w360 - PrudENT Rhinoplasty and Facial Cosmetic Surgery - Page 8
    Linkedin Facebook Youtube Instagram Whatsapp
      Linkedin Facebook Youtube Instagram Whatsapp

      MALFUNCTION OF THYROID GLAND AND ITS MANAGEMENT

      Thyroid Gland

      MALFUNCTION OF THYROID GLAND AND ITS MANAGEMENT WHAT HAPPENS WHEN THE THYROID GLAND MALFUNCTIONS? A malfunctioning thyroid can lead to various health issues. The conditions generally fall under two categories: HYPOTHYROIDISM Dr Sandeep Uppal and his team at The ENT Clinic specialise in the comprehensive care of thyroid disorders, including hypothyroidism, an underactive thyroid condition that results in reduced production of crucial hormones T4 and T3. Common causes These range from autoimmune diseases like Hashimoto’s thyroiditis to surgical removal of the thyroid gland and certain medications. Symptoms Often include fatigue, unexplained weight gain, and sensitivity to cold. Left untreated, the condition can lead to complications such as cardiovascular issues and infertility. Diagnosis Typically involves blood tests and ultrasounds. Treatment Options include hormone replacement therapy with Levothyroxine and lifestyle modifications, such as a diet rich in iodine and selenium. Ongoing monitoring through regular blood tests and symptom evaluations is crucial for effective management. HYPERTHYROIDISM Hyperthyroidism is characterised by an overactive thyroid gland that produces excess amounts of the hormones T3 and T4. Common causes Include Graves’ disease, thyroid nodules, and excessive iodine intake. Symptoms Patients may experience symptoms such as weight loss, heat intolerance, and anxiety. If left untreated, hyperthyroidism can lead to serious complications like heart disease and osteoporosis. Diagnostic measures Typically include blood tests to measure hormone levels and imaging studies like ultrasounds or radioactive iodine uptake tests. Treatment approaches These vary from antithyroid medications and beta-blockers to more invasive options like radioactive iodine therapy or surgical removal of the thyroid gland. Ongoing monitoring is essential for adjusting treatment and preventing complications. TAKE CHARGE OF YOUR HEALTH: MANAGE YOUR THYROID DISORDER TODAY! Are you constantly feeling tired, experiencing weight changes, or having trouble with temperature regulation? Thyroid gland malfunction can disrupt much more than just your metabolism—it may affect your energy levels, mood, and overall vitality. Both adults and children might suffer the consequences of this disorder, which, if neglected, can lead to serious health complications, including heart problems and mental health issues. Don’t allow thyroid dysfunction to control your life. Now is the moment to act! Seek professional thyroid management. Collaborate with Dr Sandeep to navigate towards a balanced and healthier state. Secure your consultation with Dr Sandeep for expert advice and personalized treatment options.

      MALFUNCTION OF THYROID GLAND AND ITS MANAGEMENT Read More »

      How Do We Maintain Balance?

      Balance, Ear

      HOW DO WE MAINTAIN BALANCE? NORMAL BALANCE MECHANISM: AN OVERVIEW Balance is a complex bodily function that allows us to stay upright and navigate through our environment. Understanding the nuances of the balance mechanism is crucial for diagnosing and treating related disorders. This guide aims to explain how the normal balance mechanism operates within the human body. KEY COMPONENTS INVOLVED IN BALANCE INNER EAR Contains the peripheral vestibular system responsible for detecting changes in head position and motion. EYES Provide visual cues to help orient the body in space. PROPRIOCEPTORS Sensation from touch and vibration receptors located in muscles and joints that provide information about body position. CENTRAL NERVOUS SYSTEM (BRAIN) Processes information received from the inner ear, eyes, and proprioceptors to control balance. VESTIBULAR SYSTEM IN THE INNER EAR The vestibular system is a key component of the balance mechanism. It consists of three semi-circular canals and two otolith organs (utricle and saccule): SEMICIRCULAR CANALS Detect rotational movements. OTOLITH ORGANS Sense linear movements and gravitational force. THE BALANCE PROCESS DETECTION OF MOVEMENT Any head or body movement stimulates the vestibular system in the inner ear. SIGNAL TRANSMISSION These stimulations are converted into electrical signals and sent to the brain via the vestibular nerve. INTEGRATION OF INFORMATION The brain receives signals from the vestibular system, eyes, and proprioceptors and integrates this information to assess the body’s position and motion. MOTOR RESPONSE Based on the integrated information, the brain sends commands to muscles to make necessary adjustments to maintain balance and orientation. FEEDBACK LOOP This process is continuous, providing real-time updates to the brain to sustain balance during all forms of activity and rest. BALANCE DISORDERS Balance disorders encompass various conditions, including benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and vestibular neuritis, affecting the inner ear’s function and causing dizziness and vertigo. Other disorders like labyrinthitis and acoustic neuroma involve the vestibular nerve, leading to balance problems. Additionally, conditions such as postural orthostatic tachycardia syndrome (POTS) can disrupt autonomic nervous system function, impacting balance. READ MORE ABOUT MANAGEMENT OF BALANCE DISORDERS HERE>> REGAIN STABILITY AND CONFIDENCE IN YOUR LIFE Do not let balance issues compromise your daily life and well-being. Take a proactive step towards finding solutions by scheduling a consultation with Dr Sandeep Uppal and his team at The ENT Clinic. We offer a holistic approach to address and manage balance issues, helping you regain stability and confidence in your everyday activities. Trust The ENT Clinic to help you find your balance and live life to the fullest.

