Patient Information leaflet
Patients can access detailed leaflets for guidance on ENT conditions, treatments, and self-care tips. These leaflets are designed to provide clear instructions, help understand procedures, and assist in recovery. Below are the key topics:
Tinnitus(Ringing in the ears)
ABOUT THE CONDITION What is tinnitus? Tinnitus is a sensation or awareness of sound that is not caused by a real external sound source. It can be perceived in one or both ears, inside the head or in the person's immediate environment. Although it is commonly assumed to be a ringing noise, tinnitus can take almost any form, including hissing, whistling, humming, or buzzing. Some people hear a single sound whereas others hear multiple noises. For some, the sound is constant: for others it is constantly changing. A few people have tinnitus that has a musical quality or resembles distant, indistinct speech.
BPPV & Home Epley Manoeuvre
The organ responsible for balance is located inside your ear. It consists of 3 semi-circular canals on each side which act like a gyro to detect motion. In Benign Paroxysmal Positional Vertigo or BPPV, calcium crystals can be dislodged from elsewhere and enter the balance organs. Turning the head can cause movement of these crystals. These interfere with signals sent to the brain which causes brief sensation of spinning or vertigo.
Cawthorne-Cooksey Exercises
If one or both balance organs are not working well, you will feel off balance. This may present as vertigo or a spinning sensation. Other people describe the sensation of giddiness or of being drunk. They may also feel sick (have nausea) or are sick (vomit). These symptoms can feel quite scary, and some people may lose their confidence. Please be reassured that, although scary, this condition is not life threatening.
Ear Microsuction
The ear makes wax to keep the ear canal healthy and protect it from germs and dirt. Usually, the wax comes out of the ear on its own. You don't need to use cotton buds or clean your ears. Wax build-up in the Ear Canal In some people, their ears don’t clean themselves. This results in wax build-up. Using cotton buds can also cause wax to become stuck in the ear. Click here for self-help tips for wax build-up.
Facial pasly
The nerve that makes the muscles of the face (lips, eyelids, and forehead) move is called the facial nerve. A facial nerve palsy means the nerve to the face does not work properly. The muscles in your face may not move properly or not at all. It can make everyday things like smiling, blinking, eating or saying words correctly difficult.
Glue Ear- Otitis Media with Effusion
Glue ear is a build-up of fluid inside the middle ear. The medical term for glue ear is otitis media with effusion (OME). It is a common condition. Up to 8 in every 10 children will have a short episode of glue ear before they start primary school.
Hearing, Defnees and Hearing Aids
The ear is made up of the outer, middle and inner ear. Sound travels through the outer ear and reaches the eardrum, causing it to vibrate. The vibration passes through three tiny bones (the malleus, incus and stapes) in the middle ear. The vibration then enters the inner ear, where nerve cells produce signals that are carried to the brain, where they are interpreted as sound. See figure 1 for the anatomy of the ear.
How to use ear drops or spray
1.Wash your hands.
2.Hold the bottle in your hand for a few minutes to bring the drops closer to body temperature. Do not place the bottle in hot water.
3.Twist the cap anti-clockwise to remove it. For some bottles, you may need to remove the security band and the cap used to pierce the nozzle.
4.Lie on your side with your affected ear facing upwards when applying ear drops. For ear sprays, sit upright.
Meniere’s Disease
Ménière’s disease is a condition that affects the inner ear, which controls your hearing and balance. The exact cause is not known. It is thought to occur due to an abnormal build-up of fluid in the inner ear. This can affect the ear’s ability to send signals to the brain about balance and sound.
Outer ear infections or Otitis Externa
It is when the skin in the outer ear canal is red, hot, and swollen. The infection can also spread to the outer ear and the eardrum.
Self-help tips: itchy ears and earwax build-up
The ear is made up of the outer, middle and inner ear. Sound travels through the outer ear and reaches the eardrum, causing it to vibrate. The vibration is transmitted through three tiny bones in the middle ear. The vibration then enters the inner ear, where nerve cells produce signals that are carried to the brain, where they are interpreted as sound. See figure 1 for the anatomy of the ear.
