Friday, September 17, 2010

Dengue Fever in Delhi

It's a disease to worry about. It comes with fever, cold like symptoms, eye pain, body pain and bone pain (Break bone fever). All the blood counts go down especially platelet count which may give nasal and oral bleed.

So Platelet count is good initial investigation which should cost you less than 100 rupees. but beware, on first and second day, these may be normal and serial counts may be required. If strong suspicious is there, go for NS1antigen testing (Within first week of fever). In second week Dengue serology (IgM & IgG antibodies) can be ordered.

I have come across few cases where platelet counts have dropped to 9000  which have been saved by platelet transfusion, also couple of unfortunate deaths. so indeed early diagnosis is needed.

Thursday, September 9, 2010

Eye Flu in Delhi

Eye Flu has become rampant in Delhi. I discussed the topic with Dr. Narinder Singh, Senior EYE Consultant Yashoda Hospitals


Q. Which eye drops should we use during eye flu, a common question asked to me by everybody?

Ans. Actually eye drops can harm you especially if it contains steroids. A simple superficial erosion can become ulcer with steroids eye drops. Steroids eye drops may hasten the improvement in symptoms but at a cost.

Q. What is the nature and duration of this eye-flu epidemic?

Ans. This flu lasts for 3-5 days. Only some lubricating eye drops are required and personal hygiene needs to be taken care of.

Message: Do not use eye drops on your own in eye flu. It may harm your eyes. Better consult your eye specialist.

Monday, September 6, 2010

Migraine

Introduction
A migraine is a severe headache that often has a number of associated symptoms, such as nausea, increased sensitivity, and visual problems.

Who is affected by migraines?
Migraines are common; affecting about 1 in 4 females and 1 in 12 men. It is thought that hormonal influences may be the reason why migraines affect more women than men. For example, some women find that migraine attacks are more frequent around the time of their period. However, this association has not been fully proven.

It is possible for migraines to begin later in life. However, it is more common for the condition to begin in childhood or as a young adult. About 90 per cent of people who experience migraines have their first one before they are 40 years old.

Types of migraine
There are two types of migraine - classical and common:

Classical migraine is when the headache follows a series of symptoms, known as aura (see the 'symptoms' section).
Common migraine is when a person does not experience aura symptoms.
Some people experience migraine attacks frequently, such as several times a week. Other people only experience a migraine occasionally. For example, it is possible for years to pass between migraine attacks.

Symptoms
The main symptom of a migraine is an intense headache. This usually occurs at the front, or on one side, of the head. However, during a migraine attack, the area of pain can sometimes change position. The pain can feel like a throbbing sensation and it can be moderate, or severe. The throbbing is usually made worse when you move.

Classical migraine symptoms (with aura)
Aura means a warning sign. It is the name that is used to describe the symptoms that you experience before the migraine begins. Around 1 in 4 people who experience migraines have additional aura symptoms. These can include:

Visual problems - you may experience visual disturbances, such as flashing lights, zigzag patterns, blind spots, and other visual distortions.
Stiffness - you may have stiffness, or a tingling sensation like pins and needles in your neck, shoulders, or limbs.
Problems with coordination - you may feel disorientated, or off-balance.
Difficulty speaking - you may find it difficult to express yourself properly using words.
Loss of consciousness - this only happens in very rare cases.
Aura symptoms typically start between 15 minutes and 1 hour before the headache begins. Some people may experience aura with only a very mild headache.

Common migraine symptoms
Symptoms associated with a common migraine include:

Nausea - you may feel queasy and sick. This may sometimes be followed by vomiting.
Increased sensitivity - you may experience photophobia (sensitivity to light), phonophobia (sensitivity to sound), and/or osmophobia (sensitivity to smells). This is why many people who have migraines want to rest in a quiet, dark room.
The symptoms of a common migraine often begin at the same time as the headache. However, these symptoms will usually disappear once the headache eases.

