ENT Surgery: Complete Guide to Eye, Ear, Nose & Throat Procedures

What Is ENT Surgery?

ENT surgery refers to surgical procedures involving the ear, nose, throat (otolaryngology), and often includes eye procedures (ophthalmology). These surgeries treat conditions ranging from chronic infections and hearing loss to breathing problems, voice disorders, and vision impairment. Common ENT surgeries include tonsillectomy, ear tube placement, septoplasty, and various eye surgeries.

Otolaryngology-Head and Neck Surgery, commonly called ENT, is the medical specialty concerned with disorders of the ear, nose, throat, and related structures of the head and neck. ENT surgeons, also known as otolaryngologists, are trained to manage a wide variety of conditions affecting these interconnected systems. The specialty is unique in that it combines both medical and surgical treatment options.

ENT surgery has evolved dramatically over the past few decades, with many procedures that once required hospital stays now performed as outpatient procedures. Advances in endoscopic techniques, laser surgery, and minimally invasive approaches have reduced recovery times and improved outcomes. These technological improvements mean less pain, smaller incisions, and faster return to normal activities for patients.

Eye surgery, while technically a separate specialty (ophthalmology), is often grouped with ENT procedures because many facilities combine these services. Eye surgeries range from corrective procedures like LASIK to more complex operations such as corneal transplants and cataract removal. Both ENT and eye surgeries share common principles: precision, minimal invasiveness, and preservation of function.

Common reasons for ENT surgery

Patients may need ENT surgery for various conditions that significantly impact quality of life. Chronic ear infections that don't respond to antibiotics, enlarged tonsils causing breathing or swallowing problems, persistent nasal obstruction, hearing loss, and voice disorders are among the most frequent reasons for referral to an ENT surgeon. In children, recurrent infections and enlarged adenoids are particularly common surgical indications.

Who performs ENT surgery?

ENT surgeries are performed by board-certified otolaryngologists who have completed specialized training after medical school. This training typically includes a five-year residency program focusing exclusively on ear, nose, and throat conditions. Many ENT surgeons pursue additional fellowship training in subspecialties such as pediatric otolaryngology, otology/neurotology (ear and hearing), rhinology (nose and sinuses), or laryngology (voice and swallowing).

What Are Common Ear Surgeries?

Common ear surgeries include myringotomy with ear tube placement (most common pediatric surgery), tympanoplasty for eardrum repair, mastoidectomy for chronic infections, cochlear implant surgery for severe hearing loss, and stapedectomy for otosclerosis. Most ear surgeries are performed to improve hearing or treat recurrent infections.

Ear surgeries represent some of the most common procedures performed by ENT surgeons, particularly in pediatric populations. The ear's complex anatomy, with its delicate structures for hearing and balance, requires precise surgical techniques. Understanding the various types of ear surgeries can help patients make informed decisions about their care and set appropriate expectations for outcomes.

The ear consists of three main parts: the outer ear (pinna and ear canal), the middle ear (eardrum and ossicles), and the inner ear (cochlea and vestibular system). Different surgeries target different parts of the ear depending on the underlying condition. Modern ear surgery has become increasingly sophisticated, with many procedures now performed using microscopes and endoscopes for enhanced visualization.

Ear tubes (myringotomy with tympanostomy tubes)

Ear tube placement is the most commonly performed pediatric surgery, with over 500,000 procedures performed annually in the United States alone. The procedure involves making a tiny incision in the eardrum and inserting a small tube to allow fluid drainage and air circulation in the middle ear. This prevents the accumulation of fluid that leads to recurrent ear infections and hearing problems.

The procedure takes only 10-15 minutes and is performed under brief general anesthesia in children. Recovery is remarkably quick, with most children returning to normal activities within a day. The tubes typically remain in place for 6-18 months before falling out naturally as the eardrum heals. Studies show that ear tubes reduce the frequency of ear infections by 50-60% and significantly improve hearing in affected children.

