A Family Doctor's Tale - EAR NOSE THROAT DEPARTMENT

THE ENT DEPARTMENT


The Ear Nose Throat  (ENT) Department of Singapore General Hospital is one of the smallest department with 4 consultant ENT Surgeons, 2 medical officers and 1 houseman.


It is however one of the most essential department of the hospital as 80% of cases are generally  the ear nose and throat conditions.


However 90% of the cases can be seen as outpatients or by experienced Accident and Emergency Doctors and General Practitioners.


Our job is to handle those ENT conditions which the Accident and Emergency Doctors could not handle.


Typical conditions are:


1.Foreign bodies in the ear and nose such as small marbles, small parts of toys, cotton buds in the nose of children, which can be removed with a nasal forceps or sucked out with suction tubes


2. Fish bones or chicken bones stuck  in the throat which can be removed by crocodile forceps. 
If further down the throat an endoscope may be required to remove the bones sometimes under general anesthesia.


3.Severe infections of the ear with pussy discharge which require drainage of the pus.


4.Severe blockage of the ear by wax which my required syringing of the ear with warm water to remove the wax.


5.Peritonsillar  abscess or quinsy ( A Simple Guide to Tonsillitis)which is an abscess or bag of pus surrounding the tonsil causing blockage to food, swallowing and even breathing. 
A cut just above the tonsil will usually drain the pus and relieve the blockage. However the patient will normally have to stay in hospital for one or two days to make sure the bleeding stop and he or she is able to swallow and breathe properly. 
He or she is then scheduled for a future operation to remove his tonsils.


6.Bleeding from the nose(A Simple Guide to Epistaxis)  is an emergency which has to be attended quickly because of the danger of loss of blood.
Most mild bleeding of the nose comes from bursting of blood vessel of the septum and can be stopped easily by coagulating the blood vessel with silver nitrate or cautery (electrical burning) under local anesthesia.
In severe cases packing the nose with gauze packs anteriorly from the front or posteriorly from the back to plug the bleeding can be done with great discomfort to the patient.


7.Vertigo (A Simple Guide to Vertigo) or severe dizziness may be treated with an injection of stemetil with temporary relief. Recurrence especially in cases of Meniere's Disease (A Simple Guide to Meniere's Disease)  is quite common.


8.The cancer patients of the nose and throat are particular in danger of bleeding of the nose, breathing difficulty and spread of the cancer to the rest of the body. The most common cancer seen here is Nasopharyngeal Cancer (A Simple Guide to Nasopharygngal Cancer).
Other cancers are Cancer of the Larynx, Tongue, Salivary glands.
These will be talked about in the next blog.