NECK SWELLINGS... WHAT ARE THEY ?

Some times patients come with a neck swelling and most often  they are noncancerous but some times cancerous. 

Among the swellings there are solid and cystic type. Can occur in children and adults  and if the duration of the swelling is short, detailed  evaluation and investigation has to be done. It may present any where in the neck, upper, middle, lower or side of the neck. Sometimes it could be  a lymph node draining a cancerous site. 

Here am focussing on a  cystic swelling in front of the neck which is related to the thyroid gland and is known as THYROGLOSSAL CYST or thyroglossal duct cyst. 

WHAT IS THYROGLOSSAL CYST  ? 

This cystic swelling is due to a congenital (from birth) abnormality. Normally  thyroid gland develops from a part of the tongue called foramen caecum and it comes down as a duct to lie in front of the neck before birth. This duct involutes in utero, but when it fails to involute, the duct remains in the neck. Cyst can develop anywhere along the path of the tract. 

HOW DOES IT LOOK LIKE ? 

Though it is present from birth, swelling appears during late childhood or adulthood. Site usually is in the midline but some times seen on the side of the neck.  The characteristic feature of the swelling is that, it moves up on swallowing and protrusion of the tongue. 

WHAT ARE THE COMPLICATIONS ? 

Cyst can get infected and present as a discharging fistula ( opening on the skin)  ,

if it is cut or drainage of the pus is done. Rarely cancer can develop from the cyst. 

Sometimes the cyst may be the only functioning thyroid tissue and it's removal can cause hypothyroidism. So always one has to look for normal thyroid gland, which can be examined clinically and  by ultrasound. 

HOW IS IT TREATED  ? 

If the cyst gets repeated infection and size gets bigger, the cyst along with the tract has to be removed to prevent recurrence. 

This is in short about thyroglossal duct cyst. 

PHOTO published with patient's consent. 

WHITE PATCH ON THE EAR DRUM.... WHAT IS IT ?

Some patients will have a white or chalky patch on their tympanic membrane or ear drum. It is known as TYMPANOSCLEROSIS  if middle ear and mastoids are involved , and MYRINGOSCLEROSIS if only ear drum is involved. 

WHAT IS IT   ? 

Anywhere in our body when there is an injury or inflammation, it heals by repair. When  there is an ear infection,  which could be after a bout of upper respiratory infection, where fluid gets collected in the  middle ear or inflammation of the ear drum, it happens. Certain enzymes in the middle ear fluid causes damage to the middle layer of the ear drum and there will be deposits of hyaline which is seen as white patch. Sometimes it is seen after introducing ventilation tubes through the tympanic membrane in order to drain middle ear fluid. 

WHAT ARE THE PROBLEMS  THAT CAN  OCCUR? 

If only the tympanic membrane (TM) is involved it doesn't cause any symptoms and it is nonprogressive , but when it occurs on the ear ossicles( three small bones behind the  TM)  it causes hearing problems as it is impairs the mechanism of  conduction  of sound waves. There will be involvement of the mastoid also ( bone behind the ear). 

WHEN  THERE IS A WHITE PATCH ON YOUR EAR DRUM, AND HEARING IS NORMAL NO NEED TO WORRY. NEED INVESTIGATION ONLY IF YOUR HEARING IS AFFECTED. 

PHOTO published with patient's consent

ENT MANIFESTATIONS IN A PARKINSON'S DISEASE PATIENT

Today April 11 th is celebrated as 'World Parkinson's Disease Day '. Parkinson's disease is a progressive neurodegenerative disease  affecting a part of brain called basal ganglia along with deficiency of neurotransmitter. It is characterized by resting tremors, rigidity  of the muscles and slowness of movement. 

ENT  MANIFESTATIONS

The patients present with decrease or loss of smell, drooling of saliva, decreased facial expressions ,vocal tremors, weakness, soft voice and difficulty in articulation of speech. This  difficulty in phonation is known as dysphonia. 

DYSPHAGIA or difficulty in swallowing is another problem faced by Parkinson's disease patient. It is due to changes in the voluntary and involuntary muscles and their neural control. The stages of swallow affected are oral preparatory stage and pharyngeal stage. Oral preparatory stage is affected  due to the tongue muscle rigidity, thereby tongue cannot change it's shape and propulsion of food into the oropharynx is affected. There will be delayed contraction of pharyngeal muscles . 

Patient will have impaired  or defective motility, stasis or retention of food in the hypopharynx( part behind the larynx).

 Another problem is poor movement of epiglottis which closes the laryngeal or upper airway inlet, thereby  causing ASPIRATION of food into the larynx. The laryngeal protective function is affected.  So there will be recurrent respiratory tract infections, like aspiration pneumonia. 

