ENT

To treat & dignose the disorders related to ear, nose, and throat(ENT), we not only have the ENT specialists with us but also up to the mark amenities & equipment. We specialise in stichless deafness ear surgeries. Not only this procedure is done under local anaesthesia but the eardum is repaired without giving any scar to the patient. We also have facilities for speech therapy hearing assessment, and hearing aids

PERFORATED EARDRUM & MYRINGOPLASTY [Click here]

What is a perforated eardrum?

A perforated eardrum means there is a hole in the eardrum, which may have been caused by infection or injury. Quite often a hole in the eardrum may heal itself. Sometimes it does not cause any problems. However it may cause recurrent infections with a discharge from the ear. If you have an infection you should avoid getting water in the ear. If the hole is large then you may experience some hearing loss. A hole in the eardrum can be identified by an ENT specialist using an instrument called an ‘otoscope'.

Surgery to repair the perforation

An operation to repair the perforation is called a 'myringoplasty'. The benefits of closing a perforation include prevention of water entering the middle ear, which could cause ear infection. Repairing the hole means that you should get fewer ear infections. It may result in improved hearing, but repairing the eardrum alone seldom leads to great improvement in hearing.

The myringoplasty operation

The operation is almost always done under local anesthesia. These days, the surgery is performed through the ear canal which means no incision and hence no scar. The material used to patch the eardrum is taken from canal skin. This eardrum 'graft' is placed against the eardrum. Dressings are placed in the ear canal. You may have an external dressing and a head bandage for a few days. The operation can successfully close a small to moderate size hole nine times out of ten.

CHOLESTEATOMA/MASTOID OPERATIONS [Click here]

What is a cholesteatoma?

A cholesteatoma is a cyst or sac of skin that is growing backwards behind your eardrum into the middle ear and mastoid. It results in a chronic, smelly discharge, and the longer it remains the more damage it can do to the delicate structures of the ear.

Why have an operation?

If left untreated, after many years it could destroy your hearing, destroy your balance organ and damage your facial nerve which would give you a paralysed side of your face. It can also cause brain infections, because the ear is so close to the brain. It is therefore necessary to remove it, before it is able to cause such damage.

By removing the cholesteatoma, you should no longer be at risk of these complications. It may also be possible to improve your hearing in that ear.

What does the operation involve?

It is almost always done under local anesthesia at our centre. You will have a cut either behind your ear, or just in front and above your ear. The extent of the operation depends on the extent of the disease. The aim is to remove all the disease but preserve as much of the workings of your ear as possible.

The mastoid bone is like a bony sponge, full of little pockets that can harbour the cholesteatoma, so these will need to be removed and smoothed out. If the disease is surrounding the ossicles, these little bones will also have to be removed.

The facial nerve, which supplies the muscles in your face, runs in a bony canal through your ear. Sometimes the bone overlying the nerve has been destroyed by the disease, but all care is taken to avoid damaging this nerve (see risks).

After the disease has been removed, a graft will be used to seal up any hole in the eardrum, and packing placed in the ear canal.

What happens after the operation

You will stay in hospital at least one night after the operation. If the stitches are not dissolvable, they will be removed after one week. The packing will be removed from your ear after 1 to 3 weeks.If you have a mastoid cavity after the operation, it will need regular care in the OPD until it is entirely healed.

What are the risks of the operation?

you are careful about keeping water away from your operated ear, you can wash your hair after a week.

You should be able to swim about four to six weeks after the operation, depending on how well the operation has healed, and so you should ask your surgeon at your postoperative outpatients appointment.

You should be able to fly at any time after the operation unless you have also had an operation to improve your hearing at the same time as the mastoid operation - again, check with your surgeon.

OTOSCLEROSIS [Click here]

The Ear

The ear consists of the outer, middle and inner ear. Sound travels through the outer ear and reach the eardrum, causing it to vibrate. The vibration is then transmitted through three tiny bones in the middle ear called the ossicles. These three ossicles are called malleus, incus and stapes, sometimes known as hammer, anvil and stirrup. The vibration then enters the inner ear which is a snail-shaped bony structure filled with fluid. The nerve cells within the inner ear are stimulated to produce nerve signals. These nerve signals are carried to the brain, where they are interpreted as sound.

What is otosclerosis?

Otosclerosis is a disease of the bone surrounding the inner ear. It can cause hearing loss when abnormal bone forms around the stapes, reducing the sound that reaches the inner ear. This is called conductive hearing loss. Less frequently, otosclerosis can interfere with the inner ear nerve cells and affect the production of the nerve signal. This is called sensorineural hearing loss.

