Medical and surgical treatment of diseases related to the head and neck:
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Treatments and Diseases:
Allergy Testing and Immunotherapy
Allergy testing has come a long way from the days that the patient received 50 scratches on his or her back. We primarily use the Multitest II allergy skin testing system. This is a quick, safe, and reliable method to perform skin testing with minimal discomfort on both children and adults. As a fellow of the American Academy of Otolaryngic Allergy with the help of a trained allergy staff Dr. Strominger is able to ensure that all Cayuga Ear, Nose, Throat - Head & Neck Surgery patients receive the best and safest immunotherapy. Most patients notice relief of their symptoms within 6 months of starting therapy. We offer both subcutaneous injection immunotherapy and sublingual immunotherapy. The latter can be given in the comfort of your own home. The doctors and trained staff will help you determine what is best for the treatment of your allergies.
Chronic Sinusitus and Sinus Surgery
Sinusitis afflicts approximately 37 million Americans each year. About 250 million dollars was spent on prescription sinus medications in 2005 alone. When sinusitis becomes a chronic problem it has a significant impact on a patients quality of life and productivity. With their skill in treating the infection, the causes of sinusitis including allergies, and performing minimally invasive functional endoscopic sinus surgery (FESS), Drs Cryer, Ruparelia, and Strominger are able to get the patient feeling better.
Head and Neck Cancer
Head and Neck cancer is an aggressive form of cancer of the upper aerodigestive tract including the tongue, throat and larynx which afflicts about 1.6% of the American population. It is synonymous with squamous cell carcinoma. Historically, it was thought to be a cancer that one gets from smoking. But more and more we are seeing the disease in nonsmokers. It is thought that this is because of the Human Papilloma Virus (HPV). This is the same virus that causes cervical cancer. Drs. Cryer, Ruparelia, and Strominger are well trained in the most advanced treatment of head and neck cancer. This often is a multidisciplinary approach that includes surgery, radiation therapy and chemotherapy.
As active participants in the Cayuga Medical Center tumor board we are able to develop care plans and coordinate that care with all three specialties. Cayuga Medical Center has maintained continuous approval status from the American College of Surgeons (ACS) Commission on Cancer since 1985 and has received certification with commendation from the ACS Commission on Cancer as a comprehensive Community Hospital Cancer Program for exceeding baseline standards of cancer care. Cayuga Medical Center also has a premier affiliation with Roswell Park Cancer Institute (RPCI), one of the finest cancer research and treatment centers. Cayuga Medical Center has collaborated with RPCI to have a state-of-the-art radiation therapy facility in Ithaca. With these local resources, when surgery is needed, Drs. Cryer, Ruparelia, and Strominger are able to perform oncologic surgery, including endoscopic laser assisted laryngeal surgery, with the goal of removing the cancer and preserving function. On rare occasions, when a tertiary cancer care center is needed, this affiliation allows for a collaborative approach so that the patient can get treatment conveniently with local postoperative care and long-term follow-up.
Dr. Ruparelia also has a special interest in the treatment of skin cancer of which we are seeing more and more on the face and head. Utilizing plastic surgery techniques he is able to remove the cancer and provide the best cosmetic result possible.
Hearing Loss and Vertigo
A member of the Cayuga Ear, Nose, Throat - Head & Neck Surgery team is a licensed audiologist. With a sound booth and state-of the-art audiometer, otoacoustic emission (OAE) testing and electronystagmography (ENG) we are able to diagnose all types of hearing loss and perform comprehensive evaluations for vertigo. By law physicians in New York State cannot dispense hearing aids. However, by federal law a patient must first have a physician evaluation before purchasing a hearing aid. After your evaluation, if needed you will receive medical clearance for hearing aids and recommendations as to the best hearing aid type for you.
Thyroid and Parathyroid Surgery
Dr. Cryer is a member of the Cayuga Medical Center thyroid nodule clinic . This is a comprehensive multidisciplinary care team specializing in the assessment, diagnosis, and treatment of thyroid nodules. By working as a team of an endocrinologist, cytopathologist, radiologist, and surgeons patients get state of the art care quickly and conveniently. At CMC we also perform minimally invasive parathyroid surgery utilizing intraoperative rapid PTH assay.
