Ear

The ear has external, middle, and inner portions. The outer ear is called the pine and is made of ridged cartilage covered by skin. Sound funnels through the pine into the external auditory canal, a short tube that ends at the eardrum (tympanic membrane).

Sound causes the eardrum and its tiny attached bones in the middle portion of the ear to vibrate, and the vibrations are conducted to the nearby cochlea. The spiral-shaped cochlea is part of the inner ear; it transforms sound into nerve impulses that travel to the brain.
The fluid-filled semicircular canals (labyrinth) attach to the cochlea and nerves in the inner ear. They send information on balance and head position to the brain. The Eustachian (auditory) tube drains fluid from the middle ear into the throat (pharynx) behind the nose.

Ear Conditions

• Earache: Pain in the ear can have many causes & some of these are serious, some are not serious.
• Otitis media(middle ear inflammation): Inflammation or infection of the middle ear (behind the eardrum). Usually, this is caused by an infection.
• Swimmer’s ear(Otitis external): Inflammation or infection of the outer ear (pinna and ear canal). Sudden cases are usually infections; chronic otitis is often a skin condition (dermatitis).
• Meniere’s disease: A condition in which the inner ear on one side malfunctions. Vertigo, tinnitus, hearing loss, and ear fullness are common symptoms.
• Tinnitus: Ringing in one or both ears. Usually this is due to damage from noise exposure, or from agcing.
• Cerumen(ear wax) impaction: Ear wax may block the ear canal and adhere to the eardrum.
• Ruptured eardrum: Very loud noises, sudden changes in air pressure, infection, or foreign objects can tear the eardrum. The small hole usually heals within a few weeks.
• Acoustic neuroma: A noncancerous tumor that grows on the nerve travelling from the ear to the brain. Hearing loss, vertigo, and tinnitus can be symptoms.
• Mastoiditis: Infection of the mastoid bone, just behind the ear. Mastoiditis can result from untreated middle ear infections.
• Benign paroxysmal positional vertigo (BPPV): A disruption of function in the inner ear, causing episodes of vertigo. Although not medically serious, its symptoms can be distressing.
• Cholesteatoma: This is a benign condition. It is the buildup of fibrous tissue within the middle ear and surrounding bones. Often there is a foul smelling discharge associated with hearing loss.

FEW COMMON EAR SURGERIES

Tympanoplasty: Tympanoplasty is an operation that is aimed to remove infection from your ear and close a hole in your eardrum. The aim of this operation is to prevent repeated ear infections.

Ossiculoplasty:strong> Ossiculoplasty is an operation to help improve hearing in those patients where hearing loss is due to damage to the ossicles (tiny hearing bones) following chronic ear infection. In this operation we may either use your own residual ossicle or an artificial ossicle to achieve the desired result.

Mastoidectomy:strong> Mastoidectomy is an operation that is aimed to remove any pocket of dead skin and infection in your ear and mastoid bone (ear bone) and thus stop ear discharge.  Infection in the ear can spread to the temporal / mastoid bone. Your ENT specialist may need to evacuate parts of the temporal bone if this happens. This can cause hearing loss. You can expect some hearing distress from a radical and modified radical mastoidectomy. This operation isn't as common as it used to be.

Care of the discharging ears:

Avoid moisture in ear:strong> Plug ear with Vaseline smeared cotton plug during shampoo, head wash, shower or bathing. Remove these after drying hair with towel.

Avoid oil in ear:strong> It causes fungal infection by preventing evaporation of moisture.

Avoid colored ear drops:strong> It makes subsequent examination and evaluation difficult.

Avoid Scratching ears with ear buds, hair –pin, finger nail, crochet, knitting needle, pencil, pin, toothpick, match stick etc.

Avoid feeding the baby or young child in lying down position. Prop him up. The feeds may enter the ear via Eustachian tube (ventilation tube of the ear).

If you catch a cold, take prompt treatment. Do not blow the nose during a cold – nasal discharge must not be forced up to the ear Avoid contact with people having cold.

