Tips for better communication

You can see the lips moving and forming syllables but you cannot hear properly. Or sometimes you hear a roaring sound like that of a pouring waterfall, which does not permit you to hear anything. If these are your symptoms, then it is unfortunate but your hearing may be impaired.

Hearing loss, be it partial or complete is a crippling ailment as it prevents the affected person from performing his routine activities normally. It not only restricts communication with others but also affects the confidence and composure of the patient. 

Hearing problems can be easily remedied with ENT treatment which may include simple cleaning, use of hearing aids or even minor surgery, depending upon the patient's condition.

If a person has a hearing problem, does it mean he cannot communicate? He/she very well can with the help of these tips for better communication.

Tips for better communication for the hearing impaired

1. Keep people informed of your hearing problem

No man is free of illness these days and hearing loss is just another disability like any other. Do not be shy of informing people about your difficulty in hearing. It is better to keep people informed of your hearing disability in order to avoid awkwardness and confusions later.

Before a conversation, group discussion or meeting, inform people that you have a hearing problem. This will induce them to speak louder or grab a seat in the front or speak slowly for your benefit. Remember, you can achieve a lot more by keeping people informed of your hearing ailment rather than keeping it a secret.

2. Specify your needs for good hearing

You might be suffering from a hearing problem only in on ear. So specify to people which side you will be able to hear better. They can move over to the side where you can hear best and speak to you.  You can even ask them to change the direction of their face while speaking to hear better.

Unless you specify your hearing needs, people will assume that your hearing is fine and this will not help. Specifying your hearing needs is the best way to promote effective communication.

3. Ask people to be open with you

It is not only you who is uncomfortable with your hearing loss. Others too find it difficult to express to you that they are having difficulty in communicating with you. 

It is better to put people at ease and ask them to be open in expressing their difficulties in communication so that you can remedy them. Tell others that if you stare transfixed as if you have not understood a dialogue, it means you have not heard it and they should repeat it again. Use humour to get people to feel comfortable in communicating with you in spite of your hearing problem.

4. Use gestures to communicate

Non-verbal clues come handy when you try to communicate in spite of your hearing problem. Sometimes gestures and body language can express more than words. Use them rightly for the best results.

For example, leaning towards the speaker, cupping your hand near you ear for a louder tone or swivelling your hand asking for a repeat can help you to communicate without interrupting the other person.

5. Interrupt when you have to

Follow the conversation to the best of your ability. But if the voice is low or the speaker is fast, there is no harm interrupting and asking them to repeat or clarify.

6. Maintain good health

Apart from your hearing loss, keep yourself fit with a balanced diet, exercise and enough sleep. Even for your hearing care,  consult an ENT surgeon or specialist regularly.

7. Visit the ENT specialist regularly

There is no dearth of ENT specialists in India. Go for an ENT check-up frequently as new innovations and treatments can help you cope with your hearing problem better.

Do not let hearing loss deter you from reaching the pinnacle of success. Consult the best ENT doctors in Coimbatore to climb the great walls of victory.

Managing with Headache

Headache happens to be one of the most prevalent health complaints in the daily lives of people. It may occur in one side or multiple parts of the head. It can also affect anybody irrespective of their age, gender or inheritance. According to the World Health Organization (WHO) statistics, nearly half of the adult population experience headache at least once annually.

Usually, all patients assign paramount importance to finding immediate relief to a headache by taking self-medication. But caution must be exercised particularly if they take other medicines which are likely to cause reactions with these drugs or have pre-existing medical conditions which can result in health complications. It is also crucial to closely watch the symptoms, signs and potential triggers that cause a headache. 

