Ears, Nose & Throat - Q2 2019

Q2 / 2019 A PROMOTIONAL SUPPLEMENT DISTRIBUTED ON BEHALF OF MEDIAPLANET, WHICH TAKES SOLE RESPONSIBILITY FOR ITS CONTENTS

BRITISH TINNITUS ASSOCIATION About one in eight adults in the UK are living with persistent tinnitus. » p4

BRITISH ACADEMY OF AUDIOLOGY Good hearing helps people stay connected, reduces loneliness and supports health and wellbeing. » p4

ALLERGY UK Hay fever can restrict outdoor sports such as running, cycling and cricket. » p6 © SAKEPAINT

Hearing loss can be a slow and gradual process spanning several years. It can take a long time to recognise the signs of hearing loss, so when you do it’s important to have your hearing checked.”

- Sue Falkingham, President, the British Academy of Audiology p4

EARS, NOSE & THROAT

Follow us

@MediaplanetMarketing

@MediaplanetUK

@MediaplanetUK

Project Manager: Nick Craig E-mail: nick.craig@mediaplanet.com Business Development Manager: Ross Bannatyne Content and Production Manager: Kate Jarvis Managing Director: Alex Williams Digital Manager: Jenny Hyndman Designer: Kiane Blackman Content and Social Editor: Harvey O’Donnell Mediaplanet contact information: Phone: +44 (0) 203 642 0737 E-mail: uk.info@mediaplanet.com All images supplied by Gettyimages, unless otherwise specified

Please recycle

A PROMOTIONAL SUPPLEMENT DISTRIBUTED ON BEHALF OF MEDIAPLANET, WHICH TAKES SOLE RESPONSIBILITY FOR ITS CONTENTS Š YACOBCHUK

Ear, nose and throat conditions need more funding for research The specialty of otorhinolaryngology (ear, nose and throat) looks after a range of conditions crossing the age spectrum from infants through to the elderly and everyone in between.

A

side from head and neck cancers, the majority of ear, nose and throat disorders affect quality of life rather than mortality.

As such, in the past, the specialty has not been eminent within the medical sphere for its research endeavours, with evidence for managing various conditions being experiential rather than being evidence-based in clinical trials.

In the modern era, with increasing pressure on healthcare budgets, commissioners are increasingly targeting "Procedures of Limited Clinical Effectiveness" (PoLCE).

Often, what is lacking is simply evidence of clinical effectiveness. To

2 HEALTHAWARENESS.CO.UK

counter this, it was clearly identified that high value research needed to be developed and conducted to inform us about what treatments work best and how the specialty can most effectively deliver care.

Recognising the fierce competition for research funding and resources and also the need to build capacity and expertise to deliver the research within the specialty, ENT-UK took the initiative to develop a strategic research agenda called Generate, that was launched in 2015.

Previously under-researched areas are becoming priority The Generate project developed

resea rch pr ior it ies i n si x key domains. Four years on, we are starting to see the fruits of that agenda within the specialty and within some of those domains.

Tinnitus research has previously been under-resourced with a lack of evidence for best management, but there are now three studies underway for tinnitus, two in adults and one in children.

Hearing loss is currently well supported on the national portfolio of research, with 15 active studies currently underway in the UK, ranging from laborator y-based projects to screening studies and to clinical trials.

WRITTEN BY: PROFESSOR CARL PHILPOTT Honorary Sectretary, ENT UK

Balance and smell loss need greater attention from research Balance problems have received less prominence, which may be in part due to the fact that a number of specialties have input to these patients. Three areas now receiving closer attention include tonsillitis, nasal blockage due to septal deviation and chronic sinusitis, all of which have associated operations undertaken in routine NHS practice: tonsillectomy, septoplasty and endoscopic sinus surgery.

All three procedures have faced the potential for restrictions by clinical commissioning groups, so the funding of major clinical trials by the National

Institute of Health Research has been very welcome. These trials are starting to provide evidence for the place of the procedures in managing the affected patients, and indeed in ensuring the correct patients are selected to come forwards for these procedures.

An area of the specialty where funding and new interventions are needed is that of smell and taste disorders. There will be a need to revisit the Generate agenda again in the near future and it is likely that this will provide an opportunity to take stock of key advances and refocus on areas such as balance and smell loss to secure more funding.

MEDIAPLANET

A PROMOTIONAL SUPPLEMENT DISTRIBUTED ON BEHALF OF MEDIAPLANET, WHICH TAKES SOLE RESPONSIBILITY FOR ITS CONTENTS

Why sinusitis sufferers should look to balloons for symptom relief Increased use of minimally-invasive balloon procedure could offer a fast and effective alternative to conventional sinus surgery, potentially saving the NHS millions of pounds.

