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Allergies | Audiology & Hearing | Botox for Migraines

Throat & Voice | Sleep Apnea & Snoring | Vertigo

ENT Services

Dr. Kay is specially qualified to treat a full range of ENT medical and surgical problems. Her other specialties include ear disease, and hearing disorders, cancers of the head, neck and facial skin, sinus surgery and allergies, radio frequency surgery for snoring, sleep apnea and voice disorders. She completed her surgical training at UCLA and is a member of the American Academy of Facial Plastic and Reconstructive Surgery.

 
 

Allergies

Over 50 million Americans regularly suffer from allergies, and approximately 55% of all U.S. citizens test positive to one or more allergies. In our office, we can diagnose your allergies using a simple skin test, which will show if your immune system reacts to certain allergens. Generally, we test using the "top 20" panel of most common allergies, but we can test for hundreds of allergies. Using the results from an allergy test, Dr. Kay will choose the easiest and most effective treatment plan for her patients.

Generally, allergies can be treated with medicine that alleviates symptoms, or by immunotherapy (allergy shots) that desensitize the body to specific allergens. Both treatments are effective, but the best method of treating allergies is allergen avoidance. If that's not an option, we recommend NeilMed Sinus Rinse, which you can find at any pharmacy or drug store.

Finding out what specifically what you are allergic to is the best first step in treating your symptoms. Using a HEPA air filter if you have pets, or eliminating the dust mites from your home are two ways to proactively manage and avoid your allergy suffering. Come see us and get your life without allergy suffering started today!

Indoor - Mold & Mildew Allergies

WHAT IT IS

Mold reproduces through tiny, airborne spores. Indoor molds grow in damp areas.

WHAT TO WATCH OUT FOR

Any wet surfaces in the home will attract mold and aid in reproduction. Areas to look out for include: basements, bathrooms, shower stalls, refrigerator drip trays, house plants, humidifiers and garbage pails.

WHAT TO DO

The key to reducing mold is to keep your home dry:

  • Fix leaky faucets and pipes
  • Make sure rooms are properly ventilated
  • Use a vented exhaust fan to remove excess moisture
  • Keep humidity levels below 50% with air conditioners and humidifiers
  • Use cleaning solutions designated to kill mold and mildew

Children & Outdoor Allergens

GRASS POLLEN

Grass pollen levels tend to be the highest in late spring and summer. If your kids enjoy playing in the yard during these months, make sure you keep the grass cut short. Pollen from grass is easily brought indoors by wind, people and pets, so encourage your children to shower and change clothes when they come inside.

TREE POLLEN

Trees pollinate in late winter and early spring. They produce light, dry pollen that can be carried by the wind for miles. Be wary of this when your children are eager to get outside in spring. They may be allergic to more than one type of tree pollen and it’s not always the trees in your yard.

WEED POLLEN

Weeds are a nuisance in more ways than one. They grow like crazy and produce vast amounts of pollen every day. The main weed pollen season is during the late summer and fall. Try to keep your yard weed-free and be on high alert when your kids play in areas with unkempt gardens.

Allergies at School

It’s important to talk about your child’s allergies with adults who spend time with them outside the home. This will ensure that caregivers and teachers are aware of any allergy problems and are able to help keep symptoms under control. It’s also a good idea to educate your child about allergies to help them cope.

Talking to Your Child

  • Explain a child's allergies in simple terms.
  • Show kids the items and places that will trigger allergies.
  • Create a plan to help them cope with their symptoms when you aren't around.

Tips by Season

Spring

  • Learn to recognize the types of trees that trigger your symptoms. Consider removing any of those trees from your property.
  • Keep car windows rolled up while traveling.
  • Try not to go outside between 10am and 4pm when pollen is at its worst. If you DO go outside, shower as soon as you go indoors to remove pollen from your skin and hair.

