ADVANCED ENT CARE

• What is sinus ? How does our nose & sinus work?
• Is my Cold Common ........?
• I have frequent bout of sneezing & running nose ........?
• My Child has frequent Nosebleeds....?
• My husband snores loudly and disturbs me every night.......?
• My child has a stuffy nose and Noisy breating with open mouth ?
• What is Endoscopic Sinus Surgery (FESS) ?
• What is Baloon Sinuplasty? *New
• Sinus Quiz ? *New

 

 

What is sinus ? How does our nose & sinus work?

Sinuses are air filled cavities within our skull lined with gland which secrete mucus. The mucus travels out of the mouth of the sinuses through narrow passages into the nose. The mucus spreads within the nose over the nasal bones (Turbinates) and Nasal Septum.

The mucus being sticky catches most of the dirt, pollens filtering the air we breathe.  The Turbinate bones have large number of vessels which has blood at the body temperature flowing through it so that the air we breathe is warmed or cooled to the body temperature before it reaches our lungs. Sinuses also make the skull lighter and help in the resonance of voice. The Nasal Septum is partly made of cartilage and bone and serves to grossly divide the nasal airflow between the right and left sides.

 

Is my Cold Common ..........?

Common Cold is a viral infection and is generally afflicting adults and children during change of seasons. A purely viral cold is self limiting and would generally last 3 to 4 days and is often treated with simple decongestants and antipyretics.

However in patients with Allergies or Blockage in the Sinonasal system (DNS, Polyps) increased mucus secretions are not able to flow out and stagnation of secretion happens making them thick sticky and further bacterial infection occurs.

 

This apparently common cold will prolong into a Bacterial Rhino sinusitis with headache, moderate to high fever and will last for 7 to 14 days and will almost always need antibiotics.

Ideally these patients should undergo Diagnostic Nasal Endoscopy to assess the site and severity of blockage and also Allergy Testing if appropriate to seek out long term remedy.

 

 I have frequent bouts of Sneezing and Running Nose….?

Frequent bouts of sneezing with watery nasal discharge and associated itching in the nose, palate and throat can be a manifestation of Nasal Allergy. It may be associated with inflammatory nasal obstruction due to swelling of the turbinates and nasal mucosa. It is generally provoked by exposure to inhalant allergens such as dust, smoke, pollens, perfumes, cold air etc.

Sometimes recurrent nasal inflammation can lead to Nasal Polyp formation in the nose leading to persisting nasal blockage

Often the entire upper breathing passage may be susceptible to the effects of the inhalant allergens resulting in associated symptoms of Wheezing with Bronchospasm which over a period of time can lead to Bronchial Asthma. Often such patients may also be allergic to NSAIDS like Aspirin.



Nasal Allergy should be evaluated by Nasal Video Endoscopy to document the severity and extent of allergic changes including polyp formation. An Allergy Test by In Vitro testing should also be done to establish allergens.

Avoidance of allergens is of great help along with anti allergics. Systemic anti allergics are used to control allergic symptoms affecting the eyes palate etc. Nasal Allergy is best treated using Local Antiallergic and Steroidal Antiinflammatory sprays which can be used intermittently or continuously depending on the allergy pattern.

 

My Child has Frequent Nosebleeds…..?

Most nosebleeds or Epistaxis especially in children begin in the lower part of the nasal septum, the semi-rigid wall that separates the two nostrils of the nose. Group of blood vessels that converge onto the nasal septum can be ruptured by a blow to the nose or the edge of a sharp fingernail.

Infection and Cold with secretions on the nasal septum may increase the friability of the mucosa leading to mucosal ulcers and Epistaxis. Nosebleeds are common in summer heat after exertion or during winter when dryness may result in crusting, cracking, and bleeding.

Epistaxis in Adults or Elderly people can be due to Increased Blood Pressure, tumours, Drugs or Trauma and is generally more serious, severe and happens from the blood vessels on the back of the nose.

How to Prevent Nose Bleeds

• Do not pick the nose and keep Finger nails trimmed
• Do not ignore a cold.
• A light coating of petroleum jelly or an antibiotic ointment on the end of a fingertip and then rub it inside the nose, especially on the middle portion of the nose (the septum)

 

Emergency Home Measures to Stop a Nosebleed?

