Category: Blog

Cutting Edge Biologic Options for Sinus Problems


Over the years, we have made many strides in improving the way we are able to treat sinus issues. One common problem that has continued to be a challenge is treating chronic rhinosinusitis with nasal polyposis (nasal polyps). 

When it comes to these conditions, it is possible that the future of better disease control may involve the use of biologics, and we’re thrilled to have these new options for our patients at Excel ENT.

The Basics of Biologics

Biologic response modifiers are a class of medications that treat conditions such as nasal polyps by targeting specific components of an individual’s immune system. They can modify the chemical responses of the immune system that are causing inflammation thought to be responsible for the growth of nasal polyps.

Biologics are made from living cells. Unlike many other pharmaceutical drugs, they are not synthesized chemically or from plants. They also don’t typically come in the form of a tablet but as a solution that has to be injected.

Biologics can be antibodies, enzymes, hormones, or other types of biologic components or cells (even viruses). Vaccines and insulin are types of biologics that have been available for many years.

Dupixent (dupilumab) is a biologic approved for the treatment of nasal polyps in the U.S., and it’s one that we’ve been offering for a while at Excel ENT. Another new biologic option we have is called Nucala.

Things to Know About Biologics for Nasal Polyps

Focusing primarily on Dupixent, as it’s the biologic option we’ve been offering the longest, here are some of the details we want our patients to know about.

Administered via injection

Biologics involve an injection. We will teach you how to do this, and you will either give yourself a shot or have a family member give you the injection. While there may be some discomfort with this, it often decreases over time. Injection site reactions, such as pain, redness, or swelling can be easily treated using cold or hot pads and over-the-counter pain relievers such as acetaminophen.

Possible side effects

As with all medications, biologics used for the treatment of nasal polyps may have side effects that inhibit their use by certain individuals. As with almost all medications, it is possible to have a life-threatening allergic reaction called anaphylaxis. Signs of this type of reaction may include swelling of the face and lips, difficulty swallowing, difficulty breathing, and wheezing.

When common side effects occur, they often improve on their own over time as you continue your treatment. These side effects might include injection site reactions, eye inflammation, increased white blood cell counts, sore throat, stomach problems, cold sores, joint pain, insomnia, and toothaches.

Not the best option for everyone

Dupixent is untested in individuals under the age of 6 for any use; it is approved only in individuals over the age of 18 for the treatment of nasal polyps. Women who are pregnant, those who wish to become pregnant, or those who are breastfeeding should not consider biologics for nasal polyps since they are also untested in these individuals. 

Your insurance might cover biologics

Your health insurance might require that you provide ample documentation if you are prescribed a biologic. We will work with you to provide any necessary documentation required by your insurance company. Even though there may be extra steps in the process, many companies ultimately cover the medications.

Additionally, many drug companies including the manufacturer of Dupixent offer assistance to people wanting to try new options. Copay cards or other programs may reduce the cost of the medication for individuals who apply.

Find Out If Biologics Are a Possibility for Treating Sinus Problems at Excel ENT of Alabama

Biologics are a cutting edge option that will only continue to grow when it comes to treating sinus problems, such as rhinosinusitis and nasal polyps. It’s a great option to consider, and Dr. Davis will work with you to determine if it’s a viable option in your case. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

Dangers of Earbud & Earpod Use

dangers of earbuds

From teenagers and adolescents to working adults, everyone is using either earbuds or earpods these days. These options are like tiny speakers that fit inside the ears, and while they are convenient and useful, there are some concerns when it comes to your ears and your hearing. 

May is Better Hearing and Speech Month, and it’s the perfect time to address this topic, especially since kids are getting out of school for the summer. They will be looking for ways to keep themselves entertained, and they may be using these products more often.

Dangers of Earbuds & Earpods

The dangers with these products revolve primarily around listening to music that’s too loud and doing so for too long. 

These are the two main concerns:

Otitis Externa

This is an ear infection in the ear canal, commonly called “swimmers ear,” and the condition can be caused by repeated, frequent use of in-ear headphones. Options that seal off the ear to eliminate airflow are especially concerning as these can increase the risk of otitis externa. It can be a very painful infection that may require medical treatment.

Noise-Induced Hearing Loss

Sounds at 78 to 132 decibels (dB) have the potential to cause damage to the delicate hair cells that respond to the sounds we hear. This damage can show up as tinnitus (ringing) and/or hearing loss (difficulty hearing and understanding what is said). The louder the sound, the less time it takes to damage your hearing.

Earpods can reach levels of 102 to 112 dB. At levels that high, damage to your hearing can occur in as much as 30 minutes to as little as 2 minutes. As many as one in five teenagers already have noise induced hearing loss from exposure to loud sounds. This is 30% higher than 20 years ago.

Signs that what you’re listening to is too loud:

  • You must raise your voice to be heard
  • You can’t hear or understand someone that’s three feet away
  • Speech around you sounds muffled or dull after you leave the noisy area
  • You have pain or ringing in your ears after you hear the noise (tinnitus) that lasts for a few minutes or a few days

How to Protect Hearing When Using Earbuds or Earpods

During the month of May and throughout the summer, be sure that what you are listening to and what your children are listening to is not too loud. For kids especially, the time they spend each day using earbuds or earpods should be limited. 

