JINGUMAE Ear, Nose and Throat CLINIC

   Laser Therapy Consultation

Christmas Tree　 (25.Dec. 2001　at Yoyogi Athletic Stadium）　　　©Y.KOSEKI

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INTRODUCTION

        The human body can over-react to certain antigens; we call this an Allergy. The common one is the so-called  "Ceder Pollinosis" which symptoms are: Rhinitis: sneezing, running nose, stuffy nose Conjunctivitis: Itchy eyes, watery eyes. Ｔhere are numerous causes for allergic symptoms; not only Japanese ceder but also pollen from other plants, ticks, house dust and mold. The list is quite varied and one can, if unlucky,  have allergies throughout the whole year. Even walking from one air-conditioned room to another without one can cause similar symptoms as a result of abrupt air temperature changes. When treating for allergies, the paramount important task is to determine the exact cause of the patient’s allergy; what causes it and to what degree he or she is prone to. Once we know our enemies, we can then start planning our fight against them to avoid the cause.

ABOUT THE TEST/S

     Say, you are suffering from the Cedar Pollen allergy, but your symptoms still continue past May, then chances are you are allergic to the orchard grass pollen. If you start your allergy season in the fall, you may have the rugweed allergy. As mentioned above, it is vital that you know what allergy you have and how seriously your body reacts to them. Getting to know your body is also helpful from the doctor's standpoint, too. For example, say your blood test revealed that you are allergic to cedar, and we know that your allergy level is not that high. If then we find that despite the low density of the cedar pollen one day and yet you are suffering, we can determine that perhaps the medication you are taking is not working. 

     There are 2 basic methods for testing your allergies. The first is either injecting a small portion, or scratching on your skin various known substances (called antigens) that are known to be allergy creating. With this test, your skin will start reacting in about 15 minutes; that is when the doctor examines the skin. The second method is the blood test. There are pros and cons with these 2 types of tests. The scratch test is simple and we can test various substances in a relatively short period of time; and it costs less. The problem is for people who are super sensitive as they react to just about anything applied to their skin, thus, making the diagnosis difficult. Also, with this examination, some people may feel uncomfortable with a very itchy skin. The blood test can determine specific allergy causing targets and can even indicate the patient's reaction levels. The drawbacks are that it takes a few days for the analysis to be completed and the cost is higher. For those with insurance and wanting to test the 7 major allergy-causing candidates, the cost is \4,260.

TREATMENT

     If we are to mention all the treatments known today, I will have to write a book. But, here are the main ones:

      Avoiding the Cause:

     If a person is only allergic to cedar pollen, the symptoms will only appear in the spring season. Other times pollen do not fly. If he or she is allergic to ticks and house dust, frequent dusting of the tatami mat, or carpet, rug, bed, and stuffed animal toys would be recommended. While is is impossible to completely rid of these causes for allergies, we can certianly try our best to avoid them; less causes, less symptoms.

     Medicine:

     Anti-allergy and antihistaminic agents, shots, and nose drops are commonly used to fight allergies. There are numerous medicines available, but while some may work fine for someone, it may only cause side effects for others.

     Since Dr. Koseki himself suffers from Allergic Rhinitis, he prides in testing every medication. You can rest assured that all medications that are prescribed at this Clinic have been thoroughly tested by the Doctor himself. Should you find him sneezing in the Clinic, you can guess that he is trying out something new. 

     Anti-Allergy shots are effective in decreasing the symptoms, but we often hear about allergy vaccination shots, the kind that only requires one single shot to control allergies throughout the whole single season. The problem with this shot is that it uses a powerful hormone drug, which may cause bad side effects such as menstrual irregularities and skin deformation. For these reasons the Oto-Rhino-Laryngological Society of Japan does not recommend use of this particular vaccination; this Clinic agrees and does not offer to our patients.

     Hypo-sensitization Therapy

     The allergy antigen (causing matter) is gradually injected into the body, a minute portion at first and gradually increased to create the body immunization. Patients who are allergic all year round (like with ticks) and/or with asthma require this treatment. People with a common cedar pollen allergy may also try this method, but the process takes a long time and not effective unless the treatment is continued on a long term basis. 

     Operation:

     Removing parts of the mucous membrane by operation, or applying laser are done to reduce allergy symptoms. Because we receive a lot of inquiries regarding laser treatment, the subject will be explained in detail later on (see below). 

     We need to be very cautious in deciding the effectiveness of any application. The exposure level of antigens can be vital. For example, a person who has to work outdoors during the day may have more problems, simply because he or she will have a bigger chance of being exposed to allergy causing bodies. Even a seemingly successful treatment may have been conducted in a season that had an unusually low pollen count. Or, the evaluation of the treatment was done after the peak season for allergies. All these may contribute to inaccurate diagnosis of any given treatments. To reiterate, the key is knowing to what we are allergic to, and how we are in contact with these allergy causing materials. Also, to determine our current body condition for an accurate diagnosis and treatment planning.

Total Eclipse of the Moon　(July 2000 at Mt.Fuji）　　　©Y.KOSEKI

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ABOUT LASER TREATMENT

     Laser is used either to decrease the area of the mucous membrane attacked by antigens (the allergy causing materials), or to dull the sensitivity of the membrane. In case of pollen allergies, the ideal timing is before the season begins. Laser is ideal for those who are constantly suffering from allergies, who cannot work properly because of serious symptoms, or those who wish to reduce the intake of medicine. Because laser treatment is not commonly associated with any side effects, yet very effective, this method is quickly becoming well received by many people today. Our Clinic uses the CO₂ laser because there is no pain nor bleeding. The laser is very effective for patients with stuffy nose, or those with a snoring problem.  

