Mr Joseph Manjaly - London ENT Surgeon

12/08/2022

A great card to receive from one of my young patients who had his ear operation recently 💙


(Posted with permission)

15/12/2021

Hearing loss can affect all ages, without other medical issues. Did you know that some conditions can be treated without hearing aids? Here’s an easy-to-read explainer of the different causes of hearing loss in adults. Have a look at my grid for more posts about individual conditions.

17/09/2021

So happy to receive this national award from ENT UK today at the
Comes down to the stellar colleagues I work with at ‘s Royal National ENT Hospital 🙏😊

31/05/2021

We wouldn’t think twice about encouraging a family member struggling with their vision to wear glasses or contact lenses. (Imagine the eye strain and brain fatigue without them!)

Even though the same concept applies to hearing loss, there is still a lot more stigma and apprehension around it being visible.👓🦻

You may not be aware that hearing loss is the biggest modifiable risk factor for dementia. Bigger than smoking, hypertension and diabetes. When hearing loss is unassisted, those with a mild hearing loss are twice as likely to develop dementia as people without hearing loss. Those with severe hearing loss are five times more likely.🗣👂

Now consider that more than 40% of people over 50 years old having hearing loss and the figure is over 70% for people over 70 👀

Depression, low social contact, traumatic brain injury & physical inactivity are all associated with untreated hearing loss too.👥

The first step is an ear examination and hearing test. This unlocks the underlying cause and enables clinicians to talk through which different options are available to help.📈

Sources: The Lancet, Hearing Link, RNID, Action on Hearing Loss

17/03/2021

Magic moments as a surgeon ✨

Stapes surgery provides some of the best moments, purely for the amazing and instant impact it can have on people’s lives.

Performing the operation awake allows for quicker recovery, a lower complication rate and the memorable moment of testing the hearing improvement on the operating table.

Thank you to my patient who encouraged me to share her experience so that others with conductive hearing loss might be inspired by her experience 🙌 vlog of her experience to follow 😊

04/03/2021

Thank you The Royal College of Surgeons of England for featuring me!

Specialty Training is the final stage of training on the UK surgical pathway before obtaining your Certificate of Completion of Training (CCT). ENT Consultant, Joe Manjaly, is discussing this career grade and why it's such an exciting step on the surgical ladder on the RCS England Instagram account today as part of National Careers Week. Visit our page to check it out. http://ow.ly/mXrN50DPNYP

01/03/2021

💡It’s amazing how many people still think hearing loss is something you just have to accept as you get older.

😉 There are many more causes beyond just ageing too. Many can be helped with surgery:

- Perforation of the ear drum
- Retraction of the ear drum
- Erosion of the ossicles (the tiny hearing bones behind the ear drum)
- Otosclerosis (a disease that causes stiffening of the 3rd hearing bone and progressive hearing loss)
- Glue ear
- Cholesteatoma (skin disease which destroys the hearing mechanism)
- Ear canal scarring & narrowing
- Trauma causing hearing loss
- Hearing loss resulting from surgery to clear previous disease

⚕️These conditions affect all ages and can have a huge impact on quality of life - physical, occupational, educational, social & on mental health.

🔬Examining the ear under magnificent is crucial to pick these up. Being able to reverse hearing loss is an amazing part of being an ENT specialist.

08/12/2020

Headshot for the new website. A beautiful new hospital behind Oxford Street in central London. Subspecialist ENT in our own dedicated floor. Great lineup of London ENT colleagues too!

02/12/2020

Delighted to be starting a new dedicated paediatric otology clinic for children with ear and hearing difficulties at 👂✍️

13/11/2020

The magic of local anaesthetic middle ear surgery 💫

Doing microscopic middle ear surgery with a patient awake opens up possibilities for many who can’t have a general anaesthetic. But there’s also some clear advantages to patients of all ages and health statuses having surgery this way…
1. A quick recovery - people can be on their way home an hour after surgery
2. Safer surgery - having a patient awake means they can report symptoms such as dizziness during the operation which provides great feedback for the surgeon.
3. 💫Testing the hearing improvement on the operating table!💫

🌟 I had an amazing moment this week doing stapes surgery for a 92 year old lady with otosclerosis. Her hearing had deteriorated to profound levels and she was being considered for cochlear implant surgery. She was however, unfit for a general anaesthetic of even sedation. All her wider family had given up even phoning her because it was so hard to communicate. She had become totally socially isolated. We decided together this would be her last option. She did an amazing job of keeping still as I fired the laser next to her facial nerve, and at the end of the procedure I gently spoke into her ear and she suddenly exclaimed that it was the first time she had heard in that ear for many years! ❤️

22/09/2020

🗣 People with reduced hearing in one ear can still manage conversation well in quiet environments. This can give others the impression that single-sided deafness isn’t a big deal. Even amongst ENT surgeons in the past there was a view that as long as the other ear was ok, intervention wasn’t worth it.

