Conditions

Allergies are caused by a hyperactive and oversensitive immune system, leading to an exaggerated body immune response.

Allergic Rhinitis or Nose Allergy is a condition which affects the nose as a result of exposure to external agents (allergens). The external triggers may be airborne of introduced into our body system in the food we eat. Allergies reaction then occurs when our immune system reacts to the allergens.

The common consequences of such a reaction are:

• Nose congestion. This is caused by swelling of nasal tissue.
• Nose discharge. Back flow of nose mucus frequently result in cough and throat irritation.
• Nose itch and sneezing.

Common encountered allergens:

• Dust mites
• Chemicals eg perfume, cooking fumes
• Dairy products
• Peanuts
• Chocolate
• Eggs

The goal of treatment for Allergic Rhinitis is to identify the nasal triggers and institute avoidance therapy as much as feasible. Medical therapy includes antihistamines, nasal steroids sprays and immunotherapy.

.

Not all rhinitis are allergic in nature. Rhinitis that are not allergic nature are classified as non-allergic rhinitis. Causes of non-allergic rhinitis is extensive. Below are some of the causes.

• Hormonal e.g. pregnancy
• Environment or Occupation
• Infection
• Medication
• Diseases such as sarcoidosis, hypothyroidism, immunodeficiency
• Idiopathic or vasomotor

These patients may present the same way as allergic rhinitis ie nasal congestion and runny nose. Other symptoms such as cough, crusting and foul smell in the nose may be present. Treatment involves identifying and treating the underling cause.

This is a very common symptom experienced by both children and adults. A blocked nose not only causes discomfort but affects the quality of life of the patient. It may aggravate sleep apnoea and cause snoring and often causes chronic mouth breathing with consequences of dry mouth, frequent sore throats and even abnormal facial growth issues in children.

A blocked nose can be due to problems involving the structure of the nose or due to swelling and inflammation within the nose.

Structural deformities can be both internal and external. For example a badly deviated nasal septum can cause a blocked nose sensation and this deviated nasal septum can also cause external deformities of the nose. A very bent nose due to a previous injury can cause nasal obstruction often on one side. Septoplasty and occasionally rhinoplasty may be required to relieve the patient of a blocked nose.

Swelling of the nose is often due to very large turbinates and these are often very treatable with medication orradiofrequency. Nasal polyps and other growths within the nasal passage can potentially cause a blocked nose and a diagnostic nasoendoscope will be able to determine the cause of your blocked nose.

In children and young adults, occasionally, their blocked nose symptom may be due to enlarge adenoids and this is often diagnosed after a diagnostic nasendoscope. The treatment for this is usually a course of antibiotics followed by adenoidectomy if there is little or no response to antibiotics.

.

Nasal Polyps are non-cancerous growths in the nose that result from chronic inflammation in the lining of yournose or sinuses. The exact cause of Nasal Polyps is unknown although allergy, chronic infection and abnormal nose lining function have been associated with the formation.

Nasal Polyps can affect anyone. They most commonly affect adults older than 30 and are rare in children.

Symptoms

Small Nasal Polyps can usually be detected during routine nose endoscopy.They seldom cause significant problems. Larger Nasal Polyps however frequently present with the following symptoms:

• Nose blockage
• Facial or forehead pain and discomfort
• Loss of sense of smell
• Foul smell from the nose
• Ear blockage from obstruction of the tube that connects your nose to your ears
• Very large polyps that are left untreated may even alter the shape of your nose.
• Medications are often effective in curtailing the growth of small Nasal Polyps. Surgery is however

.

Nasopharyngeal cancer (NPC) develops in the nasopharynx, a small area at the back of the nose. NPC is a fascinating cancer in that it has a tendency to cluster amongst certain racial groups and in certain parts of the world. This cancer is particularly common amongst Chinese from Southern China like Fujian and Guangzhou provinces. NPC has a tendency to affect people at the prime of their lives between 30-60 years of age. Because of the deep seated nature of the nasopharynx, patients with NPC tend to present late. In fact about 60% of patients with NPC present at stages 3 or 4 of the disease during diagnosis.The common presentations are:

• Neck swelling from spread to neck lymph nodes (60%)
• Ear symptoms eg ear blockage of tinnitus (30%)
• Nose symptoms eg nose bleeds (30%)

The initial treatment of NPC is radiotherapy (Stages 1-2) with adjuvant chemotherapy for patients with stage 3-4 disease. People with a significant family history of NPC may be required to undergo regular blood screening to check the level of antibodies to Epstein Barr Virus level in their bodies. This antibody has been observed to correlate with the risk of developing NPC.

