Ear, Nose and Throat (Ent)

What Is Ear, Nose and Throat (ENT)? Diseases and Treatment Methods

The Ear, Nose and Throat (ENT) department is the branch of medicine that deals with the diagnosis, treatment, and follow-up of diseases related to the ear, nose, throat, and head and neck region.

The ear, nose, and throat, which are also upper respiratory tract organs, are anatomically connected structures that work together. Therefore, disorders in these areas can also be interconnected. The Ear, Nose and Throat Department does not only deal with hearing, taste, and throat problems. Since the balance center is also an important part of this system, balance problems also fall within the field of ENT specialization. At the same time, surgery of the head and neck region is also within the scope of ENT.

At the Ear, Nose and Throat Department of Daviva Health Group, we aim not only to treat complaints but also to improve our patients' quality of life. We are by your side with our expert team in vertigo, rhinoplasty, pediatric ENT problems, and head and neck surgery.

What Is ENT?

The ear, nose, and throat share a common mucous membrane. They are also directly connected through channels such as the Eustachian tube. This structure functions as a single system in breathing, immunity, and sound transmission. Ear, Nose and Throat doctors deal with all disorders in this system. They are closely involved in the diagnosis and treatment of conditions such as sinusitis, vertigo, tinnitus, and allergic rhinitis. Rhinoplasty, performed both for healthy breathing and for aesthetic concerns, can also be carried out by ENT doctors.

What Is ENT in Children (Pediatric ENT)?

Although the field of Pediatric ENT exists in some countries around the world, there is no pediatric ENT specialty in Turkey. In our country, ENT specialists still manage conditions such as enlarged adenoids and tonsils, tympanostomy tube placement, or childhood hearing loss, which are more commonly seen in children.

What Are ENT Diagnostic Methods?

• Otoscopy: Examination of the outer ear, ear canal, and eardrum using a device consisting of a light source and magnifying lens. It helps identify conditions such as outer or middle ear infections, eardrum perforations, benign cysts, and the presence of foreign bodies.
• Otomicrocopy: An advanced diagnostic method that uses a microscope to examine the ear. Compared with otoscopy, it allows a more detailed view of the eardrum and ear canal. In children, it is especially helpful in identifying fluid in the middle ear, which is often difficult to diagnose with otoscopy.
• Audiometry: A hearing test performed to determine whether hearing loss is present. It has types such as pure tone testing, bone conduction testing, speech testing, auditory brainstem response (ABR test), otoacoustic emissions, and tympanometry.
• Videonystagmography (VNG): This test may be performed when there is dizziness, tinnitus, or a feeling of pressure in the ears. It is a series of tests that measure eye movements. Some of the tests within VNG examine how well the brain controls and coordinates eye movements. Other tests examine how the brain works to control and position the eyes.
• Head Impulse Test (HIT): Performed to determine the cause of problems such as sudden dizziness and loss of balance. No equipment is needed for the bedside type. The patient is asked to focus on a fixed target, usually the ENT doctor's nose. Then the patient's head is moved quickly to both the right and left. These head movements should be high-speed, low-amplitude, and unexpected. During this time, the patient's eyes are observed for any unexpected eye movements.
• Video Head Impulse Test (vHIT): A version of the head impulse test performed with a video and camera system. In the video head impulse test, eye movements are recorded and analyzed by high-speed cameras. Head movements are measured by motion sensors placed in vHIT goggles.
• VEMP Test: A special, rapid, and non-invasive diagnostic test used to evaluate the function of the vestibular system, which plays an important role in maintaining balance. This test is based on the muscle response that occurs when certain parts of the inner ear are stimulated by sound or vibration.
• Rhinoscopy: Direct examination of the inside of the nasal cavities. This examination allows the front and back parts to be viewed respectively by inserting a nasal speculum through the nose or a mirror through the mouth.
• Nasal Endoscopy: Also known as endoscopic nasal examination, this examines the nose and sinus passages with an endoscope, a thin, flexible tube with a small camera and light at the tip.
• Acoustic Rhinometry: Allows a very fast and non-invasive examination of the nasal cavity using sound waves.
• Rhinomanometry: By measuring pressure and airflow in the nasal airways, it can provide information about nasal airway obstruction (nasal resistance). It can assess nasal patency. It can monitor treatment effects and outcomes. It can help determine the need for surgery.
• Laryngoscopy: The examination of the throat, larynx, and vocal cords. This procedure can be performed with a small mirror and light source, or with a thin illuminated instrument equipped with a camera.
• Nasopharyngoscopy: A method of examination used to visualize the back of the throat. It is performed by inserting an endoscope through the nose. It is especially used in children to determine if they sound as if they are speaking through the nose and to detect air leakage that can be heard through the nose.
• Sleep Apnea Test (Polysomnography): A test used to diagnose sleep disorders. In this test, also known as polysomnography, brain waves, blood oxygen level, heart rate, and breathing are recorded during sleep. Eye and leg movements are also measured.

