Dear Dr. Paulose
As soon as I get up, I start sneezing continuosly and I have runny nose .I sneeze sometimes 20-30 sneeze non stop and sometimes it continues for the whole day…I tried all sorts of tablets, sprays and injections, homeopathic treatment, Ayurvedic products but no avail…I am fed up…Cannot concentrate in my work… Making my life miserable.. Any other remedies?
An answer to a very common problem
Sneezing is caused by irritation to the mucous membranes of the nose or throat. It can be very bothersome, but is generally not a sign of a serious problem. Allergy to pollen, mold, dander, dust and pollen -hay fever.
First try avoiding exposure to the offending allergen is the best way to control sneezing caused by allergies.
If you are fed up using all kinds of nasal sprays, antiallergic medications and injections, and no avail, then think of this minor surgery –Laser Surgery under local anesthetic. It gives very good result. And not very expensive, when done as a day case procedure.
The Laser cautery is performed under local anesthetic, spraying lidocaine and xylometazoline. If any septal spur to be removed, inject 4% Xylocaine with adrenaline.
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
Post operative care-
Nasal decongestants, analgesics and antihistamines are given for a week or two. Nasal wash with saline helps healing. There is no crusting.
How Laser work?
The pathogenesis is actually type I hypersensitive reaction of nasal mucosa. Agger nase is one of the trigger points and sensitive areas of this disease, and anterior ethmoidal nerve is the major nose-innervating parasympathetic nerve, the abnormal excitation of which plays an important role in the pathogenesis. Anterior ethmoidal nerve is distributed at the supra-anterior portion of nasal cavity, where gland density is high. Irradiation of anterior ethmoidal nerve, lateral branch and septal branch in this area will not only damage inflow of parasympathetic nerve, but also decrease acetylcholine released from nasal cavity, thereby alleviating symptoms. Meanwhile, anterior ethmoidal nerve is also a sensory nerve of supra-anterior portion of nasal cavity; the sensory function will be weakened after laser cauterization.
Laser cautery will decrease sensitivity of external nose to adverse chemical or physical stimuli. The effect of CO2 laser irradiation is as follows:
• 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.
Advantages of Co2 Laser
CO2 laser has got good flexibility, high focus of energy and minimal injury to the surrounding normal tissue. It will cause coagulation, degeneration and atrophy of protein, and cause damage of varied degree to certain branch of anterior ethmoidal nerve and sphenopalatal nerve. Moreover, laser therapy will destroy glands in this area, decreasing secretion and sensitivity of nasal mucosa to adverse external stimuli, suppressing reflex of sneezing. Thus nasal discharge and obstruction will be lessened and symptoms alleviated.
CO2 laser has such advantages as precise targeting, easy manipulation, causes no bleeding, fewer complications, good response and quick recovery. During the treatment, power output and coagulation time are to be strictly controlled, and surrounding normal tissue is to be well protected in order to ensure both efficacy and safety of treatment.
Any need to stay in the Hospital?
No. You come at 7AM after taking breakfast directly to Theatre . Have the procedure done in Operation Theatre, rest in post operative room for 1-2 hrs and can go home and take rest at home for a day. Can resume work the next day. Try avoiding dusty places. It is a very simple procedure, very effective.
How much it Cost in Jubilee Hospital, Trivandrum?
Being a Mission hospital, (non corporate establishment) the charges are moderate- Rs 5000-10,000 (depends on correcting the deviated nasal septum and removal of polyps along with LAPT).
For Appointment- call 04712334561/62/63/64, 6452020,407822
For detailed pictures, see the album- http://www.drpaulose.com/gallery-2