Dr.Santanu Bhattacharjee

1) when family members faces difficulties to communicate with you ,you should get alarmed as they are very concerned about your health and hearing ability.they are first to detect loss of hearing.you may even fight with themto hide your inability to hear and evendeny loss of hearing.
2)You find difficulty to understand telephonic conversation and make repeated request to 'repeat' .
3)You find difficulties in hearing in a noisy environment.
4) Find difficulties to hear and understand soft sound like in company board meeting or in seminar.
5) You may find yourself in an embarressing situation in social function or family gathering & gradually start withdrawing yourself.
6) You star lip reading to understand better or lean closer to understand speech.
7) When family member finds that you are listening to music or watching TV with abnormally loud volume.
8) Hearing abnormal sound in ear like buzzing,hissing or popping sound.sound in ear which coincides with pulse in peripheral artery can be early sign of tumour (GLOMUS JUGULARE) involving middle ear.

Hearing loss can happen irreversibly due to use of headphones & listening to loud misic.
It has bocome a trend to listen to loud music using earphone which damages our hearing before we can realise.
Sudden or continous exposure to loud sound/music can lead to a medical condition known as
NOISE-INDUCED HEARING LOSS which is because of irreversible damage of inner hair cells in cochlear (nerve cells that send sound signals to brain via cochlear nerve).
Therefore if you experiencefollowing symptoms in your daily activities, then you should consult ENT SPECIALIST:

1) STEP 1:- Pinch soft part of nose,sit down and bend forward for 5 minutes to15 minutes.one should not lie down .sitting up does help to reduce blood pressure in head & neck region and nasal vessels, which helps to stop bleeding.
STEP 2:- As u lean forward breathe through you mouth.
STEP 3:- Use ice packs.

2) Keep in mind adverse effect of drugs:- Elderly patients with hypertension or Diabetis or history of Cardiac surgery( heart valves replacement or CABG) are often prescribed medicine to prevent clotting of blood like anticoagulant. STOP TAKING THOSE MEDICINE IMMEDIATELY.

3) Nasal packing:- To stop bleeding doctor use a) ribbon gauge which tightly packed inside both nasal cavity b)MEROCELE PACK in both nasal cavity.

Ear discharge or otorrhoea can be due to common cause like excessive ear wax or infections(bacterial,fungal or viral) or can be due to serious problem like perforation of ear drum, osteomyelitis of mastoid bone,following fracture of temporal bone, tumour or polyps.type & colour of discharge helps to identify the cause behind discharge , specially discharge which are mixed with blood or bloody discharge.

Very often we come across patients who doesn't bother about there lumps or swelling on neck .though majority of neck swelling are of benign in nature .neck lumps/swelling can be of varying size, with or without pain.
1) Small neck swelling can be due to a lympnode swelling which majority are reactive in nature but can also be due to infection like tuberculosis or malignancies like Hodgkin's disease or Non-Hodgkin's disease which if detected early are curable.
2) Large neck swelling can be due to involvement of thyroid glands or submandibular salivary glands or involvement of lymph node which are mostly benign in nature but malignancies are not uncommon.
As soon as one notices neck swelling /lumps , one should consult doctor and be cautious before to avoid major ailment.

PARANASAL SINUSES are air filled spaces or cavities in facial bones situated around nasal cavity.These sinuses are lined by mucous membrane.
Paranasal sinuse are of 4 types as per location in their respective facial bones.These sinus are present on either side of midline of face.
1) MAXILLARY SINUS:- Located in maxillary bone .This sinus develops at birth & continue to grow in life.
2) FRONTAL SINUS:- Located in frontal bone.Develops at 7 years of age.
3) ETHMOIDAL SINUS:-Located in ethmoidal bone.Developsat birth & continously grows in life.
4) SPHENOID SINUS:- Located in sphenoid bone.Develops after 12 years.
All above sinuses drain into nasal cavity .Mucous membrane lining of sinuses produce mucous & variety of inflammatory mediators like Interleukins like any other mucous membrane present else where in body.Plenty of MAST CELLS are also present in mucous membrane of nose & paranasal sinuses. The cells of mucous membrane lining nasal cavity has special structure like CILIA (finger like projection) which when beat backward transfer mucous from anterior to posteriorly towards nasopharynx.These cilia are absent in case of CYSTIC FIBROSIS.

Drainage system of paranasal sinus are complex.These sinus drains through OSTIUM ( small opening in sinus) .Blockage of thesesinus ostia can be due to inflammatoin of mucosa , tumour or bony structure.
1) Maxillary Sinus drains through OSTIOMEATAL COMPLEX ( OMC ) area on lateral wall of nasal cavity.
2) Anterior ethmoidal sinus drains into infundibulum of OMC.
3) Posterior ethmoidal sinus drains into superior meatus.
4) Sphenoid sinus drains into sphenoethmoidal recess.
5) Frontal sinus drains into nasal cavity or OMC depending upon its relatoin with UNCINATE PROCESS.

