Thyroid and Parathyroid

Puget Sound ENT customizes thyroid treatments for every individual.

Our surgeons provide comprehensive evaluation and treatment of patients suffering from thyroid and parathyroid disease. We use the latest imaging technologies including CT parathyroid scans and ultrasound for quick assessment of thyroid and parathyroid conditions to determine the need for surgical intervention. We work closely with a multidisciplinary team consisting of oncologists, endocrinologist, and radiologists to ensure the best possible treatments and outcome. If surgery is recommended, we utilize state of the art techniques for the removal of the thyroid or parathyroid glands. In most cases, these are done in the outpatient setting, without the need for hospitalization.

Thyroid

The thyroid is a butterfly-shaped gland in the middle of the neck, located below the larynx (voice box). It produces hormones, T3 and T4, which regulate multiple functions of the body including hair, nails, weight, energy, temperature and cognition. There are a number of conditions that can affect the thyroid gland. Overproduction of thyroid hormone results in a condition called Hyperthyroidism. Conversely, low thyroid hormone production leads to Hypothyroidism. Dysregulation of thyroid hormone production is managed by an endocrinologist.

Thyroid glands can also develop lumps or nodules. The term thyroid nodule refers to any abnormal growth of thyroid cells in a lump within the thyroid. Thyroid nodules are very common. Up to half of all people have at least one thyroid nodule, although most do not know about it. We do not know what causes most noncancerous thyroid nodules to form. 9 out of 10 nodules are benign (noncancerous) Most thyroid nodules do not cause any symptoms. Your doctor usually discovers them during a routine physical examination or you might notice a lump in your neck while looking in a mirror. If the nodule is large, it may cause difficulty swallowing, “tickle in the throat” or shortness of breath if it is pressing on the windpipe. Rarely, hoarseness of voice can be caused if the nodule affects the nerves to the voice box.

Since most patients with thyroid nodules do not have symptoms, most nodules are discovered during a routine physical exam or incidentally with imaging (CT scan, Ultrasound) for other concerns. Once the nodule has been discovered, you doctor will try to determine whether the lump is benign (non-cancerous) or represents a low grade thyroid malignancy. Specialized tests such as thyroid ultrasound and/or thyroid scan can help determine if a biopsy is needed. Most thyroid nodules do not require treatment and can safely be monitored by your doctor. If the enlarged thyroid gland is causing symptoms or thyroid cancer is detected, then surgical removal of part, or all, of the thyroid is usually recommended.

Parathyroid

The parathyroid glands are four small glands in the neck that are part of the endocrine system. They produce parathyroid hormone (PTH), which maintains calcium and phosphorus levels in the blood. The primary disease associated with the parathyroid glands is an overproduction of PTH, known as Hyperparathyroidism. This is usually caused by benign enlargement (adenoma) of one or more of the parathyroid glands. Hyperparathyroidism causes bone calcium loss and higher than normal calcium in the blood and urine. Many people have no symptoms, and the condition is discovered with a routine blood test. Others have symptoms such as bone pain, osteoporosis, decreased memory, depression, fatigue, abdominal pain or kidney stones. In general, the symptoms resolve with time after surgery. This condition can run in some families, though more commonly it occurs without any family history. For most patients, the treatment involves surgical removal of the overactive parathyroid gland or glands (if there is more than one overactive gland).

Surgery is performed through a small incision in the front of the neck and the enlarged gland is removed. In most cases patients go home the same day as surgery. Recovery from parathyroid surgery is usually quick with minimal pain requiring pain medication for only a day or two and most people return to work in a week or less. Occasionally, extra calcium might need to be taken after surgery to replenish bone calcium and prevent low blood calcium levels.

Puget Sound ENT can assist in a myriad of ways:

• All Puget Sound ENT physicians are board-certified, and our surgeons are trained in thyroid and parathyroid disease diagnosis and treatment, providing leading-edge treatment plans and minimally invasive procedures.
• Puget Sound ENT provides comprehensive thyroid nodule evaluation and treatment. Our surgeons are trained in thyroid ultrasound and can perform in-office fine needle aspirations and biopsy of suspicious thyroid nodules.
• Most surgical procedures are minimally invasive and can be performed in the outpatient setting, no need for hospitalization or long recuperation times. Our goal is to return patients to their normal daily lives as soon as possible.
• The care team and Puget Sound ENT respect our patients’ time, taking a personal interest in their well-being. We strive for accessibility, working hard to set up appointment and procedures quickly and efficiently.

