Anatomy, Conditions and Treatments

ENT (also known as Otolaryngology) is an abbreviation for Ear, Nose and Throat often collectively referred to as the upper aero digestive tract. This speciality includes investigations of head and neck disorders. More specifically ENT covers in the case of the ear, the outer, middle and inner ear.

The nose includes the nostrils, septum and sinuses and lastly the throat includes the voice and swallowing functions. ENT Surgeons also deal with the soft tissues of the head and neck region which includes the thyroid and salivary glands.

 

Anatomy of the Ear

Anatomically the ear is divided into three distinct parts:

External ear or Outer ear

External ear consists of:

Pinna or Auricle: This is external part of the ear. Its purpose is to direct sound into the external auditory canal.

External auditory canal or tube: This connects the outer ear to the middle ear through which the sound travels to the eardrum.

The external auditory canal is lined by skin which has a form of sweat glands (ceruminous) these glands produce ear was. Ear wax has antibacterial properties and softens the dry flakes of skin which are constantly being shed and facilitates natural extrusion of wax and debris to the outside of the ear.

Middle ear or Tympanic cavity

The ear drum or tympanic membrane is a paper thin membrane shaped like an inverted contact lens and is approximately 8 - 10 mm in diameter. It divides the middle ear from the outer ear. When sound arrives through the external auditory canal the ear drum vibrates and the transmissions are transmitted to the inner ear by three small bones (ossicles) suspended in the middle ear cavity.

Ossicles: The ossicles are the smallest three bones in the human body. Sound vibrations cause the malleus (hammer), incus (anvil) and stapes (stirrup) to move the sound to the inner ear (cochlear).

Eustachian Tube: This is a tubular structure which links the middle ear with the back of the nose. To hear normally and for the ossicles to vibrate the pressure in the middle ear must be the same as the outside pressure. The function of the eustachian tube is to open and close during the act of swallowing, chewing and yawning thereby allowing air to pass freely and equalise pressure.

Inner ear or Labyrinth of the ear

Inner ear, also called Labyrinth of the ear consists of:

Cochlea: This is a small snail like structure that contains thin tubes of fluid, in the middle of which, is a floating membrane. Sound is transmitted in the form of vibration by the ear drum to the inner ear. This causes the delicate membranes to move stimulating hair cells which convert vibritional energy into electrical impulses. Through a confluences of nerves this passes through the cochlear nerve to the brain where the raw data from the cochlear is further processes in the side of the brain called the temporal lobe. Connected to the cochlear are three semi circular canals orientated at right angles to each other. Their purpose is to provide a sense of balance and spatial orientation. Problems with this area can result in dizziness.

Vestibule: It is an oval cavity in the middle of the bony labyrinth. The main function of vestibule is to provide balance and coordination problems in this area can cause vertigo.

Semicircular canals: Consisting of three semi-circular interconnected tubes (Anterior, Posterior and Horizontal) located in inner ear. All are lined with hairs called Cilia and a fluid called Endolymph.

Auditory nerve: Carries signals from the ear to the brain.

Anatomy of the Nose

As we breathe the nose lined with a mucus membrane cleans, warms and moistens the area before it travels down into the lungs. The nose is divided into cavities in either side of a cartilaginous septum.

The Septum

Made of cartilage in the front and bone towards the back the septum divides the nostrils into two equal cavities. The septum can be deviated giving rise to nasal obstruction symptoms.

The Nasal Cavity

This consists essentially of a tunnel through which air flows in a lamina fashion. The side walls of the nasal cavity consist of three scroll like structures (turbinates) whose function is to warm, purify and inspire the purified air.

Mucous Membrane

The nasal cavity is lined by a moist mucus membrane. The amount of mucus production is normally well controlled and in the presence of disease such as the common cold, mucus production increases. Normally mucus travels naturally towards the back of the nasal cavity.

The Sinuses

Situated above (frontal) between (ethmoid), below (maxillary) and behind (sphenoid the eyes the nasal sinuses are air filled cavities whose actual purpose is not fully understood. There is constant mucus production which flows out of the sinuses through tiny holes and drains into the back of the nasal cavity. The sinuses can be blocked by a number of conditions:

  • Found under the eyes the maxillary sinuses are the largest of the paranasal sinuses.
  • Found in the frontal bone, which forms the hard part of the forehead are the
  • Frontal sinuses, superior to the eyes,
  • Found in the ethmoid bone between the nose and the eyes the ethmoid sinuses are formed from several discrete air cells.
  • Found in the sphenoid bone at the centre of the skull base under the pituitary gland are the sphenoid sinuses.

