FESSDRRAJINI

SWIMMING-LINKED TO EAR INFECTION
INTRODUCTION
‘OTITIS EXTERNA “OR ‘SWIMMER’S EAR” OR “TROPICAL ERA”IS A DISEASE PROCESS THAT INVOLVES INFECTION OR INFLAMATION OF EXTERNAL EAR CANAL.IT CAN BE SIMPLE INFECTION OR EVEN LEAD TO NECTROTIZING OTITIS EXTERNA.
SYMPTOMS
SEVERE PAIN LEADS THE PATIENT TO SEEK MEDICAL CARE.
REDNESS OF THE EAR SKIN,ITCHING SENSATION OF THE EAR CANAL AND SCRATING THE EAR CANAL WITH UNSKILLED INSTRUMENTS AFTER SWIMMING CAUSING BREAK IN THE EAR SKIN LINING SETS THE ORGANISMS TO INVADE &LEAD TO SEVERE INFECTION.
RARELY OTITIS EXTERNA IS DUE TO ALLERGY TO EAR DROPS OR SECONDARY TO MIDDLE EAR INFECTION.
EAR OOZING IS ANOTHER COMMON COMPLAINT FROM THE PATIENTS,INITIALLY IT IS THIN SEROUS ,LATER BECOMES THICK,PURULENT, THEN THE EAR MEATUS BECOMES INFLAMED AND SWOLLEN & THERE WILL BE HEARING LOSS.
IN SEVERE CASES ,THE MEATAL SKIN BECOMES STENOSED,REGIONAL LYMPH NODES ARE ENLARGED AND PAINFUL.
CLASSIFICATION
LOCALISED OTITIS EXTERNA
DIFFUSE OTITIS EXTERNA

CAUSES ,SIGNS & SYMPTOMS
COMMON RISK FACTORS WITH OTITIS EXTERNA INCLUDE TRAUMA TO EAR CANAL .DIABETES,HIGH HUMIDITY,LOSS OF CANAL’S PROTECTIVE COATING OF CERUMEN,SWIMMING,USING HEARING AID OR STETHOSCOPE.
SYMPTOMS ARE PAIN,HEARING LOSS,DISCHARGE,ITCHING,TINNITUS.
NECROTISING OTITIS MEDIA IS A SEVERE FORM OF OTITIS EXTERNA SEEN WITH ELDERLY PATIENTS WITH DIABETES COMMON FINDINGS ARE ,PAIN,PURELENT DISCHARGE,GRANULATION OF EXTERNAL CANAL.
DIAGNOSIS IS BASED ON PHYSICAL FINDINGS
COMPLICATIONS USUALLY ARE CANAL STENOSIS,MYRINGITIS,TYMPANIC MEMBRANE PERFORATION,AURICULUM CELLULITIS,PERICHONDRITIS PAROTITIS, AND MALIGNANT OTITIS EXTERNA CAN BE FATAL.
TREATMENT
LOCAL CLEANSING OF DEBRIS,EITHER BY DRY MOPPING.SUCTION CLEARANCE OR IRRIGATION THE EAR CANAL WITH WRAM STERILE SALINE.

MEDICATED WICKS SOAKED WITH ANTIBIOTICS,STENOID PREPARTION IS KEPT IN THE EAR CANAL.GLYCERINE MASULF PAEK REDUCES THE EDEMA DRASTICALLY. ALUMINIUM ACETATE 8% OR SILVER NITRATE 3% ARE MILD ASTRINGENTS USED TO DRY UP OOZING MEATUS.
BROAD SPECTRUM ANTIBIOTICS ARE USED WHEN THERE IS CELLUTITIS OR TENDER LYMPHADENITIS.
ANALGESIC TO RELIEVE PAIN.

CONCLUSION
BY ESTABLISHING AN ACIDIC ENVIRONMENT ALONG WITH EAR TOILETING AND ANTIBIOTICS RECURRENT AND SEVERITY OF THE INFECTION CAN BE PREVENTED AND CURED

Labels: SWIMMING-EAR INFECTIONS

VERTIGO (GIDDINESS MANAGEMENT)
THE ABILITY OF NORMAL PEOPLE TO ORIENT THEMSELVES IN SPACE DEPENDS ON INFORMATION FROM THREE SETS OF SENSORS.
FIRSTLY-EYES (OPTO KINETIC)
SECONDLY- FROM THE BODY MUSCLES (PROPRIOCEPTORS)
THIRDLY- SEMI CIRCULAR CANALS IN THE INNER EAR CALLED “VESTIBULAR SYSTEM”