      How Do We Maintain Balance? Read More »

      Hoarseness and Its Management

      Uncategorized

      HOARSENESS AND ITS MANAGEMENT Hoarseness, characterized by a change in the voice that can make it sound breathy, strained, or raspy, can arise from a variety of causes ranging from overuse to underlying medical conditions. Effective management begins with a thorough evaluation to pinpoint the specific cause. This can involve a detailed analysis of the patient’s voice habits, medical history, and a series of specialized tests to assess the vocal cords and surrounding structures. Once the root cause is identified, treatment is tailored to the individual’s needs. DIAGNOSIS OF HOARSENESS Diagnosis of hoarseness is a multi-step procedure that Dr Sandeep Uppal and his team at The ENT Clinic take very seriously. Given the range of potential causes, from lifestyle factors to more serious conditions like neoplasms, a comprehensive and methodical approach to diagnosis is essential. Here are some of the key steps involved: PATIENT HISTORY The team will first obtain a thorough history of the patient, including the duration and onset of the hoarseness, any associated symptoms, and other relevant medical and lifestyle factors. VOICE ASSESSMENT Dr Uppal or a speech therapist may evaluate voice quality, pitch, and volume, usually through specific vocal tasks like speaking or singing. DIAGNOSTIC TESTS Laryngoscopy This involves using a small, flexible tube with a light and camera at the end (laryngoscope) to visualise the vocal cords and larynx. Stroboscopy A more advanced version of laryngoscopy, stroboscopy allows the team to assess the vibration of the vocal cords by using a strobe light. This test provides more detailed information. Acoustic Analysis Some cases may require an in-depth analysis of voice frequency and other acoustic properties to understand the extent of the problem. Imaging For some patients, X-rays or MRIs may be necessary to rule out tumours or structural abnormalities that could be affecting voice quality. pH Monitoring If GERD is suspected, a 24-hour pH monitor may be used to measure the acid levels in the throat. Biopsy In cases where neoplasms or other growths are identified, a biopsy may be necessary to rule out cancer. MULTIDISCIPLINARY APPROACH Given the range of potential causes, Dr Sandeep may consult with other specialists such as gastroenterologists, allergists, or neurologists to provide a comprehensive diagnosis. ROLE OF SPEECH THERAPISTS Speech therapists are integral to the team, especially when hoarseness impacts speech quality or communication skills. They assess vocal use and misuse patterns and work with the child to develop healthier vocal habits. Techniques might include vocal exercises to improve pitch and volume control, as well as strategies to avoid straining the voice. COLLABORATION WITH PAEDIATRICIANS In some instances, hoarseness may be a symptom of an underlying health issue such as allergies, acid reflux, or respiratory infections. Dr Sandeep often collaborates with paediatricians to manage these associated conditions effectively, as addressing the root cause can significantly improve vocal quality. GASTROENTEROLOGISTS Reflux Disorders:  One common cause of voice problems and throat irritation is gastroesophageal reflux disease (GERD) and its variant, laryngopharyngeal reflux (LPR). Both conditions involve stomach acid rising up the oesophagus and potentially reaching the throat, irritating the vocal cords. A gastroenterologist can diagnose reflux disorders using methods like endoscopy, pH monitoring, and barium swallow studies. Based on the findings, they can recommend dietary changes, prescribe medications, or in severe cases, recommend surgical interventions. NEUROLOGISTS Neurological Conditions: Some voice and throat issues can be a result of neurological conditions. For example, vocal cord paralysis can be caused by nerve damage, and spasmodic dysphonia is a neurological disorder affecting voice box muscles. A neurologist can perform a range of tests, such as nerve conduction studies, to diagnose the underlying neurological condition. Based on the diagnosis, treatments might include medications, Botox injections, or other therapeutic interventions FINAL DIAGNOSIS Once all tests and consultations are complete, Dr Sandeep and his team will consolidate the findings to arrive at a conclusive diagnosis. This will serve as the basis for a tailored treatment plan designed to effectively manage and, where possible, cure the hoarseness. TREATMENT OF HOARSENESS The treatment approach is determined based on the underlying cause of the hoarseness. Here’s an overview of the potential treatments: VOICE REST AND HYDRATION For cases caused by voice overuse or strain, simply resting the voice can help in recovery. Keeping the throat hydrated can relieve some symptoms. Patients are often advised to drink plenty of water and use humidifiers, especially in dry climates or seasons. VOICE THERAPY A speech therapist can provide exercises and techniques to reduce strain on the vocal cords. This is especially useful for individuals who use their voice frequently, such as singers or public speakers. MEDICATIONS Anti-inflammatory medications Can reduce swelling of the vocal cords in cases of acute laryngitis. Antibiotics Used if bacterial infection is the cause, though hoarseness is more often caused by viral infections, against which antibiotics are ineffective. Antacid medications Useful for patients with hoarseness due to GERD or LPR. Antihistamines and corticosteroids May be prescribed for hoarseness caused by allergies. Lifestyle Modifications Avoiding smoking and limiting alcohol can alleviate hoarseness in many patients. Dietary changes can reduce acid reflux symptoms, which can, in turn, alleviate hoarseness. Surgery In cases where nodules, polyps, cysts, or tumours are causing the hoarseness, surgical intervention may be necessary. Laryngeal papilloma’s, often caused by HPV, might need surgical removal. Botox Injections For conditions like spasmodic dysphonia, Botox injections into the vocal cord muscles can reduce muscle spasms and improve voice quality. Avoidance of Irritants Staying away from irritants, such as smoke or allergens, can prevent and treat hoarseness, especially in chronic cases. AMPLIFY YOUR VOICE: EXPERT SOLUTIONS FOR HOARSENESS Is a hoarse voice holding you back? Speak up and reach out! Dr Sandeep Uppal and our team at The ENT Clinic are eager to help you find your voice again. We know how important it is to be heard clearly, and we’re committed to providing you with the expert care you need. From personalized voice assessments to the latest therapeutic techniques, we have the tools to fine-tune your vocal health. We cater

