Some Questions Answered

Adenoids are small glands in the throat, at the back of the nose. In younger children they are there to fight germs. We believe that after the age of about three years, the adenoids are no longer needed.

Your body can still fight germs without your adenoids. They probably only act to help fight infection during the first three years of life; after then, we only take them out if they are doing more harm than good.

Sometimes children have adenoids so big that they have a blocked nose, so that they have to breathe through their mouths. This blocked nose often means that they snore at night. Some children even stop breathing for a few seconds while they are asleep. The adenoids can also cause ear problems by preventing the tube which joins your nose to your ear, from working properly.

We don’t know what causes people to experience chronic catarrh. Research suggests that it is not related to allergy, nor is it due to any abnormality of the way mucus is transported within the nose. It is possible that the catarrh may be due more to an abnormality of the feeling in the lining of the back of the nose and the throat. This may explain why so many patients find it difficult to spit out the mucus that they are sensing at the back of the throat.

Sinuses are air-filled spaces in the bones of the face and head. They are connected to the inside of the nose through small openings. The sinuses are important in the way we breathe through the nose and in the flow of mucus in the nose and throat. When the sinuses are working properly we are not aware of them but they often are involved in infections and inflammations which cause symptoms. These infections and inflammations are called sinusitis.

Grommets are very small plastic tubes, which sit in a hole in the eardrum. They let air get in and out of the ear. This keeps the ear healthy.

Some people get fluid behind the eardrum. This is sometimes called ‘glue ear’. It is very common in young children, but it can happen in adults too. We don’t know exactly what causes glue ear. Most young children will have glue ear at some time, but it doesn’t always cause problems. We only need to treat it if it is causing problems with hearing or speech, or if it is causing lots of ear infections.

The grommet are placed in the eardrum under a short general anaesthetic and the procedure is usually performed as a day case admission to hospital. The operation is carried out down the ear canal so there are no cuts to see on the outside of the ear. A small opening is made in the eardrum using a microscope to magnify the area and the fluid is sucked out of the ear with a fine sucker. The grommet is then placed in the opening in the eardrum. The procedure takes between ten and twenty minutes.

Grommets fall out by themselves as the eardrum is constantly growing. They may stay in for six months, or a year, or sometimes even longer in older children. You may not notice when they drop out.

Glue ear tends to get better by itself, but this can take a while. We like to leave children alone for the first three months, because about half of them will get better in this time. After three months, we will see your child again and decide whether we need to put in grommets. If the glue ear is not causing any problems, we can just wait for it to settle by itself. If it is causing problems with poor hearing, poor speech or lots of infections, it may be better to put grommets in. If we do put in grommets, the glue ear may come back when the grommet falls out. This happens to one child out of every three who has grommets put in. We may need to put more grommets in to last until your child grows out of the problem. You may change your mind about the operation at any time, and signing a consent form does not mean that your child has to have the operation. If you would like to have a second opinion about the treatment, you can ask your specialist. He or she will not mind arranging this for you. You may wish to ask your own GP to arrange a second opinion with another specialist.

Steroid nasal sprays may help some children if they have nasal allergy; Congestion in the nose caused by allergy may affect the normal function of the nose and ears. Antibiotics, antihistamines and decongestants do not help this type of ear problem. Alternative treatments, such as cranial osteopathy are not helpful. Using a nasal balloon to open the tube to the ear may help older children if used regularly. Taking out the adenoids may help the glue ear get better, and your surgeon may want to do this at the same time as putting grommets in. A hearing aid can sometimes be used to treat the poor hearing and speech problems that are caused by glue ear. This would mean that your child would not need an operation.

Grommets are not usually sore at all. You can give your child simple painkillers (e.g. paracetamol or ibuprofen) if you need to. Grommets should improve your child’s hearing straight away. Some children think everything sounds too loud until they get used to having normal hearing again. This usually takes only a few days.

Most people with grommets do not get any ear infections. If you see yellow fluid coming out of the ear, it may be an infection. It will not be as sore as a normal infection, and your child won’t be as ill. In this situation we advise you to take your child to see your GP. If you get some antibiotic ear drops from your GP doctor, the problem will quickly settle. Some doctors may give antibiotics by mouth instead of antibiotic ear drops.

