Deviated Nasal Septum

Estimates are that 80 percent of all nasal septums are off-center, a condition that is generally not noticed. A “deviated septum” occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.

Deviated septum can occur as a result of an injury to the nose. People often get these injuries from sports, fighting, or car accidents. A deviated septum can also worsen with age. It can also be congenital. This means that a person was born with it.


Most people with a deviated septum have only a minor deviation. Symptoms are unlikely in these cases. Still, possible symptoms include:

  • difficulty breathing, especially through the nose
  • having one side of the nose that’s easier to breathe through
  • nosebleeds
  • sinus infections
  • dryness in one nostril
  • snoring or loud breathing during sleep
  • nasal congestion or pressure

Severe deviation can be accompanied by facial pain. You should see your doctor if you frequently have nosebleeds or sinus infections. You should also see a doctor if breathing difficulty is affecting your quality of life.

If you are suffering from any of these symptoms. Contact us to schedule a consultation with one of our ENT Sinus experts.

Hearing Tests

Audiologist Examining the Ear for a Hearing Test

Hearing Tests at Potomac ENT

An audiologist will normally start by asking you some questions relating to your hearing, such as how you experience your hearing, if you have been subjected to loud noise or other incidents, if people in your family suffer from hearing loss or whether you hear better in one ear or the other.

Initial examination

An audiologist will start examine your ears with a special instrument called an otoscope. With this examination the audiologist can find out if there are any problems in the ear canal or with the eardrum.

After the physical examination, your hearing is tested. This takes place in a quiet room without background noise or in a special soundproof room.

Pure tone test

The first test is a pure tone test. This tests your ability to hear a number of different pure tones using a pair of soundproof headphones.

Bone conduction test

In some cases, the audiologist will carry out a bone conduction test to measure your ability to hear pure tones, by placing a small bone conductor behind your ear. The bone conduction test will reveal if there is a problem in the middle ear cavity.

Speech test

Next, the audiologist will test your ability to understand speech. The speech test investigates whether there could be problems with the auditory nerve which sends signals from the ear to the brain or whether there could be problems understanding speech and sounds in the brain itself.


The last examination is Tympanometry. Tympanometry tests the condition of the middle ear and the mobility of the eardrum.


The results of these tests are presented in an audiogram, which will show the degree of your hearing loss and if you could benefit from hearing aids.

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What Is Tinnitus?

Tinnitus is commonly described as a ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched. You might hear it in either one or both ears. Roughly 10 percent of the adult population of the United States has experienced tinnitus lasting at least five minutes in the past year. This amounts to nearly 25 million Americans.

What causes tinnitus?

Tinnitus is not a disease. It is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus. But it can also be the result of a number of health conditions, such as:

  • Noise-induced hearing loss
  • Ear and sinus infections
  • Diseases of the heart or blood vessels
  • Ménière’s disease
  • Brain tumors
  • Hormonal changes in women
  • Thyroid abnormalities

Why do I have this noise in my ears?

Although we hear tinnitus in our ears, its source is really in the networks of brain cells (what scientists call neural circuits) that make sense of the sounds our ears hear. A way to think about tinnitus is that it often begins in the ear, but it continues in the brain.

Scientists still haven’t agreed upon what happens in the brain to create the illusion of sound when there is none. Some think that tinnitus is similar to chronic pain syndrome, in which the pain persists even after a wound or broken bone has healed.

Tinnitus could be the result of the brain’s neural circuits trying to adapt to the loss of sensory hair cells by turning up the sensitivity to sound. This would explain why some people with tinnitus are oversensitive to loud noise.

Tinnitus also could be the result of neural circuits thrown out of balance when damage in the inner ear changes signaling activity in the auditory cortex, the part of the brain that processes sound. Or it could be the result of abnormal interactions between neural circuits. The neural circuits involved in hearing aren’t solely dedicated to processing sound. They also communicate with other parts of the brain, such as the limbic region, which regulates mood and emotion.

What should I do if I have tinnitus?

If your doctor cannot find any medical condition responsible for your tinnitus, you may be referred to an otolaryngologist (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will physically examine your head, neck, and ears and test your hearing to determine whether you have any hearing loss along with the tinnitus. You might also be referred to an audiologist who can also measure your hearing and evaluate your tinnitus.

What if the sounds in my ear do not go away?

Some people find their tinnitus doesn’t go away or it gets worse. In some cases it may become so severe that you find it difficult to hear, concentrate, or even sleep. Your doctor will work with you to help find ways to reduce the severity of the noise and its impact on your life.

Are there treatments that can help me?

