diseases of ear, nose and throat

15 Pages·2014·0.36 MB·English

AWARENESS

ABOUT

EAR, NOSE &THROAT DISEASES

PROFESSOR DR. MUHAMMAD RASHID ZIA

M.B.B.S, F.C.P.S. FICS (USA)
GOLD MEDALIST
E.N.T CONSULTANT

ALLAMA IQBAL MEDICAL COLLEGE/
JINNAH HOSPITAL LAHORE
PREFACE

The aim of writing this booklet is to educate the reader about common
diseases of ear, nose and throat so that every citizen can take timely
precautions and treatment. Information regarding first aid in ENT
emergencies is given. The detail of the latest relevant treatment of
diseases of Ear, Nose & Throat is also included. Preventive measures for
the diseases of Ear, Nose & Throat are mentioned keeping in view our
cultural and environmental conditions. We recommend that some of the
basic key points from this booklet about E.N.T diseases should be
included in the syllabus of primary and elementary classes.

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PREVENTIVE MEASURES AGAINST THE DISEASES
OF EAR, NOSE AND THROAT.

1. EAR

a. Please Do not clean the ear canal; it is having natural automatic
cleaning
process.Cerumin, an antiseptic oil also called wax is produced only
at the outer inlet of ear canal. It is automatically thrown out with
jaw movements and natural shedding of skin.

b. In case of feeling dryness or itching, few drops of olive oil can be
instilled in the ear canal.

c. Never use pointed metallic object to clean the ear; it may cause
infection and perforation of ear drum.

d. Individuals having excessive hairs at the outlet of ear canal, or
people using hearing aids need suction clearance of ear canal.

e. If a one year old child does not speak words, he should be examined
for hearing level and brain development immediately. Delay in
diagnosis and treatment shall minimize the chances of normal
speech acquisition .

f. In case of ear itching, instead of fiddling with it, get it examined by
an ENT doctor. Dry skin, fungus in ear canal, nose and sinus
infection are common causes of itching in the ear .

g. Tiny things like supari, seeds of fruit or grain, small plastic and
metallic objects should be kept out of children’s reach. They can
create an emergency at any time by putting these in their ears, nose
and throat . Sometimes, when it is not picked in time, after the foreign
objects have been put in the ear, it will result in ear discharge or
bleeding or emergence of bad smell in few weeks time. This can be
traced and confirmed on examination by ENT consultant.

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2. EAR DRUM PERFORATION DUE TO TRAUMA

There is always a chance of ear drum perforation as a result of severe
slap or any other trauma of this nature. In this case never pour or instill
any drops or medicines in the ear. Do not allow water entry into the ear
while taking bath because this will obstruct the healing process and
greatly increase the chance of infection. One should approach an ENT
specialist immediately for diagnosis and proper treatment of the
problem.

3. SEPARATION OF EXTERNAL EAR (VISIBLE
PART OF EAR) BY INJURY.

As a result of an accident or a fight, if the external ear gets separated, it
should be washed with clean water, wrapped in polythene paper and
preserved in ice. Then immediately contact an ENT Surgeon for
grafting.

4. ENTRY OF FOREIGN BODY INTO EAR

In case, a worm or insect gets into the ear, drops of clean oil or water
should be poured into the ear while the patient is lying down with
affected ear facing up ward. Fill the ear with drops. The insect will either
die or will come out. If a plastic or metallic object gets into ear, do not
try to remove it, otherwise this can cause perforation of ear drum. It
should be removed by ENT surgeon.

5. CHRONIC FOUL SMELLING EAR DISCHARGE

This needs urgent treatment because it indicates severe bone infection
very close to the brain and this infection at any time can enter into the
brain, leading to permanent disability or death.

6. SERIOUS SYMPTOMS OF EAR INFECTION

In case, an individual having ear infection develops severe headache,
stiffness of neck, vomiting, dizziness, blurring of vision, facial paralysis
(deviation of mouth) or semi consciousness.These symptoms indicate
that the patient is in a state of emergency. He must be admitted in the
hospital for treatment.
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7. BOTTLE FEEDING IN INFANTS

Excessive bottle feeding in infants is the main reason for ear infection.
Bottle feeding in lying down position enhances the chances of infection
because the sweet milk (in which the germs multiply) reaches the ear
through throat and causes infection.

