Dr. Block earned her Doctorate of Clinical Audiology, as well as her Bachelor of Arts degree in Hearing and Speech Sciences, at the University of Maryland. She is certified in audiology by the American Board of Audiology and is a member of the American Speech-Language-Hearing Association. Prior to joining CornerStone Ear, Nose & Throat, PA, Dr. Block practiced at Walter Reed National Military Medical Center, gaining experience both clinically and in areas of research.

“Kimberly Block is a welcomed addition to our experienced audiology team,” said practice founder William McClelland, MD, FACS. “Our doctors of audiology have the expertise to accurately diagnose hearing loss and are very well acquainted with the most modern technology including all digital hearing devices, blue tooth capable devices, fully programmable aids, and directional listening devices.”

My personal story began three years ago when we installed a CT scanner in our office and I volunteered to be one of the first test patients. My CT scan revealed some thickening in my left maxillary sinus. At that time I didn’t have any symptoms of concern, so I thought nothing of it. Over the next couple years I began to experience thick postnasal drainage, increasing left facial pressure, some upper dental pain, and periods of associated bronchitis at least twice a year. (Other symptoms that patients have include sore throat, halitosis, chronic cough, and decreased smell sensation.)

A repeat CT scan demonstrated that my maxillary thickening was increasing in severity. I was treated five times with antibiotics, which helped to some degree. I also continued to use nasal steroids, antihistamines, and nasal irrigations. All of these are treatments that I recommend to my own patients prior to considering surgery. Over the past year, my symptoms became more persistent and no longer responded to the antibiotics. I finally decided that I had enough and asked my partner William McClelland, MD, FACS, to perform the sinus surgery.

A Less Invasive Sinus Procedure

Many people are scared of sinus surgery because they have heard horror stories from someone who had surgery in the past and experienced painful nasal packing, black eyes, severe pain, excessive bleeding, and a recovery period of many weeks. Even though I didn’t particularly want to go through surgery, I still knew that the recovery time should be short and would not include the symptoms just mentioned.

While there are still some surgeons who use nasal packing, we do not use this method of treatment at CornerStone Ear, Nose & Throat. On average, our sinus surgery patients lose 50 cc of blood or less during the surgery, therefore packing is not required.

After my own surgery, there were really no surprises. I don’t remember any significant pain in the recovery room. (Then again, I don’t remember much of anything from my time in the recovery room!) For the next two days I had some pressure and mild pain in the left side of my face, fairly similar to what I experienced while having an active sinus infection. There was some bloody drainage when I leaned forward and I felt somewhat congested. However, I was able to breathe through my nose at all times. During the recovery, I took antibiotics, used nasal saline and continued my nasal steroid sprays.

I had surgery on a Thursday and on Sunday, I went to a medical conference for three days. The Wednesday following my surgery, I was back in the office seeing patients. I tell my sinus surgery patients that to be safe, they should plan to take five days off from work. But, there are plenty of patients with jobs that don’t require strenuous physical activity who have returned after only three days.

Seven days after surgery I had my first postoperative debridement of the sinuses. During a debridement, the dried blood and mucus that has formed in the sinus cavity that was operated on is removed with suction and small forceps. Prior to the procedure, a topical anesthetic is applied. I can’t say that there is absolutely no pain associated with a debridement, but it’s not terrible. I recently performed surgery on a 10-year-old who allowed me to do a full debridement in the office. Most children that age would not allow you to continue if they were in any significant pain. Only a handful of patients in my 11 years of private practice have been unable to tolerate this procedure.

For approximately two weeks after surgery, I still experienced pressure in the left side of my face when bending over. Occasionally I had some bloody clots when blowing my nose. All of these symptoms are expected to some degree.

It has now been over a month since my surgery and I am doing great. For many years I have tried to tell people what to expect after sinus surgery, and now I can at least give a recount of what I went through. I also believe that having a greater understanding of what patients experience only enhances the care I provide.

To learn more about sinus surgery, contact CornerStone Ear, Nose & Throat at any of our three area offices.

Earlier this year, researchers at Johns Hopkins Medical University and the National Institute on Aging conducted a study that found a strong link between untreated hearing loss and dementia. Dementia is generally defined as the decrease in brain function that comes naturally with advanced age, and prematurely in patients with conditions such as Alzheimer’s disease. Dementia greatly decreases quality of life, ability to remain independent and participate actively in social situations. This twelve year study concluded that people with hearing loss, especially those in the elderly population, are at higher risk for developing dementia. As the severity of hearing loss increases, so does the risk for developing cognitive dysfunction.

