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      Nasal Foreign Body Management

      Nasal, Nose

      NASAL FOREIGN BODY MANAGEMENT TYPES OF NASAL FOREIGN BODIES ORGANIC MATERIAL Includes food particles, seeds, and plant matter. These are particularly concerning because they can swell and cause infection. INORGANIC MATERIAL Beads, small toys, paper, and plastic pieces often fall into this category. METALLIC OBJECTS Items like small screws, coins, and batteries. The latter are especially dangerous due to the risk of leakage and tissue damage. SYMPTOMS Patients, especially children, who have inserted a foreign object into their nose may exhibit: NASAL DISCHARGE Often one-sided and sometimes foul-smelling, especially if the foreign body has been present in the nose for a while. NASAL OBSTRUCTION Difficulty in breathing through the affected nostril. PAIN AND DISCOMFORT This varies depending on the size and nature of the object. BLEEDING Possible if the object has caused any internal abrasions. DIAGNOSIS PATIENT HISTORY Upon arrival at the clinic, patients are promptly evaluated. In cases where the patient is unable or too young to explain, history from caregivers is invaluable. A history of sudden onset persistent cough, wheezing or shortness of breath in a young person may indicate aspiration of the foreign body and needs to be assessed immediately. CLINICAL EXAMINATION A thorough examination of the nose is carried out, usually employing an otoscope or nasal endoscope for precise visual assessment. IMAGING X-rays or CT scans may be advised for deeper or non-visible objects. TREATMENT IMMEDIATE REMOVAL For easily accessible objects, Dr Sandeep may use forceps or hooks for immediate extraction if the foreign material is present in the anterior nasal cavity and is easily accessible. Suction Devices: Useful for smaller objects that are difficult to grasp. Local Anaesthesia or Sedation: Administered to ensure patient comfort, especially in children or anxious patients. SURGICAL REMOVAL Reserved for complex cases where the object is deeply embedded or for batteries that pose immediate risk. Long standing foreign bodies form into a rhinolith that is more challenging to remove and this is usually done in an operating room under general anaesthesia. ANTIBIOTIC TREATMENT Sometimes necessary post-removal to prevent infection. FOLLOW-UP APPOINTMENT To ensure that the nasal cavity is healing properly. SYMPTOM MONITORING Parents are advised on what symptoms to watch for, such as signs of infection or discomfort. PREVENTIVE EDUCATION Dr Sandeep and his team often take this opportunity to educate caregivers and children on the dangers of inserting foreign objects into the nose. UNBLOCK THE BARRIERS: EXPERT CARE FOR NASAL FOREIGN BODY Struggling with the discomfort of a nasal foreign body? At The ENT Clinic, Dr Sandeep Uppal and his specialized team prioritize a complete care approach tailored to the unique challenges of nasal foreign bodies. We are fully equipped to address the urgency and discomfort associated with such conditions, providing prompt and adept care. Initiate your return to comfort. Secure your appointment with us and together, we’ll navigate towards restoring your nasal well-being!

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      Management of Sinusitis

