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ENT - Otorhinolaryngology (ORL) | Auckland | Te Toka Tumai | Te Whatu Ora

Public Service, ENT/ Head & Neck Surgery

Description

Formerly Auckland DHB ENT - Otorhinolaryngology (ORL)

Ear, Nose and Throat Surgery (ENT) is also known as Otorhinolaryngology, Head and Neck Surgery.  This area of medicine is concerned with disorders of the ear, nose, throat, the head and the neck.

ENT Surgeons, also known as Otorhinolaryngologists, Head & Neck Surgeons, are specialist doctors who deal with medical and surgical treatment of conditions of the ears, nose, throat and structures of the head and neck.

Consultants

Ages

Adult / Pakeke, Older adult / Kaumātua

Referral Expectations

If you have an urgent problem requiring immediate surgical assessment you are referred acutely to the ORL-HNS Department where you will initially be seen by the Registrar (a trainee specialist) who will assess you. Investigations will be performed as required. The results of this evaluation will determine whether you need to be admitted to hospital. More senior members of the ORL HNS Department, such as Consultants and/or Fellows, will be involved in your care as necessary.
 
If the problem is not urgent, the GP will write a letter to the ORL-HNS Department requesting an appointment in the outpatient clinic. Each month the Department receives more new referrals than can be seen in clinic. Consultant surgeons working in the Department review the referral letters to determine who should be seen, and the urgency of the referral, based on the information provided by the GP. Very urgent cases are usually seen within a couple of weeks, but other cases may have to wait a much longer time. Routine cases are often returned to the GP with some management advice.  

When you come to the ORL-HNS Outpatient Department you will be seen by a member of the ORL-HNS team who will ask questions about your illness and examine you to try to determine or confirm the diagnosis. This process may also require further tests (e.g. blood tests, x-rays, scans etc). Sometimes this can all be done during one clinic visit, but for some conditions this will take several follow-up appointments. Occasionally some tests are arranged even before you are seen at the hospital to try to speed up the process.
 
Once a diagnosis has been made, the medical staff will discuss treatment with you. In some instances this will mean surgery, while other cases can be managed with medication and advice. If surgery is advised you will be put on the elective surgical waiting list. Again these waiting lists are ordered according to the urgency and severity of the condition. The steps involved in the surgical process and the likely outcome are usually discussed with you at this time.
 
In order to minimise the amount of time of that you have to spend in hospital, many surgical departments run a preadmission process. This is usually done through a clinic where you are seen just prior to hospital admission. The aim of this clinic is to confirm that you still need to have the planned surgery and that you are currently fit and well enough to undergo the operation. This process usually involves the junior medical staff working in consultation with the anaesthetists, pharmacists, physiotherapists etc. Often the consultant surgeon will also take this opportunity to review your condition.

Procedures / Treatments

Neck Lumps or Masses

The important concepts in understanding neck lumps are : age, location, solitary or multiple, duration and associated symptoms. Age The vast majority of lumps in children will be either inflammatory or congenital. Single lateral neck lumps in an adult over 40 must be considered cancerous until proven otherwise. Location Subcutaneous - sebaceous cyst, epidermoid cyst Midline lumps - these are often congenital i.e. present at birth at least in vestigial form. Under the chin they may represent dermoid cysts, thyroglossal cysts (especially around the hyoid). In the lower neck they may represent thyroid abnormalities and will elevate with swallowing. Angle of jaw - most of these are parotid lumps. Most are benign parotid tumours but lymph nodes involved by skin cancer occur increasingly with age. Under the body of the mandible - usually related to abnormalities of the submandibular gland such as blocked gland, infection, tumour. As with parotid lumps, lymph nodes involved by skin cancer occur increasingly with age. In Polynesian patients in particular, a cystic swelling may be due to a "plunging ranula" which is due to chronic leakage of mucus from the sublingual gland (under the tongue) into the neck. Lumps in the lower neck in front of or deep to the neck muscles often represent thyroid abnormalities and will elevate with swallowing. Most thyroid lumps are benign but still require investigation as some are cancers. Lateral neck - usually are enlarged lymph nodes. Any persisting lateral neck lump in an adult must be treated with suspicion for malignancy. Other possibilities include nerve tumours, carotid body tumours. Number Multiple lumps are generally lymph nodes and the most common cause is inflammation e.g. glandular fever, toxoplasmosis. However multiple non-tender nodes can be due to malignancy either primarily of lymph nodes (lymphoma) or secondarily by spread from a cancer of the head and neck. Duration Generally lumps that have been present for years are benign but not necessarily so e.g. parotid or thyroid cancers can be quiescent for years before taking on a more aggressive course. Most inflammatory lumps will begin to resolve within 3 weeks. Any lumps that are persisting or growing over a few weeks or months must be investigated for malignancy. Associated symptoms Inflammatory nodes are generally associated with systemic symptoms such as tenderness, fever, malaise, sore throat. Serology for glandular fever or toxoplasmosis may be positive. Lymphomatous nodes can have similar symptoms of fever, night sweats, weight loss, and tenderness. Any nodes that persist for more than 3 weeks in the absence of a diagnosis should be investigated. Lateral neck nodes in adults may be metastases from the throat. These patients may be heavy smokers and may experience throat or ear discomfort, voice change or swallowing difficulty. Some will have a past history of skin cancers.

The important concepts in understanding neck lumps are : age, location, solitary or multiple, duration and associated symptoms.

Age
The vast majority of lumps in children will be either inflammatory or congenital. Single lateral neck lumps in an adult over 40 must be considered cancerous until proven otherwise.

Location


Subcutaneous
 - sebaceous cyst, epidermoid cyst

Midline lumps - these are often congenital i.e. present at birth at least in vestigial form. Under the chin they may represent dermoid cysts, thyroglossal cysts (especially around the hyoid). In the lower neck they may represent thyroid abnormalities and will elevate with swallowing.

Angle of jaw - most of these are parotid lumps. Most are benign parotid tumours but lymph nodes involved by skin cancer occur increasingly with age.

Under the body of the mandible
 - usually related to abnormalities of the submandibular gland such as blocked gland, infection, tumour. As with parotid lumps, lymph nodes involved by skin cancer occur increasingly with age. In Polynesian patients in particular, a cystic swelling may be due to a "plunging ranula" which is due to chronic leakage of mucus from the sublingual gland (under the tongue) into the neck. Lumps in the lower neck in front of or deep to the neck muscles often represent thyroid abnormalities and will elevate with swallowing. Most thyroid lumps are benign but still require investigation as some are cancers.

Lateral neck
 - usually are enlarged lymph nodes. Any persisting lateral neck lump in an adult must be treated with suspicion for malignancy. Other possibilities include nerve tumours, carotid body tumours.

Number

Multiple lumps are generally lymph nodes and the most common cause is inflammation e.g. glandular fever, toxoplasmosis. However multiple non-tender nodes can be due to malignancy either primarily of lymph nodes (lymphoma) or secondarily by spread from a cancer of the head and neck.


Duration

Generally lumps that have been present for years are benign but not necessarily so e.g. parotid or thyroid cancers can be quiescent for years before taking on a more aggressive course. Most inflammatory lumps will begin to resolve within 3 weeks. Any lumps that are persisting or growing over a few weeks or months must be investigated for malignancy.


Associated symptoms

Inflammatory nodes are generally associated with systemic symptoms such as tenderness, fever, malaise, sore throat. Serology for glandular fever or toxoplasmosis may be positive. Lymphomatous nodes can have similar symptoms of fever, night sweats, weight loss, and tenderness. Any nodes that persist for more than 3 weeks in the absence of a diagnosis should be investigated. Lateral neck nodes in adults may be metastases from the throat. These patients may be heavy smokers and may experience throat or ear discomfort, voice change or swallowing difficulty. Some will have a past history of skin cancers.