Causes of otosclerosis

The cause of otosclerosis is not fully understood, although it tends to run in families and can be hereditary. People who have a family history of otosclerosis are more likely to develop the disorder. Otosclerosis affects the ears only and not other parts of the body. Both ears are usually involved to some extent. However, in some individuals, only one ear is affected. It usually begins in the teens or early twenties. Some research suggests a relationship between otosclerosis and the hormonal changes associated with pregnancy.

Symtoms & diagnosis of otosclerosis

The commonest symptom is hearing loss that may take many years to become obvious. The degree of hearing loss may range from slight to severe. It can be conductive, sensorineural or both. In addition to hearing loss, some people with otosclerosis may experience tinnitus or noise in the ear. The intensity of the tinnitus is not necessarily related to the degree or type of hearing loss. Very rarely, otosclerosis may also cause dizziness.

How can otosclerosis be treated?

There is no known cure for otosclerosis. The individual with otosclerosis has several options: do nothing, be fitted with hearing aids, or surgery. No treatment is needed if the hearing impairment is mild. Hearing aids amplify sounds so that the user can hear better. The advantage of hearing aids is that they carry no risk to the patient.

The stapedectomy operation

The operation usually takes about an hour and done under local anesthesia. A cut is made above the ear opening or inside the ear canal. The top part of the stapes is removed with fine instruments. A small opening is then made at the base, or "footplate", of the stapes into the inner ear. A teflon prosthesis is then put into the ear to conduct sound from the remaining ossicles into the inner ear. You will have packing placed in the ear canal.

How successful is the operation?

The chances of obtaining a good result from this operation by experienced surgeons are over 80 percent. This means that eight out of ten patients will get an improvement of hearing up to the level at which their inner ear is capable of hearing.

Possible complications

There are some risks that you must consider before giving consent to this treatment. These potential complications are rare.
  • Loss of hearing: In a small number of patients the hearing may be further impaired due to damage to the inner ear. It can even result in a severe loss of hearing in the operated ear. For experienced surgeons, this complication happens in around one in 100 patients.
  • Dizziness:Dizziness is common for a few hours following stapedotomy and may result in nausea and vomiting. Some unsteadiness can occur during the first few days following surgery; dizziness on quick head movement may persist for several weeks. On rare occasions, dizziness is prolonged.
  • Taste disturbance: The taste nerve runs close to the eardrum and may occasionally be damaged. This can cause an abnormal taste on one side of the tongue. This is usually temporary but it can be permanent in one in ten patients.
  • Reaction to ear dressings: Occasionally the ear may develop an allergic reaction to the dressings in the ear canal. If this happens, the pinna (outer ear) may become swollen and red. You should consult your surgeon so that he can remove the dressing from your ear. The allergic reaction should settle down after a few days.
  • Tinnitus: Sometimes the patient may notice noise in the ear, in particular if the hearing loss worsens.
What happens after the operation?

You will usually go home the day after the operation or sometimes the same day. The ear may ache a little but this can be controlled with painkillers provided by the hospital. A slight amount of dizziness is normal after the operation. There may be a small amount of discharge from the ear canal. This usually comes from the ear dressings. The packing in the ear canal will be removed after two or three weeks. You may need to take one to two weeks off from work. You should keep the ear dry for the first few weeks. Plug the ear with a cotton wool ball coated with Vaseline when you are having a shower or washing your hair. Avoid straining for the first few weeks after surgery, that is, no heavy lifting. Only blow the nose gently. Avoid air travel until cleared by your surgeon.

Hearing may not return to normal for up to three months. You should consult the surgeon if there is a sudden onset of deafness, dizziness or severe pain after you are discharged from the hospital.

Glue ear is a condition in which fluid accumulates in the middle ear behind the ear drum. It is the commonest cause of partial deafness in children .

The build up of fluid in the middle ear is due to a problem of blockage of the tube that connects the middle ear to the back of the nose (Eustachian tube)

The Eustachian tube normally plays an important role in maintaining equal air pressure between the outside and inside of the middle ear. When the tube becomes obstructed, the air in the middle ear becomes absorbed and the resulting vacuum draws fluid into the middle ear cavity from the lining of the ear (the mucosa).

Initially the fluid is thin and watery but eventually it becomes thick and tenaceous, hence the name ‘glue ear'. Because the middle ear is now filled with fluid rather than air, the hearing is muffled. Obstruction of the tube may be due to repeated bacterial and viral upper respiratory tract infections, enlarged adenoids or nasal allergy.

It is important to note that in children the Eustachian tube is more horizontal and smaller than in adults and this is one of the reasons why glue ear is relatively common in children. Glue ear may lead to delayed speech development, behavioural or educational problems.

Treatment

The decision to operate and insert a grommet in the eardrum is dependent on many factors such as the patient's age, whether there are recurrent middle ear infections, pain, speech delay, learning or behavioral difficulties.

Young children with poor language development, pain or recurrent ear infections should have grommets inserted as soon as possible. Older children with few symptoms can be treated conservatively with regular follow-up visits in the outpatient clinic, to monitor their hearing and the appearance of the ear drum.