      Nose, Sinusitis

      MANAGEMENT OF SINUSITIS WHAT CAUSES SINUSITIS? Understanding the root causes of sinusitis is essential for effective management and treatment. Here’s a comprehensive look at what can cause this condition. INFECTIONS FROM VIRUSES, BACTERIA, OR FUNGI The most common cause of sinusitis is infection. Viral infections, often following a common cold, can lead to sinusitis. Bacterial and fungal infections are less common but can be more severe, requiring targeted treatment like antibiotics or antifungal medications. NASAL POLYPS OR TUMOURS One frequent cause of nasal blockage and discomfort is the growth of nasal polyps or tumours. Nasal polyps are noncancerous, swollen tissue formations in the nasal passages or sinuses, often resulting from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity, or certain immune disorders. On the other hand, nasal tumours can be noncancerous (benign) or cancerous (malignant) growths in the nasal cavity or sinuses. Both conditions can lead to symptoms such as nasal congestion, reduced sense of smell, and breathing difficulties. While nasal polyps are often treated with steroids, allergy medications, or surgery, nasal tumours require more specific treatments such as surgery, radiation therapy, or chemotherapy, depending on their nature and severity. DEVIATED NASAL SEPTUM A deviated septum can obstruct the nasal passages and impede the flow of mucus, leading to inflammation and infection. Surgical correction may be considered in severe cases. ALLERGIC REACTIONS Allergic rhinitis, often triggered by pollen, dust, or pet dander, can cause inflammation of the nasal passages and contribute to sinusitis. Anti-allergy medications and avoiding triggers are common treatment approaches. Read more regarding allergic rhinitis and its management>> TOOTH INFECTIONS Infections in the upper teeth can spread to the adjacent sinuses and trigger sinusitis. Dental treatment, often including antibiotics, is usually necessary to treat the underlying cause. NASAL FOREIGN BODIES Foreign objects lodged in the nasal passages, especially common among young children, can block mucus drainage and lead to sinusitis. Removal of the foreign body is essential for treatment. RISK FACTORS While the above are direct causes, certain risk factors can make one more susceptible to sinusitis: Smoking or exposure to second-hand smoke. Frequent upper respiratory infections. Immune system deficiencies. Learn more about nasal sinuses and sinusitis>> Read more about blocked nose here>> HOW IS SINUSITIS DIAGNOSED? Diagnosing sinusitis involves a multi-step approach that may include a combination of history-taking, physical examination, and diagnostic tests. Dr Sandeep Uppal and his team, backed by advanced training in rhinology, are adept at carrying out these procedures to accurately diagnose sinusitis. Here are the typical steps involved: HISTORY AND EXAMINATION The first step always involves taking a thorough medical history, focusing on the duration, frequency, and severity of symptoms. This is followed by a physical examination, where Dr Sandeep may check for facial tenderness, nasal congestion, and discharge. NASAL ENDOSCOPY A nasal endoscopy allows Dr Sandeep to look directly into the nasal passages and sinuses. A thin, flexible tube with a light and camera at the end is inserted through the nostrils. This can reveal signs of inflammation, polyps, or any other abnormalities that could be causing symptoms. IMAGING STUDIES In more complex or severe cases, imaging studies such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be ordered. These imaging tests provide detailed views of the sinuses and can help in identifying structural issues like a deviated septum or presence of large polyps. ALLERGY TESTING If allergic rhinitis is suspected to be contributing to the sinusitis, allergy testing may be conducted. Methods can include skin prick tests or blood tests to identify specific allergens. MICROBIOLOGICAL TESTS For chronic or recurrent cases, a culture of the sinus discharge may be taken to identify the type of bacteria or fungus causing the infection, guiding the choice of antibiotics. ADDITIONAL TESTS In some instances, additional tests like a complete blood count (CBC) may be done to rule out other underlying conditions. The comprehensive approach to diagnosis at The ENT Clinic ensures that the underlying cause of the sinus-related symptoms is accurately identified, allowing for an effective, tailored treatment plan in line with current medical guidelines. TREATMENT OF ACUTE AND CHRONIC SINUSITIS Dr Sandeep Uppal and his team are committed to adhering to the highest standards of medical care, including those set forth by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS). Here is a more detailed discussion of how treatment for chronic sinusitis might align with EPOS guidelines: TREATMENT OF ACUTE SINUSITIS By adhering to the EPOS guidelines, Dr Sandeep and his team ensure that their medical approach to acute sinusitis is not only comprehensive but also up to date with current best practices. Dr Sandeep Uppal’s management strategy is stringently aligned to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) guidelines. Here’s a more in-depth look: DIAGNOSTIC PROTOCOL Clinical Presentation: Symptoms such as rhinorrhoea, nasal congestion, facial pain or pressure, and smell abnormalities are scrutinized. The EPOS guidelines place a significant emphasis on symptom duration, generally less than 12 weeks for acute sinusitis. Diagnostic Tools: While imaging is not commonly advised for uncomplicated acute sinusitis, rhinoscopy and nasal endoscopy are performed to assess the nasal passages. PHARMACOTHERAPY Analgesics To ameliorate pain and reduce fever. Intranasal Corticosteroids Anti-inflammatory action helps to decrease mucosal swelling. Common choices include mometasone furoate and fluticasone propionate. Topical Nasal Decongestants To provide immediate relief from nasal congestion. Xylometazoline or oxymetazoline sprays are often used. Usage is limited to 3-5 days to prevent rebound congestion (rhinitis medicamentosa). Antibiotics Indicated for bacterial sinusitis, especially when symptoms are severe or prolonged. Amoxicillin-clavulanate is preferred, in line with EPOS recommendations. Typically, a 5–7-day course for uncomplicated cases. In cases of penicillin allergy, doxycycline or respiratory fluoroquinolones may be considered. Isotonic Saline Irrigation Helps to improve mucociliary clearance and symptomatic relief. High-volume, low-pressure irrigation is the technique generally recommended. Follow-Up and Monitoring Short-term Assessment: A follow-up visit within 7-10 days post-initiation of therapy is usually scheduled to evaluate treatment efficacy and compliance. Long-term Surveillance: Should symptoms persist or frequently recur, further investigations

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      Management of Enlarged and Infected Adenoids

