nasal allergy:laser treatment in india
DESCRIPTION
Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, Kerala, India. www.drpaulose.com www.snorefreesleep.comTRANSCRIPT
Nasal AllergyNasal AllergySurgical TreatmentSurgical Treatment
Dr.K.O.Paulose FRCS DLODr.K.O.Paulose FRCS DLOConsultant ENT SurgeonConsultant ENT Surgeon
Jubilee Hospital, TrivandrumJubilee Hospital, TrivandrumSouth IndiaSouth India
www.drpaulose.comwww.drpaulose.com, , www.snorefreesleep.comwww.snorefreesleep.com
Fed up with Sneezing?Fed up with Sneezing?
Achooo… in KidsAchooo… in Kids
Medical ManagementMedical Management
Medical treatment of Nasal Medical treatment of Nasal allergyallergy
Topical steroidTopical steroid Antihistamine Antihistamine
tabletstablets Decongestants Decongestants Systemic SteroidSystemic Steroid ImmunotherapyImmunotherapy
Anatomy of Nose and Anatomy of Nose and SinusSinus
The TurbinatesThe Turbinates
What is Laser?What is Laser?
INTRODUCTION OF INTRODUCTION OF LASERLASER
Laser is an acronym that Laser is an acronym that stands for Light stands for Light Amplification by Amplification by Stimulated Emission of Stimulated Emission of Radiation. Radiation. The first concept of the The first concept of the laser was initiated by laser was initiated by Albert Einstein in 1917.Albert Einstein in 1917.
Types of LasersTypes of Lasers
CO2 Laser
Argon laser
The Nd:YAG (Neodymium:Yttrium-aluminum-Garnet)
The Potassium-Titanyl-Phosphate (KTP)
CO2 LaserCO2 Laser
The CO2 laser is the most versatile laser in The CO2 laser is the most versatile laser in otolaryngology. otolaryngology.
The carbon dioxide (CO2) laser emits a colorless, The carbon dioxide (CO2) laser emits a colorless, infrared light infrared light
wavelength 10,600 nano microns wavelength 10,600 nano microns
Principle: The radiant energy produced by the CO2 laser Principle: The radiant energy produced by the CO2 laser is strongly absorbed by pure, homogeneous water is strongly absorbed by pure, homogeneous water and by all biological tissues high in water content. and by all biological tissues high in water content.
coaxial helium neon laser as aiming beam- red in colourcoaxial helium neon laser as aiming beam- red in colour
How does a CO2 Laser work?
Ability to coagulate, cut, Ability to coagulate, cut, vaporize vaporize
The main constituent of The main constituent of cells-water, readily absorbs cells-water, readily absorbs the wavelength of light the wavelength of light produced by the CO2 produced by the CO2 surgical laser. surgical laser.
The surgeon can control the The surgeon can control the extent by which the laser extent by which the laser beam is absorbed into beam is absorbed into surrounding tissue, surrounding tissue, resulting in an extremely resulting in an extremely precise tissue incision. precise tissue incision.
Indications of Co2 Laser in ENTIndications of Co2 Laser in ENT
Operations for snoring and sleep apneaOperations for snoring and sleep apnea Operations for Allergic Rhinitis,Correcting deviated Operations for Allergic Rhinitis,Correcting deviated
Nasal septum, Partial turbinectomy (LAPT), Choanal Nasal septum, Partial turbinectomy (LAPT), Choanal atresia, excision of Rhinophymaatresia, excision of Rhinophyma
Operations for voice disorders, the addition of the Operations for voice disorders, the addition of the microspot micromanipulator to the operating microspot micromanipulator to the operating microscope allows-arytenoidectomy, vocal nodules, microscope allows-arytenoidectomy, vocal nodules, early ca lesionsearly ca lesions
Operations for nose bleeds, nasal polyps, Operations for nose bleeds, nasal polyps, Rhinosporidiosis, HaemangiomasRhinosporidiosis, Haemangiomas
Excision of Facial Moles, Keloid, ScarsExcision of Facial Moles, Keloid, Scars
Indications of Co2 Laser_contdIndications of Co2 Laser_contd
Ulcers on tongue, check, multiple areas of leukoplakia Ulcers on tongue, check, multiple areas of leukoplakia can be precisely excisedcan be precisely excised
Skin lesions on head, Face and NeckSkin lesions on head, Face and Neck
TonsillectomyTonsillectomy
Tympanotomy, Myringotomy,StapedectomyTympanotomy, Myringotomy,Stapedectomy
(Bronchoscopic indications -management of recurrent (Bronchoscopic indications -management of recurrent respiratory papillomatosis or granulation tissue within the respiratory papillomatosis or granulation tissue within the tracheobronchial tree, excision of selected subglottic or tracheobronchial tree, excision of selected subglottic or tracheal strictures, excisions of bronchial adenomas.).tracheal strictures, excisions of bronchial adenomas.).
