Common ENT Conditions

Ear 

What are Grommets?

This is a common surgical procedure where a small rice sized tube is inserted into the eardrum allowing middle ear fluid to drain and ventilate in the setting of middle ear infection. This improves hearing and assists with normal speech and and learning especially important for the children development.

What is Exotosis?

Exotosis or swimmers ear is an abnormal growth of bone in the ear canals secondary to repeated cold water or cold air exposure common in swimmers or surfers. Water trapping, ear wax impaction and repeated ear infection can result in severe cases which will require surgical removal.

Myringoplasty (Repair of the Eardrum)

Ear drum perforation or hole in the eardrum often results from trauma or infection. Traumatic perforations are usually due to insertion of cotton buds, ear curettes or foreign objects. This can lead to hearing loss and recurrent ear infections. Small eardrum perforations tend to heal without surgery in vast majority of healthy individuals. Surgical repair of the ear drum will be required for closure in non healing perforations.

Otosclerosis

This is a hereditary disease with abnormal bone formation near the middle ear causing hearing loss. Hearing aid is usually indicated in moderate cases and surgery to replace the abnormal stapes bone (stapes surgery) can be considered in severe cases.

What is Cholesteatoma?

A cholesteatoma is an abnormal collection of keratin or skin cyst in the middle ear (compartment behind the eardrum). This can be due to Eustachian tube dysfunction (tube connecting the back of the nose to the ear), eardrum perforations and rarely as a complication from previous ear surgery. Due to the proximity of the middle ear to vital brain and nerve structures, early recognition and treatment will be required to prevent complications.

What is glue ear?

Glue ear is a common condition that affects the middle ear of children with the highest incidence occurring in children between three and six years of age. Glue ear (or fluid) is an accumulation of thick, "gluey" fluid in the middle ear (ie behind the eardrum) usually causing earache and partial deafness. Commonly it is the result Eustachian tube blockage from an upper respiratory infection, large adenoids, nasal allergy, poor nasal function, cleft palate, an immature Eustachian tube and a number of other factors. In the presence of bacteria, this fluid may become infected leading to an infected or abscessed middle ear. When infection does not develop, the fluid remains until the Eustachian tube again begins to function normally, at which time the fluid is absorbed or drains down the Eustachian tube into the throat. Various medical therapies are used to help clear the fluid. Most resolve spontaneously over two to three months but the remainder may persist for many months or indefinitely, unless the fluid is cleared and the middle ear artificially ventilated by a small tube.


Nose

Nasal Obstruction

The nasal septum is a partition made of cartilage and bone that divides the right nasal cavity from the left nasal cavity. The septum is usually straight and lies in the centre of the nose. A deviated septum is an abnormal bend in this partition and this may cause problems with nasal breathing and/or nasal discharge. It may be caused by an injury or birth defect.

Medical treatment of nasal obstruction

In some patients allergy, infection or other irritants may cause the nasal lining to swell and produce nasal obstruction. If there is already a deviated septum or large turbinates, a small amount of swelling can produce symptoms. On the other hand, if the swelling can be reduced with medication, this may be enough to avoid surgery.

What is a septoplasty?

A septoplasty is an operation in which the nasal septum is straightened. When there is a septal deviation there is invariably an associated swelling of tissue arising from the side walls of the nose (the turbinates). These may need to be partially reduced. The operation is performed under general anaesthesia.

What is the nasal septum?

The nasal septum is a partition made of cartilage and bone that divides the right nasal cavity from the left nasal cavity. The septum is usually straight and lies in the centre of the nose. A deviated septum is an abnormal bend in this partition and this may cause problems with nasal breathing and/or nasal discharge. It may be caused by an injury or birth defect. Inside the nose, the side walls contain small horizontal bones (turbinate) that are lined with nasal tissue. It is important to note that the nose goes through a natural cycle in which the nasal lining of the turbinates on one side (and then the other) slowly expands and contracts. These cycles occur every several hours and may lead to the perception of the nasal obstruction being intermittent and/or changing sides.

Medical treatment of nasal obstruction

In some patients allergy, infection or other irritants may cause the nasal lining to swell and produce nasal obstruction. If there is already a deviated septum or large turbinates, a small amount of swelling can produce symptoms. On the other hand, if the swelling can be reduced with medication, this may be enough to avoid surgery.

What is a Septal Reconstruction?

Septal reconstruction is an operation in which the nasal septum is straightened. During septal reconstruction part of the deviated septum is removed. Cartilage is then used to replace/reconstruct the septum (this maintains the support of the nasal framework). Swelling of the turbinates may be associated with septal deviation. Thus, turbinate reduction (resection and/or diathermy) may also be performed during the septal reconstruction.

What are the indications for a septal reconstruction?

A small number of people actually have a perfectly straight midline septum, but in most cases the amount of bending is not large enough to be a problem. A septal reconstruction is performed if the septum is so bent that it obstructs the breathing or interferes with the drainage of the sinuses, (leading to repeated sinus infections). In some cases the septum may need to be straightened in patients undergoing sinus surgery just so that the instruments needed for the surgery can fit into the nasal cavity.

What is Sinusitis?

