ENT (Ear, Nose & Throat)

ENT (Ear, Nose & Throat)

It is a branch of medicine that deals with diseases in ear, nose and throat.

Ear Diseases

Hearing loss

Hearing loss is generally studied under three categories.

  • Conductive hearing loss: refers to hearing loss of the outer ear and the middle ear.
  • Sensorineural hearing loss: refers to hearing loss associated with diseases related to inner ear, auditory nerve and brain.  
  • Mixed hearing loss: is defined as a condition in which disease is present in not only one part but several parts of the auditory duct.    

In the case of hearing loss, first, the ear should be examined to establish the cause. During this examination, if you have a disease in the outer ear or ear drum, it can be easily identified.  

In cases where the examination is normal, the cause of hearing loss is thought to be rather related to inner ear but some tests are made to determine this. The most important of these tests is a test to measure hearing, called audiometry.  

Treatment of earwax or any foreign bodies in external ear canal is performed by removing them. 

Middle ear infections are usually treated with antibiotics or other medications.  In the case of chronic middle ear infections, treatment is sometimes surgery. In the case of a disease called otosclerosis, which develops as a result of calcification of stapes bone in middle, stapes bone is removed and replaced by prosthesis. 

In the case of hearing loss related to inner ear, hearing loss is usually permanent. However, in the case of tumor induced hearing loss, the tumor must be removed by sacrificing hearing.

Dizziness (Vertigo)

Dizziness may be associated with many organs. Disorders that can cause dizziness can be related to brain, spinal cord, inner ear, eyes, joints and muscles. 

Dizziness is not a disease itself but it is a symptom of another disease so first of all the main cause should be treated. If dizziness is positional vertigo, this is treated by certain maneuvers that are applied by your doctor while he’s examining you. These maneuvers ensure that certain particles in inner ear are engaged. 

For other reasons, drug therapy may be required. 

Hospitalization may be required in some cases of severe dizziness. Surgery is rarely performed in the case of Meniere’s disease which doesn’t respond to drug therapy.

Meniere is a disease that manifests itself in the form of attacks of dizziness caused by pressure increase in fluids responsible for balance in the inner ear.  It can be seen at any age. In Meniere’s disease, dizziness starts suddenly and may take 24 hours. Ear examination of patients with Meniere’s disease looks normal. The most important finding of the patients during episodes of dizziness is involuntary eye movements.  Duration, frequency, severity of dizziness and accompanying symptoms provide information about the cause of the disease during diagnosis.  The first test to be done after examination is a hearing test called audiometry. A method that is strongly suggestive of Meniere’s disease is Glycerol test. Computed Tomography or Magnetic Resonance scans can be used to differentiate tumors or space-occupying lesions in the brain or inner ear.  Controlling dizziness attacks with medication is the first treatment method applied for Meniere’s disease. Surgical treatment is applied in cases which are inconclusive with drug treatment. 

Tinnitus

It is defined as perception of abnormal sounds by the patient without any audible stimulus from outside.  

If the cause of tinnitus is detected, a treatment can be applied to eliminate such cause.  However, the cause cannot be determined in general so a symptomatic treatment is applied.  

Middle Ear Infections

An infection of the middle ear is inflammation of the middle ear cavity behind the eardrum. It is caused by viruses or bacteria. It often occurs after dysfunction of eustachian canal, which ensures middle ear ventilation, as a result of a recent cold or an allergic problem.  

Only one or simultaneously both ears can be affected. Ear infections are more common in young children because development of middle ear anatomy hasn’t been completed in them.  

Treatment of middle ear infection is quite important. In advanced chronic middle ear inflammations, hearing loss, dissolution of middle ear bones and conditions such as meningitis may occur.

Initially, antibiotic treatment is applied.   It can be accompanied by medications reducing swelling of the mucous membrane and thinning viscosity of mucus. In patients with diagnosed allergies, anti-allergic treatment should also be added to the process. 

