The large variety of diseases affecting the ear, nose and throat calls for a suitably broad range of diagnostic and treatment methodologies, which we will present to you in more detail on the following pages.
Where surgery is necessary, our specialised surgeons and experienced anaesthetists are available along with modern technical equipment. Endoscopic and microscopic techniques, combined with the use of modern laser, are applied as a matter of course.
Children suffering from ENT diseases are always treated in the Paediatric Clinic, where they are cared for by paediatricians and ENT specialists.
Chronic otitis media with effusion
This refers to an accumulation of fluid in the middle ear that on average, around 80–90% of all children aged under eight experience at least once. From a paediatric-ENT prospective, removal of the adenoids combined with paracentesis on both sides is sensible as a first intervention. Initial insertion of tympanic drainage is used in cases of language acquisition disorders.
Inflammation of the palatine tonsils
The occurrence of inflammation of the palatine tonsils with fever is known as angina tonsillaris. The term chronic tonsillitis is used if these episodes occur several times each year. Symptoms include awkward speech, swallowing difficulties and an impaired sense of general well-being. Enlargement of the tonsils without these symptoms (tonsillar hyperplasia) usually occurs between the ages of two and seven. Another symptom is snoring, either with or without interrupted breathing.
In these cases, a removal of the adenoids (adenoidectomy), i.e. the tonsils (tonsillectomy) should take place after examination by an ENT specialist. If the severe snoring is caused merely by an enlargement of the tonsils, its size is only reduced by means of laser surgery. After the operation, the patients experience significantly less pain, and the risk of haemorrhaging is also considerably diminished.
Enlarged tonsils (polyps)
Enlarged tonsils (polyps) among infants and young children is completely normal and is due to elevated growth of the lymphatic tissue. Displacement of the nasopharynx produces the typical symptoms of obstructed nose breathing, mouth breathing, snoring, disturbed sleep, low appetite and a nasal voice. The otitis media with effusion can also lead to impaired heating and possibly delayed language acquisition.
Newborn hearing screening
All babies born at Städtisches Klinikum Görlitz are included in the hearing screening programme, so that parents are given clear information about their child's hearing capacity upon discharge. A probe is placed in the outer ear canal of the sleeping child during the first days of its life, which then offers the ear a gentle sound. The sound is approximately 50 dB loud. A normal conversation ranges around 65 dB. A healthy ear registers this sound and sends a second sound. If this sound is present, the cochlea is working properly and a green lamp lights up on the measuring device. The examination is completely painless, stress-free and only takes a few minutes.
The use of laser in the treatment of benign and malignant diseases in the airways and oesophagus means that transoral procedure – so without an external incision – can be used to remove certain malignant tumours. Patients do not have to undergo the otherwise necessary tracheotomy if this surgical method is applied. The microsurgical procedure reduces the need for blood transfusions to a minimum as well.
Chronic suppurative mucosa with tympanic membrane defect, upper/lower chain defect
Closure of the eardrum always takes place with endogenous material. Perichondrium (cartilage skin) or fascia (muscle skin) is used. A defect in the ossicle chain is usually due to an interruption in the incus-stapes joint caused by arrosion of the incus. In this case the incus is removed entirely and a titanium prosthesis is placed between the eardrum and the stapes to transmit sound. This operation can be performed under general anaesthetic or local anaesthetic. It can also be provided as an outpatient service in special cases.
Chronic suppurative otitis with tympanic membrane defect, upper/lower chain defect.
In suppurative otitis, the epithelium of the auditory canal grows into the air-filled areas of the middle ear. This is why complete removal of the spongy bone in the mastoid is often necessary. Complete removal of the entire spongy bone in the mastoid is often indicated as well. In most cases, transmission of sound is assured by implanting a specially adjusted titanium prosthesis.
Otosclerosis
In this form of hearing impairment, the stapes is stuck in place by an otosclerosis focus in the area of the footplate. The stapes is removed and a titanium prosthesis creates the connection between the incus and the inner ear. A laser is used to perforate the footplate. This contactless method is a very gentle surgical procedure.
Endoscopic endonasal paranasal sinus surgery
Human beings have four sinuses on each side; besides the maxillary sinus and the frontal sinus cavity, they are the ethmoid sinus and the sphenoid sinus. Each paranasal sinus has its own excretory ducts. If these ducts are too narrow, it may lead to the emergence of chronic inflammation of the paranasal sinuses. For instance a harmless common cold can make the duct even narrower or block it entirely. The mucous forming in the sinus can then no longer escape and remains trapped there. This is the ideal breeding ground for bacterial infections. Ultimately, this process of recurring inflammation of the sinuses becomes chronic.
