UNDERSTANDING CHOLESTEATOMA Cholesteatoma is a serious condition of the ear where a collection of skin cells and other debris forms a cyst in the middle ear. This blog delves into the intricacies of cholesteatoma, its symptoms, causes, and treatment options, with expert insights from Dr Sandeep Uppal and his team at The ENT Clinic. WHAT IS CHOLESTEATOMA? in an abnormal location – the middle ear behind the eardrum. Although non-cancerous, it can cause damage by expanding and eroding important structures within the ear, including the tiny bones necessary for hearing. The infection can also spread into important surrounding structures like the inner ear, facial nerve, and brain, leading to serious complications. SYMPTOMS OF CHOLESTEATOMA Symptoms can vary but commonly include: Ear Discharge: A persistent or intermittent discharge may indicate the presence of a cholesteatoma. Hearing Loss: Conductive hearing loss is frequently associated with this condition. Rarely the inner ear may be affected leading to sensorineural hearing loss. Ear Pain: Pain or discomfort may be experienced, although it’s less common. Odour: An unpleasant smell from the ear discharge is often reported. Vertigo or Tinnitus: In cases where the inner ear is affected, symptoms may extend to dizziness or ringing in the ears. CAUSES OF CHOLESTEATOMA The development of a cholesteatoma can be due to a variety of reasons, such as: Eustachian Tube Dysfunction: Leads to negative pressure and can draw skin into the middle ear. Chronic Ear Infections: Repeated infections can contribute to its formation. Tympanic Membrane Perforations: Holes in the eardrum can allow skin to enter the middle ear space. Genetic Factors: There may be a predisposition in some individuals towards this condition. DIAGNOSING CHOLESTEATOMA Dr. Sandeep Uppal emphasizes the importance of a comprehensive approach to diagnose cholesteatoma, which often includes: Clinical Evaluation: A thorough assessment and detailed history are key initial steps. Otoscopic Examination: Visualization of the ear canal and eardrum to look for signs of cholesteatoma. Audiometric Testing: Evaluating the extent of hearing loss. CT Imaging: In complicated cases, a CT scan provides detailed images of the ear structures. TREATMENT OPTIONS The management of cholesteatoma often requires a multifaceted approach: Ear Cleaning: To remove debris and allow for effective medication application. Medications: Topical and systemic antibiotics are used to manage infection. Surgery: Procedures such as tympanoplasty or mastoidectomy may be necessary to remove the cholesteatoma and repair any damage. POTENTIAL COMPLICATIONS If left untreated, cholesteatoma can lead to: Destruction of Middle Ear Structures: Causing significant hearing loss. Mastoiditis: Infection spreading to the mastoid bone and lead to abscess formation in adjacent structures. Facial Nerve Paralysis: Due to nerve involvement. Intracranial Complications: Such as meningitis or brain abscess, which are medical emergencies. THE IMPACT OF CHOLESTEATOMA Beyond physical symptoms, cholesteatoma can affect quality of life, leading to psychosocial issues and impacting education and employment. TAKE ACTION AGAINST CHOLEASTEATOMA Early detection and treatment are critical in managing cholesteatoma. Dr Sandeep Uppal’s team is dedicated to providing comprehensive care and education to prevent and treat this condition. If you suspect symptoms of cholesteatoma or have concerns about your ear health, schedule an appointment with our clinic today. Don’t let ear problems escalate – proactive care is key to maintaining your hearing health. Dr Sandeep has thirty-three years of experience in dealing with Chronic ear infection and has treated hundreds of patients with this condition successfully.

