Neck lumps are extremely common and in the vast majority of cases are benign. They can be found anywhere on the next and may be soft or hard, asymptomatic or painful and tender to the touch.
Neck lumps have many possible causes, so a diagnosis will be made on both the features of the neck lump itself and any associated symptoms.
Neck lumps can often appear on their own with no symptoms.
Most commonly, neck lumps are the result of a swollen lymph node. Lymph nodes are found all over your neck and are part of your immune system. They often swell when you are fighting off a disease or infection, so in most cases a neck lump will occur at the same as other symptoms of the illness you have, and disappear again once you have recovered. You won’t generally need to see a doctor to treat the lump.
However, you should seek medical help as soon as you can if you notice the following symptoms:
You doctor will start by asking how long you have had the neck lump for and how quickly it appeared. They will ask specifically about the symptoms listed above.
Next the doctor will examine your neck to check its size, how soft or hard it is, and whether any other lumps can be detected. Depending on what the doctor suspects is causing your condition, they might examine your ears, lungs, or throat.
You might then be referred for tests, such as blood tests or imaging to see the tissues in your neck.
As already mentioned, the main cause of neck lumps is a swelling in a lymph node in response to illness, from the common cold and ear infections to chickenpox, herpes, and HIV.
Other causes of neck lumps include:
Treatment of neck lumps depends on the cause. For example, thyroid problems can often be tackled with hormone treatment, whereas skin tumours or lipomas are likely to require surgery. You will be referred to the appropriate specialist as part of the diagnostic process.
The main salivary glands, those that generate and empty saliva in the mouth, consistent of three pairs:
Salivary gland surgery is responsible for removing any of these glands. Anaesthesia during the procedure will depend on the gland that is removed: if it is from major salivary glands, such as the parotid gland, the procedure involves general anaesthesia, whereas if it is of minor salivary glands, local anaesthesia will be used.
Salivary gland surgery is usually performed to remove tumours that grow in these glands and analyse them. It is estimated that more than 70% of these tumours are benign (non-cancerous), but any lump that is detected must be analysed.
The salivary glands can also present other pathologies, including:
There are several surgical techniques depending on the gland that needs intervention:
In all surgeries, the area is closed with sutures once the affected tissue is removed. In some cases, it may be necessary to put temporary drains to remove fluids, such as saliva or blood.
Before the intervention, the specialist can perform a physical examination and talk about what medications can be taken beforehand and which ones cannot.
After the procedure, the specialist observes the facial movements of the patient, asking them to smile or make facial gestures. Once at home, it is important to follow the doctor's instructions about wound care and drainage. The patient may also return to the clinic to remove the sutures. Once removed, the patient has to wash the area with mild soap and water.
Head and neck cancer can refer to a number of different types of tumours in various parts of the head and neck, including the mouth, lips, larynx (voice box), pharynx (throat), salivary glands, nose, and sinuses.
Cancer is a disease in which a group of cells in the body malfunction and multiply uncontrollably, forming a mass. This mass of abnormal cell growth is known as a malignant tumour. Cancerous cells continue to grow and divide, avoid programmed cell death, and replace normal, healthy cells, with a tendency to spread and invade other tissues.
Head and neck cancer is relatively uncommon, with around 10,000 cases diagnosed in the UK each year.
Types of head and neck cancer include:
They symptoms depend on the type and location of the cancer. Possible symptoms include:
Like all cancers, head and neck cancers can be fatal if left untreated or treated too late. However, many treatments exist to combat cancer, and curing it is possible in many cases.
Some risk factors vary depending on the type and location of cancer, but smoking and excessive consumption of alcohol are risk factors for most types of head and neck cancer. Exposure to harmful substances, infection with HIV, family history, and gender can also be factors.
The biggest risk factor for head and neck cancer is tobacco consumption. Consuming a lot of alcohol regularly also increases the risk. By cutting down on these, or by stopping smoking and drinking altogether, you can lower your risk of developing cancer. However, there is no 100% guarantee.
The type of treatment recommended depends greatly on the type and location of the cancer, but some of the usual options for cancer treatment include:
These treatments are often used in tandem to give the patient the greatest chance of eradicating the cancer with the least possible damage to their body.
A number of specialists may be involved in diagnosing and treating head and neck cancer. Oncologists specialist in treating cancer, while ENT surgeons and oral and maxillofacial surgeons may be brought in to operate on the patient, depending on the location of the tumour.
Dysphagia is the medical term for a person who has swallowing difficulties. Some people cannot swallow certain foods or liquids, whilst others have trouble swallowing at all. The condition is usually caused by nerve or muscle problems, and is more common in the older generation and babies. There are three different types:
The symptoms of dysphagia may include:
Normally, dysphagia occurs secondary to another disease or injury, such as:
Risk factors for dysphagia include ageing as this is due to general wear and tear on the body over time. Neurological conditions can make dysphagia more likely.
A speech-language specialist will try to determine the problem. The patient will take a:
The treatment depends on the type of dysphagia that the patient has. Oral dysphagia is a neurological problem and treatment can be a challenge. Swallowing therapy can be done with a speech and language therapist. The patient may also need to be fed through a feeding tube. A nasal tube or PEG (percutaneous endoscopic gastrostomy) is used to feed a patient who is at risk of pneumonia, malnutrition or dehydration.
Oesophageal dysphagia usually requires surgery. If the oesophagus needs to be widened then a small balloon is inserted and then removed. In cases of stiff muscle, Botox® is used to paralyse it in order to reduce constriction. If cancer is the cause of dysphagia, the patient is referred to a specialist for treatment to have a tumour removed surgically.
Voice disorders are disorders in sounds that depend on the larynx (vocal cords) and affect the pitch, timbre, intensity or duration. The origin of such changes can be organic, physiological, psychological or environmental. In addition, there are two types of disorders: dysphonia and aphonia. Aphonia is the total loss of voice temporarily or chronic and can be caused by overuse of the vocal cords, respiratory disease, intake of toxic or irritating products, excessive cold or nervous causes. Treatment may include resting the voice, medication, voice therapy or, in severe cases, surgery. Dysphonia is a disorder of voice intensity due to an injury in the organs of phonation (organic) or poor use of the voice (functional). The most common causes of this condition are overly straining your voice (voice hyperfunction), gastroesophageal reflux, smoking, infections such as laryngitis or tuberculosis, neurological disorders of the larynx, tumors, and trauma, among others. The treatment involves learning relaxation techniques and breathing, exercising the shoulder, neck and face muscles, and speech therapy.
Sinusitis is a condition characterised by inflammation of the paranasal sinuses which are the cavities located behind the forehead, cheeks and eyes. It occurs as a result of infection by viruses, fungi or bacteria.
There are two types of sinusitis:
The main symptoms of sinusitis are:
The cause of sinusitis is an infection caused by viruses, fungi or bacteria. When the paranasal openings are blocked, bacteria or other microorganisms can easily grow.
Obstruction of the paranasal openings may be due to:
The best way to prevent sinusitis is to avoid coming down with a cold. If you cannot avoid them, it is important to treat them quickly. Some tips to prevent sinusitis are:
In general, sinusitis heals on its own and self-care can manage the discomfort, however, if it persists antibiotics can be prescribed.
Some self-care techniques include:
If the symptoms do not disappear with the treatment, it may become necessary to perform surgery to enlarge the opening and to drain the sinuses.
Mr Stuart Winter is an experienced consultant ear, nose & throat (ENT) surgeon with a specialist interest in tumours of the head and neck. Based across the major private hospitals in Oxford, Mr Winter runs a full ENT practice for adults and children. He runs a specialist swallowing clinic at the Churchill Hospital. He holds, and has held a number of positions nationally including with NICE, ENT-UK, and is a member of the national Clinical Reference Group (CRG) for complex Head and Neck Cancer.
Originally qualifying from the University of Bristol, Mr Winter completed his surgical training in the south west of England, where he developed an early interest in head and neck cancer. In order to further develop advanced techniques for head and neck cancer and sinus surgery, he spent a year working at the Royal Adelaide Hospital in South Australia. During this time he received a number of awards, including the Lionel College Memorial Fellowship and the Ethicon Travelling Fellowship.
As Consultant Ear, Nose & Throat Surgeon at Oxford University Hospitals, Mr Winter leads an active research program into head and neck cancer, and to date has over 40 publications in peer-reviewed journals. He is regularly invited to speak at national and international conferences and he teaches on a number of local and national courses.
Adenoids are tonsil-like glands located at the back of the nose, above the roof of the mouth, at the intersection of the nostrils, throat and the eustachian tubes. During childhood, they form part of the body's defence system against infection. Their main function is to capture substances that could be harmful to the body (bacteria, viruses or dust) as they are breathed in, before they reach the lungs. Once captured, they process these substances and activate an immune response.
Adenoids increase in size from birth, until the child is around 4 years old, and then shrink until they have almost disappeared in adulthood.
Adenoids can become enlarged or swollen, usually due to infections or allergies. This is common, and is often accompanied by swollen tonsils. The adenoids may recover on their own and in most cases, they aren’t serious enough to impact the child’s day-to-day life. However, swollen or enlarged adenoids can sometimes cause problems, including:
A persistent blocked nose and the associated difficulty breathing through it leads to the child breathing through the mouth, which can cause a dry throat and, in turn, problems such as a sore throat, trouble swallowing, bad breath, and voice alterations.
Adenoids cannot be seen through the mouth like the tonsils. The specialist will need to perform a physical examination of the nose, throat, and ears to assess whether they have increased in size. A lateral x-ray of the pharynx may also be performed to see the size. In severe cases where there is associated sleep apnoea, a sleep apnoea study should be performed to assess the intensity of the episodes.
Enlarged adenoids usually occur due to bacterial or viral infections. The adenoid tissue may swell temporarily as it fights an infection in the airway, and may recover. The adenoids themselves can also become infected, and repeated infections of the respiratory tract, such as colds or flu can lead to persistent swelling.
Some adenoid problems may be caused by the streptococcus virus or the Epstein-Barr virus, among others.
