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.
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.
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
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.
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.
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
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.