The Outer Ear and Canal The outer ear is funnel-like part of the ear you can see on the side of the head plus the ear canal (the hole which leads down to the eardrum). The ear canal is shaped somewhat like an hourglass-narrowing part way down. The skin of the outer part of the canal has special glands that produce ear wax. This wax is supposed to trap dust and sand particles to keep them from reaching the eardrum. Usually the wax accumulates a bit, and the dries up and comes tumbling out of the ear, carrying sand and dust with it. Or it may slowly migrate to the outside where it is wiped off. Should you clean your ears ? Wax is not formed in the deep part of the ear canal near the eardrum, but only in the outer part of the canal. So when a patient has wax blocked up against the eardrum, it is often because he has been probing his ear with such things as cotton-tipped applicators, bobby pins or twisted napkin comers. Such objects only serve as ramrods to push the wax in deeper. Also the skin of the ear canal and the eardrum is very thin and fragile and is easily injured. Earwax is healthy in normal amounts and serves to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of earwax may result in dry, itchy ears. Most of the time the ear canals are self-cleaning, that is, there is a slow and orderly migration of ear canal skin from the ear drum to the ear opening. Old earwax is constantly being transported from the ear canal to the ear opening where it usually dries, flakes, and falls out. Under ideal circumstances, you should never have to clean your ear canals. However, we all know that this isn’t always so. When wax has accumulated so much that it blocks the ear canal (and hearing), your physician may have to wash it out, vacuum it, or remove it with special instruments. Or he may prescribe ear drops which are designed to soften the wax. You may soften the wax for a few days by instilling several drops of an earwax softener into the ear canal twice a day. If your ear still feels blocked after using the ear drops, you should consult your physician, who may elect to wash it out.

Facial Nerve Problems Twitching, weakness or paralysis of the face is a symptom of some disorder involving the facial nerve. It is not a disease in itself. The disorder may be caused by many different diseases, including infection, injury or treatment. Function of the facial nerve The facial nerve resembles a telephone cable and contains 7000 individual nerve fibers. Each fiber carries electrical impulses to a specific facial muscle. Acting as a unit this nerve allows us to laugh, cry ,smile or frown, hence the name , “the nerve of facial expression”. When half or more of the individual nerve fibres that makes up the facial nerve are interrupted, facial weakness is noted. If these nerve fibres are irritated them abnormal movements of the facial muscles appear as spasms or twitching of the face. The facial never not only carries nerve impulses to the muscles of the face, but also carries nerve impulses to the tear glands, to the saliva glands, to the muscle of a small bone in the middle ear (the stapes), and transmits taste fibres from the front of the tongue. Since the function of the facial nerve is so complex many symptoms may occur when the fibres of the facial nerve may result in twitching, weakness, or paralysis of the face, in dryness of the eye or the mouth, or in disturbance of taste. An otolaryngology-head and neck surgeon is called upon to manage facial nerve problems because of the close association of this nerve with the brain the facial nerve enters the temporal bone (ear bone) through a small bony tube (the internal auditory canal) in very close association with the hearing and balance nerve.Along its 1.5 inch course through a small bony canal in the temporal bone the facial nerve winds around the three middle ear bones, in back of the eardrum and then through the mastoid (the bony area behind the part of the ear which is visible). After the facial nerve leaves the mastoid it divides again into many branches which supply the various facial muscles. The facial nerve gives off many branches as it courses through the stapes muscle, to the tongue, and, to the saliva glands. Diagnosis, Prognosis and Treatment of Facial Nerve Disorders The three questions most often asked by the patient with a problem in facial nerve function are What is the cause ? (Diagnosis) when can I expect recovery ? (Prognosis) what can be done to bring about recovery at the earliest possible moment? (Treatment). In order to answer these three question the otolaryngology-head and neck surgeon must perform an extensive evaluation of each patient and determine the cause of the disorder and to attempt to localize the area off the facial nerve which is involved as well so that the best treatment can be prescribed. Diagnosis The most common cause of facial weakness which comes on suddenly is referred to as “Bell’s plays”. This disorder is through to be due to the body’s response to a particular virus: in reaction to the virus the facial nerve within the ear bone swells and this pressure on the nerve in the bony canal damages it. In order to be sure that this is the cause of the facial weakness, and that it is not due to some rare cause or other diseases, a special set of questions will be asked. The patient will be examined and a series of tests may be performed. The most common tests are: Hearing Test : Test of hearing are done to determine if the damage to the nerve has involved the delicate hearing mechanism. Balance Test : Balance test may be needed to determine if the balance nerve is involved. Tear Test : A test of the eye’s ability to produce tears may help the physician to determine the location and severity of facial nerve disease. Taste Test : A Test of taste may be beneficial in localizing the area of the facial nerve which is affected. Salivation Test : A Test to measure the flow of saliva may be administrated; this test may help to predict the location and severity of facial nerve involvement. X-rays : X-rays may be obtained to determine if there is infection, tumor,bone fracture or other abnormality in the area where the facial nerve lies. Electrical Test : The facial nerve is stimulated in some cases itdetermine the severity of involvement. The test may have to be repeated daily to detect progression of disease. Prognosis After the evaluation has been completed, the most likely cause of facial nerve disorder may become clear and the second question. “When can I except recovery to begin” can be answered. This will be discussed by your physician. Treatment Not all facial nerve problems require specific treatment. Many will recover spontaneously. Occasionally, however medical physical therapy or surgical treatment may be necessary, physical therapy to maintain muscle tone during nerve recovery is often of value. The most serious complication that may develop as a result of total facial nerve paralysis is an ulcer of the cornea (the clear covering) of the eye. Therefore, it is most important that the eye on the involved side be protected from this complication. Closing the eye with the finger is an effective way of keeping the eye moist. You should use the black of your finger rather than the tip in doing this, to insure that your eye is not injured. Glasses should be worn whenever you are outside. This will help to prevent particles of dust becoming lodged in the eye. If the eye is dry, you may be advised to use artificial tears. The drops should be used as often as necessary to keep your eye moist. This may require placing one or two drops in the affected eye every hour while you are awake and placing ointment in your eye at bedtime.

Are Smell and taste disorders serious? A person with a faulty sense of smell and taste is deprived of an earlty warning system that most of us take for granted. Smell and taste alert us to fires, poisonous fumes, gas leaks and spoiled foods. Loss of the sense of smell may also be a sign of sinus diseases, growths in the nasal passages or in rare circumstances brain tumors. Because an intact sense of smell and taste is required in some professions, chefs and firemen, among other may be subject to serious economic hardship. How do smell and taste work? Smell and taste belong to our chemical sensing system or chemosensation. The complicated processes of smelling and tasting begin when molecules released by the substances around us stimulate special nerve cells in the nose, mouth or throat. These cells transmit messages to the brain where specific smells or tastes are identified. Olfactory (smell nerve) cells are stimulated by the odors around us-the fragrance from a rose, the smell of bread baking. These nerve cells are found in a tiny patch of tissue high up in the nose and they connect directly to the brain. Taste cells react to food or drinks mixed with saliva and are clustered in the taste buds of the mouth and throat. Many of the small bumps that can be seen on the tongue contain taste buds. These surface cells send taste information to nearby nerve fibers which send messages to the brain. Taste and smell cells are the only cells in the nervous system that are replaced when they become old or damaged. Scientists are examining this phenomenon while studying ways to replace other damaged nerve cells. A third chemosensory mechanism called the common chemical sense, contributes to our senses of smell and taste. In this system thousands of free nerve endings – especially on the moist surface of the eyes, nose, mouth and throat – identify sensations like the sting of ammonia, the coolness of menthol and “heat” of chili peppers. We can commonly identify four basic taste sensations: sweet, sour, bitter and salty. Certain combinations of these tastes – along with texture, temperature, odor and the sensations from the common chemical sense – produce a flavour. It is flavour that lets us know whether we are eating peanuts or caviar. Many flavors are recognized mainly through the sense of smell. If you hold your nose while eating chocolate, for example, you will have trouble identifying the chocolate flavor – even through you can distinguish the food’s sweetness or bitterness. This is because the familiar flavours of chocolate is sensed largely by odor. So is the well-known flavor of coffee. This is why a person who wishes to fully savor a delicious flavor an expert chef testing his own creation will exhale through his nose after each swallow. What causes smell and taste disorders? The predominant problem is a natural decline in smelling ability that typically occurs after age 60. Scientists have found that the sense of smell is most accurate between the ages of 30 and 60 years. It begins to decline after age 60 and a large proportion of elderly persons have lost their smelling ability. Women of all ages are generally more accurate than men in identifying odors. Some people are born with a poor sense of smell or taste, but most patients develop them after an injury or illness. Upper respiratory infections are blamed for some losses, and injury to the head can also cause smell or taste problems. Loss of smell and taste may result from polyps in the nasal or sinus cavities hormonal disturbances or dental problems. They can also be caused by prolonged exposure to certain chemicals such as insecticides and by some medicines. Tobacco smoking is the most concentrated form of pollution that most people will ever be exposed to. It impairs the ability to identify odors and diminishes the sense of taste. Quitting smoking improves the smell function, but very slowly. For example: Two-pack-a-day smokers must quit for as many years as they smoked to completely restore their sense of smell. Many patients who receive radiation therapy for cancers of the head and neck later complain of lost smell and taste. They can also be lost in the course of some diseases of the nervous system. Patients who have lost their larynx or “voice box” commonly complain of poor ability to smell and taste. These senses are greatly improved when laryngectomy patients use a special “bypass” tube to breathe through the nose again rather than through an opening in the neck. How Are Smell And Taste Disordersd Diagnosed? The extent of loss smell or taste can be tested with a measurement of the lowest concentration of a chemical that a person can accurately detect to compare the smells or taste of different chemicals, or how the intensities of smells or tastes grow when a chemical’s concentration in increased. Scientists have developed an easily administered “scratch-and-sniff”test to evaluate the sense of smell. A person scratches pieces of treated paper to release different odors, sniffs them, and tries to identify each odor from a list of possibilities. In taste testing the patient reacts to different chemical concentration : this may involve a simple “sip. Spit rinse “test,or chemicals may be applied directly to specific areas of the tongue Can Smell And Taste Dissorders Be Treated? Sometimes a certain medication Is the cause of a smell or taste disorder, and improvement occurred when that medicine is stopped or changed Although certain medications can cause chemosensory problems, others- particularly anti-allergy drugs-seem to improve the senses of taste and smell. Some patients-notably those with serious respiratory infections or seasonal allergies-regain their smell or taste simply by waiting for their illness to run its course. In many cases nasal obstructions such as polyps can be removed to restore airflow to the receptor area and correct the. Loss of smell and taste. Occasionally, chemosenses return to normal just as spontaneously as they disappeared. If you experience a smell or taste problem try to identify and record the circumstances surrounding It. When did you first become aware of it? Did you exposed to air pollutants pollens,danders or dust to which you might be allergic? Is this a recurring problem/ Does it come in any special season like hayfever time? Bring all this information with you when you visit a physician who deals with diseases of the nose and throat. Also be prepared to tell him about your general health and any medications you are taking. Proper diagnosis by a trained professional can provide reassurance that your illness is not imaginary. You may even be surprised by the results. For example,what you may think is a taste problem because much of what you think you taste is you really smell. Diagnosis may also lead to treatment of an underlying cause for the disturbance. Many types of smell and taste disorders are reversible, but if yours is not, it is important to remember that you are not alone: thousands of other patients have faced the same situation

What is a cholesteatoma? A cholesteatoma is skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually due to repeated infection which causes an ingrowth of the skin of the eardrum cholesteatomas often take the form of a cyst or pouch which sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth. How does it occur? A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure (“clear the ear”). When the eustachian tubes work poorly, perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body and partial vacuum results in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum especially areas weakened by the previous infections. This sac often becomes a cholesteatoma.A rare congenital form of cholesteatoma (one present at birth) can occur in middle ear and else where such as in near by skull bones However the type of cholesteatoma associated with ear infections is most common. What are the symptoms? Initially the ear may drain, sometimes with a foul odour. As the cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. (An ache behind or in the ear, especially at night, may cause significant discomfort). Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any or all of these symptoms are good reasons to seek medical evaluation. Is it dangerous? Ear cholesteatomas can be dangerous and should never be ignored. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and rarely death can occur. What treatment can be provided? An examination by an otolaryngologist-head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of careful cleaning of the ear, antibiotics and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated. Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone next to the ear), and CT scans (3-D, x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused. Surgery is performed under general anaesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection and achieve an infection- free, dry ear. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction. Reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; and therefore, a second operation may be performed six to twelve months later. The second operation will attempt to restore hearing and at the same time, inspect the middle ear space and mastoid for residual cholesteatoma. Admission to the hospital is usually done the morning of surgery and if the surgery is performed early in the morning, discharge may be the same day, for some patients, an overnight stay is necessary. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Time off from work is typically one to two weeks. Follow-up office visits after surgical treatments are necessary and important, because cholesteatoma sometimes recurs. In cases where an open mastoidectomy cavity has been created, office visits every few months are needed in order to clean out the mastoid cavity and prevent new infections. In some patients, there must be lifelong periodic ear examinations. Summary Cholesteatoma is a serious but treatable ear condition which can only be diagnosed by medical examination. Persisting earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness signals the need for evaluation by an otolaryngologist-head and neck surgeon.

