Facial Fractures and Nasal Fractures: Evolution and Management

Face, the most salient part of the body is the sole identity of a person. First impression is the best impression pertains to the physical appearance even before one’s attitude and facial contacts are the prime source of greetings between individuals. Moreover, face mirrors the inner thoughts. One can see, think, hear, smell and eat through eyes, head, ears, nose and face is the platform for these parts. Serious complications attributing facial injuries are facial fractures.

Facial fractures are usually caused by vehicle accidents, sports injuries during sporting activities such as boxing, wrestling etc., or due to assaults, gunshots or stabbing. Whatever the cause may be, evaluating the type and intensity of facial fractures and effective management through advanced medical procedures is highly recommended for better cure and to preserve your identity.

It should be noted that displaced facial fractures hindering organ functions are the most serious concerns for surgeries.

Though eye, ear, cheek bones are some of the other facial fractures we shall discuss on nasal fractures - diagnosis, treatments and other nasal related surgeries such as sinus surgeries, snoring surgeries,  cosmetic nose surgeries to alter the nose shape and advanced surgical methods such as laser surgeries for nose related complications.

1. Symptoms of nose fractures include pain, bruises, swelling, breathing anomalies, nose bleeding or nasal septum called as septal hematoma, broken bone in the nose usually referred as ethmoid bones are serious concerns.
2. Diagnosing through a CT scan are ideal methods for any facial fracture rather than X-Ray studies.
3. Cartilage injuries and changes in nose shape are of less concern as it gets resolved in course of time except for the change in shape for which remedies are recommended, if patients are really concerned. Healing period is usually from one week to ten days.
4. Sinus - these are empty spaces that help the mucus drain down the nasal passage. Hindering this function results in sinusitis. Dysfunction may occur due to problematic tissues, any abnormal bone growth, blockage due to foreign objects or any polyp growth. Treatment involves removing the problematic tissues, bones or polyps. Usually an endoscopic sinus surgery is done by inserting a tube through the nose and conducting the surgery. Some of the benefits include - avoids open incisions, better clarity during procedures through endoscopy, less pain, swelling and discomfort.
5. Surgery for snoring has become common as in western countries. Snoring surgeries referred to as somnoplasty are recommended for sleep apnea conditions. Snoring occurs due to the vibration of uvula and soft palate during air passage from nose to the lungs. This is a heat procedure that reduces the stiffness of the uvula that hangs at rear of the mouth and soft palate that is present behind the ceiling of the mouth.
6. Nose surgery in India has become common at affordable cost. Rhinoplasty and Septoplasty are two common nose surgeries in India. Change of nose shape, nose tip, birth defects, functional anomalies such as difficulty in breathing, nose bleeding - all can be rectified through nose surgery in India.
7. Technology advancements paved way to laser nose surgery and nose shape surgery in India thus reducing pain, discomfort, swelling etc., though not all nasal problems are done with laser surgical methods. Usually cosmetic surgeons adopt laser surgery methods for nose shape surgery India usually referred to as nose jobs.

Thus, facial fractures as treated based on the intensity and abnormal functionalities. Bear in mind, all surgeries result in complications post surgery. So, next time when you complain nasal pain, swelling or bleeding consult your doctor immediately as early detection always helps in successful cure and relief from pain.

When should you consult your allergist?

Allergies or allergic diseases occur as a heightened reaction by our immune system in response to certain foreign substances that are harmless to most people, but can trigger a hypersensitivity reaction in someone who is sensitive to it. Substance that causes allergy is known as allergen. The immune system is the defensive guard of the body whose main function is to provide protection against foreign invaders such as bacteria, viruses or any other type of infection. It works by recognising the allergen and inducing an immune response through production of antibodies. Antibodies or immunoglobulins (Ig) are protective proteins that specifically target against particular antigens by attaching to its (antigen’s) surface thereby helps in their recognition and destruction by other immune cells. The antibody involved in allergic reactions is IgE.

Though allergies can develop at any age, it is more common in children and people who have family history of allergies are more prone to it. Most commonly involved allergens are pollens, dustmites, animal dander, certain food products (eggs, peanuts, soy, shellfish etc.), insect bites, latex and even some medications. Most common allergic diseases are Allergic Rhinitis (nasal allergies), Allergic Asthma, Allergic Conjunctivitis (eye allergies), Dermatitis and food allergies.

