The answer to what causes this syndrome is not yet known. No gene defect has yet to be found in PFAPA, although in some cases more than one family member has the disease. No infectious cause has been found in PFAPA, thus it is not a contagious disease. It is clear that the inflammatory process is activated during episodes, but it is not clear why it is triggered.

There are no laboratory tests, or imaging procedures, specific for diagnosing PFAPA. The disease is diagnosed based on the results of a physical examination and other symptoms. Inflammatory blood tests like the white blood cell count, erythrocyte sedimentation rate and the C-reactive protein are increased during attacks. Before the diagnosis is confirmed, it is important to exclude all other diseases that may present with similar symptoms (especially a streptococcal throat). The dramatic response to treatment (see below) also helps diagnose PFAPA.

Beacuse the cause is unknown, there is no specific treatment to cure PFAPA. The aim of treatment is to control symptoms during the episodes of fever. In most children, the disease will resolve by itself without treatment, usually after the age of 10 years. A single dose of steroid (usually prednisone), given when symptoms first appear, has been shown to shorten an episode and sometimes even end the episode. However, the interval between episodes may also be shortened with this treatment, and the next episode may occur earlier than expected. In patients with very frequent attacks, a tonsillectomy (removing the tonsils by surgery) may be considered.

Over time, the intervals between the episodes will increase and usually after the age of 10 years resolve by itself. Children with PFAPA continue to grow and develop normally.

REFERENCES:

1. PFAPA Sendromu: Bir Periyodik Ateş Tablosu, Fırat Tıp Dergisi 2006;11(1): 75-77,

Metehan ÖZEN, Gül YÜCEL, İnönü Üniversitesi Tıp Fakültesi, Malatya

2.http://my.clevelandclinic.org/disorders/periodic_fever_syndrome/rheumatology_overview.aspx

The widespread use of mobile telephones has given rise to concern about the potential influences of electromagnetic fields (EMFs) on human health. Mobile phones emit a pulsed high-frequency electromagnetic (EM) field that may have adverse effects. They transmit and receive microwave radiation at frequencies mainly ranged between 800 and 2000 MHz, which excites rotation of water molecules and some organic molecules, but is non-ionising and so would not be expected to damage DNA. This microwave radiation has been reported to have thermal and non-thermal effects in humans.

Hertz is a unit of frequency (of change in state or cycle in a sound wave, alternating current, or other cyclical waveform) of one cycle per second. For example, in the United States, common house electrical supply is at 60 hertz (meaning the current changes direction 60 cycles per second). Kilohertz (kHz) is 1000 times, Mega Hz (MHz) is 1 milion times, Giga Hz (GHz) is 1 billion times of hertz.

Mobile phone networks operate in one of three bands; 900 MHz, 1800 MHz and 2.2 GHz, using two different technologies, Global System for Mobile Communications (GSM) and Universal Mobile Telecommunication System (UMTS). GSM is the commonest international operating standard for the second generation of digital cellular mobile communications. It enables mobile phones to be used across national boundaries. In the UK this technology operates in the 900 MHz and 1800 MHz frequency bands. UMTS is the next generation (third generation ‘3G’) of mobile phone technology, which is every other day having a widespread usage of video phones and access to multimedia information.

After a press release on 9/12/2007, all of people’s minds were confused about the safety of these devices. According to research presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation’s Annual Meeting & OTO EXPO in Washington, DC, 100 people who had used mobile phones for over a year suffered increases in the degree of hearing loss over the span of 12 months. Furthermore, the study also discovered that people who used their phones for more than 60 minutes a day had a worse hearing threshold than those with less use. The authors warn users of cell phones to look out for ear symptoms such as ear warmth, ear fullness, and ringing in the ears (tinnitus) as early warning signs that you may have an auditory abnormality. They also suggest the use of earphones, which they found to be safer than holding a mobile phone up to the ears.

 So, this article would be about a review of recent researches about the effect of cell phone on the ear and brain.

WHAT IS RADIOFREQUENCY?

Telecom systems – radio, television, wireless telephones, mobile phones, pagers, radars and satellites – emit invisible electromagnetic radiation or radiofrequency (RF). The radiation spectrum includes microwaves (frequencies between 300 MHz and 300 GHZ) and reaches close to infrared radiation. RF is also used daily in microwave ovens and diathermy medical devices (thermoablation); the latter are used in treating cardiac arrhythmias, snoring and sleep apnea, tumors and other conditions.

Biological effects of radiofrequency/microwaves:

RF is a non-ionizing radiation, as opposed to X-rays and gama radiation; it does not, therefore, have enough energy to destabilize electrons or break chemical bonds in DNA.

The effect of RF on living organisms may be didactically divided into the following: 

1) Thermal effects: These are the best known effects. They result from water molecule polarization as electromagnetic waves course through tissues and produce heat (temperature variation over 1^oC). This is the principle behind microwave ovens and medical diathermy devices.Devices that generate RF between 350 and 500 kHz or microwaves over 2 GHz are used for thermoablation surgery. Tissue temperatures reach 50-100oC, resulting in local necrosis and coagulation. Temperatures over 100^oC vaporize and carbonize tissues. 

The power of radio and television transmitters may reach many kilowatts; mobile phone base stations may reach over 100 W. On the other hand, the power of mobile phone handsets and cordless phone base units is very low, respectively around 0.01-2 W and 0.09W. For this reason mobile phones do not cause thermal effects on a user’s organisms. It has been calculated that the temperature in the head increases by not more than 0.11^oC while using a mobile phone, although a feeling of warmth may be felt in the ear during a telephone call.

 2) Non-thermal effects: These take place with no temperature change in biological tissues. These effects have not yet been fully clarified, and are the reason for many debates among scientists.

These effects include electrical force induction and possibly an increase in heat shock protein synthesis in cells. Continuous heat shock protein synthesis, however, may be involved in oncogenesis (cancer formation. No study thus far has demonstrated that exposure to RF without thermal effects produces genetic mutations or chromosomal aberrations in mammal cells, which suggests that RF can not initiate tumors. 

The International Commission on Non-Ionizing Radiation Protection (ICNIRP) formulates and publishes exposure limit guidelines for EMF radiation, based on critical review of the published biological effects and health risks. In the frequency range 10 MHz to 10 GHz, which encompasses mobile phone related EM radiation, near-field models of energy absorption become important. Local (that is anatomical regional) energy absorption can be high and energy density reported as specific absorption rate in units of watts/kilograms (SAR) is the recommended dosiometric measure. Radiowaves transmitted by the most commonly used mobile cellular phones in the UK are within SAR limits set by the ICNIRP, because all makes of modern GSM (Global System for Mobile Communications) mobile phones, emit EMF radiation that results in less than 1 W/kg radiation in the head. Individual national governmental agencies set SAR guidelines, which indicate to the public safe levels of electromagnetic exposure related to electrical appliances.

The National Radiological Protection Board in the United Kingdom guideline recommends a limit of 10 W/kg in the head which is five times the ICNIRP limit. To learn about any cell phone SAR limit you can visit the web site of The Federal Communications Commission (FCC) of USA (http://www.fcc.gov/cgb/sar/). For example, did you ever read the safety information in the manual given with your cell phone? “The …………. device might not come with a holster (body-worn accessory). If you wear the ………….. device on your body, always put the ……………. device in a ……………….device holster equipped with an integrated belt clip supplied or approved by Research In Motion. If you do not use a holster equipped with an integrated belt clip supplied or approved by RIM when you carry the …………….. device, keep the…………………device at least 0.98 in. (25 mm) from your body when the ………………….device is transmitting.” Will you still carry it in your pocket over your heart?

WHAT IS THE EFFECT OF CELL PHONE ON HUMAN BODY?

A number of case-control studies have investigated the relation between mobile phone use and CNS tumors. They are as follows:

Muscat et al. (2000) 17469 cases, 422 controls, Result: No increased risk

Inskip et al. (2001) 18782 cases: 96 acoustic neuromas, 799 controls, Result: No increased risk

Muscat et al. (2002) 1990 acoustic neuromas, 86 controls, Result: No increased risk

Hardell et al. (2003) 201429 cases,1470 controls, use>5 years, Result: Increased risk when using analog handsets, and when using digital handsets for over 5 years

Christensen et al. (2004) 21106 acoustic neuromas, 212 controls, Result: No increased risk

Lönn et al. (2004) 7148 acoustic neuromas, 604 controls, Result: Increased risk when using analog

handsets for 10 years or more.

Hardell et al. (2005) 23413 cases: 84 acoustic neuromas, 692 controls, Result: Increased risk when using analog.

The International Agency for Research on Cancer (IARC) coordinated a feasibility study in 1998 and 1999, which concluded that an international study of the relationship between mobile phone use and brain tumour risk would be feasible and informative. Interphone was therefore initiated in 2000 as an international set of case-control studies in 13 countries around the world focusing on four types of tumours in tissues that most absorb RF energy emitted by mobile phones: tumours of

the brain (glioma and meningioma), of the acoustic nerve (schwannoma), and of the parotid gland. The objective was to determine whether mobile phone use increases the risk of these tumours. Interphone is the largest case control study of mobile phone use and brain tumours yet and includes the largest numbers of users with at least 10 years of exposure.

The Interphone Study Group concluded with the following key message:

A reduced odds ratio (OR) for glioma and meningioma related to ever having been a regular mobile phone user possibly reflects participation bias or other methodological limitations. No elevated OR for glioma or meningioma was observed ≥10 years after first phone use. There were suggestions of an increased risk of glioma, and much less so meningioma, in the highest decile of cumulative call time, in subjects who reported usual phone use on the same side of the head as their tumour and, for glioma, for tumours in the temporal lobe.

But, the majority of subjects in the Interphone Study Group were not heavy mobile phone users by today’s standards. The median lifetime cumulative call time was around 100 hours, with a median of 2 to 2½ hours of reported use per month. The cut-point for the heaviest 10% of users (1640 hours lifetime), spread out over 10 years, corresponds to about a half-hour per day. Today, mobile phone use has become much more prevalent and it is not unusual for young people to use mobile phones for an hour or more a day. This increasing use is tempered, however, by the lower emissions, on average, from newer technology phones, and the increasing use of texting and hands-free operations that keep the phone away from the head.

Professor Elisabeth Cardis (Interphone Principal Investigator) said that “the Interphone study will continue with additional analyses of mobile phone use and tumours of the acoustic nerve and parotid gland.” She added:,”Because of concerns about the rapid increase in mobile phone use in young people − who were not covered by Interphone −, CREAL is co-ordinating a new project,

MobiKids, funded by the European Union, to investigate the risk of brain tumours from mobile phone use in childhood and adolescence.”

IARC has scheduled a comprehensive review of the carcinogenic potential of mobile phone use under the auspices of its Monographs Programme. The review, scheduled for 24-31 May 2011, will consider all published epidemiological and experimental evidence, including the new data from the Interphone study.

RESULT

1. Read the safety information on the instructions manual very carefully and search for the SAR limit of your cell phone.
2. Never carry your cell phone over your body without a holister and don’t use it for chat. Use it if there’s any emergency and the speech should not last long.
3. Don’t let your kids use the cell phone right to their ears or with a bluetooth. They should use it with a handsfree headset if needed. It has been suggested that, using a cell phone with a headset decreases the RF exposure 90% .
4. Don’t use your cell phone while it’s plugged, because there are some cases that the cell phone exploded while the person was speaking.

REFERENCES:

1. http://www.newswise.com/articles/view/533259/
2. http://www.icnirp.de
3. Aracy Pereira Silveira Balbani, Jair Cortez Montovani. Mobile phones: influence on auditory and vestibular systems. Rev Bras Otorrinolaringol 2008;74(1):125-31;
4. Khalil S, Nunez DA. Do mobile ‘phones have a detrimental impact on auditory function? Laryngol Otol. 2006 Oct;120(10):822-6. Epub 2006 May 15.
5. Interphone study reports on mobile phone use and brain cancer risk- IARC press release, 17 May 2010
6. Lönn S, Ahlbom A, Hall P, Feychting M. Mobile phone use and the risk of acoustic neuroma. Epidemiology 2004; 15: 653-9.

Because some hearing problems can be medically corrected, first visit a physician who can refer you to an  otolaryngologist (an ear, nose, and throat specialist ). If you have ear pain, drainage, excess earwax, hearing loss in only one ear, sudden or rapidly progressive hearing loss, or dizziness, it is especially important that you see an otolaryngologist. Then, get a hearing assessment from an audiologist (a nonphysician health care professional). A screening test from a hearing aid dealer may not be adequate. Many otolaryngologists have an audiologist associate in their office who will assess your ability to hear pure tone sounds and to understand words. The results of these tests will show the degree of hearing loss and whether it is conductive or sensorineural and may give other medical information about your ears and your health.

