Department of Otorhinolaryngology and Head and Neck Surgery, 1st Medical Faculty, Charles University and University Hospital Motol

All surgical procedures in the field of otorhinolaryngology and head and neck surgery are performed at the clinic. Unique, super-specialized procedures are part of the clinic's individual surgical programs - this applies in particular to oncological operations with extensive reconstructions, skull base operations including vestibular schwannoma operations and implantation of cochlear and trunk auditory neuroprostheses for complete bilateral deafness and other operations.

The clinic has 4 operating theaters with complete equipment for conducting operations under general anesthesia, and 1 room for operations under local anesthesia. On working days, it is operated on four operating tables, the average daily number of operations is 12 - 19.

You can find more information on our Site.

Ambulance

Blue pavilion, adult part, communication node E, 1st floor

The outpatient part consists of 8 examination rooms and a surgical theater with the possibility of performing minor surgical procedures under local anesthesia.

General ENT clinic takes place every working day between 8:00 - 14:00. It provides treatment for patients with a recommendation from an ENT specialist or a general practitioner. Only patients with an urgent health problem (e.g. bleeding, risk of suffocation, etc.) are treated without a referral.

Specialized ambulances take place in the dates see overview of specialized clinics.

Before ordering a specialized outpatient clinic by phone, a referral by an otorhinolaryngologist or an examination at the local general ENT outpatient clinic is required.

For orders to specialized clinics, questions, information on the results of the examinations that can be submitted with regard to the Personal Data Act, for cancellation of the operation date by the patient, please use the phone numbers in the box Contact.

Operational information, news

Information for patients recommended for biologic therapy for chronic rhinosinusitis with nasal polyps

For the examination, you must have a recommendation from an ENT doctor, pulmonologist or allergist/immunologist. Take all documentation with you, including laboratory tests related to associated diseases.

The examination can be ordered through the ORL clinic's card file or by calling 224 434 326. Examinations are always performed on Tuesdays between 12 and 14 p.m.

Information for cochlear implant users

Dear patients, users of cochlear implants, due to the sudden death of Dr. Ing. In Vokřála, further technical care and adjustment of the speech processors of cochlear implants will take place at the Department of ENT and Head and Neck Surgery of the 1st Faculty of Medicine at the Motol General Hospital. Care will be provided by Ing. Miroslav Okluský and Ing. Lukas Bauer.

You can order by e-mail: implantacni.centrum@fnmotol.cz

Due to the extraordinary situation, the number of clients and the availability of possible dates, we ask for your patience, the date will be communicated to you within the next 2-4 weeks. For the Implantation Center FN Motol doc. MD Jan Bouček, Ph.D.

Specialized ambulances

Oncology clinic (head and neck tumors)

Wednesday, Thursday: 9 am - 12 noon.
Prof. MD Jan Klozar, CSc., as. MD Michal Zábrodský, Ph.D., as. MD Petr Lukeš, Ph.D., MUDr. David Kalfeřt, Ph.D., MUDr. Lucie Dostálová, MUDr. Vladimír Koucký, Ph.D., MUDr. Michal Votava, M.D. Jan Lazák, M.D. Michal Matyášek, M.D. Michaela Tesařová, M.D. Lucie Pavelková, as. MD Jaroslav Betka, Ph.D., MD. Michaela Mrázková, M.D. Karolína Hrubá, M.D. Aneta Klobalová, M.D. Sangyun Cha, M.D. Lenka Peterková

Endocrine outpatient clinic (thyroid gland, parathyroid glands)

Wednesday: 9 am - 12 noon
As. MD Petr Laštůvka, MD David Kalfeřt, Ph.D., MUDr. Lucie Dostálová, MUDr. Michal Votava, M.D. Jan Lazák, M.D. Michal Matyášek

Specialist outpatient clinic for salivary gland diseases

Tuesday: 9 am - 12 noon (orders only)
As. MD Jaroslav Betka, Ph.D., as. MD Michal Zábrodský, Ph.D., MUDr. Lucie Dostálová, MUDr. Michal Votava, M.D. David Kalfeřt, Ph.D., MD. Štěpán Novák, Ph.D., MUDr. Martin Kana

Rhinology outpatient clinic (nasal)

Tuesday: 12 - 14 p.m.
As. MD Zuzana Balatková, Ph.D., MD Lucie Dostálová, MUDr. Michal Matyášek, M.D. Štěpán Novák, Ph.D., MUDr. Michaela Tesařová, M.D. Martin Kaňa, M.D. Aneta Klobalová, M.D. Michaela Mrázková, M.D. Jan Lazák

Co-surgical outpatient clinic (ear surgery, cochlear implants)

Tuesday: 8 am - 10 pm, Friday: 09 am - 11 am
Prim. MD Jan Kluh, M.D. Veronika Bandúrová

Tuesday: 11 am - 13 pm, Friday: 09 am - 11 am
Doc. MD Jan Bouček, Ph.D., MD Vladimír Koucký, Ph.D.

