Services
North Queensland Ear, Nose and Throat Surgery is a team of three otolaryngologists who are based in Townsville who are delivering exceptional care for North Queenslanders with ENT conditions.
Ear conditions, definitions, ENT specialist examinations, medical and surgical treatment options.
EAR
Acute Sudden Sensorineural Hearing Loss
Acute Sudden Sensorineural Hearing Loss is a rare otological condition with an incidence of 5-20 cases per 100,000 people per year. For an unknown reason, 2020 has seen an increase in cases presenting to our clinic. Treatment for this includes steroid therapy in various forms and hyperbaric oxygen. Acute Sudden Sensorineural Hearing Loss should be treated as an otological emergency and your GP or audiologist can call the practice directly to book an urgent appointment. In this scenario DON’T WAIT TO BE CONTACTED.
Ear wax
Ear wax (known as cerumen) is normal. Wax impaction can cause hearing loss, fullness, tinnitus and ear pain. Home ear cleaning may harm your ear canal, cause infection, increase wax impaction, put a hole in your ear drum or result in middle ear injury. Cotton wool buds, hair pins, toothpicks and fingernails are all items our ENT surgeons have found in compacted ear wax removed from patients’ ears. An ear toilet or suctioning will painlessly remove any wax, fungal debris or foreign bodies. We have regular appointments for ear toilets and a referral from your GP lasts for 12 months from the date of your first appointment, so you can attend as many times as necessary.
Otitis Media with Effusion
Otitis media with effusion indicates fluid is trapped behind the ear drum. It is a common condition in children and can cause reversible hearing loss. Acute Otitis Media (middle ear infection) is an infection of this fluid. Symptoms include ear pain, fever, irritability. Sometimes this can rupture with a release of fluid and reduction in symptoms. An examination with a otoscope is recommended and often a hearing test. First line treatment includes treatment of nasal conditions, nose blowing and sometimes antibiotics. Suctioning is recommended to clean out any fluid or debris if a rupture has occurred. If this fails to help grommets are often recommended.
Acute Otitis Externa
Acute otitis externa is commonly referred to as an outer ear inflammation or Swimmer’s Ear and is one of the most common presentations to our clinic. Acute otitis externa is common in North Queensland due to the high temperature and humidity, perspiration and exposure to water from swimming. Pre-existing conditions such as psoriasis, eczema and dermatitis can result in a higher predisposition to otitis externa. It can be either bacterial or fungal in nature and can be associated with a perforated tympanic membrane. Referral to one of our ENT surgeons by your GP is required. An ENT consultation will involve a thorough medical history, list of medications, a head and neck examination, otoscopy and thorough cleaning to remove any mucopurulent debris. The treatment applied will depend upon whether it is bacterial or fungal in nature. Medical treatment must be strictly adhered to resolve the inflammation and/or infection. Follow-up appointment may be required to clear away cream or debris to determine if treatment is effective. Stubborn cases of acute otitis externa can take several visits of supervised treatment by an ENT surgeon to resolve. Call or ask your GP to call our rooms if the case is urgent.
Otorrhea
Otorrhea means discharge from the ear. This is often due to a hole in the ear drum. Otorrhea after grommet insertion is very common. In one study in young children, the incidence was almost 50%. Most will occur shortly after insertion or occur associated with rhinorrhoea (nasal discharge). Occasionally patients will have troublesome otorrhea that is resistant to treatment. Significant risk factors for otorrhea include socioeconomic status, cigarette smoke exposure, rhinorrhoea and craniofacial anomalies such as a cleft palate. A review by an experienced ENT surgeon is recommended. First line treatment includes a proper examination and obtaining a swab for histopathology. Often tissue spearing is recommended to clean out any mucopurulent debris and the use of topical antibiotics.
