Nose
Conditions Treated
Mr Ali Qureishi is a highly specialist nose and sinus surgeon treating the
whole range of common and rare nasal diseases.
This includes common and rare causes of blocked nose, smell disorders,
nasal polyps and chronic infections.
More information about the conditions treated can be seen by following the links below.
Deviated nasal septum
What is a deviated nasal septum?
The septum is the wall of cartilage and bone separating the two sides of the nose. If it bends or sits off-centre, it can narrow the airway. This may develop as the nose grows or follow an injury. Many people have some deviation without troublesome symptoms.
What are the symptoms?
You may notice blockage on one or both sides, mouth breathing or difficulty breathing comfortably through the nose during sleep or exercise. The nose can look straight externally despite a bent septum. Allergy, enlarged turbinates or narrowing at the nostril entrance may also contribute.
How is it assessed?
Assessment includes your symptoms and an examination inside and outside the nose. A small camera may help check the deeper nasal passages. A CT scan is not routinely needed for an isolated septal deviation, but may be useful if sinus disease or another problem is suspected.
What treatment is available?
Saline and prescribed nasal sprays can reduce associated swelling but cannot straighten cartilage or bone. Septoplasty may help persistent obstruction caused by the septum. It usually involves surgery inside the nose. Septorhinoplasty may be needed if the outer framework also contributes. Improvement is not guaranteed; risks include bleeding, infection, persistent blockage, a hole in the septum and changes in nasal shape.
When should I seek further help?
Arrange review for persistent blockage affecting daily life. New one-sided obstruction with bleeding needs prompt assessment. Sudden painful blockage after injury needs same-day assessment to exclude a septal haematoma, a collection of blood that may need urgent drainage.
What are nasal polyps?
Nasal polyps are soft, non-cancerous swellings of the lining of the nose and sinuses. They are linked to long-term inflammation and usually affect both sides. They are more common in people with asthma, and some people also react to aspirin or related anti-inflammatory medicines.
What are the symptoms?
Polyps can cause persistent nasal blockage, a runny nose, mucus in the throat and reduced or absent smell. Food may seem less flavoursome. Symptoms often resemble a cold that does not settle. Polyps themselves are usually painless.
How are they assessed?
An ENT examination, often using a small nasal camera, helps establish the diagnosis. A CT scan may show how much the sinuses are affected and help plan surgery. A growth on only one side requires further assessment rather than being assumed to be an ordinary inflammatory polyp.
What treatment is available?
Regular steroid nasal sprays or drops and saline rinses are commonly used. Selected patients may need a short course of steroid tablets after discussion of their risks. If symptoms remain troublesome, endoscopic sinus surgery can remove polyps and improve access for nasal treatments. Polyps can return, so ongoing medication and follow-up are often needed. For selected adults with severe disease, targeted biological injections may be an option following specialist assessment and eligibility checks.
When should I seek further help?
Seek prompt review for one-sided obstruction, recurrent bleeding, facial numbness or worsening symptoms. Swelling around an eye, double vision or reduced vision needs emergency assessment. Tell your clinician about asthma and any previous reactions to aspirin or ibuprofen.
Nasal Polyps
Enlarged Turbinates
What are turbinates?
Turbinates are normal structures along the side walls inside the nose. They contain bone covered by a soft tissue lining and help warm, moisten and filter the air. The inferior turbinates can become persistently swollen, reducing the space available for breathing.
What are the symptoms?
Nasal blockage may affect both sides or alternate from side to side, and can be worse when lying down. Sneezing, itching or a runny nose may accompany allergy. Some variation between nostrils is part of the normal nasal cycle; persistent troublesome obstruction warrants assessment.
How are they assessed?
Assessment includes an examination of the nasal passages, sometimes with a small camera. The clinician checks for allergy, other inflammation and structural narrowing. Allergy testing may help when the history suggests a specific trigger. Turbinate swelling and a deviated septum can occur together.
What treatment is available?
Treatment may include avoiding triggers, saline rinses, steroid nasal sprays and antihistamines where appropriate. Decongestant sprays should only be used for the short period advised, usually no more than a week, because prolonged use can worsen congestion. Persistent symptoms may benefit from turbinate reduction, using techniques that aim to preserve the lining. Risks include bleeding, crusting, dryness, scarring and persistent obstruction. Excessive tissue removal can rarely cause empty nose syndrome, with dryness and an abnormal sensation of blockage.
When should I seek further help?
Arrange review if blockage persists despite treatment or affects sleep and daily activities. Progressive one-sided blockage or recurrent bleeding needs prompt assessment. Severe pain, facial swelling or eye symptoms should not be attributed to simple turbinate enlargement.
