Ear Conditions

1. Otitis (Ear Infection)*
Ear infection is common in children and adults and causes pain, hearing loss and discharge. It may result in permanent hearing loss or spread of infection into adjacent anatomical structures. The external ear and middle ear are commonly involved.

Otitis externa: Inflammation or infection of the external ear

What are the symptoms of otitis externa?
Patients with otitis externa experience redness and swelling of the outer ear and ear canal, which can be very painful, scaly skin in and around the ear canal, discharge coming from the ear, itching and irritation in and around your ear canal, tenderness when you move your ear or jaw and some hearing loss.

What are the causes of otitis externa?
• Bacterial infection- common cause of otitis externa.
• Fungal infection
• Seborrhoeic dermatitis- oily areas of the skin become irritated and inflamed
• Allergic and irritant reactions

How is otitis externa treated?
• Keep the ear dry and avoid damaging the skin. Wear a shower cap while showering and bathing. Do not scratch or dig the ear with sharp items.
• Avoid contact with allergens. Remove anything from your affected ear that may be causing an allergic reaction, such as hearing aids, ear plugs and earrings.
• Relieve ear pain with painkillers.
• Treat the infection using antibiotic or antifungal eardrops.
• Treat any underlying skin condition that may aggravate your otitis externa, such as seborrhoeic dermatitis, psoriasis or eczema.

Middle ear infection (otitis media)

What is otitis media?
Otitis media is the infection of the middle ear, often because it has been filled with mucus after a cold. Acute otitis media is a short-term ear infection that often comes on suddenly. Chronic otitis media is when ear infections keep coming back or one infection lasts for a very long time.

What are the symptoms of otitis media?
Patients with otitis media report severe earache, ear discharge, fever, flu-like symptoms, and slight hearing loss. The eardrum may perforate and cause permanent hearing loss.

What are the causes of otitis media?
• A complication of the common cold. The viral infection spreads from the nose and throat to the middle ear via the Eustachian tube to cause otitis media.
• Blockage of the Eustachian tube due to swelling (edema), enlarged adenoids, tonsils or nasopharyngeal carcinoma. The Eustachian tube’s normal function is to drain fluid from the middle ear, and blockage leads to accumulation of fluid and predisposes to secondary bacterial infection (common organisms in otitis media are streptococcus pneumoniae, haemophilus influenzae, pseudomonas aeruginosa, staphylococcus aureus)
• A perforated eardrum predisposes the middle ear to external infection.

How is otitis media diagnosed?
Otitis media is a clinical diagnosis and if the doctor suspects the patient has otitis media based on the history, he may examine the ear using an otoscope/auriscope to check for discharge and assess the eardrum.

How can otitis media be treated?
Some cases of acute otitis media resolve spontaneously without treatment. Seeking medical attention is recommended to avoid complications such as hearing loss or eardrum perforation.

• Medications relieve the symptoms, speed recovery and reduce the chances of complications. Antibiotics control the infection and reduce the amount of ear discharge. Painkillers can be used to control the pain and fever. Nasal decongestants (such as antihistamines or steroids) relieve the Eustachian tube obstruction and facilitate drainage of fluid from the middle ear.

• Surgery may be recommended in recurrent cases of severe otitis media. Tiny tubes (known as grommets) may be inserted through the eardrum to help drain fluid. An operation called a myringotomy may be performed to create a small hole in the eardrum for fluid to drain. Surgical removal of enlarged adenoids and tonsils may help if they are the cause of Eustachian tube obstruction.

2. Loss of hearing*
Loss of hearing

What is hearing loss?
There are two distinct forms of hearing loss: conductive hearing loss and sensorineural hearing loss. Conductive hearing loss happens when there is a problem conducting sound waves through the outer ear, eardrum or middle ear (ossicles). Sensorineural hearing loss is a type of hearing loss in which the problem lies in the inner ear, Vestibulocochlear nerve (Cranial nerve VIII), or the brain. It is important to distinguish between the two types of hearing loss as their etiology, disease progression and management differs.

What are the signs and symptoms of hearing loss?

• Muffled quality of speech and other sounds
• Difficulty understanding words, especially against background noise or in a crowd of people
• Frequently asking others to speak more slowly, clearly and loudly
• Needing to turn up the volume of the television or radio
• Withdrawal from conversations
• In children, hearing loss may lead to poor language development and educational difficulty

You should seek medical attention if you find that your activities of daily life are being affected.

What causes hearing loss?

