Monkeypox: Causes, Symptoms, Treatment, and Prevention

Monkeypox is considered a rare medical phenomenon that is caused by the monkeypox virus. The virus comes from the same family of viruses, namely the Variola virus which is also responsible for causing smallpox.

Because of the familiarity between the viruses, the symptoms of monkeypox are almost similar to smallpox. Moreover, because of the milder effects of the virus, monkeypox is not deadly.

Monkeypox was first discovered in 1958 when a pox-like disease occurred in the lab between the colonies of monkeys used for research purposes. Although, this occurrence influenced the terminology “Monkeypox”, the source of the disease is still unknown. 

The first-ever human case of monkeypox occurred in 1970. Before the 2022 outbreak that took place globally, monkeypox cases were primarily noticed in several central and western African countries. The reason behind the global outbreak is the internationally interlinked travel between countries.

CAUSE

The cause behind monkeypox in animals and humans is the infection with the monkeypox virus. This virus is a double standard DNA virus in the Orthopoxvirus, which is a family of Poxviridae. The major cause of monkeypox in humans is the infected animal. Although, the transmission of the virus remains unknown. Many researchers have claimed that the virus enters the body through the respiratory tract, broken skin, and mucous membranes.

Apart from that, the transmission of the virus from one infected person to another is also possible. This human-to-human transference may occur during sexual intercourse, meanwhile, the animal-to-human transmission may occur through a bite, scratch, direct contact with lesion material, or indirect contact with lesion material.

SYMPTOMS

Once infected, you would notice the symptoms manifest within 21 days. Although further research about the transmission of the strain of the virus is still undergoing, we have compiled a list of symptoms of monkeypox based on the fact that it is not different from the other strains of the West African clade. The symptoms are, 

• Acute headache
• Fever
• Muscle aches
• Backache
• Swollen lymph nodes
• Exhaustion
• Chills 

A rash that appears on the face, inside the mouth, feet, chest, genital or anus. The rash looks like pimples or blisters.

The healing procedure of the rash occurs in stages. However, it would last around 2 - 4 weeks before subsiding. Depending on the severity of the infection, you would get a rash first followed by other typical symptoms. If you notice any of the symptoms, we recommend you consult a doctor from Sakra hospital to acquire medicine.

TREATMENT

There is no set-in-stone methodology of treatments specifically for monkeypox virus infections. However, given the fact that monkeypox and smallpox viruses are genetically the same, the antiviral medicine for smallpox can be used to prevent and cure monkeypox-affected individuals.

Antivirals, namely Tecovirimat, or TPOXX, are administered to people with weak immunity systems. If you have noticed the symptoms of monkeypox, you must consult the healthcare provider in Sakra Hospital, the best ENT hospital in Bangalore.

PREVENTION

Prevention is always recommended, no matter the illness. Following, we have mentioned a few preventive steps that would go a long way. 

Avoid getting close to affected people. It includes not touching the rash, or scabs of the affected individuals, and not kissing, hugging or cuddling with them. Do not share eating utensils with the affected person.
Touching or handling the bedding, towels, or clothing of a person affected with monkeypox is a no-no as well.
Sanitise your hand and wash them with soap occasionally. The sanitizer must be alcohol-based.
If you reside in Central or West Africa, avoid contact with animals that can spread the virus.
Don’t go near any dead or sick animals. Keep in mind to not touch their bedding and the materials that the affected animals might have touched.

If you are affected by the monkeypox virus, you have to do the following,

• Isolating yourself is the key.
• If you have an active rash, you must stay in a separate room so that you don’t run the risk of contamination.

CDC recommends getting vaccinated for people who are affected by the monkeypox virus. In addition to this, CDC also states that individuals who satisfy the following criteria must get vaccinated as well. 

• Those who have been identified by public health officials as someone affected by the monkeypox virus.
• People who have been exposed to the monkeypox virus through having sexual intercourse with an affected person within 2 weeks of their vaccination.
• People whose jobs may expose them to the said virus, which includes but is not limited to,
• Those who work in the laboratory to perform testing for orthopoxviruses
• Laboratory workers who work around animals with orthopoxviruses
• Healthcare or public health workers

In case you are running the risk of being exposed to the monkeypox virus, contact Sakra Hospital to get in touch with the best ENT doctor in Bangalore for further treatment.

Insomnia Can Cause Heart Attacks in Teens

Sleep is food for the brain. However, one-third of us suffer from poor sleep.

Sleep relaxes our body, gives our brain a break, and calms the heart, allowing it to work at a lower rate and enables our blood pressure to drop to lower levels. Regular poor sleep puts people at risk of serious medical conditions such as obesity, heart disease and diabetes and it shortens life expectancy.

If you have any problems related to Insomnia, then get the best insomnia treatment in Bangalore at Sakra World Hospital.

Causes

With access to the internet and bad eating habits, sleeplessness can affect anyone. Teenagers are caught in between long school days, late nights on the computers,  playing video games, piling up homework and projects, etc. They ignore sleep. Women are at higher risk of developing insomnia than men because of differences in genetics, sex hormones, stress, and reaction to stress.

The most important health condition causing poor sleep is sleep apnea which might be ignored or left undiagnosed if you snore.
Most of us need about 8 hours of good-quality sleep a night to function properly. A variety of factors can lead to poor sleep, but in most cases, it’s due to poor sleeping habits.  

Solution

Sleeping early just for a night will not solve your sleeping problems. It will take months to recover from sleep apnea. Drinking caffeine or energy drinks can disrupt your sleep patterns so try to avoid them as much as possible.

To treat your sleep problems it is a must that you change your habits and go to sleep early every night. Do not use your mobile phone or television or any digital screen before you go to bed. If you have symptoms of a blocked airway such as snoring, mouth breathing, dryness of the mouth, nose block etc, consult an ENT.

Sakra World Hospital has some of the best sleep disorder specialist in Bangalore who offer sleep apnea and sleep disorder treatment in Bangalore. At Sakra Sleep Disorder Center, we provide comprehensive treatment for common sleep disorders including insomnia, obstructive sleep apnea (OSA), snoring, excessive daytime sleepiness, etc.

https://www.deccanherald.com/living/insomnia-can-cause-heart-689586.htm

What is Black Fungus and Mucormycosis?

Mucormycosis, commonly known as black fungus, is a rare but serious fungal infection caused by a type of fungus called micromycetes, which is abundant in the environment. It mostly affects people who have health problems or take medicines that decrease the body's ability to fight germs and disease. This usually affects the nose, sinus, paranasal sinus, and sometimes even spread to the eye and the brain. It is called black fungus because it leads to the blockage of all the blood vessels small and large that supply blood in and around the vision of the face. When there is a blockage of these blood vessels due to infection, it causes the blood flow to decrease which causes a process called necrosis and that makes the whole area turn black.

What are the symptoms?

Although the blackening of the face & area over the nose, etc can be seen in Mucormycosis, there are a lot of early signs which one should be careful about when dealing with patients with decreased immunity. Patients with mucormycosis can start up complaining of headaches, they can complain of hemifacial pain, and over a period of time they can develop swelling over the face, over the eyelids and sometimes the eyeball can actually start getting pushed outwards and the patients can start developing blurry vision and decreased the visibility. They also have sometimes spread to the brain which will cause much more severe neurological complications. But patients with diabetes should always look for blood-stained mucus coming from the nose or facial pain especially if it is only on one side, which could be a very early sign of Mucormycosis.

The common symptoms of Mucormycosis include:

• Pain and redness near eyes or nose
• Fever
• Headache
• Cough
• Shortness of breath
• Bloody vomiting
• Altered mental state

Warning signs may include loosening of teeth, toothache, blurred vision, or double vision with pain.

Who are the most vulnerable?

Mucormycosis used to be an uncommon condition. We are finding more and more people with decreased immunity are more susceptible to this kind of problem. Patients who frequently get mucormycosis usually have diabetes, severe kidney disease or are on dialysis, or they have compromised immunity due to any other medications which are going on.  People with all these problems are also more prone to developing COVID.

