Procedures

The adenoid is tonsil-like tissue that is found at the back of the nose above the palate. For some children, and even teenagers, the adenoid becomes quite big and can fill this space causing difficulty breathing through the nose. The adenoid can also act as a harbour for organisms that can make a child prone to ear infections or “glue ear”. Adenoidectomy is removal of this tissue. It is performed under general anaesthesia using special curved instruments that will pass behind and above the palate.

A blepharoplasty is done to fix drooping skin around the eyelids. This procedure is usually done on the upper eyelid, but is also done to tighten the lower eyelid when it is drooping forward off the eye. For the upper eyelid the operation involves making a cut above the upper eyelids and removing a crescent of skin, and sometimes a small amount of fat. Removing this excess skin gives a tighter and more youthful appearance around the eyes. When the lower eyelid is operated on, the cut is made just below the eyelid so that it can be pulled tight up against the eye. There will always be some post-operative swelling and bruising, but this has mostly settled after a week. For older people, the bruising may take a little longer to settle.

Endoscopic sinus surgery is a procedure done to manage the effects of sinusitis. This could be to treat recurrent infections, to remove nasal polyps or to manage chronic infection. The operation is done using an endoscope (a small telescope and camera) that looks up the nose through the nostrils. This allows the surgeon to do the operation without making any cuts on the nose or face. The aim is to remove tissue from the sinuses so as to open them up and improve their natural drainage. It also makes it easier for the patient to get nasal sprays or washes into the sinuses to keep them healthy.

With sinus surgery, postoperative care is important and helps speed the recovery. A key element is regular nasal washing (sinus rinsing) to clear away blood clots and help reduce the risk of infection. During the first 6 to 8 weeks after surgery several follow up appointments may be necessary to clean the nose and ensure that everything is healing properly.

We usually recommend a minimum of 1 week off work. Some people need longer, particularly if you do either heavy or dirty work; in which case we suggest that in the second week you either take time off or do light duties.

An otoplasty, or “pinning back the ears”, is a procedure used to reduce prominent or obtrusive ears. It is performed under general anaesthetic for children; but may be done under local anaesthetic for teenagers and adults, should they prefer. The operation involves a cut in the skin behind the ear. Then the ear cartilage (gristle) is treated to either restore the natural curves, or remove excess tissue. When this is done the incision is closed and the position of the ears is checked. There will be a bandage over both ears, wrapped around the head. This stays on for a week and can feel quite tight; the purpose being to support the ears in their new position while the initial healing takes place.

The nasal septum is the wall that separates the two sides of the nose. It runs from the front of the nose to the back. It is made from both bone and cartilage. This wall usually sits in the midline but can be off-centre and cause nasal blockage. Some people can be born with a deviated septum, though it is most often the result of a facial injury. It causes breathing difficulties and sometimes nosebleeds. The inferior turbinates may be hypertrophied and need reduction as part of the procedure. Septoplasty is an operation to straighten a deviated septum. The surgery is usually done under general anaesthetic, but can be done as a local anaesthetic. After surgery the nose will feel blocked for 1 to 2 weeks. We usually recommend taking a week off work.

A septorhinoplasty involves altering and reshaping the external nose as well as straightening the nasal septum. This may be done for cosmetic reasons and to improve its functional performance. The surgery is usually done under general anaesthesia. It is similar to septoplasty but also requires rebreaking the nasal bones and sometimes refashioning the shape of the cartilage in the nasal tip. There are two types of septorhinoplasty – intranasal and external. Intranasal septorhinoplasty is done through the nostrils whereas external septorhinoplasty requires an incision just between the nostrils. Swelling is common in the early recovery, internal swelling causing blockage and external swelling making the nose look puffy. There will be a dressing over the nose and there will be visits to remove this and for nasal cleaning in the first 5 or 6 weeks after surgery. The recommendation for time off work is the same as for septoplasty. Contact sport should be avoided for at least 6 weeks after the operation.

Lumps, discoloured or crusty areas, or ulceration on the skin that could be a skin cancer. At ENT Otago we have been doing skin lesion surgery on the head and neck for the last 22 years. We offer appointments to asses skin lesions, do biopsies as needed; as well as their removal. There are three different types of skin cancer: squamous cell carcinoma (SCC) basal cell carcinoma (BCC) and melanoma, with melanoma looking quite different from the other two.