Other associated symptoms
During either a common or classical migraine, a number of associated symptoms can sometimes occur. These symptoms can include:

poor concentration
sweating
feeling very hot, or very cold
abdominal pain (which can sometimes cause diarrhoea), and
a frequent need to pass urine.
However, not everyone experiences associated symptoms, and they do not usually all occur at once.

The symptoms of a migraine can last anywhere between 4-72 hours (3 days). In between each migraine attack, all associated symptoms will usually disappear. You may feel very tired after a migraine attack, and this feeling can sometimes last for several days afterwards.

Causes
It is thought that migraines may be caused by changes in the chemicals of the brain. In particular, the level of the serotonin - the message-sending chemical - decreases during a migraine.

Low levels of serotonin can make the blood vessels in a part of your brain spasm (suddenly contract) which makes them narrower. This may cause the symptoms of aura. Soon after, the blood vessels then dilate (widen), which is thought to be the cause of the headache. However, the exact cause of the drop in serotonin levels is not yet fully understood.

Hormones
Some scientists believe that hormones are closely linked to the cause of migraines. Some women who experience migraines say that they are more likely to have an attack around the time of their period. This is known as a menstrual migraine. Fluctuating hormones are thought to be the reason why more females have migraines compared with males.

Just before women have their period, levels of the hormone, oestrogen, fall. It is not the low levels of oestrogen that cause a migraine, but it is linked to the changes from one level to another.

Women can experience menstrual migraines anytime between two days before to three days after the first day of their period. About one in seven women who experience migraines only have an attack around the time of their period. This is known as a pure menstrual migraine. However, it is possible to have migraine attacks around the time of your menstrual period and at other times as well. This happens to around 6 in 10 women who experience migraines.

Migraine triggers
Many factors have been identified as triggering the onset of a migraine. These triggers include emotional, physical, dietary, environmental, and medicinal factors.

Emotional
Emotional factors that can trigger a migraine can include:

stress,
anxiety,
tension,
shock,
depression, or
excitement.
Physical
Examples of physical factors that can trigger a migraine include:

tiredness,
poor sleep quality,
shift work,
poor posture,
neck, or shoulder, tension, and
travelling for a long periods of time.
The menopause can also trigger migraines.

Dietary
Dietary triggers of a migraine may include:

lack of food (dieting),
delayed or irregular meals,
dehydration,
alcohol,
food additives (specifically tyramine),
caffeine products, such as tea and coffee, and
specific foods like chocolate, citrus fruit, and cheese.
Environmental
Environmental factors that may cause migraines include:

bright lights,
flickering screens, such as a television or computer screen,
smoking (or smoky rooms),
loud noises,
changes in climate, such as changes in humidity or very cold temperatures,
strong smells, and
a stuffy atmosphere (a lack of fresh air).
Medicinal
Some medicines can trigger migraines, including some sleeping tablets, the contraceptive pill, and hormone replacement therapy (HRT), which is sometimes used to treat the menopause.

Diagnosis
When to visit your GP
Migraines can often be treated at home using over-the-counter (OTC) medication and self-help techniques. However, you should see your GP if you feel that painkillers, such as paracetamol, are not working, or you experience any of the things listed below.

You have aura symptoms that occur on the same side of your body with every attack.
Your first ever migraine occurs when you are over 50 years of age.
Your usual migraine symptoms have changed.
Your migraine attacks are becoming more frequent.
Diagnosing migraine
There is no specific test to diagnose migraine. On your first visit, your GP may give you a physical and neurological examination. This includes an examination of your mental functions by checking your vision, coordination, reflexes, and sensations. These checks will be carried out to make sure that there are no other underlying conditions that are causing your symptoms.

To give an accurate migraine diagnosis, your GP must identify a pattern of reoccurring headaches, alongside the associated symptoms. Migraines can be unpredictable, with differing periods of time where no symptoms are experienced. Therefore, obtaining an accurate diagnosis can sometimes be a lengthy process.

