What to Expect After the Procedure

Once we remove the enlarged gland, your calcium and parathyroid hormone levels should return to normal within as little as 20 minutes.

Whether we need look at all four glands with a parathyroid exploration or we’re able to do the minimally invasive parathyroid surgery, post-op recovery is minimal.

After a period of observation, most patients will be able to go home the day of their procedure. We ask you to check into the office the next day for a follow-up to make sure there are no complications. The most common complaints after parathyroid surgery are soreness at the incision site and slight neck pain, which is the result of your head positioning during surgery. Both of these complaints usually only last a day or two; then, you are back to normal activity.

If you’ve dealt with vocal cord conditions like irreversible swelling, polyps, or non-invasive cancer, you’re no stranger to the symptoms: chronic sore throat, difficulty speaking, or the irritating sensation of something stuck in your throat.

In certain cases, vocal cord stripping can be a safe and effective solution. 

Let’s take a closer look at this procedure to find out what it is and how it can help.

What Is Vocal Cord Stripping and What Are the Benefits?

Your vocal cords are made up of two ligaments on either side of your larynx (or voice box), covered by muscle wrapped in a delicate, fine layer of mucosal tissue. This outer tissue can sometimes become damaged, inflamed, or diseased, necessitating vocal cord stripping.

Vocal cord stripping is a surgery that involves gently removing the outermost layer of vocal cord tissue when it has become irreversibly diseased. The process removes the damaged cells and allows new tissue to grow back healthier in its place.

We might recommend vocal cord stripping if you have specific vocal cord conditions, including:

• Irreversible swelling
• Polyps
• Dysplasia (abnormal, pre-cancerous cells)
• Carcinoma in situ (non-invasive cancer that hasn’t spread to the nearby tissues)

For instance, if you have dysplasia, which is abnormal, pre-cancerous cells on the vocal cord, vocal cord stripping removes those cells before they progress to cancer.

What Happens Before the Procedure?

Vocal cord stripping isn’t the first line of treatment. Depending on the ailment, we’ll recommend other, more conservative medical treatments for vocal cord issues first, such as:

• Antibiotics
• Antifungal medications
• Oral steroids
• Reflux medications
• Behavioral modifications like avoiding cigarettes and alcohol

If none of these treatments work and your vocal cords reach the point of irreversible damage, vocal cord stripping will likely be our next step.

What Happens During Vocal Cord Stripping?

Don’t worry — this procedure takes place under general anesthesia, so you won’t feel a thing!

Once the anesthesia takes effect, we insert a scope into your mouth to see your voice box and vocal cords under a microscope.

We then use long, tiny forceps to grasp the vocal cord and a pair of tiny micro-laryngeal scissors to strip off the damaged outer layer of delicate tissue containing the abnormal cells, taking care not to injure the deeper parts of the vocal cord.

The entire surgery takes about 15–30 minutes.

What Happens After Vocal Cord Stripping?

After vocal cord stripping, you’ll need complete vocal rest — or in other words, no talking — for three to seven days. Beyond that, you’ll also want to avoid abusing your voice with shouting or excessive talking for several months, since these activities strain your vocal cords. 

Depending on the patient, we may recommend the following post-op treatments to help with healing and prevent future injury or disease:

• Speech therapy may help you develop practical vocal techniques to gradually recover your full voice function and avoid injuring your vocal cords in the future.
• Anti-reflux medications like Nexium can help prevent further injury to your vocal cords from stomach acid. 
• Behavioral changes like stopping smoking or drinking will help your throat heal faster and help prevent the need for treatment again in the future.

Talk to Your Doctor to Find Out if Vocal Cord Stripping Is Right for You

If the delicate lining of your vocal cords becomes irreversibly damaged or diseased, it’s important to treat it for your comfort and health. If medications and behavioral changes fail, vocal cord stripping may be the best solution. 

Always speak with your ENT about any vocal cord issues you’re having so you can find out the best next step for your health!

Suppose you’ve been having trouble swallowing, or you feel pressure on your neck when lying flat. Or maybe you have a visible lump on one side of your neck, and you’re not quite sure what it is.

If any of those scenarios apply to you, run, don’t walk, to consult a doctor. They could indicate the presence of a heterogeneous thyroid.

What Is a Heterogeneous Thyroid?

This is often a difficult term for patients to understand, but very simply, a heterogeneous thyroid is an irregular type of thyroid gland. It’s brought on by autoimmune thyroiditis, in which your body’s immune system can’t differentiate between your own cells and foreign cells. In these cases, your body creates antibodies that attack the healthy tissues in your thyroid glands, much like Hashimoto’s or Grave’s disease.

A heterogeneous thyroid becomes overactive (hyperthyroidism) or underactive (hypothyroidism). In either case, the thyroid produces irregular amounts of the hormone thyroxine, which affects almost all your body’s systems, including digestive functions, metabolism, bone health, and muscle control.

As a result of this condition, you might experience symptoms like hyperactivity or extreme fatigue. Doctors can prescribe medications to regulate your hormone levels and help treat these symptoms. Complete thyroid gland removal may also help you feel better. Often, with complete gland removal, any pressure in the neck also subsides.

What Causes a Heterogeneous Thyroid?