VERTIGO IS ONLY A SYMPTOM AND NOT A DISEASE.THERE ARE MAINLY THREE TYPES OF VERTIGO(DIZZINESS0
1.OBJECTIVE: PERSON FEELS THAT THE OBJECT AROUND HIM KEEPS ON MOVING.
2.SUBJECTIVE: PERSON FEELS THAT HIS HEAD IS ROTATING.
3.POSITIONAL:WHEN HIS BODY OR HEAD POSITION CHANGES(TURNING-BENDING)

SOMETIMES THIS SENSATION APPEAR ASSOCIATED WITH NAUSEA,VOMITTING,RINGING SOUND IN THE EAR(TINNITUS) WITH FULLNESS IN HEAD OR LOSS OF HEARING(MENIERS DISEASE)
SOME OTHERS NARRATE AS IF THEY TEND TO FALL WHILE WALKING(IMBALANCE).
THIS SYMPTOM MAY APPEAR INCASE OF VARIATIONS IN BLOOD PRESSURE .DIABETES MELLITUS OR EVEN WITH CASES OF CERVICAL SPONDY-LOSIS AND EVEN WITH VARYING ATMOSPHERIC PRESSURE(FLYING).HAEMODYNAMIC CHANGES,FUNCTIONS OF CAROTID & VERTEBRAL BLOOD SUPPLY TO THE BRAIN.
THEREFORE A PERSON SUFFERING FROM GIDDINESS NEEDS TO BE EVALUATED BY A PHYSICIAN,NEUROLOGIST.AN ENT SURGEON TO FIND OUT THE UNDERLINED PATHOLOGY AND FACE TREATMENT.THERE ARE MANY PEOPLE WHO ARE ON CONTINUOUS MEDICATION WITH AFEWAVAILABLE DRUGS.BUT WITH NO SIGNIFICANT IMPROVEMENT IN THE SENSITIVITY OF GIDDINESS.
BEFORE STARTING THE TREATMENT FOR GIDDINESS THE FOLLOWING INVESTIGATIONS ARE ESSENTIAL,
1. DETAILED HISTORY OF CASES
2. ENT OPINION AND OPTHALMOLOGY REPORT.
3. PURETONE AND SPEECH AUDIOMETRY.
4. IMPEDENCE AUDIOMETRY.
5. BERA(EVOKED POTENTIALS) IF REQUIRED.
6. CALORIC TEST
7. ELECTRONSTAGMOGRAPHY
8. VESTIBULAR FUNCTION ASSESSMENT.
9. CAROTID AND VERTEBRAL DOPPLER STUDIES
10. BLOOD INVESTIGATION
MANY TIMES THESE INVESTIGATIONS MAY NOT REVEAL ANY ABNORMILITY AT ALL THEY ARE A MUST TO RULE OUT ANY UNDERLINED ORGANIC PATHOLOGY.
MOST OF THE PATIENTS NARRATED THAT
1 THEY USED COLLARS OR
2.THEY USED MEDICINES LIKE VERTIN,STUGERON OR STEMITIL
3.THEY DID SOME POSTURAL NECK EXCERCISES.
ULTIMATELY ,THEY MIGHT NOT HAVE BEEN BENEFITTED.THESE PATIENTS KEEP ON CONSULTING ONE DOCTOR OR THE OTHER SPEACIALIST ALL THE TIME.FINALLY THEY BECOME DESPERATE AND A FEW MAY EVEN RESORT TO AYURVEDIC AND HOMEOPATHIC TREATMENT.IN MANY OF THE HOSPITAL ,NURSING HOMES AND CLINICS FACILITIES TO CARRYOUT ALL TESTS MAY NOT BE AVAILABLE.,BUT THIS DEPENDS ON MANY OTHER PARAMETERS AND CONDITION OF THE PATIENT.NOW ONE SHOULD THINK OF AN ADEQUATE APPROACH TO THIS PROBLEM OF TREATING GIDDINESS.IT IS KNOWN THAT THE ORGAN PROBABLY EFFECTED IS “VESTIBULAR HABITUATION: IS KNOWN IN THE LITERATURE.SO WE HAVE TO “STIMULATE”THESE ORGANS,i.e (SEMICIRCULAR CANALS,OTOLITHS,UTRICLE AND SACCULE)FOR MORE EFFECTIVE MANAGEMENT OF GIDDINESS.SO BEFORE TREATING VERTIGO PATIENTS THE EXACT CAUSE IS ESSENTIAL.
PSYCHOLOGICAL ASPECTS
LIKE ALL SENSORY SYSTEMS VESTIBULAR SYSTEM EXHIBITS A DECREASED RESPONSE TO STIMULI THAT ARE PERSISTENT(ADAPTATION)OR REPETITIVE(HABITUATION)
INCREASE IN PERCEPTUAL AND MOTOR RESPONSIVENESS TO VESTIBULAR STIMULATION IS TERMED A VESTIBULAR ENHANCEMENT THIS OCCURS WHEN STIMULATION IS NOVEL,THREATENING OR WHENEVER SOATIAL ORIENTATION IS RECEIVED TO BE IMPORATANT.IT IS BELIEVED TO BE DUE TO EFFERENT VESTIBULAR NERVOUS CONTROLLING THE GAIN OF THE VESTIBULAR SYSTEM SO AS TO EFFECT SUPPRESSION OR ENHANCEMENT ,ALSO HABITUATION DEPENDS ON “AROUSAL’ACTIVITY IN DRAIN SYSTEM NUCLEI.
ANYTHING WHICH KEEPS THE SUBJECT IN AN ALERT STATE(SUCH AS MENTAL ARITHMATIC)DELAYS OR PREVENTS HABITUATION WHILE DAY DREAMING OR LACK OF ATTENTION HELP HABITUATION.
SOME PEOPLE FEEL HABITUATION TO ANGULAR ACCELERATION
TRANSFER OF HABITUATION CANNOT BE OBTAINED FOR DIFFERENT CONDITIONS.
EACH CONDITION MUST BE PRACTICED SEPARATELY DESPITE THEIR SIMILARITY IN SENSATION AND NYSTAGMIC RESPONSES.
THERFORE IT IS ESSENTIAL TO INSTALL PARALLEL SWING FOR STIMULATING OTOLITH ORGAN AND TORISON CHAIR AND ROTATING CHAIR TO STIMULATE ALL CANALS AT THE SOMETIME.
OTHER BALANCE TESTS CAN ALSO WILL BE ADDED FOR THE BENEFIT OF THE PATIENTS.MORE THAN ANYTHING ELSE IT REQUIRES EXTREME CO-OPERATION FROM PATIENTS AND THEY HAVE TO ATTEND REGULARLY THERAPY SESSIONS ATLEAST FOR A PERIOD OF 10 TO 15 DAYS.AND THEY POSITIVELY DERIVE BENEFIT BY THESE NON MEDICAL ASPECTS OF TRAETMENT.THESE EQUIPMENTS WERE DESIGNED AND EXTENSIVELY USED ON SCIENTIFIC BASIS AND FOUND VERY MUCH BENEFICIAL .

