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Some helpful patient information
We are committed to providing the most comprehensive, compassionate care for our patients.
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Hoarseness of voice or voice loss is a common problem that affects the voice box or larynx. The larynx or the voice box is mainly made of cord like structures (vocal cords) attaching to the thyroid cartilage and back of the throat. In a complex process of opening and closing in phonation, and allowing passage of air into or from the windpipe and lungs, there is production of sound. Any inflammation or infection around the voice box, especially affecting the vocal cords themselves, results in reduced or zero sound production. Laryngitis is a term used to describe the inflammation of the vocal cord.
The causes of laryngitis are infections, inflammation from trauma from accidents or during medical procedures or certain drugs used for various diseases. Growths that emanate from the cords or the area of the cords can also cause hoarseness. The commonest are vocal cord nodules (common among singers, teachers, preachers and politicians-who use their voice a lot). Some heavy voice users may have increased vascularization on the cords leading to chronic hoarseness. Reflux disease where acid backflows into the back of the throat and the larynx can also cause hoarseness. The other common growths are vocal cord polyps. Both nodules and polyps are benign in nature but some growths can be cancerous. Since hoarseness of voice can be caused by both benign and cancerous lesions, it is imperative that hoarseness is evaluated by a specialist; usually an ENT doctor. Any hoarseness that continuously lasts more than three weeks especially in patients over 40 years of age; is deemed suspiciously cancerous untilproved otherwise.
Various examinations can be carried out by the ENT doctor includinggeneralexamination, throat examination. Modern technology has allowed doctors to use camerasand videos (video laryngoscopy or nasopharyngoscopy) to examine and even record the voice box lesion and also plan for treatment.
Invariably some lesions may need medical or surgical treatment depending on their nature.
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A swelling noticed in the neck region can be very worrying to a patient more so when the swelling progressively gets larger or is painful. The neck is can simply be divided into anterior, posterior, and lateral (sides). The general rule of the thumb is that swellings that come up suddenly, enlarge rapidly and are painful are most likely benign and could be due to infections. This includes abscesses and cellulitis or inflammation). Previous trauma should always be taken into consideration.Neck swellings can be from the skin,(keloids or cysts) ; fat (e.g. lipoma), connective tissues,( e.g. fibromas); blood vessels, muscles(e.g. myomas) or bone(e.g. sarcoma).
Malignant or cancerous neck swellings may tend to grow over a long period of time and pain is usually sets at very advanced stages. Some long growing swellings like cysts may also take long but are benign.
Anterior(front) swellings include, thyroid cysts, goiter, lipomas(fat swellings) or tuberculous nodes or rarely cancerous swellings. Lateral swellings abscesses, cysts, lymph nodes(tuberculous or otherwise); and cancerous swellings, Posterior swellings could be cysts, abscesses, or tumours. Posteriorly based swellings are much rarer.But lipomas and cysts are the commonest.A swelling should always be evaluated by a specialist. The size, the period it has been growing and the feeling on palpation a clue as to what it could be.Soft swellings could be cystic while very hard swellings could be cancerous.
To understand the nature of the swelling; an ultrasound scan, or a CT-scan of the neck or MRI scan is very useful and can give a clue as to the diagnosis.
Following a scan, a Fine Needle aspiration Cytology (FNAC) biopsy is the most important procedure that can be done to diagnose the cause of a swelling. This involves the diagnostician sticking a fine needle into the swelling and getting some cells for examination. The special exception to FNAC is a pulsating mass or swelling more so at mid neck position on the side of the neck.This is because vascular masses like Carotid body tumor or aneurysms can bleed a lot if biopsied without knowing.
After the diagnosis, most being tumours will be sorted out by surgical excision. Cancerous swelling may not always be removed in total by surgery butnot all malignantswellings removed.Some especially very extensive tumors may require a combination of chemotherapy, radiation therapy and surgery.
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Otitis media is defined as middle ear infection. The ear has three parts; the outer the middle and the inner ear. All of them are connected. The middle ear is connected to the nose and back of the throat through the Eustachian tube. It is therefore obvious that infection of the throaty or nose and the ear can spread form one region to another. The causes of otitis media are commonly throat causes of upper respiratory tract. They are both bacterial and viral causes. Because of various factors not least the connection with the nose and throat, otitis media can be recurrent and difficult to treat in children. In adults Otis media can be caused by cold or flus.Otitis media is characterized by pain, sometimes watery discharge and of fullness of the ear and hearing loss. Usually it maybe predated by cold or flu or nose/sinus infection or inflammation. In infants, display ear infection by being irritable, tagging at the ear and crying. In older children, they may complain of pain and discomfort and have fevers. In children with recurrent fevers that nay not have the benefit of assessment by pediatricians or ENT doctors otitis media should be considered as a possible cause.
