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.

Read more:

What is glue ear? And how do I know if my child has it? Symptoms and treatment explained

Article taken from

One of the most common health issues in children, glue ear affetcs 80% of UK children before the age of 10 – here’s how to spot the symptoms and treat it.

Ailments affecting your child’s ears can be frightening as we can’t really see what’s going on in there. But there are key glue ear symptoms to look out for and there are treatment options out there to get your little one fighting fit again.

Parents get used to dealing with a range of ailments, but problems with a child’s hearing can be one of the most distressing conditions to deal with, as it can cause everything from pain and trouble sleeping, to a delay in learning development and social engagement.

One of the main causes of hearing loss in children is glue ear – a common condition that’s caused when a sticky, glue-like fluid fills the middle ear and causes the child to develop hearing difficulties.

Approximately 80 per cent of children in the UK suffer with glue ear, with the majority of those under the age of ten.

It can be particularly problematic after a cough, cold, or ear infection when extra mucus builds up so it’s best to be symptom-aware as we head into cough and cold season.

Paediatrician Dr Ranj Singh has put together his top tips on spotting glue ear in a child, as well as handy advice on how to treat it.

Dr Ranj Singh’s symptom checker

1. Selective or loss of hearing

‘One of the most obvious ways to assess whether your child is suffering from glue ear is to look out for signs of hearing loss. For example, they may stop responding to instructions or struggle with conversation in a busy room unless you are face-to-face.

In fact some people mistake hearing loss for disobedience, when in fact the child isn’t ignoring instructions – they just can’t hear them.

You may also notice that they turn up the volume on the TV or that they become less responsive to everyday sounds such as the phone ringing or music on a radio.

2. Changes in behaviour

‘Another sign to look out for is any big changes in behaviour. Hearing loss can cause children to become angry and frustrated if they can’t keep up with conversations or understand what’s going on and they may even begin to isolate themselves from others or seem easily distracted and ‘zone out’.

Keep an eye out at school and in the playground to see whether they may be struggling to hear over background noise.

3. Trouble communicating

‘General problems communicating or a delay in the development of your child’s communication skills may also be a sign of glue ear. Excluding hearing problems is important in any child with speech and language issues.

Look out for changes in your child’s voice and language, especially if they are falling behind their peers at school or having difficulty in social situations.

4. Tiredness

‘It can be exhausting trying to strain to hear people all the time, so it’s no wonder that your child may become tired and more irritable if they are suffering with glue ear.

It’s usually quite normal to be tired after a long say at school or after attending a birthday party, but just be aware of any change in patterns that could be a sign that your son or daughter is having to work extra hard to keep up.

5. Ear pain

‘If left untreated, glue ear can become painful for some children. Not everyone will suffer from this, but if your son or daughter is complaining of frequent earache and has problems sleeping, it could be a sign that they are suffering from glue ear.

However, if the pain is severe or persistent, this could be a sign of an ear infection or something else, so you should always check with a healthcare professional.

Dr Ranj Singh

Dr Ranj Singh advises: “A child suffering with glue ear may present any combination of the above symptoms. In the first instance, it’s always sensible to speak to a healthcare professional to get them assessed and referred for further testing if necessary.

“Sometimes your doctor may prescribe antibiotics, particularly if there is suspicion of infection, and if the problem persists grommet surgery may also be advised.

“Unfortunately, despite the potentially significant consequences on development, there has traditionally been little in the way of definitive treatment for glue ear, other than surgery.  However, there is now a real alternative that has clinically-proven results.

Auto inflation device

“Auto-inflation devices provide a relatively non-invasive and low-cost option for helping to treat glue ear, potentially avoiding surgery & the use of antibiotics. They give parents an easy-to-use and effective treatment option for their children.”

Hay Fever In March Is A Real Blow

It may still be chilly out there, but did you know that the hay fever season is fast approaching? It’s easy for us to assume that hay fever is only a problem in the warmer summer months, but hay fever can actually be an almost year round ailment for some people.

hayfever 2What Is Hay fever, And Why Would I Get In This Early In The Year?

