Otorhinolaryngology (ENT)

Otorhinolaryngology (ENT) in MediClinic is a modern Department that handles with the most common aspects of the discipline, with an innovative approach to the diagnosis and the therapy.

Who should schedule this appointment?

All those patients with pathologies that affect the ear, the nose, the larynx, the pharynx and all the correlated anatomic parts.

Our physicians are particularly experienced in these three areas:

• Otoneurology – with particular attention to balance disorders and to vestibular rehabilitation
• Tinnitus therapy
• Snoring – study and treatment of the obstructive sleep apneas

Diagnosis and therapy

The ENT Department can provide efficient diagnosis for all the ENT pathologies.

Audiometry test

Our physicians use the most advanced technologies to perform the audiometry test to evaluate the hearing loss. The audiometry test measures the hearing function, spreading pure tones through the air and through the bones to the ears. The exam provides information about the grade and the type of the auditory deficit, that are interpreted by the physician. The exam can be performed by the physician or by the audiometry technician, but only the physician evaluates the data.

The exam takes place in the following way: the patient enters in a silent cabin (completely acoustically isolated) and wears a cap. The physician sends some auditive stimuli to the ears, one at a time, with increasing intensity and the patient informs him/her as soon as he/she hears the sound.

At the end of the exam, according to the intensity level to which the patient hears the different tones, the physician fills an audiogram. The audiogram a method that allow to evaluate a possible hearing loss (hypoacusis) and to localize the lesion (tympanic membrane, auditory ossicle, internal ear).

Impedance test

The impedance test evaluates the health condition of the external and middle ear, that is the structures that allow to our body to amplify the sound. In particular, the impedance test evaluates the functioning of the ossicular-tympanic system of the Eustachian tube.

The exam is performed positioning an insert inside the ear, that issues a sound pression, from a maximum level of 220 mm H20 to a minimum level of -600 mm H20.

Moreover, the test evaluates the presence of the acoustic reflex, establishing if the muscle contracts properly when the ear hears high intensity sounds. In patients without pathologies, the stapedial muscle contracts bilaterally even when only one ear is stimulated; in addition, it is associated to an eardrum rigidity, that reduces the sound conduction to the inner ear.

In healthy patients, the acoustic reflex happens when the ear perceives a pure tone with an intensity higher than 70-100 dB or a white noise with an intensity of 65 dB beyond the auditive threshold.

High specialization areas

The ENT Department in MediClinic can perform some specific exam to diagnose complex or rare pathologies, correlated with specific therapies and rehabilitations.

Disturbi dell’equilibrio

The ENT Department in MediClinic can perform a complete vestibular evaluation:

• Videonystagmography (VNG)
• Vestibular Evoked Myogenic Potentials (VEMPS)
• Computerized posturography (recording of the barycenter movements with an appropriate device)

Thanks to the collaboration with the Vascular Surgery Department, the balance disorders can be evaluated also with a supra-aortic duplex ultrasound. This exam is essential to evaluate if the pathology has a vascular origin, due to the microcirculation disorders. Additionally, in MediClinic it is possible to perform the Video Head Impulse Test (vHIT). It is a non-invasive exam that evaluate the vestibulo-ocular reflex (VOR), that is the main reflex that allow to keep a correct visual focus when moving the head. To perform the exam, the patient has to wear a cap with a camera that register the eyes movements in response to the head movements induced by the physician. The exam detects all the situations in which the eyes movements is not appropriate to the head ones.

In many cases, this exam allow to avoid the oto-functional exam, that is used to diagnose balance disorders but it is more invasive, because it consists in the stimulation of the inner ear with cold and warm water and it can be annoying for the patient.

A balance disorder can appear after an injury or it can be due to other causes (vascular or viral causes): for all those patients, our physician can prescribe a vestibular rehabilitation, that can be performed in MediClinic. We are equipped with treadmills and propioceptive springboards. Moreover, our ENT specialists are particularly experienced in the water vestibular rehabilitation.

Tinnitus diagnosis and treatments

Tinnitus is a difficult disorder to diagnose, because the objectivity is different from a patient to another. An ENT evaluation is the first step for a patient that suffer of this disorder.

Usually the tinnitus is a symptom that precede the hearing loss. For this reason, the first analysis to perform is an audiometry test, that evaluate the auditory threshold.

When this instrumental exam is not enough to provide an appropriate diagnosis, we recommend performing other audiology tests or an MRI to study the acoustic nerve and the central auditory canals. Sometimes also a cervical MRI can be useful to highlight a somatic cause.

Sometimes a multidisciplinary diagnosis may be necessary. Our ENT Department usually collaborates with neurologists, internists, gnathologists, physiatrists, etc. After an appropriate diagnosis, the physician evaluated the best therapy to adopt. Sometimes the patient has to assume a pharmacological therapy, he/she has to put on an acoustic prothesis, to perform some physical therapy or some psychotherapy.

Our physician can propose to our patient an innovative pharmacological therapy, the Tinnitus Retraining Therapy (TNT). It is a rehabilitation method for the tinnitus treatment, that includes sounds enrichment and focused counseling and can be associated with mindfulness and autogenic training.

Sleep disorders treatment

Sleep disorders – snoring and obstructive sleep apnea, can produce serious consequences in patients and in their family. A sleep disorder can be serious consequences when driving or in the cardiovascular risk.

The diagnosis and treatment of the sleep disorders has to be multidisciplinary, involving the ENT specialist, the pneumologist, the cardiologist, the neurologist and the maxilla-facial surgeon. The polysomnography is essential for a correct diagnosis, and it consists in the registration of different physiological parameters during the night. The ENT role is to evaluate possible obstruction of the upper airways that can provoke snoring or sleep apneas. The ENT specialists can produce the diagnosis performing an endoscopic exam that allow to explore the nasal cavities, but also other obstruction zones, like in the epiglottis. As the endoscopy being awake should be not useful, the patient can perform the Drug Induced Sedation Endoscopy (DISE): this exam is performed when sleeping and it is inducted by a light anesthesia.

The diagnosis of these disorders requires a very high precision. When the surgical treatment is not necessary, the recommended therapy can be a weight loss, a postural therapy, an application of oral devices (mandibular advancement device – MAD), a ventilation therapy with CPAP, that consists in the use of a mask that spread a positive pressure air flow to keep open the respiratory airways when sleeping.

Perché scegliere MediClinic

Choosing MediClinic means having modern technologies for the patient, professionals with superspecialist skills and a multidisciplinary approach that allows a more accurate diagnosis and therapeutic path to be followed.