Thyroid and Parathyroid FAQs

Thyroid

What is a thyroid nodule?

The term thyroid nodule refers to any abnormal growth of thyroid cells in a lump within the thyroid and they are very common. Up to half of all people have at least one thyroid nodule, although most have no symptoms.

What causes a thyroid nodule?

We do not know what causes most noncancerous thyroid nodules to form. 9 out of 10 nodules are benign (noncancerous). If the nodule is filled with fluid, it is called a thyroid cyst. Some patients’ thyroid may have a bumpy appearance that may be due to inflammation in the thyroid (Hashimoto’s thyroiditis).

What are the symptoms of a thyroid nodule?

Most thyroid nodules do not cause any symptoms. Your doctor usually discovers them during a routine physical examination or incidentally with imaging (CT, MRI, US) for other conditions. Or you might notice a lump in your neck while looking in a mirror. If the nodule is made up of thyroid cells that produce more thyroid hormone than your body needs, a patient may complain of hyperthyroid symptoms (see hyperthyroidism sheet). A few patients with thyroid nodules may complain of pain in the neck, jaw or ear. If the nodule is large, it may cause difficulty swallowing, “tickle in the throat” or shortness of breath if it is pressing on the windpipe. Rarely, hoarseness can be caused if the nodule affects the nerves to the voice box.

How is a thyroid nodule diagnosed?

Since most patients with thyroid nodules do not have symptoms, most nodules are discovered during a routine physical exam. Once the nodule has been discovered, you doctor will try to determine whether the lump is the only problem or if you have an issue with hormone production of your thyroid gland which is known as hypothyroidism or hyperthyroidism. The initial tests may include a blood draw to test thyroid hormones. Specialized tests such as thyroid ultrasound and/or thyroid scan can help determine if a biopsy is needed.

How are thyroid nodules treated?

Most thyroid nodules do not require treatment & can safely be monitored by your doctor. Sometimes surgical removal of part, or all, of the thyroid is recommended.

What are the symptoms of thyroid cancer?

In the early stages, most thyroid cancers have little or no associated symptoms. Many are found incidentally during imaging for other conditions. Further growth may produce a lump or nodule in the lower neck associated with the thyroid gland. Patients can sometimes experience rapid growth, pain, and swelling, difficulties with swallowing or hoarseness of voice. Thyroid cancer sometimes presents as enlarged lymph nodes in the neck.

Who is at risk for developing thyroid cancer?

There are 4 main types of thyroid cancer, with papillary and follicular thyroid cancer being the most common. People under the age of 50 are more likely to develop papillary thyroid cancer, with those aged 30 to 50 at the highest risk. However, adults over the age of 50 tend to have more aggressive disease. Additional risk factors include; a family history of thyroid cancer, a personal or family history of goiters, external beam radiation for cancer treatment, exposure to high levels of radiation caused by nuclear accidents or weapons testing, and a family history of certain genetic syndromes such as Cowden Syndrome. Papillary thyroid cancer is also more common in women than in men. So being a woman is considered a risk factor.

If I notice any of the symptoms, what should I do?

Begin by contacting Puget Sound ENT and scheduling your first appointment. Our in-house ENT specialists evaluate each patient and perform in-depth testing including in-office ultrasound and fine needle aspiration and biopsy of suspicious thyroid lesions for rapid diagnosis. Once a diagnosis is determined treatment options are discussed and coordinated with our multi-disciplinary team including endocrinology and oncology.

Parathyroid

What is hyperparathyroidism?

Hyperparathyroidism is overactivity of one or more of the parathyroid glands. This overactivity causes bone calcium loss and higher than normal calcium in the blood and urine.

What are the symptoms of hyperparathyroidism?

Many people have no symptoms and the condition is discovered with a routine blood test. Other patients have symptoms such as bone pain, osteoporosis, decreased memory, depression, fatigue, abdominal pain or kidney stones. In general, the symptoms resolve with time after surgery.

What is the treatment for hyperparathyroidism?

For most patients, the treatment involves surgical removal of the overactive parathyroid gland or glands (if there is more than one overactive gland).

What is the usual recovery from surgery?

In most cases, patients go home the same day as surgery. Recovery from parathyroid surgery is usually quick with minimal pain requiring pain medication for only a day or two and most people return to work in a week or less. Occasionally, extra calcium might need to be taken after surgery to replenish bone calcium and prevent low blood calcium levels.

