ENT

Rhinology is a subspecialty of ENT medicine focused on the study, diagnosis, and treatment of conditions related to the nose. Common complaints include nasal blockage, sneezing, runny nose, nasal discharge, nasal bleeding, headache, trauma, and visual disturbance.

Conditions We Treat

• Deviated nasal septum
• Acute and chronic rhino sinusitis
• Nasal polyposis
• Allergic rhinitis
• Nasal bleeding (epistaxis)
• Nasal bone fracture
• Malignancy of paranasal sinus, nasal cavity
• CSF rhinorrhoea

Investigations

• Blood tests
• Complete blood count (СВС)
• Computed tomography (CT) paranasal sinus (PNS)
• Magnetic resonance imaging (MRI)
• Nasal culture/swabs (collecting a sample for laboratory analysis)
• Allergy testing (comprehensive allergy panel testing, skin prick testing)

Non-surgical procedures

• Nasal packing/nasal bleeding management
• Nasal cleaning/suctioning (endoscope-guided)

Surgical procedures

• Nasal biopsy: Sample taken from the nasal tissue for investigation
• Nasal foreign body removal: Extracting objects lodged in the nasal cavity
• Nasal one fracture reduction: Correction of nasal bone fracture
• Septoplasty (endoscopic): Correcting a deviated septum to improve airflow
• Endoscopic sinus surgery: Removing nasal polyps and improving sinus drainage
• Balloon sinuplasty: Using a balloon catheter to open blocked sinus passages
• Turbinoplasty/turbinectomy: Reducing the size of the nasal turbinate to enhance breathing
• Rhinoplasty: Cosmetic surgery to improve nose shape
• Cerebrospinal fluid (CSF) leak repair (endoscopic)
• Optic nerve decompression: Releasing swelling- or trauma-induced pressure over the optic nerve

Laryngology, or voice and swallowing conditions, refers to a broad range of conditions and disorders that affect a person's ability to speak or perform normal daily activities, such as eating and drinking. Vocal professionals, like singers, teachers, public speakers, and sales people, are more prone to voice-related issues, such as changes/hoarseness of voice, inability to reach high pitch while singing, and sore throat. Such cases require a multi-disciplinary approach, which is provided by our multispecialty hospital, to ensure patient-centric care. Our Voice and Swallow Team manages conditions related to the larynx (voice box), in addition to other voice and swallow disorders, such as breathing or swallowing difficulties, coughing or gagging, regurgitation, frequent heartburn, and even severe conditions like laryngeal cancer. Treatment may include medications, voice therapy, or minimally invasive surgery.

Conditions We Treat

• Laryngitis (acute and chronic)
• Granuloma/contact ulcer
• Reinke's oedema
• Scarring and sulcus vocalis
• Vascular lesions such as vocal haemorrhage and varix
• Laryngeal papillomatosis
• Spasmodic dysphonia
• Vocal cord paralysis
• Vocal fold cancer
• Neurogenic disorders
• Spasmodic dysphonia (voice changes related to the brain and nervous system, or muscle dysfunction)
• Puberphonia
• Polyps, nodules, or cysts on the vocal cords
• Precancerous and cancerous growths
• Leucoplakia (white patches)
• Vocal cord scarring
• Achalasia
• Oesophageal spasm
• Oesophageal tumours
• Oesophageal ring
• GERD: Regurgitation of stomach acid into the oesophagus can damage oesophageal tissues
• Scleroderma: This causes frequent heartburn
• Neurological disorders: Diseases such as multiple sclerosis, muscular dystrophy, and Parkinson's disease can cause dysphagia
• Neurological damage: Sudden neurological damage caused by conditions, such as stroke or a brain or spinal cord injury, can affect the ability to swallow
• Pharyngoesophageal diverticulum (also known as Zenker diverticulum)
• Complications due to difficult or problematic swallowing
• Aspiration pneumonia: Caused by bacteria that enter the lungs through the airway along with food or liquid during swallowing
• Emergency:
• Foreign body removal
• Trauma
• Angioedema
• Anaphylaxis

Examinations

• Physical examination and history-taking
• Thorough evaluation by a speech-language/swallow therapist
• Laryngoscopy (rigid or flexible): Examination of the voice box
• Videostroboscopy: Use of strobe lights to view vocal cord vibrations in slow motion to assess vocal cord function

