Surgery - Introduction
ENTs differ from other physicians in that they are trained in both medicine and surgery, thus there is no need to refer our patients to other physicians if surgery is indicated. This allows us to provide our patients with individualized care. Our physicians use advanced technology and a broad range of surgical procedures in the treatment of diseases and disorders of the ear, nose and throat (ENT) and the related structures of the head and neck. Most ENT surgeries are relatively straightforward and can be performed on an outpatient basis.
In Office Procedures
In office surgical procedures include biopsies and the removal of superficial skin cancers. These procedures are performed under local anesthetic.
Biopsies are performed by excising a sample portion of a tumor or suspicious lesion. Biopsies are usually performed for unusual growths, lesions or areas that do not heal, or to determine a course of treatment. Many biopsies can be performed under local anesthesia in the physician’s office. The biopsy of tumors in deeper regions of the neck and throat are done under general anesthesia in the operating room with the use of an endoscope. Biopsies may take the form of a needle aspiration, an incision, a shave biopsy, or an excision. Learn More...
Removal of Superficial Skin Cancers
The most frequent type of skin cancer is basal cell carcinoma. This cancer is slow growing and rarely metastasizes (spreads). Squamous cell carcinoma can involve both the skin and mucous membranes. Squamous cell carcinoma often extends deeper into the tissue and can ulcerate and metastasize. Surgical removal is the treatment of choice. Malignant melanoma is the most serious of skin cancers and is known for its invasiveness and metastatic behavior. Prognosis is dependent on the depth of the tumor. Therefore, detection and removal are critical. Learn More...
Common Surgical Procedures
Three common outpatient procedures performed by South Texas ENT surgeons include a Tonsillectomy with or without an Adenoidectomy, a Septoplasty, an operation to correct a deviated nasal septum and to improve nasal breathing function, and a Myringotomy, which involves the insertion of ventilation tubes (PE tubes) into the eardrum to promote the drainage of fluid.
Tonsils are located on the back of the throat and adenoids are located high in the throat behind the nose and the roof of the mouth. Adenoids are not visible through the mouth without special instruments. Tonsils and adenoids are believed to work as part of the body's immune system by filtering germs that attempt to invade the body. Children who must have their tonsils and adenoids removed suffer no loss in their resistance to germs.
Recurrent throat and ear infections are the most common problems affecting the tonsils and adenoids. Tonsils and adenoids can also become enlarged and obstructive, which can lead to breathing and swallowing problems. In general, it is recommended that a tonsillectomy be performed for children who have three or more tonsillar infections per year.
During the surgery the patient is under a general anesthetic. The surgeon uses special instruments to cut the tissue in order to successfully remove the tonsils and adenoids. The surrounding blood vessels are then sealed to control bleeding. These procedures are usually performed on an outpatient basis and patients are typically able to return to normal activity in one week.
Several postoperative symptoms may arise. These include, but are not limited to, difficulty in swallowing, vomiting, fever, throat pain, and ear pain. Occasionally bleeding may occur after surgery. If the patient has any bleeding, the surgeon should be notified immediately.
PE Tubes (Myringotomy)
In many cases ear infections or fluid do not clear up with proper medication and home treatment. If this is the case, a procedure called a myringotomy may be recommended.
This procedure involves a small surgical incision into the eardrum to promote drainage of the fluid and to relieve pain. A ventilation tube (PE tube) can be placed in the incision to prevent further fluid accumulation and to improve hearing. The surgeon selects a ventilation tube that will remain in place for as long as required for the middle ear infection to improve and for the Eustachian tube to return to normal. This may require several weeks or months. During this time patients must keep water out of their ear(s) because it could start an infection in the middle ear. Otherwise, the placement of a PE tube has no side effects and patients will often notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.
This procedure is performed in the office or at an outpatient surgical center.
Nasal Septum Surgery (Septoplasty)
The nasal septum is the vertical wall that divides the nose into two nasal cavities. At birth the nasal septum is usually straight. However, as we age there is a tendency for the septum to bend to one side or the other. Often there is no history of injury to account for the irregular septum. Few adults have a septum that is completely straight. Sometimes trauma to the nose can play a major role in a septal deviation.
Septoplasty is an operation to correct a deviated septum. This procedure is usually done to improve the nasal breathing function but can also be done to provide adequate examination of the inside of the nose for the treatment and/or removal of nasal polyps, inflammation, tumors, or bleeding.
Endoscopic sinus surgery (ESS) involves the insertion of a very thin fiber-optic tube (an endoscope), into the nose for a visual examination of the sinus openings. With state of the art micro-telescopes and instruments, abnormal and obstructive tissues are then removed. In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars. The basic endoscopic surgical procedure is performed under local or general anesthesia.
The advantage to ESS is that the surgery is less extensive than earlier invasive procedures where the surgeon would access the sinuses by entering through the cheek area, which often resulted in scarring. There is often less removal of normal tissues with ESS and it can frequently be performed on an outpatient basis. After the operation, the patient will sometimes have nasal packing. For the ten days following the procedure nasal irrigations may be recommended to prevent crusting. There is typically very little swelling and only mild discomfort with the type of procedure.
Tympanic membrane (eardrum) perforations that do not heal on their own may require surgical repair. The procedure, called a tympanoplasty, involves grafting tissue across the perforated eardrum that will allow it to heal. This usually requires an incision behind the ear to obtain the tissue for the “patch”. For smaller perforations, sometimes a piece of fat tissue can be used, which is obtained by making a small incision behind the patient’s earlobe. Most of the time the surgeon will place a dissolvable packing behind the eardrum and in the ear canal. Drops may be used postoperatively to help the packing dissolve quicker, which will often stay in for upwards of six to eight weeks. This is an outpatient procedure and generally, the patient can return home within two to three hours following surgery.
During the postoperative period, it is very important to keep water out of the ear. Air travel is not advisable during this time, either. Any type of activity that might increase pressure in the ear should be avoided, e.g., holding back sneezes, blowing of the nose, etc. This surgery is typically very successful in repairing the eardrum and improving hearing.