Royal Society of Medicine Trainee Sinus Dissection Prize Day

Paul was one of three expert assessors at the Royal Society of Medicine Trainee Sinus Dissection Prize Day. This was the first such occasion at which senior surgical trainees in ENT Surgery were invited to participate in a day of advanced dissections, with the quality of the surgical dissections being assessed carefully by the three assessors and a Prize given for the dissection judged to be the best. This was a very successful day of training and assessment and will hopefully be repeated in future years.

Everything you ever wanted to know about vertigo (but were too dizzy to ask)

This is a great article.  Vertigo and dizziness are more commonplace than people realise, and perhaps you may even have experienced it yourself at some point.  There can be a variety of underlying causes, and here at London ENT we often treat people with these symptoms.

Feel stable again – come and see us here at London ENT.

With thanks to

Screen Shot 2016-05-30 at 10.40.19Everything you ever wanted to know about vertigo (but were too dizzy to ask)

Is it the result of stress? Or an ear infection? And will it actually go away if rest is avoided?

Photograph: Courtney Keating/Getty Images

Up to one in 10 people will experience vertigo, dizziness or unsteadiness in any given year. In the vast majority of cases, the symptoms are unpleasant but harmless, and get better without treatment. Vertigo is used by health profressionals to describe the feeling that you, or the world around you, is moving when it is not: Alfred Hitchock’s masterpiece Vertigo is actually about a man’s morbid fear of heights (acrophobia) and not true vertigo, although the terms are often used interchangeably.

Have I got dizziness or vertigo?

Specialist physiotherapist Nicola Harris says “dizziness covers a multitude of things. It can be a lightheaded feeling, like you are going to faint, which is more likely to be a cardiovascular or breathing pattern problem. Or you may feel unsteady on your feet. When you move your head, it can feel like what you are looking at has to ‘catch up’ with you afterwards.”

Dr Diego Kaski, neuro-otologist at London’s Charing Cross hospital, says vertigo creates the illusion of movement. Normally, the brain recognises that you are moving by integrating signals from your eyes, inner ear and receptors that sense body movement in the neck and limbs. But in true vertigo, you feel as though you are standing still while the world moves around you.

What causes it? 

Vertigo is often attributed to an inner ear infection called vestibular neuritis that starts after a cold and can last for up to a couple of weeks. But Kaski says vertigo is often mislabelled as this when in fact benign paroxysmal positional vertigo(BBPV), and vestibular migraine are the more common and likely culprits.

BPPV is a mechanical problem of the inner ear. We have crystals inside the inner-ear balance organs that move when we do, but if the signals lag behind those emitted from the eyes and limbs, it creates an illusion of movement. In vertigo, the inner-ear signals cause jerky, uncoordinated eye movements, known as nystagmus, which conflict with the brain’s other movement signals. The repeated attacks usually last less than 30 seconds, and are precipitated by head movements including rolling over in bed or looking up.

It could be a migraine

One in 10 people with migraines get bouts of vertigo which come and go, that don’t necessarily coincide with the more typical symptoms of a headache and can last from a few seconds to a few days. These people may be hypersensitive to light, noise and smells. The treatment is the same as managing migraine headaches: try to identify and avoid triggers, short-term painkillers and anti-sickness medication and long-term preventive treatments such as beta blockers.

How do I treat vertigo?

It depends on the cause. Medical advice for vestibular neuritis is to avoid bed rest and get back to normal life as quickly as possible. This kick-starts the brain into compensating for the vertigo so it doesn’t become a long-term problem. BPPV can be cured by head movement exercises (for example, the Epley manoeuvre or Brandt-Daroff exercises) that reset the inner-ear organ of balance. Kaski is exploring novel ways of delivering this treatment using virtual reality glasses and a mobile phone app. You will be guided through the exercises without having to wait months for an appointment with a trained physiotherapist. Drug treatment of BPPV doesn’t work very well, according to Kaski. Prochlorperazine is good for nausea, but Betahistine, often prescribed by GPs, doesn’t help much at the doses that are given.

Kaski is interested in non-invasive brain stimulation. An electrical coil is placed over the head overlying the part of the brain – the parietal lobe – that processes balance. Modifying the electrical activity in this may relieve vertigo.

Can it be caused by stress?