• Earwax blockage is a cause of hearing loss among people of all ages.
• Gradual hearing loss that occurs as you age (presbycusis) is common, a large number of the elderly experience some degree of hearing loss.
• Heredity and chronic exposure to loud noises are the main factors that contribute to hearing loss over time. Other factors, such as blockage by earwax, can prevent your ears from conducting sounds as well as they should.
• In addition, other diseases such as ear infection, ruptured ear drum abnormal bone growths or tumors of the outer or middle ear can cause hearing loss.

What are the risk factors for hearing loss?
Factors that may damage or lead to loss of the hairs and nerve cells in your inner ear include:

• Elderly age- inner ear function declines with ageing and many elderly have some degree of hearing loss
• Occupational noises. Jobs where loud noise is a regular part of the working environment, such as aviation, construction or factory work, can lead to damage inside your ear.
• Recreational noises. Recreational activities with dangerously high noise levels include listening to loud music, riding motorcycles.
• Certain medications. Drugs such as the antibiotic gentamicin and some chemotherapy drugs can damage the inner ear. Temporary effects on your hearing — ringing in the ear (tinnitus) or hearing loss can occur if you take very high doses of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarial drugs or loop diuretics.

How loud are the sounds encountered in daily life?
Below is a chart comparing common sounds to their volume in decibels. Sounds above 100dB are injurious to the ear and should be avoided.

**insert noise chart**

How is hearing loss diagnosed?
Tests to diagnose hearing loss may include:

• General screening tests. The doctor may ask you to cover one ear at a time to see how well you hear words spoken at various volumes and how you respond to other sounds.
• Tuning fork tests (Rinne and Weber’s). A tuning fork evaluation may also reveal you have conductive or sensorineural hearing loss.
• Pure tone audiometry. The patient wears earphones and hears sounds directed to one ear at a time. The audiologist presents a range of sounds of various tones and volumes and asks you to indicate each time you hear the sound. This test is the gold standard in determining if you have hearing loss.

How can hearing loss be treated?
Treatment depends on the cause, nature and severity of your hearing loss.

Options include:

• Earwax removal. Earwax blockage is a common and reversible cause of hearing loss. Your doctor may remove earwax by loosening it with oil and then flushing, scooping or suctioning the softened wax out.
• Hearing aids. If your hearing loss is due to damage to your inner ear, a hearing aid can be helpful by amplifying sounds and directing them into your ear. Your doctor will discuss with you the potential benefits of using a hearing aid and recommend a device. You may need to try more than one device to find one that works well for you.
• Cochlear implants. If you have severe hearing loss, a cochlear implant may be an option for you. A cochlear implant works as an artificial ear to convert sound energy to electrical impulses that can be recognised by the brain.

3. Vertigo
4. Otosclerosis
Otosclerosis is an abnormal growth of the temporal bone surrounding the middle ear. It can result in conductive hearing loss when the abnormal bone growth causes the fixation of the stapes bone. The disease is usual bilateral and presents between the ages of 15-45, it may be accompanied by tinnitus and vertigo, and 70% of patients have a family history of otosclerosis.
5. Cholesteatoma
A mass of keratinizing stratified squamous epithelium in the middle ear or mastoid which enlarges and may destroy local structures, leading to progressive conductive hearing loss, ear discharge and occasionally damage the brain.

Nose Conditions

1. Allergic Rhinitis (Nose Allergy)*
Hay fever, also called allergic rhinitis, causes cold-like symptoms such as a runny nose, congestion, sneezing and sinus pressure. But unlike a cold, hay fever isn’t caused by a virus — it’s caused by an allergic response to indoor or outdoor airborne allergens, such as pollen, dust mites or pet dander. Some people have hay fever year-round. For others, hay fever gets worse at certain times of the year, usually in the spring, summer or fall. One of the most common allergic conditions, hay fever affects about one in five people.

For some people hay fever symptoms are a minor, temporary nuisance. But if your symptoms are more persistent, they can make you miserable and affect your performance at work, school or leisure activities. Finding the right hay fever treatment probably won’t completely eliminate your symptoms — but for most people, it makes a big difference.

Signs and Symptoms
Signs and symptoms of hay fever usually develop immediately after you’re exposed to specific allergy-causing substances (allergens) and can include:
Runny nose and nasal congestion
Watery or itchy eyes
Itchy nose, roof of mouth or throat
Sinus pressure and facial pain
Swollen, blue-colored skin under the eyes (allergic shiners)
Decreased sense of smell or taste

Hay fever symptoms that can interfere with your day-to-day activities and have an impact on your quality of life include:

Your symptoms may start or worsen at a particular time of year, triggered by tree pollen, grasses or weeds. If you’re sensitive to indoor allergens such as dust mites, cockroaches, mold or pet dander, you may have year-round symptoms.

