Treatments

Scroll through this non exhaustive list of Ear, Nose, Throat (ENT) treatments that are more commonly encountered.

Please use the enquiry form should you have specific concerns.

Radiofrequency treatment of the nasal turbinates is a highly effective way of reducing nasal congestion. This 10 min procedure in the ENT clinic can definitively enhance nasal breathing for patients with chronic nose blockage that do not respond to medication.

Radiofrequency inferior turbinates

Tonsillectomy is a procedure where the tonsils are removed from the sides of the pharynx(throat). It is a highly effective operation when performed for the correct indication. Common indications include recurrent tonsillitis, sleep apnoea, snoring, previousperitonsillar abscess, refractory halitosis, recurrent tonsillolithesand unilateral enlarged tonsils. Typically, the procedure is performed under general anaesthesia and the patient can be discharged on the same day. Some patients may require an overnight stay if medically required.

Tonsillectomy is performed with dissection and electrocautery, alternatively newer methods using the Coblator® or PEAK® system can be used and these have been associated with lower post-operative pain.

In children, often the adenoids are removed together with the tonsils and this is usually performed to reduce middle ear infections, sleep apnoea or recurrent upper respiratory tract

Sinus surgery is a procedure that has seen rapid advances in recent years. Initially performed through “open” techniques, Functional Endoscopic Sinus Surgery or FESS has become the standard of care for patients suffering from sinus disease who require surgery. FESS involves the use of small scopes and video systems that allow the ENT doctor to visualize the sinus openings and nasal passage under magnification so that precise and targeted surgery can be performed. Even more recently, image guided technology and navigation systems have been introduced to improve safety and disease clearance in selected cases. Balloon sinuplasty has also seen increased popularity in certain scenarios and adds to our repertoire of techniques available to solve most of our patients sinus issues.

Sinus surgery is more commonly indicated for the following conditions:

  • Chronic sinusitis refractory to medical treatment
  • Recurrent sinusitis
  • Nasal polyposis
  • Antrochoanal polyps
  • Sinus mucocoeles

The procedure is typically performed under general anaesthesia and the patient can be discharged on the same day. Follow up visits are usually required to ensure proper healing takes place.

Septoplasty is a procedure where the septum (midline cartilage and bone) that divides the nasal passages into left and right is straightened to improve breathing and treat nasal obstruction. The septum may be deviated in individuals due to previous trauma or due to congenital maldevelopment.

Septoplasty may be performed together with turbinectomy, FESS(Functional endoscopic Sinus Surgery) or rhinoplasty if the external part of the nose is also deviated. It is a relatively common operation that requires careful attention to detail nevertheless. Common pitfalls in septoplasty include over-resection causing change in shape or saddling of the nose, failure to correct caudal deviations, not considering a Rhinoplasty at the same time as the septoplasty thereby losing the opportunity to use septal cartilage grafts.

At our practice, all cases of septoplasty are carefully evaluated and techniques that reconstruct and restore the septum to its appropriate form are used rather than techniques that purely remove the deviated portion of the septum (e.g. submucous resection-SMR of nasal septum). This ensures that no cartilage is wasted unnecessarily and yet patient enjoys improve nasal airflow.

Septoplasty is performed under general anaesthesia and is generally performed as a day surgical procedure. Patients may not always require nasal packing and can often breathe better immediately after surgery.There are no external scars unless it is performed together with a rhinoplasty and patients can expect to return to normal duties in one to two weeks.

Using the same techniques and equipment as sinus surgery, tumours within the nose, sinuses and skull base (in selected cases) can also be removed through the nostril, leaving no scar on the face/head. Some examples of condition that may be resected endoscopically are resection of sinonasal inverted papilloma, skull base cerebro-spinal fluid ( CSF) leak repair and pituitary surgery. Most of the skull base surgeries are performed together with a neurosurgeon except inverted papilloma.

Cerebro-spinal fluid (CSF) leak is usually due to a defect in the skull base, either follow trauma, surgeries or spontaneously due to pre-existing defects.