There is certainly a link to stress; animals, including us, rely on signals about movement of predators and prey to survive. Illusions of movement activate the autonomic nervous system, which includes an adrenaline-fuelled fight-or-flight reaction. The extra adrenaline can cause unpleasant symptoms such as palpitations and anxiety. Conversely, anxiety itself can cause unsteadiness; people say it feels as if the world is moving under their feet.

Why do some people get vertigo more than others?

Some people are prone to vertigo because they are more visually dependent than others. This group will think they are moving because the signal from their eyes isn’t being integrated with the information from their body. We all experience this to a certain extent; when you are sitting on a train and it pulls out slowly from the station, it can be hard to know what’s moving.

What else could it be?

Meniere’s disease is a rare condition that affects the inner ear. It causes sudden attacks of vertigo lasting two to three hours, with ringing in the ears (tinnitus) and progressive hearing loss. Harris says further investigations, scan and consultations are important if there are any red-flag symptoms suggesting more serious underlying disease. These rare but potentially dangerous conditions include head injuriesstrokesmultiple sclerosisacoustic neuromas (benign growths on the nerve in the inner ear) and brain tumours.

National Epistaxis Consensus Day in Leeds, UK

Paul was invited to attend a National Epistaxis Consensus Day in Leeds, UK. He was one of several invited experts gathered to consider the evidence for various aspects of the treatment pathway for patients with nose bleeds requiring admission to hospital, with the aim of formulating some common guidelines to try to reduce variability and raise standards in the treatment of this condition throughout the UK.

Almost Half Of British Women Are Sleep Deprived And Risking Long-Term Health Effects, Report Warns

Here at London ENT we regularly trScreen Shot 2016-05-30 at 10.33.55eat patients with sleep apnea.  Not only does the condition interfere with your nightly sleep patterns, leaving you feeling tired and listless, it can also be a sign of underlying health conditions.  Here is some information on why woman seem to suffer more than men.  With thanks to

If you struggle to get out of bed in the morning, you’re not alone.

Almost half of British women (43%) say they are not getting enough sleep. In fact, 45% do not feel well-rested when they wake up.

The results are part of the ‘Reclaim Your Sleep’ survey of 4,100 UK adults, conducted by YouGov and supported by the Sleep Apnoea Trust Association (SATA).

Health experts are now warning of the detrimental effect sleep deprivation can have on long-term health.

The survey uncovered that women are more likely to experience difficulty sleeping than men.

When asked about their sleeping patterns, 46% of women said they have trouble sleeping compared to 36% of men.

Women were also more prone than men to waking up during the night and having trouble getting back to sleep afterwards (36% compared to 23%).

More than half of women surveyed (60%) admitted to feeling irritable during the day because of their sleep problems and a further 33% said they felt less confidence in their appearance as a result of a bad night’s sleep.

Commenting on the findings, Professor John Stradling, a sleep expert from Oxford University said: “Often women think that feeling exhausted is just part of modern life when in fact it could be something more serious.

“Remaining untreated leaves women at risk of reduced quality of life and serious health conditions, so it is important that they speak to their GP about any sleep problems that they have – the sooner their sleep issues are addressed by a sleep expert, the better.”

Despite sleep problems clearly having a negative impact on a lot of women, only a minority of those surveyed said they have spoken to their GP about problems nodding off.

Bill Johnston, chairman from the Sleep Apnoea Trust Association warned that sleep problems such as restlessness could indicate more serious health problems such as sleep apnea.

Obstructive sleep apnoea (OSA) is a debilitating condition affecting around 1.5 million adults in the UK.

Pregnancy and the menopause can increase a woman’s risk of having sleep apnoea, yet according to the survey, the majority of women in the UK are unaware of this.

The symptoms of sleep apnea present themselves differently in women than men and include: softer snoring, lower report of sleepiness, insomnia, restless legs, fatigue/day-time sleepiness, depression, headaches and muscle pain.

If left untreated, the condition can lead to other more serious health problems such as stroke and heart disease.

Johnston said: “The overall lack of awareness around sleep apnoea symptoms and its impact on a person’s health may mean that many are suffering in silence so it is important that we work with healthcare professionals to uncover this missing group and help minimise the impact of sleep problems on their lives.

“Women also need to help their doctor understand how they sleep to avoid misdiagnosis. Discussing their sleep quality, and any difficulties sleeping (such as insomnia, frequent awakenings, snoring and sleepiness or tiredness during the day), will really help.”

