ENT procedures and treatment

Chronic sinusitis

A blocked nose, pain or pressure around the face, mucus running down the throat, a reduced sense of smell and ongoing tiredness are common reasons for seeking advice.

Sinusitis is described as chronic when symptoms last for at least 12 weeks. Diagnosis usually involves at least two main symptoms, such as nasal blockage, facial pain or pressure, mucus running down the back of the throat, a reduced sense of smell or thick nasal discharge.

Assessment

• An ENT examination and a detailed discussion of your symptoms and previous treatment.
• Nasal endoscopy to assess the inside of the nose, the nasal septum, polyps and the sinus openings.
• A sinus CT scan, which provides an anatomical map when surgery is being considered.
• In selected cases, allergy tests, a swab, or dental or neurological advice.

Treatment

Treatment usually begins with non-surgical measures such as nasal and sinus rinses, steroid nasal sprays, allergy treatment and medication chosen for your current condition. Antibiotics are used only in selected situations, mainly when there is a bacterial flare-up.

If non-surgical treatment does not provide enough relief, minimally invasive sinus surgery may be considered. The decision is based on an examination, your symptoms and the results of your tests.

Preparing for surgery

Good preparation helps reduce risk and supports a smoother recovery.

After an ENT specialist has recommended surgery, you will usually have an anaesthetic assessment. The anaesthetist checks whether a general anaesthetic can be given safely and explains what to expect during the first hours after the operation.

Tests before surgery

• Full blood count, blood group and electrolytes.
• HBsAg and blood-clotting tests, including INR and APTT.
• An ECG and any other tests recommended for you.
• A recent CT scan of the nose and sinuses, preferably available in digital form.

Medication, food and your journey home

At least 10 days before surgery, discuss any medicine that affects blood clotting, such as aspirin, Acard or Polopiryna, with your doctor. If you have a heart condition, any change in treatment should also be agreed with your cardiologist.

Before a general anaesthetic, you must not eat for at least 6 hours or drink for at least 4 hours. Arrange for another adult to take you home. Do not drive for at least 24 hours after the operation.

Surgery of the nose and paranasal sinuses

Surgery may be considered when non-surgical treatment has not provided enough improvement. The aim is to restore natural drainage, ventilation and cleaning of the sinuses while preserving healthy tissue wherever possible.

Functional endoscopic sinus surgery (FESS)

FESS is a minimally invasive operation used to treat chronic sinusitis. Using an endoscope and fine instruments, the surgeon opens the natural sinus drainage pathways and removes tissue that blocks ventilation and drainage, such as inflamed lining, polyps or abnormal bony structures.

The operation is performed through the nostrils, so there are no cuts or scars on the face. It is carried out under general anaesthetic in hospital.

When may FESS be considered?

• Recurring or chronic sinusitis that has not improved with appropriate non-surgical treatment.
• Nasal and sinus polyps.
• Selected cases of nosebleeds or removal of foreign objects from the nose or sinuses.
• Some congenital conditions, procedures involving the tear ducts and selected complex cases.

Modern surgical equipment

Computer-assisted navigation may be used in complex or repeat surgery. It uses the CT scan to help the surgeon locate instruments precisely. In selected cases, balloon sinus dilation and absorbable dressings or implants that release anti-inflammatory medication may also be considered.

Follow-up and care after surgery

Aftercare has a direct effect on healing. Follow your individual instructions and attend the scheduled follow-up appointments.

• Take prescribed medication exactly as directed.
• Take preventive antibiotics if they have been prescribed.
• Rinse the nose and sinuses as instructed.
• Do not drive during the first 24 hours after the procedure.
• Limit physical and work activity for 7 days.
• For 4 weeks, avoid strenuous exercise, swimming, the gym and air travel.
• For 14 days, do not take aspirin, Polopiryna, Acard or other medication that reduces blood clotting unless your doctor agrees.

Rinsing the nose and sinuses at home

Prepare the solution using the supplied sachet and boiled water that has cooled to room temperature. Lean over a sink, breathe through your mouth and squeeze the bottle gently so that the solution flows through the nasal passages. Avoid forceful nose blowing.

Rinsing is usually performed several times a day during the first few days. Once the rinse runs clear, it can often be continued once or twice a day, according to your doctor's instructions.

Consultations for snoring and sleep apnoea

Snoring and broken sleep can lead to tiredness, daytime sleepiness and poor concentration. In some people they may also be linked with an increased cardiovascular risk. Snoring does not always mean sleep apnoea, but it is worth assessing.

Snoring happens when relaxed tissues in the throat vibrate as air passes through. Some people also have obstructive sleep apnoea, where breathing stops repeatedly for more than 10 seconds during sleep.

Assessment

• An ENT examination of the nose, back of the nose, throat, palate, tonsils and larynx.
• A sleep study, either home respiratory polygraphy or more detailed polysomnography.
• Assessment of factors such as body weight, neck size, the shape of the nose and throat, evening alcohol use and sleeping on the back.

Treatment

Treatment depends on the cause and severity of the problem. Options may include weight reduction, regular activity, avoiding alcohol and sleeping tablets, oral appliances, CPAP or, for selected patients, a procedure to correct areas where the airway narrows.

Nasal and sinus polyps

Nasal polyps are soft, painless swellings of the lining of the nose and sinuses. They are not cancerous, but they can make breathing through the nose difficult and reduce the sense of smell.

Symptoms

• A constantly blocked nose.
• A reduced or lost sense of smell, often with a reduced sense of taste.
• Persistent runny nose and mucus running down the back of the throat.
• Headaches and a change in the sound of the voice.

Diagnosis and treatment

Polyps are diagnosed using your medical history, an ENT examination, nasal endoscopy and a CT scan. Treatment depends on their size and the severity of symptoms. Non-surgical treatment usually includes steroid nasal sprays, nasal rinses and treatment for allergies. If this is not enough, polyps can be removed endoscopically through the nostrils, without cuts on the face.

Deviated nasal septum

The nasal septum divides the nose into two passages. Small bends are common and often cause no symptoms. A problem arises when the bend significantly affects breathing.

What symptoms can it cause?

• Difficulty breathing through the nose, sometimes mainly on one side.
• One-sided blockage that changes sides when lying down.
• Recurring upper respiratory infections.
• Snoring and, in some cases, pauses in breathing during sleep.

Medication cannot permanently straighten a deviated septum. When symptoms are significant, septoplasty can correct it surgically. This is a functional operation intended to improve breathing rather than change the external appearance of the nose.

Sinus cysts

A sinus cyst is a benign, fluid-filled swelling. It most often occurs in a maxillary sinus and is sometimes found by chance on a scan.

Symptoms

• Pressure or a feeling of fullness around the sinus.
• A dull facial pain or headache that becomes worse when bending forward.
• A blocked nose on one side.
• Recurring sinus infections.

Diagnosis and treatment

Assessment includes an ENT examination, nasal endoscopy and a CT scan. If a dental cause is suspected, a dental consultation is also needed.

Small cysts that do not cause symptoms can usually be monitored. If a cyst causes symptoms, is large or continues to grow, it may be removed during minimally invasive endoscopic surgery.