Rhinological and ENT allergic conditions are among the most common and debilitating complaints of the population in Singapore. An epidemiological survey undertaken by the department showed a prevalence of 13% of perennial rhinitis in Singapore. To address this increasing trend, we have introduced a comprehensive Rhinological & ENT Allergy Service.
The Otolaryngologic (ENT) Allergy Clinic is located within the ENT Clinic at Kent Ridge Wing 2 level 3. It first started as a part-time service in 1995, and since 2002 it has been established as a fully specialised clinical service, with a team of trained full-time staff comprising physicians, allergy nurses, and a research scientist. The Allergy Clinic evaluates and treats both adults and children with otolaryngologic (ENT) allergy. These include allergic rhinitis and other nasal diseases like sinusitis and nasal polyps, and food allergy.
Nasal allergy or Allergic Rhinitis is a common nasal problem worldwide. There is a high association between allergic rhinitis, asthma and chronic sinus condition. It tends to run in families and can cause negative impact in the quality of life of people suffering from this condition. It is now recognised that early intervention in patients with allergic rhinitis can result in a decreased incidence of allergic asthma. Patients with allergic rhinitis are often inadequately treated as many do not seek treatment till their conditions are severe and affect their daily activities. Advances in diagnostic tests as well as medical and surgical treatment have resulted in better and more specific therapies. Management strategies include allergen identification and avoidance, pharmacotherapy, immunotherapy and surgery.
Allergen avoidance and pharmacotherapy are the first line treatment for patients with allergic rhinitis. Patients who do not respond adequately to the above measures will benefit from specific immunotherapy, surgery or both, depending on the nature of their symptoms. Immunotherapy (desensitization therapy or allergy shots) is currently recognised as an effective treatment for allergic rhinitis. It has been used in our department with good clinical efficacy for many years. It can be administered by 2 routes, either subcutaneous (injection) or sublingual (under the tongue). Patients who have persistent nasal obstruction secondary to structural defects will benefit from surgery to correct them.
At NUH, we have a dedicated Otolarynologic (ENT) Allergy Clinic located within the ENT Clinic at Kent Ridge Wing. From its beginnings as a part-time service in 1995, it has been established as a fully specialized clinical service since 2002, with a trained full-time staff comprising physicians, allergy nurses and research scientists. The Clinic evaluates and treats both adults and children with otolaryngologic allergy. These include allergic rhinitis and other nasal diseases like sinusitis and nasal polyps, and food allergy.
A full range of diagnostic services is available, with individualized patient testing under the supervision of a specialist physician. These may include blood (RAST), skin prick and intradermal tests, and endoscopic examination of the nose and upper airway. After consultation and testing, therapeutic options will be explored. To improve patient management, a dedicated allergy nurse in the Otolaryngologic Allergy Clinic will educate and counsel the patients on the nature of allergy, the environmental factors that can be modified to improve symptoms, the importance of pharmacotherapy compliance as well as impart correct techniques in application of nasal sprays. In addition to standard drug therapy, the Clinic offers immunotherapy which can be administered by the subcutaneous or sublingual route.
The Allergy Service also has an important role in research and medical education. It conducts and coordinates clinical trials on all aspects of otolaryngologic allergy, and its staff has accumulated an impressive list of international abstracts and publications. It also conducts local and regional meetings and teaching workshops, including successful workshops on Otolaryngologic Allergy and Immunotherapy for regional physicians.
As the Otolaryngologic Allergy Clinic is a specialized ENT service, it does not accept direct referrals. Potential patients are first assessed by an Otolaryngologist to exclude other causes of their symptoms before being directed to the Clinic for management.
Besides medical treatment, there are many surgical options to treat various nasal conditions. Some procedures are performed on an outpatient basis in the ENT clinic, under local anesthesia. They include radiofrequency reduction of the inferior turbinates for treatment of nasal obstruction and simple palatal procedures for snoring such as palatal implants and radiofrequency application.
Image Guidance Endoscopic Sinus Surgery
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