Conditions
Paediatrics
Hearing loss
Early identification and management of hearing loss in children is essential for normal speech, language, learning, and social development. Paediatric hearing loss is not uncommon and, when detected early, many children can achieve excellent long-term outcomes with appropriate treatment and support.
What is Paediatric Hearing Loss?
Paediatric hearing loss refers to a partial or complete reduction in hearing in infants, children, or adolescents. It may be present at birth (congenital) or develop later in childhood (acquired). Hearing loss can affect one ear or both ears and may be temporary or permanent.
Even mild or fluctuating hearing loss can impact a child’s speech development, behaviour, and school performance, making early assessment important.
Types of Hearing Loss
- Conductive Hearing Loss
Occurs when sound is unable to pass efficiently through the outer or middle ear. This is the most common type of hearing loss in children and is often temporary. Causes include middle ear fluid (glue ear), ear infections, or blockage of the ear canal.
- Sensorineural Hearing Loss
Results from damage to the inner ear or auditory nerve. This type of hearing loss is usually permanent and may be present from birth or develop later due to genetic factors, infections, or prematurity.
- Mixed Hearing Loss
A combination of conductive and sensorineural hearing loss.
Common Causes of Hearing Loss in Children
- Middle ear effusion (glue ear)
- Recurrent ear infections
- Genetic or inherited conditions
- Premature birth or low birth weight
- Congenital infections (such as cytomegalovirus)
Signs and Symptoms
Signs of hearing loss vary with age and severity. Parents and caregivers may notice:
- Delayed or unclear speech development
- Poor response to sounds or calling their name
- Frequently asking for repetition or saying “what?”
- Turning the television or devices up loud
- Difficulty following instructions
- Behavioural or attention concerns at school
In infants, signs may include lack of startle to loud sounds or delayed babbling.
Assessment and Diagnosis
Assessment of paediatric hearing loss involves a thorough clinical evaluation and hearing testing appropriate to the child’s age. This may include:
- Age-appropriate audiological testing
- Examination of the ears and eardrums
- Tympanometry to assess middle ear function
- Review of newborn hearing screening results
Early referral and assessment are critical, particularly for infants and young children.
Treatment and Management
Treatment depends on the type and cause of hearing loss and may include:
- Monitoring
- Treatment of ear infections
- Grommet (ventilation tube) insertion
- Hearing aids or assistive listening devices
- Cochlear implant assessment for severe hearing loss
- Coordination with audiologists, speech pathologists, and educators
Management is tailored to each child to support hearing, communication, and overall development.
When to See an ENT Surgeon
Referral to an ENT surgeon is recommended if a child has:
- Persistent or recurrent ear infections
- Ongoing middle ear fluid with hearing loss
- Confirmed or suspected permanent hearing loss
- Speech or developmental delay related to hearing
Our Approach
We provide comprehensive, child-focused assessment and management of paediatric hearing loss, working closely with families and allied health professionals. Our goal is to optimise hearing and support each child’s communication, learning, and quality of life.
Sleep Disordered Breathing
Sleep Disordered Breathing (SDB) refers to a group of conditions in which airflow is reduced or blocked during sleep. These disorders can significantly affect sleep quality, overall health, and daily functioning. As an ENT (Ear, Nose & Throat) specialist, we focus on identifying and treating the anatomical causes of breathing problems during sleep.
What Is Sleep Disordered Breathing?
Sleep Disordered Breathing includes a spectrum of conditions ranging from simple snoring to more serious disorders such as Obstructive Sleep Apnea (OSA). These conditions occur when the upper airway becomes partially or completely blocked during sleep, leading to disrupted breathing, poor oxygen levels and frequent awakening.
Common Symptoms
Sleep disordered breathing often goes undiagnosed because symptoms occur during sleep. Common signs include:
- Loud snoring
- Pauses in breathing, choking, or gasping during sleep
- Restless and sweaty sleep
- Poor concentration or memory problems
- Hyperactivity and behavioural difficulties
- Tiredness
Common Causes of Hearing Loss in Children
- Middle ear effusion (glue ear)
- Recurrent ear infections
- Genetic or inherited conditions
- Premature birth or low birth weight
- Congenital infections (such as cytomegalovirus)
What causes sleep disordered breathing in children?