Flexible Nasoendoscopy
Flexible nasal endoscopy is a procedure that is used to look inside the nose, the back of the nose, throat, voice box and base of the tongue. An endoscope is a type of flexible telescope. It is a very common test performed while you’re awake, usually in the outpatients' clinic, ward or emergency department
How to use nasal drops
1.Wash your hands and gently blow your nose
2.Gently shake the nasal drops. Twist the cap anti-clockwise to remove it. If using a nasule, twist off the top part to open it.
3.Lie on your back, with your head just off the bed. Tilt your head backwards, so that your chin is pointing upward
4.Breathe normally through your mouth while putting the prescribed number of drops into each nostril.
5.Lie in this position for two minutes after inserting the drops.
6.After inserting the drops into both nostrils, clean the nozzle and replace the cap.
How to use nasal sprays
1.Wash your hands and gently blow your nose.
2.Gently shake the nasal spray. Twist the cap anti-clockwise to remove it.
3.Keep your head upright. Insert the nozzle tip into one nostril. Keep your other nostril open.
4.Hold the bottle with your index and middle finger at the top, and your thumb at the bottom .
5.Try to direct the spray away from the septum (the middle part inside the nose). You may find it easier using your right hand for spraying your left nostril and vice versa
6.Breathe in gently as you spray. Do not sniff hard as the spray then travels past the nose into the throat.
7.After spraying both nostrils, clean the nozzle and replace the cap.
Saline Rinses for the Nose
The nose filters, moisturises and warms the air that you breathe in to your lungs. Sometimes your nose also needs to be cleansed and moisturised otherwise it becomes blocked or very runny. Saline (salty water) rinses are a gentle way to clean and moisturise the nose. It helps to wash away excess mucus and irritants inside your nose which can help reduce swelling and a blocked nose (rhinitis).
Blocked Nose
The sensation of a blocked nose is often referred to as nasal obstruction, a stuffy nose and nasal congestion. The severity of the nasal obstruction varies from one patient to the next. Some people find even mild nasal blockage quite troublesome, whereas others, with quite severe nasal obstruction, find it does not have a significant impact on their daily activities. Your specialist will take this into account when developing a plan for your treatment.
Anosmia/Smell Disorders
Anosmia is the medical name for the loss or lack of the sense of smell. There are different medical terms for other changes in the sense of smell:
- Hyposmia - reduced sense of smell
- Parosmia - smells being different to what is expected
- Phantosmia - perception of smells that are not present
- Congenital anosmia - total inability to smell from birth
Hay Fever
Hayfever is the common name given to cold-like symptoms caused by inhaling plant pollens at certain times of the year. When people who are allergic to plant pollen breathe it in, it causes the lining inside the airway to swell, this is called inflammation. It commonly affects the nose (rhinitis), eyes (conjunctivitis) throat and ears and can affect the lungs. Inflammation of the lining inside the nose is called rhinitis. Hayfever is often referred to as Seasonal Allergic Rhinitis.
Catarrh
Catarrh is very common but very difficult to describe. It means different things to different people. Some people use the term to describe a feeling of mucus (snot) at the back of their nose. Others use it to describe a build-up of mucus in their throat. For some, it simply means feeling that they keep needing to clear their throat.
Facial Pain
Facial pain is a common problem. Many people mistakenly think that because the pain is over the face, it must be coming from the sinuses. Nine out of 10 patients with facial pain referred to see an ENT specialist do not have sinus problems. Facial pain can be caused by headache, migraine, a problem with muscles, joints, your teeth, the nerves in your face and sometimes the sinuses. Headaches are very common. Other factors which may influence pain include stress, dehydration, certain foods, menstruation or lack of sleep. Keeping a diary of your symptoms may help identify triggers which you can avoid.
