Symptoms of a blocked nose may include the complaint of a stuffy nose. This may be the result of a mechanical obstruction such as a bend in the bones or cartilage of the nose or a polyp. Alternatively it may be the result of an inflammatory process such as an infection or allergy. A detailed history and examination will decide which of these factors is responsible for the symptoms. In the majority of cases surgery is not needed and often anti-inflammatory medication is all that is necessary. It is important to diagnose the cause of an allergic rhinitis in order that the substance to which the patient is allergic can be identified and avoided.
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Many people complain of sinuses or sinusitis, this overlaps with another common symptom, which is of facial pain or headache. Many people are diagnosed by themselves or are diagnosed by their GP as having sinusitis when in fact they have one of several other conditions, which can closely mimic sinusitis. It is vitally important therefore the patient see an ENT surgeon for a through consultation and examination including a telescopic examination of the nose (endoscope). Many patients are frustrated by the apparent inability to cure sinusitis because of a mistake in the original diagnosis. Sinusitis may be acute or chronic. Acute sinusitis often accompanies a cold or flu like illness, causes acute pain in the face, associated with a runny nose, loss of sense of smell, headache and secretions running down the back of the nose and into the throat (catarrh or post nasal drip). Many cases resolve without antibiotics but often a simple antibiotic from your GP will cure the problem. Chronic sinusitis can be difficult to treat. Patients often complain of headache, facial pain and post nasal drip which waxes and wanes. Antibiotics seem to make it better for a short time only and then the symptoms return. The usual cause for this is the wrong diagnosis or the correct diagnosis but inadequate treatment. If the appropriate antibiotic treatment does not work then the patient may be a candidate for modern surgical techniques (functional endoscopic sinus surgery/FESS)
This is a common symptom in children and young adults and is usually very easily treated. Before seeking the advice of a specialist the patient might like to try a simple antibiotic cream such as Naseptin or Bactroban nasal ointment. This can often be successful. If this fails then the patient should see an ENT surgeon for cautery of the bleeding blood vessel.
Nosebleeds in adults can be more difficult to deal with and very occasionally is it the sign of an underlying more sinister problem. An adult who experiences nose bleeds particularly associated with a blocked nose or pain should seek the advice of an ENT surgeon urgently.
Cautery of bleeding blood vessels is usually performed as a simple out patient procedure under local anaesthetic using a cautery stick. The use of hot wires is nowadays rarely necessary!
Broken nose/Bent nose
The nose is often broken as a result of trauma. This is usually a sporting injury or it can be the result of an assault or a road traffic accident. The patient should not delay in seeking help, as the treatment is often easy if the patient presents within three weeks of injury but after then the bones become set in their new and deformed position and further treatment involves more complicated surgery. If caught early the treatment can often be done under local anaesthetic which simple manipulation. Once bones are set in an abnormal position they would have to be rebroken in order to correct the deformity (Rhinoplasty/or Septorhinoplasty). Some people’s noses are not straight or perfect from an aesthetic point of view without their having suffered any degree of trauma. The operation of rhinoplasty (nose job) is designed to improve both the shape and function of the nose, each operation is tailored to the individual requirements of the patients. If you are unhappy about the shape of your nose even if you are comfortable with the breathing we would be delighted to discuss possible aesthetic improvement. It is important to have a realistic concept of what can and cannot be done and what particular aspects of the appearance you feel can be improved upon.
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Snoring (including obstructive sleep apnoea)
Snoring is a common problem, indeed most adult’s snore at some stage. Men snore more commonly than women but not exclusively! There are many folk laws and remedies for snoring, some of which are more successful than others. Snoring may occur in isolation or may be the sign of a more important underlying condition known as sleep apnoea where the patient actually stops breathing at night and has very adverse effect on their sleep patterns making them tired during the day and in extreme cases they can be a danger to themselves and others if they attempt to drive and fall asleep at the wheel! The key factors in overcoming snoring with or without sleep apnoea (OSA) are:
- The majority of people who snore and certainly those with sleep apnoea will be significantly above their ideal body mass. If you calculate a body mass index (weight in kilograms divided by height in metres squared) and the result is over 25 then you would probably benefit from a reduction in your weight which may improve the snoring.
- Hypothyroidism. All patients who snore or have sleep apnoea should have thyroid function tests checked.
- Nasal obstruction for whatever reason may exacerbate snoring or cause sleep apnoea.
- Alcohol, patients who drink alcohol in the evening particularly just before they go to bed will often find they are snoring worse.
Surgery for snoring should always be a last resort when other measures have failed. My own practice is to restrict surgery to patients whose BMI is no more than 27 as surgery on patients with a BMI greater than this has an increased chance of poor success in the long term. There are various surgical procedures available (UVPP/LAUP) and each has its advocates. I believe that the choice of patient for surgery is more important than the choice of operation! All operations for snoring have a failure rate and are all associated with a greater or lesser degree of discomfort. There is nothing magical about a laser it is just a tool! My normal practice is to suggest a radio frequency tissue reduction of the soft palate on the basis that this is the least painful and least destructive.
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