Sometimes questions arise that taking medicines for any other comorbidities can cause problems like this? Well, the short answer is that the medicines do not directly cause problems of mucormycosis, but they do cause a certain amount of immunosuppression. These medicines are required to decrease inflammation, but can also decrease immunity. So if patients are already unstable either due to decreased control of blood sugar or any other problems, then they are more prone to developing Mucormycosis. Now that doesn’t mean that you stop these medications because unfortunately patients are dying of COVID and these can be lifesaving drugs. So there is a very specific balance that we need to look for to prevent any side effects but at the same time prevent the effects of COVID.

How is it diagnosed?

The diagnosis of mucormycosis is primarily based on clinical evaluation by an ENT surgeon. A diagnostic endoscopy is usually conducted with visualization of the specific blackish lesion to confirm the presence of fungus. Some of these crusts are removed and sent for testing to confirm the presence of fungus. Imaging with MRI (or contrast CT if MRI is not possible) is necessary to understand the extent of the disease, and it should be done as soon as possible.

Is Mucormycosis treatable?

Mucormycosis is primarily treated with medications but not just any medication. There are specific antifungal drugs that are used for invasive fungal diseases such as Mucormycosis. There are various injections and tablet formulations that are used for longer periods. Unfortunately, these are very strong chemicals and have some side effects. So, not only you need to start medications but also need to monitor them well, and make sure that you don’t get any secondary infections or any fall in immunity. The duration of medicines can be decreased by performing certain surgeries which will reduce or remove the fungal load. 

What kind of surgery is required?

It usually involves surgical debridement by the ENT specialist. In the case of eye involvement, orbital decompression( to decrease the pressure on the eyeball), or even removal of the eye and the structures surrounding it may be required. It is a surgery done to reduce the amount of fungal load on the patient’s body and may be needed to save a patient's life. Additional local injections of drugs directly around & into the eye may be able to control the disease and relieve the eye of disease.

Childhood Hearing Loss: Importance of Early Identification and Intervention

Childhood hearing loss: Early identification & intervention is the key to success

Hearing is one of the most important senses that facilitates communication, social interaction and allows us to participate in daily activities.

For children, hearing is the key aspect to learn spoken language, perform academically and engage socially.
Hearing loss in children can occur at any time of life. The two types of hearing loss in children are:

• Acquired hearing loss (occurring after birth): Appears when the child is a toddler or enters school, or even later due to illness, recurring ear infections, head injury, certain medications, and exposure to loud noises.

• Congenital hearing loss (present from birth): Hearing loss at birth may be due to genetics factors, premature birth, low birth weight, lack of oxygen known as birth asphyxia, and neonatal jaundice.

Most types of acquired hearing loss can be managed medically or surgically. Congenital hearing losses are frequently permanent and can adversely impact in the following ways:

• Impair a child’s ability to learn speech & language

• Below-average academic performance

• Low self-esteem and psycho-social issues

Hearing loss in children is usually identified only after the child’s caregiver notices unusual behavior or speech delays, approximately at two or three-years-old which exceeds the critical time period for a child's speech and language development.
Children who receive intervention for hearing loss by 6 months of age develop on par with age-appropriate speech & language skills, academic achievement, and social and emotional development.
An early hearing loss diagnosis enables parents and families to pursue intervention such as hearing devices, cochlear implants, rehabilitation as promptly as possible.

The Universal Newborn Hearing Screening (UNHS) program recommends that every child should undergo screening at 0 months/ birth and detect hearing loss by 3 months and starts rehabilitation by 6 months of age.

At Sakra the ENT hospital in Bangalore, we believe that a proactive approach to hearing health should begin at birth. The protocol followed at Sakra for hearing loss treatment in Bangalore is compliance with the recommended UNHS guidelines. We are equipped with efficient screening & diagnostic tools to identify and rehabilitate children with hearing loss.

You need to consult ENT specialist in Bangalore  immediately if:

• There are any parental concern about a child’s hearing

• A child has any global delays or speech and language delays

• Attention problems

• Frequently asks for words to be repeated

• Has trouble following directions

• Has a delayed reaction or doesn’t respond when called upon

Looking for the best ENT specialist for congenital hearing loss treatment in Bangalore then Consult Sakra World hospital which offers you the best services and treatments for all your ENT conditions.

A Deadly Black Fungus Called Mucormycosis

1)  What are the symptoms of mucormycosis in ENT?

It is a rapidly progressing infection. Facial swelling, purulent discharge from the nose, blackening of the skin near the eye and nose, loss of sensation of the area, double vision, sudden loss of vision, rapid deterioration of general condition are some of the symptoms of rhino-orbital-cerebral mucormycosis. As the name suggests invasive rhino-orbital-cerebral mucormycosis spread rapidly from the nose to the eye and the brain. Once it spreads to the brain it is considered very critical.

2)  Why does it affect the seniors who have suffered from Covid 19 infection?

Covid 19 is caused by SARS-CoV-2 and is seen to affect people with low immunity and otherwise, it also causes severe inflammatory changes in the lungs and cardiovascular system. It lowers the immunity of a person and makes the body more prone to other diseases. An elderly person is more likely to have conditions like diabetes, hypertension, thyroid disorders, renal issues, etc. which makes them more prone to opportunistic fatal fungal infections like mucormycosis.

3). What are the different ways by which it can be treated?

Mucormycosis is one of the fatal fungal infections in humans. Usually, it is surgical debridement or removal of all the dead tissue which harbours the fungus. Mucormycosis causes ischemic necrosis, that is it causes dead tissue by clogging the blood vessels. It is of utmost importance that all the dead tissue is removed completely, multiple procedures may be required for that. Also, an intravenous anti fungal medication called ‘Amphotericin B is also given for a few weeks till the fungus is fully controlled. Oral antifungal medications are also given. The mortality rate is very high even after active management.

4)  Some tips on preventing it.

Fungal spores are present in damp areas, in the dust, soil closed dingy non-aerated rooms, etc. So it’s better to avoid such areas, wear a mask, wash hands regularly, not to pick the nose, rub the eyes or scratch the skin as we might inoculate these spores into the tissues.

5). How many cases are you seeing in a month?

It is not a very common disease, usually seen in tertiary care centres treating very sick patients. Comparatively, there has been a surge in the number of cases, especially in post-Covid 19 infections. Many cases have been reported in Delhi and Ahmedabad, and we have found few cases in Bengaluru also.

6). Who is most prone to this fungal infection and which age bracket is affected the most?

Occurs in uncontrolled diabetics in a state of diabetic ketoacidosis and people with severe immunocompromised status, long term steroid treatment, chronic renal failure, chronic liver diseases, post-chemotherapy or people on immuno-suppression medications, post-transplant. Usually seen in the elderly.

Doctors are seeing mucormycosis in Covid patients above age 60 which is a fungal infection caused by a group of moulds called mucormycetes. Sakra World Hospital has the best doctors for fungal infection treatment in Bangalore.

CSF rhinorrhea closure (CSF Leaks)

What is a CSF Leak?

CSF is the protective fluid which surrounds the brain and spinal cord. There is a barrier of bone and other tissues which separate the brain from the nasal cavity. Any breach in this barrier would cause this CSF to leak out of the nose. This condition is called CSF rhinorrhea.
A CSF leak is a serious and often incapacitating medical condition known as Cerebrospinal fluid (CSF) rhinorrhea. It can occur in the head as a result of trauma, surgery, an underlying disorder like tutors or spontaneously. The majority of these leaks stop on their own, but surgery may be needed if the leaking continues after conservative management.

What are the symptoms of CSF rhinorrhea?

• Clearwater dripping from the nose especially on bending forward.

• Headache

• Spread of infection from the nose to the CSF can lead to Meningitis presenting as severe headache, high-grade fever and neck stiffness.

If you have any of the above symptoms, then consult the Best ENT doctor in Bangalore immediately.

