Introduction of the Department
Liv Hospital Ear, Nose and Throat Department provides reliable and high quality health services in the diagnosis and treatment of diseases related to middle ear, eardrum, nose, throat and facial nerves and the diseases that occur between the inner ear and brain with the most modern medical equipment and experienced specialized staff.
Both medical and surgical treatment of ear, nose, throat and related head and neck diseases are carried out in the department with multidisciplinary approaches.
Major specialties found in Liv Hospital Ear, Nose and Throat Clinic
Facial paralysis development rate after ear surgery, sensorineural hearing loss development rate after ear surgery in Liv Hospital is recorded as 0%.
All the tests that have been accepted all over the world in the evaluation of imbalance and dizziness are performed in Liv Hospital Balance Center. Computerized dynamic posturography among these is used for both diagnosis and treatment.
Pure Tone Audiometry
It is the standard method of hearing tests that subjectively determine hearing thresholds by giving pure tones at different frequencies. It is the most frequently performed ear test. It determines the minimum volume (hearing threshold) that both ears can hear at different frequencies (250-8000 Hz). The patient is placed in a soundproof cabinet. Sound is given to the patient’s ear via a headset. The patient gives a signal by pressing the button on the hand when he/she hear the sound. Thus, the sound level heard is determined. Air and bone conduction hearing level is determined during this measurement.
Speech Audiometry
Audiometric assessment by using the human voice as a stimulant is called the speech audiometry.
Tympanometry
It is the test for measuring the pressure of the middle ear. Its implementation is very easy and it can be performed even to infants. No holes should be present in the eardrum to perform the measurement. The pressure in the middle ear is measured with a probe inserted into the external auditory canal. Consequently, a radiography and pressure value is obtained.
ABR (Auditory Brainstem Response)
ABR (auditory brainstem response) is the EEG measurement of brain waves formed with acoustic stimulants through the electrodes placed on the head. ABR measures the function of auditory nerve and brainstem auditory pathways. It is very valuable in the evaluation of hearing of babies and small children, who are not cooperative to standard hearing test. The individual to be performed this test must be in a calm or sleep state.
OAE (Otoacoustic Emissions)
Otoacoustic emissions are low-level acoustic signals by the hair cells in the inner ear. These signals may be measured via a probe placed in the external auditory canal. The test must be performed in a quiet environment and when the patient is calm. It is an objective test. It is particularly important for early detection of hearing loss in infants. Therefore it is used for newborn hearing screening test. It is helpful in the diagnosis of auditory neuropathy together with ABR. Another field of application is functional hearing loss.
(ECoG) Electrocochleography
Electrocochleography is performed by measuring the electrical activity generated by auditory stimuli in the inner ear via an electrode placed on the promontorium or membrane. It is an objective test. The test should be performed in a quiet environment. It gives valuable information in the detection of hearing loss and in the diagnosis of Meniere’s disease.
VEMP (Vestibular Evoked Myogenic Potentals)
VEMP is to measure the involuntary response of the auditory stimuli generated in the SCM muscle. It is a test that measures the function of saccule and inferior vestibular nerve. It is helpful in the diagnosis of Meniere’s disease, Superior Semicircular Canal Dehiscence Syndrome and multiple sclerosis.
VNG (Videonystagmography)
VNG test is a test that records and evaluates the movements developing in the eyes as a result of visual stimuli or position changes. It is performed by wearing glasses equipped with infrared cameras. It gives useful information in the assessment of the inner ear’s function about the balance. It is used in the differential diagnosis of Meniere’s Disease, Benign Paroxysmal Positional Vertigo (BPPV) and central nervous system related dizziness.
Dynamic Posturography
Dynamic posturography is a test that can examine three systems providing balance (the inner ear, vision and deep sense) separately, and that can detect which system causes balance problem. The evaluation is made by measuring the degree of body sway in 6 different states, while the patient is trying to stand motionless on a pressure sensitive platform. It is also possible to make balance exercises on the device.