      Hoarseness and Its Management Read More »

      Glue Ear (Otitis Media With Effusion)

      Ear

      GLUE EAR Normal ear drum Glue ear with fluid level behind the ear drum Glue ear with bubbles in fluid behind the ear drum Otitis Media with Effusion (OME), which is commonly known as “glue ear.” Following an episode of Acute Middle Ear Infection (Acute Otitis Media), fluid may remain in the middle ear for several weeks, leading to a condition known as Otitis Media with Effusion (OME). While not an acute infection, OME can still impair hearing and requires monitoring. It is particularly prevalent among children but can also affect adults. The fluid is often thick and sticky, resembling glue, hence the colloquial term. DIAGNOSIS Diagnosing OME usually involves a combination of clinical history, physical examination, and sometimes additional tests: CLINICAL HISTORY The patient often presents with hearing difficulties, a feeling of fullness in the ear, and sometimes, balance issues. However, pain is usually not a prominent symptom in OME. PHYSICAL EXAMINATION Dr Sandeep Uppal would typically use an otoscope or a microscope to examine the ear. Signs of fluid or an immobile or retracted eardrum are indicative of OME. TYMPANOMETRY This test can be performed to assess how well the eardrum is moving and to confirm the presence of fluid in the middle ear. AUDIOMETRY A hearing test might be recommended to assess the level of hearing loss, if any. TREATMENT Treatment for OME often varies depending on the severity of the condition, patient age, and associated symptoms. Here are some common treatment options: WATCHFUL WAITING In many cases, especially in children, the condition resolves on its own. Dr Sandeep and his team may adopt a ‘watch and wait’ approach, monitoring the situation over time. MEDICAL TREATMENT In some cases, a course of nasal decongestants or antihistamines may be prescribed to alleviate symptoms. However, the efficacy of these medications in treating OME is debated. VENTILATION TUBES (GROMMETS) Various kinds of ventilation tubes Size of typical ventilation tube Ventilation tube in the ear drum to treat glue ear For persistent or severe cases, Dr Sandeep may recommend the insertion of ventilation tubes, known as grommets, into the eardrum. This allows the fluid to drain, alleviating symptoms and preventing complications. ADENOIDECTOMY Sometimes large adenoids at the back of the nose block the Eustachian tubes, which in turn contributes to glue ear. In such patient’s removal of the adenoids is advised, especially if the patient has recurring episodes of OME and/or other nasal symptoms. HEARING AIDS In cases where OME leads to significant hearing loss, hearing aids may be recommended to improve auditory function. Often this is a temporary measure to give the ear enough time to recover spontaneously. POTENTIAL COMPLICATIONS OF OTITIS MEDIA WITH EFFUSION Dr Sandeep is particularly vigilant when it comes to managing complications that may arise from Otitis Media with Effusion (OME). While OME is often a self-limiting condition that may resolve on its own, there are instances where it can lead to complications. Understanding these potential complications is crucial for providing effective patient care. HEARING LOSS One of the most immediate complications is a temporary reduction in hearing. This can be particularly problematic for children in developmental stages, affecting speech and academic performance. SPEECH AND DEVELOPMENTAL DELAYS In children, prolonged OME and resultant hearing loss can lead to delays in speech development, as well as other developmental milestones. BALANCE ISSUES The accumulation of fluid in the middle ear can affect the equilibrium, leading to balance problems or dizziness. TYMPANIC MEMBRANE RETRACTION OR ATROPHY Over time, the pressure from the accumulated fluid can cause the eardrum to retract or become thin, which could potentially result in permanent damage. CHRONIC SUPPURATIVE OTITIS MEDIA (CSOM) Normal ear drum CSOM In some cases, OME can progress to a more severe form of ear infection that involves persistent drainage from the ear. CHOLESTEATOMA Rarely, chronic OME can lead to the formation of a cholesteatoma, a skin cyst that can grow and destroy the bones of the middle ear, leading to hearing loss and other serious complications. Learn more about cholesteatoma>> SOCIAL AND BEHAVIOURAL IMPACT Especially in children, recurrent episodes of OME and associated hearing loss can result in behavioural issues or decreased social interaction. CLEAR EARS, BRIGHT FUTURES! Glue ear doesn’t have to stick around. Dr. Sandeep Uppal and our team are experts at making ears clear and healthy. We check ears early to catch any gooey problems and fix them with the best care, like tiny tubes (grommets) or other helpful treatments. Our team, including hearing and speech pros, works together like a superhero squad for your ears, making sure you hear well and learn sounds and words just right. If you think glue ear is messing with hearing or talking, come see us. We’re all about keeping ears and speech clear as a bell. Book your spot with Dr Sandeep’s team now and get ready for clear hearing!