Head and Neck Cancer

Head and neck cancers are a group of malignancies affecting soft tissue and bony structures of the face, head and neck. The sites and subsites of these tumours are important because they are frequently difficult to examine and specialised techniques and equipment are required. Treatment protocols differ greatly based on the site and stage of the particular head and neck cancer. Apart from thyroid cancers, these tumours tend to be aggressive and require radical and often multimodal treatment. The main organs and sites that these cancers involve include: Skin Thyroid Mouth -tongue cancer -floor of mouth cancer -palate cancer Pharynx -nasopharyngeal cancer -oropharyngeal cancer -hypopharyngeal cancer Larynx -laryngeal cancer Nasal Cavity/Sinuses Neck Nodal metastases in the neck may be the first sign that a patient has a head and neck cancer.

Head and neck cancers are a group of malignancies affecting soft tissue and bony structures of the face, head and neck. The sites and subsites of these tumours are important because they are frequently difficult to examine and specialised techniques and equipment are required. Treatment protocols differ greatly based on the site and stage of the particular head and neck cancer. Apart from thyroid cancers, these tumours tend to be aggressive and require radical and often multimodal treatment. The main organs and sites that these cancers involve include:
Skin
Thyroid
Mouth
-tongue cancer
-floor of mouth cancer
-palate cancer
Pharynx
-nasopharyngeal cancer
-oropharyngeal cancer
-hypopharyngeal cancer
Larynx
-laryngeal cancer
Nasal Cavity
/Sinuses
Neck
Nodal metastases in the neck may be the first sign that a patient has a head and neck cancer.

Tongue Cancer

Tongue cancer presents as a persistent ulcer usually on the side of the tongue. If an ulcer anywhere in the mouth is present for more than three weeks and is progressing, cancer should be suspected. The other common site is the floor of the mouth. Patients may also present with a lump in the neck as these tumours can metastasise (spread) to lymph nodes. These will usually be in the submandibular region or in the upper lateral neck. Treatment of Tongue Cancer Cancers of the tongue present at various stages of advancement. Early stage cancers are smaller and spread to lymph nodes less commonly. Advanced tumours are larger, involve more tissues and have a higher rate of spread to the neck lymph nodes. Even small tumours have the potential to spread to nodes and treatment of the neck must be considered when treating all cases of oral cavity cancer. Tongue cancers are staged according to the AJCC staging system where smaller tumours (<4cm) are staged T1 and T2 and larger tumours (>4cm) are staged T3 and T4. Early Tongue Cancers T1 and T2 - most early tumours are best managed by a single modality and surgery is the mainstay of treatment. The portion of tongue containing the cancer is excised with a margin of surrounding normal tissue. The defect is either closed primarily, left to granulate or reconstructed with a free flap, depending on the size and components involved. If the primary lesion is very small (<1cm) and thin (<4mm) and there are no palpable lymph nodes in the neck it may be reasonable to not remove any lymph nodes and await the pathology results of the primary. If there are poor features or the lesion is deeper than 4mm, a neck dissection is recommended. For any T1 lesions larger than this or T2 lesions with a N0 neck, selective neck dissection is recommended. If there is positive neck disease then a therapeutic neck dissection is recommended and the extent of the dissection depends on the size, number and levels of involved nodes. Postoperative radiotherapy is recommended if there are poor primary pathology features or particularly if there is more than one lymph node involved or if there is spread of the tumour outside the lymph node (extranodal extension of tumour). Advanced Tongue Cancers T3 and T4 - more extensive tumours usually require combined treatment with surgery and radiotherapy. T4 tumours that involve tissue outside the oral cavity like the jaw or skin can involve complex resections and usually reconstruction with composite free tissue flaps (see section on Head and Neck Reconstruction below).

Tongue cancer presents as a persistent ulcer usually on the side of the tongue. If an ulcer anywhere in the mouth is present for more than three weeks and is progressing, cancer should be suspected. The other common site is the floor of the mouth.
Patients may also present with a lump in the neck as these tumours can metastasise (spread) to lymph nodes. These will usually be in the submandibular region or in the upper lateral neck.

Treatment of Tongue Cancer
Cancers of the tongue present at various stages of advancement. Early stage cancers are smaller and spread to lymph nodes less commonly. Advanced tumours are larger, involve more tissues and have a higher rate of spread to the neck lymph nodes. Even small tumours have the potential to spread to nodes and treatment of the neck must be considered when treating all cases of oral cavity cancer. Tongue cancers are staged according to the AJCC staging system where smaller tumours (<4cm) are staged T1 and T2 and larger tumours (>4cm) are staged T3 and T4.

Early Tongue Cancers T1 and T2  - most early tumours are best managed by a single modality and surgery is the mainstay of treatment. The portion of tongue containing the cancer is excised with a margin of surrounding normal tissue. The defect is either closed primarily, left to granulate or reconstructed with a free flap, depending on the size and components involved.

If the primary lesion is very small (<1cm) and thin (<4mm) and there are no palpable lymph nodes in the neck it may be reasonable to not remove any lymph nodes and await the pathology results of the primary. If there are poor features or the lesion is deeper than 4mm, a neck dissection is recommended. For any T1 lesions larger than this or T2 lesions with a N0 neck, selective neck dissection is recommended.

 
If there is positive neck disease then a therapeutic neck dissection is recommended and the extent of the dissection depends on the size, number and levels of involved nodes.

Postoperative radiotherapy is recommended if there are poor primary pathology features or particularly if there is more than one lymph node involved or if there is spread of the tumour outside the lymph node (extranodal extension of tumour).


Advanced Tongue Cancers T3 and T4 - more extensive tumours usually require combined treatment with surgery and radiotherapy. T4 tumours that involve tissue outside the oral cavity like the jaw or skin can involve complex resections and usually reconstruction with composite free tissue flaps (see section on Head and Neck Reconstruction below).
Neck Dissection

A neck dissection is an operation designed to remove groups of lymph nodes from the neck for treatment of cancer that has actually or potentially spread from a primary site in the head and neck to the regional nodes. There are two types of neck dissection and several subtypes within these two groups: Selective Neck Dissection Level I-III (Supraomohyoid) Level I-IV (Extended supraomohyoid) Level II-IV (Lateral) Level II-V (Posterolateral) Level VI (Central) Level VII (Superior mediastinal) Comprehensive Neck Dissection Radical Modified Radical Extended Neck dissections are either performed in isolation or in association with resection of the primary lesion and the approach may vary depending on the site of the primary. Incisions (cuts) are usually made from the region of the mastoid tip (behind the ear) passing in a curved fashion below the jaw forward into the submental (beneath the chin) region. There is frequently another incision that passes from the mid point of the upper incision down towards the clavicle (collar bone). Flaps are raised in the superficial muscle layer (platysma) of the neck. The lymph nodes and other structures are then removed with preservation of vital nerves and blood vessels. At the end of the procedure the wound is closed over suction drains.

A neck dissection is an operation designed to remove groups of lymph nodes from the neck for treatment of cancer that has actually or potentially spread from a primary site in the head and neck to the regional nodes.

There are two types of neck dissection and several subtypes within these two groups:
Selective Neck Dissection

Level I-III (Supraomohyoid)
Level I-IV (Extended supraomohyoid)
Level II-IV (Lateral)
Level II-V (Posterolateral)
Level VI (Central)
Level VII (Superior mediastinal)
Comprehensive Neck Dissection

Radical
Modified Radical
Extended

Neck dissections are either performed in isolation or in association with resection of the primary lesion and the approach may vary depending on the site of the primary. Incisions (cuts) are usually made from the region of the mastoid tip (behind the ear) passing in a curved fashion below the jaw forward into the submental (beneath the chin) region. There is frequently another incision that passes from the mid point of the upper incision down towards the clavicle (collar bone). Flaps are raised in the superficial muscle layer (platysma) of the neck. The lymph nodes and other structures are then removed with preservation of vital nerves and blood vessels. At the end of the procedure the wound is closed over suction drains.

