ENT A-Z

Hearing loss? You must know this one thing

By Dr.Amrita Basu(MBBS,MS) on April 9, 2020 8

Hearing loss? You might want to get that checked.

Ideally, it should be done by a professional in a sound-treated room. Audiometry tests are done by an audiometrist and sometimes by ENT surgeons like me. Clinically your Ear doctor will check your hearing with a tuning fork, to get an idea about the type of hearing loss. A broad classification is Conductive and Sensorineural.

You can test your hearing online here.

What are the Tests for hearing loss?

PTA: Pure tone audiometry

OAE: Otoacoustic emission

Tympanometry

Behavioral audiometry is for children less than five years.

BERA: Brainstem evoked response audiometry

The effect of hearing loss and sound trauma, have been explained in detail in multiple posts. Excessive use of earphones can also cause problems if it’s used for a long duration and at high volume. Excessive alcoholism can also cause hearing loss and tinnitus.

A hearing aid is an excellent first step in all conditions where it will help.

If you don’t use a hearing aid and you need one, the progressive starvation of the hair cells. causes potential deterioration of hearing. This when beyond a certain point, a hearing aid may not be as helpful.

Medications and systemic diseases need to be ruled out including hypothyroidism, and ototoxic drugs.

Cochlear implant has a significant role in children with speech and language delays due to hearing challenges.

Can Hearing loss be restored?

Ear disease-causing conductive hearing loss are Acute otitis media, wax, otitis media with effusion, chronic otitis media, Otosclerosis, Aeroplane ear, etc. Some of these conditions improve after medical, surgical, or a combination of therapy. Hearing in those cases does improve.

But when hearing loss is caused by sensorineural causes where the nerve damage is suspected, then only medicines or surgery will not restore complete hearing. In those cases hearing aids are useful.

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Glue Ear: Symptoms, Causes, Treatment and The Grommet

By Dr.Amrita Basu(MBBS,MS) on April 7, 2020 11

Glue Ear and the Grommet: Who needs it?

Is Glue ear even a thing? Do you really have glue in your ear ?Is that a problem? How do you get the glue out ?

It sounds strange right to have glue inside your ear, but that’s what happens in some children and adults. It’s a condition where there is a chronic accumulation of mucus(glue) in the middle ear and the mastoid air cell(the bone behind your ear) system.

Its also called serous otitis media, secretory otitis media, mucinous otitis media, glue ear, blue drum, catarrh of the middle ear.

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It’s very common in children zero to two years and can follow:

Earache and acute otitis media

Viral upper respiratory infection without earche.

Both can cause damage to the eustachian tube and retained middle ear fluids.

It can be associated with eustachian tube dysfunction, Adenoids, cleft palate(even after repair), parental smoking, allergies, and Gastro-esophageal reflux.

Its difficult to understand whether the child is hearing well at this age and its often a smart parent who notices the first symptom of decreased hearing. If a child or an adult has persistent heaviness or blocked ear with decreased hearing( most commonly conductive type), with popping sound in ear, it’s often a case of otitis media with effusion .

Diagnosis involves

An otoscopy at your ENT doctor

Pneumatic otoscopy to check mobility of thee ar drum

A Free field audiometry/Behavioural audiometry

OtoAcoustic emission

Pure Tone audiometry in children above 5 years age

Serial tympanometry where a flat B type curve indicates

Other Tests needed

Xray nose and PNS

Xray nasopharynx lateral view.

Glue ear treatment: How will the Glue ear get better?

Counseling to help parents cope better with the condition.It is a condition with a good spontaneous recovery rate. But we need the child to be in a regular follow up and parents need to be aware. If the hearing loss affects speech or schooling then other management may be needed.

Medical management which may include intranasal steroids or antibiotics

Grommet or Ventilation tubes: Let the ear breathe!

If the fluid doesn’t get dried up itself, a small slit is made in the eardrum, called Myringotomy and the fluid /glue aspirated. A small ventilation tube/grommet is inserted, which helps to create a pathway for the fluid to drain.

Once the liquid is drained, the grommet pops out. The procedure is called Myringotomy and grommet insertion, and sometimes Myringotomy may be done without grommet insertion.

Sometimes following grommet insertion, a persistent perforation can be a complication.

