Nasal Allergy:Laser Treatment in India

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Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, Kerala, India.

Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, Kerala, India.

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  • 1. Nasal Allergy Surgical Treatment Dr.K.O.Paulose FRCS DLO Consultant ENT Surgeon Jubilee Hospital, Trivandrum South,
  • 2. Fed up with Sneezing?
  • 3. Achooo… in Kids
  • 4. Medical Management
  • 5. Medical treatment of Nasal allergy Topical steroid Antihistamine tablets Decongestants Systemic Steroid Immunotherapy
  • 6. Anatomy of Nose and Sinus
  • 7. The Turbinates
  • 8. What is Laser? INTRODUCTION OF LASER Laser is an acronym that stands for Light Amplification by Stimulated Emission of Radiation. The first concept of the laser was initiated by Albert Einstein in 1917.
  • 9. Types of Lasers CO2 Laser Argon laser The Nd:YAG (Neodymium:Yttrium- aluminum-Garnet) The Potassium-Titanyl-Phosphate (KTP)
  • 10. CO2 Laser The CO2 laser is the most versatile laser in otolaryngology. The carbon dioxide (CO2) laser emits a colorless, infrared light wavelength 10,600 nano micronsPrinciple: The radiant energy produced by the CO2 laser is strongly absorbed by pure, homogeneous water and by all biological tissues high in water content.coaxial helium neon laser as aiming beam- red in colour
  • 11. How does a CO2 Laser work? Ability to coagulate, cut, vaporize The main constituent of cells-water, readily absorbs the wavelength of light produced by the CO2 surgical laser. The surgeon can control the extent by which the laser beam is absorbed into surrounding tissue, resulting in an extremely precise tissue incision.
  • 12. Indications of Co2 Laser in ENT Operations for snoring and sleep apnea Operations for Allergic Rhinitis,Correcting deviated Nasal septum, Partial turbinectomy (LAPT), Choanal atresia, excision of Rhinophyma Operations for voice disorders, the addition of the microspot micromanipulator to the operating microscope allows-arytenoidectomy, vocal nodules, early ca lesions Operations for nose bleeds, nasal polyps, Rhinosporidiosis, Haemangiomas Excision of Facial Moles, Keloid, Scars
  • 13. Indications of Co2 Laser_contd Ulcers on tongue, check, multiple areas of leukoplakia can be precisely excised Skin lesions on head, Face and Neck Tonsillectomy Tympanotomy, Myringotomy,Stapedectomy (Bronchoscopic indications -management of recurrent respiratory papillomatosis or granulation tissue within the tracheobronchial tree, excision of selected subglottic or tracheal strictures, excisions of bronchial adenomas.).
  • 14. How It Works? • The excitability of anterior ethmoidal nerve is decreased, and thereby vascular permeability and nasal secretion are also decreased. • Some of sensory nerves have been cut, the sensory- parasympathetic nerve reflex is weakened, and at the meantime release of vascular-origin intestinal peptide as well as substance P is also decreased. • Scar formation of nasal mucosa will prevent hypersensitivity.
  • 15. Advantages of Laser Surgery Minimal operative bleeding due to coagulation of blood vessels minor to 2 mm of diameter. Reduced post operative pain due to minimal thermal effect. Increased accuracy of the surgical wound Possibility of ambulatory surgery Quick post op. healing Better plastic result of surgical wounds due to minimal scarring (that effect is very obvious in the post tonsillectomy preservation of the tonsillar pillars).
  • 16. Disadvantages of Laser Cost of equipment and maintenance . (around USD 4000=Rs 4Lakh) Special surgical skills Increased setup time of equipment Need of safety eyewear Increased care for patient safety - explosion or fire hazard. Smoke
  • 17. How Laser work? Laser surgery is the most preferred technique in removing moles. Laser removal of moles is by far the most simple for eliminating moles on the skin. In most cases of laser removal anesthesia may not be necessary. The laser beam will also burn away the mole. Depending on the size of your mole, you may need multiple sessions to completely remove it. No scarring , no bleeding, no pain and can be done in OPD set up with surface anesthesia.
  • 18. How LAPT Done? Patient is kept semi sitting in an ENT chair (as seen in picture) and Co2 CW at 6 watts setting, the turbinates are cauterized. The procedure takes 10-15 mnts on each side. There is hardly any bleeding and patient goes home after few hours. This gives very good results
