Category Archives: E.N.T. care

Home Care for chronic cough

E.N.T. Care and Cure

Though general home remedies do not replace proper diagnosis and medical management but it helps as supportive treatment in faster recovery and reduces sleepless nights. It works in lessening patient’s discomfort.

  

Proper rest

 

Take balanced diet with plenty of vitamin and minerals to boost defense mechanism.

 

Vitamin c and zinc supplements.

 

Keep hydration adequate.

 

Hot soups like tomato soup, chicken soup works wonder in thinning of secretions.

 

Black pepper, basil leaves, cloves and ginger boil with water and drink at night time; it’s soothing and helps in mucus coming out.

 

Honey is age old miraculous natural cure from cough.

 

One pinch of turmeric with 1 cup warm milk helps in easy expulsion of mucus.

 

Researches show ginger, garlic and onion has medicinal properties and helps in cold and cough.

 

Gargles with warm saline (salt in warm water)

 

Saline…

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What causes Throat Pain? How to relieve it by Home remedies?

E.N.T. Care and Cure

throat pain I have a scratchy feeling in the throat or Pain in throat, sometimes with difficulty in talking and breathing, I have feverish feeling too. Sounds similar to your throat symptoms this season?

Yes, it is sore throat or throat infection.

Image  Drcamachoent – Own work at wikimedia.org

Sore throat is commonly caused by viral, not bacterial infections where antibiotic is not required.   Further allergy and acid reflux can also contribute to throat pain. Thus, home remedies are increasingly advised to provide relief from mild throat pain such as gargling with warm salt water and over the counter pain killers.

However, if sore throat is not going away in 5-7 days or you are not able to maintain usual food intake than its time to visit your ENT Specialist for treatment.

 Causes of throat pain:

Infection by contagious viruses and bacteria are reasons of majority of throat…

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You Can Permanently Lose Your Hearing From Exposure to Diwali Noise

Any sound above 85 dB has the potential to harm our ears. The noise levels in most urban areas are very high which further goes up to dangerously high levels during Diwali- Fireworks and fireworks,  music systems… soon it may end up with visit to ENT and Audiology clinics.
Serious effects of Noise
Hearing loss
Ringing in the ears (Tinnitus)
Raised blood pressure
Irritability and disturbed Sleep

Levels of noise by American Academy of Audiology

Everywhere talks and campaigns are going on to stay safe in Diwali  —

-Top ten tips for a healthy Diwali on mdhil.com which says to make sure to protect ear from loud noises .

-Top Ten Tips for safe and Healthy Diwali on MeDIndia .

– Visvesvaraya Technological University (VTU), Belgaum will be organizing ‘Campaign’ to create awareness on
the ill-effects of air and noise pollution due to bursting of crackers.

Despite several campaigns being organised to raise awareness about the hazards of firecracker-induced noise pollution, expect a noisy Diwali this year too, as reported By Akshay Deshmane mumbai DNA  Diwali 2012: Noise campaigns fall on deaf ears

So big question remains “Are we really celebrating Diwali? asks Gayatri sankar on Zeenews.com

 

E.N.T. Care and Cure

A teenage girl visited ENT clinic with her mother with ringing in the ear and felt like cotton in the ear. Previous night,  Diwali Night she had spent several hours setting off the fire crackers.

Her ear were normal on video otoscopy and Audiogram showed  35 db at 4000 and 8000 hertz, Several days later, her hearing had returned to normal.

This patient is an example of a “temporary threshold shift.” Or Reversible Hearing Loss by exposure to an intense “impulse” sound such as fireworks or loud rock concert.

If sound is too loud or duration of exposure is long enough, such as noise generated in a woodworking shop it may lead to permanent threshold shift.  This condition is called Noise Induced Hearing Loss which has no cure.

Acoustic trauma occurs when excessive sound energy strikes inner ear. When we are exposed sounds that are too loud or…

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Newborn Hearing Screening

  • Why Newborn Hearing  Screening?

  • How early should I have my baby’s hearing screened?

  • How is Hearing screening in newborn done?

  • What are the advantages of OAE screening?

  • What does ‘REFER’ or ‘FAIL’ mean?

  • What is the Hearing Screening Protocol at Audicco Gliriaa?

  • What are some of the warning signs of hearing loss in an infant?

Why Newborn Hearing  Screening?

Newborn babies learn to recognize the familiar sounds in their home in their first few months of life.  Baby if can’t hear the sound, can’t speak, profound hearing loss can lead to dumbness.  Even partial Hearing loss in children can impair normal development of speech & language, his emotional balance, academic & intellectual skills and it affects individual for the rest of his life.