Latest Treatment Methods in Balance Problems
Dizziness or balance problems are often confused with each other. The treatments related with dizziness and balance are performed in Liv Hospital Balance Center, thus the quality of the patient’s life increases. In particular, if you experience “I’m losing my balance, I will fall.” feeling, you should immediately admit to a physician.
How are dizziness and balance problems distinguished from each other?
Dizziness and balance problems are confused with each other in general. There must be a movement feeling in dizziness. There are different systems that ensure balance in the body. One or a few of them may be affected. Treatment planning is made accordingly after determining which one is affected. All around is turning in dizziness. A slight stumble feeling and wobble while walking occur when there is a balance problem; “I’m losing my balance, I will fall.” feeling is experienced.
What kind of problems will dizziness create?
Dizziness is one of the most admitted discomforts that the people admit to the physicians. The head of the person rotates continuously. Those who have balance problems may fall and hurt a part of their bodies, or hit somewhere. Bigger problems by falling may occur especially in the elderly.
When to admit a physician is needed?
Those with severe dizziness admit to the emergency department of the hospitals. The patient that experience dizziness complaint should admit to the physician as soon as possible.
How is it diagnosed?
A complete ear, nose and throat examination is performed first to the patient that admit with dizziness / imbalance complaints. Tests such as hearing test, Videonystagmography, VEMP and dynamic posturography are used in differential diagnosis. Thus, the cause of dizziness and imbalance is detected, and a treatment is determined accordingly.
Dynamic Posturography
All the tests that been accepted all over the world for the evaluation of imbalance and dizziness are performed in Liv Hospital Balance Center. Computerized dynamic posturography from these is used in diagnosis as well as treatment. Which of the system that is defective is identified and the diagnosis is put. Thus, the reason that creates balance disorder is put forth. Exercises, which are needed to be made in order to strengthen the systems that have problem, are made on the device after the diagnosis.
What are the diseases that cause dizziness?
There may be many reasons of dizziness, but the most commonly encountered reasons are inner ear diseases.
Benign Positional Vertigo:
It is caused by the leakage of crystal particles that provide balance in the inner ear wafting over the escape of the semicircular canals. This disease shows itself by the dizziness when returning right to left, left to right when sleeping. Severe but short lasting dizziness occur. The maneuvers by giving different positions to the head are used in the diagnosis and treatment of this disease. Thus, it is possible to diagnose and treat the disease within a period of 2-3 minutes.
Meniere’s Disease:
It is caused by the increase of the amount of inner ear fluid. Dizziness, ringing, feeling of pressure in the ear, feeling of discomfort from loud noises and hearing loss may be observed in the patients. Although the reason of the disease is unknown excessive salt consumption, stress and hormonal disorders, it is known to trigger dizziness attacks. Vasodilating and diuretic medications are primarily benefited in the treatment. Surgical intervention is performed in those that dizziness attacks are not stopped with medication.
Underlying causes of balance problems
How is balance problem treated?
Imbalances are not treated with surgery or medication. Balance exercises are important at a great extent, to determine the cause of the imbalance is of priority. It is needed to identify from which of the deep sense, vision and inner ear systems that imbalance has arisen from with the help of dynamic posturography. As a result of this, the treatment is performed with appropriate balance exercises.
Why do we experience dizziness and loss of balance?
There may be many different diseases that may lead to dizziness and instability. Inner ear disorders, neurological diseases and psychiatric disorders are the most common reasons we encounter. There may be many ear diseases that may lead to dizziness. The most frequently we encounter from these is short-term dizziness revealing with head movements due to the leakage of balance crystals in the inner ear to the semicircular canals called “Benign Paroxysmal Positional Vertigo”. Another common cause is the Meniere’s disease, which is a disease resulting from the increase of the fluid of the inner ear, occurring in the form of attacks, characterized by severe dizziness and lasting for long hours.