VESTIBULAR REHABILITATION EXERCISES.(EPLEY’S AND SEMENTS)
EXERCISES TO BE CARRIED OUT FOR 15 MINUTES TWICE A DAY INCREASING TO 30 MINUTES.
EYE EXERCISES TO BE CARRIED OUT SITTING IN BED.
LOOK UP FORST AND THEN DOWN.SLOWLY AT FIRST ,QUICKLY LATER 20 TIMES.
HEAD AND NECK EXERCISES TO BE CARRIED SITTING ON BED.
BEND HEAD FORWARDS ,THEN BACKWARD WITH EYES OPEN.SLOWLY FIRST,THEN QUICKLY 20 TIMES .TURN HEAD LEFT TO RIGHT THEN VICE VERSA.SLOWLY FIRST,THEN VICE VERSA.SLOWLY FIRST ,THEN QUICKLY 20 TIMES.AS DIZZINESS IMPROVES ,THESE EXERCISES SHOULD BE CARRIED OUT WITH EYES CLOSED.
SHOULDER AND TRUNK EXERCISES TO BE CARRIED OUT SITTING IN BED.
SHRUG YOUR SHOULDERS UP AND THEN DOWN SLOWLY 20 TIMES
TUM SHOULDERS TO THE RIGHT AND THEN TO THE LEFT,SLOWLY FIRST THEN QUICKLY 20 TIMES.
BEND FORWARDS AND PICK UP OBJECTS FROM THE GROUND AND SIT UP 20 TIMES.
STANDING UP EXERCISES
CHANGE FROM SITTING TO STANDING UP AND BACK AGAIN WITH EYES OPEN 20 TIMES REPEAT WITH EYES CLOSED.
THROW SMALL RUBBER BALL FROM HAND TO HAND ABOVE EYE LEVEL.
THROW BALL FROM HAND TO HAND UNDER ONE KNEE.BALL BOUNCING AND CATCHING.
MOVING ABOUT EXERCISE
WALKS ACROSS ROOM WITH EYES OPEN AND THEN CLOSED-10 TIMES
WALK UP AND DOWN A SLOPE WITH EYES OPEN AND THEN CLOSED-10 TIMES.
WALK UP AND DOWN STEPS WITH EYES OPEN AND THEN CLOSED-10 TIMES.
ANY GAME INVOLVING STOPPING OR TURNING IS GOOD .
THE ABOVE MENTIONED EXERCISES HAVE BEEN NARRATED BY EPLEY AND SEMONT

