General otorrinolaringology


Ear

Serous Otitis or Secretory Otitis Media

Serous otitis or secretory otitis media is an inflammation of the middle ear in which there is liquid collection but no signs of acute infection.

It is frequent in children bellow seven years old its highest incidence is in 2 year old children, and it usually affects both ears.

The main cause is Eustachian trump dysfunction and adenoid hypertrophy.

In adults, it is frequent in patients with chronic rhinitis or recurrent upper respiratory tract catarrh. If it affects only one ear, the doctor must discard the possibility of rhinopharynx tumour.

The most commontreatment consists in placing ventilation tubes in the eardrum (eardrum drainage). Adenoidectomy is also usually performed.

An adult, once discarded the rhinopharynx problem, will have a ventilation tube placed in the affected ear.

Myringoplasty

It is the surgical treatment to repair eardrum perforations. It consists in placing a temporalis fascia free graft to close the perforation and thus restore the audition.

Depending on the anatomical conditions of the external ear canal, this surgery can be performed under local anesthesia and sedation (endaural technique) or behind the line (retrauricular technique) under general anesthesia.

Tympanoplasty

Tympanoplasty is a surgery procedure to reconstruct middle ear auditive mechanism (eardrum, ossicular chain). Repairing the eardrum membrane is commonly called myringioplasty or type 1 tympanoplasty.

When it is the ossicular chain which has to be repaired, the procedure is called type 2 tympanoplasty, type 3 tympanoplasty, etc.

Stapedectomy

Stapedectomy is a middle ear surgical procedure to treat otosclerosis.es la cirugía de la otoesclerosis.

Otosclerosis is the ossification of the labyrinth capsule which fixates the stapes in the oval window and interferes with sound passing waves to the inner ear, thus causing hearing loss.

Mastoidectomy

Mastoidectomy is a group of surgical techniques used in treating chronic otitis media with cholesteatoma, removing all the keratinized epithelium from the middle ear and mastoids.


Nose

Septoplasty

Septoplasty is a surgical procedure used to reshape the septum when it is deviated or causes nasal respiratory failure.

Turbinate or chronic nasal obstruction surgery

Turbinates are structures located on the external wall of the nose which function is to warm and humidify the air we breathe.

When the nose is inflammated, be it caused by allergies or vasomotor or medicament related problems (abuse of sprays and drops), the turbinates swell making respiration difficult (chronic nasal obstruction).

Enlarged turbinates may be corrected with radiofrequency or laser surgery.

When the hypertrophy is severe, the doctor will advice laser surgery (with general anaesthesia).

Radiofrequency

Radiofrequency is a procedure in which low temperature and low power energy is used to make inferior turbinate tissues smaller. This energy is sent under the superficial coat (or mucosa) of the lower turbinate. The tissue being treated heats enough to create a coagulation area. During the following three to six weeks the treated tissue is eliminated naturally, and the scarring of the turbinate makes decrease, alleviating the obstruction.

Radiofrequency is a safe, fast and effective way to alleviate chronic obstruction caused by hypertrophy of the turbinates. This procedure usually lasts less than thirty minutes.


What may be expected from radiofrequency?

Radiofrequency solves chronic nasal obstruction, without the pain associated to conventional and laser surgery. After the procedure, the patient may feel some slight pain and inflammation for some days. During the following three to six weeks the patient will notice an improvement in the amount of air they can breathe through the nose. Most of the patients do not need any kind of pain medicine.

The energy is sent under the mucosa of the lower turbinate.
The tissue is heated up to 70º-75º C to create a coagulation area.
During the following three to six weeks the treated tissue decreases.

Am I a candidate to radiofrequency?

If you suffer from chronic nasal obstruction, radiofrequency might be the solution. Your doctor may evaluate your particular situation and decide whether you are candidate to such procedure.

The treatment can be repeated when more scarring is desired.

Should radiofrequency not be enough or the hypertrophy of the turbinates too severe, laser surgery, (with general anaesthesia) should be performed.

Why can't I breathe properly if my septum is straight and my turbinates are normally sized?

It may be due to problems of the nasal valve,obstruction of the side of the nose, or too small nostrils.

In order to correct any of these problems,functional rhinoplasty is needed.

What is a functional rhinoplasty?

Functional rhinoplasty is a group of surgical techniques performed on the nasal pyramid to improve the respiratory function.

Using cartilage grafts the opening angle of the nasal valve can be widened and give more rigidity to the tissues of the nostrils and thus prevent an inhaling obstruction.

The diameter of the nostrils may also be widened.

Sinusitis surgery

Sinusitis surgery consists in opening the natural sinus drainage orifices and removing the affected mucosa.