Types of Headache

Based on the cause, Headache is categorized as-

• Primary headache - These are not caused by any external factors and are stand-alone ailments. They occur due to over-exertion of the brain or problems in the head parts that are prone to pain like the blood vessels, muscles or nerves connecting the head and the neck. These headaches may also be an off-shoot of changes in the brain due to various chemical activities. Types of Primary Headache include-

• Migraine which are due to throbbing or pulsations only on one side of the head. Accompanying symptoms may include feelings of nausea or light-headedness, blurring of vision and auras (sensory disturbances).It may last for a few hours or days.
• Tension headache wherein there may be a feeling of tightening around the head, neck pain or a prevailing dull ache on either side of the head. It may occur in isolated episodes or last longer as in chronic cases.
• Cluster headache which are severe one-sided aches that may result in red, swollen areas around the eyes, drooping of eyelids and blocked nasal passages. It occurs in clusters of few days to months coupled with headache-free periods in-between.

• Secondary headache - These usually occur due to underlying causes which stimulate the pain-sensitive nerves in the head. This includes -

• Over usage of painkillers causing Rebound Headache.
• Thunderclap Headache caused by Reversible Cerebral Vasoconstriction Syndrome (RCVS) which causes constriction of blood vessels hampering the blood supply to the brain.
• Hangovers resulting from alcohol consumption.
• Brain tumours.
• Toxic effects of carbon monoxide.
• Brain freeze (ice-cream headache).
• Panic attacks.
• Life-threatening ailments like Haemorrhage (bleeding) in or around the brain, Meningitis (brain fever), Aneurysms (artery enlargements) and Cerebral Venous Thrombosis (blood clots in the brain).
• Medical conditions like glaucoma, stroke, hypertension, Upper Respiratory Tract Infections and influenza
• Sudden caffeine withdrawal
• Head injury or trauma
• Head and Neck Cancer which mostly manifests itself as Oral and Oropharyngeal Cancer

It is advisable to consult the ENT Doctor for identifying the secondary causes like respiratory infections and influenza for taking appropriate ENT Treatment.

Treatment for Headache

• Medications - Usually generic pain medications available as Over-the-Counter (OTC) drugs or preventive medicines prescribed by physicians like anti-depressants, anti-epileptic drugs or serotonin receptors are used.
• Surgical Remedies - For removal of brain tumours, surgery may be required. Cancerous growths additionally require chemotherapy and/or radiation therapy.
• Alternative Treatments - Alternative approaches like Meditation, Hypnosis, Acupuncture, Cognitive Behavioural Therapy, Herbal and Nutritional Remedies may be used for tension headache.
• Lifestyle Modifications - Regular exercise, sufficient sleep, healthy eating habits, avoiding stress and reducing caffeine consumption can prevent headache episodes substantially.

Please consult the Head and Neck Doctor or the ENT specialist to diagnose the exact cause if the headache worsens or becomes more severe, persistent or frequent. Any accompanying symptoms like fever, epilepsy, mental confusion, neck stiffness and sensory modifications require an emergency intervention for the headache or the neck pain treatment.

Effect of hearing loss on mental health

Watch a movie with the sound muted for 30 minutes. You will find it agonizing to follow the lip-sync to decipher the dialogue that the actors speak. If you cannot bear this for even half-an-hour, imagine how tormenting it would be for the hearing impaired when their entire day spins out like a silent movie? Yes, hearing loss does affect the mental health of the patients.

Most people don't realize this fact and seem to ignore the difficulties of the hearing-impaired individuals. But not anymore. With October being the "Protect your Hearing" month and October 10 being the "World Mental Health Day", let us make this an effort to spread awareness that hearing loss causes mental health issues.

What are the mental health issues that hearing loss causes?

Hearing loss causes a host of mental health issues like

1. Depression
2. Anxiety
3. Schizophrenia
4. Dementia
5. Anger outbursts
6. Suicidal tendencies 

A JAMA Otolaryngology-Head and Neck surgery Report (2014) reports that 11.6% of the hearing-impaired individuals suffer from depression more than that 5.9% who suffer from depression albeit with normal hearing. This just justifies the statement that hearing loss can really affect mental health.

How do individuals with hearing loss suffer from mental health?

Individuals with hearing loss exhibit these behavioural symptoms that show that they are mentally affected.

Hearing-impaired individuals find it difficult to carry on a conversation normally and might

• Interrupt or intrude into a conversation abruptly
• Talk off-topic
• Dominate the conversation by shouting as they think talking covers up for listening

All these actions make them inept at handling themselves socially, leading to isolation and hence severe depression.