In addition to these tests;

For masses located in the head and neck region, fine-needle aspiration biopsy, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound are also used.

What Diseases Are Treated in the Ear, Nose and Throat (ENT) Department?

• Outer Ear Canal Inflammation (External Otitis): Also known as swimmer's ear. It is an infection that occurs as a result of inflammation of the canal between the outer ear and the eardrum. Continuous contact of the outer ear canal with water is an important factor.
• Ear Fungus (Otomycosis): Fungal infection of the ear most commonly affects the ear canal. Fungi such as Aspergillus and Candida are responsible for this infection. It is seen more often when the weather is hot and humid. It is also more common in people involved in water sports.
• Earwax (Cerumen): Earwax, known as cerumen, actually helps protect the ear canal from water, infections, injuries, and foreign bodies. However, excessive buildup of earwax can lead to different problems.
• Auricular Cartilage Inflammation (Perichondritis): Inflammation of the cartilage of the ear due to causes such as injury, insect bites, or ear piercings made through the ear cartilage.
• Middle Ear Inflammation (Otitis Media): Infection of the middle ear due to various causes. It is more common in children than in adults. In many cases, middle ear infection may resolve on its own. Ear pain, high fever, and hearing loss due to fluid buildup in the middle ear are the most common symptoms.
• Otosclerosis (Stapes Bone Calcification): Abnormal bone growth in the middle or inner ear. It usually occurs when the stapes bone, which transmits sound, becomes fixed in place. When this bone cannot vibrate, sound cannot pass through the ear and hearing loss occurs.
• Tympanosclerosis (Eardrum Calcification): Calcium buildup may occur in the eardrum due to trauma or damage after surgery. This can cause the eardrum to lose its elasticity. It presents with symptoms such as hearing loss or muffled hearing, ear pain, and ear swelling.
• Perforated Eardrum: The eardrum is delicate and can perforate easily. The most common cause of eardrum perforation is, contrary to popular belief, middle ear infection. However, using cotton swabs and trauma can also cause eardrum perforation.
• Eustachian Tube Dysfunction: The Eustachian tube is an opening that connects the middle ear to the nose-sinus cavity. There is a valve in the Eustachian tube that opens and closes. If this valve does not open enough, fluid may build up in the ear. This can lead to ear pain and a feeling of pressure. If it is too open, it can cause a constant feeling of pressure and unusual sounds such as hearing your own breathing or your own voice very loudly.
• Age-Related Hearing Loss (Presbycusis): Gradual loss of hearing in both ears due to aging. Some people are not initially aware of this change. It often affects the ability to hear high-frequency sounds such as a telephone ringing.
• Sudden Hearing Loss: Also known as sudden sensorineural hearing loss, this hearing loss is caused by a problem in the hearing nerve. It usually occurs in only one ear. Symptoms such as dizziness and tinnitus may be experienced.
• Noise-Induced Hearing Loss: Develops as a result of loud noises damaging the hair cells in the inner ear that enable hearing. It can be permanent. Prolonged exposure to loud music, machine noise, or traumatic sounds such as explosions can cause noise-induced hearing loss. Difficulty hearing high-pitched sounds and understanding speech are among the most common symptoms.
• Meniere's Disease: A long-term, progressive disorder that affects the balance and hearing parts of the inner ear. Symptoms of Meniere's disease include sudden dizziness, tinnitus, increasing hearing loss, and a feeling of pressure in the ear.
• Displaced Ear Crystals: One of the most common causes of dizziness. Severe dizziness may occur when turning in bed or changing head position. If the crystals in the ear shift, nausea, vomiting, and loss of balance may also occur.
• Laryngitis: Inflammation of the vocal cords, usually due to overuse, irritation, or infection. Cough, throat-clearing, hoarseness, and a burning sensation in the throat are among the symptoms of laryngitis. Medications used according to the cause are effective in the treatment of laryngitis.
• Tinnitus: A condition perceived as noise or ringing in the ears despite the absence of a physical sound. Tinnitus is not a disease but a symptom of an underlying condition. Tinnitus can occur as a result of natural degeneration, exposure to loud noises, trauma, ear infections, or side effects of medications.