Labels: GIDDINESS

EPISTAXIS(BLEEDING FROM THE NOSE)






BLEEDING FROM INSIDE THE NOSE IS CALLED EPISTAXIS,COMMON IN ALL AGE GROUPS.IT IS A SIGN,NOT A DISEASE ,CAUSE TO BE FOUND OUT AND TREAT THE PATIENT. USUALLY IT IS AN EMERGENCY.
CAUSES:
1 LOCAL
2 GENERAL
3 IDIO PATHIC
LOCAL
NOSE

TRAUMAFROM FINGER NAILS ,FRACTURES OF MID THIRD OF FACE,SKULL BASE ,VIOLENT
SNEEZE /HARD BLOWING OF NOSE, NASOPHARY NX
ADENOIDITIS
JUVENILE ANGIO FIBROMA
MALIGNANT TUMORS
BOTH
INFECTION
ACUTE SINUSITIS
VIRAL RHINITS
TUBERCULOSIS
LIVING MAGGOTS OR LEECHES
NEOPLASM OF NOSE AND PARANASAL SINUSES
HAEMANGIOMA
CARCINOMA
ATMOSPHERIC CHANGES LIKE HIGH ALTITUDE
ATROPHIC RHINITS
FOREIGN BODIES IN THE NOSE

OR DECOMPRESSION DISEASE(DIVING)
DEVIATED NASAL SEPTUM WITH SPUR
B)GENERAL CAUSES
1 HYPER TENSION
2 A THEROSLEROSIS,MITRAL STENOSIS,PREGNANCY
3 DISORDERS OF BLOOD AND BLOOD VESSELS LIKE ANAEMIA,
HAEMOPHILIA,ALTERED CLOTTING FACTOR MECHANISM.
4 LIVER DISEASE LIKE CIRRHOSIS
5 CHRONIC NEPHRITIS
6 EXCESS USE OF ANALGESIC AND ANTICOAGULANTS.
7 TUMORS IN MEDIASTINUM
8 VICARIOUS MENSTRUATION
C) IDIOPATHIC

MANY TIMES CAUSE OF EPISTAXIS IS NOT CLEAR
1 LITTLE AREA
ANTERIOR OR INFERIOR PART OF NASAL SEPTUM,IT IS RICH IN BLOOD SUPPLY ,EXPOSED TO DRYING EFFECT OF INSPIRATORY CURRENT ,COMMON SITE FOR FINGER NAIL TRAUMA.90% OF EPISTAXIS OCCUR IN THIS REGION ESPECIALLY YOUNG ADULT& CHILDREN.
2 ABOVE AND BELOW THE LEVEL OF MIDDLE TURBINATES.
3 POSTERIOR PART OF NASAL CAVITY
4 DIFFUSE FROM BOTH THE SEPTUM AND LATERAL NASAL WALL USUALLY IN SYSTEMIC DISEASE
5 NASOPHARYNX
CLASSIFICATION OF EPISTAXIS
1 ANTERIOR EPISTAXIS ,
WHEN BLOOD FLOWS FROM BACK OF THE NOSE.
2 POSTERIOR EPISTAXIS
WHEN BLOOD FLOWS BACK IN TO THE THROAT, PATIENT SWALLOWS AND BRING IT IN VOMIT FORM.
ANTERIOR EPISTAXIS
MORE COMMON,FROM LITTLE AREA,IN CHILDREN AND YOUNG ADULT,CAUSE IS TRAUMA.
BLEEDING IS MILD & CONTROLLED BY ANTERIOR NASAL PACK
POSTERIOR EPISTAXIS
LESS COMMON,FROM POSTERIOR PART OF THE NOSE,AFTER 40 YEARS,HYPERTENSION,OR ATHEROSCLEROSIS.
BLEEDING IS SEVERE &REQUIRES HOSPITALISATION AND POST NASAL PACK.

