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Objective of this page is to open up some areas of medical world. A detailed discussion of clinical conditions and treatment is not at all its aim.

Creating an awareness of some common medical problem is all that expected.

18/01/2026

Decision
They are not happy. i could sense that.Neither i. They have come for an opinion ,it seems. The boy, their only child is having occasional nasal block. He is only 6 years. He is very active and pleasant. "Is there any mouth breathing?". "some times" mother said."What about snoring?".Father is not sure. Mother again said "Yes".She also said his teeth are protruding"..
I put the Xray on the viewer. Adenoid is occupying around 60% of airway. Both father and mother has almost round face. The child 's pre-maxilla is protruding and almost an oval face. "Why didn't you opted for adenoidectomy operation earlier?".
"Doctor, he had frequent cold and rhinorrhoea. We did consult an Ear nose throat specialist. He advised that, adenoids though a little big can wait, as it may decrease in size. Since then we are on steroid nasal spray".
Steroid nasal spray for adenoid hypertrophy is one thing i am not sure. "Regarding surgery, at present i will not say it is a must".I said. "How ever his symptoms might be relived fairly enough. Over all facial development also will be modified"
Some times decision taking is hard.

24/12/2025

⸻
Adenoids and When Surgery Is Needed

If you ask me whether adenoids should be operated or not, there is no single yes-or-no answer. Surgery depends mainly on symptoms.
But you come to me -a doctor, because something is bothering you, That symptom whether mild or severe—matters. May be like noisy breathing, constant runny nose (rhinorrhea), mouth breathing.

Adenoid is a normal structure. It is collection of lymphoid tissue located at the back of the nose,
It grow largest around 4–6 years of age. Then they normally start shrinking. After 10–12 years adenoids remain very small or disappears. In a small percentage of people, adenoids may persist into later life.
If there are no symptoms, no treatment is needed
You may ask what if symptomatic but not treated. Suffering is there like nasal block, occasional ear pain and disturbed sleep( even obstructive sleep apnoea) . Protruding crowded upper front teeth is not uncommon .May develop an Adenoid facies.
Medical treatment can be tried with nasal decongestant or steroid nasal sprey. But the large hypertrophied Adenoid mass may not subside.
There can be a silent complication like glue ear and deafness (secretory otitis media)
So if there is glue ear or Adenoid facies or obstructive sleep apnoea I suggest Adenoid surgery.
⸻

07/05/2023

Vertigo
POSITIONAL VERTIGO
is an alarming symptom. It is often due to an inner ear dysfunction. It is scaring as loss of balance is the prime feature of this problem. As you wake up and begin to get of the bed the whole world is spinning around you. The coat, the walls of the room, the roof and every thing in the room is rotating around you. There may be associated nausea and even vomiting . Vertigo can happen any time. It may occur while sitting and working or standing, bending or resting and lying on a bed.
There are many definitions for vertigo. Loss of balance is one among them. False sensation of movement, Loss of space orientation, rotation of objects around, feeling of falling are other definitions . Some people describe these symptoms as giddiness . Difficulty to hold head and neck steady, blurring of vision, heaviness of head are often described as giddiness.
Posture and equilibrium of body is maintained by the inner ear vestibular system, the visual inputs and the feed from proprioceptive impulses from muscle spindles of the musculoskeletal organs. They function in harmony. Any aberrations in the harmonious function of these three lead to loss of balance.
Vestibular system consist of three semicircular canals, utricle and saccule. These are parts of the inner ear. These have an active participation in informing orientation of body and its posture relative to the surrounding. Linear and angular acceleration of head and body is informed by this system.
Benign Paroxysmal Positional vertigo is often precipitated by bending body to stoop down or turning head to sides. It occurs while getting up from bed or tilting head forward backward or to sides . Classically vertigo last for few seconds and disappears . But recurs each time on tilting head to sides either right or left. Very short duration and fatigability is the characteristic feature of this disease . Sometimes it is very dangerous as patient may fall down. Dislodgement of otoconia crystals from utricle into one semicircular canal(posterior semicircular canal )is considered as the cause of vertigo.
The symptoms such as vertigo can be controlled with Betahistine hydrochloride or cinnarizine , or promethazine. But these should be used under the supervision of a medical expert as these drugs can cause serious sides effects .
Epley’s maneuver is a procedure by which the dislodged otoconia debris is brought back to the utricle. It is a very simple procedure done in Out Patient department. By a successful correction by this procedure drugs can be avoided.
There are some simple head neck exercises with which the positional vertigo can be controlled .
Vertigo is only a symptom .So it should be investigated to exclude brain tumors or other demyelinating or degenerating neurotological diseases .

01/10/2020

EAR ITCHING

Many people are in the habit of putting anything handy as weapons to counter the itching in the ear;- may be matchsticks, paper rolls, safety pins ,slides or scissor tips Without any mercy they put them into the ear canal and rub it. Many visit me with impacted cotton or broken sticks in the ear canal.

