E.N.T. Care and Cure

Shifted blog to http://entcare.wordpress.com/

2010-04-28T21:16:00.000+05:30

Ballon sinuplasty

2009-02-15T12:00:00.002+05:30

Sinusitis is inflammation of sinuses. Mucus collects and blocks the sinus openings.

Symptoms are headache, facial pain,nasal discharge, nasal blockage and post nasal drip.

Aim of treatment is to open up blocked sinus passageways.

Balloon sinuplasty is true advance in the field of sinus care. It works on same concept as balloon angioplasty for the treatment of clogged coronary arteries.

A wire catheter (approved by FDA) is introduced through the nostril and moved towards blocked passageways. Catheter has a balloon in the front.Then balloon gradually inflated to open up blocked passageways, then it is deflated and removed. Sinus drainage is restored.

Balloon sinuplasty alone may eliminate the need for surgery in some patients and others may require concurrent endoscopic sinus surgery.

Balloon sinuplasty is safe, effective , minimally invasive, cost effective, takes less recovery time, has less patient discomfort, and has no side effects.

Studies confirm it's safety and efficacy and high patient satisfaction. But still it is under evaluation for long term success and further studies are needed to see it's effectiveness in presence of nasal polyp or when ethmoid sinus is involved.

How to clean ear-wax?

2009-01-21T11:07:00.002+05:30

Most frequently asked question by people visiting ENT clinic is how to clean the ear and if I tell them it is not required, they will look at me puzzled and ask “then how to clean the wax?” Wax is normal secretion by glands of skin of ear canal just as sweat produced by glands of skin. Wax is normal protective layer for the sensitive skin of ear canal. This coating helps repel water& traps dust particles & when you clean it out you make your ear more vulnerable to infection. Chronic cleaning of ear causes dryness leading to itching, scratching and if you are cleaning it daily you know vicious circle. Continues itching may cause damage of skin and in turn bacterial & fungal infections. Sometimes accidentally if you dig down too deep you may hurt your ear-drum (I have seen patients having ear bleed when they were doing cleaning jobs religiously & there kids just jumped over them). You will be amazed to see the concentration focused on ear cleaning. Usually small amount of wax is secreted which comes out by its own, a process helped by jaw movement. Excess, hard wax causing obstruction is to be removed (20% of population have tendency to accumulate wax because of anatomical reasons) but if you try this by yourself you tend to push it further inside causing impacted wax and related problems like blocked ear, ear-pain, swelling in the ear and list doesn’t end here. Even most educated patients are very ignorant about ear and use anything they have in their hands to insert in the ear. Anything means anything they find which can go inside the ear- hair-pins, pen, pencil, paper, keys, and recently I removed a bulb of decoration-lights for “diwali” accidently trapped inside the ear while trying to clean it. But really nothing is safe not even so called sterile ear-buds available at chemist shop. Now, I hope you got the point, I usually tell my overenthusiastic patients “ear cleaning is useless job, you don’t need it if you don’t have the excess wax & you won’t be able to remove it if you have excess wax.” And yes it becomes a habit. People will often deny this fact, very difficult at times to convince them.

General Ear-Care

2009-01-13T11:34:00.008+05:30

General care:

Outer ear can be wiped with a wash cloth or soft towel.
If water goes in after head shower or swimming mere dabbing with towel with head turned to side, cleans water.
You can use ready made preparation of alcohol based to dry the ear if you are sure that you don't have ear infection.
Do not put anything in the ear, remember it is not only for pins; it is for ear buds and q-tips as well, believed to be safe and made for ear-cleaning( even most intellectual people think so).
Ear is not a cooking-range, does not require oil, garlic and so on.

Ear-wax:

Ear wax is not a disease, rather a protective secretion which comes out by it's own where it can be wiped out.
Excess wax causing obstruction is to be removed by your clinician.

Air-travelling:

During ascent and descent while air-travelling, swallow frequently to keep Eustachian tube open, infant can be put to bottle feeding.
Avoid air-travel during cold/sinusitis, but if not avoidable use nasal/oral decongestant before ascent and decent.