What is chronic sinusitis?
Chronic rhinosinusitis is inflammation of the nose and sinus lining lasting at least 12 weeks. It can occur with or without nasal polyps. It is a long-term inflammatory condition, and does not necessarily mean that there is an ongoing bacterial infection.
What are the symptoms?
Typical symptoms include a blocked nose, nasal discharge or mucus in the throat, reduced smell and sometimes facial pressure. Tiredness and disturbed sleep can occur. Facial pain alone is unlikely to represent chronic sinusitis and should prompt consideration of other causes.
How is it assessed?
Diagnosis combines the symptom pattern with evidence of inflammation on nasal endoscopy or a CT scan. At least two characteristic symptoms are usually present, including blockage or discharge. A CT scan is particularly useful when symptoms persist or surgery is being considered. Dental causes may need checking, especially with one-sided symptoms.
What treatment is available?
Regular saline irrigation and steroid nasal treatment are commonly recommended. Use cooled boiled water for preparing rinses and follow the device instructions. Antibiotics are reserved for selected situations. If appropriate medical treatment does not provide enough relief, endoscopic sinus surgery may improve drainage and delivery of medication. Ongoing treatment is often needed afterwards. Surgical risks include bleeding, infection and scarring, with rare serious complications involving the eye or leakage of fluid surrounding the brain.
When should I seek urgent help?
Go to A&E for swelling around an eye, double vision, reduced vision, a severe new frontal headache, neck stiffness, confusion or marked deterioration. These can indicate a complication of sinus infection and should not wait for a routine appointment.
Chronic Sinusitis
Facial Pain
What causes facial pain?
Pain around the cheeks, eyes or forehead is often described as sinus pain, but there are several possible causes. These include migraine, tension-type facial pain, dental disease, jaw joint problems and nerve pain. Sinus inflammation is more likely when pain occurs with nasal blockage, discharge or reduced smell.
What symptoms help identify the cause?
Migraine can cause facial pressure with nausea or sensitivity to light and sound, and sometimes a blocked or runny nose. Brief electric-shock-like pain may suggest trigeminal neuralgia. Pain with chewing, jaw clicking or tooth sensitivity may suggest a jaw or dental problem. These are clues rather than a diagnosis.
How is it assessed?
Assessment considers the location, timing and triggers of pain alongside nasal, dental and neurological symptoms. Examination may include the nose, mouth, teeth, jaw and nerves of the face. Nasal endoscopy or a CT scan is used when sinus disease is suspected; scans are not necessary for every person with facial pain.
What treatment is available?
Treatment addresses the cause and may involve migraine therapy, dental treatment, jaw care or medicines for nerve pain. A headache diary can help identify patterns. Sinus treatment is appropriate when sinus disease is confirmed; surgery is unlikely to help pain arising from a different cause. Some patients benefit from neurology or specialist pain assessment.
When should I seek urgent help?
Seek emergency help for sudden severe headache, new weakness, confusion or visual loss. A new headache with scalp tenderness or jaw pain when chewing, particularly after age 50, needs same-day assessment. Persistent one-sided facial pain with numbness, swelling or nasal bleeding needs prompt review.
What is loss of smell?
Complete loss of smell is called anosmia; a reduced sense of smell is hyposmia. Smells may also become distorted, called parosmia, or be perceived when no source is present, called phantosmia. Smell contributes greatly to food flavour, so a smell disorder may feel like loss of taste.
What can cause it?
Common causes include viral infections, including COVID-19, nasal polyps, sinus inflammation and allergy. Head injury, ageing and some medicines can also contribute. Occasionally no clear cause is found. Persistent unexplained changes deserve assessment, but most are not due to a serious condition.
How is it assessed?
Assessment includes when symptoms began, any preceding infection or injury, medication review and a nasal examination. Nasal endoscopy and formal smell testing may help. CT or MRI scans are arranged selectively, depending on the findings, rather than routinely for everyone.
What treatment is available?
Treating nasal inflammation or polyps may improve smell. Smell training can help some people, particularly after viral illness: this involves regularly smelling several familiar scents, usually twice daily over several months. Recovery varies and may be incomplete. Do not put essential oils inside your nose. Tell your clinician if altered smell affects your appetite, weight or mood.
When should I seek help, and how can I stay safe?
Arrange review if smell has not returned after a few weeks, or if symptoms are unexplained or worsening. Smell loss after a head injury needs prompt assessment; new neurological symptoms require emergency help. Maintain working smoke alarms, consider a suitable gas detector and follow food storage and use-by instructions instead of relying on smell.