Although hay fever can begin at any age, you’re most likely to develop it during childhood or early adulthood. It’s common for the severity of hay fever reactions to change over the years. For most people, symptoms tend to diminish slowly, often over decades.

Is it hay fever? Or is it a cold?
Signs and symptoms can be different. Here’s how to tell which one’s causing your symptoms:

Hay fever Colds
Signs and symptoms Runny nose with thin, watery discharge; no fever Runny nose with watery or thick yellow discharge; low-grade fever
Onset Immediately after exposure to allergens One to three days after exposure to cold virus
Duration As long as you’re exposed to allergens Five to seven days

Causes of Allergic Rhinitis
During a process called sensitization, your immune system mistakenly identifies a harmless airborne substance as something harmful. Your immune system then starts producing allergy-causing antibodies. The next time you come in contact with the substance, these antibodies recognize it and signal your immune system to release chemicals such as histamine into your bloodstream. These immune system chemicals cause a reaction that leads to the irritating signs and symptoms of hay fever.

Hay fever can be triggered by either seasonal or year-round (perennial) allergens. Many people have allergy symptoms all year long, but their symptoms get worse during certain times of the year.

Seasonal hay fever triggers include:
Tree pollen, common in the spring
Grass pollen, common in the late spring and summer
Weed pollen, common in the fall
Spores from fungi and molds, which can be worse during warm-weather months

Year-round hay fever triggers include:
Dust mites or cockroaches
Dander (dried skin flakes and saliva) from pets such as cats, dogs or birds
Spores from indoor and outdoor fungi and molds
Hay fever doesn’t mean you’re allergic to hay. Despite its name, hay fever is almost never triggered by hay, and it doesn’t cause a fever.

Complications of Allergic Rhinitis

Other health problems that often occur along with hay fever include:
Asthma. If you have asthma, you may have signs and symptoms such as difficulty breathing, shortness of breath, a tight feeling in the chest, coughing and wheezing.
Eczema. Also called dermatitis, this condition causes swollen, red or itchy skin.
Sinusitis. Prolonged sinus congestion due to hay fever may increase your susceptibility to sinusitis — an infection or inflammation of the membrane that lines the sinuses.
Ear infection. In children, hay fever often is a factor in middle ear infection (otitis media).

Treatment and Drugs
There are a number of over-the-counter and prescription medications available that help relieve hay fever symptoms. They include pills, liquids, nasal sprays and eyedrops. Many people get the best relief from a combination of allergy medications. You may need to try several medications to identify what works best for you. Over-the-counter medications may be enough to relieve your symptoms; or, you may need a prescription from your doctor.

If your child has hay fever, talk with your doctor about the best treatment. Some medications are approved for use in children, while others are only approved for adults. If you want to try an over-the-counter medication for your child, be sure to read the labels carefully.

Medications for hay fever include:
Nasal corticosteroids. These nasal sprays help prevent and treat the inflammation caused by hay fever. For many people they’re the most effective hay fever medications, and they’re often the first medication prescribed. Examples include fluticasone (Flonase), fluticasone (Veramyst), mometasone (Nasonex) and beclomethasone (Beconase). Although these medications can start to work after a few days of treatment, you may not notice any improvement until after you’ve used them for a week or so. Nasal corticosteroids are a safe long-term treatment for most people. Side effects can include an unpleasant smell or taste and nose irritation.
Oral corticosteroids. Corticosteroid medications in pill form, such as prednisone, are sometimes used to relieve severe allergy symptoms. Because the long-term use of oral corticosteroids can cause serious side effects such as cataracts, osteoporosis and muscle weakness, they’re usually prescribed only for short periods of time.
Antihistamines. These oral medications and nasal sprays can help with itching, sneezing and runny nose, but have less effect on congestion. They work by blocking histamine, an inflammatory chemical released by your immune system during an allergic reaction. Older over-the-counter antihistamines such as diphenhydramine (Benadryl) and clemastine (Tavist) work as well as newer ones, but can make you drowsy. Newer oral antihistamines are less likely to make you drowsy, but are more costly than the older antihistamines. Over-the-counter examples include loratadine (Claritin, Alavert) and cetirizine (Zyrtec). Fexofenadine (Allegra) is available by prescription. The prescription antihistamine nasal spray azelastine (Astelin) starts to relieve symptoms within minutes of use. It can be used up to eight times a day, but can cause drowsiness. Side effects include a bad taste in the mouth right after use.
Decongestants. These medications are available in over-the-counter and prescription liquids, tablets and nasal sprays. Over-the-counter oral decongestants include Sudafed, Actifed and Drixoral. Nasal sprays include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). Because oral decongestants can raise blood pressure, avoid them if you have high blood pressure (hypertension). Oral decongestants can also worsen the symptoms of prostate enlargement, making urination more difficult. Don’t use a decongestant nasal spray for more than two or three days at a time because it can cause rebound congestion when used longer.
Cromolyn sodium. This medication (NasalCrom) is available as an over-the-counter nasal spray that must be used several times a day. It helps relieve hay fever symptoms by preventing the release of histamine. Cromolyn sodium doesn’t have serious side effects, and it’s most effective when started before signs and symptoms develop.
Leukotriene modifiers. Montelukast (Singulair) is a prescription tablet taken to block the action of leukotrienes — immune system chemicals that cause allergy symptoms such as excess mucus production. It has proved effective in treating allergic asthma, and it’s also effective in treating hay fever. Possible side effects include headache. Less common side effects include abdominal pain, cough, dental pain and dizziness. Like antihistamines, this medication is not as effective as inhaled corticosteroids. It’s often used when nasal sprays cannot be tolerated, or when mild asthma is present.
Nasal atropine. Available in a prescription nasal spray, ipratropium bromide (Atrovent) helps relieve a severe runny nose by preventing the glands in your nose from producing excess fluid. It’s not effective for treating congestion, sneezing or postnasal drip. Mild side effects include nasal dryness, nosebleeds and sore throat. Rarely, it can cause more-severe side effects such as blurred vision, dizziness and difficult urination. The drug is not recommended for people with glaucoma or men with an enlarged prostate.
Other treatments for hay fever include:

