Laryngoscopy is a procedure performed under local anaesthesia sprays in the rooms to look at and examine deeper structures of the throat pharynx and vocal cords.
Micro laryngoscopy
This is performed in hospital under brief general anaesthesia to examine the throat, pharynx, larynx (voice box) and vocal cords. During this procedure, detailed photo documentation of any lesions is performed prior to any biopsy or removal of abnormal tissue and this is sent for pathology testing. It is typically done as a day procedure, allowing patients to go home the same day. Results of biopsies typically take around 1 week to get a full and finalised report.
Cancers affecting the head and neck are the sixth most common type of cancer. Achieving the best outcomes depends on accurate diagnosis, effective treatment and ongoing follow-up, all of which rely on both surgical expertise and a coordinated approach to care.
Management typically involves a team of healthcare professionals, including radiation and medical oncologists, general practitioners, dentists, and allied health providers such as speech pathologists, physiotherapists and dietitians. Working together, this team aims to provide comprehensive care and support.
Head and neck cancers can develop from the skin or from the lining inside areas such as the mouth, nose, sinuses, throat, tonsils and airway. They may also arise from glands in this region, including the parotid, submandibular and thyroid glands. These cancers often present with local symptoms such as pain or the feeling of a lump. In some cases, they may spread to nearby lymph nodes, appearing as a swelling in the neck.
Symptoms
Symptoms that may require further assessment include:
Ulcers in the mouth that do not heal
Pain or difficulty when swallowing
Changes in the voice
A lump in the neck
Risk factors vary depending on the type and location of the cancer.
Skin cancers, including both melanoma and non-melanoma types, are strongly linked to sun exposure.
Cancers of the mouth and throat are more commonly associated with lifestyle factors such as smoking and alcohol use. In recent years, certain viruses have also been linked to the development of some head and neck cancers, particularly in younger and otherwise healthy individuals. Early medical review of concerning symptoms is important, as early detection is associated with better outcomes.
Multidisciplinary Treatment
Dr Phillips provides specialised care in the diagnosis and treatment of head and neck cancers. Care is delivered in close collaboration with oncologists and allied health professionals to ensure all aspects of treatment and recovery are carefully managed. A multidisciplinary approach is prioritised, with coordination across both private care settings and services such as the Olivia Newton-John Cancer Centre at Austin Health.
Head and neck surgical procedures offered include for cancers affecting internal linings, lymph node surgery in the neck, and procedures involving glands such as the salivary glands (parotid and submandibular) and the thyroid.
Grommets are small ventilation tubes placed into the tympanic membrane (ear drum) to allow air to flow into the middle ear and help middle ear fluid or glue ear dissipate.
They are commonly recommended in the following situations:
Recurrent acute otitis media (middle ear infections), such as more than 4 episodes in a year or 3 within 6 months
Otitis media with effusion with poor hearing (fluid behind the ear drum) affecting both ears for three months, or one ear for six months
Delayed speech development because of persistent middle ear effusions
There are also some rare indications such as severe tympanic membrane retractions from severe eustachian tube dysfunction or needing to provide pressure relief for hyperbaric chamber treatments.
After grommet insertion, it is common for children to show a noticeable improvement in how they respond to sounds. Speech clarity may also improve as hearing becomes clearer.
Grommet insertion is considered a safe and routine procedure. In children, it is performed under general anaesthetic, and discharge home is usually possible about one hour after surgery. In adults, grommets are much more rarely required and are also often inserted in the operating theatre, although sometimes under local anaesthesia.
Grommets are designed to remain in place for around 9–24 months. They usually fall out naturally on their own, often without being noticed. The small opening in the ear drum typically heals by itself once the grommet has come out.
Surveillance checks will usually be recommended on a 6 monthly basis until the grommets naturally extrude on their own. At least 2 in 3 children who need grommets never need another set inserted.
An appointment can be made with Dr Phillips for further discussion about grommet insertion.
Grommets post-operative instructions
What to expect
Immediately post op:
Your child may experience some brief discomfort after the procedure. This is generally short-lived and often related to the effects of the anaesthetic. Discharge home usually occurs about one hour after surgery.
Day 1 – 7:
You will not usually notice any discharge. Occasionally a small amount of discharge from your child’s ear, which may include blood or pus can occur during the first few days and part of the normal healing process. Ear drops are sometimes recommended and should be used if they have been prescribed in your post op orders. If your child is in pain, paracetamol (Panadol) or ibuprofen (Nurofen) is usually sufficient. Showering is permitted, but swimming should be avoided during this time until after the first post operative visit which is usually at 2-3 weeks after the procedure.
After day 7:
Return to Swimming is usually restricted until after the first post operative visit and then can resume often without the need for any er plugs in most cases.
It is recommended to avoid submerging the head under soapy water in the bath, and also in dirty water like dams or low flowing rivers.
If you noticed discharge from your child’s ears, this is often associated with a cold or other upper respiratory infection. If discharge continues for more than 24 hours, antibiotic ear drops (such as Ciloxan 3 drops twice per day)) may be required and can be prescribed by a GP or by your Ent surgeon.
If discharge persists for longer than one week following treatment, it is important to contact the clinic, as review by your child’s surgeon may be needed. In some cases, gentle suctioning of the ears may be required or arranging to send a swab of the discharge to a lab for microscopy and culture.
Frequently asked questions
When do I follow up with the doctor?
The first follow-up appointment is usually scheduled 2-3 weeks after surgery. Further reviews are usually recommended on a 6 monthly basis and can be arranged on a shared-care basis with your GP and ENT alternating these checkups.