We can come in contact with allergens through skin (causes contact dermatitis),eyes(conjunctivitis), nose(rhinitis), mouth and stomach. The allergy attacks may vary from mild to severe and even life threatening anaphylactic reactions depending on severity of allergen attack and body’s response towards it. Symptoms of allergic rhinitis, asthma and dermatitis are:

Allergic rhinitis (Hay fever): It is the most common allergic reaction due to inhalation of allergens such as dust mites, pollens, and animal dander etc. Symptoms occur due tp the inflammation of nasal tissues when exposed to aero-allergens. Sinuses, throat, eyes and ears can also get affected. Most commonly seen symptoms are:

• Sneezing

• Runny nose

• Stuffy nose due to nasal obstruction.

• Itchy nose, eyes, mouth, throat, and ears.

• Watery, red and swollen eyes.

• Post-nasal drip.

• Fatigue (due to above mentioned symptoms).

Asthma: It is a respiratory disorder that occur due to inflammation and hypersensitivity reaction of air passages causing recurrent and reversible narrowing of air passages leading to difficulty in breathing. Most common symptoms are:

• Breathlessness.

• Wheezing.

• Coughing(especially at night)

• Tightness, pain or pressure on chest.

• Difficulty speaking.

Dermatitis: Dermatitis literally means inflammation of skin. It occurs when we come in contact with the irritant that triggers the allergic reaction. Commonly seen symptoms are:

• Sudden,painful red rash.

• Itching.

• Burning and swelling in the rash.

• Fluid oozing and skin crusting.

• Blisters/ulcerations.

• Dry cracked scaly skin due to extreme dryness.

• Tenderness.

The prime most step in Management involves detection of the allergen. The allergist will take the detailed history about work, home environment, eating habits, family’s medical history, frequency and severity of symptoms. Skin tests can also be performed which is the easiest, affordable and quick way to identify the allergen.

Treatment for allergic rhinitis: The best way is to limit the exposure to irritant.

• In case of pollen allergy, outdoor exposure should be limited when the pollen counts are high.

• Pollen masks and sunglasses should be used to minimize exposure.

• In case of dust mite allergy, the beddings should be washed frequently.

• In allergies with mold, level of humidity should not exceed more than 50%.Instead a dehumidifier can be used in damp, humid places.

• Medications involve: 

1. Antihistamines: Group of medicines to counteract the harmful, irritating effects of histamine produced in the body during allergic reaction.

2. Immunotherapy: To boostbody’s immunity to build resistance against the harmful effects of allergen.

3. Intranasal corticosteroids to reduce nasal congestion, stuffy and runny nose.

In allergic rhinitis sometimes sinus can also become swollen, congested and inflamed to remove any inhaled irritant responsible for triggering allergy leading to allergic sinusitis. Allergic sinusitis’s treatment involves medication with antibiotics, nasal decongestant sprays, antihistamines, nasal saline washes and topical nasal corticoids.

When you come across any of these symptoms very often, it is always preferable to consult the allergist to find immediate remedies for your problems. 

For more information, mail us: info@vikramenthospital.com  /  call: +91-422-2550633

Flu Vs. Cold

Flu and cold both have almost common symptoms but they are not similar. Flu can be more dangerous than the cold. This article discusses the differentiating factors of the common cold and the dangerous flu.

Flu:

Flu, known as Influenza causes by the Influenza virus. It is the lower respiratory tract infection including nose, throat and lungs of the person. About more than 10 million cases are found suffering from flu in India every year. And, about 30,000 people die due to its complications every year. It is highly infectious and can be life threatening in people with other lung or related complications.

Causes:

Influenza virus is differentiated into three types -Influenza virus A, Influenza virus B and Influenza virus C. These viruses are highly infective and can live on the surfaces for several hours. Even a single droplet of aerosol measuring about 0.5 to 5 μm can infect a person.

The virus infects person through 3 modes of transmission

1. Direct transmission - The infected person passes mucus directly on the other person by sneezes or coughs.

2. Airborne transmission - Where the person inhaling the aerosols of infected person sneeze, cough or spit get infected by it.

