Ear, Nose & Throat

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ENT (Ear, Nose and Throat) surgery may also be described as otorhinolaryngology or head and neck surgery and is widely available in the private sector in India. ENT surgery is a specialty which is broadly based, encompassing a wide range of treatments and surgical procedures.

Common problems managed by an ENT specialist include include hearing and balance problems, tumours of the nose, sinuses, throat and larynx, allergies, snoring, voice and swallowing disorders, inflammation of the throat and laryngitis.

This is the gland that is affected by Mumps. Lumps (tumours) in the parotid gland are common and are seen in all age groups. They are the result of an abnormal growth of cells within the gland, though the exact reasons for this are not clear. The vast majority (approximately 80%) of these tumours are not cancerous and are called benign tumours. Rarely, however, some tumours can be cancerous.

Other common causes of lumps in the gland include stones in the duct of the gland, which often block the flow of saliva. This blockage often gives rise to infections, which can sometimes be troublesome. Whatever the cause, however, it is prudent to establish the EXACT NATURE of the swelling.

Investigations and Treatment of Parotid Problems

During the initial consultation, a detailed history is taken and also an assessment of your problem. This is usually followed by an ultrasound scan, which is performed by an expert radiologist. During the ultrasound scan, a needle may be inserted into the lump to collect a sample of cells. These cells are then analysed under the microscope by the pathologist who will often determine the nature of the swelling. Rarely, other tests such as a plain X-ray, CT scan, MRI scan or a sialogram may be required. These will be discussed with you where necessary.

Treatment depends on the nature of the lump and the results of the tests. Removal of the swelling is usually recommended because the exact nature of the swelling is often ascertained after removal and analysis of the whole lump. Additionally, if the lumps are not removed, the majority of them will grow further and often become cosmetically unacceptable and even turn cancerous. Large, cancerous lumps are difficult to remove and complicate surgery.

Facial Nerve Considerations

Where the parotid mass is located relative to the facial nerve also determines how extensive the surgery will be. Regardless of location, the BEST way to protect the facial nerve is to identify and protect all branches of the facial nerve BEFORE removing the mass. Facial nerve identification is done by microscopic dissection with nerve monitoring. It is this facial nerve identification that takes so much time. After the facial nerve is protected, removing the mass itself takes about 5 minutes. In the illustrations below, the parotid mass is colored in green.

A "total parotidectomy" is required. Risk to facial nerve paralysis is higher than the first scenario. Surgical duration is quite long.

In order to perform this surgery and safely identify and protect the facial nerve, a LONG facial incision is potentially required... up to 6 inches long as shown in red in the illustration below. Depending on the parotid mass location, however, the incision required may be shorter. Regardless, the scar is usually not very noticable... in fact, this incision is very similar to the incision used to perform facelifts for cosmetic reasons

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