Immunotherapy. If medications don’t relieve your hay fever symptoms, your doctor may recommend allergy shots (immunotherapy or desensitization therapy). Over a period of three to five years, you receive regular injections containing purified allergen extracts. The goal is to desensitize you to specific allergens, reduce your signs and symptoms, and decrease your need for medications. Immunotherapy may be especially effective if you’re allergic to cat dander, dust mites, or pollen produced by trees, grass and weeds. In children, immunotherapy may help prevent the development of asthma.
Nasal lavage. To help with irritating nasal symptoms, your doctor may recommend that you rinse your nose with salt water. Use an over-the-counter nasal saline spray or prepare your own saltwater solution using 1/4 teaspoon of salt mixed with 2 cups of warm water. Both can be extremely effective at relieving congestion.

Prevention of Allergic Rhinitis
There’s no proven way to avoid getting hay fever — but you can prevent allergy symptoms by avoiding the things that trigger your reactions.

While the evidence isn’t clear yet, doctors think reducing a child’s exposure to allergy-causing substances such as dust mites may help delay or prevent hay fever. This may be especially true in children with a family history of allergies.

Minimize your exposure
It’s not possible to completely avoid allergens, but you can reduce your signs and symptoms by taking some steps to limit your exposure to them. It helps to know exactly what you’re allergic to so that you can take steps to avoid your specific triggers.

Pollen or molds
Close doors and windows during pollen season.
Don’t hang laundry outside — pollen can stick to sheets and towels.
Use air conditioning in your house and car.
Use an allergy-grade filter in the ventilation system.
Avoid outdoor activity in the early morning when pollen counts are highest.
Stay indoors on dry, windy days.
Use a dehumidifier to reduce indoor humidity.
Use a high-efficiency particulate air (HEPA) filter in your bedroom.
Avoid mowing the lawn or raking leaves, which stirs up pollen and molds.
Wear a dust mask when doing outdoor activities such as gardening.
Dust mites

Use allergy-proof covers on mattresses, box springs and pillows.
Wash sheets and blankets in water heated to at least 130 F (54 C).
Use a dehumidifier or air conditioner to reduce indoor humidity.
Vacuum carpets weekly with a vacuum cleaner equipped with a small-particle or HEPA filter.
Consider removing carpeting, especially where you sleep, if you’re highly sensitive to dust mites.

Block cracks and crevices where roaches can enter.
Fix leaky faucets and pipes.
Wash dishes and empty garbage daily.
Sweep food crumbs from counters and floors.
Store food, including pet food, in sealed containers.
Consider professional pest extermination.
Pet dander

Remove pets from the house, if possible.
Bathe pets weekly. Using wipes designed to reduce dander also may help.
Keep your pet out of the bedroom.

2.Non Allergic Rhinitis*
Do you have a runny or stuffy nose that won’t get better, or do these symptoms come back repeatedly? If so, you may have nonallergic rhinitis. If you do have rhinitis, the lining of your nose swells due to expanding blood vessels. The mucus glands in your nose get stimulated, causing a congested, drippy nose. The symptoms of nonallergic rhinitis are similar to those of hay fever (allergic rhinitis), but there’s no allergic reaction involved. A common problem, nonallergic rhinitis affects both children and adults.

