ENT Care

ENT Care

Tympanoplasty

Tympanoplasty, also called eardrum repair, refers to surgery performed to reconstruct a perforated tympanic membrane (eardrum) or the small bones of the middle ear. Eardrum perforation may result from chronic infection or, less commonly, from trauma to the eardrum.

Tympanoplasty
Purpose

The tympanic membrane of the ear is a three-layer structure. The outer and inner layers consist of epithelium cells. Perforations occur as a result of defects in the middle layer, which contains elastic collagen fibers. Small perforations usually heal spontaneously. However, if the defect is relatively large, or if there is a poor blood supply or an infection during the healing process, spontaneous repair may be hindered. Eardrums may also be perforated as a result of trauma, such as an object in the ear, a slap on the ear, or an explosion.

Description

The purpose of tympanoplasty is to repair the perforated eardrum, and sometimes the middle ear bones (ossicles) that consist of the incus, malleus, and stapes. Tympanic membrane grafting may be required. If needed, grafts are usually taken from a vein or fascia (muscle sheath) tissue on the lobe of the ear. Synthetic materials may be used if patients have had previous surgeries and have limited graft availability.

There are five basic types of tympanoplasty procedures:

  • Type I- Tympanoplasty is called myringoplasty, and only involves the restoration of the perforated eardrum by grafting.
  • Type II- Tympanoplasty is used for tympanic membrane perforations with erosion of the malleus. It involves grafting onto the incus or the remains of the malleus.
  • Type III- Tympanoplasty is indicated for destruction of two ossicles, with the stapes still intact and mobile. It involves placing a graft onto the stapes, and providing protection for the assembly.
  • Type IV- Tympanoplasty is used for ossicular destruction, which includes all or part of the stapes arch. It involves placing a graft onto or around a mobile stapes footplate.
  • Type V- Tympanoplasty is used when the footplate of the stapes is fixed.

The examining physician performs a complete physical with diagnostic testing of the ear, which includes an audiogram and history of the hearing loss, as well as any vertigo or facial weakness. A microscopic exam is also performed. Otoscopy is used to assess the mobility of the tympanic membrane and the malleus. A fistula test can be performed if there is a history of dizziness or a marginal perforation of the eardrum. Preparation for surgery depends upon the type of tympanoplasty. For all procedures, however; blood and urine studies, and hearing tests are conducted prior to surgery.

Tonsillectomy/ Adenoidectomy by Coblation

Tonsillectomy is a surgical procedure to remove the tonsils. The tonsils are part of the lymphatic system, which is responsible for fighting infection. The procedure is performed in response to repeated occurrence of acute tonsillitis, sleep surgery for obstructive sleep apnea, nasal airway obstruction, diphtheria carrier state, snoring, or peritonsillar abscess.

Tonsillectomy
Tonsillectomy
Purpose

Tonsils are removed when a person, most often a child, has any of the following conditions:

  • Obstruction
  • Sleep apnea (a condition in which an individual snores loudly and stops breathing temporarily at intervals during sleep)
  • Inability to swallow properly because of enlarged tonsils
  • A breathy voice or other speech abnormality due to enlarged tonsils
  • Recurrent or persistent abscesses or throat infections

Physicians are not in complete agreement on the number of sore throats that necessitate a tonsillectomy. Most would agree that four cases of strep throat in any one year; six or more episodes of tonsillitis in one year; or five or more episodes of tonsillitis per year for two years indicate that the tonsils should be removed.

Description

A tonsillectomy is usually performed under general anesthesia, although adults may occasionally receive a local anesthetic. The surgeon depresses the tongue in order to see the throat, and removes the tonsils with an instrument resembling a scoop. Alternate methods for removing tonsils are being investigated, including lasers and other electronic devices.

Tonsillectomy procedures are not performed as frequently today as they once were. One reason for a more conservative approach is the risk involved when a person is put under general anesthesia.

All Endoscopic & Microscopic Surgery (Nose & Throat)

Most ear surgery is microsurgical, performed using an operating microscope to enable the surgeon to view the very small structures of the ear. Latest in trend is Endoscopic Ear Surgery.

Endoscopic Ear Surgery is rapidly gaining momentum around the world as an ideal alternative technique for small to medium cholesteatoma and tympanoplasty surgery. Endoscopic, minimally invasive, ear surgery is relatively a young technique. Traditional microscopic procedure relies on wide exposure through a straight line access by making a large incision behind the ear. This requires a very different set of surgical skills than endoscopic ear surgery through the natural ear canal.

Advantages of Endoscopic Ear Surgery are:

  • No need for postural incision (which may be up to 10 cms)
  • Less pain
  • Early Recovery
  • Heads on Vision during Surgery (enabling better disease clearance)
  • Provides a wide view that enables surgeons to look "around the corner"
  • surgically induced trauma is quite limited, therefore less bleeding (in comparision to postaural approach in which many layers of tissue are violated and a tremendous amount of healthy bone is removed)

Microscopic surgery is the gold standard for surgeries of the middle ear, mastoid and lateral skull base.Endoscopic ear surgery is gaining increasing importance internationally as an adjunct to microsurgery and a further development of traditional microscopic ear surgery.

