Location : Banglore

Problem in Details : I had undergone FESS (right maxillary sinusitis) + septoplasty 10 days back. I still fill pain over my right maxillary sinus, upper teeth and headche on the right side. Is it normal to have this even after 10 days or any thing to worry about. Can this pain be due to any nerve problem? I am asking this because the CT scan before my surgery revealed very less infection but i was having a lot of pain before the surgery. The level and site of pain before and after the operatiion is same right now.

Doctor's Advice : Hi. it would be too early after ten days to be expecting results of surgery. Usually in my experience i wouldn't be expecting results earlier than four weeks. Now the other thing. The area of pain that you have described usually puts the first suspicion of sinusitis. And the reason is none other than nerve irritability due to pressure of pus within the sinus. Since the scan shows minimal disease, the sinusitis may or may not be responsible for this pain. It could be neuralgic, meaning nerve irritability for unclear reasons. In that case the results of surgery may not be optimal. One more point. The minimal sinusitis is sometimes causative depending upon which sinus it has involved. Minimal disease in maxillary sinus may not be as causative for pain as some disease in the frontal and ethmoidal sinuses and frontal duct area. again as i said, its too early to expect any result out of surgery as such. Be under regular follow up for nasal cleaning after surgery as scheduled. If the pain persists even after a month of surgery then you will have to seek treatment on lines of neuralgia. Best wishes.

Location : Gajraula

Problem in Details : my daughter is suffering from adenoids and tonsils for six month. I have x ray for that after that doctor given antibiotics for seven days but still she is mouth breathing 30%. Please give your valuable advise thanx.

Doctor's Advice : hi,regarding mouth breathing, if the cause has been diagnosed to be adenoids then the child should be given a trial of nasal steroid spray for at least 6 weeks. it has been seen that about 30 to 40 percent of the children with adenoids respond favourably to this treatment. an antiallergic can also be added to it. it needs te assessed if the child is having choking in the night, called apnea, and if so, whether tonsils are contributing to it.

Location : Dubai

Problem in Details : My son was suffering from tosilitis for long time and every time the doctor used to prescribe for me an antibiotic, and he suffer twice from ear pain.Now I came from the doctor and he told my son have hearing loss.Iam so disperate,please advise me he said tonsilictomy should be done. But I still worried concerning hearing loss.Please guide what to do?

Doctor's Advice : its unfortunate that your son has been diagnosed with such a problem.
let us address your concern one by one.
first, tonsillectomy is a procedure that is undertaken for many reasons. please refer to a previous query on this page for the indications. if the reason is repeated infection without abscess, then it is currently held that the child should be having about 5 to 6 infections in an year for the past two years to merit surgery. in case the child had severe infections for which he needed hospitalisation and intravenous antibiotics or had abscess of the tonsils on two occasions, then we need to consider surgery earlier than two years.
hearing loss can be of two types. i'd again refer you to a previous query on this. if the hearing loss is sensorineural, and of long duration then there are practically no chances of improvement. only cochlear implant benefits in such a condition but this is not undertaken if the other hear is hearing normally. in such a case a device called bone anchored hearing aid (BAHA) is advised in select cases. please contact your ent for details on BAHA.
however conductive hearing loss can show improvement by medications or surgery. a proper assessment is needed. basic tests like pure tone audiometry, speech audiometry and impedence are indicated upfront.
tonsillectomy can be undertaken in cases with permanent nerve deafness in one ear. however you need to make sure that the child is not administered any medication that can cause nerve deafness in the other ear too. a list of such medications is available on this link. http://www.dizziness-and-balance.com/disorders/bilat/ototoxins.html

Location: Vasant kunj,New Delhi

Problem in Details : I m 20yrs old havin a problem of chronic bad breath.consulted a dentist at no help.also tried mouthwashes,sprays.i feel there a problm at d bk of d tongue though i thoroughly clean it.plz advice its embarassing.