Subjective methods, such as ringing bells and hand clapping have not proven to be reliable for screening. Prior to Objective hearing tests such as OAE, infants with hearing loss typically remained unidentified until 2 ½ years of age. – far too late for optimal language development.

How early should I have my baby’s hearing screened?

  Your baby should have a hearing screening at birth or within the first month of life. If hearing loss is confirmed, it’s important to consider the use of hearing Aids or Cochlear Implant by 6 months of age. Hearing should be tested as child grows at any time on slightest suspicion of hearing deficit by Parents, care givers, teachers and family doctors.

How is Hearing screening in newborn done?

The procedure is performed with a portable hand held screening unit.

OAE screening–A small probe is placed in the child’s ear canal. This probe delivers a low-volume sound stimulus into the ear.

Tone or click stimuli are delivered, which travels from middle ear to inner ear where OAE is generated by the outer hair cells of the cochlea. This travels back and is measured with a microphone.

In approximately 30 seconds, the result is displayed on the screening unit as a “pass” or “refer.”

 

Automated ABR screening – Disposable surface electrodes are placed high on the forehead, on the mastoid, and on the nape of the neck.

The click stimulus (usually set at 35 dB hearing level [HL]) is delivered to the infant’s ear via small disposable earphones designed to attenuate background noise.

As with OAE screening, the sound travels through the outer, middle, and inner ear. However, in ABR, the sound continues along the eighth nerve to the brain.

An electrical response from that nerve is picked up by electrodes strategically placed on the infant’s head. This response is recorded and analyzed.

However, it lacks frequency-specific information and requires increased preparation time prior to testing.

What are the advantages of OAE screening?

Handheld otoacoustic emissions (OAE) screening is the most practical method for screening infants and toddlers because it :

  • objective and not dependent on a behavioral response from the child
  • Reliable and efficient
  • Help to detect sensorineural hearing loss and wide range of hearing-health concerns.
  • Is quick and painless
  • Simple and portable

 

What does ‘REFER’ or ‘FAIL’ mean?

 

Refer, an absent response to a click, does not always mean total deafness, but it does mean that your baby needs his/her hearing looking at more carefully.

The ear will not pass the screening if there is –

(a)  Blockage in the ear canal by wax or  amniotic,

(b) Structural problem or excess fluid in the middle ear

(c) Impaired cochlea that is not responding normally to sound.

What is the Hearing Screening Protocol ?

 All newborn should be screened at birth, or, within a month’s time.

 

Visual inspection – Outer ear abnormalities, foreign objects or blockage in the ear canal, any fluids draining from the ear, or noticeable odor; if any abnormal conditions are present, medical management should be done by ENT specialist.

 

Ist OAE screening – If both Ears Pass the test, the child’s hearing screening is considered complete

Those who have high-risk for hearing loss should be followed up at intervals of 6 months even if they are cleared at the screening. (As per Joint Committee on Infant Hearing 2000 position statement)

If the child does not pass the screening on any ear child is evaluated and managed by ENT specialist for a possible middle ear disorder within 3 months of age.

Repeat OAE screeningAfter treatment and/or medical clearance is obtained, the OAE screening is repeated.

If the ear passes the test, no further screening

However, if the ear dues not pass the Repeat test child is referred to a pediatric audiologist for complete Hearing evaluation like BERA (ABR), ASSR and Impedance.

Appropriate measures such as hearing aid fitting initiated before 6 months.

 

What are some of the warning signs of hearing loss in an infant?


If your child does not startle to loud noises or awaken from sleep by very loud noises in the house.

If your child is not babbling repetitively (ba ba, da da, etc.) by 8-10 months or

if your child doesn’t turn to localize the source of your voice by 7-8 months, you should be suspicious.

Ask for an objective set of tests. 

Tonsils and Adenoids: Mouth Breathing and Snoring in Children

As otolaryngologists, we are frequently asked to evaluate the upper airway, especially by the dentists  in children undergoing orthodontic treatment or by pulmonologist in children undergoing evaluation for sleep disorders. While assessing the upper airway parents are asked few questions.

  • Does your child keep his mouth open, especially while asleep?
  • Does your child snore at night?
  • Does he have repeated colds and coughs?


Under normal condition, breathing takes place by the nose. Mouth breathing or snoring should not be overlooked and proper evaluation is to be done. Mouth breathing syndrome may cause abnormal positioning of teeth, and facial deformity.  It May progress to sleep disorder and poor school performance and in some cases lead to adverse effects on heart and lungs.