The main objective of grommet insertion is to get rid of the fluid in the middle ear by allowing air to enter through the grommet, so temporarily bypassing the problem. Normal hearing is restored once this objective is accomplished.

Grommets are available in may different shapes and sizes. On average, a grommet will stay in place between six to 12 months and will then fall out as the healing eardrum pushes it out into the ear canal.

If the child redevelops glue ear, it may be necessary to re-insert another grommet. The operation to insert a grommet is usually performed as day-case surgery under general anaesthesia and it is the most common ear nose and throat procedure.

SEPTOPLASTY [Click here]

What is septal surgery?

The septum is a thin piece of cartilage and bone inside the nose between the right and left sides. It is about 7cms long in adults. In some people this septum is bent into one or both sides of the nose, blocking it. Sometimes this is because of an injury to the nose, but sometimes it just grows that way. We can operate to straighten the septum.

Why have septal surgery?

If you have a blocked nose because of the bend in the septum, an operation will help. Sometimes we need to straighten out a bent septum to give us room to do other things, such as sinus surgery. The operation is not meant to change the way your nose looks. In some cases a bent septum may occur with a twist in the outside shape of the nose. In these cases septal surgery may be combined with nose re-shaping surgery (septorhinoplasty) to straighten the nose.

Do I have to have septal surgery?

A bent septum will not do you any harm, so you can just leave it alone if you want to. Only you can decide if it is causing you so much bother that you want an operation.

How is the operation done?

The operation takes about 30-45 minutes. You might be asleep although some cases can be performed with only your nose anaesthetised. The operation is usually all done inside your nose - there will be no scars or bruises on your face. We make a cut inside your nose and straighten out the septum by taking away some of the cartilage and bone and moving the rest of the septum back to the middle of the nose. Then we hold it all in place with some stitches.

Packs and splints

We may need to put a dressing in each side of your nose to keep things in place and prevent bleeding. The dressings are called ‘packs', and they will block your nose up so that you have to breathe through your mouth. We will take them out the morning after your operation. You may get a little bit of bleeding when the packs come out - this will settle quickly.

Sometimes we put small pieces of plastic in your nose to prevent scar tissue from forming. They are called ‘splints' and we will take them out after about a week.

After the operation

The front of your nose can be a bit tender for a few weeks. Do not blow your nose for about a week, or it might start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. You may get some blood coloured watery fluid from your nose for the first two weeks or so - this is normal. Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation. We may give you some drops or spray to help this.

It may take up to three months for your nose to settle down and for your breathing to be clear again. Try to stay away from dusty or smoky places. There will be some stitches inside your nose - these will dissolve and usually fall out by themselves

You can expect to go home the day after your operation. Sometimes it is possible to go home the same day. You will need to rest at home for at least a week.

What can go wrong?

Septal surgery is safe, but there are some risks. Sometimes your nose can bleed after this operation, and we may have to put packs into your nose to stop it. This can happen within the first 6 - 8 hours after surgery or up to 5 - 10 days after surgery.

Infection in your nose is rare after this operation but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked and sore.

Rarely, the operation can leave you with a hole in your septum inside the nose going from one side of your nose to the other. Very rarely you may find that the shape of your nose has changed slightly, with a dip in the bridge of your nose. Most people do not notice any change, but if you are not happy with it, it can be fixed with surgery. Very rarely, you can have some numbness in the teeth, which usually settles with time.

Is there any alternative treatment?

Only an operation can fix a bent septum, but nose spray or drops can help treat swelling in the nose which might be making your nose feel blocked. If septal deformity is the cause of your nasal blockage there is no treatment other than surgery to correct the shape of the septum.

FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS) [Click here]

Sinuses and Sinusitis

Sinuses are air-filled spaces in the bones of the face and head. They are connected to the inside of the nose through small openings. The sinuses are important in the way we breathe through the nose and in the flow of mucus in the nose and throat.

When the sinuses are working properly we are not aware of them but they often are involved in infections and inflammations which cause symptoms. These infections and inflammations are called sinusitis. Sinusitis is caused by blocked, inflamed or infected sinuses. Patients will often complain of a blocked nose, pressure or congestion in the face, runny nose or mucus problems. Other symptoms include headache and loss of sense of smell.

Most patients with sinusitis get better without treatment or respond to treatment with antibiotics or nose drops, sprays or tablets. In a very small number of patients with severe sinusitis an operation may be needed. In rare cases if sinusitis is left untreated it can lead to complications with infection spreading into the nearby eye socket or into the fluid around the brain. These very rare complications are just some of the reasons that a sinus operation may become necessary.

What is endoscopic sinus surgery or FESS?