Hearing loss and depression

In a study of 2300 hearing -affected people by the National Council of ageing, 60% developed depression. The University of Colorado attributes this to "brain reorganization" where the hearing centres shrink and are replaced by other task centres. This leads to a loss of short- term memory and problem-solving skills, ending in depression.

Hearing loss and schizophrenia

Since the society mostly excludes and isolates hearing-impaired individuals, they tend to suffer from loneliness and depression. This increases the sensitization of the dopamine system causing schizophrenia. Due to this social exclusion, hearing-impaired patients tend to become psychotic with hallucinations and delusions leading to schizophrenia.

Hearing loss and dementia

Studies at the John Hopkins University have found that hearing loss leads to memory decline in aged adults followed by dementia. The reduced social engagement of the hearing-impaired patients and the cognitive stress they face in having to deal with hearing loss can make them lose their memory very quickly. This mental illness can be easily resolved by the use of simple hearing aids which will automatically increase the brain's function by hearing.

All these mental health issues can be easily remedied by consulting an expert ENT doctor and undergoing hearing loss treatment. Sometimes, hearing aids are enough to improve the situation and must be procured only from an ENT hospital. 

Tinnitus

Tinnitus is a hearing condition where the individual suffers from a "loud ringing in the ears". This may be caused due to age, excessive noise exposure or some ear injury. But this ringing persists causing fear and anger leading to mental health disorders like anger, anxiety, depression and even suicidal ideation.

Meniere's disease

Meniere's disease is an inner ear disorder that results in pain in the ear, vertigo and Tinnitus.  Due to these severe symptoms, the patients experience anxiety, stress and even have insomnia and panic attacks. This hearing problem can be resolved using cochlear implants, thereby giving the patient relief from mental stress.

Partial or total hearing loss cannot be taken lightly and must be attended to, at once as it may have severe repercussions on the mental health of the patient. Head to an expert ENT hospital and undertake the right ENT treatment to safeguard both your hearing and mental health.

Odynophagia - Causes, Symptoms, and Treatment

Odynophagia is a  medical condition when a person experiences pain while swallowing. This pain may be seen in the mouth, throat or food pipe when the person tries to swallow even saliva. Odynophagia can lead to weight loss, damage to the throat or other severe complications. It is hence best to consult an expert ENT specialist or throat surgeon immediately when a person experiences throat pain or swallowing difficulty.

Odynophagia vs. Dysphagia

Odynophagia and Dysphagia are both throat diseases but they are distinctly different. Odynophagia refers to painful swallowing while dysphagia refers to inability in swallowing.  Dysphagia may occur along with Odynophagia or both may occur separately. When they both occur together, the person is in sheer agony as he feels pain and is unable to swallow even water. Both these throat diseases are caused by infections and inflammations. But dysphagia is the  worst of the two as it may result in bacteria and irritation to the lungs, causing pneumonia. Dysphagia can also be caused by psychological factors like anxiety.

Causes of Odynophagia

Odynophagia or painful swallowing may be caused by

1. Common Infections - common cold, flu or strep throat
2. Throat inflammation due to tonsillitis, laryngitis, pharyngitis, oesophagitis etc.
3. Candida Infection-this yeast or fungal infection that occurs in your mouth may cause pain and swallowing difficulty.
4. GERD - Castro-esophageal reflux disease - This illness is due to the lower sphincter of the oesophagus not closing properly and allowing the stomach acid to leak back into the food pipe. This disease may cause Odynophagia along with chest pain or heartburn.
5. Ulcers - Ulcers formed in the mouth, throat or oesophagus may cause painful swallowing. This may be the result of untreated GERD or the prolonged use of anti-inflammatory drugs like Ibuprofen.
6. AIDS - HIV-affected patients often suffer from Odynophagia. Candida infection is one cause. The use of antiretroviral medications to cure HIV may cause acid reflux and bring in swallowing difficulty.
7. Cancer - Oesophageal cancer may be another cause for Odynophagia leading to tumours in  the throat. This cancer is caused by persistent smoking, tobacco use or alcoholism or even hereditary factors.
8. Radiation therapy - Person undergoing radiation therapy for HIV or cancer treatment are more prone to Odynophagia.
9. Weak immune systems - Persons with weak immunity who often catch colds and throat infections have swallowing difficulty.
10. Foods - Even eating very spicy foods, drinking very hot or very cold drinks continuously or eating food with sharp edges may damage the mucosal lining of the throat. This causes Odynophagia.

