ENT - Otorhinolaryngology (ORL)
Ear, Nose and Throat Surgery (ENT) is also known as Otorhinolaryngology, Head and Neck Surgery. This area of medicine is concerned with disorders of the ear, nose, throat, the head and the neck.
ENT Surgeons (or otorhinolaryngologists) are specialist doctors who deal with medical and surgical treatment of conditions of the ears, nose, throat and structures of the head and neck.
- Mr Colin Barber ORL Surgeon
- Mr Colin Brown ORL Surgeon
- Mr Michel Neeff ORL Surgeon, Clinical Director
- Mr Graeme van der Meer Paediatric ORL Surgeon
- Dr Edward Toll Paediatric ORL Surgeon
Common Conditions / Procedures / Treatments
Audiometry is the electronic testing of hearing ability. Your child will sit in a special room wearing earphones and be asked to respond when he/she hears a noise through the earphones. These tests can measure their hearing levels as well as other aspects of hearing such as the ability to recognise speech against background noise. For younger children more specialised hearing tests are available.
Tympanometry uses sound and air pressure to check middle ear function. A small, soft probe is placed in the ear for a few seconds and a computer measures the ear's response to sounds and pressure emitted through the probe. This test is often carried out in young children to assess for glue ear.
This is inflammation or infection of your middle ear (the space behind your eardrum) and is often associated with a build-up of fluid in your middle ear.
Acute Otitis Media
This is usually caused by a temporary malfunction of the Eustachian tube due to allergies, infections or trauma. The Eustachian tube connects the middle ear to the nose and allows air to enter the middle ear, thus making middle ear pressure the same as air pressure outside the head. Acute otitis media results in an infection in the middle ear causing pain, fever and a red, bulging eardrum (the thin, transparent membrane between the outer ear canal and the middle ear). This condition is usually seen in young children. The treatment may be antibiotics if it is suspected to be a bacterial, rather than viral, infection, or if there are repeated episodes, surgical insertion of grommets into the eardrums may be required. Grommets are tiny ventilation tubes that allow normal airflow into, and drainage out of, the middle ear until the Eustachian tube begins to work normally. The operation is done under general anaesthesia (the child is asleep) and takes 10-15 minutes. Most grommets fall out naturally after six to twelve months, by which time the Eustachian tubes are often working properly.
Otitis Media with Effusion (Glue Ear)
Like acute otitis media, glue ear is usually the result of a temporary malfunction of the Eustachian tube and may either follow an episode of acute otitis media or occur on its own. The condition is usually seen in children. Fluid is present in the middle ear and the ear is not usually painful, but the ear drum is not red and bulging and there is no fever. Glue ear may lead to hearing loss, which can result in speech delays, and balance problems. Treatment options include: a prolonged course of antibiotics; grommet insertion; or treatment with decongestants, antihistamines or steroids.
Chronic Otitis Media
If the Eustachian tube is blocked repeatedly over a period of several years, there may be changes to the tissues of the middle ear such as deformity of the ear drum and damage to the bones of the ear. These changes may result in hearing problems, balance problems, and persistent deep ear pain. If such long term damage has occurred, an operation called tympanomastoidectomy may be required. This involves making an incision (cut) behind or around the upper part of your ear, drilling through the mastoid bone and removing, and possibly repairing, damaged tissues.
When the growth of one of the tiny bones in your middle ear, the stapes, changes from hard to soft and spongy, it leads to the condition called otosclerosis. As this abnormal growth develops, the stapes becomes more rigid or fixed in position. The stapes needs to be able to vibrate to allow sound vibrations to pass through to the inner ear. When the stapes is not vibrating as well as it should, gradual hearing loss can occur. Otosclerosis may occur in one or both ears and may sometimes be associated with ringing/clicking/buzzing noises in your ear (tinnitus). The condition will be diagnosed by hearing tests and tympanometry. Otosclerosis most often develops during teenage and early adult years and it tends to run in families. The condition can become worse during pregnancy.