Endoscopic Sinus Surgery is the name given to operations used for severe or difficult to treat sinus problems. In the past sinus operations were done through incision (cuts) in the face and mouth but endoscopic sinus surgery allows the operation to be performed without the need for these cuts. Before any operation patients will be treated using drops, tablets or sprays for a period of few days to few weeks. Only if these treatments are unsuccessful will an operation become necessary.

What if I don't have the operation?

Endoscopic sinus surgery is only one approach to the treatment of sinusitis. Endoscopic sinus surgery is as safe, and possibly safer, than other methods of operating on the sinuses

The operation

Usually the operation is done with the you asleep (General Anaesthetic). The operation is all done inside your nose. Rarely there maybe some bruising around the eye but this is very uncommon. There should be no need for incisions (cuts) unless the operation is a complicated one in which case this will have been discussed with you before the operation.

After the operation

Immediately after the operation you may feel your nose blocked. This may be because of some dressing inside your nose. Dressings , if used, will usually be removed from your nose within 24hrs. It is common to have a stuffy blocked up nose even after removing the dressing and this does not mean that the operation has not worked. 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.

It is important that you do not blow you nose for the first 48hrs following your operation. Some doctors recommend the use of drops, ointments and salt water sprays after the operation. You will be given specific instructions by the ward staff before your discharge from hospital. Some mucus and blood stained fluid may drain from your nose for the first week or two following the operation and this is normal. It is important to stay away from dusty and smoky environments while you are recovering.

How long will I be off work?

You can expect to go home on the day of your surgery or the day after your operation depending on the size of your operation. You will need to rest at home for at least a week.

Possible complications

All operations carry some element of risk in the form of possible side effects. There are some risks that you must know about before giving consent to this treatment. These potential complications are very uncommon.

  • Bleeding:is a risk of any operation. It is very common for small amounts of bleeding to come from the nose in the days following the operation. Major bleeding is extremely uncommon and it is very rare for a transfusion to be required.
  • Eye problems: The sinuses are very close to the wall of the eye socket. Sometimes minor bleeding can occur into the eye socket and this is usually noticed as some bruising around the eye. This is usually minor and gets better without any special treatment, although it is important that you do not blow your nose. More serious bleeding into the eye socket sometimes can occur, however this is very rare. This can cause severe swelling of the eye and can even cause double vision or in very rare cases loss of sight. If such a serious eye complication did occur you would be seen by an eye specialist and may require further operations.
  • Spinal Fluid Leak: The sinuses are very close to the bone at the base of the brain. All sinus operations carry a small risk of damage to this thin bone with leakage of fluid from around the brain into the nose, or other related injuries. If this rare complication does happen you will have to stay in hospital longer and may require another operation to stop the leak. On very rare occasions infection has spread from the sinuses into the spinal fluid causing meningitis but this is extremely uncommon.

SURGERY ON THE NOSE - RHINOPLASTY [Click here]

What gives the nose its shape?

The shape of the nose on the outside is due to the shape of bone and cartilage and the overlying skin. The top of the nose is made of bone shaped like a roof, which is hard. The middle and tip of the nose are made of cartilage which is softer. The skin varies in thickness from person to person, and also affects the shape.

Reasons for surgery

Improving the features of the nose and face by cosmetic surgery can also involve improving its function and help with breathing. There is a great deal of variety in human appearance. Nasal shape depends on the bony contours, dimensions of the face, skin colour, thickness and race. Most people have reconciled themselves with their appearance but some are unhappy with it and seek surgery.

The most common features people are concerned with are deviations of the nose to one side, a nasal hump, a nasal depression, too wide or too a narrow nose, over or under projection of the soft nasal tip. There is no perfect shape to the nose and any alteration has to fit and suit the rest of the face. It is important that expectations about the effects of surgery are not unrealistic. People who believe that their lives will change if they have cosmetic surgery are often disappointed.

What is rhinoplasty?

Rhinoplasty is an operation to change the shape of the nose. The type of rhinoplasty depends on which particular area of the nose needs correction. The nose can be straightened, made smaller or bigger and bumps may be removed. The shape of the tip of the nose can be changed. Pieces of cartilage or bone may be removed from or added to the nose to change its shape. Sometimes the wall that separates the nose into right and left (nasal septum) is twisted. We may need to correct it at the same time. The combined operation is called septorhinoplasty.

Techniques

Rhinoplasty surgery employs reduction, augmentation or refinement of the patient's nose to give a balanced and proportioned nose.

Reduction rhinoplasty commonly involves the removal of a nasal hump along with re-breaking the nose to reduce the width.

The tip of the nose may be asymmetrical, depressed or the nose itself may need building up. Augmentation with can be achieved using tissue moved from another part of the patient's body such as skin or cartilage from the ear or rib.

Approaches for the surgery can be either through the nostrils (intranasal) or by the use of a small incision on the under side of the nose (external).

