A Brief Guide to Eustachian Tube Surgery

The Eustachian tube is a narrow tubular structure, connecting the middle ear to the back of the nose. Any chronic blockage of this tube as a result of a congenital defect or external injury is called eustachian tube dysfunction. The condition leads to inflammation and irritation in the lining of the nose, thereby narrowing the eustachian tube. Common illnesses such as cold or influenza could often lead narrow the eustachian tube. Additionally, instances of nasal allergy (also known as allergic rhinitis) and obesity could also predispose a person to eustachian tube dysfunction. The blog post gives you an insight into the eustachian tube dysfunction and its treatment.

Medical Treatment

Nasal Decongestion and Allergic Treatment

Nasal decongestants constrict blood vessels in the nose and reduce inflammation of the eustachian tube. Oral decongestants are effective for up to 4 hours whereas nasal sprays immediately decongest the nose. Our body gets used to such medications, thereby, their usage should be limited to up to three days in a row. Identifying and treating possible nasal allergies may help in minimizing inflammation of the lining of the Eustachian tube. Intranasal steroids and allergy shots could also reduce inflammation of the mucosal lining, and provide relief from eustachian tube dysfunction. Nasal steroids usually take up to two weeks of daily usage, before their effect is visible. Taking antihistamines may help in reducing the body’’s response to allergens, but are not as reliable as the nasal sprays.

Surgical Treatment

Surgeons resort to surgical treatment only when patients don’t get relief from medications. Through surgical procedures,  surgeons re-establish ventilation in the middle ear, by bypassing the eustachian tube. Postoperative benefits include hearing restoration, reduced affinity for ear infections and less pressure sensation in the ear.

Myringotomy

The surgical procedure involves the suction of any fluid within the middle ear cavity, through a tiny incision in the eardrum. The incision stays open for some time until the inflammation in the Eustachian tube lining completely resolves. The recovery time for the eardrum, in this Eustachian tube surgery is usually three days.

Usage of Pressure Equalization Tubes

Surgeons insert a small, hollow plastic or metallic tube, known as the pressure equalization tube into the eardrum, after removing any middle ear fluid through an incision in the eardrum. Over the time, the tube pushes out as the eardrum heals. The tube provides ventilation to the middle ear for six months to a year, and during this time period, the eustachian tube dysfunction completely heals. The procedure takes about five minutes, and a topical anesthetic in the case of adults, and a general anesthetic for children.

Wrapping up

Eustachian tube dysfunction could affect both adults and children. Several reasons such as allergic reactions, injuries or common illnesses could eventually lead to inflammation of the lining of the eustachian tube. Although the condition could be minimized using medications and decongestants at the early stages, for chronic cases, Eustachian tube surgery remains the only viable way. In such Eustachian tube surgery, recovery time ranges from a couple of days to several months, depending on the severity of the inflammation, but often, patients get permanent relief from such conditions.

The Do's and Don'ts Post Endoscopic Sinus Surgery

The minimally invasive endoscopic sinus surgery is a preferred treatment for chronic sinusitis. The doctor places a nasal endoscope into the nostrils to see inside the nose and sinuses, and there’s no need to make any incision on the face or mouth of the patient. The surgery also requires minimal nasal packing and is less painful than the traditional procedure. The recovery from the surgery depends on the type of procedure and the health of the patient, and it might take several weeks to heal completely. There are a few things that the patient needs to take care of to speed-up the recovery time, and we list a few in the blog post.

The Do’s and Don’ts After the Surgery

1. There could be some swelling and tenderness inside the nose, which is normal after the surgery. The patient might have symptoms such as sinus infection or severe cold because of mucus, dry blood or crusting in the nose. Use a saline spray and antibiotic lubricant or perform nasal irrigation to get relief from the problem.
2. There could be swelling or bleeding after the surgery, so keep the head in an elevated position. Patients need to sleep in a recliner or elevate the head with extra pillows on the first night after surgery.
3. The packing material or splints in the nose should not move from its place. If the material gets clogged, do not remove it, instead breathe through the mouth.
4. Don’t blow nose for a week after the surgery.
5. Straining, lifting heavy things, or rigorous exercising could increase the chances of bleeding in the nose.
6. Sneeze with your mouth open
7. Do not take aspirin as it increases the chances of bleedings and slows clotting

Life After the Surgery

Once the nose and sinuses heal up, the patient can resume their normal lifestyle. The symptoms would be better, and the susceptibility to sinus infection also reduces after the surgery. Many patients, however, need to know is that the surgery doesn’t guarantee complete relief from sinusitis, and there are chances that you might need other medical therapy to manage the symptoms in future.