TreatmentThere are several different approaches to treating otosclerosis, one of the most common being a surgical procedure called stapedectomy. This is a microsurgical procedure (microscopic lenses are used to help the surgeon see the tiny structures involved) usually performed through the ear canal. A small cut (incision) is made in the ear canal near the eardrum and the eardrum is lifted, exposing the middle ear and its bones. Part of the stapes bone is removed and an artificial prosthesis inserted to help transmit sound into the inner ear. The eardrum is then folded back into position. The surgery can either be performed under general anaesthetic (you sleep through it) or local anaesthetic (the area treated is numbed) plus sedation (you are given medication to make you feel sleepy). You will be advised not to fly, blow your nose or allow any water to get into your ear for about six weeks after the operation. Other treatments include use of a hearing aid or taking sodium fluoride which helps harden the bone and can improve hearing in many patients with otosclerosis.
Hearing loss can be divided into two types: conductive hearing loss (caused by some sort of mechanical problem in the external or middle ear) or sensorineural hearing loss (caused by disorders of the inner ear, hearing nerve or associated brain structures).
Conductive hearing loss is often reversible and can be due to:
- blockage of the ear by e.g. wax, inflammation, infections or middle ear fluid
- poor sound conduction because of e.g. holes or scarring in the eardrum or the bones of the middle ear (ossicles) becoming fixed and rigid.
Sensorineural hearing loss is generally not reversible and can be caused by:
- genetic make-up (this could include congenital conditions i.e. those you are born with, or late-onset hearing loss)
- head injury
- certain medications
- exposure to loud noises
- the aging process (a significant hearing loss is experienced by about one third of people aged over 70 years).
Some of the signs you might notice that indicate you have a hearing loss include:
- having to turn up the volume on the TV or radio
- finding it hard to hear someone you are talking with
- finding it hard to hear in a group situation where there is background noise e.g. in a restaurant
- having to ask people to repeat themselves
- you find people's speech is unclear - they are mumbling
Hearing loss can be partial (you can still hear some things) or complete (you hear nothing) and may occur in one or both ears.
Treatments for hearing loss range from the removal of wax in the ear canal to complex surgery, depending on the cause of the loss. One of the most common treatments for hearing loss is the use of a hearing aid. The type of aid you get depends on the cause of your hearing loss and how bad it is, as well as what your preferences are in terms of comfort, appearance and lifestyle.
If your hearing loss is severe to profound, you may be suitable for a surgical procedure known as a cochlear implant. In this procedure, a small cut (incision) is made behind your ear and a device is implanted that can bypass the damaged parts of your ear. The surgery usually takes 2-3 hours and is performed under general anaesthesia (you sleep through it). You may be able to go home the same day or have to spend one night in hospital.
- acute - usually a bacterial (or sometimes viral) infection in the sinuses that follows a cold, or an allergic reaction.
- chronic - a long term condition that lasts for more than 3 weeks and may or may not be caused by an infection.
- facial pain or pressure
- nasal congestion (blocking)
- nasal discharge
Obstructive Sleep Apnoea (OSA)
- allergic – either seasonal (hay fever) caused by pollen allergies or perennial caused by e.g. house dust mite, pets.
- infectious – e.g. the common cold
- non-allergic, non-infectious – caused by irritants such as smoke, fumes, food additives
Swallowing Disorders (Dysphagia)
- medication – antacids, muscle relaxants or medicine to slow down stomach acid production
- changes in diet and/or lifestyle
- surgery e.g. stretching or releasing a tightened muscle
- nodules on the vocal cords – these may develop after using your voice too much or too loudly over a long period of time
- gastro-oesophageal reflux disease (GERD) – stomach acid comes back up the oesophagus and irritates the vocal cords. This is a common cause of hoarseness in older people
- polyps on the vocal cords
- glandular problems