Patients with enlarged adenoids are also at increased risk of tonsillitis, and may experience headaches and sore throats more often.
The first thing the specialist will do is prescribe antibiotics to combat the infection in the tonsils, adenoids, and sinuses. This will lower mucus production and clear the nostrils, but not all the inflammation.
If breathing problems and difficulty sleeping are impacting the child’s life, the doctor will probably recommend surgical removal of the adenoid glands (adenoidectomy). If the child also frequently suffers from tonsillitis, the tonsils will likely be removed at the same time (tonsillectomy), which reduces the risk of complications.
The operation is performed under general anaesthetic and consists of scraping the adenoids away with an instrument known as a curette or burning them away using heat from a high-frequency electrical current generated by a special diathermy instrument.
The procedure is relatively quick. The child will be kept under observation for a few hours (occasionally overnight if the procedure was performed late in the day), and when the doctor is satisfied that they are recovering normally, they will be able to go home, usually in the same day.
Any problems with the adenoids are treated by a paediatric otolaryngologist.
The allergic nasal polyposis is the presence of polyps (a kind of small whitish bumps) on the inside of the nose or sinuses ( bone space between the nose and eyes) caused by inflammation of the mucosa. Although it is benign polyps, cause a number of inconveniences that hinder the patient's daily life: difficulty breathing, loss of smell and taste, headaches, and even deformation of the nose. The pharmacological treatment only serves to alleviate symptoms, so it is necessary to remove the nose through a very aggressive surgical intervention polyps. But the most effective in most patients with this pathology is trying to find the cause that produces the allergic symptomatology and the appearance of nasal polyps to apply custom processing.
Allergic rhinitis is a condition where the nose becomes inflamed by allergens, and is characterised by the presence of the typical symptoms of a cold such as sneezing, an itchy nose, stuffy nose or nasal congestion, mucus, and loss of smell.
Allergic rhinitis generally causes symptoms which are similar to those of a cold, such as a blocked or runny nose, and sneezing or itching. These symptoms will come on soon after being exposed to the allergen. In some, these reactions are common all year round as a reaction to a particular allergen, while in others, these reactions are seasonal as the allergen only appears sporadically in the year, e.g tree pollen.
Over time, symptoms sometimes ease and improve, but it is unlikely that they ever completely disappear.
The most common cause of allergic rhinitis is an allergy to a particular substance (i.e allergen), such as dust mites, pollen or the urine/saliva of certain animals.
Allergic rhinitis can be avoided rather than prevented, by avoiding the allergen itself. In the case of pollen, for example, it is recommended to stay indoors, sleep with the windows closed and drive with the windows up.
Treatment of allergic rhinitis will be based on avoiding contact with the allergen itself. Depending on the case, appropriate medications should be administered (antihistamines, decongestants, allergy vaccines, etc).
An allergy is a reaction of the immune system to exposure to a substance in the environment which is usually harmless for most people. Examples include:
Allergies can affect several parts of the body. However, the most frequently affected areas are the nose, the eyes, the respiratory tract and the skin.
Given that there are many types of allergies, there are various possible symptoms. The symptoms of an allergy can range from mild to severe. Common symptoms associated with allergies include:
More extreme allergic reactions can cause anaphylaxis or anaphylactic shock, in which the mouth and throat may swell, the patient may struggle to breathe, feel lightheaded, and may even lose consciousness. Anaphylaxis is highly dangerous and can be fatal if not treated immediately.
If you are displaying symptoms of an allergic reaction, tell your doctor about the symptoms, when and how often they occur, and if you have noticed anything that seems to trigger them. This may be sufficient for your doctor to diagnose the allergy and perhaps offer treatment and/or advice on dealing with the allergy.
If the allergy is severe, or it is not clear what is causing the reactions, you may be referred to a specialist clinic for tests, such as:
Allergies are thought to be caused by a genetic predisposition, as a family history of allergies makes a patient much more likely to also have an allergy. Allergies are an overreaction of the immune system, which produces antibodies to defend the body against harmless substances, as if they were a threat. This immune reaction can inflame the skin, airways, or digestive system.
The only way to avoid an allergic reaction is to avoid contact with the allergen. However, this can be difficult for certain allergens, such as pollen, which is released into the air by plants on a seasonal basis. Similarly, food allergies can cause problems, as small amounts of allergens, such as peanuts, can be found in many foods.
Based on the type and severity of the allergy, there are several treatment options. One of the most common treatments is antihistamines, which are used for pollen or other particular plants allergy.
Anaphylaxis can be treated with adrenaline, and patients with known extreme allergies often carry an auto-injector for this reason. If you are with someone who goes into anaphylactic shock, you should call an ambulance, lie them down flat, remove the trigger if possible, and, if you know how, help them with their adrenaline auto-injector.
To get an accurate diagnosis and get started on a treatment, you should see an allergist.
The hoarseness is the loss of voice. Usually caused by an inflammation of the larynx or trauma. Causes of hoarseness:
An audiometry exam evaluates your hearing function in terms of tone, balance and sound intensity. It focuses on the functioning of the inner ear. The human ear can perceive sounds with tones that range between 20 and 20,000 Hertz. The human ear can hear sounds with intensity ranging from 20 decibels upwards.
An audiometry exam involves several different tests. A pure tone audiometry test measures softest, quietest sounds you can hear at different pitches. This uses an audiometer which is a special machine that plays sounds via headphones. You will indicate to the clinician which sounds you can hear.
A speech audiometry exam tests how well you can hear speech at different tones.
The exam is divided into tonal and verbal audiometry. In tonal audiometry, the airway and the bony route are evaluated, which in both cases involves the exploration of the two ears separately, with the patient inside a soundproof and hermetically sealed cabin. In air audiometry, the individual must put on headphones and then the specialist plays a series of sounds from higher to lower volume until they are inaudible. The last perceived sound determines the auditory threshold, that is, to what intensity the patient can hear at a certain frequency. In the inspection of the bone path, a vibrator is placed behind the patient's ear, in the mastoid, where it receives the sound.
Verbal audiometry is also performed with the patient in a booth and with headphones, but instead of sound, words are issued at different volumes that must be repeated exactly. A word-recognition test is also performed which measures the patient’s ability to discriminate between speech and background noise.
Tympanometry testing can uncover any problems with wax or fluid build-up, ear drum damage, ossicle bone damage or tumours in the middle ear.
An acoustic reflex test is used to locate where the hearing impairment may be located.
Audiometry can detect hearing loss and is performed when a patient has trouble hearing or as part of a routine screening. An audiometry exam can determine whether someone is suffering from sensorineural hearing loss (nerve or cochlea damage) or conductive hearing loss (ear drum or ossicle bone damage).
Hearing loss commonly results from:
No special preparation is needed to perform this test.
During the test, the patient does not feel any discomfort. The duration of the exam varies depending on whether it is an initial evaluation, which can last between 5 to 10 minutes; or if it is a detailed evaluation that can last up to almost an hour.
Audiometry is non-invasive and carries no risks.
The results are shown on a graph (audiogram). The results are reviewed by the specialist and if they confirm hearing loss, management and treatment techniques will be discussed. These could include wearing a hearing aid.
A blocked nose, or nasal congestion, is when the nose is blocked due to mucus or other obstruction. This could be due to the common cold, or a problem like sinusitis, or nasal polyps.
Botulinum toxin, more commonly known as Botox™, is a neurotoxin that is used to treat various medical conditions. The toxin is actually released by the microbe that causes botulism (a type of food poisoning). It is also used as a cosmetic treatment and is administered via injection. Botox™ was the first drug developed to use botulinum toxin, but others have also been developed.
The most common uses for botulinum toxin are:
Botulinum toxin acts by temporarily paralysing certain muscles, for example, when used for facial muscles this smoothens their appearance. This also has the added benefit of preventing certain facial expressions, such as wrinkling your forehead which acts as an anti-ageing measure. Botulinum toxin injections weaken and paralyze certain muscles, blocking some nerves. They are injected with thin needles and the number you receive in a treatment session will depend on what they are being used for.
The effects of the injection are not immediate, they begin to reveal after three or four days have elapsed, depending on each patient. The results can be highly satisfactory. In addition, depending on the patient, the effect of botulinum toxin can last between four and eight months; so, to keep the same look regular treatments would be required.
Pregnant or breastfeeding patients cannot undergo a botulinum toxin treatment. Although the injections are not too painful, some patients will prefer to have the skin numbed beforehand using topical anaesthesia.
You can usually resume normal activities the same day as your treatment. You should avoid rubbing or massaging the treated area as this can move the toxin to other areas within the surrounding skin and muscle.
Possible side effects of botulinum toxin injections include:
Most coughs cause discomfort, but they usually serve a use – when we cough, we expel germs, mucus and foreign material from our lungs. Most only last a short time. However, sometimes they linger for weeks or even months.
A chronic cough is defined as one that lasts for eight weeks or longer in adults or over four weeks in children. They can potentially be very disruptive to the patient’s life, interrupting sleep and leading to fatigue, and in severe cases, they can cause vomiting, light-headedness, and even rib fractures.
The cough itself is a symptom of an underlying condition, but it may be accompanied by other symptoms, some of which may be a result of the coughing.
There are several things that can cause a chronic cough:
In rarer cases the following can also be responsible:
When a cough lasts for more than a few weeks, it is worth having it checked out by a doctor. If you cough up blood, or experience weight loss, fever, or trouble sleeping, you should consult your GP or a specialist.
Treatment for chronic cough depends largely on the cause, as treatment tends to be targeted at the underlying illness, rather than the symptom. For example, antibiotics may be prescribed to treat a bacterial infection, while asthma could be treated with steroids and/or bronchodilators. If you have a chronic cough, consult a doctor and follow their advice.
Specialists in pulmonary and respiratory medicine and otolaryngologists may both treat chronic cough, and other specialties may be involved, depending on the underlying cause.
