Empty Nose Syndrome

Empty Nose Syndrome (ENS) , otherwise often referred to as Atrophic Rhinitis, is a disorder of the nose and nasal passage. Sufferers of this rare condition will have clear nasal passages that appear regular but they will have a range of symptoms. People who have had nasal surgery are most likely to suffer from ENS.



Multiple previous operations on the nose or nasal passage will increase your chances of developing ENS. People who have had a turbinectomy of any kind may suffer symptoms of ENS but it doesn’t mean that every turbinectomy will lead to it. A turbinectomy is a procedure that removes part or all of the turbinate structure in the wall of the nose, in order to make the nasal passages larger and make breathing easier. Historically, turbinectomy was undertaken rather more aggressively with removal of a large part of the inner nasal lining. Nowadays it is customary to preserve as much functioning mucosa as possible, thereby vastly reducing the risk of developing ENS.



  • Nasal bleeding
  • Dizziness
  • Headaches
  • Difficulty breathing
  • Soreness and inflammation
  • Weakened sense of smell and taste
  • Sleep issues
  • Inhaled air seeming too cold or dry



Unfortunately, there is no quick fix or easy treatment for ENS. Temporary symptom relief is the main goal of most treatments. Saline drips and gels can help to relieve the dryness of the nose but they can also remove beneficial mucus meaning bacteria can spread to the nasal cavity more easily. Antibiotic nasal sprays are advised alongside saline treatments due to this risk.

There are some home remedies that can relieve the symptoms of ENS:

  • Using a humidifier at night
  • Using a CPAP machine to help with breathing
  • Hot soups and hot liquids can ease symptoms
  • Living somewhere warm and humid

ENS is often diagnosed once other conditions that can cause similar symptoms have been ruled out. A cotton test used to be performed by the doctor if they suspected ENS, which involved a small piece of wet cotton being held where the turbinate would be. If this gives relief than the person could be an ENS sufferer. This test is rarely performed nowadays as it is not sufficiently reliable.

The Best Food And Drink For A Sore Throat

Having a sore throat can be a horrible experience, making it difficult and painful to eat and swallow. Obviously, eating and drinking are essential for your health. Here we look at the food and drink you should be consuming to help your sore throat and the ones to avoid.


Foods And Drinks That Are Good For A Sore Throat

  • Bananas – A soft fruit that will be easy on the throat and is healthy and filling too.
  • Pomegranate Juice – Studies suggest pomegranate juice can reduce inflammation and fight off infection.
  • Frozen Fruit – Fruit sherbets and popsicles can soothe the inflammation.
  • Honey – Studies suggest honey can heal wounds and fight infection, as well as being tasty and soothing.
  • Chicken Soup – Chicken soup has been said to have inflammatory properties that can clear airways, relieving the symptoms of a sore throat.
  • Tea – Teas and other hot drinks can soothe the throat.
  • Yoghurts And Smoothies – These are packed with nutrition and can be sipped throw a straw to make consumption easier.
  • Scrambled Eggs – The texture makes scrambled eggs soft and easy to consume. Also eggs are a great source of protein.
  • Vegetables (Well Cooked) – As long as they are cooked until they are soft, vegetables such as potatoes, cabbage and carrots are a good option if you have a sore throat.


Foods And Drinks To Stay Clear Of

  • Anything Citrus – Citrus fruits and juices are acidic meaning they can irritate a sore throat further.
  • Hard Or Crunchy Foods – Dry toast, nuts and crackers all have sharp edges that could cause more pain to an already inflamed throat.
  • Tomato Sauces – Tomatoes are also acidic which can anger a sore throat.
  • Alcohol – Alcohol and mouthwashes that contain alcohol can cause stinging to a sore throat. Alcohol can also make you dehydrated which can cause further problems.
  • Tobacco – Smoking and inhaling second hand smoke will only aggravate a sore throat.
  • Some Spices – Some spices such as chillies, nutmeg and hot sauces can make an inflamed throat even worse.
  • Sour Or Pickled Food – Any foods made with vinegar or salt can irritate an inflammation further.


