General

Nasal trauma refers to an injury to your nose or the immediate area around your nose. These can include internal and/or external injuries. The bones, tissue and cartilage of your nose are in a vulnerable place within the skull, which is why nasal injuries and nasal trauma are common.
Types of nasal trauma
There are various types of nasal trauma, with the following being the most common:
• Breaks and fractures of the nasal bones
• Nasal obstruction or blockage caused by a foreign or unusual object
• Nosebleeds (Epistaxis)
• Chemical irritation
• Injuries or irritation to the inside of the nose
• Septal haematoma
Nasal Fractures And Complications
Nasal fractures account for almost 40% of all injuries involving the face. Not only will this damage the skin, bone, and tissue around the nose, but it can also lead to more severe issues. Don’t forget that if you have sustained a force that is sufficiently strong to break the nose, it could have caused some other collateral damage to nearby structures as well, and these must be looked out for.
These include:
Septal haematoma – This condition causes blood to collect within the lining of the septum. The blood then clots to stop the bleeding, forming a haematoma. If this condition is left untreated, it can prevent the cartilage from receiving sufficient nutrition and oxygen, causing it to weaken and eventually collapse. This can cause severe complications including a septal abscess, ascending cavernous sinus infections of the internal vessels of the brain (thankfully extremely rare!), necrosis of the septal cartilage, saddle deformity and septal perforation. Septal haematomas should be swiftly drained to prevent any issues. This will usually be performed under a general anaesthetic although a local anaesthetic is possible in some people.
Cerebral spinal fluid (CSF) Leak – CSF is a watery fluid that surrounds the brain within the skull. A leak of CSF is a potential complication that can occur after a skull injury and requires urgent attention. This can happen immediately or even a few days after a head injury, with the patient describing a watery discharge from the nose, usually from one side. A sample may be tested to determine if the fluid is indeed CSF (as there are many more common causes of a watery or runny nose such as nasal mucus). Treatment may vary from bed rest, hydration and saline infusions to surgical procedures.
Anosmia – this means a complete loss of the sense of smell (hyposmia means a partial loss of smell). This could be temporary or long-term. Treatment will depend on the direct cause and may not always be effective.
Septal deviation – A condition in which one air passage is smaller than the other due to displacement of the septum. This can be caused by head trauma and may cause further issues such as a blocked or congested nose, breathing difficulties, sleep disruption and nosebleeds.

Managing nasal trauma
A patient who has suffered complications following a nasal trauma should seek medical advice – whether attending A&E immediately (for more severe problems) or consulting a professional ENT consultant.
Depending on the nature of the trauma, advice and treatment may be successfully provided by a professional ENT consultant. You may also have some follow up appointments shortly after to ensure the recovery process is successful.
If there are no complications, and the only injury is the fracture to the nasal bones, it is usual practice to leave the nose for 5-7 days to allow any surface swelling to reduce, as the swelling can make it difficult to assess the precise degree of movement of the nasal bones underneath. You might therefore be asked to return to the clinic at that point. If the nasal bones are definitely out of place due to the injury, one option is for you to undergo a manipulation of the fractured nose (MUA). This is a simple procedure, undertaken under a general anaesthetic. It needs to be performed ideally within 14 days and if possible no more than 21 days from the date of the trauma, otherwise the nasal bones might have set in their new position by then, making a manipulation after this time point very difficult to move the bones back into position.
Sometimes, an MUA may not be successful, even if performed within the correct timeframe, or where there has been trauma previously to the nose, which can make it difficult to render the nasal bones perfectly straight. If this is the case, or if you are also suffering from a deviated nasal septum causing a blocked nose, you might benefit from a septorhinoplasty, which is a more formal operation aimed at resetting the nasal bones and nasal septum. It is usually performed several months after the index injury, once all swelling and healing from the injury have taken place, and is more successful at being able to straighten the nasal bones and septum as well as correct any other deformities or irregularities that might be present. The decision as to whether to proceed with septorhinoplasty surgery will be discussed in detail with you during the consultation.
For more information on the management of nasal trauma or on any of the ENT services we offer, please contact London ENT on 0203 865 7225 or contact@london-ent.co.uk.

If you have been suffering from chronic sinus infections, you will no doubt be wanting to find answers and solutions. But did you know that an infected tooth could cause frequent reoccurring sinus issues?
Maxillary sinusitis of odontogenic origin is when an infection in the root of your tooth spreads to your sinuses. Your upper back teeth have roots that can extend towards the cheekbones, reaching the maxillary sinus. If one tooth has an infection, you are at risk of it spreading through the root of the tooth and into the sinus.