• Stay calm, reassure the child
• Make the child sit up and lean forward (otherwise the blood may drain in to the throat)
• Pinch the lower half of the nose between the thumb and the index finger and apply pressure.
• Apply ice-crushed in a plastic bag or handkerchief to nose and cheeks.
• Hold the position for five minutes. If it's still bleeding contact your ENT Doctor.

 

If frequent nosebleeds are a problem, a Nasal Video Endoscopy is required to locate the bleeding vessel and depending on the bleeding severity and size of blood vessel further treatment is planned. Most commonly bleeding vessel is shrunk with Cautery (Chemical or Thermelectric). Nasal Packing with medicated gauze may be required to control severe bleeding.

 

My Husband Snores very loudly and disturbs me every night….?

Loud and frequent snoring can be more than just a nuisance to your partner and may indicate a serious health condition. Snoring is more frequent in males and overweight.      

What Causes Snoring?

People who snore may suffer from:

• Poor muscle tone in the tongue and throat, either from alcohol or sleeping pills the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. This can also happen during deep sleep
• Nasal Blockage by polyps, Deviated Nasal Septum(DNS), Adenoid
• Oropharyngeal Blockage by Long Uvula or Bulky Palate, or Enlarged Tonsils or Bulky Tongue base can lead to snoring
• A chronically snoring child with Mouth breathing should be examined by ENT Doctor for problems with tonsils and adenoids WHICH CAN HYPERTROPHY AND BLOCK THE AIRWAY.

 

Is Snoring Serious?

Yes! It disturbs sleeping patterns and deprives the snorer and the bed partner of appropriate rest. When snoring is severe, it can cause Obstructive Sleep Apnea (OSA), in which the relaxed throat muscles block the airway briefly hundreds of times each night stopping the breathing and depriving your body of oxygen. In the short-term this causes tiredness and sleepiness during the day, irritability and restlessness, and puts you at risk of accidents when driving for example. In the long-term it can cause high blood pressure, heart attacks and strokes.

What is the Treatment of Snoring?

A Snoring Assesment by ENT will find out the Site (Nose or Throat) and the Severity (Simple vs Obstructive) of blockage. Some patients may also need a Sleep Study (PSG).

Simple Snoring may only need simple lifestyle changes, such as losing weight or sleeping on your side and avoiding alcohol or sedatives, can help decrease snoring,

For Obstructive Snoring, Minimally Invasive surgery which can be done on a outpatient clinic setting like UVPPP/ TAP using special RF probes is available that reduces disruptive snoring by removing the obstruction in the breathing passage. People with obstructive sleep apnea may require further help by a nasal mask that delivers air pressure into the throat (CPAP) or Oral Appliance (OA) etc after Surgery to decrease the Obstruction.


Remember, snoring means obstructed breathing, and obstruction can be serious. It's not funny, and not hopeless.

 

My child has a Stuffy nose and Noisy breathing with Open Mouth?

Some children with frequent cold and cough and noisy Mouth breathing at night may be having Adenoidal Enlargement which causes nasal blockage. Enlarged Adenoids will block the nose which will lead to mucus flowing through the nose as it cannot pass into the throat.  Due to blockage of the breathing passage the mouth opens up leading to noisy breathing.



Enlarged Adenoids may further block the Ventilation tube of the Ear (Eustachian tube) and lead to either Recurrent Ear Infections (Otitis Media) or Glue Ear with Hearing impairment.

Enlarged Adenoids and Their Symptoms


If you or your child's adenoids are enlarged, it may be hard to breathe through the nose.

Other signs of constant enlargement are:

• Breathing through the mouth instead of the nose most of the time
• Nose sounds "blocked" when the person speaks
• Noisy breathing during the day
• Recurrent ear infections
• Snoring at night

Breathing stops for a few seconds at night during snoring or loud breathing (sleep apnea). Some orthodontists believe chronic mouth breathing from large adenoids causes malformations of the face and improper alignment of the teeth 

 

An X ray of the Nasopharynx along with some Hearing Tests are required for diagnosis. In older children Video Nasopharyngoscopy may be done to visualize the Adenoids.

