Procedures

Tonsillectomy/ Adenoidectomy

Removal of tonsils and/or adenoids is one of the most frequently performed throat operations. It has proven to be a safe, effective surgical method to resolve breathing obstruction, throat infections and manage recurrent childhood ear disease. Pain following surgery is an unpleasant side effect, which can be reasonably controlled with medication. It is similar to the pain patients have experienced with throat infections, but often is also felt in the ears after surgery. There are also some risks associated with removal of tonsils and/or adenoids. Post operative bleeding occurs in about 2% of cases, most often immediate, although it can occur at any time during the first 2 weeks after surgery. Treatment of bleeding is usually an outpatient procedure, but sometimes requires control in the operating room under general anesthesia. In rare cases, a blood transfusion may be recommended. Because swallowing is painful after surgery, there may be poor oral intake of fluids. If this cannot be corrected at home, the patient may be admitted to the hospital for IV fluid replacement. Anesthetic complications are known to exist; they are quite uncommon, however, since patients are usually young and healthy.

Myringotomy and Tubes

Myringotomy with or without tympanostomy tube insertion is the most commonly performed ear operation. It is extremely safe and effective. Complications are minor and usually in the form of infection, which may be treated with antibiotics. The tube usually remains in place for 6 to 12 months, although it may be rejected sooner or remain in place for years. Post op care including water precautions are individualized and will be discussed by your physician. Occasionally the tympanic membrane fails to heal after tubes have been removed, and the resulting perforation may require surgical repair. In some cases, tympanostomy tubes may need to be replaced. Hearing improvement is usually immediate after fluid has been removed from the ear. Failure to improve hearing may indicate a second problem in the middle or inner ear.

Thyroidectomy

Thyroidectomy is an operation in which one or both lobes of the thyroid gland are removed. The most common indications for thyroidectomy include a large mass in the thyroid gland, difficulties with breathing related to a thyroid mass, difficulties with swallowing, suspected or proven cancer of the thyroid gland and hyperthyroidism (overproduction of the thyroid hormone). Your physician will discuss the need for thyroidectomy based on your history, the results of a physical examination and test. The most common tests to determine whether a thyroidectomy is necessary include a fine needle aspiration biopsy, thyroid scan, ultrasound, x-rays and/or CT scan, and assessment of thyroid hormone levels.

The procedure is usually done under general anesthesia. The extent of surgery (removal of one or both lobes) may sometimes be determined in the course of surgery after microscopic examination of tissue removed during the surgery.

After surgery it is very common to have difficulties and/or pain with swallowing. This pain usually resolves within 24 to 72 hours. Bleeding or infection are also possible short term complications. Although rare in thyroid surgery, some patients may develop a thick scar or keloid.

Two complications specific to thyroid surgery are hypocalcemia and vocal cord weakness or paralysis. Hypocalcemia, or low blood levels of calcium, may occur after complete removal of both thyroid lobes. This condition is caused by injury to four tiny glands called parathyroid glands, which are located within or very close to the thyroid gland. Hypocalcemia is usually temporary, but fortunately rare. Vocal cord weakness or paralysis may be caused by swelling, stretching, or injury to the recurrent laryngeal nerve which passes very close to the thyroid gland. Temporary hoarseness may result. Again, this is an uncommon, usually temporary complication. Permanent vocal cord paralysis is rare.

Depending on the final histologic (microscopic examination) diagnosis of the gland removed, continuous follow up by your endocrinologist and/or surgeon may be indicated.

Sinus Surgery

Rare occurrences include: permanent blindness, permanent double vision, permanent chronic headache or ear pressure change, permanent voice changes, permanent nasal regurgitation of food, loss of facial cheek sensation. Brain fluid leakage requiring hospitalization with spinal drain or re-operation. In the setting of brain fluid leak rare complications such as meningitis, brain abscess, stroke or death are possible.

Problems seen intermittently: bleeding requiring re-operation or nasal packing, permanent loss of smell, scarring requiring re-operation or office treatment, persistent sinus infection requiring re-operation or office treatment, hole of the nasal septum, persistent nasal breathing blockage requiring re-operation.

Problems expected in all patients: possible need for allergy treatment with shots or medications, temporary and mild post operative discomfort, nasal drainage, sinus fullness sensation, need for post operative cleaning and follow up.