Anatomy of the Throat

The throat is a circular muscular tube with a complex structure acting as a passageway for food, air and liquid and also helping in speech production. The throat is divided into two main areas:

Pharynx

The pharynx itself is divided into three parts. The uppermost part is called the nasopharynx and is at the back of the nose. It can contain enlarged adenoids and at the side of the nasopharynx are the openings to the eustachian tube which connect to the middle ear. The middle part or oropharynx is what you see when you open your mouth and look in the mirror.

The tonsils are visible on either side and protrude into the oropharynx to a variable degree. In the middle of the soft palate is the dangly part called the uvula which can vibrate during sleep and cause snoring. Further down is the base of the tongue also known as the hyperpharynx. This effectively is a muscular conduit through which food and liquids pass into the upper gullet or oesophagus. During the act of swallowing a flap like structure called the epiglottis closes the airway to prevent choking.

Larynx

The voice box or the larynx is in the middle of the hyperpharynx when seen from above and as stated is protected by the epiglottis flap. The function of the glottis is twofold. Firstly it prevents foreign bodies from entering the windpipe and resulting in choking its other purpose is in the production of speech.

Our voice is produced when the vocal cords come together and create a very narrow slit through which air passes and creates a vibration of the lining of the vocal cords. Synchronised movement of the lips and tongue make the crude noise from the larynx into the normal speech that we so much take for granted.

Trachea

The trachea is a continuation of the larynx and is a hollow tube passing into the chest. It divides into a right and left bronchus feeding each lung with air.

The whole respiratory tree from the tip of the nose down to lower most part of the lung is lined by special mucosal (respiratory epithelium) and this fact explains the close connection between nasal and chest disease such as allergy.

ENT conditions treated

The Ear

  • Earache
  • Ear Infections
  • Hearing Loss
  • Tinnitus (Noise in the Ear)
  • Dizziness
  • Childhood ENT Infections
  • Glue Ear & Grommet Insertion
  • Balance Disorders
  • Acoustic Neuroma

The Nose

  • Nasal and Sinus Tumours
  • Nasal Allergy
  • Nasal Polyps
  • Persistent Nose Bleeds
  • Deviated Nasal Septum
  • Functional & Cosmetic Rhinoplasty
  • Nocturnal Airway Obstruction
  • Nasal Blockage
  • Nasal Deformity
  • Facial Pain

The Throat and Voice

throat-voice-conditions_treated

  • Swallowing disorders
  • Hoarseness
  • Persistent Cough
  • Tumours and Lumps in the Head & Neck
  • Salivary Gland Tumours
  • Thyroid Tumours
  • Lesions of the Oral Cavity
  • Tonsil & Adenoid Surgery
  • Thyroid Problems
  • Acute/Chronic Sinusitis
  • Endoscopic Sinus Surgery

Treatment for Ear conditions

External Ear Reconstructive Surgery

skull-labelled_comcastSurgery to reconstruct the external ear is usually performed on individuals that are born without all, or part of, an external ear. It can also be performed due to injury, trauma or infection (autogenous) that damages all or part of the external ears.

There are two birth conditions that require surgical reconstruction of the external ear:

The first is Anotia which means the absence of an external ear structure which is in contrast to "aural atresia" which is the complete absence of the ear canal, including the tympanic membrane

The second is Microtia which is defined as an incompletely formed external ear and in most cases the middle and inner ears are perfectly normal making the condition cosmetic as opposed to nerve related deafness

Microtia

There are 4 grades of microtia:

  • Grade I microtia is defined as a smaller-than-normal ear but where the ear has most of the workings of a normal ear.
  • Grade II microtia is defined as an ear that has some of the features, for example the helix and lobule, but other features are absent.
  • Grade III microtia is defined as having a vertical skin appendage present at the location of the ear, with a evidence of a lobule at the lower end and some cartilage tissue at the upper end but no ear canal.
  • Grade IV microtia is defined as having no vestige of an external ear present.

Surgery for Microtia

Microtia repair is complicated, the requirement to create a natural looking ear paramount and involves the creation of a rigid, compatible frame and its coverage with skin. There is no natural substitute for the thin pliable cartilage or the quality and elasticity of the skin. The key elements to a successful reconstruction is the provision of a significant helix profile, scaphoid fossa, and antihelix to create the illusion of thin skin overlying thin cartilage.