      Glue Ear (Otitis Media With Effusion) Read More »

      Fungal Sinusitis

      Nose, Sinusitis

      FUNGAL SINUSITIS Fungal sinusitis refers to the inflammation of the sinuses caused by a fungal infection. It is less common than bacterial or viral sinusitis but can be more challenging to treat. The condition is primarily seen in individuals with weakened immune systems or uncontrolled diabetes, but can also affect healthy individuals, especially when exposed to certain environmental conditions. TYPES OF FUNGAL SINUSITIS ACUTE INVASIVE FUNGAL SINUSITIS This is a rapidly progressing and severe form of the disease, often observed in individuals with weakened immune systems. It can be life-threatening if not treated promptly. CHRONIC INVASIVE FUNGAL SINUSITIS Chronic invasive fungal sinusitis is a slow-progressing form of fungal infection that gradually damages the sinuses and facial structures, typically seen in individuals with slightly compromised immune systems. While less aggressive than its acute counterpart, it requires long-term treatment and monitoring to prevent serious complications. FUNGUS BALL (MYCETOMA) This type involves the presence of a fungal ball within a sinus cavity, usually the maxillary sinus. It doesn’t invade the sinus tissue but causes symptoms due to its mass effect. ALLERGIC FUNGAL SINUSITIS (AFS) This is an allergic reaction to environmental fungi that colonise the sinuses. It typically affects individuals with a history of allergies or asthma. The sinuses may be filled with thick fungal debris and mucus. Read more regarding allergic rhinitis and its management>> CAUSES Fungal spores are abundant in the environment, but only a few types can cause sinus infections. Individuals with compromised immune systems or those who have had prolonged antibiotic, chemotherapy, or immunosuppressive therapy are more susceptible. SYMPTOMS Symptoms can vary depending on the type of fungal sinusitis, but they generally include: Nasal congestion Nasal discharge Facial pain or pressure Decreased sense of smell Fever (particularly in invasive types) Eye symptoms such as bulging, pain, double vision, loss of vision (especially if the infection spreads) Headache Chronic cough Read more about blocked nose here>> TREATMENT SURGICAL DEBRIDEMENT Especially important for invasive fungal sinusitis, where the infected tissue must be removed. ANTIFUNGAL MEDICATIONS Administered to manage and eradicate the fungal infection. CORTICOSTEROIDS May be used, especially in cases of allergic fungal sinusitis, to reduce inflammation. IMMUNOTHERAPY For those with allergic fungal sinusitis, allergy shots might help prevent the condition from returning. SINUS IRRIGATION Using saline solutions can help keep the sinuses clear. Learn more about nasal sinuses and sinusitis>> Learn more about management of sinusitis>> TAKE CONTROL OF FUNGAL SINUSITIS WITH EXPERT CARE Fungal sinusitis can be a complex condition, with treatment and outcomes varying significantly depending on the precise diagnosis. It’s imperative to have a specialist who can accurately identify and treat your specific type of fungal sinusitis. Dr Sandeep Uppal and his skilled team are at the forefront of ENT healthcare, offering comprehensive services to tackle this condition head-on. Don’t let fungal sinusitis diminish your quality of life. Reach out to Dr Sandeep and his team for top-tier advice, thorough diagnosis, and a range of treatment options tailored to your needs. Take the first step towards relief and recovery—contact us today for a consultation.

      Fungal Sinusitis Read More »

      Differences Between Snoring and Obstructive Sleep Apnoea

      Snoring and Sleep Apnoea, Throat

      DIFFERENCES BETWEEN SNORING AND OBSTRUCTIVE SLEEP APNOEA Snoring and obstructive sleep apnoea (OSA) are often confused due to their similar manifestations involving the respiratory system during sleep. However, they are distinct conditions with different clinical implications. Dr Sandeep Uppal and his team are skilled in distinguishing between the two and providing appropriate treatment for each. SNORING Definition: Snoring is the sound produced by the vibration of soft tissues in the throat and nasal passages during sleep. It is typically continuous and occurs during the inhalation and exhalation of breath. Causes: It can result from various factors, including nasal congestion, obesity, alcohol consumption, and sleep position. Symptoms: The primary symptom is the snoring sound itself, which can vary in volume and pattern. There may be no other associated symptoms. Impact: While snoring can be disruptive to sleep quality for both the individual and their partner, it is generally not considered a medical emergency unless it is a symptom of OSA or another underlying condition. Treatment: Often managed through lifestyle changes, anti-snoring devices, or, in severe cases, surgical interventions. Learn more about snoring>> Learn more about management options for snoring>> OBSTRUCTIVE SLEEP APNOEA (OSA) Definition: OSA is a serious sleep disorder characterized by repeated interruptions in breathing during sleep due to a temporary blockage of the airway. Causes: Like snoring, OSA can also be caused by obesity, but it is often exacerbated by other factors like anatomical abnormalities, muscle relaxation, and other medical conditions. Symptoms: Apart from snoring, OSA is associated with symptoms like choking or gasping for air, long pauses in breathing, daytime sleepiness, irritability, and morning headaches. Impact: OSA can lead to a range of health complications, including cardiovascular disease, hypertension, and increased risk of accidents due to poor concentration and daytime sleepiness. Treatment: More complex and often requires the use of Continuous Positive Airway Pressure (CPAP) machines, Bi-Level Positive Airway Pressure (BiPAP) devices, or even surgical interventions. Learn more about Obstructive Sleep Apnoea>> Learn more about management of Obstructive Sleep Apnoea>> KEY DIFFERENCES Breathing Interruptions: Snoring is usually continuous, while OSA involves frequent pauses in breathing. Daytime Symptoms: OSA often leads to noticeable daytime symptoms like extreme fatigue and irritability, which are generally not present in cases of simple snoring. Health Risks: OSA carries significant health risks and often requires medical intervention, while snoring is generally less severe but may still warrant treatment to improve sleep quality. TAKE CONTROL OF YOUR SNORING AND OBSTRUCTIVE SLEEP APNOEA (OSA) Given the prevalence and potential complications associated with snoring and obstructive sleep apnoea (OSA), it’s essential to seek specialized care. Dr Sandeep Uppal and his dedicated team are here to provide expert assistance. Don’t wait any longer—take proactive steps to manage snoring and OSA effectively. Our multidisciplinary approach combines medical expertise with cutting-edge technology, offering a comprehensive range of services designed to diagnose and treat both snoring and OSA, addressing their underlying causes. Regain control over your sleep and overall health—act now.

