Outpatient Procedures

Special Examinations and treatments undertaken in the ENT Clinic


Microsuction of the earMicrosuction is an examination and treatment of the ear using a high powered binocular operating microscope. We use very fine instruments, including a miniature vacuum cleaner. This ‘hoovering’ of the ear canal is usually done as an out-patient procedure. Sometimes, and especially in younger children, it is done as a day case surgery under general anaesthetic. Microsuction of the ear is carried out :

  1. To diagnose the condition of the ear accurately using
    • binocular vision for 3-d stereoscopic view
    • high power magnification
    • very bright illumination
  2. To remove material blocking the ear canal such as
    • wax
    • infected debris
    • dead skin layers
    • foreign bodies
  3. To apply medication to the ear
    • by clearing the ear one can apply drops/ointment more effectively
  4. After microsuction of the ear
    • occasionally people are a little ‘dizzy’ after this procedure but it would normally be short lived (and there would normally be no problem with driving after this)

A flexible laryngoscopeThis out-patient examination procedure is carried out to diagnose conditions of the nose and throat. A flexible laryngoscope (see illustration)

  • allows close up views of inaccesible areas of the nose and throat
  • the flexible instrument allows us to see around corners
  • very bright illumination helps diagnose conditions of the nose, nasopharynx, larynx and hypopharynx accurately
  • the vocal cords can be seen in motion

Normal vocal cordsThe picture on the right shows normal vocal cords as viewed through a flexible nasolaryngoscope.

 

Having flexible fibreoptic nasolaryngoscopy: What to expect

Before the procedure

  • you may receive a local anaesthetic spray immediately beforehand
  • if local anaesthetic is used it will taste bitter and you may imagine your throat feels swollen (this is just the local anaesthetic working and the feeling disappears within 20 minutes)

During the procedure

  • the instrument will be passed gently through your nose
  • you will be asked to sit still and breathe through your mouth
  • you may be asked to sing a high pitched note or to cough – do not worry, you will be told exactly what to do during the procedure

After the procedure

  • I will normally tell you the result of the examination straight away
  • you should not eat or drink until the local anaesthetic has worn off – often in about 30 minutes to an hour
  • you should be ok to drive without any problems after the consultation

Rigid Nasal Sinus endoscopy

This out-patient examination procedure is carried out

  • to diagnose conditions of the nose, sinuses and nasopharynx accurately, using
    • a Storz Hopkins rod telescope (a rigid lens system telescope as shown above) for magnified view of narrow openings angled lenses to see around corners
    • high power magnification
    • very bright illumination
  • to carry out minor treatments such as
    • removal of blood clots & crusts following nasal surgery
    • sucking out pus from infected sinuses
    • cautery for nosebleeds

Having rigid nasal sinus endoscopy: What to expect

Before the procedure

  • you may receive a local anaesthetic spray immediately beforehand (this is not always required)
  • the local anaesthetic will taste bitter and you may imagine your throat is swelling up. Don't panic, that is just the local anaesthetic working

During the procedure

  • the instrument will be passed gently through your nose, you will be told exactly what to do during the procedure
  • you will be asked to sit/lie still and breathe through the mouth

After the procedure

  • I will normally tell you the result of the examination straight away
  • you should be ok to drive after the procedure

If there is a history of hearing loss/noise in the ear/ imbalance then there is a case for obtaining an objective measure of the hearing levels. A pure tone audiogram determines how well you hear sounds at different frequencies or tones. This is a relatively straightforward test that can be undertaken at the same time as your consultation in the majority of cases.

This will be performed if appropriate during your consultation. Topical local anaesthetic will be applied to the nose. Silver nitrate will then be applied to the bleeding point. This causes a mild chemical burn to seal the bleeding point. The procedure may be mildly uncomfortable and may cause some sneezing. You will be able to drive after this procedure

Usually an antibacterial cream called Naseptin will be prescribed after the procedure. This is to be applied twice a day to the area cauterised for up to a few weeks after the procedure (Naseptin contains a nut oil so should not be used if you have an allergy to nuts).

 After the procedure you may experience a little bleeding in the first week or so, this is normal. The area that has been cauterised will start to go crusty, do not pick the crust as the blood vessel is healing behind this. You can blow your nose but GENTLY only. If you sneeze try to do it with your mouth open to reduce the pressure inside your nose.