Conditions
Laryngology
Hoarseness and voice change are often caused by disorders affecting the vocal cords. This could be something as simple as viral laryngitis but could also be a sign of something more serious. Fortunately most hoarseness is caused by benign conditions and improves quickly. Any hoarseness lasting more than two weeks should be discussed with a doctor and warrants endoscopic examination of the voice box. At the London Voice and Swallowing Clinic we give fast appointments to offer you that peace of mind and for early treatment.
At the London Voice and Swallowing Clinic we offer vocal cord polyps and cysts excision, haemorrhagic polyps laser treatment, vascular lesions KTP laser, papilloma excision and laser treatment as well as vocal cord injections for the aging voice.
Singers, actors, teachers and lawyers have a heavy voice workload leading to strain, voice trauma and nodules. We offer state-of-the-art examination facilities including laryngeal stroboscopy. The London Voice and Swallowing Clinic collaborates with experienced voice therapists, with years of experience looking after professional voice users.
One or both vocal cord immobility can lead to hoarseness, difficulty swallowing, weak cough and difficulty breathing. Most commonly, the cause is surgery such as thyroid, lung, cardiac or vascular procedures. Tumours in the neck or chest can also cause vocal cord paralysis and require urgent investigations. Around one third of patients have no identifiable cause. Treatment of vocal cord paralysis includes voice therapy, vocal cord injection under local or general anaesthesia and external implant surgery (thyroplasty).
Laryngeal dysfunction can manifest in a variety of symptoms, including chronic paroxysmal cough, laryngeal spasm, difficulty swallowing, throat irritation and exercise- induced laryngeal obstruction. Management requires a multidisciplinary approach, with therapy as the mainstay treatment. Medical and surgical management are required in some cases.
The London Voice and Swallowing Clinic works with world-leading speech and language therapists who can offer full endoscopic and radiological assessment of swallowing. Surgical interventions include endoscopic stapling of the pharyngeal pouch, webs and strictures balloon dilation and botox injection for muscle spasm.
Mr Al Yaghchi has a special interest in airway stenosis (narrowing of the windpipe). He is one of two consultants at the National Centre for Airway Reconstruction. he offers treatments for all conditions affecting the airway using minimally-invasive endoscopic laser techniques as well as major airway reconstruction surgery.
For the first time in the UK, Mr Al Yaghchi is able to offer serial steroid injections under local anaesthetic. In addition, he offers endoscopic dilation, minimally-invasive endoscopic reconstruction and open cricotracheal resection.
EMG-guided botox injection in office under local anaesthesia or in the operating theatre under short general anaesthetic. Mr Al Yaghchi also offers injections for other oromandibular dystonias.
Paediatric ENT
Tonsillitis is a viral or bacterial infection of the tonsils leading to (a sore throat), inflammation and swelling of the tonsils. Acute bacterial infection often requires antibiotics treatment. Children who suffer persistent recurrent tonsillitis might require surgery to remove the tonsils (tonsillectomy). Current guidelines recommend surgery if the child suffers more than 7 episodes in 1 year, 5 episodes a year during a 2-year period or 3 episodes a year during a 3-year period. Tonsillectomy can be combined with removal of the adenoids (adenoidectomy) if the child exhibits obstructive symptoms.
Sleep disordered breathing (SDB) is a wide spectrum of conditions from simple snoring to severe obstructive sleep apnoea. In an otherwise healthy child the most common cause for SDB is adenotonsillar enlargement. Severe SDB might require surgical intervention in the form of adenotonsillectomy. Children with more complex health needs often require a sleep study, amongst other investigations and might also require a night time ventilation device.
Laryngomalacia (floppy larynx) is the most common cause of noisy breathing (stridor) in infants. It is caused by congenital softening of the voice box. Mr Al Yaghchi will perform an endoscopic examination in-clinic to confirm the diagnosis. The condition is often self-limiting and improves with age. Severe cases that affect the child's ability to feed and impact their growth will require endoscopic surgical intervention.
Narrowing of the windpipe in children can be congenital or acquired. Children most at risk are those premature who were intubated (breathing tube) after birth and those who underwent cardiac surgery. Mr Al Yaghchi uses the endoscopic balloon dilation technique to widen the windpipe. More severe cases might require an open surgical approach.
Mr Al Yaghchi has extensive experience in children with swallowing difficulties and chronic aspiration, with almost half of his NHS paediatric practice dedicated to helping these children. Aspirating children often have a complex medical background and will require clinical and radiological tests to assess the severity of aspiration and guide treatment. Confirmed diagnosis often requires endoscopic examination under anaesthetic (MLB). If a structural defect such as a laryngeal cleft was identified it can be repaired at the same setting.