Your child can start swimming a couple of weeks after the operation; diving under the water is not a good idea as water may pass through the grommet into the ear. Some parents have earplugs made if their child is a very keen swimmer, to use until the grommets have come out. The hole in the grommet is too small to let water through, unless the water is dirty or has shampoo or soap in it. So you need to be careful in the bath or the shower. You can plug your child’s ears with a cotton-wool ball covered in Vaseline until the grommets have come out. How long will my child be off nursery or school? Your child should be able to get back to normal the day after the operation.

It is OK to fly in an aeroplane with grommets. The pain from the change in pressure in the aeroplane cannot happen when the grommets are working. We need to check your child’s hearing after grommets have been put in, to make sure their hearing is better, and see your child once the grommets have come out to check their ears and hearing; this will usually be about nine to twelve months after the operation. Sometimes when a grommet comes out, a small hole in the eardrum is left behind. This usually heals up with time, and we rarely need to operate to close the hole. The grommet can leave some scarring in the eardrum; this does not usually affect the hearing.

The evidence is that neither medical treatments such as antibiotics or antihistamines nor alternative treatments such as cranial osteopathy are any better than waiting for a period of three months to see if the glue ear clears on its own. What happens if the glue ear is not treated? Doctors do not really know if any damage occurs to the ear or hearing if the glue ear is not treated. We usually advise treating the problem if it does not clear up on its own to avoid the risk of long-term damage to the ear and hearing or problems in later life with language skills. Is glue ear common in adults? Glue ear is uncommon in adults. It can follow on from a bad head cold, flu or other viral infection of the ear, nose or sinuses. Rarely, it can be caused by a serious blockage of the tube that goes from the back of the nose to the ear. (The Eustachian tube). Adults with glue ear should be seen by a ENT specialist as soon as possible.

In 2008, the National Institute for Health and Clinical Excellence (NICE) published a guideline about the treatment of glue ear in children. [www.nice.org.uk]. If you have concerns about your child’s hearing or speech and language development, you should ask your health visitor or GP to refer your child for a hearing test.For children under the age of four years, this will probably be at a community hearing clinic. For older children, they will probably be referred to an ENT (ear, nose and throat) clinic in a hospital to see a specialist and have a hearing test. For most children, the glue ear will get better with no treatment. You will probably be asked to come back for a second hearing test three or four months after the first test. Many children will get better over this time. Those children who do still have problems after this period of what doctors call ‘watchful waiting’ or ‘active monitoring’ will probably be recommended surgical treatment. This may be grommet surgery or adenoidectomy and grommet surgery.

For some children, glue ear can be a problem for much longer than others. In children with Down’s syndrome or cleft palate, hearing aids should be discussed with your specialist as a first treatment for glue ear.

Hearing aids will help the hearing and give more time for the glue ear to clear. You can discuss this with your specialist.

It is important that you do not blow you nose for the first 48 hours following your operation. Your surgeon will advise you on when you can start to gently blow your nose. Some doctors recommend the use of drops, ointments and salt water sprays after the operation. You will be given specific instructions by the ward staff before your discharge from hospital. Some mucus and blood stained fluid may drain from your nose for the first week or two following the operation and this is normal. It is important to stay away from dusty and smoky environments while you are recovering.

It is common for the nose to be quite blocked and to have some mild pain for a few weeks after the operation. This usually responds to simple painkillers.

Endoscopic Sinus Surgery is the name given to operations used for severe or difficult to treat sinus problems. In the past sinus operations were done through incisions (cuts) in the face and mouth but endoscopic sinus surgery allows the operation to be performed without the need for these cuts. Before any operation patients will be treated using drops, tablets or sprays for a period of weeks if not months. Only if these treatments are unsuccessful will an operation become necessary. After an examination of your nose with a telescope your surgeon will discuss whether or not you will need to have a CT scan to help decide about the need for an operation.

Sinusitis is caused by blocked, inflamed or infected sinuses. Patients will often complain of a blocked nose, pressure or congestion in the face, runny nose or mucus problems. Other symptoms include headache and lose of sense of smell. Sinusitis can be difficult to diagnose and your specialist will want to examine your nose with a telescope in order to help find out what is wrong. Most patients with sinusitis get better without treatment or respond to treatment with antibiotics or nose drops, sprays or tablets. In a very small number of patients with severe sinusitis an operation may be needed. In rare cases if sinusitis is left untreated it can lead to complications with infection spreading into the nearby eye socket or into the fluid around the brain. These very rare complications are just some of the reasons that a sinus operation may become necessary.

