INTRODUCTION While septoplasty is a commonly performed operation in adults, its use in children is less frequent and controversial. Paediatric Septoplasty is performed by a paediatric ENT specialist with unique training and expertise in managing nasal issues in children and teens. The procedure was first described in 1902 by Freer [1], but initial results were unfavourable, leading to deformities such as saddle nose and maxillary retrusion. In the 1950s, surgeons cautioned against performing septoplasty in children, fearing that resection of the quadrilateral cartilage would impair nasal growth [2]. Farrior and Connolly reinforced this belief in the 1970s, arguing that nasal surgery should be delayed until complete nasal development [3]. However, later studies and clinical observations began to support the safety and necessity of paediatric septoplasty in appropriately selected cases [4]. DEBUNKING THE MYTH: DOES PAEDIATRIC SEPTOPLASTY/ SEPTORHINOPLASTY AFFECT GROWTH? Early concerns about paediatric Septoplasty and Septorhinoplasty were based on flawed animal studies where aggressive septal cartilage removal without mucoperichondrium preservation led to growth inhibition [5]. Research by Hartshorn and others indicated that septal cartilage removal with mucoperichondrial preservation did not impede facial growth, affirming that modern conservative techniques can preserve nasal and maxillary development [6]. Jugo and Triglia et al. conducted human studies in the 1990s, demonstrating that paediatric external septoplasty, when performed appropriately, does not cause adverse anthropometric effects [7]. Additional anthropometric studies confirmed that septoplasty does not significantly alter facial skeletal growth, and Tasca et al. in 2011 validated these findings with long-term follow-up on endonasal paediatric septoplasty cases [8]. UNDERSTANDING NASAL GROWTH CENTRES Figure : Original figure by Grant S. Hamilton, III. The neonatal nasal septum showing ventrocentral area of thin cartilage, sphenospinal zone, and sphenodorsal zone. The nasal septum plays a pivotal role in facial development, particularly in the sphenodorsal and sphenospinal zones [9]. Research highlights that preserving the mucoperichondrium is crucial for maintaining nasal growth [10]. Failure to intervene when necessary can result in progressive nasal obstruction, worsened facial asymmetry, and compromised maxillary growth [11]. INDICATIONS FOR SEPTORHINOPLASTY IN CHILDREN Paediatric septorhinoplasty is indicated for multiple conditions, including: Septal abscess with cartilage necrosis – This is an emergency and requires immediate septal reconstruction. Severe Nasal Obstruction – Chronic breathing issues can impair sleep, learning, and exercise tolerance [12]. Obstructive sleep apnoea. Post-Traumatic Deformities – Early correction can prevent long-term functional and aesthetic complications [13]. Congenital Malformations – Conditions such as dermoid cysts and cleft lip and palate necessitate surgical intervention [14]. Progressive Nasal Distortion – Delay in correction can lead to worsened asymmetry [15]. Saddle Nose Deformity – Delayed treatment can lead to nasal contracture, complicating future interventions [16]. THE RISKS OF DELAYING SEPTORHINOPLASTY IN CHILDREN Delaying necessary surgery in children with nasal deformities can have long-term consequences, including: Nasal Contracture and Structural Collapse – Progressive contracture of soft tissues can lead to severe deformities [17]. Deficient Skin Envelope – Delayed intervention may necessitate complex reconstructive procedures [18]. Psychosocial Impact – Nasal deformities can contribute to social stigma and self-esteem issues [19]. COMPARING SURGICAL AND NON-SURGICAL MANAGEMENT OPTIONS While mild cases may be managed with nasal stents, CPAP, or steroid sprays, these options provide only temporary relief [20]. In severe cases, septoplasty is required to restore function and prevent long-term complications [21]. THE CHANGING ANATOMY OF THE NASAL SKELETON The paediatric nasal skeleton undergoes significant changes during development [22]. The cartilaginous septum reaches its maximum size by age two, with subsequent growth occurring primarily through ossification [23]. Two critical nasal growth periods have been