Is hyperparathyroidism ever due to cancer?

Rarely is this condition due to a parathyroid gland cancer. In the vast majority of patients, there is no malignancy. In addition, the gland is always sent for testing to rule out cancer after the surgery.

Can hyperparathyroidism recur?

It’s possible but rare. In less than 5% of patients, the condition will either not respond to surgery or recur later. The majority of patients are cured permanently by surgery.

Our Surgeons Can Assist

Michael J. Wolfe, MD
Tyler G. Kimbrough, MD
John T. Parker, MD

Bone Anchored Devices

Osseointegrated Devices

Osseointegrated devices provide hearing gain in ears altered by surgery, infection, trauma, or tumors. People with a large conductive hearing loss or those with no hearing in one ear and normal hearing in the other qualify for a Baha or a Ponto device. The technology includes an implanted post or fixture placed behind the ear in surgery. Bone then integrates into the fixture over the next 4-6 weeks. An audiologist then connects the hearing device (Processor) to the abutment, which is attached to the integrated fixture.

Baha Implants

There are two types of Baha® Systems made by Cochlear. Both feature the Baha Implant, the strong foundation of every system, which is designed to provide you a lifetime of better hearing.

Baha Connect

The Baha Connect System uses a small abutment that offers a direct connection between the implant and the sound processor, designed to provide optimal hearing. The Baha Connect System is easy to use and requires little daily care; you simply snap the Baha 5 Sound Processor onto the abutment. Also, the abutment conveniently comes in different lengths to fit your needs.

Unlike conventional systems, the Baha Connect System abutment features state of the art Dermalock technology with a unique surface coating and concave shape that preserves the hair and skin around the abutment. These abutments were designed specifically for better cosmetic outcomes and reduced surgery time.

Magnetic resonance imaging (MRI) can be an important diagnostic tool. You can rest assured that you can get an MRI with the Baha Connect System. Approved for a high level of MRI compatibility—up to 3.0 Tesla, all you need to do is remove the Baha 5 Sound Processor prior to the procedure. The abutment and implant can remain in place.

Baha Attract

The Baha Attract System sets a new standard for hearing performance, comfort and simplicity in bone conduction implant solutions. By using internal and external magnets that attract to one another, it is comfortable and both easy to use and care for.

The Baha Attract System magnets are available in different strengths to suit your individual needs. Skin and hair thickness can impact the optimal magnet strength. Your surgeon will recommend the most appropriate choice.

For added comfort and performance, we provide the Baha SoftWear™ Pad that adapts comfortably to the shape of the head and distributes pressure evenly across the surface.

Magnetic resonance imaging (MRI) can be an important diagnostic tool. The Baha Attract System is approved for MRIs up to 1.5 Tesla. If you require an MRI scan higher than 1.5T, a simple procedure to remove the magnet may be necessary.

Our Surgeons Can Assist

Daniel J. Lee, MD

Audiology and Hearing Services

Hearing Devices

At Puget Sound ENT, we focus on connecting people of all ages to the hearing world by evaluating, diagnosing and treating hearing loss. We get to know you in order to offer personalized solutions to improve your ability to communicate with friends, family, at work and when you are doing other things you like to do. We start our process with an accurate hearing test. When reviewing the results with you we determine your listening needs and introduce you to a comprehensive variety of technologies. Together we prescribe the level of technology that is best suited to your listening environments. We offer traditional hearing aids, CROS and BiCROS (contralateral routing of signal) hearing aids, osseointegrated devices (Baha and Ponto), and cochlear implants. We use many of these options for people with hearing loss or deafness in one or both ears. Our team consists of our licensed audiologists, board-certified physicians, office staff, you and any family, friends or caregivers you feel would help to make your journey to hear successful. We also work to connect patients to hearing and therapy services in our state.

In addition to assisting you with the new device selection, counseling, fitting and adjustment, we may recommend accessories such as remote microphones and Bluetooth connection to your phone or TV, to further enhance your listening. We also reprogram current hearing devices, fit here or elsewhere provided we have the computer software to do so. We offer hearing aid repairs, cleaning supplies and batteries.

Puget Sound ENT can assist in a myriad of ways:

• Our staff audiologists are licensed in the state of Washington to perform diagnostic hearing tests and dispense hearing devices.
• We offer a variety of hearing device options, including hearing aids, CROS aids, cochlear implants and osseointegrated hearing devices (Baha and Ponto options).
• We fit the latest hearing aid technology, including aids with Bluetooth connectivity and those that are rechargeable.
• Our audiologists employ tinnitus therapy to provide relief to patients suffering from tinnitus.

