The Department of Otorhinolaryngology (ENT) at Columbia Asia Hospitals, aims to provide comprehensive solutions to patients with ear, nose and throat problems. The department has highly qualified and experienced specialists, who provide treatment as per international standards. Most of the surgeries are done on a day care basis and are offered as minimally invasive surgeries that are less painful.
The ENT surgeons team up with neurosurgeons to perform Skull base surgeries, many of which are done by endoscopic technique. Cochlear implants and BAHA surgeries for patients who have congenital or acquired hearing loss are also performed.
Well trained audiologists and speech therapists handle diagnostic audiology and provide speech therapy to pediatric and adult patients. All babies born in the hospital mandatorily undergo test for hearing defects, so that it can be identified and corrected early.
Treatments and Procedures:
- Micro-laryngeal and ear surgery
- Endoscopic sinus surgeries for chronic sinusitis and nasal polyps. FESS (Functional endoscopic sinus surgery)
- Rhinoplasty for correction and restructuring, restoring functions and aesthetically enhancing the nose
- Cochlear implantation and BAHA surgeries
- LASER assisted surgeries done for tonsillectomy, nasal septum deviation and tympanoplasty (ear drum surgeries)
- Head and neck cancer surgery
- Micro ear surgeries
- Advanced endoscopic surgeries for CSF Rhinorrhea and anterior skull base tumours
- Micro-laryngeal surgeries for vocal nodules, polyps and thyroplasty for vocal cord palsy
- LASER surgeries for stapedotomy, turbinoplasty , uvulo palato pharyngeoplasty (UPPP ) surgery for Snoring
- Multi-speciality care for skull base tumours, microtia repairs and laryngo tracheal stenosis
- Diagnosis & treatment of snoring and sleep apnoea syndrome
- Full range of audiometry services including speech laboratory, hearing aids, sleep laboratory (Digital Polysomnography)
Snoring And Sleep Apnoea
The Snoring and Sleep Apnoea Clinic at Columbia Asia Referral Hospital Yeshwanthpur offers complete solution for snoring and sleep apnoea problems.
Snoring is the vibration of respiratory structures due to obstruction of air movement through the respiratory passages during sleep. The sound ranges from soft to loud and unpleasant. Snoring may be the first sign of obstructive sleep apnoea (OSA). It affects approximately 40% of men and 25% of women, as men have narrower air passages than women. Older people are more prone to snoring.
Why does snoring occur?
- A weak throat (due to an inherent cause, alcohol or drug consumption) causing the throat to close while sleeping
- Wrongly positioned jaw due to jaw clenching
- Fat accumulation in and around the throat
- Obstruction of the nasal passages
- Obstructive sleep apnoea
- Tongue falling backwards when sleeping on the back
- Cleft palate and enlarged adenoids
- Nasal problems like a deviated nasal septum or sinusitis
Effects of snoring
- Sleep deprivation leading to daytime drowsiness, lack of libido and inability to focus
- Studies have shown a distinct co-relation between snoring and heart attacks / strokes.
What is sleep apnoea?
Sleep apnoea, one of the causes of snoring, is a potentially life-threatening condition that requires medical treatment. It is a breathing obstruction, causing a transient dip in the oxygen supply to the brain. One stops breathing for periods of more than 10 seconds at a time during sleep. The person wakes up to breathe normally and then goes back to sleep. This causes a sleep deficiency and the person suffers from fatigue and sleepiness during the day.
When to see a doctor for snoring
Snoring may be a sign of something serious. You need to see a doctor if:
- You snore loudly and heavily and are tired during the day
- You stop breathing, gasp or choke during sleep
- You fall asleep at inappropriate times, like during a conversation or a meal
What are tonsils and tonsillitis?
Tonsils are two oval lumps of tissue situated on either side, at the back of the throat to help the body fight infections from the age of 1-5 years, after which they are non-functional and become a source of infection in some individuals and results in tonsillitis.
What is tonsillectomy?
This is a surgery to remove the tonsils and is advised for those who have repeated and very severe attacks of infection of the tonsil, either bacterial or viral. When the tonsils are infected, they cause sore throat, pain and difficulty in swallowing, headache and fever. A tonsillectomy will be done only after the current infection is treated.
It is usually done under general anaesthesia. Prior to the surgery, you will be advised to fast for at least 6 hours. After surgery, the throat will be sore, jaws stiff and ears will ache. After about 12 hours, a whitish membrane will appear where the tonsils were. This is just new mucosa growing. It is usually advised not to go to public places for at least two weeks to avoid contact with people with cough, cold or other infections.