To help with the diagnosis, it can be useful to keep a diary of your migraine attacks. You should note down details including the date, time, and what you were doing when the migraine began. It is also helpful to make a note of the food you ate that day, as this can help your GP to identify any potential triggers.

Treatment
There is currently no cure for migraine. However, a number of treatment methods can be used to treat the symptoms of migraine. Treatments are mostly in the form of medicines. It may take time to work out which is the best method of treatment for you. For example, you may have to try different types of medicines, or different combinations, before you find the most effective ones.

Painkillers
Many people who experience migraine find that over-the-counter (OTC) remedies, such as painkillers, help to ease their symptoms. Paracetamol and aspirin are painkillers that are commonly used to treat a migraine.

When taking paracatemol, or aspirin, always make sure that you read the instructions on the packaging, and follow the dosage recommendations.

Children under 16 years of age should not take aspirin, unless it is under the specific guidance of a healthcare specialist.

Aspirin is also not recommended for adults who have (or have had in the past) stomach problems, such as a peptic ulcer, liver problems or kidney problems.

Painkillers are usually the first method of treatment for migraine, and they tend to be more effective if they are taken at the first signs of a migraine attack. This gives them time to absorb into your bloodstream and ease your symptoms.

Some people only take painkillers when their headache becomes very bad. However, this is not advisable because it is often too late for the painkiller to work. Soluble painkillers (tablets that dissolve in a glass of water) are a good choice because they are absorbed quickly by your body.

If you cannot swallow painkillers due of nausea, or vomiting, suppositories may be a better option. These are 'bullet-shaped' capsules that contain specific medicines. The suppository is inserted into the anus (back passage).

Stronger types of painkillers are also available, but they need to be prescribed either by your GP, or by a specialist.

Anti-inflammatory medicines
Due to their anti-inflammatory properties, you may find that anti-inflammatory medicines, such as ibuprofen, are more effective in treating your symptoms of migraine.

You can buy ibuprofen over-the-counter (OTC) at the pharmacists, and it is also available on prescription. However, as with aspirin, you should not take ibuprofen if you have (or have had in the past) stomach problems, such as a peptic ulcer, or if you have liver, or kidney problems.

Diclofenac, naproxen, and tolfenamic acid are other types of anti-inflammatory medicines that are only available on prescription

Anti-sickness medicines
If nausea is a symptom of your migraine, you can take anti-sickness medicines. These can be prescribed by your GP, and can be taken alongside painkillers. Ask your GP about anti-sickness medicines.

As with painkillers, anti-sickness medicines work better if taken as soon as your migraine symptoms begin. Anti-sickness medicines usually come in the form of a tablet, but they are also available in the form of a suppository.

Combination medicines
There are a number of combination medicines for migraine, which you can buy over-the-counter (OTC) at your local pharmacy. These medicines contain both painkillers and anti-sickness medicines. If you are not sure which medicine is best for you, ask your pharmacist for advice.

Many people who experience migraines find that combination medicines are convenient. However, you may find that either the doses of painkillers, or anti-sickness medicine, are not high enough to combat your symptoms. If this is the case, you may prefer to take painkillers and anti-sickness medicines separately. This will allow you to easily control the doses of each. Again, ask your GP or pharmacist if you are not sure about which medication is most suitable for you.

Triptan medicines
If ordinary painkillers are not helping to relieve your migraine symptoms, triptan medicines might be the next option. Triptan medicines are only prescribed by your GP, or by a specialist.

Triptan medicines are not the same as painkillers. They make the blood vessels around the brain contract. This combats the dilating (widening) blood vessels, which are believed to be part of the migraine process. Triptans are available in the form of tablets, injections, and nasal sprays.

Some triptan medicines work for some people but not for others. If one type of triptan medicine does not seem to be working, you should see your GP and ask them about other types.

Complementary medicines
Some people find that complementary therapies, such as acupuncture and homeopathy, help with migraines. However, there is a lack of scientific evidence as to the effectiveness of such treatment methods.