Although nonallergic rhinitis is more annoying than harmful, it can make you miserable. Triggers of nonallergic rhinitis symptoms vary from person to person and can include certain odors or irritants in the air, changes in the weather, some medications, certain foods, and chronic health conditions. A diagnosis of nonallergic rhinitis is made after an allergy cause is ruled out. This may require allergy skin or blood tests.

If you have nonallergic rhinitis, you probably have symptoms that come and go year-round. You may have constant symptoms, symptoms that last for hours or symptoms that last for days. Signs and symptoms of nonallergic rhinitis may include:

Stuffy nose
Runny nose
Mucus (phlegm) in the throat (postnasal drip)
Nonallergic rhinitis doesn’t usually cause itchy nose, eyes or throat — symptoms associated with allergies such as hay fever.

When to see a doctor
See your doctor if:

Your symptoms are severe.
You have signs and symptoms of nonallergic rhinitis that aren’t relieved by over-the-counter medications or self-care.
You have bothersome side effects from over-the-counter or prescription medications for rhinitis.

Causes of Nonallergic Rhinitis
Nonallergic rhinitis occurs when blood vessels in your nose expand (dilate), filling the nasal lining with blood and fluid. There are several possible causes of this abnormal expansion of the blood vessels or inflammation in the nose. But, whatever the trigger, the result is the same — swollen nasal membranes and congestion.

Many things can trigger the nasal swelling in nonallergic rhinitis — some resulting in short-lived symptoms while others cause chronic problems. Nonallergic rhinitis triggers include:

Environmental or occupational irritants. Dust, smog, secondhand smoke or strong odors, such as perfumes, can trigger nonallergic rhinitis. Chemical fumes, such as those you might be exposed to in certain occupations, also may be to blame.
Weather changes. Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose.
Infections. A common cause of nonallergic rhinitis is a viral infection — a cold or the flu, for example. This type of nonallergic rhinitis usually clears up after a few weeks but can cause lingering mucus in the throat (postnasal drip). Sometimes, this type of rhinitis can become chronic, causing ongoing discolored nasal discharge, facial pain and pressure (sinusitis).
Foods and beverages. Nonallergic rhinitis may occur when you eat, especially after eating hot or spicy foods. Drinking alcoholic beverages, such as beer and wine, also may cause the membranes inside your nose to swell, leading to nasal congestion.
Certain medications. Some medications can cause nonallergic rhinitis. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others) and high blood pressure (hypertension) medications, such as beta blockers. Nonallergic rhinitis can also be triggered in some people by sedatives, antidepressants, oral contraceptives or drugs used to treat erectile dysfunction. Overuse of decongestant nasal sprays can cause a type of nonallergic rhinitis called rhinitis medicamentosa.
Hormone changes. Changes in hormones due to pregnancy, menstruation, oral contraceptive use or a hormonal condition such as hypothyroidism can cause nonallergic rhinitis.
Stress. Emotional or physical stress can trigger nonallergic rhinitis in some people.

Complications from nonallergic rhinitis include:

Nasal polyps. These are soft, noncancerous (benign) growths that develop on the lining of your nose or sinuses due to chronic inflammation. Small polyps may not cause problems, but larger ones can block the airflow through your nose, making it difficult to breathe.
Chronic sinusitis. Prolonged nasal congestion due to nonallergic rhinitis may increase your chances of developing sinusitis — an infection or inflammation of the membrane that lines the sinuses. When sinusitis lasts for longer than 12 consecutive weeks, it’s referred to as chronic sinusitis. Sinusitis causes pain, tenderness and swelling around your eyes, cheeks, nose or forehead.
Middle ear infections. Increased fluid and nasal congestion may lead to middle ear infections.
Interrupted daily activities. Nonallergic rhinitis can be disruptive. You may be less productive at work or school, and you may need to take time off because your symptoms flare up. You may also miss work or school because you need to see your doctor.

Tests and Diagnosis
Nonallergic rhinitis is diagnosed based on your symptoms and ruling out other causes, especially allergies. Your doctor will perform a physical examination and ask questions about your symptoms. He or she may also recommend certain tests. There are no specific, definite tests used to diagnose nonallergic rhinitis.

Your doctor is likely to conclude your symptoms are caused by nonallergic rhinitis if you have symptoms of nasal congestion, runny nose or postnasal drip, and tests for other conditions don’t reveal an underlying cause such as allergies or a sinus problem.

In some cases, your doctor may have you try a medication and see whether your symptoms improve.

Ruling out an allergic cause
In many cases, rhinitis is caused by an allergic reaction. The only way to be sure rhinitis isn’t caused by allergies is through allergy testing, which may involve skin or blood tests.