SO WHEN A PARKINSONS DISEASE PATIENT COMES TO AN ENT ONE HAS TO LOOK FOR THE ABOVE MENTIONED PROBLEMS. 

IMPORTANCE OF HEALTH AND WORLD HEALTH DAY

Today 7 th of APRIL is celebrated by WHO as WORLD HEALTH DAY. It is celebrated to create awareness among people regarding importance of health and quality of living conditions. This year's theme is   BUILDING A FAIRER AND HEALTHIER WORLD FOR EVERYONE. 

GLOBAL HEALTH is an important concern especially during this pandemic. Various measures to be taken  in order to improve the health of the  population globally. 

WHY HEALTH IS IMPORTANT ? 

It is very important to maintain our HEALTH and for that we have to follow a healthy lifestyle. If our health is affected, our body becomes weaker and our immune system will be affected which in turn leads to onset of various diseases either infective or noninfective  type . 

WHAT ARE THE MEASURES TO BE  TAKEN  ? 

Improving our health care facilities in such a way, that it  can be ACCESSIBLE to all the rural and urban areas globally. 

HEALTH EDUCATION to be given in order to create awareness about a healthy way of living. To improve the standard of our living conditions, in the sense to keep our surroundings  clean, to take measures in order to reduce or prevent environmental pollution .To prevent breeding of house flies and mosquito  which in turn will prevent diseases like diarrhoea, Dengue, malaria , filaria, chickun gunya, Japanese encephalitis respectively. Air pollution causes various lung diseases .Need to educate and provide Clean and Safe Drinking Water to prevent water borne diseases.  To  avoid spitting  in public places, covering one's mouth and nose while coughing and sneezing .To  implement Sanitation Measures like preventing open defeacation  or urination by usage  of toilets  inorder to prevent water borne diseases like diarrhoea, dysentery, cholera to name a few. 

Educate the population regarding importance of nutrition and balanced diet, especially for young children, pregnant and lactacting( breast feeding) mothers. Calcium supplements for menopausal  women to prevent osteoporosis. Balanced diet is needed for growth and development, to improve our physical and mental health. Certain preventable diseases like cretinism ( childhood goitre) , anaemia, hypocalcemia, scurvy and other vitamin deficiency disorders can be  prevented by using fortified  foods or including it in the form of  vegetables, fruits, egg, fish, milk etc. 

Educate the people regarding importance of  drinking  adequate  water  to  prevent dehydration and urinary tract infections and to use ORS or oral rehydration supplements in case of loose motions to prevent shock and renal (Kidney ) problems. 

HYGIENE  personal and surrounding  is very important to prevent various communicable diseases. 

Educate regarding side effects of Smoking , Alcohol consumption and Unhealthy food habits which can lead on to various lung diseases, cancer,  alcoholic liver  disorders, obesity, fatty liver and cardiovascular diseases respectively. Importance of exercise  to prevent  or control various  conditions like Obesity, Diabetes, Hypertension ( high blood pressure) and Hypercholestrolemia. 

Create awareness about the importance of Vaccination to control or prevent, polio, diphtheria, tetanus, measles, mumps ,typhoid, chicken pox etc. Measles, mumps  can cause nerve deafness and other complications. 

Educate the population  regarding HIV  infection and AIDS  and safe practises. Tuberculosis and Leprosy  early identification and treatment is also very important. 

Mental health and early identification and treatment of mental health problems also   implemented. Screening of target population for various endemic diseases and cancers, by means of surveys, epidemiological studies, workshops and investigations for suspected cases  are  implemented . 

EARLY DIAGNOSIS AND TREATMENT CAN PREVENT VARIOUS DISEASES AND FOR THAT HEALTH EDUCATION IS VERY IMPORTANT. 

NOSE BLEEDING AMONG KIDS

Bleeding through the nose  is common among the kids, usually in the age groups of 3 to 8 years. Most often it resolves on its  own , 

but when it becomes recurrent or frequent it can cause anxiety and stress among parents and the concerned  kid. 

WHY DOES IT BLEED  ? 

Nose bleed can be due to various causes. It can be from the front part of the nose( anterior) or from behind ( posterior).Anterior or front part of the nose is commonly involved in bleeding due to  plenty of blood vessels present there. 

CAUSES OF BLEEDING

Most common cause is drying of nasal mucosa( seasonal more during winter and summer) which lead on to crusting and nose picking thereby causing digital trauma. 

Other NASAL causes are nose rubbing, injury or trauma like blunt trauma, fracture to nasal bones or foreign body. 

It can also be due to inflammation and congestion  during an upper respiratory infection, nasal allergies or inflammation of blood vessels ( vasculitis) . Some structural abnormalities like deviation of nasal septum and hole or perforation in the septum can also cause bleeding. 

