EAR NOSE AND THROAT DISEASES Comments turned off

EAR INFECTIONS AND EARACHE

By admin on January 28th, 2008

What Is Otitis Media?

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)

EAR NOSE AND THROAT DISEASES Comments turned off

WHAT ARE EAR TUBES?

By admin on January 28th, 2008

Painful ear infections are a rite of passage for children – by the age of five, nearly every child has experienced at least one episode. Most ear infections either resolve on their own (viral) or are effectively treated by antibiotics (bacterial). But sometimes, ear infections and/or fluid in the middle ear may become a chronic problem leading to other issues such as hearing loss, behavior, and speech problems. In these cases, insertion of an ear tube by an otolaryngologist (ear, nose, and throat surgeon) may be considered.

 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)

EAR NOSE AND THROAT DISEASES Comments turned off

DIZZINESS AND MOTION SICKNESS

By admin on January 28th, 2008

Each year more than two million people visit a doctor for dizziness, and an untold number suffer with motion sickness, which is the most common medical problem associated with travel…

 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)