A heterogeneous thyroid is an autoimmune disease — a condition in which your immune system misfires and attacks your own body. Unfortunately, there’s nothing you can do to prevent a heterogeneous thyroid. Doctors don’t know exactly what causes autoimmune diseases, but women are more likely to get them.

Treatment Options for a Heterogeneous Thyroid

If you have symptoms of a heterogeneous thyroid, the first step is to be evaluated by an ENT doctor or an endocrinologist, an expert in the study of your body’s hormones.

The doctor will check your thyroid levels and perform a thyroid ultrasound. They may also perform a test like a nuclear medicine scan to check for abnormal tissue growths like thyroid nodules or tumors.

Whether the doctor finds that your thyroid is heterogeneous or homogeneous (healthy), they’ll pay special attention to any internal nodules. If they have concerns about possible thyroid cancer, they may want to perform a needle biopsy to extract a tissue sample for further testing.

Depending on their findings, they may also recommend removing the entire thyroid gland; a surgical procedure called a thyroidectomy.

What Should I Do Next?

Your doctor will recommend an individual treatment plan based on the results of their initial evaluation. They may prescribe medications to balance your hormones if you have an underactive or overactive thyroid. However, if the medicine isn’t effective, a thyroidectomy may be preferred.

Similarly, several other factors could prompt your doctor to remove one of your thyroid glands, including its overall size, the presence of nodules, or the presence of Hashimoto’s disease or Grave’s disease.

Regardless, the best thing you can do is seek expert treatment recommendations from a medical professional. They will help you determine the proper next steps based on your symptoms and diagnosis.

An ENT Doctor Will Ensure Safe and Effective Treatment for a Heterogeneous Thyroid

Understandably, if you’re experiencing symptoms of a heterogeneous thyroid, you might be anxious or worried about a diagnosis. Fortunately, you’re in good hands with an ENT doctor. They can guide you through the proper steps to address your symptoms and ensure you get the treatment you need to feel your best again.

As you age, your likelihood of being diagnosed with sleep apnea increases — people over 65 are twice more likely to need CPAP machines than younger people because of the loss of muscle tone that comes with aging. While this may be frustrating, rest assured that it’s just another part of the natural aging process.

What also may seem out of your control is your sleeping position, which could be leading to sleep apnea’s more harmful side effects. This is a topic we’ve been asked about often over the years — believe it or not, some patients have even sewed tennis balls to the back of their pajamas to keep from sleeping on their back!

The fact is, we only have so much control over our sleeping position, but there are minor things we can do to alter it for our health’s sake. Let’s look at how your sleeping position could be causing side effects like snoring and abnormal breathing and identify the best sleeping position for sleep apnea.

What Is Sleep Apnea?

Sleep apnea is a sleep disorder in which your breathing repeatedly stops and starts throughout the night. The most common type of sleep apnea is called obstructive sleep apnea (OSA), which occurs when the throat muscles relax.

When you sleep, your throat and tongue muscles relax. If you sleep on your back, gravity makes your tongue collapse into your airway, restricting airflow and causing that classic snoring noise we’re all familiar with.

Thankfully, sleep apnea treatments like Inspire are highly effective. This tiny implantable device stimulates the hypoglossal nerve, which controls tongue movement and other airway muscles, keeping your airway open while you sleep.

Other small lifestyle changes, like your sleep position, may also negate some of the adverse side effects of sleep apnea — thus why I’ve heard the question so many times throughout my career.

How Does Sleeping on Your Side Affect Sleep Apnea?

If you suffer from sleep apnea, one of the best ways you can manage it is by sleeping on your side. Whether you sleep on your right or left, your tongue won’t fall back very much, and your airway will remain more open, enabling you to breathe correctly. A recent study found that people with sleep apnea who sleep on their side are less likely to experience disordered breathing at night.

Although there are several different ways you can sleep on your side, the fetal position — sleeping on your left or right side with your legs curled inward toward your body — is the most popular. Research indicates that sleeping in the fetal position may reduce snoring and airway blockage among people with sleep apnea.

How Does Sleeping on Your Stomach Affect Sleep Apnea?

Similarly, when you sleep on your front or belly, your tongue won’t fall back into your throat as much as it would if you were on your back. According to the Better Sleep Council, only about 17% of people sleep on their stomachs, so while it may not be the most desirable sleeping position for most people, it will keep your airway clear at night and help prevent the snoring associated with sleep apnea.

How Does Sleeping on Your Back Affect Sleep Apnea?

Sorry to break it to all you back sleepers, but sleeping on your back is the least favorable position for sleep apnea. If you’re on your back, your tongue can easily fall back into your throat and restrict your airflow. If this is your preferred sleeping position, it may take some time to adjust to a new position, but if you suffer from obstructive sleep apnea, it’s well worth the effort.

What Treatments Are Best for People With Sleep Apnea?

