12 symptoms that otolaryngologists say you should never ignore

Your ears, nose, and throat may be trying to tell you something.

You may see an ear, nose, and throat (ENT) doctor for frequent sinus infections. Someone else might see one because of a thyroid tumor, a voice that doesn't return after a cold, or trouble breathing during sleep. All of them are under the authority of the ear, throat and nose.

These doctors, who are officially called otolaryngologists, treat diseases related to the ear, nose, throat and most of the head and neck. This includes problems that affect your hearing, swallowing, breathing and voice – and some that require immediate care. "A lot of people think, 'Oh, yeah, there's no otolaryngology emergency,' and there definitely is," says Dr. Ryan Salvador, an otolaryngologist at Sinus and Snoring Specialists in Austin.

We asked three otolaryngologists what they wish patients would ignore.

You answer your phone and realize that you can barely hear your friend's voice in your left ear. Go to your right and everything looks normal. Salvador says it's tempting to assume that muffled ears must jump. But a sudden change in hearing can be a medical emergency.

One possibility is sudden sensorineural hearing loss that affects the inner ear. Salvador knows how easily it can be mistaken for something else: His father went to urgent care and was told he had fluid behind his eardrum. By the time he saw the ear, nose and throat, about eight weeks had passed. "He's completely deaf in that ear now," Salvador says.

An otolaryngologist can examine the ear and order a hearing test to find out what is causing the loss. If it's sudden sensorineural hearing loss, steroids may help — but, as Salvador says, "the sooner the better." If you experience sudden hearing loss, even if you feel full in your ears or have recently had a cold, seek medical attention immediately.

You may discover it while shaving when your razor passes over a spot that suddenly isn't straight. Or maybe you notice an unfamiliar bump in the mirror. Since it doesn't hurt, you decide it can't be that serious.

Dr. Arnbjorn Tost, director of head and neck surgery at Good Samaritan University Hospital and Catholic Health in New York, hears this argument from patients: "Doctor, it's not going to hurt me. I don't have any symptoms." But pain is not a reliable way to judge a neck mass. It may be a large lymph node, a thyroid nodule, or a growth in a salivary gland. But some lumps are cancerous.

Dr. Sean Desai, chief of otolaryngology at New York Medical College and Westchester Medical Center in New York, remembers a medical student who thought his lump was related to a cold. "He sat on this lump in his neck for eight months," says Desai. It turned out to be a salivary gland tumor. If a new lump doesn't have a clear explanation or is still there after two weeks, make an appointment.

A sore throat is hardly unusual. One that progresses from "this hurts" to "I can hardly swallow" is another matter. Salvador is of particular interest when the pain keeps getting worse and you also have trouble opening your mouth or hoarseness. "You talk like you have a hot potato in your mouth," he says.

These changes could indicate an abscess—a pocket of pus that forms around the tonsil. "These can be life-threatening," says Salvador. If swelling makes breathing difficult, seek emergency care. Worsening of the sore throat with difficulty swallowing, opening the mouth, or speaking normally also requires immediate evaluation.

Your partner says he can't breathe at night

Your partner hears you snore. Then, suddenly, nothing. After a pause, you gasp and start breathing again. Until the morning, you may not realize it happened.

Snoring may be what your partner is complaining about. Desai wants to know about silence. The bigger concern is whether your partner won't breathe for a few seconds. he says Frequent pauses can be a sign of obstructive sleep apnea, in which the airway narrows or closes during sleep. You may wake up tired despite spending the whole night in bed. Untreated sleep apnea can also contribute to high blood pressure. Desai worries about people who become so sleepy during the day that they stay awake while driving.

Tell your doctor about pauses, shortness of breath, and any sleepiness during the day. A sleep study can reveal whether apnea is the cause. As Desai says, "Apnea is the bigger question and can be dangerous if left untreated."

Swelling around the eyes during a sinus infection

Sinus pressure can cause pain around the eyes. What Salvador doesn't want you to talk about with regular sinus misery is this new storm around the eye — especially if the area is red or your vision changes.

"The only thing that separates the sinus cavity from the eye is a very thin bony plate," he says. Rarely, the infection spreads to the tissues around the eye. Salvador has treated patients whose infections created cavities of pus that had to be drained to protect their vision.

Get immediate medical attention for a newly swollen eye during a sinus infection. If you develop double vision or trouble moving your eyes, seek emergency care. Don't wait for these symptoms to appear: Diplopia is "a very late sign," Salvador says.

