Providence North Everett Ear, Nose and Throat
Providence North Everett Ear, Nose and Throat
Our board-certified head and neck surgeons treat a wide range of conditions affecting the face, ears, nose, head and neck. We are committed to providing the highest quality medical care and an excellent patient experience.
Our sophisticated electronic medical record allows us to access your health history from Providence providers, and often times from outside systems as well. Our integration with Providence Medical Group allows us to collaborate with the best doctors from other specialties to help optimize your care.
We would be honored to care for you or your loved ones.
- Dr. Tasneem Shikary is board certified in otolaryngology - Head and Neck Surgery and specializes in the full-spectrum of head and neck surgery, with a special interest in thyroid/parathyroid surgery, sinus surgery and sleep apnea surgery.
- Dr. Prabhat Bhama is dual board-certified in facial plastic and reconstructive surgery and otolaryngology – Head and Neck surgery and performs reconstructive and cosmetic surgery for the face, nose, ears and neck, as well as general otolaryngology care.
- Dr. Lori Walker is our audiologist and provides hearing assessments and hearing aids.
- Nose reshaping (rhinoplasty)
- Revision Rhinoplasty
- Minimally invasive (closed) rhinoplasty
- Septoplasty
- Nasal valve surgery
- Turbinate reduction
- Functional endoscopic sinus surgery
- Browlift (endoscopic or direct)
- Eyelid lift (blepharoplasty)
- Lip lift
- Facelift
- Mini Facelift
- Neck lift
- Chin augmentation/chin implants
- Dermabrasion
- Fat grafting
- Skin cancer treatment
- Melanoma
- Squamous cell carcinoma
- Basal cell carcinoma
- Mohs reconstruction
- Scar revision
- Ear pinning (otoplasty)
- Ear lobe tear reconstruction
- Reconstruction after skin cancer treatment
- Botox
- Browlift
- Eyelid weight placement
- Lower eyelid tightening
- Static facial suspension
- Temporalis tendon transfer
- Gracilis free flap
- Lip augmentation
- Facial skin cancer reconstruction
- Nasal surgery for breathing
- Facial trauma
The facial nerve is the most commonly paralyzed nerve in the human body. Injury to the facial nerve can result in inability to move the face on the affected side. This causes not only functional problems (difficulty closing the eye, trouble smiling, etc.), but can cause difficulties with social interaction and even lead to depression. It is important to know that facial paralysis is a treatable condition, and although surgery can be an option to manage facial paralysis in many cases, oftentimes non-surgical measures are more appropriate.
There are many different causes of facial paralysis, and treatment of facial paralysis oftentimes depends upon the underlying cause. As such, it's critical to have an evaluation with a surgeon who has a comprehensive understanding of the facial nerve. We are uniquely qualified to manage facial paralysis because of the rigorous training with regards to the facial nerve that each surgeon goes through as part of their otolaryngology residency.
Facial paralysis is a disease that evolves with time. Because nerves can regenerate, there is the possibility of the paralysis resolving, or changing quality with time. Because of the dynamic nature of the disease, surgeons sometimes think of symptoms of facial paralysis in two broad categories – acute and chronic. Acute symptoms are those that occur within a few days to weeks after the onset of facial paralysis. Chronic symptoms are those that start to occur a few months after the onset of the paralysis and can continue for years. The character of the symptoms depends a great deal upon how successful your body was in repairing the initial injury.
When the body does try to recover, there are three eventual trajectories of recovery. First, your body may completely recover function. Second, your body may not recovery function at all, resulting in what surgeons call "Post-paralytic flaccid paralysis." Flaccid refers to the inability to move the face. Lastly, your body may recover partially resulting in what surgeons call "Post-paralytic synkinetic paralysis." Synkinetic is a word that describes involuntary movement of the face or neck when trying to move other portions of the face. See the next sections for more details.
The symptoms you have will help guide your surgeon to a particular treatment. It's important that your surgeon assess your entire face and neck, since facial paralysis can affect various zones, or all zones of the face and neck. Oftentimes, surgeons will divide the face into three zones (see figure) to help guide treatment. See treatments section below for more details.