Avoid swimming – do not bathe in a river, lake, sea or swimming pool.

Avoid air travel during episode of cold.

Why people keep scratching Ear?

Why People keep scratching ears or use ear buds frequently?

Most of  my outdoor patients complain of itching in the ear. On examination, I find often no abnormality in ear except for broken hairs, bald canal skin or scratch marks. The problem is really not in the ear but in the mind. the Indian mindset is set from childhood that ear is a dustbin full of dirt and it should be cleaned regularly. but the truth is else.

There are Two Myth

• That the ear contains dirty substance or Wax.
• So Ear should be cleaned regularly.

I tell you the Wax is natural gift of the God to man. its a substance secreted by modified sweat glands and it contains lysozymes which inhibit the growth of bacteria. it's being a sticky substance catches all dust, foreign particles etc and does not let go towards the eardrum. it also acts as a physical barrier.

But then still wax become the center of all ear problems why?

Sometimes wax becomes dry or hard then it may cause discomfort but if you put some wax softening drops, then most of the people even will not have this discomfort. and rarely Wax is the cause of ear problems unless water enters into ears when it swells up or catches fungal infection.

Ear has a natural mechanism of cleaning the wax in form of migratory epithelium and hair which push the wax out.  Problem comes when people starts using earbuds thinking by promotional advts that these are the right instruments for cleaning ear. but they are not Why?

• Can you take out ice-cream from ice-cream pot with an instrument like ear bud. No, in fact you require scoop. but even with scoop would you like to take out ice-cream with your eyes closed. Never, but most of people do this to ear while cleaning the ear. their this very act injures the skin and delicate hairs resulting in bruises, infection, eczema skin, stenosed ear canal and much more.
• It's a psychological  problem. a kind of obsessive compulsive disorder. Ear is a special sense organ. any sub-threshold stimulus here is perceived as pleasant to brain and brain signals hand to scratch ear again. this is vicious cycle and in this process Ear gets the injury.
• Ear share it's nerve supply with Tonsil, Teeth, Throat, Larynx and Stomach. A simple acidity can cause low grade itching in ear. So Why should you scratch the ear when gulping few antacids can solve your problem.

The best way to solve your problem is first to consult a ENT specialist to rule out other causes of itching and then if this is the cause (indeed this is the cause in most of the cases), forget the ear. I quote like this.

IF YOU FORGET THE EAR, THE EAR PROBLEMS WILL FOGET YOU :-)

NOISE INDUCED HEARING LOSS??

What is noise induced hearing loss & How does it occur? When excessive sound energy strikes the inner ear, it damages the hair cells of the cochlea. If it is brief and not very loud, the noise may cause a temporary reversible damage called temporary threshold shift. This is seen in the initial stages off factory exposure, music concerts, loud i-POD music etc. If the noise is loud and for long duration or sudden and very loud, it may cause a permanent (irreversible) threshold shift.??

SUDDEN HEARING LOSS( An ENT Emergency)

This is a real E.N.T emergency. Many a time it is termed as ear attack like heart attack. Pathophysiology behind it is decreased blood supply to the inner ear/ hypoxia  or baro trauma, or any other cardiovascular event . It can be reversed if patient reports with in 5-15 days. When this kind of symptom is noticed, immediately contact an E.N.T doctor.

Anatomy of The Human Nose

The visible part of the human nose is the protruding part of the face that bears the nostrils. The shape of the nose is determined by the ethmoid bone and the nasal septum, which consists mostly of cartilage and which separates the nostrils. On average the nose of a male is larger than that of a female.

The nasal root is the top of the nose, forming an indentation at the suture where the nasal bones meet the frontal bone. The anterior nasal spine is the thin projection of bone at the midline on the lower nasal margin, holding the cartilaginous center of the nose.

Adult humans have nasal hairs in the anterior nasal passage.

