Ear, nose, and throat surgery





Definition

Ear, nose, and throat surgery is the the surgical treatment of diseases, injuries, or deformations of the ears, nose, throat, head, and neck areas.


Purpose

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.


Demographics

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.

Description

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.


Diagnosis/Preparation

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.


Aftercare

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.


Risks

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.


Normal results

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).


Alternatives

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.

Resources

BOOKS

McPhee, Stephen, et al. "Ears, Nose, and Throat." In Current Medical Diagnosis and Treatment. 35th ed. Stamford: Appleton & Lange, 1995.

ORGANIZATIONS

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?


User Contributions:

Suresh patel
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Dec 1, 2008 @ 3:03 am
hi, first of all thanks to provide this mush of essential information & further I need to know that after surgey which types of medication you prescribe for bleeding as well as wound healing
yaya shasha
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Sep 12, 2009 @ 12:12 pm
I would like to know after effects of having a polyp between the vocal cords removed be?will the voice change and what should a patient expect to go through?Also what foods are ideal for fast healing
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Jul 21, 2010 @ 7:19 pm
I would like to know after effects of having a polyp removed from a vocal cord.
Recovery time. Recovery care. Food recomendations.
I am a healthy 64 year old male.
jes
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Sep 23, 2010 @ 8:08 am
How long is the surgery for this on the nose and throat?
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Oct 27, 2010 @ 11:11 am
Hello thanks very much for a detailed document. I have a few questions about radiotherapy as my dad has been through this. On completion of the radiotherapy is it essential that he has a scope but down his throat to check for infection of any kind? How many times should something like this be carried out?
Lety
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Dec 27, 2010 @ 7:19 pm
It is day seven counting the day of the surgery. I am 18 and I had a tonsillectomy/adenoidectomy/septoplasty/turbinate reduction. I previously had a rhinoplasty a year and a half ago, I still could not breathe through my right nostril. I went to an ENT and he not only recommended a septoplasty but also a tonsillectomy. He told me that he would also remove my adenoids and make my turbinates smaller so that I could breathe much better. Well day of the surgery everything went fine, painless iv and I felt drunk within 10 seconds. The anesthesiologist walked me to the operating room and I laughed just at the thought of not being able to walk or speak clearly. I was asked my name and birth date and was instantly gone. Next thing I know is I can hear voices and I do realize that the surgery is over, whoa. For some strange reason I was kinda moaning and crying ow quietly repeatedly. My eyes were tearing, they asked me If I wanted some pain medication, "yes," I pleaded. I think it was an exaggeration to be crying, I was probably just confused. They gave me spoonfuls of popsicle and in about 30 minutes I went home.

Okay make sure you have a vaporizer at all times, keeping the throat moist will lessen the pain and prevent any bleeding. Take your pain medication every 4-6 hours at the onset of pain. Keep your head elevated and chew crushed ice. Remember to eat soft foods for the next 2 weeks, anything abrasive can cause bleeding and send you to the emergency room. My throat bleed on the fourth night and I was able to stop it by applying an ice pack and chewing more ice. Make sure you have someone responsible to help you for the first 5 days.

Foods I recommend: popsicles, gelatin, baby food, mashed potatoes, ice cream (after 7 days), and pudding. Avoid hot food and acidic food.

I had my splints removed on day 6, the discomfort is very subtle and mild. I have a tendency to freak out and cry, so today my ENT removed one stitch in each nostril, that part was completely painless but the next was not. Next, the splints were removed, it really is not painful unless you think about it being painful. I go back in two weeks for another revision. I feel really great now that the splints are out, because I can immediately breath through my nose (though it is still very swollen inside). You can begin cleaning the nose the day after your surgery using a cotton swab and neosporin. I asked my doctor about using hydrogen peroxide and he told me not to. You can also use a saline spray but only up to 4 times a day is recommended. Do not blow your nose until the splints are removed and do this very gently. Also, do not blow your nose hard for a few weeks, a medium blow after 2 weeks won't hurt you.

