What is ENT?

What is an ENT specialist and why would I need to see one?

ENT stands for Ear, Nose and Throat and is a surgical specialty concerned with the diagnosis, management, and treatment of diseases and disorders of the ear, nose, throat and related structures of the head and neck, including the sinuses, larynx (voice box), oral cavity, and pharynx (mouth and throat).

It might seem a bit strange that three different areas of your body are covered by the same discipline. But, that’s because all these cavities are interconnected, and therefore assessing and solving any issues in these areas requires looking at the bigger picture to recommend the most appropriate treatment and prevent future problems in neighbouring areas.

At our medical clinic in Gibraltar, we are very fortunate to have two great ENT surgeons who run clinics every week and offer cutting-edge exploratory techniques for the diagnosis and treatment of issues affecting the ears, nose and throat.

Dr Robin Reyes is a highly-experienced surgeon, performing surgery for snoring, nasal and sinus problems as well as microsurgery of the larynx. We spoke to him to find out more about this speciality and how he and his colleague Mr Julian Danino can help patients in Gibraltar.

Why would someone come to see an ENT surgeon and what can you do?

There are many different reasons why a patient will come to see me. Here are the most frequently treated conditions:

• Hearing loss
• Ear infections
• Glue ear
• Dizziness and tinnitus
• Continuously blocked nose
• Nasal breathing problems
• Sinusitis
• Nasal polyps
• Problems with smell
• Snoring/sleep apnoea
• Pharyngitis/ laryngitis
• Tonsilitis

When you come in for an initial appointment, we start by getting a thorough understanding of the patient’s condition. Through medical history and examination, possible causes of the problem will be identified and medical treatment or surgical intervention will be recommended if necessary. We always try to explain things clearly, in a way that is easy to understand, as it is a complex area.

For example, if we see a patient who has difficulties breathing through their nose there are a number of things we would do. After noting their medical history, they are asked about other associated symptoms and they then undergo an examination using videonasofibrolaryngoscopy which is able to detect, for example, septal deviation which might require surgical intervention or rhinitis (inflammation of the nasal mucosa) which would require medical treatment.

We have a range of surgical procedures that we can undertake to improve your hearing or speech. For example, we offer tympanic membrane and middle ear surgery. If the membrane becomes perforated or doesn’t close spontaneously due to an injury or infection it can cause issues with hearing. We can perform a graft to close it and allow it to function correctly.

Another example is removing lesions from the vocal cord which are preventing the vocal cord from vibrating. We do this using laryngeal microsurgery, a procedure which enables the lesion to be removed without an external incision, removing the lesion through the mouth under microscopic surgical control.

Let’s drill down a little more and answer some common questions our patients often ask.

What is sinusitis, what are the symptoms and how can it be treated?

Sinusitis is basically inflammation of the paranasal sinuses, which are cavities behind your cheekbones and forehead, under normal circumstances these are completely filled by air. When you have sinusitis the lining of these cavities becomes inflamed, blocking the mucus produced there from draining.

The most common symptoms described by patients affected by sinusitis are difficulty breathing through the nose and considerable thick mucus (usually yellowy-green in colour) which is sometimes foul smelling. They often suffer headaches, heaviness and light headedness. Sometimes they may have a fever or inflammation of the eyes or cheeks.

We diagnose sinusitis during an ENT assessment. This includes an accurate clinical history, an examination involving visualisation of the inside of the nostrils and the sinuses using a rhino-fibro-laryngoscope, and on occasion the performance of imaging (CT sinuses) to reach an accurate diagnosis.

Treatment for sinusitis depends on the severity of symptoms. It can range from medical treatment using nasal sprays, mucolytics, anti-inflammatories and antibiotics to the need for surgical intervention to washout and clean the affected sinuses.

You can find out more about sinusitis on the NHS information website.

What should parents do if their children have frequent ear infections or a constant runny nose?

In both cases I would start by bringing their child in for an ENT assessment to see what is causing the problem.

In the case of ear infections (otitis) we need to find out the cause and why it continues to recur. Rhinitis, adenoiditis, vegetation or adenoid hypertrophy would be among the most common causes which give rise to recurrent otitis and must be treated sometimes with medical treatment, and sometimes with surgical treatment such as adenoidectomy, grommets or even tonsillectomy.