Pituitary surgery is performed to remove tumour arising from the pituitary gland. Traditionally, pituitary surgery is performed either using microscopes or external approach. In recent years, endoscopic removal of pituitary tumour via the nose approach became the standard of care.

The endoscopic endonasal approach avoids external scars on the face or scalp and hence patient recovers faster. Yet, it does not compromise the success rate of surgery. This approach is well accepted and widely practised around the world.

The thyroid gland may require removal in certain conditions and in such cases, part of the gland or the entire gland may be removed depending on the exact indication for thyroidectomy.

Thyroidectomy or surgical removal of the thyroid gland is usually indicated for the 4 “C”s:

  • Cancer
  • Compression
  • Control of thyroid hormones
  • Cosmesis

Surgery of the thyroid gland involves working around the voice box, parathyroids (glands that control your calcium) and important blood vessels in the neck. Therefore, great care has to be taken to preserve all these structures during surgery.

Thyroidectomy is performed under general anaesthesia and patients wake up with a small tube coming out from their neck to drain excess blood and serum. This tube is then removed after a few days. Most patient stay in hospital till the tube is removed but others prefer the option of going home with the drain and resting in the comfort of their own home before returning to remove the tube after a few days.

Rhinoplasty is an operation to alter the external appearance of the nose as well as to improve the function of the nose. Patients undergo rhinoplasty for various reasons, and this can range from a need to correct deformity due to previous injury or trauma,congenital malformations, functional issues affecting their breathing, or for enhancing the aesthetic appearance of their nose.

Regardless of whether the surgery is desired for functional or cosmetic reasons, your choice of a qualified surgeon is of paramount importance. Surgeons who are trained in ear, nose, throat, and facial cosmetic surgery, provide you, the patient, with the highest level of training and expertise. You can expect a thorough evaluation of both the inside and outside of your nose before your rhinoplasty and any concomitant sinus or nasal septal issues can be addressed at the same sitting. The surgeon will take photographs of you and discuss the options available. Occasionally, additional procedures may be recommended to enhance the effect of your rhinoplasty. This may include chin augmentation (genioplasty) to bring “balance” to the face.

Understanding The SurgeryRhinoplasty can be performed “Closed” where all the incisions are made inside the nose, or “Open” where an incision is made in the area of skin separating the nostrils. The choice of “Open” or “Closed” rhinoplasty depends on patient factors and type and extent of correction required. Being trained in both techniques, our doctors will be able to offer you the most comprehensive explanation for the ideal technique suited to your concerns.

In Asian versus Caucasian rhinoplasty, due to differences in anatomy, techniques used differ somewhat between the two. Asian noses tend to require more augmentation and improved definition whereas Caucasian noses tend to require refinement and reduction. Having been trained with the techniques used in both Caucasian and Asian rhinoplasty, our doctors are able to address the specific concerns and deficiencies that may be present in an Asian or Caucasian nose.

Pertaining to Asian rhinoplasty, patients can choose between different types of implant material for nasal augmentation. While the preference would be for autologous (patient’s own) tissue, other options available include synthetic implants (Silicon, Medpore®), homologous tissue (Alloderm®, Tutoplast®). Our doctors will be able to discuss with you the most suitable options for your needs.

Rhinoplasty is generally performed under general anaesthesia and you can expect tape and a cast over your nose for the first week following surgery. The cast and dressing is typically removed after a week. Swelling is to be expected though it varies from individual to individual. This swelling typically takes anything from weeks to several months to resolve.

Otoplasty is surgery to correct deformities or imperfections of the external ear. These imperfections may range from “Bat” ears orprominent ears, to “Cup” ears or constricted ears. Very severe congenital deformities like microtia or anotia is occasionally seen as well. Depending on the extent and type of deformity you may be concerned about; various techniques can be used to correct them.

