Ear, nose, and throat surgery
Ear, nose, and throat surgery is the the surgical treatment of diseases, injuries, or deformations of the ears, nose, throat, head, and neck areas.
The purpose of surgery to the ears, nose, throat, head, and neck is to treat an abnormality (defect or disease) in these anatomical areas. An anatomical deformity is a change that usually occurs during embryological development, leaving the affected person with the apparent defect. A disease in this area usually develops later in life, such as head and neck cancer. Additionally, the specialty known as otorhinolaryngology (ears [ oto ], nose [ rhino ], and throat [ laryn ], referring to the larynx or throat) also includes surgical intervention for diseases in the head and neck regions. Most ears, nose, and throat (ENT) surgeons in the United States are referred to as otolaryngologist and the specialty as otolaryngology. Ear surgery is usually performed to correct specific causes of hearing loss. Nose surgery can include different types of procedures necessary to treat sinus problems (sinus surgery). Throat surgery can include complicated procedures such as cancer of the larynx ( laryngectomy ), or more simple procedures such as surgical removal of the adenoids ( adenoidectomy ) or tonsils ( tonsillectomy ). Head and neck surgery may be necessary to remove a tumor or reconstruct an area after disfigurement from trauma or injury.
Ears, nose, throat surgery comprises many different types of surgical procedures and spans over all age groups regardless of gender or ethnicity. A special subspecialty, pediatric otolaryngology, is the branch that treats ENT disease for infants and children.
ENT surgery is the oldest surgical specialty in the United States, and it is one of the most elaborate fields of surgical specialty services, using advanced technology and a broad range of procedures that also includes major reconstructive surgery to correct deformity or injury. Cosmetic surgery can include surgical procedures to improve wrinkles in the face, contours of the nose and ears, chin augmentation, and hair transplantation .
Typically, ear surgery is utilized to correct defects causing hearing loss or impairment. Such procedures include stapedectomy (removal of all or part of a bone in the middle ear called the stapes), tympanoplasty (reconstruction of the ear drum), and cochlear implants (implantation of a device to stimulate nerve ends within the inner portion of the ear to enable hearing). Surgery of the ear also includes myringotomy (insertion of ear tubes to drain fluid in persons with chronic ear infections).
Common surgical procedures of the throat include removal of tonsils (tonsillectomy) or adenoids (adenoidectomy). The tonsils (either side and in back of the throat) and adenoids (higher up the throat behind the nose) are masses of lymph tissue that play an active role in body defenses to fight infection. The tonsils and adenoids can get chronically infected, in which case surgical removal is usually indicated to relieve breathing problems and infection recurrence. Furthermore, chronic inflammation of the adenoids can cause repeated middle ear infections that can ultimately impair hearing.
Surgery of the nose can include procedures that treat sinus diseases (sinus surgery). Advanced endoscopic surgery for sinus and nasal disorders can eliminate the need for external incisions and greater surgical precision. Other common surgical procedures include correction of a deviated nasal septum ( septoplasty ) and for chronic nasal obstruction (congestion).
Surgery of the neck region can commonly include tracheotomy (a surgical procedure in which an opening is made in the trachea or window). Tracheotomy is indicated for a person who is unable to deliver enough air (oxygen) to the lungs. Additionally, ENT surgeons perform complicated surgical procedures for the treatment of malignant head and neck cancers. In addition to tumor removal , when indicated, ENT surgeons may perform an operation called radical neck dissection , during which the ENT will remove cancer that has spread via lymphatic vessels to regional neck lymph nodes. Neck dissection is also useful since specimens can be removed for pathological examination, which can provide important information concerning metastasis (spread) and can direct the treatment plan (i.e., radiation therapy and/or chemotherapy may be recommended for aggressive cancers). ENT surgeons also treat sleep-related disorders such as sleep apnea and excessive snoring; a procedure called laser-assisted uvula palatoplasty (LAUP) will remove tissue to allow for unobstructed airflow.
Other ENT procedures include surgical reconstruction of ear deformities (otoplasties), special surgery for diseases in the inner ear, and skull-based surgeries (neuro-otology). As well, ENT surgeons can surgically treat abnormalities near the eye, perform oral surgery for treatment of dental and jaw injury, and remove skin cancer within the head and neck region. ENT surgeons also perform special surgical techniques that can preserve nerve and blood vessel function ( microsurgery ) and reconstruction of bone and soft tissue.
