The new Reading ENT Consultancy based at CircleReading

News for General Practitioners | Number 13 | June 2014
News
Upcoming
educational
events
We like to keep our GP community informed
and updated on all educational matters
in a relaxed and informal environment.
If you haven’t already attended one of our
in-house educational events, it is a lovely
way to meet consultants, other healthcare
professionals in your area, and stack up
those CPD points. We look forward to
welcoming you soon.
Tuesday 10th June at 7pm
ENT educational evening
An introduction to the new ENT Unit.
The new Reading ENT Consultancy based
at CircleReading
The established Reading ENT consultant surgeons based at Circle have
formed a partnership to enhance patient care and simplify GP referrals.
From 1st of May 2014 Mr Rogan Corbridge,
Mr Rory Herdman and Mr Nick Mansell will
combine their practices to become The ENT
Consultancy. A full range of paediatric and adult
services will be provided. The partnership will
allow greater flexibility in offering convenient
appointments with the appropriate consultant
specialist for the patient’s problem. Personal
referral to a named consultant is still available
if preferred.
A launch event will be taking place at
CircleReading hospital on Tuesday 10th
June and we would be delighted to see our
colleagues from General Practice at this
occasion when we will expand on our plans
for private healthcare in Berkshire.
A private clinic will be available every day
in Reading. Patients can also be seen at
Wallingford, Newbury and Henley.
A single telephone number and email address
will provide easy, rapid access to our dedicated
secretaries.
T: 0118 922 0004
E: [email protected]
F: 0118 986 9262
www.theENTconsultancy.co.uk
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The evening will include three short talks:
• How to spot ENT cancers
• ENT emergencies
• Update on sinusitis
Followed by break-out into three rooms:
• Practical demo of videonasendoscopy
• How to deal with nose bleeds
• GP assessment of hearing in primary care
• Management of the discharging ear
Mr Rogan Corbridge, Mr Nick Mansell and
Mr Rory Herdman – Consultant ENT Surgeons
Thursday 26th June at 7pm
Knee injuries in sport – injury profiles
and management strategies
Dr Kate Hutchings – Sports Medicine
Mr Chris Gordon – Physio
Mr Nick Gallogly – Orthotist
Tuesday 15th July at 7pm
Hand surgery educational evening
Mr Charles Pailthorpe, Mr Donald Sammut
and Mr Zulfi Rahimtoola – Consultant
Orthopaedic Surgeons
To book your places, please RSVP to
[email protected].
All GP events are accompanied with dinner
prior to the talk, and CPD certificates are
given at the end of the evening.
circlereading.co.uk
More news...
Sinusitis pearls
This article sets out to enhance community care of patients with chronic rhino-sinusitis (CRS).
Other articles will deal with acute sinusitis and its complications and the role of surgery.
For most patients CRS is characterised by
low grade nasal cavity symptoms such as
obstruction to airflow/crusting and also perinasal congestion with fluctuant facial pain/
headache. An allergic aetiology is suggested
by sneezing and clear rhinorrhoea. Sinogenic
facial pain is unlikely in the absence of nasal
obstruction or other nasal cavity symptoms.
The accepted definition of CRS describes
symptoms for three months or more.
The majority of patients with CRS can be
successfully treated medically. Surgical
intervention is only considered for those who
have persistent symptoms despite maximal
medical therapy and they will need to continue
medical treatment long term following surgery.
The following cases describe three important
issues regarding the successful medical
treatment of CRS. The first case deals with the
effective use of medical treatment, the second
the association with other respiratory disease
and the last the return of symptoms following
Functional Endoscopic Sinus Surgery (FESS).
Case 1
Presentation
A 46-year-old non-smoker with previous
mild asthma presents with bilateral fluctuant
nasal obstruction and crusting, associated with
intermittent frontal and mid-facial pain. He had
used Beconase topical nasal steroid intermittently
in the past but found it exacerbated the nasal
crusting and ineffective so he gave up using this.
Management
He certainly has nasal cavity symptoms and
given the past asthma he probably has some
degree of low grade nasal mucosa inflammation
and swelling. The distribution of the facial pain
is consistent with CRS and due to sinus ostia
obstruction.
He requires medical treatment which is
similar to his previous asthma treatment.
The topical treatments need to be taken
regularly/effectively and applied long term.
Effective medical treatment includes the use
of decongestant topical nasal steroids such as
Nasonex/Flixonase (these are slightly more
expensive than Beconase but give rise to
fewer side effects and have lower systemic
bioavailability). These should be sprayed into
the nose then the head should be put forward
and down for 10 seconds to prevent the
steroid passing straight through the nose and
being wasted. To allow adequate absorption
of steroid the mucosa needs to be clean and
therefore saline wash is critical. Initially, daily
saline douche (eg. Neilmed Sinus Rinse) is
essential management and should be used in
the evening, with steroid application in the
morning. Occasionally macrolide antibiotics
such as Clarithromycin can be used for four
to six weeks for their anti-inflammatory and
antibiotic effect in cases where purulent
rhinorrhoea is a prominent symptom.
If this management is not controlling the
patient’s symptoms over a two-month period
referral to ENT is reasonable.
Outcome
The patient was educated to understand the
need for long term topical treatments for the
nose. Given the resolution of his symptoms
and subtle improvement in his respiratory
function he continued with topical steroid
spray regularly with occasional saline wash.
He became a very grateful patient!
Case 2
Outcome
The nasal mucosa had healed one month postoperatively and at three months she had fully
recovered from the operation. She continued to
take Nasonex and saline wash. The symptoms
of nasal airway obstruction/congestion and
headache had completely resolved but she
was most pleased with the improvement in
peak flow rate and overall exercise tolerance.
There is no doubt that chest and nasal function
have a real effect on each other. Optimising
nasal function improves peak flow and vice
versa. In patients with asthma and COPD
always ask about nasal symptoms.
Case 3
Presentation
A 37-year-old man who had undergone initially
successful FESS returned to the clinic after 12
months complaining that the operation had
failed, his symptoms had returned and he
wanted repeat surgery.
Management
This man had used topical nasal steroids
and saline wash for two months following
the surgery as prescribed by the hospital. He
believed that surgery would be a cure and
medical treatments would not be necessary
long term. It was explained to him that surgery
is only useful when medical treatments have
failed and long term medical treatment is
mandatory to prevent return of symptoms.
Presentation
A 63-year-old woman with COPD presented
with nasal obstruction and low grade facial
pain. Her respiratory function was gradually
deteriorating in parallel with the onset of
her nasal symptoms. Examination confirmed
nasal mucosal swelling with obstruction of
the sinus ostia.
Outcome
Once restarted on his medical treatment the
symptoms resolved and no further surgery was
necessary. Despite counselling pre-operatively
that long-term treatment is essential this is
a common misconception amongst patients.
Always continue post-op patients on medical
decongestant treatment.
Management
A two-month course of topical steroid and
saline rinse improved her nasal obstruction
to some degree but she continued to feel
congested with some facial discomfort. A
CT sinuses was performed which confirmed
the presence of mucosal swelling throughout
and she therefore underwent functional
endoscopic sinus surgery.
For further information consult:
European Position Paper on Rhinosinusitis
and Nasal Polyps 2012.
Fokkens WJ1, Lund VJ, Rhinol Suppl.
2012 Mar;(23):3 p1–298.
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