Our Services

Glue Ear (Otitis Media)

Glue ear occurs when the middle ear is unable to drain properly and it fills up with fluid. Over time this fluid thickens to form a glue-like consistency. If this glue persists it can cause hearing loss. Over time, this hearing loss can lead to problems with speech and language development or recurrent infections.

Young children with glue in their middle ears can present with frustration, irritability and delayed speech development. It can also affect balance and walking.

Unfortunately there are no medicines that are proven to fix this problem. If a child has persistent fluid in the ears for 3 or more months or is exhibiting speech delay it can be useful to obtain a hearing test and an opinion from an ENT specialist.

Grommets

These are small plastic tubes that help ventilate the part of the ear under the eardrum (middle ear). They are sometimes placed for children or adults with recurrent ear infections, hearing loss or both. Young children have under-developed middle ear drainage tubes (Eustachian tubes) which occasionally get blocked and lead to fluid build up with subsequent pain, infection or hearing loss.

The condition is less common in adults but can occasionally occur. In those kids with a blocked or snotty nose in conjunction with blocked ears, adenoidectomy is sometimes performed at the same time as grommet insertion. A hearing test is needed prior to tube placement to help ascertain if there is any hearing loss. Tubes are placed in the ear drums under general anaesthetic using a microscope. The procedure is quick and relatively pain-free and can be done as a day procedure. Most patients are "back to normal" in a day or two.

While grommets can let fluid drain out and air in, water can also occasionally cause concern in those with grommets.

Snoring and OSA

Simple snoring is common amongst both children and adults but it is important to recognise that it can sometimes be harmful.

Snoring occurs when the tissues at the back of the throat become relaxed during sleep and collapse on inspiration. The air flowing through the narrow throat passage makes the tissues vibrate and the breathing becomes audible. Sometimes it can be very loud.

Occasionally the airway completely blocks when the child inspires, causing them to pause in their breathing and wake momentarily. This frequent waking occurs to protect the child from significant drops in oxygen. This condition is called obstructive sleep apnoea (OSA), and can occur many times during the night.

If your child suffers from OSA they may not be having any restful sleep and this can have a negative effect on their energy levels, their concentration and their ability to learn.

What can be done about Obstructive sleep anoea?

There is a large body of evidence that supports removing obstructive tissue from the throat (tonsils) and the back of the nose (adenoids) in children with obstructive sleep apnoea. Of course, not all children who snore require surgery and it is important that parents observe their children closely (and even make video recordings) before making an appointment to see a surgeon.

With a thorough history and comprehensive examination, an ENT surgeon can assess the benefits of surgery and discuss the options and the risks to the parents so they can make an informed decision.

Sleep studies will occasionally be used to assess the severity of obstructive sleep apnoea, though this investigation is usually reserved for children with more complex medical issues.

Adenoids

These are glands that live at the back of the nose and are usually present between early childhood and adolescence. They are probably a useful part of the immune system in early infancy but there is no evidence they possess any useful immunological role beyond that time.

If they become too large or infected, adenoids can be quite a burden – leading to nasal obstruction, nasal discharge and snoring. Infected adenoids are a common cause of recurrent childhood sinusitis and post-nasal drip. Longstanding nasal obstruction due to enlarge adenoids can also effect growth of the upper teeth and lead to orthodontic issues.

Adenoidectomy

This may be done on its own, or combined with tonsillectomy, grommets or other nasal surgery. If the enlarged adenoids block the openings to the drainage tubes from the ears (Eustachian tubes), ear infections and hearing loss can sometimes happen (see grommets above). Adenoidectomy is performed with a small curette (through the mouth) or with a precision electrocautery device. Recovery is usually a day or so and the procedure is usually done as a day procedure.

Tonsillectomy

This common operation is performed for kids or adults who suffer many bouts of tonsillitis or in those where the tonsils get so large they block the throat and cause difficulty with eating, breathing and sleeping. Tonsillectomy used to be done very routinely but we are more selective nowadays, and take many different factors in the history and examination into account before recommending surgery. Most tonsillectomies are done in little kids aged 3-7 and in young adults aged 16-20. Occasionally people over 30 or under 3 need tonsillectomy. The surgery is done using very precise instrumentation and is very safe. Blood loss is usually less than a routine blood test and local anaesthetic put in during surgery makes the recovery well tolerated. The team at ENT Victoria have performed well over 5,000 tonsillectomies.

Most kids and adults stay overnight after surgery but some fit and well adolescents do very well going home on the same day as the operation. Prior to planning any surgery the risks and the expected course of recovery will be explained to the patient and/or their parents.