Investigations

• Flexible endoscopic evaluation of swallowing (FEES): To assess the swallowing function as food and beverages pass through the throat
• Narrow band imaging
• Electromyography
• Transnasal esophagoscopy
• Videofluoroscopic evaluation of swallowing
• Neck ultrasonography (USG)
• CT
• MRI
• Barium swallow
• Blood tests

Procedures

• Microlaryngoscopy (conventional or laser-assisted): Minimally invasive surgery for benign (noncancerous) entities like polyps or nodules
• Injection laryngoplasty: Injecting Botulinum, collagen, or other gel fillers to temporarily manage vocal cord paralysis or muscle weakness
• Laryngoplasty and thyroplasty: For improving muscle attachment to the vocal cords to improve their function
• Laryngectomy and laryngeal reconstruction surgery
• Biopsy: For examining any suspected mass or lesion and to help diagnose granulomatous or autoimmune disorders
• CO2 laser surgery: For vocal cord cysts or nodules and cancer treatment.
• CO2 and potassium titanyl phosphate (KTP) laser treatment: For removing vocal cord lesions while preserving the nearby healthy tissue
• Spasmodic dysphonia
• Vocal cord medialisation and lateralisation
• Phonosurgery
• Mass excision with co-ablation
• Endoscopic surgery
• Transoral laser microsurgery
• Subglotic and tracheal stenosis surgery: endoscopic conventional and balloon dilation
• Professional voice-modulation surgery
• Post-radiation therapy: This treatment can lead to inflammation and scarring of the oesophagus

Common head- and neck-related complaints include pain, headaches, neck swelling, oral cavity ulcers, restricted mouth opening, facial swelling, proptosis, epiphora, epistaxis, clear fluid discharge from the nose, oral cavity lesions, haemoptysis, hematemesis, loss of smell or vision, and personality changes. These conditions require detailed history taking by the ENT specialist followed by a meticulous ear, nose, and throat examination.

Examinations

• Physical examination of the ears, nose, and throat
• Nasal endoscopy
• Flexible laryngoscopy
• Neck examination

Investigations

• USG
• CT
• MRI
• FNAC
• Biopsy
• HPE

Surgical procedures

• Thyroidectomy: For benign and malignant conditions of the thyroid (multinodular goitre, papillary carcinoma of thyroid, follicular neoplasm of thyroid)
• Parotidectomy: Superficial and deep lobe for parotid tumours (pleomorphic adenoma, Warthin’s tumour, adenoid cystic carcinoma)
• Submandibular gland excision: For benign and malignant conditions of the submandibular gland (pleomorphic adenoma, mucoepidermoid carcinoma, submandibular sialolithiasis)
• Sialendoscopy: For sialadenitis, sialectasis and sialolithiasis
• Sistrunk operation: For thyroglossal cyst and sinus
• Maxillectomy: For paranasal sinus tumours (carotid artery, maxilla)
• Excision of oral swellings (leukoplakia, mucous retention cyst)
• Tracheostomy: For stridor (respiratory distress due to growth in airways)
• Tracheoplasty: For airway stenosis (resection and end-to-end anastomosis of stenotic airway)
• Laryngectomy: For laryngeal cancer
• Drainage of retropharyngeal and parapharyngeal abscesses (deep neck space infections)
• Tonsillectomy and adenoidectomy (recurrent tonsillitis and adenoid hypertrophy)
• Sleep apnoea surgeries (uvulopalatoplasty, tongue base reduction, epiglottis trimming)
• Choanal atresia surgery (congenital nasal anomaly)
• Transsphenoidal pituitary tumour excision (pituitary adenoma, pituitary apoplexy, prolactinoma)
• Optic nerve decompression (traumatic)
• Orbital decompression for thyroid eye disease
• Foreign body removal from ear, nose, trachea, and oesophagus (bronchoscopy, esophagoscopy)
• CSF rhinorrhoea repair (repair of a defect in brain covering)

The Paediatric ENT Department at Sir H.N. Reliance Foundation Hospital provides expert care for children with a wide range of ear, nose, and throat conditions. With a team of skilled paediatric ENT specialists, surgeons, audiologists, and nurses, we deliver personalised treatment plans that prioritise the well-being of each child. Our approach ensures the highest standard of care in a supportive, child-friendly environment, where every child’s unique needs are met with compassion and expertise.

