Adult ENT - Nose

Nose

The nose functions as a portal of air entry into our respiratory system, equilibrates pressure to our sinuses and middle ear, cleans the air of foreign particles and enables us to smell.
Nasal symptoms include itchy, runny nose, blocked nose, nose bleeds, post nasal drip, problems with smell, nasal pain and facial congestion. As the nose is linked to the ear and throat, associated ear symptoms of ear blockage, decreased hearing, tinnitus or throat symptoms of dryness, pain or problems swallowing may occur.
Nasal endoscopy will most likely be performed during your visit. It is a comfortable and quick procedure with our modern and slim scopes. This procedure is performed to examine your entire nasal cavity, upper airway to the level of your throat. If required, nasal biopsies, chemical cautery for nasal bleeds and nasal toileting to remove thick secretions can be performed in the same setting.

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Nasal Conditions

Nose Bleeds (Epistaxis)

Epistaxis may occur spontaneously and bleed profusely. Triggers may include uncontrolled rhinitis, upper respiratory infections, uncontrolled hypertension and coagulopathies (taking blood thinners). You are advised to consult an ENT specialist if episodes are profuse, recurrent or persistent. A full head and neck examination with nasal endoscopy is advised to rule out sinister causes. Cauterization, nasal packing and admission is required if bleeding is profuse.

Nasal Bone Fracture

If you experienced nasal bleeding, bruising, swelling or nasal obstruction following nasal or facial trauma, your nasal bone may be fractured (“broken nose”). Physical examination with nasal endoscopy is required to exclude septal hematoma (blood clot in your septum), which is a medical emergency. X-ray of the nasal bone or CT facial bones maybe ordered to exclude any associated facial fractures. Manipulation and reduction of a displaced nasal bone fracture should be performed early.

Allergic rhinitis (Hay fever)

Allergic rhinitis is a type of inflammation in the nose that is caused by an allergen (eg. house dust mites). Symptoms consist of early morning sneezing, runny nose or stuffy nose. You may experience other hyper-sensitivity conditions like asthma, allergic conjunctivitis or eczema. First line management include oral antihistamines and nasal steroidal sprays. You should consult an ENT specialist If your symptoms are persistent despite using the above medications.

Inferior turbinate hypertrophy (swollen nasal lining)

The inferior turbinate is a lining situated at the sidewalls of your nasal cavity. It can become inflamed and enlarged giving problems of nasal obstruction, snoring/sleep apnea, decreased sense of smell and hypo-nasal speech. This condition is commonly associated with allergic rhinitis. Nasal endoscopy is commonly performed to assess the severity of inferior turbinate hypertrophy. Treatment consist of topical nasal steroidal sprays and decongestants. Turbinate reduction procedures maybe considered in cases of severe obstruction despite medications.

Sinusitis (sinus infection)

Sinusitis occurs when there is an inflammation of your sinusitis (mucosal lined spaces in your head) commonly due to prolonged colds (superimposed bacterial infection) or allergies. Patients described this condition as having a very bad cold with thick nasal mucus, nasal obstruction, headaches, post-nasal drip causing cough. If chronic, some patients have a decreased ability to smell.
Nasal endoscopy is performed to assess the degree of inflammation and nasal toilet is commonly performed to suction away the thick nasal mucus providing instant relief to patients. Treatment of sinusitis typically consist of oral antibiotics, nasal steroidal sprays, mucolytics and nasal wash. CT sinus scans maybe ordered to assess the severity and extent of sinus obstruction if symptoms are persistent, recurrent or chronic despite medications. Sinus surgery may be required in some cases.

Nasal Polyps (lump in the nose)

Nasal polyps are non-cancerous growths in your nose or sinuses and are the result of chronic inflammation. They tend to grow and block up your sinus passages. It is advisable to consult an ENT specialist if your nose is chronically blocked, experience decreased ability to smell and post-nasal drip. Nasal endoscopy is required to assess the size of nasal polyps and degree of sinus obstruction. Treatment include anti-inflammatory medications consisting of nasal steroidal sprays, antibiotics and nasal wash. CT sinus scan is required to assess the degree and severity of sinus obstruction and associated sinusitis. Surg

Deviated nasal septum (crooked nose)

The structural divide of the nasal cavity is called the nasal septum. You may be able to see that your nasal septum is slanted by lifting the tip of your nose. Some patients may have an externally rotated nose as well. It is common for the nasal septum to be deviated but not everyone with the condition requires surgical correction. Nasal endoscopy is commonly required to assess the full degree of nasal septal deviation together with anterior rhinoscopy and Cottle’s manoevre. If severe, septoplasty or septorhinoplasty is required to shift and remove the deviated segment to create space for you to breathe.