Mouth breathing and snoring due to adenoid is common in children, but since the signs and symptoms of adenoids are so ubiquitous, often the general physician or pediatrician may fail to think about adenoids.

Nose block may be of three types–

a. Organic—some mechanical obstruction –enlarged adenoids, tonsils, deviated nasal septum, allergic rhinitis, nasal foreign bodies, enlarged nasal turbinates, Nasal polyps etc.

b. Functional

c. Neurological

Adenoids and Tonsils

Tonsils and adenoids are clumps of lymphoid tissue, the tonsils are located on both sides of the back of the throat (Oropharynx) and adenoids are located higher in the passage that connects the back of the nose to the throat (Nasopharynx).

The tonsils are visible through the mouth, but the adenoids are not directly visible. A small mirror or a nasal endoscope is used to see the adenoids.

Role of the Adenoids/Tonsils:

Tonsils and adenoids trap bacteria and viruses entering through the throat and nose and produce antibodies to help the body fight infections. But they are not considered to be very important as our body has other means of preventing infection and fighting off bacteria and viruses.

Children are born with adenoids which are quite small and usually the adenoids shrink after about 5 years of age, and it practically disappear by the teenage years.

Some children (and adults) are prone to develop infections of the tonsils and adenoids. These infections can be caused by different kinds of bacteria other than streptococcus( the one most people know about).

Symptoms of enlarged tonsils and adenoids

Adenoids enlarge because of repeated allergy or infection. Children with enlarged tonsils or adenoids may have a sore throat and discomfort or pain during swallowing.

Enlarged or hypertrophied adenoids can block a child’s nasal passages and result in–

  • Nasal block and Difficulty breathing through the nose

Diagnosing tonsillitis and the enlarged Adenoids—

Most common cause of nasal obstruction in children is enlarged adenoids but nasal allergy may be contributing factor which should also be ruled out and managed.

Proper history and clinical examination are very important.

Number of episodes of sore throat during the past 1 to 3 years is more important than the size of the tonsils alone. Very large tonsils may be normal and chronically infected tonsils may be normal-sized.

Redness of the tonsils, enlargement of lymph nodes in the neck, and the effect of the tonsils on breathing is also assessed.

Parents may neglect open mouth of the child while sleeping, considering it normal or habitual but actually it may be an indication of sleep apnea.

Sometimes Parents may report that child has restless sleep indicated by moving around in bed or the child stops breathing frequently during sleep.

History of Dry mouth may be found on probing. The child may be hyperactive and have poor performance in school and may be falsely labeled as ADHD (attention deficit hyperactive disorder).

Patient may have a high arched palate and overcrowding of teeth, change in the face called adenoid facies.

Investigations to diagnose Tonsillitis and Adenoids

The tonsils are visible through the mouth, but the adenoids are not directly visible.

To view Adenoids post nasal mirror or nasopharyngoscopy (Rigid or fibreoptic) is usually required. Nasenendoscopy is reliable in assessing the size of the adenoids.

X-Ray of soft tissue of nasopharynx / Occasional CT scan is done.

Observation or Video recording of a child while sleeping may be helpful.

Polysomnography (Sleep Study) may be advised to see oxygen levels in the blood.

 

Why to remove the Tonsils and adenoids?

Tonsil surgery is less common now. The tonsils are normally large during childhood and begin to shrink in size after the age of 7-8 years.

Children who benefit from Tonsil surgery include those with the following:-

  • Obstructive sleep apnea
  • Extreme discomfort when talking and breathing
  • Lack of weight gain: Children may not eat sufficiently because of pain
  • Multiple throat or ear infections (Seven or more infections in 1 year, five or more infections a year over 2 years, or three or more a year over 3 years)
  • Chronic or recurrent tonsillitis associated with the streptococcal sore throat not responding to beta-lactamase-resistant antibiotics
  • Persistent foul taste or breath due to chronic tonsillitis not responsive to medical therapy

The only treatment for enlarged obstructing adenoids is to surgically remove them. Antibiotics and other medications do not help.

Though adenoids usually shrink in the second decade of life, however, blockage and sleep apnea may affect growth and development and cause permanent changes in facial or dental development. Decision to remove adenoids is usually taken before it occurs.