For an otherwise healthy child, sleep disordered breathing is caused by enlargement of the tonsils and adenoids. The adenoids lie at the back of the nose and can lead to obstruction of nasal airflow whilst the tonsils are at the back of the throat and cause collapse of the upper airway.
Other contributing factors include other causes of nasal obstruction such as hay fever, facial anatomy and elevated weight for age.
Evaluation and Diagnosis
Your assessment may include:
- A detailed medical and sleep history
- Nasal and throat examination
- Flexible nasendoscopy (airway examination using a camera)
- Possible referral for a sleep study (polysomnography or home sleep testing)
This comprehensive approach allows us to determine both the severity and cause of your sleep disordered breathing.
Treatment Options
Treatment is tailored to each patient and may include:
- Close monitoring
- Nasal sprays or allergy management
- Tonsillectomy or adenoidectomy
Nose
Blocked nose
A blocked nose can be more than just an annoying inconvenience—it can affect your sleep, your energy levels, and your overall quality of life. Whether it's caused by a cold, allergies, or an underlying structural issue, nasal obstruction can make it hard to breathe comfortably. As an ENT (Ear, Nose, and Throat) specialist, we help you identify the cause of your blocked nose and recommend the most effective treatments.
What Is Nasal Obstruction?
A blocked nose, or nasal obstruction, occurs when there’s a blockage or narrowing in the nasal passages, making it difficult to breathe through your nose. This can be caused by a variety of factors, ranging from temporary issues like a cold or allergies to more persistent conditions like deviated septum or chronic sinusitis.
Common Causes of a Blocked Nose
- Allergic Rhinitis (Hay Fever): Allergies to pollen, dust, mould, or pet dander can cause nasal congestion and sneezing.
- Deviated Septum: A structural abnormality in the nasal septum that can obstruct airflow in one or both nasal passages.
- Sinusitis: Inflammation of the sinuses can cause congestion, facial pressure, and difficulty breathing.
- Nasal Polyps: Non-cancerous growths that develop in the lining of the nasal passages or sinuses and can block airflow.
- Enlarged Turbinates: Swelling of the nasal turbinates (structures inside the nose) that can narrow the nasal airways.
- Chronic Rhinitis: Long-term inflammation of the nasal passages often due to environmental irritants, allergies, or chemical exposure.
Symptoms of a Blocked Nose
Nasal obstruction can present with a range of symptoms, including:
- Difficulty breathing through one or both nostrils
- Constant nasal congestion
- Snoring, especially at night
- Loss of smell or taste
- Headaches or facial pain
- Post-nasal drip (feeling of mucus dripping down the back of your throat)
- Sinus pressure or pain around the eyes, cheeks, or forehead
- Mouth breathing, especially during sleep
- Frequent sinus infections or colds
Why Nasal Obstruction Matters
While a blocked nose can be uncomfortable, it can also impact your overall health. Some of the potential complications include:
- Sleep Disruption: Difficulty breathing through the nose can lead to poor sleep quality or snoring.
- Increased Risk of Snoring and Sleep Apnea: A blocked nose can contribute to obstructive sleep apnea and other sleep disorders.
- Reduced Quality of Life: Persistent nasal obstruction can affect your ability to concentrate, work, and engage in daily activities.
Diagnosis of Nasal Obstruction
An accurate diagnosis is crucial for effective treatment. During your consultation, we will perform a thorough physical exam and review your symptoms. We may also recommend additional diagnostic tests, such as:
- Nasal Endoscopy: A flexible scope is inserted into the nose to visualize the nasal passages and sinuses, helping to identify obstructions such as polyps or a deviated septum.
- CT Scan: Imaging may be used to assess the sinuses and nasal structures in more detail.
- Allergy Testing: If allergies are suspected, we may recommend skin testing or blood tests to pinpoint the specific allergens affecting you.
Treatment Options for Nasal Obstruction
Treatment for a blocked nose depends on the underlying cause. Some of the common treatment options include:
Non-Surgical Treatments
- Nasal Decongestants: Over-the-counter or prescription medications to reduce nasal swelling and improve airflow.
- Saline Nasal Sprays: These help rinse out mucus and allergens from the nasal passages and relieve congestion.
- Antihistamines: If allergies are the cause, antihistamines can reduce inflammation and relieve symptoms.
Nasal Steroid Sprays: These can reduce inflammation in the nasal passages, especially for conditions like allergic rhinitis.