Intratympanic Dexamethasone perfusion
Intratympanic dexamethasone perfusion or titrations are performed under a sterile environment in our NQ ENT consultation room to treat Acute Sudden Sensorineural Hearing Loss, Meniere’s disease and other conditions. These perfusions are usually performed in a series over several weeks for the purpose of reducing inflammation of the inner ear. There are side effects to the use of a corticosteroid and these will be discussed prior to consent for perfusion.
Ménière’s Disease
Meniere’s Disease is a disorder of the inner ear which can result in imbalance, vertigo (spinning), hearing loss symptoms, ringing in the ears (tinnitus), pressure symptoms, nausea and vomiting. It was first reported by Prosper Ménière in 1861. Attacks are usually spontaneous and can be associated with low frequency sensorineural hearing loss. It is important to seek a referral to a specialist otologist, such as Dr Anderson, to ensure you are accurately diagnosed and consider treatment options. Keeping a journal of your symptoms is a good idea to help with correct diagnosis and some tests which might be ordered include an audiogram, MRI and balance testing. Some of the treatments include dietary modification, medications, middle ear injections, vestibular physiotherapy or surgery.
Benign Paroxmyal Positional Vertigo (BPPV)
Another form of dizziness is BPPV which is prompted by head movements such as rolling over in bed or looking up that last for seconds at a time. Severe cases result in an inability to control eye movements. It is useful to keep a diary of your symptoms or, if possible, take a video of your eyes when feeling dizzy. This can be useful for correct diagnosis. A review with Dr Anderson will involve a full medical history (including any head injuries or falls), full head and neck examination, detailed vestibular and ocular examination. Dr Anderson may request a MRI scan, to rule out other causes for the dizziness, and request an electronystagmography (ENG) or videonystagmography (VNG). Treatment may include vestibular physiotherapy, canalith repositioning or surgery.
Implantable Hearing Devices
Implantable Hearing Devices include middle ear implants, bone anchored hearing aids, cochlear implants and brainstem implants. Dr Anderson is accredited by Cochlear Corporation, MedEL Australia and AB Bionics to implant their devices. For hearing impaired persons there are many disadvantages to conventional hearing aids such as discomfort, poor fitting, wax impaction, poor sound quality, lack of high frequency benefit, feedback or background noise amplification. The advantages of an implantable device include reduction or elimination or occlusion effect (blockage) and feedback, improved comfort (particularly for swimmers) and improved sound by direct stimulation. The disadvantages for having an implantable device include cost, risks associated with undergoing a surgical procedure and potential to worsen residual hearing. These factors will be discussed with you in detail at your consultation. There are various implantable devices and a complete audiological assessment by a suitably qualified audiologist is recommended prior to seeing Dr Anderson. This will determine the nature of your hearing loss for example and what is the best option for you. Dr Anderson will receive an audiological assessment often recommending either a hearing aid or a certain implantable device. The cochlear implantation assessment process involves a full audiological assessment, CT scan and/or MRI scan, vestibular and balance assessment, psychological review and depending upon age, a geriatric assessment. Dr Anderson will review these reports and determine suitability for surgery. The post-operative audiological rehabilitation for candidates is long and exhaustive, particularly for those with longer periods of hearing deprivation.
Otosclerosis
Otosclerosis is defined by the Royal Australasian College of Surgeons as a hereditary disorder that causes progressive hearing loss which may occur in one or both ears. Often an audiologist will recommend you seek a referral to an ENT surgeon. The diagnosis of otosclerosis can be made following an audiogram and clinical examination by an ENT surgeon. Your ENT surgeon will require a detailed medical history including any health problems you may have had, and any medications you may be taking. The treatment of otoscelerosis may include watchful waiting, use of hearing aids or surgery, commonly in the form of a stapedectomy.
Eustachian Tube Dysfunction
Eustachian Tube Dysfunction is a condition where the pressure generated in the middle ear is not released properly to the nasal cavity. It is a very common condition. Typically it causes a feeling of fullness, pain with flying and a hearing loss. Audio entry and pressure testing pick can indicate this condition. Having a cold or flu makes it worse. Investigation includes examination of the back of the nose where the Eustachian tubes sit and the ear. Treatment includes ensuring the nasoendoscopy is as clear as possible and occasionally grommets or balloon tuboplasty. Your ENT surgeon will discuss the risks, benefits and alternatives to these procedures.