Sinonasal tumour are rare. They may be benign or malignant. Examples of benign tumours are hemangioma, osteoma and inverted papilloma. Inverted papilloma is a benign tumour that behaves like a malignant tumour with high recurrence. This tumour can be resected endoscopically with meticulous, yet less destructive technique such as a pre-lacrimal approach to shorten the recovery time and lower recurrence. Malignant tumours are very rare. Examples of malignant tumour are olfactory neuroblastoma, lymphoma, adenocarcinoma, squamous cell carcinoma. Malignant tumour usually need chemotherapy and radiation therapy as well.

Other conditions that mimic a tumour include mucocele of the sinuses, naso-labial cyst, rhinolith and nasal polyps. All these conditions may be treated with endoscopic sinus surgery.

Everyone would have experienced at least one episode of nose bleeding in their lives. The manner in which bleeding occurs usually determines whether a person with Nosebleeds seek medical help or not. Most people tend to dismiss an occasional slight blood staining of nose discharge when blowing or digging the nose. Severe bleeding from the nose, especially when the problem is recurrent can however be frightening and socially embarrassing. People with troublesome bleeds tend to seek help earlier.

Nose bleeding in children, especially if recurrent, can be an extremely distressing problem to cope with. Parents are often called by teachers in school when a child’s Nosebleeds frequently disrupts class activities. Waking up in the morning with blood-stained pillow cases caused by Nosebleeds during sleep can also be a traumatic experience for children.

Fortunately, Nosebleeds from life-threatening causes are very rare in children.

The Little’s area can cause a big problem

Most of the Nosebleeds In Children occur in an area located on the nasal septum (the midline wall that divides the right nostril from the left) near the entrance of the nose. This is called the Little’s area, a patch of mucosa rich in tiny blood vessels. This area is frequently subjected to surface tears when we dig our nose with our fingers, rub our nose too hard or insert tissue paper to clean the inner part of our nostrils. Blowing the nose too aggressively can also result in bleeding from Little’s area.

The Little’s Area

First aid measures to stop Nosebleeds In Children

Nothing is more important than to stay calm when we help a child with Nosebleeds. Sit the child down and press the sides of his nostrils together. Ask the child to lean forward and make him breathe through his mouth. Bleeding usually stops in a few minutes. Whenever possible, place an ice pack over the forehead, face or neck to quicken the cessation of bleeding.

Causes of Nosebleeds In Children

Nose allergy remains the commonest cause of nose bleeding in children. Nose blockage, nose discharge and nose crusting that result from allergic rhinitis are the usual precursors of Nosebleeds. Malignancy of the nose and sinuses are extremely rare in children.

Definitive treatment

Treatment of allergic rhinitis with nasal steroids, antihistamines and environment control measures is the key to treating children with frequent Nosebleeds. In children who have prominent blood vessels in the Little’s area, treatment with a chemical called silver nitrate is an effective treatment option. Silver nitrate is applied onto the Little’s area under topical anesthesia. The chemical reaction that results causes scarring of the blood vessels. Larger vessels can be treated with electro-cautery, a simple procedure that requires application of a special electrical applicator to ablate blood vessels. In adults, this form of treatment can be undertaken in the clinic under local anesthesia. For children, electro-cautery is usually carried our under sedation or general anesthesia.

What is Sleep Apnea?

Sleep Apnea means abnormal breathing during sleep; “apnea” means “without breathing” and refers to long pauses between breaths. It is a surprisingly common sleep disorder. Because apnea usually causes a slight awakening, having this disorder robs a person of deep, continuous and refreshing sleep. It also causes drops in oxygen level in the blood, which can cause changes in blood pressure and strain on the heart and lungs. People with Sleep Apnea also frequently have snoring.

What are the symptoms of Sleep Apnea?

The most common symptoms of Sleep Apnea include:

• Long breath pauses or struggling to breathe during sleep
• Significant daytime sleepiness
• Sensation of poor quality sleep
• Frequent awakening

Other symptoms include restlessness or movement during sleep, choking or gagging during sleep, heartburn,increased urination during the night, sweating, morning headaches, poor concentration, poor memory,irritability and depression.

What causes Sleep Apnea?

In obstructive Sleep Apnea, the most common type, the patient tries to breathe but cannot because of tissue obstruction in the upper airway which is more pronounced when the patient lies down, or from muscle relaxation during deep sleep. This obstruction can be from excess tissue, and also from disproportionate anatomy in the upper airway.

Snoring is caused by vibration of excess soft tissue in the upper airway, usually the soft palate and uvula. Since both snoring and obstructive Sleep Apnea can be caused by excess tissue, many patients have both, but again they are not always related. Both Sleep Apnea and snoring can be caused or worsened by sleep position; typically both are worse while sleeping on the back.

What happens to people who have Sleep Apnea?

