Mouth & Throat

Adenoid surgery

Disclaimer:

The details in this section are for general information only. Always check with your own doctor.

What are the adenoids?

Adenoids are small glands in the throat at the back of the nose. They are there to fight germs in younger children. We believe that after the age of about three years, the adenoids are no longer needed.

Your body can still fight germs without your adenoids. We only take them out if they are doing more harm than good.

Why take them out?

Sometimes children have adenoids so big that they have a blocked nose, so that they have to breathe through their mouths. They snore at night. Some children even stop breathing for a few seconds while they are asleep. The adenoids can also cause ear problems by stopping the tube which joins your nose to your ear from working properly. For children over three years of age, removing the adenoid at the same time as putting grommets in the ears seems to help stop the glue ear coming back. Removing the adenoids may also make colds that block the nose less of a problem for your child.

What are the alternatives to having the adenoids removed?

Your adenoids get smaller as you grow older, so you may find that nose and ear problems get better with time. Surgery will make these problems get better more quickly, but it has a small risk. You should discuss with your surgeon whether to wait and see, or have surgery now.

For some children, using a steroid nasal spray will help reduce congestion in the nose and adenoids, and may be helpful to try before deciding on surgery. Antibiotics are also sometimes prescribed but they do not cause drastic improvement.

Other operations

If we are taking adenoids out because of ear problems, we may put in grommets at the same time. If your child has sore throats or stops breathing at night, we may also take their tonsils out at the same time. We will tell you what these operations involve if we are going to do them.

The operation

Arrange for a week off school. Let us know if your child has a sore throat or a cold in the week before their operation - it may be safer to put it off for a few weeks.

Your child will be asleep for the operation. We will take out the adenoids through his or her mouth, and then stop the bleeding before he or she is woken up.

We prefer to keep children in hospital for one night. Either way, we will only let him or her go home when he or she is eating and drinking and feels well enough.

Most children need about a week off nursery or school. They should rest at home away from crowds and smoky places. Stay away from people with coughs and colds.

Possible complications

Adenoid surgery is very safe, but every operation has small risks. The most serious problem is bleeding, which may need a pack to stop it. However, bleeding after adenoidectomy is very uncommon. It is very important to let us know well before the operation if anyone in the family has a bleeding problem.

During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if your child has any teeth like this.

Some children feel sick after the operation. This settles quickly.

A small number of children find that their voice sounds different after the surgery. It may sound like they are talking through their nose a little. This usually settles by itself within a few weeks.

The child’s nose may seem blocked up after the surgery, but it will clear by itself in a week or so.

The child’s throat may be a little sore. Prepare normal food. Eating food will help your child’s throat to heal. Chewing gum may also help the pain.

Your child may have sore ears. This is normal. It happens because your throat and ears have the same nerves. It does not mean your child has an ear infection.

Give painkillers as needed for the first few days after consulting your ENT practitioner.

Bleeding can be serious

If you see any bleeding from your child’s throat or nose, you must see a doctor. Either call your specialist or go to your nearest hospital casualty department.

Tonsil surgery                                                                                                        TOP

Disclaimer:

The details in this section are for general information only. Always check with your own doctor.

What are tonsils?

Tonsils are small glands in the throat, one on each side. They are there to fight germs when you are a young child. After the age of about three years, the tonsils become less important in fighting germs and usually shrink. Your body can still fight germs without them. We only take them out if they are doing more harm than good.

Why take them out?

We will only take tonsils out if they cause recurrent sore throats despite treatment with antibiotics.

The other main reason for removing tonsils is if they are large and block the airway. Sometimes small children have tonsils so big that they block their breathing at night.

A quinsy is an abscess that develops alongside the tonsil, as a result of tonsil infection, and is most unpleasant. People who have had a quinsy therefore often choose to have a tonsillectomy to prevent having another.

Tonsils are also removed if we suspect there is a tumour. A rapid increase in the size of a tonsil or ulceration or bleeding occurs if a tumour of the tonsil develops. Tumours of the tonsil are rare.

Do I have to have my tonsils out?

