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Private Silent Reflux (LPR) Treatment London & Essex | Mr Gaurav Kumar

  Silent Reflux (LPR): Managing the Hidden Cause of Throat Irritation Many people are familiar with Gastroesophageal Reflux Disease (GERD)—the uncomfortable burning sensation in the chest known as heartburn. However, there is another form of reflux that completely bypasses the chest and targets the throat directly. This is Laryngopharyngeal Reflux (LPR) , frequently called "Silent Reflux." Because it doesn't produce the classic "burning" sensation, many patients live with chronic throat discomfort for months or years, mistaking it for a persistent cold, an allergy, or vocal strain. This guide explains how silent reflux works, how to spot its hidden symptoms, and how a specialist ENT evaluation can help you protect your throat and voice. What is Laryngopharyngeal Reflux (LPR)? LPR occurs when stomach contents—including harsh gastric acid and the digestive enzyme pepsin—travel back up the oesophagus and spill over into the larynx (voice box) and pharynx (throat). ...

Ear cartilage meatoplasty

 


Ear cartilage meatoplasty (conchal cartilage reduction) for external ear canal stenosis — an operation to widen the entrance (outer/cartilaginous part) of the ear canal by reshaping/removing the obstructing conchal cartilage and associated soft tissue, so the canal stays open and can ventilate, drain, and be cleaned. 

Why is this being recommended?

Your ear canal is narrowed because the conchal cartilage (the bowl-shaped cartilage at the ear opening) is bulky or positioned in a way that crowds the canal entrance. This can lead to a cycle of wax trapping, recurrent otitis externa/inflammation, discharge, blocked hearing, difficulty examining the eardrum, and repeated need for microsuction. Meatoplasty aims to restore a stable, self-cleaning canal opening and reduce recurrent problems. 

What benefit can you reasonably expect?

The intended benefits are: easier ear toilet/cleaning, fewer blockages and infections, improved access for drops and examination, and (in some patients) improved hearing if blockage and chronic inflammation have been contributing. Outcomes across studies are generally favourable, but vary depending on the cause of stenosis, degree of inflammation/scarring, and adherence to postoperative care (packing/splinting and follow-up). 

What the operation involves

Meatoplasty is performed under local or general anaesthetic depending on complexity and patient preference/clinical factors. An incision is made at/near the canal entrance (often endaural/conchal), the obstructing conchal cartilage and bulky soft tissue are conservatively reduced or repositioned, and the skin is re-draped to line the widened opening. Dissolvable and/or removable sutures may be used. Many techniques exist (for example, Z-plasty or other flap designs), and the surgeon will choose a method that best suits your anatomy and the pattern of narrowing. 

Reasonable alternatives (including no surgery)

In line with Montgomery principles, the “right” option depends on what matters most to you (symptom control, recurrence risk, cosmesis, clinic visits). Alternatives can include:

  • No surgery / watchful waiting, with advice on keeping the ear dry and prompt treatment of flare-ups.
  • Regular microsuction and topical therapy for inflammation/infection (drops as appropriate).
  • Stenting/splinting/dilation protocols in selected cases, particularly when stenosis is evolving,      and inflammation control is the main issue.
  • Canalplasty or more extensive reconstruction (e.g., skin grafting) if narrowing is more medial/bony or associated with significant scarring/atresia (sometimes combined with meatoplasty). 

Material risks and complications (with realistic rates where known)

All operations carry risk. Some risks are uncommon but “material” because of potential impact. Published rates vary because studies include different diseases (post-inflammatory stenosis, congenital stenosis, revision cases, mastoid cavity meatoplasty) and different techniques.

1) Restenosis (re-narrowing) / need for further procedures

  • Restenosis is widely described as the most common longer-term issue after surgery for ear canal stenosis, and some reviews cite rates up to ~30% in challenging acquired/post-inflammatory disease. (J Clin Otolaryngol Head Neck Surg)
  • In selected series using specific techniques, restenosis rates can be much lower (for example, a “modified meatoplasty” report described restenosis in 2/145 cases (1.38%)). (PubMed)
    What this means for you: your personal risk depends on the degree of inflammation/scar tendency, skin quality, prior surgery/infection, and how well postoperative packing/splinting and follow-up can be maintained.