Tumours of the nose, whether it is benign or noncancerous like polyp, angioma, juvenile nasopharyngeal angiofibroma(adolescent  boys with spontaneous recurrent bleeding ) or papilloma, or cancerous   tumours cause bleeding. 

Excess use or abuse of intranasal medications can also cause bleeding. 

Systemic or non nasal causes are bleeding disorders, abnormalities of the blood vessels, liver diseases, use of certain drugs and heamorrhagic fever like Dengue. 

WHAT  CAN BE DONE  ? 

Detailed history about any injury, allergy, foreign body, drug history to be taken and condition has to be assessed by examination of the nose and other ent areas along with systemic examination ( pallor , jaundice) 

INVESTIGATIONS has to be done especially if  nasal cause is not found. 

Minor bleeding  will stop on its own by simple compression( with open mouth breathing) . Any open wound may require ointment, sometimes lubrication in nasal drying, nasal packing or cauterization to stop the bleeding may also  be required. 

Bleeding in the age group of less than 2 years need thorough investigations. 

REASSURING THE PATIENT AND THE PARENTS  IS IMPORTANT. 

This topic was selected because  patients have been coming with bleeding mainly due to digital trauma and drying of the nose especially during winter and now during summer. Hope this post will  ease your worries. 

FUNCTIONAL DISORDERS MANIFESTING AS ENT SYMPTOMS AMONG KIDS

ENT Consultants sometimes have paediatric patients, who come with certain  symptoms but detailed examination and investigation reveals no pathology. So in such cases we have to look upon the possibility of functional disorders. 

WHAT ARE THE SYMPTOMS ? 

Children may have various complaints, of which ear complaints are, pain in the ear , ringing sensation, hearing loss, balance problems. After ear examination , audiological and radiological evaluation, everything  may be normal. 

Neck and throat complaints are difficulty in swallowing, neck pain, difficulty or pain during talking. Sometimes they will complain about breathing difficulty or stomach pain. 

HOW TO DEAL WITH SUCH PATIENTS ? 

Great deal of patience and  time is needed as for the kid their symptoms will be real. Detailed  history  to be taken, in order to find out any issues or problems kid is facing .it could be at school, or any fight between siblings, parents ,family members or friends. Sometimes it could be  because of  arrival of a new baby and constant attention given to the newborn or bullying by school mates . The changes that occur during puberty or adolescence also have an impact on kids health and wellbeing. 

WHAT HAS TO BE DONE  ? 

Have a nice rapport with the kid. Detailed history, thorough examination, audiological and  radiological investigation and sometimes endoscopy may be needed,  before arriving at a diagnosis of functional disorder. Explain the condition to the parents  and reassure them. Sometimes these kids may need psychological evaluation as there will be anxiety and depression problems too. 

MANAGEMENT depends upon individual kids. Some of them require only reassurance, emotional support and counselling. Few may require further follow up. 

 Once in our emergency department an adolescent kid came  with sudden loss of voice and vocal cords (sound box) were normal on examination and after talking to the kid  further,  she told me about the teasing she had to face from her neighbors for getting low marks in a subject. Her way of response was to stop talking altogether. Other instances they complaint about stomach ache and refuse to go to school for the fear of bullying or scolding from the teachers. 

This topic was chosen to create awareness about this  problem. We  should  give time for these kids to open up and should show compassion towards the kid and  his or her parents also. 

EAR PAIN AMONG CALL CENTRE EMPLOYEES

Those who work as call centre operatives, experience  various types of pain. Most often it is due to , exposure to sudden unexpected sounds through their telephone handset or head set. This condition is known as ACOUSTIC SHOCK SYNDROME or ACOUSTIC  INJURY. 

WHAT ARE THE SYMPTOMS? 

Symptoms can be of sudden and late onset. Pain is the most important symptom, manifests as ear pain followed by neck, jaw or facial pain. There will be associated ringing sensation in the ear and some balance disorders. There will  also be  temporary hearing loss some times. 

Delayed symptoms are anxiety, sleep disorders, hyperacusis or hypersensitivity to sounds, ear fullness or congestion and increased vigilance. 

WHAT CAUSES THIS? 

The sounds that are produced close to the ear usually causes this acoustic shock, than distant sounds. So many theories have been put forth, but the most accepted one is tonic contraction of middle ear muscles. Hence this condition is also known as TONIC TENSOR TYMPANI SYNDROME. 

WHAT CAN BE DONE? 

Reassurance, counselling, audiological and psychological evaluation, if tinnitus and hyperacusis is present. Treatment given according to the audiometry. Some exercises for relaxation of neck and eye muscles also can be done. 

Hope this post was useful.