Every human being is born with sinuses. There are 4 types of sinuses viz Maxillary Sinus, Ethmoid Sinus, Frontal Sinus and Sphenoid Sinus. Maxillary sinuses are one in either cheek. Ethmoid sinuses are between eyes on each side of nose. Frontal sinuses are in the forehead area and sphenoid sinuses are behind the ethmoid sinuses i.e behind eyes. When there is infection or inflammation in any of these sinuses then this is called sinusitis.
Why Sinusitis Happens?
To understand the reason for infection, first we need to understand how the aeration in the sinus happens. The air we breathe through our nose goes into the sinuses where it gets humidified. This humidified air goes into the throat from where it goes into the ears through the Eustachian tubes behind the tonsils. So precisely the air we breathe travels from nose to throat and then to an ear which is why ENT (Ear Nose and Throat) is put under one specialty.
However, this circulation of air in many people is not normal as explained above. This can be due to many reasons:
- A Deviated Nasal Septum (DNS) – A Deviated Nasal Septum is a condition where the bone that divides the two nostrils is deviated towards one side. This can cause mild to severe obstruction in airway leading to lack of aeration in sinuses.
- Nasal Polyps – Nasal Polyp is a tissue growth which originates from the sinuses and blocks the airways. Polyps are notorious and tend to come back if not taken care of after removal.
- Hypertrophied Turbinated – Turbinates are long narrow passage in the nose when they swell up or are too large they can lead to blockage in the airway.
What are the types of Sinusitis?
Mainly there are two types of infective sinusitis which can be termed as bacterial sinusitis and fungal sinusitis. There is lot of hue and cry about black fungus which is actually a type of fungal sinusitis and it is nothing new it existed before the Covid era as well. Symptoms of bacterial and fungal sinusitis are almost same. “I have been getting lot of patients who have taken course of steroid during covid and are scared that it might be invasive fungal sinusitis. Let me be very clear that all fungal sinusitis are not invasive. Also to differentiate fungal and bacterial sinusitis you mostly do not need a MRI of PNS. Infact a simple CT scan of para nasal sinuses is also good enough. In the CT images we can differentiate between a fungal and bacterial sinusitis. The best part is that the treatment for both kind of sinusitis is same. In both the cases we need to operate upon the patient through FESS (Functional Endoscopic Sinus Surgery). Yes, there is definitely risk in case of fungal sinusitis as it can start eating into the bone and can invade to optic nerve as well as brain. Hence incase of invasive fungal sinusitis anti fungal needs to be started along with the debridement surgery at the earliest”, says Dr Priyanjana Acharyya Sharma, leading ENT specialist and surgeon in Gurgaon.
Why is oxygen therapy during covid leading to fungal sinusitis?
Fungus thrives on moisture that is why earlier cases of black fungus that emerged in India were mainly in the coastal areas and in the areas close to water bodies. However, when a patient is on oxygen therapy, oxygen is supplied through humidifier. Hence when the patient is on long term oxygen support there is lot of humidification that he gets through the nose which helps the fungus to grow. Invasive fungul sinusitis is mostly seen in patients who are immuno-compromised or having co-morbidities like diabetes.
Like every other disease if fungal sinusitis is diagnosed and treated in time then the risk of invasion can be reduced to minimum.
A cochlear implant is a boon for patient having hearing loss. It is best and most effective in cases with paediatric patients. However the surgery can be performed in adults as well. Cochlear Implant surgery in India is mostly done on patients with hearing loss due to inner ear damage. It is different from the hearing aid as it does not amplify the sound. Rather it bypasses the damaged portion of the inner ear to send signal to the auditory nerves.
Cochlear Implant Working
Cochlear implants use a sound processor that fits behind the ear. The processor captures sound signals and sends them to a receiver implanted under the skin behind the ear. The receiver sends the signals to electrodes implanted in the snail-shaped inner ear (cochlea). The signals stimulate the auditory nerve, which then directs them to the brain. The brain interprets those signals as sounds, though these sounds won’t be just like normal hearing.
Surgery and Training
Cochlear implant surgery is performed by ENT Surgeons in India. It is done under general anaesthesia and lasts for about 1.5 hours. Before the surgery patient undergoes an MRI scan of the inner ear and brain as well as CT scan of the temporal bone. Apart from the radiological scans patient also undergoes hearing tests like audiometery. This is the part of planning for the cochlear implant surgery in India.