Summer

  • Learn to recognize which grasses trigger your symptoms.
  • Plan a low-pollen getaway to the beach.
  • Think about replacing your grass lawn with low pollen ground cover - Irish Moss, Bunch and Dichondra - or pollen-free features like rocks, sand and water.
  • Keep the grass in your yard short and weed-free.
  • Wear a mask when you mow the lawn, or ask someone without allergies to help.

Fall

  • Don't hang clothing or linen outdoors to dry.
  • Mulch with rocks or plastic gravel to stop weeds from growing.
  • Remove brush and weeds from your property.
  • Learn to recognize the weeds that trigger your symptoms.

Winter

  • Keep an eye on the mold spore count.
  • Wear a mask or cover your face while gardening to avoid inhaling spores.
  • Keep your garden tidy - piles of leaves or other foliage are a haven for mold.
  • Try not to come into contact with damp soil.

Sublingual Allergy Therapy

Similar to allergy shots, are drops that are placed under the tongue that expose your body to the substance that you are allergic to. They gradually increase in strength to help your body build tolerance to the allergen. Patients usually use the drops 3 times a day for 3 to 5 years, though some patients may need more time.

Taken from the allergychoices website, here are the advantages of allergy drops: 

  • Treats the cause of your allergies, not just temporary symptoms. The goal of allergy drops is to help you build long-term tolerance to your allergens so ongoing treatment and medication is no longer needed.
  • Affordable and convenient. Compared to other therapies, allergy drops are less expensive and require fewer office visits. And you can take your drops where and when it’s most convenient for you (work, school, sports practice, vacation, etc.).
  • Less medication. Patients report, and research shows, that allergy-related medication use typically decreases after using drops, resulting in savings and less medication.
  • Better quality of life. The end benefit of allergy drop treatment is feeling better and enjoying life with fewer related hospital and clinic visits, and less time lost from work and/or school.

Allergy drops are safe and effective, and a great alternative to allergy shots. Schedule an appointment today to consult with Dr. kay about sublingual allergy therapy. 

Audiology & Hearing

Hearing Loss

Hearing loss affects everyone, whether it is someone you love or yourself. Testing for hearing loss is simple. If you think you might need a hearing test, here are the top ten signs to look out for.

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  • You want the volume to be turned up louder than everyone else in the room
  • You ask others to repeat what they said more than a few times a day, especially when you are in a noisy room
  • You hear a ringing sound (tinnitus) in one or both ears
  • You are positive that people are mumbling, especially women and small children
  • You find yourself avoiding social situations because you know you're going to struggle to hear what people are saying
  • You hear better out of one ear than the other
  • You dread answering the phone because you know you're going to have a problem understanding the person on the other end
  • You have a harder time hearing later in the day than early in the morning
  • Your loved ones are begging you to get your hearing checked

The average person waits 5 to 7 years before they decide to do something about their hearing loss. With the proper medical care, those are years that could have been spent hearing the finer things in life.

Pediatric Testing

Children and young adults who have trouble hearing often have a difficult time learning or focusing at school, or fitting in socially with their peers. Our friendly staff offers comprehensive testing for young children and adolescents, with excellent audiology and therapy services for both the patient and their parents, to help everyone achieve a higher quality of life.

Deafness

Deafness is the inability to hear sound. It has many causes and can occur at any age. People can go deaf suddenly as a side effect of a virus, or lose their hearing over time because of disease, nerve damage, or an injury caused by noise or physical trauma. Sudden or profound deafness is easy to recognize, since there is such a noticeable change in hearing. Milder hearing loss may not be noticed right away, since it often comes on gradually and most people just get used to it.

One of the most common birth defects is hearing loss, or congenital deafness, which affects as many as 3 in every 1,000 babies born. Genetics are also believed to play a significant role in hearing loss in the elderly. Other factors may include medical problems, environmental exposure, trauma, and medications.

