Ear, Nose & Throat

Leading cause of chronic itching and discharge in middle-aged patient. Causes - Chronic Otitis Externa are varied from simple infection to fungal origin. Can turn complicated in uncontrolled diabetes leading to skull base osteomyelitis. (Severe involvement of surrounding bones by the infection) Symptoms - Itching, blocked feeling and swelling in the ear accompanied with watery discharge. Prevention - Self ear clearing by use of various sharp items and even earbuds is to be strictly avoided, and aural hygiene to be practiced. Risk factors - Person having skin allergies, chronic ear discharge, diabetes need special precautions. Diagnosis - Detailed history, Ear examination by oto microscope, Treatment - Medically by antibiotics, anti-allergic, strict control of sugar, healthy ear practices.

Age related hearing loss (Presbycusis) is the decline in hearing that many people experience as they grow older. Almost 1 in 3 adults experience hearing loss b/w the age in 65 – 74. Causes – Diabetes, family history of hearing loss, high blood pressure, noise-induced, ototoxicity Symptoms - Difficulty making out higher pitches, such as children voices or some electronic sounds, lip-reading, trouble understanding speech in crowded or noisy places, tinnitus (ringing, buzzing, roaring noises )   Prevention - Avoid loud environments. Managing health conditions like (diabetes/hypertension) turning the volume down on the radio and T.V. Diagnosis - Otoscopic examination, hearing evaluation by pure tone audiometry .which help you to provide the clues about appearance of eardrum and type / degree of hearing loss. Management and Treatment - Assistive listening devices, hearing aids, cochlear Implants. People can reduce risk of losing hearing as they get older by protecting themselves from noise induced hearing loss

Balance disorder are very common in the elderly population it has a very crippling effect on the QOL. Symptoms - Spinning sensation, which can be positional, persistent associated with nausea / vomiting Causes - Can range from simple inner ear viral infection to tumor. Multifactorial in elderly. Neurological causes needs to be ruled out by proper evaluation. Diagnosis - Detailed history and special investigation are needed to make the diagnosis starting from thorough ear examination like PTA (Pure tone audiometry), positional test, ENG   Treatment - Depending on the cause. Medical – Labyrinthine sedatives Vestibular rehabililatative exercises Special partical repositioning maneuvers - Epley’s maneuver

It is commonly the ringing sound perceived by the patients without any external sound. It affects 15-20% older population. Its perception is more in quite environment and leads to anxiety with respect to the etiology in the patient. It is mostly subjective but can be objective due to some circulatory causes. Symptoms - Various kinds of sounds are heard by the patient without any external stimulus it may be accompanied by hearing loss or other conditions. Causes - Hearing loss, ear infection, trauma, medications, Eustachian tube dysfunction, ear tumors, atherosclerosis, high blood pressure, chronic conditions Risk factors - Loud voice exposure, age, addiction, tobacco chewing, obesity, cardiovascular diseases. Complication - Anxiety, irritability, decrease productivity Prevention - Avoid loud sounds exposure, manage chronic conditions, limit addictions Diagnosis - Audiological tests, Imaging, Blood investigations   Treatment - Counseling, tinnitus retraining therapy, tinnitus masker, Cognitive Behavioral therapy.

Enlarged adenoids cause multiple problem in young children at around 5 years of age due to bilateral nasal obstruction. Symptoms - Noisy breathing, snoring & obstructive sleep apnea, chronic ear sinus infection, fluid in the middle ear causing conductive deafness. Complications - Untreated adenoids can use to chronic ear & sinus infection, adhesive otitis media, affect dental and palatal development due to chronic mouth opening scholastic performance due to disturb sleep & conductive hearing loss. Diagnosis - History along with typical adenoid facies, nasal endoscopy, radiological & otological investigation give a full picture of the extent of the involvement Treatment - Medical steroid nasal spray Surgical - Endoscopic microdebrider assisted adenoidectomy and/or myringotomy & grommet insertion if serous otitis media is also present.

Most common chronic disease significantly affecting the quality of life of young and middle age group patients Symptoms - Episodes of sneezing, nasal block, nasal discharge, itching in eyes & throat, decrease sense of smell. Complications - Unmanaged or inadequately managed upper airway allergy can lead to chronic rhinosinusitis, nasal polyposis, bronchial asthma Causes - Wide variety of allergens – food/air can cause symptoms on exposure Diagnosis - Nasal endoscopy increased eosinophil count in CBC and ACE test. Skin and food allergy test. Radiological investigation.   Prevention - Identify triggers of allergy and prevention of exposure to the allergen is the best prevention

