Otolaryngology, commonly known as ENT, is the medical specialty dedicated to the diagnosis and treatment of conditions affecting the ears, nose, and throat. Problems in these interconnected areas can significantly affect fundamental functions like breathing, hearing, and speech. When non-surgical treatments fail to resolve chronic issues, structural problems, or persistent infections, an ENT surgeon may recommend an operation. These surgical interventions aim to restore normal function and improve a patient’s overall quality of life. The most frequently performed ENT surgeries address chronic infection, fluid buildup, and physical blockages in the airway.
Procedures Related to the Throat and Voice Box
The most common procedures concerning the throat involve the removal of the tonsils and adenoids, often performed together in a procedure called adenotonsillectomy. The tonsils are two masses of lymphoid tissue located at the back of the throat, while the adenoids are similar tissue situated high up behind the nose.
When these tissues become chronically infected (recurrent tonsillitis) or significantly enlarged, surgery is often indicated. Enlarged tonsils and adenoids are a primary cause of obstructive sleep apnea (OSA) in children because they physically block the upper airway during sleep. Removing this obstructing tissue resolves the condition in approximately 79% of children who undergo the procedure for OSA.
Another procedure in this area is laryngoscopy, which involves examining the larynx, or voice box, using a thin, lighted tube. This procedure is used both for diagnosis, such as investigating persistent hoarseness or difficulty swallowing, and for minor surgical treatments. During a laryngoscopy, a surgeon may remove small lesions, polyps, or cysts from the vocal cords to restore voice quality.
Procedures Related to the Ears
The ear procedure performed with the highest frequency, especially in children, is tympanostomy, which involves the surgical placement of ear tubes, or grommets, into the eardrum. This procedure is primarily recommended for children who experience recurrent acute otitis media (ear infections) or chronic otitis media with effusion (persistent fluid buildup in the middle ear).
The middle ear is connected to the back of the throat by the eustachian tube, which is responsible for pressure equalization and fluid drainage. The tubes inserted during a tympanostomy create an alternate opening in the eardrum, allowing air to flow into the middle ear and permitting trapped fluid to drain out. This process ventilates the middle ear, equalizes pressure, and significantly reduces the frequency of infections and the associated temporary hearing loss.
Less common, but still regularly performed, are procedures like tympanoplasty, which is the surgical repair of a perforated eardrum. This operation aims to restore the integrity of the eardrum using a tissue graft to improve hearing and prevent recurrent middle ear infections. Additionally, a mastoidectomy may be performed to clean out infection from the mastoid bone behind the ear, typically when chronic infection has spread beyond the middle ear space.
Procedures Related to the Nose and Sinuses
Common surgical procedures in the nasal and sinus cavity are often performed to address structural issues that impede airflow and drainage, leading to chronic congestion or pain. Septoplasty is a procedure designed to straighten the nasal septum, the wall of cartilage and bone that divides the two nasal passages. A deviated septum can obstruct one or both sides of the nose, causing breathing difficulty, chronic congestion, and sometimes contributing to recurrent sinus infections.
During a septoplasty, the surgeon makes internal incisions to access and then reshape or remove the deviated portion of the cartilage and bone, ultimately repositioning the septum to a straight, midline position to improve nasal airflow. This surgery is often performed in conjunction with a turbinate reduction, or turbinoplasty, where the turbinates—scroll-like structures that filter and humidify air—are reduced in size. The turbinates can become enlarged, often in response to a deviated septum, worsening the nasal obstruction.
For chronic sinusitis that does not respond to medication, Functional Endoscopic Sinus Surgery (FESS) is the standard surgical intervention. FESS is a minimally invasive technique that uses an endoscope, a thin instrument with a camera, to visualize the inside of the nasal passages and sinuses. The goal of FESS is to remove blockages, such as swollen tissue or nasal polyps, and widen the natural drainage pathways of the sinuses. Widening these openings allows mucus to drain properly, preventing the buildup that leads to chronic infection and significantly relieving symptoms like facial pressure and congestion.