Currently, treatment is more conservative and surgery has become less common, as medical treatment does resolve the majority of cases.

A runny nose can be caused by a number of things and can be treated simply through a nasal washout with saline solution, an antihistamine and a nasal spray or even surgical treatment in extreme cases.

You mentioned grommets, what are they and what are they used for?

Grommets create an alternative route for the middle ear to communicate with the posterior part of the nose to ensure it is correctly aerated. They are needed when the middle ear is occupied by mucus or is badly ventilated due to malfunctioning of the Eustachian tube (the tube which allows the middle ear to communicate with the posterior part of the nose, keeping it aerated).

Although in paediatric patients, the procedure requires a general anaesthetic, in adults they can be inserted with local anaesthetic in less than 10 minutes.

There are grommets which last for a limited amount of time and which usually fall out in around 6-12 months and long-term grommets which can last for several years. The selection of one or the other depends on the condition and will be decided by the ENT surgeon.

Let’s talk about snoring – something which causes many issues in relationships and lots of sleepless nights. Can you help stop snoring?

Thankfully there have been great improvements in both diagnosis and treatment of snoring in the last few years.

I’ll start by stressing that it’s not something to take lightly as it can be a bigger issue than you might expect. It can be related to sleep apnoea (periods when the patient stops breathing completely), which can have significant consequences for the patient’s health, both in the medium and long term and which very often remains undiagnosed.

If someone comes to us for snoring, we will examine all the upper airway to find the cause of the snoring. Examination with videonasofibrolaryngoscopy will allow correct assessment and diagnosis.

There are a number of medical and surgical treatment options. For example, we may recommend a mandibular advance device, a surgical intervention with a septal device or resection of the uvula or part of the soft palate. If necessary, we coordinate with a respiratory physician and recommend the use of CPAP, a device which emits air at a constant pressure to prevent collapse of the airway during sleep.

If your snoring is affecting you or your partner it’s worth visiting an ENT specialist to see if there’s something we can do.

Any tips for keeping ears clean and healthy and anything you should avoid doing?

The first thing that I would have to say is that WAX IS GOOD. Our ear produces wax to prevent infections by producing an acidic environment, offering a mechanical barrier to trap particles which are harmful for the ear, it also contains a lysozyme which acts as an antibacterial agent.

Therefore, my first recommendation would be – do not remove the wax! Wax is expelled naturally by our bodies due to growth of the skin towards the outside of the ear. Only remove wax which is already outside the auditory canal and is unsightly. Wax which is completely blocking the auditory canal and has made a plug can be removed by a doctor.

As a general piece of advice, do not use cotton buds. Often, although part of the wax may be removed, more of it will be pushed into the ear.

Tell us about your ENT clinic in Gibraltar

I am available at the Specialist Medical Clinic in Gibraltar every two weeks, alternating with my colleague Mr Julian Danino. We have the technology required to make an accurate diagnosis, as well as offering the necessary treatment to our patients.

I have recently introduced the latest videonasolaryngoscope to my clinic which allows a higher image resolution and, due to its small diameter (2.8 mm), it also enables a more comfortable examination. The image recording system allows the ENT specialist to be able to explain to the patient about their condition as well as assess the progress of lesions over time.

The ear can also be examined with high precision microscopy and videotoscopy.

Impedancemetry/tympanometry and assessment of stapedial reflexes allows assessment of correct ventilation of the middle ear, the functioning of the Eustachian tube and the movement of the bone chain.

Meet the Expert

Dr Robin Reyes is an ENT Consultant Surgeon, registered locally with the Gibraltar Medical Registration Board.

Dr Robin Reyes and his fellow ENT surgeon Mr Julian Danino both hold clinics at the Specialist Medical Clinic in Gibraltar, alternating to provide a weekly service. They see both adults and children with a wide range of conditions including hearing loss, ear infections and glue ear, dizziness and tinnitus, continuously blocked nose, sinusitis, snoring, pharyngitis/laryngitis, tonsilitis and more.

Please contact us to arrange an appointment with Dr Reyes or Mr Danino.