What if the grommets fall out?
Grommets are designed to come out on their own, so this is expected and not a cause for concern. Once the grommets have fallen out, a repeat hearing test is recommended, along with a review appointment with the surgeon.
Functional endoscopic sinus surgery (FESS) is a surgical procedure performed through the nostrils to open the sinus passages providing relief for many patients with chronic sinusitis with or without nasal polyps.
Over the past 10 years, there have been major improvements in how this surgery is done. Better imaging, more precise surgical techniques, specialised instruments, advances in anaesthesia, and closer follow-up care have all led to much better outcomes for patients.
Dr Phillips has extensive training in endoscopic sinus surgery and takes a careful, detailed approach.
Most patients who are suitable for this surgery will have already tried appropriate medical treatments for their sinus condition before surgery is considered.
The way sinus surgery is performed has changed significantly over the last 10 years. The focus is now on restoring normal sinus function by opening blocked areas and treating all affected sinuses.
Older methods, sometimes described as a “sinus scrape,” often did not give lasting relief. Current techniques aim to properly open the affected sinuses so they can drain, be appropriately cleaned, and be easily monitored in the rooms after surgery.
In some cases, image-guided technology is used during the procedure to ensure all diseased areas are treated. After surgery, nasal packing is often not needed. In the past, removing nasal packs caused significant discomfort, but this is now uncommon.
With improvements in both surgery and anaesthesia, significant bleeding is also unusual during and after the operation. As result, many patients are able to go home the same day, although an overnight stay may occasionally be recommended if the surgery is more extensive.
After surgery, regular saline rinsing is recommended as an important part of recovery. A low-pressure, high-volume rinse should be used 4 times a day for at least 2 months. Follow-up appointments are also essential, allowing the sinuses to be checked and any remaining debris that has not been washed out by the saline to be gently cleared.
Further information about recovery can be found in the post-operative handouts.
To discuss endoscopic sinus surgery further, an appointment can be made with Dr Phillips.
Post operative instructions
What to expect
Immediately post op:
A small piece of gauze is usually placed under your nose after surgery. Breathing through your nose is often fairly comfortable at this stage. Pain is usually mild due to the local anaesthetic used during the procedure.
Day 1:
Some blood-stained fluid may ooze from your nose overnight. This is normal and does not mean there is active bleeding. Your nose may feel more blocked compared to immediately after surgery because of this ooze of blood and serous fluid. You can change the gauze under your nose as necessary (eg. if it becomes full).
You may occasionally have 2 small, clear splints present inside your nose if there has been extensive septal deviation correction during the same operation, held in place with stitches.
A saline wash bottle will be provided to you by the nurses and should be started on this day. This step is as important as the surgery for healing. The bottle should be filled with cooled, previously boiled water, and the supplied solvent should be added.
While leaning over a sink, insert the bottle into your nostril and gently squeeze the bottle. A lot of the fluid will run through and come out of the nose, which is expected. Half the bottle should be used on each side. This should be done at least four times a day for about three months.
At night:
Taking pain relief before bed on the first night can help you with comfort. Sleeping with your head raised on two pillows is recommended. A towel on the pillow and gauze under your nose can help catch any drainage and protect the skin.
Day 2 – 7:
During this time, it is common to feel as though there is a cold, with nasal blockage and congestion. Some numbness around the tip of the nose and upper lip may also be noticed. This is normal and settles with time.
Day 8 – 10:
If splints are present in your nose, they are usually removed at the first follow-up visit. Breathing often improves straight away, and the feeling of congestion reduces. If there are no splints used your first follow-up visit will be scheduled around 2-3 weeks post op.
Any concerns or unexpected changes should be addressed promptly by contacting the clinic, where support is readily available during the recovery period.
Frequently asked questions
Pain relief?
FESS is generally not a very painful procedure. A feeling of pressure or fullness in the sinuses is more common than pain after surgery in most people.
Regular pain relief is recommended for the first 24 hours, then taken as needed.
Anti-inflammatories such as ibuprofen or Celebrex along with regular paracetamol will be recommended. Stronger pain relief will be provided for you from the hospital pharmacist to use if required with written instructions.
Antibiotics?
Antibiotics are not usually prescribed after FESS. There is little evidence for benefit in average uncomplicated cases.
What should I eat?
A normal diet can be resumed after surgery.
What are the activities I shouldn’t do?
No very hot showers or baths – 72 hours
No heavy lifting or nose blowing – 7-10 days
No vigorous or strenuous exercise – 7-10 days
No blood thinning medication – 2 weeks or until advised by your surgeon.
How much time do I need off work?
Most individuals require around one week away from lightwork, although this may vary depending on recovery or if a more strenuous work is undertaken.
How important is the wash bottle?
Regular use of the wash bottle is essential following this procedure. It plays a critical role in supporting healing of the nasal lining after surgery. Use at least 4 times daily is required, though more frequent use – up to 10 times per day – may provide additional benefit without causing harm.
Using the wash bottle more than 4 times per day will not result in any harm.
What do I do if I get bleeding?
If bleeding occurs, start by using a wash in the nose. Sit leaning forward with your mouth open, applying firm pressure to the sides of your nose down at the tip for a total of 10 minutes. Use of ice packs over the nose may also be helpful. If this is unsuccessful after 10 minutes, then give yourself another wash. If bleeding persists, seek care at the nearest public hospital with an Emergency Department.