How do we differentiate dizziness and loss of balance from each other?
Dizziness (vertigo) is the illusion of motion, in other words the patient get the feeling that he/she or his/her environment moves. It can be accompanied by nausea and vomiting. While the loss of balance occurs when there is a problem with one or more of 3 systems that (the inner ear, touch and sight) that ensure a person’s balance or the cerebellum, which coordinates these systems. The patient has difficulty in providing balance; falls may occur.
Is everyone with dizziness should consult a doctor? Which conditions are dangerous?
There are many causes of dizziness. Some of these diseases can be treated with medication treatments, while some with some turning maneuvers. Sometimes low blood pressure may cause dizziness, and sometimes dizziness may be the first sign of a tumor in the head. Therefore, a patient with dizziness should always admit to a physician. The most common cause of dizziness is inner ear diseases. So, usually we as Otolaryngology Physicians see the patients with dizziness first. The patient can be consulted in Neurology or Psychiatry Departments if there is no problem with the inner ear. Besides, if there are complaints in patient like weakness or loss of sensation along with dizziness, it would be appropriate to admit directly to neurology.
How is dizziness treated?
Each treatment of dizziness is different, because there are many different causes of dizziness. Turning maneuvers are used in the treatment of the most common cause Benign Paroxysmal Positional Vertigo. Medications and surgical intervention, in the cases where medications are not sufficient, are used in the treatment of Meniere’s disease. Besides, if the cause of dizziness is a tumor formation in the head, then a surgical intervention or radiation therapy may be required. A complete ear, nose and throat examination is performed to our patients admitted with dizziness first. Ear is evaluated under the microscope if necessary. A maneuver called “Dix-Hallpike” is applied in cases suspected of positional dizziness. Hearing test is an examination of great help in the diagnosis of inner ear originated dizziness, mainly Meniere’s disease. We benefit from a device called “Videoelectronistagmography” in the evaluation of the involuntary eye movements called nystagmus.
Dizziness is the cause of depression!
Dizziness is a complaint that creates a lot of discomfort in people. It creates feeling of helplessness, fear and depression especially in patients with severe and long-lasting dizziness. Besides, the patients have risks due to dizziness such as wounding by falling, making accidents while driving.
Lawyer and Stockbrokers are at Risk!
Although stress does not directly cause dizziness, we know that stress trigger dizziness attacks by increasing the inner ear fluid especially in Meniere’s disease. Sometimes, soul sucking dizziness attacks are caused by intense and stressful professional life. People that we have diagnosed with Meniere’s disease due to dizziness complaint are often stockbrokers, banker, lawyer or senior company executives that work with intense stress.
Salt consumption should be restricted! We know that excessive salt consumption increases the risk of attacks in Meniere’s disease. Other than that, malnutrition can cause dizziness if it leads to anemia.
Surgery of head and neck tumors and reconstructive (repair) surgery, larynx, esophagus and pharynx, oral cavity cancer surgery are performed in Liv Hospital Head and Neck Surgery Department by equipped technology and experienced staff; and safe and quality health care services are offered by taking the support of Neurosurgery Department and other branches when necessary.
Modern ear, nose and throat practices, microsurgery and endoscopic surgery have been successfully performed in the clinic.
Eyebrows, orbit and eyelid reconstruction, earlobe repair, nose and lip repair, the treatment of facial injuries, animal bites and bone fractures, benign and malignant tumors, the treatment of salivary gland diseases and tongue tumor, the treatment of other congenital facial abnormalities such as harelip (colloquially) and birthmarks, the treatment of facial paralysis sequela, elimination of deformities due to accidents, injuries and burns, the loss function, scars of previous surgery and wounds, the treatment of temporomandibular joint disorders have been successfully carried out in Liv Hospital Head and Neck Surgery Department.
Medical and surgical treatment of diseases caused by outer, middle and inner ear, and the auditory nerve is performed in Liv Hospital Otoneurology Department with is specialized staff and superior equipments.