2) Infection, perichondritis/chondritis (infection of cartilage), delayed healing

  • Local wound infection or cartilage inflammation can occur and may require antibiotics, dressings, and closer follow-up. One series (in a mastoidectomy setting) reported complications including perichondritis and canal stenosis in 12.5% (note: different patient group and operation context). (PJohns)

3) Bleeding, bruising, pain, scarring, tenderness

Usually minor and self-limiting. Occasionally a small collection (haematoma) or troublesome bleeding requires treatment.

4) Cosmetic change

Because the procedure reshapes conchal cartilage, there can be a subtle change in the ear opening/shape or asymmetry. This is typically mild but can be important to some patients.

5) Hearing effects

Meatoplasty is designed to widen the entrance and improve the canal environment; it is not primarily a hearing reconstruction. Temporary muffled hearing is common from packing/swelling. Persistent conductive change is uncommon but possible depending on underlying disease. Severe inner ear hearing loss is rare in typical lateral meatoplasty series. (PubMed)

6) Numbness or altered sensation

Temporary altered feeling around the ear/canal entrance can occur due to small skin nerve disturbance; usually improves over weeks to months.

7) Very rare but serious risks

Serious complications (e.g., major nerve injury) are rare in reported meatoplasty series, but no operation is risk-free. (PubMed)

What we will do to reduce risks (good practice commitments)

We will confirm the indication, examine the pattern of narrowing, treat active infection/inflammation before surgery where possible, use meticulous technique to preserve healthy skin lining, and arrange structured follow-up for packing removal, debridement, and early management of granulation/scar. Evidence and expert guidance consistently emphasise that postoperative care is critical to minimise restenosis. (PMC)

Anaesthetic and peri-operative considerations

You may have the operation under local anaesthetic with/without sedation or general anaesthetic. We will discuss the options, including what matters to you (comfort, anxiety, time, medical conditions), and the anaesthetic team will explain their own risks on the day.

Postoperative care and guidance

After meatoplasty, the early phase is about protecting the new canal shape while skin settles:

Dressings/packing
A dressing or canal pack is commonly used to support the widened opening and reduce bleeding. Do not remove it unless instructed. If it falls out, contact the ENT team for advice.

Ear drops
You may be prescribed ear drops (often antibiotic/steroid) to reduce inflammation and support healing. Use exactly as directed.

Keeping the ear dry
Keep water out of the ear until your surgeon confirms it is safe (commonly several weeks). Use a cotton ball lightly coated with petroleum jelly at showering; avoid swimming until cleared.

Pain control
Expect soreness for a few days. Paracetamol and/or ibuprofen are usually sufficient unless you have a reason not to take them.

Activity
Avoid pressure on the ear (sleeping on that side), avoid heavy exertion for a short period, and do not insert cotton buds or ear plugs unless advised.

Follow-up and microsuction
Regular follow-up is part of the operation’s success. You may need gentle cleaning/debridement in clinic to prevent crusting and to spot early narrowing.

When to seek urgent advice
Contact ENT urgently if you develop: increasing severe pain, spreading redness/swelling of the outer ear, fever, foul-smelling discharge, significant bleeding, sudden marked hearing drop after initial improvement, or dizziness/weakness of the face.

Shared decision-making (Montgomery principles)

The key decision is whether the expected benefit (a stable, cleanable, less-infected canal) outweighs the burdens and risks for you—particularly the possibility of restenosis and the need for committed postoperative follow-up. If you tell me what matters most (symptom relief vs avoiding cosmetic change vs minimising repeat procedures), I can tailor the risk/benefit discussion and document the specific “material risks” relevant to your priorities.

 

Consultant Ear, Nose, and Throat Surgeon
Consulting at

Nuffield Health Brentwood
Spire Hartswood Brentwood
Spire London East 

To make an appointment

Call
07494914140







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