As with any aspect of life, a balance is the ideal, however sticking to the advice above may help you manage a sore throat better.

Could Snorting Chocolate Powder Be The New Energy Buzz?

An Orlando based company called Legal Lean are promoting snorting the chocolate powder known as ‘Coco Loko’, for a legal and drug free buzz, selling the product in a tin of 10 servings for $24.99 (£19.30).

The trend that has been catching on in Europe is expected to become more popular with chocolate powder potentially replacing caffeinated drinks. The buzz is said to last anywhere from 30 – 60 minutes and works by the ingredients of the substance being dissolved into the nasal mucus membranes.

Ear Nose And Throat (ENT) specialist Dr Paul Chatrath has explained that whilst there are understandable medical reasons why inhaling chocolate through the nose could give the desired effects, there could be some potentially negative side effects of snorting the powder that are currently not known. Telling the independent: “We simply don’t know the negative effects of snorting the powder over a period of time”.

To read the full article click here: http://www.independent.co.uk/life-style/health-and-families/health-news/snorting-chocolate-powder-coco-loko-energy-buzz-legal-drug-free-caffeine-guarana-ginko-biloba-a7827111.html

Vertigo – All You Need To Know

What Is Vertigo?

Vertigo can be caused by a number of conditions. It is a very specific form of dizziness in which the person feels as though the room is spinning around them. It can arise when there is an issue with the brain, ear or sensory nerve pathway. You often hear people associating vertigo with a fear of heights but this is not medically correct. The correct term for a fear of heights is Acrophobia.

Vertigo can occur at any time but it usually happens after the age of 65 and can be temporary or long term.



Someone who is suffering from vertigo will feel that they or their surroundings are rotating or spinning when there is no actual movement occurring. The following symptoms are often associated with vertigo :

  • Light-headedness and issues with balance
  • Dizziness
  • Vomiting and nausea
  • A feeling of motion sickness
  • Tinnitus



Causes can depend on the type of vertigo. There are two main types, Peripheral and central vertigo.

  • Peripheral Vertigo – This happens when there is a problem with the balance organs of the inner ear. Usually this will be caused by an inflammation or viral infection. It can also come on following ear surgery, a heady injury, prolonged bed rest, labyrinthitis and vertebrobasilar. Other causes include a positional vertigo (‘BPPV’) or Meniere’s disease.
  • Central Vertigo – This happens when there are problems with the sensory nerve pathways of the brain. Migraine headaches are the most common cause. Less common causes are brain tumours, strokes, multiple sclerosis, transient ischemic attacks and acoustic neuroma.



Some cases of vertigo can resolve in time without any form of treatment needed. However, if there is an underlying issue, I.e. a bacterial infection, then this will need to be addressed. There are drugs that can relieve the symptoms of vertigo, for example anti-emetics to reduce nausea and motion sickness. The treatment will largely depend on the cause. Antibiotics or steroids may also be prescribed. If the vertigo does not improve within 2 weeks, it would be worth getting a referral to an ENT specialist for further investigation.

Don’t Tell The Doctor

Paul Chatrath featured in an episode of Channel 5’s ‘Don’t tell the Doctor’ recently. A young musician was referred to him to have his hearing thoroughly assessed and to discuss treatment going forward due to a loss of hearing a suspected tinnitus.

The patient explained that he has noticed very low volume and a high pitched ringing sound in his ears. Paul examined the patient’s ears and noticed that one ear drum was clean and healthy but the other had quite a build up of wax which he advised should be removed. He then performed a test using a tuning fork placed on the forehead which revealed the young man’s eardrums were normal. This showed that the cause of the tinnitus was not in the ear drum or middle ear but most likely the noise exposure due to the loud music the patient encounters when performing as a live musician. Paul went on to explain that this could be a temporary issue or it could actually be long term if there has been some damage to the inner ear that is not reversible. This does not mean that further damage is unavoidable as there are some changes that can be made to protect against this, such as using ear plugs and avoiding loud music events when possible. The tinnitus is unlikely to be permanent and may improve in time.

