CONDITIONS OF THE NOSE

Mr Anwar is experienced in the diagnosis and treatment of all aspects of nose and sinus disorders, and below is a brief description of each condition, with emphasis on both medical and surgical treatment aspects.

ALLERGIC RHINITIS AND HAY FEVER

Patients would commonly complain from symptoms of sneezing, runny nose and nasal congestion. Additionally, allergic symptoms might also include itchy and watery eyes, itchy and painful throat and loss sense of smell. Allergies can be seasonal: caused by allergies to grass, trees and pollens, or all-year-long: caused by allergies to dust, animal dandruff and moulds. Mr Anwar will look to to diagnose your symptoms based on your history and his examination of the nose, and commonly would ask for a simple skin-prick allergy test to confirm the diagnosis. Treatments include advice on how best to avoid exposure to those allergens, anti-histamin tablets, nasal sprays and regular nasal rinsing with saline water. Surgery will mainly be for severe cases that fail to respond to medical treatment. Endoscopic surgery to reduce the size of the inferior turbinates (natural projections within the side walls of the nose) is occasionally offered to patients to relief their nasal symptoms but not as an alterative to medical treatment. Mr Anwar will discuss those options with you and offer the best suitable treatment for your condition.

NON-ALLERGIC RHINITIS

Patients with a negative skin prick allergy test might have a viral or chemical (perfumes, smog, spices and tobacco) induced inflammation of the lining of the nose (rhinitis). Treatment options are similar to the above (allergic rhinitis), without the need for anti-histamin treatment. Radiological investigation in the shape of CT scans to your nose and sinuses might help in confirming the diagnosis and Mr Anwar will discuss the indication for this test during the consultation.

SINUSITIS

Sinusitis is the inflammation of the lining of the nose and sinuses. There are two main types of sinusitis: acute and chronic. Acute sinusitis is caused by bacterial infection of the sinuses and can last for up to 6 weeks. Symptoms commonly include headaches, congestion, nasal discharge, fever and occasionally swelling and redness around the eye (peri-orbital cellulitis). Tooth infections in some cases can spread into the sinuses in your cheek and would persist despite of your dentist initial treatment with antibiotics and dental treatment. Radiological investigations either by simple x-ray images or CT scans of the sinuses can help with the diagnosis and Mr Anwar will discuss these options with you during the consultation. Treatment would include, pain control, prolonged course of specialised antibiotics and nasal rinsing with saline water.

Chronic sinusitis is inflammation of the lining of the sinuses that can last for several weeks and sometimes can follow an episode of acute sinusitis. Symptoms would include headache, facial pain, toothache, nasal discharge, congestion, obstruction and loss sense of smell. During the consultation Mr Anwar might need to examine your nose with a specialised fibreoptic nasal endoscope to confirm the diagnosis. CT scan of the sinuses is essential in confirming the final diagnosis. Treatment can be divided into medical and surgical treatment. Medical treatment includes a prolonged course of specialised antibiotics, topical nasal steroids, nasal douching and irrigation with saline water. Surgical treatment can be spared for cases that fail to respond to medical treatment, or can be offered at the time of diagnosis, depending on discussion with Mr Anwar during the consultation.

OBSTRUCTION & APPEARANCE

Nasal obstruction is a common complaint between ENT patients. Mr Anwar has a special interest in nasal obstruction surgery. Blockages of the nasal passages can be caused by a mechanical obstruction (deviation of the partition of the nose – septal deviation) as a result of trauma to the nose or occasionally can be congenital. Other causes of nasal obstruction include functional for example: rhinitis- hayfever or rhinosinusitis with or without nasal polyps. Whilst functional causes of nasal obstruction and congestion are often treated initially with medical and topical medications followed by endoscopic sinus surgery, mechanical causes of obstruction (septal deviation, narrowing of nasal passages) commonly are treated by nasal surgery: septoplasty & Septorhinoplasty.

Mr Anwar has an interest in aesthetic and functional nasal re-shaping surgery (Rhinoplasty). Often the aesthetic appearance and the functionality of the nose inter-connect and correcting one aspect of it inevitably improve the other. Please visit the review page to read some of the feedbacks left by Mr Anwar’s patients’ whom had nasal corrective surgery under his care.

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an ENT doctor from West London examining his patient
an ent specialist performing a nasoendoscopy

NASAL POLYPS

an ENT doctor from West London examining his patient

Nasal polyps are benign mucosal growths arising from the mucosal lining of the nose and sinus cavities. They are usually inflammatory in origin and non-cancerous. Often patients might not be aware of them, and they are diagnosed on close endoscopic examination of the nasal cavity in clinic. Their appearance resembles a cluster of small bags full of mucus, and can cause obstruction of the nasal cavity, sinusitis and loss sense of smell. They go hand in hand with chronic sinusitis, although chronic sinusitis can exist without nasal polyps. Investigation and treatment options of nasal polyps are exactly those of chronic sinusitis, although more often patients would be advised to receive a short course of steroids tablets to help shrink the polyps and relief the sinus obstruction. Otherwise, treatment would again typically include topical steroid treatment, antibiotics and nasal douching with saline water. Surgical treatment is via endoscopic sinus surgery and balloon sinoplasty. Mr Anwar will confirm the diagnosis following full clinical history and examination, including endoscopic fibreoptic examination of the nasal cavity in clinic, and will discuss the most appropriate treatment plan during the consultation.

