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Nose & Sinus Conditions

Dr Dennis Chua is widely regarded as one of the best ENT specialist to manage complex nose and sinus conditions.

Sinusitis

Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. Normally, sinuses are filled with air. But when they become blocked and filled with fluid, germs (bacteria, viruses, and fungi) can grow and cause an infection.

Nose & Sinus Conditions

Conditions that can cause sinus blockage include the common cold, allergic rhinitis (swelling of the lining of the nose), nasal polyps (small growths in that lining), or a deviated septum (a shift in the nasal cavity). Patients with sinusitis frequently present with yellowish-green nasal discharge with nasal congestion, fever, headaches or even facial pain. It is important to differentiate allergic rhinitis from sinusitis since they can be very similar in presentation. In severe cases of sinusitis, they can have hyposmia (decreased sense of smell) or even anosmia (total loss of sense of smell).

Most sinusitis can be treated successfully with medications and only a small proportion will require sinus surgery (Functional endoscopic sinus surgery- FESS) to relieve the condition and washout the pus.

Balloon Sinuplasty (BSP) is a safe and effective sinus procedure for chronic sinusitis patients seeking relief from uncomfortable sinus pain symptoms. In selected cases, these can be performed in the clinic.

Nose & Sinus Conditions

Nasal polyps with loss of smell

Dr Dennis Chua is an accomplished ENT specialist that has managed several patients with anosmia (loss of smell) or hyposmia (decreased smell).

Nose & Sinus Conditions

Nasal polyps are benign lumps in the nose that can result in anosmia (loss of smell) or hyposmia (decreased sensation of smell). Anosmia/hyposmia can result in sensation of taste whilst eating and this can result in a decrease in quality of life for the individual. These polyps can be safely removed via a functional endoscopic sinus surgery under IGS (Image Guided Surgery) to improve the safety and greatly reduce complication rate.

HYPERTROPHIED (“SWOLLEN”) INFERIOR TURBINATE

This is a common reason for nasal congestion in Singapore. The high humidity results in high prevalence of house dust mites and molds which stimulate an allergic reaction resulting in swollen inferior turbinates. A swollen inferior turbinate frequently result in nasal obstruction and excessive production of mucus which can lead to postnasal drip and throat symptoms. A simple skin prick test can test for possible aero-allergens that result in a swollen inferior turbinate. Allergen avoidance is key in managing this condition and can help avoid long term reliance on nasal medications.

Nose & Sinus Conditions

Allergic Rhinitis

Dr Dennis Chua is an experienced ENT specialist that manages nasal allergies.

Allergic rhinitis is a very common condition in Singapore due to the high humidity. Common allergens include house dust mites and mold (fungi) in Singapore. If tested positive, there are several measures to help reduce exposure to these allergens to help treat the condition. A Skin Prick Test (SPT) is a painless procedure that can be performed quickly in the clinic and the results can be interpreted within 30 minutes.

Sinonasal tumors

Nasal tumors can be either benign or malignant. The commonest benign nasal tumor is an inverted papilloma. Though benign, this tumor is locally invasive ( and thus can erode into the surrounding vital structures such as the eye and brain) and has a 10% chance of turning malignant (cancer). If it occludes the opening of the sinus ostium, it can also result in recurrent infections (sinusitis).
This tumor will have to be removed completely and the stalk of the tumor traced to ensure its completely eradicated. This will minimize any chances of recurrence.

Nose & Sinus Conditions

Although tumors of the nasal cavities are equally divided between benign and malignant types, most tumors of the paranasal sinuses are malignant. Approximately 55% of sinonasal tumors originate from the maxillary sinuses, 35% from the nasal cavities, 9% from the ethmoid sinuses, and the remainder from the frontal and sphenoid sinuses. Squamous cell carcinoma is the most common malignant histologic type (approximately 70-80%) followed by adenoid cystic carcinoma and adenocarcinoma (approximately 10% each).

The treatment for this will be more aggressive and usually includes a combination of surgery, radiotherapy or chemotherapy.