Halfway through the meal, you notice a sensitive bump under your jaw. It settles later—then comes back the next time you eat.

This pattern can indicate a blocked salivary gland, says Tost. Eating produces saliva, but stones can prevent saliva from draining and cause the gland to swell. It may also be painful or red.

If it still happens, check it. The cause is often benign, but an exam and sometimes imaging can distinguish a stone from another problem in the gland, Tost says. If the swelling keeps coming back, check the tuber - even if it goes down between meals

You've been talking all weekend, you've recently caught a cold. Your voice certainly sounds hoarse—or maybe it's strangely breathy and you can't project like you used to. Desai says these are reasonable explanations for a temporary change. When you are less confident, the sound is not restored

Salvador remembers a teacher who struggled to speak out loud for his class. "I can't project," she told him. When he examined her, he discovered that one of her vocal cords was not moving properly due to a thyroid tumor. Persistent hoarseness can have other explanations, including irritation or a benign growth, but an otolaryngologist must look for it to find out.

If hoarseness lasts four weeks, see an otolaryngologist sooner - if you smoke or have other worrying symptoms. Your doctor may pass a small camera through your nose to look at your vocal cords. If that sounds daunting, Desai says the administrative exam "only takes a minute or two."

Prostheses that suddenly do not fit easily

Your dentures fit last month. Now every time you put them on they rub the same spot or don't fit quite right. You may need moderation - or someone to look at what's going on underneath.

New discomfort may draw your attention to "a small sore at the gum line," says Tost. Rubbing can cause scarring, but growth in the mouth can also change the way the denture fits. This is one possible symptom of oral cancer, although there are other explanations.

Ask your dentist to examine the tissue under the denture, especially if the wound has not healed after two weeks. They can check what has changed before adjusting the fit.

Most nosebleeds start from the front of the nose and stop with pressure. Bleeding that begins further away is more difficult to control. The blood vessels there can "pump and pump and pump," Salvador says, "and blood may come out of the back of your throat." Doctors call this posterior nosebleed.

If your nose starts to bleed, lean forward and apply steady pressure to the soft part for 15 minutes. If the bleeding is heavy or does not stop, or you feel weak or light-headed, seek emergency care.

A nosebleed that stops may still be worth investigating if it recurs. Salvador remembers a 30-year-old man who had a nosebleed about 6 months before being examined for an intranasal tumor. It's an uncommon cause, but it's a good reason to tell your doctor about frequent bleeding — especially if it's on the same side.

Your ear hurts, so you probably have an ear infection, right? Not necessarily. Sometimes during the examination there is no problem in the ear itself. Nerves in the head and neck carry the signal from somewhere else, and sometimes, "your brain tricks you" as to where it originated, Tost says.

The source may be your jaw joint, which is just in front of your ear. Less commonly, it could be a problem with your throat or the base of your tongue. If the pain persists despite a routine ear exam, ask your doctor what else should be checked — especially if it hurts to swallow or you've noticed a lump in your neck.

Colds and allergies can make your entire nose miserable. An obstruction that only sticks on one side catches Desai's attention. "When you can't breathe through one nostril, it's always a little more stressful," he says.

The explanation may be a deviated septum, but growths inside the nose or sinuses can also block one side. Desai worries about the delay when people tell themselves, "Oh, it's a cold," or "I just have a bloody nose." If the blockage is more than what appears to be a common cold—especially if that side also bleeds frequently—get it checked out.

Most small mouth ulcers go away within a week or two. You are more concerned about one that stays put, grows, or becomes increasingly painful – especially around the tongue.

He remembers seeing a young woman in the emergency room one Friday night. He had swelling in his neck and the doctors who called you thought it might be an abscess. During the examination, he noticed a wound on the side of his tongue. He had seen dentists and other specialists, and previous biopsies were benign, but the ulcer had remained for about six months.

"I had a biopsy. The biopsy was negative, so I left it alone," Tost remembers him telling her. He examined the wound and became concerned. "I had to cut it open for him," she says. Another biopsy confirmed it. The swelling in her neck was where the cancer had spread.

If the lesion is still present, a reassuring biopsy should not be the end of the conversation. According to the American Academy of Otolaryngology-Head and Neck Surgery, any mouth ulcer that has not healed after two weeks should be evaluated.