Congenital malformations are defects or abnormalities in the baby's body that develop during pregnancy. There are more than 4000 types of congenital malformations, and they are categorised into two main groups:
According to figures from the World Health Organization, every year 303,000 new-borns die during the first 4 weeks of life, due to congenital malformations. However, many of these diseases can be avoided if they are detected early during pregnancy.
There are many degrees of severity in congenital malformations, with some not requiring treatment, whereas others may need treatment and monitoring for a few years or for life, or even require emergency surgery. The reality is that congenital malformations represent an important cause of infant mortality, disabilities and chronic diseases.
Due to advances in medicine, congenital malformations occur in very few cases. On the other hand, since many of them are rare or uncommon diseases, they represent a major challenge for thousands of families, who are far more helpless when facing an unknown disease.
When a baby is in the womb and presents anomalies it does not cause symptoms in the mother, so the only way to detect them is to carry out a correct pregnancy follow-up and genetic and prenatal studies.
On the other hand, the symptoms that cause congenital anomalies in the new-born are very diverse depending on the malformation and the degree that it presents. Some malformations are unnoticeable or allow a totally independent life, whilst others are disabled or require lifelong treatment.
The majority of diagnostic tests for congenital malformations are usually performed during pregnancy in the check-ups that the expectant mother must perform with the specialist. An ultrasound allows the gynaecologist to check the development of the foetus, which can detect a large number of congenital malformations: for example, it can detect Down’s syndrome during the first trimester of pregnancy or serious foetal anomalies up until the second trimester.
Amniocentesis is another of the key tests that allows the detection of congenital malformations, such as neural tube defects or chromosomal abnormalities during the first two trimesters of pregnancy.
On the other hand, before a pregnancy it is also recommended that the couple should perform genetic testing to know the risk they have of having a baby with congenital anomalies, as some are hereditary.
Most of these malformations are of unknown origin, but several factors have been detected that may be related to the development of several of them:
Specialists in gynaecology, obstetrics and healthcare organisations such as the World Health Organization recommend a series of primary prevention measures for congenital malformations:
Many congenital malformations can be corrected or improved with paediatric surgery, even during pregnancy. In other cases, new-borns may need pharmacological treatment from birth or even undergo emergency operations to save their lives. The treatment that each patient will need will vary depending on their malformation or congenital pathology, as well as their development.
Gynaecologists and obstetricians who carries out pregnancy check-ups are usually the first to detect any congenital malformations. A paediatric surgeon can intervene in the treatment of some malformations, just as the paediatrician will be the specialist in charge of monitoring and assessing the baby after birth. Other specialists, such as speech therapists or psychologists may also be involved in the treatment of congenital malformations.
Deafness, also known as hearing loss, describes difficulty hearing or the total inability to hear. Deafness can be partial or complete and can occur gradually, with age or it can happen suddenly. Some people are born with deafness.
Particularly if hearing loss is happening gradually, noticing it can be difficult. However, the following are common signs that you may be going deaf:
The causes of deafness can be congenital or acquired. Congenital causes present at birth or soon after and can be hereditary or non-hereditary, and are due to complications during pregnancy or childbirth.
As for the acquired causes, these can occur at any age due to:
There are certain risk factors that can damage the ear or cause deafness, so prevention can be sought by:
Sometimes, hearing loss will get better on its own, for example, if earwax is removed or treated with eardrops. However, other forms of deafness can be permanent. In such cases, treatment will aim to improve what hearing you have left. This can be done with hearing aids, cochlear implants, or by teaching lip reading or sign language.
Nasal breathing disorders are relatively common and mainly cause difficulties in breathing properly through the nose.
The most common nasal breathing disorders include:
The symptoms vary for each disorder.
Sinusitis –
Deviated septum –
Nose / sinus trauma due to injury
Nasal Valve Collapse (NVC)
Sinusitis is most often caused by an infection. It can also be caused by a common cold, allergic rhinitis (which causes the lining of the nose to swell), nasal polyps on the lining of the nose or a deviated septum. Sinusitis is very common and it is very common to have sinusitis following a cold of the flu.
A deviated septum is usually something some people are born with, but it can also be caused by trauma or injury to the nose.
Nasal Valve Collapse can be caused by:
Sinusitis -
Treating simple sinusitis does not usually involve seeing a doctor, and doing the following will usually clear it up:
If sinusitis persists, a doctor may prescribe antibiotics, for a course of usually 10 to 14 days.
For those suffering from chronic sinusitus, a warm compress to the nose, saline nose drops and prescribed steroids can help.
Deviated septum –
In some cases, the symptoms caused by a deviated septum can be relieved by medication. However, if this is not the case, then a surgical procedure called a septoplasty might be recommended. This procedure restores the crooked septum to improve nasal breathing. A septoplasty involves the removal of excess bone and cartilage and is sometimes performed under general anaesthetic. This procedure is often combined with a rhinoplasty to imporve the appearance of the nose.
Nasal Valve Collapse –
There are two key approaches to treating NVC:
Dizziness refers to feeling light-headed, off-balance, faint, like you are spinning, or like things are spinning around you (also called vertigo). Dizziness is very common and it’s not something which is usually a cause for concern. It can happen, for example, when we stand up too quickly after bending down, or when we’re feeling particularly hot. However, dizziness can also be a symptom experienced with certain conditions or an indication of an underlying problem.
While dizziness is common, there are certain conditions which can cause you to feel dizzy for no obvious reason, of which there are many. Some of the more commonly experienced conditions include:
You may also feel dizzy during pregnancy. It’s important to visit your doctor if your dizziness keeps coming back, or if you experience symptoms such as vision loss, double vision, limb numbness/weakness, tinnitus (ringing or sounds coming from inside the ears), hearing loss, or nausea along with the dizziness.
Dizziness is a symptom rather than a condition, so if it is caused by an underlying condition then the condition itself must be treated. However, if you feel dizzy and it is not a common occurrence, there are things you can do to help the dizziness go away:
If dizziness is a regular occurrence then you should make an appointment with your GP, who can refer you to a specialist if necessary.
Dysphagia is the medical term for a person who has swallowing difficulties. Some people cannot swallow certain foods or liquids, whilst others have trouble swallowing at all. The condition is usually caused by nerve or muscle problems, and is more common in the older generation and babies. There are three different types:
The symptoms of dysphagia may include:
Normally, dysphagia occurs secondary to another disease or injury, such as:
Risk factors for dysphagia include ageing as this is due to general wear and tear on the body over time. Neurological conditions can make dysphagia more likely.
A speech-language specialist will try to determine the problem. The patient will take a:
The treatment depends on the type of dysphagia that the patient has. Oral dysphagia is a neurological problem and treatment can be a challenge. Swallowing therapy can be done with a speech and language therapist. The patient may also need to be fed through a feeding tube. A nasal tube or PEG (percutaneous endoscopic gastrostomy) is used to feed a patient who is at risk of pneumonia, malnutrition or dehydration.
Oesophageal dysphagia usually requires surgery. If the oesophagus needs to be widened then a small balloon is inserted and then removed. In cases of stiff muscle, Botox® is used to paralyse it in order to reduce constriction. If cancer is the cause of dysphagia, the patient is referred to a specialist for treatment to have a tumour removed surgically.
Dysphonia is a disorder characterised by an alteration of the timbre of the voice (difficulty in speaking) which can be due to various organic or functional causes of the larynx and vocal cords. When it occurs in children, it can come from neurological disorders, malformations of the larynx, laryngeal papillomatosis caused by viral infections, or from the voice being overly strained. The latter is the most common cause of dysphonia in adults, and that an untreated hyperfunction voice can produce other pathologies such as nodules or polyps on the vocal cords. In addition, other factors that can trigger dysphonia: gastro reflux, smoking, infections such as laryngitis or tuberculosis, neurological disorders or tumours of the larynx.
Eagle syndrome, also known as styloid syndrome, stylohyoid syndrome, or styloid-carotid artery syndrome, is a rare disorder of the stylohyoid ligaments that connect the skull with the hyoid bone of the neck. The condition may occur as a result of an elongated or misshaped styloid process (a slim pointed bone located just below the ear).
Eagle syndrome is characterised by recurrent pain which occurs in the middle area of the throat, otherwise known as the oropharynx. Recurrent pain can also occur in the face, and the throat pain may feel worse or radiate further towards the ear as you turn your head.
Other symptoms of Eagle syndrome include:
There is a small, pointy bone just below the ear called the styloid process. It is located 5 cm deep and connects the skull with the neck through the stylohyoid ligament.
The causes of Eagle syndrome are not completely understood, but the syndrome may also be related to the calcification or fibrosis of the styloid ligament, which usually occurs in middle-aged adults, although it can also affect young people, presenting a higher incidence in women than in men. There may also be a genetic factor in the appearance of Eagle syndrome.
The treatment for Eagle syndrome varies depending on the symptoms.
Depending on the case, it may be medically managed by pain or anti-inflammatory medications, or even corticosteroid injections. In more severe cases, the styloid process is shortened through surgery. Techniques are frequently improving and developing, and more recently this surgery has been carried out using minimally-invasive techniques, such as an endoscope-assisted styloidectomy.
Earwax build-up, also known as earwax plugs, are the accumulation of earwax in the ear, which usually result in hearing loss.
In the external auditory canal there are a series of glands and follicles that create wax, which accumulates in the outer ear, where it is removed by washing the ears. However, often this earwax is not removed properly and forms plugs in the ear canal, which are the most common cause of hearing loss.
Signs that you have a build-up of wax in your ears include:
In severe cases, it can cause fever and discharge from the ear.
Earwax exists to protect the ear from bacteria, dust, water and external agents in general. However, some people produce more earwax in their ears than is removed, leading to wax building up and hardening in the ear canal. Also, during washing, the wax can accidentally be pushed deeper into the ear, blocking it.
Good hygiene of the ears is fundamental to avoid the accumulation of wax that causes the plugs. While it is true that some people’s ears produce more wax than others, more necessary will be a routine cleaning of the ears to remove excess wax.
