Vertigo - Causes and Treatment

Vertigo is a common medical ailment that gives the feeling of being rocked, whirled or objects moving around when actually they are still. It usually occurs due to inflammation of the inner ear or problems in its balancing function. Sometimes, it may also arise due to issues in certain brain areas. Symptoms of Vertigo include dizziness, disorientation issues, a feeling of being in spin and giddiness. The continued symptoms sometimes result in vomiting and tinnitus (ringing sound in the ears).

Causes of Vertigo

• Labyrinthitis - Viral or bacterial infections in the inner ear which may also result in hearing loss.
• Head injury that is either ignored or inappropriately addressed.
• Vestibular Neuronitis- Inflammation of vestibular nerve which connects the inner ear to the brain. This nerve transmits messages and controls the balancing function.
• Benign Paroxysmal Positional Vertigo (BPPV)  which is triggered by certain head movements.
• Meniere’s disease – A rare condition that affects the inner ears resulting in hearing loss, tinnitus and a high pressure feeling in the ear(also called aural fullness).
• Side effects caused due to certain medications.

Vertigo Treatment

A plethora of treatments are available for Vertigo and the precision of the cure is being enhanced day by day, thanks to the new inventions in modern medical science.

1. Medications

• During the initial stages, the Vertigo symptoms can be treated with a variety of medications like oral medicines, patches placed on the skin, intravenous (IV) drugs and suppository.
• Specific remedies like
• Antibiotics for infection of middle or inner ear.
• Giving low salt diets and medications for increasing urinary output for Meniere’s Disease patients.
• Surgical remedies are suggested by ENT (Ear Nose Throat) specialists for recurring/persistent infections due to holes in the inner ear.

2. Certain Physical Therapies are recommended mostly for BPPV patients like

• ‘Epley maneuver’ which is a vestibular rehabilitation therapy .This is an exercise wherein the patient is required to sit on the table edge and then lie down to one side. This step is repeated multiple times on the same and opposite sides until the vertigo symptoms diminish.
• Particle repositioning in which the head is repositioned to ensure the restoration of tiny displaced stones in the vestibular system of inner ear to normal position. This repetitive exercise is done until abnormal eye movements’ stop.

3. Self-Care Measures and Remedies at home
(To be adopted at home after appropriate diagnosis of vertigo and under adequate medical supervision.)

• Doing a modified version of ‘Epley maneuver’ at home after receiving proper instructions from therapists.
• Taking vitamin D supplements (specifically for BPPV patients).
• Consuming plenty of fluids daily.
• Using natural herbal remedies like ginger and coriander.
• Undergoing Acupuncture Therapy for some types of vertigo.
• Avoiding substances that adversely affect blood circulation like tobacco, alcohol and caffeine.
• Additionally, some essential oils like ginger, peppermint, lavender and frankincense may relieve vertigo symptoms.

Lump in the throat

Have you ever suffered from an unusual feeling or sensation of lump in your throat that might have subsided on its own? Let’s find out in this blog what that unusual feeling is!

The sensation of lump in the throat is a common problem people complain about. This feeling is often described as irritating but is not associated with any pain or physical discomfort. Sometimes people also experience a feeling of a lump or swelling without the presence of any lump or swelling in the throat. This condition is known as “Globus Sensation”.

What causes the lump sensation?

The exact cause for this condition is still not clear and remains questionable. However studies have associated this condition with many factors outlined below:

Aberrant Muscle coordination

Any abnormality or in coordination in the functioning of the throat muscles may induce a feeling of muscle tightness in the throat.

Gastric Reflex

Stomach acid entering your oesophagus is also capable of giving rise to muscle tension or swelling in the tissue surrounding the throat. This eventually may feel like a lump or tissue in the throat.

Stress and Anxiety

Many studies based largely on women, have also suggested that a persistent feeling of stress, depression or anxiety may trigger globus sensation. Studies have also confirmed that globus sensation in men is associated with psychopathology like depression and somatic disorders.

Mucosal Lesion and underlying pathological mass

A mucosal lesion which often occurs as a result of trauma or an ulcer can also induce the lump sensation in an individual. A mucosal lesion is a result of trauma or an ulcer. Certain kind of mass like tumor, cysts, granuloma, or enlarged thyroid may predispose to this feeling.

So, is this lump serious?

This lump is a benign condition and do not involve any severe complication. However, some other conditions may present initially as globus sensation so it is important to seek medical care when globus sensation is associated with other symptoms like pain, dysphagia (difficulty in swallowing), lump mass, fever, or weight loss to rule out any other clinical condition.

What are the symptoms of the globus sensation?

