In the facial bones surrounding your nose, there are four pairs of hollow air spaces known as sinuses or sinus cavities. These sinuses all open into your nose, allowing air to move into and out of the sinus and mucous to drain into the nose and the back of your throat. If the passage between the nose and sinus becomes swollen and blocked, then air and mucous can become trapped in the sinus cavity causing inflammation of the sinus membranes or linings. This is known as sinusitis. Sinusitis can be: acute - usually a bacterial (or sometimes viral) infection in the sinuses that follows a cold, or an allergic reaction. chronic - a long term condition that lasts for more than 3 weeks and may or may not be caused by an infection. Sinusitis can be a recurrent condition which means it may occur every time you get a cold. Symptoms of sinusitis include: facial pain or pressure nasal congestion (blocking) nasal discharge headaches fever. Most sinusitis will respond to medication but a sinus infection is similar to an abscess. As such prolonged courses of antibiotics are required: 2 – 3 weeks for acute sinusitis and 4 – 6 weeks for chronic sinusitis. Broad spectrum antibiotics such as Doxycycline, Roxithromycin, Amoxil, Augmentin or Co-Trimoxazole are appropriate. To decrease inflammation and improve drainage, oral steroids (Prednisone) for 14 - 21 days and topical decongestants can be useful. Oral decongestants and antihistamines have not been proven to be beneficial. Those who fail medical therapy become candidates for surgery. If surgery is contemplated a CT scan of the sinuses will be required. Most sinus surgery is performed endoscopically - through the nostrils. The aim is to drain any infection and to imprve the ventilation and subsequent drainage of the sinuses.

Snoring and obstructive sleep apnoea are two ends of the spectrum of conditions covered by the term sleep disordered breathing. Snoring occurs because the airway is narrowed during sleep, leading to turbulent airflow, vibration of soft tissues and noise. Obstructive Sleep Apnoea is simply an extension of snoring, where the airway becomes obstructed and airflow ceases. The definition of apnoea varies, but in general it is accepted that cessation of airflow for more than 10 seconds represents an apnoeic event. Snoring is a social problem whereas apnoea, depending on its severity, can be a medical problem. The initial symptom of apnoea may be day time sleepiness due to sleep deprivation, but later there can be cardiac and respiratory complications, depending on the frequency and duration of events. Both snoring and obstructive sleep apnoea have multiple causes and in any individual the cause of sleep disordered breathing is often multifactorial. There are both anatomic and general causes. Common anatomic causes include nasal obstruction due to deviated nasal septum, nasal polyposis or sinusitis, enlarged adenoids and tonsils, a long palate and an enlarged tongue base. General causes include the use or overuse of muscle relaxants, particularly alcohol and raised body mass index (weight). The history is adequate to diagnose snoring but is unreliable in diagnosing obstructive sleep apnoea. The only accurate way to diagnose and quantify obstructive sleep apnoea is with polysomnography (a sleep study). The only proven treatments for sleep disordered breathing are CPAP and tracheostomy. The latter is fortunately seldom required. Nonetheless many patients suffering from both conditions derive significant benefit from surgery including septoplasty or septorhinoplasty, endoscopic sinus surgery, adenotonsillectomy or palatal surgery. On occasions hyoid or mandibular advancement may also be required. On some occasions prosthetic devices, particularly mandibular advancement splints may also be beneficial. Adequate assessment treatment of sleep disordered breathing requires liaison between the general practitioner, ORL Surgeon and sleep physicians. I am happy to assess any patient with sleep disordered breathing in the first instance.

Rhinitis is the inflammation of the lining of the nose (nasal mucosa). The most common symptoms are a blocked, runny and itchy nose. Rhinitis can be: allergic – either seasonal (hay fever) caused by pollen allergies or perennial caused by e.g. house dust mite, pets. infectious – e.g. the common cold non-allergic, non-infectious – caused by irritants such as smoke, fumes, food additives In the case of allergic rhinitis, the specific allergen (the thing that you are allergic to) may be identified by skin prick tests. This involves placing a drop of the allergen on your skin and then scratching your skin through the drop. If you are allergic, your skin will become red and swollen at the site. The management of allergic rhinitis has four modalities: avoidance, medication, surgery and immunotherapy. The treatment requirements of an individual allergy sufferer vary but often more than one modality is required.