Diagnosing CSF Rhinorrhea

CSF rhinorrhea diagnosis requires testing the drainage from the nose for a protein called Beta-2 transferrin which is only found in brain fluid. The discharge is collected and sent for laboratory tests to determine if it is cerebrospinal fluid.
Once there is a diagnosis, the evaluating doctor may order several other tests to determine the location of the leak. A CT scan and MRI scan of the brain and paranasal sinuses often reveals the source of the leak and helps the surgeon plan any needed surgery.
Additional tests may be required such as lumbar puncture (spinal tap), where dye is used to help pinpoint the area of the leak.
You may also have to undergo evaluations by an Ophthalmologist to rule out high intracranial pressure. Tests may include an eye exam and lumbar punctures to measure the pressure of the fluid surrounding your brain and spinal cord.

How is CSF Rhinorrhea Treated?

Patients with symptoms of CSF Rhinorrhea should still visit ENT specialist in Bangalore due to the increased risk of meningitis that is associated with CSF leaks. It is important to first localise the leak and identify the cause of the leak. If its not a major breach then it can be treated conservatively with medication, adequate rest. It is mandatory to avoid straining on stools, coughing, sneezing, lifting weights as these activities can raise the intracranial pressure and the leak can increase. This will prevent the leak from closing spontaneously.
Looking for the best hospital for CSF Rhinorrhea treatment in Bangalore? Visit Sakra World Hospital to consult the ENT doctor in Bangalore.

If conservative treatment doesn’t work then surgery is necessary to repair cranial cerebrospinal fluid leaks. There are two ways to approach the leak - a neurosurgical approach through the skull by retracting the brain or nasal endoscopic procedure through the nose by ENT - skull base surgeon.

Computer-Assisted Surgery 

Sakra World Hospital has extensive experience in nasal endoscopic and Skull base surgeries which are much less invasive than traditional surgical methods. This surgery is performed using nasal endoscopes and endoscopic instruments. The doctor places these tools up the nostrils and into the nose and sinuses to reach the defect in the skull base. These surgeries are done using a piece of special advanced equipment called Computer Assisted Surgery or Navigation Assisted Surgery which helps in exact localisation of the defect and also the instruments which are used. These surgeries are very delicate because of the vital structures around which the procedure is done, especially the brain, eye, optic nerve, major blood vessels and nerves. The doctor may use small pieces of fat from your abdomen, fascia and/ or muscle to repair the leak and also tissue glue. The nose will be packed with a medicated sponge-like material after the closure of the leak
Surgery usually requires a hospital stay of 3 to 4 days. Patients will be on medications like antibiotics, for pain relief and to reduce the CSF pressure.

Some people can have multiple leaks due to weak bone or due to persistent raised intracranial pressure. These patients will need further medications or might require multiple procedures.

Phonosurgery

Phonosurgery is a surgical procedure that maintains, restores, and improves the voice.

Phonomicrosurgery

Phonomicrosurgery is a specialized form of phono surgery in which ent specialists use microsurgical techniques and instruments to treat abnormalities on the vibratory edge of the vocal fold, thus helping a patient regain or improve voice function.      
Phonomicrosurgery can also be used to remove lesions such as vocal fold nodules, polyps, or cysts via the mouth to improve the quality of one’s voice. The procedure is performed under general anaesthesia which involves the placement of a metal tube through the mouth to push the tongue out of the way. The surgeon examines the vocal cords under high magnification using a microscope to determine the type of lesion present.      

Sakra World hospital has the best ENT doctor in Bangalore providing the best care and treatment you need.
An infusion of saline water is used to identify areas of scarring and allow preservation of the gel-like layer (superficial lamina propria) of the vocal fold. Using an instrument, a small incision is made on the vocal fold to dissect the area of concern away from the normal underlying vocal fold.

There are no incisions made on the neck. The goal is to preserve all normal areas of the vocal fold to achieve the best vocal outcome. The surgery is performed with the help of laser technology.

Usually, patients go home on the same day of the surgery. We have the best ENT specialist in Bangalore who advises the complete voice rest (no speaking, whispering, or other kinds of sound production) following the procedure for a period ranging from one to three weeks depending on the complexity of the procedure performed.      

Vocal Nodules and Polyps:

The vocal folds are inside larynx or voice box. When someone talks, air moves from the lungs through the vocal folds to the mouth. The vocal folds vibrate to produce sound. Anything which causes trouble for the vocal folds to vibrate can cause a voice problem.
Vocal fold nodules are benign (non-cancerous)  growths that form on the vocal folds. When someone uses their voice in the wrong way, the vocal folds may swell and over time, the swollen spots can get harder, like a callous. These nodules can get larger and harder if vocal abuse continues.

Polyps look like a swollen spot or bump, a blister, or a thin, long growth and can be found on one or both of the vocal folds. Most polyps are bigger than nodules and are also called polypoid degeneration or Reinke’s edema. An easy way to remember is to think of a nodule as a callous and a polyp as a blister.

Signs of Vocal Fold Nodules and Polyps

• Nodules and polyps cause similar symptoms. These include:

• Hoarseness

• Breathiness

• A "rough" voice

• A "scratchy" voice

• A harsh-sounding voice

• Shooting pain from ear to ear

• Feeling a lump in a throat

• Neck pain

• Less ability to change your pitch

• Voice and body tiredness

Causes of Vocal Fold Nodules and Polyps

Mostly vocal abuse or misuse causes nodules and long-term vocal abuse can lead to polyps. But polyps can occur after just one instance of vocal abuse, like yelling at a concert. other factors include smoking cigarettes for a long time, thyroid problems, and reflux.

Vocal abuse can occur due to:
 

• Allergies

• Smoking

• Tense muscles

• Singing

• Coaching

• Cheerleading

• Talking loudly

• Caffeine and alcohol

Vocal Chord Polyp Surgery: 

Vocal cord polypectomy is typically a short daycare procedure. The polyps are often pedunculated unilateral masses located on the vocal cords, they occur from a ruptured capillary in the lamina propria of the vocal cord, resulting in a thickened epithelium over a fibrin stromal matrix.
Newer surgical techniques for polyp or cyst removal are directed to lifting the normal lining of the vocal cord, using fine instruments to remove the lesion(which often comes from deeper layers), and repositing the normal skin lining in its normal place. This technique is called “Microflap Surgery”

Laryngoplasty Phonosurgeries

A term used to describe all forms of laryngeal framework surgery to improve the voice
This is of various types and is used to change the quality of the voice. In various situations, it may be used to pull the vocal cords apart, push them closer, or shorten, lengthen them. These procedures are used to change the pitch or amplitude of our voice

Medialization:  used to strengthen the voice in vocal cord paralysis causing breathy voice
Lateralization:  Used to open up the airway and improve breathing
Shortening:  Used to deepen the voice or lower the pitch
Lengthening: Used to give a higher pitch to the voice

Consult the best ENT specialist in Bangalore if you have any concerns regarding your ear, nose and mouth.

Voice Disorders

A problem with pitch, volume, tone, and other qualities of your voice which usually occur when your vocal cords don't vibrate normally is defined as a voice disorder.
Voice is the sound produced by humans using the lungs and the vocal folds in the larynx or voice box. Vocal cords are 2 folds of tissue inside the voice box (larynx). The vibration of those cords is what makes a speech.

Voice disorders include:

Laryngitis: This is when your vocal cords swell. It makes the voice sound hoarse or you may not be able to speak at all. Acute laryngitis happens suddenly. It is often caused by a virus or bacteria in the upper respiratory tract. It often lasts just a few weeks. Treatment is to rest the voice(speak less) and drink plenty of fluids. Chronic laryngitis is defined as the swelling of the vocal cords for a long time. Common causes include a chronic cough, using inhalers for asthma, and Acid reflux (gastroesophageal reflux disease). Treatment of chronic laryngitis depends on its cause.

Vocal cord paresis or paralysis: The vocal cords can be partly or fully paralyzed. This can be caused by a viral infection that affects vocal cord nerves, an injury to a nerve during surgery, stroke, or cancer. If both of your vocal cords are paralyzed in a nearly closed position, you may have noisy or difficult breathing. If one vocal cord is paralyzed in an open position, you may have a weak, breathy voice. Some people will get better over time. In other cases, the paralysis is permanent. Appropriate voice therapy may help the voice in some cases. There are surgeries which can help recover the voice quality if therapy doesn’t help. 

