ENT

Anatomy Of Tonsils And Adenoids

Tonsils are a part of the immune system located in throat while adenoids are a similar tissue located in nasopharynx( part behind the nose). Both act as a first line of defence against microbe invasion of aerodigestive tract.

While performing this immunoprotective task, the se tissues by themselves may become a part of the disease process by becoming a site of infection themselves. Additionally adenoids by virtue of their location may further cause nasal obstruction leading to poor nasal breathing. Both conditions are more common in children .

Symptoms Of Tonsillitis

• Throat pain - Frequent sore throat
• Enlarged neck lymph nodes
• difficulty in swallowing
• May lead to conditions like Rheumatic Heart disease or Glomerulonephritis in children
• Failure to grow/thrive in children

Tonsillectomy

If the above symptoms are found , there may be a need to undergo tonsillectomy surgery pending further evaluation , whereby tonsils are removed from both sides. Tonsils are very much a removable tissue, and are removed intraorallyi.e via mouth

Symptoms Of Adenoid Enlargement

• Nasal blockage
• Breathing through mouth, especially noted at night
• Nasal bleed
• Failure to grow/ thrive in children
• Facial changes in children ( called as adenoid facies)
• Ear symptoms like decreased hearing, effusion (fluid) in the ear and ear discharge

Adenoidectomy

In case the above symptoms are present , there may be a need to undergo adenoidectomy surgery pending further evaluation. At our centre adenoidectomy is carried out under endoscopic vision and with the help of a special blade called as microdebrider ; among the many techniques of adenoid removal, the above technique has been found to be superior to all others, as complete removal of adenoid tissue is ensured without the risk of damage to any vital structures and any chances of recurrence.

Moreover , often both the conditions are found to be coexisting in the same patient with children being most commonly affected and hence they must be diagnosed and treated to prevent further complications.

• Skull is a composition of bones and cartilages. These bones & cartilages form the face and the cranium surrounding the brain.
• Five bones form the bottom of the cranium. These bones form the eye socket, roof of the nasal cavity, few sinuses and the surrounding bones of the ear.
• Skull area has crucial openings that the spinal cord, many blood vessels, and nerves all pass through.
• Tumours both benign and cancerous ones which grow on the underside of the brain are removed by skull base surgery. Abnormalities over the underside of brain and in few cases on the top few vertebrae of the spinal column are removed by skull based surgery.
• The surgical area being complicated and crucial one, skull base surgery may be done by a minimally invasive endoscopic procedure. In such procedure insertion of instruments is through natural opening of the skull i.e. nose or mouth. In some case the insertion happens through a small hole just above the eyebrow.
• Team of specialists involved in this surgery are ENT surgeons, neurosurgeons and radiologists.
• In earlier times the only way to remove such growths in this area of the body was by making an opening in the skull. Now due to development and advancements in endoscopic skull base surgery there is minimum invasive endoscopic procedure.
• In some cases, an opening in the skull may be needed to remove the growth.

Growths And Conditions That May Be Treated By Skull Base Surgery :

• Cysts that develop from birth.
• Growths caused by infections
• Pituitary tumors. The pituitary gland is behind the nose and eyes.
• Meningiomas. These tumor growths are from the meninges. It is a tissue that covers the brain and lies in between the brain and skull.
• Chordomas. This tumour grows slowly at the base of the skull.
• Trigeminal neuralgia, a growth with intense pain on one side of the face.
• Craniopharyngiomas, growths that occur near the pituitary gland.
• Craniosynostosis, a condition in infants in which the bones of the skull close too early. This causes brain problems and growth & shape of the skull are adversely affected.
• Cerebrospinal fluid fistulas.
• Cerebral aneurysm, a weak, often bulging area in a blood vessel in the brain.
• Arteriovenous malformations. These are arteries and veins that are abnormally connected to one another.

Types Of Skull Base Surgery

• Endoscopic or minimally-invasive skull base surgery.
  An ENT surgeon makes a small opening inside the nose. This allows the neurosurgeon to remove the growth using an endoscope (it is a thin lighted tube). Radiologist takes MRI pictures which further help the neurosurgeon to ensure that the growth is completely removed.
• Traditional or open skull base surgery.
  This surgery makes incisions in the facial area and in the skull. Partial bone may need to be removed so that the growth can be reached and removed completely.

Symptoms

The following symptoms are shown to indicate any abnormality in the skull base area. Symptoms will depend on the size, type, and location of the growth or abnormality :

• Facial pain
• Headache
• Dizziness
• Visual problems
• Numbness
• Weakness of the face
• Hearing loss or ringing in the ears
• Nasal congestion or frequent sinus infections

Our department comprises of an Audiologist, Speech Therapist, & Hearing Aid Consultant. For diagnosis and management of hearing disorders we have

Diagnostic Audiological Tests

• Pure tone Audiometry (PTA)
• Impedance Audiometry (middle ear and eustachian tube studies)
• Otoacoustic emissions (OAE) (for the assessment of cochlear function for monitoring ototoxicity secondary to chemotherapy and radiation as well as for hearing screening in infants)
• Tinnitus evaluation and management with Tinnitus Retraining Therapy (TRT)
• Auditory steady state responses (ASSR)—detailed frequency-specific hearing assessment through recording of brain activity
• Electrocochleography (ECOG)—for differential diagnosis of Meniere’s disease
• Auditory Evoked Responses
• Auditory brainstem responses (ABR or BERA)

Digital Hearing Aids And Assistive Listening Devices

We offer hearing aids and assistive listening devices to fit each patient’s particular need.

• Major brands of hearing aids available
• Fitting various types of digital hearing aids
• Ear protection devices
• Occupational
• Recreational
• Batteries and hearing aid supplies
• Rehabilitation program for hearing loss
• Repair service
• Tubing replacement

Introduction To Cochlear Implant

Speech and Hearing is the most effective method of communication, it is a unique boon to a human being. Unfortunately some are born deaf called ‘Prelingual Deaf’. Those born with normal hearing but have lost hearing after acquiring speech are called as “Postlingual deaf”. Deafness identified early helps addressing the challenges in rehabilitation of a Deaf child successfully. A cochlear implant is an established, effective and long-term hearing solution for people with moderate to profound hearing loss. Unlike traditional hearing aids that amplify, or make sounds louder, a cochlear implant system can be a more effective hearing solution for certain people. A cochlear implant is capable of directly stimulating the cochlea hearing nerve, bypassing the damaged area of the hearing pathway. When it comes to effectively managing hearing loss, among other factors, the brand of ear implants has been shown to make a significant difference in the speech performance outcomes of post-linguistically deafened adults.

Why Such Aggressive Steps Towards Cochlear Implant Required: (Use It Now Or Lose It Permanently)

The cost of implant being the biggest constraint we are unable to do implant in the huge no. of deaf and mute children. As a social obligation we have decided to help these children by raising funds for them in our public Charitable trust, HCP ENT Charitable Trust. So please donate generously which shall be a highly appreciable contribution to this noble cause.