How It Works?How It Works? • • The excitability of anterior The excitability of anterior
ethmoidal nerve is ethmoidal nerve is decreased, and thereby decreased, and thereby vascular permeability and vascular permeability and nasal secretion are also nasal secretion are also decreased.decreased.
• • Some of sensory nerves Some of sensory nerves have been cut, the sensory-have been cut, the sensory-parasympathetic nerve parasympathetic nerve reflex is weakened, and at reflex is weakened, and at the meantime release of the meantime release of vascular-origin intestinal vascular-origin intestinal peptide as well as substance peptide as well as substance P is also decreased.P is also decreased.
• • Scar formation of nasal Scar formation of nasal mucosa will prevent mucosa will prevent hypersensitivity.hypersensitivity.
Advantages of Laser SurgeryAdvantages of Laser Surgery
Minimal operative bleeding due to coagulation of Minimal operative bleeding due to coagulation of blood vessels minor to 2 mm of diameter. blood vessels minor to 2 mm of diameter.
Reduced post operative pain due to minimal thermal Reduced post operative pain due to minimal thermal effect. effect.
Increased accuracy of the surgical wound Increased accuracy of the surgical wound Possibility of ambulatory surgery Possibility of ambulatory surgery Quick post op. healing Quick post op. healing Better plastic result of surgical wounds due to Better plastic result of surgical wounds due to
minimal scarring (that effect is very obvious in the minimal scarring (that effect is very obvious in the post tonsillectomy preservation of the tonsillar post tonsillectomy preservation of the tonsillar pillars). pillars).
Disadvantages of LaserDisadvantages of Laser
Cost of equipment and maintenance . Cost of equipment and maintenance . (around USD 4000=Rs 4Lakh)(around USD 4000=Rs 4Lakh)
Special surgical skills Special surgical skills Increased setup time of equipment Increased setup time of equipment Need of safety eyewear Need of safety eyewear Increased care for patient safety - explosion Increased care for patient safety - explosion
or fire hazard.or fire hazard. Smoke Smoke
How Laser work?How Laser work?
Laser surgery is the most preferred Laser surgery is the most preferred technique in removing moles. Laser removal technique in removing moles. Laser removal of moles is by far the most simple for of moles is by far the most simple for eliminating moles on the skin. In most cases eliminating moles on the skin. In most cases of laser removal anesthesia may not be of laser removal anesthesia may not be necessary.necessary.
The laser beam will also burn away the mole. The laser beam will also burn away the mole. Depending on the size of your mole, you may Depending on the size of your mole, you may need multiple sessions to completely remove need multiple sessions to completely remove it. No scarring , no bleeding, no pain and can it. No scarring , no bleeding, no pain and can be done in OPD set up with surface be done in OPD set up with surface anesthesia.anesthesia.
How LAPT Done?How LAPT Done? Patient is kept semi Patient is kept semi
sitting in an ENT chair sitting in an ENT chair (as seen in picture) and (as seen in picture) and Co2 CW at 6 watts Co2 CW at 6 watts setting, the turbinates setting, the turbinates are cauterized. The are cauterized. The procedure takes 10-15 procedure takes 10-15 mnts on each side. mnts on each side. There is hardly any There is hardly any bleeding and patient bleeding and patient goes home after few goes home after few hours. This gives very hours. This gives very good resultsgood results
Laser SurgeonLaser Surgeon
Testing Laser Testing Laser
LOCAL ANESTHESIALOCAL ANESTHESIA
The anesthesia parameters used in The anesthesia parameters used in all patients were for premedication , all patients were for premedication , diazepam 5mg + atropine 0,5 diazepam 5mg + atropine 0,5 mg .For local superficial anesthesia mg .For local superficial anesthesia xylocaine spray 10 % + For xylocaine spray 10 % + For infiltration anesthesia xylocaine 2 % infiltration anesthesia xylocaine 2 % + 1: 100.000 adrenaline solution.+ 1: 100.000 adrenaline solution.
