Nasal Polyps A quick guide for understanding nasal polyps & the different treatments available Nasal polyps are soft, abnormal, swollen, sac-like/grape-like growths of inflamed tissue. This usually lines the inside of your nose, arising from your sinuses. The sinuses are a group of air-filled spaces inside the bones of your face. They connect with the nasal cavity. This is the large, air-filled space behind your nose. Normally, these spaces are fairly open. Nasal polyps can grow large enough to block them and cause trouble while breathing. Remember, anyone can have nasal polyps. Nasal polyps are a subgroup of chronic rhinosinusitis. This is a condition where the nasal cavity and sinuses are inflamed for more than 4 to 12 weeks. Not all people with rhinosinusitis will develop nasal polyps. Other types of growths too can arise in the nasal cavity. Some of these types may be cancer. But true nasal polyps are not cancer, but have to be ruled out only on excision and histopathological examination. Important note: It is important to remember that certain genes may help lead to the development of nasal polyps. This is especially true with genes that play a role in the immune system and inflammatory response. You are more likely to have nasal polyps if other members of your family have had them. What is the treatment for nasal polyps? Treatment depends on your symptoms, age, and general health, as well as how severe the condition is. Surgery is generally recommended by your ENT doctor to remove your polyps. A few treatments for nasal polyps are recommended by ENT doctors: ✔ Medicines to help decrease inflammation ✔ Antibiotics to help reduce polyp size ✔ Anti allergic medications, to reduce allergic reactions ✔ Allergen immunotherapy and removal of allergens ✔ Aspirin desensitization therapy Nasal polyps are more common in people with these health conditions:  Asthma  Aspirin sensitivity  Allergic rhinitis  Chronic sinus infections  Cystic fibrosis Visit your doctor if you may still have symptoms despite trying these other therapies. Different approach is required in certain circumstances. Patients with certain issues, such as large polyps in their sinuses, may need traditional surgery to correct the issue and get relief from chronic sinusitis. When do I visit my ENT doctor, and what are the red flags? Sinus infections, allergies, and other causes of nasal obstruction can make breathing difficult at night. Visit your ENT doctor if your symptoms don’t get better even after a few days of treatment. Reach out to your ENT doctor immediately if signs of possible problems such as abnormal vision, swelling around your eyes; confusion, or loss of alertness are witnessed. Nasal polyps are more common in people with these health conditions:  Asthma  Aspirin sensitivity  Allergic rhinitis  Chronic sinus infections  Cystic fibrosis Visit your doctor if you may still have symptoms despite trying these other therapies. What is a sinus rinse? Is it helpful? Performing a sinus rinse is a safe and simple way to clean the nose and sinuses for patients who suffer from allergies or recurrent sinus infections. There are many different devices available to rinse the nose, but they all essentially work the same. A saltwater mixture is pushed into one nostril and out the other. As the fluid moves out of the nose, it washes out dust, pollen, and other debris, as well as mucus and allergens; helps to loosen any thick mucus in the nasal passages that may be present. – Dr. Prashanth R Reddy “E.N.T. health – ENTry for better senses”. Previous Blog

Snoring and Obstructive Sleep Apnea “Why do I snore loudly and feel tired and irritable even after a full night’s sleep?” Answer is – You might have sleep apnea… We find it unbelievable that we only snore at night and not during the day, but why is that the case? During the day, our muscles of the neck keep the airway wide and help air pass through the nose and throat smoothly. Meanwhile, during sleep, neck muscles loosen and collapse into this airway, narrowing it and causing airflow turbulence. The suction current created by the rapid airflow vibrates and stretches the uvula and soft palate. Due to the negative pressure pulling the tongue back and blocking the airway, this force causes snoring and sleep apnea.  