The usual symptom is the sensation of a lump in the throat which can come and go. It is usually felt in the front of the neck and can move around, usually up or down. It does not affect eating or drinking and, in fact, in some people, symptoms can be relieved by eating or drinking. There is not usually any pain present in the throat. Many people with globus sensation notice the symptoms most when they are swallowing their saliva.

How is the lump in the throat detected or diagnosed?

An ENT specialist should be consulted in case you have a persistent feeling. A diagnosis for exclusion of any underlying condition is must. A special equipment known as nasolaryngoscopy is placed through the nose to carefully examine the mouth, nose and throat. Sometimes, if the diagnosis of globus sensation is not clear, various other investigations like chest x-ray, oesophageal manometry, videofluoroscopy or barium swallow test may be employed to rule out other pathology.

How is globus sensation treated?

As such there is no definite treatment for globus sensation due to the idiopathic nature of the disease.Some of the recommended treatments include:

Muscle Therapy

Depending upon the cause, an ENT specialist or speech therapist may be required for appropriate physiotherapy to improve the muscle movement.

Treatment for gastric reflux

Patients with the gastric refluxes are likely to have a treatment with antacids and acid regulators to eliminate the acid regurgitation in the throat.

Treatment for reducing stress and anxiety

In people suffering from stress and anxiety: psychological counselling or medical management with antidepressants is undertaken.

Quit Smoking

Smoking is associated with many health hazards, quitting this habit is also one of the preventive approach for the globus sensation. 

Vocal Cord Cysts and Polyps

What are vocal cord cysts and polyps?
Vocal cord cysts and polyps also referred as vocal fold lesions are non-cancerous, benign (localised) abnormal growth on the vocal cord.  Vocal cord lesions are primarily divided into three types: nodules, polyps and cysts. They are particularly common among people using voice as part of their profession for instance hawkers, singers etc.  Pulp polyp and cysts may attribute to voice disorders.

  
What causes vocal cord cysts and polyps?
Although vocal cysts and polyps remains an idiopathic (cause unknown) disease, some evidences have linked the cause with the vocal abuse. A heavy traumatic use of the vocal cord, like shouting or yelling, speaking loudly, and coaching, high pitch voice may lead to this clinical condition. Other factors involved are certain kind of allergies, alcoholism, smoking, muscle tension, caffeine intake etc.

What are the symptoms or manifestations of vocal cysts and polyps?
The symptoms of vocal cysts and polyps include loss of voice pitch, hoarseness, breaking of voice, frequent throat clearing, delay in voice initiation, raspy voice and fatigue of the voice.

Vocal cord polyps
A vocal cord polyp is commonly found on one vocal cord (unilateral), but it may develop on both cords. They often resemble blisters and have a characteristic red colour due to surface dominated by blood vessels. They frequently result from an initiating acute phonatory injury. Their effects on the voice are wide-ranging, depending on the type of polyp.  Most polyps must be surgically removed to restore a normal voice. A distinct type of vocal cord polyp known as Rinke’s edema or polypoid corditis is found in patients with smoking habit.

Vocal cord cysts
A vocal cord cyst is a tissue mass, localized within the vocal cord membrane. It can be seen both on the surface or deeper into the segment.  Vocal cord cysts are differentiated into: epidermoid cysts and mucus retention cysts. The size and location of vocal cord cysts has a linear impact on the extent of the disruption of vocal cord vibration and the severity of the voice problem or hoarseness in the patient.

How are vocal cysts and polyps diagnosed?
The diagnosis is based on the history of the voice issue or complication narrated by the patient, following which a thorough examination is performed by the otolaryngologist.  The vocal cords are also evaluated for any underlying medical conditions that may affect the voice (e.g., reflux laryngitis, allergic rhinitis).Diagnostic procedures like laryngoscopy having a stroboscopic light source are employed to examine the vocal cords. In this procedure, a telescope-tube is approached through the mouth of the patient until the vocal cords allowing the doctor to assess the voice box. The images can be recorded on video.

What is the treatment for vocal cysts and polyps?
The management approach can be both medical and surgical depending upon the severity of the case. The patient may be placed on voice rest, voice therapy. In a typical management plan, a patient can be scheduled a period of vocal rest with steroid treatment.

Surgical intervention is generally given to those patients, in which the speech therapy and medical treatments do not show progress. Phonomicrosurgery is the type of surgery done to treat vocal cord abnormalities. The patient is anesthetized, and the airway is secured by high-pressure jet ventilation through the laryngoscope, endotracheal intubation, or, for an inadequate upper airway, tracheotomy.  Surgery with subsequent by voice therapy is the gold standard treatment for vocal cord cysts.

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