INTERVIEW WITH: MR JOHN DE CARPENTIER Consultant ENT Surgeon and Rhinologist

P

eople suffering for years with persistent sinus problems could have symptom relief with a quick recovery, if only a proven balloon technology was more widely adopted within the NHS.1 New technology, which is approved by the National Institute for Health and Care Excellence (NICE) and available on the NHS, can get people with chronic sinusitis back at work within hours of treatment. According to NICE, the tech could also save the NHS millions of pounds compared to conventional treatment requiring a full surgical team, general anaesthetic and a hospital stay.

Sinusitis is a common problem, particularly during hay fever season, affecting around one in ten people with painful inflammation of the airfilled pockets around the nose. For

some people, symptoms can persist for years despite trying over-the-counter decongestants or nasal steroids and/or antibiotics from the GP. The new treatment option is called a balloon sinuplasty, which involves inserting and then inflating a small balloon into the sinus cavity to physically expand the space, restoring drainage. Treatment takes around 20-30 minutes under local anaesthetic and people can generally be back at work the next day.1 As Dr Raj Bhalla says: “Using local anaesthetic means you’re potentially freeing up theatre infrastructure; freeing up the anaesthetist who would have been working with you in theatre, freeing up the theatre team, so they can be doing something else that helps the NHS to reduce waiting times.

INTERVIEW WITH: MR RAJ BHALLA Consultant Rhinologist and Endoscopic Skull Base Surgeon

Consultants just need to be convinced that the results will be good, and for me, the results already are.”

Balloon sinuplasty benefits can last a lifetime Since development of the technology in 2004, hundreds of thousands of patients worldwide have benefitted from this procedure’s success rate, which is clinically proven in excess of 80%.1 According to Mr John De Carpentier, a consultant ENT surgeon in Preston, Lancashire, the best outcomes are seen in patients who receive the balloon treatment within 12 months of diagnosis.

“Unfortunately, there are delays in the system,” he says.

Peter Andrews, also an ENT con-

INTERVIEW WITH: MR PETER ANDREWS MD, FRCS Consultant Rhinologist and Facial Plastic Reconstructive Surgeon

sultant and a head and neck surgeon at the Royal National Throat, Nose and Ear Hospital, says around one in three patients will wait up to five years before they are referred. He says: “We need to see patients earlier, but it’s such a subjective area: unlike high blood pressure or high blood sugar levels, sinus congestion cannot be measured. There is nothing available in primary care to point patients and their GPs to a definitive diagnosis.”

Recognising the benefits and cost savings of offering patients minimally-invasive, out-patient procedures, the NHS is supportive of balloon sinuplasty: Medicines watchdog NICE approved the technology in 2016.

But more needs to be done to improve take-up of the procedure, says Andrews. He suggests that GP services could include ‘nose clinics’, where

1: Chandra RK, Kern RC, Cutler JL, Welch KC, Russell PT. REMODEL larger cohort with long-term outcomes and meta-analysis of standalone balloon dilation studies. Laryngoscope. 2016 Jan;126(1):44-50

specialist practitioners give specific input on diagnosis, symptom management and treatment. Consultants also need to get into the habit of using this technique as their first line intervention in suitable patients, he says.

“It will be a slow change, but one that will be facilitated by new-generation devices launched in the past three to four years, which are much more effective and easier to use.

Written by: Ailsa Colquhoun

Sponsored by

Read more at ent.stryker.com/medical devices

A PROMOTIONAL SUPPLEMENT DISTRIBUTED ON BEHALF OF MEDIAPLANET, WHICH TAKES SOLE RESPONSIBILITY FOR ITS CONTENTS

“Nothing can be done about tinnitus…” is unhelpful and untrue A wasp buzzing; a whistling kettle; constant static on the radio. Imagine what it’s like to hear noises in your head. They are strident and intrusive and yet no one else can hear them. You are having trouble sleeping at night, and during the day, you can’t concentrate on your work.

WRITTEN BY: DAVID STOCKDALE Chief Executive, British Tinnitus Association

T

his is the reality for some people living with tinnitus.

Tinnitus is a very common condition, which can be very distressing for those that experience it. While there is no cure at the moment, there are a number of management techniques that can be used to reduce its impact.

What is tinnitus?

Tinnitus is an awareness of sound in the head or ears where there is no corresponding external sound. This sound may be ringing, whistling, buzzing or be more complex. It is a very common condition – about one in eight adults in the UK are living with persistent tinnitus. Around 1.05 million GP consultations for tinnitus are held in the UK every year.

Who gets tinnitus?

Although tinnitus is more common in older people, it can occur at any

age, including in childhood. Men and women are equally affected.