Nigel completes the London Marathon for the British Tinnitus Association

This years London Marathon saw Tinnitus sufferer Nigel Webster run to raise money for the British Tinnitus Association.  London ENT specialises in the treatment of Tinnitus, so we are delighted to see money and awareness being raised for such a great cause.

Much more than just a ringing in the ears, Tinnitus can be a life limiting affliction to suffers.  Here is Nigel’s story:

With thanks to

Nigel said: ‘It was really good, and there were so many supporters cheering us on.

‘The last ten miles were hard but the crowds were fantastic, cheering ‘go big ears!’

‘I was wearing ‘big ears’ to draw attention to the British Tinnitus Association – which aims to build awareness around tinnitus, and also encourage young people to wear ear plugs when listening to loud music.’

Nigel suffers from tinnitus, and explained how it feels to suffer with the condition: ‘Late one evening a few years ago, I noticed a high-pitched sound in my head behind my ears – the sort I had experienced many years ago on a number of occasions when emerging from a nightclub in the early hours.

‘This sound always disappeared by the morning and I thought nothing more about it. ?‘Forty years on, now I have to live with it 24 hours a day. If I think about it, the sound becomes very loud and also it seems to be worse if I get stressed. And so the only way I cope is to occupy myself and mind on other things.’

Nigel continued: ‘There is no cure and I can imagine that for some without support it could be difficult at times to deal with.

‘Noise is all around us every day but most people can find peace and quiet somewhere sometime. However with tinnitus there is always a noise and nobody knows you suffer with it unless you tell them.

‘There are times through lack of sleep I get irritable and increasingly I find myself asking people to repeat things several times because my hearing is impaired. My concentration has been affected too by this condition and sometimes completing tasks at work can be that much harder.

‘I find it very difficult to cope with noise and crowds, and restaurants, shops and traffic can be quite stressful.

‘Running helps my physical and mental fitness and raising money to support the BTA promote better awareness for this condition gives it some purpose.

Nigel has raised £649.93 so far, and will continue fundraising to reach his target of £2,000 pledged to the BTA.

Nigel added: ‘I would like to thank those people who have donated, along with the BTA for giving me the opportunity to run and help raise awareness for this condition.’

To donate money to the British Tinnitus Association, visit Nigel’s webpage at

Halitosis – How To Avoid It!

It is estimated that up to half of us have bad breath.
 It is estimated that up to half of us have bad breath. Photograph: Getty Images

With thanks to

“Don’t fool yourself,” said a 1928 advert for Listerine mouthwash, “Since halitosis never announces itself to the victim, you simply cannot know when you have it.” Many of us do indeed worry that our breath smells fetid and sulphurous. There’s even halitophobia, when people are convinced they have bad breath but don’t. It is estimated that up to half of us have bad breath, which seems a bit excessive: the rate of “objectionable bad breath” is thought to be more like 2.4% of adults.

It’s hard to diagnose it yourself. Breathing into your hands and sniffing them only tells you if your hands smell. Licking the back of your wrist and smelling it after 10 seconds isn’t accurate either. Flossing and then smelling is only likely to reflect any decaying food. The taste in your mouth isn’t closely related to how your breath smells. Breath clinics have machines such as halimeters that measure sulphur emissions, but the most reliable way is for an expert to smell and score the level and type of odour. Or failing that, a close friend.

In 85% of people, halitosis originates in the mouth. You may think that’s obvious, but tonsillitis, acid reflux in the oesphagus and kidney and liver problems can also make the breath smell. However, it’s the 600-plus bacteria in the mouth – particularly the ones producing unstable sulphur compounds from proteins breaking down – that are usually the culprits.

A BMJ review says that it is poor oral hygiene that’s usually to blame. The most likely cause is food and bacterial plaque on the tongue and teeth – especially when this causes gum inflammation. The main culprit is the back of the tongue, and some people happen to have grooves that allow a white coating to accumulate. A coating that is only 0.1mm thick can reduce the oxygen to the tongue, allowing the bacteria that grow best without oxygen to flourish and produce smelly compounds.

The solution

Regular teeth-brushing and flossing will reduce the problem. A systematic review found that tongue scraping (which I always thought was a stupid idea) might work – but do it gently, back to front, as there are more bacteria at the back. Another review found that mouthwashes with chlorhexidine gluconate, which reduce bacterial levels, can help, especially after tongue-brushing when the bacteria are exposed and defenceless (although too much mouthwash can stain the teeth). Using before bedtime may also work well, as bacteria multiply at night when the mouth is dry and gets less oxygen. Ones without alcohol are best as they avoid drying out the mouth.

