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Medical Services


ENT DISEASES

ENT Diseases List

Dr Ahmed Elbassiouny, dealing with the following ENT diseases

Nose / Sinus Problems

Symptoms

  • Nose obstruction
  • Allergic nasal symptoms ; frequent sneezing , running nose and itching sensation
  • Facial pain and sinus headache
  • Nose bleeding
  • Nose and facial fractures
  • smell disorders

Nose endoscopy (rigid and flexible scope) should be done for every nasal complaint ,with the support of C.T for the paranasal sinuses, as a guide for precise diagnosis and suitable treatment (medical or surgical)

Ear / Hearing Problems

Symptoms

  • Ear blockage & Old age hearing loss
  • Noisy ear sounds
  • Ear discharge
  • Ear pain
  • Ear trauma
  • Dizziness & Vertigo

Assessment of hearing (pure tone audiogram and tympanogram) may be needed for most of the cases

Culture and sensitivity from ear discharge can be also indicated in cases of ear discharge

Voice & Throat Problems

Symptoms

  • Hoarseness of voice , voice weakness / pain
  • Swallowing problems, choking, aspiration
  • Chronic throat irritation
  • Frequent throat clearing
  • Throat pain
  • Swallowed Fish Bone

Endoscopy, Video-stroboscopy or radiological evaluation may be needed for most of the cases

Voice or Speech therapy may be needed for some patients

Allergy in ENT

  • Skin prick testing for allergies
  • Blood Allergy testing (Immunoglobulins - IgE, IgG serology testing)
  • Food Allergy testing
  • Neck pains and swellings
  • Difficulty in swallowing
  • Thyroid swelling
  • Salivary gland disease
  • Cancer screening

Radiological evaluation (sonar neck or C.T neck) and blood tests are usually needed for accurate diagnosis

Pediatric ENT

Symptoms

  • Recurrent tonsillar infection
  • Mouth breathing and snoring
  • Nasal bleeding (epistaxis)
  • Nasal obstruction
  • Recurrent Ear infections
  • Hearing loss
  • Congenital abnormalities

Assessment of hearing (tympanogram +/- pure tone audiogram) and x ray for adenoid may be needed for most of the cases

Adenotonsillectomy usually done using coblation technology and not by the usual cold instruments

Snoring and obstructive sleep apnea

INTRODUCTION

Snoring and obstructive sleep apnea are a spectrum of a disease: sleep-disordered breathing (SDB). Snoring, at one end of the spectrum, related to vibration of the soft tissues around the soft palate while OSA, at the other end of the spectrum, is related to the collapsibility of the soft tissues of the upper airway; however, the condition is usually a multilevel one. Habitual snoring is a major symptom of obstructive sleep apnea.

Unfortunately, 80 to 90 percent of adults with clinically significant obstructive sleep apnea remain undiagnosed.

Snoring is a social problem while OSA is a medical problem. Obstructive sleep apnea poses a threat to your life and has been clinically documented to produce medical consequences to your body such as obesity, hypertension, heart attack, stroke, diabetes and unexplained sudden death.

Common risk factors for snoring and obstructive sleep apnea

  • Obesity
  • increasing age.
  • Alcohol and medications contributing to muscle relaxation
  • Craniofacial structure abnormalities.
  • Enlarged tonsils and adenoids.
  • Race — higher incidence of obstructive sleep apnea in African Americans, Mexican Americans, Pacific Islanders and Asians.

SNORING / SLEEP APNEA FAQ

What is Snoring?

Snoring is defined as noisy breathing during sleep. It is caused by vibrations of the soft palate, uvula, base of tongue and other soft tissues in the throat and implies an increased upper airway resistance to the airflow of air during inspiration.

Is Snoring a problem?

Snoring is a social problem and not an illness .however, If a patient developed in addition symptoms of tiredness, poor concentration, daytime sleepiness, choking sensations at night, this patient may have obstructive sleep apnea which considered a serious medical problem which may leads to heart attacks heart failure, high blood pressure, strokes and sudden death while sleeping.

What is Obstructive Sleep Apnoea (OSA)?

Cessation of breathing with no air flow at the nose & mouth for at Least 10 seconds. It is characterised by repetitive collapse of the airway, resulting in low oxygen levels.

Can it be cured?

Yes

There are a number of different treatment options. Precise patient evaluation is the key of sucess for any treatment modality.

How it can be diagnosed?

Diagnosis of OSA requires clinical and a flexible naso-endoscopy examination. sleep assessment is usually recommended.

Symptoms of OSA

DURING THE DAY:

  • Daytime sleepiness / tiredness
  • Lack of concentration
  • Poor memory, Mood changes
  • Morning headaches

DURING THE NIGHT:

  • Loud snoring
  • Choking sensation
  • Gasping for air during sleep
  • Frequent arousals
  • Nocturia

DISEASES ASSOCIATED WITH OSA

  • Obesity
  • Hypertension
  • Ischaemic Heart Disease
  • Stroke (Cerebrovascular Accidents)
  • Diabetes Mellitus

SNORING / SLEEP APNEA IN KIDS

Children who snore or struggle to breathe during sleeping may suffer from obstructive sleep apnea (OSA)

This may be due to :

Nasal congestion, allergic rhinitis or sinusitis

Enlarged adenoid and tonsils

Is child’s snoring is serious?

Children how snore and experience some difficulty sleeping at night and behavioral problems during the day may have OSA

How do I know my child has Sleep Apnea?

1. habitual loud snoring

2. Short periods of stoppages in breathing during the night

3. Difficulty waking up, even though it seems that he/she has had adequate sleep

4. Falling asleep or excessive daytime sleepiness

5. Irritable, aggressive

6. Poor school performance

SLEEP TESTS

Do I need a sleep test?

