ENT & Head Neck Surgery

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Introduction

The ENT department of Goenka Hospitals is abreast with advancement in medical technology and uses latest treatment modalities for ENT related problems while being equally sensitive towards patient care in rendering a human touch.

As costs escalate, we strive for affordable treatment without compromising on quality parameters like success, safety and ease of processes. Also, as most patients feel more comfortable in the surroundings of their home, the ENT department offers patients the choice of day care surgery in majority of situations. With day care ENT Surgery, patients admitted to the hospital undergo operations, recover from anaesthesia and go home with their family, all in the same day.

Pre-assessment

The ENT surgery requires pre-assessment of all patients, especially those who have a history of heart problems, asthma or any other chronic diseases. The anaesthetist may assess the patient pre-operatively if required. The patients are informed about the surgical procedure, associated risks & recovery and asked to sign consent for surgery. The patients are also asked to provide information about current medications, allergies, any previous hospitalizations with dates, and other relevant information.

Goenka ensures that the patients compulsorily inform the hospital in case of falling ill during the week before scheduled surgery. This is very important because even a mild cold or upper respiratory infection can lead to an increased risk from anaesthesia. This includes the development of pneumonia or asthma after surgery. The surgery, thus, is rescheduled after treating the problem. When performing ear, throat or nasal surgery, it is imperative to have preoperative control of any infection so that chances of congestion and bleeding are minimized. Antibiotics or decongestants if required are given at this level of pre-assessment. Also, if the patient is on aspirin or any other drug which may adversely affect surgery, the patient is asked to stop the drug or prescribed an alternative. Thus pre- operative care is ensured to the minutest detail.

Ear surgery

Majority of the ear surgeries are done as day care cases.

Myringotomy and Grommet insertion:

It involves making an incision in the eardrum to drain middle ear fluid and putting in a ventilation tube. This is easily done under local anesthesia without sedation in the adult patient, and the patient may be sent home within 1 hour of the operation. Children can be treated with short general or ketamine anesthesia and sent home as soon as they are fully awake, and after the anesthetist’s consent.

Tympanoplasty:

Repair of the ear drum with restoration of the middle ear hearing apparatus. This is done under   local anaesthesia with sedation and the patient may be  sent home when fully alert.

Mastoidectomy:

Removal of disease, usually cholesteatoma, from the mastoid and middle ear, with or without reconstruction of tympanic membrane and hearing apparatus. Cholesteatoma is a type of skin cyst and commonly occurs due to complication of chronic ear infection located in the middle ear.

This is usually done under local anesthesia with sedation. If the patient is apprehensive, general anaesthesia may be required as the surgery may sometimes stretch to 3 hours or more. These patients can also be sent home the same day.

The patient may occasionally experience vertigo after Mastoidectomy or ossiculoplasty and is sensitized about it before hand. Vertigo is a dizzying feeling or a   reeling sensation as if one is about   fall. In this case the patient may have to stay in the hospital for an extra day. In the normal course, they will be asked to follow up after 3 days for routine dressing and 7 days for suture removal. In case of pain, vertigo or bleeding the surgeon sees nthen to alleviate the condition.

Stapedectomy:

Surgery for restoration of hearing in   otosclerosis. This is usually done with local anaesthesia and sedation. These patients can sometimes   have post-operative vertigo and even vomiting. In the event of vertigo, or complicated surgery, the patient should be kept overnight, or till the patient feels better. Most patients can however go home the same day, provided travel is short and smooth. Air travel is not advisable   in the immediate post operative period.
Tympanoplasty and stapedectomy are only occasionally done in children. Mastoidectomy is always done with  general anaesthesia and the children are usually asked  to stay overnight.

Nasal Surgery

Most septal and sinus surgery can be done under local anaesthesia with sedation. However, both involve nasal  packing. Whilst patients can be sent home with nasal  packs, many  surgeons  don’t recommend this . If the patient were to have some  bleeding at home, then neither he nor the doctor would  know if it was significant bleeding unless seen.

It could so turn out that the   the surgeon is needed to  rush  to the patient’s home in the middle of a busy day, maybe  to find only insignificant oozing! All these eventualities are thwarted by keeping them in the hospital for observation and easily accessible medical help. On the other hand, most patients do not bleed and tend  to be more comfortable at home and could be called to   the clinic after 24-48 hours for pack removal.

Endoscopic Dacryocystorhinostomy (DCR) can be done easily under local anaesthesia and sedation and the  patient sent home after pack removal in the evening, provided there is no bleeding.

Endoscopic sinus surgery involving extensive polyposis or disease and in the posterior sinuses is done under  general anaesthesia and these patients  are usually advised to stay in hospital as there may be bleeding associated with  major sinus surgery.

Endoscopic surgery for pituitary adenomas, optic nerve decompression, orbital surgery and CSF rhinorrhoea also involves staying in the hospital for a few days. Patients who have epistaxis, a medical term for nose bleed, (without any major causative pathology) are excellent candidates for day care endoscopic surgery. Earlier these patients would be packed for 48 hours and the packs removed with frequent rebleeding. Now, with the endoscope, the bleeding point can be identified and cauterized and the patient sent to the room without packing and fear of bleeding. They are then discharged soon after a few hours of observation.

Throat and laryngeal surgery

Tonsillectomy and adenoidectomy have always been done as day care procedures. The patients are sent home in the evening after checking the fauces for clots or bleeding. Oral biopsies, buccal leucoplakia excision and other such minor surgeries are also excellent day care situations. Even most rigid endoscopies, such as direct laryngoscopy, microlaryngoscopy and oesophagoscopy, done under general anaesthesia lend themselves to being day care cases. These are usually short procedures for diagnosis, biopsy, and therapeutic excision of small lesions or foreign body removal and do not entail much bleeding or major surgery.

Rigid bronchoscopy or surgery for tumors would require more hospital stay.

ENT surgeons diagnose and treat conditions of the ears, nose, throat, head and neck, and undertake some cosmetic procedures.

Ears

Hearing loss,Ear discharge,Earache,Balance disorders,Tinnitus

Nose

Nasal blockage, Nasal deformity, Cosmetic surgery / Rhinoplasty, Sinusitis, Allergic Rhinitis e.g. hay fever and house dust mite allergy, Tumors of the nose and sinuses, CSF leak repair, Orbital and optic nerve decompression

Throat

Sore throat including tonsillitis, Snoring, Hoarse voice, Swallowing disorders, Tumors of the throat and larynx

Head and neck

Facial weakness, Neck swellings, Thyroid disorders, Salivary gland diseases.