Otoplasty

Some children are born with ears that protrude more than they would like and can be a significant source of source of unhappiness and teasing. Otoplasty refers to the surgical procedure involved in pinning back ears that stick out too far. This procedure is usually considered in children around the age of 5 and is generally well tolerated. The procedure is conducted under a full general anaesthetic and takes about 1 hour. The operation is performed from behind the ear and there are no visible scars. Bandages are worn over the ears for a day and then changed over to new ones to ensure proper healing. The ears will be a bit puffy for a few weeks and then return to a normal shape and position.

If you are concerned about the appearance of your child’s ears, ask your GP for a referral to see one of our ENT specialists. With the use of photos and diagrams our surgeons would be happy to explain the steps involved as well as the risks and benefits of the procedure.

Hearing loss is a common disability and can affect people of all ages. Hearing loss can either be sudden or progressive, single sided or bilateral, conductive or sensorineural (see below).

ENT Surgeons are the medical specialists who are best able to determine the most appropriate investigation and management for patients with hearing loss.

Conductive hearing loss occurs when sound waves are blocked from entering the inner ear – with problems like wax, ear drum damage, glue ear or injured hearing bones. Conductive hearing loss can be managed with office treatments, medicines or sometimes surgery.

Sensorineural hearing loss occurs when sound waves entering the inner ear are not translated properly into electrical impulses that travel to the brain. The commonest form of this type of deafness is age related symmetrical hearing loss. Damage to the hearing organ (cochlea), the hearing nerve or even the brain can interfere with one’s sensorineural hearing. After appropriate investigation, treatment usually includes hearing aids or occasionally other devices such as cochlear implants.

Sudden hearing loss is of particular importance as early treatment is vital in maximizing outcomes. If your hearing deteriorates over a very short period it is important to contact our offices for an urgent assessment.

Hearing Aids

The specialists at ENT Victoria are happy to provide advice for patients seeking hearing aids – and to treat the medical conditions that may be impacting their hearing. ENT Victoria has made a conscious decision not to sell hearing aids as our prime focus is on the medical and surgical management of hearing loss. For our patients seeking hearing aid assessment and advice we recommend Neurosensory – a company founded on the basis of integrity and quality, or Hear With Me Audiology Care who provides warm, personalised & honest hearing care to help you connect with loved ones.

Ear Infections

Ear infections are common in Australia as we love to spend time around water.

Outer ear canal infections are usually the result of water exposure in the setting of damaged or inflamed ear canals. Frequent cotton-bud use and swimming are common causes. Itch, discharge, blockage and pain can all occur. The best treatment is gentle cleaning by a qualified ENT surgeon and the right topical drops. Oral antibiotics are rarely useful. Occasionally ear canal wicks (mini-tampons) are needed to treat more aggressive canal infections.

Rarely ear canal infections can spread to adjacent bone in the canal and lead to severe infections. These are more common in diabetics and often need in-hospital management.

Middle ear infections are possibly the most common medical condition on Earth. They generally affect young children with poor drainage pathways and cause pain, fever, irritability and reduced hearing. Sometimes the infection can overwhelm the ear drum and lead to rupture with discharge. Oral antibiotics are often prescribed but the benefit of antibiotics is often minimal.

Occasionally some children can suffer many ear infections and require assessment for possible ventilation tube (grommet) placement.

Inner ear infections are uncommon and manifest as dizziness, ringing in the ears, hearing loss or a combination of all three. They are usually viral and generally settle spontaneously. Occasionally there is permanent hearing loss in the affected ear.

Ear Drum Perforation

Depending on the size and location of ear drum holes, they can cause hearing loss or be associated with ear discharge. Most ear drum perforations due to trauma will heal on their own but occasionally they need surgical correction. Sometimes ear drums perforate after infections or after sudden changes in pressure. Most ear drum surgery can be done down the ear canal itself or from behind the ear, using a patient's own tissues as a graft. Surgery is not very painful and can often be done as a day case. Successful healing occurs in 80-90% of cases.

Otosclerosis

An inherited cause of hearing loss, otosclerosis tends to cause gradual loss of hearing in the 20's and 30's and usually affects both ears. The condition causes a stiffening of the third hearing bone (stapes) and options for correction include surgery or a hearing aid. Surgery (Stapedectomy) involves removing the third hearing bone with a laser and then replacing it with a tiny metal prosthesis. It is done under a general anaesthetic and can sometimes be done as day surgery.