It is not always necessary to remove the tonsils. You may want to just wait and see if the tonsil problem gets better by itself. The doctor should explain to you why he or she feels that surgery is the best treatment.

Before the operation

Arrange for one week off work or school. Let us know if you have a chest infection or tonsillitis before the admission date because it may be better to postpone the operation. It is very important to tell us if has you have any unusual bleeding or bruising problems, or if this type of problem might run in the family.

How is the operation done?

You will be asleep under general anaesthesia. We take the tonsils out through the mouth, and then stop the bleeding. This takes about 30 minutes. A child who has had a tonsillectomy will then be taken to a recovery area to be watched carefully as he or she wakes up from the anaesthetic.

How long will I be in hospital?

In most hospitals, surgeons prefer tonsillectomy patients to stay in hospital for one night. In some hospitals tonsil surgery is done as a day case, if your home is close to the hospital. Either way, we will only let you go home when you are eating and drinking and feel well enough.

Possible complications

Tonsil surgery is very safe, but every operation has a small risk. The most serious problem is bleeding. This may need a second operation to stop it. About two out of every 100 children who have their tonsils out will need to be taken back into hospital because of bleeding, and one of these will need a second operation. As many as five adults out of every 100 who have their tonsils out will need to be taken back into hospital because of bleeding, but only one adult out of every 100 will need a second operation.

During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if you have any teeth like this.

After the operation

Some children feel sick after the operation, and may need to be given medicine for this, but it usually settles quickly.

Your throat will sore for approximately a week. It is important to take painkillers regularly, half an hour before meals for at least the first week. Do not take aspirin because it may make you bleed.

Eat soft food - it will help your throat to heal. It will help the pain too. Drink plenty and stick to bland non spicy food. Chewing gum may also help the pain.

You may have sore ears. This is normal - it happens because your throat and ears have the same nerves. It does not mean that you have an ear infection.

Your throat will look white - this is normal while your throat heals. You may also see small threads in your throat – they are used to help stop the bleeding during the operation, and they will fall out by themselves.

Some people get a throat infection after surgery, usually if they have not been eating properly. If this happens you may notice a fever and a bad smell from your throat. Call your specialist for advice if this happens.

Adults and children will need 7 to 10 days off work or school. Make sure you rest at home away from crowds and smoky places. Keep away from people with coughs and colds. You may feel tired for the first few days.

Bleeding can be serious

If you notice any bleeding from your throat, you must see a doctor. Call your specialist or go to your nearest hospital casualty department.

Microlaryngoscopy                                                                                                        TOP

Disclaimer:

The details in this section are for general information only. Always check with your own doctor.

What is Microlaryngoscopy?

Microlaryngoscopy is the examination of your larynx (voice box) while you are under a general anaesthetic. Microlaryngoscopy is done to find and treat problems of the voice box, such as hoarseness.

Your surgeon will put a short metal tube (a laryngoscope) through your mouth into your voice box. A microscope is then used to look into the voice box to find what the problem is. If needed, surgery on your voice box can also be done through the laryngoscope.

If there are any problem areas, a small part of the lining of the voice box is taken away for laboratory examination. This is called a biopsy. Depending on the type of lesion a laser is sometimes used to remove it.

Microlaryngoscopy is quite a short operation and usually takes less than 30 minutes.

How will I feel after the operation?

After microlaryngoscopy you may find that your throat hurts. This is because of the metal tubes that are passed through your throat to examine the voice box. Any discomfort settles quickly with simple painkillers and usually only lasts a day or two.

Some patients feel their neck is slightly stiff after the operation. If you have a history of neck problems, you should inform the surgeon about this before your operation.

After laryngoscopy, your voice may sound worse, especially if any biopsies have been taken. This should be temporary until the lining of the voice box heals.

You can usually eat and drink later the same day. You should be able to use your voice as normal after the procedure. However, if the surgeon has taken a biopsy from your voice box, he may advise you to rest your voice for a short period.

Possible Complications

Microlaryngoscopy is very safe. You may have a slightly sore throat afterwards.