The research has led to the theory that hearing loss causes one to strain cognitively to hear and understand conversation. Over time, this straining can overwhelm the brain, which can somehow cause these people to be more at risk of developing or exhibiting signs of dementia. Years of over-stimulation can result in a greater incidence of social isolation, anxiety, and depression. However, rehabilitation of hearing loss with hearing aids or other means of amplification can, based on this research, theoretically reduce this risk.

Even mild degrees of hearing loss left untreated can result in negative consequences. Having to ask others to repeat themselves can be stressful and embarrassing for the hearing impaired and can be considered an inconvenience and annoyance to the person speaking. To avoid this anxiety and frustration, the person with hearing loss may stop attending family gatherings and social events that they used to enjoy, ultimately leading to suppressed anger, depression and social isolation.

These recent studies support the importance of addressing hearing loss as soon as it is suspected. Utilizing appropriate devices to improve hearing can indirectly slow potential development of dementia by decreasing the negative social implications that can be associated with hearing loss. When a person receives the help they need to hear better, they may feel more comfortable participating in and contributing to family gatherings, social events, and discussion, allowing the individual the ability to once again enjoy these activities.

Taking steps towards improving hearing, can create great strides towards a better quality of life and may decrease the risk of developing dementia in the hearing impaired. The quality and scope of hearing devices available has advanced greatly, with solutions for most all types and ranges of hearing losses and lifestyles.

To take the first step in addressing the negative emotional and physical impact that hearing loss can have on daily life and the potential risk of its resulting dementia, contact a professional audiologist and schedule a hearing consultation. Audiologists and ear, nose and throat physicians are best qualified to assess hearing loss and its possible causes, offering the most suitable options to improve hearing.

After a hectic few weeks of packing, moving, phone upgrades, and reestablishment of network communications, our warm and friendly (always!) staff members and medical assistants are ready to greet our patients and show off our new space. Having always been at the forefront of paperless medical office technology, recent improvements and upgrades in our paperless medical records system and communications system now seamlessly connect all our offices. We have a full time IT Director who is constantly maximizing the benefits we receive for our investments in modern electronic health records. Now that our new office is fully “on-line” with our other two offices, our staff, physicians, and audiologists can easily communicate and share information within a single electronic medical record from different locations. This means that our patients can contact or be seen at any of our three offices and their entire health record will be available to that office staff and physician. And, when you call any of our offices, you can be connected to anyone at any of our offices.

Some things never change about our practice, though. You can expect the same high level of attention we’ve always given to each patient. Our audiologists are also ready with beautiful diagnostic and work spaces. Aimee Kern, assistant to Audiology, loves the open office plan and the new Audiology and Hearing Aid Center as well as the easy to access, ground level entrance. “And, there is quick access to the amenities of The Arboretum Shopping Center and it’s so easy to get to I-485.”

According to Dr. William McClelland, the decision to expand our office at this time and in this location is “simply a reflection of our increased commitment of resources to the greater Charlotte-Mecklenburg area to better accommodate our expanding patient volumes and increased referral base. In addition to our expanded clinical capabilities, we are pleased to offer a full and comprehensive Audiology division that includes adult, pediatric, and infant diagnostic hearing testing, inner ear/balance testing, and full service hearing aid offerings including evaluations, fittings, sales, and repairs.”

Dr. McClelland goes on to point out that “Our mission, since starting the practice in 1994 has always been and remains to provide the highest quality and most technologically advanced ear, nose and throat care to the citizens of Mecklenburg, Union, and surrounding counties in a physician-directed, friendly, comfortable, caring and personal environment.” We encourage our existing patients and referring physicians to stop by for a tour of our new office. For those who would like to begin a relationship with us, we invite you to call us for your appointment or request an appointment via our Appointment Request Form.

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Both Marina and Michelle are CPR certified and looking forward to their careers as Certified Medical Assistants. They are fluent in both the Spanish and English languages and enjoy working with a diverse population of patients.

“I am learning something new every day,” says Michelle, “and being involved in patient care of ear, nose and throat cases is both challenging and rewarding.” Michelle says she also enjoys working in the specialty of otolaryngology because day-to-day variety includes anything from new patient consults, to basic and surgical follow-up care and even in-office surgical procedures. “I like working with all the different patients we see from newborns to older adults and am glad to be able to assist in their care,” she adds.