Here are some specific things you can do to protect your hearing:

  • Frequently wash earbuds with rubbing alcohol and allow them to dry completely before putting them back in the ear.
  • Use bone conduction headphones that leave the ear open and do not create an environment that’s ideal for infections to grow.
  • Set a volume limit on phones or tablets to reduce your exposure to loud sounds.
  • Take a break from listening to music with earbuds or earpods.
  • Give your ears time to rest and recover from exposure to sound so you will avoid hitting that “maximum noise dose” that puts you at greater risk for hearing loss and tinnitus.
  • Wear earplugs when around loud sounds, such as when you are doing yard work, going to concerts, sporting events, and more.
  • Consider having custom earplugs made that are more comfortable than standard foam ear plugs.
  • Get an annual hearing test or a baseline test so you can track your hearing health.

Check Your Hearing or Address Hearing Problems at Excel ENT of Alabama

Remember that there is no cure for hearing loss or tinnitus, so it’s crucial that you protect your hearing starting as early as possible. You want your hearing to last a lifetime! If you’d like to schedule a hearing test or baseline test, we can help you with that at Excel ENT. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

Q-Tips & Ears: Good or Bad?

q-tips in ears

Keeping cotton swabs, such as Q-tips, in the bathroom to clean out your ears is very common, and many people think this is a necessary task, but it’s one that carries significant risks. 

According to the American Academy of Otolaryngology, the use of cotton-tipped swabs or other home instruments pose a serious risk of damage to the eardrum and ear bones. When you use cotton swabs, you can accidentally damage your ears, and the most common cause of eardrum rupture is from trauma such as this. 

Instead, you should visit your doctor for an assessment if you experience uncomfortable symptoms, such as

  • Ear fullness
  • Hearing loss
  • Discomfort
  • Itching
  • The feeling of too much wax buildup

At Excel ENT, we will be able to help you with these issues in an appropriate manner. We can look inside your ear and safely remove wax, which is always the best course of action. Read on to learn more!

Q-Tips to Remove Earwax: FAQs & Dangers

We do know that earwax can be pesky. In some cases, too much earwax may cause hearing problems, itching, dizziness, and discomfort. However, you do not need to routinely clean out your ears. In most cases, earwax is actually healthy and protective for the ear. Earwax helps protect against infections, dry skin, and unwanted dirt and debris. 

What are the dangers of using a Q-tip to clean the ears?

Using cotton swabs or other instruments at home to clean your own ears can cause serious problems, such as:

  • Rupturing the eardrum – The most common cause of eardrum rupture is injury to the ear, typically occurring as a result of using cotton swabs or other instruments in the ear at home. This is painful and can lead to hearing loss and infections. 
  • Infection – Using a cotton swab in your ear can introduce bacteria, dust, and dirt into your ear and lead to ear infections. 
  • Pain – Even if you don’t fully rupture your eardrum, you can cause damage like scratches and inflammation. Cotton swabs also tend to push wax further into the ear canal, which will make the discomfort worse. 
  • Getting material stuck in the ear – Cotton material from swabs can get lodged and stuck in the ear. This can also cause hearing loss, infections, and discomfort. You will also likely need a doctor’s visit to remove it. 

How often should I clean earwax from my ears?

Most people do not need to routinely clean earwax from their ears. Our ears are normally “self-cleaning,” since earwax traps dirt and debris and slowly pushes it out. Here, it dries and falls out on its own. This helps prevent particles from getting in our ears and also prevents infection.

Why should I be so worried about my eardrum?

When using a cotton swab, you can easily reach your eardrum. But because the eardrum is so delicate, it can be easily ruptured with even gentle pressure from a swab. The pain is severe, and the ear may also leak a clear fluid. While a punctured eardrum will heal, it can take a while and can even lead to conductive hearing loss.

How should I clean my ears? 

As mentioned above, your ear typically does a great job of cleaning itself. In most cases, the ear canal does not need to be cleaned. During routine hair washing or showers, enough water enters the ear canal to loosen wax that has accumulated, and it typically loosens and falls out . on its own while you are asleep. If you’d like to clean your outer ear, also known as the pinna, occasionally you can use just a little soap, water, and a washcloth while you shower. Be very gentle. 

Let Excel ENT of Alabama Help With Issues Related to the Ears, Nose, and Throat

Whether you are dealing with earwax build-up, hearing troubles, or ear pain, our specialists at Excel ENT of Alabama can help. We have experts who can treat other issues related to the nose and throat as well. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

What to Do About Frequent Throat Clearing

throat clearing

We all clear our throats sometimes without giving it much thought. We may do it to get someone’s attention, to clear our throats of mucus or the feeling that something’s stuck, or it may be a nervous habit.

While there are several reasons for throat clearing, when it becomes a chronic occurrence, it can cause problems, including damage to your vocal cords. 

So what are the underlying causes of chronic throat clearing, and what can we do about it?

Why We Clear Our Throats & When It Becomes a Problem

When we clear our throats, we are transferring mucus out of our airway and into the throat. It’s normal for us to secrete up to two liters of mucus per day! Throat clearing can become excessive when mucus is too thick or copious. 

When this throat clearing process happens over and over again, it can cause redness and swelling of your vocal cords. If the clearing is very extensive, small growths called granulomas can form. If these granulomas get large, they can affect your breathing and your voice and may require surgery for removal. 

In addition, the irritation and swelling produced by chronic throat clearing can cause even more mucus production, which causes more throat clearing. As you can see, it can become a never ending cycle. Without a conscious effort to break the cycle, chronic throat clearing will likely continue. 