      Differences Between Snoring and Obstructive Sleep Apnoea Read More »

      Chronic Tonsillitis and Its Management

      Adenoids and Tonsils

      CHRONIC TONSILLITIS AND ITS MANAGEMENT WHAT IS CHRONIC TONSILLITIS? Chronic tonsillitis is a persistent or recurrent inflammation of the tonsils, lasting for extended periods, often for more than three months. Unlike acute tonsillitis, which is a short-term condition, chronic tonsillitis can significantly affect one’s quality of life over time. CAUSES OF CHRONIC TONSILLITIS RECURRENT ACUTE INFECTIONS Multiple episodes of acute tonsillitis can eventually lead to a chronic condition. PERSISTENT LOW-LEVEL INFECTION Sometimes, a less aggressive but enduring infection can cause chronic tonsillitis. ENVIRONMENTAL FACTORS Exposure to irritants like tobacco smoke or pollution. IMMUNOLOGICAL FACTORS Weak immune responses can fail to clear previous infections, contributing to chronicity. CLINICAL PRESENTATION (SYMPTOMS) PERSISTENT SORE THROAT Mild but nagging pain, often worse in the mornings. HALITOSIS (BAD BREATH) Due to bacterial activity. LOW-GRADE FEVER May be intermittent. DIFFICULTY SWALLOWING Especially problematic with solid foods. SWOLLEN LYMPH NODES Often tender to touch, located in the neck. TONSIL STONES (TONSILLOLITHS) The term “tonsilloliths” refers to tonsil stones, which are calcified deposits that form in the crevices of the tonsils. Here’s some general information about them: They are formed when debris, such as food, dead cells, and other substances, get trapped in the nooks and crannies of the tonsils. Over time, this debris can harden or calcify, forming tonsil stones. They can vary in size and colour, often appearing as white or yellowish formations. DIAGNOSTIC MEASURES HISTORY-TAKING IN CHRONIC TONSILLITIS A detailed medical history is the cornerstone of diagnosing chronic tonsillitis effectively. Duration of Symptoms Understanding how long the patient has been experiencing symptoms helps distinguish between acute and chronic cases. Frequency of Episodes The number of times the symptoms have recurred over a specific period is vital for diagnosis. Severity of Symptoms Questions about pain levels, difficulty swallowing, and other symptoms help gauge the impact on the patient’s life. Associated Symptoms Queries about fever, bad breath, or tonsil stones could provide additional diagnostic clues. Treatment History Information about any previous treatments, including antibiotic use, is collected to determine their effectiveness or any patterns of resistance. Lifestyle Factors Exposure to environmental irritants like smoke or allergens, dietary habits, and oral hygiene practices may also be discussed. EXAMINATION IN CHRONIC TONSILLITIS Inspection The tonsils are visually inspected for size, colour, and the presence of exudates or tonsil stones. Palpation The area around the neck, particularly the lymph nodes, is palpated to check for tenderness or swelling. Throat Swab A culture may be taken from the tonsils to identify any bacterial infection. This helps in tailoring antibiotic treatment. Endoscopic Examination In some cases, a flexible endoscope may be used for a more detailed visual inspection, especially if there are symptoms suggesting deeper throat or nasal issues. Imaging Though rarely needed in chronic tonsillitis, imaging tests like X-rays or CT scans may be considered for complex cases or to rule out other conditions like tonsil tumours or enlarged styloid process. Total Blood Count (TBC) Blood tests can help identify markers of chronic inflammation or infection. Allergy Tests Depending on the initial findings, other tests like allergy panels might be considered. TREATMENT MODALITIES The management of chronic tonsillitis requires a multi-faceted approach that encompasses pharmaceutical treatment, lifestyle modifications, and, in some cases, surgical interventions. Here is how Dr Sandeep Uppal and his expert team at The ENT Clinic approach the treatment of this persistent condition. PHARMACEUTICAL TREATMENT Extended Antibiotic Therapy In cases where bacterial infection is identified, a longer course of antibiotics, often lasting several weeks, may be prescribed to eradicate the lingering infection. Anti-Inflammatory Medication Corticosteroids may be used for short periods to alleviate severe inflammation but are generally not recommended for long-term treatment due to potential side effects. Symptomatic Relief Over-the-counter pain relievers like paracetamol or ibuprofen may be suggested for controlling pain and discomfort. LIFESTYLE MODIFICATIONS Dietary Adjustments Eating soft, non-irritating foods can help reduce symptom severity. Hydration Adequate fluid intake, especially warm fluids like herbal teas, can offer relief. Oral Hygiene Maintaining good oral hygiene can prevent bacterial build-up and subsequent tonsil stones. Environmental Factors Avoiding irritants like tobacco smoke, alcohol and allergens can help in symptom management. FOLLOW-UP AND MONITORING Regular Check-ups Follow-up appointments are crucial for adjusting treatment plans and monitoring for potential complications. Symptom Journal Patients may be asked to maintain a record of symptom severity and frequency to gauge treatment efficacy. Self-care Techniques Instructions on warm saltwater gargles, proper brushing techniques, and dietary choices are often provided. SURGICAL MANAGEMENT: TONSILLECTOMY Tonsillectomy, the surgical removal of the tonsils, is often considered under specific conditions where medical treatment has failed, or the symptoms significantly impact quality of life. Dr Sandeep Uppal and his team at The ENT Clinic follow evidence-based guidelines to determine when a tonsillectomy is warranted. Here are some of the indications for tonsillectomy. Recurrent Acute Tonsillitis For recurrent throat infections, the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) guidelines* recommend tonsillectomy if a child has experienced: Seven or more episodes of tonsillitis in the past year. Five or more episodes per year for the past two years. Three or more episodes per year for the past three years. Documentation in the medical record for each episode of sore throat and one or more of the following: T>38.3 0C (1010F), neck lymph node enlargement, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus. However, tonsillectomy may be considered for children who have fewer episodes than these criteria but have specific modifying factors, such as: Multiple antibiotic allergies. Periodic fever. Aphthous stomatitis, pharyngitis, and adenitis (PFAPA). History of more than one peritonsillar abscess. Chronic Tonsillitis When symptoms last for a prolonged period and significantly affect the patient’s quality of life. Obstructive Sleep Apnoea (OSA) According to AAO-HNS guidelines tonsillectomy is recommended for children with documented obstructive sleep apnea confirmed by overnight polysomnography. There’s also a recommendation to inquire about coexisting conditions that might improve after tonsillectomy, like growth retardation, poor school performance, enuresis, asthma, and behavioural problems. Peritonsillar Abscess (Quinsy) Usually, tonsillectomy is considered when the patient has had 2 episodes

