Mr Abhijeet Parikh

Mr Abhijeet Parikh
Otolaryngology / ENT
Central London


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Mr Abhijeet Parikh

Otolaryngologist in
London

PhD(Lon) FRCS(ORL-HNS) MS(ENT)

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Mr Abhijeet Parikh areas of expertise:

Professional statement

Mr Abhijeet Parikh is an eminent consultant ear, nose and throat surgeon practising in his private clinics in London. With particular specialisation in hearing loss, ear infections, and other problems related with the ear, he is also expert in a wide range of ENT procedures, including nose and voice problems. Mr Parikh completed studies in Mumbai before moving to the UK to continue his studies and experience. He achieved his PhD after undertaking a research position studying aspirin-sensitive patients being treated for nasal polyps with Dr Glenis Scadding. Alongside his clinical practice, Mr Parikh devotes time to teaching the next generation of ENT surgeons and doctors, and has published over 40 peer-reviewed articles and contributed to a number of chapters in books in his field of expertise.

 Doctor's articles

otosclerosis_treatment
Otosclerosis: a common cause of hearing...

 Credentials

GMC: ‍4008514

 Professional experience

• More than 25 years of experience
• Consultant Otolaryngologist, Hospital of St John and St Elizabeth, (present)
• Consultant Otolaryngologist, Lindo Wing, St Mary's Hospital, Imperial College Healthcare NHS Trust (2003 - present)
• Consultant Otolaryngologist, The Medical Chambers (present)
• Consultant Otolaryngologist, BMI The Clementine Churchill Hospital (present)

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 Sub-specialties

• Hearing loss
• Otosclerosis
• Ear infections
• Cholesteatoma
• Rhinitis
• Polyps
• Voice problems

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 Teaching posts

• Teacher of medical students, Imperial College London (present)
• Teacher on the Diploma in Otolaryngology Head and Neck Studies (DOHNS) (present)
• Teacher on the North London SpR training course (present)
• Examiner of year 3 medical students (present)

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 Education

• MBBS (Bachelor of Medicine, Bachelor of Surgery), University of Mumbai (1982)
• MS (Otolaryngology), University of Mumbai (1986)
• FRCS (Otolaryngology), Royal College of Surgeons Edinburgh (1991)
• FRCS (ORL-HNS), Royal College of Surgeons Glasgow (2001)
• PhD (ORL), University of London (2007)

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 Professional membership

• Member of the British Medical Association
• Member of ENT UK
• Member of the Royal College of Surgeons of Edinburgh

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Languages spoken

  • English
  • Gujarati
  • Hindi

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08/10/2018

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28/06/2018

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25/09/2017

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Diseases, Medical Tests and Treatments

Cholesteatoma

A cholesteatoma is an abnormal skin growth in the middle ear behind the eardrum, usually in the form of cysts or pouches that shed layers of old skin. ...

Hearing loss

What is hearing loss? Hearing loss is a reduction in hearing sensitivity affecting one or both ears. It can be classified by type and degree. Th ...

Nasal polyps

What are nasal polyps? Nasal polyps are semi-transparent growths that can form in any part of the sino-nasal mucosa. These are benign, but they may ...

Otosclerosis

What is otosclerosis? Otosclerosis is the abnormal growth of bone in the middle ear, which usually causes hearing loss. What are the symptom ...

Rhinitis

What is rhinitis? Rhinitis is a condition where the nasal mucosa becomes inflamed. The nasal mucosa is the lining of the inside of the nose. This is a common condition and is thought to affect one in every five people in the UK. Rhinitis can be triggered by allergies, which is called allergic rhinitis (e.g. hay fever). Rhinitis can be acute or it can be chronic (long-lasting). What are the symptoms of rhinitis? The main symptoms are sneezing, an itchy nose, itchy eyes, an itchy throat, a lack of smell and a blocked nose with nasal discharge. Due to nasal congestion, the patient cannot breathe freely or easily. The symptoms occur mostly in the morning. This can be confused with a simple cold, but a cold will resolve in around two weeks, whereas rhinitis persists. What causes rhinitis? There are several causes of rhinitis. Rhinitis can be classified into three main groups: Allergic rhinitis – caused by the immune system reacting to an allergen. Often flares up on a seasonal basis. Non-allergic rhinitis – infection (bacterial or viral) causes infectious rhinitis; vasomotor rhinitis is caused by vasoconstrictor medications; hormonal rhinitis is caused by hyperthyroidism or pregnancy; mechanical rhinitis is caused by foreign bodies or a deviated septum. Atrophic rhinitis – caused by the reduction in size of the nasal mucosa. How can rhinitis be prevented and treated? For allergic rhinitis, it is difficult to completely avoid the triggering allergens, however, attempts can be made to reduce exposure, such as avoiding leaving the house early in the morning when pollen is at its worst and keeping the windows closed. Other treatment measures include: Regularly cleaning the nasal passages Antihistamines can help with allergic rhinitis Corticosteroid sprays Immunotherapy Antibiotics Surgery ...

Voice disorders

Voice disorders are disorders in sounds that depend on the larynx (vocal cords) and affect the pitch, timbre, intensity or duration. The origin of such changes can be organic, physiological, psychological or environmental. In addition, there are two types of disorders: dysphonia and aphonia. Aphonia is the total loss of voice temporarily or chronic and can be caused by overuse of the vocal cords, respiratory disease, intake of toxic or irritating products, excessive cold or nervous causes. Treatment may include resting the voice, medication, voice therapy or, in severe cases, surgery. Dysphonia is a disorder of voice intensity due to an injury in the organs of phonation (organic) or poor use of the voice (functional). The most common causes of this condition are overly straining your voice (voice hyperfunction), gastroesophageal reflux, smoking, infections such as laryngitis or tuberculosis, neurological disorders of the larynx, tumors, and trauma, among others. The treatment involves learning relaxation techniques and breathing, exercising the shoulder, neck and face muscles, and speech therapy. ...

Adenoids

What are adenoids? Adenoids are tonsil-like glands located at the back of the nose, above the roof of the mouth, at the intersection of the nostrils, throat and the eustachian tubes. During childhood, they form part of the body's defence system against infection. Their main function is to capture substances that could be harmful to the body (bacteria, viruses or dust) as they are breathed in, before they reach the lungs. Once captured, they process these substances and activate an immune response. Adenoids increase in size from birth, until the child is around 4 years old, and then shrink until they have almost disappeared in adulthood.   What conditions can affect the adenoids Adenoids can become enlarged or swollen, usually due to infections or allergies. This is common, and is often accompanied by swollen tonsils. The adenoids may recover on their own and in most cases, they aren’t serious enough to impact the child’s day-to-day life. However, swollen or enlarged adenoids can sometimes cause problems, including: Blocked or runny nose Difficulty breathing Difficulty sleeping, including snoring and sleep apnoea Middle ear infections Glue ear Recurrent or persistent sinusitis A persistent blocked nose and the associated difficulty breathing through it leads to the child breathing through the mouth, which can cause a dry throat and, in turn, problems such as a sore throat, trouble swallowing, bad breath, and voice alterations.   Medical tests for enlarged adenoids Adenoids cannot be seen through the mouth like the tonsils. The specialist will need to perform a physical examination of the nose, throat, and ears to assess whether they have increased in size. A lateral x-ray of the pharynx may also be performed to see the size. In severe cases where there is associated sleep apnoea, a sleep apnoea study should be performed to assess the intensity of the episodes.   What causes adenoid problems? Enlarged adenoids usually occur due to bacterial or viral infections. The adenoid tissue may swell temporarily as it fights an infection in the airway, and may recover. The adenoids themselves can also become infected, and repeated infections of the respiratory tract, such as colds or flu can lead to persistent swelling. Some adenoid problems may be caused by the streptococcus virus or the Epstein-Barr virus, among others. Patients with enlarged adenoids are also at increased risk of tonsillitis, and may experience headaches and sore throats more often.   Treatments for enlarged adenoids The first thing the specialist will do is prescribe antibiotics to combat the infection in the tonsils, adenoids, and sinuses. This will lower mucus production and clear the nostrils, but not all the inflammation. If breathing problems and difficulty sleeping are impacting the child’s life, the doctor will probably recommend surgical removal of the adenoid glands (adenoidectomy). If the child also frequently suffers from tonsillitis, the tonsils will likely be removed at the same time (tonsillectomy), which reduces the risk of complications. The operation is performed under general anaesthetic and consists of scraping the adenoids away with an instrument known as a curette or burning them away using heat from a high-frequency electrical current generated by a special diathermy instrument. The procedure is relatively quick. The child will be kept under observation for a few hours (occasionally overnight if the procedure was performed late in the day), and when the doctor is satisfied that they are recovering normally, they will be able to go home, usually in the same day.   Which specialist treats adenoid problems? Any problems with the adenoids are treated by a paediatric otolaryngologist. ...