Tuesday: 8.30 am - 11 pm, Friday: 09 am - 11 am
As. MD Zdeněk Fík Ph.D.

Otoneurology clinic (dizziness)

Monday, Tuesday, Wednesday, Friday (by appointment only)
more information https://zavrate.info/
As. MD Zuzana Balatková, Ph.D., MD Vladimír Koucký, Ph.D., MUDr. Veronika Bandúrová, M.D. Markéta Bonaventurová, MUDr. Květoslav Červený

Videoendoscopy clinic at NBI

Wednesday 9-12: 30 (only ordered)
As. MUDr. Petr Lukes, Ph.D., As. MD Michal Zábrodský, Ph.D., MUDr. Lucie Dostálová, MUDr. Michal Votava, M.D. Markéta Bonaventurová, MUDr. Štěpán Novák Ph.D., MUDr. Martin Kana

Ambulance for the rehabilitation of swallowing disorders

Thursday: 13-15 pm (orders only)
MD Michal Votava, M.D. Lenka Peterková, MD Květoslav Červený, Mgr. Agáta Ptáčková

Hearing prosthetics clinic (hearing aids)

Monday: 13:00 - 14:30, Wednesday: 8:00 - 11:00
MUDr. Radim Kaňa

Voice prosthetics clinic (voice prostheses)

Thursday: 12 - 14 hours
MD Vladimír Koucký, Ph.D., as. MD Michal Zábrodský, Ph.D., As. MD Petr Lukeš, Ph.D., As. MD Zdeněk Fík Ph.D., MUDr. Štěpán Novák, Ph.D., MUDr. Markéta Bonaventurová

Laryngology clinic (only ordered)

Thursday: 9 - 14 hours
As. MD Michal Zábrodský, Ph.D., as. MD Petra Kalitová, Ph.D., MUDr. Michal Votava, M.D. Štěpán Novák, Ph.D., MUDr. Markéta Bonaventurová

Objective audiometry (objective hearing examination)

Tuesday, Friday: 11 am - 13 pm
As. MD Petra Kalitová, Ph.D., MD Veronika Svobodová, M.D. Michaela Tesařová, M.D. Lenka Peterková

Outpatient breathing clinic (sleep apnea syndrome, snoring)

Friday: 9 am - 10:30 am
Prof. MD Jan Klozar, CSc., as. MD Jaroslav Betka, Ph.D., MD. Michal Matyášek, M.D. Jan Lazák, M.D. Lucie Pavelková

Cranial base surgery clinic

more informations <a href="https://cdn.shopify.com/s/files/1/1932/8043/files/200721_ODSTOUPENI_BEZ_UDANI_DUVODU__EN.pdf?v=1595428404" data-gt-href-en="https://en.notsofunnyany.com/">here</a> 
Friday: 10 am - 12 noon.
Prof. MD Jan Betka, DrSc., Prof. MD Eduard Zvěřina, DrSc., as. MD Zdeněk Fík, Ph.D., MUDr. Jan Lazák, M.D. Vladimír Koucký, Ph.D.

Inpatient department

Intensive Care Unit divided into oncological and standard part with a total of 12 beds (6 + 6)

1st bed station with 27 beds with a special oncology operation.
2st bed station with 27 beds with standard equipment and operation.

Bed wards are equipped with mostly 3-bed rooms, bathroom (shower, toilet) is common for 2 rooms.
In each department there is also a superior 1-bed and 2-bed room with private facilities, TV, telephone, refrigerator.

Specialization

The clinic carries out a complete diagnosis of diseases in the field of otorhinolaryngology and head and neck surgery, including endoscopic examination of patients with swallowing disorders (FEES), examination for the early detection of superficial mucosal lesions (tumors and pre-tumor conditions) - Narrow Band Imaging (NBI) or autofluorescence, sonographic neck examination including aspiration biopsy, comprehensive audiological examination and otoneurological examination (see  https://zavrate.info/) etc.