There are unfortunately no cures for chronic catarrh. It is quite possible that those catarrh sufferers who also have runny nose will benefit from a steroid nasal spray. For those who do not have runny nose, they usually do not find these sprays helpful. On the whole, antibiotics do not seem to be helpful. Simple remedies such as saline nasal rinses, which can be made at home or purchased over the counter at a pharmacist, are reported by some sufferers to give partial relief of their symptoms. These need to be used regularly (3 or 4 times per day) and over a long period of time, for as long as it provides benefit. Homeopathy practitioners often have an interest in managing catarrh although again there are no reliable studies to say whether or not homeopathy can be proven to work for catarrh.

Self-help is probably the most important part of managing your catarrh. It is worth bearing in mind that although you have the intense feeling of phlegm in the back of your nose or throat, it is quite possible that this is more to do with the feeling within the lining rather than an actual build up of mucus. Furthermore, although catarrh patients often find their condition “frustrating” and “disgusting”, it is worth remembering that mucus is not in any way harmful to the body. Persistent throat clearing often becomes a vicious cycle whereby the action of clearing your throat actually worsens and perpetuates the situation. It is therefore worth trying to avoid clearing your throat and you may find sipping iced water useful in suppressing the urge to do so. Some patients report an improvement in their symptoms from avoiding dairy products in their diet although there is no research at the moment to say whether or not this is truly beneficial. Over-the-counter catarrh cures are okay to try but many people find these unhelpful. Unfortunately chronic catarrh does seem to be a problem that affects people for many years of their life regardless of the remedies that they try. It is therefore worth finding ways to adapt to your symptoms and ways to lessen them, rather than looking for a fix or a cure. Salt water nasal rinses are helpful for lessening the symptoms of catarrh and are simple to make and administer.

There is no diagnostic test for catarrh given that it is not due to an actual disease. When people are said to have catarrh, it is based only on a sensation that they feel. We know from research that tests for allergy, tests of mucus flow and CT x-ray scans of the sinuses are not helpful in the management of people who experience chronic catarrh.

Catarrh is associated with a great number of other symptoms. Apart from the sensation of mucus at the back of the nose or throat, or of a persistent desire to clear the throat, patients may also notice other symptoms. These include:- • A sensation of nasal congestion, • ineffective nose blowing, • throat discomfort, • crackling or dragging sensation in the ears, • a sensation of choking or something stuck in the throat, • a constant cough or of feeling sick.

Catarrh is a condition that is very common but yet very difficult to describe well. It means different things to different people. Some people use the term catarrh to describe a feeling of mucus at the back of their nose. Others use it to describe a build up of phlegm in their throat and for some it simply means the continuous desire to clear their throat. Catarrh is not even well defined in the medical textbooks – except to say that the term comes from ancient Greek times and literally means ‘to flow down’. What we do know about people who suffer from catarrh is that they experience the sensation most of the time and often for many years. Most people will get a degree of catarrh when they have a cold or flu, but this usually clears away quite quickly. People with chronic or long standing catarrh usually describe the feeling of having a constant cold but without any of the other symptoms of a cold.

Adenoid surgery is very safe, but every operation has small risks. The most serious problem is bleeding, which may need a second operation to stop it. However, bleeding after adenoidectomy is very uncommon. In a survey of all adenoid surgery in England, bleeding happened in one in every two hundred operations. It is very important to let us know well before the operation if anyone in the family has a bleeding problem. During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if your child has any teeth like this.

Your adenoids get smaller as you grow older, so you may find that nose and ear problems get better with time. Surgery will make these problems get better more quickly, but it has a small risk. You should discuss with your surgeon whether to wait and see, or have surgery now. For some children, using a steroid nasal spray will help to reduce congestion in the nose and adenoid and may be helpful to try before deciding on surgery. Antibiotics are not helpful and only produce temporary relief from infected nasal discharge. They have side effects and may encourage “super-bugs” that are resistant to antibiotics. Signing a consent form does not mean that your child has to have the operation; you may change your mind about the operation at any time. If you would like to have a second opinion about the treatment, you can ask your specialist. He or she will not mind arranging this for you. You may wish to ask your own GP to arrange a second opinion with another specialist. There is no evidence that alternative treatments such as homeopathy or cranial osteopathy are helpful for tonsil problems. If you would like to have a second opinion about the treatment, you can ask your specialist. He or she will not mind arranging this for you. You may wish to ask your own GP to arrange a second opinion with another specialist.