UNLOCKING THE MYSTERY OF MÉNIÈRE’S DISEASE Meniere’s Disease is a complex and often misunderstood inner ear disorder that affects the vestibular system, which is responsible for maintaining balance and spatial orientation. Characterized by episodes of vertigo, tinnitus (ringing in the ears), hearing loss, and a feeling of fullness or pressure in the ear, Meniere’s Disease can significantly impact the quality of life of those affected. CAUSES OF MÉNIÈRE’S DISEASE The exact cause of Meniere’s Disease remains unclear, but it is believed to be related to an abnormal volume or composition of fluid in the inner ear. This imbalance in inner ear fluid can disrupt the signals sent from the inner ear to the brain, leading to the symptoms of Meniere’s Disease. Several factors may contribute to this imbalance, including: AUTOIMMUNE RESPONSES The body’s immune system mistakenly attacks healthy cells in the inner ear. VIRAL INFECTIONS Past viral infections might trigger inflammatory responses affecting the inner ear. GENETIC PREDISPOSITION Family history may increase the risk of developing Meniere’s disease. STRESS Emotional stress is known to exacerbate symptoms. DIETARY HABITS Certain dietary factors, such as high salt intake, can affect fluid retention, impacting inner ear fluid dynamics. CLINICAL PROGRESSION Meniere’s Disease progresses in stages, each with its own set of symptoms: EARLY STAGE Characterized by sudden and unpredictable episodes of vertigo, fluctuating hearing loss, tinnitus, and ear fullness. These episodes can last from 20 minutes to several hours. MIDDLE STAGE Vertigo episodes may become less severe and less frequent, but hearing loss and tinnitus may worsen. Periods of remission are common. LATE STAGE In the final stage, hearing loss may become permanent, and tinnitus may continue. However, vertigo episodes tend to become less frequent and may stop altogether. DIAGNOSIS Diagnosing Meniere’s Disease involves a comprehensive evaluation by a healthcare professional, typically an otolaryngologist (ear, nose, and throat specialist) or an audiologist. Diagnosis is based on the characteristic pattern of symptoms, hearing tests, and, sometimes, balance tests. Tests may include: Hearing Tests: To assess the degree of hearing loss. Balance Tests: To evaluate the inner ear’s function and balance. MRI or CT scans: To exclude other possible causes of the symptoms, such as a brain tumour or multiple sclerosis. MANAGING MENIERE’S DISEASE While there is no cure for Meniere’s Disease, several management strategies can help control symptoms and improve quality of life. These include: DIETARY CHANGES Reducing salt intake can help regulate fluid levels in the body and potentially reduce the severity of symptoms. MEDICATIONS Diuretics may be prescribed to manage fluid retention, and anti-vertigo medications can help control episodes of dizziness. THERAPY Vestibular rehabilitation therapy can help improve balance and reduce the impact of vertigo. STRESS MANAGEMENT Techniques like meditation, yoga, and counselling can help manage stress, which may trigger or worsen symptoms. SURGERY In severe cases where medical management is not effective, surgical options such as endolymphatic sac decompression or vestibular nerve section may be considered. FIND YOUR BALANCE AGAIN If you or someone you love is experiencing symptoms suggestive of Meniere’s Disease, don’t wait to seek help. Early diagnosis and management are key to controlling symptoms and maintaining a high quality of life. Remember, you’re not alone in this journey—support and treatment options are available to help you find your balance again. “Take Back Control: Navigate Meniere’s with Confidence and Support!” Make an appointment to see Dr Sandeep through our appointment booking system or contact us through WhatsApp.