3. Hand-eye, Hand-nose, Hand-mouth transmission - Where the person gets infection by touching the contaminated surface or use pens, books, knobs etc and then touches his eyes or mouth or nose thereby acquiring the infection.

Risk group:

Although it can infect any person, the highest risk group of infection are children, pregnant women, old age people, and people with chronic respiratory diseases and in patients with less immunity like HIV and in people with chronic steroids.

Symptoms:

Usually symptoms appear about 2-3 days after the exposure of the virus. It usually lasts up to 2-3 weeks. Common symptoms for flu are headache, fever ranging between 100-103°F, cold sweats, shivers or chills, muscular aches especially severe joint pains, nasal watery discharge, sneezing, nasal congestion, sore throat, irritation in the eyes with watering, dry cough and extreme weakness. In children there can also be gastric disturbances like nausea, vomiting and diarrhoea present.

Complications:

Flu can be life threatening when not treated early and can lead to the complications like emphysema, viral pneumonia or secondary bacterial pneumonia, COPD, bronchitis, ear infections like otitis media and many other chronic conditions are triggered or aggravated during this period such as cardiac diseases like coronary heart diseases, congestive cardiac failure, metabolic disorders like diabetes, HIV, cancer, liver diseases and kidney diseases.

It may also lead to the condition called Narcolepsy, a neurological disorder where the person will have excessive sleeping spells irrespective of time and place. It is noted that almost about 2 lakh people get hospitalized for the complications every year.

Diagnosis:

• Usually it gets difficult to diagnose between the cold and flu, but careful history and symptoms can be helpful in diagnosing.
• It is also diagnosed through the viral culture done by the samples taken from nose, mouth and sputum. 
• A rapid card test called Rapid influenza diagnostic test is also conducted where the results are obtained within 30 minutes of the sample collection.
• A polymerase chain treatment can also be done for the accurate diagnosis of the case.

Prevention:

World Health Organization (WHO) has recommended vaccinations for flu every year in adults, but it is partially effective.

Clean hands with soap after direct contact of the infected person.

It is advisable for flu patients to avoid social gatherings.

Treatment:

• The treatment for flu include both conservative line of treatment and the oral medications.
• In conservative line of treatment, doctors advise to increase the fluid intake and adequate rest.
• Oral medications include the anti-viral drugs like Tamiflu and Relenza which are mostly recommended. Analgesics, decongestants and cough syrups are used according to symptoms.
• Aspirin should be avoided in children as this may lead to Reye’s syndrome.

Common Cold:

Cold is the most commonly seen infectious disease. About more than 10 million people are affected by common cold every year in India. It is usually low-risk infectious viral disease.

Causes:

It is disease caused by about 200 viruses. The most commonly seen viruses are rhinovirus, corona virus, adenovirus, respiratory syncytical virus and the para influenza virus. It is an upper respiratory tract infection including nose and throat. It is usually self-limiting and lasts for about 7-10 days.

Symptoms:

The symptoms of cold are sneezing, thin watery nasal discharge, watery eyes with irritation in the eyes and nose, nasal congestion, sore throat, fatigue, body ache and loss of appetite. Sometimes in the later stages there may also be yellow or greenish nasal discharge. But in children cold usually be associated with fever.

Complications:

As this is a self-limiting disease, it does not have any other complications.

Diagnosis:

It is usually self-diagnosable by the signs and symptoms. No tests are required for the diagnosis of the disease.

Prevention:

• Avoid exposure to cold weather for those who are sensitive to cold weather and cold winds.

• As the infection spreads through air, by the sneeze and cough droplets of the infected person, personal hygiene is to be maintained and use of face masks can be helpful.

• Avoid direct contact with the infected person.

Treatment:

Cold treatment includes the first line of treatment such as drinking plenty of fluids. In case of sore throat, gargling salt water can be helpful. Other symptoms require symptomatic medicines like analgesics or decongestant sprays. No antibiotics are required for the common cold.

