THE NOSE

CONDITIONS, TREATMENTS & PROCEDURES

Mr Mohiemen Anwar has a broad range of knowledge and expertise in the diagnosis and management of all aspects of adult and paediatric Ear Nose and Throat diseases.

His main sub-speciality and special interest is in the management of nasal or sinus diseases and disorders (Rhinology).

Diseases and disorders of the nose are often non serious and self-limiting, like in the case of the common cold and simple viral illnesses. But when it is more than this, it is expected to have a large impact on the patient’s overall quality of life and restrict their day-to-day activities, like work, exercise and sleep. Patients with nasal and sinus disorders would commonly complain from nasal obstruction, congestion, catarrh, headaches, nose bleeds, runny nose, abnormal sense of smell/taste and recurrent nose and sinus infections.

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Trauma to the nose can cause change in the shape of the nose, both internally and externally. Operation to correct the internal deformity of the nose is called Septoplasty, whilst if the deformity extends to the outside appearance of the nose is called Rhinoplasty. A combined procedure to correct abnormalities of the internal and external structures of the nose is called Septorhinoplasty.

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.  

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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.

Endoscopic Sinus Surgery

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.

Nasal Polyps

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.

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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. 

Rhinoplasty (nose-reshaping surgery)

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). He is often on the receiving end of excellent reviews for his surgical skills from his patients. Please visit his latest reviews page

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.