identified: infancy and puberty. Historically, elective septoplasty was delayed until adolescence, but contemporary evidence suggests that early intervention can be beneficial in select cases [24]. THE IMPORTANCE OF SURGICAL TECHNIQUE Surgical success in paediatric septoplasty depends on: Preservation of the Mucoperichondrium – Essential for cartilage regeneration [25]. Conservative Cartilage Resection – Techniques such as cartilage overlap maintain nasal structure [26]. Appropriate Timing – Surgery is recommended from age six onward in functionally impaired children [27]. Minimally Invasive Techniques – Endoscopic approaches reduce trauma and improve recovery [28]. ETHICAL AND PARENTAL CONSIDERATIONS Paediatric septorhinoplasty involves ethical considerations regarding informed consent and long-term follow-up [29]. Parents should be thoroughly counselled about the benefits and potential risks of surgery. CONCLUSION Contemporary research overwhelmingly supports the safety and efficacy of paediatric septoplasty and septorhinoplasty. Studies show that delaying necessary surgery can lead to worsened outcomes, including nasal obstruction, asymmetry, and psychosocial distress. With proper technique and timing, these procedures can restore nasal function, improve aesthetics, and enhance overall quality of life. Breathe Better, Live Better: Expert Paediatric Septoplasty & Septorhinoplasty in Singapore with Dr Sandeep Uppal Is your child struggling with persistent nasal blockage, difficulty breathing, or recurrent sinus infections? A deviated nasal septum or structural nasal issues could be the cause. Dr. Sandeep Uppal, an internationally recognised specialist in Facial Plastic Surgery, Rhinology, and ENT – Head & Neck Surgery, offers expert paediatric Septoplasty and Septorhinoplasty to restore both function and aesthetics. With his extensive experience in rhinoplasty and nasal airway surgery, Dr. Sandeep provides personalized, child-friendly care to ensure the best possible outcomes for your little one. Why Choose Dr. Sandeep Uppal? ✅ Dual Expertise in ENT & Facial Plastic Surgery – Ensuring both functional improvement and natural aesthetics ✅ Specialized Approach for Paediatric Cases – Gentle techniques tailored for growing facial structures ✅ Comprehensive Care – Addressing nasal breathing issues, sinus health, and facial harmony ✅ Trusted Internationally – Board-certified and a leader in the field of facial plastic surgery Give your child the gift of easy breathing and confidence. Schedule a consultation with Dr. Sandeep Uppal today! REFERENCES Freer O. The Correction Of Deflections Of The Nasal Septum With A Minimum Of Traumatism. JAMA. 1902;XXXVIII(10):636. Grymer L, Bosch C. The nasal septum and the development of the midface. Rhinology. 1997;35(1):6-10. Gilbert J, Segal S. Growth of the Nose and the Septorhinoplasty Problem in Youth. Plast Reconstr Surg. 1959;23(3):293. Farrior RT, Connolly ME. Septorhinoplasty in Children. Otolaryngol Clin North Am 1970;3:345-64. Sarnat B, Wexler M. The Snout After Resection of Nasal

Blocked ears, discomfort, and difficulty hearing are symptoms many of us have experienced, often brushing them off as minor inconveniences. However, persistent issues could indicate Eustachian Tube Dysfunction (ETD), a condition that, if untreated, can lead to chronic ear pain, hearing loss, and even recurrent infections. With advances in ENT care, treatments like Eustachian Tube Balloon Dilation offer promising relief. This comprehensive blog delves into ETD, its causes, and its modern management options. What is the Eustachian Tube ? The Eustachian tube is a narrow passageway connecting the middle ear (part of the ear behind the ear drum) to the nasopharynx (the area behind the nose). It plays a vital role in: Equalizing ear pressure with the external environment. Draining fluid from the middle ear. Protecting the ear from pressure changes and infections. At rest, the tube remains closed and opens during activities like swallowing, yawning, or sneezing. When the tube becomes blocked or does not function correctly, it results in Eustachian Tube Dysfunction. Symptoms of Eustachian Tube Dysfunction People with ETD may experience: Ear blockage or fullness. Pain or discomfort in the ear. Hearing difficulties or muffled