We’re Experts in Ear, Nose and Throat Conditions

ENT & Allergy Specialists evaluate, diagnose and treat a broad range of conditions related to the ears, nose and throat, including facial plastic surgery. Our patients come to us with conditions and problems related to sinusitis, nasal obstruction, allergies, asthma, nasal and facial fractures, rhinoplasty, facial plastic surgery, head and neck cancer, skin cancer, sleep apnea and snoring and ear dysfunctions including hearing loss and balance disorders. To schedule an appointment with one of our providers, please call 610-415-1100. For additional information, please visit our website.

Opinions expressed here are those of myself, Dr. Broker, and occasionally, my partners. They are not intended as medical advice and cannot substitute for the advice of your personal physician.

Tuesday, February 9, 2016

ENT and Allergy Specialists Exciting News

In an effort to continually improve the services that we provide, we have launched a new website and blog! The content may have moved, and the site may look different, however our mission hasn't changed, and the information that we share will continue to educate and inform you. Our new mobile friendly site offers the convenience of booking an appointment on-line, a list of services that we provide, as well as biographical information about our highly-respected team of ear, nose, throat and allergy specialists. Connect with us here.

Monday, October 12, 2015

Pediatric Ear, Nose and Throat

Did you know that the vast majority of all tonsillectomies are performed in community hospitals or outpatient surgery centers and not in pediatric speciality hospitals? Board Certification for all ENT doctors includes Pediatric ENT training and certification and there is no extra certification for doctors who limit their practice to children. The same is true for anesthesiologists.  So for common ENT surgeries like tonsillectomy, is the care at a pediatric speciality hospital better than the care at an outpatient surgery center?

Using the Institute of Medicine's quality guidelines, the only study to look at this question is Grisel, J and Arjmand, E. Comparing quality at an ambulatory surgery center and a hospital-based facility:Preliminary findings. Otolaryngology Head Neck Surgery 2009 Dec;141(6):701-9. The guidelines look at the skill of the surgeon and other important factors such as patient safety, patient-centeredness of care, timeliness, efficiency, and equitability. The outpatient surgery center was found to be superior to the pediatric specialty hospital. This isn't surprising when you consider that pediatric speciality hospitals have a lot on their plate, caring for much sicker children and simply cannot concentrate on simpler procedures like tonsillectomies or ear tubes the way an outpatient surgery center can.

Also, pediatric hospitals are typically teaching hospitals where junior residents are most often assigned to tonsillectomies and ear tube surgeries. Several studies have shown that there is a steep learning curve in surgical residencies and that junior residents have significantly higher complication rates than senior residents or attending surgeons (those surgeons who have finished their training). (2-4) Similar findings have been shown for anesthesiologists. (5) Thus, it stands to reason that Ear, Nose and Throat doctors and anesthesiologists at an outpatient surgery center who are experienced in pediatrics will have comparable if not superior results when compared to a pediatric speciality hospital. (1)

Lastly, pediatric specialty hospitals are typically not nearby to most of the communities that they serve as they cover large areas that include many community hospitals. Thus, if an emergency or complication of the surgery arises, the pediatric hospital is simply too far away to treat the patient. But if a complication of surgery arises its better if the original surgeon can treat the patient and thus, having surgery at a local facility improves the quality of care when an unexpected problem arises after the surgery.

So, now that you know, where would you rather have your child's tonsils removed?

1) Grisel, J and Arjmand, E. Comparing quality at an ambulatory surgery center and a hospital-based facility:Preliminary findings. Otolaryngology Head Neck Surgery 2009 Dec;141(6):701-9.

2) J Surg Res. 2006 May 15;132(2):159-63. Epub 2006 Jan 18. Influence of resident and attending surgeon seniority on operative performance in laparoscopic cholecystectomy.  Kauvar DS, Braswell A, Brown BD, Harnisch M.

3) Arch Ophthalmol. 2007 Sep;125(9):1215-9. The resident surgeon phacoemulsification learning curve. Randleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek DH, Srivastava SK.

4) Ann Surg. 2001 Sep;234(3):370-82; discussion 382-3. Comparison of surgical outcomes between teaching and nonteaching hospitals in the Department of Veterans Affairs. Khuri SF, Najjar SF, Daley J, Krasnicka B, Hossain M, Henderson WG, Aust JB, Bass B, Bishop MJ, Demakis J, DePalma R, Fabri PJ, Fink A, Gibbs J, Grover F,Hammermeister K, McDonald G, Neumayer L, Roswell RH, Spencer J, Turnage RH; VA National Surgical Quality Improvement Program.

5) Anesthesiology. 2008 Dec;109(6):973-7. Effects of supervision by attending anesthesiologists on complications of emergency tracheal intubation. Schmidt UH, Kumwilaisak K, Bittner E, George E, Hess D.

Monday, October 5, 2015

Sports Endurance/ Nasal Airway


The ability to continue exercise during high-intensity sports such as cycling is dependent on both physiologic factors and the perception of fatigue.