      Chronic Tonsillitis and Its Management Read More »

      Chronic Middle Ear Infection

      Ear

      CHRONIC MIDDLE EAR INFECTION Chronic Suppurative Otitis Media (CSOM) is a persistent infection of the middle ear and mastoid cavity that typically lasts for more than three months. It typically presents with a specific set of signs and symptoms. This condition is characterised by the presence of a perforated tympanic membrane (the membrane separating the external ear from the middle ear) and Cholesteatoma. It is a significant health issue that can lead to various complications if not properly managed. Learn more about management of hole in the ear drum>> COMMON SYMPTOMS EAR DISCHARGE Persistent or intermittent ear discharge (Otorrhoea) that is often purulent. The ear discharge may have a distinct, often foul, smell. HEARING LOSS Gradual loss of hearing, usually conductive but may involve sensorineural elements. Read more about various kinds of hearing loss>> EAR PAIN Occasional pain or discomfort, although less common than in acute forms of otitis media. VERTIGO OR TINNITUS If the infection effects the inner ear balance mechanism, patients may experience dizziness. Rarely there is ringing in the ear. WHAT CAUSES CSOM? RECURRENT ACUTE OTITIS MEDIA Frequent episodes of acute ear infections can evolve into CSOM if not adequately treated. EUSTACHIAN TUBE DYSFUNCTION Poor function of the Eustachian tube can lead to negative middle ear pressure, fluid retention, and subsequent infection. ENVIRONMENTAL FACTORS Living in crowded conditions, poor hygiene, and exposure to smoke can increase the risk. POORLY MANAGED PREVIOUS EAR INFECTIONS Inadequate or incomplete treatment of prior ear infections can set the stage for CSOM. GENETIC FACTORS Some individuals may be genetically predisposed to developing recurrent ear infections, leading to CSOM. HOW IS CSOM DIAGNOSED? Diagnosis of Chronic Suppurative Otitis Media (CSOM) is a multi-step process that involves a combination of clinical evaluation and diagnostic tests. Dr Sandeep Uppal and his team at The ENT Clinic employ a rigorous approach to diagnosing this condition, which usually includes the following elements: CLINICAL EVALUATION A thorough clinical evaluation is crucial to diagnose the condition as well it’s potential complications. Patient History: Collecting a detailed history of symptoms, previous ear infections, and other medical conditions. Physical Examination: An in-depth otoscopic examination to assess the condition of the ear canal, tympanic membrane, and any visible structures in the middle ear. If the ear canal contains discharge or debris, these are cleared with ear toilet under the microscope. DIAGNOSTIC TESTS Otoscopic Findings: A hole or tear in the tympanic membrane is often visible upon otoscopic examination. There may be signs of fluid or pus in the middle ear space behind the perforated tympanic membrane. In chronic cases, granulation tissue or cholesteatoma may be visible in the middle ear or ear canal. Tympanometry: Utilised to measure the movement of the tympanic membrane, which can provide insights into middle ear pressure and fluid presence. Pure Tone Audiometry: Conducted to assess the degree and type of hearing loss. ADVANCED IMAGING CT Scan of the Temporal Bones: This is usually reserved for complicated or atypical cases and is crucial for surgical planning. It can help in assessing the extent of the disease and identifying complications such as mastoiditis, cholesteatoma or intracranial complications. PUS CULTURE Culture and Sensitivity: A sample of the ear discharge may be sent for microbiological analysis to identify the specific bacteria causing the infection and their antibiotic sensitivities. By employing a comprehensive, multi-modal diagnostic approach, Dr Sandeep Uppal and his team ensure an accurate diagnosis of CSOM. This, in turn, enables them to develop a targeted treatment plan tailored to each patient’s unique needs, thereby increasing the likelihood of a successful outcome. TREATMENT OF CSOM We adopt an evidence-based, patient-centric approach for treatment, this often involves a combination of medical and surgical options, tailored to the severity of the disease, the patient’s general health, and any associated complications. Here are the key components of their treatment strategy: EAR CLEANING Micro suction is performed under the microscope for removal of pus and debris. It facilitates better penetration of topical medications. TOPICAL ANTIBIOTICS Often first-line treatment for uncomplicated CSOM when the ear drum is perforated. Corticosteroids may be used to reduce inflammation and are often combined with antibiotics in ear drops. SYSTEMIC ANTIBIOTICS Used in severe cases or when complications are suspected. Usually broad-spectrum until culture results are available. TYMPANOPLASTY Surgical repair of the tympanic membrane. Indicated for persistent perforations and hearing loss. MASTOIDECTOMY Procedure performed for removal of infected mastoid air cells and cholesteatoma. Generally reserved for complicated cases or those not responding to medical treatment. OSSICULOPLASTY Repair or replacement of damaged middle ear bones is performed if ossicular chain is disrupted. HYGIENE MEASURES Patients are educated on how to keep the ear dry and clean. MONITORING Regular appointments are scheduled for symptom review and otoscopic examination. TREATMENT ADJUSTMENT Treatment regimens may be modified based on response and any emerging complications. WHAT ARE THE POTENTIAL COMPLICATIONS OF CSOM? Untreated Chronic Suppurative Otitis Media (CSOM) poses a risk of developing serious complications that can have severe consequences. Dr Sandeep Uppal and his team at The ENT Clinic are vigilant in educating patients and healthcare professionals about these potential complications, which can be categorized as follows: CHOLESTEATOMA FORMATION Microscopic photograph showing ear drum perforation and cholesteatoma. Accumulation of skin cells and debris can erode surrounding structures, including the bones of the middle ear. Read more about cholesteatoma here>> OSSICULAR CHAIN DESTRUCTION Erosion or damage to the tiny bones in the middle ear can result in more severe hearing loss. MASTOIDITIS Infection of the mastoid bone, which can lead to abscess formation and require surgical intervention. FACIAL NERVE PARALYSIS The facial nerve runs through the middle ear, and infection can lead to paralysis, affecting facial movements. MENINGITIS Infection can spread to the membranes covering the brain and spinal cord, becoming a life-threatening condition. BRAIN ABSCESS CT scan showing brain abscess resulting from middle ear infection Accumulation of pus within the brain tissue, requiring immediate surgical intervention. EXTRADURAL ABSCESS Formation of an abscess between the dura mater and skull, also requiring immediate attention. LABYRINTHITIS Infection