Sleep Apnea causes frequent interruptions in sleep pattern. The person usually does not wake up completely, and so is often unaware of the severity of the sleep disturbance. These interruptions in restful sleep cause powerful and dangerous sleepiness during the day. In addition, Sleep Apnea is probably linked to heart and lung problems including high blood pressure. The death rate from all causes is also higher in patients with moderate to severe obstructive Sleep Apnea.

What is the treatment for Sleep Apnea?

There are several treatment options for Sleep Apnea. Each option has advantages and disadvantages, and treatments have different success rates and levels of patient satisfaction. Treatment options are as follows:

• Weight loss
• CPAP (Continuous Positive Airway Pressure) These are both worn during sleep and administered through a small mask or nasal pillows attached to a pressure machine.
• Sleep position modification.
• Oral and dental appliances. These custom-made devices can help hold the jaw and tongue in a position that prevents airway obstruction.
• Surgery.

What is Snoring?

Snoring is the sound that occurs during sleep when flow of air is obstructed in the area where the tongue and upper throat meet the soft palate and uvula. Snoring noises occur when these structures vibrate against each other during breathing. Snoring is obstructed breathing. In addition to disturbed sleep patterns and sleep deprivation, other serious health problems may result. Snoring may also be a symptom of other medical conditions.

What causes Snoring?

Snoring may be caused by many factors, including:

• Poor muscle tone
• Excessively bulky throat tissue
• Long soft palate
• Stuffed or blocked nasal passages
• Deformities of the nose
• Deformities of the nasal septum

Can Snoring be prevented?

Mild or occasional Snoring may be helped by:

• A healthy lifestyle that includes exercise and proper diet
• Losing weight
• Avoiding tranquilizers, sleeping pills before bedtime
• Avoiding alcohol before bedtime
• Establishing regular sleeping patterns
• Sleeping on your side

Heavy or chronic Snoring may require medical care.

Treatment for Snoring:

Specific treatment for Snoring will be determined by based on:

• Your age, overall health, and medical history
• Extent of the disorder
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disorder
• Treatment may include a nasal mask that provides continuous positive airway pressure (CPAP) or surgery.

Is it true that thyroid symptoms are often misdiagnosed?

There are 2 main groups of thyroid management problems that doctors encounter clinically. The first is the problem of abnormal nodular growth in the thyroid gland while the second involves thyroid gland dysfunctions. Misdiagnosis most frequently occurs in problems related to the latter group. A thyroid gland may become overactive and produce excessive amount of thyroid hormone (thyroxine) or under-secrete them. Former results in a condition called hyperthyroidism and the latter is termed hypothyroidism. Patients with hyperthyroidism frequently present with non-specific symptoms such as anxiety, insomnia, irritability and weight loss. Assessment of one’s blood thyroid hormone level will nail the diagnosis.

Why do Thyroid Disorders tend to be misdiagnosed?

The problem with Thyroid Disorders (hyper or hypo states) is that the symptoms tend to be non-specific. Unless the GP taking care of the patient has a high index of suspicion, patients usually go untreated until the disease become more established and obvious. With widespread annual full body checkups offered by medical clinics, however, patients with deranged thyroid functions are now detected much earlier.

What may happen if Thyroid Disorders are misdiagnosed?

As the diseases progresses, symptoms usually become more severe. Patients with hyperthyroidism for example may begin to lose unaccounted and dramatic amount of weight. Or they may suffer increasingly troublesome restlessness and insomnia. Patients who go untreated may suffer from heart complications which results from hyperthyroidism.

Has there been any data showing how common Thyroid Disorders (or each Thyroid Disorder) is among Singaporeans?

There is currently no data on this but extrapolation from predictive models based on studies in the US has the following estimates.

Prevalance Rate for Thyroid Disorders:

• approx 1 in 13 or 7.35%
• 320,139    |    Population of 4,353,893²

Undiagnosed Prevalence Rate for Thyroid Disorders:

• approx 1 in 20 or 4.78%
• 208,090    |    Population of 4,353,893²

Which group of people is at greatest risk for Thyroid Disorders? Why?

Women are 8 times more likely then men to face the disorder. People with a family history of thyroid problem and those with a high exposure to radiation also have higher chances of a Thyroid Disorders as the gland is sensitive to any form of radiation. Elderly people amongst us also have a higher risk of developing thyroid problems.

Who should check for Thyroid Disorders? How often should these tests be repeated? 

Patients with symptoms of increased thyroid hormone levels (unexplained weight loss in spite of an increase in appetite, anxiety, insomnia, inability to withstand heat, palpitation and bowel irritability etc) or decreased thyroid levels (weight gain, lethargy, constipation and mental slowness. Patients with unusual thyroid lumps (at the front of your neck) should also seek medical attention. For patients with abnormal thyroid functions, assessment of the blood thyroid hormone levels will usually review the severity of the problem. Patients with thyroid lumps will require fine needle biopsy, ultrasound of the thyroid and blood thyroid levels assessment.