I sometimes hear ringing in my ears. Is this unusual? Not at all. Tinnitus is the name for these head noises, and they are very common. Tinnitus may come and go, or you may be aware of a continuous sound. It can vary in pitch from a low roar to a high squeal or whine, and you may hear it in one or both ears. When the ringing is constant it can be annoying and distracting Can other people hear the noise in my ears? Not usually, but sometimes they are able to hear a certain type of tinnitus. This is called objective tinnitus, and it is caused either by abnormalities in blood vessels around the outside of the ear or by muscle spasms which may sound like clicks or cracklings inside the middle ear. What causes tinnitus? There are many possible causes for subjective tinnitus, the noise only the patient can hear. Some causes are not serious (For instance, a small plug of wax might cause temporary tinnitus.) tinnitus can also be a symptom of more serious middle ear problems such as infection, a hole in the eardrum, an accumulation of fluid or stiffening (otosclerosis) of the middle ear bones. Tinnitus can also be a symptom of a head and neck aneurysm or acoustic neuroma, either of which can be life threatening. These problems often involve a loss of hearing. Tinnitus may also be caused by allergy, high (or low) blood pressure, a tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other specific causes including: anti-inflammatory drugs, antibiotics, sedatives antidepressants and aspirin. (Aspirin can be a possible cause of tinnitus if over used, depending on the size of the patient. Talk to your doctor if you take aspirin and your ears ring.) The treatment will be quite different in each case. It is important to see a physician who specializes in ear disorders (an otolaryngologist) to attempt to determine the cause of your tinnitus, and what kind of treatment, if any, may be needed. What is the most common cause of tinnitus? Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. Advancing age is generally accompanied by a certain amount of hearing nerve impairment – and even tinnitus. Exposure to loud noises is probably the leading cause of tinnitus in today’s world, and it often damages hearing as well. Unfortunately, many people are unaware of, or unconcerned about, the harmful effects of excessively loud industrial noise. Fire arms noise, high intensity music and other loud noises. Stereo headsets played too loudly appear to be an increasing cause of ear damage in otherwise healthy young people. What is the treatment of Tinnitus? In most cases, there is no specific treatment for noises in the ear or head. In an otolaryngologist finds on examination that your tinnitus has a specific cause, he may be able to remove the cause and thus eliminate the noise. This investigation may require a fairly extensive workup including X-rays, hearing tests, CT scan and nerve conduction tests. However, most causes of tinnitus cannot be identified. Occasionally, medicines may help noise even though no cause can be identified. The medicines used are many, frequently the patient is requested to take a medicine to see if it helps. Tinnitus – locating the problem Tinnitus can arise in any of the four sections of the ear: the outer ear, the middle ear, the inner ear, and the retro cochlear area (either nerve or brain). A medical history, physical examination, and series of special tests can help determine precisely where the problem is. When there is no identifiable cause, can something be done to lessen the tinnitus? Yes, the following list of do’s and don’ts can help lessen the severity of tinnitus. First of all, remember that the auditory (healing) system is one of the most delicate and sensitive mechanisms of the human body. Since it is a part of the central nervous system, its responses are affected to some degree by the anxiety state of the person involved. Therefore, it is advisable to make every effort to: Avoid exposure to loud sounds and noises. Get your blood pressure checked; if it is high, seek your doctor’s help to get it under control. Decrease your intake of salt (which impairs good blood circulation). Avoid salty foods and do not add salt to your food at the table. Avoid nerve stimulants such as coffee and colas (caffeine) and tobacco (nicotine). Exercise daily. It improves your circulation. Get adequate rest and avoid over fatigue. Stop worrying about the noise. Tinnitus will not cause you to go deaf or result in losing your mind or your life. Recognize your head noises as an annoying but minor reality, and then learn to ignore them as much as possible. This type of control can sometimes be greatly enhanced via the techniques of biofeedback and / or masking. Reduce nervous anxiety, which may further stress an already tense hearing system. What is masking? Tinnitus is usually more bothersome when the surroundings are quiet, especially when you are in bed. A competing sound such as a ticking clock or a radio may help mask head noises, making them less noticeable. Some physicians suggest listening to music at low volume. It helps block the more offensive Tinnitus sounds. Will hearing aids help reduce the noise? People with impaired hearing sometimes find that their hearing aids reduce head noise and occasionally cause it to go away. Even a person with a minor hearing deficit may find that hearing aids relieve his tinnitus. However, a thorough trial before purchase is advisable if the primary purpose is the relief of tinnitus. Often, when the hearing aid is removed, the head noise reutrns to its former level. Conclusion Tinnitus is not a disease but a symptom, and can be caused by numerous conditions. To find out what may be causing your problem, a complete ENT examination and special tests may be necessary. The key to successful treatment of tinnitus is getting the most accurate diagnosis possible. Once your doctor has completed this evaluation, an essential part of the treatment will be to help you understand your tinnitus, what has caused it, and how best it may be treated. Your hearing is too precious to treat carelessly. That is why this pamphlet is offered. We hope it has been helpful. If you have further questions, your otolaryngolgist will be happy to try to answer them for you.

What Is Your Thyroid Gland ? Your throid is one of the endocrine glands which make hormones to regulate physiological functions in your body. The thyroid gland manufactures thyroid hormone, which regulates the rate at which your body carries on its necessary functions. Other endocrine glands are: the pituitary, the adrenal glands, the parathyroid glands, the testes and the ovaries. The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and just above your clavicle (collar bone). It is shaped like a “bowtie” , having two halves (lobes) a right lobe and a left lobe joined by an “isthmus”. (See below) you can rarely feel a normal thyroid gland. When is the thyroid gland abnormal? The most common diseases are an over or under-active gland. These conditions are called hyperthyroidism or hypothyroidism. Sometimes the thyroid gland can become enlarged from over activity (as in hypothyroidism). An enlarged thyroid gland is often called a “goiter”. Patients may develop “lumps” or “masses” in their thyroid glands (see below). These masses can either be benign or malignant. They may appear gradually or very rapidly. Patients who had radiation to the head or neck as children for acne, adenoids or other reasons are more prone to develop thyroid malignancy. All thyroid “lumps” (nodules) should generate suspicion and a prompt visit to the doctor. How Does Your Doctor Make The Diagnosis? The diagnosis of a thyroid mass is made by taking a medical history and examining the neck. Your doctor may have you lift up your chin, extending your neck to make the thyroid gland more prominent. He / she may also ask you to swallow. This helps to distinguish a thyroid mass from other lumps and bumps in the neck. Other tests that your doctor may order include. Fine needle aspiration biopsy. A thyroid scan An ultrasound exam A CT scan A chest x-ray Blood tests of thyroid function. Fine Needle Aspiration After diagnosing a thyroid “lump”, your doctor may recommend a fine or “skinny” needle aspiration of the lump. This is a safe relatively painless procedure. A fine needle is passed into the lump in the thyroid, and a sample of the tissues is taken. Most patients require several passes with the needle. There is little pain afterwards and very few complications from the procedure. If you have a tendency to bleed excessively, this procedure may not be appropriate. This test gives the doctor more information on the nature of the “lump” in your thyroid gland. The results are read by a doctor called a cytopathologist. This report will help your doctor decide upon the proper treatment for this thyroid mass. Treatment Of Your Thyroid “Lump” Once a diagnosis has been made, a treatment plan will be proposed by your doctor based on his examination and your test results. Most thyroid “lumps” are benign. They are usually treated with thyroid medication known as “suppression” therapy. The object of this treatment is to see if the “lump” will shrink over time while on this medication. The usual time period for some improvement is 3 to 6 months. A repeat fine needle aspiration may be required during this time period. If the “lump” continues to grow during the time when you are taking thyroid medication, most doctors would recommend removal of the thyroid “lump”. If the fine needle aspiration is atypical or suggestive of a malignancy, then thyroid surgery is required. What Is Thyroid Surgery? Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anaesthesia is usually required. Usually the operation removes the lobe of the thyroid gland containing the “lump” and possibly the isthmus. A frozen section (an immediate pathological reading) may or may not be used to determine if the rest of the thyroid gland should be removed. Sometimes, based on the frozen section, the surgeon may decide to stop and remove no more thyroid tissue, or proceed to remove the entire thyroid tissue, or proceed to remove the entire thyroid gland, and / or other tissue in the neck. This is a decision usually made in the operating room by the surgeon based on findings at the time of surgery. These options will be discussed by your surgeon with your preoperatively. After surgery you may have a drain (a tiny piece of plastic tubing), which prevents fluid from building up in the wound. This is removed after the fluid accumulation is minimal. Most patients are discharged two to three days after surgery is performed. Complications after thyroid surgery are rare. They include bleeding, a hoarse voice, difficulty swallowing, numbness of the skin on the neck and low blood calcium. Most complications go away after a few weeks. Patients who have all of the thyroid gland removed have a higher risk of low blood calcium post-operatively. Patients who have thyroid surgery may be required to take thyroid medication to replace thyroid hormones after surgery. Some patients may need to take calcium replacement if their blood calcium is low. This will depend on how much thyroid gland remains, and what was found during surgery. If you have any questions about thyroid surgery, ask your doctor and he/she will answer them in detail.