Acquired Hearing Loss - An Overview

Acquired hearing loss is the hearing loss that occurs after birth and can happen at any point of time in one’s life. Acquired hearing loss can appear suddenly, after having previous normal hearing because of illness, injury or toxic medications. Sudden hearing loss can be very challenging for children as it can greatly affect their learning and development. Child can also experience depression, fearfulness and show behavioural changes. Hearing loss affects the quality of life of adults as well. Unmanaged hearing loss can have an overall impact on education, employment and general well-being of the individual.

The most common causes of acquired hearing loss are:

1. Ear infection (otitis media).
2. Eardrum perforation caused by untreated ear infection, head injury or blow to the ear.
3. Middle ear blockage usually due to accumulation of wax.
4. Illnesses and infections such as Meningitis, Measles, Mumps, Chicken Pox, Influenza, etc.
5. Prolonged exposure to noise.
6. Head injury.
7. Certain drugs and medications.
8. Cysts and tumours within the ear canal.
9. Aging.

Types

Ear is divided into three parts outer, middle and inner. 

• Hearing loss associated with outer and middle is termed as conductive hearing loss. 
• Hearing loss concerned with inner ear is termed as sensorineural hearing loss. Sensorineural hearing loss may be permanent in nature. 
• Mixed hearing loss: Some people have both conductive and sensorineural hearing loss.

Hearing loss symptoms
In case of sudden hearing loss, the ability to hear will decrease or disappear (completely) at once, from the affected ear. In case of gradual hearing loss, at first the person may have difficulty in understanding conversation, due to which may ask others to repeat frequently or may also misunderstand the conversation. Due to decreased ability to hear, person’s family may complain about loud TV or music.

Hearing loss due to certain ailments and conditions can also produce additional symptoms, which include:

1. Tinnitus(ringing in ears)
2. Deep earache
3. Discharge or bleeding(from ear)
4. Stuffiness inside ear
5. Dizziness
6. Nausea

Treatment and prevention
After proper diagnosis, that is identifying the type and measuring the degree of hearing loss, various treatment options are suggested to patients to improve their hearing ability. In case of temporary hearing loss, the underlying cause of hearing loss has to be treated first e.g., in case of infection, antibiotics are recommended. For blockage with earwax, earwax has to be removed. In case of permanent hearing loss treatment options available are:

1. Hearing aids: It is the easiest and most commonly offered treatment option for hearing loss and proved to be highly effective in age related deafness. These are electronic instruments that can be worn inside or behind the ear. Hearing aids amplify the sounds and thus improve deafness. Usually it takes some time to get used to hearing aid as things might sound little different initially.
2. Cochlear implants: In case of severe hearing loss  surgical intervention is required in which a cochlear implant is placed in the inner ear that will help converting the perceived sounds into electrical signals which can then be transmitted to brain and thus sound sensations are perceived. Cochlear implant can be recommended in one or both ears depending upon the severity.
3. Assistive listening devices (ALDs): ALDs are sound amplifying devices in cell phones, telephones and can be implemented in places like theatres and auditoriums.
4. Speech reading: People dealing with hearing loss can be trained for this in which they need to pay close attention and watch how the speaker’s lips and body are moving. This will help understand conversation little easily.

Hearing loss can affect the person at personal and professional levels, disturbs the emotional well being of person and thus has an overall negative impact on general well being of individual. By taking the below mentioned precautions, hearing loss can be prevented:

1. Protection from prolonged loud noise.
2. Never put any foreign objects inside ears.
3. Protection from head trauma. Wearing helmets and seat belts while driving.
4. Consult the doctor before taking any serious medications.

Nasal Polyp - An Overview

If you have got the nasal obstruction, or got the repeated sneezing since a long time then you got to blame Nasal polyp. Not necessarily it is the only cause, but most cases will be due to the nasal polyp. Yes, nasal polyp is an outgrowth of the soft tissue within the nasal cavity. It is usually diagnosed when taken for clinical examination for other symptoms like mouth breathing in children or for acute episode of chronic rhinitis.

Incidence of Nasal Polyp

It is a most commonly seen disease. Every 3 of 20 cases in a day in outpatient department of ENT branch are the cases of nasal polyp. There is no age limitation in nasal polyp as it can be seen very commonly from the new born to adults.

What is a Nasal Polyp?