Endoscopic Sinus Surgery

Endoscopic sinus surgery is performed intra nasally and is recommended only after it has been determined that medical management has been unsuccessful. Surgery, medical management, and failure to intervene all have risks, including as a group, postoperative bleeding, orbital complications (visual impairment), intracranial extension (brain damage or infection), leakage of cerebrospinal fluid, persistent or recurrent nasal obstruction due to failure to manage polyps and recurrent nasal or sinus infection.

Radiographs and endoscopic findings considered in conjunction with the patients clinical status following medical evaluation and therapy - will identify the appropriate sinuses to treat.

Tympanoplasty/Mastoidectomy

Tympanoplasty or reconstruction of the middle ear hearing mechanism serves the purpose of rebuilding the tympanic membrane and/or middle ear bones. An excellent result may be expected in 80-90% of cases, failure to improve is not a complication. Success depends almost as much on the ability of the body to heal and preserve the reconstruction as it does on the surgeon’s skill. Fortunately, even those cases that fail may be revised and have the same high degree of expected good result. There are, nevertheless, some complications that do occasionally occur. Further hearing loss (rarely total) happen less than 10% of the time when the middle ear bones are rebuilt, and for that reason ossiculoplasty is not advised unless hearing is poor. Hearing loss is uncommon if the operation is limited to repairing the tympanic membrane. Injury to the facial nerve as a result of this surgery is rare. There is a slightly greater risk when mastoidectomy is also performed, but once again, the most experienced surgeons may only encounter this complication once or twice in a career. As a general statement, complete success in restoring hearing without complication is related to the severity of the disease present before surgery, and those are the cases that have the highest priority for surgical management. Loss of sense of taste on the side of the tongue may occur. It is usually only a minor inconvenience for a few weeks. Persistent post operative dizziness is almost unheard of after surgery limited to the repair of a tympanic membrane perforation and uncommon after rebuilding the ear bones. Unless control of infection or concern of cholesteatoma (as skin in the middle ear exists) is the reason for surgery, tympanoplasty is an elective procedure. Use of a hearing aid may be an alternative to reconstructive surgery. If the tympanic membrane perforation is not repaired, ear plugs are recommended to protect the middle ear from contamination when bathing. This may help to prevent infection and its complications.

Mastoidectomy is an operation to remove disease from the bone behind the ear, when medical management is inadequate. Sometimes a mastoidectomy is required in order to gain better exposure to the disease. Although complications do not often occur, they include persistent ear drainage, infection in the mastoid cavity, and hearing loss. Weakness of the face on the side of surgery is a rare but potential hazard in mastoid surgery. There may be dizziness for a short time after surgery, but it is rarely permanent. Loss of taste on the side of the tongue may occur and last a few weeks, but may be permanent.

Fiberoptic Laryngoscopy

Fiberoptic laryngoscopy and nasopharyngoscopy are diagnostic procedures using a fiberoptic endoscope. The endoscope is attached to a bright light to look into the nasal passages and back of the throat as far down as the voice box. The instrument is usually passed through the nose after a nasal spray is used to shrink and numb the nasal membranes. This frequently performed examination allows for a more thorough look at the nose, mouth and throat in order to diagnose problems that are otherwise difficult to visualize. Complications associated with this examination are rare and include temporary sneezing, coughing, gagging, and bleeding.

Fine Needle Aspiration

A fine needle aspiration may be performed in the office to obtain a small sample of cells for diagnosis of a mass. Usually anesthetic is injected first into the area for numbing purposes, then a small needle is inserted to attempt collection of some cells for testing. The cells are then sent for analysis and results are usually obtained within 1 to 2 weeks.

After the procedure, the aspiration the site may have some soreness. Tylenol is usually sufficient to relieve any discomfort. Possible risks include pain, bleeding and bruising. Sometimes the needle aspiration does not obtain an adequate sampling of the tissue and further evaluation is necessary such as excision of the mass in the operating room.

Reduction of Mandible Fracture

Fractures of the mandible (lower jaw) can occur alone or in combination with other facial injuries. The goal of treatment is to facilitate anatomically correct healing and satisfactory function. Treatment of these fractures is by wiring, plating, wiring upper and lower jaws together (intermaxillary fixation), or a combination of the above. Certain fractures may require only soft diet and pain relievers. Special dental treatment plans may be required for children.

Complications or unsatisfactory results may develop after surgery. Infection, slow or impaired healing, abnormal union, or non-union of the fracture, malocclusion, numbness, facial weakness and scarring are some of the unsatisfactory outcomes. As with any other type of surgery, bleeding or infection are possible short term complications, though fortunately, these are rare. Some patients may also develop thick scar tissue or keloid.

