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Ear discharge

What is ear discharge?

Ear discharge simply means water or pus coming from your ear. It could be clear watery type, mucous type, thick yellowish purulent type, sometimes even blood stained

There are many causes of ear discharge, the most common being infection

1. Wax

2. Infection of the external ear ( otitis externa)

3. Infection of the middle ear ( otitis media)

4. Fungal infection ( otomycosis)

5. Trauma

6. Infection of the temporal bone ( Mastoiditis)

7. Fracture of the temporal bone ( CSF leak )

8. Cancer of the temporal bone

Wax

Can I put earbuds in to clean the wax?

The answer is “no.” The wax inside the ear cleans itself naturally. Putting an earbud or any other sharp instrument in an ear to clean it may push the wax inside and also damage the skin of the ear canal.
This trauma may lead to infection in the outer ear, which manifests as ear discharge and pain.
This needs meticulous and regular cleaning of the ear and antibiotic ear drops by an ENT doctor.
Self-medication (over-the-counter ear drops) may lead to the spread of infection to deeper parts of the ear and many other complications.

Otitis Externa

Otitis Externa is the infection of the middle ear. This infection can be caused by repeated cleaning of the ear with contaminated earbuds, water entering the ear repeatedly, foreignbody in the ear canal that gets impacted and infected among others. It can manifest mainly as ear pain, ear discharge, blocked sensation in the ear. The ear needs to be examined by otoendoscopy, suction clearance of any debris or discharge or removal of foreign body has to be done. It also requires appropriate medications to reduce the pain and infection. Self medication may be inadequate, may lead to complications and hence should be avoided.

Otitis media

Otitis media is an infection of the middle ear. The microorganisms can enter the middle ear through a damaged ear drum or via the eustachian tube( A narrow tube that connects the nose and ear )

You may have mucopurulent ear discharge, which is continuous and foul-smelling you may also experience reduced hearing. Visit your ENT doctor at the earliest possible time for treatment.

Treatment of otitis media is tricky because the hidden source of infection may be your nose.
Evaluation of the nose with endoscopy is mandatory for the treatment of ear infections.
Treatment may also include surgery of the ear, nose or throat depending on the root cause.

Cholesteatoma

Ear discharge may not always be due to infection. Cholesteatoma refers to a slow-growing disease in the ear. It is a ‘bone-eating’ disease that can erode the bones that surround the ear causing spread of the disease into the brain, major blood vessels of the brain, facial nerve, balance organs of the body or it may also erode the ossicles which are small bones in the ear that help in hearing hence causing deafness.

You may have very foul smelling ( fishy odor), minimal discharge with significant hearing loss
Surgery is the main treatment modality for cholesteatoma and may require hearing reconstruction too

Ear discharge in children

Children are more prone to ear discharge, and the main source of infection is the nose!

Children have a smaller horizontal eustachian tube that can easily pass the infection from the nose and throat. They are also at higher risk of adenoid hypertrophy, which can block the Eustachian tube and cause middle ear effusion.

The management of ear discharge in children depends on the source of the infection. Your ENT doctor will advise an endoscopy of the nose and examine the ear and decide on the management

Avoid using earbuds on children to clear the wax. Always seek the help of your doctor. .

Other causes of ear discharge are dermatitis, foreign bodies in the ear, middle ear effusion with a ruptured drum, and psoriasis. Visit your ENT doctor for a thorough examination and treatment.

Malignant otitis externa/ Skull base osteomyelitis

As the name suggests, the infection is in the bone at the base of the skull. It is a more serious disease that needs sequential radiological assessment with long-term IV antibiotics.

Risk factors

1. Reduced Immunity

2. Long-standing and uncontrolled diabetes

3. Old age

4. Recurrent and untreated ear infection

The disease may present with night-time severe ear pain, reduced sleep due to ear pain, and ear discharge. Patients may also present with difficulty swallowing, jaw pain, and severe headaches, depending on the spread of the infection.

How can an ENT doctor help you?

Hearing and balance are two important senses that help us understand and respond to our surroundings.

Visit your ENT doctor if you have signs of possible problems such as yellow, brown, or bloody discharge from the ear that continues for more than a week, persistent pain, hearing problems, or balance-related problems.

An ENT doctor can also help with the assessment of your hearing status and provide advice regarding the methods of prevention and treatment of conductive hearing loss, by performing an endoscopic assessment and cleaning of the ear.

– Dr. Prashanth R Reddy
“E.N.T. health – ENTry for better senses”.