      Adenoids and Tonsils, Nose

      MANAGEMENT OF ENLARGED AND INFECTED ADENOIDS WHAT ARE ADENOIDS? The adenoids are lymphatic tissues located at the crossroads of the nasal and oral passages and the throat. Individual size variation of the adenoids is common, with changes occurring with age. Adenoids typically reach their maximum size between ages 3 and 5. They usually shrink during adolescence. Adenoids are comprised of specialized cells called lymphocytes, which are involved in filtering bacteria and viruses from the air. ADENOIDITIS (ADENOID INFECTION) Adenoiditis is an inflammation of the adenoids. Causes of adenoiditis typically include infections, either viral or bacterial. SYMPTOMS Sore Throat Due to the inflammation of the adenoids. Stuffy Nose Swelling of the adenoids can block the nasal passages. Mouth Breathing The blockage can force mouth breathing. Snoring or Sleep Apnea Blocked air passages may result in snoring and episodes of halted breathing, causing blood oxygen levels to dip below normal. Ear Problem Enlarged adenoids block the eustachian tubes, leading to middle ear infections or hearing difficulties. Bad Breath Due to the infection and postnasal drip. Swollen Neck Glands Reflecting the body’s response to infection. TREATMENT Treatment for adenoiditis depends on the severity and the cause. If it’s a bacterial infection, antibiotics may be prescribed. In recurrent or chronic cases, or if the adenoids are causing significant problems like sleep apnea, surgical removal of the adenoids (adenoidectomy) might be recommended. ADENOID HYPERTROPHY (ENLARGED ADENOIDS) Adenoid hypertrophy refers to the abnormal enlargement of the adenoids. This condition is more common in children, as the adenoids are typically larger in childhood and tend to shrink with age. CAUSES OF ADENOID HYPERTROPHY Chronic Infections Repeated infections can lead to the enlargement of the adenoids. Allergic Reactions Allergies can cause inflammation and swelling of the adenoids. Immune System Activity As part of the immune system, the adenoids may enlarge in response to various stimuli. SYMPTOMS OF ADENOID HYPERTROPHY Nasal Congestion or Obstruction Difficulty in breathing through the nose. Mouth Breathing Especially noticeable during sleep. Snoring and Sleep Apnea Disrupted sleep patterns due to obstructed airways. Speech Alterations Nasal-sounding voice due to blocked nasal passages. Ear Problems Such as middle ear infections or hearing difficulty, since enlarged adenoids can block the eustachian tubes. Chronic Sinusitis Persistent or recurrent sinus infections. CAN ENLARGED ADENOIDS EFFECT THE WAY MY CHILD LOOKS? The simple answer is yes. Enlarged adenoids can lead to dental issues, Adenoid Facies, and effect facial growth. MOUTH BREATHING Chronic nasal obstruction from enlarged adenoids often forces a child to breathe through their mouth. This can lead to what is referred to as “adenoid facies,” which includes features such as a long face, open mouth, and an undeveloped nose bridge. DENTAL ISSUES Over time, mouth breathing can affect the development of the teeth and jaws. It can lead to changes such as an overbite or other dental malocclusions. FACIAL GROWTH The chronic mouth breathing associated with enlarged adenoids may influence the normal growth of facial bones, potentially leading to alterations in facial structure. FACIAL EXPRESSION Due to chronic nasal congestion and difficulty breathing, a child may often have a tired or listless facial expression. DIAGNOSTIC PROCEDURES CLINICAL EXAMINATION Detailed history-taking focuses on the frequency, duration, and severity of symptoms. NASOPHARYNGOSCOPY A flexible endoscope is inserted through the nose to visualize the adenoids directly. RADIOLOGICAL ASSESSMENT Lateral neck X-rays or CT scans can offer insights into the size of the adenoids and their impact on the airway. SLEEP STUDIES In cases where sleep apnea is suspected, a polysomnogram sleep study might be conducted. TREATMENT MODALITIES WATCHFUL WAITING In mild cases, especially if the child is likely to outgrow the condition. PHARMACOTHERAPY Antibiotics like amoxicillin are often prescribed for bacterial adenoiditis. Antihistamines and corticosteroid nasal sprays may be used to reduce inflammation and symptoms. SURGERY (ADENOIDECTOMY) Adenoidectomy, the surgical removal of the adenoids, is a well-established procedure with specific indications that warrant its consideration. Conducted under general anaesthesia. The adenoids are accessed through the open mouth, and specialized instruments are used for their removal. INDICATIONS FOR ADENOIDECTOMY Here are the key scenarios where Dr Sandeep Uppal and his team might recommend an adenoidectomy: CHRONIC OR RECURRENT ADENOIDITIS Symptoms: Persistent nasal congestion, runny nose, frequent sinus infections, and ear problems. Criteria: When adenoiditis recurs frequently or persists despite appropriate medical treatment, surgical removal is often considered. RECURRENT NASOPHARYNGEAL INFECTIONS Symptoms: Frequent upper respiratory tract infections affecting the nasopharynx. Criteria: If the adenoids are deemed to be a focus of infection, their removal can reduce the frequency of these infections. OBSTRUCTIVE SLEEP APNOEA AND SLEEP DISORDERED BREATHING Symptoms: Loud snoring, restless sleep, and daytime sleepiness. Criteria: When adenoid hypertrophy is found to be a significant contributing factor to sleep apnea or sleep disordered breathing, an adenoidectomy may be recommended and can have a significant impact on patients’ quality of life. CHRONIC SINUSITIS OR RHINITIS Symptoms: Persistent nasal discharge, facial pain, and post-nasal drip. Criteria: When the adenoids are a reservoir for chronic infection that exacerbates sinus issues, their removal is considered. OTITIS MEDIA WITH EFFUSION (GLUE EAR) Symptoms: Hearing loss, frequent ear infections, or persistent fluid in the middle ear. Criteria: Adenoidectomy may be recommended in conjunction with myringotomy and tube insertion to resolve recurrent or chronic ear issues. IMPAIRED NASAL BREATHING Symptoms: Difficulty breathing through the nose, leading to chronic mouth breathing and dry mouth. Criteria: When enlarged adenoids block the nasal airway, their removal can alleviate symptoms. FAILURE TO THRIVE IN CHILDREN Symptoms: Poor weight gain, reduced activity, and developmental delays. Criteria: In rare cases, severe adenoid hypertrophy can contribute to feeding difficulties and poor growth, warranting surgical intervention. SPEECH AND DENTAL ISSUES Symptoms: Nasal-sounding speech or development of dental issues like an overbite. Criteria: Adenoidectomy may be considered to correct or prevent speech and dental problems associated with adenoid hypertrophy. TAKE ACTION AGAINST ADENOID INFECTIONS AND ENLARGEMENT: PROTECT YOUR HEALTH TODAY! Are you or a family member struggling with persistent nasal congestion, snoring, or ear issues? Adenoid infections and enlargement can cause these symptoms and more, leading to