A careful history and physical examination of the ears, nose, throat, head, and neck is a standard approach during initial consultation. Different instruments with light sources (i.e., otoscope for ear examinations) enable ENT surgeons to quickly visualize the ears, nose, and throat. Visualization of these areas can reveal the severity of the disease or deformity. The head and neck area is inspected and the neck and throat area is typically felt with the surgeon's hands (palpation). Special technological advancements have enabled ENT surgeons to further visualize deep internal anatomical structures. Nasal endoscopy allows visualization of the upper airway to detect anatomical problems related to sinuses. Videostroboscopy can be used to visualize the vocal cords, and triple endoscopy (laryngoscopy, esophagoscopy, and bronchoscopy ) can diagnose and stage head and neck cancers. Preparation before surgery is fairly standardized and includes blood work-up and instructions to have nothing to eat or drink after midnight of the night before the procedure.
The aftercare for ENT surgery depends on the procedure and state of the health of the patient. The aftercare for a patient who is 60 years old with head/neck cancer is more extensive than a tonsillectomy performed in a young adolescent or child. Generally, aftercare should be directed toward wound care and knowledge gained from the surgeon specifically detailing the expected length of average convalescence. Wound care (cleansing, dressing changes, etc.) and postoperative follow-up with the ENT surgeon is essential. Medications for pain may be prescribed. Patients stay in the hospital for eight to 10 hours (for the effects of anesthesia to subside) for same-day surgical procedures (i.e., tonsillectomy), or they may be admitted for a few days for more complicated procedures (i.e., cancer). Aftercare and convalescence may take longer for complicated procedures such as advanced cancer and temporal-bone (two bones on both sides of the skull near the ear) surgery for nerve disorders (that can affect balance) or for tumors.
The risk of ENT surgery depends on the procedure and the health status of the patient. Some procedures do not have much risk, while complications for other procedures can carry considerable risk. For example, the risk of a complicated operation such as neck dissection could result in loss of ear sensation, since the nerve that provides the feeling of sensation is commonly severed during the procedure.
There will be a cure (i.e., tonsillectomy) or an improvement (i.e., cancer of the head and neck) of the primary disease. Ear surgery should help individuals hear well. Throat surgery can help remove chronically inflamed tonsils, or adenoids, polyps, or cancer. Nose surgery for deviated septums or nasal congestion will improve breathing problems and help a person breath more easily and effectively through the nose. Neck surgery can help remove diseased tissue and prevent further spread of cancer. Surgery for sleep apnea will remove redundant tissue that blocks airways and obstructs normal airflow.
Morbidity and mortality rates
Outcome and disease progression vary for each disease state. There are no general statistics for all ENT procedures. Some procedures are generally correlated with excellent morbidity (over 90% success rates for all cases receiving tympanoplasty) and no mortality, while others may be associated with poor outcome and much illness (i.e., advanced head/neck cancer).
Usually, surgery is indicated when benefit from surgery is a clear-cut primary intervention or when medical (also referred to as conservative) treatment has failed to provide sustained symptomatic improvement. A person diagnosed with cancer may not have an alternative conservative treatment, depending on the stage (progression of cancer). However, a person with sinus problems may be treated conservatively (with antibiotics , saline nasal spray wash, steroid nasal spray, and/or antihistamine spray) before indication or necessity for surgery. There are many other services that the ENT surgeon uses to treat specific diseases, including audiology services for diagnostic and therapeutic (hearing aids) purposes, and services to treat disorders of speech and voice.
McPhee, Stephen, et al. "Ears, Nose, and Throat." In Current Medical Diagnosis and Treatment. 35th ed. Stamford: Appleton & Lange, 1995.
American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince Street, Alexandria, VA 22314-3357. (703) 836-4444. http://www.entnet.org .
American Hearing Research Foundation. 55 E. Washington St., Suite 2022, Chicago, Il 60602. (312) 726-9670. http://www.american-hearing.org/ .
American Speech-Language-Hearing Association. 10801 Rockville Pike, Rockville, MD 20852. (800) 638-8255. http://www.asha.org .
Laith Farid Gulli, MD,MS Robert Ramirez, BS
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
The procedure is usually performed in a hospital that has an ENT department. The ENT surgeon receives one year of general surgical training and five years of training in the disease of and the surgery of the ears, nose, throat, head, and neck. Most surgeons are board certified. Some ENT surgeons obtain a further one to two years of advanced training in one of the seven areas of subspecialty that includes otology/neurotology; pediatric otolaryngology (treatment of infants and children); head and neck area; facial plastic and reconstructive surgery; rhinology (treatment of diseases of the sinuses and nose); laryngology (treatment of throat diseases); and allergy. The department typically provides other professional clinical services during diagnosis and treatment, such as speech-language pathologists and hearing specialists. Larger medical centers may also have one or two medical researchers on staff.
QUESTIONS TO ASK THE DOCTOR
- What can I expect in the postoperative period?
- What are the specific aftercare recommendations for my specific surgical procedure?
- What are the expected normal results for my specific procedure?
- What medications will I be given to relieve any postoperative discomfort?
- Are there any side effects that I should expect in the postoperative period?