Audiology and Hearing FAQs

Which type of hearing aid works best?

Hearing aids come in many sizes and styles based on performance capabilities. Many things factor into selecting the right hearing aid including individual hearing loss, listening environments, options required, cosmetic considerations, manual functionality, and budget. The experts at Puget Sound ENT will help guide you through the process from the start.

How do I care for my hearing aid?

Clean your hearing aid per the manufacturer’s recommendations, avoid hair products, be sure to avoid moisture and excessive heat, power off hearing aids during down time, replace dead batteries quickly, and plan to schedule a follow up visit with Puget Sound ENT for a check-up.

Are there different types of hearing loss?

Hearing loss can most often be categorized into three categories: conductive (caused by a condition or disease that impedes the movement of sound waves), sensorineural (damage to the neurons in the inner ear), or central (originates from the central nervous system or the brain). The treatment options vary based on the type of hearing loss that’s occurred.

Our Audiologists Can Assist

Leah Alvis, AU.D, CCC-A
Mary Chollman, Au.D.
Erin E. Lazar, Au.D.

Cochlear Implants

About

Cochlear implants are designed to mimic the function of a healthy inner ear or cochlea. They replace the function of damaged sensory hair cells inside the cochlea to help provide clearer sound than what hearing aids can provide. Unfortunately, damaged or missing sensory hair cells do not regenerate, so this type of hearing loss doesn’t improve without treatment.

There are two primary components of the Cochlear™ Nucleus® System: the external sound processor and the implant that is surgically placed underneath the skin attached to the electrode array that is inserted in the cochlea.

We offer a choice of sound processor wearing options.

Our Surgeons Can Assist

Daniel J. Lee, MD

Head and Neck (Cancer)

Puget Sound ENT coordinates oncology consultations for every individual.

Both benign (non-cancerous) and malignant (cancerous) tumors in the head and neck area require special handling to preserve the proper functioning of sensory organs, as well as reducing the cosmetic impact of surgery. Treatment of head and neck tumors is complicated, requiring a team of doctors to be involved with expertise in this area. Our specialists are experienced in head and neck surgery for the removal of tumors in the vicinity of the face, eyes, ears, mouth, nose, throat, salivary glands, skull base, and neck.

Non-cancerous growths in the head and neck

In most instances, a benign (non-cancerous) diagnosis can be determined prior to surgery. Surgical removal can be performed with a simple outpatient procedure. Common benign growth removed from the head and neck are listed below:

• Benign lesions of the lips and oral cavity (mouth); papillomas, fibromas, hemangiomas
• Salivary gland tumors; pleomorphic adenoma, cysts, Warthins tumors
• Chronically infected or obstructed submandibular glands
• Benignly enlarged lymph nodes
• Thyroid enlargement (goiter), Parathyroid adenomas
• Developmental cysts (thyroglossal duct, branchial cleft, otogenic (ear), bronchogenic)
• Tumors of vascular origin (hemangiomas, paragangliomas, lymphovascular malformations)
• Tumors of neural origin (neuromas, schwannomas)
• Dermal and Epidermal cysts of the head and neck

Cancer of the head and neck

Treatment of head and neck cancer requires the involvement of a multidisciplinary team of specialists to coordinate diagnosis and treatment recommendations. Your ENT surgeon is an integral member of this team. Diagnosis usually involves a biopsy, either in the office or with a diagnostic surgical procedure. Once cancer has been confirmed additional workup usually involves further imaging; (CT scan, PET scan, MRI) and consultation with other members of the multidisciplinary team (radiology, oncology, radiation oncology, speech and swallowing therapists) Treatment recommendations (surgery or radiation therapy alone, surgery followed by radiation therapy, or combined chemotherapy with radiation therapy without surgery) will depend on the type of tumor you have, the stage of presentation and will take into consideration your overall health status. Our goal is to maximize your potential for a cure while minimizing your treatment side effects.

