Surgeon Interviews
INTERVIEW WITH DR. WAYNE SHAIA
TOPIC: WHAT IS OTOLARYNGOLOGY?
Julie: Hi, I am Julie Bragg and I am here with Dr. Wayne Shaia, and you are an otolaryngologist. What does that mean?
Dr. Shaia: Otolaryngology is a regional specialty of the ears, the nose, and the throat. So, we handle all problems that deal with ears, with balance, nose, sinus infections, as well as any issues with the throat and swallowing.
Julie: What do you do most commonly?
Dr. Shaia: I deal mostly with vertigo, balance, and any aspect of ear disease.
Julie: How do you treat vertigo?
Dr. Shaia: Vertigo simply means dizziness or spinning sensation. Often people get that diagnosis, and they think that is what they have, when indeed there is something causing it. So, there are many different things that cause vertigo, from something called Ménière’s disease, positional vertigo, migraine headaches can also cause it; there is a whole laundry list we go through to sort of figure out what is causing the vertigo and then we can treat our patients.
TOPIC: UNDERSTANDING VERTIGO
Julie: Hi, I am Julie Bragg and I am here with Dr. Wayne Shaia, and you are an otolaryngologist.
Dr. Shaia: Yes Ma’m.
Julie: What does that mean?
Dr. Shaia: Otolaryngology is a regional specialty of the ears, the nose, and the throat. So, we handle all problems that deal with ears, with balance, nose, sinus infections, as well as any issues with the throat and swallowing.
Julie: What do you do most commonly?
Dr. Shaia: I subspecialized in just ears, so I deal mostly with vertigo, balance, and any aspect of ear disease.
Julie: How do you treat vertigo?
Dr. Shaia: Well, first, when you are treating vertigo, you need to isolate the cause of the vertigo. Vertigo simply means dizziness or spinning sensation. Often people get that diagnosis and they think that that is what they have, when indeed there is something causing it. So there are many different things that can cause vertigo, from something called Ménière’s disease, positional vertigo, migraine headaches can also cause it, there is a whole laundry list we go through to sort of figure out what is causing the vertigo and then we can treat our patient.
TOPIC: TREATMENTS FOR VERTIGO
Julie: What are some of the treatments for vertigo?
Dr. Shaia: Well, once we have diagnosed the cause of vertigo, then we can start treating it. So, for someone with Ménière’s disease, which is a type of vertigo where you have low frequency hearing loss, ringing in the ear, and dizzy spells that last several hours, we start with the medical management. We might start off with a mild fluid pill and a low salt diet and if that does not take care of the vertigo then we move into other surgical options for it.
Julie: You mentioned hearing loss. What are some of the things you do to treat hearing loss?
Dr. Shaia: Well, first when someone comes to us for hearing loss, we have to diagnose whether it is nerve damage, or whether or not they have a surgical correctible form of hearing loss. Oftentimes the bones that convey the hearing in the middle ear become fixed, and a simple operation can remove those bones, put in a prosthetic ear bone, and the hearing can come back to a near normal level. Most people, though, do have nerve damage, and the technology of hearing aids has become so advanced now, there are several different options that can help them with their hearing loss.
Julie: That has got to be gratifying for you when you restore that hearing to someone. I can only imagine what that is like, when somebody gets that back.
Dr. Shaia: Correct. Hearing restoration is the goal, and with the new technology we have moved into other forms of hearing loss—uh, excuse me.
Julie: That’s all right.
Dr. Shaia: Hearing restoration is the goal, and it used to be that when people or children were born deaf, that they didn’t really have any other options other than the traditional sign language schools, and alternate forms of education. Fortunately now if the child is born deaf and we recognize it early we can implant something called the cochlear implant into their inner ear, and they can go to mainstream kindergarten with your child and my child, so we have really come a long way in the last 20 or 30 years with hearing loss.
Julie: Any other things or advancements in technology that have changed the way you take care of your patients?
Dr. Shaia: Absolutely. Also, when patients lose hearing in one ear, which does happen to folks, they suddenly lose hearing in an ear due to a viral infection, we can also implant or surgically implant something called a bone-anchored hearing aid device, there are several on the market, and with this device they are able to at least get some input from their deaf side, which allows them to localize sound better, as well as hear their environment a little bit more normally, and it has really made a big change in a lot of peoples’ lives.
TOPIC: THE WHEELS PROGRAM
Julie: Stony Point Surgery Center is sponsoring The Wheels Program, which I work with, where we are doing hearing screenings on preschool children. How does a parent recognize if their child might have hearing loss?
Dr. Shaia: Well, in Virginia, in the state of Virginia as well as in many other states, all children are screened for hearing loss at a very young age, usually typically while they are still in the hospital, and if they pass that screening there really isn’t anything else that the parents usually need to worry about until they see some signs. Some of the signs they may see is a child who doesn’t pay attention, a child who they have to reprimand a lot, or a child with a speech deficiency, and that is usually either picked up when they make it to grade school or if they have a good preschool that they are in, the teachers may start recognizing a speech impediment or a speech delay, I should say, and start asking them to refer them to someone who can at least test their hearing, or to a Wheels Program, which is a screening program for children. So I know the Wheels Program has helped out many children in the Richmond area. I have seen several in my office who have been screened and we have located some hearing loss or identified some hearing loss and we were able to make a difference in these children. The key is finding the hearing loss early. The earlier you find it, and the earlier the detection, the better chance you have of having a child at a normal speech pattern as well as a normal life.
Julie: Is there any hope as far as the treatment end to catching it early? Or is it just fixing the problem so they can continue to develop. You know what I mean, they are not missing things as they are going along?
Dr. Shaia: Well, once we identify it early, we can then instill hearing aids or place a child in hearing aids and we do that as young as four months of age, and again, if they have complete deafness, we would set them up for what we call a cochlear implant, which is a device that we place into the ear, right into the cochlear, which is the hearing organ of the inner ear, and with proper programming the children do quite well.
TOPIC: WHAT CAUSES RINGING IN THE EARS?
Julie: What causes ringing in the ears?
Dr. Shaia: Ringing in the ears is a very common problem. Most of the time it is caused by high frequency hearing loss. And most of the time, ringing in the ears or tinnitus or “tinnitus”, either way you want to call it, doesn’t cause a person much trouble. We need to do a routine hearing test, make sure the hearing is symmetric, and then we can go into some medical management If the ringing in the ear is actually causing a problem with their lifestyle.
TOPIC: ANATOMY OF THE EAR
Dr. Shaia: This is the anatomy of a typical ear. It can be divided into three sections: the outer ear, the middle ear, and the inner ear. The outer ear consists of the portion of the ear that you see as well as the external ear canal and eardrum or tympanic membrane. The middle ear houses the three bones that help us hear and this is where fluid can accumulate that causes inner ear infections. The inner ear has our balance organ as well as our hearing organ, the cochlea, and helps us with our balance and hearing. This is the area where the nerves receive information and plugs into the brain. The middle ear is what we will focus on as this is where the fluid accumulates and the need for ear tubes arises. The eustachian tube which is highlighted now is the culprit or cause of ear infections. In children the eustachian tube does not become fully functional until around age 7 or 8. The eustachian tube is responsible for regulating the pressure and fluid that accumulates in the middle or ear space. If this tube does not work properly, then fluid will accumulate, and ear infections will occur. Sometimes the fluid is thin and can escape, but oftentimes the fluid becomes thickened and stays in the middle ear space. This can cause hearing loss as well as recurrent infections.