If drug therapy remains inconclusive, surgical treatment is applied.During surgery for inflammation of the middle ear, the eardrum is perforated or a tube is attached.  By perforating the eardrum, the fluid inside is drained off. In some cases, the fluid cannot be removed due to its very sticky nature and in this case, a tube is attached to the location of perforation in the eardrum. Ventilation of middle ear is ensured by this tube. Surgeries for chronic inflammation of the middle ear are performed under general anesthesia by making an incision behind the ear. The fluid is drained off and the hole in the eardrum is closed.

Nasal diseases 

Allergic Rhinitis

Inflammation of the mucosa lining inside of the nose resulting from allergic factors is called allergic rhinitis.  

The first thing to do during treatment is avoiding allergy-causing factors. Drug and vaccine therapy are applied in the treatment of allergic rhinitis. 

Sinusitis

Sinusitis is inflammation of the cavities inside bone structures surrounding the nose. All the sinuses open into the nose through a hole. These holes opening to the nose also provide ventilation of the sinuses. 

The nose and sinuses are areas of inflammation caused by bacteria and viruses settling there.  There are always bacteria and viruses that may cause inflammation in these areas and if ventilation of sinuses is disturbed, sinus inflammation develops.  Other than bacteria and viruses, fungi also cause inflammation, though rarely.  Sinusitis mostly occurs after upper respiratory tract infections such as common cold, influenza.  In this type of infections, sinus holes opening into the nose are closed due to edema, preventing sinus secretions from draining into the nose.  Ventilation of the sinuses also deteriorates. In this case, sinus inflammation develops easily. Apart from this, conditions including allergies blocking sinus openings, nasal bone curvature, hypertrophy, foreign body and adenoid facilitate the development of sinusitis. 

The goal of sinusitis treatment is to destroy bacteria and open sinuses’ holes opening to the nose. Bacteria are destroyed by antibiotics. 

 In case of no response to medications, presence of other factors facilitating sinusitis is investigated and an appropriate treatment is applied. However, surgery may be required occasionally. Drug therapy is also applied first in the case of chronic sinusitis. However, in case of an anatomical problem such as frequent allergies, or curvature of bone and cartilage or hypertrophy, it requires surgical treatment. 

Septal deviation

Septum is the name given to a wall dividing inside of the nose into two and consisting of, cartilage and bone.  This structure can lead to blockage in people in whom curvature of this structure is high or in particularly narrow regions of the nose because of its curved structure, even though such curvature is small.  

This curvature often results from strokes on the nose in the past. Curvature of cartilage and bone structure may occur in anyone who has had a bleeding nose because of an accident. Babies are exposed to nasal trauma during birth.

The operation made to correct septal deviation is called septoplasty and entirely performed through the nose without any skin incision. Purpose of the operation is to correct parts which are curved.

Concha Growth

Placed in the wall between the nose and sinuses, three bones on both sides and soft tissue covering them comprise conchas. 

Initially, drug therapy is applied to shrink conchas. Cortisone nasal sprays were found to be the most effective for this purpose. Treatment of allergy in the case of allergy-induced concha growth can help shrink concha. However, drug treatment is often not sufficient and surgery is needed. 

Throat Diseases

Tonsillitis

Tonsils are lymphatic nodules. Tonsils are located on both sides at the back of your mouth. In addition to their other tasks, they filter our harmful organisms entering the mouth. But when a lot of bacteria enter, they cannot resist. They get inflamed and swollen. This is called tonsillitis and it is very common, especially among children. 

Get plenty of rest, eat soft food and liquid food that will relieve your sore throat. Pain is relieved by gargling with warm salty water.

Adenoid

Adenoid is the other tonsil located in the cavity at the back of the nose. During examination, these small tonsils cannot be seen. It protects respiratory tract against viruses and germs from outside.

If it frequently catches an infection, it grows and becomes a germ slot and causes continuous throat, ear and nose diseases.

Signs of adenoid hypertrophy may begin during infancy. Sleep disturbances, loss of appetite, snoring in addition to occasional signs of difficult breathing such as  nasal flaring may occur.

