Allergy, Airway, Sleep & Snoring

The ENT Clinic provides comprehensive quality care for your upper airway. We look after nasal and sinus problems, sinus infections, allergies and sensitivities, snoring and sleep apnoea, narrowing (stenosis) and collapse of the larynx and trachea. Many of these conditions overlap and we undertake a holistic approach, recognizing that patients often suffer from multiple co-existing problems.

Chronic cough, as an example, is multifactorial and it is important to ascertain whether infections such as sinusitis, acid reflux (GERD), asthma or allergies have a role to play in exacerbating a persistent cough.

To help evaluate the airway, we employ the latest technologies to ensure that we obtain an accurate diagnosis. Flexible nasal endoscopy or nasoendoscopy offers an unparalleled assessment of the nose, sinuses, nasopharynx (or postnasal space), larynx (glottis) and upper airway (subglottis). This is very comfortably performed in clinic after application of a simple anaesthetic spray into the nose, taking just a few seconds for the nasoendoscopy to be completed (figure 2). Nasal endoscopy is a reimbursable procedure that is covered by most major insurance policies and Medisave. The clinic will assist you with claims for this procedure.

For an extremely detailed view of your vocal cords (or larynx), our surgeons employ high definition laryngeal videostroboscopy. This procedure – also done in clinic – gives a dynamic view of the vocal cords or vocal folds. It enables us to identify vocal cord nodules, vocal cysts, vocal polyps and other conditions affecting the larynx with greater clarity. It thus allows us to manage hoarseness with even greater efficacy.

Allergies are very common. Approximately 40% of young children and adolescents in Singapore suffer from allergies. The most common allergies are to house dust mite, although allergies to cockroach, cats and dogs are exceedingly common too. Our clinic has facilities for comprehensive in-house inhalant allergy testing. The simplest form of testing is skin prick testing which is quick and effective (figure 3). In some cases, blood tests for allergies (total IgE, Phadiatop and RAST allergy tests) are more accurate and provide us with helpful information on allergy severity.

The clinic offers sublingual immunotherapy (SLIT) for patients with allergies. This state-of-the-art treatment is recommended by the World Allergy Organisation for patients above the age of 5 with inhalant allergies. There two most common treatments prescribed at present are OralTek by Immunotek and Acarizax by Abbott.

The nose and windpipe are a window to the lung. Many nasal conditions are associated with lung problems: The “One Airway” principle means that rhinitis and asthma often co-exist in patients, with one condition potentially affecting the control of the other, if left undiagnosed and untreated. Our clinic offers basic lung function testing or spirometry to help us exclude co-existing lung or respiratory problems such as bronchitis or asthma.

Snoring and sleep apnoea are a common condition that the clinic manages. We see both children and adults with snoring, sleep-disturbed breathing and obstructive sleep apnoea (OSA). We offer a range of sleep study options from ambulatory home sleep studies (WatchPAT) to in-patient polysomnography (figure 4). Our management of snoring and sleep apnoea adheres to evidence-based medicine and we prescribe continuous positive airway pressure (CPAP) therapy, bilevel positive airway pressure therapy (BiPAP), mandibular advancement splints or oral appliances and surgical modification of the upper airway. Surgery may involve septoplasty, turbinoplasty. adenoidectomy, tonsillectomy, uvulopalatopharyngoplasty (UPPP) and tongue base reduction surgery.