All surgical procedures in the field of otorhinolaryngology and head and neck surgery are performed at the clinic. Unique, super-specialized procedures are part of the clinic's individual surgical programs - this applies in particular to oncological operations with extensive reconstructions, skull base operations including vestibular schwannoma operations and implantation of cochlear and trunk auditory neuroprostheses for complete bilateral deafness and other operations.

Overview of the types of surgical procedures performed:

• Common ear, nose, and throat operations (tonsillectomy, adenotomy, tympanostomy, tracheostomy, extirpation of nodes, skin and subcutaneous tumors, branchiogenic neck cysts and fistulas).
• Ear surgery (rehabilitation and reconstruction), otosclerosis surgery, super-specialized procedures - implantation of cochlear and trunk auditory neuroprostheses for adults, vestibular schwannoma surgery.
• Surgery for tumors of the external ear, ear canal and middle ear.
• Laser surgery - microlaryngoscopy using a CO2 laser, tolerance of skin tumors, uvulopalatoplasty. Possibilities of using the diode laser in nasal surgery.
• Head and neck surgery for malignant tumors of the oropharynx, hypopharynx, larynx, parapharyngeal space and skull base, including all types of neck block dissection for metastases of malignant tumors.
• Robotic surgery for malignant tumors of the head and neck.
• Reconstructive surgery after ablation procedures in the head and neck area (vascularized and free musculocutaneous flaps, jejunal free grafts with vascular microsurgical anastomosis, colonic pull-up).
• All types of thyroid surgery for benign and oncological diagnoses and parathyroid surgery
• Surgery for airway stenosis, including resection of the cervical part of the trachea with an end-to-end suture.
• Surgery of diverticula of the upper third of the esophagus by endoscopic or external approach, treatment of tracheoesophageal fistulas.
• Microsurgical endoscopic operations of the larynx in jet ventilation.
• Surgery for tumors of the nose, nasopharynx and paranasal sinuses, affecting the orbit, skull base and neurocranium.
• Surgery for inflammatory diseases of VDN, including eye and intracranial complications.
• Corrective surgery of the nasal septum and external nose.
• Functional endoscopic surgery of the nose and VDN using a navigation system.
• Argon-plasma coagulation of the nasal mucosa at the Rendu-Osler-Weber m.

Vestibular schwannoma

Vestibular schwannoma is a benign tumor arising from the cells surrounding the fibers of the balance-auditory nerve, which conducts information from the inner ear to the central nervous system.

In the Czech Republic, about 200-400 people fall ill with this type of tumor every year. Its most common manifestations include unilateral hearing impairment, tinnitus and balance impairment. Hearing loss tends to be gradual and inconspicuous at first, it may first manifest itself, for example, when talking on the phone.

Over time, difficulties with localization of sound and understanding speech in a noisier environment appear. Eventually, there may be complete hearing loss on the affected side.

Difficulties in the sense of dizziness or instability affect roughly half of the patients, but they tend to be of a mild nature. Really large tumors can also manifest themselves with other neurological symptoms, especially impaired sensitivity of the face, headaches, deterioration of vision, mobility, speech and, in the worst case, impaired consciousness.

Large schwannomas can threaten the patient by oppressing the cerebellum and brainstem, where the centers of basic vital functions and coordination of movements are located. Furthermore, cerebrospinal fluid circulation may deteriorate.

Due to modern diagnostic methods and the slow growth of the tumor, however, the vast majority of patients are detected in time and adequate therapeutic procedures occur before the development of these life-threatening conditions.

Diagnosis is based on clinical manifestations and hearing examination. If the presence of this tumor is suspected, an imaging examination (magnetic resonance) is added to confirm the finding and determine the stage of the disease.

Comprehensive treatment program for patients with vestibular schwannoma it has been taking place at the Department of Otorhinolaryngology and Head and Neck Surgery of the 1st Faculty of Medicine of the UK and FN in Motola for more than 25 years. We are the only workplace in the Czech Republic that offers comprehensive treatment from diagnostics to post-operative rehabilitation. The number of more than 700 operated patients ranks us in the first rank among surgical workplaces. We perform surgeries in cooperation with the Neurosurgery Clinic of the 2nd Faculty of Medicine of the UK and the Motol Medical Center. The close cooperation between an otolaryngologist and a neurosurgeon is completely unique in this field in the Czech Republic and brings our patients the benefits of both expertise.