Main Diseases treated in the clinic
Middle ear effusion: Middle ear fluid problems are common in childhood. They are usually developed following recurrent upper respiratory tract infections. Although a significant part gives response to medication treatment, it may be need to insert ear tubes in patients who have not responded.
Holes in the Eardrum: The eardrum is a mechanical barrier that protects the middle ear from the external environment. Ear inflammations are frequent in cases that it is with a hole. The eardrum with holes also causes hearing loss at the same time. Therefore, surgical repair of the eardrum is recommended.
Cholesteatoma: It is caused by uncontrolled progress of the outer ear canal skin through to the back of the eardrum. Continuous and smelly ear discharge and hearing loss are observed. It may leas to consequences that may be fatal such as meningitis and brain abscess if not treated surgically as a result of the inflammation extending to the surrounding organs.
Otosclerosis (calcification of the stapes): It causes conductive type hearing loss because calcification of the stirrup bone makes the sound to be conducted to the inner ear. It is more common in middle ages, in women and in patients with otosclerosis family story. Hearing loss can be eliminated surgically with the help of a prosthesis placed between the anvil bone and inner ear.
Use of Implants in Hearing Losses Caused by the Inner Ear
Hearing loss caused by inner ear can occur due to genetic or acquired reasons. Although conventional hearing aids may be sufficient in mild to moderate hearing losses, active middle ear implants or cochlear implant (bionic ear), or brain stem implant may be necessary in severe losses. All of the surgical treatment for hearing loss in the world is being implemented successfully.
Latest Treatment Methods
All the tests accepted all over the world to be used to evaluate the imbalance and dizziness are performed in Clinical Balance Center. Computerized dynamic posturography from these is used in diagnosis as well as for treatment.
Dizziness or balance problems are often confused with each other. The treatments related with dizziness and balance are performed in Liv Hospital Balance Center, thus the quality of the patient’s life increases. In particular, if you experience “I’m losing my balance, I will fall.” feeling, you should immediately admit to a physician.
Hearing threshold is detected subjectively by clinical Audiological – Vestibular tests by giving pure tone in frequencies
The medical subspecialty of otoneurology is focused on the interface between the ear and brain. Sometimes referred to as neuro-otology, otoneurology is a very limited subspecialty; Liv Hospital is one of the hospitals in the region with a dedicated Otoneurology Service.
The ear and brain coordinate a delicate balance, working in concert to produce and process the information we interpret as sound and our sense of balance and position. Concentrating on that ear/brain relationship, Liv Hospital’s otoneurology specialists are expert at diagnosis and treatment of problems associated with a variety of diseases, problems and symptoms, including but not limited to:
Working closely with other departments at Liv Hospital, the Otoneurology Service puts its expertise and experience to work solving problems and forging solutions and a plan for treatment and management for our international patients.
Liv Hospital’s otoneurology specialists have deep expertise in diagnosis, along with specialized X-ray and other imaging technologies. Treatment and management in otoneurology are limited to action without surgery. Patients who need surgery are referred to the appropriate surgical specialty area within Liv Hospital’s multidisciplinary approach.
Otoneurology physicians and other specialists will be called in when physical problems in the ear are ruled out and the problem appears to be in the relationship between the ear and the brain. An example would be vertigo present when no problems or deformities exist directly in the inner ear, which houses organs critical to our sense of balance. This vertigo could be the result of a brain malfunction, infection or the manifestation of migraine symptoms.
The workspace in Liv Hospital Pediatric Ear, Nose and Throat Department includes the diagnosis and treatment of ear, nose and throat problems, which emerged due to congenital or acquired infectious, neoplastic, developmental and traumatic reasons observed in the childhood.