Surgical Treatments
If conservative treatments don’t provide relief, surgery may be necessary to correct structural issues. Surgical options include:
- Septoplasty: Surgical correction of a deviated septum.
- Inferior turbinate Reduction: Reduction in the size of the turbinate by removing part of the bone and thickened lining.
- Nasal Polyp Removal: Surgical removal of nasal polyps may be recommended if they are causing persistent nasal blockage.
- Sinus Surgery: In cases of chronic rhinosinusitis, surgery is used to open the sinuses to allow for the administration of topical treatments.
Sinusitis
What is Chronic Rhinosinusitis?
Chronic rhinosinusitis is a condition where the sinuses become persistently inflamed for 12 weeks or longer. This prolonged inflammation leads to a variety of uncomfortable symptoms and can interfere with your daily life. Sinuses are air-filled spaces in the skull around the nose and when these sinuses become blocked or infected, it can lead to congestion, pain and difficulty breathing through the nose.
Symptoms of Chronic Rhinosinusitis
Chronic rhinosinusitis presents with a wide variety of symptoms that can affect both your nose and your overall well-being. Common symptoms include:
- Persistent Nasal Congestion: Difficulty breathing through the nose.
- Facial Pressure and Pain: A feeling of fullness or pressure around the eyes, cheeks, forehead, or upper teeth.
- Headaches: A constant headache or facial pain that worsens with certain movements or changes in position.
- Thick Nasal Discharge: Mucus that is yellow or green in color, often accompanied by post-nasal drip (mucus dripping down the back of your throat).
- Reduced Sense of Smell and Taste: Difficulty smelling or tasting food properly.
- Coughing: Persistent cough, particularly at night.
- Fatigue: Ongoing tiredness or lack of energy due to disrupted sleep and chronic discomfort.
Bad Breath (Halitosis): Foul-smelling breath due to sinus drainage.
Causes of Chronic Rhinosinusitis
Chronic rhinosinusitis can develop due to an interplay of multiple factors such as:
- Environmental exposures – allergens, pollutants, tobacco smoke
- Allergies
- Dysfunction of the membranes lining the nasal cavity
- Alterations in the bacteria which normally reside in the nose
Risk Factors for Chronic Rhinosinusitis
Certain factors can increase your likelihood of developing chronic rhinosinusitis, including:
- Allergies to dust, pollen, mould, or pet dander.
- Exposure to environmental irritants like tobacco smoke or pollution.
- A deviated septum or other structural issues in the nasal passages.
- Underlying health conditions such as asthma or cystic fibrosis.
Diagnosis of Chronic Rhinosinusitis
If you are experiencing persistent sinus symptoms, a thorough evaluation will be undertaken to determine the cause and best treatment approach. The diagnostic process may include:
- Physical Exam and Medical History: A comprehensive exam to review your symptoms and medical background.
- Nasal Endoscopy: A flexible scope is used to examine the inside of your nose and sinuses, helping us detect any obstructions, nasal polyps, or other issues.
- Imaging (CT Scan): A CT scan of the sinuses can provide a detailed view of your sinus anatomy, revealing inflammation, infection, or structural issues.
- Allergy Testing: If allergies are suspected, we may conduct allergy tests to identify potential triggers.
- Sinus Culture: In cases of suspected bacterial infection, we may take a sample of your nasal discharge to identify the underlying pathogen.
Treatment Options for Chronic Rhinosinusitis
Treatment options may include:
Non-Surgical Treatments
- Nasal Steroid Sprays: Prescription nasal sprays reduce inflammation in the sinuses and help to clear mucus.
- Oral steroid medication: Reduces the inflammatory reaction which underlies most cases of chronic rhinosinusitis.
- Saline Irrigation: Rinsing the nasal passages with a saline solution can help flush out mucus, allergens, and irritants.
- Antibiotics: If a bacterial infection is suspected, a course of antibiotics may be prescribed.
- Antihistamines: For patients with allergy-related chronic rhinosinusitis, antihistamines can help control allergic reactions and reduce sinus swelling.
Surgical Treatments
If medical treatments do not provide sufficient relief, surgical intervention may be required.
Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive surgery that involves using an endoscope to clear blocked sinuses, remove polyps, or correct anatomical issues like a deviated septum. This immediately improves nasal airflow and allows for medicated nasal irrigations to reach all the lining of the nose reducing the inflammatory reaction which drives chronic rhinosinusitis.
