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.

Signs you need a Hearing Test this Year!

hearingHearing loss is the 3rd most common health problem in the United States. It currently affects 36 million Americans per day. There can be several reasons for hearing loss such as illness, certain medications, infection, trauma, allergies, or part of the aging process. It can also affect people of all ages. If you’re experiencing any of the signs listed below, it’s important to be further evaluated to prevent any further hearing loss and be cared for. 

  1. Sudden change in hearing. It’s important to get tested as soon as possible in this situation.
  2. Difficulty differentiating noises. You struggle to hear other people talk in noisy environments such as restaurants or group events.
  3. You feel like everyone else is mumbling. You only catch parts of words sometimes.
  4. You often ask others to repeat themselves.
  5. Ringing or buzzing in the ears (tinnitus). This can be in both ears or just one. It can come and go or always be there too.
  6. You find it hard to understand conversations over the phone or when someone isn’t facing you directly. 
  7. You’ve been turning up the TV volume too much.
  8.  Missing out on day-to-day sounds, such as cell phone ringing or the birds tweeting outside.
  9. If you experience Vertigo.

What’s the difference between Hearing Screening and a Hearing Test?

Hearing screenings are commonly confused with a formal hearing test, also called Audiograms. Hearing screenings are quick, basic tests that one either passes or fails. The patient wears headphones and signals when noises are heard. Audiograms, on the other hand, are completed by Audiologists. They use a variety of different tests to determine your ability to hear sound. The patient sits in an enclosed sound-proof booth to complete the test. Audiograms are painless and take about 10-15 minutes.

How often do I need my hearing tested?

This answer varies from person to person. Typically, we recommend baseline Audiograms starting at age 65 years old. Depending on the results, one may require testing annually or every other year to monitor progress or any changes. If there is any sign of infection, fluid in your ear, sudden change in hearing, an Audiogram is also indicated as soon as possible.

How can we help?

At Montgomery County Ent Institute, we offer formal Audiograms with specially trained and highly experienced Audiologists. The test takes 10-15 minutes and are reviewed afterwards with Dr. Melissa Schwartz or one of our Physician Assistants. In addition to reviewing Audiograms, we also thoroughly examine the outside and inside of your ears, nose, and throat for any other underlying causes.

Call Today to Schedule an Appointment.

5 Ways to Prevent Nosebleeds this Winter

winter photo (1)Fall is officially over and winter is here! With this change comes cold weather, chilly winds, and less humid air which means it’s the season of nosebleeds. Nosebleeds, also known as epistaxis, are most commonly caused by dry air. Nosebleeds occur when the blood vessels that line the inside of your nose break and bleed. Therefore, it’s important to keep the inside of your nose moist. Here are 5 helpful tips to prevent nosebleeds during this holiday season!

  1. Humidifier: Purchase a small humidifier to moisturize the air and your nasal membranes while you sleep. You can also use it during the day. Be sure to clean it regularly so mold and bacteria doesn’t grow.
  2. Saline nasal spray: Spray 2-3 squirts of saline spray in each nostril multiple times per day to keep the nasal mucosa moist. Examples of brands include Ocean, Deep Sea.
  3. Don’t pick your nose: Any picking or scratching of the nose can cause irritation to the mucosa and rupture a blood vessel, leading to a nosebleed. It could be helpful to trim your nails in case you accidentally scratch your nasal mucosa.
  4. Saline Gel: In addition to saline spray, nasal gels can also help keep your nasal mucosa moist. Examples of brands include Ayr, Rhinase
  5. Use nasal sprays correctly: Prescription nasal sprays can cause dryness when sprayed towards the septum (middle of the nose). This can increase your risk of nosebleeds. It’s important to use your right hand to spray in your left nostril and your left hand to spray in your right nostril. 

Our office is always here to help! If you have any additional questions or concerns or if you are struggling to deal with nosebleeds this winter, call our office to schedule an appointment.

Additional Office Location

Dear Patients,

We are excited to announce that effective September 1st, 2016, the Montgomery ENT Institute will be merging with Dr. Sondra Saull’s office located in the Holy Redeemer Medical Office Building in Meadowbrook, PA.  This union of teams will ensure the level of excellence in patient care that you have come to trust from both practices.

Both Dr. Schwartz and Dr. Ondik will continue to have hours at their Elkins Park office, but will now have additional hours at the new Holy Redeemer office.  Dr. Saull will continue to see patients at the Holy Redeemer office.

Dr. Saull has been in practice for 30 years and is board certified in Otolaryngology, Head & Neck Surgery.  She uses an integrative approach to the medical management of Ear, Nose and Throat conditions, and has a special interest in working with the older patient.

Dr. Schwartz founded the Montgomery County ENT Institute in 2007 to address a need for personalized and specialized care. With 20 years of experience, her passion for patient care has served patients of all ages in the Philadelphia region. She is board certified in Otolaryngology, Head & Neck Surgery and is a Fellow of the American Academy of Otolaryngic Allergy.

Dr. Ondik joined Montgomery County ENT Institute in 2014, and in addition to ENT care, is a double-board certified surgeon with a special interest in facial plastic and cosmetic surgery. He is board certified in Otolaryngology, Head & Neck Surgery and Facial Plastic and Reconstructive Surgery.

We look forward to continuing to serve our patients as the Montgomery County ENT Institute.


Melissa Neumann Schwartz, DO FAOCO FAAOA
Sondra C. Saull, MD
Michael P. Ondik, MD

Posted in ENT

When To Worry About A Sore Throat

Sore throat

A sore throat is a fairly common complaint, and there are many causes from post-nasal drip to more serious causes, like infection or tumor. Otolaryngologists are doctors who specialize in ear, nose and throat disorders. They are able to conduct a thorough examination with special scopes to visualize the throat and voice box, and evaluate the cause of your sore throat.