What Conditions Can Cause Chronic Throat Clearing?

Keep in mind that chronic throat clearing itself isn’t really a diagnosis. It’s a symptom of an underlying condition. Some of those might include:

1. Reflux

Laryngopharyngeal reflux (LPR) is a condition in which stomach acid escapes out of the stomach and goes into the esophagus and throat. The acid irritates the throat, the vocal cords, and even the nasal passages. It may result in voice problems, swallowing problems, sinus drainage, and the frequent need to clear the throat. The most effective treatment is usually a combination of medication and lifestyle changes, such as avoiding certain types of food and drink, reducing stress, and losing weight.

2.  Postnasal drainage

Another common cause of throat clearing is postnasal drainage, also called postnasal drip. Postnasal drip happens when your body starts producing extra mucus. You may feel it dripping down your throat from the back of your nose. Other symptoms may include cough, nausea, sore throat, and bad breath. Allergies are a common cause, along with viral infections, sinus infections, dry air, and changes in the weather.

Treatment for postnasal drip varies depending on the cause. If it’s related to allergies, avoiding the allergen or taking medications may stop the drip. Other treatments may include over-the-counter decongestants, antihistamines, saline nasal sprays, and staying hydrated.

3.  Allergies

Nasal allergies and food allergies can contribute to frequent throat clearing. In some cases, a food allergy or sensitivity may cause a tickling in your throat that makes you clear it. Dairy is a frequent cause, but foods such as eggs, rice, and soy may also be culprits. The treatment in such cases is avoiding the food that leads to symptoms.

Nasal allergies occur when the body’s immune system overreacts to the presence of substances, called allergens, that are usually harmless. Common allergens include pollen, dust, and animal dander. Nasal allergies can lead to excess mucus production, which can cause frequent throat clearing. Antihistamines, nasal sprays, and nasal rinsing can help with allergies, as well as avoiding the allergens when possible.

4.  Side Effect of Medication

Some blood pressure medications can cause a tickle in your throat that contributes to chronic throat clearing and chronic cough. If you’re taking blood pressure medication and are frequently clearing your throat, talk to your doctor about a potential substitute.

5.  Habit

Sometimes, there may be no underlying condition causing throat clearing. It can become a habit or something you subconsciously do when anxious or stressed. To break the habit, you can drink more fluids, ask someone to help you monitor your throat clearing, or look for an alternate activity to do when the need to clear your throat arises, such as tapping your fingers. Stress management can also be very helpful.

6.  Swallowing Problems

Swallowing problems can arise for many reasons, and there are many ways to address them, depending on the exact situation. In general, difficulty swallowing can lead to throat irritation and frequent throat clearing as well as hoarseness, coughing, and choking when eating.

7. Vocal Cord Growths

When abnormal growths, such as polyps, nodules, or cysts grow on the vocal cords, you may feel as though something unusual is in the back of the throat. If you do not know that this is a physical growth, you may try to clear your throat in an attempt to dislodge the perceived object.

Causes of these growths can include smoking; allergies; overusing or straining the vocal cords from excessive singing or shouting; and frequent or strenuous coughing.

Treatment for Chronic Throat Clearing

Long-term treatment for chronic throat clearing depends on determining the underlying condition causing it. Treatment may include lifestyle changes, medications, or, in some cases, surgery.

Here are a few general tips for the treatment and prevention of chronic throat clearing:

  • Drink plenty of water to keep the throat moist, which may relieve or lessen the feeling that something has become lodged in the throat. When you feel like you want to clear your throat, take a sip of water instead. Also, increase your water intake to help thin mucus and make it easier to swallow.
  • Eat and chew slowly if you have difficulty swallowing.
  • Use a humidifier to keep the air moist, which may help reduce throat irritation.
  • Clear your throat as few times as possible. Instead of clearing your throat, hold your breath and swallow.

Find the Cause of Chronic Throat Clearing at Excel ENT of Alabama

Our Speech-Language Pathologist, Amy Pittman, is an expert at working with patients to find the cause of chronic throat clearing and treating the underlying condition. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

Lingering Loss of Smell After COVID-19? Here’s What to Do

covid-19 loss of smell

Smell is one of our five senses that we often think little about even though it’s strongly linked to emotion and memory. It can alert us to danger and works with our sense of taste to allow us to experience the flavor of food.

To lose your sense of smell (also called anosmia), and most likely your sense of taste to some extent as well, can pose several challenges, both mentally and physically. The COVID-19 pandemic has shined a light on anosmia, and doctors and scientists are still trying to figure out more about this common symptom.

Here’s information about why COVID-19 may cause us to lose these senses and some advice about how to manage it.

Loss of Smell After COVID-19 Infection

Many people wonder how common this symptom really is. A recent study collected data regarding COVID-19-related loss of smell or taste from 69,841 individuals who self-reported symptoms. The findings provide a genetic link to the biological mechanisms underlying COVID-19-related loss of smell or taste.

Of those who reported a positive test, 68% said they experienced loss of smell or taste (47,298 out of a total of 69,841 individuals). Female respondents were more likely than male respondents to report this symptom and those with this symptom were typically younger than those without it (mean age of 41 years for those with loss of smell or taste versus 45 years for those without).

While we can clearly see that a large fraction of COVID-19 patients report loss of smell or taste, the underlying mechanism is unclear. The most likely cause is that damage occurs to the cells that support and assist the olfactory neurons, called sustentacular cells. These cells can regenerate from stem cells, which may explain why smell recovers quickly in most cases.