Tinnitus is partly generated by the ear but also partly by the brain, therefore over time people tend to adjust to it. Paul explained that within a few months the tinnitus should become less of a problem as the brain adapts to the small amount of damage, resulting in the symptoms subsiding and therefore the high pitched ringing sound decreasing and even stopping. This was a relief for the young musician who feared a much longer struggle.

Split Earlobe Repair

The Problem

Stretched ear lobes can, over time, cause a painful and potentially embarrassing but fairly common problem – Split ear lobes. This is when an earlobe has been torn by the usage of heavy ear rings or stretched by things such as flesh tunnels. This can actually cause the earlobe to tear leaving a painful and unattractive area on the side of your head. The old saying “Pain is Beauty” can apply to many things, but while suffering a small blister to enjoy the party heels is one thing, a torn ear lobe is something more permanent and can not be hidden away so easily, especially if you have short hair!


Earlobe Repair Surgery – What It Entails

Earlobe repair surgery is an option to fix the issue of both torn and stretched earlobes, whether severe or slight. This is a minor procedure that is performed under local anaesthetic and usually takes no more than 20 – 30 minutes to complete per ear. The excess tissue is removed and very fine, dissolvable stitches are then used to carefully stitch back together the two split areas. If the procedure is being performed on stretched ears it could take a little longer depending on how big the hole that needs to be repaired is. The fact that this minor procedure is very quick means that you can have it done and walk out of the clinic the same day. This means minimal disruption to your schedule, which is always a bonus!


Life After Earlobe Repair Surgery

It generally takes around four to six months for the ear to heal. You may have a small, subtle scar on your ear but this will fade over time and will certainly be far less obvious than the tear or stretching that it fixed. After six months you can re pierce ears if you wish, but it is advised that you seek advice from a practitioner first as to the best place for the holes so as to ensure no further damage to your ear lobes.

Cosmetic Nasal Surgery Explained

Should I have my Rhinoplasty performed by an ENT surgeon or a plastic surgeon?

This is something that is best decided after talking with your GP, however there are no firm reasons why you would require one over the other. An Ear nose and throat surgeon would perform a lot more rhinoplasties during their training as cosmetic rhinoplasty is not permitted on the NHS, but functional rhinoplasty (to improve nasal breathing) is and it is almost always carried out by an ENT surgeon. This means that ENT surgeons have extensive experience in rhinoplasties before they become consultants. Also, the external shape of the nose if often affected by bends or deviations in the nasal septum which is inside the nose. An ENT Surgeon will be better placed to be able to assess the impact of any such nasal septal deformity on the appearance of the nose and to correct this at the same time as the rhinoplasty.


Will my nose look like it has been operated on?

The aim is to perform a rhinoplasty that results in a normal looking nose. This could mean straightening a bent nose, removing a lump, turning up a down pointed nose etc but it will never mean making a nose look artificial. A good and well trained surgeon will leave you with the nose as close to your ideal nose as possible and no tell tale signs.


Which way of performing the surgery is best, closed technique or open technique?

An open technique rhinoplasty is done with a small cut at the base of the nose and also an internal cut. A closed technique means solely working on the inside of the nose. Both techniques can produce amazing results and the approach chosen should be down to the individual needs of the patient. A good surgeon will explain to you which method they intend to use and their reason why they intend to use it.


Can I have a second rhinoplasty if I am unhappy with the result of my first?