Complications
There are several complications that are linked to migraine:

Stroke
Migraine is associated with a small increased risk of ischaemic stroke. An ischaemic stroke occurs when the blood supply to the brain is blocked by a blood clot, or fatty material in the arteries.

Although it has been identified as a risk factor, the reasons why ischaemic stroke is linked to migraine are not entirely clear. However, an ischaemic stroke as a result of a migraine is very rare.

Another risk factor for ischaemic stroke is the use of the combined oral contraceptive pill. The general advice of medical professionals is that women who experience migraine with aura should avoid using the combined contraceptive pill.

Women who experience migraine without aura are able to take the combined contraceptive pill. However, if you take the combined contraceptive pill, and you experience aura symptoms, or if your migraines become more frequent, you should see your GP as soon as possible. They may advise you to stop taking the combined contraceptive pill.

Mental health problems
Migraine is associated with an increased risk of mental health problems including:

depression,
manic depression,
anxiety disorder, and
panic disorder.
Although migraine and mental health problems are linked, they are believed to have different causes.

Prevention
Although there is no cure for migraine, it is possible to bring the condition under control. This can be achieved through treatments and also by taking preventative measures.

Triggers
One of the best methods of preventing migraines is recognising the signs and the triggers of an attack. This is why keeping a migraine diary is helpful. For example, if you experience a migraine on several different occasions, after eating certain foods, you should avoid eating them. The same applies for avoiding other known triggers, such as avoiding stress, or anxiety.

Recognising the signs
Some people who experience migraines begin to feel unwell before a migraine attack. This can be up to a day, or so, before the more obvious symptoms, like a headache, begin.

The strange feelings that are sometimes experienced prior to having a migraine are known as the prodrome, and are often the first signs of a migraine attack. These can include:

a change in mood,
tiredness,
hyperactivity, or
food cravings.
However, as these feelings are not specific to migraine, it can be difficult to identify them as warning signs. Your relatives, or friends, might be first to notice these changes.

Medication
Medication is available to prevent a migraine attack. These medicines are usually given if you have tried other preventative measures and you are still experiencing migraines. Your GP may also prescribe these medicines if you experience very severe migraine attacks, or if your attacks happen frequently.

Medications used to prevent migraines include:

Beta-blockers
Beta-blockers include propranolol, metoprolol, and atenolol. They are traditionally used to treat angina and high blood pressure. It is not currently known how beta-blockers work to prevent migraine attacks. Beta-blockers are unsuitable for some people with asthma. Side effects of beta-blockers can include hallucinations, cold hands and feet, and tiredness.

Anti-depressants
Amitriptyline is a type of anti-depressant. However, it has been shown to work against migraines in a different way to how it treats depression. The medicine is usually started on a low dose which can be increased if necessary. Amitriptyline can be used together with beta-blockers.

Anticonvulsants
Topiramate is a type of anticonvulsant. Anticonvulsants are usually used to prevent seizures in people with epilepsy. However, they have also been found to help prevent migraines. Topiramate is currently the only anticonvulsant licensed for migraine prevention in the UK.

Serotonin agonists
Two serotonin agonists are pizotifen and methysergide. Some people who experience migraines find that these medicines can reduce the severity and frequency of their attacks. However, side effects can include drowsiness and weight gain.

Keep a migraine diary
You should be aware that these medicines may not stop your migraine attacks completely. Keeping a migraine diary will help you, and your GP, to monitor how well the medicine is working. As it can take up to three months for the medicine to take full effect, it is important to keep taking it for at least three months, even if you think that it is not working.