Spasmodic dysphonia: It is a disorder that causes the vocal cords to spasm. It can make the voice sound tight, hoarse, or groaning. At times, the voice may sound normal. Other times, the person may not be able to speak. Assessment by a voice specialist helps in diagnosis. Speech therapy may be tried, but often shots (injections) of botulinum toxin to the vocal cords are the solution to this problem. 

What causes voice disorders?  

For normal speech, the vocal cords need to touch together smoothly inside the larynx. Anything that interferes with vocal cord movement can cause a voice disorder. Many voice disorders can be treated when diagnosed early.

Voice disorders can be caused by many factors such as :

Growths: In some cases, extra tissue may form on the vocal cords which can stop the cords from working normally. The growths can include cysts (fluid-filled sacs), papilloma (wart-like lumps), or nodules (callus-like bumps). There may be patches of damaged tissue called lesions or areas of scar tissue. In some people, the web (a band of tissue) can grow between the vocal cords. Other growths include a small area of chronic inflammation (granuloma) and small blisters called polyps. Growths can have many causes. These include illness, injury, cancer, but the most important and common cause is vocal abuse(overuse or improper use of voice).

Inflammation and swelling: Many things can cause vocal cord inflammation and swelling such as surgery, respiratory illness or allergies, GERD, some medicines, exposure to certain chemicals, smoking, alcohol abuse, and vocal abuse.

Nerve problems: Multiple sclerosis, myasthenia gravis, Parkinson disease, Amyotrophic lateral sclerosis (ALS), and Huntington disease can affect the nerves that control the vocal cords. Certain neck surgeries can also harm nerves.

Hormones: There are certain disorders which affect thyroid hormone, female and male hormones, and growth hormones which can cause voice disorders.

Vocal abuse: The vocal cords can be stressed when you speak using high pitch and it can cause problems in the throat muscles and affect the voice or cause a voice disorder. Vocal abuse is anything that harms the vocal cords such as too much talking, shouting, or coughing. Smoking and constantly clearing the throat is also vocal abuse. Vocal abuse can cause the vocal cords to get nodes and polyps or cysts. These change how the voice sounds. In some cases, a vocal cord can break or burst from vocal abuse and can lead to haemorrhage (cord bleeding). You can lose your voice. Vocal cord bleeding should be treated properly.

What are the symptoms of a voice disorder?

Symptoms of a voice disorder include:

1. Have a quivering sound

2. Harsh sound

3. Strained or choppy sound

4. Be weak, whispery, or breathy

5. Having a high pitch or low pitch

You may have pain in your throat while speaking, or feel like you are not able to speak. You may feel a lump in your throat when having food. Or you may feel pain when you touch the outside of your throat.    

How are voice disorders diagnosed?

If you feel the change in voice then consult an ENT - ear, nose, and throat specialist (otolaryngologist). The doctor will ask you about the symptoms and how long you've had them. The ENT doctor will check your vocal cords and larynx using certain tests. These may include:

Laryngoscopy: This lets the doctor check your throat from inside. With indirect laryngoscopy, the ENT specialist holds a small mirror at the back of the throat and shines a light on it. With fibre-optic laryngoscopy, a thin, lighted scope (laryngoscope) is used. 
Laryngeal EMG (electromyography): It measures electrical activity in the throat muscles. A thin needle is put into some of the neck muscles. At the same time, electrodes send signals from the muscles to a computer. This can show nerve problems in the throat. 
Stroboscopy: This test uses a strobe light and a video camera and a microphone to see the pattern of vibrations of the vocals cords as we speak
Imaging tests: X-rays and MRI can show growths or other tissue problems in the throat.    
Sakra World hospital has the best ENT doctor in Bangalore providing the best care and treatment you need.

How are voice disorders treated?
Treatment for a voice disorder depends on its causes. Treatment may include:

Lifestyle changes: These changes may help reduce or stop symptoms. 

• Not yelling or speaking loudly. And resting your voice often if you speak or sing a lot. 

• Exercises to relax the vocal cords and muscles around them can help in some cases. 

• Warm up the vocal cords before long periods of speaking. 

• Drink fluids to stay hydrated.      

Speech therapy: Working with a speech-language pathologist can help with certain voice disorders. Therapy may include exercises and changes in speaking behaviours. Some of these may include timing deep breaths so that they power your speech with adequate breathing.
Medicines: Some voice disorders are caused by a problem that can be treated with medicine. For example, antacid medicine may be used for GERD or hormone therapy may be used for problems with thyroid or female hormones.
Injections: Your doctor can treat muscle spasms in the throat with a shot of botulinum toxin. In some cases, your doctor can inject fat or other fillers into the vocal cords. This can help them close better.
Surgery:  ENT doctor in Bangalore can remove some tissue growths. If cancer causes growth, you may need other treatment. This may include radiation therapy. 
Consult the best ENT specialist in Bangalore if you have any concern regarding your voice.

Computer Navigation Assisted Endoscopic Sinus Surgery

Computer-assisted surgery (CAS) is used in ENT surgery since 1986 allowing intraoperative navigation for ENT surgeons leveraging digital imaging data like CT, MRT, etc. Owing to higher precision, this is one of the most successful surgical methods

Computers process the images as the surgeon performs the procedure & navigate around sensitive areas of ear, nose & throat using a connected measuring system. Since the areas or landmarks of the surgery are delicate & narrow for patients of sinonasal diseases, CAS navigation helps with preoperative surgical planning & guides the surgeon during the operation.

Sakra World Hospital located in Marathahalli comprises of Best ENT surgeons who are highly experienced to perform a CAS endoscopic sinus surgery by inserting an endoscope, which is a small tube with a camera attached to the end of it, into the nasal cavity through a nostril. With the images captured by the camera, the surgeons navigate around, to detect abnormalities in the sinus area & remove or reposition them with precision instruments. 

Being one of the best multispeciality hospitals in Bangalore, CAS sinus surgery involves the following:

1. Local or General Anesthesia.

2. Insertion of the Endoscope.

3. Tissue Repositioning or Resection.

4. Recovery.

The benefits of endoscopic sinus surgery with assisted computer navigations are:

1. Decreased surgical time

2. Less damage to normal structure

3. Minimally invasive.

4. Less tissue removal.

5. Lesser bleeding post-op.

6. Fewer complications.

7. Long term results

8. Minimal pain.

9. No scarring of the nose.

For patients with chronic sinus complications, when medicine hasn’t yielded many results or there is no relief, CAS sinus surgery is the right choice for the conditions such Revision sinus surgery, Nasal polyps, Chronic sinusitis that lasts for three months or more and Sinonasal tumour surgery, where normal surgery landmarks are often distorted.

Sakra World Hospital in Bangalore has a team of the Best ENT doctors & staff who are adept in performing Computer Navigation Assisted Endoscopic Sinus Surgery. Although the endoscopic procedures make the science of it all easier, we pride ourselves on being anatomically thorough & aim to deliver the best patient care. 

POEM- A Minimal Invasive Procedure for Swallowing Disorders

Overview 

Peroral Endoscopic Myotomy (abbreviated as POEM) is an endoscopic procedure to treat swallowing disorders, such as achalasia. It’s a disorder where entry of food and liquids into the stomach is impaired. 

Achalasia is usually caused by malfunction of the esophageal muscles and lower sphincter muscles, which makes it hard for food or liquid to pass down the throat. The symptoms of swallowing disorders include weight loss, difficulty eating, pain while swallowing, and a burning sensation in the chest. POEM is a surgical procedure that helps to relax the tight esophageal muscles and opens up the esophageal passage which has narrowed. The complete procedure takes around two to three hours. 

