November 14, 2018

Common Medical Conditions

Acute Otitis Media in Children

Otitis media means inflammation of the middle ear cavity with or without mastoid cavity inflammation. Otitis media can be bacterial or viral.

The middle ear is a cavity connected to the oropharynx by the eustachian tube and connected with the mastoid cavity by the mastoid antrum.

Otitis media is more common in children than in adults because the eustachian tube is shorter and more horizontal than in adults. These anatomical features cause the infection to be delivered more easily from the oropharynx to the middle ear cavity.

In children over 3 years, the diagnosis is easy as the child can talk and describe the illness and also detect the diseased ear. Also, endoscopic ear examination is possible which reveals middle ear inflammation. But, in children below 3 years, the diagnosis is difficult as the child cannot describe the illness. The child just cries loudly and sometimes hits his diseased ear with his palm.

In children below 3 years, otitis media can be missed by the physician and the sickness may be misdiagnosed as gastroenteritis because otitis media in this age presents with fever, vomiting, and diarrhea. Here, the endoscopic ear examination is helpful to confirm middle ear infection.

Treatment

The treatment of acute otitis media in children is classified according to the stage of the disease whether it is before suppuration or after suppuration. Suppuration is the collection of pus behind the eardrum.

Before suppuration, the treatment is antibiotics, mucolytics, vasoconstrictor nasal drops, and analgesics. After suppuration, the treatment is mainly surgical. Myringotomy is mandatory to drain the collected pus from behind the eardrum and a prophylactic treatment is prescribed.

In the case of recurrent acute otitis media, surgical causes should be excluded such as enlarged adenoid tissue. Ventilation tubes can be introduced through the eardrum for adequate middle ear ventilation.

For more information, request for Dr Mohammed Osama Aboborda in your consultation with us.

Snoring: How to Stop This Annoying Problem?

Snoring is one of the most common problems we face in our life. Generally speaking, each one of us has an experience with snoring at least once in our lifetime.

In medical terms, snoring is defined as a loud noisy breathing during sleep without sleep apnea syndrome as we are talking here about simple snoring. Sleep apnea syndrome is another topic which needs a separate article.

Snoring affects about twenty percent of the whole population and about sixty percent of males over forty years of age. Snoring is more common in males than females.

In fact, snoring is a symptom not a disease in itself. In other words, snoring is a result of a certain underlying disease.

Causes:

Causes of snoring are many as any disease that causes a partial obstruction of the airway can cause snoring. So, the causes of snoring are classified according to the level of airway obstruction as follows:

Nasal.

Palatal.

Tongue base.

Pharyngeal causes.

Now, let us have an idea about these causes.

Nasal causes are so many. Simply, these are any nasal diseases that cause partial airway obstruction like deviated nasal septum with its two types – the C-shaped deviation to one side and the S-shaped deviation which obstructs both the nasal cavities.

Hypertrophied nasal turbinates because of allergic rhinitis or nasal tumors.

Sinonasal polyps which arise from the nasal sinuses and extend to the nasal cavity. These polyps can be inflammatory, allergic or neoplastic.

Even a common cold attack can cause snoring due to inflamed swollen nasal mucosa partially obstructing the nasal airway.

One of the rare nasal causes of snoring is neglected impacted foreign body inside the nasal cavity. It is common in young children and associated with persistent unilateral offensive nasal discharge.

Palatal causes include large redundant soft palate which vibrates with every breath during sleep causing a loud vibratory sound. In some cases, the redundant soft palate is associated with a long uvula which produces a continuous sensation of swallowing of something in the absence of having anything in the mouth.

Tongue base causes – simply when the tongue base is larger than normal it is narrowing the airway producing a snore.

Before talking about pharyngeal causes, it is better to understand a few physiological facts about the pharynx. The pharynx is a common pathway for food and air. The pharyngeal space is maintained by the muscle tone of pharyngeal dilator muscles. So, any cause that alters this tone will cause a collapse or at least a narrowing of the airway and will lead to snoring. Factors which alter the pharyngeal dilator muscle tone are excessive alcohol intake, sedatives and muscle relaxants, neuromuscular diseases and sometimes deep sleep.

Away from the muscular physiology of the pharynx, any space-occupying lesion can cause snoring. Enlarged tonsils, as seen in chronic tonsillitis, can produce snoring. Nasopharyngeal tumors and enlarged adenoids partially obstructing the airway also cause snoring.

One of the common causes of snoring is obesity. Condensation of fats under the skin around the neck and among neck organs and compartments narrows the pharyngeal airway.

Everyone suffering from snoring wants to end it for the well-known causes such as to stop driving the roommate crazy and also put an end to the daily headache and drowsiness. But, there are other risks you should know about.

Effects of Snoring:

Snoring has cardiovascular effects such as hypertension, arrhythmias and coronary heart diseases. To beat snoring, the underlying cause must be discovered. So, the airway must be examined.

Investigations and Management:

Nasal cavity and the nasopharynx can be examined by rigid endoscopy which can show septal deviations, sinonasal polyps, impacted foreign bodies and the enlarged adenoid tissue if any.

The oropharynx and soft palate can be examined by simple inspection through the mouth.

Flexible fiberoptic endoscope can also examine the airway. Polysomnography can be used in case of snoring associated with obstructive sleep apnea.