Throat
Tonsillitis
Tonsillitis is a common condition caused by inflammation of the tonsils, most often due to infection. It can affect both children and adults and may range from mild, self-limiting illness to recurrent or severe infections that significantly impact quality of life.
What Are the Tonsils?
The tonsils are two oval-shaped lymphoid tissues located at the back of the throat. They form part of the immune system and help fight infection, particularly in early childhood. However, in some people, the tonsils themselves become repeatedly infected or chronically inflamed.
Causes of Tonsillitis
- Viral infections (most common)
- Bacterial infections, including Group A Streptococcus
Symptoms
Common symptoms of tonsillitis include:
- Sore throat
- Pain or difficulty swallowing
- Fever
- Enlarged, red, or pus-covered tonsils
- Swollen lymph nodes in the neck
- Bad breath
- Ear pain (referred pain)
In children, symptoms may also include:
- Poor appetite
- Drooling
- Irritability or lethargy
Treatment Options
Medical Management
Most cases of viral tonsillitis resolve with supportive care, including rest, fluids, and pain relief. Bacterial tonsillitis may require antibiotics.
Surgical Management
Removal of the tonsils (Tonsillectomy) may be recommended for patients with:
- Recurrent, well-documented episodes of tonsillitis
- Severe infections affecting school, work, or daily activities
- Complications such as peritonsillar abscess (quinsy)
- Significant tonsillar enlargement causing breathing or swallowing problems
The decision for surgery is based on symptom severity, frequency, response to medical treatment, and overall impact on quality of life.
Tonsillectomy
Tonsillectomy is a common and effective procedure performed under general anaesthesia. It aims to reduce or eliminate recurrent throat infections and related complications. Recovery typically involves a short period of throat discomfort, with most patients returning to normal activities within one to two weeks.
Laryngopharyngeal Reflux (LPR)
Laryngopharyngeal reflux (LPR) is a condition in which stomach contents reflux into the throat and voice box (larynx). Unlike typical gastro-oesophageal reflux disease (GORD), LPR often occurs without heartburn and can cause persistent throat and voice symptoms.
What is Laryngopharyngeal Reflux?
LPR occurs when acidic or non-acidic stomach contents travel upwards beyond the oesophagus and reach the larynx and pharynx. The tissues of the throat and voice box are particularly sensitive to reflux, and even small amounts can cause significant symptoms.
Because LPR frequently occurs during the day and while upright, many patients do not experience classic reflux symptoms such as heartburn or indigestion.
Common Symptoms
Symptoms of LPR are often chronic and may fluctuate in severity. Common features include:
- Persistent throat clearing
- Sensation of a lump in the throat (globus)
- Hoarseness or voice fatigue
- Chronic cough
- Excess throat mucus or post-nasal drip sensation
- Sore or irritated throat
- Difficulty swallowing or discomfort when swallowing
Causes and Risk Factors
LPR is usually related to dysfunction of the upper and lower oesophageal sphincters. Contributing factors may include:
- Dietary triggers (caffeine, alcohol, spicy or fatty foods)
- Eating late at night
- Obesity
- Smoking
- Certain medications
Assessment and Diagnosis
Diagnosis is based on a detailed history and ENT examination. Flexible nasendoscopy is commonly performed to assess the larynx and surrounding structures for signs of reflux-related inflammation.
In some cases, further investigations may be recommended, including:
- Reflux questionnaires and symptom scoring
- Referral for gastroenterology assessment
- pH or impedance monitoring in selected cases
Treatment and Management
Management of LPR focuses on reducing reflux and allowing the larynx to heal. Treatment is individualised and may include:
Lifestyle and Dietary Modification
These form the cornerstone of LPR management and may include:
- Avoiding trigger foods and drinks
- Eating smaller meals
- Avoiding meals within 2–3 hours of bedtime
- Elevating the head of the bed
- Weight management and smoking cessation
Medical Treatment
Medication may be prescribed to reduce acid exposure or reflux episodes.
When to See an ENT Surgeon
Referral to an ENT surgeon is appropriate if symptoms are:
- Persistent or worsening despite initial treatment
- Associated with voice change, swallowing difficulty, or chronic cough
- Atypical or concerning in nature
Thyroid
Nodules
Thyroid nodules are common and usually benign lumps that develop within the thyroid gland. While most thyroid nodules do not cause symptoms or require surgery, careful assessment is important to exclude malignancy and guide appropriate management.