Latest methods of tonsillectomy
Laser assisted / co-ablation assisted tonsillectomy are contemporary technologies, with the advantage of less pain, lower risk of bleeding and quicker recovery.
When is tonsillectomy advised?
Tonsillectomy is advised when there is:
- More than 2-3 bouts of tonsillitis in the past year
- Difficulty in breathing or swallowing and this worsens with each bout
- Frequent ear infections
- Difficulty in sleeping or going to school or work
- To reduce snoring and sleep apnoea
Risks include the following but are not limited to these only:
- Bleeding: during surgery and anytime in the first two weeks after the surgery. Delayed bleeding may require readmission to the hospital to undergo another surgery to stop the bleeding.
- Burns from the equipment used to seal off bleeding areas during surgery
- Infection, which may be characterised by bad breath, worsening throat discomfort or delayed bleeding and may require antibiotics
- Throat pain of varying intensity for two weeks
- Injury to the teeth, lips, gums or tongue. There may be a temporary loss of taste.
- Abnormal scarring may occur causing narrowing or stenosis of the throat
- Sometimes, there is nasal speech and leakage of food / fluids through the nose, which settles down over time and is usually due to pain and restricted movement.
- Recurrence of symptoms
Post operative care
- Diet control: Though there are no clear cut contraindications, it is advisable to avoid spicy food for about a week after the surgery.
- It is advisable to start eating / drinking as soon as possible after the surgery since this will help tissues heal faster.
- Regular gargles to keep the tonsillar fossa healthy are recommended.
What is nasal septum?
A nasal septum is the partition inside the nose which separates the two nostrils. It is made up of bone at the back and cartilage in the front and is straight and in the middle of the nose.
What is septoplasty?
Septoplasty is a surgical procedure to correct the deviated nasal septum, defects or deformities of the septum. These may be congenital or develop as a result of injury. The procedure is done under general anaesthesia. For anterior and minor deviations, a local anaesthetic is all that is required.
Reasons for septoplasty
- Severe nasal airway obstruction which results in mouth breathing, sleep apnoea, recurrent nasal infections and protruding teeth of the upper jaw
- Septal spur headache: which is caused due to impaction in the nose
- Uncontrollable nose bleed
- Deformities of the nasal septum
- To create access to sinuses during FESS (a surgery done for sinusitis)
What is the procedure?
This is a day-care procedure. A cut is made inside the wall of one side of the nose, the mucous membrane is lifted up and any part blocking the area is removed. The mucous membrane is repositioned either with stitches or nasal packs. ENT surgeons with additional training often do this using a contemporary technique with a nasal endoscope.
- Improved nasal breathing
- Reduction in frequency of infection of the sinuses, ears and nasal cavity
Pre operative instructions
- Assessment of difference in airflow between the two nostrils
- Fasting from about 6-8 hours prior to surgery
- To stop taking blood thinners 5-7 days prior to surgery
- You will be asked not to take your diabetes medicines on the morning of the surgery but medications for hypertension and thyroid dysfunctions can be taken with a sip of water.
- The patient will have to breathe through the mouth when the nasal pack is in place.
- All dressings are removed in a day or two.
- The head end should be elevated when lying down for the first 48 hours.
- Small amount of bloody discharge is normal but excessive bleeding should be reported to the doctor immediately.
- Antibiotics are given only if the pack is retained for over 24 hours.
- Avoid strenuous activity for two weeks after surgery.
Risks and complications though rare may include but are not limited to:
- Bleeding: during the surgery and anytime in the first two weeks after surgery. Delayed bleeding may require re-admission to hospital to undergo another surgery to stop bleeding.
- Infection, which may require antibiotics and can cause bleeding
- Recurrence of symptoms
- Abnormal healing of external wounds with scar formation
- Change in shape of the nose
- Impaired sense of smell and taste
- Abnormal scarring inside the nose requiring further surgery
- Cerebrospinal fluid / orbital haematoma / septal abscess / haematoma
- May cause increase in snoring and sleep disturbance due to nose block immediately after surgery but resolves with time and healing
- Rarely, septal perforation leading to a whistling sound during breathing. This may need a surgery.
Benign Paroxysmal Positional Vertigo (BPPV)
What is benign paroxysmal positional vertigo (BPPV)?
