Daily Mail Medicine can be confusing…..!
One of my patients recently arrived in my Clinic brandishing an article they had read from the Health section of the Daily Mail. ‘Here you are’, they cried joyously, ‘all you need to do is to do this operation on me and I’ll be cured ! When can I book in….!?’
Here is the reference for your interest – .
Unfortunately, life (and medicine) is rarely that simple, and if you want to induce much eye rolling from any Doctor, please bring us an article from the aforementioned source !!
In this particular case, having read the article, I think it is actually misleading and brings to light the fact that patients often become confused about their condition after research in the lay press and on the internet, and I will attempt to unravel and comment on some of these issues in this particular case here.
Firstly, the temptation to blindly believe in ‘new gadgets’. Lasers of varying types are used a lot in many different areas of medicine with great benefit for patients, but are not in any way a panacea that can in some mythical way cure all ills. Put bluntly, they burn or cut tissue and are an alternative to the cold steel of a scalpel or alternative methods of tissue cautery. They do not have some magical ‘wand-like’ power like sometimes we see in the movies, and potentially may cause infection and scarring just like the more ‘old fashioned’ traditional surgical methods. For instance not so long ago in ENT Surgery it was thought that Tonsillectomy with a Laser or Coblation machine (an alternative new fangled device) would be the new way forwards and would replace the cold steel dissection that had been the norm previously. Thorough nationwide audit of results and complications has however shown than the tried and trusted cold steel method was far safer, and the newer techniques have been largely abandoned.
Secondly, be very careful about believing in new techniques that have not been formally tried and tested against a placebo (i.e seeing whether the patient gets better on their own or with a ‘dummy’ treatment as compared to the patient having the new operation or treatment.)
Thirdly, do not believe in procedures that have only short term success or outcomes reported. Many operations in ENT do have short term benefit, but long term you can be no better and may return to exactly the same state as you were before the operation without careful follow up and monitoring of your condition. A good example of this is surgery for nasal polyps or for snoring.
As a trainee, I was personally involved in one of the first ENT Units in the UK to try a new technique for snoring called LAUP (Laser Assisted UvuloPalatoplasty), a technique that is still performed in many ENT units (and private snoring clinics in particular!) throughout the UK.
I audited the long term results of our group of patients, and the results 5 years after surgery were universally poor – in general, only 25% of patients had improvement in their snoring at this stage. This operation has now been abandoned in our Department.
Personally, I am only happy to perform a new procedure if I have read or heard of convincing evidence of long term success in the medical press or at meetings, where the new treatment has ideally been compared to the existing treatment or a placebo, and the long term results of that treatment audited and published showing a statistically significant better result for the patient.
Fourthly, beware of thinking that one treatment or operation can cure all your symptoms. This is where even I found this article particularly confusing. Even the title is confusing – ‘I blew my nose 200 times a day until a laser cleared my stuffed sinuses’. Does that mean her main symptom was a blocked nose (could mean a deviated nasal septum and/or swollen nasal lining and turbinates…) or does it mean that she had blocked sinuses, which were producing too much mucous which she felt the need to clear by blowing her nose? If the latter is true, this may need an operation to clear out the sinuses via endoscopic surgery up inside the nose (see ‘Functional Endoscopic Sinus Surgery’ under ‘Treatments’ on this website.) The introduction also refers to ‘…painful sinus problems…’ and Danni’s picture is underscored with her ‘…laser therapy for sinusitis…’
This may sound like semantics, but the treatment for these differing symptoms to get long term success is very different, and for you to presume from this article that an operation to basically cut / cauterize the inferior turbinates inside the nose with a special laser can cure all your nasal symptoms is unfortunately (in the vast majority of patients) pure fantasy. In particular, to think that an operation to shrink the inferior turbinates can cure sinusitis in the long term is, in my opinion, not correct !
I personally have started to perform a new operation called ‘powered endoscopic turbinoplasty’ where I think enlarged turbinates are the cause of patient symptoms of a blocked nose. See for more details.
This technique was pioneered and first published recently by Professor P.J Wormald from Adelaide in Australia, a world authority on endoscopic endonasal surgery, and (as with all papers published by him) a trial of this technique was carried out comparing it to a more conventional technique before he published the technique in a Medical Journal. The results have been properly audited and statistically analysed.
Mr Dilkes refers to the technique described by Professor Wormald (reducing the size of the turbinates with a microdebrider or ‘tiny whizzing blade’) as causing ‘… a lot of bleeding and a two week recovery time, along with a risk of bruising.’ I haven’t found this to be the case in my hands, and what the Wormald technique does do is give LONG LASTING relief – tissue removed with the laser unfortunately will usually grow back in my experience.
To add to my (and no doubt your) confusion, Mr Dilkes then refers to an operation to ‘inflate a balloon on a catheter within the sinuses, to enlarge them so that they drain more easily.’ Indeed there is such an operation, called ‘Balloon Sinuplasty’ and there is a video of this in the Gallery Section of my website. But this operation is performed for particular cases of long standing sinusitis, usually in the forehead (frontal) sinuses and not for a patient with a blocked nose…..!!
As you can see, I’m thoroughly confused as to what Danni’s symptoms actually are and what the best treatment would be – I can imagine that you are somewhat the same !
If this is a representative example of what is published, I would therefore take the information presented in any article you read in the health section of The Daily Mail with a large pinch of salt.
As always, my advice would be that if you have a problem specific to a particular area, go and see an expert in that field.
If you have a nasal problem, go to a Specialist Rhinologist who can precisely tailor your treatment on the basis of your symptoms and physical signs and not on the availability of an expensive laser in their Hospital.
This is the sort of service I will offer you in ‘The Canterbury Nose Clinic’.
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