Patulous Eustachian Tube
Patulous Eustachian tube dysfunction is where the Eustachian tube remains completely or intermittently open, rather than being closed. Usually the cause of patulous eustachian tube dysfunction is unknown. Commonly suffers report being able to hear their own voice or pulse or breathing loudly. Classically symptoms get better with a cold or flu. Symptoms may include a feeling of fullness in the ear, tinnitus, autophony, hearing loss or suprathreshold hearing. It is a very discomforting condition and can result in anxiety when breathing, especially when exercising. Medical treatment may involve weight loss/gain (if medically indicated), increasing fluid intake, nasal saline drops or irrigations to improve hydration of mucosa. If medical treatment is not successful, surgical treatment may include myringotomy with tympanostomy tube replacement or reconstruction of the valve of the eustachian tube lumen. Your ENT surgeon will discuss the risks, benefits and alternatives to these procedures.
Surgical ear procedures
- Myringoplasty is an operation to repair a perforation of the ear drum. A perforation may result in a constantly discharging ear, frequent ear infections, hearing loss, build-up of granulation tissue. It may also occur as a result of disease such as cholesteatoma. Myringoplasty will need to be performed under a general anaesthetic and may require an overnight stay in hospital. Each perforation is different and our surgeon will discuss in detail the surgery required. Commonly a tissue graft is harvested and is fixed to the ear drum. Your surgeon may also wish to explore the middle ear space to ensure there is no further underlying pathology. Your recovery will take 1-2 months. Up to 5% of grafts fail and further surgery may be required.
- Stapedectomyis an operations to bypass the effects of otosclerosis on hearing. It involves removal of the stapes bone and replacement with a piston. Other options include hearing aids. Your surgeon will discuss in detail the risks, benefits and alternatives of this procedure.
- Mastoidectomy is a procedure to remove the mastoid air cells behind the ear canal. This can be done for access to the inner ear structures or to removed infection from this area. It can be combined with performing a myringoplasty and ossicular chain reconstruction.
- Ossicular Chain Reconstruction is a procedure to repair the ossicles (hearing bones) of the middle ear. They can be damaged due to infection and trauma. Often reconstruction with a prosthesis results in the re establishment of hearing.
Nasal conditions, definitions, ENT specialist examinations, medical and surgical treatment options.
NOSE
Epistaxis, or commonly a nosebleed, more commonly occur in children and the elderly. A nosebleed can be a dramatic event due to the quantity or blood loss, particularly in children. It is important to remain calm and if persistent seek urgent medical advice. Certain nasal saline sprays, barrier cream or humidifiers can help resolve epistaxis. However, sometimes bleeding from the nostril, nasal cavity or nasopharynx warrants medical attention and your general practioner may refer persistent epistaxis to an ENT surgeon for assessment and cauterisation. Examination by an ENT surgeon usually requires the use of a rigid endoscope to identify the source of bleeding. Usually a patient can be treated in the consultation room with local anaesthetic and silver nitrate cauterisation. Worst cases may require a general anaesthetic and cauterisation.
Nasal Obstruction Nasal Obstruction can include nasal valve collapse, deviated septum, enlarged adenoids, enlarged inferior turbinates can contribute to snoring. A consultation may involve spray with a nasal decongestant, spray with local anaesthetic and a nasopharyngoscopy.Snoring and Sleep Apnoea
Treatment for Obstructive Sleep Apnoea (OSA) include medical and surgical options to better help manage your OSA or snoring. Medical options include a formal sleep study to accurately diagnose the sleep disorder, nasal corticosteroid sprays, Continuous Positive Airway Pressure (CPAP) therapy, mandibular advancement splint, positional therapy and/or weight loss. The success depends upon how long and consistently you follow the recommended medical therapy. If medical management is unsuccessful, surgical procedure/s can help reduce the severity of the disorder. Surgical procedures which may improve nasal patency or breathing include a modified uvulopalatopharyngoplasty (UPPP), coblation tongue channelling, inferior turbinate reduction and septoplasty. Surgery is not always a cure and follow-up surgery may be required in following years or decades.