Aphonia (loss of voice)

The hoarseness is the loss of voice. Usually caused by an inflammation of the larynx or trauma. Causes of hoarseness: Respiratory diseases Speak very loudly, shouting, etc. Abuse snuff, alcohol, ... Causes nerve. Excessive cold; (Drinking very cold fluids, ice cream ...) ...

Audiometry

What is audiometry? An audiometry exam evaluates your hearing function in terms of tone, balance and sound intensity. It focuses on the functioning of the inner ear. The human ear can perceive sounds with tones that range between 20 and 20,000 Hertz. The human ear can hear sounds with intensity ranging from 20 decibels upwards. What does audiometry involve? An audiometry exam involves several different tests. A pure tone audiometry test measures softest, quietest sounds you can hear at different pitches. This uses an audiometer which is a special machine that plays sounds via headphones. You will indicate to the clinician which sounds you can hear. A speech audiometry exam tests how well you can hear speech at different tones. The exam is divided into tonal and verbal audiometry. In tonal audiometry, the airway and the bony route are evaluated, which in both cases involves the exploration of the two ears separately, with the patient inside a soundproof and hermetically sealed cabin. In air audiometry, the individual must put on headphones and then the specialist plays a series of sounds from higher to lower volume until they are inaudible. The last perceived sound determines the auditory threshold, that is, to what intensity the patient can hear at a certain frequency. In the inspection of the bone path, a vibrator is placed behind the patient's ear, in the mastoid, where it receives the sound. Verbal audiometry is also performed with the patient in a booth and with headphones, but instead of sound, words are issued at different volumes that must be repeated exactly. A word-recognition test is also performed which measures the patient’s ability to discriminate between speech and background noise. Tympanometry testing can uncover any problems with wax or fluid build-up, ear drum damage, ossicle bone damage or tumours in the middle ear. An acoustic reflex test is used to locate where the hearing impairment may be located. Why is audiometry done? Audiometry can detect hearing loss and is performed when a patient has trouble hearing or as part of a routine screening. An audiometry exam can determine whether someone is suffering from sensorineural hearing loss (nerve or cochlea damage) or conductive hearing loss (ear drum or ossicle bone damage). Hearing loss commonly results from: Chronic ear infections Birth defects Damage to the ear drum or inner ear Exposure to loud noises on a regular basis Inner ear diseases Inherited conditions How to prepare for audiometry: No special preparation is needed to perform this test. How does it feel during the audiometry exam? During the test, the patient does not feel any discomfort. The duration of the exam varies depending on whether it is an initial evaluation, which can last between 5 to 10 minutes; or if it is a detailed evaluation that can last up to almost an hour. Risks of audiometry: Audiometry is non-invasive and carries no risks. What do abnormal results mean? The results are shown on a graph (audiogram). The results are reviewed by the specialist and if they confirm hearing loss, management and treatment techniques will be discussed. These could include wearing a hearing aid. ...

Deafness

What is deafness? Deafness, also known as hearing loss, describes difficulty hearing or the total inability to hear. Deafness can be partial or complete and can occur gradually, with age or it can happen suddenly. Some people are born with deafness. What are the symptoms of deafness? Particularly if hearing loss is happening gradually, noticing it can be difficult. However, the following are common signs that you may be going deaf: Asking people to repeat themselves Needing to turn the television up loud Difficulty hearing people, especially in loud places Muffling of speech Withdrawing from taking part in conversations What causes deafness? The causes of deafness can be congenital or acquired. Congenital causes present at birth or soon after and can be hereditary or non-hereditary, and are due to complications during pregnancy or childbirth. As for the acquired causes, these can occur at any age due to: Infection or growths (tumours) Chronic ear infection Exposure to excessive noise Ageing Build-up of earwax Ruptured ear drum Can deafness be prevented? There are certain risk factors that can damage the ear or cause deafness, so prevention can be sought by: Avoiding loud noises (e.g. music concerts for long periods of time, listening to music too loudly) Vaccinating children against measles and meningitis Having hearing tests for children Avoiding certain medications, if possible Taking care if your work involves loud noises, wearing ear protectors What is the treatment for deafness? Sometimes, hearing loss will get better on its own, for example, if earwax is removed or treated with eardrops. However, other forms of deafness can be permanent. In such cases, treatment will aim to improve what hearing you have left. This can be done with hearing aids, cochlear implants, or by teaching lip reading or sign language. ...

Dysphagia

Dysphagia, or discomfort when swallowing, refers to difficulty in swallowing or swallowing food, and is most common in elderly patients. In many cases it is a consequence of cerebrovascular accidents, Alzheimer's, Parkinson's or tracheotomies, diseases that cause problems in the tongue, the muscles of the throat and the oesophagus. Practical treatments focus on preventing food from getting stuck: exercises to strengthen the jaw muscles, sitting upright, waiting for three hours after eating in order to go to sleep, ingesting food in small amounts and accompanying it with plenty of liquid, and eating meals slowly. ...

Dysphonia

Dysphonia is a disorder characterised by an alteration of the timbre of the voice (difficulty in speaking) which can be due to various organic or functional causes of the larynx and vocal cords. When it occurs in children, it can come from neurological disorders, malformations of the larynx, laryngeal papillomatosis caused by viral infections, or from the voice being overly strained. The latter is the most common cause of dysphonia in adults, and that an untreated hyperfunction voice can produce other pathologies such as nodules or polyps on the vocal cords. In addition, other factors that can trigger dysphonia: gastro reflux, smoking, infections such as laryngitis or tuberculosis, neurological disorders or tumours of the larynx. ...

Endoscopic sinus surgery

What is endoscopic sinus surgery?       Sinus surgery was typically performed in the past using external incisions, which caused discomfort and a significant amount of pain to the patient. Nowadays, however, endoscopic sinus surgery tends to be the standard surgery performed for conditions such as chronic sinusitis. In endoscopic surgery, a small telescope with a camera on the end is inserted up the nose to view the area to be operated on. This surgery is used to treat injuries or abnormalities that alter normal nose function or surrounding structures. Surgery is done under general anaesthetic.      Why would you do it? This surgery is done when there is chronic nasal and sinus inflammation, especially in chronic sinusitis, nasal polyps, or acute recurrent sinusitis that has not responded well to medical treatment. The treatment aims to restore normal nasal sinus function through a minimally invasive surgical procedure. This surgery is also used for septoplasty, turbinate surgery, closure of cerebrospinal fluid fistulas, and orbital decompression among others.         What does it involve?     A nasal decongestant should be used before dissecting the nose. A thin optic fibre is inserted in the nasal fossa to be able to view the sinus openings. With the right tools, the abnormal or obstructive tissue is resected. After surgery any bleeding points will be checked on, and in some cases nasal packing will be done to prevent haemorrhages, or silicone sheets will be placed to prevent the walls sticking to each other and forming anomalous scars.      Surgery tends to last between 1 and 3 hours depending on the complexity of the case. The nasal cavities are blocked with coagulant foam and special sponges that dissolve, or plugs that can be taken out easily.   How to prepare for it Before surgery a sinus CT scan will be done to be able to plan the best form of treatment. Preoperative tests will also be carried out, as the surgery is done under general anaesthetic. The patient is normally in for a short stay surgery, they are only there one night. The patient should fast for 6 to 8 hours before the procedure.    Post-operative care The nose is usually blocked, so the patient can’t breathe through it. Bleeding may occur, so a gauze is placed under the nose, although it’s not always needed. For the first 3-4 days, the patient is advised not to; smoke, drink alcohol, or physically exert themselves. Patients are also told to rest at home, avoid blowing their nose, and sit in a position that reduces blood flow to the head, head congestion, and bleeding. Patients should follow a soft food diet and drink plenty of fluids for throat dryness due to nasal packing. It is not a painful procedure, but it can cause discomfort. Anti-inflammatory medication is generally prescribed. Antibiotics may also be prescribed to prevent an infection of the retained mucus.    ...