If you have sleep apnea, some great ways to reduce the negative side effects include:

• Maintaining a healthy weight: Excess tissue in the throat can cause further obstruction and breathing issues at night. Achieving and maintaining a healthy weight will reduce the amount of tissue in your throat and may improve your breathing.
• Avoid drinking alcohol at night: Research suggests alcohol consumption is associated with a higher risk of sleep apnea because it disrupts sleep patterns, relaxes muscles excessively, and decreases overall sleep quality. Certain prescription drugs like muscle relaxants, sedatives, and narcotics have the same effects, so try to avoid those as well.
• Avoid sleeping on your back: Experimenting with the best sleeping positions for sleep apnea may reduce its side effects. Do your best to sleep on your side, preferably in the fetal position if that feels comfortable. If you tend to roll onto your back during the night, try placing a pillow between your legs. It may hinder your movements and keep you on your side.
• Use evidence-based treatments: Your doctor may recommend proven treatments for sleep apnea, including a mouthguard, CPAP (continuous positive airway pressure therapy) machine, or, if you can’t tolerate CPAP, Inspire.

See an ENT Doctor for Effective Sleep Apnea Treatment

If you’re struggling with disrupted breathing and snoring caused by sleep apnea, switching to an ideal sleeping position for sleep apnea, like side or stomach sleeping, may help. If not, a trusted ENT doctor can help you identify other solutions.

Though thyroid nodules don’t make the news very often, they’re incredibly common.

According to the American Thyroid Association, half of all Americans will develop at least one thyroid nodule by the time they’re 60. The risk increases with age, so about 50% of 50-years-olds have a thyroid nodule, and 70% of 70-years-olds have one. Women are also four times more likely to develop thyroid nodules than men.

Fortunately, only about 5% of thyroid nodules are cancerous. But since they’re so prevalent, how do you know when to worry and when not to worry about thyroid nodules?

What Is the Thyroid?

The thyroid is a small, butterfly-shaped gland at the base of your neck, with a lobe sitting on either side of your windpipe. This little gland plays a big role in keeping major bodily functions running properly, including:

• Heart rate
• Metabolism
• Muscle and digestive function
• Brain development
• Energy levels

Since the thyroid plays such a significant role in our bodies, we have good reason to pay attention to its health and to developments like thyroid nodules. Nodules can indicate or coincide with conditions like:

• Hyperthyroidism
• Hypothyroidism
• Grave’s disease
• Iodine deficiency
• Hashimoto’s hypothyroidism
• Thyroid cancer

However, the presence of a thyroid nodule doesn’t necessarily mean you have one of these conditions. They can exist without causing any problems at all.

When Should I Worry About Thyroid Nodules?

Many thyroid nodules are so small that doctors can only detect them using ultrasound. Others are large enough to feel with your fingers when you palpate the area around your lower neck.

While these larger nodules are more worrisome than the tiny ones, size doesn’t necessarily reveal the nature of a thyroid nodule. For this reason, nodules of any size need medical evaluation.

Whether your doctor noticed your thyroid nodule or you discovered one yourself, any sort of unexpected growth is alarming and disconcerting. Let’s walk through the specific guidelines doctors use to help them decide when to worry about thyroid nodules.

The Thyroid Nodule Rating System

ENTs, endocrinologists, and radiologists use the TI-RADS, or the Thyroid Imaging Reporting and Data System, to rate the various traits of thyroid nodules. By measuring five characteristics (composition, echogenicity, shape, margin, and echogenic foci), the system ranks thyroid nodules on a suspicion scale of 0–5.

A score of 2 or below means you don’t need to worry about your thyroid nodule. A score of 3 or above means your doctor should perform followup testing in the form of a fine needle aspiration biopsy. You can see the full scale and its classifications below.

Score <1-2 = SAFE: Thyroid nodules scoring between 0 and 2 are not suspicious and don’t require further workup.

Score 3 = MILDLY SUSPICIOUS: Perform fine needle aspirate if the thyroid nodule measures over 2.5 centimeters.

Score 4 = MODERATELY SUSPICIOUS: Perform fine needle aspirate if the thyroid nodule measures over 1.5 centimeters.

Score 5 = VERY SUSPICIOUS: Perform fine needle aspirate if the thyroid nodule measures over 1 centimeter.

A nodule’s size in and of itself doesn’t mean it’s suspicious, but if it exhibits other characteristics on the TI-RADS scale, size becomes an important factor. Ultrasound imaging can help doctors identify your nodule’s characteristics, and the fine needle aspirate allows your doctor to remove a tiny sample of the suspicious nodule for examination under a microscope. This can reveal whether the nodule is cancerous or benign.

Treating Thyroid Nodules

In the 95% of cases where a thyroid nodule is benign, no treatment is necessary. Your doctor will continue to monitor the nodule over time. If it grows or becomes suspicious according to the TI-RADS calculator, your doctor can perform another biopsy to test for the development of thyroid cancer.

If a biopsy reveals a malignant nodule, you’ll likely need thyroid surgery to remove all cancerous cells.

In some cases, even benign thyroid nodules can cause worrisome symptoms. If a nodule grows too large, it can cause pain or interfere with breathing or swallowing, especially when the person lies down. In these cases, thyroid surgery may also be necessary.

The Bottom Line on When to Worry About Thyroid Nodules

Thyroid nodules are incredibly common, and doctors can’t (and don’t want to) simply remove everyone’s thyroid gland. This is why the medical community developed some very specific criteria to evaluate thyroid nodules both large and small and determine which need to be removed.

So if you discover a thyroid nodule, your best course of action is to visit an ENT, endocrinologist, or radiologist for a workup. Let them worry about your thyroid nodules for you. By visiting your doctor and getting evaluated, you’re doing everything in your power to take care of your health.