Adenoidectomy is recommended for the following:

  • Recurring nasal congestion and sinus infections
  • Blockage of back of nose :- Enlarged adenoids may cause “mouth breathing”, snoring, or sleep apnea (stop breathing for brief periods during sleep). Because of the blockage of upper airway, oxygen levels in the blood may be low, and children may wake up frequently and feel sleepy during the day. Rarely, obstructive sleep apnea can cause serious effects on lung and heart.
  • Chronic ear infections and hearing loss: -Adenoids block eustachian tubes (tube connecting back space of nose to the middle ear) resulting in fluid accumulation in the middle ear.
  • lack of weight gain: -Children may not eat sufficiently because of pain or because breathing takes constant physical effort

 

Surgery to Remove Adenoid and Tonsils

Usually surgery is under general-anaesthesia and child will not be allowed to eat or drink minimum 6 hours before surgery start time, and the patient doesn’t feel any pain during surgery.

Tonsils and the adenoids are removed through open mouth —no need to cut through skin.

Adenoids– traditional curettage method, endoscopic shaver, electrocautery or suction coagulator

Tonsil -Cold blunt dissection method, Bipolar Diathermy, LASER or Radio frequency

Complications  of tonsils and adenods surgery:

Anesthetic risk -serious anesthetic complications can occur, but are very unusual.  Bleeding is rare.

The Tonsillar and adenoid bed usually becomes superficially infected, and can cause 7-10 days of bad breath, but serious infections are very rare.

Adenoids should be removed with careful consideration and examination to avoid effects on speech and/or swallowing.  To be avoided in achild with sub mucous cleft palate.

Bleeding is a potential complication of tonsillectomy and before embarking on surgery family history of any abnormal bleeding should be excluded and patient’s coagulation profile is to be examined.

What to expect after Tonsils /adenoid surgery -read next blog post

To conclude–

  • Tonsillectomy and adenoidectomy are usually done on an outpatient basis. These operations should be done at least 3 weeks after any infection has cleared to avoid risk of complications.
  • Removing the adenoids can help reduce snoring, but may not completely cure it because several other reasons may be responsible for snoring.
  • Tonsillectomy and adenoidectomy do not appear to decrease the frequency or severity of colds or cough.
  • Voice may sound different for a short while after the operation because of swelling in the area. However, this usually comes to normal within 1 or 2 weeks.
  • Removing the tonsils or adenoids does not cause any problems with the immune system.

White patches on the tonsils are mistaken for an infection. Most often this is of no medical significance. Furthermore, large tonsils do not necessarily mean the child needs to have them removed. The most common reasons to consider removal of the adenoids and tonsils are recurrent infections and obstructive sleep apnea (OSA).  Adenoidectomy has tremendous benefits for child’s health and is essential to safeguard child’s breathing and hearing.

Image attributes-

Sleeping child with mouth open– By Daniel Dwase (http://www.child-development-guide.com) [GFDL (www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (www.creativecommons.org/licenses/by/3.0)], via Wikimedia Commons from Wikimedia Commons

Tonsil image– By Klem (Own work) [GFDL (www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (www.creativecommons.org/licenses/by/3.0)], via Wikimedia Commons

How is the body’s balance maintained?

Nature has given us certain sensors which are spread in different parts of the body. These sensors pick up the information and constantly inform the brain about the stability of the ground and the surroundings via afferent neural pathway.

The information coming from the eyes, skin, muscle and joints is integrated with the information coming from the inner ears and processed in the brain.  Central processing of information in the brain is essential for balance.

 

 

******************

 

—> In response the brain evolves a motor output via efferent nerves– thereby creating a precise and timed contraction of different body muscles to restore the stability.

—> Resulting in movement of head and neck, legs, eyes and rest of the body to maintain the balance and have clear vision while person is moving

Thus Maintenance of balance is a reflex action with the involvement of a sensory organ, an afferent neural pathway, a center of the reflex in the brain stem, an efferent neural pathway and an effector motor organ.

Afferent sensory organs–

  • Eyes – Inform brain about our position and movement.
  • Proprioceptors–Skin, muscles and joints inform the positions of our arms, legs, and other parts of body.
  • Inner Ear Vestibular organs –Movement & position of head

Center of the reflex—

Situated in the brain-stem where 4 vestibular nuclei are present

Efferent neural pathway –

Neural tracts in the brain and spinal cord and peripheral nerves

Effector motor organ–

Different muscles of the body

Skeletal Muscles of the limb, trunk and neck (Vestibulo-spinal pathway)—vestibulospinal reflex —

Small Muscles of the eye Vestibulo ocular reflex pathway

Hence in order to have a properly working balance system we basically need:–

A perfectly working vestibulo spinal reflex system

A perfectly working vestibulo ocular system

A very good cerebellar system

For good balance eyes, nerve signals from the skin muscles and joints, and inner ears should work normally.

