Health

Meniere’s disease: Symptoms, Tests, the truth about treatment

By Dr.Amrita Basu(MBBS,MS) on April 14, 2020 13

What is this Meniere’s Disease?

Meniere’s disease is a disease that makes one’s head spin! Yes, the condition is complex, and the main symptom is vertigo or spinning sensation. Diagnosis is complex and needs a detailed history, clinical examination, and tests. The spinning of the head is often accompanied by sudden projectile vomiting, hearing loss, and blocked feeling in the ears.

(If you want a review of your ENT condition ,you can consult me online for a discussion .)

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What are the Symptoms of Meniere’s disease

Recurrent intractable vertigo, which lasts from 20 minutes to up to 24 hours. It’s disorienting and makes the person bedridden for days. It’s the most distressing symptoms of Meniere’s disease.

Nystagmus associated with vertigo

Nausea and vomiting with the vertigo

Ringing sound in-ear or Tinnitus, which is usually in one ear and is low pitched.

Sensorineural hearing loss, which is fluctuating, gradually increases, usually starts in one ear. It usually involves lower frequencies.

Feeling of pressure in-ear.

Who is affected by Meniere’s disease?

More common in females and often start in the middle ages. The hearing loss and Tinnitus may start in one ear and later may be bilateral.

Pathophysiologically it’s endolymphatic hydrops. It happens as an independent disease in most cases. But can occur after damage to the inner ear system after mumps, measles, meningitis, syphilis or even head trauma,

How do the Doctor’s test for Meniere’s disease?

It’s a disease affecting the inner ear which houses the delicate system of hearing and balance.

Diagnostic tests

PTA(Pure Tone Audiometry for hearing loss assessment
Nystagmography
Videonystagmography
Electrocochleography Glycerol dehydration test
CT brain
MRI CPA to rule out other conditions

How is Meniere’s Disease treated?

1)Supportive treatment to manage symptoms of vertigo in Meniere’s disease include-

Intratympanic steroid
Intratympanic gentamicin

2)Lifestyle changes include-Salt restricted diet and diuretic, restricted coffee, alcohol, tobacco, chocolates, monosodium glutamate(MSG).

3)Counseling and vestibular rehabilitation exercises.

4)Surgical options include endolymphatic decompression and vestibular neurectomy.

In Conclusion:

In my experience in India, the hearing loss and vertigo symptoms respond very well to repeated Intratympanic steroid injections. Recurrence may need a repeated dose, but patients tolerate it well with improvement in vertigo symptoms and also better hearing. The disease is unpredictable. It may have different patterns and severity of the presentation. Surgical treatment is only offered if other modes of treatment don’t give relief from intractable unrelenting vertigo.

Important: If you suffer from Meniere’s disease or vertigo due to any other causes, you must avoid driving.

Have you heard about vertigo?Let me know in the comments below.

Read about hearing loss in Kidney disease .

Read the blog .

ENT A-Z articles

Kissing disease: The kiss of the virus (Infectious Mononucleosis)

By Dr.Amrita Basu(MBBS,MS) on April 12, 2020 4

Kissing disease? Is there is something called that or is the self quarantine affecting my brain?

Yes, there is and it’s more common than you think. Infectious mononucleosis or kissing disease is caused by the Epstein Barr virus. It is spread by contact with oral secretions among young adults and from asymptomatic adults to infants during kissing.

The majority of asymptomatic but seropositive people shed the virus in saliva. The incubation period is long, ranging from 30-50 days(4-6 weeks).

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Most common: Oral ulceration is what many patients present at an ENT clinic.

Other symptoms are

Fever,fatigue,malaise,myalgia

Throat pain and difficult Swallowing

Enlarged tonsils

Signs

Pharyngitis. Tonsillitis with an exudative membrane over tonsils /pharynx It has to be distinguished from Diphtheria

Rash and redness over the palate

Lymph node swelling,

Skin rash

Enlarged liver/spleen

Rare presenting features

Facial nerve palsy

Guillen Barre Syndrome and other systemic manifestations

A characteristic serological test and atypical lymphocytes in peripheral blood help in diagnosis.

The Epstein Barr virus is linked to many diseases including

NPC-Nasopharyngeal cancer

Burkitt’s lymphoma

Hodgkins disease

B cell lymphoma in those with immunodeficiencies.

EBV infections occur worldwide and, most commonly, in childhood. But IM is a disease if a young adult. Have you heard of the kissing disease? Let me know in the comments below.

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Just 4 Important Truths You Must Know before going for the Less-painful Vaccine(with video)

By Dr.Amrita Basu(MBBS,MS) on April 10, 2020 7

Preventive medicine and the role of immunization are immense to keep children safe. So it’s important to always check the authenticity and avoid misconceptions.

Therefore, I decided to write about the less-painful vaccine.

Many parents think there are special procedures or facilities to make vaccination less painful for children. While your doctor will always give you tips to make your child comfortable during and after vaccination, you must know this.

Injections given with expertise can reduce pain. But the needle prick is not entirely painless.
Dr.Amrita Basu
healthwealthbridge.com

So, what is the talk about the less painful vaccine?

One -The less-painful vaccine is an option only for DPT/DTwP or DTaP based combination vaccines, but not other vaccines.