Skin test. To find out whether your symptoms might be caused by a certain allergen, your skin is pricked and exposed to small amounts of common airborne allergens such as dust mites, mold, pollen, cat and dog. If you’re allergic to a particular allergen, you develop a raised bump (hive) at the test location on your skin. If you’re not allergic to any of the substances, your skin looks normal.
Blood test. A blood test can measure your immune system’s response to common allergens by measuring the amount of certain antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical laboratory, where it can be tested for evidence of sensitivity to specific allergens.
In some cases, rhinitis may be caused by both allergic and nonallergic causes.

Ruling out sinus problems
Your doctor will also want to be sure your symptoms aren’t caused by a sinus problem such as a deviated septum or nasal polyps. If your doctor suspects a sinus problem may be causing your symptoms, you may need an imaging test to view your sinuses.

Nasal endoscopy. This test involves looking at the inside of your nasal passages. This is done with a thin, fiber-optic viewing instrument called an endoscope. Your doctor will pass the fiber-optic endoscope through your nostrils to examine your nasal passages and sinuses.
Computerized tomography (CT) scan. This procedure is a computerized X-ray technique that produces images of your sinuses that are more detailed than those produced by conventional X-ray exams.

Treatment and Drugs
Treatment of nonallergic rhinitis depends on how much it bothers you. For mild cases, home treatment and avoiding triggers may be enough. For more bothersome symptoms, certain medications may provide relief, including:

Oral decongestants. Available over-the-counter or by prescription, examples include pseudoephedrine-containing drugs (Sudafed, Actifed, others) and phenylephrine (Neo-Synephrine, others). These medications help narrow the blood vessels, reducing congestion in the nose.
Saline nasal sprays. Use an over-the-counter nasal saline spray or homemade saltwater solution to flush the nose of irritants and help thin the mucus and soothe the membranes in your nose.
Antihistamine nasal sprays. Try a prescription antihistamine spray such as azelastine (Astelin, Optivar). While oral antihistamines don’t seem to help nonallergic rhinitis, antihistamine in the form of a nasal spray may reduce symptoms of nonallergic rhinitis.
Anti-drip anticholinergic nasal sprays. The prescription drug ipratropium (Atrovent) is often used as an asthma inhaler medication. But it’s now available as a nasal spray and can be helpful if a runny, drippy nose is your main symptom.
Corticosteroid nasal sprays. If your symptoms aren’t easily controlled by decongestants or antihistamines, your doctor may suggest a prescription corticosteroid nasal spray, such as fluticasone (Flonase) or mometasone (Nasonex). Corticosteroid medications help prevent and treat inflammation associated with some types of nonallergic rhinitis.
Decongestant nasal sprays. These include oxymetazoline (Afrin, Nostrilla, others). Don’t use these medications for more than three or four days, as they can cause congestion to come back with even worse symptoms when you stop using them.
Over-the-counter oral antihistamines, such as diphenhydramine (Benadryl), clemastine (Tavist) and loratadine (Claritin), typically don’t work nearly as well for nonallergic rhinitis as they do for allergic rhinitis.

In rare cases, surgical procedures may be an option to treat complicating problems such as a deviated nasal septum or persistent nasal polyps.

3.Nasal Polyps*
Nasal polyps are edematous (swollen) outgrowths of mucosa found in the nasal cavity and paranasal sinuses. Most polyps arise from the ethmoid sinuses, with the maxillary sinus being a less common source. They are benign masses, although if unilateral, a biopsy can be performed to exclude malignancy. It is thought that they are caused by allergy and chronic sinus infection. Nasal polyps tend to affect the patient with progressive nasal obstruction (nose blockage) and rhinorrhea (running nose). Treatment for nasal polyps includes medical options (steroid drops or spray to reduce polyp size) and surgical options (intranasal polypectomy- surgically remove the nasal polyps. However, high rate of polyp recurrence hence surgery may have to be repeated)
4.Nasopharyngeal Carcinoma (Nose Cancer)*
What is nasopharyngeal carcinoma?
Nasopharyngeal carcinoma (NPC) is a cancer originating in the epithelium of nasopharynx (the uppermost region of the throat).

What puts me at risk of developing nasopharyngeal carcinoma?
Its occurrence has been linked to infection by Epstein Barr virus, genetic susceptibility (highest rates in the southern Chinese from the Guangdong province) and consumption of foods containing carcinogenic nitrosamines (salted fish, salted vegetables). Although it is uncommon worldwide, it is relatively common in Asia and Africa.