People suffering from dandruff are more likely to develop severe itching in the ear canal. High humidity of our state aggravates the itching. When we look into ear we can see dry scales in the ear skin and canal. Some will say that a white powder is falling from their ears. Medically we call it seborrhoeic otitis externa. `

Fungal infections in the ear canal (otomycosis )can also produce severe itching. Discharge in the ear canal from middle ear infections also produce itching.

Some people tend to clean the ear canal daily and are more prone to develop severe itching in the ear; especially diabetic patients.

The most important point in treatment of itching in the ear is not to scratch the ear canal. The more we scratch the more severely the symptom recurs. Some where we have to break the cycle.

Local application of steroid containing ointments in the ear canal gives good relief of itching. I advise patients to apply the ointment lightly (gently rub the ear canal with ointment.)using cotton buds two times per day for three to five days.

For patients suffering from diabetes the possibility of fungus infection should be excluded. In such situations a combination cream of steroid ,antifungal drug and antibiotic can be considered.I. prefer a combination of beclomethasone, Clotrimazole and Neomycin

Some dos and fonts

*Always keep the ear dry and clean

*Don’t instil oil in the ear canal.

*Avoid the habit of daily cleaning of the ear .

*1%spirit boric ear drops, two drops three times in the ear canal for three to four days give very good relief of the itching symptom.

*Treatment of dandruff itself will reduce itching. Scalp shampoos containing selenium sulphide is one that I prefer. But it has the side effect of photosensitivity and rarely hair fall.

23/09/2020

THE COMMON COLD

Running nose, sneezing, nasal block and a mild fever and we say, ‘Oh I have got a cold’. Some people develop a burning sensation of throat or even sore throat and cough. A stuffy nose is irritating.
Common cold spreads from person to person. If one family member gets a cold then other members also can develop the cold. It is very contagious and children bring it from school . It is so frequent that children.may develop it more than three to four times per year, making them frequent absentees from school.
Common cold spreads by droplet infection or by direct contact with fomite. Covering the nose and mouth ,while coughing and sneezing, will reduce the droplet spread. Practicing good personal hygiene is one ways of blocking the spread.

Common cold is caused by virus . Different viruses can cause common cold .(rhino virus, adeno virus,respiratory syncytial virus etc …). It often lasts for five to seven days . No specific treatment is available for cold. No preventive medicine or vaccine is so far available for common cold.

Nasal block can be relieved by saline nasal drops three drops, three to four times daily to each nostril. It is preferred in children.

Xylometazoline or oxymetazoline nasal drops preparations are available which reduce the congestion of nasal cavity. Two drops two times per day in each nose is advised. But these drugs should be used by hypertensive patients with caution Paediatric preparations are available for children.

For fever, paracetamol tablets are useful which will relieve any associated headache as well.

If sneezing is unbearable, cetirizine tablet ( 5mg )one daily is good for two to three days. But cetirizine produces dizziness ,sleep and dryness of mouth.
For children cetirizine has specific dosage and should not be given with out direct medical supervision.
Warm saline gargle three to four times per day is good enough for sore throat.
Patients should take plenty of oral fluids, fruits and healthy food. Since it is a viral infection rest is of prime importance.
Antibiotics are required only if there is any superadded bacterial infection.

13/09/2020

MIGRAINE

At any time of the day headache can be disturbing . Headaches can occur on a beautiful morning ,spoiling the whole day . A good lunch, a dinner ,an interesting meeting or a nice get together ,are less enjoyable with a splitting headache. The headache need not be always very intense -it may be vague and lingering.
Typically a migraine headache starts on one side of the head ,often in the temporal region and spreads to other side and back of head. It may be associated with visual disturbances and many dislike too much light. So irritable they are that the patient likes to be undisturbed and feel comfortable alone and with the lights off. Nausea is a common accompanying symptom of migraine.
At the peak of headache, vomiting occurs : the migraine subsides and most of the patients go to sleep. After a good sleep often times they feel much comfortable.
A previous history of migraine is common in migraine patients. Journey,stress & strains ,fatigue ,menstrual tension and even allergy may be triggering factors for a migraine attack

So far no treatment modality completely has cured migraine.Recurrences tend to happen.
So symptomatic treatment is the best .
For adults a single dose of paracetamol 15mg/kg and to a maximum of 2 gm per day is good enough to relieve the headache. But paracetamol can produce side effects like allergy anaphylaxis and gastritis. It is hepatotoxic in excess doses
A tab of prochlorperazine is good to relive nausea and vomiting. Prochlorperazine can produce side effects like allergy dizziness and neurological problems

Disclaimer
There are different views regarding migraine . Headache has to be investigated to make sure it is migraine only. Readers are advised not to take above medicine without direct medical supervision

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