Most often, smell dysfunction does improve soon after the infection. Approximately 90% of those affected can expect improvement within four weeks. But for others, it can take months or recovery may be incomplete. 

Tips to Help Recover Sense of Smell

Currently, there is no proven treatment for lasting smell dysfunction. Topical corticosteroid sprays are often used in the short-term for treatment, but they are unlikely to help outside of the acute illness period. 

One type of treatment that has shown promise is smell retraining therapy, or olfactory retraining. This involves exposing the patient to different strong scents for several minutes for an extended period of time. Smell retraining therapy can be effective for many different causes of smell loss, and not just from COVID.

Typically, you will smell a series of four strong scents that can be found in the home, or in the form of essential oils. Each scent is gently sniffed for 20 seconds. This process is repeated three times daily for six weeks. Long-term commitment is usually required to see improvement.

Smell training may be most effective if you work on the same four scents each day, rather than alternating. It’s also recommended that you concentrate on the scent fully, giving it your full attention, for the entire 20 seconds.

The following scents often work well:

  • ground coffee
  • rose
  • citrus
  • eucalyptus
  • vanilla
  • clove
  • mint

Another good option to consider is ginger, powdered or raw. It has a distinctive, pungent scent that makes it beneficial for use in smell training. Drinking ginger tea may also help. It can help reduce inflammation in the nasal airways and reduce excess mucus formations that block nasal passages, which may be a factor in loss of smell.

If you are unable to smell the above essences at all, try remembering what they smell like. Our brains are powerful tools and may be able to engage your senses. It does take time and commitment, but many people notice an improvement in their ability to smell within a few weeks.

Nasal irrigation can also sometimes help by flushing out allergens and mucus from the nasal cavity. This may help in COVID cases, but it can also help when other common viral upper respiratory illnesses, such as the common cold, cause dysfunction with the sense of smell.

Get More Advice About Correcting Loss of Smell from Excel ENT of Alabama

While these are methods you can try at home to help recover your sense of smell, it can be a good idea to work with an ENT, such as Dr. Davis from Excel ENT of Alabama to come up with a more specific treatment plan. We are happy to offer additional advice and options. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.


All About Nasal Congestion

nasal congestion

There are two words we hear a lot at Excel ENT all year round, but especially during these cold winter months: “nasal congestion.” While it can be short lived, and it may resolve quickly without intervention, it often comes out of nowhere and it’s usually the first of many symptoms. 

Nasal congestion can be tricky though, because there are many causes. Our doctor, Dr. Davis, wants to help you figure out not only the cause, but also a treatment plan so that you can get back to living your life without a stuffy nose! 

Causes of Nasal Congestion

Nasal congestion, which many of us refer to as a “stuffy nose,” occurs when the blood vessels inside the nose (in addition to the adjacent tissues) become inflamed and swollen with excessive fluid. This fluid is what gives the nose the feeling of being “stuffy.”

Symptoms of nasal congestion include stuffy/runny nose, nasal pain, mucus buildup, and/or nasal swelling. There could be a number of issues causing your nasal congestion symptoms, including but not limited to:

  • Allergies
  • Benign tumors
  • Chronic sinusitis
  • Common cold
  • Deviated septum
  • Flu
  • Hay fever
  • Nasal polyps
  • Sinus infection
  • Various irritants, like tobacco smoke

With so many possible causes, it is important to seek medical attention, especially if your symptoms have lasted several days without relief, or new symptoms have appeared. 

Treatments for Nasal Congestion: Home Remedies

A good place to start may be with home remedies. Some of our patients do find that these work to alleviate symptoms. 

  • Sleep with a humidifier at night. A humidifier adds moisture to the air, which can help break up mucus and soothe inflamed nasal passages. 
  • Place a warm cloth over your face.  This can also help sooth your nasal passages. You might also want to try this method while using pillows to prop your head up during the night, which can help you breathe easier. 
  • Take a hot shower. This can assist in clearing up your nasal congestion, as the steam from the shower can improve breathing by allowing the mucus to drain through the nose. 

Nasal Rinsing

Another great option you can do at home is nasal rinsing, which is the process of flushing your sinuses with a saline (saltwater) rinse. One of your nose’s primary functions is to filter air before it enters your lungs. The mucus lining your sinuses is vital to the filtration process. However, dryness and inflammation make it hard for mucus to drain, which leads to congestion and pressure. Nasal irrigation thins mucus and cleanses your nasal passages. The saline solution used in a rinse also helps restore moisture in dry sinuses. 

Performing a nasal rinse is simple, and we recommend the pre-measured sinus rinse packets from NeilMed that you mix with eight ounces of lukewarm distilled water. NeilMed offers several types of irrigation devices including squeeze bottles, a neti pot, and a battery-operated cordless pulsating nasal washer. Read more about how to perform a nasal rinse in this article.

Treatments for Nasal Congestion: When to See A Doctor

If home remedies don’t work, it may be time to see Dr. Davis so that he can give you a more specific diagnosis and treatment plan. This might include:

  • Antibiotics
  • Nasal spray, which includes an antihistamine 
  • Nasal steroid
  • Prescription-strength decongestants
  • Surgery, if caused by nasal polyps or tumors
  • Non-surgical treatment options

Nasal Polyps

For some people, the source of long-lasting congestion is nasal polyps. These are soft, painless, benign growths inside the nasal passages. When polyps are small, you may not know they’re there. However, polyps that grow in clusters can block the nasal passages and inhibit sinus drainage causing congestion.