A myringotomy and aspiration may not improve hearing. But the grommet insertion does improve hearing levels. The effect is better with adenoidectomy, in someone with enlarged adenoids blocking the eustachian tubes. For children, this needs General anesthesia.

Do adults have Glue Ear?

Yes they can .They too will have decreased hearing,popping sound inear ,occasional mild earache,ringing sound in ear

Did you ever have a glue ear? Have you ever had your ear popping? Let me know in the comments below.

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Functional Endoscopic Sinus Surgery in Polyps: Breath Easy! #BlogchatterA2Z

By Dr.Amrita Basu(MBBS,MS) on April 6, 2020 7

FESS is a short form for functional endoscopic sinus surgery. It’s a minimally invasive method of removing nasal mucosal disease, most often polyps. One of my first surgical cases as a private practitioner was a FESS patient.

It’s a graceful surgery. The surgeon uses endoscopes(Metallic tubes with special magnifying lens at the end) attached to the camera, to look deep into the nasal cavity, the sinuses. A good visual field helps in preserving normal tissues and selective removal of the disease. This helps the nose breathe again.

When adults have polypoidal masses coming out of both nasal cavity, its often ethmoidal polyposis. In case it’s in a child and involves one nasal cavity, its often Antro choanal polyp.

Ethmoidal polyps :How do they look

The appearnce is classic.Swollen, hypertrophied nasal and sinus mucosa, which looks like a bunch of bluish-grey grapes, is the commonest presenting feature in my practice.

It is smooth, mobile, generally painless, and doesn’t bleed on touch. These are the nasal and sinus membrane, filled with discharge, secretions and inflammatory cells, causing it t become swollen.

It is common in males. It can be infective, allergic, or a combination of both. It has an association with cystic fibrosis.

Kartagener’s syndrome

Kartagener’s syndrome is a disease of immotile cilia(primary ciliary dyskinesia). It often presents with ENT symptoms like chronic sinusitis polyposis, bronchiectasis, cystic fibrosis, infertility and situs inversus. It is a rare autosomal recessive genetic disease. That means both your parents must carry this genetic trait for you to have this syndrome.

Cilia is the fine hair cells in your mucosa which helps to clear up secretions. Cilia also help sperms move and reach the ova during fertilization. One cause of male infertility is Kartagener’s syndrome.

Symptoms of sinusitis with polyposis

Nasal obstruction nasal discharge

History of snoring and poor sleep

History of nose blowing

Decreases sense of smell hyposmia

Sneezing and symptoms like allergic rhinitis

Hyponasal voice

Mouth breathing

It can be associated with a deviated septum and inferior turbinate hypertrophy

Nasal bleeding in case of infection and forceful nasal cleaning.

Tests you need before Sinus Surgery

Routine blood test including checkup for blood sugar and absolute eosinophil count, coagulation profile and more as needed.

The investigation includes CECT Nose and PNS,a diagnostic Nasal endoscopy.

A biopsy is done sometimes if your doctor suspects a fungal polyp or neoplastic lesion.

Computed Tomography or a CT scan is needed before Sinus Surgery

Is Surgery the only treatment for Sinusitis?

Treatment involves medical management, which can consist of oral and /or intranasal steroids with or without antibiotics and antihistamines. Both preoperatively and postoperatively medicines and nasal sprays help improve nasal functions.

After maximal medical therapy of three months, if the response is not adequate, FESS is done. In the case of allergies being the cause behind polyps, there is a need for continuing proper precaution for allergic rhinitis and Sinusitis.

FESS: Functional Endoscopic Sinus surgery

Functional Endoscopic Sinus surgery is the endoscopic approach to nasal surgery. Its commonly used to treat nasal polyposis and Sinusitis not improving with medicines.FESS is also used to do many other nasal surgeries, which I have mentioned later in this post.

A series of fine endoscopes with different angulation to their lens, like zero thirty degrees, forty-five degrees, is used for surgeries of the nose. The size of the adult and pediatric endoscopes are different. A full Endoscopic setup is needed, including a camera, monitor and a trained anesthetist.

The best part about FESS is it’s minimally invasive.No external cuts are made, and no sutures are needed. Tissue removal is done to improve the physiological pathways of nasal drainage.No aggressive debridement is done. Histopathological test of tissue is done and also stained for fungal debris.