Adenoid and tonsil problems, otitis media are among the most common ear, nose and throat complaints in children in Liv Hospital Pediatric Ear, Nose and Throat Department. Many treatment options such as cochlear implant (bionic ear), brainstem implant, active middle ear implants and hearing devices placed into the bones are offered according to the type and degree of hearing loss in line with evolving technology in recent years in the treatment of common genetic hearing loss in our country. The treatment of congenital or acquired narrowing of the airways is also one of the important work areas of the Pediatric Otolaryngology Department. The treatment of benign and malignant masses originating from the head and neck region, upper respiratory tract inflammations and foreign bodies are other work areas that can be mentioned.
In Liv Hospital Pediatric Otolaryngology Department;
The treatment of
are carried out.
ADENOID AND TONSIL PROBLEMS
Adenoid and tonsil problems are among the most common ear, nose and throat complaints in children. The surgery of these problems that causes gaping sleep, snoring, cessation of breathing during sleep (apnea) are performed with the most modern techniques.
MIDDLE EAR INFLAMMATION / FLUID
Otitis media is a childhood disease. Although it usually improves with medication, it also requires the insertion of ear tubes to the ear in not responding to treatment or recurrent cases.
HEARING LOSS
Many treatment options such as cochlear implant (bionic ear), brainstem implant, active middle ear implants and hearing devices placed into the bones are offered according to the type and degree of hearing loss in line with evolving technology in recent years in the treatment of common genetic hearing loss in our country.
NARROWINGS OF THE AIRWAYS
The treatment of congenital or acquired narrowing of the airways is also one of the important work areas of the Pediatric Otolaryngology Department. Some of these narrowing require surgical treatment.
TUMORS
Benign and malignant masses originating from the head and neck region can also be seen in children as in adults. One or more than one of surgery, chemotherapy and radiotherapy may be needed in the treatment of malignant masses, while surgery is enough for the treatment of benign masses.
The nose is the most important factor in determining the aesthetics of the face. Thus, it is very important for the nose to have natural appearance and be functional. The shape of the nasal hump or nose tip can be changed by rhinoplasty surgery performed in order to give shape to the nose.
Nose and sinus surgery, endoscopic sinus surgery, rhinoplasty and functional reconstructive surgery is performed by experienced specialists staff with reliable and quality service via current treatment approaches in Liv Hospital Rhinology Department.
Problems such as polyps, sinusitis, nasal meat and deviated septum that cause problems in breathing are also treated in Liv Hospital Rhinology Department.
Successful Treatments in the Treatment of Rhinosinusitis (sinusitis)
Endoscopic sinus surgery with current treatment approaches in the treatment of chronic or recurrent sinusitis is used in Liv Hospital Rhinology Department. Endoscopic sinus surgery is a closed method, and it is performed by the insertion of endoscopes connected to the camera into the nose.
Endoscopic sinus surgery is a functional surgical technique to ensure the aeration and drainage of the sinuses by opening the drain paths often under general anesthesia. The aim is to preserve healthy tissue while eliminating the diseased tissue. The operations performed with accurate diagnosis and careful surgical approach increases the expected success in the clinic as in any surgical approach.
Liv Hospital Sound, Speech and Swallowing Disorders Clinic give diagnosis and treatment services of congenital oracquired disorders that affect speech-language and swallowing. The aim of the clinic is detect the speech disorders and to provide improvement with appropriate treatment methods.
Clinical Voice and Speech Therapists serves via a multidisciplinary approach with their wide area of specialization; from speech and language pathology to psychology.
Isolated Cabin Exclusive Services
The isolated cabin located in our Liv Hospital Sound, Speech and Swallowing Disorders Clinic allows the use of rare and privileged technological equipment such as stroboscopy, videofloroscopy, nasoendoscopy, ultrasound, acoustic analysis systems “PAS” and “MDVP” in the diagnosis and treatment.
Also in our department, we can offer evaluation and diagnosis of individuals with hearing impairment in coordination with the audiology department that we have the opportunity to work integrated, to improve their communication with their families, and device implantation and counseling services when necessary.
Major Treated Disorders From Stuttering to Fast Speech
