Otolaryngology Specialties

The Balance Center at Lahey Hospital & Medical Center is a multidisciplinary program for the diagnosis and treatment of dizziness, vertigo, disequilibrium and impaired balance which may arise from the central or peripheral vestibular systems. The peripheral vestibular system is a portion of the inner ear involved in the maintenance of balance and gaze stability. The central vestibular system is located in the cerebellum or main balance center of the brain.

Dizziness and other forms of impaired balance are among the most frequent reasons patients visit the doctor, especially patients over the age of 75. There are numerous causes of such conditions. While most are not life-threatening, the resulting symptoms can severely reduce one’s quality of life.

Anyone experiencing a balance problem should visit his or her doctor. Once the physician has ruled out more serious conditions that might result in balance impairment, such as strokes, certain heart problems, and certain blood pressure abnormalities, an appropriate treatment plan can be developed.

Lahey Hospital & Medical Center offers a comprehensive program of care for diseases and conditions of the external, middle and inner ear, including the auditory, vestibular and facial nerves.

Medical conditions treated by our specialists include:

Our multispecialty team approach is key to our success in delivering uniquely coordinated patient care. Our team of physicians, audiologists, physical therapists, speech language pathologists and psychologists collaborate in evaluating and managing hearing and balance problems. To learn more about hearing problems, including information on our audiology programs, hearing aids and implantable devices, visit our Hearing Aid Center. For information on balance problems, including Ménière’s disease and benign positional vertigo, please visit our Balance Center.

Lahey takes a true multidisciplinary approach to head and cancer, providing both surgical and non-surgical solutions, in conjunction with radiology, oncology, plastic surgery, and cranial base surgery. We will help you navigate the experience, deal with the physical and emotional stress that cancer can bring, and find specialized rehabilitation for patients who have undergone radiation or surgical reconstruction.

For patients undergoing extensive head and neck cancer surgery, we have an OR team with a dedicated microvascular component, allowing simultaneous treatment and reconstruction of the affected area. During the same operative session, the patient will have his or her cancer resected and the surgical defect reconstructed. This approach results in quicker recovery, an improved cosmetic and functional outcome, and more successful rehabilitation.

Cranial Base Surgery

The treatment of tumors and other problems at the base of the skull requires special expertise and collaborative effort. Traversing the skull base are important structures, nerves and blood vessels that are vital to our function and appearance.

Lahey Hospital & Medical Center offers patients complete care for cranial base tumors and is one of only a handful of institutions in the United States to offer comprehensive diagnostic, surgical and medical care across the full spectrum of cranial base disorders. As such, it has become a referral base for patients across the region, the nation and the world.

Recent advances in technology and an interdisciplinary surgical approach that combines physicians from neurosurgery and otolaryngology have revolutionized cranial base surgery. Under the codirection of Elizabeth Toh, MD, FACS, and Carlos David, MD, Lahey Hospital & Medical Center’s Clinical Center for Cranial Base Surgery provides diagnostic, treatment and rehabilitation services for patients with a range of skull base disorders and lesions. The Center’s multidisciplinary medical team includes well-known leaders in the fields of otolaryngology, neurosurgery, radiation and medical oncology, head and neck reconstructive surgery, interventional neuroradiology, and vestibular and rehabilitation medicine.

Complementing the team have been major improvements in microsurgery and anesthesiology related to surgery on the brain, brain stem, nerves and blood vessels associated with cranial base lesions; intraoperative cranial nerve monitoring (i.e., monitoring hearing or facial function during surgery); and diagnostic and interventional radiology. In addition, the development of microvascular free-tissue transfer techniques and their application to cranial base surgery permits functional and aesthetic reconstructive options.

Facial Plastic & Reconstructive Surgery

Facial Plastic & Reconstructive Surgery

At Lahey Hospital & Medical Center, we understand the emotional impact of facial irregularities or disfigurement, whether caused by genetic circumstance, cancer, accident or other trauma. Our physicians perform hundreds of facial reconstructive procedures in the head and neck area every year, vastly improving the lives and self-image of those we treat.

Facial Reconstructive, & Microvascular Surgery

Facial reconstructive surgery is an art by which physical deformities, either present at birth or the result of injuries, burns, disease or aging, are corrected. At Lahey Hospital & Medical Center, our facial reconstructive surgeons employ a wide variety of techniques to treat facial deformities and irregularities. Our focus and expertise are specifically in the head and neck region, and our lead surgeon, Robert Dolan, MD, FACS, is not only double board certified by the American Board of Otolaryngology – Head and Neck Surgery and the American Academy of Facial Plastic and Reconstructive Surgery, but is also a Fellow of the American College of Surgeons.