  Last Few Words

Endoscopic surgery is the last option to treat chronic sinusitis, so the patient needs to try other medications and over-the-counter treatments before opting for it. Always speak with the doctor to learn more about other ways of reducing the problem or getting relief in severe cases, instead of directly opting for surgery.

Summary

Patients with chronic sinusitis undergo sinus surgery to relief from the problem. They however, need to take care of a few things to ensure a quick recovery from the surgery. The blog post discusses the do’s and don’ts after the procedure.

The Do's and Don'ts Post Endoscopic Sinus Surgery

The minimally invasive endoscopic sinus surgery is a preferred treatment for chronic sinusitis. The doctor places a nasal endoscope into the nostrils to see inside the nose and sinuses, and there’s no need to make any incision on the face or mouth of the patient. The surgery also requires minimal nasal packing and is less painful than the traditional procedure. The recovery from the surgery depends on the type of procedure and the health of the patient, and it might take several weeks to heal completely. There are a few things that the patient needs to take care of to speed-up the recovery time, and we list a few in the blog post.

The Do’s and Don’ts After the Surgery

1. There could be some swelling and tenderness inside the nose, which is normal after the surgery. The patient might have symptoms such as sinus infection or severe cold because of mucus, dry blood or crusting in the nose. Use a saline spray and antibiotic lubricant or perform nasal irrigation to get relief from the problem.
2. There could be swelling or bleeding after the surgery, so keep the head in an elevated position. Patients need to sleep in a recliner or elevate the head with extra pillows on the first night after surgery.
3. The packing material or splints in the nose should not move from its place. If the material gets clogged, do not remove it, instead breathe through the mouth.
4. Don’t blow nose for a week after the surgery.
5. Straining, lifting heavy things, or rigorous exercising could increase the chances of bleeding in the nose.
6. Sneeze with your mouth open
7. Do not take aspirin as it increases the chances of bleedings and slows clotting

Life After the Surgery

Once the nose and sinuses heal up, the patient can resume their normal lifestyle. The symptoms would be better, and the susceptibility to sinus infection also reduces after the surgery. Many patients, however, need to know is that the surgery doesn’t guarantee complete relief from sinusitis, and there are chances that you might need other medical therapy to manage the symptoms in future.

Last Few Words

Endoscopic surgery is the last option to treat chronic sinusitis, so the patient needs to try other medications and over-the-counter treatments before opting for it. Always speak with the doctor to learn more about other ways of reducing the problem or getting relief in severe cases, instead of directly opting for surgery.

Summary

Patients with chronic sinusitis undergo sinus surgery to relief from the problem. They however, need to take care of a few things to ensure a quick recovery from the surgery. The blog post discusses the do’s and don’ts after the procedure.

All that you Need to Know About Bulging Eyes and Proptosis

Variations in anatomy and other diseases such as hyperthyroidism lead to bulging of one or both the eyes, which is called Proptosis. Sudden development of exophthalmos in both the eyes could be a serious problem and the individual needs to consult a doctor. The bulging orbit might increase the intraocular pressure inside and behind the eyes and increase the risk of glaucoma and other diseases. Proptosis surgery is the only option left in case of severe protrusion of eyes. The blog post talks more about Proptosis, its symptoms, reasons, and treatment.

Symptoms Visible white between the iris (colored part of the eye) and upper eyelid is a sign of abnormal eye bulging and proptosis. Other symptoms of the disease are:

• Drying of cornea
• Difficulty with eye movement
• Discomfort
• Difficulty in blinking or closing eyes fully when sleeping
• Scarring that could result in permanent vision loss

Reasons Some people are born with prominent eyes, which is genetic and not a very serious problem. If bulging eyes are not genetic, thyroid is a common reason in most of the cases. Prominent eyes are different from bulging eyes, and as a result, many people fail to recognize the problem at an early stage. Some of the common reasons that cause bulging eyes include Hemangioma, Leukemia, Neuroblastoma, Glaucoma, Grave’s disease, Orbital cellulitis, Histiocytosis, and Periorbital cellulitis.

Treatment

The doctor measures the eyes of a patient with a ruler called exophthalmometer. If the measurement is within a certain range, there is no need to perform any tests. If the doctors find the measurements are more than normal, they would prescribe other tests such as MRI, ultrasound, and even a biopsy. Though corticosteroids and similar medications reduce inflammation behind the eyes, a plastic or reconstructive surgery might be the only option in serious cases. If Grave’s disease is the reason for proptosis, the doctor may perform orbital decompression that involves partial or complete removal of one or more of the four walls of the eye socket.

