Oral health day

 World Oral health day is  on 20 th March .Theme this year (2024 )is "A HAPPY MOUTH   is ......a HAPPY BODY".

Mouth  extends from the lips and cheeks and it's divided into oral cavity and oropharynx. Infections from the mouth can spread to involve nose, ear, jaw joint and throat. Salivary gland ducts open into the mouth, hence infection can spread on to the salivary glands.Tissue spaces  associated with the mouth hasten the spread of infection.

Dental infection 

Carries teeth  or tooth decay is the  common cause of infection and if untreated dental  abscess can spread rapidly to adjacent areas, if patient is having uncontrolled Diabetes  or any low immunity. conditions. Lower dental abscess spread to spaces below the jaw and upper  dental Infection into maxillary sinus area ( cheek ).Gum infection,ulcer, swelling it can be due to local pathology or secondary to  certain medications and systemic disease manifestations.

Oral mucosa  ( lining the cheek, palate, floor  of the mouth) can present with ulcer, swelling, redness , fungal infection .Premalignant and malignant lesions to be kept in mind. Any nonhealing ulcer needs to be examined . Certain immunological conditions affect oral cavity and oropharynx like Lichen planus.

Dehydration, obstruction to salivary duct leads to stone formation. Multivitamin deficiency  has oral manifestations like cheilitis, glossitis, stomatitis.

Smoking and smokeless tobacco  as in paan  with betel leaves, arecanut, lime leads to mucositis, submucous fibrosis,cancer.

Oral health is  necessary to prevent various infections. Maintain oral hygiene by brushing teeth, rinsing mouth after eating, drink adequate water to prevent dehydration  and other problems.Those with Diabetes Mellitus  and other immunodeficiency diseases need to take special care, any carries teeth needs to be examined by a dentist. Various systemic conditions have oral manifestations,needs to be evaluated.

MAINTAIN ORAL HEALTH  TO IMPROVE QUALITY OF LIFE .

SMOKING AND IT'S HARMFUL EFFECTS

Smoking can affect  the body thereby our health in various ways. It depends on the duration, number of cigarettes  and associated comorbidities which smoking can contribute or  worsen.

Every year March second Wednesday  is considered as NO SMOKING DAY. Smoking can lead on  Cardiovascular diseases, lung diseases or can aggravate existing lung conditions and can  cause Cancer.

SMOKING  AND IT'S  MANIFESTATIONS IN ENT 

Tobacco contains certain substances which are carcinogens like polycyclic aromatic hydrocarbons and nitrosamines. Use of  unfiltered cigarette, pipe will increase the carcinogenic effect ,:along with alcohol intake synergistic effect occurs as alcohol increases absorption of carcinogens contained in the tobacco. Duration of smoking, amount of cigarettes daily increase the carcinogenic effect.

Head and neck cancers like oral cavity and oropharynx  , Larynx, hypopharynx  majority of the patients give history of smoking and alcohol intake.

Chewing tobacco or smokeless tobacco  lead on to cancers of  oral cavity and oropharynx. Paan mixed with  lime ,where lime lowers the pH thereby increasing the release of alkaloids from tobacco and  arecanut  making more prone to cancer . It can lead on to fibrosis, oral submucous fibrosis where patient will have difficulty in opening the mouth due to  fibrous bands.

Smoking can worsen laryngitis,cause polypoid chan ges in the larynx. Bronchitis and exacerbation of asthma have been observed.

Ear infections and hearing loss

Smoking is a risk factor for ear Infections like middle ear Infections especially in children due to parental smoking. Age related hearing loss and noise induced hearing loss aggravated by smoking. its also related to tinnitus ( sound in the ear ). Smoking  causes Ventilating or Eustachian tube dysfunction and causes  increased mucus build up in the middle ear.

Nose and paranasal sinuses

Smoking  affects the inner lining of nose and PNS, decrease the number of cilia , change the viscosity thereby alter the mucociliary  pathway,  causing mucus build up. It can lead on to Rhinitis due to the irritating effect, worsening  of occupational rhinitis or prolongation of rhinosinusitis. Tobacco smoke will irritate the nerves related to smell resulting in decrease in smell sensation, which will reverse once smoking is stopped.

Certain lesions like polyp,  inverted papilloma  has history of active or passive smoking.

To summarise smoking leads to various diseases, interfere with the quality of life. Stopping smoking will improve mucociliary function. Active and passive smoking  is a health hazard, parents should be careful if they have small kids and avoid smoking in front of them or try to quit the habit.

DEAF AWARENESS WEEK

September last week is celebrated as DEAF AWARENESS WEEK internationally. 

Aim is to create awareness among  hearing impaired people and others, their  human rights, needs  and to support  and rehabilitate them. 

Deafness or hearing impairment can be from birth (congenital)  due to genetic defects or in utero infection (TORCH  infection  or other infection among pregnant women ). 

Acquired causes can be due to infection be it viral  like measles, mumps , rubella or bacterial infection like pnuemoccal or other bacteria resulting in severe ear infection or meningitis. Other causes are trauma to the ear by physical impact, NIHL( noise induced hearing loss), barotrauma. Cardiovascular diseases can also result in hearing impairment. 

WHAT CAN BE DONE ? 

Genetic counselling, educate  pregnant women of various infections and proper care. Early identification of the problem by screening during neonatal  period and later at school (audiological tests)  and vaccination . 

Can give Hearing aid, or Cochlear implant  according to the pathology, so speech and language development will not be affected. Ear infections should be treated promptly. AWARENESS regarding ear safety measures among factory workers, or over use of earphones, listening to loud sound , prolonged use of ototoxic medication should be done. 

REHABILITATION

Hearing impaired people  should be  supported emotionally and economically . Have patience while talking to them, repeat the sentence again, have eye contact as they depend on lip reading. Learn sign language and make sure they understand, can also write or draw. Support them  by promoting their business, art or any enterprises started by them. Bring them back to mainstream. Motivate them to carry on with their lives and educate them regarding their human rights. 

Let's make this Deaf awareness  week   fruitful by helping those who need our hand and support them. 

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.