In the case of fungal polyposis, systemic Antifungals may be needed and is a potentially severe condition.

Postoperatively patient needs a nasal pack, most often Merocel to prevent bleeding. Strict bed rest for some time, depending on the extent of disease and surgery.

What are the Risks of Endoscopic Sinus Surgery?

It depends on the extent of disease and patient conditions. But major complications include persistent nasal bleeding, visual disturbances, and intracranial complications.

Will the polyps come back?

Recurrence is far less in the case of FESS and 90% of patients have improved quality of life. Postoperative follow up with medicines is often needed for long term disease-free life.

Other indications of Sinus Surgery

Chronic rhinosinusitis not improving with medicines,

Sinus mucocele,

Allergic fungal sinusitis,

Nasolacrimal duct obstrution,

Cerebrospinal fluid leak,

Severe nasal bleeding,

Tumors of the mose and sinuses,

Transnasal surgical approack for skull base lesions .Have you heard about this type of surgery ?Let me know in the comments below.

How can I permanently cure Sinusitis?

DiabetesThe treatment depends on the type of sinusitis allergic,bacterial or fungal .It also depends on whether its of a long duration of less than 3 months (acute) or prolonged duration (chronic).Whether patient has Diabetes will affect the course of disease

Treatment options for Sinusitus are

Nasal wash
Steam inhalation
Antibiotic/Antifungal depending on type.
Nasal steroid sprays
Allergy treatment (if allegic)
Surgery like FESS
Oral steroids for brief period preoperative or specific cases.

ALLERGIC RHINITIS: WHAT YOU NEED TO KNOW (Part 1)

Test and Treatment for Allergic Rhinitis (Part 2)

6 Things you can do to Fight Indoor Allergy

Functional Endoscopic Sinus Surgery in Polyps: Breath Easy!

COVID 19

Swine Flu: Symptoms

Everyday practices to prevent Swine Flu

Cold and Flu

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References:

ENT Telehealth in India: It’s here #Healthwealthbridge

By Dr.Amrita Basu(MBBS,MS) on April 4, 2020 15

ENT Telehealth: It’s here

If you want a telehealth consultation ,you can contact me at dramrita @healthwealthbridge.com.Call or message .Video,audio ,text consultations is available,

9735796809

No one can escape writing about the new Coronavirus . With the current scenario, I have written about and even appeared for an interview with Blogchatter about Coronavirus. It’s also one form of telehealth. Offering health education through technology.

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Telehealth/Telemedicine allows Registered Medical professionals to assess, evaluate, diagnose, counsel, offer treatment. In remote locations, patients can access medical expertise quickly, efficiently, and without travel.

How to find your doctor in Indian Medical Council Register

I started offering telemedicine advice since 2013 when I signed up with the Lybrate platform. Lybrate needs registered medical practitioners to upload their qualifications, including registration number and details, to the platform for verification. You can check the Doctor’s credentials, reviews, advice, and many more.

I started my website Healthwealthbridge in 2014 to have a platform to explore writing, but also write about ENT diseases, common healthcare FAQ s, health, nutrition, and educational material for those who want to take responsibility for their own health. It’s now also a quick and easy way to offer Telehealth/telemedicine services. The following part has necessary self-promotional elements, but I think you will forgive me.

Healthcare is a two-way street.

Until you commit to being responsible and choose the right healthy lifestyle practices, few things can help you. India’s population has made the doctor-patient ratio facing a crisis. More so in the Coronavirus issue amongst many.

People are ignoring Self-quarantine and self-reporting rules and totally ignoring Lockdown in many places. But all is not lost. If we take care of listening to good advice, follow the lockdown, we will be okay.

But if not …

It’s now the survival of the fittest -Darwin said it and its still true.

Many health care practitioners are moving to offer services through audio, video, email, and text chats.

India released a National Digital Health Blueprint detailed framework in January 2020. This is good, and we need to adapt to it quickly. Both Doctors and patients.

Luckily the penetration of telecom services is much better than other sectors, and this helps us provide health education, primary care, First aid, follow-ups at different levels, even at a remote location.

