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FAQ’s on Ear Surgeries

An ear disease can manifest in a variety of ways like ear discharge, earache, reduced hearing, facial asymmetry, ear bleeding among others. Ear diseases refractory to medications would be cleared by surgery of the ear. Since the ear is a sensitive organ and the anatomy is intricate, the surgery is done using either a microscope or an endoscope, each having its own advantages and disadvantages.

Some ear surgeries are done through the ear canal and some require an incision behind the ear on the natural crease line to minimize the post-operative scar. Depending on the type of surgery required the surgeon usually takes a call on the endoscopic or microscopic surgery, if microscopic, whether to be done through the ear canal or if it requires an incision from behind the ear.

As with any surgery, the patient undergoing it runs a modest of risks including bleeding, pain and risk of infection.

Before the surgery

Here are a few things to the patient can do before the surgery so things run smoothly:

Prior to having my ears operated on, should I have a hearing test and a scan?

● A pure tone audiometry (hearing assessment) is required before the surgery to assess the degree of hearing loss and the type of hearing loss.

● A High Resolution scan of the Ear may be required by the surgeon to assess the extent of the disease inside the ear and mastoid region.

What is the importance of Nose and throat examination before ear surgeries ?

● A full assessment of the Ear, Nose and Throat is mandatory.

● Endoscopic examination of the nose becomes important as it is the main organ of ventilation of the ear through the Eustachian tube which is at the back end of Nose.

What can patients do to prepare for ear surgeries?

● Inform the doctor about any medical condition(s) or medication(s) that the patient is on and ask whether it has to be taken on the morning of the surgery.

● Stop smoking if the patient is a smoker at least 3 weeks prior to surgery.

● Arrange for an attendee for the duration of the hospitalization.

● Make sure insurance clearance has been done before admitting the patient to the hospital and if there is any query raised by the insurance company, kindly Whatsapp us the same to us at 8217884802.

● If you have been planning for a day-care surgery (admission and discharge on the same day) kindly get admitted before 6 am or as discussed by your doctor and carry all the reports and scan films along.

During the surgery

Patients are not allowed to eat or drink anything from midnight before the day of surgery. If any medications are advised by the doctor, it has to be taken with a few sips of water.

Will I be awake during the procedure?

Ear being an organ of intricate anatomy and organ of hearing, simple ear surgeries may last for about 1.5 to 2 hrs, more complex ear surgeries may take longer time. Most ear surgeries are usually done under general anesthesia (the patient will not be conscious during the procedure) to aid comfort to the patient and operating surgeon.

After the Surgery

After the procedure, will there be a dressing?

● Mastoid dressing will remain for 5 days after the operation and will be changed to box / tegaderm dressing on first follow-up

● Box / Tegaderm dressing shall remain for 10 days after being put and will be removed on second follow-up

● Both dressings should be maintained clean and water should not come in contact with both dressings

How to apply ear drops after removal of dressing ?

● After the box / tegaderm dressing is removed, NEOSPORIN H ear drops will be started.

● NEOSPORIN H EAR DROPS to be used 4 drops thrice daily in case of intact canal procedures and 6 drops thrice daily in case of canal wall down procedures

● 3 bottles of ear drops for intact canal wall and 4 bottles for canal wall down procedures to be used after which the patient shall come for follow-up

● During the use of ear drops, water should not enter the ear while bathing / washing face etc. for which cotton balls soaked in coconut oil to be squeezed dry and placed in the ear during them.

General precautions

● Avoid bending forwards

● Avoid lifting heavy weights

● Avoid vigorous cough or straining while passing stools, report to the hospital / surgeon in such case

● Sneeze with mouth open at all times

● Avoid sleeping on the operated side

● Head bath should be avoided for 3 weeks after surgery

● In case of any respiratory condition of the patient requiring use of inhalers / rotacaps, patient shall switch over to nebulizers after consulting with pulmonologist

● All medications should be used at the prescribed manner by the patient without fail

● In case of any emergency, patient should report to hospital emergency

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

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Biofilms In Ear infections

A biofilm is a thin layer of microbial slime and proteins adhering to a surface. Biofilm forms when
bacterial cells adhere to a surface and produce a matrix of extracellular polymeric substances (EPS), a
sticky, glue-like material. The bacteria remain embedded within the EPS, which protects them

Bacteria and fungi are present naturally in the air and water. This can attach to damp surfaces and
multiply to form a visible black slime or stain in various colors – black, red, and pink. These growths are
known as biofilms or microbial slime.This is most noticeable in bathrooms and kitchens

What are the stages of biofilm formation?

There are five stages of biofilm development. They are:

● Initial attachment.

● Irreversible attachment.

● Maturation I.

● Maturation II.

