Knysna ENT - serving the EDEN district.

27/12/2022

Great article on tinnitus! I endorse it 100%!

Ringing, buzzing and hissing in the ear – hearing specialist offers tips to turn down the tinnitus

Some researchers say tinnitus is generated in the ear, while others hypothesise that it happens in the brain. At the moment, there is no cure.

10/07/2022

https://www.dailymaverick.co.za/article/2022-07-10-cotton-buds-just-keep-them-out-of-your-ear/?utm_term=Autofeed&utm_medium=Social&utm_source=Facebook&fbclid=IwAR1LN05wFjXzrRlZPtD6NfD2-e5IVOAEgrpeeOZ6EILuehp5qCJ9dgHNQUw&fs=e&s=cl =1657477036

Although cotton buds are marketed as make-up application and removal aids, large numbers of consumers use them to clean their ears, a practice that continues despite numerous warnings from medical professionals. Here is why you should keep them out of your ears.

12/04/2022

Michael Golenhofen is an ENT doctor working in Germany and treating tinnitus patients for the last 25 years, approximately.

07/04/2022

Melanie de Freitas
Audiologist and Speech-Language Pathologist

05/09/2021

30/08/2021

What is the range of pathology that we ENT’s diagnose and treat? What do we do?

Here goes … We treat ….

Waxy ears, sore ears, blocked ears, infected ears, deaf ears, funny looking ears, running ears, ringing ears …

Big noses, small noses, bent noses, broken noses, narrow noses, itchy noses, blocked noses, runny noses, infected noses and sinuses, sneezing, snoring, bleeding noses, smelly noses and noses that can’t smell …

Sore throats, itchy throats, snoring throats, post nasal drippy throats, irritated throats, hoarse throats, swollen throats, dry throats.

Swollen necks, lumpy necks, growths that stick out where they shouldn’t …

We diagnose and treat the dizzy, the off balance, and those whose heads are spinning.

From time to time we save lives - by catching the throat cancer when it is small and easily treated. Or stopping the torrential nosebleed. Or performing a tracheostomy. Or draining a deep neck abscess …

We work in dark holes, narrow spaces, deep tunnels, like cave explorers, or miners, with microscopes or cameras. Our instruments are strictly-for-purpose, delicate, and very expensive …

And we explain, reassure and comfort those who need it.

I’m pretty satisfied with what I do.

29/07/2020

Ear, nose and throat HOUSE CALLS now available

Covid19 has forced some major changes on the way we all do things ..

I understand how a fear of getting infected has kept people away from their regular medical care. People who feel vulnerable do not want to take unnecessary risks.

In reality, doctors’ waiting rooms and most medical consultations are relatively low risk environments. Most of us pull out all the stops to keep ourselves and our patients safe.

But for many, especially the highly vulnerable, this is not enough.

So, I have decided to offer house visits to those who want them in the safety of their own homes.

This is how it will work.

Should you want a house visit for an ENT problem, please ring my rooms at 0443820800 and make that request clear.

We will need your details and a brief indication as to your symptoms to be sure that a house visit is appropriate. All paperwork will be done ahead of time to reduce the length of time I need to be at your house.

You will then be given an approximate time at which I will arrive at your home, bringing all my equipment.

I will wear an N95 mask, face shield and gloves, and will expect that you also wear a mask while I am near you.

If possible we will do the consultation outside, where the risk of spreading Covid19 is even lower.

Any medication prescriptions can be emailed directly to the pharmacy if required.

House visits are permitted by most medical aids, but carry different codes to office visits.

There are additional fees due to mileage travelled and the time thereof, and also a fee relating to the N95 mask.

The consultation fee must be paid at the time of the visit - I will have a card machine with me.

I believe this can be done in a near ‘zero risk’ manner.

Let me know via Loretta at my rooms - 0443820800

06/04/2020

Telemedicine is the new future.

Anyone wanting an online appointment, follow the link:)

http://www.drmartinyoung.com/appointments-and-telemedicine.php

04/04/2020

Telemedicine is here and here to stay! This is going to be one of the opportunities created by the Covid19 crisis and its benefits will long outlast this pandemic.

Most doctors have a good idea of what is potentially wrong with their patients simply by listening to their stories and asking relevant questions. In my opinion, 70-80% of patients presenting with ENT problems can have an accurate diagnosis made without having a hand laid on them. This can be done completely using the internet as a tool.

The response to the initial telemedicine diagnosis can be supportive, non-medication advice, or medication as a trial of treatment, or perhaps setting a plan for the future when Covid19 is behind us.

Additionally there will be those patients who have to be seen and examined physically.

A telemedicine consultation will identify that fairly small number of patients who should balance the risk of leaving lockdown against the risk of leaving a potentially serious problem unattended.

The goal in the time of Covid19 is to permit medical care to go on without having to go out.

Here are the applications where telemedicine is useful for ENT.

Ear infections including blocked ears
Hearing loss
Tinnitus

A blocked nose
Postnasal drip
Sinusitis

Throat infections including tonsillitis
Halitosis

Hoarseness

Snoring

Dizziness and vertigo

Neck lumps or masses.