Treatment options

Patients with vestibular schwannoma come to a specialized consultation room, where the nature of the disease and its treatment are explained to them. Together with the patient, the doctor then chooses the most suitable procedure. Nowadays, there are three basic therapeutic approaches: monitoring ("wait and scan"), microsurgical removal of the tumor and stereotactic radiotherapy. The size of the tumor and its growth activity, the condition of the hearing and balance system, the patient's age, his general health and the patient's preferences play a role in the decision. The choice of a treatment procedure is therefore a complex and individual process, and the optimal procedure cannot be determined in advance without a proper examination.

Wait and scan tracking – we choose in patients with a smaller tumor, without hearing impairment or in patients for whom surgery would be too risky. We perform control (repeated) magnetic resonance imaging and hearing tests. The first imaging examination will most often take place 6 months after the diagnosis. If no tumor growth occurs during this time period, the patient is monitored using magnetic resonance at regular annual intervals for a minimum of 3 years. If the tumor continues to grow, we can consider extending the follow-up interval.

Stereoradiotherapy – targeted application of a high dose of ionizing radiation (one-time) to the tumor area to stop its growth. One of the most commonly used systems is Leksell's gamma knife and CyberKnife. The advantage of this modality is the short duration of treatment without the need for general anesthesia. In the case of vestibular schwannomas, we choose this procedure for small and medium-sized growing tumors. Irradiation does not remove the tumor, its growth activity is stabilized.

Microsurgical resection – its goal is the radical removal of the tumor under microscopic control. It is primarily indicated for more advanced and growing tumors. For small tumors, we indicate surgery if we are trying to save deteriorating hearing or improve balance problems. It is a procedure under general anesthesia, during which doctors specializing in otorhinolaryngology and neurosurgery collaborate. During the procedure, the operators try to preserve the function of the adjacent structures as much as possible, especially the facial nerve and, in case of favorable hearing test results, also the auditory nerve.

Surgical treatment

Before the operation, the patient is examined and instructed. A detailed hearing and balance examination is necessary to perform the surgery correctly. According to the results of the examination, the most suitable surgical approach is selected after consultation with the patient. At the same time, the patient is informed about the method of postoperative balance rehabilitation.

For the operation itself, it is necessary to shave a narrow strip of hair behind the ear on the affected side. The procedure is performed under general anesthesia under the guidance of a specialized anesthesiologist who is a permanent part of our team. Vascular accesses are established and the patient is connected to vital signs monitoring systems. Electrodes are also placed for sensing the function of individual cranial nerves near which the surgical team moves. It is mainly the facial nerve and in some cases also the auditory nerve. Depending on the size of the tumors, we can also monitor other nerves and nerve pathways.

The operation itself is performed by a multidisciplinary team of otorhinolaryngologist and neurosurgeon. From an approx. 5-8 cm ace-shaped incision behind the ear, it is first necessary to create a path to the tumor through the skull bones. The tumor is then radically removed from the pontomerebellar angle and from the internal auditory canal under magnification using a digital microscope with a three-dimensional image, which enables a perfect view not only for the operator himself, but also for other members of the operating team. An ultrasonic aspirator is used to shrink the tumor, followed by a number of highly specialized micro-instruments for the preparation itself.

After the operation, the patient is awakened directly in the operating room, in the case of a long procedure with an interval of a maximum of several hours in the anesthesiology-resuscitation department. A rest regime is prescribed on the first postoperative day, and rehabilitation under the guidance of a physiotherapist begins on the second postoperative day.

Rehabilitation

Post-operative rehabilitation focuses mainly on balance and hearing. During radical surgery, the balance nerve from which the tumor grows must be cut. This results in varying degrees of imbalance in patients. With well-conducted rehabilitation, in most cases the balance disorder can be very well compensated for by strengthening other components of the balance system. However, timely rehabilitation under the guidance of an experienced rehabilitation worker is important. We usually use virtual reality in these situations, which helps patients manage previously common, but now problematic situations, such as riding on escalators or driving a car.

In the event that patients no longer hear in the affected ear, compensation can be accelerated even before surgery by applying an ototoxic antibiotic to the middle ear. This will gradually eliminate the balance apparatus on the affected side. With targeted exercises, the patient achieves compensation of the balance system before surgery, and the postoperative period is then less burdensome for him.

