What is dysphonia?
Dysphonia or hoarseness is a change in the sound of your normal voice.
What causes a hoarse voice?
A hoarse voice is most commonly due to laryngitis, which is irritation or inflammation of your voice box or larynx.
Most cases of laryngitis are temporary and occur as part of a viral infection.
Chronic laryngitis is laryngitis that persists beyond 3 weeks. Common causes of chronic laryngitis are misuse or overuse of your voice, exposure to irritants such as smoking and alcohol and reflux disease.
Chronic laryngitis and persistent hoarseness can sometimes be due to more serious pathology such as throat cancer.
What is the management of a hoarse voice?
Your Westside ENT surgeon will carry out a comprehensive assessment including a nasendoscopy or examination of your throat and larynx with a flexible endoscope.
This allows us to diagnose the cause of your voice problem and recommend the best treatment for you.
In some cases, it may be necessary to undergo further tests such as a CT scan or examine your larynx under anaesthesia to take a biopsy.
At WestsideENT we also work closely with speech and language pathologists should voice therapy be recommended as part of your treatment.
What is dysphagia or difficulty swallowing?
Dysphagia or difficulty swallowing means that you have difficulty getting food or fluids from your mouth to your stomach.
Swallowing is a very complex process so swallowing problems are relatively common.
They can occur at any age but are more common in older people due to loss of coordination of the complex sequence of events involved in swallowing.
What causes swallowing problems?
Most swallowing problems are temporary and related to eating too fast or not chewing your food well enough.
Persistent dysphagia or difficulty swallowing may be due to a more serious medical condition such as throat cancer, especially if it is associated with other symptoms such as weight loss, voice change or a neck lump.
How are swallowing problems managed?
WestsideENT surgeons are experts in the assessment of head and neck conditions such as dysphagia.
Your surgeon will carry out a comprehensive assessment including a nasendoscopy or examination of your throat with a flexible endoscope.
Arrangements will also be made for you to have any tests necessary such as a barium swallow, scans or an endoscopy.
Your WestsideENT surgeon will then discuss the results with you and formulate a treatment plan. This may include liaising with other medical specialists such as gastroenterologists as well as speech and language pathologists and dietitians to help manage your swallow problem.
What causes a sore throat?
The most common cause of a sore throat or pharyngitis is a viral infection associated with a cold or flu. Viral pharyngitis does not respond to antibiotics but it rarely causes complications.
Tonsillitis is another common cause of a sore throat and may occur repeatedly.
A sore throat can also occur due to dryness of the lining of the throat secondary to air conditioning or mouth breathing.
Other common causes of a sore throat include allergy, irritation of the throat due to acid reflux and exposure to environmental irritants such as cigarette smoke, alcohol and air pollution.
A persistent sore throat can also be due to more serious medical conditions such as throat cancer.
What is the treatment of a sore throat?
Our surgeons at WestsideENT are experts in the assessment of head and neck conditions such as a persistent sore throat.
Your surgeon will carry out a comprehensive assessment which may include a nasendoscopy or examination of your throat with a flexible endoscope.
Arrangements will also be made for you to have any tests necessary such as a barium swallow, scans, an endoscopy or a biopsy if indicated.
Your WestsideENT surgeon will then discuss the results with you and formulate a treatment plan.
What are the tonsils?
Tonsils are made up of lymphoid tissue and form part of the immune system. They sample things we eat and breathe such as viruses and bacteria and mount a defense or immune response to prevent or fight infection.
What causes tonsillitis?
Most cases of tonsillitis are caused by a viral infection but bacterial infections also occur. The most common bacterial infection is a streptococcal infection. It can be difficult to tell if the infection is viral or bacterial.
People with tonsillitis commonly have a sore throat, pain with swallowing, fever, red or swollen tonsils with a yellow or white coating and tender, enlarged lymph nodes or glands in the neck.
Tonsils can also cause other problems such as tonsil stones, airway obstruction and infection of the surrounding tissues or quinsy.
Recurrent tonsillitis in adult life can significantly impact your quality of life and work.
How is tonsillitis managed?
Surgery to remove your tonsils or tonsillectomy may be indicated if you have frequent episodes of tonsillitis, chronic tonsillitis, airway obstruction due to enlarged tonsils or if you have had a complication of tonsillitis such as a quinsy.
