General

What is chronic rhinitis?

Chronic rhinitis is a long-term inflammation of the inner nose lining. If your rhinitis symptoms persist for more than four weeks, it is considered to be chronic rhinitis. There are many possible causes of rhinitis, including triggers that can irritate or inflame the lining of the nose, or a neural (nerve-related) imbalance which results in an influx of signals to the inner nose, causing the nose to swell and produce a lot more runny discharge than usual.

Symptoms of Chronic Rhinitis

• Runny nose
• Stuffy or blocked nose
• Itching of the nose
• Persistent urge to sniff
• Nasal congestion
• Post-nasal drip
• Coughing

Causes

Chronic rhinitis is caused by over-stimulation of the nose. Things that could trigger this include:

• Allergies – Hay fever, dust allergies.
• Irritants – Second-hand smoke, some perfumes, fumes.
• Weather changes – Humidity or very hot weather.
• Dietary factors – Food sensitivities can develop at any age and may trigger an allergic reaction. Spicy food and alcohol are both known to irritate the lining of the nose.
• Medications – If you notice the symptoms of rhinitis after beginning a course of new medicines, you should stop taking this medication and consult your doctor.
• Other health conditions – Viral infections such as a cold or the flu, sleep apnoea, acid reflux, chronic fatigue syndrome, diabetes.
• Hormonal changes – This includes pregnancy, menstruation, contraceptive use and menopause.

Complications

There are a few complications that can arise from long-term chronic rhinitis. These include:

Nasal polyps – These benign lumps form in the nose lining or sinuses and are caused by long-term inflammation. They can block the airway and hinder breathing.

Sinusitis – Sinus infections can flare up due to the continued irritation of the lining of the nose and sinuses.

Impacting on day-to-day quality of life – Chronic rhinitis can disrupt your daily activities and affect your mental health. It can reduce your productivity and make you feel tired due to lack of sleep.

Treatments

There are several ways of treating the symptoms of chronic rhinitis. The best thing to do is to have a consultation with an ENT professional, such as London ENT, to determine the best treatment for you.

Treatment options include:

• Nasal sprays
• Nasal drops
• Anti-allergy medications (antihistamines)
• Saltwater nasal rinses/douching
• Steam inhalations

If your symptoms continue despite the above treatments, there are some surgical options available, although these are not suitable or appropriate in all cases. Surgical options include trimming the lining of the nose either by cauterisation to the inferior turbinates, or coblation. Occasionally surgical reduction might need to be considered.

There are also some new minimally invasive treatments becoming available soon which involve cryotherapy to the nerves in the nose responsible for the production of the majority of the internal nasal swelling and nasal discharge. Clarifix^TM is one such treatment and can be undertaken under a local anaesthetic, sometimes with sedation.

For information on the specialist ENT treatments and consultations we offer at London ENT, contact us on 0203 865 7225.

What is Vestibular Migraine?
Vestibular migraine, or VM, is a migraine that causes dizziness. Dizziness is a common migraine symptom, with most sufferers experiencing some form of dizziness either directly before or during their migraine.

Symptoms
• Visual issues – Flashing lines, zig-zags.
• Dizziness or a spinning sensation (vertigo) – This usually lasts several hours although can go on for days
• Nausea
• Light sensitivity
• Sound sensitivity
• One-sided, pulsing headache
• The need to lie down in a dark room
• Tinnitus – this is a less common symptom but has been reported in up to 1/3 of patients
• Less commonly, a numbness or tingling sensation in various parts of the body
• Less commonly, trouble with speech can occur, which can last anywhere from 5 to 60 minutes

Diagnosis
Diagnosis largely depends on the individual sufferer’s history as there is currently no test that can identify the condition. Your GP, ENT specialist or neurologist can run through your symptoms and family history to help assess your health.