Treatment is initially by antibiotics, decongestants and steam inhalation. Children who do not respond to these measures and continue to get recurrent ear infections and have severe obstruction to breathing (Sleep Apnea) will need removal of the Adenoid gland (Adenoidectomy). If there is also accompanying mucus filling the ear and hearing loss, drainage by a Myringotomy and placement of the Ventilation tube (Grommet) may be required. Often Tonsils are also hypertrophied and chronically infected and may need removal along with Adenoids.    

 

Medical Research has proven that there is no decrease in immunity afer removal of tonsils and or adenoids.

 

What is Endoscopic Sinus Surgery (FESS)?

Functional Endoscopic sinus surgery (ESS) is a Minimal Access Surgery for the sinuses. It allows access to the sinuses without an external incision and the Endoscope allows precise visualization and magnification.

It targets the ostiomeatal complex (OMC), an area where the drainage from the sinuses converge. Obstruction in the OMC can lead to subsequent infection of the maxillary, frontal, and sphenoid sinuses.  

Functional Endoscopic sinus surgery (ESS) aims to unblock the OMC and open the blocked sinuses. It is a function preserving surgery as only diseased areas are removed leaving behind healthy mucosa, thereby shortening the recovery time. 

Endoscopic surgery can also be utilized for removal of polyps and to straighten the septum thus restoring a normal flow from the sinuses. Unlike other sinus surgical procedures, endoscopic sinus surgery has minimal and usually temporary effect on the patient's appearance.

              

What to expect from endoscopic surgery?

The endoscopic procedure usually lasts from one to three hours and is performed using general or local anesthesia. Generally, the patient goes home next day after surgery after Nasal Pack removal.

Full recovery happens over few weeks. Dry blood, mucus, and crusting in the nose may occur, presenting symptoms of a severe cold or sinus infection. Nasal irrigation or salt-water sprays are recommended to facilitate normal sinus activity. Proper post-operative care is essential to prevent scar formation and allow normal healing. The surgeon performing the procedure will generally perform all required follow-up procedures.

After FESS	Nasal polyps blocking sinus

 

 

What is Baloon Sinuplasty ? *New

Balloon Sinuplasty   technology is a FDA-cleared, endoscopic, catheter-based system for patients suffering from sinusitis. The technology uses a small, flexible, Sinus Balloon Catheter to open up blocked sinus passageways, restoring normal sinus drainage and function. When the sinus balloon is inflated, it gently restructures and widens the walls of the passageway while maintaining the integrity of the sinus lining.

It is similar in principle to an Angioplasty in which balloons are used to open up clogged blood vessels.

Steps in using the Balloon Sinuplasty technology

Gain Access to the Sinus.To gain initial sinus access, our sinus guide catheter is introduced into the nasal cavity to target the sinus ostia under endoscopic visualization. Our sinus guidewire or our sinus illumination system is introduced through the sinus guide catheter and gently advanced into the target sinus.	Inflate Balloon Across Ostium. The sinus balloon catheter is introduced over the sinus guidewire or sinus illumination system and positioned across the blocked ostium. The position of the sinus balloon catheter is confirmed and the balloon is gradually inflated to open and remodel the narrowed or blocked ostium	Deflate and Remove Balloon. The sinus balloon catheter is then deflated and removed, leaving the ostium open allowing the return of sinus drainage. There is little to no disruption to mucosal lining.

The technology is used by qualified ENT Surgeons.

The Benefits in Using the Balloon Sinuplasty  technology

• Safe and Effective
• Minimally Invasive
• Reduced Bleeding
• No need for Uncomfortable Nasal Packing
• Shortened Recovery Time upto 24 hours
• Does Not Limit Treatment Options

* Literature and Illustrations from www.acclarent .com

Sinus Quiz *New

Do you suffer from Sinus?

Take the following quiz to see.

Choose "yes" if you have any of the following symptoms for 10 days or longer; otherwise, choose "no."
 

1. Do you have facial pressure, fullness, congestion or pain?
  yes      no

2. Do you have nasal congestion, blockage or a stuffy nose?
  yes      no

3. Do you have thick, yellow-green nasal discharge?
  yes      no

4. Do you have thick post-nasal drainage?
  yes      no

5. Do you have a reduction in your sense of smell?
  yes      no

6. Do you have headaches?
  yes      no

7. Do you have bad breath or cough?
  yes      no

If you have answered YES to more than 2 questions you are suffering from Sinusitis. Consult an ENT Doctor.

* Adapted from the Sinusitis Quiz of the AA0-HNS