If you are troubled by problems with your tonsils, your WestsideENT surgeon can talk with you about your personal circumstances and the risks and benefits of tonsillectomy to help you make a decision about how best to manage your condition.
What is Sleep Disordered Breathing?
Sleep disordered breathing (SDB) is a general term encompassing several chronic conditions in which partial or complete cessation of breathing occurs many times during the night. It includes snoring and obstructive sleep apnoea.
Snoring is the harsh noise that occurs when tissues in the upper airway vibrate as you breathe.
Most people snore occasionally but for some people snoring is a chronic problem which can have a significant impact on the quality of life of their partner or other family members.
Snoring can occur in isolation, known as primary snoring but it is more commonly associated with obstructive sleep apnoea (OSA).
Obstructive sleep apnoea (OSA) is the cessation of airflow due to collapse of the upper airway. There is loud snoring followed by periods of silence when breathing stops. You then wake up, usually with a loud gasping noise.
This pattern repeats throughout the night resulting in poor quality sleep, restless sleep, waking up in the morning feeling tired and unrefreshed, feeling excessively tired during the day and having difficulty concentrating.
OSA also has other long-term health consequences including increased risk of heart disease, diabetes, stroke and an accident at work or in the car.
What causes Sleep Disordered Breathing?
The causes of sleep disordered breathing are complex.
There is usually a combination of multiple factors underlying SDB. These include increased weight, sleep position, alcohol intake, poor tone of the muscles of the throat, body and neck shape, anatomic factors such as large tonsils and nasal blockage and genetic factors.
What is the management of SDB?
The management of SDB is complex and variable.
Lifestyle changes such as weight loss, avoidance of alcohol before bed, avoidance of sleeping on your back and nasal decongestants are important management strategies.
Oral splints or mandibular advancement splints which advance the position of your jaw and tongue to keep your airway open may be helpful.
Continuous positive airway pressure or CPAP therapy is the most reliable and effective treatment for SDB. This involves wearing a mask over your nose or mouth while asleep. The mask blows air down your airway to keep it open and eliminates snoring by stopping the throat tissues from vibrating.
In selected cases, upper airway surgery can be beneficial especially if there are anatomic abnormalities such as large tonsils or a blocked nose which can be corrected.
At WestsideENT, we work closely with our sleep physician colleagues to jointly manage patients with snoring and OSA.
Your WestsideENT specialist will carry out a comprehensive assessment which includes a fibreoptic examination of your upper airways.
Arrangements will also be made for you to have a sleep study or polysomnography if indicated.
We will discuss our examination findings and the results of the sleep study with you and determine an individual management plan for you in consultation with our sleep physician colleagues.
What are the salivary glands?
There are 3 pairs of major salivary glands, the parotid glands in front of the ears, the submandibular glands under the jaw and the sublingual glands under the tongue. Each major salivary gland has a duct that transfers saliva to the mouth.
There are also numerous minor salivary glands scattered throughout the lips, cheeks, mouth and throat.
The salivary glands produce saliva which helps digestion, keeps you mouth moist and helps maintain healthy teeth.
What conditions can affect the salivary glands?
A variety of conditions can affect the salivary glands.
Sialadenitis is inflammation of the salivary gland. It usually occurs due to an infection of the salivary gland or because the gland becomes obstructed, blocking saliva flow into the mouth. Obstruction can also then result in a bacterial infection of the gland. Sialadenitis causes fever and pain, swelling and tenderness of the salivary gland.
Salivary gland obstruction occurs due to blockage of the duct carrying saliva from the gland to the mouth. It is most commonly caused by salivary stones or calculi. The majority of stones develop in the submandibular gland duct, followed by the parotid duct. Gland obstruction can also occur due to narrowing of the salivary duct or autoimmune conditions such as Sjogren’s syndrome.
Tumours can also occur within the salivary glands. Most salivary gland tumours are benign and occur in the parotid gland. Malignant tumours or cancer of the salivary gland can occur. Patients with a history of facial skin cancer can also develop cancer in lymph nodes within the parotid gland or neck.
What is the management of Salivary Gland Disease?