General AnesthesiaGeneral Anesthesia
These include wrapping aluminum tape These include wrapping aluminum tape around the tube, placing wet cottonoids around the tube, placing wet cottonoids around the endotracheal tube cuff, placing around the endotracheal tube cuff, placing saline within the cuff using a metal or xomed saline within the cuff using a metal or xomed endotracheal tube. endotracheal tube.
Flexible stainless steel corrugated tubes are Flexible stainless steel corrugated tubes are availableavailable
The most morbid complication of laryngeal The most morbid complication of laryngeal laser surgery is airway fire.Various methods laser surgery is airway fire.Various methods have been suggested for protecting the have been suggested for protecting the endotracheal tube and larynx.endotracheal tube and larynx.
Advantages of LAPTAdvantages of LAPT
FastFastPainlessPainlessIn OfficeIn OfficeNo SuturesNo SuturesNo BleedingNo BleedingFast RecoveryFast RecoveryNo HospitalizationNo HospitalizationNo General AnesthesiaNo General AnesthesiaImmediate Return To WorkImmediate Return To Work
Laser SafetyLaser Safety
Eye wearEye wear Smoke evacuatorSmoke evacuator Fire HazardsFire Hazards
Laser SafetyLaser Safety
Allergic RhintisAllergic Rhintis Allergic RhinitisAllergic Rhinitis is an is an
inflammation of the nasal inflammation of the nasal passages, usually passages, usually associated with watery associated with watery nasal discharge and nasal discharge and itching of the nose and itching of the nose and eyes. eyes.
Allergic Rhinitis affects Allergic Rhinitis affects about 20-30 percent of the about 20-30 percent of the population. The symptoms population. The symptoms occur in the nose and eyes occur in the nose and eyes and usually occur after and usually occur after exposure to dust, danders, exposure to dust, danders, or certain seasonal pollens or certain seasonal pollens in people that are allergic in people that are allergic to these substances. to these substances.
Causes of Nasal AllergyCauses of Nasal Allergy House Dust mites, House Dust mites,
cockroaches, molds and cockroaches, molds and animal dander, are animal dander, are examples of year-around examples of year-around allergens. allergens.
Tree, grass and ragweed Tree, grass and ragweed pollens are primarily pollens are primarily seasonal outdoor seasonal outdoor allergens. allergens.
Animal allergens are also Animal allergens are also important indoor important indoor allergens. The major cat allergens. The major cat allergen is secreted allergen is secreted through the sebaceous through the sebaceous glands of the animal's glands of the animal's skin. skin.
Symptoms of Nasal Symptoms of Nasal AllergyAllergy
Repetitive sneezing; Repetitive sneezing; runny nose, post-nasal runny nose, post-nasal drip; nasal congestion, drip; nasal congestion, itchy eyes, ears, nose or itchy eyes, ears, nose or throat; and generalized throat; and generalized fatigue. fatigue.
wheezing, eye tearing, wheezing, eye tearing, sore throat, and impaired sore throat, and impaired smell. smell.
chronic cough may be chronic cough may be secondary to postnasal secondary to postnasal drip drip
Sinus headaches and ear Sinus headaches and ear ache, and itching are also ache, and itching are also common common
ENT Evaluation in OPDENT Evaluation in OPD
Nasal ExaminationNasal Examination
InvestigationsInvestigations
CT ImagingCT Imaging
Enlarged pale Enlarged pale turbinatesturbinates
Nasal PolypsNasal Polyps Congested nasal Congested nasal
mucosamucosa Mucopus if sinusitisMucopus if sinusitis Septal spur,DNSSeptal spur,DNS Concha bullosaConcha bullosa Sinus pathologySinus pathology
Diagnosis of Allergic Diagnosis of Allergic RhinitisRhinitis
Medical history Medical history ENT ExaminationENT Examination RAST-Radio RAST-Radio
immunoassay immunoassay CT ImagingCT Imaging
Self CareSelf Care
Avoidance Avoidance measuresmeasures
Air purifiers and Air purifiers and dust filters may dust filters may help. help.