● Dispersion.

The biofilm infection life cycle generally follows the steps of
attachment (interaction between bacteria and the implant), accumulation (interactions between
bacterial cells), maturation (formation of a viable 3D structure), and dispersion or detachment (release
from the biofilm).

Why is biofilm so dangerous?

Inside biofilms, bacteria can communicate, live, feed, and grow. Bacteria are typically 200 times harder to
kill with antibiotics or disinfectants inside a biofilm. While they are alive, they remain a threat to
patients. The bacteria will continue to grow until the biofilm is disturbed or the released bacteria are
transferred to other surfaces by hands, gloves, cleaning cloths, or other materials.

Only highly effective systems and products can assist with the removal of biofilms and kill harmful
bacteria and other microorganisms.

Biofilms and health hazards

One common example of biofilms in the human body is the dental plague. They form a yellow coating on
your teeth and cannot be easily removed.

Biofilms and ear infections – Studies have
shown biofilm formation in a chronic
middle ear infection and in the mastoid.
These biofilms are difficult to treat and
contribute to recurrent ear infections.
Similar implants used in the ear like
grommets, ossicular prostheses, and
cochlear implants have also shown biofilm
formation

How to treat BIofilms in the ear?

The treatment of biofilms is tricky. As
antibiotics are less effective here, mechanical removal of the slime/plaque is important. Similar to this,
tympanoplasty ( ear surgery to close the perforation ) is done to remove the biofilms and enhance
healing thereby preventing recurrent infections

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

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Ear wax

A quick guide for understanding ear wax related problems.

First, let us try to understand what earwax is. Ear wax is a substance that is produced in your ear canal by ceruminous glands in the external ear canal. It helps prevent some dust and small particles from entering the ear and damaging or disrupting the eardrum. Everyone produces ear wax, although some produce more than others, and it is determined genetically.

Important note: Ear wax dries up and its self-cleaning, secondary to the vibration of the ear canal due to the movement of the jaw joint that’s in front of the ear. But for some people, they experience an earwax buildup of earwax impaction.

Your ENT doctor can see if you have an earwax blockage by looking in your ear. Your doctor uses an endoscope that lights up and magnifies your ear to examine it well.

Symptoms of earwax build-up:

Here are a few symptoms of earwax build-up:

▪ You may experience hearing loss

▪ Ear pain or blocked feeling in the ears.

▪ Buzzing or ringing in your ears (tinnitus)

▪ Vertigo – feeling dizzy and unable to balance

Ways to treat earwax build-up at home and keep your ears squeaky clean:

Avoid using your fingers or any objects like cotton buds, keys, or safety pins to remove earwax. This will push it deeper and make it worse.

There are certain drops that you can buy over the counter that can help soften the ear.

Apply 2 to 3 drops of medical grade olive or almond oil in your ear 3 to 4 times a day. You can try this for 3 to 5 days.

Note: Do not use drops if you have a hole in your eardrum or a perforated eardrum. Remember, there is no evidence that ear candles get rid of earwax.


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

If, for whatever reason, you feel that the home remedies have failed, you can visit your ENT doctor. Your doctor will be able to recommend medicines to dissolve the earwax.

Also, you may need to visit your health care provider once or twice a year for regular cleaning.

Visit your ENT doctor when conditions such as discomfort in your ears or issues with your hearing persist for a long time, ear pain, a blocked feeling in your ear, ringing or buzzing in your ears, or when you experience vertigo related problems – spinning sensations, loss of balance, an inability to walk, persistent vomiting, or a high fever.

Treatment for ear wax impaction::

Treatment of an earwax impaction depends on the severity of your earwax problem; quality and consistency of the earwax that is built up.

If your ear wax looks hard or dried up, your ENT doctor may use a small drop of an oil solution inside your ear canal. This will help to soften the earwax before they try to remove it.

Your ENT doctor can remove excess wax by using a small, curved tool called a curet or by using suction techniques under endoscopic vision.

Medicated ear drops may also be recommended to help soften the wax, such as carbamide peroxide. Since these drops can irritate the delicate skin of the eardrum and ear canal, use them only as directed by your ENT doctor.

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

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I hear ringing in my ear – FAQ

Ringing in the ears is called tinnitus. This sensation is not caused by an external sound and hence cannot be heard by others. You may have the sensation of hearing buzzing, hissing, chirping, whistling, ringing, or other sounds that could be intermittent or continuous.

The loudness of tinnitus may vary. It is often worse when the background noise is low; hence, you may hear this more at night when you are making an effort to fall asleep.

It affects about 15% to 20% of people and is especially common in older adults. It’s a signal to listen to your body.

Why do I have tinnitus?

