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One of the best clinics in Dubai, Aster, hosts the most experienced ENT doctors who specialise in  evaluation, diagnosis and treatment of a full spectrum of ear, nose and throat disorders

Sinusitis — What you need to know

Dr Mukesh Kumar Ramani, Specialist ENT Surgeon, Aster Clinic (Aster Jubilee Medical Complex), Bur Dubai

What causes sinusitis and who is more likely to get it?

There are four pairs of hollow spaces in the bones of your face. These are called sinuses. The sinuses are connected to each other and drain through the nose. The most common cause is a virus, such as the common cold. Bacteria can grow in the mucus trapped in your sinuses. This can lead to a bacterial sinus infection. Anyone can get a sinus infection, but people with nasal allergies, hay fever, or asthma have an increased risk. Other risk factors include exposure to cigarette smoke, nasal polyps, and changes in pressure (such as during flying or scuba diving). Sinus infections can also be caused by a deviated septum, which is when the part of your nose that separates the nostrils is out of place.

Dr Mukesh Kumar Ramani

Dr Mukesh Kumar Ramani, Specialist ENT Surgeon, Aster Clinic (Aster Jubilee Medical Complex), Bur Dubai

What are the likely signs and symptoms?

Thick, yellow to green discharge from the nose, nasal congestion or blockage, facial pain, pressure, or fullness. Other acute sinusitis symptoms can include fever, fatigue, cough, difficulty or inability to smell, ear pressure or fullness, headache, and bad breath.

How do you diagnose a person with sinusitis? How does one treat sinusitis?

Any patient with typical features of sinusitis is diagnosed with sinusitis on clinical grounds, however X-Ray PNS (fluid levels in the PNS) and nasal endoscopy (showing mucopurulent discharge in the key area of sinuses) can help diagnose the case of acute sinusitis.

The primary treatment for sinusitis involves symptom relief. Symptomatic treatment of a sinus infection aims to relieve symptoms of discomfort and congestion such as pain relief. Nasal irrigation that involves flushing the nose and sinuses with a saline solution several times a day can decrease pain and congestion. Also Nasal steroids can help reduce swelling inside the nose, usually within two to three days.

What are the possible complications if someone delays treatment or poorly treats sinusitis?

Chronic sinusitis can sometimes develop from an acute sinusitis. This is the most common complication. Other complications are rare. However, they can be serious. For example, the infection may spread from a sinus to around the eye, into bones, into the blood, or into the brain.

Otitis media: A common childhood illness

Dr Varun Bidi, ENT Physician and Surgeon, Aster Clinic, Dubai Silicon Oasis

Can you please define otitis media?

The ear is divided into three spaces — the external ear, the middle ear and the inner ear. Otitis media is the infection of the middle ear space

Dr Varun Bidi

Dr Varun Bidi, ENT Physician and Surgeon, Aster Clinic, Dubai Silicon Oasis

What are the likely signs and symptoms? How does one prevent otitis media?

We have to understand that the middle ear is connected to the nose by a tube called the eustacian tube. So, middle ear infections (otitis media) are almost always caused by some nose infections, which travel to the ear by this tube or nose-related conditions causing blockage of this tube. It may cause ear pain, ear blockage, ear drum perforations leading to reduced hearing and ear discharge.

Why do children get more ear infections than adults?

The eustacian tube connecting the nose and the middle ear is shorter and horizontal in children. Hence, the infections are easily transmitted to the middle ear from the nose. As they grow this tube becomes longer and vertical as seen in adults and the frequency of ear infections reduces.

How does one treat otitis media?

It can be treated with antibiotics and painkillers for the ear, while antihistamines and nose sprays can treat any nose infection or swelling. Surgery is required for eardrum perforations, eardrum retractions and bone erosions.

Most common ENT ailments in the UAE

Dr Carmen Chiran, ENT Specialist, Aster Tecom

What are the most common ENT conditions and when do we have to see a specialist?

The most common ENT conditions are allergies, infections of the nose, sinuses, throat and ears, vertigo and hearing problems.

