Wax the universal suspect!!
WAX !!!!! the poor good Samaritan !! the one who takes the blame for nearly everything to go wrong with the ear.
- Ear pain - WAX
- Ear itching - WAX
- Deafness - WAX
- Ear discharge - WAX
When a patient goes to a doctor with any complaint related to the ear the one who gets blamed is ?? you guessed it right - WAX
Wax is omnipresent – everyone’s ears have it in varying quantity. Some have it in copious amounts, some have it in little bits floating around.
Wax can be flaky dry, it can be brownish black and wet, it can sometimes also be reddish brown resembling clotted blood crusts.
Wax is in fact good for you!! In some studies wax has been shown to have lysosomal enzymes and other ingredients which have antibacterial properties thus protecting your ear from infections.
Wax can of course sometimes cause some problems. A large ball of impacted wax can cause a mild conductive hearing loss. This especially happens after an excursion to a beach or a swimming pool. But in such cases there is no hearing loss. Whenever a patient who appears to have a large quantity of wax in his ear complains of pain, there is sure to be otitis media lurking behind.
Impacted wax can also cause formation of a wax granuloma due to repeated irritation of the external canal skin. Most such cases can be managed medically though the occasional case may require surgical intervention.
It is important to discourage self cleaning of ear wax at home. This advice is of paramount importance to mothers as one repeatedly gets complaints like “ my child’s ears are soooooo dirty !” some mothers are in fact positively ashamed of the fact that their children have a lot of ear wax. They need to be assured that this is a normal body secretion: definitely nothing to be ashamed of or feel squeamish of !!!!
The consequences of cleaning wax at home may be dire and cause more pain and suffering than the wax ever will !
"Sinusitis" is a much abused term today; surprisingly , more so by the medical community than by lay people !! It is, rightly or wrongly, so often quoted that everyone seems to be aware of it and ready to make a diagnosis that " I have sinus problems". It is the need of the hour to spread awareness about this problem so that it is more correctly diagnosed and treated.
The nasal cavity is surrounded by the paranasal sinuses; the frontal, maxillary, ethmoid and sphenoid sinuses. The exact function of these paranasal sinuses remains unknown but they are thought to help in humidification and temperature regulation of the inhaled air. Many anatomical variations have been documented in the anatomy of these sinuses. Some of these variations predispose and contribute towards causing sinus disease.
"EVERY HEADACHE IS NOT A SINUS HEADACHE"
Sinusitis is a very specific clinical entity with usually precise symptoms and signs. Sinusitis can be broadly defined as an inflammation of the mucosa lining the sinus cavity, usually secondary to infection. Sinusitis can occur secondary to a severe infection of the nose; for example a severe cold that gets prolonged for a long time. Normally the sinuses have the ability to fight such infections and revert back to normal. However in the presence of overwhelming infection or certain anatomical variations that hamper adequate sinus recovery, sinusitis occurs. Sinusitis can be an acute episode which recovers completely or can progress to a chronic process in which between attacks the sinus does not return back to normal.
Commonest symptom of sinusitis is headache, frontal or localized between the eyes. The patient may have facial pain or heaviness. The intensity of the pain may have diurnal variation. There usually are other concomitant symptoms like nasal obstruction; unilateral or bilateral; cold with whitish or yellowish nasal discharge, sneezing bouts etc. On examination of the nose of a patient with sinusitis one finds mucopus in the nose usually in the area of the middle meatus. There may be other findings like a deviated nasal septum, occasional presence of a nasal polyp and reddish nasal mucosa. A nasal polyp is a variation of sinusitis where the mucosa is irreversibly damaged. However a polyp may also occur due to allergy in which case it is usually bilateral.
Acute sinusitis is treated medically with antibiotics, nasal decongestants, anti-histamines and anti inflammatory agents. Surgical intervention is rarely needed in acute sinusitis. In patients with chronic sinusitis surgical intervention is usually needed. The patients should be treated with adequate antibiotics following which a CT Scan of the paranasal sinuses is carried out. Depending on the findings on the CT Scan, the patient undergoes Endoscopic sinus surgery. The aims of the surgery are to remove irreversibly damaged mucosa, modify any anatomical variations if present and to enhance the natural drainage of the sinuses so that the lining mucosa may revert back to normal. The complication rate of sinus surgery is less in experienced hands and the results of such treatment are quite good. In cases where complication of sinusitis are present, however it is wise to go for an external open approach to treat the sinusitis.
All in all sinusitis if recognized early, diagnosed well and treated properly is easily curable and we can give good relief to our patients who have " Sinus trouble ".