Dr. Joseph D. Peterson, MD

For visualization, bronchoscopy can be done alone, or it can be combined with ultrasound. Endobronchial ultrasound (EBUS) allows real-time imaging of the airway and is used for diagnosing and staging lung cancer, as well as for determining where the cancer has spread. EBUS can be performed with TBNA, a procedure known as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Doctors can also use bronchoscopy as a treatment for lung problems. For example, if a foreign body is trapped in the airway, doctors can insert forceps through the bronchoscope to remove it. If the airway has become narrowed - which may occur if patients have an infection, cancer, or some other inflammatory issue - bronchoscopy can be used to place a device called a stent in the area of constriction. The stent will keep the airway open, allowing the patient to breathe properly.

During a bronchoscopy, patients will be given medication (sedative) to help them relax. If it is only a diagnostic bronchoscopy, patients will be kept awake, but if the bronchoscopy is for therapeutic purposes, patients will be put to sleep by general anesthesia. After the procedure, patients will need to stay in the hospital for a few hours. They will not be able to eat or drink for about 2 hours. Some patients may experience discomfort, such as a sore throat or pain while swallowing. Throat lozenges and gargling may help alleviate these symptoms, which should go away after a few days. Patients will need to have someone drive them home once their doctor determines that they are ready.

Tonsillectomies are usually performed on children; however, many adults also undergo the procedure. A tonsillectomy generally only lasts for about half an hour following the administration of anesthesia. The otolaryngologist (ENT) or surgeon performing a tonsillectomy may employ a variety of medical techniques, such as:

• Cold Knife Dissection: A cold knife dissection is the most popular tonsil removal method. A surgeon removes the tonsils using a steel scalpel and repairs the region with sutures (stitches) or electrocautery (high heat) to stop bleeding. This technique is favored for those with obstructed breathing.
• Electrocautery: Other tonsillectomy methods include a full tonsil removal by electrocautery, where the surgeon uses a high heat device to burn off the tonsils and cauterize the bleeding tissue. Electrocautery is more painful than cold knife dissection.
• Harmonic Scalpel: A third technique is where the surgeon uses a harmonic scalpel (vibrating bladed device) to first cut off the tonsils, and then coagulate bleeding using the harmonic scalpel's heat and vibration. Harmonic scalpel is the most precise form of tonsillectomy.
• Radiofrequency Ablation: To perform the radiofrequency ablation technique, the surgeon places small probes into the tonsil that transmit radiofrequency energy to the tonsil tissue. The delivered energy damages and scars the tonsils, gradually minimizing the tonsils' size. Unlike the other three methods, radiofrequency ablation is performed in-office with or without general anesthesia and has minimal recovery time. Patients can expect to return to daily activities nearly immediately and may receive radiofrequency ablation every few months. While radiofrequency ablation does reduce tonsil inflammation, it is not often prescribed to those with severe tonsillitis or breathing disorders.

Patients are typically able to return home shortly after having their tonsils removed. Tonsillectomy recovery time may range from around ten days to two weeks. During this time, it is common for patients to have a sore throat, neck pain, and a hoarse voice. Patients are advised to consume soft foods such as ice cream and applesauce to avoid further throat irritation. After recovering from tonsillectomy, many patients experience improved breathing, reduced irritation, and an overall improved quality of life.

Tracheostomy is performed for a variety of reasons when a bypass to the normal airway is needed. A patient may have an object lodged in their throat or have an injury that damaged their windpipe. They may have cancer or a swelling in their throat that stops air from moving freely. Sometimes tracheostomy is performed to make breathing easier when patients are paralyzed or have trouble coming off a ventilator.

A tracheostomy can be temporary or permanent. A temporary tracheostomy tends to heal over easily when the tube is removed, leaving a small scar. A permanent tracheostomy can make speech difficult at first. It takes time to learn how to use the throat and air in a new way.

Tracheostomy is a fairly simple procedure, but it can make all the difference in a life or death situation.