But all these things need to be used continually. Chewing sugar-free gum stimulates saliva and reduces bad breath and is a good insurance policy during the day.

Why this may be the year you get hay fever for the first time

With thanks to: The Daily Mail,  April 11th 2016

Rise of ‘super allergies’: Why this may be the year you get hay fever for the first time

  • New reports say so-called ‘super allergies’ are on the way
  • Reactions will last longer & affect ‘those who haven’t had allergies before’
  • So what’s going on – and what can you do to protect yourself?

There’s been worrying news for allergy sufferers recently, with reports that so-called ‘super allergies’ are on the way.

Not only will these allergic reactions last longer – depressing enough for the estimated 21 million allergy sufferers in the UK – but they’ll also affect ‘even those who have not had allergies before’, explains Dr Bill Frankland, a leading allergy expert based at the London Allergy Clinic.

So what’s going on – and what can you do to protect yourself?

Screen Shot 2016-04-27 at 22.05.09


‘Most allergies are caused by inhaled, small water soluble proteins carried on dry particles such as pollen, or dust-mite faeces,’ says Dr Frankland, the expert who devised the scientific daily pollen count now included in weather reports.

‘Once these particles land on the mucosa, the membranes that line the airways, the allergen diffuses into it, setting up the reaction.’

Hay fever is up to twice as common in towns and cities as in the countryside, largely because of higher levels of traffic pollution, adding to irritation in the airways, according to charity Asthma UK.

‘It is not that people are allergic to pollutants, but this can make the situation worse for people who are already allergic to pollen,’ says Dr Hilary Longhurst, a consultant clinical immunologist at St Bartholomew’s Hospital in London.

Hay fever is up to twice as common in towns and cities as in the countryside [file photo]

And there is also evidence that the mucosal irritation caused by pollutants can ‘prime’ people who would not normally develop allergies to become allergic, adds Professor Sir Malcolm Green, founder of the British Lung Foundation.

He says the situation is being made worse at times by air pollution which is coming from fume-filled areas of Eastern Europe due to south-easterly winds (the UK’s prevailing winds are south-westerly).

The tiny particles of pollution (particulates) released by diesel fuel are considered particularly hazardous.

‘Pollutants, including diesel particles, which are really just minute globules of toxic tar, and ozone (formed by the effect of sunlight on nitrous oxide, a vehicle exhaust pollutant) irritate the lining of the lungs and make them more sensitive,’ says Professor Green. ‘So when an allergen such as pollen comes along, the lungs are already primed to react.’

In some cases, particulates may trigger allergies in people who did not have them before, he says. ‘Some people are “tipped over” into an allergic response because their lungs are sensitised by particulates.’

Pollution may even make some allergens more potent. A study in the journal Plant, Cell & Environment, found that ragweed plants exposed to high levels of nitrogen oxide, from power stations and vehicles, produced modified pollen that was more virulent, producing more severe or prolonged allergic reactions.

Ragweed, one of the daisy family, thrives along rivers and roadsides.

Screen Shot 2016-04-27 at 22.09.19


Airborne pollen is the most common cause of seasonal allergies – around 95 per cent of hay fever sufferers are allergic to grass pollen, for instance.

The temperature and the weather make a huge difference to the levels of pollen and other irritants such as diesel particulates and dust circulating in the air.

When it’s warm and dry, these particles stay suspended in the air for longer, entering the nose and mouth and landing on the delicate mucosal layer of the upper airways. Fourteen of the 15 hottest years on record have occurred since 2001, say the UN World Meteorological Organisation.

Last year was the hottest year since records began and 2016 is likely to be another record-breaking year, says Dr Grant Allen, a senior research fellow at the School of Earth, Atmospheric and Environmental Sciences at the University of Manchester.

‘And 2016 is expected to break that record again due to the compounding influence of the periodic El Niño, the warm phase of a recurring climate pattern that develops in the tropical Pacific.’


It’s not just that the allergens could be hanging around in the air for longer, but there may be more pollen, too. The hay-fever season normally starts in January when the alder trees release their pollen and lasts through to September when nettle pollen disappears.

The peak season for grass pollen is usually mid-June, according to Beverley Adams-Groom, chief palynologist (pollen expert) and pollen forecaster at the National Pollen and Aerobiology Unit at the University of Worcester.

