Host

Good evening, everyone. Welcome to our webinar on ear, nose and throat treatment. I'll be your host for this evening our expert presenter is Consultant ENT Surgeon, Mr Robert Hone.

The presentation will be followed by Q and A session, so if you'd like to ask a question during or after the presentation, please do so via the Q and A icon which is on the bottom of your screen, this can be done with or without giving your name.

If you would like to book your consultation, we'll provide the link at the end of this session.

Please note, this webinar is being recorded I'll now hand over to Mr hone and you'll hear from me again shortly.

Mr Robert Hone

Good evening.

Thanks very much for joining. I'm Robert Hone, I am an ENT consultant in East Kent and I qualified for medical school in London back in 2008 and surgical training started for me in 2010 and I was appointed as a consultant around three years ago and I did a masters of surgery back in 2015 during training part-time. I did my fellowship as well at Eastern, I trained all over the Southeastern London.

So this session is going to cover some simple diagnosis in ENT, some of the more common winter ear nose and throat symptoms will discuss sinusitis and nasal blockage and how we manage those as well as sort of more chronic sinusitis which can go on all year. We'll have a discussion about some of the structural problems in your nose which often if you end up having surgery for your sinusitis need to be fixed at the same time and some common ear problems as we often see are reduced hearing which is usually secondary to coughs and colds which will be more common in the winter. We do get blocked ears and again that's often due to eustachian tube getting interrupted from information within the nose and you often feel that your ears are popping or muffled.

We see a number of ear infections usually very treatable with antibiotics and sometimes we see tinnitus as well because when you get the popping and muffling or changes in your hearing you often detect your tinnitus at that point. With regards to your nose, a blocked nose is very common with any cough or cold but you do have the more chronic problems such as sinusitis. You can get typical sinus infections and these can be short-lived and very treatable with simple antibiotics and topical treatments or sometimes they can be persistent in the and more difficult to treat.

We do see headaches and facial pain in ENT. We tend not to deal with headaches and it's really differentiating between headaches and pain from your sinuses hay fever we don't really see in the winter but generally it's a part of an allergic sinusitis which is where an allergy is causing your symptoms and you can get that all year round. Sleep apnoea is more in children over the winter and when they get up which attracts infections because they're tonsils and adenoids tend to get inflamed and they get some problems with their sleep we see a lot of sore throats and tonsillitis for which there's a number of causes so most of the sort of common conditions we'll taHost briefly about our upper respiratory tract infections which there's many I've mentioned and put a slide in on COVID-19 as it's it's fairly topical and obviously we're probably going to see some rates increase so I don't think we'll have any problems with lockdowns again.

As I say about sinus infections, ear infections obviously there is cold and flu and then there's sort of strep throat is obviously in the news a lot at the moment as is tonsillitis.

So upper respiratory tract infections covers any infection of the upper respiratory tract. Now obviously we all know about the common cold but there are numerous different viruses; COVID-19 and tonsillitis would fall into an upper respiratory infection as well. And we often see they're usually presented with a simple sore throat which gets worse for a couple of days then resolves. And you break out into your nasal symptoms which starts with initially stuffiness, a blocked nose and a lot of nasal discharge and these usually last around three to five days before your nose starts to dry up and you start to get dryness, crusting and irritation which settles over sort of a week to two weeks.

You tend to get the systemic symptoms of a bit of tiredness and lethargy, you can have the temperature and some people get headache and even muscle aches. And I think it's just important to mention that managing these symptoms when you when you have a cold is important to potentially try and prevent some of the later problems. For example, making sure that you you know you can use decongestants if your nose is particularly blocked. That'll help with your sinus drainage. And obviously maintaining good hydration.

Making sure you take your pain relief often settles a lot of the sort of more persistent throat symptoms that we sometimes see such as chronic throat clearing and persistent irritation as well as laryngitis which we do see particularly after COVID and I'll talk a little bit about that later.

So, tonsillitis we do see a lot and certainly it increases over the winter. 90% of tonsillitis is viral in origin so it doesn't need antibiotics. The slide, the picture at the top here, shows quite large tonsils with these sort of white/yellow spots, pus on the tonsils. Around about 10% of tonsillitis is bacterial and - although some viral infections do tend to have bacteria superimposed onto them - that's why you don't necessarily need antibiotics with every bout of tonsillitis.