Nasal Polyps
A polyp is a swelling of the lining of the nose, which is usually due to inflammation of the lining of the nose.
Causes
Nasal polyps come from the lining of the nose and often originate from the ethmoid sinuses, which drain into the side wall of the nasal cavity. Nasal polyps contain inflammatory fluid and, while they can be associated with allergy and infection, the exact reason why some people get them and not others is not known.
Nose Bleeds
Who is likely to suffer from nosebleeds?
Anyone can experience a nosebleed.
Nosebleeds are slightly more common in men than women.
Nosebleeds tend to affect the elderly but are also very common in children.
Over half of children aged between 6 and 15 years old have nosebleeds regularly.
Septal Surgery (Septoplasty)
The nasal septum is the thin wall between your two nostrils, made up of cartilage (gristle) and bone. The nasal septum can sometimes be twisted or bent to one side. This can make the inside of your nose narrower, often on one side, and makes the nose feel blocked. It can be caused by a previous injury to the nose, but sometimes it just grows that way. We can operate on the septum to straighten it. This operation is called septal surgery, or septoplasty.
Sinus Infection(Sinusitis)
The nasal septum is the thin wall between your two nostrils, made up of cartilage (gristle) and bone. The nasal septum can sometimes be twisted or bent to one side. This can make the inside of your nose narrower, often on one side, and makes the nose feel blocked. It can be caused by a previous injury to the nose, but sometimes it just grows that way. We can operate on the septum to straighten it. This operation is called septal surgery, or septoplasty.
Sinus Surgery
Sinuses are air-filled spaces in the bones of the face and head. They are connected to the inside of the nose through small openings.
Tumours of the Nose
Tumour is Latin for swelling but not all swellings are cancer. Benign tumours grow slowly and do not invade the local structures. These are the most common variety in the sinonasal cavity. Malignant tumours are most commonly called cancer. These tumours invade the local tissues and can also spread to distant parts of the body.
Turbinoplasty
The inferior turbinates are made up of ridges of bone covered with soft tissue and the nasal lining. There is one on the right and one on the left side of the side walls on the inside of the nose. The turbinates play an important role in making the air we breathe warm and moist.
Head and Neck Cancer
Head and Neck (H&N) cancer is the term used to describe a variety of cancerous (also called malignant) tumours which develop in the mouth (oral cavity), throat (pharynx), voice box (larynx), salivary glands, and the nose and sinuses. In some H&N cancer centres, cancers of the skin of the scalp, face and neck may also be treated by the H&N cancer team. Cancer of the Thyroid gland is discussed in a separate section.
Thyroid Lumps and Thyroid Surgery
The thyroid gland is found in the neck, in front of the windpipe, between the collarbone and the Adam’s apple. It is shaped like a bowtie or butterfly (see figure 1), with two halves, the right and left thyroid lobes, connected by a bridge of tissue called the isthmus. The thyroid gland produces a hormone called thyroxine. Thyroxine is released into the bloodstream and is important in controlling your metabolism.
Thyrotoxicosis-Thyroid Surgery for Benign Thyroid Disease
The thyroid gland is found in the neck, in front of the windpipe, between the collarbone and the Adam’s apple. It is shaped like a bowtie or butterfly. There are two halves, the right and left thyroid lobes, connected by a bridge of tissue called the isthmus. The thyroid gland produces a hormone called thyroxine. Thyroxine is released into the bloodstream and is important in controlling your metabolism.
Parotidectomy
The parotid gland is the biggest of the three main glands in your face that produce saliva (spit). You have one on each side. They are in your cheeks, most of the gland is in front of your ears with a small tail that goes behind and below your ears. Small tubes in the parotid glands move saliva into the mouth. There are also hundreds of small glands in your mouth that produce saliva. Saliva helps keep your teeth clean and starts breaking down food as you chew it.
Neck Disssection
A neck dissection is an operation to remove groups of lymph nodes from the neck. This operation is performed on patients with cancer of the head and neck.