      Chronic Middle Ear Infection Read More »

      Allergic Rhinitis and Its Management

      Nose

      ALLERGIC RHINITIS AND ITS MANAGEMENT Allergic rhinitis, which many of us know as “Hay Fever”, is a common condition that affects many people around the world, including in Singapore. HOW COMMON IS ALLERGIC RHINITIS? Hay fever affects about 10-30% of people worldwide. In Singapore, because of its warm and urban environment, about 20-30% of people have hay fever. WHAT CAUSES ALLERGIC RHINITIS? When someone who is sensitive to certain substances (allergens) breathes them in, their body tries to fight off these allergens. This reaction causes the nose to become inflamed. WHAT ARE THE MAIN ALLERGENS WORLDWIDE AND IN SINGAPORE? Globally, tree, grass, and weed pollen are frequent hay fever triggers. In Singapore, house dust mites are the primary concern. Additional irritants in Singapore and globally include: Pet hair Mould Cockroach droppings WHAT ARE THE COMMON SYMPTOMS OF NASAL ALLERGIES? Allergic rhinitis, manifests with a variety of symptoms that result from the body’s reaction to air borne allergens. The common symptoms include: Sneezing: Often in bouts or sequences, often in the morning. Runny nose: Clear, watery nasal discharge. Nasal congestion: A stuffy or blocked nose. Itchy nose: An urge to scratch the inside of the nose. Itchy eyes: Along with redness and watering of the eyes. Itchy throat: Sometimes leading to a cough or throat clearing. Swollen, blue-coloured skin under the eyes: Often referred to as “allergic shiners”. Postnasal drip: Sensation of mucus dripping from the back of the nose into the throat, which can lead to cough or a sore throat. Reduced sense of smell: Due to nasal congestion. Fatigue: Due to disrupted sleep or the body’s reaction to allergens. Worsening of asthma: In some people, allergic rhinitis can also trigger or exacerbate other symptoms or conditions, such as asthma or eczema. If one experiences these symptoms regularly or in particular seasons, it may be indicative of allergic rhinitis. It’s advisable to see a healthcare professional, like an ENT specialist, for an accurate diagnosis and appropriate management. WHY DO SOME PEOPLE GET HAY FEVER? There are two main reasons: Genetic predisposition: If family members have allergies, one is more likely to develop hay fever. Exposure to allergens: High exposure to triggers at an early age can increase the risk. Being born during pollen season: There is some evidence to suggest that those born during high pollen seasons may be more susceptible. Having other allergies or asthma: Those with existing allergies or asthma are more likely to develop hay fever. Living or working in an environment that constantly exposes one to allergens can also heighten the risk. HOW IS ALLERGIC RHINITIS DIAGNOSED? HISTORY AND EXAMINATION Dr Sandeep gathers a detailed history of symptoms and their occurrences. A comprehensive ENT examination is performed, and a nasal endoscopy is conducted to check for: Enlarged, pale and boggy nasal turbinates. Deviated septum. Presence of polyps or other pathology. Signs of sinus infection like mucous or pus emanating from the nasal sinuses. TESTS FOR ALLERGY These tests help determine the specific allergens causing the symptoms. Skin Prick Test (SPT): Small amounts of allergens are introduced into the skin. If there’s a reaction, it suggests an allergy to that specific allergen. Blood Test (RAST or ImmunoCAP): Allergy panel measures the amount of allergen specific IgE antibodies in the blood. HOW IS ALLERGIC RHINITIS TREATED? The approach to treating allergic rhinitis is multiprong, the aim is symptom control. ALLERGEN AVOIDANCE The first step is to identify and avoid triggers. House Dust Mite Avoidance Encase Mattresses and Pillows: Use allergen-proof covers to keep mites out. Wash Bedding Regularly: Wash sheets, blankets, and pillowcases weekly in hot water (at least 60°C) and dry them in a hot dryer. Reduce Humidity: Keep home humidity below 50% using dehumidifiers or air conditioners. Remove Carpeting: Where possible, replace carpets with hardwood, tile, or linoleum flooring. Regular Cleaning: Vacuum weekly using a vacuum cleaner with a HEPA (high-efficiency particulate air) filter. Wear a mask while vacuuming. Declutter: Dust mites thrive in clutter. Reduce items that collect dust, like knick-knacks and books. Clean Curtains and Upholstery: Wash with hot water or vacuum regularly with a vacuum cleaner with a HEPA (high-efficiency particulate air) filter items like bed linen and curtains, and consider using blinds instead of fabric curtains. Air Purifiers: Use air purifiers with HEPA filters to reduce airborne allergens. Soft Toys and Allergen Avoidance Measures Soft toys can be a haven for dust mites and allergens, especially if they are frequently handled or placed in areas prone to dust accumulation. If someone in the household has allergies, particularly to dust mites, it’s essential to take measures to keep soft toys as allergen-free as possible. Here are some measures to reduce allergens in soft toys: Regular Cleaning: Wash soft toys in hot water (at least 60°C) regularly. Ensure they are thoroughly dried before giving them back to children. For toys that can’t be washed, placing them in a plastic bag and freezing them overnight can kill dust mites. After removing them from the freezer, let them return to room temperature, and then give them a good shake or vacuum to remove dead mites. Storage: Store soft toys in closed cabinets or toy boxes to prevent dust accumulation. Avoid placing soft toys on beds, especially if they aren’t regularly cleaned, as this can be a significant source of allergens. Limit Number of Soft Toys: Consider having fewer soft toys, especially in sleeping areas. This reduces potential allergen accumulation points. Choose Allergen-Friendly Toys: Opt for toys labelled as hypoallergenic. These toys are made of materials less likely to provoke an allergic response. Avoid Second-hand Soft Toys: If possible, refrain from using second-hand soft toys, as their previous environment might have exposed them to a variety of allergens. Use Protective Covers: Use allergen-proof covers or bags for toys, especially those that children might take to bed with them. Regular Air Out: Periodically let soft toys air outside in direct sunlight. The ultraviolet light from the sun can help reduce the number of dust mites. Vacuuming: If