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Facial palsy

A quick guide for understanding facial palsy

It is important to understand what has happened to your face, why it has happened and what to expect from your recovery.

The term Facial Palsy, generally refers to weakness of the facial muscles, mainly resulting from temporary or permanent damage to the facial nerve or cranial nerve. There are different degrees of facial palsy.

Sometimes only the lower half of the face is affected. Sometimes the whole side of the face is affected. In rare cases, both sides of the faces can be affected.

It is estimated that 25-35 people have Facial Palsy for every 1, 00,000 in India.

Facial paralysis occurs when cranial nerve VII , also known as the facial nerve, is injured. The facial nerve is responsible for several functions in the face, including stimulating:

▪ The muscle responsible for motions in the face

▪ The gland responsible for producing tears

▪ The small muscle in the ear responsible for dampening certain noises

▪ The taste gland in the tongue

▪ Sensation in a small portion of the skin of the ear

Important note : Bell’s palsy is the most common form of facial paralysis. Most people with Bell’s palsy or facial palsy recover fully with treatment within 3-4 weeks. Remember there is no one-size-fits-all treatment for Bell’s palsy.

Surgical procedures causing Facial palsy:

▪ Cosmetic procedures, such as facelifts

▪ Dental procedures

▪ Mastoid or parotid surgery

▪ Nerve blocks in the face

▪ Skull base surgery

Many conditions can produce isolated facial nerve palsy identical to Bell’s palsy. Structural lesions in the ear or parotid gland (e.g., cholesteatoma, salivary tumors) can produce facial nerve compression and paralysis. Other causes of peripheral nerve palsies include Guillain-Barré syndrome, Lyme disease, otitis media, Ramsay Hunt syndrome (an outbreak of herpes zoster in the facial nerve distribution), sarcoidosis, and some influenza vaccines.


The different conditions and factors that may increase the risk of developing facial palsy:
:

▪ diabetes

▪ high blood pressure

▪ pregnancy

▪ obesity

▪ preeclampsia, which can lead to high blood pressure during pregnancy

▪ being middle aged or an older adult, but with an average age of 40 years

Depending on the severity and the proximity of the nerve affected, it can also result in:

▪ Inability to close their eye (temporal and zygomatic branches)

▪ Hyperacusis (nerve to stapedius)

▪ Metallic taste (chorda tympani)

▪ Reduced lacrimation (greater petrosal nerve)

How can an ENT doctor help you?

It is not all bad news. Not all facial paralysis after procedures is permanent. Procedures in the area of the nerve will often cause temporary paralysis (neuropraxia) and recovery can be seen over several months.

The mainstay of pharmacologic therapy for Bell’s palsy or facial nerve palsy is early, short-term oral steroid treatment. In severe, acute cases, combining antiviral therapy with steroids may improve outcomes. Also, eye care is essential for patients with an incomplete eye closure.

Patients with Bell’s palsy should be treated within three days of the onset of symptoms with a seven-day course. The medicines will be prescribed by your ENT doctor. Patients may also be monitored for eye irritation and be prescribed eye lubrication. Physiotherapy is started to initiate muscle movements and forms an important part of the treatment.

Note: For anyone in any stage of recovery from facial palsy, it can be beneficial to attend a support group to help reduce isolation and benefit recovery

Treatment for facial palsy may also include surgery, depending on the cause, time of onset, and severity. Surgical options include facial nerve decompression, grafting, and nerve crossover.

– Dr. Prashanth R Reddy
“E.N.T. health – ENTry for better senses”.

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Hearing Loss or Deafness

Hearing is the ability to perceive sounds around us and understand our surroundings with the help of our ears. It’s one of the very essential senses that helps us maintain balance and understand things. Hearing loss refers to reduced or very less hearing compared to the standards ( normal hearing < 20db)

Physiology of hearing

There are 3 steps to conduct sound from the pinna to the brain

Step 1- Collection of sound from the surroundings and transferring the energy to the Eardrum

Step 2- Vibration of eardrum and ear bones that amplifies the sound and transfers it to the inner ear

Step 3 – From the inner ear, the auditory nerve transfers information to the brain.

Impairment of the vibration mechanism is also called conductive hearing loss and impairment of the inner ear and/or nerve mechanism is called sensori-neural hearing loss.

Are all “hearing loss” the same?

Not all hearing loss are the same. There are some correctable causes of hearing loss, like wax blocking the canal, FB in the ear , and infections of the ear.

But as age progresses, the nerves that conduct the sound to the brain get weaker, which will lead to hearing loss. This is called presbycusis.