Swallowing Disorders Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty in passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are non-threatening and temporary. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself, in a short period of time, you should see an otolaryngologist-head and neck surgeon. How you swallow People normally swallow hundreds of times a day, to eat solids or drink liquids, and swallow the normal saliva and mucous which the body produces. The process of swallowing has four stages. The first is oral preparation, where food or liquid is manipulated and chewed in preparation for swallowing. During the oral stage, the tongue propels the food or liquid to the back of the mouth, starting the swallowing response. The pharyngeal stage begins as food or liquid is quickly passed through the pharynx (the canal which connects the mouth with the esophagus) into the esophagus or swallowing tube. In the final, esophageal stage, the food or liquid passes through the esophagus into the stomach. Although the first and second stages have some voluntary control, stages three and four occur by themselves, without conscious input. What causes swallowing disorders? An interruption in the swallowing process can cause difficulties. It may be due to simple causes such as poor teeth, ill-fitting dentures, or a common cold. One of the most common causes of dysphagia is gastroesophageal reflux. This occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort. Other causes may include: stroke progressive neurologic disorder, the presence of a tracheostomy tube, a paralyzed or unmoving vocal cord, a tumor in the mouth, throat or esophagus, or surgery in the head, neck or esophageal areas. Symptoms Symptoms of swallowing disorders may include: Drooling A feeling that food or liquid is sticking in the throat during or after a meal or while swallowing saliva Discomfort in the throat or chest, especially when gastroesophageal reflux is present Weight loss and inadequate nutrition due to, prolonged or more significant problems with swallowing. Coughing or choking caused by food, liquid or saliva not passing easily during swallowing, and small amount of food, liquid or saliva being sucked into the lungs. Who evaluates and treats swallow disorders? In many cases especially common Conditions such as a cold or temporary gastroesophageal reflux, the family physician will diagnose and effectively treat the condition. When the a more significant swallowing disorders when the cause is not obvious, a surgical or medical specialist may become involved. These specialists include professionals in otolaryngology-head and neck surgery, speech and language pathology gastrointestinal medicine, neurology, thoracic (chest) surgery, nutrition, neurology, and dentistry. Frequently a team approach is provided by some or all of these professionals for complete diagnosis and treatment.. Evaluations of a Persistent swallowDisorder When dysphagia is persistent and the is not apparent, the otolaynologist-head neck surgeon will discuss the history of the problem and examine the mouth and the this may be done with the aid of mirrors or a small tube (flexible laryngoscope,) which provides vision of the back of the tongue, throat, and larynx (voice box) If necessary, examination of the esophagus, stomach, upper small intestine (duodenum) may be carried out by the otolaryngologist or a gastroenterologist. These specialists may recommend x-rays of the swallowing mechanism, called a barium swallow or upper G-I, which is done by a radiologist. If special problems exist, a speech pathologist may consult with the radiologist regarding a modified barium swallow or video fluoroscopy- these help to identify all four stages of the swallowing process. Using different consistencies of food and liquid, and having the patient swallow in various positions; speech pathologist will test the ability to swallow. An exam by a neurologist may be necessary if the swallowing disorder stems from the nervous system, perhaps due to stroke or other neurologic disorders Possible treatments Once the cause is determined, Swallowing disorders may be treated with: Medication Swallowing therapy Surgery Many of these disorders can be treated with medication. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is tailored to the particular cause of the swallowing disorder. Gastroesophageal reflux can often be treated by changing eating and living habits – for example: Eat a bland diet with smaller, more frequent meals Reduce weight and stress Avoid food within three hours of bedtime Elevate the head of the bed at night. If these don’t help antacids between night meals and at bedtime may provide relief. Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercise for coordinating the swallowing muscles or restimulate the nerves which trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary. Surgery is used to treat certain problem. If a narrowing or stricture exists, the area may need to be stretched or dilated. If muscle is too tight, it may need to be dilated or even released surgically. This procedure is called a myotomy and is performed by an otolaryngogist-head and neck surgeon Many causes contribute to swallowing disorders. If you have a persistent problem swallowing, see an otolaryngologist-head and neck surgeon

What is post-nasal Drip? Post-nasal discharge, also called post-nasal drip (PND), describes the sensation of mucous accumulation in the throat or a feeling that mucous is dripping downward from the back of the nose. PND can be caused by excessive or thick secretions or throat muscle and swallowing disorders. Normally, the glands lining the nose and sinuses produce one to two quarts of thin mucous a day. On the surface of this mucous membrane lining, the rhythmic beat of invisible cilia (which look like tiny hairs under the microscope) thrust the mucous backward. Then it is swallowed unconsciously. This mucous lubricates and cleanses the nasal membranes, humidifies air, traps and clears inhaled foreign matter, and fights infection. Mucous production and clearance is regulated by a complex interaction of nerves, blood vessels, glands, muscles, hormones, and cilia. Abnormal secretions Increased thin clear secretion can be due to colds and flu (upper respiratory viruses), allergies, cold temperatures, bright lights, certain foods and spices, pregnancy and hormonal changes, various drugs (including birth control pills and especially high blood pressure medication) and structural abnormalities such as deviated or irregular nasal septum. (The septum is the cartilage and bony partition which divides the nose into its two sides, beginning at the nostrils and extending to the back of the nasal cavity). Vasomotor rhinitis describes no allergic “hyperirritable nose”, which may feel congested, blocked or wet. Increased thick secretions are frequently caused by wintertime low humidity in homes and building heated without adding moisture to the air. They can also result from sinus or nose infections and some allergies; especially to certain foods such as dairy products. If the secretions of a common cold become thick and green or yellow it is likely that a bacterial sinus infection is developing. Also, particularly in children, they can signify a foreign body in the nose (such as a bean, wadded paper, piece of toy etc.) Decreased secretions may be caused by any of the following: Long –term exposure to environmental irritants (such as cigarette smoke, industrial pollutants, and automobile fumes) which can dry and damage nasal mucous membranes. When secretions are reduced, they are usually thicker than normal and produce the false sensation of increased mucous. Structural abnormalities (such as nasal septal irregularities) which alter air currents may then dry surrounding membranes. (Thus, depending on their type, structural problems can increase or decrease secretions.) Age mucous membranes commonly shrink and dry with age, causing reduced mucous that is thicker than normal which the elderly perceive as PND Other less common disorders of the tissues lining the nose and sinuses can alter mucous production or flow. Swallowing problems Swallowing is a complicated process by which food and fluid go from the mouth into the esophagus (tube connecting the throat to the stomach). It requires coordinated nerve and muscle interaction In the mouth, throat; and esophagus. Swallowing problems may result in accumulation of solids or liquids in the throat, which can spill into the voice box (larynx) and breathing passages (trachea and bronchi) causing hoarseness, throat clearing, or cough. Several factors contribute to swallowing problems With age, swallowing muscles often lose strength and coordination. Thus, even normal.secretions may not pass smoothly into the stomach. During sleep, swallowing occurs much less frequently, and secretions may accumulate. Coughing and vigorous throat clearing are often needed when awakening. At any age, nervous tension or stress can trigger throat muscle spasms, resulting in a sensation of a lump in the throat. Frequent throat clearing, which usually produces little or no mucous can make the problem worse by increasing irritation. Growths or swelling in the food passages may slow or prevent the passage of liquids and/or solids. Swallowing dysfunction may be caused by gastroesophageal reflux, which is a return of stomach contents and acid into the esophagus or into the throat. Heartburn, indigestion, and sore throat are common symptoms which may be aggravated while lying down (especially following eating.) Hiatal hernia, a pouch-like structure at the junction of the esophagus and stomach, often contributes to the reflux. Chronic Sore Throat Post-nasal drip often leads to a sore, irritated throat. Usually throat cultures will not show strep or other infections, but the tonsils and other glandular tissues in the throat may swell, causing discomfort or a feeling of a throat lump. Successful treatment of the post nasal drip will usually clear up these throat symptoms. Before treatment is started, a diagnosis must be made. This requires a detailed ear, nose, and throat exam and possible laboratory, endoscopic, and x-ray studies

What Is It?, Why Did It Grow? Acoustic neuromas constitute 6 to 10% of all brain tumors. They are benign and usually are slow growing. Their early symptoms are deceptive because they are like those with many less serious problems. There is no typical pattern of symptoms caused by a developing acoustic neuromo, thus making early diagnosis a challenge. The cells which form an acoustic neuroma are called schwann cells and make up the lining of the eighth cranial nerve as it passes through a tiny canal which connects the inner ear to the brain. Unknown events lead to an overproduction of schwann cells. As they multiply, they form a small tumor which fills the canal. What Causes Acoustic Neuroma And What Is Its Growth Pattern? The cause of acoustic neuroma is unknown, except for a small percentage of individuals in whom both sides are involved. In these instances, there often is a hereditary factor. Acoustic neuromas usually grow very slowly, sometimes over a period of many years. They characteristically remain within their lining (encapsulated), and displace normal tissue very slowly, so that the body accommodates as long as possible to this Abnormal growth. An acoustic neuroma first distorts the eighth nerve, then presses on the seventh nerve. The slowly enlarging tumor protrudes from the internal auditory canal inside the skull into an area behind the mastoid bone called the cerebellopontine angle. It now begins to assume a pear shape, the small end within the canal. The tumor then presses on adjacent nerves, such as the fifth, or trigeminal, which is the nerve of facial sensation, and on other parts of the brain, causing more intense symptoms, and finally damages a portion needed to maintain life. How Often Do Acoustic Neuroma Occur? Estimates of occurrence of acoustic neuroma which cause symptoms range from one in every 3,500 persons to five in every million people. More women than men are affected, and most acoustic neuroma surgery is performed between the ages of 30 and 60. What Damage Can It Cause If Untreated? As the tumor expands, it extends into the brain, assuming a pear shape and putting pressure on the nerves and brain. By this time the patient may have had some of the symptoms which an acoustic tumor can cause-hearing impairment in one ear, ear noise called tinnitus, and fullness in the ear. Other symptorns which may develop Include unsteadiness or imbalance and facial numbness or twitching. Continued growth can produce further symptoms, and death may eventually result if the tumor goes undiagnosed and untreated. How Is It Found? The diagnosis of acoustic neuroma is made after a patient reports one-sided hearing loss, and the appropriate tests are done to locate the cause. Sophisticated audiometry testing can suggest that an acoustic neuroma is the cause of a hearing problem. CT and MRI scans are used to make the final diagnosis. What Can Be Done About It? The good news for the person diagnosed with an acoustic tumor is that one is commonly cured with modern treatment. Surgery is the best treatment for most patients. The surgery is often done by a two-specialist team made up of a neurosurgeon (brain surgeon) and a neuro-otologist (ear surgeon). Removal of the tumor may be approached through the back of the head (sub-occipital or posterior fossa), the mastoid and inner ear structure (translabyrinthine), or above the ear (middle fossa). The choice depends on the location and size of the tumor, degree of residual hearing, and the surgeon's operating preference. The surgeon will review the details of the operation including a discussion of the incisions and approach, special instrumentation, the expected length of hospitalization, recuperation period before returning to activity, and post-operative care. Instructions about care at home, activity level„ and follow-up appointment will also be given at the time of hospital discharge. What Are The Special Cautions About Removal? The goal of acoustic neuroma treatment and surgery is to preserve life and to leave unchanged as- much nerve and other uninvolved tissue as possible. However, because of the delicate location of the tumor and necessary manipulation during surgery, neurological damage may be increased, atleast for a time after surgery. This may include total and permanent one-sided hearing loss where formerly there was only a mild hearing loss, less than perfect balance, facial weakness, eye discomfort and headaches. However, modern operating techniques using microsurgery, experienced surgeons, and careful follow-up care have significantly reduced for many patients the problems developing after treatment. In general, the smaller the tumor at the time of surgery, the least chance of complications Residual problems: Facial weakness or Paralysis Eye problems Taste disturbance and Mouth Dryness or Excessive Salivation. Swallowing, Throat and vocal problems Balance Problems. Fatigue Headache Dental Problem Protecting the other ear by avoiding extreme and sudden noises near the good ear. Hearing loss Tinnitus