Cold/sinusitis/Eustachian tube and ear:

Do not blow nose forcefully during cold, it forces secretion towards middle ear via Eustachian-tube.
Take care of upper respiratory tract infection/sinusitis to reduce risk of ear infection.
During infant feeding , keep his head high to avoid milk/fluid entering middle ear via Eustachian tube as infants have short and horizontal tube.

Noise and ear:

Turn down volume of MP3 player/television.
While working in noisy area, rock concerts wear ear protection devices.

Visit your doctor:

If you have excess itching, pain,blocked ear, ringing in the ear, drainage from ear, dizziness, uncontrolled URI/sinusitis, visit a doctor.

Home care for sinusitis

2009-01-07T13:06:00.005+05:30

Infection of sinuses is called sinusitis. Sinusitis may be caused by anything that interfere with airflow into the sinuses and mucus drainage out of the sinuses, usually follow a viral infection, allergy, or irritants. Thus any treatment is aimed at thinning of secretions for easy drainage or reducing inflammation to open up blocked sinus passageways.

Home remedies effecvely reduce symptoms of sinusitis and reduce visits to doctors clinic.

Home care for sinusitis-

Proper rest

Balanced diet rich in vitamin and minerals to boost body's defence mechanism.

Vitamin C, A and zinc.

Sleep with head elevated.

Maintain adequate hydration as it dilutes mucus.

Drink hot drinks like hot soups, and tea.

Steam inhalation- Plain water or medicated steam with menthol has soothing effect and helps in improving sinus drainage. hot shower also helps.

Hot fomentation-application of warm cloth, hot water bottle or gel pack to face for 5-10 minutes relieves pain and inflammation to some extent.

Saline irrigation- nose and sinuses should be washed by 1/4 tsf salt in 1 cup water using bulb syringe, alternatively commercially availabe saline nasal sprays can be used.

Avodance of allergen if any.

Avoidance of irriants/smoking/strong perfumes

Use of humidifier.

If symptoms persist visit your physician or otolaryngologist.

Nasal douching or "jala-neti" for sinusitis

2009-01-02T11:00:00.006+05:30

Originally a yogic tradition nasal Wash, nasal douching, nasal irrigation or "jala neti" is very effective and safe in sinusitis-allergic or infective, post-nasal drip, and post-sinus surgery to clean nasal passages and easy breathing. As an E.N.T. specialist I have witnessed improved quality of life and reduced visits of patients to my clinic. Alternatively saline nasal sprays can also be used to clean the nose and sinuses. Randomized controlled trials ( General of family practice by Dr Rabago) shows that it improves smptoms of sinusitis and quality of life, with decreasing use of medications.

**Hyper tonic saline used in nasal irrigation improves drainage of secretion by:-
Improving mucocilliary clearance ( Sinuses are lined by respiratory epithelium with Goblet cells to secrete mucus (forming mucus blanket) and cilia (fine hair like structure) to help trap and propel pollutant and bacteria outward to nose through osteum (opening) of sinuses.
Helps in thinning of mucus.
Possibly reduce inflammation.

**Procedure for "jala-neti"**

You will find so many articles written on procedure and some very cumbersome but believe me it is very simple, there is no need of sophisticated equipments- "It is saline that works not equipment".

Take slightly warm water in a bowl or "jala-neti pot".
Add 1/2 teaspoonful of salt and a pinch of sodium-bicarbonate and mix well.
Lean over sink and keep head bowed slightly.
Pour some into the palm of your hand and sniff into your nose, alternatively you can use "chip syringe or bulb syringe" or "simple 10 cc syringe" to gently push solution into your nose.
Let your nose drain by it's own first, you can very gently blow one nostril at a time keeping other nostril closed. Do not blow forcefully.
Repeat procedure at least 3 times on each side.

It is amazing to see the smiling patients with easy breathing. Saline irrigation should be included in daily hygiene of people with sinusitis or post nasal drip with brushing of teeth.

Noise induced hearing loss

2009-01-01T13:55:00.004+05:30

Noise level goes up with new year celebrations, social gatherings, party, music and fire works, and so does people visiting E.N.T. and audiology clinics with hearing problems or ringing in the ear(tinnitus).
Children and teens listening to loud music are also more prone to develop hearing loss later in life.
People with occupations involving exposure to noise above 85 decibel are also at risk.