A fractured nose is a common injury. It can lead to both nasal obstruction and nasal deformity. For the first three weeks following a nasal fracture (closer to two weeks in children) the nasal bones remain mobile and can often be reduced removing the need for further treatment at a later date. The best time to reduce a nasal fracture is at the time of the injury. Within a very short time frame however swelling and bruising develops, which makes assessment and treatment of the fracture difficult. The best time therefore to see nasal fractures is between one and two weeks following the injury. By this time the swelling has reduced enough to see if the deformity requires further treatment, but it is also early enough for the bones to be simply manipulated. Nasal fracture reduction can usually be achieved under local anaesthetic but on some occasions general anaesthesia may be employed. We are currently unable to provide this service in the rooms due to ACC requirements. Please refer patients to the fractured nose clinic via the acute on call Registrar at Auckland City Hospital. Patients should be referred for assessment at the time of their initial presentation but inform them they will be seen when the swelling has reduced, usually between one and two weeks. X-rays are not required for nasal fractures and do not alter the management. If the nose is deformed following an injury the nose can be reduced irrespective of the X-ray findings. Similarly if there is no deformity, no reduction will be required, irrespective of the X-ray findings. The success rate of nasal fracture reduction is probably in the region of 50%. The commonest reason for failure is deviation of the nasal septum which is not easily corrected by simple manipulation. If the reduction is unsuccessful, either cosmetically or functionally, or if reduction is not possible because the two week window of opportunity is missed, then the patient becomes a candidate for a septorhinoplasty. ACC funds treatment of nasal fractures but not in the acute phase . If surgical correction is required I am happy to see nasal fractures for appropriate assessment and treatment. PAEDIATRIC NASAL FRACTURES Nasal fractures also occur in children. However acute intervention is less frequently required or beneficial in the paediatric age group. Any intervention that is appropriate requires a general anaesthetic. In addition nasal fractures tend to fuse or heal earlier than in adults. Referral therefore is time sensitive from the point of referral to treatment under general anaesthesia. I therefore recommend a referral to the acute ORL Registrar at Starship Hospital for all nasal fractures in children 12 and under. Non acute correction of subsequent deformities such as septoplasty and septorhinoplasty are also much less frequently undertaken in the paediatric age group. In general we endeavour to wait until facial growth is complete usually after the age of 14 in females and 15 or more in males. Clearly there will be exceptions and I am happy to see non-acute paediatric patients post nasal trauma to discuss the treatment options with their parents.

This operation repositions the nasal septum and is performed entirely within your nose so that there are no external cuts made on your face.

Surgery can be carried out to improve the appearance of your nose e.g. straightening it if it’s crooked or increasing or decreasing its size. Small cuts (incisions) are made either on the inside or outside (in the creases) of the nose. Excess bone and/or cartilage is removed and the nose reshaped. The surgery takes about 2 hours and is performed under general anaesthetic (you sleep through it). You may be able to go home the same day or, in some cases, you may have to stay in hospital overnight. You will need to arrange for another person to drive you home. Your nose will be covered with a splint that you will have to wear for about 1 week. It will take about six weeks for the worst of the swelling to disappear.

Your tonsils are the oval-shaped lumps of tissue that lie on both sides of the back of the throat. Sometimes tonsils can become inflamed (red and swollen with white patches on them) as the result of a bacterial or viral infection; this is known as tonsillitis. If you have tonsillitis, you will have a very sore throat and maybe swollen glands on the side of your neck, a fever, headache or changes to your voice. In some cases, pus can be seen on the tonsils. Tonsillitis mostly occurs in young children and can be a recurrent condition (it keeps coming back). If the tonsillitis is caused by bacteria, antibiotics will be prescribed. If the tonsillitis is caused by a virus, treatment will usually consist of medications to relieve symptoms such as a pain killer. If tonsillitis occurs often over a period of two or more years, then surgical removal of the tonsils (tonsillectomy) may be considered.