Nasal polyps can develop in people of all ages, but they are most common in young adults and middle-age adults. Patients with prolonged inflammation from allergies, infections, or chronic sinusitis have an increased risk of developing obstructive nasal polyps. Unfortunately, polyps are a chronic problem. It’s likely that once they occur, they will persist throughout a patient’s life.

Treatment often starts with a nasal steroid spray to reduce polyp inflammation, and we may also recommend nasal rinses, but these are temporary solutions. The next option is surgical removal of the polyps, also known as sinus surgery. 

We are excited that we have a new sinus implant called SINUVA, which is a nonsurgical treatment option if a patient’s polyps return after surgery. This innovative treatment involves a sinus implant made of bioabsorbable polymers. It delivers an anti-inflammatory corticosteroid right into the polyps. The medicine shrinks the polyps, opening a patient’s airway and allowing better sinus drainage.

Address Nasal Congestion with Excel ENT of Alabama

Nasal congestion is common, but it shouldn’t be long-lasting. If you are experiencing persistent congestion, we’d love to help you find the cause and make a treatment plan. We are always happy to answer questions about nasal congestion and any other ear, nose, and throat issues. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

Causes of Chronic Cough

chronic cough

A cough that just won’t go away is one of the most common reasons for a visit to the doctor. Many people initially visit their primary care physician, but if the issue isn’t easily resolved, other doctors and specialists may become involved, such as allergists, pulmonologists, otolaryngologists (ENT), and speech-language pathologists (SLP), such as Excel ENT’s SLP, Amy Pittman.

Amy sees patients often who complain of a chronic cough. It’s annoying for the person experiencing it and others in the home, and it can disrupt sleep and cause headaches. We’re thankful that there are many ways in which Amy can help get to the bottom of the cause and find an effective solution.

Definition & Causes of Chronic Cough

According to the American Speech-Language Hearing Association, coughing helps you clear your throat and lungs and can prevent infection. But sometimes a cough can become chronic, lasting more than four weeks in children and more than eight weeks in adults. Aside from the extended duration of the cough, signs and symptoms include the frequent need to cough and having a rough-sounding voice due to that frequent coughing.

Chronic cough can be tricky because there are several possible causes. Here are the most common ones we see.

Postnasal Drip

Also called upper airway cough syndrome, postnasal drip is a common cause of a persistent cough. When a virus, allergies, dust, chemicals, or inflammation irritate your nasal membranes, they make runny mucus that drips down your throat. This makes you cough, especially at night when you lie down.


When you have asthma, the muscles around your airways tighten, the lining of your airways swells, and cells in your airways produce thick mucus. Coughing is your body’s way of trying to get air into those restricted areas and can be triggered by infections, weather, allergies, tobacco smoke, medications, exercise, and emotions.


After you have recovered from a cold, flu, or pneumonia, you may continue to have a cough as your body completely heals and gets over the infection. COVID-19, the illness caused by SARS-CoV-2, sometimes leads to lasting lung inflammation and a lingering dry cough. The prolonged cough from COVID-19 is no different than any other virus that affects your lungs. The injured parts of your lungs are trying to clear out the infection and heal.

Laryngopharyngeal Reflux (LPR)

LPR, sometimes confused with gastroesophageal reflux disease (GERD), is a condition in which acid escapes from the stomach and goes into the esophagus and throat. This causes irritation to the throat, vocal cords, and even the nasal passages. It may result in voice problems, swallowing problems, sinus drainage, the frequent need to clear the throat, and chronic cough. 

Blood Pressure Medications

ACE inhibitors for blood pressure can cause a chronic dry cough. When a patient has a persistent cough and takes an ACE inhibitor, a slight change in medication often helps resolve the cough.


Smoking damages your lungs, as well as the rest of your body. Smokers often experience chronic cough because chemicals and particles in tobacco smoke irritate the lungs. In response, the body makes mucus to try to get rid of it through frequent coughing. In all situations, we recommend stopping smoking to address a chronic cough and for many other reasons.

Irritable Larynx Syndrome (ILS)

ILS involves a range of conditions including chronic throat clearing, chronic cough, and others. With ILS, the larynx (voice box) becomes very sensitive to stimuli, such as strong smells, cold air, talking, and more. There are several possible causes, including viral illnesses that cause inflammation of the nerve that supplies the voice box, GERD, allergies, sinusitis, certain medications, environmental exposures, and stressful life occurrences.

Symptoms of ILS usually last longer than three weeks and have no other identifiable cause. Symptoms may include frequent non-productive throat clearing, chronic coughing attacks that bring up little or no mucus, and difficulty breathing with the sudden onset of stridor (noisy breathing).

Testing & Treatment for Chronic Cough

Our SLP, Amy Pittman, will likely work with you to get a comprehensive history regarding your chronic cough. She may perform a thorough laryngoscopic and stroboscopic examination to visualize patterns of vocal fold motion and vocal fold vibration. She may also test your voice to see if there are any changes in vocal quality that the cough might be causing.

We can work to find out more about what triggers your cough so that you can avoid those triggers. In some cases, treatment is straightforward, such as recommendations to stop smoking or making changes to medications. In other cases, you may need treatment for medical conditions, such as allergies, asthma, or LPR if those are triggers for your chronic cough. 