Children are more prone to developing glue ear as the tube connecting the nose and ear (Eustachian tubes) doesn't function as well as in adults. This is a common condition where fluid accumulates in the middle ear leading to hearing loss. This is often temporary and the fluids will resolve spontaneously within few weeks. Persistent glue ear that lasts over three months will require hearing assessment and might require surgical intervention to insert ventilation tubes (grommets).
This is a common condition in childhood and often self-limiting. Severe ear infection, especially in younger children, might require antibiotics treatment. Persistent recurrent infections can be an indication for grommet insertion.
Nose bleeds (epistaxis) are a very common complaints in childhood and often don't require any intervention. Persistent recurrent epistaxis can be treated with cautrisation either in the clinic or the operating theatre.
General ENT
Sinusitis is an inflammation of the lining of the sinuses often caused by an infection and can be acute or chronic. Symptoms include facial pain, congestion, nasal discharge, headache, reduced sense of smell and bad breath. Investigations and treatment are often similar to those of rhinitis described above. Long course of antibiotics might be prescribed. Functional endoscopic sinus surgery (FEES) is a minimally invasive surgical procedure to remove nasal polyps and open up the blocked sinus to restore ventilation.
Viral throat infections are often self limiting and only requires simple painkillers and hydration. Bacterial tonsillitis often requires antibiotics treatment. Recurrent and chronic tonsillitis can be an indication for tonsillectomy (surgical removal of the tonsils).
Epistaxis (nose bleed) in adults is often related to high blood pressure or the use on blood thinning medications. In-office treatment involves chemical cauterisation using silver nitrate. Persistent nose bleeds might require admission to hospital and insertion of a balloon device (nasal pack) to stem the bleed.
Ear wax is a natural part of ear protection. It traps dirt and prevents bacterial growth and it is removed naturally by the ear. Wax can accumulate in the ear due to use of cotton buds or narrowing of the ear canals. Wax blockage can lead to ear ache, hearing loss and ear infection. We offer wax removal using microsuction (small vacuum device) under the microscope. This technique is safer and more comfortable than ear syringing and can be used in infected ears or perforated ear drums.
Bacterial or viral infections can affect the ear canal (otitis externa) or the middle ear (otitis media) with different treatment approaches. Otitis externa is often related to water exposure (swimmers ear) frequently while on holiday, or ear canal trauma due to excessive use of cotton buds, while otitis media is often related to common colds causing inflammation of middle ear with pain and pressure. This can be complicated with ear drum perforation and chronic discharge from the ear. Treatment will include microsuction ear drops and oral antibiotics in some cases.
Rhinitis is an inflammatory condition affecting the nose leading to congestion, runny nose, reduced sense of smell, itchiness and sneezing. Rhinitis can be infectious (common cold), allergic (hay fever) or non- allergic. Investigations will include endoscopic examination of the nose and sinuses, skin or blood allergy test. CT scan might be required if sinusitis is suspected. Treatment options are mainly medical in the form of steroid nasal spray and nasal rinse tailored to each patient depending on the severity and the length of symptoms. Surgical intervention in the form of septoplasty is indicated if the septum (the partition in the middle of the nose) is deviated to one side leading to persistent blockage.
Hearing loss can be divided into sensorineural (involving inner ear), conductive (involving middle ear) or mixed. Common causes for hearing loss are age related (presbycusis), noise exposure, recurrent ear infections and ear drum perforation. Some of these can be surgically corrected, but often the management of significant hearing loss will involve hearing aid device.
Tinnitus is the perception of sound or ringing noise is the ears. It is a common problem that can affect up to 20% of people and very rarely a sign of a serious medical condition. Tinnitus in itself is not a disease but a symptom of an underlying condition such as hearing loss, noise trauma, vascular diseases or the use of certain medications. However it is common to have tinnitus with no identifiable cause. Investigations include hearing tests and in some cases a CT or an MRI scan. Treatment options include correcting the underlying condition if one is identified, masking techniques including white noise generators, hearing aids and hearing therapy.
Blocked ears can be simply caused by wax accumulation which can be cleared with microsuction. Eustachian tube dysfunction where the tube connecting the ear with the back of the nose doesn't function normally , can lead to difficulty ventilating the middle ear. Eustachian tube dysfunction can lead to intermittent ear pressure, earache, reduced hearing and tinnitus. Symptoms are particularly bad after flying or catching a cold. Mr Al Yaghchi offers medical and surgical treatment to help these symptoms including balloon tuboplasty (using a balloon to widen the Eustachian tube) under local or general anaesthesia.
A new lump in the neck almost always requires review by an ear, nose and throat specialist, as well as further scans and biopsies. While a significant proportion of these lumps are benign in nature it is essential to exclude more serious causes. At the London Voice and Swallowing Clinic we will arrange an urgent ultra sound scan and biopsy to offer you that peace of mind.