Air from outside transits to the nasopharynx via the nose. Any obstruction in this passage will cause snoring. The deviated nasal septum that blocks the airway is one of the major causes. As patients feel difficulty breathing through the nose, they tend to sleep with their mouths open at night. This causes turbulence of airflow as it bypasses the nose and results in snoring  Similar causes of snoring are Allergic rhinitis and nose block, Sinusitis with nasal polyps, tumors of the nasal cavity  Patients with tonsillar hypertrophy will also experience snoring because of the same phenomenon and here obstruction to airflow is at the level of the oropharynx.  In obese patients,there will be increased neck circumference due to fat deposition, shorter neck, and loose neck muscles. These are contributing factors to increase the turbulence of airflow and snoring  Acidic reflux in the long term causes elongation of the uvula and edema of the mucous membrane of the throat. The movement of the long uvula with breathing will also cause turbulence and snoring How loud do I snore? Usually, snoring is reported by your partner/ roommate. There are several ways to assess the loudness of snoring with the help of questionnaires. What are the treatment options? A qualified ENT surgeon will evaluate you to assess the causes of snoring. Treatment options aim at creating a smoother airway during sleep. Usually, a holistic approach is needed in terms of lifestyle changes and surgery together is needed for the reduction of snoring In cases of obstruction at the level of the nose like a deviated septum or allergic rhinitis, or nasal polyps, the treatment aims at clearing the disease and creating a nasal pathway for the smooth conduct of air. Some doctors recommend a balloon sinuplasty procedure to reduce the forces that create vibration, snoring, and sleep apnea. However, balloon sinuplasty is considered ineffective in reducing sleep apnea symptoms. Balloon sinuplasty comes with a higher risk of complications and an extended recovery period. Today there are procedures to stiffen or soften the soft palate that can reduce snoring and open the airway in the back of our throat. . Tonsillar hypertrophy causing snoring needs to be addressed with the removal of tonsils. This clears up the oropharynx and along with stiffening of the soft palate will help in reducing snoring. In some cases, an oral appliance may also be needed to assist in holding the mouth closed and move the jaw slightly forward to shift an oversized tongue away from the back of the throat. What’s beyond snoring? Heard of Obstructive sleep apnea? In some people, the throat closes so much that not enough air can get through to the lungs, and when this happens, the brain sends an alarm to open the airway. Most often, this is associated with brief arousal from sleep. The brain quickly reactivates the muscles that hold the throat open. Air gets through again, and our brain goes back to sleep. When we experience this disorder, the term given to it is “obstructive sleep apnea.” In this process, the person tends to keep his mouth open to breathe easily. Mouth breathing also dehydrates the tongue, which results in progressive tongue enlargement, increasing the chance of sleep apnea. Do I have Obstructive sleep Apnoea? Check it out !! Here are the symptoms of obstructive sleep apnea: A qualified ENT surgeon will evaluate you to assess the causes of snoring. Treatment options aim at creating a smoother airway during sleep. Usually, a holistic approach is needed in terms of lifestyle changes and surgery together is needed for the reduction of snoring  Excessive daytime sleepiness  Loud snoring  Observed episodes of stopped breathing during sleep  Abrupt awakenings accompanied by gasping or choking  Awakening with a dry mouth or sore throat  Morning headache  Difficulty concentrating during the day  Mood changes, such as depression or irritability  High blood pressure  Decreased libido Factors that increase the risk of sleep apnea include:  Excess weight. Obesity greatly increases the risk of sleep apnea.  Neck circumference. People with thicker necks might have narrower airways.  A narrowed upper airway.  Shorter jaw  Double chin  Being older.  Family history.  Use of alcohol, sedatives, or tranquilizers.  Smoking.  Nasal congestion/ Nasal block  Medical conditions like diabetes, Parkinson, etc., Tonsillar hypertrophy causing snoring needs to be addressed with the removal of tonsils. This clears up the oropharynx and along with stiffening of the soft palate will help in reducing snoring. In some cases, an oral appliance may also be needed to assist in holding the mouth closed and move the jaw slightly forward to shift an oversized tongue away from the back of the throat. Lifestyle changes to adapt  If you’re overweight, try to lose weight.  Sleep on your side  Raise the head of your bed.  Treat nasal congestion or obstruction  Limit or avoid alcohol and sedatives.  Quit smoking today.  Get enough sleep. You can visit your doctor if you have, or if your partner observes the following:  Snoring loud enough to disturb your sleep or that of others  Waking up gasping or