In all cases of snoring with symptoms suggesting obstructive sleep apnea , sleep lab. Should be done

Do I need to stay for one night in the hospital?

No. The home based devices are now avalable and are more easier than traditionnel sleep lab., as the patient sleeps at home, in his regular environment; so, the sleep will be more physiological and would yield a more accurate result.

TREATMENT OPTIONS

Conservative Measures

  • Weight loss
  • Sleep on the side might be helpful
  • Stop smoking
  • Avoid being sleep deprived
  • Avoid alcohol, sedatives
  • Regular exercise

CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)

This is a method of treatment that requires the use of continuous positive airway pressure by a nasal mask worn by the patient throughout the night to act as a splint for the collapsable upper airway. CPAP is an effective treatment for OSA, however, compliance is an issue.

ORAL APPLIANCES (OA)

These are mouthpieces that are worn while sleeping to prevent the airway from collapsing. It works by repositioning the tongue or mandible forward.

SURGICAL OPTIONS

Does surgery work?

Yes. Surgical intervention is tailored according to the preoperative patient evaluation Many surgical procedures are included in sleep surgery and include:

  • Nose surgery - Septoplasty, Turbinate Reduction surgeries, Endoscopic Sinus Surgery, Balloon Sinuplasty
  • Palate Surgery - Uvulopalatopharyngoplasty, Fairbank's UPPP, Pang's Expansion pharyngoplasty, Laser assisted palatoplasty, Anterior Palatoplasty, Pillow Implants, Palatal advancement
  • Tonsil surgery - Tonsil Removal, Tonsil Reduction
  • Tongue Surgery - Tongue Reduction (Cold instruments, Coblation, Laser, Radiofrequency), Tongue Suspension, Genioglossus advancement
  • Jaw Surgery - Jaw Advancement Surgery

As the airway pattern and the severity of obstruction vary greatly between individuals, the success rate of a given surgical procedure also varies greatly. In general, as OSA increased in severity, the degree of invasiveness of the required procedures becomes more in order to achieve successful surgical outcomes.

CPAP

Is CPAP is effective ?

CPAP is the most effective and frequently used treatment for OSA, but the issue of compliance is a major problem.

How can i will use the CPAP ?

A mask worn by the patient on the nose or the face throughout the night.two types of machines are avalable ; manual , delivers a fixed pressure of air, pre-determined by your sleep specialist based on either an overnight sleep study with the CPAP on, or Automatic , a dynamic machine that will titrate and adjust the amount of pressure required by the patient, which may be slightly may expensive but is probably more user friendly for the patient and more comfortable for usage.

What about machine tolerance ?

CPAP adherance, use the machine the entire night and every night of the week,is the most important for its sucess. Failure of adherence will leads to treatment failure.

Surgery

Surgical solutions for children

Obstructive sleep apnea in children is usually due to adenotonsillar hypertrophy. Nasal obstruction due to enlarged allergic nasal turbinates and jaw deformity can also be major contributors to developing obstructive sleep apnea.

The primary treatment for obstructive sleep apnea in children is adenoidectomy and tonsillectomy. The author of this website usually use coblator II in all cases of adenotonsillectomy. Occasionally, turbinate reduction by radiofrequency may be performed.

A sleep study before surgery is often recommended but is not mandatory when there are obvious signs and symptoms of OSA.

Additional treatment options such as nasal CPAP, maxillofacial surgery may be considered.

Surgical solutions for adults

Different surgical procedures have been developed to treat the airway components causing obstructive sleep apnea.

Clearly, prior to any sleep apnea surgery, the diagnosis of level of upperr airway obstruction and severity of obstructive sleep apnea based on sleep study and DISE ( drug induced sleep endoscopy )results is essential. The surgical plan is tailored according to DISE results and severity of OSA. Successful surgical outcome depends on proper patient selection as well as the choice of surgical procedure(s).

A post-operative, six months, polysomnogram is usually needed to evaluate outcome. Maxillomandibular advancement can be adviced for patients with persistent obstructive sleep apnea .

However, the staged approach may actually increase unnecessary surgical manipulation for some patients. Therefore, patients with severe obstructive sleep apnea with morbid obesity and significant hypopharyngeal obstruction such as severe mandibular deficiency can certainly be considered as candidates for maxillomandibular advancement as a primary surgical treatment option.

NOSE

Nasal surgery is important for many reasons:

1. The nose has a considerable role of the upper airway (about 50%), hence, having a Patients nasal airway is important.

2. A Patients nosal airway is important for a patient who is using the CPAP machine as this will helps usage and improves compliance

3. Nose surgery helps improve snoring and obstructive sleep apnea to a good extent (if done together with other procedures, like palate or tongue)

PALATE

Palatal surgery is important for many reasons:

1. Soft palate contributes to 70% to 80% of snoring sites.

2. Surgery to the palate will reduce snoring and obstructive sleep apnea effectively.

The ideal palatal surgery is that improving snoring and OSA without recurrence and complications (fobrosed palate with nasopharyngeal stenosis ).

Dr Ahmed Elbassiouny invented the following surgical techniue that meet with the ideal palatal surgery and have a very sucess rate regarding both snoring and OSA

1. Coblation-assisted soft palatal webbing flap uvulopalatoplasty

2- Use of Glubran 2 in uvulopalatoplasty

3- Soft palatal webbing flap palatopharyngoplasty

TONGUE

The tongue play an important role in sleep apnea and mangement of tongue is one of the main lines of treatment in such cases

Success Rate of Treatment

The key of success is good preoperative patient evaluation and patient selection Snoring and obsrtactive sleep apnea surgery can be performed as a staged or multilevel sngle stage surgery. The author of this website usually perfomring single stage nasal and palatal surgery and tongue base can be done as a second stage operation if needed.