sounds. Tinnitus (ringing in the ears). Dizziness or balance problems. These symptoms can significantly impact daily life, particularly during activities involving pressure changes, such as flying or SCUBA diving. Causes of Eustachian Tube Dysfunction ETD is often linked to conditions causing swelling or blockage in the nasal passages or nasopharynx, including: Allergies and nasal inflammation. Upper respiratory infections like colds or sinusitis. Environmental pollutants such as smoke or dust. Rapid pressure changes, such as during air travel or diving. Temporomandibular Joint (TMJ) disorders that may affect ear function. Chronic ETD can increase the risk of ear infections and even lead to long-term hearing loss. Treatment Options for Eustachian Tube Dysfunction The treatment for ETD depends on the severity of symptoms and the underlying cause. 1. Watchful Waiting For mild cases, ETD symptoms may resolve independently without medical intervention. A “watchful waiting” approach combined with techniques like the Valsalva manoeuvre (blowing gently with the nose pinched shut) can help. 2. Medical Management Nasal Steroid Sprays: These reduce nasal inflammation, particularly in cases associated with allergies or sinusitis (e.g., Avamys, Nasonex). Nasal Decongestants: Short-term use of decongestants like Oxy-nase, Afrin or Iliadin can improve Eustachian tube function. Antihistamines with Decongestants: Medications like Telfast-D or Zyrtec-D are effective for allergy-related ETD. 3. Eustachian Tube Balloon Dilation (BET) For persistent or severe cases, Eustachian Tube Balloon Dilation is an advanced treatment option offering long-term relief. What is Eustachian Tube Balloon Dilation? This minimally invasive procedure uses a small balloon to dilate the Eustachian tube, improving ventilation and relieving symptoms.  The Procedure Balloon Catheter Insertion: A thin catheter with a deflated balloon is inserted into the Eustachian tube through the nasal passage. 2. Balloon Inflation: The balloon is gently inflated to widen the tube, improving its function. 3. Balloon Deflation and Removal: After a few seconds, the balloon is deflated and removed. The entire procedure is quick (15-30 minutes) and can be performed under general or local anaesthesia. Patients typically return home the same day. Benefits of Balloon Dilation Long-term symptom relief. Minimal downtime (1–2 days off work/school). Reduced risk of complications compared to other surgical options. Potential Risks of Balloon Dilation While rare, potential complications include: Minimal bleeding during or after the procedure. Infection in the nasal or middle ear, which may require antibiotics. Injury to surrounding structures, including the nasal passage or Eustachian tube. In some cases, symptoms may persist, requiring additional treatments. Why Treating ETD is Crucial If left untreated, ETD can lead to: Chronic ear discomfort. Temporary or permanent hearing loss. Increased risk of recurrent middle ear infections. By addressing the condition promptly, patients can avoid these complications and improve their quality of life. Post-Procedure Care and Recovery Following Balloon Dilation, patients can expect: Mild nasal or ear discomfort, which typically resolves within days. Avoidance of forceful nose-blowing for a few days. Use of over-the-counter pain relievers like paracetamol for any discomfort. Regular follow-up appointments are essential to monitor progress and ensure long-term relief. Informed Decisions with Expert Guidance The decision to undergo Eustachian Tube Balloon Dilation should be made after a detailed consultation with an experienced ENT specialist, such as Dr Sandeep Uppal, who will: Evaluate your symptoms and medical history. Perform a thorough examination, including nasal endoscopy and hearing tests. Discuss the benefits, risks, and alternatives to the procedure. Take the First Step Towards Healthier Ears Today! Do not let Eustachian Tube Dysfunction disrupt your life any longer. Whether you are dealing with persistent ear discomfort, hearing issues, or pressure changes that just will not go away, relief is within reach. Schedule a consultation with Dr Sandeep Uppal, an expert in ENT and Eustachian Tube Balloon Dilation, to explore personalized solutions tailored to your needs.