Many times, the goal of treatment for chronic cough is to give you the tools to better manage it, and Amy can teach you more about keeping your vocal cords healthy.

Address Chronic Cough with Excel ENT of Alabama

We are happy to answer questions about chronic cough and other ear, nose, and throat issues. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

Major Jumps in Hearing Device Technology You Should Know About

hearing device technology

New Hearing Device Technology at Excel ENT of Alabama


The world of hearing devices can be a little confusing. There are so many different brands and so many features to consider. While hearing aids are available by mail order or from some “big box” retailers, you are missing out on so much with those options. 

Instead of going those routes, there are several reasons why you should purchase your hearing aids directly from Excel ENT of Alabama. We provide a customized fitting for your hearing aid, which is crucial to optimum hearing success. We also stay up-to-date on the latest advancements in hearing aid technology and which hearing devices are the best. 

We are big fans of all the hearing aids we offer, and we can help you find the right one. Recently, there have been some big advancements in technology with two of our favorite brands!

New Features of Phonak Hearing Devices 

The newest Phonak hearing aids in the Paradise line feature a brand new chip (the PRISM chip). In the hearing aid world, this is a big jump in technology and provides more processing power, which translates to better, faster, and smarter. 

Phonak has also recently launched a new hearing aid in the Paradise family that is called Audeo Paradise Life. It is the first fully rechargeable waterproof hearing aid. This is important not so much for the fact that it is waterproof, but more so in terms of thinking about technology being susceptible to moisture, sweat, dust, or debris.

They have also made improvements to their Bluetooth connection. We are now able to have more devices paired to the hearing aids and have two devices actively paired at the same time. In addition, Phonak hearing aids are made for all Bluetooth connectivity. This means that if you have Bluetooth on your phone, you should be able to connect to your hearing aids for streaming phone calls and audio regardless of the specific phone you have.

There is a new processing feature within these hearing aids called Motion Sensor which simply means that the hearing aids can tell when a user is moving or walking around and will automatically change its processing of the sound accordingly.

Tap Control is another feature that can be enabled in these hearing aids which allows a patient to activate voice assistant, such as Siri or Google; accept or end phone calls; and pause/resume streaming by tapping on the hearing aid instead of having to get the phone out or press the button on the hearing aid

Lastly, Phonak also recently added a new CROS-P hearing aid that is compatible with the Paradise hearing aids. CROS hearing aids are used for patients with single sided deafness where they do not have usable hearing in one ear (also called an un-aidable ear). They also work well for patients who have normal hearing in the other ear or hearing loss that can be treated with a hearing aid.

New Features of Oticon Hearing Devices

In this line, Oticon More hearing aids are their newest option, and they have provided some interesting stats. Oticon More provides 20% more speech information compared to two of their top competitors.

Conversation is difficult in complex listening environments and then hearing loss makes it even harder. Their goal is to provide as much speech information to the brain as possible. To do this, Oticon More adapts faster to provide important details to the patient as conditions within their environment change.

Oticon also has a personalization process that I can use during an initial fitting that involves me having the patient listen to different sound clips and choosing their preferences. Based on these results, the hearing aid programming will take those preferences into consideration.

Find this New Hearing Device Technology at Excel ENT of Alabama

We are happy to answer questions about these hearing aid advancements and teach you how to use all the features. Getting a custom-fitted hearing aid can truly be a life-changing decision, and we’re here to help however we can! Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

The Driving Force Behind All Sinus Issues: Inflammation

sinus inflammation

Many patients often wonder WHY they continue to have sinus problems. What’s the root cause and the driving force behind sinus headaches, drainage, congestion, and pain? The answer is inflammation, and knowing what this means will result in a better overall understanding of your sinus issues.

More About Sinus Inflammation

Chronic sinusitis occurs when the spaces inside your nose and head (sinuses) are swollen and inflamed for three months or longer, despite treatment.

This common condition interferes with the way mucus normally drains, and makes your nose stuffy. Breathing through your nose may be difficult, and the area around your eyes might feel swollen or tender.

Chronic sinusitis can be brought on by an infection, by growths in the sinuses (nasal polyps), or by swelling of the lining of your sinuses. Also called chronic rhinosinusitis, the condition can affect both adults and children.

Common signs and symptoms of chronic sinusitis include:

  • Nasal inflammation
  • Thick, discolored discharge from the nose (runny nose)
  • Drainage down the back of the throat (postnasal drainage)
  • Blocked or stuffy (congested) nose causing difficulty breathing through your nose
  • Pain, tenderness and swelling around your eyes, cheeks, nose, or forehead
  • Reduced sense of smell and taste

Other less common signs and symptoms can include:

  • Ear pain
  • Headache
  • Aching in your upper jaw and teeth
  • Cough or throat clearing
  • Sore throat
  • Bad breath
  • Fatigue

Chronic sinusitis and acute sinusitis have similar signs and symptoms. However, acute sinusitis is a temporary infection of the sinuses often associated with a cold. The signs and symptoms of chronic sinusitis last at least 12 weeks, but you may have several episodes of acute sinusitis before developing chronic sinusitis. 

Many things can cause inflammation that leads to sinus issues, such as:

  • Deviated nasal septum — A crooked septum, the wall between the nostrils, may restrict or block sinus passages, making the symptoms of sinusitis worse.
  • Respiratory tract infections — These types of infections are most commonly colds, and they can inflame and thicken your sinus membranes and block mucus drainage. These infections can be viral, bacterial, or fungal.
  • Nasal polyps — These are painless, benign growths inside the nasal passages. Prolonged inflammation and swelling of the sinuses from infection and allergies may increase your likelihood of developing polyps.
  • Allergies — Inflammation that occurs with allergies can block your sinuses. 
  • Regular exposure to pollutants — Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages.