Facts About Chronic Sinusitis

Sinuses are air-filled pockets behind the facial bones surrounding the nose. Each sinus has an opening through which mucus drains. This drainage keeps your sinuses working well and healthy. Anything that obstructs that flow may cause a buildup of mucus in the sinuses, which may lead to infection and inflammation of the sinuses. Sinusitis occurs when the linings of your nose sinuses and throat become inflamed, possibly from a pre-existing cold or other allergies. Chronic sinusitis is when this inflammation lasts three months or more.

Common Symptoms include

• Facial pain, pressure and congestion.
• Difficulty in breathing through the nose.
• Discharge of yellow or green mucus from the nose.
• Pain in teeth.
• Loss of the sense of smell or taste.
• Headache.
• Fatigue.
• Sore throat.
• Bad breath.

Nose And Sinus (Rhinology) Surgery

• We Offer the best of therapeutic care and Sinus Surgery in Delhi by expanding the advantages of progressions being made in the realm of prescription. Our services for Nose and Sinus in Delhi   offer best treatment.
• Septoplasty.
• The septum is the midline partition within the nose dividing it into left and right nasal cavities A septoplasty is an operation designed to straighten a bend/deviation in the septum of the nose and thus improve nasal airflow.
• Turbinate reduction.
• The turbinates are scrolls of tissue in the side walls of the nose. Turbinate reduction is carried out to reduce the size of enlarged turbinates and therby correct the problem of nasal blockage.
• Nasal Polypectomy.
• Nasal polyps are growths in the nose often as result of allergy and infections. Polypectomy is a surgical procedure to remove these nasal polyps and improve breathing. This is often combined with functional endoscopic sinus surgery in Delhi.
• Functional Endoscopic Sinus Surgery.
• Endoscopic sinus surgery is an established modern type of sinus surgery with minimally invasive techniques utilising telescopes and small instruments to operate on sinuses through the nostrils. The aim is to widen the openings of the sinuses to remove sinus disease and also so that mucus does not get trapped.
• Balloon Sinuplasty.
• BSP is a minimally invasive procedure where a flexibale balloon is used to open blocked sinuses and facilitate drainage of mucus in patients who suffer from chronic sinusitis. While recuperation time differs with every patient, recuperation is ordinarily quick. In an investigation of in-office balloon dilation, most patients were asked to perform regular work and daily actions after 2 days of operation.
• Dacryocystorhinostomy (DCR).
• DCR (dacro-cysto-rhinostomy) is the name given to an operation that is designed to allow drainage of tears from a blocked tear sac into the nose by creating a new opening. This is performed endoscopically through the nose to avoid external scars.
• Septorhinoplasty.
• This is a combination of a septoplasty and a rhinoplasty to improve the nasal airflow as well as improve the appearance of the nose.

FAQ`s about Steam Vs Nebulization

How should I take steam?

Steam can be taken by either the convenient Steamer or from the boiling water on a heater. The second option is dangerous especially with kids.

It's not necessary to keep the face too close to container. Even a chair close to the steamer is enough. You can leave the steamer on and do your table work.

Should I put something into boiling water like vicks or karvol?

Steam is a pure form of water. Water evaporates after boiling and when it condenses into air passage, then it leaves moisture there. This moisture helps moving dried up small hairs which ultimately moves the mucus. Putting these things may increase the pleasant experience like smell but as such they do not have an additional function and may not be necessary to use.

Can I take Nebulizer instead of steam?

Nebulizer is no substitute of steam. It has different function which can not be done by steam either.

Nebulizer is for lungs whereas steam is both for lungs and nose. Nebulizer is way of delivering drungs for local action in lungs while steam delivers moisture both to lungs and nose.

Some viruses like Rhinovirus which causes common cold are susceptible to heat. So taking steam helps in eliminating such virus.

Voice and Throat

Throat is the front part of the neck, positioned in front of the vertebra. It contains the pharynx and larynx. An important section of it is the epiglottis, which is a flap separating the esophagus from the trachea (windpipe) preventing food and drink being inhaled into the lungs.