Flexible thin endoscopy tubes are passed through the patient’s mouth. It allows the physician to view and examine the surrounding area without any large incision on the body. Endoscopic procedure is highly beneficial for swallowing disorders because there’s no incision on the chest or abdomen. It’s a minimally invasive procedure and includes no post procedures. 

Procedure

Before the procedure 

Prior to the procedure, our doctors will have a word with the patient regarding the specific preparations that a patient needs to follow. This helps to prepare both physically and mentally. The patient is asked to follow a liquid diet for two days. Before the surgery, he/she is not allowed to drink or eat anything at least for 12 hours. The fasting hours will keep the esophagus and stomach clean and easy for the endoscope to pass through and is important to prevent complications like aspiration of stomach contents into the lungs. 

If the patient is on any medications, they should talk to the doctor whether is it safe to take the medications or not. Before the surgery, a patient will undergo a series of medical tests to assess their overall health and fitness for surgery. 

During the procedure 

Once the patient is prepared, he/she will be taken into the operating room and given IV anaesthesia. The surgery is performed under general anaesthesia and the procedure begins with insertion of the endoscope tube into the mouth. A small camera is mounted at the end of a tube that helps the doctor to view the affected area closer on a TV monitor. 

The endoscope tube passes through the lining of the esophagus muscles to make a pathway. A surgical knife is attached to the endoscope tube end and tunnels into the pathway. This knife helps to cut away unwanted tissue and loosens the tight esophagus muscles, which a major causative factor for swallowing disorders. 

Once the procedure is completed, endoscopic clips are inserted into the lining of the esophagus to help keep the incision open. The endoscope tube is removed through the mouth. This procedure helps to relieve the tight esophagus muscles and allows food to pass down to the stomach normally. 

After the procedure 

The patient will be asked to stay in the hospital for a night to observe if there are any complications after the surgery. Post-surgery, the patient will not be allowed to eat or drink solid foods for a certain period of time. After the surgery, the patient will undergo a barium X-ray to verify that the esophagus muscles are open and there’s no leakage. 

The follow-up sessions include meeting with the doctor to check improvement in health for 7 to 10 days. Then again the patient should visit the hospital after three months for a swallow test to make sure the esophagus is functioning well. 

Diet for achalasia 

Foods that help to reduce the risk factors of achalasia:

Soft foods, like mashed vegetables, porridge, and soups 
Peppermint and yogurt helps to reduce gastric secretion 
Ginger helps in digestion and prevents heartburn 
Drink a minimum of 10 glass of water to keep the body hydrated

Living with a swallowing disorder

Swallowing disorder, such as achalasia is a long-term disease. 
Here’s a list of lifestyle changes that will help to regulate the symptoms:

• Avoid tobacco usage
• Avoid fried or spicy foods that can trigger heartburn
• Drink plenty of water while chewing food
• Have smaller meals frequently
• Sleep with your head slightly raised

Maintain a balanced and nutritional diet for healthy living. Add more fibre in the diet for digestion and healthy life. 

Senior Consultant ENT & Head neck surgery
MS (ENT), Laryngology Fellowship (USA)

Book Appointment With Dr. Shantanu Tandon,ENT

NBI New Advent in Screening and Diagnosing Cancers of Upper Aerodigestive Tract

Head and neck cancers arise in multiple sites and sub sites, mostly detected so late that the oncological treatment encompasses extensive surgery and post-operative functional defects to the individual causing significant cosmetic changes, difficulties in swallowing, chewing, breathing and speaking. Hence early detection of these tumours in one of the main factors in treatment success.

 Efforts to achieve the earliest detection of malignant disease have led to the development of new endoscopic examination methods. Endoscopic examination has hence become a corner stone for the diagnosis and treatment of cancers of the upper aero digestive tract. However, a laryngoscope with conventional white light (CWL) has technical limitations in detecting small or superficial lesions on the mucosa. Narrow band imaging especially combined with magnifying endoscopy (ME) is useful for the detection of superficial squamous cell carcinoma (SCC) within the oropharynx, hypo pharynx, and oral cavity. 

Narrow band imaging (NBI) is a novel endoscopic technique enhances the diagnostic sensitivity of endoscopes for characterizing tissues by using narrow-bandwidth filters in a sequential red, green and blue illumination system. It exploits the neoangiogenetic pattern of vasculature, hence enabling to differentiate between benign & malignant/ premalignant condition. This filter cuts all wavelengths in illumination except two narrow wavelengths. One of these wavelengths is of 415 nm which corresponds to the peak absorption spectrum of haemoglobin to emphasize the image of capillary vessels on surface mucosa. Superficial lesions are identified by changes in the colour tone and irregularity of surface mucosa during endoscopic examinations.

NBI is a non-invasive technique that can be carried out in the outpatient clinic without need of general anaesthesia. NBI system consists of the same components as conventional video endoscopic systems - light source, camera unit and camera head or chip equipped video endoscope. The blue filter enhance the image of capillary vessels (IPCL - Intraepithelial Papillary Capillary Loops) on mucosal surface. The 540 nm wavelength light penetrates deeper and highlights the sub mucosal vascular plexus. The reflection is captured by a charge coupled device chip (CCD), and an image processor creates a composite pseudo colour image, which is displayed on a monitor, enabling NBI to enhance mucosal contrast without the use of dyes.

Healthy nasopharyngeal mucosa in white light (A) and NBI (B).

Submucosal vessels are visualised with greater contrast.

 Dysplasia in Vallecula in white light (A) and NBI (B). 

Submucosal changes for dysplasia, Carcinoma in situ can be appreciated as brown dots irregularly distributed in a well demarcated area. Hence NBI has proved useful in targeted biopsies of suspected areas and to determine limits of resection.

For follow up post Radiotherapy 

NBI has high sensitivity (91.3 - 100%) and specificity (91.6 - 98%) in Head and Neck cancer follow up patients.

Supraglottic spread (of Glottic carcinoma) well appreciated on NBI.

Dysplastic changes; brown dots on NBI

LIMITS OF NBI: As it is dependent on direct visualisation of the mucosa, conditions that prevent direct visualisation can alter the results obtained for example, pooled saliva, sticky mucus, or verrucous lesions where the epithelium has a layer of hyperkeratosis which prevents visualisation of the submucosa.   Laryngeal papilloma is another entity where NBI cannot discriminate between benign & malignant lesions.

Laryngeal papilloma

NBI has proved to be a useful screening tool aero digestive malignancy, as well as in the pre-operative, intraoperative and post-operative staging of patients affected by squamous cell carcinoma in the head and neck area. Hence NBI is increasingly being used in otorhinolaryngology as a convenient screening method for detection of new diseases, but also for follow-up of patients after treatment for head and neck malignant tumours, when early detection of possible recurrence is crucial. 

Sialoendoscopy As Newer frontiers in minimally invasive ENT treatments

What is sialoendoscopy

New technology aims to visualize the lumen of the salivary ducts and Treat various inflammatory and obstructive pathologies

How is it done? 

Sialoendoscopy involves the use of miniature endoscopes to enter the small ducts of the salivary system in search of disease

What kind of instruments are used?  

Flexible endoscopes which are 0.75 – 1mm in diameter are used. After dilating the passage of the salivary duct, these scopes are passed in. One by one many ducts can be examined.

What are the procedures possible using this technique?

    1. Diagnostic scopy to examine the ducts
    2. Washes to remove sludge and mucus plugs
    3. Stone removal
    4. Dilation of duct strictures
    5. Biopsies of the gland

How long does it take? 

This may be possible in 30 minutes for a diagnostic examination, to 1-1.5 hours for therapeutic procedures ?

How is it different and advantageous from earlier treatment methods? 

Traditional methods were limited to medications followed by open surgery for complete removal of the gland. This required a long hospital stay, risk of complications e.g. nerve injury, bleeding, pain, etc.

With this new method the advantages are:

    1. No Scar
    2. Quick Recovery
    3. Return Home Same Day
    4. No Tissue Damage To Surrounding Areas

When can we use this technology? 

