The ins and outs of common ear, nose and throat conditions

The Ear, Nose and Throat (ENT) specialism covers possibly the widest spectrum of ages and disease than any other specialty; everything from helping people manage conditions without the need for surgery, including conditions that affect the voice, breathing and swallowing, to carrying out a vast range of operations - from major head and neck procedures, to complex facial reconstructions following trauma or cancer and microsurgery on the ear.

It's an area that has seen some amazing scientific advances around minimal invasive surgical techniques, including robotic techniques for head and neck surgery.

And it's an area that has also helped lead medical thinking since the start of the pandemic.

Loss of smell as a diagnostic tool

ENT specialists often treat conditions that affect the senses, such as hearing and balance disorders or smell and taste problems. An ENT expert from the UK, observing in the early days of the pandemic that loss of smell was occurring much more than would be expected with viral infections - not only in patients but also in frontline workers on Covid wards - prompted action in the form of a letter on behalf of the British Rhinological Society and ENT UK to Public Health England (PHE). This led to PHE sending out a press release, the response to which quickly spread around the world.

At a time when testing wasn't yet available, loss of smell was found to have diagnostic value, experts quickly establishing that sudden loss of smell was one of the most common symptoms of Covid-19.

Anosmia in the spotlight

While most recover from Covid 'anosmia' (total or partial loss of smell), 10% to 20% of patients continue to suffer with persistent anosmia or a distorted sense of smell.

Anosmia can have profound psychological and social effects. It's a problem for which there is no simple solution and, Covid-19 aside, it normally affects an estimated 5% of the population aged under 60 years old and approximately 20% of those aged over 60 in the UK.

So, if a silver lining can be attributed to the pandemic, it's that awareness of this problem has improved amongst the general public. And that GPs are better equipped with the tools and knowledge to help people manage this problem.

All of that said, loss of smell isn't quite as common as some ENT conditions, three of which we take a closer look at here.

Throat - Tonsillitis

Tonsils are fleshy pads located at each side of the back of the throat. Containing white blood cells, they are part of the body's immune system, acting to stop germs entering the body through the mouth of the nose. There is plenty of this tissue all around the throat, so removing the tonsils and/or adenoids does not mean you are more likely to become unwell and if they themselves are causing problems then those people may well be better off without them.

Tonsillitis is inflammation of the tonsils that is caused by a viral or bacterial infection. It's a common illness in children but can affect people of any age.

The main symptoms include:

A sore throat
Problems swallowing
A high temperature of 38C or above
Coughing
A headache
Feeling sick
Earache
Feeling tired
Tummy ache in children

Fact or fiction?

Tonsillectomy operations are done less often now because they're not necessary. This is part fact, part fiction. These days, surgery is only necessary where: tonsils are so big they block the airway and make it hard for children to breathe with a condition called obstructive sleep apnoea; or the tonsils are getting infected a lot. Experts define 'a lot' as when a doctor diagnoses a child with at least 7 infections a year, more than 5 infections a year for 2 years in a row, or three infections a year for 3 years.

Middle Ear infections

This is inflammation of the middle ear, usually caused by a virus or bacteria, that causes fluid to build up behind the eardrum. They can affect people at any age but are much more common in children. In fact, five out of six children will have at least one ear infection by their third birthday.

This is because the tubes connecting the ears to the nose in children ears are smaller and more level than they are in adults' ears, making it difficult for fluid to drain out of the ear. If the tubes are swollen or blocked with mucus due to a cold or another respiratory illness or because they have adenoids, this makes it even harder for the fluid to drain. Also, a child's immune system isn't as effective as an adult's making it more difficult for children to fight infections.

Of course, it's hard to tell what is wrong with babies and toddlers but tell-tale signs of an ear infections include:

Tugging or pulling at the ear/s
Fussiness and crying
Trouble sleeping
Fever
Fluid draining from the ear canal

Ear infections usually go away on their own or, failing that, can be diagnosed and treated with antibiotics by a general practitioner. An ENT specialist tends only to get involved if an individual keeps getting ear infections. In such instances, a longer course of antibiotics may be given or, particularly if the hearing is also affected, a surgical procedure might be recommended whereby a small ventilation tube called a grommet is placed in the eardrum to improve air flow and prevent fluid building up in the middle ear.

Fact or fiction?

Vaccinating your child against the flu virus can help prevent ear infections. This is true. The best way to prevent ear infections is to prevent the risk factors associated with them. For children, this might include making sure your child gets the flu vaccine every year. Also, studies show that children vaccinated with the 13-valent pneumococcal conjugate vaccine (PCV13) get far fewer ear infections than children who aren't vaccinated.

Other ways to reduce risk factors include: washing hands frequently to prevent the spread of germs; avoiding exposing your baby to cigarette smoke; and limiting your child's exposure to others who are poorly.

Nose - Sinus infections

Sinuses are air-filled spaces in the bones of the face and head. Connected to the inside of the nose through small openings, they are important in helping the flow of mucus in the nose and throat.

Sinus infections tend to start with similar symptoms to a cold and are usually caused by viruses and sometimes by bacteria. They usually settle on their own but using decongestant drops or sprays (making sure not use them for more than a week) and salt water washes can help to clear them up more quickly. Antibiotics are occasionally needed.

Sinusitis can be acute - usually occurring after an infection, such as a cold - or chronic, where the condition continues for many weeks and might be the result of an underlying allergy.

Symptoms include:

Nasal obstruction
Facial obstruction
Headaches
Nasal discharge (sometimes discoloured)
Teeth pain
Coughing
Fever
Congestion
Stuffiness
Bad breath

Where symptoms persist despite the use of ongoing medication, surgery might be required. There are a number of options open to the ENT specialist depending on the severity of the problem. Endoscopic sinus surgery is the name given to operations for sinus problems and it is performed through the nose without any cuts or stitches to the face.

Fact or fiction?

Women are more prone to sinusitis when they're pregnant. This is fact. According to experts, pregnancy hormones cause the linings of the sinuses to swell. Prevention involves maintaining a healthy immune system by eating a well balanced diet. Cleansing the nose with salt water washes is safe and may help and there are some medications that can be used in pregnancy, but only after consultation with a GP or pharmacist.

About the author

Suzanne Clarkson is the Managing Director of Coach House Communications.