Tinnitus does not have a cure yet, but treatments that help many people cope better with the condition are available. Most doctors will offer a combination of the treatments below, depending on the severity of your tinnitus and the areas of your life it affects the most.

  • Hearing aids often are helpful for people who have hearing loss along with tinnitus. Using a hearing aid adjusted to carefully control outside sound levels may make it easier for you to hear. The better you hear, the less you may notice your tinnitus. Read the NIDCD fact sheet Hearing Aids for more information.
  • Counseling helps you learn how to live with your tinnitus. Most counseling programs have an educational component to help you understand what goes on in the brain to cause tinnitus. Some counseling programs also will help you change the way you think about and react to your tinnitus. You might learn some things to do on your own to make the noise less noticeable, to help you relax during the day, or to fall asleep at night.
  • Wearable sound generators are small electronic devices that fit in the ear and use a soft, pleasant sound to help mask the tinnitus. Some people want the masking sound to totally cover up their tinnitus, but most prefer a masking level that is just a bit louder than their tinnitus. The masking sound can be a soft “shhhhhhhhhhh,” random tones, or music.
  • Tabletop sound generators are used as an aid for relaxation or sleep. Placed near your bed, you can program a generator to play pleasant sounds such as waves, waterfalls, rain, or the sounds of a summer night. If your tinnitus is mild, this might be all you need to help you fall asleep.
  • Acoustic neural stimulation is a relatively new technique for people whose tinnitus is very loud or won’t go away. It uses a palm-sized device and headphones to deliver a broadband acoustic signal embedded in music. The treatment helps stimulate change in the neural circuits in the brain, which eventually desensitizes you to the tinnitus. The device has been shown to be effective in reducing or eliminating tinnitus in a significant number of study volunteers.
  • Cochlear implants are sometimes used in people who have tinnitus along with severe hearing loss. A cochlear implant bypasses the damaged portion of the inner ear and sends electrical signals that directly stimulate the auditory nerve. The device brings in outside sounds that help mask tinnitus and stimulate change in the neural circuits. Read the NIDCD fact sheet Cochlear Implants for more information.
  • Antidepressants and antianxiety drugs might be prescribed by your doctor to improve your mood and help you sleep.
  • Other medications may be available at drugstores and on the Internet as an alternative remedy for tinnitus, but none of these preparations has been proved effective in clinical trials.

Request an Appointment with one of our Tinnitus Experts Today!

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What Causes Nasal Congestion?

Nasal congestion is usually caused by underlying anatomic abnormalities of the nose and/or inflammation and swelling of the lining of the nose called the “mucosa.”

The inside of the nose contains the septum that divides the left and the right side. This is made of bone and cartilage and covered by mucosa. Most people have some degree of “septal deviation.” This means that the septum is crooked to one side or the other. It can sometimes be deviated to both sides in different places. When there is a significant deviation, there can be blockage on one side of the nose and sometimes both. You can be born with the deviation or this could have been acquired through trauma to the nose.

On each side of the nasal cavities you have turbinates. These bony protuberances project into the airway to help the flow of air. They increase the surface area to allow for warming, humidification, and filtration of the air we breathe.

The mucosa lines the septum and turbinates and produces mucous that coats all of the internal nasal surfaces. The mucous helps to trap and filter particles we breathe in. It also provides moisture and humidity. The mucosa contain tiny specialized cells that have microscopic hairs that sweep mucous to the back of the nose and eventually down into the throat where it is swallowed. This is a process that normally you don’t notice. When there is increased mucous, you may notice this as postnasal drip.
Underneath the mucosa, vascular tissue called submucosa help with warming the air we breathe. When there is increased inflammation due to infections such as the common cold or allergy, the mucosa and submucosa swell causing the nose to feel blocked. There is also increased mucous production resulting in a runny nose or postnasal drip. If there are severe allergies the mucosa and submucosa can swell significantly over time and form polyps that can lead to even more nasal congestion.

Request an Appointment with one of our ENT Specialists Today!

Snoring and Sleep Apnea

Do you snore or know someone that snores? Snoring is very common and according to the National Sleep Foundation, affects more than 90 million Americans!

What Causes Snoring?

Snoring is a sound made by vibrations of excess soft tissues in the back of the nose and throat that include the soft palate, uvula, the tonsils, and the back of the tongue. When we go to sleep, the brain tells the body to relax. The muscles surrounding our throat also become more relaxed and vibrate more easily when we breathe during sleep. The vibrations that occur while we breathe in our sleep result in the sounds we know as snoring. Snoring by itself is not dangerous, although it can be harmful to your relationship with your bed partner! What is more harmful to your health is if your snoring is associated with “obstructive sleep apnea.”

