Ear Nose and Throat Procedures

Ear, Nose and Throat Treatments

Tonsillectomy

Tonsillectomy is minor surgery to remove your tonsils. It’s the only reliable way to stop recurrent tonsillitis, a condition that involves your tonsils repeatedly becoming inflamed and a sore throat. Your ENT surgeon will talk you through the criteria for a tonsillectomy.

Your tonsils are oval shaped and are found at the back of your throat. They are part of a group of glands in your neck, called lymphoid tissues, that have the function to defend your body from germs you breath in or swallow.

A tonsillectomy is usually carried out on an outpatient basis, taking just half an hour. You’ll be given a general anaesthetic and your ENT surgeon will remove your tonsils through your mouth. Your tonsils can be removed using a scalpel or a surgical tool with heat, laser or ultrasound.

Surgical treatment for hearing loss

There are two types of hearing loss:

  • Sensorineural - the hair cells in the cochlea and/or the hearing nerve become damaged causing a problem with nerve impulse transmission from the inner ear to the brain. This type of hearing loss is challenging to treat. Hearing aids and cochlear implants may improve hearing.
  • Conductive – sound doesn’t pass freely to the inner ear, often due to a blockage in the outer or middle ear such as ear wax, fluid or infection or, an abnormality in the structure of the outer ear, ear canal or middle ear, for example abnormal growths of skin, bone or tumours or a perforated or collapsed ear drum. Hearing can usually be improved or corrected by medical or surgical treatments.

Surgeries we perform for conductive hearing loss include:

  • Tympanoplasty – collapsed ear drum is surgically repaired.
  • Myringotomy – perforated ear drum due to otitis media (middle ear fluid or infection) is repaired.
  • Stapedectomy – surgery to restore hearing loss caused by otosclerosis (abnormal bone growth inside the ear).
  • Cholesteatoma removal – abnormal skin growth in your middle ear is removed.
  • Ossiculoplasty - repair of ossicular chain (damaged/discontinued ossicles of the middle ear).
  • Perilymph fistula (PLF) repair – repair of abnormal connection in one or both of the small, thin membranes that separate the air filled middle ear and the fluid filled perilymphatic space of the inner ear allowing perilymph fluid leakage.
  • Translabyrinthine surgery – removal of tumours, for example acoustic neuroma.

Tinnitus

Tinnitus is the hearing of sound in your ears or head that isn’t due to an external source. Sounds can be in one or both ears and include: whistling, buzzing, ringing, hissing, humming or roaring. They can start gradually or suddenly. Sounds can be regular or occasional and if heard at night can interfere with sleep.

Treatment often involves managing the condition unless an underlying cause is known such as earwax which can simply be removed or otosclerosis which will require surgery. Listening to music, distraction through hobbies, regular sleep patterns and support groups may help.

Management treatment includes: sound therapy (silence is filled with neutral sounds with the aim of distracting you from your tinnitus sound), counselling (discussing coping strategies), cognitive behavioural therapy (CBT, aims to reduce anxiety and change your thoughts about tinnitus so that it becomes less noticeable) and tinnitus retraining therapy (retraining your reaction to tinnitus to allow you to tune out and become less aware of it).

Sinus disease

Sinus disease, also known as sinusitis, is an inflammation or swelling of small air-filled cavities found behind your forehead and cheekbones called sinuses. Sinuses that are blocked and fluid-filled can cultivate germs and cause infection. Sinusitis can be very painful, present discharge, fever, headache and a blocked nose.

Sinusitis will often pass after a few weeks. If it persists and you develop chronic sinusitis you should seek medical advice for self-help remedies, medical support or surgery.

Surgery aims to unblock your sinuses and improve your mucus drainage. Functional endoscopic sinus surgery (FESS) is most often performed. It’s carried out under general anaesthetic using a thin and flexible telescope called an endoscope that allows your surgeon to see inside your sinuses and insert surgical instruments to remove bone and mucus membrane that are blocking your sinuses.

Balloon sinuplasty is another option. Again, carried out under general anaesthetic, your surgeon inserts a small, flexible tube into your sinus and inflates a balloon on the end of it to unblock your sinus.

Sleep apnoea

Sleep apnoea, also called obstructive sleep apnoea (OSA), happens when the air passage in your throat narrows or collapses causing a total blockage for ten or more seconds whilst you sleep. The muscles in your mouth, nose and throat relax too much during sleep if you’ve OSA. Your brain wakes you momentarily so you can take in air. This can happen throughout the night causing extreme tiredness.

Treatment is based on the severity of your symptoms, your health and preferences. Initially lifestyle changes may be advised such as: losing weight, smoking cessation, reducing alcohol consumption and avoiding sedatives.

A mandibular advancement device (MAD) may be recommended for mild OSA. It’s a dental appliance, worn over your teeth whilst you're sleeping and is designed to hold your jaw and tongue forward allowing you more space to breathe.

If you’ve moderate or severe OSA, continuous positive airway pressure (CPAP) is often the first line of treatment. It blows pressurised air into your upper airways through a mask whilst you’re sleeping to keep your airways open.

If surgery is required your surgeon may: remove your tonsils or adenoids, insert a tube into your neck to allow you to breathe freely or recommend weight loss surgery if you’re obese.

Snoring

Snoring is caused by vibrations of the soft palate and other tissue in the mouth, nose and throat. When you’re asleep your muscles in this area relax and your airways can narrow or even close up.

Snoring isn’t harmful but the coarse sound can affect the people around you! It may also be a sign of sleep apnoea.

Recommendations include: losing weight, increasing physical activity, reducing alcohol and stopping smoking. Anti-snoring devices such as mouth guards or nasal strips may stop you from snoring.

Surgery may be required and normally involves removing the soft tissue causing your snoring or preventing the tissue from vibrating by tightening it. Surgery may correct any anatomical problems that contribute to your snoring such as a tonsillectomy if you’ve got large tonsils.

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