Growths, lumps, tumours or masses on the head and neck can be benign (noncancerous) or cancerous and can form in the larynx, pharynx, thyroid gland, salivary gland, mouth, neck, face or skull. Tests to diagnose a mass may include: Neurological examination – assesses eye movements, balance, hearing, sensation, coordination etc MRI – magnetic resonance imaging uses magnetic fields and radio waves to give images of internal organs and body structures CT Scan – computer tomography combines x-rays with computer technology to give cross-sectional images of the body Biopsy – a sample of tissue is taken for examination under a microscope. Enlarged Lymph Nodes Lymph nodes in the neck often become swollen when the body is fighting an infection. Benign Lesions Noncancerous masses such as cysts are often removed surgically to prevent them from pressing on nerves and other structures in the head and neck. Cancer Cancerous masses spread to surrounding tissues and may be: Primary – they arise in the head or neck. Mostly caused by tobacco or alcohol use Secondary – they have spread from a primary tumour in another part of the body. Cancers may be treated by a combination of radiotherapy, chemotherapy and surgery Head and Neck Surgery Thyroidectomy An incision (cut) is made in the front of and at the base of the neck and part or all of the thyroid gland is removed. Parathyroidectomy An incision (cut) is made in the front of and at the base of the neck and one or more of the parathyroid glands are removed. Parotidectomy An incision (cut) is made in front of the ear and runs down below the jaw line. Part or all of the parotid gland is removed. Superficial Parotidectomy: an incision is made in front of the ear and runs down beneath the ear lobe. The superficial (top) lobe of the parotid gland is removed. Radical Neck Dissection All lymph nodes (bean-shaped glands that filter harmful agents picked up by the lymphatic system) from the collar bone to the jaw and from the front of the neck to the back are removed, along with the sternocleidomastoid muscle (moves the head from side to side), the spinal accessory nerve (involved in speech, swallowing and some head movements), the submandibular gland (one of the salivary glands) and the internal jugular vein. Modified or Functional Neck Dissection All lymph nodes (bean-shaped glands that filter harmful agents picked up by the lymphatic system) from the collar bone to the jaw and from the front of the neck to the back are removed.

Hearing loss can be divided into two types: conductive hearing loss (caused by some sort of mechanical problem in the external or middle ear) or sensorineural hearing loss (caused by disorders of the inner ear, hearing nerve or associated brain structures). Conductive hearing loss is often reversible and can be due to: blockage of the ear by e.g. wax, inflammation, infections or middle ear fluid poor sound conduction because of e.g. holes or scarring in the eardrum or the bones of the middle ear (ossicles) becoming fixed and rigid. Sensorineural hearing loss is generally not reversible and can be caused by: genetic make-up (this could include congenital conditions i.e. those you are born with, or late-onset hearing loss) head injury tumours infections certain medications exposure to loud noises the aging process (a significant hearing loss is experienced by about one third of people aged over 70 years). Some of the signs you might notice that indicate you have a hearing loss include: having to turn up the volume on the TV or radio finding it hard to hear someone you are talking with finding it hard to hear in a group situation where there is background noise e.g. in a restaurant having to ask people to repeat themselves you find people’s speech is unclear – they are ‘mumbling’ Hearing loss can be partial (you can still hear some things) or complete (you hear nothing) and may occur in one or both ears. Treatment Treatments for hearing loss range from the removal of wax in the ear canal to complex surgery, depending on the cause of the loss. One of the most common treatments for hearing loss is the use of a hearing aid. The type of aid you get depends on the cause of your hearing loss and how bad it is, as well as what your preferences are in terms of comfort, appearance and lifestyle. If your hearing loss is severe to profound, you may be suitable for a surgical procedure known as a cochlear implant. In this procedure, a small cut (incision) is made behind your ear and a device is implanted that can bypass the damaged parts of your ear. The surgery usually takes 2-3 hours and is performed under general anaesthesia (you sleep through it). You may be able to go home the same day or have to spend one night in hospital.

The appearance of ears that are misshaped or protruding (‘bat ears’) can be improved surgically. This type of operation is often carried out in children. Cuts (incisions) are made behind the ears through which the cartilage in the ear can be reshaped or removed. The surgery lasts 1-2 hours and can be performed under local anaesthetic (the area treated is numb but you are awake), allowing you to go home the same day. For children, the procedure would be performed under general anaesthetic (they sleep through it) and they will remain in hospital overnight. You will need to wear head bandages for about 1 week and will probably be able to return to normal daily routines after that.