MANAGEMENT
IT IS IMPORATANT TO KNOW MODE OF ONSET OF BLEEDING, SPONATNEOUS /TRAUMA.
FREQUENCY OF BLEEDING
AMOUNT OF BLOOD LOSS
SITE OF THE NOSE BLEEDING
TYPE ANTERIOR OR POSTERIOR
KNOWN BLEEDING TENDENCY
MEDICAL ILLNESS (HYPERTENSION,NEPHRITIS,LEUKEMIAS ETC)
FIRST AID
PINCH THE NOSE WITH INDEX &THUMB FINGER FOR 5 MINUTES .BREATH THROUGH THE MOUTH,LEAN FORWARD TO SPIT OUT BLOOD .LATER COLD COMPRESSION TO THE NOSE.
CAUTERISATION OF THE BLEEDING AREA.
MAINLY FOR ANTERIOR EPISTAXIS WITH SILVER NITRATE OR ELCTRO CAUTERY.
ANTERIOR NASAL PACKING
USUALLY PROFUSE BLEEDING ESPECIALLY ANTERIOR EPISTAXIS,IF IT IS NOT CONTROLLED WITH CAUTERISATION, A LONG RIBBON GAUZE WITH LIQUID PARAFIN IS INSERTED ALONG THE FLOOR OF NASAL CAVITY, IN LAYERS ,TIGHTLY FROM BEFORE BACKWARDS.IT IS
KEPT FOR ATLEAST 24 HOURS.
POSTERIOR NASLA PACKING
A POST NASAL PACK IS USED OR A FOLEY’S CATHETOR CAN BE USED FOR POSTERIOR EPISTAXIS.THESE DAYS NASAL BALLOONS ARE ALSO USED .IT HAS 2 BULBS ONE FOR POST NASAL SPACE ONE FOR NASAL CAVITY.
ENDOSCOPIC CAUTERY.
USUALLY POSTERIOR BLEEDING POINTS CAN BE LOCATED AND CAUTERISED.
SEPTOPLASTY PLUS SPUR CORRECTION
IT WILL CURE EPISTAXIS PERMANENTLY
LIGATION OF VESSELS
LIGATION OF MAXILLARY ARTERY IS DONE IN UNCONTROLLABLE POSTERIOR EPISTAXIS.
GENERAL MEASURES OF EPISTAXIS.
1 REASURRE THE PATIENT NOT TO PICK NOSE,MILD SEDATION SHOULD BE GIVEN
2 CHECK BP,PULSE RESPIRATION HOURLY ,MAINTAIN HAEMODYNAMICS,BLOOD TRANFUSION MAY BE REQUIRED.
ANTIBIOTICS TO BE GIVEN TO PREVENT SINUSITIS BEYOND 24 HOURS OF NASAL PACK.
INVESTIGATE AND TREAT THE CAUSE.
OXYGEN MAY BE REQUIRED WITH BILATERAL NASAL PACK.
HEAD END TO BE IN ELEVATED POSTION.
RECORD THE AMOUNT OF BLOOD LOSS.

Labels: BLEEDING FROM THE NOSE

EAR PROTECTION AND NOISE

INTEREST IN NOISE AND POTENTIAL HARMFUL EFFECT ON HEARING IS INCREASING RAPIDLY.THIS INCREASE CAN BE ATTRIBUTED TO THE GROWTH IN THE INTENSITY AND DURATION OF NOISE,THE INCREASING AWARENESS OF VARIOUS FORMS OF POLLUTION AND EFFORTS BY VARIOUS AGENCIES TO CONTROLTHE HARMFUL EFFECTS OF NOISE.

NOISE HAS BOTH PHYSIOLOGICAL AND PSYCHOLOGICAL EFFECTS.THE EFECTS OF NOISE AND HEARING LOSS VARIES FROM PERSON TO PERSON AND HIS SUSCEPTILITY TO NOISE.

DAMAGE CAUSED TO HEARING IS IRREVERSIBLE IN NATURE AND HENCE ONE HAS TO TAKE PRECAUTIONERY MEASURES AGAINST NOISE.THE DEGREE OF DAMAGE DEPENDS ON THE INTENSITY LEVEL OF NOISE THAT IS MORE THAN 85 DECIBELS,DURATION OF EXPOSURE,WHETHER IT IS CONTINUOUS OR INTERMITTENT. HIGH FREQUENCY NOISE MORE HARMFUL THAN LOW TONES.THE OTHER EFFECTS OF NOISE ARE ANNOYANCE IRRITABILITY ,TINNITUS,LACK OF APPETITE,DISTURB SLEEP,LOSS IN HEARING WITH DIFFICULTY IN UNDERSTANDING SPEECH,INCREASED BLOOD PRESUURE,CHANGES IN THE NERVES SYSTEM ETC...

THE ONLY METHOD TO AVOID THE DAMAGE IS TO REDUCE NOISE AT SOURCE OTHERWISE ,PROPER EAR PROTECTORS (DEFENDERS)SHOULD BE WORN AT WORK. IT IS ALSO IMPORTANT TO INTRODUCE HEARING CONSERVATION PROGRAMMES IN ALL INDUSTRIES AND CHECK THE HEARING OF WORKERS (AUDIOMETRY)EVERY YEAR.

