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.
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.
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.