We can use this technology to diagnose and treat some common problems salivary glands. By far the most common problem is stones, causing sialadenitis

    1. Duct calculi   (stones)        
    2. Strictures
    3. Dryness of mouth        
    4. Foreign Bodies
    5. Mucus plugs/sludge        
    6. Ductal granulomas

This is also used to get biopsies from intraductal lesions, and for complicated autoimmune conditions which may involve the salivary glands.

Can this be used for large stones as well? 

Yes. With newer technologies, a narrow (Holmium)laser fiber can be passed with the endoscope and used to break down large stones, which can then be retrieved in a minimally invasive manner.

How long is the recovery process following a sialendoscopy (salivary stone removal)?

It is recommended that a patient rest and relax for the remainder of the day Some pain and discomfort, as well as swelling, is to be expected. Most patients can resume all activities within a day 

Can this technology be used in children? 

Yes. Recurrent infection can happen in children, and often requires repeated antibiotics or even surgery. This procedure can be done safely, even in young children.

Causes, Symptoms and Treatments of Allergy

What is an Allergy? 

An allergy is the response of the body's immune system to normally harmless substances. Whilst in most people these substances (called “allergens”) pose no problem, in allergic individuals their immune system identifies them as a’ threat’ and produces an inappropriate response.

What causes an allergic reaction?

When the allergic person comes into contact with the offending substance, his body's immune system rushes to his rescue and begins to produce antibodies to fight off the invader. These antibodies alter the way in which the body reacts, and may produce allergic symptoms. 

How common are allergies? 

It is estimated that at least 20% of the population is likely to develop some kind of allergy. 

In India, this value varies from city to city depending on the level of industrialization, type of vegetation, etc.  Bangalore is gradually becoming the hub of allergies, and the prevalence maybe 30% or even more 

 What are the most common allergic symptoms?

Allergy can involve any part of the body. Any system. Any tissue. Most reactions involve the areas cared for by your Otolaryngologist, especially the nose, sinuses, throat, voice box and trachea. 

Many of these allergies, can cause secondary infections of the sinuses and middle ear

Is an allergy a serious illness?

An allergic reaction can vary from a mildly irritating problem to a very serious and life threatening one. Most people usually develop a response of their nasal passage (Allergic Rhinitis). Some may develop a response of their Lower airway (Asthma).

A sudden severe reaction can cause a generalized response called Anaphylaxis - which can cause shutting down of the breathing passage, circulatory collapse, shock and even death.

Are allergies inherited?

While specific allergies themselves are not inherited, the tendency towards allergies is. The more allergic one's family is, the more likely one is to develop allergies.  

At what age is a person most likely to develop an allergy?

It is most common for allergies to begin in childhood, but it is quite possible at any age group

Will I outgrow my allergies?

No. It is common for people to change the way their other allergic symptoms affect them, but the symptoms usually persist. 

What is the 1st treatment for allergies?

First of all, a careful history of the allergic person is taken. The most basic treatment, once an allergen has been identified, is to eliminate the allergen.

Should an ENT treat my Allergies? 

The majority of the problems encountered due to allergy affect the ear, nose or throat. Chronic nasal congestion and postnasal drip, seasonal or constant, is often allergic and may be complicated by chronic sinus and middle ear disease.  

It is often advisable to approach an ENT doctor to treat such problems

Some ENT’s also run allergy clinics, and are equipped to do proper allergy testing and should be preferred.

Such specialists are also capable of offering specialized examinations of the ear, nose and throat. When required, such specialists may also suggest surgical treatment, such as polyp removal, placement of middle ear ventilating tubes, straightening of the nasal septum, and treatment of sinus infections. 

In isolated cases of skin allergies, dermatologists may be referred to for treatment of allergies

Should I do any tests for allergies?

 Although the diagnosis of allergy usually based on clinical history, various tests can help

Blood test – help in assessing the severity of the problem 
Skin prick Test – this helps identify the cause of allergy, and helps us decide how to avoid these allergens

How can I prevent allergies?

Allergic rhinitis can be prevented by avoiding exposure to allergic triggers. Here are some useful tips:

House dust mite:

    1. Minimize allergen ‘reservoirs’ like carpets, sofas and curtains
    2. Regular clean these fabrics in hot water
    3. De clutter your home and damp dust regularly.
    4. Open windows after bathing and cooking

Pet dander:

    1. Wash pets regularly and always wash your own hands after touching it.
    2. Dander settles on carpets and soft furnishings. Keep the house ventilated and also vacuum regularly.

Mould spores:

    1. Keep your home dry by closing any cracks and leaks. Also use an exhaust fan in damp areas
    2. Dry all clothes outside whenever possible.
    3. A HEPA air purifier can help trap allergen particles

What if the allergen cannot be eliminated?

Drug treatment has long been a cornerstone of allergy treatment. Antihistamines and/or decongestants (for the nose) and bronchodilators (for asthma) counteract the symptoms caused by the main chemical released by the body's immune system in an allergy attack. There are other drugs, both pills and nasal sprays, which can prevent the release of these inflammatory chemicals or suppress the immune reactions themselves. 

When can I stop taking medications that I have been using to treat allergy problems?

As symptoms are relieved, you may taper off of these medications. Oral steroid such as Prednisone should be slowly tapered down, following instructions from your prescribing doctor. Prescribed and over the counter allergy medications approved by your doctor can be continued if you find you can prevent or relieve allergy problems

7 Things You Should Know About Skin Prick Test

What is a Skin Prick Test?

A Skin Prick Test is a diagnostic procedure done to identify the allergy-causing agents (called allergens) that trigger various kinds of allergic diseases. Also known as a scratch test, this test helps to check allergic reactions to various kinds of allergens like - Fungi, Mites, Pollen, Dusts, Epithelia, Insects, and Food.
Thus this test helps confirm what particular substance one touches, breathes or eats is causing the symptoms of concern.

Where can this test be done?

The test is generally performed in a doctor’s office where the doctor himself or a trained nurse performs the test and the results are interpreted by an allergist or a general physician. In adults, the test is usually done on the forearm, whereas for children (not done for children under the age of 10) it is mostly done on the upper back.

How long does it take to get the results?

A Skin Prick Test usually takes about 20 to 30 minutes. In certain tests allergic reactions develop within 15 minutes of exposure to an allergen detecting a specific range of allergies, while some tests detect delayed allergic reactions, which develop over a period of several days.

A positive skin test is when a visible allergic reaction develops corresponding to a specific allergen. Bigger wheals usually indicate a greater degree of sensitivity. A negative skin test means that you probably aren't allergic to a particular allergen.

Does it hurt?

Skin Prick is a Non-invasive Test and is not painful. This type of testing uses needles (lancets) that barely penetrate the skin's surface. There is no bleeding and only mild to moderate discomfort is felt at the site of the prick.
One may have symptoms such as itching, a stuffy nose, red watery eyes, or a skin rash if one is allergic to the allergens used in the test.

How is the test done?

Before any allergy testing, the health care provider will need some information about:

1. Details of the past allergic reactions experienced

2. Family history of specific allergies

3.  Past illnesses

4. Work and home environment

5. Lifestyle and habits

6. Food and eating habits

Procedure

1. In adults, the test is performed on the forearm.

2. The test site is first cleaned and disinfected.

3. The forearm is then marked using a water-soluble skin marker.

4. A drop of each allergen is then placed corresponding to a number on the grid.

5. Then a sterile needle (lancet) is used to prick in the middle of each drop of allergen using light pressure. There is no bleeding in the process and the needle only allows the allergen to penetrate into the skin.

6. The site is then cleaned and the patient is asked to wait for some time.

7. If one is allergic to a particular allergen being tested, an allergic reaction in the form of a raised, red, itchy bump (called a “wheal”) develops on the corresponding site within 15 minutes or so.

8. The results are then recorded and the grid marks are cleaned with an alcohol solution.

After interpreting the results the allergist or the physician will then recommend treatment options for your allergy. The treatment plan can include medications, changes to be made in the work or home environment or dietary changes and immunotherapy if required.