There are other causes of nerve damage, like viral infection, loud noise exposure, and brain tumors. With these, there is a less likely chance of a full recovery in due course.

Children and Hearing Impairment

Every newborn in our country is screened for hearing impairment. The major cause of severe hearing loss in children is birth anomalies. Other reasons could be intra uterine infection, meconium in the ear, etc.

Hearing impairment in children is of the utmost importance because without hearing, their learning and speech will be delayed.

Occupation and hearing loss

Exposure to loud noise continuously will also affect your hearing. Occupations like traffic policemen, workers who work with machines, and Army personnel are more prone to noise-induced hearing loss.

Hearing music via headphones for a longer duration can also affect hearing in due course.

It is better to use earplugs and sound cancellation devices in these cases to prevent hearing loss.


How severe is the hearing loss?

A whisper is about 30 dB, normal conversation is 60 dB, and a horn is about 90 dB.

The degree of hearing loss depends on the inability to hear the various decibels. It can be mild, moderate, moderately severe, severe, and profound.

What is conductive hearing loss?

Conductive hearing loss happens when there is impairment of the vibration mechanism of hearing that is any restriction to the sound wave contacting the eardrum, vibration of the eardrum, transmission of these vibrations to the inner ear by ossicles (small bones) can cause conductive hearing loss. Various conditions that can cause conductive hearing loss are:

● Wax / foreign objects / infection of external ear that prevents sound reaching the eardrum

● Perforated eardrum (loss depends on the size of perforation)

● Retracted or thick eardrum

● Fluid collection behind the eardrum

● Fixed ear ossicles

● Eroded ear ossicles

● Otosclerosis (fixation of footplate that transmits the vibrations into the inner ear

What is sudden hearing loss?

A person who is apparently normal experiences a hearing loss of 30 dB or more in a short span of hours to three days.

Causes of sudden hearing loss

1. Infection ( bacterial/ viral ) of the inner ear

2. Fracture to the bone above the inner ear

3. Vasculitis

4. Ototoxic Drugs – Drugs affecting inner hair cells

5. Viral infections like COVID-19

6. Unknown causes (most often)


What is the treatment for hearing loss?

Treatment depends on the degree and type of hearing loss.

To know how much of your hearing you’ve lost, your ENT doctor can perform one or more tests:

Physical exam to look in your ear for earwax buildup, infection, or structural problems.

Tuning fork testswhere you wear earphones and listen for sounds directed into your ear. The level of sound you can hear can be measured with greater accuracy with this test by an audiologist than with other screening tests.

Audiometer tests where you wear earphones and listen for sounds directed into your ear. The level of sound you can hear can be measured with greater accuracy with this test by an audiologist than with other screening tests.

Note:Note: Today, we also have tablet and smartphone apps that you can use on your own to screen for hearing loss. If you have hearing loss, begin treatment as soon as possible.

Treatment of conductive hearing loss varies from simple wax removal to surgery to reconstruct the hearing mechanism depending on the cause of hearing loss.

Treatment of nerve loss may include medications, surgery, hearing aid or a combination of these depending on the root cause.

What is a hearing aid?

A hearing aid is an amplifier that amplifies external sounds and helps with hearing..

There are different types of hearing aids that can be worn behind the ear, in the ear, or completely in the ear ( not visible from the outside). Hearing aids are mostly battery-operated.

Every candidate for a hearing aid needs specific tuning according to their needs. It may require a few sessions with an audiologist to fine-tune it.

Types of hearing aid:

Important note –

Do not buy hearing aids over the counter, as they will cause more discomfort than benefit.

Beyond Hearing Aids

Children with congenital anomalies or severe nerve damage will need cochlear implantation to improve their hearing. Cochlear implants are the only bionic sense organ. They are implantable hearing aids where electrodes are surgically placed inside the ear.

If you or a family member is having difficulty hearing, an audiologist or an ENT doctor can check your hearing and tailor a personalized treatment.

– Dr. Prashanth R Reddy
“E.N.T health – ENTry for better senses”

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Vertigo

What is vertigo?

Vertigo is not a disease; it’s a symptom/ manifestation of any disease. Vertigo is a sensation in which the person feels as though the world is spinning around them or that they are spinning around in space. Vertigo happens when the balance between the sensory systems is lost

What are the types of vertigo?