Doctor's Advice : bad breath or halitosis as we call it can be due to various causes. it can be due to oral, nasal or gastric reasons. common mouth problems like poor dental hygiene or advanced diseases of the mouth like osteomyelitis or oral ulcers cause bad breath. nasal problems like sinusitis or atrophic rhinitis cause bad breath. it can also be caused by laryngopharyngeal reflux caused due to stomach problems. seek an ent specialist's opinion on above lines.

Problem in Details : Since last month my wife (age 45 yrs) was facing swelling problem on neck..Thyroid reports was OK.Vocal cord was OK.Normal thyroid surgery done successfully.All reports were normal including biopsy. Now problem is that after surgery my wife's voice is very low.She talks but very low sound.According to surgen, She should speak because all test is OK.She is eating/breathing without any problem.According to physicians, She will take one month for normal voice.My wife is a teacher.We are worried. Pls advise.

Doctor's Advice : hi. breathy voice after thyroid surgry can be due to vocal cord paralysis. however as you said, the doctor has found nothing of this sort on evaluation. another possibility is arytenoid dislocation due to intubation during general anesthesia. this too is obvious on clinical evaluation.i would suggest you to undergo a fibreoptic endoscopy of vocal cords for a detailed evaluation.
one more reason for altered voice after thyroid surgery is superior laryngeal nerve paralysis. this leads to inability to raise pitch and is more noticable in singers and not noticed while talking in general.please let me know the tissue diagnosis report after surgery. in thyroid cancers there is a possibility of vocal cords being affected after a time gap from surgery due to disease recurrence or in select cases after radioiodine therapy for thyroid cancers

Continuation - Problem : Dear Dr Harpreet, Thanks for reply.You are absolutelty right.We found right vocal cord parlsy after endoscopy of vocal cords. According to a doctor we consulted, normally voice recovered within 6 months after tablets in many cases. What is best treatment in your opinion ? This is temporary breathy voice or permanent.What is precautions ?

Doctor's Advice : vocal cord paralysis after thyroid surgery shows improvement depending upon its status during surgery.
if the surgeon is 100 percent positive that the nerve has been preserved but there could be a stretch of the nerve, then the voice could improve within one to two months and is benefitted by giving steroids. note that in such a case its the vocal cord that has been paralysed that starts improving.
in case the nerve has been damaged during surgery then the voice improvement that occurs later is due to compensation of the opposite normal vocal cord. this improvement may or may not occur. this is not benefitted by giving medicines. the time frame that can be given is about three to six months. if the voice shows no improvement then another surgery called thyroplasy or vocal fold fat injection can be undertaken to restore voice.
in my experience speech therapy doesnt help much. what i feel is that the more the pateint tries to speak, more the chances of voice improvement due to compensation

Location : Bangalore

Problem in Details : My son is 3 years old.  He is often scratching his ears.  Especially during bedtime and while taking bath.  He expects me to use cotton to his ears regularly.  Is that safe to his ears?  He is having some wax too.  Doctor has prescribed to use \"SOLIWAX\" ear drops daily..  Would u please clearly explain how to tackle ?

Doctor's Advice : hi,this is a common complaint and not very well addressed by many practitioners so i'll answer that in detail.
irritation in the ears can be due to wax, fungal infection, ear skin involvement due to dandruff (seborrhoeic dermatitis), dryness of the ear canal or habitual. in few patients it may be due to allergies too. in the last case it is often associated with allergies elsewhere in skin.
ear wax has a protective action in the ear. it forms a water repellant layer in the ear which prevents water from accumulating in the ear after bath or swim. it should never be removed in routine. ear wax removal leads to ear infection (otitis externa and otomycosis). ear wax is formed in the outer half of the ear canal and tends to shed out. you can gently remove the tiny bits of wax from the out side of the ear canal if you feel that it has been shed. if we scratch the ear then this tends to push the wax into the inner half of the skin canal from where it doesnt shed on its own and has to be removed. never ever use ear buds to remove the ear wax. it tends to push the wax further in and causes trauma to skin of the ear, predisposing it to infection.
ear wax should be removed only by your ent practitioner. and the need for it usually doesnt arise more frequently than once in an year of even less frequently than that. wax dissolving medications (eg. soliwax) only liquifies the wax. and many times if the wax is not evacuated after softening, it tends to become very hard. insist on ear wax to be removed by vacuum (suctioning) which is very safe and painless way. if that doent help then it needs to be removed by a jet of water (syringing), best wishes