In some cases the build-ups of wax may disappear by softening the wax, for which water or baby oil is usually used. In most cases, the wax plugs will require a professional wash with a syringe that will dissolve the wax with water under pressure. It is recommended to leave this treatment in the hands of an otolaryngologist (ENT specialist) to avoid damage to the eardrum. The otolaryngologist may also act on the earwax plug by other methods, such as suctioning the ear canal or using a curette.
Sinus surgery was typically performed in the past using external incisions, which caused discomfort and a significant amount of pain to the patient. Nowadays, however, endoscopic sinus surgery tends to be the standard surgery performed for conditions such as chronic sinusitis. In endoscopic surgery, a small telescope with a camera on the end is inserted up the nose to view the area to be operated on. This surgery is used to treat injuries or abnormalities that alter normal nose function or surrounding structures. Surgery is done under general anaesthetic.
This surgery is done when there is chronic nasal and sinus inflammation, especially in chronic sinusitis, nasal polyps, or acute recurrent sinusitis that has not responded well to medical treatment. The treatment aims to restore normal nasal sinus function through a minimally invasive surgical procedure. This surgery is also used for septoplasty, turbinate surgery, closure of cerebrospinal fluid fistulas, and orbital decompression among others.
A nasal decongestant should be used before dissecting the nose. A thin optic fibre is inserted in the nasal fossa to be able to view the sinus openings. With the right tools, the abnormal or obstructive tissue is resected. After surgery any bleeding points will be checked on, and in some cases nasal packing will be done to prevent haemorrhages, or silicone sheets will be placed to prevent the walls sticking to each other and forming anomalous scars.
Surgery tends to last between 1 and 3 hours depending on the complexity of the case. The nasal cavities are blocked with coagulant foam and special sponges that dissolve, or plugs that can be taken out easily.
Before surgery a sinus CT scan will be done to be able to plan the best form of treatment. Preoperative tests will also be carried out, as the surgery is done under general anaesthetic. The patient is normally in for a short stay surgery, they are only there one night. The patient should fast for 6 to 8 hours before the procedure.
The nose is usually blocked, so the patient can’t breathe through it. Bleeding may occur, so a gauze is placed under the nose, although it’s not always needed. For the first 3-4 days, the patient is advised not to; smoke, drink alcohol, or physically exert themselves. Patients are also told to rest at home, avoid blowing their nose, and sit in a position that reduces blood flow to the head, head congestion, and bleeding. Patients should follow a soft food diet and drink plenty of fluids for throat dryness due to nasal packing.
It is not a painful procedure, but it can cause discomfort. Anti-inflammatory medication is generally prescribed. Antibiotics may also be prescribed to prevent an infection of the retained mucus.
Epistaxis is a nosebleed originating from the nostrils. It can be caused by trauma, irritation or dryness of the lining of the nose, allergic rhinitis, colds or sinusitis. Other causes include nasal obstruction such as a deviated septum or foreign objects in the nose. In most cases it stems from the septum, which is the vertical cartilage that separates the nasal chambers and is covered by fragile blood vessels, which may break. A nosebleed usually stops by itself but any epistaxis requires medical help if it persists after 15 or 20 minutes, if nosebleeds are frequent, if the blood drains into the throat or neck or head injury is suspected. The best way to stop the bleeding is to sit leaning forward pinching the nose above the nostrils with the fingers and breathing through the mouth.
The facial nerve controls the muscles on the sides of the face, allowing us to smile, wink, cry, frown and make many other facial expressions. The facial nerve also helps us to control our facial movements when eating, drinking and speaking. There are two facial nerves – one on each side of the face which travels around the middle ear, exiting at the skull base and branching from the parotid gland. These branches allow motor function for all of the different facial muscles.
Damage to the facial nerve can result from:
Facial nerve disorders can result in the following symptoms:
Symptoms will depend on the severity of damage caused to the facial nerve.
If a patient is experiencing symptoms of facial nerve damage, tests will be run to determine the underlying cause, so that the correct treatment can be given.
The following tests may be used:
Depending on the cause, the following are potential treatments for the symptoms of facial nerve disorders:
Fibroscopy is an endoscopic examination used especially in otorhinolaryngology. A flexible fibre-optic instrument connected to a cold light source, a camera and a monitor are used to directly examine the cavities of the body.
Fibroscopy involves introducing a camera with a light source into the cavities to be examined and is used especially for the respiratory tract (nose and mucous membranes, and throat). With the fibrescope connected to a camera, the specialist will be able to illuminate, examine and see the inside of the nose, pharynx and larynx in order to make a more precise diagnosis.
In otorhinolaryngology, fibroscopy is used to examine the nose, rhinopharynx, nasopharynx, hypopharynx, and larynx. This allows for a more accurate diagnosis. The technique has a specific name depending on the area to be examined. Thus, a nasal examination with fibroscopy is called nasofibroscopy; examination of the larynx, fibrolaryngoscopy; and examination of the entire upper airway is called nasofibrolaryngoscopy.
Specifically, it is used for people with throat, nose or ear problems. Fibroscopy is frequently performed for the diagnosis of sinusitis, stuffy nose, sleep apnoea, tumours, nasal polyps, deviated nasal septum, dysphonia, nodules, polyps, vocal cord cysts or tumours, and gastroesophageal reflux.
Less common applications include examination of the glottis and trachea and the main bronchi in people with a tracheostomy cannula.
In principle, no special preparation is necessary before undergoing fibroscopy. If you have a particularly sensitive gag reflex, the specialist will apply some topical anaesthetic spray (though this is not usually necessary).
Fibroscopy causes a small amount of discomfort because the fibre rubs slightly against the nasal or pharyngeal mucosa. In most cases it is tolerated and can be performed without anaesthetic. It does not cause choking and doesn’t usually cause nausea. However, if the area is sensitive or if you have a severe gag reflex, some anaesthetic spray may be required.
Fibroscopy can be used to diagnose respiratory tract dysfunctions or pathologies. Based on the results, the specialist performing the examination will consider the best treatment. As this examination is highly precise, it allows the specialist to clearly identify any problems with the throat, nose, larynx or pharynx.
Functional rhinoplasty, sometimes known as septoplasty, is the operation of the nose designed to correct functional aspects of the nose. In contrast, a standard rhinoplasty is focused on improving the appearance of the nose. An operation to both improve the nose’s appearance and its function is known as a septorhinoplasty.
A functional rhinoplasty can be done under local or general anaesthesia, depending on the area to be treated.
A functional rhinoplasty aims to restore breathing through the nose which may be resulting in sleep apnoea, pressure headaches, or a reduced sense of smell. This may be due to structural problems such as:
A functional rhinoplasty is also carried out in patients whose blockage is caused by inflammation of the sinuses or an upper airway infection, where their breathing has not been improved through conservative treatment.
There are different kinds of functional rhinoplasty depending on what is causing the problem. A surgeon may need to operate on:
Before surgery, you will meet with the specialist to inform them about your medical history and about any medication, herbs or drugs without a prescription you is taking. You may have to stop taking any drug that makes it hard for blood to clot. You will not be able to eat or drink anything from the midnight on the night before surgery.
After the operation you will usually be able to go home the same day. The doctor can cover both sides of the nose with cotton or fluffy materials to prevent nosebleeds. Normally, these plugs are removed after a day or a day and a half. Swelling and drainage may appear for a few days at the beginning, and you may be prescribed painkillers to take in the weeks after the operation.
This condition is caused when the middle ear fills with fluid, usually mucus. It can cause hearing impairment and usually clears up by itself, but may need treatment if it goes on for longer than three months after which grommets can be placed to aid the drainage. It's a common cause of temporary deafness in children, and factors like infection, parents smoking and being formula fed as a baby have been linked to this condition.
Halitosis is a common problem characterised by an unpleasant odour on the patient’s breath. Normally, halitosis is caused by poor oral hygiene, with bacteria breaking down pieces of food trapped in the teeth and releasing foul-smelling gases. Halitosis can affect the patient psychologically, due to the stigma of bad breath, and can lead to problems in their social life.
In most cases, the causes of bad breath are oral in nature. In some cases, the smell may originate from the nose, sinuses, throat, lungs, oesophagus, or stomach. Some common causes are:
Halitosis can be prevented with good oral hygiene:
You should also book periodic check-ups with a dentist to ensure that your teeth and gums are healthy.
In most cases, improving oral hygiene is enough to eliminate bad breath, brushing your teeth and gums, flossing and cleaning your tongue as a daily routine.
Cutting down on or avoiding tobacco, alcohol or certain foods and drinks such as coffee may also be recommended.
If the halitosis is a consequence of a different pathology, such as gastro-oesophageal reflux disease or a H. pylori infection, you may be referred to a relevant specialist to deal with the cause.
Head and neck cancer can refer to a number of different types of tumours in various parts of the head and neck, including the mouth, lips, larynx (voice box), pharynx (throat), salivary glands, nose, and sinuses.
Cancer is a disease in which a group of cells in the body malfunction and multiply uncontrollably, forming a mass. This mass of abnormal cell growth is known as a malignant tumour. Cancerous cells continue to grow and divide, avoid programmed cell death, and replace normal, healthy cells, with a tendency to spread and invade other tissues.
Head and neck cancer is relatively uncommon, with around 10,000 cases diagnosed in the UK each year.
Types of head and neck cancer include:
They symptoms depend on the type and location of the cancer. Possible symptoms include:
Like all cancers, head and neck cancers can be fatal if left untreated or treated too late. However, many treatments exist to combat cancer, and curing it is possible in many cases.
Some risk factors vary depending on the type and location of cancer, but smoking and excessive consumption of alcohol are risk factors for most types of head and neck cancer. Exposure to harmful substances, infection with HIV, family history, and gender can also be factors.
The biggest risk factor for head and neck cancer is tobacco consumption. Consuming a lot of alcohol regularly also increases the risk. By cutting down on these, or by stopping smoking and drinking altogether, you can lower your risk of developing cancer. However, there is no 100% guarantee.
The type of treatment recommended depends greatly on the type and location of the cancer, but some of the usual options for cancer treatment include:
These treatments are often used in tandem to give the patient the greatest chance of eradicating the cancer with the least possible damage to their body.