Symptoms of Odynophagia

• Dull or sharp stabbing pain in the mouth, throat or food pipe while swallowing
• Even liquids cause throat pain but dry solids make it worse.
• Weight loss due to reduced intake of food.
• Dehydration due to reduced intake of food
• Other symptoms like fever, fatigue, body ache etc.

Diagnosis of Odynophagia

Odynophagia is diagnosed by endoscopy. A small lighted camera or endoscope is placed inside the patient's throat by the doctor to take a look at your oesophagus. Tests are also taken by asking the patient to swallow.

Odynophagia Treatment

1. Medication

Odynophagia can be treated by using medication for

• Throat pain, tonsillitis, laryngitis, pharyngitis, oesophagitis
• GERD to prevent acid reflux from entering the throat
• Candida infection to rid the fungus
• HIV or cancer medication.

2. Surgery

If the patient has tumours in his throat, it may be a sign of oesophageal cancer. The throat surgeon may advise surgery after proper diagnosis and screening.

3. Rest

Sometimes painful swallowing resolves on its own if adequate rest is given to the throat.

Strep throat: Causes, diagnosis, and treatments

Monsoons and winter both usher in a spate of coughs, colds and sore throats among both children and adults.  Among these, sore throats are quite common and almost 15% of them are caused by a bacterial infection. A sore throat caused by the Streptococcus A bacteria is commonly called as "strep throat".

Strep throat is prevalent mostly among children of age 5-15. In children less than 3 yrs, this infection affects the ear as otitis media instead of affecting the throat. Anyway, strep throat might be accompanied by tonsillitis or sinus infection too. That is why it is best to consult an ENT hospital for strep throat treatment.

What is strep throat?

Strep throat is a bacterial throat infection caused by Streptococcus A bacteria. It is spread by

• Airborne droplets when an infected person coughs or sneezes
• Touching the items touched by the infected person like clothes, utensils, doorknobs etc.

Strep throats are not serious and usually get cured within a week. But if left untreated, it may lead to complications like rheumatic fever or kidney inflammation. Therefore it is best to take immediate ENT treatment for strep throat.

Symptoms of Strep throat

• Sore, red throat with white patches on tongue
• High fever more than 101˚F
• Headaches
• Swollen lymph nodes near the throat
• Red spots on the palate or roof of the mouth
• Chills
• Trouble in swallowing 
• Loss of appetite
• Nausea or vomiting
• Body ache 

When to see the ENT specialist for strep throat?

Head to an ENT hospital if 

• a sore throat does not subside within 2 days
• a sore throat is accompanied by rashes 
• a sore throat is accompanied by swollen lymph glands near the neck
• there is difficulty in breathing or swallowing
• fever is above 101˚F

Strep throat diagnosis

After a physical examination of the patient, the ENT doctor may order for one of these tests

Rapid Antigen Test

The ENT specialist does a throat swab and gets an Antigen Test done on the sample. If the test is negative, he suggests throat culture.

Throat culture

The ENT specialist dabs a sterile swab over the back of the throat and the tonsils to get a sample of the throat secretion. This sample is then sent to the lab for testing.

Strep throat treatment

At home

• Gargle with salt water 3-4 times daily.
• Drink lots of water to wet your sore throat.
• Drink warm liquids like tea or lemon water
• Drink cold liquids to numb the throat
• Suck on throat lozenges
• Use a cool mist humidifier and clean it daily.
• Eat soothing foods like soups, broths, cereal, porridge etc. which are easy to swallow.
• Avoid spicy foods and acidic drinks like orange juice.
• Stay from irritants like cigarette smoke.
• Stay away from school or work at least for 24 hours as strep throat is contagious.