8. DIZZY SPELLS

Dizzy spells are caused because of any defect in internal portion of the
ear. These spells are intense but short. It may be associated with
episodes of vomiting. These are increased by moving the head and neck.
In such a condition consult a doctor immediately, because these spells
can be controlled through special physiotherapy of the neck and body
and prescribed exercises. Persistent dizzy spells occur as a consequence
of weakness, high blood pressure, sugar, indiscriminate use of medicines
and defects in brain (cerebellum).

9. MOTION SICKNESS ( VOMITNG WHILE TRAVELING)

Some people suffer from dizziness, nausea, vomiting and heart sinking
while traveling by car, bus, train or an aero plane. Such individuals
should take no or little food and drink before and during traveling. The
possibilities of vomiting can be reduced if a tablet of stemetil or
gravinate is taken 15 minutes before the start of journey.
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10. TINNITUS

Tinnitus is a ringing sound or noise perceived by the patient. Usually
it involves one ear but it may effect both ears. In most patients no
underlying pathology is detected. Patient counseling is done
and they are reassured about the benign nature of the disease.
Background noise or sound is introduced into the bedroom at night.
Various tools are used to distract patient’s attention. Tinnitus can also be
suppressed by introduction of sound (TINNITIS SUPRESSOR OR
MASKER) to the affected ear. This tool can be worn like hearing aid
and effectively relieves the symptoms. Patient is to be managed under
guideline of Tinnitus Retraining Therapy (TRT).

11. VERTIGO

Vertigo is the subjective feeling of self rotation or rotation of
surrounding objects. In most of the patient vertigo is short lived (less
than a minute) but violent, related to certain change of position of head.
It is not associated with auditory symptoms like tinnitus or hearing loss.
Most common cause is Benign Paroxysmal Positional Vertigo due to
internal ear problem. Diagnosis is made on history and clinical
examination.Halpike maneuver is specific technique to diagnose BPPV.
Treatment includes reassurance that this condition is not dangerous, rest
and administration of vestibular sedatives like stemetil
(prochlorperazine) or stugeron(cinnarazine).In resistant cases it may be
helped by specific vestibular head exercises. Alternatively particle
repositioning maneuver, Epley`s technique can efficiently relieve the
symptoms.

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PROBLEMS OF NOSE AND THROAT

1. SORE THROAT

By observing rules of hygiene and general cleanliness one can avoid
common cold and sore throat (tonsillitis). Children should be trained to
perform gargles and to flush nose properly. Preferably when you have to
perform ablution (Wudu), demonstrate to the children and ask them to
do the same themselves. After every meal, ensure soft brushing of teeth
and gargles. Make sure that the toothbrush or miswak does not damage
the gums.

2. COMMON COLD/FLU

If you feel that flu or common cold is imminent, flush your nose with
fresh saline water (pour ½ tea spoonful of common salt in a glass of
water). Take more hot drinks. Ensure proper rest. Avoid going into
smoky or dusty environments. By adopting these measures, generally the
flu is stopped immediately because at this stage the virus is attacking
only soft tissues of nose i.e. epithelium.

3. BLOCKED NOSE AND POST NASAL DRIP

Persistent mental worries, environmental pollution like excessive dust
and smoke increases the cases of blocked nose and post nasal drip.
Motorcyclists and the Bicyclists should cover their mouth and nose with
a mask or a piece of cloth. For better safety they must wear helmets.
Severe cold or heat weather causes inflammation inside the nose and
increase the risk of infection. Deviated septal nasal bone and formation
of polyps cause blockage of nose.

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4. NOSE BLEEDING

This disease is common among the children and old people. Nasal
bleeding in generally caused by repeated nose picking with finger by
children or persistent infection in the nose. In old age the causes of nose
bleeding are high blood pressure, prolonged use of medicines and
presence of tumor in the nose. As first aid, pinch the nose between
thumb and index finger for five minutes, breathe through mouth, sit up,
apply cold water or ice on face. For proper examination, diagnosis and
treatment approach a doctor. If nose bleeding coupled with discharge
persists for longer duration there is possibility of tumor especially in
case of elderly. In such a condition immediate check up is required. In
case of profuse bleeding, with the help of epistaxis catheter
endoscopically, this can be controlled by diathermisation in the
operation theater.
5. SNORING

In case of snoring reduce your weight and exercise regularly. The main
reason for snoring is narrowing of air passage in the nose and throat. Its
proper diagnosis and timely treatment is essential. Otherwise it will
cause complicated problems due to undue pressure on heart and lungs.
These are called pulmonary hypertension and cor pulmonale(the heart is
enlarged). Snoring can be controlled through reduction of weight and
undergoing surgery.