If they tend to present with a severe sore throat which can sometimes go into the ear and it's a matter of keeping on top of your pain relief and making sure you maintain hydrated.

You will have again systemic symptoms such as tiredness and and fever but as long as you're eating and drinking and managing your pain relief, you don't necessarily need any further help we do see admissions into hospital where patients can't eat or drink at all and they tend to come in for some interviewing the antibiotics and actually we give them some a couple of doses of high-dose steroids which reduces the inflammation significantly and gets them eating and drinking again.

The photo at the bottom is more of a viral type of tonsillitis because there's no obvious pustules, however here you can see this right hand side is pushing the uvula which is the dangly bit in the middle off to the opposite side and there's a lot of swelling here now this could be a quinsy which is essentially an abscess which forms between the tonsil and the muscle of your throat and they're very painful and they tend to present with a hoarse voice and and definite pain radiating or moving to the ear and they often do need to come into hospital because people tend to struggle to eat and drink and what you need to do is you just need to get the past or the abscess out from the side here.

Now, if you're having a lot of admissions to hospital with tonsillitis or if you're getting a lot of tonsillitis, we could take those out then we do tend to do that, in the NHS the guidelines are quite strict but they can be more flexible in the private sector depending on how severe your episodes are and certainly if you have at least more than one quinsy or peritonsillar abscess we would definitely recommend having your tonsils removed because if you've had two your 25% your chance of you getting another one is around 25% and the tonsillectomy is a fairly straightforward procedure where we do everything through the mouth so there's no scars and you literally just remove the tonsils as it takes about 10 to 15 minutes of operative time. Now, the the guidelines do vary as I say but there's a general rule it's around seven episodes in one year, four for two years in a row or three for three years in a row, or complications of tonsillitis.

So, you do have to have quite a bit of tonsillitis to be eligible and that is because sometimes you do get runs of tonsillitis and I have seen patients who have had five or six episodes in six months, they come to you and you say oh you know you're getting a little list you and you see them six months later or even longer now for their operation and actually they haven't had any more episodes, it's just stopped so that's the reason for the they want the regular episodes.

COVID-19 causes a lot of ENT symptoms, the obvious one that I think most people probably know about is the anosmia or loss of smell and that was one of the sort of defining symptoms of COVID and when it was first added it was probably the most reliable of all the sort of main symptoms of high fever, cough, temperature and loss of smell. The one that if you had it you were likely to have COVID was loss of smell and the British Mr Robert Honeinology Society released guidelines and if you have COVID and if you've had it for more than three months you should you can be referred to ENT but we tend not to do an MRI if you don't have COVID and you lose your sense of smell you can be referred within four to six weeks and to be honest the a lot is just excluding other causes as to why you might have lost your smell and sometimes if you can't find anything we will do an MRI just to have a look at where the nerves of this of smell come through from your brain into the nose to make sure there's nothing going on at that point.

Laryngitis I said is very common following upper respiratory tract infections and essentially your voice gets dry when you get a slightly hoarse voice you start using your voice slightly differently and it gets hoarse and again the British Voice Association particularly with COVID released guidance on how to look after your voice and treat laryngitis after COVID because it can be raspy and husky and also people tend to throat clear for some time afterwards. It is essentially something called vocal hygiene which taHosts about just maintaining good hydrational status avoiding lots of hot and caffeinated beverages as well as fizzy and sugary drinks and you can also use steam inhalations and making sure you don't overuse or strain your voice.

Tinnitus has been shown to increase in COVID however I say that with a caveat because obviously when covered started everyone was very anxious about it and there was a concern that actually the tinnitus might be increasing because people are more concerned about their symptoms and it was an exacerbation of a pre-existing tinnitus balance disorders and and sort of disequilibrium where you feel like you're on a boat, your vertigo can be caused by any upper respiratory tract infection and notably as well in COVID-19 and some people noticed hearing loss. Just anecdotally as well you know speaking to colleagues and friends around the region we also noticed that we were getting a few additional nerve palsies going which are the nerves of the voice box and we feel that COVID may have influenced that as well.