A thyroidectomy seems like a simple enough procedure, right? “Thyroid” refers to the butterfly-shaped gland that sits at the base of your neck, and “-ectomy” means “to remove.”

But wait. Once you start to research this procedure, you find out there are different types of thyroidectomy: subtotal thyroidectomy, partial thyroidectomy, hemithyroidectomy, total thyroidectomy. What do all these terms mean?

In reality, there are only three types of thyroidectomy, and really only two that we commonly perform today. So let’s take a look at the three types of thyroidectomy, the differences between them, and when a thyroidectomy is needed.

Who Needs a Thyroidectomy?

The thyroid is a small organ with a lot of power. It affects many metabolic functions in your body — like breathing and body temperature — and it releases vital hormones to keep your body running.

Sometimes, however, the thyroid can develop problems. In these cases, one of the types of thyroidectomy can become necessary.

Problem 1: Thyroid Nodules

The most common reason patients undergo a thyroidectomy is the presence of one or more thyroid nodules. Thyroid nodules are extremely common, and their incidence increases with age. In fact, ENT doctors often use age as a reference point for how common nodules are. For example, about 50% of 50-year-olds have nodules on their thyroid.

When your doctor notices a suspicious nodule on your thyroid gland, they may want to perform further testing, such as an ultrasound and/or a fine-needle aspirate (a type of biopsy).

A system called TI-RADS classifies thyroid nodules according to how concerning they are on a scale of one through six. A TI-RADS score of three or more usually indicates the need for a needle biopsy, after which a pathologist looks at the nodule cells under a microscope to determine whether they are cancerous. If the pathologist’s findings are inconclusive, then genetic testing can be performed as well.

More than 90% of nodules in adults will not be cancerous, but it’s crucial to identify the ones that are.

Problem 2: Enlarged and Pressing on Vital Structures

Another reason for a thyroidectomy is when the thyroid gland becomes very large and presses on other structures in the neck, such as the esophagus and trachea, making swallowing and breathing difficult.

Problem 3: Overactive Thyroid

People with certain thyroid diseases may require a thyroidectomy because their gland produces too much thyroid hormone. This is often impossible to control medically, making removal of the thyroid gland the best option. Graves’ disease is one example of such a condition.

Subtotal Thyroidectomy / Partial Thyroidectomy

In past years, subtotal thyroidectomies (also called partial thyroidectomies) were common for patients with overactive thyroid glands from conditions like Graves’ disease. The thought for this surgery was that if the entire gland wasn’t removed, the patient wouldn’t need to rely on prescription thyroid medication for the rest of their life.

However, the thinking surrounding this issue has changed in more recent years. Thyroid hormone replacement therapy is now quite safe, effective, and affordable, and it’s difficult to accurately estimate how much of the thyroid gland to remove and how much to leave.

As a result, the subtotal thyroidectomy or partial thyroidectomy is almost obsolete in our practice. While this procedure was an effort to minimize possible thyroidectomy complications, we now have better ways to minimize this risk, such as choosing a high-volume thyroid surgeon and closely following their postoperative instructions.

The other two types of thyroid surgeries listed below are much safer.

Hemithyroidectomy / Total Thyroid Lobectomy

A hemithyroidectomy, also called a total thyroid lobectomy, removes only one side of the thyroid gland, leaving the other lobe intact.

A hemithyroidectomy is usually performed when a patient has a suspicious-looking thyroid nodule. Sometimes, despite an ultrasound and a fine needle aspiration, it’s still hard to determine whether a nodule is cancerous. In many cases, once we remove the side of the thyroid with the nodule, we can immediately analyze it to find out whether cancer is present.

If no cancer is discovered, then the surgery is finished and the patient continues on with one thyroid lobe remaining. Often, they may not even need to take supplemental thyroid hormone because the existing side compensates for the side that was removed.

If cancer is discovered in the operating room like this, the surgeon may need to continue on to a total thyroidectomy. If you’re going in for a hemithyroidectomy, your thyroid surgeon will discuss the possibility of a total thyroidectomy with you before your surgery.

In the case of thyroid cancer, removing the entire thyroid allows for treatment with radioactive iodine, which can destroy any remaining microscopic disease.

Total Thyroidectomy

A total thyroidectomy is exactly what it sounds like: the removal of both sides (lobes) of the thyroid gland.

As mentioned above, a total thyroidectomy is often needed when cancer is found on one side of the thyroid. Another indication for a total thyroidectomy is when the thyroid gland grows to be extremely large and compresses the esophagus and trachea. In this case, removal relieves pressure in the neck, aids in swallowing and breathing, and serves a cosmetic function as well.

A total thyroidectomy is also the new standard type of thyroidectomy for controlling overactive thyroid glands due to conditions like Graves’ disease.

Looking for More Information About the Different Types of Thyroidectomy?

If you’ve been told that you may need a thyroidectomy, you may be a little anxious about the procedure and want as much information as possible.

We’ve written several articles to provide you with useful information about thyroid surgeries. Take a look at our guide to choosing a thyroid surgeon and our ultimate guide to thyroidectomies. We also have a post about how to manage and avoid thyroidectomy complications, tips to speed your thyroidectomy recovery process, and what you need to know about the scar you’ll have after thyroid surgery.