1. Rotational Vertigo – True rotational vertigo is the feeling of ones surrounding going around or the feeling of oneself rotating with respect to surroundings. In cases when you feel a wavering motion or slight imbalance it’s not true rotational vertigo

2. Spontaneous/ Induced vertigo – Here the episode of vertigo starts without any external trigger. In the case of Induced (Nonspontaneous vertigo), the triggering factor could be sudden head movement or fall.

What are the causes of vertigo?

Vertigo can be due to disorders of the brain ( Central vertigo ) or due to Vestibular organs ( Peripheral vertigo )

The causes of central vertigo are

1. Hypertension

2. Reduced Blood supply to the brain

3. Head Injury

4. Tumors of brain

5. Infection – Meningitis

Peripheral causes of vertigo are

1. BPPV (Most typical)

2. Vit D deficiency

3. Inner ear diseases like Meniere’s disease

4. Inflammation – Vestibular neuronitis

5. Tumor of the vestibular nerve( Acoustic neuroma

6. Infection – Syphilis

What is BPPV or ear balance disorders?

VerBPPV stands for Benign Paroxysmal Positional Vertigo and is commonly known as an ear balance disorder.

They typically start out as brief, recurrent episodes of vertigo that last under a minute. Specific head movements, as well as rising from or lying down in bed, can bring on the symptoms. Patients typically feel nauseated and vomit as well.

BPPV is caused when small particles called otoliths in the inner ear get displaced and float freely. Hence, the treatment aims at repositioning the otolith. This is done by the Dix-Hallpikee test and Epley’s maneuver.

Vitamin D deficiency and vertigo

The body maintains an adequate level of vitamin D through oral ingestion and cutaneous photosynthesis. According to some estimates, one billion people worldwide lack sufficient amounts of vitamin D. Age, obesity, the prevalence of several chronic illnesses, geographic latitude, time of day, solar radiation exposure, season, weather condition, air pollution, clothing, sunscreen use, and skin pigmentation all contribute to vitamin D deficiency. Nowadays, people spend most of their time indoors, increasing the likelihood of a deficiency. People with diabetes taking anti-diabetic medications are at risk due to malabsorption.

Vitamin D has a significant impact on calcium metabolism, which may have an effect on the matrix and density of calcium carbonate crystals (otoconia). Studies conducted all over the world have shown that vitamin D deficiency can cause BPPV and that taking vitamin D supplements has decreased the frequency of dizziness.

What is Sinusitis vertigo ?

Allergies and dizziness are unusual symptoms. The equilibrium required to stand, walk, or run is maintained by both the brain and the ear.

The Eustachian tube, a thin tube that connects the ear to the back of the nose, aids in the maintenance of middle ear pressure. Any disruption to this system can result in an imbalance.

In the case of sinusitis/allergies, the mucosa of the nose becomes irritated, causing the eustachian tube to become clogged. Because a clogged Eustachian tube cannot equalize pressure inside the ear, fluid accumulates, and you may suffer from dizziness, lightheadedness, or a spinning sensation ( vertigo).

Remember that sinusitis and vertigo are not life-threatening; however, they will necessitate therapy that is more extensive than what OTC (over-the-counter) drugs can supply.

Precautions to be taken at home

Move slowly – When you stand up from a lying down position, make sure you move slowly. Many people experience dizziness if they stand up too quickly.

Drink plenty of fluids – Staying well hydrated can prevent or relieve several types of dizziness

Avoid caffeine and tobacco, they restrict blood flow and make your symptoms worse.

Avoid alcohol – it aggravates the imbalance.

Get adequate rest /sleep – relieve your tension

Avoid allergens that initiate sinusitis

Don’t self-medicate

Visit your ENT doctor if you experience any sudden, recurrent, severe, prolonged, or unexplained dizziness or vertigo.

– Dr. Prashanth R Reddy
“E.N.T. health – ENTry for better senses”.

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My child has put something inside of his/her ear. – FAQs


So, what do I do now, my child has put something in his/her ear.

Parents may not worry since getting an object stuck in the ear is relatively a common problem, especially in children or toddlers. The vast majority of items are lodged in the ear canal, which is the small channel that ends at the eardrum.

Home remedy : You can try to see if the object will fall out simply by tilting your child’s head. If you can see the object in the ear and think you can remove it easily, carefully pull it out with a pair of tweezers. Be careful not to push it in deeper, and don’t poke at the ear or try to remove the object by force.

Visit your nearest ENT doctor to get the foreign object removed in case the child complains of pain or the object is in the ear for more than 24 hours. Remember, the longer an object is left in the ear, the harder it is to remove. Also, the longer an object stays in the ear, the higher the chances of ear infection.