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      Fungal Sinusitis

      Nose, Sinusitis

      FUNGAL SINUSITIS Fungal sinusitis refers to the inflammation of the sinuses caused by a fungal infection. It is less common than bacterial or viral sinusitis but can be more challenging to treat. The condition is primarily seen in individuals with weakened immune systems or uncontrolled diabetes, but can also affect healthy individuals, especially when exposed to certain environmental conditions. TYPES OF FUNGAL SINUSITIS ACUTE INVASIVE FUNGAL SINUSITIS This is a rapidly progressing and severe form of the disease, often observed in individuals with weakened immune systems. It can be life-threatening if not treated promptly. CHRONIC INVASIVE FUNGAL SINUSITIS Chronic invasive fungal sinusitis is a slow-progressing form of fungal infection that gradually damages the sinuses and facial structures, typically seen in individuals with slightly compromised immune systems. While less aggressive than its acute counterpart, it requires long-term treatment and monitoring to prevent serious complications. FUNGUS BALL (MYCETOMA) This type involves the presence of a fungal ball within a sinus cavity, usually the maxillary sinus. It doesn’t invade the sinus tissue but causes symptoms due to its mass effect. ALLERGIC FUNGAL SINUSITIS (AFS) This is an allergic reaction to environmental fungi that colonise the sinuses. It typically affects individuals with a history of allergies or asthma. The sinuses may be filled with thick fungal debris and mucus. Read more regarding allergic rhinitis and its management>> CAUSES Fungal spores are abundant in the environment, but only a few types can cause sinus infections. Individuals with compromised immune systems or those who have had prolonged antibiotic, chemotherapy, or immunosuppressive therapy are more susceptible. SYMPTOMS Symptoms can vary depending on the type of fungal sinusitis, but they generally include: Nasal congestion Nasal discharge Facial pain or pressure Decreased sense of smell Fever (particularly in invasive types) Eye symptoms such as bulging, pain, double vision, loss of vision (especially if the infection spreads) Headache Chronic cough Read more about blocked nose here>> TREATMENT SURGICAL DEBRIDEMENT Especially important for invasive fungal sinusitis, where the infected tissue must be removed. ANTIFUNGAL MEDICATIONS Administered to manage and eradicate the fungal infection. CORTICOSTEROIDS May be used, especially in cases of allergic fungal sinusitis, to reduce inflammation. IMMUNOTHERAPY For those with allergic fungal sinusitis, allergy shots might help prevent the condition from returning. SINUS IRRIGATION Using saline solutions can help keep the sinuses clear. Learn more about nasal sinuses and sinusitis>> Learn more about management of sinusitis>> TAKE CONTROL OF FUNGAL SINUSITIS WITH EXPERT CARE Fungal sinusitis can be a complex condition, with treatment and outcomes varying significantly depending on the precise diagnosis. It’s imperative to have a specialist who can accurately identify and treat your specific type of fungal sinusitis. Dr Sandeep Uppal and his skilled team are at the forefront of ENT healthcare, offering comprehensive services to tackle this condition head-on. Don’t let fungal sinusitis diminish your quality of life. Reach out to Dr Sandeep and his team for top-tier advice, thorough diagnosis, and a range of treatment options tailored to your needs. Take the first step towards relief and recovery—contact us today for a consultation.

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      Allergic Rhinitis and Its Management

      Nose

      ALLERGIC RHINITIS AND ITS MANAGEMENT Allergic rhinitis, which many of us know as “Hay Fever”, is a common condition that affects many people around the world, including in Singapore. HOW COMMON IS ALLERGIC RHINITIS? Hay fever affects about 10-30% of people worldwide. In Singapore, because of its warm and urban environment, about 20-30% of people have hay fever. WHAT CAUSES ALLERGIC RHINITIS? When someone who is sensitive to certain substances (allergens) breathes them in, their body tries to fight off these allergens. This reaction causes the nose to become inflamed. WHAT ARE THE MAIN ALLERGENS WORLDWIDE AND IN SINGAPORE? Globally, tree, grass, and weed pollen are frequent hay fever triggers. In Singapore, house dust mites are the primary concern. Additional irritants in Singapore and globally include: Pet hair Mould Cockroach droppings WHAT ARE THE COMMON SYMPTOMS OF NASAL ALLERGIES? Allergic rhinitis, manifests with a variety of symptoms that result from the body’s reaction to air borne allergens. The common symptoms include: Sneezing: Often in bouts or sequences, often in the morning. Runny nose: Clear, watery nasal discharge. Nasal congestion: A stuffy or blocked nose. Itchy nose: An urge to scratch the inside of the nose. Itchy eyes: Along with redness and watering of the eyes. Itchy throat: Sometimes leading to a cough or throat clearing. Swollen, blue-coloured skin under the eyes: Often referred to as “allergic shiners”. Postnasal drip: Sensation of mucus dripping from the back of the nose into the throat, which can lead to cough or a sore throat. Reduced sense of smell: Due to nasal congestion. Fatigue: Due to disrupted sleep or the body’s reaction to allergens. Worsening of asthma: In some people, allergic rhinitis can also trigger or exacerbate other symptoms or conditions, such as asthma or eczema. If one experiences these symptoms regularly or in particular seasons, it may be indicative of allergic rhinitis. It’s advisable to see a healthcare professional, like an ENT specialist, for an accurate diagnosis and appropriate management. WHY DO SOME PEOPLE GET HAY FEVER? There are two main reasons: Genetic predisposition: If family members have allergies, one is more likely to develop hay fever. Exposure to allergens: High exposure to triggers at an early age can increase the risk. Being born during pollen season: There is some evidence to suggest that those born during high pollen seasons may be more susceptible. Having other allergies or asthma: Those with existing allergies or asthma are more likely to develop hay fever. Living or working in an environment that constantly exposes one to allergens can also heighten the risk. HOW IS ALLERGIC RHINITIS DIAGNOSED? HISTORY AND EXAMINATION Dr Sandeep gathers a detailed history of symptoms and their occurrences. A comprehensive ENT examination is performed, and a nasal endoscopy is conducted to check for: Enlarged, pale and boggy nasal turbinates. Deviated septum. Presence of polyps or other pathology. Signs of sinus infection like mucous or pus emanating from the nasal sinuses. TESTS FOR ALLERGY These tests help determine the specific allergens causing the symptoms. Skin Prick Test (SPT): Small amounts of allergens are introduced into the skin. If there’s a reaction, it suggests an allergy to that specific allergen. Blood Test (RAST or ImmunoCAP): Allergy panel measures the amount of allergen specific IgE antibodies in the blood. HOW IS ALLERGIC RHINITIS TREATED? The approach to treating allergic rhinitis is multiprong, the aim is symptom control. ALLERGEN AVOIDANCE The first step is to identify and avoid triggers. House Dust Mite Avoidance Encase Mattresses and Pillows: Use allergen-proof covers to keep mites out. Wash Bedding Regularly: Wash sheets, blankets, and pillowcases weekly in hot water (at least 60°C) and dry them in a hot dryer. Reduce Humidity: Keep home humidity below 50% using dehumidifiers or air conditioners. Remove Carpeting: Where possible, replace carpets with hardwood, tile, or linoleum flooring. Regular Cleaning: Vacuum weekly using a vacuum cleaner with a HEPA (high-efficiency particulate air) filter. Wear a mask while vacuuming. Declutter: Dust mites thrive in clutter. Reduce items that collect dust, like knick-knacks and books. Clean Curtains and Upholstery: Wash with hot water or vacuum regularly with a vacuum cleaner with a HEPA (high-efficiency particulate air) filter items like bed linen and curtains, and consider using blinds instead of fabric curtains. Air Purifiers: Use air purifiers with HEPA filters to reduce airborne allergens. Soft Toys and Allergen Avoidance Measures Soft toys can be a haven for dust mites and allergens, especially if they are frequently handled or placed in areas prone to dust accumulation. If someone in the household has allergies, particularly to dust mites, it’s essential to take measures to keep soft toys as allergen-free as possible. Here are some measures to reduce allergens in soft toys: Regular Cleaning: Wash soft toys in hot water (at least 60°C) regularly. Ensure they are thoroughly dried before giving them back to children. For toys that can’t be washed, placing them in a plastic bag and freezing them overnight can kill dust mites. After removing them from the freezer, let them return to room temperature, and then give them a good shake or vacuum to remove dead mites. Storage: Store soft toys in closed cabinets or toy boxes to prevent dust accumulation. Avoid placing soft toys on beds, especially if they aren’t regularly cleaned, as this can be a significant source of allergens. Limit Number of Soft Toys: Consider having fewer soft toys, especially in sleeping areas. This reduces potential allergen accumulation points. Choose Allergen-Friendly Toys: Opt for toys labelled as hypoallergenic. These toys are made of materials less likely to provoke an allergic response. Avoid Second-hand Soft Toys: If possible, refrain from using second-hand soft toys, as their previous environment might have exposed them to a variety of allergens. Use Protective Covers: Use allergen-proof covers or bags for toys, especially those that children might take to bed with them. Regular Air Out: Periodically let soft toys air outside in direct sunlight. The ultraviolet light from the sun can help reduce the number of dust mites. Vacuuming: If

