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Amanda W. has lived in Murfreesboro for 15 years and uses Murfreesboro Medical Clinic for all of her family’s medical needs. She appreciates the convenience of having accessible doctors close by to fit her family’s busy schedules. 

In June of 2018, she was referred to Dr. Brannon Mangus, one of MMC’s Comprehensive ENT Specialists, after her primary care physician examined a swollen lymph node in her neck.  Dr. Mangus quickly scheduled surgery for Amanda, and was able to give her the diagnosis of Stage One Non-Hodgkin's Lymphoma.

Non-Hodgkin's Lymphoma is a cancer that starts in the lymphatic system of the body. The condition occurs when the body produces too many abnormal lymphocytes, a type of white blood cell. Many times,it is first noticed by the patient or their PCP when they feel a swollen lymph node in the neck. Surgical removal of the lymph node is not a cure, but rather is necessary to diagnose what type of lymphoma it is.

“He came in, shook my hand, sat down with me,got on eye level with me, and explained to me that we did not have the news that we had hoped for; however, he assured me that this was a season -- this was not going to be my life. We were going to get through this and move forward to the next step.”

Although Amanda was devastated by this unfortunate news, she was comforted by Dr. Mangus and his staff and the time they took to encourage her.

“Dr. Mangus showed that he really cared and that I wasn’t just a patient. He really cared about my health and my well-being.”

Amanda’s initial scans, surgery and diagnosis were all obtained at MMC.

“It was so nice to just be 15-20 minutes down the road because I would be at the doctor’s office sometimes twice a week.”

Amanda was able to continue on with her life and caring for her kids, even in the midst of her treatment. 

“I felt like they really cared. They knew me by my name, they knew me by my face, they knew my story.”

Today, Amanda is in remission and is living a happy, healthy life. She and her family still use Murfreesboro Medical Clinic for all of their healthcare needs and are grateful for the care they received at MMC by Dr. Mangus and his staff.

Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT

The state of Tennessee has lifted the stay-at-home orders inmost areas, and the weather is heating up. Pools are opening here in Murfreesboro, and the lakes are overflowing with people going outside to rediscover a sense of normalcy here in Middle Tennessee. However, frequent water activities and humidity can lead to an increase in water related ear infections.

The type of ear infection that can present when habitually around water or humidity is called otitis externa, or more commonly, swimmer’sear.  Otitis externa simply refers to the inflammation of the outer ear, which can include the ear canal or auricle.  Children ages 5-15 have the highest likelihood of developing swimmer’s ear, but persons of any age can be affected. Signs and symptoms include pain,drainage, itching of the ear, and decrease in hearing.  The ear has several inherent defense mechanisms to protect itself, including hair follicles and cerumen (ear wax).  Cerumen is important because it is an acidic medium that helps inhibit the growth of both bacteria and fungus. Water or excess moisture leads to cerumen breakdown which changes the flora and acidity of the ear canal, making it more susceptible to infection. Frequent water exposure is the most well-known risk factor for swimmer’s ear infections, but anything that causes cerumen destruction or trauma to the ear canal can also stimulate an infection.  Therefore, Q-tip use is discouraged!

The most common causes of a swimmer’s ear infection are bacterial, fungal or dermatologic (i.e. related to skin conditions). Each of these types of infections is treated differently, and therefore requires a thorough ear, or otoscopic, examination for differentiation. The otoscopic examination is also important to assess for other possible diagnoses like otitis media and tympanic membrane perforation. Some mild forms of otitis externa with only mild drainage and swelling may only require antibiotic ear drops for treatment. Other more severe infections that severe pain, edema, and hearing loss may need more extensive cleaning, a wick to relieve an occlusion, an ear culture, or even a hearing test.

All our providers at Murfreesboro Medical Clinic ENT are specially trained to diagnose and treat these ear infections, so if you need our services feel free to call and arrange an appointment.

