Ear, Nose & Throat (ENT)
The ears, nose and throat are responsible for much of your interaction and communication with the world around you. ENT surgeons treat disorders of balance and hearing, through change in smell or voice, all the way to cancer of the throat or thyroid. Below is a brief outline of some of the many ENT conditions we treat.
Head & Neck Conditions
Swellings or Lumps in the neck
A medical opinion should be sought for new lumps in the neck. In most cases the swelling are benign, but a thorough history and examination is needed to rule out cancer. The examination often includes endoscopic examination of the lining of the nose and throat.
Foreign Body Sensation (Globus Sensation)
The feeling of something in the throat is a common symptom which is often easily diagnosed and treated. It is usually harmless, but further investigation may be warranty to rule out a cancer. The examination will include endoscopic examination of the lining of the nose and throat.
Hoarseness/Voice Change (Dysphonia)
Change in voice can occur naturally with ageing, but change in voice persisting over 6 weeks should be investigated. The causes of voice change are varied and most likely benign and diagnosis is usually made with endoscopic visualisation of the vocal cords.
Swallowing Difficulty (Dysphagia)
Difficulty in swallowing, such as obstruction and/or regurgitation of food needs urgent investigation. Causes of swallowing difficulty are diverse and most likely benign, but more serious problems including throat or oesophageal cancer need excluding.
Inflammation of the tonsils often occurs as a result of bacterial or viral infection. Frequent episodes are debilitating and can cause prolonged absence from school or work. Removal of the tonsils (tonsillectomy) can help reduce the frequency and severity of sore throats. A persistent sore throat that extends beyond 4 weeks requires urgent investigation to rule out cancer.
Changes in the function of your thyroid function should result in an endocrine review. If any enlargement or lumps associated with the thyroid gland are noted, then assessment with a thyroid surgeon should be sought to rule out cancer. Lumps within the thyroid gland are referred to as nodules and require investigation with ultrasound and possibly biopsy. Enlargement of the thyroid gland in referred to as a goitre, if the enlargement of the thyroid is secondary to several nodules then it is referred to as a multinodular goitre.
Parotid and Submandibular Salivary Gland Disease
There are glands in the cheeks and underneath the jaw bone which produce saliva. Lumps associated with these glands, whilst predominantly benign, require investigation to rule out malignancy. Sudden swelling of these glands can be secondary to small stones causing an outflow obstruction of saliva and subsequent infection, these stones often require removal.
Facial Skin Cancers
Due to increased sun exposure, relative to the rest of the body, most skin cancers occur in the head and neck region. Any new lesion of the skin should be assessed by a doctor and biopsy performed if clinical concern of a skin cancer. Surgical excision and reconstruction is predominantly the recommended treatment for skin cancer.
Nose Bleeds (Epistaxis)
Nosebleeds are most common in children and the elderly. There is often a link with blood thinning medication. Treatment includes chemical nasal cautery or electric cautery or sometimes simply a antibacterial cream. Very occasionally nasal surgery is indicated to clip arteries on the nose.
Nasal obstruction, excessive secretions from the nose, facial pain and lack of sense of smell are all signs of inflammation of the lining of the nose and sinuses. If these symptoms extend beyond 12 weeks the likely diagnosis is chronic rhinosinusitis. These symptoms are sometimes related to allergy and can lead to the development of nasal polyps. Treatments include allergy avoidance, nasal steroids or sinus surgery.
Recurrent Acute Sinusitis
Some patients have frequent sinus infections. Symptoms include facial pain, nasal obstruction and excessive nasal secretions with resolution of these symptoms between bouts. Endoscopic sinus surgery may be able to prevent further episodes.
Deviated Nasal Septum
Another cause of nasal obstruction is a deviated nasal septum, this may be secondary to trauma or present since childhood and can be corrected surgically (septoplasty).
Dizziness and Vertigo
There are many causes of dizziness and several are related to the inner ear. Common causes which can be treated include benign paroxymal positional vertigo (BPPV), labyrinthitis/vestibular neuronitis and vestibular migraine.
Infection can either affect the ear canal (otitis externa) or behind the ear drum (otitis media). Otitis externa is normally treated with antibiotics, but occasionally microsuction of debris from the canal is required to help resolve the infection.
Otitis media is more common in children but is not unusual in adults. Usually this infection occurs with a cold, but occasionally a hole in the ear drum will lead to recurrent ear infections. In these cases closure of the hole in the ear drum (myringoplasty) can be performed.
Cerumen is produced by glands in the ear canal and has antimicrobial and antifungal properties. It is normal, but occasionally can cause obstruction of the ear canal leading to hearing loss, a blocked sensation or trap water leading to infection. Some people over produce ear wax and benefit from micro suction of the wax on a regular basis.
Glue ear is a accumulation of viscous fluid in the middle ear (behind the ear drum). It causes hearing loss and is transient in most children (it can also occur in adults, usually related to a cold). Occasionally this fluid will persist and the associated hearing loss can delay development and make communication more difficult. In these cases either hearing aids or placement of ‘grommets’ is advised.
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