Mastoidectomy

The mastoid bone is a bone located behind the ear which when viewed in cross section looks to be filled with honeycomb and the individual comb spaces are filled with. The mastoid bone is connected to the middle ear and assists in the normal movement of the eardrum. On occasion the mastoid connection to the middle ear can also be responsible for the spread of middle ear infections to the mastoid bone commonly known as mastoiditis. Mastoidectomy surgery is undertaken to remove an infection or skin growth behind your eardrum.

Why do I need surgery?

If a mastoid infection is left untreated it can result in :

1) Smelly discharge from the ear
2) Permanent damage the fragile structures of the ear and the facial nerve and could lead to facial paralysis on the infected side of the face
3) Mastoid infections can spread to the brain causing further complications including meningitis, brain abscesses and blood clots in the veins of the brain

Diagnosis

Prior to any surgery your consultant will undertake a complete physical examination of the eardrum, and middle ear and test for hearing and facial nerve function. Xrays and CT scans will also be carried out.

Surgery

A mastoidectomy is performed with the patient fully asleep (under general anaesthesia). A surgical cut (incision) is made behind the ear. The mastoid bone is then exposed and opened with a surgical drill. The infection or growth is then removed. The incision is closed with stitches under the skin. A drainage tube may also be placed.

Subject to the severity of the infection, various degrees of mastoidectomy can be undertaken.

In a simple mastoidectomy, your surgeon makes a small incision in the bone and surgically removes any infection. In contrast a radical mastoidectomy removes almost all the mastoid and potentially if the infection is extensive the eardrum and middle ear structures. Where possible the stapes are preserved to help maintain some hearing.

After the Procedure

It is not uncommon for a tube may be placed in the eardrum to drain any fluid or pus from the middle ear.

Should a radical mastoidectomy be necessary the result will often lead to a partial loss of hearing.

In rare cases bleeding and further infection can occur, however antibiotics and good post operative care will help prevent this.

Meatoplasty of external auditory canal

Meatoplasty surgery is used to widen the entrance to the external ear canal.

Why do I need surgery?

The external opening of the ear canal often referred to as the auditory meatus. Meatoplasty surgery is often the only remedy for patients whose meatus is too small and is restricting the normal flow of ear wax. As a result ear wax and dead skins cells build up leading to frequent infection and a temporary reduction in hearing ability.

Surgery

Meatoplasty surgery can be performed under either a local or general anaesthetic. A section of cartilage is removed from around the ear canal opening whilst preserving the overlying skin. The skin is then re-stitched to the underling tissue to open up the canal. Surgery takes anywhere from 30 minutes to 1 hour

Patient stays in hospital for 1 night after the operation. A tight head bandage is applied and removed the following day.

After the Procedure

Patients can require up to a week off work depending on their profession. The risks from Meatoplasty surgery are small the greatest risk being that as the ear canal heals and narrows. It is possible for post operative bleeding to occur which on occasion may require further surgery.

Myringotomy / Myringoplasty

Myringoplasty

Myringotomy surgery is often performed as a treatment for a severe infection of the middle ear which has resulted in the Eustachian tube being partially or completely blocked. The procedure involves making a small incision in the eardrum to relieve pressure caused by the build-up of fluid, or as a method for draining pus. The incision in most cases will heal within fourteen days or so of a surgery. In extreme cases it is sometimes necessary to keep the incision open for an extended period to ensure the infection has gone. In this situation a tube or stent is inserted into the opening to allow the incision to remain open for an extended period.

The most common complication to myringotomy is the failure of the eardrum to heal after the tube has fallen out or been removed. In these cases a Myringoplasty is used to close up the original incision.

Myringoplasty / Tympanoplasty

Myringoplasty surgery is used to treat a perforated eardrum when the perforation won't heal on its own. The procedure involves using a piece skin taken from another part of the body and grafting it in placing over the perforation.

What Causes A Perforated Ear Drum?

Your ear drum can become perforated following an infection of the ear where fluid has caused pressure to build-up, resulting in a split or tear to the ear drum. Perforation can also occur as a result of very sudden changes in atmospheric air pressure, trauma or from sudden and very loud noises.

Why do I need surgery?

In most cases of eardrum perforation, the hole will simply seal itself with no additional complications. Where this does not happen and the ear drum remains perforated the ear becomes open to to further infection or damage.