Cochlear implants

Cochlear implants are electronic devices surgically implanted to provide a sense of sound to people with severe to profound hearing loss who don't benefit from hearing aids. Unlike hearing aids that amplify sound, cochlear implants bypass damaged hair cells in the inner ear and directly stimulate the auditory nerve. The surgery involves placing an internal component under the skin behind the ear and threading electrodes into the cochlea.

The procedure takes 2-4 hours and typically requires one night in the hospital. Recovery from the surgical aspect takes about 2-4 weeks, but learning to hear with the implant is an ongoing process that requires audiological rehabilitation. Cochlear implants have transformed the lives of hundreds of thousands of people worldwide, enabling speech understanding and even music appreciation.

Surgery for otosclerosis

Otosclerosis is a condition where abnormal bone growth in the middle ear causes the stapes (stirrup bone) to become fixed, resulting in progressive hearing loss. Stapedectomy or stapedotomy surgery involves removing all or part of the stapes and replacing it with a prosthesis. This surgery has a high success rate, with approximately 90% of patients experiencing significant hearing improvement.

Tympanoplasty and mastoidectomy

Tympanoplasty repairs holes (perforations) in the eardrum using a graft, often taken from tissue behind the ear. This surgery restores the eardrum's ability to vibrate properly and protects the middle ear from water and infection. Mastoidectomy involves removing infected mastoid bone behind the ear and is often performed for chronic ear infections or cholesteatoma (an abnormal skin growth in the middle ear).

What Are Common Nose Surgeries?

Common nose surgeries include septoplasty (straightening the nasal septum), turbinate reduction (shrinking enlarged nasal tissues), rhinoplasty (reshaping the nose), sinus surgery (opening blocked sinuses), and adenoidectomy (removing the adenoid gland). These surgeries improve breathing, treat chronic sinusitis, or address structural abnormalities.

Nasal surgery addresses problems with breathing, chronic sinus infections, and structural abnormalities of the nose. The nose serves critical functions including filtering, warming, and humidifying inhaled air, as well as providing our sense of smell. When these functions are impaired by structural problems or chronic disease, surgical intervention may be necessary to restore normal function and quality of life.

Many patients suffer for years with nasal obstruction, chronic sinusitis, or breathing difficulties before seeking surgical evaluation. Modern nasal surgery has become increasingly minimally invasive, with many procedures performed endoscopically through the nostrils without external incisions. This approach results in less swelling, faster recovery, and no visible scarring.

Septoplasty

Septoplasty corrects a deviated septum, the wall of cartilage and bone that divides the nose into two nostrils. When the septum is significantly crooked, it can block airflow through one or both nostrils, causing chronic nasal congestion, difficulty breathing, recurring sinus infections, and sleep disturbances including snoring. Studies suggest that 70-80% of people have some degree of septal deviation, though only severe cases require surgical correction.

The surgery is performed through the nostrils with no external incisions, taking about 60-90 minutes under general anesthesia. Most patients return to work within 1-2 weeks, though complete healing takes several months. Success rates are high, with 85-90% of patients reporting significant improvement in nasal breathing after septoplasty.

Turbinate reduction

The turbinates are shelf-like structures inside the nose covered with mucous membrane that warm and humidify inhaled air. When turbinates become chronically enlarged (hypertrophied), they can obstruct airflow and contribute to nasal congestion. Turbinate reduction surgery reduces the size of these structures while preserving their important function.

Several techniques exist for turbinate reduction, including radiofrequency ablation, coblation, and partial resection. Many of these procedures can be performed in an office setting under local anesthesia. Recovery is typically quick, with most patients experiencing improved breathing within 1-2 weeks as swelling resolves.

Adenoidectomy

The adenoids are lymph tissue located behind the nose that help fight infection in young children. When adenoids become chronically enlarged, they can block nasal breathing, contribute to ear problems, and cause sleep apnea. Adenoidectomy removes this tissue and is often performed together with tonsillectomy or ear tube placement.

The procedure takes about 20-30 minutes and is performed through the mouth with no external incisions. Recovery is generally faster than tonsillectomy, with most children returning to normal activities within 3-5 days. Unlike tonsils, adenoids may partially regrow in young children, though this rarely causes recurrent problems.