Each year more than 2 million people visit a doctor for dizziness, z.nd an untold number suffer with motion sickness; which is the most common medical problem asso:iated with travel. What Is Dizziness? Some people describe a balance problem by saying they feel cizzy lightheaded, unsteady or giddy. This feeling of imbalance or dysequilibrium, withctit a sensation of turning or spinning, is sometime; due to an inner ear problem. What Is Vertigo? A few people deszribe their balance problem by using the word vertigo, which comes from the latin verb "to tura". `They often say that they or their surroundings are turning or spinning-Vertigo is frequently due to an inner ear problem. What Is Minere`s Disease? Minere`s disease, also railed idiopathic endolymphatichydrops, is a disorder of the inner ear. Although the cause is unknown, it probably results from an Abnormality in the fluids of the inner ear. Minde`s disease is one of the most common causes af dizziness originating in the inner ear. In most cases only one ear is involved, but both ears mar be affected in about 15% of patients. Minere`s disease typically starts between the ages of 20 and 50 years. Men and women are affected in equal numbers. What Is Motion Sickness And Sea Sickness? Some people experience nausea and even vomitting when riding in an airplane, automobile, or amusement park ride, and dm` is called motion sickness. Many people experience motion sickness when riding on a boat or ship, and this is called sea sickness even though it is the same disorder. Motion sickness or sea sickness is usually just a minor annoyance and does not signify any serious medical illness, but some travellers are incapacitated by it, and a few even suffer symptoms for a few days after the trip. The Anatomy Of Balance Dizziness, Vertigo, Minere`s Disease and motion sickness all relate to the sense of balance and equilibirium. Your sense of balance is maintained by a complex interaction of the following parts of the nervous system. The inner ear, which monitors the directions of motion, such as turning or forward - back - ward, side-to-side, and up-and-down motions. The eyes which monitor where the body is in space (i.e. upside down, right side up etc.) and also directions of motion. The skin pressure receptors such as in the joints and spine, which tell what part of the body is down and touching the ground. The muscle and joint sensory receptors, which tell what parts of the body are moving. The Central nervous system, .(the brain and spinal cord) which processes all the bits of information from the four other systems to make some coordinated sense out of it all. The symptoms of motion sickness and dizziness appear when the central nervous system receives conflicting messages from the other four systems. Symptoms Of Minere`s Disease The symptoms of Minere`s disease are episodic rotational vertigo, hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affezted ear. Vertigo is usually the most troublesome symptom of Minere`s disease. The vertigo of Minere`s disease occurs in attacks of a spinning sensation and is accompanied by dysequilibrium (an off-balance sensation) .nausea, and sometime; vomiting. Vertigo lasts for 20 minutes to two hours or longer. During attacks, patients are usually unable to perform activities normal to their work or home life. Sleepiness may follow for several hours, and the off-balance sensat.on may last for days. There may be intermittent hearing loss early in the disease, especially in the low pitches, but a fixed hearing loss involving tones of all pitches commonly develops in time. Loud sounds may be uncomfortable and appear distorted in the affected ear. The tinnitus and fullness of the ear may come and go with changes in hearing, occur during or just before attacks, or be constant. The symptoms of Minere`s disease may be only a minor nuts` ance or can become disabling especially if the attacks of vertigo are severe, frequent, and occur without warning. What Medical Diseases Cause Dizziness? Dizziness can be a symptom of all sorts of disorders. Most common are vestibular disorders - problems in the inner ear, particularly in the vestibular system which controls our sense of balance. Other underlying disorders could be in the central nervous system - or brain - resulting from disease or injury. Or dizziness can be a sign of cardiovascular problems like high blood pressure or anaemia Dizziness can be a symptom of an infection - bacterial or viral. Dizziness can also be a reaction to some medications. Sometimes no specific cause for dizziness can be identified, but by eliminating the more serious possibilities, you and your physician can confidently deal with the symptoms and allow the body`s self correcting capabilities time to take effect. How Is Diagnosis Made For Vertigo, Dizziness Et Minere`s Disease? The physician will take a history of the frequency duration, severity and characer of your attacks, the duration of hearing loss or whether it has been changing and whether you have had tinnitus or fullness in either or both ears. You may be asked whether there is a history of any illness in the past. You may be asked questions about your general health, such as whether you have diabetes, high blood pressure, high blood cholesterol, thyroid, neurologic or emotional disorders. Tests may be ordered to look for these problems in certain cases. The physical examination of the ears, and other structures of the head and neck is usually normal, except during an attack. An audiometric examination (hearing test) is recommended. An ENG may be performed to evaluate balance function. A CT scan or magnetic resonance (MRI) may be needed to rule out a tumoroccuring on the hearing and balance nerve. What Can I Do To Reduce Dizziness? Avoid rapid changes in position. Avoid extremes of head motion. Eliminate or decrease use of nicotine, Caffeine and salt, which impair circulation. Minimize your exposure to circumstances that precipitate your dizziness, such as stress and anxiety or substances to which you are allergic. Avoid hazardous activities. What Can I Do For Minere`s Disease Avoid caffeine, smoking- and Alcohol Get regular sleep and eat properly Remain physically active, but avoid excessive fatigue. Avoid driving, Swimming and ladders What Can I Do For Motion Sickness? Always ride where your eyes will see the same motion that your body and inner ears feel. Do not read while travelling. Do not watch or talk to another traveller who is having motion sickness Avoid strong odors and spicy or greasy foods. Take one of the varieties of motion sickness medicines, before your travel begins, as recommended by your physician.

Middle Ear Fluid Serous Otitis Media Tympanotomy /Grommet Serous otitis media is the medical term for "fluid in the middle ear." Its symptoms primarily hearing loss with pressure or pain are frequently experienced by children and adults alike, and typically follow an upper respiratory infection. In most cases, the symptoms of serous otitis media disappear, but in some children and adults, especially those with enlarged adenoids or allergies, symptoms may persist. Generally, the problem is found to be a blockage of the Eustachian tube. This narrow canal connects the middle ear to the back of the nose and permits air to enter the middle ear cavity, allowing the hearing mechanism to function properly. When the symptoms of serous otitis media, such as hearing loss persist, particularly at a time when a child is learning to speak, medical evaluation and treatment are recommended. Eustachian tube function An upper respiratory infection or allergy can interfere with Eustachian tube function. Tubes may swell & shut thus preventing drainage. In addition, adenoids at the back of the throat can become enlarged, blocking the Eustachian tube opening. Treatment CHILD: In children, treatment improves Eustachian tube function, allowing air to enter the middle ear to restore hearing. Antihistamines, decongestants, antibiotics, nasal sprays, and allergy management may reduce swelling and fluid secretion. Surgical tympanotomy, with or without tube insertion, and adenoidectomy may also be recommended. ADULT: Antihistamines, decongestants, and steroids may be used to reduce swelling of the Eustachian tube. Tympanotomy and allergy management are sometimes recommended. Surgical Treatment Tympanotomy If hearing loss or fluid in the middle ear persists, an operation called a tympanotomy, with or without tube insertion, may be recommended in order to remove middle ear fluid. This procedure requires a general anaesthetic for young children. Also in children, surgery to remove enlarged adenoids-adenoidectomy may be done at the same time as tympanotomy. Your Tympanotomy After your anesthetic takes effect, the doctor, using an operating microscope, makes a tiny incision in your eardrum through the outer ear canal. Fluid, if present, will be removed. A tiny ventilating tube may be inserted (tymponotomy). This tube (Grommet tube) takes care of ventilation of the middle ear more than allowing drainage of fluid. The tube usually stays for 2-6 months. Then the body rejects it automatically. Going Home You`ll be able to go home the same day as your surgery. Parents must accompany children. If you had a general anaesthetic, you may feel temporarily drowsy or nauseated. Discharge Instructions Keep water out of your ear to avoid infection. Check with your doctor about showering or swimming. Call your doctor if : You have drainage of pus or blood that lasts more than a few minutes. You have pain unrelieved by prescribed medication. You have a fever over 101°F/38.3°c After Tympanotomy An improvement in hearing is usually noticed right away and the incidence of middle ear infections should decline. In about 6 to 12 months, the tympanotomy tube will automatically expel into the outer ear canal to be removed by the doctor during follow-up visit. . Caution After tympanotomy, it is important to keep water out of the ear, especially when the tube is in place. Water in the middle ear increases the chance of infection. Don`t place your head under water or expose your ear directly to shower spray (wear the shower cap). To help prevent recurrences of serous otitis media, your doctor may recommend that you take decongestants and antihistamines at the first sign of nasal or sinus congestion. Understanding The Problem Treatment of serous otitis media is designed to restore ventilation to the middle ear. Medications and allergy management may open the Eustachian tube and reduce fluid secretion. When needed, a tympanotomy, with or without tube insertion, can be used to allow air to flow into the middle ear cavity. Follow-Up Care Your doctor will arrange a follow-up visit to make sure your ear is healing well. For a complete and speedy recovery, be sure to follow your doctor`s instructions.

What Is "Swimmer`s Ear"? "Swimmer`s ear" is one of a number of names for infection of the outer ear canal. It is also called "fungus" of the ear or "jungle ear" Sometimes it really is caused by a fungus, Out more often, especially in painful cases, it is caused by one of nature`s common bacteria. How Do You Avoid It? When water gets into your ear, it may bring with it bacteria or fungus particles. Usually the water runs back out; the ear dries out, and the bacteria and funguses don`t cause problems. But sometimes the water remains trapped in the ear canal, and the skin gets soggy. Then the bacteria and funguses grow, flourish, and can infect the ear. First the ear feels blocked and may itch. Soon the ear canal becomes swollen, sometimes swells shut, starts draining a runny milky liquid, and becomes very painful. It is also very tender to touch, especially on the tragus (the triangular piece of cartilage in front of the ear canal). When the infection gets to this stage, a doctor`s treatment is needed. This is also true if glands in the neck become swollen. However, the entire sequence of events can be easily prevented if you use antiseptic eardrops whenever you feel that water is trapped in your ears. If your ear feels moist or blocked after swimming, hairwashing, showering, etc. put your head over with that ear up, pull the ear upwards and backwards and instill the eardrops into it. Wiggle your ear to get the drops to go all the way down in, and then turn your head to let them drain out. * If yours is a frequently recurring problem, your doctor may instead recommend placing ear drops in your ears before .swimming to protect them from the effects of the water. CAUTION :If you already have an ear infection, or if you have ever had a perforated, punctured, ruptured, or otherwise injured eardrum, or if you have had ear surgery, you should consult an ear doctor before you go swimming and before you use any type of ear drops. If you do not know if you have or ever had a perforated, punctured, ruptured, or otherwise injured eardrum, you should consult your ear doctor. Why Do Ears Itch? An itchy ear is a. maddening symptom. Sometimes it comes from a fungus [especially in acute cases], but more often it is a chronic dermatitis [skin inflammation] of the ear canal.one type is seborrheic dermatitis, a condition similar to dandruff in the scalp; the wax is dry, flaky, and abundant. Some patients with this problem will do well to decrease their intake of foods that aggravate it, such as greasy food, carbohydrates [sugar and starches], and chocolate. Doctors often prescribe an oily or cortisone-containing eardrop to use at bedtime whenever the ears itch. There is no long-term cure, but it can be kept under control. Itchy ears in a few patients are caused by allergies that require specific medical treatment. Patients with itchy, flaky ears or ears that accumulate wax are very likely to develop "swimmer`s ear". What About Insects And Foreign Objects? Of the many types of insects that can get into the ears, ants, moths, and roaches are the most common. Bigger insects cannot turn around; neither can they crawl backwards. They keep on struggling, though and their motion can be painful and frightening. Small Insects are easily washed out with warm water from a rubber bulb syringe. Beads, pencil lead, erasers, bits of plastic toys and dried beans are common objects that children put into their ears. Removal is a delicate task - one for the doctor to perform.