In 2008 Ansley, et al (1) showed that head cooling significantly decreased the perception of fatigue and increased the exercise time to fatigue by 51%. Not only were athletes able to exercise dramatically longer with head cooling, but their production of a stress hormone thought to be involved in feeling fatigue, prolactin, was nearly eliminated.

In 1995 White and Cabanac found that this head cooling is achieved by the body during exercise via increased blood flow to the nose (2) and that improving nasal airflow increases cooling (3).

Taken together, these studies suggest that improving the nasal airway in athletes will dramatically improve their endurance. Its important to point out that there have been many misleading claims made over the years about how this works and attempts by not-so-reputable groups to sell useless products based on this information. A better nasal airway does not improve an athlete's VO2 max (maximum exercise capacity of heart and lungs) or his/her oxygen intake. A better nasal airway does improve an athlete's ability to continue exercise under conditions of heat and fatigue by measurably decreasing both.

So how can you achieve a "Better Nasal Airway"? One simple solution are Breathe Right Strips. They have been shown in studies to increase the internal cross-sectional area of the nose. However, if you have significant allergies, a deviated septum, or other nasal abnormalities these strips may have limited effectiveness. In that case, treating the allergies or nasal obstruction will give you a Better Nasal Airway.

With improvements in both allergy treatments (such as Sublingual Immunotherapy orAllergy Drops) and minimally invasive nasal surgery (turbinate reduction, septoplasty, nasal valve augmentation), a Better Nasal Airway can be achieved with little effort, downtime or discomfort.  Visit our website for more information or an appointment;www.ENTandAllergySpecialists.com.

1) Ansley L, Marvin G, Sharma A, Kendall MJ, Jones DA, Bridge MW  The effects of head cooling on endurance and neuroendocrine responses to exercise in warm conditions. Physiol Res. 2008;57(6):863-72. Epub 2007 Nov 30.  

2) White MD, Cabanac M.  Eur J Appl Physiol Occup Physiol.  Nasal mucosal vasodilatation in response to passive hyperthermia in humans. 1995;70(3):207-12.

3) White, M. D. and Cabanac, M. (1995). Physical dilation of the nostrils lowers the thermal strain of exercising humans. European Journal of Applied Physiology, 70, 200-206.

Monday, September 28, 2015

What is Facial Plastic Surgery?

Facial Plastic Surgeons are Specialists for the Face. They do not perform surgery on other areas and concentrate only on the face, creating more expertise in this area. Trust your face to a specialist.

Dr. Broker is fellowship trained in facial plastic surgery in Beverly Hills, CA and at the UCLA Medical Center. Click here for more information about his training and experience.

Insight into procedures

  • Why consider facial plastic surgery?
  • What kinds of problems are treated?
  • and more...
Facial expressions are a way to interact with others. How we look has an impact on how others perceive us, so most of us are concerned about our face’s appearance.
Some would like to change certain things about their face. Others are born with facial abnormalities such as a cleft lip, a birthmark, or other birth defects. Many of us notice the effects of aging, sun damage, or previous facial trauma. Fortunately, many of these conditions can be corrected through surgical procedures performed by a surgeon.

Why consider facial plastic surgery?
The range of conditions that otolaryngologists diagnose and treat are widely varied and can involve the whole face, nose, lips, ears and neck. Facial plastic surgery treats a specific component of these conditions and can be divided into two types—reconstructive and cosmetic. Reconstructive plastic surgery is performed for patients with conditions that may be present from birth, such as birthmarks on the face, cleft lip and palate, protruding ears and a crooked smile. Other conditions that are the result of accidents, trauma, burns, or previous surgery are also corrected with this type of surgery. In addition, some reconstructive procedures are required to treat existing diseases like skin cancer. Cosmetic facial plastic surgery is surgery performed to enhance visual appearance of the facial structures. Typical procedures include facelifts, eye lifts, rhinoplasty and liposuction. An otolaryngologist surgeon is well trained to address all of these problems.

What training is necessary?
An otolaryngologist can receive up to 15 years of college and post-graduate training in plastic surgery, concentrating on procedures that reconstruct the elements of the face.

Post-graduate training includes a year of general surgery, four years of residency in otolaryngology (disorders of the ears, nose and throat) and may also include one to two years in a fellowship dedicated to facial plastic surgery.

After passing a rigorous set of exams given by the American Board of Otolaryngology, otolaryngologists may become board-certified in the specialty of Otolaryngology—Head and Neck Surgery. Because they study the complex anatomy, physiology and pathology of the entire head and neck, these specialists (sometimes called ENTs) are uniquely qualified to perform the procedures that affect the whole face.

What kinds of problems are treated?
The following are examples of procedures:

Rhinoplasty/Septoplasty—Surgery of the external and internal nose in which cartilage and bone are restructured and reshaped to improve the appearance and function of the nose.