At the ENT hospital

• The ENT specialist recommends antibiotics to cure the infection and analgesics to relieve the pain.
• Antibiotics like Penicillin or Amoxycillin are usually suggested.
• Some patients may be allergic to Penicillin. For such patients, Azithromycin, Clarithromycin or Cephalosporins are suggested.
• The doctor recommends a suitable diet to help quicken the process of remedy.

Caution

Never take OTC (over-the-counter) medication for strep throat. Some patients may be allergic to penicillin and such allergy is evident only by doing a skin test. Penicillin allergy can result in mild reactions like rashes and itching to adverse effects like Anaphylaxis which is life-threatening. this is why it is always best to consult an ENT hospital for strep throat treatment.

Do not ignore strep throat as it may lead to sinusitis, tonsillitis, ear infections, scarlet fever or pneumonia. Consult an expert ENT hospital for quick relief from strep throat infection.

What is REM sleep?

Good sleep is very important for maintaining health. Most of us experience sleeping issues at some point of time in life. This may be temporary and caused due to travel, ailments, mental stress or hurdles that change the normal routines. Yet many people experience long term difficulties in falling asleep as they struggle with sleep disorders. These disorders are conditions that affect an individual’s ability to sleep regularly and peacefully for getting sufficient rest.

Prolonged sleeping problems must be scrutinized for any underlying medical conditions by consulting an ENT doctor (ENT-Ear Nose Throat). Diagnosis may be done by undertaking sleep studies to identify the cause of sleep disturbances in a Sleep Laboratory at an ENT Hospital which is also usually equipped with an Audiology Lab. Commonly diagnosed sleep disorders include snoring, sleep apnea and REM sleep Behavioural Disorder (RBD).

Let us discuss REM sleep and RBD here.

REM sleep (Paradoxical/Desynchronized Sleep)

During sleep, the brain transits through five distinct stages. One of them is Rapid Eye movement (REM) sleep which occurs at intervals during the night. This phase is characterised by vivid dreaming, lower muscle tone, faster pulse rates and breathing. The skeletal muscles appear to be paralyzed. The other four phases are termed as Non-REM (NREM) sleep. During REM sleep, the behaviour of the brain and body is very different than those during other sleep phases.

There are physiological similarities to the waking phase in REM sleep with rapid, low-voltage and desynchronized brain waves. This cycle is typically characterized by an abundance of a neurotransmitter called acetylcholine and almost a near absence of other mono amine neurotransmitters like histamine, serotonin, and nor epinephrine.

RBD is a type of sleep disorder that involves unusual actions or behaviours during the REM phase. Here strange or dangerous events occur that disturb or intrude sleep. Other related manifestations include nocturnal dissociative disorder and walking, talking or terrors in sleep. People with this order don’t experience the temporary muscle paralysis as in REM cycle. These are either incomplete or may be completely absent. So, the person with RBD physically enacts his dreams, sometimes in dramatic or violent ways.

RBD Symptoms:

• Physical agitation, active movement of limbs, getting up and executing actions of ‘wakefulness’
• Talking, shouting, screaming, hitting or punching during sleep.
• Injury of self or bed-partners
• Making violent movements while witnessing frightened dreams

Common Causes for RBD:

• Degenerative neurological diseases including Parkinson’s Disease, Dementia, Multiple System Atrophy, Shy-Drager syndrome and Narcolepsy
• Cognitive problems, stress, anxiety, executive functioning disorders, low attention scores, apathy
• Reaction to certain drugs or sudden withdrawal of some medications
• Sleep Apnea also affects REM memory and REM Sleep

RBD Treatment:

Medication:

• Most RBD cases are treated by drugs like low doses of Clonazepam that suppresses the muscular activity and relaxes the body during the sleep duration. However, this drug must be with caution patients with Dementia, Gait Disorders and Obstructive Sleep Apnea. OSA requires sleep apnea treatment that may involve lifestyle changes or using treatment options like Airway Therapy, Surgery or Oral Appliances.
• Patients not responding to Clonazepam may be treated with anti-depressants or melatonin for reducing violent behaviour.