Most people are a little nervous before they go in for any kind of surgery, including a tonsillectomy.

Tonsillectomy complications are rare, but they can happen. In this post, we’ll provide information about the five possible tonsillectomy complications to show that they are, in fact, very rare. We hope this post sets your mind at ease and calms any anxieties you have about tonsillectomy complications.

5 Possible Tonsillectomy Complications

All surgeries and medical procedures come with some level of risk. All the possible complications must be listed in full on the informed consent documents you sign before you (or your child) undergo a surgery.

Some side effects are to be expected while recovering from a tonsillectomy, but fortunately, actual complications from a tonsillectomy are extraordinarily rare.

Awareness of the signs of potential complications will allow you to identify any potential problems quickly. And the sooner you contact your doctor about a complication, the sooner you can be on your way to feeling better!

Below are five possible tonsillectomy complications (and side effects), and who’s at risk for each.

1. Pain and Difficulty Swallowing

Pain and difficulty swallowing are less complications of a tonsillectomy and more side effects. All patients experience pain and difficulty swallowing after a tonsillectomy simply because it’s a surgical procedure requiring incisions in the throat.

Pain management is an important step in tonsillectomy recovery. Patients should follow their surgeon’s instructions for administering prescription pain medication in order to keep pain under control.

Significant pain and difficulty swallowing are sometimes more severe in adults who undergo tonsillectomies than in children. While children are usually uncomfortable for about a week or so, a steady diet of jello and ice cream is often enough to keep their throats soothed. In adults, however, the pain is often more intense as a result of the larger area of tonsillar tissue being removed.

Some patients try to avoid drinking/swallowing after a tonsillectomy due to the severity of the pain, but this can quickly lead to dehydration. Symptoms of dehydration include dry mucous membranes, dry skin, extreme thirst, dark-colored urine, and dizziness. Very cold or frozen liquids, such as popsicles, can be helpful in getting enough hydration even with a painful throat.

Rarely, cases of dehydration after tonsillectomy may require IV hydration. So it’s important to contact your doctor if you’re experiencing symptoms of dehydration.

2. Referred Ear Pain

Most patients are surprised by pain in their ears after a tonsillectomy. This is another example of a common side effect versus a complication.

Ear pain after a tonsillectomy is called “referred pain” and is actually just nerve pain from your throat traveling through the glossopharyngeal and vagus nerves and being felt in your ears instead. Sometimes tonsillectomy ear pain is even more severe than the throat pain!

Most patients report referred ear pain about a week after their tonsillectomy. Fortunately, the ear pain usually resolves after a few days. Once you get over this hump, the rest of the healing process is usually uneventful. Following your surgeon’s instructions regarding hydration and pain management can help decrease your referred ear pain in the meantime.

3. Feeling of Something Stuck in Your Throat

Another common side effect of a tonsillectomy is feeling like something is stuck in your throat. This feeling can occur because of the expected inflammation and the scabs in your throat after surgery, but nothing besides your own tissue is really there.

Keeping your throat moist through a steady intake of water, popsicles, juice, and other soothing liquids may help ease some of the discomfort. And when the inflammation dissipates and your scabs fall off (usually 7–10 days after surgery), this sensation will disappear as well.

Scabs can be white or dark in color. Sometimes patients see white and assume it’s an infection, but this isn’t the case. Darker scabs can mean there is a little dried blood in the scab and are also not a concern unless there is active bleeding.

4. Bleeding After Surgery

Bleeding after surgery can either be a tonsillectomy complication or a side effect. Fortunately, it isn’t difficult to differentiate between the two.

Bleeding immediately after a tonsillectomy or later during the day of your surgery is very rare. If this occurs, contact your surgeon immediately.

Delayed mild bleeding in the days after a tonsillectomy is a bit more common and falls into the category of side effect. Some light bleeding during postoperative days 7–10 occasionally occurs when the tonsillectomy scabs fall off. This bleeding, however, should be very light — more like a little blood in your saliva turning it pink. Nothing more significant. It should stop on its own or resolve with gargling a bit of ice water.

Occasionally, in about 1–3% of cases, bleeding is more extensive and qualifies as a tonsillectomy complication. With this more severe bleeding, patients might see larger amounts of fresh, bright red blood in the mouth or nose, or they may vomit bright or dark blood. This tonsillectomy complication requires immediate attention and a possible return to surgery to cauterize the throat.

In children, a risk factor for post-tonsillectomy bleeding is dehydration, so make sure to keep your child well hydrated during their recovery period.

In addition to dehydration, another major risk factor for post-tonsillectomy bleeding in adults is smoking. While we don’t ever recommend tobacco use, it’s especially dangerous after a tonsillectomy. Smoking dries out and irritates your throat, increasing your risk of severe bleeding. Smoking also decreases your tissue’s oxygen supply and can prolong the healing process.

So the top two measures you can take to reduce your risk of bleeding after a tonsillectomy are to drink plenty of fluids and avoid smoking before and after surgery. It’s also advisable to avoid non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin at this time as well, since they can increase your bleeding risk.

5. Anesthetic Complications

Fortunately, anesthetic complications are extraordinarily rare when your tonsillectomy is performed by a board-certified ENT specialist working with a board-certified anesthesiologist.