Surgery can be carried out to improve the appearance of your nose e.g. straightening it if it’s crooked or increasing or decreasing its size. Small cuts (incisions) are made either on the inside or outside (in the creases) of the nose. Excess bone and/or cartilage is removed and the nose reshaped. The surgery takes about 2 hours and is performed under general anaesthetic (you sleep through it). You may be able to go home the same day or, in some cases, you may have to stay in hospital overnight. You will need to arrange for another person to drive you home. Your nose will be covered with a splint that you will have to wear for about 1 week. It will take about six weeks for the worst of the swelling to disappear.

In the facial bones surrounding your nose, there are four pairs of hollow air spaces known as sinuses or sinus cavities. These sinuses all open into your nose, allowing air to move into and out of the sinus and mucous to drain into the nose and the back of your throat. If the passage between the nose and sinus becomes swollen and blocked, then air and mucous can become trapped in the sinus cavity causing inflammation of the sinus membranes or linings. This is known as sinusitis. Sinusitis can be: acute - usually a bacterial (or sometimes viral) infection in the sinuses that follows a cold, or an allergic reaction chronic - a long term condition that lasts for more than 3 weeks and may or may not be caused by an infection. Symptoms of sinusitis include: facial pain or pressure nasal congestion (blocking) nasal discharge headaches fever. Treatment for bacterial sinusitis is antibiotics and for non-infective sinusitis may include steroid nasal sprays and nasal washes. Sinusitis can be a recurrent chronic condition which means it may occur every time you get a cold. If this treatment is unsuccessful, surgery may be considered. This is usually performed endoscopically; a tiny camera attached to a tube (endoscope) is inserted into your nose. Very small instruments can be passed through the endoscope and used to remove abnormal or obstructive tissue thus restoring movement of air and mucous between the nose and the sinus.

Snoring is the harsh rattling noise made by some people when they sleep. Snoring occurs when the flow of air through the back of the mouth and nose becomes partially blocked and structures such as the tongue, soft palate (the back part of the roof of the mouth) and uvula (the tag that hangs at the back of the mouth) strike each other and vibrate. Causes of snoring include: nasal polyps; a bend in the nasal septum (the partition running down the middle of the nose), large tonsils or adenoids, obesity, smoking, excess alcohol. Surgical treatment of snoring involves the removal of excess loose tissue in the throat or soft palate.

There are three large pairs of glands (parotid, sublingual and submandibular) in your mouth that produce saliva which helps break down food as part of the digestion process. Salivary Gland Malfunction Salivary gland malfunction that results in a decrease in saliva production can be caused by conditions such as Parkinson’s disease, depression, HIV infection and chronic pain. Saliva production can also be decreased by certain medications such as some antidepressants, antihistamines and sedatives. Reduced saliva can lead to increased tooth decay and difficulty speaking and swallowing. Good dental care is important in this condition. In some cases, saliva substitutes can be helpful. Salivary Gland Swelling If the duct or tube carrying saliva from the gland to the mouth becomes blocked, the gland will swell. The glands can also swell as the result of mumps, bacterial infections and certain other diseases. If the duct is blocked by a stone, it can sometimes by squeezed or pulled out but may on occasion require surgery to remove it. Salivary Gland Surgery Parotidectomy: an incision (cut) is made in front of the ear and runs down below the jaw line. Part or all of the parotid gland is removed. Superficial Parotidectomy: an incision is made in front of the ear and runs down beneath the ear lobe. The superficial (top) lobe of the parotid gland is removed. Submandibular Gland Surgery: an incision is made just below the jaw bone and the submandibular gland removed.

Tonsillectomy Tonsils are removed in an operation performed through your mouth. The tissue between your tonsils and throat is cut and your tonsils removed. Adenoidectomy Your adenoids may be removed as part of a tonsillectomy (see above). This operation is also performed through your mouth.