Benign paroxysmal positional vertigo (BPPV) is an inner ear problem that causes short periods of vertigo when your head is moved in certain positions. It occurs most commonly when lying down, turning over in bed and looking up. Even though you are still, you may feel like you are moving or that the room is moving around you. You may also experience nausea, vomiting, sweating and abnormal eye movements. If the vertigo is accompanied by double vision, difficulty in speaking,change in alertness, arm / leg weakness or an inability to walk, you should immediately contact your doctor.
What causes BPPV?
BPPV occurs when small crystals of calcium carbonate, commonly referred to as rocks, in the inner ear break loose and fall into another area within the balance canals. The crystals may break loose for many reasons following an inner ear infection, fever, concussion or whiplash injury. BPPV can also occur along with other diseases of the inner ear such as Meniere's disease, migraines or as a 'normal' aging process.
How is BPPV treated?
About 85% people recover from specific neck manoeuvres, performed by their physician or physical therapist which are designed to move the crystals back into place. Research shows that the repositioning manoeuvre works on the first effort, 80-90% of the time. After the treatment is complete, you may feel nauseous, dizzy or have more trouble balancing than before. This can last for several hours. Avoid dangerous activity and follow the instructions given by the physician.
What else should I do after treatment?
For several hours, you should not turn your head quickly or tilt your head far up (as if looking to the sky) or far back, such as when lying on your back, looking down at your shoes or picking something up from the floor. You can sleep that night in whatever position you choose. Starting the next day, you should continue your normal activity and move your head as normally as possible.
Can dizziness come back?
Since we do not know the exact cause of BPPV, it is also not possible to know how to prevent it. Unfortunately, medication has not been proven effective but rather can cause more harm than good. If your BPPV does return, you should contact your physical therapist. The crystals may be in a different place, so your treatment may be different than before. You should never try to put the crystals back on your own unless instructed by your healthcare provider. Remember, BPPV is treatable and the manoeuvres can greatly reduce your vertigo and other symptoms associated with BPPV.
It is likely that your neurologist will perform several tests, including:
- Electroencephalography (EEG), which records brain wave patterns
- Magnetic resonance imaging (MRI) of the brain
- Blood tests
What are the treatment options?
The most common treatment to prevent seizures is the daily use of medications. Nearly 70% of people with epilepsy can have good control of their seizures using medications. Most people whose seizures are controlled with drugs have few restrictions on their activities. Many medications are available. Some of them work better for one type of epilepsy than another. Talk to your neurologist about the choice of medication, how often it is taken and any side effects. Side effects may vary from one drug to another and from one person to another. Your neurologist will make sure that the prescribed drug is the best medication for you.
In some cases, medication does not work. Then surgery or vagus nerve stimulation may be an option. In vagus nerve stimulation, a device similar to a pacemaker is implanted under the skin in the chest. It reduces seizures by delivering electrical signals to the brain via the vagus nerve in the neck. Epilepsy surgery usually involves identifying and removing the seizure focus. It can be very effective and even curative for some people, even when medications have failed. It is not a 'last resort'. Talk to your neurologist about the best treatment for your seizures.
Living with epilepsy
Epilepsy is different for everyone. Some people have seizures that are easily controlled; their epilepsy doesn’t have much effect on their daily lives. Others may find that their seizures will have a bigger impact on their lives; it may affect the way they work, socialise or complete daily activities.
- Diet: Do not fast or skip meals. Eat solids.
- Rest: Adequate rest is essential.
- Exercise: is a must but do not overdo
- Stress: should be avoided
To help control your seizures:
- Take your medication as prescribed.
- Maintain regular sleep patterns.
- Avoid excessive alcohol use or use of illegal drugs.
- Work to reduce and manage stress.
- Talk to your neurologist about any changes in symptoms or new symptoms.
- Exercise to maintain your overall health.
Driving and safety
- Driving should be avoided.
- Talk to your neurologist about this issue and your overall safety.
- People with epilepsy also need to avoid sports or activities that could be hazardous if they were to lose consciousness or become unable to control their movements.
- Working at a height should also be avoided, along with swimming alone.
Women and epilepsy
- Women with epilepsy should talk to their neurologist before becoming pregnant.
- Most pregnancies in women with epilepsy have a happy outcome and a healthy baby.
- But both seizures and the drugs that treat seizures can be harmful to the developing baby.
- Women need to be under close medical care to make sure epilepsy is under the best control possible.
Partnering with your neurologist
- Inform the neurologist about all symptoms and medical history.
- In a diary, you record the dates, frequency and severity of your seizures.
Epileptic seizure first aid
When a person is having a seizure:
- Stay calm and remain with the person.
- If there is food or fluid in the mouth, roll him / her onto the side immediately.