Care and Prevention Most nosebleeds are mere nuisances; but some are quite frightening, and a few are even life threatening. Physicians classify nosebleeds into two different types. 1. AnteriorNosebleed : The nosebleed that comes from the front part of the nose and begins with a flow of blood out one or the other nostril if the patient is sitting up or standing. 2. PosteriorNosebleed : The nosebleed that comes from deep in the nose and flows down the back of the mouth and throat even if the patient is sitting up or standing. Obviously, if the patient is lying down, even the anterior nosebleeds seem to flow in both directions, especially if the patient is coughing or blowing his nose. Nevertheless, it is important to try to make the distinction since posterior nosebleeds are often more severe and almost always require the physician`s care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face. Nosebleeds in children are almost always of the anterior type. Anterior nosebleeds are common in dry climates or during the winter months when the dry air parches the nasal membranes so that they crust, crack and bleed. This can be prevented if you will place a bit of lubricating cream or ointment about the size of a pea on the end of your fingertip and then rub it up inside the nose, especially on the middle portion (the septum). If the nosebleeds persist, you should see your doctor, who may recommend cautery to the blood vessel that is causing the trouble. To Stop An Anterior Nosebleed If you or your child has an anterior nosebleed, you may be Ale to care for it yourself using the following steps 1. Pinch all the soft parts of the nose together between your thumb and two fingers. 2. Press firmly toward the face - compressing the pinched parts of the nose against the bones of the face. 3. Hold it for 5 minutes (timed by a clock). 4. Keep head higher than the level of the heart - sit up or lie with head elevated. 5. Apply ice (crushed in plastic bag or washcloth) to nose and cheeks. To Prevent Re-bleeding After Bleeding Has Stopped 6. Do not pick or blow nose (sniffing is all right). 7. Do not strain or bend down to lift anything heavy. 8. Keep head higher than the level of the heart. If Re-bleeding Occurs 9. Clear nose of all blood clots by sniffing in forcefully. 10. Pinch and press nose into face again, as in steps 1-3 above. 11. Call doctor. When To Call The Doctor Or Go To A Hospital Emergency Room IF bleeding cannot be stopped or keeps reappearing. IF bleeding is rapid or if blood loss is large. IF you feel weak or faint, presumably from blood loss. IF bleeding begins by going down the back of the throat rather than the front to the nose.

SORE THROATS What Causes a Sore Throat ? Everyone experience a sore throat now and then. A raw painful throat can make swallowing difficult and interfere with daily life. Sore throat is one symptom of an array of different medical disorders. Infections cause the majority of sore throats, and these are the sore throats that are contagious (can be passed from one person to another). Infections can be caused by either viruses or bacteria. The most important difference between viruses and bacteria is that bacteria respond well to antibiotic treatment, but viruses do not. There are many kinds of sore throats. Those associated with an upper respiratory infection, such as a cold, are called acute. Those associated with long-term problems and those return regularly - such as allergies, poor nasal function, and acid reflux - are called chronic. Pharyngitis and Tonsillits are the two most common types of sore throats. Pharyngitis involves the pharynx (the back of the throat) while tonsillitis is confined to the tonsils on either side of the pharynx. Medical treatment is recommended whenever a sore throat is severe or recurs regularly. A thorough medical exam can help establish whether your sore throat is acute or chronic, and what’s causing it. Tonsillitis : Tonsillitis is an inflammation of the tonsils on both sides of the back of the pharynx caused by a viral or bacterial infection. Acute tonsillitis may follow an upper respiratory infection whereas chronic tonsillitis is a recurring problem both forms can be painful. A recent study has shown that children who suffer from frequently recurrent episodes of tonsillitis (such as 3-4 episodes each year) were healthier after their tonsils were surgically removed Pharyngitis : Pharyngitis means ` inflammation of the pharynx". Acute pharyng can be very painful but generally lasts only a few days. It is most oft often caused by a viral infection, for which antibiotics are ineffective Medication may help reduce pain and relieve a runny nose, watery eyes, and itching. Chronic pharyngitis is generally due to allergies, nasal obstructions that cause "dry throat" or acid reflux, antibiotics are not commonly prescribed. Viruses : Most viral sore throats accompany the "flu" or a `cold". When a stuffy-runny nose, sneezing, and generalized aches and pains accompany the sore throat, it is probably caused by one of the hundred of known viruses. These are highly contagious. The body cures itself of a viral infection by building antibodies that destroy the virus, a process .that takes about a week. Sore throats accompany other viral infections such as measles, chickenpox, whooping cough, and croup canker sores and fever blisters in the throat also can be very painful. Bacteria : "Strep throat" is an infection caused by a particular stain of streptococcus bacteria. This infection can also cause damage to the heart valves (rheumatic fever) and kidneys (nephritis). Streptococcal infections can also use scarlet fever, tonsillitis, pneumonia, sinusitis arid ear infections. Because of the possible complications, a "strep throat" should he treated with an antibiotic. "Strep" infections usually cause a longer lasting sore throat than a "cold" or the "flu". But "strep" is not always easy to detect by examination, and a throat culture may be needed. Allergy : Hayfever and allergy sufferers can get an irritated throat during an allergy attack the same way they get a stuffy, itchy nose, sneezing and post nasal drip. The same pollens and molds that irritate the nose when they are inhaled may also irritate the throat. Irritation : During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need examination and treatment of the nose. An occasional cause of morning sore throat is regurgitation of stomach acids up into the back of the throat where they are extremely irritating. This can be avoided if you tilt your bed-frame so that the head is elevated four to six inches higher than the foot. You should also avoid eating and drinking for one to two hours before retiring to bed. You might find antacids helpful. If these fail, see your doctor. Industrial pollutants and chemicals in the air can irritate the nose and throat, but by far the most common and pervasive air pollutant is tobacco smoke. It cannot be tolerated by many persons who are either allergic or over sensitive to its contents. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods. A person who strains his voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain, but also from the rough treatment of his throat membranes. Well-trained, experienced public speaker& and singer learn not to abuse their throats and voices in this way. They produce loud voices by taking deep breaths and using their chest and abdominal muscles more than their throat muscles. Tumors : Tumors of the throat, tongue and larynx (voice box) are usually (but not always) associated with long time use of tobacco and alcohol. Sore throat and difficult swallowing -sometimes with pain radiating to the ear - may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Other important symptoms include hoarseness ,a lump in the neck, unexplained weight loss and/or spitting up blood in the saliva or phlegm. The diagnosis will require examination by a physician with special training in diseases of the ears, nose, throat, head and neck. Special mirrors or telescopic instruments will be used to see the suspicious areas of the throat. How Can I Treat My Own Sore Throat? A mild sore throat associated with "cold" or "flu" symptoms can be made more comfortable with the following remedies. Increase your liquid intake. (Warm tea with honey is a favourite home remedy). Use a steamer or humidifier in your bedroom. Gargle with warm salt water several times daily: 1/4 tsp salt to 1/2 cup water. Take throat lozenges. When Should I See a Doctor? Whenever a sore throat is severe, persists longer than the usual five to seven day duration of a "cold" or "flu" and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your physician. Severe and prolonged sore throat Difficulty breathing Difficulty swallowing Difficulty opening the mouth Joint pains Earache Rash Blood in saliva or phlegm Frequently recurring sore throat Lump in the neck Hoarseness lasting over 2 weeks Fever (Over 100) When Should I Take Antibiotics ? Antibiotics are drugs that kill or impair bacteria. Pencillin or erythromycin (well-known antibiotics) are prescribed when the physician suspects streptococcal or other bacterial infection that will respond to them. However, a number of bacterial throat infections do" not cure viral infections, but viruses do lower the patient`s resistance to bacterial infections. When such a combined infection occurs, antibiotics may become necessary. When an antibiotic is prescribed, it should be taken - as the physician directs - for the full course. Otherwise the infection will probably be suppressed rather than eliminated, and it can return. What If My Throat Culture Is Negative? A "strep" culture tests only for presence of streptococcal infections. Many other infections, both bacterial and viral, will yield negative cultures and sometimes so does a streptococcal infection. Therefore, when your culture is negative, your physician will base his decision for treatment on the severity of your symptoms and the appearance of your throat on examination. Do not discontinue your medications unless your physician instructs you to do so. Should Other Family Members Be Treated? or Cultured ? When "strep" throat is proven by test or culture, many experts recommend treatment of other family members, because streptococcal infections are so highly contagious. Others recommend treating only the family members with sore throats and culturing the others. So be sure you tell your physician how other family members are feeling.Practice good sanitary habits; avoid close physical contact and sharing of napkins, towels and utensils with the infected persons. Handwashing makes good sense. The advice in this pamphlet is for general information. But remember, the best advice for your specific case is what you get from your physician who hears your symptoms and examines your throat.

Ear Surgery your Questions Answered Why do I have persistent discharge from my ear? One of the common symptoms of middle ear infection (otitis media) is ear discharge. Otitis media may occur following a common cold. It may also occur following infection through a perforation in the eardrum or as a result of infected sinuses or adenoids. Frequent middle ear infections and the presence of an infected cholesteatoma (a mass of dead skin cells) often cause the eardrum to perforate and discharge foul smelling pus. Do I need to go for ear surgery? There are different ways of treating ear disorders. When surgery is indicated, your doctor will advise you about it. Please refer to your doctor or nurse for specific information about your particular operation. Can my hearing be improved by surgery? Your hearing may be improved by surgery especially if it is done specifically for hearing loss. However sometimes, ear surgery is carried out to prevent further complications of certain conditions and in such instances your hearing may not be improved. Are there things to be done before an operation? For certain operations, it is necessary to shave hair within 2 cm of the ear. To prevent infection of your ear, you will be prescribed with antibiotics. Hair wash is necessary the night before surgery. What should I do after surgery? You should lie comfortably with your head on the pillow and with the operated ear uppermost. After the operation, certain patients may have the urge to vomit or feel giddy. These symptoms are usually controlled by medication. To relieve discomfort of the ear, you will be prescribed an analgesic (pain killer). If a head bandage has been applied in the operating theatre, it will be removed the next day for a lighter dressing. Cotton wool at the entrance of the ear will be changed. You need to be careful not to remove any dressing, which has been inserted into the ear canal itself. Usually stitches are removed on the seventh day. Avoid blowing your nose to prevent damage to the repaired eardrum. You are advised to avoid bending or to turn your head suddenly. What is your advice for me following my discharge from the hospital? We would like you to remember these important instructions: DO`S You are to keep the ear clean and dry. When you rinse your face, please be careful. You may change the cotton wool at the entrance of the ear if it is stained. Don`ts You should not swim, drive or fly until the doctor has given his approval. Avoid blowing your nose until your ear is completely healed. Do not cover your nose or mouth when you have to sneeze or cough. Just turn away and do so with your mouth open. Do not allow water to get into the ear canal when washing your hair because it may give rise to an ear infection.