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      Nasal Bone Fractures

      Facial Injury, Nasal, Nose

      NASAL BONE FRACTURES X-Ray showing nasal bone fracture. OUR MANAGEMENT PHILOSOPHY Nasal bone fractures are the most commonly encountered facial fractures, and we are committed to providing unparalleled care in their diagnosis and treatment. Our treatment philosophy hinges on holistic client care. We believe in treating you, not just your symptoms. We involve you in the treatment planning, taking into account your lifestyle, aesthetic goals, and psychological factors that may be affecting you due to the injury. We create a personalized plan geared toward optimal recovery and the best possible aesthetic results. WHAT CAUSES NASAL BONE FRACTURES? Nasal fractures are usually the result of: Blunt trauma to the face. Motor vehicle collisions. Sporting incidents. Falls or trips. Physical altercations. SYMPTOMS TO LOOK OUT FOR If you’ve suffered an injury to the nose, be aware of the following symptoms: Localized pain and tenderness. Swelling and discoloration. Difficulty or changes in breathing through the nose. Visible deformity. Frequent nosebleeds. Altered sense of smell Although rare, headache, nausea, vomiting, leakage of clear fluid (CSF) from the nose, drowsiness or altered level of consciousness may occur and may be a sign of concussion or brain injury. These require immediate attention in a hospital setting. OUR MANAGEMENT APPROACH IMMEDIATE CARE First Aid: If you suspect a nasal fracture, immediate first aid measures such as applying a cold compress to the area can help control swelling and pain. Emergency Assessment and Diagnosis: Timely medical evaluation is crucial for determining the extent of the injury and for preventing complications such as difficulty in breathing. DIAGNOSIS Your journey to recovery begins with an accurate diagnosis. We utilize detailed physical examination combined with modern imaging techniques like CT scans to determine the type and extent of your fracture. TREATMENT OPTIONS NON-SURGICAL TREATMENTS Nasal fractures are often undisplaced and not associated with any nasal septal deviation. For such fractures treatment is observation and injury avoidance while the fracture heals naturally. Treatment includes: Cold compresses to manage swelling. Pain Management: Over-the-counter pain relievers like acetaminophen or ibuprofen are effective in controlling. If needed our team will prescribe other anti-inflammatory medication for control of pain and swelling. Nasal Decongestants: To help with breathing if the nasal passages are obstructed. SURGICAL TREATMENTS CLOSED REDUCTION (MANIPULATION OF NASAL BONES) Simple fractures of nasal bones are realigned without making any external incisions. This type of treatment is ideally performed within 7-10 days of injury. OPEN REDUCTION For more complex fractures, especially if 7-10 days have passed since the injury. SEPTORHINOPLASTY An advanced procedure that addresses both the fracture of the nasal bones and nasal septum along with any pre-existing functional or aesthetic deformities. POST-TREATMENT CARE Follow-up Appointments: To assess the healing process and make any necessary adjustments to your treatment plan. Cosmetic Reconstruction: If required, additional surgical procedures can be performed to ensure optimal aesthetic results. IMMEDIATE POST-OPERATIVE CARE IN THE RECOVERY ROOM Your vitals will be monitored closely. Pain management protocols will be initiated to ensure your comfort. BEFORE DISCHARGE You’ll receive detailed instructions regarding at-home care. Medications will be prescribed to manage pain and prevent infection. AT-HOME CARE GUIDELINES PAIN MANAGEMENT Continue prescribed medications as advised. Using a cold compress may also help relieve discomfort. SWELLING AND BRUISING Keep your head elevated to reduce swelling. Apply ice packs periodically, avoiding direct contact with the skin. WOUND CARE Keep the surgical area clean and dry. Follow specific cleaning instructions provided by Dr Sandeep. BREATHING AND SLEEP Breathing might be more laborious initially; take care not to exert yourself. Sleep in a position that minimizes pressure on your nose. It is recommended to sleep on your back. DIET Stick to soft foods that don’t require extensive chewing for the first few days. EXERCISE Avoid vigorous exercise like running, lifting weights, and bending forwards for 3 weeks to reduce the risk of bleeding. Avoid contact sports and crowded places for 2-3 months after surgery to prevent the risk of accidental injury to the nose. CLOTHING AND ACCESSORIES Soft, Loose-Fitting Tops: Avoid any clothing or accessories that come into direct contact with the treatment area. It is best to avoid garments which must be negotiated around the head. Instead opt for garments with buttons down the front to avoid any contact with your nasal area when dressing. Cotton or moisture-wicking materials can help keep you comfortable, especially if you’re experiencing hot flushes or temperature changes post-surgery. Headgear: Avoid hats or any headgear that sits tightly on your head or puts pressure on your nose. Glasses and Sunglasses: If you usually wear glasses, consider switching to contacts during the initial recovery period to avoid putting pressure on your nose. If you must wear glasses, do not rest them on the nasal bridge. It is best to tape them to the forehead. Our team can suggest specialized padding or advice on minimizing stress on the nasal area. FOLLOW-UP APPOINTMENTS Regular follow-ups are essential for assessing the healing process. During these visits, any stitches or splints may be removed, and further care options will be discussed. MONITORING FOR COMPLICATIONS Contact us immediately if you experience: Excessive bleeding. Signs of infection such as increased redness, warmth, or discharge. Severe pain not relieved by prescribed medication. PREVENTIVE MEASURES Your safety is our concern even beyond the clinic walls. We encourage: The use of protective headgear during high-impact activities. Vigilance in car safety, including seat belt use. Being cautious in environments where slips and falls are likely. RESTORE HARMONY: NASAL BONE FRACTURE TREATMENT WITH DR SANDEEP Is a nasal fracture affecting your facial symmetry? Our Nasal Bone Fracture Treatment is focused on meticulously realigning and restoring the natural contour of your nose, ensuring both functional and aesthetic recovery. Trust in our compassionate and detailed-oriented approach for optimal results. Reclaim the balance of your features and breathe with ease. Initiate your journey to a restored profile today. Book a specialized consultation for nasal bone fracture treatment with Dr Sandeep.  Read more to learn about Rhinoplasty>>