 

• Conductive Hearing Loss

A hearing loss is conductive when there is a problem with the ear canal, the eardrum and/or the three bones connected to the eardrum. Common reasons for this type of hearing loss are a plug of excess wax in the ear canal or fluid behind the eardrum. Medical treatment or surgery may be available for these and more complex forms of conductive hearing loss.  

• Sensorinural Hearing Loss

A hearing loss is sensorineural when it results from damage to the inner ear (cochlea) or auditory nerve, often as a result of the aging process and/or noise exposure. Sounds may be unclear and/or too soft. Sensitivity to loud sounds may occur. Medical or surgical intervention cannot correct most sensorineural hearing losses. However, hearing aids may help you reclaim some sounds that you are missing as a result of nerve deafness. 

  

Styles Of Hearing Aids

There are several styles of hearing aids:  

• Behind-the-ear (BTE) hearing aids are placed over the ear and connected with tubing to custom-fitted earpieces.
• In-the-ear (ITE) hearing aids fill the entire bowl of the ear and part of the ear canal.
• Smaller versions of ITEs are called half-shell and in-the-canal (ITC).
• The least visible aids are completely-in-the-canal (CIC).

Hearing aid options, which are appropriate for your particular hearing loss and listening needs, the size, and shape of your ear and ear canal, and the dexterity of your hands will all be considered in deciding what type of hearing aid is the best for you. Many hearing aids have special telecoil “T” switches to aid in use of the telephone and certain public sound systems. Discuss your need for a T-coil switch while you are considering hearing aid options.

  Will I Need A Hearing Aid For Each Ear?

Usually, if you have hearing loss in both ears, using two hearing aids is best. Listening in a noisy environment is difficult with amplification in one ear only, and it is more difficult to distinguish where sounds are coming from. If, however, the quality of hearing in one ear is very different from the other, one hearing aid may be better than two.What Other Questions Should I Ask?

• Ask about charges for the hearing evaluation, dispensing fee(s), and future servicing and repair.
• Inquire about the trial period policy and what fees are refundable if you return the hearing aid(s) during the trial period.
• Ask about the warranty coverage for your hearing aids and the consumers’ protection program for hearing aid purchasers in your state.

What Will Happen At My Hearing Aid Fitting?

• The hearing aids will be fitted for your ears.
• Then, while wearing your hearing aids, you will be tested for word understanding in quiet and in noise and for improvement in hearing tones.
• Next, you will receive instruction about the care of your hearing aids, the batteries used to power them, a suggested wearing schedule, general expectations, and helpful communication strategies.
• You will also practice properly inserting and removing the hearing aids and batteries.

 How Should I Begin Wearing The Aids?  

• Start using your hearing aids in quiet surroundings, gradually building up to noisier environments.
• Note where and when that you find the hearing aids beneficial.
• Be patient and allow yourself to get used to the aids and the “new” sounds they allow you to hear.
• Keep a diary to help you remember your experiences.
• Report any concerns on a follow-up appointment

(SOURCE: http://www.entnet.org/healthinfo/hearing/hearing_aid.cfm)  

The shape of your nasal cavity could be the cause of chronic sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.

Estimates are that 80 percent of all nasal septums are off-center, a condition that is generally not noticed. A “deviated septum” occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.

Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma.

A deviated septum may cause one or more of the following:

• Blockage of one or both nostrils
• Nasal congestion, sometimes one-sided
• Frequent nosebleeds
• Frequent sinus infections
• At times, facial pain, headaches, postnasal drip
• Noisy breathing during sleep (in infants and young children)

In some cases, a person with a mildly deviated septum has symptoms only when he or she also has a “cold” (an upper respiratory tract infection). In these individuals, the respiratory infection triggers nasal inflammation that temporarily amplifies any mild airflow problems related to the deviated septum. Once the “cold” resolves, and the nasal inflammation subsides, symptoms of a deviated septum often resolve, too.

 Diagnosis Of A Deviated Septum: Patients with chronic sinusitis often have nasal congestion, and many have nasal septal deviations. However, for those with this debilitating condition, there may be additional reasons for the nasal airway obstruction. The problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof. A trained specialist in diagnosing and treating ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal obstruction.

Your First Visit: After discussing your symptoms, the primary care physician or specialist will inquire if you have ever incurred severe trauma to your nose and if you have had previous nasal surgery. Next, an examination of the general appearance of your nose will occur, including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril.

Surgery may be the recommended treatment if the deviated septum is causing troublesome nosebleeds or recurrent sinus infections. Additional testing may be required in some circumstances.

Septoplasty: Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery.

The time required for the operation averages about one to one and a half hours, depending on the deviation. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. After the surgery, nasal packing is inserted to prevent excessive postoperative bleeding. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.

If a deviated nasal septum is the sole cause for your chronic sinusitis, relief from this severe disorder will be achieved.

(SOURCE: http://www.entnet.org/healthinfo/sinus/deviated-septum.cfm )

Forty­-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons and it usually grows worse with age. Snoring sounds are caused when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose.

Only recently have the adverse medical effects of snoring and its association with Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) been recognized. Various methods are used to alleviate snoring and/or OSA. They include behavior modification, sleep positioning, Continuous Positive Airway Pressure (CPAP), Uvulopalatopharyngoplasty (UPPP), and Laser Assisted Uvula Palatoplasty (LAUP), and jaw adjustment techniques.

What Is Continuous Positive Airway Pressure (CPAP)?

Nasal CPAP delivers air into your airway through a specially designed nasal mask or pillows. The mask does not breathe for you; the flow of air creates enough pressure when you inhale to keep your airway open. CPAP is considered the most effective nonsurgical treatment for the alleviation of snoring and obstructive sleep apnea.

If your otolaryngologist determines that the CPAP treatment is right for you, you will be required to wear the nasal mask every night. During this treatment, you may have to undertake a significant change in lifestyle. That change could consist of losing weight, quitting smoking, or adopting a new exercise regimen.

Before the invention of the nasal CPAP, a recommended course of action for a patient with sleep apnea or habitual snoring was a tracheostomy, or creating a temporary opening in the windpipe. The CPAP treatment has been found to be nearly 100 percent effective in eliminating sleep apnea and snoring when used correctly and will eliminate the necessity of a surgical procedure.

So, If I Use A Nasal CPAP I Will Never Need Surgery?

With the exception of some patients with severe nasal obstruction, CPAP has been found to be nearly 100 percent effective, although it does not cure the problem. However, studies have shown that long­term compliance in wearing the nasal CPAP is about 70 percent. Some people have found the device to be claustrophobic or have difficulty using it when traveling. If you find that you cannot wear a nasal CPAP each night, a surgical solution might be necessary. Your otolaryngologist will advise you of the best course of action.

Should You Consider CPAP?

If you have significant sleep apnea, you may be a prime for CPAP. Your otolaryngologist will evaluate you and ask the following questions:

• Do you snore loudly and disturb your family and friends?
• Do you have daytime sleepiness?
• Do you wake up frequently in the middle of the night?
• Do you have frequent episodes of obstructed breathing during sleep?
• Do you have morning headaches or tiredness?

Suitability for CPAP use is determined after a review of your medical history, lifestyle factors (alcohol and tobacco intake as well as exercise), cardiovascular condition, and current medications. You will also receive a physical and otorhinolaryngological (ear, nose, and throat) examination to evaluate your airway.

Before receiving the nasal mask, you would need to have the proper CPAP pressure set during a “sleep study.” This will complete the evaluation necessary for prescribing the appropriate treatment for your needs.

(SOURCE: http://www.entnet.org/healthinfo/snoring/cpap.cfm)

Q. How common is sinusitis?

A. More than 37 million Americans suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade possibly due to increased pollution, urban sprawl, and increased resistance to antibiotics.

Q. What is sinusitis?

A. Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants; chronic sinusitis is characterized by at least four recurrences of acute sinusitis. Either medication or surgery is a possible treatment.

Q. What are the signs and symptoms of acute sinusitis?

A. For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough not due to asthma (in children). Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain, and cough.

Acute sinusitis can last four weeks or more. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection.

Q. How is acute sinusitis treated?

A. Acute sinusitis is generally treated with ten to 14 days of antibiotic care. With treatment, the symptoms disappear, and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms.

Q. What are the signs and symptoms of chronic sinusitis?

A. Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: facial pain/pressure, facial congestion/fullness, nasal obstruction/blockage, thick nasal discharge/discolored post-nasal drainage, pus in the nasal cavity, and at times, fever. They may also have headache, bad breath, and fatigue.

Q. What measures can be taken at home to relieve sinus pain?

A. Warm moist air may alleviate sinus congestion. Experts recommend a vaporizer or steam from a pan of boiled water (removed from the heat). Humidifiers should be used only when a clean filter is in place to preclude spraying bacteria or fungal spores into the air. Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are also helpful in moisturizing nasal passages.

Q. How effective are non-prescription nose drops or sprays?

A. Use of nonprescription drops or sprays might help control symptoms. However, extended use of non-prescription decongestant nasal sprays could aggravate symptoms and should not be used beyond their label recommendation. Saline nasal sprays or drops are safe for continuous use.

Q. How does a physician determine the best treatment for acute or chronic sinusitis?

A. To obtain the best treatment option, the physician needs to properly assess the patient’ s history and symptoms and then progress through a structured physical examination.

Q. What should one expect during the physical examination for sinusitis?

A. At a specialist’ s office, the patient will receive a thorough ear, nose, and throat examination. During that physical examination, the physician will explore the facial features where swelling and erythema (redness of the skin) over the cheekbone exist. Facial swelling and redness are generally worse in the morning; as the patient remains upright, the symptoms gradually improve. The physician may feel and press the sinuses for tenderness. Additionally, the physician may tap the teeth to help identify an inflamed paranasal sinus.

Q. What other diagnostic procedures might be taken?

A. Other diagnostic tests may include a study of a mucous culture, endoscopy, x-rays, allergy testing, or CT scan of the sinuses.

Q. What is nasal endoscopy?

A. An endoscope is a special fiber optic instrument for the examination of the interior of a canal or hollow viscus. It allows a visual examination of the nose and sinus drainage areas.

Q. Why does an ear, nose, and throat specialist perform nasal endoscopy?

A. Nasal endoscopy offers the physician specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. First, the patient’ s nasal cavity is anesthetized; a rigid or flexible endoscope is then placed in a position to view the nasal cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the physician specialist also looks for pus as well as polyp formation and structural abnormalities that may cause recurrent sinusitis.

Q. What course of treatment will the physician recommend?

A. To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral decongestants. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). Antihistamines may be recommended for the treatment of allergies.

Q. Will any changes in lifestyle be suggested during treatment?

A. Smoking is never condoned, but if one has the habit, it is important to refrain during treatment for sinus problems. A special diet is not required, but drinking extra fluids helps to thin mucus.

Q. When is sinus surgery necessary?

A. Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell). Inflammation from allergy causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus surgery can correct the problem.

Q. What does the surgical procedure entail?

A. The basic endoscopic surgical procedure is performed under local or general anesthesia. The patient returns to normal activities within four days; full recovery takes about four weeks.

Q. What does sinus surgery accomplish?

A. The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in place as possible. Otolaryngologist–head and neck surgeons have found endoscopic surgery to be highly effective in restoring normal function to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus.

Q. What are the consequences of not treating infected sinuses?

A. Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and infection of the bone or bone marrow can occur.

Q. Where should sinus pain sufferers seek treatment?

A. If you suffer from severe sinus pain, you should seek treatment from an otolaryngologist–head and neck surgeon, a specialist who can treat your condition with medical and/or surgical remedies.

(SOURCE: http://www.entnet.org/healthinfo/sinus/sinus_questions.cfm)

 

Insight Into Causes, Treatment, And Prevention 

Forty-five million Americans suffer from a recurring problem called allergy. Allergic rhinitis was once known as hay fever because workers would sneeze and develop nasal and sinus congestion when they worked around hay in the fields. Hay fever, asthma, and eczema are the most common symptoms of an allergic reaction.

Allergy symptoms appear when the body’s immune system begins to respond to a substance as though it were a dangerous invader (called an antigen or allergen). It does this by sending specific defenders called antibodies to the entry site. The battle between allergen and antibody results in a release of chemical mediators, such as histamine, into the bloodstream. Those chemical mediators cause changes in the body, which produce the symptoms that we feel.