Marina says she also enjoys the variety of patient issues she encounters daily. Born in Mexico and raised in Brooklyn, NY, Marina came to Charlotte around 2005. “I enjoy helping people, so I always knew I wanted to be involved in the medical field,” explains Marina. She adds that each day is a new learning experience for her and it is important to her to be able to make a contribution to the care of CornerStone patients and the improvement of their health. “I like to see patients happy when they feel better after they are treated by one of our doctors,” she said.

Michelle and Marina assist our physicians at all three CornerStone Ear, Nose & Throat, PA, locations in Union and Mecklenberg Counties. We are pleased to welcome them and are excited about their futures at CornerStone.

When Treatment Fails

So, when U.R. (initials used for patient privacy) had endured these symptoms, along with stopped up ears and throat irritation, 3-4 times a year for several years, his primary care doctor referred him to an otolaryngologist for further evaluation. “This is a typical progression of chronic sinusitis,” said Daron J. Smith, MD, board-certified otolaryngologist and partner at CornerStone Ear, Nose &Throat, PA, who assessed and treated the patient’s persistent condition.

While the patient had been treated with topical nasal steroid sprays, several antihistamines, steroid injections, and numerous antibiotics, he reported that his symptoms—aggravated by weather and temperature changes—were only partially and temporarily alleviated. A nasal exam with endoscopy revealed the cause of the patient’s complaints of nasal congestion, indicating 80% nasal obstruction. On Dr. Smith’s recommendation, the patient left his appointment with prescriptions for an antibiotic and a steroid dose pack to reduce the nasal swelling, an appointment with an allergist and for a CT scan of his sinuses.

Diagnosis Confirmed

Both the allergist and the CT scan confirmed Dr. Smith’s suspected diagnosis of chronic sinusitis, with the CT scan showing severe pansinusitis, involving all of the paranasal sinuses, but mostly affecting the maxillary sinuses. On follow-up, the patient reported that he felt the same as he did prior to treatment, with no improvement in his symptoms.

Based on these findings and that the patient would be a good candidate for a successful outcome, Dr. Smith advised proceeding with sinus surgery, septoplasty and turbinate reduction. He explained the minimally invasive techniques used with these procedures, including the no-sinus-packing approach, and Mr. R agreed to proceed. After undergoing the 90-minute procedure, he went home the same day to begin his recovery, which he describes as “great,” and returned to work in just one week.

Important Post-op Follow-up

“I am breathing so much better already,” the patient reported one week later at his first post-operative appointment, one of an estimated three visits following surgery during which the sinuses are cleaned and debris is removed from the surgical area. “These post-operative debridements,” explains Dr. Smith, “are critical to proper healing and lead to much less likely recurrence of sinus disease following surgery.”

At his final post-op visit just one month after surgery, Mr. R presented with an excellent post-operative result with his sinus cavities appearing open, clear and healthy. As adjunct treatment and to maintain these successful surgical results, Dr. Smith recommended that the patient continue the use of nasal steroid spray and an over the counter antihistamine regularly, with instruction for adjustment as his allergic symptoms fluctuate. He will also follow-up regularly one to two times each year.

Seek Specialist Care when Symptoms Persist

Other symptoms of chronic sinusitis can include, pain, tenderness and swelling around the eyes, cheeks, nose or forehead, a reduced sense of smell and taste, ear pain, upper jaw and tooth pain, cough, fatigue and others. A patient could also have several bouts of acute sinusitis that can develop into chronic sinusitis. Patients should seek medical care for these symptoms and be referred to a specialist in otolaryngology when the symptoms persist and become chronic. Any of the four board-certified otolaryngologists at CornerStone Ear, Nose & Throat, PA, welcome and treat patients of all ages with conditions affecting the ears, nose, throat, head and neck.

Six months after his surgery, Mr. R says, “I still feel great!” He adds that he’s thankful for Dr. Smith’s care and is very pleased with the results of his sinus surgery, emphasizing that he tells his co-workers with sinus problems to call CornerStone Ear, Nose & Throat.

The External Ear: Form and Function

The external ear is designed to help focus sound waves as they enter the ear canal to maximize vibration of the eardrum, and thereby facilitate better hearing. As such, it is a relatively delicate structure, ill-suited to sustain significant trauma. The presence of a normal external ear is not required for hearing, but does help maximize hearing (and is also useful for supporting eyeglasses and some forms of jewelry). The external ear is made up of three basic layers of soft tissue: a core skeleton of cartilage, the perichondrium and the outer layer of skin. The skeleton of cartilage has the consistency of a thin but resilient sheet of rubber that gives the ear its characteristic shape. The cartilage has no blood supply within it, and therefore cannot aid in healing wounds. Overlying the cartilage is a layer of tissue called the perichondrium. This layer carries blood to the cartilage to provide oxygen and nutrients, which keeps the cartilage soft and pliable. The outer layer of skin is like a wrap around the cartilage and perichondrium.

