Otolaryngology (Ear, Nose and Throat) is a medical-surgical speciality that is responsible for the prevention, diagnosis and medical and surgical treatment of conditions of the ear, the upper aerodigestive tract (nose, mouth, pharynx and larynx) and the neck and facial skeleton structures related to these.
It is a broad speciality that requires different knowledge and technology for the correct diagnosis and treatment of conditions related to the different areas.
Furthermore, Otolaryngology, as with the other medical specialities, is undergoing continuous changes and has experienced a real revolution in recent years, with new technologies being incorporated.
The logical consequence is the shift to an increasingly bigger sub-specialisation within our speciality.
At the Ruber International Hospital we have trained, highly specialised professionals, who work full time, as well as state-of-the-art technology for the diagnosis and treatment of the different areas of Otolaryngology.
Nose and paranasal sinuses
Nose and paranasal sinus disorders are one of the most prevalent conditions in Otolaryngology (Ear, Nose and Throat).
We study and treat nasal obstruction, aesthetic disorders of the nasal pyramid, rhinitis, sinusitis, septal perforations and problems with sense of smell until the most suitable solution is found in each particular case.
The surgical treatment of these conditions has undergone a radical change in recent years.
Endoscopic Sinonasal Surgery
Firstly, the use of endoscopes with different angles has resulted in the emergence of endoscopic sinonasal surgery which is normally used for the treatment of sinusitis, polyposis and tumours of the nasal cavity and paranasal sinuses. This has allowed us to treat these conditions using less aggressive and more functional procedures that provide much more comfortable post-operative periods, practically pain-free and without the need for nasal packing in most cases.
Neuronavigation Systems
Secondly, endoscopic surgery has experienced an enormous boost thanks to the use of neuronavigation systems in operating theatres which make it possible to reach farther and with greater safety. These neuronavigation systems provide treatment in those cases in which the anatomy is altered, particularly in patients who have already been operated on several times, with a history of trauma and are an essential support to treat cavity and paranasal sinus tumours and some skull base tumours through advanced endoscopic sinonasal surgery.
Cosmetic Nose-reshaping (Rhinoplasty)
Cosmetic nose-reshaping (rhinoplasty) has been part of the normal service portfolio in Otolaryngology for years. In-depth knowledge of the anatomy of the nose and extensive experience in functional surgery, places otolaryngologists in a privileged position for the treatment of functional and cosmetic problems of the nose in the same surgical procedure. In this way, in the same surgical procedure we can correct cosmetic deformities, treat sinusitis through endoscopic procedures and improve breathing by correcting the nasal septum, treating polyposis, or turbinate reduction with radiofrequency etc.
Olfactory Unit
At the Ruber International we also have an Olfactory Unit, especially dedicated to the diagnosis and rehabilitation of sense of smell problems, which is a pioneer in Spain. We carry out measurements of the ability to smell with subjective and objective tests (modified CCCRC, fMRI olfactometry and EEG olfactometry) and we have a team for sensorineural smell loss.
PAEDIATRIC ENT
Paediatric otolaryngology covers the specialist care of ear, nose and throat problems up to the age of 14.
Poviding children with appropriate, personalised and quality care requires not only scientific knowledge, but also special skills to win over their trust and to manage to get them to cooperate in the evaluation.
Early Detection of Hearing Loss Programme
At the Ruber International Hospital, in collaboration with the Neonatology Department, we carry out the Early Detection of Hearing Loss Programme. For this, we have equipment for Screening Potentials, Brainstem Auditory Evoked Potentials, Steady-State Auditory Evoked Potentials and staff trained in children's audiology. All of this allows us to carry out an early diagnosis of hearing loss and to select the most appropriate treatment in each case.
Hearing problems and problems with the adenoid-amygdalar tissue
The majority of consultations related to paediatric otolaryngology are related to hearing problems and problems with the adenoid-amygdalar tissue.
Recurrent infections of the ear (acute otitis media, serous otitis media) and of the upper airway (tonsillitis, colds, sinusitis, laryngitis, etc.) are usually susceptible to medical treatment. If there is no improvement, it may be necessary to carry out a surgical procedure: tonsillectomy, adenoidectomy and/or placement of transtympanic drains.
Sleep-related breathing disorders
Sleep-related breathing disorders are also very common in the paediatric population. Tiredness when waking up, irritability, night sweats, restless sleep, frequent position changes while sleeping, and even nocturnal hyperactivity or enuresis are symptoms associated with sleep apnoea in children. The majority of times the obstruction is produced in the oropharynx due to an increase in the size of the tonsils and adenoid vegetations, thereby their removal or reduction solves the problem. Other times, the obstruction is produced as a result of congenital laryngotracheal malformations, with the laryngomalacia being the most common. They can coexist with other causes that we must consider, such as nasal polyps, choanal atresia, neurological and muscular disorders, symptoms of craniofacial malformations and upper airway tumours.