Head and Neck Reconstruction

Resecting head and neck cancers and benign tumours of the face and neck can create large defects that have a profound effect on cosmesis and function. Over the past 25 - 30 years, significant advances have been made in improving patients' functional and aesthetic outcomes following creation of these defects. Most of the advances have been in reconstruction of the defects with autologous (the patient's own) tissue. A number of important anatomical donor sites have been identified from where complex tissue can be removed with its own blood supply with minimal donor site problems. Some of these sites are near the head and neck so the the tissue can be moved but is anchored by a pedicle (pedicled or regional flaps) and some are from distant sites. The tissue from these distant sites is brought up with an artery and vein that are then anastomosed (joined) to blood vessels in the neck to ensure a robust blood supply. This technology is called Free Tissue Transfer and the components are referred to as Free Flaps.

Resecting head and neck cancers and benign tumours of the face and neck can create large defects that have a profound effect on cosmesis and function.

Over the past 25 - 30 years, significant advances have been made in improving patients' functional and aesthetic outcomes following creation of these defects. Most of the advances have been in reconstruction of the defects with autologous (the patient's own) tissue. A number of important anatomical donor sites have been identified from where complex tissue can be removed with its own blood supply with minimal donor site problems. Some of these sites are near the head and neck so the the tissue can be moved but is anchored by a pedicle (pedicled or regional flaps) and some are from distant sites. The tissue from these distant sites is brought up with an artery and vein that are then anastomosed (joined) to blood vessels in the neck to ensure a robust blood supply. This technology is called Free Tissue Transfer and the components are referred to as Free Flaps.

Head and Neck Surgery

Head and Neck Surgery is a subspeciality of Otolaryngology that involves diagnosis and surgical treatment of benign and malignant conditions of structures in the face, head and neck excluding the brain, spine or neck muscles. These conditions include: tumours and swellings of the thyroid and salivary glands; abnormal endocrine activity of the thyroid and parathyroid glands; congenital, inflammatory or malignant lumps in the neck. Head and neck oncologic surgery involves managing: Cancers of the tongue, palate, floor of mouth, upper and lower jaws, nasal cavity and sinuses and tumours of the throat and larynx. Malignant skin tumours or melanomas that have spread to the parotid gland, neck lymph nodes or involve large areas of skin, muscle or bone. The specialty also involves managing voice and swallowing problems. Operating on these types of conditions often creates complex defects that require reconstruction using a wide range of techniques including Free Tissue Transfer. Patients frequently require further oncologic and supportive treatment following surgery and the specialty has strong links with Oncology, Dental, Speech Therapy and Nutritional Services. Not all ENT surgeons and general surgeons are head and neck surgeons and this specialty requires training way beyond that of most basic surgical training programs. The occasional surgeon in this specialty has much higher complication rates than those who perform these procedures every week.

Head and Neck Surgery is a subspeciality of Otolaryngology that involves diagnosis and surgical treatment of benign and malignant conditions of structures in the face, head and neck excluding the brain, spine or neck muscles.

These conditions include: tumours and swellings of the thyroid and salivary glands; abnormal endocrine activity of the thyroid and parathyroid glands; congenital, inflammatory or malignant lumps in the neck.

Head and neck oncologic surgery involves managing:

  • Cancers of the tongue, palate, floor of mouth, upper and lower jaws, nasal cavity and sinuses and tumours of the throat and larynx.
  • Malignant skin tumours or melanomas that have spread to the parotid gland, neck lymph nodes or involve large areas of skin, muscle or bone.

The specialty also involves managing voice and swallowing problems.

Operating on these types of conditions often creates complex defects that require reconstruction using a wide range of techniques including Free Tissue Transfer. Patients frequently require further oncologic and supportive treatment following surgery and the specialty has strong links with Oncology, Dental, Speech Therapy and Nutritional Services.

Not all ENT surgeons and general surgeons are head and neck surgeons and this specialty requires training way beyond that of most basic surgical training programs. The occasional surgeon in this specialty has much higher complication rates than those who perform these procedures every week.

Thyroidectomy

The thyroid gland is a small organ in the midline of the neck, just below the Adam's apple. It consists of a right and left lobe joined across the front of the trachea (windpipe) by a narrow bridge of thyroid tissue called the isthmus. The job of the thyroid gland is to make a hormone called thyroxine; the gland requires a small amount of iodine in the diet to produce thyroxine. Thyroidectomy is performed for nodules or lumps, cancers, Goitre with compressive symptoms, Graves Disease and cysts that involve the gland. Either the whole gland (total thyroidectomy) or a single lobe (hemithyroidectomy or lobectomy) is removed. Occasionally most of the gland is removed but a small portion left behind (subtotal thyroidectomy). Thyroid surgery is performed under general anaesthesia through a horizontal incision low down in the front of the neck. The incision can vary in length depending on the size of the thyroid gland. There are several important structures near the thyroid gland that are at risk of injury during this type of surgery. Your surgeon will explain the risks of the operation to you.

The thyroid gland is a small organ in the midline of the neck, just below the Adam's apple. It consists of a right and left lobe joined across the front of the trachea (windpipe) by a narrow bridge of thyroid tissue called the isthmus. The job of the thyroid gland is to make a hormone called thyroxine; the gland requires a small amount of iodine in the diet to produce thyroxine.

Thyroidectomy is performed for nodules or lumps, cancers, Goitre with compressive symptoms, Graves Disease and cysts that involve the gland. Either the whole gland (total thyroidectomy) or a single lobe (hemithyroidectomy or lobectomy) is removed. Occasionally most of the gland is removed but a small portion left behind (subtotal thyroidectomy).

Thyroid surgery is performed under general anaesthesia through a horizontal incision low down in the front of the neck. The incision can vary in length depending on the size of the thyroid gland.

There are several important structures near the thyroid gland that are at risk of injury during this type of surgery. Your surgeon will explain the risks of the operation to you.

 

Parathyroidectomy

Hypercalcaemia is the medical word for a high level of calcium in the blood. This condition can occur in a number of different ways. The most common cause is primary hyperparathyroidism (overactive parathyroid glands). Secondary and tertiary hyperparathyroidism occur in renal dysfunction and result in enlargement of all four parathyroid glands. Parathyroidectomy The object of the operation is to locate and remove the overactive parathyroid tissue (usually one gland). The operation is performed through an incision in the front of the neck low down and usually in a skin crease. The thyroid gland is exposed and partially lifted out of the way to expose the parathyroid glands. The enlarged gland(s) are then removed completely. There are several important structures near the parathyroid glands that are at risk of injury during this type of surgery. Your surgeon will explain the risks of the operation to you.

Hypercalcaemia is the medical word for a high level of calcium in the blood. This condition can occur in a number of different ways. The most common cause is primary hyperparathyroidism (overactive parathyroid glands). Secondary and tertiary hyperparathyroidism occur in renal dysfunction and result in enlargement of all four parathyroid glands.

Parathyroidectomy
The object of the operation is to locate and remove the overactive parathyroid tissue (usually one gland).

The operation is performed through an incision in the front of the neck low down and usually in a skin crease. The thyroid gland is exposed and partially lifted out of the way to expose the parathyroid glands. The enlarged gland(s) are then removed completely. There are several important structures near the parathyroid glands that are at risk of injury during this type of surgery. Your surgeon will explain the risks of the operation to you.

Tonsillitis

Your tonsils are the oval-shaped lumps of tissue that lie on both sides of the back of the throat. Sometimes tonsils can become inflamed (red and swollen with white patches on them) as the result of a bacterial or viral infection; this is known as tonsillitis. If you have tonsillitis, you will have a very sore throat and maybe swollen glands on the side of your neck, a fever, headache or changes to your voice. In some cases, pus can be seen on the tonsils. Tonsillitis mostly occurs in young children and can be a recurrent condition (it keeps coming back). If the tonsillitis is caused by bacteria, antibiotics will be prescribed. If the tonsillitis is caused by a virus, treatment will usually consist of medications to relieve symptoms such as a pain killer. If tonsillitis occurs often over a period of two or more years, then surgical removal of the tonsils (tonsillectomy) may be considered.

