Surgery can be carried out to improve the appearance of your nose e.g. straightening it if it’s crooked or increasing or decreasing its size.

Small cuts (incisions) are made either on the inside or outside (in the creases) of the nose. Excess bone and/or cartilage is removed and the nose reshaped. The surgery takes about 2 hours and is performed under general anaesthetic (you sleep through it). You may be able to go home the same day or, in some cases, you may have to stay in hospital overnight. You will need to arrange for another person to drive you home. Your nose will be covered with a splint that you will have to wear for about 1 week. It will take about six weeks for the worst of the swelling to disappear.

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.

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

• Rhinoplasty – reshapes the nose for cosmetic or functional reasons.
• 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.

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.

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.

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 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).

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.

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.

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

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.

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.

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 Malfunction
Salivary gland malfunction that results in a decrease in saliva production can be caused by conditions such as Parkinson’s disease, depression, HIV infection and chronic pain. Saliva production can also be decreased by certain medications such as some antidepressants, antihistamines and sedatives.

Reduced saliva can lead to increased tooth decay and difficulty speaking and swallowing. 

Good dental care is important in this condition. In some cases, saliva substitutes can be helpful. 

Salivary Gland Swelling
If the duct or tube carrying saliva from the gland to the mouth becomes blocked, the gland will swell. The glands can also swell as the result of mumps, bacterial infections and certain other diseases.

If the duct is blocked by a stone, it can sometimes by squeezed or pulled out but may on occasion require surgery to remove it.

New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun.
Risk factors for developing skin cancer are:  prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds.
There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

Basal Cell Carcinoma (BCC)
This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body.  Sometimes BCC’s can ulcerate and scab so it is important not to mistake it for a sore.
BCCs occur more commonly on the face, back of hands and back.  They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour.

Treatment
Often a BCC can be diagnosed just by its appearance.  In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis.
Removal of a BCC will require an appointment with a doctor or surgeon. It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal.

Squamous Cell Carcinoma (SCC)
This type of skin cancer also affects areas of the skin that have exposure to the sun. The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body. The spreading (metastasising) can potentially be fatal if not successfully treated.
A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges.  SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown. Sometimes it can appear like a recurring ulcer that does not heal.
All SCCs will need to be removed, because of their potential for spread. The removal and diagnosis is the same as for a BCC. 

Malignant Melanoma
This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease.
A melanoma usually starts as a pigmented growth on normal skin.  They often, but not always, occur on areas that have high sun exposure.  In some cases, a melanoma may develop from existing pigmented moles.

What to look for:

• an existing mole that changes colour  (it may be black, dark blue or even red and white)
• the colour pigment may be uneven
• the edges of the mole/freckle may be irregular and have a spreading edge
• the surface of the mole/freckle may be flaky/crusted and raised
• sudden growth of an existing or new mole/freckle
• inflammation and or itchiness surrounding an existing or new mole/freckle. 

Treatment
It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading.
A biopsy or removal will be carried out depending on the size of the cancer. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required.  If the melanoma has spread more surgery may be required to take more of the affected skin.  Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread.
Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer).
A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.

Service types: Thyroid disorders.

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. Thyroxin has an important role in the body as it affects many organs including the heart, muscles and bones.  Diseases that affect the thyroid can make it either overactive (producing too much thyroxin), underactive (not producing enough thyroxin) or enlarged (goitre).  

Tests
Thyroid problems are usually picked up with a blood test but there are other tests you may have to work out why the problem has occurred.  These include:

• an ultrasound scan.  This is where a hand-held scanner head is passed over your thyroid gland and pictures are taken
• a nuclear medicine scan.  This is where you are given something to drink that contains a substance that only goes to the thyroid gland.  Although it is radioactive it does not damage you or anyone else.  Pictures are then taken of the thyroid gland that give the doctor information about what might be causing the problem
• fine needle aspirate (FNA). This is where the doctor puts a very fine needle (smaller than for a blood test) into the thyroid gland to take some cells to look at under the microscope.

The parathyroid glands are four small glands located in the neck which produce parathyroid hormone, a hormone involved in the regulation of calcium and phosphate levels. Overactivity of one or more of the glands results in excessive parathyroid hormone production, kmown as hyperparathyroidism.

Your adenoids may be removed as part of a tonsillectomy. This operation is also performed through your mouth.

The appearance of ears that are misshaped or protruding (‘bat ears’) can be improved surgically. This type of operation is often carried out in children.

Cuts (incisions) are made behind the ears through which the cartilage in the ear can be reshaped or removed. The surgery lasts 1-2 hours and can be performed under local anaesthetic (the area treated is numb but you are awake), allowing you to go home the same day. For children, the procedure would be performed under general anaesthetic (they sleep through it) and they will remain in hospital overnight. You will need to wear head bandages for about 1 week and will probably be able to return to normal daily routines after that.

A ruptured eardrum (tympanic membrane perforation) is when a hole or tear occurs in the thin membrane (eardrum) that separates the ear canal from the middle ear. Causes may include middle ear infections, traumatic injury or sudden changes in air pressure.

The eardrum usually heals by itself but sometimes a minor surgical procedure might be required to repair it. This typically involves patching the hole with a piece of tissue from a different part of your body. This is usually performed under general anaesthetic.

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 small pieces of bone and soft tissue. This opens up the ventilation and drainage pathways in the outer wall of your nose.

This operation is performed through the ear canal. A hole is made in the eardrum and the middle ear drained. A small hollow tube (grommet) is placed in the eardrum hole which allows air into the middle ear.

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.

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.

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.

A tiny camera attached to a long tube is inserted into your mouth and passed down through your pharynx into your oesophagus. This allows the surgeon to make a diagnosis either by seeing directly what is causing the problem or by taking a small tissue sample (biopsy).

The parathyroid glands are four small glands located in the neck which produce parathyroid hormone, a hormone involved in the regulation of calcium and phosphate levels. Overactivity of one or more of the glands (hyperparathyroidism) results in excessive parathyroid hormone production.

Parathyroidectomy is a surgical procedure to remove one or more of the parathyroid glands through an incision (cut) in the front of and at the base of the neck.

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.

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.

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

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.

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

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. Thyroxin has an important role in the body as it affects many organs including the heart, muscles and bones. Diseases that affect the thyroid can make it either overactive (producing too much thyroxin), underactive (not producing enough thyroxin) or enlarged (goitre). Endocrinologists specialise in these diseases as well as cancer of the thyroid.

Tests

Thyroid problems are usually picked up with a blood test but there are other tests you may have to work out why the problem has occurred. These include:

• An ultrasound scan. This is where a hand-held scanner head is passed over your thyroid gland and pictures are taken.
• A nuclear medicine scan. This is where you are given something to drink that contains a substance that only goes to the thyroid gland. Although it is radioactive it does not damage you or anyone else. Pictures are then taken of the thyroid gland that give the doctor information about what might be causing the problem.
• Fine needle aspirate (FNA). This is where the doctor puts a very fine needle (smaller than for a blood test) into the thyroid gland to take some cells to look at under the microscope.

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).