Is Acid Reflux Causing My Symptoms?

The stomach naturally produces acid to digest food. Sometimes this acid can make its way up the esophagus and into the throat, a condition called Laryngopharyngeal Reflux (LPR). LPR often occurs without heartburn, making it difficult to diagnose, and is often considered a “silent” disease.

What are some symptoms of LPR?

  • Hoarseness, especially in the morning
  • Chronic throat clearing or persistent cough
  • Chronic sore throat
  • A feeling of something caught in the throat (also known as globus)
  • Excessive mucus/post-nasal drip
  • Difficulty swallowing
  • Restless sleep

How do we diagnose LPR at Montgomery County ENT Institute?

In order to properly evaluate your symptoms, we will use a camera to directly visualize your nose and throat (nasolaryngoscopy). This can be done in the office at the time of your visit with some topical anesthesia. This allows us to assess the cause of your symptoms. Signs of LPR in the larynx usually involve inflammation or redness around the larynx.

What is the treatment for LPR?

Typically treatment for LPR involves dietary changes and an over-the-counter Anti-Reflux medication. Here is a list of some foods to limit when suffering from LPR:

  • Cigarettes
  • Coffee
  • Alcohol
  • Peppermint, spearmint
  • Tomatoes and tomato sauces
  • Spicy foods
  • Milk and milk products
  • Orange juice
  • Fatty foods

In addition to eliminating these foods, here are some additional tips to manage LPR:

  • Eating smaller, more frequent meals
  • Sleeping with your head elevated 4-6 inches
  • Using a wedge pillow
  • Placing a brick or block under the head of your bed frame
  • Weight loss

Aren’t GERD and LPR the same thing?

Although GERD and LPR are related to acid produced from your stomach, they can be caused by different amounts and types of reflux. It’s possible to have GERD without LPR and to have LPR without GERD. Because of this, it’s important for an ENT professional to examine you.

What if my symptoms don’t go away?

Depending on the severity of symptoms and the in office exam, some patients require longer treatments than others. If symptoms are not improving, you might require an evaluation by another specialist (like a gastroenterologist).

How can Montgomery County ENT Institute help?

If you or anyone you may know is experiencing symptoms that might be from acid reflux or “silent” reflux, contact our office today for a thorough evaluation of your throat.

OTC Hearing Aid Q & A

What are over the counter (OTC) hearing aids?   
OTC hearing aids are hearing aids that consumers can buy directly from a retail store (such as Bestbuy) without needing a prescription. As of October 2022, Congress passed a legislation that allowed OTC hearing aids to be available in traditional retail and drug stores. 
Who is a good candidate for OTC hearing aids vs prescription hearing aids?
OTC hearing aids are best for those who are 18+ years old and have mild to moderate hearing loss. The person might ask others to repeat words often and have difficulty hearing in crowded spaces. A hearing test by a professional Audiologist needs to be completed in order to know the severity of the hearing loss. Some examples of people who are not good candidates for OTC hearing aids are those who are <18 years old, those who have hearing loss in only 1 ear, those who have ear pain or drainage, or those born with hearing loss.
What are the benefits and concerns associated with OTC hearing aids?
The primary benefit of OTC hearing aids is the lower cost and easy accessibility for the patient. However, the OTC hearing aids will not work well for everyone and there are multiple areas of concern for the success of them. The person needs to know whether or not they are good candidates for the OTC hearing aids and also how and when to use them correctly. As mentioned previously, there are many situations and medical conditions that they will not work well for.
How much will OTC hearing aids cost?
Approximately $1000 for one pair (2 hearing aids total).
Will my insurance, Medicare, and/or Medicaid cover OTC hearing aids?
Traditional Medicare and Medicaid do not cover hearing aids. Medicare Advantage plans may have some coverage. Most private insurance plans do not cover the cost of hearing aids, so you should check with your insurance carrier regarding coverage.
How can Montgomery County ENT Institute help?
We are always looking to provide the highest level of service to our patients. We will be offering OTC hearing aids at our office for those who are good candidates. To learn more, you will need to schedule an appointment. An up-to-date Audiogram (hearing test) might also be recommended prior to discussing hearing aids with our Audiologist.
Sources: ASHA,
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Common Causes of Vertigo