Nasal polyp is the non-cancerous soft tissue growth or the fluid collection results in the formation of the polyp. They are usually seen as soft, pedunculated mass. It is the result of the increased cell growth of the soft tissues. It has no sensation and are non bleeders. They are usually not painful and can be seen in single nostrils or in both the nostrils.

Causes of Nasal Polyp

Nasal polyp may be the result of the accumulation of the fluids or mucus within the nasal cavity due to the sinusitis, chronic rhinitis and due to the long term effects of drugs like aspirin.

Symptoms of Nasal Polyp

The symptoms of polyps in nose includes the severe nasal obstruction leading to the mouth breathing in children and in some adults, there is also decreased or complete loss of smell where the person with polyp will not be able to smell anything as a result he cannot enjoy the food and this affects his appetite too. And there is a post-nasal drip where the mucus gets accumulated and drains back in to the throat giving a strange sensation every time. The nasal polyps also results in the repeated nasal allergies like allergic rhinitis commonly associated with frequent sneezing, thin watery discharge from the nose and the dull headache.

Diagnosis

As the nasal polyps are non-painful, they are detected accidental for the other symptoms like nasal congestion or nasal obstruction. A simple X-rays is done for the examination of the paranasal sinuses helping in the diagnosis. It is also confirmed through CT scans which can give the exact location and extension of the polyp. It also helps to differentiate with the other diseases like carcinogenic growths, fungal infections or angiofibromas.

Treatment

The sinus infection treatment becomes the utmost importance before treating the actual nasal polyp. The sinusitis being the main cause for the nasal polyp to be treated in early cases. When this is neglected or continued for many years, it may result in the formation of the polyp. It is usually treated by the administration of corticosteroids, antihistamines, decongestants and with antibiotics.

If the symptoms still persists then do not delay in consulting an ENT specialist for the further treatment of the nasal polyps. The specialized doctors opt for nasal polyp surgery only when the other conservative methods fail and there is no further improvement in the patient.  

Surgery involves the nasal polyp removal, this is the final method opted for the treatment of nasal polyps. The removal of nasal polyps includes 2 procedures Functional endoscopic sinus surgery where all the polyps are removed under endoscopy. And the other method involves nasal polyp removal under local or general anesthesia called as Nasal Polypectomy.

For more information, mail us: info@vikramenthospital.com  /  Call: +91-422-2550633

Ear discharge

Ear discharges are the most common symptom in the ear problems. About more than 10 million cases in a year suffer from the ear discharges. Ear discharges may lead to loss of hearing in many cases. Ear discharge is common among all age group. It can affect from the children to the aged people.

The causation for the ear diseases may be of acute origin or the chronic reasons. The most common causes include the foreign bodies, middle ear infections, injury to the ear drum or the other allergies like Eczema. The discharges may be thick, whitish or yellow in colour. They are thick and foul smelling in nature. It may be occasionally blood stained. Ear discharges are the most common symptom if the disease or infection is involved in the ear.

Ear infections

Ear infections or the Otitis Media are the most common cause for the ear discharge in many people. It is usually acquired or congenital. In this condition there is a keratinized growth of squamous epithelium in the middle ear called as Cholesteatoma. In complications it may be associated with hearing loss, facial palsy, CNS dysfunctions and vertigo. Causes include Viral, bacterial and fungal infections like E. coli, Staphylococcus aureus, Candida albicans, Rhino virus etc. Many risk factors also include smoke exposure and Nasal discharges, where the force blowing of the nose will lead to middle ear infections. Symptoms include ear discharge with foul smelling and white or yellow discharge, ear pain, Fever, tinnitus, Loss of hearing and poor sleep.

The treatment for the ear infections includes the analgesics, topical ear drops and antibiotics for the pain, fever and discharge. The medications for ear infection include Ibuprofen, Paracetamol, drops with Benzocaine are advised by the ENT doctors. If there is chronic ear infection for more than a year then surgical procedure like Radical mastoidectomy with cavity obliteration is followed under trained and professional ENT specialists and for irreversible hearing loss, hearing aids are provided.

