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Education Summary - Dr Jayne Ingham - 'Snorters & Snorers' 21.03.16

Dr Daniel Timperley, who is an ENT specialist from the Sunshine Coast, has started consulting and operating at the North Lakes Day Hospital. Daniel talked to us about snorers and snorters.  We covered a lot of ground in 90 minutes with questions afterwards so I will try and pull out the salient points.  

Allergic Rhinitis

Intranasal steroids are effective.  Need to aim the tip of the nasal spray when inserted into the nose toward the ear so the spray doesn't hit the septum and cause bleeding.  Intranasal steroids do not affect growth in children.  Dymista is useful.  Can use a combination such as nasonex, an antihistamine and singulair.  (Singulair helps allergic rhinitis bu thte indication is for asthma in children.)

Saline lavage helps control and can be used in pregnancy.  

Immunotherapy is useful and effective but is a big commitment to three to five years of SC densitisation. There is a growing evidence for a sublingual treatment.

Non Allergic Rhinitis is when people react to such things as perfume, smoke or red wine.

Steroid sprays are not effective.  Atrovent for vasmotor rhinitis.  Capsaicin in the form of Sinol nasal spray can be used daily.  Olapatidine (Patanol) antihistamine eye drops dropped in the nose can also help.

Turbinate Surgery is sometimes needed for nasal obstruction not responding to medical treatment.

Sinusitis

Mucociliary transport is affected in sinusitis.  Bacteria and fungus form biofilms which are difficult to move. (Photos of very thic mucous being pulled out of the sinus and nose - yuk.) Maximum medical treatment for sinusitis needed two to three weeks of Augmentin of Klacid, three weeks of steroids instranasally and maybe a surfactant or wash such as sinus wash in a squeeze bottle.  If not settling to have a CT scan to look at thickening of the mucousa in the sinuses.

Some will need sinus surgery to open the sinuses to drain.  Post surgery need steroid washes - make up a solution using diprosone OV cream or pulmicort nebule in a bottle with saline solution or if there is crusting and biofilm, a surfactant wash with Johnson baby shampoo, bactroban ointment in warn saline solution.

Adult Obstructive Sleep Apnoea and ENT

Surgery decreases Obstructive Sleep Apnoea.  CPAP works but compliance is poor with some people not wearing masks and also taking them off in their sleep.

Need to assess what the problem is, where the obstruction is.  There may be a blocked nose, tonsils or adenoids enlarged.  Large tongue that falls back or a jaw that need splinting forwards.  The nose may collapse with inhalation.  The palate may need restructuring.  There are different operations depending ont he cause.

Once again, I learnt some new, useful information from our education event

In the last GPpartners' newsletter, in the summary of the 'Snorers and Snorters' there was a query about the use of nasal steroids in allergic rhinitis.  Nasal steroids are efficacious in allergic rhinitis but not vasomotor rhinitis.

 
 

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Events

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'Renal disease: when to refer'

Presentation by Dr Roshini D'Souza at North Lakes Dialysis Clinic

6 November 2019 6.30pm

'GPpartners AGM - rescheduled'

Annual General Meeting, including Director election.

From the Chair

  • From the Chair - February 2019

    From the Chair - February 2019

    From the Chair. This year is starting to race past again. Paeds in a Pod are offering an evening at North Lakes for GPs with two presenters, Dr Jamie Ross, who is a general paediatrician with an interest in neurology is going to discuss updates in epilepsy, and Dr Marlon Radcliffe, who will  talk about diagnosis and management of conditions in babies. From my experience paediatric neurologists are difficult to find so Dr Ross’s experience in neurology will be greatly appreciated. The details of the evening are in the flyer attached.  In Metro North, GPs with Special Interests have taken up positions in many different out patient areas. Some inside information is that there is now a clinic at RBWH where EEGs can be obtained for patients after a first fit. There is also a Gynaecology Clinic at RBWH offering Mirena insertions for patients who may not be able to access this service in General Practice. The clinics are listed in the dropdown menu in the electronic referral form to RBWH. (GPWSI positions are still available if you are interested please contact MNHHSGPwSIProject@health.qld.gov.au)   There are also high risk foot clinics at Redcliffe, Caboolture, Prince Charles and Royal Brisbane Hospitals for foot ulcers or Charcot’s joints. The patients are assessed by podiatrists and if needed referred to vascular surgeons. These early interventions are to prevent amputations. Referral is through the Central Referral form and after the referral is received the patient is seen within two working days.    GPpartners have had a request to see if any GPs are interested in working with Dr Benjamin Tsang (Staff Neurologist at Sunshine Coast University Hospital) in OPD. This is a GP with special interest position paid at VMO rates 3 sessions a week. Please contact Maree.Willett@health.qld.gov.au or Benjamin.Tsang@health.qld.gov.au      Carer’s Queensland have been funded to assist patient with applying for the NDIS in the Moreton Bay Region. They are situated at Level 5, The Corso, North Lakes and phone number is  3384 1601.    I find that the information that makes our lives easier as GPs, isn’t always readily available. GPpartners are continuing to develop GPpreferal which will centralise the local information. It is a slow process developing an IT solution but watch this space.   We are looking forward to another year of education and catching up with GPs. If you have any suggestions or requests please email contact@gppartners.com.au     Dr Jayne InghamGPpartners

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