Tinnitus is more frequent in people with hearing loss, but the severity of the tinnitus does not depend on the severity of the hearing loss. It is quite possible to have tinnitus with normal hearing.

What are the causes of tinnitus?

The causes of tinnitus are still not fully understood, but it can be associated with: • Hearing loss • Exposure to loud noise • Stress and anxiety • Ear infections • Ear wax build up What can be done about tinnitus?

For many people, tinnitus is distressing when the problem begins,

WRITTEN BY: NIC WRAY Communications Manager, British Tinnitus Association

About one in eight adults in the UK are living with persistent tinnitus.” but it improves over time. However, for some, tinnitus remains a chronic condition. We do not know why this is the case, and research is happening to investigate this.

We frequently hear that people with tinnitus have been told by their GPs that, “nothing can be done about tinnitus,” or, “you’ll just have to learn to live with it.” Feedback like this is unhelpful and untrue and can contribute to the distress felt by the patient.

It can be easier to manage tinnitus if help is given early A positive attitude from medical professionals and accurate information and reassurance is generally helpful.

Clinicians involved in tinnitus care are

Hearing well matters: stay connected to your loved ones

When was the last time you thought about your hearing? How do you know you are hearing all the sounds you need to lead a connected, engaged life? Is it time to have you’re hearing assessed?

I

didn’t quite catch that. One in six people in the UK have a hearing loss. It is estimated 20% of the population will have a hearing loss by 2031.1 Hearing is an important form of communication; when this is affected you can find yourself withdrawing from conversations and social situations, which could lead to feelings of isolation and loneliness.2 Frequently turning up the TV volume, asking people to repeat what they’re saying and struggling to hear when in noisy surroundings are signs of a hearing loss.1 Hearing loss can be a slow and gradual process spanning several years. It can take a long time to recognise the signs of hearing loss,

so when you do it’s important to have your hearing checked.

Age-related cognitive decline can be prevented with early hearing loss diagnosis You can have your hearing assessed either by visiting your GP for an NHS audiology referral or by going directly to a private hearing aid dispenser.

The audiology professional will assess your hearing levels and help you to decide on the next steps to help you hear well again. The earlier you can see a professional the better, as research shows that keeping people engaged and active by adopting hearing devices can significantly reduce age-related cognitive decline.3

Where can I go if I want to get my hearing checked?

You shou ld f i rst ment ion a ny concerns about your hearing to your GP. They can ensure your ears are healthy and you have no wax blocking your ears. The GP can also refer you to an NHS audiology service.

Alternatively, you can visit a pr ivate hea r i ng a id d ispen ser directly, without contacting your GP fi rst. In most cases, your audiologist can provide a complete service from diagnosis through to technology provision and follow up appointments to discuss your progress and answer any questions as you go through your journey to hearing well and living well.

firmly of the opinion that all patients with tinnitus should, at the very least, receive an audiological assessment.

Experience shows that when early help is given, patients manage their tinnitus more effectively.

Self-help for tinnitus is often useful.

Information and resources such as the British Tinnitus Association’s helpline, information leaflets and website are available to give people the tools for self-management.

Other treatment options available include: • Counselling (such as CBT) • Correcting any hearing loss • Sound therapy • Relaxation techniques • Mindfulness meditation Research into biomarkers and drugs to control tinnitus There is an urgent need to look for

and evaluate a drug for tinnitus.

Biomarkers and objective measures of tinnitus have been identified as necessary by industry to move tinnitus research forwards. Both of these are vital areas for tinnitus research that need more attention.

The BTA will be driving forward research in this area to achieve our vision of a world where no one suffers from tinnitus.

British Tinnitus Association

Helpline: 0800 018 0527 Website: tinnitus.org.uk takeontinnitus.co.uk

Read more at healthawareness.co.uk

WRITTEN BY: SUE FALKINGHAM President, British Academy of Audiology What to expect from your hearing assessment appointment Visiting an audiologist will involve a physical examination of your ears, some questions about your health and lifestyle and a hearing test. The health and lifestyle discussion will help to ensure any options provided address your concerns.

Solutions to help you hear better can be a combination of communication advice, hearing technology and other assistive listening devices. The settings of any hearing aids provided will be tailored to your hearing level.

Tailoring your hearing device to your lifestyle Together with your audiologist, you

can agree which setting options you would like to try. You may prefer the completely automatic option, or opt for one with extra settings to be used in noisy places or to listen to music.

You may find you prefer an option that includes connectivity to your mobile phone. If any technology is provided, the audiology professional will go through maintenance and use of any devices and can point you in the direction of a range of support services that may exist in your local area.

Don’t live in silence or isolation when, through a couple of appointments, you could be hearing well and living well again.