A number of specialists may be involved in diagnosing and treating head and neck cancer. Oncologists specialist in treating cancer, while ENT surgeons and oral and maxillofacial surgeons may be brought in to operate on the patient, depending on the location of the tumour.
Hearing loss is a reduction in hearing sensitivity affecting one or both ears. It can be classified by type and degree.
There are three main types of hearing loss:
The different degrees of hearing loss are as follows:
Some of the most common symptoms are:
Other symptoms may include:
Causes of hearing loss include:
Prevention is based on avoiding risk factors as much as possible. However, prevention is not possible for hearing loss of a genetic origin. In general, it is important to avoid exposure to high volumes and to use protective gear if you work in such an environment where noise is the norm.
Treatment depends on the degree of hearing loss. The conventional treatment for mild or moderate hearing loss is a hearing aid. In cases of profound hearing loss, a bone-anchored hearing aid may be implanted; this device transmits sound via the cranium to the affected ear.
Hoarseness is when the voice becomes raspy and strained, and can be accompanied by a sore throat. It can follow an illness like viral laryngitis or can be caused by overuse of the voice through singing or shouting. If it lasts longer than six weeks it could be chronic and need further investigation.
Mouth cancer is the most common type of head and neck cancer. It can affect:
Symptoms of mouth cancer include:
Tobacco and alcohol consumption increases the risk of developing mouth cancer, as does infection with HIV.
For a suspicious-looking mouth wound that has not healed in a couple of weeks, the doctor should be consulted to examine the lesion.
Early detection is essential for the treatment of mouth cancer. Treatment may involve radiotherapy, chemotherapy, surgery, or a combination of the three. Some patients require reconstructive surgery to restore the affected area to its normal functionality and appearance afterwards.
Nose and sinus cancer is a type of head and neck cancer concentrated in the nasal passages and sinuses.
This rare type of cancer has symptoms similar to that of the common cold or flu, which can make it difficult to spot. These symptoms include:
Later stage symptoms can include the following:
The symptoms tend to be long-lasting, rather than disappearing after a few days like a cold.
There are certain risk factors for nasal cancer, including:
Diagnostic methods are usually biopsy and various imaging tests (radiology, CT scan). A nasal endoscopy will be performed to examine the inner structures of your nose. This can be a bit uncomfortable, but local anaesthetic spray can be given to make this less uncomfortable.
Treatment is based on surgical removal and associated radiotherapy. Microsurgery to reconstruct the areas and restore the functionality and appearance of the organ to the patient may be required depending on the extent of the surgery.
A nasal endoscopy is a multifunctional exploratory procedure performed at the otorhinolaryngologist’s clinic to examine the nose, neck and larynx. It is carried out using a flexible fibre-optic instrument with a cold light source, a camera and a monitor. This allows for an easy and direct exploration of cavities in the body that are normally difficult to see.
A nasal endoscopy is performed using a flexible fibre optic tube which is inserted through the nose. The procedure lasts approximately three minutes and is performed at the clinic. Local anaesthetic may or may not be used, depending on the case.
It is performed to diagnose respiratory tract pathologies or dysfunctions. The procedure allows images and video to be obtained, which is useful for explaining to the person the nature of their pathology. It also allows the specialist to keep a visual record, which helps them evaluate the pathology and its evolution over time, and the effectiveness of the applied treatments.
No prior preparation is required. You only need to follow the specialist’s instructions and they will indicate any procedures that need to follow. Only in some cases will local anaesthetic be applied to the nostril through which the fibrescope is inserted (deviation of the nasal septum or a nasal pathology).
It can be a bit uncomfortable, because a foreign body being inserted into your nose. So, a little anaesthetic may be necessary in some cases.
This is a quick and effective technique for detecting pathologies or dysfunctions in these structures. Any abnormality can be easily spotted and subsequently treated by the specialist.
Nasal polyps are semi-transparent growths that can form in any part of the sino-nasal mucosa. These are benign, but they may grow to the extent that they obstruct the nasal cavities. This condition is also called polypoid sinusitis. The polyps can develop at different sites in the cavities, but usually new ones develop further inwards, on the roof and sides of the nasal cavities.
Symptoms of nasal polyps vary according to their size. Initially, sense of smell and taste may be muted, which can then be accompanied by partial or complete nasal obstruction. You may also experience a sensation of constant mucus, which does not improve even when you blow your nose.
The presence of multiple or very large polyps may cause:
The causes of nasal polyps are not fully understood, but we know that it has to do with inflammation of the mucous membrane of the nose and sinuses. It is thought that people who develop nasal polyps might have a different immune system response or differences in the chemical build-up of their mucous membrane. There are also suggested links with infection, severe untreated allergies, asthma, and cystic fibrosis. Polyps can develop at any age, though they are more common in young and middle-aged people.
Prevention consists of treating diseases like allergy or asthma and following the required treatments. In addition, it is important to avoid nasal irritations and to practice good hygiene via nasal washes. It may also be helpful to use a humidifier at home to moisturise the nasal cavities. If the problem is an allergy, use of antihistamines, nasal aerosols and/or an anti-allergy vaccination may help to prevent nasal polyps.
Medical treatment is recommended according to the grade of the polyps. It may consist of a topical corticosteroid, an oral corticosteroid and/or antibiotics if there is sign of infection. If there is no response to treatment, a surgical treatment is recommended; this consists of removal of the nasal polyps and opening of the paranasal sinuses using endoscopic techniques.
The nose has two cavities which are separated by a septum. This is made from both bone and cartilage and is responsible for separating the nasal cavities and channelling airflow into the nose. A perforated septum described when a hole develops in the septum, which depending on the size of the hole can cause mild to extreme symptoms.
Some people with a perforated nasal septum won’t experience any symptoms, however, more severe perforations can result in more severe and debilitating symptoms. With the right treatment, a perforated septum can be fixed.
The main feature of a perforated nasal septum is a hole in the septum which can vary in size (less than 1cm to more than 2cm). Sometimes you might not be aware of a perforated nasal septum, especially if you haven’t experienced any symptoms.
Symptoms can include:
If you suspect you may have a perforated nasal symptom, you should visit your doctor. They will examine your nose and ask for a medical history. Certain tests to better examine the perforation include a nasal endoscopy or a rhinoscopy.
There are numerous potential causes of a perforated nasal septum, including:
You can reduce your risk of getting a perforated nasal septum by:
Treatment will first attempt to treat the underlying cause. There are several non-surgical measures that will also be used, including antibiotic cream, irrigating the nose with saline spray and using a dehumidifier at home. Your doctor may also recommend a prosthesis to block the hole in the septum. These can help to reduce the symptoms. In some cases, surgery will be needed to repair the hole. This is fairly complex and will be performed under general anaesthesia as tissue may be taken from your ears or ribs to fill the hole.
An otolaryngologist (ENT) surgeon would treat a perforated nasal septum.
Nasal injuries are injuries to the nose.
Neck lumps are extremely common and in the vast majority of cases are benign. They can be found anywhere on the next and may be soft or hard, asymptomatic or painful and tender to the touch.
Neck lumps have many possible causes, so a diagnosis will be made on both the features of the neck lump itself and any associated symptoms.
Neck lumps can often appear on their own with no symptoms.
Most commonly, neck lumps are the result of a swollen lymph node. Lymph nodes are found all over your neck and are part of your immune system. They often swell when you are fighting off a disease or infection, so in most cases a neck lump will occur at the same as other symptoms of the illness you have, and disappear again once you have recovered. You won’t generally need to see a doctor to treat the lump.
However, you should seek medical help as soon as you can if you notice the following symptoms:
You doctor will start by asking how long you have had the neck lump for and how quickly it appeared. They will ask specifically about the symptoms listed above.
Next the doctor will examine your neck to check its size, how soft or hard it is, and whether any other lumps can be detected. Depending on what the doctor suspects is causing your condition, they might examine your ears, lungs, or throat.
You might then be referred for tests, such as blood tests or imaging to see the tissues in your neck.
As already mentioned, the main cause of neck lumps is a swelling in a lymph node in response to illness, from the common cold and ear infections to chickenpox, herpes, and HIV.
Other causes of neck lumps include:
Treatment of neck lumps depends on the cause. For example, thyroid problems can often be tackled with hormone treatment, whereas skin tumours or lipomas are likely to require surgery. You will be referred to the appropriate specialist as part of the diagnostic process.
The nose is the part of our face which sticks out above the mouth, and through which we breathe and smell. The nose houses the nostrils, which help us to take in and expel air as part of the respiratory system (along with the mouth). Our nose plays an important role in our overall health, as it filters the air that we breathe and removes dust and irritants. It contains nerve cells which help our sense of smell, and also helps warm the air coming in through it in order to keep the lungs and throat from drying out. Therefore, if there is a problem with our nose, our health can be affected.
There are many conditions and medical problems which can affect the nose, including:
Ear, nose and throat problems, if passed to a specialist, are typically treated by an otolaryngologist, more commonly known in the UK as an ENT doctor (ear, nose and throat). However, it depends on the pathology affecting the patient, as allergic problems may also be treated by a specialist allergist.
Cosmetic procedures affecting the nose such as rhinoplasty may be performed by a plastic surgeon, though it is advisable to visit a specialist facial plastic surgeon (often an ENT doctor, but sometimes an oral and maxillofacial specialist) as they have a thorough knowledge of the nose, its anatomy, and the conditions affecting it.
ENT surgeons can also correct problems with the nose which are non-cosmetic and related to breathing/respiratory difficulties, such as a deviated septum.
Orbital cellulitis is an acute infection of the tissues surrounding the eyes, specifically the eyelids and eyebrows that can spread to the cheeks.
Symptoms can include:
Your doctor will diagnose the condition with a simple physical exam and take a look at your medical history. If eye pain and vision problems are present, your doctor may perform a blood test. Sometimes a CT scan or MRI scan will be used to get a clearer picture of the eye and the inflammation.
