Ear, Nose and Throat (ENT) Surgery

Another term for glue ear is “otitis media with effusion” or OME. This term is used because the “glue” is often left behind after an episode of otitis media or middle ear infection.

Other causes of glue ear include a poorly functioning Eustachian tube, cleft palate or structural or immune system issues.

If glue ear is not treated, the eardrum can gradually be pulled inwards causing thinning and occasionally a condition called a “cholesteatoma”. This occurs when skin cells become trapped within the retracted eardrum.

Cholesteatomas can grow into the brain or inner ear. They require surgical removal.

A large portion of patients with glue ear will eventually drain the fluid without needing medical treatment.

Surgical procedures include grommets, treating any underlying allergies, and adenoid removal.

Grommets (middle ear ventilation tubes) are small tubes that are used to treat patients with middle ear and Eustachian tube problems. They may be used for patients with acute otitis media, recurrent acute otitis media, and chronic otitis media with effusion (glue ear) or for patients who have a Eustachian tube which is not functioning adequately.

Grommets allow air to flow into the middle ear and glue to drain out and benefits include:

• Better hearing – when grommets are inserted all the glue is suctioned away. Hearing should return to normal levels as long as there has been no inner ear damage from ear infections.
• Improved behaviour – it has been observed that when glue is removed children’s behaviour often improves.
• Prevention of retraction pockets and cholesteatoma – grommets prevent further damage to the eardrum, middle ear bones and reduce the risk of cholesteatoma formation.
• Decreased frequency of ear infections – grommets help to decrease the frequency and severity of ear infections.

This is a procedure to improve “lop ears” or prominent ears, often a source of embarrassment and distress.

In recent years, as with all facial plastic surgery, surgeons have focused on minimally invasive techniques that involve careful place of permanent sutures to re-shape the ear into its normal shape and position.

Prominent ears can be corrected at any age. The ideal time is when a young child is 4 to 5 years old.

At this age the ears are fully developed but the child has not yet started school where they may be teased. The cartilage is also still very soft and pliable and this lends itself particularly well to suture folding surgical techniques.

This surgical procedure involves an incision behind the ear, dressing to reduce normal swelling that occurs post-surgery and bandages generally removed in a week. Pain after surgery can be addressed with over-the-counter medication and the scar will be almost undetectable.

Most adults return to work about five days following ear surgery while children should wait a week or so to return to school. All patients should temporarily limit their physical activities for about 3 weeks until their ears are completely healed.

A rhinoplasty or a nose job is a plastic surgery that reconstructs the nose to give a more aesthetically enhancing appearance.

After surgery patients will wear an external splint on the outside of the nose which needs to be kept dry and will be removed with any stitches one week after surgery.

Blowing the nose is to be avoided during recovery as it can cause bleeding; though minor bleeding is a common side effect.

Patients will also be given a salt water spray (sinus rinse) to be used twice daily and to help assist with breathing.

The tip of the nose may feel numb for some time and there is commonly bruising for a few weeks or so.

The shape of the nose will take several weeks to settle and the final result up to 12 month.

AFTER SURGERY

Rhinoplasty patients should:

• Expect to take 7 days off work
• Avoid exercise or any aerobic activity for 2 weeks.
• Avoid rubbing the nose
• Sneeze through the mouth, rather than the nose.
• Avoid the sun and accidental knocks for 8 weeks.
• Wear sunscreen for 6 months.
• Avoid wearing glasses for 2 weeks
• Keep the nose dry while any dressings are in place.
• Avoid spicy foods, big meals and excess alcohol as they can make your nose run.

A septoplasty is a corrective surgical procedure to straighten the nasal septum (the partition between the two nasal cavities. READ MORE

A septoplasty is a commonly performed day procedure to remove a bump, narrow nostril width, change the angle between the nose and the mouth or else to correct birth defects, or other problems.

The operation takes around one hour to perform.

In most cases an internal incision is made inside the nostril so that no scars are present on the outside.

Very severe bends in the portion located near the nostrils may require a small external incision to correct.

Deviated nasal septum or “crooked” internal nose can occur at childbirth or as the result of an injury or other trauma. If the wall that functions as a separator of both sides of the nose is tilted towards one side at a degree greater than 50%, it might cause difficulty breathing.

