Medical and Surgical ENT Services Pediatric and Adult

Cosmetic Surgery, Procedures and Skin Care

Audiology and Hearing Aid Services

Surgical Procedures
- Endoscopic Sinus Surgery: (FESS - Functional Endoscopic Sinus Surgery)
- Septoplasty and Turbinoplasty
- UPPP and LAUP for Obstructive Sleep Apnea and Snoring.
- Tonsillectomy and Adenoidectomy for Pediatrics and Adults.
- Bilateral Myringotomy with Tubes for chronic ear infections.
- Tympanoplasty: Repair of the eardrum.
- Thyroidectomy
- Parotidectomy
- Laryngoscopy

Patients of all ages are treated for ear, nose and throat diseases. Treatment is also available for hearing and balance disorders

With FESS there is very little postoperative discomfort - and an excellent chance of improvement in symptoms. Keep in mind, however, that ongoing medical therapy may be required to control underlying causes of inflammation - the sensitivities that made surgery necessary in the first place. After surgery, severe chronic inflammation may take months or even years to disappear completely. With FESS, serious complications are very rare, but because of the proximity of sinus structures to the eyes and the brain, it is not risk-free.

FESS procedures are a highly effective treatment strategy for complicated acute sinusitis and chronic sinusitis. Endoscopic surgical techniques that are similar to FESS are also used to treat benign (non-cancerous) tumors and occasionally even selected malignant (cancerous) ones. The primary advantage is that endoscopic procedures are much less invasive compared with the open surgical operations that were once standard. With FESS, risk is lower, discomfort is minimal and recovery times are shorter.

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Septoplasty and Turbinoplasty
The nasal septum is made of cartilage and bone covered with a lining (mucosa). It divides the nose into two separate chambers, left and right. Normally, the septum is relatively straight, with right and left nasal cavities of similar size. Occasionally, however, the nasal septum may be severely bent, or deviated - enough to encroach upon a nasal cavity. A deviated nasal septum may develop as the nose matures or could result from an injury to the nose. Common complications are breathing interference and a predisposition to sinus infections.

A deviated nasal septum that interferes with proper function of the nose is corrected by septoplasty. The surgery can take place under general or local anesthesia. Using a headlight or an endoscope, the surgeon makes an incision inside the nose, lifts up the lining of the septum, and removes and straightens the deviated portions of the septal bone and cartilage.

In the early period following the surgery, there is usually some tenderness and swelling inside the nose. Over time, because the nasal cartilage has some "memory," there can be a tendency for the septum to reshape itself back toward its deviated position. Other complications from the surgery are very rare, but can include bleeding, change in shape of the nose, some numbness of the front teeth, or impairment and even loss of the sense of smell.

Reduction/Removal of the Inferior Turbinate
Protruding into each breathing passage are bony projections called turbinates that increase the surface area of the inside of the nose and boost its 'air conditioning' and air-filtering functions. There are three turbinates (inferior, middle, and superior) on each side of the nose.

Large, swollen inferior turbinates can lead to blockage of nasal breathing. There are two main reasons for enlargement. Most of the time, enlarged inferior turbinates are the result of allergies, irritating environmental exposure, or some minor persistent inflammation within the
sinuses. Another reason is deformity of the nasal septum that has caused the bone on the wider side of the turbinate to increase in size. In the case of allergy- or irritant-related enlargement, treatment of the underlying problem may reduce turbinate swelling and solve the problem. If not, turbinate reduction surgery may be required. Because the turbinates help the nose to clean and humidify the air we breathe, it is usually better to leave as much tissue intact as possible. The doctor will opt for selective, or targeted, turbinate reduction - rather than extensive reduction.

If the procedure is isolated, and not part of another sinus operation, reduction of the inferior turbinate is usually performed under local anesthesia. Sometimes, surgery is guided by a headlight, but increasingly, surgeons use endoscopes to improve visualization and provide a magnified view during surgery. Once oriented, the surgeon makes an incision in the lining mucosa of the turbinate and carefully removes the underlying bone of the turbinate. If selective removal of soft tissue is also necessary, it can be accomplished using a microdebrider or laser. Occasionally, persistent swollen inferior turbinates are effectively treated with a freezing technique (cryotherapy). Alternately, they are heated with radio frequency electrical current (cautery or radiofrequency surgery). These methods cannot be used when the surgeon must remove an enlarged underlying turbinate bone.