Isometric Neck Exercises

When we speak of isometric exercises, we are referring to those designed to strengthen specific muscles by pitting one muscle or part of the body against another or against an immovable object in a strong but motionless action. This can be used effectively in exercising the neck with these routines:
Isometric Sides: Place your right hand flat on the side of your head. Next, firmly push your head against your right hand. The key to this exercise is to not allow your head to move so as to create and maintain constant tension on your neck muscles. Continue pushing against your right hand for a 10 second count and then switch to the left side and repeat the exercise.
Isometric Front and Back: For the front exercise, place your hands flat on your forehead. Next, firmly push your forehead forward against your hands. The key to this exercise is to not allow your forehead to move forward so as to create and maintain constant tension on your neck muscles. Continue pushing forward for a 10 second count and then relax and switch to the back or rear part of this exercise. For the rear exercise, begin by clasping your hands behind you head. Next, firmly push the back of your head against your hands. The key to this exercise is to not allow your head to move backward so as to create and maintain constant tension on your neck muscles. Continue pushing for 10 seconds and then relax and switch to the front part of this exercise and repeat.

How to protect yourself from Influenza pandemic

HOW TO PROTECT YOURSELF AT WORKPLACE DURING PANDEMIC

The best strategy to reduce the risk of becoming ill with pandemic influenza is to avoid crowded settings and other situations that increase the risk of exposure to
someone who may be infected. If you must be in a crowded setting, minimize your time there. Some basic hygiene and social distancing precautions that can be
used in every workplace include the following:

• Stay home if you are sick.
• Wash your hands frequently with soap and water for
20 seconds or with a hand sanitizer if soap and water
are not available.
• Avoid touching your nose, mouth and eyes.
• Cover your coughs and sneezes with a tissue, or cough
and sneeze into your upper sleeve. Dispose of tissues
in no-touch trash receptacles.
• Wash your hands or use a hand sanitizer after coughing,
sneezing, or blowing your nose.
• Avoid close contact (within 6 feet) with coworkers and
customers.
• Avoid shaking hands and always wash your hands
after physical contact with others.
• If wearing gloves, always wash your hands after removing
them.
• Keep frequently touched common surfaces (for example,
telephones, computer equipment, etc.) clean.
• Try not to use other workers’ phones, desks, offices, or
other work tools and equipment.
• Minimize group meetings; use e-mails, phones and
text messaging. If meetings are unavoidable, avoid
close contact (within 6 feet) with others and ensure
that the meeting room is properly ventilated.
• Limit unnecessary visitors to the workplace.
• Maintain a healthy lifestyle; attention to rest, diet,
exercise and relaxation helps maintain physical and
emotional health.

GERD

Rules to follow:

1. Do not eat later than 3 hours before plan to sleep. Generally, try to eat early in the evening, and always make the evening meal a light one.

2. Reduce your weight.

3. Stop smoking

4. Do not wear very tight clothing that could constrict the abdomen

5. Generally do not eat large meals, but smaller ones, and in the evening before reclining, do not eat any food on the restricted list.

6. Before sleeping, spend a few moments at a window and do some deep breathing, inhaling and exhaling deeply.

This will energize your nervous system and can assist in the prevention of GERD if the other measures are also followed.

Dietary Restrictions: The evening meal must not be large, or heavy, and completed no later than 3 hours before your intended sleep.

Foods to Avoid

There are many foods that must be avoided, and the following list is indicative only It is a guide to sensible evening eating. By use of the word "avoid" below, we do not mean eliminate, but if you plan to eat any of the following, eat them sparingly.

1. Avoid all acid containing foods (such as coffee, tea, chocolate, orange juice, cranberry juice, tomatoes and tomato sauce), spicy foods (such as garlic and onion). Avoid all soft drinks such as coca-cola and Pepsi cola, and except for special natural mineral digestive waters, all soda water in any form.

2. Avoid fried and fatty foods

3. Avoid any alcohol, peppermint/spearmint, and chocolate.

4. Avoid as much as possible dairy products, including cheese, egg and egg-containing products.

5. Finally, avoid all chewing gum, and any form of sugar, candy or desserts.

The list above may seem restrictive, but any of the foods eaten in excess before sleep can worsen and aggravate the GERD condition.

Avoid Heartburn Physical Measures:

Arrange your bed and pillows to support your shoulders, and elevate your truck to a 15degree angle. This physical limitation does wonders (using gravity) to restrict the GERD effect.