Allergies can disrupt your daily life, causing discomfort and frustration. However, with the right medications, managing symptoms and improving your quality of life is possible. Here’s what you need to know about allergy medications, their effectiveness, and potential side effects. Types of Allergy Medications Allergy medications come in various forms, each tailored to address specific symptoms. Understanding your options can help you make informed decisions. Antihistamines: The First Line of Defense Antihistamines are the most commonly used medications for allergy relief. They work by blocking histamines, chemicals that trigger symptoms like sneezing, itching, and watery eyes. Dr. Sandeep, an ENT specialist, explains, “Antihistamines are the frontline treatment for most allergy sufferers. They offer quick relief for common symptoms.” There are two main categories of antihistamines: First-Generation Antihistamines  Examples: Diphenhydramine (Benadryl) These are effective but often cause drowsiness, making them less suitable for daytime use. Second-Generation Antihistamines Examples: Loratadine (Claritin), Cetirizine (Zyrtec) These options, marketed as “nonsedating”  are less sedating and ideal for long-term management of chronic allergies. An added benefit is that second-generation antihistamines last longer than Benadryl. Nasal Corticosteroids: Targeted Relief For those struggling with nasal congestion, sneezing, or a runny nose, nasal corticosteroids can be transformative. Medications like Fluticasone (Avamys) and Mometasone (Nasonex) reduce inflammation in the nasal passages. Dr. Sandeep notes, “Nasal corticosteroids can be a game-changer for patients with significant nasal congestion. They tackle inflammation directly at its source.”   Leukotriene Receptor Antagonists: For Persistent Symptoms For severe or persistent symptoms, particularly when antihistamines and nasal sprays are insufficient, leukotriene receptor antagonists like montelukast (Singulair) can be beneficial. “Combining treatments may be necessary for patients with both allergies and sinusitis to achieve optimal control,” adds Dr. Sandeep   Effectiveness of Allergy Medications Antihistamines are excellent for alleviating sneezing, itching, and runny noses. Nasal corticosteroids are more effective for congestion and overall nasal inflammation. Combination therapies may provide comprehensive relief for patients with multiple or severe symptoms. Potential Side Effects While allergy medications are generally safe, they can have side effects. Knowing what to expect can help you manage them effectively. First-Generation Antihistamines: Drowsiness, dry mouth, dizziness Second-Generation Antihistamines: Headaches, mild sedation (rare) Nasal Corticosteroids: Nasal irritation or bleeding, especially with overuse Dr. Sandeep advises, “It’s important to monitor how your body reacts to any medication and consult a healthcare provider if you experience concerning side effects.”   Finding the Right Solution Selecting the appropriate allergy medication depends on your specific symptoms, lifestyle, and any underlying conditions like sinusitis. A consultation with a healthcare professional can ensure you receive personalized care and guidance. By understanding the various allergy medications available, their effectiveness, and potential side effects, you can take proactive steps toward symptom relief and a better quality of life. Don’t let allergies hold you back—effective treatment is within reach! These symptoms persist as long as you’re exposed to the allergen, making it important to identify and avoid triggers whenever possible. Answering Key Questions About Allergy Medications   How do allergy medications interact with other medications? Allergy medications, particularly antihistamines, nasal corticosteroids, and leukotriene receptor antagonists, can interact with other medications. For example: First-generation antihistamines may enhance the sedative effects of other medications, such as sedatives, painkillers, or alcohol. Second-generation antihistamines generally have fewer interactions but may still affect medications metabolized by the liver. Nasal corticosteroids rarely interact with other drugs due to their localized action but should be monitored in patients on high-dose steroids, growth issues in children or antifungal medications. Dr. Sandeep emphasizes the importance of discussing your current medications with your healthcare provider to avoid potential complications. What factors should individuals consider when choosing an allergy medication? Selecting the right allergy medication depends on: Symptoms: For sneezing and itching, antihistamines are suitable. For nasal congestion, corticosteroids