Epistaxis

Epistaxis is a nosebleed originating from the nostrils. It can be caused by trauma, irritation or dryness of the lining of the nose, allergic rhinitis, colds or sinusitis. Other causes include nasal obstruction such as a deviated septum or foreign objects in the nose. In most cases it stems from the septum, which is the vertical cartilage that separates the nasal chambers and is covered by fragile blood vessels, which may break. A nosebleed usually stops by itself but any epistaxis requires medical help if it persists after 15 or 20 minutes, if nosebleeds are frequent, if the blood drains into the throat or neck or head injury is suspected. The best way to stop the bleeding is to sit leaning forward pinching the nose above the nostrils with the fingers and breathing through the mouth....

Facial nerve

What is the facial nerve? The facial nerve controls the muscles on the sides of the face, allowing us to smile, wink, cry, frown and make many other facial expressions. The facial nerve also helps us to control our facial movements when eating, drinking and speaking. There are two facial nerves – one on each side of the face which travels around the middle ear, exiting at the skull base and branching from the parotid gland. These branches allow motor function for all of the different facial muscles. What are some common conditions that affect the facial nerve? Damage to the facial nerve can result from: Trauma or injury (e.g. fractures, facial or ear injuries or surgical trauma) Skull base tumours Infection (e.g. Lyme disease and Ramsay Hunt syndrome) Toxins (alcoholism) Stroke and other neurological conditions Bell’s palsy (inflammation of the facial nerve) Trigeminal neuralgia What are the symptoms of conditions involving the facial nerve? Facial nerve disorders can result in the following symptoms: Drooping of the face Facial paralysis Weakened facial muscles Facial twitches Excessive salivation Dry eyes Changes in taste Symptoms will depend on the severity of damage caused to the facial nerve. How can the causes of facial nerve disorders be diagnosed? If a patient is experiencing symptoms of facial nerve damage, tests will be run to determine the underlying cause, so that the correct treatment can be given. The following tests may be used: Balance test Hearing test (to check the health of the auditory nerve) Taste test Salivation test Scans (CT, ultrasound, MRI) Electrical nerve stimulation tests How can facial nerve problems be treated? Depending on the cause, the following are potential treatments for the symptoms of facial nerve disorders: Artificial tears to keep the eyes moist Nerve repair or grafts Muscle transfers Eyelid procedures to reposition the eyelids Removing tumours that may be causing the nerve symptoms ...

Facial paralysis

What is facial paralysis? Facial paralysis is a condition that causes partial or total motor paralysis of the facial nerve and, therefore, of the facial musculature. What are the symptoms of facial paralysis? The symptoms of facial paralysis include being unable to perform certain movements such as smiling, opening and closing the eye completely or raising the eyebrow. What causes facial paralysis? Facial paralysis can be caused by various factors, including tumours, trauma, acute and chronic ear infections and congenital disorders (Moebius syndrome). However, its causes are mostly unknown, and in this case it is known as Bell's palsy or peripheral facial paralysis. How is facial paralysis treated? Normally steroids are given to slow down the progressive deterioration of the nerve and massages are performed on the facial muscles. In the more severe cases, specific surgical treatments are also performed, using both static and dynamic techniques to restore the movement and functionality of the muscles. Treatment for Bell's palsy, or peripheral facial paralysis, should be started immediately after onset for a faster and more effective recovery. Are there any complications during recovery? Recovery from facial paralysis is sometimes incomplete because the nerve is damaged and unable to function normally. Complications may occur, such as hemifacial spasm (where some of the muscles are permanently contracted) or synkinesis (when an involuntary movement occurs during a voluntary movement). Fortunately, both complications can be improved through appropriate rehabilitative treatment such as neuromuscular facial retraining exercises or, in some cases, infiltration with botulinum toxin. ...

Fibroscopy

What is a fibroscopy? Fibroscopy is an endoscopic examination used especially in otorhinolaryngology. A flexible fibre-optic instrument connected to a cold light source, a camera and a monitor are used to directly examine the cavities of the body. What does a fibroscopy involve? Fibroscopy involves introducing a camera with a light source into the cavities to be examined and is used especially for the respiratory tract (nose and mucous membranes, and throat). With the fibrescope connected to a camera, the specialist will be able to illuminate, examine and see the inside of the nose, pharynx and larynx in order to make a more precise diagnosis. Why is fibroscopy performed? In otorhinolaryngology, fibroscopy is used to examine the nose, rhinopharynx, nasopharynx, hypopharynx, and larynx. This allows for a more accurate diagnosis. The technique has a specific name depending on the area to be examined. Thus, a nasal examination with fibroscopy is called nasofibroscopy; examination of the larynx, fibrolaryngoscopy; and examination of the entire upper airway is called nasofibrolaryngoscopy. Specifically, it is used for people with throat, nose or ear problems. Fibroscopy is frequently performed for the diagnosis of sinusitis, stuffy nose, sleep apnoea, tumours, nasal polyps, deviated nasal septum, dysphonia, nodules, polyps, vocal cord cysts or tumours, and gastroesophageal reflux. Less common applications include examination of the glottis and trachea and the main bronchi in people with a tracheostomy cannula. Preparing for a fibroscopy: In principle, no special preparation is necessary before undergoing fibroscopy. If you have a particularly sensitive gag reflex, the specialist will apply some topical anaesthetic spray (though this is not usually necessary). What do you feel during the examination? Fibroscopy causes a small amount of discomfort because the fibre rubs slightly against the nasal or pharyngeal mucosa. In most cases it is tolerated and can be performed without anaesthetic. It does not cause choking and doesn’t usually cause nausea. However, if the area is sensitive or if you have a severe gag reflex, some anaesthetic spray may be required. Meaning of abnormal results: Fibroscopy can be used to diagnose respiratory tract dysfunctions or pathologies. Based on the results, the specialist performing the examination will consider the best treatment. As this examination is highly precise, it allows the specialist to clearly identify any problems with the throat, nose, larynx or pharynx. ...

Functional rhinoplasty

Functional Rhinoplasty is surgery to correct breathing problems. These operations are not aimed at improving the aesthetics of the nose but to improve breathing. Conditions treated include turbinate hypertrophy, deviation of the septum, nasal polyps or chronic sinusitis....

Mastoiditis

What is mastoiditis? Mastoiditis is an infection of the mastoid bone, a portion of the temporal bone of the skull located behind the ear. The mastoid bone is full of tine air-filled spaces called mastoid cells. Mastoiditis occurs if the mastoid cells become infected or inflamed, often following a persistent middle ear infection (otitis media). The condition can be either acute or chronic. The infection is more common in children.   What are the symptoms of mastoiditis? The symptoms of mastoiditis include: Redness and swelling behind the ear or of the ear lobe Tenderness/pain of the mastoid bone Fever Tiredness and irritability Discharge from the ear Headache Hearing loss in the affected ear The symptoms are often similar to those of otitis media, along with swelling behind the ear. Complications of mastoiditis can include nausea, vomiting, brain abscesses and facial paralysis.   How is mastoiditis diagnosed? Your doctor will examine your ear with an otoscope to see if there’s any oedema or irritation. If your GP suspects mastoiditis, they may refer you to an ENT specialist, who may order further tests, such as: Complete blood count (CBC), to see where your leukocyte level stands Ear culture Computed tomography (CT) scan X-rays   What causes mastoiditis? Middle ear infections are the main cause of mastoiditis. When the infection spreads to the back of the ear and to the temporal bone, honeycomb structure of the mastoid bone can become infected and inflamed. The most common bacteria causing this infection are pneumococcus, pseudomonas aeruginosa, haemophilus influenzae and group A streptococcus (GAS). Other diseases which may lead to mastoiditis are meningitis, sinus thrombosis, cerebral abscess and facial nerve palsy. Cholesteatoma, an abnormal build-up of skin cells inside the ear which can prevent proper drainage, is another possible cause.   How can mastoiditis be prevented? The most effective way of preventing mastoiditis is to timely identify and treat infections of the ears.   How is mastoiditis treated? You will have to start taking antibiotics to fight the bacteria causing this infection. To reduce the symptoms, you can take NSAIDs or painkillers. Antipyretic treatment can help you with the symptoms of fever. If the disease isn’t going away with any of these treatment, you may have to undergo a small surgery to drain away any potential abscess there may be in the affected area.   Which doctor should I talk to? You should see an ear, nose and throat (ENT) specialist to treat mastoiditis. After doing some tests in order to formulate an accurate diagnosis, the doctor will identify the cause of the infection and suggest the best treatment for you. ...