So this slide shows quite simply the anatomy of the sinuses you have a number of sinuses within the nose and these build up mucus as well and they do drain the mucus and you can see here you've got your frontal sinuses above your eyes you have maxillary sinuses above your nose below your nose or in in sort of on the sides of your nose and you have your ethmoidal sinuses which are just to the centre of your nose between your eye and your nose itself now when you have an upper respiratory tract infection cold or even Mr Robert Honeinosinusitis. The lining of the nose gets very inflamed and that includes the lining within the sinuses which is why when you have a cold you often feel that you have pressure under your eyes and or around your eyes and you feel very congested. It does cause the pressure and often when you lean forwards that's the pressure pushing on the lining and causing that distort, now normally your sinuses drain the mucus out of this area here which is called your osteomata complex and you will drain the mucus away and you shouldn't have too many symptoms and this is where when you have a cold using a decongestant such as ultramine or or sudafed can help open up these pathways because it reduces the inflammation around the areas allowing your sinuses to drain and you can use that for sort of up to two weeks really with the cold but ideally no more than one and it will hopefully help a lot of your sinus symptoms what can happen particularly if your sinuses get infected inflammation in this area blocks the drainage pathways and you get persistent build-up of mucus which is quite hard to shift and that can lead to notably infections and excessive discharge or you can simply get sinus pain and pressure.

What what are the symptoms of a blocked nose and sinus symptoms? So, to have chronic Mr Robert Honeinosinusitis or Mr Robert Honeino senses you have to have really a blocked nose with sort of nasal congestion or blockage and you have to have discharge either one of those has to be present and the blockage really has to be fairly persistent and on both sides of your nose. Some people do have blockage on one side of their nose at all times and it's called the normal nasal cycle where one side of your nose rests and the other is active and therefore one serving is always slightly more block than the other which is why we tend to look for make sure it's persistent and not alternating between sides. The discharge from your nose can go down the front or back and it can either be clear or even infected. Interestingly the commonest cause of the feeling of mucus dripping down the back of your nose if you don't have anterior or frontal nasal discharge or a blocked nose is often actually in digestion where sort of your stomach contents come into your throat and it causes thick mucus it makes you feel like things are dripping down the back so it is important to have those symptoms. Facial pain and headache is a common symptom of sinus infection or or blockage and classically it's worse on leaning forwards, again it's important to make sure you have either discharge or a blocked nose because without those I would suggest that it's more of a sort of neurological facial pain. Again, with sinus problems you will potentially have a reduction your smell, often taste seems to be preserved if you have sneezing and itching and you may get watering eyes but if you have season itching of your nose classically that is an allergic type of reaction or an allergy that's causing the inflammation. Nose bleeds can occur and that's often due to dryness although I would say with chronic Mr Robert Honeinitis you tend to get a bit of blood stain mucus rather than a full nose bleed. If you're getting full nose beads it's less likely to be related to to the inflammation in your nose, as mentioned you do often get blocked ears and muffled hearing and that's because the tube between the back of your nose and your ears can get blocked and your ears don't ventilate as well so that you feel like you're persistently underwater or just like when you have a cold and you can't hear quite as easily. You can get a watery or itchy eye and again that would suggest an allergy.

So how would we diagnose whether or not you've got chronic Mr Robert Honeinos sinusitis or inflammation in the nose? This is one of my colleagues and he's performing what's called the nasal endoscopy, we have now since COVID which has been a it's allowed us to progress our equipment quite well because we now have to have video equipment which allows us to see everything on the screen and patience to see what we're looking at if we find anything but we have a little three millimetre fibre optic telescope with a well it's not fibre optic anymore it's you've got a little chip in the in the tip and that relays the images to the screen, this is called a fibre optic node endoscopy, it is very small and it's it is a little bit uncoHostortable and it can make your eyes water but we would have a look at the front of your nose with simply a headlight to see if we can see in the obvious from the front and then we do pass this camera along the nose and here in this picture you can see this is going down the patient's left hand side and that's what's called the turbinate which helps warm and humidify air and these can also be inflamed and enlarged and that's heading towards the back of the nose and we would do have a look around and we would check that osteomata complex to make sure it's open or if there's any puss or a lot of information there if your nose does get hugely inflamed you can develop something called polyps which is where the lining of the nose swell so much it hangs down from the nose and these can be particularly problematic and often need surgical removal. This little camera can go all the way through the nose to the back of the nose to check the area that whether you'll use station tube opens at the back of your nose so we can see if they're blocking the eustachian tube to your ear and this picture here is of this patient's voice box and so we can have a good look at your vocal cords and make sure that everything in your throat is healthy, particularly if you're getting lots of voice has changes and with the new cameras the definition is excellent you can get very good views to see if there is anything going on in the voice box and it's really fundamental part of the ENT examination.