Should people with thyroid nodules be concerned that the lumps are cancerous?

The incidence of thyroid nodules increases with age. It has been estimated that about ten percent of the adult population have some form of thyroid nodules. Autopsy studies have reveal the presence of thyroid nodules in 50 percent of the population. Fortunately 95% of solitary thyroid nodules are benign. The chance of a solitary nodule being malignant is therefore only five percent.

Is thyroid cancer common in Singapore? 

Thyroid cancer is fortunately not common in Singapore. According to the Singapore Cancer Registry, between 1998 – 2002, only 184 cases were reported in Singapore. It is the 9th commonest cancer in Singapore women.

How likely is a person suffering from thyroid cancer to recover from it?

Thyroid cancers are amongst the cancers with the best cure rates. These cancers consist of a diverse group of cancers with varying survival rates. Those commonly encountered are the papillary (65%) and the follicular (30%) types. Cure rates of more than 95% can frequently be attained when treated early and effectively. Unusual thyroid cancers include the medullary type (4%) and the anaplastic type (1%). The latter is extremely aggressive and gives poor prognosis.

How are common Thyroid Disorders are treated, including common side effects of drugs or complications?

Patients with hypothyroidism require daily thyroid hormone replacement.

Patients with hyperthyroidism may be treated by anti-thyroid hormones (such as carbamazepine or PTU), cellular destruction of the thyroid gland by radio-iodine or by subtotal removal of the thyroid gland.

Patients with thyroid tumours will require surgical excisions.

Are there any misconceptions and myths regarding Thyroid Disorders?

That only women gets thyroid problems. That it is mostly frequently caused by eating too much seafood. Or that it is caused by iodine deficiency.

Tonsilitis is a condition in which our tonsils become inflamed. Tonsils are normal structures found at the sides of the back of our throat. When they become inflamed, tonsils often enlarge and become painful. This makes eating and drinking extremely painful.

1. Acute Tonsillitis

This is said to occur when an occasional tonsil infection happens. This is usually associated with fever.

Oral antibiotics, pain-killers and anti-septic gargles are necessary to treat such a condition.

2. Recurrent Tonsillitis

Recurrent Tonsillitis is a term used to describe Tonsillitis which recurs intermittently throughout the year. This troublesome condition is frequently treated definitively with tonsillectomy (removal of tonsils).

When is surgical removal of tonsils (tonsillectomy) required?

The main indications of tonsillectomy are:

• To treat recurrent Tonsillitis
• To treat patients with difficulty breathing as a result of large tonsils which obstructs the airway
• To treat patients who have a tendency to develop abscess near the tonsils (Peritonsillar abscess)

A thorough physical examination and hearing test will often be adequate to help a clinician make a
definitive diagnosis. Occasionally, radiological imaging may be required to visualize the middle and
inner ear more to rule out abnormal growth.

Patients with Hearing Loss should be investigated.

The common causes of Hearing Loss are:

• Problems involving the outer ear

– Ear wax impaction
– Foreign body in the ear
– Ear canal narrowing (developmental abnormality or a result of repeated ear canal trauma)

• Problems involving the middle ear

– Ear drum hole
– Middle ear infection
– Fluid in the middle ear, usually caused by nasal infection
– Abnormal middle ear bone (ossicles)
– Barotrauma (middle ear pressure induced Hearing Loss)

• Problems involving the inner ear

– Age-related hearing nerve degeneration
– Hearing nerve degeneration from exposure to excessive loud noise
– Drug-induced hearing nerve degeneration
– Hearing Loss from viral infection
– Birth related Hearing Loss
– Hearing nerve damage from previous head injury

What tests are required?

A thorough physical examination and hearing test will often be adequate to help a clinician make a definitive diagnosis. Occasionally, radiological imaging may be required to visualize the middle and inner ear more to rule out abnormal growth.

What are the treatment options?

Hearing Loss can frequently be restored with the eradication of the cause. In cases involving irreversible damage to ear structures, such as Hearing Loss from nerve degeneration, hearing aids may be required to help patients hear. An audiologist will assist in the fitting of suitable hearing aids.

ertigo refers to the sensation of spinning or movement that occurs as a result of a disturbance in balance (equilibrium). The term is also frequently used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness.

Inner ear conditions that can lead to giddiness include Meniere’s Disease, acute inner infection (acute vestibular dysfunction) or Benign Paroxysmal Positional Vertigo

The group of ‘Non-ENT’ causes of giddiness is diverse and largely related to a multitude of chronic medical conditions such as stroke, diabetes, heart and kidney diseases. Lack of exercise, exposure to extreme stress, lack of sleep and rest are also common causes of giddiness.

The objective of therapy is to treat the underlying disease condition and to rehabilitate one’s vestibular function.

Contents of this page will be available soon.