Remember, you can text me, send audio messages, send video messages, request live telecalls, WhatsApp calls, and video consultation. Consulting through telehealth protects patients under the same confidentiality with restrictions for a specific category of medicines. In case you are interested, you can enquire with your Doctor whether they are providing telehealth services/Telemedicine services.

You can text, send audio, video or schedule an audio/video consultation and Pay through NEFT/PayTM or other modes

9735796809

Lybrate Profile Link Dr.Amrita Basu

Consult me on Lybrate

ENT TELEHEALTH INDIA DR.AMRITA BASU — ENT TELEHEALTH INDIA

Difficulty Swallowing? Dysphagia in Cancer #BlogchatterA2Z

By Dr.Amrita Basu(MBBS,MS) on April 3, 2020 8

Difficulty swallowing or dysphagia is a common ENT complaint. It’s the ENT surgeon bread -butter version complaint. Today I will tell you about the danger hidden behind such a common and innocuous symptom.

A few months back a 75-year-old man had come to my clinic with his daughter-in-law. The complaint was the inability to swallow food for one month. On detailed questioning, the initial complaint of dysphagia started almost two months back with on and off the review by quacks(you know my thoughts about that) and alternative therapy. He had never visited an ENT doctor for his complaints. He also had not been given any prescriptions for alternative medical therapy.

He was suffering so much, that swallowing his own saliva was difficult. He was severely dehydrated, hardly ate anything. But he was still smoking. Without going into too many details, I can tell you that his HRCT of the thorax(chest) showed a growth obstructing more than two-third of his food pipe. I referred them to Apollo Kolkata and Tata Medical Centre Kolkata and explained to them about the need for urgent intervention.

Time is crucial for malignancies as such and more so for your breathing tubes and food pipe.If every time you swallow saliva

It has a long list of causes and can be divided easily into acute or chronic.
The most infectious condition with pain throat also has difficulty swallowing like in tonsillitis and Pharyngitis. If you have hawking, repeated clearing of the throat and a postnasal drip, that can cause dysphagia too.

When it’s difficulty swallowing with pain, its called odynophagia.

Fear of swallowing or Phagophagia occurs in Rabies, hysteria, tetanus
Globus hystericus is a sensation of a lump in the throat often associated in chronic anemia and common in women.

Today I will talk about malignancy causing dysphagia and the signs you should be aware of.

The Early warnings

Its the progressively increasing painless difficulty swallowing. Most common in a smoker with a history of regular high volume alcohol intake. Presenting with maybe a hot potato voice is cause for worry /Cancer of the upper part of the throat, often present with difficulty swallowing. So does cancer of the esophagus.

There may or may not be a lump in the throat/change of voice and difficulty breathing. Sudden significant unexplained weight loss is common in cancer of food pipe.

Anything more than two weeks’ duration needs the help of diagnostic tests . A Fibreoptic laryngoscopy is an office procedure to have a peek into the pharynx/larynx and pyriform fossa. If that looks clear, you need a Barium, swallow esophagus, and a CECT Neck and HRCT thorax as further workup.

As a rule of thumb, if the malignancy arises from the vocal cords and then spreads to food pipe, hoarseness precedes dysphagia.

Malignancy causing Dysphagia

Pharyngeal malignancy
Oesophageal malignancy
Laryngeal malignancy involving food pipe.

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Treatment depends on the site, size, spread, and type of cancer.
Prognosis is dependent on histological type, local spread, metastasis, and patient profile. In more cases, the correlation between smoking and alcohol abuse is very high in such cancers. Surgery and adjuvant therapy are planned after a full review . Nowadays Proton therapy is another modality that is considered.

Cancer of the Tongue: Chewing habits to chew on!

By Dr.Amrita Basu(MBBS,MS) on April 3, 2020 12

Cancer!The C-word which now has competition from Corona.Just like COVID19 prevention, with lockdown and social distancing
, for this cancer prevention works.

The slightly raised edges, feeling of roughness, giving rise to a small nodule that breaks down and forms an ulcer. The ulcer doesn’t heal with all your self-medication, alternative medicines and several multivitamin tablets supplied by the friendly pharmacy shop owner. This is, in short, the life story of cancer of the tongue

I have written about throat cancer and extensively about mouth cancer. Cancer of the tongue falls under mouth cancer or oral cancer, and broadly the treatment policy follows a similar pattern.It often follows the abuse of gutkha paan masala and other tobacco chewing habits.

