Thursday, August 6, 2020

Water sounds in my ear

Water sound could be because of some fluid in outer or middle ear or because of a process known as Tinnitus happening due to inner ear perception of unknown sounds.

Let's put this way. If your outer ear has some fluid entered during swimming or bath or else because of discharge coming from middle ear from ear drum perforation, All this will give water sounds in ear.

Tinnitus happens usually when you have some hearing loss and in absence of external masking sounds, Cochlea picks up sounds of its own outer hair cells as some whistling or bird chirping or machine sounds especially in a quiet environment.

Dr. Ajay Jain

Consultant Otolaryngologist

Wednesday, June 17, 2020

Role of Zinc supplements during Coronavirus pandemic

There is no direct evidence for ZINC in COVID-19. All evidence is general.


1. Zinc has context dependent effects on NF-kB. It can inhibit NF-kB in some scenarios, and activate the same in other context. - Net effect in vivo on NF-kB – not clear.


2. Zinc is recommended in common colds, there are references that Zn reduces inflammatory cytokines. This could definitely help in controling cytokine storms.


3. Zinc supplementation of zinc increases NK cells.


4. Zinc deficiency decreases T lymphocyte number.


5. Zinc inhibits SHP, thus increasing signaling from TCR.


6. Zinc binds IKKB and reduces NF-kB activation, with beneficial effects in sepsis.



Relevant ref -

Self-Care for Common Colds: The Pivotal Role of Vitamin D, Vitamin C, Zinc, and Echinacea in Three Main Immune Interactive Clusters (Physical Barriers, Innate and Adaptive Immunity) Involved during an Episode of Common Colds-Practical Advice on Dosages and on the Time to Take These Nutrients/Botanicals in order to Prevent or Treat Common Colds.
Regulation of T cell receptor signaling by activation-induced zinc influx

https://fit.thequint.com/fit-webqoof/fit-webqoof-can-taking-vitamin-a-and-zinc-prevent-covid-19-fact-check

In summary, Zinc deficiency can make Covid19 worse but supplementing it above and beyond the daily requirement is unlikely to do much.
Regular supplement doses cannot hurt.
(As posted by Dr. Ravi on our whatsapp group of PGIMER Alumni) 

No evidence about zinc. In Covid pandemic. I recall  Prof Mehra  talking about George shambough  that these days he is selling zinc for COM. This was during 1985 86.  No harm though cap zevit containing 22.5 mg zinc twice a day could not be an unsafe bet (Posted by my teacher n mentor Prof: Naresh Kumar Panda on our WhatsApp group) 

Sunday, April 5, 2020

Traumatic ear drum perforation




Ear drum injury is a very common event in my practice which is completely preventable. After injury, people do foolish things to complicate the matter.
ENT Surgeon describes simple Do and don'ts to facilitate natural healing of eardrum. The author also explains about medico-legal aspect of eardrum perforation. Slap by husband to wife is very common in the Indian scenario. Wife often hides this thing and this is also covered.

Tuesday, March 31, 2020

Masks and Respirators

In this era of Corona panic and fear, there are lot of confusion and misconceptions existing regarding the use of mask, not only amongst the laypersons but also among the health care providers.
On one hand masks are not available for the risk group while on the other hand, who are not at risk, spending unnecessary money and energy to procure these masks.
This provoke me to write this blog, hope this would improve the understanding of the various types of commonly used masks and clarify the proper indications of use.

Q1 ... What are the common types of masks
Ans... 
1 Cloth mask
2 Surgical mask

Q2... What are the Respirators
Ans.
N- 95
N- 99
N- 100
are the respirators

Q3.. what is the difference between mask and respirator
Ans.
Mask has a loose fit, it doesn't seal nose and mouth snugly.
During respiration air moves along the edges of the mask, while respirator has a tight seal and most of the time air passes only through its material after filtration.

Q4... Are all respirator masks are same
Ans...
No, respirators are graded according to their filtration efficiency.
According to the used filter type
According to the type of materials used 
And additional features
They are of different types.

Q5... what is the efficiency grading
Ans...
According to the efficiency of filtration these are usually graded as-
95, 99 and 100
This means these respirator masks are capable of traping 95%, 99% and 99.9% of particles, smaller up to the 0.3-micron size.
This grading can also be done as
P1 (FFP1) - 80%
P2 (FFP2) - 95%
P3 (FFP3) - 99.95%
Filtration efficiency.

