Nasal Allergy:Laser Treatment in India

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

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Nasal Allergy:Laser Treatment in India

  1. 1. Nasal Allergy Surgical Treatment Dr.K.O.Paulose FRCS DLO Consultant ENT Surgeon Jubilee Hospital, Trivandrum South Indiawww.drpaulose.com, www.snorefreesleep.com
  2. 2. Fed up with Sneezing?
  3. 3. Achooo… in Kids
  4. 4. Medical Management
  5. 5. Medical treatment of Nasal allergy Topical steroid Antihistamine tablets Decongestants Systemic Steroid Immunotherapy
  6. 6. Anatomy of Nose and Sinus
  7. 7. The Turbinates
  8. 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. 9. Types of Lasers CO2 Laser Argon laser The Nd:YAG (Neodymium:Yttrium- aluminum-Garnet) The Potassium-Titanyl-Phosphate (KTP)
  10. 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. 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. 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. 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. 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. 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. 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. 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. 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. 19. Laser Surgeon
  20. 20. Testing Laser
  21. 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. 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. 23. Advantages of LAPT Fast Painless In Office No Sutures No Bleeding Fast Recovery No Hospitalization No General Anesthesia Immediate Return To Work
  24. 24. Laser Safety Eye wear Smoke evacuator Fire Hazards
  25. 25. Laser Safety
  26. 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. 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. 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. 29. ENT Evaluation in OPD
  30. 30. Nasal Examination
  31. 31. Investigations
  32. 32. CT Imaging Enlarged pale turbinates Nasal Polyps Congested nasal mucosa Mucopus if sinusitis Septal spur,DNS Concha bullosa Sinus pathology
  33. 33. Diagnosis of Allergic Rhinitis Medical history ENT Examination RAST-Radio immunoassay CT Imaging
  34. 34. Self Care Avoidance measures Air purifiers and dust filters may help. Jel Neti , saline Nasal Wash
  35. 35. Spraying Local Anesthetic
  36. 36. Injecting Local Anesthetic
  37. 37. Peter Malakkof: Packing Nose
  38. 38. Peter Malakkof: Septoplasty
  39. 39. Peter Malakoff:LAPT
  40. 40. Patient #027
  41. 41. Patient #009
  42. 42. Dr Senthil Gets LAPT
  43. 43. Patient #021
  44. 44. Patient#009
  45. 45. Patient #046
  46. 46. Laser Nasal Allergy in OPD
  47. 47. Patient#019
  48. 48. LAPT
  49. 49. Patient #018
  50. 50. Vasomotor Rhintis:Laser
  51. 51. Patient #016
  52. 52. Patient #011
  53. 53. Diode Laser
  54. 54. Post op Laser Nose
  55. 55. Post op Laser Ashish
  56. 56. Ashish Gets Laser Treatment 2
  57. 57. Ashish Gets Laser Treatment
  58. 58. Patient #037
  59. 59. Sr.Anjelina gets Laser treatment
  60. 60. Laser Treatment in a little girl
  61. 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. 62. Antral Lavage before Laser
  63. 63. Fr.Sony Gets Laser Treatment
  64. 64. Patient #036
  65. 65. LAPT in Jubilee
  66. 66. Giving Local Anesthetic
  67. 67. Doubting “Thomas”
  68. 68. After Laser
  69. 69. Patient #012
  70. 70. Laser Treatment as Day Case
  71. 71. Laser Therapy
  72. 72. LAPT #034
  73. 73. Patient #016
  74. 74. LAPT GA
  75. 75. LAPT GA
  76. 76. Laser Surgery Under GA
  77. 77. LAPT Under GA
  78. 78. Patient #011
  79. 79. Patient No #022
  80. 80. Patient No #019
  81. 81. Patient No #018
  82. 82. Patient No #015
  83. 83. Coblator Turbinoplasty
  84. 84. Coblation Turbinoplasty
  85. 85. Coblator Nose: CAPT
  86. 86. Coblator Surgery of Nose
  87. 87. SMD:Submucus Diathermy GA
  88. 88. SMD GA
  89. 89. Laser Team in Jubilee Hospital, Trivandrum
  90. 90. Laser Therapy #018
  91. 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. 92. THANK YOU Dr.K.O.Paulose FRCS DLO Consultant ENT Surgeon Jubilee Hospital, Trivandrum, kerala, South Indiawww.drpaulose.com www.snorefreesleep.com

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