Laryngology, Voice And Swallowing
Changes in the voice, difficulty swallowing, choking and shortness of breath are symptoms that can indicate that there is a laryngeal disorder, which must be studied and treated in a specialist laryngology unit.
In our hospital, we have a specialist unit, with resources and experience in the most innovative diagnostic and therapeutic techniques that can be carried out in this field. Some more specific conditions such as laryngeal tremor, spasmodic dysphonia and laryngeal paralysis require the collaboration of the Neurology and Neurophysiology departments, also available at our Hospital and with extensive experience in movement disorders.
Disorders of the larynx
We treat organic and functional disorders of the larynx:
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- Polyps, oedemas and vocal cord cysts
- Vocal cord movement disorders such as paralysis, tremors and
- Spasmodic dysphonia
- Professional and artist voice disorders
- Gender dysphonia
- Oropharyngeal dysphagia.
Diagnosis
For the diagnosis, we have specific tests such as acoustic voice analysis, laryngostroboscopy, laryngeal electromyography and videoendoscopic swallowing study.
- Acoustic voice analysis:
Acoustic voice analysis is the determination of acoustic parameters collected via a voice recording. - Laryngostroboscopy:
Laryngostroboscopy is an examination in which, through a camera that is inserted into the mouth or the nose, we can see the vibration of the vocal cords.. - Laryngeal electromyography:
Laryngeal electromyography is a diagnostic test that consists of placing some electrodes on the laryngeal muscles to assess how the laryngeal nerves and muscles work. - Videoendoscopic swallowing study (VESS):
The VESS is a test that consists of checking how the patient swallows, through the direct vision of the larynx and hypopharynx with a fibroscope while the patient ingests liquids thickened at different consistencies and dyed with a stain for improved vision.
- Acoustic voice analysis:
Depending on the diagnosis, the treatment of these conditions may involve a logophoniatric treatment, medical treatment and it is sometimes necessary to resort to surgery. Surgical procedures can sometimes be carried out as an outpatient at the clinic, such as injection laryngoplasty in some cases or botulinum toxin infiltrations for spasmodic dysphonia and laryngeal tremor.
Snoring and Sleep Disorders
Sleep apnoea affects approximately 4% of the population. Patients with sleep apnoea present repeated episodes of total or partial obstruction of the upper airway while they sleep. This means that they stop breathing during these periods. As a result, the patient does not rest well, significantly impairing their quality of life. These patients with sleep apnoea have a higher risk of heart disease, strokes and even road traffic accidents.
Just as this condition requires, we tackle the problem from a multidisciplinary point of view, working in close collaboration with the Departments of Respiratory Medicine, Neurology, Paediatrics, Endocrinology, Dentistry and Maxillofacial Surgery. Amongst all of them, and assessing the preferences of each patient, we offer the most appropriate solutions for each case.
Once the diagnosis has been made by means of a nocturnal polysomnography, we will suggest the treatment that we consider to be most appropriate in each case.
In order to assess whether or not a patient is a candidate for surgical treatment, and what is the most indicated procedure in their case, we use a drug-induced sleep endoscopy (DISE). This test is performed in the operating theatre. It consists of producing, with intravenous medication, sleep which is as similar as possible to physiological sleep. While the patient is sleeping, we insert a fibrescope through the nasal cavities to see what is happening in the respiratory tract when the patient has a respiratory pause. According to the level in which the obstruction occurs, we will offer different surgical options.
Otology and Audiology
In the field of audiology and otology, the scope of action of the otolaryngologist ranges from prevention to the diagnosis and treatment of different ear disorders, and the age of intervention ranges from childhood to adulthood and the elderly.
At the Ruber International we carry out medical or surgical treatment of the different ear disorders: eardrum perforations, cholesteatomas, serous otitis media, otosclerosis, balloon dilation tuboplasty, implantable hearing devices… and we provide advice in relation to the adjustment of hearing aids.
We have all the necessary resources to carry out a complete hearing study by hearing aid specialists and specialised audiologists: Pure Tone Audiometry, Paediatric Audiometry, Tympanometry, Otoacoustic Emissions, Screening Automated Potentials, Brainstem Auditory Evoked Potentials, Steady-State Auditory Evoked Potentials. vHIT, Videonystagmography and VEMP.
