ENT Conditions
Blocked nose
Everyone suffers a blocked nose occasionally, this is normally with a viral infection which causes the lining of the nose to temporarily thicken thus reducing the space in the nose through which we can breathe.
Some people suffer similar symptoms for much longer periods. This problem is given the medical name, rhinosinusitis. Rhinosinusitis can occur as a result of infections but there are other causes such as allergies.
Some patients with rhinosinusitis can develop growths in the nose, commonly called polyps. Rhinosinusitis with or without polyps can be managed with medication but in some people surgery may also have a role.
In some people a blocked nose is caused by the partition in the nose being bent thus occluding one or indeed both sides if it is zig zag. This problem is called a deviated nasal septum for which septal surgery maybe helpful.
Ear infections
Ear infections from different parts of the ear normally have different causes. This affects how they are managed.
The outside part of the ear down to the ear drum is called the outer ear. The ear drum to the bony wall deep to the ear drum is the middle ear. The Inner ear is contained in bone from here to the brain. We will consider inner ear problems in the balance section and the hearing loss section.
Outer ear infections generally enter the ear through the ear hole and are more common in adults. They are generally better managed with drops into the ear canal. Sometimes they will need ear cleaning or the placement of ear dressings which can be done in clinic.
Middle ear infections are more common in children. Many will settle without antibiotics but some will need antibiotics. Longer term middle ear infections may need surgery. Depending on the nature of the problem this can be as simple as insertion of grommets all the way to complex surgery involving precise dissection of diseased tissue from the intricate structures in the middle ear. This will require the assistance of an ENT surgeon specialising in ear surgery.
Ear Wax
It is normal for the ear to produce wax. It is produced in the outer part of the ear canal and largely comes out by itself. Any attempt to remove wax can potentially push some if it further down the canal from where it is less likely to come out.
Some people are prone to making too much wax and this can block the ear canal.
Simple over the counter wax softening drops such as olive oil can be effective in allowing the wax to extrude. In some people this does not work and indeed can make symptoms worse as the wax swells with the oil, making the ear feel more blocked. In this case the wax needs to be physically removed, either by ear syringing or with microscope assisted suctioning of the wax.
Some GP practices offer syringing. If this is not available, referral is required for microscope assisted suction. This is most often performed by an ENT doctor. In some areas, there are nurses and audiologists who are able to perform this.
Hearing loss
There are a number of causes of hearing loss but they basically affect one of the two processes which allow us to hear. For sound to get from the outside world to the parts of the brain that recognise it, it first travels as vibration. This vibration is picked up and turned into an electrical signal in the inner ear.
Sound in the environment travels mainly as vibration in the air. This travels down the ear canal and hits the ear drum. The ear drum vibrates and passes this vibration through the small bones of hearing to the entrance of the inner ear. This causes movement of fluid in the inner ear. This fluid movement is picked up and converted into an electrical signal along the hearing nerve to the the brain allowing the perception of sound.
Hearing loss is thus either a problem getting the vibration into the inner ear or a problem with the inner ear converting this to an electrical signal and sending it to the brain. The first type of hearing loss is "conductive loss" the second type is "sensory loss".
Any treatment of hearing loss depends on the cause. This could be as simple as removing wax or intricate as middle ear surgery. Inner ear hearing loss is largely managed with aiding.
Any sudden hearing loss must be assessed urgently, ideally within 48 hours of the hearing loss.
Hoarse Voice
The most common cause of a hoarse voice is a local viral infection often called "laryngitis". However any patient with a hoarse voice for 3 weeks or more should be referred by their GP to be seen urgently by an ENT doctor so that their voice box can be examined in clinic with an endoscopic camera. The reason for the urgent referral is to look for any evidence of a growth causing the hoarse voice.
Patients with a growth on the voice box need to be managed by and ENT surgeon who specialises in the treatment of cancer.
In the majority of patients, where no growth is found, the treatment is through referral to a Voice Therapist. However, many patients feel this is not necessary once a growth has been ruled out by endoscopic examination.
Sinusitis (Rhinitis & Rhinosinusitis)
ENT doctors regard sinusitis and rhinitis under one word "rhinosinusitis". When patients perceive sinus symptoms, it is often as a fullness or pressure in the front of the face. The other symptoms of sinusitis include a runny nose, a blocked nose and change in sense of taste or smell. Some patients with sinusitis develop pale coloured soft growths in the nose, nasal polyps.
For short lived sinusitis GP's can guide patients to management. For long periods of sinusitis, especially in patients who develop polyps ENT surgeons will consider other treatments including sinus surgery.
Tonsils
Tonsils are made of a type to tissue that produces cells that fight infection. We have 2 tonsils, one at each side at the back of the mouth.
In most of us they never cause in problems but in some of us they can. These include repeated painful infections (tonsillitis) and blockage to breathing (sleep apnoea). Some people find that their tonsils repeatedly discharge so called tonsil stones which can be unpleasant. Tumours can also grow in the tonsils.
For all these reasons surgery to the tonsils needs to be considered. Sometimes, particularly in children the adenoids are removed at the same time as the tonsils.
Tinnitus
Tinnitus is a common symptoms. It is very rarely due to any problem what will worsen your health. Nevertheless some people can find it very difficult to manage. It may unfortunately remain for a long time so it is useful to think about the different option for managing it. Click below to see a guide to how different options may help