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 immaturity, infections, allergies or trauma. The Eustachian tube connects the middle ear to the area behind 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 is an infection in the middle ear causing pain, fever and a red, bulging eardrum (the thin, transparent membrane between the ear canal and the middle ear). This condition is commonly seen in young children. The treatment may include antibiotics. If there are repeated episodes, surgical insertion of grommets into the eardrums may be helpful. Grommets are tiny ventilation tubes that allow airflow into 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 twelve to eighteen 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 most commonly seen in children. Fluid is present in the middle ear. The ear is not usually painful, the eardrum is not red and bulging and there is no fever. Glue ear may cause hearing loss, which can result in speech delays, and balance problems. Treatment options include: watchful waiting; grommet insertion; or rarely hearing aids. Chronic Otitis Media If the Eustachian tube does not function over a period of several years, there may be changes to the tissues of the middle ear such as deformity of the eardrum and damage to the hearing bones. These changes may result in hearing problems, balance problems, and persistent ear discharge. If not responsive to antibiotic treatment, an operation called tympanomastoidectomy may be required. This involves making an incision (cut) behind your ear, drilling through the mastoid bone and removing, and possibly repairing, diseased tissue.

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 sore throat, maybe swollen glands in your neck, a fever, a headache and difficulty swallowing. 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.

A cholesteatoma is a non-cancerous but abnormal growth of skin cells in the middle ear or mastoid bone. It can occur as a result of repeated ear infections, trauma, or congenital abnormalities. The cholesteatoma grows slowly and can cause damage to the surrounding structures, leading to hearing loss, dizziness, and facial weakness or paralysis. It may cause chronic ear discharge or foul-smelling discharge from the ear. Treatment usually involves surgical removal of the cholesteatoma, which can be a complex procedure. Without treatment, a cholesteatoma can cause serious complications, including hearing loss, infection, and meningitis.

In otosclerosis, there is new bone formation around the stapes (hearing bone) in the middle ear. The stapes becomes more rigid or fixed in position and is unable to vibrate to allow sound to pass to the inner ear. When the stapes is not vibrating as well as it should, gradual hearing loss will 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 tends to run in families. The condition can become worse during pregnancy. Treatment Patients should trial a hearing aid as first line of treatment. For those unhappy with a hearing aid a procedure called stapedotomy can be performed. 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 will be performed under general anaesthetic (you sleep through it). 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 taking sodium fluoride which theoretically helps harden the bone, preventing progression of otosclerosis.

This is a slow-growing, benign (non-cancerous) growth of the fatty lining of the balance nerve. Patients may present with a slight hearing loss or mild tinnitus (ringing/clicking/buzzing noises in the affected ear). There may be a progressive loss of hearing, tinnitus and balance problems. The tumour can be confirmed on an MRI scan. Vestibular schwannomas are usually found in one ear and generally occur in people over 40 years of age. Treatment If the vestibular schwannoma is small, you may not require any active treatment. Yearly MRI scans may be all that is needed. Active treatment may include surgery or, on rare occasions, radiotherapy. Surgical treatment may be suggested for larger or growing tumours. Surgery will be performed under general anaesthetic. Following surgery you will recover in hospital for about one week. Rarely, radiotherapy can be considered for small tumours. It involves low-dose radiation to the tumour. You can discuss this with your surgeon.

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 1-2 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.

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. The majority of patients find that these changes can help control their symptoms. Maintenance therapy includes betahistine and diuretic medication (reduces the amount of fluid in your body) may also be introduced. During an acute attack a course of oral steroids and antiemetics may be useful. When these measures are not helpful surgery may be considered.

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. For ear disorders, a full diagnostic hearing test is almost always required and should be arranged before the appointment. My staff will be happy to arrange these tests. A separate charge applies with the provider.

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.

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.