Voice disorders are medical conditions affecting the production of voice / speech Speech disorders are type of communication disorders where normal speech is disrupted, many disorders where normal speech is disrupted, many disorders can affect our ability to speak and communicate .causes may include hearing disorders deafness, voice problem such as a Dysphhonia or these caused by cleft lip or palate, speech problems like stuttering, developmental disabilities, Learning disorder, autism , brain injury, and stroke Symptoms - May include hoarseness, difficulty projecting your voice, vocal fatigue, reduced range of voice pitch brakes . Causes - Voice disorders are often caused by vocal abuse or misuse, such as excessive use of voice while singing, talking, smoking, coughing, yelling or inhaling irritants. Other disorders induce laryngitis, vocal nodules, polyps, and vocal fold paralysis. Diagnosis - Speech-Language Pathologist assess the larynx using (laryngeal flexible / rigid) test radiological investigation, voice analysis, speech-language assessment.   Treatment - Of voice disorders and speech depends on the severity and causes. It may include – surgical (micro laryngeal surgery), medicines, speech therapy and life style changes.

Very common presenting complaints of young age group. It has a cosmetic and a functional aspect. Symptoms - External deviation, nose block, headache, chronic nasal infections Causes - Congenital /traumatic/iatrogenic Diagnosis - Clinical examination and radiological investigation in form of C.T. scan.   Treatment - Surgical by open /closed procedure Septorhinoplasty. Gives good cosmetic and functional results.

Chronic infective condition affecting the school going & mid-teenage children Symptoms - Severe pain in throat with difficulty in swallowing fever, enlarged nodes in the neck, voice change, pain abdomen. Complications - Peritonsillar abscess, affects growth and development of child. In strep infection, there is a risk of rheumatic fever, kidney involvement. Causes – Mostly viral but bacterial in some, then streptococcal infection needs to be ruled out. Risk factors – Young age, frequent exposure of infections from peer group Prevention – Good hygiene. Sick child should not be sent to school. Diagnosis - Oral cavity examination inflamed & congested tonsils. Neck has enlarged lymph nodes Throat swab to rule out step infection CBC Treatment - General supportive & symptomatic treatment, fluids, rest, analgesics, antipyretics. Antibiotics in case of bacterial infection Surgery - If more then 3 episodes in last 3 years.

Malignant lesions of this area are fairly common & present late in stage when they are advance Symptoms - There are vague ranging from irritation in throat to difficulty in swallowing, cough to voice change, breathing difficulty, lump in neck. Complications - Peritonsillar abscess, affects growth and development of child. In strep infection, there is a risk of rheumatic fever, kidney involvement. Causes – Tobacco chewing, smoking, long-standing infections, GERD (Gastroesophageal reflux disease) Prevention – Stop addictions, healthy diet, early specialist opinion for chronic ENT ailments. Diagnosis - ENT examination, endoscopies, to look into the hidden areas, imaging studies early biopsy of the suspicious lesions. Treatment - Surgical + Radiotherapy + Chemotherapy. Targeted drug therapy, immunotherapy Surgery - Laryngopharyngectomy + neck dissection. Palliative treatment in inoperable cases rehabilitation for voice & swallowing difficulties.

It is a very common under-diagnosed condition causing chronic vague symptoms of throat Symptoms - sore throat, mild hoarseness, foreign body sensation, repeated throat clearing, sticky sensation, chronic dry cough. Complication - chronic cough, hoarseness of voice, worsening of asthma, risk of cancer Causes – There is reflux of acid contents from the esophagus into the larynx due to lax sphincter, dietary habits, stress, obesity, tight clothing Diagnosis - Careful & through history, laryngeal endoscopy Esophageal ph monitoring, upper G.I. endoscopy. Prevention - Healthy diet, weight reduction, small meals, avoid alcohol & tobacco, caffeine Treatment - Dietary modifications Medical - antacids, proton pump inhibitors, prokinetics.

It is the most common sleep disorders which can affect children as well as adults & can have serious implications Symptoms - loud snoring with frequent awakening with gasping, choking, daytime sleepiness, headache, high blood pressure Complications – Cardiovascular risks of arrhythmias & hypertension, sudden death. Causes – Critical narrowing of the nasopharyngeal airway due to collapse of the surrounding soft tissue walls louding to temporary cessation of the breathing. The causes may be central or peripheral. Risk factors – Obesity, age, obstructed airway, high B.P. addictions of alcohol, systemic disease with D.M. asthma Diagnosis - Polysomnography, ENT examination & investigations Treatment - Lifestyle changes, stop smoking/Alcohol and weight reduction. Positive airway pressure with CPAP or BIPAP devices. Oral devices. Medical - UPPP Uvulopalatopharyngoplasty. Jaw surgery maxilla mandibular advancement. Nasal surgery it required tracheostomy if other methods have failed