Why do some people require nasal and sinus surgery? – FAQs The nose is the first point of communication for air entry from the environment to the nasopharynx and lungs. Sinuses are air-filled cavities in our faces and behind our eyes. They are lined by mucous membranes that secrete mucus, which traps microorganisms and dust that enter the nose. They are subsequently drained to the back of the nose through an organized drainage pathway. So, what are the reasons to have nasal and sinus surgery? Nasal passage is blocked for any reason can lead to nasal obstruction, difficulty in breathing, reduced smell sensation and disturbed sleep  Deviated nasal septum  Sluder’s Neuralgia  Tumors What are the reasons for Sinus Surgeries? When you have badly damaged sinus tissue, benign growths (called polyps), a fungal infection, or structural problems that are preventing your sinuses from draining, you may need sinus surgery  Recurring sinus infections with an impaired immune system  Nasal polyps and severe allergies  Antrochoanal polyp  Fungus ball  Allergic fungal sinusitis (AFRS)  Foreign body in the sinuses  Chronic bacterial sinus infections that have failed all medical interventions  Aspirin sensitivity  Tooth abscess Important tip: Unfortunately, some people are more prone to colds. Usually, you can treat allergies or try to avoid getting colds just by washing your hands regularly. Thereby you can avoid surgery How is sinus surgery done? Sinus surgery is done via an endoscope, and it’s also called Functional Endoscopic Sinus Surgery(FESS). After pre-anesthetic evaluation and under general anesthesia, an endoscope of 4 mm diameter is introduced to the nose. The images are magnified on the attached screen, and surgery is done with specialized endoscopic nasal instruments. The endoscopy procedure offers an opportunity to collect tissue samples to test for diseases, disorders, and conditions that may be causing inflammation, blockages, cancer links, and swelling in the nose. Before surgery: Here are a few things you can do before surgery to help things go more smoothly: ● Tell your doctor about any medications you are taking and ask whether you should take them on the morning of surgery. ● Stop smoking at least 3 weeks before your surgery date. ● Arrange for an attendee for the duration of hospitalization, usually 1-3 days depending on the type of surgery. What are the risks of endoscopic sinus surgery? As with any surgery, there are risks involved with having endoscopic sinus surgery. While risks with sinus surgery are exceedingly rare, it is important for you to understand what these are. ● Bleeding: During surgery, small amounts of blood loss are expected and these are tolerated well by patients. Mild bleeding after surgery is also common and usually subsides after the first day. Very rarely bleeding occurs after surgery that requires a visit to your surgeon and may involve placement of nasal packing to stop the bleeding. In rare cases, excessive bleeding may occur that requires stopping the surgical procedure. ● Infection: Patients are usually given a dose of antibiotics during surgery and a prescription for antibiotics after surgery to reduce this risk. Occasionally a patient may develop a sinus infection after surgery that requires a stronger antibiotic. ● Cerebrospinal fluid (CSF) leak: During endoscopic sinus surgery the surgeon is working beneath the bone that separates the brain from the nose. It is extremely rare for this bone to be injured during sinus surgery, which would result in a CSF leak. Such an injury would generally be identified at the time it occurred and would be repaired immediately. ● Changes in vision: The sinuses are very close to the eyes, and therefore injury to the eyes may occur during sinus surgery resulting in temporary or permanent double vision or visual changes. Injury to the tear ducts may also cause excessive tearing after surgery. Fortunately, these are exceedingly rare complications. Swelling may also occur around the eyes after surgery. Temporary blurry vision does occur in some patients but resolves without the need for further treatment. ● Other risks include changes in your nasal breathing or sense of smell. If a septal surgery is performed during your sinus surgery there is a small risk of developing a septal perforation or numbness in your teeth. After surgery: You can expect some nasal stuffiness, bleeding, and crusting for 3-6 weeks after surgery. You have to come for follow-up visits to our OPD at 1 week, 3 weeks, and 2.5 months after surgery for “post-operative nasal endoscopy.” Many patients are back at work or school 2-3 days after surgery. Following these suggestions can help you prevent complications and recuperate more quickly The First Few Days ● Sleep with your upper body elevated to keep pressure off of your head. ● Nasal douching with a Nasowash kit is mandatory for three times daily for 1st-week post-op. Expect few clots /blood-stained discharge during the wash. ● Use pain medication as directed by your doctor or mild non-aspirin pain relievers (Calpol/Dolo). ● Take any additional medications prescribed by your doctor. ● Drink plenty of fluids to prevent dry mouth. A bedside humidifier may be helpful(OPTIONAL) ● To help control any bothersome nasal bleeding, an icepack can be applied over the nose and cheeks. Tilt your head forward while sitting up and breathe gently through your nose. Do not snort the blood through your nose as this will promote more bleeding. If bleeding continues, otrivin or nasivion nasal decongestant spray (1-2 sprays in each nostril) may be used sparingly every 6 to 8 hours for 1-2 days. The First Few Weeks ● Continue the nasal douching- Nasowash in the bottle to squirt the solution into your nose a few times a day. Otrivin or nasivion nasal decongestant spray will open the nasal passage and may be used just before rinsing with salt water. ● In case of nasal splint application in surgery- it will be removed during your first follow-up visit, generally around Post op day 7 in ENT OPD ● Mild headache

Nose bleeds in children It is certain to have at least one nosebleed or probably many during their early years of childhood. Some preschoolers may have several a week. This is neither abnormal nor dangerous, but it can be very frightening. However, if blood flows down from the back of the nose into the mouth and throat, your child may swallow some of it, which in turn may lead to nausea or vomiting or both, vomiting will have blood mixed with it Most of the time, the bleeding is coming from the front part of the nose. Some blood vessels that sit in the front of the nose can dry out, just like the rest of our body, the skin can get dry inside the nose as well. Therefore, the parents of the kids need to take care of that and keep it from being dry. So it is important that the kids learn to keep their nose nice and moisturized. Oftentimes, in children it gets worse when they put things in their nose, like fingers. In case of severe or chronic bleeding, or if the bleeding lasts longer, or it seems like happening frequently, it is recommended that you seek the help of your ENT doctor immediately. What are the causes of nosebleeds in children?  Colds and allergies: A cold or allergy causes swelling and irritation inside the nose and may lead to spontaneous bleeding.  Trauma: A child can get a nosebleed from picking their nose, putting something into it, or just blowing it too hard. A nosebleed also can occur if they are hit in the nose by a ball or other object, or fall and hit their nose.  Low humidity or irritating fumes: If your house is very dry, or if you live in a dry climate, the lining of your child’s nose may dry out. This makes it more likely to bleed. If they are frequently exposed to toxic fumes (fortunately, an unusual occurrence), they may get nosebleeds, too.  Anatomical problems: Any abnormal structure inside the nose can lead to crusting and bleeding.  Abnormal growths: Any abnormal tissue growing in the nose may cause bleeding. Although most of these growths (usually polyps) are benign (not cancerous), they still should be treated promptly.  Abnormal blood clotting: Anything that interferes with blood clotting can lead to nosebleeds. Medications, even common ones, can alter blood-clotting just enough to cause bleeding. Blood diseases, such as hemophilia, also can provoke and worsen nosebleeds.  Chronic illness: Any child with a long-term illness, or who may require extra oxygen or other medication that can dry out or affect the lining of the nose, is likely to have nosebleeds. Treatment: Here are few do’s and don’ts that must be considered while treating nosebleeds in children: Do’s  Remain calm. A nosebleed can be frightening, but is rarely serious.  Keep your child in a sitting or standing position. Tilt their head slightly forward.  Pinch the lower half of your child’s nose (the soft part) between your thumb and finger and hold it firmly for at least 10 minutes. If your child is old enough, they can do this themselves. Don’t release the nose during this time to see if it is still bleeding (no peeking)! Stopping the pressure may interfere with the forming of the clot and allow the bleeding to continue.  Release the pressure after 10 minutes and wait, keeping your child quiet and still. If the bleeding hasn’t stopped, hold pressure again. If after 10 more minutes of pressure the bleeding hasn’t stopped, call your pediatrician or go to the nearest emergency department.  Panic. You’ll just scare your child.  Have them lie down or tilt back their head.  Stuff tissues, gauze, or any other material into your child’s nose to stop the bleeding. When do I see my doctor and what are the red flags? Visit your doctor immediately if you notice these signs and symptoms – You think your child may have lost too much blood or continues to bleed heavily. (Remember that the blood coming from the nose always looks like a lot..), the bleeding is coming only from your child’s mouth, or he’s coughing or vomiting blood or brown material that looks like coffee grounds, your child is unusually pale or sweaty, or is not responsive. Arrange to get your child to the emergency room; your child has a lot of nosebleeds, along with a chronically stuffy nose. This could also mean that your child has a small, easily broken blood vessel in the nose or on the surface of the lining of the nose, or a growth in the nasal passages. Important note: If a blood vessel is causing the problem, the doctor may touch that point with a chemical substance (silver nitrate) to stop the bleeding. – Dr. Prashanth R Reddy “E.N.T. health – ENTry for better senses”. Previous Blog