Sinus surgery

Functional endoscopic sinus surgery (FESS) opens blocked sinus passages to treat chronic sinusitis that hasn't responded to medical treatment. Using an endoscope inserted through the nostrils, the surgeon removes obstructing tissue, polyps, and bone to restore normal sinus drainage. This procedure has largely replaced older, more invasive sinus surgeries.

What Are Common Throat Surgeries?

Common throat surgeries include tonsillectomy (removal of tonsils), laryngoscopy (examination and treatment of the voice box), vocal cord surgery, surgery for sleep apnea, and removal of throat masses. Tonsillectomy is one of the most performed surgeries worldwide, particularly in children with recurrent throat infections or obstructive sleep apnea.

The throat, or pharynx, connects the mouth and nose to the esophagus and larynx. It plays essential roles in breathing, swallowing, and speech. Throat surgeries address conditions ranging from chronic infections and enlarged tonsils to voice disorders and sleep apnea. These procedures can significantly improve quality of life for patients suffering from chronic throat problems.

The decision to perform throat surgery is typically made after conservative treatments have failed or when the condition is severe enough to warrant surgical intervention. For conditions like tonsillitis, specific criteria have been established to identify patients most likely to benefit from surgery. Understanding these criteria helps patients and families make informed decisions about treatment options.

Tonsillectomy

Tonsillectomy, the surgical removal of the palatine tonsils, is one of the most commonly performed surgical procedures worldwide. The tonsils are lymphoid tissue at the back of the throat that help fight infection, particularly in young children. However, when tonsils become chronically infected or so enlarged that they obstruct breathing, surgical removal may be necessary.

According to clinical practice guidelines, tonsillectomy is recommended for children who have experienced 7 or more documented episodes of throat infection in one year, 5 or more episodes per year for two consecutive years, or 3 or more episodes per year for three consecutive years. It is also indicated for obstructive sleep apnea caused by enlarged tonsils, peritonsillar abscess, or significant difficulty swallowing or breathing.

The surgery takes about 30-45 minutes and is performed under general anesthesia. Recovery typically takes 10-14 days, with the first 3-5 days being the most difficult due to throat pain. Adults generally experience more pain and longer recovery than children. Post-operative bleeding, the most significant risk, occurs in approximately 2-4% of patients, usually 5-10 days after surgery when scabs fall off.

Vocal cord surgery

Vocal cord surgery, or laryngeal surgery, treats various conditions affecting the voice including nodules, polyps, cysts, paralysis, and cancer. These procedures are often performed using microlaryngoscopy, where the surgeon operates through a laryngoscope using microscopic instruments or lasers. The goal is to restore normal voice function while preserving as much healthy tissue as possible.

Voice rest is critical after vocal cord surgery, with patients typically advised not to speak for 1-2 weeks. Voice therapy before and after surgery helps optimize outcomes. Most patients see significant voice improvement, though complete recovery may take several months as the vocal cords heal and patients retrain their voice use.

Salivary gland surgery

Surgery on the salivary glands may be necessary to remove stones (sialolithiasis), treat chronic infections, or diagnose and treat tumors. The major salivary glands include the parotid glands (near the ears), submandibular glands (under the jaw), and sublingual glands (under the tongue). The parotid gland is most commonly affected by tumors, while the submandibular gland is most prone to stone formation.

Parotidectomy, removal of the parotid gland, requires careful preservation of the facial nerve that runs through the gland. Submandibular gland removal carries lower risk of nerve injury. Modern techniques including sialoendoscopy allow removal of salivary stones through the mouth without external incisions in many cases.

What Are Common Eye Surgeries?

Common eye surgeries include LASIK and PRK for vision correction (96%+ achieve 20/20 or better), cataract surgery (most common surgery in those over 65), corneal transplantation, and glaucoma surgery. Eye surgery has become extremely safe and effective, with many procedures performed in outpatient settings with rapid recovery.

