Out Patient Procedures in the Ear Nose and Throat Clinic

Special examinations and treatments carried out in the ENT Clinic

Please note the following describes our usual clinical practice. There may be reasons why your procedure is carried out in a different way. Other specialists will use their own preferred methods. There are many valid ways to carry out these examinations and treatments.

The most commonly performed ENT out-patient procedures are:


Photo of surgeon carrying out microsuction of the ear as an outpatient procedure. Patient is lying on a couch and specialist uses a speculum and tiny suction tube to examine and treat conditions of the outer and middle ear

Microsuction of the Ear

Surgeon's magfified view down the ear speculum of removal of ear wax by microsuction


Information on Microsuction of the Ear updated 16 August 2014


Microsuction is an examination and treatment of the ear using a high powered binocular operating microscope. We use very fine delicate instruments, including a miniature vacuum cleaner. This Hoovering of the ear is usually done as an out-patient procedure. Sometimes, and especially in younger children, it is done as a day case surgery under general anaesthetic.

Typical ear problems that are treated using microsuction of the ear include

Microsuction of the ear is carried out

  • to diagnose the condition of the ear accurately using
    • binocular vision for 3-d stereoscopic view
    • high power magnification
    • very bright illumination
  • to remove material blocking the ear canal such as
    • wax
    • infected debris
    • dead skin layers
    • foreign bodies
  • to apply medication to the ear

Earol olive oil spray applied to ear canal to soften wax

Having microsuction treatment: what to expect and what to do

Before microsuction of the ear

You may be asked to use ear drops or Earol olive oil spray for several days beforehand. This will make the treatment easier for you.

During the procedure of microsuction of the ear

  • You do need to lie very still.
  • Despite all our efforts to be as gentle as possible, it will be noisy, and may be painful.
  • It usually causes some short lived vertigo (dizzines), lasting no more than a minute or so.

After the procedure of microsuction of the ear

  • Don’t get up until the nurse says so – you may be dizzy.
  • You should be ok to drive afterwards but may need to wait until any dizziness has settled.

Cleaning the ear without microsuction using cotton wool on a Jobson-Horne probeWhat’s the alternative?

Dry mopping

An alternative to microsuction often used in children with runny, discharging ears is to gently mop out the ear with a cotton wool applicator. Illumination is from light shone over the child’s shoulder and focussed onto the ear by a head mirror worn by the surgeon. The view is nothing like as good, and we can’t normally reach right down to the eardrum, but it is less scary for the child.

Microsuction of ear under general anaesthesia

If we can’t carry out an adequate examination with the child (or adult) awake, a General Anaesthetic may be recommended.



Surgeon carrying out rigid nasal sinus endoscopy and suction treatment
Nasal polyp seen through an endoscope in the right side of the nose. Key:mt = middle turbinate it = inferior turbinate s = nasal septum p = polyp
Rigid Nasal Sinus Endoscopy (RNE, FESS telescope)


Information on rigid nasal endoscopy updated 16 August 2014


The rigid nasal endoscope is a small instrument, like a silver pencil with a light on the end, 4 millimetres or less in diameter and around 20cm long. With a range of angled lenses to see around corners, and a powerful fibreoptic light source, the surgeon gets detailed close-up views of the internal nose and sinuses. We can also check the back of the nose, and the openings of the Eustachian Tubes which connect with the middle ear. The endoscopic examination looks into all the nooks and crannies of the nose, showing the exact location of any narrowings, bony deformities, polyps and the source of any pus drainage. This helps us make a plan for treatment.

This out-patient examination procedure involves placing a small camera in the nose. It is done

  • to diagnose conditions of the nose, sinuses and nasopharynx accurately, using
    • Storz Hopkins rod telescope for magnified view of narrow openings
    • angled lenses to see around corners
    • high power magnification
    • very bright illumination
  • to cary out minor treatments such as
    • removal of blood clots & crusts following nasal surgery
    • sucking out pus from infected sinuses
    • cautery for nosebleeds

Having rigid nasal sinus endoscopy: What to expect

Before the procedurelocal anaesthetic spray applied to nose before flexible fibreoptic nasolaryngoscopy

  • you will normally receive a local anaesthetic spray immediately beforehand
  • the local anaesthetic will taste bitter and you may imagine your throat is swelling up. Don’t panic, that is just the local anaesthetic working

During the procedure

  • the instrument will be passed gently through your nose, you will be told exactly what to do during the procedure
  • lie still and breathe through the mouth
  • remember your nose is 4 to 5 inches long

After the procedure

  • don’t get up until the nurse says so – you may be dizzy
  • we will normally tell you the result of the examination straight away
  • you should not eat or drink till the local anaesthetic has worn off – about an hour
  • you should be ok to drive after an hour

What other options are there?