How successful is the operation?

Everybody's nose and face is different, so it may not be possible to make your nose look exactly like your perfect nose. The thickness of the skin is important in how much better the nose will look after rhinoplasty and in what can be done. If the skin is thin, it makes bumps or hollows in the nose difficult to hide. If it is thick not all changes that can be made on the inside will show up on the outside. Your surgeon will aim to produce a nose that looks natural. However, your surgeon may not be able to say exactly how your nose will look after your operation. It is important that you discuss your expectations with your surgeon. 90-95 % of patients are happy with the results of their operation but some people request more surgery.

How is the operation done?

Photographs will be taken to allow a record to be kept in your notes of how your nose looked before surgery, and to allow the surgeon to plan your operation. Rhinoplasty and septorhinoplasty are usually performed with you asleep. Cuts are made inside your nose. Occasionally a small cut on the skin between the nostrils or at the base of the nostrils may be necessary. The skin of your nose is gently lifted off the bone and cartilage underneath. A hairline fracture may be made in the nasal bones to allow the surgeon to change the shape of the nose. Pieces of bone and cartilage can be removed from or added to the nose to smooth out any bumps or dips

Packs and splints

We may need to put a dressing in each side of your nose to keep things in place and prevent bleeding. The dressings are called ‘packs', and they will block your nose up so that you have to breathe through your mouth. We may take them out the morning after your operation. You may get a little bit of bleeding when the packs come out - this will settle quickly. Sometimes we put small pieces of plastic in your nose to prevent scar tissue from forming. These are called ‘splints' and we will take them out after a week. You will have a temporary splint on the outside of the nose for a week. This should be kept dry.

After the operation

The front of your nose can be a bit tender for a few weeks. Do not blow your nose for about a week, or it might start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. You may get some blood-coloured watery fluid from your nose for the first two weeks or so - this is normal. Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation. We may give you some drops or spray to help this.

It may take up to three months for your nose to settle down and for your breathing to be clear again. Try to stay away from dusty or smoky places. There will be some stitches inside your nose - these will dissolve and fall out by themselves. You may have some bruising and swelling around your nose and eyes for one to two weeks. Sleeping upright with extra pillows for a few days helps.

Most of the swelling has subsided after two weeks but it may be longer before the skin and soft tissues over the bone and cartilage settle. Fine swelling may take up to a year to settle at which time the final results of surgery may be judged.

How long will I be off work?

You can expect to go home the day after your operation. Sometimes it is possible to go home the same day. You should rest at home for at least a week. Most people need one to two weeks off from work.

What can go wrong?

Sometimes your nose can bleed after the operation, and we may have to put packs into your nose to stop it. This can happen within the first 6 - 8 hours after surgery or up to 5 - 10 days after surgery. Very occasionally patients need to have another general anaesthetic and return to the operating theatre to stop the bleeding.

Infection in your nose is rare after this operation but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked and sore.

Very rarely, you can have some numbness of your teeth, which usually settles with time.Up to 10% of people may have some reservations about the end results and about 5-10% of patients need further operations in the future to further adjust the shape of the nose.

ADENOID SURGERY [Click here]

What are the adenoids?

Adenoids are small glands in the throat at the back of the nose. They are there to fight germs in younger children. We believe that after the age of about three years, the adenoids are no longer needed. Your body can still fight germs without your adenoids.

Why take them out?

Sometimes children have adenoids so big that they have a blocked nose, so that they have to breathe through their mouths. They snore at night. Some children even stop breathing for a few seconds while they are asleep. The adenoids can also cause ear problems by stopping the tube which joins your nose to your ear from working properly. For children over three years of age, removing the adenoid at the same time as putting grommets in the ears seems to help stop the glue ear coming back. Removing the adenoids may also make colds that block the nose less of a problem for your child.

What are the alternatives to having the adenoids removed?

Your adenoids get smaller as you grow older, so you may find that nose and ear problems get better with time. Surgery will make these problems get better more quickly, but it has a small risk. You should discuss with your surgeon whether to wait and see, or have surgery now. For some children, using a steroid nasal spray will help reduce congestion in the nose and adenoids, and may be helpful to try before deciding on surgery.

Antibiotics are not helpful and only produce temporary relief from infected nasal discharge. They have side effects and may promote 'superbugs' that are resistant to antibiotics.

Other operations

If we are taking adenoids out because of ear problems, we may put in grommets at the same time. If your child has sore throats or stops breathing at night, we may also take their tonsils out at the same time. We will tell you what these operations involve if we are going to do them.

The operation

Arrange for a week off from school. The child is asleep when the adenoids are removed through the mouth. In most hospitals, adenoid surgery is done as a day case, so that the patient can go home on the same day as the operation.