Treatment of Ear discharge

The treatment for other diseases involving the ear discharge depends on the cause. In some cases, the child unknowingly pushes the objects like seeds, nuts, peas or cotton and in adults insects like cockroaches, moths, and flies get in to the ear and start the problems like pain, tinnitus with foul smelling discharge from the ears. This has to be removed with the great tactfulness and only by the ENT surgeons. Other causes like rupture of the ear drum or any injury to the ear drum can also leads to the discharges and sometimes bleeding too.

The ear discharge treatment is usually done on the basis of the cause involved. In case of only discharge with no pathological indication then cleaning, suction and dry swabbing is done but if there is rupture of the ear drum then surgery of the injured tissue is done. Common medicines for ear discharge involves analgesics and antipyretics such as paracetamol, ibuprofin, aspirin and opioid drugs and antibiotics like Amoxicillin is frequently used in the treatment of the ear discharges. In severe cases Corticosteroids are applied in form of topical ear drops. Tympanoplasty and Tympanic membrane repair or the ossicular reconstruction is done.  

For more information, mail us: info@vikramenthospital.com / call: +91-422-2550633

Sleep Therapy

Sleep is a state of unconsciousness in which the person can be aroused by the sensory stimuli. A good sleep is very much necessary for the proper functioning of the brain and Human body. A man requires about 7-8 hours of sleep, if there is continuous disturbance in the sleep then it may lead to behavioral abnormalities, cardiac diseases like hypertension, stroke and cardiac arrest, metabolic diseases like Diabetes and irritability, restlessness, anger and other altered behavior.

Sleeping also has the positive effects on our human body. It is been proved that in sickness we sleep more just to relax our body and brain and in turn this helps the immune to build up to fight against diseases. This sleep is disturbed by many reasons primarily being the Sleep Apnea and Snoring disorders. This disturbance can be treated by the sleep therapy for the individual causes.

The specialized and trained ENT doctors are striving each day hard to relieve the sleep disorders and get the new innovative devices and therapies for the following diseases.

Snoring

Snoring is a condition where there is a vibration of sounds due to the airway obstruction of the pharyngeal walls. It may be due to thickening of the walls of pharynx as in Obesity, or due to any other obstructions like large tongue, Tonsillitis, Adenoids, Nasal polyps and Deviated nasal septum. Though sleeping do not have any immediate effects on health, a long time sleep disturbance leads to cardiovascular diseases. It may affect anyone and in any age group. Female attaining Menopause also gets Snoring due to hormonal changes.

Sleep Apnea

When there is a severe obstruction of the air way by the complete air entry stoppage leading to the breath gasping, it leads to a condition called Sleep Apnea. This can be acute attacks with instant air blockage during sleep where the patient gets up from sleep, takes breath and sleeps again. This attacks may be of 10 seconds with repeated frequency of about 30 bouts in a duration of 6 hours of sleep. This Obstructive sleep apnea is a complete sleep disturbance. The patient repeatedly wakes and sleep leading to poor and restless sleep.

The long term effects of Sleep Apnea leads to many accidents like car accidents while driving or industry accidents due to the disturbed sleep and sleeplessness in the previous night. This also leads to the altered and poor performance in the next day work. Other effects also include Heart related diseases like Hypertension, stroke and cardiac arrest.

The sleeplessness disorder may be due to the obesity and other diseases like Adenoids, Nasal polyp, Tonsillitis, large flabby tongue, loose pharyngeal walls and Deviated nasal septum. These diseases are manageable and treatable depending on the cause.

Treatment for Sleep Apnea & Snoring

The sleep apnea treatment depends on managing the cause of the disorder. In severe cases of Obesity, weight reduction can be helpful. Continuous positive air way pressure (CPAP) is administered to the patient, a device where the patient is connected to the ventilator where there is continuous flow of air making him get sound sleep. Though this is most effective it is not well accepted by the patient due to the discomfort.

The treatment of Snoring depends on the cause involved. Surgical methods are followed in cases of any anatomical obstructions like Adenoids, or polyps or Deviated Nasal septum. In some cases with loose pharyngeal walls, tissue tightening or wall stiffening methods are followed. There are even devices like Fitness Trackers which are helpful to record snoring time and proper sleep.

For more information, mail us: info@vikramenthospital.com / call: +91-422-2550633