This condition is usually the result of a sinus infection which spreads to the eyes, eyelids and areas surrounding the eyes, like the brows and cheeks. Bacterial infection, that might occur after an injury or an insect bite can also lead to orbital cellulitis. Children are more likely to be infected in comparison to adults. The bacteria that most commonly causes orbital cellulitis are:
Hib (Haemophilus influenza type B) vaccines can prevent Haemophilus influenza type B infection in children and prevent this from causing orbital cellulitis. It is also possible that children who share a family group with someone who has this infection have to take antibiotics to avoid becoming infected.
On the other hand, adequate treatment of a sinus infection or a dental infection can prevent bacteria from spreading to the eyes and causing cellulitis of the eyelids and tissues around the eyes.
It is essential to treat orbital cellulitis adequately so that it does not cause damage that can persist into adulthood. Most cases will require hospitalization. Antibiotics will be given intravenously through a vein in the arm.
Surgery may also be needed to drain the abscess or relieve pressure around the eyes. Orbital cellulitis should be treated rapidly to avoid complications or loss of vision.
Otitis is also known as an ear infection and occurs when there is a bacterial or viral infection within the ear. Ear infections can be acute, lasting a short duration, or chronic with frequent occurrence. Otitis can affect the internal or external parts of the ear. Ear infections are common in children.
These are the different types of otitis:
The most frequent symptoms of otitis are:
Common causes of otitis are:
There are a few preventative measures that can be taken to avoid ear infections, including:
Mild ear infections will usually go away without intervention, and relieving symptoms with painkillers and warm cloths to the ear will suffice. If the infection is more severe, antibiotic medicine or eardrops can be prescribed.
ENT is a medical subspeciality that deals with the prevention, diagnosis, and treatment of conditions that affect the ear, nose, and throat in children.
There are some disorders that almost uniquely affect children. The most commonly treated conditions within paediatric ENT are:
Seromucinous otitis, also known as glue ear, is the most common reason for hospital admission for an operation and the most common cause of hearing loss or deafness in children.
Issues with the tonsils are also a very common reason for appointments within paediatric ENT. The tonsils are located at the back of the throat and they are the first line of defence against potential infections.
Hearing loss is also very common in children. It can be more difficult to study and treat in children due to their inability to communicate their symptoms in the same way an adult could.
Paediatric ENT uses other medical specialities to treat each issue, they include:
It is advisable to see an ENT specialist when a child has:
There are three main pairs of salivary glands that produce and release saliva into the mouth: the submandibular glands, the sublingual salivary glands and the parotid glands. The parotid glands are responsible for secreting saliva into the mouth to start the process of digestion.
Parotid gland surgery, also known as a parotidectomy, is an operation to remove tumours that grow in the parotid gland. It is estimated that more than 70% of these tumours are benign (non-cancerous), but any lumps detected should be analysed.
There are different variations of this surgery, which are performed according to the type, size and location of the tumour. The most common interventions are superficial parotidectomy and total parotidectomy. A key part of these procedures is to preserve the facial nerve to avoid complications of facial paralysis.
The salivary glands may also be affected by other pathologies, the most common of which are:
The parotid is a soft gland, not very palpable under normal conditions, that occupies the space between the jaw and ears. When the parotid is removed, it leaves a hollow area between the jaw and the sternocleidomastoid muscle that may be quite evident.
To resolve this problem, once the gland has been removed, we reconstruct the defect with an SMAS flap. This consists of covering over the area by tightening the fascia that covers the parotid gland and the platysma muscle of the neck. This technique can be used in most cases, except in patients with malignant tumours.
The incision typically made in this procedure leaves a visible scar on the neck. However, there is another, more aesthetic, type of incision. This is made behind the ear, hidden in the hair, and is practically invisible after a few months.
This happens when the top part of the gullet does not relax when swallowing, the pressure causes a small hernia over time.This can cause a chronic cough, or get larger and fill up with fluids, causing infection.
Pharyngitis, or a sore throat, is the inflammation of the pharynx, which is located between the tonsils and the larynx, at the back of the mouth. It is characterised by a scratchy feeling and difficulty swallowing. Pharyngitis usually subsides within a week and is caused by a viral or bacterial infection. It causes a sore throat, fever, a rash, redness of the pharynx, swollen lymph nodes, a headache and difficulty swallowing.
Most cases tend to occur during the colder months. The condition is contagious and often spreads among family members and close contacts.
A sore throat is the main symptom of pharyngitis. Other symptoms include:
Pharyngitis is caused either a virus or bacteria, such as:
The following are risk factors for developing pharyngitis:
To prevent pharyngitis, you should avoid contact with those already infected. Some measures include:
If the cause of the pharyngitis is viral, then home care is the main treatment. It is important to stay hydrated, eat well, gargle with warm, salty water and get lots of rest. Throat lozenges and over-the-counter painkillers can also help relieve any pain or discomfort.
If it is caused by a bacterial infection, antibiotics can be prescribed, commonly amoxicillin and penicillin.
Phonosurgery is undertaken to restore, change or improve the voice. It can be in the form of injections, microsurgery or open surgery. The reasons may be due to disease damage, misuse of the voice, or part of the gender reassignment process.
Radiofrequency turbinate reduction surgery involves the application of high-frequency radio waves which cut through nasal tissue in a controlled way, reducing the turbinates to improve air flow. The waves are applied directly to the targeted tissue using cold electrodes. At the start of the procedure, a thin radiofrequency probe is inserted through the nostrils.
Radiofrequency nasal surgery is performed to reduce the size of the turbinates and to make breathing better and easier. Turbinates are small structures within the nose that are responsible for cleaning and humidifying the air that passes through the nostrils. If they become inflamed and swollen, either by infection, allergies or irritation, they produce mucous, causing congestion.
The procedure is performed under local anaesthesia and usually lasts between 5 to 15 minutes. A needle-like probe is inserted through the nostrils, which then transmits energy to the targeted tissues. The surgery is performed under local anaesthesia and usually lasts between 5 to 15 minutes. The radiofrequency energy helps to reduce the size of the turbinates without harming the nasal mucosa. No scarring is caused by this procedure.
You should speak with your specialist about which medications you can take before the procedure. You may have to stop taking certain medications, such as anti-inflammatories or anticoagulants.
Post-operative care is fast and straightforward; you will have to perform nasal washes with saline, to promote healing and to clean the treated area. Also, in the first few days after the procedure, you should avoid physical exercise, intense heat and aspirin. Nasal scabs will probably form in the first few weeks.
Rhinitis is a condition where the nasal mucosa becomes inflamed. The nasal mucosa is the lining of the inside of the nose. This is a common condition and is thought to affect one in every five people in the UK. Rhinitis can be triggered by allergies, which is called allergic rhinitis (e.g. hay fever). Rhinitis can be acute or it can be chronic (long-lasting).
The main symptoms are sneezing, an itchy nose, itchy eyes, an itchy throat, a lack of smell and a blocked nose with nasal discharge. Due to nasal congestion, the patient cannot breathe freely or easily.
The symptoms occur mostly in the morning. This can be confused with a simple cold, but a cold will resolve in around two weeks, whereas rhinitis persists.
There are several causes of rhinitis. Rhinitis can be classified into three main groups:
For allergic rhinitis, it is difficult to completely avoid the triggering allergens, however, attempts can be made to reduce exposure, such as avoiding leaving the house early in the morning when pollen is at its worst and keeping the windows closed.
Other treatment measures include:
Robotic head and neck surgery is one of the latest technological advances in surgery. This novel technology helps overcome restrictions present with conventional surgical techniques. Surgery is not performed by a robot but by the surgeon using robotic technology. Robotic surgery permits access to small spaces and removes all natural hand tremor. It permits precision surgery in real time using a 3D visual field.
The main salivary glands, those that generate and empty saliva in the mouth, consistent of three pairs:
Salivary gland surgery is responsible for removing any of these glands. Anaesthesia during the procedure will depend on the gland that is removed: if it is from major salivary glands, such as the parotid gland, the procedure involves general anaesthesia, whereas if it is of minor salivary glands, local anaesthesia will be used.
Salivary gland surgery is usually performed to remove tumours that grow in these glands and analyse them. It is estimated that more than 70% of these tumours are benign (non-cancerous), but any lump that is detected must be analysed.
The salivary glands can also present other pathologies, including:
There are several surgical techniques depending on the gland that needs intervention:
In all surgeries, the area is closed with sutures once the affected tissue is removed. In some cases, it may be necessary to put temporary drains to remove fluids, such as saliva or blood.
Before the intervention, the specialist can perform a physical examination and talk about what medications can be taken beforehand and which ones cannot.
After the procedure, the specialist observes the facial movements of the patient, asking them to smile or make facial gestures. Once at home, it is important to follow the doctor's instructions about wound care and drainage. The patient may also return to the clinic to remove the sutures. Once removed, the patient has to wash the area with mild soap and water.
A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse.
Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease.
In addition, there are certain situations where a second medical opinion is sought after:
The aims of obtaining a second medical opinion are:
Possible disadvantages of seeking a second medical opinion include:
You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion.
Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals.
Septoplasty is a corrective surgical procedure done to straighten the nasal septum, eliminating any congenital or trauma-induced deviations.
Such deviations represent an obstruction which makes breathing harder.
During the procedure, the surgeon may also resect your turbinates (if they are hypertrophic). Sometimes the procedure may involve an aesthetic intervention on your nose, thus becoming a rhynoseptoplasty.
Your ENT specialist may suggest surgery if you have trouble breathing due to a deviated septum.
Should there be a severely deviated septum, the surgeon may have to remove the septum completely, straighten it and then insert it back. In other cases, the surgery can be done internally from your nose, passing through the nostrils.
During the surgery, the cartilage segments (and sometimes small bone fractions) causing the deviation are removed.
First of all, you’ll need to go through your medical history with your doctor.
The doctor will also check your general state of health and study the shape of your nose.
If you smoke, you’ll need to stop before the procedure. You will also have to avoid taking any non-steroidal anti-inflammatory drugs (NSAIDs) two weeks before and two weeks after the procedure.
