Cauliflower Ear

Have you ever wondered why wrestlers and boxers wear a headgear?

Headgears ensure protection to their ears. Blunt trauma to ears can give rise to a clinical condition known as ‘Cauliflower Ear’

What is Cauliflower ear and its cause?

Auricular hematoma also known as ‘cauliflower ear’occurs subsequent to any physical trauma to the auricle or the external ear. As a result of the direct injury, there is hematoma formation or accumulation of blood between the perichondrium (tissue surrounding bone or cartilage) and the cartilage. Clinically there is prominent redness and swelling which if left untreated, leads to the formation of a fibrocartilagenous mass with a characteristic appearance known as ‘Cauliflower Ear’. This disfigurement of the ear can be irreversible if not attended or managed immediately. 

What are the causes and complication of the cauliflower ear? 

Cauliflower ear is a consequence of a closed blunt trauma or any direct hit to the auricle leading to the hematoma formation. Although it is frequently witnessed in sports persons, one can suffer from it, following any injury or infection to the ear.  Due to the  accumulated blood (hematoma), the nutrient and the blood flow to the healthy surrounding tissue gets compromised, if not cured, gets the skin separated from the cartilage which disfigure into a shrived up structure or mass or deformity referred as cauliflower ear. 

Ultimately, there is necrosis or death of the cartilage, which further increases the susceptibility to infection.Some studies have also reported that subperichondrial hematoma can stimulate the formation of new asymmetrical cartilages. 

What are the symptoms of cauliflower ear? 

The symptoms largely depend on the extent or the severity of the injury. Most common findings are pain, bruising, swelling, and a deformity in the curvature of the ear.  Severe cases may present with findings such as facial swelling, uncomplicated rupture of the ear drum, loss of hearing and facial palsy or paralysis of the facial muscles. 

How is cauliflower ear treated? 

Although this deformity is permanent or irreversible in nature, immediate management can prevent the injury advancing into the cauliflower ear. The goal of treatment is to ease the blockage so that blood can again flow normally into the injured tissues. The treatment strategy is to reduce the inflammation, drain blood from hematoma, minimize infection and re-establish the lost connection between the skin and the cartilage.

What to do for an immediate Management? 

Quickly following any ear injury, applying ice to the affected area reduces the chances of swelling. Seeking medical management at earliest reduces the chance of deformity or the cauliflower ear. 

Medical Management

Medical management is accompanied by both surgical and pharmacological approach. The hematoma drainage is performed by making a small incision into the mass. Stiches are applied to reconnect the tissue with the cartilage and a pressure dressing is applied. The site is monitored to eliminate chances of infection and any further complication.  Antibiotics are prescribed to rule out chances of infection and facilitate healing.

How to avoid or protect oneself from cauliflower ear? 

For wrestlers and sportsperson wearing protective headgear and helmets are imperative to avoid this clinical condition. For common people wearing a helmet can keep them protected from any direct injury which can attribute to auricular damage or head injury.  

In case one witnesses any minor or major injury to the ears, visiting the specialist at the earliest for definite care can avoid such clinical scenario. 

Migraine- the head pricking headache

Ads of migraine painkillers are prominent on television channels; hence we can deduce that migraine is a common disorder. Reports show that, this throbbing pain is experienced largely by people in the age group of 35-45 years. Compared to men, women are more frequently affected due to their drastic hormonal changes.

Usually you would begin to feel vaguely sick a few days before the migraine. The symptoms could be piercing pain in the arms and legs, irritability, food cravings, tiredness or high sensitivity to light and sound. Migraine induces severe pain in the head and is usually followed by nausea.

Migraine Causes

• It has been proven that consuming certain kind of food items can trigger migraines. The food list includes – red wine, chocolates, cheese and MSG.
• Hormonal imbalances – As mentioned above an imbalance in hormones is the common reason for migraines in women. Women are likely to experience it during their first menses, during pregnancy or post-delivery.
• Hectic routines and stress 
• Insufficient water intake. Skipping meals
• Irregular sleeping patterns
• Changes in climate

Symptoms of Migraine

• Throbbing pain in the head that lasts for up 2-3 days
• Severe headache usually on one side
• Feelings of nausea or vomiting
• Increased sensitivity to light, smell and sound

Diagnosis

There is no specific test for the diagnosis of migraine. You need to consult a head and neck doctor or an ENT surgeon who will conduct a series of tests to determine whether the headache is caused by any other underlying illnesses.

Treatment

The treatment for migraine is simple – doctors usually prescribe painkillers. 

• Over-the-counter medicines – drugs like paracetamol, ibuprofen and aspirin are effective in relieving migraine symptoms. But if you experience frequent headaches, do not do a self-diagnosis but instead get checked by an expert. Preventive medicines are also available for treating migraines.
• Botox treatment – Don’t be surprised, you read right. Botox injections help treat the imploding aches in the forehead and at the back of the neck. Botox injections are usually administered for those who have migraines induced due to stress and tension. Also note that this option does not work if you are experiencing the pain on top of the head, behind the ears, between the eyes or on the cheeks. Also pregnant women and Myopathic and Neuromuscular disorders, do not qualify for this treatment. 
• Cognitive Behavioral therapy – During a CBT treatment, a professional therapist will help the patient manage and prevent negative thoughts and behavior. Negativity plays a key part in building anxiety and stress which eventually cause migraine. 
• Holistic approaches – Relaxation techniques such as meditation, yoga, deep breathing exercises and stretches have shown to ease the symptoms. Acupuncture is also a highly sought-after treatment for migraine. However, it is best to discuss with your physician before you try acupuncture.

Since prevention is better than cure, it is wise to take measures to prevent a migraine rather than popping pills for the same. If you experience headaches on and off, you could make recordings to find out what the trigger is. This would help prevent migraines in future. 

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