Author: tomDP

What is dysphonia?

Dysphonia, also known as hoarseness, is a very common disorder affecting the voice. It occurs when sounds cannot be produced normally due to problems with the structures involved in voice production. 

The vocal cords (voice box) play the central role, but other parts of the body – including the lungs, trachea (windpipe) and mouth – also contribute to how the voice is shaped.

There are many possible causes, ranging from simple infections such as viral laryngitis through to more serious conditions including cancer. Ongoing or persistent hoarseness should always be assessed by a specialist to determine the underlying cause.

What are common causes?

Viral laryngitis

Inflammation of the voice box caused by an upper respiratory tract infection (such as a cold).

Muscle tension dysphonia

Occurs when the muscles around the voice box are overused or used incorrectly, rather than relying on the vocal cords themselves.

Vocal nodules (singer’s nodules)

These are small areas of thickening on the vocal cords caused by strain or overuse. They are commonly seen in singers and those who regularly use their voice heavily, such as coaches or teachers.

Gastro-oesophageal Reflux Disease (GORD)

Reflux can affect more than just the oesophagus. Stomach acid can reach the throat and voice box, causing irritation and swelling of the vocal cords; it can also impact healing after surgery.

Laryngeal cancer

Laryngeal cancer, or cancer of the voice box, most often occurs in people over the age of 40 with a history of smoking, although it can occasionally develop in non-smokers. When detected early, outcomes are generally very good.

Dr Phillips is experienced in the assessment and management of voice disorders. Any ongoing or concerning change in voice should be discussed with a general practitioner for further evaluation.

What is snoring?

Snoring is a sound produced during sleep when airflow becomes turbulent as it passes through the upper airway. The vibration of surrounding tissues creates the characteristic noise.

What is the cause of snoring?

Snoring usually has more than one contributing factor. Common causes include:

• Nasal obstruction
• Enlarged tonsils
• Excess or relaxed tissue in the soft palate
• A relatively large tongue
• Sedative medications
• Alcohol
• Increased body weight

What can be done about snoring?

Management of snoring generally starts with identifying and treating any nasal blockage, as this can play a significant role. If snoring persists, further assessment is often focused on the soft palate and other areas of the airway that may be contributing.

Does soft palate surgery work?

In carefully selected patients, surgery on the soft palate can be very effective in reducing snoring. It is not suitable for everyone, but when the anatomy is appropriate, outcomes are often favourable. Assessment by an ENT surgeon like Dr Phillips is required to determine whether this type of procedure is likely to be beneficial.

Rhinosinusitis

Rhinosinusitis refers to inflammation affecting the lining of the sinuses around the nose (paranasal sinuses).

Symptoms

Common symptoms include:

• Nasal blockage
• Runny nose
• Post-nasal drip (mucus running down the back of the throat)
• Reduced sense of smell
• Facial pressure or discomfort

Rhinosinusitis can be divided into two main types: polypoid (where nasal polyps are present) and non-polypoid. 

While the underlying causes may differ, initial treatment for both types usually involves nasal sprays and medications to reduce inflammation and improve drainage.

Surgery

Surgery is generally considered when your symptoms continue despite appropriate medical treatment. The aim of surgery is not only to open the sinuses but also to improve how well medications can reach the lining of your nose and sinuses.

The surgical procedure used to treat rhinosinusitis is known as functional endoscopic sinus surgery (FESS).

Nasal Obstruction

Nasal obstruction refers to difficulty breathing through the nose with enough airflow. This is not considered normal and, in most cases, can be effectively treated.

Symptoms

Symptoms can vary. Some are more obvious, such as a feeling of a blocked nose, while others may be less direct, including:

• Reduced sense of smell
• Snoring
• Runny nose
• Waking with a dry throat

It is common for one nostril to feel more blocked than the other at times. This can be part of the normal nasal cycle, where tissue inside the nose (the inferior turbinates) naturally swell on one side while shrinking on the other, alternating throughout the day.

Management

There are two main approaches to managing nasal obstruction:

• Nasal sprays
• Surgery

In most cases, treatment begins with a trial of nasal sprays. This typically involves a combination of saline rinses (saline douche) and intranasal steroid sprays. These should be used consistently for around 6 weeks to assess their effectiveness.

If your symptoms do not improve with sprays, surgery may be considered. The specific procedure will vary depending on the cause of the blockage, but the overall aim is to improve airflow by increasing the space inside the nasal passages, while maintaining normal nasal function.