may work better. Duration of use: Second-generation antihistamines are ideal for long-term management, while first-generation options are better for short-term relief. Lifestyle: Non-drowsy second-generation antihistamines are better for those needing to stay alert, e.g. pilots. Age and overall health: Special considerations may be needed for children and the elderly, as detailed below. Can you explain the importance of proper dosing and administration of nasal corticosteroids? Proper use of nasal corticosteroids is essential to maximize their benefits and avoid side effects. Key points include: Correct technique: To properly use a nasal spray and prevent irritation or bleeding, follow these steps: Hold the spray bottle in your right hand when using it for your left nostril, and in your left hand when using it for your right nostril. Tilt your head slightly forward to position the nasal passages optimally. Gently insert the nozzle into the nostril, aiming slightly away from the nasal septum. Begin inhaling through your nose and, while breathing in, press the spray to release the medication. Complete the process by breathing out through your mouth to avoid medication dripping out of the nose. This technique ensures proper delivery and minimizes the risk of discomfort or side effects. Consistent use: Regular application is more effective than occasional use. It takes nearly two weeks for full effect of medication. Avoid overuse: Excessive doses can lead to side effects like nasal irritation or dryness. Dr. Sandeep advises following dosing guidelines and consulting a professional if symptoms persist. What role do immunotherapy options play in long-term allergy management? Immunotherapy, including allergy shots or sublingual tablets, offers a long-term solution for allergy sufferers. It works by desensitizing the immune system to allergens over time. This approach is especially effective for individuals whose symptoms are not well-controlled with medication or who wish to reduce dependence on daily medications. Are there any specific allergy medications you recommend for children or elderly patients? For children, second-generation antihistamines like loratadine or cetirizine are preferred due to their safety and non-drowsy effects. Nasal corticosteroids, such as fluticasone (Avamys), can be used under medical supervision. For elderly patients, non-sedating antihistamines are recommended to avoid dizziness or falls. Dr. Sandeep notes that elderly patients should also use nasal sprays cautiously to prevent nasal dryness. What are the latest

Do you often struggle with nasal congestion, sneezing, or sinus pressure and wonder what’s causing it? Many people confuse allergies with sinusitis because the symptoms can overlap, but understanding the difference is key to getting the right treatment and relief. What are Allergies   Allergies occur when your immune system overreacts to harmless substances like pollen, dust mites, or pet fur. This reaction triggers the release of histamines, leading to symptoms such as: Sneezing Runny or stuffy nose Itchy or watery eyes Post-nasal drip These symptoms persist as long as you’re exposed to the allergen, making it important to identify and avoid triggers whenever possible. What Is Sinusitis? Sinusitis is an inflammation of the sinus cavities, often caused by: Infections (viral, bacterial, or fungal) Allergies Structural issues in the nasal passages When your sinuses are inflamed, they can become blocked, leading to: Facial pain or pressure Thick nasal discharge (yellow or green) Fatigue and low energy Headaches or ear discomfort Sinusitis can be acute (lasting less than four weeks) or chronic (lasting months and significantly affecting your daily life). Key Differences Between Allergies and Sinusitis Dr. Sandeep Uppal, ENT Specialist and Rhinologist at The ENT Clinic, explains: “While allergies can cause long-term discomfort as long as allergens are present, sinusitis often arises after an infection or a cold. Recognizing the difference is vital for proper treatment.” If your symptoms include itchy eyes, sneezing, or worsened discomfort during allergy seasons, allergies might be the culprit. However, if you experience facial pain, thick nasal discharge, or ongoing congestion following a cold, sinusitis is more likely. How Are Allergies Treated? Treating allergies involves reducing your body’s reaction to allergens. Common treatments include: Nasal saline rinse Oral antihistamines Nasal sprays (antihistamine or very mild steroid-based) Lifestyle changes to avoid triggers Dr. Sandeep adds, “For those with severe or persistent allergies, immunotherapy (allergy shots) can help build long-term tolerance and provide