Read more at healthawareness.co.uk

1: Action on Hearing Loss (2018) Facts and Figures (Online) Available at: https://www.actiononhearingloss.org.uk/about-us/media/facts-and-figures/ [Accessed 16th May 2019] 2: NHS England and Department of Health (2015) Action Plan on Hearing Loss (Online) Available at: https://www.england.nhs.uk/wp-content/uploads/2015/03/act-plan-hearing-loss-upd.pdf [Accessed 16th May 2019] 3: Asri Maharani PhD, Piers Dawes PhD, James Nazroo PhD, Gindo Tampubolon PhD, Neil Pendleton PhD. Longitudinal Relationship Between Hearing Aid Use and Cognitive Function in Older Americans. Journal of the American Geriatrics Society Volume 66, Issue 6 2019

4 HEALTHAWARENESS.CO.UK

MEDIAPLANET

A PROMOTIONAL SUPPLEMENT DISTRIBUTED ON BEHALF OF MEDIAPLANET, WHICH TAKES SOLE RESPONSIBILITY FOR ITS CONTENTS © KZENON

Sponsored by

About the Nottingham Biomedical Research Centre The specialist hearing team is based at the NIHR Nottingham Biomedical Research Centre, established to accelerate understanding of some of the most common health conditions. Their research is part of a five-year programme, funded by the National Institute for Health Research (NIHR), translating new science into NHS treatments and therapies.

National research programme brings new hope for people with hearing loss Hearing problems can profoundly affect our personal, social and working lives. Collaboration between scientists and clinicians can help translate the latest research into new treatments and therapies for hearing loss. Three members of the Nottingham Biomedical Research Centre team explain how research is changing approaches to hearing loss.

WRITTEN BY: DR HELEN HENSHAW Senior Research Fellow, Mild to Moderate Hearing Loss, NIHR Nottingham Biomedical Research Centre

WRITTEN BY: PROFESSOR DOUGLAS HARTLEY Research Lead, Objective Measures, NIHR Nottingham Biomedical Research Centre

What’s next for the hearing aid?

Hearing aids are probably what most of us would recognise when thinking about managing hearing loss.

Digital technology is changing the functionality of hearing aids. There are now models that are controlled via mobile phone apps, aids that can monitor health markers – such as pulse rate and movement – and aids that can alert users that they may be about to fall.

Alternative, over-the-counter choices, include ‘hearables’.

These comprise personal sound amplification products and hearing aid mobile apps, which widen the options for people managing their own hearing.1 Research to understand if these could replace hearing aids is a priority for patients.2

Artificial intelligence could improve children’s hearing The cochlear implant has restored hearing to hundreds of thousands of deaf people worldwide, to the point where users can understand speech without the need to lip-read.

Implants are currently aimed at individuals with severe-to-profound hearing loss in both ears. Research is examining the case for using double implants in adults and using artificial intelligence to understand why there is such variation in children’s development after implants.

Managing hearing loss over time Hearing loss is often a lasting and progressive condition, but educational tools can help people manage their condition with ongoing support. Research indicates that these tools can improve patients’ understanding of hearing aids and increase hearing aid usage.3 With one in six of the UK population living with hearing loss, rising to one in five by 2035, future research will need to consider a comprehensive approach to managing adult hearing loss. This approach will need to combine campaigns to raise awareness and reduce stigma, routine screening to enable early detection, and integrated health and care systems to offer better support.

How cochlear implants work in adults and infants Listeners with normal hearing use two ears to hear, particularly in the presence of background noise. For this reason, deaf children are provided with implants in both ears. However, adults only receive one. New clinical trials are being designed to examine the benefits of implanting adults in both.4 The UK’s universal neonatal hearing screening programme has enhanced the early detection of hearing loss among newborn babies. Early intervention with implants has been proven to maximise their ability to develop spoken language and access mainstream education. However, despite early intervention with implants, some children do not do as well as others. Novel neuroimaging techniques and artificial intelligence can identify children who will need extra help, based on their brain responses. This data will help to provide personalised therapies that are tailored to individual needs.5

WRITTEN BY: PROFESSOR DAVID BAGULEY Research Lead, Clinical Hearing Sciences, NIHR Nottingham Biomedical Research Centre Combating the effects of cancer treatment on hearing While there is substantial research on hearing problems associated with age and noise, there has been considerably less into those associated with medications. This effect – ototoxicity - can result in hearing loss, tinnitus, or imbalance, and can have a major impact on quality of life.

