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 mucus to drain into the nose and the back of your throat. If the passages between the nose and sinuses becomes swollen and blocked, then air and mucus can become trapped in the sinus cavities causing sinus symptoms. Sinusitis occurs when the sinus lining becomes inflamed and sometimes infected. Sinusitis can be: Acute - usually a viral or bacterial 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. Sinusitis can be a recurrent condition which means it may occur every time you get a cold. Symptoms of sinusitis include: facial pain or pressure nasal congestion (blocking) nasal discharge headaches fever. Treatment for sinusitis includes saline and alkaline saline nasal washes (Sinus Rinse Kit), steroid nasal sprays, pain relief (if required) and inhalations. If infection is confirmed by a swab and CT imaging then antibiotics and sometimes anti-fungals are required. If this treatment is unsuccessful, surgery may be considered. This is usually performed endoscopically; a small camera is attached to the endoscope which is inserted into your nose during the operation. Small instruments are passed into the nose and sinuses next to the endoscope and are used to remove abnormal or obstructive tissue. The aim is to restore normal ventilation to, and free drainage from, the sinuses.

Rhinitis is the inflammation of the lining of the nose (nasal mucosa). The most common symptoms are a blocked, runny and itchy nose. Rhinitis can be: allergic – either seasonal (hay fever) caused by pollen allergies or perennial caused by e.g. house dust mite, pets infectious – viral, bacterial or fungal non-allergic, non-infectious – caused by irritants such as smoke, fumes, food additives. In the case of allergic rhinitis, the specific allergen (the thing that you are allergic to) may be identified by skin prick tests. This involves placing a drop of the allergen on your skin and then scratching your skin through the drop. If you are allergic, your skin will become red and swollen at the site. These tests are carried out at the laboratory and are free. Treatment of allergic rhinitis involves avoiding the allergen if possible, but if not possible then corticosteroid nasal sprays and antihistamines are the usual medications prescribed. When medical treatment is not successful or not well tolerated by the patient, then sometimes surgery can be used. This is aimed to correct any obvious structural abnormalities in the nose such as a deviated septum or enlarged turbinates (the soft tissue on each side of the inside of your nose).

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 folds which are the sound-producing parts of the voice box (larynx). The most common cause of hoarseness is laryngitis (inflammation of the vocal folds) 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 folds – these may develop after using your voice too much or too loudly over a long period of time smoking gastro-oesophageal reflux disease (GORD) – when stomach acid comes back up the oesophagus and irritates the larynx and vocal folds allergies masses, cysts or polyps on the vocal folds endocrine gland (thyroid) problems tumours (benign and malignant) in the head and neck region injuries to the neck - such as in sport or in a fight. Diagnostic tests will include viewing the vocal folds by inserting a small flexible tube (endoscope) through your nose under local anaesthesia. If a more detailed examination of your voice and larynx is needed then videostroboscopy will be required to analyse the larynx in more detail. In some case, assessment by the Speech and Language Therapists and computer voice analysis will be needed. Treatment depends on the cause of the hoarseness and may include resting your voice or changing how it is used (arranged with Speech and Language Therapy), avoiding smoking, improving lubrication in the voice box and taking medication to correct acid reflux. Sometimes surgery is also required.

If you find it difficult to pass food or liquid from your mouth to your stomach, you may have a swallowing disorder or dysphagia. Symptoms may include: a feeling that food is sticking in your throat, discomfort in your throat or chest, a sensation of a ‘lump’ in your throat, coughing or choking. A disorder may occur in any part of the swallowing process such as the mouth, pharynx (tube at the back of the throat that connects your mouth with your oesophagus), oesophagus (food pipe that takes food to your stomach) or stomach. Causes of dysphagia include: gastro-oesophageal reflux, strictures, benign or malignant tumours, infections and various neurological disorders including strokes. Diagnosis is usually made by examining the oral cavity, pharynx and oesophagus directly, identifying whether any acid is getting up to the larynx or pharynx from the stomach, evaluating the way the oesophagus functions with x-ray studies and assessing the muscle function in the pharynx and the oesophagus (pressure measurements). The examination of the pharynx, oesophagus and stomach is done with an endoscope (a flexible tube) that is inserted down the back of your throat. This may initially be a small endoscope and the procedure is carried out under local anaesthesia, or it may require a gastroscopy (using a bigger endoscope) which is performed in a specialised clinic. A Modified Barium Swallow is performed by the radiologists and studies the dynamics of swallowing at each stage of the swallow. Pressure measurments are rarely needed. Sometimes patients need 24 hr pH monitoring to assess how much acid is present in the oesophagus at different levels. This requires placement of a small tube through the nose to measure acid levels in the oesophagus over a 24 hr period. Treatments for dysphagia depend on the causes, but may include: medication – antacids, muscle relaxants or medicine to control acid production in the stomach changes in diet and/or lifestyle weight loss surgery - may involve procedures to prevent acid reflux, reduce the stomach size (lap banding) or even biopsies if a tumour is suspected or seen.

Snoring is the harsh rattling noise made by some people when they sleep. Snoring occurs when the soft tissues in the mouth, nose and throat vibrate when the person is asleep. The structures such as the tongue, the soft palate (the back part of the roof of the mouth), uvula (the tag that hangs at the back of the mouth), the tonsil area and the sides of the throat vibrate and this creates the noise. Causes of snoring include: nasal obstruction (nasal polyps or a deviation in the nasal septum (the partition running down the middle of the nose), large tonsils or adenoids, jaw problems, a floppy palate. General causes of snoring include weight gain and obesity, increasing age, alcohol at night and sedative medication at night. Snoring can be treated by correcting the general causes and directing treatment to the particular areas that are noted to be the problem. Some people need CPAP (continuous positive airway pressure) devices. This works by pushing a steady stream of air into the throat through a mask worn at night. Surgical treatment of snoring is aimed to correct the particular areas that are causing the snoring and may involve nasal surgery, adenoidectomy, tonsillectomy and palate surgery. All the general causes have to be looked at, especially weight control and alcohol consumption.