- Keep the person safe and protect them from injury.
- Place something soft under their head and loosen any tight clothing.
- Do not restrain while having fits.
- Reassure the person until they recover.
- Time the seizure, if you can.
Functional Endoscopic Sinus Surgery (FESS)
What are sinuses?
Sinuses are air filled spaces in the bones of the face and skull. There are four pairs of sinuses:
- Maxillary sinuses in the cheek bones
- Ethmoid sinuses between the eye socket
- Frontal sinuses in the forehead and above the eyebrows
- Sphenoid sinuses deep in the head or back of the nose
What is FESS?
It is a procedure done to restore normal functioning of the sinuses, which have become swollen and clogged due to allergy and / or infection, etc. leading to sinusitis. This results in severe headache and heaviness. A thin instrument, an endoscope with a light, is inserted into the nose to enable the doctor to see different parts of the nose and sinuses and identify what is causing the blockages and remove them. The surgery is performed through the nostril and hence does not involve an external incision or cutting the bone. It is a day-care procedure.
Why is it done?
Surgery is the last option. In the initial stages, medication is tried. If the symptoms are long standing and affecting work, the doctor will ask for a CT scan to see all the sinuses. In some cases, a pre-operative nasal endoscopy may also be done and then a decision for surgery will be taken.
- Less painful
- No visible scars
- Less bleeding
- Less discomfort after surgery
- Needs less packing of the nose after surgery
- Faster recovery
Preparation for surgery
You will be advised to:
- Stop blood thinners at least 5-7 days prior to the surgery.
- Not take your diabetes medication on the morning of the surgery but medicines for thyroid dysfunction or hypertension can be taken with a sip of water
- Fast for at least 6-8 hours prior to surgery. Clear water, black tea or coffee are allowed up to two hours before the surgery.
These instructions may vary according to an individual's condition and extent of surgery.
Post operative instructions
- Nasal dressing is done after surgery and is removed after 1-2 days.
- There will be nose block after surgery, during this time the patient will breathe through the mouth.
- Nose blowing should be completely avoided for at least a week after surgery.
- Head should be elevated when lying down.
- Keep the nose free from dry crusting by using a saline spray 6-8 times a day.
- Avoid strenuous activity for at least one week.
- It is safer not to fly for at least 2 weeks after surgery.
- Do not smoke.
- Drink plenty of water.
- You would require regular follow-ups as advised by your doctor for a clean-up or nasal toilet of your nose. This is done in the OPD.
Risks and complications though rare may include but are not limited to:
- Bleeding: during surgery and anytime in the first few weeks of surgery
- Eye injury: bruising around the eye, double vision or partial or permanent loss of vision
- Brain injury: cerebro spinal fluid leak, meningitis or brain abscess
- Tear duct injury
- Infection of nose and sinuses
- Altered taste and smell that may be permanent depending on the severity of disease.
- Scar tissue may grow inside the nose, preventing sinus drainage and needing surgery.
- Hole in the nasal septum needing another surgery
- Recurrence of symptoms
Deafness and cochlear implant
Deafness is defined as complete loss of hearing, while hearing impairment is defined as partial loss of hearing in one or both ears. It may occur at any age from birth onwards. Deafness may lead to speech impairment. Deafness occurs due a variety of reasons such as newborn and childhood illnesses, age related deafness, exposure to drugs, toxins or loud noise or from inherited disorders.
Contemporary technology has revolutionised diagnosis and treatment of hearing loss, especially with modern treatment modalities such as cochlear implants.
A dynamic specialist team led by reputed ENT specialists has made Columbia Asia Hospitals the destination of choice for parents keen to get cochlear implants for their hearing impaired children.
Columbia Asia Hospitals have state-of-the-art technology, with an expert team of specialists who are not only highly skilled and well-trained but follow international protocols and practice evidence-based medicine. We also work closely with paediatricians and professionals working with specially abled children.
The services from evaluation to proper selection of the treatment modality (cochlear implant) are done in an atmosphere of empathy and understanding.
Anatomy of the ear
Ear is the organ which aids hearing and balance. The outer ear collects the sound and amplifies it through the middle ear. The inner ear is hollow and is filled with fluid and is lined by a sensory epithelium studded with microscopic hair cells, which are mechano receptors. These receptors release a chemical neuro transmitter when stimulated. In this way the sound is transformed into nerve impulses.
Causes of hearing loss
Hearing loss may be partial or total and may occur due to:
- Babies born after a high-risk pregnancy
- Babies in neonatal ICU at birth for low oxygen, jaundice, infections etc.