THE VARIOUS TYPES OF DEFENDERS ARE

1.INSERT TYPE

2.MUFF TYPE

3HELMET TYPE.

THE OTHER INSERT TYPE OF DEFENDERS ARE MADE UP OF MATERIALS LIKE EBONITE,RUBBER,PLASTIC OR FOAM TYPE.THEY ARE CALLED “FLENTS”.THESE GIVE PROTECTION OF 15 DECIBELS AT VARIOUS FREQUENCIES.IT CAN BE USED AT PLACES WHERE NOISE LEVELS DOES NOT EXCEED 95 TO 100 DECIBELS.THE FOAM TYPE OF EAR PROTECTOR AT PRESENT IS THE BEST AVAILABLE WHIC GIVES ATTENUATION UP TO 35 DECIBELS AT VARIOUS FREQUENCY AND IT IS COMFORTABLE TO WEAR AND EASILY DISPOSABLE .

IF THE NOISE LEVEL EXCEEDS 110 DECIBELS,THE MUFF TYPE OF DEFENDERS MUST BE PROVIDED TO WEAR DURING EXPOSURE HOURS.

IN SOME OF THE OCCASIONS BOTH INSERT AND MUFF TYPE SHOULD BE USED IN COMBINATION TO GIVE GREATER PROTECTION.THE HELMET TYPE OF DEFENDERS ARE USEFUL FOR PILOTS WHO FLY JETS AND FIGHTER AIR CRAFT.THEY MAY WEAR IT ALONG WITH BONE DOMES AND HENCE GIVES GREATER PROTECTION.

TO CONCLUDE ,IT IS NECESSARY TO STRESS THE VIEW THAT THE WORKERS TO PROTECT THEIR EARS WITH SUITABLE DEFENDER WHILE ON JOB.THE PUBLIC SHOULD ALSO BE EDUCATED ABOUT THE UTILITY OF DEFENDERS TO PROTECT FROM NOISE POLLUTION AND PREVENT NOISE INDUCED HEARING LOSS WHICH IS IRREVERSIBLE.

Labels: EAR PROTECTION

TINNITUS (NOISE IN THE EAR)

TINNITUS IS RINGING SOUND OR NOISE IN THE EAR,USUALLY THE SOUND IS WITH IN THE PATIENT,USUALLY IT IS UNILATERAL MAY ALSO AFFECT BOTH THE EARS.IT IS DESCRIBED BY THE PATIENT AS HISSING,ROARING,RUSTLING,OR CLICKING TYPE OF NOISE.

TINNITUS IS MORE ANNOYING IN QUIET SURROUNDINGS ESPECIALLY AT NIGHT.

TYPES OF TINNITUS
A.SUBJECTIVE WHICH CAN ONLY BE HEARD BY THE PATIENT.
B.OBJECTIVE
CAN EVEN BE HEARD BY THE EXAMINER WITH STETHOSCOPE,
CAUSES OF TINNITUS
SUBJECTIVE TINNITUS USUALLY ORIGINATES FROM EXTERNAL EAR,8TH NERVE OR CENTRAL NERVOUS SYSTEM.
SYSTEMIC DISORDERS LIKE ANAEMIA,ATHEROSCLEROSIS,HYPERTENSION & FEW DRUGS MAY ACT THROUGH INNER EAR OR CENTRAL AUDITORY PATHWAY.

OBJECTIVE TINNITUS IS LESS COMMON MAINLY BECAUSE OF VASCULAR LEISION EG:GLOMUS TUMOR OR CAROTID ARTERY ANEURISM.
CONTRAACTION OF MIDDLE EAR MUSCLES(STAPEDIUS AND TENSOR TYMPANI MUSCLE MAY ALSO CAUSE TINNITUS.
TINNITUS IS ALSO PSYCHO GENEIC.
TREATMENT

IT IS A SYMPTOM NOT DISEASE SO THE CAUSE IS DISCOVERED AND TREATED WHEN NO CAUSE IS FOUND OUT,MANAGEMENT INCLUDES
1.REASSURANCE PSYCHOTHERAPY
2.TECHNIQUES OR RELAXATION AND BIOFEEDBACK
3 SEDATION AND TRANQUILLIZERS. ONLY IN INITIAL STAGES TILL PATIENT GETS ADJUSTED.
4.MASKING OF TINNITUS
TINNITUS IS MORE ANNOYING AT BED TIME DUE TO QUITE SURROUNDINGS SO USE OF FAN LOUD CLOCK OR MILD MUSIC USE OF HERAING AID IN PATIENTS WITH HEARING LOSS CAN BE USED.
TINNITUS MASKERS CAN BE USED IN PATIENTS WITH NO HEARING LOSS.