What is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) occurs when the airway becomes blocked by the collapse of the relaxed throat or nasal tissues when breathing during sleep. When there is significant blockage, the brain senses this and arouses the person from the different stages of sleep. When people don’t get enough of the deeper stages of sleep, they can have daytime fatigue, sleepiness, and even insomnia. Other symptoms of OSA include, grinding the teeth, morning headaches. This can happen to children as well since many children have big tonsils and adenoids that can block their airways. In children, obstructive sleep apnea may be manifested by bed wetting, daytime irritability, and hyperactivity.

How is Obstructive Sleep Apnea Harmful to your Health?

Compared to the general population, patients with obstructive sleep apnea have increased risk for car accidents, heart attacks, and strokes. Since the brain is constantly arousing the patient at night time and activating the “fight or flight” response, this can contribute to elevating blood pressure. Obstructive sleep apnea also makes the heart work harder and this can lead to heart failure and cardiac arrhythmias. It also disrupts our circadian rhythms and disrupts hormones associated with them.

How is Obstructive Sleep Apnea Diagnosed?

Sleep disorders are diagnosed in a sleep lab. Patients spend the night in the sleep lab where monitors are used to record your breathing, heart rhythm, oxygen level, and body movements, while you are asleep. The number of times there are blockages that cause arousals are recorded to determine if the patient has sleep apnea and how severe it is.

In certain patients, an in-home sleep study can be done by wearing a device that measures, however this provides less information than an in-lab sleep study.

How is Obstructive Sleep Apnea Treated?

Obesity is a strong risk factor for obstructive sleep apnea. Excess weight around the neck makes the airway in the throat more collapsible during sleep. Men who have neck sizes greater than 17 and women with neck sizes greater than 15.5 are predictive of OSA. This means that weight loss can help decrease the severity or even cure sleep apnea!

For patients with mild sleep apnea. Dental devices can be fitted by a dentist to reposition the jaw forward so that the tongue does not collapse the airway during sleep.

The gold standard for treatment of OSA is a device called Continuous Positive Airway Pressure or “CPAP.” The patient wears a mask that is connected to the machine that blows air into the airway to prevent the airways from collapsing. To be maximally effective, one should wear the device all night.

CPAP can be used for mild, moderate, or severe obstructive sleep apnea.

What if you can’t tolerate using CPAP?

In certain patients, surgeries involving the airway can decrease the severity or even cure sleep apnea depending on the site of suspected obstruction. Surgery can also help a patient better tolerate the CPAP machine. If nasal blockage is a major factor, surgeries such as septoplasty and turbinate reduction may be beneficial. If the back of throat is the suspected area of collapse, procedures such as uvulopalatopharyngoplasty “UPPP” that remove the tonsils and excess soft tissue of the uvula and palate may be beneficial. To address the collapse of the back of the tongue, procedures such as tongue base reduction, hyoid suspension, and genioglossal advancement may be beneficial.

Potomac Ear, Nose and Throat has physicians that are board certified in Sleep Medicine. All of the physicians are trained to perform airway surgeries to treat sleep apnea. If you think you have obstructive sleep apnea, call today for an evaluation with the physicians at Potomac Ear, Nose and Throat at 703-499-8787

How is Rhinosinusitis Treated?

For viral rhinosinusitis, supportive therapy including analgesics, nasal saline, decongestants, and nasal steroid sprays can be beneficial. Viral infections are self limited and usually resolve within 10 days. If symptoms get worse after 10 days, you may have a bacterial infection. Sometimes, a bacterial infection may be present if you improve within 10 days, but suddenly worsen again. Bacterial rhinosinusitis is treated with oral antibiotics. Occasionally oral steroids may be needed to help decrease the swelling inside the nose. Treatment of allergies may help to decrease the number of sinus infections.

Surgical intervention can be considered for patients who have recurrent infections (more than 4 per year) or if there are symptoms lasting more than 12 weeks or greater (chronic rhinosinusitis) AND if medications have not been sufficient to improve symptoms. Surgeries for the sinuses are done endoscopically (with a thin telescope connected to a camera). The goal is to enlarge the openings into the sinuses so that they are less likely to be blocked by inflammation. This can be done via a minimal invasive approach in the office called balloon sinuplasty for certain cases or in the operating room called functional endoscopic sinus surgery for more complex cases.

If you have sinus related symptoms, call today for an evaluation with the physicians at Potomac Ear Nose, and Throat at 703-499-8787.