Tonsils & Adenoids "T&A" (short for tonsillectomy and adenoidectomy) is the second most common -operation performed for children, and it is not unusual for an adult to require a tonsillectomy. Although T&A is not recommended as often as before the days of antibiotics,It is still a valuable operation that improves the health of many children and adults.. Recent studies indicate that adenoidectomy may be beneficial treatment for some young children affected by chronic otitis media with effusion (fluid in the ears). What is the Purpose of Tonsils and Adenoids? Tonsils and adenoids are composed of tissue that is similar to the Lymph nodes or "glands" found in the neck, groin, and other places in the body. They are part of a "ring" of glandular tissue encircling the back of the throat. The adenoids are located high in the throat behind the nose and soft palate (roof of the mouth) and, unlike tonsils, are not visible through the mouth without special instruments. The tonsils are the two masses of tissues on either side of the back of the throat. Tonsils and adenoids are strategically located near the entrance to the breathing passages where they can catch incoming infections. They "sample" bacteria and viruses and can become infected themselves. It is thought that they then help form antibodies to those "germs" as part of the body`s immune system to resist and fight future infections. This function is performed in the first few years of life, but it is less important as the child gets older. In fact, there is no evidence that tonsils or adenoids are important after the age of three. One recent large study showed by laboratory tests and follow-up examinations, that children who must have their tonsils and adenoids removed suffer no loss whatsoever in their future immunity to disease. There is a popular myth that tonsils and adenoids filter bacteria out of what we swallow and breathe, somewhat like a kitchen strainer. This is untrue. Any filter that could strain out microscopic bacteria would not allow the passage of any food particles and would make eating impossible. How does the Doctor check Tonsils and Adenoids? The primary methods that are used to evaluate tonsils and adenoids include: Medical history Physical examination Bacteriological cultures X-rays Blood tests Possible additional studies Your physician will take history about the patient`s ear, nose and throat problems and perform an examination of the head and neck. Examination of the nose and throat may be aided by the use of small mirrors or a flexible lighted instrument. The physical examination will also determine whether the lymph nodes in the neck are enlarged. Cultures are important in diagnosing certain infections in the throat, especially "strep" throat. Whether or not a culture is taken will depend on your physician`s judgment and on the appearance of the throat. Cultures for other bacteria and even for viruses can be done but are seldom necessary, X-rays are sometimes helpful in determining the size and shape of the adenoids. These X-rays are quite safe. What Diseases Affect Tonsils and Adenoids? The most common problems affecting the tonsils and adenoids in children are recurrent infections (causing sore throats) and significant enlargement (causing trouble with breathing and swallowing). Recurrent acute infections of the tonsils also occur in adults. So do abscesses around the tonsils, chronic tonsillitis, and infections of small pockets (crypts) within the tonsils that produce bad smelling, cheesy-like formations. Tumors can also grow in the tonsils but they are rare. When should I consult my Doctor? You should see your doctor when you or your child suffer the common symptoms of infected and enlarged tonsils and adenoids: recurrent sore throats, fever, chills, bad breath, nasal congestion or post-nasal drainage or obstruction, recurrent ear infections, mouth breathing, snoring and sleep disturbances. How are Diseases of the Tonsils and Adenoids Treated? Bacterial infections of the tonsils, especially those caused by "strep" are initially treated with antibiotics. Removal of the tonsils and/or adenoids may be recommended for some children and adults. The two primary reasons for tonsil and/or adenoid removal are (1) Recurrent infection despite antibiotic therapy and (2) Difficulty breathing due to enlarged tonsils and/or adenoids. Obstruction to breathing causes snoring and disturbed sleep patterns that lead to daytime sleepiness in adults and behavioral problems in children. Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes malformations of the face and improper alignment of the teeth. Chronic infection in the tonsils and adenoids can also affect nearby structures such as the Eustachian tube (the passage between the back of the nose and the inside of the ear).This can lead to frequent or chronic ear infections with earaches and hearing loss. In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may progress to a point of obstructing the airway. For these patients, treatment with steroids (i.e., cortisone) is sometimes helpful. How should the patient prepare for Surgery? If your physician has determined that a tonsillectomy and/or adenoidectomy is needed you should prepare for the operation. Parents should discuss openly and frankly the child`s feelings about the surgery and provide strong reassurance and support throughout the process. Encourage the child to think of this, as something the doctor will do to make him healthier. Try to be with the child as much as possible before and after the surgery. Children should be aware they will have a sore throat after surgery, but it will only last a few days. They should also be reassured the operation does not remove important parts of the body, and they will not look differently afterward. If there is a friend who has had this surgery, it may be helpful for the child to talk to the friend about it. If the patient is taking any other medications, the doctor should be informed. The surgeon should be informed of any problems the patient or the patient`s family may have had with anesthesia. If the patient has sickle cell disease, bleeding disorders, is pregnant, has specific views on the transfusion of blood, or if steroids have been used by the patient in the past year, the surgeon should be informed. Generally, after midnight, the day before the operation, nothing may be taken by mouth. This restriction also applies to chewing gum, mouth washes, throat lozenges, toothpaste, and water. If the restriction is broken, the operation may be cancelled because anything in the stomach may be vomited at the beginning of the anesthesia. and this is dangerous. A blood test and possibly a urine test will usually be required prior to surgery. When the patient arrives at the hospital, he/she will go either to his hospital room or to a holding area while preparations are made for surgery. In the holding area, the anesthesiologist or nursing staff may meet with the patient who will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery. After the operation, the patient will enter the recovery unit. Observation should be continued until the patient is adequately recovered from surgery and safe to be discharged. Many patients are discharged after 8- 10 hours. Others are kept overnight. No standard fixed period of observation is safe for all patients. Your physician will provide the details of the pre-operative and post-operative care and answer any other questions you may have. What may occur after Surgery? There are several post-operative symptoms that may arise. These include, but are not limited to, swallowing problems, vomiting, fever, throat pain and ear pain. These are not uncommon, and they may all occur. Occasionally, bleeding may occur post operatively. In this case, your surgeon should be notified immediately.

Sinus Pain, Pressure, Drainage Help, my sinuses are killing me! Have you ever said that? Have you ever felt like that? Have you ever taken medicine for sinuses? Does everyone have sinuses? Yes even a newborn baby has little tiny ones. Sinuses begin as pea-sized pouches extending outward from the inside of the nose into the bones of the face and skull. They expand and grow through childhood into young adulthood. They are air pockets: Cavities that are lined with the same kind of membranes that line the nose, and they are connected to the inside of the nose through small openings about the size of a pencil lead. What do sinuses do? Sinuses are part of the nasal air and membrane system that produces mucus. Normally, the nose and sinuses produce between a pint and a quart of mucus and secretions per day. This mucus passes into and through the nose, sweeping and washing the membranes, picking up dust particles, bacteria, and other air pollutants along the way. The mucus then flows backward into the throat where it is swallowed, down into the stomach where acids destroy any dangerous bacteria. Most people do not notice this mucus flow because it is just a normal bodily function. What is "post-nasal drip"? When the nasal passages are irritated by allergies, air pollution, smoke or viral infections (such as "cold"), then nose and sinus membranes secrete more than the normal amount of mucus. This will be clear, watery, and profuse mucus that is supposed to wash away the irritants or allergy. This is the most common type of "post-nasal drip". Another form of "post-nasal drip" is mucus that is thick and sticky. This occurs when the air is too dry and the nose membranes cannot produce enough moisture to put into the mucus for it to flow easily. Bacterial infections also produce thick, sticky mucus with pus in it, turning it a yellow or green colour What is Sinusitis? It is a medical term for infection or inflammation, so "sinusitis" is an infection or inflammation of the sinuses. A typical case of acute sinusitis begins with a cold or "flu" or an allergy attack that causes swelling of the nasal membranes and increased watery mucous production. The membranes can become so swollen that the tiny openings from the sinuses become blocked. When mucus and air cannot flow easily between the nose and sinuses, abnormal pressures occur in the sinuses, and mucus can build up in them. This creates a pressure-pain in the forehead or face, between and behind the eyes, or in the cheeks and upper teeth, depending on which sinuses are involved. A blocked sinus cavity filled with mucus becomes a fine place for bacteria to grow. When a person`s "cold" lasts more than the typical week or so, and when his mucus turns yellow/green or develops a bad odour or taste, then a bacterial infection has probably taken over. The pressure and pain in the face and forehead can be quite severe in acute bacterial sinusitis. Chronic sinusitis occurs when the sinus opening is blocked for an extended period. Headaches are less prominent in chronic sinusitis, but congestion and unpleasant nasal secretions usually persist. Also, fleshy growths known as polyps can develop as an exaggerated form of inflammatory swelling of the membranes. Some cases of sinusitis come from infections in the upper teeth that extend into the sinuses. Is sinusitis dangerous? Most cases of sinusitis respond promptly to medical treatment and are not serious. However, an infection that is in the sinus is also very close to the eye and to the brain. Extension of a sinus infection to the eye or brain is rare. Furthermore, it is not healthy for the lungs to have infected mucus dripping down from infected sinuses. Bronchitis, chronic cough and asthma are often aggravated, or even brought on, by sinusitis. What is sinus headache? In the face, cheeks, forehead or around the eyes that comes on during a "cold" or when the nose is congested and runny or filled with mucus, is probably a "sinus headache": One caused by sinus infection. Another kind of sinus headache is the one that occurs in the sinus areas during descent (landing) in an aeroplane, especially if you have cold or active allergy (this is called vacuum headache). Unfortunately there are many other causes of headaches that can be confused with sinusitis. For example migraine and other forms of vascular or "tension" headaches also give pain in the forehead and around the eyes, and they may even cause a slight stuffy-runny nose. But they are more likely to come and go away in a day or so without a physician`s treatment, whereas sinusitis usually gives a headache that lasts for days or weeks until it is treated with antibiotics. Furthermore, intermittent headaches that cause nausea and vomiting are more typical of a migraine-type headache than sinusitis. Severe, frequent, or prolonged headaches deserve a visit to a physician for diagnosis and treatment. Who gets into sinus trouble? Actually, anyone can "catch" a sinus infection, but certain groups of people are more likely to develop sinusitis. People with allergies: An allergy attack, like a "cold", causes swelling in the nasal membranes that will block the sinus openings, obstruct the mucous drainage, and predispose to infection. People with deformities of the nose that impair good breathing and proper drainage: Examples are a crooked nose or a deviated septum (the structure between the nostrils that divides the inside of the nose into right and left sides). People who are frequently exposed to infection: School teachers and health workers are especially susceptible. People who smoke: Tobacco smoke, nicotine, and other pollutants impair the natural resistance to infection. What will a doctor do for my sinuses? You physician will ask you questions about your breathing, the nature of your nasal mucus and the circumstances (time of day or seasons) that give you symptoms. Be prepared to explain your headaches: When and how often they occur, how long they last, and if they are associated with nausea, vomiting, vision changes, or nasal congestion. An otolaryngologist-head and neck surgeon is the kind of physician who will especially examine your ears, nose, mouth, teeth, and throat with particular attention to the appearance of your nasal membranes and secretions. He/she will check for deformities of your nose that impair breathing and for tenderness over your sinuses. X-rays of your sinuses might be needed. Treatment will depend on the diagnosis that your physician establishes. Infections may require either antibiotics or surgery or sometimes both. Acute sinusitis most likely will improve on medication, but chronic sinusitis more often requires surgery. If your symptoms are due to allergy, migraine, or some other disease that mimics sinusitis, your doctor will have alternative treatment plans. what can I do for my own sinuses? Use a humidifier when you have a cold, and sleep with the head of your bed elevated. This promotes mucus drainage. Decongestants can also be helpful, but they contain chemicals that act like adrenalin and are dangerous for persons with high blood pressure, irregular heart rhythms, heart disease, or glaucoma. They are also like stimulants that can produce sleeplessness. You should consult your physician before you use these medications. Avoid air pollutants that irritate the nose, especially tobacco smoke. Minimize exposure to persons with known infections if possible. and practice sanitary health habits when you must be around them (such as hand washing and avoidance of shared towels. napkins, and eating utensils) A large variety of non-prescription medications are sold as sinus remedies, but it is a folly to try them before a proper diagnosis is established. The best advice you can ever get, of course, is what is given to you by your physician who evaluates your own special symptoms and examines your own nose and sinuses.

