The most commonly done blood test is that for Thyroid Stimulating Hormone (TSH). This can affect your voice if abnormal. It is also important if you have a lump in the thyroid.
Thyroid antibodies are abnormal proteins that may act as a stimulator or inhibitor to the thyroid gland, which can result in over activity or under activity. The measurement of these may in understanding the nature of the cause.
Examination of the voice box (flexible laryngoscopy)
Flexible laryngoscopy is an examination of the voice box and throat using a small telescope. This can be done using a local anaesthetic, which is sprayed in the nose, but can also be done without. The local anaesthetic makes the nose and the back of the throat numb. The telescope is then placed into the nose and used to examine the voice box. Most people do not experience any discomfort from the procedure.
This is a harmless, painless, non invasive imaging test using sound waves. It is most readily recognised as the imaging technique used to see the developing child before birth. It is excellent for imaging more superficial parts of the body such as the thyroid and salivary glands, the neck lymph glands and neck lumps in general. Its helps to determine where the lump is actually arising from; helps to characterise it e.g. - solid or cystic (liquid); and in addition, and it helps to see its local extent.
Fine Needle Aspiration (FNA) and ultrasound guided FNA
Fine Needle Aspiration or FNA biopsy is a technique used to take a sample of cells from the lump to assess its nature. It is carried out using a small blood sample needle or sometimes a larger biopsy needle (called ‘core biopsy’). Local anaesthetic can be applied beforehand although is rarely required – just like a blood test. The needle is placed in the relevant area, through the skin. The cells can then be sent to the laboratory and analyzed by a pathologist. Most thyroid and salivary lumps are suitable for FNA biopsy. The procedure can be performed with ultrasound guidance, which helps to accurately locate the lump and guide the needle to the important area. It is a safe technique, and almost all patients will be able to continue about their normal business immediately after having the test. There is normally only mild discomfort during the procedure – similar to a blood test. Occasionally one may feel some prolonged discomfort, usually due to a small amount of bleeding into the lump or the skin, which can cause bruising and mild soreness for a few days.
A videofluoroscopy is a moving x-ray of your swallowing. It can help us understand more about your swallowing. Videofluoroscopy should not cause any discomfort.
The speech and language therapist will perform this examination with a radiologist and a radiographer. You will be asked to sit/stand by an x-ray machine and you will be asked to eat/drink small amounts of different textures of fluids and food whilst pictures are taken of your swallowing. The food/fluids will be mixed with barium so that they can be seen on the x-ray.
Unless you have been advised otherwise, you can eat and drink as normal before your appointment. If you are currently feeding through a tube, you can take your feeds as normal up until your appointment time. It is important that you inform the speech and language therapist of any food allergies.
After the videofluoroscopy,you can go home immediately after your appointment. You may be given some basic information after each procedure but this is not always possible. Our results will be analysed by the swallowing team and follow-up will then be arranged as appropriate.
CT (Computed Tomography) is a specialised type of scan that utilises x-rays to produce much more detailed pictures showing the different organs of the body.
During the examination, the patient lies on the scanning table, which then moves into the scanner. It may involve the use of injection during the procedure. You need to let us know if you have an allergy to iodine.
Magnetic Resonance Imaging (MRI) combines a powerful magnet with a sophisticated computer to produce very detailed images of the body without the need for x-rays. It gives us good views of the internal tissues of the body.
During the examination, the patient lies on the scanning table, which then moves into the scanner. It often requires no special preparation and may require an injection during the scan.
Due to the strong magnetic field patients with pacemakers, ear implants and certain type of aneurysm clips or those who have had metallic fragments in the eyes may not be able to undergo the scan. Please let us know if you have had these.
Also people who are claustrophobic may find this test difficult. Please let us know if you are claustrophobic.
Example of MRI image showing a tumour in the hearing nerve
This usually involves the injection of small amounts of slightly radioactive material, which does not make you feel any different. This is usually taken up by parathyroid glands that are normally situated in the neck. It allows us to detect the location of the parathyroid glands to allow for easy access surgery.
PET stands for Positron Emission Tomography. It is an imaging technique that uses small quantities of radioactive tracer called Fluorodeoxyglucose (FDG), which is similar to sugar. It produces images of how the body is functioning.
CT (Computed Tomography) utilises x-rays to produce pictures showing the density of different organs of the body.
By combining these two techniques, we are able to produce detailed images of different organs in the body. By combining these two techniques in one scanner, we are able to provide important information to help plan appropriate treatment in certain disease conditions such as cancers.
Example of a PET CT scan showing tumour in the tonsil
The only special test needed for diagnosis of gastro-oesophageal reflux is called '24 hr oesophageal pH & Manometry'.
It determines the total acid exposure over a 24 hour period, to distinguish between day time and night time reflux and also to assess how well the oesophagus is contracting helping to move food and fluid in to the stomach.
A fine probe is passed through one nostril, positioned at the bottom end of the food pipe; patient is given a small pager / bleeper which will record the acid reflux over a period of 24 hours. Patients are asked to have a normal day at work or home. They return the following day, when the probe and bleeper are removed.
The computer then provides necessary information about the amount and severity of reflux. This helps the surgeon to advise the patient about medical treatment and surgery, recovery and the likely long term results.
There are no complications associated with this test.
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