If you want some different reading material with the letter C, try Coronavirus outbreak, Taiwan fight with New Corona virus:why they ignored Chinese data, or Home Quarantine For Corona: the right way

How does tongue cancer present?

It can present in the anterior two-thirds(45%) or posterior one-third of the tongue. The majority of those in the anterior part is seen at the lateral border of the tongue.
Nonhealing ulcer of the tongue.
A raised area with areas of ulcer and tissue piled up. There may be bleeding from the tongue.
The doctor will take a wedge biopsy or an excisional biopsy depending on the size of the lesion.

In uncontrolled diabetes, a nonhealing ulcer may often confuse clinical diagnosis.

On palpation of the tumor/ulcer, it most often will have an indurated base In advanced cases there will be a pain in the tongue
There will be difficulty in complete protrusion of tongue and difficulty articulating clearly. This happens due to the spread to the floor of the mouth.

If cancer involves the posterior part and base of the tongue, the treatment is often difficult.
A neck lump is an indication of spread to the neck or may be due to secondary inflammatory changes in the lymph node. Loosening of teeth of the lower jaw indicates, spread to the mandible,if not proved otherwise.

Where can Tongue Cancer it spread?

The floor of the mouth.
Mandible(lower jaw).

Cancer of the posterior part of the tongue can spread to tonsils, pharynx and into the larynx
Most people (70%)will have neck mass at presentation. Sometimes neck nodes on both sides may be involved.

What tests will be needed?

Diagnostic tests involve biopsy, FNAC MRI tongue, and imaging for the neck and chest. Mandibular involvement and status of dentition need to be evaluated.

The MRI of the tongue and a CECT of the neck and chest helps us know about the spread of the disease.

An FNAC from the neck mass will help in finding out the nature of the neck lump, and the biopsy of the tongue ulcer will help us know about the tongue lesion.

Treatment often involves.

Treating primary lesions depending on size. Excision is done with adequate margin and reconstruction depending on mass resected. The neck needs to be treated. A combination of surgery and radiotherapy may give best results

Preoperative counseling:Why is it crucial?

To stop all addictions.

Treat withdrawal symptoms.

Improve lung function.

Improve oral hygiene.

The potential need for tracheostomy and loss of voice explained.

The possible need for re-construction with flaps explained.

Speech therapy needed postoperatively.

Explanation regarding Adjuvant radiotherapy/chemotherapy or both, depending on tumor-free margin after biopsy report.

Need for post-operative followup at a Head Neck Cancer /tumor clinic.

ENT A-Z

Hearing loss? You might want to get that checked.

What are the Tests for hearing loss?

Can Hearing loss be restored?

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Glue Ear and the Grommet: Who needs it?

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It’s very common in children zero to two years and can follow:

Diagnosis involves

Other Tests needed

Glue ear treatment: How will the Glue ear get better?

Grommet or Ventilation tubes: Let the ear breathe!

Do adults have Glue Ear?

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Ethmoidal polyps :How do they look

Kartagener’s syndrome

Symptoms of sinusitis with polyposis

Tests you need before Sinus Surgery

Is Surgery the only treatment for Sinusitis?

FESS: Functional Endoscopic Sinus surgery

What are the Risks of Endoscopic Sinus Surgery?

Will the polyps come back?

Other indications of Sinus Surgery

How can I permanently cure Sinusitis?

Treatment options for Sinusitus are

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References:

Sharing is good Karma!

ENT Telehealth: It’s here

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You can text, send audio, video or schedule an audio/video consultation and Pay through NEFT/PayTM or other modes

Lybrate Profile Link Dr.Amrita Basu

Sharing is good Karma!

Difficulty swallowing or dysphagia is a common ENT complaint. It’s the ENT surgeon bread -butter version complaint. Today I will tell you about the danger hidden behind such a common and innocuous symptom.

The Early warnings

Malignancy causing Dysphagia

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Sharing is good Karma!

How does tongue cancer present?

Where can Tongue Cancer it spread?

What tests will be needed?

Treatment often involves.

Preoperative counseling:Why is it crucial?

Sharing is good Karma!

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