How Inflammation Causes Sinus Symptoms

Pain in your sinuses — Pain is a common symptom of sinusitis. You have several different sinuses above and below your eyes as well as behind your nose. Any of these can hurt when you have a sinus infection because inflammation and swelling cause your sinuses to ache with a dull pressure. You may feel pain in your forehead, on either side of your nose, in your upper jaws and teeth, or between your eyes. This may lead to a headache.

Nasal discharge — When you have a sinus infection, you may need to blow your nose often because of nasal discharge, which can be cloudy, green, or yellow. This discharge comes from your infected sinuses and drains into your nasal passages. The discharge may also bypass your nose and drain down the back of your throat. You may feel a tickle, an itch, or even a sore throat. This is called postnasal drip, and it may cause you to cough at night when you’re lying down to sleep and in the morning after getting up. It may also cause your voice to sound hoarse.

Nasal congestion — Your inflamed sinuses may also restrict how well you can breathe through your nose. Infections cause swelling in your sinuses and nasal passages. Because of the nasal congestion, you probably won’t be able to smell or taste as well as normal. Your voice may sound “stuffy.”

Sinus headaches — The ongoing pressure, swelling, and inflammation in your sinuses can give you symptoms of a headache. Sinus pain can also give you earaches, dental pain, and pain in your jaws and cheeks. Sinus headaches are often at their worst in the morning because fluids have been collecting all night long. Your headache can also get worse when the barometric pressure of your environment changes suddenly.

Throat irritation and cough — As the discharge from your sinuses drains down the back of your throat, it can cause irritation, especially over a long period of time. This can lead to a persistent and annoying cough that can make sleeping difficult. Sleeping upright or with your head elevated can help reduce the frequency and intensity of your coughing.

Sore throat and hoarse voice — Post nasal drip can leave you with a raw and aching throat. Although it may start as an annoying tickle, it can get worse. If your infection lasts for a few weeks or more, the mucus can irritate and inflame your throat as it drips, resulting in a painful sore throat and hoarse voice.

How to Lessen Inflammation & Improve Sinus Issues

Avoiding things that irritate your nose and sinuses can help decrease sinusitis. While this is not always possible, there are several lifestyle changes and at-home strategies you can try, such as:

  • Using a cool-mist humidifier
  • Nasal rinsing several times per day
  • Wearing a pollen mask when mowing the grass or cleaning the house
  • Keeping windows closed when pollen counts are high
  • Using HEPA filters in your vacuum
  • Changing heating and air conditioning filters often
  • Avoiding nasal irritants, such as smoke, perfume, aerosol sprays, smoke, smog, and car exhaust
  • Washing bedding often; ideally weekly in hot water

Treatments for Sinus Issues at Excel ENT

If you have had sinusitis several times, and the condition doesn’t respond to treatment; if you have sinusitis symptoms that last more than 10 days; or if your symptoms don’t improve after you see your regular doctor, it’s time to see an ENT specialist, such as Dr. Davis. 

He may have new at-home remedies to suggest, and he may feel that there are other treatment options that may be beneficial. Which treatment option may be right for you will vary greatly depending on your specific situation, including what is causing your sinus problems. Here are a few of our treatment options.

Balloon Sinuplasty 

This treatment promotes sinus drainage through a minimally invasive technique for mild to moderate chronic and recurrent sinusitis. During the procedure, Dr. Davis threads a small catheter through the sinus opening and inflates a balloon with water. The balloon dilates the sinus opening and widens the outflow tract, which encourages it to drain. The procedure is a quick, non-invasive way to improve drainage, reduce the potential for bacterial infections, and improve breathing. Numerous studies have shown that 90 to 95% of balloon sinuplasty patients benefit from the procedure for at least two years.

Functional Endoscopic Sinus Surgery

This is a procedure we use to treat moderate to severe sinus problems. If you’re no longer responding to treatments like nasal irrigation, antibiotics, and decongestants, you may be a good candidate. During the procedure, Dr. Davis uses an endoscope to locate and remove bone and tissue in the sinuses that are preventing drainage. Sinus surgery creates larger drainage pathways to reduce the chances of mucus buildup after recovery. General anesthesia is often required for the procedure, which usually takes between one and three hours. Recovery is typically quick, with very little pain.


This is an innovative treatment for nasal polyps. For many people, nasal polyps are a chronic problem that persists throughout their lives with symptoms such as runny nose, congestion, sinus pressure, postnasal drip, snoring, headaches, and more.

SINUVA is a non-invasive nasal implant that delivers an anti-inflammatory corticosteroid (mometasone furoate) directly to the polyps. Dr. Davis can place the SINUVA implant in the office if you have had previous endoscopic sinus surgery. The implant stays in place for approximately 90 days, after which he will remove it. SINUVA successfully reduces polyp inflammation without surgical intervention.

VIVAER Nasal Airway Remodeling

The VIVAER treatment, performed in our office, is a non-invasive procedure that involves no cutting. Your nasal valve area is gently and permanently reshaped using low-temperature radiofrequency energy. Immediately after treatment, you’ll begin to experience a noticeable improvement in nasal breathing.


