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Ear Nose Throat | ENT

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Avicenna Hospital Ear Nose Throat (ENT) department is a medical branch that carries out the diagnosis and treatment of diseases related to the outer ear, eardrum, middle ear, nose, throat, esophagus, vocal cords and facial nerves for all age groups.

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Ear Nose Throat | ENT

Ear Diseases

Hearing problems, ear infections, balance
problems, problems with the facial or cranial nerve, outer ear and inner ear
problems are generally included in ear diseases. Diseases for which ENT
specialists provide diagnosis and treatment services for ear; Tinnitus,
fluid accumulation in the ear, problems due to earwax, acute otitis media,
external ear canal inflammation and hearing loss. They also deal with
problems such as ear tumors, ear discharge, earache and ear bleeding.

Nose Diseases

Diseases such as runny nose, cold, deformities
in the nose, nasal curvatures, nosebleeds for no reason, smell problem,
rhinoplasty, sinusitis and allergic rhinitis are treated by otolaryngologists.

Throat Diseases

General problems of upper respiratory tract and digestive
tract or digestive tract diseases and problems related to the structure of the
throat are also under the expertise of otolaryngologists. Breathing, voice
and swallowing problems are also included in diagnosis and treatment. Ear,
nose and throat specialists perform the treatment of diseases such as sleep
apnea, snoring and pharyngitis, as well as tonsil surgeries.

Neck Masses

When a mass is seen on the neck, an ENT doctor should be consulted.

The most common cause of swelling in the neck is enlarged
lymph nodes that develop due to infections and are usually very painful. There
are about 300 lymph nodes in the head and neck, normally they are not palpable
and are not visible. Sometimes they can be palpated by deep palpation in
thin people and in thin and long necks. Sometimes, these lymph tissues
grow rapidly, they are painful and they are more than one.

Apart from this, they also occur with the growth or
infection of some cystic residues that have existed from birth. Sometimes
they can also occur due to the spreading of malignant tumors in the lymph nodes
themselves or to the lymph nodes in the head and neck. These masses are longer
lasting, stiff and adherent to each other and do not regress with
treatment. It is necessary to consult a doctor especially in neck masses
exceeding 15-20 days without any infection. The most common cause in
children is infections, malignant tumors should be ruled out in adults with
rapidly growing masses.

In differential diagnosis; Biochemical examinations,
detailed classical and endoscopic examinations, ultrasonography, computed
tomography or MRI examinations may be requested. If necessary, fine needle
aspiration biopsy, true-cut biopsy or incision may be required to take biopsies
from the mass. A definitive diagnosis can be made as a result of the
pathological examination.

Depending on the diagnosis, medical or surgical
treatment, or radiotherapy or chemotherapy may be required.

7-14 days of antibiotics are used for those related to
infections. The pain and swelling disappear in a short time, but it may
take a few weeks for the swelling of the lymph nodes to disappear
gradually. In specific infections such as tuberculosis, treatment takes months.
If there is a congenital cystic lesion, the treatment is primarily
surgery. If malignant tumors are caused by the cause, neck dissection
operations or radiotherapy-chemotherapy may be required to remove these masses
from the neck in addition to the treatment of the actual tumor.

Endoscopic Sinus Surgery (ESC)

The modern treatment method used in the
operation of sinus diseases (chronic infections, polyps, cysts, some tumors) is
called endoscopic sinus surgery (ESS). Without any incision outside the
nose, it is made with instruments specially developed for the sinuses under the
monitor’s view through nasal telescopes entering the nose.

ESS is generally used in chronic sinus infections, nasal polyps,
sinus tumors and also in injuries of the anterior head pit, eye socket damage
due to trauma, cerebrospinal fluid leakage, tear sac inflammation without
external incision (dacryocystorhinostomy), and surgical treatment of pituitary tumors.

For this, it should be performed by experienced surgeons who are
experienced in these issues and the procedures to be performed in the
complications that may occur, otherwise complications (bleeding, infraorbital
bleeding, orbital trauma, tear duct injury, CSF leakage, intracranial
complications) are inevitable.

General anesthesia is generally preferred. The duration of
the operation varies depending on the number of sinuses to be intervened,
whether it is unilateral or bilateral, and the prevalence of pathologies in the
sinuses and nose.

There is no need to place tampons except in rare cases, if there
is a possibility of bleeding or if the septum and turbinates are also
intervened, it may be necessary to put a tampon. One-night hospitalization is
sufficient. Drug treatment is given for ten days. Nasal mouthwashes
and moisturizing sprays are applied for crusting in the nose. Controls and
dressings should be visited every few days at intervals determined by the doctor.

Myringoplasty– Closing the Eardrum Hole

It is the process of repairing the eardrum due
to perforations in the eardrum due to previous middle ear infections or
permanent holes due to trauma of the eardrum (slapping, explosion, foreign body).

In patients with a hole in the eardrum; In the type of
conduction hearing loss, infections occur from time to time as a result of
water escaping from outside especially during bathing or swimming in the pool.
Apart from that, there may be ear humming. If left untreated, hearing loss
may increase due to recurrent infections. People constantly have to
protect their ears and cannot enter the sea or pool.

