MMC blog header

Nasal Obstruction

October 21st, 2020

What is Nasal Obstruction?

In America, more than 20 million people are expected to suffer from nasal obstruction. Nasal obstruction can be described in many ways. Most patients report a sensation of a chronically stuffy nose, or nasal congestion. These symptoms can be seasonal in nature, or occur year-round. Sometimes, they tend to be worse at night when lying in bed. Nasal obstruction can significantly affect quality of life by contributing to conditions including exercise limitation, snoring, poor CPAP tolerance, sore throat and sinusitis.

What Causes Nasal Obstruction?

Multiple factors can contribute to nasal obstruction including allergies (seasonal or year-round), nasal irritants (such as tobacco smoke), prior nasal surgery, or nasal trauma. There are also multiple anatomic features of your nose that can contribute to nasal obstruction. These include a deviated nasal septum, enlarged nasal turbinates, or a condition called nasal vestibular stenosis (a tendency for the nose to collapse when you take a breath in). 

How is Nasal Obstruction Normally Treated?

For almost all patients, the treatment of nasal obstruction begins with the consistent use of intranasal medications. Patients are recommended to use nasal saline spray in addition to consistent use of an intranasal steroid spray, such as fluticasone nasal spray. Both of these medications are available over the counter.

When using intranasal steroids, there are some important points to remember. First, the spray does not provide significant benefit until there has been at least two weeks of consistent use. An adequate trial of this medication often requires daily use for at least 6-8 weeks. Second, proper administration of the medication is very important. Patients are encouraged to point the tip of the nasal spray bottle away from the center of their nose, in an upward and back direction, toward the ear. This distributes the spray in the correct location in the nose, and reduces the risk of a common side effect, nosebleeds.

If you have significant allergy symptoms, or if your symptoms are more seasonal in nature, you could consider the addition of an oral antihistamine, such as Claritin or Zyrtec. 

If these medications do not provide significant benefit, you should see an ENT doctor to discuss additional options for treatment of nasal obstruction.  This could include further medical workup or treatment with allergy testing, or the addition of an intranasal antihistamine spray. However, there are also a multitude of nasal procedures available to patients with symptoms of nasal obstruction despite medical treatment. These include procedures that can be done in the office under local anesthesia, in addition to procedures that require a trip to the operating room. Often times, procedures to treat nasal obstruction can reduce or eliminate the need for daily nasal spray use, depending on other symptoms the patient may have. Overall, there are many options for patients living with chronic nasal obstruction, and many of these can provide a significant improvement in a patient’s quality of life.

Call 615-867-8110 today to schedule an appointment, and visit www.mmclinic.com/ENT to learn more!






By Britni Caplin, M.D. - MMC Comprehensive ENT Specialist

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

Globus is the medical term for the feeling of something stuck in the throat.  The term globus comes from the last route for globe or sphere. Hence, it is used to describe a feeling of a large lump or “ball” of mucus in the throat.  This symptom is often described in multiple ways.

  • Feeling of ball of mucus in throat

  • Feeling of tightness in the throat

  • Feeling of food or a lump stuck in throat

  • Phlegm that will not come out

  • A feeling or need to swallow harder than in the past.

It is not uncommon for symptoms to temporarily improve when people eat or drink.  Globus can be one of the more frustrating symptoms and diagnosis to deal with as the physical exam is often unremarkable.  The symptom generally does not cause pain, but can be extremely annoying.  As a general rule, women of child bearing age and women around menopause tend to be affected the most. 

Globus can last days to weeks to even months and can be recurrent.  If symptoms last longer than a couple weeks, often, the patient will be referred to an Otolaryngologist or an ENT.  The ENT will do a thorough exam which often includes a flexible scope being used to evaluate the entire throat.  This is done to ensure there are no concerning findings.  Often the exam is unremarkable. 

Common causes of Globus include:

  • Stress, anxiety, or depression

  • Silent reflux also known as laryngopharyngeal reflux

  • Post-nasal drainage

  • Inflammatory disorders such as infection or allergies.

What treatment options are there for globus? 

This will obviously depend on what is identified at the time of the examination.  What is most important is to have this evaluated by an ENT. Often, symptoms will improve after examinations that reveal no concerning findings.  In other words, there is a lot of relief in knowing there is nothing worrisome taking place.  Otherwise, your otolaryngologist will often recommend a treatment schedule. It is very important to understand that, although annoying, globus is not a serious condition.  However, it can be difficult to resolve and often treatments do not provide immediate relief.  It is important to stick to the treatment schedule unless otherwise directed by your physician.








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

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

The next blog in our series of blogs about medication side effects on the voice will focus on steroid inhalers.  These are medications often used to treat asthma and COPD.  Unfortunately, these medications can have an adverse effect on the throat and can contribute to sore throat and hoarseness.  Many of these medications contain a particulate matter of steroid.  The medications were designed in this manner so they could penetrate deeper into the lungs. However, they can also contribute to build-up within the larynx.  The larynx is where our vocal cords are. 

Over time, if these medications continue to build within the larynx, there can developed an adverse effect on the voice.  In general, the through a these can affect the voice:

  1. The build-up of debris can stiff in the vocal cords and not allow them to vibrate naturally. This can create a raspy voice.
  2. In some patients, the medication can contribute to a yeast infection within the throat. This is more commonly known as “thrush.” Often, benign always, there will be an associated pain in the throat when talking or swallowing.
  3. Issues for a lengthy period of time, the medication can cause atrophy of the vocal cords.  This is essentially shrinking of the vocal cords.  Thus the voice becomes weaker and breathier. 