Common sites of head and neck cancer include:

• Cancer of the mucosal lining of the mouth and gums including tongue, cheeks, gingiva, lips
• Cancer of the tongue base and tonsils
• Cancer of the hypopharynx and larynx (voice box)
• Cancer of the nasopharynx (behind the nose)
• Salivary Gland cancer including the parotid gland, submandibular gland and minor salivary glands
• Malignant skin cancer including melanoma
• Cancer arising in the lymph nodes (Lymphoma or cancer spread from other sites)

Puget Sound ENT can assist in a myriad of ways:

• We understand the functional and cosmetic challenges involved in the removal of tumors from the head and neck region.
• All Puget Sound ENT physicians are board-certified, and trained in head and neck surgery, providing leading-edge treatment plans which minimize patient recovery and maximize functional outcomes.
• Cancer of the head and neck is managed with a multidisciplinary team involving specialists in oncology, radiation oncology, radiology, nutritionists and speech pathology. Our goal is to return patients to their normal daily lives as soon as possible.
• The care team and Puget Sound ENT respect our patients’ time, taking a personal interest in their well-being. We strive for accessibility, working hard to set up appointments and procedures quickly and efficiently.

Head and Neck FAQs

What are the symptoms of head and neck cancer?

If you encounter a lump in your neck lasting more than 2 weeks, it should be assessed by a physician as soon as possible. While most lumps are benign (non-cancerous) they can be the first sign of cancer originating from the mouth, throat, larynx (voice box), thyroid and salivary glands. Or they may represent a more systemic cancerous process such as lymphoma. Other common presenting symptoms include changes in voice, pain with swallowing or difficulties with swallowing, ear pain, persistent sore throat and a painful or visible growth in your mouth or throat.

What are the risk factors for the development of head and neck cancer?

There are many known risk factors for the development of head and neck cancer including the use of tobacco (cigarettes, cigars, chewing tobacco, or snuff) and alcohol consumption. Cancer arising from the mouth has been associated with chronic dental disease, infections and inflammation. HPV virus has recently become the leading cause of tonsil and tongue base cancer. Skin cancer of the lips, face and ears is caused by sun exposure. An important cause of nasopharyngeal cancer (behind the nose) is the Epstein Bar Virus (EBV) most often associated with people of Southeast Asian ancestry.

If I notice any of the symptoms, or have concerns, what should I do?

Begin by contacting Puget Sound ENT and scheduling your first appointment. Our in-house ENT specialists provide comprehensive evaluations and perform in-depth testing to quickly lead to diagnosis and development of a treatment plan. If you have any symptoms or concerns about head and neck cancer, contact us right away.

How is head and neck cancer treated?

Treatment of Head and Neck Cancer requires the involvement of a multidisciplinary team of specialists including Otolaryngology-Head and Neck Surgeons, Oncology, and Radiation Oncologists. Treatment is tailored to the specifics of a patient tumor location, tumor stage and the patient’s overall health status at the time of initial presentation. Treatment may consist of surgery or radiation therapy alone, a combination of surgery followed by radiation therapy or chemotherapy combined with radiation therapy without surgery.

Our Surgeons Can Assist

Michael J. Wolfe, MD
Tyler G. Kimbrough, MD
John T. Parker, MD
Lisa M. Mulligan, MD

Mouth, Voice and Swallowing

We are uniquely suited to address your voice and swallowing disorder needs.

Puget Sound ENT offers patients expert examination and management of voice and swallowing disorders. Our highly skilled physicians take great care in providing the best treatment for patients with voice disorders such as laryngitis, chronic cough, benign vocal fold lesions, laryngeal tumors and dysplasia, laryngopharyngeal reflux, vocal fold atrophy and more.

Our physicians also evaluate and treat a multitude of swallowing disorders, including fiberoptic endoscopic evaluation of swallowing and more.

Our experienced surgeons are trained to improve the quality and function of your voice and swallowing and believe that when you choose Puget Sound ENT, you’re going to receive the very best skill and care available in the Pacific Northwest.

Whether you’re seeking care due to a neurological disorder (such as a stroke or Parkinson’s disease), head and neck cancer, pulmonary disease, growths, overuse or post-surgical effects, we promise to keep your unique medical requirements top of mind, and work alongside you, our patient, to ensure you receive exemplary surgical precision and care.

Puget Sound ENT can assist in a myriad of ways:

• Expect highly skilled physicians and proven results specific to each patient’s needs.
• We understand the importance of restoring and improving the ability to talk, eat and breathe.
• Our surgeons are board-certified both in otolaryngology/head and neck surgery making us uniquely suited to address a wide range of concerns.
• With two accessible locations in Edmonds and Mill Creek, we schedule patient appointments as soon as possible, maintain open communication lines, provide 24-hour support to established and post-surgical patients.

