Biopsy Under Local Anaesthesia

A lymph node biopsy removes lymph node tissue to be looked at under a microscope for signs of infection or a disease, such as cancer. Other tests may also be used to check the lymph tissue sample, including a culture, genetic tests, or tests to study the body's immune system (immunological tests).

Lymph nodes are part of the immune system. They are found in the neck, behind the ears, in the armpits, and in the chest, belly, and groin.

Lymph nodes in healthy people are usually hard to feel. But lymph nodes in the neck, armpit, or groin can get bigger and become tender. Swollen lymph nodes usually mean an infection. But the swelling can also be caused by a cut, a scratch, an insect bite, a tattoo, a drug reaction, or cancer.

There are several ways to do a lymph node biopsy. The lymph node sample will be looked at under a microscope for problems.

Biopsy (Incisional / Punch) also done in case of suspicious Ulcers in oral cavity & other parts of head & neck region for tissue diagnosys

Examination / Micro Suctioning under Operating Microscope

For some ear problems, using a microscope to magnify the view of the ear drum helps the surgeon with diagnosis. The microscope is mounted on an arm that is attached to the wall. There is a very bright light. The motor to drive the machine makes a low humming sound. Examination with the microscope may be done with the patient sitting up or reclining. The examination is painless and takes 5 minutes.

Ear toileting means to clear the ear canal and middle ear of any fluid, wax or foreign material. This is often combined with a microscope examination. Ear toileting can be used for:

• wax impaction.
• otitis externa (infection in the skin of the ear canal).
• middle ear infection with discharge from a perforation or grommet.
• removal of foreign objects, like beads in children.

The ear can be cleaned by:

• wiping with miniature cotton tips,
• sweeping with wax rings, hooks or curettes,
• using miniature forceps (like tweezers),
• suction

A suction machine is like a miniature vacuum cleaner. Some patients prefer wiping or curetting and others prefer suctioning. At times wiping can be very tender particularly if the ear is infected. Suctioning can be very loud and is quicker with less tenderness than wiping. People who have had ear surgery in the past, particularly mastoidectomy, can have vertigo for a few minutes during suctioning.

Examination with the microscope and aural toileting can take as little as 5 minutes or as long as 30 minutes depending on the problem. You will need to lie still and breathe normally. This treatment is suitable for children and adults. You will be able to drive home or return to work immediately after the procedure.

OTOEndoscopy

Otoendoscopy is a video-graphic examination of the ear with an endoscope and a camera.

Is Otoendoscopy a painful procedure?

It is painless procedure and doesn’t require anesthesia.

Why is Otoendoscopy done?

Videos are excellent aides for explaining the disease process to the patients and their families. The treatment is based on the findings.

What all conditions can be identified on Otoendoscopy?

Few examples of the ear diseases or findings that can be identified on otoscopy are:

• Otomycosis (fungal infection of the ear): Black, white, grey or green colored fungal spore may be seen on endoscopy.
• Otitis media with effusion: bubbles and air fluid levels are seen behind an intact tympanic membrane.
• Ear drum perforations: size and location of the perforations can be documented.
• Cholesteatoma: these can present as a small perforation with a white mass seen behind the ear drum.
• Myringosclerosis: white plaque like discoloration of the ear drum.
• Glomus tympanicum: a reddish mass seen behind an intact ear drum.
• Foreign body can be visualized and removed under vision.
• Eustachian tube function assessment: on performing Valsalva manoeuvre intact tympanic membrane is seen to move.

Myringotomy & Grommet Insertion

Myringotomy is a surgical procedure of the eardrum or tympanic membrane. The procedure is performed by making a small incision with a myringotomy knife through the layers of tympanic membrane (see the image below). This surgical procedure permits direct access to the middle ear space and allows the release of middle-ear fluid, which is the end product of otitis media with effusion (OME), whether acute or chronic. OME is classified as serous, mucoid, or purulent.

Hearing Test (Audiogram / Tympanogram)

Determining the type and cause of your hearing loss can be like a putting together a puzzle, and the many tests that make up a thorough hearing evaluation are like pieces to that puzzle.

Often used to assess the function of the middle ear, tympanometry is one test that can determine whether your hearing loss can be helped by hearing aids or whether a medical treatment is available to treat your loss instead. It's also used to detect middle ear problems, especially in children, even if they do not have hearing loss.

What is Tympanogram?

A tympanogram is a graphic representation of how the eardrum moves in response to the air pressure in the ear canal.

When the eardrum is activated by a sound wave, part of the sound is absorbed and sent through the middle ear, while the other part of the sound wave is reflected. The information derived from tympanometry provides additional information regarding middle ear function, especially Eustachian tube function.

If the tympanogram is within normal limits, the line makes a "mountain" shape around 0 daPA as the eardrum moves in response to the stimulus. The results are depicted in the picture to the right. If the tympanogram is abnormal, it may peak before or after the 0 daPa mark, or a flat line will be plotted if the eardrum doesn't move (due to perforation) or can't move (due to fluid or another cause). Note that daPa stands for decapascals, a unit of air pressure.

Foreign Body Removal from Ear / Nose / Throat

Foreign bodies in the ear, nose, and throat are occasionally seen in family medicine, usually in children. The most common foreign bodies are food, plastic toys, and small household items. Diagnosis is often delayed because the causative event is usually unobserved, the symptoms are nonspecific, and patients often are misdiagnosed initially. Most ear and nose foreign bodies can be removed by a skilled physician in the office with minimal risk of complications. Common removal methods include use of forceps, water irrigation, and suction catheter. Pharyngeal or tracheal foreign bodies are medical emergencies requiring surgical consultation. Radiography results are often normal. Flexible or rigid endoscopy usually is required to confirm the diagnosis and to remove the foreign body. Physicians need to have a high index of suspicion for foreign bodies in children with unexplained upper airway symptoms. It is important to understand the anatomy and the indications for subspecialist referral. The evidence is inadequate to make strong recommendations for specific removal techniques.