Sinusitis
Sinusitis is swelling of the sinuses as a result of an infection. Sinusitis is common after a cold or the flu. Symptoms may include pain or tenderness around your cheeks eyes or forehead, green or yellow discharge from the nose, headache, toothache or a blocked nose. Seek a referral to an ENT specialist if your symptoms are severe, pain relief is ineffective, or you are having repeat episodes of sinusitis. An ENT specialist may also request a CT scan of the sinuses, radio-allergosorbent testing (RAST) or skin prick testing. There are various forms of medical treatment including nasal saline douching, intranasal corticosteroids or oral antibiotics. If a concerted effort is made by the patient with medical treatment and it fails, there are surgical options. Surgical options include functional endoscopic sinus surgery (FESS) under a general anaesthetic.
RhinosinusitisRhinosinusitis is inflammation of the nose and paranasal sinuses. The Royal Australasian College of GPs defines chronic rhinosinusitis as a condition with 12 weeks of consecutive symptoms. Symptoms can include facial pressure, pain, congestion, frontal headaches, feeling of fullness, nasal obstruction or blockage, nasal discharge or postnasal drip. An examination by an ENT may include the use of nasal decongestion spray prior to an otoscopy and endoscopy to obtain a detailed examination of the nasopharynx and post nasal space. You may also have a swab taken to determine histopathology to enable accurate medical treatment. Your ENT surgeon may also request a CT scan of the sinuses, radio-allergosorbent testing (RAST) or skin prick testing. There are various forms of medical treatment including nasal saline douching, intranasal corticosteroids or oral antibiotics. If a concerted effort is made by the patient with medical treatment and it fails, there are surgical options. Surgical options may include Functional endoscopic sinus surgery (FESS).
Allergic rhinitis
Allergic rhinitis is the most common allergic disorder and often coexists with asthma, sinus disease, eczema and conjunctivitis. It typically causes symptoms such as sneezing, itchiness, a blocked or runny nose. It involves inflammation of the inside of the nasal vault as a result of an allergen. Common allergens include dust, pollen, pet hair or dander or mould. Allergic rhinitis is divided into seasonal or perennial rhinitis. Allergic rhinitis is your immune system triggering a response to an allergen which results in inflammation of the nasal mucosa and production of mucous. Allergen avoidance is often a first line of treatment. Seek a referral to a sub-specialist ENT surgeon, such as Dr Liebenberg, if your symptoms are persisting for more than 12 weeks and are adversely affecting your life such as your sleep, ability to exercise or performance at work or school. Your ENT surgeon may also request a CT scan of the sinuses, radio-allergosorbent testing (RAST) or skin prick testing. There are various forms of medical treatment including nasal saline douching, intranasal corticosteroids or oral antibiotics. If a concerted effort is made by the patient with medical treatment and it fails, there are surgical options.
Anosmia
Anosmia is the complete loss of smell. Studies suggest approximately 1 in 10,000 people are affected by congenital anosmia. Some of the symptoms include a thick foul smelling nasal discharge. Some of the causes of anosmia include nasal congestion from a cold allergy sinus infection, nasal polyps, blockages of the sinus nasal passages or trauma to the nose. Treatment of the underlying cause of the anosmia often results in an improvement in sense of smell for example, removal of nasal polyps or correction of an anatomical anomaly. It can often take several weeks to several months to regain a sense of smell. On the 4th of May 2020, the World Health Organisation added the loss of taste or smell to its list of COVID-19 symptoms.