🧠 However, we know there are specific difficulties associated with reduced hearing in one ear:
- Conversation in noisy environments (‘Speech in noise’)
- Knowing which direction a sound is coming from (‘Spatial hearing’)
- Not hearing sounds from one side of the head (‘The head shadow effect’)
- Appreciating audio recorded in stereo
- Increased listening effort & ‘cognitive fatigue’
- Lack of stimulation meaning the brain stops learning to process sound on that side (‘Plasticity’)

👂The solutions for hearing improvement are dependent on:
- the middle ear (determined by examination, hearing test and CT scan)
- the inner ear (determined by MRI scan)
- the level of deafness (determined by hearing test)

🏨 Options to rehabilitate partial deafness include:
- Middle ear surgery
- Conventional hearing aid
- Bone conduction hearing aid
- Bone conduction implant (BAHA/Ponto/Bonebridge/Osia)
- Middle ear implant (Vibrant Soundbridge)

↪️ However, once deafness reaches profound levels in one ear, even the loudest amplification won’t help. Focus then moves to sending sound over from the deaf side to the good ear. Options for this are:
- CROS hearing aid (’Contralateral Routing Of Signal’)
- Bone conduction hearing aid
- Bone conduction implant

👉 Sending sound to the good ear will overcome the ‘head shadow effect’ but WON’T help with ‘spatial hearing’. (Good for crossing the road 🛣, not so for finding your ringing phone📱)

✨ There is however another emerging option: Cochlear Implantation for single-sided deafness. Research over the last decade has shown that ‘spatial hearing’ and improved ‘speech in noise’ can be achieved. Consequently, cochlear implantation for single-sided deafness gained FDA approval in 2019. Multi-specialist assessment involving audiology & speech therapy is essential before implant surgery.

💫 Feel free to ask me more about one-sided deafness.

20/09/2020

🤱A child having an operation needs lots of care, patience & reassurance.
👨‍👩‍👦 It’s also important to think about their parents, who quite often may be anxious, sleep deprived, have lots of questions and are also going hungry whilst their child is fasting.
💬 Here are some tips that form our team’s approach.
👇I’d love to hear your suggestions and insights 😊

20/09/2020

👂Are you a community-based health professional, junior doctor or medical student that finds looking in ears and making an accurate diagnosis quite difficult sometimes?

🔬Let’s be honest - without a microscope that we are fortunate to have in ENT clinics, some diagnoses can be challenging!

📱Here's one great thing to come out of the pandemic. In the lead up to lockdown I had been working on setting up a new telehealth otology service that would enable us to assess, advise and manage patients with ear and hearing problems remotely. My team & I worked with an NHS spin-out called Tympahealth who have developed a modified smartphone which enables microsuction of the ear followed by high definition video recordings of the eardrum and specialist remote review with hearing test results.

🖥 By enabling detailed assessment by our own audiologists outside the hospital, there is now the potential to reduce footfall to the hospital, save on visits in each patient pathway, enable highly specialist management of more numbers of patients per day, and direct patients to the correct specialist sooner.

💫We have now completed a pilot to test its feasibility. Getting it off the ground during the pandemic was made possible by the kind offer of clinic room space from Boots Hearing care in their Oxford Street store - a gesture of good will towards the NHS which came at a time of need. Once the pilot data has been analysed, the hope is we will roll this service out across GP practices in North Central London and beyond.

20/09/2020

There are lots of important steps on the morning of surgery before we put knife to skin. ✅✅✅💉✍️

20/09/2020

Not quite cradle to grave, but these two books are designed to guide you from F1 through to ST8 💫

20/09/2020

Everyone loves a fascinating fact to share with friends at a dinner party. 🗣
Well here’s one about sharing facts at dinner parties 😄💫
Hearing is precious in more ways than we appreciate and there are many things that can be done to help with hearing difficulties. 🙌

20/09/2020

There are many ear problems that can be helped with surgery.

- Perforation of the ear drum
- Retraction of the ear drum
- Erosion of the ossicles (the tiny hearing bones behind the ear drum)
- Otosclerosis (a disease that causes stiffening of the 3rd hearing bone and progressive hearing loss)
- Glue ear
- Cholesteatoma (skin disease which destroys the hearing mechanism)
- Ear canal scarring & narrowing
- Trauma causing hearing loss
- Hearing loss resulting from surgery for previous disease
- Developmental abnormalities causing varying levels of deafness

These conditions affect all ages and can have a huge impact on quality of life - physical, occupational, educational, social & mental health. Being trained with the skills to help is an amazing part of being an ENT specialist.
💉👂

15/09/2020

Facts about Ear Wax! 👂🐝

👂Ear wax is a combination of skin, sweat and trapped dust and dirt.
✨Your ear produces it as a way of protecting the ear, lubricating and keeping it clean.
👂 The ear canal is sometimes called the ‘greenhouse of the human body’, being warm, dark, humid and moist. So without the protection of wax, your ear is actually more prone to infections.
⚡️Wax can be wet or dry and this depends on your genetics and ethnicity.
👂 Lots of people ask how they are meant to keep their ears clean and remove ear wax…
👉Wax only need to be removed if:
- it is causing hearing loss
- It is causing pain or infection
- a specialist needs to be able to see the ear drum to diagnose other problems.

🙋🏽‍♂️Often wax can be left alone. Some people though are prone to significant wax buildup. People who have had previous ear surgery may also get more wax build-up.
⛔️ Problems usually happen when people try to clean their own ears.
❌ Using cotton buds can feel satisfying and sometimes feel like you’ve got some wax out, but almost always you will also be pushing most of the wax further down the ear canal and causing problems.

🙌 So the main thing to remember is never try and clean your own ears. Nothing smaller than your elbow inside your ears! 💪 If wax has built up to a point where it does need to be removed, then things like cotton buds, ear candling and ear screws that you might see advertised online, are all going to be ineffective.
✅ If wax does need to be removed, it is best for this to be done with microsuction. This is performed by a specialist – with a microscope or other magnifiying equipment and special tools and suction equipment to release and remove the wax without damaging any important structures in the ear.
💫 Sometimes it can be helpful to soften the wax, using drops such as olive oil or sodium bicarbonate. This won’t usually clear the wax, but can be useful for reducing discomfort, itching and making microsuction easier.