Dr. Shyam Kalyan. N
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My family doctor referred me to an ENT to investigate a persistent sinus discharge problem that seemed to be causing voice hoarseness, likely from mucus building up in my throat. I thought the hoarseness might be a side effect of the Tamsulosin I take each day for BPH, but he did not think so. During the exam by the ENT, he found that my nostrils were almost completely blocked. Although I had not complained of problems breathing through my nose, so air could get through, his scope with the light and camera on the end could only be inserted part way through either nostril. As a result, I am being scheduled for (endoscopic?) surgery to reconstruct the separation between my nostrils and clear the airways through my nose. Apparently, it will take about 30 minutes and will not leave scars or require any packing or lengthy recovery time (just a few days). The ENT thinks that will clear up the nasal discharge and ultimately solve the hoarseness. Does this sound reasonable?
Hi,
Welcome to icliniq.com.
Have you had any complaints with nose before? Has a CT scan been done to check for sinus inflammation or pathology? How much is the nasal airway compromise? Has he given you any sprays? Has he ruled out allergy?
Patient's Query
Thank you doctor,
Have you had any complaints with nose before? I have always been a bit of mouth breather, especially when sleeping (although I do not snore), and I have always generated a lot of mucus, externally and back into my throat, but no real complaints. I guess I just always assumed that was normal. Has a CT scan been done to check for sinus inflammation or pathology? No scans of any kind were done. How much is the nasal airway compromise? Not enough to prevent breathing through the nose, but enough to prevent the ENT's thin fiber-optic scope from passing through either nasal passage. He tried to get it through several times without success. That caused an extreme flow of mucus and eye-watering. Has he given you any sprays? No, he has not and there was no suggestion that might help. Has he ruled out allergy? He asked about allergies and I told him an allergist had determined when I was about age 8 that I am allergic to dust, feathers, tobacco, and trees. The dust and trees are hard to avoid. I think the fact that he could not pass the scope through my nasal passages, together with what he could see on-screen as far as it would go, indicated to him the problem was that the nasal passages were mostly closed. He asked me more than once if I had ever had an injury to my nose, to which I answered that in my hockey years I had been smashed in the face many times, but never had a broken nose.
Hi,
Welcome back to icliniq.com.
When we look at your problem and history in an objective way: 1. It is quite possible and often common to find sino-nasal pathology causing persistent post-nasal drip and mucus flow that results in hoarseness of voice and other throat problems. 2. In such cases, we examine the nose thoroughly to check what is causing the problem. 3. Nasal endoscopy is the first office procedure we do for that. When the endoscope cannot be passed, in my practice, I give a sinonasal CT scan before doing any surgical procedure. 4. CT scan of nose and sinuses will help me understand if there is a bony deformity, the extent of bony deformity, sinus inflammation, polyps, post nasal space, condition and anatomy of sinuses. Ideally, before going for the procedure we do the CT. In many cases with recurrent post nasal drip, there is some associated sinus pathology which comes out in CT especially in cases where endoscopy fails due to lack of space. We would eventually create a proper airway surgically but a prior CT would let us plan the surgery better and advise us regarding the need for additional steps in the surgery like sinus drainage restoration or ventilation improvement or restoring osteomeatal patency or reducing the thickness of turbinates or doing submucous diathermy or removal of polyps. Without a CT the ENT would only be planning to do an airway correction and may not know if there is any other intranasal pathology which can be addressed in the same sitting.
Patient's Query
Hi doctor,
Thank you very much for the prompt and thorough response.
Hi,
Welcome back to icliniq.com.
Do revert back to me if you need any more help. Happy to guide you.
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Otolaryngology (E.N.T)
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