Mouth, Voice and Swallowing FAQs

What are some of the symptoms of a voice and swallowing disorder?

Disorders concerning your voice or swallowing can have a serious impact on your daily life. Common symptoms for voice disorders may include hoarseness, strain, pitch breaks, throat pain, recurring voice loss, inability to speak at a louder volume, frequent cough or running out of air when speaking. Common symptoms for swallowing disorders may include gagging, coughing, choking, painful swallowing, weight loss or lung infections such as bronchitis and pneumonia.

What is the recovery time like for voice and swallowing treatment?

Every patient is unique and will experience a different recovery timeline based on factors like the treatment or therapy plan, or factors such as genetics, diet, lifestyle, and pre-existing health conditions. At Puget Sound ENT, we will outline a recovery plan unique to your surgical and health needs. Be sure to follow all treatment and postoperative instructions and come in for follow-up appointments so we can ensure you’re healing and progressing as expected.

What happens during a consultation to discuss voice and swallowing disorders?

One of our experienced physicians will personally meet with you during the consultation. He or she will examine and evaluate you, then explain the treatment options from beginning to end. This explanation will include what type of therapy will be best suited for your needs or if surgery is required, our physicians will provide an explanation of the surgical technique he or she will use, where the surgery will be performed, what type of anesthesia will be administered, and a step-by-step explanation of what the recovery will be like. You will be contacted by the surgical coordinator who will explain the scheduling details and cost.

Our Surgeons Can Assist

Michael J. Wolfe, MD
Tyler G. Kimbrough, MD
John T. Parker, MD

Pediatric ENT

Specialized ear, nose and throat care for your child

For over 40 years, our ENT specialty group has been serving the needs of South Snohomish, North King County, and the greater Puget Sound region – and many of our patients are children. We understand and pay attention to the special care required to evaluate and treat younger patients. It’s no easy task to entrust the care and health of your child to someone else, and we don’t take that choice lightly. Know that when you choose to work with the care team at Puget Sound ENT, you are working with experienced specialists who go above and beyond to make sure your child is receiving the best and safest ear, nose and throat treatment available.

Our pediatric otolaryngology team is led by specialists and surgeons with many years of experience, working together with your family to achieve optimum results for your child.

We specialize in the following childhood ENT diseases:

• Tonsil and Adenoid Removal
• Coblation Tonsillectomy
• Ear Tube Placement
• Removal of Neck Masses
• Tongue Tie Release

As a multi-disciplinary group dedicated to the care of children, our doctors, nurses and support staff understand the special needs of children and do their best to minimize pain, discomfort and anxiety. Offering a full spectrum of therapies and procedures, rest assured, there’s reason Puget Sound ENT is the premiere ENT group in the Puget Sound region, and we consider it a privilege to work with your family and your child.

Puget Sound ENT can assist in a myriad of ways:

• Our care-centric audiologists can perform in-depth testing to determine if children could benefit from a cochlear implant or hearing aid, providing support before and after.
• From the first visit to pre/post-surgery, our medical staff always walks the entire family through the process, step-by-step, alleviating concerns and answering all questions along the way.
• Expect compassionate care for infants, children and adolescents with ear, nose, and throat disorders including deviated septums, ear infections, rhinitis, sinusitis, tonsillitis, and more.
• With two accessible locations in Edmonds and Mill Creek, we schedule patient appointments as soon as possible, maintain open communication lines, and provide 24-hour support to established and post-surgical patients.

Pediatric ENT FAQs

Why should I choose Puget Sound ENT for my child?

Our pediatric team is the region’s leader for the treatment of all types of children’s sinus, throat and ear conditions. Our board-certified otolaryngologists use the latest in technology and medical advancements to provide exceptional care for children of all ages, from infants to young adults.

What pediatric ENT conditions do you treat?

We offer comprehensive diagnosis, treatment and management of all types of ear, nose and throat conditions. Our surgery center is state-of-the-art, and we employ leading surgical techniques that minimize invasiveness, anxiety, and pain. We also treat hearing loss and a variety of audiology disorders.

How can I best prepare my child for surgery?

Be there for your child before, during, and after surgery as a source of strength and support. Bring questions to your consultation and make sure your child has a chance to think about and bring questions of their own too. Remember, we are also there every step of the way to support your child and family through the process.