If when we've seen you in clinic examined we feel that we would want to do further investigations the most common one to look at your sinuses especially if we're thinking you do have sinus disease is a CT scan which is this scanner here which is like a donut it's not an MRI so it's not particularly close, it's not claustrophobic and it's quite quick and it produces images of your sinuses and if you have inflammation in there. We can do allergy tests we often used to do skin prick tests but we've we tend to move on to blood tests now to look at your total IG level which is a marker of how much of an allergic reaction is occurring at that time and the rest is to specific allergens so we generally test for house dust mite which obviously will cause an allergy all year round and grass trees and often sometimes mould as well as certain foodstuffs or pets as well and as mentioned we may well do the diagnostic endoscopy. If you have permanent blockage and discharge in your nose it can be either allergic or non-allergic, there's a lot of different classifications but this is some of the easiest and it can be intermittent or persistent so this is seasonal all year round and allergic Mr Robert Honeinitis is more associated with asthma or ATP or any other allergic if you've got other allergies you're more potentially more likely to have it you may get triggers where for instance in the summer you or in the even patients actually going to bed at night negative systems get worse and that's if they're allergic to house dust mites because dust is in their pillow and you tend to get a reaction where you start sneezing and you often have an itching nose and you produce copious amounts of generally quite clear watery discharge from your nose then you may also have itching eyes or watering eyes non-allergic tend to be more of a purulent discharge and you're more likely to get more facial pressure and pain rather than just copious discharge and blockage and and this and you can get but you can get polyps with either.

So how is it treated well most patients get treated medically and I think there's a number of different guidelines on the treatment and it does partially depend on the cause obviously. If it's allergic you want to try and avoid give you allergy avoidance but the mainstay of treatment is nasal drops and sprays and these tend to be using a topical steroid spray and the modern steroid sprays because I know people worry about steroids is a medication they tend to be topical and not systemically absorbed so most of the common ones we use only about 0.4 percent is systemically absorbed and that tends to be and they're in low doses anyway some of the older sprays. The other thing that's particularly useful is something called a nasal douche and this is particularly useful again in in allergic symptoms and there's two that I would generally recommend one is something called sterema which you can buy in the chemist and is literally a saltwater spray and it helps lubricate the nose washing out secretions and it also washes out the allergens so for example if you went out in the summer and you had allergy to grass, the grass pollen goes up your nose and it causes an allergic reaction if you were to wash that out it would it would reduce the amount of reaction and reduce your symptoms and the other one actually which if you can tolerate it is better is sinus rinse and that is literally a bottle of salty water that you spray up your nose to wash the pollens and irritants out. Targeted antibiotics are are important when you have an infection you wouldn't necessarily use those for allergic they would be for non-allergic to treat a number of different bacteria and they tend to be for fairly long courses of up to four weeks sometimes even longer. Antihistamines are very useful in again hay fever in non-allergic Mr Robert Honeinitis I wouldn't give an antihistamine my one caveat with using antihistamines is I remember when I was training I had a very good lecture from one of our academic days and someone put up a lot of data on antihistamines and drowsiness and even the modern non-drowsy ones they can affect concentration so I tend to just say to people using antihistamine when required when you sort of get an attack or you know you've come into contact with the allergen to reduce your symptoms rather than doing it every day but that's personal preference then you can certainly use them every day and as mentioned. If it's untreated the information can get so severely developed nasal polyps and also it it can cause worsen of your asthma and this comes down to what is now being termed reactive airway disease where we know that your noses your throat and your lungs are all connected and obviously if you have asthma that is reactive to allergens then your nose may be as well so controlling your nose often helps your asthma symptoms.