- Droopiness of the eyebrow
- Inability to close the eye
- Tearing of the eye
- Dryness of the eye
- Difficulty with smiling
- Drooling and difficulty chewing
- Change in taste
- Increased sensitivity to sound
- Dryness of the mouth
- Overall weakness of one side of the face
- Pain on the affected side of the face
All of the above, including the following:
- Dry eye, visual difficulties, or even blindness in the affected eye
- Involuntary movement of different areas of the face or neck (synkinesis)
- For example, when you smile, the eye on the affected side squeezes down too hard, making it difficult to see
- Overall weakness of the affected side of the face
- Inability to raise the eyebrow, and drooping of the eyebrow at rest
- Inability to close the eye (called lagophthalmos)
- Drooping of the lower eyelid (called retraction or ectropion in some cases)
- Dropping of the corner of the mouth
- This can cause drooling and difficulty chewing
- Inability to smile
- Asymmetric jowls on the affected side resulting in a droopy jawline
- Depression
- Overall tightness of the affected side of the face
- Tightness around the eye when smiling
- Difficulty moving the corner of the mouth when trying to smile
- Dimpling of the chin, especially when talking (your family and friends may notice this more than you!)
- Tightness and pain the neck when closing eyes or talking
There are many different causes of facial paralysis, and it's oftentimes really difficult to determine exactly what is causing the problem. Facial paralysis is oftentimes caused by Bell's Palsy, but in some cases can be caused by benign or even cancerous tumors. It can be tricky to determine which cases are caused by something like Bell's Palsy or something more serious like a tumor.
There are oftentimes subtle clues in the physical examination and history that might lead your surgeon to order an imaging study like an MRI or CT scan. This is one of the reasons it's critical to visit a board-certified FPRS when you are diagnosed with facial paralysis so that together you can determine the cause of the paralysis. Here's a list of some of the possible causes of facial paralysis:
- Bell's Palsy
- Lyme Disease
- Ramsey Hunt Syndrome
- Temporal bone trauma (fracture of the bones around the ear)
- Sharp trauma to the cheek or face
- Tumors (benign or cancerous)
- Acoustic neuroma
- Cholesteatoma
- Schwannoma
- Hemangioma
- Parotid tumors
- Congenital (present at birth)
- Stroke
Treatments for facial paralysis are dependent upon the cause of the paralysis, length of time that has passed since the onset of paralysis, and what is bothering the patient the most. Oftentimes, other co-morbid conditions you may have can influence how your surgeon may decide to manage your paralysis. There is no standard treatment protocol that can be applied to everyone with facial paralysis, so it's important you discuss all options with your surgeon.
Treatment for acute onset facial paralysis is usually managed by the doctor you visit with initially. For instance, if you go to the ER with facial paralysis and are diagnosed with stroke, your stroke will be managed first, and then you might be referred to a FPRS for management of your face. For Bell's Palsy, many patients present to their primary care physicians or the ER. Typically, treatment for acute Bell's palsy involves oral steroids and antiviral medications, followed by physical therapy.
Since facial paralysis is a dynamic disease, once your recovery has stabilized, your surgeon may discuss several options with you. Treatments can be divided into non-surgical and surgical options. Surgical options can also be categorized based on what part of the face and/or neck they focus on managing.
- Physical therapy
- Biofeedback training
- Chemo denervation (such as botulinum toxin injections)
- Injectable fillers
- Taping the eye shut and moisturizing the eye
- Electrical stimulation and Acupuncture (not proven effective)
For all zones of the face, nerve repair (neurorrhaphy) is an option for people with acute onset facial paralysis that results in physical trauma to the nerve (such as stab wound to the face). Keep in mind that many of the procedures done below can be performed in clinic under local anesthetic, meaning that you can go back to work the same day.
- Browlift
- Endoscopic
- Power brow (Hadlock)
- Direct or mid-forehead
- Eyelid
- Platinum or gold eyelid weight
- Lower eyelid tightening
- Other
- Cross-face nerve grafting
- Selective neurectomy
- Temporalis tendon transfer
- Static facial suspension
- Gracilis free flap
- Cross-face nerve grafting
- Nerve transfer surgery (hypoglossal or masseteric nerve)
- Nasal valve repair
- Selective neurectomy
- Lip depressor muscle resection
- Platysmectomy
- Selective neurectomy
We offer treatment of diseases and conditions affecting the ears, nose, sinuses, larynx (voice box), mouth and throat, as well as structures of the head and neck.
- Ear tube placement
- Repair of ear drum perforation
- Outer ear reconstruction
- Hearing assessment
- Treatment of auricular hematoma
- Repair ear lobe tear
- Functional endoscopic sinus surgery
- Septoplasty
- Turbinate reduction
- Rhinoplasty
- Thyroid and parathyroid surgery
- Removal/biopsy of neck masses
- Head and neck cancer treatment
- Neck dissection
- Tonsillectomy
- Adenoidectomy
- Uvulopalatopharyngoplasty (UPPP)
- Removal of tongue masses
- Sleep apnea surgery
- Facial and neck skin cancer treatment
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At Providence North Everett Ear, Nose and Throat, you'll have access to a vast network of dedicated and compassionate providers who offer personalized care by focusing on treatment, prevention and health education.