The most common symptom of vestibular schwannoma is hearing impairment. All treatments carry the risk of further hearing loss. There are a number of methods by which hearing loss can be compensated for in patients. The simplest method is a hearing aid that acts as a sound amplifier. If the ear is already deaf, different systems can be used to transfer sounds from the deaf side to the hearing side. Either two hearing aids communicating with each other (CROS) or a bone hearing aid that directly stimulates the inner ear of the healthy side (BAHD) can be used (Fig). If the auditory nerve is preserved during the operation, then a cochlear implant can also be used. It is the only method that can restore full hearing to the affected party in this case.

Contact

Department of Otorhinolaryngology and Head and Neck Surgery of the 1st Faculty of Medicine of the UK and the Faculty of Medicine in Motola
phone: 224 434 326
Email: zdenek.fik@fnmotol.cz

History

The Department of Ear, Nose and Throat Diseases at Charles University in Prague was established thanks to Prof. MUDr. Emilian Kaufman in 1892 as the first Czech otorhinolaryngological clinic.

From its inception until 1997, it was located in the General University Hospital in Prague near Charles Square. Throughout its existence, it has been and is the leading workplace in its field in the country, both in number and in the range of medical procedures performed. 

The head of the clinic was gradually replaced by personalities, widely recognized by the professional public not only at home but also abroad - Prof. MUDr. Otakar Kutvirt, academic Prof. MUDr. Antonín Přecechtěl, DrSc., Prof. MUDr. Karel Sedlacek, CSc., Prof. MUDr. Stanislav Tichý, DrSc. and Prof. Jan Betka, MD, DrSc., FCMA.

Prof. Betka has made a decisive contribution to significantly expanding the range of surgeries performed by expanding into areas previously banned by otolaryngologists in our countries, such as cranial base surgery and thyroid and parathyroid surgery. Under his leadership, the clinic moved from the General University Hospital in Prague to the University Hospital in Motol at the end of 1997, where it was further developed.

The current head is Prof. MUDr. Plzák, Ph.D.

endowment fund

The website of the foundation fund can be found at https://orl.lf1.cuni.cz/nadace-5971.

Gallery

Contact

Clinic homepage

Department of Otorhinolaryngology and Head Surgery 1st Faculty of Medicine, UK and Motol University Hospital
Motol University Hospital
V Úvalu 84
150 06 Prague 5

The head

Prof. MUDr. Jan Plzak, Ph.D.
phone: 224 434 301

Secretariat of the Head

Renata Kodetová, phone: 224 434 301, fax: 224 434 319
contact e-mail: renata.kodetova@fnmotol.cz

Deputy head for medical and preventive activities

MD Jan Kluh
phone: 224 434 303

Head nurse

M.Sc. Jitka Hovorková
phone: 224 434 305
contact e-mail: jitka.hovorkova@fnmotol.cz

File - ambulance

Please use these contacts:

1. to order in specialized clinics
2. to questions and information about the performed examinations – if descriptions of individual examinations are available for a personal consultation (with regard to the Personal Data Act, examination results cannot be communicated other than during a personal consultation)
3. to cancel the surgery appointment by the patient.

• card file, phone: 224 434 326, or mobile: 602 278 701 on weekdays from 13: 00 15 to: 00 (primarily we recommend using a landline number)
• Email: orl.dospeli@fnmotol.cz               

Preference should always be given to telephone contact during the above-mentioned hours, please choose the e-mail communication method only in the case of the impossibility of using telephone contact.

It is not possible to answer questions regarding your state of health, recommend or otherwise consult a treatment procedure, or arrange an alternative surgery date via e-mail.

In case:

• 1st ambulance, phone: 224 434 375, from 8:00 a.m. to 12:00 p.m.
• 2nd ambulance, phone: 224 434 323, from 8.00 a.m. to 12.00 p.m.
• 3nd ambulance, phone: 224 434 324, from 8.00 a.m. to 12.00 p.m.
• Audiology clinic - Communication channel reserved only for patients with severe hearing impairment, with whom it is not possible to establish telephone contact - audio@fnmotol.cz

Inpatient stations

• 1st inpatient station, phone: 224 434 332
• 2nd bed station, tel .: 224 434 333
• ICU, tel .: 224 434 331, 224 434 330