This depends on the individual factors, but assuming the aim is a reasonable and realistic one and all risks of surgery are understood by the patient then there should be no reason why a second, or even (rarely) a third rhinoplasty procedure can not be performed and achieve the desired results. The complexity of each subsequent rhinoplasty does however increase as do the potential risks so it is essential to think very carefully about what you are trying to achieve before proceeding with revision rhinoplasty surgery. Your surgeon will evaluate your aims and align them to what is technically and realistically achievable. The key is to arrive at a clear goal to avoid requiring more procedures than are necessary.

A Five Minute Guide To Glue Ear In Children

screen-shot-2016-12-04-at-13-58-33Glue ear?  What is it, how do you get it, and more importantly how can you get rid of it?  Here’s a quick guide from the experts at madeformums

What is glue ear?

Glue ear is a common childhood condition that occurs when the area behind the eardrum, known as the middle ear, fills with a sticky, glue-like fluid rather than air. This substance prevents the ear from working correctly, and affects the ability to hear. Glue ear is also known as otitis media with effusion (OME), or serious otitis media.

What causes it?

Doctors don’t know exactly what triggers glue ear, but it’s thought to be related to the eustachian tube, through which fluid normally drains away from the middle ear. When this stops functioning properly, fluid builds up in the middle ear, causing glue ear. Over time, this build-up of fluid prevents the eardrum from working like it should. Remember, this substance is behind the eardrum, so you won’t be able to see it or clean it out, so leave those cotton buds well alone!

What are the main symptoms?

The main symptom of glue ear is moderate hearing loss in one or both ears. To your child, this will be a similar sensation to the one you experience when you put your fingers in your ears. Keep an eye out for signs that may suggest your little one is having problems hearing. This can include struggling to keep up with conversations when there is a lot of background noise, and difficulty understanding people who are far away, or speak quietly. Some children with glue ear also suffer from mild ear pain or balance problems, although this isn’t very common.

What age group does it tend to affect most?

Glue ear usually affects children under the age of 7, and is most likely to be seen in those between the ages of 2 and 5. In fact, around one in five children around the age of 2 are affected by the condition.

Why should I be worried if my child has it?

Glue ear can occasionally delay language and speech development, particularly if hearing loss persists. Always see your GP if you’re worried that your child may be having problems with her hearing.

Is glue ear contagious?

No, glue ear is not contagious, although the cold virus which may have caused it can be. If your child has glue ear, your needn’t be concerned about infecting other children.

How is it treated?

In most cases, glue ear will clear up on its own within three months, so doesn’t need to be treated, just monitored by your doctor. However, if symptoms do persist, your GP may recommend treatment, especially if he’s concerned that the hearing loss may interfere with your child’s language and speech development. In these circumstances, grommets or t-tubes may be suggested. These are inserted during a minor operation, and will drain the glue-like fluid from the middle ear.

Will it have any lasting health effects?

It’s very unlikely that your child will suffer any long-lasting effects, so try not to worry. However, in very few cases there can be a minor delay in speech and language development, due to the moderate hearing problems caused by glue ear. This is usually only temporary and is more likely to occur in children who suffer from recurrent glue ear – when the condition returns even after treatment.

Here at The London ENT we can help to solve the ongoing problem of Glue Ear in children.  There are many medical treatments which have been tried over the years, including antihistamine medication for allergy, steroid nasal sprays and drops, steroid medication by mouth and antibiotics. The vast majority of these have not been shown to be effective in the long term treatment of glue ear. One of the few non-surgical treatments which have been shown to be helpful in selected cases is a balloon inflation device such as the OtoventTM balloon. This is used by placing one end of the device into one of the nostrils and inflating the balloon. This sends a jet of air into the nose, which in turn opens up the Eustachian tube and allows better ventilation of the middle ear. Once air reaches the middle ear, this encourages displacement of the glue ear out of the middle ear. The procedure needs to be repeated often several times a day for many days or even weeks. It is suitable for both children and adults and many patients find this effective.

Another option is for your child to be fitted with a hearing aid. Although this does not cure the underlying glue ear, it does allow your child to hear normally without the need for any other treatments or surgery. This then allow sufficient time for the glue ear to disappear by itself.