Most children need about a week off from school. They should rest at home away from crowds and smoky places. Stay away from people with coughs and colds.

Possible complications

Adenoid surgery is very safe, but every operation has small risks. The most serious problem is bleeding, which may need a second operation to stop it. However, bleeding after adenoidectomy is very uncommon. It is very important to let us know well before the operation if anyone in the family has a bleeding problem. During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if your child has any teeth like this.

Some children feel sick after the operation. This settles quickly. A small number of children find that their voice sounds different after the surgery. It may sound like they are talking through their nose a little. This usually settles by itself within a few weeks.

Post-op care

The child's nose may seem blocked up after the surgery, but it will clear by itself in a week or so. The child's throat may be a little sore. Prepare normal food. Eating food will help your child's throat to heal. Chewing gum may also help the pain. Your child may have sore ears. This is normal. It happens because your throat and ears have the same nerves. It does not mean your child has an ear infection.

TONSIL SURGERY [Click here]

What are tonsils?

Tonsils are small glands in the throat, one on each side. They are there to fight germs when you are a young child. After the age of about three years, the tonsils become less important in fighting germs and usually shrink. Your body can still fight germs without them. We only take them out if they are doing more harm than good.

Why take them out?

We will only take tonsils out if they cause recurrent sore throats despite treatment with antibiotics. The other main reason for removing tonsils is if they are large and block the airway. Sometimes small children have tonsils so big that they block their breathing at night. A quinsy is an abscess that develops alongside the tonsil, as a result of tonsil infection, and is most unpleasant. People who have had a quinsy therefore often choose to have a tonsillectomy to prevent having another. Tonsils are also removed if we suspect there is a tumour. A rapid increase in the size of a tonsil or ulceration or bleeding occurs if a tumour of the tonsil develops. Tumours of the tonsil are rare.

Before the operation

Arrange for one week off from work or school. It is very important to tell us if has you have any unusual bleeding or bruising problems, or if this type of problem might run in the family

How is the operation done?

You will be asleep under general anaesthesia. We take the tonsils out through the mouth, and then stop the bleeding. This takes about 30 minutes. A child who has had a tonsillectomy will then be taken to a recovery area to be watched carefully as he or she wakes up from the anaesthetic.

How long will I be in hospital?

In most hospitals, surgeons prefer tonsillectomy patients to stay in hospital for one night. In some hospitals tonsil surgery is done as a day case, if your home is close to the hospital. Either way, we will only let you go home when you are eating and drinking and feel well enough.

Possible complications

Tonsil surgery is very safe, but every operation has a small risk. The most serious problem is bleeding. This may need a second operation to stop it. About two out of evert 100 children who have their tonsils out will need to be taken back into hospital because of bleeding, and one of these will need a second operation. As many as five adults out of every 100 who have their tonsils out will need to be taken back into hospital because of bleeding, but only one adult out of every 100 will need a second operation. During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if you have any teeth like this.

After the operation

Your throat will be sore for approximately ten days. It is important to take painkillers regularly, half an hour before meals for at least the first week.Eat normal food - it will help your throat to heal. It will help the pain too. Drink plenty and stick to bland non spicy food. Chewing gum may also help the pain.You may have sore ears. This is normal - it happens because your throat and ears have the same nerves. It does not mean that you have an ear infection.Your throat will look white - this is normal while your throat heals. Some people get a throat infection after surgery, usually if they have not been eating properly. If this happens you may notice a fever and a bad smell from your throat. Make sure you rest at home away from crowds and smoky places. Keep away from people with coughs and colds.

MICROLARYNGOSCOPY [Click here]

What is Microlaryngoscopy?

Microlaryngoscopy is the examination of your larynx (voice box) while you are under a general anaesthetic. Microlaryngoscopy is done to find and treat problems of the voice box, such as hoarseness.

we will put a short metal tube (a laryngoscope) through your mouth into your voice box. A microscope is then used to look into the voice box to find what the problem is. If needed, surgery on your voice box can also be done through the laryngoscope.

If there are any problem areas, a small part of the lining of the voice box is taken away for laboratory examination. This is called a biopsy. Depending on the type of lesion a laser is sometimes used to remove it.

Microlaryngoscopy is quite a short operation and usually takes less than 30 minutes.

How will I feel after the operation?

After microlaryngoscopy you may find that your throat hurts. This is because of the metal tubes that are passed through your throat to examine the voice box. Any discomfort settles quickly with simple painkillers and usually only lasts a day or two. Some patients feel their neck is slightly stiff after the operation. If you have a history of neck problems, you should inform the surgeon about this before your operation.

After laryngoscopy, your voice may sound worse, especially if any biopsies have been taken. This should be temporary until the lining of the voice box heals.

You can usually eat and drink later the same day. You should be able to use your voice as normal after the procedure. However, if the surgeon has taken a biopsy from your voice box, he may advise you to rest your voice for a short period.