Ménière's disease

What is it? Ménière's disease (MD is a disease which affect the ears (usually, one at a time) and causes: a sudden ringing noise inside the ear (tinnitus) a roaring or buzzing inside the ear a feeling of fullness in the ear The condition may also lead to sudden attacks of nausea, vomiting, vertigo and hearing loss (hypacousia). Attacks can occur in clusters or several times a week, or they may be separated by weeks, months or years. Vertigo attacks may become as severe as to cause loss of balance and falling down. What causes it? Although there are no known causes for this condition, according to some studies Ménière's disease is caused by blood vessels constriction, which in turn may have been caused by previous viral infections, autoimmune reactions, allergies or genetic factors. The condition may appear at any age; however, the most affected age range is between 40 and 60 years old. People suffering from the following conditions have a higher chance of developing the condition: immune system conditions autoimmune diseases viral infections inner ear electrolyte imbalance vascular conditions Finally, you’re more likely to develop Ménière's disease if you have a family history of the condition. How is it diagnosed? The first step for diagnosing Ménière's disease for an ear, nose, and throat specialist to look at your clinical history. The doctor will ask you if the symptoms last more than 20 minutes per attack, and if you suffer from any hearing loss. You may also have some tests, including: electrocochleography – a record of the electrical response of the ear to sound to check if hearing loss originates from the inner ear or from the acoustic nerve nystamgus – this involves filling the ear with water or air to check if there are any issues with your balancing apparatus To rule out the possibility of a tumour, which in its acute phase may cause symptoms much alike to those of Ménière's disease, you should also have a CT scan and a MRI scan. How can Ménière's disease be treated? As of today, there is no cure for Ménière's disease, but medication can help you control some of the symptoms. A combination of psychiatric medications and H1-antihistamines, which fight the symptoms of vertigo, is the most common treatment. In most complex cases, you may also start taking antiemetics drugs, which can help with the vomiting, as well as anti-inflammatory drugs and immunosuppressive agents. Some changes in your lifestyle can help you fight this condition: eating a low-salt diet (aimed at reducing water retention and thus the fluid build-up within the ear), stopping smoking avoiding alcohol cutting down on chocolate and caffeine Psychotherapy can help you deal with vertigo attacks better and to improve your quality of life. Finally, if these treatments are not effective, the doctor may recommend ear surgery. ...

Middle ear implants

What are middle ear implants? A middle ear implant is a small device that is inserted into the middle ear and attached to the parts of the ossicle or oval window in order to improve hearing. Unlike other hearing aids, a middle ear implant does not require a speaker. Simply put, middle ear implants work by transmitting sounds to the inner ear via small microphone worn behind the ear. These sounds are converted into vibrations which are sent to the implant in the middle ear. Why are middle ear implants needed? Middle ear implants are often recommended to patients that have not benefited from conventional hearing aids, or those with other problems such as with damaged ear canals or malformed ears. They are suitable for patients with mild to moderate conductive hearing loss, sensorineural hearing loss or mixed hearing loss. Conductive hearing loss is a problem with the transmission of sound between the ear drum and the inner ear. Sensorineural hearing loss is damage to the hairs in the cochlea or to the hearing nerves. What does a middle ear implant consist of? The middle ear implant captures sounds and converts them into mechanical vibrations. These vibrations are then amplified and transmitted to the implanted device located near the cochlea (this is responsible for sensing sound). Once at the cochlea, the vibrations create the sensation of sounds for the patient. The surgery of application is performed using general anaesthesia, with a single incision behind the auditory pavilion through which the middle ear will be accessed, where the active part of the implant is fixed. The microphone behind the ear can be attached using an implanted magnet just beneath the skin and is usually fitted a few weeks following surgery. Pain following surgery is minimal. Taking care of your middle ear implant For proper operation, the external parts of the device should not get wet and should be protected from static electricity. It is also recommended to avoid sports or activities that may cause strong blows to the head, or use adequate protection such as a helmet. ...

Middle ear surgery

What is middle ear surgery? Middle ear surgery is a series of surgical interventions to treat problems in the tympanic membrane, in the chain of tiny interconnected bones (the hammer, anvil and stirrup) and in the mastoid cells (cavities of the temporal bone). There are two major surgical procedures: tympanoplasty and mastoidectomy. Tympanoplasty involves ossiculoplasty (repairing the bones) and myringoplasty (closing a hole in the eardrum). Why is middle ear surgery performed? These interventions are recommended for treating middle ear problems. Tympanoplasty is recommended for large eardrum perforations or middle ear infections such as acute or chronic otitis media that cannot be cured with antibiotics. Mastoidectomy is an operation to remove the flat air cavities of the skull behind the ear (temporal bone) in order to treat infections of the mastoid portion in that part of the skull, to treat complications of otitis media, abnormal bone growth, cholesteatoma (skin cell cyst in the middle ear), or to place cochlear implants. What does middle ear surgery involve? The middle ear is accessed through a cut behind the ear or through the ear canal so that the appropriate procedures can be performed, depending on the injury presented by the person. The procedure may involve removing any infection or dead tissue in the eardrum, placing a graft to reconstruct the tympanic membrane, or placing a prosthesis to replace a damaged bone. Preparing for middle ear surgery: Before the operation, the otorhinolaryngologist will check to make sure you don’t have an ear infection. This will require several tests, including an ear examination and a hearing test. In some cases, a CT scan of the head may also be needed. You must also consult your doctor about medication you can or cannot take. For example, you may need to stop taking certain drugs such as aspirin, anti-inflammatories or blood thinners a week prior to surgery. Post-surgery care: To ensure proper recovery after middle ear surgery, you should avoid: Sneezing too hard, or holding in a sneeze Being hit by a jet of water, so you should ask the specialist how to shower and wash your hair Flying Swimming or diving Lifting weights and excess tension You will have to wait a few weeks after the operation to know whether it has been successful or not. Full recovery will take approximately four weeks if the post-operative care guidelines have been followed according to the specialist’s recommendations. ...

Nasal endoscopy

What is a nasal endoscopy? A nasal endoscopy is a multifunctional exploratory procedure performed at the otorhinolaryngologist’s clinic to examine the nose, neck and larynx. It is carried out using a flexible fibre-optic instrument with a cold light source, a camera and a monitor. This allows for an easy and direct exploration of cavities in the body that are normally difficult to see. What does a nasal endoscopy involve? A nasal endoscopy is performed using a flexible fibre optic tube which is inserted through the nose. The procedure lasts approximately three minutes and is performed at the clinic. Local anaesthetic may or may not be used, depending on the case. Why is a nasal endoscopy performed? It is performed to diagnose respiratory tract pathologies or dysfunctions. The procedure allows images and video to be obtained, which is useful for explaining to the person the nature of their pathology. It also allows the specialist to keep a visual record, which helps them evaluate the pathology and its evolution over time, and the effectiveness of the applied treatments. Preparing for a nasal endoscopy: No prior preparation is required. You only need to follow the specialist’s instructions and they will indicate any procedures that need to follow. Only in some cases will local anaesthetic be applied to the nostril through which the fibrescope is inserted (deviation of the nasal septum or a nasal pathology). What does it feel like during a nasal endoscopy? It can be a bit uncomfortable, because a foreign body being inserted into your nose. So, a little anaesthetic may be necessary in some cases. Meaning of abnormal results: This is a quick and effective technique for detecting pathologies or dysfunctions in these structures. Any abnormality can be easily spotted and subsequently treated by the specialist. ...