Last Few Words

Prevention of bulging eyes is not possible in some cases, and if it is genetic or because of hyperthyroidism, the patient can not prevent the bulging of eyes. Consulting a doctor to know the possible steps to take to prevent exophthalmos works in most of the cases.

Summary

Proptosis or the bulging of eyes could be a serious problem if not treated on time. Read the blog post to learn more about the problem.

4 Unknown Activities that May be Causing Recurrent Sinus Infections

More than 37 million people in the US experience a few bouts of sinus infections in a year. Sinus infections keep coming back and gradually takes the shape of recurrent sinusitis. The symptoms of sinus lead to severe headaches, discomfort and an increase in facial pressure. If a person suffers from sinus infection, the first step is to relieve the symptoms followed by consulting a recurrent sinusitis expert. A few lifestyle changes may prevent the recurrence of sinusitis infections that remain unknown to the masses. The blog post discusses a few things to avoid that may prevent recurrent sinusitis infections. Here we go.

1. Smoking

Similar to air pollutants, cigarette smoke can irritate your nose and lead to sinus infection. People who smoke are at a higher risk of getting sinus infection. Nasal and sinus membranes produce one or two quarts mucus every day that acts as a protective blanket for the whole respiratory system. Tiny hair-like structures called cilia helps in purifying the sinus passages by cleaning particulate matter, microbes and excess mucus. Smoking may damage the cilia, aggravate mucus production and clog the sinus openings that become breeding grounds for microbial infection. Smoking also makes a person susceptible to frequent cold and allergies that may lead to sinus infections in future.

2. Swimming

Although swimming is a great physical activity, microbial presence and chlorine in the pool may lead to chronic and recurrent sinusitis infections. While swimming underwater can result in fluctuating pressure levels inside the sinus cavities causing nasal congestion, chemicals in the chlorine tend to enhance the mucus production. Excess mucus leads to blocking the sinus passages, accelerating the microbial infections to invite recurrent sinusitis infections. Moreover, liquid trapping inside the sinus passages may also worsen the sinus symptoms. Swimming and diving are not recommended for persons with a  sinusitis history. Consult a recurrent sinusitis expert who can suggest nasal irrigation methods or nose clips post swimming sessions if you face repeated instances of sinus infection.

3. Frequent Air Journeys

Air pressure reduces inside a flight, causing pressure buildup in the head and sinus cavities of a person. Although most individuals tend to get away with it, people with a history of sinus infections have a hard time dealing with headaches and sinus congestion. If a person has suffered from a few bouts of sinus infections, it is advisable to avoid air journeys. Many a time, air travel will be inevitable so it is advisable to consult a sinusitis expert to get a few nasal decongestants and sprays before the flight.

4. Overdoing Antibiotics and Nasal Sprays

Relying on antibiotics and nasal sprays to relieve recurrent sinus infections may at times cause more harm than providing relief. Prolonged use of nasal sprays and antibiotics may aggravate the symptoms. Overuse of nasal sprays may even cause rebound nasal congestion- a condition where a person becomes less sensitive to the effects of nasal spray and leading to a swollen nose.

The Way Forward

Lifestyle changes can help in relieving sinusitis to a great extent. If the symptoms aggravate beyond an extent, it is necessary to consult a sinusitis expert instead of trying home remedies or self-medication. The lifestyle changes may take some time to show an impact on recurrent sinus infections, but worth giving a shot.

A Brief Guide to Sinonasal Tumor Staging

Sinonasal cancer staging helps to assess the stages of cancer in the nasal cavity. The process also enables doctors to decide the treatment required for sinus cancer and gauging the chances of recovery. Sinonasal tumor staging involves the compilation of results of medical examinations such as biopsy, endoscopy and imaging procedures including MRI and CT scans. The stages are assigned according to the size of cancer and the involvement of lymph nodes. Read on to find out more about sinonasal cancer staging. 

The TNM Staging Process

The TNM staging process has been developed by The American Joint Committee on Cancer to evaluate the primary factors for treating cancers including the sinonasal and head cancers. The system describes:

1. Tumor (T) Stages

T stage assesses the size of the primary tumor while investigating if cancer has spread to the nasal cavity tissues, paranasal sinuses and skull bones. There are 4T stages of sinonasal cancer

• T1- T1 stage indicates that the tumor present in one part of the nasal cavity, but might have spread to the nasal bones.
• T2- The stage indicates tumor has started advancing to nasal and paranasal cavities.
• T3- During this stage, the tumor spreads to the eye socket bones and the palate.
• T4- Tumor spreads to the nearby nerves and organs such as eye, skull, brain, cheek and the skin.