TREATMENTS

SEPTOPLASTY

The nasal septum is the midline partition of the nose that separates the right and left nasal cavities. It is partly cartilage (the soft malleable front most part of the partition) and partly bony (the deeper part of the partition and often not felt by the patient). Septal deviation is one of the most common deformities in the human body, and whilst most septal deviations are unnoticed by patients, some patients will present to ear nose and throat specialist with symptoms of nasal obstruction due to a deviated nasal septum. Commonly a deviated nasal septum would have two components, the convex part (semi-circular protrusion into the nasal cavity) and the concave part (deep cavity within the midline partition of the nasal cavity). The side affected by the convexity of the nose is the obstructed side whilst the concavity side is widely open. Therefore, a single sided obstruction symptom is often caused by a deviated nasal septum. However, an ‘S’ shaped deformity of the nasal septum and bilateral nasal obstruction is not uncommon, especially if the deviation is caused by a previous injury to the head and nose. Mr Anwar will take a detailed history and examination of your nasal symptoms and your nose in order to establish if your nasal obstruction is caused by mainly a nasal septal deviation, and role-out other causes like rhinitis or chronic sinusitis, before discussing the option of surgery to correct the deformity via a septoplasty. Patients can be suffering from a combination of the physical obstruction caused by the septal deviation and symptoms of rhinitis and sinusitis.

The surgery is performed as a day surgery, and no external scars would be visible, as all cuts will be within the inside of the nose. Patients need not to worry about bruising following this procedure, however minor bleeding and aching is expected following septoplasty. No external casts or plasters will be applied to the nose following isolated septal surgery. Further details will be discussed with the patient during a face-to-face consultation with Mr Anwar.

BALLOON SINOPLASTY AND TUBOPLASTY

Is the gold standard surgical treatment for chronic sinusitis. Mr Anwar has a special interest in this particular area of ENT surgery and has a vast experience in performing endoscopic sinus surgery with a high success rate and positive long-term outcomes for his patients. The surgery is commonly performed as day surgery (patients would expect to be discharged home on the same day), no external scars are visible (key-hole surgery), and with minimal expected side effects (usually confined to minor bleeding and post-operative infection). Mr Anwar will discuss the full details of the operation upon consultation.

Endoscopic Balloon Sinoplasty: In recent years, the use of a balloon catheter balloon dilatation of obstructed sinus openings has increased in popularity, as it is associated with fewer complications and quicker recovery. The operation is performed commonly under general anaesthesia, although in rare occasions can be performed under local anaesthetic. The approach is similar to endoscopic sinus surgery, but would include passing a small-cuffed catheter into the sinus opening and inflating the balloon to dilate the sinus opening and drain any retained mucus and secretions within the sinus cavity. Mr Anwar is widely experienced in using this surgical technique and is accredited in introducing this technique to his current NHS based Trust Chelsea and Westminster NHS Foundation Trust.

ENDOSCOPIC SINUS SURGERY

Mr. Anwar is providing a novel therapeutic technology to his patients that revolutionised the management of frontal sinus disease and eustachian tube dysfuncion, referred to as Balloon Sinus Dilatation and Balloon Eustachian Tuboplasty respectively. Recurrent frontal sinus disease can be caused by a damage to the drainage pathway of the frontal sinus (the air pocket within the bone of the forehead) during a routine Endoscopic Sinus Surgery (FESS) that subsequently causes scarring and further stenosis of the sinus opening (ostia). Balloon frontal sinuplasty offers a minimally invasive and less damaging procedure which causes less scarring and future stenosis of the frontal sinus ostia. It also reduced the rate of recurrence and the need to subsequent surgeries.

Eustachian Tube Dysfunction (ETD) in adults are often caused by frequent air-travels, post- viral upper respiratory tract infection and chronic rhinosinusitis. They are often transient and might be managed successfully with a long-term topical nasal steroid. Short-term ventilation tube insertion (grommets) are another way of dealing with ETD when topical medical treatment alone fails. Balloon Tuboplasty offers a minimally invasive procedure with several positive studies supporting its effective use in ETD as a one-off alternative to ventilation tube insertion. It works by inserting a balloon via the nose into the eustachian tube orifice and dilating the cartilaginous tube.

ENDOSCOPIC SINUS SURGERY

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RHINOPLASTY

Rhinoplasty, or more commonly “nose-job” surgery is offered to patients with external deformities of the nose either caused by trauma or “birth-defects”. Although more commonly regarded as a cosmetic procedure, rhinoplasty can be offered to improve the functionality of nose in situations where the external deformity is affecting the nasal airflow (nasal valve compromise).

Mr Anwar is experienced in performing rhinoplasty surgery to improve the overall appearance of the nose (straightening a deviated nose and/or reducing the size of the nose) and the functionality of the nose (nasal valve surgery).

Rhinoplasty is performed either via an internal “close” approach (no visible scars externally), or an external “open” approach (a small incision made at the columella; small soft bridge separating the two nostrils). Mr Anwar will discuss the details of the surgery during the initial consultation and probably a follow-up consultation after a “cooling-off” period, during which Mr Anwar would arrange for the patient to have clinical photographs for better pre-operative surgical planning and documentation. The surgery is again commonly performed as day surgery; patients would expect to have certain levels of bruising and swelling following surgery. A cast made of plaster or a ready-made splint over the bridge of the nose is applied at the end of the operation to fix the nose in place. A follow-up appointment to remove the cast/splint will be arranged for the patient to see Mr Anwar a week after initial surgery.