Simply pinning back the ear cartilage may be all that is required for patient lacking an anti-helical fold and this procedure is typically performed under local anaesthestic in our clinic. More extensive deformities requiring rib grafting or cartilage resection is typically performed under general anaesthesia.

For patients with microtia, the benefit of working with an Ear, Nose and Throat surgeon familiar with ear reconstruction would be that your hearing function would be evaluated and can potentially be corrected as part of the whole reconstructive effort.

This is an operation to close a hole in your ear drum. Myringoplastyis typically performed for patients who have had frequent ear infections or it may be to improve hearing if the perforation has contributed to significant hearing loss. Temporalis fascia (tissue from behind the ear) is then used as a graft to cover the perforation to allow a new lining to develop over the graft. The operation is usually performed under general anaesthesia and as a day surgical procedure.

A bandage over your ear is placed over 24 hours before its removed the next day. Follow up visits are then scheduled to remove the sutures and dressings placed internally over the following weeks.

There are several treatment options for Sleep Apnoea. Each option has advantages and disadvantages, and treatments have different success rates and levels of patient satisfaction.

Treatment options are as follows:

  • Weight loss:

We work closely with endocrinologist, bariatric surgeons andphysiotherapist to develop a customized strategy for you to lose those extra kilos. Weight loss alone has been shown to lower the severity of sleep apnoea and forms an integral part of treating sleep apnoea.

  • CPAP (Continuous Positive Airway Pressure):

This is administered through a small mask or nasal pillows attached to a pressure machine. These days with improved technology and increased competition within the CPAP machine market, a reliable and comfortable machine can be purchased at a very affordable price. Our practice works closely with a range of reliable vendors who not only supply our patients with the machines, they also provide coaching and after sales service to the hundreds of patients who are prescribed CPAP every year by our practice.

  • Sleep position modification:

This is the least invasive method to treat sleep apnoea and in very selected patients, it can make enough difference to reduce the issue of sleep apnoea. Typically this is prescribed in milder cases where the sleep study suggest that sleeping on the side eliminates the sleep apnoea.

  • Oral and dental appliances:

These custom-made devices can help hold the jaw and tongue in a position that prevents airway obstruction. Our patients are referred to our dental partners who are experts at fashioning these devices.

  • Surgery:

In selected individuals, surgery may confer the best results. The decision to undergo surgery for sleep apnoea is a complex one and with every patient being different, it demands that the evaluation be thorough so that a customized solution can be tailored to the patient’s specific issue. Surgery can range from radiofrequency of the turbinates, radiofrequency of the palate, tonsillectomy, palate surgery or genioplasty. Rest assured that at this practice, emphasis on evidence based treatments is used and only procedures with a clear track record are used.

This is a procedure where an operation is performed on the vocal cords. It may be for polyps, growths or even abnormally positioned vocal cords causing hoarseness.  Prior to undergoing voice box surgery, a laryngoscopy is performed in clinic to evaluate your vocal cords. Occasionally, speech therapy is commenced before surgery is deemed appropriate.

This operation is performed under general anaesthesia and requires voice rest of 2 weeks following surgery. Any reflux disease is also treated aggressively as it can worsen an already diseased voice box.

Dacryocystorhinostomy is performed to relief an obstructed tear duct in the nose. This surgery may be performed endoscopic and still give the same outcome as the external approach. This surgery is performed with another eye surgeon. Patients usually present with excessive tearing or sometimes an infected tear sac.

Following the surgery, a stent may be inserted to keep the duct open. This stent does no affect the vision and is removed in the ENT clinic several weeks later.

Immunotherapy is a process when a minute amount of allergen (a substance that the patient is allergic to) is introduce to the patient (without causing symptoms) over a period of time to cause a change in the immune system, such that the patient is no longer allergic to the allergen. This is called desensitization. This treatment is administrated through a drop/a spray or a tablet under the tongue, on a daily basis over 1-3 years. When successful, immunotherapy can cure the patient of allergic diseases such as allergic rhinitis. Patient no longer needs regular antihistamine or nasal steroids to control his allergic rhinitis.