Call us today on (0)7969 562855 to find out more.


When Is A Sore Throat More Than A Sore Throat?


Tonsillitis and a throat infection have many similar symptoms. That’s because strep throat can be considered a type of tonsillitis. But people with strep throat will have additional, unique symptoms.
Symptoms of tonsillitis Symptoms of a sore throat
large, tender lymph nodes in the neck large, tender lymph nodes in the neck
sore throat sore throat
redness and swelling in the tonsils small red spots on the roof of your mouth
difficulty or pain when swallowing difficulty or pain when swallowing
fever higher fever than in people with tonsillitis
stiff neck body aches
upset stomach nausea or vomiting, especially in children
white or yellow discoloration on or around your tonsils swollen, red tonsils with white streaks of pus
headache headache
 Tonsillitis can be caused by a variety of germs, including viruses and bacteria. It’s most commonly caused by viruses, however, such as:
  • influenza
  • coronavirus
  • adenovirus
  • Epstein-Barr virus
  • herpes simplex virus
  • HIV

Tonsillitis is only one symptom of these viruses. Your doctor will need to run tests and review all of your symptoms to determine which virus, if any, is the cause of your tonsillitis.

Strep throat is caused specifically by the group A Streptococcus bacteria. No other group of bacteria or virus causes it.

Risk factors for tonsillitis and sore throats include:

  • Young age. Tonsillitis caused by bacteria is most common in children ages 5 to 15.
  • Frequent exposure to other people. Young children in school or day care are frequently exposed to germs. Similarly, people who live or work in cities or take public transportation may have more exposure to tonsillitis germs.
  • Time of year. Sore throats are most common in the fall and early spring.

You can only have tonsillitis if you have tonsils.

In extreme cases, strep throat and tonsillitis can lead to the following complications:

  • scarlet fever
  • kidney inflammation
  • rheumatic fever

You may not need to see a doctor for tonsillitis or strep throat. In most cases, symptoms will resolve within a few days of home care, such as rest, drinking warm liquids, or sucking on throat lozenges.

You may need to see a doctor, however, if:

  • symptoms last longer than four days and show no signs of improvement or have gotten worse
  • you have severe symptoms, such as a fever over 102.6°F (39.2°C) or difficulty breathing or drinking
  • intense pain that won’t subside
  • you have had several cases of tonsillitis or strep throat in the past year


Your doctor will ask you about symptoms and do a physical exam. During the physical exam, they will examine your throat for swollen lymph nodes, and check your nose and ears for signs of infection.

If your doctor suspects tonsillitis or a sore throat, they will swab the back of your throat to take a sample. They can use a rapid strep test to determine if you are infected with strep bacteria. They can get results within a few minutes. If you test negative for strep, your doctor will use a throat culture to test for other potential bacteria. The results of this test usually take 24 hours.

Based on your test results and symptoms, your doctor should be able to give you a diagnosis.


Most treatments will relieve your symptoms instead of actually treating your condition. For example, you can use anti-inflammatory medications to relive pain from fever and inflammation, such as paracetamol or ibuprofen

To relieve symptoms of sore throat, you can try these home remedies:

  • rest
  • drink lots of water
  • drink warm liquids, such as broth, tea with honey and lemon, or warm soup
  • gargle with salty warm water
  • suck on hard candy or throat lozenges
  • increase humidity in your home or office by using a humidifier


If you have tonsillitis caused by a virus, your doctor will not be able to treat it directly. If your tonsillitis is caused by bacteria, your doctor may prescribe antibiotics to treat the infection. Make sure to take antibiotics exactly as directed by your doctor.

Taking antibiotics will also help you reduce your risk of infecting other people. A research study involving 2,835 cases of sore throat showed that antibiotics reduced the duration of symptoms by an average of 16 hours.