Deafness may be caused by one of two ways:

  • Conductive hearing loss occurs when something blocks sound waves from reaching the inner ear
  • Sensoineural hearing loss is caused by damage to the inner ear, or to the nerves that send sound to the brain, and is more likely to be permanent and cause deafness

We will test your hearing loss to find out the root cause. Once we discover the exact reason you are suffering from a profound loss of hearing, there are many treatments that will be considered, depending on your individual case.

Audiology Testing

At our Pasadena office, we provide the services of a certified audiologist who can help diagnose hearing loss, as well as provide therapeutic services for rehabilitation and management of hearing loss. With extensive training, skills, and testing equipment to evaluate the hearing of adults, infants, and children of all ages, we provide a comprehensive solution for our patients.

Auditory brainstem reflex testing examines the complete auditory pathway from the inner ear to the brain. The test takes approximately one hour, where we measure the response to "clicking" sounds presented at various loudness levels. This data allows us to determine how efficiently sound is moving through the hearing system.

Tympanometry is also used to evaluate the function of the middle ear. The tympanogram provides us with a graphic representation of the relationship of air pressure in the ear canal to the impedance (or resistance to movement) of the ear drum and middle ear system. When the ear drum is disturbed by a sound, part of the sound is absorbed and sent through the middle ear, while the other part of the sound is reflected back. A typanogram provides us with additional information, especially the Eustachian tube function, to help diagnose and treat your hearing disorder.

Click here to meet our Audiologist Dr. Rose Keshishyan 

Noise Prevention & Exposure

Noise is one of the most common causes of hearing loss, and one of the most common occupational illnesses in the United States. A single shot from a large caliber firearm, experienced at close range, may permanently damage your hearing in an instant. Repeated exposure to loud machinery may, over an extended period of time, present serious risks to our hearing.

According to the National Institute on Deafness and Other Communication Disorders, up to 10 million Americans have already suffered irreversible hearing damage from noise, and 30 to 50 million more are exposed to dangerous noise levels (over 85 decibels) each day.

(Don't forget to check out the "noise thermometer" below!)

Noise-induced hearing loss is almost entirely preventable. While each individual's susceptibility to hearing loss varies, it is always good to take the following precautions:

  • Know which noises can cause hearing damage, including jet engines, lawn mowers, chainsaws, powerboats, and MP3 players or loud music.
  • Try to reduce noise at the source. Keeping equipment in good maintenance or placing loud machines inside of an enclosure can shield you from damaging sound.
  • Personal listening devices, such as iPods, MP3 or CD players, can present risks to hearing if used at too high of a volume for too long. Use noise-canceling earphones to block out background noise and help you moderate your listening level, and give yourself breaks if you do choose to listen loud.
  • Wear hearing protection devices, such as earplugs or earmuffs, when involved in loud activities. A proper hearing protection device is required by law to be labeled with a "Noise Reduction Rating" that is based on the performance obtained under ideal laboratory conditions. Make sure to wear the device correctly.

Occupations particularly at risk for hearing loss due to noise exposure include:

  • Firefighters
  • Police officers
  • Factory workers
  • Miners
  • Farmers
  • Construction workers
  • Military personnel
  • Heavy industry workers
  • Musicians
  • Entertainment industry professionals
  • Office staff in crowded buildings

In addition to hearing loss, another condition that is often caused by noise exposure is tinnitus--or the perception of ringing, buzzing, or hissing sounds in the absence of any external stimulus. Those who suffer from tinnitus find it difficult to experience quiet, and this can be very distressing. 

BOTOX FOR MIGRAINES

Originally used to fight wrinkles, botox can now be used to help relieve migraines! Botox can be injected into facial muscles to help relax them and fight migraines before they start. Thousands of people have now turned to botox to help with their chronic migraines! Botox is a quick solution that can last you for months. The best part is, it may be covered under your insurance if you have been diagnosed with chronic migraines! Call to see how we can help you with your migraine problems.

Information taken from the Botox website 

 

Throat & Voice

Hoarseness, Speech, and Vocal Cords

Hoarseness is a general term which describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to the vocal folds, which are the sound-producing parts of the voice box.