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      Biologics for Nasal Conditions

      Nasal, Nose

      BIOLOGICS FOR NASAL CONDITIONS Dr Sandeep Uppal and his team at The ENT Clinic are at the forefront of employing advanced treatments for nasal conditions, including the use of biologics for nasal polyposis and nasal allergies. Biologics are a class of medications derived from living cells and are designed to target specific components of the immune system. They have gained prominence in recent years for their effectiveness in treating various chronic conditions, including severe asthma, rheumatoid arthritis, and certain skin conditions. BIOLOGICS FOR NASAL POLYPOSIS Biologics like Dupilumab are increasingly being used for treating severe cases of nasal polyposis that are unresponsive to traditional treatments such as corticosteroids. These medications are often considered for treating severe eosinophilic forms of chronic sinusitis with nasal polyps, especially when other treatments have proven ineffective. These medications work by inhibiting specific pathways involved in inflammation, thus reducing the size of the polyps and alleviating symptoms like nasal obstruction and loss of smell. Dr Sandeep Uppal and his team are committed to a patient-centric approach, providing comprehensive information and closely monitoring patients who are on Anti-IL5 therapies. This ensures that the treatment is not only effective but also safe for the patient. BIOLOGICS FOR NASAL ALLERGY Similarly, biologics are also proving effective in managing severe nasal allergies that are unresponsive to antihistamines and other traditional medications. By targeting specific cytokines and inflammatory pathways, these drugs can offer significant relief from symptoms such as sneezing, itching, and nasal congestion. Dr Sandeep keeps abreast of the latest advancements in biologics for nasal allergies and is experienced in tailoring these treatments to individual patient needs. EVIDENCE-BASED APPROACH Dr Sandeep and his team strictly adhere to evidence-based guidelines for the use of biologics in treating nasal conditions. Their commitment to scientific rigor ensures that patients receive the most current and effective treatment available. SAFETY AND MONITORING The use of biologics is generally well-tolerated but requires close monitoring for potential side effects, such as increased susceptibility to infections. Dr Sandeep and his team place a high emphasis on patient safety and will conduct regular follow-up appointments to monitor treatment efficacy and any potential adverse effects. Dr Sandeep Uppal and his team at The ENT Clinic are vigilant about informing patients regarding the potential side effects and precautions associated with Anti-IL5 therapies like Mepolizumab, Reslizumab, and Benralizumab. Here is a detailed overview:         POTENTIAL SIDE EFFECTS Injection Site Reactions: Redness, swelling, or itching at the injection site is common. Respiratory Issues: Some patients may experience a worsening of asthma symptoms or bronchospasm. Headaches: A common side effect that usually resolves with time. Fatigue: Patients may feel unusually tired or lethargic. Muscle Pain: Some people report mild to moderate muscle soreness or cramps. Hypersensitivity Reactions: Including rash, itching, or severe allergic reactions. Elevated Blood Parameters: Changes in blood counts or liver enzymes may occur and are usually monitored via regular blood tests. Increased Risk of Infections: Particularly upper respiratory tract infections. PRECAUTIONS TO BE TAKEN DURING TREATMENT Prior Allergy Assessment: A thorough review of any past allergic reactions to similar medications is essential. Concurrent Medications: A complete medication review is undertaken to identify potential drug interactions. Pregnancy and Breastfeeding: These therapies should be used cautiously in pregnant or breastfeeding women, and only if the benefits outweigh the risks. Vaccinations: It’s advisable to update vaccinations before starting therapy, as the medication could potentially interfere with the effectiveness of certain vaccines. Regular Monitoring: Blood tests to monitor eosinophil levels, liver function, and other parameters are often performed. Emergency Plan: Due to the risk of severe allergic reactions, an emergency action plan is usually discussed with the patient. Informed Consent: Detailed discussions are held with the patient to ensure they are fully aware of the risks and benefits of the treatment.