Many patients benefit from a septoplasty (to straighten the septum) combined with a turbinoplasty (to reduce the size of the turbinates). In more complex cases, or where previous surgery has not been successful, a functional rhinoplasty may be recommended.

For further information about treatment options, an appointment can be arranged with Dr Phillips.

Uvulopalatopharyngoplasty (UPPP)

What to expect

Immediately post op:

Your pain should usually be quite manageable at this stage, as local anaesthetic is placed in the surgical area. It is important to start eating and drinking early, along with taking pain relief. The local anaesthetic will gradually wear off over about 10 hours.

Day 1:

This is often the most uncomfortable day. Regular pain relief is important. Keeping hydrated is important, so regular fluid intake and icy poles can help. Your throat will have stitches, and a white coating may be visible – these are both normal. Swelling of the uvula (the small tissue at the back of the palate) is also common.

Day 2 – 3:

Pain relief should continue to be taken regularly, even your pain feels under control. Staying well hydrated is essential. Eating is encouraged but not as important as drinking fluids. Icy poles can continue to provide relief. Bad breath is common during this stage and is also normal.

Day 3 – 7:

Pain relief can usually be reduced and taken only as needed.

Day 7 – 10:

A temporary increase in pain for about 24 hours can occur during this time, which is normal and expected. Regular pain relief during this time is recommended and symptoms will usually settle again afterwards.

Frequently asked questions

About the procedure

Septoplasty (straightening of the nasal septum) combined with turbinoplasty (reduction of the inferior turbinates) is the most commonly performed procedure to treat a blocked nose.

Septoplasty involves gently lifting the lining inside the nose to access the septum, which is the cartilage dividing the nasal passages. The bent or misaligned portion is then straightened or removed. The incision is made inside the nose, so there are no visible external cuts or bruising. This procedure is performed under general anaesthetic and usually takes around 60 minutes, although can be longer if a more extensively deviated septum is addressed.

In most cases, septoplasty is performed by Dr Phillips as a completely endoscopic minimal access procedure. This together with reduction of the turbinates can often be done as day case surgery when done entirely endoscopically. In more advanced cases a one night overnight hospital stay may be recommended.

The nasal turbinates can be enlarged or swell due to a range of conditions, particularly from allergies such as allergic rhinitis. Turbinoplasty involves carefully lifting the lining over these structures and reducing their size by removing some of the underlying bone.

This surgery is generally not associated with significant pain and is commonly performed as a day procedure. Some, mild blood stained ooze bleeding is expected during the first week which usually settles on its own. A saline douche (saltwater rinse) such as FLO post op sinus rinse is required for around 6 weeks after surgery to support healing. 

Overall, the procedure is more than 90% effective in improving nasal blockage.

Before the procedure

Before surgery, a detailed assessment of the nose is required. This includes a thorough discussion of symptoms along with a physical examination. In most cases, a nasal endoscopy is performed using a small camera to assess the back of the nasal passages.

Tests to measure airflow through the nose (rhinomanometry) are also commonly carried out for patients undergoing septal or turbinate surgery.

Prior to the operation, there will be a detailed discussion outlining the surgical plan and what to expect during recovery.

During the procedure

The operation is usually performed through very small incisions made inside the nose. In some cases, particularly when the septal deviation is located towards the front of the nose, a small external incision may be required on the columella (the tissue between the nostrils).

Once the deviated section of cartilage has been corrected or removed and any necessary grafts have been placed, the incisions are closed. The septum is then positioned centrally. Silicone splints may sometimes be placed inside the nose to provide support during healing if there has been very extensive surgery required.

The turbinates are reduced using specialised endoscopic instruments. Dissolvable packing is often used to minimise bleeding. This gradually clears with the help of saline rinses in the weeks following surgery, supporting proper healing.

Post procedure recovery

Most patients can go home on the same day as surgery without needing to stay overnight. Depending on whether splints or packing have been used, a short course of antibiotics may be prescribed, but mostly is not required. 

If splints are inserted, they are typically removed about one week after surgery. A further follow-up appointment is usually arranged at around 4 to 6 weeks.

Some bleeding during the first week is normal, although significant bleeding requiring readmission to hospital is uncommon. Pain is usually mild and can be managed with simple medications such as paracetamol and ibuprofen.

What’s next?

After recovery, the nasal blockage that led to surgery should be noticeably improved. In some cases, repeat nasendoscopy and surveillance of sinuses may be required.