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.
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:
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:
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
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:
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
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.
It’s that time of year again when the coughs and colds are everywhere and can wreak havoc with your sinuses. Sinus infections and inflammation can cause a number of unpleasant symptoms – headaches, fever and tiredness, to name just a few. But are you aware that toothache can be one of those unpleasant symptoms?
We all have a total of eight sinuses – these are air-filled holes or spaces within the bones of the face and head. They are found behind your cheekbones, over your forehead/above your eyes, in between your eyes and deeper inside the head. It is not clear why we have or need sinuses although specialists believe that they help to filter the air in your nasal cavity as well as producing mucus to clean your nose. They also contribute to the strength of the facial bones and skull. Colds can lead to these becoming blocked with fluid, which can cause inflamed and swollen sinus tissue (sinusitis as it is otherwise known) and possible infection. The pressure created by this congestion can cause what is known as referred pain. This pain can radiate through your head and nose, as well as your teeth. This is because the nerves that serve the upper teeth run in the floor of the cheek (maxillary) sinuses; therefore any inflammation in these sinuses can cause swollen nerves to the teeth, which can be painful.
So how can you tell whether your toothache is down to sinusitis or an unrelated dental problem? Here is a list of a few of the symptoms to look out for if you feel your toothache is actually sinus-related:
• Sinus toothache is felt in the upper teeth, usually the back molars, and does not feel as if it is from one specific tooth.
• The pain will intensify when you move your head, or if you jump up and down (not recommended if you’re feeling under the weather!). The pain may lessen when you lie down.
• You have general cold symptoms such as a runny nose, feeling tired and sore throat.
• Ears feeling painful and full.
• Pressure/pain around your eyes, forehead and nose.
• Not being able to taste or smell.
Before a visit to the GP for antibiotics, you could try over the counter remedies (decongestants) or home remedies. These include breathing in steam and drinking plenty of fluids. Saltwater (saline) rinses to the nose are also usually extremely helpful in clearing out mucus from the nose – they can also enable prescribed medications such as steroid sprays or decongestants to work better on the nasal lining.
If your symptoms persist despite the above treatments, you may need to see an ENT specialist for a thorough examination and further treatment as required.
What Are They?
Tonsil Stones, also known as tonsilloliths, are lumps that form within the tonsils. These can be either white or yellow and are usually firm. Though very unpleasant for the sufferer, tonsil stones are not contagious and rarely go on to be anything serious. Quite often, a person with tonsil stones will not be aware they have them to start with as they aren’t easy to see and although they can get to be the size of a grape, they can also be as small as a grain of rice. They can cause swelling and pain in the tonsils and they have an unpleasant odour.
Causes
Mucus, food, saliva and dead cells can build up in the pockets of the tonsils (tonsil crypts). This causes bacteria and fungi to develop and with time this will form a tonsil stone. Sometimes one will form, other times it can be several at a time. Things that can cause this build-up include:
Symptoms
It can be hard to visibly spot tonsil stones but there are symptoms that come with them that will make you aware there is an issue. These include:
Prevention
Tonsil stones can return once you have them. There are several things you can do to prevent this from happening. These include:
Treatment
Although tonsil stones are usually harmless, most people understandably want them gone as soon as possible. Methods to remove them include:
The National Institute of Clinical Excellence (NICE) has published guidance in September 2019 about Implant surgery for prominent ears, including Earfold. The recommendations support the use of Earfold in the context of a clinical or research study. I am in the process of preparing a clinical study protocol so that patients can continue to benefit from a choice between traditional pinnapasty and minimally invasive techniques such as Earfold, in order that the most appropriate recommendations can be made.
It is surprising and somewhat alarming how common it is for these small household batteries to be swallowed by children, and the fatality rate has actually risen in the last decade. These batteries are small and sweet-shaped which makes them a hazard with young children around. Damage from swallowing the battery can occur within two hours so it is essential that removal takes place as soon as possible to reduce oesophageal damage. The battery reacts with the oesophagus tissue and saliva, forming a hydroxide-rich alkaline substance that damages tissue.