Voice and Swallowing
Most people’s careers depend on their voices. This is obvious for singers and those in the theater arts. But it isn’t as intuitive for teachers, attorneys and other professionals. So, although the former group will need medical care for their voices, the latter group comprises a significant number of patients treated in the Ithaca Voice and Swallowing Clinic. This is collaboration between Dr. Strominger and May Pitti M.S CCC-SLP assistant professor in the Ithaca College Sir Alexander Ewing Speech and Hearing Clinic. By combining the expertise of the otolaryngologist and the speech pathologist the patient is able to get the most comprehensive evaluation possible. This may include the use of Kay Pentax videostroboscopy. Also, by working together we are able to develop a treatment plan that combines the knowledge and skill of both the physician and therapist. Often speech therapy is needed. And if surgery is necessary, Dr. Strominger is skilled in the most advanced techniques in microlaryngeal phonosurgery. For spasmodic dysphonia he performs EMG guided vocal cord BOTOX injection.
Aspiration pneumonia
Aspiration pneumonia is the leading cause of death after stroke. It is also one of the most debilitating problems with progressive neurologic disorders such as ALS and Parkinson’s disease. In the past the only way to evaluate a patients swallowing was with an x-ray called a modified barium swallow or video swallow. These are still useful tools, but since the development of functional endoscopic evaluation of swallowing (FEES), for many patients they have become unnecessary . With FEES the physician and the therapist are able to evaluate a patient’s swallowing function in the outpatient clinic, without exposure to radiation and with a more natural position. During the evaluation we can assess the benefit of various therapeutic swallowing strategies/maneuvers. After swallowing therapy the patient can be reevaluated to see how he/she has progressed.
Snoring and Obstructive Sleep Apnea.
Snoring and Obstructive sleep apnea (OSA) are caused by the development of resistance to airflow in the upper airways during sleep. The first thing to happen is that the tissues in the throat start to vibrate causing snoring.
Snoring can be treated in the office with laser assisted uvuloplasty (LAUP), injection snoreplasty, or radiofrequency palatoplasty. As the resistance to airflow increases breathing is disrupted and obstructive sleep apnea develops. The disruption in sleep can lead to being tired during the day but more importantly contribute to the development of high blood pressure, heart attack and heart failure.
A necessary component of the workup of OSA is a thorough examination by ENT to see if the patient has any anatomy that is contribution to the obstruction. This may include a complete fiberoptic evaluation of the upper airways with flexible fiberoptic nasolarygoscopy. Common problems are septal deviation causing nasal obstruction, an elongated uvula or tonsillar enlargement. Surgery directed at correcting this problem might be all the patient needs. If this is not the case, OSA is diagnosed and quantified by obtaining an all night polysomnogram or sleep study. These are usually obtained at the sleep disorders center at CMC. With this information we can determine the severity of sleep apnea and make treatment recommendations. Initially, most patients try CPAP or BiPAP to treat the OSA.
We work closely with most of the Ithaca area home health agencies so the patient can obtain the appropriate CPAP or BiPAP settings. If the patient is unsuccessful with nonsurgical therapy then Drs, Cryer, Ruparelia and Strominger are skilled in advanced sleep apnea surgery including UPPP, lateral expansion pharyngoplasty, Laryngohyoid suspension and tongue base reduction.
Middle Ear and Mastoid
Although not as common as in the preantibiotic era chronic otitis media requiring bilateral myringotomy with tubes (BMT) is still one of the most common problems that Drs. Cryer and Ruparelia and Strominger have to treat. In patients with chronic ear infections, tympanic membrane perforations , mastoiditis and cholesteatoma formation still occurs. Otosclerosis, requiring a stapedectomy, is a common cause of hearing loss. Drs. Cryer and Ruparelia are skilled in tympanoplasty, ossicular reconstruction, mastoidectomy and stapedectomy.