Types of External Ear Injuries

Acute soft tissue injuries to the external ear include contusions, lacerations and hematomas. Contusions are basically bruises. These form as a result of blunt force directed against the soft tissue of the external ear. Small blood vessels burst under the suddenly increased pressure, creating a bruise affect with purple discoloration and soft tissue swelling. If no other injury occurs, contusions will generally heal well, with no intervention except ice, rest and over-the-counter pain relievers. It may take a visit to an otolaryngologist (ENT doctor) to distinguish a very swollen, contused ear from an auricular hematoma. These injuries require very different treatment, and if there is any doubt, an ear nose and throat doctor should be consulted (see below) within a few days of the injury.

Lacerations

Lacerations are easily identified by the bleeding. A laceration (open cut) can be very minor or involve near complete avulsion of the external ear with extensive cartilage tearing and damage. Immediately after sustaining a laceration, medical attention should be sought. Pressure should be applied to help control bleeding. As bleeding slows, if the edges of the laceration can easily be pulled apart, or they gape open, especially if cartilage can be seen (yellow in appearance), then the wound should be treated as soon as possible in an emergency room setting. If a specialist is required to repair a complex laceration of the external ear, the emergency room physician will arrange for it. Much more often, these wounds may be closed by the urgent care or emergency room physician with a skin adhesive or a few fine sutures. Local anesthesia and careful cleaning of the wound before closure is important.

Auricular Hematoma and Cauliflower Ear

Auricular Hematoma

Auricular hematoma is a potentially more serious injury, in many ways, than even a complex laceration of the external ear. A hematoma simply refers to a collection of pooled blood under the skin. Elsewhere in the body, hematomas generally are resorbed by the body over several weeks, and the biggest concern is to avoid infection. In the case of the external ear, however, this type of injury can lead to permanent disfigurement. Auricular hematomas occur, generally but not exclusively, after a shearing force type injury; that is to say an injury where the ear is rubbed tangentially, rather than struck perpendicularly. If you imagine two wrestlers rubbing their opposing ears together during a match or drilling, or a snugly fitting football helmet being torn off during a tackle, you can see there is ample opportunity for such an injury in these sports.

Cauliflower Ear

The unique thing about an auricular hematoma is that during this injury, the perichondrium is peeled off of the cartilage allowing blood and serous bodily fluids (like the fluid in a blister) to collect between these two layers. Because the cartilage has no blood supply or ability to heal, it is effectively inert and does not participate in healing. Even if the blood is drained from between the perichondrium and the cartilage, fluid eventually refills that space lifting the perichondrium off of the cartilage again because there is no healing tissue under the perichondrium. It is much like trying to stick half of a piece of Velcro to a table. In a similar wound elsewhere in the body, the two layers would heal to each other preventing the fluid from re-accumulating. This does not happen in the case of an auricular hematoma because the cartilage lacks blood supply and the ability to heal. This fluid can be aspirated with a needle or drained through an incision, but if the incision is not kept open somehow, the hematoma will re-accumulate with serous fluid (seroma). Well-intentioned trainers and athletes will often apply pressure to the swelling which represents the collection of blood, which only causes this blood or serous fluid to spread outward between the layers of cartilage and perichondrium, making the problem, or potential space filled with fluid, worse. Over several months and even years, this blood or serous fluid is replaced by soap-like calcium deposits which greatly thicken the delicate external ear structure, and draw the edges of the external ear inward. After multiple such injuries, the external ear will begin to look like a cauliflower; thus the term “cauliflower ear.”

Preventing External Ear Sports Injuries

Prevention of such injuries begins with wearing proper protective gear, and knowledge of how these injuries occur. All wrestlers should be instructed to wear their headgear anytime they are involved with drilling or live wrestling. Other contact sport athletes generally wear head protection which is very effective. Despite all best efforts, occasionally, as with a particularly violent tackle or a basketball player’s flying elbows, injuries will occur. At that point, if a rounded soft swelling is noted on the external ear, avoid firm pressure. Ice may be gently applied. If the soft swelling does not rapidly improve within 48-72 hours, or if it is clear there is fluid built up under the skin, an ear nose and throat specialist should be consulted to make the correct diagnosis and recommend proper treatment. This may include needle aspiration, prescription of antibiotics, as well as surgical correction.