As a rule, a computer tomography of the paranasal sinuses must be performed before every operation. The images reveal the extent of the infection and permit an assessment of the anatomic structures. This way, the surgery can be explained to the patient in an understandable form.
The procedure is performed under general anaesthetic using minimally invasive, endoscopic imaging technology. Patients do not usually require tamponade. During surgery, the affected narrow ducts are deliberately enlarged, which involves inserting an endoscope through the nose. From an anatomical perspective, the sinuses are located adjacent to the eye and the brain. Therefore, surgery on the paranasal sinuses should only be performed by extremely experienced ENT physicians. There would otherwise be a risk of complications affecting the eye, the skull base or the brain.
Hoarseness of the voice always occurs when the two vocal folds in the larynx are not positioned ideally next to each other when speaking and hence show impaired oscillation patterns. A distinction is made between functional and organic dysphonia. The former is diagnosed by a phoniatrist and then treated by a speech therapist. Depending on the underlying condition, a variety of surgical procedures are indicated for organic dysphonia, for instance lumps or polyps on the vocal fold can be removed by means of micro-laryngoscopy. Hoarseness caused by recurrent paresis (paralysis of the vocal cord) can be treated using thyroplasty. This surgical intervention is performed under local anaesthetic in order to review the improvement in vocal performance even during the operation.
During thyroplasty, a window in the thyroid cartilage is cut out via a small skin section and a titanium implant is inserted, to which the vocal fold is connected. This procedure is also suitable for patients with prior removal of a vocal cord by laser surgery for the treatment of malignant diseases. Vocal fold injection is a less invasive procedure. It involves injecting endogenous material (fat, fascia lata) or collagen, i.e. hyaluronic acid, into the M. vocalis. We use a wide variety of laser surgery methods to prepare an individual concept for the treatment of both-sided vocal cord paralysis that represents the best solution for the patient. Ultimately it is a question of obtaining more air to breathe, without reducing the performance of the voice. A tracheotomy is thankfully not necessary for most patients. In both cases – one and two-sided paralysis – initially temporary techniques are used, which are then permanent after 9 to 12 months. By proceeding this way, spontaneous recovery of the nerve and therefore its function are not impaired.
Snoring is the most frequent sleep disorder, and in most cases it is not the affected person who suffers most, but the other one sharing their bed. One of the causes of snoring is a relaxation of the upper airways level with the pharynx. The muscles keep the airways open in this region. These muscles relax during sleep. Snoring is produced by alternate flattering and constriction of the airway walls (tongue base, soft palate, pharynx).
Snoring is aggravated by taking sleeping medication, alcohol, large evening meals, obesity and a blocked nose.
Unlike snoring with just a few interruptions in breathing, which is not harmful at all, snoring that involves suspensions of breathing can be a life-threatening condition. If the breaks in breathing or the apnoea (lull in the air) exceed a certain number or extent, and the afflicted person suffers from daytime fatigue, poor concentration and morning headaches, it is reasonable to suspect that the nocturnal, interrupted breathing may indeed be the cause. Severe sleep apnoea can lead to serious complications like hypertension, cardiac arrhythmia, a greater risk of heart attacks or strokes and severe depression.
Many people afflicted with the condition do not even realise that they have sleep apnoea. This is why the first step is a thorough examination from the perspective of sleep medicine, which may end in the sleep lab. The correct treatment can then be selected based on the data acquired in these examinations. Our clinic primarily optimises nose breathing by surgical means. Palatoplasty can be performed using a laser to tighten the region. Alternatively, after removing the palatal tonsils, a special form of palatal-pharyngeal insert can be fitted, also using a laser. Another surgical treatment is to restrain the tongue base against the lower jaw.
ENT doctors cooperate with radiotherapists and oncologists on our Tumour Board to select the best and most gentle treatment pathway. Difficulty swallowing (dysphagia) is one of the most frequent initial symptoms of malignant tumours of the throat. Pain may radiate upward into the ear later on. A gradual swelling of the lymph nodes in the neck also accompany malignant tumours of the throat. If the tumours are still small, they are removed using a CO2 laser with microscope visualisation of the oral cavity.
The lymph nodes in the neck are usually dealt with in the same surgical procedure (neck dissection). In this process, the affected lymph nodes and the surrounding fatty tissue are removed, usually with preservation of the muscles, nerves and the large vessels. However, if the extent of the disease prevents a successful outcome of laser surgery, the relevant areas are removed by creating an external access. A variety of methods (local flaps, distant flaps, vascular pedicle flaps) are applied to individually reconstruct the food passageway.