Stuffy Nose and Allergy Nasal congestion, stuffiness or obstruction to nasal breathing is one of man`s oldest and most common complaints. While it may be a mere nuisance to some people, to others it is a source of considerable discomfort and it detracts tom the quality of their lives. Infections An average adult suffers a common "cold" two, three times per year, more often in childhood and less often the older he gets as he develops more immunity. The common cold is caused by any number of different viruses, some of which are transmitted through the air, but most are transmitted from hand - to nose contact. Once the virus gets established in the nose, it causes release of the body chemical histamine, which dramatically increases the blood flow to the nose - causing swelling congestion of nasal tissues and which stimulates the nasal membranes to produce excessive amounts of mucus Antihistamines & decongestants help relieve the symptoms of a "cold", but time alone cures it. During a Virus infection, the nose has poor resistance against bacterial infections of the nose and sinuses, which so often follow a "cold" When the nasal mucus turns from clear to yellow or green, it usually means that a bacterial infection has taken over and a physician should be consulted. Acute sinus infections produce nasal congestion, thick discharge and pain and tenderness in the cheeks and upper teeth between and behind the eyes, or above the eyes and in the fore head, depending on which sinuses are involved. Chronic sinus infections may or may not cause pain, but nasal obstruction and offensive nasal or postnasal discharge is often present. Some people develop polyps (fleshy growths in the nose) from sinus infections, and the infection can spread down into the lower airways leading to chronic cough, bronchitis and asthma. Acute sinus infection generally responds to antibiotic treatment, chronic sinusitis usually requires surgery. Structural Causes Included in this category are deformities of the nose and the nasal septum, which is the thin, flat cartilage and bone that separates the nostrils and the nose into its two sides. It consists of cartilage in the front and bone in the back. The normal anatomic position of the septum is midline and straight and significant deviations from this position can produce varying degrees of nasal obstruction. Perhaps slightly over half of septal deformities are acquired primarily from nasal trauma i.e. a blow to the nose in adult life or even during childbirth. The remainder of these deformities is congenital. A septal deformity alone is not an indication for surgical intervention. One that causes clinical symptoms may be one, in addition to nasal obstruction, the deformity can be a predisposing factor for sinusitis, if there is compromise of the sinus openings by the deviated septum. In certain instances septal deformities can cause Eustachian tube dysfunction and resultant middle ear problems such as fullness, popping, fluid accumulation, etc. The treatment is variable ad no treatment is needed for minor degrees of deviation without nasal airway obstruction. A clinically symptomatic septal deformity can be surgically corrected with a septoplasty as a day Surgery procedure either under local or general anesthesia. At times it will be necessary to surgically reduce the inferior turbinate or improve the nasal airway. The inferior turbinates’ can be reduced by "sub mucous diathermy" (SMD). All incisions for these procedures are made inside the nose, and since no chisel cuts are made on the external nasal skeleton there will be no facial swelling or "black eyes" post operatively. One of the most common causes for nasal obstruction in children is enlargement of the adenoids: tonsil-like tissues, which fill the back of the nose, up behind the palate. Children with this problem breathe noisily at night and even snore. They also are chronic mouth breathers, and they develop an idiotic looking face and sometimes dental deformities. Surgery to remove the adenoids and sometimes tonsils may be advisable. Other causes in this category include Nasal tumours and foreign bodies. Children are prone to inserting various objects such as peas, beans, rubbers, beads, buttons, safety pins and bits of plastic toys into their noses. Beware of one-sided foul smelling discharge, which can be caused by a foreign body. A physician should be consulted in such case. Allergy Hay fever, rose fever, grass fever, and summer time "colds" are various names for allergic rhinitis. Allergy is an exaggerated inflammatory response to a foreign substance which, in the case of a stuffy nose, is usually a pollen mould, animal dander, or some element in house dust. Foods sometime play a role. Pollens may cause problems in summer, whereas house dust allergies are often most evident in the winter. Moulds may cause symptoms year-round. Ideally the best treatment is avoidance of these substances, but that is impractical in most cases. In the allergic patient, the release of histamine and similar substances results in congestion and excess production of water, nasal mucus. Antihistamines help relieve the sneezing and runny nose of allergy. Combinations of antihistamines with decongestants are also available, and they are highly successful in allergic patients. The physician determines the best concentration for initiating the treatment. Patients with allergies have an increased tendency to develop sinus infections. Allergic persons have a decreased resistance to colds, flu and ear infections. Furthermore they are more uncomfortable with such infections than people without allergies, and even more seriously, they may also develop asthma Vasomotor Rhinitis "Rhinitis" means inflammation of the nose and nasal membranes. "Vasomotor" means blood vessel forces. The "membranes of the nose have an abundant supply of arteries, veins and capillaries which have a great capacity for both expansion and constriction. Normally these blood vessels are in a half constricted state. But when a person exercises vigorously, his hormones of stimulation (i.e., adrenalin) increase. The adrenalin causes constriction or squeezing of the nasal blood vessels, which shrinks the nasal membranes so that the air passages open up and the person breathes more freely. The opposite takes place when allergic attack or a "cold" develops. The blood vessels expand, the membranes become congested and the nose becomes stuffy or blocked. In addition to allergies and infections other events can also cause nasal blood vessels to expand Leading to vasomotor rhinitis. These include psychological uses, inadequate thyroid function, pregnancy, certain anti-high blood pressure drugs, over use or prolonged use of decongesting nasal sprays and irritants such as perfume and tobacco smoke. In the early stages of each of these disorders, the nasal stuffiness is temporary and reversible. That is it will improve if the primary cause is corrected. However, if the condition persists for a long enough period, the blood vessels lose their capacity to constrict. The congestions often interfere with sleep. Surgery may offer dramatic and long-time relief. Summary: Stuffy nose is one symptom caused by a remarkable array of different disorders, and the physician with special interest in nasal disorders will offer treatment based on the specific causes.

The Endoscopic Approach for Diagnosis & Treatment of Salivary Gland Diseases What Is Sialendoscopy? Sialendoscopy is a new procedure aiming to visualize the lumen of the salivary ducts and their pathologies. It is a promising new method for diagnosis and treatment of most of the inflammatory conditions of the major salivary glands and can therefore prevent salivary gland excisions. Standard Diagnostic Approaches The classical investigative methods of salivary glands are X-Rays, Ultrasound, CT scan, Sialography and MR Sialography which up to now is considered as the Gold Standard for evaluation of salivary ductal system. With the introduction of sialendoscope, the ductal systems of parotid and submandibular salivary glands can be directly visualized and documented. This provides direct reliable information about most pathologies and reduces the need for radiological investigations. Diagnostic Sialendoscopy All patients with salivary gland enlargement, recurrent sialadenitis must be subjected to a diagnostic sialendoscopy to diagnose the condition and to visualize the different pathologies present like mucous plugs, sialolithasis (stones), ductal stenosis, sialectasis and ductal tumors. Interventional Sialendoscopy Following diagnostic sialendoscopy, if stones are found their extraction is performed with wire baskets of various sizes. In cases of ductal stenosis, the site is localized and using semi rigid dilators or a balloon tipped catheter, it is dilated. Sialendoscope can be used for instilling medication into the salivary glands and for taking biopsy from suspicious areas. Indication The indications for sialendoscopy are all salivary glands swellings. There is no specific contraindication, mostly because sialendoscopy is a minimally invasive outpatient procedure performed under local anesthesia.

Nasal and sinus surgery your questions answered My nose is often blocked. Is it all right for me to breathe through my mouth? The nose is the first part of the breathing passage. When it is blocked, you need to breathe through your mouth instead. But you will then experience dryness of your mouth and may even have an irritating throat. Why my nose is often blocked? There are several causes of nasal obstruction. The common causes are: rhinitis, sinusitis, nasal polyps, enlarged turbinates’’, deviated nasal septum and nasal allergy. There are different ways of treating nasal and sinus disorders. When surgery is indicated, your doctor will advise you about it. What can I expect after the operation? 1. Soon after the operation you will have a blocked nose due to the nasal packs. The packs will be left in the nose for 24-48 hours. This is to prevent bleeding. 2. You are advised to breathe through the mouth and not to pull out the packs. You will have a mild headache, watering of the eyes and dryness of the mouth. 3. To make you feel more comfortable you will be given mouthwashes and oral medications. You may wish to take frequent sips of water or ice chips to soothe your dry mouth. After a few hours you will be allowed a drink of water. It is unlikely that you will want to eat until the next day. 4. One or two days after the operation, your packs will be removed by the doctor. Once the packs are removed, you are advised as follows: Do not take any hot drinks within an hour. Continue to breathe through your mouth. Do not blow your nose If you have to sneeze or cough, do so with your mouth open Do not tamper with your nostrils Instil nose drops as prescribed. 5. The doctor will see you each day and before you are discharged, which is likely to be two days after your operation. Before you go home you will be given an outpatient appointment and any medications, which you need to take. After discharge advice - Post Operative Care Your nose will continue to be blocked for a few days due to swelling, blood clots and crusting. You will expect some blood stained mucous discharge from the nose for the next few days to a week. During the first week after the operation you should rest at home and avoid contact with people suffering from colds, coughs or other infections. Do not smoke or visit crowded places such as shopping centres and cinemas. You will be given medical leave until the next appointment with your doctor. If you experience any heavy bleeding from the nose or the throat, you must come to the hospital immediately.