The throat contains various blood vessels, pharyngeal muscles, the nasopharyngeal tonsil, the tonsils, the palatine uvula, the trachea, the      esophagus, and the vocal cords.

Mammal throats consist of two bones, the hyoid bone and the clavicle. The "throat" is sometimes thought to be synonymous for the      isthmus of the fauces.

It works with the mouth, ears and nose, as well as a number of other parts of the body. Its pharynx is connected to the mouth, allowing      speech to occur, and food and liquid to pass down the throat. It is joined to the nose by the nasopharynx at the top of the throat, and to      ear by its Eustachian tube.

The throat's trachea carries inhaled air to the bronchi of the lungs.

The esophagus carries food through the throat to the stomach.

Adenoids and tonsils help prevent infection and are composed of lymph tissue. The larynx contains vocal cords.

The epiglottis (preventing food/liquid inhalation), and an area known as the subglottic larynx—the narrowest section of the upper part of the throat.

In the larynx, the vocal cords consist of two membranes that act according to the pressure of the air.

ADENOIDS
What are Adenoids?

Adenoids are like tonsils but are present behind your nose and functions like tonsils. They help in fighting infections and sometimes gets enlarged in response to infection. They usually starts increasing by age of 2 and keep increasing up to 7 year of age and regressed thereafter.

If they are our fighters then how do they trouble us?

Yes, they are fighters but if they are unable to fight, they start increasing their size . This increase in size compromises the air passage, causing a difficulty in breathing especially while sleeping.

What are the symptoms of Adenoid enlargement??

Child may present with mouth breathing, snoring at night, ear pain, tiredness, malocclusion of teeth, recurrent chest infections, typical facial appearance in which nostril are visible from inside, depressed cheek and pursed like lips known as Adenoid Facies.

Is Adenoid removal is bad for child’s Immunity?

No, in fact this is small fighter in comparison to overall immunity of body. The child needs good breathing for proper oxygenation which is much more important.

What is Adenoidectomy?

Adenoid removal is a surgery to shave off the adenoid glands. These glands are located behind  nose and when enlarged cause difficulty in breathing especially during the night. Often, adenoid removal is done at the same time during removal of tonsils. Adenoid removal is also called adenoidectomy. Most adenoidectomies are done on children.

How the Adenoidectomy is done? Whether any external incision will be given to baby?

• Your child will not be given any external incision for the surgery .
• Your child will be given general anesthesia before surgery. This means they will be unconscious and unable to feel pain.
• The surgeon will insert a small instrument into your child’s mouth to prop it open.
• The surgeon will remove the adenoid glands with a curette (a spoon-shaped medical device) or a microdebrider (a medical device used to cut away soft tissue).
• Bleeding will be controlled with packing material, which will absorb blood, and with cauterization.
• Your child will stay in the recovery room after surgery until they are awake and can breathe easily.

Endoscopic powered adenoidectomy

This is one surgery in ENT where a blind person can do this surgery. Are you surprised?. I am not kidding. In fact, this surgery is still done blindly by many ENT Surgeons. Adenoid tissues, which are like tonsils but placed behind the nose, is not easily visible. In a child of 3-4 yrs of age, sometimes it is not possible to put typical 4 mm nasal telescopes through nose which is commonly available with ENT surgeons. So, surgeon feels the adenoid tissues through putting a finger through the mouth and with help of specially designed shavers, shaves them off without actually seeing them.

This is no more scene now specially with availability of angled microdebriders. This is wonderful to work like as you are working on a video game.. 

COMMON THROAT, VOICE AND LARYNGEAL SURGERIES

Video Laryngoscopy, Bronchoscopy
Endoscopic evaluation of the larynx (voice box) , trachea ( main wind pipe) and bronchi ( lower airways). This is often required for the diagnosis and treatment of hoarseness, noisy breathing and breathing difficulty.