Simple measures to alleviate heartburn

The three measure, as in common sense rules, dietary restriction and sleep position can limit or eliminate the GERD effect.

Should it not, we recommend you consult your doctor immediately for additional measures, as GERD, if left untreated can lead to much more serious conditions.

Formulas for Average Height/Age/Weight

   WEIGHT                                 KG                                         POUNDS

AT BIRTH                          3.25 KG                                         7


 3-12 MONTHS              AGE ( MO) +9                     AGE IN MONTHS+11
                                      ____________

                                              2


1-6 YEARS                  AGE(YR)  X 2    + 8                 AGE(YR)  X 5  +  17




7-12 YEARS                 AGE ( YR) X 7   - 5                  AGE ( YR)  X 7  +   5
                                    _________________
                                  
                                                    2                                                                                                                                                  

                             *********   HEIGHT**********



     HEIGHT                               CENTIMETERS                                    INCHES


AT BIRTH                                         50                                                      20                

AT 1 YR                                            75                                                       30


2-12 YRS.                            AGE ( YR )   X  6 + 77              AGE ( YR) X 2.5  + 30

Friday, September 3, 2010

Nasal Polyps-Medical or Surgical treatment, Personal Experience

Nasal Polyps is one disease where Rhinologists would love to operate but hate to follow up the patients. Good job of clearing the disease through latest instruments goes in vain when the polyps start coming again after few days or months. Local inhaled steroids help preventing the recurrence but not always. Systemic steroids are given as a desperate measure to save surgical reputation of surgeon. Only very few lucky patients does not require steroids. Many require revision surgery eventually but few undergo by the same surgeon and the same cycles starts again.
May be my other colleagues have a better experience. Initially I thought my technique is wrong and I felt frustrated treating nasal polyposis. For last couple of years I have started giving systemic steroids for recurrent cases. The results were wonderful. All allergic polyps melted like anything. But, the moment steroids are withdrawn, polyps started coming again. So many of my operated cases have become steroid dependent now and I am giving them in low dosage for maintenance. (Is Steroid an ENT Friend?).
Taking this cue from my experience, I treated a 14 year child with systemic steroids whose parents were not willing for surgery. After One month, there was almost 50 percent reduction in nasal polyp mass. Quite impressed with results on CT scan, I started tapering the steroid dose over a one month time. A repeat CT after two months showed the same pre-treatment bulk of nasal mass on CT Scan.
SO, Either Surgery or Steroids are no permanent solution. So where should we look for permanent treatment of nasal polyps. Few points are mention worth here
1. Is Nasal Polyps primarily a Medical or surgical disease?
All Rhinologists are too much focused on Surgical aspects and more funds should be diverted for research in medical treatment of nasal polyps and I see a permanent treatment there.
2. Why only one side affected?
In many case, I have observed that sinuses opposite to the deviated nasal septum develops the Nasal Polyposis. So, why there is so much fuss especially in private . practice to cash DNS into currency. Is some kind of excess flow of air provokes polyp formation?
3. Many cases, mostly females, who doesn’t have polyps in CT scan , but are troubled by thick nasal discharge, which responds to medical treatment temporarily. Is there any role of surgery in Non Polyposis chronic sinusitis?

4. I have seen conventional open surgery for nasal polyps like cold well luc and External ethmoidectomy during my residency. For recurrent Nasal Polyps, are these radical surgeries justified instead of giving life long steroids?