What should I do if an insect gets stuck inside my ear?

If accidentally an insect gets stuck inside the ear do not try to pull it out alive. Sometimes attempts to pull it out can cause damage to the ear canal or the eardrum. Always get the help of an ENT doctor to get the foreign body out.

Do you have a habit of putting earbuds/ key/pencil/ sharp things inside the ear to clean it?

Our ear always self-cleans itself; we need not use any earbuds / any other instruments to clean it. Using these may push the wax further inside and damage the ear canal /eardrum. It can also be the source of ear infections.

– Dr. Prashanth R Reddy
“E.N.T. health – ENTry for better senses”.

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Migraine-like Headache: Permanent Cure through Surgery


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Migraine and Migraine like sinus headaches


What is a migraine?

A migraine is not just a headache.

To sense our world, your nerves send electrical signals to and from your spinal cord and brain. Sensors throughout our body collect information about our surroundings. This information is sent as signals to our brain through a series of nerve cells. Communication with our brain occurs via pathways and nerve centers at the base of our brain, called the brain stem. The brainstem helps control sleep, heart rate, and breathing. Migraine is a disease where one or more parts of this communication system do not function properly.

Around 9.2% of Asians experience migraines. Migraine affects over 200 million people in India alone.

Migraine is a type of neurological headache that can cause severe pain. Neck pain may be the most common migraine symptom, beginning at the same time as the headache. In order to be diagnosed with migraine disease, patients must have had at least 5 headache attacks that lasted 4–72 hours.

An episode usually occurs in stages and can last for several days. Severe cases can affect a person’s daily life, including their ability to work or study. Some people have more than one episode each week, while others have them only occasionally. Migraine can affect people in different ways, and the triggers, severity, symptoms, and frequency can vary

It is important to understand that a migraine episode is different from a typical headache. The experiences are different, and they can have different causes.


Migraine-like sinus headaches

Sinusitis is another cause of headaches. It may resemble migraine and is usually misdiagnosed.

When a nerve inside the nose is compressed, it can cause headaches or other types of facial pain, which is known as Sluder’s neuralgia. This might be caused by a deviated septum in the nose, which would cause nerve compression.

How does Sluder’s neuralgia present?

Sluder’s neuralgia starts at the

1.Base of the nose,

2. Moves towards and around the eye on the same side,

3. Effects on the upper jaw and teeth, as well as the lower jaw and teeth on occasion

4. It occasionally reached the ear and beneath the cheek.

5. The back of the head, neck, shoulder, chest, shoulder blade, and so forth could all experience pain.

6. It can spread to the arm, forearm, hand, or angular joints and cause a painful throat

7. Patients can feel numbness along soft palate, oropharynx and tonsils

How to differentiate between migraine and Sluder’s neuralgia?

The majority of the time, migraine headaches are brought on by a trigger and may or may not be accompanied by an aura. Aura refers to visual or auditory sensations experienced before the start of a migraine. Migraine headaches may be unilateral and can last for 4-72 hours.

On the other hand, Sluder’s neuralgia causes radiating headache/facial pain, dull aching, and can last for several days. They rarely have triggers and are not associated with auras.

Different types of headaches

Treatment of Migraine like sinus headache

Medical Management of Migraine

During an acute episode of migraine, your doctor may prescribe drugs to reduce headache and other symptoms (Abortive therapy).Long term treatment of migraine aims at reducing the frequency of migraine attacks and reducing the intensity of headache (Preventive therapy)


Management of Sluder’s Neuralgia / Migraine-like Sinus Headache
:

The main objective of treatment is to relieve nerve compression and reduce headache intensity. Therefore, the compression-causing factor is surgically fixed, such as a deviated septum touching the lateral wall of the nose. When the compression is released, the pain immediately goes away. Today, ENT surgeons perform endoscopic septoplasty that is painless and scarless.

When should you seek medical attention ?

Seek immediate medical attention if your headache is accompanied by – sudden onset headache or a sudden change in baseline headache; neck stiffness; a high fever; muscle weakness; changes to speech or vision; numbness or tingling sensations; convulsions; confusion; or changes in awareness.

Headaches and their accompanying symptoms can occasionally be a sign of a more serious underlying medical emergency, like a stroke.

Also, if you have a history of stroke, heart disease, or diseases of the liver or kidneys, take extra precautions. A changing headache could indicate a life threatening emergency.