The symptoms of a child with an oesophageal button battery include:
The serious complications that could be caused by an oesophageal button battery include:
The longer it is between ingestion of the battery and the removal, the higher the risk of these serious complications. This has led to research being carried out into the effectiveness of certain household products that can help to reduce potential damage before the battery is successfully removed. Sodas, juices and sports drinks have all been tested, but honey has proven to be the most effective in protecting small children against button battery injury. This has been demonstrated by a team of ENT specialists at the Philadelphia Children’s Hospital, USA, who found that eating some honey after swallowing a button battery can help minimise injuries for young children. The research suggests that honey can reduce morbidity and mortality from the batteries significantly. The honey works by coating the battery thereby preventing the alkaline-rich solution from damaging tissue. It should not be used in children less than a year old or where there is a known allergy to honey. It is essential that the administration of the honey should not delay the transfer of the child to their nearest A&E department for definitive management. Obviously, it is also advised to ensure all batteries are kept out of reach of children and those that are in household items and toys should not be easily accessed.
Inflamed and swollen sinuses can cause sinus headaches, and this can be due to infections, colds or allergies. It can sometimes be difficult to differentiate between a sinus headache and a migraine and it is always best to seek advice from your GP to be sure. Both conditions can cause very similar symptoms, including pain in the face and head, although there are some key differences. Sinus headaches tend to cause pain in the face and frontal part of the head (forehead), including the cheeks, eyes, ears and upper teeth, but rarely anywhere else. In migraines, the headaches are usually also more severe, one-sided and often preceded by an aura or symptoms that the migraine is about to start, such as flashing lights or a feeling of nausea. Pain that is felt predominantly in the neck area is unlikely to be due to sinusitis and is also rare due to migraine. Other causes might need to be considered, such as neck stiffness due to a musculoskeletal cause, an injury or a vascular (blood vessel) cause. It is, however, possible to get some tightness in the neck due to tension or stress, and this can also accompany sinusitis or migraine, although the neck pain is likely to be less severe than the facial pain/pressure.
In the case of a sinus infection, you may also be experiencing other sinus related issues such as nasal congestion, a stuffy or runny nose (especially with an unpleasant nasal mucus discharge which can be green or yellow), or excessive sneezing. If neck pain is present it will likely be a tension-type pain, which is often worse after long periods of inactivity such as after sleeping, on bending over or going from hot to cold temperatures. This neck and head pain together can make you feel fatigued and can be quite unpleasant especially if you also have a fever.
Remedies
To treat sinus headaches and neck pain successfully you can start by using over the counter medicines such as decongestants and anti-inflammatory painkillers such as ibuprofen. This will not only help to relieve the pain but also the pressure caused by congestion. Antihistamines can also be effective if the issue has been irritated by allergies. It is always best to consult your GP before choosing your medication. If there are also signs of an infection, such as green/yellow nasal discharge and a fever, then it is possible that you will require a course of antibiotics from your GP or specialist.
Steps to Prevent flare-ups
The first step towards preventing sinus headaches and neck pain is to find out what the cause is. If the cause is a virus or common cold, then take the usual precautions to prevent a cold by washing hands and surfaces thoroughly and avoiding close contact with people suffering from a cold. If allergies are the cause, then you can take an antihistamine daily, as well as making efforts to avoid the substances to which you are allergic. It is also advised to avoid activities that alter the air pressure such as underwater swimming and flying activities, until such time that the symptoms have improved and you are feeling much better. Otherwise, the changes in air pressure can make the sinus infection (and therefore symptoms) much worse.
Signs Of Something More Serious
It is important to note that a fever along with a headache, neck stiffness and in some cases a skin rash can also be a sign of a more serious issue such as meningitis so always be sure to consult your GP if you are not sure or if your symptoms worsen suddenly over a short period of time.