Recommended at home treatment and prevention for swimmer’sear:

  • Dry ears out with hairdryer after swimming
  • Consider fitted ear plugs for swimming (can be fitted for you at your Murfreesboro Medical Clinic ENT appointment)
  • Homemade ear drops with half rubbing alcohol, half vinegar can help to evaporate water in the ears and prevent a swimmer’s ear infection
  • If a perforation (hole in the eardrum) or ear tubes are in place, consult with your Murfreesboro Medical Clinic ENT doctor before using ear drops
  • Do not use q tip or other foreign bodies to clean ear wax






Chad Richardson, FNP-C - MMC Comprehensive ENT Specialists

Chad Richardson moved to Rutherford County to attend college at Middle Tennessee State University in 1999. He currently lives in Murfreesboro with his family, including his daughter and son. His interests include hiking, baseball, hunting, fishing, and golf. 

Chad studied nursing, and received his bachelor's degree from Middle Tennessee State University in 2004.  While completing his bachelors he began his MMC journey by working in the Pediatric department. After graduation he then left the clinic to work in Vanderbilt Pediatric Emergency Room.  After 3 years away from the clinic he then returned to work at MMC in 2007 and worked both in the PACU and OR in the SurgiCenter.  While working in the SurgiCenter, he then completed his master's degree studies from Tennessee State University, and became a board certified nurse practitioner in 2018. 

Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT

Learning to Hear Again

July 15th, 2020

Purchasing hearing aids for the first time starts you on a path of rehabilitation similar to other conditions that require someone to learn a new set of skills.

Very commonly, a person with hearing loss has forgotten everyday specific sounds such as the refrigerator hum, a clock ticking, the toilet flushing.  Or even sounds that connect them to their world such as their grandchild’s laughter, the pastor at church, or hearing their friends at the local Bridge Club. 

We’ve all been in a movie theater on a bright, sunny day.  When we leave the dark theater and into the sunlight, it can be overwhelmingly bright.  You reach for your sunglasses and shield your eyes, but this uncomfortable sensation only occurs for a few hours.

A similar sensation occurs when you wear hearing aids for the first time.  You may not have experienced the “brightness” of hearing in a long time, and can be“overwhelmed” with all the renewed sounds. This is where the experience and knowledge from one of our Audiologists come into play.  We can help you set appropriate expectations of your new hearing journey, allowing you to adapt and enjoy the experience.  Adapting to your new hearing aids is not an overnight process. With patience, guidance, and effort, appropriate expectations can be set and learning to hear again can become a life changing experience.






By MMC Audiologist Megan Shissler, Au.D., CCC-A

Megan is originally from the western suburbs of Chicago, but is very excited to relocate to middle Tennessee with her husband.  Megan earned her Doctorate of Audiology degree in 2013 from Illinois State University.  Since then, she has worked for one of the top hearing aid manufacturers performing research and development for upcoming hearing aid technology and various ENT clinical settings across the Chicago land area.  In her free time she enjoys spending time with her husband and stepson, cooking, shopping and cheering for the Chicago Cubs!

Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT

Vocal Cord Hemorrhages

July 8th, 2020

There are very few emergencies that can occur regarding the voice. We will focus on one of these today – vocal cord hemorrhage. A vocal cord hemorrhage occurs when a blood vessel within the vocal cord ruptures causing blood to collect within the layers of the vocal cord. This can occur when a voice is used in an extreme manner such as with screaming, singing, or prolonged talking engagement. Knowledge of this topic is particularly important for professional voice users such as singers, lecturers, and teachers. Not knowing the signs and symptoms of a vocal cord hemorrhage can lead to permanent voice changes.

In general, a vocal cord hemorrhage can occur when the voice is being abused such as screaming or a prolonged singing session. Symptoms generally involve a sudden voice change or a total loss of voice. Often patients will experience a sudden onset of pain on one side of their neck.Prompt diagnosis of vocal cord hemorrhage is important. If you experience a sudden change in voice, it is advised that you not try to “push through” the performance. It is advised that you rest your voice and contact your voice physician for evaluation. Patients who are taking blood thinners such as aspirin, clopidogrel, enoxaparin, or warfarin are at a higher risk for vocal cord hemorrhage.

