Monday, January 31, 2011

Tinnitus both ears


Dear R....,

Any cause which results in hearing loss  can produce ringing sounds in ear. So if we can improve hearing with any modality (Surgery, Medicine or hearing aid), then it should result in diminished ringing sensation.

I need to see your audiometry report and scans to tell you what best can be done for you. You can send the same via email or meet in my clinic with prior appointment. 


with Best Regards,

Dr. Ajay Jain



30 Jan, 2011
  Dear Dr. Ajay Jain,Medical Guide Ad Response 


Sender Details and Message









 City.   :   Bronshoj
 Country   :   Denmark
 Message/Query
Hi,
i am Razib.
my nationality from bangladesh.
i live in denmark As a IT specialist.
i have much more hearing problem from 2 months.its coming too much sound from
my both of the ears.
now suddenly it has reduce my hearing too much.i can only hear from very very near to me.
and when i walk,during that time,it comes walking sound in my ears.

i visited denmark doctors,they have scaned my brain but every thing is ok.
even they could see any infection in my ear.
they can not guess why i m not hearing,and why is the sound.but now a days,im too much sick for
the sound in the ear.
i would like to come and get treatment from your hospital if you help me to overcome my ear problem.

waiting for your response.

Thanks
R....

http://www.whereincity.com

Saturday, January 22, 2011

Steam Vs Nebulization

How should I take steam?

Steam can be taken by either the convenient Steamer or from the boiling water on a heater. The second option is dangerous especially with kids.

It's not necessary to keep the face too close to container. Even a chair close to the steamer is enough. You can leave the steamer on and do your table work.

Should I put something into boiling water like vicks or karvol?

Steam is a pure form of water. Water evaporates after boiling and when it condenses into air passage, then it leaves moisture there. This moisture helps moving dried up small hairs which ultimately moves the mucus. Putting these things may increase the pleasant experience like smell but as such they do not have an additional function and may not be necessary to use.


Can I take Nebulizer instead of steam?

Nebulizer is no substitute of steam. It has different function which can not be done by steam either.
Nebulizer is for lungs whereas steam is both for lungs and nose. Nebulizer is way of delivering drungs for local action in lungs while steam delivers moisture both to lungs and nose.

Some viruses like Rhinovirus which causes common cold are susceptible to heat. So taking steam helps in eliminating such viruses.

Question-Answer

Dear Sunny,

Any hearing loss whatever may be the cause, can result in ringing sensation in the ear.
You have not told your age, I guess you are young.

So first get an ENT consultation followed by pure tone audiometry and if needed impedance audiometery. If the cause of hearing loss is found, then treatment would be easy.

With regards

Dr. Ajay Jain



21 Jan, 2011
  Dear Dr. Ajay Jain,Medical Guide Ad Response 

You have recieved a mail against your Ad in Whereincity.com Medical Guide. Details are as follows :

Sender Details and Message
 Name   :   sunny
 Email   :   mrmist27@aol.com
 Phone No.   :  
 City.   :   dekhi
 Country   :   India
 Message/Query
Hi i have earringing all the time from last month i didnot notice before but now i cant sleep some one time i heard driping noise in ear how much going to cost the treet meant please help me thanks .
Thanks for using our Medical Guide Services !

Regards
Whereincity.com Team
http://www.whereincity.com

Wednesday, January 12, 2011

Who heals the patient's suffering?

I am of the firm opinion that apart from good surgery, it's the faith of the patient in doctor that heals the patient's suffering. Sometimes I was not happy with the surgery but patient's longanimity and faith of him in me that he is happy with the outcome. At other times, I have done a wonderful job surgically but still patient is not happy. So TRUST is the key issue for good outcome.

There are instances where I had to revise my cases with revision surgery. I even offered the patient that someone else might do the same surgery whom I think is better than myself yet patient insisted me only to do the job. Fortunately results were satisfying.

Those patients who have happy-go-attitude towards life do very well after surgery and those are emotional kind, have unrealistic expectations towards life do worst despite surgeon's best job.

Sunday, January 9, 2011

Extrasinus Mucocoele of right Maxillary sinus invading the orbit







Thanks Dr. Shivram Gopal Iyer for entrusting this case to me.
The case was operated upon by right infraorbital incision, right sublabial incision and right FESS to marsupialize the cyst which drained into right nose. the patient is doing fine in postoperative period with slight diplopia in certain eye movements.

Transpalatal incision for excision of Angiofibroma


This case was unusual in that here the boy presented at the age of 33 years with a history of left side nasal bleed for last one years. To prove it to be a case of Angiofibroma, I took biopsy under local anesthesia. luckily, since the tumour mass was occluding the choanea, it did not bleed into oropharynx. Biopsy showed thick angiod element with final inference of benign vascular growth. DSA showed it to be getting supply from both internal maxillary artery and left ascending pharyngeal artery which were embolized by PVA particle.
The case was operated upon by team of Dr. Atul Jain, Dr. Ajay Jain and Dr. Poonam Gautam at Pushpanjali Crosslay Hospital. A Transpalatal approach was used as shown in first figure. It bled a lot but no transfusion was required. The final histopathological examination of specimen confirmed it to be Angiofibroma.

Tuesday, January 4, 2011

Haemostasis during Tonsillectomy

Haemostasis during Tonsillectomy is an extremely important step and different surgeons have different preference for securing it. Some like suturing the bleeder which may be technically challenging at times or some like diathermy. Diathermy may be unipolar or bipolar.

Recently I did a paediatric tonsillectomy where I was comfortable with sutures and an adult tonsillectomy where sutures did not work and bleeding could be secured by bipolar cautery only. The apparent reason could be the larger and deeper tonsillar bed in adults where its difficult to secure sutures and because of too much fibrosis, it bleeds a lot.

In my opinion, suturing is best method with vicryl provided you can secure the knots at right place otherwise bipolar cautery is good. Radio-frequency is an excellent substitute for cautery and of late coblation has come. The adverse effect of using diathermy (cautery, radio-frequency or coblation) is increased postoperative pain and long term chances of developing neuralgic pain (Acquired Eagle's Syndrome).