Nasal septal perforation

What is a perforated nasal septum? The nose has two cavities which are separated by a septum. This is made from both bone and cartilage and is responsible for separating the nasal cavities and channelling airflow into the nose. A perforated septum described when a hole develops in the septum, which depending on the size of the hole can cause mild to extreme symptoms. Outlook of a perforated nasal septum: Some people with a perforated nasal septum won’t experience any symptoms, however, more severe perforations can result in more severe and debilitating symptoms. With the right treatment, a perforated septum can be fixed. Symptoms of nasal septum perforation: The main feature of a perforated nasal septum is a hole in the septum which can vary in size (less than 1cm to more than 2cm). Sometimes you might not be aware of a perforated nasal septum, especially if you haven’t experienced any symptoms. Symptoms can include: Nose pain Headache Nosebleeds Wheezing when breathing through the nose Feeling like the nose is blocked or obstructed Scabbing in the nose Medical tests to diagnose a perforated nasal septum: If you suspect you may have a perforated nasal symptom, you should visit your doctor. They will examine your nose and ask for a medical history. Certain tests to better examine the perforation include a nasal endoscopy or a rhinoscopy. What causes a perforated nasal septum? There are numerous potential causes of a perforated nasal septum, including: Prior surgery to the nose Infection Trauma or injury Certain medicinal sprays Drug use (e.g. cocaine) Industrial chemical exposure Can a perforated nasal septum be prevented? You can reduce your risk of getting a perforated nasal septum by: Using protective equipment if you work in an industry with exposure to chemicals. Avoiding cocaine use Avoiding nose picking Treatments for a perforated nasal septum: Treatment will first attempt to treat the underlying cause. There are several non-surgical measures that will also be used, including antibiotic cream, irrigating the nose with saline spray and using a dehumidifier at home. Your doctor may also recommend a prosthesis to block the hole in the septum. These can help to reduce the symptoms. In some cases, surgery will be needed to repair the hole. This is fairly complex and will be performed under general anaesthesia as tissue may be taken from your ears or ribs to fill the hole. Which type of specialist treats a perforated nasal septum? An otolaryngologist (ENT) surgeon would treat a perforated nasal septum. ...

Nystagmus

What is nystagmus? Nystagmus is an ophthalmological condition characterised by an involuntary, repetitive movement of the eyes. The velocity of the movement varies, from fast to slow, and generally both eyes are affected. Nystagmus can be classified into different groups: Neurological nystagmus is related to the central nervous system; it can occur after different diseases, such as a brain tumour or multiple sclerosis. Idiopathic nystagmus appears in childhood, normally in the first 6 months of life. The cause is a congenital defect in the part of the nervous system responsible for stabilising the gaze. Sensory nystagmus is caused by a profound visual deficit during the earliest stages of growth. It is frequently due to congenital cataracts or early retinal diseases. Symptoms of nystagmus The most visible symptom is involuntary movement of the eyeball. However, the primary symptom is poor vision, especially with idiopathic nystagmus, given that it is more difficult to fix the gaze on the object correctly and to project a clear image onto the retina. As a result, the eye does not develop as it should. Oscillopsia is a condition that may occur with acquired nystagmus; it is the sensation that your surroundings are moving about. In some cases, there is a gaze position in which the movement is minimal or almost disappears. This is called the neutral zone and it may lead to torticollis, as a result of the patient moving their head and eyes to achieve this neutral zone. Torticollis refers to an abnormal, asymmetrical head or neck position. What are the causes of nystagmus? The cause may be congenital, either due to a genetic condition or congenital eye disease. Other causes include ingestion of certain medications, hereditary factors, trauma, inner ear problems, drug or alcohol abuse etc. Can it be prevented? This condition cannot be prevented. However, it is important to control alcohol consumption. It is also important to undergo annual ophthalmological evaluations. What is the treatment? The treatment depends on the type of nystagmus, given that each type has a range of potential causes. Treatment may consist of certain medications to reduce the movement or the use of botulinum toxin for its “paralysis” action; however both types of treatment can sometimes be associated with side-effects. In cases of torticollis, glasses with prisms or surgery of the muscles can help to improve the position of the head, as they shift the neutral zone to somewhere in front. In addition, it may reduce the intensity of nystagmus. ...

Orbital cellulitis

Orbital cellulitis is an acute infection of the tissues surrounding the eye, particularly the eyelids, eyebrows and parts of the cheeks. This condition is often caused by a sinus infection where the virus spreads to the aforementioned areas. It most commonly occurs in childhood and it is essential it is treated properly to ensure treat without causing damage that can be maintained in adulthood....

Otitis

What is otitis? Otitis is also known as an ear infection and occurs when there is a bacterial or viral infection within the ear. Ear infections can be acute, lasting a short duration, or chronic with frequent occurrence. Otitis can affect the internal or external parts of the ear. Ear infections are common in children. These are the different types of otitis: Otitis externa – also known as a swimmer's ear, it affects the external ear, specifically the ear canal. Otitis media – also known as a middle ear infection, with inflammation forming behind the eardrum. Acute otitis media – usually painful, but occurs suddenly and lasts a brief period. Chronic ear infection – when the infection does not disappear or it keeps recurring. Otitis media with effusion (OME) – following an infection, mucous or fluid continues to build-up in the middle ear, making the ear feel “full”, affecting hearing. What are the symptoms of otitis? The most frequent symptoms of otitis are: Earache Fever Irritability Difficulty sleeping Vertigo (loss of balance) Nausea and/or vomiting Diarrhoea Yellow, clear discharge from the ears Loss of appetite What causes otitis? Common causes of otitis are: If the Eustachian tube becomes blocked or swollen, causing fluid to build-up Infection of the upper respiratory tract that spreads to the ears Allergies (allergic otitis) Sinus infections Exposure to moisture causes Swimmer’s ear Changes in air pressure Adenoid infection Can otitis be prevented? There are a few preventative measures that can be taken to avoid ear infections, including: Towel drying your ears after bathing When swimming use a swimming cap and earplugs Prevent any foreign objects entering your ears (e.g. cotton buds) Wash your and your child’s hands often Ensure your child’s vaccines are up-to-date Avoid smoky environments Feed your child upright, rather than on their back What is the treatment for otitis? Mild ear infections will usually go away without intervention, and relieving symptoms with painkillers and warm cloths to the ear will suffice. If the infection is more severe, antibiotic medicine or eardrops can be prescribed. ...

Otology

What is otology? Otology is the branch of medicine concerned with the study of the ear and its diseases. This discipline is part of otorhinolaryngology, the speciality concerned with the prevention, diagnosis and treatment of diseases of the ear, nose and throat. Unlike otorhinolaryngologists (also known as Ear, Nose and Throat [ENT] specialists), otologists do not treat diseases of the nose and neck. Otologists are specialised in the physiology, function and diseases of the ear. Otology is a branch of medicine and surgery; as such otologists are also qualified to perform surgical interventions.   Which diseases does otology treat? Otology is dedicated to treating ear problems, so not only hearing problems but also balance problems. The ear plays a fundamental role in balance and the sensation of vertigo and dizziness. Some of the most common pathologies in the otology clinic are the following:   Otitis or ear infection: very frequent, especially in babies and children. Tinnitus: annoying perception of continuous sound or ringing, which sometimes prevents the patient from hearing clearly. Barotrauma: a lesion caused by changes in barometric (air) or water pressure. Menière’s disease: a common cause of vertigo and dizziness, due to liquid problems in the middle ear. It also usually causes tinnitus.   What are the subspecialties within otology? Otology is focused on the study of the ear and is a subspecialty of otorhinolaryngology. Professionals may further specialise in a specific disease or a specific part of the ear (external, middle or internal ear), for example, damage to the eardrum or middle ear surgery.   When would I have to visit the otologist? You may need to visit the otologist if you experience changes in hearing, or pain or discomfort in your ears, or dizziness or vertigo. ...