Q.6.. what is the N, R or P meaning written over the mask
Ans...
N - not oil-proof
R- oil resistant
P- oil-proof
(Eg. N 95 is not oil proof).

Q7. Few respirator masks have valve, what is that.
Ans.
That valve is nothing but a simple exhalation port with one-way valve mechanism, it reduces the effort of expiration, reduce heat inside the mask, dissipate humidity and reduce co2 the amount of from the dead space of mask.

Q.8. When to use surgical masks.
Ans... Surgical mask or procedure mask is the most common mask used by health workers. 
It is not designed to protect the wearer from inhaling the air born bacteria and viruses.
 It is used to block only large-particle droplets, splashes, sprays or splatter.
It also reduces the exposure of the wearer's saliva and respiratory secretions to others. Surgical mask also reminds wearer not to touch their mouth/nose which could otherwise transfer virus/bacteria after having touched a contaminated surface.

Q9... what is the filtration capacity of surgical mask
Ans... It can vary between 10-90% according to the manufacturer.

Q..10.. how one can assure about the quality of the mask
Ans.
Mask should be certified by the
NIOSH (National institute for occupational safety and health)
Or
NPPTL (National personal protective technology laboratory)

Q.11... Does the cloth mask effective?
Ans.
The cloth is a woven material thus pore size is bigger than a surgical mask which is made up of non-wooven polypropylene material thus cloth mask is less effective than surgical mask in terms of filtration efficiency.

Q..12 ... Does extra layer improve the efficacy of cloth mask
Ans.. No, it's not advisable. Each extra layer adds only 2% of extra protection on the cost of comfort.

Q.13... Can surgical/cloth mask be used routinely
Ans.
Yes these can be used routinely. 
Few studies done on normal population concluded that the use of simple mask can decrease the incidence of flu up to 75%.
Few east asian countries following this practice of routine use of mask.

Q.14.. Can mask be reused?
Ans. -Cloth mask can be reused after washing
- Surgical mask should be discarded after single use or after soiled
- Respirator mask should be discarded when resistance of breathing get increased or get solied.
Viruses/bacterias can grow and flourish inside the reused mask.

Q..15.. what are the WHO recommendations for using masks?
Ans...
- For the normal population, any type of mask is not required, maintaining the social distance and hand hygiene are the sufficient.
- Sick person should wear surgical mask
- Any person who is taking care of sick person should also wear the surgical mask.
- N 95 mask should be used by the person who is potential to get expose with the respiratory secretions of the infected patient eg. During the Endotracheal intubation, CPR, Ventilation, Bronchoscopy and Tracheostomy etc.

Summery...
Please don't create panic and use this precious commodity judiciously. 

Stay safe...
🙏🙏🙏

Wednesday, March 25, 2020

Online ENT Consultation during Coronavirus Pandemic and Lockdown in Delhi.

Hello,
We are in a situation we have never faced before. Though it looks like everything has been put on pause, we know that medical problems don't wait and we need help from the world we are trying to avoid. 

Few problems can be discussed with the doctor through phone or video consultation. Online consultation has it's own big limitations as clinical examination is not possible. Therefore, the relief from the clinical problem may not be as expected in some cases where clinical examination plays a major role in diagnosis. Nevertheless, we strive to achieve the best possible given the constraints imposed upon us.  

Keeping this idea in mind, Online consultation with Dr. Ajay Jain is offered 

DISCLAIMER

The outcome of the online consultation has no bearing on the fees paid (Non-refundable).                    Please use your own discretion to understand the shortcomings of online consultation. 

Timings: 10-1 PM and 5-7 PM

Follow the steps.

1. Ask for an appointment by WhatsApp on 9871166370
2. Fees:  Rs. 500 



BHIM / UPI /Paytm

drajayjain@upi 
drajayjain@icici
drajayjain@hdfcbank 
drajayjain@paytm

PATYTM Wallet
9871467637

Bank Transfer

Account Number: 50200032402894
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Branch: PREET VIHAR G BLOCK
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3. You will receive a call at the appointed time from the doctor. If needed, face to face Video consultation can be done to see any visible finding. 

Dr Ajay Jain's Clinic address and timings

  ENT Clinic (Preet Vihar)   Address :  Shop number 1,2,3 DDA Market-1, G-block, Preet Vihar, Vikas Marg, Delhi-92. Landmark :  Enter G-Bloc...