Symptoms that may be caused by allergy are itching eyes, sneezing, nasal stuffiness, nasal congestion and drainage, and sometimes headache. Some people experience hearing changes, scratchy sore throats, hoarseness, and cough. Other less common symptoms include balance disturbances, swelling in face or throat tissues, skin irritations, and even respiratory problems and asthma.

Some allergy sufferers experience symptoms all year. Others find certain seasons bring on attacks. Allergy symptom control is most successful when multiple management approaches are used simultaneously. Minimizing exposure to allergens, managing symptoms with medications, and desensitization with allergy shots are all methods that can be useful in controlling allergic symptoms.

Medications properly used can be very helpful. Over the counter drugs can be beneficial, but some cause drowsiness. Sometimes prescription medications offer the best chance for good control.

Immunotherapy, or allergy shots, provide the only treatment method that can offer lasting relief or cure from allergies. Before beginning a series of such shots, allergy testing must be performed.

Beware Of The Allergens

Anything can be an allergen. Some substances, because of their chemical make-up, are more prone to generate an allergic response in humans. Pollens, food, mold, dust, feathers, animal dander, chemicals, drugs such as penicillin, and environmental pollutants commonly cause many to suffer allergic reactions.

Hay fever is caused by pollens. The most significant cause of hay fever in the United States is ragweed. It begins pollinating in late August and continues until the first frost. Late springtime pollens come from the grasses, i.e., timothy, orchard, red top, sweet vernal, Bermuda, Johnson, and some bluegrasses. Early springtime hay fever is most often caused by pollens of trees such as elm, maple, birch, poplar, beech, ash, oak, walnut, sycamore, cypress, hickory, pecan, cottonwood, and alder.

Certain allergens are always present. These include house dust, household pet danders, foods, wool, various chemicals used around the house, and more. Symptoms from these are frequently worse in the winter when the house is closed up. Mold spores cause at least as many allergy problems as pollens.

Molds are present all year long, and grow outdoors and indoors. Dead leaves and farm areas are common sources for outdoor molds. Indoor plants, old books, bathrooms, and damp areas are common sources of indoor mold growth. Molds are also common in foods, such as cheese and fermented beverages.

Colorful or fragrant flowering plants rarely cause allergy because their pollens are too heavy to be airborne.

Can Allergies Be Serious?

Allergies are rarely life threatening, but often cause lost workdays, decreased work efficiency, poor school performance, and less enjoyment of life. It is common for allergy sufferers to develop sinus or respiratory infections if allergy symptoms are not controlled. Considering the millions spent in anti-allergy medications and the cost of lost work time, allergies cannot be considered a minor problem.

  Treatment And Prevention

A number of medications are useful in the treatment of allergy including antihistamine, nasal decongestant sprays, steroid sprays, and saline sprays. The medical management of allergy also includes counseling in proper environmental control. Based on a detailed history and thorough examination, your doctor may advise testing to determine the specific substances to which you are allergic.

Medicines, Symptoms and Possible Side Effects:

Antihistamine: For sneezing, runny nose, stuffy nose, itchy eyes, congestion. Possible side effects are drowsiness, dry mouth and nose

Decongestants: For stuffy nose, congestion. Possible side effects are stimulation, insomnia, rapid heart beat
The treatments employed by your otolaryngologists will depend on the materials to which you are allergic and the degree of your sensitivity to them. The only “cure” available for inhalant allergy is the administration of injections that build up protective antibodies to specific allergens (pollens, molds, animal danders, dust, etc.). Your physician will oversee your progress and care for any other nasal and sinus disorders that may contribute to your symptoms.

Tips for Controlling Your Environment:

(SOURCE: http://www.entnet.org/healthinfo/allergies/allergies_hayfever.cfm)

Approximately two to four of every 1,000 children in the United States are born deaf or hard-of-hearing, making hearing loss the most common birth disorder. Many studies have shown that early diagnosis of hearing loss is crucial to the development of speech, language, cognitive, and psychosocial abilities. Treatment is most successful if hearing loss is identified early, preferably within the first month of life. Still, one in every four children born with serious hearing loss does not receive a diagnosis until age three or older. 

When Should A Child’s Hearing Be Tested?

The first opportunity to test a child’s hearing is in the hospital shortly after birth. If your child’s hearing is not screened before leaving the hospital, it is recommended that screening be done within the first month of life. Should test results indicate a possible hearing loss, seek further evaluation as soon as possible; preferably within the first three to six months of life.

Is Early Hearing Screening Mandatory?

In recent years, health organizations across the country, including the AmericanAcademy of Otolaryngology – Head and Neck Surgery, have worked to highlight the importance of screening all newborns for hearing loss. These efforts are working. In 2003, more than 85 percent of all newborns in the United States were screened for hearing loss.  In fact, some 39 states have passed legislation requiring some form of hearing screening of newborns before they leave the hospital. This still leaves more than a million babies who are not screened for hearing loss before leaving the hospital.

How Is Screening Done?

Two tests are used to screen infants and newborns for hearing loss. They are:

Otoacoustic emissions (OAE)involves placement of a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable “echo” should be produced when sound is emitted through the earphone. If no echo is measured, it could indicate a hearing loss.

Auditory brain stem response (ABR) is a more complex test. Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child’s brain responds to the sound.    

If either test indicates a potential hearing loss, your physician may suggest a follow-up evaluation by an otolaryngologist.

Signs Of Hearing Loss In Children

Hearing loss can also occur later childhood, after a newborn leaves the hospital. In these cases, parents, grandparents, and other caregivers are often the first to notice that something may be wrong with a young child’s hearing. Even if your child’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss including:

• Not reacting in any way to unexpected loud noises,
• Not being awakened by loud noises,
• Not turning his/her head in the direction of your voice, 
• Not being able to follow or understand directions,
• Poor language development, or
• Speaking loudly or not using age-appropriate language skills.

If your child exhibits any of these signs, report them to your doctor.

What Happens If My Child Has A Hearing Loss?

Hearing loss in children can be temporary or permanent. It is important to have hearing loss evaluated by a physician who can rule out medical problems that may be causing the hearing loss, such as otitis media (ear infection), excessive earwax congenital malformations, or a genetic hearing loss.

If it is determined that your child’s hearing loss is permanent, hearing aids may be recommended to amplify the sound reaching your child’s ear. Ear surgery may be able to restore or significantly improve hearing in some instances. For those with certain types of profound hearing loss who do not benefit sufficiently from hearing aids, a cochlear implant may be considered. Unlike a hearing aid, a cochlear implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve and allows the child to hear louder and clearer sound.

You will need to decide whether or not your deaf child will communicate primarily with oral speech and/or sign language, and seek early intervention to prevent language delays. Research indicates that habilitation of hearing loss by age six months will prevent subsequent language delays. Other communication strategies such as auditory verbal therapy, lip reading, and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently.

(SOURCE: http://www.entnet.org/healthinfo/hearing/hearing_screening.cfm)

 For 2007, the American Cancer Society estimates there were over 11,000 new cases of larynx cancer in the United States, and more than 3,500 deaths. Even for disease survivors, the consequences of laryngeal cancer are often severe.Laryngeal cancer is a preventable disease because the risk factors are associated with modifiable behaviors.

The Causes Of Laryngeal Cancer

Development of this deadly disease is a process which involves many factors, but approximately 90 percent of head and neck cancers occur after exposure to known carcinogens (cancer causing substances) causing a type of the disease called squamous cell carcinoma (SCCA).

Smoking:More than 95 percent with laryngeal SCCA are smokers.Smoking contributes to cancer by causing mutations or changes in genes, impairing clearance of carcinogens from the respiratory tract, and decreasing the body’s immune response.Tobacco use is measured in pack-years, where one pack per day for one year is one pack-year (or one pack per day for two years, or two packs per day for one year, equals two pack-years).Depending upon the number of pack-years smoked, studies have reported that smokers are about five to 35 times more likely to develop laryngeal cancer than nonsmokers.Other research findings indicate that the duration of tobacco exposure is probably more important overall to the cancer causing effect than the intensity of the exposure.

Alcohol:This acts as a promoter of the cancer causing process making it another important risk factor for laryngeal cancer. The major clinical significance of alcohol is that it enhances the harmful effects of tobacco at a magnitude that is more than just additive.Essentially, people who smoke and drink alcohol have a combined risk that is greater than the sum of the individual risks.The American Cancer Society recommends that those who drink alcoholic beverages should limit the amount, and one drink per day is considered a limited alcohol exposure.

Other Risk Factors:Certain viruses, such as human papilloma virus (HPV), acid reflux, and occupational exposure to asbestos likely contribute to causing laryngeal cancer.Vitamin A and beta-carotene may play a protective role in the disease process.

Signs And Symptoms Of Laryngeal Cancer Include:

Progressive or persistent hoarseness

Anyone with these signs or symptoms, and having risks for laryngeal cancer, should be evaluated by an otolaryngologist (ear, nose, and throat specialist).The primary treatment options include surgery, radiation therapy, chemotherapy, or a combination of these treatments.

Remember that this is a preventable disease in the vast majority of cases, because the main risk factors are associated with modifiable behaviors.Do not smoke and do not abuse alcohol.

Hoarseness or roughness in your voice is often caused by a medical problem.Contact an otolaryngologist-head and neck surgeon if you have any sustained changes to your voice.

(SOURCE: http://www.entnet.org/healthinfo/throat/Throat_Cancer.cfm)

Secondhand smoke is a combination of the smoke from a burning cigarette and the smoke exhaled by the smoker. Also known as environmental tobacco smoke (ETS), it can be recognized easily by its distinctive odor. ETS contaminates the air and is retained in clothing, curtains and furniture. Many people find ETS unpleasant, annoying, and irritating to the eyes and nose. More importantly, it represents a dangerous health hazard. Over 4,000 different chemicals have been identified in ETS, and at least 43 of these chemicals cause cancer.

Is Exposure to Environmental Tobacco Smoke Common?

Approximately 26% of adults in the United States currently smoke cigarettes, and 50 to 67% of children under five years of age live in homes with at least one adult smoker.

Who Is At Risk For Secondhand Smoke?

Although ETS is dangerous to everyone, fetuses, infants and children are at most risk. This is because ETS can damage developing organs, such as the lungs and brain.

Secondhand Smoke And Its Effect On…

The fetus and newborn: Maternal, fetal, and placental blood flow change when pregnant women smoke, although the long-term health effects of these changes are not known. Some studies suggest that smoking during pregnancy causes birth defects such as cleft lip or palate. Smoking mothers produce less milk, and their babies have a lower birth weight. Maternal smoking also is associated with neonatal death from Sudden Infant Death Syndrome, the major cause of death in infants between one month and one year of age.

Children’s lungs and respiratory tracts: Exposure to ETS decreases lung efficiency and impairs lung function in children of all ages. It increases both the frequency and severity of childhood asthma. Secondhand smoke can aggravate sinusitis, rhinitis, cystic fibrosis, and chronic respiratory problems such as cough and postnasal drip. It also increases the number of children’s colds and sore throats. In children under two years of age, ETS exposure increases the likelihood of bronchitis and pneumonia. In fact, a 1992 study by the Environmental Protection Agency says ETS causes 150,000 to 300,000 lower respiratory tract infections each year in infants and children under 18 months of age. These illnesses result in as many as 15,000 hospitalizations. Children of parents who smoke half a pack a day or more are at nearly double the risk of hospitalization for a respiratory illness.

The Ears: Exposure to ETS increases both the number of ear infections a child will experience, and the duration of the illness. Inhaled smoke irritates the eustachian tube, which connects the back of the nose with the middle ear. This causes swelling and obstruction which interferes with pressure equalization in the middle ear, leading to pain, fluid and infection. Ear infections are the most common cause of children’s hearing loss. When they do not respond to medical treatment, the surgical insertion of tubes into the ears is often required.

The Brain: Children of mothers who smoked during pregnancy are more likely to suffer behavioral problems such as hyperactivity than children of non-smoking mothers. Modest impairment in school performance and intellectual achievement have also been demonstrated.

Secondhand Smoke Causes Cancer

You have just read how ETS harms the development of your child, but did you know that your risk of developing cancer from ETS is about 100 times greater than from outdoor cancer-causing pollutants? Did you know that ETS causes more than 3,000 non-smokers to die of lung cancer each year? While these facts are quite alarming for everyone, you can stop your child’s exposure to secondhand smoke right now.

What Can You Do To Avoid Secondhand Smoke?