Following an infection that has been diagnosed by your GP, a follow-up appointment will often be required to ensure the infection has been successfully eliminated and that there is no perforation to the eardrum.

Diagnosis

Will often result from a visit to your GP.

What Is Involved In The Operation?

Your surgeon under a general anaesthetic will select the best piece of skin for the graft; commonly this is usually taken from just above the ear itself. This area will then be stitched back together.

Using specially designed surgical instruments your surgeon then attached the graft to the underside of the eardrum using adhesive that will hold the graft in place until it has attached itself to the new surface.

It may be necessary for the ear then be packed with gauze soaked in anti-biotic drops used to help prevent an infection, and the whole ear is then covered with a cotton dressing.

After the Procedure

Following surgery you can expect to have some discomfort from the antibiotic packing, along with a loss of hearing whilst the dressings are in place. Some pain may be experienced but can be managed using prescription drugs or with paracetamol. 

Avoid blowing your nose or allowing water into your ears for the first three weeks after surgery when the packing will normally be removed and the eardrum will be assessed.

Ossiculoplasty

Our middle ear contains three tiny bones called ossicles; these bones translate the vibration of the eardrum into waves and transfer acoustic energy from compression waves in air to fluid membrane waves within the cochlear.

Why do I need surgery?

The aim of the surgery is of course to improve your hearing ability, by what degree your hearing is improved is very much dependent on how severe the damage to the ear bones and middle ear is.

The operation involves either reshaping the existing bones to improve performance or implanting replacements.

Surgery

Surgery is carried out under general anaesthesia and down the ear canal, in most cases surgery takes about an hour. The damaged bones of the ear are either reshaped or removed and replaced with artificial bones that are usually made out of titanium.
Occasionally it is necessary to take cartilage from inside the ear to strengthen the eardrum.

After the Procedure

In most cases you to be discharged the same day. A little discomfort / dizziness and pain can arise but your consultant will discuss how best this can be managed with you and explain how often to change your dressing.

In the days following the operation you may experience a watery discharge mixed with blood from the ear, which can last for up to fourteen days.

It is very likely that the ear will feel blocked for a few weeks after surgery due to the dressing and any discharge that has collected in the middle ear. You should allow up to six weeks for the graft to heal fully.

You should avoid blowing your nose or getting your ear wet for up to 14 days after surgery and flying for two months.

Pinnaplasty

Corrective Ear surgery purely for cosmetic reasons is referred to as a Pinnaplasty or Otoplasty. This surgical procedure is most often performed on children between the ages of six and fourteen and adults who weren't offered surgery during childhood or whose ears have been damaged as a result of an accident.

Pinnaplasty surgery is currently the most common paediatric surgery undertaken in the UK, it is a quick and simple operation designed to reduce the size or minimise the level of protrusion. Ears reach full size normally between the ages of five and six. Surgery is often carried after this age and once our ears have matured to avoid complications.

Alternatives to Surgery

After birth and before the age of six months, it can be possible to flatten the ears using special splints or ear moulds. These can be used to mould the ears cartilage while it's still pliable. After the age of six months the only recourse is surgical intervention.

Surgery

There a variety of Pinnaplasty techniques have been used in the past to reshape the ear but after an independent review in 2005 the cartilage sparing Pinnaplasty with a posterior fascial flap was shown to significantly improve both aesthetic and functional results.

(From Comparison of Cartilage Scoring and Cartilage Sparing Otoplasty - a Study of 203 Cases. Abstract , British Journal of Plastic Surgery (2005) 58, 127-144 Mandal, Bahia and Stewart)

The surgery can be performed under general or local anaesthetic. The use of a local anaesthetic particularly popular as the recovery time is much shorter and you will be leave hospital within a few hours of surgery.

After the Procedure

Your consultant will provide individual advice about pain management. Please read and follow the instructions in accompanying information leaflet. You should keep your head raised and supported as this will help reduce swelling and bruising. A head bandage may need to be worn for up to two weeks.

Your child may need to wear a smaller and lighter headband for a few weeks after the bandage is removed. The headband may need to be worn day and night, or only at night to stop the ears being bent forward against the pillow.

Children usually need about a week off school.

Stapedectomy

Our middle ear contains three tiny bones called ossicles; the one closest to the inner ear is called the stapes. Hearing difficulty can occur as a result of a growth of bone on the stapes which makes it inflexible and stuck to the other two small bones. As a result the vibration does not get transferred to the inner ear and hearing loss occurs.

