Robert Gance Audiologist

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Robert Gance Audiologist

General Practitioners

Medical Weight Loss
When Head & Neck cancers are advanced, they will usually lead to difficulty swallowing and loss of appetite. These 2 factors usually result in rapid weight loss. Any unintentional weight loss greater than 5 pounds in a given month should be considered a possible sign of cancer. If combined with any of the previously described signs of Head & Neck cancer, a thorough examination by an ENT specialist should be performed.

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Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Physicians & Surgeons, Dermatology, Physicians & Surgeons, Endocrinology, Diabetes & Metabolism, Physicians & Surgeons, Otorhinolaryngology (Ear, Nose & Throat), Physicians & Surgeons, Surgery-General

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Phone: (610) 376-9728

Address: 1 Granite Point Dr Ste 300, Reading, PA 19610

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Robert Gance Audiologist

General Practitioners

Medical Weight Loss
When Head & Neck cancers are advanced, they will usually lead to difficulty swallowing and loss of appetite. These 2 factors usually result in rapid weight loss. Any unintentional weight loss greater than 5 pounds in a given month should be considered a possible sign of cancer. If combined with any of the previously described signs of Head & Neck cancer, a thorough examination by an ENT specialist should be performed.
Primary Care
Acid reflux is a problem that can affect the larynx. When gastroesophageal reflux occurs, small amounts of stomach acid travel from the stomach into the throat, burning the vocal cords and surrounding structures. This causes swelling and inflammation of the larynx. Patients will typically experience hoarseness, a need to clear the throat often, and a sensation of a lump in the throat. These symptoms can also be caused by other more dangerous problems. Therefore a full evaluation by your physician is recommended. Your primary care physician may determine that referral to an Otolaryngologist is warranted. The treatment for gastroesophageal reflux disease (GERD) involves modifying certain behaviors that may be producing the problem, as well as the use of prescription strength antacids. This treatment should be instituted under the direction of your physician.
Ear Infections
Ear infections are a very common problem in children. It is estimated that as many as 80% of all children will have at least one ear infection by the time they are 3 years old. The first treatment a child is given for an ear infection is antibiotics. In most cases this will eliminate the infection. However, after the infection clears, some children are left with fluid behind the eardrum. In most instances this fluid will drain out within a few months and the child will be back to normal. Alternatively this fluid may persist. This fluid can cause a hearing loss, and it can become reinfected. When a child has persistent fluid behind the eardrum parents may notice the hearing loss, and children may fail to develop clear speech. Children may also develop recurrent infections of this fluid. They typically will develop another ear infection shortly after a course of antibiotics is completed. Children with persistent fluid behind the eardrum, or with frequent ear infections are candidates for placement of ear tubes.

Endocrinologist

Thyroid
Thyroid Cancer
Radiation exposure can increase your risk for most types of cancer. In the Head & Neck region the biggest risk increase is for thyroid cancer. Even small doses of radiation to the thyroid gland can increase your risk of thyroid gland cancer. If you work in an environment where you are exposed to radiation you should have your thyroid gland checked regularly by your physician. You should also take steps to reduce your exposure to radiation whenever possible.

Chemotherapy
Cancers of the oral cavity and tongue are often aggressive and need to be treated as early in their course as possible. Small tumors can often be treated with surgery or radiation therapy. Larger tumors and tumors affecting other areas of the mouth and throat usually require surgery, radiation, chemotherapy, or some combination of these three forms of treatment. For a detailed discussion regarding the treatment of Head & Neck cancers click here.
Radiation Therapy
Radiation therapy is often used to fight cancer. It is actually a powerful tool used in the fight of Head & Neck cancers. It may therefore come as a surprise that radiation can actually lead to an increase risk of cancer. In fact, accidental, industrial, or medical radiation exposure can increase your chances of developing cancer in the future. This should NOT stop you from accepting radiation therapy if your doctors prescribe it for cancer treatment. The future risk of cancer is always weighed against the need for radiation before any treatment is prescribed.
Radiation Oncology
A team approach to the treatment of Head and Neck Cancer allows Berks ENT to provide the most advanced care to patients. Extensive surgical experience and a commitment to provide multidisciplinary care to patients with Head and Neck cancers gives patients University level care. Many experimental protocols are available through joint efforts with the departments of Radiation Oncology and Medical Oncology at the Reading Hospital. The entire team of surgeons at Berks ENT specialize in organ sparing head and neck cancer surgery, salivary gland surgery, and airway reconstruction.

