ENT Central - Naveed Basheeth

This is inflammation or infection of your middle ear (the space behind your eardrum) and is often associated with a build-up of fluid in your middle ear.

Acute Otitis Media

This is usually caused by a temporary malfunction of the Eustachian tube due to allergies, infections or trauma.  The Eustachian tube connects the middle ear to the nose and allows air to enter the middle ear, thus making middle ear pressure the same as air pressure outside the head.  Acute otitis media results in an infection in the middle ear causing pain, fever and a red, bulging eardrum (the thin, transparent membrane between the outer ear canal and the middle ear).  This condition is usually seen in young children.  The treatment may be antibiotics if it is suspected to be a bacterial, rather than viral, infection, or if there are repeated episodes, surgical insertion of grommets into the eardrums may be required.  Grommets are tiny ventilation tubes that allow normal airflow into, and drainage out of, the middle ear until the Eustachian tube begins to work normally.  The operation is done under general anaesthesia (the child is asleep) and takes 10-15 minutes. Most grommets fall out naturally after six to twelve months, by which time the Eustachian tubes are often working properly.

Otitis Media with Effusion (Glue Ear)

Like acute otitis media, glue ear is usually the result of a temporary malfunction of the Eustachian tube and may either follow an episode of acute otitis media or occur on its own. The condition is usually seen in children. Fluid is present in the middle ear and the ear is not usually painful, but the ear drum is not red and bulging and there is no fever. Glue ear may lead to hearing loss, which can result in speech delays, and balance problems. Treatment options include: a prolonged course of antibiotics; grommet insertion; or treatment with decongestants, antihistamines or steroids.

Chronic Otitis Media

If the Eustachian tube is blocked repeatedly over a period of several years, there may be changes to the tissues of the middle ear such as deformity of the ear drum and damage to the bones of the ear. These changes may result in hearing problems, balance problems, and persistent deep ear pain.  If such long term damage has occurred, an operation called tympanomastoidectomy may be required. This involves making an incision (cut) behind or around the upper part of your ear, drilling through the mastoid bone and removing, and possibly repairing, damaged tissues.

When the growth of one of the tiny bones in your middle ear, the stapes, changes from hard to soft and spongy, it leads to the condition called otosclerosis. As this abnormal growth develops, the stapes becomes more rigid or fixed in position. The stapes needs to be able to vibrate to allow sound vibrations to pass through to the inner ear. When the stapes is not vibrating as well as it should, gradual hearing loss can occur. Otosclerosis may occur in one or both ears and may sometimes be associated with ringing/clicking/buzzing noises in your ear (tinnitus). The condition will be diagnosed by hearing tests and tympanometry. Otosclerosis most often develops during teenage and early adult years and it tends to run in families. The condition can become worse during pregnancy.

Treatment

Hearing loss can be divided into two types: conductive hearing loss (caused by some sort of mechanical problem in the external or middle ear) or sensorineural hearing loss (caused by disorders of the inner ear, hearing nerve or associated brain structures).

Conductive hearing loss is often reversible and can be due to:

Sensorineural hearing loss is generally not reversible and can be caused by:

Some of the signs you might notice that indicate you have a hearing loss include:

Hearing loss can be partial (you can still hear some things) or complete (you hear nothing) and may occur in one or both ears.

Treatment

Treatments for hearing loss range from the removal of wax in the ear canal to complex surgery, depending on the cause of the loss. One of the most common treatments for hearing loss is the use of a hearing aid. The type of aid you get depends on the cause of your hearing loss and how bad it is, as well as what your preferences are in terms of comfort, appearance and lifestyle.

If your hearing loss is severe to profound, you may be suitable for a surgical procedure known as a cochlear implant. In this procedure, a small cut (incision) is made behind your ear and a device is implanted that can bypass the damaged parts of your ear. The surgery usually takes 2-3 hours and is performed under general anaesthesia (you sleep through it). You may be able to go home the same day or have to spend one night in hospital.

This is a slow-growing, benign (non-cancerous) overgrowth of tissue on the nerves that affect your hearing and balance. When the neuroma is small, there may either be no symptoms or you may have a slight hearing loss or mild tinnitus (ringing/clicking/buzzing noises in your ear). As the neuroma grows and exerts pressure on the nerves, there will be a more noticeable loss of hearing, more tinnitus and problems with balance. The condition is diagnosed using hearing tests and MRI or CT scans.

Acoustic neuromas are usually found only in one ear and generally occur in people over 40 years of age.