Labels: TINNITUS

EAR ACHE (OTALGIA)

INTRODUCTION
PAIN IN THE EAR CAN BE DUE TO PROBLEM IN THE EAR OR FROM REMOTE AREAS.

LOCAL CAUSES
OUTER EAR OR EXTERNAL EAR

IMPACTED WAX,OTOMYCOSIS(FUNGUS),FURUNCLE HERPES ZOSTER,OTITIS EXTERNA.

MIDDLE EAR
ACUTE OTITIS MEDIA
EUSTACHIAN TUBE OBSTRUCTION,MASTOIDITIS,EXTRADURAL ABSCESS.

REFERED CAUSES
EAR RECEIVES NERVE SUPPLY FROM 5TH,9TH 10TH CRANIAL NERVES SO PAIN MAY BE REFERRED FROM THESE AREAS.

VIA 5TH NERVE

• A) DENTAL
• CARIESTOOTH, IMPACTED MOLAR, MAL OCCLUSION.

• B) ORAL CAVITY
• ULCERATIVE LEISION OF ORAL CAVITY OR TONGUE.

• C) TEMPEROMANDIBULAR JOINT DISORDER

• OSTEO ARTHRITIES,RECURRENT DISLOCATION ILL FITTING DENTURES.

• D) SPHENOPALATINE NEURALGIA.
VIA 9TH NERVE
• A) OROPHARYNX
• ACUTE TONSILLITIS,PERITONSILLAR ABSECSS ,AFTER TONSILLECTOMY.
• ULCERS OF SOFT PALATE,TONSILS AND PILLARS.

• B) BASE OF TONGUE
• TUBERCULOSIS OR CANCER.

• C) ELONGATED STYLOID PROCESS.

VIA 10 TH NERVE
CANCER OR ULCERATIVE LEISIONS OF EPIGLOTTIS,LARYNX,OR ESOPHAGUS

VIA C2 AND C3 SPINAL NERVES.TUBERCULOSIS OF SPINE,SPONDYLOSIS OF SPINE OR INJURY TO THE SPINE,

PSYCHOGENIC CAUSE.
PAIN MAY BE FUNCTIONAL AND PATIENTS MUST BE KEPT ON PERIODIC RE EVALUATION .

CONCLUSION

OTALGIA IS A SYMPTOM SO IT IS ESSENTIAL TO FIND THE CAUSE ,THEN SPECIFIC TRAETMENT CAN BE GIVEN.

Labels: EAR PAIN

RHINOSINISITIS
THE TERM RHINOSINUSITIS MEANS INFLAMATION OF CONTIGUOS TISSUES OF UPPER RESPIRATORY TRACT ,WHERE THE EFFECT OF NASAL MUCOSA ALSO AFFECTS THE ADJACENT SINUS TISSUES.
THE MUCOUS MEMBRANE OF NOSE AND SINUS CAVITIES CONTIGUOS AND SUBJECT TO THE SAME DISEASE PROCESS,THEREFORE RHINOSINUSITIS IS A MORE ACCURATE TERM FOR WHAT IS TERMED AS SINUSITIS SINUSITIS WITHOUT RHINITIS IS RARE.

RHINOSINUSITIS IS DIVIDED IN IN TO 4 SUB TYPES
1 ACUTE
2 RECURRENT ACUTE
3 SUB ACUTE
4 CHRONIC

ACUTE RHINOSINUSITIS

INFLAMATION OR INFECTION OF MUCOSA OF NASAL PASSAGES ATLEAST ONE OF THE PARANASAL SINUS.IT IS CAUSED BY VIRUS WITH OR WITHOUT BACTERIAL CO INFECTION.THE ONSET IS RAPID OCCURS WITH IN 5 TO 7 DAYS AND PATIENT RECOVERY WITH OR WITHOUT MEDICATION.
RECURRENT ACUTE RHINOSINUSITIS IS DEFINED AS 4 OR MORE EPISODES OF ACUTE DISEASE WITH IN 12 MONTHS PERIOD

SUB ACUTE RHINOSINUSITIS
IT IS BASICALLY A LOW GRADE CONTINUOUS INFECTION OF MORE THAN 4 WEEKS BUT LESS THAN 12 WEEKS DURATION.