Jel Neti , saline Jel Neti , saline Nasal WashNasal Wash
Spraying Local Spraying Local AnestheticAnesthetic
Injecting Local Injecting Local AnestheticAnesthetic
Peter Malakkof: Packing Peter Malakkof: Packing NoseNose
Peter Malakkof: Peter Malakkof: SeptoplastySeptoplasty
Peter Malakoff:LAPTPeter Malakoff:LAPT
Patient #027Patient #027
Patient #009Patient #009
Dr Senthil Gets LAPTDr Senthil Gets LAPT
Patient #021Patient #021
Patient#009Patient#009
Patient #046Patient #046
Laser Nasal Allergy in Laser Nasal Allergy in OPDOPD
Patient#019Patient#019
LAPTLAPT
Patient #018Patient #018
Vasomotor Rhintis:LaserVasomotor Rhintis:Laser
Patient #016Patient #016
Patient #011Patient #011
Diode LaserDiode Laser
Post op Laser NosePost op Laser Nose
Post op Laser AshishPost op Laser Ashish
Ashish Gets Laser Ashish Gets Laser Treatment 2Treatment 2
Ashish Gets Laser Ashish Gets Laser TreatmentTreatment
Patient #037Patient #037
Sr.Anjelina gets Laser Sr.Anjelina gets Laser treatmenttreatment
Laser Treatment in a Laser Treatment in a little girllittle girl
Post Op after 6 monthsPost Op after 6 months
CT Scan of a CT Scan of a patient who patient who underwent Laser underwent Laser surgery to the surgery to the TurbinatesTurbinates
The turbinates are The turbinates are reduced in sizereduced in size
Patient symptom Patient symptom freefree
Antral Lavage before Antral Lavage before LaserLaser
Fr.Sony Gets Laser Fr.Sony Gets Laser TreatmentTreatment
Patient #036Patient #036
LAPT in JubileeLAPT in Jubilee
Giving Local AnestheticGiving Local Anesthetic
Doubting “Thomas”Doubting “Thomas”
After LaserAfter Laser
Patient #012Patient #012
Laser Treatment as Day Laser Treatment as Day CaseCase
Laser TherapyLaser Therapy
LAPT #034LAPT #034
Patient #016Patient #016
LAPT GALAPT GA
LAPT GALAPT GA
Laser Surgery Under GALaser Surgery Under GA
LAPT Under GALAPT Under GA
Patient #011Patient #011
Patient No #022Patient No #022
Patient No #019Patient No #019
Patient No #018Patient No #018
Patient No #015Patient No #015
Coblator TurbinoplastyCoblator Turbinoplasty
Coblation TurbinoplastyCoblation Turbinoplasty
Coblator Nose: CAPTCoblator Nose: CAPT
Coblator Surgery of NoseCoblator Surgery of Nose
SMD:Submucus SMD:Submucus Diathermy GADiathermy GA
SMD GASMD GA
Laser Team in Jubilee Hospital, Laser Team in Jubilee Hospital, TrivandrumTrivandrum
Laser Therapy #018Laser Therapy #018
All Healing Comes From GodAll Healing Comes From God
All healing comes All healing comes from Godfrom God whether whether it is supernatural it is supernatural or through a or through a surgeon or a surgeon or a physician. He is physician. He is still the source of still the source of our healing. our healing.
I am the LORD who heals you, says God
THANK YOUTHANK YOU
Dr.K.O.Paulose FRCS DLODr.K.O.Paulose FRCS DLOConsultant ENT SurgeonConsultant ENT Surgeon
Jubilee Hospital, Jubilee Hospital, Trivandrum, kerala, South IndiaTrivandrum, kerala, South India
www.drpaulose.comwww.drpaulose.com www.snorefreesleep.comwww.snorefreesleep.com