In more extreme cases, your tonsils may be so swollen that you can’t breathe. Your doctor will prescribe steroids to decrease inflammation. If that doesn’t work, they will recommend a surgery called tonsillectomy to remove your tonsils. This option is used only in rare cases. Recent research also questions its effectiveness, with one study noting that tonsillectomy is only modestly beneficial.

Strep throat

A sore throat is caused by bacteria, so your doctor will prescribe an oral antibiotic within 48 hours of the illness starting. This will reduce the length and severity of your symptoms, as well as the complications and risk of infecting others. You can also use home remedies to manage the symptoms of inflamed tonsils and sore throat.


Tonsillitis and a sore throat are both contagious, so avoid being around other people while you’re sick, if possible. With home remedies and lots of rest, your sore throat should clear up in a few days. See your doctor if your symptoms are extreme or persist for a long time.

10 Tips for people who sleep with a snorer

We often see patients who suffer from very loud bursts of snoring.  Well, actually it is generally their partners who suffer from it as sleeping with a snorer can mean you lose, on average, an hours sleep a night.

www.telegraph.co.uk has come up with a pretty good list of tips to help you get more shut eye, we thought we would share them with you:

Changing your pillows to elevate the head can help to reduce snoring

Roll them over
Lying on your back makes the base of your tongue collapse to the back wall of your throat, often causing the snoring sound. Gently roll your partner over on to their side, and wedge some pillows snugly against their back to make sure they don’t revert to their previous position.

Change your pillows 
People with allergies are most likely to be snorers, as their nasal passages regularly get congested. To eliminate allergens, and decrease the severity or likelihood of snoring, dust regularly and replace your pillows every six months. Margo also recommends elevating your head by sleeping on a thicker pillow. “This will help open up your airways,” she explains.

Get a bigger bed
Sharing a tiny bed can be difficult at the best of times. But having limited space when your partner is snoring is particularly frustrating, launching a double-pronged attack on your potential for a decent night’s sleep. Both of you may find you sleep better in a wider bed.

Earplugs are a cheap and effective way of handling snoring. While basic earplugs usually do the trick, you can buy specialist earplugs that combat the low-frequency snoring sound.

Advise them to avoid alcohol before bed
Your whole body relaxes during sleep, but drinking alcohol can relax your muscles even further, which is no good thing. When your throat muscles relax too much, your tongue falls backwards into the airway, causing you to snore. “Also stay away from sleeping pills and antihistamines, as they too relax your airways,” Margo advises.

Invest in blackout curtains
To increase your chances of having a full sleep cycle when sharing a bed with a snorer, make sure other distractions are limited. Blackout curtains block both natural and artificial light from outside. The thick lining also means they’re also good at muffling outside noise.

Invest in white noise
White noise, a neutral sound, can dim our perception of sounds like snoring, making it more bearable. You can download white noise files online, or buy a white-noise machine that works alongside different sounds.

Having a comfortable mattress is half the battle to getting good sleep

Get your partner to shower 
Snoring happens when nasal passages are congested. One way to free up your sinuses is to take a long, hot shower and breathe in the steam. Another method is to breathe in steam from a cup of boiling salt water.

Choose the right mattress
Having a comfortable mattress is half the battle to getting good sleep, even if your partner snores. Mattress springs compress over time, meaning your spine gets less support. As well as trying them for yourself, it’s worth getting advice from staff when buying a new mattress.

Be understanding 
It can be frustrating trying to fall asleep when someone’s snoring, or to be woken by the sound. But getting angry can often exacerbate the struggle to get to sleep. Try to keep calm and tune out, rather than focusing on how irritated you are.

• Sammy Margo is a chartered physiotherapist sleep expert, and author of The Good Sleep Guide and The Good Sleep Guide for Kids

Here at London ENT we can help to treat snoring when it becomes a real problem.  Sleep apnea is a recognised medical condition which can be dangerous for the sufferer.  Call us today on (0)7969 562855 to book a consultation.