– Dr. Prashanth R Reddy
“E.N.T. health – ENTry for better senses

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Thyroid swelling

Everybody has thyroid. The thyroid is in the lower part of the neck. It is a butterfly shaped gland, hence it has a lobe on one side and lobe on the other side. It puts out a hormone called T3 and T4. Those hormones are responsible for how we feel and how our cells work, how energetic we are, and how much moisture is present in our skin. That’s because of the thyroid gland.

If a thyroid gland is swollen, it could be due to two reasons, number one, it could be due to an overactive gland. People feel nervous, excited or irritable, always speak fast, always doing something, and also lose weight even though they are eating well, only because of the over active gland.

People may feel tired, sometimes sluggish and depressed, your skin gets dry, GI tract doesn’t work well, also in women, the menstrual cycle may become irregular, due to an underactive thyroid.

Thyroid goiter is a condition where there is an abnormal enlargement of your thyroid gland.

Goiter is one of the most common thyroid problems. When you have goiter the thyroid glands get enlarged and there will be visible swelling in the neck, Goiter has several causes such as infection, or iodine deficiency, or benign or malignant disease. Remember that a malignant disorder is extremely rare.

Important note:

Your doctor will study how much the pituitary gland is trying to control the thyroid. Your doctor will precisely know if it is underactive or overactive depending on the symptoms.

About Thyroid swelling:

A goiter is a lump or swelling at the front of the neck caused by a swollen thyroid. The thyroid is a small gland in your neck that makes hormones. Goiters are not usually serious but should be checked by your doctor.

How does a thyroid lump feel?:

Remember that most thyroid nodules don’t cause symptoms. For people who do have symptoms, they may have trouble swallowing or breathing or have a feeling of fullness, pain, or pressure in the throat or neck. Some people might notice a lump in their neck when they look in the mirror, but this is uncommon.

Note: Although some thyroid nodules (especially smaller ones or those filled with fluid) can go away on their own, they tend to gradually grow, even when they’re benign.

What are the symptoms?

Most people with goiters have no signs or symptoms other than a swelling at the base of the neck. In many cases, the goiter is small enough that it’s only discovered during a routine medical exam or an imaging test for another condition.

Remember other symptoms depend on whether thyroid function changes, how quickly the goiter grows and whether it obstructs breathing.

Underactive thyroid (hypothyroidism)

Signs and symptoms of hypothyroidism include:

▪ Fatigue

▪ Increased sensitivity to cold

▪ Increased sleepiness

▪ Dry skin

▪ Constipation

▪ Muscle weakness

▪ Problems with memory or concentration

Overactive thyroid (hyperthyroidism)

Symptoms of hyperthyroidism include:

▪ Weight loss

▪ Rapid heartbeat (tachycardia)

▪ Increased sensitivity to heat

▪ Excess sweating

▪ Irritability and nervousness

▪ Muscle weakness

▪ Frequent bowel movements

▪ Changes in menstrual patterns

▪ Sleep difficulty

▪ High blood pressure

▪ Increased appetite

Children with hyperthyroidism might also have the following:

▪ Rapid growth in height

▪ Changes in behavior

▪ Bone growth that outpaces expected growth for the child’s age

▪ Obstructive goiter

The size or position of a goiter may obstruct the airway and voice box. Signs and symptoms may include:

▪ Difficulty swallowing

▪ Difficulty breathing with exertion

▪ Cough

▪ Hoarseness

▪ Snoring

Treatment

Goiter treatment depends on the size of the goiter, your signs and symptoms, and the underlying cause. If your goiter is small and your thyroid function is healthy, your health care provider may suggest a wait-and-see approach with regular checkups.

Medications

● For increasing hormone production. An underactive thyroid is treated with a thyroid hormone replacement. The drug levothyroxine (Levoxyl, Thyquidity, others) replaces T-4 and results in the pituitary gland releasing less TSH. The drug liothyronine (Cytomel) may be prescribed as a T-3 replacement. These treatments may decrease the size of the goiter.

● For reducing hormone production. An overactive thyroid may be treated with an antithyroid drug that disrupts hormone production. The most commonly used drug, methimazole (Tapazole), may also reduce the size of the goiter.

● For blocking hormone activities. Your health care provider may prescribe a drug called a beta blocker for managing symptoms of hyperthyroidism. These drugs — including atenolol (Tenormin), metoprolol (Lopressor) and others — can disrupt the excess thyroid hormones and lower symptoms.

● For managing pain. If inflammation of the thyroid results in pain, it’s usually treated with aspirin, naproxen sodium (Aleve), ibuprofen (Advil, Motrin IB, others) or related pain relievers. Severe pain may be treated with a steroid.

