Patient's Zone – Clinic Services & Procedures

The following procedures are performed in the clinic:

Wax removal
Nasal endoscopy
Control of nose bleeds
Nasopharyngoscopy/laryngoscopy
Biopsies of neck lumps
Small biopsies of the skin
Other minor surgical procedures

Wax removal

If you have wax within your ears, the doctor will likely decide to remove this for you.  This is generally accomplished with an otoscope, which is an ear telescope, or an ear microscope, using some small tools that can gently remove the wax.  Suction is often also used to remove the wax.  A small amount of wax within the ear is healthy.  It helps prevent infection, and keeps the ear canal skin healthy.  However, an excessive amount of wax can lead to outer ear infections and decreased hearing.

Nasal endoscopy

A nasal endoscope is a telescope that is used specifically to examine the nasal cavity and the sinus drainage pathways.  If this procedure is performed, your nose will be anesthetized and decongested with Tetracaine and Afrin.  The telescope is then inserted through your nose to directly visualize the drainage pathways.  This allows the physician to see polyps, to make a diagnosis of sinusitis, to look for small tumors in the nasal cavity, and to closely inspect for other abnormalities such as septal deviation, allergies or overgrowth of the adenoids.

Control of nose bleeds

If you have a problem with nose bleeds, treatment can often be rendered in the clinic with simple procedures.  Generally this will require a thorough examination of your nose to identify the site of bleeding.  When the site of bleeding is identified, a local anesthetic can be applied to the area.  After adequate numbness is achieved, generally a chemical cautery can be used to take care of the offending vessel.  Ointment is then applied to the area.  If you have your nose cauterized, the doctor will ask you to irrigate your nose with salt water, to keep it moist and to apply ointment daily for two weeks.

Nasopharyngoscopy/laryngoscopy

The nurse will likely spray your nose with a mixture of Tetracaine and Afrin.  This is a local anesthetic and a nasal decongestant.  The anesthetic and Afrin combination has a bad taste, but will not harm you if swallowed.  It does give a sensation of numbness to the throat, and some patients complain of a runny nose for several hours after the anesthetic is applied.  We recommend that you do not eat or drink for approximately 30-45 minutes after the anesthetic is applied to avoid any swallowing problems.  The anesthetic and decongestant allows for this to be accomplished in the most comfortable manner.  The doctor will use a small flexible telescope that is passed through your nose to examine the sinus drainage pathways, the back of the nose, the back of the tongue and throat, as well as the voice box and the top of the swallowing tube.  This procedure is performed in nearly all smokers or people with a history of smoking.  While mildly irritating to the nose, the procedure is accomplished quickly, and allows the physician to fully evaluate and explore problems in these areas.   

Biopsies of neck lumps

If you are coming to the doctor for evaluation of a neck lump, or if the doctor finds a neck lump on your exam about which he is concerned, a fine needle aspirate (FNA) may be performed.  This is accomplished when the pathologist comes to the clinic and inserts a very fine needle into the lump to sample a few of the cells to determine what the lump is likely to be.  The pathologist will talk to you about this in detail before it is performed.  The advantage of having this type of biopsy done is that generally we can get a preliminary diagnosis on what the lump may represent, and a plan on how to manage the lump can be made at that clinic visit.  Occasionally we will have to wait for the final pathology to make further recommendations.

Small biopsies of the skin

Small biopsies of the skin may also be accomplished in clinic.  This is generally accomplished using a little bit of Novocain injected into the area to provide numbness for the procedure.  In general, a small sample of the area will be taken and sent to the pathologist for examination.  In some cases, we may elect to excise the entire abnormality, particularly if it is small.  If this is so, we will generally use a few sutures to secure the skin edges together and apply an antibiotic ointment.

Other minor surgical procedures

Additional small procedures may be performed in clinic, which may include repair of a split ear lobe, temporal artery biopsy, incision and drainage of a small infection.  Additionally, procedures for snoring can be accomplished in the clinic through a number of different techniques.