Otolaryngology is a surgical specialty that deals with the ears, nose, throat and related areas of the head and neck. Otolaryngologists are more commonly called Ear, Nose and Throat (ENT) specialists. Often, they work in conjunction with oral and maxillofacial surgeons.

The ENT specialty encompasses many surgical procedures for children and adults. ENT surgeries performed at Mission Hospitals include but are not limited to:

• Direct laryngoscopy. The surgeon inserts a fiber optic endoscope or laryngoscope into the larynx, which is the part of the respiratory tract that contains the vocal cords. The procedure can be done under local or general anesthesia and can involve any of the following:

• finding lesions, foreign objects or any narrowing of the larynx

• confirming cancer in the larynx

• removing benign lesions or foreign objects in the larynx

• Ear surgery. ENT specialists perform a wide range of surgery involving the ear, such as eardrum procedures and reconstruction of ear bone. One of the most common is myringotomy tube insertion to resolve recurrent inner ear infections on many children and some adults.

• Functional endoscopic sinus. For patients who have recurrent sinusitis--or inflammation of the sinus, functional endoscopic sinus surgery is often done after non-surgical treatment fails. This minimally invasive procedure involves the use of fiber optic scopes and CT scans that allow the surgeon to see inside the affected area and restore normal sinus function.

• Head and neck malignancy. ENT specialists perform surgery to treat cancers in the head and neck area, including:

• tumors in the jaw, larynx, mouth, nose and throat, oral cavity, pharynx, thyroid, upper airway, and voice-box

• vascular and salivary tumors

• temporal bone carcinoma

• skin and scalp cancer

• Septoplasty (straightening of the nasal septum). The nasal septum is a combination of cartilage and thin bone that separates the right nasal cavity from the left nasal cavity. If the nasal septum is deviated (crooked) to the point that it interferes with breathing, it can be corrected with a surgical procedure called septoplasty. The procedure involves adjusting or removing the crooked portions of the septum. In these cases, the surgeon almost always works through the nose with no external incision. Septoplasty can be done in conjunction with rhinoplasty, a reconstructive procedure done on the nose for cosmetic reasons or to repair it after an injury.

• Surgical management of skin cancer and non-cancerous lesions. Most of these cases involve the removal (excision) of several types of skin cancer in the head and neck areas. However, other types of skin growth may be excised for cosmetic reasons or to prevent development of skin cancer. Excision is followed by reconstruction, usually involving a skin flap or skin graft technique.

• Surgical treatment for sleep apnea. Obstructive sleep apnea (OSA) is a condition in which a partial or complete obstruction of the upper airway is caused when the muscles of the upper airway relax during sleep. It causes the person with OSA to partially awaken from deep stages of sleep until the airway clears, often many times in one night. Characteristics associated with sleep apnea can include:

• large tonsils, palate, and tongue

• a short thick neck

• being overweight

• hypothyroidism

• deviated septum or nasal obstruction

Surgical treatments for sleep apnea range from tonsillectomy to removal of other tissue in the upper airway. In severe cases, a tracheotomy--insertion of a breathing tube through an incision in the neck below the area of obstruction--can be performed.

• Tonsillectomy and adenoidectomy. The tonsils occupy the back of the mouth and are thought to produce antibodies that fight infections. The adenoids have the same function, but are located above the soft area of the roof of the mouth. However, if inflammation and infection are present in these areas, an ENT surgeon may elect to remove the tonsils, adenoids or both. This is one of the most the most common types of surgery performed on children in the United States.

Certain ENT procedures can be performed on an outpatient basis (requiring no hospital stay) under local or general anesthesia. When possible, ENT surgery is done using minimally invasive techniques. Many outpatient surgeries are done at Mission's Asheville Surgery Center, a state-of-the-art ambulatory surgery facility opened in May 2000.