The procedure usually takes about 60 minutes under a general anaesthetic with the recovery time about two weeks with a splint worn on the inside of the nose.

A septoplasty is frequently combined with a turbinoplasty procedure to improve airflow. The turbinates often enlarge and grow into the space left by a deviated septum.

If this is not corrected, breathing will not return to normal.

The incision is closed at the end with dissolving stitches.

Breathing is still possible around or through these splints.

Generally a septoplasty is deferred in children until they have finished growing. This is usually around the age of 16 in girls and 17 in boys, although all children are different. However, if symptoms are severe a septoplasty can be performed at any age. In these cases surgery is generally more conservative.

Some children may need a slight revision operation when they are older and have finished growing.

AFTER SURGERY

Small splints often need to be left in the nose after a septoplasty for one week. After a septoplasty, a single overnight stay in hospital may be necessary but not always. One week off work and two to three weeks off any heavy exercise is recommended.

SAFETY

Septoplasty is generally a well-tolerated procedure and most patients will report side effects of bruising swelling and pain for the first week or so after surgery.

A few of the possible but much less common complications of sinus surgery include.

• Abnormal bands of scar tissue (adhesions) may form across the nasal cavity within two weeks of surgery, which requires minor corrective surgery.
• Drooping of the nose is also a rare complication, which may require surgery.
• Numbness of the teeth and nose.
• Nasal stuffiness may still occur due to allergies or swollen turbinates so further treatment may be needed.
• Very rare but serious complications include severe adverse reactions to anaesthetic, a blood clot, stroke, heart attack and cerebrospinal fluid (CSF) leak.

Sinus surgery is an effective way to treat a number of problems with the sinuses. Techniques have improved significantly in recent years leading to better results and a faster recovery.

The most common reasons for sinus surgery are to treat a sinus infection that will not resolve with medications or to treat patients with recurrent severe sinus infections.

Sinus surgery may also be needed in patients with severe pain when flying or diving, to remove polyps or other growths or to provide keyhole access to other parts of the skull.

In patients with polyps or severe chronic sinusitis, sinus surgery helps to create a cavity within the nose that is favorable to topical treatments.

The aim of sinus surgery is usually to restore ventilation and improve drainage to one or more blocked sinuses.

Sinus surgery is now performed without any external incisions and is performed under a general anaesthetic.

The medical term for modern sinus surgery is “Functional Endoscopic Sinus Surgery” or a “FESS”.

The term “endoscopic sinus surgery” means “keyhole sinus surgery”.

Small telescopes called “endoscopes” are place in the nose and the image is projected onto a large digital monitor. Sinus surgery performed in this way allows very delicate and precise changes to be made with minimal bleeding.

Angled telescopes can be used in sinus surgery to see around corners. This allows even the difficult to access frontal sinuses to be widely opened and treated via keyhole sinus surgery techniques.

• Sinus surgery takes from one to three hours depending on the complexity of the case.
• After surgery patients will be transferred to recovery.
• Small “patties”, packs or splints may help control bleeding if this is a problem.
• The procedure is usually same day, but usually an overnight bed is booked as a precaution.
• A saline nasal wash is started the day after sinus surgery and this well help to clean out any left over blood inside the nose.

A tonsillectomy is a procedure to remove the tonsils. The tonsils are clumps of lymph tissue that sit at the back of the mouth.

An adenotonsillectomy removes the tonsils as well as the adenoids, which is a clump of lymph tissue sitting at the back of the nose.

Tonsils are adenoids are usually removed to treat the following conditions:

• Frequent episodes of tonsillitis
• A chronic tonsillitis infection that does not respond to antibiotics
• Recurrenct quinsies (an abscess around the tonsil)
• Snoring or sleep apnoea
• Drooling or eating problems in children
• Asymmetrical tonsils where there suspicion for a growth
• Recurrent formation of tonsil stones causing bad breath

Sometimes only the adenoids are removed and this may be for other conditions such as problems with Eustachian tube, recurrent ear infections or for breathing and snoring problems The Eustachian tube (also known as the auditory tube) joins the nose to the middle ear. The adenoids are located very close to where the Eustachian tube opens into the nose and cause problems with its function.