Although endoscopic ear surgery is still in its infancy, it is gaining increasing attention internationally. The first reason for this increasing interest is the patients’ wish for minimal invasive surgery to avoid an external incision.

The quality of endoscopic images is at least equal to microscopic visualization. Secondly, endoscopic visualization has improved significantly during the past decades due to high-definition (HD) video imaging and wide-field endoscopy, such that today, the quality of endoscopic images is equal or in some aspects maybe even superior to microscopic visualization.

Endoscopic DCR

Endoscopic dacryocystorhinostomy (DCR) is used to treat patients diagnosed with lacrimal sac or nasolacrimal duct obstruction (NLDO). This can be caused by chronic stenosis of the nasolacrimal duct and can be congenital or acquired. NLDO is common but is not a serious condition.

Patients develop symptoms of tearing when there is an imbalance between tear production and drainage function of lacrimal system. Tearing can therefore be caused by Hypersecretion Epiphora Combinations of the above.

Hypersecretion (lacrimation) is excessive tearing caused by reflex hypersecretion due to irritation of the cornea or conjunctiva e.g. trigeminal nerve stimulation in corneal disease.

Endoscopic-DCR
NLDO

Epiphora occurs with poor lacrimal drainage due to:

  • Mechanical obstruction of the lacrimal drainage system related to trauma, dacryocystolithiasis, sinusitis, and congenital nasolacrimal duct obstruction in children.
  • Lacrimal pump failure (functional epiphora) may be caused by eye-lid laxity (as in facial nerve palsy), eye-lid malposition, and punctum eversion.

The external DCR is standard treatment. Endoscopic DCR is a minimally invasive procedure performed by ophthalmologists and otorhinolaryngologists to unblock tear ducts and correct other causes of decreased patency of the nasal passages. A decongestant is administered to clear the nasal passage first and then gauze, soaked with anaesthesia that numbs the area and constricts blood vessels, is inserted.

A rigid endoscope is inserted into the nasal cavity to the lacrimal sac via the lacrimal duct to explore and confirm the nature of the obstruction. The nasal mucous membrane is incised and removed, to allow for the creation of a window on the lacrimal sac and upper nasolacrimal duct. A portion of the lacrimal and maxilla bone is removed and using a blade, a vertical incision is made in the lacrimal sac and nasolacrimal duct. Silicone tubes can be inserted to assist long-term patency.

Cancer Diagnostic Centre

ENT (Ear, Nose, Throat) cancers are also known as head and neck cancers. They are a group of cancers that affect the soft tissue organs in the head and neck region.

Head and neck cancer is a group of cancers that start in the oral cavity, larynx, pharynx, salivary glands, nasal cavity or paranasal sinuses. They usually begin in the squamous cells inside the mouth, nose and throat and are often identified as squamous cell carcinoma. Typical symptoms include a persistent sore throat, difficulty swallowing, mouth sores that won’t heal, and a hoarse voice.

Symptoms
Neck-Lump

Lump in the neck – Most lumps developing in the neck are benign (non-cancerous). However, a lump that persists for more than 2 weeks, or is painless, or keeps growing, should be seen by a doctor. Lumps in the neck can occur in nose, thyroid and lymphoid cancers, as well as other ENT cancers. The position of the lump in the neck may give a clue to its cause.

Nosebleeds – Nosebleeds usually occur because of trauma to the nose lining, often due to dry weather, infection or allergy, which can cause people to rub or scratch their noses more. However nosebleeds can also be a sign of cancer, in particular nose cancer. Especially if bleeding is persistent, scanty, or associated with a headache or unusual smell, then it is important to get checked. Nosebleeds sometimes drain backwards into the throat, causing blood-stained phlegm.

Swelling or ulcer in the mouth – A swelling, ulcer or sore area in the mouth that does not go away within a week should be evaluated by a doctor. This is particularly important if accompanied by a lump in the neck. Ulcers that come and go in different areas of the mouth are typically non-cancerous, and known as aphthous ulcers.

Hoarse voice – Hoarseness can occur with cancers of the voice box. It can also be a sign of thyroid cancer. This is because nerves to the vocal cords run closely behind the thyroid gland and can be affected by cancer within the gland. While most voice changes are not due to cancer, you should not take the chance, and if the hoarse voice persists, you should see your doctor.

Thyroid

Difficulty swallowing – A feeling that something is stuck in the throat, or even difficulty swallowing food can be a sign of cancer of the throat, and should be evaluated by a doctor. A swallowing x-ray or an oesophagoscopy (direct examination of the food passage with a scope) may be necessary to find the cause. This can be carried out in the clinic using a technique known as transnasal oesophagoscopy (TNE). This involves passing a thin flexible camera through the nose while the patient is awake, to view the oesophagus and stomach.

Ear Pain

Pain or blockage in the ear – Pain or blockage in the ear does not always represent a problem with the ear, but can be due to disease or a tumour in the nose or throat. Nose cancers can present with a blocked ear or sometimes unexplained pain or discomfort around the ear as the only symptom. Examining the ear will help make the distinction between a problem within the ear or a surrounding area.