• Pharyngitis: Inflammation of the mucous membrane lining the back of the throat. Sore throat is the most common symptom of pharyngitis. Difficulty swallowing, hoarseness, and cough are among the symptoms of pharyngitis.
• Acoustic Neuroma: An acoustic neuroma is a benign (non-cancerous) tumor. These tumors grow on the vestibular nerve, which connects the inner ear to the brain. Symptoms of acoustic neuroma may not be noticed immediately. Hearing loss or ringing in one ear, dizziness or balance problems, and facial numbness are the most common symptoms of acoustic neuroma.
• Vocal Cord Nodules: Benign vocal cord lesions are non-cancerous growths that can occur on one or both vocal cords. Many vocal cord nodules are caused by improper use of the vocal cords. Treatments include voice therapy and surgery.
• Sleep Apnea and Snoring: The sleep disorder that occurs when regular breathing is interrupted during sleep is known as sleep apnea. Snoring is common in patients with sleep apnea, but not everyone who snores has sleep apnea. Changing sleep habits, use of a device known as CPAP that improves breathing during sleep, oral appliances, and surgical options are among the treatments for sleep apnea.
• Vertigo: Commonly known as dizziness. However, vertigo and dizziness do not describe the same condition. Dizziness can be described as a feeling of imbalance and faintness. Vertigo, on the other hand, is the sensation that you or the things around you are spinning. Vertigo attacks may also involve symptoms such as nausea, vomiting, and sweating. The most common cause of vertigo is displacement of the crystals in the balance center of the inner ear. However, it can also result from different causes such as Meniere's disease. Vertigo treatment varies depending on the cause.
• Dysphagia (Difficulty and Disorders of Swallowing): During swallowing, many muscles and nerves work together. When there is a problem in the muscles and nerves involved in swallowing, coughing or a feeling of choking may occur during swallowing. Difficulty swallowing can be a symptom of serious conditions such as stroke. If left untreated, food and liquids may enter the airway. This can lead to much more serious problems.
• Salivary Gland Stones: Calcium crystals in saliva can harden into stones in the salivary glands or ducts. When salivary gland stones block the salivary ducts, they cause painful swelling. Although they are seen more often in the salivary gland under the jaw, they are rarely seen in the salivary gland in front of the ear and under the tongue. Treatment of salivary gland stones, which are more common in adults than in children, is endoscopic or surgical treatment.
• Sinusitis: Inflammation of the cavities in the skull called sinuses, located behind the eyes, nose, forehead, and cheeks. Runny nose, nasal congestion, changes in the sense of smell, and facial pain or a feeling of pressure in the face are among the symptoms of sinusitis. These symptoms may worsen when bending forward or may radiate to the teeth. In the treatment of sinusitis, pain relievers, saline solution, steroid nasal sprays, or decongestant medications may be used. Surgical options should also be considered in cases of chronic sinusitis.
• Laryngeal Cancer: Laryngeal cancer, which presents with symptoms such as persistent sore throat, hoarseness, difficulty swallowing, a feeling of something stuck in the throat, and swelling in the neck or throat, is closely associated with smoking. Especially in early-stage laryngeal cancer, the first step of treatment is surgery. Depending on the stage of laryngeal cancer, part or all of the vocal cords may be removed. Radiotherapy, chemotherapy, and immunotherapies are also used in the treatment of laryngeal cancer.
• Oral Cavity and Tongue Cancers: Cancers seen in the front part of the tongue, the roof or floor of the mouth, gums, lips, and cheeks fall into this group. Red or white patches that may appear on the tongue or gums, mouth sores that do not heal, unusual bleeding in the mouth, pain that does not go away while chewing or speaking, and difficulty moving the tongue and jaw are among the symptoms of oral cavity and tongue cancers. In most oral cavity and tongue cancers, the patient first undergoes surgery, followed by radiotherapy and chemotherapy depending on the characteristics of the tumor.