A GUIDE TO BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) Benign paroxysmal positional vertigo (BPPV) is a prevalent inner ear disorder characterized by short, intense episodes of vertigo or dizziness triggered by changes in the head’s position. This condition occurs due to the displacement of calcium carbonate crystals, known as otoconia, within the semi-circular canals of the inner ear. The movement of these crystals disrupts the normal fluid flow within the canals, sending incorrect signals to the brain about the body’s position and causing the sensation of spinning. CAUSES OF BPPV BPPV is primarily caused by the dislocation of otoconia from their usual position in the utricle, leading to their accumulation in one of the semi-circular canals. This displacement can result from: Minor Head Injuries Even a slight bump or knock to the head can dislodge these crystals. Degeneration of the Vestibular System Natural aging processes can contribute to the detachment of otoconia. Other Factors Conditions like inner ear infection or prolonged positioning on the back (such as during dental procedures or hair salon visits) can also trigger BPPV. TYPES OF BPPV AND INDIVIDUAL TREATMENTS BPPV is classified based on the affected canal and the location of the crystals within it. The two primary types are: CANALITHIASIS In this most common type, the crystals freely move in the fluid of the canal, causing brief vertigo when the head’s position changes. The Epley manoeuvre is the primary treatment, effectively relocating the dislodged crystals to the utricle, where they no longer cause symptoms. CUPULOLITHIASIS Here, crystals adhere to the cupula of a semi-circular canal, making it sensitive to gravity changes. The Semont manoeuvre or Liberatory manoeuvre can dislodge the crystals from the cupula, providing relief from vertigo. MANAGING BPPV BPPV symptoms can be distressing, but the condition is manageable with the right approach. Diagnosis involves specific positional tests like the Dix-Hallpike test, performed by a healthcare professional to confirm BPPV and its type. TYPES OF BPPV AND THEIR TREATMENTS BPPV is classified based on the affected semi-circular canal and whether the crystals are free-floating or attached to a specific part of the canal. POSTERIOR CANAL BPPV This is the most common form, where crystals accumulate in the posterior semi-circular canal. The Epley manoeuvre is the preferred treatment, designed to guide the crystals out of the canal and back into the utricle, where they can no longer cause vertigo. This manoeuvre involves a series of specific head and body movements performed by a trained healthcare provider and can also be taught to patients to perform at home. HORIZONTAL (LATERAL) CANAL BPPV In this type, crystals affect the horizontal canal. The Lempert Roll manoeuvre (or barbecue rotation) is often used, involving rotating the patient’s body along with their head around a horizontal axis to move the crystals out of the horizontal canal. ANTERIOR CANAL BPPV This rare form affects the anterior canal and is more challenging to treat due to the canal’s position. A modified version of the Epley manoeuvre, targeting the anterior canal, may be attempted, though its effectiveness varies. SYMPTOMS AND DIAGNOSIS BPPV symptoms include vertigo, nausea, and, less commonly, vomiting, triggered by specific head movements. Diagnosis typically involves the Dix-Hallpike test for posterior canal BPPV or the supine roll test for horizontal canal BPPV, aiming to elicit vertigo and observe the induced nystagmus. PROGNOSIS AND MANAGEMENT While BPPV can recur, it’s not considered a serious condition and often resolves within one to two weeks with proper treatment. Lifestyle modifications and precautions can help manage and reduce the risk of recurrence. These include avoiding sudden head movements that have previously triggered episodes and, in some cases, using prophylactic manoeuvres periodically. CONCLUSION BPPV is a manageable condition that affects a significant portion of the population, especially among older adults. Understanding the different types of BPPV and their specific treatments allows for targeted management, offering relief from the distressing symptoms of vertigo. If you experience symptoms of BPPV, seeking prompt medical advice is crucial for accurate diagnosis and appropriate treatment. With the right care, most individuals can lead a normal, vertigo-free life. REGAIN YOUR BALANCE: TAKE THE FIRST STEP AGAINST BPPV TODAY! If you’re experiencing sudden, brief episodes of dizziness or spinning with head movements, don’t let BPPV take over your life. Understanding the causes and types of BPPV is the first step toward effective management. Consult a healthcare professional who can offer a precise diagnosis and tailored treatment plan, including manoeuvres like the Epley or Semont, which you might also learn to perform at home safely. Remember, while BPPV can recur, it’s highly treatable. Most individuals find significant relief or complete resolution of symptoms with proper treatment. Don’t ignore your symptoms; take action today to reclaim your balance and well-being. Make an appointment with Dr Sandeep through our appointment booking service or contact us via WhatsApp.