The symptoms of VM can overlap with other inner ear conditions, such as vestibular neuronitis or more rarely Meniere’s disease, although in the latter case you would usually expect to see symptoms of hearing loss, with a documented reduction in hearing on hearing assessment, and tinnitus in most cases. In vestibular migraine, the hearing is almost always normal.

Causes
It is not always understood why a person may suffer from VM. Some of the common causes or triggers are similar to those for migraines in general, and include:
• Rapid head-turning
• Having your head in a particular position
• Certain foods or drinks (Caffeine, dark chocolate)
• Hormonal issues, such as periods or HRT
• Stress
• Lack of sleep
• Excessive use of screens – computers, mobile phones, films
• Exercise
• Flashing Lights
• Family history of migraines

Investigations
After a thorough examination, you may require some blood tests, as well as a formal hearing assessment. In some cases, a scan might be needed, such as a MRI scan of the inner ear and brain, to help rule out other possible causes.

Treatment
Painkillers can be taken to help reduce the acute headache, such as paracetamol or ibuprofen, assuming you are not allergic to them. The vertigo symptoms are less likely to respond to medications although in some instances you may need a prescription for a vestibular sedative such as prochlorperazine (stemetil) if the symptoms are very bad and/or persistent. Alternatively, an anti-sickness type medication can be helpful for more persistent, milder symptoms, for example, cinnarizine, which can be obtained over the counter in most pharmacies. Ultimately, if the attacks of dizziness are linked to migraine-type headaches, you may require specific advice to treat the current migraine attack and prevent future attacks from occurring. Your ENT specialist may recommend a review by a neurologist for further more specific treatment of the migraine.

Prevention
The best way to prevent future VM attacks is to identify the root cause. If a particular food or drink seems to trigger it, eliminate this from your diet.
Some preventative medications can be tried, such as amitriptyline and propranolol. Speak with your ENT specialist to establish which medication or form of prevention is best suited to you. There may be side effects to these medicines which should be discussed and considered.
Vestibular migraines are rarely a sign of something more serious, but your symptoms should never be ignored.

Be sure to consult an ENT professional, such as London ENT, for advice. For more information, contact London ENT on 0203 865 7225.

What is Nonallergic Rhinitis?
Nonallergic rhinitis is a condition in which inflammation occurs within the nose, causing symptoms of sneezing, coughing and a runny or blocked up nose. As the name suggests, it is not caused by an allergy.
Symptoms
• Stuffy nose
• Runny nose
• Excess mucus in the throat
• Sneezing
• Coughing
• Nasal discomfort
• Reduced sense of smell
In rare cases in which nonallergic rhinitis is severe or untreated, the sufferer may experience sinusitis, nasal polyps, or a middle ear infection.
Causes
• Viral infections that affect the lining of the throat and nose, such as colds
• Local irritation by dust or other environmental pollutants
• HRT treatment during menopause
• Medications such as the oral contraceptive pill
• Hormonal upheaval (Pregnancy, menopause, puberty)
• Exposure to extreme temperatures or humidity
• Intrinsic – ie. having an inherited tendency or predisposition

Diagnosis
Nonallergic rhinitis is diagnosed after assessment of your symptoms and the ruling out of allergies. This will be done by asking questions about your symptoms and performing a physical evaluation. There are no specific tests for nonallergic rhinitis, but other tests to rule out different causes may be requested. This could be a skin test to detect allergies or a blood test to check your immune system. Your doctor or ENT specialist will also want to rule out sinus-related issues.
Treatment
The treatment of nonallergic rhinitis will vary from person to person. If the case is mild, it can be treated at home by avoiding triggers. If the issue is causing discomfort, several treatments may be required to provide relief. These include:
Nasal Sprays
• Over the counter saline nasal sprays can help to thin the mucus, which will soothe the nasal membranes.
• Antihistamine nasal sprays sometimes help to reduce symptoms.
• Corticosteroid nasal sprays may be better suited if your symptoms do not respond to antihistamines or decongestants. These types of sprays can treat and prevent inflammation.
• Your doctor or ENT specialist may prescribe anti-drip anticholinergic nasal sprays.
Decongestants – These are available both over the counter and by prescription. They help to narrow the blood vessels, which reduces nasal congestion. They should only be used for a few days at a time to avoid the risk of dependency.
Surgical procedures – In some rare cases, surgery may be an option. Only extreme or complex cases of nonallergic rhinitis will require surgery. This may be suggested if the sufferer has a deviated septum or nasal polyps. Recent advances have led to the development of more minimally invasive methods for reducing a runny nose, such as the ClarifixTM cryotherapy device.
If you are experiencing the symptoms of nonallergic rhinitis, you should consult an ENT specialist, such as London ENT, for a consultation.
Contact London ENT for professional advice and assistance on 0203 865 7225.