Know more

The programmes for speech, language, and swallowing therapy at Sir H.N. Reliance Foundation Hospital include:

• Speech and Language Development Programme: The Speech and Language Therapy Programme is recommended for children with speech and language disorders, delays, and disabilities. The children receive high-quality evaluations, coordinated multi-disciplinary healthcare, and interventions with state-of-the-art medical technology to support their physical, emotional, social, and academic development.
• Articulation and Phonological Intervention Clinic: This programme is for children and adults with difficulties in producing speech sounds or groups of speech sounds that persist beyond the typical period of speech development and/or result in difficulty understanding speech. This programme includes screening, assessment, diagnosis, and treatment of persons with speech sound disorders. Latest evidence-based methods, such as oral placement therapy, are used as interventions.
• Voice Clinic: This programme is for singers, actors, TV news broadcasters, telemarketing agents, teachers, and other professionals who use their voice to perform their jobs. Additionally, it is also useful for patients with neurological conditions or those experiencing the side effect of treatments such as radiation therapy for cancer. This programme includes diagnosis and management of patients with voice disorders like dysphonia, puberphonia, and presbyphonia (voice).
• Neurocommunication Disorder Clinic: This programme is for patients experiencing speech and language difficulties post brain injury or as complications of neuroprogressive disorders such as Parkinson’s disease. The Speech, Language, and Swallowing Therapists will assess and recommend exercises to help the patient regain/improve lost functions. We also offer the Lee Silverman Voice Therapy Programme for patients with Parkinson's disease.
• Augmentative and Alternative Communication Intervention: Alternative and Augmentative Communications are a set of strategies, methods, and devices to assist people who are unable to meet their communication needs through speech or writing.
• Stuttering Intervention: Stuttering is a complex disorder. This programme includes a multi-modal approach to bring about the behavioural changes needed to achieve improvements that will be integrated into daily life.
• Onco-rehabilitation: For patients with head and neck tumours, assessment and treatment are offered at various stages of therapy, i.e. pre-surgery, post-surgery, during radiation, and post-radiation.
• Swallowing Clinic: Dysphagia, i.e., difficulty in swallowing, can occur as a result of neurological conditions, oncological conditions, or developmental disabilities. We provide detailed assessments, including bedside clinical assessment, FEES, and Modified Barium Swallow.

Other programmes, such as muscle strengthening programme, electrical stimulation, vital Stim, and diet modification, are used with appropriate patient education to achieve safe and efficient swallowing.

We provide comprehensive audiological services and specialise in identifying, diagnosing, treating, and monitoring the disorders of the auditory and vestibular systems, such as hearing loss, tinnitus, and balance disorders. We provide hearing aids, manage and rehabilitate individuals with hearing loss, and assess candidacy for hearing implants, such as cochlear implants and bone conduction implants.

Hearing Aid Clinic

In the Hearing Aid Clinic, we provide awareness regarding the prevention of hearing loss. We also provide counselling on hearing loss and hearing aid trial, fitting, and troubleshooting. Our team of audiologists brings extensive experience and expertise to provide the highest standard of care. We provide customised gadgets utilising cutting-edge technology for optimal fitting and comprehensive counselling to guide individuals through the adjustment and rehabilitation process. We provide individualised rehabilitation programmes enhanced by advanced auditory training tools to ensure the achievement of optimal hearing potential. From initial assessments to ongoing support, our clinic offers a continuum of care to address all aspects of hearing health.

Hearing Aid Clinic services include:

• Hearing assessments: Our clinic provides thorough hearing assessments conducted by skilled audiologists. These evaluations help determine the extent of hearing loss, enabling us to create personalised treatment plans.
• Consultations: Our team attempts to understand each patient's unique needs, lifestyle, and communication preferences. Through detailed consultations, we guide individuals in selecting the most suitable hearing aid options.
• Hearing aid fittings: Precise and comfortable fittings are crucial for optimal hearing aid performance. Our audiologists ensure that the chosen devices are custom-programmed and adjusted to meet the individual requirements of each patient.
• Trial periods: We offer trial periods for selected hearing aids, allowing patients to experience the benefits in real-life situations before making a final decision. This ensures satisfaction and confidence in their chosen devices.
• Follow-up care: Our commitment extends beyond the initial fitting. We provide ongoing support, adjustments, and follow-up appointments to address any concerns, ensuring that patients continue to optimally enjoy their hearing aids.