There is substantial evidence to show that the timing of some of the pollen seasons in the UK is getting earlier and lasting longer

‘If the predicted combination of prolonged periods of warm, dry weather with intervals of some wet weather occurs, we’ll experience high grass pollen counts,’ she says. During the past ten years the ‘plant’ growing season has been getting longer as a result of warmer springs and summers, meaning that the pollen season is extending, too.

As Dr Mark McCarthy, manager of the National Climate Information Centre, explains: ‘Between 1861 and 1890, the average growing season by this measure was 244 days, and measuring the same period a century later, the average growing season had extended by just over a week.

‘For the most recent ten years between 2006 and 2015, the average growing season has been 280 days.’

Dr Jean Emberlin, of Allergy UK, adds: ‘There is substantial evidence from pollen monitoring records and vegetation surveys to show that the timing of some of the pollen seasons has been changing in the UK, getting earlier and lasting longer over the past few decades. In addition there has been a trend to increasing pollen loads of some types.’

Dr Longhurst points out that the severity of allergy symptoms are directly related to length of time of exposure, so ‘symptoms will be worse and also go on for longer’.

Screen Shot 2016-04-27 at 22.09.11FOREIGN INVADERS MAKE IT WORSE

There are around 30 different types of pollen that cause hay fever and it is possible to be allergic to more than one type.

While most people with hay fever are allergic to grass pollen, warmer weather means there are more potential allergens, as it is helping non-native plants to thrive and some of these are highly allergenic. ‘Invading plants such as ragweed, which is the main cause of pollen allergy in the U.S., will be bringing increasing amounts of allergy-inducing pollen to Britain,’ says Dr Frankland.

In the past, children played outdoors in the mud and muck and their immune systems learned to recognise harmful pathogens

Ragweed carries a potent allergen known as Amb a1 (antigen E) which is more irritating to the airways than either grass or birch pollen (another common cause of hay fever, with one in four sufferers affected by it).

The peak ragweed pollen season is mid September. ‘These allergens produce an abnormally vigorous response causing more severe symptoms,’ explains Dr Frankland.

Not every hay fever sufferer is allergic to ragweed, and currently our cool, damp summers keep it in check, but this is likely to change, as temperatures rise.

Christoph Sarran, a scientist at the Met Office, says that there is a possibility that warmer temperatures will prompt some allergenic species to start producing pollen twice in a single season. On the plus side, ‘some allergenic native species may reduce or disappear’.


More people than ever are affected by allergies, but it’s not clear why. One theory is that it’s down to children’s lack of exposure to bacteria because their environment is too clean, causing the immune system to overreact to harmless proteins such as those found in pollen grains.

Grass pollen becomes a problem in May and peaks in mid June [file photo]

‘This doesn’t answer all the questions, but it is the best explanation we have,’ says Dr Longhurst.

‘In the past, children played outdoors in the mud and muck and their immune systems learned to recognise harmful pathogens and distinguish them from harmless things. The price we pay for Western living standards is a rise in allergies of all kinds.’


Holly Shaw, nurse adviser at Allergy UK, says that people can do a lot to help themselves.

She advises checking the pollen forecast in your area to plan your outdoor activities and avoid being outside when the pollen count is highest (usually early morning/evening).

It helps if you know what pollen types you’re allergic to so you can minimise your exposure and start treatment at the right time – this may simply be a question of guesswork, based on when your symptoms are most severe and which plants are pollinating.

According to Beverley Adams-Groom, hazel and alder come first in late January and February followed by the birch pollen season which typically starts at the end of March.

Grass pollen becomes a problem in May and peaks in mid June. Weed pollen and mould spores come into their own in late summer.

Holly Shaw also advises that people who suffer from hay fever keep doors and windows closed in peak pollen times.

‘If you need to go outside during times when pollen counts are high, wear wraparound sunglasses.’

A balm applied around the rim of your nostrils can act as a pollen trap. If you know the pollen count is going to be high, nasal steroid sprays can be used preventatively before your symptoms start, says Holly Shaw.

The symptoms themselves can be ‘effectively managed by taking a daily non-sedating anti-histamine, which reduces inflammation in the lining of the nose and throat,’ she says. ‘Your GP or pharmacist will be able to advise on the correct medication choice for the severity of your symptoms.’