After the surgery, you’ll need to go back to the hospital twice (one week apart from each visit) to check on and replace the dressing, to monitor your recovery and to remove any potential adhesions.
Spraying a hyaluronic acid mist on your face can help with the scarring and tissues healing.
One week after the procedure, the bones and cartilage should be completely healed. After two weeks your nose won't be as swollen and the mucosa will have healed as well.
If you have a mild deviation, laser surgery can be a good option. In this case, the deviated septum is straightened with laser septoplasty.
This technique can be helpful for straightening the septum without causing you any pain (neither before nor after it), with much less bleeding and an easier healing process.
Sinusitis is a condition characterised by inflammation of the paranasal sinuses which are the cavities located behind the forehead, cheeks and eyes. It occurs as a result of infection by viruses, fungi or bacteria.
There are two types of sinusitis:
The main symptoms of sinusitis are:
The cause of sinusitis is an infection caused by viruses, fungi or bacteria. When the paranasal openings are blocked, bacteria or other microorganisms can easily grow.
Obstruction of the paranasal openings may be due to:
The best way to prevent sinusitis is to avoid coming down with a cold. If you cannot avoid them, it is important to treat them quickly. Some tips to prevent sinusitis are:
In general, sinusitis heals on its own and self-care can manage the discomfort, however, if it persists antibiotics can be prescribed.
Some self-care techniques include:
If the symptoms do not disappear with the treatment, it may become necessary to perform surgery to enlarge the opening and to drain the sinuses.
Sleep apnoea is the interruption of breathing that occurs moments after falling asleep, preceded by a period of loud snoring for at least 10 seconds. If this process is repeated 5 times for each hour of sleep it is called Obstructive Sleep Apnoea Syndrome. Obstruction of breathing causes a decrease in oxygen levels in the body that makes it difficult for the person to have a restful sleep and causes tiredness the next morning. In addition, the persistence of this lack of oxygen could lead to pulmonary hypertension and future right-sided heart failure or myocarditis, so it is important to detect it early and perform relevant tests for a safe diagnosis. A sleep study is carried out to establish treatment that includes the change of some lifestyle habits (diet, abstention from alcohol, postural changes) and the prescription of a CPAP machine, which generates air pressure via a nasal mask. This stops respiratory obstruction, preventing snoring and favouring restful sleep. In some cases, surgery may be required if there are any airway scars or when the mask is not effective.
Snoring and obstructive sleep apnoea are disorders characterised by temporary upper airway occlusion at the pharynx level during sleep. This causes problems with sleep, fatigue and breathing, and other related problems.
As well as snoring, in more severe cases breathing may stop (sleep apnoea) for more than 10 seconds, resulting in episodes of sleep disturbances throughout the night. These episodes cause oxygen deficiency in the brain, which increases the risk of cardiovascular problems, diabetes or stroke. The affected person may also suffer from drowsiness, general tiredness or depression, and may suffer from impaired concentration and professional and personal performance.
The most common causes of snoring and sleep apnoea are obesity, nasal obstruction (polyps, deviated septum), an elongated soft palate, and hypothyroidism, among others. The common denominator in all situations is that there is a permanent or functional narrowing, which can have its origin at various levels of the upper airway. This produces an intense vibration on the walls of the pharynx, which transforms into the sound we perceive as snoring.
It is difficult to prevent snoring but steps can be taken to improve it. For example:
Treatment can be based on weight loss, changing lifestyle habits, and giving up smoking and drinking. You can also use a nasal mask that provides air pressure controlled by a mechanical device (CPAP), or you can have surgery.
Surgery may be helpful for anatomical abnormalities such as a deviated nasal septum or thickening of the uvula and soft palate. Non-invasive surgical techniques performed under local anaesthetic have been used for years now and they offer rapid postoperative recovery. Another non-invasive alternative is a mandibular advancement device. This is a kind of "dental sleeve" that you wear when sleeping. It moves the lower jaw forward of the upper jaw, thus widening the retrolingual area. It helps prevent snoring and sleep apnoea, is simple to use and has an easy adaptation process.
Surgical oncology is a branch of surgery focussing on the surgical management of tumours, in particular malignant (cancerous) tumours.
While the term is frequently used, surgical oncology is not recognised as a specialty by the GMC (General Medical Council); rather, it is a term encompassing a number of disciplines across several specialties, for example, an otolaryngologist with a sub-specialty interest in the surgical treatment of head and neck cancer could be said to be a specialist in surgical oncology, as could a gynaecologic oncologist.
Because of the varying natures and locations of different cancers, it is virtually impossible for one surgeon to specialise in surgery for every kind of tumour; however, surgeons of any specialty who are thoroughly involved in performing operations to treat cancer/tumours may consider themselves surgical oncologists.
Cells in just about every part of the body have the potential to mutate and become cancerous or form tumours. For this reason, surgical oncology covers a myriad of conditions. It is common for the surgeon to specialise in treating illnesses of the specific part of the body, with surgical oncology as a sub-specialty, as oppose to specialising in all types of cancer.
Conditions that fall under the category of surgical oncology include:
Surgical oncology essentially involves cutting the tumour or cancer out of the patient in a very delicate operation. Once the only option for curing a patient of cancer, the last century has seen the arrival of two sister branches of cancer care: medical oncology and radiation oncology. With many cancers, medication and radiation is not enough, and they are used in conjunction with surgery. Because of the advances in modern cancer care and cancer research, surgical oncology has also evolved, with the oncological surgeon now typically leading multi-disciplinary teams, collaborating with radiation oncologists, medical oncologists, radiologists, and others to counter the cancer in the most effective way possible. They must have a complete understanding of the biology and history of the disease.
While it is not currently recognised as a specialty in the UK (or in many other countries), there is some debate as to whether it should be. While some argue that no surgeon can truly specialise in every type of cancer, other propose that due to the expertise involved, and the importance of understanding the multi-disciplinary approach to treating cancer, there should be a specialist ‘surgical oncology’ accreditation. The European Society of Surgical Oncology is one such proponent of the latter, arguing that having such accreditation standardised would raise cancer care standards across Europe.
Currently, there are a number of fellowships available for surgeons looking to get specialist training in surgical oncology.
Throat cancer, also known as pharyngeal cancer, is a form of cancer characterised by the presence of malignant tumour cells in the throat. There are various types of pharyngeal cancer, which include:
There are also another two types of throat cancer:
The symptoms of pharyngeal cancer depend on the location and extent of the tumours, but in all cases a lump (nodule) may appear in the neck. Some common signs and symptoms can include:
Pharyngeal cancer, like all types of cancer, is caused by abnormal cell mutation and its reproduction. There are certain risk factors that can increase the chances of this type of cancer developing:
Specialists recommend quitting smoking. It is also advisable to reduce the consumption of alcohol and follow a healthy lifestyle, which consists of eating properly and doing physical exercise on a regular basis. It is also advised to reduce the risk of HPV, by having safe sex and using protection.
Treatment for throat cancer varies according to the type of throat cancer present. If the tumour is located in the nasopharynx, chemotherapy and radiotherapy sessions are recommended; for tumours of the oropharynx and hypopharynx, the patient will undergo surgical intervention if the tumour is small; and finally, the lumps of the neck can be removed with surgery, which will be accompanied by chemotherapy and radiotherapy. In some cases, a portion of the voice box will have to be removed surgically in a procedure called a laryngectomy.
If diagnosed early enough, throat cancer has a good survival rate, however, if diagnosed in later stages when the cancer has likely metastasised to other parts of the body, treatment focuses on prolonging life and slowing the progression of the cancer.
Cancers of the throat and larynx are types of head and neck cancer. Depending on the location, the cancer can be classified as supraglottic tumour (above the glottis), glottic tumour or subglottic tumour (below the glottis).
The larynx, or voicebox, is an important part of the throat that helps us to speak and breathe. Laryngeal cancer comes in the form of malignant tumours that affects the cells of the larynx where the vocal cords are located.
Symptoms of laryngeal cancer include:
Throat cancer or oropharyngeal cancer tends to start behind the nose in the part of the throat that helps you swallow.
Symptoms of Oropharyngeal cancer include:
Smoking tobacco, drinking a lot of alcohol, an unhealthy diet, and exposure to harmful chemicals or substances like coal dust or asbestos increase the risk of laryngeal cancer. It also seems to run in families with a history of head and neck cancer.
Early detection of the disease is essential to increase the life expectancy of patients. The treatment is based on removing the tumour, while avoiding its spread to other parts of the body. Depending on the case, surgery may involve partial or total removal of the vocal cords, and treatment with radiotherapy and chemotherapy.
Thyroplasty is a surgical procedure that is performed for vocal cord paralysis. It is used to improve a patient’s voice and ability to cough. The procedure alters the thyroid cartilage of the larynx (the voice box) which houses the vocal cords, in order to change the length or position of the cords.
Vocal cords are found at the entrance of the trachea. Normally, the vocal cords are in an open position when at rest to allow breathing. When speaking the vocal cords close off and vibrate. When the vocal cords are paralysed there is a weakness in at least one of the cords that causes hoarseness and even slight choking.
Treatment depends on the cause. Speech therapy is the primary treatment but if this does not help then vocal fold injections, such as fat or collagen, can add some bulk to the vocal cord. If the vocal cord is completely paralysed then the surgical procedure thyroplasty is performed.
The short procedure is performed under local anaesthesia and using intravenous sedation so that the surgeon can check the patient’s voice throughout the process. A small hole is made in the neck area of the voice box and the thyroid cartilage is removed to provide access to the vocal cords. An implant is positioned near the vocal cord, which pushes the vocal cord closer to the middle section. Once in place, a fibre optic scope is inserted, which allows the surgeon to view the larynx and check that the implant is in the correct position. The patient may then be asked to speak during the laryngoscopy to enable the surgeon to check the movement of the vocal cords.