The essence of plastic surgery technique is tissue repositioning. Tissue can be removed or transferred either locally or from a remote part of the body to another location where it can substitute for damaged, deformed or lost tissue.

The Facial Plastic Surgery Section of Lahey Hospital & Medical Center’s Department of Otolaryngology has extensive experience in facial reconstructive surgery, including microvascular techniques, providing state-of-the-art reconstructive services for patients with oncologic, congenital and trauma-related defects in the head and neck area.

One of our main goals is maximizing patients’ postoperative functional and cosmetic outcomes following radical procedures involving the jaw, face, tongue, cheeks, soft palate, hard palate and esophagus. Various reconstructive services are offered, including prosthetics, rehabilitative services and expertise in the transfer of tissue-including soft tissue and bone-to the head and neck. Our dedicated physicians, nursing and ancillary staff make every step of the process as smooth and informative as possible.

For patients undergoing extensive head and neck cancer surgery, we have an OR team with a dedicated microvascular component, allowing simultaneous treatment and reconstruction of the affected area. During the same operative session, the patient will have his or her cancer resected and the surgical defect reconstructed. This approach results in quicker recovery, an improved cosmetic and functional outcome, and more successful rehabilitation.

Facial Plastic & Cosmetic Surgery

In addition to the extensive care provided for reconstructive efforts we have experts in Facial Plastic and Cosmetic Surgery as well. We understand the need to look and feel your best and we have the ability to address all of your facial rejuvenation needs.

The most common facial procedures fall into three overlapping categories:

• Surgery that refines facial features
• Surgery for the aging face
• Surgery that treats skin imperfections

Procedures offered include:

At Lahey Hospital & Medical Center’s Hearing Aid Center, we know that hearing loss can impact every part of your life – such as communicating on the phone, interacting with others and being productive at work – and this can be devastating.

Hearing loss is most common among older adults, but it can occur at any age. Because Lahey offers medical care as well as audiology, you will have access to a wide range of solutions that best fit your needs.

If you are experiencing hearing loss, the experts at Lahey Hospital & Medical Center’s Hearing Aid Center can deliver a level of care, service and expertise that is second to none.

Our Audiologists treat hearing problems in people of all ages. We can determine if you are a candidate for a traditional hearing aid, if you would benefit from an implantable device, or if you need treatment by a physician for a medical condition that may be contributing to your hearing loss.

Whatever your hearing need, we are here for you at our two convenient Hearing Aid Center locations:

• Lahey Hospital & Medical Center, Burlington
• Lahey Medical Center, Peabody

Lahey Hospital & Medical Center offers a comprehensive program of care for diseases and conditions of the nose and sinuses. These include functional problems such as the common forms of rhinitis (inflammation of the mucus membranes of the nose), acute or chronic sinusitis (inflammation of the sinuses), sinus headaches and fungal-related sinus disease, as well as nasal obstruction from deviated septums, nasal tumors and nasal polyps.

Minimally Invasive Sinus Technique (MIST)

Lahey Hospital & Medical Center’s Department of Otolaryngology is a nationally and internationally recognized pioneer in minimally invasive sinus surgery (formally known as minimally invasive sinus technique, or MIST).

Most patients with sinus problems can be treated with antihistamines, nasal sprays, antibiotics or, in some cases, steroids, but for patients with chronic or recurrent sinusitis, surgery may be necessary to provide relief. MIST technologies are extremely patient-friendly, avoid external incisions and can often be done in 45 to 50 minutes, with no bandages or packing in the nose. There is no external evidence that surgery was performed.

Our comprehensive program includes state-of-the-art imaging options, including intra-operative surgical navigation technology, which enables our specialists to diagnose and surgically treat conditions with the utmost accuracy. MIST technology can also be applied to neoplasms of the nasal and sinus areas, such as pituitary tumors, angiofibromas, inverted papillomas, hemangiomas and even certain cancers. When necessary, these procedures are performed in collaboration with neurosurgeons.

MIST aims to uncover the entrances to the sinuses, where blockages typically cause problems, rather than invading and opening the sinuses themselves. Using a state-of-the-art viewing tool called an endoscope and a precise, powerful surgical instrument called a microdebrider, the surgeon is able to enter through the nostrils and carefully and efficiently remove the offending tissue, leaving behind no swelling, bruising, black eyes or a nose packed with gauze. Patients are usually awake and alert within 15 minutes after the anesthesia is turned off and able to resume normal activities within a day or two (There are typically a few short-term aftereffects such as a feeling of congestion in the nose and some blood when blowing the nose, but these are temporary).