Why do I need surgery?

The aim of the surgery is of course to improve your hearing ability, by replacing the damaged stapes.

Surgery

Surgery is carried out under general anaesthesia and down the ear canal, in most cases surgery takes about an hour. The damaged stapes is removed and replaced with an artificial bone that is usually made out of titanium. 

Occasionally it is necessary to take cartilage from inside the ear to strengthen the eardrum.

After the Procedure

In most cases you to be discharged the same day. A little discomfort / dizziness and pain can arise but your consultant will discuss how best this can be managed with you and explain how often to change your dressing.

In the days following the operation you may experience a watery discharge mixed with blood from the ear, which can last for up to fourteen days.

It is very likely that the ear will feel blocked for a few weeks after surgery due to the dressing and any discharge that has collected in the middle ear. You should allow up to six weeks for the graft to heal fully.

You should avoid blowing your nose or getting your ear wet for up to 14 days after surgery and flying for two months.

Treatments for Nose conditions

Adenoidectomy

adenoid_www.ent-info.nhs.ukThe surgical removal of your adenoids is called an adenoidectomy and is performed predominantly in children. Our adenoids are lymphatic tissue and located in the back of the nose and, work to fight infection and producing antibodies. Adenoids continue to grow from birth to between three and five years old and can during this time can cause an obstruction of the nasal passage making breathing problematic and snoring when asleep. From the age of seven their adenoids would normally begin to shrink any existing symptoms disappear and by the time we reach adulthood our adenoids would have disappeared completely.

Why do I need surgery?

Adenoids may become swollen or enlarged as a result of an infection or allergic reaction and even though the infection / reaction will eventually clear up, the adenoids may remain enlarged.

Children can develop enlarged adenoids in the womb, so may have had them from birth which can lead to complications after birth.

Diagnosis

It is not possible to see your child's adenoids by looking in their mouth. If you are concerned consult your GP who will be able to examine the adenoids using a light and a mirror.

Surgery

The risks from adenoid surgery are minor and their removal will not increase the risk of your child of developing infection. Your child's immune system is more than capable of dealing with an infection or virus.

After the Procedure

Following surgery, your child may feel sleepy and will need to spend a few hours in hospital.

Your child's throat will be sore and their consultant will usually prescribe painkillers.

Between two to three hours after the operation your child will normally be able to start drinking liquids and have something to eat three to four hours after that.

Your child will need to rest for several days and will require about a week off school to minimise the risk of coming into contact with any infections.

Balloon Sinuplasty

Balloon Sinuplasty is a new, safe, innovative and effective technology for patients suffering from sinusitis. It is a minimally invasive procedure where the technology uses a small flexible balloon catheter to open up the blocked sinus passageways. This results in normal sinus function and drainage for the patient.

There are many benefits associated with this procedure as opposed to more traditional methods of surgery including the possibility of reduced bleeding, which usually requires uncomfortable nasal packing. The method has an excellent safety profile, significantly reducing the risk of trauma to neighbouring structures such the eye socket and base of the skull. In addition, there is improved recovery time and usually patients can return to normal activities within 24 hours.

This technique has been approved by NICE and is helpful in the management of sinus problems for patients who suffer from symptoms including facial pain, pressure and congestion, nasal obstruction, nasal discharge, loss of smell or taste, headache, dental pain and halitosis.

Balloon Sinuplasty is offered at The Wellington Hospital by Mr Kalpesh Patel.

Functional Endoscopic Sinus Surgery (FESS)

FESS is the operation that can be used to treat severe or difficult sinus problems. Conducting the operation using an endoscope means the surgery can be performed without the need for incisions (cuts) in the mouth or face. The operation is all done inside the nose, however you may also need to have a CT scan to help decide about the need for an operation.

Usually the operation is perform under a general anaesthetic, but it can also be done under a local anaesthetic. There should be no need for incisions unless the operation is a complicated one, and you can discuss the most appropriate approach with your consultant prior to your procedure.

It is common for the nose to be quite blocked and to have some mild pain for a few weeks after the operation. This usually responds to simple painkillers.

Nasal Polypectomy

nasal polypectomy diagramA nasal polyp is usually a benign growth originating from the mucous membranes, which line your sinuses. Your sinuses are hollow spaces in the bones of your face and skull. Polyps can come through these hollow spaces and block your nasal passages. Their exact cause is not known although they are often the result of an underlying condition and surgery is therefore only one part of the treatment.