Very rarely, there is a risk that the metal tubes may chip your teeth. Your surgeon uses a gum guard to help prevent this happening.

When will I know what happened?

Your surgeon will usually be able to tell you what was found, and what they did to help you, on the same day as your operation.

If any biopsies were taken, these normally take a few days to process in a laboratory. Your surgeon will arrange to see you again for your results.

When can I go home?

Often you can go home the same day as the operation, as long as you have someone with you. Depending on how you feel afterwards, you may need to stay overnight for observation.

You may be advised to stay off work for a few days to rest your throat, depending on your job.

Hoarseness and laryngitis                                                                                           TOP

Disclaimer:

The details in this section are for general information only. Always check with your own doctor.

Hoarseness is often used to describe a change to the voice. People suffering from hoarseness may experience a strained, raspy and/or breathy voice. People may also notice a difference in how loud they are able to speak and/or changes in how high or low their voice sounds (Pitch).

What causes Hoarseness?

There are several causes of hoarseness, fortunately most are not serious and tend to go away after a short period of time. Hoarseness is a result of the vocal cords in the voice box (Larynx) not working properly. Normally when we talk/sing the vocal cords come together and vibrate. This creates a sound which we know as the voice. There are several reasons why the vocal cords may not be working correctly. The most frequent are:

• An upper respiratory tract viral infection, which causes the voice box to swell ( Laryngitis)

• the build up of tissue (polyps) and or callous like growths (nodules) on the vocal cords. These can develop   when the voice is used too much or too loudly for extended periods of time (Singer’s Nodules)

• the growth of tumours on the vocal cords and or voice box (larynx). These tumours are may be non   cancerous (benign) or cancerous (malignant)

• Stomach acid irritating the vocal cords (Gastro-oesophageal Reflux)

How is Hoarseness treated?

Mild hoarseness

In most cases hoarseness will clear up on by itself. To help relieve the symptoms it may help to:

• rest the voice

• drink plenty of fluids

• avoid alcohol

• not smoke

• have bed rest

• take common painkillers e.g. Paracetamols or soluble aspirin

• take Antacids e.g Rennin, for hoarseness caused by the build up of excess stomach acid in the throat

Severe or Recurrent Hoarseness

People suffering from the following symptoms should seek medical advice from their General Practitioner GP):

• prolonged hoarseness for over four weeks

• repeated case of hoarseness without the symptoms of a viral infection or flu

• prolonged sore throat or difficulty swallowing for more than two weeks

• severe change in the sound of the voice which lasts for several weeks

The GP may decide to refer you onto to an ENT surgeon. The surgeon will examine the throat to identify the cause of the hoarseness. This is done by passing a flexible telescope to the back of the nose under local anaesthetic (Fibreoptic Endoscope). Depending on the clinical findings, the following treatment may be advised:

Speech Therapy

The majority of patients will have no structural abnormality identified. The problem with their voice will be related to the way that they are using their voice i.e. they are ‘straining’ it in some way. Under these circumstances the speech therapists will be able to advise exercises that might help the quality of the voice.

Microlaryngoscopy

An operation to remove nodules, polyps and non cancerous (benign) tumours may be recommended if these are identified in the outpatients. This type of operation is usually done under general anaesthetic using a rigid telescope (Endoscope) and a microscope (to provide magnification). It will remove the problem in the case of polyps, nodules etc. and will provide a piece of tissue to be looked at under the microscope (a biopsy) and hence make the diagnosis of cancer if the tumour is malignant. If a malignant tumour of the larynx is diagnosed by biopsy then the management options will include:

Radiotherapy:

Surgery:

After total laryngectomy patients will not breathe and speak in a normal way. Breathing will occur through a permanent opening in the front of the neck (the Stoma or Tracheostoma). Advice and treatment on alternative methods of speaking will be given by the operating surgeon, which could include, surgical voice restoration (inserting a small valve at the time of surgery), oesophageal voice (swallowing air into the stomach and ‘burping’ this back up in a controlled way) and artificial voice aids (a hand held vibration source which can be held on the neck).