1. Stop smoking, if you do smoke. Consult your physician for help, if needed. There are many new pharmaceutical products available to help you quit.
2. If you have household members who smoke, help them stop. If it is not possible to stop their smoking, ask them, and visitors, to smoke outside of your home.
3. Do not allow smoking in your car.
4. Be certain that your children’s schools and day care facilities are smoke free.

Acknowledgment is made to the American Academy of Pediatric Otolaryngology for contributions to this content

(SOURCE: http://www.entnet.org/healthinfo/tobacco/secondhand_smoke.cfm)

Insight Into Tonsillectomy and Adenoidectomy

Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or “glands” found in the neck, groin, and armpits. Tonsils are the two masses on the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments.

Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. They “sample” bacteria and viruses and can become infected themselves. Scientists believe they work as part of the body’s immune system by filtering germs that attempt to invade the body, and that they help to develop antibodies to germs.

This happens primarily during the first few years of life, becoming less important as we get older. Children who must have their tonsils and adenoids removed suffer no loss in their resistance.

What Affects Tonsils And Adenoids?

The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing and swallowing problems.

Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. Tumors are rare, but can grow on the tonsils.

When Should I See My Doctor?

You should see your doctor when you or your child suffer the common symptoms of infected or enlarged tonsils or adenoids.

The Exam

The primary methods used to check tonsils and adenoids are:

• Medical history
• Physical examination
• Throat cultures/Strep tests
• X-rays
• Blood tests

What Should I Expect At the Exam?

Your physician will ask about problems of the ear, nose, and throat and examine the head and neck. He or she will use a small mirror or a flexible lighted instrument to see these areas.

Cultures/strep tests are important in diagnosing certain infections in the throat, especially “strep” throat.

X-rays are sometimes helpful in determining the size and shape of the adenoids. Blood tests can determine problems such as mononucleosis.

How Are Tonsil And Adenoid Diseases Treated?

Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Sometimes, removal of the tonsils and/or adenoids may be recommended. The two primary reasons for tonsil and/or adenoid removal are (1) recurrent infection despite antibiotic therapy and (2) difficulty breathing due to enlarged tonsils and/or adenoids.

Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children. Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes malformations of the face and improper alignment of the teeth.

Chronic infection can affect other areas such as the eustachian tube – the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and potential hearing loss.

Recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).

In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids.

In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., cortisone) is sometimes helpful.

Tonsillitis And Its Symptoms

Tonsillitis is an infection in one or both tonsils. One sign is swelling of the tonsils. Other signs or symptoms are:

• Redder than normal tonsils
• A white or yellow coating on the tonsils
• A slight voice change due to swelling
• Sore throat
• Uncomfortable or painful swallowing
• Swollen lymph nodes (glands) in the neck
• Fever
• Bad breath

Enlarged Adenoids And Their Symptoms

If you or your child’s adenoids are enlarged, it may be hard to breathe through the nose.

Other signs of constant enlargement are:

• Breathing through the mouth instead of the nose most of the time
• Nose sounds “blocked” when the person speaks
• Noisy breathing during the day
• Recurrent ear infections
• Snoring at night
• Breathing stops for a few seconds at night during snoring or loud breathing (sleep apnea)

Surgery For Tonsils and Adenoids

Your child: Talk to your child about his/her feelings and provide strong reassurance and support throughout the process. Encourage the idea that the procedure will make him/her healthier. Be with your child as much as possible before and after the surgery. Tell him/her to expect a sore throat after surgery. Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward. If your child has a friend who has had this surgery, it may be helpful to talk about it with that friend.

Adults and children: For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome).

• If the patient or patient’s family has had any problems with anesthesia, the surgeon should be informed. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed.
• A blood test and possibly a urine test may be required prior to surgery.
• Generally, after midnight prior to the operation, nothing (chewing gum, mouthwashes, throat lozenges, toothpaste, water) may be taken by mouth. Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous.

When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.

After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient until discharged. Every patient is special, and recovery times vary for each individual. Many patients are released after 2-10 hours. Others are kept overnight. Intensive care may be needed for select cases.

Your ENT specialist will provide you with the details of pre-operative and postoperative care and answer any questions you may have.

After Surgery

There are several postoperative symptoms that may arise. These include (but are not limited to) swallowing problems, vomiting, fever, throat pain, and ear pain. Occasionally, bleeding may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately.

Any questions or concerns you have should be discussed openly with your surgeon, who is there to assist you

(SOURCE: http://www.entnet.org/healthinfo/throat/tonsils.cfm)

You may not have heard of it, but you use it hundreds of times every day. It is the Temporo-Mandibular Joint (TMJ), the joint where the mandible (the lower jaw) joins the temporal bone of the skull, immediately in front of the ear on each side of your head. A small disc of cartilage separates the bones, much like in the knee joint, so that the mandible may slide easily; each time you chew you move it. But you also move it every time you talk and each time you swallow (every three minutes or so). It is, therefore, one of the most frequently used of all joints of the body and one of the most complex.

You can locate this joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way and shut it. The motion you feel is the TMJ. You can also feel the joint motion in your ear canal.

These maneuvers can cause considerable discomfort to a patient who is having TMJ trouble, and physicians use these maneuvers with patients for diagnosis.

How Does TMJ Work?

When you bite down hard, you put force on the object between your teeth and on the joint. In terms of physics, the jaw is the lever and the TMJ is the fulcrum. Actually, more force is applied (per square foot) to the joint surface than to whatever is between your teeth. To accommodate such forces and to prevent too much wear and tear, the cartilage between the mandible and skull normally provides a smooth surface, over which the joint can freely slide with minimal friction.

Therefore, the forces of chewing can be distributed over a wider surface in the joint space and minimize the risk of injury. In addition, several muscles contribute to opening and closing the jaw and aid in the function of the TMJ.

Symptoms:

• Ear pain
• Sore jaw muscles
• Temple/cheek pain
• Jaw popping/clicking
• Locking of the jaw
• Difficulty in opening the mouth fully
• Frequent head/neck aches

How Does TMJ Dysfunction Feel?

The pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew, or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head (the temple), the cheek, the lower jaw, and the teeth.

A very common focus of pain is in the ear. Many patients come to the ear specialist quite convinced their pain is from an ear infection. When the earache is not associated with a hearing loss and the eardrum looks normal, the doctor will consider the possibility that the pain comes from a TMJ dysfunction.

There are a few other symptoms besides pain that TMJ dysfunction can cause. It can make popping, clicking, or grinding sounds when the jaws are opened widely. Or the jaw locks wide open (dislocated). At the other extreme, TMJ dysfunction can prevent the jaws from fully opening. Some people get ringing in their ears from TMJ trouble.

How Can Things Go Wrong with TMJ?

In most patients, pain associated with the TMJ is a result of displacement of the cartilage disc that causes pressure and stretching of the associated sensory nerves. The popping or clicking occurs when the disk snaps into place when the jaw moves. In addition, the chewing muscles may spasm, not function efficiently, and cause pain and tenderness.

Both major and minor trauma to the jaw can significantly contribute to the development of TMJ problems. If you habitually clench, grit, or grind your teeth, you increase the wear on the cartilage lining of the joint, and it doesn’t have a chance to recover. Many persons are unaware that they grind their teeth, unless someone tells them so.

Chewing gum much of the day can cause similar problems. Stress and other psychological factors have also been implicated as contributory factors to TMJ dysfunction. Other causes include teeth that do not fit together properly (improper bite), malpositioned jaws, and arthritis. In certain cases, chronic malposition of the cartilage disc and persistent wear in the cartilage lining of the joint space can cause further damage.

What Can Be Done for TMJ?

Because TMJ symptoms often develop in the head and neck, otolaryngologists are appropriately qualified to diagnose TMJ problems. Proper diagnosis of TMJ begins with a detailed history and physical, including careful assessment of the teeth occlusion and function of the jaw joints and muscles. If the doctor diagnoses your case early, it will probably respond to these simple, self-remedies:

• Rest the muscles and joints by eating soft foods.
• Do not chew gum.
• Avoid clenching or tensing.
• Relax muscles with moist heat (1/2 hour at least twice daily).

In cases of joint injury, ice packs applied soon after the injury can help reduce swelling. Relaxation techniques and stress reduction, patient education, non-steroidal anti-inflammatory drugs, muscle relaxants or other medications may be indicated in a dose your doctor recommends.

Other therapies may include fabrication of an occlusal splint to prevent wear and tear on the joint. Improving the alignment of the upper and lower teeth and surgical options are available for advanced cases. After diagnosis, your otolaryngologist may suggest further consultation with your dentist and oral surgeon to facilitate effective management of TMJ dysfunction.

(SOURCE: http://www.entnet.org/healthinfo/topics/tmj.cfm)

Sore throat is a symptom of many medical disorders. Infections cause the majority of sore throats and are contagious. Infections are caused either by viruses such as the flu, the common cold, mononucleosis, or by bacteria such as strep, mycoplasma, or hemophilus.

While bacteria respond to antibiotic treatment, viruses do not.

Viruses: Most viral sore throats accompany flu or colds along with a stuffy, runny nose, sneezing, and generalized aches and pains. These viruses are highly contagious and spread quickly, especially in winter. The body builds antibodies that destroy the virus, a process that takes about a week.

Sore throats accompany other viral infections such as measles, chicken pox, whooping cough, and croup. Canker sores and fever blisters in the throat also can be very painful.

One viral infection takes much longer than a week to be cured: infectious mononucleosis, or “mono.” This virus lodges in the lymph system, causing massive enlargement of the tonsils, with white patches on their surface and swollen glands in the neck, armpits, and groin. It creates a severely sore throat and, sometimes, serious breathing difficulties. It can affect the liver, leading to jaundice- yellow skin and eyes. It also causes extreme fatigue that can last six weeks or more.

“Mono,” a severe illness in teenagers but less severe in children, can he transmitted by saliva. So it has been nicknamed the “kissing disease,” but it can also be transmitted from mouth-to-hand to hand-to-mouth or by sharing of towels and eating utensils.

Bacteria: Strep throat is an infection caused by a particular strain of streptococcus bacteria. This infection can also damage the heart valves (rheumatic fever) and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections.

Because of these possible complications, a strep throat should be treated with an antibiotic. Strep is not always easy to detect by examination, and a throat culture may be needed. These tests, when positive, persuade the physician to prescribe antibiotics. However, strep tests might not detect other bacteria that also can cause severe sore throats that deserve antibiotic treatment. For example, severe and chronic cases of tonsillitis or tonsillar abscess may be culture negative. Similarly, negative cultures are seen with diphtheria, and infections from oral sexual contacts will escape detection by strep culture tests.

Tonsillitis is an infection of the lumpy tissues on each side of the back of the throat. In the first two to three years of childhood, these tissues “catch” infections, sampling the child’s environment to help develop his immunities (antibodies). Healthy tonsils do not remain infected. Frequent sore throats from tonsillitis suggest the infection is not fully eliminated between episodes. A medical study has shown that children who suffer from frequent episodes of tonsillitis (such as three- to four- times each year for several years) were healthier after their tonsils were surgically removed.

Infections in the nose and sinuses also can cause sore throats, because mucus from the nose drains down into the throat and carries the infection with it.

The most dangerous throat infection is epiglottitis, caused by bacteria that infect a portion of the larynx (voice box) and cause swelling that closes the airway. This infection is an emergency condition that requires prompt medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult. A strep test may miss this infection.

Allergy: The same pollens and molds that irritate the nose when they are inhaled also may irritate the throat. Cat and dog danders and house dust are common causes of sore throats for people with allergies to them.

Irritation: During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need examination and treatment of the nose.

Pollutants and chemicals in the air can irritate the nose and throat, but the most common air pollutant is tobacco smoke. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods.

A person who strains his or her voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain but also from the rough treatment of his or her throat membranes.

Reflux: An occasional cause of morning sore throat is regurgitation of stomach acids up into the back of the throat. To avoid reflux, tilt your bedframe so that the head is elevated four- to six-inches higher than the foot of the bed. You might find antacids helpful. You should also avoid eating within three hours of bedtime, and eliminate caffeine and alcohol. If these tips fail, see your doctor.

Tumors: Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long-time use of tobacco and alcohol. Sore throat and difficulty swallowing, sometimes with pain radiating to the ear, may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Other important symptoms include hoarseness, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.

When Should I See a Doctor For A Sore Throat?

