Masses on the head and neck can be benign (noncancerous) or cancerous and can form in the larynx, pharynx, thyroid gland, salivary gland, mouth, neck, face, skull or any other structure in the head and neck region.

Noncancerous masses such as cysts are often removed surgically to prevent them from pressing on nerves and other structures in the head and neck.

Cancerous masses may be primary (arise in the head or neck) or secondary (they have spread from a primary tumour in another part of the body) and may be treated by a combination of radiotherapy, chemotherapy and surgery.

Surgery can be quite extensive, including removal of lymph nodes in the neck, and require major reconstruction.

Nose surgery includes a range of procedures to change the shape, improve the function, or treat medical conditions of the nose. Common types include:

• Septoplasty – straightens a deviated nasal septum (the thin wall between the nostrils) to improve breathing.
• Turbinoplasty – reduces swollen nasal tissues to ease airflow.
• Sinus surgery – treats chronic sinus infections or blockages.

The thyroid is a gland that sits in the front, and towards the bottom of, your neck. It is responsible for producing a hormone called thyroxin that affects many organs including the heart, muscles and bones.

Thyroidectomy is a surgical procedure to remove all or part of the thyroid gland for reasons such as thyroid cancer, goitre (enlarged thyroid), thyroid nodules or overactive thyroid (hyperthyroidism) that doesn't respond to other treatments.

A thyroidectomy may be total (removal of the entire thyroid gland) or partial or lobectomy (removal of part of the gland).

Head and neck cancers may be primary (they start in the head or neck) or secondary (they have spread from a primary tumour in another part of the body). They mainly involve the skin, thyroid gland, mouth, pharynx, larynx, nasal cavity/sinuses or neck.

Treatment can include surgery, radiation therapy, chemotherapy, or a combination of these, depending on where the cancer is, how big it is, and if it has spread. Surgery for head and neck cancers can be quite extensive, including removal of lymph nodes in the neck, and require major reconstruction.

Growths, lumps, tumours or masses on the head and neck can be benign (non-cancerous) or cancerous and can form in the larynx, pharynx, thyroid gland, salivary gland, mouth, neck, face or skull.

Tests to diagnose a mass may include:

• Neurological examination – assesses eye movements, balance, hearing, sensation, coordination etc
• MRI – magnetic resonance imaging uses magnetic fields and radio waves to give images of internal organs and body structures
• CT Scan – computer tomography combines x-rays with computer technology to give cross-sectional images of the body
• Biopsy – a sample of tissue is taken for examination under a microscope.

Enlarged Lymph Nodes

Lymph nodes in the neck often become swollen when the body is fighting an infection.

Benign Lesions

Non-cancerous masses such as cysts are often removed surgically to prevent them from pressing on nerves and other structures in the head and neck.

Cancer

Cancerous masses spread to surrounding tissues and may be:

• Primary – they arise in the head or neck. Mostly caused by tobacco or alcohol use
• Secondary – they have spread from a primary tumour in another part of the body.

Cancers may be treated by a combination of radiotherapy, chemotherapy and surgery.

A surgical procedure involving the removal of lymph nodes (bean-shaped glands that filter harmful agents picked up by the lymphatic system) from the neck to control the spread of cancer. It is most commonly done to treat head and neck cancers that have spread, or have the potential to spread, to the lymph nodes.

There are different types of neck dissection, depending on how much tissue is removed – ranging from selective (only certain lymph nodes) to more extensive procedures.

This is a surgical procedure to remove part or all of the parotid gland, which is the largest of the salivary glands and is located in front of and just below the ear.

This surgery is most commonly done to remove tumours, which can be benign (non-cancerous) or malignant (cancerous). It may also be performed for chronic infections or other gland problems.

Special care is taken during the surgery to protect the facial nerve, which runs through the parotid gland and controls movement of the face.

There are three large pairs of glands (parotid, sublingual and submandibular) in your mouth that produce saliva which helps break down food as part of the digestion process.

Salivary gland surgery involves the removal of one or more of the salivary glands for reasons including: tumours (benign or cancerous), chronic infections or blockages, salivary stones or injuries or cysts.

Care is taken to avoid damaging nearby nerves, especially those that control facial movement.

Skin cancer of the face, ears, scalp and neck is very common in New Zealand. The most common types are basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body while melanoma can spread to other parts of the body and urgent removal is usually recommended.

Treatment of skin cancer usually involves surgery to remove the cancer. Most skin cancers can be treated successfully if found early.

A pharyngeal pouch (also called a Zenker’s diverticulum) is a pocket or pouch that forms in the back wall of the throat where the throat (pharynx) meets the food pipe (oesophagus).

It happens when the muscle in that area weakens, and occurs most commonly in elderly patients. Food or saliva can collect in the pouch, which may lead to symptoms like:

• Difficulty swallowing
• Regurgitation of undigested food
• Gurgling noises when swallowing

Treatment may involve surgery to remove or reduce the pouch and improve swallowing.

This operation repositions the nasal septum and is performed entirely within your nose so that there are no external cuts made on your face.

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.

Nasal polyps are removed by inserting small instruments through your nostrils which can grasp and cut out the polyps.

Service types: Septoplasty (straighten nose).

The thin wall between the nostrils (septum) is often uneven or crooked, making one nostril narrower than the other. Most people experience no symptoms from this condition but sometimes the reduced airflow can lead to difficulty breathing, congestion, infections, nosebleeds and snoring or sleep apnoea.
Symptoms can be treated with medication such as decongestants and steroid sprays but if symptoms persist surgery (septoplasty) may be required.

Septoplasty

This operation repositions the nasal septum and is performed entirely within your nose so that there are no external cuts made on your face.

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.

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.

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.

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.

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).

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

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.