Location: Bangalore

Problem in Details : I have tosilitis problems.i wanted to know if there is any laser surgery for it.If yes how much will the surgery cost

Doctor's Advice : Hi, tosillectomy can be undertaken by the usual cold steel dissection, laser or radiofrequency technique.laser surgery has its own merits and demerits.

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Tonsillectomy using laser. Use of laser for tonsillectomy may result in higher rates of haemorrhage than some other techniques, and clinicians wishing to use lasers should be specifically trained in their use.A laser is used to dissect the tissue and to coagulate blood vessels. This can involve resecting the tonsillar tissue completely (laser tonsillectomy) or reducing (laser-assisted serial tonsillectomy or laser-assisted tonsil reduction) or vaporising (laser vaporisation tonsillectomy) the tissue.Five comparative studies assessed pain after laser dissection tonsillectomy. In four of these studies, patients treated with laser tonsillectomy reported less pain at the first postoperative assessment (usually within 24 hours) compared with those who had cold-steel dissection. At subsequent assessments, however, patients treated with laser tonsillectomy had comparatively higher pain scores until at least 2 weeks after surgery. Three studies reported on healing after laser tonsillectomy. All three studies reported that wound healing was slower after laser tonsillectomy than after cold-steel dissection.

the cost of surgery is pretty higher than the usual tonsillectomy procedure. the operating time is longer too. best wishes.

Location: Hyderabad

Problem in Details : I have been experiencing a serious hoarseness of voice from past couple of years..doctors here are saying its chronic pharyngitis which in turn having some effect on the voice box. there r reddish spots like lumps on the back of the wall ..and at times having some difficulty while breathing too and the throat is dry all the time. There is no saliva coming whatsoever.So if u can tell me what should i do in this matter, it would certainly be a great help . I just cant be myself because of the voice.All the time gotta to talk forcibly ..it jus dont come out naturally as the way it should.

Doctor's Advice : few things first. the problem of chronic pharyngitis has many potential causes (please read response to an earlier query on this issue). the more common ones are sinusitis and reflux. the differentiation can be made to a significant extent on clinical evaluation and sinusitis can further be ruled out after a scan of sinuses. reflux can be diagnosed on pH monitoring but that investigation is available at fewer places and is done by gastroenterologists if your clinical picture suggests possibility of reflux. an upper GI endoscopy too is undertaken to evaluate further ( this is available very commonly) and any hiatus hernia of stomach, erosions of food pipe (esophagus), stomach, or any motility problem (movement distubances of food tract) can be diagnosed.
till the time the cause of pharyngitis is addressed any attempt to treat the pharyngitis alone will be futile. the red spots on the back of your throat are many a times seen in normal individuals too and by themselves may not merit treatment.dryness of throat is very subjective and doesnt reflect much on the cause except when you are having stuffiness of the nose and are breathing from mouth. in reflux, on the contrary, i ve seen patients having increases salivary flow.
you merit an endoscopy of the voice box for evaluation of the vocal cords. any issue of hoarseness can only be addressed after that. and if a stroboscopic asessment of the vocal cords can be done (evaluation of vibratory pattern of the vocal cords by giving flashes of light) all the more better. so seek a review by ent for endoscopy, get evaluation done for sinusitis (clinically and if need be by CT scan, x rays are useless for chronic problems), meet a gastroenterologist and then get back with the results and opinion.
for improving voice take steam inhalation for ten minutes at least twice daily, dont take excess spices and oils, avoid smoking (even passive) and alcohol, talk less with more relevant content in your conversation and avoid wasting your speech and avoid throat clearing. i usually put my patients on tab esomoprazole 40 mg to be taken once daily before breakfast for at least six weeks and if the cause is reflux then minimum three months.
best wishes