Submandibular Gland Excision
The submandibular gland is the second largest of the main salivary glands . It is the size of a walnut and sits just below the jawbone on either side of the neck. The gland produces saliva, which drains through a duct (tube) into the front of the mouth under the tongue.
Thyroglossal Duct Cyst
A thyroglossal duct (TGD) cyst is a fluid-filled sac or lump in the front of the neck. It is uncommon.
What causes a thyroglossal duct cyst?
The thyroid gland travels from the back of the tongue down into the neck while a baby is in the womb. A sac of fluid or cyst may form along the path the thyroid gland follows. This is called a thyroglossal duct cyst (TGD cyst).
Rigid Pharyngoscopy and Upper Oesophagoscopy
Pharyngoscopy is the examination of the throat, and oesophagoscopy is the examination of the oesophagus (or gullet) while under a general anaesthetic. It is done to investigate problems of the gullet, such as difficult or painful swallowing. Occasionally it may need to be done urgently to remove food or objects, such as dentures, that are stuck in the gullet. Oesophagoscopy is usually a short operation. You may go through another procedure at the same time, called a microlaryngoscopy or rigid laryngoscopy. Your surgeon will give you a leaflet on microlaryngoscopy if this is the case.
Microlaryngoscopy: An operation on your voicebox
Microlaryngoscopy is an in-depth examination of your voice box (also known as your larynx) while you are asleep under a general anaesthetic. It is a short operation and usually takes about 30 minutes. You may have another operation at the same time called a pharyngoscopy and upper oesophagoscopy. Please refer to the patient information leaflet on Pharyngoscopy and upper oesophagoscopy if this is the case.
Tonsillectomy (Taking out your Tonsils)-
Tonsillitis is an infection or inflammation of the tonsils. Tonsillitis is caused by a viral or bacterial infection in the throat.
Snoring and Obstructive Sleep Apnoea in Adults
When you are asleep, and progressing from light to deep sleep, the muscles in the throat may become very relaxed. These muscles include the soft palate, pharynx and back of the tongue. Snoring is the sound made when air vibrates the relaxed soft tissue in the throat when the air moves in and out of the nose and/or mouth.
Your Voice and How to look after it
What is causing the problems with my voice?
Many different things can cause discomfort or changes in your voice quality. These include:
a recent cold or infection
damage to the voice box from injury
the way in which the voice is used, such as shouting or screaming
lung conditions, such as asthma, can reduce the airflow needed to form your voice
imbalance in the voice box’s muscle tone
stress and worry
excess acid refluxing into the voice box
smoking
Physiotherapy management of Temporomandibular Joint (TMJ) pain
The jaw is also known as the TMJ or Temporomandibular Joint. It can be painful as the result of injury, inflammatory disease, poor postures and habits or growth disorders. This leaflet gives you advice on managing your jaw pain.
Laryngopharyngeal Reflux
Laryngopharyngeal reflux partly contributed by lifestyle what we adopt. It is important to reflect on our lifestyle and modify to reduce stimulants which produce acid in your stomach. Common food which produces lot of acid in your stomach are- fizzy drinks, energy drinks, sparkling water, excessive consumption of tea and coffee, fatty and deep fried food, drain products-milk, cheese, yogurts, chocolates, tomatoes, peppers, onion, garlic, chilies, oranges, lemons, grape fruit, alcohol and avoid having late meals and avoid lying down for 2-3 hours after last meal of the day. These above mentioned food/drinks produce lot of acids and I strongly suggest to avoid consumption of these in excessive amounts.