Prompt diagnosis of a vocal cord hemorrhage is important. If you continue to sing or speak, this can lead to scarring or even permanent voice changes. Treatment often involves total rest of the voice until the blood can be reabsorbed. Patient's will often be treated by their voice specialist byway of repeated endoscopies. With proper voice rest and treatment, patients are able to resume normal voice function without ill effect.

As always, we encourage you to speak with your ENT or Voice Specialist if you have any questions or concerns about vocal cord hemorrhage.








By Andrew Celmer, M.D. - MMC Comprehensive ENT Specialists


Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT

Sudden Hearing Loss

July 1st, 2020

Approximately 48 million Americans have some degree of hearing loss. While it is fairly common, that doesn’t lessen the difficulty.We’re here to answer any questions you may have and give our words of advice.

I woke up this morning and could not hear. What should I do?

Sudden hearing loss can be a very scary thing.  If your hearing returns to normal in a few seconds to minutes, continuing to monitor and observe for additional or worsening symptoms is reasonable. However, if symptoms last 24 hours or more, further evaluation from an ENT provider is recommended. Dizziness and tinnitus (ringing in ears) may also accompany the hearing loss.

How hearing loss is diagnosed:

A prompt initial assessment and audiogram are the first steps in evaluating hearing loss. AAO-HNSF guidelines advise getting audiometric testing as soon as possible after symptom onset but for certain within the first 2 weeks. There are 3 types of hearing loss, sensorineural, conductive, and mix of these two.

  • Conductive hearing loss occurs when there is an issue transporting sound waves through the outer or middle ear. This would include the ear canal, tympanic membrane, or ossicles. Examples include ear infection, cerumen impaction, and eustachian tube dysfunction.
  • Sensorineural hearing loss occurs when the origin of the problem occurs in the inner ear or the vestibulocochlear nerve. Common causes of sensorineural loss include aging, noise exposure, viral infection, medications or even tumors.
  • Mixed hearing loss is a combination of both conductive and sensorineural loss.

Further Evaluation and Treatment

Distinction your type of hearing loss is very important in determining treatment. Treatment of conductive hearing loss can usually be cured by treating the source of the problem. These treatments can range from removing ear wax from the ear canal to prescribing antibiotics for ear infection.

However, treatment for sudden sensorineural hearing loss (SSNHL) can be more complex. Most SSNHL are idiopathic (arising spontaneously from unknown cause) and diagnosis of this type of loss can only be made through an audiometric testing. After obtaining the audiogram, with results showing a sensorineural hearing loss of ≥30 dB affecting at least 3 different frequencies and MRI is recommended. The MRI will be focusing on retrocochlear pathology such as vestibular schwannoma. AAO-HNSF guidelines state the recommended treatment for SSNHL is oral steroids or intratympanic steroids(injection of steroids into the ear). Prompt evaluation is needed because oral steroids need to be started within the first 2-3 weeks of onset of symptoms. If oral steroids fail to completely resolve symptoms or a person cannot tolerate oral steroids then the use of intratympanic steroids within the 2-6 weeks is also encouraged.

Without appropriate care permanent hearing loss,tinnitus or decreased quality of life can occur from sudden hearing loss. Timely evaluation from an ENT provider and audiogram are extremely important for proper diagnosis and obtaining positive outcomes after sudden hearing loss.Schedule an appointment with us you have concerns about your hearing. Give us a call today.






By Chad Richardson, FNP-C, MMC Comprehensive ENT Specialist

Chad Richardson moved to Rutherford County to attend college at Middle Tennessee State University in 1999. He currently lives in Murfreesboro with his family, including his daughter and son. His interests include hiking, baseball, hunting, fishing, and golf. 

Chad studied nursing, and received his bachelor's degree from Middle Tennessee State University in 2004.  While completing his bachelors he began his MMC journey by working in the Pediatric department. After graduation he then left the clinic to work in Vanderbilt Pediatric Emergency Room.  After 3 years away from the clinic he then returned to work at MMC in 2007 and worked both in the PACU and OR in the SurgiCenter.  While working in the SurgiCenter, he then completed his master's degree studies from Tennessee State University, and became a board certified nurse practitioner in 2018. 

Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT

You may be familiar with scheduling an annual physical, eye exam or even a dental visit for teeth cleaning twice a year. Your hearing deserves the same care! Hearing is an important part of your everyday life. That’s why we believe that hearing preventative care should be an important part of your routine annual screenings.

According to MMC Audiologist Megan Shissler, Au.D., CCC-A, hearing tests evaluate the entire auditory system including the balance system in our ears as well as hearing.

“We recommend obtaining a baseline of hearing ability, so if symptoms arise at a later date we have an audiogram to compare. If medical intervention is needed, we can monitor the progress of treatment. It is especially important to monitor any changes in hearing, movement of the ear drum, and evaluate the auditory system.”

Hearing tests are simple and easy, as demonstrated by the video below. They are necessary to ensure the health of your hearing, no matter your age. If you would like to schedule a hearing test for you or your child, please call MMC Otolaryngology (Comprehensive ENT Specialists) at 615-867-8110 or visit mmclinic.com/ENT today.

Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT

What Are Thyroid Nodules?

June 24th, 2020

Thyroid nodules are more common than you probably think. By the age of 60, 50% of all people have them. We’re going to answer a few of the commonly asked questions about thyroid nodules.

What are thyroid nodules?

To start, the thyroid gland is a fluid-filled or solid lump that develops on the airway in the lower neck. The thyroid gland produces the thyroid hormone, which helps to control many of the body’s metabolic functions. A thyroid nodule is an abnormal collection of cells within the thyroid gland and can present as a lump or bump in the lower neck. They can typically be felt during a general physical exam. Thyroid nodules are very common, with up to 50% of people developing thyroid nodules during their lifetime.

What are symptoms of thyroid nodules?

Many thyroid nodules do not cause symptoms. Very large cases can cause compression on surrounding structures in the neck, which can sometimes lead to changes in swallowing or breathing. If the nodule is producing an excess of thyroid hormones, it’s possible to develop symptoms of hyperthyroidism. Those can be rapid/irregular heartbeat, unexplained weight loss, muscle weakness, trouble sleeping, and nervousness. That being said, most thyroid nodules are non-functioning in nature. Often times, thyroid blood tests are normal in patients with nodules. 

Most thyroid nodules appear as bumps in the lower neck, so they can be felt or seen in the mirror. If you suspect you have thyroid nodules, consult your doctor.

What are the differences between hot, warm and cold nodules?

Hot, warm, and cold are the three ways that thyroid nodules are classified. Nodules that produce excess thyroid hormone are classified as hot nodules. If they are nonfunctioning and appear as holes in the scan, they are cold nodules. A warm thyroid nodule is producing a normal amount of hormone. 85% of cold nodules, 90% of warm nodules, and 95% of hot nodules are benign.

How are thyroid nodules diagnosed? And how can it be treated?

Thyroid nodules are typically evaluated by thyroid ultrasound, which allows for the endocrinologist to tell if it is cancerous or not.  Based on the findings of the ultrasound, the American Thyroid Association has recommendations to guide physician as to when additional workup of the nodules is needed.  This can include fine needle aspiration biopsy or thyroid surgery.  Biopsies are usually performed in the office, with ultrasound guidance.  Thyroid biopsy results are classified into categories based on the appearance of the cells when viewed under a microscope.  Ultimately, this classification system (the Bethesda System for Reporting Thyroid Cytopathology) will help you and your doctor decide whether your nodules can continue to be monitored with ultrasound, or whether additional testing or surgery is necessary. Treatment options will be determined the size and type of thyroid nodule. Your endocrinologist may even decide not to treat it in the case that the nodule isn’t cancerous and isn’t causing problems. To be safe, your doctor may perform occasional biopsies even if the nodule started out as benign.