CHRONIC RHINOSINUSITIS
IT IS SUB ACUTE INFECTION SPREAD OUT SIDE THE SINUSES TO ORBITAL AREA OR TO MENINGES THE SYMPTOMS PERSISTS FOR 12 WEEKS OR MORE
CAUSES OF RHINOSINUSITIS
AIR POLLUTION,ESPECIALLY TOBACCO SMOKE ,NASAL POLYPS,ALLERGY ,ASTHMA.
SINUS OSTIA OBSTRUCTION
MEDICATION SIDE EFFECTS (USE OF TOPIC NASAL VASO CONSTRICTOR DRUGS)
IMMUNO DOFFICIENCY OR MUCO CILITARY DYSFUNCTION
SYMPTOMS
MAJOR SYMPTOMS
1 FACIAL PAIN SWEELING
2 NASAL BLOCK
3POST NASAL DISCHARGE
4 LOSS OF SMELL
5 FEVER (ACUTE CASES ONLY0

MINOR SYMPTOMS
1 HEAD ACHE
2 FEVER
3 BAD BREATH
4 TIREDNESS
5 DENTAL PAIN
6 PERSISTENT COUGH
7 EAR PAIN OR PRESURE
COMPLICATION
SIGNS AND SYMPTOMS WORSEN AND MAY LEAD TO INTRACRANIAL OR INTRA ORBITAL EXTENSION OF INFECTION PATIENT THEN PERSISTENT WITH DOUBLE VISION
PROTRUTION OF EYE BALL
ORBITAL MOVEMENT ABNORMALITES
SEVERE HEADACHE
MENINGEAL SIGNS
ALTERED MENTAL STATUS
HIGH FEVER

DIAGNOSIS
CLINICAL EXAMINATION
NASAL ENDOSCOPY FOR STRUCTURAL ALTERNATIVE OF NASAL CAVITY
XRAY PARA NASAL SINUS
CT SCAN FOR DELINEATING OSTEOMEATUS COMPLEX DISEASE ,POLYPOSIS,ETC IT IS GOLD STANDARD FOR THE SINUS DISEASE.
MRI
MRI IS OVERLY SENSITIVE TO TRABIENT MUCOSAL CHANGAES
LAB STUDIES
TO DETERMINE SUSPECTED ALLERGIES IMMUNE DEFICIENCES ETC

BACTERIAL CULTURE AND SENSITIVE OF THE PUS FROM NASAL CAVITY

MANAGEMENT
1 TO CONTROL INFECTION
2 TO DIMINISH TISSUE ODEMA
TO REVERS SINUS OSTEAL OBSTRUCTION IMMEDIATELY
1.PAIN MANAGEMENT
2 ANTIBIOTIC THERAPY
3 SPEACIAL ATTENTION GIVEN TO DISEASE WHICH IMPEDE NORMAL RECOVERY LIKE DIABETES ,ASTHMA ,IMMUNE DEFICIENCY,CHRONIC OBSTRUCTIVE PULMONARY DISEASE

SURGERY
IF MEDICAL TREATMENT FAILS INFECTION,DECISION IS EMPIRICAL AND ALSO TREATMENT CHOICE DEPENDS ON THE DIAGNOSIS AND TYPE OF RHINOSINUSITIS ,WHETHER MEDICAL OR SURGICAL MANAGEMENT DEPENDS AND DIFFERS FROM PATIENT TO PATIENT.

Labels: RHINOSINUSITIS

Functional Endoscopic Sinus Surgery – Concepts of Surgery

Significant controversy reigned throughout the 20th century with regard to the extent of surgery that should be performed in chronic sinusitis. Debate is sure to continue until the pathogenesis of chronic sinusitis is better understood. The concept of “irreversibly diseased” mucosa that needs to be surgically removed has now largely been eliminated. Indeed, the problems associated with exposure of bone from mucosal stripping during surgery have been increasingly appreciated. Moriyama and colleagues have shown that denuded bone results in extremely delayed healing. The bone may remain exposed for 6 months or more, and ciliary density may never return to normal at these sites. Greater emphasis thus should be placed on mucosal preservation within the ethmoid sinus during surgery. The initial understanding of functional endoscopic sinus surgery (FESS), namely, that drainage of the involved sinuses is sufficient to induce disease resolution, currently has been modified somewhat, based on continued improvement of the understanding of the disease process.

BALOON SINOPLASTY

Balloon sinuplasty was developed in 2006 and this new iteration of it is considered different from prior french biliary catether in that the new technique can fracture bones. Kennedy concluded in a recent study that this technique may lead to bacterial introduction and subsequent osteitis, mucositis, and mucoceles.

Conclusions

Functional endoscopic surgery is a complex and constantly evolving field with new techniques, instruments and approaches continually described. The most important aspect to remember when performing sinus surgery is that one must be safe and the best way to assure one is safe is to have an excellent understanding of the anatomy of the paranasal sinuses. Even in the advent of image guidance, it is paramount to have a good understanding of the proximity of structures to avoid damage to them. The second most important aspect of sinus surgery, as in all other surgery, is understanding the indications and knowing what type of surgery is best fitted for each individual patient.