The major cause of tinnitus is damaged hair cells in the inner ear. It could be due

1. Old age- As age advances, the hair cell are more prone to oxidative damages

2. Exposure to loud sound for a longer time- May be occupation related, can lead to hair cell damage

3. Ménière’s disease- Inner ear disease associated with balance disorders

4. Ear infections / accumulated wax

5. Brain tumors

6. Hormonal changes in women

7. Thyroid abnormalities

8. Medications- NSAID , diuretics, antidepressants etc

9. Acid reflux

10. Jaw disorders – Like TMJ arthritis/tenderness

Important note

Tinnitus may also be associated with hearing loss.
Patients who were infected with Covid 19 also present with sudden hearing loss and tinnitus

Treatment for tinnitus

The doctor may conduct a detailed physical examination of the ENT region, especially the ear and nose endoscopically. Inform the doctor about the medications that you take. A detailed audiogram (hearing test) will also be taken for assessing the hearing status of the patient. To rule out structural damage to the inner ear The doctor may suggest you MRI of the brain and inner ear.

Treatment depends on the cause of tinnitus. Any correctable causes/ underlying medical conditions will be evaluated and managed first.

Depending on the severity and time of onset, your ENT doctor may recommend:

⮚ Medications

⮚ Injections into the ear

⮚ Hearing aids.

⮚ Counseling.

⮚ Wearable sound generators

⮚ Acoustic neural simulation.

⮚ Tabletop sound generators

⮚ Cochlear implants.

Hearing aids and sound generators create a band of noise that helps to cancel out the ringing sensation in the ear. Hearing soft music at night may help with sleeping.

Tinnitus Retraining therapy

To get rid of tinnitus, we must train our brain to become accustomed to this signal. This requires time and effort from the patient to get used to it and ignore the tinnitus sound.

Cognitive therapy and Relaxation techniques will also help you with the same

How to prevent Tinnitus?

1. Avoid exposure to loud sounds.

2. Wear Earplugs at the workplace in case of loud noise

3. Reduce the volume if you’re listening to music; avoid loud music.

4. Avoid self medications

5. Avoid too much alcohol, caffeine, smoking ( Nicotine)

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Why is my ear blocked? – FAQ

So, why is my ear blocked?

You have clogged or muffled sensations in the ear due to a block in the ear canal, like wax, a foreign body, or sometimes jaw problems. Another major cause of ear block sensation is fluid collection inside the ear impairing the hearing mechanism

Wax or foreign body has to be removed under medical endoscopic supervision. Avoid probing your ear with earbuds. This could injure the eardrum directly or push the wax deeper into the canal.

Hearing impairment as a part of aging or due to nerve damage can also manifest as an ear block.

How does fluid collect inside the ear?

The main reasons for fluid accumulation are an active ear infection, a sudden change in pressure, or a dysfunctional eustachian tube.

1. Otitis Media

A clogged ear, also known as Otitis Media, is an ear infection that occurs when fluid builds up in the middle ear and a virus or bacteria starts to multiply in the fluid. It could be a part of the common cold or cause nasal allergies too. In infants and toddlers, faulty breastfeeding techniques can also cause this.

Note: This is not a serious condition, but it is still difficult and uncomfortable to live with, and this can undoubtedly make everyday life feel hard. You may also end up with a Swimmer’s Ear which is a condition that results from water being trapped in the ear. Also, it is good to be sure that you aren’t missing something more serious than just a little fluid or wax in the ear.

2. Otitic barotrauma.

Ear Block after a flight journey is called Otitic barotrauma. You may end up with a cold when you fly or dive, which prevents adequate equalization of pressure in the middle ear. Sometimes your middle ear and the back of your nose get blocked. You may experience a feeling of fullness or pressure in your ears. This causes ear pain, dizziness, and muffled hearing. There are times when the swelling from the cold subsides, and the blockage usually resolves itself.

3. Eustachian Tube Dysfunction (ETD)

The Eustachian tube is a small canal that runs from either ear (from the middle ear) to the back of the nose and upper throat. For the most part, the Eustachian Tubes remain closed, but they will open as a person chews, yawns, or swallows and equalize the pressure inside the ear. Another function of the eustachian tubes is to drain built-up mucus into your nose or throat.

Please note: Eustachian tube dysfunction (ETD) can trigger physical blockage, swelling-induced blockage, and a ruptured eardrum.

Remedies to unblock your clogged ears:

✔ In case your ears are plugged, try swallowing, yawning, or chewing sugar-free gum to open your Eustachian tubes.

✔ Take a deep breath and try to blow out of your nose gently while pinching your nostrils closed and keeping your mouth shut. If you hear a popping noise, you know you have succeeded.