Dr. Caplin spent her early life in West Virginia, prior to attending medical school and completing residency at Vanderbilt University in Nashville.  Prior to her arrival at MMC, she worked in private practice in Massachusetts, then served as the Chief of Otolaryngology within the Tennessee Valley Healthcare System, while also holding an appointment as an Assistant Professor at Vanderbilt University Medical Center in the Department of Otolaryngology – Head & Neck Surgery. 

Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT

What is your favorite sound in the world?  Your favorite song?  A loved one’s laughter?  Waves crashing on the beach?  Life is filled with so many amazing sounds;it would be a shame to miss them. 

Take a moment to think about what sounds that made an impact on your life.  Whether it be a story told by your grandfather, the first dance with your spouse at your wedding, or the cries of your child. Whatever sound you think of, think about how much that meant to you and how different your life would be if you missed it.

If you’re one of the millions of people with hearing loss, there is no reason why you should.  We know so much more about hearing loss today than we have in the past and the technology to solve those issues are at its best.  At MMC, we have hearing aids and communication solutions designed to help those with hearing loss.  Some of the advanced features of hearing aids available today include direct connectivity to smart phones, rechargeable batteries, and the ability to drown out background noise.

We know how hearing can change a person’s life.  We see it every day.  And every day we come to work to help our friends, family, neighbors, and community hear those sounds that enrich their lives. 






Megan is originally from the western suburbs of Chicago, but is very excited to relocate to middle Tennessee with her husband.  Megan earned her Doctorate of Audiology degree in 2013 from Illinois State University.  Since then, she has worked for one of the top hearing aid manufacturers performing research and development for upcoming hearing aid technology and various ENT clinical settings across the Chicago land area.  In her free time she enjoys spending time with her husband and stepson, cooking, shopping and cheering for the Chicago Cubs!

Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT

Via Healthline

Medically reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT — Written by Adrian White

Ginger is a spicy, pungent herb that’s used for cooking and, sometimes, in healing. One medicinal use of ginger, supported by both scientific studies and tradition, is for the treatment of sore throat and voice problems.   Ginger may help sore throats in several ways. For example, it may provide some pain relief as an anti-inflammatory. It also boosts immunity to help fight infections that cause sore throat.

Ginger contains bioactive compounds. Bioactive compounds are phytonutrients found in certain foods that have beneficial effects on your health. The most notable bioactive compounds in ginger are gingerols and shogaols.

Studies show these compounds have anti-inflammatory properties that may help manage or reduce your risk for many conditions, including sore throat.  Ginger is also believed to have antimicrobial properties that may help fight infections (bacterial or viral), including those that cause sore throat.

Ginger has antioxidant properties. Antioxidants may provide protective and healing benefits against disease. In one study, fresh ginger was found to provide more antioxidative benefits than dried ginger

The anti-inflammatory effects of ginger can help soothe a sore throat by relieving inflammation. Research suggests that ginger may do this by blocking pro-inflammatory proteins in the body. These proteins cause inflammatory pain and itchiness

Lastly, Ginger has antimicrobial properties. It may help inhibit pathogens that cause sore throats, and may be an alternative to antibiotics for treating some bacterial infections.

So how can I use Ginger in my daily life?

Raw Ginger Root

Raw ginger root can be found in the produce section at some grocery stores. It looks like a pale brown root, and can be purchased in various sizes.  To use, start by removing the exterior, bark-like surface. You can do this by gently rubbing a spoon along the surface of the root.  Then,slice off a 1-inch (2.5 cm) piece of fresh raw ginger root, and chew on it.It’s okay to swallow the root as it turns to pulp, or you can spit it out if the pulp irritates you.  Chew on a piece of ginger root two to three times per day for relief.  This is the most intense way to take ginger due to the herb’s spicy heat. It may not be for everyone.

Ginger Candy, Chew, or Lozenge

A less intense way to consume ginger is to suck on a ginger lozenge. You can purchase these from your local grocery store or pharmacy.They’re also available online from Amazon. Common brand names are Ginn Ginns. 