Throat reflux

The stomach secretes acid to digest the food ingested. The valve system existing to prevent contents of the stomach and gastric fluid from getting out of the stomach tries to prevent gastric fluid from leaking out of the stomach. When the valve between the stomach and esophagus doesn’t function properly, acidic contents of the stomach escape into the esophagus. When the valve between esophagus and the throat doesn’t function properly, contents of the stomach reach up to the throat and larynx, i.e. vocal chords, which are more sensitive to acid , stomach contents and bile.  This condition is called a reflux.

This is different from the reflux commonly known as gastric reflux.  Throat reflux is more during the day and while standing, whereas gastric reflux is more frequent and irritating while lying. Sensitive structure of larynx and pharynx tissues and certain nerve reflexes as well as the movements of the esophagus have an important role in development of LFR. 

Head and neck cancers

The most important factor in head and neck cancers is long-term smoking and alcohol consumption. Depending on the region where the cancer has settled, symptoms including lump in the neck, voice changes, the growth of the lips, mouth / nose / throat bleeding, skin discoloration, difficulty in swallowing, and persistent ear pain are seen. 

In head and neck cancers, laryngeal cancer, cancer of the back of the nose, vocal cord cancer , tonsil cancer, cancer of top of esophagus are the most common types of cancer. 

Treatment of the disease varies depending on the region, type and stage of the disease.  Surgical therapy, chemotherapy and radiotherapy techniques may be used separately or together during treatment. 

Snoring

Snoring can be explained as an annoying noise caused by collective or individual crashing and vibration of structures comprising upper respiratory tract, including the nose, palate, and uvula, during sleep.

Simple snoring can heal by simple measures without the need for operation. Such measures will be to lose weight, eat dinners early, etc.

Main treatment in snoring is to identify the cause of snoring and perform treatment aimed at the cause.

Sleep Apnea

Sleep apnea is an important disease that arises from breathing pauses during sleep and causes deterioration of regular sleep routine.  Sometimes snoring may accompany sleep apnea. In this serious condition, airway is fully closed and respiration completely stops. In sleep apnea, severe snoring is followed by a silence of 10 seconds or more. Gradually decreasing oxygen and increasing carbon dioxide in the blood send warning signals to the body, resulting in a strong breath as well as a loud snoring.

If sleep apnea is left untreated, problems may arise, such as high blood pressure, loud snoring, fatigue, excessive irritability, depression, forgetfulness, lack of concentration, morning headaches, uncontrollable obesity, sleep sweating, frequent urination, and heartburn. 

Final diagnosis can be made by monitoring the person’s night sleep in sleep laboratories.

The most common surgery for sleep apnea is known as “UPPP” in medicine. In this operation, tonsils are removed and ” uvula ” hanging down at the back of hard palate is shrunk and the tissues become strained. 

Diagnostic Methods in Use

Hearing Tests (Audiometric Tests)

Hearing tests are important in the diagnosis of diseases of the ear. There are a wide range of hearing tests and each gives information on different subjects. Otolaryngologist will decide which one to be conducted according to the patient’s complaints, examination findings and the results of other diagnostic tests.

Computed tomography

Computed tomography is a special imaging technique that gives a cross-sectional image of the tissues and organs of the body using x-rays.   In comparison to ordinary plain radiographs, CT provides more detailed information about head injuries, brain tumors and other brain disorders. Bone, soft tissues and blood vessels can also be displayed by CT.

Magnetic resonance (MR)

MR is a painless procedure that can display internal organs and tissues in a clear and detailed manner. MR uses radio waves and a strong magnetic field, instead of X-rays.

Sinus Film (Waters Graphy)

Waters graphy is an x-ray film taken by normal x-ray machines, by which results are obtained in a short time. The patient must have a computed tomography scan so that the diagnosis is verified. 

Ultrasound

Ultrasound uses sound waves to view internal organs of the body.  Frequency of the sound waves used is so high that a human ear cannot hear. The amount of sound reflected by each tissue will be different so the image perceived will be different. Thus, tissues and organs will be seen on the screen of ultrasound device. By this method, different images can be detected for tissues like a cyst or tumor.

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