The procedure is generally safe but, as with all operations, complications can still arise. This includes:
• Poor voice quality (hoarseness) – worsening of the voice is rare
• Difficulty breathing – swelling after surgery
• Implant migration – there have been reports of migration into the airway or neck
• Bleeding – this is rare but typically stops on its own
• Infection – this is treated with antibiotics or surgery in rare cases
• Pain in the neck – which is common after surgery
Tinnitus refers to the hearing of noises that are not caused by an external source. Often heard has a ringing or buzzing sound, these may be heard temporarily or chronically. Often, these noises are accentuated when there is absolute silence. Tinnitus is not a condition in itself, but a symptom of an underlying condition.
In addition to hearing the buzzing, ringing sounds, tinnitus can cause difficulty sleeping and concentrating. As a result, it can sometimes put a strain on someone’s psychological well-being and personal relationships, particularly if it is chronic.
Tinnitus is not a disease, but a symptom of other ear pathologies, such as hearing loss. Therefore, the causes that can trigger it are multiple. Common causes include:
To prevent tinnitus, it is best to keep the ear clean and free of wax. It is also important to avoid caffeine, smoking, alcohol and excessive salt intake. It is also important to avoid noisy environments. People with cardiovascular problems are at a higher risk of developing tinnitus, so ensuring you maintain a healthy blood pressure and eat a healthy diet are important.
Treatment will depend on the underlying cause and treating this is the first step. Often this will involve either removing excessive earwax, changing your medications for other conditions or treating a blood vessel problem. If these do not help, then there are other therapies that can help you overcome the irritation caused by the tinnitus. For example, noise suppression training involves using special devices to suppress noise (e.g. white noise machines, tinnitus retraining devices or masking devices).
In addition, managing stress, and removing irritants (e.g. alcohol, caffeine and cigarettes) can help too.
Tonsillitis is an inflammation of the tonsils that are located at the back of the throat. It is very common in children and adolescents, but adults can suffer from tonsillitis too.
If you have tonsillitis, your tonsils will be red and swollen. You will also have a combination of the following symptoms:
Tonsillitis is caused by a viruses or bacterial infection. Streptococcal tonsillitis is the most common cause. The tonsils are vulnerable to infection because they are one of the body’s first lines of defence in the immune system.
Tonsillitis can be prevented by practising good hygiene:
If your tonsillitis is caused by a virus, then at-home care is the only treatment for recovery. The following can be used to promote a quicker, more comfortable recovery:
If your tonsillitis is caused by a bacterial infection, then you will be prescribed a course of antibiotics. These must be taken as instructed, and the full course finished.
People who suffer from tonsillitis frequently are advised to have the tonsils removed.
If an abscess forms between the tonsils (this is called a quinsy), see a doctor, as this may need to be drained.
Tracheal stenosis refers to a narrowing of the trachea, more commonly referred to as the windpipe. It occurs as a result of the formation of scar tissue in the trachea, or due a malformation of the cartilage in the trachea. The narrowing, if mild in nature, may not be noticed, but if the narrowing becomes more severe (over 50% of the airway) then complications are likely to occur.
Tracheal stenosis has three main causes:
Other causes include congenital malformations, infections in the trachea, trauma to the trachea, radiotherapy, cancer, and certain inflammatory diseases such as sarcoidosis.
If stenosis is mild, and is congenital (e.g from birth) then symptoms may not be identifiable or obvious until later in life. They can, however, be similar to those of asthma or bronchitis. You may notice wheezing while inhaling, and in more serious cases, the following symptoms may present:
If the stenosis is caused by injury to the trachea, these symptoms may not present until several weeks after the original trauma.
There are various treatment methods used in the management of tracheal stenosis, but most cases are treated through endoscopy, where a long thin tube with a light and camera on the end is inserted into your trachea so the surgeon can have a good view of the obstruction.
In milder stenosis, a stent may be placed, and some of the scarring can be removed through laser treatment. However, in cases of more severe stenosis, a procedure called tracheal resection may be recommended. In this procedure, the part of the trachea affected is removed and tissue is taken from another part of the body (e.g the cheek) to repair the trachea.
Typically, otolaryngologists (ENT doctors), who are specialists in conditions affecting the ear, nose and throat, treat tracheal stenosis.
A tracheostomy involves opening up the trachea, or windpipe, through a surgically made hole. A tracheostomy tube or cannula is placed in the opening so the patient can breathe and so that any lung secretions are removed.
It tends to be done due to obstruction at the oropharynx, larynx, or upper part of the trachea. It is also done when there is:
There are different types of tracheostomy according to the cause, it may be an emergency tracheostomy or an elective tracheostomy. These can be temporary or permanent.
A tracheostomy involves making a hole in the trachea to avoid asphyxiation. A 1.5cm wide incision is made in the throat, in front of the trachea, then the trachea is punctured and dilated until a tube can be inserted.
This technique may involve some risks (other than those involved with surgery and anaesthesia) such as damage to the thyroid, trachea erosion, puncture of the lung, and scarring of the trachea that causes pain and difficulty breathing.
This procedure is normally performed under general anaesthetic, unless the tracheostomy is performed as an emergency, in which case there may not be time. When performed as an emergency, local anaesthetic is used so that the patient does not feel pain, while when it has been planned, the patient will be given a general anaesthetic.
A person with a tracheostomy is advised to take extra care to keep the area clean, and be ready to know how to deal with a partial or total blockage of the cannula. It is recommended that exposure to aerosols or airborne particles be avoided, to prevent them entering the respiratory tract.
In temporary tracheostomies, the cannula is removed, but if it is permanent, the hole will remain open.
Turbinate hypertrophy is a condition affecting the respiratory mucosa. The turbinates, also known as nasal conchae, is a part of the nasal fossa. They are six narrow, curled shelves of bone and connective tissue covered by a mucosa that protrude into the breathing passage of the nose. The turbinates ensure that the air passing through the nose is heated up and humidified. Sometimes they can become inflamed and increase in size. This is what happens when you have turbinate hypertrophy.
Turbinate hypertrophy can cause the following symptoms:
To confirm a diagnosis of turbinates hypertrophy, you’ll need to go through your medical history with your doctor and do the following exams:
Some risk factors that may lead to turbinate hypertrophy are:
The treatments largely depend on the individual case. Your doctor may prescribe you a local treatment based on nasal solutions which can reduce the swelling of the turbinates (in case of a mild to moderate hypertrophy). Should this not be enough, you may consider the option of surgery (middle turbinectomy, inferior turbinates mucotomy or submucosal dissection), consisting in the resection of a part of the mucosa and bones of the turbinates, or you can consider one of the new, non-invasive techniques based on laser or radiofrequency.
For an accurate diagnosis and treatment of turbinate hypertrophy, you should see an ENT specialist.
Tympanometry is a test to evaluate the functioning of the middle ear and the tympanic membrane. The test involves inserting a device into the outer ear to achieve a tight seal. Then the specialist causes a change in air pressure inside the atrial cavity to check the mobility of the eardrum and to see how the ear reacts to sound and pressure changes. During the test, the patient can hear very loud sound and may notice discomfort because of the probe. The results are plotted on a graph called a tympanogram. This technique is used to detect alterations in the middle ear, tympanic perforation, infectious otitis, tumours, bone diseases affecting the middle ear and birth defects, among others.
Vertigo is not actually a condition in itself, but is a symptom. It describes the feeling that everything around you is spinning, or that you are spinning yourself. In most cases vertigo gets better by itself, but if it happens repeatedly or keeps affecting you, it should be investigated.
‘Attacks’ of vertigo can last for just a few seconds, but they can also last longer, even for days or months in extreme cases.
Vertigo is generally caused by problems with the inner ear, as the inner ear affects balance, causing the sensation of vertigo. Although sometimes the specific cause is unknown, some common problems with the inner ear causing vertigo include:
Certain head movements, certain medications, and migraines can also cause vertigo.
Vertigo generally gets better on its own. You can manage vertigo attacks using some of the following measures:
If your vertigo keeps coming back, you should make an appointment with your doctor, who may refer you to a specialist to try and determine the cause. If the vertigo is caused by an infection, then antibiotics or other medication may be prescribed to clear up the infection. Your doctor may give you exercises to do when you experience vertigo to lessen symptoms.
If vertigo is experienced along with hearing loss, double vision, loss of vision, difficulty when speaking, or limb weakness/numbness, you should visit A&E.
Generally vertigo clears up on its own, but if you are having repeated attacks, your GP may refer you to an ENT doctor (otolaryngologist).
Voice disorders are disorders in sounds that depend on the larynx (vocal cords) and affect the pitch, timbre, intensity or duration. The origin of such changes can be organic, physiological, psychological or environmental. In addition, there are two types of disorders: dysphonia and aphonia. Aphonia is the total loss of voice temporarily or chronic and can be caused by overuse of the vocal cords, respiratory disease, intake of toxic or irritating products, excessive cold or nervous causes. Treatment may include resting the voice, medication, voice therapy or, in severe cases, surgery. Dysphonia is a disorder of voice intensity due to an injury in the organs of phonation (organic) or poor use of the voice (functional). The most common causes of this condition are overly straining your voice (voice hyperfunction), gastroesophageal reflux, smoking, infections such as laryngitis or tuberculosis, neurological disorders of the larynx, tumors, and trauma, among others. The treatment involves learning relaxation techniques and breathing, exercising the shoulder, neck and face muscles, and speech therapy.
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A pharyngeal pouch at the top of the oesophagus can cause food to stick in your throat, regurgitation, aspiration, and in extreme cases can even make it impossible to eat. Treating this condition usually involves surgery. Expert ENT surgeon Mr Stuart Winter is here to explain how this is done.
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A pharyngeal pouch is like a hernia at the top of your oesophagus. It can be problematic as food can collect in the pouch. What causes this phenomenon and how can it be fixed? Experienced consultant ear, nose & throat (ENT) surgeon Mr Stuart Winter is here to explain.
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With head and neck cancers on the increase each year, we ask our expert otolaryngologist Mr Stuart Winter to explain the commonest causes of throat cancer and which preventative measures can be taken....
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