Routine Ear, Nose & Throat Surgery
Apart from the specific and advanced domains of surgeries mentioned in other heads, its important not to forget the routine ear, nose, throat disease conditions and surgeries, as they are the conditions more common and in larger population, requiring utmost care and optimal management
When Should You See an Otolaryngologist?
Your primary care physician (PCP) may refer you to an ENT specialist if you experience:
- Persistent sore throat
- Runny nose that won’t go away
- Chronic cough
- Frequent sinus infections or nasal congestion
- Dizziness or vertigo
- Severe allergies
- Difficulty swallowing (dysphagia)
- Hearing loss or persistent ear infections
- Hoarseness or voice changes
- Lump or swelling on the face or neck
- Severe snoring or sleep apnea
- Tonsillectomy
- Adenoidectomy
- Septoplasty
- Myrigotomy
- Tympanolplasty
- Cyst removals
- Oral biopsies
- Foreign body removal from ear, nose , throat
- Management of epistaxis(nasal bleeding)
Tonsillectomy
Tonsillectomy is a surgery to remove the tonsils. The tonsils are two oval-shaped pads of tissue at the back of the throat. There’s one tonsil on each side.
Tonsillectomy was once used to treat infection and inflammation of the tonsils. This is a condition called tonsillitis. Tonsillectomy still is used for this condition, but only when tonsillitis happens often or doesn’t get better after other treatments. Tonsillectomy is also used to treat breathing problems that happen during sleep, called obstructive sleep apnea. where in the large size of tonsils lead to obstruction and snoring, difficulty in breathing and swallowing as well.
Recovery time for a tonsillectomy takes 10 to 14 days.
A tonsillectomy is used to treat:
- Repeated acute tonsillitis, chronic tonsillitis.
- Breathing problems that happen during sleep.
- Post serious infections like peritonsillitis or quinsy
- Cyst/ tonsilolith of the tonsils that becomes symptomatic in terms of discomfort, foreign body sensation, swallowing difficulty
- As an approach to operate for diseases deeper to tonsils, like styloidectomy ( removal of enlarged styloid process)
- As a part of surgery for cancer (cancer of tonsils or surrounding region)
Different ways of Tonsillectomy
- Coblation Tonsillectomy
- cold knife dissection (traditional)
- Laser Tonsillectomy
- radiofrequency tonsillectomy
- electrocautery
Coblation Tonsillectomy
Coblation tonsillectomy is a surgical procedure in which the patient’s tonsils are removed by destroying the surrounding tissues that attach them to the pharynx. It was first implemented in 2001. The word coblation is short for ‘controlled ablation’, which means a controlled procedure used to destroy soft tissue.
it has the advantage of quicker surgery and negligible bleeding.
How it works:
- Radiofrequency Energy: A radiofrequency wand is used to deliver energy through a conductive medium, typically saline solution.
- Plasma Field: The radiofrequency energy interacts with the saline, creating a plasma field of highly ionized particles.
- Tissue Dissolution: These energized particles disrupt the intercellular bonds within the target tissue, leading to its dissolution or removal at relatively low temperatures (around 60-70°C).
- Reduced Heat Damage: The use of saline and the low temperatures involved minimize the risk of burning or charring healthy tissue, which is a common concern with traditional electrocautery.
Benefits of Coblation Tonsillectomy
Coblation tonsillectomy offers potential benefits like less pain, faster recovery, and reduced bleeding compared to traditional methods, making it a gentler option for tonsil removal.
Adenoidectomy
An adenoidectomy is an operation to remove enlarged adenoids.
Adenoids are small lumps of tissue at the back of the throat behind the nose. They’re part of the immune system and help fight infection.
Why an adenoidectomy is done?
An adenoidectomy is mainly done in children to help with problems caused by enlarged adenoids.
These problems can cause pain or partially block the airway. They include:
- difficulty breathing through the nose, which can cause mouth breathing or snoring
- sleep apnoea, where breathing stops and starts during sleep
- glue ear, an infection in the middle ear which can cause hearing problems
- frequent ear infections
The adenoids usually start to shrink around late childhood/teenage, but may be persistently enlarged in some adults as well, who have more chronic infection and allergies.