For more information, request for Dr Mohammed Osama Aboborda in your consultation with us.

Dealing with Foreign Body Inside the Ears

You may come across this condition in your life, especially if there are children around. The foreign body inside ears is a widely common theme. Outside bodies are classified as living or nonliving. Nonliving remote bodies are further classified as organic and inorganic. Now, I will discuss each category.

Living foreign bodies such as fly, ant, spider, mosquito, larvae, and many types of bugs can get into our ears. You may see the insect getting into the ear of your kid and this makes the diagnosis easy. But, sometimes, you cannot see the insect getting into the ear. In this case, the diagnosis depends on the complaint of the patient and endoscopic examination of the ears. The patient may complain of a sensation of moving object inside the ear with or without pain. The pain is present if the insect bites. Alcohol is utilized to kill the bug, then the bug is pulled out of the ear by special instruments or just washed out with water.

Nonliving organic foreign bodies such as seeds and food particles can be pushed unintentionally into the ears. In this case, ear wash is contraindicated as It can cause swelling, making it more impacted in the ear. In this case, I like to utilize little forceps.

Nonliving inorganic foreign bodies such as little plastic balls and batteries can be brought incidentally into the ear. The common age group for this scenario is young children. It is a hazardous condition as by pushing it further, the kid can hurt the eardrum and even puncture it. In this case, I like to utilize snared instruments. Sometimes, the hard foreign body can be badly impacted and needs a careful surgical operation to move it out. In case the object is a little battery, you should rush to a healing center to expel it as soon as possible as the battery can release acids within a few hours of its insertion. These acids are corrosives which can damage the skin and disintegrate the ear bones.

Finally, I assert you not to attempt to expel foreign bodies from the ears yourselfbecause while doing so, you can puncture the eardrum. A foreign body inside the ear is a crisis situation. If you ignore it, it will be even more difficult for the clinical practitioner to remove it.

For more information, request for Dr Mohammed Osama Aboborda in your consultation with us.

 

When Should Tonsils Be Removed in Adults?

Tonsillectomy is one of the most popular operations in the otorhinolaryngology field. The most frequently asked questions about tonsillectomy are:

When is tonsillectomy indicated?

Does tonsillectomy affect our immunity?

What is the best method for tonsillectomy?

What are tonsillectomy complications?

When Is Tonsillectomy Indicated?

Tonsillectomy is indicated in certain cases of chronic tonsillitis. Chronic tonsillitis is characterized by inequality in size of both tonsils, congested anterior pillars which cover tonsils anteriorly, the collection of pus inside the tonsillar crypts even in the absence of acute inflammation, recurrent attacks of acute follicular tonsillitis and palpable neck lymph nodes.

Peritonsillar abscess is an important indication for tonsillectomy. Peritonsillar abscess is an acute infection presented by the collection of pus in the space between the tonsil capsule and anterior pillar, fever, dysphagia, and severe throbbing pharyngeal pain. Peritonsillar abscess is usually unilateral. Just one attack of peritonsillar abscess is an indication for tonsillectomy.

Impacted foreign body inside the tonsils is another indication for tonsillectomy. Many different foreign bodies may be impacted into the tonsils but the most common are fish and bird bones. These bones are impacted in the tonsils during eating. If the foreign body cannot be extracted through the mouth, tonsillectomy would be indicated.

Does Tonsillectomy Affect Our Immunity?

Tonsils are lymphoid tissues. Tonsils play an important role in human immunity but its removal does not harm immunity because the body is full of other lymphoid tissues. The important point is the presence of an indication for tonsillectomy.

What Is the Best Method for Tonsillectomy?

Now, there are a lot of methods for tonsillectomy such as diathermy, radiofrequency, laser surgery, cryosurgery and the cold surgery. Cold surgery means the use of surgical instruments away from any source of heat as diathermy and laser. The best method is the method that your surgeon prefers. The aim is to remove tonsils completely without primary bleeding.

What Are Tonsillectomy Complications?

Some of the complications of tonsillectomy are primary hemorrhage, secondary hemorrhage, and residual tonsil tissue.

Primary hemorrhage is the hemorrhage that happens within the first twenty-four hours after the operation. Primary hemorrhage can be because of slipped ligature, detached thrombus which occludes a blood vessel and elevated blood pressure after coming back from anesthesia effect. Primary hemorrhage is an emergency. The patient must go through surgical closure of the bleeding blood vessel. Sometimes, external carotid ligation is mandatory if direct closure of the bleeding vessel has failed.

Secondary hemorrhage is the hemorrhage that happens after the first twenty-four hours have passed. It is mostly secondary to the bacterial infection at the site of surgery. So, antibiotics are important after tonsillectomy to prevent bacterial infection. Dealing with secondary hemorrhage is different from that of primary hemorrhage. In case of secondary hemorrhage, the patient’s throat must be irrigated with hydrogen peroxide under general anesthesia to remove all the infected tissues. In many cases, just previous irrigation is enough to stop the bleeding but in other cases, external carotid ligation is needed to stop bleeding.

Residual tonsil tissue is a common complication. Residual tonsil tissue can be inflamed again and again. Residual tonsil tissue can increase in size because of repeated inflammation. This hypertrophied residual tonsil tissue may need another surgery to be removed.

For more information, request for Dr Mohammed Osama Aboborda in your consultation with us.

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