Request an Appointment with one of our Sinus Experts Today!

Differences Between Acute and Chronic Sinusitis

Sinusitis is common! Acute sinusitis can be triggered by a cold or allergies and may resolve on its own. Chronic sinusitis can last from four to eight weeks and may be caused by an infection or growths and can linger for years, its cause can be hard to pin down and hard to treat.

Symptoms include: facial pain, runny nose, nasal congestion and headache.

Differences between Acute and Chronic Sinusitis

Acute Sinusitis

Usually doesn’t require any treatment beyond symptomatic relief with medications.

Chronic Sinusitis

May require antibiotics and sometimes due to problems with the structure of the nasal passages, or growth such as nasal polyp that keeps the sinus from draining normally.

Acute and Chronic sinusitis have similar symptoms of facial pain and pressure, thick discolored mucus and congestion.

Treatment is Key! Finding the right Sinus specialist is not always an easy task. You want to find a specialist that has experience in treating both acute and chronic sinusitis.

When diagnosing the specialist needs to determine whether you have acute or chronic sinusitis, this determines the correct treatment.

Request an Appointment with one of our Sinus Experts Today!

What is Sinusitis

Sinusitis Overview & Treatments

Healthy (Left) Sinus vs. Inflamed (Right) Sinus

Sinusitis affects 37 million people each year, making it one of the most common health problems in the U.S.  Is defined as an inflammation of the sinus lining, and is commonly caused by structural issues such as ostial blockage, bacterial infections, viral infections or a combination of these.

Symptoms include: drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat; nasal obstruction or congestion; tenderness and swelling around the eyes, cheeks, nose and forehead; and/or a reduced sense of smell and taste.

For many patients, symptoms vary and may include nasal congestion, facial discomfort, nasal discharge, headache and fatigue. Sinusitis is considered acute when symptoms last 4 weeks or less and chronic when it lasts 12 weeks or longer.

Treatment Options

The most common treatments for sinusitis aim to reduce mucosal swelling and relieve obstructions within the sinus ostium and ostio-meatal region, and include:

  • Medical therapy with antibiotics
  • Topical nasal steroid spray
  • Natural remedies, including cool and hot mist vaporizers, steam, Neti Pot and sinus rinsing.

However, It is estimated that at least 20% of chronic sinusitis patients are not successfully treated with medical therapy.

Balloon Sinuplasty is a minimally invasive, breakthrough technology used by a qualified ENT doctor to treat recurrent acute sinusitis patients, or chronic sinusitis patients, who have sinusitis symptoms that have not responded to sinus medications and therapies.

In some areas, Balloon Sinuplasty can be performed right in the ENT doctor’s office under local anesthesia. The doctor begins by inserting a small, flexible balloon catheter into the nose to reach the inflamed sinus. The sinus balloon is slowly inflated to restructure the blocked nasal passage.

Unlike conventional sinus surgery, Balloon Sinuplasty preserves the normal anatomy of the sinuses and mucosal tissue, and does not require the removal of bone and tissue.

Functional Endoscopic Sinus Surgery (FESS)

Previously, the only surgical option for clearing blocked sinuses was known as functional endoscopic sinus surgery (FESS), which removes bone and tissue from the nose to enlarge the sinus opening. This removal of bone and tissue can require uncomfortable nasal packing after surgery and lead to post-surgery pain and scarring.

Is Balloon Sinuplasty Right For You?

Sinusitis symptoms are painful and they can slow you down. Contact us to schedule a consultation with one of our ENT experts.

Potomac ENT is now a Division of The Centers for Advanced ENT Care (CAdENT)

The Centers for Advanced ENT Care, the Mid-Atlantic’s premier provider of comprehensive ear, nose, and throat services, offers patients the highest standard of professional medical care with state-of-the-art equipment at convenient and readily-accessible practice locations.

With over 30 locations and 60 providers throughout the Virginia/Maryland/DC tri-state area, our compassionate providers deliver expert treatment in all areas of ear, nose, and throat care, including: General Adult and Pediatric ENT, Hearing and Balance Disorders, Throat and Voice Complications, Nasal and Sinus Disorders, Facial Plastics and Reconstructive Surgery, Head and Neck Surgery, Allergy and Asthma Management, Diagnostic Audiology, and Hearing Aid Dispensing. We offer a number of the region’s most highly-skilled sub-specialists who focus on managing the most complex ear, nose and throat cases.

At The Centers for Advanced ENT Care, we participate with a vast majority of the area’s insurance carriers.

Request an Appointment with one of our Sinus Experts Today!