External Ear Injury Treatment Options

Fortunately, new surgical techniques are now available which allow acute hematoma and seroma injuries to be treated in such a way that they will not progress to form permanent disfiguring cauliflower ear. This involves an incision and drainage of the fluid by a surgeon who then uses a dissolvable suture to tack the skin down to the underlying cartilage. While not perfect, this greatly improves the cosmetic result of such an injury and prevents the permanent disfigurement of cauliflower ear. Even old injuries that have already developed into cauliflower ear can in some cases be re-contoured and reshaped to improve their appearance.

Swallowing difficulties can occur at any age, but are most common among the elderly population due to the aging process and a natural weakening of the muscles of the esophagus which must propel the food toward the stomach. One cause of dysphagia in older patients is a Zenker’s diverticulum.

A Zenker’s diverticulum is a pouch that forms at the end of the throat and the beginning of the esophagus (the swallowing tube). Over a lifetime of swallowing, when there is excessive pressure within the lower portion of the pharynx (the back wall of the throat), the weakest portion of the pharyngeal wall balloons out. Over time, a diverticulum forms which can gradually increase in size and become several centimeters in diameter. Thus, this is a condition almost always seen in the elderly (patients over 60).

The most common symptoms of a Zenker’s diverticulum are difficulty swallowing food, choking, collection of mucus in the throat, hoarseness and/or bad breath, all of which can be distressing. When the Zenker’s diverticulum is small, most patients usually experience no symptoms, but as it increases in size, over time, the symptoms listed above begin to develop. Food may be regurgitated back into the throat or mouth in a relatively undigested form, several minutes to hours after eating.

The diagnosis of a Zenker’s diverticulum is made using a simple radiographic test called a barium swallow. Contrast material called barium is swallowed and the diverticulum is able to be visualized using real-time x-ray called fluoroscopy.

Surgical intervention is the only treatment available that will effectively cure patients with a Zenker’s diverticulum, permanently relieving symptoms and improving the quality of life. There are no medications available that will treat the condition and if left untreated, patients with a Zenker’s diverticulum will continue to have difficulty swallowing, with possible associated risks of weight loss, malnutrition, and pneumonia caused by food entering the lungs from the pouch. Although uncommon, these can be life-threatening.

The physicians at CornerStone Ear, Nose & Throat are experts at diagnosing and treating swallowing problems. At Cornerstone Dr. Lukacs is able to perform an endoscopic excision of a Zenker’s diverticulum which is an approach done through the mouth to correct the Zenker’s diverticulum. This newer technique is less invasive than the traditional approach of removing a Zenker’s diverticulum through an incision in the neck. This allows for a quicker recovery and return to a normal diet in a shorter period of time. Although technically difficult, this procedure is a safer approach for the patient when it can be performed successfully.

Patients experiencing prolonged difficult or painful swallowing should consult one of the board-certified otolaryngologists at CornerStone Ear, Nose and Throat, PA. While these symptoms could indicate a Zenker’s diverticulum, there are a variety of other conditions that could be the cause. The physicians at CornerStone Ear, Nose & Throat, PA, will gladly help you understand and resolve your swallowing difficulties.

There are certain qualifications that a patient must meet in order to be a good candidate for a cochlear implant. For this type of amplification device, a patient’s age and the severity of their hearing loss are two significant determining factors. Patients ages 18 and over can qualify for a cochlear implant if they have bilateral moderate to profound sensorineural hearing loss. Patients between the ages of 25 months to 17 years 11 months of age can qualify if they have a bilateral severe to profound sensorineural hearing loss. Patients between 12 to 24 months can qualify if they have bilateral profound sensorineural hearing loss. Qualifications for obtaining cochlear implants also include scores for certain types of speech testing (varies by age), absence of any medical contraindications, high motivation, and appropriate expectations from both patient and family. A general rule of thumb is that as long as a hearing aid is benefitting te patient and improving their hearing, they are probably not yet a cochlear implant candidate.

The first step in determining if a cochlear implant is an option for you, is a visit to an audiologist. The doctors of audiology at Cornerstone Ear, Nose, and Throat can perform a comprehensive audiological examination and discuss with you the best options for your specific hearing needs. At CornerStone Ear, Nose, and Throat we do not perform cochlear implants surgeries but we can direct you to the appropriate facilities in the event that you or your child is an implant candidate.