Nasal Endoscopy

Nasal endoscopy is done when there may be a condition or disease in the nose or sinuses that is not adequately visualized on routine examination. The nose may be sprayed with a decongestant and anesthetic before insertion of a rigid and/or flexible endoscope. The procedure can be performed on both adults and children comfortably. The throat may be numb for several minutes following use of an anesthetic.

Reduction of Nasal Fracture

Nasal fractures are common. If no airway obstruction or nasal deformity has occurred due to the fracture, surgical treatment may not be needed. For nasal fractures resulting in deformity or airway obstruction, surgery may be indicated to open the nasal passage and/or improve appearance. Surgery for nasal trauma may not be able to completely correct the traumatic deformity and/or may not correct pre-existing deformities. Nasal infection, bleeding, or hematoma are possible, yet infrequent complications.

Parotidectomy

Parotidectomy is a surgical operation to remove a large salivary gland (the parotid gland) located in front and just below the ear. The most common reasons for removal of all or part of this gland are a mass in the gland, chronic infection of the gland, or obstruction of the saliva outflow from the gland causing chronic enlargement of the gland. Masses in the parotid are most commonly benign, but about 20% are malignant. The physician will discuss with you the need for parotidectomy based on your medical history, the results of a physical examination of the head and neck, and results of other tests if indicated. The most common tests to determine whether a parotidectomy is necessary include a fine needle aspiration biopsy (withdrawing a small amount of fluid from the parotid to see if malignant cells are present), CT san (an x-ray test that helps to determine the size and position of the parotid tissues), and MRI (an imaging test that does not use x-rays and helps to determine the size and position of parotid tissues). In some cases no additional testing may be needed prior to surgery.

The procedure is usually done under general anesthesia. The amount of parotid gland to be removed is often determined at the time of surgery based on the size and location of the diseased parotid tissue. The extent of surgery may also depend on pathological examination of tissues removed during the surgery.

The nerve that controls motion to the face (the facial nerve) runs through the parotid gland. This nerve is important in closing the eyes, wrinkling the nose, and moving the lips. Most often the parotid gland can be removed without permanent damage to the nerve, however, the size and position of the diseased tissue may require that the nerve, or small branches of the nerve, be cut to assure complete removal. Even if the nerve is not permanently injured, there may be decreased motion of the facial muscles as the nerve recovers from the surgical procedure. If facial motion does not fully return your physician will discuss with you ways to rehabilitate facial movement. Other possible short term complications include bleeding and infection. Although rare in parotid surgery, some patients may develop a thick scar or keloid. Many patients experience numbing of the earlobe and outer edge of the ear after parotid surgery. This generally resolves slowly over time. In a small proportion of patients the face on the side of the parotidectomy sweats at mealtimes, (“gustatory sweating”). Most often this goes essentially unnoticed, however, if it should become bothersome medication and sometimes surgery are available.

Depending on the final diagnosis after the tissue is reviewed by a pathologist, additional diagnostic tests and follow-up examinations may be needed. Most often masses of the parotid are benign, and complete removal is the only treatment needed.

Septoplasty

Septoplasty is an operation to correct a deformity of the partition between the two sides of the nose. The usual purpose is to improve breathing, but it may also be required to permit adequate examination of the inside of the nose for treatment of polyps, inflammation, tumors, or bleeding. When the nasal septum is deformed, there is no medicine that will cause it to be straightened, so surgery is the only solution to this problem. The undesirable results that may occur include a hole in the septum, failure to completely improve breathing, postoperative bleeding (usually easy to control), nasal crusting, and very rarely, a change in appearance.

Skin Biopsy

A skin biopsy is a procedure performed in the office in which a small sample of skin is removed from a lesion for testing and diagnosis. This sample may help to diagnose diseases such as skin cancer, infection or other skin disorders.

The biopsy site id first cleansed with topical alcohol and iodine. Then an anesthetic is usually injected for numbing purposes. A scalpel or rounded blade is then used to obtain a small sample of the lesion. This sample is then sent for analysis, results usually received with 1 to 2 weeks.

You may have some soreness around the biopsied site for 1 to 2 days. If stitches are placed they will be removed in 5 to 7 days. Try to keep the area as clean as possible. A small scar will form at the biopsied site. Possible risks include bleeding, infection, pain and overgrowth of the scar called a keloid. Be sure to tell the doctor if you have a history of poor scar formation.