There are many causes of hoarseness, but most are not serious and tend to go away in a short period of time. The most common causes are acute laryngitis, which usually occurs due to swelling from a common cold, upper respiratory tract infection, or irritation caused by excessive voice use such as screaming or yelling at a sporting event or concert.

While hoarseness due to a cold or flu may be short-lived and easy to manage, hoarseness that lasts longer than two weeks or has no obvious cause should be evaluated. It is very important to see a doctor if your hoarseness lasts longer than two weeks, or if you experience coughing up blood, difficulty swallowing, a lump in the neck, or a complete loss/change in voice lasting longer than a few days.

Spasmodic Dysphonia

Maybe you've heard someone whose voice sounds tight, strangled, broken, whispery, or otherwise not quite right. These are the distinguishing characteristics of spasmodic dysphonia, which is a neurological disorder that causes muscles to contract and spasm involuntarily.

We have successfully used Botox to treat our patients with spasmodic dysphonia. By injecting a small amount of the medication into the muscles surrounding the vocal cords, the symptoms generally subside for a period of 3 to 4 months. Most insurances now cover BOTOX for these treatments!

Speech & Voice Therapy

In addition to all of our medical treatments or procedures for the voice and vocal cords, we provide the services of a certified speech therapist in our office to work one-on-one with our patients. Our speech therapist does a professional voice evaluation for one hour.

We help develop individualized plans of treatment for varying degrees of speech conditions, including sound production, improvement of voice quality, communication, and the professional voice. These sessions are generally 30 minutes a week, and are very effective for many conditions, including singing and speaking.

Radiesse Voice - Do You Have Trouble Speaking?

Many patients who previously suffered from speech disorders have found great improvement using Radiesse® Voice, which is now used to treat vocal fold weaknesses associated with serious aspiration disorders. Muscle weakness or degeneration can lead to poor vocal fold closure and a weak, hoarse voice.

Radiesse Voice also helps patients suffering from Parkinson's, too! Working closely with Huntington neurologists, these treatments have proven to benefit swallowing, aspiration (breathing) problems, speaking, and helps the patient as well as their caregiver.

Videostroboscopy

To accurately diagnose vocal cord disorders, we utilize a technology called videostroboscopy, which is a state-of-the-art technique that provides a magnified, slow-motion view of the patient's vocal cords in action. It allows us to accurately and efficiently diagnose many of the conditions and diseases of the vocal cords, including vocal cord polyps or vocal cord paralysis. If you suffer from hoarseness, a speech impediment, or any other disorder that affects your communication, there are many options to greatly improve your quality of life.

  • Please note that there is a $100 fee for canceling your videostroboscopy appointment.

Throat and Throat Health

Thyroid and Parathyroid

Information about thyroid and parathyroid coming soon!

Swallowing Disorders

Difficulty swalling (dysphagia) is common among all age groups, but especially the elderly. It may be caused by many factors, most of which are non-threatening and temporary. Rarely, difficulties in swallowing are signs of a more serious issue, such as a tumor or neurological disorder. If the difficulty in swallowing does not clear up by itself within a short period of time, you should see a doctor.

In our office, we do a fiberoptic laryngoscopy procedure in order to see inside your throat for any potential swallowing disorders. This gives an accurate diagnosis, which is crucial to developing a proper and effective treatment plan. The procedure is non-invasive, lasts only a few minutes, and there is no discomfort.

Symptoms of swallowing disorders may include:

  • Drooling
  • A feeling that food or liquid is sticking in the throat during or after a meal, or while swallowing saliva
  • Discomfort in the throat or chest, including acid reflux
  • A sensation of a foreign body or lump in the throat
  • Weight loss and inadequate nutrition due to prolonged or significant problems swallowing
  • Coughing or choking caused by food, liquid, or saliva not easily passed during swallowing, and small amounts of food, liquid, or saliva being sucked into the lungs

Once the cause is determined, our patients may be treated with medication, swallowing therapy, or surgery. Most of these disorders can be treated with medication. Acid reflux is best treated by changing eating and living habits, such as eating a more bland diet, smaller and more frequent meals, elimination of alcohol or caffeine, reducing weight and stress, avoiding food within three hours of bedtime, or elevating your head while sleeping.