Blepharoplasty—Surgery of the upper and/or lower eyelids to improve the function and/or look of the eyes.

Rhytidectomy—Surgery of the skin of the face and neck to tighten the skin and remove excess wrinkles.

 Browlift,—Surgery to improve forehead wrinkles and droopy eyebrows.

Liposuction—Surgery to remove excess fat under the chin or in the neck.

Facial implants—Surgery to make certain structures of the face (cheek, lips, chin) more prominent and well defined.

Otoplasty—Surgery to reshape the cartilage of the ears so they protrude less.

Skin surface procedures—Surgery using lasers, chemical peels or derma-abrasion to improve the smoothness of the skin.

Facial reconstruction—Surgery to reconstruct defects in facial skin as a result of prior surgery, injury or disease. This includes reconstruction of defects resulting from cancer surgery, scar revision, repair of lacerations to the face from prior trauma, removal of birth marks and correction of congenital abnormalities of the skull, palate, or lips.

Non-surgical procedures—Techniques such as chemical peels, microdermabrasion and injectables. Injectables are medications that can be placed under the skin to improv the appearance of the face, such as botox, collagen, Restylane and other fillers.

How do I find a surgeon?
The Academy can recommend a board-certified otolaryngologist in your area who has a specific interest in facial plastic surgery. A reputable surgeon will take a thorough patient history and advise you on the best procedure for you. Patients should also be cautious not to be swayed by doctors who have the latest equipment, but should instead focus on finding the provider who possesses the skills, expertise and experience necessary to choose the right treatment method for each individual.

What should you know prior to facial plastic surgery?
Your surgeon should discuss the procedure, risks and recovery with you. Knowing what to expect will put you more at ease. You should ask how many of the particular type of procedures the surgeon has performed, and how often. You should also know what sort of preparation plans you need to make, how long the procedure will take, and any associated risks. Your surgeon should advise you about any medications you should avoid before your surgery.

Some risks might include: nausea, numbness, bleeding, blood clots, infection and adverse reactions to the anesthesia. Additionally, if you smoke, you should avoid doing so for two weeks before your surgery in order to optimize healing following your procedure.

You will also want to understand all associated costs and payment options before undergoing any procedure. Insurance will usually cover reconstructive plastic surgery, but check with your provider. If you will be paying for the procedure, find out what payment options are available and if there is a payment plan.

What will recovery be like?
Most plastic surgery will not require a long hospital stay. Depending on the extent of your surgery, some procedures can be completed on an outpatient basis, meaning you would not require a hospital stay. Other procedures may require a hospital stay overnight or for a day or two. Either way, before you are released from the hospital, your surgeon will discuss with you any special care to take while you’re recovering at home. You will be provided with gauze and other types of dressings to tend to your incision area. Permanent sutures and surgical staples will be removed in the office about a week after the procedure. Your surgeon should also explain any special diet you should follow, medications you should take or avoid and any restriction on activities.

Following your surgery, generally, you should:
  • Avoid aerobic exercise for two weeks.
  • Refrain from weight lifting and contact sports for one month.
  • Talk with your surgeon about medication to manage pain and swelling.
  • Avoid aspirin because it can cause bleeding and make bruising worse.
Most patients feel comfortable returning to work one to two weeks following their surgery, when swelling and bruising are reduced and their appearance has improved.

Copyright 2010. American Academy of Otolaryngology — Head and Neck Surgery

Friday, December 21, 2012

ENT and Allergy Specialists named Main Line's Top Docs... Again!

For the 10th year our physicians have been named Top Docs in their field. Dr's Broker and Swanson for Otolaryngology/ Ear, Nose and Throat and Dr Actor for Allergy.

Dr Broker has also been named the single best ENT doctor by Main Line Today Magazine's Patient's Choice Poll.


Saturday, January 28, 2012

Climate change

As i sat here at the beach today, at the end of January in 60 degree heat, i couldn't help but wonder why there isn't more outrage and panic over climate change. Are people so stupid as to not understand how this is likely to affect our lives? Can't they see this leading to water and food shortages, conflict and death? Are people so self-centered as to not even care if it affects their own kids as long as they escape the consequences? Even if you are so daft as to believe its all due to "sunspots", why would you not want to try to mitigate the damage when to do nothing is probable suicide?

If we don't at least try, we deserve what we get. But our kids don't.

Friday, August 5, 2011

Bachelorette Tropical Frog Mating Calls

Research by New Orleans scientists showed that female tropical frogs use sophisticated thinking that is on par with humans to distinguish which male is making a noise that she likes. They state that this research will help them understand human hearing and attention disorders. Much like "The Bachelorette", the males all simultaneously compete for the female with mating calls and the female has to figure out which male is making the sound she likes best. Apparently, this requires some big time deductive reasoning that compares subtle differences in the calls.

Read more at http://bit.ly/pPiv7w

Hearing loss experts, hearing aids, tinnitus treatment, Neuromonics.

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