5. Few of my patients who have recurrent polyps and not inclined for revision surgery, there polyp bulk is same for so many years on inhaled steroids. Except for thick discharge occasionally, there is no other complaint. Like a small glomus in an elderly, should we leave such subset of patient on inhaled steroids alone

Wednesday, September 1, 2010

SEPTOPLASTY


Definition
Septoplasty is surgery to correct the deviated Nasal Septum (DNS), the wall inside the nose that separates both the nasal cavities.
Alternative Names
Nasal septum repair
Description
This surgery can be done under both general and local anaesthesia. If done under general anaesthesia, you will be unconscious and unable to feel pain. Some have the surgery under local anesthesia, which numbs the area to block pain. You will stay awake if you have local anesthesia. Surgery takes about 1 to 1 ½ hours. Patients usually go home the same day.
Your surgeon will make a cut inside the wall on one side of your nose.
* The mucus membrane lining that covers the wall will be lifted up.
* Then your surgeon will remove or move any cartilage or bone that is causing the blockage in the area.
* After this, your surgeon will put the mucus membrane lining back in place. This membrane will be held in place by stitches, splints, or packing material.
Risks
Risks for any surgery are:
* Allergic reactions to medicines
* Breathing problems
* Heart problems
* Bleeding
* Infection
Risks for this surgery are:
* Return of the nasal blockage. This would require another surgery.
* Scarring
* A perforation, or hole, in the septum wall
* Changes in skin sensation
* Unevenness in the appearance of the nose
* Skin discoloration
* Fluid buildup in the nose

Final words:  

By large, this is commonly performed procedure by ENT surgeons and should be uneventful. This surgery will not remove the cause of your allergy but simply helps to ease out your nasal breathing in a mechanical way.

Adenoids


What are Adenoids?
Adenoids are like tonsils but are present behind your nose and functions like tonsils. They help in fighting infections and sometimes gets enlarged in response to infection. They usually starts increasing by age of 2 and keep increasing up to 7 year of age and regressed thereafter.

If they are our fighters then how do they trouble us?
Yes, they are fighters but if they are unable to fight, they start increasing their size . This increase in size compromises the air passage behind the nose of the child, causing a difficulty in breathing especially while sleeping.

What are the symptoms of Adenoid enlargement?
Child may present with mouth breathing, snoring at night, ear pain, tiredness, malocclusion of teeth, recurrent chest infections, typical facial appearance in which nostril are visible from inside, depressed cheek and pursed like lips known as Adenoid facies.

Is Adenoid removal is bad for child’s Immunity?
No, in fact this is small fighter in comparison to overall immunity of body. The child needs good breathing for proper oxygenation which is much more important.

What is Adenoidectomy?
Adenoid removal is a surgery to shave off the adenoid glands. These glands are located behind your nose and when enlarged cause difficulty in breathing especially during the night. Often, adenoid removal is done at the same time during removal of tonsils. Adenoid removal is also called adenoidectomy. Most adenoidectomies are done on children.

How the Adenoidectomy is done? Whether any external incision will be given to baby?
Your child will not be given any external incision for the surgery and he wouldn’t feel the pain either.
Your child will be given general anesthesia before surgery. This means they will be unconscious and unable to feel pain.
The surgeon will insert a small instrument into your child’s mouth to prop it open.
The surgeon will remove the adenoid glands with a curette (a spoon-shaped medical device) or a microdebrider (a medical device used to cut away soft tissue).
Bleeding will be controlled with packing material, which will absorb blood, and with cauterization.
Your child will stay in the recovery room after surgery until they are awake and can breathe easily, cough, and swallow. Most patients can go home several hours after this surgery.

Is my child not very young for a surgery?
Though Adenoids peak at 7 years of age and regresses thereafter but enlarged symptomatic adenoids can be seen as young as 2 years and even in adults. It’s not the age but the severity of symptoms which dictates the indication of surgery.

What are the risks involved in surgery?
Risks for any anesthesia are: Reactions to medicines, breathing problems
Risks for any surgery are:
Bleeding: This is the main risk and occurs very rarely. The bleeding is likely to occur in first few hours of surgery and if it is significant enough, the child may again be taken to operation theatre and bleeding point may be cauterized. Child may require packing of the operated area and blood transfusion

What Precautions are required after Surgery?

If the surgery is only adenoidectomy, then your child can be discharged on the same day or after an overnight stay in the hospital. They require nasal drops, antibiotics, anti allergic and a pain killer in the first week. Diet is as the child likes.