Why do I need surgery?

Nasal polyps that cause blockage problems should be removed. If left, polyps can grow causing nasal and sinus blockage, reducing your sense of smell and possibly cause fluid build up in your sinuses which can lead to further infection.

Diagnosis

If you have a blocked nose as a result of nasal polyps, and medical treatment in the form of nasal sprays etc have not been useful, then surgery can offer lasting results. Your GP will be able to advise you.

Surgery

A Nasal polypectomy is used to remove the polyps from the inside of your nose and is carried out under general anaesthetic. The surgery usually takes about 45 minutes.

After the Procedure

Nasal polyp removal is a routine and safe procedure. It is common for your nose to bleed after surgery, and your nose will be packed after surgery to reduce this possibility. Occasionally bruising may appear around the eyes and you will need to rest at home for a week however your consultant will advise you of the best aftercare regime to follow for your particular situation.

Nasal Septum Cauterisation

Two methods of Nasal cauterisation are used in the treatment of persistent sores and frequent nose bleeds. The first uses a caustic chemical agent, for example silver nitrate, the second uses an electrically charged wire to stop bleeding in the nasal mucous membrane. Chemical cauterisation of visible blood vessels on the frontal part of the nasal septum is the most common treatment method for frequent nosebleeds.

Diagnosis

Self diagnosis is likely, if you are having frequent nose bleeds or if your septum has been damaged and as is refusing to heal, then cauterisation may be the answer. However it is important to check with your GP first to ensure that this treatment is appropriate for you.

Treatment

Cauterisation using cream can be an effective treatment and easier when treating children. However where symptoms persist then treatment is more likely to involve the use of a cauterisation wire.

After the Procedure

Serious adverse effects are rare from either procedure is rare but chemical cauterisation can be painful. The area that has been cauterised can harden and thicken and itching is common. Please follow your consultants' aftercare instructions fully to avoid delaying the healing process a possible infection.

Septorhinoplasty / Septoplasty

Septorhinoplasty is a specialist nose procedure for people who both want to make their nose look better, and who also suffer breathing difficulties due to problems with their septum.

Your septum is the thin piece of cartilage which forms the wall between the two sides of your nose. Ideally the septum would lie exactly in the middle of our nose which allows us to breathe easily and gives the noses its symmetrical appearance. It is estimated that only one in five of us have a perfectly straight septum, most of us have a septum that is slightly off centre.

Why do I need surgery?

In some cases it can be very off-centre and this is referred to as having a deviated septum, this can occur naturally or can occur as a result of an injury and can cause frequent nosebleeds and problems breathing.

In this situation you may opt for surgery to fix your septum, called septoplasty. Should you opt for a more radical procedure, which both straightens the cartilage and bone and also approves the nose's overall outer appearance, it is called Septorhinoplasty.

Diagnosis

Will in most cases result from a visit to your GP.

Surgery

The surgery usually takes between two to three hours and is performed under general anaesthetic. An incision is initially made on the inside the nose where some of the bone and cartilage is removed to straighten the septum, the second part reshapes the nose.

Stitches will be used and you will require a splint on your nose.

After the Procedure

It is recommended you arrange for at least two weeks off work as your nose may be packed with cotton wool or special dressings after surgery, and your nose is likely to be bruised and swollen. Do not to blow your nose for at least a week and avoid smoky environments. Numbness and a small amount if bleeding can also occur and may last for some time after surgery.

All operations come with risks: include bleeding, pain, infection and blood clots. A Septorhinoplasty can also have additional complications; these are rare but can occur and include redness, scarring, nerve injury, nasal obstruction and excessive bruising.

There is also the risk as this operation is also partly cosmetic that you won't be entirely happy with your nose after surgery.

Somnoplasty or Turbinates Hypertrophy Reduction

somnoplasty diagramSomnoplasty is in fact a generic treatment for three conditions, habitual snoring, chronic nasal obstruction and obstructive sleep apnea. The treatment uses targeted radio wave energy to shrink underlying tissue that would otherwise cause an obstruction.

Why do I need surgery?

Symptoms can range from mild congestion and/or excessive secretion from the nose to complete nasal blockage. If you suffer from turbinate obstruction you may experience sleep apnoea, nasal congestion, postnasal drainage and, possibly facial pain and discomfort. In the case of nasal obstruction this is often caused by swelling of the bones that line the walls of the noses called Turbinates. This is often in response to an allergic reaction or underlying illness.

