The ENT Medical Specialty – small Holes with LARGE Problems
Note: The ENT speciality requires four to five years additional study and training following the normal medical degree program. There is a fellowship examination or national board examination required for full certification as an ENT Fellow or Board Certified Specialist in most advanced programs.

An Ear, Nose and Throat specialist is a physician concerned with the medical and surgical treatment of the ears, nose, throat and related structures of the head and neck.

ENT diseases can affect patients of all ages and range from the very simple to the most challenging of problems. An example of the latter is the treatment of ENT / H&N cancers. Often, the treatment requires the expertise of specialists from other disciplines such as orofacial maxillary, neuro, plastic surgeons, oncologist, radiotherapist, audiologist and speech therapist.

While the variety of abnormal conditions or diseases is extensive, there are a few that are more commonly encountered and would make up the bulk of an ENT specialist's work.
Adenoids and Tonsils

Adenoids and Tonsils
Adenoids and tonsils are lymphoid tissues located at the back of the mouth, nose and throat. They are part of the immune system and for the correct indications can be surgically removed without adversely affecting the health of the person. It is not true, contrary to popular local belief, that their removal will "weaken" the immune system.

Although the indications for adenotonsillectomy are better defined and more stringent, compared to previously, they still account for a significant number of ENT surgical procedures.

The commonest indications are recurrent or chronic infection, obstructive adenoidal and tonsillar enlargement, with or without obstructive sleep apnoea (OSAS), and middle ear infection (otitis media).

Obstructive Sleep Apnoea Syndrome (OSAS)
OSAS describes sleep-related upper airway obstruction that causes significant physiological disturbances like blood oxygen and carbon dioxide concentrations.

OSAS has been recognised frequently in children, and complications can occur when the condition is not diagnosed and treated properly. Adenotonsillar enlargement is the leading cause of childhood OSAS, although other causes are seen. OSAS can be diagnosed objectively, and its severity assessed, by polysomnography (sleep study).

Adenotonsillectomy successfully treats OSAS in otherwise healthy children.

Sinusitis
Sinusitis often mimics a cold - fever, fatigue, congestion, running nose and sore throat. But it has a different cause and treatment. It often lasts longer and is much more likely to need treatment, unlike a cold.

Sinus infection can be acute, one that lasts less a week, or chronic, one that lasts longer than 12 weeks. Although the signs and symptoms are similar, the chronic ones may not be as apparent.

Chronic sinusitis is usually more difficult to treat and your doctor may refer you to an ENT specialist. Nasoendoscopy to examine your nasal passages and the openings into the sinuses and CT scanning may be performed.

Medical treatment such as prolonged antibiotics, decongestants, mucolytics, saline douche can be tried but may not work.

Endoscopic sinus surgery (ESS) may be advised and it is the most common surgical treatment for chronic sinusitis. ESS enlarges the opening between your nose and your sinuses, improving drainage. 80 - 90% of people who have ESS report significant improvement.

Chronic Sinusitis Vs Chronic Rhinitis
Although many symptoms are similar, rhinitis, which is exceedingly common, should not be mistaken for sinusitis. This is important because the treatment method is different.

Rhinitis is an inflammation of the mucous membrane of the nose and is often caused by allergies, increased sensitivity to irritants (smokes etc.), temperature changes. Surgery has limited role and the treatment emphasis is on medical therapy like inhaled steroids, oral antihistamines and life-style adjustments. Poorly controlled rhinitis can lead to sinusitis, hence the term chronic rhinosinusitis.

Nasopharyngeal Cancer (NPC)
NPC is the commonest cancer affecting adult males, according to the Sarawak Cancer Registry. Approximately 160 new cases are reported per year. Such incidence, 8/100,000 population, is regarded as averagely high in the world. These figures are very likely an under estimate due to under reporting. Male outnumber female by a ratio of 3:1. The peak occurrence is between the ages of 50 - 70 years and interestingly, it is more common among the Chinese and Dayak.

NPC is a cancer. And cancer is a group of diseases that occurs when cells become abnormal and divide without control or order.

NPC is a cancer located in the nasopharynx which is a space behind the nose, just above the back of the throat.

The exact cause of NPC is not known. However, there are some factors associated with an increased risk of the disease. They are genetic / racial, smoking, alcohol consumption and certain food e.g. salted fish and environmental pollutants.

The commonest signs and symptoms are painless neck swelling on the side the neck, unilateral hearing loss and blood stained nasal or post nasal discharge.
When a diagnosis of NPC is suspected, an ENT examination is mandatory. Confirmation of diagnosis is made by histologic examination of tissue biopsied from the nasal pharynx or neck swelling.

The main mode of treatment for NPC is external radiotherapy possibly combined with chemotherapy. Surgery has only a very limited role. Unfortunately the majority, over 80%, of our patients at diagnosis belong to the advanced stages, III and IV. Even so, 2 year survival post treatment is around 80%, indicating the radiosensitive nature of NPC.

With increased public awareness, education and early detection, we hope to see better treatment outcomes.

Dr B. C. Kho
Consultant ENT / Head & Neck Surgeon