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      Septoplasty Surgery and Procedure

      Nose

      SEPTOPLASTY TECHNIQUES Over the years, various techniques have been developed and refined by Dr Sandeep to address simple to complex septal deviations. Here’s an overview of the primary techniques used by Dr Sandeep in septoplasty. TRADITIONAL SEPTOPLASTY The deviated portions of the septum are either removed, realigned, or reshaped to achieve a straight septum. SUBMUCOUS RESECTION (SMR) This is a traditional technique where the aim is to preserve as much of the supportive structure of the septum as possible while removing the deviated parts. CARTILAGE SCORING This technique involves making strategic cuts or scores in the cartilage without removing it. These scores make the cartilage more malleable, allowing it to be reshaped and straightened. CARTILAGE GRAFTING In cases where a significant portion of the septal cartilage needs to be removed or if there’s a septal perforation, cartilage grafts (from the ear or rib) may be used to provide structural support. SPREADER GRAFTS These are thin strips of cartilage placed between the septum and the upper lateral cartilages. They are often used to correct internal nasal valve collapse and dorsal septal deviations. BATTEN GRAFTS These are used to provide strength and support to the septum that is deviated due to an intrinsically weak cartilage which has bent under the weight of the overlying nasal structures. SUTURING TECHNIQUES Strategic placement of sutures can help in straightening mild deviation of the cartilaginous portion. ENDOSCOPIC SEPTOPLASTY Using nasal endoscopes provides better visualization, especially for posterior deviations. This approach is less invasive and allows for more precise corrections of localized deviations but may not be suitable for major deviations requiring reconstructive septoplasty. SEPTORHINOPLASTY Indicated when both the nasal septum and nasal bones are deviated. It addresses nasal obstruction and straightens a crooked nose effectively. It is suitable for more complex anatomical nasal deviations, where septoplasty is ineffective or likely to unsuccessful. Traditional septoplasty may be insufficient if the deviation is: More pronounced towards the caudal end (closer to the tip of the nose). Along the dorsum (the top or bridge) of the nose. Septorhinoplasty combines cosmetic and functional correction EXTRACORPOREAL SEPTOPLASTY Extracorporeal septoplasty is a specialized technique in septoplasty where the entire nasal septum is temporarily removed. Deviated portions can be removed or reshaped, and the septum is straightened. This often involves using sutures, scoring techniques, or cartilage grafts to achieve a straight, functional septum. The reconstructed septum is then re-inserted into the nose and sutured back to the remaining caudal and dorsal struts. This approach is particularly useful for clients with complex septal deformities where traditional septoplasty techniques might not provide satisfactory results. Dr Sandeep learned this procedure during his European Academy of Facial Plastic Surgery Fellowship under Professor Wolfgang Gubisch, who first described this procedure, and has developed particular expertise in it over the years, treating many clients who had failed Septoplasty in other institutions. THE SEPTOPLASTY PROCEDURE DETAILED PREPARATION Prior to the procedure, Dr Sandeep will conduct a comprehensive assessment of the septal deviation, including a meticulous review of the client’s medical history and a detailed physical examination. This evaluation typically involves the use of a nasal endoscope and diagnostic imaging techniques such as CT scans to fully understand the extent and impact of the deviation. ANAESTHESIA While septoplasty can be performed under local anaesthesia with sedation, general anaesthesia is often preferred to ensure the client’s comfort. SURGICAL APPROACH In traditional septoplasty the approach is through an incision inside the nostril, the mucosal lining covering the septal cartilage is carefully lifted. This provides direct access to the deviated cartilage and bone. If septorhinoplasty approach is used an incision is made across the columella (the narrow strip of tissue that separates the nostrils, allowing the surgeon to lift the skin and access the nasal structures directly. This approach provides better visibility and precision, allows the surgeon to lift the skin off the nose and work on the internal structures. CORRECTION The deviated portions are strategically reshaped, realigned, removed, replaced, or bolstered. The goal is to straighten the septum without compromising its structural integrity so that the nasal breathing is improved, and the nose shape is maintained or enhanced. FINISHING UP The mucosal lining is repositioned and sutured back into place. Sutures are placed to quilt the lining to the cartilage to aid in healing and prevent complications like septal haematoma. Soft nasal packs are inserted to reduce postoperative bleeding, these are removed after a few hours. Dr Sandeep rarely uses internal splints to stabilize the septum. Any external incisions are sutured. POSTOPERATIVE JOURNEY IMMEDIATE RECOVERY Clients might feel groggy as the anaesthesia wears off. Breathing might feel obstructed due to internal swelling and any packing or splints. MANAGING DISCOMFORT Mild to moderate pain, swelling, and nasal congestion are common. Pain medications and cold compresses can help manage these symptoms. ACTIVITY RESTRICTIONS Clients are advised to avoid strenuous activities, nose blowing, contact sports and wearing glasses directly on the nasal bridge for a few weeks. NASAL DOUCHE Helps to clear the nose of any secretions, blood clots and crusts, aids in healing, while minimizing the risk of infection. FOLLOW-UP VISITS These are crucial to monitor healing, address any concerns, and remove sutures or splints. POTENTIAL COMPLICATIONS As with any surgical intervention, septoplasty carries potential risks and complications. Here’s a detailed look at the complications associated with septoplasty: Immediate Bleeding: Some postoperative bleeding is expected, but excessive bleeding can be a concern and may require intervention, including readmission. Septal Hematoma Formation: A collection of blood, known as a hematoma, can form between the septal cartilage and its overlying lining, the mucoperichondrium. This can compromise the blood supply to the cartilage, leading to cartilage death, if not promptly drained. Infection: Infections after septoplasty are rare but can be serious. Symptoms might include increased pain, swelling, fever, and discharge from the nose. Septal Abscess: A collection of pus between the septal cartilage and its mucosal covering. It requires drainage and antibiotics. Septal Perforation: A hole can develop in the septum postoperatively. This can lead to symptoms

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      Management of Septal Perforation