Cochlear implant can be placed in one ear or both the ears. However most of the ENT surgeons in India prefer to operate one ear at a time and see the results before operating upon the other. Patient needs to be in the hospital for one day. Post surgery the device is not activated for atleast 6 weeks. This is the time needed for healing post surgery. The activation of the implant in India is done by a team of ENT surgeon and audiologist who would adjust the sound processor to the comfort of the patient and check other components of the implant.
Rehabilitation After Surgery in India
Post activation a 6 weeks training is provided by the team of speech therapists, this is called rehabilitation. Rehabilitation involves training your brain to understand sounds heard through the cochlear implant. Speech and everyday environmental noises will sound different from what you remember. Your brain needs time to recognize what these sounds mean.
Cost of Cochlear Implant Surgery in India
The cost of cochlear implant surgery in India is approximately USD 14000 to 16000 depending upon the type of the implant used. Hospital stay is for one day. Stay in India would be divided into phases. In first phase stay is for 10 days. In second phase it is for about 6 to 8 weeks.
Septoplasty Surgery for Nose Correction
We get patients daily who complain of recurrent cough and cold. In severe cases complain includes ear pain as well. In fact the culprit is not the throat but your nose. God has not made us absolutely straight and one of the bones that is generally not straight is your nasal bone, medically we call it nasal septum. In some people it is just slightly deviated hence do not cause too much of blockage in the airway whereas in some people it is grossly deviated which leads to blockage, we call the condition Deviated Nasal Septum or DNS. Due to the blockage in the airway the sinuses do not get proper aeration leading to clogging of sinuses and post nasal drip of the the infected mucus into the throat. In case of gross deviation we need to correct the same and the surgery is called Septoplasty. The bone that is corrected do not grow back again after 18 years of age.
The main reason for getting the surgery for correction of deviated nose bone is obstructed airway. However reasons could be others as well:
– Blockage of airway
– Difficulty in breating through nose
– Feeling of breathlesness in night while sleeping
– Post nasal drip into throat
– Ear pain
– Recurrent cough and cold
In case the treatment is not taken symptoms could become severe and could hamper your day to day life. Life gets even more complicated and painful for people who have to take flights regularly. They generally experience severe pain in ears especially during the take off and landing.
Symptoms & Treatments
Septoplasty is performed to straighten the shape of the septum (cartilage) and bones. The septum (cartilage) is between the two nostrils. The purpose is to correct the deformities and defects of the cartilage (septum). The septum in adults is partly composed of bone and partly of cartilage In some people there are no symptoms due to deviated septa. Only the severe septa produces important symptoms that require surgical treatments. The surgical procedure of Septoplasty is performed along with a Rhinoplasty for cosmetic uses. However it is to be noted that septoplasty is different from a rhinoplasty surgery. A rhinoplasty surgery is correction of shape externally whereas septoplasty is internal correction of the misaligned septum. In India the surgery is done best by Dr Priyanjana Sharma either under local or general anaesthesia. The septoplasty surgery normally takes 30 to 45 minutes and patient is required to stay for just 1 day and the next day patient is discharged. Post discharge patient comes for two follow ups which are scheduled on 5th and 10th day. During the visit a cleaning of the nose is done and patient starts feeling better after the first visit. After the second cleaning patient is perfectly fine.
Cost of the spetoplasty surgery in India is approximately USD 1800 to USD 2000.
Tinnitus or Sounds in Ear Treatment
Tinnitus is a condition where the person person has a sensation of ringing sound in the ears. The noise can be intermittent or continuous, and can vary in loudness. It is often worse when background noise is low, so you may be most aware of it at night when you’re trying to fall asleep in a quiet room. These days tinnitus has become very common these days in young population as well and one of the major reasons exposure to loud noise whether at discotheques or while using ear phones.
In many cases tinnitus affects the daily routine of a person and affects the concentration. It infact has a psychological impact on the person suffering from tinnitus. Some instances of tinnitus are caused by infections or blockages in the ear, and the tinnitus can disappear once the underlying cause is treated. Tinnitus previously was believed to affect old age population mainly. However with increase in usage of head phones, call centres, loud music and phones the problem of tinnitus is affecting young population more than the older people.