How can Nasopharyngeal carcinoma be treated?
Nasopharyngeal carcinoma is best treated with radiotherapy (targeted at the primary tumor and secondary lymph nodes) and chemotherapy. Surgery is difficult due to the anatomical proximity of nasopharyngeal carcinoma to many important structures, hence is rarely recommended. However, the treatment of nasopharyngeal carcinoma has many side effects from chemotherapy and radiotherapy (secondary radiation damage to the adjacent anatomical structures. Side effects include hearing loss, pituitary dysfunction, hypothyroidism, poor salivation, mouth ulcers, appetite loss and hair loss.

5.Epistaxis (Nose Bleeding)*
Most cases of nose bleeding arise spontaneously, but some cases arise due to a specific condition. Local conditions include trauma to the nose, tumors in the nose or sinuses and perforation of the nasal septum. Systemic conditions include bleeding tendency (due to low platelets, anticoagulation drug therapy, leukaemia) or systemic vascular disorders. Severe nose bleeding can lead to profuse blood loss, hypotension and tachycardia, requiring intravenous resuscitation with blood or plasma substitute.

Throat Conditions

What is tonsillitis?
Tonsillitis is the infection of the tonsils by bacteria or viruses. Common bacteria involved in tonsillitis are B-haemolytic streptococcus (50%), staphylococcus and pneumococcus. Patients report a sore throat, pain on swallowing, fever, malaise and difficulty swallowing. On examination, the pharyngeal mucosa appears red and the tonsils are enlarged and covered by microabcesses/exudate. There may be enlargement of the cervical lymph nodes, most commonly the jugulodigastric nodes. A full blood count may reveal raised white blood cell counts.

What are the complications of tonsillitis?
Besides causing pain and discomfort to the patient, a case of tonsillitis may be complicated by the formation of an abcess in the neck (peritonsillar or parapharyngeal abscess) or spread of infection to the ear (acute otitis media).

How is tonsillitis treated?
Most cases of tonsillitis are treated with bed rest, antibiotics and adequate hydration. Recurrent episodes of tonsillitis may require the surgical removal of the tonsils (tonsillectomy). If the tonsillitis is complicated by an abcess, the abcess would require incision and drainage of the pus.

2.Gastro-Esophageal Reflux Disease (GERD)*
What is Gastro-Esophageal Reflux Disease(GERD)?
Gastro-Esophageal Reflux Disease, as the name suggests, occurs when the acidic stomach contents of the stomach spill backwards into the esophagus, causing damage to the esophageal mucosal wall. GERD may be due to incompetence of the lower esophageal sphincter, transient lower esophageal sphincter relaxation, or hiatal hernia of the stomach. Patients with GERD report heartburn, difficulty swallowing, regurgitation, nausea, excessive salivation. Uncommonly, GERD may present as a chronic cough, hoarse voice, asthma, sinusitis and damaged teeth.

What are the complications of GERD?
Besides causing discomfort and irritation to the esophageal mucosa, severe GERD can cause reflux esophagitis and esophageal ulcers, esophageal strictures, and increases the risk of developing esophageal cancer.

How is GERD treated?
GERD can be treated with lifestyle changes and with medication. Lifestyle changes that reduce the severity of GERD include weight loss, sleeping with the head of the bed elevated and avoiding eating 2 hours or more before bedtime. Medical treatment generally targets at reducing gastric acidity (with proton pump inhibitors such as Nexium and Pariet, histamine antagonists and antacids), protecting the esophageal mucosa (with alginates such as Gaviscon) and using prokinetics (metoclopramide) to increase the gastric emptying rate and the tone of the lower esophageal sphincter.

3.Voice & Airway Disorders
4.Salivary gland disorders

Thyroid Conditions

1.Hyperthyroidism; Grave’s Disease*
What is Grave’s disease?
Graves’ disease is an autoimmune disease where the thyroid is overactive, producing an excessive amount of thyroid hormones. This is caused by autoantibodies to the TSH-receptor (TSHR-Ab) that activate that TSH-receptor (TSHR), thereby stimulating thyroid hormone synthesis and secretion, and thyroid growth (causing a diffusely enlarged goiter). The resulting state of hyperthyroidism can cause a constellation of neuropsychological and physical signs and symptoms. It is the most common cause of hyperthyroidism in children and adolescents, and usually presents itself during early adolescence. It is more common in females than males, and many patients have family history of thyroid disease. About 20-25% of people with Graves’ disease will also suffer from Graves’ ophthalmopathy (a protrusion of one or both eyes), caused by inflammation and swelling of the eye muscles by attacking autoantibodies.

