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 months 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 bacterial sinusitis is antibiotics and for non-infective sinusitis may include steroid nasal sprays and nasal washes. If this treatment is unsuccessful, surgery may be considered. This is usually performed endoscopically; a small, rigid telescope (endoscope) is inserted into your nose. Very small instruments can be passed by 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) vibrate due to turbulent airflow. 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 can involve scarring of the soft palate or the removal of excess loose tissue in the throat or soft palate among many procedures.

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 and tonsils. 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 day and your work, driving and overall performance may be affected. The usual treatment for OSA is to wear a nasal mask that delivers pressurised air to keep the airways open while you sleep. This treatment is known as Continuous Positive Airway pressure (CPAP). There are also operative procedures which can help to make using the CPAP machine easier. Alternatively, for those people who find difficulty in effectively using a CPAP machine, some operative procedures are also used.

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 – e.g. the common cold 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. 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.

A small telescope (endoscope) is inserted into your nose. Instruments can be passed by the endoscope and used to remove small pieces of bone and soft tissue. This opens up the ventilation and drainage pathways in the outer wall of your nose.

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 but mostly you will 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. The final result from a rhinoplasty can take 12 - 18 months to be realised.

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.

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 be squeezed or pulled out but may on occasion require surgery to remove it.

Scar appearance can be improved by various methods including a surgical procedure known as scar revision. This usually involves cutting out the old scar, closing the wound with stitches and, in some cases, moving the scar so that it is hidden by natural features of the body. Scar revision is usually performed under local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic). Sometimes you may also be given steroid injections at the time of surgery. Immediately following the procedure, you will need to remain at the clinic for about an hour, during which you will be encouraged to walk around. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Non-dissolving stitches will be removed in approximately 1 week. You may need to take a few days off work after the surgery.

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.

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: the common cold, gastro-oesophageal reflux, stroke or a tumour. Diagnosis may be by examination of a mucous sample or by viewing the pharynx, oesophagus and stomach using a small, flexible tube with a tiny camera on the end that is inserted down the back of your throat. Treatments for dysphagia depend on the causes, but may include: medication – antacids, muscle relaxants or medicine to slow down stomach acid production changes in diet and/or lifestyle surgery e.g. stretching or releasing a tightened muscle

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.

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.

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 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.

When the growth of one of the tiny bones in your middle ear, the stapes, changes from hard to soft and spongy, it leads to the condition called otosclerosis. As this abnormal growth develops, the stapes becomes more rigid or fixed in position. The stapes needs to be able to vibrate to allow sound vibrations to pass through to the inner ear. When the stapes is not vibrating as well as it should, gradual hearing loss can occur. Otosclerosis may occur in one or both ears and may sometimes be associated with ringing/clicking/buzzing noises in your ear (tinnitus). The condition will be diagnosed by hearing tests and tympanometry. Otosclerosis most often develops during teenage and early adult years and it tends to run in families. The condition can become worse during pregnancy. Treatment There are several different approaches to treating otosclerosis, one of the most common being a surgical procedure called stapedectomy. This is a microsurgical procedure (microscopic lenses are used to help the surgeon see the tiny structures involved) usually performed through the ear canal. A small cut (incision) is made in the ear canal near the eardrum and the eardrum is lifted, exposing the middle ear and its bones. Part of the stapes bone is removed and an artificial prosthesis inserted to help transmit sound into the inner ear. The eardrum is then folded back into position. The surgery can either be performed under general anaesthetic (you sleep through it) or local anaesthetic (the area treated is numbed) plus sedation (you are given medication to make you feel sleepy). You will be advised not to fly, blow your nose or allow any water to get into your ear for about six weeks after the operation. Other treatments include use of a hearing aid or taking sodium fluoride which helps harden the bone and can improve hearing in many patients with otosclerosis.

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.

This is a slow-growing, benign (non-cancerous) overgrowth of tissue on the nerves that affect your hearing and balance. When the neuroma is small, there may either be no symptoms or you may have a slight hearing loss or mild tinnitus (ringing/clicking/buzzing noises in your ear). As the neuroma grows and exerts pressure on the nerves, there will be a more noticeable loss of hearing, more tinnitus and problems with balance. The condition is diagnosed using hearing tests and MRI or CT scans. Acoustic neuromas are usually found only in one ear and generally occur in people over 40 years of age. Treatment If the neuroma is small and not causing significant problems, you may not receive any treatment but the growth and effects of the neuroma will be measured regularly. If treatment is being considered, it may be either radiotherapy or surgery. Radiotherapy, which is used for small to medium neuromas, involves low-dose beams of radiation aimed at the neuroma. This does not require anaesthesia but you will probably be in hospital for 1-2 days. For larger neuromas that are causing significant problems, surgical treatment may be suggested. Depending on the size of the neuroma, there are several different types of operation that can be performed. Whatever surgical approach is used, it will be performed under general anaesthetic (you will sleep through it) and you will probably remain in hospital for about one week.

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.