✔ Quit smoking today, as smoking causes ciliary movement dysfunction leading to mucous non clearance

✔ A warm compress can help reduce the pain caused by clogged ears.

✔ Gargling with water (with/without salt) may help prevent upper respiratory infections. It can also help ease the symptoms of nasal congestion and clogged ears associated with a cold or flu.

✔ Cooking vinegar contains acetic acid, which can heal chronic ear infections.

Other ways to clear plugged ears:

✔ Nasal decongestants which should be used only for a few days

✔ Topical nasal steroids, especially in people with allergies (as recommended by your ENT doctor)

✔ Ventilation tubes, in severe cases, drain fluid and relieve pressure

Important tip:

If the blockage does not clear, this could mean that there is dysfunction in the eustachian tube, which could cause further complications and lead to infection if not treated. If your symptoms are severe or last more than two weeks, visit your ENT doctor immediately.

Adjust your lifestyle habits and remember to follow your doctor’s instructions to lead a healthy life.

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

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Ear pain

A quick guide for understanding ear pain

Ear pain is medically known as otalgia. Ear pain may arise from any complaints in the ear or can secondarily be due to other conditions(Referred otalgia)

The direct causes of ear pain can be

1. Injury or laceration of the pinna

2. Infection of the cartilage of the pinna( Perichondritis)

3. Injury to the external ear canal(otitis externa)

4. Infection to the middle ear ( Otitis media)

5. Impacted wax

6. Otic barotrauma ( injury due to pressure changes )

7. Infection in the temporal bone( Mastoiditis)

8. Tumors of the ear

The secondary causes ( Referred otalgia )

1. Dental caries and impacted molar teeth

2. Jaw disorders and jaw joint arthritis

3. Elongated styloid bone ( styalgia)

4. Tonsillitis

5. Pharyngeal infection /tumors

6. Herpes zoster infection

Ear pain due to mastoiditis ( Infection of ear bone)

Mastoiditis is a bacterial infection that affects the mastoid bone behind and under the ear. It is common in children. Most people recover quickly with no complications as long as the condition is diagnosed and treated quickly.

Ear infections, and particularly middle ear infections, are the most common cause of mastoiditis. The bacteria responsible could spread without effective treatment. This may happen if a person stops the course of treatment before it is complete or if the bacteria are resistant to the prescribed antibiotics.

An abnormal growth of skin cells in the middle ear, called a cholesteatoma, can also cause a blockage that allows bacteria to multiply and leads to mastoiditis.

Consultation Hours :

Note: This condition is rare and can be life threatening without proper treatment.

Symptoms of Mastoiditis include:

▪ Throbbing or burning pain in or around the ear

▪ Pus or other fluids coming from the ear

▪ Fever or chills

▪ Swelling behind or under the ear

▪ Redness behind the ear

▪ Bad smell coming from the ear

▪ Ear appearing to stick out more or be pushed forward

▪ Difficulty hearing

▪ Ringing in the ears

▪ Mood changes

▪ Pulling on their ears (especially in children)

Please note:If these treatments do not work, your ENT doctor may recommend surgery to prevent further complications.

What are the triggers for ear pain?

Using earbuds, probing the ear, Acute ear infections and untreated tooth infections are the primary triggers for exaggerated ear pain

Treatment for ear pain:

Treatment of ear pain depends on the causative factor. Visit your ENT doctor to identify the cause and start the treatment

Ear infections often clear up on their own. Treatment may begin with managing pain and monitoring the problem. Usually, antibiotics (orally and topically) are used to clear the infection.

Consultation Hours :

Home remedies at the time of pain are

✔ An ice pack or warm compress Soak a washcloth in either ice water or warm water, wring it out, and then put it over the ear that’s bothering you.

✔ A heating pad: Lay your painful ear on a warm, not hot, heating pad.


How can an ENT doctor help you?

ENT doctors deal with the senses that help you work very efficiently. Earlier screening and detection of ENT disorders can help you avoid permanent health issues.

Visit your ENT doctor if you have signs of possible problems such as redness of the ear canal, swelling of your outer ear, fever, ear pain, blockage of your ear canal, draining fluids and discharge of pus, severe

pain that might radiate to your face, neck, or side of your head, and swelling in the lymph nodes in your neck.

If an earache is accompanied by dizziness, a serious headache, swelling around the ear, or a dropping of the facial muscles on one side of the face, then it may be time to seek medical treatment. A persistent fever of 104ºF (40 ºC) or higher in children is a clear sign that medical attention is necessary.

An ENT doctor can also help with the assessment of your hearing status and provide advice regarding the methods of prevention and treatment of hearing loss.

– Dr. Prashanth R Reddy

“E.N.T health – Entry for better senses”.

Consultation Hours :

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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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