Sinusitis is an infection or inflammation of the sinuses. Normally, the sinuses and nose are cleaned by the flow of this mucous and anything that blocks the outflow of this mucous, can lead to sinus pressure, pain, and infection. Colds, allergies or exposure to smoke, can all thicken the mucosa and block the flow of mucous. Bacteria can subsequently grow in the blocked sinus, resulting in sinusitis.

What are the symptoms of sinus disease?

The most common symptom of a sinus infection is pressure and/or pain in the facial region or behind the eyes. This is usually associated with nasal obstruction, green or yellow nasal discharge, post-nasal drainage, and may include a fever. Sinusitis can cause redness and swelling of the skin near the eyes if the infection is severe. Headaches can be caused by sinusitis (and many other conditions). Although it is difficult to actually see into the sinuses themselves, a nasendoscope (a telescope for looking into the nose) can be used to look at the openings of the sinuses. In some patients pus can actually be seen coming out of the sinuses, which will confirm the diagnosis. Another typical findings of acute sinusitis is a swollen and red nasal cavity.

What are the treatment options for sinus disease?

  1. Medical Treatment
    In some patients allergy, infection or other irritants may cause the nasal lining to swell and produce sinusitis. Medications (nasal sprays, antibiotics, and others) may be enough to avoid surgery.
  2. Surgical Treatment
    If sinus infections persist despite maximum medical treatment, then surgery may be necessary. The aim of surgery is to improve the natural drainage system of facial sinuses and to remove any anatomical obstruction or diseased areas which cause recurrent or chronic sinus infection.

The surgical method used is Functional Endoscopic Sinus Surgery (FESS).

The use of endoscopes has revolutionised all forms of surgery in the past ten years by providing vision into body spaces with excellent illumination, magnification and "around the corner" views. Endoscopic sinus surgery is performed through the nostrils and occasionally external incisions.

The operation is performed under a general anaesthetic and may requires an overnight stay in hospital and 7-14 day's absence from school or work.


Throat

Tonsillitis

Tonsillitis occurs when the tonsils become inflamed from infection. Tonsils and adenoids may cause problems if they become enlarged or infected. Tonsillitis is most commonly seen in children between the ages of 6 and 8. There are many causes of tonsillitis (viruses, bacteria, fungal infections). Cigarette smoke may increase incidence of tonsillitis. Symptoms of tonsillitis may include: sore throat, fever, headache, decrease in appetite, not feeling well, nausea, vomiting, stomach aches and painful swallowing. If tonsils are very large periods of apnoea (stopping breathing) may occur at night.

Adenoiditis

Adenoiditis is an inflammation of the adenoids due inflammation or infection. Symptoms of adenoiditis or enlarged adenoids may include: mouth breathing, noisy breathing or snoring, nasal speech, or if very large periods of apnoea may occur at night. Specific treatment for tonsillitis and adenoiditis will be determined based on: age, general health and medical history; severity and frequency of infections; the occurrence of any airway problems; and your opinion or preference.

Surgery for Tonsillectomy & Adenoidectomy

In children the tonsils and adenoids are frequently removed at the same time, but sometimes, only one is removed. Tonsillectomy and adenoidectomy (T&A) surgery is one of the most common major operations performed on children. The most common reasons for performing tonsillectomy and adenoidectomy are recurrent tonsillitis (not just a sore throat) and/or airway obstruction causing problems with breathing.

What is sleep apnoea?

Paediatric obstructive sleep apnoea (or a “newer term” sleep disordered breathing) in children is a medical condition in which children have breathing problems while they are asleep. Sleep apnoea can affect children’s sleep and behaviour, and if untreated can lead to more serious problems. When children (and adults) fall asleep, the muscles in the upper airway relax and become floppy. These can be partially or totally blocked by large tonsils and adenoids while the child is asleep. Snoring in children is common (15-20%) however, obstructive sleep apnoea is less common. It affects approximately 2-3 children in every 100.

What are the main symptoms of sleep apnoea?

Sleep apnoea may be difficult to diagnose, thus is it important to look for the following symptoms:

  • Snoring
  • Laboured breathing during sleep
  • Excessive Sweatiness AND/OR Restlessness during sleep
  • Excessive day time Sleepiness AND/OR morning Tiredness/Headaches
  • Pauses in breathing AND/OR “Choking”/Gasping/Snorting during sleep
  • Awakening due to bad dreams (“parasomnias”) AND/OR sleep walking
  • Positions (sleeping in unusual positions; eg extended neck, sitting up)
  • Nasal obstruction and mouth breathing
  • Overweight or Underweight
  • Enuresis (bedwetting)
  • Attention/learning/behavioural problems

How is obstructive sleep apnoea treated?

Enlarged tonsils and adenoids are a common cause, thus dissection tonsillectomy and curettage adenoidectomy are performed to treat this problem. Allergic rhinitis/nasal obstruction is treated with medication (+/- surgery). Obese and overweight children are started on exercise and weight management programs.

Panendoscopy

This procedure is performed to diagnose cancers in the upper aero digestive tract

Microlaryngoscopy

This procedure is performed for pathological conditions in the voice box or the larynx

Uvulopharyngopalatoplasty (UPPP)

This is a procedure performed to assist with reducing or eliminating snoring. Surgery in removing parts of the uvula at the back of the mouth.