Otolaryngology

Ear, Nose and Throat (ENT) Surgery

Ears, nose, throat (ENT) surgery comprises many different types of surgical procedures and is one of the oldest surgical specialties. It is also one of the most elaborate fields of surgery, using advanced technology and encompassing a broad range of procedures including major reconstructive surgery.

Typically, ear surgery is used to correct defects causing hearing loss or impairment. Such procedures include tympanoplasty (reconstruction of the ear drum), stapedectomy (removal of all or part of a bone in the middle ear), and cochlear implants (implantation of a device to stimulate nerve ends within the ear to enable hearing). Myringotomy (insertion of ear tubes to drain fluid in persons with chronic ear infections) is another common procedure.

Care of the nasal cavity and sinuses is one of the primary skills of the ENT specialist. Common Surgical procedures of the nose can include sinus surgery, correction of a deviated septum (septoplasty) and relief of chronic nasal congestion. Advanced endoscopic surgery for sinus and nasal disorders can eliminate the need for external incisions and major surgery.

The ENT specialist is also called upon to manage diseases of the larynx (voice box) and the esophagus including disorders of the voice, respiration (breathing) and problems swallowing. Surgery of the throat includes removal of tonsils (tonsillectomy) or adenoids (adenoidectomy). Tonsils and adenoids are lymph tissue that help in the body’s defenses to fight infection. The tonsils and adenoids can get chronically infected, in which case surgical removal is usually required. Chronic inflammation of the adenoids can also cause repeated middle ear infections that can ultimately impair hearing.

Recovery for ENT surgery depends on the procedure and health of the patient. Because of the high possibilty of infections, cleansing and dressing changes of the wound as well as postoperative follow-up with the ENT surgeon is essential. Patients may need to stay in the hospital for six to ten hours for procedures such as tonsillectomy, depending on the anesthesia, or they may be admitted for a few days for more complicated procedures.

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Sinusitis

Sinusitis is one of the most common problems that brings patients to physicians’ offices. The symptoms of sinusitis (infection or inflammation of the sinuses) are well known to most people. These symptoms include nasal congestion, facial pressure, and nasal discharge or post nasal drip. The treatment of acute sinusitis is most commonly antibiotics, and often decongestants are used as well. The majority of patients will respond to this initial therapy; however, a smaller subset of people do not respond and are left with persistent symptoms.

What if medical therapy fails?
For patients who have a sinus infection that is unresponsive to all of the above measures, frequently a CT scan (x-ray) of the sinuses is ordered. These films are reviewed with the patient and help the physician identify structural problems of the sinuses that are preventing normal drainage. It also helps identify which sinuses are infected. The findings on x-ray and the patient’s history then guide the physician and the patient in considering the need for sinus surgery.

Sinus surgery (endoscopic sinus surgery) is performed with the same fiberoptic telescopes as are used for nasal endoscopy. The procedure can be done either with sedation and local anesthesia or under general anesthesia (the patient is completely asleep). Essentially, working through the nostrils and using the fiberoptic telescope and small dissecting instruments, each of the blocked sinuses are opened and good drainage is established. Occasionally, some packing is placed in the nose overnight. Most patients are able to go home on the same day of their surgery.

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Balloon Sinuplasty™

Sinusitis afflicts 37 million Americans each year, causing headaches, congestion, fatigue and other symptoms. This condition significantly impacts an individual’s physical, functional, and emotional quality of life. Now there is an alternative solution to endoscopic sinus surgery with the Balloon Sinuplasty™ system by Acclarent™.  A small, flexible balloon catheter is placed through a nostril into the blocked sinus passageway. The balloon is then inflated to gently restructure and open the sinus passageway, restoring normal sinus drainage and function.

This clinically proven, minimally invasive technology for treating chronic sinus inflammation is available now at Edgewood Surgical Hospital. Gabriel Te, M.D. is one of the first physicians in this area to offer this technology. He performs this technologically advanced procedure here at Edgewood.

Sinusitis patients who are considering their options can learn more about Edgewood’s Balloon Sinuplasty™ capabilities by clicking here. Patients can also contact Dr. Te’s office at 724-588-2772 to schedule a consultation.

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Nasal Obstruction

Nasal obstruction is a sense of blockage within the nose or difficulty breathing out of one or both sides of the nose.