Too loud noise damages sensitive nerve endings in inner ear and cause sensorineural loss. Sudden exposure to loud noise may cause temporary sensorineural hearing loss which usually recovers over 24 to 48 hours. But if sound is too loud, or loud sound is too close or loud sound is exposed over a long period of time(more than 85 db), permanent sensorineural hearing loss can occur. and 85 decibels is not as loud as you will think. Sound from an ipod shuffle is usually 115 db and with firework it goes at 150 db.

Protection from noise- Unfortunately physician can not do much in sensorineural haring loss except prescribing a hearing aid. So primary aim is prevention and early detection.

Person working in noise above 85 db should use noise protection devices-ear plugs and ear muffs. It is as simple a concept as using goggles to protect your eyes from UV rays of sun.
people with occupations involving noise exposure should undergo periodic hearing screening (audiometry test).
On earliest sign of noise trauma like irritability, buzzing sound in ear or difficulty in hearing visit your physician.
Turn down the volume of television and MP3 players.

Sinus, Sinusitis and Management of Acute sinusitis

2008-12-22T20:40:00.015+05:30

Management of sinusitis has witnessed fundamental chagne in the last two decades. Nasal endoscopy and CT scan has revolutionized visualization of nose and sinuses.

Basic understanding--(What is sinus?) Human skull contains four pairs of hollow air filled caivities connected to the space between npstril and nasal passages; these are called sinuses(or para nasal sinuses). Sinuses help insulate the skull, reduces its weight and add resonance to voice.

There is 4 major pair of sinuses-frontal (in the forhead), maxillary (behind the cheek bones), Ethmoid (between the eyes) and sphenoid (behind the eyes).

Sinuse are lined by respiratory epethelium with Goblet cells to secrete mucus and fine cilia to help trap and propel pollutant and bacteria outward to nose through opening of sinuses (sinus-osteum). Most of he sinuses drain into a key area (osteomeatal complex). Thus treatment of sinusitis is focused on this area.

Acute sinusitis-

Infection of sinuses is called sinusitis - acute or chronic based on time span. Sinusitis may be caused by anything that interfere with airflow into the sinuses and mucus drainage out of the sinuses, usualyy follow a viral infection, allergy, or irritants.

Signs and symptoms of sinusitis depend on which sinus is involved-usually present with nasal congestion and discharge or post nsal drip, headache, facial pain or pain under or around the eyes, fever.

Treatment of acute sinusitis:-

Aims of management are--

1. To achieve normal healthy sinuses

2. To decrease duration of symptoms

3. To prevent complications

4. To prevent development of chronic sinusitis.

Most patients of acute sinusitis can be benefitted wihout many investigations as diagnosis is mainly clinical. Proper visualization of noe and sinues by Nasal endoscopy is important for appropriate management. Endoscopic assessment of nose guides the surgery and at the same time accurate pus-swab can be obtained for bacteriological examination.

Sometimes if symptoms persist for longer duration further investigations may be required like Ct scan of sinuses, examination of mucocilliary mechanism, allergic and immune status of patient.

Medical management-

Antibiotics, analgesics, decongestant, mucolytics and/or steroids may be given to reduce swelling and thus increase clearance and drainage from the sinuses.

Antibiotics- studies confirm that sinusitis treated with antibioticshave more rapid resolution of symptoms. A effective antibiotic for a period of 10 days is usually required but in some cases especially recurrent cases up to 2 weeks course may be given.

Nasal decongestant drops- nasal decongestant drops are used to decongest sinus-osteum and thus encourage drainage. Nasal drops should not be used for for longer duration because it backfires as it has rebound effect.

Oral decongestants or mucolytics-May be used to decongest mucosa or to help thinning of secretion for easy drainage.

Analgesics-Any suitable and safe pain killer medicine may be taken.

Home care-

Steam inhalation- Plain water or medicated steam with menthol has soothing effect and helps in improving sinus drainage.

Hot fomentation-application of warm cloth, hot water bottle or gel pack to face for 5-10 minutes relieves pain and inflammation to some extent.

Saline irrigation- nose and sinuses should be washed by 1/4 tsf salt in 1 cup water using bulb syringe, alternatively commercially availabe saline nasal sprays can be used.