Symptoms
Symptoms of sinus infections caused by dental-related sinusitis include sinus congestion, sinus pressure, allergy-like nasal issues, facial swelling, pressure pain, headaches and even nausea. Your doctor may prescribe a course of antibiotics. This will be a temporary solution, as the issue with the offending tooth will remain untreated. The sinus infection will keep returning until the underlying tooth infection is rectified.
As with many sinusitis sufferers who do not routinely experience tooth-related pain, it can be hard to identify that the sinus problems are a side effect of a tooth infection. This means that many sufferers will have reoccurring sinus infection for months or even years before the real cause of the problem is recognised and correctly diagnosed. Seeking advice from a dentist is the best course of action.

Treatment
The good news is that once diagnosed, sinusitis of dental origin can be readily treated. Often, root canal therapy will eradicate the bacteria responsible for the infection. If the infection has come from a tooth that has previously undergone root canal treatment, a second root canal procedure can sometimes be performed. Your dentist will be able to advise you on the correct way forward.
In addition, you may need treatment for the sinusitis, such as with antibiotics, nasal steroid or decongestant sprays and/or saltwater rinses. If your symptoms persist despite the above treatments, it is best to seek professional advice from the likes of London ENT.
If you would like further information about the treatments and procedures that we offer at London ENT, feel free to contact us using our online contact form.

Overuse of antibiotics is one of the many battles medicine is facing today. While they do an excellent job in one respect, the overuse of antibiotics can have a devastating effect on the human body and the human race.

Preventing the spread of infections has been one of their key factors, however, antibiotics being used to treat bacterial infections hasn’t conclusively proven to assist in this particular area. The main issue with overuse is the this encourages the development of resistant bacterial strains. Bacteria are extremely adept and change their DNA with time, and if this results in a more resistant strain being created, the antibiotics will become less effective. Once this process starts, the resistant bacteria multiply, increasing the resilience of the overall bacterial community and making it harder for patients to get well.

Infections becoming harder to treat has only come about due to the misuse of antibiotics. Antibiotics are helpful but only when they are used in the correct way.

For example. some forms of ear infections are bacterial, and the immune system is equipped to often fight them off without the use of antibiotics. This means the use of antibiotics in cases where they are not needed makes them useless.

Other examples would be viruses, such as colds, flu and sinus infections being treated with antibiotics. Again, antibiotics are not always suitable and no good will come from using them.

Left-over antibiotics, availability on the internet, the wish to get better quickly and the possible chance of other symptoms developing contribute to the misuse of antibiotics.

Infections can take a while to clear up and we sometimes expect to feel better a lot quicker than we should do.  Always talk to your doctor if you have any concerns and would strongly advise against self-medicating. Antibiotics are there for a reason but are increasingly misused by the public. This will cause global health problems if antibiotics continue to be used unnecessarily.

Finally, if you are prescribed a course of antibiotics, it is crucially important that you complete the full course. Whilst this may seem at odds with the discussion above about resistance, if you stop the course too early, the antibiotics may not yet have had a chance to kill off all of the bacterial strains. This usually means that the strongest, most resilient bacteria are left behind, which are then able to multiply and grow further, thereby causing recurrent or more severe infections.

It is very common to reach for painkillers such as aspirin to ease a headache or a fever, but if you suffer from a disorder known as aspirin-exacerbated respiratory disease (AERD) taking this medication could actually make you feel much worse. AERD can often be treated easily, it causes breathing issues and is triggered by sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs)
Causes
Things that can make you at risk of AERD include:
• Smoking or being exposed to second-hand smoke as a child
• AERD tends to be more common among people between the ages of 20-50
• Having asthma can increase the risk
• Nasal polyps
Symptoms
There is a range of respiratory issues that can occur for an AERD sufferer. These include:
• Sinus problems and pain
• Stuffy nose and nasal congestions
• Headaches
• Watery eyes
• Sneezing
• Nasal polyps
• Asthma attack
• Wheezing or coughing
• Tightness of the chest
• Dizziness
• Fatigue
• Abdominal cramping
• Nausea
• Some people with AERD also find that alcohol can cause respiratory issues.
Diagnosis
There is no blood test to confirm AERD but your doctor can diagnose you by checking your respiratory reactions and symptoms when taking NSAIDs. They can perform what is known as an ‘aspirin challenge’, this is when they watch you take aspirin and monitor your reaction to it. This is usually undertaken along with a full respiratory assessment (lung spirometry). The aspirin challenge should be avoided if you are pregnant or have heart, liver or kidney disease.
Treatment
There are no known cures for AERD but there are ways to treat and manage it. You may be prescribed inhaled steroids to take daily, nasal steroid sprays or steroid sinus rinses. If you have nasal polyps, you can have injections into the polyps to remove or shrink them. Another possible treatment is aspirin desensitisation. This involves a doctor watching you take small doses of aspirin and increasing the dose over time. When you show a reaction, you will remain on that dose until you are able to manage it with ease. Then the process continues. This has proven successful in up to 90% of cases, although you do need to continue to take the aspirin to maintain the benefit of tolerance to the medication. Don’t forget that taking aspirin regularly can have some side effects, such as gastrointestinal irritation or gastritis, so other medications to reduce this may be necessary.