Surgery

The procedure uses a needle introduced through the tongue, throat or soft palate to target the affected areas. The needle is then heated by radio waves causing the underlying tissue to die and to shrink beneath the outer tissue. While the internal tissue shrinks the outer layer remains undamaged.

In the case of nasal obstruction caused by a swelling of the Turbinate bones surgery can also be performed to trim back the bones or cauterisation can be used to shrink the turbinate lining.

After the Procedure

Between 6-8 weeks after the procedure the underlying tissue will have been absorbed by the body. It is this process of absorption that reduces the obstruction and enlarges your airway. It is possible that more than one procedure will be required.

Treatments for the Throat and Voice

Endoscopic Resection of Pharyngeal Pouch

A Pharyngeal Pouch will often result because of a lack of co-ordination between the sphincter muscle at the top of the oesophagus and the muscles of the pharynx contracting. If the oesophagus muscle does not open at the right time, the resulting pressure can cause the posterior wall of the pharynx to herniate creating a pouch.

Why do I need surgery?

Symptoms of a pharyngeal pouch vary from none to a problem swallowing, the feeling of a lump in the throat or of food catching in the throat which can lead to the unwanted regurgitation of food.

Food may enter the pouch and not down the oesophagus and this may result in weight loss, recurrent chest infections.

If left untreated there is a low but very real risk of a carcinoma developing in the pouch.

Diagnosis

Diagnosis is confirmed with a barium swallow test.

Surgery

Pharyngeal pouches are generally treated by endoscopic surgery through the mouth. The primary objective of the procedure is to dividing the wall separating the pouch and the oesophagus to create one cavity using endoscopic stapling.

Endoscopic surgery is minimally invasive and as a result benefits the patient with shorter operating times and a much quicker recovery time. The risks of post operative complications are also drastically reduced using endoscopic surgery.

After the Procedure

Patients may start to drink fluids on the day of the operation and gradually build up to normal food. Patients are normally discharged two to three days after surgery.

Complications can occur with this procedure including post operative bleeding which may require further surgery.

Microlaryngoscopy

Microlaryngoscopy diagramAn examination under a general anaesthetic is needed to find out what is wrong; this procedure is called a microlaryngoscopy. It enables your consult to see a clear and detailed view of your larynx using a microscope.

Why do I need surgery?

If you are experiencing problem with your larynx (voice box) and the cause cannot be establish by conventional examination techniques a Microlaryngoscopy is used to investigate further.

Surgery

By passing short metal tube (a laryngoscope) through your mouth and into your voice box your consultant is able to use a microscope to examine your voice box to establish what is causing the problem.

Once diagnosed, surgery on your voice box can also be carried out through the laryngoscope. If there are any problem areas, small sections of the lining of the voice box can be biopsied and sent away for further examination. Microlaryngoscopy surgery is short usually lasting less than 30 minutes.

After the Procedure

After surgery it is likely that your throat will be sore for a day or two. This can be managed using painkillers. It is possible that your voice may sound hoarse particularly if any biopsies have been taken. This is temporary until the lining of the voice box heals.

You can usually eat and drink the same day. If your consultant has taken a biopsy you may advised you to rest your voice for a while.

Nasendoscopy

Our Lodge Road facility has the most advanced outpatient ENT endoscopy equipment.

If you have a problem with your nose or throat, it is probable that your doctor will wish to examine you with a small telescope. These are passed into the nose, mostly following a local anaesthetic spray. For examining the nose and sinuses, a short metal telescope is used and allows a magnified close-up view of the inside of the nose and sinuses. Your doctor will be looking for blockages, inflammation, polyps and secretions.

For examining the throat, a flexible telescope is used, again passed through the nose, but this time to get a bird's eye' view of the throat from above. Your ENT doctor will be looking at how the larynx (voice box) looks and moves, and at the amount of inflammation and secretions, as well as to rule out any abnormal lumps or bumps. A strobe light can be used to see more detail regarding vocal cord motion.

Either sort of telescope can also be used to perform minor procedures in the outpatients, such as cauterising a bleeding nasal blood vessel, removing a foreign body, cleaning sinuses after surgery, or injecting a paralysed vocal cord.

Whilst mildly uncomfortable (they may make the eye water, for example), nasendoscopy usually does not take more than a couple of minutes to perform. Complications, such as nose bleeds are very rare indeed. These examinations and procedures also can be recorded and/or pictures printed to compare before and after treatment, or to show you what is happening inside your nose and throat if desired and to feed back to your GP or other referring doctor.

