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  What Are Tympanostomy Tubes? Understanding the Big Impact of Tiny Grommets If your child has been struggling with muffled hearing, continuous speech delays, or a relentless cycle of painful middle ear infections, you have likely heard your GP or local health visitor mention "grommets." Known scientifically as tympanostomy tubes or pressure equalisation (PE) tubes, these microscopic devices are the most frequently performed ambulatory (day-case) surgical intervention in children worldwide. Yet, for many parents across East London and Essex, the prospect of any surgical procedure involving their child’s ears can feel incredibly daunting. You might find yourself searching for answers: What exactly do these tiny tubes do? How do they stay in place? Will my child be in pain? This guide breaks down the science behind these miniature devices, explaining how a microscopic tube can make a monumental impact on your child's development. The Anatomy of the Problem: Why Ears Need ...

Having Functional or Cosmetic Rhinoplasty










The most important thing when considering Rhinoplasty surgery is to discuss with your surgeon the aim of the procedure and the outcome you will be satisfied with. It is important to discuss in detail about the procedure.


Septoplasty or Rhinoplasty

Septoplasty is the correction of cartilage division between left and right nostril. Rhinoplasty can be performed with septoplasty to correct the crooked nose, nasal hump and making the nose smaller. It can be performed to improve breathing by supporting the nasal valve area.

Is Rhinoplasty covered by insurance?

Rhinoplasty if performed for cosmetic reasons is not covered by insurance companies. Rhinoplasty can be performed to improve breathing and deformity due to trauma. It is important to check with the insurance company coverage of your insurance policy.

What can be achieved in your rhinoplasty surgery?

Rhinoplasty is a very complex surgery. It is very important to discuss achievable targets. I will discuss with you the surgical plan. It is important to understand that even if we perform all surgical steps well we may not achieve a good result. Revision surgery is offered to such patients. Rarely nose might not look the same again.

What are the complications of the Rhinoplasty procedure?

· Bleeding Nasal packs may be put into the nose at the end of the operation, these will stay in until the doctor advises removal. On removal of the packs, it is usual for some bleeding to occur; this usually stops quickly. If the bleeding becomes severe a further pack may need to be put in.
· Disappointment/failure Whilst every care is taken for the end cosmetic appearance to be improved, occasionally the patient is not happy with the end result. Perfection or certain preference is not guaranteed. Broad nose, as the main aim of the procedure, is to improve the nasal airflow the nose may feel broad due to cartilage grafts used.
· Infection This usually occurs as a discoloured discharge from the nostrils several days after the operation and you will need to see your family doctor (GP) regarding this. You may also experience dry crusting mucous leading to discomfort, saline nasal douching should resolve this.
· Intranasal adhesions This can happen if the raw areas within your nose stick together or following an infection. These can be divided at a later date under a short general anaesthetic.
· Shape change Rarely the shape of the nose can become “saddled”. This is due to the collapse of cartilage in the centre of the nose if this should occur further surgery might be needed.
· Septal perforation There is a 1-2% risk of this happening. This is a hole in the middle partition of the nose, which will be permanent.
Bruising and Swelling--You may develop bruising and swelling around the eyes/nose, this will resolve but may take a few weeks. You are advised to sleep propped up for a few nights to prevent pooling of blood/fluid and encourage natural drainage. Application of ice packs will reduce this.
· Nasal tip/teeth numbness This should resolve but may take some time.
· Scar- sometimes the surgeon will need to access the nasal bone externally which may leave a pinprick scar each side of the nasal bone.



What should I do before the Rhinoplasty surgery?
You will have preoperative final consultation to discuss the surgical plan. Clinical photographs will be taken. Do not take any herbal or any other medication which increases bleeding. This can lead to increased bruising.

What is post-procedure advice after Rhinoplasty?

• Your doctor will advise you on a specific period of recovery but in general rest for one to two weeks. If you need a sick certificate, please ask the medical staff before you leave.
 • The nose will feel blocked due to post-operative swelling and can take a few weeks to settle down. If prescribed, apply any nasal drops/spray to decongest the nose and follow the recommended method of installation. You will be given antibiotic ointment to apply on the scar.
 • You may have a blood-stained watery discharge from the nose. This is normal and should settle after a few days.
• Scabbing within the nose may occur as it heals. Do not pick this off as the area will bleed. You may have been advised to douche (rinse) the nose and the nursing staff will advise you on the correct technique.
• For the first few days, avoid very hot drinks, meals, baths or showers. For one week, avoid blowing your nose and sneeze with your mouth wide open. These all help to reduce any risk of bleeding.
• Avoid or cut down on smoking as smoking affects the body’s ability to heal and irritates the inside of the nose. Staff can advise you on quitting, provide you aids to help you quit (e.g., nicotine patches) and contacts for support groups.
• Avoid crowded or dusty places and people with coughs and colds, as infection can be picked up in the nose.
• If nasal splints or plaster are in place, do not touch and attend the arranged-out patient's appointment for their removal. You may also have a splint inside your nose to help keep the partition straight, this stays in for one week or two and you will be informed if it is there.
• If you have an external plaster or splint, this will be secured in place with tape and stays in place for one to two weeks. This supports the nasal bones in their new position and must be kept dry.
• Avoid contact sports for eight weeks due to the risk of trauma and bleeding.
• If fresh, steady bleeding occurs, pinch the fleshy part of the nose, lean forward and apply ice to the forehead and bridge of the nose. A frozen bag of vegetables is a good alternative if you don’t have ice in the freezer. Avoid swallowing any blood as it can make you feel sick. If the bleeding does not stop after 30 minutes, ring the ward for advice.

When can go to work or exercise?

You can start gentle exercise four weeks post-surgery but avoid vigorous exercise for eight weeks. If you can work from home on the computer, you will be able to do so after four to five days.

When can I get nose pierced?

I would advise leaving nose to be pierced again for six months. Early piercing the nose can make your cartilage weaker and can lead to nasal obstruction.

 When can I use steam and sauna bath after Rhinoplasty?

 I would be adviced to leave steam and sauna bath for 3 months till all swelling has settled down. Early use of steam and sauna can lead to nose bleed and swelling to persist longer.

 Will rhinoplasty change my voice?
Rhinoplasty can be done for cosmetic reasons and functional reasons.  If we are changing the looks and the airflow through the nose is going to be the same then having rhinoplasty will not change your voice. If the person has a nasal voice which could be due to crooked septum later corrective functional rhinoplasty will improve the voice quality. The change will be more towards the natural sound. If you are a professional, who has to use his or her voice for work then discuss with your surgeon how rhinoplasty will impact your work and quality of life.



Will rhinoplasty change my smile?

Rhinoplasty is a complex procedure to address different deformities of nasal dorsum or nasal tip. The main aim of the procedure is to have well-balanced nose shape which blends well with the shape of your face. Rhinoplasty steps which are addressing nasal hump will not affect the lip. If rhinoplasty involves work in the nasal tip area then may use a graft to fix to the bone just above the upper lip. These rhinoplasty manoeuvres may lead to little numbness of the upper lip and upper lip feeling tight when you smile. The smile may feel pronounced for a few weeks but all these symptoms should go back to normal after some time. Discuss with your surgeon as stabilisation of nasal tip is a very important step in rhinoplasty.


Mr Gaurav Kumar

Ear Nose Throat Consultant

To Book An Appointment

Call 07494914140
Email  entappointmentuk@gmail.com

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Disclaimer: For General Information Only, Always Seek Medical Advice From Your Treating Consultant.





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