What Are Common ENT Diseases in Children? (Pediatric ENT Diseases)

• Enlarged Adenoids: The adenoids are an important part of the immune system during early childhood. However, sometimes these lymphatic tissues can become a problem because they increase in size and cause a range of troublesome symptoms. Recurrent infections, allergic reactions, and chronic sinus inflammation are among the causes of enlarged adenoids. Enlargement of the adenoids in children can cause problems such as nasal congestion, sleep problems, speech problems, recurrent ear infections, and facial and dental development issues. In the treatment of enlarged adenoids, medications targeting the cause of the enlargement and surgical options are effective.

What Are the Risks of Adenoid Surgery?

Enlarged adenoids are operated on through the mouth. In adenoid surgery, the ENT specialist may use special instruments that cut or apply heat or radiofrequency energy.

The risks of adenoid surgery can be listed as follows.

• As with any surgery, there are risks associated with the use of anesthesia during adenoid surgery.
• Bleeding in the throat may occur after adenoid surgery.
• Damage to the teeth may occur.
• Infection may develop in the area where adenoid surgery is performed.
• Difficulty breathing may occur due to swelling in the throat.
• There may be changes in voice tone. However, this problem usually resolves on its own within a few weeks.
• The adenoids may grow again. However, this is very rare.
• Fluid Build-Up in the Middle Ear: In children, fluid buildup in the middle ear may result from causes such as the common cold, ear infection, daily nasal congestion, or dysfunction of the Eustachian tube. Fluid in the ear is not related to water entering the ear after swimming or bathing. Symptoms of fluid buildup in the middle ear include hearing problems such as children turning up the television volume very high, speech delay, and balance problems. The first step in treating fluid buildup in the middle ear is medication. However, in children who do not respond to medication, a ventilation tube may be placed in the eardrum.
• Ear Tube Surgery: Ear tubes are tiny tubes made of metal or plastic. During ear tube surgery, a small hole is made in the eardrum and the tubes are placed. The ear tube helps keep air pressure between the middle ear and the outside balanced and helps drain fluid that has collected behind the eardrum. Most children do not later need surgery to remove the ear tube. Ear tubes usually fall out on their own as the eardrum heals.
• Tonsillitis: Tonsils are lymph nodes located at the back of the throat. Tonsillitis is one of the most common throat infections in children. It usually occurs after a viral or bacterial infection that causes sore throat, difficulty swallowing, and fever. Treatment of tonsillitis in children depends on the cause of the infection and the severity of the symptoms. In most cases, the infection is mild and can improve with effective home remedies. However, in some cases antibiotics or additional treatment may be needed. Tonsil surgery should be considered for recurrent tonsillitis that does not improve despite treatment and makes swallowing and breathing difficult.
• Allergic Rhinitis (Hay Fever): Allergic rhinitis, also known as hay fever, can affect people of all ages. However, children are more affected by allergic rhinitis than adults. It is an allergic reaction that occurs inside the nose and can also affect the eyes, sinuses, and throat. Seasonal hay fever is mostly seen in spring and summer. It affects people who are allergic to pollens from trees, plants, flowers, weeds, and grasses. Hay fever cannot be cured, but to relieve your child's symptoms, you can avoid allergens, use saline nasal spray, and oral antihistamines.

What Are the Treatments for Tinnitus?

• Various therapies can be used to reduce the impact caused by tinnitus.
• Masking therapies that use small electronic devices to make tinnitus less noticeable.
• Retraining therapy that combines counseling and sound masking to retrain the brain to perceive the sound as unimportant
• Speech therapy
• Hearing aids may be used if tinnitus is accompanied by hearing loss.
• Stress-reducing activities such as regular exercise, yoga, and meditation may reduce the severity of symptoms.
• Antidepressants or anti-anxiety medications may be used to reduce the distress caused by tinnitus.