Doctors Backous, Anstead and Clinkscales are now seeing patients in the Seattle area at 515 Minor Ave, Suite 140, Seattle, WA 98104.

Head + Neck (Cancer)

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 South East 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 patients 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.


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.

Inspire Therapy

What does Inspire therapy stimulation feel like?

You should feel only tongue movement from the stimulation. Typically, patients adjust quickly and lose awareness that the device is working. The stimulation should not be painful or uncomfortable and the level is adjustable. Our Inspire therapy-trained doctor will make any adjustments as needed anytime to ensure you sleep in comfort.

Why do some people struggle with CPAP devices?

Many people do not tolerate having the CPAP mask on their face or remove the mask once they fall asleep. Other people develop nasal irritation or obstruction or swallow the pressurized air and develop stomach pain. There are a variety of other issues but approximately 40 percent of patients do not use CPAP regularly.

How do I get started with Inspire therapy?

Begin by setting up an office visit at Puget Sound ENT. Our Inspire trained surgeon Dr. John Parker will determine if Inspire is the right form of treatment for you. If you’re a candidate, our office, and the Inspire reimbursement team, will work with you and your insurance company on next steps including preauthorizing and scheduling the procedure.

Mouth + Voice + Swallowing

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.

Nose + Sinus

Why do sinuses have so many issues?

Sinuses drain mucus into the nasal cavity, and from there into the back of the throat. The openings of the sinuses are only a few millimeters in diameter, and the swelling of these openings can cause obstruction to this drainage. The mucus gets stuck in the sinus, and can stagnate, leading to changes within the sinus that predispose to infections and inflammations.

What is a Balloon Sinuplasty?

A breakthrough sinus procedure, the physicians at Puget Sound ENT perform a Balloon Sinuplasty with local anesthesia. The minimally invasive surgery opens sinus passages to relieve sinus pain and pressure safely and effectively.

Is nasal or sinus surgery always the answer?

Not always, our clinic’s expansive care team to includes ENT specialists that try to pin point the source of the issue and establish a treatment plan that’s as minimally invasive as possible.

How does Puget Sound ENT stand apart?

Our medical support staff and experienced doctors maintain a comprehensive knowledge base and employ the latest techniques in ENT testing, treatment, and recovery. We are accessible, results focused, honest, and caring.

Otology + Neurotology

How do you become a neurotologist?

Dr. Backous graduated from college at Seattle Pacific University, obtained his medical degree from the University of Washington, completed a six-year residency at Baylor College of Medicine (Houston, TX) and did his two-year Neurotology fellowship at Johns Hopkins University (Baltimore, MD).

What does a neurotologist do?

A neurotologist focuses their practice on treating conditions of the ear, facial nerve and skull base. The take care of advanced conditions related to hearing, balance and facial nerve function.

Will a cochlear implant restore normal hearing?

Although cochlear implant technology is rapidly advancing, the device does not restore someone with severe-to-profound hearing loss to normal hearing.

Performance with the device varies from person to person. Properly selected patients will do much better with a Cl than with a hearing aid. Patients who work hard to listen with their Cl will continue to improve many ears after device switch­ on.

Do children outgrow the internal device requiring an additional surgery after their bodies grow?

The inner ear (cochlea) is full size at birth and the skull is nearly completed growth by ages7-9 years. The internal device is designed to adapt as people grow and rarely needs to be replaced. The external component of the Cl device will be replaced as new advances reach the market.

What is an osseointegrated hearing device?

An 01 is a titanium fixture placed in the skull behind the ear with a minor surgery, which then fills with growing bone. At roughly four to six weeks, our audiologist will connect an external device which will by-pass the middle ear to correct a conductive hearing loss on the same side or will transmit a signal to the opposite side if the same side is deaf. We offer Baha and Ponto at Puget Sound ENT.

Pediatric ENT

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.

Sleep Apnea + Snoring

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.


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.


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.

Balance + Vestibular Rehabilitation

Who would benefit from Vestibular Rehabilitation?

If you experience positional vertigo, dizziness, headaches, nausea or symptoms related to movement, have a history of falls, motion sensitivity, experience poor balance, have Labyrinthitis or Vestibular Neuritis, Concussion related symptoms, Acoustic Neuroma, etc. you would benefit from our comprehensive treatment program. If you’re unsure of the issue, feel free to make an appointment with us; through an in-depth consultation, we will determine the best treatment plan for you.

What does a Vestibular Rehabilitation therapy program look like?

It’s different for every person and depends of the impairment you’re experiencing. Our expert therapists will design a program that arms you with the tools and strategies needed to live life feeling more balanced and to optimize your functions. We employ a series of balance strategies, sensory organization techniques, habituation exercises, and individualized home exercise programs to help you maximize the benefits of your therapy program.

How do I get started?

Get started today by contacting Puget Sound ENT and scheduling your first appointment. Our in-house certified Vestibular Physical Therapists will evaluate each patient by performing in-depth testing to diagnose the condition and will develop a customized treatment plan that helps you start to return to a more functional and optimal life.

Allergy Testing + Treatment

What sets MQT allergy testing apart?

Advanced allergy testing, also known as MQT (Modified Quantitative Test), is currently the most advanced and precise way to test patients for allergies, determine their allergen sensitivities and relieve them of seasonal and year-round discomfort. This test is widely used to help diagnose allergic reactions including: hay fever, allergic asthma, dermatitis, food allergies, penicillin allergy, bee venom allergy and latex allergy.

How is MQT performed?

We begin with two rounds of simple, in-office testing. After an initial consultation, we’ll advise you to refrain from taking certain medications for a minimum time period before the test. On the day of the test, a prick test is completed, followed by a series of small injections, using very fine needles, in rows on your arms. Each reaction is measured and recorded carefully. The results are used to produce the serums required for allergy shots. This allergy treatment is found to alleviate the allergic symptoms by using diluted injections of allergens to build an immunity.

What are the side-effects of MQT?

The most common side effect of skin testing is slightly swollen, red, itchy bumps (wheals) much like a TB skin test. These wheals may be most noticeable during the test. In some people, an area of swelling, redness and itching may develop a few hours after the test and last for as long as a couple of days.

The best patient care is put into practice every day at Puget Sound ENT — we consider it a privilege to serve you.
Edmonds Center for Outpatient Surgery (ECOS)

7320 216th St SW

Suite 140

Edmonds, WA 98026

425-673-3750 Directions

76th Professional Commons
21911 76th Ave W
Suite 211
Edmonds, WA 98026

Fax: (425) 670-6718
Alt Fax: (425) 670-6719
1 (425) 775-6651 Directions
Mill Creek

Swedish Mill Creek Medical Center
13020 Meridian Ave S, 2nd Floor
Everett, WA 98208

Fax: (425) 670-6718
Alt Fax: (425) 670-6719
1 (425) 337-4810 Directions

Ear Nose Throat & Allergy Associates
104 27th Ave SE
Puyallup, WA 98374
*Dr. Backous only

1 (253) 770-9000 Directions
Minor & James (Center for Specialty Surgery)

First Hill Medical Building

515 Minor Ave (on the corner of Minor & James)

Suite 130

Seattle, WA 98104