It has been widely publicised that sufferers from sinus infections or sinusitis can alleviate symptoms by taking a natural spice called Turmeric. Known for its anti-inflammatory, antibacterial and antibiotic qualities, turmeric can be used in the fight to treat sinus infection.

Natural cures have been used by people from all over the world for many years, especially when modern medicine is not always available. Even with a lack of research as to why turmeric has such a positive effect on sinus infections, it still does not deter sufferers from turning to turmeric as an alternative to over the counter pharmaceutical products.

When sinus infections occur, the nasal passage becomes inflamed, causing discomfort, headaches and possible breathing problems. Using turmeric as a natural anti-inflammatory can bring much relief to the sufferer and provide clearer airways in which to breathe easier.

Turmeric has also been known to provide other natural health benefits such as liver detoxification and cancer-fighting properties.

Try this…

You’ll need Turmeric root – 2 x 2” pieces, 1 Lemon, 1 tablespoon of honey, 1 small pinch of cayenne pepper and water. 1 banana (optional). Method: Mix ingredients together to make a smoothie. Take this for 3 days and symptoms should start to improve.

As a somewhat simpler alternative, turmeric supplements are also available in easy to swallow capsules.

Sinus infections can also be relieved with a warm compress to the nose or drinking a glass of water with organic apple cider vinegar added to it (you can also add honey for a preferred taste). Honey and apple cider vinegar are notorious for their health properties and come to the aid of many people looking to use natural alternatives. In the prevention of sinus infections, Vitamin C is a great way to improve your immune system too.

Professor Chatrath was recently featured in the Healthcare Innovations section of The Guardian on Saturday newspaper on 28th March 2020. His article focussed on minimally invasive an innovative surgical approaches, including functional and cosmetic nasal surgery, minimally invasive otoplasty techniques, and non-surgical rhinoplasty and facelift techniques.

Click here to see the article

Please read the following for advice on caring for a fractured nose at home. We are here to answer any questions or concerns you may have regarding a fractured nose.

Injuries to the nose

Fractures to the nose are common, making up over 50% of all fractures to the face. Most are either related to sporting injuries, assaults or road traffic accidents. Swelling of the soft tissues over the nose and face occurs relatively quickly and dramatically, as a response by the body to protect and repair itself. There will usually also be substantial bruising. It can take anything up to 3 weeks for swelling to reduce but we would advise that a doctor assesses the injury as soon as it happens. Often the extent of the swelling can camouflage or mask the true severity of the injury or position of the nose.

There are several options available, depending on how well you feel or whether you have any additional symptoms. You can see your GP as an urgent patient or visit your nearest A&E department, who will examine you and advise as to the next steps.

If you have any of the symptoms below then further more urgent tests are likely to be required:

• Bruising over the sclera (whites) of your eyes
• Other facial fractures
• Severe nose bleeding
• Clear watery discharge from the nose
• Visual disturbance
• Reduction in consciousness
• A completely blocked nose due to a blood clot/haematoma

If you think you have any of these, you are advised to go straight to A&E. If there are none of the above features, then it is likely that you will be asked to attend an appointment at the ENT (Ear, Nose and Throat) clinic approximately 7 to 10 days after the injury. This is necessary to determine whether any further treatment to the bone or cartilage is needed, as by this time the swelling will have subsided and a clearer assessment of the position of the nasal bones can be made.

Immediate care:

• Use ice packs for 10 minutes at a time, 3 times a day, to reduce swelling. Frozen peas wrapped in a damp towel work really well
• Take pain relief if needed
• Pinch the soft lower part of your nose if you are having nose bleeds, whilst breathing through your mouth.