Dr Priyanjana Sharma is of the best ENT specialists in India for the treatment of tinnitus which also involves counseling of the patients about the precautions they need to take to avoid getting this problem.
Prolonged exposure to loud sounds is the most common cause of tinnitus. Up to 90% of people with tinnitus have some level of noise-induced hearing loss. The noise causes permanent damage to the sound-sensitive cells of the cochlea, a spiral-shaped organ in the inner ear. A single exposure to a sudden extremely loud noise can also cause tinnitus. Apart from loud noise there are other reasons that can cause tinnitus. In India we come across patients who are suffering from tinnitus and we find following reasons for the ringing problem in ear or tinnitus:
- Blockage in the ear due to wax or an ear infection or in rare case a tumour can cause ringing sound in ear or tinnitus.
- With age nerves inside the ar tend to get weak and lead to ringing sound or tinnitus. That is a natural process.
- Miniere’s disease is also a reason for tinnitus. In India we get lot of cases which have tinnitus due to Minere’s disease.
- Stiffning of the small bones in mid ear can cause tinnitus. This condition is called otoscelrosis.
- In India we have seen that any injury to neck and head can also cause tinnitus.
Symptoms & Treatment
The symptoms of tinnitus include a noise in the ears, such as ringing, roaring, buzzing, hissing, or whistling; the noise may be intermittent or continuous.Most of the time, only the person who has tinnitus can hear it (subjective tinnitus). However, there are some types that the doctor can hear if a stethoscope is put in the ear (objective tinnitus).
If your tinnitus is due to one of the above mentioned conditions then that condition has to be treated through medical or surgical management. But if the tinnitus remains after treatment, or if it results from exposure to loud noise, our chief ENT specialist and doctor will treat your condition of ringing in ear (as patients normally call) by certain special medicines to control tinnitus and boost nerves. Sometimes, tinnitus goes away spontaneously, without any intervention at all. It should be understood, however, that not all tinnitus can be eliminated or reduced, no matter the cause.
Cough & Cold
Chronic cough is a cough that persists over time. Chronic cough is not a disease in itself, but rather a symptom of an underlying condition. The main challenge is to diagnose the main problem. Most of the time patients are treated symptomatically as the diagnosis is not right. The reason is that most of the time a physician is consulted instead of an ENT specialist. Many a times the seasonal cold may get treated through over the counter medicine and syrup but in cases where underlying cause may be your nose or sinuses then the recurrence happens.
There are several types of chronic cough that are generally treated at ENT hospitals in India.
Dry Cough: Dry cough is a cough that does not produce any mucus and is irritating to the lungs and throat. This may be a sign of a viral infection or sinus problems.
Chronic Productive Cough: It is cough that produces mucus (sputum), and depending on the color, may indicate a bacterial infection or fluid in the lungs.
Stress Cough : It is a reflexive spasm of the airways caused when you are under stress. It usually produces no mucus and is not generally related to infections.
Asthma: An asthma-related cough may be recurrent which may come and go with the seasons, appear after an upper respiratory tract infection, or become worse when you’re exposed to cold air or certain chemicals or fragrances. In one type of asthma (cough-variant asthma), a cough is the main symptom.
Post Nasal Drip: When your nose is blocked due either deviated septum or due to swelling in nasal tissues or sinuses produce extra mucus, it can drip down the back of your throat and trigger irritating cough and recurrent cold like stuffy feeling. This condition is also called upper airway cough syndrome. This needs a through examination followed by CT scan of nose and sinuses.
GERD: In this common condition, stomach acid flows back into the tube that connects your stomach and throat (esophagus). The constant irritation can lead to chronic coughing. The coughing, in turn, worsens GERD. This is one of the most commonly missed diagnosis.
Symptoms & Treatments
Right diagnosis leads to right treatment and that is very much applicable in case of recurrent cough and cold. There are so many reasons for a chronic and recurrent cough and cold that we observe at ENT hospital in India. In case of asthma we provide the anti allergics along with certain inhalers. In case of problem with nasal septum or sinuses we initially try to manage conservatively however in some case we have to resort to surgical treatment that is the correction of nasal bone and opening of sinus cavities. If the recurrent cough is because the GERD then the patient is advised life style changes along with certain antacids and other medications.