Complications associated with inferior turbinate surgery include bleeding, crusting, dryness, and scarring. If you undergo an inferior turbinate reduction, your doctor may prescribe a spray or watery solution to relieve dryness and aid in healing. There is generally less risk of serious complications today than in the past, when inferior turbinates were extensively cut out, sometimes causing excessive crusting and nasal dysfunction.

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Uvulopalatopharyngoplasty (UPPP) and Laser Assisted Uvulaplasty (LAUP)
Uvulopalatopharyngoplasty (UPPP) is a surgical procedure for the treatment of severe Obstructive Sleep Apnea (OSA). In UPPP, soft tissue on the back of the throat and soft palate (the uvula) is removed. The tonsils and possibly other excess tissue may also be removed, if present. The procedure increases the width of the airway at the throat opening, improves the opening ability by interrupting muscular action, and "squares off" the palate to enhance its movement and closure. UPPP does not address apnea or snoring caused by obstructions at the base of tongue.

Surgeons usually use either conventional scalpel techniques or newer laser methods (LAUP, or Laser-Assisted Uvulopalatoplasty). LAUP may have a higher rate of success than UPPP, but it also requires the expertise of a surgeon highly skilled in laser procedures. UPPP is an invasive procedure that typically requires general anesthesia and an overnight hospital stay.

Laser Assisted Uvula Palatoplasty (LAUP)
LAUP allows treatment of snoring and mild OSA by removing the obstruction in your airway in an outpatient setting under local anesthesia. A laser is used to vaporize the uvula and a specified portion of the palate. LAUP is performed while you are positioned in an upright sitting position in an examination chair.

Before administration of anesthesia, you are informed that the back of your throat will become numb and that you will lose the sensation of swallowing and breathing. A local anesthesia is sprayed over the back oral cavity, soft palate, tonsils, and uvula followed by an injection of additional anesthesia in the muscle layer of the uvula. After several minutes, a CO2 laser is used to make both, vertical incisions in the palate on both sides of the uvula. The uvula is shortened, eliminating the obstruction that has contributed to the snoring.

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Tonsillectomy & Adenoidectomy
The most common reason for tonsillectomy and adenoidectomy is to remove enlarged tonsils and adenoids which block a child's breathing passages. The nose may be so blocked by the adenoid (which is located behind the nose and above the back of the throat) that a child can't smell, has a congested nose, and talks like he has a cold all the time. If the tonsils are too large, a child may not eat well, taking only small, soft foods. The child may also have some choking and mouth breathing. Often, a child snores very loudly, may not breathe well while asleep, and may actually stop breathing for several seconds. If severe and not treated, this can put strain on the heart and lungs. It has been shown that removal of the tonsils and adenoids is effective in treating obstructive sleep apnea in children.

Coblation® tonsillectomy is a gentle way to remove both tonsils. Coblation tonsillectomy uses radiofrequency, or RF, to remove tonsillar tissue. RF is a form of energy like radio waves, but with a higher frequency. Coblation tonsillectomy uses this energy in a precise and carefully controlled surgical process that causes very little harm to healthy tissue. Published studies have shown Coblation tonsillectomy to have the following patient benefits:

1. Less pain and less frequent use of narcotics
2. Significantly faster return to normal diet (2 - 4 days versus 7 - 6 days on average)
3. Less incidence of postoperative nausea and throat swelling
4. Less thermal damage to adjacent tissue
5. Faster healing

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Bilateral Myringtotomy with Tubes
The primary objective of surgical treatment for chronic serous otitis media is to re-establish ventilation of the middle ear, or equalize pressure of the middle ear with that in the ear canal. This keeps the hearing at a normal level and prevents recurring infections that might damage the tympanic membrane and middle ear bones. This involves a myringotomy with aspiration of fluid and insertion of a ventilation tube. A myringotomy (incision in the eardrum) is performed to remove the middle ear fluid. A hollow plastic tube or metal tube (ventilation tube) is inserted to prevent the incision from healing and to insure middle ear ventilation. The ventilation tube temporarily takes the place of the eustachian tube in equalizing middle ear pressure. This tube usually remains in place for six to nine months, during which time the eustachian tube blockage should subside. The tubes can be removed at a later date, but most of the time it is preferable to let the tubes work their way out of the eardrum. When the tube dislodges, the eardrum heals: the eustachian tube then resumes its normal pressure equalizing function. In rare instances (less than 5% of cases) the eardrum membrane does not heal following extrusion of the tube. The perforation may be repaired myringoplasty at a later date if this occurs. Usually this small perforation poses no problem, as it also would act as a ventilation tube. In adults, a myringotomy and insertion of a ventilation tube is usually performed in the office under local anesthesia, with the use of a topical solution placed on top of the tympanic membrane. In children, general anesthesia is required.