Improving Sleeping Habits:

• Adopting healthy sleep patterns for ensuring predictable sleep-wake cycles, reducing sleep deprivation and avoiding alcohol consumption helps in RBD Treatment. Other strategies for safe sleeping include
• Using a floor mattress with cushions all around
• Installing padded bedrails for avoiding  injuries
• Sleeping on the floor(for RBD sleep walkers)
• Not keeping furniture and sharp objects near the bed
• Removing dangerous objects from the bedroom

Thus RBD may be successfully handled by ENT treatment by usage of appropriate medication and adoption of healthy sleeping habits.

All about Coughs and their Causes

Cough is a reaction of the human body to clear the throat which may be obstructed by irritating substances. These substances   may be foreign particles, microbes, fluids, pollens or mucus which irritate the body cells. They prevent   clear passage of air from nose or mouth to the lungs during breathing. The result is the rapid expulsion of air from the lungs due to high pressure which manifests as Cough (also called Tussis). Cough may be voluntary or involuntary.

What causes Coughing?

Acute Cough lasts for durations less than three weeks. It occurs due to

• Infectious causes  like common cold and flu, sinus infections and respiratory infections including bronchitis and pneumonia
• Non-infectious reasons as existence of chronic ailments like asthma, emphysema and also because of allergic environmental factors.

Sub-Acute Cough lasts anywhere between three and eight weeks and improves subsequently.

Chronic Coughs are persistent episodes of cough that last for more than eight weeks. It is caused due to

• Throat Infections caused by sore throats including Laryngitis, Tonsillitis and Pharyngitis
• Throat Diseases resulting in damage of  vocal chords
• Post nasal drips where there is excessive mucus dripping down the throat from the back of the nose
• Gastro Esophageal Reflux Disease(GERD)
• Asthma
• Certain medications like ACE inhibitors(ACE -Angiotensin Converting Enzyme)used for primarily treating hypertension and heart problems
• Severe ailments in adults like tuberculosis, fungal infection of lungs, oral cancer and lung cancer

When to seek medical attention?

Generally coughs subside on their own. But it is advisable to seek medical attention by consulting the ENT (Ear Nose Throat) Specialist if it lasts for more than three weeks.

It is also important to visit the ENT hospital for check-up if following symptoms prevail-

• Coughing increases or there is no relief in prevailing symptoms
• Swelling or lumps are seen in the neck area
• Weight loss is experienced
• There is difficulty in swallowing or in breathing
• Permanent changes  occur in the voice
• Chest pain or discomfort is experienced
• Bouts  of fever continue
• Blood is expelled when coughing

Cough Treatment

There are a variety of ways for treating cough based on its cause.

Home Remedies

• Keeping yourself well hydrated
• Doing hot salt water  gargling
• Using nose decongestant sprays or cough drops for soothening the throat
• Avoiding pollutants like smoke, dust or other allergic substances and alcohol
• Consuming natural antidotes  like ginger, honey with lemon, pepper and hot tea

Medications

• Coughs occurring due to bacterial infections need throat treatment with antibiotics. However antibiotics are not effective for viral infections which need symptomatic treatment.
• Expectorant cough syrups (for wet cough) and cough suppressants containing codeine (for dry cough) may be prescribed for reducing coughs.

Diagnostic Tests

• Additional tests like Chest X-Ray (to ensure lungs are clear) and mucus/phlegm analysis (for signs of tuberculosis) may be done if no evident cough causes are found.
• Rarely, if a heart disorder is suspected as the cause of cough, an Echocardiogram is done to investigate the possibility.
• For more complicated and persistent cases, CT scan may be recommended for in depth view of chest and airways and checking for possibility of cancer. Appropriate treatment follows thereof.
• Further, if CT scan results do not portray the cause, the patient may be referred to Gastroenterologist or Pulmonary Specialist for investigating evidence of GERD.

Prognosis

Coughs are uncomfortable and annoying ailments which usually resolve quickly with simple remedies and medications. However if symptoms persist, it is important to take ENT treatment through physician consultation.