Nonallergic Rhinitis – Symptoms, Causes, Diagnosis, and Treatment.

What is Nonallergic Rhinitis?

Nonallergic rhinitis is a condition causing sneezing, coughing and a runny or blocked up nose.

Symptoms

• Stuffy nose
• Runny nose
• Excess mucus in the throat
• Sneezing
• Coughing
• Nasal discomfort
• Reduced sense of smell

In rare cases in which nonallergic rhinitis is severe or untreated, the sufferer may experience sinusitis, nasal polyps, or a middle ear infection.

Causes

• Viral infections that affect the lining of the throat and nose, such as colds.
• HRT
• The contraceptive pill
• Hormonal upheaval (Pregnancy, menopause, puberty)
• Exposure to extreme temperatures or humidity

Diagnosis

Nonallergic rhinitis is diagnosed after assessment of your symptoms and the ruling out of allergies. This will be done by asking questions about your symptoms and performing a physical evaluation. There are no specific tests for nonallergic rhinitis, but other tests to rule out different causes may be requested. This could be a skin test to detect allergies or a blood test to check your immune system. Your doctor or ENT specialist will also want to rule out sinus related issues.

Treatment

The treatment of nonallergic rhinitis will vary per person. If the case is mild, it can be treated at home by avoiding triggers. If the issue is causing discomfort, several treatments may be required to provide relief. These include:

Nasal Sprays

• Over the counter saline nasal sprays can help to thin the mucus, which will soothe the nasal membranes.
• Antihistamine nasal sprays sometimes help to reduce symptoms.
• Corticosteroid nasal sprays may be better suited if your symptoms do not respond to antihistamines or decongestants. These types of sprays can treat and prevent inflammation.
• Your doctor or ENT specialist may prescribe Anti-drip anticholinergic nasal sprays.

Decongestants – These are available both over the counter and by prescription. They help to narrow the blood vessels, which reduces nasal congestion.

Surgical procedures – In some rare cases, surgery may be an option. Only extreme or complex cases of nonallergic rhinitis will require surgery. This may be suggested if the sufferer has a deviated septum or nasal polyps.

If you are experiencing the symptoms of nonallergic rhinitis, you should consult an ENT specialist, such as London ENT, for a consultation.

Contact London ENT for professional advice and assistance on 02038 657225.

Anosmia is the medical term for the loss of smell, otherwise known as smell-blindness. Up to 40% of anosmia cases occur in adults with or recovering from a virus. There is perhaps little surprise that loss of sense of smell is a common symptom for those who test positive for COVID-19.
In some countries, as many as 2/3 of COVID-19 patients reported anosmia as a symptom, with other countries reporting up to 30%. It is often the case that a person who has otherwise mild COVID-19 symptoms will also suffer from anosmia – in fact, there is some evidence that more severe COVID infections are less likely to be accompanied by anosmia. There has also been an increase in people reporting anosmia as their only symptom. With this in mind, such patients could be making up the large number of those who are unknowingly spreading the virus, with many not even thinking that this one symptom could relate to COVID infection. If these people do not present with other symptoms such as a persistent cough or high temperature, they may not consider taking a test or isolating.