TYMPANIC MEMBRANE PERFORATION (HOLE IN THE EARDRUM) Clinical photograph showing normal tympanic membrane The tympanic membrane is commonly referred to as the eardrum. A perforation in the tympanic membrane is often known as a ruptured or punctured eardrum. Clinical photographs showing perforated ear drums. CAUSES TRAUMA Clinical photograph showing perforation ofthe eardrum caused by injury due to ear bud Impact to the ear, perhaps from a slap or the insertion of a foreign object like a cotton bud or hair pin. INFECTIONS Severe middle ear infections can lead to pus build up behind the ear drum,  the pressure of the pus causes the ear drum to rupture. Normal ear drum Image of an inflamed and bulging ear drum due topus accumulation in the middle ear behind the ear drum. BAROTRAUMA Pressure changes, commonly experienced in air travel or diving. ACOUSTIC TRAUMA Exposure to extremely loud noises. PREVIOUS SURGERIES Ear surgeries can sometimes result in perforation. SYMPTOMS HEARING LOSS The conductive hearing loss is due to poor conduction of sound through the tympanic membrane, it is often temporary but can be permanent. Hearing test showing poor hearing in theleft ear (Blue squares) due to hole in the ear drum PAIN The conductive hearing loss is due to poor conduction of sound through the tympanic membrane, it is often temporary but can be permanent. Sharp, intense pain commonly occurs at the time of rupture, either due to trauma or as a sequelae of Acute otitis media. EAR DISCHARGE Fluid or pus may drain from the affected ear. TINNITUS A ringing or buzzing noise in the ear. VERTIGO Dizziness or imbalance may occur. BLEEDING Blood may also be present due to traumatic perforation. DIAGNOSIS Diagnosing a tympanic membrane perforation is a meticulous process that Dr Sandeep Uppal and his team at The ENT Clinic carry out with utmost care. Here are the typical steps involved: INITIAL CONSULTATION Patient History: The team starts by taking a detailed medical history, focusing on any incidents that could have led to the perforation, such as trauma or infections. Symptom Review: Symptoms like pain, hearing loss, discharge, and bleeding are discussed to assess the severity and duration of the condition. PHYSICAL EXAMINATION Otoscopy Using an otoscope, the team examines the ear canal and the eardrum to assess the size, location, and severity of the perforation. Microscopic Examination Dr Sandeep  also uses the microscope to check for signs of infection, discharge, or other abnormalities in the ear. SPECIALISED TESTS Audiometry A comprehensive hearing test is performed to evaluate the extent of hearing loss. This helps in understanding the impact of the perforation on auditory function. Tympanometry This test measures the movement of the eardrum and the air pressure in the middle ear, providing valuable information on the condition of the eardrum and middle ear. CT Scan In complex or severe cases, a computed tomography (CT) scan of the ear may be recommended to get a detailed view of the middle ear, mastoid, inner ear structures and any signs of complications. Culture Test If an infection is suspected, a sample of the ear discharge may be taken for culture to identify the causative bacteria or fungi. Consultation and Treatment Planning Dr Sandeep Uppal and his team will review all the findings and discuss them with the patient. Based on the diagnosis, an individualised treatment plan is then formulated, which is crucial for the effective management of tympanic membrane perforation. TREATMENT Observation The approach of observation, often termed “watchful waiting,” is one of the initial treatment pathways. Many minor perforations of the tympanic membrane due to trauma or acute otitis media have the ability to heal spontaneously over time, typically within a few weeks. Observation allows for a more personalised treatment plan. If the perforation doesn’t heal naturally or worsens, more aggressive treatments like surgical closure can be employed later. The decision to observe a tympanic membrane perforation is a measured one, rooted in both medical and practical considerations. During the observation period, patients are generally advised to keep the ear dry and to avoid inserting anything into the ear canal. Follow-up appointments