Procedures

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Cochlear Implants

Cochlear implants were first approved by the Food and Drug Administration in the United States in 1985 for adults and in 1990 for children. Today, over 20,000 individuals have received cochlear implants, including over 8,000 children.

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Adenoidectomy

Like the tonsils, the adenoids are masses of lymph tissue in the back of the throat that help the body fight invading bacteria and viruses. Also like the tonsils, the adenoids are prone to infection and enlargement. This can lead to sore throat, ear infections, stuffy nose, and breathing and swallowing problems.

If antibiotics or steroids fail to resolve the problem, the adenoids may be removed in a procedure called an adenoidectomy. It can be performed with local or general anesthesia.

Tonsillectomy

Tonsillectomy, or removal of the tonsils, is one of the most common throat operations. The tonsils are masses of lymph tissue in the back of the throat. They work with the adenoids and immune system early in life to defend the body against invading bacteria and viruses.

Sometimes the tonsils become infected, abscessed, or enlarged, leading to any of a variety of symptoms, including sore throat, fever, ear infections, and difficulty swallowing or breathing.

Surgery is recommended when more conservative treatments such as antibiotics or steroids fail to relieve symptoms, or when patients have frequent infections or difficulty breathing. There are a variety of methods used, including traditional surgery, microcautery, and radiofrequency ablation. Tonsillectomy may be performed with local or general anesthesia.

Tympanoplasty

Tympanoplasty is an elective, ambulatory, microsurgical procedure performed to close a perforation in the tympanic membrane (eardrum) when nonsurgical methods are ineffective. Perforations may be caused by infections, injuries, flying with a cold, and cotton swabs; symptoms include drainage or bloody discharge from the ear, hearing loss, dizziness when water enters the ear, and frequent ear infections. Antibiotics, decongestants, ear drops, and abrasion with a small hook are often tried before surgery is recommended.

Surgery may not be recommended for very young children or patients with chronic sinus or nasal problems, such as severe allergies, acute infection in the sinuses or nose, or poorly controlled diabetes or heart disease.

Tympanoplasty can require either local or general anesthesia and may be performed in conjunction with a mastoidectomy if infection is present there. An incision is made either in the ear canal or behind the ear, depending on the size and depth of the perforation. The damaged ear drum is lifted and the perforation located; skin from behind the ear or from the ear lobe (tragus) is removed, thinned, dried, and applied to the eardrum.

The bones of the middle ear are examined for damage. In a supplemental procedure known as ossicular reconstruction, the damaged or eroded bones may be bridged with a bone or cartilage graft, reshaped using an operating microscope, or strengthened by the implantation of an artificial bone strut made of hydroxy apatite to reduce the risk of rejection. Another, rarer ossicular-reconstruction procedure called malleus fixation involves the reshaping of the malleus bone (“hammer”).

The incision is then closed. Stitches beneath the skin will be required if the ear was opened.

Patients often return home in about three hours after tympanoplasty or the next morning if ossicular reconstruction is performed, and they may return to work within the week. Swimming and showering without ear plugs may be resumed in three to four months. Antibiotics or Tylenol® usually relieve any postsurgery pain. The graft is checked at 10 days and again at three weeks, and a hearing test is performed after four to six weeks. The perforation heals properly in over 90% of cases. Failure may result from immediate infection, water getting into the ear, or displacement of the graft after surgery.

Complications are uncommon but may include temporary dizziness, tinnitus, loss of taste on one side of the tongue, facial nerve injury, and further hearing loss.

Sinus Surgery

For patients who suffer from frequent sinus infections, sinus surgery widens the sinus openings and allows the removal of mucus or diseased tissue. The procedure can be performed endoscopically, that is, using a thin fiberoptic tube (an endoscope) inserted through the nostrils and real-time video imaging to guide the surgeon inside the nose and sinuses. This minimally invasive technique lets patients enjoy a shorter recovery time and less postoperative pain.

Swallowing Problems (Dysphagia)

There are many possible causes for a person to suffer difficulty or pain when swallowing food or liquid. The most common causes include:

  • Conditions that narrow the esophagus – sore, swollen, or infected throat; esophageal strictures caused by lodged pills or other objects; gastroesophageal reflux disease (heartburn); tumors or cancers.
  • Conditions that compress the esophagus from the outside – goiter (enlarged thyroid gland); tumors, cancers, or other abnormalities of the throat, larynx, spine, and neck.
  • Dry mouth – Sjogren syndrome, nerve or brain damage, medication side effects.
  • Muscle weakness – autoimmune or nerve disorders, nerve or brain damage such as ALS or stroke.
Patients with dysphagia will be asked about the exact sensations they feel when swallowing, how quickly the problem appeared and how long it has been occurring, whether they are taking any medications that could cause these side-effects, what other symptoms they are experiencing (if any), and whether there is a family history of such problems. If a physical exam is not enough to make a diagnosis, other tests may be ordered, such as x-rays of the upper GI tract or brain, endoscopy of the esophagus and stomach, or blood sampling. Treatment and recovery depend on the underlying condition.