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

Moved my blog to entcare.wordpress.com

Ballon sinuplasty

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?

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

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

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

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

• 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.