Tonsils & Adenoids

The tonsils and adenoids are composed of tissue that is similar to the lymph nodes, strategically located near the entrance to the breathing passages to catch incoming infections. Since they "sample" bacteria and viruses as part of the immune system's first response, they can become infected themselves. This is generally what happens when we experience a sore throat.

The tonsils can also harbor "stones" of bacteria or decaying food matter without causing any type of infection or discomfort. While this is not a serious medical issue, it may be responsible for halitosis, or bad breath, and is something we can help treat. Some of our patients who suffer from sleep apnea or frequently snore may benefit from an airway evaluation. It is not uncommon for the tonsils to be the cause of these disorders. Chronic infection of the tonsils or adenoids can also affect nearby structures such as the eustachian tubes, which is the passage between the back of the nose and the inside of the ear. This can lead to frequent or chronic ear infections, or hearing loss.

Bacterial infections of the tonsils, especially "strep throat", are initially treated with antibiotics. Removal of the tonsils and/or adenoids may be recommended for some children or adults who suffer recurring infections despite antibiotic therapy, or who have difficulty breathing or sleeping due to enlarged tonsils or adenoids. In any case, surgery is always a last resort, and Dr. Kay is very experienced in surgery of both pediatric and adult patients.

Sleep Apnea & Snoring

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Millions of people suffer from sleeping disorders. We successfully treat many of these conditions, including sleep apnea and snoring. Generally, treatment options are not too painful or uncomfortable, but may take some getting used to.

Sleep apnea is a disorder characterized by abnormal pauses in breathing, or instances of abnormally low breathing during sleep. Each pause can last from about ten seconds to a few minutes, and may occur 5 to 30 times or more per hour.

Snoring is the vibration of respiratory structures, due to obstructed air movement during breathing while sleeping. In some cases, the sound may be soft and not too disturbing. In other cases, however, snoring can be loud and unpleasant. Snoring during sleep may also be an early sign of sleep apnea.

In-Office Procedures for Sleep Apnea or Snoring

We offer many proven treatments for problematic snoring and sleep apnea that can be done right here in our office. Please meet with Dr. Kay and find out which procedure(s) may be right for you.

  • Soft Palate Coblation is a procedure that can be performed in our office with only a local anesthetic to treat snoring or certain mild cases of sleep apnea. By inserting a needle-like device in the soft palate, Dr. Kay will reduce the overall size and thickness of the soft palate. When healed, the palate will be less prone to vibration, reducing one’s chances of snoring.
  • Medtronic Pillar Procedure is a relatively painless in-office procedure also used to relieve snoring or mild to moderate cases of obstructive sleep apnea. Dr. Kay will place three tiny woven implants into the soft palate while her patient is under local anesthesia. This procedure only takes about 20 minutes to complete. Over time, the implants, together with the body’s natural fibrotic response, will add structural support to stiffen the tissue and reduce the the vibration that leads to snoring.
  • Dental Splints can treat mild to moderate sleep apnea by fitting the patient with a device (similar to an orthodontic retainer) worn in the mouth while sleeping. The stint tightens the soft tissue in the airway to prevent obstruction of the airway during sleep. By tightening the tissue, the dental splint prevents vibrations that causes a person’s snoring.
  • Provent Therapy is a painless and non-invasive treatment for obstructive sleep apnea. The Provent Nasal Device utilizes a valve design that attaches over the nostrils with hypoallergenic adhesive. The valve opens and closes as necessary, redirecting the air through small holes to create resistance when breathing out, while allowing the patient to breathe in freely. This increases and maintains pressure in the airway, helping to keep the airway open until the start of the next inhalation.