Lahey surgeons are currently treating 400 to 500 patients each year using the MIST approach. Where necessary, we also provide allergy, asthma or pulmonary consultations, drawing on experts from these Lahey Hospital & Medical Center teams.

Snoring, Sleep Apnea & Minimally Invasive Nasal Surgery

At Lahey Hospital & Medical Center, we take a multidisciplinary approach to the evaluation of sleep disorders. The departments of Otolaryngology, Pulmonary Medicine and Neurology participate to diagnose and treat all types of sleep disorders. Although sleep apnea is the most common sleep disorder, the multidisciplinary nature of the sleep clinic allows the treatment of less common sleep problems, such as chronic insomnias, narcolepsy and sleep movement disorders. Frequently, the evaluation will be supplemented with a sleep test through Lahey Hospital & Medical Center’s fully accredited sleep lab. This will assist in making a diagnosis, so that the correct therapy can be initiated.

Habitual snoring affects up to 20 percent of the population. Thirty percent of patients who snore have obstructive sleep apnea (OSA). Snoring and OSA are part of a continuum of the same disease. The problem consists of either partial or complete airway obstruction during sleep. The difference between the two is important: OSA is clearly correlated with medical illnesses, such as heart problems and an increased risk of sudden death, while snoring is not. As such, snoring is considered a social problem (although sometimes it may have significant consequences at home!). A sleep test may be necessary to differentiate between snoring and OSA.

An otolaryngology evaluation is essential to evaluate snoring and OSA. A careful examination of the upper airway is performed both to try to determine the site of airway collapse and to make sure that there are no other medical problems that might be causing the sleep disturbance. Possible sites of obstructions include the nose, tonsils, soft palate and uvula, tongue and voice box. Treatments, including minimally invasive nasal surgery, will differ depending on the severity of the problem and the results of the exam.

Lahey Hospital & Medical Center also has a Sleep Disorders Center, combining specialists from the departments of Otolaryngology, Pulmonary Medicine and Neurology. Please visit this site for more information on sleep disorders, their causes, and the diagnostic and treatment options available.

Treatment Options for Snoring

Treatment options for snoring include the following:

• Weight loss
• Avoidance of alcohol and certain medications that may worsen snoring
• Obtaining adequate sleep, so that an individual is not overly sleepy, which can worsen snoring
• Specially made earplugs for the bed partner
• Dental mouthpieces
• Nasal surgeries
• Minimally invasive outpatient procedures performed in the clinic to stiffen the soft palate and decrease its flutter and noise. These procedures include injection snoreplasty, PillarTM implants, radiofrequency treatment to the soft palate (Somnus) and laser-assisted uvulopalatopharyngoplasty (LAUP). At Lahey Hospital & Medical Center, we perform all of these procedures, and your consultation would include a discussion of which would be best for you.

Treatment Options for Sleep Apnea

Treatment options for obstructive sleep apnea include the following:

• Weight loss
• Avoidance of alcohol and certain medications that may worsen sleep apnea
• Continuous positive airway pressures (CPAP), in which an appliance forces air through the nose and acts as a stent to keep the airway open at night. This is a very successful treatment for obstructive sleep apnea and is usually tried before other therapies. However, some patients do not tolerate the mask and seek other options.
• Dental mouthpieces (usually for mild sleep apnea problems)
• Minimally invasive surgery that may include operations on the nose, soft palate and uvula, tongue and neck. These operations are directed at the possible sites of obstruction in an effort to do the minimal surgery necessary to correct the sleep problem. These types of surgery would be discussed with you at the time of consultation and specific recommendations would be made.

For More Information

The Otolaryngology Department at Lahey has an active interest in research and state-of-the-art medicine, which allows us to offer a variety of new and innovative techniques for the treatment of sleep apnea and chronic sinusitis. These newer techniques are minimally invasive and often can be performed in an outpatient clinic or day surgery setting with significantly less discomfort than traditional approaches. These techniques may not be appropriate for everyone. If you are interested in making an appointment, please call 781-744-8467.

Using innovative diagnostic and treatment technology, Speech Pathology (part of the Otolaryngology – Head & Neck Surgery) at Lahey Hospital & Medical Center addresses a wide range of voice disorders, as well as speech and swallowing problems. From care of the professional voice to care of patients learning to speak or swallow after a stroke or other illness, the department’s team of specialists focuses exclusively on conditions affecting the voice box (larynx) and surrounding areas of the throat and mouth. In recent years, the department has expanded to meet patient needs and to reflect the growth of technology and treatments specific to voice and speech.