Adequate hydration.

Hot fluid like soups helps.

Avodance of allergen if any.

Avoidance of irriants/smoking

Use of humidifier.

Surgical management-

Usually acute sinusitis is treated by medicines. Most cases resolve with proper and effective management.

Surgical treatment is reserved for-Failure of medical management, Severe pain, or Impending complications.

Surgical management aim at cleaning the sinuses by antral lavage, endoscopic cleaning or frontal sinus wash out.

Functional endoscopic sinus surgery--

Recurent acute bacterial sinusitis or sinusitis of long duration unresponsive to medicine is major indication for endoscopic sinus surgery. Endoscopic surgery is minimal invasive surgery done by endoscope inserted through nose, it does not require skin incision.CT scanning is must before surgery.One thing is to be remembered -meticulous post oprative cleanig is equally important for success as is the expertise of operating surgeon.

Treatment plan for acute sinusitis may vary according to experience of treating physician but it is crucial to undersatnd the importance of "osteomeatal region".Effective medical mangement require good docto-patient understanding. Medical prefessional should take time for patient to educate them on importance of taking antibiotics regularly and in proper doses as advised. Often it is irregular time interval and missed doses which creates resistant bacteria and failure of medical treatment.

From my article at helium.com- http://www.helium.com/items/1269826-treatment-of-acute-sinusitis

Hearing loss in adults, Management and Hearing-aids

2008-12-11T11:39:00.008+05:30

Hearing loss in adult should be evaluated and managed properly taking care of emotional and social impact of condition on patient & his family. Bilateral hearing loss may affect professional life of a person. Aim is to know the treatable cause and manage effectively to prevent further loss. Sensori-neural loss which can not be cured by medicines should be started with rehabilitation by hearing-aids.

Symptoms of hearing loss:

Sound may be distorted, quieter and less clear
Patients usually have difficulty in hearing in noisy area or while in a group
Problem in hearing over telephone
Turn up volume of television/Mp3 player
Ask people frequently to repeat the sentence/words
Patients often misunderstand what others are saying
Patients think others are not speaking well

Evaluation of patient:

Thorough medical history(ear infection, giddiness, tinnitus, past medical illness or medication, trauma, exposure to noise-occupational or otherwise if any).

Clinical examination of Ear-Nose and Throat and patient.

Investigation-Audiometry tests to know degree and type of hearing impairment. Depending on clinical clues CT/MRI may be required.

Most common cause of hearing-impairment in adult is wax and after exclusion of wax tympanic membrane perforation is most common cause.

Management of Hearing loss

Management depends on type and cause of hearing loss; loss is of two types conductive and sensori-neural. Sometimes it may be mixed loss.

Conductive hearing loss:

When something hampering conduction of sound from your ear-canal, ear-drum and ear ossicles to reach inner ear or nerves of hearing.

Can be corrected by medicine and/or surgery, like-

Wax or foreign body-removal
Eustachian tube blockage or fluid in the middle ear -medicines or by procedure of putting small tube (grommet) in ear drum
Infection(otitis media)-Medicines
Perforation in ear drum-Surgery(Tympanoplasty)
Otosclerosis-stapedectomy& piston placement
Any cause in nose/throat is managed by medicine/surgery.

Sensorineural hearing loss:

When problem is in inner ear or nerves of hearing (same as one has weak eye-sight).

Causes-

Age -hearing loss after age of 65
noise-trauma
Menieres disease
Post viral infections like mumps, measles, influenza, herpes
Ototoxic drugs like aminoglycoside antibiotics (neomycin, streptomycin, amikacin, gentamicin, netilmycin), Salycylates, certain diuretics, antimalarial ( quinine & chloroquine), erythromycin and cisplatinum.
Hereditary
Immune mediated
Endocrine& metabolic disorders
Vascular or neurogenic
tumor

Management of sensorineural hearing loss

Mostly chronic sensori-neural loss can not be cured and person is prescribed to wear hearing-aids. In bilateral severe to profound hearing loss cochlear implant (electronic device, a part is implanted under skin by surgery) may be successful.

Some treatable causes:

If it is sudden loss, spontaneous recovery may be expected assisted by steroids. Underlying etiology present in 10-15 % should be identified & treated.