Eye surgery encompasses a wide range of procedures from routine cataract removal to complex retinal surgery. Advances in technology have revolutionized eye surgery, making many procedures faster, safer, and more precise than ever before. Laser technology, in particular, has transformed how we correct vision problems and treat various eye conditions.

Vision is precious, and the thought of eye surgery naturally causes anxiety for many patients. However, modern eye surgery is among the safest surgical procedures performed today. Understanding what to expect can help alleviate fears and ensure patients are well-prepared for their procedure and recovery.

Refractive surgery (LASIK and PRK)

Refractive surgery corrects common vision problems including nearsightedness (myopia), farsightedness (hyperopia), and astigmatism, reducing or eliminating the need for glasses or contact lenses. LASIK (Laser-Assisted In Situ Keratomileusis) is the most popular refractive procedure, using a laser to reshape the cornea and correct focusing problems.

During LASIK, the surgeon creates a thin flap in the cornea, uses an excimer laser to reshape the underlying tissue, then replaces the flap. The procedure takes about 15 minutes for both eyes and is performed under topical anesthesia (numbing drops). Over 96% of patients achieve 20/20 vision or better after LASIK, with most noticing significantly improved vision within 24 hours.

PRK (Photorefractive Keratectomy) is an alternative that removes the surface layer of the cornea instead of creating a flap. While recovery takes longer (about a week for initial healing), PRK may be preferred for patients with thin corneas or certain eye conditions. Both procedures are considered elective and are typically not covered by health insurance.

Cataract surgery

Cataract surgery is the most commonly performed surgery in people over 65, with millions of procedures performed worldwide each year. A cataract is a clouding of the eye's natural lens that occurs with aging, causing blurry vision, glare, and difficulty seeing in low light. Surgery involves removing the clouded lens and replacing it with a clear artificial lens (intraocular lens or IOL).

Modern cataract surgery uses phacoemulsification, where ultrasound breaks up the cataract through a tiny incision. The procedure takes 15-30 minutes per eye and is performed under local anesthesia on an outpatient basis. Recovery is quick, with most patients seeing well within a few days. Different types of IOLs can correct distance vision, near vision, or both, potentially reducing dependence on glasses.

Corneal transplantation

Corneal transplantation replaces a damaged or diseased cornea with healthy donor tissue. This surgery is necessary when the cornea becomes scarred, clouded, or misshapen due to conditions like keratoconus, corneal dystrophies, or injury. Several types of corneal transplant exist, from full-thickness transplants to partial-thickness procedures that replace only diseased layers.

Recovery from corneal transplant takes longer than most eye surgeries, with vision gradually improving over several months to a year. Patients require long-term follow-up and may need to use steroid eye drops to prevent rejection. Despite the longer recovery, corneal transplantation has a high success rate and can restore sight to those with severe corneal disease.

How Should I Prepare for ENT Surgery?

Preparation for ENT surgery includes attending pre-operative consultations, stopping smoking 4-8 weeks before surgery, reviewing all medications with your doctor, fasting as instructed (usually 6-8 hours), arranging transportation and post-operative care, and preparing your home for recovery with appropriate supplies and foods.

Proper preparation for surgery can significantly impact outcomes and recovery. The weeks leading up to surgery provide an opportunity to optimize your health and ensure the best possible conditions for healing. Following your surgical team's instructions carefully is essential for a safe procedure and smooth recovery.

Pre-operative preparation begins at your consultation appointment, where you'll learn about the specific procedure, risks, benefits, and what to expect during recovery. This is the time to ask questions and address any concerns. Make sure you understand all instructions and have them in writing to refer to later.

Lifestyle modifications before surgery

Smoking significantly increases surgical risks and impairs healing. Nicotine constricts blood vessels, reducing oxygen delivery to tissues, while carbon monoxide in smoke further diminishes oxygen-carrying capacity. Stopping smoking at least 4-8 weeks before surgery reduces the risk of wound complications, infections, and anesthesia problems. Even reducing smoking helps, though complete cessation is ideal.

