Otorhinolaryngology is a field of medicine dedicated to diagnosing and treating ear, nose and throat (ENT) diseases. In their everyday work, otorhinolaryngologists, also called ENT doctors, tests patients for balance and hearing, and perform different surgeries and procedures. Otorhinolaryngology includes also head and neck surgery to remove and treat tumors in these body regions. Below we describe some of the main and most debated ENT diseases and their treatment options.
Inflammatory conditions of the paranasal sinuses
As rhinitis is probably the most frequent disease in the world, its various aftermaths and complications are also very common.
One very common disease is otitis media in which the tympanic membrane, also called the eardrum, and the mucous membrane of the middle ear are inflamed. Acute otitis media is caused mostly by bacteria, but sometimes by viruses as well. Although antibiotics are the main treatment method, sometimes it is necessary to perform paracentesis of the eardrum. During this procedure, first the eardrum is rendered numb and then a tiny hole is made in the eardum to drain the pus. In case of persistent and/or recurrent inflammations, small plastic drainage tubes are inserted in the eardrum which serve as an exit for the pus. In some rare cases when the eardrum fails to heal after the removal of the tube, myringoplasty (surgical restoration of the eardrum) is performed.
Another disease with a similar etiology is sinusitis or an inflammation of the paranasal sinuses, which leads to the accumulation of mucus or pus in these cavities. Other sinuses may become inflamed as well, but maxillary sinuses are affected most often. In case of recurrent disease, one of the treatment options is surgical, called functional endoscopic sinus surgery (FESS). During this procedure, the maxillary sinuses are widened and cleaned to prevent the recurrence of the disease and improve ventilation.
Tonsils and adenoid
Palatine tonsils, often called simply tonsils, are pinkish lumps of tissue located on the left and right sides at the back of the throat. Although the function of the tonsils is to fight against pathogens, certain bacteria may cause the tonsils to become inflamed, a condition called tonsillitis. If the acute inflammation becomes frequent or is not treated adequately, chronic or permanent inflammation may develop. As a result, inflammatory agents and toxic products may leak from the tonsils to the blood and damage the heart, kidneys, joints and other organ systems. In that case it is advisable to remove the tonsils by means of an operation called tonsillectomy.
There is another tonsil – nasopharyngeal or pharyngeal tonsil – which is usually called adenoid. The adenoid plays an important role in the function of the immune system and protection against pathogens. Adenoid enlargement is a problem that more often affects children and more seldom adults. It may cause snoring, sleep disturbances, sleep apnea, headaches, coughing fits at night, and in children even speech problems and maldevelopment of the facial cranium. Enlarged adenoid may also lead to frequent otitis media. The only effective treatment is the surgical removal of the adenoid, called adenoidectomy.
Breathing and sleep problems
There are other conditions that may cause breathing and sleep problems, such as deviated nasal septum, nasal polyps, and sleep apnea.
Nasal septum deviation is usually caused by a trauma, such as nasal bone fracture. Its characteristic symptom is difficulty breathing through one or both nostrils. Quite often it also causes chronic rhinitis. Here as well the only effective treatment is surgical. During the operation, called septoplasty, the nasal septum is straightened.
Nasal polyps are growths or swellings of the lining of the nasal passages or sinuses, probably caused by allergic and chronic rhinitis. In most cases, polyps arise from the ethmoidal air cells and maxillary sinuses. When polyps get bigger, they start to fill the nasal passages and may cause persistent obstruction and loss of sense of smell. Treatment options include local steroid treatment or surgical removal.
(Obstructive) sleep apnea is a breathing pause during sleep, lasting over 10 seconds, caused by the collapse of the upper airway. For diagnosing a disease, a person has to have over five apnea episodes per hour. Its main symptom is loud snoring during sleep. Other, not so evident symptoms include restless sleep, morning headache, daytime sleepiness, recurrent airway inflammation, high blood pressure etc. To alleviate symptoms, mostly nonsurgical treatment is used (including eliminating risk factors). One of the minimally invasive surgical methods is called coblation, whereby excessive soft tissue is removed by using thermal energy.
Rhinoscopy is an examination of the nasal cavity, performed by means of a special thin tube-like instrument called rhinoscope. A rhinoscope is equipped with a lamp, so that the doctor can observe the nasal cavity. Usually rhinoscopy is performed in two stages – anterior rhinoscopy and posterior rhinoscopy. For anterior rhinoscopy, the rhinoscope is inserted through the left and right nostrils; posterior rhinoscopy is performed by inserting the rhinoscope via the mouth in order to examine the back of the nasal cavity from behind the soft palate.