The elderly and patients with high-risk health conditions such as heart disease, high blood pressure, and diabetes are more at risk for complications from anesthesia. Overall, however, a tonsillectomy is a very short procedure, meaning the time spent under anesthesia is also very short.

Riding the Tonsillectomy Recovery Wave

Recovering from a tonsillectomy can sometimes be a bit of a roller coaster. Most patients can expect a recovery period of 10–14 days. The initial few days after surgery are painful, followed by a few days of progress. About a week after surgery, expect a little regression period with referred ear pain lasting for a few days. Once you clear this final hump, you should be on the downhill slope toward complete recovery!

When To Call a Doctor About Tonsillectomy Complications

Following all of your surgeon’s postoperative instructions should allow you to avoid most tonsillectomy complications. You should contact your ENT doctor if you experience any of the following:

• The pain is too severe to stay hydrated.
• You feel like you’re becoming dehydrated.
• Postoperative bleeding occurs more than once.
• You notice more significant bleeding or begin vomiting blood.

Tonsillectomies are one of the safer surgeries a person can have, and tonsillectomy complications are rare. By being knowledgeable about the few potential complications, you can take precautions to lessen your likelihood of developing them and be prepared to spot them if they do occur.

“Tumor” is a scary word. We associate tumors with cancer, and then cancer with shortened lifespans.

But fortunately, tumors don’t always mean cancer.

If something unusual is going on with your salivary glands, you may be worried about a salivary gland tumor. Here, we’ll take a look at some common salivary gland tumor symptoms, along with who’s at risk for this specific kind of tumor.

What Are Salivary Gland Tumors?

Salivary gland tumors are unusual growths that can form in the salivary glands or the ducts leading out of the salivary glands. The job of the salivary glands is to produce saliva to help maintain oral health, moisten the mouth, and begin the breakdown of food.

Besides the many minor salivary glands scattered throughout the mouth, people have three pairs of major salivary glands:

• Parotid salivary glands directly in front of the ears.
• Submandibular salivary glands below the border of the jaw.
• Sublingual salivary glands underneath the tongue.

Tumors can occur in any of these major salivary glands. But the vast majority of salivary gland tumors (about 80%) form in the parotid glands.

Not many people develop salivary gland tumors. But even if you do, odds are in your favor for it not being cancerous. About 75% of parotid gland tumors are benign, and 50% of submandibular gland tumors are benign. Sublingual gland tumors are more likely to be cancerous, but these are extremely rare.

Salivary Gland Tumor Symptoms

Salivary gland tumor symptoms can be a bit tricky to spot because the symptoms don’t appear immediately. The tumors tend to grow slowly, which means they may not be large enough to cause symptoms for some time.

The most common salivary gland tumor symptom is a small lump in front of the ear, near the jaw, or in the neck. Patients usually can’t feel this lump until the tumor grows to at least 1 centimeter (cm) in diameter. Once it grows to 2 cm or larger, patients may be able to see a bump when they look in the mirror. A doctor may notice less visible lumps when palpating a patient’s neck or jaw during a routine exam.

Salivary gland tumors can involve the nerves, muscles, and other structures in the face, so they can sometimes interfere with the normal functioning of those structures. As such, other salivary gland tumor symptoms to watch for include:

• Unusual swelling in your face, mouth, or neck that doesn’t go away.
• Pain in your face, mouth, or neck that doesn’t go away.
• One side of your face or neck changing in appearance.
• Numbness or weakness on one side of your face.
• Difficulty opening your mouth fully.
• Difficulty swallowing normally.

Who’s at Risk for Salivary Gland Tumors?

Many times, tumors, cancers, and abnormal growths can be linked to genetics, lifestyle choices, and other clear causes. Unfortunately, researchers have yet to find a clear link between most salivary gland tumors and any clear cause.

Warthin tumors, a specific type of salivary gland tumor, have been linked to smoking. But possible causes for other types of salivary gland tumors are less clear.

About two out of three cancerous salivary gland tumors are diagnosed in adults older than 55, meaning (as with many cancers) age may be a risk factor.

Exposure to radiation and certain workplace substances, such as sawdust, pesticides, and industrial solvents, may also increase people’s risk for developing specific salivary gland cancers.

How Common Are Salivary Gland Tumors?

Salivary gland tumors aren’t very common.

One population-based study concluded that about five people per 100,000 develop a benign salivary gland tumor, and only one develops a cancerous tumor.

The American Cancer Society reports that cancerous salivary gland tumors account for 6–8% of all head and neck cancers. They estimate between 2,000 and 2,500 cases of salivary gland cancer in the U.S. each year.

When To Call a Doctor About Salivary Gland Tumor Symptoms

Although salivary gland tumors are rare, it’s always best to get anything concerning checked out. If you think you might be experiencing salivary gland tumor symptoms, contact your ENT doctor to make an appointment.

While you might be hesitant to call just for an innocuous little lump, some of the other salivary gland tumor symptoms are more concerning and warrant immediate investigation. These include:

• Swelling or pain in your mouth that worsens while eating or chewing.
• A lump in the mouth or neck that grows and/or doesn’t disappear within two to three weeks.

Other concerning symptoms include:

• Pain in the lump.
• An immobile lump.
• A rock-hard lump.
• Facial weakness.
• Facial paralysis.