Whenever a sore throat is severe, persists longer than the usual five- to seven- day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your physician:

• Severe and prolonged sore throat
• Difficulty breathing
• Difficulty swallowing
• Difficulty opening the mouth
• Joint pain
• Earache
• Rash
• Fever (over 101°)
• Blood in saliva or phlegm
• Frequently recurring sore throat
• Lump in neck
• Hoarseness lasting over two weeks

When Should I Take Antibiotics For A Sore Throat?

Antibiotics are drugs that kill or impair bacteria. Penicillin or erythromycin (well-known antibiotics) are prescribed when the physician suspects streptococcal or another bacterial infection that responds to them. However, a number of bacterial throat infections require other antibiotics instead. Antibiotics do not cure viral infections, but viruses do lower the patient’s resistance to bacterial infections. When such a combined infection occurs, antibiotics may be recommended. When an antibiotic is prescribed, it should be taken as the physician directs for the full course (usually 10 days). Otherwise the infection will probably be suppressed rather than eliminated, and it can return. Some children will experience recurrent infection despite antibiotic treatment. When some of these are strep infections or are severe, your child may require a tonsillectomy.

Should Other Family Members be Treated or Cultured?

When a strep test is positive, many experts recommend treatment or culturing of other family members. Practice good sanitary habits; avoid close physical contact; and sharing of napkins, towels, and utensils with the infected person. Handwashing makes good sense.

What If My Throat Culture Is Negative?

A strep culture tests only for the presence of streptococcal infections. Many other infections, both bacterial and viral, will yield negative cultures and sometimes so does a streptococcal infection. Therefore, when your culture is negative, your physician will base his/her decision for treatment on the severity of your symptoms and the appearance of your throat on examination.

How Can I Treat My Sore Throat?

A mild sore throat associated with cold or flu symptoms can be made more comfortable with the following remedies:

• Increase your liquid intake.
• Warm tea with honey is a favorite home remedy.
• Use a steamer or humidifier in your bedroom.
• Gargle with warm salt water several times daily: ¼ tsp. salt to ½ cup water.
• Take over-the-counter pain relievers such as acetaminophen (Tylenol Sore Throat®, Tempra®) or ibuprofen (Motrin IB®, Advil®).

(SOURCE: http://www.entnet.org/healthinfo/throat/sore_throat.cfm)

Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age.

More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. Some are variations on the old idea of sewing a sock that holds a tennis ball on the pajama back to force the snorer to sleep on his side. (Snoring is often worse when a person sleeps on his back). Some devices reposition the lower jaw forward; some open nasal air passages; a few others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs. But, if you snore, the truth is that it is not under your control whatsoever. If anti-snoring devices work, it is probably because they keep you awake.

What Causes Snoring?

The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway (see illustration) where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.

People who snore may suffer from:

• Poor muscle tone in the tongue and throat. When muscles are too relaxed, either from alcohol or drugs that cause sleepiness, the tongue falls backwards into the airway or the throat muscles draw in from the sides into the airway. This can also happen during deep sleep.
• Excessive bulkiness of throat tissue. Children with large tonsils and adenoids often snore. Overweight people have bulky neck tissue, too. Cysts or tumors can also cause bulk, but they are rare.
• Long soft palate and/or uvula. A long palate narrows the opening from the nose into the throat. As it dangles, it acts as a noisy flutter valve during relaxed breathing. A long uvula makes matters even worse.
• Obstructed nasal airways. A stuffy or blocked nose requires extra effort to pull air through it. This creates an exaggerated vacuum in the throat, and pulls together the floppy tissues of the throat, and snoring results. So, snoring often occurs only during the hay fever season or with a cold or sinus infection.

Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.

Is Snoring Serious?

Socially, yes! It can be, when it makes the snorer an object of ridicule and causes others sleepless nights and resentfulness.

Medically, yes! It disturbs sleeping patterns and deprives the snorer of appropriate rest. When snoring is severe, it can cause serious, long-term health problems, including obstructive sleep apnea.

Obstructive Sleep Apnea

When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea. Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder.

The immediate effect of sleep apnea is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur.

Can Heavy Snoring be Cured?

Heavy snorers, those who snore in any position or are disruptive to the family, should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is and what effects it has on the snorer’s health.

Snoring Treatment

Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal allergy, infection, deformity, or tonsils and adenoids.

Snoring or obstructive sleep apnea may respond to various treatments now offered by many otolaryngologist-head and neck surgeons:

• Uvulopalatopharyngoplasty (UPPP) is surgery for treating obstructive sleep apnea. It tightens flabby tissues in the throat and palate, and expands air passages.
• Thermal Ablation Palatoplasty (TAP) refers to procedures and techniques that treat snoring and some of them also are used to treat various severities of obstructive sleep apnea. Different types of TAP include bipolar cautery, laser, and radiofrequency. Laser Assisted Uvula Palatoplasty (LAUP) treats snoring and mild obstructive sleep apnea by removing the obstruction in the airway. A laser is used to vaporize the uvula and a specified portion of the palate in a series of small procedures in a doctor’s office under local anesthesia. Radiofrequency ablation-some with temperature control approved by the FDA-utilizes a needle electrode to emit energy to shrink excess tissue to the upper airway including the palate and uvula (for snoring), base of the tongue (for obstructive sleep apnea), and nasal turbinates (for chronic nasal obstruction).
• Genioglossus and hyod advancement is a surgical procedure for the treatment of sleep apnea. It prevents collapse of the lower throat and pulls the tongue muscles forward, thereby opening the obstructed airway.

If surgery is too risky or unwanted, the patient may sleep every night with a nasal mask that delivers air pressure into the throat; this is called continuous positive airway pressure or “CPAP“.

A chronically snoring child should be examined for problems with his or her tonsils and adenoids. A tonsillectomy and adenoidectomy may be required to return the child to full health.

Self-Help for the Light Snorer

Adults who suffer from mild or occasional snoring should try the following self-help remedies:

• Adopt a healthy and athletic lifestyle to develop good muscle tone and lose weight.
• Avoid tranquilizers, sleeping pills, and antihistamines before bedtime.
• Avoid alcohol for at least four hours and heavy meals or snacks for three hours before retiring.
• Establish regular sleeping patterns
• Sleep on your side rather than your back.
• Tilt the head of your bed upwards four inches.

Remember, snoring means obstructed breathing, and obstruction can be serious. It’s not funny, and not hopeless.

(SOURCE: http://www.entnet.org/healthinfo/snoring/snoring.cfm)

Gastroesophageal reflux, often referred to as GERD, occurs when acid from the stomach backs up into the esophagus. Normally, food travels from the mouth, down through the esophagus and into the stomach. A ring of muscle at the bottom of the esophagus, the lower esophageal sphincter (LES), contracts to keep the acidic contents of the stomach from “refluxing” or coming back up into the esophagus. In those who have GERD, the LES does not close properly, allowing acid to move up the esophagus.

When stomach acid touches the sensitive tissue lining the esophagus and throat, it causes a reaction similar to squirting lemon juice in your eye. This is why GERD is often characterized by the burning sensation known as heartburn.

In some cases, reflux can be SILENT, with no symptoms until a problem arises. Almost all individuals have experienced reflux (GER), but the disease (GERD) occurs when reflux happens on a frequent basis often over a long period of time.

 What Is LPR?

During gastroesophageal reflux, the acidic stomach contents may reflux all the way up the esophagus, beyond the upper esophageal sphincter (a ring of muscle at the top of the esophagus), and into the back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux (LPR), which can affect anyone. Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning, or something “stuck.” Some may have difficulty breathing if the voice box is affected.

In infants and children, LPR may cause breathing problems such as: cough, hoarseness, stridor (noisy breathing), croup, asthma, sleep disordered breathing, feeding difficulty (spitting up), turning blue (cyanosis), aspiration, pauses in breathing (apnea), apparent life threatening event (ALTE), and even a severe deficiency in growth. Proper treatment of LPR, especially in children, is critical.

 What Are The Symptoms Of GERD And LPR?

The symptoms of GERD may include persistent heartburn, acid regurgitation, nausea, hoarseness in the morning, or trouble swallowing. Some people have GERD without heartburn. Instead, they experience pain in the chest that can be severe enough to mimic the pain of a heart attack. GERD can also cause a dry cough and bad breath. Some people with LPR may feel as if they have food stuck in their throat, a bitter taste in the mouth on waking, or difficulty breathing although uncommon.

If you experience any symptoms on a regular basis (twice a week or more) then you may have GERD or LPR. For proper diagnosis and treatment, you should be evaluated by your primary care doctor for GERD or an otolaryngologist-head and neck surgeon (ENT doctor).

 Who Gets GERD Or LPR?

Women, men, infants, and children can all have GERD. This disorder may result from physical causes or lifestyle factors. Physical causes can include a malfunctioning or abnormal lower esophageal sphincter muscle (LES), hiatal hernia, abnormal esophageal contractions, and slow emptying of the stomach. Lifestyle factors include diet (chocolate, citrus, fatty foods, spices), destructive habits (overeating, alcohol and tobacco abuse) and even pregnancy. Young children experience GERD and LPR due to the developmental immaturity of both the upper and lower esophageal sphincters.

Unfortunately, GERD and LPR are often overlooked in infants and children leading to repeated vomiting, coughing in GER and airway and respiratory problems in LPR such as sore throat and ear infections. Most infants grow out of GERD or LPR by the end of their first year; however, the problems that resulted from the GERD or LPR may persist.

 What Role Does An Ear, Nose, And Throat Specialist Have In Treating GERD And LPR?

A gastroenterologist, a specialist in treating gastrointestinal orders, will often provide initial treatment for GERD. But there are ear, nose, and throat problems that are either caused by or associated with GERD, such as hoarseness, laryngeal (singers) nodules, croup, airway stenosis (narrowing), swallowing difficulties, throat pain, and sinus infections. These problems require an otolaryngologist-head and neck surgeon, or a specialist who has extensive experience with the tools that diagnose GERD and LPR. They treat many of the complications of GERD, including: sinus and ear infections, throat and laryngeal inflammation and lesions, as well as a change in the esophageal lining called Barrett’s esophagus, which is a serious complication that can lead to cancer.

Your primary care physician or pediatrician will often refer a case of LPR to an otolaryngologist-head and neck surgeon for evaluation, diagnosis, and treatment.

 Diagnosing And Treating GERD And LPR

In adults, GERD can be diagnosed or evaluated by a physical examination and the patient’s response to a trial of treatment with medication. Other tests that may be needed include an endoscopic examination (a long tube with a camera inserted into the nose, throat, windpipe, or esophagus), biopsy, x-ray, examination of the throat and larynx, 24 hour pH probe, acid reflux testing, esophageal motility testing (manometry), emptying studies of the stomach, and esophageal acid perfusion (Bernstein test). Endoscopic examination, biopsy, and x-ray may be performed as an outpatient or in a hospital setting. Endoscopic examinations can often be performed in your ENT’s office, or may require some form of sedation and occasionally anesthesia.

Symptoms of GERD or LPR in children should be discussed with your pediatrician for a possible referral to a specialist.

Most people with GERD respond favorably to a combination of lifestyle changes and medication. On occasion, surgery is recommended. Medications that could be prescribed include antacids, histamine antagonists, proton pump inhibitors, pro-motility drugs, and foam barrier medications. Some of these products are now available over-the-counter and do not require a prescription.  

Children and adults who fail medical treatment or have anatomical abnormalities may require surgical intervention. Such treatment includes fundoplication, a procedure where a part of the stomach is wrapped around the lower esophagus to tighten the LES, and endoscopy, where hand stitches or a laser is used to make the LES tighter.

Adult Lifestyle Changes To Prevent GERD And LPR

• Avoid eating and drinking within two to three hours prior to bedtime
• Do not drink alcohol
• Eat small meals and slowly

• Limit problem foods:

  • Caffeine

  • Carbonated drinks

  • Chocolate

  • Peppermint

  • Tomato and citrus foods

  • Fatty and fried foods

• Lose weight

• Quit smoking

• Wear loose clothing

(SOURCE: http://www.entnet.org/healthinfo/topics/GERD.cfm)

Not at all. Tinnitus is the name for these head noises, and they are very common. Nearly 36 million Americans suffer from this discomfort. Tinnitus may come and go, or you may be aware of a continuous sound. It can vary in pitch from a low roar to a high squeal or whine, and you may hear it in one or both ears. When the ringing is constant, it can be annoying and distracting. More than seven million people are afflicted so severely that they cannot lead normal lives.

Can Other People Hear the Noise in My Ears?

Not usually, but sometimes they are able to hear a certain type of tinnitus. This is called “objective tinnitus,” and it caused either by abnormalities in blood vessels around the outside of the ear or by muscle spasms, which may sound like clicks or crackling inside the middle ear.

