Infants and Toddlers have a much more permeable GI tract and are very susceptible to food allergies. These can be difficult and can be mediated through both IgE and IgG. They can result in terrible GI symptoms of vomiting, diarrhea, bloating and colic. They can also result in skin symptoms such as atopic dermatitis and eczema or upper respiratory tract symptoms such as nasal congestion, ear and sinus infections. They lead to many sleepless nights for both the child and parents.

The diagnosis is made primarily by taking a history. Your physician needs to be educated and aware food allergies. Unfortunately the allergy skin and blood tests are not very sensitive for IgG mediate (or cyclic) food allergies. A food diary for the child or nursing mother is paramount. IgG testing has not been proven helpful. It has often been called a very expensive means to a food diary. IgE blood testing and skin testing can be helpful and we do typically perform them here at Midwest ENT. Eosinophilic esophagitis is a new and disturbing end point for allergies affecting the gastrointestinal tract.

Treatment is primary dietary manipulation. We encourage mothers to continue nursing and actually monitor their own diet as many antigenic proteins pass through the breast milk. Casein and Whey are the primary antigenic proteins in Cow’s milk, and dairy is the biggest culprit. In children that are not nursing we often will try a hypoallergenic formula. Our favorites include Elecare, Neocate, and Neutramogen. They can be quite expensive and Neutramogen smells funny. I recommend buying them on E-Bay. EO28 Splash is another excellent option. Goats milk is a good alternative for some, Soy milk is excellent if they are not Soy allergic. Rice milk is also a good option.

Desensitization is controversial, however, we do now offer the LaCrosse protocol for our patients. This has proven extremely helpful for many of our patients and represents an exciting break through. The good news is that, with the exception of fixed food allergies (such as those to peanut), most children will outgrow these sensitivities. As the intestinal tract matures fewer proteins can cross and more foods will be tolerated. We can help you work through these trying times and offer you any and all possible treatments.

Reinke’s Edema is a polypoid degeneration of the true vocal cords.  Synonyms include Polypoid Corditis and Chronic Hypertrophic Laryngitis.  Reinke’s Space is a collection of loose gelatenous material in the superficial layer of the Lamina Propria between the non keritinizing stratus squamous epithelium of the true vocal cord and vocal ligament.  It is bounded anteriorly by Broyles ligamant and posteriorly by the arytenoids.
There is a strong association with smoking, vocal abuse and GERD.  These are fun people that you would want to hang around with. Some have mentioned hypothyroidism.
Treatment is smoking cessation, empiric treatment of LPR/GERD, and screening for thyroid issues.  Beyond that surgical intervention is warranted.  Hirono’s method is the creation of a superior true vocal cord incision and suctioning the excess gelatenous material out.  Laser and microdebrider techniques have been described.  Any excess flap then is trimmed with the micro laryngeal scissors.  I also like to add in a therapeutic steroid injection.

Meth mouth is a dental condition characterized by severe decay and loss of teeth, as well as fracture, enamel erosion, and other oral problems symptomatic of extended use of the drug methamphetamine (meth). The specific cause of the condition is unknown, although drug-induced xerostomia (dry mouth) and bruxism (grinding of the teeth) are thought to be involved. Other frequently cited factors are poor nutrition and lack of dental hygiene, common among long-term users of the drug. The legitimacy of meth mouth as a unique condition has been questioned because of the similar effects of some other drugs on teeth. Advocates of its status as a unique condition cite the pattern and scope of the decay as distinguishing factors.