I will add more as I think of them.

30/03/2020

Some of the changes we have made to accommodate the Covid19 threat ...

I forgot to include the signage and handwashing instructions in the toilet ..

26/03/2020

Article today in the Australian Financial Review:

EXTREME VIRAL RISK CUTS EAR, NOSE AND THROAT SURGERY

Jill Margo - Health Editor

Mar 23, 2020 – 10.55am

Surgeons who operate on the ear, nose and throat (ENT) are taking radical and unprecedented action to protect themselves and their teams from the new coronavirus.
ENT surgeons work in the viral epicentre of the body and are at extreme high risk of infection. They are now restricting themselves to urgent operations and cutting back their clinics. Some are closing them.
Routine operations such as tonsillectomies, nasal and much sinus surgery will be suspended for at least a month.

Deaths of ENT surgeons have been reported in China, Iran, Italy and the UK, says Professor Sacks.
The unavailability of these common procedures means many people will continue to live with their symptoms until the pandemic curve flattens.
"This is unprecedented in my life," said Professor Raymond Sacks, deputy president of the Australian Society of Otolaryngology, Head and Neck Surgery.

“The toll on ENTs has been terrifying, with deaths reported in China, Iran, Italy and the UK – and one of two on life support in the UK dying over the weekend.
“In China, infection from a patient of unknown COVID-19 status spread to 14 members of an endoscopic skull-base surgical team, operating on a pituitary tumour through the nose.”
Professor Sacks, who is professor of surgery at Sydney and Macquarie universities, said the viral load was highest in the nose, the area joining the back of the nose to the throat, and the throat.

There is already high infectivity among ENTs around the work, and high fatality rate.
— Professor Raymond Sacks, Australian Society of Otolaryngology, Head and Neck Surgery

“So instrumentation and working in these areas places practitioners at a greater risk of increased viral load. There is already high infectivity among ENTs around the work, and high fatality rate.

“They get it badly and, unlike the general community, it affects all ages. One ENT resident [trainee] was only in his 30s.”

Professor Sacks is deeply concerned about himself, his colleagues, his staff and his patients.
“We should be operating with appropriate full personal protective equipment but we need to be cognisant of scarce resources, particularly at this early stage of the pandemic.”

The society has changed its guidelines, recognising that “time sensitivity” and “urgency” are determined by individual surgeons who need to be aware of potential risks to themselves and their staff.
The society suggests that routine elective clinic visits be stopped and, where possible, telephone and video consultations be used.

Members need to be extremely vigilant and consider patients vulnerable to the consequences of viral infection, such as those with a tracheostomy, respiratory compromise or immune suppression.

Not definitive

Although negative test results are not definitive, the society stresses the importance of testing patients before surgery. In the absence of confirmed negative status by two tests more than 24 hours apart, patients should be treated as positive.

From Monday, elective sinus and nasal surgeries, the removal of adenoids and tonsils, ear drum repairs and hearing rehabilitation surgery including cochlear implantation will cease.
Conditions requiring emergency/immediate or urgent (within 30 days) surgery such as tracheotomies, head and neck cancer, removal of airway foreign bodies and drainage of abscesses in the head, neck and ear will continue.

“All cases will be treated on their own merit, with individual surgeons making decisions based on the risks and benefits to both the patient and the peri-operative staff," Professor Sacks said.

11/11/2019

Company generated $3bn in revenues in 2018

11/07/2019

The Sports Performance Research Institute New Zealand concluded that surfers only spend 8% of the entire surf session riding waves. The rest is paddle work.

06/07/2019

05/07/2019

Some of you might have heard of 'ultrasound' surgery for surfers ear.

What is this and is it a good thing? Read on.

The other word for this new technology is piezo surgery, and it is a metal probe that vibrates at ultrasound frequencies and literally melts away bone without injuring fleshy tissue.

The main application has been in dentistry, but ENTs have been interested in it for a while and there are some research papers from 2018 that support using piezo for surfers ear.

But is it any better than the chisel technique?

There is no research out there that suggests that it is, or that it offers significant benefits for the patients. Yet.

I can see a very definite advantage for the surgeon, in that this is a machine that is hand held and works at a constant rate without needing to tap, as with the chisel, or make big skin incisions, as with the drill. It may make the surgery much easier and potentially faster than the alternatives.

There appears to be no advantage in terms of healing time or pain after surgery. Both chisel and piezo appear to have the same healing times and low level of discomfort according to anecdotal reports. But that is not the same as hard scientific fact, and the studies have not been done.

The big disadvantage of piezo is the cost of each usage. The tip is a single use consumable that is going to cost many thousands of rands. The chisel costs nothing extra....... So for those paying their own accounts, and not on a medical aid, this is a big issue.

I will be getting my hands on one as soon as I can and making that call for myself. Anything that makes surgery easier and faster may be well worth the extra cost.

I'll keep you posted.