What Causes Tinnitus?

Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. If you are older, advancing age is generally accompanied by a certain amount of hearing nerve impairment and tinnitus. If you are younger, exposure to loud noise is probably the leading cause of tinnitus, and often damages hearing as well.

There are many causes for “subjective tinnitus,” the noise only you can hear. Some causes are not serious (a small plug of wax in the ear canal might cause temporary tinnitus). Tinnitus can also be a symptom of stiffening of the middle ear bones (otosclerosis).

Tinnitus may also be caused by allergy, high or low blood pressure (blood circulation problems), a tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other causes including medications such as anti-inflammatories, antibiotics, sedatives, antidepressants, and aspirin. If you take aspirin and your ears ring, talk to your doctor about dosage in relation to your size.

Treatment will be quite different in each case of tinnitus. It is important to see an otolaryngologist to investigate the cause of your tinnitus so that the best treatment can be determined.

Tinnitus Treatment

In most cases, there is no specific treatment for ear and head noise. If your otolaryngologist finds a specific cause of your tinnitus, he or she may be able to eliminate the noise. But, this determination may require extensive testing including X-rays, balance tests, and laboratory work. However, most causes cannot be identified. Occasionally, medicine may help the noise. The medications used are varied, and several may be tried to see if they help.

The following list of DOs and DON’Ts can help lessen the severity of tinnitus:

• Avoid exposure to loud sounds and noises.
• Get your blood pressure checked. If it is high, get your doctor’s help to control it.
• Decrease your intake of salt. Salt impairs blood circulation.
• Avoid stimulants such as coffee, tea, cola, and tobacco.
• Exercise daily to improve your circulation.
• Get adequate rest and avoid fatigue.
• Stop worrying about the noise. Recognize your head noise as an annoyance and learn to ignore it as much as possible.

Can You Help Me Cope With Tinnitus?

Concentration and relaxation exercises can help to control muscle groups and circulation throughout the body. The increased relaxation and circulation achieved by these exercises can reduce the intensity of tinnitus in some patients.

Masking. Tinnitus is usually more bothersome in quiet surroundings. A competing sound at a constant low level, such as a ticking clock or radio static (white noise), may mask the tinnitus and make it less noticeable. Products that generate white noise are also available through catalogs and specialty stores.

Hearing Aids. If you have a hearing loss, a hearing aid(s) may reduce head noise while your are wearing it and sometimes cause it to go away temporarily. It is important not to set the hearing aid at excessively loud levels, as this can worsen the tinnitus in some cases. However, a thorough trial before purchase of a hearing aid is advisable if your primary purpose is the relief of tinnitus.

Tinnitus maskers can be combined within hearing aids. They emit a competitive but pleasant sound that can distract you from head noise. Some people find that a tinnitus masker may even suppress the head noise for several hours after it is used, but this is not true for all users.

Summary

Prior to any treatment of tinnitus or head noise, it is important that you have a thorough examination and evaluation by your otolaryngologist. An essential part of your treatment will be your understanding of tinnitus and its causes

(SOURCE: http://www.entnet.org/healthinfo/hearing/tinnitus.cfm)

Causes Of Swimmer’s Ear

Swimmer’s ear is an infection of the outer ear structures. It typically occurs in swimmers, but the since the cause of the infection is water trapped in the ear canal, bathing or showering may also cause this common infection.When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing infection and irritation of the ear canal. If the infection progresses it may involve the outer ear. 

Symptoms Of Swimmer’s Ear

The most common symptoms of swimmer’s ear are mild to moderate pain that is aggravated by tugging on the auricle and an itchy ear.Other symptoms may include any of the following:   

• Sensation that the ear is blocked or full
• Drainage
• Fever 
• Decreased hearing
• Intense pain that may radiate to the neck, face, or side of the head
• The outer ear may appear to be pushed forward or away from the skull
• Swollen lymph nodes

 Treatment Of Swimmer’s Ear

Treatment for the early stages of swimmer’s ear includes careful cleaning of the ear canal and eardrops that inhibit bacterial growth. Mild acid solutions such as boric or acetic acid are effective for early infections.

For more severe infections, if you do not have a perforated ear drum, ear cleaning may be helped by antibiotics. If the ear canal is swollen shut, a sponge or wick may be placed in the ear canal so that the antibiotic drops will be effective. Pain medication may also be prescribed.

Follow-up appointments with your physician are very important to monitor progress of the infection, to repeat ear cleaning, and to replace the ear wick as needed. Your otolaryngologist has specialized equipment and expertise to effectively clean the ear canal and treat swimmer’s ear.

 Prevention Of Swimmer’s Ear

A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture after swimming or bathing. Removable earplugs, sometimes worn for hearing protection, can be used to keep moisture out of the ear canal. Q-tips should not be used for this purpose, because they may pack material deeper into the ear canal, remove protective earwax, and irritate the thin skin of the ear canal creating the perfect environment for infection.

The safest way to dry your ears is with a hair dryer. If you do not have a perforated eardrum, rubbing alcohol or a 50:50 mixture of alcohol and vinegar used as eardrops will evaporate excess water and keep your ears dry.

Before using any drops in the ear, it is important to verify that you do not have a perforated eardrum. Check with your otolaryngologist if you have ever had a perforated, punctured, or injured eardrum, or if you have had ear surgery.

People with itchy ears, flaky or scaly ears, or extensive earwax are more likely to develop swimmer’s ear. If so, it may be helpful to have your ears cleaned periodically by an otolaryngologist

(SOURCE: http://www.entnet.org/healthinfo/ears/swimmers.cfm)

A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.

Causes Of Eardrum Perforation

The causes of perforated eardrum are usually from trauma or infection. A perforated eardrum can occur:

• If the ear is struck squarely with an open hand
• With a skull fracture
• After a sudden explosion
• If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal.
• As a result of hot slag (from welding) or acid entering the ear canal

Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the ear-drum resulting in a perforation. In this circumstance, there maybe infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation.

On rare occasions a small hole may remain in the eardrum after a previously placed PE tube (pressure equalizing) either falls out or is removed by the physician.

Most eardrum perforations heal spontaneously within weeks after rupture, although some may take up to several months. During the healing process the ear must be protected from water and trauma. Those eardrum perforations which do not heal on their own may require surgery.

Effects On Hearing From Perforated Eardrum

Usually, the larger the perforation, the greater the loss of hearing. The location of the hole (perforation) in the eardrum also effects the degree of hearing loss. If severe trauma (e.g. skull fracture) disrupts the bones in the middle ear which transmit sound or causes injury to the inner ear structures, the loss of hearing maybe quite severe.

If the perforated eardrum is due to a sudden traumatic or explosive event, the loss of hearing can be great and ringing in the ear (tinnitus) may be severe. In this case the hearing usually returns partially, and the ringing diminishes in a few days. Chronic infection as a result of the perforation can cause major hearing loss.

Treatment Of The Perforated Eardrum

Before attempting any correction of the perforation, a hearing test should be performed. The benefits of closing a perforation include prevention of water entering the ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and diminished tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures.

If the perforation is very small, otolaryngologists may choose to observe the perforation over time to see if it will dose spontaneously. They also might try to patch a cooperative patient’s ear-drum in the office. Working with a microscope, your doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. Usually with closure of the tympanic membrane improvement in hearing is noted. Several applications of a patch (up to three or four) may be required before the perforation doses completely. if your physician feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or attempts with paper patching do not promote healing, surgery is considered.

There are a variety of surgical techniques, but all basically place tissue across the perforation allowing healing. The name of this procedure is called tympanoplasty. Surgery is typically quite successful in closing the perforation permanently, and improving hearing. It is usually done on an outpatient basis.

Your doctor will advise you regarding the proper management of a perforated eardrum

(SOURCE: http://www.entnet.org/healthinfo/ears/perforation.cfm)

Ménière’s disease, also called idiopathic endolymphatic hydrops, is a disorder of the inner ear. Although the cause is unknown, it probably results from an abnormality in the fluids of the inner ear. Ménière’s disease is one of the most common causes of dizziness originating in the inner ear. In most cases only one ear is involved, but both ears may be affected in about 15 percent of patients. Ménière’s disease typically starts between the ages of 20 and 50 years. Men and women are affected in equal numbers.

What Are The Symptoms?

The symptoms of Ménière’s disease are episodic rotational vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Tinnitus and fullness of the ear in Ménière’s disease may come and go with changes in hearing, occur during or just before attacks, or be constant. There may also be an intermittent hearing loss early in the disease, especially in the low pitches, but a fixed hearing loss involving tones of all pitches commonly develops in time. Loud sounds may be uncomfortable and seem distorted in the affected ear. From all the Ménière’s disease’s symptoms, vertigo is usually the most troublesome. It is commonly produced by disorders of the inner ear, but may also occur in central nervous system disorders. Vertigo may last for 20 minutes to two hours or longer. During attacks, patients are usually unable to perform activities normal to their work or home life. Sleepiness may follow for several hours, and the off-balance sensation may last for days. The symptoms of Ménière’s disease may be only a minor nuisance, or can become disabling, especially if the attacks of vertigo are severe, frequent, and occur without warning.

  How Is A Diagnosis Made?
The physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. You may be asked whether there is history of syphilis, mumps, or other serious infections in the past, inflammations of the eye, an autoimmune disorder or allergy, or ear surgery in the past. You may be asked questions about your general health, such as whether you have diabetes, high blood pressure, high blood cholesterol, thyroid, neurologic or emotional disorders. Tests may be ordered to look for these problems in certain cases. When the history has been completed, diagnostic tests will check your hearing and balance functions. They may include:

For Hearing

• An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear. Speech discrimination (the patient’s ability to distinguish between words like “sit” and “fit”) is often diminished in the affected ear.

For Balance

• An ENG (electronystagmograph) may be performed to evaluate balance function. In a darkened room, recording electrodes are placed near the eyes. Warm and cool water or air are gently introduced into each ear canal. Since the eyes and ears work in a coordination through the nervous system, measurement of eye movements can be used to test the balance system. In about 50 percent of patients, the balance function is reduced in the affected ear.
• Rotational testing or balance platform, may also be performed to evaluate the balance system.

Other Tests

• Electrocochleography (ECoG) may indicate increased inner ear fluid pressure in some cases of Ménière’s disease.
• The auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computed tomography (CT) or, magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing and balance nerve. Such tumors are rare, but they can cause symptoms similar to Ménière’s disease.

  Recommended Adult Lifestyle Changes To Reduce The Frequency Of Ménière’s Disease Episodes

• Avoid alcohol, caffeine, excessive fatigue, smoking, and streess
• Eat properly
• Get plenty of sleep
• Remain physically active

  Diagnosing And Treating Ménière’s Disease

A low salt diet and a diuretic (water pill) may reduce the frequency of attacks of Ménière’s disease in some patients. In order to receive the full benefit of the diuretic, it is important that you restrict your intake of salt and take the medication regularly as directed. Anti-vertigo medications, e.g., Antivert® (meclizine generic), or Valium® (diazepam generic), may provide temporary relief. Anti-nausea medication is sometimes prescribed. Anti-vertigo and anti-nausea medications may cause drowsiness. Avoid caffeine, smoking, and alcohol. Get regular sleep and eat properly. Remain physically active, but avoid excessive fatigue. Stress may aggravate the vertigo and tinnitus of Ménière’s disease. Stress avoidance or counseling may be advised. If you have vertigo without warning, you should not drive, because failure to control the vehicle may be hazardous to yourself and others. Safety may require you to forego ladders, scaffolds, and swimming.

  When Is Surgery Recommended?

If vertigo attacks are not controlled by
conservative measures and are disabling, one of the following surgical procedures might be recommended:

• Intratympanic treatment, also known as chemical labyrinthotomy, is an office procedure in which a medicine, such as gentamicin, is injected into the middle ear. Other medicines may be used. Gentamicin is an antibiotic that causes a partial loss of balance function in the treated ear, controlling vertigo in about three fourths of cases and usually preserving hearing. Apart from a period of disequilibrium that can occur as the patient adjusts to the new level of balance function, this treatment is usually very well tolerated.
  It is also significantly simpler and less invasive than other surgical treatments.
• The endolymphatic shunt or decompression procedure is an ear operation that is usually preserves hearing. Attacks of vertigo are controlled in one-half to two-thirds of cases, but control is not permanent in all cases. Recovery time after this procedure is short compared to the other procedures.
• Selective vestibular neurectomy is a procedure in which the balance nerve is cut as it leaves the inner ear and goes to the brain. Vertigo attacks are permanently cured in a high percentage of cases, and hearing is preserved in most cases.
• Labryrinthectomy and eighth nerve section
  are procedures in which the balance and
  hearing mechanism in the inner ear are destroyed on one side. This is considered when the patient with Ménière’s disease has poor hearing in the affected ear. Labryrinthectomy and eighth nerve section result in the highest rates for control of vertigo attacks.