By repairing the eardrum, the patient’s hearing improves and they
do not have to protect their ears.

If the hole is too small, it can be repaired by entering the
external auditory canal with local anesthesia. If the hole is large, it
can be repaired under general anesthesia, usually through the external auditory
canal or behind the ear. For the repair of the perforation, the patient’s
own sheath of the temporal muscle, the membrane of the ear cartilage and
cartilage are generally used. In some cases, ready-to-use materials such
as fascia, meninges, and vascular walls can also be used. If the patient
has a problem in the acicular chain at the same time, it must be repaired, we
call this procedure tympanoplasty.

The patient can usually be discharged on the same day and return
to his normal life. Due to the dressings placed in the external auditory
canal, there will be dressings in the external auditory canal for one week to
three weeks, depending on the size of the hole in the membrane. Once the
dressings are drained, antibiotic drops will be used for a while. Hearing
will return to normal within a month and a half.

Fluid Collection in the Ear (Chronic Serous or Mucoid Otitis Media) and Ear Tube (Groomed Tube) Insertion

In upper respiratory tract infections, effusion (fluid)
may be collected temporarily with pain in the ears. This situation
improves in a short time with treatment. The reason for this is the
obstruction of the nasal opening of the eustachian tube, which goes from the
nasal passage to the middle ear, due to edema due to infection.

All children have at least one such middle ear infection
by the age of six, and most infections are viral in origin.

Fluid in the ear is most common in children. It can
also be seen in adults, it is usually unilateral in adults and tumoral
formations in the nasal cavity should be ruled out. Children have frequent
upper respiratory tract infections and are prone to otitis media.

The function of the eustachian tube is to vent the middle
ear cavity and to resist the mucus inside the throat. The eustachian tube
in children is short, straight and horizontal in comparison to adults, but
reaches the angulation in adults at the age of seven. Due to frequent
upper respiratory tract infections, nasal hypertrophies, allergic rhinitis or
inflammatory cysts, the eustachian tube is blocked and cannot function so that
non-inflammatory fluid accumulates in the middle ear.

If the fluid accumulated in the middle ear does not
improve in more than three months despite all treatments, a ventilation tube
should be inserted to provide ventilation and drainage of the middle
ear. The nasal passage must be checked and adenoid, if any, must be
removed in the meantime.

The patient has a conductive hearing impairment, turns up
the TV or approaches to the TV, cannot hear, especially if he is sitting in the
back row at school, he becomes indifferent to the lesson, occasionally he has
earache. Diagnosis is made by examination and, if necessary, hearing tests
and middle ear pressure measurements.

The operation is performed under general
anesthesia. Without making an external incision in the ear, paracentesis
(ear cut) is performed on the anterior lower quadrant of the eardrum under
microscopic vision by entering through the external auditory canal, first the
fluid or mucus in the middle ear is aspirated and then a grommed tube is
inserted. The patient does not have any serious pain after this
procedure. Hearing returns to normal even on the same day.

The purpose of the tube is to undertake its duty until
the eustachian tube returns to its normal function. For the first time,
short-term (4-6 months) tubes are used and the tubes are automatically thrown
into the external auditory canal. If the situation recurs after the tubes
have been disposed, then it is necessary to put in the tubes called T-tubes
that cannot be disposed of themselves, but this is rare. It stays in place
for more than a year and can be removed under the doctor’s supervision.

After the operation, petroleum jelly should be put on the
ears while bathing until the tubes are removed, and the pool should not be
entered into the sea. In upper respiratory tract infections, discharge may
occur, and a doctor should be consulted immediately.

Septoplasty – Nasal Septum Deviation Operation

The division that separates both nasal cavities from the
middle is called the septum. It consists of cartilage in the front and
bone in the back. On both sides of these structures are soft tissues
called mucoperichondrium and mucoperiosteum. The curvatures of this
structure that prevent breathing through the nose are called septum deviation.

Nasal cavities are not always in the same
opening. At varying times from person to person (between 3 and 12 hours),
volume changes occur alternately in the mucous membranes in the nose and the
concha on the side walls of the nose (nasal concha). This event is called
the nasal cycle. This situation, which is not noticed in normal people, is
noticed in those with deviation, and they feel the nose opening and closing
during the day. Those with deviation usually lie on the obstructed side of
the nose so that the open one remains open.

In those with deviation and turbinate hypertrophy, those
with allergic rhinitis; if the cold takes longer and the possibility of
sinusitis increases. In addition, throat dryness occurs due to mouth
breathing at night, sleep quality deteriorates, and susceptibility to upper and
lower respiratory tract infections increases. Odor disorders and sleep
apnea may occur in those who are extreme

The operation should not be performed before the age of
17, since the development of the nose is not fully completed. However, in
children with deviation, which causes severe nasal trauma or severe bilateral
nasal obstruction, limited operation can be performed, it should be known that
a second operation will be required if the curvatures that cause nasal
obstruction continue after the age of 17-18.