Hayfever, otherwise known as seasonal allergic rhinitis, is caused by an allergy to pollens and fungal spores. It happens when your body makes antibodies in response to certain triggers, such as pollen. The charity Allergy UK estimates that as many as nearly 18 million people have hay fever in the UK, with common symptoms usually including sneezing, itchy and watery eyes, and a stuffy nose.

It is very common in children but can often be found in adults as well. Symptoms are usually much worse for sufferers during the summer months as the pollen count rises, but some pollens can be found in the atmosphere much earlier.

If you happen to have symptoms that start as early as January or February for example, and continue until late March, it may be that you’re allergic to early flowering trees, such as the hazel and alder. In fact, many trees and grasses are flowering sooner and for longer, creating more of the pollen which is the main trigger of hay fever.

How Do I Know If I Have Early Hayfever?

The most common symptoms of hay fever include:

  1. frequent sneezing.
  2. a runny or blocked nose.
  3. itchy, red or watery eyes (allergic conjunctivitis)
  4. an itchy throat, mouth, nose and ears.
  5. cough, caused by postnasal drip (mucus dripping down the throat from the back of the nose)

These are the easiest symptoms to spot and are a tell tale sign of hay fever.  Sufferers can be unfortunate enough to also suffer from a decreased sense of smell,  facial pain, headaches, earache and fatigue.  No matter what your symptoms, hay fever can feel like a debilitating condition, especially if you have it from March right through unit  the end of the summer or even early autumn in many cases.

How Should I Treat My Hayfever

You can start by reducing some of the symptoms of hay fever by making sure you are in good physical condition.  Good stress management, a healthy diet, plenty of exercise and a good amount of sleep every night should put you in tip top condition.

Should you need to take medication to relieve your symptoms, hay fever tablets, called antihistamines, are very effective at relieving the symptoms of hay fever. You can usually buy these over the counter and they are available in tablet or liquid form or even as eye drops or nasal sprays. Antihistamines work by blocking the action of histamine, a chemical released by the body after it has been exposed to pollen. This, in turn, reduces the itchy eyes and runny nose.

The key to successful use of antihistamines is to start using them as a preventative treatment, two weeks before your symptoms usually begin. Of course, if you suffer from early hay fever, this can mean taking medication as early as February.  Taking the medications occasionally, or on the worst days is much less effective than taking them regularly as a preventative measure.

There are also a wide range of different nasal sprays which can be tried. These usually contain steroids in a low dose so that it can be taken regularly without fear of serious side effects, and as with antihistamines, they need to be taken before the symptoms start to have maximum benefit. Some can be bought over the counter, although many are prescription only, and it would certainly be advisable to consult with your GP if you have persistent symptoms to obtain access to the widest possible range of medications and treatments.

Most people with allergic rhinitis are successfully managed with allergy avoidance and medical therapies. However there are certain situations in which surgery may have a role. These would be as follows:

  • If you suffer from persistent symptoms resistant to medical treatment
  • If you suffer from anatomically large, swollen intranasal tissue (inferior turbinates)

Both of the above can be improved with the right surgery, although by and large surgery is not the only solution as the underlying allergy will still remain. Good anti-allergy management is therefore key.

For a very small number of patients with the most severe allergies, a treatment called immunotherapy is an option. This involves receiving a very gradual and graded exposure to the substance or allergen that you are allergic to. When given in very small doses, your immune system will gradually build up a tolerance or resistance to the allergen which means that you won’t react aggressively when exposed to it in the future.

Here at London ENT we are able to offer advise on a wide variety of allergies and prospective treatments to alleviate the same.  Speak to us today on 07969 562855 or click here to contact us by email, to find out how we can help you.

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.


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
Bad breath
Thick yellow or green mucus draining from your nose or down the back of your throat (postnasal drip)
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.