(SOURCE: http://www.entnet.org/healthinfo/balance/meniere.cfm)

Never put anything smaller than your elbow in your ear! Cotton swabs are for cleaning bellybuttons, not ears. You have probably heard these admonitions from relatives and doctors since childhood…read on to find out what they meant.  

The Outer Ear And Canal

The outer ear is the funnel-like part of the ear you can see on the side of the head, plus the ear canal (the hole which leads down to the eardrum).

The ear canal is shaped somewhat like an hourglass-narrowing part way down. The skin of the outer part of the canal has special glands that produce earwax. This wax is supposed to trap dust and dirt particles to keep them from reaching the eardrum. Usually the wax accumulates a bit, dries out and then comes tumbling out of the ear, carrying dirt and dust with it. Or it may slowly migrate to the outside where it can be wiped off. The ear canal may be blocked by wax when attempts to clean the ear push wax deeper into the ear canal and cause a blockage. Wax blockage is one of the most common causes of hearing loss.  

Should You Clean Your Ears?

Wax is not formed in the deep part of the ear canal near the eardrum, but only in the outer part of the canal. So when a patient has wax blocked up against the eardrum, it is often because he has been probing his ear with such things as cotton-tipped applicators, bobby pins, or twisted napkin corners. These objects only push the wax in deeper. Also, the skin of the ear canal and the eardrum is very thin and fragile and is easily injured.Earwax is healthy in normal amounts and serves to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of earwax may result in dry, itchy ears.

Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of ear canal skin from the eardrum to the ear opening. Old earwax is constantly being transported from the ear canal to the ear opening where it usually dries, flakes, and falls out.

Under ideal circumstances, you should never have to clean your ear canals. However, we all know that this isn’t always so. If you want to clean your ears, you can wash the external ear with a cloth over a finger, but do not insert anything into the ear canal.

What Are the Symptoms of Wax Buildup?

• partial hearing loss, may be progressive
• tinnitus, noises in the ear
• earache
• fullness in the ear or a sensation the ear is plugged

Self Treatment For Earwax

Most cases of earwax blockage respond to home treatments used to soften wax if there is no hole in the eardrum. Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial ear wax removal drops, such as Debrox®, Mack’s® Wax AwayTM, Murine®, or Physicians’ ChoiceTM in the ear. These remedies are not as strong as the prescription wax softeners but are effective for many patients. Rarely, people have allergic reactions to commercial preparations. Detergent drops such as hydrogen peroxide or carbamide peroxide may also aid in the removal of wax. Patients should know that rinsing the ear canal with hydrogen peroxide (H2O2) results in oxygen bubbling off and water being left behind-wet, warm ear canals make good incubators for growth of bacteria. Flushing the ear canal with rubbing alcohol displaces the water and dries the canal skin. If alcohol causes severe pain, it suggests the presence of an eardrum perforation.  

When Should I See My Doctor?

If you are uncertain whether you have a hole (perforation or puncture) in your eardrum, consult your physician prior to trying any over-the-counter remedies. Putting eardrops or other products in your ear in the presence of an eardrum perforation may cause an infection. Certainly, washing water through such a hole could start an infection. In the event that the home treatments discussed in this article are not satisfactory, or if wax has accumulated so much that it blocks the ear canal (and hearing), your physician may prescribe eardrops designed to soften wax, or he may wash or vacuum it out. Occasionally, an otolaryngologist (ENT specialist) may need to remove the wax using microscopic visualization.

Other Possible Causes of Hearing Loss

(SOURCE: http://www.entnet.org/healthinfo/ears/earwax.cfm)

Have you ever wondered why your ears pop when you fly on an airplane? Or why, when they fail to pop, you get an earache? Have you ever wondered why the babies on an airplane fuss and cry so much during descent?

Ear problems are the most common medical complaint of airplane travelers, and while they are usually simple, minor annoyances, they occasionally result in temporary pain and hearing loss.

How Does Air Pressure Affect The Ear?

It is the middle ear that causes discomfort during air travel, because it is an air pocket inside the head that is vulnerable to changes in air pressure.

Normally, each time (or each second or third time) you swallow, your ears make a little click or popping sound. This occurs because a small bubble of air has entered your middle ear, up from the back of your nose. It passes through the Eustachian tube, a membrane-lined tube about the size of a pencil lead that connects the back of the nose with the middle ear. The air in the middle ear is constantly being absorbed by its membranous lining and resupplied through the Eustachian tube. In this manner, air pressure on both sides of the eardrum stays about equal. If and when the air pressure is not equal, the ear feels blocked.

Blocked Ears And Eustachian Tubes

The Eustachian tube can be blocked, or obstructed, for a variety of reasons. When that occurs, the middle ear pressure cannot be equalized. The air already there is absorbed and a vacuum occurs, sucking the eardrum inward and stretching it. Such an eardrum cannot vibrate naturally, so sounds are muffled or blocked, and the stretching can be painful. If the tube remains blocked, fluid (like blood serum) will seep into the area from the membranes in an attempt to overcome the vacuum. This is called “fluid in the ear,” serous otitis, or aero-otitis.

The most common cause for a blocked Eustachian tube is the common cold. Sinus infections and nasal allergies (hay fever, etc.) are also causes. A stuffy nose leads to stuffy ears because the swollen membranes block the opening of the Eustachian tube.

Children are especially vulnerable to blockages because their Eustachian tubes are narrower than adults.

The Three Parts Of The Ear 

• The outer ear: the part that you can see on the side of the head plus the ear canal leading down to the eardrum.
• The middle ear: the eardrum and ear bones (ossicles), plus the air spaces behind the eardrum and in the mastoid cavities (vulnerable to air pressure).
• The inner ear: the area that contains the nerve endings for the organs of hearing and balance (equilibrium).

How Can Air Travel Cause Ear Problems?

Air travel is sometimes associated with rapid changes in air pressure. To maintain comfort, the Eustachian tube must open frequently and wide enough to equalize the changes in pressure. This is especially true when the airplane is landing, going from low atmospheric pressure down closer to earth where the air pressure is higher.

Actually, any situation in which rapid altitude or pressure changes occur creates the problem. You may have experienced it when riding in elevators or when diving to the bottom of a swimming pool. Deep sea divers are taught how to equalize their ear pressures; so are pilots. You can learn the tricks too.

How To Unblock Your Ears

Swallowing activates the muscle that opens the Eustachian tube. You swallow more often when you chew gum or let mints melt in your mouth. These are good air travel practices, especially just before take-off and during descent. Yawning is even better. Avoid sleeping during descent, because you may not be swallowing often enough to keep up with the pressure changes. (The flight attendant will be happy to awaken you just before descent).

If yawning and swallowing are not effective, unblock your ears as follows:

• Step 1: Pinch your nostrils shut.
• Step 2: Take a mouthful of air.
• Step 3: Using your cheek and throat muscles, force the air into the back of your nose as if you were trying to blow your thumb and fingers off your nostrils.

When you hear a loud pop in your ears, you have succeeded. You may have to repeat this several times during descent.

Babies’ Ears

Babies cannot intentionally pop their ears, but popping may occur if they are sucking on a bottle or pacifier. Feed your baby during the flight, and do not allow him or her to sleep during descent.

Precautions

• When inflating your ears, you should not use force. The proper technique involves only pressure created by your check and throat muscles.
• If you have a cold, a sinus infection, or an allergy attack, it is best to postpone an airplane trip.
• If you recently have undergone ear surgery, consult with your surgeon on how soon you may safely fly.

What About Decongestants And Nose Sprays?

Many experienced air travelers use a decongestant pill or nasal spray an hour or so before descent. This will shrink the membranes and help the ears pop more easily. Travelers with allergy problems should take their medication at the beginning of the flight for the same reason.

Decongestant tablets and sprays can be purchased without a prescription. However, they should be avoided by people with heart disease, high blood pressure, irregular heart rhythms, thyroid disease, or excessive nervousness. Such people should consult their physicians before using these medicines. Pregnant women should likewise consult their physicians first.

If Your Ears Will Not Unblock

Even after landing you can continue the pressure equalizing techniques, and you may find decongestants and nasal sprays to be helpful. (However, avoid making a habit of nasal sprays. After a few days, they may cause more congestion than they relieve). If your ears fail to open, or if pain persists, you will need to seek the help of a physician who has experience in the care of ear disorders. He/she may need to release the pressure or fluid with a small incision in the ear drum.

(SOURCE: http://www.entnet.org/healthinfo/ears/altitude.cfm)

Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded for children who visit physicians for illness. It is also the most common cause of hearing loss in children.

Although otitis media is most common in young children, it also affects adults occasionally. It occurs most commonly in the winter and early spring months.

Is Otitis Media Serious?

Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal.

Otitis media is also serious because the infection can spread to nearby structures in the head, especially the mastoid. Thus, it is very important to recognize the symptoms (see list) of otitis media and to get immediate attention from your doctor.

How Does The Ear Work?

The outer ear collects sounds. The middle ear is a pea sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Attached to the eardrum are three tiny ear bones. When sound waves strike the eardrum, it vibrates and sets the bones in motion that transmit to the inner ear. The inner ear converts vibrations to electrical signals and sends these signals to the brain. It also helps maintain balance.

A healthy middle ear contains air at the same atmospheric pressure as outside of the ear, allowing free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear. When you yawn and hear a pop, your eustachian tube has just sent a tiny air bubble to your middle ear to equalize the air pressure.

What Causes Otitis Media?

Blockage of the eustachian tube during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum. This is the infection called acute otitis media. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, you or your child may have hearing problems.

Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This condition makes one subject to frequent recurrences of the acute infection and may cause difficulty in hearing.

What Are The Symptoms Of Otitus Media?

In infants and toddlers look for:

• pulling or scratching at the ear, especially if accompanied by the following…

1. hearing problems
2. crying, irritability
3. fever
4. vomiting
5. ear drainage

In young children, adolescents, and adults look for:

• earache
• feeling of fullness or pressure
• hearing problems
• dizziness, loss of balance
• nausea, vomiting
• ear drainage
• fever

Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.

What Will Happen At The Doctor’s Office?

During an examination, the doctor will use an instrument called an otoscope to assess the ear’s condition. With it, the doctor will perform an examination to check for redness in the ear and/or fluid behind the eardrum. With the gentle use of air pressure, the doctor can also see if the eardrum moves. If the eardrum doesn’t move and/or is red, an ear infection is probably present.

Two other tests may be performed for more information.

An audiogram tests if hearing loss has occurred by presenting tones at various pitches.

A tympanogram measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move.

The Importance Of Medication

The doctor may prescribe one or more medications. It is important that all the medication(s) be taken as directed and that any follow-up visits be kept. Often, antibiotics to fight the infection will make the earache go away rapidly, but the infection may need more time to clear up. So, be sure that the medication is taken for the full time your doctor has indicated. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both.

Sometimes the doctor may recommend a medication to reduce fever and/or pain. Analgesic ear drops can ease the pain of an earache. Call your doctor if you have any questions about you or your child’s medication or if symptoms do not clear.

What Other Treatment May Be Necessary?

Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, further treatment may be recommended by your physician. An operation, called a myringotomy may be recommended. This involves a small surgical incision (opening) into the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days with practically no scarring or injury to the eardrum. In fact, the surgical opening can heal so fast that it often closes before the infection and the fluid are gone. A ventilation tube can be placed in the incision, preventing fluid accumulation and thus improving hearing.

The surgeon selects a ventilation tube for your child that will remain in place for as long as required for the middle ear infection to improve and for the eustachian tube to return to normal. This may require several weeks or months. During this time, you must keep water out of the ears because it could start an infection. Otherwise, the tube causes no trouble, and you will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections.

Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted.

Allergies may also require treatment.

So, Remember . . .

Otitis media is generally not serious if it is promptly and properly treated. With the help of your physician, you and/or your child can feel and hear better very soon.

Be sure to follow the treatment plan, and see your physician until he/she tells you that the condition is fully cured.