What are the common causes for nasal obstruction?
There are many potential causes for nasal obstruction. Some of the most common causes are nasal allergies, deviation of the nasal septum (the partition in the middle of the nose on the inside), sinus or nasal infection, or a number of other potential causes.

Why do allergies cause nasal obstruction?
Nasal allergies result from the lining of the nose being over-reactive to substances in the environment, such as dust for example. When a patient who is allergic to dust encounters a dusty environment, the lining of the nose on the inside swells and produces watery secretions. This swelling inside the nose takes up much of the space which is normally available for breathing and makes the passageways for airflow much smaller. This is the cause of nasal obstruction for this particular patient. Treatment can be directed at reducing this hyperactivity of the nasal lining in order to improve this type of nasal obstruction.

“The responsiveness of the entire hospital staff to the physicians and the patients and their families exceeds all expectations of patient care.”

– Gabriel Te, M.D.
Otolaryngologist (ENT) Surgeon

What is a deviated septum?

When the physician reports that a patient has a deviated septum, this means that the partition in the middle of the nose (the septum) is bent and is blocking one or both sides of the nose. This can cause symptoms of nasal obstruction, which can be quite bothersome. Many patients have a deviated septum and do not have a history of an injury to their nose, but some patients have developed a deviated septum due to a prior episode of trauma to the nose. The patient may or may not have actually fractured their nose in the past. Depending on how much difficulty the patient is having with his or her nasal airway, a procedure called septoplasty may be recommended in order to straighten the septum and improve the nasal airway. This procedure is performed with an incision that is placed inside the nose to allow the surgeon to work on the septum.

Are there any other structural problems that can give nasal obstruction?
Yes. In addition to a deviated septum, a patient may also have large turbinates. The turbinates are finger-like projections on the inside of the nose on each side which humidify and clean the air as we breathe. Sometimes the turbinates are large enough to cause significant difficulty with nasal breathing. Some patients will have both large turbinates and a deviated septum, which can further worsen nasal breathing. Sometimes the turbinates are enlarged simply as a part of nasal allergies. If this is the case, treatment may be directed at the allergy itself. The turbinates may also be treated with a procedure. The turbinates may be reduced in size by a surgical procedure in the Operating Room.

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Tonsils and Adenoids

The tonsils and adenoids are both made up of lymphatic tissue. This is the same type of tissue that is in the lymph nodes in the neck and other parts of the body. Lymph nodes are present in the body to help fight infection. Interestingly, removal of the tonsils does not cause problems with fighting infections. There are plenty of other lymphatic tissues to help fight infection. The tonsils are located in the back of the throat on the right and left sides and sometimes are easily visible. If the tonsils are small, often they are difficult to see. The adenoids are made up of the same type of tissue and are above the roof of the mouth, all the way behind the nose. The tonsils and adenoids are frequently involved in infections of the throat. Frequently during these times, the tonsils and adenoids will swell.

What kind of problems occur with the tonsils and adenoids?
Sometimes patients will have recurring infections of the tonsils. This is often due to a strep infection. Other people may have difficulty with erratic breathing at night. They may snore loudly and even have periodic pauses in the breathing, followed by a gasp for air. This repeated cycle of ceasing to breathe and then restarting is often referred to as sleep apnea. Enlarged tonsils and adenoids, particularly in children, can cause this syndrome of obstructive sleep apnea. Either sleep apnea or recurring tonsillitis may cause the physician and patient, as well as the parents, to consider removal of the tonsils and/or adenoids. Other less common problems may also indicate the need for tonsillectomy. The decision for this type of surgery is made on an individual basis for each patient. It is particularly helpful for the patient’s partner or caregiver to observe their sleep pattern on several different occasions to allow the physician to know the pattern of sleep.

Why are recurring throat infections a problem?
There are many different reasons why throat infections can present a problem for patients. For some adults or children, simply the amount of time spent with infection and the number of infections becomes a major inconvenience and can make a significant impact on his or her lifestyle. Some patients will miss significant periods of work or school with infection and this can certainly be considered as well in the decision of how to manage the problem. Occasionally, patients may have a medical disorder which causes them to have trouble fighting infections. For this type of patient, recurring throat infections may be more of a problem than for the average patient. This might lead the physician and the family to choose to have the tonsils removed at an earlier time than with a more typical situation.

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