Treatment: Eating and drinking should not be done at
least six hours before the operation, that is, you should come on an empty
stomach. If the person gives the districts he uses regularly, he should
tell his doctor, blood thinners should be stopped at least one week before,
they cause excessive bleeding during and after the regeneration.

The curvature and hypertrophy in the concha are corrected
by entering through the nose without an external incision. The operation
can be performed under local anesthesia or under general anesthesia. When
the operation is completed, depending on the condition of the septum and the
procedures applied to the turbinates, no tampon may be placed or silicone
splints and / or merocell pads that do not cause extreme discomfort to the
person can be placed.

The tampons placed are usually removed on the second day.
If there is bleeding, it may be necessary to put tampons again, but this is
rare. Buffers do not cause serious trouble and can be easily
removed. Self-melting stitches are used, stitches do not need to be removed.

There is no swelling on the face.

After the effect of anesthesia wears off, oral feeding
begins 3-4 hours later, there is no food restriction.

There may be dry throat and tearing in the eyes due to
tampons. There may be occasional bloody leaks from the tip of the nose and
nasal passages. Lying with a high head reduces pain.

After the tampons are removed, there may be edema and
crusting in the nose for a gradually decreasing time. These will be cleaned
with sea water or warm saline carbonated nasal rinses and your doctor will
clean it if necessary. The nose can be cleaned with light blowing without
excessive application.

Excessively intense exercise should be avoided for the
first month. Patients usually return to their normal daily life when their
tampons are removed.

If there is fever (exceeding 38 degrees), excessive
bleeding, bad smell from the nose, pain that does not relieve with painkillers,
a doctor should be consulted.

Rhinoplasty – Septorhinoplasty – Aesthetic Nose Operation

Restructuring the shape of the nose is called
rhinoplasty or aesthetic nose operation. If there are conditions that
prevent the patient from breathing (deviation, concha hypertrophy, etc.), then
if these are corrected at the same time, a septorhinoplasty is performed. This
operation should not be done before the age of 18, except in rare cases.

Structurally, nasal deformities caused by dislike of nasal shape,
previous traumas, nasal deformities after accidents or tumors should be
corrected. In addition, the operation can be requested without any
problems in the nose only due to the aesthetic appearance. For this, the
person should have reached a certain age maturity, without any psychological
problems, without being affected by the person alone.

The operation can be done with open and closed techniques. Depending
on the doctor’s preference, closed technique is applied if there is no
excessive deformity in the cartilages at the tip of the nose and the upper
parts of the septum. The open technique is applied by making an incision
in the middle of the nostrils called the columella, leaving no serious scar. In
this technique, the skin on the cartilages and bones can be removed and
reconstruction can be achieved more easily and properly under direct vision. The
required grafts can be placed more easily and properly. Other than this,
there is no difference between the two techniques.

There may be swelling and mild bruising on the face for a few
days. No excessive tampon is put into the nose, silicone splints can be
placed or not at all. Tapes and plaster or similar stabilizing material
are placed on the outside of the nose. These are removed at least a week
later, and taping is applied for about a week.

Edema and swelling on the back of the nose completely subside
within two weeks. Minor interventions may be required for a minority of
patients after at least a year.

Patients should not wear glasses for six months. They can use
glasses that do not touch the nose.

Avoid excessive sun exposure. Non-smoking affects healing
positively. For both documentation and operation planning, photographs of
the patient are taken from the front, profiles, top and bottom of the head
before the operation. If blood thinners are taken at least ten days before
the operation, they should be discontinued, smoking should be avoided.

Tonsillectomy– Tonsil Operation

The tonsils are the largest part of our body’s
defense system, located at the intersection of our respiratory and nutritional
pathways. It helps to recognize germs that enter the body through the
respiratory tract or nutrition. Apart from the tonsils, there are adenoids
(adenoids), tongue root tonsils, lateral lymphoid columns on the opposite wall
in the throat and plenty of lymphoid tissues. With the removal of the
tonsils, these other tissues continue the same task. In some cases, these
may also be required.

Chronic tonsillitis and abscesses, which often cause bacterial
angina, are large enough to shock breathing and feeding, hypertrophy that will
cause snoring and sleep apneas, bad breath, and tumor growth.

The operation is performed under general anesthesia. Classical
surgical tonsillectomy can be performed as well as by bipolar cautery, thermal
welding or coblation method. The advantage of these is that there is no
bleeding, it ends in a short time and there is less pain afterwards. Stitches
can be used to control bleeding when necessary. There may be bleeding at a
rate of one percent. Early bleeding occurs within the first four hours. Bleeding
is likely to occur in the first ten days at gradually decreasing rates. If
bleeding occurs, the doctor should be contacted immediately.

The patient is discharged on the same day or the next day. Medications
are given for pain. Oral feeding can be started two to four hours after
the operation. Non-solid foods such as warm liquid foods, soups, pudding,
yoghurt, fruit juices and purees are given. It usually resolves within a
few days to ten days.

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