Location: Mumbai

Problem in Details : I have undergone operation of sinus. after the operation my nose looked very big from upper both sides. after 3months it looked the same. kindly tell what is reason and now what i have to do. plz reply.

Doctor's Advice : Hi, after endoscopic surgery for sinusitis or nasal polyps, occasionally some swelling may be noted around the eyes. this is more often seen in cases where the surgery has been undertaken around the frontal and ethmoidal sinuses and surgery has been tedious and disease extensive. however this resolves in few days only. in your particular case this seems to have been predominantly around the root of the nose. i would recommend you to get in touch with your operating surgeon for any clarification on this issue.
best wishes

Location: Kolkata

Problem in Details : Is it possible to treat my chronic,long-standing laryngopharyngitis with low power laer therapy or any other techinque at your clinic ? I have been suffering for years with no relief from conservative treatment. I gargle every day, but this has helped only a little bit. My throat is always congested and irritated and I keep on swallowing mucus other problems include an inflamed and ulcerated right nasal valve and osa. Throat symptoms are very bad, right nasal valve region is also chrnically inflamed and ulcerated with no help from regular saline douching. I am using otrinoz nasal drops daily.

Past Medical/Surgical History : Serere nasal allergy and persistent nasal obstruction (Hypertrophic Rhinitis/Vasomotor rhinitis) since early childhood, multiple turbinate sergeries, Nissen fundoplication for severe gerd/lprd (done in toronto,canada: tonsillectomy,surgery for enlarged lingual tonsils,reflusx is now proctically gone, buit I still take one pantocid tablet daily as per medical advice.

Doctor's Advice : Hi, you have detailed your problems very well and its very obvious that its been a cause of so much botheration to you. I' like to mention few things in response to this. Firstly, the nasal symptoms (and by that i mean your complaints and not the diagnosis of nasal problem) needs a bit of detailing. Chronic laryngopharyngitis (clp) can be caused by allergies, reflux and postnasal drip due to sinusitis. Merely the fact that you do not percieve reflux doesn't rule it out as in majority of the cases of laryngopharyngeal reflux, heartburn and frankl reflux is
imperceptible. I am keen in knowing as to why you underwent surgery for turbinates. Secondly, surgery for lingual tonsils is usually undertaken in very very selected group of patients. Why you were subjected to it and was there any specific instrumentation like radiofrequency used? Thirdly, chronic mucous swallowing points more towards sinus infection being the cause of this problem, though current studies have implicated reflux as a further reason for sinusitis in few cases. Now for your treatment. I would be more inclined to put my patients on tablet esomoprazole 40mg once daily half hour before breakfast instead of pantoprazole. Initially for at least 6 weeks. Along with that i would be inclined to start them on tablet rupata.Dine 10mg once daily for 2 weeks initially for allergic nasal problems. Few tests are also considered in your scenario:
       ct scan of sinuses: ncct pns, axial and coronal cuts with 3 mm cuts at omc
       serum ige levels
       total eosinophil counts
as for laser treatment that you asked for, i don't advocate any such thing. To decrease reflux few lifestyle changes are needed which i'm sure your gastroenterologists can let you know. Best wishes

Location : Hyderabad

Problem in Details : Iam facing a challenge/trouble of my life. My 11 months old son is stated to have deafness of 60% hearing loss in both the ears.After advice we have started using the hearing aids. (Siemens).He is listening to noisier sounds without the hearing aids.