If your child gets lots of tonsillitis (sore throats) or has difficulty breathing at night then we may decide to take out the tonsils at the same time as the adenoids.

There is no good evidence that adenoidectomy reduces immune function or makes people more prone to chest infections. If possible, it is probably wise to avoid adenoidectomy in children less than three years of age as the adenoids may be helping develop their ability to fight off infections.

This is possible but uncommon.

The traditional technique is to use a curette, which is a special type of surgical cutting device. This is a safe technique, although a consideration for small children having the operation is that the blood loss may be higher at the time of surgery. Other techniques are becoming more popular. Electric diathermy and Coblation dissection have the advantage of less blood loss at the time of surgery. The laser has fallen out of favour because of the much higher levels of pain after the operation.

Adenoidectomy is generally avoided in children under 15kg weight, approximately three years of age, because of the small risk of blood loss during or after the operation. There is no upper age limit, but the adenoid has usually shrunk to almost nothing by the teens.

Hay fever is the common name given to cold-like symptoms caused by breathing in plant pollen at certain times of the year.

Plants only disperse their pollen during their growing season and therefore individual plant pollen is not in the air all year round. Plants release their pollen at the same time every year, when the weather is dry. Wet weather conditions will influence pollen dispersal and will affect how long it remains in the air. Throughout the pollen season, specialist pollen monitoring centres trap pollen and calculate the daily concentration of the various airborne pollens. The daily pollen count is broadcast by media outlets, along with the weather forecast and is reported as low, medium or high. Highly sensitive individuals can suffer hay fever symptoms even when the pollen count is low. When the pollen count is high, most people sensitised to the pollen are likely to have symptoms.

Hearing loss is a symptom of a variety of conditions affecting the hearing organ or its nerve connection to the brain. It may be caused by problems affecting the transmission of sound through the eardrum and bones of hearing (called ossicles) to the cochlea (the organ of hearing), or it may be due to problems in the cochlea and the auditory nerve that connects the cochlea to the brain. Conductive hearing loss is caused when something interferes with the transmission of sound from the ear canal to the cochlea. Sensorineural hearing loss is caused when there is a problem with the cochlea, or the nerve connection from the cochlea to the brain.

Conductive hearing loss can be due to problems in the ear canal, ear drum (tympanic membrane) or the middle ear bones (ossicles). These three bones are called the Hammer, Anvil and Stirrup (or Malleus, Incus and Stapes). In children the commonest type of hearing loss is conductive hearing loss. This is usually due to fluid being trapped behind the eardrum. This condition is called glue ear, or Otitis Media with Effusion (OME). The fluid stops the eardrum from vibrating. Sometimes there are other causes for childhood conductive hearing loss. Rarely children may be born with poorly formed middle ear bones, or these structures can be damaged through ear infection. Conductive hearing loss in adults is less common, but may be due to problems with the bones of hearing or occasionally glue ear. Heavy wax accumulation in the ear canal can also cause a mild degree of conductive hearing impairment.

Most adults first start to notice difficulty in following conversation when there is background noise or when more than one person is talking. Often their friends will complain that they don’t listen or that they turn the television volume up too loud. They may become increasingly withdrawn and frustrated that they cannot socialise easily. In children, parents find that they might be inattentive, or ignore instructions or appear naughty. Listening to the television at high volumes is common and some times the child’s teachers will complain. Young children with delayed speech production should always be assessed for hearing loss.

Action On Hearing Loss, formerly The Royal National Institute for the Deaf (RNID), offers an Online Hearing Test. In most circumstances you should see your doctor, who will be able to examine you for wax impaction and look for signs of ear disease. Your doctor can then arrange hearing tests and if necessary review by an ENT consultant.