Often patients are told to rinse the mouth out after using this medication.  However, it is also advised to gargle with water with salt water in order to cleanse the throat as well. If these measures are unsuccessful, then sometimes the patient has to be switched to more traditional HFA inhalers.  If this is unsuccessful, then patients may need to be taken off the medication altogether,or determine the risk/benefit ratio.

Common types of steroid inhalers are:

  • Advair
  • Qvar
  • Breo
  • Symbicort

  • Flovent
  • Pulmicort

If for some new no is having voice problems while using these medications, foods contact your primary care provider for a recommendation to see an ENT or laryngologist.








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

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

The next couple blogs will focus on common medications and how they can affect vocal function. Today we will specifically focus on antihypertensive medications.  We will specifically focus on to classes of blood pressure medications - angiotensin-converting enzyme inhibitors (ACE-I) andangiotensin receptor blockers (ARBs.)

Both ACE-I and ARBs are common medications utilized to control elevated blood pressure.  They work by blocking the effects of angiotensin, a chemical that narrows blood vessels.  By doing so, they help widen the blood vessel and allow blood to flow more easily, which lowers the blood pressure.  This also reduces stress on the heart.  Unfortunately, they both can cause side effects which are specific to the throat and voice.

A common side effect of both classes of medications is a nagging, dry cough.  Symptoms can start at the onset of medication use.  However,side effects can also develop years later. In general, patients who develop a cough while on this medication can be difficult to treat.  Symptoms can include a dry cough, but also can present as a lump in the throat sensation or a constant need to clear one’s throat. Often patients will have to be switched to a different class of blood pressure medication in order to improve the cough.  Is always advised to seek evaluation by an ENT physician or Laryngologist for the cough as there can be other causes.  However, if an endoscopy is normal, the patient is often referred back to their primary care physician to discuss other options for blood pressure control.  Some common ACE inhibitors and ARBs are listed below.


ACE inhibitors                                                                    ARBs

Lisinopril                                                                              Azilsartan

Quinapril                                                                             Candesartan

Ramipril                                                                               Eprosartan

Benazepril                                                                           Irbesartan

Captopril                                                                              Losartan

Enalapril                                                                               Valsartan









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

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

Can I make my own saline rinses?

September 2nd, 2020

You’ve probably heard of nasal rinses and the many benefits they can bring: preventing sinus infection, improving breathing, reducing swelling, washing away mucus and allergens, etc. They are an efficient way to keep your sinuses healthy. Many patients are recommended to use nasal saline irrigations as part of treatments for multiple nasal diagnoses. Administration of nasal saline rinses can be done with a variety of products including a sinus rinse bottle, neti pot, or a nasal lavage device. Nasal saline rinses provide away to wash the sinus and nasal cavities, while also allow for administration of medications in some patients. It cleanses the nasal cavities of debris or mucus providing a great sense of relief for most patients immediately.

You have many different brands and method of using a saline rinse. They come in shapes like a teapot to a squeeze bottle. Many patients have questions about how to make saline rinses at home, and whether it is safe to do so. Yes, it is!  First, it’s very important that you use boiled water (that has cooled), or distilled water to avoid any unnecessary contamination that could occur from using tap water. Distilled water is available by the gallon at many retailers for less than $1. Once you have filled your rinse bottle with water, you can make saline by adding a salt packet purchased at your local pharmacy. These contain all the necessary ingredients for your rinse. These are available in the aisle where sinus rinse bottles and nasal sprays are available for purchase. You can clear your sinuses and breathe easily for just a couple dollars.

Lots of people want to make their own saline mix at home instead of purchasing the packet. Here is a recipe you can follow to do so:

  • 1 cup (8 oz) distilled water or boiled water that has cooled
  • ½ teaspoon of salt
  • ½ teaspoon of baking soda

Shake to mix. 

If you need a refresher on how best to administer saline rinses, here is a video that you might find helpful.

Visit mmclinic.com/ENT for more information, or call 615-867-8110 today to schedule an appointment!






By Britni Caplin, M.D. - MMC Comprehensive ENT Specialist

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

The next couple blogs will focus on common medications and how they can affect vocal function. Today we will specifically focus onantihypertensive medications. These are more commonly known as blood pressure medications.

Generally, all blood pressure medications have a drying effect on the upper airways. Patient's will often experience dry mouth. This can also affect the normal lubrication required within the throat for proper vocal cord function. Without proper lubrication, the vocal folds do not vibrate naturally. Patients with generally experience a dry, raspy throat. Proper hydration with water both before and after speaking engagements and performances can go a long way toward preserving normal vocal function. The natural remedies such as ginger have also been shown to help with lubrication of the voice. Future blogs will address homeopathic remedies.








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

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

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

Murfreesboro Medical Clinic | 615-893-4480 | see all locations
close this layer

As of September 23rd, face coverings are still required at all Murfreesboro Medical Clinic locations until further notice. MMC is dedicated to the health well-being of everyone who enters our buildings. We believe that this requirement is still in the best interest 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.

pixel image