Skin lesion removal is usually done using local anaesthetic and is conducted in our minor procedure room at the clinic. Sometimes we can assess and treat on a same-day basis. Patients can expect swelling and bruising following the procedure, but this subsides within a week or two.

Otosclerosis is a middle ear condition that involves the stapes (stirrup bone of the middle ear). The condition causes “new” spongy bone to form across the joint between the stapes and the inner ear. This stops the stapes moving properly and sound is not transmitted to the inner ear. This results in hearing loss. The condition can show its effect in one or both ears.

Otosclerosis can be treated in one of three ways. One option is to do nothing and the hearing will probably remain much the same as it is and the symptoms would be much the same as they are. As time passes the hearing could worsen and the patient would notice this.

Another option is to wear a hearing aid. A hearing aid is potentially a good rehabilitation measure for otosclerosis. It amplifies sound presented to the tympanic membrane and therefore the stirrup bone moves more, so presenting louder noise to the normal hearing inner ear. One of the down sides of wearing a hearing aid is that you have something in the ear and it does tend to amplify all sounds, not just speech sounds and at times this can be frustrating.

The third option is to have the operation of stapedectomy. This is usually done under general anaesthetic; you are asleep and unaware of what is going on. During the operation, the eardrum is lifted to inspect the chain of hearing bones. The diagnosis is confirmed and the arch of the stirrup bone is removed, a small hole is made to open the hearing organ and a piston put in place and hooked over the anvil bone. The piston becomes a moving part and the hearing chain functions normally and the patient’s hearing should be restored.

With surgery there will be visits to the clinic during the first 6 weeks after surgery. These are to ensure everything is going well. The patient will not notice the hearing improvement straightway and it can be 6 weeks or so before the patient will know if their hearing has come up. Water must be kept out of the ear for the first 6 weeks after surgery and patients are advised against flying during this time. SCUBA diving is not advisable after stapedectomy.

A thyroidectomy is a procedure that involves the removal of a half or the whole of the thyroid gland. This surgery may be required to treat conditions such as goitre or thyroid cancer. Goitre is simply an enlargement of the thyroid gland, either due to an over or underactive gland, or due to small nodules on the gland – a goitre may be removed for cosmetic or functional reasons if it is causing difficulty breathing or swallowing. Thyroid nodules are common and frequently benign, and may be due to an overgrowth of normal thyroid tissue, or a cyst containing fluid.

Thyroid cancers are also relatively common, but fortunately are very treatable and have excellent long term survival rates.

The operation is done while the patient is asleep under general anaesthetic. An incision is made low in the neck, in a skin crease if there are any. The thyroid is identified and depending upon the condition, either half, or all the gland is removed. The wound is closed with staples or stitched and there will be a wound drain in place. The drain is usually removed the next day. The stitches/staples are removed after a week.

The tonsils are found at the sides of the back of the mouth. They can be seen with a mirror and can vary in size being much easier to see when they are enlarged. The tonsils are part of the immune system; they process organisms, such as viruses and bacteria, and are involved in making antibodies that will recognise and attach to the organisms to help the white cells kill them. There is a plentiful supply of tonsil-like tissue in the throat, so if the tonsils are causing a lot of trouble, removing them does not stop this immune system activity. Most of this immune system activity occurs in the first few years of life. Tonsillitis is an inflammation of the tonsils usually caused by viral or bacterial infection. If it occurs frequently it can have a significant impact on a person’s life, causing more trouble than good. When tonsillitis occurs repeatedly it may be necessary to remove the tonsils. For some people, the tonsils and adenoids can be big enough to block the airway during sleep. This can produce sleep disruption and at its worst this is called sleep apnoea. If the sleep disturbance is sufficiently bad and the specialist doctor thinks the tonsils and/or adenoids are the cause, then their removal may be recommended.

