Masters in Surgery (ENT) Diploma

Paul attended the Masters in Surgery (ENT) Diploma at Canterbury Christ Church University, Kent where he is module lead for the rhinology and facial plastic surgery lectures.


Throat just sore, or something more?

sorethroatHere at London ENT we know that having a sore throat can be a painful and sometimes debilitating business.  Often times, your sore, dry, tickly throat is the result of a cold or a virus.  Many sore throat symptoms improve as your cold or virus does, without the need for any further treatment.  But sometimes a sore throat can mean a further infection that may need to be treated with a course of antibiotics.

This time of year we are particularly susceptible to colds and flu-like viruses as our immune systems are fed up of winter and desperately need the vitamin D of the Spring sunshine.  Most of us will come down with a cold at some point over the Winter season, and most of us will deal with it accordingly without too much fuss.  But, when you can’t swallow, or feel like you have swallowed a razor blade, it could well be time to take that throat to the doctors for further examination.

What kinds of sore throat are there?

1. Viral Sore Throat

This usually occurs at the same time as, or shortly after, a ‘flu-like illness or cold affecting the nose and sinuses (also known as the upper respiratory tract). As part of the illness, the throat usually becomes inflamed and sometimes infected as well. Symptoms may include a runny nose, sneezing, hoarseness, dry cough, decreased hearing and redness of the pharynx and tonsils. To treat a viral sore throat common painkillers such as paracetamol and/or ibuprofen, drinking plenty of fluids and gargling with saltwater all help to ease symptoms.  Find out more about viral sore throats from our specialist ENT surgeon.

2. Tonsillitis

The tonsils are part of the immune system and are made up of lymphoid tissue, whose job it is to fight infections or viruses when they occur. In most people the tonsils therefore play an important role but if they become unhealthy in their own right, they can occasionally give rise to infections of their own. An acute attack of tonsillitis can be quite severe and debilitating for the patient. Tonsillitis  causes particularly severe sore throat which is the main symptom, occasionally but not always associated with flu-like symptoms, during which the tonsils become enlarged, red and inflamed and cause pain on eating, fever, referred pain to the ears and enlarged neck glands. Paul Chatrath, our consultant ENT, has written more information about tonsillitis here.

3. Quinsy (Peritonsillar Abscess)

This is a condition in which an abscess forms next to the tonsil. It usually occurs following a severe episode of acute tonsillitis, which results in spread of the infection to the tissues outside the tonsil and the subsequent build up of pus. This causes the tonsil to bulge in wards, pushing part of the soft palate over to the other side. Symptoms of quinsy tend to be even more severe than those of tonsillitis, and can be very painful for the patient.  Find out more about what a Quinsy is here.

4. Glandular Fever (Infections Mononucleosis)

This condition most often occurs in teenagers and young adults. It is caused by the ‘Epstein- Barr’ virus, which is easily transmitted from person to person through saliva or droplets. Symptoms include a severe sore throat, feeling of tiredness and lethargy which can outlast the duration of the infection, fever, enlarged tonsils often with a surface white membrane, enlarged neck lymph nodes (cervical lymphadenopathy) and occasionally the presence of a red rash. If you would like to know more about glandular fever, it’s symptoms and recommended treatments, read our article here.

There are, of course, certain other medical complaints that can cause a sore throat, but which are less common. These can include a blocked nose, acid reflux or even tumours in the throat.

In most instances of sore throat your GP will be able to assist you with any symptoms and prescribe medication where necessary, but if you are concerned or would like to find out more call us on 07969 562855 to see how we can help.


When is a cold, more than just a cold? Is it the sniffles or a Sinus Infection.

lady-blowing-her-nose

When is a cold, more than just a cold? Is it the sniffles or a Sinus Infection?

With winter very much upon us, the cold season is in full flow. Have you felt the tingle at the back of your throat yet, the stuffy feeling in your nose? If not, you can assume it will probably get you at some point over the next few months.

The common cold is literally as..ahem….common as can be at the moment. Coughs and sneezes are very easily transmittable and can pass round family homes, schools, workplaces and other populated areas at a rate of knots. Whilst there is no real cure for a cold, keeping warm, keeping hydrated and fighting off symptoms with painkillers and decongestants, can help us get through it without too much fuss. But when is it more than just a cold? Some conditions present with very similar symptoms to a cold, but can be a chronic condition that may need medical intervention.

A cold will generally last anything between 3-14 days and symptoms can take a few days to appear after the infection with the virus. Colds are, of course, most common in winter, but can happen all year round. A cold will give you a nice batch of varied symptoms including coughing, aches, fatigue, a raised temperature, itchy eyes, a sore throat and a stuffy, blocked nose.

