I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that
we do in the head.
The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get
to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great
feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work
that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient
and relatives after surgery.
In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for
long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life,
as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose
bleeds and airway obstructions which can be life threatening.
One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep
Snoring is the noise made during sleep when something obstructs airflow through the airways. The air squeezes past the
obstruction, making a whistling or rattling sound.
Snoring that gets worse over time may lead to OSA. In these cases, the obstruction is so severe that the air entering
the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply.
The lungs become so tired that they “take a break.” The sleeper actually stops breathing. A nonbreathing period that
lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than five apnea
episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting
over a minute long each.
OSA has many undesirable effects. When the blood oxygen levels drop, there is drop in the oxygen supply to the brain and
other organs, possibly leading to "brain suffocation" and adversely affecting the body's performance and functions. Also,
because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could
increase the risk of heart attack or stroke. Thus, early intervention is important.
Overy my years of experience, there are many cases that are significant, but one that immediately comes to mind is a
lady whom I saw again recently. I first saw her about 12 years ago. She had nose cancer, which had recurred after three
rounds of radiotherapy and chemotherapy. The radiation oncologist could not give any more radiotherapy. The cancer was
deep-seated in the nose, in the base of the skull. The radiation oncologist could not give any more radiotherapy. The
cancer was deep-seated in the nose, in the base of the skull. After detailed discussion with the patient about her surgical
options, we decided to proceed with endoscopic surgery. At that time, the conventional approach for a tumour in this
area was a rather traumatic surgery known as “face-splitting” (the name says it all). At that time, endoscopic surgery
was considered quite innovative.
Endoscopic sinus surgery involves the insertion of a scope through the nose, without external excision. Although the
equipment at that time was in its early stages and some improvisation was needed, the entire cancer was removed. The
brave lady had a good recovery and is still well and cancer-free, 12 years on. I am glad to say that great advances have
been made in endoscopic sinus surgery and its instrumentation over the last decade and it is now considered the norm.
Recent technology and medical advancements continue to make ENT a very interesting and challenging field. You can never
stop studying and mastering new things! All in all, I find the practice very interesting, challenging and fulfilling.