This kind of surgery is practiced inside the nose using endoscopic techniques that lessen the surgery traumatism and improve the post surgery.


Mouth

Tonsils

In adults, tonsils must be operated on when they are affected by a tumour or recurrent infection or after suffering from one or two pretonsillar abscesses. Also in chronic snoring surgery and sleep apnoea surgery.

In children, besides from recurring tonsillitis, sleep apnoea is also common.

Tonsils are always operated on with general anaesthesia. Depending on the cause that triggers the surgery and the size of the tonsils, different surgical techniques shall be practiced:

  • On recurring infections or pretonsillar abscesses, total tonsillectomy must be practiced, removing all tissue that may bring the infection back.

Dr Máiz has a lot of experience with total tonsillectomies under microscope and assisted by laser. This technique is very accurate when removing the affected tonsil without damaging the surrounding tissues and with better control of the hemostasis, which translates into less painful post surgery and less bleeding.

  • Total tonsillectomy will be applied if the presence of a tumour is suspected.
  • Tonsillectomy shall also be total if it is associated to uvulopalatopharyngoplasty (removal of tissues of the palate in chronic snoring surgery).
  • In children with tonsils bigger than normal, partial or subtotal tonsillectomy will be practiced.
  • When the size of the tonsils causes sleep apnoea, laser subtotal tonsillectomy is recommended.
  • When the size of the tonsils only causes snoring, radiofrequency partial tonsillectomy is recommended.

When there's tonsillar hypertrophy, the patient has generally checked the adenoid vegetations, and if they were also big, adenoidectomy would be practiced also.

Adenoids

Adenoids, also called adenoid vegetations, are lymphoid tissues similar to tonsils located on the ceiling of the pharynx (behind the nose). In children they can be oversized, thus blocking the nasal cavities and making the child breath through the mouth, and even blocking the Eustachian tube, causing secretory otitis media (serous otitis). Secretory otitis media (serous otitis).

Adenoids must be operated on in the following cases:

  • When they cause chronic serous otitis or recurrent acute otitis.
  • When the tonsils have to be operated on and the adenoids are big.
  • When the child, due to a total blocking of nasal breathing, develops dental malposition.

Lingual and lip frenulum

In both cases, they must be operated on when they are too short. Too short lingual frenulum causes pronunciation impediments, and too short lip frenulum causes the upper gum to show too much.

Snoring

What causes snoring?

People snore when the soft tissues of the upper respiratory tract relax and vibrates while sleeping.

Most of the times snoring is caused by overgrowth of the soft palate and uvula, even though tong, tonsils, adenoids and congested nasal cavities might also contribute. The level of the snoring may worsen with alcohol, tobacco and overweight.

Is snoring bad for my health?

Snoring may be a sign of obstructive sleep apnoea, a syndrome that stops the affected from breathing various times in their sleep. The doctor must perform a complete analysis to establish whether you just snore or have a more serious breathing problem. Any of these cases can be treated easily: simple snoring is treated with radiofrequency, and sleep apnoea with various other treatments.

How will the doctor study my snore?

If you are considering the possibility of treating your snore, dismissing sleep apnoea is essential. Your medical record will be thoroughly examined. The best way to evaluate your snoring and breathing patterns is with a test under medical vigilance during the night (nocturnal polysomnography).

How is it treated?

The treatment will depend on the seriousness of the case. Should there be severe obesity, it must be treated, and the patient will have to quite myorelaxant medication (sleep pills, tranquilizers, etc) and alcohol.

When there is just snoring without sleep apnoea in which the uvula al soft palate are low,radiofrecuency is recommended.

If the tissue of the palate and tonsils is too large, an intervention to resect excess soft palate and tonsils with the aim of obtaining the greatest possible space (uvulopalatopharyngoplasty) is recommended. This procedure can be performed by laser surgery or traditional surgery.

What is radiofrequency?

Radiofrecuency s a procedure in which low temperature and low power energy are used to treat a well defined area of the uvula or soft palate. This energy is sent from below the surface of the soft palate (mucosa). The tissue being treated heats enough to create a coagulation area. During the following three to six weeks the treated tissue is eliminated naturally, decreasing the volume and strengthening the area responsible for the snoring.

There may appear some inflammation or discomfort during the following days to the procedure that feel like a cold. During the following month the patient should feel that their snoring has improved. Depending on its level, it may be necessary to repeat the process.

Since the delicate line of the palate is protected, radiofrequency is not very painful at all and allows a faster recovery.

The energy is sent under the surface of the soft palate.
The treated tissue is heated enought to create a coagulation area.
During the following four to six weeks the treated tissue decreases and strengthens.

Am I a candidate to radiofrequency?

If you snore loudly frequently and do not have any other breathing problem, radiofrequency might be the best option.