Hoarseness or Dysphonia means a change in the sound of someone’s voice. People suffering from hoarseness can experience a strained, husky or breathy voice. • They may also notice a difference in loudness and/or changes in how high or low their voice sounds (Pitch). • Changes in voice pitch are common in young children as they grow through puberty (voice “breaking”). • A complete loss of voice, resulting in only a whisper, is called Aphonia.

Normally when we talk/sing the vocal cords come together and vibrate. This creates a sound which we know as the voice. Hoarseness results from the vocal cords in the voice box (Larynx) not working properly. There are several causes of hoarseness, fortunately most are not serious and tend to go away after a short period of time. Common causes are: • A viral upper respiratory tract infection, causing the voice box lining to swell (Laryngitis) • Stomach acid/enzymes irritating the throat (Laryngopharyngeal Reflux) • A build-up of soft tissue (polyps) or thickenings (nodules) on the vocal cords. These can develop when the voice is used too much or too loudly for long periods of time (Singer’s Nodules). Vocal cord polyps are often related to smoking. • Problems with the strength of the lungs can also lead to a change in voice • Rarely a growth or tumour develops on the vocal cords and or voice box. These may be non-cancerous (benign) or cancerous (malignant). • Problems with movement of the vocal cords (paralysed vocal cords). One or both of the vocal cords may be paralysed if it’s nerve is affected by infection or tumour.

A key question here is whether the hoarseness is constant or getting worse or does it come and go with periods of “normal” voice in between. Intermittent mild episodes of hoarseness: In most cases this will settle by itself. To help relieve the symptoms one can: • rest the voice (but don’t resort to whispering which can make matters worse). • drink plenty of fluids (avoid too many fizzy drinks). • avoid alcohol. • avoid cigarette smoke. • take Antacids e.g Gaviscon if you get a build-up of acid in the throat.

The ear consists of the outer, middle and inner ear. Sound travels through the outer ear and reaches the eardrum, causing it to vibrate. The vibration is then transmitted through three tiny bones (ossicles) in the middle ear. The vibration then enters the inner ear where the nerve cells are. The nerve cells within the inner ear are stimulated to produce nerve signals. These nerve signals are carried to the brain, where they are interpreted as sound.

A hole in the eardrum is known as a “perforation”. It can be caused by infection or injury to the eardrum. Quite often a hole in the eardrum may heal itself. Sometimes it does not cause any problem. However a hole in the eardrum may cause a discharge from the ear. If the hole in the eardrum is large, then the hearing may be reduced.

You will need an examination by an otolaryngologist (ear, nose and throat specialist) to rule out any hidden infection behind the perforation. The hole in the eardrum can be identified using a special medical instrument called ‘auriscope’. It consists of a magnifying lens and light. Examination with the auriscope is pain free. The amount of hearing loss can be determined only by careful hearing tests. A severe hearing loss usually means that the ossicles are not working properly, or the inner ear is damaged.

If the hole in the eardrum has only just occurred, no treatment may be required. The eardrum may simply heal itself. If an infection is present you may need antibiotics. You should avoid getting water in the ear until the eardrum heals. A hole in the eardrum that is not causing any problems can be left alone. If the hole in the eardrum is causing discharge or deafness, or if you wish to swim, it may be sensible to have the hole repaired. The operation is called a “myringoplasty”. You should discuss with your surgeon whether this surgery is appropriate for you.

Microlaryngoscopy is the examination of your larynx (voice box) while you are under a general anaesthetic.

The mastoid bone is the bony prominence that can be felt just behind the ear. It contains a number of air spaces, the largest of which is called the antrum. It connects with the air space in the middle ear. Therefore ear diseases in the middle ear can extend into mastoid bone.

Operations on the mastoid may be necessary when ear infection within the middle ear extends into the mastoid. Most commonly this is a pocket of skin growing from the outer ear into the middle ear, known as cholesteatoma. This causes infection with discharge and some hearing loss. The pocket gets slowly larger, often over a period of many years, and causes gradual erosion of surrounding structures. Erosion of the ossicles can result in hearing loss. The only effective way to get rid of this pocket of skin is surgery. You may change your mind about the operation at any time, and signing a consent form does not mean that you have to have the operation. If you would like to have a second opinion about the treatment, you can ask your specialist. He or she will not mind arranging this for you. You may wish to ask your own GP to arrange a second opinion with another specialist.