Alcohol should be avoided for at least 1-2 weeks before surgery as it can affect bleeding, interact with anesthesia, and impair healing. A healthy diet rich in protein, vitamins, and minerals supports tissue repair. Regular exercise, if approved by your doctor, improves circulation and overall fitness for surgery.

Medication review

Many medications and supplements can affect bleeding or interact with anesthesia. Blood thinners (including aspirin, warfarin, and newer anticoagulants) typically need to be stopped 7-14 days before surgery. Herbal supplements like ginkgo, garlic, ginseng, and vitamin E can also increase bleeding and should be stopped 2 weeks before surgery. Always provide your surgical team with a complete list of all medications, supplements, and over-the-counter drugs you take.

Some medications should NOT be stopped before surgery, including heart medications, blood pressure drugs, and certain psychiatric medications. Your surgical team will provide specific instructions about each of your medications. Never stop a medication without explicit guidance from your healthcare provider.

The night before and day of surgery

Fasting is typically required for 6-8 hours before surgery under general anesthesia to prevent aspiration. This means no food or drink, including water, after midnight if your surgery is in the morning. Some surgeons allow a small sip of water to take essential medications. Follow your specific instructions carefully.

Arrange for a responsible adult to drive you home after surgery and stay with you for at least 24 hours. You will not be able to drive or make important decisions while recovering from anesthesia. Prepare comfortable, loose clothing for surgery day and leave jewelry and valuables at home.

What Should I Expect During Recovery?

Recovery varies by procedure: ear tube patients recover in 1-2 days, septoplasty requires 1-2 weeks off work, and tonsillectomy takes 10-14 days for full recovery. General principles include adequate rest, proper pain management, staying hydrated, avoiding strenuous activity, and following all post-operative instructions carefully.

Recovery from ENT surgery requires patience and attention to post-operative care instructions. Understanding what to expect during each phase of recovery helps you prepare appropriately and recognize when something might not be normal. Most ENT surgeries have predictable recovery patterns, though individual experiences vary.

The immediate post-operative period focuses on managing pain, preventing complications, and allowing initial healing. As days progress, activity levels gradually increase while restrictions are lifted. Complete healing may take weeks to months depending on the procedure, though most patients return to normal activities much sooner.

Pain management

Pain is expected after surgery and should be managed proactively to maintain comfort and promote healing. Your surgeon will prescribe appropriate pain medications, which may include opioids for the first few days and non-opioid alternatives like acetaminophen as pain decreases. Taking pain medication on a schedule (rather than waiting until pain becomes severe) provides better control.

For procedures like tonsillectomy, pain often peaks around days 3-5 and may temporarily worsen around days 7-10 when scabs fall off. Ice packs, cold compresses, and staying hydrated can help manage discomfort. After eye surgery, discomfort is usually mild and managed with lubricating drops and over-the-counter pain relievers.

Activity restrictions

Most ENT surgeries require limiting physical activity during recovery. Strenuous exercise, heavy lifting, and straining should be avoided as they increase blood pressure and risk of bleeding. The duration of these restrictions varies: ear tube patients have minimal restrictions, while tonsillectomy patients should avoid strenuous activity for 2 weeks.

For nasal surgery, avoid blowing your nose forcefully, bending over, or lifting heavy objects for 1-2 weeks. After eye surgery, avoid rubbing your eyes, getting water in your eyes, or wearing eye makeup for the specified period. Swimming and water activities are typically restricted after ear, nose, and eye surgeries until healing is complete.

When to call your doctor

While some discomfort and minor symptoms are normal during recovery, certain signs require prompt medical attention. Contact your surgeon if you experience: excessive bleeding, fever over 101.5F (38.6C), severe pain not controlled by prescribed medications, signs of infection (increasing redness, swelling, or drainage), difficulty breathing, or any symptoms that concern you.

What Are the Risks of ENT Surgery?

Risks vary by procedure but generally include bleeding (2-4% for tonsillectomy), infection, adverse reactions to anesthesia, nerve injury, and changes in voice or hearing. Most ENT surgeries have low complication rates when performed by experienced surgeons. Understanding risks helps patients make informed decisions and recognize problems early.