6. HOARSE VOICE

Hoarseness of voice is generally accompanied with pain in throat and
dry cough. In case of hoarse voice or change of tone, take voice rest,
reduce talking and take more hot drinks. Inhaling steam is also useful. If
there is no relief within one week, contact an ENT specialist for
examination and treatment. Hoarseness of voice, among the smokers of
cigarettes or huka is a dangerous indication because it can result in
formation of a tumor.
7. ARTIFICIAL DENTURES

Those people, who use removable artificial denture, should remove their
teeth before going to sleep. Otherwise these teeth can go deep in the
throat thereby creating a very difficult and complicated situation.
Remember to clean the artificial teeth and then rinse them in water or
antiseptic mouthwash.
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8. BLEEDING FROM THE THROAT

Bleeding from the patient’s throat is a matter to worry. Generally the
blood comes from the gums, respiratory pipe, lungs or in the throat
behind the nose. In case of bleeding, instead of showing anxiety, contact
an ENT specialist for diagnosis and timely treatment. Gentle brushing,
and lots of fresh fruits and vegetables containing vitamin C, avoid such
bleeding.

9. SWELLINGS ( GLANDS) IN NECK

When the swellings appear in the neck, generally these cause pain and
fever. These glands are usually caused by infection in nose, ear or throat.
One of the common causes is T.B.(tuburculosis). In old age the glands
are caused by the spread of cancer.Now the diagnosis of such glands has
become easier due to latest techniques available in the modern science.
Fine needle aspiration cytology (FNAC) is initial investigation for those
patients who present with neck swelling. It is easy, cheap and minimally
invasive with accurate results.

10. IF PIECE OF MEAT OR CICKEN BONE/ FISH BONE IS
STUCK IN THE DEEP THROAT

Meat should be eaten carefully and chewed thoroughly; otherwise any
piece of bone can get stuck in throat or the food pipe. This will make the
swallowing difficult. In such a situation, do not insert your fingers in the
throat otherwise it would cause another injury. Take water or try to
swallow it down with the help of some soft food. If it does not work,
contact an expert ENT specialist who can take out the object with the
help of surgical instruments. If the fish bone gets stuck , eat soft fruit or
chapati morsels. Ordinarily the fish bone will pass down. If it does not
contact an ENT specialist. Children should be given fish to eat after
removing all its bones.

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MODERN SCIENCE AND THE DISEASES OF EAR
NOSE AND THROAT

NOSE
1.

ENDOSCOPIC EXAMINATION OF NOSE

Fantastic developments have taken place in the diagnosis and treatment
of the diseases of nose. With the use of Endoscopes, the interior of nose
can be checked in detail which otherwise was not possible. Now, the
endoscope has greatly facilitated the diagnosis and treatment of the
diseases concerning interior of nose; e.g. deflection/deviation of bone,
polyp formation, causes of nose bleeding, sputum and sneezing. This
process can be seen on TV screen by the patient and his attendants as
well. Another important development is that after operation of nose
gauze packing is not necessary. Because of this, patient can breathe
through nose normally.

MICRODEBRIDER

This is hand held machine that cuts and sucks simultaneously. Mostly
used with nasal endoscopic surgery.

USE OF LASER IN ENT

CO 2 (carbon dioxide) LASER is the most commonly used laser in the
E.N.T. Different diseases of ear, Nose and Throat can be treated
effectively with minimal blood loss. It is very effective to vaporize
tissues and give a bloodless field. During operation, tissue damage is
minimal and hence postoperative recovery is rapid with less pain. It is
very beneficial in patients with bleeding disorders. Other LASERS
like Diode are also used.

COBLATION

It acts like energy based knife. It cuts tissue at low temperature leading
to less damage to surrounding tissues. It is getting popular after LASER.

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