Ear Surgery
3-D image guidance for sinus surgery is now available at Pennsylvania Eye & Ear Surgery Center, LLC and The Reading Hospital & Medical Center.
Otolaryngology
Dr. Toso graduated from the University of Bologna Medical School, Italy in 1956. He completed his Otolaryngology, Head and Neck Surgery Residency at the Newark Eye & Ear Infirmary, New Jersey in 1963 and started his practice in Reading, Pennsylvania in 1964. Dr. Toso has been a leader in the development and advancement of ear surgery. In 1986 he started The Reading Hospital & Medical Center Cochlear Implant program with Elca Swigart, Ph.D., becoming the first surgeon in Eastern Pennsylvania to perform a cochlear implantation. Dr. Toso is Board Certified and his practice encompasses all aspects of Otorhinolaryngology. He specializes in ear surgery, and has developed advanced techniques for reconstruction of the ear canal and elimination of the mastoid cavity after ear surgery. He served as Section Chairman of the Department of Otolaryngology, The Reading Hospital and Medical Center until 1997.

Plastic Surgeons

Botox
Botox blocks nerve impulses, temporarily paralyzing the muscles that cause wrinkles, giving the skin a smoother, more refreshed appearance. It is a nonsurgical treatment for moderate to severe wrinkles. Botox is used to eliminate or reduce frown lines, forehead creases, crow's feet, and thick bands in the neck. No anesthesia is needed, and discomfort is minimal an brief. A noticeable improvement is seen within several days, and effects can last up to 6 months.
Brow Lift
This procedure restores a more youthful, refreshed look to the area above the eyes. The skin of the forehead is lifted, and the muscles and underlying tissues are altered to produce a smoother appearance and reduce frown lines. An endoscopic brow lift is performed using a small, thin telescope placed through small incisions. All of these incisions are hidden in the scalp and are not visible. No hair is shaved for this procedure. This procedure is commonly combined with eyelid surgery. Swelling will occur in the forehead and upper eyelids, but this resolves after a few days. The majority of patients can be seen in public after 7 to 10 days.
Eyelid Surgery
Liposuction
The goal of a rhytidectomy is to provide a more youthful appearance by improving sags, bulges, and deep folds of the face and neck. The best candidate is a woman or man whose face has begun to sag, but whose skin still has some elasticity. It will make your look younger and fresher. The goal is to reposition sagging tissue to a natural, youthful appearance while at the same time avoiding a stretched, over-operated look. Incisions are hidden in the natural skin folds around the ears and in hair-bearing scalp. No hair is shaved during the surgery. The surgeon tightens the underlying muscles, then pulls back and removes excess skin. Many rhytidectomies involve liposuction of the face and neck to allow for better contouring. Following surgery, a small tube may be placed under the skin behind your ear to drain away any blood that may collect. This drain is usually removed the next day. Most patients are presentable in public in 1 to 2 weeks, and approximately 80% of the swelling is gone after 2 weeks. "Mini" or "Quick Lifts" are also commonly performed. These procedures are smaller incisions and allow quicker operating times. They tend to be more suitable for younger patients, aged 40 to 60 years. Patients heal more quickly, most return to work within one week. It is absolutely necessary to stop smoking for at least 2 weeks prior to surgery.
Rhinoplasty
The goal of rhinoplasty is to place the nose into better harmony with the rest of the face. It is a procedure where the shape and function are of equal importance. The newly shaped nose should not only have a nice appearance and not draw attention to itself, but should allow the patient to breath easily. Rhinoplasty can increase or decrease the size of your nose, change the shape of the tip or bridge, and narrow the width of your nostrils. It can be combined with other procedures such as straightening a deviated nasal septum, endoscopic sinus surgery, or other kinds of plastic surgery. For patients unhappy with a previous rhinoplasty, secondary rhinoplasty can be performed to improve appearance as well as breathing. This is sometimes performed using cartilage harvested from the nasal septum or the ear. For teenagers, it is best to wait until after their growth spurt. Girls usually can undergo rhinoplasty around age 15. Boys generally have to wait longer. Most insurance policies do not cover purely cosmetic procedures; however, if is performed for reconstructive reasons (i.e., nasal fracture) or to correct breathing problems, it may be covered. After surgery, a small splint remains on the nose for 5-7days. Some swelling or bruising may occur around the eyes, but this is usually resolved after a week.