Otitis media can be acute or chronic. When acute ear infection is not treated properly it can lead to congestion with sterile fluid in a condition called otitis media with effusion (OME). However on the other hand the infection can cause the ear drum to sell and bulge to eventually ‘burst” causing a perforation. This may lead to chronic ear discharge; a common condition in low especially in low social economic set ups. In communities where antibiotics are available are improperly and given for otitis media, OME is more common.
To avoid these complications it is important to seek proper care when a child shows signs of ear infection.
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Tonsillectomy is a surgery that aims at removing tonsils from the body.The tonsils are glandular tissues in throat. There is a left and a right tonsil. The tonsils are present at birth. As the child grows, the tonsils also grow. The tonsils are part of the lymphoid tissues in the oral cavity that are involved in immune protection. There many situations that would require ENT doctors to remove tonsils. These include; recurrent infections, upper airway obstruction (mainly in children and sometimes adults). In adults, recurrent infections, abnormal enlargement, recurrent bad smell, tumors or airway obstruction are some of the causes.Tonsillectomy is the most common pediatric surgery the world over. Each year thousands of tonsillectomies are done the world over. In purely children’s hospital, tonsillectomy and adeno-tonsillectomy comprises not less than 60% of all hospital surgeries. Tonsillectomy is usually done under general anesthesia. The surgery can last between 20 to 45 minutes in children and could last more than 1 hour in adults. Usually in set ups where patients have good access to medical care and emergencies, tonsillectomy patients are done as day surgeries. After hospital observation of 4-6 hours patients can be discharged home. In our local set up moist ENT doctors are comfortable observing their patients overnight.
The main risk of tonsillectomy is bleeding after the surgery. It is imperative that parents or patients disclose bleeding tendencies (e.g. heamophilia or sickle cell aneamia) or use of any medications including herbs prior to undergoing surgery. However the surgeon will always make sure that the bleeding is totally controlled before waking up the patients. To avoid bleeding in the ward, patients are encouraged to take sift or liquid diet and avoid hot foodstuffs. In the modern surgical world, tonsillectomy is therefore a very safe surgery. It is important for patients to follow the doctors’ instructions post-surgery to avoid complications
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Tonsillitis is the inflammation of the tonsils. The tonsils are glandular tissues in throat. There is a left and a right tonsil. The tonsils are present at birth. As the child grows, the tonsils also grow. The tonsils are part of the lymphoid tissues in the oral cavity that are involved in immune protection. The other lymphoid tissues are immediately up and behind the uvula and are called adenoids. The other name of adenoids is pharyngeal tonsils. The posterior aspect of the tongue has rough looking nodules that are called lingual tonsils. There are many other minor tonsils embedded within the oral cavity. Most of these will be visible in severely immune deficiency situations, like cancer or HIV/AIDS. Immediately, the bacteria or other foreign material enters the throat, the tonsils produce antibodies that trap or attach to the foreign bacteria and neutralize them, thereby conferring protection.The tonsils have a tendency to get inflamed and infected regularly especially in young children from age three onwards. This is common when they join school and the infections may spread between the children themselves. Tonsillitis is characterized by pain, difficulty in swallowing, fever and general malaise.Most children or adultcannot eat well. Usually the tonsils would swell, and can be septic with pus.
This usually needs treatment by a physician. Usually antibiotics, anti- fever and anti-pain medicine would be given. Because tonsillitis tends to recur, in these particular patients, it is generally recommended especially in young children, avoidance of cold or sweet foodstuffs.The risks of chronic or recurrent tonsillitis include the development of rheumatic heart fever and disease. It is therefore important for this to be treated properly.
In case of recurrent tonsillitis regardless of age, the patient may need to be reviewed by an ENT doctor. If the recurrence are more than three times in a year or five times in the previous two years, the ENT doctor may recommend the removal of the tonsils through a surgery called tonsillectomy.
Usually in small children, tonsils may be removed together with adenoids in a surgery called adeno-tonsillectomy. This is usually under general anesthesia. Note that tonsils may be removed because of being too large and causing obstruction, especially in small children.