lasting relief.” How Is Sinusitis Treated? Sinusitis treatment depends on its cause. Options may include: Saline nasal rinses to clear blockages Decongestants to reduce swelling Antibiotics (if a bacterial infection is present) For chronic sinusitis or cases associated with nasal polyps, advanced treatments like sinus surgery may be necessary if medical management isn’t effective. When to Seek Professional Help If you’re unsure whether your symptoms are caused by allergies or sinusitis, consulting a specialist is the first step to relief. Persistent symptoms or severe discomfort should never be ignored. Dr. Sandeep advises, “Getting the right diagnosis early prevents complications and ensures effective treatment tailored to your needs.” By identifying whether your symptoms stem from allergies or sinusitis, you can regain control over your health and enjoy a more comfortable, symptom-free life. Don’t let nasal issues disrupt your daily routine—take action today and breathe easier! If you’re ready to find lasting relief, contact The ENT Clinic to book a consultation. Together, we’ll develop a treatment plan to help you feel your best. What are the most common misconceptions about allergies and sinusitis? Misconception: Allergies and sinusitis are the same condition. Fact: Allergies involve an immune system response to allergens, while sinusitis is inflammation or infection of the sinus cavities. Misconception: Sinusitis always requires antibiotics. Fact: Many sinusitis cases, especially viral ones, resolve without antibiotics. Overuse can lead to antibiotic resistance. Misconception: Sinusitis is only caused by infections. Fact: Structural issues like a deviated septum, enlarged or mis-shaped turbinates, nasal polyps, or chronic allergies can also cause sinusitis. What lifestyle changes or preventive measures do you recommend for those prone to allergies or sinusitis? For Allergies: Use HEPA-filter air purifiers to reduce allergens indoors. Shower after being outdoors to remove pollen from hair and skin. Regularly clean upholstery, curtains, and bed linen in hot water or steam them to reduce dust mites. Avoid known triggers like pet dander, mould, and pollen. For Sinusitis: Use saline nasal rinses to maintain clear sinuses. Stay hydrated to keep mucous membranes moist. Avoid smoking or exposure to second-hand smoke. Address nasal blockages, such as deviated septum or polyps, through medical or surgical intervention. How does climate or seasonal changes affect allergies and sinusitis? Allergies: Seasonal pollen surges can trigger symptoms—tree pollen in spring, grass in summer, and ragweed in autumn. Humidity can increase mould spores, exacerbating allergies. Sinusitis: Cold, dry air in winter can dry out nasal passages, making them more susceptible to infections. Conversely, high humidity can encourage bacterial or fungal growth in the sinuses. What role do stress and overall health play in the severity of allergies and sinusitis? Stress: Weakens the immune system, increasing vulnerability to infections and allergic responses. Overall Health: A balanced diet, regular exercise, and sufficient sleep can bolster immunity and reduce the impact of symptoms for both conditions. Are there specific populations more susceptible to either allergies or sinusitis? Allergies: Those with a family history of asthma, eczema, or allergic rhinitis, as well as children and young adults, are more prone to allergies. Sinusitis: Individuals with structural nasal issues (e.g., deviated septum, nasal polyps), chronic respiratory conditions, or a weakened immune system are at higher risk. Can you discuss the relationship between allergies and sinusitis? How can one condition lead to the other? Allergies can cause swelling and inflammation of the nasal passages, obstructing sinus drainage and leading to collection of  mucous in the sinuses. This blockage creates a moist environment conducive to bacterial or fungal growth, leading to sinusitis. Effective allergy management reduces the risk of sinusitis development. What advances in treatment options should patients be aware of? Biologic Therapies: Target specific immune pathways, such as dupilumab for chronic sinusitis with nasal polyps. Minimally Invasive Surgery: Functional Endoscopic Sinus Surgery (FESS) or balloon sinuplasty can effectively manage chronic sinusitis. Immunotherapy: Allergy shots or sublingual tablets desensitize the body to allergens, providing long-term relief. Posterior Nasal Nerve Ablation: Reduces sneezing and nasal discharge in severe allergic rhinitis. Are there any common triggers that patients often overlook? For Allergies: Dust mites in bedding and carpets, mould in damp areas, and pet dander are