As costs escalate, we strive for affordable treatment without compromising on quality parameters like success, safety and ease of processes. Also, as most patients feel more comfortable in the surroundings of their home, the ENT department offers patients the choice of day care surgery in majority of situations. With day care ENT Surgery, patients admitted to the hospital undergo operations , recover from anaesthesia and go home with their family, all in the same day.
Majority of the ear surgeries are done as day care procedures.
Myringotomy and Grommet insertion: It involves making an incision in the eardrum to drain middle ear fluid and putting in a ventilation tube. This is easily done under local anaesthesia without sedation in the adult patient, and the patient may be sent home within 1 hour of the operation. Children can be treated with short general or ketamine anaesthesia and sent home as soon as they are fully awake, and after the anaesthetist's consent.
Tympanoplasty: Repair of the ear drum with restoration of the middle ear hearing apparatus. This is done under local anaesthesia with sedation and the patient may be sent home when fully alert.
Mastoidectomy: Removal of disease, usually cholesteatoma, from the mastoid and middle ear, with or without reconstruction of tympanic membrane and hearing apparatus. Cholesteatoma is a type of skin cyst and commonly occurs due to complication of chronic ear infection located in the middle ear.
This is usually done under local anaesthesia with sedation. If the patient is apprehensive, general anaesthesia may be required as the surgery may sometimes stretch to 3 hours or more. These patients can also be sent home the same day. The patient may occasionally experience vertigo after mastoidectomy or ossiculoplasty and is sensitized about it before hand. Vertigo is a dizzying feeling or a reeling sensation as if one is about fall. In this case the patient may have to stay in the hospital for an extra day. In the normal course, they will be asked to follow up after 3 days for routine dressing and 7 days for suture removal. In case of pain, vertigo or bleeding the surgeon sees nthen to alleviate the condition.
Stapedectomy: Surgery for restoration of hearing in otosclerosis. This is usually done with local anaesthesia and sedation. These patients can sometimes have post-operative vertigo and even vomiting. In the event of vertigo, or complicated surgery, the patient should be kept overnight, or till the patient feels better. Most patients can however go home the same day, provided travel is short and smooth. Air travel is not advisable in the immediate post operative period.
Tympanoplasty and stapedectomy are only occasionally done in children. Mastoidectomy is always done with general anaesthesia and the children are usually asked to stay overnight.
Most septal and sinus surgery can be done under local anaesthesia with sedation. However, both involve nasal packing. Whilst patients can be sent home with nasal packs, many surgeons don’t recommend this . If the patient were to have some bleeding at home, then neither he nor the doctor would know if it was significant bleeding unless seen.
It could so turn out that the the surgeon is needed to rush to the patient’s home in the middle of a busy day, maybe to find only insignificant oozing! All these eventualities are thwarted by keeping them in the hospital for observation and easily accessible medical help. On the other hand, most patients do not bleed and tend to be more comfortable at home and could be called to the clinic after 24-48 hours for pack removal.
Endoscopic Dacryocystorhinostomy (DCR) can be done easily under local anaesthesia and sedation and the patient sent home after pack removal in the evening, provided there is no bleeding.
Endoscopic sinus surgery involving extensive polyposis or disease and in the posterior sinuses is done under general anaesthesia and these patients are usually advised to stay in hospital as there may be bleeding associated with major sinus surgery.
Endoscopic surgery for pituitary adenomas, optic nerve decompression, orbital surgery and CSF rhinorrhoea also involves staying in the hospital for a few days. Patients who have epistaxis, a medical term for nose bleed, (without any major causative pathology) are excellent candidates for day care endoscopic surgery. Earlier these patients would be packed for 48 hours and the packs removed with frequent rebleeding. Now, with the endoscope, the bleeding point can be identified and cauterized and the patient sent to the room without packing and fear of bleeding. They are then discharged soon after a few hours of observation..
Throat and laryngeal surgery
Tonsillectomy and adenoidectomy have always been done as day care procedures. The patients are sent home in the evening after checking the fauces for clots or bleeding. Oral biopsies, buccal leucoplakia excision and other such minor surgeries are also excellent day care situations. Even most rigid endoscopies, such as direct laryngoscopy, microlaryngoscopy and oesophagoscopy, done under general anaesthesia lend themselves to being day care cases. These are usually short procedures for diagnosis, biopsy, and therapeutic excision of small lesions or foreign body removal and do not entail much bleeding or major surgery.
Rigid bronchoscopy or surgery for tumours would require more hospital stay.
LIST OF ENT SURGERIES PERFORMED AT SHALBY HOSPITALS
ENT surgeons diagnose and treat conditions of the ears, nose, throat, head and neck, and undertake some cosmetic procedures.
Head and Neck
Dauji Dental Clinic, Friends Palak Plaza, Langde Ki Chauki, Bypass Road, Agra
Dr. Jaybabu Cardio Diagnostics Centre, Nr. Big Bazar, Professor Colony, Agra
Shalby Clinic Sobo Centre Near Sun City South Bopal