  • 19. Laser Surgeon
  • 20. Testing Laser
  • 21. LOCAL ANESTHESIA The anesthesia parameters used in all patients were for premedication , diazepam 5mg + atropine 0,5 mg .For local superficial anesthesia xylocaine spray 10 % + For infiltration anesthesia xylocaine 2 % + 1: 100.000 adrenaline solution.
  • 22. General Anesthesia These include wrapping aluminum tape around the tube, placing wet cottonoids around the endotracheal tube cuff, placing saline within the cuff using a metal or xomed endotracheal tube. Flexible stainless steel corrugated tubes are available The most morbid complication of laryngeal laser surgery is airway fire.Various methods have been suggested for protecting the endotracheal tube and larynx.
  • 23. Advantages of LAPT Fast Painless In Office No Sutures No Bleeding Fast Recovery No Hospitalization No General Anesthesia Immediate Return To Work
  • 24. Laser Safety Eye wear Smoke evacuator Fire Hazards
  • 25. Laser Safety
  • 26. Allergic Rhintis Allergic Rhinitis is an inflammation of the nasal passages, usually associated with watery nasal discharge and itching of the nose and eyes.  Allergic Rhinitis affects about 20-30 percent of the population. The symptoms occur in the nose and eyes and usually occur after exposure to dust, danders, or certain seasonal pollens in people that are allergic to these substances.
  • 27. Causes of Nasal Allergy House Dust mites, cockroaches, molds and animal dander, are examples of year-around allergens. Tree, grass and ragweed pollens are primarily seasonal outdoor allergens. Animal allergens are also important indoor allergens. The major cat allergen is secreted through the sebaceous glands of the animals skin.
  • 28. Symptoms of Nasal Allergy Repetitive sneezing; runny nose, post-nasal drip; nasal congestion, itchy eyes, ears, nose or throat; and generalized fatigue. wheezing, eye tearing, sore throat, and impaired smell. chronic cough may be secondary to postnasal drip Sinus headaches and ear ache, and itching are also common
  • 29. ENT Evaluation in OPD
  • 30. Nasal Examination
  • 31. Investigations
  • 32. CT Imaging Enlarged pale turbinates Nasal Polyps Congested nasal mucosa Mucopus if sinusitis Septal spur,DNS Concha bullosa Sinus pathology
  • 33. Diagnosis of Allergic Rhinitis Medical history ENT Examination RAST-Radio immunoassay CT Imaging
  • 34. Self Care Avoidance measures Air purifiers and dust filters may help. Jel Neti , saline Nasal Wash
  • 35. Spraying Local Anesthetic
  • 36. Injecting Local Anesthetic
  • 37. Peter Malakkof: Packing Nose
  • 38. Peter Malakkof: Septoplasty
  • 39. Peter Malakoff:LAPT
  • 40. Patient #027
  • 41. Patient #009
  • 42. Dr Senthil Gets LAPT
  • 43. Patient #021
  • 44. Patient#009
  • 45. Patient #046
  • 46. Laser Nasal Allergy in OPD
  • 47. Patient#019
  • 48. LAPT
  • 49. Patient #018
  • 50. Vasomotor Rhintis:Laser
  • 51. Patient #016
  • 52. Patient #011
  • 53. Diode Laser
  • 54. Post op Laser Nose
  • 55. Post op Laser Ashish
  • 56. Ashish Gets Laser Treatment 2
  • 57. Ashish Gets Laser Treatment
  • 58. Patient #037
  • 59. Sr.Anjelina gets Laser treatment
  • 60. Laser Treatment in a little girl
  • 61. Post Op after 6 months CT Scan of a patient who underwent Laser surgery to the Turbinates The turbinates are reduced in size Patient symptom free
  • 62. Antral Lavage before Laser
  • 63. Fr.Sony Gets Laser Treatment
  • 64. Patient #036
  • 65. LAPT in Jubilee
  • 66. Giving Local Anesthetic
  • 67. Doubting “Thomas”
  • 68. After Laser
  • 69. Patient #012
  • 70. Laser Treatment as Day Case
  • 71. Laser Therapy
  • 72. LAPT #034
  • 73. Patient #016
  • 74. LAPT GA
  • 75. LAPT GA
  • 76. Laser Surgery Under GA
  • 77. LAPT Under GA
  • 78. Patient #011
  • 79. Patient No #022
  • 80. Patient No #019
  • 81. Patient No #018
  • 82. Patient No #015
  • 83. Coblator Turbinoplasty
  • 84. Coblation Turbinoplasty
  • 85. Coblator Nose: CAPT
  • 86. Coblator Surgery of Nose
  • 87. SMD:Submucus Diathermy GA
  • 88. SMD GA
  • 89. Laser Team in Jubilee Hospital, Trivandrum
  • 90. Laser Therapy #018
  • 91. All Healing Comes From God All healing comes from God whether it is supernatural or through a surgeon or a physician. He is still the source of our healing. I am the LORD who heals you, says God
  • 92. THANK YOU Dr.K.O.Paulose FRCS DLO Consultant ENT Surgeon Jubilee Hospital, Trivandrum, kerala, South