Your tonsils are the oval-shaped lumps of tissue that lie on both sides of the back of the throat. Sometimes tonsils can become inflamed (red and swollen with white patches on them) as the result of a bacterial or viral infection; this is known as tonsillitis.
If you have tonsillitis, you will have a very sore throat and maybe swollen glands on the side of your neck, a fever, headache or changes to your voice. In some cases, pus can be seen on the tonsils.
Tonsillitis mostly occurs in young children and  can be a recurrent condition (it keeps coming back).
 
If the tonsillitis is caused by bacteria, antibiotics will be prescribed. If the tonsillitis is caused by a virus, treatment will usually consist of medications to relieve symptoms such as a pain killer.
If tonsillitis occurs often over a period of two or more years, then surgical removal of the tonsils (tonsillectomy) may be considered.
Hoarseness (Dysphonia)

Hoarseness can be described as abnormal voice changes that make your voice sound raspy and strained and higher or lower or louder or quieter than normal. These changes are usually the result of disorders of the vocal cords which are the sound-producing parts of the voice box (larynx). The most common cause of hoarseness is laryngitis (inflammation of the vocal cords) which is usually associated with a viral infection but can also be the result of irritation caused by overuse of your voice e.g. excessive singing, cheering, loud talking. Other causes of hoarseness include: nodules on the vocal cords – these may develop after using your voice too much or too loudly over a long period of time smoking gastro-oesophageal reflux disease (GERD) – stomach acid comes back up the oesophagus and irritates the vocal cords. This is a common cause of hoarseness in older people allergies polyps on the vocal cords glandular problems tumours. Diagnostic tests may include viewing the vocal cords with a mirror at the back of your throat or by inserting a small flexible tube with a camera on the end (endoscope) through your mouth. Sometimes tests may be done to analyse the sounds of your voice. Treatment depends on the cause of the hoarseness and may include resting your voice or changing how it is used, avoiding smoking, medication to slow stomach acid production and sometimes surgical removal of nodules or polyps.

Hoarseness can be described as abnormal voice changes that make your voice sound raspy and strained and higher or lower or louder or quieter than normal.
These changes are usually the result of disorders of the vocal cords which are the sound-producing parts of the voice box (larynx).
 
The most common cause of hoarseness is laryngitis (inflammation of the vocal cords) which is usually associated with a viral infection but can also be the result of irritation caused by overuse of your voice e.g. excessive singing, cheering, loud talking.
 
Other causes of hoarseness include:
  • nodules on the vocal cords – these may develop after using your voice too much or too loudly over a long period of time
  • smoking
  • gastro-oesophageal reflux disease (GERD) – stomach acid comes back up the oesophagus and irritates the vocal cords. This is a common cause of hoarseness in older people
  • allergies
  • polyps on the vocal cords
  • glandular problems
  • tumours.
 
Diagnostic tests may include viewing the vocal cords with a mirror at the back of your throat or by inserting a small flexible tube with a camera on the end (endoscope) through your mouth. Sometimes tests may be done to analyse the sounds of your voice.
 
Treatment depends on the cause of the hoarseness and may include resting your voice or changing how it is used, avoiding smoking, medication to slow stomach acid production and sometimes surgical removal of nodules or polyps.
Voice Therapy

Voice Therapy is available at Auckland City Hospital in the Outpatient Clinic on Level 6 of the Support Building (Building 1). Clinic hours: Monday to Friday: 8.00 am - 4.00 pm Referrals can be made using the eReferral system on Clinical Portal. Please select ‘SLT-Laryngology’ as the service to refer to. Alternatively referrals can be sent directly to the Central Referrals Office for Auckland DHB. Please email a written referral to Central Referrals Office and specify that the referral is for voice therapy: Email: Voice therapy is provided by a Speech-language Therapist or SLT. The SLTs on our team are: Carlene Perris Naomi McLellan Kristyn Anderson Alana Brady Voice therapy involves assessment, analysis and management of concerns relating to voice, swallowing, breathing or coughing. It is essential that a person is examined by a Laryngologist, or Ear, Nose & Throat Specialist, prior to voice therapy. At an initial voice therapy consultation, a thorough history will be taken, examining the history of the presenting issue, any triggers and potential risk factors. An auditory-perceptual, acoustic and physical examination will also take place at this initial consultation. Following this initial appointment, in consultation with the patient, voice therapy may be offered and may focus on the following: Advice to reduce laryngeal (throat) irritation Strategies to reduce laryngeal (throat) tension and discomfort Exercises to promote clear, strong voice production Recommendations to improve safety or ease of swallowing. If you have any questions about the voice therapy service at Auckland City Hospital, feel free to email the team on .

Voice Therapy is available at Auckland City Hospital in the Outpatient Clinic on Level 6 of the Support Building (Building 1).

Clinic hours: Monday to Friday: 8.00 am - 4.00 pm

Referrals can be made using the eReferral system on Clinical Portal. Please select ‘SLT-Laryngology’ as the service to refer to.

Alternatively referrals can be sent directly to the Central Referrals Office for Auckland DHB.  Please email a written referral to Central Referrals Office and specify that the referral is for voice therapy:

  • Email:

Voice therapy is provided by a Speech-language Therapist or SLT. The SLTs on our team are:

  • Carlene Perris
  • Naomi McLellan
  • Kristyn Anderson
  • Alana Brady

Voice therapy involves assessment, analysis and management of concerns relating to voice, swallowing, breathing or coughing. It is essential that a person is examined by a Laryngologist, or Ear, Nose & Throat Specialist, prior to voice therapy.

At an initial voice therapy consultation, a thorough history will be taken, examining the history of the presenting issue, any triggers and potential risk factors. An auditory-perceptual, acoustic and physical examination will also take place at this initial consultation.

Following this initial appointment, in consultation with the patient, voice therapy may be offered and may focus on the following:

  • Advice to reduce laryngeal (throat) irritation
  • Strategies to reduce laryngeal (throat) tension and discomfort
  • Exercises to promote clear, strong voice production
  • Recommendations to improve safety or ease of swallowing.

If you have any questions about the voice therapy service at Auckland City Hospital, feel free to email the team on .

Swallowing Disorders (Dysphagia)

If you find it difficult to pass food or liquid from your mouth to your stomach, you may have a swallowing disorder or dysphagia. Symptoms may include: a feeling that food is sticking in your throat, discomfort in your throat or chest, a sensation of a ‘lump’ in your throat, coughing or choking. A disorder may occur in any part of the swallowing process such as the mouth, pharynx (tube at the back of the throat that connects your mouth with your oesophagus), oesophagus (food pipe that takes food to your stomach) or stomach. Causes of dysphagia include: gastro-oesophageal reflux, a tumour, a narrowing of the swallowing passage (stricture) or a neurological disorder (such as a stroke). Diagnosis may be by examination of a mucous sample or by viewing the pharynx, oesophagus and stomach using a small, flexible tube with a tiny camera on the end that is inserted down the back of your throat. Treatments for dysphagia depend on the causes, but may include: Medication – antacids, muscle relaxants or medicine to slow down stomach acid production Lifestyle changes, eg. diet Swallowing therapy Surgery e.g. stretching or releasing a tightened muscle

If you find it difficult to pass food or liquid from your mouth to your stomach, you may have a swallowing disorder or dysphagia. Symptoms may include: a feeling that food is sticking in your throat, discomfort in your throat or chest, a sensation of a ‘lump’ in your throat, coughing or choking.
 
A disorder may occur in any part of the swallowing process such as the mouth, pharynx (tube at the back of the throat that connects your mouth with your oesophagus), oesophagus (food pipe that takes food to your stomach) or stomach.
Causes of dysphagia include: gastro-oesophageal reflux, a tumour, a narrowing of the swallowing passage (stricture) or a neurological disorder (such as a stroke).
 
Diagnosis may be by examination of a mucous sample or by viewing the pharynx, oesophagus and stomach using a small, flexible tube with a tiny camera on the end that is inserted down the back of your throat.
 