If we only want to look, we can use a flexible nasolaryngoscope instead. But the rigid endoscope is better if we want to do something in the nose, because the surgeon only needs one hand to hold the rigid nasendoscope, and the other hand is then free to carry out therapeutic procedures such as suction of secretions or cauterisation for nosebleeds.

Without any kind of endoscope, we can see only just inside the front inch (2-3cm) of the nose, by stretching the nostrils a little and shining a light. We can sometimes get a view of the back of the nose using a mirror held in the mouth, and that was the standard method before nasal endoscopes were in widespread use. Because the nose is 4-5 inches 10-12cm long, the view into the middle part of the nose – where the sinuses open into – is not very good, so without using some kind of endoscope, the examination is incomplete.



Flexible fibreoptic nasolaryngoscopy (FOL)


Information on flexible fibreoptic nasolaryngoscopy updated 18 January 2016


This out-patient examination procedure may also be referred to as

  • Fibreoptic nasendoscopy – FNE
  • Fibreoptic laryngoscopy or laryngoscope
  • Nasal laryngoscopy or Nasal laryngoscope
  • Rhinolaryngoscopy or Rhino-laryngoscope
  • Video laryngoscope (if done with a monitor)
  • Laryngeal stroboscopy (if done with a strobe light source)
  • Vocal cord check

Flexible fibreoptic nasolaryngoscopy is carried out to diagnose conditions of the nose and throat. Typical symptoms to be investigated with flexible fibreoptic nasolarynggoscopy include

  • Blocked nose
  • Catarrh
  • Post nasal drip
  • Sore throat
  • Hoarse voice
  • Difficulty swallowing
  • Feeling of a lump in the throat
  • Cough
  • Lump in the neck

A flexible laryngoscope

  • allows close up view of inaccesible areas of nose and throat
  • the flexible instrument allows us to see around corners
  • the vocal cords can be seen in motion
  • very bright illumination helps diagnose conditions of the nose, nasopharynx, larynx and hypopharynx accurately

Having flexible fibreoptic nasolaryngoscopy: What to expect

Before the procedure
local anaesthetic spray applied to nose before flexible fibreoptic nasolaryngoscopy

  • you will normally receive a local anaesthetic spray immediately beforehand to reduce any tendency to gag
  • the local anaesthetic will taste bitter and you may imagine your throat is swelling up. Don’t panic, that is just the local anaesthetic working
  • it is also possible to undergo the examination without any local anaesthetic spray – but it may be a little painful in the nose, and you may tend to gag

During the procedureFlexible fibreoptic nasolaryngoscopy: ENT Specialist passing flexible endoscopic camera through the seated patient's nose, while nurse supports the head from behind

  • the instrument will be passed gently through your nose & into your throat
  • sit still and breathe through the mouth, the nurse will support you
  • you may be asked to sing a high pitched note, maybe to cough, and to puff out your cheeks – don’t worry, you will be told exactly what to do during the procedure

After the procedure

  • don’t get up until the nurse says so – you may be dizzy
  • Surgeon's view of laryngitis as seen by flexible fibreoptic nasolaryngoscopywe will normally tell you the result of the examination straight away
  • you should not eat or drink till the local anaesthetic has worn off – about an hour
  • you should be ok to drive after an hour

What other options are there?

Indirect laryngoscopy (mirror examination of voice box)

Until we had the flexible scopes, the standard way of examining the larynx was to use a mirror held in the mouth, with the patient’s tongue pulled out. This technique is known as indirect laryngoscopy. Indirect laryngoscopy (mirror examination) can still be done, but it requires considerable skill and practice. In those parts of the world where the flexible fibreoptic laryngoscope is readily available, indirect laryngoscopy using a mirror is a dying art. Most patients find it less tolerable than the scope, and the view for the doctor is not so good.

Direct laryngoscopy under general anaesthesia

Before we had the flexible fibreoptic laryngoscope, many patients were subjected to a general anaesthetic for a direct laryngoscopy, just because it was not possible to get a good enough view with the mirror. It is still sometimes necessary to carry out a direct laryngoscopy under a general anaesthetic for the rare patient who cannot tolerate the flexible laryngoscope. It may also be necessary to have a general anaesthetic where it is necessary to take a biopsy from something found with the flexible scope.