What Are Thyroid Nodules?
The thyroid gland is a butterfly-shaped gland located at the front of the neck, responsible for regulating metabolism and energy levels through hormone production. A thyroid nodule is a discrete lump or swelling within the thyroid tissue.
How Common Are Thyroid Nodules?
Thyroid nodules are very common, particularly with increasing age. The majority are benign, and only a small proportion are cancerous. Careful assessment allows identification of nodules that require further investigation or treatment.
Symptoms
Most thyroid nodules are discovered incidentally. When symptoms do occur, they may include:
- A visible or palpable lump in the neck
- Sensation of pressure or fullness in the neck
- Difficulty swallowing
- Changes in voice (rare)
- Shortness of breath if the nodule is large
Assessment and Diagnosis
Assessment begins with a thorough medical history and neck examination. Investigations may include:
Ultrasound of the Thyroid
High-resolution ultrasound is the key imaging test to assess the size, structure, and characteristics of thyroid nodules and to guide further management.
Fine Needle Aspiration (FNA) Biopsy
If a nodule has concerning features or reaches a certain size, an ultrasound-guided FNA biopsy may be recommended. This procedure is performed under local anaesthesia and involves using a thin needle to collect cells for analysis.
Management Options
Management depends on the size of the nodule, biopsy results, symptoms, and patient preference.
Observation and Monitoring
Benign nodules without symptoms may be monitored with periodic ultrasound and clinical review.
Surgical Management
Surgery may be recommended if:
- The nodule is suspicious or confirmed to be malignant
- Biopsy results are indeterminate
- The nodule is growing or causing compressive symptoms
- There are cosmetic concerns
- There is patient preference after appropriate counselling
Surgical options include removal of part of the thyroid (hemithyroidectomy) or the entire thyroid gland (total thyroidectomy), depending on the clinical situation.
Thyroid Cancer
Thyroid cancer results from the abnormal growth of cells within the thyroid gland. It often presents as a thyroid nodule and is frequently detected incidentally on examination or imaging. It generally has an excellent prognosis when diagnosed and treated appropriately as many are slow growing and highly treatable.
Types of Thyroid Cancer
Papillary Thyroid Cancer
The most common type of thyroid cancer. It typically grows slowly and has an excellent long-term prognosis.
Follicular Thyroid Cancer
Less common than papillary cancer and usually has a good prognosis, though it can spread via the bloodstream in some cases.
Medullary Thyroid Cancer
A rarer form arising from specialised thyroid cells. It may occur sporadically or as part of inherited syndromes.
Anaplastic Thyroid Cancer
A rare and aggressive form of thyroid cancer, usually occurring in older adults.
Symptoms and Signs
Many patients with thyroid cancer have no symptoms. When present, symptoms may include:
- A painless lump in the front of the neck
- Enlargement of a thyroid nodule
- Hoarseness or voice changes
- Difficulty swallowing
- Shortness of breath
- Enlarged lymph nodes in the neck
Assessment and Diagnosis
Assessment involves careful evaluation to determine the nature and extent of disease.
Clinical Assessment
A detailed history and examination of the neck, thyroid, and lymph nodes.
Ultrasound and Imaging
High-resolution ultrasound is essential for evaluating thyroid nodules and cervical lymph nodes. Additional imaging in the form of a CT scan may be required in selected cases.
Fine Needle Aspiration (FNA) Biopsy
Ultrasound-guided biopsy is used to assess suspicious nodules and lymph nodes.
Blood Tests and Genetic Testing
Blood tests may assess thyroid function. Genetic testing may be indicated in cases of medullary thyroid cancer.
Treatment and Management
Management is individualised based on cancer type, size, spread, and patient factors.
Surgical Management
Surgery is the primary treatment for most thyroid cancers. Depending on the disease, this may include:
- Removal of part of the thyroid (hemithyroidectomy)
- Total thyroidectomy
- Removal of involved lymph nodes in the neck
Adjuvant Treatment
Some patients may require additional treatment following surgery, including radioactive iodine therapy or long-term thyroid hormone replacement.
Ongoing Surveillance
Long-term follow-up is essential and may include blood tests, ultrasound surveillance, and clinical review.
