Dr. Yanka Shtiliyanova

Tonsillectomy is a surgical procedure involving the complete removal of the palatine tonsils. Located at the back of the throat, these lymphatic organs help filter out infections. However, when the tonsils themselves become a source of chronic inflammation and compromise overall health, surgical removal becomes the most effective solution.

Indications: When is a Tonsillectomy Needed?

An ENT specialist may recommend surgery under the following conditions:

• Chronic Tonsillitis: Frequent and severe throat infections (more than 4–5 times a year) accompanied by high fever and poor response to antibiotic treatment.

• Peritonsillar Abscess: A pus-filled pocket developing in the tissues around the tonsil as a complication of severe tonsillitis.

• Obstructive Sleep Apnea (OSA): Significantly enlarged tonsils physically blocking the airway during sleep, leading to loud snoring and repeated breathing pauses.

• Chronic Focal Infection: Bacteria persisting in the tonsils release toxins capable of damaging the joints (rheumatic fever), heart (myocarditis), or kidneys (nephritis).

Procedures at MBAL Varna

• Preoperative Preparation: Routine blood tests (including bleeding and clotting times) performed in the Clinical Laboratory, followed by an anesthesiology consultation to assess overall health.

• Anesthesia: At MBAL Varna, the surgery is performed under general endotracheal anesthesia. This ensures the patient remains deeply asleep and completely pain-free, allowing the surgical team to work with maximum safety.

• Surgical Technique: The surgeon accesses the tonsils through the patient's open mouth—leaving no external incisions or scars on the neck. The tonsils are carefully dissected from surrounding tissues, followed by precise hemostasis (bleeding control).

• Duration: The operation itself takes between 30 and 45 minutes.

Postoperative Care and Recovery

Patients typically stay in the ENT inpatient unit under medical supervision for 24 to 48 hours.

• Diet: A strict dietary regimen is required during the first few days, consisting exclusively of cold, liquid, and soft foods (ice cream, yogurt, lukewarm soups). Hot, spicy, acidic, or hard foods must be strictly avoided to prevent wound irritation.

• Pain Management: Throat and ear pain during swallowing is normal for 7 to 10 days and is effectively managed with prescribed pain relievers.

• Recovery: Full mucosal healing takes approximately two weeks, during which strenuous physical activity should be avoided.

The surgery at MBAL Varna is covered under the relevant National Health Insurance Fund (NHIF) clinical pathway upon presentation of a Hospitalization Referral Form No. 7 issued by an ENT specialist.

Septoplasty is a surgical procedure aimed at correcting deformities, deviations, or asymmetry of the nasal septum. The nasal septum is a cartilage-and-bone structure that divides the nasal cavity into two halves. When it is significantly deviated, it narrows one or both nasal passages, restricting normal breathing.

Indications: When is a Septoplasty Needed?

An ENT specialist recommends septoplasty for patients suffering from:

• Chronic Nasal Obstruction: A persistent feeling of a blocked nose that does not respond to nasal drops or sprays.

• Recurrent Sinus Infections: A deviated septum blocks the natural drainage of the sinuses, creating ideal conditions for chronic inflammation.

• Snoring and Sleep Apnea: Impaired nasal breathing forces the patient to mouth-breathe during sleep, leading to snoring, sleep disruption, and morning headaches.

• Chronic Nosebleeds (Epistaxis): The deviated segment causes localized dryness of the mucosa, making blood vessels fragile and prone to bleeding.

Procedures at MBAL Varna

• Preoperative Preparation: Routine laboratory blood tests and an anesthesiology consultation are performed. A baseline evaluation of the nasal anatomy via anterior rhinoscopy or nasal endoscopy is often required.

• Anesthesia: The operation is performed under general anesthesia, ensuring maximum patient comfort and allowing the surgical team to work with high precision.

• Surgical Technique: The procedure is performed entirely endonasally—meaning inside the nostrils—leaving no external facial incisions or visible scars. The surgeon makes a small incision in the internal mucosa, lifts it from the cartilage and bone, reshapes or repositions the deviated sections (or removes bony spurs), and repositions the mucosa.

• Nasal Packing: Special soft nasal packs are placed in both nostrils to stabilize the septum in its new alignment and prevent bleeding.

• Duration: The procedure takes between 45 and 60 minutes.

Postoperative Care and Recovery

Patients typically stay in the ENT inpatient unit for 24 to 48 hours.

• Removal of Nasal Packing: The nasal packing is gently removed by the surgeon, usually the day after surgery, providing immediate breathing relief.

• Postoperative Period: Mild mucosal swelling and minor discharge are normal during the first few days. Healing nasal sprays or ointments are prescribed to soothe the nasal lining.

• Recovery: Full functional recovery and optimal breathing efficiency are achieved within 10 to 14 days. Strenuous physical exercise and hot baths should be avoided during this period.

The surgery at MBAL Varna is covered under the National Health Insurance Fund (NHIF) for insured patients upon presentation of a Hospitalization Referral Form No. 7.

Paracentesis (also known as myringotomy) is a precise, minimally invasive procedure in which a microscopic incision is made in the eardrum (tympanic membrane). This intervention allows fluid, pus, or blood accumulated behind the eardrum in the middle ear to be evacuated (drained), immediately relieving pressure and preventing severe complications.

Indications: When is Paracentesis Needed?

An ENT specialist performs paracentesis under the following clinical conditions:

• Acute Suppurative Otitis Media: Significant accumulation of pus behind the eardrum, causing severe throbbing pain, high fever, and a risk of spontaneous rupture of the membrane.

• Serous Otitis Media (Fluid in the Ear): Prolonged retention of thick, sticky fluid behind the eardrum leading to progressive hearing loss (commonly seen in children with an enlarged adenoid / third tonsil).

• Failure of Antibiotic Therapy: When the ear infection does not respond to medical treatment and pain remains severe.

• Barotrauma: Middle ear damage caused by sudden changes in atmospheric pressure (e.g., during air travel or scuba diving).

Procedures at MBAL Varna

• Preparation: Prior to the procedure, the doctor cleans the ear canal and evaluates the condition of the eardrum using an otoscope or operating microscope.

• Anesthesia: For adult patients, the procedure is performed under local anesthesia—a specialized numbing solution or spray is applied to the eardrum, making the sensation completely tolerable. For young children or anxious patients, brief general anesthesia (mask anesthesia) is administered.

• Surgical Technique: Guided visually by an ear microscope, the ENT surgeon creates a fine incision (approx. 1–2 mm) in the lower segment of the tympanic membrane using a specialized thin needle (paracentesis knife). The fluid is then gently aspirated (suctioned out). In chronic cases of serous otitis media, a miniature ventilation tube (grommet) may be inserted into the incision to provide continuous drainage and middle ear aeration.

• Duration: The procedure is exceptionally fast, taking between 5 and 10 minutes.

Postoperative Care and Recovery

• Immediate Relief: The moment the incision is made, middle ear pressure drops and acute pain subsides immediately. Hearing begins to improve progressively.

• Water Protection: The most critical post-procedure rule is to strictly keep water out of the ear during bathing or hair washing. Specialized earplugs or petroleum-jelly-coated cotton balls should be used to prevent secondary infections through the incision.

• Healing: The microscopic incision is reversible—the tympanic membrane possesses remarkable regenerative capacity and typically heals completely on its own within a few days to a week (unless a long-term ventilation tube was placed).

At MBAL Varna, this procedure is performed in the specialized ENT consulting room or in the department's operating theater based on clinical indications.