Cholesteatoma

These are benign skin growths that develop in the ear drum. They often present with recurrent ear infections, discharge, hearing loss and sometimes pain. Cholesteatomas take a long time to grow and are often associated with a long history of ear problems. They can occur in children or adults and require surgery to fix them. Some cholesteatoma surgery is performed in multiple stages, depending on the location and extent of the disease. The hearing loss associated with the condition is sometimes permanent but each individual case is different. Workup includes thorough history and examination (often with a microscope) and investigation is with CT scanning and hearing tests.

Tinnitus

This is an extremely common and troubling symptom. It relates to the ringing in the ears that is usually associated with hearing loss. If it is associated with slow gradual age related hearing loss, it is best managed by an audiologist with a special interest in the condition eg: Neurosensory Audiologists or Hear With Me specialist Audiologists.

Another excellent resource is the Tinnitus Association of Victoria..

Noise in the ears that is single sided or pulsatile (in rhythm with the heart beat) can rarely represent a more significant problem and warrants examination by an ENT surgeon. Hearing tests and occasionally scans are needed to clarify the diagnosis.

Exostoses (Surfer's Ear)

These are benign bone growths that occur over many years in the setting of cold water exposure. If they grow large enough they can block hearing or become frequently infected. Occasionally they can lead to a water-logged ear that remains full 24 hours after water exposure.

If any of these symptoms occur it may be worth considering having the excess bony growths removed. This is done under a general anaesthetic and can take as long as 3 hours. Surgery is usually performed from behind the ear and can be done as a day case. A bandage is worn for 24 hours and recovery can take up to 1 week. Swimming is best avoided for up to 8 weeks after surgery.

ENT Surgery is the only specialty to possess all the training and tools to address problems related to the nose. The surgeons at ENT Victoria routinely assess and treat patients with many different nasal conditions.

Sinusitis

This is a very unpleasant condition that is first managed medically and sometimes surgically for patients with longstanding or severe symptoms. A comprehensive assessment with history, examination (often with nasal endoscopy) and investigations such as CT scanning are used to tailor an individual management plan for our patients.

Surgery for sinus disease is varied and designed specifically for the individual patient. Sinus surgery used to be quite involved and unpleasant but modern techniques have made the impact of the surgery minimal and the post-operative discomfort far less than in the past.

Endoscopic sinus surgery is the mainstay of the surgical management of sinus disease. It requires special equipment and training and the surgeons at ENT Victoria have performed hundreds of these operations. The surgery is often performed as day-surgery and nasal packing (once the greatest fear of nose surgery patients) is very rarely used.

Nasal Obstruction

Once medical treatments such as nasal sprays or allergy treatments have been exhausted or maximized, it is sometimes necessary to consider surgery to correct underlying anatomical problems. Septoplasty with or without turbinate reduction is a common procedure used to correct these anatomical problems. Surgery is usually done as a day procedure and soft dissolvable nasal packing is kept to a minimum.

Nasal Polyps

These are benign inflammatory growths that occur in the nose in response to longstanding allergy. Patients with these may also suffer asthma or other allergic conditions. They usually present with a blocked and runny nose. Once diagnosed, the options of medical or surgical management will be discussed with the patient. If surgery is warranted, endoscopic surgery with or without corrective septoplasty surgery is often performed.

Rhinoplasty

Rhinoplasty is usually described as functional or cosmetic.

The distinction lies in the main aim of the procedure. When an improvement in nasal breathing is the main goal of the nasal surgery, we call it a functional operation. This type of surgery may involve straightening the middle of the nose (septum) as well as the nasal bones and occasionally work is done to the nasal tip to correct drooping or collapse that occurs when breathing in.

Surgery that is done mainly for cosmetic reasons may involve correction of any or all components of the nose to improve the aesthetics of the nose. A significant proportion of rhinoplasty is done to correct both functional and cosmetic concerns.

ENT Surgeons are well placed to perform rhinoplasty as they have a comprehensive understanding of how the nose and sinuses work as well as how the nose should look.

Rhinoplasty operations are only performed after a thorough assessment. This involves a comprehensive history and examination of all aspects of the nose, ears and throat. Objective analysis of the face and formal photography is performed prior to planning any operation. Understanding patient concerns and having a realistic approach to outcomes is critical for this type of surgery.

Nasal surgery is done under general anaesthetic and can usually be performed as a day procedure. Rhinoplasty is generally done as with "open" or "closed" approach. Open rhinoplasty involves an incision between the nostrils and allows excellent exposure of the entire nasal skeleton. It is longer and more complex than the closed approach which is done via incisions inside the nose. There are many different techniques described for the management of each particular aspect of the nasal anatomy and treatment needs to be individualized.