Hoarseness can be described as abnormal voice changes that make your voice sound raspy and strained and higher or lower or louder or quieter than normal. These changes are usually the result of disorders of the vocal cords which are the sound-producing parts of the voice box (larynx). The most common cause of hoarseness is laryngitis (inflammation of the vocal cords) which is usually associated with a viral infection but can also be the result of irritation caused by overuse of your voice e.g. excessive singing, cheering, loud talking. Other causes of hoarseness include: nodules on the vocal cords – these may develop after using your voice too much or too loudly over a long period of time smoking gastro-oesophageal reflux disease (GERD) – stomach acid comes back up the oesophagus and irritates the vocal cords. This is a common cause of hoarseness in older people allergies polyps on the vocal cords glandular problems tumours. Diagnostic tests may include viewing the vocal cords with a mirror at the back of your throat or by inserting a small flexible tube with a camera on the end (endoscope) through your mouth. Sometimes tests may be done to analyse the sounds of your voice. Treatment depends on the cause of the hoarseness and may include resting your voice or changing how it is used, avoiding smoking, medication to slow stomach acid production and sometimes surgical removal of nodules or polyps.

Most headaches are not due to significant underlying problems but you may be referred if your GP is worried about the nature of your headaches or you are having difficulty controlling them with standard treatment. Migraine headaches are repeated or recurrent headaches, often accompanied by other symptoms. They can be triggered by certain factors/events/foods. In some people, a visual disturbance called an aura happens before the headache starts. Other symptoms that may precede or accompany the headache include loss of appetite, nausea, vomiting, increased sweating, irritability, fatigue, intolerance of light or noise. The headache may last several hours to days. Prior to coming to clinic for review of headaches it is useful to keep a diary. Write down: when your headaches occurred, how severe they were, additional symptoms, what you've eaten, sleep patterns, menstrual cycles, any other possible factors. There is no cure for migraine headaches but treatment is aimed at: preventing migraines from occurring, stopping the migraine once early symptoms develop, and treating the symptoms of migraine (e.g. pain, nausea). For more information about migraines and headache visit www.migraine.co.nz

Otherwise known as degenerative arthritis. OA occurs when there is a breakdown of the cartilage, leaving the bones unprotected. It is very common and usually affects people as they get older. You can get it at any age and are more likely to if you have previously injured a joint, or are overweight. The symptoms can be very mild with just occasional pain with activity. Worsening symptoms include pain with activity and stiffness with rest. Joints can become swollen and restricted in movement. Joints can change shape as the bone changes in response to loss of protection. You otherwise feel well. The diagnosis is made on the basis of the history, examination findings and sometimes x-rays. The severity of joint damage seen on x-ray does not always correlate with the degree of pain you experience. Treatment includes guided exercises, weight reduction if needed, pain relief and sometimes surgery. For more information see www.arthritis.org.nz

RA is an autoimmune disease where the body’s immune system attacks the lining of the joints. This results in inflamed (red, hot, swollen), stiff and painful joints and eventually the destruction of the cartilage and bone of joints. RA can occur at any age. The cause is unknown. Symptoms do not only involve the joints but you may suffer from tiredness, low energy, fevers, poor appetite with weight loss and poor sleep. Diagnosis is made on the basis of your history and examination of your joints. X-rays may be normal in the early stages of the disease. MRI can be more sensitive at picking up early changes but can also be normal. Blood tests are done looking for an antibody that is present in about 75% of people with RA. This is called the rheumatoid factor. Unfortunately people who don’t have RA can have a positive rheumatoid factor test. Other blood tests can also help make the diagnosis. Treatment includes medications to relieve pain and inflammation. It also involves medication aiming at modifying the immune system to stop it from damaging the joints further. There are several medications in this group and your specialist will discuss side effects and benefits with you so you can work out which suit you best. For more information see www.arthritis.org.nz

This is a syndrome of widespread aches, pains and fatigue. There may be morning stiffness and sleep problems. The diagnosis is made on the history of the pain and accompanying symptoms as well as the presence of tender points at specific sites on the body. There are a number of different theories and reasons for this condition. There will often be blood tests and maybe x-rays to exclude other diagnoses. Treatment involves pain killers, exercises, rest and sometimes antidepressant medication. For more information see www.arthritis.org.nz

This is an autoimmune disease where the immune system harms cells of the body. It can affect the joints, skin, nervous system, kidneys and heart. It is a disease for which there is no cure. It can be managed and usually controlled with medication. It affects different people differently and can have symptoms that come and go. Symptoms initially can include tiredness, muscle and joint pain and swelling, hair loss, rash, and fevers. The diagnosis is made on the basis of the history and examination findings as well as blood tests and urine tests. For more information see www.arthritis.org.nz