I'm briefly going to taHost about structural problems in the nose and the only reason to really taHost about this is because sometimes if you do need to sinus surgery this will need to be fixed it's not obviously any worse in the winter months although some people do feel that when they get a cold one side is particularly badly affected and blocked compared to the other and that may be because the septum is is bent off to one side. You can see here that this septum is the middle part of the nose and it's made up of cartilage and Bone and it runs between your two nostrils all the way to the back of your nose it can cause narrowing which can make you feel that your nose is obstructed and that would generally be persistent you can again try treating this with a simple spray and if it helps then you potentially don't need this correcting it can be treated on its own even if you don't have Mr Robert Honeino sinusitis and you can do something called a septoplasty if someone's persistently blocked you to a bend the inferior turbulence I said you often see them sitting in the nose just down here and they help warm and humidify the air if your septum is bent one of those may be enlarged or again if you have inflammation of the nose they can be enlarged and we can reduce those to help one is to improve your nasal airway and help you breathe in other words it does tend to mean you get a little bit less secretions as well.

This is a CT scan of your sinuses and it demonstrates very clearly fluid within the sinus so air on a CT scan appears black and this is called your maxillary sinus which is the one that sits under your eye which is just here and this is the inferior turbinate we were taHosting about which looks a little bit enlarged and you can see that all of these air cells on the right are nicely aerated and there's no obstruction, no fluid filling them. However, on this left hand side it's grey and that is the same color as soft tissue and it suggests that there's fluid within here and that there's probably a blockage at this point which the osteomiator complex which is why the fluid's filled up and that will be causing potential infections discharge pain and persistent the feeling of blockage on that side. Interestingly the CT scan also shows a big bend in the nasal septum and you can see this bony strut sticking out and that is probably partially contributing to the blockage of the sinus here because it's poking up into the area where it drain and any cold would increase that information and really block this sinus and I have to say we do see that quite a lot. This patient would probably need what's called function endoscopic sinus surgery where we would go in we would open up the sinuses to let them drain wash them out probably remove this big struct here and straighten the centre of the nose and this picture on the right shows exactly that you can see the gap between the sort of wall of the nose and the sinus is very open and the sinus is drained. The septum here the middle bit of the nose is very straight and is no longer causing a blockage on that side and both sides show that they've got air and this side you can see on the right this is the right hand side you can see that they haven't necessarily opened the sinus it's just been done on one side and that patient would almost certainly have very good symptomatic relief.

Moving on to the ear, I'll give you a little bit of information on the anatomy of the ear and it's broken really up into three parts so you've got your earlobe here which is called your pinner, this goes into your ear canal you've got your eardrum and then behind your eardrum you have something called the middle ear and that connects you to the eustachian tube which runs all the way to the back of your nose. Beyond that you have your inner ear which houses something called your cochlear and your vestibular system which controls your balance and you can see these three semi-circular canals which are little Loops which tell your brain which way your head is moving and along which axis. Therefore we break things up into the three areas of outer ear, middle ear and inner ear and within the middle ear you have your bones of hearing as well which are these three here and we'll taHost a little bit about the different causes of hearing loss and what can give you problems. The main things we see in clinic are hearing loss which there are a lot of causes for it ranging from fluid behind the eardrum, a blockage in the outer ear or just general wear and tear of the inner ear, tinnitus is a ringing in the ears or in fact I'll clarify that it's any noise which potentially you hear that other people can't and there's no external source, so classically high-pitched ringing but it can be a whooshing or it can even be pulsatile if it is pulsatile and in time with your heartbeat we'd want to see you because we'd want to potentially do a little scan to make sure there's no sort of blood vessels pressing on the nerve. You may get some pain in these, pain is classically associated with infection or fluid behind the eardrum causing a pressure on the eardrum if you get discharge that once again generally points to an infection and that can be in the outer ear or from behind the eardrum when your eardrum bursts and if you do have an infection behind your eardrum the pain will get worse and then when you get the discharge classically the pain gets better because the pressure is resolved as your eardrum is perforated and made a hole and they're nothing to really worry about most heel on their own very quickly. Balance problems such as dizziness and vertigo is usually due to the problems with the inner ear and around the cochlea and the vestibular system.

