The surgical procedure for placing tubes in the ears has become one of the most commonly performed operations of any kind.  A tiny tube, with a collar on both ends is slipped through a tiny incision in the eardrum. This pressure-equalization (PE) tube provides a temporary, extra Eustachian tube to allow bacteria and fluid to drain from the middle ear. 

Tympanoplasty

The tympanic membrane, or ear drum, is made of tissue similar to skin. In most cases, perforations of the ear drum by some type of trauma, such as a puncture by a cotton tipped applicator, or a slap injury, will heal spontaneously, in much the same way a cut on an arm would heal.

When a tympanic membrane perforation persists, the middle ear is unprotected and is vulnerable to infection. When a perforation is present, the ear canal must be kept dry. Repair of the tympanic membrane perforation reinstates the protective barrier to the middle ear, and in some cases can also improve hearing.

Mastoidectomy

Mastoid air cells are open, air-containing spaces in the skull behind the ear. A mastoidectomy is the surgical removal of these mastoid air cells. The surgery may extend into the middle ear.

The surgery used to be a common way to treat an infection in the mastoid air cells, which usually came from an ear infection that spread to the nearby bone in the skull. Mastoidectomy is now seldom needed, as the infections are commonly treated with antibiotics. However, this surgery may be used to treat other problems.

Septoplasty

Septoplasty is an operation that corrects any defects or deformities of the nasal septum, which is the wall between the two nostrils.  The goal of the surgery is to straighten out the nasal septum or to relieve obstructions or other problems related to deviation of the septum  An incision is made internally on one side of the nasal septum. Afterwards, the mucous membrane is elevated away from the cartilage and bone, obstructive parts are removed, and plastic surgery is performed as necessary. Then the mucous membrane is returned to its original position. The tissues covering the septum are maintained in the midline by either sutures or packing.

Turbinate Reduction Surgery

Enlarged inferior turbinates are often the cause of chronic nasal congestion. Even after the underlying problem is addressed, such as chronic infection or allergy, the enlargement may remain. There are varying ways to reduce the size of the turbinate, from radiofrequency ablation done in the office under local anesthesia (no down time for the  patient), to submucous resection or even partial turbinectomy done in the operating room as an outpatient. Each has advantages and disadvantages over the other choices. The best approach for each patient would be discussed at the time of the office visit.

Endoscopic Sinus Surgery

Endoscopic sinus surgery is used to increase the amount of air flowing through the sinuses and allow mucus to drain properly out of the nose. The procedure can relieve nasal blockages, improve breathing, improve the sense of smell and taste and relieve facial pain.  The endoscope, which utilizes fiberoptic technology, allows doctors to see inside the sinuses without cutting the face, and makes it possible to see parts of the sinuses that were formerly difficult to reach.

Sleep Apnea Surgery

For mild cases of obstructive sleep apnea, treatment often consists of using methods to avoid sleeping on one’s back. For people with significant nasal congestion, a decongestant therapy may be prescribed. Patients with obstructive and central apnea should avoid central nervous system depressants such as alcoholic beverages, sedatives and narcotics. Weight loss and diet control are encouraged for overweight patients. 

Many serious cases of obstructive sleep apnea can be relieved by a treatment called nasal continuous positive airway pressure (nasal CPAP). Nasal CPAP uses a mask-like device and pump that work together to keep the airway open with air pressure during each inspiration. For those patients who cannot tolerate the nasal CPAP, surgical options include UvuloPalatalPharyngoplasty (UPP surgery- the shortening of the excess palate and elimination of any tonsillar tissue from the throat).  If this does not "cure" the problem, then procedures to move the tongue forward such as genioglossis advancement or maxillomandibular osteotomy can be done. Some doctors also believe that radiofrequency ablation of the tongue base can help. So far laser surgery of the palate has not been shown to help significant sleep apnea.

Tonsillectomy

The tonsil glands serve as agents against infections. However, in some people, particularly in children who have large tonsils, these glands perform less efficiently and can cause frequent throat and ear infections or may obstruct breathing. In these cases, surgery to remove the tonsils is of benefit.

While the patient is under general anesthesia, the ENT surgeon holds the mouth open to expose the tonsils. The tonsils are then cut away with an instrument or a cautery (burning instrument). Bleeding is controlled, and the cut heals naturally without stitches.

Adenoidectomy

Adenoid removal, also called adenoidectomy, is the surgical removal of the adenoid glands from the area between the nasal airway and the back of the throat (nasopharynx). Adenoidectomy is frequently done in conjunction with surgical removal of tonsils (tonsillectomy).

While the patient is under general anesthesia, the ENT surgeon inserts a small instrument into the mouth to prop it open. The adenoid tissue can be removed with an instrument such as a curette or a microdebrider. Some surgeons may opt to cauterize the adenoids instead of removing the tissue. Bleeding is controlled with packing and cauterization.

The patient will remain in the recovery room after surgery until he is awake and able to breathe easily, cough, and swallow. Most patients are allowed to go home several hours later.

Neck Mass Excision

There are many causes of lumps in the neck. The most frequently seen lumps or swellings are enlarged lymph nodes, which can be caused by bacterial or viral infections, malignancy, and other rare causes. Enlargement of the submandibular salivary glands (under the jaw) may result from infection or malignancy. Lumps in the muscles of the neck, almost always in the front of the neck and involving the sternocleidomastoid muscle, result from injury or torticollis. Lumps in the skin or just below the skin are often caused by cysts such as sebaceous cysts.

The thyroid gland may also produce a lump, multiple lumps, or swelling in the neck as a result of thyroid disease or malignancy. Most cancers of the thyroid gland are extremely slow growing and often curable by surgery even if they have been present for several years.