When does ear wax create problems? Dry, hard wax when accumulated over a long period becomes impacted and causes pain, blockade and itching in the ears. In such cases application of wax solvent drops and if necessary removal of impacted wax by the ENT specialist may be required.
What are the causes of ear discharge and how serious is this symptom? Purulent ear discharge may be due to ruptured boil in the ear/fungal infection of the external ear or infection of the middle ear. The causes can be repeated usage of pins/match sticks/keys/ear buds in the ear/swimming in contaminated water or a bout of cold. This symptom should not be neglected as it can lead to other complications like cellulitis of periaural tissues, spread of the infection to the mastoid bone, chronic perforation of the ear drum and subsequent deafness.
What are the causes of deafness in children? The most common cause is impacted wax, the second being glue ear or wax, collection of fluid in the middle ear for more than 3 weeks following an episode ear infection. The other causes are sensorineural deafness by birth or perforation of the ear drum with repeated pus discharge.
How can deafness be evaluated? The treatment depends on the cause. If it is sensorineural hearing loss, there is no permanent remedy. One has to opt for digitalized hearing aids or in case of profound hearing loss one can go for the cochlear implant which consists of inbuilt array of electrodes implanted in the cochlea to stimulate the auditory nerve. In cases of conductive hearing loss the remedy is medical and or surgical treatment depending on the specific cause.
How can deafness be treated? The treatment depends on the cause. If it is sensorineural hearing loss, there is no permanent remedy. One has to opt for digitalized hearing aids or in case of profound hearing loss one can go for the cochlear implant which consists of inbuilt array of electrodes implanted in the cochlea to stimulate the auditory nerve. In cases of conductive hearing loss the remedy is medical and or surgical treatment depending on the specific cause. In cases of conductive hearing loss the remedy is medical and or surgical treatment depending on the specific cause.
What is allergic rhinitis? It is a hyper-responsiveness of the body to certain allergens like dust-mites, fungus, food items, pollen, animal dander etc. On exposure to these allergens the body mounts an IgE-anti body mediated response. This leads to release of certain chemicals like leukotrienes, histamines, etc. The symptoms manifested are sneezing bouts, watery nasal discharge, stuffiness of nose & itching of nose, eyes, ears and throat.
Is this condition hereditary? If one parent has history of atopy, allergic rhinitis, bronchial asthma or skin allergy, there is a 10% chance of transmission to the children. If both parents have history of allergy then the chance of children acquiring this disease is 30%.
How can this condition be treated? The most important factor is identifying the allergens and trying to avoid the particular food items or aero allergens. The next factor is regular usage of antihistamines, leukotreine inhibitor drugs and intra nasal steroid sprays for a minimum duration of 3-6 months especially in the season during which the patient has maximum symptoms. If the above treatment modalities fail then immunotherapy can be tried. By this procedure the patient is exposed to low doses of allergens in the form of injections periodically to develop his immune system and make it resistant to the allergens.
What are the complications if allergy rhinitis is untreated? The patient may develop sinonasal polyposis, bronchial asthma, skin allergies etc.
Tonsils & Adenoids:
What are the Adenoids and Tonsils? These are lymphoid tissue collections in the region behind the nose and in the throat, they form part of the waldeyer’s ring which is a group of lymphatic aggregates in the upper respiratory tract.
Do they have any role to play in the immunity of children? They contain B-lymphocytes so help fight against upper respiratory tract viral and bacterial infections up to the age of 5years.
What are the problems related to tonsils and adenoids? When these lymphoid tissues enlarge in size or get infected they produce symptoms like throat pain, high-grade fever, nasal blockade, snoring, earpain, swallowing difficulty etc.
When is surgery advocated for infection of tonsils/adenoids? When the children suffer from repeated attacks of adenotonsillitis (5-6 attacks per year for 2-3 years consecutively) or if the enlargement of these glands is significant enough to cause breathing difficulty and snoring in children then adenotonsillectomy is advocated.
Snoring & Obstructive Sleep Apnea:
What is snoring? It is caused by vibration of the soft tissues of the throat due to laxity and reduced muscle tone of the uvula , soft palate & loose mucosa of the throat when the person breathes in a supine position.
What are the causes for snoring? Partial obstruction of the nasal, pharygeal passages during sleep lead to snoring. The causes can be obesity, short thick neck, small lower jaw, large base of tongue, loose flabby soft palate, polyps, deviated nasal septum or turbinate hypertrophy in the nose etc. Regular intake of alcohol/sedatives, hypothyroidism, hyperlipidaemia, diabetes, hypertension can be associated triggers.
What is obstructive sleep apnea? Near complete blockade of the upper respiratory throat during sleep leading to snoring with intermittent complete cessation of air flow for 10seconds or more(apnoeic spell) is called obstructive sleep apnea.
What are the symptoms of obstructive sleep apnea(OSA)? Snoring, frequent waking spells at night, choking of breath in sleep, tiredness and daytime excessive sleepiness are the main symptoms.
How does one diagnose OSA and grade its severity? Complete Head & Neck examination by Ent specialist is done. Body mass index, neck circumference, nasal pathology, position of the tongue, tonsillar enlargement, lower jaw position etc are assessed. Flexible nasal endoscopy is done while performing Muller’s Manoeuvre . Polysomnography(sleep lab studies) to monitor various parameters like Bp, heart rate, respiratory rate, chest and abdominal movements during respiration, oxygen saturation etc during an 8 hour sleep period is performed. We can find out the apnea-hypoapnea index by this test and grade the severity of OSA. A dynamic MRI scan of the head-neck during sleep is also done to ascertain the level of airway obstruction/collapse.
How is OSA treated? Mild OSA or simple snoring is treated by conservative measures like weight loss, dietary & life – style changes, change of posture while sleeping etc. The nasal pathology can be corrected surgically by septoplasty, turbinoplasty or FESS. Despite these methods if OSA persists then CPAP machine can be used by the patient during sleep. This device delivers continuous positive air pressure via a mask to keep the upper airway patient and prevent it from collapsing and patient going into apnea.
What are the surgical modalities for treating OSA? For moderate OSA the treatment of choice in a fit patient is surgical intervention to reduce the length of the flabby soft palate, remove enlarged tonsils, reduce excess base of tongue which is falling backwards and closing the airway in sleep etc. These surgeries can be performed in a conservative way by radio frequency stiffening of the lax, bulky tissues or by surgical excision, depending on the requirement.
What are the complications of untreated OSA? Reduced concentration in work and studies, lethargy and excessive sleepiness during daytime, uncontrolled hypertension and diabetes, pulmonary hypertension & Cardiac failure.