Micro laryngeal surgery
Surgery of the larynx ( voice box) is carried out under the magnification of an operation microscope. This is use to diagnose and treat a number of conditions that affect the larynx and voice. Often a laser is used for precision.

Phonosurgery
This is a series of surgical procedures carried out on the vocal cords under endoscopy or microscopy to improve the quality of voice in a patient with hoarseness. 

Tonsillectomy
Tonsillectomy is an operation where the tonsils are removed. It is usually performed in someone who has recurrent sore throats due to tonsillitis or because they interfere with breathing and swallowing. 

Myringotomy & Grommets (Ventilation tubes)
A myringotomy is a tiny incision made in the ear drum under a surgical microscope and a tiny tube called ventilation tube / grommet is placed in the hole to keep it open and allow air to reach the middle ear space.
 It is performed when a person experiences repeated middle ear infection (acute otitis media) or has a hearing loss caused by the persistent presence of middle ear fluid (otitis media with effusion).

Laryngotracheal reconstruction
LTR are a set of operations designed to enlarge the child’s narrow airway by dividing the scarred areas and using cartilage grafts to widen the airway and thus improve the childs’s breathing. The tracheal narrowing can include a few sections of the air passages, might involve the voice box or tracheal rings, and can be either firm or delicate, circumferential or longitudinal, smooth or sporadic, developmental or acquired.

Head & Neck

Head & Neck

Neck mass excision
A lump in the neck may occur due to a number of causes. These may include lymph nodes, branchial cyst, thypoglossal cyst and other rare tumours. Most neck masses in kids are because of either inflammation or inborn issue. The treatment for most inherent neck masses is surgical extraction, and as a rule, surgery is a consistent treatment for masses that don't show response to medication.
We are happy to serve you with all possible assistance. Visit us for the queries related to hearing aids, hearing implants, and other surgical options. Save you and your child from future suffering as we are confident to help you with best possible care. 
An otolaryngologist-is a specialist of Head And Neck Surgery in India who has been licensed to give great therapeutic and surgical care of patients with maladies that influence the ears, the nose, the respiratory and upper digestive system, and related structures of the head and neck.

Thyroidecomy
This is an operation that is used to remove part or all of the thyroid gland. A thyroidectomy may be required to treat a thyroid lump or tumour. In addition to malignancies, a thyroidectomy is additionally a practical choice for patients with symptomatic thyroid masses or goiters. 

Parotidectomy
A parotidectomy is an operation to remove part or all of the parotid salivary gland. The main purpose is to remove lumps or tumours arising from the parotid gland.

Salivary gland stone removal
Stones may form in one or more of the salivary glands due to aggregation of salts in the saliva. Once large they can block the flow of saliva and thus cause enlargement of the gland or recurrent infections.

Branchial cyst and fistula
A branchial cyst is a developmental anomaly resulting in the formation of a cyst in the side of the neck. Surgery may be required if it is very large or to prevent repeated infections. With surgical extraction, complete excision is targeted.
 
Palatoplasty
This is a procedure carried out to shrink and stiffen the soft palate using a radiofrequency device. It is carried out for the treatment of snoring where the soft palate vibration is contributing. Any individual with any level of a congenital fissure is a possibility for palatoplasty. The methodology is typically performed on newborn children. The perfect age for the patient is in the vicinity of six and twelve months of age. In the event that the surgery is done much past three years old, discourse improvement may not be ideal. 80% of the time, advancement of the sense of taste and discourse is typical after just a single procedure.

Tongue Base Reduction
This is a method of reducing the bulk of the tongue base using radiofrequency to treat snoring or obstrcutive sleep apnoea where collpase of the tongue base is contributing. The Tongue Base Reduction procedure is conducted by specialist to gain best results. The procedure is very simple and less time consuming.
Our teams has the expertise for Surgical treatment or conservative management for ailments, neoplasms, disfigurements or infections of the ears, the respiratory and upper digestive system, the face and the other head and neck structures