10/06/2019

For the scared surfers out there ...

More of your questions about surfers ear surgery with the chisel technique answered ...

1. Do I need the surgery?

Well, you have to be the one to make that decision. The benefits of surgery have to be higher than the risks and negatives, and only you know how much of an issue your ears are to you.

2. What are the risks to me of putting off the surgery if I already have symptoms?

The biggest risk is that you reach a point where avoiding the surgery is really no longer an option due to your discomfort, hearing loss and repeated ear infections affecting everyday quality of life. At this point the risks of surgery may now be significantly higher, because the exostoses are bigger and require ‘more’ surgery under a more difficult situation where your eardrum may no longer be visible. In this instance your surgeon will be working ‘blind’ as to the location of your eardrum for the first and most crucial part of the surgery, and the risk of injury to your facial nerve, jaw joint, eardrum and middle ear structures are highest. These are as big concerns to your doctor as to you. While complications are rare, the worse your situation is, the more likely they are to occur.

A ‘difficult’ operation can take more than twice as long as an ‘easy’ operation. With theatre times as high as R300 a minute, this is obviously a factor in people who are not insured in any way for the surgery.

3. What would be the last point beyond which the surgery becomes harder?

While I can still see your eardrum past the exostoses, the surgery is easier. When the exostoses close up the canal completely, the surgery is harder to do. Not impossible by any means, and I still operate on those who want the surgery, but the procedure is definitely more difficult.

In essence, the sweet spot for having the surgery is when you are having symptoms, but before your ear canals are completely closed.

4. How long does the surgery take?

It depends on how much bone needs to be removed, and how close the exostoses are to the drum. A rough estimation would be around one hour per ear. Many cases are significantly shorter than this. Some can take longer.

The relevance of this question is that many hospitals charge per minute for time in theatre, unless your doctor has negotiated a fixed rate beforehand. As I generally do. This has obvious implications on the cost of the procedure. Bank on two hours for both ears. This is substantially less than the time required for surgery using the drill.

5. Which ear do you do first?

I prefer to do the ear causing more symptoms first, on the assumption that it will be the trickier ear to do. If all goes well with that side, and with your agreement beforehand, I do the other ear at the same sitting.

6. Do I stay in hospital overnight?

Not unless you have a bad reaction to the anaesthetic, with pain or nausea and vomiting. The vast majority of patients leave hospital the same day.

7. When do I need follow up after the surgery?

The biggest challenge in this surgery, and one we are still working on, is how to dress the ear canals after the operation with a minimal amount of discomfort and blockage, so that healing takes as little time as possible. The purpose of any checkups is to remove blood clots and scabs, and to get you back to normal as soon as possible.

The absolute minimum is a check up three days later to remove blood clots and dressings. The ideal would be another consultation about a week after the surgery.

Those whose schedules do not allow this should ideally have a backup with an ENT in their home towns. This consultation would be to remove crusts and scabs that are an inevitable part of healing. These will disappear without intervention, but this takes a bit longer.

8. Will the exostoses grow back?

Bluntly put, if you do not use ear plugs or a hoodie afterwards, yes.

If you were unlucky enough to get them in the first place, they will definitely come back again if you do not remove the cause, the ‘wet-cold-wind chill’ cycle that caused them in the first place.

9. Do medical insurers cover the surgery?

In general they do, unless they can show that you signed up with them with a pre-existing condition. In which case they may refuse.

The amount they pay out is dependent on your policy. Usually the hospital fees are covered in full, and this is about half the total cost. The surgeon and anaesthetist fees are generally not covered in full, and I highly recommend that you get quotes and negotiate fees beforehand.

For those who can, ‘gap cover’ is a cheap insurance to cover those ‘self-payment gaps.’

10. What can I expect after surgery using the chisel technique?

For most people the worst thing to deal with will be a minor degree of discomfort and blocked ears until the dressings are removed after three days. There are some people who do find the surgery painful, but these are the minority, and medication is available to deal with this. I have no way of predicting who those people might be, unfortunately. Ringing in the ears - tinnitus - is common but will disappear as your ear canals heal.

11. How long before I can get back into the water?

I suggest you wait until all canal swelling is down, about two weeks. As long as your ears are protected with plugs to keep seawater out, surfing again should not be a problem. You will be using ear drops regularly anyway for at least a month after the surgery.

My goal with the chisel technique is to get you back into the water ASAP.

12. Where do you operate?

I prefer to do all my operations in Knysna, where I have all the equipment I need, and have theatre staff and anaesthetists who know my requirements.

I hope to expand my practice to Hermanus and perhaps Cape Town, but again, the equipment I need still has to be bought by the relevant hospital groups.

Having your surgery done by a surgeon in his or her own comfortable and familiar environment is a significant advantage, and worth making an effort over ...

For follow up, I try to accommodate people where they live wherever possible, either in Knysna, Plettenberg Bay, or in the Cape area.

13. How do I go ahead with having my ears done by you?

Send an email to knysnaent at gmail dot com. My staff and I will get back to you with all the info you need.