Most often when the ventilation tube is extruded there is no further middle ear ventilation problem. Should recurrent serous otitis media occur, reinsertion of a tube may be necessary. In some difficult cases it is necessary to insert a more permanent type of tube. When a ventilation tube is in place, a patient may carry on normal activities with the exception that no water must enter the ear canal. Often this can be prevented with vaseline on a cotton ball or Silly Putty can be used to provide occlusion of the ear canal. In addition a custom made earmold will often prevent water from entering the ear canal. One should be reminded that the purpose of a ventilation tube is not to drain the fluid in the middle ear space. This fluid is drained at the time of the surgery. The purpose of a tube is to equalize the pressures across the eardrum. This prevents the reoccurrence of fluid in the middle ear and re-establishes normal middle ear function.

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Myringoplasty
Most ear infections subside and the structures of the middle ear heal completely. In some cases, however, the eardrum may not heal and a permanent perforation (hole) in the eardrum results.Myringoplasty is the operation performed for the purpose of repairing a perforation in the eardrum when there is no middle ear infection or disease of the ear bones. This procedure seals the middle ear and improves the hearing in many cases.

Surgery is usually performed under general anesthesia through the ear canal or behind the ear. Fascia from muscle above the ear is used to repair the defeat in the eardrum. The patient is hospitalized for one night. Healing is complete in most cases in six weeks, at which time any hearing improvement is usually noticeable.

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Tympanoplasty
An ear infection may cause a perforation in the eardrum and may also damage the three bones that transmit sound from the eardrum to the inner ear and hearing nerve. Tympanoplasty is the operation performed to repair both the sound transmitting mechanism and any perforation in the eardrum. This procedure seals the middle ear and improves the hearing in many cases. Surgery may be performed through the ear canal or from behind the ear, under a local or a general anesthetic. The perforation is repaired with the fascia from muscle above the ear. Sound transmission to the inner ear is accomplished by repositioning or replacing diseased ear bones. In some cases it is not possible to repair the sound transmitting mechanism and the eardrum at the same time. In these cases the eardrum is repaired first and, four months or more later, the sound transmitting mechanism is reconstructed.

The patient is hospitalized for one night and may return to work in several days to a week. Healing is usually complete in six weeks. A hearing improvement may not be noted for a few months.

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Thryoidectomy
A thyroidectomy (THI-roy-DEK-tuh-mee) is surgery to remove all or part of your thyroid gland. The thyroid, an organ in the front of the neck, is divided into 2 lobes. It makes hormones that control how much energy you have and how fast your body uses it. If the thyroid grows too large, you may have difficulty swallowing and breathing. A surge of extreme overactivity (thyroid storm) can be life-threatening. If this happens, or if you have thyroid cancer, the gland must be removed. There are three types of thyroidectomy:

1. Total thyroidectomy (removal of the entire gland)
2. Subtotal thyroidectomy (removal of only the front part of each lobe)
3. Thyroid lobectomy (removal of only 1 side of the thyroid)

The operation is performed through an incision across the neck. The incision usually follows the natural skin lines and folds so that it will not be noticeable when it heals. Total operating time is typically 1 to 3 hours.

Risks: There are always risks with surgery. You might develop internal bleeding or get an infection. Blood clots could form and lodge in the lungs, making it difficult to breath. However, medical personnel are always alert for such complications, and know how to remedy them. Without the surgery, you risk thyroid storm, spreading cancer, or asphyxiation by the swollen gland.

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Parotidectomy
Surgery to remove all or part of the parotid gland (a large salivary gland located in front of and just below the ear). In a radical parotidectomy, the entire gland is removed.

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Laryngoscopy
Laryngoscopy is an examination that lets your doctor look at the back of your throat, your voice box (larynx), and vocal cords with a scope (laryngoscope). There are two types of laryngoscopy, and each uses different equipment.

Indirect laryngoscopy
Indirect laryngoscopy is done in a doctor's office using a small hand mirror held at the back of the throat. Your doctor shines a light in your mouth and wears a mirror on his or her head to reflect light to the back of your throat. Some doctors now use headgear with a bright light.indirect laryngoscopy is not done as much now because flexible laryngoscopes let your doctor see better and are more comfortable for you.

Direct fiber-optic (flexible or rigid) laryngoscopy
Direct laryngoscopy lets your doctor see deeper into your throat with a fiber-optic scope. The scope is either flexible or rigid. Flexible scopes show the throat better and are more comfortable for you. Rigid scopes are often used in surgery.

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