Throat and Head and Neck Cancer conditions, definitions, ENT specialist examinations, medical and surgical treatment options.
THROAT CONDITIONS & hEAD AND nECK cANCER
Neck Mass
A lump or mass on your neck does not mean you have cancer. Risks for malignancy may include if the mass has been present for longer than 4 weeks, voice change, swallowing difficulties, pain on swallowing, weight loss, sore throat, ear pain or hearing loss. A referral from your GP can be marked urgent. Your ENT surgeon will ask for a detailed medical history and will conduct a thorough head and neck examination. The ENT specialist may also perform a laryngoscopy and use a camera to examine your throat and a local anaesthetic will be administered prior to this. You may require medical imaging (CT scan or MRI scan) and/or a fine needle aspiration (FNA) with a follow-up appointment within a short period of time. An examination under a general anaesthesia may be required to evaluate the throat, larynx, back of your nose, upper trachea and upper oesophagus. Your ENT surgeon may collect tissue for histology or pathology. Results are usually available in 48-72 hours.
Sialadenitis
Sialadenitis is sometimes also known as siloadenitis, adenitis, salivary gland inflammation. Sialadenitis is an infection of the salivary glands and is most commonly caused by a virus or bacteria the parotid in front of the ear and submandibular under the chin glands are the most commonly affected areas it can be associated with pain tenderness redness and gradual localised swelling of the infected area. It can affect anyone of any age. An ENT surgeon will conduct a thorough physical clinical exam including head and neck examination to determine any swelling or lymphadenitis. A CT scan, an MRI scan or an ultrasound may be requested by your surgeon to determine whether or not there is an abscess or examination for stones. Treatment will depend on whether the cause is bacterial or viral. Commonly treatment includes the use of antibiotics warm compression, hydration and practising good oral hygiene. Worst case scenario is you may require minor surgery under a general anaesthetic for removal of stones or the gland.
Gastro-oesophageal Reflux Disease and Laryngo-pharyngeal Reflux Disease
Gastro-oesophageal Reflux Disease is simply the return of the stomach’s contents back up into the oesophagus. Your General practitioner may refer you to an E NT surgeon for more detailed examination Namely an endoscopy. An endoscopy is a procedure individuals that involves the use of a small lighted tube which has a video camera on the end this is known as an endoscope the ENT surgeon will place this down into the oesophagus to ascertain whether there is inflammation or irritation of the tissue in the lining of the larynx parents an oesophagus. In the event that your ENT surgeon discovers suspicious tissue or cells it may warrant further examination or a biopsy under a general anaesthetic.
The Royal College of General Practioners report in 2017 (Fraser-Kirk, 2017) stated half of the laryngeal complaints referred to ENT specialists are ultimately diagnosed as laryngeal pharyngeal reflux disease. Laryngopharyngeal reflux is a distinct entity to gastro oesophageal reflux disease. It is known as the passage of gastric contents beyond the upper oesophageal sphincter with contamination of the larynx pharynx an lungs constant exposure of these contents may cause mucosal injury damage to dilated respiratory epithelium and mucus stasis. Common symptoms include throat tightness and discomfort or a feeling of something stuck or hoarseness of voice and reduced vocal quality. Referral to an ENT specialist will result in a laryngoscopy or a nice endoscopy your specialist may also refer you for a barium swallow to determine if there is a hiatus hernia or pharyngeal pouch. In isolated cases, an oesophageal endoscopy under general anaesthetic may be required. Medical management may include altering diet food avoidance speech and language therapy altered sleeping patterns treatment for anxiety and antacid treatment. Surgery may be indicated if maximum medical therapy fails.