The surgery is performed under general anaesthetic. While the patient is asleep special instruments are used to take the tonsils away. Any bleeding is stopped with small stitches next to the tongue and diathermy. After the surgery a white patch can be seen where the tonsils used to be. This slowly comes away as the throat heals over the following 10 to 14 days. Postoperative pain is common and is usually at its worst for 7-10 days and for most people is settled by 14 days. The pain and tightness in the muscles at the side of the throat make swallowing difficult. Regular pain relief is recommended and the patient needs to make extra effort to ensure both eating and swallowing, as doing both of these will speed the recovery. After surgery the patient will need to take some time off school or work - a minimum of 1 week, but possibly longer especially if the patient is involved in heavy or dirty work.

The turbinates are part of the nasal lining on each side of the nose; they are responsible for warming and humidifying the air as it moves through the nose. They can become enlarged and cause nasal blockage, sometimes in conjunction with a deviated nasal septum (see septoplasty). Turbinate reduction is done to increase the size of the nasal airway and involves removing part of the turbinate. After reducing the turbinate there will be a “cut edge” that has to heal. A dissolving dressing is usually placed over this to reduce the chance of significant bleeding during the recovery.

Perforation, retraction pocket (thinned, indrawn eardrum) and ossicular (small hearing bones) injury may be the result of childhood ear infections or trauma. They can cause both hearing loss and ear discharge.

These operations aim to repair a defect in the tympanic membrane, to eradicate disease from the middle ear and restore hearing and middle ear function. A myringoplasty involves repairing only the tympanic membrane, when the rest of the middle ear is healthy. Tympanoplasty repairs a defect in the tympanic membrane, as well as eradicating disease from the middle ear to restore hearing and/or middle ear function.

The operation is done under general anaesthetic. A small cut is usually made, either just in front, or behind, the ear. Then the ear drum is lifted, the diseased tissue removed and a graft used to repair the ear drum. If there is damage to the little hearing bones these may be repaired with an “ossiculoplasty”; this is a small implant used to reconnect the hearing bones to the ear drum.

The recovery takes up to 6 weeks and you may feel that their hearing is either no better, or worse, during this time. There will be visits to have the ear canal cleaned and any stitches removed. We advise against getting water in the ear, and against flying, during this time.

The uvula is the small bit of tissue that hangs off the palate at the back of the mouth. It can become broad or long and is associated with snoring.

A uvelectomy is a procedure that involves removing all or part of the uvula. This is usually done to treat snoring or as part of treatment for sleep apnoea. It is often done in conjunction with septoplasty and tonsillectomy. The recovery is more painful than you may expect, especially if tonsillectomy is done at the same time. You will need regular pain relief and it can take two or three weeks for the pain to fully settle. Time off work will be required as for tonsillectomy.

About 10% of children are prone to ear trouble during their first 7 or 8 years. This is because of poor function of the small tube (Eustachian tube) that connects the nose to the ear, letting air up to behind the ear drum. This can allow infection up to the ear or result in fluid collecting behind the ear drum. This can lead to recurrent ear infections (more common during the first 3 years) or “glue ear” (more common after age 4 years). The frequency of ear infections, or the persistent mild to moderate hearing impairment associated with glue ear may lead to the specialist recommending Ventilation Tubes (also known as grommets). These are tiny plastic tubes that are inserted into the ear drum to allow air to get into the middle ear. They effectively bypass the Eustachian tube and prevent recurrent middle ear infections and glue ear.

Usually the operation does not take too long. While the child is asleep under general anaesthetic the surgeon will examine the ear drum, make a small nick and remove any fluid trapped behind the ear drum. Then the ventilation tube is placed in the incision and allows air through to the middle ear. Eardrops are put in the ear to prevent postoperative infection and sometimes they are recommended to be used for a few days after surgery. We recommended that children with grommets should wait for at least two weeks before getting water in their ears, or going swimming. The grommets are designed to come out on their own after about a year. While they are in place the child should not have ear trouble (infection and/or hearing impairment). The grommets do not “cure” the ear problem, but rather they “get around it”; it is time that allows the child to grow out of the condition. This means that some children will have more problems with their ears after the grommets come out and they may need another set. If the ear problem comes back the surgeon may suggest doing an adenoidectomy to remove the harbour for organisms that contribute to glue ear troubles.

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