2. Node (N) Stages

Lymph nodes are immunity cells that protect the body against infections and mostly the first target for the cancer cells in the human body. The N-stage estimates lymph node involvement near the primary tumor. The stage can be further classified as:

• N0- No lymph nodes with cancer cells
• N1- Cancer cells present in one lymph node on the same side of the neck but node size is 3cm or less

• N2a- Same as N1, node size lies between 3cm and 6cm

• N2b- Cancer cells present in more than one lymph node on the same side of neck and none of them are more than 6cm

• N2c-Cancer cells are present in lymph nodes on the other half of the neck with an approximate size 6cm

• N3- One or more lymph nodes contain cancer cells, and one of them is more than 6cm

3.    Metastasis (M)

The stage indicates that cancer has spread from the sinonasal cavity to other parts of the body. Sinus cancer primarily targets lungs as the first site for metastasis followed by the bones. Further classification of M is as follows:

• M0- Cancer cells are localized and haven’t spread to other parts of the body.
• M1- Cancer cells have attacked other parts of the body such as the brain, lungs, and the liver.

The Way Forward

Low-grade cancers grow slow and are less likely to spread as compared to high-grade cancer. During the process of cancer staging, doctors assign the values of T, N and M to the disease based on the microscopic appearance. The doctors thoroughly review the medical, family history and other factors to develop a treatment plan for patients.

Nosebleeds – Types, Causes, and Treatment

Nosebleed, in most of the cases, is not a serious problem and easy to manage at home. The nose contains small blood vessels that bleed easily. Air moving through the nose causes dryness and irritation in the linings of the membranes inside the nose. Dryness leads to crusts in the nose that start bleeding when irritated. There are two types of nosebleeds – anterior and posterior, categorized based on their point of origin. The blog talks about both types of nosebleeds, causes, and cure.

Understanding anterior and posterior nosebleed

Anterior nosebleed

Anterior nosebleed is quite common and originates from the front of the nose. Bleeding in the most of the cases originates from the blood vessel on nasal septum and is easy to control.

Posterior nosebleed

Posterior nosebleed originates from the back of the nose and is less common than anterior. The problem occurs mostly in elderly people. The artery in the back of the nose is usually the point of origin of bleeding. Posterior nosebleed is complicated, and the patient needs to visit an otolaryngologist for treatment.

More About Nosebleeds

Nosebleeds mostly occur in dry and cold climates. Though there’s no age limit for the problem to start, it is common among children aged 2 to 10 years and adults aged 50 to 80 years. Nosebleed mostly occurs in morning hours in most of the cases. Trauma to the nose, such as a blow or nose picking, are some of the common reasons of nosebleed. A few more conditions that may lead to nosebleed include:

• Nasal infection
• Sinus infection
• Vigorous nose blowing
• Exposure to dry or warm air for long period
• Allergic rhinitis
• Nasal surgery
• Foreign body stuck in the nose
• Deviated or perforated nasal septum
• Use of cocaine, chronic alcohol abuse
• Topical nasal medications
• Blood-thinning medications
• Liver disease, inherited blood clotting disorder, kidney disease or certain medication may also cause a nosebleed
• Vascular malformations in nose and nasal tumors
• High blood pressure

Treating Nosebleed

The individual should sit up straight, tip the head slightly forward, and use thumb and forefinger to pinch the soft part of the nose shut. Bleeding mostly occurs in the soft part of the nose and a spraying a medicated nasal spray before applying pressure may stop nosebleed. Applying ice pack on nose and cheeks also helps. If the bleeding continues after 20 minutes and recurs four or more times in one week, it is advised to seek the consultation of an ENT specialist. The doctor conducts a physical examination of the nose and might recommend an X-ray to know more about the reason behind bleeding before prescribing medication.

Answering 4 FAQs about Sinusitis

Sinusitis, an infection of the sinuses, affects a substantial percentage of the American population. Many people ignore the problem even after the initial symptoms of this medical condition are explicitly clear. The reason is a lack of information. Sinusitis patients can lead perfectly normal lives if they consult certified rhinologists in time. It is also important for patients to know the nature of this medical condition, to ensure they seek help on time and live a healthy life. This brief read delves into four common questions people have about sinusitis, providing simple answers in all cases. Let’s take a look.