Elevated EBV serology and Nasopharyngeal Carcinoma

Nasopharyngeal Carcinoma (NPC), otherwise known as nose cancer, occurs when cancer develops in your nasopharynx (space at the back of your nose). Male, Chinese, with a family history of NPC are at risk. Other factors include exposure to Epstein Barr Virus and a high salt-cured diet.

Please see an ENT specialist immediately if you experience symptoms of nasal obstruction, unilateral ear blockage, blood-stained saliva, a lump in the neck (enlarged neck nodes) or blood-stained nasal discharge. Do not be alarmed if your EBV serology result is reactive on health screening and you have none of the above symptoms. It is extremely rare for NPC to be asymptomatic.
You will require a full head and neck examination together with nasal endoscopy, post-nasal space biopsy. Once histology is positive for NPC, you will require staging scans (MRI PNS and PET-CT). Treatment will be advised according to disease stage.

Sinonasal tumors

Sinonasal tumors are tumors that occur in the nasal cavity or paranasal sinuses which may be cancerous or non-cancerous. Treatment depends on histology and frequently involves surgery.

Nasal Procedures

Nasal endoscopy

Nasal endoscopy is a clinic procedure whereby Dr Soon will insert a flexible tube with a tiny camera and light into your nose to visualise your upper airway (entire length of nose to throat level). Our slim and modern videoscope provides a quick and comfortable examination. This procedure is registered as a day surgery procedure and is eligible for reimbursement through Medisave or personal insurance.

Nasal toilet

Nasal toilet is performed with a rigid nasoscope or direct visualisation with a headlight. Nasal suctioning is applied to remove thick secretions or blood clots found in your nasal cavity, which may contribute to nasal and sinus congestion, obscure accurate visualisation and assessment of lesions, or obstruct the opening of the eustachian tube.

Manipulation and reduction of Nasal Bone Fractures

This procedure involves shifting the nasal bones back into position and is done in cases of displaced nasal bone fractures (proven on lateral nasal bone xray) secondary to trauma. It is best performed within the first ten days after injury. You would need to wear a nasal splint after the procedure. Nasal packs maybe introduced to support and prevent further movement of the fractured segment. Bone healing will take place within two weeks.

Endoscopic septoplasty

This procedure involves removal of the deviated portion of the nasal septum through an incision inside your nose (no external scar). It is indicated for patients with nasal obstruction secondary to deviation of the nasal septum. It is performed under general anesthesia. Nasal packs are commonly inserted into your nose after surgery to prevent septal hematoma. In severe deviations, functional septorhinoplasty has to be considered to adequately address the deviated nasal septum.

Endoscopic turbinoplasty

This procedure involves partial removal of the inferior turbinate bone and lining under general anesthesia. It is performed to improve airflow through the nose. It is indicated in patients with nasal obstruction secondary to enlarged inferior turbinates, not better with topical nasal steroidal sprays and decongestants.

Radiofrequency ablation inferior turbinates

This is a minimally invasive technique done under local anesthesia to achieve volumetric reduction of the inferior turbinates. It is an office procedure and patients can return to work on the same day. It is an alternative procedure to endoscopic turbinoplasty.

Endoscopic sinus surgery

This procedure involves widening the natural ostia of your sinuses, to improve ventilation and drainage of your sinus passageways. It is performed under general anesthesia, and with guided CT for complex revision cases. It is performed commonly for chronic sinusitis.

Cauterisation and hemostasis of epistaxis

This procedure is performed under general anesthesia for major nose bleeds which is not amendable to nasal packing or chemical cautery. The source of nose bleeds is first localized and diathermised. In severe cases of nose bleeds, the feeding vessels are ligated (eg sphenopalatine artery ligation)

Balloon sinuplasty

Balloon sinuplasty is a minimally invasive procedure which involves dilating the sinus openings using a small balloon, to improve ventilation to the sinuses. It is an alternative procedure to endoscopic sinus surgery.

Clarifix application

Clarifix application is a minimally invasive technique which involves applying cryotherapy to the posterior nasal nerves (freezing the nerves which regulate nasal secretions). This procedure is an option for patients with chronic rhinitis.

Book an Appointment

At Adult and Child ENT Specialists, We are committed on providing Effective, Personalised & Holistic Care for all patients.