Hoarseness (Dysphonia)
Hoarseness of voice is known as dysphonia and is sometimes referred to as impaired voice production or impaired voice quality. Dysphonia is common and can affect children and adults. The symptoms of dysphonia can include loss of projection and poor quality of voice. Common causes of dysphonia include overuse of voice (particularly in teacher and performing artists), acid reflux, allergies, age-related changes, side effects of certain medications and smoking. The most dysphonia is related to upper respiratory tract infection and will resolve in time. A referral to an ENT specialist may be require for persistent symptoms and will require a full head and neck examination and laryngoscopy of the larynx, pharynx and oropharynx to observe anatomy. Hoarseness can be treated with voice rest, voice therapy, Botox injection or surgery. Surgery may require direct laryngoscopy under a general anaesthetic. Recovery from throat surgery requires voice rest, regular pain medication and plenty of fluids to rehydrate. Discuss with your ENT surgeon which option is best suited for you.
ENT conditions more prevalent in children and specialised treatment and surgical procedures.
paediatrics
Grommet Insertion
A grommet is a tube in the ear drum to allow equalisation of pressure from the middle ear. Infants and school aged children commonly suffer from ear infections. Many ear infections will resolve on their own, particularly if they are viral in nature. If an infection is bacterial in nature, often antibiotic treatment will resolve the infection. Recurrent ear infections can lead to fluid building up in the middle ear space. Problems can then arise such as hearing loss, pain, poor behaviour, speech and language difficulties, poor balance and poor performance at school. A review by an ENT surgeon will require an otoscopy of both ears to assess the anatomy of the ear. It may also be necessary for a swab to be taken for pathology to ascertain the microbiology causing the infection.
Ear tubes or ventilation tubes are commonly referred to as grommets. Ear tubes/grommets may be recommended for repeated middle ear infection, known as acute otitis media or for hearing loss caused by persistent middle ear fluid, known as otitis media with effusion. A myringotomy is performed which involves a small incision in the ear drum or tympanic membrane and an ear tube is placed within the hole to permit air to reach the middle ear space. Grommet insertion is one of the most commonly performed surgeries for children requiring a general anaesthetic. The average age for ear tube insertion is 1-3 years of age – American Academy of Otolaryngologists and Head and Neck Surgeons.
Tonsillectomy
Tonsillectomies in children are one of our most common procedures performed by NQ ENT surgeons. Our ENT surgeons look for a number of indications for surgery including obstructive sleep apnoea, recurrent infections and the specific risks, benefits and alternatives to surgery in children. Tonsils (and adenoids) can grow large and obstruct the airway making it difficult to get into a deep sleep. Snoring during sleep is not enough to diagnose obstructive sleep apnoea. It is important to observe the child during sleep to ascertain the nature of the snoring and whether there is a gasp/s for air. When it is unclear, your ENT surgeon may request a polysomnogram which will study the child’s sleep pattern. There are many non-surgical options such as watchful waiting, weight loss, medications and positioning during sleep. It is important that you understand the risks of and complications following surgery and these will be explained by the surgeon during your consultation. The most common complications post operatively in North Queensland are de-hydration and bleeding. It is our policy that the child remains within 1 hour of the Townsville area for 14 days post surgery. Surgery will involve a general anaesthetic and an overnight stay in hospital. An overnight stay in the Intensive Care Unit is often recommended for infants and children with co-morbidities.
Adenoidectomy
Adenoids are tissue which is located in the back of the nasal cavity and they trap bacteria and viruses that you breathe or swallow. This is very important for infants and children. Often the adenoids can swell, particularly during an infection, and remain enlarged. This may result in difficulty breathing or swallowing and ear infections. It is important that you understand the risks of and complications following surgery and these will be explained by the surgeon during your consultation. It is also common for adenoids to grow back after surgery and repeat surgery may be required in older children. The most common complications post operatively in North Queensland are de-hydration and bleeding. It is our policy that the child remains within the Townsville area for 14 days post surgery. Surgery will involve a general anaesthetic and an overnight stay in hospital. An overnight stay in the Intensive Care Unit is often recommended for infants and children with co-morbidities.
Note: The Mater Group provide a useful guideline for what to expect if admitted for paediatric surgery here.