The drugs involved are usually powerful, and only administered in life-saving situations. We must now identify ways in which the inner ear can be protected from the side effects of these medications. By identifying factors such as genetics, we may be able to also predict who will be vulnerable to suffering ototoxic effects.6 Commonly used medications Aminoglycoside antibiotics used to treat life-threatening infections and platinum-based chemotherapy drugs (a mainstay of treatment for many solid tumour cancers) are both under review for their effects on the inner ear. The same properties that make the latter effective in combatting cancer cells also have an impact on the inner ear. The consequence is that many people who go through chemotherapy are living with high frequency hearing loss and/or tinnitus after their cancer has been treated.7 Read more at nottinghambrc.nihr.ac.uk/hearing/

1: Maidment DW, Barker AB, Xia J, Ferguson MA. A systematic review and meta-analysis assessing the effectiveness of alternative listening devices to conventional hearing aids in adults with mild-to-moderate hearing loss. Int J Audiol. 2018;57(10):721-729. 2: Henshaw, H., Sharkey, L., Crowe, D., & Ferguson, M. (2015). Research priorities for mild-to-moderate hearing loss in adults. The Lancet, 386(10009), 2140-2141. 3: Ferguson, M., Brandreth, M., Brassington, W., Leighton, P., & Wharrad, H. (2016). A randomized controlled trial to evaluate the benefits of a multimedia educational program for first-time hearing aid users. Ear and hearing, 37(2), 123. 4: Kitterick, P.T., O’Donoghue, G., Twomey, T., Walker, D.M., Hardwick, B., Smyth, M., Jones, A., Clayton, D. (2019). FOUNDATION study: Feasibility of conducting a randomised control trial to examine the benefit of bilateral cochlear implantation compared with unilateral cochlear implantation in adults with severe to profound deafness. http://www.foundation-study.org.uk/. 5: Anderson, C. A., Wiggins, I. M., Kitterick, P. T., & Hartley, D. E. (2017). Adaptive benefit of cross-modal plasticity following cochlear implantation in deaf adults. Proceedings of the National Academy of Sciences, 114(38), 10256-10261. 6: Tserga, E., Nandwani, T., Edvall, N.K., Bulla, J., Patel, P., Canlon, B., Cederroth, C.R. and Baguley, D.M., (2019). The genetic vulnerability to cisplatin ototoxicity: a systematic review. Scientific reports, 9(1), p.3455. 7: Pearson, S. E., Taylor, J., Hoare, D. J., Patel, P., & Baguley, D. M. (2019). Exploring the Experiences of Cancer Patients with Chemotherapy-Induced Ototoxicity: Qualitative Study Using Online Health Care Forums. JMIR cancer, 5(1), e10883.

MEDIAPLANET

HEALTHAWARENESS.CO.UK

5

Don’t let hay fever ruin your summer

A PROMOTIONAL SUPPLEMENT DISTRIBUTED ON BEHALF OF MEDIAPLANET, WHICH TAKES SOLE RESPONSIBILITY FOR ITS CONTENTS

Sunny days bring dreams of sitting in the garden, enjoying the sunshine and having fun outdoors for many. But, if you have hay fever, it can be quite the opposite. Debilitating symptoms can make everyday life impractical and force big changes to your daily routine.

A

llergic rhinitis is common and affects 10–15% of children and 26% of adults in the UK. It affects quality of life, school and work attendance, and is a risk factor for development of asthma.

For some people with hay fever, symptoms can be relatively mild and managed effectively with overthe-counter medication. However, for people who suffer more severe symptoms, it can make life a misery.

Symptoms of allergic rhinitis can cause sleep deprivation, lethargy a nd i mp a i r e d c onc e nt r at ion , combined with a poor sense of smell and taste, which may make many unfit to work.

It’s not just the inconvenience of having to ensure you constantly carry tissues, but it can be embarrassing at work and social events.

For some pollen-allergic people, hay fever can restrict outdoor

sports such as running, cycling and cricket, due to chest tightness. And if it’s your job to mow the lawn, it can be a very miserable experience in the summer months.

Hay fever can be difficult to manage Katie Wood’s 12-year-old daughter, Em ma, suffers from hay fever alongside managing a number of food allergies. She says the summer is a particularly difficult time of year because it leads to her having to avoid situations regularly.

“If Emma sits on the grass, she gets hives and itchy red patches where her skin makes contact with the grass. Her eyes itch and water, her nose runs and her face gets the classic allergic rhinitis pattern of redness around the eyes and mouth.

It also brings on asthma.

“It means that, at break and

Although often mild, AR can be severe and can interfere with sleep, cause poor concentration and a deterioration in work or school performance. lunchtime, she needs to stay indoors and it’s particularly difficult when the grass is being cut at school. We now have various coping strategies that we need to think about during hay fever season. This includes making sure she’s taking the right medication, not hanging her clothes or bedsheets on the washing line and showering every day as soon as she comes home to remove pollen from her hair and skin.