While pollen forecasts do not currently reflect pollution levels, there is a daily air quality index (published by the Department for Environment, Food & Rural Affairs ) that shows where areas of pollution in the UK are high, with forecasts for up to five days available.

Read more:



Advanced Skull Base Dissection and Rhinoplasty

Paul attended the University of Pennsylvania Advanced Skull Base Dissection and Rhinoplasty Courses as an international guest. This was a 4 day intensive course aimed at refining advanced surgical skills in complex situations.

Simon Cowell’s guide to beating bad breath

With thanks to: The Daily Mail Online

How drinking black coffee and forgetting mouthwash can stop halitosis

cowellMusic mogul Simon Cowell may have a fine set of snow-white teeth, but he’s clearly worried that his breath isn’t quite as fresh as that Hollywood smile.

This week he was pictured in his limo with a packet of CB12 boost — sugar-free gum containing zinc (a deficiency of which can cause halitosis) that promises to zap smelly breath.

Oral hygiene expert Dr Phil Stemmer, of the Fresh Breath Centre in London, says Cowell’s smoking and coffee-drinking habits are common causes of halitosis: ‘Cigarettes reduce the flow of saliva through the mouth, which is needed to wash away bacteria that give off odorous gases.’

It would be a brave soul who broke bad-breath news to the most powerful man in music — but according to Dr Stemmer, minty gum may only mask the problem temporarily.

So, given that up to 65 per cent of us will suffer from halitosis at some point in our lives, what other ingenious ways are there to banish it?

We all know a cappuccino can leave a strong taste in the mouth. But it’s the dehydrating effect of the caffeine, combined with milk residue fermenting in your mouth, that causes the pong, rather than the coffee beans.

In fact, Israeli scientists found that coffee can inhibit the bacteria that lead to bad breath. So if you don’t want to cut back, at least try drinking it black, followed by plenty of water.

An even better way to get your caffeine kick, and keep your breath sweet, is switching to green tea.
Made from the same plant as your normal cuppa, it retains less caffeine and more polyphenols, which are believed to neutralise the sulphurous gases given off by oral bacteria.

Ever noticed that your breath is bad after a night on the sauce? That’s because alcohol is a diuretic, which dries up the saliva needed to break down and rinse away bacteria.

But many mouthwashes contain alcohol, too —  so when the minty smell wears off, you could be left with even staler breath than before.

sluicing with coconut oil for ten to 15 minutes, then spitting it out, could be the best way to dislodge oral bacteria from their hiding places.

Dr Payman Langroudi, a dentist from the chain Enlighten Smiles, says: ‘These micro-organisms contain fatty membranes that are attracted to the oil as you swill it around. Coconut oil also has antibacterial properties.’

Up to 85 per cent of the bacteria that cause bad breath are on the tongue’s surface. Some dentists offer ‘tongue manicures’ to strip away smelly debris, though experts at the British Dental Association say a toothbrush without toothpaste works well, too.

Try the Orabrush Tongue Cleaner (£5.10, which claims to keep breath fresh for up to 12 hours.

If you’ve scraped your tongue and ditched the coffee but your breath is still off-putting, try yoghurt.

According to the International Association for Dental Research, volunteers who ate 90g of yoghurt twice a day for six weeks saw an 80 per cent drop in the levels of hydrogen sulphide — a  major cause of bad breath — in their saliva.

that tingling feeling as you suck a fresh-breath mint isn’t killing bacteria. It’s just a sensation.
The main reason why chewing gum works is that  it stimulates saliva production — but chew for too long and your stomach will produce extra acid in anticipation of food that never arrives, causing different smells.

Dr Mel Rosenberg, from the British Dental Association, recommends chewing a piece of sugarless gum for a few minutes, then throwing it away.

This is the best way to remove food from teeth before it can putrefy. Food that lingers eventually turns to plaque, contributing to bad breath.

Much of our diet is too processed, says dentist Dr Phil Stemmer: ‘Because we chew less, there is less friction and the bacteria is not removed in the digestion process.’ Try eating crisp fruit and vegetables such as apples, celery and carrots.

Cowell may be a halitophobic – someone who thinks he has bad breath when he doesn’t.
Dr Stemmer estimates that 1 per cent of us wrongly think we have a problem:

‘The numbers are definitely growing and it has debilitating consequences. One lady I treated didn’t leave her house for seven years.’