Our Surgeons Can Assist

Michael J. Wolfe, MD
Tyler G. Kimbrough, MD
John T. Parker, MD
Lisa M. Mulligan, MD
Daniel J. Lee, MD

Sleep Apnea and Snoring

We work with you to diagnose and treat all conditions holding you back from a good night’s sleep.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) occurs when the walls of the pharynx collapse inward during sleep and obstruct the airway. Patients experience repeated episodes of airway obstruction throughout the night, causing sleep disruption, poor sleep quality and daytime sleepiness. Untreated OSA can lead to decreased alertness, difficulty functioning at work, depression and decreased interest in social interaction. Patients with OSA also have an increased risk of developing hypertension, heart disease and cerebrovascular disease.

If OSA is suspected, a thorough examination of the airway is indicated. This involves an in-office examination of the nasal, pharyngeal, hypo-pharyngeal and laryngeal airway. If indicated, an overnight sleep study is performed. In most cases this can be performed in the comfort of the patient’s own home. For special cases, the study is done in a sleep laboratory. The sleep study determines the presence or absence of obstructive sleep apnea and, if present, determines the severity. If necessary, a drug-induced sleep endoscopy can also be performed. The study involved observing the airway while sleeping is induced. This allows precise identification of the site of airway obstruction and the anatomic structures contributing to the obstruction.

Once OSA is diagnosed, treatment is recommended. Treatment options include weight loss, positioning during sleep, continuous positive airway pressure or CPAP, an oral appliance and surgical therapy. Surgical treatment options include correction of nasal airway obstruction, upper airway surgery and hypoglossal nerve stimulation (Inspire Therapy).

Choosing a treatment option depends on personal preference, individual anatomy, social factors and any other associated medical conditions. At Puget Sound ENT, we have the expertise and experience to help you choose the therapy that works for you.

Snoring

Snoring can be a sign of obstructive sleep apnea but is frequently seen in the absence of apneic events. The snoring noise is generally produced by vibration of the soft palate. Snoring is very common and can be a severe problem causing sleep disturbance for a bed mate. Treatment options include weight loss, positioning, correction of nasal airway obstruction, tonsillectomy and palate surgery. Palate procedures are generally accomplished under local anesthesia in an office setting. These procedures generally involve either shrinkage of palate tissue or insertion of stiffeners to diminish palate vibration.

Puget Sound ENT can assist in a myriad of ways:

• With two locations in Edmonds and Mill Creek, we work hard to schedule our patients as quickly as possible, often seeing them within the first week of contact.
• We offer a range of snoring and sleep apnea treatment options that are non-surgical including Continuous Positive Airway Pressure (CPAP) and Inspire Upper Airway Stimulation Therapy.
• With so many surgical options, oral appliances, nasal devices, and therapies available today, trust the experts at Puget Sound ENT to conduct a complete evaluation and coordinate a treatment plan that’s just right for you.
• Whether you experience light snoring, heavy snoring, or a more serious ENT condition such as sleep apnea, we strive to provide all patients with the education and care they deserve to sleep comfortably and worry free.

Sleep Apnea and Snoring FAQs

What causes snoring?

Snoring is caused by the vibration of soft tissue in the airway, usually the soft palate. Narrowing of the airway is most commonly due to nasal blockage, palate elongation, large tonsils and patient anatomy.

Is there a cure for snoring?

There are a wide variety of treatment options available. Recommended treatment for each patient depends on findings and examination, and patient preference. You don’t have to accept heavy snoring as part of daily life. At Puget Sound ENT, an otolaryngologist will provide a thorough examination of your nose, mouth, throat, palate, and airway. If needed, we’ll order a sleep study in a laboratory environment as well to help determine how serious the snoring is and what effects it has on the snorer’s health. Then, find a solution that fits your lifestyle.

What is Continuous Positive Airway Pressure (CPAP)?

CPAP delivers air into your airway through a specially designed nasal mask or pillow. The mask does not breathe for you; the flow of air creates enough pressure when you inhale to keep your airway open. CPAP is considered an effective nonsurgical treatment for the alleviation of snoring and obstructive sleep apnea. For those who would prefer not to wear a mask at night, we also offer Inspire Upper Airway Stimulation Therapy – a cutting edge innovation that provides you with a restful night without the mask, hose, or noise.

Our Surgeons Can Assist

Michael J. Wolfe, MD
Tyler G. Kimbrough, MD
John T. Parker, MD
Lisa M. Mulligan, MD