This may sound silly, but that’s a bit of a faff for a young teen who wants to slump on the sofa after a long day at school. I even have to

WRITTEN BY: AMENA WARNER Head of Clinical Services, Allergy UK

limit the amount of time Emma pets the dog during the pollen season as the dog carries pollen into the house on his coat. This is in addition to making sure she’s avoiding foods she’s allergic to, so it can be hard for her at times.”

Emma’s story isn’t unusual – having to change her daily routine to manage symptoms is a part of life for many people with hay fever and it can be difficult to manage.

Practical advice It’s really important that symptoms are treated to reduce the impact on your life where possible. This can include nasal balms that act as an allergen barrier when applied around the outside of the nostrils, antihistamines and topical nasal corticosteroids.

Re se a rch a l so shows t h at a combined antihistamine and nasal

steroid spray is effective and popular with those living with hay fever due to the speed with which it reduces symptoms. However, this is a prescription-only medication.

Over-the-counter medication, such as nasal saline douching, can also be effective. Managing triggers can also help reduce the impact on everyday life. If you’re experiencing symptoms and they’re affecting you, speak to your GP. You can also visit Allergy UK at allergyuk.org for more information and advice on managing the symptoms of allergic rhinitis. There is a healthcare professional part of the website where clinicians can find important information and resources that may help in their clinical practice.

Read more at healthawareness.co.uk

Hay fever - not so benign Hay fever is already upon us – birch pollen caused problems in April, followed by plane trees in May, and grass pollens are at high levels from now to the end of July.

H

ay fever is the common name for allergic rhinitis (AR), the most common immunological disease in man.

It now affects approximately one quar ter of t he U K popu lat ion, but was a rare disease 200 years ago. The reasons for this change are unknown, but may relate to microbial exposure and possibly pollution.

AR involves a misplaced allergic reaction in which, after initial sensitisation (formation of IgE antibodies) to pollen, secondary exposures result in degranulation of mast cells in the nasal lining, with release of chemical mediators – including histamine – and symptoms of nasal itching, sneezing, rhinorrhoea and blockage in the nose. The eyes are often involved too, in what is then called rhinoconjunctivitis.

Why does it matter?

Although often mild, AR can be severe and can interfere with sleep,

cause poor concentration and a deterioration in work or school performance. GCSE performance is adversely affected. It can also progress to, or worsen, asthma. AR reduces control of existing asthma.

D u r i n g t hu nders tor m s, when pollen grains are disrupted, hay fever sufferers may develop sudden, severe, and even fatal asthma.

What can be done?

In primary care, the diagnosis can usually be made on the history of nasal symptoms recurring at the same time of year. Itching and eye involvement suggest allergy rather than a viral cold.

Initial management includes allergen avoidance, pharmacotherapy and patient education. Useful guidelines are available online. 1 Simple measures to reduce allergens in the nose include nasal douching with saline and/or barrier balm.

Antihistamines are helpful in mild AR, but must be non-sedating,

otherwise the psychomotor retardation caused by AR is worsened. Most GP patients have moderate to severe AR - so need intranasal corticosteroids (INS), which are more effective than antihistamines, though slower in onset. Corticosteroids in recent nasal sprays are minimally systemically bioavailable and can be used in children. It is important to demonstrate correct use.

Subjects who are uncontrolled on INS can be given a combination of fluticasone propionate (INS) and azelastine (anti-histamine) in a single spray. This is superior to either drug used alone and offers rapid onset of relief in 15 minutes.

A brief course of oral prednisolone (for example, 0.5mg per kg orally in the morning for five days) can be used additionally as rescue for severe symptoms. Depot injection corticosteroids are not recommended as pre-seasonal prevention because of an adverse risk/benefit profile and the timing of release is inappropriate.

WRITTEN BY: DR GLENIS K SCADDING Honorary Consultant Allergist & Rhinologist, British Society for Allergy and Clinical Immunology

Immunotherapy Unlike pharmacotherapy, immunotherapy can alter disease course: with evidence for a reduction in new asthma and new allergic sensitisations.

Sub-lingual, dissolvable tablets of grass pollen allergen are available and are effective. Initial dosing is under supervision, after which they are taken regularly at home.

Sub-cutaneous regimes vary; some require four to six pre-seasonal injections, others – which appear more effective – involve year-round immunisation, initially weekly, then monthly.

A ll forms of immunotherapy require referral, usually to an allergist or immunologist for assessment of suitability for treatment.

Patients with uncontrolled hay fever, despite concordance with pharmacotherapy, are prime candidates.

Also consider referring patients who cannot tolerate pharmacotherapy or whose futures may be impaired by their symptoms, such as teenagers

who face years of important examinations in June.