      Allergic Rhinitis and Its Management Read More »

      Acute Tonsillitis and Its Management

      Adenoids and Tonsils

      ACUTE TONSILLITIS AND ITS MANAGEMENT Acute tonsillitis refers to a sudden inflammation or infection of the tonsils, which are the lymphoid tissues located at the back of the throat. This condition typically manifests as a painful, sore throat accompanied by other symptoms like fever. CAUSES VIRAL INFECTIONS Common cold viruses Influenza Epstein-Barr virus (often leading to infectious mononucleosis) BACTERIAL INFECTIONS Streptococcus pyogenes (most common) Staphylococcus aureus Haemophilus influenzae BONE REDUCTION These may include allergens, irritants, and weakened immune systems. CLINICAL PRESENTATION (SYMPTOMS) SEVERE SORE THROAT Often the primary complaint, making swallowing difficult and painful. FEVER AND CHILLS A sudden rise in body temperature with chills is common. MALAISE AND FATIGUE A general feeling of being unwell. HEADACHE General discomfort and headache may accompany. SWOLLEN TONSILS Visible swelling, often with a white or yellow coating. SWOLLEN LYMPH NODES Particularly in the neck area. DIAGNOSTIC MEASURES PHYSICAL EXAMINATION Dr Sandeep and his team will typically inspect the throat, mouth, and neck. THROAT SWAB CULTURE Dr Sandeep and his team may take a throat swab to identify the bacteria’s causing the tonsil infection and the most appropriate antibiotic to treat it. TOTAL BLOOD COUNT (TBC) To check for infection markers and rule out other conditions. RAPID ANTIGEN TEST Quick test to detect streptococcal bacteria. TREATMENT MODALITIES ANTIBIOTICS If bacterial in origin, antibiotics such as penicillin or amoxicillin are prescribed. SYMPTOMATIC RELIEF Over-the-counter analgesics like paracetamol for pain and fever. Lozenges and throat sprays may offer temporary relief. HYDRATION AND NUTRITION Adequate fluid intake is crucial. Soft foods to lessen irritation during swallowing. REST Adequate sleep and rest are essential for rapid recovery. HOSPITAL ADMISSION In severe cases when the fever is very high and patient is unable to swallow at all, the patient may need to be admitted for antibiotics, pain killers and fluids to be administered through the veins. Complications and Follow-up Untreated or inadequately treated acute tonsillitis can lead to complications like: Peritonsillar abscess Rheumatic fever Otitis media (middle ear infection) Regular follow-ups may be scheduled to ensure complete resolution of the infection and to monitor for any potential complications. TAKE IMMEDIATE ACTION ON ACUTE TONSILLITIS: SECURE YOUR WELL-BEING! Experiencing severe sore throat, fever, or swollen tonsils? Acute tonsillitis can cause significant discomfort and may affect your ability to eat and speak, often leading to more serious conditions if not treated promptly. Prompt intervention is key to recovery and preventing complications such as rheumatic fever or kidney inflammation. Don’t delay your health needs. Act swiftly to tackle the pain and inconvenience of acute tonsillitis. Reach out to Dr Sandeep for urgent care and effective treatment solutions. Book your urgent consultation to get back to health.

      Acute Tonsillitis and Its Management Read More »

      ×