ENT Knowledge Base

Diagnosis

Nose

Epistaxis (Nose Bleed)

Nose bleed is caused by injuring the nose through nose pricking, nose injury and sneezing. For the heavy one, immediate medical advice is necessary. Endoscope is used to find out the bleeding point and perform suitable treatment.

Deviated nasal Septum

Deviated nasal septum (DNS) is very common. Upon routine examination of the nasal cavity, up to 20% of normal population has some degree of septal deviation. However, only minority of them experiences nasal obstruction. Causes include congenital, forceps delivery and minor nasal trauma during childhood. A small crack in the septal cartilage can become progressively curved as the nose develops. Treatment is only indicated for significant difficulty in breathing.

Turbinate Hypertrophy

​Hypertrophied inferior turbinates are the end result of chronic rhinitis and allergic rhinitis. Medical therapy is the initial treatment option. Turbinate reduction is offered when maximal medical therapy fails.

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Before Laser Cauterisation

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​Normal nasal septum (CT - scan)

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After Laser Cauterisation

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Deviated nasal septum  (CT scan)

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Turbinate Hypertrophy

Tumour of nasal cavity & sinuses

Nasal tumour can be benign or malignant. It can arise from the nasal cavity or the nearby structures including the sinuses, nasopharynx or the nerve for smell (the olfactory nerve). Blood-stained nasal discharge and nasal obstruction are the major warning signs.

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Normal nasopharynx

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Nasopharyngeal Mass

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Nasopharyngeal Cancer

Foreign Body Inhalation

It happens usually in patients under 5 years old. Common foreign bodies are batteries, peas, tissues etc.

Crooked nose and saddle nose

Nose defines the beauty of a face. Unfavorable nose including crooked nose, deviated nose, big nose, nose hump, short nose and hooked nose.

Rhinoplasty is offered to patients who are unhappy with their nose profile.

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Fractured Nasal Bone

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Fractured Nasal Bone - Post Reduction

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Nasal Bone and 3D-Imaging

Nasopharyngeal Cancer

  • Common in Southern China and Singapore

  • Cause unknown

  • associated with genetic and geographical factors, Ebstein-Barr virus (EBV)

Diagnosis & Treatment

What are the warning signs of NPC?

If you discover blood streaks or clots in nasal secretion or saliva, treat this seriously. This may be the only early or even late sign of Nasopharyngeal Cancer. Other signs include:

  • Hearing loss and ringing in one ear

  • Painless lump in the neck

  • Double vision

  • Headache

  • Ear pain

Consult a ENT specialist and have a nasoendoscopy performed. With experience, more than 95% of NPC can be directly visualized on the surface. If NPC grows under the surface, MRI or PET scans will be useful.

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Normal nasopharynx

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Nasopharyngeal Cancer

Allergic Rhinitis

Allergic rhinitis (AR) is a common ENT disease affecting millions of people worldwide. Up to 40% of population in industrialized cities like Hong Kong suffer from AR and the trend is rising. Untreated, it can cause more serious and even potentially lethal complications of the ENT and respiratory system.

Symptoms

  • Blocked nose

  • Running nose

  • Itchy nose

  • Sneezing

  • Post-nasal Drip

  • Nose bleed especially in children

  • Dry throat

  • Recurrent sore throat

  • Hoarseness

  • Dry cough at night or during talking

If untreated, Allergic Rhinitis can develop into:

  • Sinusitis

  • Nose bleed

  • Ear block

  • Middle ear infection

  • Obstructive Sleep Apnea Syndrome

If untreated, Allergic Rhinitis can develop into:

  • Sinusitis

  • Nose bleed

  • Ear block

  • Middle ear infection

  • Obstructive Sleep Apnea Syndrome

Skin cancer of Nose

Not common in Hong Kong

  • Commonly occurs in fair skin Caucasian living in areas with high UV light such as Australia.

  • Appears as a non-healing ulcer over the nose

  • Treatment by local excision and plastic reconstruction

Blockage of nasolacrimal duct

Teary eyes are the primary symptom of nasolacrimal duct (tear duct) blockage. Treatment by surgical means is advised if syringing the tear ducts fail.

Cerebrospinal Fluid Leak

Leakage of cerebral spinal fluid is due to trauma and subsequently fractures of the anterior skull base. If the cerebrospinal fluid leak does not cease, surgical repair of the leak id recommended.

Common Cold

Common cold is usually caused by virus. The symptoms are familiar to all of us e.g. nose block, running nose and sneezing. For a normal healthy person, common cold should not arise more than 4 times a year. Those who have the above symptoms consistently, they may have allergic rhinitis.

Should Antibiotics be prescribed for all common cold?

Wrong, giving antibiotics will only increase the bacterial resistance and thus weaken the body. 'Preventive' antibiotics taking do not change the course of viral disease. In these cases, symptomatic treatment is used instead.

Nasal Polyp

Nasal polyps have been known to physicians since ancient time. They are like ‘bunch of grapes’ hanging down from sinuses, causing severe nasal obstruction and sinusitis.

Untreated nasal polyposis can lead to complete loss of smell, sinusitis, chronic pharyngitis due to mouth breathing. With high-tech video-endoscopic control and better CT scans, more complete and safer removal is possible with functional endoscopic sinus surgery (FESS).

How to diagnose nasal polyps?

  • Nasoendoscopy

  • CT scan of sinuses

  • How to treat nasal polyps
    - Medication treatment comes first. Anti-histamines and nasal steroid spray to shrink down the polys.
    - If polys are not responding to above medications, Laser-assisted polypectomy (LAP) or Functional Endoscopic Sinus Surgery (FESS) is recommended

Sinusitis

Sinuses locate next to the nasal cavity and continuously produce mucus to the nasal cavity. If the drainage is obstructed partially, headache and sinus congestion will result. Complete obstruction will leads to acute or chronic sinusitis.

Rhinitis and Sinusitis can happen spontaneously.

The sinuses are poorly developed in kids under the age of 4 and therefore, it's unlikely for patients under the age of 4. CT scan is a detailed study of the structure of paranasal sinuses. Thickening of lining of the sinuses do not imply that a surgery is needed. Functional Endoscopic sinus Surgery (FESS) is the surgical treatment to those who have irreversible sinus blockage with large nasal polyps.

How should acute sinusitis be treated?

Consult an ENT specialist is a must. Bacterial Culture swab must be taken from sinus opening before giving antibiotics. Hospitalization for IV antibiotics for severe cases What are the potential complications of poorly treated acute sinusitis?

Since the sinuses are adjacent to the eyeballs and frontal part of the brain, the followings may occur:

  • Abscess around the eyeball and eyelid

  • Meningitis

  • Brain abscess

Balloon Sinuplasty

It uses a guide wire to enter the blocked sinus cavity and a narrow balloon is then inflated to reopen the sinus passageway to allow drainage with minimal structural damage. This is particular useful for patients who has frontal sinusitis. It is akin to the angioplasty that is in widespread use today for blocked coronary arteries. The down side of Balloon Sinuplasty technique is it cannot deal with nasal polyps or ethmoid sinsusitis properly.

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Nasal Polyp

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Rhinosinusitis

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Rhinosinusitis X-ray

Dysthyroid eye disease

Protruding of eyeballs due to defective functioning of thyroid glands can lead to presence of multiple spots within both corneas. Decompression by surgical means improves eye closure.