However, if we shut our eyes, we still have a good sense of balance because of the signal from inner ears, and other parts of our body

Role of Ear—

The labyrinth of the inner ear is composed of the vestibule (utricle and saccule) and the 3 semicircular canals. These are–

  • The vestibular labyrinth is made up of three semicircular canals (lateral, posterior and superior) at right angles to each other and joining together at the vestibule (Utricle and Sacule).
  • filled with fluid called endolymph and have receptors to inform the brain about the head’s position in space
  • Semicircular canals detect direction of gravity and detect and measure movements and acceleration in all three planes of space.
  • The right and left balance organs work together, constantly sending signals via the audiovestibular nerves to the brain, about position and direction of movement.

Vertigo is caused by conflict of information between inner ear and other sensory system or defect in central integration of vesitbular information in brain.

entindia by Dr Rajesh Kalra

I am always inspired by Dr Rajesh Kalra’s blog – ‘http://www.entindia.net/‘ , a sincere and nice effort helpful to E.N.T fraternity and to all.

I regularly follow his blog to know recent activity or conference going on in the field of oto-laryngology, in fact I found his blog long back while searching for ‘workshops in Mumbai’.

E.N.T. clinic set up; Instruments and common terms

E.N.T. Specialist (oto-rhino-laryngologist):-

A doctor who specializes in diagnosing and managing diseases (by medicines or surgery) of Ear-Nose and throat.

Evaluation of the ear, nose and throat requires good source of light. Most important is, no doubt, skilled hands and experienced eyes.

Some instruments and common terms used in E.N.T. practice:

Head-mirror and bulls lamp: –

bulls-lamp Bulls lamp placed above and behind the patient’s shoulder has got a bulb and Plano-convex lens to send focused light to head mirror.

head mirror and ent-specialist1 Head mirror (I like to describe it as “naag-mani”), has special concave lens to reflect light from bull’s lamp. The examiner sees through the hole in the center of the mirror for binocular vision.


images1

Some professionals use Head-light in place of bull’s lamp and head mirror.



Endoscopy unit:

endoscopelight source, camera and nasal endoscope are being used in a modern

ENT set-up for video demonstration of otherwise hidden- from patient’s-cavities.


Tongue depressor: –

tongue-depressor

To depress tongue and examine oral cavity.


Nasal speculum: –

thudichum nasal_speculumHelp in viewing inside of nose, procedure to inspect nasal cavity is called anterior rhinoscopy.


Laryngeal mirrors: –

il-mirror Used to examine larynx and laryngo-pharynx. Doctor will hold your tongue and will see reflection of larynx in the mirror that is why it is called indirect laryngoscopy.

Video-laryngoscopy is routinely used now a days using telescope.

Postnasal mirror: -used to examine nasopharynx and posterior part of nasal cavity, a procedure called posterior rhinoscopy.

Ear-speculum: –

ear_specula Inserted into ear to see inside of ear canal and ear drum.


Otoscope:

otoscope

It is battery operated device with magnifying glass, gives magnified view of ear drum.

ear-exam1Otoscope is most essential tool in the hands of otolaryngologist; I often use it to inspect ear, nose and throat of infant, child or bed-ridden patients or places (like rural-camps) where an equipped E.N.T. set-up is not present.


Siegel’s speculum: – It helps to test mobility of ear drum, a very essential part of ear examination.

Jobson-Horne’s probe:

jobson-horn-and-probe1 I call it “chhoti jadu ki chhadi” (tiny magic-stick). On the one end of the probe cotton can be applied and used to clean ears of any discharge. Other end has got ring like structure to remove wax, dried secretion and foreign body.


Forceps

hartmann-forceps161noyes-forceps141 (Tilley’s or Hartman’s) for packing or grasping.

Eustachian catheter: – To see the patency of Eustachian tube.


Suction-apparatus: – To suck out discharge or blood from ear or nose for detailed examination.


Ear microscope (operating microscope): –

ent-microscope To examine the ear drum more precisely under magnification, a procedure called Examination under microscope (EUM).

It gives the doctor the freedom to use suction and other Instruments in the ear.

Microscopy is used to clean discharge, to inspect ear drum, middle ear or any pathology before surgery, and to remove impacted wax or foreign bodies from ear.


Tunning Forks:

tunning-forkTo roughly assess degree and type of hearing impairment.


Pure tone audiometer and impedance meter:-

To test degree and type of hearing-loss.


tympanometer1

pure tone audiometer

Pure tone audiometer and Tympanometer