When snoring is interrupted by episodes of totally obstructed breathing, it is known as obstructive sleep apnoea. The obstruction is caused by the relaxation of muscles that support the soft tissues at the back of the throat such as the uvula, soft palate, tongue, tonsils and the sides of the throat and pharynx. These tissues then collapse and momentarily block the airway. Episodes may last 20 seconds or more and may occur hundreds of times per night. While you are not breathing, the levels of oxygen in your blood drop which causes your blood pressure to go up and adds strain to your cardiovascular system. In addition, you are likely to feel overly tired during the next day. Your work, driving and overall performance may be affected. The usual treatment for OSA is to wear a nasal or oral/nasal mask that delivers pressurised air to keep the airways open while you sleep. This treatment is known as Continuous Positive Airway Pressure (CPAP). The machines are reasonably quiet but sometimes the mask takes some getting used to. Surgery can be considered in some cases. All of the general problems that lead to snoring also apply to obstructive sleep apnoea and need to be addressed.

Your tonsils are the oval-shaped lumps of tissue that lie on both sides of the back of the throat. Sometimes tonsils can become inflamed (red and swollen with white patches on them) as the result of a bacterial or viral infection; this is known as tonsillitis. If you have tonsillitis, you will have a very sore throat and maybe swollen glands on the side of your neck, a fever, headache or changes to your voice. In some cases, pus can be seen on the tonsils. Tonsillitis mostly occurs in young children and can be a recurrent condition (it keeps coming back). If the tonsillitis is caused by bacteria, antibiotics will be prescribed. If the tonsillitis is caused by a virus, treatment will usually consist of medications to relieve symptoms such as a pain killer. If tonsillitis occurs often over a period of two or more years, then surgical removal of the tonsils (tonsillectomy) may be considered.

If there is a stone (calculus) in the duct under the tongue, this can be removed under local anaesthetic by making a small cut in the floor of the mouth over the stone. If the stone is in the salivary gland under the jaw (submandibular gland) then removal may require an operation under general anaesthetic.

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.

Audiometry is the electronic testing of hearing ability. You will sit in a special room wearing earphones and be asked to respond when you hear a noise through the earphones. These tests can measure your hearing levels as well as other aspects of hearing such as the ability to recognise speech against background noise. Tympanometry uses sound and air pressure to check middle ear function. A small, soft probe is placed in your ear for a few seconds and a computer measures your ears response to sounds and pressure emitted through the probe. This test is often carried out in young children to assess for glue ear.

This is inflammation or infection of your middle ear (the space behind your eardrum) and is often associated with a build-up of fluid in your middle ear. Acute Otitis Media This is usually caused by a temporary malfunction of the Eustachian tube due to allergies, infections or trauma. The Eustachian tube connects the middle ear to the nose and allows air to enter the middle ear, thus making middle ear pressure the same as air pressure outside the head. Acute otitis media results in an infection in the middle ear causing pain, fever and a red, bulging eardrum (the thin, transparent membrane between the outer ear canal and the middle ear). This condition is usually seen in young children. The treatment may be antibiotics if it is suspected to be a bacterial, rather than viral, infection, or if there are repeated episodes, surgical insertion of grommets into the eardrums may be required. Grommets are tiny ventilation tubes that allow normal airflow into, and drainage out of, the middle ear until the Eustachian tube begins to work normally. The operation is done under general anaesthesia (the child is asleep) and takes 10-15 minutes. Most grommets fall out naturally after six to twelve months, by which time the Eustachian tubes are often working properly. Otitis Media with Effusion (Glue Ear) Like acute otitis media, glue ear is usually the result of a temporary malfunction of the Eustachian tube and may either follow an episode of acute otitis media or occur on its own. The condition is usually seen in children. Fluid is present in the middle ear and the ear is not usually painful, but the ear drum is not red and bulging and there is no fever. Glue ear may lead to hearing loss, which can result in speech delays, and balance problems. Treatment options include: a prolonged course of antibiotics; grommet insertion; or treatment with decongestants, antihistamines or steroids. Chronic Otitis Media If the Eustachian tube is blocked repeatedly over a period of several years, there may be changes to the tissues of the middle ear such as deformity of the ear drum and damage to the bones of the ear. These changes may result in hearing problems, balance problems, and persistent deep ear pain. If such long term damage has occurred, an operation called tympanomastoidectomy may be required. This involves making an incision (cut) behind or around the upper part of your ear, drilling through the mastoid bone and removing, and possibly repairing, damaged tissues.

Meniere's disease is a disorder in which there is an abnormality in the fluids of the inner ear resulting in increased pressure in the inner ear. There is no general agreement as to what causes this abnormality, but there are probably many different causes including injury (immune, infectious, trauma, allergic etc) to the ear. Symptoms of Meniere's include episodes: of vertigo (you feel you are spinning), hearing loss that comes and goes, tinnitus (ringing/clicking/buzzing noises in your ear), a feeling of fullness around your ear. Episodes may last for hours or days. The condition will be diagnosed using hearing tests and possibly an MRI or CT scan. Meniere's disease usually occurs in one ear only and typically appears between the ages of 20 and 50 years. Treatment The initial treatment approach is usually a lifestyle and diet change, including a low salt diet; avoidance of alcohol, tobacco, caffeine and stress; and increased exercise and rest. The majority of patients find that these changes can help control their symptoms. Diuretic medication (reduces the amount of fluid in your body) may also be introduced. In severe cases where dietary/lifestyle changes have not been successful, surgery may be considered.