Some cases are self-limiting and can be managed using over the counter medication. When evolution is more severe and long-lasting, symptoms are more serious: headache, pressure over sinuses, persistent nasal discharge, severe throat pain, prolonged cough, breathing difficulties, voice problems, etc. These symptoms are signs of complications, which are potentially avoidable if the patients are visiting the clinic.

Dr Carmen Chiran

Dr Carmen Chiran, ENT Specialist, Aster Tecom

What ENT conditions can be managed using traditional therapies?

Most cases of allergic rhinitis without complications benefit from anti-allergic medication. Acute respiratory infections and ear infections are responding well to symptomatic, and sometimes antibiotic therapy if indicated. Various types of dizziness or vertigo are treated by specific medication and vestibule rehabilitation. Voice disorders can benefit from speech therapy.

What are the most common ENT surgeries?

In children, removal of adenoids and/or tonsils is the most common procedure. In Adults, most common surgical procedures are done for sinusitus and deviated nasal septum.

Is ENT a speciality where preventive/lifestyle changes or medication can help patients to avoid surgery?

Yes, it is. The best example is conservative treatment of rhinitis, sinusitis or otitis media, which can prevent complications requiring surgery.

Flu or Covid-19? Look out for the symptoms

Dr Vishwanath Natesh, Specialist Otolaryngologist at Aster Clinic, Al Khail Mall

With Covid-19’s presence, is the infamous flu season in dormancy?

The onset of the Covid pandemic, schools closed, travel and tourism came to a standstill. Wearing masks and work from home became the norm and so the flu season and cases did go into dormancy and thankfully the twindemic did not happen.

Maybe the presence of coronavirus as the dominant circulating virus suppressed the flu, but once daily life normalises the potential of a larger and out-of-season flu outbreaks is difficult to predict and all effective measures to curb the same should be followed.

Dr Vishwanath Natesh

Dr Vishwanath Natesh, Specialist Otolaryngologist at Aster Clinic, Al Khail Mall

What are the similarities between Covid-19 and the flu?

Covid-19 and flu both are contagious respiratory viruses spreading by droplets and aerosol of an infected individual as also by touching a contaminated surface. Symptoms may range from being asymptomatic to severe with fatalities. Although all age groups can be infected, the elderly, people with chronic and immunocompromised conditions, and pregnant females are at risk of both infections. The same preventive and protective measures work for both infections and there are safe and effective vaccines for both conditions.

Ibuprofen vs Paracetamol, which medicine should you take in case you suspect infection?

Looking at all the scientific data and practical experience it seems sensible and safer to use Paracetamol first if there is a suspicion of either infection. Paracetamol has fewer side effects and is less likely to cause any complication compared to Ibuprofen. It is always wise to follow up with your physician and follow all instructions coming with the medication.

Apart from maintaining hand hygiene, what else can people do to protect themselves?

Avoid crowded and poorly ventilated places, wear a well-fitted mask and maintain social distancing, avoid touching your nose, mouth, or eyes after touching any surface, keep your home and office well ventilated, cough or sneeze into a tissue or your bent elbow.

Isolate yourself if you have any related symptom and the most important one is to get yourself vaccinated and follow all related advice from local authorities.

The trouble of allergic rhinitis

Dr Midhuna Prathap, Specialist ENT Surgeon, Aster clinic, Abu Hail

What happens if rhinitis is left untreated?

If left untreated, it can cause a reaction in the nose causing persistently blocked nasal passages, runny nose, sneezing and itching, which lead to nasal polyps and sinusitis. It can cause inflammation in the ear causing middle ear infections. It can cause itchy throat due to constant post nasal drip. Ocular symptoms such as redness and watery eyes are also noted. There can be abnormal lung functions due to increased airway resistance, thus posing a risk factor for asthma. There are also orthodontic changes and other symptoms such as fatigue, malaise, and sleep disorders.

Dr Midhuna Prathap

Dr Midhuna Prathap, Specialist ENT Surgeon, Aster clinic, Abu Hail

Which other diseases is allergic rhinitis confused with?