Otomycosis

What otomycosis? Otomycosis is a fungal infection of the outer ear. There are many types of fungus that can cause an ear infection, the most common being Aspergillus and Candida. Because fungi require warmth and moisture to grow, otomycosis is most commonly seen in hot and humid climates, particularly during the summer. It is also more common among people who play water sports or go diving. Finally, you are more vulnerable to otomycosis if you have a weakened immune system, eczema, or you have had injury or surgery to the ear. What’s the prognosis? Generally, the infection will respond well to treatment. It can take longer to recover if you use a cotton bud to “clean out” the ear. Unfortunately, the infection is likely to recur if you return to the environmental conditions that cause it – such as going straight back to water sports. You’re also more likely to have further infections if your body’s ability to fight off infections is weakened. This can be the case if you have a condition such as diabetes or AIDs. Symptoms of otomycosis Common symptoms of otomycosis include: pain around the outer ear redness and itching swelling hearing problems discharge from the ears – this could be white, yellow, green or black How is otomycosis diagnosed? If you go to the GP with the symptoms above, they are likely to suspect a bacterial infection and will initially give you antibiotics as a first line of treatment. Antibiotics are ineffective against a fungal infection, so if you have recently practised water sports in a tropical climate and you suspect it could be fungal, it’s important to let your doctor know about this. To diagnose otomycosis, the doctor can take a swab of your ear and have this tested in the laboratory for any fungi or bacteria. Can otomycosis be prevented? The main steps you can take to prevent otomycosis are: try to prevent water getting in your ears when swimming or surfing. Special swimming caps or ear plugs are available to purchase online or in sports shops. try to avoid swimming in contaminated water. dry your ears thoroughly after swimming and after showering avoid using ear buds in your ears How is otomycosis treated? At first, the doctor is likely to clean your ear first using swabs and a syringe. This may need to be carried out several times. You’ll then be prescribed antifungal ear drops to take regularly. You’ll be told how quickly to expect results and when to come back if you don’t notice any improvement. Finally, you will receive some advice on what to do yourself to help the infection improve, including activites to avoid. ...

Parotid gland

There are three major salivary glands that generate and empty saliva into the mouth: the submandibular gland, sublingual salivary glands and the parotid glands. Surgery of the parotid gland, also known as parotidectomy, is the operation to remove tumours that grow in the gland. It is estimated that over 70% of these tumours are benign (noncancerous) but all instances should be investigated. The type of operation performed depends on the type of tumour , its size and its location. The most common are superficial parotidectomy or total parotidectomy, with conservation of the facial nerve, which also involves a lymph node dissection. The salivary glands may also develop other diseases. The most common are sialolithiasis, which is blockage and inflammation of the salivary glands by calcium stones that do not allow the output of saliva; and sialadenitis which can be an effect of sialolithiasis, or be caused by a virus or bacteria. ...

Perforation of the eardrum

The perforated eardrum is a break or hole produced in the membrane that separates the middle ear from the external. This injury can cause infections by bacteria entering the ear, even to cause hearing loss. The eardrum is a structure that can be broken by a loud noise, a sudden change in pressure, trauma or the use of certain objects to clean ears. When a patient has a ruptured eardrum, other than notice a decrease in hearing, which will be more or less severe depending on the size and location of the injury, you may also experience other symptoms such as ear pain, drainage of pus or blood, fever, dizziness, congestion and internal noise in the ears. But overall, the perforated eardrum heals on its own within weeks or months and in most cases fully recovered hearing. Otherwise, the patient will need to be practiced a type of surgery called tympanoplasty. Milder cases are cured simply by following a series of recommendations: preventing water from entering the ear, taking antibiotics and even by placing a patch over the eardrum by the doctor. A perforated eardrum is a break or hole in the membrane that separates the middle ear from the external ear. This injury can cause infections from bacteria entering the ear, even lead to hearing loss. The eardrum is a structure that can be broken by a loud noise, a sudden change in pressure, trauma or the use of certain objects to clean the ears. When a patient has a ruptured eardrum, other than noticing a decrease in hearing, which will be more or less severe depending on the size and location of the injury, there may also be symptoms such as ear pain, drainage of pus or blood, fever, dizziness, congestion and internal noise in the ears. A perforated eardrum heals on its own within weeks or months and in most cases hearing is fully recovered. If not, tympanoplasty surgery is performed. Milder cases are cured simply by following a series of recommendations: preventing water from entering the ear, a course of antibiotics by wearing a patch over the eardrum placed by a doctor. ...

Pharyngitis

What is pharyngitis? Pharyngitis, or a sore throat, is the inflammation of the pharynx, which is located between the tonsils and the larynx, at the back of the mouth. It is characterised by a scratchy feeling and difficulty swallowing. Pharyngitis usually subsides within a week and is caused by a viral or bacterial infection. It causes a sore throat, fever, a rash, redness of the pharynx, swollen lymph nodes, a headache and difficulty swallowing. Most cases tend to occur during the colder months. The condition is contagious and often spreads among family members and close contacts. What are the symptoms of pharyngitis? A sore throat is the main symptom of pharyngitis. Other symptoms include: A runny nose Fever A headache A cough Fatigue Muscle aches and joint pain Chills Swollen lymph nodes A rash Loss of appetite General malaise What causes pharyngitis? Pharyngitis is caused either a virus or bacteria, such as: The common cold Influenza Mononucleosis Strep throat (caused by group A streptococcus) The following are risk factors for developing pharyngitis: Exposure to colds and the flu (e.g. people with jobs in healthcare) Allergies Sinus infections Exposure to smoking Smoking Can pharyngitis be prevented? To prevent pharyngitis, you should avoid contact with those already infected. Some measures include: Avoid contact with sick individuals Avoid smoking Wash your hands often Don’t share food or drinks with people How is pharyngitis treated? If the cause of the pharyngitis is viral, then home care is the main treatment. It is important to stay hydrated, eat well, gargle with warm, salty water and get lots of rest. Throat lozenges and over-the-counter painkillers can also help relieve any pain or discomfort. If it is caused by a bacterial infection, antibiotics can be prescribed, commonly amoxicillin and penicillin. ...

Septoplasty

What is it? Septoplasty is a corrective surgical procedure done to straighten the nasal septum, eliminating any congenital or trauma-induced deviations. Such deviations represent an obstruction which makes breathing harder. During the procedure, the surgeon may also resect your turbinates (if they are hypertrophic). Sometimes the procedure may involve an aesthetic intervention on your nose, thus becoming a rhynoseptoplasty. What is it for? Your ENT specialist may suggest surgery if you have trouble breathing due to a deviated septum. How does it work? Should there be a severely deviated septum, the surgeon may have to remove the septum completely, straighten it and then insert it back. In other cases, the surgery can be done internally from your nose, passing through the nostrils. During the surgery, the cartilage segments (and sometimes small bone fractions) causing the deviation are removed. How can I prepare for it? First of all, you’ll need to go through your medical history with your doctor. The doctor will also check your general state of health and study the shape of your nose. If you smoke, you’ll need to stop before the procedure. You will also have to avoid taking any non-steroidal anti-inflammatory drugs (NSAIDs) two weeks before and two weeks after the procedure. Post-operative progress After the surgery, you’ll need to go back to the hospital twice (one week apart from each visit) to check on and replace the dressing, to monitor your recovery and to remove any potential adhesions. Spraying a hyaluronic acid mist on your face can help with the scarring and tissues healing. One week after the procedure, the bones and cartilage should be completely healed. After two weeks your nose won't be as swollen and the mucosa will have healed as well. Other treatment options If you have a mild deviation, laser surgery can be a good option. In this case, the deviated septum is straightened with laser septoplasty. This technique can be helpful for straightening the septum without causing you any pain (neither before nor after it), with much less bleeding and an easier healing process. ...