- Babies conceived in a consanguineous marriage
- Exposure to noise of high intensity
- Chronic ailments like diabetes, hypertension heart disease etc.
- Illness like measles, meningitis, mumps, etc.
- Otitis media, especially in children
- Foetal alcohol syndrome
- Neurological disorders
- Some medicines
At Columbia Asia Hospital, we mandatorily screen all newborns for deafness and educate parents for follow-up if there are any concerns about hearing or speech.
- Immunisation of the mother against rubella to reduce congenital infections
- Immunisation of baby against H. influenzae and S. pneumonia to reduce cases of otitis media
- Avoiding or protection against loud noise exposure
A cochlear implant is an electronic medical device that provides sound perception through direct electrical stimulation of the hearing nerve, bypassing the inner ear- the most common culprit of hearing loss.
A cochlear implant is comprised of two parts – an internal device and an external device. The internal device is surgically implanted under the skin and comprises of a receiver, a magnet and a bundle of fine wires, the electrode array. The external device includes the sound processor, a cable and a microphone-all housed in an earpiece. The sound processor analyses incoming sounds from the microphone and converts those sounds into patterns of electrical current. The current is carried along the cable and delivered across the skin by radio wave transmission to a receiver implanted under the skin. The receiver carries the current to an electrode array, which has been implanted into the cochlea, the portion of the inner ear that contains hearing nerve fibres. The current stimulates fibres of the auditory nerve results in the perception of sound.
The ENT surgeon trained in cochlear implants first places a receiver under the skin behind the ear through a small incision. The receiver is connected to the electrodes, which is put into the cochlea in the inner ear. This is a day-care procedure. After 2 weeks, a microphone is placed behind the ear and is connected to the processor.
Cochlear implants can help patients with severe to profound sensori-neural hearing loss in both ears that cannot benefit adequately from the use of hearing aids. People of all ages can qualify. The ideal candidate has hearing loss of short duration.Children born with deafness, an early implantation is preferred so that they may experience speech sounds in time to begin learning language, before the age of 2-3.
Advantages of a cochlear implant
- May be able to hear speech at near normal levels
- May be able to understand speech without lip reading
- Easier to converse on phones
- Better control over own voice to communicate with others
Cochlear implant surgery is relatively safe. Possible complications include:
- Bleeding, infections and reaction to medication as occurs with any surgery
- A nerve injury that changes sense of taste
- Facial nerve damage
- Ringing in the ears
- Failure of the device or infected device
- Meningitis in rare cases
Why Columbia Asia
- The hospital has highly skilled and experienced ENT consultants and audiologists to diagnose and treat deafness.
- Contemporary infrastructure with state-of-the-art audiology facilities
- Excellent follow-up services
Cochlear Implant In Adults
Hearing aids can improve the communicative abilities of most individuals with hearing loss.
Amplification of sound is added in individuals with more severe hearing loss to improve the individual’s word discrimination and speech understanding abilities.
Impact of hearing loss
- Impairs communication at home, work or in social settings
- Reduces the quality of life
- Leads to depression, social isolation and anxiety
When hearing deficits progress beyond the ability of hearing aids to produce meaningful benefit, a cochlear implant (CI) provides an alternative hearing rehabilitative modality by stimulating the auditory nerve and nervous system directly.
A cochlear implantation typically entails a two-hour outpatient surgery and activation of the cochlear implant occurs four weeks after the surgery. During surgery, the receiver-stimulator device and electrode array is inserted into the basal turn of the cochlea.
After implant activation, sound is detected by the external processor, transmitted wirelessly to the implanted receiver-stimulator device and then converted to synchronised electrical impulses which are delivered through the electrode array to the spiral ganglion (hearing) nerve. Sound is therefore transmitted to the hearing nerve bypassing the impaired cochlea. Patients receiving cochlear implants typically require 6–12 months of experience and practice with the cochlear implant before optimal hearing and speech understanding results are achieved.
Candidacy for cochlear implant
- Moderate to profound sensorineural hearing loss in both ears
- Should have a functioning auditory nerve
- No physical contraindications for placement of implant
- Medical clearance for surgery
- Should have tried hearing aids and got almost no improvement in hearing
- Anyone who can hear well with hearing aids is not a good candidate for cochlear implants.
Evaluation for eligibility for cochlear implant
- Medical evaluation
- Hearing test
- Hearing aid evaluation
- Tests of speech understanding with appropriate hearing aids
- General communication assessment
- Balance assessment
- MRI or CT scan
- Psychology consultation