Nasal Trauma

Dr Dennis Chua is widely regarded one of the best ENT doctors to manage nasal trauma. He is one of the few ENT Surgeons that is board certified by the International Board of Facial Plastics & Reconstructive Surgery and is skillful enough to manage complex nose & sinus conditions.

The nose is the commonest site traumatized on the face due to its prominence.
A nasal septal hematoma (blood clot) is a feared complication that should be picked up as soon as possible after a nasal injury and the hematoma should be evacuated within 12 hours due to the potential of septal cartilage necrosis.

Nasal septal cartilage necrosis can result in a saddle nose deformity with nasal obstruction.

Nasal trauma can result in a nasal fracture with nasal obstruction and/or cosmetic deficits such as a saddle nose or crooked nose.

The critical window for a closed nasal reduction for treatment of nasal fracture is before 2 weeks in adults and before 1 week in the pediatric patient.

The treatment for persistent nasal deformities beyond 1 month after injury may require a functional septorhinoplasty to treat the nasal deformity and ensure a patent nasal passage for breathing.

The nose is frequently traumatized in facial injuries and this often results from motor vehicle accidents, sports-related injuries and altercations. When the injury is significant, this can result in nasal fractures with its accompanying nasal deformity. There are 2 main problems that nasal trauma can result in: a nasal septal hematoma or nasal fracture with nasal obstruction or nasal deformities.

Click here for Management of Nasal Fracture article

Nasal Septal Hematoma

A nasal septal hematoma is one of the most feared complication that can occur with nasal trauma. Though uncommon, a septal hematoma can lead to complications such as septal abscess, septal perforation, cartilage necrosis with potential saddle nose deformity if the diagnosis is delayed. A nasal septal hematoma can be usually diagnosed with a careful clinical examination using a good light source with a nasal speculum. A fluctuant reddish-blue swelling can be noted on the anterior part of the nasal septum drainage of the hematoma should be performed urgently to prevent complications as mentioned above.

Nose & Sinus Conditions

Nasal Fracture

A nasal fracture can be diagnosed clinically if there is gross deviation of the nose from its pre-injury appearance. An x-ray though frequently performed may not be always necessary as it does not change the management.

First aid measures:

  • If the nose is bleeding, digital pressure over the soft fleshy part of the nose on its lower half can be applied for 15 minutes to slow down bleeding.
  • The head should be tilted forward during this time to prevent aspiration of the blood into the lungs.
  • Place ice wrapped in a cloth or a bag of frozen peas over the nose for about 15 minutes at a time. This process can be repeated hourly throughout the day. Using ice packs at the time of injury and for 1-2 days afterward helps to reduce pain, swelling and reduce nose bleeds. Take breaks between applications, and do not apply the ice directly to the skin.
  • Take paracetamol or NSAIDS to reduce pain. The pain is usually worse in the first 5 days after the injury.
  • Nasal decongestant such as oxymetazoline can be used to help with the nasal obstruction. However these should not be used beyond 5 days.
  • Elevate the head, especially when sleeping, to avoid increased swelling of the nose. Prop the head up with pillows or lift the head of the bed by placing large blocks or phone books under the mattress.
  • A closed nasal reduction can be attempted within 3 hours of injury before swelling sets in or between 3 days to 14 days when the swelling has improved. This helps in the evaluation of the precise nasal deformity the patient is suffering from. This procedure can be performed under local anaesthesia and is frequently painless. (Figure 1) A satisfying “click” can usually be felt or even heard when the nasal fracture is pushed back in place. There is usually increased swelling over the nose and some periorbital bruising may sometimes occur post nasal reduction. Some small amount of nose bleeds is usually expected in the first 48 hours after a nasal reduction. A nasal cast is usually applied for the next 1 week to protect the reduced nasal fragments. It is important that the patient avoids all contact sports (eg basketball, football) for the next 6 weeks following a closed nasal reduction till the nasal fragments are healed in place.

Epistaxis (Nose bleeds)

Nose & Sinus Conditions

The commonest reason for nose bleeds will be from trauma (eg from digging the nose). Certain conditions such as allergic rhinitis can predispose to epistaxis as the inflamed nasal lining are prone to bleeding after contact.

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