Vertigo and Balance Disorders
Balance disorders are common and often disabling.
Several body systems must work well and interact so that we are able to maintain our body's balance: sight, hearing, joints and muscles, nervous system…
We can understand, therefore, that the study and treatment of balance disorders is sometimes very complex, and it should incorporate very sophisticated and specific technology.
In this unit, the Ruber International Hospital offers its patients the possibility of carrying out a comprehensive diagnosis of conditions that affect the inner ear (labyrinth) and the symptoms of which include the following: vertigo, dizziness, imbalance, hearing loss, clogging or tinnitus.
Ménière's disease, benign paroxysmal positional vertigo, ototoxicity, acoustic neurinoma… these are some of the numerous conditions that can cause balance disorders that must be studied and treated in a specialist vertigo unit.
For this, we not only have professionals of renowned national and international prestige, but also all the equipment necessary to make a specific diagnosis for every condition. We are able to analyse each subsystem of the inner ear in detail.
Equipamiento
Esta equipación está compuesta de:
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- Audiometría tonal y verbal, impedanciometría, potenciales evocados auditivos de tronco cerebral, de estado estable y automatizados: con estas pruebas se puede hacer un análisis del estado de la cóclea, así como de la membrana timpánica y la cadena osicular.
- Videonistagmografía: Permite el estudio de los movimientos oculares que se producen en pacientes afectos de vértigo, de origen tanto vestibular como central.
- Test calórico bitermal: Gracias a un estímulo por gradiente de temperatura aplicado al oído externo, podemos conocer la funcionalidad vestibular (aquella parte del oído encargada del equilibrio), analizando la respuesta nistágmica que se produce.
- Visoculares: Se puede valorar el estado de los mecanismos de estabilización de la mirada, cuyo origen es entre otros, el cerebelo.
- Video Head Impulse Test (VHIT): Mediante este sistema, se puede analizar la integridad de cada uno de los 6 canales semicirculares que forman parte del vestíbulo.
- Vestibular Evoked Myogenical Potential (VEMPs): tanto cervicales como oculares.
Estas pruebas permiten estudiar los reflejos originados tanto en el utrículo como en el sáculo, ambos órganos fundamentales en la función vestibular.
- Audiometría tonal y verbal, impedanciometría, potenciales evocados auditivos de tronco cerebral, de estado estable y automatizados: con estas pruebas se puede hacer un análisis del estado de la cóclea, así como de la membrana timpánica y la cadena osicular.
Thanks to all of the above, the Otology and Otoneurology Unit manages to carry out in a detailed manner, and with the greatest scientific rigour, an accurate and individualised assessment for every patient, thereby being able to advise a specific treatment for each condition.
Head and Neck Cancer
Within the cervicofacial pathology, head and neck tumours stand out, which are mainly those that originate in the mucous membranes of the upper aerodigestive tract, i.e. the oropharynx, hypopharynx and larynx, as well as the oral cavity in many cases, but also includes benign and malignant tumours of the neck, including the thyroid gland and salivary glands.
Treatment of head and neck tumour pathology has evolved remarkably in recent years in many ways.
Surgical techniques have evolved towards more functional techniques, which are far less aggressive, without losing oncological outcomes. These techniques include partial resections of the pharynx and larynx, either through traditional open cervical approaches or via minimally invasive approaches, including transoral approaches and, recently, robotic approaches.
Transoral Robotic Surgery (TORS)
EIn this respect, transoral robotic surgery (TORS) provides the most innovative tool for minimally invasive surgery via the da Vinci system, whose latest model (the da Vinci XI) offers particular value in certain procedures. Benign pathology, sleep disorders and malignant tumours of certain locations, whose treatment until now required complex and aggressive accesses, can be directly treated through the mouth, using robotic surgery, avoiding the injuries caused by other procedures.
Where it acquires its greatest usefulness is in tumour pathology of the oropharynx (tonsil and base of the tongue) and of the larynx. In selected cases, it enables a better functional and oncological outcome, by carrying out surgeries that previously required very aggressive removal procedures using minimally invasive approaches. For example, in certain cases of oropharyngeal tumours that required a transmandibular approach, we can now tackle them with the da Vinci system through the mouth without needing to touch the jaw.
Nervous System Monitoring
Most notably in surgery of the thyroid and of the parotid gland, can be added to this, preserving the nerves with better functional outcomes compared to the classical procedures.
Flaps
Lastly, in cases in which extensive surgery is required, reconstructive procedures using the so-called flaps, either from nearby tissue or using vascular microsurgical techniques, have improved extraordinarily.