Before Laser: Mucous membrane is swollen   After 1 month of Laser: Space is created
      and cannot breathe through the nose.         in the nose and one can breathe normally.

     When Laser is fired the mucous membrane may temporarily react and create an inflammation causing sneezing and watery nose for a few days. These symptoms normally cease after about a week. Possible side effects include, pain during the treatment, bleeding after, contraction of the membrane, watery eyes due to obstruction of the nasolacrimal duct (the blockage of the duct that connects the nose and the eye). Fortunately, none of these symptoms have been experienced by any patients at our Clinic to date, but over doing the laser can cause complications. Regular clinic visits after the laser operation is vital, too, to prevent sticking of the membranes causing a stuffy nose. We sometimes are asked if laser firing can cause any decline in the sense of smell. The membrane area we treat is quite different from the area governing the sense of smell, and therefore, one need not worry about any side effects. Once successfully operated by laser, one can expect anywhere between 1 to 3 years without any complications depending on the individual and the procedures taken at the clinic. Unlike in the old days when insurance did not cover laser treatments costing tens of thousands of Yen, a typical fee is \7,710 for a 30% copay patient. At our Clinic we take care of both sides at one firing, followed by subsequent firings as required. Several Clinic visits are required after the operation. For the convenience of those who live far away, we can refer to clinics closer to their homes after the laser treatment is successfully completed at our Clinic. After the initial consultation, reservations are required for your laser treatments. Laser treatments are routinely conducted at our Clinic during normal business hours. Please ask us for appointment procedures.

* Laser treatment is designed to decrease the discomfort affecting the patient's nose, and not to permanently remove the trouble. The effect is varied depending on the individual.  On a heavy pollen day, some may feel some slight symptoms even after the laser treatment. For discomfort with the eyes, an eye drop may be necessary. The symptoms may reoccur sooner for those who suffer from allergies caused by ticks and house dust. Because we have not established any definite conclusions (not enough data in some cases) as to the safety of these treatments, our Clinic does not offer more than four consecutive laser treatments on the same patient.

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Case History of Laser at our Clinic

     Throughout the period of 2 years and 7 months since the opening of the Clinic in October, 2000, 693 Laser treatments had been conducted on 571 cases. The level of cases were 51% serious, 35% mediocre, 6% minor, 8% with Vasomotor Rhinitis and others. Cases referred from other institutions and not capable of being monitored for post-applications were intentionally left out. 59% of patients being treated reported the symptoms almost gone, 38% were satisfied although suffered minor symptoms on high pollen count days, only 3% said there was no significant improvement. 29% said the improved condition continued onto the second year, 61% said they were satisfied with the result although they had to cope with minor irritations on high pollen-count days, and 10% said they did not find any considerable results. Going into the third year (after the laser application) 6 patients said they were able to find controlled results, and 9 patients said they could relax except on days the pollen count was high. Among patients who reported no significant results, one was suffering from a complication of severe Deflected Nasal Septum, one with severe case of hyper-sensitive nasal membrane, and one due to a high level of exposure to pollen working outdoors. 9% of patients experienced a slight tingling pain when applied with laser (no ill effect to the laser application itself), 91% had no pain whatsoever. No one experienced any bleeding after the application, one case of increased nasal discharge (the patient did not return for further treatment, hence, have no further information). No one complained of any side effects. 

       We would like to update you on further findings as we compile more data.

Round Tower　(Copenhagen）　　　©Y.KOSEKI

SUMMARY  (and additional comments)

1. For the most effective treatment, both the patient and doctor have to work together to  properly screen out the cause of the allergy by means of a blood test.

2. The seriousness of the allergy is determined by the balance between the level of the  patient's allergy reaction and the amount he/she is exposed to the allergy triggering substances, or antigens.

3. Laser treatment needs to be completed before the start of the pollen season. (This Clinic starts taking appointments in December.)

4. From the medical as well as from safety standpoint, we do not recommend receiving laser treatment every year. We need to think about sustaining the functions of the nose. For this reason, this Clinic recommends a total of 3 treatments during the period of 2 to 3 years.

5. The first choice is to take medicine internally. Except for Hypo-Sensitization Therapy, we do not recommend applying shots as they cannot challenge the effective internal medicine available today. 

6. There is no need to worry about medicine to be less effective with continued use. If your medicine once working fine seems to be less effective today, chances are you are taking the wrong medication or that you are exposed to more pollen or other substances (called antigens) causing your allergy symptoms.

7. Proper selection of the medicine, nasal spray and eye drops is vital to producing the right effects. Medications are not all the same and we need to determine those that work best for you.

8. If the cause of the patient’s allergy is identified and symptoms are under control, the Clinic can prescribe medication up to a whole month supply. This is due to the revision of the law last year, but excludes those medications that have been on the market for less than 12 months.

9. Regardless of the treatment being given, patients need to be prepared to experience some symptoms during the peak of the allergy season with high pollen count.

10. Unfortunately, there is no such thing as a complete cure for the allergy from exposure to high pollen count. Some relief often is the result of less exposure to pollen in one given season.

11. The Japanese government must seriously work on two major causes of our allergy syndrome today, i.e. 1. the national forestry policy of planting only cedar trees and neglecting control, and 2. the emission control issue especially from diesel engines. 

Street Sale on Omotesando St.　　　© Y.KOSEKI　

JINGUMAE Ear, Nose and Throat CLINIC

6-1-5　Jingumae, Shibuya, Tokyo, JAPAN