Problems of the middle ear {present with conductive or mixed hearing loss} are generally due to a hole in the ear drum, discharge from the middle ear and mastoid bone, bone erosion in the middle ear bone chain [ossicular chain], fixation of joints or thickening of bone and collection of fluid behind the ear drum following a cold. Very rarely it can be due to tumors of the nerve and blood vessels [neuroma and glomus respectively]. Except a few situations, majority will require surgical treatment for providing dry ear, hearing improvement and removal of tumor. Surgeries can vary from simple day care procedures like a myringotomy grommet insertion, stapedotomy, ossiculoplasty, various different types of tympanoplasty, mastoidectomy, facial nerve decompression, glomus tympanum / jugulare removal.

Majority of surgeries in the ear nose and throat can be performed on an out patient basis in adults under local anesthesia as the region to be operated upon are peripheral. This could be

Ear - ear lobe piercing, Ear lobe repair, Keloid excision from pinna, Otoplasty for bat ear, window operation for seroma / hematoma auris, myringotomy grommet insertions, myringoplasty, tympanoplasty

Nose: turbinate reduction surgery, septoplasty, cauterization for anterior bleeding in the nose, a few rhinoplasty procedures

Throat - diagnostic sialendoscopy, floor of mouth surgeries, laser removal of leukoplakia, mucosal cyst excisions, selected procedures for vocal cords and soft palate

In India, we do not have a sub speciality for pediatric ENT, most ENT surgeons handle pediatric problems affecting the ear nose and throat. Some frequent complaints with which parents bring children to the ENT consultation are – itchiness in the ears, wax in the ear, hearing deficits, poor speech or delayed speech development, stammering, mouth breathing, snoring, frequent colds, frequent throat infections. These are generally handled in the out patient itself and rarely will require admission.

Tonsillectomy and adenoidectomy are one of the most frequent surgical procedures which children undergo worldwide. The indications for surgery in todays times are obstruction to breathing, i.e., the size of tonsils and adenoids are so big that they obstruct breathing causing, snoring, disturbed sleep and poor performance at school, inattentiveness, dentition problems. Conventionally tonsillectomy and adenoidectomy are done by what is described as dissesction and curettage, this can be accompanied with some amount of blood loss. Modern technology has helped in making this a nearly bloodless surgery with the help of instruments such as coblation – which has a suction, cutting and coagulating tool incorporated in one handle. Most parents prefer this option for a safe, near bloodless and less painful surgery for their child.

for nose or Nose job or Rhinoplasty – As the face is the index of a person, the nose is the index of the face. Any deformity in size, shape or form of the nose draws attraction towards itself rather than the entire face itself. People can have a very long nose, crooked nose, broad or wide nose, round shaped tip of the nose, hump on the nose, broken nose following injury or trauma, which they would want corrected. Most of these people may also have nasal obstruction, An ENT surgeon can provide with corrections of shape, aesthetics as well as functional aspect of correcting obstructed nasal breathing.

An ENT surgeon’s, [who specializes in otology or the ear ] clinic is incomplete without audiological backup. Audiologists are qualified specialists who deal with assessing of hearing, middle ear function, inner ear function evaluation, speech assessment and rehabilitation of the same. Common audiological tests include pure tone audiometry, tympanometry, Oto acoustic emissions [OAE], Brain stem Evoked Response Audiometry [BERA]. They also help people with hearing problems by fitting hearing aids and teaching them to use these delicate instruments. They are also involved in rehabilitation of children who have undergone hearing implant surgeries such as cochlear implants and BAHA.

People who have difficulty in speaking – especially pronouncing, stammering, in children and post stroke in adults, will require rehabilitation from specialists namely speech therapists.

are electronic device which are also called as miracle ear. People who have profound hearing loss, unable to have any benefit with the most powerful of hearing aids or children who are born with hearing disability, who do not develop speech despite intensive speech therapy and hearing aid use, with further evaluation and right candidacy have a good chance to hear sound and perform well by undergoing a surgery to implant a device into the inner ear or cochlea, called the Cochlear Implant. Surgery is the first step towards hearing, This is followed by intensive speech therapy and AVT to help child be able to integrate into hearing society as quickly as possible. The earlier the child is identified as a potential candidate for cochlear implant and child undergoes the same, the better are the results.

are the most common cancers affecting the Indian population. This is due to high prevalence of using tobacco products, smoking, alcoholism. They can affect the nasal cavity, sinuses, nasopharynx [area behind the nose], oral cavity, tongue, tonsils, cheek, throat , voice box. Some of these areas are hidden and not easily visible to naked eye and routine clinical examination. A person suspected of having cancers of the head and neck, generally present with an ulcer, bleeding from the organ, swelling in the neck, dysfunction of the affected organ like nasal obstruction, ear pain, throat pain, difficulty in swallowing, change in voice. These people will need to be examined thoroughly with pan endoscopy and undergo appropriate tests. Most of these can be done on an out patient basis and diagnosed at an early stage to facilitate aggressive early treatment and good prognosis.

are the most common cancers affecting the Indian population. This is due to high prevalence of using tobacco products, smoking, alcoholism. They can affect the nasal cavity, sinuses, nasopharynx [area behind the nose], oral cavity, tongue, tonsils, cheek, throat , voice box. Some of these areas are hidden and not easily visible to naked eye and routine clinical examination. A person suspected of having cancers of the head and neck, generally present with an ulcer, bleeding from the organ, swelling in the neck, dysfunction of the affected organ like nasal obstruction, ear pain, throat pain, difficulty in swallowing, change in voice. These people will need to be examined thoroughly with pan endoscopy and undergo appropriate tests. Most of these can be done on an out patient basis and diagnosed at an early stage to facilitate aggressive early treatment and good prognosis.

Noisy breathing during sleep – snoring, is a manifestation of obstruction in the upper airway, mainly the nasopharynx to the trachea. People who have snoring need to be identified whether they are simple snorers [which is largely a social or marital problem] or as one having obstructive sleep apnea which is a major health concern in modern world. OSA can predispose to many ailments affecting the heart and brain. It is usually a lifestyle disease and warrants a detailed interview, examination and evaluation. Management is usually multi-pronged approach, including but not restricted to weight management, exercise, lifestyle alteration, use of devices and surgery.

Voice is produced by the vibrations of true vocal cords in the voice box. When the vocal cord becomes inflamed, swollen, irregular, or does not move well due to mass effect or muscle weakness [vocal cord palsy], distortions and hoarseness of voice ensues. The assessment of hoarseness will require a fiberoptic laryngoscopy, stroboscope and visit to a speech therapist. Some conditions however, require surgical treatment, current day technology allows us to be able to do the same on an outpatient basis in optimally selected patients using fiberoptic endoscopy and laser. Those who cannot will need formal vocal cord surgery [PHONOSURGERY] under anesthesia with day care or one day admission.

The interiors of the nose and sinuses were largely unknown areas, hidden, The advent and use of endoscopes in nasal and sinus surgery have opened up corridors which were hereto considered impossible to reach through the nose. In vogue for more than 2 decades, it has revolutionized the management of people with chronic sinus infections, polyps in the nose. It has also opened up access from the nose into the lacrimal sac [DCR], skull base – management of CSF leaks, tumors of skull base, pituitary, tumors of the nose like angiofibroma, management of bleeding from the nose [sphenopalatine artery ligations],

This is an extension of the use of endoscope use in the nose – largely for what is called as anterior skull base lesions – is usually a surgery undertaken along with neurosurgeons for complex skull base pathologies like csf leaks, tumors