I have discharge coming from my ears. What should I do?Q

A discharging ear means that you have ear infection. The infection may be limited to the external ear canal or may be arising from the middle ear cavity. In case there is infection in the middle ear it may mean that your ear drum has a perforation or that the bone behind your ear has become infected. Both these conditions may be associated with a decrease in the hearing level. Often, the treatment for these is surgical in the form of a tympanoplasty/mastoidectomy.

You need to see an ENT surgeon immediately to determine the type of infection you have and you will need to be put on antibiotics for the same. Please make sure that you do not allow any water to enter your ear canal and keep your ear dry. Do not insert any ear buds or instill any oils in the ear.

Watch out for accompanying symptoms like fever, headaches, bleeding from the ear and report to your doctor immediately in case any of these symptoms arise.

What does vertigo mean?Q

All children including newborns should ideally respond to a sound presented to them. A baby usually turns towards the direction of sound by the age of 3 months. A child who does not respond to sounds and has delayed speech is most likely to have an underlying hearing loss. Such a child needs to undergo a thorough audiological evaluation.

Hearing loss could either be due to a defective conduction of sound to the inner ear or due to a defect in the inner ear or auditory nerves. The management of both these conditions differs.

My child does not respond to sounds and has delayed speech. What should I do?Q

Vertigo classically means a sense of rotation. It occurs when there is disruption of the normal mechanism of balance which is governed by the inner ears, eyes and the brain. The cause of vertigo may or may not be related to the ears. Presence of concomitant hearing loss, ear fullness or ringing sounds in the ear point towards a problem in the inner ear balance system (vestibular system).

In case you have repeated episodes of vertigo and especially if there is associated nausea or vomiting, you need to consult an ENT surgeon to rule out a problem of the vestibular system e.g. BPPV, Meniere’s disease, vestibular neuronitis etc.

What does sensorineural hearing loss mean?Q

Sensorineural hearing loss is a condition in which there is a defect in the inner ear (cochlea) or the auditory nerves which carry the sound signals from the ear to the brain. Sensorineural hearing loss could be congenital, progressive or sudden onset. A child with congenital hearing loss will usually have delayed speech. The parents would have noticed that the child does not respond to sounds.

Progressive sensorineural hearing loss is that which develops over a period of time ranging from months to years. It could be age-related or due to other disorders affecting the inner ear.

Sudden onset sensorineural hearing loss is a medical emergency. Treatment for sudden sensorineural hearing loss involves administration of intravenous steroids and vasodilators. Steroid injections into the ear (intra-tympanic) can also be given. It is important to start treatment for this condition as urgently as possible. The chances of regaining hearing are better if treatment is initiated within the first 24 hours.

Sensorineural hearing loss can be diagnosed by doing a pure tone audiogram (PTA). In case of very young patients in whom a PTA may not be possible, a BERA or ASSR will be required. These tests may require mild sedation.

Patients with significant sensorineural hearing loss would require sound amplification by means of hearing aids. If however, a patient with bilateral sensorineural hearing loss does not gain any benefit even with the most powerful hearing aids (as in cases of bilateral severe to profound sensorineural hearing loss), a cochlear implant may be considered.

I suffer from frequent colds and nose block. What should I do?Q

Recurrent colds and nose block could occur due to allergic rhinitis and sinusitis. A mechanical obstruction in the nasal cavity such as a deviated nasal septum or a nasal mass may also contribute to a nose block.

Allergic rhinitis occurs as a result of the body’s reaction to a variety of allergens such as dust, pollens or even certain foods. Patients usually complain of watery nasal discharge, sneezing and nose block. It may be associated with watering of eyes, headaches or other allergic tendencies like skin rashes, allergic bronchitis, etc. Treatment includes anti-allergic medication and decongestants alongwith local steroid sprays. An allergy test can be done to pinpoint the offending allergen. Avoidance of the causative allergen would help in preventing further episodes. In very severe cases, not responding to the initial line of treatment, a short course of oral steroids may be prescribed.

Sinusitis is a condition in which there is inflammation of the lining of the sinus walls which may or may not be due to an infection. The patient will complain of nasal discharge, nose block, headaches, facial pain or pressure. Treatment involves a course of antibiotics, anti-allergic medication and decongestants. In patients who do not improve with medication and those who develop complications, surgery is required.

A nose block may also result secondary to a deviation in the central partition in the nose (nasal septum). A deviated nasal septum is present in about 70% of the normal population and needs to be corrected only when symptomatic. The procedure for correcting a deviated nasal septum is called septoplasty.

What causes a nose bleed?Q

Bleeding from the nose (epistaxis) is a common occurrence and can be due to a variety of reasons.

Dryness in the nose and nose picking is one of the commonest reasons especially in children.

Patients suffering from high blood pressure may experience epistaxis if the blood pressure becomes very high. This occurs due to rupture of tiny blood vessels inside the nose.

Sometimes even the simple act of vigorously blowing the nose can cause slight blood tinged discharge.

Bleeding disorders, certain tumors of the nose can result in epistaxis. Some drugs like aspirin, clopidogrel, etc may also cause epistaxis.

What immediate measures are to be taken in case of epistaxis?Q

Pinch the nostrils together between your thumb and side of the index finger. Press firmly but gently toward the face, compressing the pinched parts of the nose against the bones of the face for about 4-5 minutes, the whole time keeping your head at a higher level than your heart. Keep the head elevated even if sitting or lying down. Apply ice to nose and cheek areas. If symptoms get worse, see a doctor.

My child gets repeated attacks of tonsillitis. Is surgery required?Q

Tonsillitis means an infection of the tonsils. Symptoms of tonsillitis are a severe sore throat, difficulty swallowing, headache, fever and chills. The tonsils look red, swollen and can sometimes have white patches. Acute attacks are effectively controlled with antibiotics and analgesics. If the episodes become frequent, and are with associated fever, requiring repeated courses of antibiotics, it is better to get a tonsillectomy done. Your pediatrician or ENT surgeon can make a decision regarding this.

What are the causes of a change of voice?Q

A change in voice may result from many different causes.

One of the commonest causes is an inflammation of the vocal cords (laryngitis).

Any swelling on the vocal cords or a muscular weakness of the cords causing impaired movement can alter the voice.

A diagnostic laryngoscopy will help in identifying the cause of the voice change.

Management will depend on the cause of the hoarseness.

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