Most of the time, treatment involves removing all or part of the salivary gland and its accompanying duct. Cancerous tumors may require radiation as well.

The outlook for patients after salivary gland tumor treatment is generally excellent, especially with early detection. Patients can help by paying attention to any salivary gland tumor symptoms they notice and consulting their doctor as soon as possible. The earlier we detect a salivary gland tumor, the earlier we can treat it.

If you’ve been told that you need a thyroidectomy, you likely have some concerns about the procedure. First, rest assured that thyroidectomies have a very low rate of complications.

But as with any procedure, complications do sometimes occur. Today we’re taking a look at the five most common thyroidectomy complications and how to deal with each of them.

What Is a Thyroidectomy?

A thyroidectomy is a surgery to remove part or all of the thyroid gland that sits at the base of your neck.

The thyroid gland sits in front of your voice box and is shaped like a butterfly, with two lobes connected in the middle by an isthmus. It makes and releases thyroid hormones into your bloodstream, playing an important role in many vital body functions like heart rate, temperature level, energy level, and metabolism.

When the thyroid doesn’t function properly, it can lead to problems that may make a thyroidectomy necessary. Some conditions that may require a thyroidectomy include:

• Overactive thyroid (hyperthyroidism).
• Thyroid cancer.
• Suspicious nodules.
• Goiter (noncancerous thyroid enlargement).

Possible Thyroidectomy Complications

Although a thyroidectomy is a fairly straightforward and routine procedure, a few complications can sometimes arise after surgery. We’ll address them here from most common to least common.

1. Low Calcium Levels

A low calcium level, also known as hypocalcemia, is the most common thyroidectomy complication. Behind the thyroid are four small glands called the parathyroid glands. Sometimes after a thyroidectomy, your parathyroid glands experience a kind of “shock” and don’t function properly for a short time due to inflammation.

This parathyroid shock results in not enough parathyroid hormone being released into the body and causes transient hypocalcemia, a temporary reduction in the calcium levels in your blood. It is common after a complete (versus partial) thyroidectomy, particularly when the thyroid gland is extremely enlarged, as with Graves’ disease.

Because hypocalcemia is so common, we recommend that our patients take calcium tablets like Tums for a few weeks after their thyroidectomy to make sure their calcium levels stay within normal range. You can also supplement with vitamin D to ensure the calcium is well absorbed.

2. Injury to the Recurrent Laryngeal Nerve

Because the recurrent laryngeal nerve is so close to the thyroid gland, it can be easily damaged during a thyroidectomy. Damage to this nerve can cause vocal cord problems (paresis) and difficulty breathing and swallowing.

Talk to your doctor if you find that your voice is hoarse or you experience trouble with breathing or swallowing after your thyroidectomy. In most cases the injury resolves itself with time — usually several months — but some surgical treatments are available if necessary.

This complication is much less common with high-volume surgeons, which is why we recommend seeking out an experienced, high-volume surgeon for your thyroidectomy.

3. Abnormal Scarring

Most thyroidectomy incisions now are significantly smaller than they were in past years, so there is less opportunity for scarring. Your grandmother’s thyroid scar, for instance, may have been long and curvy across her whole upper chest, but a thyroidectomy scar today is usually short and straight across the lower neck.

Surgeons close thyroidectomies in the same way that plastic surgeons close face lift and breast augmentation incisions. They place the stitches underneath the skin, and only thin, adhesive bandages remain outside.

The best way to avoid abnormal scarring is to follow your surgeon’s postoperative instructions. But some people’s skin is simply more prone to abnormal scarring, such as hypertrophic or keloid scarring, than others. If you develop an abnormal scar, you can talk to your doctor about topical treatments, scar injections, or scar-reduction surgery.

4. Excessive Bleeding

Excessive bleeding after thyroidectomy surgery is extremely rare, and having an experienced, high-volume surgeon makes it even more rare. This complication will most likely appear while the patient is still in recovery at the surgery center.

Excessive bleeding after a thyroidectomy is a serious complication that can require a return to surgery. If you’re taking blood thinners like aspirin or warfarin before surgery, it’s important to ask your surgeon how long prior to surgery you need to stop taking these medications.

5. Infection

Unfortunately, infection is a risk any time a surgical incision is made on the body. The good news is that the neck has excellent blood flow, so infection following a thyroidectomy is unusual. Infection is a more rare complication even than bleeding.

When it does happen, though, post-surgical infection usually arises a few days after surgery. Signs of infection usually include redness and swelling around the incision. You should contact your doctor immediately if you think your surgical site might be infected.

Infection can be treated with antibiotics, but sometimes drainage may also be necessary.

A Tip for a Complication-Free Thyroidectomy Recovery

One of the most important recommendations we can give about thyroidectomy recovery is to follow your ENT surgeon’s postoperative instructions. Be sure to keep your follow-up appointments as well, so your healthcare team can help you be proactive in spotting any abnormalities.

The physicians at ENT Associates of Lubbock are high-volume thyroid surgeons, performing multiple thyroidectomies every week. Call ENT Associates of Lubbock today to schedule a consultation. We’ll be happy to answer any questions you have and will be by your side throughout your recovery.