This is inflammation or infection of your middle ear (the space behind your eardrum) and is often associated with a build-up of fluid in your middle ear. Acute Otitis Media This is usually caused by a temporary malfunction of the Eustachian tube due to allergies, infections or trauma. The Eustachian tube connects the middle ear to the nose and allows air to enter the middle ear, thus making middle ear pressure the same as air pressure outside the head. Acute otitis media results in an infection in the middle ear causing pain, fever and a red, bulging eardrum (the thin, transparent membrane between the outer ear canal and the middle ear). This condition is usually seen in young children. The treatment may be antibiotics if it is suspected to be a bacterial, rather than viral, infection, or if there are repeated episodes, surgical insertion of grommets into the eardrums may be required. Grommets are tiny ventilation tubes that allow normal airflow into, and drainage out of, the middle ear until the Eustachian tube begins to work normally. The operation is done under general anaesthesia (the child is asleep) and takes 10-15 minutes. Most grommets fall out naturally after six to twelve months, by which time the Eustachian tubes are often working properly. Otitis Media with Effusion (Glue Ear) Like acute otitis media, glue ear is usually the result of a temporary malfunction of the Eustachian tube and may either follow an episode of acute otitis media or occur on its own. The condition is usually seen in children. Fluid is present in the middle ear and the ear is not usually painful, but the ear drum is not red and bulging and there is no fever. Glue ear may lead to hearing loss, which can result in speech delays, and balance problems. Treatment options include: a prolonged course of antibiotics; grommet insertion; or treatment with decongestants, antihistamines or steroids. Chronic Otitis Media If the Eustachian tube is blocked repeatedly over a period of several years, there may be changes to the tissues of the middle ear such as deformity of the ear drum and damage to the bones of the ear. These changes may result in hearing problems, balance problems, and persistent deep ear pain. If such long term damage has occurred, an operation called tympanomastoidectomy may be required. This involves making an incision (cut) behind or around the upper part of your ear, drilling through the mastoid bone and removing, and possibly repairing, damaged tissues.

Hearing loss can be divided into two types: conductive hearing loss (caused by some sort of mechanical problem in the external or middle ear) or sensorineural hearing loss (caused by disorders of the inner ear, hearing nerve or associated brain structures). Conductive hearing loss is often reversible and can be due to: blockage of the ear by e.g. wax, inflammation, infections or middle ear fluid poor sound conduction because of e.g. holes or scarring in the eardrum or the bones of the middle ear (ossicles) becoming fixed and rigid. Sensorineural hearing loss is generally not reversible and can be caused by: genetic make-up (this could include congenital conditions i.e. those you are born with, or late-onset hearing loss) head injury tumours infections certain medications exposure to loud noises the aging process (a significant hearing loss is experienced by about one third of people aged over 70 years). Some of the signs you might notice that indicate you have a hearing loss include: having to turn up the volume on the TV or radio finding it hard to hear someone you are talking with finding it hard to hear in a group situation where there is background noise e.g. in a restaurant having to ask people to repeat themselves you find people's speech is unclear - they are mumbling Hearing loss can be partial (you can still hear some things) or complete (you hear nothing) and may occur in one or both ears. Treatment Treatments for hearing loss range from the removal of wax in the ear canal to complex surgery, depending on the cause of the loss. One of the most common treatments for hearing loss is the use of a hearing aid. The type of aid you get depends on the cause of your hearing loss and how bad it is, as well as what your preferences are in terms of comfort, appearance and lifestyle. If your hearing loss is severe to profound, you may be suitable for a surgical procedure known as a cochlear implant. In this procedure, a small cut (incision) is made behind your ear and a device is implanted that can bypass the damaged parts of your ear. The surgery usually takes 2-3 hours and is performed under general anaesthesia (you sleep through it). You may be able to go home the same day or have to spend one night in hospital.