Thyroidectomy

thyroidectomy diagramThe thyroid gland is shaped like a 'W' and covers the Trachea (Windpipe) located at the front and base of your neck. Its purpose is to produce and deliver two hormones into your bloodstream, Triiodothyronine and Thyroxine. These hormones combine to control your metabolism.

Why would you need a Thyroidectomy?

The need for a Thyroidectomy is assessed by way of a consultation and outpatient tests in line with your medical history.

The most common tests utilised in this process include:

  • Thyroid scan
  • Ultrasound
  • X-rays and/or CT scan
  • Assessment of thyroid hormone levels
  • Fine needle aspiration

Diagnostic tests

Initially you will need to have blood tests to check the level of thyroid hormones in your blood to determine the extent and impact of any underlying problem. In the case of a tumour or growth or enlarged thyroid gland, you may have an ultrasound scan to provide an image of the inside of your neck.

Fine Needle Aspiration Biopsy

Sometimes it may be necessary to perform a Fine Needle Aspiration to determine the underlying makeup of a cyst or tumour to remove samples of tissue or fluid from a mass found under the skin. Once the samples of cells have been removed, they are sent to the laboratory for further testing.

How does fine needle aspiration work?

A very thin needle is gently inserted through the skin into the lump or organ below. Often there is a syringe attached to the needle. The doctor can use the syringe to help take a sample of cells. Usually, the test can be done without the need to make a cut in the skin. This helps to minimise any discomfort to the person having the test as well as the risk of infection or other complications.

Treatment

Every case is different and depending on the results of the tests your consultant may recommend full or part removal of your thyroid for the following conditions:

  • A benign (noncancerous) thyroid tumour or cyst
  • Cancer of the thyroid gland
  • An overactive thyroid gland (Thyrotoxicosis) where the use of radioactive iodine is not appropriate
  • A thyroid swelling (nontoxic goitre) that makes it hard to breathe or swallow

Total/Partial Thyroidectomy Surgery

An incision measuring approximately 3-5 inches in length is made in the lower part of the neck through which your consultant will then remove all or part of the thyroid. Surgery to remove your whole thyroid may take up to 4 hours or less if only part of the thyroid is removed. During surgery your consultant may place a small tube (catheter) into the area to help drain blood and other fluids that build up. The drain will be removed in 1 or 2 days.

After the Procedure

The standard length of stay for a Thyroidectomy is up to 2 nights in hospital, but this can vary depending on whether you have a Total or Partial removal. In general you must be able to swallow liquids before you can be discharged home.

Doctors

Browse doctors for this speciality, and find out more about their skills

Mr Solomon Abramovich Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Mr Solomon Abramovich
Mr Ghassan Alusi Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Mr Ghassan Alusi
Mr C Martin Bailey Consultant Paediatric ENT Surgeon
ENT (Ear, Nose & Throat)
Mr C Martin Bailey
Mr Elliot Benjamin Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Mr Elliot Benjamin
Mr Abir Bhattacharyya Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Mr Abir Bhattacharyya
Professor Martin Birchall Consultant Otorhinolaryngology
ENT (Ear, Nose & Throat)
Professor Martin Birchall
Mrs Helen Caulfield Consultant Paediatric ENT Surgeon
ENT (Ear, Nose & Throat)
Mrs Helen Caulfield
Mr Christopher Dunn Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Mr Christopher Dunn
Mr S Alam Hannan Consultant Otorhinolaryngologist
ENT (Ear, Nose & Throat)
Mr S Alam Hannan
Mr Jonathan Hughes Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Mr Jonathan Hughes
Miss Ekpemi Irune Consultant ENT, Head and Neck Surgeon
ENT (Ear, Nose & Throat)
Miss Ekpemi Irune
Professor Antony Narula Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Professor Antony Narula
Mr Paul E O'Flynn Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Mr Paul E O'Flynn
Mr Kalpesh S Patel Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Mr Kalpesh S Patel
Mr Robert E Quiney Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Mr Robert E Quiney
Professor Shakeel Saeed Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Professor Shakeel Saeed
Mr Neil S Tolley Consultant ENT Surgeon
ENT (Ear, Nose & Throat)
Mr Neil S Tolley
Mr Michael Wareing Consultant in Ear, Nose and Throat
ENT (Ear, Nose & Throat)
Mr Michael Wareing