Surgery Options for Sleep Apnea or Snoring

If the in-office procedures don’t prove to be effective or for more severe cases of problematic snoring or sleep apnea, there are many surgical options available.

  • Uvulopalatopharyngoplasty, or UVPPP, is a procedure designed to treat sleep apnea and involves the removal of obstructive tissues that may be found in the uvula, soft palate, tonsils, adenoids, or pharynx. This allows the loose tissue that affects breathing to tighten, leading to reduction in the obstruction of the upper throat. There is a bit of discomfort for a short period after the surgery, but our patients generally snap back into their lives quickly.
  • Hyoid Suspension is a procedure performed to treat sleep apnea by securing the hyoid bone in front of the larynx. The hyoid bone is a U-shaped bone in the neck which is an attachment point for tongue muscles. This reduction in movement combined with a more strategic placement of the muscles attached to the hyoid bone will reduce a patient’s airway blockage during sleep.
  • Septoplasty is a procedure used to straighten the nasal septum. The nasal septum is the partition between the two nasal cavities, which should ideally run down the center of the nose. Breathing can become obstructed and difficult when the septum deviates into one of the cavities. Dr. Kay will make an incision inside the patient’s nostril and remove any cartilage or bone found to cause a blockage in the area. This is generally a quick and relatively painless surgery with no swelling or discoloration to the external nose or face.
  • Turbinate Reduction is done to increase the amount of air that can flow through your nose when breathing. The turbinates are responsible for helping us breathe, fighting off bacteria and viruses, and preserving our sensitive olfactory (or smell) receptors. However, large or swollen turbinates may make it hard to breathe. By carefully reducing the size of the turbinates, it may be possible to increase airflow sufficiently enough to resolve any sleeping or breathing disorders.
  • Tonsillectomy is the removal of the tonsils. We generally hear about children or young adults having their tonsils removed due to frequent infection, but it can also greatly benefit breathing in cases where the tonsils are simply too large, or frequently become enlarged due to infection. Enlarged tonsils can greatly contribute to sleeping or breathing disorders.

TONSILS AND ADENOIDS

The tonsils and adenoids are composed of tissue that is similar to the lymph nodes, strategically located near the entrance to the breathing passages to catch incoming infections. Since they "sample" bacteria and viruses as part of the immune system's first response, they can become infected themselves. This is generally what happens when we experience a sore throat.

The tonsils can also harbor "stones" of bacteria or decaying food matter without causing any type of infection or discomfort. While this is not a serious medical issue, it may be responsible for halitosis, or bad breath, and is something we can help treat. Some of our patients who suffer from sleep apnea or frequently snore may benefit from an airway evaluation. It is not uncommon for the tonsils to be the cause of these disorders. Chronic infection of the tonsils or adenoids can also affect nearby structures such as the eustachian tubes, which is the passage between the back of the nose and the inside of the ear. This can lead to frequent or chronic ear infections, or hearing loss.

Bacterial infections of the tonsils, especially "strep throat", are initially treated with antibiotics. Removal of the tonsils and/or adenoids may be recommended for some children or adults who suffer recurring infections despite antibiotic therapy, or who have difficulty breathing or sleeping due to enlarged tonsils or adenoids. In any case, surgery is always a last resort, and Dr. Kay is very experienced in surgery of both pediatric and adult patients.

VERTIGO ENG TESTING

Vertigo is a common vestibular disorder that people of all ages can suffer from, but it is more common in older adults. Dr. Kay can diagnose patients with vertigo and treat them to help them overcome symptoms like imbalance or nausea. 

Electronystagmography (ENG) testing is a procedure that tests disorders in the peripheral nervous system. It is a low-risk procedure that can tell you if your vertigo is coming from your brain or in your inner ear. After the test, Dr. Kay can move forward with prescribing the best way to treat your vertigo.

*Most information taken from John Hopkin's Medicine webpage