Possible Complications

Microlaryngoscopy is very safe. You may have a slightly sore throat afterwards. Very rarely, there is a risk that the metal tubes may chip your teeth.

When can I go home?

Often you can go home the same day as the operation, as long as you have someone with you. Depending on how you feel afterwards, you may need to stay overnight for observation. You may be advised to stay off work for a few days to rest your throat, depending on your job.

COMMON TYPES OF HEAD AND NECK CANCER & HOW THEY ARE TREATED [Click here]

Salivary Gland Cancer

Tumours can involve the major salivary glands, particularly the Parotid glands, which are situated just in front of the ear on the side of the face. Such tumours are uncommon (the majority of parotid tumours are benign) and rarely effect children. They are often discovered by accident, as this type of tumour shows no visible symptoms. However signs of malignancy include a lump or growth on the gland, paralysis of the face and changes in skin colour.

Treatment Benign lumps are usually removed, as over time they do increase in size and may become more difficult to remove. Malignant tumours are removed and, in some cases , a course of post-operative radiotherapy may be recommended. Radiotherapy is the use of high energy radiation, usually in the form of X-rays, to kill cancerous cells.

Laryngeal Cancer

Malignant tumour or lumps on the voice box (Larynx) frequently occur in middle aged people, who have a history of smoking and drinking alcohol. Lesions develop on the vocal cords (Glottis) and the upper part of the larynx, which is located above the vocal cords (Supraglottis). Cancerous cells grow from flat cells that are located on the surface of the throat / larynx (Squamous Cell Carcinoma). This is the most common type of malignant growth in the head and neck.

Treatment Radiotherapy is used to kill small malignant tumours in the voice box (Larynx) in many cases although some surgeons are advising the use of the laser to remove small tumours, there is still some debate regarding this form of treatment. If radiotherapy is unsuccessful or the cancer is recurrent, then surgery is recommended to remove some or all for the voice box (Partial or Total Laryngectomy). Many patients undergoing laryngectomy will retain voice , either through developing oesophageal speech or the use of a small ‘valve' that is placed at the time of surgery.

Cancer of the Mouth (Oral Cavity)

Malignant growths from the thin flat cells that line the structures in the mouth (Squamous Cell Carcinoma) are the cause of all oral cancers. Oral cancer is widespread amongst smokers, people with high alcohol consumption and in patients with chronic dental infection.

Treatment Surgical removal or radiotherapy, or sometimes a combination of these in more advanced tumours may be the initial treatment. If radiotherapy is the initial treatment and is unsuccessful, then surgery may be used to deal with the problem.

Cancer of the Thyroid Glands

The thyroid gland is located in the front of the neck just below, and either side of, the voice box (larynx). This gland produces hormones that help regulate our metabolism. These tumours usually present as an isolated lump in the neck. Thyroid cancer is more common in women.

Treatment Surgery would normally be the primary treatment of this condition although radiotherapy may have a part to play in some cases. Drugs which affect the activity of the thyroid gland are also sometimes used in their treatment.

Cancer of the Nose and Paranasal Sinuses

Cancers of the nose and sinus are extremely rare. Symptoms arising from these tumours include nasal obstruction, bleeding from the nose, pain, and occasionally eye symptoms such as double vision , watering eye etc.

Treatment Surgery is used to remove tumours in the nose (Nasal Cavity). Post-operative radiotherapy may be recommended if the tumours are more extensive. A combination of Radiotherapy and Chemotherapy is used to treat malignant tumours in the area at the back of the nose (Postnasal Space).

PAROTID SURGERY [Click here]

What is the parotid and what causes parotid lumps?

The parotid gland makes saliva; in fact you have 2 glands, one on each side, in front of your ears. Lumps occur in the parotid due to abnormal overgrowth of some part of the salivary glands (a parotid gland tumour).

The vast majority of these tumours are benign, which means that they are not cancerous and do not spread to other parts of the body. Rarely, malignant tumours can also affect the parotid.

Why remove the lump?

Although 80% of these lumps are benign in most cases we recommend that they be removed since they generally continue to grow and can become unsightly, and after many years a benign lump can turn malignant. Also the bigger the lump the more difficult it is to remove. Lastly, there is always some concern regarding the exact cause of the lump until it has been removed.

What is a Parotidectomy operation?

A parotidectomy is the surgical removal of part or all of the parotid gland. The operation is performed under general anaesthesia, which means that you will be asleep throughout. An incision will be made which runs from in front of your ear and down into your neck. This incision heals very well indeed, in fact it is nearly the same incision, which is used in "face lift" surgery, and in time the scar is likely to be minimal.

At the end of the operation ,we will place a drain (plastic tube) through the skin in order to prevent any blood clot collecting under the skin. Most patients will require 24 - 48 hours in hospital after the operation before the drain can be removed and they can go home. You will need one week off from work.