Recent advances The World Health Organization Allergic Rhinitis and its Impact on Asthma (ARIA) initiative aims to provide individualised care to rhinitis sufferers using an app (MASK-air, Android and iOS). This uses a visual analogue scale to assess symptom control and work productivity, and has a clinical decision support system.

Cessation of hay fever is unusual; many patients progress from grass pollen allergy to other sensitisations and to perennial rhinitis. Patients with hay fever have a threefold risk of developing asthma compared with those without, so hay fever can be the start of an allergic career.

Read more at healthawareness.co.uk

1: Scadding GK et al. Clinical & Experimental Allergy. Volume 47, Issue 7, July 2017, Pages: 856-889 , available at www.bsaci.org

6 HEALTHAWARENESS.CO.UK

MEDIAPLANET

A PROMOTIONAL SUPPLEMENT DISTRIBUTED ON BEHALF OF MEDIAPLANET, WHICH TAKES SOLE RESPONSIBILITY FOR ITS CONTENTS © PAVLO STAVNICHUK

Talking allergies and self-managing them

WRITTEN BY: CATRIONA WILLIAMS Director, talkhealth Partnership

Allergies affect more than one in four people in the UK. In most cases, common allergies can be treated and kept under control to help you get on with your day as normal. These include allergies such as hay fever, food and dust mites.

W

ith these t y pes of allergies, you may experience symptoms such as sneezing, a runny nose, a red rash and itchy, watery eyes.

In the first instance, it’s really important to see your GP if you suspect you or your child has an allergy, as they can help distinguish the difference between an allergy, sensitivity or intolerance and offer the right advice to help you manage

the condition.

Once you’ve established what allergy you suffer with, your doctor will recommend appropriate medication and treatment, but there are a few lifestyle changes you can make to help you manage allergies.

Tackling allergies in the home Home remedies include frequently washing your bedding, throws, toys

and any fabrics around the home to reduce dust mites or pollen. It also helps to hoover regularly and replace any carpets and rugs with hardwood flooring where possible. A relaxing, warm shower before bed will also ensure you’ve washed out any potential pollen and prevent allergy-related symptoms like irritated eyes.

Fixing any leaks and reducing moisture in damp-prone areas using

dehumidifiers can also help reduce symptoms flaring up while you’re at home. If you have any food allergies, then taking extra caution when eating out and checking food labels is an absolute must.

I also highly recommend simply t a l k i n g ab out you r c ond it ion with other people. Discuss your sy mptoms w it h col leag ues, friends and family, and you may be surprised to discover that your

allergy is more common than you thought.

Starting a conversation about your allergy also helps create awareness and educate others about your allergies. You may even learn how to manage your allergies from others in a way you hadn’t previously discovered.

Read more at healthawareness.co.uk

The importance of self-care for minor ear, nose and throat conditions WRITTEN BY: DR GRAHAM JACKSON GP and Co-Chair, NHS Clinical Commissioners

Encouraging self-care for certain minor ear, nose and throat conditions has the potential to improve care for patients, writes Dr Graham Jackson, co-chair of NHS Clinical Commissioners.

S

elf-care refers to the steps people can take to develop, protect, maintain and improve their own health and wellbeing and has a really important role to play in health promotion and illness prevention. Many common ear, nose and throat conditions are suitable for self-care, and at NHS Clinical Commissioners (NHSCC), we place great importance on encouraging medical professionals to promote the benefits of self-care to their patients and the populations they serve.

For clinical commissioners like me, the priority is getting the best possible care for patients in the context of the NHS’s finite resources.

Part of that is making the most of the resources that we do have.

Appropriate self-care can play an important role in helping commissioners get the best value for

taxpayers’ money from the NHS. NHSCC has been working with N H S Engla nd on beha l f of its members to develop new commissioning guidance1 for over-the-counter items that should not routinely be prescribed in primary care. This guidance, published in March 2018, applies to conditions that are self-limiting, which do not need treatment, such as acute sore throat, coughs and colds, or which are better suited to self-care, like hay fever or a build-up of earwax, which can often be treated with easily available over-the-counter products.

This initiative alone is already releasing a significant amount of money, which can instead be spent on higher priority areas and has the potential to release even more funds to be re-invested in other areas of the NHS.

The shift to self-care for certain conditions doesn’t mean we leave patients to go it alone, but we do need to abandon the outdated, paternalistic approach that has led to the current situation of potentially overmedicalising self-limiting conditions.”

Clinicians must support patients to self-care The shift to self-care for certain conditions doesn’t mean we leave patients to go it alone, but we do need to abandon the outdated, paternalistic approach that has led to the current situation of potentially over-medicalising self-limiting conditions.