Is there a treatment for this sudden hearing loss  considering his age?He always has irritation feeling and always plucks both the ears with his hands.For six months after his birth he did not have any trouble with his hearing. It might be sensual nerve hearing loss.Please let me know the alternatives

Doctor's Advice : hi, its very sad to hear about the problem you are faced with. its indeed very challenging and disturbing. at this point of time its difficult for me to pinpoint the cause of the deafness. however i would like to know how it was deduced that the deafness levels could be about 60 pc. was a free field audiometry done or an ABER or ASSR test was done?
its difficult at the moment for me to provide you with all the answers because the situation needs to be addressed on many aspects.
at this point of time you should very very strictly consider three things..
first, if the diagnosis has been established, how to rehabilitate your child's hearing? and the first step is to provide him with suitable hearing aids in consultation with an ent and an audiologist.
second, to provide speech therapy. and one of the parents will have to learn the simple and sometimes elaborate exercises that are imparted to the the child to facilitate language developement.
third, if the hearing aid trial provides insufficient benefit to the child even after a period of three to six months with the best suited hearing aid, then cochlear implantation should be considered. although cochlear implantation in both ears ears is being undertaken in children as young as 9 months in many western countries, in indian setup this has not yet taken roots as a norm in most centres. i would recommend you to seek consultation from a cochlear implant surgeon to discuss this issue as in indian setup the prime concen in this regard is the child candidacy for implantation and the cost factors.
best wishes

GREATER NOIDA

Problem in Details :I UNABLE TO HEAR FROM MY RIGHT EAR AND THERE ARE A LOT OF VOICES VIBRATES IN THE EAR

Doctor's Advice : the impaired hearing can be due to various causes. it can be due to diseases involving the ear drum, the ear bones (ossicles) or the auditory nerve. while the former two can be addressed surgically after careful assessment, the nerve deafness can be cured surgically in select cases of bilateral deafness by an implant.
however in the latter case the hearing and problem of noises in the ear (tinnitus) can occasionally be well addressed by a hearing aid. consult your ENT for as thorough evaluation.

DHAKA

Problem in Details :Change of Voice 6 months,
Laryngoscopy report on Larynx : Right vocal cord polyp at the junction between anterior 1/3rd and posterior 2/3rd. Movement of vocal cords is normal with adequate airway. There remains a potential gap during adduction of vocal cords.Comments : Right cocal cord polyp

Doctor's Advice: your report indicates vocal polyp. the problem merits surgery. the results of surgery are very good. its very safe in expert hands and if advise regarding the voice rest after surgery is religiously adhered to, the chances of any recurrence of the problem would be almost negligible.

NOIDA

Problem in Details :Problem is regarding snoring. It seems to me symptoms of sleep Apnea. I want to know the diagonsis of this problem?

Doctor's Advice : apnea is a complex problem often told by the spouse of the patient who witnesses it rather than patient himself. the symptoms it produces are mostly related to lack of sleep like daytime sleepiness, lethargy and decreased sleep latency. it also tends to adversely affect heart when severe and hence needs merits urgent attention. the reasons of sleep apnea are varied and the treatment too sometimes needs to be tailored to the cause. you should see a ENT specialist along with a sleep disorder specialist who will guide you to proper evaluation and treatment.

NOIDA

Problem in Detail: My father, aged 68, is suffering from Vertigo. Symptoms include diziness, headeache, vomiting. For the last six month 4 or 5 times such symptoms occurred. Please advice me wheather any treatment is available for vertigo and who are the best hospital for treatment. regards

Doctor's Advice: vertigo does have a cure. the cure of course lies in the correct diagnosis. it is a complex issue dealt by ENT, neurology, orthopedics, cardiology and occasionally ophthalmology. only correct history taking can ensure what the problem actually is. the way you are describing the symptoms it seems to be a case of meniere's disease. however i would strongly recommend you to see a ENT guy for further evaluation and treatment.