Prof. Dr. C V Harinarayan receives the prestigious Dr. B C Roy National Award

Sakra World Hospital is proud to congratulate Prof. Dr. C V Harinarayan for receiving the prestigious Dr. B C Roy National Award on 1^stJuly 2016 from the Hon’ble President of India, Shree Pranab Mukherjee.                                                                   

B.C.ROY Natianal Award is given annually by the Medical Council of India for doctors of highest accomplishments in the medical field. The B. C. Roy award for the year 2009 was conferred to Prof.  Dr. C V Harinarayan - Director, Institute of Endocrinology, Diabetes, Thyroid and Osteoporosis Disorders, Sakra World Hospitals, Bangalore for his accomplishments in the field of endocrinology and metabolic bone diseases. His work on metabolic bone diseases is quoted in many textbooks of medicine.

From his studies he showed that low vitamin D status of Indian population is the cause of bone disease in patients with primary hyperparathyroidism. It is hard to believe that in a sun drenched country like India we have vitamin D deficiency. Later this fact was confirmed by many scientific workers across the country. His land mark population study from south India by his group is the FIRST and ONLY study till date to document the low dietary calcium intake and low vitamin D status in agricultural labourers residing in villages. Subsequently his group documented that by ampoule model of previtamin D synthesis and showed that we as Indians can synthesize enough vitamin D on exposure to sunlight from 11 am to 2 pm, by exposing 10 to 15% of body surface area for 15 to 30 minutes.

His work was the first to show that renal tubular damage is the major cause of metabolic bone diseases in patients with flurosis (Ranked top 10 publications - year 2006 by Internet). The work with BARC, Mumbai helped to indigenously develop intact IRMA radioimmunoassay for parathyroid hormone in India (make in India concept). With all this in background his group developed the “Clinical Practice Guidelines for the management of Postmenopausal osteoporosis (2012-13) – Executive summary and Recommendations” for Indian Menopause society. He was instrumental in developing the Department of Endocrinology, SVIMS, Tirupati, (for nearly two decades) with a good dedicated endocrine laboratory infrastructure.

Media Coverage 

We got featured in various newspaper dated on the 2nd July, 2016 titled as, "President of India, Shri Pranab Mukherjee presents Dr. BC Roy National Award to Prof.Dr.C.V.Harinarayan". 

Dr. Honey Ashok
Senior Consultant - ENT, Head Neck Surgery & Head Neck Onco Surgery

Book Appointment With Dr. Honey Ashok,ENT Surgeon

Dr. Shantanu Tandon
Senior Consultant ENT & Head neck surgery

Book Appointment With Dr. Shantanu Tandon,ENT

Dr. Dali Chandran
Attending Consultant - ENT and Head Neck surgery

Dr. Divya .B
Attending Consultant - ENT and Head Neck surgery

66 year old cured from a rare Benign Phosphaturic Mesenchymal Tumour (PMT)- only 12 such cases repo

Doctors at Sakra World Hospital have successfully treated a very rare case of sino-nasal vascular tumour on a 66-year old male in the city. The Phosphaturic Mesenchymal Tumour (PMT), Hemangio Pericytoma of Ethmoid Sinus was found in a 66-year-old male patient who was confined to a wheel-chair. Only 12 such rare cases of the tumour has been reported worldwide till date according to medical journals.

He is a writer and was bed-ridden for the last 6 months, who had undergone a hip replacement surgery after a fall in the bathroom two years ago. He should have completely recovered post-surgery but unfortunately his condition kept deteriorating. Visits to multiple hospitals neither identify the core issue nor treated his condition. His condition further worsened that he was confined to a wheelchair and had to be carried around even for his ablutions. Being the sole bread winner of the house he could not afford to be in this situation, over and above he was also diabetic, hypertensive and had a CABG (Coronary artery bypass grafting) done in past.  

The patient was referred to Prof.Dr.C.V. Harinarayan, Director Diabetes, Endocrinology and Osteoporosis, who identified the problem to be the loss of phosphorus from the body.  According to Dr. Harinarayan, ‘Phosphorus along with calcium, phosphate, vitamin D etc. are important components for the formation of the bones. In normal conditions the phosphorus is reabsorbed into the body by the kidneys, but in this case it was excreted resulting in soft bones.  Such a condition occurs due to the presence of a Phosphaturic Mesenchymal Tumour which is a rare benign tumour which inappropriately produces a substance known as FGF23 (Fibroblast Growth Factor 23) which decreases the rate of reabsorption of phosphorous in the body.’

Based on the above biochemical assessment a Positron Emission Tomography (PET) scan was conducted in order to locate the position of the tumour. The scan revealed a tumour at the base of the skull, very close to the eyes and base of the brain (Posterior Ethmoidal Sinus). The size and position of the tumour made it very complicated and required highly-skilled and experienced doctors to handle.

Based on the assessment and location of the tumour, the team at Sakra World Hospital performed a specialised CT scan and generated a 3D image of the tumour and decided on the complex procedure.  ‘Being a vascular tumour, the risk of blood loss could have been very high and any mishap could have led to serious damages to the eyes and the brain. The navigation assisted endoscopic procedure along with the CT scan helped in successfully performing the surgery with minimal blood loss and without any incisions,’ said, Dr. Honey Ashok, Senior Consultant - ENT, Head Neck Surgery & Head Neck Onco Surgery.

The patient showed signs of recovery within just a few hours of the surgery and laboratory tests showed a steady rise in phosphorus levels. The patient was discharged the very next day with advice for regular follow up. Now his FGF level has returned to normal.

“The past one year of my life has been a very difficult with what had taken place. Being confined to a wheel-chair and not being able to perform even the daily chores made me miserable. Visited many doctors and hospitals and unfortunately no one could locate the problem. I am thankful that Dr. Harinarayan and team who could not only locate the problem, but also through their expert advice and experience treat the same. I am able to walk again and can complete all my pending jobs,” says the cured male patient.

Media Coverage

Dr. Honey Ashok
Senior Consultant - ENT, Head Neck Surgery & Head Neck Onco Surgery

Book Appointment With Dr. Honey Ashok,ENT Surgeon

Dr. Shantanu Tandon
Senior Consultant ENT & Head neck surgery

Book Appointment With Dr. Shantanu Tandon,ENT

Dr. Dali Chandran
Attending Consultant - ENT and Head Neck surgery

Dr. Divya .B
Attending Consultant - ENT and Head Neck surgery

Sinusitis Symptoms Diagnosis Treatment and Recovery

What should know about Sinuses & Sinusitis?

• Sinuses are a connected systems of empty spaces in the facial bones, filled with air. They have different names, depending on their location: ethmoid, frontal, maxillary and sphenoid sinuses. Sinuses have a skin lining and a layer of mucus that filters and humidifies the air we breathe,

• Sinusitis is an inflammation or swelling of the tissue lining the sinuses. But when they become blocked and filled with fluid, germs (bacteria, viruses, and fungi) can grow and cause an infection.

Conditions that can cause sinus blockage include the common cold, allergic rhinitis (swelling of the lining of the nose), nasal polyps (small growths in that lining), or a deviated septum (a shift in the nasal cavity).

Risk factors for Sinusitis

1. Swelling inside the nose caused by common cold or allergies

2. Deviation of the nasal septum

3. Nasal polyps

4. Conditions that make an infection more likely, such as immune system deficiencies or medications that suppress the immune system.

5. In children, the contributing factor for sinusitis includes allergies, illnesses from other kids at day care or school, pacifiers, drinking from a bottle as they lay on their back and smoke in the environment.

6. The main risk factors for adults are infections and smoking.

Symptoms of Sinusitis

1. A feeling of pain or fullness in your face- over the cheekbones, between or above the eyes

2. Nasal obstruction or blockage

3. Pus in the nasal cavity

4. Fever

5. Nasal discharge or discoloured postnasal drainage

6. You may also have, Headaches, Bad breath, Fatigue and Dental pain

How to diagnose sinusitis?

Having a history of the above symptoms are a strong indicator of sinusitis. During a medical screening, doctors may press your sinuses for tenderness, and tap your teeth to see if you have an inflamed paranasal sinus.