Deviated septum – FAQ What is a deviated septum? A deviated septum occurs when your nasal septum which is a thin wall that separates your right and left nasal passage, is displaced to one side. In many people, the nasal septum is off-center — or deviated — making one nasal passage smaller. Also note that injury to the nose can cause a deviated septum. Nasal injuries may occur due to falls, sports, car accidents, or even getting hit in the nose during a fight or an accident. A deviated septum may also be congenital, or present at birth. The deviation may be from a difficult birth or connective tissue disease. In severe cases, it can block one side of the nose and reduce airflow, causing difficulty breathing. The exposure of a deviated septum to the drying effect of airflow through the nose may sometimes contribute to crusting or bleeding in certain people. Note: A nasal blockage or congestion or obstruction can occur from a deviated nasal septum, from swelling of the tissues lining the nose or from both. TYPES OF NASAL DEVIATION Important note: Most septal displacements result in no symptoms, and you may not even know you have a deviated septum. Some septal deformities may cause the following symptoms: People with a severely deviated septum may have a change in the shape of their nose. Other deviated septum symptoms include difficulty breathing on one or both sides of the nose along with one or more symptoms like:  Headaches or face pain.  Nasal congestion.  Noisy breathing.  Nosebleeds.  Sinusitis (inflammation of the sinuses).  Sleep apnea.  Neck pain  Shoulder pain  Migraine like headaches  Snoring What are my treatment options?: A nasal blockage or congestion or obstruction can occur from a deviated nasal septum, from swelling of the tissues lining the nose or from both. In some cases, treatment of nasal obstruction may include medications to reduce the swelling. Treatment for a deviated septum is a surgery called a septoplasty. . If you have breathing problems, frequent sinus infections or other bothersome symptoms, a septoplasty is recommended A septoplasty is usually a one to two hour procedure. You can go home the same day, in most cases. Three main steps of a septoplasty are:  Anesthesia: Your surgeon uses local and general anesthesia to make sure you’re comfortable. Local anesthesia numbs the area. General anesthesia puts you to sleep during the procedure.  Repair: Your surgeon under the vision of an endoscope will separates the membrane that covers the septum. Then the surgeon removes the cartilage and bone that is deviated. Your surgeon then replaces the membranes and places intranasal splints on both sides of the septum sutures them together with stitches.  Bandaging: Your surgeon may pack your nose with gauze only if there’s any unforseen bleeding. How early do I see my doctor? Visit your ENT doctor if you experience a blocked nostril (or nostrils) that don’t respond to treatment; or frequent nose bleeds, or recurring sinus infections. – Dr. Prashanth R Reddy “E.N.T health – ENTry for better senses”. Previous BlogNext Blog

Allergic rhinitis What is an allergy? Allergy is the body’s reaction to an external agent. The nasal mucosa prevents external contaminants like dust, pollen, and other micro-particles from reaching the lungs by trapping them. These agents can initiate an allergic response in the mucosa. Allergic Rhinitis is inflammation of the nasal mucosa to an allergen. Note: Allergy can be seasonal (as in the case of specific pollen grains), non-seasonal (all year), or occupational ( like in the wood or any Dusty environments in the industry). What are the causes of allergic rhinitis? Allergic rhinitis can be hereditary. But not all people are allergic. A few of us will be sensitized to certain external factors that can initiate an allergic reaction. So when a sensitized person comes incontact with an allergen, it releases histamine, which will cause allergic reactions in the nose, leading to allergic rhinitis and its symptoms, including a runny nose, sneezing, and itchy eyes. Pollen is the most identified causative agent for allergic rhinitis. The other allergens are grass pollen, dust mites, animal dander, which is old skin, cat saliva, and mold. External factors that can trigger or worsen this