Adenoid facies
Adenoid facies refers to the characteristic facial features that can result from persistent adenoid hypertrophy. Adenoid facies is commonly known as “long face syndrome” as it’s characterized by a long, lean face with a slightly open mouth.
Features of Adenoid facies
- Long, thin face
- High-arched palate
- Narrow maxillary arch
- Short upper lip
- Elevated nostrils
- Crowded front teeth
- Slightly open mouth
Adenoid facies is a result of Chronic nasal obstruction from enlarged adenoids and Mouth breathing. Other symptoms Abnormal breathing patterns, Hyponasal voice, Midface retrusion, Dental malocclusion, and Small maxilla bone.
The ideal treatment for enlarged adenoids which have caused manifestations of obstruction ans sleep apnea, recurrent middle ear infections and conductive hearing loss, develepoment of adenoid facies as described above is a procedure called adenoidectomy.
though when intervened on time, an optimal medical management for adenoids can help avoiding the progression of the adenoids to a stage that necessitates surgery.
What is Coblation Adenoidectomy?
Coblation adenoidectomy is a cutting-edge surgical procedure aimed at removing adenoid tissues. The adenoids, located behind the nasal passages, can sometimes enlarge or become infected, causing discomfort or impeding normal functions like breathing or swallowing.
This technology involves the use of heat to dissolve and then remove the troublesome adenoid tissues. Unlike traditional methods, such as cold curettage, coblation adenoidectomy minimises the damage to surrounding tissues and offers a host of benefits, such as reduced pain, bleeding, and quicker recovery time.
What is the Procedure for Coblation Adenoidectomy?
Here are the steps you can expect during the procedure:
- Endoscopic Visualisation: The doctor uses a nasal endoscope to visually examine the extent and size of the adenoid tissue.
- Coblation Wand Insertion: A special coblation wand is inserted into your nasopharynx, near the adenoid tissue but not directly touching it.
- Tissue Ablation: The coblation wand uses radiofrequency energy and a saline solution to gently dissolve and remove the adenoid tissue, causing minimal harm to surrounding tissues.
- Endoscopic Inspection: After removal, your surgeon will inspect your nasopharynx using the endoscope to make sure all adenoid tissue has been completely removed.
- Hemostasis: If there are any areas of bleeding, they are coagulated using the coblation wand or other methods to achieve hemostasis, a process to stop bleeding.
- Post-operative care: After the surgery, you will be monitored closely for any signs of complications, such as pain, bleeding, or infection.
Advantages Coblation Adenoidectomy
The advantages observed with coblation adenoidectomy, compared with the curettage technique are:
- the lack of bleeding (abundant bleeding with curettage)
- provides a direct endoscopic view of the adenoid (while traditional adenoidectomy is a blind surgery or mirror view with traditional cold curettage)
- the ability to reach all the areas up to the Eustachian tube opening (the cranial part of the nasopharynx cannot be reached with curettage)
- lower risk of residual adenoid tissue after coblation surgery
- fewer complications (no cutting blade with coblation adenoidectomy)
- it is suitable for patients of all ages, although the decrease of pain intensity and duration is important in paediatric patients.
- Its mostly a day-care procedure, and the patient can go home on same day and carry on routine work from subsequent day
and for all the benefits as mentioned above, this technique has to be done in experienced hands.
Septoplasty
Septoplasty is a type of nose surgery. It straightens the wall of bone and cartilage that divides the space between the two nostrils. That wall is called the septum. When the septum is crooked, it’s known as a deviated septum. A deviated septum can make it harder to breathe through the nose.
During septoplasty, the septum is moved back to the middle of the nose. The surgeon may need to cut and remove parts of the septum first. Then, these parts might be placed back into the nose in a corrected position.
A crooked septum is common. But when it’s very crooked, a deviated septum can block one side of the nose and reduce airflow. This makes it hard to breathe through one or both sides of your nose.
Septoplasty straightens the nasal septum. The surgeon does this by trimming, moving and replacing cartilage, bone or both.
