EAR NOSE AND THROAT DISEASES Comments turned off

MENIERE’S DISEASE

By admin on January 28th, 2008

What Is Meniere’s Disease?

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)

EAR NOSE AND THROAT DISEASES Comments turned off

EARWAX

By admin on January 28th, 2008

 

“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

  • perforated eardrum
  • middle ear infection (otitis media)
  • external ear infection (otitis externa)
  • acoustic trauma

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

    EAR NOSE AND THROAT DISEASES Comments turned off

    EARS AND ALTITUDE

    By admin on January 28th, 2008

     

     

    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)