It is important to get the balance right; when people seek help from

healthcare professionals it is appropriate to advise patients regarding self-care options to encourage that independent behaviour. It is well recognised that the NHS can be difficult to navigate, which makes it confusing for people to know where to go for advice. Simplifying access to care and directing patients to supported self-care go hand-in-hand to making the system more efficient and effective for the population it serves.

Encouraging self-care, with support, will educate and empower the population to make better decisions about their own health, which means they can, in turn, help others to help themselves. It also gives people the confidence to know when self-care isn’t enough, and that sometimes doing nothing - to wait and see - is the right course of action.

It’s also important to acknowledge

that this can be difficult for some people, which is why it’s so important to have accessible, usable and free resources – such as those available from the Self Care Forum 2 and the NHS Choices website.3 When it comes to self-care for ear, nose and throat conditions, a bathroom cabinet that’s well stocked with over-the-counter products is important, but it is much more than that. Small lifestyle factors like exercising or getting enough sleep – as well as more significant changes like giving up smoking – can help prevent these conditions in the first place and help the body to recover from illness more quickly. Health promotion and illness prevention should always be seen as best practice.

Read more at healthawareness.co.uk

1: www.nhscc.org/latest-news/new-commissioning-guidance-on-prescribing-of-over-the-counter-items/ 2: www.selfcareforum.org/resources/self-care-leaflets/ 3: www.nhs.uk/

MEDIAPLANET

HEALTHAWARENESS.CO.UK

7

© IMAGES PROVIDED BY SPECSAVERS

Losing your hearing?

Let’s lose the stigma too Hearing loss is suprisingly common. Factors such as age, lifestyle, job and hobbies as well as where you live can all play a part, which is why Specsavers encourages everyone to look after their ears.

S

ome hearing loss – such as that caused by a build-up of wax, or ear infections, can be reversible. However, age-related and noise-induced are two of the most common types of permanent hearing loss.

Noise-induced hearing loss occurs when noise damages the hairs in the ear that help you hear which, as result, don’t grow back. And age-related hearing loss is caused by natural changes that happen to the inner ear as you get older.

Over 55s should test their hearing every two years That is why, for those aged over 55, audiologists recommend you have your hearing tested every two years – even if you do not think there is anything necessarily wrong.

Gordon Harrison, Specsavers chief audiologist, says: “While hearing loss can sometimes be sudden, more often than not there is a gradual decline as we age, which many people do not notice at first.”

Signs that your hearing may be deteriorating “While it can be hard to initially recognise, there are some tell-tale signs that may indicate that your hearing has worsened. For example, having to increase the volume of your television, if you feel like those around you are mumbling or if you struggle to carry out a conversation in a noisy place, could all indicate a decrease in hearing quality.

“Having to ask people to keep repeating themselves in person or during telephone conversations as well as your friends and family making comments about your hearing could also suggest there may be a problem too,”says Harrison.

How audiologists test your hearing – what to expect As everybody’s hearing is different, a number of techniques and the latest technology allows audiologists to tailor hearing care to an individual’s needs.

MEDIAPLANET

WRITTEN BY: GORDON HARRISON Chief Audiologist, Specsavers

You do not need to let hearing loss affect your quality of life. It’s really important that we normalise hearing loss and remove the stigma associated with wearing hearing aids.”

After asking a series of questions to understand any areas of difficulty, what family members have been saying, as well as taking into consideration medical history and lifestyle, audiologists will look inside the ears to check the health of the ear drums and ear canal.

You will then undergo a hearing test where you will be asked to wear a set of headphones and press a button each time you hear a sound.

These will be a mix of different volumes and pitches. The results of the test are then plotted on an audiogram and recommendations, such as hearing aids, are made based on levels of loss.

We need to normalise hearing aids You do not need to let hearing loss affect your quality of life. It’s really important that we normalise hearing loss and remove the stigma associated with wearing hearing aids. After all, many people wear glasses to help with their eyesight, so why should our hearing be any different?

“Of course, just like contact lenses or spectacles, wearing a hearing aid can feel strange at first,” says Gordon.

“There will need to be a period of adjustment. However, give yourself some time to get used to it and this will change. Your audiologist will be happy to assist in the unlikely event you experience any problems or pain.

Hearing aids are discrete these days “Hearing aids are the most discreet they have ever been. Technology is becoming so advanced that many now enable you to control their settings from your mobile phone.

Because of this, the stigma around wearing hearing aids has reduced significantly in recent years. It is definitely not something to be embarrassed about and you might find many of your friends and family don’t even notice you’re wearing a hearing aid at first.”

Sponsored by

For more information or to book a free hearing check specsavers.co.uk/hearing HEALTHAWARENESS.CO.UK

8