Surgery to fix a deviated septum might be right for you if your symptoms affect your quality of life. Patient might have trouble breathing through nose or have frequent nosebleeds, frequent headaches, frequent sinusitis etc
Septoplasty is also a very important component of surgery in septo-rhinoplasty or rhinoplasty, and its rather a workhorse of a most optimal outcome in rhinoplasty.
Benefits of Septoplasty
- Improved airflow: Septoplasty straightens the septum, which can improve airflow through the nose.
- Reduced snoring: Septoplasty can reduce or eliminate snoring, which can help with sleep quality.
- Fewer sinus infections: Septoplasty can help sinuses drain better, which can reduce the risk of sinus infections.
- Reduced nosebleeds: A straightened septum can reduce friction that can cause nosebleeds.
- Improved sleep quality: Septoplasty can help with sleep disturbances caused by nasal obstruction.
- Improved appearance: Septoplasty can improve the appearance of the nose if the deviated septum causes asymmetry or deformity.
Risks in Septoplasty
- Bleeding which can be managed with certain office based procedures
- A hole in the septum (septal perforation)
- Less sense of smell.
- Clotted blood between septal flaps that has to be drained.
- Short-term loss of feeling in the upper gum, teeth or nose.
- Sometimes change in the shape of the nose, which is a rarity though due to advances in surgical techniques
The risks mentioned above are not very common in todays day, age and can be dealt with effectively, in the hands of an experienced surgeon.
Foreign body in the ENT
Foreign body involves surgically retrieving objects lodged in the body, with methods varying based on location and object type, ranging from simple techniques like forceps or suction to more complex procedures like endoscopy or surgery.
Foreign body in the ear
Foreign body in the ear is a procedure to remove objects that have accidentally gotten stuck in the ear.
Signs and symptoms
- Pain
- Deafness
- Unilateral discharge
- Bleeding
- May be symptomless
Foreign body from the nose
Foreign body from the nose is a procedure that involves removing an object that is not normally present in the nose.
Signs and symptoms
- Unilateral foul smelling discharge
- Unilateral nasal obstruction
- Unilateral vestibulitis
- Epistaxis
Foreign body in the throat
Signs and symptoms
- Acute onset of symptoms
- Constant pricking sensation on every swallow
- Drooling
- Dysphagia
- Localised tenderness in the neck, if above the thyroid cartilage then look carefully in the tongue base and tonsil regions
- Pain on rocking the larynx from side to side
- Soft tissue swelling.
Epistaxis
Epistaxis is the medical term for a nosebleed. It’s a very common condition that occurs when a blood vessel in the nose bursts, as nose has a rich blood supply.
Causes
- Nose picking
- Blowing the nose too hard
- Injury to the nose
- Colds and allergies
- Objects/foreign bodies in the nose
- tumors especially angiofibromas, inverted papilloma or cancers in nasal cavity
- Dry air, can form crusts in nose which can cause bleeeding when attempted to remove
- granulomatous diseases of nose
- Side effect of certain medicines like blood thinners etc
- uncontrolled hypertension
Symptoms
- Bleeding from the nose which can be both the nostrils or one nostril
- Blood in the throat, which is actually the trickled blood from nose, which can cause nausea or vomiting
Treatment
Initially till the medical help is available, simply pinching the nose and applying ice around the nose can stop the bleeding, one has to remain calm and avoid getting anxious all this while.
medical management includes
- Nasal packing with gauze, sponges, or foam
- stabilisation of blood pressure if its raised
- Cauterization with a chemical or heat energy to seal the bleeding blood vessel
- Medication adjustments, such as reducing blood-thinning medications
- Surgery to repair a broken nose or correct a deviated septum
- in severe cases not responding, Ligation (to tie off )the bleeding blood vessel, and sometimes occlusion of thew offending vessel by an intervention radiologist
thanks to the present era of endoscopes, nowadays in well equipped set ups, like we have, nasal bleed can be quickly managed by nasal endoscopic bipolar cauterisation, which many a times doesn’t even require uncomfortable packing of the nose
Prevention
- Use a humidifier to add moisture to the air
- Use saline nasal spray or gel to maintain nasal moisture
- Avoid scratching the nose
- management of blood pressure if one has hypertension
- to remain cautious when on blood thinning medications like aspirin etc