Medical procedures

Most nasal fractures do not require X-rays. Only if complications arise will an X-ray be required. A nose fracture tends to heal by itself and swelling will eventually go down. In the case of a deformed nose, after swelling has been reduced, a medic can carry out a manipulation procedure, which will be under anaesthesia, to reposition the nose. A CT scan may be required if there is evidence of other facial injuries or fractures, if your consciousness is reduced or if there is a clear watery discharge from the nose.

What is a manipulation of a fractured nose (MUA)?

A MUA (manipulation under anaesthesia) is a procedure to improve the appearance of the nose. It may also prevent further complications to the nasal passage. The most successful manipulations are performed within 14 days of the injury, but some cases may be performed up to 21 days after the day of the injury. In the majority of cases, a MUA is performed under a general anaesthetic, although they can be performed whilst you are awake, under local anaesthetic, particularly if the procedure is carried out immediately or very soon after the injury has occurred, and before any swelling has developed.

Nosebleeds

It is not unusual for patients to experience nosebleeds after a fracture to the nose. We would advise that you sit forward and pinch firmly the soft part of your nose (around the nostrils). This should be done for around 15 minutes. Seek medical advice or help if bleeding continues for longer. Nasal packing treatment at a hospital may occasionally be required if bleeding does not stop.

Septal haematoma

Blood collects between the septum (central partition wall) of the nose and lining and causes it to swell. Patients may experience pain, cartilage damage and nasal obstruction and will need to be referred to the ENT (Ears, Nose and Throat) Department for urgent drainage.

Nasal blockage

Common problems occurring from nasal fractures include a blocked nose, which can be due to swelling of the nasal lining, or due to a deviated nasal septum. Sometimes surgery is needed several weeks later to repair a deviated septum particularly if the nasal blockage persists.

Complications

A rare occurrence may happen which is called a CSF (cerebrospinal fluid) leak. This is where a thin plate of bone in the roof of the nose is fractured and causes clear fluid that surrounds the brain to leak through your nose. If this happens, you are likely to require an urgent CT scan and a review by an ENT (Ear, Nose and Throat) specialist and sometimes a neurosurgeon, in case a repair may be required.

Sense of smell

It is possible to develop a reduced sense of smell, especially during the maximum period of swelling. It often recovers fully; however, a permanent loss of smell can occur due to injury to the delicate nerve endings. Recovery times can vary widely between different people.

Ongoing care after a fractured nose

• Sleep on a few pillows with the head of the bed elevated for 2-3 nights so that your head is slightly propped up, which will encourage the swelling to reduce faster
• Avoid playing contact sports for 6 weeks

If you wish to book an appointment or get in touch, please contact us on 0203 865 7225 or email: contact@london-ent.co.uk

Obstructive Sleep Apnoea, or OSA, is a condition in which there is an obstruction of the airways. This can be caused by a number of different things, for example a weakening or relaxation of  the muscles in the throat during sleep. This narrows the airways, reducing airflow and making it harder to breathe. This can cause irregular breathing and snoring, particularly in those with large adenoids or tonsils. This can temporarily wake the sufferer while they try to resume a normal breathing pattern, leading to disrupted, poor quality sleep.

Causes

There are various causes for OSA in both adults and children. Children with enlarged tonsils and adenoids are at risk of OSA as this will block part of their airway. This is the most common cause of obstructive breathing and/or OSA in children. Other causes include childhood obesity, Down’s syndrome and sickle cell disease.

In adults, the causes are much broader and in general more complex to evaluate as there is rarely one problem that is causing the symptoms, unlike in children where the problems are usually more straightforward. These include nasal problems (nasal blockage due to a deviated nasal septum, sinusitis, allergy or nasal polyps), throat related problems (tonsillitis, large tonsils, an elongated uvula), voice issues (eg. laryngeal swelling due to acid reflux), and issues with neck size or swellings in the neck (eg. increased neck size due to obesity, thyroid problems, enlarged lymph nodes).

Symptoms

Snoring is often the first symptom of OSA. Parents of children with OSA may notice their child is sleeping in unusual positions in order to help them to breathe. Frequent but brief arousal from sleep is also common among sufferers, along with increased sweatiness or restlessness. This is the brain alerting the body to the struggle with breathing. Being extra tired during the daytime will be a repercussion of this. Some children may be aggressive or hyperactive during the day due to feeling over-tired. Struggling to focus or concentrate is another side effect. In extreme cases, the sufferer may lose their appetite and growth as well as school- work could suffer.