are scheduled for re-evaluation, and treatment plans may be adjusted based on the healing progress and symptomatology. Antibiotics Antibiotic ear drops or systemic antibiotics may be employed to fight off infection. Surgery For severe cases, myringoplasty or tympanoplasty may be advised to graft tissue onto the perforation to repair it . Audiological Support Hearing aids may be used during the recovery period. COMPLICATIONS OF UNTREATED PERFORATIONS Failure to promptly address a perforated eardrum can result in complications such as: CHRONIC OTITIS MEDIA Persistent infection in the middle ear. Learn more about chronic middle ear infections here>> CHOLESTEATOMA FORMATION Growth of a skin cyst in the middle ear. Learn more about cholesteatoma>> PERMANENT HEARING LOSS The longer the perforation remains untreated, the greater the risk of permanent hearing loss. TINNITUS Persistent ringing or buzzing in the ear may become chronic. Learn more about tinnitus here>> STEP TOWARDS HEALING EAR DRUM PERFORATIONS! A hole in the ear drum can be a silent troublemaker, but it doesn’t have to stay that way. Dr Sandeep Uppal and the team at The ENT Clinic are your partners in patching things up. With our deep understanding and personalized care plans, we’re all about fixing those tiny tears in a way that’s just right for you or your child. Don’t ignore a perforated ear drum. Let Dr Sandeep and our experts take a look and tailor a treatment that’s music to your ears. Contact us at The ENT Clinic for care that brings harmony back to your hearing! Act now by scheduling an appointment through our appointment scheduling page or connecting with us via WhatsApp.

TINNITUS AND ITS MANAGEMENT Tinnitus is a condition characterized by the perception of noise or ringing in the ears when no external sound is present. It can manifest as ringing, buzzing, hissing, whistling, swooshing, or clicking. Tinnitus isn’t a disease itself — it’s a symptom of an underlying condition, such as age-related hearing loss, ear injury, or a circulatory system disorder. For those experiencing tinnitus, it can range from a minor nuisance to a significant issue that affects daily activities and quality of life. While there’s no cure for chronic tinnitus, there are various ways to manage the condition. Read more about tinnitus>> DIAGNOSIS For patients presenting with tinnitus, particularly unilateral tinnitus (occurring in one ear), Dr Sandeep Uppal and his team at The ENT Clinic consider the possibility of a tumour as an underlying cause. A meticulous medical history and a thorough physical examination are the cornerstones of effective diagnosis. MEDICAL HISTORY Type of Tinnitus Determining whether the tinnitus is pulsatile or non-pulsatile, and whether it’s occurring in one or both ears, is critical for understanding the possible underlying cause. Onset and Duration The team will inquire about how suddenly or gradually the tinnitus started, as sudden onset could point to different causes than a gradual onset. Associated Symptoms Questions about other symptoms like hearing loss, vertigo, or imbalance can give clues about the nature of a possible tumour. Previous ENT Problems A history of ear infections, surgeries, or other ENT issues may be relevant. Family History A family history of tinnitus, hearing loss, or benign tumours like acoustic neuroma could be significant. Medication History Some medications are ototoxic and can exacerbate tinnitus or even contribute to tumour growth. Lifestyle and Occupational Factors Exposure to loud noises, smoking, or alcohol use can be pertinent information. PHYSICAL EXAMINATION Otoscopy Examination of the ear canal and eardrum to rule out simpler causes like earwax impaction, infection and middle ear conditions like cholesteatoma. Neck and Jaw Examination Palpation of the neck and jaw areas can sometimes reveal abnormal masses that might be causing tinnitus. Hearing Tests Pure-tone audiometry is performed to determine any hearing loss, which often accompanies tumours like acoustic neuroma. Tympanometry This test evaluates the function of the middle ear, providing insights into pressure changes behind the eardrum. Blood Pressure High blood pressure can cause or exacerbate tinnitus, so it’s a standard part of the physical exam. Vestibular