Usually a general anaesthetic is used. There are several ways of doing the operation, depending on the extent of the ear disease and the surgeon. They have various names such as atticotomy and mastoidectomy and take between one and three hours. The surgeon should discuss with you about his choice before the operation. It involves a cut either above the ear opening or behind the ear. You may also wish to discuss with your GP or do your own research before signing the consent form. The bone covering the infection within the mastoid cells is removed. The resultant bony defect is called a mastoid cavity. Some surgeons leave the mastoid cavity open into the ear canal. This allows the surgeons to inspect the mastoid cavity easily. Other surgeons close up the mastoid cavity with bone, cartilage or muscle from around the ear. You should discuss with your surgeon his/her preferred approach. At the end of the operation, packing will be placed in your ear while it heals.

The ear may ache a little after mastoid surgery but this can be controlled with painkillers provided by the hospital.

The chances of obtaining a dry, trouble free ear from this operation by experienced surgeons are over 80 percent. In some patients it is possible to improve the hearing as well. You should enquire from your surgeon the likelihood of success in your particular case.

The sensation of a blocked nose is often referred to as nasal obstruction, nasal blockade, a stuffy nose and nasal congestion. The severity of the nasal obstruction varies from one patient to the next. Some people find even mild nasal blockage quite troublesome, whereas others, with quite severe nasal obstruction, find it does not have a significant impact on their daily activities. Your specialist will take this into account when developing a plan for your treatment.

Nasal obstruction can be due to problems with the shape of the inside of the nose, or swelling of the lining of the inside of the nose. Problems with the shape of the inside of the nose can be due to twisting of the middle partition of the nose (the nasal septum), or to weakness of the outside of the nose. Either of these may be associated with abnormalities of the shape of the outside of the nose. Occasionally other structures, such as the adenoids, can be enlarged leading to nasal obstruction. The nose is lined by a thin mucous membrane which can swell to cause blockage. Folds of the mucous membrane called turbinates are particularly prone to swelling. We all experience this swelling in response to the common cold, in which case the lining swells in response to a viral infection. Doctors often refer to swelling of the lining of the nose as “rhinitis” and it can have many other causes. Apart from viral infections, rhinitis may be due to bacterial infection in the nose and sinuses, allergy, or overuse of nasal decongestant medication. Occasionally the mucous membrane swells enough to cause the formation of polyps in the nose. For more information on nasal polyps please see the appropriate patient information leaflet.

Nasal obstruction is a symptom in itself. In certain conditions it may be accompanied by other symptoms such as rhinorrhoea (nasal discharge, which can drip from the front of the nose, or into the back of the throat – catarrh), facial pain, anosmia (loss of sense of smell), sneezing, itching and crusting. Your specialist will consider these other symptoms when making a diagnosis and developing a plan for your treatment.

The septum is a thin piece of cartilage and bone inside the nose between the right and left sides. It is about 7 cms long in adults. In some people this septum is bent into one or both sides of the nose, blocking it. Sometimes this is because of an injury to the nose, but sometimes it just grows that way. We can operate to straighten the septum.

• If you have a blocked nose because of the bend in the septum, an operation will help. • Sometimes we need to straighten out a bent septum to give us room to do other things, such as sinus surgery. The operation is not meant to change the way your nose looks. • In some cases a bent septum may occur with a twist in the outside shape of the nose. In these cases septal surgery may be combined with nose re-shaping surgery (septorhinoplasty) to straighten the nose.

A bent septum will not do you any harm, so you can just leave it alone if you want to. Only you can decide if it is causing you so much bother that you want an operation. You may change your mind about the operation at any time, and signing a consent form does not mean that you have to have the operation. If you would like to have a second opinion about the treatment, you can ask your specialist. He or she will not mind arranging this for you. You may wish to ask your own GP to arrange a second opinion with another specialist.

Not really, but sometimes the front of your nose can be a bit tender for a few weeks.

Oesophagoscopy is done under general anaesthetic. It is done to help problems of the gullet, such as difficult or painful swallowing. Occasionally, Oesophagoscopy may need to be done urgently to remove food stuck in the gullet. Your surgeon will pass a long metal tube (oesophagoscope) through your mouth into your gullet. This allows the surgeon to look at the inside of the gullet to identify any problems that may be affecting your swallowing. If there are any problem areas, a small part of the lining of the gullet is taken away for laboratory examination. This is called a biopsy. Oesophagoscopy is quite quick and usually takes less than 20 minutes. Sometimes it is performed together with a microlaryngoscopy or direct laryngoscopy.