Plastic Surgery
Dr. Watson graduated from the University of Medicine and Dentistry of New Jersey, School of Osteopathic Medicine in 1998. He completed his Otorhinolaryngology, Head and Neck, and Facial Plastic Surgery Residency at the Philadelphia College of Osteopathic Medicine in 2004. He began service in 2004 as a clinical instructor in the Department of Otolaryngology of Thomas Jefferson University. Dr. Watson joined Berks E.N.T. Surgical Associates, Inc. in July of 2005. He is Board Certified in Otolaryngology as well as Facial Plastic Surgery, and his practice encompasses all aspects of Otorhinolaryngology. His interests include sinus and allergy, children’s ENT, disorders of the voice and swallowing, and facial cosmetic surgery.
Face Lift
The chin and cheeks are areas of the face that may be improved with implants. Chin implants may be placed through a small incision in a natural crease under the chin or an incision inside the mouth. Frequently, chin augmentation (mentoplasty) is performed with other procedures such as rhinoplasty or liposuction of the neck. Neck liposuction helps improve the angle between the skin of the neck and the chin and helps establish the outline of the jaw. As we age, the muscles, connective tissues, and fat deposits in the faced diminish leaving sagging skin. Lipostructure and Restylane help replace this tissue without the risk of allergic reaction. During Lipostructure, fat is harvested with a small cannula from the patient's abdomen. Tiny droplets are then reinjected into the proper spots. It can be used for nasolabial folds, marionette lines, hollowness around the eyes and cheeks, or used to compliment a facelift. Both Restylane and Lipostructure can be used to augment the lips.
Blepharoplasty
The main purpose of blepharoplasty is to remove the excess skin and bulges around the eyes. It corrects drooping upper lids and puffy bags below your eyes - features that make you look older and more tired than you feel. The intended results are a more youthful and rested area around the eyes. Most commonly, this is done under local anesthesia with sedation on an outpatient basis. Incisions follow the natural lines of your eyelids; in the creases of your upper lids and just below the lashes of your lower lids. In some patients, the lower incisions are hidden inside the lower eyelids, leaving no visible scar (transconjunctival approach). Small sutures are usually removed in the first 5 days, and the majority of the swelling is gone in a week. Blepharoplasty does not lift sagging eyebrows, but it can be performed with a brow lift to correct both conditions at the same time.
Otoplasty
Otoplasty is a surgery to correct the protruding ears of children as well as adults. The majority of cases are performed on children between the ages of 4-14. The ears are almost fully grown by age four, and the best time to perform this surgery is before entering school. The earlier surgery is done, the less teasing and ridicule the child will have to endure. Incisions are placed behind the ears and scars are will concealed. The patient's head will be wrapped in a bulky bandage following surgery. This will be removed in 1 to 2 days. It will be necessary to wear a headband for several weeks after surgery.
Cosmetic Surgery
Chin Augmentation

Lesions
Polyps and papillomas are 2 type of common benign lesions which can affect the vocal cords and the airway. Polyps are generally thought to arise due to chronic vocal cord irritation, while papillomas are related to exposure to certain types of viruses. Both of these lesions are an abnormal growth of tissue. When they occur on the vocal cords they can cause hoarseness. If they enlarge, or if they extend down into the trachea, they can cause you to have difficulty breathing. The treatment of these lesions in most cases requires surgical removal. The physicians of Berks ENT Surgical Associates, Inc. have extensive experience in the use of endoscopic microsurgical and laser techniques for the removal of these lesions. The advances in surgical technique he brought to the Reading Hospital and Medical Center allow these lesions to be removed through endoscopes, with no external incisions. Often the voice outcome is greatly enhanced as a result of the use of these techniques.

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