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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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From the Chair

  • July 2017

    July 2017

    From the Chair I have been to a couple of forums recently where Health Planning has been discussed. Maybe because General Practice is so well established, acknowledged as the cornerstone of Primary Health Care and so well run that we don't get on the agenda or we are not represented at these fora because GPs are working in practices seeing patients. I think it may be the latter. I went to the Mental Health Planning Day where the funding after 2018 is open for discussion. I think the problem is with Mental Health that everything is put in the one basket. Certainly the social determinants of health such as education, social support, housing and jobs are important but the patients need to enter the Medical Model for treatment of their condition. Some despite all the efforts to avoid hospital admission actually need to be in hospital. There also needs to be evidence that models that are funded work. It is also not good to throw the baby out with the bathwater and if a service is working build on it rather than start afresh. I think there is enough evidence now hence the Health Care Homes that a patient with a specific GP in a practice with a Primary Healthcare team has better outcomes than a patient who goes from practice to practice. As I have said before General Practices are easily accessible, trusted, already have the infrastructure and 85 % of the population goes to them each year. The problem I find is knowing what other services are out there as they tend to come and go with funding. The patient never seems to fit the criteria for referral despite the patient requiring a service. Maybe it will all change with the NDIS and My Aged Care where the patient can use their funding to pay for a service. Unfortunately the system is going to be so complex that the patients will be paying a navigator to negotiate services for them. You may be already seeing these navigators advertised on TV and digital media. Speaking of digital media I encourage to join and add comments to GPpartners facebook page but other very active sites are Brisbane Medical Mums and Business for Doctors. There is a lot of discussion on varied topics from Clinical to how to run a business.  Jayne Ingham Chair, GPpartners

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