Until fairly recently, most people believed that the tonsils and adenoids were useless, unnecessary tissue. But medical researchers now understand that these are important parts of the immune system.

Today tonsillectomies and adenoidectomies aren’t performed as cavalierly as they were in the past, but they can still be necessary at times.

So what exactly are the tonsils and adenoids? Why would they need to be removed? And what’s the difference between a tonsillectomy and an adenoidectomy?

What Are the Tonsils and the Adenoids?

Tonsils and adenoids are made up of the same type of lymph tissue. They work as part of the body’s immune system to identify and protect against foreign invaders like bacteria and viruses. Sometimes, though, the tonsils or adenoids can become infected or inflamed and cause problems.

People have three pairs of tonsils at birth. What we traditionally think of as “the tonsils” are really the palatine tonsils. Palatine tonsils are the two round masses on either side of the back of your throat, which you can easily see in the mirror.

The adenoids are also known as the nasopharyngeal tonsils and are smaller clusters of lymph tissue behind the nose and roof of the mouth. The adenoids are fairly large at birth, but tend to shrink between the ages of eight and 12.

The palatine tonsils and adenoids are the most likely to cause problems and require removal via tonsillectomy or adenoidectomy.

The lingual tonsils sit far back in the throat, at the base of the tongue. They hardly ever cause problems or need to be removed.

Tonsillectomy vs. Adenoidectomy

Now that we’ve covered some basic facts about the location and function of the tonsils and adenoids, let’s look at why and how they are removed.

Tonsillectomy

The two primary reasons for tonsil removal are obstruction and infection.

When tonsils become swollen and inflamed, they can block the airway, making breathing difficult. This airway blockage can lead to snoring and sleep apnea. Obstructive sleep apnea in particular can have devastating health consequences that can sometimes be avoided through a simple tonsillectomy.

Additionally, swollen tonsils can sometimes cause abnormal dental development in children.

Recurrent infection in the tonsils, also known as chronic tonsillitis, is also a common reason to remove the tonsils. This is most often due to strep throat. Most ENT doctors agree that you should consider a tonsillectomy if you’ve had:

• Seven infections in one year.
• Five infections for two consecutive years.
• Three infections per year for three years.

Patients with chronic tonsillitis may notice symptoms like tonsil stones, very bad breath, chronic sore throats, and drainage from the tonsils.

The tonsils may also be removed due to the presence of abscesses or tumors, but this is very rare.

Adenoidectomy

Adenoidectomies are usually only needed in children, since adenoids are generally small or nonexistent by adulthood.

Swollen adenoids can lead to chronic sinus infections and worsening allergies. Because the adenoids sit so close to the eustachian tube, they can swell and block off the tube’s opening. If your child is dealing with chronic eustachian tube dysfunction, your ENT surgeon may recommend removing the adenoids.

Depending on the specific case, the surgeon may also recommend a tonsillectomy along with the adenoidectomy.

Before, During, and After Tonsillectomy and Adenoidectomy

Tonsillectomy and adenoidectomy preparation, surgery, and recovery are very similar.

Before Surgery

Tonsillectomies and adenoidectomies are usually performed in an outpatient surgery center under general anesthesia. You will be asked to refrain from eating and drinking starting from midnight the previous night, and you will need someone to drive you to and from the surgery center.

When patients arrive at the surgery center, a nurse will go over the details of the surgery, and you should also have a chance to speak with your surgeon before the procedure begins. For adults, a nurse will insert an IV before taking them back to the operating room. Once in the operating room, a mask and the IV will be used to administer anesthesia.

For young children, an IV is usually placed after they have been anesthetized to avoid any upset before the surgery begins.

During Surgery

When the patient is asleep, the surgeon inserts a retractor to hold the mouth open and operates through the mouth. For an adenoidectomy in children, they remove the adenoids, and for a tonsillectomy, they remove the tonsils from the surrounding muscle.

In adult patients undergoing a tonsillectomy, the surgeon double-checks to make sure the adenoids are no longer there. Since adenoids usually shrink and disappear by the age of 12, it’s rare that adults need these removed as well. But if any tissue remains, the surgeon removes it.

The entire procedure takes about 20-45 minutes depending on the size of the tissue to be removed and the extent of any infection.

After Surgery

Patients will spend one to two hours in the recovery area after surgery. If they are recovering well and drinking fluids, they are sent home.

Depending on the age of the patient, recovery may take up to two weeks. During this time, hydration is the most important factor. Drink plenty of fluids and stick to a soft diet. Avoid using straws with thick liquids such as shakes, sharp or scratchy foods like chips, and participating in any strenuous activity.

Swallowing will be quite painful, similar to a strep throat infection. For children, plan to have an adult nearby during this time to help keep the child hydrated and restrict activity.

When Is a Tonsillectomy or Adenoidectomy Necessary?

If you or your child is experiencing breathing problems, sleep apnea, or chronic strep throat, talk with an ENT doctor to see if a tonsillectomy or adenoidectomy could be the answer. If your child’s pediatrician or dentist has referred them to visit an ENT, we highly recommend following up on that referral.

The physicians at ENT Associates of Lubbock are high-volume surgeons who are experienced in performing tonsillectomies and adenoidectomies. We can help you decide whether a tonsillectomy or adenoidectomy is necessary.