Recovery is usually a week or so and a plaster splint will sit on the nose for 7 days. Bruising and swelling is highly variable and depends on many different factors.

Once medical treatments such as nasal sprays or allergy treatments have been exhausted or maximized, it is sometimes necessary to consider surgery to correct underlying anatomical problems. Septoplasty with or without turbinate reduction is a common procedure used to correct these anatomical problems. Surgery is usually done as a day procedure and soft dissolvable nasal packing is kept to a minimum.

Ear nose and throat surgeons frequently see patients who suffer with sore throats, snoring, troublesome coughing or problems with their voice.

Comprehensive assessment with a full history, examination and endoscopy are usually diagnostic. Occasionally further investigation with CT scans or swallowing tests are needed. A visit to an ENT surgeon may help rule out anything sinister and treatment of the problem may then be commenced.

Occasionally, referral to other health specialists such as gastroenterologists, respiratory medicine specialists or speech therapists may be necessary.

Voice Problems

These may vary from with issues with singing to an inability to make any voice at all. A solid understanding of the complex anatomy and disorders of the larynx (voice box) enable the ENT to assess and manage of the causes of a patient's voice disorder. Depending on the patient we use endoscopy in the clinic and/or laryngoscopy in the operating theatre to fully assess the larynx. We work closely with highly qualified speech therapists to obtain the best outcome for our patients.

Snoring

This troublesome condition often affects the whole family and can be an indication of potentially unhealthy sleep.

Snoring that is associated with obstructive sleep apnoea (pausing in the breathing) often presents to ENT surgeons for management. This sleep disorder presents with daytime sleepiness and headaches and can put significant stress on the heart and lungs. Severe obstructive sleep apnoea can sometimes require the use of a cPAP machine. Occasionally these patients are suitable for surgery (on the nose or throat or both) and a multi-disciplinary approach (with sleep studies and respiratory physician contribution) is sometimes necessary.

Simple snoring (loud noisy sleeping without pausing) is extremely common and is addressed with a comprehensive history and examination. Snoring without apnoeas is usually more amenable to surgical correction and a variety of approaches and techniques exist to improve the airway and prevent its collapse during sleep. Surgery would only be considered once other factors such as lifestyle and weight issues are maximized.

With a broad understanding of the anatomy, physiology and disorders of the nose and throat, ENT Surgeons are well placed to discuss the most effective snoring management options with their patients.

Difficulty Swallowing (Dysphagia)

This condition can be a normal part of ageing or represent a more significant problem. Swallowing problems are best assessed by an ENT specialist with a comprehensive history and examination. Further investigations with radiology and/or endoscopy in the operating theatre may be warranted.

Throat Cancer

Each of the surgeons at ENT Victoria has comprehensive experience in managing patients with throat cancer. If a sore throat or change in voice persists for more than 4 weeks it is important for an ENT specialist to examine your throat and larynx (voice box). Early detection of throat cancer can make a very big difference in patient outcome.

Skin Cancer

Australia has the world’s highest rate of skin cancer. A significant proportion of these are in the head and neck region. The surgeons at ENT Victoria have vast experience in managing skin cancers on the face, neck and ear.

Submandibular Gland

This saliva gland that lies under the jaw secretes the majority of the saliva in the mouth. It can occasionally become blocked or infected leading to pain and swelling. Rarely it can develop lumps within it. Our surgeons frequently manage these problems with careful assessment and investigation. State-of-the-art sialoendoscopy can sometimes be offered to patients with submandibular stones that would otherwise mandate gland removal.

Thyroid Gland

Our ENT surgeons are well placed to manage lumps within the thyroid. Lumps are common and often benign but occasionally can be suspicious and warrant surgical management. Thyroid surgery is intimately related to the anatomy of the neck and larynx (voice box), both areas well understood by ENT specialists. Thorough assessment with imaging, pathology and upper airway endoscopy is routine for the management of thyroid lumps in our facility.

Parotid Gland

This is the largest saliva gland in the body and sits in front of the ear. It normally secretes watery saliva but can occasionally become blocked and/or infected. Rarely it can develop lumps within it. These are usually benign but can interfere with function or cosmesis. Most parotid lumps are removed by ENT surgeons. A comprehensive understanding of the gland’s relationship to important structures (i.e the nerve to the muscles of the face) is crucial to managing problems in this area.

Thyroglossal Cysts

These are swellings that occur below the jaw in the midline. They can occur in childhood or early adulthood. They represent a small amount of thyroid tissue that has not descended down to the proper place during development. They are almost always benign but can occasionally be large and become infected. ENT surgeons are well placed to manage these.