GREATER NOIDA

Problem in Detail: I hv a problem regarding nose... my nose is often closed at sleeping time ...so m feeling difficulty in breathing.. and my nose is also vry long...n i want to reshape it response.

Doctor's Advice : Nasal obstruction while sleeping is common phenomenon. But usually is not significant. Occasional partial blockage of the side of nose which is downward while you are sleeping to your side is physiological and doesn't need treatment. However bothersome blockage on lying straight on back and mouth breathing needs to be evaluated. It can be due to nasal septal deviation which needs surgical correction. The shape of nose needs to be evaluated for advice as to what best effort can be put in your particular case to reshape it. Best wishes

NEW DELHI

Problem in Details: My daughter is 6 yrs and 9 months old. She had been diagonised for adenoids and tonsils. We took Digital X-Ray (February 24, 2008), the report of which says \"Thickening of soft tissues of the posterior nasopharynx is seen, suggestive of significant adenoid hypertophy. Nasopharyngeal airway is compromised. Hypopharynx is normal\". ENT specialist gave antibiotics for two weeks like Cefdrin and Coriminic syrup. After two weeks he advised for undertaking surgery for adenoids and tonsils. We went to Dr. ******* Homeopathy who assured us that our child will be able to breathe normally within a year, however, the adenoids and tonsils will go back to their places as time passes. We started homeopathy from May 3, 2008. In the first two months we found it very good as the tonsil on the left side had gone and the right side was shrinking. In July 2008 she was having sore throat and antibiotics was given by an MBBS. The inflammation of tonsil (redness) had gone, however, the enlargement of tonsil continued to remain. When we went to Dr. ******* (who has given us 1 year package) they said that enlargement of tonsil will go within 2 months and within 1 year her breathing will improve. Daughter has nose block during night, difficulty in mouth breathing. However, she does not compalin of any such problems. Our question is how long can we wait for one year till the Dr. ******* package of one year gets over? Any risk involved in waiting?

Doctor's Advice : Adenoid hypertrophy in the age group of 6 to 8 years is considered physiological. In most cases it doesn't merit any operative intervention. However adenoid hypertrophy does produce some other changes too that can make surgeons consider surgery earlier. This includes advanced changes of ear drum in form of retraction, deafness due to fluid in ear, changes in dentition (teeth arrangements), changes in facial profile and obstructed breathing in night. Surgery for tonsils too is considered if some parameters are met like repeated infections, obstructed breathing, any abscess in tonsil. On these parameters if surgery has been planned then i'd advise you to go ahead. I'm not competent to comment on homoeopathy so i'd not advise you regarding that. Antibiotics in my experience do not help much as regards adenoid hypertrophy. However few patients do respond favourably to nasal steroid sprays. Please note that any decision on surgery is taken purely on evaluation of patient. My opinion is based on the inputs you provided and should in no circumstances be taken to be absolute and final. Best wishes.

MAHARASTRA

Problem in Details :i m male 38 years, 60 kgs. for last 2 months i have been sneezing heavily, immediately on waking up in the morning and also in evening when i go for tennis , also in night. there is a itching feeling inside the nose. i took some homeopathy medicine for allergy for some time but did not help. now problem is aggravating.my nose waters when i go to sleep and sleep is disturbed. please help diagnose and suggest medicines please.

Doctor's Advice : hi, the details of your problems are sketchy. it needs to be clarified if your complaints are seasonal or lasting all through the year. also, in many patients with allergic rhinitis, the ailment you are having, there also could be some symptoms of asthma. the latter needs to be evaluated and treated simultaneously. in this condition, i need to know how many days in a week you are having these symptoms, and how badly is it affecting your work/ schedule at home, and if you are having bothersome blocking of nose apart from the sneezing episodes. please also let know if any of your family members or grandparents had allergies in form of skin problem (urticaria), asthma or nasal allergy,as in your case.the treatment will be suggested after that.
best wishes