Could it be from allergies? Or a cold?

Post-nasal drip is when excessive mucus produced in the nose drains down the throat causing irritation. Allergies or an upper respiratory infection like the common cold can lead to post-nasal drip. A post-nasal drip from allergies can be seasonal or year-round. Allergy testing is beneficial to help identify which allergens are triggering your symptoms. Topical nasal steroid sprays and/or antihistamines can be helpful. If your symptoms persist even on medications, you may benefit from allergy therapy with allergy shots, allergy drops placed under the tongue or allergy tablets.

Could there be an infection causing my sore throat?

An infection of the tonsils, known as tonsillitis, is a common cause of a sore throat which is usually severe in intensity. It comes on quickly and is often accompanied by fever, pain when swallowing and swollen lymph nodes in the neck. Pus is usually present on the tonsils when it is bacterial. ‘Strep throat’ refers to the name of the bacteria (Streptococcus) that causes a common bacterial tonsillitis. This kind of throat infection should be treated with antibiotics; however a viral infection of the tonsils does not require antibiotic therapy. Both types of infections usually resolve within 7-10 days. A tonsillectomy may be necessary for patients who experience multiple episodes of tonsillitis each year.

Could it be related to my diet?

Acid reflux, also known as Gastroesophageal Reflux (GER) or Laryngopharyngeal Reflux (LPR), can cause recurrent sore throats. This is when acid from the stomach travels up into the esophagus and around the voice box causing inflammation. Many notice the sore throat is worse in the morning just after waking up, and this is due to acid reflux occurring during the night while you are sleeping. Heartburn and indigestion are not always present with LPR, and this is known as ‘silent reflux.’ Other symptoms include a dry cough, a sensation of mucus in the throat, throat clearing, hoarseness, and difficulty swallowing. Antacid therapy, such as Tums, Pepcid, Prilosec (Omeprazole) are a few of the over-the-counter medications that can help alleviate the sore throat caused by reflux when taken over a few weeks. It is important to treat acid reflux because it is a risk factor for cancer of the esophagus. Lifestyle changes are also important to help eliminate this problem causing your sore throat. Caffeine, chocolate, alcohol, spicy food, peppermints, acidic fruit juices are common food triggers of acid reflux. It helps to elevate the head of the bed when sleeping and to avoid eating late at night. A pH probe is a useful test to help diagnose and determine the severity of acid reflux. It entails having a small, thin probe placed into the nose and throat which can detect if acid is reaching the back of your throat. You can still eat, drink, and sleep normally while having the pH probe in place. This is a useful test since many patients have acid reflux at night when they are sleeping so they are unaware it is occurring.

Is this a symptom of something more worrisome?

Sometimes a sore throat is from a malignancy, or tumor, in the head and neck. If you have a sore throat that persists longer than 1-2 weeks, you should schedule an appointment with a medical provider. Certain symptoms, such as difficulty swallowing, a change in your voice, unexplained weight loss, or a lump in the neck raise a red flag of something more worrisome causing your sore throat, and you should see a medical provider immediately.


Posted in ENT

Is My Sore Throat From Acid Reflux: Understanding LPR

What is laryngopharyngeal reflux, or LPR?

This is a common disorder where acidic contents from the stomach go up beyond the esophagus and into the area around your voice box creating irritation and inflammation. Small amounts of acid can damage this area of your throat since it is not equipped like the esophagus to handle acid exposure. As few as 3 reflux episodes can cause severe laryngeal inflammation and injury.

What is “silent reflux”?

This is the name given to LPR since many patients do not experience classic heartburn or indigestion, and in fact, may be completely unaware it is occurring. Some common symptoms of LPR include hoarseness, a feeling of mucus in the throat, or throat clearing. It may occur when you are upright or lying down.

How is LPR diagnosed?

Swelling and irritation around the voice box can be indicative of acid reflux. Your ENT provider has special scopes to visualize this area in the office.

A 24 hour pH probe monitor is a great test to objectively measure and confirm acid reflux. This test detects acid that occurs above your esophagus. A small probe is placed into one nostril and sits above the back of the throat. It does not interfere with eating, drinking or sleeping. This test is more sensitive in diagnosing LPR than traditional pH testing. Additionally, this test is easy to administer, is more comfortable and less expensive than standard pH manometry.

What is the best treatment for LPR?

Your doctor may prescribe a Proton-Pump Inhibitor (PPI) or a different class of antacid medication. It is important to take the medication every day as prescribed. It can take 4-6 weeks for the inflammation to appear improved on exam.

Besides medication, lifestyle changes are very important. Elevation of the head of the bed (using wooden blocks or a wedge pillow) is a great way to decrease acid reflux at night. Some studies show this to be more effective than medication. Avoidance of caffeine, chocolate, acidic juices (OJ, Grapefruit), peppermints, and spicy food help. It is beneficial to stop eating 2-3 hours before lying down, and to eat smaller, more frequent meals rather than large meals.

Why is it important to treat LPR?

Laryngopharyngeal reflux has serious potential consequences. Barrett’s esophagus is a precancerous condition of the esophagus that happens in a small percentage of people who have acid reflux. Chronic acid exposure creates changes in the esophagus which can potentially become cancer of the esophagus. It is important to have routine checkups with your ENT provider.

New Treatment for Nasal Polyps – PolypVac on “The Doctors”

Recently aired on the TV show, The Doctors, is a device for the removal of nasal polyps called the PolypVac which we have in our office. This device vacuums and removes the polyps in the nasal and sinus cavities that cause nasal blockage and in some patients, affect the sense of smell and taste. The procedure can be done under local anesthesia in the office.
Check out this link and call us for a consultation if you think you may be a candidate.