Head and Neck
Neck Lumps
A neck lump is a common reason for referral to an ENT surgeon. While many neck lumps are benign and related to infection or inflammation, some require further investigation to exclude more serious conditions, including cancer.
What Is a Neck Lump?
A neck lump is any swelling or mass in the neck. Neck lumps may arise from lymph nodes, salivary glands, thyroid gland, skin, or other soft tissues. They can occur in both children and adults, with causes varying depending on age and clinical features.
How Common Are Thyroid Nodules?
Thyroid nodules are very common, particularly with increasing age. The majority are benign, and only a small proportion are cancerous. Careful assessment allows identification of nodules that require further investigation or treatment.
Common Causes of Neck Lumps
Enlarged Lymph Nodes
The most common cause of neck lumps. Lymph nodes often enlarge in response to infection or inflammation and usually resolve over time.
Infections
Viral or bacterial infections of the throat, tonsils, teeth, skin, or salivary glands can lead to tender neck lumps.
Thyroid Conditions
Thyroid nodules or goitre can present as a lump in the lower front of the neck.
Salivary Gland Disorders
Blockage, infection, or tumours of the salivary glands may cause lumps under the jaw or near the ear.
Congenital Lumps
Some neck lumps are present from birth or childhood, such as branchial cleft cysts or thyroglossal duct cysts.
Tumours
Both benign and malignant tumours can present as neck lumps. In adults, a persistent, painless neck lump may represent head and neck cancer until proven otherwise.
Red flag symptoms
Features that may require urgent assessment include:
- A lump persisting for more than 2 weeks
- Rapidly increasing size
- A firm or hard lump
- Painless swelling
- Associated voice change, difficulty swallowing, or breathing problems
- Unexplained weight loss or night sweats
- History of smoking or alcohol use
Assessment and Diagnosis
Clinical Examination
Assessment of the neck, mouth, throat, larynx, and salivary glands, along with a full head and neck examination.
Endoscopic Examination
Flexible nasendoscopy may be performed in the clinic to assess the upper aerodigestive tract.
Imaging
Ultrasound, CT, or MRI may be used to define the nature and extent of the lump.
Fine Needle Aspiration (FNA) Biopsy
A minimally invasive biopsy often performed under ultrasound guidance to obtain cells for diagnosis.
Management and Treatment
Management depends on the underlying cause:
- Observation or medical treatment for reactive lymph nodes or infections
- Surgical removal of benign cysts or tumours
- Surgical and oncological management for malignant conditions
Neck Lumps in Children
In children, neck lumps are most commonly related to infection or congenital conditions. However, persistent or enlarging lumps still require specialist assessment to ensure appropriate management.
When to See an ENT Surgeon
Referral to an ENT surgeon is recommended if:
- A neck lump persists beyond 2 weeks
- The lump is enlarging, firm, or painless
- There are associated symptoms affecting speech, swallowing, or breathing
- Imaging or biopsy is required
- There is concern about cancer
Head and Neck Cancer
Head and neck cancer refers to a group of cancers that arise in the mouth, throat, voice box, nose, sinuses, salivary glands, and lymph nodes of the neck. Early diagnosis and specialist management are critical, as outcomes are significantly improved when treatment begins promptly.
What is Head and Neck Cancer?
Head and neck cancers most commonly arise from the lining of the upper aerodigestive tract and are typically squamous cell carcinomas. These cancers can affect essential functions such as speech, swallowing and breathing.
Common Sites of Head and Neck Cancer
- Oral cavity (tongue, lips, floor of mouth, gums)
- Oropharynx (tonsils, base of tongue)
- Larynx (voice box)
- Hypopharynx
- Nasal cavity and sinuses
- Salivary glands
- Lymph nodes of the neck
Risk Factors
Risk factors vary depending on the cancer site and include:
- Tobacco use (smoking or chewing)
- Alcohol consumption
- Human papillomavirus (HPV), particularly for oropharyngeal cancer
- Sun exposure (lip cancer)
Symptoms and Warning Signs
Symptoms depend on the location of the cancer and may include:
- A persistent lump in the neck
- An ulcer in the mouth that does not heal
- Persistent sore throat
- Difficulty or pain with swallowing
- Hoarseness or voice change lasting more than 2 weeks
- Unexplained weight loss
- Ear pain
- Nasal blockage or bleeding (for nasal and sinus cancers)
Any persistent or unexplained symptom should be assessed promptly.