Surgery

You may need surgery to remove all or part of your thyroid gland (total or partial thyroidectomy) may be used to treat goiter with the following complications:

● Difficulty breathing or swallowing

● Thyroid nodules that cause hyperthyroidism

● Thyroid cancer

You may need to take thyroid hormone replacement, depending on the amount of thyroid removed.

Radioactive iodine treatment

Radioactive iodine is a treatment for an overactive thyroid gland. The dose of radioactive iodine is taken orally. The thyroid takes up the radioactive iodine, which destroys cells in the thyroid. The treatment lowers or eliminates hormone production and may decrease the size of the goiter.

As with surgery, you may need to take thyroid hormone replacement to maintain the appropriate levels of hormones.

When do I see my doctor and what are the red flags?

Visit your doctor immediately if you notice these signs and symptoms – persistent fatigue, sleepiness or even sleep difficulty, irritability and nervousness, problems with memory or concentration, irregular menstrual cycle (in women), difficulty swallowing or breathing, high blood pressure, excess sweating, sensitivity to heat, changes in behavior, changes in height, dry skin, or frequent bowel movements, or experience rapid heartbeat.

– Dr. Prashanth R Reddy
“E.N.T. health – ENTry for better senses”.

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Back of my neck is swollen – FAQs

So, why is the back of my neck swollen?

Your posterior cervical lymph nodes are located near the back of your neck. Several things can cause a swollen posterior cervical lymph node, but the most common cause is a viral infection, such as a cold or the flu.

Common causes of swollen lymph nodes include: strep throat, ear infections, abscessed teeth, and skin wounds or infections.

A few additional symptoms you may experience include:

▪ Tenderness & pain in the lymph node

▪ Runny nose, sore throat, and other symptoms of an upper respiratory infection

▪ Fever

▪ Chills

▪ Night sweats

▪ Multiple swollen lymph nodes throughout your body

Health tips:

1. You can try ice packs, baking soda baths, and fever-reducing medication

2. You can apply a warm, wet compress, such as a washcloth dipped in hot water, and hold it on the affected area.

3. Antibiotic medications prescribed by your ENT doctor can help the lumps heal, if your skin lump is caused by an infection or abscess.

Red flag signs:

1. Swelling persisting for more than a wee

2. Increase un size of swelling

3. Associated with pain

4. Associated with fever, night sweats, or unexplained weight loss

Treatment

An ENT doctor will examine the swelling, look for similar swelling in other parts of the body, and advise an endoscopy to rule out infection. You may also be advised to take a CT scan to rule out the possibility of tumor growth.

The treatment will be tailored according to the cause of swelling, and surgical removal of swelling is mandatory in cases of head and neck tumors.

– Dr. Prashanth R Reddy
“E.N.T. health – ENTry for better senses”

Health tips:

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Ways to self assess mouth cancer

Whether you are looking for answers for yourself or someone you love, we are here to give you the best information available.

Oral cancer, also known as mouth cancer, forms in the oral cavity, which includes all parts of your mouth that you can see. If you open your mouth wide and look in the mirror, you will see your lips, gums, tongue, cheeks, roof, and floor of the mouth.

Oral cancer forms when the cells on the lips or in the mouth mutate. Most often, they begin in the flat thin cells that line your lips and the inside of your mouth. Small changes to the DNA of these cells make the cells grow abnormally. Then these mutated cells accumulate, forming a tumor that grows in the mouth and often spreads to the lymph nodes in the neck.

Important note:Oral cancer is curable if detected at an early stage. The detection of small, early-stage oral cancer has been shown to lead to significantly reduced deaths and suffering

Who gets oral cancer?

The average age of those diagnosed with oral cancer is around 63. Just over 20 percent of cases occur in patients younger than 55. However, it can affect anyone.

There are several known risk factors that could increase your risk of developing oral cancer. If you use any kind of tobacco, including cigarettes, cigars, pipes, chewing tobacco, and others, you are at greater risk. Heavy alcohol use and those with HPV are at increased risk of getting oral or mouth cancer.

What are the ways to self assess oral or mouth cancer?

You can perform an oral cancer risk assessment by following the steps given below:

Face – Examine the symmetry of the face in a mirror, and check for irregularities and new imbalance between the two sides.

Lips – Pull up upper and lower lips to check the texture and color.

Gums – Raise upper and lower lips to check color and conditions of the gums.

Cheeks – Draw back the side of the mouth to check inside the cheeks.