Ginger Tea

Sipping hot ginger tea is a popular and effective sore throat home remedy. The warm liquid may be soothing to an inflamed throat, and the tea is an easy way to consume ginger and allow it to come into contact with your throat.  Ginger tea is easy to make.  A common recipe is available by Dr. Celmer.  You can also purchase prepackaged ginger tea bags.

Ginger Powder or Seasoning

You can use powdered ginger to season your meals. Powdered ginger is available from the spice section at many grocery stores.

A Common Ginger Tea Recipe

The ingredients were chosen for their medicinal properties.  Generally, the tea is made with a base of Ginger, water, honey, and lemon. Cinnamon and pepper can be added if tolerated.

Ginger is a natural anti-inflammatory and it also improves the absorption of nutrients.

Lemon is a rich source of Vitamin C, it helps flush toxins out of your body, it has powerful natural antibiotic properties, it’s good for your liver and skin, it helps reduce pain and inflammation in joints.

Cinnamon has been thought to help with blood sugar control,it has natural antimicrobial properties, it is rich in manganese, iron, calcium and fiber, it’s a powerful antioxidant.

Honey is antibacterial and anti-fungal, it’s probiotic, it’s good for you skin, and it helps with sore throats and coughs.

Cayenne Pepper is a good source of essential minerals and vitamins C and A, it’s beneficial to the circulatory system.


Ingredients

1 large fresh ginger root (peeled and cut into 1-inch chunks(enough to have 8 to 10 1-inch chunks))

5 cups water

Juice from 1 fresh lemon

Honey

Cinnamon

Cayenne pepper (powder)


Instructions

In a saucepan, simmer the ginger chunks in the water,for a minimum of 20 minutes, but the longer the better. We like to let ours simmer for 30-45 minutes.

Divide the tea between 2 large mugs, or 4 smaller mugs,making sure not to serve the chunks of ginger!

Now it’s time to dress the tea. This part is very individual-taste dependent! We like our tea very strong, so here’s what we add to our tea! For each mug add:

Juice from 1/2 lemon

1/2 tsp honey

1/4 tsp cinnamon

Generous dash of cayenne pepper

Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT

When you think about eyeglasses, what do you think? Most likely you will think of your own pair or those of a loved one. If you like fashion, you may think of some you have seen in a magazine or on your favorite celebrity. You definitely do not think of old age.

But what do you think of hearing aids? It is probably a different story.

In the United States, 14 million people 12 years or older have a vision impairment. 30 million people 12 years or older have hearing loss – that’s one out of every eight people. Both eyeglasses and hearing aids correct a sense impairment, so why are eyeglasses a fashion statement, but it takes, on average, seven years for someone to get their hearing tested after noticing a change in their hearing?

The idea of hearing loss affecting you when you are older is simply not true. Here are some statistics to prove our point:

  • 2 to 3 of every 1,000 U.S. babies are born with a detectable hearing loss.
  • According to the World Health Organization, millennials risk hearing loss because of damaging volumes via personal audio devices.
  • About 1 in 7 U.S. adults ages 20 to 69 has hearing loss.

Clearly, hearing loss leaves no age group untouched. But the stigma of hearing aids remains, and only 1 in 5 people who could benefit from hearing aids actually use them. The technology today is a far cry than the hearing aids 20 years ago. The digital age of today is sleek and discreet, minimizes background noise, improves speech clarity and focuses on your conversation partner rather than the noise behind you. If you have noticed any changes in your hearing in the last few years, regardless of your age, it’s important to have your hearing checked by a hearing professional. Contact us today to learn more!

Posted by Murfreesboro Medical Clinic | Topic: ENT  | Category: ENT

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As of July 1, 2020, face coverings (covering the wearer’s nose and mouth) will be required at all MMC locations for all patients and visitors ages 2 and above. Due to an increase in COVID-19 positive cases locally, across our state and around the country, MMC believes that it is in the best interests of our community, patients and staff. While this may not be convenient, our goal is to protect our community. Everyone is encouraged to bring their own face coverings to enter the building. If patients or visitors do not have a face covering they will be given one. Any person who chooses not to comply with this policy will have their appointment rescheduled. Thank you for understanding. 

Your health is our mission.

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