Immune mediated -steroids

Tumor-surgery

Ototoxicity-Medicine stopped.

Hearing-Aids--

Though hearing aids are not as good as normal ear but if properly met with fitting requirements it can compensate well for hearing loss.

Hearing aids should be fitted and customized to individual after thorough hearing evaluation by by E.N.T. specialist and audiologist.

Most patients are benefited but there is limitation of sound quality and back ground noise that means it works well in quiet environment but some users have trouble enjoying music and listening in a crowded room.Improving FM (frequency modulation) boosts the performance of hearing aid and hearing aids can be optimally set for music.

Quality of hearing aid is of utmost importance and it takes few days to adjust but eventually initial chaotic sound disappear and person is able to appreciate the difference. Usually patients are happy after few weeks of use often coming to tell us that it has improved their quality of life.

Sensori-neural hearing loss may be shocking news to the patient and his relatives. Good doctor-patient relationship and understanding is required to help accept the fact. Talk with your doctor, friends, family and person with same problem to support you.

Hearing loss in children:Early intervention

2008-12-11T10:40:00.005+05:30

Why earliest intervention?

Our ears are filled with music of our child's first talk and our heart tries to retain the memory of that sound. But imagine a situation where all you hear is "silence...". Hearing loss in children can impair normal development of speech & language, his emotional balance, and academic & intellectual skills. Profound hearing loss can lead to dumbness which can be avoided.

From birth to first three years of life are important for a child to learn speaking, so early detection and intervention is very important. Babies should be screened for hearing at birth especially high risk ones. Child with mild hearing loss is generally labelled as inattentive or slow learner. But care for your kid and try to find out if he is hearing normally. Hearing should be tested as child grows on slightest suspicion of hearing-deficit by parents, care givers, teachers and family doctors.

Simple observation at home

Birth to 3 months: child startle to loud sound
3 to 6 months : turns eyes or head towards sound
6 to 12 months : listen attentively to familiar sound, respond to name, initiate some sound and few words like bye-bye
15 to 24 months : follow simple commands, repeat phrases.

When to visit a specialist: warning signs

Delayed mile stones/speech
Kid isolating/irritable
Difficulty in following verbal instructions
Ask for repetition of sentence/word
Difficulty listening in noisy surroundings
Turn up volume of T.V./radio
Have academic problem
Have repeated ear infection/blockage

On slightest doubt child should be seen by an Ear-Nose-Throat (ENT) specialist for thorough examination and evaluation of cause of hearing impairment. Audiologist may perform tests to assess degree & type of hearing-loss. Conductive hearing loss is largely preventable and can be managed by medicine or surgery. Sensorineural loss should be managed by hearing-aids.

Management of hearing-impairment

Depends on types of hearing-loss

Conductive: When sound is blocked to reach the inner ear. Causes may be wax, foreign body, allergy, fluid in the middle ear(glue ear), repeated ear infection, or perforation of ear-drum.

Usually it can be prevented and managed by medicine and/or surgery

Sensori-neural: Damage to nerve of hearing or inner ear.May be present at birth or may develop after some fever, ototoxic medication, loud noise, head/ear trauma, tumors.

Usually it is permanent and requires rehabilitation in the form of hearing-aids or cochlear implants.

Management of deaf child is team effort. Fitting of hearing aids should be considered as soon as deafness severe enough to impede natural speech development is diagnosed. Fitting should be done by experts with wide experience in the field for this age group. Auditory training, speech therapy and psychological counselling are required along with supportive handling by parents, family and teacher.

Hearing-Aids:-

Hearing-aids are instruments to amplify the sound so that you hear well.

Hearing aids should be customized and fitted as per individual children's needs.

They come in several shapes and sizes ; pocket type, behind the ear, in the ear, in the canal, ans smallest completely in the canal .

Digital hearing aids are example of advancing technology in the field and known for greater precision.They convert sound waves and modify the sound to provide clear amplified signal, so noise discomfort can be avoided. Some hearing aids have special characteristics direction setting, telephone setting, audio zoom and FM technology.

Cochlear implant :--

Child with profound hearing-loss which can not be helped by hearing-aids may be considered for cochlear-implant.