Treatments for dysphagia depend on the causes, but may include:
  • Medication – antacids, muscle relaxants or medicine to slow down stomach acid production
  • Lifestyle changes, eg. diet
  • Swallowing therapy
  • Surgery e.g. stretching or releasing a tightened muscle
Pharyngeal Pouch

A pharyngeal pouch or Zenkers Diverticulum is an outpouching of the pharynx at the level of the larynx (voice box). It occurs in older people and is a result of scarring of a band of muscle at the top of the oesophagus called the cricopharyngeus. This muscle usually relaxes during swallowing but because of the scarring it remains tight. The pressure created with the swallow causes the lining of the throat above to bulge out through a weaker area of muscle above the cricopharyngeus called Killians Dehiscence. Surgery is the only treatment for pharyngeal pouch. There are a variety of surgical approaches split into two main groups: endoscopic and external approaches.

A pharyngeal pouch or Zenkers Diverticulum is an outpouching of the pharynx at the level of the larynx (voice box). It occurs in older people and is a result of scarring of a band of muscle at the top of the oesophagus called the cricopharyngeus. This muscle usually relaxes during swallowing but because of the scarring it remains tight. The pressure created with the swallow causes the lining of the throat above to bulge out through a weaker area of muscle above the cricopharyngeus called Killians Dehiscence.

Surgery is the only treatment for pharyngeal pouch. There are a variety of surgical approaches split into two main groups: endoscopic and external approaches.

Hearing Loss

Hearing loss can be divided into two types: conductive hearing loss (caused by some sort of mechanical problem in the external or middle ear) or sensorineural hearing loss (caused by disorders of the inner ear, hearing nerve or associated brain structures). Conductive hearing loss is often reversible and can be due to: blockage of the ear by e.g. wax, inflammation, infections or middle ear fluid poor sound conduction because of e.g. holes or scarring in the eardrum or the bones of the middle ear (ossicles) becoming fixed and rigid. Sensorineural hearing loss is generally not reversible and can be caused by: genetic make-up (this could include congenital conditions i.e. those you are born with, or late-onset hearing loss) head injury tumours infections certain medications exposure to loud noises the aging process (a significant hearing loss is experienced by about one third of people aged over 70 years). Some of the signs you might notice that indicate you have a hearing loss include: having to turn up the volume on the TV or radio finding it hard to hear someone you are talking with finding it hard to hear in a group situation where there is background noise e.g. in a restaurant having to ask people to repeat themselves you find people's speech is unclear - they are mumbling Hearing loss can be partial (you can still hear some things) or complete (you hear nothing) and may occur in one or both ears. Treatment Treatments for hearing loss range from the removal of wax in the ear canal to complex surgery, depending on the cause of the loss. One of the most common treatments for hearing loss is the use of a hearing aid. The type of aid you get depends on the cause of your hearing loss and how bad it is, as well as what your preferences are in terms of comfort, appearance and lifestyle. If your hearing loss is severe to profound, you may be suitable for a surgical procedure known as a cochlear implant. In this procedure, a small cut (incision) is made behind your ear and a device is implanted that can bypass the damaged parts of your ear. The surgery usually takes 2-3 hours and is performed under general anaesthesia (you sleep through it). You may be able to go home the same day or have to spend one night in hospital.

Hearing loss can be divided into two types: conductive hearing loss (caused by some sort of mechanical problem in the external or middle ear) or sensorineural hearing loss (caused by disorders of the inner ear, hearing nerve or associated brain structures).

Conductive hearing loss is often reversible and can be due to:

  • blockage of the ear by e.g. wax, inflammation, infections or middle ear fluid
  • poor sound conduction because of e.g. holes or scarring in the eardrum or the bones of the middle ear (ossicles) becoming fixed and rigid.

Sensorineural hearing loss is generally not reversible and can be caused by:

  • genetic make-up (this could include congenital conditions i.e. those you are born with, or late-onset hearing loss)
  • head injury
  • tumours
  • infections
  • certain medications
  • exposure to loud noises
  • the aging process (a significant hearing loss is experienced by about one third of people aged over 70 years).

Some of the signs you might notice that indicate you have a hearing loss include:

  • having to turn up the volume on the TV or radio
  • finding it hard to hear someone you are talking with
  • finding it hard to hear in a group situation where there is background noise e.g. in a restaurant
  • having to ask people to repeat themselves
  • you find people's speech is unclear - they are mumbling

Hearing loss can be partial (you can still hear some things) or complete (you hear nothing) and may occur in one or both ears.

Treatment

Treatments for hearing loss range from the removal of wax in the ear canal to complex surgery, depending on the cause of the loss. One of the most common treatments for hearing loss is the use of a hearing aid. The type of aid you get depends on the cause of your hearing loss and how bad it is, as well as what your preferences are in terms of comfort, appearance and lifestyle.

If your hearing loss is severe to profound, you may be suitable for a surgical procedure known as a cochlear implant. In this procedure, a small cut (incision) is made behind your ear and a device is implanted that can bypass the damaged parts of your ear. The surgery usually takes 2-3 hours and is performed under general anaesthesia (you sleep through it). You may be able to go home the same day or have to spend one night in hospital.

Otology (Ear) Tests

Audiometry is the testing of hearing ability. You will sit in a special room wearing earphones and be asked to respond when you hear a sound through the earphones. These tests can measure your hearing levels as well as other aspects of hearing such as the ability to recognise speech against background noise. Tympanometry uses sound and air pressure to check middle ear function. A small, soft probe is placed in your ear for a few seconds and a computer measures your ears response to sounds and pressure emitted through the probe. This test is often carried out in young children to assess for glue ear.

Audiometry is the testing of hearing ability.  You will sit in a special room wearing earphones and be asked to respond when you hear a sound through the earphones.  These tests can measure your hearing levels as well as other aspects of hearing such as the ability to recognise speech against background noise.

Tympanometry uses sound and air pressure to check middle ear function.  A small, soft probe is placed in your ear for a few seconds and a computer measures your ears response to sounds and pressure emitted through the probe. This test is often carried out in young children to assess for glue ear.

Otitis Media

This is inflammation or infection of your middle ear (the space behind your eardrum) and is often associated with a build-up of fluid in your middle ear. Acute Otitis Media This is usually caused by a temporary malfunction of the Eustachian tube due to allergies, infections or trauma. The Eustachian tube connects the middle ear to the nose and allows air to enter the middle ear, thus making middle ear pressure the same as air pressure outside the head. Acute otitis media results in an infection in the middle ear causing pain, fever and a red, bulging eardrum (the thin, transparent membrane between the outer ear canal and the middle ear). This condition is usually seen in young children. The treatment may be antibiotics if it is suspected to be a bacterial, rather than viral, infection, or if there are repeated episodes, surgical insertion of grommets into the eardrums may be required. Grommets are tiny ventilation tubes that allow normal airflow into, and drainage out of, the middle ear until the Eustachian tube begins to work normally. The operation is done under general anaesthesia (the child is asleep) and takes 10-15 minutes. Most grommets fall out naturally after six to twelve months, by which time the Eustachian tubes are often working properly. Otitis Media with Effusion (Glue Ear) Like acute otitis media, glue ear is usually the result of a temporary malfunction of the Eustachian tube and may either follow an episode of acute otitis media or occur on its own. The condition is usually seen in children. Fluid is present in the middle ear and the ear is not usually painful, but the ear drum is not red and bulging and there is no fever. Glue ear may lead to hearing loss, which can result in speech delays, and balance problems. Treatment options include: a prolonged course of antibiotics; grommet insertion; or treatment with decongestants, antihistamines or steroids. Chronic Otitis Media If the Eustachian tube is blocked repeatedly over a period of several years, there may be changes to the tissues of the middle ear such as deformity of the ear drum and damage to the bones of the ear. These changes may result in hearing problems, balance problems, and persistent deep ear pain. If such long term damage has occurred, an operation called tympanomastoidectomy may be required. This involves making an incision (cut) behind or around the upper part of your ear, drilling through the mastoid bone and removing, and possibly repairing, damaged tissues.

This is inflammation or infection of your middle ear (the space behind your eardrum) and is often associated with a build-up of fluid in your middle ear.