When your nasal passages become infected however, it turns into a sinus infection, called sinusitis, which is harder to get rid of than a cold. Whilst colds don’t usually cause sinus infections per se, they do offer a breeding ground for them.
Look for the following symptoms to help you decide whether you have a cold or an infection:
Sinus pressure behind the eyes and the cheeks
A runny, stuffy nose that lasts more than a week
A worsening headache
A fever
Cough
Bad breath
Thick yellow or green mucus draining from your nose or down the back of your throat (postnasal drip)
Fatigue
Decreased sense of smell

If you think you have a sinus infection, you may need to see your doctor. Your doctor may even prescribe you a course of antibiotics to help clear the infection. If you find that you are suffering from sinus infections on a regular basis, there are other treatments you can try. A sinus irrigation, for example, can help ease symptoms. There are even surgeries that can be performed to ease the symptoms of chronic (ongoing) sinusitis. One option, called functional endoscopic sinus surgery (FESS) may be recommended. This is a procedure to improve the drainage of mucus from your sinuses and will be undertaken by a specialist under general anaesthetic. Another possibility is balloon sinuplasty, which is a much less invasive operation, requiring less surgical cutting and in some cases being able to be performed under a local anaesthetic whilst you are awake.

At the London ENT we can help with a wide variety of conditions and specialise in finding solutions for chronic sinusitis. Our experienced consultant, Mr Paul Chatrath, will be happy to meet with you to find out how we can help improve your quality of life. Find out more about how we can help cure your sinusitis by calling us today on 01708 763581 or 07969 562855.


Balloon sinuplasty – noninvasive treatment for sinusitis

This noninvasive technology has revolutionised the management of sinusitis and is now increasingly being used either alone or alongside traditional sinus surgery techniques. It is now also being offered to selected patients under local anaesthetic and/or sedation, avoiding the need for a full general anaesthetic.

Please refer to the separate page on balloon sinuplasty (under procedures) for further information on this technique.


Titanium Nasal Implant

A total of eleven patients have now received the Titanium BreatheTM nasal implant in the last 6 months, and all with excellent results so far. Many more have had the implant in the UK and abroad, in all cases for the correction of a weak inner nasal valve or outer (alar) cartilage. Without exception patients have reported a much improved nasal airway, with no instances of graft migration or visibility.


Surgery for halitosis (bad breath)

Halitosis, or bad breath, may occur for several reasons, ranging from dietary factors, a blocked nose causing mouth breathing, and problems within the mouth itself. One of the commonest reasons is due to a build up of debris within the tonsils which occurs when food particles get stuck inside one or more of the deep crypts which make up the surface of the tonsils. Mouthwashes and regular rinses may help albeit only temporarily.

If the problem becomes particularly severe, your specialist may recommend either a tonsillectomy (removal of the tonsils) or tonsillotomy(reduction in the size of the tonsils). This can be performed with or without the laser. Both are performed as day case procedures under a general anaesthetic, and results are almost always excellent.


Incision-less Pinnaplasty

Incision-less pinnaplasty. In recent years, a novel technique has been developed for pinning back prominent ears without the use of any external cuts or incisions to the skin. This is achieved with the use of carefully placed sutures passed into the ear cartilage. The operation can be performed under local anaesthesia more easily than a conventional pinnaplasty, usually as a day case. The advantages of an incision-less versus conventional pinnaplasty are a shorter operation, no need for external incisions or cuts in the skin, fewer postoperative complications, equivalent cosmetic result with minimally invasive surgery, easier to perform under local anaesthetic, no need to wear a postoperative head bandage and same-day discharge home.

Please refer to the separate information sheet on pinnaplasty for further information and images.


Cyclops endoscope (Acclarent)

The company responsible for the highly successful balloon sinuplasty technology, (Acclarent), has recently been taken over by Johnson & Johnson. The company identity is to be retained, an alliance which should hopefully yield further improvements to the already successful design. Please see www.acclarent.com for further information.

A further development has seen the introduction of the Cyclops rotating rigid endoscope which allows for a wide field of view which can be rotated through 10 to 90 degrees using the same endoscope. This formally was only possible by changing the endoscope each time a different angle is required.


Gaviscon AdvanceTM

Now licensed for use in laryngopharyngeal acid reflux. Gaviscon Advance TM, by Reckitt-Benckiser, is widely known as an effective treatment of indigestion and symptoms of gastric acid reflux, including burning behind the chest and pains in the upper part of the abdomen. It works by acting as a protective barrier within the stomach, preventing naturally occurring episodes of acid reflux from entering the oesophagus. The acid stays in the stomach where it causes fewer symptoms.

In some patients, acid or other substances including the enzyme pepsin reflux into the upper oesophagus and larynx, causing symptoms of burning in the throat, sore throat, hoarseness and a feeling of something stuck in the throat (also known as globus pharyngeus). These symptoms can occur even in the absence of the usual symptoms of gastric acid reflux. This condition is known as laryngopharyngeal reflux (LPR). Up to now, Gaviscon AdvanceTM has been used in patients with LPR to good effect although its use has not been formally licensed until recently. This is good news for the many sufferers of this condition as Gaviscon AdvanceTM has minimal side effects and is effective in the majority of patients, either alone or in combination with other treatments.