Possible complications
  • Facial weakness:There is a very important nerve, the facial nerve, which passes right through the parotid gland. This makes the muscles of the face move and if it is damaged during the surgery can lead to a weakness of the face (facial palsy). In most cases the nerve works normally after the surgery, however occasionally (about 15-20% of cases), where the tumour has been very close to the nerve, a temporary weakness of the face an occur that can last for a few weeks. In 1% of cases there is a permanent weakness of the face following this sort of surgery for benign tumours.
  • Numbness of the face and ear: The skin of the side of the face will be numb for some weeks after the operation, and often you can expect your ear lobe to be numb permanently.
  • Blood clot A blood clot can collect beneath the skin (a haematoma). This occurs in about 5% of patients and it is sometimes necessary to return to the operating theatre and remove the clot and replace the drain.

SUBMANDIBULAR GLAND SURGERY [Click here]

What is the submandibular gland?

The submandibular glands are a pair of salivary glands under the jaw bone. Each gland produces saliva which goes through a long duct to its opening under the tongue at the front of the mouth. The production of saliva increases when we eat. The saliva secreted by the submandibular gland is a bit thicker than that produced by other salivary glands. Because of its thickness this saliva can sometimes form little stones

What problems can you have with the submandibular gland?

The commonest problem is blockage of the salivary duct. This can be caused by the presence of stones or simply a narrowing of the salivary duct. Blockage of the salivary duct can cause a painful swelling of the gland when you eat. Sometimes the swelling may settle on its own. When the blockage is severe, it can lead to persistent inflammation of the gland. Occasionally, a painless lump may develop within the submandibular gland. Those lumps are often benign but need thorough checking, as up to half of them may be or become cancerous. Even benign lumps can get gradually bigger.

What investigation are you likely to have?

An X-ray or CT scan of the submandibular gland to see if there are stones inside the gland or the duct.

Sialogram: The doctor fills the duct at the front of the mouth with some contrast liquid and then takes x-rays. This will show up stones or narrowing inside the duct.

Ultrasound: This test uses sound waves to detect any lumps inside the gland.

Fine needle aspiration: This can help to find out the nature of the lump. The doctor uses a fine needle to draw some cells out from the lump. The cells are sent to the laboratory for analysis.

Why operate on the submandibular gland?

If stones inside the duct do not come out, the gland may swell up when you eat. These stones can be removed. This procedure is done through the mouth either under a local or general anaesthetic. If stones are stuck inside the submandibular gland, the gland can become permanently inflamed and swollen. If it gives you undue discomfort over a longer time, your specialist may advise to have the gland removed.

If a lump has developed in the submandibular gland, we recommend removing the gland. As a fairly high number of submandibular lumps can be cancerous the whole gland should be removed. By removing the gland we can find out whether it is benign or cancerous.

The operation to remove the gland

The operation is performed under general anaesthetic, which means that you will be asleep throughout. An incision will be made in the neck below the jaw where the submandibular gland lies. The operation will take about an hour. At the end of the operation we will place a drain (plastic tube) through the skin in order to prevent any blood clot collecting under the skin. Most patients will require 24-48 hours in hospital after the operation before the drain can be removed and they can go home. You will need one week off work.

Possible complications Blood clot

A blood clot can collect beneath the skin (this is called a haematoma). This occurs in up to 5% of patients and it is sometimes necessary to return to the operating theatre and remove the clot and replace the drain.

Wound infection

This is uncommon in the neck but can happen if the submandibular gland was badly infected. Wound infection will require antibiotic treatment. Pus collected under the skin may need to be drained.

Facial weakness

There is an important nerve that passes under the chin close to the submandibular gland. It makes the lower lip move. If it is damaged during the surgery it can lead to a weakness of the lower lip. In most cases this nerve works normally after the surgery, however in some cases weakness of the lower lip can occur, particularly when the gland is badly inflamed or if the nerve is stuck to a lump. This weakness is usually temporary and can last for 6-12 weeks. Occasionally there is a permanent weakness of the lower lip following this surgery.

Numbness of the face and ear

The skin around the wound may be numb after the operation. If that happens the numbness will usually improve over the next three months.

Numbness of tongue

The nerve which gives sensation and taste to one half of the tongue runs close to the duct of the gland. It very rarely gets injured. However, if this nerve is damaged your tongue may feel numb immediately after the operation. This will usually go, and permanent numbness of the tongue is rare.

Injury to the nerve that ‘moves' the tongue

Another nerve runs close to the submandibular gland that supplies the muscles of the tongue on that side (and hence helps with movement of the tongue). It would be very unusual for this nerve to be damaged in this surgery. If it were to occur, it is unlikely to produce any noticeable disability.

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