Assessment and Diagnosis
Clinical Examination
Comprehensive head and neck examination, including inspection of the mouth, throat, larynx, and neck.
Endoscopic Assessment
Flexible nasendoscopy is commonly performed to visualise the throat and voice box.
Imaging
CT, MRI, or PET scans are used to assess the size of the tumour and spread to surrounding tissues or lymph nodes.
Biopsy
Tissue sampling is required to confirm the diagnosis and determine tumour type.
Treatment and Management
Treatment is individualised and depends on tumour site, stage, pathology, and patient factors. A multidisciplinary team of specialist head and neck oncologists work together to recommend a personalised treatment plan for each patient.
Surgery
Surgical removal of the tumour and involved lymph nodes may be recommended.
Radiotherapy and Chemotherapy
These treatments may be used alone or in combination with surgery, depending on the cancer type and stage.
Multidisciplinary Care
Head and neck cancer treatment is coordinated through a multidisciplinary team (MDT), involving ENT surgeons, medical and radiation oncologists, radiologists, pathologists, speech pathologists, dietitians, and specialist nurses.
Rehabilitation and Support
Rehabilitation is a vital part of care and may include:
- Speech and swallowing therapy
- Nutritional support
- Voice rehabilitation
- Psychological support
Long-term follow-up is essential to monitor for recurrence and manage treatment-related effects.
When to See an ENT Surgeon
Referral to an ENT surgeon is recommended if:
- A neck lump persists for more than 2–3 weeks
- Mouth ulcers lasting longer than 2 weeks
- There is persistent hoarseness or swallowing difficulty
- Symptoms are unexplained or worsening
- There is concern for head and neck malignancy
Sleep and Snoring
Obstructive Sleep Apnoea (OSA)
Obstructive sleep apnoea (OSA) is a common sleep disorder caused by repeated collapse of the upper airway during sleep. This leads to disrupted breathing, poor-quality sleep, and reduced oxygen levels, with significant effects on daytime functioning and long-term health.
What is Obstructive Sleep Apnoea?
OSA occurs when the muscles of the throat relax during sleep, allowing the airway to narrow or collapse. This causes repeated pauses in breathing (apnoeas) or shallow breathing (hypopnoeas), often followed by brief arousals from sleep.
Common Symptoms
Night-time symptoms
- Loud, habitual snoring
- Witnessed pauses in breathing
- Gasping or choking during sleep
- Restless or unrefreshing sleep
Daytime symptoms
- Excessive daytime sleepiness
- Morning headaches
- Poor concentration or memory
- Irritability or mood changes
- Reduced work or driving performance
Why OSA Matters
Untreated obstructive sleep apnoea is associated with increased risk of:
- High blood pressure
- Heart disease and stroke
- Type 2 diabetes
- Workplace and motor vehicle accidents
- Reduced quality of life
Causes and Risk Factors
OSA often results from a combination of anatomical and lifestyle factors, including:
- Narrow upper airway anatomy
- Enlarged tonsils or adenoids
- Obesity
- Alcohol use and smoking
- Nasal obstruction
Assessment and Diagnosis
Assessment involves a detailed history and ENT examination to identify sites of airway obstruction.
ENT Evaluation
Examination of the nose, palate, tonsils, tongue, and jaw. Flexible nasendoscopy is used to evaluate the collapsibility of the throat and the potential sites of obstruction.
Sleep Studies
A formal sleep study (polysomnography or home sleep study) is required to confirm the diagnosis and determine severity.
Treatment Options
Management of OSA is individualised and depends on severity, anatomy, and patient preference.
Lifestyle and Medical Management
- Continuous Positive Airway Pressure (CPAP), the gold-standard treatment for moderate to severe OSA
- Weight management
- Reducing alcohol intake
- Treatment of nasal obstruction
Oral Appliances
Custom-fitted mandibular advancement splints may be suitable for selected patients with mild to moderate OSA.
Surgical Management
Surgery may be considered when anatomical obstruction is identified or when CPAP is poorly tolerated. Procedures may target:
- Nasal obstruction
- Enlarged tonsils
- Soft palate
- Base of tongue
When to See an ENT Surgeon
Referral to an ENT surgeon is recommended if:
- CPAP is not tolerated
- There is significant nasal obstruction impeding the use of CPAP