Diagnosis

Difficulties with breathing while sleeping can be linked to several medical conditions, so it is important the right tests are carried out to determine a diagnosis. An over-night sleep study performed by a technologist or physiologist is the best method. Breathing, heart rate and oxygen levels will be recorded. This can often be performed as a home sleep study so you do not necessarily have to stay overnight in hospital.

Treatment

Treatment will vary from patient to patient. If the tonsils or adenoids are the primary cause, then an operation to remove those may be arranged. Other possible treatment options include positive airway pressure therapy (CPAP OR BiPAP), nasopharyngeal airway treatment (NPA), nasal steroids and mandibular advancement (moving the jaw forward).

What are chronic ear infections?

Chronic ear infections are recurring ear infections that can be caused by several things. If an ear infection does not heal by itself or keeps returning, it will be classed as a chronic ear infection. This condition can escalate to cause hearing loss, a ruptured eardrum or in extreme cases, nerve paralysis. Anyone with a chronic ear infection must seek medical help.

Causes

Children are more likely to suffer from ear infections than adults. This is due to their Eustachian tubes (the tube that drains fluid from the middle ear) being smaller and more horizontal compared to adults. When an adult suffers an ear infection, it tends to be caused by an upper respiratory infection or a swimming-related injury. Other causes of chronic ear infections include sinus issues, allergies, and bacterial infections caused by colds or flu.

Symptoms

It is sometimes the case that symptoms of recurring, chronic ear infections may be less severe than those of an acute case. They also may come and go intermittently. Symptoms include:

• Ear pressure
• Fever
• Pus or liquid leaking from the ear
• Sleep issues
• Reduced hearing
• Pain in the ear
• Dizziness
• Tinnitus (a ringing sound in the ear)
• In infants, loss of appetite, irritability and tugging on the ear

Treatment

Home remedies may include a warm compress on the ear and over the counter pain relief medications. When you see the doctor, they will examine your ear. They may take an ear swab or arrange some blood tests to check for bacteria, as well as further tests such as a CT scan to see if an infection has spread. Your doctor will likely prescribe antibiotics. These will either be in tablet or ear drop form. Surgery may be required if the chronic ear infection is severe or has spread.

Prevention

• Wash your hands often and thoroughly to stop bacteria spreading
• Do not smoke and avoid second-hand smoke
• Keep up to date with vaccinations
• Ensure an ear infection is completely gone after the treatment
• Keep the ear scrupulously dry until the ear infection has settled. This includes avoiding swimming and also protecting your ear whilst having a bath or showering, such as with an earplug or cotton wool coated in Vaseline.

Speech and language delay is a reasonably common problem in preschool children, with as many as 10% being affected. Some of the possible causes are thought to be:
• Slower than normal development
• Loss of hearing
• Autism
• Not spending enough time talking with adults
• Elective muteness – choosing not to talk
If your child does not appear to be developing at a similar rate to other children his or her age, it may be speech and language delay. Although you should always remember, children will develop at their own pace, with some being faster in certain ways than others. If you do suspect speech and language delay, take your child to their doctor, who can refer you to a specialist if they feel it is appropriate.
They may decide to begin by referring you to an audiologist to have your child’s hearing checked. A hearing problem at a young age can cause speech delay or unclear speech because when a child learns to speak, they can only repeat back the sounds that they can hear. Therefore, if what they are hearing is ‘different’ to them, their speech will reflect this and will be less clear or understandable than it should be. If a hearing problem is the issue, then hearing aids or implants may be needed, and perhaps even enable your child to ‘catch up’ with other children their age developmentally once the issue is resolved. Very commonly, hearing problems in young children between the age of 18 months and 3 years of age are due to glue ear, which is a build up of fluid behind the eardrum. This can be easily managed with either medications or in some cases a small operation where a grommet is inserted into the eardrum to release the fluid. Once the hearing of whatever cause is treated, the speech usually begins to improve within a few weeks.
If your doctor feels your child needs help from a psychologist, behavioural specialist or social worker, then they will refer you to a health visitor who can make those arrangements for your child. Sometimes, of course, it may be a case of no real treatment, just that your child is taking a little longer than others with no real cause or explanation, and they will catch up eventually with no lasting adverse effects.
Lastly, remember it can be very frustrating for both the child and parents when dealing with speech and language delay. A child who cannot express themselves may act out in other ways and it is common for behavioural issues to occur, even as the main problem. It is essential to remain patient as much as possible and praise every effort, for it is not something the child can generally control.