      Nose

      MANAGEMENT OF SEPTAL PERFORATION DIAGNOSTIC PROCEDURES MEDICAL HISTORY Dr Sandeep takes a detailed medical history to assess the overall health of the client and assess the cause of perforation. Client’s functional and aesthetic needs are assessed to aid in planning management. PHYSICAL EXAMINATION Initially, a functional and aesthetic nasal examination is done to assess the nose. This involves: Endoscopy: A nasal endoscopic examination is performed for a more detailed view of the septum and other internal nasal structures. This helps to identify any pathology that may be leading to the perforation. Chest X-rays, CT scan or MRI: These imaging tests may be necessary for a complete evaluation and to rule out other conditions like tumours and Wegener’s granulomatosis. Blood tests: These may be performed to rule out an inflammatory cause for the septal perforation. Biopsy: The nasal mucosa may be biopsied if a tumour, chronic infection, or chronic inflammatory disease. Allergy Testing: To rule out ongoing allergies that could complicate the healing process. Read more about the causes and symptoms of Septal perforation here>> (Place link to Nasal Septal Perforation webpage here.) TREATMENT OPTIONS CONSERVATIVE MANAGEMENT SALINE SPRAYS Helps to keep the area moist and free of crusts. HUMIDIFIERS To prevent the nasal passages from drying out. CORTICOSTEROID CREAM May help in reducing inflammation. ANTIBIOTIC OINTMENTS Can prevent secondary infections. SEPTAL BUTTONS These are less invasive and can be good short-term solution to reduce symptoms. SURGICAL CLOSURE Surgery for nasal septal perforation is usually considered a last-resort treatment when other conservative methods have failed to provide relief or when the perforation is large and causing significant symptoms. Here’s a more detailed overview: LOCAL FLAP SURGERY This is Dr Sandeep’s preferred method for closure of septal perforations. Dr Sandeep harvests tissue flaps made from mucosal tissue lining from inside the two nasal cavities to close the perforation. The flaps may be rotated or advanced to achieve the desired result. INTERPOSITIONAL GRAFTING A graft is placed between the two mucosal layers around the perforation. This provides an additional layer between the flaps and helps in closing the perforation and reduces the risk of reperforation significantly. Commonly used grafts include bone or cartilage harvested from the back of the septum (if available) or cartilage from the ear or rib. Temporalis fascia harvested from the lining of the temporalis muscle, or AlloDerm or similar graft is another option. SURGICAL PROCEDURE Anesthesia Assessment: The surgery is usually performed under general anaesthesia. Pre-anaesthesia check-up to assess fitness for anaesthesia. Incision: The procedure can be performed by making internal nasal incisions when the septal perforation is small. However, for most client’s Dr Sandeep prefers an external approach, which involves making a tiny incision in the party wall between the two nostrils along with some internal nasal incisions. This provides the greatest exposure during the surgery. Preparation: The margins of the perforation are usually freshened to facilitate better healing. Closure Technique: Local flaps and Interpositional grafting are used for closure of the perforation. Additional Measures: Sometimes, a temporary packing or a splint may be placed to support the repair. Monitoring: Initial recovery and monitoring in a post-anaesthesia care unit. Follow-Up Appointments: Regular follow-up appointments will be necessary to monitor healing, perform nasal toilet, assess the long-term success of the procedure, and manage any complications. Antibiotics: May be prescribed to prevent infection. Nasal Irrigation: Regular cleaning of the nasal passages with saline solution to promote healing. Avoidance of Nasal Irritants: Including smoke and harsh chemicals. POTENTIAL RISKS AND COMPLICATIONS Failure to Close the Perforation: In some cases, the surgical procedure may not successfully close the perforation. Sometimes the graft or flap may not fully integrate, leaving a residual perforation. Often, despite closure of the perforation the symptoms may be minimized if the perforation becomes smaller in size. Recurrence: Even after successful surgery, there’s a possibility that a perforation could recur, necessitating additional procedures. Localized Infection: The surgical site itself may become infected, requiring antibiotic treatment. Systemic Infection: Although rare, infections can spread to other parts of the body, leading to more serious issues. Immediate Bleeding: Excessive bleeding can occur during or immediately after the surgery, requiring immediate intervention. Delayed Bleeding: Some clients may experience slow, ongoing bleeding, which may necessitate further treatment. Altered or lost sense of smell and taste. Anesthesia Risks Internal Scarring: Scar tissue may form around the surgical site, causing issues like blockage or narrowing of the nasal passages. External Scarring: There’s a risk of visible scarring if a trans columellar incision heals poorly. Septal Hematoma: Collection of blood within the septum can occur, requiring drainage. Septal Deformity: Altered structure can result from the surgery, affecting the shape and function of the nose. PRECAUTIONS Avoid Nose Picking: This can exacerbate the condition. Limit Over the Counter Decongestant Nasal Sprays: Stick to a doctor’s prescription. Allergy Management: Properly treating allergic rhinitis can prevent further damage. Prompt Treatment: Address any symptoms or signs of infection quickly. Before opting for surgery, it’s crucial to discuss all options, possible complications, and expected outcomes with Dr Sandeep. Surgery is generally considered only when the benefits outweigh the potential risks and after all conservative options have been exhausted. The key to successful treatment often lies in a comprehensive preoperative assessment, a well-executed surgical procedure by an experienced surgeon, and diligent postoperative care. If you have a nasal septal perforation which is symptomatic, please consult Dr Sandeep for a proper diagnosis and treatment plan tailored to your condition. RESTORE YOUR NASAL HARMONY: BOOK YOUR SEPTAL PERFORATION CONSULTATION TODAY! Reclaim comfort in your breathing with a specialized Septal Perforation treatment. If you’re experiencing nasal whistling, crusting, or airflow disruption due to a septal perforation, a bespoke consultation with Dr Sandeep can guide you to a solution tailored to your needs. Journey with us towards restoring your nasal function and comfort. Our treatment options are designed to repair the perforation, enhancing both the structure and the function of your nasal passages. Feel the difference a repaired septal perforation can make to your respiratory health,

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