This document discusses nasal allergy treatment using laser surgery. It begins with an introduction to lasers and the CO2 laser specifically. It then covers the medical management of nasal allergies, anatomy of the nose, and indications for laser surgery to treat conditions like nasal polyps, deviated septum, and rhinitis. The benefits of laser surgery like minimal bleeding and scarring are presented. Images of laser treatments and postoperative results are also included. The document emphasizes that laser surgery provides an effective treatment for nasal allergy symptoms with quick recovery.

1. Nasal Allergy
Surgical Treatment
Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon
Jubilee Hospital, Trivandrum
South India
www.drpaulose.com, www.snorefreesleep.com

2. Fed up with Sneezing?

3. Achooo… in Kids

4. Medical Management

5. Medical treatment of Nasal allergy
 Topical steroid
 Antihistamine tablets
 Decongestants
 Systemic Steroid
 Immunotherapy

6. Anatomy of Nose and Sinus

7. The Turbinates

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. Types of Lasers
 CO2 Laser
 Argon laser
 The Nd:YAG (Neodymium:Yttrium-
aluminum-Garnet)
 The Potassium-Titanyl-Phosphate (KTP)

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 microns
Principle: 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. 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. 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. 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. 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.

16. 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).

17. 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

18. 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.

19. 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

20. Laser Surgeon

21. Testing Laser

22. 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.

23. 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.

24. Advantages of LAPT
 Fast
Painless
In Office
No Sutures
No Bleeding
Fast Recovery
No Hospitalization
No General Anesthesia
Immediate Return To Work

25. Laser Safety
 Eye wear
 Smoke evacuator
 Fire Hazards

26. Laser Safety

27. 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.

28. 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
animal's skin.

29. 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

30. ENT Evaluation in OPD

31. Nasal Examination

32. Investigations

33. CT Imaging
 Enlarged pale turbinates
 Nasal Polyps
 Congested nasal mucosa
 Mucopus if sinusitis
 Septal spur,DNS
 Concha bullosa
 Sinus pathology

34. Diagnosis of Allergic Rhinitis
 Medical history
 ENT Examination
 RAST-Radio
immunoassay
 CT Imaging

35. Self Care
 Avoidance measures
 Air purifiers and dust
filters may help.
 Jel Neti , saline Nasal
Wash

36. Spraying Local Anesthetic

37. Injecting Local Anesthetic

38. Peter Malakkof: Packing Nose

39. Peter Malakkof: Septoplasty

40. Peter Malakoff:LAPT

41. Patient #027

42. Patient #009

43. Dr Senthil Gets LAPT

44. Patient #021

45. Patient#009

46. Patient #046

47. Laser Nasal Allergy in OPD

48. Patient#019

49. LAPT

50. Patient #018

51. Vasomotor Rhintis:Laser

52. Patient #016

53. Patient #011

54. Diode Laser

55. Post op Laser Nose

56. Post op Laser Ashish

57. Ashish Gets Laser Treatment 2

58. Ashish Gets Laser Treatment

59. Patient #037

60. Sr.Anjelina gets Laser treatment

61. Laser Treatment in a little girl

62. 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

63. Antral Lavage before Laser

64. Fr.Sony Gets Laser Treatment

65. Patient #036

66. LAPT in Jubilee

67. Giving Local Anesthetic

68. Doubting “Thomas”

69. After Laser

70. Patient #012

71. Laser Treatment as Day Case

72. Laser Therapy

73. LAPT #034

74. Patient #016

75. LAPT GA

76. LAPT GA

77. Laser Surgery Under GA

78. LAPT Under GA

79. Patient #011

80. Patient No #022

81. Patient No #019

82. Patient No #018

83. Patient No #015

84. Coblator Turbinoplasty

85. Coblation Turbinoplasty

86. Coblator Nose: CAPT

87. Coblator Surgery of Nose

88. SMD:Submucus Diathermy GA

89. SMD GA

90. Laser Team in Jubilee Hospital, Trivandrum

91. Laser Therapy #018

92. 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

93. THANK YOU
Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon
Jubilee Hospital,
Trivandrum, kerala, South India
www.drpaulose.com www.snorefreesleep.com