(SOURCE: http://www.entnet.org/healthinfo/ears/earache.cfm)

 What Are Ear tubes?
Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes.  These tubes can be made out of plastic, metal, or Teflon and may have a coating intended to reduce the possibility of infection. There are two basic types of ear tubes: short-term and long-term.  Short-term tubes are smaller and typically stay in place for six months to a year before falling out on their own.  Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long term tubes may fall out on their own, but removal by an otolaryngologist is often necessary.

 Who Needs Ear Tubes?
Ear tubes are often recommended when a person experiences repeated middle ear infection (acute otitis media) or has hearing loss caused by the persistent presence of middle ear fluid (otitis media with effusion). These conditions most commonly occur in children, but can also be present in teens and adults and can lead to speech and balance problems, hearing loss, or changes in the structure of the ear drum. Other less common conditions that may warrant the placement of ear tubes are malformation of the ear drum or Eustachian tube, Down Syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure), usually seen with altitude changes such as flying and scuba diving.  

Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia.  The average age of ear tube insertion is one to three years old. Inserting ear tubes may:

• reduce the risk of future ear infection,
• restore hearing loss caused by middle ear fluid,
• improve speech problems and balance prob-lems, and
• improve behavior and sleep problems caused by chronic ear infections.

 How Are Ear Tubes Inserted?
Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to an incision (a hole) in the ear drum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel (tiny knife), but it can also be accomplished with a laser.  If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation).

  Ear Tube Surgery 
A light general anesthetic (laughing gas) is administered for young children. Some older children and adults may be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops may be administered after the ear tube is placed and may be necessary for a few days. The procedure usually lasts less than 15 minutes and patients awaken quickly. Sometimes the otolaryngologist will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed.  This is often considered when a repeat tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infection and the need for repeat surgery.

What To Expect After Surgery
After surgery, the patient is monitored in the recovery room and will usually go home within an hour if no complications are present. Patients usually experience little or no postoperative pain but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily.  Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery. Sometimes children can hear so much better that they complain that normal sounds seem too loud. The otolaryngologist will provide specific postoperative instructions for each patient including when to seek immediate attention and follow-up appointments. He or she may also prescribe antibiotic ear drops for a few days.

To avoid the possibility of bacteria entering the middle ear through the ventilation tube, physicians may recommend keeping ears dry by using ear plugs or other water-tight devices during bathing, swimming, and water activities. However, recent research suggests that protecting the ear may not be necessary, except when diving or engaging in water activities in unclean water such as lakes and rivers. Parents should consult with the treating physician about ear protection after surgery.

Possible Complications
Myringotomy with insertion of ear tubes is an extremely common and safe procedure with minimal complications. When complications do occur, they may include:

• Perforation – This can happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (ear drum) does not close. The hole can be patched through a minor surgical procedure called a tympanoplasty or myringoplasty.
• Scarring – Any irritation of the ear drum (recurrent ear infections), including repeated in-sertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this causes no problems with hearing.
• Infection – Ear infections can still occur in the middle ear or around the ear tube. How-ever, these infections are usually less frequent, result in less hearing loss, and are easier to treat – often only with ear drops. Sometimes an oral antibiotic is still needed.
• Ear Tubes Come Out Too Early Or Stay In Too Long – If an ear tube expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long may result in perforation or may require removal by the otolaryngologist.

Consultation with an otolaryngologist (ear, nose, and throat surgeon) may be warranted if you or your child has experienced repeated or severe ear infections, ear infections that are not resolved with antibiotics, hearing loss due to fluid in the middle ear, barotrauma, or have an anatomic abnormality that inhibits drainage of the middle ear.

(SOURCE: http://www.entnet.org/healthinfo/ears/Ear-Tubes.cfm)

 What Is Dizziness?

Some people describe a balance problem by saying they feel dizzy, lightheaded, unsteady, or giddy. This feeling of imbalance or dysequilibrium, without a sensation of turning or spinning, is sometimes due to an inner ear problem.

What Is Vertigo?

A few people describe their balance problem by using the word vertigo, which comes from the Latin verb “to turn”. They often say that they or their surroundings are turning or spinning. Vertigo is frequently due to an inner ear problem.

What Is Motion Sickness And Sea Sickness?

Some people experience nausea and even vomiting when riding in an airplane, automobile, or amusement park ride, and this is called motion sickness. Many people experience motion sickness when riding on a boat or ship, and this is called seasickness even though it is the same disorder.

Motion sickness or seasickness is usually just a minor annoyance and does not signify any serious medical illness, but some travelers are incapacitated by it, and a few even suffer symptoms for a few days after the trip.

The Anatomy Of Balance

Dizziness, vertigo, and motion sickness all relate to the sense of balance and equilibrium. Researchers in space and aeronautical medicine call this sense spatial orientation, because it tells the brain where the body is “in space:” what direction it is pointing, what direction it is moving, and if it is turning or standing still.

Your sense of balance is maintained by a complex interaction of the following parts of the nervous system:

• The inner ears (also called the labyrinth), which monitor the directions of motion, such as turning, or forward-backward, side-to-side, and up-and-down motions.
• The eyes, which monitor where the body is in space (i.e. upside down, rightside up, etc.) and also directions of motion.
• The skin pressure receptors such as in the joints and spine, which tell what part of the body is down and touching the ground.
• The muscle and joint sensory receptors, which tell what parts of the body are moving.
• The central nervous system (the brain and spinal cord), which processes all the bits of information from the four other systems to make some coordinated sense out of it all.

The symptoms of motion sickness and dizziness appear when the central nervous system receives conflicting messages from the other four systems.

For example, suppose you are riding through a storm, and your airplane is being tossed about by air turbulence. But your eyes do not detect all this motion because all you see is the inside of the airplane. Then your brain receives messages that do not match with each other. You might become “air sick.”

Or suppose you are sitting in the back seat of a moving car reading a book. Your inner ears and skin receptors will detect the motion of your travel, but your eyes see only the pages of your book. You could become “car sick.”

Or, to use a true medical condition as an example, suppose you suffer inner ear damage on only one side from a head injury or an infection. The damaged inner ear does not send the same signals as the healthy ear. This gives conflicting signals to the brain about the sensation of rotation, and you could suffer a sense of spinning, vertigo, and nausea.

What Medical Conditions Cause Dizziness?

Circulation: If your brain does not get enough blood flow, you feel light headed. Almost everyone has experienced this on occasion when standing up quickly from a lying down position. But some people have light headedness from poor circulation on a frequent or chronic basis. This could be caused by arteriosclerosis or hardening of the arteries, and it is commonly seen in patients who have high blood pressure, diabetes, or high levels of blood fats (cholesterol). It is sometimes seen in patients with inadequate cardiac (heart) function or with anemia.

Certain drugs also decrease the blood flow to the brain, especially stimulants such as nicotine and caffeine. Excess salt in the diet also leads to poor circulation. Sometimes circulation is impaired by spasms in the arteries caused by emotional stress, anxiety, and tension.

If the inner ear falls to receive enough blood flow, the more specific type of dizziness occurs-that is-vertigo. The inner ear is very sensitive to minor alterations of blood flow and all of the causes mentioned for poor circulation to the brain also apply specifically to the inner ear.

Injury: A skull fracture that damages the inner ear produces a profound and incapacitating vertigo with nausea and hearing loss. The dizziness will last for several weeks, then slowly improve as the normal (other) side takes over

Infection: Viruses, such as those causing the common “cold” or “flu,” can attack the inner ear and its nerve connections to the brain. This can result in severe vertigo, but hearing is usually spared. However, a bacterial infection such as mastoiditis that extends into the inner ear will completely destroy both the hearing and the equilibrium function of that ear. The severity of dizziness and recovery time will be similar to that of skull fracture.

Allergy: Some people experience dizziness and/or vertigo attacks when they are exposed to foods or airborne particles (such as dust, molds, pollens, danders, etc.) to which they are allergic.

Neurological diseases: A number of diseases of the nerves can affect balance, such as multiple sclerosis, syphilis, tumors, etc. These are uncommon causes, but your physician will think about them during the examination.

What Will the Physician Do For My Dizziness?

The doctor will ask you to describe your dizziness, whether it is light headedness or a sensation of motion, how long and how often the dizziness has troubled you, how long a dizzy episode lasts, and whether it is associated with hearing loss or nausea and vomiting. You might be asked for circumstances that might bring on a dizzy spell. You will need to answer questions about your general health, any medicines, you are taking, head injuries, recent infections, and other questions about your ear and neurological system.

Your physician will examine your ears, nose, and throat and do tests of nerve and balance function. Because the inner ear controls both balance and hearing, disorders of balance often affect hearing and vice versa. Therefore, your physician will probably recommend hearing tests (audiograms). The physician might order skull X rays, a CT or MRI scan of your head, or special tests of eye motion after warm or cold water is used to stimulate the inner ear (ENG – electronystagmography). In some cases, blood tests or a cardiology (heart) evaluation might be recommended.

Not every patient will require every test. The physician’s judgement will be based on each particular patient. Similarly, the treatments recommended by your physician will depend on the diagnosis.

What Can I Do To Reduce Dizziness?

• Avoid rapid changes in position, especially from lying down to standing up or turning around from one side to the other.
• Avoid extremes of head motion (especially looking up) or rapid head motion (especially turning or twisting).
• Eliminate or decrease use of products that impair circulation, e.g. nicotine, caffeine, and salt.
• Minimize your exposure to circumstances that precipitate your dizziness, such as stress and anxiety or substances to which you are allergic.
• Avoid hazardous activities when you are dizzy, such as driving an automobile or operating dangerous equipment, or climbing a step ladder, etc.

What Can I Do For Motion Sickness?

Always ride where your eyes will see the same motion that your body and inner ears feel, e.g. sit in the front seat of the car and look at the distant scenery; go up on the deck of the ship and watch the horizon; sit by the window of the airplane and look outside. In an airplane choose a seat over the wings where the motion is the least.

• Do not read while traveling if you are subject to motion sickness, and do not sit in a seat facing backward.
• Do not watch or talk to another traveler who is having motion sickness.
• Avoid strong odors and spicy or greasy foods immediately before and during your travel. Medical research has not yet investigated the effectiveness of popular folk remedies such as soda crackers and & Seven Up^® or cola syrup over ice.
• Take one of the varieties of motion sickness medicines before your travel begins, as recommended by your physician.

Some of these medications can be purchased without a prescription (i.e., Dramamine®, Bonine®, Marezine®, etc.) Stronger medicines such as tranquilizers and nervous system depressants will require a prescription from your physician. Some are used in pill or suppository form.

Remember: Most cases of dizziness and motion sickness are mild and self-treatable disorders. But, severe cases and those that become progressively worse, deserve the attention of a physician with specialized skills in diseases of the ear, nose, throat, equilibrium, and neurological systems.

(SOURCE: http://www.entnet.org/healthinfo/balance/dizziness.cfm)

What Is A Cholesteatoma?

A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually due to repeated infection, which causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth.

Causes Of Cholesteatoma

A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure (“clear the ears”). When the eustachian tubes work poorly perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body, and a partial vacuum results in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.

Cholesteatoma Symptoms

Initially, the ear may drain, sometimes with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss. (An ache behind or in the ear, especially at night, may cause significant discomfort.) Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. Any, or all, of these symptoms are good reasons to seek medical evaluation.

Is It Dangerous?

Ear cholesteatomas can be dangerous and should never be ignored. Bone erosion can cause the infection to spread into the surrounding areas, including the inner ear and brain. If untreated, deafness, brain abscess, meningitis, and rarely death can occur.

Treatments For Cholesteatoma

An examination by an otolaryngologist-head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated.

Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone next to the ear), and CAT scans (3-D x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused.

Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection and achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; and therefore, a second operation may be performed six to twelve months later. The second operation will attempt to restore hearing and, at the same time, inspect the middle ear space and mastoid for residual cholesteatoma.

Admission to the hospital is usually done the morning of surgery, and if the surgery is performed early in the morning, discharge maybe the same day. For some patients, an overnight stay is necessary. In rare cases of serious infection, prolonged hospitalization for antibiotic treatment may be necessary. Time off from work is typically one to two weeks.

Follow-up office visits after surgical treatment are necessary and important, because cholesteatoma sometimes recurs. In cases where an open mastoidectomy cavity has been created, office visits every few months are needed in order to clean out the mastoid cavity and prevent new infections. In some patients, there must be lifelong periodic ear examinations.

Summary

Cholesteatoma is a serious but treatable ear condition which can only be diagnosed by medical examination. Persisting earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness signals the need for evaluation by an otolaryngologist-head and neck surgeon.

(SOURCE: http://www.entnet.org/healthinfo/ears/cholesteatoma.cfm)