Management depends on the underlying problem.
Non-surgical treatment measures may be appropriate in some cases. These measures involve keeping well hydrated, massaging the gland to express saliva and sucking sour sweets or citrus fruit to stimulate saliva flow and flush out the gland.
Sialendoscopy is the endoscopic management of salivary gland disease secondary to gland obstruction caused by stones or duct narrowing. A very small camera or micro-endoscope is inserted into the natural opening of the salivary gland duct where it enters the mouth. Small instruments are then inserted through the micro-endoscope to remove stones or dilate areas of duct narrowing. The gland can also be washed out with saline to remove debris in the duct. The aim of endoscopic treatment is to improve your symptoms without having to remove the entire gland.
Tumours of the salivary glands require surgery. Radiation treatment after surgery may also be recommended if the tumour is malignant.
Your WestsideENT specialist is an expert in the management of conditions affecting the salivary glands. This includes sialendoscopy as well as conventional surgery.
Following a comprehensive assessment, your specialist will arrange for you to have any necessary investigations. These may include blood tests, scans or a needle biopsy. Your specialist will then discuss the results with you and develop a plan to manage your condition.
What is the thyroid gland?
The thyroid gland is a bow tie shaped gland that is usually found below the Adam’s apple and in front of the trachea or windpipe. The thyroid gland produces thyroid hormone, which is essential in the regulation of metabolic processes within the body.
What are the parathyroid glands?
Most people have four parathyroid glands that are located in the neck immediately behind the thyroid gland. The parathyroid glands control the level of calcium in the blood by secreting parathyroid hormone.
What is a thyroid nodule?
Thyroid nodules are solid or fluid filled lumps that form within the thyroid gland.
How common are thyroid nodules and what are the symptoms?
Thyroid nodules are extremely common. Some nodules can be felt within the neck however it is very common for thyroid nodules to be found incidentally during scans of the neck for other reasons. Around 50% of people will have a thyroid nodule that can be detected through either scans or examination by the age of 60. More than 90% of thyroid nodules are benign or non-cancerous. The majority of thyroid nodules do not cause any symptoms at all. Rarely, depending on the size and location of thyroid nodules, patients can develop voice change, pain in the neck region or swallowing difficulties.
How are thyroid nodules investigated?
Before you are referred to a specialist your GP will usually refer you for blood tests to check the function of your thyroid gland and an ultrasound scan of your neck. A thyroid ultrasound scan is an essential step in the investigation of any thyroid nodule. The scan will show the number and size of any nodules present, whether the nodule is a solid nodule or a cyst and if the nodule has any suspicious features. Nodules that appear suspicious on the ultrasound scan may require further investigation with a needle biopsy.
What is the treatment for thyroid nodules?
The treatment of thyroid nodules is largely dependent on the results of the ultrasound scan, the needle biopsy and whether or not they are causing any symptoms for the patient. During your consultation, your specialist will discuss with you the results of all of your tests and investigations and determine the most appropriate treatment plan. At WestsideENT we work closely with endocrinologists and your GP to provide comprehensive care for all patients with thyroid problems.
What is a goitre?
An enlarged thyroid gland is commonly referred to as a goitre.
What causes a goitre?
Historically, iodine deficiency was the most common cause for a goitre and in certain parts of the world this is still the case today. Goitres are more common in females and become more frequent with increasing age. Women often develop thyroid enlargement during pregnancy and menopause.
Multiple nodules within the thyroid gland can lead to substantial enlargement of the thyroid gland. This is known as a multinodular goitre.
Other causes of goitre include Grave’s disease and Hashimoto’s thyroiditis. Grave’s disease frequently results in an enlarged and very overactive gland. Hashimoto’s thyroiditis is an autoimmune disease where there is gradual damage and destruction caused by the patient’s own immune system. This ultimately results in an underactive and often enlarged gland.
How is a goitre diagnosed?
A goitre is commonly found during routine examination by the patient’s doctor. Enlargement of the thyroid gland is usually an indication of an abnormality of the gland and requires further investigation. These investigations may include blood tests, an ultrasound scan of the neck, a needle biopsy of any suspicious nodules or a CT scan to check the size and position of the gland.
What is the treatment of a goitre?