Treatment

If the neuroma is small and not causing significant problems, you may not receive any treatment but the growth and effects of the neuroma will be monitored regularly.

If treatment is being considered, it may be either radiotherapy or surgery.

Radiotherapy, which is used for small to medium neuromas, involves low-dose beams of radiation aimed at the neuroma. This does not require anaesthesia but you will probably be in hospital for 1-2 days.

For larger neuromas that are causing significant problems, surgical treatment may be suggested. Depending on the size of the neuroma, there are several different types of operation that can be performed. Whatever surgical approach is used, it will be performed under general anaesthetic (you will sleep through it) and you will probably remain in hospital for about one week.

Treatment

Surgery can be carried out to improve the appearance of your nose e.g. straightening it if it’s crooked or increasing or decreasing its size.

Small cuts (incisions) are made either on the inside or outside (in the creases) of the nose. Excess bone and/or cartilage is removed and the nose reshaped. The surgery takes about 2 hours and is performed under general anaesthetic (you sleep through it). You may be able to go home the same day or, in some cases, you may have to stay in hospital overnight. You will need to arrange for another person to drive you home. Your nose will be covered with a splint that you will have to wear for about 1 week. It will take about six weeks for the worst of the swelling to disappear.

Growths, lumps, tumours or masses on the head and neck can be benign (noncancerous) or cancerous and can form in the larynx, pharynx, thyroid gland, salivary gland, mouth, neck, face or skull.

Tests to diagnose a mass may include:

Enlarged Lymph Nodes
Lymph nodes in the neck often become swollen when the body is fighting an infection.

Benign Lesions
Noncancerous masses such as cysts are often removed surgically to prevent them from pressing on nerves and other structures in the head and neck. 

Cancer
Cancerous masses spread to surrounding tissues and may be:

 Cancers may be treated by a combination of radiotherapy, chemotherapy and surgery

There are three large pairs of glands (parotid, sublingual and submandibular) in your mouth that produce saliva which helps break down food as part of the digestion process. 

Salivary Gland Malfunction
Salivary gland malfunction that results in a decrease in saliva production can be caused by conditions such as Parkinson’s disease, depression, HIV infection and chronic pain. Saliva production can also be decreased by certain medications such as some antidepressants, antihistamines and sedatives.

Reduced saliva can lead to increased tooth decay and difficulty speaking and swallowing. 

Good dental care is important in this condition. In some cases, saliva substitutes can be helpful. 

Salivary Gland Swelling
If the duct or tube carrying saliva from the gland to the mouth becomes blocked, the gland will swell. The glands can also swell as the result of mumps, bacterial infections and certain other diseases.

If the duct is blocked by a stone, it can sometimes by squeezed or pulled out but may on occasion require surgery to remove it.

The thyroid is a gland that sits in the front, and towards the bottom of, your neck.  It is responsible for producing a hormone called thyroxin.  Thyroxin has an important role in the body as it affects many organs including the heart, muscles and bones.  Diseases that affect the thyroid can make it either overactive (producing too much thyroxin), underactive (not producing enough thyroxin) or enlarged (goitre).  

Tests
Thyroid problems are usually picked up with a blood test but there are other tests you may have to work out why the problem has occurred.  These include:

New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun.
Risk factors for developing skin cancer are:  prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds.
There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

Basal Cell Carcinoma (BCC)
This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body.  Sometimes BCC’s can ulcerate and scab so it is important not to mistake it for a sore.
BCCs occur more commonly on the face, back of hands and back.  They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour.

Treatment
Often a BCC can be diagnosed just by its appearance.  In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis.
Removal of a BCC will require an appointment with a doctor or surgeon.  It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal.

Squamous Cell Carcinoma (SCC)
This type of skin cancer also affects areas of the skin that have exposure to the sun.  The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body.  The spreading (metastasising) can potentially be fatal if not successfully treated.
A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges.  SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown.  Sometimes it can appear like a recurring ulcer that does not heal.
All SCCs will need to be removed, because of their potential for spread.  The removal and diagnosis is the same as for a BCC. 

Malignant Melanoma
This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease.
A melanoma usually starts as a pigmented growth on normal skin.  They often, but not always, occur on areas that have high sun exposure.  In some cases, a melanoma may develop from existing pigmented moles.

What to look for:

Treatment
It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading.
A biopsy or removal will be carried out depending on the size of the cancer.  Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required.  If the melanoma has spread more surgery may be required to take more of the affected skin.  Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread.
Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer).
A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.