condition are cigarette smoke, chemicals, cold temperatures, humidity, wind, air pollution, hairspray, perfumes, colognes, Deo sprays, wood smoke, and fumes What are the symptoms of allergic rhinitis? For many people, allergic rhinitis is a lifelong condition. A recent survey shows that nearly 10 percent of adults in the world experience allergic rhinitis of some kind. Also, allergies affect about 33 percent of Indians. ▪ Sneezing, running nose or stuffy or blocked nose ▪ Itching and irritation of the nose ▪ Coughing, post nasal drip ▪ A dark line on the tip of the nose, nasal crease Allergic manifestations are also seen in the eyes. The major eye symptoms are ▪ Itchy and watery eyes ▪ dark circles under the eyes ▪ headaches ▪ eczema-type symptoms, such as having extremely dry, itchy skin that can blister and weep You may usually feel one or more of these symptoms immediately after coming into contact with an allergen. Few symptoms, such as recurrent headaches and fatigue, may only happen after long-term exposure to allergens. Important note: It is important to note that children can also develop allergic rhinitis. It typically appears before the age of 10. Your child may develop cold-like symptoms at the same time each year, this means they probably have seasonal allergic rhinitis. ▪ Sneezing, running nose or stuffy or blocked nose ▪ Itching and irritation of the nose ▪ Coughing, post nasal drip ▪ A dark line on the tip of the nose, nasal crease Allergic manifestations are also seen in the eyes. The major eye symptoms are Remember, the symptoms in children are similar to those in adults. Children usually develop watery, bloodshot eyes, which is called allergic conjunctivitis. Your child may have asthma if you also notice wheezing or shortness of breath in addition to other symptoms. What’s the treatment for allergic rhinitis? Treatment of allergic rhinitis needs medical and lifestyle changes. Firstly avoidance of triggers is the key to controlling allergies. An ENT doctor and immunologist may evaluate you to identify the causes of your allergy. The acute phase of allergic rhinitis is managed medically with antihistamines, decongestants, anticholinergics, and topical eye preparations. Intranasal corticosteroids and mast cell stabilizers will help reduce the response to allergens. Immunotherapy is saved for more severe cases of not responding to medications. They are given as injections, need 5-6 doses depending on the severity, and are comparatively costly. There is no surgical correction for allergic rhinitis, surgical clearance of its complications like sinusitis can only be done. Remember, – allergies can rarely be cured, they are always kept under control, just like diabetes or hypertension, by making necessary lifestyle modifications. What are the complications of allergic rhinitis? ? Long-standing allergic rhinitis can cause chronic sinusitis, nasal polyposis, headaches, otitis media with effusion, and hearing loss. Non-ENT complications include developing bronchial asthma, hernias, retinal detachment, chest pain, urinary incontinence, and acid reflux. How early do I see my doctor? Visit your ENT doctor if you experience severe symptoms, have signs and symptoms that aren’t relieved by over-the-counter medications or self-care, or have bothersome side effects from over-the-counter or prescription medications for rhinitis, or itchy, watery eyes, sneezing, nasal congestion, itching, and rhinorrhea or running nose. Talk to your doctor about possible allergies if your symptoms last for more than a few weeks and don’t seem to be improving. – Dr. Prashanth R Reddy “E.N.T. health – ENTry for better senses”. Previous BlogNext Blog

FAQs About Nose Surgery What are the frequently asked questions by patients about nose surgery? 1. Will there be any scars on my face or neck after my nose surgery? No. It is a scar-free surgery. 2. What steps do I take before my surgery? ▪ Kindly get the CT scan films to the hospital at the time of admission. ▪ Make sure Insurance clearance pre-approval is done before admitting the patient at the hospital. If there is any query raised by the insurance company, kindly whatsapp us at 8217884802 or forward the mail to us at ent.prash@gmail.com ▪ If you’re planned for a day care surgery (getting admitted and discharged the same day) then get admitted at 6am in the morning, get all the blood investigations, CT scans and PAC (Pre-anesthesia checkups) documents with you. ▪ If your discharge is planned on the 2nd day after surgery, you can get admitted in the evening on the previous day