Tests If there are symptoms of dizziness or imbalance, tests may be performed to evaluate the vestibular system. Auscultation In cases of suspected vascular tumours, a stethoscope might be used to listen for abnormal blood flow in the neck or temporal area. Throat examination This helps to confirm palatal myoclonus. For suspected tumours, additional diagnostic tests like MRI or CT scans are typically ordered. In some cases, a biopsy may be recommended. Angiography is used for vascular tumours to understand the blood supply to the tumour. Through a detailed medical history and comprehensive physical examination, Dr Sandeep Uppal and his team at The ENT Clinic aim to diagnose the underlying causes of tinnitus, including tumours. Their commitment to thorough evaluation ensures that each patient receives the most effective and individualised care possible. MEDICAL MANAGEMENT OF TINNITUS Tinnitus can be a debilitating condition that significantly impacts a person’s quality of life. While there is no definitive cure, various medical management strategies can help alleviate the symptoms. PHARMACOLOGICAL TREATMENT Vasodilators Drugs like Ginkgo Biloba, a herbal remedy, is occasionally used. Corticosteroids Oral or injectable forms may be used in cases of sudden-onset tinnitus, often associated with hearing loss or an inflammatory condition. Intratympanic Injections Steroid injections directly into the ear are sometimes considered for severe tinnitus, although this is generally a second-line treatment. Botulinum Toxin Injections Antidepressants Medications like Amitriptyline or Nortriptyline are sometimes prescribed for tinnitus, particularly if depression or anxiety co-exist. Antianxiety Medications Benzodiazepines like Clonazepam can sometimes be used on a short-term basis to alleviate tinnitus. NON-PHARMACOLOGICAL TREATMENT Sound Therapy White noise machines, tinnitus maskers, or hearing aids with a masking function can help drown out the tinnitus sound. Cognitive Behavioural Therapy (CBT) This psychological treatment aims to change the way a person thinks about their tinnitus so that it becomes less bothersome. Biofeedback and Neurofeedback These therapies teach patients how to control physiological functions that may exacerbate tinnitus. Tinnitus Retraining Therapy (TRT) This involves a combination of sound therapy and counselling to help people become less aware of their tinnitus. Mindfulness and Relaxation Techniques Methods like deep breathing, progressive muscle relaxation, and mindfulness meditation can help manage the stress and anxiety associated with tinnitus. MONITORING AND FOLLOW-UP Regular Audiology Tests To monitor any changes in hearing levels or tinnitus intensity. Medication Reviews To adjust dosages or switch medications based on efficacy and side effects. Lifestyle Counselling Advice on avoiding triggers like loud noises, and managing stress and diet to reduce tinnitus symptoms. Patient Education Providing comprehensive information on tinnitus management, including the use of hearing protection and stress management techniques. SURGICAL MANAGEMENT OF TINNITUS While medical management is often the first line of treatment for tinnitus, surgical intervention may be considered in certain cases. TUMOURS Microsurgical removal is performed for benign tumours like acoustic neuromas and glomus tumours. CHRONIC EAR INFECTIONS Persistent middle ear infections and cholesteatoma that contribute to tinnitus may require surgical intervention. Tympano-mastoid surgery to remove infected tissue and improve drainage may be performed. OTOSCLEROSIS This is a bone growth disorder in the middle ear which can cause tinnitus and may be treated surgically. Stapedotomy/Stapedectomy, a surgical procedure to replace the stapes bone in the middle ear can be performed. EUSTACHIAN TUBE DYSFUNCTION Eustachian Tube Balloon Dilation, a minimally invasive procedure where a balloon is inserted into the Eustachian tube and inflated to improve function of the eustachian tube. VASCULAR CONDITIONS Abnormal blood vessels causing pulsatile tinnitus may require surgical correction. Glomus tumours of the middle ear and carotid body tumours fall in this category. Endovascular surgery techniques such as coiling, or embolization may be used.