Allergy Clinic And Immunotheraphy

WHAT IS SINUS?

The sinuses are small air pockets located behind your forehead, nose, cheekbones, and in between the eyes. The sinuses produce mucus, which is a thin and flowing liquid that protects the body by trapping and moving germs away. 

SINUSITIS

Sometimes, bacteria or allergens can cause too much mucus to form, which blocks the openings of your sinuses. 
The infection causes your sinuses and nasal passages to become inflamed, and this inflammation is called sinusitis

Typical symptoms include facial pressure or pain, blocked nose, high temperature, green/yellow nasal discharge and a reduced sense of smell. If the infections are mild and infrequent, in most cases, very little treatment is necessary, a person feels better with medications.
Should the symptoms not resolve easily, there may be an underlying bacterial infection in which case antibiotics may be necessary. In these cases, it is important to seek medical help from a sinus specialist.

Additionally, for some patients, sinusitis may be a recurring problem several times a year. This can have a profound impact on work, mood and general well-being. For such patients, it may be necessary to conduct an endoscopic examination of the nasal cavity, perform specialised blood tests to assess immune function and carry out a CT scan of the sinuses. Treatment is then tailored to the individual and includes steroid sprays/drops, saline irrigation, long term antibiotics, endoscopic sinus surgery (FESS)

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NASAL POLYP

Nasal polyps are tissue swellings within the nose that can profoundly impact one's quality of life. They occur as part of a spectrum of a condition called chronic rhinosinusitis (CRS). They frequently run-in families and can also be associated with conditions such as asthma.
Left untreated, symptoms include nasal blockage, nasal discharge and catarrh, reduced or absent sense of smell, sneezing and facial pressure. Nasal polyps are not typically painful and do not tend to bleed. Chronic rhinosinusitis and nasal polyps are best managed through a combination of nasal steroid drops, nasal irrigation and sometimes antibiotics.
For many patients who do not improve with medical management alone, endoscopic sinus surgery may become necessary. This is to improve the sinus drainage pathways, to remove the polyps and to enable medications to get into the sinuses more effectively. It is important to note that sinus surgery itself is usually an adjunct to medical management and the majority of patients will need saline nasal irrigation and nasal steroids in the long-term to help keep the polyps at bay.

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FESS (FUNCTIONAL ENDOSCOPIC SINUS SURGERY)

Functional endoscopic sinus surgery or FESS is the commonest surgeryperformed for patients with  chronic rhinosinusitis. Patients may present with a variety of symptoms like nasal obstruction, reduced sense of smell, nasal discharge and facial pain.

Prior to consideration of any surgery, patients are treated for weeks with topical medications such as nasal douches, nasal steroid sprays or drops, oral antibiotics and oral steroids.

Treatment must be tailored to the individual patient. If there is no improvement, a CT scan of the sinuses is necessary to illustrate sinonasal anatomy for surgical planning and to help determine the extent of disease.

Surgery itself is conventionally carried out under general anaesthesia, particularly for moderate to severe sinonasal disease. It typically takes 1.5 to 2 hours and involves opening up the natural drainage pathways and removing unhealthy tissue or nasal polyps. The aim of surgery is to improve the nasal airway, alleviate nasal obstruction and to permit better delivery of medication. The sense of smell can improve after surgery but is not guaranteed.

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OTHER SURGERIES

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ENDOSCOPIC SEPTOPLASTY 

Septoplasty is a surgical procedure to correct a deviated septum. Septoplasty straightens the septum, allowing for better airflow through your nose. 

For relatively minor septal deviations, minimally invasive endoscopic septoplasty is done.

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ENDOSCOPIC DACRYOCYSTORHINOSTOMY (DCR) SURGERY (WATERY EYE SURGERY)

This type of surgery is extremely effective in patients suffering with watery eyes (epiphora). Frequently it is caused by the eye's natural drainage system to inadequately drain tears from the eyes in to the nose. Excessive tears can cause irritation of the skin and stickiness of the eyes and is a source of embarrassment for some patients. For others, the drainage pathway can become affected from an obstruction within the nose too, e.g. a large septal deviation or nasal polyps.
At our centre, this surgery is done endoscopically to avoid external scar.

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CSF LEAK REPAIR

Cerebrospinal fluid (CSF) is a colourless fluid that protects the brain by acting as a cushion as well as providing some immunological protection. If a defect develops in the dura (membrane of the brain), either spontaneously or secondary to direct head trauma, then this fluid can leak from the nose. It requires prompt assessment by an ENT surgeon, ideally specialised in rhinology, as if left untreated it can lead to meningitis. If a diagnosis of CSF leak through the nose is made through laboratory analysis of the specimen, then expedited surgery is required.

Most such cases are done at our center through the nose endoscopically but occasionally, for larger defects, an open approach with a neurosurgeon is necessitated. Tissue from the leg (fascia lata) is often required to help close larger defects.

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ENDONASAL ENDOSCOPIC OPTHALMIC SURGERY

The most common type of these surgeries which are done at our center are-

» Endoscopic DCR

» Orbital Decompression

» Optic Nerve Decompression 

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