Acute Otitis Media

This is usually caused by a temporary malfunction of the Eustachian tube due to allergies, infections or trauma.  The Eustachian tube connects the middle ear to the nose and allows air to enter the middle ear, thus making middle ear pressure the same as air pressure outside the head.  Acute otitis media results in an infection in the middle ear causing pain, fever and a red, bulging eardrum (the thin, transparent membrane between the outer ear canal and the middle ear).  This condition is usually seen in young children.  The treatment may be antibiotics if it is suspected to be a bacterial, rather than viral, infection, or if there are repeated episodes, surgical insertion of grommets into the eardrums may be required.  Grommets are tiny ventilation tubes that allow normal airflow into, and drainage out of, the middle ear until the Eustachian tube begins to work normally.  The operation is done under general anaesthesia (the child is asleep) and takes 10-15 minutes. Most grommets fall out naturally after six to twelve months, by which time the Eustachian tubes are often working properly.

Otitis Media with Effusion (Glue Ear)

Like acute otitis media, glue ear is usually the result of a temporary malfunction of the Eustachian tube and may either follow an episode of acute otitis media or occur on its own. The condition is usually seen in children. Fluid is present in the middle ear and the ear is not usually painful, but the ear drum is not red and bulging and there is no fever. Glue ear may lead to hearing loss, which can result in speech delays, and balance problems. Treatment options include: a prolonged course of antibiotics; grommet insertion; or treatment with decongestants, antihistamines or steroids.

Chronic Otitis Media

If the Eustachian tube is blocked repeatedly over a period of several years, there may be changes to the tissues of the middle ear such as deformity of the ear drum and damage to the bones of the ear. These changes may result in hearing problems, balance problems, and persistent deep ear pain.  If such long term damage has occurred, an operation called tympanomastoidectomy may be required. This involves making an incision (cut) behind or around the upper part of your ear, drilling through the mastoid bone and removing, and possibly repairing, damaged tissues.

Otosclerosis

When the growth of one of the tiny bones in your middle ear, the stapes, changes from hard to soft and spongy, it leads to the condition called otosclerosis. As this abnormal growth develops, the stapes becomes more rigid or fixed in position. The stapes needs to be able to vibrate to allow sound vibrations to pass through to the inner ear. When the stapes is not vibrating as well as it should, gradual hearing loss can occur. Otosclerosis may occur in one or both ears and may sometimes be associated with ringing/clicking/buzzing noises in your ear (tinnitus). The condition will be diagnosed by hearing tests and tympanometry. Otosclerosis most often develops during teenage and early adult years and it tends to run in families. The condition can become worse during pregnancy. Treatment There are several different approaches to treating otosclerosis, one of the most common being a surgical procedure called stapedectomy. This is a microsurgical procedure (microscopic lenses are used to help the surgeon see the tiny structures involved) usually performed through the ear canal. A small cut (incision) is made in the ear canal near the eardrum and the eardrum is lifted, exposing the middle ear and its bones. Part of the stapes bone is removed and an artificial prosthesis inserted to help transmit sound into the inner ear. The eardrum is then folded back into position. The surgery can either be performed under general anaesthetic (you sleep through it) or local anaesthetic (the area treated is numbed) plus sedation (you are given medication to make you feel sleepy). You will be advised not to fly, blow your nose or allow any water to get into your ear for about six weeks after the operation. Other treatments include use of a hearing aid or taking sodium fluoride which helps harden the bone and can improve hearing in many patients with otosclerosis.

When the growth of one of the tiny bones in your middle ear, the stapes, changes from hard to soft and spongy, it leads to the condition called otosclerosis. As this abnormal growth develops, the stapes becomes more rigid or fixed in position. The stapes needs to be able to vibrate to allow sound vibrations to pass through to the inner ear. When the stapes is not vibrating as well as it should, gradual hearing loss can occur. Otosclerosis may occur in one or both ears and may sometimes be associated with ringing/clicking/buzzing noises in your ear (tinnitus). The condition will be diagnosed by hearing tests and tympanometry. Otosclerosis most often develops during teenage and early adult years and it tends to run in families. The condition can become worse during pregnancy.

Treatment

There are several different approaches to treating otosclerosis, one of the most common being a surgical procedure called stapedectomy. This is a microsurgical procedure (microscopic lenses are used to help the surgeon see the tiny structures involved) usually performed through the ear canal. A small cut (incision) is made in the ear canal near the eardrum and the eardrum is lifted, exposing the middle ear and its bones. Part of the stapes bone is removed and an artificial prosthesis inserted to help transmit sound into the inner ear. The eardrum is then folded back into position. The surgery can either be performed under general anaesthetic (you sleep through it) or local anaesthetic (the area treated is numbed) plus sedation (you are given medication to make you feel sleepy). You will be advised not to fly, blow your nose or allow any water to get into your ear for about six weeks after the operation. Other treatments include use of a hearing aid or taking sodium fluoride which helps harden the bone and can improve hearing in many patients with otosclerosis.
Meniere's Disease

Meniere's disease is a disorder in which there is an abnormality in the fluids of the inner ear resulting in increased pressure in the inner ear. There is no general agreement as to what causes this abnormality, but there are probably many different causes including injury (immune, infectious, trauma, allergic etc) to the ear. Symptoms of Meniere's include episodes: of vertigo (you feel you are spinning), hearing loss that comes and goes, tinnitus (ringing/clicking/buzzing noises in your ear), a feeling of fullness around your ear. Episodes may last for hours or days. The condition will be diagnosed using hearing tests and possibly an MRI or CT scan. Meniere's disease usually occurs in one ear only and typically appears between the ages of 20 and 50 years. Treatment The initial treatment approach is usually a lifestyle and diet change, including a low salt diet; avoidance of alcohol, tobacco, caffeine and stress; and increased exercise and rest. The majority of patients find that these changes can help control their symptoms. Diuretic medication (reduces the amount of fluid in your body) may also be introduced. In severe cases where dietary/lifestyle changes have not been successful, surgery may be considered.

Meniere's disease is a disorder in which there is an abnormality in the fluids of the inner ear resulting in increased pressure in the inner ear. There is no general agreement as to what causes this abnormality, but there are probably many different causes including injury (immune, infectious, trauma, allergic etc) to the ear. Symptoms of Meniere's include episodes: of vertigo (you feel you are spinning), hearing loss that comes and goes, tinnitus (ringing/clicking/buzzing noises in your ear), a feeling of fullness around your ear. Episodes may last for hours or days. The condition will be diagnosed using hearing tests and possibly an MRI or CT scan. Meniere's disease usually occurs in one ear only and typically appears between the ages of 20 and 50 years.

Treatment

The initial treatment approach is usually a lifestyle and diet change, including a low salt diet; avoidance of alcohol, tobacco, caffeine and stress; and increased exercise and rest. The majority of patients find that these changes can help control their symptoms. Diuretic medication (reduces the amount of fluid in your body) may also be introduced. In severe cases where dietary/lifestyle changes have not been successful, surgery may be considered.
Acoustic Neuroma

This is a slow-growing, benign (non-cancerous) overgrowth of tissue on the nerves that affect your hearing and balance. When the neuroma is small, there may either be no symptoms or you may have a slight hearing loss or mild tinnitus (ringing/clicking/buzzing noises in your ear). As the neuroma grows and exerts pressure on the nerves, there will be a more noticeable loss of hearing, more tinnitus and problems with balance. The condition is diagnosed using hearing tests and MRI or CT scans. Acoustic neuromas are usually found only in one ear and generally occur in people over 40 years of age. Treatment If the neuroma is small and not causing significant problems, you may not receive any treatment but the growth and effects of the neuroma will be monitored regularly. If treatment is being considered, it may be either radiotherapy or surgery. Radiotherapy, which is used for small to medium neuromas, involves low-dose beams of radiation aimed at the neuroma. This does not require anaesthesia but you will probably be in hospital for 1-2 days. For larger neuromas that are causing significant problems, surgical treatment may be suggested. Depending on the size of the neuroma, there are several different types of operation that can be performed. Whatever surgical approach is used, it will be performed under general anaesthetic (you will sleep through it) and you will probably remain in hospital for about one week.