The nasal septum is the wall between the nostrils that separates the two nasal passages, and problems in this area can make breathing difficult. Surgery to straighten the septum is called a septoplasty, or deviated septum surgery.

The procedure usually takes 60 to 90 minutes and is performed in an outpatient surgery center. Before the surgery, we look at your nasal passages and view the shape of your septum. Dr. Davis then uses surgical tools to enter the nostrils and straighten the septum.


Dupixent is a new biologic option to treat and manage sinus conditions for those who may have been candidates for sinus surgery in the past. It is a game-changer for managing sinus disease! 

Dupixent is a treatment used with other medicines to treat chronic rhinosinusitis with nasal polyposis in adults to reduce the size of nasal polyps, improve congestion, improve loss of smell, and reduce the need for surgery.

Discover how the team at Excel ENT of Alabama can help manage inflammation and sinus issues.

If you are experiencing sinus issues, schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

Do You Have Good Vocal Hygiene?

vocal hygiene

When you think of “good hygiene” you may immediately come up with washing your hands, brushing your teeth, showering often, and keeping your nails clipped. But did you realize that there is such a thing as “vocal hygiene,” and that it’s very important for your ability to speak and communicate?

We use our voices constantly, although some jobs, professions, and roles may require more speaking. We all have the risk of developing voice problems, but people who use their voices more often may have an increased risk. An estimated 17.9 million adults in the U.S. report problems with their voice, but some of these disorders can be avoided by taking care of your voice, according to the National Institute on Deafness and Other Communication Disorders.

So what should you be on the lookout for, and how can you keep your voice healthy?

What Is Vocal Hygiene?

Your vocal cords are two tiny muscles covered with layers of tissue, and they are very delicate. When you speak, your vocal cords vibrate to produce sound. Any problems with the vocal cords significantly impact the voice. This might include growths on the vocal cords, infections, or improper use of the vocal musculature.

Good vocal hygiene encourages your vocal cords and voice are working properly with no problems. Signs that you have a voice problem might include:

  • Hoarse or raspy voice
  • Lost ability to hit some high notes when singing
  • Voice that suddenly sounds deeper
  • Throat that often feels raw, achy, or strained
  • Talking has become an effort
  • Repeatedly feeling the need to clear your throat

What Causes Voice Problems?

There are many things that can cause voice problems such as:

  • Upper respiratory infections
  • Inflammation caused by gastroesophageal reflux (sometimes called acid reflux, heartburn, or LPR)
  • Vocal misuse and overuse
  • Growths on the vocal folds, such as vocal nodules or laryngeal papillomatosis
  • Cancer of the larynx
  • Neurological diseases (such as spasmodic dysphonia or vocal fold paralysis)
  • Psychological trauma

Most voice problems can be reversed by treating the underlying cause or through a range of behavioral and surgical treatments. In some cases you have little or no control over what’s happening to your voice, but in other instances, there are several healthy habits that will help you have good vocal hygiene.

Improve Your Vocal Hygiene

  • Stay hydrated — Drink plenty of water, especially when exercising. If you drink caffeinated beverages or alcohol, balance your intake with plenty of water.
  • Take vocal breaks — Rest your voice throughout the day.
  • Use a humidifier in your home — This is especially important in winter or in dry climates.
  • Avoid or limit use of certain medications — Some medications may dry out the vocal folds, including some common cold and allergy medications. If you have voice problems, ask your doctor which medications would be safest for you to use.
  • Don’t smoke and avoid second-hand smoke — Smoke irritates the vocal folds. Also, cancer of the vocal folds is seen most often in individuals who smoke.
  • Avoid spicy foods — Spicy foods can cause stomach acid to move into the throat or esophagus, causing heartburn or laryngopharyngeal reflux (LPR).
  • Eat healthy foods — Include plenty of whole grains, fruits, and vegetables. These foods contain vitamins A, E, and C that help keep the mucus membranes that line the throat healthy.
  • Hand hygiene — Wash your hands often to prevent getting a cold or the flu.
  • Get enough rest — Physical fatigue has a negative effect on voice.
  • Exercise regularly — Exercise increases stamina and muscle tone which will help provide good posture and breathing, which are necessary for proper speaking.
  • Try not to overuse your voice — Avoid speaking or singing when your voice is hoarse or tired.
  • Avoid using the extremes of your vocal range — This includes screaming or whispering, both of which can stress your voice. Consider using a microphone when appropriate.
  • Practice good breathing techniques — When singing or talking, support your voice with deep breaths from the chest, and don’t rely on your throat alone. Talking from the throat, without supporting breath, puts a great strain on the voice.

Let Excel ENT Help You Improve Your Vocal Hygiene

No matter what voice problems you may be experiencing, our Speech-Language Pathologist, Amy Pittman, is experienced in treating voice problems, and she can teach you how to use your voice in a healthy way.

She may conduct an examination using video laryngoscopy to see your throat, larynx, and vocal cords. The short procedure involves putting a tiny camera through the lower nasal passage to reach the throat. You will be awake so that you can speak, which helps Amy see the vocal cords while they vibrate and move. The procedure isn’t painful and lasts less than one minute.

Amy will be able to see if there are any growths or signs of an infection. She also watches how you use your voice and whether there’s tension in the muscles. Then, she’s able to determine whether you would benefit from voice therapy or if other medical or surgical treatment is needed.

If you or your loved one are experiencing voice problems, we can help. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.