Tongue and floor of mouth – Move the tongue, check as far back as can be seen in the mirror, and feel the area.

Neck – Feel for anything unusual on the sides of the neck.

Trachea – Hold the thyroid cartilage (the Adam’s apple). It should go up and down when you swallow.

How early do I see my doctor, and what are the red flags?

Oral cancer can present itself in many different ways. This can include – a lip or mouth sore that doesn’t heal, a white or reddish patch on the inside of your mouth, loose teeth, a growth or lump inside of your mouth, mouth pain, ear pain, and difficulty or pain while swallowing, opening your mouth, or chewing.

If you are experiencing any of these issues and they persist for more than 2 weeks, visit your doctor. Your doctor will be able to rule out the most common causes first, like an infection.

Prevention of Oral Cancer:

✔ Quit smoking or the consumption of any form of tobacco

✔ Quit betel quid/areca/gutkha/chewing tobacco consumption

✔ Also discourage children and young adults from experimenting with harmful lifestyle habits

✔ Eat plenty of fresh fruits and green-yellow vegetables daily.

Note:

Remember, improving awareness among the general public, including primary care practitioners, dispensing screening or early diagnostic facilities for people, especially for tobacco and alcohol users, and providing adequate treatment for those diagnosed with cancer are critical.

– Dr. Prashanth R Reddy
“E.N.T health – ENTry for better senses”.

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Voice Box Cancer

Larynx helps us breathe, speak, and swallow.

Cancer that forms in any part of the larynx (voice box) is called laryngeal cancer.

This cancer happens when cells grow uncontrollably. As the cells multiply, they invade and damage the body.

The vocal cords are controlled by the laryngeal muscles and nerves, which can be damaged by cancer of the larynx and hypopharynx. Cancer of the larynx may cause a hoarse voice because it affects how the vocal cords move and may cause difficulty swallowing and breathing since it blocks the passage of food and air. Because the vocal cords don’t close properly, we call this aspiration when food or water gets down to the lungs. Finally, they may allow food and air into the windpipe, causing you to cough or develop chest infections.

Important note:

If laryngopharyngeal or hypopharyngeal cancers spread to the lymph nodes, there might be a lump in the neck. Lymph nodes are bean shaped glands in the neck (there are around 900 of them) that are part of the immune system’s defense against infection.

What are the risk factors for laryngeal cancer?

Smoking or using other tobacco products greatly increases your risk of developing laryngeal cancer. Drinking alcohol, especially a lot of it, also raises your risk. Also, using alcohol and tobacco together increases the risk even more.

A few other risk factors for laryngeal cancer include:

▪ Age: Laryngeal cancer happens more in people age 55 and older.

▪ Gender: Men are more likely to develop this cancer, possibly because smoking and heavy alcohol consumption happen more among men.

▪ History of head and neck cancer: About one in four (25%) people who have had head and neck cancer will get it again.

▪ Job: People who have exposure to certain substances at work are at higher risk. These substances include sulfuric acid mist, wood dust, nickel, asbestos or manufacturing mustard gas. People who work with machines are also at higher risk.

What are the symptoms of laryngeal cancer?

● Sore throat or cough that doesn’t go away.

● Voice change, such as hoarseness, that doesn’t improve after two weeks.

● Pain or other difficulties when you swallow.

● Lump in the neck or throat.

● Dysphonia, trouble making voice sounds.

● Ear pain.

If you have these symptoms, seek medical attention immediately:

▪ Trouble breathing (dyspnea).

▪ Stridor, difficulty in breathing that’s noisy and high-pitched.

▪ Globus sensation, feeling that something’s in your throat.

▪ Coughing up blood (hemoptysis).

Treatment

Your doctor will ask you about your symptoms and medical history. Also, they will do a physical exam, examining your throat and neck. After the initial exam, you will most likely need other tests to confirm a diagnosis.

Laryngeal or hypopharyngeal cancers can be treated by surgery or radiation therapy. Many patients receive a combination of treatments, including chemotherapy and radiotherapy.

Depending on the size, location, and spread of the cancer, your doctor will suggest treatments suitable for you.

When do I see my doctor, and what are the red flags?

Visit your doctor immediately if you notice these signs and symptoms – persistent sore throat or cough, lump in the neck or throat, voice change, pain or difficulty swallowing, trouble making voice sounds, ear pain, trouble breathing, high-pitched noisy breathing, or coughing up blood.

– Dr. Prashanth R Reddy
“E.N.T. health – ENTry for better senses”.

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