This is a slow-growing, benign (non-cancerous) overgrowth of tissue on the nerves that affect your hearing and balance. When the neuroma is small, there may either be no symptoms or you may have a slight hearing loss or mild tinnitus (ringing/clicking/buzzing noises in your ear). As the neuroma grows and exerts pressure on the nerves, there will be a more noticeable loss of hearing, more tinnitus and problems with balance. The condition is diagnosed using hearing tests and MRI or CT scans.

Acoustic neuromas are usually found only in one ear and generally occur in people over 40 years of age.

Treatment

If the neuroma is small and not causing significant problems, you may not receive any treatment but the growth and effects of the neuroma will be monitored regularly.

If treatment is being considered, it may be either radiotherapy or surgery.

Radiotherapy, which is used for small to medium neuromas, involves low-dose beams of radiation aimed at the neuroma. This does not require anaesthesia but you will probably be in hospital for 1-2 days.

For larger neuromas that are causing significant problems, surgical treatment may be suggested. Depending on the size of the neuroma, there are several different types of operation that can be performed. Whatever surgical approach is used, it will be performed under general anaesthetic (you will sleep through it) and you will probably remain in hospital for about one week.

Cochlear Implants for Adults in New Zealand

Cochlear implants can be used at any age to treat severe to profound sensorineural hearing loss which is not helped by appropriate quality hearing aids. Most people are aware of this advanced technology for children, but not for adults who can speak but have lost hearing. New Zealand has a publicly funded service for this, allowing 40 adults (aged over 19 years) per year to have one cochlear implant fitted. Full funding for bilateral implants for children up to 19 years is available. There is also a private service for adults; the specialist and hospital costs can be covered by medical insurance but not the device. Children have a fully funded service with separate funding. The need for adults is thought to be many more than referred, with only 1 in 20 being identified. New Zealand has over 20,000 people with severe hearing loss which is a severe disability in terms of socialisation, employment, isolation and mental health issues. There are two main centres for surgical assessment and implantation if appropriate, Auckland and Christchurch, and two schemes north and south. New Zealand was one of the early adopters of cochlear implants in the world starting in the 1980s. Over the past 30 years advancements in cochlear implant technology have changed the lives of many adults giving them back hearing with improved health and quality of life outcomes. The under recognition of availability for adults is a worldwide phenomenon for a mix of reasons, the first being awareness and experience by GPs, practice nurses, audiologists and ENT specialists, and then amongst the patients themselves. Hearing loss is an invisible disability. Stigma, under-confidence and communication difficulties may hold the patient back from seeking help. Adults living with deteriorating hearing often withdraw in order to limit social embarrassment and communication difficulty - including with their regular healthcare providers. Hearing loss has been viewed by society as an inevitable consequence of ageing, by contrast we don’t regard blindness from cataracts as acceptable. In addition, most media coverage refers to children. Being aware and raising this with our patients and / or family is often the first step towards a life changing device. WHO released figures in 2018 showing an estimated 466 million people worldwide, about 6% of the world’s population, have disabling hearing loss. They released this statement, supported by New Zealand: “Hearing loss can no longer be ignored as a health priority. We know it affects a third of older people. Evidence reveals it will significantly impact individuals, health systems and society as people live longer.” What is a Cochlear Implant (CI)? A CI is a surgically implanted electronic device that provides the sensation of sound. There are two parts: The implant which is placed just under the skin behind the ear. It has an array of electrodes that are placed inside the cochlear by a specialist surgeon The processor is worn behind the ear and sits lightly on the side of the head held in place by a magnet. A microphone gathers sound and the processor converts this and sends it to the implant which stimulates the auditory nerve. The brain interprets this as sound. What are the benefits? The return of hearing and the ability to converse normally. What are the risks? Minimal wound with very low risk of infection. The usual perioperative risks associated with surgery and co-morbidities. What are the drawbacks? One CI works well. Two is ideal but not publicly funded. Often an additional hearing aid will be worn to collect low tones. An annual check-up is required to re tune and check the device. Cost? Free if meet criteria. Private $40,000 – $50,000 Is it waterproof? The processor can be removed at any time or covered with a bespoke waterproof cover. How a cochlear implant works (MP4, 7.5 MB)

Cochlear implants can be used at any age to treat severe to profound sensorineural hearing loss which is not helped by appropriate quality hearing aids. Most people are aware of this advanced technology for children, but not for adults who can speak but have lost hearing.

New Zealand has a publicly funded service for this, allowing 40 adults (aged over 19 years) per year to have one cochlear implant fitted. Full funding for bilateral implants for children up to 19 years is available.

There is also a private service for adults; the specialist and hospital costs can be covered by medical insurance but not the device. Children have a fully funded service with separate funding.

The need for adults is thought to be many more than referred, with only 1 in 20 being identified. New Zealand has over 20,000 people with severe hearing loss which is a severe disability in terms of socialisation, employment, isolation and mental health issues.

There are two main centres for surgical assessment and implantation if appropriate, Auckland and Christchurch, and two schemes north and south.

New Zealand was one of the early adopters of cochlear implants in the world starting in the 1980s. Over the past 30 years advancements in cochlear implant technology have changed the lives of many adults giving them back hearing with improved health and quality of life outcomes. The under recognition of availability for adults is a worldwide phenomenon for a mix of reasons, the first being awareness and experience by GPs, practice nurses, audiologists and ENT specialists, and then amongst the patients themselves. Hearing loss is an invisible disability. Stigma, under-confidence and communication difficulties may hold the patient back from seeking help. Adults living with deteriorating hearing often withdraw in order to limit social embarrassment and communication difficulty - including with their regular healthcare providers. Hearing loss has been viewed by society as an inevitable consequence of ageing, by contrast we don’t regard blindness from cataracts as acceptable. In addition, most media coverage refers to children. Being aware and raising this with our patients and / or family is often the first step towards a life changing device.
WHO released figures in 2018 showing an estimated 466 million people worldwide, about 6% of the world’s population, have disabling hearing loss. They released this statement, supported by New Zealand:

“Hearing loss can no longer be ignored as a health priority. We know it affects a third of older people. Evidence reveals it will significantly impact individuals, health systems and society as people live longer.”

What is a Cochlear Implant (CI)?

A CI is a surgically implanted electronic device that provides the sensation of sound.

There are two parts:

  1. The implant which is placed just under the skin behind the ear. It has an array of electrodes that are placed inside the cochlear by a specialist surgeon
  2. The processor is worn behind the ear and sits lightly on the side of the head held in place by a magnet. A microphone gathers sound and the processor converts this and sends it to the implant which stimulates the auditory nerve. The brain interprets this as sound. 

What are the benefits?

  • The return of hearing and the ability to converse normally.

What are the risks?

  • Minimal wound with very low risk of infection.
  • The usual perioperative risks associated with surgery and co-morbidities.

What are the drawbacks?

  • One CI works well. Two is ideal but not publicly funded. Often an additional hearing aid will be worn to collect low tones.
  • An annual check-up is required to re tune and check the device.

Cost?

  • Free if meet criteria.
  • Private $40,000 – $50,000

Is it waterproof?

  • The processor can be removed at any time or covered with a bespoke waterproof cover.
Rhinitis

Rhinitis is the inflammation of the lining of the nose (nasal mucosa). The most common symptoms are a blocked, runny and itchy nose. Rhinitis can be: allergic – either seasonal (hay fever) caused by pollen allergies or perennial caused by e.g. house dust mite, pets. infectious – e.g. the common cold non-allergic, non-infectious – caused by irritants such as smoke, fumes, food additives In the case of allergic rhinitis, the specific allergen (the thing that you are allergic to) may be identified by skin prick tests. This involves placing a drop of the allergen on your skin and then scratching your skin through the drop. If you are allergic, your skin will become red and swollen at the site. Treatment of allergic rhinitis involves avoiding the allergen if possible, but if not possible then corticosteroid nasal sprays and antihistamines are the usual medications prescribed.