The tonsils will appear white for some time until the scabs fall off, that hasn't happened with me yet. The uvula will be really swollen right after the surgery but will go down in week. Remember that no matter the discomfort and pain these surgeries are worth it!
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Feb 15, 2011 @ 2:14 pm
hi!i just want to know if how long on for reconstruction of eardrums?and how log the recovery?which kind of food should be eating?which best hospital in bahrain is the good and recommended for ear surgery?
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Nov 4, 2011 @ 4:04 am
Hi,Salma here..i want to know about ear surgery if possible..i hv hearing loss..but it couldnt benefit from medicines..kindly tell me ...or if i can visit to u..many thanx
khensani
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Dec 12, 2011 @ 6:06 am
hi, thanks for the informative document. how safe is it for a 17 months baby to have a surgery of the ENT.
sherry
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Jun 7, 2013 @ 12:12 pm
my child was born with a cleft palate, he had surgery done at 9mths old, I was told he would need speech therapy when he starts talking, while waiting for this, he would get post nasal drip, sinus, etc. This year he got tinnitus, and liquid dripped from his ear, took him to the doctor and he gave him antibiotics, ear drops. I've taken him to therapy but the therapist told us to go for an audiology test, which we did, the audiologist said he has a collapsed eardrum with holes in and fluid, they referred me to a ENT Specialist. I've been reading articles and they say that myringoplasty or tympanoplasty helps with the holes in the eardrum, the ENT specialist wants to put gromitts in his ear, I want to know will this help drain the fluid in the ear, and what about the holes? I've searched the net and it looks like myringoplasty and tympanoplasty is not done in my country, does this mean my child will never heal? I'm very worried about this.
george waite
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Jun 27, 2013 @ 9:21 pm
I am a patient at john dingell vamc hospital in detroit michigan.in sept.2003 i was ill with an ear infection.the pyhsicians i had diagnosed me with acute otitis media and an earache.i was treated with amoxocillin capsules.i couldnt figure out why i wasnt getting any better with it.i knew something was wrong.i really had viral labyrintitus of the inner ear.no physician or ent diagnosed me correctly.i diagnosed myself according to my symptoms on the internet.no physician explained anything to me.i have a chunk moving around in my cochlea.my pinna turns red everyday.i am seeking a ent surgeon or an otologist or a neurologist with microsurgery procedures.i need a cochlea or an inner ear tranpslant.i have lived with it for 10 years.if you are wanting to help a patient that has need you may contact dr.amitha parvarateni firm c 1st floor john dingell vamc medical center detroit michigan or dr.ho cheng lin chief of otarolgy.at john dingell vamc hospital detroit michigan.thankyou for reading from the patient mr.g waite.
lisa
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Jun 29, 2013 @ 9:09 am
I have a problem. So I have a tooth in my sinus area that's now causing me to cough excessively and is effecting my speech because I'm always hoarse. Should I see a ENT or dentist for a resolution?
george waite
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Aug 18, 2013 @ 8:20 pm
I am a patient at john dingell vamc in detroit michigan.the va doesnt have the equipt.for an inner ear transplant.it has been done in 1984 without the advanced micro invasive techniques we have today.if you are an ent or surgeon with the necessary skills.would you contact dr.vandergreen or dr.ho cheng lin at the dingell vamc in detroit michigan.i have had many tests.the inner ear is tissue .i was not diagnosed correctly with the ear illness i had by the internal medicine physician dr.rameshbhai m . patel or dr.emillio ortiz cardona in river rouge michigan.dr.garlapady didnt even diagnose it correctly in dearborn michigan.i wish to get better with it.i have a chunk in my cochlea moving around.thankyou.from mr.g.waite
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Aug 10, 2014 @ 4:16 pm
Dr.parnes at Albany medical center ent dept. dr. Allison lupenitti ent dept. I have a chunk moving in my cochlea for 11 years now. Would you go and get it and replace it with a transplanted inner ear. I want to get better with it. There isn't any reason for this today. I am a veteran. Thankyou from mr. G waite
dr ahmad
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Oct 8, 2014 @ 10:10 am
hi
we have a patient she suffers with throat adenoid now she is about to operate and one of ENT surgical dr will operate hem so would u plz tell me what is important point for preoperative and postoperative procedures ok?

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