So what are the common problems in the outer ear? Well we do see wax which causes a blockage in the outer it it can cause pain if it gets infected but it will potentially cause hearing loss because it's like putting your finger in your ear It generally doesn't cause any problems, although it can be quite tricky to remove and we can do that very easily in clinic. Infections of the outer ear are very painful and they can cause discharge as well as muffled hearing, similar to putting a finger in the ear that's what the hearing loss will sound like the ear canal can swell and that's along with the discharge that's what causes the blockage very rarely we'll see well not very well in children we see quite a few foreign bodies in the air but sometimes your hearing aid more can come off. You shouldn't put cotton buds in your ear but again some people do I can still remember a case when I was quite junior, a man came in saying oh my ears blocked and we removed a cotton bud and then five cotton buds later we'd managed to clear them all out of his ear.

The middle ear so that the condition we discussed affects this area here the middle ear here you may get eustachian tube dysfunction now that is where your eustachian tube here every time you swallow or yawn you potentially open this tube and air can get into the middle ear area here and help it ventilate when you get a cold this can get inflamed at the top and it can feel blocked and muffled and that's exactly the same as when you're on a plane when you go up and down on a plane you're just struggling to change those pressures quite so easily or when you dive so you can do something called a blue balloon eustachian tube tuboplasty which is where you cannulate which means just thread a little wire through this tube and you inflate a little balloon to open it as the symptoms can persist after a or after a cold. The evidence for it is is is variable and it's to be used in selected patients only who who fit the criteria and we generally do a questionnaire before before we would go down that route. Glue air which is fluid behind the ear now there's two types really there's it's quite serous fluid which is quite thin fluid and that's called a middle ear effusion or gluey where it's quite thick if you have that that can reduce your hearing and cause recurrent infections and we would make a little cut in your eardrum and drain the fluid out to try and improve your hearing or prevent future infections there are some nasty infections called a cholesteatoma which is where your ear doesn't clean itself in a ball of skin builds up and essentially unfortunately it dissolves the bone in the area it can easily it can be treated but it's a bigger operation and sometimes these ossicles or bones can get disrupted so that the transmission of sound from the eardrum doesn't go through the bones down to the cochlea and you get a drop in your hearing as well.

The inner ear tends to be what's called sensory neural hearing loss whereas the middle ear causes a conductive hearing loss so you can test that the nerve is working and whether the eardrum is on a hearing test and you can differentiate between the hearing problem in the middle ear and the inner ear but we often see age-related hearing loss commonly noise-induced hearing loss is quite common in your hearing test will classically show a drop at a specific frequency for that a number of medications can can drop your hearing as can trauma and there are some other conditions as well but I'm not going to go into all of those at this point. Vertigo we see a lot of vertigo and vertigo is specifically the illusion of movement and it's important to clarify that as the symptom because you can get this equilibrium which is simply the illusion or the feeling of unsteadiness and the two are very different in ENT the main ones we see is Meniere's which is very rare, BPPV or benign paroxysmal regional vertigo which is usually very short-lived vertical moving your head, labyrinthitis which follows a cold and vestibular migraine we see a lot of multi-level vestibulopathy which is essentially multiple areas of your balance system are affected and that's often in all the all the patients and then rarer things such as persistent postural perceptual dizziness is where you get it in certain scenarios and superior semi-circular decisions where this little semi-circular canal is not formed properly and it can cause some dizziness as well and in very rare instances you can get a benign tumour on the nerve of hearing which can cause hearing loss. Tinnitus and vertigo as well in clinic we can happily remove wax from the ear canal we use a microscope and a little hoover here it is noisy and can be a little uncoHostortable but it shouldn't be painful, rarely it can make you a little bit unsteady on your feet afterwards but that is very uncommon and we offer hearing tests in a soundproof booth to assess whether your hearing is reduced as well and we can also test for the fluid behind the ear with the pressure test.