Diagnosis is made based on symptoms and signs confirmed by blood tests for thyroid hormone levels (T3/4, TSH) and antithyroid antibodies (anti-TSH receptor). Due to the nonspecific nature of the disease presentation, Graves’ disease often affects the patient for months and years before it is properly diagnosed and treated. It may also be wrongly diagnosed and treated as other illness (e.g. psychiatric illness).

How is Grave’s disease treated?
Treatment options for Grave’s disease are aimed at reducing circulating thyroid hormone (T3/4) levels, and include medical treatment with carbimazole or propylthiouracil (be alert for the side effects of neutropenia and aplastic anemia), medical treatment with radioactive iodine, and surgery to remove thyroid tissue. Generally, treatment for Grave’s disease is complicated as treatment often takes weeks to months to take effect, the treatment may result in hypothyroidism or recurrent hyperthyroidism, and hence patients may need to take thyroid hormone replacement (levothyroxine) for life.

2.Multinodular Goiter*
What is a goiter?
A goiter is a mass in the neck caused by the enlargement of the thyroid gland. This enlargement can be diffuse, or nodular. There are many causes of thyroid goiter, notably Grave’s disease, Hashimoto’s disease, multinodular goiter and thyroid cancer. The person’s thyroid hormone levels (T3/T4) may be elevated, normal, or low.

What are the complications of goiter?
Firstly, the person’s thyroid hormone levels may be deranged. If the person’s thyroid hormone levels are elevated, he/she is said to be hyperthyroid. If the person’s thyroid hormone levels are low, he/she is said to be hypothyroid. The individual would then suffer from the systemic manifestations of hyperthyroidism (such as weight loss despite increased appetite, restlessness, palpitations, anxiety, diarrhea) or hypothyroidism (such as lethargy, depression, weight gain, constipation).
Secondly, the large thyroid gland may compress on the adjacent anatomical structures in the neck and cause difficulty breathing, trouble swallowing and impair venous drainage of the head.
Thirdly, a large neck goiter is aesthetically displeasing and may cause emotional distress to the individual.
Lastly, some of the causes of goiter (such as multinodular goiter) are known to increase the individual’s risk of developing thyroid cancer.

How is goiter treated?
The treatment of goiter depends on the cause of the goiter. Goiter can be treated with medication or with surgery.
If the thyroid gland is overproducing thyroid hormones, the patient can receive antithyroid medications (such as carbimazole or propylthiouracil) to suppress thyroid hormone synthesis. If the patient lacks thyroid hormone, then it can be replaced (exogenous thyroid hormone administration). Overactive thyroid tissue can be eliminated using radioactive iodine.
Surgery is an option in cases of goiter that are resistant to medical treatment, or if thyroid cancer is suspected/diagnosed. Surgical removal of the thyroid gland (hemithyroidectomy or total thyroidectomy) would require the patient to take lifelong thyroid hormone replacement.

3.Thyroid carcinoma

Sinus Conditions

1.Sinusitis (Acute & Chronic)*
What is sinusitis?
Sinusitis is the infection and inflammation of the sinuses. It is a common condition that causes much discomfort to the person with it. It happens after sinus drainage is impaired (commonly due to a cold or allergic rhinitis causing mucosal swelling) and sinus secretions accumulate, predisposing to infection. It can occur in any of the 4 sinuses, with maxillary sinusitis being the most common. The most common complication of acute sinusitis is progression to chronic sinusitis, although rarely serious complications such as orbital cellulitis, intracranial abcess and cavernous sinus thrombosis may occur.

How do I know if I have sinusitis?
Patients with sinusitis usually report localized pain, dull pain in the face and head (which may be perceived as a headache), blocked nose, runny nose (with clear secretions or with pus) and low-grade fever.

How is sinusitis treated?
• Medical treatment with antibiotics and nasal decongestants
• Surgeries available include antral washout of the maxillary sinus, functional endoscopic sinus surgery, and frontal sinus trephine and drainage

Sleep Conditions

1.Obstructive Sleep Apnea*
What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is the intermittent cessation of breathing during sleep due to the collapse of the airway, which disrupts sleep. Patients usually report shortness of breath during sleep, frequent awakenings, poor quality sleep, excessive daytime sleepiness, irritability and fatigue. Obstructive sleep apnea has been shown to be a risk factor for many other conditions such as hypertension, diabetes, stroke and heart attack. Risk factors for developing obstructive sleep apnea include obesity and poor airway structure.

How can obstructive sleep apnea be treated?
• Lifestyle modifications-weight loss, use of oral devices to maintain airway position, modification of sleep position
• Use of Continuous/Bilevel Positive Airway Pressure ventilation
• Surgery aimed at modifying the airway and neck structures to reduce pressure on the airway during sleep


*No special preparation is required prior to the examination procedure.