One way to check if you do have bad breath, the British Dental Association says, is to smell your dental floss after you’ve used it.

But Dr Stemmer says: ‘The best test is asking a close friend or family member. If they love you, they’ll tell you the truth.’

Read more:

Me and my operation: The magic tube that helped me breathe again

Taken from: The Daily Mail Online

Around 600,000 Britons suffer from nasal polyps, which can lead to loss of smell, breathing difficulties and severe headaches.

Beverley Rudman, 52, an accountant who lives with her husband Ian near Romford, Essex, underwent a new treatment for them, as she tells DAVID HURST.



My nose caused me suffering for over ten years — I can’t count the number of times I went to the doctor about it. Often, I could barely breathe. I was constantly sniffing and sounded really nasal. I also suffered from headaches and snored, and I used to burn things a lot because I couldn’t smell.

Flavours had to be very strong before I could taste them — my enjoyment of cooking and eating were totally spoiled. The doctors said it was hayfever. They prescribed tablets and told me to try steam inhalations, neither of which made much difference.

A few years ago, a friend said it sounded like I had polyps — tiny swellings in the nose or sinuses, which made breathing difficult. Even though I thought that’s what it was, I didn’t mention it to my GP because I assumed he knew best. If only I had, it would have shortened my misery by years.

I was also concerned about the treatment, which involved putting instruments up your nostrils to cut out the polyps. And in some cases, when the polyps are large, they have to do this through your cheek, which can cause eye and even brain problems.

I decided instead to grin and bear it.

But then last year things got really bad: I was in constant discomfort and my sleep was being ruined by my snoring. If it was polyps, I thought, the operation couldn’t be worse than how I was feeling.

So, in November, my GP referred me to an ENT consultant. He confirmed I did have polyps and gave me special nasal drops to control the inflammation.

When I went back to see him a month later, I already felt better. He explained that the polyps needed to be removed and told me about a new procedure, which was less painful and more efficient than the other one. There was also less of a risk of injury.

This new procedure involved inserting a tiny tube into my sinuses to deliver steroids into the area. These would be slowly released over four weeks, reducing the inflammation and the polyps until they shrank away.

I had the operation in January under general anaesthetic. I thought afterwards I’d be in pain and have black eyes, but there was nothing. I was allowed to eat and drink normally and was discharged that evening.

It took about a fortnight for my taste and sense of smell to return. People have said that I sound less nasal. My breathing is also normal and my snoring has vastly improved.

And I can now enjoy cooking and eating — it’s so wonderful to be able to smell again!


Paul Chatrath is a consultant ear, nose and throat surgeon at Queen’s Hospital, Romford, and Spire Roding and Hartswood Hospitals, Essex.

He says… A nasal polyp is an abnormal growth of tissue that forms because of inflammation in the tissue lining the nose or sinuses; the inflammation causes fluid to build up in the tissues, forming small, grape-like swellings. They usually affect both nostrils.

It’s not clear what causes the inflammation, but likely triggers include a bacterial or viral infection or an allergy — conditions such as asthma and hayfever cause sinus inflammation, making it more likely for polyps to form.

Polyps can trigger headaches, double vision, loss of taste and smell, breathing problems and cold-like symptoms.

Diagnosis is with a CT scan. The first line of treatment is a steroid nasal spray, drops or tablets. But if this doesn’t work, a patient will require surgery known as a polypectomy.

Using an endoscope — a thin tube that contains a video camera — we look inside the nose and sinuses to locate the polyps. We then insert small surgical instruments into the nostrils to remove them.

In some cases, small pieces of bone are also removed from the nose to reduce the chances of them returning. There is a 0.5 per cent risk of injury to the eyes or brain with this treatment.

Generally, patients will be able to go home the same day. However, in approximately three out of four people who have surgery, the polyps grow back after an average of four years.

With the new op, if the patient has polyps in their sinuses, this is usually performed in conjunction with another relatively new procedure, balloon sinuplasty, in which the sinus is enlarged by having a tiny balloon inflated inside.
This increased space makes it possible to use the new technique.

First, a tiny tube — or stent — containing steroids is inserted into the sinus. The device has fine pores that allow the steroids to seep into the surrounding tissues over the next few weeks. This reduces the inflammation, which in turn shrinks the polyps.

The operation takes between 45 minutes and an hour, and patients feel better immediately. Beverley’s results have been tremendous — she can smell, taste and breathe properly once again.

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