Sinusitis

What is sinusitis? Sinusitis is a condition characterised by inflammation of the paranasal sinuses which are the cavities located behind the forehead, cheeks and eyes. It occurs as a result of infection by viruses, fungi or bacteria. There are two types of sinusitis: Acute sinusitis – when the symptoms are present for four weeks or less. It is caused by bacteria that proliferate in the paranasal sinuses. Chronic sinusitis – occurs for more than 12 weeks and the causes can include infection, nasal polyps or a deviated nasal septum. What are the symptoms of sinusitis? The main symptoms of sinusitis are: Bad breath Loss of sense of smell Pain and swelling on your cheeks, eyes and forehead Fever A headache Fatigue A cough (which gets worse at night) A sore throat Congestion and nasal discharge What causes sinusitis? The cause of sinusitis is an infection caused by viruses, fungi or bacteria. When the paranasal openings are blocked, bacteria or other microorganisms can easily grow. Obstruction of the paranasal openings may be due to: The small hairs of the paranasal sinuses do not manage to remove the mucus properly. Colds and allergies can cause too much production or mucus. A deviated nasal septum, a nasal bone spur or nasal polyps. Can sinusitis be prevented? The best way to prevent sinusitis is to avoid coming down with a cold. If you cannot avoid them, it is important to treat them quickly. Some tips to prevent sinusitis are: Reduce stress Wash hands frequently Avoid smoke and pollutants Take decongestants during an upper respiratory infection Use a humidifier to increase the humidity in the nose What is the treatment for sinusitis? In general, sinusitis heals on its own and self-care can manage the discomfort, however, if it persists antibiotics can be prescribed. Some self-care techniques include: Rest Lots of fluids to stay hydrated Apply a warm compress to your face Ensure your nasal passages are drained Sleep with your head elevated Use over-the-counter painkillers to manage any pain If the symptoms do not disappear with the treatment, it may become necessary to perform surgery to enlarge the opening and to drain the sinuses. ...

Sleep apnoea

Sleep apnoea is the interruption of breathing that occurs moments after falling asleep, preceded by a period of loud snoring for at least 10 seconds. If this process is repeated 5 times for each hour of sleep it is called Obstructive Sleep Apnoea Syndrome. Obstruction of breathing causes a decrease in oxygen levels in the body that makes it difficult for the person to have a restful sleep and causes tiredness the next morning. In addition, the persistence of this lack of oxygen could lead to pulmonary hypertension and future right-sided heart failure or myocarditis, so it is important to detect it early and perform relevant tests for a safe diagnosis. A sleep study is carried out to establish treatment that includes the change of some lifestyle habits (diet, abstention from alcohol, postural changes) and the prescription of a CPAP machine, which generates air pressure via a nasal mask. This stops respiratory obstruction, preventing snoring and favouring restful sleep. In some cases, surgery may be required if there are any airway scars or when the mask is not effective. ...

Temporal bone microsurgery

What is microsurgery of the temporal bone? Temporal bone microsurgery is the surgical procedure performed on the delicate bones that make up the side of and the base of the skull. The temporal bone consists of four parts: the squamous, mastoid, petrous and tympanic parts.  Temporal bone functions include: Protect the encephalon and auditory organs. Provide part of the joint surfaces for the temporomandibular joint. It is part of the temporal region and the temporary fossa.   As the temporal bone has the tympanic cavity and the Eustachian tube in it, it is often associated with ear related disorders, such as tinnitus or ringing in the ears, dizziness, and Ménière’s disease.   Why is microsurgery necessary in some cases? Temporal bone microsurgery may be carried out due to an ear disorder or if there has been a trauma to the temporal bone. In fact, fractures are the most common injury. If the fracture can’t properly be seen, there are certain signs that doctors look out for:   Soft tissue invasion within mastoid cells or in the tympanic cavity and air in unusual places. The ossicular chain can be dislocated or injured due to a luxation or a fracture, which will be analysed by CT scan. Injuries that affect the skull are the most common reason for problems of the temporal bone, especially direct hits, foreign bodies, or penetrating wounds. When there is a temporal bone fracture there has been a trauma, which is why it is often linked to other skull fractures.   What does it involve? Temporal bone dissection is a complex procedure for otologists, neuro-otologists, and ear/skull surgeons. It is essential for the surgeon to have surgical skills and knowledge in order to be able to adequately manage diseases that affect this bone. There are different surgical procedures depending on what the issues are. These include:   Simple mastoidectomy: removal of the mastoid cells, the air-filled spaces in the skull behind the ear. In most cases, it is a condition caused by an ear infection and that spreads to the surrounding bone in the skull. Posterior tympanostomy: opening the facial recess by mastoidectomy to communicate the middle ear with the mastoid. It is a posterior ear cavity surgery. It enables direct access and treatment of the pathological processes located in said cavities, while also giving access to other cavities such as the epitympanum and the eardrum.   How to prepare for microsurgery of the temporal bone Depending on the procedure to be carried out, the specialist will recommend different pre-procedural instructions. A CT scan will be done to get an idea of the depth and type of lesion. Once diagnosed, an otorhinolaryngologist will recommend what steps the patient should take.   Post-operative care Certain precautions will be necessary after surgery because the surgical site is sensitive as it includes the skull and other fragile bones such as the ones that make up the auditory structures. The otorhinolaryngologist will recommend the appropriate post-operative care.   Alternative treatments Progress is being continually made in finding minimally invasive procedures, and the subspecialty of temporal bone surgery is no exception. It is a very delicate area, with many nerve endings and sensitive structures, meaning that the less invasive surgery is, the better. ...

Tinnitus

What is tinnitus? Tinnitus refers to the hearing of noises that are not caused by an external source. Often heard has a ringing or buzzing sound, these may be heard temporarily or chronically. Often, these noises are accentuated when there is absolute silence. Tinnitus is not a condition in itself, but a symptom of an underlying condition. What are the symptoms of tinnitus? In addition to hearing the buzzing, ringing sounds, tinnitus can cause difficulty sleeping and concentrating. As a result, it can sometimes put a strain on someone’s psychological well-being and personal relationships, particularly if it is chronic. What causes tinnitus? Tinnitus is not a disease, but a symptom of other ear pathologies, such as hearing loss. Therefore, the causes that can trigger it are multiple. Common causes include: Hearing loss Exposure to loud noises Blockages (from a build-up of earwax) Meniere’s disease TMJ disorders Head or neck injuries Certain medications (e.g. antibiotics, aspirin and certain antidepressants) High blood pressure and circulatory problems Can tinnitus be prevented? To prevent tinnitus, it is best to keep the ear clean and free of wax. It is also important to avoid caffeine, smoking, alcohol and excessive salt intake. It is also important to avoid noisy environments. People with cardiovascular problems are at a higher risk of developing tinnitus, so ensuring you maintain a healthy blood pressure and eat a healthy diet are important. What is the treatment for tinnitus? Treatment will depend on the underlying cause and treating this is the first step. Often this will involve either removing excessive earwax, changing your medications for other conditions or treating a blood vessel problem. If these do not help, then there are other therapies that can help you overcome the irritation caused by the tinnitus. For example, noise suppression training involves using special devices to suppress noise (e.g. white noise machines, tinnitus retraining devices or masking devices). In addition, managing stress, and removing irritants (e.g. alcohol, caffeine and cigarettes) can help too. ...

Tonsillitis

What is tonsillitis? Tonsillitis is an inflammation of the tonsils that are located at the back of the throat. It is very common in children and adolescents, but adults can suffer from tonsillitis too. What are the symptoms of tonsillitis? If you have tonsillitis, your tonsils will be red and swollen. You will also have a combination of the following symptoms: A sore throat A fever (temperature of 38C or over) A headache Fatigue Nausea Difficulty swallowing Earache White pus-filled spots on the tonsils Swollen glands in the neck What causes tonsillitis? Tonsillitis is caused by a viruses or bacterial infection. Streptococcal tonsillitis is the most common cause. The tonsils are vulnerable to infection because they are one of the body’s first lines of defence in the immune system. Can tonsillitis be prevented? Tonsillitis can be prevented by practising good hygiene: Not sharing eating and drinking utensils. Avoiding contact with those infected. Washing hands frequently. How is tonsillitis treated? If your tonsillitis is caused by a virus, then at-home care is the only treatment for recovery. The following can be used to promote a quicker, more comfortable recovery: Throat lozenges Rest Staying hydrated Avoiding caffeine Gargling with salt water Using painkillers to manage discomfort If your tonsillitis is caused by a bacterial infection, then you will be prescribed a course of antibiotics. These must be taken as instructed, and the full course finished. People who suffer from tonsillitis frequently are advised to have the tonsils removed. If an abscess forms between the tonsils (this is called a quinsy), see a doctor, as this may need to be drained. ...