Nose bleeds in adults Nosebleeds, also called epistaxis, can occur easily because of the location of the nose and the close-to-the-surface location of blood vessels in the lining of your nose. Nose is a very vascular structure in our body.In simple words, a nosebleed is the loss of blood from the tissue that lines the inside of your nose. Frequent or heavy nosebleeds may indicate more serious health problems, such as high blood pressure or a blood clotting disorder, and should be checked. Excessive bleeding over a prolonged period of time can also lead to further problems, such as anemia. Depending on the source, there are two different types of nasal bleeding. The first one is an anterior nasal bleed, where the origin is at the front part of the nose. They are easily controlled and less severe. The second starts at the back end of nasal septum and is less accessible. These nosebleeds usually involve large blood vessels and result in heavy bleeding, which can be dangerous. In adults aged between 45 and 65, blood may take longer to clot in mid-life and older adults. They are also more likely to be taking blood thinning medicines, have high blood pressure, atherosclerosis (hardening of the walls of arteries), or a bleeding disorder. Also, people who have blood clotting disorders such as hemophilia or von Willebrand disease can experience nose bleeds. In pregnant women, the blood vessels in the nose expand which puts more pressure on the delicate blood vessels in the lining of the nose leading to nose bleeds What are the causes of nose bleeds in adults? Nosebleeds are generally caused by dry air or picking your nose, but here are some other causes: ▪ Bleeding disorders ▪ Nasal and sinus infection ▪ Allergies ▪ Foreign body in the nose ▪ Trauma to the nose and face. ▪ Common cold ▪ Blood-thinning drugs (aspirin, non-steroidal anti-inflammatory drugs, warfarin, and others). ▪ Chemical irritants (chemicals in cleaning supplies, chemical fumes at the workplace, other strong odors). ▪ Chronic sinusitis ▪ Nasal sprays ▪ Cocaine and other drugs inhaled through the nose. ▪ Non-allergic rhinitis ▪ Deviated septum ▪ Blowing your nose with force. ▪ Inserting an object into your nose ▪ High altitudes. The air is thinner (lack of oxygen) and drier as the altitude increases. ▪ Frequent use of nasal sprays and medications to treat itchy, runny or stuffy nose. These medications – antihistamines and decongestants – can dry out the nasal membranes. A few other, less common causes of nosebleeds are: ▪ Alcohol use. ▪ High blood pressure ▪ Nasal tumors. ▪ Nasal polyps ▪ Atherosclerosis. ▪ Immune thrombocytopenia. ▪ Leukemia. ▪ Pregnancy. What are the treatment options? : Most nosebleeds can be handled at home, but certain symptoms should be checked by your ENT doctor. Also, this could be an early sign of other medical problems that need to be investigated. The most appropriate way to stop a nosebleed is by bending our heads forward, pinching the nose with a tissue, and breathing through the mouth for two minutes. You can also try using a cold compress on the bridge of your nose and lightly blowing to remove any blood clots. An anterior bleed from nose stops with compression or nasal packing for 24 hrs. After the bleeding stops, an ENT doctor assesses the inside of the nose with an endoscope to look for bleeding points. If identified, they are cauterized either chemically or electrically. In cases of refractory nasal bleeds, endoscopic ligation of the artery is also performed rarely. Home remedies to avoid nasal bleeds When do I see my doctor, and what are the red flags? You should seek medical attention right away if you experience any of these symptoms or signs because you could be bleeding excessively or have lost too much blood. Additionally, keep in mind that blood coming from the nose always appears to be a lot If you experience bleeding from the mouth, cough out blood, or vomit blood, seek medical attention immediately. The blood loss can be severe and you may look pale / sweaty or not responsive You should seek medical care in case of nasal bleeds after accidents/trauma, feeling light- headed after nasal bleeds, breathing difficulty or continues to feel blood taste in the mouth If your nose has been bleeding for longer than 20 minutes, consider it a red flag. – Dr. Prashanth R Reddy “E.N.T. health – ENTry for better senses”. Previous Blog