So that's at the end of my taHost, if anyone has any questions I'd be delighted to take them.

Host

Thank you, Mr hone. That was a really interesting presentation and we'll now take some questions, we have a couple in the Q and A box. The first question is I have suffered with earwax problems before I'm wondering what your thoughts are on ear hygiene including cotton buds?

Mr Robert Hone

So I would say definitely do not use cotton buds, cotton buds are problematic for a number of reasons the first is that they tend not to clean your ear they tend to just push wax deeper into your ear they also tend to cause sort of micro trauma and that can cause infections as well and obviously lastly the end of the cotton bud can come off and get stuck in your ear. Your ear should self-clean itself actually, the main thing that means it often doesn't is that the wax can be a little bit dry and there's a simple thing you could just put a drop of simple olive oil in your ear once or twice a week to try and keep the wax loose and it should work its way out, the only problem is obviously start doing too much it gets too wet and can obviously give you symptoms of there being sort of water and fluid in your ear. I think it is difficult to because some people do need regular micro suction for their ears because they do get blocked and obviously if you're hearing a user where you're constantly putting the tip of your hearing in here then you then potentially you will need more regular micro suction or cleaning out of your ears as well.

Host

Okay, thank you very much.

Next question, I experienced bouts of dizziness for short periods a couple of times a week, at what point should I seek advice?

Mr Robert Hone

I would probably seek advice now I think, again it depends on the dizziness sort of vertigo which is the illusion of movement and the room spinning that's more ENT if it's the feeling of being on a boat or at sea that's this equilibrium or if you feel light-headed then that's something to get into your general practitioner about. I mean it it's it's dizziness or balance disorders are quite complicated and it's all in the history really as to what the potential cause would be but if you're getting bouts of true vertigo which occur a couple of times a week it might be that you know you can come and see someone and we can certainly rule out a few things or or maybe if it is BPP treat it very easily in clinic with something called the epley manoeuvre.

Host

Next question, I take antihistamines most days I don't generally have drought drowsy side effects, is it safe to continue doing this?

Mr Robert Hone

Yes I think so, if they help your symptoms and you feel they're the thing that controls your symptoms then absolutely carry them on. As I said, I just tend to be a little bit more cautious and I'll try and control nasal symptoms with douches and sprays but lots of people are on antihistamines long term yes that's fine.

Host

Next question, can a fest be done on both sides I.E the left and right sides in the same surgery or are separate faces required?

Mr Robert Hone

No we can definitely do both sides during one operation and truly obviously if you have symptoms in both sides of your nose we would definitely do both sides at once that scan was just because it showed one side only and that's why and to be honest they had a clear septal bend which was probably a significant part of their problem but yes definitely you can do it on both sides at once.

Host

Okay, one last question we have. So a patient has a very itchy right ear over two decades which has now improved with medication, there is now increased episodes of sudden muffleness and low buzzing, could this be meniere's or how can it be verified?

Mr Robert Hone

I wouldn't have thought itching would be meniere's, itching in the outer ears is often due to dry and flaky skin or often getting water in your ears. The biggest thing really for itching is actually after showering people get water in there is and it does irritate the ears particularly soapy water or shampoo the was it muffling they said or they're getting some tinnitus so tinnitus on its own I mean meniere's is of course is is rare, it does cause it but actually it's much more likely that it's either a little bit of hearing loss or there's another cause in the history that would be the reason for the tinnitus.

Host

Okay, thank you.

So that's all the questions that we've had in this evening, so thank you to everyone that's asked those questions and attended the webinar this evening.

If you would like to book your consultation then do contact us on the number on the screen between 8 A.M and 6 P.M Monday to Friday. We are offering a discount for those that are joining this session with the terms on the screen.

You will receive a short survey and I would be grateful if you could spend a couple of minutes just let us have your feedback.

Our next webinars are in January and they include weight loss surgery, orthopedics and gynecology and you can visit our website to sign up for these and find out some more information.

So on behalf of Mr Hone, myself and the team at Benenden Hospital, I would like to say thank you very much for joining us this evening and we hope to hear from you soon and have a very good evening.

Mr Robert Hone

Thank you and good evening, bye.