The whole-cell Pertussis (Bordetella Pertussis) containing DPT is often called a painful vaccine or DPT. The less painful vaccine, also known as DTaP with acellular Pertussis vaccine. It is the nature of the P or Pertussis component, which makes it less painful.

Pertussis (whooping cough), the P component of DPT /DTaP, is an infectious disease and a significant cause of infant disease and death. It is still a public health concern even after high vaccination coverage.

In infants and children less than five years worldwide, it is an important preventable cause of death. Since both types of vaccines give good coverage in the age group (who are susceptible), WHO stresses on discretion in choosing the vaccine. So it’s a conversation you will need to start with your Paediatrician before starting the primary immunization schedule.

But why does it even matter? The confusion parents feel while choosing for their little ones is common across the globe. You want the best.

This is why you must understand the critical aim of Pertussis vaccination. It is to decrease the risk of severe Pertussis in infants and young children. All children worldwide, including HIV-positive individuals, should be immunized against Pertussis. You can’t do away with the P part of the vaccine!

Two -Always Vaccinate your child as recommended

Vaccination coverage is most important to protect children. You must do it on time and complete it too. This is something everyone agrees on. The coverage should in no way be hampered. Every country tries to achieve early and timely immunization. Universal immunization (vaccination for all) is a must to protect your children, improve community coverage, and also protect future generations.

Remember: What you decide today has a long-term effect.

Three-Efficacy of the less painful vaccine

Now this one was tricky. The decision was about efficacy as well as acceptability. As an adult, you can be brave, but still you want medicines and vaccines to work.

WHO, IAP, AAP recommendations about the less painful vaccine

IAP mentions this German study about the 88.7% efficacy rate [1] of painless acellular vaccine for Pertussis and reading this, I took to heart. Even though the painful vaccine is recommended in terms of long-term efficacy, even more, important is the coverage of immunization in infancy and childhood when the risk of Pertussis is highest.

In fact, in the early years of life, the protection is found to be similar. The immunity decreases faster with the acellular or less painful vaccine. [2,3,4]
In Government healthcare setup, NGOs the whole-cell vaccine is often given for free. In a private set up, parents may reduce discomfort as well as provide adequate protection.

Acellular vaccine or less painful vaccine is comparatively less immunogenic. But it also causes less reaction; this is more acceptable to many parents. Over a 6 to 12 years period, the immunogenicity has been seen to be lowered in developed nations. But WHO recommends that we continue vaccination for complete vaccination coverage first.
Either type of vaccines needs to be used for primary immunization 3 doses [5,6]

Given the anxiety related to the whole-cell vaccine and the popularity of combination vaccination, the less painful vaccine can be used even in the primary series.

The exact efficacy and immunogenicity have more reviews going on. Additional boosters and vaccination of mothers can also be done is what WHO says.

Four-Talk to your Paediatrician for a personalized recommendation

Now my husband is the person who is my child’s Paediatrician too. But we discuss a lot about the pros and cons of every health decision as a family. You should consult your own doctor before making any decision regarding immunization. It’s important your child gets vaccinated with what is available and the final decision rests with the parent.

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References:

1) Schmitt HAJ, von König CH, Neisse A, Bogaerts H, Bock HL,
Schulte-Wissermann H, et al. Efficacy of acellular pertussis
vaccine in early childhood after household exposure. JAMA.
1996;275:37-41.

Winter K, Harriman K, Zipprich J, Schechter R, Talarico J,
Watt J, et al. California pertussis epidemic, 2010. J Pediatr.
2012;161:1091-6.
Centers for Disease Control and Prevention (CDC).
Pertussis epidemic—Washington, 2012. Morb Mortal
Wkly Rep. 2012;61:517-22.
Pertussis vaccines: WHO Position Paper – August 2015
No. 35. World Health Organization. Weekly
Epidemiological Record. 2015;90:433-60.
5) World Health Organization. Pertussis Vaccine Evidence to
Recommendations (WHO). Available from: http://
www.who.int/immunization/position_papers/Pertussis
GradeTable3.pdf. Accessed November 6, 2018.
6) WHO Position paper on Pertusis Vaccine, 2005. World
Health Organization. Weekly Epidemiological Record.
2005;4:29-40.

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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Health

What is this Meniere’s Disease?

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What are the Symptoms of Meniere’s disease

Who is affected by Meniere’s disease?

How do the Doctor’s test for Meniere’s disease?

Diagnostic tests

How is Meniere’s Disease treated?

Sharing is good Karma!

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Most common: Oral ulceration is what many patients present at an ENT clinic.

Signs

Rare presenting features

The Epstein Barr virus is linked to many diseases including

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

Sharing is good Karma!

So, what is the talk about the less painful vaccine?

Two -Always Vaccinate your child as recommended

Three-Efficacy of the less painful vaccine

WHO, IAP, AAP recommendations about the less painful vaccine

Four-Talk to your Paediatrician for a personalized recommendation

Featured post

References:

Sharing is good Karma!

Hearing loss? You might want to get that checked.

What are the Tests for hearing loss?

Can Hearing loss be restored?

Featured post

Sharing is good Karma!

Glue Ear and the Grommet: Who needs it?

Featured post

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?

Featured post

Sharing is good Karma!

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!

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