Is the Doctor really Right About the Risks of smoking Cigarettes? Yes – absolutely! The medical evidence proving the health hazards of smoking is now beyond question. Tobacco use, including pipe and chewing tobacco, increases your risk of developing cancer, heart disease, stroke, and lung disease. Consider the following questions. What about Cancer? Tobacco smoke and tobacco juices contain carcinogens, chemicals that can cause normal cells in the body to change into cancer cells. The result is: *Smoking is the cause of about 30% of all cancers and 75% of lung cancer. Lung cancer is already the leading cause of death for men and has just surpassed breast cancer as the leading cause of death for women. *There is a significant link between cancer of the mouth, lip, tongue and throat, and the use of cigarettes, pipes, cigars or chewing tobacco. *Pipe and cigar smokers are 3-5 times more likely than non-smokers to develop cancer of the mouth and esophagus (swallowing passage). *Lip and tongue cancer appear to be related to pipe and cigar smoking. *Smoking is the major cause of cancer of the larynx (voice box), a cancer that can rob you of your natural voice or lead to death. Beside Cancer, What Else? Tobacco users suffer a loss of the elasticity of their body tissues more rapidly than other persons of their same age. This means that those body tissues that need to be flexible, to expand and contract, cannot do so as well. The loss of elasticity in the smoker leads to hardening of the arteries; high blood pressure; heart attacks and strokes at an earlier age than nonsmokers. In fact, smokers have two times the risk of dying of heart attacks and three times the risk of dying of strokes than nonsmokers. Tobacco is even a health risk to unborn babies of mothers who smoke. It increases the risk of miscarriage, low birth weight, complications during pregnancy, and the likelihood of health problems during infancy. As if all that were not enough, smoking decreases the resistance of the nose, sinuses, and lungs to infections. Thus, the smoker is more likely to contract pneumonia, and catches “colds”, bronchitis and sinus infections more often and has more difficulty recovering from these than nonsmokers do. Even nonsmokers who work around or live with smokers (who cannot avoid breathing their “second-hand smoke”) will suffer this decreased resistance to infections. This is especially true with little children who live in a smoker’s household. Tobacco is the most preventable cause of death. Why Do People Still Smoke? Smoking is a form of drug addiction because tobacco contains nicotine, an addictive drug. This means that a smoker goes through physical and psychological drug-withdrawal effects when trying to quit. These may include intense food craving, jittery nerves, anxiety, short temper, depression and sleeplessness. Some people smoke because they think it will help them appear more important, fashionable or glamorous. Others use it as a crutch to overcome self consciousness in social situations. Teenagers often buckle under peer-group pressure and smoke because their friends do and they want to be accepted by the crowd. Fortunately, the last decade has seen these attitudes change as people have become better educated and more sophisticated about health. The more popular thinking today is that smoking is not glamorous at all ,when it yellows your teeth, gives you bad breath and fills the room with odors that are offensive and hazardous to others. Increasingly, smoking carries with it a social stigma. In fine restaurants, and in commercial aero planes, the smoker is assigned to segregated seating. Unfortunately, some persons who have smoked for years feel “it’s too late for them and the damage is already done so why quit?” But medical evidence has proven that this is not true. Your body starts the process of healing as soon as you finish that last puff. How Can I Quit? Mark twain once quipped, “It is easy to quit smoking; I’ve done it hundreds of times.” For a few disciplined persons it is easy to quit abruptly but for many others it is not easy at all. Since the prospect of never smoking again may seem unbearable to you, make your promise to quit for just one week. After you have conquered the first smokeless week then promise another week, and so on, until you are permanently cured. You have two major hurdles to overcome; First, the Addiction to nicotine, and secondly, the Habit of smoking How Can I kick the ADDICTION? If you quit abruptly, the addiction withdrawal symptoms will be at their worst in the first week and less severe in the second. After a month most of the withdrawal symptoms will be gone. If you quit gradually, the withdrawal may be less intense but will be more prolonged. This is why many experts recommend quitting abruptly. Tell your friends, your family, your boss, and your fellow workers that you have just quit smoking. You may be temporarily irritable, depressed, and anxious for one week or so, but these withdrawal symptoms will pass. Ask for everyone’s support and understanding. Do anything to keep busy and keep your mind off smoking. Exercise; work on that talent or hobby you always wanted to develop, especially if it involves use of your hands (sewing, model building, practicing the piano, etc.). Go visit your nonsmoking friends, but avoid circumstances you associate with smoking such as cocktail parties, watching television, balancing the checkbook, talking on the telephone or your usual “cup of coffee and a cigarette”. An excellent time to quit smoking is when you are hospitalized. The controlled hospital environment is very helpful. Furthermore, physicians often insist that you quit smoking before surgery and anesthesia, so you can better resist post-operative pneumonia that smokers are more likely to develop. Once you have conquered the addiction, NEVER try a cigarette again-not even just one little teeny one. Many a successful quitter has stumbled back into a full addiction by trying “one” cigarette”just to be sociable”. How Can I Break the HABIT of Smoking? You must break that habit of automatically lighting-up and taking a puff before you think of it. So from now on, every time you start to light up, become conscious of fact that you are doing so. Next try to think of why you are doing this: Are you upset about something? Are you in an environment where you usually smoke? Are you nervous? If you can determine exactly when it is you most often smoke and why it is you do so at that time, you will then be in a better control of situation and be able to effectively deal with it. Instead of having a cigarette, keep a pack of chewing gum in the place where your cigarettes would usually be. Or, drink a glass of water each time the urge to smoke occurs. Also, try hiding your cigarette in places where you ordinarily wouldn’t took for them, such as is in the trunk of you car, down in the basement or in the bureau drawer. You will then have a make conscious effort to look for them, and hopefully, this will be troublesome enough so that you will smoke fewer of them. Also from now on, buy cigarettes by the single pack only & not by the carton. The added inconvenience may deter you even more Weight gain is the frequent problem for smoker’s who are quitting. This is because food tastes better and also helps to satisfy an oral craving. So avoid sweets and other fattening foods, and use low calorie, healthful ones instead, e.g .,chew carrots or celery sticks. Start an exercise program to burn off those calories. Exercise also reduces stress and anxiety. Do Nicotine Gum and Patches Really Help? Nicotine gum and patches may help as you try to break the HABIT of smoking: Both systematically reduce your nicotine ADDICTION. By providing an alternative source of nicotine, without the other harmful additives found in tobacco products, they allow the smoker to concentrate on overcoming psychological and social factors of the smoking habits. Both patches and gum require a doctor’s prescription. The patches contain nicotine which is slowly released into your bloodstream through the skin; they come in different styles and strengths. Depending on how much you smoke, you may start with a higher dose and reduce to a lower strength. Remember, When you use the patch you cannot keep smoking. If you do, the double amounts of nicotine can lead to very serious condition called nicotine toxicity and a heart attack. If you continue to smoke while using the Patch, you may end up with a trip to hospital. Nicotine gum also provides an alternative source of nicotine. Once the habit is broken, you then stop chewing the gum and go through drug withdrawal. For some, separating the withdrawal from the habit breaking makes quitting easier. Although either can help satisfy your nicotine craving, they are only aids. · They are no substitutes for willpower and won’t work unless you are committed to quitting. · The gum or patch should be used in conjunction with a smoking cessation program; you can’t be magically cured of your habit. For those ready to quit smoking, who are having trouble with nicotine withdrawal, nicotine gum or patch might provide the extra edge needed to quit for good. Where Can I Seek Help? Your Physician can help motivate you by discussing your personal health and the risks you take when you smoke. Nicotine chewing gum requires a doctor’s prescription. Your physician might even prescribe a tranquilizer for your worst few days of withdrawal, But he would not want you to substitute a new addiction for an old one. Is It Worth It? Ask anyone who has quit smoking. Most who have quit are justly proud of the significant personal accomplishment. They feel healthier, more attractive and more robust; they breathe better; food tastes better; and some people even feel younger. Their homes and offices are no longer polluted with smoke, cigarette butts and ashes, and they have finished finding cigarette burns on their carpets, furniture and clothes. Yes, it’s worth it. Doctors and medical statistics say so. Even if you have smoked for many years, you can beat odds by quitting.

Otitis media is the most frequent diagnosis recorded for children who visit physicians for illness. Approximately one third of all children have more than three ear infections during the first three years of life. This results in 30 million doctor visits per year. Otitis media is also the most common cause of hearing loss in children What is Otitis Media ? The best way to define the otitis media is to look at what the words mean. They are actually made up of three parts: Ot-meaning “ear”, -itis meaning “inflammation”, and media meaning “middle” or more exactly, “middle ear”. So, otitis media means “inflammation of the middle ear”. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Although otitis media is most common in young children, it also affects adults occasionally. It occurs most commonly in the winter and early spring months. Is It Serious? Yes, it is serious because of the hearing loss it creates, and such hearing loss may impair the child’s learning capacity and even delay his speech development. It is also serious because it can cause severe earache and because infections can spread to nearby structures in the head, especially the mastoid. However, otitis media is not serious if it is treated promptly and effectively, and then hearing can almost always be restored to normal. Thus, it is very important to recognize the symptoms of otitis media and to get medical attention from the start How Does the Middle Ear function? The middle ear is a pea-sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three tiny ear bones (see diagram). When sound waves strike the eardrum, it vibrates and sets the bones into motion that is transmitted to the inner ear, which generates nerve impulses that are sent to the brain. A healthy middle ear must contain air at the same atmospheric pressure as outside of the ear so all these structures can vibrate freely. Air enters the middle ear through a narrow tube called the Eustachian tube, which passes from the back of the nose up into the ear. When you yawn or swallow and hear a pop (or click) in your ear that means your Eustachian tube has just sent a tiny little bubble of air up into your middle ear to equalize the air pressure. This happens automatically over 1,000 times a day. What causes Otitis Media? Acute otitis media is caused by bacteria (or viruses) that enter from nose and throat and ascend the Eustachian tube to reach the middle ear. This occurs when Eustachian tube is not functioning properly, often because it is inflamed from cold, sinus or throat infection, or an allergy attack. Infection in the middle ear causes earache, a red inflamed eardrum, and mucous behind the ear drum. Sometimes the eardrum ruptures and pus drains out of the ear. But more commonly, the pus and the mucus remain in the middle ear because of swollen, inflamed Eustachian tube cannot open up to let it drain naturally. This is called middle ear fluid or effusion or serous otitis media. And it often remains even years after the acute, painful part of the infection is over. Further more, it makes the child subject to frequent recurrences of the acute infection. What Are the Symptoms of Otitis Media? The most prominent symptom of acute otitis media is earache, associated with a feeling of pressure and blockage in the ear. Children who cannot describe earache may simply tug or rub the effected ear. Fever often accompanies the earache, especially in children. Hearing is usually muffled. This happens because the fluid in the middle ear prevents the ear drum (see the diagram) from vibrating as it should. With proper treatment, this hearing loss is temporary; once the fluid drains, full hearing is restored. Without proper treatment, however, hearing loss may become chronic or permanent. What to Expect at Doctor’s Examination During your child’s examination, the doctor will look inside the ears, using an instrument called on otoscope. With otoscope inserted in the ear, the doctor can check for redness and fluid behind the ear drum and see if the ear drum moves in response to air pressure. A mobile (vibrating) eardrum is normal, In addition two tests may be performed to give the doctor information that cannot be learned through observation alone. One of these tests is an audiogram, in which tones are sounded at various pitches. An audiogram is used to measure how much hearing loss has occurred. The second test, called a tympanogram, measures the air pressure in the middle ear; this indicates how well the Eustachian tube is functioning. These two tests help the doctor determine the severity of the problem and decide the course of treatment. You can help the doctor by making sure your child remains quiet and still during the examination. Also be sure to keep all the follow-up appointment with your doctor to help insure your child’s complete recovery. The Importance of Medication The doctor may prescribe one or more medication for your child. One may be antibiotic, which fights infection. Although the antibiotic may help the earache go away very rapidly, the infection itself may need more time to clear up . So be sure your child takes the antibiotic for the full time it is prescribed, usually 10-14 days. Always read the label on the prescription bottle and follow the instruction carefully. The doctor may also prescribe an antihistamine (especially if your child suffers with allergies) or a decongestant or a combination of these medicines when a cold or allergy or both are present. The doctor may also recommend medication to relieve the pain and reduce fever. Sometimes analgesic (pain-reliever) ear drops are prescribed. Call the doctor if you have any questions about any of your child’s medications or if any symptoms do not clear up What other Treatments May be Necessary? Most of the time, otitis media clears up with proper medication and home treatment. in many cases, however, further treatment may be recommended by your physician, for instance an operation, a myringotomy may be recommended. This involves a small surgical incision (opening) in to the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days and creates practically no scarring or injury to the ear drum, In fact, the surgical opening often heals over before the ear infection has fully recovered and therefore fluid can reaccumulate. To overcome this problem, your physician can place a tiny hollow tube into the opening of the ear drum. The tube, known as ventilation tube, helps by equalizing air pressure and preventing accumulation of fluid in the middle ear. It improves child’s hearing. The surgeon selects the ventilation tube for your child that will remain in place as long as required for the middle ear infection to improve and for the Eustachian tube to return to normalcy. This may require several weeks or even several months. During this time, you must take care to keep water out of child’s ear because it could start an infection. But otherwise the tube causes no trouble at all, and you will probably notice a remarkable improvement in child’s hearing and a welcome decrease in the frequency of ear infections. Otitis media may recur from time to time as a result of chronically infected adenoids and tonsils. If this is found to be recurring problem for your child, the doctor may recommend an operation to remove the adenoids, tonsils, or both and this might be done at the same time he inserts the ventilation tubes in to the eardrum Allergies may also require treatment. But Remember……. Otitis media is generally not serious if it is properly and promptly treated. With the help of your physician, you can help your child to feel and hear better very soon. Be sure to follow the Treatment plan and see your physician until he tells you the condition is fully cured.