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.

Benign Paroxysmal Positional Vertigo

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. You will be assessed in the clinic before decisions on management are made. You may have to go to Auckland for some of these treatments. 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 Lumps in the neck may be the first sign that a patient has a head and neck cancer.

Head and Neck Surgery is a subspecialty 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 extra training. Northland Head and Neck surgeons work in conjunction with the surgeons in Auckland. Some of your treatment may be able to be done in Whangarei, but most will be done in Auckland.

Hearing loss

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.

Meniere's Disease

Obstructive Sleep Apnoea

Otitis Media (middle ear infection)

Audiometry is the electronic testing of hearing ability. You will sit in a special room wearing earphones and be asked to respond when you hear a noise 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.

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.

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.

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

Snoring

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: the common cold, gastro-oesophageal reflux, stroke or a tumour. 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 changes in diet and/or lifestyle surgery e.g. stretching or releasing a tightened muscle

Tonsillitis

Thyroid Disease