Tracheostomy

What is a tracheostomy? A tracheostomy involves opening up the trachea, or windpipe, through a surgically made hole. A tracheostomy tube or cannula is placed in the opening so the patient can breathe and so that any lung secretions are removed.       Why would you do it? It tends to be done due to obstruction at the oropharynx, larynx, or upper part of the trachea. It is also done when there is: Prolonged intubation     Aspiration of pulmonary secretions Permanent swallowing deficit     Complex head or neck surgeries             There are different types of tracheostomy according to the cause, it may be an emergency tracheostomy or an elective tracheostomy. These can be temporary or permanent. What does it involve?  A tracheostomy involves making a hole in the trachea to avoid asphyxiation. A 1.5cm wide incision is made in the throat, in front of the trachea, then the trachea is punctured and dilated until a tube can be inserted.     This technique may involve some risks (other than those involved with surgery and anaesthesia) such as damage to the thyroid, trachea erosion, puncture of the lung, and scarring of the trachea that causes pain and difficulty breathing.     How to prepare for it This procedure is normally performed under general anaesthetic, unless the tracheostomy is performed as an emergency, in which case there may not be time. When performed as an emergency, local anaesthetic is used so that the patient does not feel pain, while when it has been planned, the patient will be given a general anaesthetic.   Post-operative care A person with a tracheostomy is advised to take extra care to keep the area clean, and be ready to know how to deal with a partial or total blockage of the cannula. It is recommended that exposure to aerosols or airborne particles be avoided, to prevent them entering the respiratory tract. In temporary tracheostomies, the cannula is removed, but if it is permanent, the hole will remain open.          ...

Turbinate hypertrophy

What is turbinate hypertrophy? Turbinate hypertrophy is a condition affecting the respiratory mucosa. The turbinates, also known as nasal conchae, is a part of the nasal fossa. They are six narrow, curled shelves of bone and connective tissue covered by a mucosa that protrude into the breathing passage of the nose. The turbinates ensure that the air passing through the nose is heated up and humidified. Sometimes they can become inflamed and increase in size. This is what happens when you have turbinate hypertrophy. What are the symptoms of turbinate hypertrophy? Turbinate hypertrophy can cause the following symptoms: A sensation of blocked, obstructed nose; Trouble breathing; Headache; Secretion of mucus from the nose into your throat; Sinusitis; Snoring; Dry, tickly cough; Dry mouth; Impaired sense of smell; Bad breath; Itchy nose; Sleep apnoea; Pain at the base of your nose; Sneezing; Nosebleeds (epistaxis); Nasal or metallic sounding voice (rhinolalia); Hearing loss (hypacousia); A muffled sensation in your ears How is turbinate hypertrophy diagnosed? To confirm a diagnosis of turbinates hypertrophy, you’ll need to go through your medical history with your doctor and do the following exams: Rhinofibrolaryngoscopy; Nasal cytology; Rhinomanometry; Allergy testing What causes turbinate hypertrophy? Some risk factors that may lead to turbinate hypertrophy are: Seasonal or perennial allergic rhinitis; Non-allergic or vasomotor rhinitis; A change in temperature or humidity; Taking certain medications or being on hormone therapy; Frequently recurring common cold; Exposure to certain chemicals; Smoking; Emotional stress How is turbinate hypertrophy treated? The treatments largely depend on the individual case. Your doctor may prescribe you a local treatment based on nasal solutions which can reduce the swelling of the turbinates (in case of a mild to moderate hypertrophy). Should this not be enough, you may consider the option of surgery (middle turbinectomy, inferior turbinates mucotomy or submucosal dissection), consisting in the resection of a part of the mucosa and bones of the turbinates, or you can consider one of the new, non-invasive techniques based on laser or radiofrequency. Which doctor should I talk to? For an accurate diagnosis and treatment of turbinate hypertrophy, you should see an ENT specialist. ...

Tympanometry

Tympanometry is a test to evaluate the functioning of the middle ear and the tympanic membrane. The test involves inserting a device into the outer ear to achieve a tight seal. Then the specialist causes a change in air pressure inside the atrial cavity to check the mobility of the eardrum and to see how the ear reacts to sound and pressure changes. During the test, the patient can hear very loud sound and may notice discomfort because of the probe. The results are plotted on a graph called a tympanogram. This technique is used to detect alterations in the middle ear, tympanic perforation, infectious otitis, tumours, bone diseases affecting the middle ear and birth defects, among others. ...

Vertigo

Vertigo is characterised by a feeling of imbalance arising from the inner ear (vestibular system). When a sudden movement or a rapid change of the position of the head occurs, it can result in vertigo. The most common symptoms is dizziness which can also be caused by diseases or disorders such as arrhytmia or Ménière's disease.   The Vertigo is a sensation of instability of self or spinning objects in the environment, which is accompanied by malaise, fever, nausea, vomiting, loss of balance and feeling faint. It can be temporary or last days, and is usually caused by an alteration of the ear, the ear nerve connection to the brain or the brain itself. Also, the origin of these alterations may be an infection in the ear, lack of blood pressure, medications, skull fractures, brain tumors, pressure changes or loud noises, among others. There are different types of vertigo, classified according to the location of the problem that originates or feelings of the patient, ie if you notice instability of your body or if the environment that is spinning. The treatment involves the administration of drugs, as a function of the underlying cause dizziness, and the realization of a set of physical exercises. ...

Vestibular testing

What is vestibular testing? Vestibular testing is a series of tests that check the functioning of the vestibular (balance) section of the inner ear. The vestibular system and the eyes work together to maintain balance and to maintain clear vision when the head is moving. This is known as the vestibular-ocular reflex (VOR). People who complain of dizziness will often go through vestibular testing. What does vestibular testing involve? Vestibular tests often use special equipment that monitor the eyes for normal and abnormal movements, whilst the vestibular section of the inner ear is stimulated. There are different types of vestibular tests, including: Electronystagmography (ENG) Electrocochleography (ECOG) Rotation tests Video head impulse testing (VHIT) Vestibular evoked myogenic potential (VEMP) Why is vestibular testing done? Vestibular tests check the functioning of the vestibular section of the inner ear. If these tests can confirm its functioning, then symptoms like dizziness can be attributed to other causes, such as neurological disorders, low blood pressure or psychological problems. However, first ruling out inner ear problems can save time on running other costly, time-consuming tests.  Preparation for vestibular testing Patients are advised to wear loose-fitting clothing on the day of testing and to avoid wearing make-up.  Up to 48 hours beforehand the following must be avoided: alcohol nausea or dizziness medication sleeping pills cold-flu remedies over-the-counter pain medication What to expect during vestibular testing ENG: This test measures involuntary eye movement (nystagmus) whilst stimulating the subject’s balance. Eye movements are measured using an infrared video system. ECOG: This test measures the response to sounds from the nervous system. An earphone plays sounds in the ear, whilst an electrode measures the response. Rotation tests: Assesses how the eyes and inner ear are working together. Video goggles or electrodes are used to measure eye movements. This is either carried out through auto-head rotation, computerised rotary chair or a screening test. VHIT: Special glasses with a camera monitor eye movements. Small and quick head movements are evaluated (the vestibulo-ocular reflex). VEMP: Checks if particular vestibular organs and nerves are functioning correctly. Responses are measured from muscles in the neck and around the eyes. Adhesive skin electrodes are used. Sounds are played for a few seconds, and the electrodes record the vestibular response. What do abnormal results mean from vestibular testing? If the vestibular system is found to be functioning fine, then other tests will be carried out to determine the cause of the patient’s dizziness. This may be an MRI, blood pressure test or psychological evaluation. ...

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