The treatment of a goitre depends on the underlying cause, the results of any investigations and whether or not the goitre is causing symptoms due its size. During your consultation, your specialist will discuss with you the results of all your tests and investigations and determine the most appropriate treatment plan. At WestsideENT we work closely with endocrinologists and your GP to provide comprehensive care for all patients with thyroid problems.
What are the main types of thyroid cancer?
Thyroid cancer is rare, however it is increasing in frequency. Papillary thyroid cancer and Follicular thyroid cancer account for more than 90% of thyroid cancer cases. They are commonly referred to as differentiated thyroid cancer (DTC). This is because the cells of these cancers have similar features to normal thyroid cells. Other, infrequently encountered, types of thyroid cancer include Medullary cancer and Anaplastic thyroid cancer.
What causes thyroid cancer?
The exact cause of thyroid cancer is unknown although several risk factors are known to increase the risk of developing thyroid cancer. The most important risk factors are previous radiation exposure to the head and neck region and a family history of thyroid cancer. Having these risk factors does not mean that you will develop thyroid cancer. Most people with thyroid cancer have no known risk factors.
What are the symptoms of thyroid cancer?
Frequently patients have no symptoms whatsoever and the cancerous nodule is detected during scans for an unrelated reason. While most nodules in the thyroid gland are non-cancerous it is very important to have these investigated. Sometimes patients can develop difficulty swallowing, shortness of breath or even voice changes such as hoarseness if the cancer causes pressure on important structures in the area.
How is thyroid cancer diagnosed?
A needle biopsy can diagnose or suggest the possibility of a thyroid cancer in a suspicious thyroid nodule. Occasionally the biopsy is unable to provide a definite answer and, in these circumstances, further tests may be indicated.
What is the treatment for thyroid cancer?
WestsideENT specialists provide comprehensive care for all patients with thyroid cancer. The treatment of thyroid cancer depends on the particular type of thyroid cancer as well as the stage of the cancer at the time of diagnosis.
Your WestsideENT specialist is a member of the Multidisciplinary (MDT) Thyroid Clinic. Coordinated care via the Thyroid MDT results in expert input from a number of highly trained specialists such as endocrinologists, nuclear medicine specialists and oncologists. MDT care streamlines management, improves patient outcomes and provides an opportunity for a second opinion.
Your WestsideENT specialist will discuss with you the results of all your tests and investigations and the recommendations of the Thyroid MDT Clinic to determine the most appropriate treatment plan for you.
What is Primary Hyperparathyroidism (PHPT)?
PHPT is a relatively common medical problem caused by overproduction of parathyroid hormone, by one or more of the parathyroid glands. This in turn leads to an increase in the level of calcium in the blood.
What are the symptoms of hyperparathyroidism?
The symptoms of hyperparathyroidism depend on the level of calcium within your blood. The higher the calcium level, the more likely you are to have symptoms. Frequently patients have no symptoms at all however common symptoms include feeling tired, indigestion, thirst and passing more urine than usual. Persistently high calcium levels in the blood can also lead to kidney stones and brittle bones.
How is hyperparathyroidism investigated?
PHPT is usually diagnosed on the basis of blood tests that show that both the calcium and parathyroid hormone levels are elevated. The most common cause of PHPT is a parathyroid adenoma. A parathyroid adenoma is a non-cancerous growth of the parathyroid gland that makes too much parathyroid hormone.
What is the treatment for hyperparathyroidism?
The treatment for primary hyperparathyroidism depends on a variety of factors. These include the calcium level in your blood, whether you have any symptoms, your age and bone density to name but a few. Depending on these factors, medical therapy or surgery may be indicated.
At WestsideENT we work closely with endocrinologists to determine the most appropriate treatment for each of our patients. The treatment options will be discussed with you in detail during your consultation.
What causes a neck lump?
Although neck lumps are relatively common, development of an unexplained lump in the neck can be worrying as most people are concerned that the lump is a cancer.
There are many different types of neck lump. They may be variations of normal anatomy, they may be benign or non-cancerous lumps and sometimes they are a malignant or cancerous lump.
How is a neck lump managed?
Our WestsideENT surgeons are experts in the assessment of head and neck conditions such as neck lumps.