Nose & paranasal sinus are part of upper respiratory tract .Nose & paranasal sinus helps in
1) sensation of smell through OLFACTORY FIBRES present in upper part of nose (Olfactory fossa) & base of skull .
2) Acts as air conditioner in humidifying regulating temperature of inhaled air.
3) Acts as air filter when it filters dust particle in inhaled air.

Sinusitis are inflammation of mucous membrane lining paranasal sinuses.These inflammation can be due to
1) INFECTION ( BACTERIA , VIRUS , FUNGUS)
2) CHEMICAL (ACCIDENTAL INHALATION OF FUMES OF NITRIC ACID, HYDROCHLORIC ACID, SULPHURIC ACID, CARBON DIOXIDE OR CARBON MONOXIDE)
3) ALLERGY
4) TUMOUR

1) ACUTE:- WHEN SYMPTOMS LAST LESS THAN 4 WEEKS.
2) CHRONIC:- WHEN SYMPTOMS LAST MORE THAN 3 MONTHS.
3) RECURRENT:- 4 OR MORE EPISODE OF ACUTE SYMPTOMS IN A YEAR.

1) INFECTION:- a : Viral : INFLUENZA INFECTION
b : Bacterial : STREPTOCOCCUS PNEUMONAE, STAPHYLOCOCCUS , MORAXELLA CATARRHALIS etc.
c : Fungus : It is common in patients with Diabetes Mellitus , Cystic Fibrosis , Immunocompromised patient.
2) ALLERGY :-When allergen enter through nose inflammatory reaction starts in cells of mucus membrane leading to release of enormous number of inflammatory mediators like Interleukins, eosinophils, histamine, prostaglandin etc. These allergic reactions cause oedema or swelling of mucus membrane and increase in production of mucous
3) CHEMICAL INHALATION : Common in goldsmith.
4) OBSTRUCTION IN DRAINAGE PATHWAYS :- Any cause which block or interfere with normal outflow of secretion out of paranasal sinues and nose or cause which leads to excess production of mucous secretion like
a :- Congenital anomalies in structure of nose like DEVIATED NASAL SEPTUM ( DNS ) or anomalies in pneumatisation of Concha ( Concha Bullosa ) or variation in pneumatisation of Ethmoidal bone ( Haller Cell , Onodi Cell ).
5) INFECTION IN ROOT OF MOLAR TOOTH
6) TRAUMA / FRACTURE OF FACIAL BONES
7) FOREIGN BODY IN NOSE AND PARANASAL SINUS
8) GASTRO -ESOPHAGEAL REFLUX DISEASE ( GERD )
9) PRESENCE OR ABSENCE OF ADENOIDS AND TONSILS
10) CLEFT PALATE

Symptoms of sinusitis depends on age , duration of illness , whether congenital anomalies are present or absent , immunity of host , comorbid conditions are present or absent and iatrogenic..

1) BLOCKED NOSE / NASAL OBSTRUCTION
2) RHINORRHOEA-------- a) watery b) thick / inspissated
3) NOCTURNAL COUGH
4) HEADACHE
5) FACIAL PAIN
6) PERIORBITAL SWELLING
7) HALITOSIS/ BAD BREATH
8) FEVER
9) SORETHROAT
10) EPIPHORA / WATERING OF EYES
11) PAIN / DISCOMFORT / BLOCKED EAR
12) ASSOCIATION WITH ASTHMA

1) HISTORY & CLINICAL EXAMINATION
2) XRAY OF PARANASAL SINUS
3) CT SCAN WITH CONTRAST OR WITHOUT CONTRAST
4)MRI SCAN
5) NASAL SWAB CULTURE & EVALUATION OF BIOFILMS

1) Treatment choice depends on factors like
a) age
b) presence or absence of comorbidity
c) major or minor disease
d) presence of complication
e) individual tolerance to specific medicine or procedure
2) Treatment may include :---
a) ANTIBOITICS
b) ANALGESIC & ANTIPYERITICS
c) DECONGESTANT :- LOCAL OR SYSTEMIC
d) CORTICISTEROIDS :-- INTRANASAL OR SYSTEMIC
e) ANTIHISTAMINICS & MAST CELL STABILISER
f) TREATMENT FOR GERD
g) ENDOSCOPIC SINUS SURGERY :--- FUNCTIONAL (LIMITED ) OR EXTENSIVE ( NASAL TUMOUR OR EXTENSIVE POLYPOSIS )
h) SURGERY FOR TONSILS , ADENOID OR CLEFT PALATE
i) IMMUNOTHERAPY