Tonsillectomy
It is normal to expect substantial pain every morning when you wake up after surgery. This pain is due to accumulation of pain substance in your muscles in the throat. This pain substance accumulated in throat muscles can only come out of the muscle once you start eating and drinking and that is the most important aspect of management here. You should take ONLY soluble/liquid full-dose paracetamol (1 g 4 times daily) and ibuprofen (400 mg 3 times daily) every morning along with Oromorph (5-10 mg) and wait for 40 minutes. It is best to start with four piece of toast in the morning which will help to remove the pain substance from muscle. It might sometime takes 1-2 hours to finish four pieces of toast during your breakfast which is normal. For the rest of the day ,you should continue to have some solid diet and lots of waterregularly with constant sips which will help to keep the pain well-controlled throughout the day. I would suggest to continue with regular painkillers at least paracetamol and ibuprofen every day for the full 2 weeks. You should certainly take Oromorph every morning, however if the pain is well-controlled you probably do not need Oramorph regularly. You should expect the pain will become particularly worse from day 5 to day 8 and I would strongly suggest to take Oromorph 2 to 4 times per day during this period. If the pain is not well-controlled, you will struggle to eat and drink which in turn make your pain worse. If you are not taking an oral diet and liquids regularly, it will increase the chance of getting an infection and increase the risk of having a bleed. If you notice any bleeding in your mouth which is more than a streak of blood, you should report to nearest accident and emergency department and this bleeding can get worse in the next 24-48 hours.
Septoplasty or FESS(Sinus Surgery)
You will need steroid nasal drops, Naseptin nasal cream and analgesics which will be provided in neuro discharge back. You should buy Neil Med sinus rinse kit (bottle with sachets) either in Amazon/boots/Superdrug or any other pharmacies. There will be some absorbable stitches inside of your nose which should resolve on its own and will fall out when ready. Should use Naseptin nasal cream 3 times daily from day 1 after surgery and you should use that for full 3 weeks after surgery. The correct technique to use Naseptin nasal cream to use is to apply using the long tip of the cream tube directly over the septum and massage with your finger on the outer aspect of nose like how you pinch your nose. You should start washing your nose from day 2 after surgery twice daily, once after shower in the morning and then before going to bed. Ideally you should 1st have shower and then blow your nose at the end of shower to remove the scabbing inside your nose. You should use then Neil Med sinus rinse. Fillup with lukewarm water up to dotted line on the top of the bottle and then add 1 sachet into the bottle and shake to mix the sachet. You should then lean forward in front of wash basin and use 1 bottle each side of nasal cavity to remove scabbing in her nasal cavity. You should then use steroid nasal drops after washing your nose. You should not apply steroid nasal drops while sitting on a chair and it should be applied whilst lying down in the bed and ideally head extended beyond the pillow and turned to 1 side with chin-up, 3 drops should be instil over the dependent side of the sidewall (lateral) of your nose and stay in that position for 3 minutes. You should always apply this steroid nasal drops only after washing your nose by above technique. You should continue with saline douches and steroid nasal drops twice daily for full 6 weeks to get desired outcome. If you to not washing her nose with saline douches you will produce enormous amount of scabbing which will have significant impact on final outcome of your surgery. You’ll need painkillers-paracetamol and/or ibuprofen for first few days however if you are in any pain and discomfort you should continue to use these painkillers for up to 2 weeks.
Thyroidectomy/ Parathyroidectomy
You will have a small tape like dressing on the front of your neck which should stay up to 7 days after your surgery. If it comes out before 7 days no need to be concerned and you should aim to keep the wound dry. I would suggest you to clean your face and hair with wet towels only to avoid getting wet of your neck wound and you can wash below your neck. You should not have any shower in the 1st 7 days after surgery. After 7 days you can remove the tape over the wound and there won’t be any stitches to be removed as the sutures used to close your wound were all absorbable sutures. You can then apply a thick layer of Vaseline over the wound every day before your shower for next 7 days. After 7 days you do not need any Vaseline over the wound before your shower. You should start massaging your neck scar after 2 weeks from surgery with either bio oil or E45 and you should massage your neck scar at least twice daily for 10-15 minutes from Adam’s apple to collar bone in the neck. The scarring process takes several months depending on each individual healing process and this neck massage should continue for up to 3 to six-months depending on the thickness of the scar.