Nasal vestibulitis – Danger area of the Face A quick guide Nasal vestibulitis is inflammation of your nasal vestibule. This is the area where nose hairs grow, just inside of your nostril. The inflammation can cause swelling and pain as your body tries to heal itself or fight an infection. It is a bacterial infection at the opening of the nose. It may look like a pimple or sore just inside the nose. It often develops when hair follicles become infected, such as after a person picks their nose or plucks their nose hair. Children pick and blow their noses more frequently, so nasal vestibulitis is slightly more common. Please note: Mild nasal vestibulitis is quite common. You are more likely to have nasal vestibulitis if: ▪ You are a diabetic. ▪ You have a weakened immune system or taking anti-cancer drugs. Causes of nasal vestibulitis: ▪ Picking your nose ▪ Plucking nose hairs ▪ Blowing your nose excessively ▪ Using nasal sprays and steroids ▪ Getting objects stuck in the nose. Here are the symptoms of nasal vestibulitis: ▪ Redness ▪ Pain ▪ Swelling ▪ A spot may be present. ▪ Scabs in the area ▪ A yellow crust around the nose ▪ Nose bleeds Note: Also, you may also feel unwell or have a fever. It is important to know that you don’t need to have all of the above symptoms to have nasal vestibulitis. Nasal vestibulitis is diagnosed clinically. This also means no special tests are needed. In most cases, your doctor will ask you about your symptoms and look at the nostril area. Also reassuringly, nasal vestibulitis is rarely complicated and will clear up on its own or with simple treatments from your ENT doctor.. Treatment: ✔ Your ENT doctor may prescribe an antibiotic cream to rub on the affected area. ✔ In more severe cases of nasal vestibulitis, your ENT doctor may also prescribe you oral antibiotics for 7 – 10 days ✔ Some nasal washes to clean the area, may also be recommended. ✔ To treat yourself at home, you can put a clean flannel soaked in hot water on the area 2 to 3 times a day for 15 to 20 minutes. This can help relieve pressure from any spots or boils. When do I see my doctor, and what are the red flags? Visit your doctor immediately if you notice these signs and symptoms – pain deep in your face, feeling unwell and a fever; a severe headache that starts suddenly It is important to note that some people may develop a painful, infected boil called a furuncle. If this occurs, a doctor may recommend surgically removing and draining the furuncle to prevent the infection from returning or spreading. Also never attempt to pop a boil at home, as this can increase the risk of infection. Nasal vestibulitis tends to be a benign condition. However, in rare cases, it can spread to other areas of the body. For this reason, a person should seek prompt treatment. Home remedies alone will not cure the infection. – Dr. Prashanth R Reddy “E.N.T. health – ENTry for better senses”. Previous BlogNext Blog

I am Experiencing a Sudden Loss of Smell and Taste – FAQ Taste and flavor Taste is the sensation felt on the tongue while eating. It could be sweet, bitter, salty, sour, or umami. The flavor is a combination of taste and aroma (smell). These are interrelated, allowing us to experience good food and memorize it in our brains. Our tongue is coated with taste receptors that carry information from the tongue to our brain via nerves. Loss of taste and Smell The reduced sensation of taste can be either partial or total. Hypogeusia and hyposmia refer to a reduced sense of taste and smell respectively, and ageusia and anosmia refer to a complete loss of taste and smell. The major causes are:  Common cold  Viral infections like COVID -19  Sinusitis / Nasal allergies/ nasal polyps  Aging  Head injury  Tumors in the nose ( olfactory neuroblastoma)  Brain tumors, temporal lobe seizures A loss of smell receptors due to aging causes a decreased ability to smell in older people. People typically notice changes in smell by age 60. After age 70, changes are substantial. What is Parosmia? Parosmia refers to an altered sense of smell / or they feel a wrong smell/ bad smell. These people will have trouble detecting certain scents in their environment, smell a foul odor, particularly when food is present, or find previously pleasant scents overpowering and undesirable. What is the treatment for smell and taste-related disorders? Tests used to diagnose taste and smell-related disorders: ● Threshold tests use solutions of various strengths to test how strong a sweet, sour, bitter, or salty flavor must be for an individual to be able to recognize it. ● Odor tests present the patient with a set of smells that they are asked to identify. Diagnosis is dependent on successfully (or unsuccessfully) identifying the smells. ● ENT doctors may perform an Endoscopy of the nose to rule out obstructive causes for hyposmia ● CT/MRI may be advised to rule out any polyps, sinusitis, or tumors. Treatment options are ✔ Changing medicines that help lead to the disorder ✔ Correcting the underlying health problem ✔ Surgery to remove blockages that may be causing the disorder ✔ Quit smoking ✔ Counseling helps. ✔ Olfactory ( smell ) training therapy – Dr. Prashanth R Reddy “E.N.T health – ENTry for better senses”. Previous Blog