After oesophagoscopy, you may find that your throat hurts. This is because of the metal tubes that are passed through your throat to examine the gullet. Any discomfort settles quickly with simple painkillers and usually only lasts a day or two. Some patients feel their neck is slightly stiff after the operation.

Tonsils are small glands in the throat, one on each side. They are there to fight germs when you are a young child. After the age of about three years, the tonsils become less important in fighting germs and usually shrink.

Your body can still fight germs without them. We only take them out if they are doing more harm than good.

We will only take your child’s tonsils out if he or she is getting lots of sore throats, which are making him or her lose time from school. Sometimes small children have tonsils so big that they block their breathing at night.

Your child may not need to have his or her tonsils out. You may want to just wait and see if the tonsil problem gets better by itself. Children often grow out of the problem over a year or so. The doctor should explain to you why he or she feels that surgery is the best treatment. Antibiotics may help for a while, but frequent doses of antibiotics can cause other problems. A low-dose antibiotic for a number of months may help to keep the infections away during an important period such as during examinations. There is no evidence that alternative treatments such as homeopathy or cranial osteopathy are helpful for tonsil problems. You may change your mind about the operation at any time, and signing a consent form does not mean that your child has to have the operation. If you would like to have a second opinion about the treatment, you can ask your specialist. He or she will not mind arranging this for you. You may wish to ask your own GP to arrange a second opinion with another specialist.

Tinnitus is a sensation or awareness of sound that is not caused by a real external sound source. It can be perceived in one or both ears, inside the head or in the person’s immediate environment. Although it is commonly assumed to be a ringing noise, tinnitus can take almost any form including hissing, whistling, humming and buzzing. Some people even hear musical sounds or sounds resembling indistinct speech. Some people hear a single sound whereas others hear multiple noises. For some, the sound is constant: for others it is constantly changing.

It is often assumed that tinnitus is caused by damage to the ears. This is true in some cases but it is perfectly possible to have tinnitus with normal ears and normal hearing. Several studies have been performed where people who do not have tinnitus were placed in soundproofed rooms and told to listen intently. In this situation almost everyone becomes aware of a sound sensation. Many scientists think that tinnitus is generated by random electrical signals that can occur in any part of the hearing pathway. Thus tinnitus may originate in the ears, in the hearing nerve or in the brain. Such random signals are common and usually we are not aware of them happening. Occasionally something happens that causes some people to interpret these random signals as sound. Common triggers for this process are emotional shocks and loss of hearing, either gradual or sudden. However, in many people, the trigger is unknown. Once we become aware of the tinnitus signal, it draws the attention of the brain making tinnitus even more distressing. This type of tinnitus is called subjective tinnitus because it is only heard by the sufferer. A few people have tinnitus that is attributable to a real sound, generated inside the body by blood flow or muscular activity. This type of tinnitus may be detectable by other people, either just by careful listening or by using a stethoscope. This kind of tinnitus is known as objective tinnitus.

• Tinnitus is a symptom in itself. • It may be accompanied by hearing loss, dizziness, pain in the ears (otalgia) or dislike of loud sounds (hyperacusis). • Many people with tinnitus also feel that their ears are blocked. Your specialist will consider these other symptoms when making a diagnosis and developing a plan for your treatment.

The first thing your specialist will do to diagnose your condition is to ask some questions about your symptom. This is actually all that is necessary to reach a diagnosis and there is no special ‘tinnitus test’. Of course your specialist will want to know as much as possible about your hearing and will perform a full examination of your ears. Other areas such as the nose, jaw joints and throat may be examined. If the specialist thinks that you may have objective tinnitus he or she may listen around your ear and neck with a stethoscope. In almost all cases the specialist will arrange some tests. The most common test is a hearing test (pure tone audiogram). There are some hearing tests that try and match the persons’ tinnitus but they do not influence treatment greatly. Many specialists therefore do not request these tests. For selected patients, the doctor may wish to order an MRI scan though other tests such as CT scans or ultrasound scans are sometimes utilised. Blood tests may occasionally be required but this is unusual in the diagnosis of tinnitus.

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