Turbinate Cautery

Turbinate cauterization involves treatment of a portion of the membrane of an enlarged inferior turbinate to reduce its size. Partial turbinate resection involves removal of a portion of bone and sometimes the mucous membrane of an enlarged inferior turbinate. It is a safe and effective procedure to relieve nasal congestion which has not improved with treatment of other underlying nasal, sinus, and/or allergy problems. Inferior turbinate procedures are performed under local or general anesthesia, sometimes, employing cautery, laser, cryotherapy or radio frequency ablation. They may be performed in association with other nasal and/or sinus procedures. Post operative bleeding may occur. Nasal sprays and lubrications may be prescribed to relieve dryness and aid in healing. Long term complications that may be associated with turbinate surgery include bleeding, crusting, dryness, odor, scarring and sinusitis.

Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP) is an operation to improve certain sleep disorder symptoms such as obstructive sleep apnea and snoring. Because there may be several causes occurring at the same time, this procedure may only give partial relief depending on the relative importance of palate and uvula size. The success rate in treating apnea cases has been reported to be greater that 50% and the expectation for snoring improvement may be greater than 80%. The most common complications include bleeding after surgery, infection, and temporary airway obstruction due to post operative swelling. Occasionally patients with severe obstruction or added risk due to obesity may require a temporary tracheostomy. Some patients also have complaints due to an inability of a shortened palate to make contact with the back of the throat. This may cause some nasal regurgitation and a hyponasal or hollow-sounding voice. The opposite effect due to narrowing of the space behind the nose (nasopharynx) is even less likely. As a general rule, the more carefully patients with sleep disorders are studied and selected, the greater the likelihood of improvement after UPPP.

Snoreplasty

Injection Snoreplasty is a non-surgical treatment for snoring that involves the injection of a hardening agent into the upper palate. Army researchers from Walter Reed Army Medical Center introduced this procedure at the 2000 Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundations. Their early findings indicate that this treatment may reduce the loudness and incidence of primary snoring (snoring without apnea or cessation of breath). The Academy neither endorses nor discourages the use of injection Snoreplasty for the treatment of snoring.

Those seeking injection snoreplasty to reduce snoring should first be screened for obstructive sleep apnea or OSA by undergoing a sleep study. If sleep apnea is confirmed, other treatment may be recommended.

Injection Snoreplasty is performed on an outpatient basis under local anesthesia. After numbing the upper palate with a topical anesthetic, a hardening agent is injected just under the skin on the top of the mouth in front of the uvula, creating a small blister. Within a couple of days, the blister hardens, forms scar tissue, and pulls the floppy uvula forward to eliminate or reduce the palatal flutter that causes snoring.

In some patients, the treatment needs to be repeated for optimum benefits. If snoring occurs from vibrations beyond the palate and uvula and/or obstructive sleep apnea is suspected, further testing and alternative treatment options may be advised. A thorough examination by an ear, nose and throat specialist is recommended to diagnose the source and type of snoring and determine whether injection snoreplasty may be helpful.

Nasal Saline Irrigation

Recipe for hypertonic saline (saltwater) for home or office irrigation:

1 quart of warm water (distilled is preferred)
2 – 3 heaping teaspoons of canning, pickling or sea salt (do not use table salt)
1 teaspoon baking soda

Nose should be irrigated 2 -3 times per day. Stand over a sink, using a bulb syringe, squirt the saltwater into the nose so that you are able to spit some of the saline out of your mouth. Aim the stream towards the back of your head, NOT the top. It is acceptable to sniff the saltwater directly into the nose.

The amount of salt added will depend on your tolerance. The more salt added, the greater the decongestant effect will be. The baking soda is a buffer and will allow the saltwater to be less irritating.

The benefits of hypertonic saline irrigation:

1. It is a solvent. It cleans mucous, crusts and other debris from the nasal passages.
2. It decongests the nose. Because of the high salt concentration, fluid is pulled out of the membrane. This shrinks the membrane, which improves nasal airflow and opens sinus passages.
3. It improves nasal drainage. Studies have shown that saltwater cleansing of the nasal membranes improves ciliary beating so that normal mucous is transported better from the sinuses through the nose and into the throat.

If you are also using a nasal steroid, such as Beconase, Vancenase or Nasacort, you should always cleanse the nose first with saltwater before utilizing the nasal steroid. The nasal steroid is most effective when sprayed into clean nasal membranes, and it reaches deeper into the nose after cleansing and decongestion.

Over the counter saline rinses: NeilMed Sinus Rinse, Ayr, Simply Saline, Ocean, Little Noses.