1. What is Sinusitis?

Sinusitis is a medical condition which results from the inflammation of the sinus lining. Things get out of hand when the inflammation blocks the sinus opening, thereby, interfering with drainage of the mucus. The symptoms of this medical condition are painful and can last anywhere between 4-12 weeks.

2. What are the symptoms of Sinusitis?

Some of the common symptoms that sinusitis patients experience are:

1. Facial pain
2. Swelling around the eyes, nose, and cheeks
3. Inability/difficulty in breathing through the nose
4. Severe and recurrent headaches
5. Energy loss
6. Continuous nasal discharge that can block the throat, making it sore

3. Which specialist should I consult?

General physicians and allergists can prescribe medication in normal cases, however, patients suffering from acute sinusitis should waste no time in consulting an ENT specialist/rhinologist specialist. ENT/Rhinologist specialists are the right medical professionals to help people with acute sinusitis. People with sinusitis can leverage numerous medication and treatment options from the medical professionals.

4. What treatment options are available?

• Specialists may prescribe antibiotics and nasal steroid sprays in normal cases. Inhaling steam or using nasal sprays can also deliver favorable results. If the patients does not respond to the treatment, specialist may recommend surgery.
• Traditional sinus surgery includes removing bone and tissue to expand the sinus opening to make sure it is wide enough to let the mucus pass. The procedure is painful and can also leave post treatment scars.
• An effective and less painful alternative to the above procedure is Balloon Sinuplasty which includes placing a balloon into the nose and inflating it to alter the structure of the sinus opening.

Few Final Words

Although sinusitis is not a life-threatening condition, the condition of patients who avoid treatment can worsen over time. In extreme cases (although very rare) the infection can reach brain cells, creating grave complications. It is, therefore, imperative for patients to get in touch with a rhinologist specialist when the first symptoms of sinusitis surface. There are many touting their services as the best rhinologists in Houston, and therefore, you need to exercise caution.

Symptoms, Diagnosis and Treatment of Low CSF Pressure Headache

Cerebrospinal fluid (CSF) acts as a shock absorber for the Central Nervous System.Its primary function is to provides support and cushion the brain within the skull . Leakage of Cerebrospinal fluid through the meninges during or after a spinal tap lead to low-pressure headaches. CSF leakages cause brain displacement down the skull stretching the adjacent tissues and nerves resulting in a headache. A recent study reports that low pressure headaches occur in 10% people who suffered from spinal taps. Additional causes of low pressure headaches include cysts and injury to the meninges. It is imperative to visit an ENT physician if you are suffering recurrent headaches and a stiff back after or without a spinal tap. The blog discusses some of the symptoms, diagnosis and treatment for low CSF pressure headaches.

Symptoms

Low-pressure headaches are acute and accompanied by stiffness in the neck and nausea. The pain usually triggers while a patient is sitting or standing upright and disappears when lying flat. The headaches generally don’t occur during early in the morning hours but gets worst shortly after getting out of the bed.

Diagnosis

An MRI of the brain with injected contrast dye reveals the enhancement of the meninges lining of the brain. It may sometimes indicate the evidence of brain sagging downward from the neck to the skull. Lesser known symptoms involve one or more of the following imaging tests:

CT Myelogram

A CT scan of the back is done by injecting dye into the spinal fluid. CT Myelogram may directly reveal the site of the leak.

CSF Cisternogram

The medical test may reveal the leak directly or may only give an indirect evidence of the presence of the leak though it may not reveal the exact location of the leak.

Magnetic Resonance Imaging

MRI scan of the neck and back to check fluid leakage from normal locations.

Must Read: Frequently Asked Questions About CSF Leak

Treatment

The preliminary treatment includes pain relievers and increased fluid intake to enhance the production of Cerebrospinal Fluid. Avoiding upright postures and lying flat also helps in relieving the pain. An ENT physician may suggest some secondary treatment such as epidural blood patch if the problem persists. If the headache persists, a small amount of blood is injected into the spine at the close or exact location of the leakage at the lower back of the patient. The process slows down the CSF leakage and provides instant relief from the symptoms. The medical practitioner can repeat the procedure if required. If the patient suffers from critical cases of CSF leakage, it needs to be addressed by a proficient ENT physician or neurosurgeon.

The Way Forward

Recurrent headaches and back pain can be a cause of CSF leakage and shouldn’t be ignored or self-medicated. There are certain CSF leakage instances that don’t show any signs such as nasal drip and vomiting. You need to contact your ENT physician or health care provider if you notice any of the symptoms of CSF leak. Surgery, however, is rarely required to treat CSF leak.

Further Read: A Runny Nose Could be a Sign of CSF Rhinorrhea