Your surgeon will carry out a comprehensive assessment including a nasendoscopy or examination of your throat with a flexible endoscope.
Arrangements will also be made for you to have any tests necessary such as blood tests, scans or a biopsy.
Your WestsideENT surgeon will then discuss the diagnosis with you and formulate a treatment plan.
Some of the benign conditions we frequently see and manage include:
Painful nodules on the ear
Painful nodules of the ear are quite common. The medical term is chondrodermatitis nodularis which means inflammation of both the skin and underlying cartilage of the ear. They are most likely caused by pressure following minor trauma or cold injury.
It is a harmless condition which usually responds to conservative management, however it can be very painful and troublesome, especially at night time.
Rhinophyma is a skin condition where the oil glands or sebaceous glands in your nose become enlarged, resulting in a build-up of tissue on your nose.
The nose becomes red, swollen and bumpy and as the disease progresses, the affected skin becomes quite bulky, significantly altering the shape of the nose.
Rhinophyma most commonly affects men between the ages of 50 and 70.
The cause of rhinophyma is not fully understood but there is an association between rosacea, another skin condition that affects the nose, cheeks and forehead and the development of rhinophyma.
Keloid and Hypertrophic Scars
Any wound or injury involving the skin heals through the formation of a scar.
If the resulting scar is very raised and thickened it is called a hypertrophic scar. Hypertrophic scars do not extend beyond the border of the original wound and tend to stabilise after a period of time.
A keloid scar, on the other hand, is a scar where there is an overgrowth of dense scar tissue which extends beyond the borders of the original wound, often becoming much larger than the original wound. Keloid scars usually develop slowly, appearing months after the wound has healed.
In the head and neck region, keloids are most commonly associated with piercings, especially ear piercings.
Australia has the highest rate of skin cancer in the world.
Two out of three people will be diagnosed with a skin cancer by the time they are 70. Skin cancer develops primarily on areas of sun exposed skin such as the scalp, face, ears, and extremities. Excessive sun exposure causes damage to skin cells that can lead to cancer.
The three main types of skin cancer are:
- Basal Cell Carcinoma (BCC)
- Squamous Cell Carcinoma (SCC)
BCC is the most common type of skin cancer. The sun exposed areas of the head and neck are the most commonly involved sites. BCC’s tend to be slow growing. They can invade and destroy surrounding skin and other structures but BCC’s rarely spread to other parts of the body.
SCC is the second most common type of skin cancer. Excessive sun exposure is the most important risk factor. SCC’s invade local tissue and have the potential to spread to other parts of the body such as the lymph nodes or glands in the neck.
Melanoma can develop anywhere on your body but it is most common on the face and trunk in men and the lower legs in women. Some melanomas arise from pre-existing moles but most arise as new lesions. Melanoma can occur in skin that hasn’t been exposed to sun but excessive sun exposure, especially frequent episodes of sunburn, is a major risk factor in developing melanoma.
Most skin cancers are preventable if you follow these sun avoidance tips.
- Stay out of the sun during the middle of the day.
- Use a broad spectrum sunscreen and reapply every 2 hours or after swimming.
- Wear protective clothing such as a broad-brimmed hat and clothing that covers your arms and legs
- Check your skin regularly and have your GP regularly check your skin.
How is facial skin cancer diagnosed?
Diagnosis is primarily by visual inspection. Your GP will examine your skin to see whether skin changes may be due to skin cancer. A skin biopsy may be taken.
What is the treatment for facial skin cancer?
If your GP feels that you have facial skin cancer then you may be referred to a WestsideENT specialist for further management.
Your specialist will carry out a comprehensive assessment and arrange additional tests such as a CT or MRI scan, if indicated.
Treatment for skin cancer varies, depending on the size, type and location of the tumour.
The most common treatment for facial skin cancer is surgical excision of the lesion. Radiation therapy may be an option if the tumour can’t be completely removed with surgery.
If the cancer has spread to the lymph nodes or glands in the neck then surgery to remove the lymph nodes of the neck may be required. In this situation, post-operative radiation therapy may also be recommended.
At WestsideENT, we specialise in all aspects of facial skin cancer management, including local skin flaps for reconstruction and where indicated neck dissection for removal of involved lymph nodes.