Approximately 69 million Americans have varying problems with dizziness and balance. At Montgomery County ENT Institute, we evaluate and treat patients who are dizzy or experiencing vertigo.
What is Vertigo?
Vertigo describes any abnormal sense of movement. Many people describe it as feeling like the room is spinning, feeling off balance or feeling “off.” It’s sometimes associated with ear noises, ear fullness, nausea, vomiting, and nystagmus (eye movement). These episodes can be temporary or chronic. They sometimes occur with sudden movements, like turning your head quickly or rolling over in bed. Vertigo can be very debilitating and a scary experience. It’s important to be evaluated by an Ear, Nose, and Throat specialist to find out the underlying cause of the vertigo and treat it.
What causes Vertigo?
There are several conditions that can cause vertigo. Here are some of the most common ones that we see in our office:
  • Benign Paroxysmal Positional Vertigo (also known as BPPV): This occurs when small crystals in the inner ear are displaced. Symptoms are brought about by positional movements – turning quickly, rolling over in bed, or bending over.
  • Meniere’s Disease: This fluid imbalance in the inner ear may also cause vertigo. Vertigo episodes may also be associated with hearing loss, ear fullness, and tinnitus (hearing a noise in your ear). Symptoms may fluctuate.
  • Deep Wax Buildup: Sometimes if there is a wax (cerumen) buildup up against the eardrum, some people can have problems with their balance as well as ear discomfort.
  • Other ear related causes of vertigo: ear infections, labyrinthitis, vestibular migraines.
  • Other non ear related causes of vertigo: low blood pressure, medications, head injury, stroke, tumor, or others.
When to seek help for Vertigo?
If vertigo persists, you should be evaluated by an Ear, Nose, and Throat specialist. You should also discuss this with your primary care doctor. Evaluation usually involves taking a thorough history to understand what the person is experiencing. Next, a physical examination of the ears, nose, and throat is performed. An Audiologist will complete a formal hearing test and positioning tests will be completed. The positioning tests check for displaced crystals in the inner ear (BPPV). Click HERE to watch a video of what this looks like.
What is the treatment for Vertigo?
The treatment for vertigo varies depending on the cause of the vertigo. If it’s BPPV, which is one of the most common causes of vertigo, we usually provide at-home exercises to help strengthen the inner ear and vestibular system. These are called Cawthorne Exercises. Again, these are only for a specific type of vertigo and sometimes formal vestibular therapy is prescribed. Click HERE to learn more about a common repositioning tool called the Epley Maneuver.
If the ENT specialist determines that the cause of the vertigo is not ear related, then they may refer you to another specialist for evaluation depending on what you’ve been experiencing.
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6 Signs of a Sinus Infection

sinusitisSinuses are air-filled cavities inside our skull that help circulate and humidify the air that we breathe and shape our skulls. They have outflow tracts that drain into our nose which can sometimes get blocked or inflamed. When this happens, it can lead to a sinus infection. Acute Sinusitis, aka acute rhinosinusitis, is inflammation of the nasal cavity and surrounding sinuses. This can be caused by both bacterial or viral infections.
Below are some signs and symptoms that you may have a sinus infection:
  1. Thick, discolored nasal discharge: The color can vary, but may be yellow, green, or white.
  2. Facial pressure: Your face may be tender or painful (over your cheeks, in between your eyes, or even sometimes down to your teeth!).
  3. Nasal congestion: It might be difficult to breath through your nose from the increased mucous production in your nose.
  4. Loss of smell: Anything that blocks your nasal passage can take away your sense of smell. This can, in turn, affect your sense of taste as well.
  5. Postnasal drip: With the increased mucous production, it may be dripping down the back of your throat.
  6. Persistent symptoms for >2 weeks. Common colds or flus typically last 7-14 days. Anything persisting longer and not improving may be a sign of a bacterial sinus infection.
So how do you know if you have a cold, a sinus infection, or it’s just your allergies? If symptoms are progressing and persist after 2 weeks, we recommend formal evaluation by an ENT professional. Part of the visit is looking in your nose with a camera to visualize where your sinuses drain as well as in the back of your throat. After a thorough history and the endoscopy exam, we can determine the cause of your symptoms and treat as needed.

How to Fight Spring Allergies

March 20th is the official first day of spring! As we are excited for warmer weather and flowers blooming, some people are bracing themselves for a flare of allergies. Spring allergies can last anywhere from early March to beginning of June. When plants grow and bloom, they also produce pollen. Pollen from trees, weeds, and grasses can circulate in air and spread around with the wind or a breeze. Inhaling these can trigger a response in our body such as runny nose, postnasal drip, itchy eyes. If you suffer from Spring Allergies, here are are some helpful tips to help fight them this spring!

  1. Start taking your allergy medications before the spring allergy season begins (nose sprays or antihistamines)! This will help prevent manage symptoms by reducing your reaction before it starts.
  2. Remove allergen sources from your home the best you can. Keep your home and car windows closed. Use air purifiers to help circulate the air. Use central air conditioning.
  3. Use saline nasal rinses after a day of being outside (we love the NeilMed saline rinses).
  4. Change and wash your clothes after being outdoors.
  5. If doing yardwork outside, wear a mask and gloves to minimize direct exposure to possible allergens.
  6. Avoid peak pollen times, usually around 5-10 a.m. and at dusk. Pollen is also higher on warm, breezy days.
  7. Clean your pets with a towel when they come inside to reduce the spread of pollen.

What are some of the symptoms of allergies? Symptoms may vary from person to person, but can include some of the following: sneezing, stuffy nose, runny nose, itchy/water eyes.

How do I know if I have allergies? If you experience some of the symptoms of allergies listed above, it’s possible that you suffer from allergies. Formal diagnosis by an experienced healthcare professional is needed to confirm that you have allergies.

How can Montgomery County ENT help with your allergies? Here at Montgomery County ENT Institute, we discuss your symptoms and complete a thorough physical exam. We offer in-office formal skin allergy testing. This allows you to understand what allergies you have and at what time of the year they are likely to bother you. From there, we come up with a plan to treat your allergies and symptoms. This may include over the counter medications, nose sprays, or immunotherapy.