around 6pm (3 days and 2 nights insurance plan) ▪ One attendant must be present from the patient’s side who can stay with the patient. Please ensure that the surgical consent form is signed. ▪ Patients should not eat anything and should not take water after 10 pm, on the previous day and in the morning too. ▪ Diabetic patients must not take sugar tablets before surgery I, e on the day of surgery. ▪ Patients who are taking morning doses of antihypertensive, antiepileptic and thyroid medications should take tablets with one sip of water before surgery as advised by the anesthesiologist. ▪ Rest all medications should be taken before 10 pm from the previous day itself. ▪ If you have any queries or questions you can also whatsapp us at 8217884802 ▪ If you are getting hospitalized, you can go for either AC or non AC room. 3. What should I do when my nose bleeds? In case of a nasal bleeding emergency after your surgery, you can try these steps – Pinch your nose, bend forward and breathe through your mouth for 2 minutes. Inform the doctor immediately if the bleeding is more. 4. What medicine do I take for nose block? For Nose block issues – use Otrivin nasal spray which is standard for nose block.. 5. After my surgery, when is my next follow up session scheduled with my ENT doctor? After your nose surgery, you need to visit the doctor one week later for splint removal. This will be your first follow up session. After Splint removal, you need to visit the doctor after 2 weeks for an endoscopy procedure. This will be your second follow up session. This is followed by 2 months and 6 months successively. 6. How many times do I do the nasal wash? During the first week of your surgery, you need to do Nose wash/sinus rinse 3 times a day. After 2 weeks – Nose wash should be done for 2 times a day. For the next 2 months: First month – one time a day in the evening. Followed by alternate evenings in the second month. Post Surgery Nasal Wash https://www.enthealth.in/wp-content/uploads/2023/06/nasel_surgery_new.webm 7. What conditions can sinus surgery treat? Sinus surgery can help you feel better if you have: ▪ Chronic sinus headaches or sinusitis ▪ Chronic sinus infections ▪ Abnormal sinus growths ▪ Nasal or sinus polyps ▪ Fungal sinus disease ▪ Obstructions in your sinuses ▪ Nasal or sinus polyps ▪ Structural problems in your sinuses 8. What tips do you have for me to ease some discomfort and pain soon after my surgery? Complete your medication as prescribed by your ENT doctor. Visit the hospital after 7 days for splint removal (depending on your case; as recommended by your doctor). You can also message us on whatsapp if you have any other symptoms after your surgery. Here are few additional health tips that you can follow: ✔ Cough and sneeze with your mouth open. ✔ Do not blow your nose during the first week. During that time, if you have congestion, sniff gently and spit into a tissue. ✔ Avoid hot, spicy foods. ✔ Do not drink through a straw. ✔ Take sufficient rest. 9. Can I see my doctor in case I still have a few symptoms and what are those symptoms? When will they be reduced? Yes, you can visit your doctor if these symptoms last for more than 3 days: ● You are bleeding excessively. ● You have signs of an infection such as fever, yellow-green drainage, unrelieved headache, or increased pain. ● You have decreased or double vision, swelling of the eyes, a stiff neck, or extreme fatigue. ● You have clear watery drainage from your nose. However, remember post splint removal, most of your symptoms will reduce or be eliminated. 10. Can I take a bath after my surgery? Yes, you can have a complete body bath the same day or the next day. 11. Can I move after my surgery? You will be able to mobilize on the same day following 4-5 hours of surgery. Walking, non-strenuous activity can be started from post op day 2. 12. What diet should I follow after my surgery? Intake 3-4 liters of fluids daily (if no medical condition contraindicates the same). A normal, regular diet is advised. Avoid spicy, oily, and sour foods to reduce acidity. 13. What happens soon after my surgery? Are there any risks involved? You can expect some nasal stuffiness, bleeding, and crusting for 3-6 weeks after surgery. Many patients are back to work or school 2-3 days following surgery. Following your doctor’s suggestions can help you prevent complications and recover more quickly. As with any surgery, you run a slight risk of infection and bleeding, including numbness in your front teeth. – Dr. Prashanth R Reddy “E.N.T. health – ENTry for better senses”. Next Blog