Common Cold
It is important to note that the loss of smell is often down to a common cold virus. Therefore, anosmia as a symptom alone will not automatically mean the sufferer has COVID-19. The only way to determine this for sure is to book a COVID-19 test. If the test proves to be negative, and the sufferer is not displaying any other COVID-19 symptoms, they will not be required to isolate.

Oral steroids such as corticosteroids should be avoided if a patient is suffering from anosmia, due to a possible effect on worsening the infection. However topical steroids in the forms of drops or sprays, and in some cases, oral steroids taken with antibiotics may be considered.

Other Causes
There are a few other causes of anosmia. These include:
• Nasal polyps
• Sinus infection
• Allergies
• Smoking
• Nonallergic rhinitis
• Rare growths or tumours affecting the olfactory (smell) nerve

It would be impossible to know how many people suffer from anosmia and how many of those cases are COVID-19 related. If every person with this symptom were to self-isolate, there is a good chance the infection rate would fall, but this is not an easy thing to enforce.

If you notice the loss of your sense of smell or taste and have a negative COVID-19 test, contact an ENT professional, such as London ENT, for a consultation.
London ENT offers a wide range of specialist treatments and consultations. Contact us on 0203 865 7225 to find out more information on the services we offer.

What is swimmer’s ear?
Swimmer’s ear, also called otitis externa, is a painful condition in which the skin of the outer ear, or ear canal, is infected. This is different from middle ear infections, also known as otitis media, which is common in children.
Swimmer’s ear is more common in children and young adults, but it is possible to suffer from it at any age. It is rarely a serious condition; however, the infection can spread to other areas in the head area, such as the skull. This can usually be treated sufficiently with antibiotics.
Symptoms
The main symptoms of swimmer’s ear include:
• Feeling of having a bubble in your ear
• Muffled hearing
• Itching in or around the ear
• Water coming from your ear
• Dry or flaky skin around the ear
• Swelling of the ear canal
Causes
Despite the name ‘swimmer’s ear’, you do not have to be swimming to suffer with it. The common cause is moisture being trapped in the ear canal. This means that baths, showers, humid environments and washing hair can lead to swimmer’s ear. The condition can also be caused by a foreign object getting stuck in the ear. Examples of this are chemicals such as sprays or cotton buds.
People who suffer from skin conditions such as eczema and psoriasis, and those who wear hearing aids, earplugs or buds are also at greater risk of developing swimmer’s ear.
Treatment and prevention
If you get water in your ear, be sure to get the water out as safely as you can. Tilting your head and pulling on the earlobe can help. To limit the water that enters your ear, you could use earplugs or a bathing hat and be sure to towel dry around your ears after you have washed. One of the best ways is to use a big piece of cotton wool with some Vaseline, which makes the cotton wool waterproof. This is relatively cheap and you can use a clean piece each time you shower.
You are more likely to get an infection whilst having a bath or shower at home that swimming in a public swimming pool. This is because swimming pools in the UK contain chlorine which kills off most infectious organisms, unlike bath or shower water. Also shampoo and soap can irritate the skin of the ear canal, particularly if the ears remain wet and moist after showering. Therefore, strict water precautions are very important to maintain.
The good news is that swimmer’s ear is typically easy to treat. Your physician can arrange for any pus to be removed from the area by microsuction, undertake a swab of the ear if an infection is suspected, and prescribe antibiotics to treat the infection. Avoid getting your ears wet while the infection is being treated and do not insert anything other than prescribed drops into them. Infection is usually treated successfully with antibiotic ear drops over the course of 7 – 10 days. If the infection has spread to another area, you may need to take oral antibiotics.
You may also want to take over the counter pain relief medication, such as ibuprofen. If symptoms do not improve or new symptoms appear after seven days, you will need to contact your GP or ENT specialist once again for a further assessment.
An ENT specialist, such as London ENT, can provide professional advice on swimmer’s ear and all other ENT conditions and procedures. Contact us on 0203 865 7225.

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.