All surgeries carry some risk, and it's important to understand potential complications before making a decision about surgery. However, when weighing risks against benefits, most patients find that surgery offers significant improvement in quality of life that outweighs the relatively small risks involved. ENT surgeries have generally excellent safety profiles.

Risk factors that may increase complications include smoking, obesity, diabetes, bleeding disorders, and certain medications. Discussing your individual risk factors with your surgeon helps you understand your personal risk profile and take steps to minimize complications.

General surgical risks

All surgeries carry risks of bleeding, infection, and adverse reactions to anesthesia. Modern anesthesia is remarkably safe, with serious complications occurring in less than 1 in 10,000 cases for healthy patients. Pre-operative evaluation identifies patients at higher risk who may need special precautions.

Bleeding during or after surgery is a consideration for all ENT procedures given the rich blood supply to the head and neck region. Post-operative bleeding after tonsillectomy occurs in approximately 2-4% of patients, typically 5-10 days after surgery. Nasal surgery may result in post-operative nosebleeds, usually minor and self-limited.

Procedure-specific risks

Ear surgery carries small risks of hearing changes, tinnitus (ringing in the ears), dizziness, and rarely, facial nerve injury. The facial nerve runs through the middle ear, and while injury is rare, it can cause weakness of facial muscles. Cochlear implant surgery has additional risks including device failure and the need for revision surgery.

Nasal surgery risks include septal perforation (a hole in the nasal septum), numbness of the upper teeth or nose tip, and rarely, changes in sense of smell. Eye surgery risks vary by procedure but may include infection, vision changes, dry eyes, and the need for additional procedures. LASIK-specific risks include glare, halos, and under- or over-correction.

Throat surgery risks include changes in voice, difficulty swallowing, and injury to nearby structures. Tonsillectomy can rarely cause velopharyngeal insufficiency (nasal-sounding speech) if the palate doesn't close properly after surgery. Salivary gland surgery near the facial nerve carries risk of facial weakness.

What Should Parents Know About ENT Surgery in Children?

ENT surgeries are among the most common procedures in children, particularly ear tubes and tonsillectomy. Children generally recover faster than adults. Preparation involves age-appropriate explanations, maintaining routines, and having comfort items available. Parents play a crucial role in post-operative care and recognizing complications.

When a child needs surgery, parents naturally feel anxious and protective. Understanding what to expect helps you prepare your child and yourself for the experience. Children often handle surgery better than parents anticipate, especially when they're prepared appropriately and feel supported.

Pediatric ENT surgery has evolved to be minimally invasive and child-friendly. Specialized pediatric anesthesiologists understand children's unique needs, and recovery areas often have child-life specialists to help children cope. Many surgical centers use techniques like applying numbing cream before IV placement and allowing parents to be present during the initial stages of anesthesia.

Preparing your child for surgery

How you explain surgery depends on your child's age and temperament. Young children benefit from simple, honest explanations given close to the surgery date. Older children may want more details and time to ask questions. Books, videos, and hospital preparation programs can help children understand what to expect.

Maintain normal routines as much as possible in the days before surgery to reduce anxiety. Pack a bag with comfort items like a favorite stuffed animal or blanket. For older children, consider bringing headphones and age-appropriate entertainment for the waiting period.

Post-operative care for children

Children typically recover faster than adults from most ENT procedures. After ear tube surgery, most children return to normal activities within a day. Tonsillectomy recovery in children usually takes 7-10 days, shorter than the typical adult recovery of 10-14 days.

Pain management in children requires careful attention. Younger children may not express pain clearly, so watch for behavioral signs like irritability, not eating, or not playing. Administer pain medication on schedule as prescribed, even if your child seems comfortable, to stay ahead of pain. Encourage fluids to prevent dehydration, which can worsen discomfort.

Know the signs that require medical attention: excessive bleeding, high fever, inability to drink fluids, severe pain despite medication, or breathing difficulties. Most pediatric ENT surgeries are safe and uncomplicated, but parents should know when to seek help.