Vasomotor rhinitis or non allergic rhinitis, rhinitis medicamentosa (due to antihypertensives and topical decongestants), hormonal rhinits (due to pregnancy or contraceptive use), Immotile Cilia syndrome, CSF leak and granulomatous rhinitis.

How is allergic rhinitis diagnosed in adults and what is the treatment?

We conduct a blood investigation that includes peripheral eosinophilia and radio allegro sorbent test for specific IGE. We also do a nasal smear, skin prick and intra dermal tests. For treatment avoidance of allergen or irritant is key, then long-term use of intranasal steroids, oral antihistamines, or short course of topical decongestants. Besides, immunotherapy may also be recommended to provide relief.

Is it possible to prevent allergic rhinitis?

The effects of this condition can be lessened by avoiding triggering allergens such as dust, pollen, etc. Consider the use of air filters when indoors and also the use of saline nasal irrigation can be helpful.

Primary reasons for ENT disorders in children

Dr Shyam Anil Pai, Paediatric ENT Specialist, Aster Clinic Al Nahda Dubai

What are some common paediatric ENT conditions?

* Blocked ears due to ear wax

* Pain in ears due to severe cold and cough attack that causes infected fluid accumulation inside middle ear spaces.

* Enlarged tonsils and adenoids causing blocked nose and snoring with disturbed sleep.

* Allergic Rhinitis due to dust, AC use, and weather changes.

Dr Shyam Anil Pai

Dr Shyam Anil Pai, Paediatric ENT Specialist, Aster Clinic Al Nahda Dubai

How can I prevent or manage allergies in children?

* Breastfeeding exclusively for the first four to six months, or using a hypoallergenic formula, may strengthen the immune system while delaying or preventing atopic dermatitis and milk allergy.

* Solid foods should be introduced gradually between four to six months of age. Egg, dairy, peanut, tree nuts, fish and shellfish can be gradually introduced after less allergenic foods have been tolerated. In fact, delaying the introduction of these foods may increase your baby’s risk of developing allergies.

* Reducing exposure to some allergens, such as dust mites, may delay or prevent allergy or asthma symptoms.

* Exposure to tobacco smoke before and after birth increases your infant’s risk of developing wheezing and asthma.

From allergies to flu, when does your child’s ear, nose or throat condition become a cause for concern?

* Sleep apnea is when a child has trouble breathing during sleep. It usually happens because something obstructs or blocks the airway and makes the body’s oxygen levels fall and interrupt sleep. Enlarged tonsils and adenoids are a very common cause which can make kids miss out on a healthy restful sleep. Untreated obstructive sleep apnea can lead to learning, behaviour, growth, and heart issues.

* Ear infections are painful because the inflammation and build-up of excess fluid increases pressure on the eardrum which would make child cry in the night and have restless sleep.

* Children who are not able to hear or respond to calling can be a cause of concern. Its important for parents and caregivers to look for the signs of hearing loss in children because hearing loss can cause significant development and emotional problems for them.

* Studies say among the many hundreds of children coming to the ENT clinic few symptoms are due to an underlying genetic condition. Can you elaborate what genetic conditions an ENT specialist finds out?

* ENT surgeons dealing with children need to know the ENT features of a few common syndromes for example Down’s syndrome, Treacher Collins syndrome and Goldenhar syndrome, as they are likely to meet children with these conditions in their paediatric practice. Common to these conditions is external ear and middle ear abnormalities, facial asymmetry and certain characteristic defects, deafness, etc.

* Less common situation is when the ENT surgeon suspects that a child may have a syndrome, which has not yet been diagnosed. This is rightly the territory of the geneticist and while it is intellectually stimulating to try to piece together a syndrome it is best to avoid mentioning any suspicions at this stage. Referral to a geneticist is appropriate not only for children with undiagnosed conditions but also for those with the common syndromes so that genetic counselling and genetic testing can be offered both to the immediate family and also to those in the extended family. It may be surprising how many children with known genetic diagnoses who are under multiple hospital specialties, have never seen a geneticist.