You may also need other tests like Nasal Endoscopy where we use a tubular camera to see inside your nose and sinus drainage areas.

Can Sinusitis cause any complications?

Though uncomfortable and painful, in most patients sinusitis is not dangerous. In some cases, the infection from the sinus can easily spread around the eye, the bones, blood or into the brain.  The complications are more common among children, so if your child has swelling or redness of the eyelid or cheek, then it should be immediately reported to the doctor.

Surgical treatment for Sinusitis

FESS or endoscopic sinus surgery can be considered if antibiotics and other medicines don't clear the sinus.

An endoscope is used to visualize and widen the passageway of the sinuses. It is also used for cleaning out the mucus or pus and restoring the ventilation of all nasal sinuses. Most people can get back to their normal activities within 5 to 7 days.

Doctors may additionally do a procedure called “septoplasty” to straighten the nasal septum or "turbinectomy" to shrink the swollen tissues of the nose.  

Newer Surgical treatment – Balloon Sinuplasty

A modern approach for treating sinusitis is a minimally invasive technique called Balloon Sinuplasty. In this process a balloon is placed over a wire catheter to dilate the sinus passageway. The idea is to restore the normal drainage in the sinus passageway. This opens up swollen, inflamed sinuses much like a heart surgeon opens blocked blood vessels to the heart with a balloon angioplasty.

Advantages of Balloon Sinuplasty

The Balloon Sinuplasty can be performed either in the hospital or at a doctor’s clinic considering how the procedure is relatively easy. Though performed under general anesthesia, it is slowly being performed under local anesthesia by many doctors

Computer Navigation Assisted Sinus Surgery

Computer Assisted Surgery is a new technology used during nasal and sinus procedures.

These systems use a computer specialized software, and electromagnetic tracking technology similar to a global positioning system (GPS) in a car, that allows the driver to see the exact location on a virtual roadmap. This tells us the exact position of the surgical instruments

Sinuses are irregular structures with a variable anatomy and in close proximity to the eyes, brain and multiple arteries and nerves.  With the ability to track instruments, surgeons can more safely perform delicate procedures without damaging these critical surrounding structures. This helps surgeons to be accurate, thorough and safe.

What to expect after Sinus surgery?

• It is normal to have some blood tinged discharge after sinus surgery

• Straining or nose blowing soon after surgery

• You will often be stated on a Nasal Saline Spray to moisturise & make your nose more comfortable. 

• You will be taught sinus which will clean out the debris left behind in your sinuses after surgery. This is important and improves results  

Recovery after a Sinus Surgery

Immediately after surgery, most patients will find some improvement. Like any surgery though, the body takes a few weeks to heal completely. That’s when most patients will realise full improvement. 

Dr. Honey Ashok
Senior Consultant - ENT, Head Neck Surgery & Head Neck Onco Surgery

Book Appointment With Dr. Honey Ashok,ENT Surgeon

Dr. Shantanu Tandon
Senior Consultant ENT & Head neck surgery

Book Appointment With Dr. Shantanu Tandon,ENT

Dr. Dali Chandran
Attending Consultant - ENT and Head Neck surgery

Dr. Divya .B
Attending Consultant - ENT and Head Neck surgery

10 Facts About Snoring And Sleep Apnea You Should Know

 WHAT IS SNORING?

A block of airfow through any part of the breathing passage in the mouth and/or nose causes turbulence & vibrations of the soft tissue. The sound that these vibrations cause is called snoring.

 WHAT CAUSES SNORING?

When we are awake the upper part of the airway to the lungs is held wide open by muscles. However, when we are asleep these muscles can become rather slack allowing the airways to narrow, causing turbulence & vibrations. 

WHAT CAN PREDISPOSE TO SNORING ISSUES?

• WEIGHT: Excess fat, especially around the neck area, squashes the airway
• SMOKING: causing the nasal lining to swell and produce excess catarrh. This results in nasal congestion
• ALCOHOL/SLEEPING TABLETS: causes a decrease in the tone of the muscles that keep the breathing passage open leading to airway collapse

WHAT MEDICAL CONDITIONS CAN CAUSE SNORING AND SLEEP APNEA?
Conditions causing the nose to become blocked

• Recurrent cold or allergies
• Nasal polyps
• Deviated nasal septum

Conditions causing the throat to get choked up

• Large tonsils
• Large uvula and soft palate
• Bulky back of the tongue

 IS SNORING A SERIOUS PROBLEM?

Snoring may seem to be just a personal problem affecting only our partner and family. It can also be a social problem, especially when we travel. But Snoring may also be a sign of a more serious condition called SLEEP APNEA or OSA (Obstructive Sleep Apnea) which can lead to high blood pressure, heart disease, lung problems and diabetes amongst a whole list of other medical problems!

 WHAT IS OSA (OBSTRUCTIVE SLEEP APNEA)?

Obstructive Sleep Apnea occurs when there are repeated episodes of complete or partial blockage of the upper airway (Apnea) during sleep. During such episodes, the brain wakes up and ensures that breathing resumes (usually with a loud gasp, snort, or body jerk). These episodes can interfere with sound sleep. They can also reduce the flow of oxygen to vital organs and cause irregular heart rhythms.

ARE THERE ANY TESTS TO CHECK IF I HAVE OSA?

• Polysomnography (Sleep Study): This is an overnight test which monitors our sleep pattern, sleep breaks, heart and lung activity while sleeping oxygen levels etc.
• Sleep Endoscopy: A thin flexible camera is used to look for obstruction while the patient is asleep

CAN I DO SOMETHING MYSELF TO TREAT THIS PROBLEM?

Sometimes snoring can be treated with changes in lifestyle, such as: 

• Weight loss
• Quitting smoking
• Reducing the use of alcohol, sedatives and sedating antihistamines
• Changing your sleep position to the side and/or elevating your head and neck

 WHEN SHOULD I MEET AN ENT DOCTOR?

In most cases, a person with OSA is not aware of these repeated awakenings because they occur below the level of consciousness. One should consider meeting an ENT doctor if:

1. Complaints of snoring from partner/friends/ family
2. Feeling of daytime tiredness, sleepy feeling,
3. Poor quality sleep with problems of memory, concentration, and mood changes.

 WHAT CAN BE DONE TO TREAT THIS?

• CPAP machine
• Surgical procedures
• Newer minimally invasive radiofrequency reduction procedures

Dr. Sachin Kumar
Senior Consultant – Pulmonology

Book Appointment With Dr. Sachin Kumar,Pulmonologist

Dr. Arjun Satapute
Attending Consultant - Respiratory and Sleep Medicine

ENT- Image Based Case Study for Air Gun Injury

A 34 year old Bangalore patient, Mr X had an accidental air gun injury in which the bullet directly went through the eye and into the nose and sinuses. Multiple metal pellets got lodged between the eye and the paranasal sinuses. An eye specialist treated him said that he had initial vision problems which occurred due to the trauma. Some pellets remained in the junction where the optic nerve crosses near the nasal sinus, and posed a possible risk in the future.

Recently, the patient visited Dr. Shantanu Tandon, Consultant - Ear, Nose & Throat (ENT) at Sakra World Hospital for a thorough examination.  

An endoscopic removal of these multiple pieces of the bullet was planned by Dr. Tandon. The challenge was that, these pellets were small, and surrounded by blood and tissue, and thus difficult to identify .The pieces had spread to different areas & were also very close to the eye. Dr Tandon used a surgical navigation system to assist the endoscopic surgery.

With the help of this excellent navigation technique, the doctors could get a sense of where the bullet pieces were lodged and how far they were from delicate nerves, eye and the brain . This aided in retrieving the pieces without any significant blood loss, shorter surgery time and patient recuperated in 2 ½ days.

What makes this surgery beneficial for patients:  Endoscopic sinus surgery is the most popular method for treating “Sininasal Diseases”. However, there are some pitfalls with this technique that can result in serious complications. Under the assistance of a navigation system, surgeons can overcome such problems.

Air gun Injury through the eye into the nose and sinus