Rhinitis is the inflammation of the lining of the nose (nasal mucosa). The most common symptoms are a blocked, runny and itchy nose.
 
Rhinitis can be:
  • allergic – either seasonal (hay fever) caused by pollen allergies or perennial caused by e.g. house dust mite, pets.
  • infectious – e.g. the common cold
  • non-allergic, non-infectious – caused by irritants such as smoke, fumes, food additives
 
In the case of allergic rhinitis, the specific allergen (the thing that you are allergic to) may be identified by skin prick tests. This involves placing a drop of the allergen on your skin and then scratching your skin through the drop. If you are allergic, your skin will become red and swollen at the site.
 
Treatment of allergic rhinitis involves avoiding the allergen if possible, but if not possible then corticosteroid nasal sprays and antihistamines are the usual medications prescribed. 
Sinusitis

In the facial bones surrounding your nose, there are four pairs of hollow air spaces known as sinuses or sinus cavities. These sinuses all open into your nose, allowing air to move into and out of the sinus and mucous to drain into the nose and the back of your throat. If the passage between the nose and sinus becomes swollen and blocked, then air and mucous can become trapped in the sinus cavity causing inflammation of the sinus membranes or linings. This is known as sinusitis. Sinusitis can be: acute - usually a bacterial (or sometimes viral) infection in the sinuses that follows a cold, or an allergic reaction. chronic - a long term condition that lasts for more than 3 weeks and may or may not be caused by an infection. Sinusitis can be a recurrent condition which means it may occur every time you get a cold. Symptoms of sinusitis include: facial pain or pressure nasal congestion (blocking) nasal discharge headaches fever. Treatment for bacterial sinusitis is antibiotics and for non-infective sinusitis may include steroid nasal sprays and nasal washes. If this treatment is unsuccessful, surgery may be considered. This is usually performed endoscopically; a tiny camera attached to a tube (endoscope) is inserted into your nose. Very small instruments can be passed through the endoscope and used to remove abnormal or obstructive tissue thus restoring movement of air and mucous between the nose and the sinus.

In the facial bones surrounding your nose, there are four pairs of hollow air spaces known as sinuses or sinus cavities. These sinuses all open into your nose, allowing air to move into and out of the sinus and mucous to drain into the nose and the back of your throat. If the passage between the nose and sinus becomes swollen and blocked, then air and mucous can become trapped in the sinus cavity causing inflammation of the sinus membranes or linings.  This is known as sinusitis.
Sinusitis can be:
  •   acute -  usually a bacterial (or sometimes viral) infection in the sinuses that follows a cold, or an allergic reaction.
  •   chronic - a long term condition that lasts for more than 3 weeks and may or may not be caused by an infection.
Sinusitis can be a recurrent condition which means it may occur every time you get a cold.
 
Symptoms of sinusitis include:
  •     facial pain or pressure
  •     nasal congestion (blocking)
  •     nasal discharge
  •     headaches
  •     fever.
 
Treatment for bacterial sinusitis is antibiotics and for non-infective sinusitis may include steroid nasal sprays and nasal washes.
If this treatment is unsuccessful, surgery may be considered. This is usually performed endoscopically; a tiny camera attached to a tube (endoscope) is inserted into your nose. Very small instruments can be passed through the endoscope and used to remove abnormal or obstructive tissue thus restoring movement of air and mucous between the nose and the sinus.
Snoring

Snoring is the harsh rattling noise made by some people when they sleep. Snoring occurs when the flow of air through the back of the mouth and nose becomes partially blocked and structures such as the tongue, soft palate (the back part of the roof of the mouth) and uvula (the tag that hangs at the back of the mouth) strike each other and vibrate. Causes of snoring include: nasal polyps; a bend in the nasal septum (the partition running down the middle of the nose), large tonsils or adenoids, obesity, smoking, excess alcohol. Surgical treatment of snoring involves the removal of excess loose tissue in the throat or soft palate.

Snoring is the harsh rattling noise made by some people when they sleep. Snoring occurs when the flow of air through the back of the mouth and nose becomes partially blocked and structures such as the tongue, soft palate (the back part of the roof of the mouth) and uvula (the tag that hangs at the back of the mouth) strike each other and vibrate.
 
Causes of snoring include: nasal polyps; a bend in the nasal septum (the partition running down the middle of the nose), large tonsils or adenoids, obesity, smoking, excess alcohol.
 
Surgical treatment of snoring involves the removal of excess loose tissue in the throat or soft palate.
Obstructive Sleep Apnoea (OSA)

When snoring is interrupted by episodes of totally obstructed breathing, it is known as obstructive sleep apnoea. The obstruction is caused by the relaxation of muscles that support the soft tissues at the back of the throat such as the uvula, soft palate, tongue and tonsils. These tissues then collapse and momentarily block the airway. Episodes may last 20 seconds or more and may occur hundreds of times per night. While you are not breathing, the levels of oxygen in your blood drop which causes your blood pressure to go up and adds strain to your cardiovascular system. In addition, you are likely to feel overly tired during the day and your work, driving and overall performance may be affected. The usual treatment for OSA is to wear a nasal mask that delivers pressurised air to keep the airways open while you sleep. This treatment is known as Continuous Positive Airway Pressure (CPAP).

When snoring is interrupted by episodes of totally obstructed breathing, it is known as obstructive sleep apnoea. The obstruction is caused by the relaxation of muscles that support the soft tissues at the back of the throat such as the uvula, soft palate, tongue and tonsils. These tissues then collapse and momentarily block the airway.
 
Episodes may last 20 seconds or more and may occur hundreds of times per night. While you are not breathing, the levels of oxygen in your blood drop which causes your blood pressure to go up and adds strain to your cardiovascular system. In addition, you are likely to feel overly tired during the day and your work, driving and overall performance may be affected.
 
The usual treatment for OSA is to wear a nasal mask that delivers pressurised air to keep the airways open while you sleep. This treatment is known as Continuous Positive Airway Pressure (CPAP).
Ear Nurse Specialist

The Ear Nurse Specialist at ADHB works from the Ear Clinic at Greenlane Clinical Centre. The following services are offered: Remove wax safely by suction and probe (e.g. patients with perforations, grommets, wax impactions etc). Diagnose and manage otitis media. Refer as necessary to other specialists e.g. Otolaryngologist, Audiologist. Treat otitis externa. Treat otorrhoea. Remove foreign bodies from the ear canal. Clean mastoid cavities. Your GP can refer you to this service.

The Ear Nurse Specialist at ADHB works from the Ear Clinic at Greenlane Clinical Centre.

The following services are offered:

  • Remove wax safely by suction and probe (e.g. patients with perforations, grommets, wax impactions etc).
  • Diagnose and manage otitis media.
  • Refer as necessary to other specialists e.g. Otolaryngologist, Audiologist.
  • Treat otitis externa.
  • Treat otorrhoea.
  • Remove foreign bodies from the ear canal.
  • Clean mastoid cavities.

Your GP can refer you to this service.

Contact Details

Auckland City Hospital

Central Auckland

  • Patient enquiries

    (09) 375 4300

  • Known extension/pager

    (09) 307 4949

  • Acute Referrals Service

    (09) 375 7030, Ext: 24048 

  • Emergency Department

    (09) 367 0000, open 24 hours / 7 days

  • Outpatient appointments & surgical booking enquiries

    (09) 638 0400 / scheduling@adhb.govt.nz 

Mental Health Services

  • 24 Hour Crisis Line

    0800 800717

  • GP / External Specialist Help Desk

    (09) 307 2800

2 Park Road
Grafton
Auckland 1023

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Street Address

2 Park Road
Grafton
Auckland 1023

Postal Address

Private Bag 92 024
Auckland Mail Centre
Auckland 1142

This page was last updated at 11:40AM on February 22, 2024. This information is reviewed and edited by ENT - Otorhinolaryngology (ORL) | Auckland | Te Toka Tumai | Te Whatu Ora.